BACKGROUND & AIMS: :An undecapeptide which potentiates the beat of the ventricle in the African giant snail, Achatina fulica Ferussac, was purified from the atria of the snail. Its primary structure was determined to be H-Ser-Gly-Gln-Ser-Trp-Arg-Pro-Gln-Gly-Arg-Phe-NH2. This peptide was found to have excitatory actions not only on the ventricle but also on the penis retractor muscle, the buccal muscle and the identified neurons controlling the buccal muscle movement of Achatina.

背景与目标： : 从蜗牛的心房中纯化了一种增强非洲巨型蜗牛Achatina fulica Ferussac心室搏动的十一肽。它的一级结构被确定为H-Ser-Gly-Gln-Ser-Trp-Arg-Pro-Gln-Gly-Arg-Phe-NH2。发现该肽不仅对心室具有兴奋作用，而且对阴茎牵开器肌肉，颊肌和控制Achatina颊肌运动的已识别神经元具有兴奋作用。

BACKGROUND & AIMS: BACKGROUND AND PURPOSE:Intracerebral hemorrhage (ICH) is a particularly devastating form of stroke with high mortality and morbidity. Hematomas are the primary cause of neurologic deficits associated with ICH. The products of hematoma are recognized as neurotoxins and the main contributors to edema formation and tissue damage after ICH. Finding a means to efficiently promote absorption of hematoma is a novel clinical challenge for ICH. Peroxisome proliferator-activated receptor gamma (PPARγ) and nuclear factor erythroid 2-related factor 2 (Nrf2), had been shown that, can take potential roles in the endogenous hematoma clearance. However, monascin, a novel natural Nrf2 activator with PPARγ agonist, has not been reported to play a role in ICH. This study was designed to evaluate the effect of monascin on neurological deficits, hematoma clearance and edema extinction in a model of ICH in rats. METHODS:164 adult male Sprague-Dawley (SD) rats were randomly divided into sham; vehicle; monascin groups with low dosages (1mg/kg/day), middle dosages (5mg/kg/day) and high dosages (10mg/kg/day) respectively. Animals were euthanized at 1, 3 and 7days following neurological evaluation after surgery. We examined the effect of monascin on the brain water contents, blood brain barrier (BBB) permeability and hemoglobin levels, meanwhile reassessed the volume of hematoma and edema around the hematoma by Magnetic Resonance Imaging (MRI) in each group. RESULTS:The high dosage of monascin significantly improved neurological deficits, reduced the volume of hematoma in 1-7days after ICH, decreased BBB permeability and edema formation in 1-3days following ICH. CONCLUSION:Our study demonstrated that the high dosage of monascin played a neuroprotective role in ICH through reducing BBB permeability, edema and hematoma volume.

背景与目标：

BACKGROUND & AIMS: :Coronary artery fistula with giant coronary artery ectasia is a rare abnormal CHD. Multidetector CT is useful for the diagnosis. Early diagnosis and surgery are recommended.

背景与目标： 冠状动脉瘘合并巨大冠状动脉扩张是一种罕见的异常冠心病。多探测器CT可用于诊断。建议早期诊断和手术。

BACKGROUND & AIMS: PURPOSE:Giant cell reparative granulomas are rare bone tumors. Although benign, these tumors are locally destructive and can be highly vascular. They seldom occur in the cranial vault. We describe a multidisciplinary approach to a case of giant cell reparative granuloma of the cranium in a 3-year-old patient. CASE REPORT:A 3-year-old girl female referred to the pediatric neurosurgery department for evaluation of a retro-auricular mass. She had a history of recurrent otitis media with two subsequent courses of antibiotics without resolution. CT imaging revealed an expansive lesion located in the right mastoid region. Open surgical biopsy revealed a hemorrhagic tumor consistent with a giant cell reparative granuloma. Angiography identified a hypervascular tumor blush that was supplied by the occipital artery. Preoperative transcatheter embolization was performed followed by a multidisciplinary surgical resection and reconstruction. Blood loss was minimal, and the patient recovered well after surgery. CONCLUSION:Preoperative endovascular embolization and a multidisciplinary intraoperative approach with primary resection and cranial vault reconstruction is an effective approach to hypervascular giant cell reparative granulomas.

背景与目标：

BACKGROUND & AIMS: :We present an unusual case of spinal cord ischemia from an acute type B intramural hematoma that was successfully treated with blood pressure elevation and drainage of cerebral spinal fluid.

