Duplicated filum terminale in non-split cord malformations: An underrecognized cause for treatment failure in tethered cord syndrome

Context: Anatomical variations of the filum terminale (FT) have been described in association with split cord malformations (SCM) but they appear to be a rare finding in its absence. We report the first case in literature of a duplicated FT in a patient presenting with tethered cord syndrome (TCS) without any radiological evidence of SCM.

Findings: A 47-year-old man presented with invalidating back pain radiating to both legs. Magnetic resonance imaging revealed an intradural dorsal lipoma in a low-lying conus. Intraoperatively two distinct fibrous bands were anatomically and electrophysiologically identified as the FT and both were sectioned. The diagnosis of FT was confirmed for both specimens by histology.

Conclusion: In absence of SCM, a duplicated FT has not been previously described as a cause of TCS. It may be a cause of treatment failure for TCS if unrecognized on preoperative imaging and during surgery if one filum remains intact. We highlight the importance of a meticulous cauda equina dissection supported by intraoperative nerve stimulation to identify this rare anomaly. We hypothesize that this entity may represent a variant of SCM involving the caudal neural tube but which requires further validation at an embryological level.     

A型肉毒毒素对疱疹后神经痛患者疗效及安全性分析

目的 评价皮内注射A型肉毒毒素治疗疱疹后遗神经痛(PHN)的疗效和安全性。方法80例PHN患者,随机分为治疗组和对照组,每组40例。治疗组:皮下注射含100单位肉毒素A的生理盐水20 mL,对照组:皮下注射含有100 mg利多卡因的生理盐水20 mL。评价治疗前、治疗后1天、2周、8周疼痛症状严重程度(VAS)。采用放射免疫分析法测定β-内啡肽。结果治疗2周、8周VAS评分治疗组和对照组之间差异显著,治疗组总有效率为80%显著高于对照组的56.7%,治疗组血浆β-内啡肽含量明显升高,均无严重不良反应。结论皮内注射A型肉毒素治疗PHN安全、有效,血浆β-内啡肽可能参与了其作用机制。     

Dissecting antigen processing and presentation routes in dermal vaccination strategies

The skin is an attractive site for vaccination due to its accessibility and presence of immune cells surveilling this barrier. However, knowledge of antigen processing and presentation upon dermal vaccination is sparse. In this study we determined antigen processing routes that lead to CD8⁺ T cell activation following dermal DNA tattoo immunization, exploiting a model antigen that contains an immunoproteasome-dependent epitope. In agreement with earlier reports, we found that DNA tattoo immunization of wild type (WT) mice triggered vigorous responses to the immunoproteasome-dependent model epitope, whereas gene-deficient mice lacking the immunoproteasome subunits β5i/LMP7 and β2i/MECL1 failed to respond. Unexpectedly, dermal immunization both of irradiated bone marrow (BM) reconstituted mice in which the BM transplant was of WT origin, and of WT mice transplanted with immunoproteasome subunit-deficient BM induced a CD8⁺ T cell response to the immunoproteasome-dependent epitope, implying that both BM and host-derived cells contributed to processing of delivered model antigen. Depletion of radiation-resistant Langerhans cells (LC) from chimeric mice did not diminish tattoo-immunization induced CD8⁺ T cell responses in most mice, illustrating that LC were not responsible for antigen processing and CD8⁺ T cell priming in tattoo-immunized hosts. We conclude that both BM and non-BM-derived cells contribute to processing and cross-presentation of antigens delivered by dermal DNA tattoo immunization.     

A型肉毒毒素治疗疼痛的机制研究进展

A型肉毒毒素(botulinum toxin-A,BTX-A)是由100 ku的重链和50 ku的轻链通过二硫键相连形成的双链多肽式结构,其中轻链是一种蛋白酶可与神经肌肉接头处的融合蛋白结合,防止突触小泡锚定在细胞膜上释放乙酰胆碱,从而干扰神经冲动传递,因此在临床中作用效果广泛。近年来针对BTX-A临床应用范围的讨论也一直是热点,研究显示,A型肉毒毒素(BTX-A)能有效治疗疼痛,具有可持续性发挥疗效和无成瘾性等特点,但对于BTX-A作用机制仍旧存有争议。本篇文章将分别对BTX-A在外周神经系统和中枢神经系统中作用机制的相关研究进行综述。     

Therapeutic Strategies to Protect the Central Nervous System against Shiga Toxin from Enterohemorrhagic Escherichia coli

Infection with Shiga toxin-producing Escherichia coli (STEC) may cause hemorrhagic colitis, hemolytic uremic syndrome (HUS) and encephalopathy. The mortality rate derived from HUS adds up to 5% of the cases, and up to 40% when the central nervous system (CNS) is involved. In addition to the well-known deleterious effect of Stx, the gram-negative STEC releases lipopolysaccharides (LPS) and may induce a variety of inflammatory responses when released in the gut. Common clinical signs of severe CNS injury include sensorimotor, cognitive, emotional and/or autonomic alterations. In the last few years, a number of drugs have been experimentally employed to establish the pathogenesis of, prevent or treat CNS injury by STEC. The strategies in these approaches focus on: 1) inhibition of Stx production and release by STEC, 2) inhibition of Stx bloodstream transport, 3) inhibition of Stx entry into the CNS parenchyma, 4) blockade of deleterious Stx action in neural cells, and 5) inhibition of immune system activation and CNS inflammation. Fast diagnosis of STEC infection, as well as the establishment of early CNS biomarkers of damage, may be determinants of adequate neuropharmacological treatment in time.     

中医儿科胎毒理论源流考

胎毒理论是中医儿科学对某些疾病病因的独特认识。运用传统文献整理方法对中医儿科胎毒理论源流进行梳理,认为其在宋之前开始萌芽,此时尚处于胎病理论阶段,认识到小儿尤其是新生儿诸多疾病的病因是在胎儿时期获得的,与患儿母亲胎孕时期养护及饮食不当相关,防治上注重清热解毒;宋金元时期明确提出胎毒为诸多儿科疾病的病因,并出现了胎毒医案的记载;明清时期渐趋成熟,认为胎儿形成前或胎儿期,由于父母嗜食辛辣甘肥,或五志过极化火,或房事过度,或孕母感受寒热之邪,形成胎毒内蕴,导致小儿出生后罹患鹅口疮、重舌、木舌等口腔疾病,虫疖、流丹、湿疹、痈疖等皮肤疾病,胎黄、胎惊等新生儿疾病以及麻、痘等传染性疾病,防治方法上注重辨证祛胎毒。     

从"肺毒"探析特发性肺纤维化

肺毒系指无论外感还是内伤,导致脏腑生理功能失调,气血津液运行失常而产生的有毒物质,蕴积于肺脏,主要包括痰毒和瘀毒。特发性肺纤维化归属中医"肺痹"范畴,痰瘀毒痹阻肺络,致使特发性肺纤维化隐匿性起病,其致病特点呈损正性、顽恶性,伤人形质,预后较差。