股骨头缺血坏死合并股骨颈疝窝的CT诊断

目的:分析股骨头缺血坏死(avascular necrosis of the femoral head,ANFH)合并股骨颈疝窝的CT表现,提高诊断和鉴别诊断水平.方法:回顾性分析15例有典型影像学表现的ANFH合并股骨颈疝窝CT表现.结果:15例中9例为双侧ANFH,6例为单侧ANFH,共累及24侧股骨头；2例股骨颈疝窝为双侧,余13例为单侧.股骨颈疝窝病灶均位于股骨头颈交界区前外侧皮层下,呈圆形、卵圆形或轻度分叶,病灶最大径均小于1cm,病灶中心呈低密度,周围均有明显环状硬化.ANFH病灶均大于3cm,病灶均累及股骨头前部外上方承重区,与正常区相比病灶中心呈等密度15侧、低密度7侧、高密度2饲,18侧ANFH病灶周围呈单纯线状高密度硬化带分隔病灶与正常区,余6侧于高密度硬化带内侧伴行线状低密度影.结论:ANFH和股骨颈疝窝均有特定的发生部位和CT表现,可依据病灶位置、大小、形态和密度对两者鉴别及诊断ANFH合并股骨颈疝窝.     

Ipomoea obscura (L.) enhances the functions of immunological effector cells,inhibits proinflammatory cytokines and nitric oxide production by LPS induced macrophages

Most of the synthetic chemotherapeutic agents available today are immunosuppressant, cytotoxic and exerts variety of side effects. Botanical based immunomodulators are often employed as supportive or adjuvant therapy to overcome the undesired effects of cytotoxic chemotherapeutic agents and to restore normal health. The methanolic extract of traditionally important medicinal plant Ipomoea obscura exhibited immunomodulatory activity in BALB/c mice. Intraperitoneal administration of five doses of the extract (10 mg/kg body wt) was found to enhance the total WBC count (13912cells/mm³) on the 12^th day, bone marrow cellularity (28.9 × 10⁶cells/femur) and number of α-esterase positive cells (1246 cells/4000 cells). Treatment with the extract along with the antigen, sheep red blood cells (SRBC), produced an enhancement in the circulating antibody titer and the number of plaque forming cells (PFC) in the spleen. Maximum number of PFC (267.6 PFC/10⁶ spleen cells) was obtained on the 6^th day. At the same time administration of Ipomoea obscura extract significantly reduced the elevated levels of proinflammatory cytokines and nitric oxide production by lipopolysaccharide stimulated macrophages. These results indicate the immunomodulatory activity of the alcoholic extract of Ipomoea obscura.     

Safety of growth hormone replacement therapy in adults

Growth hormone (GH) is a powerful metabolic hormone that regulates fuel homeostasis through its protein anabolic and lipolytic actions. The introduction of recombinant human GH has expanded the narrow indication of treating children with severe GH deficiency (GHD) to include a broader target population of children with growth retardation and short stature and adults with hypopituitarism and severe GHD. Furthermore, because children continue to receive GH replacement therapy into adult life, the duration of treatment exposure has increased and the safety of long-term GH treatment has become increasingly important. This is of particular concern given that GH-deficient children and adults may be more vulnerable to the mitogenic stimuli of GH and insulin-like growth factor-1, both because of the underlying cause of GHD and also because of previous treatment such as radiotherapy and chemotherapy. This review focuses on the safety of treating adults with severe GHD, with specific emphasis on dose regimens, carbohydrate metabolism, neoplasia, and morbidity and mortality. Available experience from long-term replacement therapy, studies using supraphysiological doses of GH in adults and lessons learned from patients with acromegaly who have high endogenous GH levels over many years, is considered.     

Lack of association between TNFα rs1800629 polymorphism and schizophrenia risk: A meta-analysis

Evidence has suggested that tumour necrosis factor α (TNFα) may be involved in the aetiology of schizophrenia, but the underlying association between TNFα-308G/A polymorphism (rs1800629) and schizophrenia risk is still ambiguous. This meta-analysis was performed to quantitatively summarise the evidence for such a relationship. Eligible studies were identified by searching PubMed, EMBASE, CNKI (China National Knowledge Infrastructure), CBM (Chinese Biomedical Literature Database) and WANFANG databases within a range of published years from 1990 to July 2012. The odds ratio (OR) corresponding to the 95% confidence interval (CI) was used to assess the different associations. Twenty-one studies with 4340 cases and 5745 controls were included in this meta-analysis. The pooled examination displayed that there was no significant association between TNFα-308G/A polymorphism and susceptibility to schizophrenia overall (OR=1.047, 95% CI=0.876–1.253, P=0.614 for A vs. G), and no difference in Caucasian subgroup (OR=1.041, 95% CI=0.815–1.331, P=0.747) and Asian subgroup (OR=1.057, 95% CI=0.807–1.386, P=0.686). Lack of association was also found in males (OR=0.862, 95% CI=0.413–1.797, P=0.692) and females (OR=0.797, 95% CI=0.579–1.097, P=0.163) with a dominant model. Taken together, this meta-analysis suggests that TNFα-308G/A polymorphism may not be associated with schizophrenia susceptibility.     