背景与目标： : 我们介绍了急性b型壁内血肿引起的不寻常的脊髓缺血病例，该病例已成功通过血压升高和脑脊液引流治疗。

BACKGROUND & AIMS: :Recent clinical studies have suggested that denosumab is associated with beneficial tumour response, surgical down-staging, and reduced surgical morbidity in patients with giant cell tumour of bone. However, these studies reported results of patients still on denosumab treatment, or patients after denosumab treatment but with a short follow-up. Other studies reported that the new osseous tumour matrix and thickened cortical bone that develop with denosumab treatment does not allow the surgeon to delineate the true extent of the tumour, and probably increases the risk for local recurrence. A study showed that cell proliferation is only diminished by denosumab; the cells continue to proliferate in vitro, albeit at a slower rate. More importantly, nine cases of malignant transformation of GCT during denosumab therapy without previous radiation exposure have been reported; inhibition of RANKL may increase the risk of new malignancies due to immunosuppression. With these concerns in mind, this article is an attempt to put essential information in one place, creating a comprehensive review that the curious reader would find interesting and informative.

背景与目标： : 最近的临床研究表明，denosumab与骨巨细胞瘤患者的有益肿瘤反应，手术分期降低和手术发病率降低有关。然而，这些研究报告了仍在接受denosumab治疗的患者或denosumab治疗后但随访时间短的患者的结果。其他研究报告说，denosumab治疗产生的新的骨性肿瘤基质和增厚的皮质骨无法使外科医生确定肿瘤的真实范围，并且可能增加了局部复发的风险。一项研究表明，denosumab仅能减少细胞增殖; 细胞在体外继续增殖，尽管速度较慢。更重要的是，据报道，在denosumab治疗期间没有先前的放射线照射的情况下发生了9例GCT恶性转化。抑制RANKL可能会由于免疫抑制而增加新恶性肿瘤的风险。考虑到这些问题，本文试图将基本信息放在一个地方，创建一个全面的评论，好奇的读者会发现有趣和信息丰富。

BACKGROUND & AIMS: UNLABELLED:Hematoma formation requiring operative treatment after shoulder arthroplasty may be associated with higher patient morbidity. We therefore determined whether there was an association of hematoma formation requiring operative treatment with deep infection after shoulder arthroplasty. Between 1978 and 2006, we performed 4147 shoulder arthroplasties in 3643 patients. Of these, 12 shoulders (0.3%) underwent reoperation for hematoma formation. The mean time interval from arthroplasty to surgery for the hematoma was 7 days (range, 0.5-31 days). Among nine cases in which cultures were taken, six had positive cultures; the organisms included Propionibacterium acnes in three, Staphylococcus epidermidis in one, Streptococcus species in one, and Staphylococcus epidermidis with Peptostreptococcus in one. The minimum followup was 12 months (mean, 68 months; range, 12 to 294 months). Two of the 12 patients eventually underwent resection arthroplasty for deep infection. The Neer score was excellent in one, satisfactory in six, and unsatisfactory in five patients. The data suggest hematoma formation after shoulder arthroplasty is often accompanied by positive intraoperative cultures. The surgeon should be aware of the high rate of unsatisfactory results associated with this complication as well as the possibility of developing a deep infection requiring additional surgery. LEVEL OF EVIDENCE:Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

背景与目标：

BACKGROUND & AIMS: OBJECTIVES:Anti-phospholipid antibodies have been recognized to play a role in vascular thrombosis and pregnancy morbidity. They were first thought to be directed to phospholipids, but it is now known that the majority of pathogenic antibodies recognizes epitopes on phospholipid-binding plasma proteins such as beta2-glycoprotein I (beta2GPI) or possibly also annexin A5 (ANXA5). The mechanism of their prothrombotic action is still not completely understood. The aim of the present study was to observe the effect of antibodies against ANXA5 (aANXA5) and antibodies against beta2GPI (abeta2GPI) on the binding of ANXA5 to the negatively charged phospholipid membrane. METHODS:Giant phospholipid vesicles (GPVs) were used as a simple model of the membrane surface. GPVs composed of phosphatidylserine and phosphatidylcholine were produced in an aqueous medium. A single GPV was transferred to the solution containing ANXA5 conjugated with Alexa Fluor 488 (FANXA5) and (i) aANXA5 or abeta2GPI and (ii) different concentrations of abeta2GPI together with beta2GPI. The emission of the fluorescent light from the GPV surface, as the result of FANXA5 binding, was measured. RESULTS:Beta2GPI together with abeta2GPI reduced the binding of FANXA5 to GPVs. On the contrary, aANXA5 enhanced the binding of ANXA5 to the GPV surface. CONCLUSIONS:Our results point to the competition between FANXA5 and complexes of beta2GPI-abeta2GPI for the same binding sites and therefore support the hypothesis of the disruption of the ANXA5 protective shield on procoagulant phospholipid surface. The influence of increased cell surface ANXA5 concentration in the presence of aANXA5 on coagulation needs to be further studied.

