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Malignant Phyllodes Tumor of the Right Breast with Sacral Bone Metastasis- A Clinical Case from our Practice with A Literature Review 右侧乳腺恶性皮样瘤伴骶骨转移--临床病例及文献综述
Pub Date : 2024-02-29 DOI: 10.47363/jjcmr/2024(4)162
L. Marinova, N. Kahchiev, V. Vasileva
Phyllodes breast neoplasms are rarely diagnosed biphasic tumors that are benign, borderline, or malignant. We present a rare malignant phyllodes tumor in a 62-year-old woman with bone metastasis in the sacrum, presented 4 months after radical breast tumor surgery. Because of a severe pain syndrome, we performed intensity modulated radiotherapy with a high single dose of 8 Gy in two fractions, once a week. In this article we emphasize the difficult histopathological diagnosis, as well as the differential diagnosis, requiring immunohistochemistry of the two tumor components / epithelial and stromal/, as well as the clinical and pathological characteristics determining the malignant nature of the disease. In the presence of a soft tissue component of the bone metastasis, a biopsy with immunohistochemistry is required to prove the histopathological diagnosis of the distant metastasis. Distant metastases require complex treatment, including chemotherapy and palliative radiation therapy
乳腺梭形细胞瘤是一种很少诊断的双相肿瘤,有良性、边缘性或恶性之分。我们报告了一名 62 岁女性的罕见恶性蝶形花瘤,患者在乳腺肿瘤根治术后 4 个月出现骶骨骨转移。由于严重的疼痛综合征,我们对患者进行了强度调节放疗,单次剂量为 8 Gy,每周一次,分两次进行。在这篇文章中,我们强调了组织病理学诊断的困难性,以及鉴别诊断,这需要对两种肿瘤成分(上皮和基质)进行免疫组化,以及确定疾病恶性的临床和病理特征。如果骨转移瘤中存在软组织成分,则需要进行活检并进行免疫组化,以证明远处转移瘤的组织病理学诊断。远处转移需要复杂的治疗,包括化疗和姑息性放疗。
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引用次数: 0
DPP4 valorphin activate NR4As pathway and OPA1 that protect from CoQ10 deficiency from OPA1 dysfunctions and from WMH DPP4 valorphin 可激活 NR4As 通路和 OPA1,从而防止因 CoQ10 缺乏而导致的 OPA1 功能障碍和 WMH
Pub Date : 2023-12-31 DOI: 10.47363/jjcmr/2023(3)160
A. Tantawi
Valorphin (known as VV-hemorphin-5 ) is nine essential amino acids : Leu_Val_Val_Tyr, _Pro _Pro _Thr_ Gln_& Arg are having important role in activating mitochondrial functions and in activating both serotonin and NR4As pathway that promote oxytocin and Nrf2 synthesis. Deficiency in Thr, Tph (TGG), Glu, Gln (cycle) and Leucine due to increasing in the polarizability in mTORC1 and in S6K genes and subunits can cause disorders or deficiency in OPA1 repair that can be the result of Primary coenzyme Q10 (CoQ10) deficiency disease that characterized by damage in the inner mitochondrial membrane which is necessary for activating glucocorticoids receptor GCR Synthesis. Mitochondrial damage or disorder can lead to accumulation in pro-inflammation which can cause mutations in subunit and protein. The reduction in tryptophan, in Gly (which considered as the mirror of tryptophan triplets), and in Arg will cause reductions in Proline synthesis and consequently reductions in tRNAs, followed by reduction in mitochondrial OPA1 repairs and functions (that reduction in Gly can cause reduction in GTPase), followed by reduction in IL17 synthesis and accumulation of proinflammatory molecules, and followed by reduction in serotonin synthesis and in all of GC-beta, oxitocin, and Nrf2 production, that will be followed by decreasing in megakaryocytes proliferation and followed by reduction in hematopoiesis which associated to white matter hyperintensity
瓦洛啡(又称 VV-hemorphin-5 )是九种必需氨基酸:Leu_Val_Val_Tyr、_Pro _Pro _Thr_ Gln_& Arg 在激活线粒体功能以及激活促进催产素和 Nrf2 合成的血清素和 NR4As 途径方面发挥重要作用。由于 mTORC1 和 S6K 基因及亚基的极化性增加,Thr、Tph (TGG)、Glu、Gln (cycle) 和亮氨酸的缺乏会导致 OPA1 修复紊乱或缺乏,这可能是原发性辅酶 Q10(CoQ10)缺乏症的结果,该病的特点是线粒体内膜受损,而线粒体内膜是激活糖皮质激素受体 GCR 合成所必需的。线粒体损伤或失调会导致促炎因子的积累,从而引起亚基和蛋白质的突变。色氨酸、甘氨酸(被认为是色氨酸三联体的镜像)和氩氨酸的减少会导致脯氨酸合成减少,进而导致 tRNA 减少,继而导致线粒体 OPA1 修复和功能减少(甘氨酸的减少会导致 GTPase 减少)、IL17 合成减少,促炎分子积累,血清素合成减少,所有 GC-beta、oxitocin 和 Nrf2 生成减少,巨核细胞增殖减少,造血减少,导致白质密度增高。
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引用次数: 0
Keypoints in Cells and Atherogenesis 细胞与动脉粥样硬化的关键点
Pub Date : 2023-12-31 DOI: 10.47363/jjcmr/2023(3)161
Tania Leme da Rocha Martinez
