琼脂石蜡双包埋切片在胸水细胞学诊断中的应用

目的探讨胸水琼脂石蜡双包埋切片在肿瘤细胞学诊断中的意义。方法对44例胸水沉淀物分别进行常规涂片和琼脂石蜡双包埋切片,并对琼脂石蜡双包埋切片进行免疫组织化学染色。结果在确诊的21例恶性胸水中,琼脂石蜡双包埋切片法检测癌细胞的阳性率为90.48%,显著高于涂片法52.38%。11例涂片法阳性的标本中,只有5例做出了病理分类诊断,而19例琼脂石蜡双包埋切片阳性的标本均做出了病理分类诊断。琼脂石蜡双包埋切片的免疫组织化学染色阳性结果定位准确,图象背景清晰。结论琼脂石蜡双包埋切片细胞集中,可以提高恶性胸水癌细胞的检出率和做出分型的病理诊断,利于以及进行免疫组织化学检测。     

Mild emphysema: a novel method using formalin-fixed lungs for computed tomography and pathological analyses

We evaluated a novel method of computed tomography (CT) analysis using formalin-fixed lungs of autopsy cases with mild emphysema. Eight formalin-inflated lungs (FILs) obtained at autopsy were examined using CT after draining off the formalin and air inflation with an air pump, and subjected to pathological study including pathological scoring of emphysema and microscopic image analysis (MIA). Satisfactory CT examination was carried out within 5 h of lung fixation. The mean alveolar area determined by MIA correlated highly with the lung volume (r=0.845) and CT score (r=0.722). This method is simple compared with conventional polyethylene glycol fixation for CT and enables CT examination of resected lungs without anxiety about biohazards. Mild emphysema can be detected by MIA.     

Cytological examination and cellular composition of bone marrow in healthy, adult, cynomolgus monkeys (Macaca fascicularis)

The purpose of this study was to evaluate the cellular composition of the bone marrow of cynomolgus monkeys (Macaca fascicularis). Femoral bone marrow smears from 23 healthy, adult animals (11 males and 12 females) were examined. For each animal, three femoral bone marrow smears were prepared immediately after euthanasia and stained with May-Grünwald-Giemsa. On two of the three smears available, and for each of these smears, a 500-cell differential count was performed and the myeloid: erythroid (M:E) ratio established. The M:E ratio for males varied from 0.67∶1.00 to 1.85∶1.00 with a mean of 1.03∶1.00 and for females from 0.67∶1.00 to 1.63∶1.00 with a mean of 1.02∶1.00. The mean percentage of granulocytic, lymphocytic, plasmacytic and erythroid series was 47.60, 5.44, 1.45 and 46.05% for males and 47.28, 5.12, 1.49 and 46.28% for females. No significant differences were noted between males and females. All cell lines were well represented and showed normal maturation in both sexes. Megakaryocytes were adequate in number and morphology in all animals. Cynomolgus monkeys showed a bone marrow composition similar to rhesus monkeys (Macaca mulatta). Cytological examination of bone marrow was found to be a simple and rapid procedure, well suited to the toxicological research environment. It provided excellent information on cell distribution, morphology and maturation of the haematopoietic system.     

Infrared spectroscopy: A new diagnostic tool in Alzheimer disease

Biological markers play an evolving role in the diagnosis of Alzheimer disease (AD). We compare conventional measurements of cerebrospinal fluid (CSF) tau and β-amyloid_1–42 proteins to a novel approach – Fourier transformed infrared (FT-IR) spectroscopy – a simple technique derived from chemical and physical sciences that characterizes intramolecular bonds. For automatic diagnostic analysis, we developed an artificial neural network (ANN). We examined 71 patients with a clinical diagnosis of AD and 66 controls. β-Amyloid_1–42 was decreased (sensitivity 80% and specificity 78%); tau was elevated (sensitivity 76% and specificity 88%) in CSF of AD patients. The combined tau/β-amyloid_1–42 quotient was able to distinguish healthy from diseased subjects with 99% sensitivity and 86% specificity. The ANN could separate FT-IR spectroscopy data with 88.5% sensitivity and 80% specificity. FT-IR spectroscopy proved to be cost-effective and simple to perform. Diagnostic sensitivity and specificity is in the range of CSF tau and β-amyloid_1–42 protein analysis. Larger sample numbers for ANN training and validation could increase diagnostic accuracy and thus prove to be a useful screening tool.     

Review of 1,000 consecutive cases of severe head injury treated before the advent of CT scanning