背景与目标：

BACKGROUND & AIMS: :We describe an unusual case of myasthenia gravis. Our patient had been diagnosed as having myasthenia gravis with thymoma at the age of 64 years, and died of acute respiratory failure at the age of 80 years. Post mortem examination revealed CD8-positive lymphocytic infiltration with numerous giant cells in the skeletal muscles and myocardium. Immunohistochemical and ultrastructural studies revealed that there were two types of giant cells: histiocytic and myocytic in origin. Furthermore, both types of giant cells were immunopositive for proteins implicated in the late endosome and lysosome-protease systems, suggesting that endocytosis may be the key mechanism in the formation of giant cells. The present case, together with a few similar cases reported previously, may represent a particular subset of polymyositis, that is, giant cell polymyositis and myocarditis associated with myasthenia gravis and thymoma.

背景与目标： : 我们描述了一个不寻常的重症肌无力病例。我们的患者在64岁时被诊断为患有胸腺瘤的重症肌无力，并在80岁时死于急性呼吸衰竭。验尸后发现CD8-positive淋巴细胞浸润，骨骼肌和心肌中有许多巨细胞。免疫组织化学和超微结构研究表明，有两种类型的巨细胞: 组织细胞和肌细胞起源。此外，两种类型的巨细胞对与晚期内体和溶酶体-蛋白酶系统有关的蛋白质均具有免疫阳性，这表明内吞作用可能是巨细胞形成的关键机制。本病例以及先前报道的一些类似病例可能代表多发性肌炎的特定子集，即与重症肌无力和胸腺瘤相关的巨细胞多发性肌炎和心肌炎。

BACKGROUND & AIMS: :The authors present 2 patients with VP shunt-induced subdural hematomas (SDH) treated with pressure-programmable valve implantation and endoscopic third ventriculostomies (TV). The first patient is an 11-year-old girl who developed a shunt-induced SDH. Revision of the shunt valve with a higher-pressure valve resulted in a prolonged deterioration of her consciousness. External ventricular drainage at low pressure led to clinical improvement. A pressure-programmable valve set at 50 mm H(2)O was implanted, and the pressure gradually increased. At a pressure of 120 mm H(2)O symptoms recurred, even though the subdural collection was beginning to decrease in size. An endoscopic TV was performed, and the valve pressure was then increased to 200 mm H(2)O without any neurological symptoms. The second patient, a 7-year-old boy with shunt-induced SDH, had recurrent SDH, even after shunt revision with placement of a higher-pressure valve, which resulted in prolonged lethargy. A pressure-programmable valve was implanted with concurrent endoscopic TV. Gradual valve pressure increases up to 200 mm H(2)O could be performed without recurrent symptoms. Eventually, the shunt system was ligated to resolve residual positional headache, and the TV has been patent for more than 3 years. In both patients, the pressure-programmable valve was useful, since the optimal CSF drainage pressure changed during the period of recovery from symptomatic subdural collections. Concurrent TV appeared to enable increasing the valve pressure gradually without any neurological symptoms. The advantages of this combined approach are discussed.

背景与目标： : 作者介绍了2例VP分流诱发的硬膜下血肿 (SDH) 患者，该患者接受了压力可编程瓣膜植入和内镜下第三脑室切开术 (TV) 治疗。第一位患者是一名11岁的女孩，患有分流诱导的SDH。使用较高压力阀修改分流阀会导致她的意识长期恶化。低压下的外部心室引流导致临床改善。植入设置在50毫米H(2)O的压力可编程阀，并且压力逐渐增加。在120毫米H(2)O的压力下，即使硬膜下集合的大小开始减小，症状也会复发。进行内窥镜TV，然后将瓣膜压力增加到200毫米H(2)O，而没有任何神经症状。第二名患者是一名7岁的男孩，患有分流诱导的SDH，即使在放置高压阀进行分流翻修后也出现了SDH复发，这导致了长时间的嗜睡。同时植入内窥镜电视的压力可编程阀。瓣膜压力逐渐增加至200毫米H(2)O可以进行而没有复发症状。最终，该分流系统被结扎以解决残留的位置头痛，并且该电视已获得3年以上的专利。在两名患者中，压力可编程阀都是有用的，因为在从有症状的硬膜下收集恢复期间，最佳的CSF引流压力发生了变化。并发电视似乎可以逐渐增加瓣膜压力，而没有任何神经系统症状。讨论了这种组合方法的优点。