Endothelial dysfunction is the initial event in the atherogenic process, resulting from several events, such as expression of leukocyte binding sites, production of growth factors, chemotactic and vasoreactive molecules, ability to oxidize low-density lipoprotein (LDL) and respond to oxidized lipoproteins, ability to express procoagulant activity, and modulation of vascular permeability. Thus, the endothelium, when subjected to different conditions and factors, plays an active role in the development of atherosclerotic plaque. The expression of several adhesion molecules, such as intracellular adhesion molecule-1 (ICAM-1), E-selectin, vascular cell adhesion molecule-1 (VCAM-1), P-selectin in atherosclerotic plaques, mediating the interaction between endothelial cells and leukocytes, has been described. The modification of LDLs, in conjunction with other chemotactic factors produced by injured endothelial cells, recruit circulating monocytes into the subendothelial space, where they become macrophages. The proliferation of smooth muscle cells is an important event in the progression of arterial injury, occurring in 3 stages: smooth muscle cell replication still within the media layer; migration from the middle layer to the intima and proliferation within the intima. Apoptotic cells were evidenced in the atherosclerotic lesion, suggesting that apoptosis is part of the normal vascular healing process. The final stage of atherosclerotic lesion development is conversion of the fibrotic lesion to an advanced lesion, a lesion in which a thrombus forms as a result of plaque ulceration or intraplaque hemorrhage.
内皮功能障碍是动脉粥样硬化过程中的初始事件,由多个事件引起,如白细胞结合位点的表达、生长因子、趋化和血管活性分子的产生、氧化低密度脂蛋白(LDL)和对氧化脂蛋白做出反应的能力、表达促凝活性的能力以及血管通透性的调节。因此,内皮在受到不同条件和因素的影响时,在动脉粥样硬化斑块的形成过程中发挥着积极作用。动脉粥样硬化斑块中存在多种粘附分子,如细胞内粘附分子-1(ICAM-1)、E-选择素、血管细胞粘附分子-1(VCAM-1)和 P-选择素,它们介导内皮细胞和白细胞之间的相互作用。低密度脂蛋白的修饰与损伤的内皮细胞产生的其他趋化因子一起,将循环中的单核细胞招募到内皮下空间,并在那里变成巨噬细胞。平滑肌细胞的增殖是动脉损伤进展过程中的一个重要事件,分为三个阶段:平滑肌细胞仍在中层复制;从中层向内膜迁移;以及在内膜增殖。动脉粥样硬化病变中出现了凋亡细胞,这表明凋亡是正常血管愈合过程的一部分。动脉粥样硬化病变发展的最后阶段是纤维化病变转化为晚期病变,即由于斑块溃疡或斑块内出血而形成血栓的病变。
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引用次数: 0
Femoral Preparation Before Head Dislocation in Hip Hemiarthroplasty for Fractured Neck of Femur Saves Time and Keeps the Acetabulum Clean of loose bone fragments: A Retrospective Study and Technical Report 髋关节半关节置换术治疗股骨颈骨折时,在股骨头脱位前进行股骨准备可节省时间并清除髋臼内松动的骨碎片:回顾性研究与技术报告
Pub Date : 2023-12-31 DOI: 10.47363/jjcmr/2023(3)159
Mohamed Shaalan, Brandon Lim
Introduction: Femoral neck fractures are the most common traumatic injuries associated with increasing age and osteoporosis, occurring most in older females. The femoral neck is under constant strain from externally and internally generated forces, approximately 500 – 200 micro-strains from daily activities. Common causes are falls in the elderly and road traffic accidents in younger patients. There is a significant in-house mortality and one-year mortality rate associated with femoral fractures. Fractures can be classified using the Garden Classification or the 2018 AO/OTA classification. Management includes open reduction and internal fixation, cannulated or sliding screws and hemiarthroplasty or total hip arthroplasty. This study examines the benefits of femoral preparation before head dislocation in hip hemiarthroplasties by assessing differences between pre-operative and post-operative haemoglobin levels and surgical times. Methods: We report the surgical techniques of hip hemiarthroplasty where the femur is prepared before the femoral head is removed and the hip is reduced in the flexion position. A retrospective review of electronic patient records of patients who underwent hemiarthroplasties from June 2022 to June 2023 was conducted. Results: Surgical times for this surgical technique were 30 minutes faster than traditional methods while the differences in haemoglobin levels were minimal. Conclusion: Longer surgical times are associated with adverse events such as infections and wound dehiscence while increasing risks via surgeon fatigue and longer anaesthesia durations. Innovations in surgical techniques should thus aim to minimise surgical time without compromising procedures. This technique saves 30 min on average while having similar levels of blood loss to traditional techniques, maintaining standards, and not compromising on patient safety. Femoral preparation before dislocating the femoral head reduces the steps taken in leg repositioning which saves time and effort by the assistant. The reduction technique also avoids any risk of intra-operative iatrogenic fracture that can happen, especially if the assistant is a junior surgeon who lacks experience with hip reduction.
