人工全膝关节置换术中联合股骨外髁滑移截骨术矫正股骨外弓畸形的疗效分析

目的探讨人工全膝关节置换术（total knee arthroplasty，TKA）中采用股骨外髁滑移截骨术（lateral condyle sliding osteotomy，LCSO）矫正股骨外弓畸形的疗效。方法回顾分析2018年7月—2020年7月TKA中采用LCSO治疗的17例伴股骨外弓畸形的骨关节炎患者临床资料。男3例，女14例；年龄58～68岁，平均63.2岁。股骨外弓畸形病因：股骨发育畸形12例，股骨骨折畸形愈合5例。膝关节骨关节炎Kellgren-Lawrence分级：Ⅲ级4例，Ⅳ级13例。术前生理外翻角为9.5°～12.5°，平均10.94°。病程3～25年，平均15.1年。术前及末次随访时测量股骨远端机械外侧角（mechanical lateral distal femur angle，mLDFA）、髋-膝-踝角（hip-knee-ankle angle，HKA）、机械轴偏向（mechanical axis deviation，MAD），评估关节外畸形在关节内矫正及下肢机械力线恢复情况；采用膝关节学会评分系统（KSS）膝评分和功能评分、疼痛视觉模拟评分（VAS）、膝关节活动度（range of motion，ROM）评估疗效；行膝内、外翻应力试验，X线片复查截骨片愈合情况，评估关节稳定性及LCSO的安全性。结果术后患者切口均Ⅰ期愈合，无切口感染、下肢深静脉血栓形成等术后早期并发症发生。17例患者均获随访，随访时间12～36个月，平均23.9个月。截骨片均达骨性愈合，愈合时间2～5个月，平均3.1个月。术后膝内、外翻应力试验均为阴性，未发生外侧副韧带松弛、断裂，膝关节不稳，假体松动、翻修、感染等情况。末次随访时mLDFA、HKA、MAD及膝关节ROM、VAS评分、KSS膝评分和功能评分均较术前显著改善，差异有统计学意义（P<0.05）。 结论在伴有股骨外弓畸形TKA中应用LCSO疗效确切且安全，关节外畸形在关节内矫正，一次手术可同时恢复下肢机械力线和关节平衡。     

A preliminary observation: Male pattern hair loss among hospitalized COVID‐19 patients in Spain – A potential clue to the role of androgens in COVID‐19 severity

A preliminary observation of high frequency of male pattern hair loss among admitted COVID‐19 patients and suggest that androgen expression might be a clue to COVID‐19 severity.     

外源性信号通路JAK/STAT在ALA-光动力诱导人SCC细胞凋亡中的作用

目的：明确外源性凋亡机制(JAK/STAT信号通路)在5-ALA-PDT诱导人鳞状细胞癌细胞(SCC)凋亡中的作用。方法：体外培养鳞状细胞癌细胞系A431和COLO-16,分为空白对照组、转染阴性对照组、光动力组、转染阴性+光动力组、STAT3高表达载体组、STAT3-siRNA组、STAT3高表达载体+光动力组,STAT3-siRNA组+光动力组。CCK-8,流式细胞术（FCM）法分别检测各组细胞的存活率和凋亡率,qRT-PCR和Western Blot检测STAT3及其下游基因Bax和Bcl-2的mRNA和蛋白水平。结果：5-ALA-PDT组A431和COLO-16凋亡率为24%和22%高于STAT3高表达载体+光动力组(11%和10.5%),低于 STAT3-siRNA+光动力组（36%和39%）;5-ALA-PDT组STAT3和Bcl-2 mRNA水平和蛋白水平低于高表达载体+光动力组,高于STAT3-siRNA组。5-ALA-PDT组Bax mRNA和蛋白的水平高于高表达载体+光动力组,低于STAT3-siRNA组。结论：外源性凋亡通路JAK-STAT3可能参与5-ALA-PDT诱导的上皮鳞癌细胞的凋亡过程。     

5‐Alpha reductase inhibitors in androgenetic alopecia: Shifting paradigms,current concepts,comparative efficacy,and safety

Androgenetic alopecia (AGA) is a multifactorial disease that carries a significant psychological burden with it. Dihydrotestosterone, the main pathogenic androgen in AGA, is produced by conversion of testosterone, which is catalyzed by the 5‐alpha reductase (5‐AR) isoenzyme family. Finasteride and dutasteride are inhibitors of these enzymes. Finasteride, which is a single receptor 5‐alpha reductase inhibitor (5‐ARI), acts by blocking dihydrotestosterone (DHT). Dutasteride, a dual receptor DHT blocker, has a higher potency than its predecessor, finasteride. This review corroborates the evidence of superiority of dutasteride over finasteride, and its comparable safety profile concerning fertility, teratogenicity, neurotoxicity, and hepatotoxicity.     

