BACKGROUND Endoprosthetic distal femoral replacement(DFR)is a well-established salvage procedure following resection of malignant tumors within the distal femur.Use of an all-polyethylene tibial(APT)component is cost-...BACKGROUND Endoprosthetic distal femoral replacement(DFR)is a well-established salvage procedure following resection of malignant tumors within the distal femur.Use of an all-polyethylene tibial(APT)component is cost-effective and avoids failure due to locking-mechanism issues and backside wear,but limits modularity and the option for late liner exchange.Due to a paucity of literature we sought to answer three questions:(1)What are the most common modes of implant failure for patients undergoing cemented DFR with APT for oncologic indications?(2)What is the survivorship,rate of all-cause reoperation,and rate of revision for aseptic loosening of these implants?And(3)Is there a difference in implant survivorship or patient demographics between cemented DFRs with APT performed as a primary reconstruction vs those performed as a revision procedure?AIM To assess outcomes of cemented DFRs with APT components used for oncologic indications.METHODS After Institutional Review Board approval,a retrospective review of consecutive patients who underwent DFR between December 2000 to September 2020 was performed using a single-institutional database.Inclusion criteria consisted of all patients who underwent DFR with a GMRS®(Global Modular Replacement System,Stryker,Kalamazoo,MI,United States)cemented distal femoral endoprosthesis and APT component for an oncologic indication.Patients undergoing DFR for non-oncologic indications and patients with metal-backed tibial components were excluded.Implant failure was recorded using Henderson's classification and survivorship was reported using a competing risks analysis.RESULTS 55 DFRs(55 patients)with an average age of 50.9±20.7 years and average body mass index of 29.7±8.3 kg/m2 were followed for 38.8±54.9 mo(range 0.2-208.4).Of these,60.0%were female and 52.7%were white.The majority of DFRs with APT in this cohort were indicated for oncologic diagnoses of osteogenic sarcoma(n=22,40.0%),giant cell tumor(n=9,16.4%),and metastatic carcinoma(n=8,14.6%).DFR with APT implantation was performed as a primary procedure in 29 patients(52.7%)and a revision procedure in 26 patients(47.3%).Overall,twenty patients(36.4%)experienced a postoperative complication requiring reoperation.The primary modes of implant failure included Henderson Type 1(soft tissue failure,n=6,10.9%),Type 2(aseptic loosening,n=5,9.1%),and Type 4(infection,n=6,10.9%).There were no significant differences in patient demographics or rates of postoperative complications between the primary procedure and revision procedure subgroups.In total,12 patients(21.8%)required a revision while 20 patients(36.4%)required a reoperation,resulting in three-year cumulative incidences of 24.0%(95%CI 9.9%-41.4%)and 47.2%(95%CI 27.5%-64.5%),respectively.CONCLUSION This study demonstrates modest short-term survivorship following cemented DFR with APT components for oncologic indications.Soft tissue failure and endoprosthetic infection were the most common postoperative complications in our cohort.展开更多
BACKGROUND The coronavirus disease 2019(COVID-19)pandemic altered education,exams,and residency applications for United States medical students.AIM To determine the specific impact of the pandemic on US medical studen...BACKGROUND The coronavirus disease 2019(COVID-19)pandemic altered education,exams,and residency applications for United States medical students.AIM To determine the specific impact of the pandemic on US medical students and its correlation to their anxiety levels.METHODS An 81-question survey was distributed via email,Facebook and social media groups using REDCapTM.To investigate risk factors associated with elevated anxiety level,we dichotomized the 1-10 anxiety score into low(≤5)and high(≥6).This cut point represents the 25th percentile.There were 90(29%)shown as low anxiety and 219(71%)as high anxiety.For descriptive analyses,we used contingency tables by anxiety categories for categorical measurements with chi square test,or mean±STD for continuous measurements followed by t-test or Wilcoxson rank sum test depending