药物性重型肝炎1例肝细胞体内移植治疗的效果

目的探讨人肝细胞体内移植治疗药物性重型肝炎患者的有效性与安全性。方法分离健康志愿者捐献的肝脏,获得人原代肝细胞并冷冻保存,复苏后经股动脉插管移植到脾脏,观察治疗前后患者临床症状、血液生化指标及脾脏核磁共振信号的改变。结果人肝脏可获取2×1010肝细胞,复苏后肝细胞活率在70%以上,移植的肝细胞数为2×109个。移植后1个月,患者临床症状明显改善,血BIL、NH3、ALT、AST明显降低,PA水平明显升高。出院50天后随访各项血生化指标均恢复正常,脾脏内可见肝细胞信号。结论肝细胞体内移植是一项安全有效的治疗方法,移植的肝细胞能够在脾脏内增殖、分化,替代或部分恢复肝脏合成、解毒和代谢功能;将为终末期肝病治疗开辟一项新的治疗途径。     

Interfractional fluctuation of rectal dose in high dose rate brachytherapy for prostate cancer

Purpose The aim of the study was to explore the cause of the difference in the maximal rectal dose between the first and second high dose rate (HDR) brachytherapy applications by comparing the thickness of the anterior rectal wall. Materials and methods The rectal dose and the thickness of the anterior rectal wall were analyzed in 26 patients with prostate cancer. After undergoing external beam radiation treatment with a total isocenter dose of 50 Gy, they were treated with HDR brachytherapy of 7.5 Gy/fraction, two fractions daily. The interval between the first HDR brachytherapy session and the second was 5 h. The rectal doses were directly surveyed during irradiation of the HDR brachytherapy. Thickening of the anterior rectal wall was measured at the same level by axial computed tomography scans obtained before the first and second HDR brachytherapy applications. Results The maximal surveyed rectal doses during the first and second HDR brachytherapy applications were 188 ± 51 cGy and 220 ± 35 cGy, respectively (P < 0.01). The fluctuation ratio exceeded 1 in each case. The thickness of the anterior rectal wall before the first and second HDR brachytherapy applications was 18.78 ± 4.34 mm and 14.95 ± 4.09 mm (P < 0.01), respectively. The fluctuation difference exceeded 0 in each case. Conclusion The different rectal dose is attributable to thinning of the anterior rectal wall. The total rectal dose is within the range of doses at risk of exerting a toxic effect on the rectum.     

中西结合治疗椎动脉型颈椎病62例临床观察

1 临床资料 本组62例中,男38例,女24例;年龄最大67岁,最小21岁,平均36岁;病程最长8 a,最短2个月,平均15个月.全部病例均有眩晕症状,常在颈部旋转或屈伸时出现或加重,伴颈枕部不适或疼痛,颈肌僵硬.伴耳鸣32例,伴恶心或呕吐23例,伴上肢麻木感15例.     

The chemokine receptor CXCR2 is differentially regulated on glial cells in vivo but is not required for successful remyelination after cuprizone-induced demyelination

Unravelling the factors that can positively influence remyelination is one of the major challenges in multiple sclerosis research. Expression of the chemokine receptor CXCR2 on oligodendrocytes both in vitro and in MS lesions has suggested a possible role for CXCR2 in the recruitment of oligodendrocyte precursor cells (OPC). To investigate the function of CXCR2 during remyelination in vivo, we studied this receptor in cuprizone-induced demyelination and subsequent remyelination. We found that CXCR2 is constitutively expressed on OPC, whereas on macrophages/microglia CXCR2 is upregulated upon activation during demyelination. Hence, the expression of CXCR2 is differentially regulated in oligodendrocytes and macrophages/microglia. Furthermore, we subjected CXCR2-/- mice to the cuprizone model demonstrating that remyelination was not altered in comparison to wildtype controls. In addition, the number of OPC and the amount of microglial accumulation were similar in both CXCR2-/- and wildtype animals during the whole demyelination and remyelination process. These results suggest that despite expression on OPC and microglia CXCR2 plays only a minor role during remyelination.     

