Severity of alcohol-induced painful peripheral neuropathy in female rats: role of estrogen and protein kinase (A and Cepsilon)

Small-fiber painful peripheral neuropathy, a complication of chronic ethanol ingestion, is more severe in women. In the present study, we have replicated this clinical finding in the rat and evaluated for a role of estrogen and second messenger signaling pathways. The alcohol diet (6.5% ethanol volume:volume in Lieber-DeCarli formula) induced hyperalgesia with more rapid onset and severity in females. Following ovariectomy, alcohol failed to induce hyperalgesia in female rats, well past its time to onset in gonad intact males and females. Estrogen replacement reinstated alcohol neuropathy in the female rat. The protein kinase A (PKA) inhibitor (Walsh inhibitor peptide, WIPTIDE) only attenuated alcohol-induced hyperalgesia in female rats. Inhibitors of protein kinase Cepsilon (PKCepsilon-I) and extracellular-signal related kinase (ERK) 1/2 (2'-amino-3'-methoxyflavone (PD98059) and 1,4-diamino-2, 3-dicyano-1, 4-bis (2-aminophenylthio) butadiene (U0126)) attenuated hyperalgesia in males and females, however the degree of attenuation produced by PKCepsilon-I was much greater in females. In conclusion, estrogen plays an important role in the expression of pain associated with alcohol neuropathy in the female rat. In contrast to inflammatory hyperalgesia, in which only the contribution of PKCepsilon signaling is sexually dimorphic, in alcohol neuropathy PKA as well as PKCepsilon signaling is highly sexually dimorphic.     

胸骨左缘第二肋间切口微创治疗动脉导管未闭31例

摘要： 目的 评估经胸骨左缘第二肋间切口微创治疗动脉导管未闭的临床疗效和可靠性。方法 收集2014年1 月—2017年11月我科对31例婴儿期患儿行动脉导管结扎术的临床资料, 所有手术均采用经胸骨左缘第二肋间切口入路, 总结该术式的手术过程, 分析其临床转归。结果 本组病例手术过程顺利, 手术切口长度 （2.5±1.0） cm, 手术时间 （1.5±0.2） h, 术中出血不超过5 mL, 术后平均住院日 （15.1±4.2） d, 未出现死亡、 大出血等重大并发症, 术后无需放置胸腔引流管。术后随访1个月~4年, 无导管再通及动脉瘤形成。结论 胸骨左缘第二肋间切口微创治疗动脉导管未闭是一种安全可靠的方法, 并发症少, 远期疗效满意。     

121例二线抗结核药品不良反应分析

目的探讨二线抗结核药品药品不良反应(ADR)发生的特点。方法从某院2017年度ADR报告汇总表中选取二线抗结核药品所致ADR患者的病历,对不同性别、年龄的患者ADR发生情况,ADR类型以及患者各种ADR所涉及的器官系统及其主要临床表现、转归数据信息进行统计分析。结果报告的121例二线抗结核药品ADR患者中,男性占比较高(72例,59. 50%),年龄 60岁者居多(70例,57. 85%)。引发ADR的药品剂型主要是注射剂型(80例,66. 12%),主要药品是莫西沙星(38例,31. 40%)和左氧氟沙星(29例,23. 96%)。ADR累及的器官系统以全身性为主(69/128,53. 91%),其次是中枢及外周神经系统(22/128,17. 19%)。严重的ADR患者9例(7. 44%),痊愈和好转的ADR患者118例(97. 52%)。结论使用二线抗结核药品ADR多发生于老年患者,尤其以喹诺酮类药品的全身性损害和中枢及外周神经系统损害为主。在诊治过程中,应及时对高危人群和主要治疗药品进行ADR监测和主动干预,并作出应对处理。     

Parametric models for biomarkers based on flexible size distributions

Recent advances in social science surveys include collection of biological samples. Although biomarkers offer a large potential for social science and economic research, they impose a number of statistical challenges, often being distributed asymmetrically with heavy tails. Using data from the UK Household Panel Survey, we illustrate the comparative performance of a set of flexible parametric distributions, which allow for a wide range of skewness and kurtosis: the four‐parameter generalized beta of the second kind (GB2), the three‐parameter generalized gamma, and their three‐, two‐, or one‐parameter nested and limiting cases. Commonly used blood‐based biomarkers for inflammation, diabetes, cholesterol, and stress‐related hormones are modelled. Although some of the three‐parameter distributions nested within the GB2 outperform the latter for most of the biomarkers considered, the GB2 can be used as a guide for choosing among competing parametric distributions for biomarkers. Going “beyond the mean” to estimate tail probabilities, we find that GB2 performs fairly well with some disparities at the very high levels of glycated hemoglobin and fibrinogen. Commonly used linear models are shown to perform worse than almost all the flexible distributions.     

