Comparative utility of vestibular function tests in patients with peripheral and central vestibular dysfunction

Background: Bithermal caloric irrigation, video head impulse test(vHIT), and rotational testing are commonly used to assess peripheral vestibular function, but the relative clinical utility of each test in differentiating patients with peripheral vestibulopathy is debated.Objectives: To determine whether(1) the combination of two or more vestibular tests enhances diagnostic utility over a single test;(2) abnormal test results on vestibular tests correlate with one another.Methods: Retrospective analysis of data collected from multidisciplinary vestibular clinics at two academic medical centers from 2016 to 2022.Results: 150 patients(54.10 ± 15.09 years, 88 females) were included. No individual test was significantly better at predicting the presence of peripheral vestibular damage(p > 0.05). vHIT test results improved significantly when combined with either the caloric test(p = 0.007) or rotary chair test(p = 0.039). Caloric and rotational testing had high sensitivity(74.65% and 76.06%, respectively) and specificity(83.54% and 78.48%, respectively). vHIT demonstrated excellent specificity(89.87%) but poor sensitivity(47.89%). Caloric, vHIT, and rotary chair tests results did not correlate with one another(p > 0.05).Conclusions: Vestibular function tests have comparable diagnostic utility, yet each offers unique advantages. Caloric and rotational testing may be best suited for screening peripheral damage and vHIT may function ideally as a confirmatory test.

The clinical value, principle, and basic practical technique of mindfulness intervention

正念干预是基于佛教修行的冥想,结合当代心理学理论和方法所发展的一种心理疗法。近年来的实证研究表明正念干预在降低抑郁复发,缓解抑郁、焦虑症状,减少物质滥用,减轻疼痛,血压管理,提高免疫力,改善睡眠等方面的应用均产生了良好的效果。当前,正念疗法在欧美心理治疗界中已成为心理治疗的主流。近几年我国心理学界和心理治疗领域也开始对正念治疗进行介绍,但在临床精神健康领域却缺乏相关的实践和研究。本文将对正念的概念,干预的基本机制,临床实践中的基本技能和指导原则简要介绍。

Correlation of endoscopic disease severity with pediatric ulcerative colitis activity index score in children and young adults with ulcerative colitis

To investigate of pediatric ulcerative colitis activity index (PUCAI) in ulcerative colitis correlate with mucosal inflammation and endoscopic assessment of disease activity (Mayo endoscopic score).METHODSWe reviewed charts from ulcerative colitis patients who had undergone both colonoscopy over 3 years. Clinical assessment of disease severity within 35 d (either before or after) the colonoscopy were included. Patients were excluded if they had significant therapeutic interventions (such as the start of corticosteroids or immunosuppressive agents) between the colonoscopy and the clinical assessment. Mayo endoscopic score of the rectum and sigmoid were done by two gastroenterologists. Inter-observer variability in Mayo score was assessed.RESULTSWe identified 99 patients (53% female, 74% pancolitis) that met inclusion criteria. The indications for colonoscopy included ongoing disease activity (62%), consideration of medication change (10%), assessment of medication efficacy (14%), and cancer screening (14%). Based on PUCAI scores, 33% of patients were in remission, 39% had mild disease, 23% had moderate disease, and 4% had severe disease. There was “moderate-substantial” agreement between the two reviewers in assessing rectal Mayo scores (kappa = 0.54, 95%CI: 0.41-0.68).CONCLUSIONEndoscopic disease severity (Mayo score) assessed by reviewing photographs of pediatric colonoscopy has moderate inter-rater reliability, and agreement was less robust in assessing patients with mild disease activity. Endoscopic disease severity generally correlates with clinical disease severity as measured by PUCAI score. However, children with inflamed colons can have significant variation in their reported clinical symptoms. Thus, assessment of both clinical symptoms and endoscopic disease severity may be required in future clinical studies.

Small bowel perforation after duodenal stent migration:An interesting case of a rare complication

Duodenal stents are frequently used for palliating malignant gastric outlet obstruction.Successful stent placement relieves obstructive symptoms,is cost effective,and has a relatively low complication rate.However,enteral stents have the potential of migrating distally and rarely,even lead to bowel perforation.We present a rare case of a duodenal stent placed as a palliative measure for gastric outlet obstruction due to unresectable pancreatic cancer that migrated distally after a gastrojejunostomy resulting in small bowel perforation.

Continuing challenges in the diagnosis and management of obscure gastrointestinal bleeding

The diagnosis and management of obscure gastrointestinal bleeding(OGIB) have changed dramatically since the introduction of video capsule endoscopy(VCE) followed by deep enteroscopy and other imaging technologies in the last decade. Significant advances have been made, yet there remains room for improvement in our diagnostic yield and treatment capabilities for recurrent OGIB. In this review, we will summarize the latest technologies for the diagnosis of OGIB, limitations of VCE, technological enhancement in VCE, and different management options for OGIB.