New vitamin D analogs as potential therapeutics in melanoma

Extensive evidence shows that the active form of vitamin D3 – 1α,25-dihydroxyvitamin D3 – plays an important role in cancer prevention, has tumorostatic activity and may potentially be used in therapy for melanoma. Vitamin D3 and its analogs (secosteroids) exert multiple effects on cancer cells, including inhibition of cell growth and induction of differentiation. Activity of secosteroids depends on multiple cellular factors, including expression of the vitamin D receptor. Despite its endogenous origin, the key drawback for the use of pharmacologically effective doses of 1α,25-dihydroxyvitamin D3 is its hypercalcemic effect leading to profound toxicity. The solution may lie in properties of vitamin D3 analogs with modified side chains, which demonstrate low calcemic activity but conserve the anti-tumor properties. Noncalcemic vitamin D compounds were found to be potent in multiple studies that mandate further clinical testing. Finally, recent studies revealed alternative metabolic pathways for secosteroids and new targets in the cells, which opens up new therapeutic possibilities.     

阴茎背神经离断术联合α1受体阻断药治疗早泄的疗效

目的探讨阴茎背神经离断术联合高选择性α1受体阻断药治疗早泄的疗效。方法对89例早泄患者随机分为3组:单纯药物治疗组、单纯阴茎背神经离断组、联合治疗组,每组给予相应治疗,观察阴道内射精潜伏期的变化。结果联合治疗组阴道内射精潜伏期(160.4±57.7 s)较单纯药物α1受体阻断药治疗组(64.3±23.2 s)和单纯阴茎背神经离断组(106.5±41.4 s)明显延长(P<0.01)。结论阴茎背神经离断术联合高选择性α1受体阻断药治疗早泄效果明显。     

Femur chondrosarcoma misdiagnosed as acute knee arthritis and osteomyelitis—Further developing a hitherto unreported complication of tumor embolic ischemic ileal perforation after arthroscopic lavage

The differentiation between osteomyelitis and bone tumor may be difficult due to their overlapping clinical and radiological features. A 25-year-old lady presented with left knee pain and joint effusion associated with redness and hotness. A sub-optimally taken plain radiograph showed mixed osteolytic and osteoblastic lesion in the left lower femur with surrounding soft tissue swelling. Since the clinical diagnosis was acute osteomyelitis and arthritis, arthroscopic lavage was performed as a diagnostic and therapeutic procedure. The removed loose bodies and fibrinous tissue showed pathological features suspicious of chondrosarcoma. Subsequent MRI revealed an infiltrative tumor eroding through the cortex and joint cartilage. En bloc excision of the left lower femur, upper tibia including the knee joint and patella was performed, and the final diagnosis was grade 2 chondrosarcoma. The patient developed bilateral pulmonary metastasis 33 months after operation. Five months later, she suffered from a hitherto undescribed complication of ischemic perforation of the terminal ileum secondary to tumor embolic arterial obstruction with no macroscopic intestinal or peritoneal tumor deposit. The patient developed multiple brain metastases and died 43 months after initial presentation.Our case illustrates that malignant bone tumor as a differential diagnosis of acute osteomyelitis and arthritis merits recognition and exclusion before arthroscopic lavage, which may enhance tumor dissemination and in our patient results in embolic ischemic ileal perforation.     

Label retaining cells in cancer – The dormant root of evil?

The phenomenon of cellular dormancy has been observed in normal adult stem cells in many different tissues such as the skin, the intestine and the hematopoietic system. These dormant cells have been proposed to be important for life-long self-renewal and for the generation of the different cellular lineages. As tumor cells can share properties with normal stem cells, dormant cells might also exist within a tumor. The term tumor dormancy has evolved from the clinical observation in cancer patients that relapse can occur years to decades after apparently successful treatment, suggesting that some cancer cells might resist chemotherapy and persist in a dormant state. Several studies investigating the role of cellular dormancy in normal stem cells and in cancer hint towards a complex network involving different pools of cells. These cells might interact with each other or even dynamically switch their phenotypes dependent upon so far unknown endogenous and microenvironmental stimuli. In this review, we will discuss the recent findings related to cellular dormancy in normal adult stem cells and in cancer. Furthermore, the clinical relevance of dormancy and its dynamic regulation in tumor cells will be highlighted.