克罗恩病肉芽肿的临床意义

目的通过比较克罗恩病肉芽肿组与非肉芽肿组的临床特点,探讨肉芽肿的临床意义。方法对1995—2005年期间北京协和医院住院病历中符合克罗恩病的75例患者进行回顾性分析。结果肉芽肿组较非肉芽肿组在疾病活动度、免疫抑制剂的使用、手术次数及术后并发症等方面无明显升高。结论肉芽肿可能是疾病严重程度的一个标志,有待进一步的研究和认识。     

降钙素原和白介素-6在感染性疾病病原体诊断中的联合检测价值

目的 探讨降钙素原（PCT）与白介素-6（IL-6）两种血清学标志物在感染性疾病,病原体种类检测中价值.方法 采用上转发光免疫分析仪及配套试剂检测79例细菌感染性疾病患者、59例病毒感染性疾病患者和68例健康体检者血清样本中PCT和IL-6含量,应用受试者工作特征（ROC）曲线进行分析.结果 细菌感染组PCT和IL-6含量高于病毒感染组及正常对照组,差异具有统计学意义（P＜0.05）,病毒感染组PCT和IL-6含量与正常对照组比较差异不具统计学意义（P＞0.05）;应用ROC曲线分析PCT和IL-6鉴别诊断细菌感染的效能,曲线下面积分别为0.854和0.783,显示PCT效能优于IL-6;对三组的PCT与IL-6水平进行了相关性分析,结果显示,PCT与IL-6在检测细菌感染中成线性相关（r=0.424,P＜0.001）;对两项指标进行单项检测时,PCT的灵敏度和特异性分别是82.3％和79.5％,IL-6的灵敏度和特异性分别是69.6％和68.5％;二者联合检测时灵敏度和特异性是88.6％和67.0％.结论 在病原微生物的感染诊断中,PCT是一个优秀指标,若能与IL-6联合检测,更有利于细菌感染性疾病与病毒感染性疾病的鉴别诊断.     

Clinical significance of Y chromosome loss in hematologic disease

We have studied 215 male patients (aged 45-97 years) whose sole cytogenetic abnormality was clonal loss of the Y chromosome in metaphase cells from unstimulated cultures. The patients comprised a control group with no evidence of hematologic disease and four disease case groups: 1) myelodysplastic syndrome (MDS), refractory anemia, refractory anemia with excess blasts (RAEB), RAEB in transformation, and chronic myelomonocytic leukemia; 2) acute myelogenous leukemia; 3) myeloproliferative disorder (MPD), chronic granulocytic leukemia, and polycythemia vera; and 4) B-cell lymphoma/leukemia. The frequency of cells with Y loss increased with age and was significantly greater in cases than in controls, but it was not correlated with survival or with prior therapy. The frequency of cases with a -Y clone was 6.3% of male karyotypes and represented 16.4% of all abnormal male cytogenetic reports. Much of the difference between cases and controls appears to be accounted for by a greater frequency of cases with > 75% Y loss. A value of 81% chromosome Y loss maximized the combined sensitivity (28%) and specificity (100%) for predicting disease status, but a 75% cutoff provided the best estimate of disease risk. Even in older males, if > 75% of metaphase cells are 45,X,-Y, they probably represent a disease-associated clonal population, and it is possible that the critical genetic change is not visible through the microscope. This observation is true for MDS, MPD, B-cell disease, and especially acute myelogenous leukemia. The prognostic association of Y chromosome loss for survival appears to be neutral or favorable. Genes Chromosomes Cancer 27:11-16, 2000.     

儿童14和6Hz正相棘波的临床意义

目的：对ＥＥＧ具有１４和６Ｈｚ正相棘波的儿童进行病因学和ＥＥＧ的分析，以评价其临床意义。方法：应用电视录相ＥＥＧ对２～１４岁各种症状儿童进行自然睡眠监测，分析正相棘波的出现率及相关因素。结果：２６２例各种症状的患儿中有３２例出现这种正相棘波，出现率为１２％。癫痫组、植物神经症状组和精神行为症状组儿童正相棘波的出现率无明显差别。对出现这种正相棘波的ＥＥＧ分析表明，伴随其他非特异性异常脑电现象者正相棘波出现率明显高于具有正常ＥＥＧ或癫痫样放电ＥＥＧ者（Ｐ＜０．０５）。结论：这种正相棘波是一种非特异性的异常脑电现象，无病因学方面的意义，和癫痫活动无关。     

