外周血涂片发现白细胞聚集1例

外周血白细胞聚集是一种罕见现象,根据细胞聚集的类型可以分为中性粒细胞聚集、淋巴细胞聚集、混合细胞聚集等.白细胞聚集导致白细胞计数(WBC)假性升高或假性降低均有报道[1-4],而本例白细胞聚集对 WBC未产生明显影响,现报道如下.     

不同针法分期治疗肩关节周围炎90例

ObjectiveTo observe the clinical efficacy of different acupuncture modalities in the treatment of adhesive capsulitis a tthrough different clinical stages.MethodsNinety patients of adhesive capsulitis weregraded in three different stages based on clinical presentations. Patients in painful stage were treated with silver needles once every 5to 7 days for two courses; patients in adhesive stage were given acupotomy treatment every 7 to 10 days for two courses; while patients in recovery stage were treated with acupuncture with warm needles by moxibustion on tendon knots, once a day 10 times in a course, for two courses of treatment. The disease scores were compared between all groups before and after the treatment, and clinical efficacy was evaluated after the treatment.ResultsThe disease scores in patients of all three stages were higher after treatment, and the differences were statistically significant (all P < 0.05). Among 90 patients with adhesive capsulitis, 32 cases were clinically under controlled, 37 cases claimed remarkably effective, 18 were effective, and 3 ineffective cases, thus the total effective rate for this stage-based treatment is 96.7%.ConclusionFor adhesive capsulitis,different acupuncture modalities targeting patients in different clinical stages were feasible and effective, the disease scores of patients were significantly improved.     

非小细胞肺癌患者呼出气冷凝液与血清及组织中miRNA486检测的比较研究和临床意义

摘要：目的?分析非小细胞肺癌(NSCLC)患者呼出气冷凝液(EBC)中microRNA486(miR-486)的表达水平及其临床应用价值。方法?选取2016年6月至2017年12月在南通市第一人民医院呼吸科和胸外科接受治疗并经病理证实为NSCLC的50例患者为研究组，50例健康体检者为对照组。用实时定量PCR技术检测EBC和血清中miR-486的表达水平，同时检测NSCLC患者组织中miR-486的表达水平。用化学发光法检测血清中CEA、细胞角蛋白19片段(CYFRA211)的表达水平。分析miR-486在NSCLC不同病理分期和病理类型的表达水平差异；并用ROC曲线分析EBC miR-486单独及其联合血清CEA、CYFRA211对NSCLC的筛查效能。结果?NSCLC患者EBC和血清中miR-486的相对表达量低于对照组(P<0.05)。非小细胞肺癌晚期(Ⅲ～Ⅳ期)患者EBC和血清中miR-486的表达量低于早期(Ⅰ～Ⅱ期)患者(P<0.05)。ROC分析显示，EBC和血清中miR-486诊断NSCLC的敏感性分别为92%、74%；特异性分别为52%、72%，miR-486与血清CEA、CYFRA211联合筛查非小细胞肺癌敏感性为72%，特异性为78%。结论?miR-486在NSCLC患者癌组织、血清和EBC中均低表达，EBC中miR-486与血清CEA、CYFRA211联合检测对NSCLC的早期诊断有潜在的价值。     

以短暂性脑缺血发作为首发症状的蛛网膜下腔出血1例报告

蛛网膜下腔出血(subarachnoid hemorrhage, SAH)是一种致死率极高的脑血管疾病,约占所有脑卒中的5%~10%,其中动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoidhemorrhage, aSAH)约占所有SAH 的80%[1],及时识别和早期治疗可改善患者临床预后。此类疾病通常表现为突发剧烈头痛并贯穿整个病程,可伴有恶心呕吐、颈项强直、局灶性神经功能障碍等症状。但是在部分患者中,临床表现并不典型,因此常常被误诊而延误病情。以类似短暂性脑缺血发作(transient ischemic attack, TIA)为首发症状的非动脉瘤性SAH 在国内外已有报告[2-3]。但目前以此为首发症状的aSAH在国内外尚未见报告,现报告1 例以TIA 为首发症状的aSAH 病例,为非典型表现SAH的诊断提供一定借鉴。     

皮下脂膜炎样T细胞淋巴瘤叠加红斑狼疮病理特征一例

患者男，49岁。因皮下结节9个月余，发热5 d，于2018年11月19日至我院就诊。患者9个月前无明显诱因全身出现多个散在直径2 ~ 5 cm皮下结节，曾于我院行皮损活检，提示“皮下脂膜炎，不除外皮肤T细胞淋巴瘤”，当时未予特殊处理……