黄斑区内界膜剥除联合38G套管针应用治疗黄斑区视网膜下全氟萘烷残留的疗效

目的：观察黄斑区内界膜(ILM)剥除联合38G套管针应用治疗黄斑区视网膜下全氟萘烷残留的疗效。
　　方法：选取来自厦门眼科中心2008-01/2013-10期间的29例29眼视网膜复位良好、但黄斑区视网膜下全氟萘烷残留的患者,分为A组、B组。 A组14例14眼,取出硅油后,直接以38 G套管针吸除黄斑区视网膜下全氟萘烷液体,术闭填充过滤空气。 B组15例15眼,取出硅油后,染色并完整剥除黄斑区ILM,范围约4PD,以38G套管针吸除黄斑区视网膜下全氟萘烷液体,术闭填充过滤空气。所有病例如在术后1 wk复查OCT发现黄斑裂孔形成者,均再行气液交换,填充16% C3 F8气体。观察两组病例术后4,8,24 wk最佳矫正视力( BCVA )变化,复查OCT观察黄斑区视网膜下全氟萘烷液体有无残留、有无黄斑裂孔形成及黄斑区形态变化等。
　　结果：两组术后 4, 8, 24 wk 的 BCVA 均有提高, B 组的BCVA提高值优于A组( P<0.05)。 A 组术后24 wk 有7例(50%)黄斑裂孔形成,黄斑区无全氟萘烷残留。 B组术后24 wk 1例(7%)黄斑裂孔形成,黄斑区无全氟萘烷残留。
　　结论：黄斑区内界膜剥除联合38 G套管针应用治疗黄斑区视网膜下全氟萘烷残留的方法可以彻底吸除黄斑区视网膜下全氟萘烷,较少出现黄斑裂孔,该方法安全、有效、微创,有效保护了黄斑区视功能。     

Pathology of toxic leucoencephalopathy in drug abuse supports hypoxic‐ischemic pathophysiology/etiology

The histopathological features of leucoencephalopathy caused by illicit drugs (such as opioids and cocaine) are well documented in acute cases but not in long‐survival cases. There are several hypotheses about the pathogenesis of this disorder, including hypoperfusion, direct drug toxicity resulting from the neurotoxic effects of the drug itself or contaminants in the illicit drug vehicle. We reviewed the post mortem findings in five males (aged 24 to 56 years, with survival intervals ranging from 7 days to 5 months) with a history of illicit drug use and concomitant fatal white matter changes. The histological characteristics of leucoencephalopathy vary with survival period. Prominent axonal injury and axonal spheroids were observed with shorter survival and spongiform changes becoming apparent with longer survival (acute and chronic incomplete infarct pattern). Necrosis was present in all cases and its appearance changed with longer survival (acute and chronic complete infarct pattern). Significant primary demyelination was not observed. These observations suggest that the primary defect in this leucoencephalopathy is hypoxic‐ischemic injury, predominantly in the white matter. Spongiform leucoencephalopathy likely represents the longer‐survival incomplete infarct pattern and is observed with polydrug abuse.     

Toxic tau: structural origins of tau aggregation in Alzheimer's disease

Alzheimer’s disease is characterized by the extracellular accumulation of the amyloidβin the form of amyloid plaques and the intracellular deposition of the microtubule-associated protein tau in the form of neurofibrillary tangles.Most of the Alzheimer’s drugs targeting amyloidβhave been failed in clinical trials.Particularly,tau pathology connects greatly in the pathogenesis of Alzheimer’s disease.Tau protein enhances the stabilization of microtubules that leads to the appropriate function of the neuron.Changes in the quantity or the conformation of tau protein could affect its function as a microtubules stabilizer and some of the processes wherein it is involved.The molecular mechanisms leading to the accumulation of tau are principally signified by numerous posttranslational modifications that change its conformation and structural state.Therefore,aberrant phosphorylation,as well as truncation of tau protein,has come into focus as significant mechanisms that make tau protein in a pathological entity.Furthermore,the shape-shifting nature of tau advocates to comprehend the progression of Alzheimer’s disease precisely.In this review,we emphasize the recent studies about the toxic and shape-shifting nature of tau in the pathogenesis of Alzheimer’s disease.     