on data normality.Least Absolute Shrinkage and Selection Operator was used to select important predictors for the final multivariate model.Hierarchical Poisson regression model was used to fit the final multivariate model by considering the nested data structure of students clustered within State.RESULTS 397 medical students from 29 states were analyzed.Approximately half of respondents reported feeling depressed since the pandemic onset.62%of participants rated 7 or higher out of 10 when asked about anxiety levels.Stressors correlated with higher anxiety scores included“concern about being unable to complete exams or rotations if contracting COVID-19”(RR 1.34;95%CI:1.05-1.72,P=0.02)and the use of mental health services such as a“psychiatrist”(RR 1.18;95%CI:1.01-1.3,P=0.04).However,those students living in cities that limited restaurant operations to exclusively takeout or delivery as the only measure of implementing social distancing(RR 0.64;95%CI:0.49-0.82,P<0.01)and those who selected“does not apply”for financial assistance available if needed(RR 0.83;95%CI:0.66-0.98,P=0.03)were less likely to have a high anxiety.CONCLUSION COVID-19 significantly impacted medical students in numerous ways.Medical student education and clinical readiness were reduced,and anxiety levels increased.It is vital that medical students receive support as they become physicians.Further research should be conducted on training medical students in telemedicine to better prepare students in the future for pandemic planning and virtual healthcare.展开更多
In this editorial we comment on the review by Zhou et al reviewing the landscape of nanomedicine in the treatment of hepatocellular carcinoma(HCC).We focus on the immense potential of nanotechnology,particularly ligan...In this editorial we comment on the review by Zhou et al reviewing the landscape of nanomedicine in the treatment of hepatocellular carcinoma(HCC).We focus on the immense potential of nanotechnology,particularly ligand-receptor mediated nanotherapy,in revolutionizing the treatment landscape of HCC.Despite advan-cements in multidisciplinary treatment,HCC remains a significant global health challenge.Ligand-mediated nanotherapy offers the opportunity for precise drug delivery to tumor sites,targeting specific receptors overexpressed in HCC cells,thereby enhancing efficacy and minimizing side effects.Overcoming drug resistance and aggressive tumor biology is facilitated by nanomedicine,bypassing traditional hurdles encountered in chemotherapy.Examples include targeting glypican-3,asialoglycoprotein,transferrin receptor or folic acid receptors,capitalizing on their over-expression in tumor cells.The ability for multi-receptor targeting through dual-ligand nanoparticle modification holds the prospect of further enhancement in specificity and efficacy of directed therapy.However,challenges including immune responses,reproducibility in nanoparticle synthesis,and production scalability remain.Future directions involve refining targeting strategies,improving drug release mechanisms,and streamlining production processes to enable personalized and multifunctional nanotherapies.Overall,the integration of nanotherapy in HCC treatment holds immense promise,but continued partnership and effort are needed in offering hope for more effective,precise,and accessible clinical care in the management of HCC.展开更多
Sarcopenia and metabolic dysfunction associated steatotic liver disease(MASLD)are closely intertwined.Sarcopenia,traditionally a disease of the older adult and chronic disease population,has been closely studied as on...Sarcopenia and metabolic dysfunction associated steatotic liver disease(MASLD)are closely intertwined.Sarcopenia,traditionally a disease of the older adult and chronic disease population,has been closely studied as one of the pathophysiologic conditions at play in the development of MASLD.They share similar risk factors of insulin resistance and physical inactivity.Given similar pathophysiology along the liver-muscle axis,sarcopenia has been studied as a risk factor for MASLD,and vice versa.Current research suggests a bidirectional relationship.Given the chronicity of MASLD as a chronic inflammatory liver disease,it can break down muscle mass and lead to sarcopenia,while