血源播散性肺结核继发噬血细胞综合征1例

Hemophagocytic lymphohistiocytosis (HLH) was a life-threatening syndrome due to the uncontrolled immune activation of cytotoxic T lymphocytes, natural killer (NK) cells, and macrophages. HLH is characterized by primary and secondary causes, the early diagnosis and treatment of patients are closely related to the prognosis and clinical outcome of patients. The clinical presentation is variable but mostly includes prolonged fever, splenomegaly, coagulopathy, hypertriglyceridemia, and hemophagocytosis, none of them is specific and particular for HLH. Tuberculosis (TB) infection is one of the causes of HLH. HLH caused by TB is very rare clinically, but it has a high mortality. For patients with fever of unknown origin, HLH-related clinical manifestations sometimes present before the final diagnosis of TB, and HLH is associated with the most significant mortality rate. This article is mainly about a 28-year-old patient with HLH who suffered from severe TB infection. The patient attended a hospital with a history of 2 months of prolonged fever, 10 days booger and subcutaneous hemorrhage in lower limbs. Before this, he was in good health and denied any history of tuberculosis exposure. Combined with relevant laboratory test results (such as splenomegaly, hemoglobin, platelet count, and hypertriglyceridemia) and clinical manifestations (e.g. fever), the patient was diagnosed with hemophagocytic lymphohistiocytosis, but the etiology of HLH remained to be determined. To confirm the etiology, the patient was asked about the relevant medical history (intermittent low back pain) and was performed chest CT scan, bone marrow biopsy, and fundus photography. Finally, he was diagnosed with hemophagocytic lymphohistiocytosis caused by hematogenous disseminated pulmonary tuberculosis. In response to this, intravenous methylprednisolone and anti-tuberculosis treatment (isoniazid, pyrazinamide, moxifloxacin, and amikacin) were administered to the patient. After more than a month of treatment, the patient recovered from HLH caused by severe TB infection. Therefore, this case suggests that we should be vigilant to the patient who admitted to the hospital with fever for unknown reasons, to diagnose HLH as early as possible and clarify its cause, then perform interventions and treatment, especially HLH secondary to tuberculosis. Also, cases of atypical TB and severe TB should be carefully monitored to achieve early diagnosis and early intervention.     

肝细胞癌组织Glypican3和Sonic Hedgehog蛋白表达及其功能分析*

目的 探讨肝细胞癌(HCC)组织Glypican3(GPC3)和Sonic Hedgehog(Shh)蛋白表达及其功能分析。方法 取96例HCC患者癌组织和癌旁肝组织,体外培养HepG2、MHCC97H、Huh7和SMMC7721细胞,采用免疫组织化学染色法检测组织GPC3和Shh蛋白表达水平,采用免疫荧光染色和蛋白印迹法检测体外培养的肝癌细胞GPC3和Shh蛋白表达,应用String数据库预测GPC3和Shh蛋白之间相互作用。结果 在96例HCC癌组织,GPC3和Shh阳性率分别为77.1%和68.8%,而两种蛋白高表达率分别为60.4%和53.1%;高分化HCC癌组织GPC3蛋白阳性率为85.7%,显著高于低分化组的50.0%(P<0.05), Shh蛋白阳性率为81.0%,显著高于低分化组的40.0%(P<0.05);存在微血管侵犯(MVI)的HCC癌组织GPC3蛋白阳性率为72.7%,显著高于无MVI组的50.0%(P<0.05),Shh蛋白阳性率为65.9%,显著高于无MVI组的42.3%(P<0.05);体外培养的HepG2、MHCC97H、Huh7和SMMC7721四种肝癌细胞胞浆GPC3和Shh蛋白共表达,两种蛋白表达趋势一致。结论 GPC3和Shh蛋白可能影响HCC肿瘤细胞分化和MVI形成,并且两种蛋白可能存在共表达及相互作用。     

