Prevalence of overlap of antineutrophil cytoplasmic antibody associated vasculitis with systemic autoimmune diseases: an unrecognized example of poliautoimmunity

Clinical Rheumatology - We aimed to estimate the frequency of overlap of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) with systemic autoimmune diseases. Retrospective...     

新型冠状病毒与脑血管病的关系

自2019年12月起,2019冠状病毒病(COVID-19,又称新型冠状病毒肺炎)首先在武汉被发现,随后该病迅速蔓延至全国乃至其他国家。该病具有传播广、死亡及重症率高的特点,影响深远,引起国内外的广泛重视。而脑血管病同样为我国人群主要的慢性疾病,每年也可造成一定的死亡及致残风险。COVID-19的发病机制与脑血管病的危险因素以及脑血管病本身都有很密切的关系,易合并存在,引发院内感染。笔者根据COVID-19现有的资料结合以往相关疾病的临床经验对新型冠状病毒与脑血管疾病的关系做一归纳,以求更好地指导临床个体化诊疗。     

Prognostic factors for the survival of patients with papillary renal cell carcinoma after surgical management

To examine the possible prognostic factors in patients with type 1 and type 2 papillary renal cell carcinoma (pRCC) after surgical management and to identify the independent predictive factors of the prognosis. From 2010 to 2017, 1405 patients underwent surgery for renal cell carcinoma, of whom 114 had type 1 or type 2 pRCC and follow-up data were available for 88 patients. Clinicopathological and prognostic parameters were compared between type 1 and type 2 pRCC. Possible prognostic factors were retrospectively analyzed by univariate and multivariate analyses with Cox regression. The study included 63 males and 25 females with a mean age of 54.27 ± 12.91. 53 patients were diagnosed by regular physical examination and others presented with hematuria or lumbago. 53 (60.2%) underwent radical nephrectomy and 35 (39.8%) underwent nephron sparing surgery. After a mean follow-up of 46.08 ± 22.65 months, 16 patients died of pRCC metastasis and the 5-year disease-specific survival was 79.3%. The comparison of the 39 (44.3%) type 1 and 49 (55.7%) type 2 pRCCs revealed that type 2 pRCC had significantly higher grade and worse prognosis. Univariate analysis showed that symptomatic diagnosis, type, grade, and tumor stage were prognostic factors. Multivariate analysis identified that type and tumor stage were independent factors of the prognosis. Pathological type and tumor stage could serve as independent factors for the prognosis of patients with pRCC.     

Comparative study of the relative signal intensity on DWI,FLAIR, and T2 images in identifying the onset time of stroke in an embolic canine model

In acute stroke magnetic resonance imaging, many attempts have been made to identify the onset time of ischemic events using the simply quantitative judgment of relative signal intensity (rSI) from various MR images. However, no uniform opinion has been achieved broadly till now. The controversy might derive from the potential patients’ selection bias of clinical retrospective study, the discrepant MR parameters, and the various sample sizes among different studies. Thus, we evaluated the temporal change of the relative DWI signal intensity (rDWI), relative ADC value (rADC), relative FLAIR signal intensity (rFLAIR), and relative T2 signal intensity (rT2), and further compare their diagnostic value in identifying the hyperacute lesions based on our embolic canine model with clear onset time. Twenty ischemic models were successfully established. All rSI values were linearly correlated to time with significance until 24 h after model establishment (P < 0.05). Paired comparison of ROC curves showed that significant difference was found between rADC and other three rSIs (P < 0.0001). However, no significant difference was found among rDWI, rT2 and rFLAIR. Our results indicated that rDWI, rFLAIR and rT2 may be helpful to predict the onset time of ischemic events with the similar diagnostic value. However, the rADC does not have comparable predictive value in our embolic canine model.     

多元化理念应对突发公共卫生事件的实践与思考

目的　研究安徽省“非典”防治健康教育实践 ,为今后的突发公共卫生事件应急健康教育工作提供可以参考的依据。方法　运用资料分析、座谈等形式 ,研究安徽省“非典”健康教育实践过程 ;运用问卷调查研究“非典”健康教育效果。结果　安徽省运用多元化理念开展“非典”防治健康教育。健康教育机构的工作主要包括组织指导与信息沟通、社会动员与部门协作、材料制作与使用、组织开展健康教育活动等。在“非典”防治健康教育工作开展 1个多月后进行效果调查 ,调查对象“非典”防治知识知晓率为 88.75 % ,相关行为符合率为 81.76 %。结论　健康教育多元化在抗击“非典”过程表现出许多优势。在应急健康教育过程中 ,健康教育机构的主要任务应当是决策支持和信息支持。经常性工作对于应急处理有重要意义。     

湖南省2012—2017年学生肺结核登记情况及流行特征

目的分析湖南省学生肺结核患者登记情况,了解流行特征,为完善全省学校结核防治策略提供依据。方法利用2012-2017年中国结核病信息管理系统中登记的资料,统计分析湖南省学生结核病患者登记率及其流行特征。结果2012-2017年湖南省发现学生肺结核患者7 940例,登记发病率为13.23/10万,涂阳肺结核患者2 203例,登记发病率为3.67/10万。2012-2017年学生活动性肺结核登记发病率比较,差异有统计学意义（χ2=80.079,P<0.001）;2012-2017年学生涂阳肺结核登记发病率比较,差异有统计学意义（χ2=112.213,P<0.001）。二季度学生肺结核登记人数最多（占32.2%）,以男性为主（占60.8%）,年龄以15～19岁为主（占61.8%）。2012-2017年各市州学生肺结核登记情况比较,差异有统计学意义（χ2=320.432,P<0.001）,累计登记总数居前三位的分别是长沙市、湘西州、衡阳市。2012-2017年登记学生肺结核患者来源以转诊为主（占38.8%）,99.8%患者接受抗结核治疗,诊断治疗以涂阴患者、非重症、非耐药、初治患者为主,分别占67.9%、95.2%、99.5%、99.3%。结论应加强学校结核病防治工作,加强对高中和大学入学新生的结核病筛查,定期开展学校结核病知识的宣传,提高学校结核病防治的意识。     

