Sea-blue histiocyte syndrome in bone marrow secondary to total parenteral nutrition including fat-emulsion sources: a clinicopathologic study of seven cases

Bone marrow examination revealed a lipid-laden histiocytosis in seven patients undergoing long-term total parenteral nutrition necessitated by extensive short-bowel surgical resection. Clinical abnormalities occurred during this treatment which required bone marrow examination. These included hepatosplenomegaly and peripheral blood cytopenia; the median time to the detection of these abnormalities was 64 months.   The most striking change within the bone marrow was the presence of many pigment-laden histiocytes which had the typical morphology of sea-blue histiocytes seen in the so-called idiopathic sea-blue histiocyte syndrome. The occurrence of sea-blue histiocytosis in the bone marrow in association with long-term parenteral nutrition for short-bowel syndrome has not, to our knowledge, been reported previously and should now be considered in the differential diagnosis of bone marrow sea-blue histiocytosis.     

Autologous bone marrow transplantation for acute myeloid leukemia using busulfan plus etoposide as a preparative regimen

We have studied the use of a new preparative regimen for the treatment of patients in remission of acute myeloid leukemia (AML) with autologous bone marrow transplantation. Chemotherapy consisted of busulfan 1 mg/kg every 6 hours for 4 days (total dose, 16 mg/kg) on days -7 through -4 followed by an intravenous infusion over 6 to 10 hours of etoposide 60 mg/kg on day -3. Autologous bone marrow, treated in vitro with 100 micrograms/mL of 4-hydroperoxycyclophosphamide, was infused on day 0. We have treated 58 patients up to the age of 60 years, 32 in first remission, 21 in second or third remission, and 5 with primary refractory AML unresponsive to high-dose Ara-C, but achieving remission with aggressive salvage regimens. Of the first remission patients, there has been 1 treatment related death and 5 relapses. With median follow-up of 22 months, the actuarial relapse rate is 22% +/- 9% and disease-free survival is 76% +/- 9% at 3 years. Patients with favorable French-American-British (FAB) subtypes (M3 or M4 EO) did especially well, with no relapses seen in 15 patients observed for a median of 30 months. Actuarial relapse rate at 3 years was 48% for first remission patients with less favorable FAB subtypes. Of patients in second or third remission, there were 5 treatment related deaths and 4 relapses. With median follow-up of 22 months, the actuarial relapse rate is 25% +/- 11% and disease-free survival is 56% +/- 11% at 3 years. Four of five primary refractory patients died during treatment and 1 remains in remission with short follow-up. These preliminary data are very encouraging and, if confirmed, support the use of autologous purged bone marrow transplantation using aggressive preparative regimens as one approach to improve the outcome of adults with AML.     

肺癌患者血浆cofilin蛋白含量检测在肺癌诊断中的应用分析

目的探讨血浆cofilin蛋白检测对诊断肺癌的价值。方法随机抽取60例肺癌患者作为实验组,80例健康体检者为对照组,检测两组血浆cofilin蛋白含量并比较。结果实验组血浆cofilin蛋白水平(0.538±0.145)ng/ml,对照组(0.187±0.132)ng/ml,实验组高于对照组(t=14.924,P=0.000);方差分析,实验组的三个临床分期的血浆cofilin蛋白水平差异有统计学意义(F=12.382,P0.05),Ⅲ期、Ⅳ期的血浆cofilin蛋白水平高于Ⅱ期(t=3.529,P=0.001;t=5.674,P=0.000),Ⅳ期高于Ⅲ期(t=2.085,P=0.045)。结论血浆cofilin蛋白的检测对诊断肺癌有重要参考价值,肺癌患者的血浆cofilin蛋白含量高于健康者,且临床分期越晚含量越高。     