ABCG5 基因突变致植物固醇血症1 例

目的探讨ABCG5基因突变所致的植物固醇血症的临床及基因变异特征。方法回顾分析1例ABCG5基因突变致植物固醇血症患儿的临床资料。结果 1岁3个月男性幼儿,约4月龄时腕、踝关节皮肤褶皱处开始出现线状黄瘤,后渐加重。血固醇谱检查示菜油固醇、二氢胆固醇明显升高。全外显子检测示ABCG5基因c.904+1(IVS7)GA剪切位点突变和c.-76(exonl)CT非编码区突变。经严格控制植物固醇摄入、少量限制动物固醇摄入以及口服消胆胺治疗40天后,复查患儿血固醇谱,植物固醇水平较前明显降低。结论 ABCG5变异可致植物固醇血症,及时诊断以及药物和饮食控制可改善预后。     

Vitamin B6 in acute encephalopathy with biphasic seizures and late reduced diffusion

BackgroundThe initial presentation of acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is indistinguishable from that of complex febrile seizures (FS), which poses a great diagnostic challenge for clinicians. Excitotoxicity is speculated to be the pathogenesis of AESD. Vitamin B6 (VB6) is essential for the biosynthesis of gamma-aminobutyric acid, an inhibitory neurotransmitter. The aim of this study is to investigate our hypothesis that VB6 deficiency in the brain may play a role in AESD.MethodsWe obtained cerebrospinal fluid (CSF) samples from pediatric patients with AESD after early seizures and those with FS. We measured pyridoxal 5′-phosphate (PLP) and pyridoxal (PL) concentrations in the CSF samples using high-performance liquid chromatography with fluorescence detection.ResultsThe subjects were 5 patients with AESD and 17 patients with FS. Age did not differ significantly between AESD and FS. In AESD, CSF PLP concentration was marginally lower (p = 0.0999) and the PLP-to-PL ratio was significantly (p = 0.0417) reduced compared to those in FS.ConclusionsAlthough it is impossible to conclude that low PLP concentration and PLP-to-PL ratio are causative of AESD, this may be a risk factor for developing AESD. When combined with other markers, this finding may be useful in distinguishing AESD from FS upon initial presentation.     

Anatomical and behavioral impact of a lentiviral tool tapping onto hippocampal serotonin reuptake in rats

We aimed at the further characterization of rats in which SERT gene silencing was achieved by hippocampal injection of a lentiviral vector, carrying three si-RNA to block SERT mRNA at 66% of normal levels. Improved self-control and reduced restlessness were already demonstrated in these rats. Present further studies consisted of male adult rats, bilaterally inoculated within the hippocampus; control rats received lentivirus particles inactivated with heat. Both groups were maintained in isolation for 5 months, starting from inoculation. Neurochemical changes were studied by proton magnetic resonance spectroscopy (1H-MRS): we found increased hippocampal viability and bioenergetic potential; however, rats showed a behaviorally depressive pattern, also characterized by enhanced affiliation. Based on the extent of such effects, the whole lenti-SERT group was divided into two subgroups, termed intermediate- and extreme- phenotype profiles. While all rats had a widespread modification within dorsal/ventral striatum, amygdala, and hypothalamus, only the former subgroup showed an involvement of Raphé medialis, while, for the latter subgroup, an increase of SERT within hippocampus was unexpectedly caused. Within the less-affected “intermediate” rats, hippocampal 5-HT7 receptors were down-modulated, and also similarly within substantia nigra, septum, and neocortex. This picture demonstrates that additional rather than fewer neurobiological changes accompany a lower phenotypic expression. Overall, tapping hippocampal SERT affected the balance between habits versus strategies of coping by promoting morphogenetic processes indicative of a serotonergic fiber plasticity. Supplementary studies about serotonergic dynamics and neurogenesis within fronto-striatal circuits are needed.