sarcopenia promotes intramuscular lipid accumulation that releases cytokines that can aggravate inflammation in the liver.However,for the longest time,a lack of consensus definition for MASLD and sarcopenia made it difficult to study their relationship and outcomes.A recent nomenclature update to diagnosing MASLD has made it easier for researchers to identify cohorts for study.However,no gold standard technique to measure muscle mass or consensus sarcopenia definition has been identified yet.Future studies are needed to reach a consensus and reduce diagnostic variation.With similar pathophysiology and shared risk factors between the two diseases,future research may also identify potential therapeutic targets along the liver-muscle axis that would benefit both sarcopenia and MASLD in order to maximize their outcomes.展开更多
The issue of childhood obesity is expanding at an accelerated rate compared to previous generations. Both medical and societal conesquences have arisen from this predicament in children and adults. The significance of...The issue of childhood obesity is expanding at an accelerated rate compared to previous generations. Both medical and societal conesquences have arisen from this predicament in children and adults. The significance of parental influence as a factor is of key interest in developing possible prevention programs. Three major categories of focus are parental control, attitudes, and behavior in association with childhood overweight and obesity. This comprehendsive systematic and evidence-based review summarizes currently published results, as well as addresses gaps and flaws which should be included in future research on pediatric obesity and parental influence.展开更多
Purpose: The aim of the study was to evaluate the effectiveness of a new techn ique to repair penile torsion in children. Methods: Eighteen boys with penile to rsion were evaluated in our department from 1989 to 2003....Purpose: The aim of the study was to evaluate the effectiveness of a new techn ique to repair penile torsion in children. Methods: Eighteen boys with penile to rsion were evaluated in our department from 1989 to 2003. Eleven had associated hypospadias, 4 had chordee without hypospadias, and 3 had torsion only. The dire ction of rotation was counterclockwise in 16 cases and clockwise in 2 cases. Tor sion was repaired in 6 patients by degloving the penis and reattaching the darto s and the skin (comparative group). In 11 patients (1 with prior repair), the to rsion was corrected by suturing the lateral edge of the corpus cavernosum to the pubic periosteum (study group). Two patients were not treated. Result: Follow- up ranges from 6 months to 7 years. All of the 11 cases in the study group had s atisfactory correction of the penile torsion. All of the urethroplasties for hyp ospadias were successful. In the comparative group, non e of 6 patients had satisfactory correction of the rotation. Conclusion: The technique of degloving the penis and reattaching the skin cannot reliably correct p enile torsion in our experience. Lateral suturing of tunica albuginea to the pub ic periosteum to repair penile torsion appears to be a better technique.展开更多
Background:Sphingosine-1-phosphate(S1P),a key regulator of vascular homeostasis and angiogenesis,is enriched in exosomes derived from platelet-rich plasma(PRP-Exos).However,the potential role of PRP-Exos-S1P in diabet...Background:Sphingosine-1-phosphate(S1P),a key regulator of vascular homeostasis and angiogenesis,is enriched in exosomes derived from platelet-rich plasma(PRP-Exos).However,the potential role of PRP-Exos-S1P in diabetic wound healing remains unclear.In this study,we investigated the underlying mechanism of PRP-Exos-S1P in diabetic angiogenesis and wound repair.Methods:Exosomes were isolated from PRP by ultracentrifugation and analysed by transmission electron microscopy,nanoparticle tracking analysis and western blotting.The concentration of S1P derived from PRP-Exos was measured by enzyme-linked immunosorbent assay.The expression level of S1P receptor1–3(S1PR1–3)in diabetic skin was analysed by Q-PCR.Bioinformatics analysis and proteomic sequencing were conducted to explore the possible signalling pathway mediated by PRP-Exos-S1P.A diabetic mouse model was