胱天蛋白酶14在慢性光化性皮炎患者皮损中的表达及中波紫外线对其mRNA和蛋白在HaCaT细胞中表达的影响

【摘要】 目的 观察胱天蛋白酶14（caspase-14）在慢性光化性皮炎（CAD）患者皮损中的表达以及中波紫外线（UVB）对HaCaT细胞caspase-14 mRNA和蛋白表达的影响。方法 2016年在昆明医科大学第一附属医院皮肤科门诊收集慢性光化性皮炎、湿疹患者皮损各10份作为试验组和阳性对照组,以10例健康人整形手术后的正常皮肤组织作为阴性对照。免疫组化染色检测caspase-14在正常皮肤、CAD及湿疹皮损中的表达。培养HaCaT细胞,分别给予0、30、60、90 mJ/cm2 UVB照射,加或不加甲基化酶抑制剂（5-AzaC）培养24 h后提取细胞,实时荧光定量PCR、Western印迹法检测UVB照射及加入5-AzaC 前后HaCaT细胞caspase-14 mRNA和蛋白表达水平。采用SPSS22.0软件,率的比较采用卡方检验,组间均数比较采用t检验和双因素方差分析。结果 在CAD和湿疹皮损内,caspase-14主要表达于棘层和颗粒层,角质层不表达;正常皮肤组织角质层中caspase-14表达显著。10例CAD患者中5例皮损caspase-14阳性,10例健康人中9例阳性,两组阳性比例差异有统计学意义（χ2 = 7.30,P < 0.05）。实时荧光定量PCR及Western印迹检测显示,不同剂量UVB照射后caspase-14 mRNA、蛋白的表达差异均有统计学意义（F值分别为87.54、23.46,均P < 0.05）,caspase-14 mRNA、蛋白的表达随UVB剂量升高有下降趋势。UVB剂量为0、30、60、90 mJ/cm2时,5-AzaC组的caspase-14 mRNA、蛋白的表达均高于UVB照射不加5-AzaC的对照组（均P < 0.05）。结论 CAD皮损中caspase-14表达降低,角质层不表达;UVB照射可下调HaCaT细胞caspase-14 mRNA及蛋白表达水平。     

Factors associated with needle breakage of antegrade suture passer and effect of intratendinous remnant needle tip on clinical outcomes after arthroscopic rotator cuff repair

ObjectiveThe aim of this study was to evaluate factors associated with the needle breakage of antegrade suture passer and the effect of intratendinous remnant needle tip on clinical outcomes after rotator cuff repair.MethodsWe retrospectively reviewed 283 patients (138 men and 145 women; mean age: 59.7 ± 9.3 years) who underwent arthroscopic repair for full-thickness rotator cuff tear. We evaluated the characteristics of 16 patients in whose needle tip had been broken and embedded and remained in the rotator cuff (remnant needle group) and compared them with the remaining 267 patients (control group). Afterwards, another 64 patients were selected from control group (1:4 matching) after propensity score matching (PSM). The groups were compared anatomically with MRI or ultrasonography and functionally (serial pain VAS and ROM; ASES, Constant, UCLA and SST scores) at a minimum follow-up of 1 year.ResultsThe remnant needle group showed preoperative thicker tendon (6.72 mm vs 5.33 mm, p = 0.047), higher tendinosis (mean grade, 1.88 vs. 1.43, p = 0.029), and more frequent delaminated tears (p = 0.035) compared with control group. When we compare the clinical outcomes after PSM, the initial pain VAS of the remnant needle tip group was higher up to 3 months (pain VAS: 4.13 ± 2.07 vs 2.48 ± 1.61 (p = 0.032) at 5 weeks and 3.79 ± 2.12 vs 2.25 ± 1.76 (p = 0.044) at 3 months), however the difference disappeared after 6 months postoperatively. In final evaluation, there was no significant differences in every outcome parameters (all p > 0.05).ConclusionBreakage of the needle of the antegrade suture passer occurred more frequently in the thicker tendon, higher tendinosis, and delaminated tears. The retained broken needle tip was associated with higher pain scores during the early postoperative period, but revealed no difference in final outcomes by using PSM.Level of EvidenceLevel III, Therapeutic Study     

Umbrella handle technique for fixation of FDP avulsion fracture

We present the treatment course of a 29-year-old male patient with for a Type 3 FDP avulsion (Jersey's finger) of a fifth finger treated with umbrella handle technique. The patient had a volar base fracture of distal phalanx with dorsal subluxation of DIP joint after a fall. Following open reduction of the FDP avulsion fracture and fixation was achieved with a 0.9 mm one edge hooked Kirschner wire under fluoroscopy control. The straight edge of the wire was driven out in a central position in sterile nail matrix just distal to lunula. The wire was removed at the fifth week when the complete union of the fracture was observed. The patient achieved full flexion in DIP joint without an extension lag.     

