大骨瓣减压加颞肌切除术对大面积脑梗死的疗效

目的探究分析标准大骨瓣减压联合颞肌切除术在大面积脑梗死患者中的临床治疗效果。方法从2016年12月-2018年11月我院收治的大面积脑梗死患者中抽选46例,采取数字随机分配法分为两组。试验组24例,采取标准大骨瓣减压联合颞肌切除术治疗,对照组22例,采取单纯标准大骨瓣减压术治疗,对比两组患者临床治疗效果。结果试验组中线回复(11.37±2.11)^15.09±2.79mm,对照组中线回复(12.24±3.31)^16.22±3.11mm,试验组中线回复情况优于对照组,死亡率(33.33%)明显低于对照组(63.64%),P<0.05,差异具有统计学意义。结论在大面积脑梗死患者中采取标准大骨瓣减压联合颞肌切除术治疗能够有效改善脑梗死情况,降低病死率,临床治疗效果显著。     

Vancomycin-related convulsion in a pediatric patient with neuroblastoma: A case report and review of the literature

BACKGROUNDVancomycin is often used as an anti-infective drug in patients receiving anti-tumor chemotherapy. There are concerns about its adverse drug reactions during treatment, such as nephrotoxicity, ototoxicity, hypersensitivity reactions, etc. However, potential convulsion related to high plasma concentrations of vancomycin in children receiving chemotherapy has not been reported.CASE SUMMARYA 3.9-year-old pediatric patient with neuroblastoma receiving vancomycin to treat post-chemotherapy infection developed an unexpected convulsion. No other potential disease conditions could explain the occurrence of the convulsion. The subsequently measured overly high plasma concentrations of vancomycin could possibly provide a clue to the occurrence of this convulsion. The peak and trough plasma concentrations of vancomycin were 59.5 mg/L and 38.6 mg/L, respectively, which were much higher than the safe range. Simulation with the Bayesian approach using MwPharm software showed that the area under the concentration-time curve over 24 h was 1086.6 mg· h/L. Therefore, vancomycin was immediately stopped and teicoplanin was administered instead combined with meropenem and fluconazole as the anti-infective treatment strategy.CONCLUSIONUnexpected convulsion occurring in a patient after chemotherapy is probably due to toxicity caused by abnormal pharmacokinetics of vancomycin. Overall evaluation and close therapeutic drug monitoring should be conducted to determine the underlying etiology and to take the necessary action as soon as possible.     

Detection of vancomycin variable enterococci (VVE) among clinical isolates of Enterococcus faecium collected across India-first report from the subcontinent

PurposeEmergence of vancomycin variable enterococci (VVE) poses a challenge to empiric vancomycin therapy. Vancomycin-variable enterococci (VVE) are vanA-positive, yet phenotypically vancomycin-susceptible enterococci that can switch to a vancomycin-resistant phenotype when exposed to vancomycin. The aim of the present study was to determine the prevalence of VVE in India.MethodsIsolates of phenotypically vancomycin susceptible Enterococcus faecium from 20 tertiary care hospitals across India were collected and tested for the presence of vanA, vanR, vanS, vanB and vanC genes by conventional PCR using previously published primers. Isolates positive for vanA gene were considered as VVE.ResultsThe prevalence of VVE was 1.5% (5/340). Only one VVE isolate was positive for vanR and vanS, and all the isolates were negative for vanB and vanC.ConclusionsAlthough the prevalence is low, our finding emphasizes the importance of routinely screening for van genes in enterococci that are phenotypically susceptible. Silenced vanA able to escape detection and revert to resistance during vancomycin therapy represents a new challenge in clinical settings.     

胰岛素样生长因子结合蛋白-4对大鼠骨髓间充质干细胞增殖和神经分化的影响

目的探究胰岛素样生长因子结合蛋白4(IGFBP4)对骨髓间充质干细胞(BMSC)增殖和神经分化的影响。方法通过全骨髓贴壁法分离培养BMSCs,免疫荧光检测IGFBP4在P1、P4、P6、P8和P10 BMSCs的表达。取第4代BMSC细胞,分为单纯培养基组和添加IGFBP4组,用CCK8试剂盒检测单纯培养基组和添加IGFBP 4组吸光度值A450 nm。再将BMSC细胞分为3组:neurocult组、EGF+b FGF组、EGF+b FGF+IGFBP4组,每组连续测定7 d,每天6个平行孔,诱导培养基Neuro Cult培养再分别添加EGF+b FGF和EGF+b FGF+IGFBP4,诱导其向神经祖细胞分化,免疫荧光染色检测Nestin和Sox-2表达,并观察神经球数量和细胞增殖活性。结果成功获得原代大鼠BMSCs,可见CD105、CD44和CD90表达,IGFBP4的表达随培养代数而增加,外源IGFBP4能明显抑制BMSCs的增殖(P0.05)。经诱导BMSCs形成的神经球样结构表达Nestin和Sox-2,细胞增殖活性升高(P0.05)。结论 IGFBP4能抑制BMSCs的增殖,促进其向神经祖细胞分化。     

Splinted and unsplinted overdenture attachment systems: A systematic review and meta‐analysis

Splinted and unsplinted overdenture attachment systems have unique advantages and disadvantages. The aim of the present systematic review was to determine the influence of splinted and unsplinted overdenture attachment systems on the marginal bone loss, prosthetic complications and implant survival rate. PubMed/MEDLINE , Scopus and Cochrane databases were searched for articles published up to October 2017, using the following search terms: “overdenture AND attachment OR overdenture AND bar OR overdenture splinted.” The PICO question “Do splinted overdenture attachment systems promote better clinical results in comparison to unsplinted systems?” was evaluated. Eligible studies included randomized controlled clinical trials, prospective studies with at least 10 participants and a minimum follow‐up of 6 months, and studies published in English that compared splinted and unsplinted attachment systems within the same study. The 95% confidence interval (CI ) was considered for all outcomes analysed. After completion of the different steps in the article selection process, nine articles were included in the qualitative and quantitative analyses. A total of 984 implants were placed in 380 patients (mean age: 62.8 years). The meta‐analysis demonstrated no statistically significant differences between splinted and unsplinted attachment systems with regard to marginal bone loss (P  = .39; MD : ?0.11; 95% CI : ?0.37 to 0.14), complications (P  = .31; RR : 1.26; CI : 0.80‐1.99) and implant survival rate (P  = .14; RR : 0.37% CI : 0.10‐1.36). In addition, splinted and unsplinted overdenture attachment systems achieved similar results with regard to marginal bone loss, prosthetic complications and implant survival rate.