小腿外侧皮瓣在口腔内缺损修复中的应用：附9例报道

目的研究小腿外侧皮瓣在口腔颌面软组织缺损修复中的应用。方法应用该修复方法，共进行了９例口腔颌面部肿瘤术后缺损的修复，并对该皮瓣的应用解剖，制作技术及其优缺点进行了讨论。结果应用的９侧小腿外侧皮瓣均获得成功。结论小腿外侧皮瓣，修复口腔颌面部肿瘤术后的软组织缺损并和腓骨肌皮瓣共蒂和串联修复软组织缺损均是一种可取方法     

地塞米松诱发小鼠腭裂时AnnexinⅠ、cPLA2和PCNA表达的研究

目的 检测膜联蛋白(Annexin Ⅰ)、胞质磷腊酶A2(cytosolic phospholipase A2,cPLA2)、增殖细胞枝抗原(proliferating cell muclear antigen,PCNA)在地塞米松诱导小鼠腭裂腭胚突中的表达变化情况。探讨腭裂的发生机制和预防方法。方法 A/J和C57BL/6j受孕小鼠随机分为正常对照组、地塞米松致畸组（DEX组）、VitB12致畸拮抗组(DE Vit组)和VitB12组。应用蛋白质免疫印迹的方法检测Annexin 0281、cPLA2和PCNA的相对含量。结果 A／J小鼠中，在正常对照组中，随着腭胚突的发育，Annexin Ⅰ表达逐渐升高，其余各实验组也呈相似变化。在DEX组和DEX VitB12组中， AnnexinⅠ的表达明显较对照组和VitB12组高，对照组与VitB12组间差异无显著性。而cPLA2则和对照组与DEX组间在AnnexinⅠ和cPLA2测量差异无显著性。结论 AnnexinⅠ和cPLA2介导了糖皮质激素诱发腭裂的过程。VitB12未能阻遇DEX上调AnnexinⅠ的表达。但可以对抗DEX抑制cPLA2的作用，这可能是VitB12拮抗糖皮质激素致畸作用的机制之一。     

颧骨骨折复位径路与固定部位的临床研究

目的　探讨颧骨骨折复位的径路与钛板固定部位。方法　总结 6 5例 (6 5 / 70 )颧骨或颧骨复合体骨折手术复位固定患者的软组织切口、钛板固定部位、钛板数目 ,术后随访 3～ 2 4个月 ,按三级标准评价手术效果 ,其中包括面形和功能的恢复 ,手术切口愈合情况 ;观察术后X线片 ,统计钛板的固定部位、数目及手术并发症。结果　手术软组织切口均一期愈合 ;面形恢复满意、两侧对称、开闭口功能正常 18例 (2 5 7% ) ;面形恢复两侧基本对称 ,开闭口功能正常 4 6例 (6 5 8% ) ;面形恢复两侧不对称 ,开闭口功能基本恢复为 6例 (8 5 % ) ;头皮下血肿 5例 ,钛板外露 1例 ,头皮有不规则瘢痕且宽度 >0 5cm 6例 ,额部和头皮感觉异常 8例。结论　应用冠状切口 (包括口内联合切口 )对 5 1例(5 1/ 6 5 )进行颧骨和颧骨复合体骨折复位固定 ,具有术野显露广泛、在明视下解剖复位、精确固定的优点。 6 5例共用钛板 179块 ,坚固内固定具有精确固位、外形稳定的优点。单纯颧骨骨折下端内陷或外翘移位可做一点固定 ,其他骨折尤其是复杂或陈旧性骨折均应做二点或多点固定     

F6.5输尿管硬镜联合输尿管鞘治疗女性输尿管上段结石的疗效分析

目的探讨F6.5输尿管硬镜联合输尿管鞘治疗女性输尿管上段结石的临床疗效。方法选取2017年1月至2019年6月于本院行手术治疗的输尿管结石女性患者63例作为研究对象。所有患者均使用F6.5输尿管镜硬镜联合F12/14输尿管鞘进行碎石手术,并使用结石封堵器,患者均为一期手术,术前不常规留置双J管,比较术后手术疗效与安全性。结果所有患者中,找到结石成功率为100%(63/63),一期置鞘成功率90.5%(57/63),术中结石上移率为12.7%(8/63),一期手术成功率为98.4%(62/63)。79.3%(50/63)患者可单纯通过F6.5硬镜联合输尿管鞘处理结石,11.1%(7/63)的患者术中需加用软镜,7.9%(5/63)的患者通过F6.5硬镜联合封堵器处理结石。平均手术时间(54.2±15.7)min,结石净石率为93.6%(59/63),术后出现发热2例(3.2%)。结论选用F6.5输尿管硬镜联合输尿管鞘能减少软镜的使用,提高一期手术成功率,值得临床推广。