Rigid membranes of Malayan ovalocytes: a likely genetic barrier against malaria

A high frequency of nonhemolytic hereditary ovalocytosis in Malayan aborigines is thought to result from reduced susceptibility of affected individuals to malaria. Indeed, Kidson et al. recently showed that ovalocytes from Melanesians in Papua New Guinea are resistant to infection in culture by the malarial parasite Plasmodium falciparum. In order to determine if protection against parasitic invasion in these ovalocytes might be the result of some altered membrane material property in these unusual cells, we measured their membrane and cellular deformability characteristics using an ektacytometer . Ovalocytic red cells were found to be much less deformable in comparison to normal discoid red cells. Similar measurements on isolated membrane preparations revealed a marked reduction in ovalocytic membrane deformability. To produce equal deformation of ovalocytic and normal membranes, ovalocytes required an 8-10-fold increase in applied shear stress, indicating that their membrane was capable of deforming under sufficient stress. To test the possibility that this increased membrane rigidity might confer resistance to parasitic invasion, we performed an in vitro invasion assay using Plasmodium falciparum merozoites and Malayan ovalocytes of varying deformability from seven different donors. The level of infection of the ovalocytes ranged from 1% to 35% of that in control cells, and the extent of inhibition appeared to be closely related to the reduction in membrane deformability. Moreover, we were able to induce similar resistance to parasitic invasion in nonovalocytic normal red cells by increasing their membrane rigidity with graded exposure to a protein crosslinking agent. Our findings suggest that resistance to parasite invasion of Malayan ovalocytes is the result of a genetic mutation that causes increased membrane rigidity.     

双源CT联合血清CRP水平检测对痛风性关节炎的诊断价值

目的 探讨双源CT联合血清C反应蛋白（CRP）水平检测对痛风性关节炎的诊断价值。方法 选择本院2018年1月—2022年3月收治的166例疑似痛风性关节炎患者,分为痛风性关节炎组与非痛风性关节炎组行双源CT及血清CRP水平检测,以美国风湿病协会（ACR）制定的痛风性关节炎诊断标准明确痛风性关节炎诊断,计算双源CT及血清CRP单独与联合诊断痛风性关节炎的效能并分析其临床价值。结果 共有126例患者（75.90%）明确痛风性关节炎诊断。痛风性关节炎组双源CT图像绿色结晶检出率高于非痛风性关节炎组,差异有统计学意义（P＜0.05）。痛风性关节炎组血清CRP水平高于非痛风性关节炎组（P＜0.05）,但两组血清CRP阳性率比较,差异无统计学意义（P＞0.05）。双源CT联合血清CRP诊断痛风性关节炎的特异性、准确率、阳性预测值、阴性预测值均高于单项诊断,差异有统计学意义（P＜0.05）。结论 双源CT联合血清CRP水平检测能够为痛风性关节炎的无创诊断提供可靠参考     

Excel、SPSS拟合血清乙型肝炎病毒大蛋白浓度标准曲线的效果比较

目的考察SPSS和Excel对血清乙型肝炎病毒（HBV）大蛋白（—LP）浓度标准曲线的拟合效果。方法HBV—LP标准品吸光度检测采用酶联免疫吸附试验．分别用SPSS软件曲线估计和Excel软件规划求解对HBV—LP标准品浓度与吸光度进行线性模型、对数线性模型、二次多项式模型、三次多项式模型的曲线拟合,比较两种拟合方法的各回归模型拟合效果的一致性。并根据各回归模型决定系数的大小来优选血清HBV—LP浓度标准曲线回归模型。结果HBV—LP标准品浓度与吸光度的散点图呈非线性趋势;两种拟合方法的线性模型、对数线性模型、二次多项式模型、三次多项式模型的回归方程均有意义（P〈0．001）,其决定系数小数点后四位是一致的：其中二次多项式模型、三次多项式模型的拟合精度较高,决定系数均大于0．95。结论Excel软件规划求解拟合血清HBV—LP浓度标准曲线的效果与SPSS高度一致．是一种临床实验室定量标准曲线拟合与优选的有效方法。     

与护理有关的医疗纠纷原因分析及其对策

对21所医疗机构与护理有关的医疗纠纷发生情况进行调查分析.结果 发现与护理有关的医疗纠纷案件增多,医疗事故争议诉讼案件显著增长,争议补(赔)偿数额明显增加.提出与护理有关的医疗纠纷发生原因包括医院管理方面、护理人员方面、患者方面及社会因素等;需要采取完善医院管理、提高护理人员自身防范意识、加强医护惠三方沟通及树立良好社会形象等措施加以防范.