咳嗽、腹痛、消瘦

病历摘要 患者男,62岁,因＂咳嗽3个月,腹痛、消瘦2个月＂于2010年10月29日入院。患者3个月前出现咳嗽,咳少量白痰,无发热、乏力、盗汗。2个月前无明显诱因出现腹胀、腹痛,腹痛无明显规律。1个月前因发热,体温39℃,在外院静点左氧氟沙星5 d后体温恢复正常。     

结核性系统性红斑狼疮一例

患者,女性,13岁.因反复发热、咳嗽10个月,全身水肿、关节疼痛8个月,加重1个月于1999年3月12日入院.1998年5月出现发热,体温40 ℃,咳嗽、咯痰,无咯血,无水肿和关节疼痛,尿检无异常,在当地医院拍摄胸片发现右肺门影增大,少许片状影,诊断为肺结核,经异烟肼、利福平、乙胺丁醇三联治疗1个月,体温正常,咳嗽减轻后停药.     

累及大肠的播散型组织胞浆菌病1例

1 临床资料 患者男,70岁,退休教师.因＂反复腹泻、发热8个月加重伴消瘦半年＂于2008年6月23日入院.2007年10月初,患者无明显诱因出现腹泻,黄色稀烂便,无脓血,量不多,3～4次/d;有轻微里急后重,伴少量黏液,无腹痛,体温37.5℃～38℃,双下肢水肿.     

长期发热、腹痛、腹部肿块

长期发热、腹痛、腹部肿块湖南医科大学附属湘雅医院关键词结核，淋巴结病历摘要病人男３３岁已婚因反复发热２月半，间歇腹痛１月余，于１９９３年９月１５日入院。患者１９９３年６月３０日，无明显诱因突起寒颤、发热，体温３８．５℃，在外院就诊，予以复方氨基比林、...     

第52例:临床表现反复发热伴栓塞

<正>患者女性,23岁,因"反复发热9个月,右侧肢体无力1个月"于2016年7月7日急诊入院。患者2015年11月至2016年5月期间,无明显诱因反复出现发热、寒战,伴头疼,体温最高为40℃,多次就诊于当地医院,给予抗生素治疗(具体方案不详),抗生素使用疗程3~10 d不等。使用抗生素期间患者体温可降至正常,停用抗生素7~15 d后体温再     

以长期发热和腰痛为突出表现的布氏杆菌病1例报道

1 病历资料 患者男,38岁,司机.因间断发热伴腰痛4个月于2008-05-22入院.患者于4个月前无明显诱因出现发热,体温最高40℃,以午后为著,持续3～5 d后恢复正常,如此反复,4个月来除反复发热外,伴明显腰痛,疼痛呈阵发性针刺样,休息时疼痛减轻,活动加重,腰痛与发热无明显关系,无放射痛,有全身乏力和肌肉关节疼痛,盗汗.     

第46例——发热皮下结节血性腹腔积液

1 病历摘要 患者女,27岁.主因"发热1个半月,皮下结节1周"于2009年7月10日收入院.患者1个半月前于劳累后出现发热,体温37.3～38℃,无其他不适,给予口服退热药后体温可降至正常,但患者仍反复发热,无明显规律,曾多次就医均未明确病因.     

第46例——发热皮下结节血性腹腔积液

1 病历摘要 患者女,27岁.主因"发热1个半月,皮下结节1周"于2009年7月10日收入院.患者1个半月前于劳累后出现发热,体温37.3～38℃,无其他不适,给予口服退热药后体温可降至正常,但患者仍反复发热,无明显规律,曾多次就医均未明确病因.     

第46例——发热皮下结节血性腹腔积液

1 病历摘要 患者女,27岁.主因"发热1个半月,皮下结节1周"于2009年7月10日收入院.患者1个半月前于劳累后出现发热,体温37.3～38℃,无其他不适,给予口服退热药后体温可降至正常,但患者仍反复发热,无明显规律,曾多次就医均未明确病因.     