关节液中纳米颗粒的测量对关节疾病诊断的意义

 目的：探讨不同状态下关节液中纳米颗粒与关节疾病种类的相关性。方法：抽取正常人、膝关节骨性关节炎（KOA）和滑膜炎（KTS）患者的关节液，利用准弹性激光散射技术测定关节液中纳米颗粒的粒度大小及其分布，利用相分析电泳光散射技术测定关节液纳米颗粒的Zeta电位，并采用相关分析方法分析纳米颗粒的粒度、Zeta电位与疾病的相关性。结果：KOA和KTS关节液纳米颗粒的平均粒度和Zeta电位都分别显著大于正常对照（P<0.01），粒度和Zeta电位分布曲线比正常对照组的宽（P<0.01）。关节液中纳米颗粒的平均粒度（r_p=0.7972，P<0.01）、Zeta电位（r_p=0.6319，P<0.01）与关节的疾病种类存在很好的相关性。结论：关节液纳米颗粒的粒度和Zeta电位与关节疾病存在显著的相关关系, 可建立起一个关节疾病早期诊断的检测方法。     

Clinical significance of combined detection of interleukin-6 and tumour markers in lung cancer

Tumour markers play an important role in the early diagnosis and guidance of prognosis of lung cancer. This study focused on the significance of combined monitoring of interleukin (IL)-6 and tumour markers in improving the specificity and sensitivity of lung cancer diagnosis and disease. The expression of IL-6, carcinoembryonic antigen (CEA), neuron-specific enolase (NSE) and cytokeratin 19 fragment antigen 21-1 (CYFRA21-1) in serum of patients with non-small cell lung cancer (NSCLC) (n?=?138) was significantly higher compared to patients with benign pulmonary lesions (BPL) (n?=?60) and was associated with the clinicopathological features of NSCLC patients. The simultaneous increase in the expression of IL-6 and tumour markers worsened the prognosis of patients. Lung cancer cells were grouped into the blank control group, IL-6 group, niclosamide group (IL-6 pathway inhibitor, NIC) and IL-6?+?NIC group. The expression of CEA, NSE, CYFRA21-1, p-Erk1/2 and p-AKT in the IL-6 group was significantly higher compared to the other groups. Therefore, the combined detection of IL-6 and tumour markers is critical to improve the specificity and sensitivity of lung cancer diagnosis. This in-depth study not only helped to elucidate the mechanism of how IL-6 promotes lung cancer but also provided new ideas and entry points to resolve the low specificity and sensitivity of lung cancer-related tumour markers.     

广州市6例克雅氏病病例特征分析

目的探讨克雅氏病（CJD）的临床表现,提高对该病的诊治能力。方法收集广州市报告的CJD患者共6例,均行磁共振成像（MRI）和脑电图检查,14-3-3蛋白及PRNP基因检测。结果多为急性亚急性起病,首发症状以进行性痴呆（2例）和椎体外系症状（2例）为主。病例均无痴呆类疾病家族史和手术、脑垂体生长激素使用史。MRI检查显示,无特异性异常信号。脑电图检查结果,均出现弥漫性慢波,4例出现特征性的周期性三相波。3例14-3-3蛋白阳性,而PRNP基因序列分析均为无突变型。1例进行脑组织活检,蛋白酶K抗性朊蛋白（PK抗性PrP）阳性。结论 CJD早期临床表现不典型,脑脊液14-3-3蛋白检测和持续动态的脑电图检查可能是CJD早期诊断的特异性方法。     

胃癌中HMGA2与HDAC6表达的临床意义及其相关性

目的检测胃癌中高迁移率族蛋白2(HMGA2)和组蛋白去乙酰化酶6(HDAC6)在胃癌中的表达情况及相关关系,分析其与临床病理特征的关系。方法分别用免疫组织化学法、Western blot和real-time PCR检测82例配对人胃癌、癌旁及正常组织中HMGA2和HDAC6的蛋白及mRNA表达,并分析其与临床病理参数的关系及两者表达的相关性。结果胃癌组织中HMGA2和HDAC6蛋白阳性表达率分别为69.51%(57/82)和65.85%(54/82),明显高于癌旁组织14.63%(12/82)、12.20%(10/82)和正常组织9.76%(8/82)、7.32%(6/82)(P0.05);胃癌组织HMGA2、HDAC6蛋白和mRNA表达较癌旁组织及正常组织高(P0.05),且两者表达水平与肿瘤的临床分期和淋巴结转移相关(P0.05);HMGA2和HDAC6在胃癌组织中的表达呈明显正相关(r=0.56,P0.05)。结论 HMGA2和HDAC6基因在胃癌组织中存在高表达且共存现象,可能与胃癌恶性程度有关。     

肾综合征出血热患者血清IL—6测定的临床意义

应用双抗体夹心ＥＬＩＳＡ法、放射免疫测定法和间接免疫荧光测定法，同步检测了４８例ＨＦＲＳ患者血清ＩＬ６，β２ＭＧ，特异性ＩｇＭ和ＩｇＧ的动态变化。结果表明，ＨＦＲＳ患者血清ＩＬ６水平发热期已高于正常组（Ｐ＜００１），并达较高水平，少尿期达高峰，与临床病情的进展相一致；ＩＬ６、特异性ＩｇＭ和ＩｇＧ分别于病程的第６ｄ，第９ｄ及第１１ｄ达高峰，ＩＬ６与血清球蛋白呈明显的正相关，ＩＬ６与ＨＦＲＳ患者病程中特异性抗体的升高有明显关系；轻、中、重和危重型患者血清ＩＬ６与ＩｇＧ间呈正相关，且ＩＬ６随病情加重而升高。提示：ＩＬ６可能与体液免疫功能亢进所致免疫病理损伤有关，并根据ＩＬ６与血清β２ＭＧ，尿素氮（ＢＵＭ）和肌酐（Ｃｒ）均呈高度正相关，表明ＩＬ６参与了肾脏的免疫损伤。     

