儿童脓毒症与噬血细胞综合征的临床异同关系

儿童脓毒症是严重感染所致的宿主免疫反应失调,噬血细胞综合征(HLH)是自然杀伤细胞/细胞毒性T细胞过度激活导致的过度免疫活化综合征,两种疾病都可导致危及生命的多器官功能障碍,临床特征既有相似又存在差异,且脓毒症可能进展为HLH,HLH也可继发脓毒症。本文就脓毒症和HLH的临床异同关系进行综述,为临床医生提供更深入的认识。     

肺结核并发肺癌患者的临床特征及生存状况研究

目的探讨肺结核并发肺癌患者的临床特征及生存状况。方法该院2009年6月至2014年6月收治的80例肺结核并发肺癌患者,分析首次病发症状、肿瘤特征、影像学特点和生存状况。结果首次病发症状:咳嗽36例(45.00%)、咯痰咯血22例(27.50%)、胸闷25例(31.00%)、胸背部疼痛18例(22.50%)、发热22例(27.50%)。CT和病理学检查:单侧肺部肿瘤87.50%,周围型肿瘤65.00%,中后期肿瘤40.00%,腺癌30.00%。肿瘤直径范围:2.2~10.1cm,平均直径5.1cm。病灶部位:合并空洞影15例(18.75%),结节团块组织密度影35例(43.75%),右上肺突变影5例(6.25%),右中叶肺不张5例(6.25%),上肺突变影4例(5.00%),双肺弥散结节影8例(10.00%),肿瘤与结合病灶部位同侧38例(47.50%),不同侧30例(37.50%),双侧结核病灶11例(13.75%)。随访调查:女性、年龄小于55岁、无吸烟史、肿瘤直径小于5.1cm、中央型位置、Ⅰ期、稳定性肺结核、肿瘤与结核不同侧和手术治疗的患者的累积生存5年时间的比例较高(P0.05)。肺结核并发肺癌患者的1年累积生存率为66.70%,3年45.00%,5年30.00%。结论女性、年龄小于55岁、无吸烟史、肿瘤直径小于5.1cm、中央型位置、Ⅰ期、稳定性肺结核、肿瘤与结核不同侧和手术治疗的患者的生存时间较长。     

高职护理专业不同人口社会学特征学生人际容纳状况的差异性研究

目的分析不同人口社会学特征学生人际容纳状况的差异性。方法采用自制高职护理专业学生一般资料调查表和Fey编制的容纳他人量表和被他人容纳量表对336名学生进行调查,按照不同人口社会学特征进行对比分析。结果高职护理专业学生人际容纳首期评价(71.72±2.9)分、后期评价(79.37±2.4)分。容纳他人、被他人容纳、人际容纳总分,三校生均高于普高生(P0.05),非独生子女高于独生子女(P0.05),学习成绩优秀者高于成绩一般者(P0.05)。与首期评价相比,各类型学生经过专业后期教育与临床实习,人际容纳总分明显提高(P0.05),普高生与三校生比较已无差异,而非独生子女仍高于独生子女(P0.05),学习成绩优秀者仍高于成绩一般者(P0.05)。三校生、非独生子女、学习成绩优秀者容纳他人与被他人容纳呈正相关(r=0.298~0.419,P0.01)。普高生、三校生、单亲家庭、独生子女与学习成绩优秀者之间呈正相关(P0.05)。结论后期教育对提高学生人际容纳起积极作用,同时高职教育应针对不同人口社会学特征的学生进行个性化教育。     

Pulmonary mucoepidermoid carcinoma in Chinese population: a clinicopathological and radiological analysis