简介股骨颈骨折是与年龄增长和骨质疏松症相关的最常见外伤,多发于老年女性。股骨颈持续受到外力和内力的作用,在日常活动中大约会产生 500 到 200 个微小应变。常见原因是老年人跌倒和年轻患者的道路交通事故。股骨骨折的内部死亡率和一年死亡率都很高。骨折可根据花园分类法或2018年AO/OTA分类法进行分类。治疗方法包括切开复位内固定术、套管螺钉或滑动螺钉以及半髋关节置换术或全髋关节置换术。本研究通过评估髋关节半关节置换术术前和术后血红蛋白水平及手术时间的差异,探讨了髋关节半关节置换术中股骨头脱位前股骨准备的益处。方法:我们报告了髋关节半关节置换术的手术技术,即在切除股骨头之前对股骨进行准备,并在屈曲位缩小髋关节。我们对 2022 年 6 月至 2023 年 6 月期间接受半关节置换术的患者的电子病历进行了回顾性审查。结果显示该手术技术的手术时间比传统方法快 30 分钟,而血红蛋白水平的差异却很小。结论:较长的手术时间与感染和伤口开裂等不良事件有关,同时也会因外科医生疲劳和麻醉时间延长而增加风险。因此,手术技术的创新应在不影响手术的前提下尽量缩短手术时间。这种技术平均可节省 30 分钟,同时失血量与传统技术相近,既能保持标准,又不影响患者安全。股骨头脱位前的股骨准备减少了腿部复位的步骤,从而节省了助手的时间和精力。这种还原技术还能避免术中可能发生的先天性骨折风险,尤其是在助手是缺乏髋关节还原经验的初级外科医生的情况下。
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引用次数: 0
Outcome of Long Segment Posterior Spinal Stabilization Incorporating the Fractured Vertebra for Unstable Thoraco-Lumbar Junctional Brust Fracture 后路长节段脊柱稳定合并椎体骨折治疗不稳定胸腰椎关节性骨折的疗效
Pub Date : 2023-06-30 DOI: 10.47363/jjcmr/2023(3)157
A. Islam, S. Saha, Naiemuzzaman Siddique
Objectives: To evaluate the outcome of long segment posterior spinal stabilization incorporating the fractured vertebra with posterolateral fusion for unstable thoraco-lumbar junctional brust fracture. Background: Thoracolumbar junction is the commonest site of traumatic spinal injury. Now a days, it is managed surgically most of the time because it is often associated with the spinal cord injury. Its mode of surgical management is a field of controversy. Huge debate is still going on between the superiority of long & short segment stabilization. In this study, we evaluated the outcome of long segment posterior spinal stabilization incorporating the fractured vertebra Materials & Method: This prospective interventonal study included 30 case of thoraco-lumbar junctional unstable brust fractures was carried out in the Spine unit of Orthopaedic surgery department of Bangabandhu Sheikh Mujib Medical University, Dhaka and other private hospital in Dhaka City, Bangladesh, from January 2016 to July 2022. All the patients with positive clinical findings, X-ray, MRI & CT scan findings and underwent long segment posterior spinal stabilization incorporating the fractured vertevra with posterolateral fusion. Average follow-up period was 12 months. Pre & Post-operatively, neurological assessment was done by the ASIA Impairment Score, improvement of pain control by VAS score, fusion rate by Bridwell’s criteria, Kyphotic angle was measured by Cobb’s angle measurement method & Overall functional assessment by modified Odom’s score. Results: Total number of patients was 30. Average age was 34 years (range 21- 47). ASIA score improved from B to C in 5 patients, B to D in 5 patients, C to D in 8 patients , C to E in 3 patients, patients, D to E in 7 patients. 2 patient did not improved following surgery. Fusion was achieved in 29 patients & 1 patient developed pseudoarthrosis. Pre & Post- operative VAS score was 7.30±1.9 & 3.3±1.8 respectively. The average kyphotic correction was 15 ∞. In our series, we have no bedridden patients after surgery. There was no radiographic progression after surgery. Conclusion: Early treatment within 21 days of injury with long segment posterior spinal stabilization incorporating the fractured vertevra with posterolateral fusion is a very effective surgical procedure with preservation of the motion segment to treat unstable thoracolumbar junctional brust fracture.