Summary This is a review of 1,000 consecutive cases of severe head injury admitted to our Neurosurgical Department between January 1973 and August 1976, before the advent of CT scanning. All patients were comatose following head injury (GCS8) and were treated homogeneously by the same neurosurgical team by a protocol that included immediate resuscitation on arrival, diagnosis of intracranial lesions by angiography, early surgery when needed, mechanical ventilation, steroids, and mannitol. Extracranial lesions, even if preponderant, were treated by various specialists in the Neurosurgical Department, which for all practical purposes operated as an Emergency Department. Admission criteria were very broad with no preadmission selection. The overall mortality for this series was 45%. A little less than half the patients made good recoveries or remained moderately disabled (47%); 6% were severely disabled, and 2% survived in a persistent vegetative state. More than two-thirds of the patients were brought to our Neurosurgical Department after a short stay at a general hospital; 72% were admitted within 6 hours of injury; 71% were traffic accident victims; and 34% had significant associated extracranial injuries. Carotid angiography was performed in 78% of the patients and indicated the presence of an intracranial haematoma requiring surgery in 36% of the whole series. Mortality was significantly higher in operated than in unoperated patients (56% versus 39%); those treated surgically, however, were older, in worse clinical condition, and showed a higher incidence of acute subdural haematomas associated with brain contusion. Carotid angiography proved very effective in revealing the presence of an expansive lesion but failed to reflect the severity of brain damage, since the group with negative angiograms showed a high mortality (52%). Patients with a lucid interval had a higher percentage of surgical lesions than those with immediate coma (58% versus 26%); but fully 42% of them did not require surgery, and 25% had negative angiograms. From the prognostic point of view the clinical data elicited after initial resuscitation were highly predictive of the outcome: some individual neurological signs, such as mydriasis, posturing and eye movements, were not inferior to the GCS score in that respect. Age also proved a strong predictor, since elderly patients are more likely to have severe subdural and parenchymal lesions and their clinical severity is accordingly greater.Our series amounts to a data bank of cases both contemporary to and in good agreement with that collected by Jennett and his associates in their 1977 multinational study; and it affords a useful reference in the assessment of epidemiological variations and alternative management in relation to outcome.     

显微镜血细胞形态学检验在发热疾病临床诊断中的应用价值及效果评价

目的:评价在发热疾病临床诊断过程中显微镜血细胞形态学检验的临床应用价值。方法:纳入2019年2月~2020年2月在本院接受发热疾病治疗的48例患者作为观察组,接受常规健康体检者48例作为对照组,所有实验对象均给予显微镜血细胞形态学检验,对其检验结果进行分析与比较。结果:统计与分析后发现,观察组患者除平均红细胞血红蛋白外的血细胞形态学指标与对照组健康体检者存在显著差异,具有统计学意义(P<0.05);同时,与对照组健康体检者相比观察组患者异常细胞、白细胞改变、小细胞贫血、大细胞贫血、异型淋巴细胞改变等血细胞形态异常检出率明显较高(P<0.05)。结论:大多数发热疾病患者会出现血细胞形态学异常变化,因此,实施发热疾病患者临床诊断的过程中可以运用显微镜血细胞形态学检验,以便及时发现患者的病情并给予针对性治疗。     

2017—2019年北京某高校教职工健康体检结果分析

目的 掌握中国人民大学教职工的健康状况及变化趋势,为改善教职工的生命质量、提出合理的健康教育和促进策略提供数据支持。方法 将2017—2019年参加体检的中国人民大学的教职工(含离退休人员)纳入研究,对获得的体检资料进行分析,采用χ2趋势检验分析异常指标在2017—2019的变化趋势。结果 2017—2019年有效体检的教职工人数分别为6 082,6 088和6 507人,各年的平均年龄在44～45岁左右,其中女性多于男性。全体职工在2017—2019年3年间高血压检出率分别为16.29%、15.85%、20.01%;高血糖检出率分别为12.20%、17.34%、29.29%;尿酸偏高检出率分别为16.36%、20.28%、20.81%;心电图异常的检出率分别为14.24%、17.58%、19.43%,检出率均逐年递增;而血脂异常检出率分别为44.33%、32.29%、32.1%;血清谷丙转氨酶偏高的检出率分别为9.48%、7.62%、7.82%,检出率呈现降低趋势(P<0.05)。2017—2019年,在各个年龄组中高血糖检出率最低为2017年<35岁组(0.81%),最高为2019年≥60岁组(48.55%);尿酸偏高的检出率最低为2017年<35岁组(15.04%),最高为2018年≥60岁组(24.4%),均明显上升,血脂异常和谷丙转氨酶偏高的检出率在各个年龄组呈下降趋势(P<0.05),血脂异常检出率最低为2019年<35岁组(15.96%),最高为2017年50～59岁组(50.79%);谷丙转氨酶偏高检出率最低为2018年≥60岁组(7.62%),最高为2019年35～49组(12.08%)。校正了年份、年龄和性别后,高血压、高血糖、血脂异常、尿酸偏高、谷丙转氨酶偏高和心电图异常的检出率均随着BMI的升高而递增(P<0.05),各项指标在肥胖组的检出率分别为30.83%、33.7%、58.51%、45.67%、27.97%和21.0%。结论 2017—2019年本校教职工的健康状况不容乐观,高血压、高血糖、尿酸偏高和心电图异常的检出率均呈现上升的趋势,血脂异常的检出率呈现逐年下降,35岁以下教职工心电图异常检出率升高明显。     

303例闭经患者的病因学分析

目的分析统计女性闭经的病因。方法收集2016年1月至2019年6月云南省第一人民医院妇科门诊闭经患者303例,通过病史、查体、抽血查性激素六项、甲状腺功能、空腹血糖等指标、影像学评估及对原发性闭经患者行染色体检查,确定闭经原因并进行统计分析。结果303例患者中,原发性闭经36例(11.89%),继发性闭经267例(88.11%)。导致原发性闭经最常见的疾病为苗勒管发育不全综合征(Mayer-Rokitansky-Kuster-Hauser syndrome,MRKH综合征),36例患者中有7例是MRKH综合征患者,多囊卵巢综合征(polycystic ovarian syndrome,PCOS)是次要原因,有5例患者为PCOS。在继发性闭经中,Asherman综合征和PCOS是最主要的致病原因,分别占29.96%和29.59%。36例原发性闭经患者中,正常核型46,XX患者24例,占原发性闭经患者总数的66.67%。结论闭经患者最常见病因是PCOS和Asherman综合征。