used to evaluate the effect of PRP-Exos on wound healing.Immunofluorescence for cluster of differentiation 31(CD31)was used to assess angiogenesis in a diabetic wound model.Results:In vitro,PRP-Exos significantly promoted cell proliferation,migration and tube formation.Furthermore,PRP-Exos accelerated the process of diabetic angiogenesis and wound closure in vivo.S1P derived from PRP-Exos was present at a high level,and S1PR1 expression was significantly elevated compared with S1PR2 and S1PR3 in the skin of diabetic patients and animals.However,cell migration and tube formation were not promoted by PRP-Exos-S1P in human umbilical vein endothelial cells treated with shS1PR1.In the diabetic mouse model,inhibition of S1PR1 expression at wounding sites decreased the formation of new blood vessels and delayed the process of wound closure.Bioinformatics analysis and proteomics indicated that fibronectin 1(FN1)was closely related to S1PR1 due to its colocalization in the endothelial cells of human skin.Further study supported that FN1 plays an important role in the PRP-Exos-S1Pmediated S1PR1/protein kinase B signalling pathway.Conclusions:PRP-Exos-S1P promotes angiogenesis in diabetic wound healing via the S1PR1/protein kinase B/FN1 signalling pathway.Our findings provide a preliminary theoretical foundation for the treatment of diabetic foot ulcers using PRP-Exos in the future.展开更多
Background:Wernicke encephalopathy is caused by thiamine(vitamin B1)defi ciency.It is generally considered to be a disease of adult alcoholics.However,it is known to occur in the pediatric population and in non-alcoho...Background:Wernicke encephalopathy is caused by thiamine(vitamin B1)defi ciency.It is generally considered to be a disease of adult alcoholics.However,it is known to occur in the pediatric population and in non-alcoholic conditions.Data sources:We searched PubMed with the key words Wernicke,thiamine,pediatric,children and adolescents and selected publications that were deemed appropriate.Results:The global prevalence rates of hunger,poverty and resultant nutrient deprivation have decreased in the 21st century.However,several scenarios which may predispose to Wernicke encephalopathy may be increasingly prevalent in children and adolescents such as malignancies,intensive care unit stays and surgical procedures for the treatment of obesity.Other predisposing conditions include magnesium defi ciency and defects in the SLC19A3 gene causing thiamine transporter-2 deficiency.The classic triad consists of encephalopathy,oculomotor dysfunction and gait ataxia but is not seen in a majority of patients.Treatment should be instituted immediately when the diagnosis is suspected clinically without waiting for laboratory confi rmation.Common magnetic resonance findings include symmetric T2 hyperintensities in dorsal medial thalamus,mammillary bodies,periaqueductal gray matter,and tectal plate.Conclusions:Wernicke encephalopathy is a medical emergency.Delay in its recognition and treatment may lead to significant morbidity,irreversible neurological damage or even death.This article aims to raise the awareness of this condition among pediatricians.展开更多
文摘BACKGROUND Endoprosthetic distal femoral replacement(DFR)is a well-established salvage procedure following resection of malignant tumors within the distal femur.Use of an all-polyethylene tibial(APT)component is cost-effective and avoids failure due to locking-mechanism issues and backside wear,but limits modularity and the option for late liner exchange.Due to a paucity of literature we sought to answer three questions:(1)What are the most common modes of implant failure for patients undergoing cemented DFR with APT for oncologic indications?