鼓膜大穿孔耳内镜下鼓膜成形术的临床报告

目的探讨对鼓膜大穿孔病例应用耳内镜下单纯鼓膜成形术的疗效。方法选取2015年9月-2018年1月收治的鼓膜大穿孔患者43例(46耳),耳内镜下采取耳屏软骨-软骨膜进行鼓膜成形术,对鼓膜愈合及听力情况进行评价。结果 43耳鼓膜愈合,3耳未愈合,愈合率93.5%,听力改善患者满意,1例出现迟发性面瘫,药物治疗后恢复,其余均无并发症出现。结论耳内镜下应用耳屏软骨-软骨膜修补鼓膜大穿孔操作相对简单,能抵近观察,手术成功率高,比显微镜下手术更具优势,利于年轻医师上手,值得临床推广。     

Diagnosis and treatment of vertebral hemangiomas with neurologic deficit: a report of 29 cases and literature review

Background contextVertebral hemangiomas (VHs) are called benign tumors but are actually just vascular malformations. The diagnosis and treatment for aggressive VHs is still controversial, due to their rarity.PurposeTo evaluate the safety and efficiency of the present diagnostic methods and treatment choices.Study designA retrospective study of aggressive VHs with neurologic deficit.Patients sampleA total of 29 consecutive aggressive VH cases were diagnosed and treated in our department since 2001.Outcome measuresWe routinely took anteroposterior and lateral spinal roentgenograms, computed tomography, and magnetic resonance images.MethodsTrocar biopsy is indicated in suspected malignant cases. Radiotherapy was usually our first choice if the neurologic deficit was mild or developed slowly. Surgery was indicated if the neurologic deficit was severe or developed quickly or if the radiotherapy was not effective.ResultsThis series included 12 males and 17 females, and the mean age at diagnosis was 44.0 years (range, 21–72 years). Ten patients had radiculopathy, 1 had cauda equina syndrome, and 18 cases had myelopathy. Twenty-one cases had lesions in the thoracic spine, 5 in the lumbar, and 3 in the cervical region. Eleven cases had untypical image findings, including five cases with pathologic vertebral fracture. The neurologic compression came from only epidural soft tumor mass in 18 cases, whereas it came from both bony compression and soft lesion in the other 11 cases. Ten cases had radiotherapy alone, but two failed and had surgery later. Twenty-one cases had surgery. In the 12 cases having surgical decompression without vertebroplasty, the average estimated blood loss was 1900 mL, and it was 1093 mL for the eight cases having decompression with vertebroplasty. The average follow-up was 51.1 months (range, 24–133 months). There was no recurrence in those cases with radiotherapy, whereas three had local recurrence in those six cases treated by surgical decompression alone without radiotherapy.ConclusionsIn aggressive VHs, epidural soft-tissue compression was usually the main reason for neurologic deficit. In cases with rapid progressive and/or severe myelopathy, posterior decompression and stabilization could be combined with intraoperative vertebroplasty to reduce blood loss.     

核转录因子-κB-基质金属蛋白酶-9信号通路在糖尿病大鼠认知功能障碍中的作用

目的探讨核转录因子-κB(NF-κB)-基质金属蛋白酶-9(MMP-9)通路在糖尿病(DM)大鼠认知功能障碍中的作用。方法采用55 mg/kg链脲激酶(STZ)单次腹腔注射诱导DM大鼠模型,随机分为3组(每组10只):对照组、DM组和DM吡咯烷二硫氨基甲酸酯(PDTC)治疗组(DM+PDTC组)。DM+PDTC组予以PDTC[150 mg/(kg·d)]持续灌胃6周。6周后采用Morris水迷宫检测学习记忆功能,选取上述同样处理的3组(每组6只)用于检测海马MMP-9及NF-κB的蛋白表达。结果 DM组的潜伏期在训练的第3、4、5天较对照组明显延长(P<0.05),而PDTC治疗可明显改善DM引起的潜伏期延长(P<0.05)。在空间探索试验中,目标象限的停留时间百分比比较,DM组较对照组明显下降(P<0.05),而DM+PDTC组较DM组明显增加(P<0.05)。DM组海马MMP-9和NF-κB的表达较对照组显著升高(P<0.05),而DM+PDTC组NF-κB的表达与对照组比较无显著性差异(P>0.05)。DM+PDTC组的MMP-9的表达较DM组显著降低(P<0.05),但较对照组仍显著升高(P<0.05)。结论DM可能通过激活NF-κB信号通路,从而部分上调MMP-9的表达,从而导致认知功能障碍的发生。     