Need for urodynamic evaluation as a regular follow-up tool in assessment of long-term urological outcomes in patients with sacrococcygeal teratoma

AimTo assess the long-term urologic outcomes in follow-up of patients of sacrococcygeal teratoma (SCT) using urodynamic study (UDS) in addition to clinical and radiologic evaluation.MethodsA prospective study of clinical, radiological and urodynamic evaluation in patients with SCT who underwent resection between January 2002–June 2015 and were followed up till January 2016 was conducted.ResultsTotal 57 patients, 42 (73.7%) females and 15 (26.3%) males with 35 (62.4%) following treatment for benign and 22 (38.5%) for malignant disease were included. Twenty-eight of 57 (49.12%) had urological problems. Clinical complaints in 21 (36.8%) patients included stress urinary incontinence-14 (66.7%), enuresis-9 (42.9%), and poor stream or dribbling of urine-6 (28.6%). Eight of 51 patients (15.7%) had abnormal ultrasound findings, which included contracted, trabeculated thick walled bladder (3), bilateral hydronephrosis (3) and significant post void residue (PVR) (6). Seven of 57 underwent micturating cystourethrogram (MCU), 5 had an abnormal report[significant PVR (4), small trabeculated bladder (3), reflux (2) and large capacity bladder (1)]. Urodynamic study was done in 27 patients, 18/27 (66.7%) had abnormalities. Six patients without any clinical or ultrasonographic abnormalities had abnormal UDS. Total 28 (49.12%) had urological comorbidities. Three patients had overactive bladder, five dysfunctional voiding, one underactive bladder and one had giggle incontinence. Children were managed by behaviour therapy and pharmacotherapy.ConclusionUrodynamic evaluation could detect abnormalities in patients who had no urinary complaints or abnormality on ultrasound. The abnormalities have a potential for progressive upper tract damage. Urodynamics should be an integral part of urological surveillance in patients operated for SCT.Type of studyPrognostic study.Level of EvidenceLevel II (Prospective cohort study).     

Accreditation in Belgium: a 10 Years’ Experience

Purpose : Toxic adenoma is one of the main causes of hyperthyroidism. We investigated the efficacy of surgery in the treatment of toxic adenoma.

Methods : Serum thyroid stimulating hormone (TSH) measurement, ultrasound and scintigraphy of the thyroid were made for diagnostic purpose. The safety of surgery was evaluated by postoperative clinical course of patients. The efficacy of surgery was determined by the function of the remaining thyroid tissue.

Results : The incidence of hyperthyroidism was 53% in surgically treated patients with nodular goitre in our iodine deficient region. The cause of thyrotoxicosis was toxic adenoma in 15 patients (14%). Suppressed serum TSH levels indicated the hyperthyroidism in all of 15 patients. Solitary solid adenoma was found by ultrasonographic examination, and solitary autonomous hot nodule by thyroid scintigraphy. Surgical treatment consisted of unilateral total lobectomy. It was the primary treatment in 13 patients. Two patients had surgery as secondary treatment after unsuccessful primary radioactive iodine application. The early postoperative clinical course of all patients was uneventful. Thirteen patients who had surgery as primary treatment had normal thyroid function postoperatively contrary to other two patients who became hypothyroid after having unsuccessful radioiodine therapy, and surgery as the secondary treatment. Conclusions : The incidence of hyperthyroidism and toxic adenoma is high in our surgically treated patients with nodular goitre. The diagnosis of toxic adenoma is not difficult by serum TSH measurements, and ultrasound and nuclear imaging of the thyroid. Surgery is effective and safe, and the treatment of choice for patients with toxic adenoma in order to control radically the hyperthyroidism and to achieve the goal of providing the euthyroid status.     

Impairment of colour vision in patients with n-hexane exposure-dependent toxic polyneuropathy

The aim of this study was to investigate the effects of n-hexane on visual function and to determine the duration of any symptoms related to workplace exposure. The study involved 26 workers diagnosed as having polyneuropathy following n-hexane exposure. The FM-100 Hue test was used to determine colour discrimination in study volunteers. Their results were compared with a control group of 50 people who had not been exposed to n-hexane. The mean total error score for the exposed group was 168.3 (SD = 70.5) for the right eye and 181.5 (SD = 103.0) for the left eye. The mean total error scores for the control group for the right and left eyes were 36.0 (SD = 19.8) and 35.6 (SD = 18.2), respectively. Differences between total and partial error scores for exposed and control groups were statistically significant (P < 0.001). These results may indicate a relationship between n-hexane exposure and development of defects in colour vision, and would support a recommendation for periodic assessment of workers exposed to n-hexane and chemically related solvents.