第316例--发热、反复口腔溃疡、皮疹、腹泻

病历摘要患者男 ,2 2岁。主因不规则发热伴反复口腔溃疡 8个月 ,腹泻 1个月 ,一过性皮疹 1周 ,于 2 0 0 3年 3月 2 8日以发热待查收住入院。患者于 2 0 0 2年 8月中旬无诱因出现间断发热 ,体温最高 39℃ ,以晚间高热为主 ,经常自服维C银翘片病情好转 ,同年 8月底再次发热 ,体温波动在 38～ 39℃ ,静脉滴注青霉素治疗 ,体温正常数日后又出现间歇不规则发热。同年 10月初体温逐渐降至正常。 2 0 0 3年 2月初出现腹泻 4～ 5次 /d ,为黄色稀水便 ,无里急后重。并再次出现间断无规律发热 ,体温 38～ 39℃ ,以午后明显 ,无盗汗 ,服用维C银翘片体…     

Point mutations in the c-K-ras 2 gene in multiple colorectal carcinomas

Abstract The c-K-ras 2 gene mutations were examined in colorectal tumours from patients with synchronous or metachronous tumours in order to investigate tumorigenesis. Sixty-seven colorectal carcinomas from patients with a single lesion, 50 from patients with synchronous lesions, and 12 from patients with metachronous lesions were analysed for the presence of point mutations in codons 12 and 13 of c-K-ras proto-oncogene. In the patients with metachronous or synchronous lesions, the finding of the mutation in one tumour was not associated with a greater frequency of the mutation in other carcinomas from the same patient. In the patients with tumours that each contained the mutation, the mutations were not always the same. In tumours from the patients with original and synchronous lesions, the mutation frequency was significantly lower in advanced carcinomas invading through the entire muscularis propria (10.5%) than in early carcinomas confined to the mucosa (47.8%), and the mutation frequency in carcinomas invading through the entire muscularis propria was significantly lower in patients with synchronous lesions (10.5%) than in patients with a single lesion (37.7%). These results suggest that the tumorigenesis of colorectal carcinomas from patients with synchronous lesions is different from that in patients with a single lesion.     

From the Cover: Aquatic biodiversity enhances multiple nutritional benefits to humans

Humanity depends on biodiversity for health, well-being, and a stable environment. As biodiversity change accelerates, we are still discovering the full range of consequences for human health and well-being. Here, we test the hypothesis—derived from biodiversity–ecosystem functioning theory—that species richness and ecological functional diversity allow seafood diets to fulfill multiple nutritional requirements, a condition necessary for human health. We analyzed a newly synthesized dataset of 7,245 observations of nutrient and contaminant concentrations in 801 aquatic animal taxa and found that species with different ecological traits have distinct and complementary micronutrient profiles but little difference in protein content. The same complementarity mechanisms that generate positive biodiversity effects on ecosystem functioning in terrestrial ecosystems also operate in seafood assemblages, allowing more diverse diets to yield increased nutritional benefits independent of total biomass consumed. Notably, nutritional metrics that capture multiple micronutrients and fatty acids essential for human well-being depend more strongly on biodiversity than common ecological measures of function such as productivity, typically reported for grasslands and forests. Furthermore, we found that increasing species richness did not increase the amount of protein in seafood diets and also increased concentrations of toxic metal contaminants in the diet. Seafood-derived micronutrients and fatty acids are important for human health and are a pillar of global food and nutrition security. By drawing upon biodiversity–ecosystem functioning theory, we demonstrate that ecological concepts of biodiversity can deepen our understanding of nature’s benefits to people and unite sustainability goals for biodiversity and human well-being.