Melatonin impedes Tet1‐dependent mGluR5 promoter demethylation to relieve pain

Melatonin (N‐acetyl‐5‐methoxytryptamine)/MT2 receptor‐dependent epigenetic modification represents a novel pathway in the treatment of neuropathic pain. Because spinal ten‐eleven translocation methylcytosine dioxygenase 1 (Tet1)‐dependent epigenetic demethylation has recently been linked to pain hypersensitivity, we hypothesized that melatonin/MT2‐dependent analgesia involves spinal Tet1‐dependent demethylation. Here, we showed that spinal Tet1 gene transfer by intrathecal delivery of Tet1‐encoding vectors to naïve rats produced profound and long‐lasting nociceptive hypersensitivity. In addition, enhanced Tet1 expression, Tet1‐metabotropic glutamate receptor subtype 5 (mGluR5) promoter coupling, demethylation at the mGluR5 promoter, and mGluR5 expression in dorsal horn neurons were observed. Rats subjected to spinal nerve ligation and intraplantar complete Freund's adjuvant injection displayed tactile allodynia and behavioral hyperalgesia associated with similar changes in the dorsal horn. Notably, intrathecal melatonin injection reversed the protein expression, protein‐promoter coupling, promoter demethylation, and pain hypersensitivity induced by Tet1 gene transfer, spinal nerve ligation, and intraplantar complete Freund's adjuvant injection. All the effects caused by melatonin were blocked by pretreatment with a MT2 receptor‐selective antagonist. In conclusion, melatonin relieves pain by impeding Tet1‐dependent demethylation of mGluR5 in dorsal horn neurons through the MT2 receptor. Our findings link melatonin/MT2 signaling to Tet1‐dependent epigenetic demethylation of nociceptive genes for the first time and suggest melatonin as a promising therapy for the treatment of pain.     

M2 polarization of monocytes in ankylosing spondylitis and relationship with inflammation and structural damage

The aim of this study was to evaluate the polarization of peripheral blood monocytes in the patients with ankylosing spondylitis (AS) and to determine the correlations between monocyte polarization and inflammation and structural damage. A total of 120 AS patients, 50 rheumatoid arthritis (RA) patients and 100 healthy controls were enrolled in the study. M1 (CD68+CD192+) and M2 (CX3CR1+CD163+) monocytes were characterized by flow cytometry. Demographic, clinical, radiographic and laboratory data were collected and analyzed. A large increase in M2 (CX3CR1+CD163+) monocytes was observed in AS, and M2/M1 ratio was 7.18 ± 6.12, 2.54 ± 3.14 and 35.61 ± 20.04 in control, RA and AS, respectively. The M2/M1 ratio correlated with modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) (r = 0.565; p < 0.001), ESR (r = ?0.321; p < 0.001, CRP (r = ?0.265; p < 0.001) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) (r = ?0.201; p = 0.028). Anti‐TNF‐α therapy induced a significant reduction in the percentage of M1 monocyte, ESR, CRP and BASDAI in AS patients. The present results demonstrated that M2 type polarized monocytes are predominant in the peripheral blood in AS and the M2/M1 ratio is correlated with structural damage (mSASSS), inflammatory biomarkers (ESR and CRP) and BASDAI.     