BACKGROUND & AIMS: BACKGROUND:Among primary cardiac tumors, atypical lipoma is very rare. In particular, cases with lipomas in both the pericardium and the atria are even rare. CASE PRESENTATION:We report the case of a 49-year-old male patient presented to our department because of chest pain. Echocardiography revealed two large masses in both the pericardium and the right atrium. Then the tumors were completely resected and the histopathological examination revealed atypical lipoma. The patient recovered well without any complication and discharged from hospital. CONCLUSIONS:We report a very rare case of a huge atypical lipomas located on the pericardium and right atrium. These tumors were easily detected by echocardiography and final diagnosed after surgical resection and pathological examination.

背景与目标：

BACKGROUND & AIMS: :A pregnant woman was referred to our hospital due to fetal cardiomegaly. We recognised a dilated umbilical vein, which raised a suspicion of placental chorioangioma. A male neonate was delivered at 37 weeks of gestation. The cardiomegaly was gradually improved. Pathological examination identified five non-giant placental chorioangiomas. Multiple non-giant chorioangiomas may cause fetal complications despite the difficulty of prenatal diagnosis.

背景与目标： : 一名孕妇因胎儿心脏扩大被转诊至我院。我们发现脐静脉扩张，这引起了胎盘绒毛膜血管瘤的怀疑。一名男性新生儿在妊娠37周时分娩。心脏扩大逐渐改善。病理检查发现了五个非巨大的胎盘绒毛膜血管瘤。尽管产前诊断困难，但多发性非巨大绒毛膜血管瘤可能会引起胎儿并发症。

BACKGROUND & AIMS: :Net primary production (NPP) is influenced by disturbance-driven fluctuations in foliar standing crop (FSC) and resource-driven fluctuations in rates of recruitment and growth, yet most studies of NPP have focused primarily on factors influencing growth. We quantified NPP, FSC, recruitment, and growth rate for the giant kelp, Macrocystis pyrifera, at three kelp forests in southern California, U.S.A., over a 54-month period and determined the relative roles of FSC, recruitment, and growth rate in contributing to variation in annual NPP. Net primary production averaged between 0.42 and 2.38 kg dry mass x m(-2) x yr(-1) at the three sites. The initial FSC present at the beginning of the growth year and the recruitment of new plants during the year explained 63% and 21% of the interannual variation observed in NPP, respectively. The previous year's NPP and disturbance from waves collectively accounted for 80% of the interannual variation in initial FSC. No correlation was found between annual growth rate (i.e., the amount of new kelp mass produced per unit of existing kelp mass) and annual NPP (i.e., the amount of new kelp mass produced per unit area of ocean bottom), largely because annual growth rate was consistent compared to initial FSC and recruitment, which fluctuated greatly among years and sites. Although growth rate was a poor predictor of variation in annual NPP, it was principally responsible for the high mean values observed for NPP by Macrocystis. These high mean values reflected rapid growth (average of approximately 2% per day) of a relatively small standing crop (maximum annual mean = 444 g dry mass/m2) that replaced itself approximately seven times per year. Disturbance-driven variability in FSC may be generally important in explaining variation in NPP, yet it is rarely examined because cycles of disturbance and recovery occur over timescales of decades or more in many systems. Considerable insight into how variation in FSC drives variation in NPP may be gained by studying systems such as giant kelp forests that are characterized by frequent disturbance and rapid rates of growth and recruitment.

背景与目标： : 净初级生产 (NPP) 受干扰驱动的叶面作物 (FSC) 波动和资源驱动的招聘和增长速度波动的影响，但对NPP的大多数研究主要集中在影响增长的因素上。我们在54个月的时间内对美国南加州的三个海带森林中的巨型海带Macrocystis pyrifera的NPP，FSC，招募和增长率进行了量化，并确定了FSC，招募，和增长率对年度NPP变化的贡献。在这三个地点，净初级产量平均在0.42和2.38千克干重x m(-2) x yr(-1) 之间。最初的FSC出现在生长年的开始以及该年新植物的招募分别解释了NPP中观察到的年际变化的63% 和21%。前一年的NPP和波浪干扰共同占初始FSC年际变化的80%。没有发现年增长率 (即单位现有海带质量产生的新海带质量) 与年NPP (即单位海底面积产生的新海带质量) 之间的相关性，主要是因为与最初的FSC和招聘相比，年增长率是一致的，后者在年份和地点之间波动很大。尽管增长率不能很好地预测年度NPP的变化，但它主要是导致大囊藻观察到NPP的高平均值的原因。这些高平均值反映了相对较小的立地作物 (最大年平均值 = 444克干重/平方米) 的快速生长 (平均约每天2%)，该作物每年约替代自身7次。FSC中的扰动驱动的变异性通常对于解释NPP的变化很重要，但是很少进行检查，因为在许多系统中，扰动和恢复的周期会在几十年或更长时间的时间范围内发生。通过研究以频繁干扰以及快速生长和招募速度为特征的巨型海带森林等系统，可以对FSC的变化如何驱动NPP的变化有相当大的了解。