Species losses and range shifts because of climate change, harvesting, and other human activities are altering aquatic biodiversity locally and globally (1–5). In aquatic ecosystems, not only are some species severely depleted because of overfishing or habitat loss (3, 6–8), the ecosystem-level dimensions of biodiversity such as the total number of species and their functional diversity have also changed (9). Beyond the loss of particular species, changes in ecosystem-level dimensions of biodiversity threaten numerous ecosystem services to humans, which include the cultural, economic, or health benefits people derive from nature (10–13). In many regions, such as tropical coastal systems, the cumulative impacts of human activities are severe and associated with strong declines in taxonomic and ecological functional diversity (6) and coincide with regions with a high dependence of people upon wild-caught seafood for food and nutrition (14). In temperate regions, where some coastal communities depend on local wild seafood harvests to meet their nutritional needs (15, 16), species richness may be increasing as species recover from exploitation and warmer oceans allow species to expand their ranges into new territory (1, 2, 17).There is growing concern that biodiversity change leads to changes in human health and well-being (10, 13, 18). Specific and quantitative links between aquatic biodiversity and human health that distinguish contributions of species diversity from those of biomass, as predicted by biodiversity–ecosystem functioning theory, have not been established. At a time of unprecedented global change and increasing reliance on seafood to meet nutritional demands (19), there is an urgent need to understand how changing aquatic ecosystem structure may alter the provisioning of seafood-derived human nutrition.Seafood, consisting of wild-caught marine and freshwater finfish and invertebrates, provides an important source of protein and calories to humans. Additionally, unlike staple foods such as rice or other grains, seafood can address multiple dimensions of food and nutritional security simultaneously by providing essential micronutrients, such as vitamins, minerals, and polyunsaturated essential fatty acids critical to human health (19–22). Given the multiple attributes of seafood that are valuable to human health, it is possible that the diversity of an aquatic assemblage, distinct from the inclusion of any particularly nutritious species, could support human well-being consistent with a large body of evidence for biodiversity’s major contributions to ecological functions (11, 23–26). Dietary diversity is a basic tenet of a nutritious diet (27) and it is widely appreciated that diets composed of more food groups and more species are more nutritious (28–31). Ecological measures of dietary diversity (diet diversity, species richness, functional diversity, and Simpson’s index of evenness) have been associated with the nutritional value of diets in a range of contexts (27, 29, 32–38). These studies rely on relationships between species included in the diet (or other food intake measures) and nutritional adequacy of reported diets. However, a simple correlation between dietary diversity and a measure of dietary benefits provides only partial support for a claim that biodiversity benefits human well-being, consistent with the same ecological processes by which biodiversity supports numerous ecosystem functions and services (23, 26). We build upon this foundation of empirical relationships between diet diversity and diet quality by placing this question in the quantitative ecological theoretical framework that relates biodiversity to function (24, 25), thereby laying the groundwork for additional development of links between biodiversity science and our understanding of human well-being.Ecological theory predicts that biodiversity can be ecologically and economically important, apart from the importance of total biomass or the presence of particular species (23, 39). According to theory and over 500 explicit experimental tests (23, 40, 41), diversity in ecological communities and agricultural systems enhances ecosystem functioning by two mechanisms: 1) more diverse assemblages may outperform less diverse assemblages of the same density or biomass of individuals because more diverse assemblages will include more of the possible species and are therefore more likely to include high-performing species, assuming random processes of including species from the species pool (a selection effect), or 2) more diverse assemblages of a given density (or biomass) contain species with complementary functional traits, allowing them to function more efficiently (a complementarity effect) (25, 39). For aquatic animals, increased diversity enhances productivity of fish biomass (42) and also enhances temporal stability of biomass production and total yields (43, 44), providing economic and nutritional benefits to humans related to increased stability of harvests and production of biomass for consumption (43). However, when considering aquatic species from the perspective of human nutrition, functions other than biomass production become relevant because total seafood biomass consumption is not predictive of micronutrient benefits from seafood (45, 46).Here, we test a hypothesis central to ecological theory in the 21st century: whether biodiversity per se (species richness and ecological functional diversity), distinct from the identities and abundance of species, enhances human well-being (Fig. 1). We chose a measure of human well-being distinct from provision of protein, calories, or total yields—the micronutrient and essential fatty acid benefits of seafood. For increasing biodiversity per se (as opposed to increasing total seafood consumption) to enhance nutritional benefits as predicted by biodiversity–ecosystem functioning theory (25, 47), the amounts of various nutrients within edible tissues must differ among species, and furthermore, nutrient concentrations must trade