(2)What is the survivorship,rate of all-cause reoperation,and rate of revision for aseptic loosening of these implants?And(3)Is there a difference in implant survivorship or patient demographics between cemented DFRs with APT performed as a primary reconstruction vs those performed as a revision procedure?AIM To assess outcomes of cemented DFRs with APT components used for oncologic indications.METHODS After Institutional Review Board approval,a retrospective review of consecutive patients who underwent DFR between December 2000 to September 2020 was performed using a single-institutional database.Inclusion criteria consisted of all patients who underwent DFR with a GMRS®(Global Modular Replacement System,Stryker,Kalamazoo,MI,United States)cemented distal femoral endoprosthesis and APT component for an oncologic indication.Patients undergoing DFR for non-oncologic indications and patients with metal-backed tibial components were excluded.Implant failure was recorded using Henderson's classification and survivorship was reported using a competing risks analysis.RESULTS 55 DFRs(55 patients)with an average age of 50.9±20.7 years and average body mass index of 29.7±8.3 kg/m2 were followed for 38.8±54.9 mo(range 0.2-208.4).Of these,60.0%were female and 52.7%were white.The majority of DFRs with APT in this cohort were indicated for oncologic diagnoses of osteogenic sarcoma(n=22,40.0%),giant cell tumor(n=9,16.4%),and metastatic carcinoma(n=8,14.6%).DFR with APT implantation was performed as a primary procedure in 29 patients(52.7%)and a revision procedure in 26 patients(47.3%).Overall,twenty patients(36.4%)experienced a postoperative complication requiring reoperation.The primary modes of implant failure included Henderson Type 1(soft tissue failure,n=6,10.9%),Type 2(aseptic loosening,n=5,9.1%),and Type 4(infection,n=6,10.9%).There were no significant differences in patient demographics or rates of postoperative complications between the primary procedure and revision procedure subgroups.In total,12 patients(21.8%)required a revision while 20 patients(36.4%)required a reoperation,resulting in three-year cumulative incidences of 24.0%(95%CI 9.9%-41.4%)and 47.2%(95%CI 27.5%-64.5%),respectively.CONCLUSION This study demonstrates modest short-term survivorship following cemented DFR with APT components for oncologic indications.Soft tissue failure and endoprosthetic infection were the most common postoperative complications in our cohort.
文摘BACKGROUND The coronavirus disease 2019(COVID-19)pandemic altered education,exams,and residency applications for United States medical students.AIM To determine the specific impact of the pandemic on US medical students and its correlation to their anxiety levels.METHODS An 81-question survey was distributed via email,Facebook and social media groups using REDCapTM.To investigate risk factors associated with elevated anxiety level,we dichotomized the 1-10 anxiety score into low(≤5)and high(≥6).This cut point represents the 25th percentile.There were 90(29%)shown as low anxiety and 219(71%)as high anxiety.For descriptive analyses,we used contingency tables by anxiety categories for categorical measurements with chi square test,or mean±STD for continuous measurements followed by t-test or Wilcoxson rank sum test depending on data normality.Least Absolute Shrinkage and Selection Operator was used to select important predictors for the final multivariate model.Hierarchical Poisson regression model was used to fit the final multivariate model by considering the nested data structure of students clustered within State.RESULTS 397 medical students from 29 states were analyzed.Approximately half of respondents reported feeling depressed since the pandemic onset.62%of participants rated 7 or higher out of 10 when asked about anxiety levels.Stressors correlated with higher anxiety scores included“concern about being unable to complete exams or rotations if contracting COVID-19”(RR 1.34;95%CI:1.05-1.72,P=0.02)and the use of mental health services such as a“psychiatrist”(RR 1.18;95%CI:1.01-1.3,P=0.04).However,those students living in cities that limited restaurant operations to exclusively takeout or delivery as the only measure of implementing social distancing(RR 0.64;95%CI:0.49-0.82,P<0.01)and those who selected“does not apply”for financial assistance available if needed(RR 0.83;95%CI:0.66-0.98,P=0.03)were less likely to have a high anxiety.CONCLUSION COVID-19 significantly impacted medical students in numerous ways.Medical student education and clinical readiness were reduced,and anxiety levels increased.It is vital that medical students receive support as they become physicians.Further research should be conducted on training medical students in telemedicine to better prepare students in the future for pandemic planning and virtual healthcare.