散发型克雅病7例患者的临床、脑电图及影像学分析

目的 探讨散发型克雅病(sCJD)的临床、脑电图及影像学特点。方法 回顾性分析7例散发型克雅病患者的临床表现、脑电图、影像学特点。结果 本组亚急性起病5例,慢性起病2例,主要的临床症状和体征有进行性痴呆、精神行为异常、视觉障碍、头晕、共济失调、肌阵挛、言语笨拙、锥体外系症状和锥体束征等; EEG检查均有异常,其中6例脑电图检查示典型的周期性三相波发放,1例患者入院脑电图检查未见异常波发放,1月后复查脑电图发现周期性三相波; 7例均行颅脑MRI检查,T₂加权序列(T₂WI)、液体衰减反转恢复序列(T₂ FLAIR)及弥散加权成像(DWI)在皮质、尾状核、壳核等发现异常高信号,其中1例在DWI像上发现随着疾病进展尾状核、壳核、皮层信号先明显增高,后稍微下降; 6例行脑脊液14-3-3蛋白检测,其中4例为阳性,2例为阴性。结论 临床上对快速进展型痴呆的患者,应考虑克雅病的可能,尽早行脑电图、颅脑MRI以及脑脊液14-3-3蛋白检测有助于临床早期诊断; 脑电图、颅脑MRI在疾病早期可无典型改变,则应短期内复查,动态观察。     

MTHFR基因多态性与儿童支气管哮喘易感性及糖皮质激素疗效的相关性

目的探讨亚甲基四氢叶酸还原酶（methylenetetrahydrofolate reductase，MTHFR）基因多态性与儿童支气管哮喘易感性及糖皮质激素（glucocorticoid，GC）疗效的相关性。方法选取2018年6月至2020年12月住院治疗的儿童支气管哮喘患儿173例为观察组，均接受GC雾化吸入治疗，连续3个月。选取同期体检的健康儿童178例为对照组。采用PCR检测两组受试儿MTHFR基因C677T位点的基因型，分析两组基因型分布差异性；比较观察组不同基因型患儿治疗前后血清免疫球蛋白E、白细胞介素-8（interleukin-8，IL-8）、白三烯B4（leukotriene B4，LTB4）水平，肺功能指标差异及临床疗效差异。结果与对照组相比，观察组TT基因型及T等位基因频率均显著升高（P<0.001）；TT/CT基因型及T等位基因是支气管哮喘易感性的独立危险因素（OR分别为6.615、7.055，P<0.001）。GC治疗后3种基因型患儿免疫球蛋白E、IL-8和LTB4水平较治疗前显著降低，第1秒用力呼气容积（forced expiratory volume in 1 second，FEV1）、用力肺活量（forced vital capacity，FVC）、FEV1/FVC%较治疗前显著升高（P<0.001）；TT基因型患儿IL-8和LTB4水平显著低于CC基因型患儿，LTB4水平明显低于CT基因型患儿，TT基因型患儿FVC明显高于CT基因型患儿，FEV1/FVC%显著高于CC基因型患儿（P<0.05）；治疗后3种基因型患儿临床GC治疗疗效比较差异有统计学意义，其中TT基因型患儿GC疗效良好比例显著高于CC基因型患儿（P<0.05），且TT基因型是GC疗效良好的独立影响因素（OR=2.111，P=0.018）。结论MTHFR基因多态性与儿童哮喘易感性及GC疗效相关，携带TT/CT基因型儿童支气管哮喘发病风险更高，TT基因型对GC治疗具有更高的敏感性。     

Limitations and opportunities for immune checkpoint inhibitors in pediatric malignancies

Immune checkpoint inhibitors (ICI) have shown great promise in a wide spectrum of adult solid and hematological malignancies, achieving objective tumor responses and prolonging survival. However, there is limited clinical success amongst pediatric patients. In this review, we summarize the current understanding of ICI and present an up-to-date overview of recent and ongoing clinical trials of ICI in pediatric malignancies. In addition, we will discuss immunologic and clinical difficulties in this young population, as well as future prospects for combination of ICI with other immune-based and conventional treatments.     

Leukocyte function-associated antigen-1 deficiency impairs responses to polymicrobial sepsis

AIM: To determine the role of leukocyte functionassociated antigen-1(LFA-1) in polymicrobial sepsis model in mice.METHODS: Cecal ligation and puncture model was used to study polymicrobial sepsis in wild type and LFA-1 knockout(KO)(= CD11 a KO) mice. Their survivals were examined. Neutrophil recruitment to the abdominal cavity, bacterial tissue load and bacterial killing by neutrophils, tissue cytokine profiles, and serum cytokines were examined. Apoptosis of tissues was assessed using cleaved-caspase 3 and TUNNEL staining. The recruitment of neutrophils to various tissues was assessed using myeloperoxidase staining or measuring myeloperoxidase activity. RESULTS: LFA-1 deficiency significantly decreased survival(P = 0.0024) with the reduction of neutrophil recruitment to the abdominal cavity and higher bacterial load in blood. It was also associated with increased apoptosis in spleen and more organ injuries probed by interleukin-6 m RNA level. However, the deficiency of LFA-1 did not prevent neutrophil recruitment to lung, liver, spleen or kidney, which suggested the existence of LFA-1 independent recruitment mechanism in these organs. CONCLUSION: LFA-1 deficiency did not attenuate neutrophil recruitment to various organs to adequately mitigate secondary tissue injury in sepsis. It was associated with decreased neutrophil recruitment to the abdominal cavity, higher bacterial load, leading to increased mortality in an abdominal, polymicrobial sepsis.