Intrinsic functional connectivity of insular cortex and symptoms of sickness during acute experimental inflammation

Task-based fMRI has been used to study the effects of experimental inflammation on the human brain, but it remains unknown whether intrinsic connectivity in the brain at rest changes during a sickness response. Here, we investigated the effect of experimental inflammation on connectivity between areas relevant for monitoring of bodily states, motivation, and subjective symptoms of sickness. In a double-blind randomized controlled experiment, 52 healthy volunteers were injected with 0.6 ng/kg LPS (lipopolysaccharide) or placebo, and participated in a resting state fMRI experiment after approximately 2 h 45 min. Resting state fMRI data were available from 48 participants, of which 28 received LPS and 20 received placebo. Bilateral anterior and bilateral posterior insula sections were used as seed regions and connectivity with bilateral orbitofrontal and cingulate (anterior and middle) cortices was investigated. Back pain, headache and global sickness increased significantly after as compared to before LPS, while a non-significant trend was shown for increased nausea. Compared to placebo, LPS was followed by increased connectivity between left anterior insula and left midcingulate cortex. This connectivity was significantly correlated to increase in back pain after LPS and tended to be related to increased global sickness, but was not related to increased headache or nausea. LPS did not affect the connectivity from other insular seeds. In conclusion, the finding of increased functional connectivity between left anterior insula and middle cingulate cortex suggests a potential neurophysiological mechanism that can be further tested to understand the subjective feeling of malaise and discomfort during a sickness response.     

巨大肝癌外科治疗探讨

目的：探讨巨大原发性肝癌的外科治疗。
方法：回顾性分析109例行手术切除治疗的巨大肝癌患者的临床资料。
结果：肿瘤最大径10.5~30(14.46±3.84)cm;病灶单发92例,多发17例;肿瘤位于左肝41例,右肝63例,超过半肝5例;83例合并肝炎后肝硬化,5 例肝癌破裂出血,19例合并门静脉癌栓(4例并有胆道癌栓),15例有肝门或肝周腹腔淋巴结转移;术前肝功能Child A级101例, B级8例;98例AFP>500 μg/L,11例<20 μg/L;临床分期IIa期2例,IIb 期92例,IIIa期15例;规则切除42例,局限性肝切除67例,手术失血量400~2 200 mL;全组住院期无死亡,术后并发症82例次(75.23%);68例获随访2~72个月,肝癌破裂出血5例切除术后生存8~13个月,63例非破裂肝癌择期手术切除后1,3,5年生存率分别为44.07%,13.06%和7.84%
结论：巨大肝癌切除近期效果优良,远期效果仍待提高;具备条件的巨大肝癌破裂出血可行一期切除。     

自发性胃十二指肠动脉瘤破裂出血一例

目的 报道1例罕见的胃十二指肠动脉瘤自发性破裂出血,提高临床医师对该病的认识。方法 全腹CTA（256层iCT）及剖腹探查。结果 经全腹CTA、术中探查确诊为胃十二指肠动脉瘤破裂出血。结论 胃十二指肠动脉瘤自发性破裂出血死亡率极高,一经确诊应迅速得到确切治疗,手术止血效果好,并可清除腹腔积血以助术后恢复。     

肾血管平滑肌脂肪瘤自发破裂出血的急诊处理(附24例报告)

目的 探讨肾血管平滑肌脂肪瘤自发破裂出血的急诊处理.方法 对24例肾血管平滑肌脂肪瘤自发破裂出血患者的临床资料及随访结果进行回顾性分析.术前均行B超和CT检查,22例诊断为肾血管平滑肌脂肪瘤自发破裂出血,2例未能排除肾癌出血.3例保守治疗,4例行选择性肾动脉栓塞术,17例急诊手术.结果 3例保守治疗患者中1例病情稳定,2例改行手术治疗.4例行肾动脉栓塞术患者栓塞成功,出血停止.4例行肾切除术,13例行保留肾单位手术,其中5例行后腹腔镜手术.术后病理诊断为肾血管平滑肌脂肪瘤并出血.随访3个月～6年,肿瘤无复发或转移.结论 B超和CT是诊断肾血管平滑肌脂肪瘤出血的重要手段.治疗可以选择保守治疗、肾动脉栓塞或者急诊手术.     

Spontaneous rupture of splenic hematoma in a malaria patient: Case report and review of literature

IntroductionBlunt abdominal trauma is the most common cause of splenic rupture. Malaria is the most frequent tropical infectious cause of spontaneous splenic rupture. The exact mechanism is not well-defined.Case reportWe report a case of thirty-year-old male patient known to have malaria who presented with spontaneous splenic rupture. A trial of conservative treatment failed and splenecomy was done to control bleeding.ConclusionSpontaneous splenic rupture should be kept in mind in malaria patients presenting with left upper quadrant pain and signs of hypovolemia. Early diagnosis and treatment is essential.     