off among species, such that species that have relatively high concentrations of some nutrients also have relatively low concentrations of others (25). Specifically, a “biodiversity effect” (sensu ref. 25) on nutritional benefits requires that concentrations of multiple nutrients are negatively correlated with each other, or uncorrelated, when compared among species, creating a complementary distribution of nutrients across species. In contrast, if nutrient concentrations in edible tissue are positively correlated for multiple nutrients across species such that, for example, a species containing high amounts of iron also has a high essential fatty acid concentration, thereby containing multiple nutrients in high concentrations simultaneously, seafood species or ecological functional diversity in the diet would not be important. In the case of positive correlations among nutrient concentrations, the ecosystem service of nutritional benefits would be enhanced by consuming more fish biomass or by selecting a few highly nutritious species, without considering species richness or ecological functional diversity.Open in a separate windowFig. 1.Aquatic biodiversity increases human well-being because edible species have distinct and complementary multinutrient profiles (A) and differ in mean micro- and macronutrient content (shown here relative to 10 and 25% thresholds of recommended dietary allowance, RDA, guidelines) for representative finfish (Abramis brama, Mullus surmuletus), mollusc (Mytilus galloprovincialis), and crustacean species (Nephrops norvegicus). Biodiversity–ecosystem functioning theory predicts that nutritional benefits, including the number of nutrient RDA targets met per 100 g portion (NT; i, iii) and minimum portion size (P_min; ii, iv) (B and E), are enhanced with increasing seafood species richness. Orange dots in B and E correspond to potential diets of high and low biodiversity levels. Seafood consumers with limited access to seafood each day may not reach RDA targets if diets are low in diversity (D–F versus A–C; gray shading indicates proportion of population that meets nutrient requirements). DHA: docosahexaenoic acid, EPA: eicosapentaenoic acid.We aimed to bridge two distinct theoretical frameworks—the biodiversity–ecosystem functioning theory and human nutrition science—by quantitatively testing for effects of aquatic species richness and ecological functional diversity (48, 49) in seafood diets on nutritional benefits via complementarity or selection effects. We used the public health measure of recommended dietary allowance (RDA) index to quantify nutritional benefits. RDAs are nutrient-based reference values that indicate the average daily dietary intake level that is sufficient to meet the nutrient requirement of nearly all (97 to 98%) healthy individuals in a particular life stage and gender group (50). Here, we used the RDA for females aged 19 to 50 y (SI Appendix, Tables S1 and S2; see SI Appendix, Table S1 for definitions of key terms). We measured nutritional value in terms of concentrations relative to RDAs, and we refer to these recommended amounts (or portions thereof) as “RDA targets” (SI Appendix, Tables S1 and S2 and Metrics). We quantified nutritional value in two ways: 1) the minimum amount of seafood tissue (in grams) required to meet given RDA targets (either for a single nutrient or the five micronutrients and fatty acids simultaneously; referred to as “minimum portion size required,” P_min [SI Appendix, Table S1, Eq. A1, and Metrics]) and 2) the number of nutrients that meet an RDA target in a single 100 g seafood portion (NT, SI Appendix, Table S1, Eq. A2). By considering nutritional value per unit biomass in both metrics, we avoided confounding diversity of seafood consumed with the total amount consumed (Metrics). We first tested two hypotheses: 1) seafood species richness increases NT because of complementarity in nutrient concentrations among species, and 2) seafood species richness increases the nutritional value of a 100 g edible portion of seafood, thereby lowering the minimum portion size, P_min, and improving the efficiency with which seafood consumers reach nutritional targets (Fig. 1). Following biodiversity–ecosystem functioning theory, we predicted that increased species richness is correlated with ecological functional diversity (51) in potential seafood diets and that ecological functional diversity is related to diversity in the concentration of essential elements and fatty acids that have nutritional value to human consumers, such that species and ecological functional diversity yields increased nutritional benefits. We also tested the hypothesis that seafood diversity increases total intake of heavy metal contaminants because some aquatic animals are known to bioaccumulate toxic metals in their tissues. For this reason, variation in bioaccumulation among species could lead to a biodiversity effect on contaminant intake that is detrimental to human health.In a global analysis of over 5,040 observations of nutrient concentrations in 547 aquatic species (SI Appendix, Fig. S1), we considered the provision of nutritional benefits to human consumers. To assess whether the relationships between biodiversity and human nutrition benefits depend on the geographic extent (global or local) over which seafood are harvested or accessed (11), we tested whether seafood species richness is associated with higher nutritional value at local scales (versus global scale) in traditional Indigenous seafood diets in North America (SI Appendix, Methods 1.4). Seafood is critical for Indigenous groups, who on average consume seafood at a rate that is 15 times higher than the global average per capita consumption rate (16). To test our hypotheses at the geographic scale of local consumer communities, we complemented our global analysis with additional analyses of 25 to 57 species in 14 geographically constrained groups of species consumed together as part of traditional Indigenous diets (SI Appendix, Methods 1.4).     