牵引加推拿治疗腰椎间盘突出症疗效欠佳病例原因分析

采用牵引加推拿治疗腰椎间盘突出症220例，取得了一定的疗效，但其中56例疗效欠佳，文中对这56例进行了分析总结，提出了治疗中的注意事项。     

100例正常围产新生儿足背动脉血流速度检测分析

动静脉血流疾患、心脏疾患及休克、心衰、新生儿硬肿症等,均可引起肢体血流速度的改变。目前国内尚无新生儿足背动脉血流速度测定值的报告。为了提供正常新生儿足背动脉血流速度正常值,进一步研究新生儿硬肿症、休克、心衰的诊断指标积累资料,对100例正常新生儿足背动脉血流速度做了检测分析,报告如下。     

自拟“巨牛升板汤”治疗原发性血小板减少性紫癜30例

[目的]探讨"巨牛升板汤"降低血小板抗体,提升血小板的效果。[方法]60例原发性血小板减少性紫癜(ITP)患者随机进入治疗组和对照组各30例,两组同时服用糖皮质激素(强的松),治疗组在服用激素的同时,加入具有"清肺败毒、活血化瘀"的"巨牛升板汤",观察血小板升高、血小板抗体降低、激素减量后血小板升高及稳定情况。[结果]治疗组和对照组总有效率为分别为96.67%和50.00%,两组总有效率比较,差异有统计学意义(P<0.05),治疗组明显优于对照组。[结论]"巨牛升板汤"治疗原发性血小板减少性紫癜(ITP)可平稳撤减激素,降低血小板抗体,升高血小板。     

子宫癌肉瘤和子宫肉瘤的MR影像特征在术前手术方案评估中的意义初探北大核心CSCD

目的探讨在术前评估中MR影像特征对子宫癌肉瘤和子宫肉瘤鉴别诊断的应用价值。方法回顾性分析2010年4月~2021年5月经手术病理证实的21例子宫癌肉瘤和20例子宫肉瘤资料,由2位放射科医生评估下列MR指标:肿物大小、中心位置、生长类型分型、肿瘤出血、淋巴结增大,比较2组临床和MR表现上的差异。结果癌肉瘤组90%(19/21)肿瘤中心位于宫腔,肉瘤组为40%(8/20)(P=0.001);癌肉瘤组和肉瘤组肿瘤出血出现率分别为48%(10/21)和80%(16/20)(P=0.031)。2组其他影像学指标和临床资料差异无统计学意义(P>0.05)。结论通过盆腔MR平扫观察肿瘤中心位置可以在一定程度上区分子宫癌肉瘤与肉瘤,提示临床即便子宫肿瘤在术前活检及快速冰冻病理均未提示肿瘤内存在癌的成分,但MR提示肿物为宫腔来源,仍需要警惕肿瘤中癌成分的存在,可能存在淋巴结活检或进行淋巴结清扫的必要性。     

CD44及CK18在卵巢浆液性癌中的表达及临床意义

目的:研究卵巢浆液性癌中CD44及CK18的表达及预后意义。方法:免疫组化法检测CD44及CK18蛋白在72例卵巢浆液性癌组织中的表达水平,分析其表达水平与卵巢癌临床病理指标的相关性。结果:CD44及CK18的阳性表达率分别为66.7%及100%。CD44阳性的肿瘤细胞呈团簇状分布于肿瘤组织中,这种表达模式在高级别浆液性癌中更明显。CK18表达与患者年龄、淋巴结转移有关(P分别为0.014及0.015);CD44、CK18表达与化疗效果、总生存期及无病生存期无关。卵巢浆液性癌中CD44、CK18表达无相关性。结论:CD44及CK18蛋白在卵巢浆液性癌组织中的表达能在一定程度上反映患者的预后,但与化疗效果及生存期无关。     

成熟性囊性畸胎瘤伴肠型黏液上皮进展为交界性黏液性肿瘤1例

<正>1病例资料患者,女,32岁。发现盆腔肿物7年,每年复查超声,肿块逐渐增大,无明显压痛。体检一般情况良好;专科检查,脐下偏左侧可触及大小约6 cm×6 cm大小肿块,压痛,边界清楚,活动度较差。腹部CT：左侧附件区囊性占位性病变,少量盆腔积液。