Spontaneous and simultaneous rupture of both Achilles tendons and pathological fracture of the femur neck in a patient receiving long-term hemodialysis

Spontaneous rupture of the Achilles tendons in hemodialysis patients is a rare complication. The majority of these patients have additional predisposing factors, such as previous use of fluoroquinolone antibiotics or corticosteroids. Spontaneous rupture of bilateral Achilles tendons without any of those predisposing factors is exceptional. In this paper, we report a 43-year-old woman who had been undergoing regular hemodialysis for 16 years. She developed bilateral spontaneous and simultaneous rupture of the Achilles tendons. She also developed pathological fracture of right femur neck 3 years later. Based on previous cases of tendon ruptures in uremic patients and the lack of history for the use of corticosteroids or fluoroquinolones, we believe that secondary hyperparathyroidism is the predisposing factor in this patient.     

Spontaneous rupture of a hepatic cystadenoma and cystadenocarcinoma: report of two cases

Hepatobiliary cystadenomas and cystadenocarcinomas are rare tumors. Differentiating between these tumors and benign hepatic cysts may be difficult. Because of their rarity, diagnosis is often delayed and may result in inaccurate treatment, resulting in unnecessary morbidity and mortality. The purpose of this report is to draw attention to these entities and their complications. We report on two cases with spontaneous rupture of hepatobiliary cystadenoma and cystadenocarcinoma cysts, initially treated as simple hepatic cysts by aspiration, or by aspiration combined with sclerotherapy. The spontaneous rupture of the cysts appeared years after the initial treatment of the cysts, leading in one case to a prolonged stay in an intensive care unit. In both cases, a formal liver resection was carried out and microscopic investigations revealed a mucinous cystadenocarcinoma and cystadenoma. In conclusion, although hepatobiliary cystadenomas and cystadenocarcinomas are rare findings, they should not be forgotten in the diagnostic workshop when examining patients with hepatic cysts. If hepatobiliary cystadenomas and cystadenocarcinomas cannot be excluded following radiological imaging, surgery is recommended.     

早期自然流产患者绒毛滋养细胞中CXCL14的表达及其临床意义

目的研究正常早孕妇女和早期自然流产妇女之间绒毛滋养细胞中CXCL14的表达情况,探讨其表达的临床意义。方法选取33例正常早孕妇女绒毛组织和37例早期自然流产妇女绒毛组织,HE染色后光镜下观察两组绒毛组织的形态学变化;采用免疫组化SP三步法检测两组绒毛滋养细胞中CXCL14的表达。结果HE染色下两组绒毛滋养细胞形态对比,见早期自然流产组绒毛组织滋养细胞层变薄、滋养细胞变性甚至坏死、滋养细胞嗜酸性增强、绒毛间质水肿坏死;免疫组化示正常早孕组绒毛滋养细胞CXCL14的表达量为0.07±0.05,自然流产组绒毛滋养细胞CXCL14的表达量为0.12±0.02,两组比较差异具有统计学意义（P＜0.01）;首次流产组CXCL14表达量0.116±0.067,多次流产组CXCL14表达量0.086±0.127,两组比较差异无统计学意义（P＞0.01）。结论早期自然流产绒毛滋养细胞中CXCL14表达升高,可能在自然流产的发生中起着重要作用。     

肝炎肝硬化合并白发性细菌性腹膜炎48例临床分析

目的探讨肝硬化自发性细菌性腹膜炎（SBP）的发病情况。方法对48例肝硬化合并SBP的临床资料进行回顾性分析。结果肝硬化合并SBP的发生率为39．6％，致病菌为革兰阴性（G-）菌。结论肝硬化合并SBP的临床特点是起病不典型，腹水多形核白细胞和／或细菌培养是SBP的诊断依据，预防性应用抗生素可防止肝硬化腹水并发SBP。     

科技动态

目的初步探讨大龄雄性F344大鼠自发性不育症与精子参数、生精细胞及精子核成熟度之间的关系。方法4、7、10、13月龄雄性F344、SD、Wistar大鼠分别记为A1、A2、A3、A4组,B1、B2、B3、B4组,C1、C2、C3、C4组,测定各组精子参数、生精细胞和精子核成熟度并与A4组作比较。结果A4组精子存活率除了与A3组无统计学差异(P≥0.05)外,显著低于其它组(P<0.01);其精子畸形率不仅高于C1组(P<0.05),且显著高于其它组(P<0.01);其精子活动力a级和b级均显著低于其它组(P<0.01);其精子核苯胺蓝染色 率显著高于其他组(P<0.01),阴性率显著低于其他组(P<0.01)。结论精子存活率减少、畸形率高、活动力低下、核成熟度异常可能是大龄雄性F344大鼠生殖力明显下降或自发性不育症的病因。