Microglia activation in the offspring of prenatal Poly I:C exposed rats:a PET imaging and immunohistochemistry study

Background The well-known ‘pyrotherapy’ of Julius Wagner-Jauregg might be the beginning of the study on the immunological concepts of schizophrenia. As the primary immune effector cells in the brain, microglia play a pivotal role in neuroinfammatory processes. Maternal viral infection during pregnancy is associated with an increased risk for psychiatric disorders with presumed neurodevelopmental origin, including autism spectrum disorders and schizophrenia. The present study was to quantify microglia activation in vivo in the mature offspring of rats exposed to polyriboinosinic–polyribocytidilicacid （Poly I：C） during pregnancy using ^11C-PK11195 positron emission tomography （PET） and immunohistochemistry.Objective The study aimed to quantify microglia activation in vivo in the prefrontal cortex and hippocampus in mature offspring of prenatal Poly I：C exposed rats.Methods Offspring of Poly I：C-treated dams were the model group, offspring of saline-treated dams were the control group. Behavioural test for two groups was taken by spontaneous activity, prepulse inhibition （PPI） and latent inhibition （LI） test （including active avoidance conditioning task and passive avoidance conditioning task）. Randomly selected successful model rats were assessed by behavioural test in the model group and control group rats. 11C-PK11195 micro-PET/CT and immunohistochemistry were performed on the selected rats to measure microglia activation.Results The treatment group showed hyperlocomotion and defcits in PPI and LI compared with the control group. The treatment group also showed an increased 11C-PK11195 uptake ratio in the prefrontal cortex （t=-3.990, p=0.003） and hippocampus （t=-4.462, p=0.001）. The number of activated microglia cells was signifcantly higher in the treatment group than in the control group （hippocampus： t=8.204, p〈0.001; prefrontal： t=6.995, p〈0.001）. Within the treatment group, there were signifcant correlations between the behavioural parameters and the activation of microglia as measured by PET and immunohistochemistry.Conclusions The present study demonstrated microglia activation in vivo in the prefrontal cortex and hippocampus in mature offspring of prenatal Poly I：C exposed rats. This study suggests that microglia activation may play a possible or potential role in the pathogenesis of schizophrenia.

Impact of recipient functional status on 1-year liver transplant outcomes

BACKGROUND The Karnofsky Performance Status(KPS)scale has been widely validated for clinical practice for over 60 years.AIM To examine the extent to which poor pre-transplant functional status,assessed using the KPS scale,is associated with increased risk of mortality and/or graft failure at 1-year post-transplantation.METHODS This study included 38278 United States adults who underwent first,non-urgent,liver-only transplantation from 2005 to 2014(Scientific Registry of Transplant Recipients).Functional impairment/disability was categorized as severe,moderate,or none/normal.Analyses were conducted using multivariableadjusted Cox survival regression models.RESULTS The median age was 56 years,31%were women,median pre-transplant Model for End-Stage for Liver Disease score was 18.Functional impairment was present in 70%;one-quarter of the sample was severely disabled.After controlling for key recipient and donor factors,moderately and severely disabled patients had a 1-year mortality rate of 1.32[confidence interval(CI):1.21-1.44]and 1.73(95%CI:1.56-1.91)compared to patients with no impairment,respectively.Subjects with moderate and severe disability also had a multivariable-adjusted 1-year graft failure rate of 1.13(CI:1.02-1.24)and 1.16(CI:1.02-1.31),respectively.CONCLUSION Pre-transplant functional status is a useful prognostic indicator for 1-year posttransplant patient and graft survival.

皮肤神经内分泌腺瘤:一少见肿瘤

Background: Cutaneous neuroendocrine neoplasms are typically malignant. Benign cutaneous neuroendocrine tumors are uncommon. Methods: We report the case of a 32-year-old female who presented with a granular mass in the right external auditory canal. Results: Microscopic examination of a shave biopsy revealed a poorly circumscribed neoplasm with glandular differentiation. While cytologic atypia and mitotic activity were not evident, pagetoid spread was observed. Immunohistochemistry was indicative of neuroendocrine origin. Conclusions: This case report of neuroendocrine adenoma indicates that this entity should be entertained in the repertoire of conditions affecting the external ear.

