放线菌病临床特征及诊断分析

目的 探讨放线菌病的疾病类型以及肺放线菌病的临床表现、影像学表现及诊断,以提高临床医师对放线菌病的诊治水平。方法 回顾性分析2009年1月至2022年12月福建省立医院病理诊断、涂片或培养发现放线菌的病例33例的疾病类型,临床症状、影像学表现及诊断方法。结果 面颈部疾病22例,胸部病例9例,其中肺放线菌病7例,腹部及其他部位病例各1例,其中定植病例为21例（63.6%）,致病病例为12例（36.4%）。在肺放线菌病例中,发现肺放线菌男性比例明显高于女性,临床症状无特异性,可表现为咳嗽（29.4%）、咳痰（17.6%）、发热（23.5%）、咯血（17.6%）、胸痛（11.8%）。影像学表现中发现大部分可表现为中心低密度灶（16.7%）和空洞气泡征（20.8%）。诊断方法以组织病理诊断为主（57.1%）。结论 放线菌病可发生在人体的任何部位,其中面颈部、胸部最常见。在肺放线菌病患者中,临床表现缺乏特异性,胸部CT表现多可出现中心低密度坏死灶,以及典型“空洞-悬浮气泡征”。放线菌培养难度大,诊断大多需要靠组织病理诊断。因此对于怀疑放线菌感染,建议获取组织病理活检结果。     

胸部放线菌病的CT表现并文献复习

目的探讨胸部放线菌病的CT表现,提高临床医师对该病的影像学诊断水平。方法回顾性分析广东省人民医院1995年1月至2008年3月确诊的4例胸部放线菌病病例并复习国内外相关文献。结果4例患者,分别通过CT引导下经皮肺穿刺活检（2例）和支气管镜下活检（2例）获得组织病理学诊断为胸部放线菌病。根据临床资料和影像学特征,此4例患者中1例为支气管放线菌病,3例为肺放线菌病。3例肺放线菌病患者cT表现存在共同的特征：软组织密度影,病灶多发（3例）;可见支气管扩张（2例）;增强扫描病灶环形强化,肿块中见大片低密度坏死,坏死区多发虫蚀样空洞（3例）;邻近胸膜增厚（3例）,纵膈和肺门淋巴结肿大（3例）。结论肺放线菌病的典型CT表现为慢性节段性有空泡的肺部实变影,实变区域中有低密度区,周围组织强化,邻近胸膜增厚,纵膈和肺门淋巴结肿大。该病临床少见,容易误诊造成不必要的外科手术。     

AIDS病患者常见的胸部影像表现及其病理机制初步探讨

目的 探讨AIDS病患者常见的胸部影像表现及其病理机制。方法 归纳1996-1999年在博茨瓦纳玛丽娜公主医院（PMH）527例AIDS病患者的胸部影像资料。结合其临床资料和实验室检查结果,随访其治疗和结果。结果 肺部感染以肺结核（PTB）多见,在AIDS病早期其影销售量表现同陈旧性结核复燃;在后期同原发性肺结核表现一致,卡氏肺囊虫性肺炎（PCP）典型影像表现为渗出性病变分布于肺门周围,向周围肺野发展呈明显融合趋势,细菌性肺炎的影像表现与正常人群大致相同。但进展快,程度重,淋巴瘤表现为非典型性纵隔淋巴结肿大,合并其它部位淋巴结肿大。     

胸腺增生1例

1病例介绍 患儿男．18天．出生后24小时内出现呼吸加快急促，口唇青紫，喉有痰鸣、低热，听诊肺部湿啰音明显，按肺炎治疗7天，病情缓解、体温下降，但仍有喉痰鸣，8天后病情加重。 X线胸片（见图1、2）：右肺上叶呈致密性改变，局部纵隔及气管向右侧移化。电视下动态显示右上纵隔旁沿纵轴呈类椭圆形致密影，边缘隐约可见，其外周显示充气的肺组织影。X线诊断：右上纵隔旁软组织块影原因待查，同时合并肺不张。CT平扫（见图3、4）：右上肺呈片状密度增高影，内缘紧贴纵隔缘。病灶内可见充气支气管征，下肺野清晰。纵隔上部向右移位．纵隔内未见明显肿大淋巴结影。CT诊断：右上肺不张。手术所见：开胸后发现胸腺明显增大，压迫右上肺支气管形成右上肺不张。剥开胸腺并经气囊注气后右上肺复张，遂将增大之胸腺切除。术后诊断：胸腺瘤。切后胸腺组织标本送病理室，病检结果为胸腺增生。     

84例老年肺部真菌感染的临床分析

探讨肺部真菌感染的临床特点、胸部X线表现、真菌感染的类型及预后。对2002年1月至2006年12月84例肺部真菌感染病例进行回顾性分析。100％的患者有基础疾病，其中以慢性阻塞性肺疾病（COPD）、长期机械通气、晚期肿瘤为多见，原发性肺部真菌感染少见。肺部真菌感染的，临床表现无特异性，X线表现以支气管肺炎多见（79．8％），病原菌主要以酵母菌属为主（83．3％），肺部真菌感染病死率较高。肺部真菌感染是多种疾病继发感染的重要原因，发病呈上升趋势，应引起，临床高度重视。     