文摘In this editorial we comment on the review by Zhou et al reviewing the landscape of nanomedicine in the treatment of hepatocellular carcinoma(HCC).We focus on the immense potential of nanotechnology,particularly ligand-receptor mediated nanotherapy,in revolutionizing the treatment landscape of HCC.Despite advan-cements in multidisciplinary treatment,HCC remains a significant global health challenge.Ligand-mediated nanotherapy offers the opportunity for precise drug delivery to tumor sites,targeting specific receptors overexpressed in HCC cells,thereby enhancing efficacy and minimizing side effects.Overcoming drug resistance and aggressive tumor biology is facilitated by nanomedicine,bypassing traditional hurdles encountered in chemotherapy.Examples include targeting glypican-3,asialoglycoprotein,transferrin receptor or folic acid receptors,capitalizing on their over-expression in tumor cells.The ability for multi-receptor targeting through dual-ligand nanoparticle modification holds the prospect of further enhancement in specificity and efficacy of directed therapy.However,challenges including immune responses,reproducibility in nanoparticle synthesis,and production scalability remain.Future directions involve refining targeting strategies,improving drug release mechanisms,and streamlining production processes to enable personalized and multifunctional nanotherapies.Overall,the integration of nanotherapy in HCC treatment holds immense promise,but continued partnership and effort are needed in offering hope for more effective,precise,and accessible clinical care in the management of HCC.
文摘Sarcopenia and metabolic dysfunction associated steatotic liver disease(MASLD)are closely intertwined.Sarcopenia,traditionally a disease of the older adult and chronic disease population,has been closely studied as one of the pathophysiologic conditions at play in the development of MASLD.They share similar risk factors of insulin resistance and physical inactivity.Given similar pathophysiology along the liver-muscle axis,sarcopenia has been studied as a risk factor for MASLD,and vice versa.Current research suggests a bidirectional relationship.Given the chronicity of MASLD as a chronic inflammatory liver disease,it can break down muscle mass and lead to sarcopenia,while sarcopenia promotes intramuscular lipid accumulation that releases cytokines that can aggravate inflammation in the liver.However,for the longest time,a lack of consensus definition for MASLD and sarcopenia made it difficult to study their relationship and outcomes.A recent nomenclature update to diagnosing MASLD has made it easier for researchers to identify cohorts for study.However,no gold standard technique to measure muscle mass or consensus sarcopenia definition has been identified yet.Future studies are needed to reach a consensus and reduce diagnostic variation.With similar pathophysiology and shared risk factors between the two diseases,future research may also identify potential therapeutic targets along the liver-muscle axis that would benefit both sarcopenia and MASLD in order to maximize their outcomes.
文摘The issue of childhood obesity is expanding at an accelerated rate compared to previous generations. Both medical and societal conesquences have arisen from this predicament in children and adults. The significance of parental influence as a factor is of key interest in developing possible prevention programs. Three major categories of focus are parental control, attitudes, and behavior in association with childhood overweight and obesity. This comprehendsive systematic and evidence-based review summarizes currently published results, as well as addresses gaps and flaws which should be included in future research on pediatric obesity and parental influence.
文摘Purpose: The aim of the study was to evaluate the effectiveness of a new techn ique to repair penile torsion in children. Methods: Eighteen boys with penile to rsion were evaluated in our department from 1989 to 2003. Eleven had associated hypospadias, 4 had chordee without hypospadias, and 3 had torsion only. The dire ction of rotation was counterclockwise in 16 cases and clockwise in 2 cases. Tor sion was repaired in 6 patients by degloving the penis and reattaching the darto s and the skin (comparative group). In 11 patients (1 with prior repair), the to rsion was corrected by suturing the lateral edge of the corpus cavernosum to the pubic periosteum (study group). Two patients were not treated. Result: Follow- up ranges from 6 months to 7 years. All of the 11 cases in the study group had s atisfactory correction of the penile torsion. All of the urethroplasties for hyp ospadias were successful. In the comparative group, non e of 6 patients had satisfactory correction of the rotation. Conclusion: The technique of degloving the penis and reattaching the skin cannot reliably correct p enile torsion in our experience. Lateral suturing of tunica albuginea to the pub ic periosteum to repair penile torsion appears to be a better technique.
基金supported by the Chongqing Youth High-end Talent Studio(Grant No.ZQNYXGDRCGZS2021008)the fund of Sichuan Provincial Western Psychiatric Association’s CSPC LEADING Scientific Research Project(Grant No.WL2021002)+2 种基金the Natural Science Foundation of Chongqing Municipal Science and Technology Bureau(CSTB2022NSCQ-MSX0489)partially supported by National Institutes of Health,National Institute of Diabetes and Digestive and Kidney Diseases Award Number 1R01124789-01A1National Science Foundation(NSF)Center to Stream Healthcare in Place(#C2SHiP)CNS Award Number 2052578 awarded to DGA.
