Severe Systemic Reaction to the Pneumococcal Revaccination

Predictors of severe reaction to polyvalent pneumococcal vaccine (PPV) are not established. In the absence of prospective studies, revaccination within 5 years and high titer of protective antibody appear to increase the risk of a local reaction that manifests as self-limiting pain, localized erythema, and edema. A more severe systemic reaction, manifesting as fever, arthralgia, and extensive edema involving the entire upper extremity, is rare, and we report a case in a patient with myeloproliferative disease.     

Open reduction and internal fixation in a one-stage anterior cruciate ligament reconstruction surgery for the treatment of tibial plateau fractures: A case report and literature review

Treatment of tibial plateau fractures associated with anterior cruciate ligament (ACL) injuries can be challenging. Maintaining the joint surface and axis are two main principles for the management of patients with tibial plateau fractures. Herein, we describe a patient with tibial plateau fracture of Schatzker type VI associated with complete ACL rupture. Although in a two-stage reconstruction surgery for treatment of its rupture seem to be accepted by most orthopaedic surgeons in cases of ACL injuries, we treated our patient with ORIF in a one-stage ACL reconstruction surgery. At the 1-year follow-up, the patient gained full range of motion and was functioning well. We reviewed the literature on performing ORIF in a one-stage ACL reconstruction for the treatment of tibial plateau fractures, which seemed to be a reasonable management approach that supported its use for the treatment of this patient.     

Associations between cytokines,endocrine stress response,and gastrointestinal symptoms in autism spectrum disorder

Many children and adolescents with autism spectrum disorder (ASD) have significant gastrointestinal (GI) symptoms, but the etiology is currently unknown. Some individuals with ASD show altered reactivity to stress and altered immune markers relative to typically-developing individuals, particularly stress-responsive cytokines including tumor necrosis factor alpha (TNF-α) and interleukin 6 (IL-6). Acute and chronic stress is associated with the onset and exacerbation of GI symptoms in those without ASD. The present study examined whether GI symptoms in ASD were associated with increases in cortisol, a stress-associated endocrine marker, and TNF-α and IL-6 in response to stress. As hypothesized, a greater amount of lower GI tract symptoms were significantly associated with post-stress cortisol concentration. The relationship between cortisol response to stress and GI functioning was greater for children who had a history of regressive autism. Exploratory analyses revealed significant correlations between cortisol response, intelligence, and inappropriate speech. In contrast, symptoms of the lower GI tract were not associated with levels of TNF-α or IL-6. Significant correlations were found, however, between TNF-α and IL-6 and irritability, socialization, and intelligence. These findings suggest that individuals with ASD and symptoms of the lower GI tract may have an increased response to stress, but this effect is not associated with concomitant changes in TNF-α and IL-6. The relationship between cortisol stress response and lower GI tract symptoms in children with regressive autism, as well as the relationships between cortisol, IL-6, and intelligence in ASD, warrant further investigation.     

A split-face study: comparison of picosecond alexandrite laser and Q-switched Nd:YAG laser in the treatment of melasma in Asians

To evaluate efficacy and safety of picosecond 755 nm alexandrite laser as compared to 1064 nm QS-Nd:YAG laser for melasma treatment in Asians. Twelve patients received 4 sessions of treatments at 1-month interval in a split-face manner. The right side of each patient’s face received 755 nm picosecond laser, and the other side received 1064 nm QS-Nd:YAG laser. Zoom handpiece of 755 nm picosecond laser at fluence of 0.88–1.18 J/cm² was applied. The treatment protocol used for 1064 nm QS-Nd:YAG laser was 8 mm spot size at fluence of 2.0 J/cm² initially followed by 6 mm spot size at fluence of 3.5 J/cm², and finishing with 4 mm spot size at 3.2 J/cm². For both 755 nm picosecond laser and 1064 nm QS-Nd:YAG laser, the endpoint was mild erythema and swelling without petechiae. Objective evaluation with visual analogue score was conducted by two independent physicians. Subject self-assessment for each patient was conducted as well. Statistical results showed that higher pigmentation clearance rate was achieved at the 755 nm picosecond laser side after the second treatment. At the 3 months follow-up, greater clearance was observed at the 755 nm picosecond laser side compared to the 1064 nm QS-Nd:YAG side. 755 nm alexandrite picosecond laser has been observed to achieve a faster and better clearance rate for melasma compared to 1064 nm QS-Nd:YAG laser. We conclude that the 755 nm picosecond laser could be a safe and effective modality for melasma treatment in Asians.     

脑部化学交换饱和转移成像研究

化学交换饱和转移(chemical exchange saturation transfer,CEST)成像是在磁化传递及化学交换理论基础上发展起来的一种磁共振成像新方法,其扩展了磁共振分子影像新领域,但还处于研究阶段。其以细胞内物质为内源性对比剂,通过水信号间接检测代谢物信息,进行组织的酸碱度成像及其各种代谢物成像。本文主要探讨MRI领域中与水相关的化学交换饱和转移现象,阐述其原理、研究现状及其在不同场强磁共振仪上脑部疾病的应用。     

A multivariate analysis of prognostic factors for health-related quality of life in patients with surgically managed meningioma

