联合检测TEG和CCTs对创伤严重程度的临床诊断研究

目的探讨血栓弹力图(TEG)和常规凝血指标(CCTs)联合检测对创伤严重程度的临床诊断方法和意义。方法选取2018年3月至2020年3月上饶市人民医院收治的40例(观察组)多发创伤患者,及同期健康体检者40例(对照组),入院时对观察组患者采用坎帕拉创伤评分(kampala trauma score,KTS)进行伤情初步分级测评,将观察组患者分为轻症组、中症组和重症组,于伤后10 h内对4组行CCTs和TEG检查,并对检查指标的差异性进行评估,以精确诊断患者凝血功能和创伤严重程度。结果 TEG检验各指标[R值、K值、α角和MA值]比较,轻症组、中症组、重症组与对照组差异有统计学意义(P<0.05),轻症组、中症组和重症组比较差异有统计学意义(P<0.05),轻症组和中症组仅MA值差异有统计学意义(P<0.05);轻症组、中症组、重症组与对照组CCTs检验各指标[PT、APTT、TT、FIB和D-D]比较差异有统计学意义(P<0.05),轻症组、中症组和重症组差异有统计学意义(P<0.05),轻症组和中症组间,随着患者创伤严重程度提升,PT、FIB和D-D差异有统计学意义(P<0.05)。结论 TEG、CCTs在多发创伤患者和健康体检者区别判断方面均有显著特异性,联合检测TEG和CCTs可全面诊断创伤多发患者的严重程度,具有临床推广价值。     

肾小球滤过率评估方程在不伴有躯体疾病的精神分裂症患者中的适用性研究

目的分析研究肾小球滤过率(eGFR)评估方程在不伴有躯体疾病的精神分裂症患者中的适用性,找出更适用的eGFR评估方程,为肾小球滤过率临床计算提供指导。方法回顾分析2019年在本院住院的194例不伴有躯体疾病的精神分裂症患者,采用17种eGFR评估方程分别计算eGFR,比较其均值及所在正常区间范围的比例。结果17种eGFR方程计算的eGFR值相差较大,中老年组的eGFR低于青少年组,女性组低于男性组。改良化MD、中国课题、改良肾脏病饮食改良(MDRD)等3种方程算出的各组eGFR差异有统计学意义(P<0.01),其余14种方程算出的eGFR除在总体组和女性组中差异有统计学意义(P<0.05)外,其余各组之间差异均无统计学意义(P>0.05)。结论应用改良化MD、中国课题、改良MDRD等3种方程计算eGFR,能早期发现肾功能异常。     

Combined lung fibrosis and 'mechanic's hand': a clinical diagnostic clue to amyopathic antisynthetase syndrome

Abstract:   Combined interstitial lung disease and the presence of 'mechanic's hands' could be a clinical clue in the early diagnosis of the rare disease, amyopathic antisynthetase syndrome for which anti-Jo-1 antibody is a useful diagnostic tool. The case is reported of a patient who suffered from shortness of breath and dry cough, with pulmonary fibrosis on CXR and CT scan, and interstitial pneumonitis on trans -bronchial biopsy. She was also positive for anti-Jo-1 and anti-Ro antibodies. 'Mechanic's hands' were noted bilaterally but with no evidence of myopathy in either the electromyogram or on muscle biopsy. The patient was treated with prednisolone and her clinical picture, including the 'mechanic's hands' and lung fibrosis, subsided gradually, suggesting that the sign may be a useful follow up tool in this disease. Early diagnosis and corticosteroid therapy could be beneficial for these patients.     

Squamous cell carcinoma of the pancreas with liver metastasis: a case report

Squamous cell carcinoma of the pancreas is an unusual cancer of ductal cell origin. In a review of 6668 cases of exocrine pancreatic cancer from various registries reported from 1950 through 1985, the incidence of squamous carcinoma and adenosquamous carcinoma was 0.005% and 0.01%, respectively） We report a case of squamous cell carcinoma of the pancreas with liver metastasis.     