BACKGROUND & AIMS: BACKGROUND:Aortic structural damage (ASD) may complicate the course of patients with giant cell arteritis (GCA). However the frequency and outcome of ASD has not been assessed in long term prospective studies. METHODS:In a previous screening of 54 biopsy proven GCA patients, significant ASD was detected in 12 (22.2%) after a median follow-up of 5.4 years. These patients were periodically evaluated (every 4 years) over a median of 10.3 years (range 4-16.6 years) in order to investigate the development of new ASD and the outcome of previously detected abnormalities. RESULTS:18 of the 54 patients abandoned the study due to death or other reasons. The remaining 36 patients were subjected to a second screening and 14 to a third screening. 12 (33.3%) of the 36 patients re-screened and 16 (29.6%) of the initial cohort developed ASD, all but one in the thoracic aorta. Aortic diameters at the ascending and descending aorta significantly increased over time. One patient (1.9% of the initial cohort) died from aortic dissection. Surgery was advised in eight (50%) patients with ASD but could only be performed in three patients (37.7%). The development of ASD was not associated with persistence of detectable disease activity. CONCLUSIONS:The incidence of ASD is maximal within the first 5 years after diagnosis but continues developing over time, affecting up to 33.3% of individuals after long term follow-up. Once ASD occurs, dilatation increases over time, underlining the need for periodic evaluation. Surgical repair is feasible in about one-third of candidates.

背景与目标：

BACKGROUND & AIMS: INTRODUCTION:Pyoderma gangrenosum (PG) is a phenomenon of cutaneous ulceration with unknown etiology. About half the cases have associated extracutaneous manifestations or associated systemic diseases. The most commonly associated systemic disorders include inflammatory bowel disease (IBD), hematologic malignancies, autoimmune arthritis, and vasculitis. This is a case report about giant PG with ulcerative colitis (UC), which is extremely rare. CASE PRESENTATION:A 39-year-old female farmer with UC for the past 3 years presented with multiple painful ulcers, erosion, exudation, and crusting on the right leg for 1 month. A cutaneous examination showed diffusely distributed, multiple, well-defined, deep purulent ulcers on the right medial shank measuring 6 to 20 cm and sporadic worm-eaten ulceration on the right ectocnemial, with severe oozing and erosions. The ulcerations exhibited deep undermined borders, granulated tissue and a black eschar at the base. The right shank and feet were severely swollen, restricting movement. The arteria dorsalis pedis pulse was good, with normal sensation on the skin of the right shank and feet. Laboratory examinations showed a white cell count of 11.8 × 109/L, hemoglobin was 91 g/L, erythrocyte sedimentation rate was 82 mm/h, unelevated procalcitonin, serum C-reactive protein was 131.29 mg/L, and a negative tuberculin skin test. Enteroscopy demonstrated endoscopic evidence of UC. A skin lesion biopsy showed superficial erosion and scarring. Partial epidermal hyperplasia, partial epidermal atrophy and thinning, mild edema of the dermal papill. Most of the middle and lower part of the dermis, showed dense lymphocytes, histiocytes, multinucleated giant cells, and neutrophil infiltration. PG with UC was diagnosed based on clinical manifestations, laboratory examinations and enteroscopy results. INTERVENTIONS:She was treated with topical applications of povidone iodine and kangfuxin solution twice daily, methylprednisolone sodium succinate 40 mg and compound glycyrrhizin 60 mg via intravenous drip once a day, along with thalidomide 50 mg twice daily. The UC was controlled with mesalazine. OUTCOMES:She required multiple therapies to achieve PG healing 3 months later. No PG recurrence was observed during the 1-year follow-up. CONCLUSION:Recognizing the clinical features of PG and its pathogenic nature, ensuring timely management fundamental for preventing severe destruction and deformity, and control of associated diseases are important aspects of treatment. Combination therapy is essential for PG patients with IBD.

背景与目标：