IFN ‐γ is generally believed to be important in the autoimmune pathogenesis of type 1 diabetes ( T 1 D ). However, the development of spontaneous β‐cell autoimmunity is unaffected in NOD mice lacking expression of IFN ‐γ or the IFN ‐γ receptor ( IFN γ R ), bringing into question the role IFN ‐γ has in T 1 D . In the current study, an adoptive transfer model was employed to define the contribution of IFN ‐γ in CD 4 + versus CD 8 + T cell‐mediated β‐cell autoimmunity. NOD . scid mice lacking expression of the IFN γ R β chain ( NOD . scid . IFN γ RB null ) developed diabetes following transfer of β cell‐specific CD 8 + T cells alone. In contrast, β cell‐specific CD 4 + T cells alone failed to induce diabetes despite significant infiltration of the islets in NOD . scid . IFN γ RB null recipients. The lack of pathogenicity of CD 4 + T ‐cell effectors was due to the resistance of IFN γ R ‐deficient β cells to inflammatory cytokine‐induced cell death. On the other hand, CD 4 + T cells indirectly promoted β‐cell destruction by providing help to CD 8 + T cells in NOD . scid . IFN γ RB null recipients. These results demonstrate that IFN ‐γ R may play a key role in CD 4 + T cell‐mediated β‐cell destruction.
Background: Drowning is an important contributor to the burden of death in China. Exposure to open water is a risk factor for drowning, but few studies quantify its impact on drowning. The purpose of this study was to provide an up-to-date analysis of unintentional drowning risk in China, including impact of exposure to open water. Methods: We used Chinese provincial data from the GBD Study 2019 to describe the burden of unintentional drowning in 33 provinces in China and changes from 1990 to 2019. We included provincial outdoor open water resource data into the analysis to explore the relationship between outdoor open water resources and drowning burden using K-median clustering analysis. Findings: There were 2.9 million drowning deaths between 1990 and 2019 in China. Between 1990 and 2019, the unintentional drowning incidence, mortality and DALY rates declined by 31.2%, 68.6% and 74.9% respectively, with differences by age, sex and province. In 2019, the DALY rate for drowning was relatively higher in children under 20 year, the elderly over 80 years and males. Drowning incidence rate among females is higher than that of males. Provincial differences in unintentional drowning burden show a positive relationship to the availability and size of outdoor open water. Interpretation: As expected availability of water increases drowning risk. There is a need to address drowning risk among children and the elderly. Localised water safety plans which consider unique drowning burden and risk factors are needed in China to ensure a sustained decline of unintentional drowning.Funding: Bill & Melinda Gates Foundation.Declaration of Interest: We declare no competing interests.
Objective
To explore the surgical method and clinical effect of endoscopic endonasal approach for the treatment of invasive pituitary adenomas (IPA).
Methods
A retrospective analysis was conducted on the clinical data of 49 patients (50 procedures) with IPA treated through endoscopic endonasal approach at Department of Neurosurgery, the First Affiliated Hospital of Shenzhen University, from May 2014 to September 2017. Among them, the trans-cavernous approach was taken in 29 patients, the lateral-cavernous approach in 9 patients, the tuberculum sella planum approach in 7 patients and the diaphragma-sellae-cut and (or) dorsum-sellae-removal approach in 5 patients. The following aspects were investigated including extent of resection, curing rate and complications in patients with varying Knosp classifications and Hardy stages.
Results
Among all 50 procedures, gross total resection (GTR) was achieved in 34 cases (68.0%). Subtotal resection was in 10 case(20.0%) and 6 cases(12.0%) of partial resection. Biology cured 28 cases(57.1%, 28/49). The GTR rate for pituitary adenoma was 10/11 for grade 3 and 4/16 for grade 4 based on Knosp classification. The GTR rate was 9/10 for Hardy stage C, 10/12 for stage D and 6/19 for stage E. The rate of biology cure was 8/10 for stage C, 8/12 for stage D and 4/19 for stage E. Postoperative complications included 7 (14.3%) cases of cerebrospinal fluid leaks, 16 (32.7%) cases of electrolyte imbalance, 23 (46.9%) cases of transient diabetes insipidus, 16 (32.7%) cases of hypopituitarism, 2 (4.1%) cases of permanent hypopituitarism, and 1 (2.0%) case of epistaxis. The follow-up lasted 4-31 months with an average of 16 months. None reported recurrence in the group of GTR. One undergoing subtotal resection reported recurrence and received a second operation. Three patients underwent postoperative Gamma knife radiosurgery. Two patients with refractory IPA were administered temozolomide and metformin chemotherapy.
Conclusion
Based on the invasiveness of IPA, proper choice of endoscopic surgical approach could help with tumor resection and complication reduction.
Key words:
Invasive pituitary adenomas; Neuroendoscopy; Neurosurgical procedures; Approach
To observe the effect of auricular acupoint pressing (AAP) for analgesia during perioperative period of total knee joint replacement.Sixty patients with osteoarthritis of ASA grade I - III scheduled to receive unilateral total knee joint replacement were equally randomized into the AAP group and the control group, 30 in each group. The general anesthesia on all patients was implemented by physicians of an identical group through endotracheal intubation. To the patients in the AAP group, AAP with Vaccaria seed was applied before operation, and the local analgesia on affected limb with acupoint pasting was used after operation. Besides, administering of celecoxib 400 mg on the day before operation, and celecoxib 200 mg twice daily post-operation was given to all patients. When the visual analogue scales (VAS) reached more than 7 points, 0.1 g of bucinnazine hydrochloride was given for supplement. Meantime, same post-operative training methods were adopted in both groups. The resting VAS pain scores, contentment of sedation, incidence of adverse event, postoperative range of motion (ROM) of knee joint and Hospital for Special Surgery (HSS) score were recorded.The resting VAS pain scores at 6 h and 24 h after operation was 5.99 +/- 0.67 scores and 4.26 +/- 0.59 scores in the AAP group respectively, which was significantly lower than that in the control group at the corresponding time (7.02 +/- 0.85 scores and 4.92 +/- 0.43 scores, P < 0.01); but it showed insignificant difference between the two groups at 1 h and 48 h after operation (P > 0.05); sedation contentment in the two groups was similar; incidence of adverse event in the AAP groups seemed lower (4 cases vs. 11 cases), but the intergroup difference was statistically insignificant (P > 0.05). ROM before surgery were 75.63 degrees +/- 5.74 degrees and 75.43 degrees +/- 5.63 degrees in the two groups respectively, showing no significant difference (P > 0.05), two weeks after operation, the initiative ROM raised to 96.50 degrees +/- 3.79 degrees and 93.50 degrees +/- 3.50 degrees, and the passive ROM reached 107.8 degrees +/- 3.37 degrees and 105.27 degrees +/- 3.25 degrees in the two groups respectively, with statistical significance between them (P < 0.05). HSS score was similar between groups before operation (60.23 +/- 3.44 scores vs. 61.70 +/- 2.83 scores, P > 0.05); while it became 86.97 +/- 2.33 scores and 85.37 +/- 2.30 scores after operation, showing significant difference between groups (P < 0.05).Applying auricular acupoint pressing in perioperative period of knee joint replacement is favorable for alleviating postoperative pain, decreasing narcotic consumption, and promoting early rehabilitation, and it has the advantages of low cost, less complication, simple manipulation and high safety.
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