文摘Background:Sphingosine-1-phosphate(S1P),a key regulator of vascular homeostasis and angiogenesis,is enriched in exosomes derived from platelet-rich plasma(PRP-Exos).However,the potential role of PRP-Exos-S1P in diabetic wound healing remains unclear.In this study,we investigated the underlying mechanism of PRP-Exos-S1P in diabetic angiogenesis and wound repair.Methods:Exosomes were isolated from PRP by ultracentrifugation and analysed by transmission electron microscopy,nanoparticle tracking analysis and western blotting.The concentration of S1P derived from PRP-Exos was measured by enzyme-linked immunosorbent assay.The expression level of S1P receptor1–3(S1PR1–3)in diabetic skin was analysed by Q-PCR.Bioinformatics analysis and proteomic sequencing were conducted to explore the possible signalling pathway mediated by PRP-Exos-S1P.A diabetic mouse model was used to evaluate the effect of PRP-Exos on wound healing.Immunofluorescence for cluster of differentiation 31(CD31)was used to assess angiogenesis in a diabetic wound model.Results:In vitro,PRP-Exos significantly promoted cell proliferation,migration and tube formation.Furthermore,PRP-Exos accelerated the process of diabetic angiogenesis and wound closure in vivo.S1P derived from PRP-Exos was present at a high level,and S1PR1 expression was significantly elevated compared with S1PR2 and S1PR3 in the skin of diabetic patients and animals.However,cell migration and tube formation were not promoted by PRP-Exos-S1P in human umbilical vein endothelial cells treated with shS1PR1.In the diabetic mouse model,inhibition of S1PR1 expression at wounding sites decreased the formation of new blood vessels and delayed the process of wound closure.Bioinformatics analysis and proteomics indicated that fibronectin 1(FN1)was closely related to S1PR1 due to its colocalization in the endothelial cells of human skin.Further study supported that FN1 plays an important role in the PRP-Exos-S1Pmediated S1PR1/protein kinase B signalling pathway.Conclusions:PRP-Exos-S1P promotes angiogenesis in diabetic wound healing via the S1PR1/protein kinase B/FN1 signalling pathway.Our findings provide a preliminary theoretical foundation for the treatment of diabetic foot ulcers using PRP-Exos in the future.
基金Funding:The authors report receipt of no financial support for the research and/or authorship of this article
文摘Background:Wernicke encephalopathy is caused by thiamine(vitamin B1)defi ciency.It is generally considered to be a disease of adult alcoholics.However,it is known to occur in the pediatric population and in non-alcoholic conditions.Data sources:We searched PubMed with the key words Wernicke,thiamine,pediatric,children and adolescents and selected publications that were deemed appropriate.Results:The global prevalence rates of hunger,poverty and resultant nutrient deprivation have decreased in the 21st century.However,several scenarios which may predispose to Wernicke encephalopathy may be increasingly prevalent in children and adolescents such as malignancies,intensive care unit stays and surgical procedures for the treatment of obesity.Other predisposing conditions include magnesium defi ciency and defects in the SLC19A3 gene causing thiamine transporter-2 deficiency.The classic triad consists of encephalopathy,oculomotor dysfunction and gait ataxia but is not seen in a majority of patients.Treatment should be instituted immediately when the diagnosis is suspected clinically without waiting for laboratory confi rmation.Common magnetic resonance findings include symmetric T2 hyperintensities in dorsal medial thalamus,mammillary bodies,periaqueductal gray matter,and tectal plate.Conclusions:Wernicke encephalopathy is a medical emergency.Delay in its recognition and treatment may lead to significant morbidity,irreversible neurological damage or even death.This article aims to raise the awareness of this condition among pediatricians.