Clinical significance of urinary sediment dysmorphic red blood cells and casts in renal disease]

We investigated the utility of measuring dysmorphic red blood cells (d-RBC) and urinary casts in the diagnosis and assessment of prognosis of renal diseases by evaluating these parameters in a total of 278 urine specimens from 78 patients with various renal diseases at our hospital. Urinary sediments obtained by the conventional method with in 4 hours after voiding were subjected to Sternheimer and Malbin's staining and examined under a conventional light microscope. We used the criteria we previously devised for classification of RBC as d-RBC and for classification of casts hyaline, granular, epithelial, red blood cell, white blood cell, fatty, or waxy. When there were 5 or more urinary sediment red blood cells per high-power field, d-RBC was found in 94% of samples from patients with chronic glomerulonephritis. The finding of d-RBC was not related to glomerulonephritis pathologically diagnosed according to the WHO classification system for biopsy specimens. Even when there were fewer than 5 red blood cells per high-power field, d-RBC was sometimes found. Casts of all types were found in samples from patients with chronic glomerulonephritis or chronic renal failure. In samples from patients with chronic pyelonephritis, however, white blood cell, fatty, and waxy casts were not found, and less than 1 granular or epithelial cast per low-power field was found. The findings for the presence and the extent of both d-RBC and casts were in good accord with and changed with the clinical course, indicating that d-RBC and casts of urinary sediment can be used to predict the prognosis of patients with renal disease.     

Clinical significance.

This article initiates the special section on clinical significance. Within a brief précis and overview, the 4 methodological articles and the integrative commentary of the special section are introduced. A call for the inclusion of the assessment of clinical significance in treatment evaluations is extended.     

Clinical significance of mites in urine

We report a case where a mite egg found in urine caused diagnostic confusion. The possibility of gut or bladder mite infection should be entertained only after repeated identification of mites in urine or stool samples from a symptomatic patient with no other cause for the symptoms and where the possibilities of contamination and spurious infection have been excluded.     

Clinical significance of CK5/6 and PTEN protein expression in patients with bilateral breast carcinoma

AIMS: To assess the expression of cytokeratin (CK) 5/6 in bilateral breast cancers and to assess the relationship between its expression and other prognostic variables, as well as between CK5/6 expression and patients' survival. METHODS AND RESULTS: The expression of CK5/6, PTEN protein, oestrogen receptor, progesterone receptor, p53 and c-erbB-2 protein were evaluated by immunohistochemistry in 88 primary breast cancers diagnosed in 44 women. To assess the prognostic value of studied factors, Cox regression analysis was performed. Expression of CK5/6 was found in 23 of 88 primary breast carcinomas (23/88; 26%). The hazard ratio of development of distant metastasis in patients in whom at least one cancer was CK5/6+ was 99.8 (P=0.037) and in patients with at least one carcinoma with reduced PTEN expression it was 10.8 (P=0.044). CK5/6 expression was correlated with absence of oestrogen (P<0.0001) and progesterone receptors (P<0.0001) and very strong expression of p53 (P<0.05). Reduced PTEN expression was correlated with presence of axillary metastases (P<0.01), with very strong expression of c-erbB-2 (P<0.05) and with reduced expression of oestrogen receptor (P<0.05). CONCLUSIONS: Analysis of expression of CK5/6 and PTEN protein in bilateral breast carcinomas may be of value in clinical practice and warrant further studies.     

Anatomical significance in aortoiliac occlusive disease

Aortoiliac occlusive disease is a subset of peripheral arterial disease involving an atheromatous occlusion of the infrarenal aorta, common iliac arteries, or both. The disease, as it is known today, was described by the French surgeon René Leriche as a thrombotic occlusion of the end of the aorta. Leriche successfully linked the anatomic location of the occlusion with a unique triad of symptoms, including claudication, impotence, and decreased peripheral pulses. The anatomical location of the atheromatous lesions also has a direct influence on classification of the disease, as well as choice of treatment modality. Considering its impact on diagnosis and treatment, we aimed to provide a detailed understanding of the anatomical structures involved in aortoiliac occlusive disease. Familiarity with these structures will aid the physician in interpretation of radiologic images and surgical planning. Clin. Anat. 27:1264–1274, 2014. © 2014 Wiley Periodicals, Inc.