81例原发性小肠肿瘤诊治体会

目的探讨原发性小肠肿瘤的临床表现、影像诊断、治疗方法及术后病理。方法回顾性分析安徽医科大学第一附属医院2005年1月-2009年1月间经手术或术前内镜病理证实的81例原发性小肠肿瘤临床资料。结果病理：腺癌58例，恶性间质瘤17例，腺瘤局部癌变1例，腺瘤2例，神经内分泌瘤1例，未分化癌1例，平滑肌肉瘤1例部位：十二指肠55例（67．9％），空肠19例（23．5％），回肠7例（8．6％）。常见临床表现：腹痛，黄疸，腹部包块，肠梗阻，消化道出血，肠穿孔。内镜、X线钡餐、B超、CT、MRCP、ERCP、血管造影是主要检查方法。结论原发性小肠肿瘤早期临床表现无特异性，内镜影像学可增加疾病检出率，手术是治疗的主要方法。     

肺平滑肌肉瘤6例临床分析并文献复习

目的:探讨肺平滑肌肉瘤的临床特点及预后,为临床早期诊断、治疗提供更全面的参考依据。方法:回顾性分析6例肺平滑肌肉瘤的临床资料并进行文献复习。结果:6例患者主要症状为咳嗽、咳痰、胸痛;胸片示肺野肿块影或团块影最常见;肺部CT检查常可发现肿块影,纵隔或肺门淋巴结肿大等改变,增强扫描呈不均匀强化;病理需结合免疫组化检查确诊;手术治疗5例,放疗1例。结论:肺平滑肌肉瘤发病率低,纤维支气管镜和经皮肺穿刺活组织检查可明确诊断,治疗以手术为主,同时应结合放疗、化疗等多学科综合治疗。     

629例肾小球疾病病理类型及流行病学分析

目的探讨629例已接受肾活检的患者肾小球疾病病理类型及流行病学特点。方法对驻马店地区629例肾活检病理资料进行回顾性分析。结果肾小球疾病患者行肾活检时的年龄11-81岁,平均年龄（40.2±14.7）岁。病因分布：原发性肾小球疾病530例（84.3%）,继发性肾小球疾病94例（14.9%）,小管间质性疾病5例（0.8%）。病理类型分布：原发性肾小球疾病中男性多见,以膜性肾病为主,共218例（41.1%）;肾小球轻微病变122例（23.0%）;Ig A肾病84例（15.8%）;系膜增生性肾小球肾炎45例（8.5%）。继发性肾小球疾病中以狼疮性肾炎为主,共46例（48.9%）,并以女性多见;紫癜性肾炎12例（12.8%）;糖尿病肾病9例（9.6%）。结论驻马店地区的肾脏疾病患者中以原发性肾小球疾病为最常见,其中又以膜性肾病占多数,其次为微小病变肾小球肾炎和Ig A肾病,而在继发性肾小球疾病中,狼疮性肾炎占主要地位,青年女性多发。肾小管间质性肾病及遗传性肾病较少见。     

肾组织活检359例临床病理分析

目的：探讨成人肾活检患者各种肾脏病理构成比例及其临床表现关系。方法：参照WHO肾小球疾病组织学分型方案,回顾性分析359例肾活检的临床资料。结果：患者平均年龄（29.26±14）岁。原发性肾小球疾病占首位（55.99%）,继发性肾小球疾病占44.01%。原发性肾小球疾病的病理类型中最多见者为系膜增生性肾小球肾炎（49.25%）,其次为IgA肾病（29.85%）和局灶节段性肾小球硬化（8.96%）。继发性肾小球疾病中狼疮性肾炎（34.18%）占首位,其次为紫癜性肾炎（21.52%）和乙肝相关性肾炎（17.09%）。结论：以原发性肾脏疾病最常见,其中系膜增生性肾小球肾炎是最常见的病理类型,其次为IgA肾病。继发性肾小球疾病以狼疮性肾炎、紫癜性肾炎和乙肝相关性肾炎居3位。原发性肾病综合征中非IgA系膜增生型肾病最常见。     

肺结核并肺部真菌感染的临床特点及诊治方法

目的：探讨肺结核并肺部真菌感染的临床特点及诊治方法。方法回顾性分析2012年2月—2014年1月田林县人民医院收治的26例肺结核并肺部真菌感染患者的临床资料。观察所有患者临床表现、真菌类型、合并症、X线检查结果、转归，探讨治疗方法与治疗结果。结果患者均有发热、咳嗽、咳痰的临床表现；白色假丝酵母菌感染最常见（61.54%），其次为光滑假丝酵母菌感染（11.54%），热带假丝酵母菌、曲霉菌、酵母菌及毛霉菌感染少见；患者合并支气管扩张9例（34.62%），合并慢性阻塞性肺疾病10例（38.46%），合并糖尿病3例（11.54%），合并肾功能不全2例（7.69%），其中合并2种及以上疾病者8例（30.77%），低蛋白血症6例（23.08%），T淋巴细胞下降7例（26.92%），贫血5例（19.23%）；胸部X线检查示双肺呈多发云絮状改变13例（50.00%），弥散分布大小结节影5例（19.23%），斑块、斑点实变伴纤维条索阴影5例（19.23%）；结核灶累及3个以上肺野23例（88.46%），空洞形成16例（61.54%）；感染真菌表现为病灶扩大、播散、增浓20例（76.92%）；治疗后患者治愈或明显好转25例（96.15%）；感染性休克死亡1例（3.85%）。结论肺结核并肺部真菌感染与机体免疫功能下降及多种因素有关，临床表现多为肺结核相关症状加重，通过胸部X线及痰检查可进行诊断，根据痰检查中分离得相关真菌予以对症药物治疗可获得满意的临床治疗效果。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.