The objective of this study was to examine the prognostic significance of health-related quality of life (HQOL) parameters combined with baseline clinical factors in patients undergoing neurosurgery for treatment of meningioma. A total of 147 patients (61 male, 86 female; mean age 43 years, range 5–77 years) who underwent resection of a meningioma between January 2002 and December 2004 were studied. HQOL was evaluated using a modified questionnaire based on the World Health Organization Quality of Life-100 Scale and the Karnofsky Performance Scale. The relationships between HQOL and clinical history, radiological findings, extent of resection, histological grade and recurrence were investigated using multivariate analysis. The mean HQOL score was 73.94 ± 1.79 for preoperative patients with meningioma, 84.88 ± 2.14 for postoperative patients, and 91.13 ± 1.61 for healthy controls. HQOL for patients with meningioma was significantly lower than that for normal controls (P < 0.001), and postoperative patients had a more satisfactory HQOL than preoperative (P < 0.05). Cox proportional hazards analysis showed that significant predictors of health-related quality of life were tumor size, extent of surgical excision, and histologic grade. Multivariate backward logistic regression yielded the regression equation HQOL = 119.1097 – 1.5002X₃ – 8.6650X₆ – 10.4210X₇ (R = 0.7466; where X₃ is tumor size, X₆ is extent of surgical excision, and X₇ is the histologic grade of the tumor). This equation can be used preoperatively to predict the HQOL of meningioma patients after neurosurgery. A specialized HQOL questionnaire for patients with meningioma provides useful information when planning the operative procedure, and may make it more likely that patients have a satisfactory HQOL after surgery.     

Erythropoietin response to anemia and its association with autonomic neuropathy in type 2 diabetic patients without advanced renal failure

AimWe aim to investigate erythropoietin (EPO) response to anemia and its association with autonomic neuropathy in type 2 diabetic patients without advanced renal failure.MethodsA cross-sectional study was conducted on 211 type 2 diabetes mellitus patients without advanced renal failure [estimated glomerular filtration rate (eGFR) >40 ml/min/1.73 m²]. The response of EPO to anemia of type 2 diabetic patients without advanced renal failure was compared with those of nondiabetic control subjects. Autonomic nerve function was assessed using three cardiovascular tests (deep breathing, the Valsalva maneuver, and lying-to-standing). The results of each test were scored as 0 if normal, 1 if borderline, and 2 if abnormal. Autonomic neuropathy was diagnosed when a total score of the tests was 2 or more.ResultsFifty-eight patients were anemic; compared with nonanemic patients, they had a longer duration of diabetes (16.69±10.11 vs. 10.67±8.41 years, P<.001), lower eGFR (66.43±16.30 vs. 81.74±19.49 ml/min/1.73 m², P<.001), and higher cardiovascular autonomic neuropathy score (3.17±1.95 vs. 1.79±1.72, P<.001). Serum EPO level was weakly correlated with hemoglobin (Hb) level (r=?.085, P<.001). However, the slopes of regression lines between EPO and Hb levels differed significantly between type 2 diabetic patients and nondiabetic control subjects (?0.0085 vs. ?0.255, P=.008). Multiple linear regression analysis revealed that cardiovascular autonomic neuropathy score was independently related to Hb (P<.001) or EPO level (P=.052).ConclusionsAutonomic neuropathy is associated with a blunted EPO response to anemia in type 2 diabetic patients without advanced renal failure.     

复方柴郁温胆汤及其拆方对抑郁模型 大鼠血清铜、锌含量的影响

目的:探讨复方柴郁温胆汤(柴胡、郁金、枳实、半夏、陈皮、竹茹、人参、茯苓、大枣、炙甘草)对抑郁模型大鼠血清铜、锌的影响。方法:健康雄性SD大鼠84只,随机分为7组。采用Katz刺激方法制备慢性轻度不可预见性应激(CUMS)抑郁模型。分别拆方为化痰组(半夏、陈皮、竹茹)、调气血组(柴胡、郁金、枳实)、养心脾组(人参、茯苓、大枣、炙甘草)。血清铜、锌采用原子吸收法检测。结果:采用孤养和CUMS刺激方法成功制备动物抑郁模型。模型组血清铜含量较正常组明显升高、血清锌含量较正常组明显降低;而柴郁温胆汤组较模型组比较均能够逆转上述改变;其中化痰组可以提高血清锌的水平、养心脾组可以降低血清铜的水平。结论:柴郁温胆汤具有良好的抗抑郁作用,同时能逆转大鼠行为学、体内微量元素锌和铜的改变;其中起主要作用的可能为化痰组和养心脾组药物。     

口腔种植研究——上颌前牙平台转换种植体周围应力分布的有限元分析

目的建立种植体支持的上颌中切牙模型,分析平台转换基台连接方式对种植体周围组织应力分布的影响,为临床应用平台转换基台提供参考。方法利用Solidworks画图软件建立种植体支持的上颌中切牙模型,基台采用传统平齐对接（Normal Model,N）和平台转换（Platform switching Model,PLS）设计,将数据导入ANSYS11．0分析软件建立三维有限元模型进行应力分布分析。垂直舌侧牙面进行加载,载荷为118N,比较两种模型种植体周围各部位的应力分布情况。结果两种模型皮质骨最大应力值均位于种植体颈部颊侧骨皮质,N和PLS最大VonMises应力值分别是50．08Mpa、37．34Mpa．两种不同设计钛基台周围的应力值分别是133．05Mpa、284．15Mpa。结论与平齐对接形式相比,平台转换设计可减少种植体颈部皮质骨组织的应力,但同时使基台肩台、种植体颈部、牙冠颈部所受应力增加,两种模型松质骨应力大小相似。