Beh et’s disease complicated by multiple aseptic abscesses of the liver and spleen

Aseptic abscesses are an emergent entity and have been described in inflammatory bowel disease,especially in Crohn’s disease,and in other diseases.However,aseptic abscesses associated with Beh et’s disease are extremely rare.We report a Japanese male diagnosed with an incomplete type of Beh et’s disease who developed multiple aseptic abscesses of the spleen and liver.In 2002,the spleen abscesses were accompanied by paroxysmal oral aphthous ulcers and erythema nodosum.As the patient’s response to antibiotic treatment was inadequate,a splenectomy was performed.Severe inflammatory cell infiltration,largely of polymorphonuclear neutrophils,was observed without evidence of bacterial or fungal growth.Although the patient had no history of ocular symptoms or genital ulcers,a diagnosis of incomplete Beh et’s disease was made according to the Japanese diagnostic criteria because of the presence of paroxysmal arthritis and epididymitis since 2002.In 2005,multiple liver abscesses developed with right hypochondrial pain and seemed to be attributed to Beh et’s disease because the abscesses yielded negative results during a microbiologic investigation and failed to go into remission under antibiotic therapy.Oral prednisone(15 mg/d) was started in May 2006,and the abscesses dramatically disappeared 4 wk after treatment.Although the patient had a relapse of the liver abscesses in association with the tapering of prednisone,the augmentation of prednisone dosage yielded a response.The abscesses of the liver and spleen were strongly suggested to be attributed to Beh et’s disease.Clinician should be aware of the existence of aseptic abscesses as uncommon manifestations of Beh et’s disease.     

Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns

Upon delivery, the neonate is exposed for the first time to a wide array of microbes from a variety of sources, including maternal bacteria. Although prior studies have suggested that delivery mode shapes the microbiota''s establishment and, subsequently, its role in child health, most researchers have focused on specific bacterial taxa or on a single body habitat, the gut. Thus, the initiation stage of human microbiome development remains obscure. The goal of the present study was to obtain a community-wide perspective on the influence of delivery mode and body habitat on the neonate''s first microbiota. We used multiplexed 16S rRNA gene pyrosequencing to characterize bacterial communities from mothers and their newborn babies, four born vaginally and six born via Cesarean section. Mothers’ skin, oral mucosa, and vagina were sampled 1 h before delivery, and neonates’ skin, oral mucosa, and nasopharyngeal aspirate were sampled <5 min, and meconium <24 h, after delivery. We found that in direct contrast to the highly differentiated communities of their mothers, neonates harbored bacterial communities that were undifferentiated across multiple body habitats, regardless of delivery mode. Our results also show that vaginally delivered infants acquired bacterial communities resembling their own mother''s vaginal microbiota, dominated by Lactobacillus, Prevotella, or Sneathia spp., and C-section infants harbored bacterial communities similar to those found on the skin surface, dominated by Staphylococcus, Corynebacterium, and Propionibacterium spp. These findings establish an important baseline for studies tracking the human microbiome''s successional development in different body habitats following different delivery modes, and their associated effects on infant health.     

Hierarchies, multiple energy barriers, and robustness govern the fracture mechanics of alpha-helical and beta-sheet protein domains

The fundamental fracture mechanisms of biological protein materials remain largely unknown, in part, because of a lack of understanding of how individual protein building blocks respond to mechanical load. For instance, it remains controversial whether the free energy landscape of the unfolding behavior of proteins consists of multiple, discrete transition states or the location of the transition state changes continuously with the pulling velocity. This lack in understanding has thus far prevented us from developing predictive strength models of protein materials. Here, we report direct atomistic simulation that over four orders of magnitude in time scales of the unfolding behavior of alpha-helical (AH) and beta-sheet (BS) domains, the key building blocks of hair, hoof, and wool as well as spider silk, amyloids, and titin. We find that two discrete transition states corresponding to two fracture mechanisms exist. Whereas the unfolding mechanism at fast pulling rates is sequential rupture of individual hydrogen bonds (HBs), unfolding at slow pulling rates proceeds by simultaneous rupture of several HBs. We derive the hierarchical Bell model, a theory that explicitly considers the hierarchical architecture of proteins, providing a rigorous structure-property relationship. We exemplify our model in a study of AHs, and show that 3-4 parallel HBs per turn are favorable in light of the protein's mechanical and thermodynamical stability, in agreement with experimental findings that AHs feature 3.6 HBs per turn. Our results provide evidence that the molecular structure of AHs maximizes its robustness at minimal use of building materials.