多发性细胞性神经鞘黏液瘤:1例报道及免疫组化辅助作用的综述

Background: Cellular neurothekeoma is a relatively rare, benign cutaneous neoplasm, which usually presents as a solitary papule or nodule involving the head and neck area of young adults. Multiple neurothekeomas have not, to date, been known to occur. Methods: We report a 30-year-old, otherwise healthy, male who presented with multiple neurothekeomas (15) in the head and neck area over a period of 12 years. Results: While the unifying feature of all biopsied (10 of 15) lesions was the presence of epithelioid cells the lesions differed in their cellularity and the degree of sclerosis of the stromal component. Antigenic profiling of the lesional cells revealed expression of vimentin, NKI/C3, PGP 9.5, factor XIIIa and CD68 but not S100, HMB45, MelanA, EMA, MSA, desmin, CD57 or NGF-R. Conclusions: This case report is the first to document the occurrence of multiple cellular neurothekeomas. An unusual histologic feature of some of the biopsied lesions was the presence of a markedly sclerotic stroma.

残留花生四烯酸诱发的血小板激活是通过二磷酸腺苷依赖性、环氧合酶1和2非依赖性途径所致:一项包括700例患者的阿司匹林抵抗研究

背景:接受阿司匹林治疗的冠心病患者中仍可出现血栓事件。方法和结果:为了更好理解“阿司匹林抵抗”,作者连续观察了700例进行阿司匹林治疗且接受心脏导管检查的患者,分析其血清血栓素B2(TXB2),并进行流式细胞检查以确定花生四烯酸诱发的血小板激活(分别在离体加入阿司匹林和吲哚美辛之前和之后)。682例可进行评估的患者中,有680例较之未服用阿司匹林的健康志愿者其血清TXB2浓度有所降低。

碱性成纤维细胞生长因子对大鼠血管平滑肌细胞作用机制的研究

目的 探讨外源性碱性成纤维细胞生长因子（bFGF）对自发性高血压大鼠（SHR）血管平滑肌细胞（VSMC）的作用机制. 方法 取用SHR和正常SD大鼠的胸主动脉,运用组织贴块法培养原代VSMC.不同浓度的外源性bFGF（0 ng/ml、20 ng/ml、40 ng/ml、60 ng/ml、80 ng/ml、100ng/ml）分别作用于SHR和SD大鼠的VSMC 48 h.四甲基偶氮唑盐（MTT）比色法检测VSMC增殖.对照组外源性bFGF（100 ng/ml）作用于SHR的VSMC;试验组外源性bFGF（100 ng/ml）＋蛋白激酶C（PKC）抑制剂作用于SHR的VSMC,均为48 h. 结果 不同浓度（0 ng/ml、20 ng/ml、40ng/ml、60 ng/ml、80 ng/ml、100 ng/ml） bFGF作用于SD大鼠VSMC 48 h后,吸光度（A）值分别为0.402±0.103、0.605±0.090、0.696±0.131、0.812±0.080、0.901±0.065、1.056±0.078.不同浓度（0 ng/ml,20 ng/ml,40 ng/ml,60 ng/ml,80 ng/ml,100 ng/ml） bFGF作用于SHR大鼠VSMC 48 h后,A值分别为：0.404±0.065、0.507±0.078、0.608±0.057、0.704±0.107、0.812±0.097、0.908±0.032.与对照组比较,试验组加入PKC抑制剂后bFGF对SHR胸主动脉VSMC的促增殖作用减弱,0.402±0.003比0.605±0.004（t=-5.40,P＜0.05）;与对照组比较,加入100 ng/ml的bFGF作用48 h后测得的A值为0.929±0.017（t=4.00,P＜0.05）. 结论 外源性bFGF对SHR和正常SD大鼠的VSMC均有促增殖效应,且呈浓度依赖性.PKC在外源性bFGF促SHR VSMC增殖的信号转导机制中起着重要的作用.

Single incision laparoscopic cholecystectomy using the one-incision three-trocar technique with all straight instruments:how I do it?

Single incision laparoscopic surgery(SILS)is a novel minimally invasive surgical technique that is gaining popularity around the world.One of the most commonly performed procedures is single incision laparoscopic cholecystectomy(SILC).Most reported techniques utilize special purpose-made access port and articulating instruments,rendering the procedure costly and difficult to learn.This article provides a stepwise description of SILC technique using all straight instruments without the need for a special port.It aims to shorten the learning curve for surgeons wishing to adopt a safe and cost-effective SILC technique to their practice.

Unexpected findings at laparotomy of a 12-year old girl with obstructive jaundice and choledocholithiasis:a case report

Congenital duodenal obstruction(CDO)is a relatively common neonatal anomaly with a reported incidence of 1 in 2500-10000 live births.12 Diagnosis can be made prenatally with ultrasound(US)during antenatal care or during the postnatal period commonly as bilious vomiting and feeding intolerance.Patients with a partial stenosis can survive to present in a much-delayed fashion.