Cochlear implantation in a patient with atypical Cogan's syndrome complicated with hypertrophic cranial pachymeningitis

A 55-year-old woman had bilateral sensorineural hearing loss (SNHL), vertigo, uveitis, and aortitis associated with Cogan's syndrome (CS). She had a history of listeria meningitis and hypertrophic cranial pachymeningitis (HCP), both of which were considered to be related to SNHL progression. She developed bilateral profound deafness within 1 year, despite medical treatment with corticosteroids and methotrexate (MTX). She underwent cochlear implantation (CI) of the left ear. Although the left and right basal turns of the cochleae were ossified, all electrodes were successfully inserted, and subsequently the inferior segment of the basal turn was drilled out. The patient did not have any postoperative complications and showed good speech perception.     

心衰再同步治疗中左室电极放置的技巧和方法

目的顽固性慢性充血性心力衰竭（CHF）经介入植入双心室起搏三腔起搏器治疗在合适的病例中已是指南建议的ⅠA类适应症,本文就左室电极安放技巧和方法进行探讨,旨在于提高手术成功率.方法结合多角度造影技术、冠脉介入导丝及交换球囊技术、球囊支撑技术等,优化左室电极植入.结果对8例行左室再同步治疗（CRT）,成功率100%,左室电极到位操作快捷、靶血管选择满意、无不良并发症发生.结论本文所采取的左室电极植入技术可靠、安全,有推荐和进一步探讨的临床应用价值。     

A subset of presympathetic-premotor neurons within the centrally projecting Edinger–Westphal nucleus expresses urocortin-1

Numerous motivated behaviors require simultaneous activation of somatomotor and autonomic functions. We have previously characterized the organization of brain circuits that may mediate this integration. Presympathetic premotor neurons (PSPMNs) that are part of such circuits are distributed across multiple brain regions, which mediate stress-elicited behavioral and physiological responses, including the Edinger–Westphal nucleus (EW). Based on its connectivity and function, EW has recently been re-classified into a preganglionic (EWpg) and a centrally projecting (EWcp) population. Neurons within EWcp are the major source of urocortin 1 (Ucn-1), an analog of the corticotropin-releasing factor that binds the CRFR1 and CRFR2 receptors and has been implicated in mediating homeostatic responses to stress. We hypothesized that a subset of EWcp PSPMNs expresses Ucn-1. Utilizing dual-label immunofluorescence, we initially mapped the distribution of Ucn-1 and cholinergic neurons within EW in colchicine pre-treated rats. Based on this labeling we divided EWcp into three neuroanatomical levels. To examine connections of EWcp neurons to the gastrocnemius muscle and the adrenal gland, we next employed trans-synaptic tract-tracing in a second group of rats, utilizing two pseudorabies virus (PRV) recombinants that express unique reporter proteins. Using multi-label immunofluorescent staining, we identified the presence of Ucn-1-positive PSPMNs, dually labeled with PRV and present throughout the entire extent of EWcp and intermingled with Ucn-1 neurons infected with one or neither of the viral recombinants. Compared to rats pretreated with colchicine, we observed significantly fewer Ucn-1 neurons in animals that received PRV injections. Post hoc analyses revealed significantly fewer Ucn-1 neurons at the rostral level as compared to the caudal and middle levels. These data suggest functional and anatomic heterogeneity within EWcp; this organization may coordinate various aspects of stress-elicited and emotionally salient behaviors.     

Investigations into Pulsed High-Intensity Focused Ultrasound–Enhanced Delivery: Preliminary Evidence for a Novel Mechanism

Pulsed high-intensity focused ultrasound (HIFU) exposures without ultrasound contrast agents have been used for noninvasively enhancing the delivery of various agents to improve their therapeutic efficacy in a variety of tissue models in a nondestructive manner. Despite the versatility of these exposures, little is known about the mechanisms by which their effects are produced. In this study, pulsed-HIFU exposures were given in the calf muscle of mice, followed by the administration of a variety of fluorophores, both soluble and particulate, by local or systemic injection. In vivo imaging (whole animal and microscopic) was used to quantify observations of increased extravasation and interstitial transport of the fluorophores as a result of the exposures. Histological analysis indicated that the exposures caused some structural alterations such as enlarged gaps between muscle fiber bundles. These effects were consistent with increasing the permeability of the tissues; however, they were found to be transient and reversed themselves gradually within 72 h. Simulations of radiation force–induced displacements and the resulting local shear strain they produced were carried out to potentially explain the manner by which these effects occurred. A better understanding of the mechanisms involved with pulsed HIFU exposures for noninvasively enhancing delivery will facilitate the process for optimizing their use. (E-mail: vfrenkel@cc.nih.gov)     

双眼同时人工晶状体植入术的报告

目的：观察双眼同时进行白内障摘出及人工晶状体植入的手术效果和风险情况。方法：47例双眼财时进行现代白内障囊外摘出及人工晶状体植入术，术后观察视力1眼内炎症等情况，并与同期单眼同样手术进行对照。结果：同时手术的双眼与单眼同样手术的眼之间在手术视力并发症方面差异均无显著性意义（P＞0．05）。结论：双眼白内障时行囊外摘出及人工晶状体植入术在临床上是安全的，但不主张向患者推荐双眼同时手术。     

The Interdependency of Protein-Energy Malnutrition, Aging, and Dysphagia

Advancing age is increasingly associated with confounding chronic and acute ailments, predisposing elderly individuals to conditions such as malnutrition and swallowing dysfunction. This enhanced susceptibility to malnutrition and dysphagia in this aging demographic lends itself to exacerbating, disabling conditions that may result in increased morbidity and mortality in the event of an aspiration episode. Early identification of substandard nutritional status and subsequent interventiion in the elderly dysphagic population may circumvent the deleterious effects of malnutrition.     

粒子植入放疗联合肝动脉化疗栓塞治疗肝癌的临床研究

目的观察局部125I粒子植入放疗联合肝动脉化疗栓塞(TACE)治疗肝细胞性肝癌疗效和患者耐受性。方法56例患者先采用TACE治疗1-3次,再行CT引导下125I粒子植入放疗。125I粒子植入12周后采用世界卫生组织标准评价疗效,采用美国国立癌症研究所毒性标准和美国放疗肿瘤组毒副反应评价标准评价急慢性肝脏毒副反应及其他毒副反应。结果56例中部分缓解18例,稳定36例,进展2例。全组中位生存时间31个月,1、3年生存率分别为88%、54%。1、3年局部控制率分别为93%、70%。1、3年远处转移率分别为9%、13%。单因素分析表明T分期、门脉癌栓、放疗前肝硬化Child-pugh分级、肿瘤数目和125I粒子空间排列对生存率有影响。多因素分析显示125I粒子空间排列、肿瘤数目和肝硬化Child-pugh分级是患者预后独立影响因素。5例发生急性肝脏毒副反应,1级2例,3级3例。9例出现1级上消化道急性损伤,其中1例出现轻度上消化道出血,8例表现为恶性、呕吐。10例出现1、2级外周血白细胞降低。2例出现放射性肝病。结论局部125I粒子植入放疗联合TACE综合治疗安全、有效,值得进一步研究。