孕早中期孕妇肠道菌群差异与子痫前期发病关系的研究

背景 子痫前期病情严重者可进展至子痫并威胁母婴生命安全,而肠道菌群构成变化可能参与子痫前期的发生、发展,但尚无明确证据。 目的 探讨孕早中期孕妇肠道菌群差异与子痫前期发病的关系。 方法 选取2019年1月至2021年1月桂林医学院第二附属医院产科招募且符合本研究纳入标准的孕妇455例。将妊娠20周后确诊为子痫前期的孕妇作为子痫前期组（n=32）,未发生子痫前期的孕妇作为非子痫前期组（n=423）。收集孕妇的临床资料,并分别留取孕早期（≤12+6周）、孕中期（13~27+6周）粪便标本进行肠道菌群生物信息学分析,分析其与子痫前期发病的关系。 结果 子痫前期组和非子痫前期组年龄、孕早期Shannon指数和Simpson指数比较,差异均有统计学意义（P<0.05）。多因素Logistic回归分析结果显示,年龄≥35周岁〔OR=1.894,95%CI（1.432,2.369）〕、孕早期Shannon指数下降〔OR=0.709,95%CI（0.465,0.921）〕、孕早期Simpson指数下降〔OR=0.612,95%CI（0.354,0.893）〕是孕妇发生子痫前期的独立危险因素（P<0.05）。孕早期Shannon指数预测孕妇子痫前期发病的受试者工作特征（ROC）曲线下面积为0.745〔95%CI（0.652,0.838）〕,截断值为6.255,灵敏度为76.58%,特异度为60.00%;孕早期Simpson指数预测孕妇子痫前期发病的ROC曲线下面积为0.724〔95%CI（0.623,0.826）〕,截断值为0.945,灵敏度为62.90%,特异度为60.61%。 结论 孕早期粪便肠道菌群Shannon指数、Simpson指数降低是孕妇发生子痫前期的独立危险因素,且对子痫前期发病具有早期预测价值。     

腹腔镜手术与保守治疗异位妊娠效果及对患者再孕成功率的影响

目的探讨腹腔镜手术与保守治疗异位妊娠效果及对患者再孕成功率的影响。方法选取2018年4月至2019年4月本院收治的异位妊娠患者75例为研究对象,采用简单随机化法分为A组(n=37)与B组(n=38)。A组接受保守治疗,B组接受腹腔镜手术治疗。比较两组临床疗效、临床症状消失时间及再孕成功率。结果 B组治疗总有效率(94.74%)略高于A组(86.49%),但差异无统计学意义。B组腹痛消失、阴道出血症状消失、HCG恢复正常及月经恢复正常时间均短于A组,差异有统计学意义(P<0.05)。B组1年后宫内妊娠率高于A组,差异有统计学意义(P<0.05)。结论腹腔镜手术与保守治疗应用于异位妊娠患者均有良好治疗效果,但腹腔镜手术更利于患者症状的改善,提高再孕成功率。     

关节镜下双后内侧入路单纯缝线联合经胫骨骨隧道二次固定治疗后交叉韧带胫骨止点撕脱骨折16例疗效分析

目的　研究关节镜下双后内侧入路单纯缝线联合经胫骨骨隧道二次固定治疗后交叉韧带胫骨止点撕脱骨折的临床效果。　方法　选取2018年5月至2020年8月收治的单纯后交叉韧带止点撕脱骨折16例,对其行关节镜下双后内入路单纯缝线复位固定联合经胫骨骨隧道二次固定技术,术后随访1年,对其临床治疗效果（Lysholm评分、IKDC评分及后抽屉试验）进行评价。　结果　手术顺利,术中无副损伤。术后1年后抽屉试验阴性,Lysholm膝关节功能评分（91.67±5.16）及IKDC评分（89.74±4.28）较术前明显增加,差异有统计学意义（P<0.05）。　结论　关节镜下双后内入路,应用单纯缝线联合经胫骨骨隧道二次固定技术治疗单纯后交叉韧带止点撕脱骨折临床效果肯定,值得普遍推广。     

Risks of injury in distal metatarsal minimally invasive osteotomy when comparing standard and modified techniques: A cadaveric study

BackgroundThe objectives of the study were to evaluate the structures at risk in distal metatarsal mini-invasive osteotomy (DMMO) and to compare standard and intraosseous approaches.MethodsDMMO was performed on the second and fourth metatarsals of 11 fresh-frozen cadaveric specimens. The standard technique was performed in 11 metatarsals. It was then compared to a modified intraosseous technique that entails starting inside the bone in 11 other metatarsals. The cadavers were dissected to identify unintentional injury to soft tissue structures.ResultsIn the standard group the most injured structures were the metatarsal joint capsules (MJC) (27%), extensor digitorum longus (EDL) (18%), and extensor digitorum brevis (EDB) (9%). The modified intraosseous group injured the EDL (27%), not the MJC (0%) and the EDB (0%). Distances between osteotomies and the dorsal metatarsal head articular surface (DMHAS) were 6.08 ± 3.99 mm in the standard and 9.92 ± 3.42 mm in the modified (p = 0.02).ConclusionThe DMMO techniques most frequently injured the EDL. Intra-articular positioning of the osteotomy was more observed in the standard. Overall, it appears the modified method could be an alternative to the standard DMMO.Clinical relevanceThe modified minimally invasive DMMO has a comparable rate of potential iatrogenic injuries. This intraosseous procedure may present as an option when planning surgery to the lesser metatarsals.Level of EvidenceLevel III. Comparative Cadaveric Study.     