Background: Pulmonary mucoepidermoid carcinoma (PMEC) is a rare malignant neoplasm with remarkable resemblance to mucoepidermoid carcinoma of the salivary glands. It constitutes a unique set of patient population. In this study we briefly discussed the current state of knowledge of PMEC and described the clinical presentation and management of 27 PMEC cases. This study aimed to discuss the utility of surgical treatment in the patients with pulmonary mucoepidermoid carcinoma. Methods: We retrospectively studied 27 cases with the diagnosis of PMEC, divided into low grade and high grade based on histopathological characteristics. The clinical symptoms, radiological manifestations, pathological characteristics, treatment strategy and prognosis were systemically analyzed. Results: The tumor could occur in any lobe of the lungs. The treatment included surgical intervention and/or adjuvant therapies. While the sex-age distribution and initial staging was not different between low- and high- grade PMEC, the disease control rate (95%) and 5 year survival (95%) were much higher in low-grade PMEC than the high-grade cases (57.1% and 42.9%, respectively). Conclusion: The clinical, radiographical and pathological features of PMECs were systemically analyzed and summarized, and the utility of pathological grading system as the independent prognostic factor in addition to clinical staging was confirmed.     

Recurrent subependymoma of fourth ventricle with unusual atypical histological features: A case report

Subependymoma is a rare subtype of benign ependymal neoplasm with distinct histological features. Anaplastic transformation has not yet been reported in this tumor to date. We present here a very unusual case of a 62‐year‐old woman with recurrent subependymoma of the fourth ventricle with multiple atypical histological features. Histologically, the resected recurrent tumor showed characteristic small cell clusters and nests of ependymal cells with an interspersed gliofibrillary matrix as seen in a classic subependymoma. In addition, there were very unusual histological features, including multiple areas of necrosis, microvascular proliferation, thrombosed blood vessels, and scattered mitotic figures. No coexisting ependymoma component of higher World Health Organization (WHO) grade was present. Immunohistochemically, MIB‐1 labeling index was high, with up to 15% in the highest areas. Review of this patient's initial tumor, which was resected 6 years prior to recurrence, demonstrated features of a typical classic subependymoma without atypical features or a secondary tumor component. Subependymomas are known to be low‐grade tumors and are usually cured if completely excised. The tumor presented here is unique in that several atypical pathological features were found in an otherwise typical subependymoma. Our case may represent anaplastic transformation of subependymoma, although no such examples have been reported to date.     

脑膜血管周细胞瘤临床病理分析

目的:探讨脑膜血管周细胞瘤(hemangiopericytoma,HPC)的临床病理特点及鉴别诊断.方法:对9例脑膜HPC患临床病理资料进行回顾性分析和随访15~95个月,并复习相关文献.结果:脑膜HPC常见症状为头痛头昏、肿瘤压迫和颅内高压;CT/MRI检查见肿瘤与脑膜相连,增强扫描明显强化.光镜下肿瘤细胞丰富,核圆形或卵圆形,核仁不明显;间质富含"鹿角状"血管,网状纤维包绕单个瘤细胞.免疫标记瘤细胞CD34局灶阳性,PR阴性,1例EMA局灶弱阳性.7例随访15~95个月,4例术后复发,复发病例中1例术后35月腰椎转移.结论:脑膜HPC是一种少见肿瘤,确诊需依靠病理学检查.脑膜HPC影像学上与脑膜瘤相似,但其生物学行为、病理组织学及预后不同于脑膜瘤,易复发和远处转移,术后需长期随访.     

流浪精神障碍患者临床特征与安全管理对策

目的:了解流浪精神障碍患者的临床特征和危险因素,为进一步改进安全管理措施提供依据。方法:对收治由"110"民警送入院的120例流浪精神障碍患者,进行回顾性统计分析。结果:1流浪精神障碍患者共73例,其中男性47例,女性26例,男性多于女性,差异有统计学意义(P<0.05);年龄18~68岁,平均年龄(33.95±12.24)岁;2合并躯体疾病30例(41.10%),以感染性疾病、皮肤软组织损伤、中重度贫血比例为高。结论:精神障碍患者外出流浪既有病理、心理和社会因素,又有独特社会人口学特征,掌握流浪精神障碍患者的临床特征,有效规避了精神科护理安全的风险,保证了患者的安全。