Trend of non-communicable disease mortality for three common conditions in the elderly population from 2002 to 2010: A population-based study in China

ObjectiveThere is a lack of data focusing on non-communicable disease (NCD) mortality in the Chinese elderly population over the past decade.MethodsUsing mortality data from the Chinese Health Statistics, we explored the crude and age-standardized mortality trend of three major NCDs in the Chinese population ≥65 years of age from 2002 to 2010, namely, malignant neoplasms, heart diseases, and cerebrovascular diseases. Subpopulations characterized as rural and urban residence, and by gender and age were examined separately.ResultsMortality increased with age and was higher among males than among females across the three NCDs, with the gender difference being most remarkable for malignant neoplasms and least for heart diseases mortality. Condition-specific crude mortalities increased between 2002 and 2010, overall and in all the pre-specified subpopulations. After age-standardization, rising trends were observed for people ≥65 years old, and condition-specific mortalities generally increased in rural regions and decreased in urban regions, especially for cerebrovascular diseases.ConclusionsThere were increasing trends for mortality due to malignant neoplasms, heart diseases, and cerebrovascular diseases in China between 2002 and 2010, which were largely driven by the population aging. Disparities existed by rural and urban residence, gender, and age.     

学生标准化病人在内科护理学客观结构化临床考试中的应用

目的了解内科护理学客观结构化临床考试（OSCE）中学生标准化病人（SSP）的模拟水平，分析SSP在模拟病人方面存在的问题，从而为进一步改进SSP提供依据。方法自行设计问卷，以我院参加内科护理学出科考试的74名学生作为调查对象，评价SSP的模拟水平。结果学生对SSP模拟病人逼真程度评价总分为（15．69±1．951）分，其中SPP能自然地回答学生提出的问题评价评价得分为（3．24±0．463）分。所有学生均认为运用SSP考核学生的临床能力是有效的，97％学生认为与传统考试模式相比标准化病人考核模式更能真实地反映学生的临床实际水平。结论培训护理专业学生为sP用于内科护理学OSCE考试可行性好，但需要进一步采取措施提高SSP模拟体征的逼真程度及各站SSP表演的协调一致性程度。     

Increase of toll-like receptor 4 but decrease of interleukin-8 mRNA expression among ischemic stroke patients under aspirin treatment

ObjectivesToll-like receptors (TLRs) are molecules conserved in evolution for detecting pathogen invasions and tissue damage and are involved in atherogenesis. This study explores the mRNA expression of TLRs and their probable role in further disease occurrence among ischemic stroke patients.Design and MethodsA total of 89 ischemic stroke patients and 166 controls were recruited for this study. Total RNA was extracted and mRNA was reverse-transcribed to cDNA and was analyzed for TLRs and interleukin 8 (IL8).ResultsThe TLR4 mRNA expression level is significantly higher in the stroke group. Conversely, IL-8 mRNA levels decreased significantly in the patient group.ConclusionOur results suggest that TLR4 overexpression in mRNA levels is observed in stroke patients, which might account for the probable inflammatory injury before or after stroke. A reduction of IL-8 expression could result from the downregulatory effects of aspirin.     

Analysis of IgG subclass antibodies and expression of T-Cell receptor signaling molecules in anti-CD4 monoclonal antibody treated mice with autoimmune cardiomyopathy

T-cell immune abnormality in patients of dilated cardiomyopathy has been intensively studied over the past 10 years. In this study, we aim to focus on the molecular mechanism of T-cells in autoimmune cardiomyopathy mouse model by detecting the expression of three T-cell signaling molecules. Balb/C mice (n = 12) were immunized with the peptides derived from human ADP/ATP carrier on the 1st, 14th, 28th, 49th and 79th days, and half of them were also injected with anti-L3T4 McAb on the ? 1st, 0 and 1st days. The sham-immunized mice were taken as the controls (n = 6). The main result shows that the antibody response of IgG subclasses such as IgG1, IgG2b and IgG3 were definitely blocked except IgG2a in CD4⁺ cell-depleted Balb/C mice. In addition, the average mRNA expression of p56lck, p59fyn and zap-70 were all found to be dramatically higher in the mice immunized with only ADP/ATP carrier peptides than in the control-group. At meantime, reduced levels of the protein kinases p56lck, p59fyn and zap-70 were clearly observed in anti-CD4 McAb immunized group compared with DCM group. We propose that the proliferation of T-cells was significantly inhibited in anti-CD4 treated mice and CD4⁺ T-cells may play a critical role in ADP/ATP carrier caused mouse DCM.