目的:评价椎体骨折后外侧融合长节段后路稳定治疗不稳定胸腰椎联合骨折的疗效。背景:胸腰段交界处是创伤性脊柱损伤最常见的部位。现在,大多数情况下都是手术治疗因为它通常与脊髓损伤有关。其手术处理方式是一个有争议的领域。关于多头和空头稳定孰优孰劣的争论仍在继续。在这项研究中,我们评估了结合骨折椎体的长节段后路脊柱稳定的效果。材料和方法:这项前瞻性介入研究包括30例胸腰椎关节不稳定的爆裂性骨折,于2016年1月至2022年7月在孟加拉国达卡市的Bangabandhu Sheikh Mujib医科大学骨科及其他私立医院脊柱部进行。所有患者均有阳性的临床表现、x线、MRI和CT扫描表现,并接受了长节段后路脊柱稳定术,合并骨折椎体后外侧融合。平均随访期为12个月。术前、术后采用ASIA损伤评分评估神经功能,VAS评分评估疼痛控制改善程度,Bridwell评分评估融合率,Cobb角度测量法测量后凸角,改良Odom评分评估整体功能。结果:患者总数30例。平均年龄34岁(21- 47岁)。ASIA评分由B至C者5例,由B至D者5例,由C至D者8例,由C至E者3例,由D至E者7例。2例术后无好转。29例患者实现融合,1例患者出现假关节。术前、术后VAS评分分别为7.30±1.9和3.3±1.8。平均后视矫正量为15∞。在我们的系列中,我们没有手术后卧床不起的病人。术后无影像学进展。结论:在伤后21天内进行长节段后路脊柱稳定联合骨折椎体后外侧融合是一种非常有效的保留运动节段的治疗不稳定胸腰椎联合骨折的手术方法。
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引用次数: 0
Lipid Effects of Experimental Oophorectomy and Cardiovascular Risk Association 实验性卵巢切除术的脂质效应与心血管风险关联
Pub Date : 2023-04-30 DOI: 10.47363/jjcmr/2023(3)148
T. L. Martinez, A. Gasparoto
In view of the controversy between hormonal replacement in postmenopausal women and decreased cardiovascular morbidity and mortality, and the effects of estrogens associated with progesterones, or progesterone alone, we developed a protocol to evaluate the repercussions of hormone therapy with progesterone in oophorectomized rabbits submitted to atherogenic diet, on the development of atherosclerotic lesions induced in animals. Forty New Zealand rabbits were oophorectomized and divided into three groups. After 90 days, when the animals were sacrificed and the lesions that developed in the aorta and coronary arteries were evaluated. The results showed an increase in serum cholesterol in the four groups of animals. In groups II, III and IV, there was an increase of approximately fifteen times the baseline values, with no significant differences between these groups observed in 5 time courses. Regarding triglyceride levels, we found that group III showed a significant increase in values in Time 4, but this difference was not verified in Time 5. When quantitatively analyzing the area occupied by the lesion, we found that there were no statistically significant differences between the groups submitted to the atherogenic diet, observing that the coronary arteries presented a lower number of compromised arteries
鉴于绝经后妇女激素替代与降低心血管发病率和死亡率之间的争议,以及雌激素与黄体酮或单独黄体酮相关的影响,我们制定了一项方案,以评估黄体酮激素治疗在卵巢切除的兔子接受致动脉粥样硬化饮食后对动物诱导的动脉粥样硬化病变发展的影响。40只新西兰兔切除卵巢,分为三组。90天后,当动物被处死时,评估主动脉和冠状动脉的病变。结果显示,四组动物的血清胆固醇都有所增加。在II, III和IV组中,增加了大约15倍的基线值,在5个时间疗程中,这些组之间没有观察到显著差异。关于甘油三酯水平,我们发现III组在时间4中显示出显著的数值增加,但这种差异在时间5中没有得到证实。在定量分析病变占据的面积时,我们发现在致动脉粥样硬化饮食组之间没有统计学上的显著差异,观察到冠状动脉的受损动脉数量更少
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引用次数: 0
A Case of Neck Avm Supplied By Arteria Lusoria 颈动脉供血1例
Pub Date : 2023-04-30 DOI: 10.47363/jjcmr/2023(3)150
S. M., Ruchi N, Saiful A
Classification of Vascular malformation is based on ISSVA classification. Here is a brief outline of vascular malformation classification.