Biophysique de l’échauffement cutané par conduction et par radiation: implications pour l’étude différentielle des afférences Aδ et C chez l’homme

Résumé  Pour caractériser les différents types de récepteurs cutanés thermosensibles, il para?t essentiel de définir les conditions de stimulation thermique, plus précisément les paramètres physiques du stimulus et les propriétés thermophysiques de la peau. Trois méthodes expérimentales de transfert de chaleur à la peau sont étudiées. La première représente la situation idéalisée d’une peau à température initiale constante soudainement mise en contact avec une sonde thermique maintenue à température constante. La seconde méthode représente la situation où la peau est mise en contact avec une sonde dont la température cro?t de manière linéaire à partir d’une température initiale. La troisième méthode représente la situation où la peau est exposée à une source d’énergie calorifique radiante ayant une densité de puissance constante. Les résultats de ces études illustrent que le fait de négliger la relation entre les paramètres physiques du stimulus et les propriétés thermophysiques de la peau peut conduire à des observations en apparence paradoxales. Par contre, en contr?lant ces paramètres de manière appropriée, l’expérimentateur peut faire varier de manière considérable le délai entre l’arrivée des informations en provenance des récepteurs A∂ et C au niveau du premier relais spinal. Cela lui permet ainsi d’étudier leurs interactions. Finalement, il appara?t qu’une source radiante dans le lointain infra-rouge (laser CO₂) approte des avantages certains sur les stimulateurs calorifiques conventionnelles.

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Summary  To characterise cutaneous thermoreceptors, it seems essential to define exactly the conditions of thermal stimulation, more precisely the physical parameters of the stimulus and the thermophysical properties of the skin. Three experimental procedures of heat transfer to the skin are examined. The first procedure represents the ideal situation of a skin at a given base temperature suddenly put in contact with a thermode at a fixed temperature. The second procedure represents a situation in which the skin is put in contact with a thermode producing a linear heat ramp. The third procedure represents a situation in which the skin is exposed to a radiant heat source of constant energy density. The results of these studies show that neglecting the relationship between parameters of the thermal stimulus and the thermophysical properties of skin may lead to apparently paradoxical observations. In contrast, when properly controlled, these parameters can allow to vary considerably the delay between the arrival at the first spinal relay of information conveyed by A∂ and C-fibres and as a consequence allow to study their interactions. Finally, it seems that a source of radiation in the far infrared (CO₂ laser) offers several advantages over conventional heat stimulators.

Texte présenté lors du Congrès SFD-SOFRED des 15–17 juin 2000.     

The use of polyvinyl alcohol hydrogel implants in the lesser metatarsal heads. Is it safely doable? A cadaveric study

BackgroundThe use of synthetic polyvinyl alcohol hydrogel (PVAH) implants for treatment of lesser toe metatarsophalangeal joint (MTPJ) arthritis is promising and currently limited by the size of implants available. The primary objective of this cadaveric study was to investigate the maximum drilling size and largest PVAH implant dimension that could be safely introduced while still preserving an intact bone rim of the lesser metatarsal heads.MethodsHeight and width of all lesser metatarsals were measured on CT and during anatomic dissection. Sequential reaming of the second to fourth metatarsals was performed. Maximum reaming size, largest implant inserted, and failure of the metatarsal head were recorded. Metatarsal head sizes were compared and a multiple regression analysis evaluated measurements that influenced maximum drilling and implant size.ResultsCT and anatomical measurements demonstrated significant correlation (ICC range, 0.–0.85). Mean values for height and width of the metatarsal heads were respectively: second (14.9 mm and 9.9 mm), third (14.8 mm and 8.8 mm), fourth (14.0 mm and 8.7 mm) and fifth (12.3 mm and 9.3 mm). All the second, third and fourth metatarsal heads could be safely drilled up to 7.5 mm, preserving an intact bone rim. At 80% of the time, the heads could be safely drilled up to 8.0 mm. Height of the metatarsal heads was the only factor to significantly influence the size of maximum reaming and implant introduced. In respectively 20%, 40% and 50% of the second, third, and fourth metatarsal heads, neither 8 mm nor 10 mm PVAH implants could be used.ConclusionsOur cadaveric study found that the even though the majority of the lesser metatarsal heads could be safely drilled up to 8 mm, the smallest PVAH implant size currently available in most countries (8 mm) could be inserted in most of the second, but only in about half of the third and fourth metatarsal heads. The remaining bone rim around inserted implants was considerably thin, usually measuring less than 1 mm. In order to optimize the use PVAH in lesser metatarsal heads, smaller implant options are needed.