The resistance and transmission mechanism of Acinetobacter baumannii isolates in a tertiary care hospital,China

The aim of this study was to analyse the resistance and epidemiological data of 117 Acinetobacter baumannii isolates from Southwest Hospital, Chongqing, China. Except for polymyxin B, tigecycline, minocycline, cefoperazone/sulbactam, amikacin and levofloxacin, the resistance rates of other antimicrobial agents were above 90%. All the clinical isolates had the bla_OXA-51 gene and 114 isolates had the bla_OXA-23 gene. Forty-nine isolates were found to contain the bla_IMP-4 gene. PFGE data showed that 117 isolates were divided into 25 groups. Sixty-three (53.85%) were found to carry the class 1 integron, and the sequence analysis of the class 1 integron internal variable regions – five types, one of which had the bla_IMP-4 gene. For the bla_IMP-4 positive strain without class 1 integron, we found the flanking sequence had the TnpA gene. The result suggested that the resistance gene was widely distributed in our hospital; moreover, the modes of presence and transmission are different and complicated. The results of our study can improve the infection empirical treatment method and infection control programme.     

A prospective study of autoantibodies to Ezrin and pancreatic cancer risk

Purpose

No biomarker is available for pancreatic cancer early detection, but a small prospective European study involving 16 cases and 32 controls raised the possibility that anti-Ezrin autoantibodies may be associated with risk of pancreatic cancer. We aimed to validate this finding in a case–control study nested within a prospective study in the USA.

Methods

Levels of anti-Ezrin autoantibodies were examined using ELISA in pre-diagnostic plasma samples of 73 cases and 145 matched controls. Paired t test and paired signed rank tests were used to determine the difference between two groups, and conditional logistic regression was used to evaluate the association between anti-Ezrin autoantibody levels and risk of developing pancreatic cancer.

Results

No association was found between levels of anti-Ezrin plasma autoantibodies and subsequent risk of developing pancreatic cancer.

Conclusion

Anti-Ezrin autoantibodies did not appear to be useful as a plasma biomarker for early detection of pancreatic cancer.

     

乳腺超声弹性成像检查的影响因素及解决策略

超声弹性成像(UE)是近年来应用于乳腺疾病诊断的一种新技术,在乳腺良恶性肿瘤的鉴别诊断中已显示出良好的应用前景。为提高UE对乳腺病变诊断的准确性,必须正确认识UE原理,掌握正确的检查方法,避免或减少主观因素造成误诊;进一步研究UE表现的相应病理基础;以超声特征诊断乳腺恶性病变的Logistic回归模型有助于鉴别乳腺良、恶性病变。对于超声检查不典型的乳腺病灶仍有必要行穿刺活检以明确诊断。     

Evidence for altered hippocampal volume and brain metabolites in workers occupationally exposed to lead: a study by magnetic resonance imaging and (1)H magnetic resonance spectroscopy

Environmental and occupational exposure to lead (Pb) remains to be a major public health issue. The purpose of this cross-sectional study was to use non-invasive magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy ((1)H MRS) techniques to investigate whether chronic exposure to Pb in an occupational setting altered brain structure and function of Pb-exposed workers. The Pb-exposed group consisted of 15 workers recruited from either a Pb-smelting factory or a Pb-battery manufacturer. The control group had 19 healthy volunteers who had no history of Pb exposure in working environment or at home. The average airborne Pb concentrations in fume and dust were 0.43 and 0.44mg/m(3), respectively, in the smeltery, and 0.10 and 1.06mg/m(3), respectively, in the Pb battery workshop. The average blood Pb concentrations (BPb) in Pb-exposed and control workers were 63.5 and 8.7mug/dL, respectively. The MRI examination showed that brain hippocampal volume among Pb-exposed workers was significantly diminished in comparison to age-matched control subjects (p<0.01), although the extent of this reduction was relatively small (5-6% of the control values). Linear regression analyses revealed significant inverse associations between BPb and the decreased hippocampal volume on both sides of brain hemisphere. Among five brain metabolites investigated by MRS, i.e., N-acetyl-aspartate (NAA), creatine (Cr), choline (Cho), inosine (mI), glutamate/glutamine (Glx) and lipids (Lip), a significant decrease in NAA/Cr ratio (7% of controls, p<0.05) and a remarkable increase in Lip/Cr ratio (40%, p<0.01) were observed in the brains of Pb-exposed workers as compared to controls. Furthermore, the increased Lip/Cr ratio was significantly associated with BPb (r=0.46, p<0.01). Taken together, this study suggests that occupational exposure to Pb may cause subtle structural and functional alteration in human brains. The MRI and MRS brain imaging techniques can be used as the non-invasive means to evaluate Pb-induced neurotoxicity.