血管畸形的分类基于ISSVA分类。以下是血管畸形分类的简要概述。
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引用次数: 0
Is Medical Success of Donation and Transplantation, A Rewarding Ethical and Social Progress? 捐赠和移植的医学成功,是有益的伦理和社会进步吗?
Pub Date : 2023-04-30 DOI: 10.47363/jjcmr/2023(3)152
F. Cantarovich
Organ transplantation is the great advance in medicine of the 20th century. Progresses in anti- rejection therapy have led to a globally statistical increase in its frequency. However, it is important to call attention to the progressive of patients waiting lists, as well as the constant and sometimes its frequent mortality expecting for an organ that will not arrive, the so call “Organ Shortage”. This vital problem is an evident exponent of a social behaviour, that is not conclusively defined towards organ donation. This crucial paradox of the possibility of medically turning death into life, basically required by the donation of an organ, mainly from a deceased donor; without a doubt, facilitates this intention to analyse the causes of this social phenomenon, and the current or possible proposals to overcome this persistent global health crisis.
器官移植是20世纪医学的一大进步。抗排斥治疗的进步导致其发生频率在全球范围内增加。然而,重要的是要引起人们对患者等待名单的进展的关注,以及对器官无法到达的持续(有时甚至频繁)死亡的期望,即所谓的“器官短缺”。这个至关重要的问题是一种社会行为的明显表现,这种行为对器官捐赠并没有决定性的定义。医学上有可能将死亡变为生命,这是一个关键的悖论,基本上需要捐赠器官,主要来自已故捐赠者;毫无疑问,这有助于分析这一社会现象的原因,以及目前或可能提出的克服这一持续存在的全球健康危机的建议。
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引用次数: 0
The Mathematical Modelling of the Systems Theory 系统理论的数学建模
Pub Date : 2023-04-30 DOI: 10.47363/jjcmr/2023(3)149
J. Vincze, Gabriella Vincze-Tiszay
Life is an embodiment of matter that is a common feature of living organisms and can be used as a fundamental criterion for characterizing them. Everything that is common to living organisms falls under the umbrella of biological motion. Everything that is common to living organisms falls under the umbrella of biological motion. The new approach – qualitatively different and more than that of classical or borderland sciences – is the interdisciplinary perspective. The first important milestone in the scientific establishment of general systems theory was the year 1942, when the second edition of Theoretische Biologie by Ludwig von Bertalanffy. One of the main aims of general systems theory is to develop a general orientation and a general theoretical framework that enables a practitioner of a discipline to take up structurally and organizationally relevant contributions from others. Examples are totality, additivity, leap and slow evolution, similarity, gradual selection, growth-evolution, mechanization and centralization, individuality, adapta¬tion, aggression, hierarchical order, parts with a control function, the avalanche ef¬fect, purposiveness and unity of purpose, rhythmicity, physical and biological time.
生命是物质的体现,是生物体的共同特征,可以作为表征它们的基本标准。所有生物共有的东西都属于生物运动的范畴。所有生物共有的东西都属于生物运动的范畴。新的方法——在性质上不同于经典科学或边缘科学——是跨学科的观点。一般系统理论科学建立的第一个重要里程碑是1942年,路德维希·冯·伯塔朗菲出版了《生物学理论》第二版。一般系统理论的主要目标之一是发展一个一般的方向和一般的理论框架,使一个学科的实践者能够从其他人那里获得结构和组织上相关的贡献。例如整体性、可加性、飞跃性和缓慢进化、相似性、渐进选择、生长进化、机械化和集中化、个性、适应性、攻击性、等级秩序、具有控制功能的部分、雪崩效应、目的的合向性和统一性、节律性、物理和生物时间。
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引用次数: 0
Pulmonary Agenesis in a Newborn 新生儿肺发育不全
Pub Date : 2023-04-30 DOI: 10.47363/jjcmr/2023(3)153
S. Bittmann, E. Luchter, Lara Bittmann
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引用次数: 0
期刊
Japan Journal of Clinical & Medical Research
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