噬血细胞综合征治疗后继发急性白血病2例报告并文献复习

目的探讨噬血细胞综合征(HLH)治疗后继发急性白血病的临床特征及预后。方法收集2例EB病毒相关HLH(EBV-HLH)患儿在接受化疗后继发急性白血病的临床资料,并复习相关文献。结果 2例患儿均为男性,分别为4岁、7岁,均接受HLH-2004方案化疗,依托泊苷(VP 16)的累积量分别为1 500 mg/m2及3 900 mg/m2;例1于首次化疗18个月后继发急性早幼粒细胞白血病(M3),予维甲酸加柔红霉素诱导化疗后达完全缓解(CR),此后规则化疗,随访30个月,持续CR;例2于首次化疗50个月后继发急性单核细胞白血病(M5),予化疗后达CR,但于诊断急性白血病15个月后复发,继予造血干细胞移植后再次达CR,此后随访1年,持续CR。2例患儿加文献报道13例HLH接受化疗后继发急性白血病患儿,共15例患儿,男10例、女5例,中位年龄2岁6个月(4个月～19岁),VP16的累积剂量中位数3 900 mg/m2(400～20 975 mg/m2),HLH与继发白血病的间隔中位时间24个月(6～72个月)。15例患儿中,5例M3,只接受化疗,均无病存活;10例其他类型急性白血病,3例接受化疗(1例死亡、2例不明),6例造血干细胞移植(3例存活、3例死亡);1例放弃治疗。结论 HLH治疗后继发的急性白血病多为急性髓系白血病,其中急性早幼粒细胞白血病接受维甲酸为基础的联合化疗,预后良好;而其他类型急性白血病预后差,造血干细胞移植或可改善预后。     

Testicular neoplasms: 29 tumors studied by high-resolution US

High-resolution (10-MHz) ultrasonography produces extremely detailed anatomic images of the testis. The sonographic features most helpful in detecting tumors are mass, bright echogenic foci, and diffuse parenchymal texture change. Of 29 patients with testicular neoplasms, 21 (72%) had one or more masses, 19 (66%) had one or more echogenic foci, and nine (31%) had a diffuse parenchymal texture change. Bright echogenic foci were present in six (86%) of seven testes that had a regressed germ-cell tumor. In an attempt to define the histologic features of bright echogenic foci, we performed needle localization under real-time guidance on four operative specimens. We observed immature bone and cartilage, calcification, tubular atrophy and fibrosis, and focal noncalcific scarring. Discovery of occult testicular neoplasms was common (9/29); four patients were thought to have had "extragonadal" germ-cell tumors before abnormalities were found on the sonograms.     

同伴支持模式在2型糖尿病自我血糖监测中的应用

目的:探讨同伴支持模式干预对社区2型糖尿病患者自我血糖监测的影响.方法:选取黄浦区瑞金二路街道在册管理的2型糖尿病患者110名,按照随机数字表法分为对照组(54例)和干预组(56例).对照组采用常规糖尿病健康教育,干预组进行常规糖尿病健康教育和同伴支持干预.比较干预前后两组患者的便携式血糖仪拥有率,自测血糖次数达标率,糖化血红蛋白水平,空腹血糖水平和自我效能得分等情况.结果:干预3个月后,干预组患者的便携式血糖仪拥有率,自测血糖操作技能,监测次数达标率,糖化血红蛋白和空腹血糖的平均水平,自我效能得分均比对照组有改善,差异均有统计学意义(P<0.05).结论:同伴支持模式有助于改善2型糖尿病患者自我管理能力,血糖监测情况的提高,促进血糖及糖化血红蛋白指标的明显改善,是一种适合在社区开展的2型糖尿病健康教育模式.     

Stress in utero alters neonatal stress-induced regulation of the synaptic plasticity proteins Arc and Egr1 in a sex-specific manner

The present study in juvenile rats investigated a “two-hit model” to test the impact of prenatal stress exposure (“first hit”) on the regulation of the synaptic plasticity immediate early genes Arc and Egr1 in response to a second neonatal stressor (“second hit”) in a sex-specific manner. Three stress-exposed animal groups were compared at the age of 21 days in relation to unstressed controls (CON): preS animals were exposed to various unpredictable stressors during the last gestational trimester; postS animals were exposed to 45 min restraint stress at postnatal day 21, pre/postS animals were exposed to a combination of pre- and postnatal stress as described for the two previous groups. The postS and pre/postS groups were killed 2 h after exposure to the postnatal stressor, males and females were separately analyzed. In line with our hypothesis we detected sex-specific stress sensitivity for both analyzed proteins. Males did not show any significant changes in Arc expression irrespective of the stress condition. In contrast, females, which had been pre-exposed to prenatal stress, displayed an “amplified” Arc upregulation in response to postnatal stress (pre/postS group) compared to unstressed controls, which may reflect a “sensitization” effect of prenatal stress. For Egr1, the females did not show any stress-induced regulation irrespective of the stress condition, whereas in males, which were pre-exposed to prenatal stress, we observed a “protective” effect of prenatal stress on postnatal stress-induced downregulation of Egr1 expression (pre/postS group), which may indicate that prenatal stress exposure may induce “resilience”.     

Magnet induced perforated appendicitis and ileo-caecal fistula formation

Foreign body ingestion is a common paediatric problem. In the majority of cases spontaneous passage occurs. Magnet ingestion is rare and solitary magnet ingestion usually does not cause any complications. A number of gastrointestinal complications have been reported, such as fistula formation, perforation and volvulus following multiple magnet ingestion. We review magnet ingestion and describe the first case in the literature of magnet induced perforated appendicitis with an associated ileo-caecal fistula.     

乳杆菌肽聚糖调节小鼠免疫细胞基因表达的通路分析

目的:探索乳杆菌肽聚糖免疫调节作用的机制.方法:BALB/c小鼠腹腔注射乳杆菌肽聚糖,从腹腔巨噬细胞和脾淋巴细胞提取RNA,基因芯片分析基因表达情况,基于已知的基因网络数据库利用PathwayExplorer和GeneMAPP分析乳杆菌肽聚糖刺激特异性的基因网络.结果:PathwayEx-plorer分析得到的最显著变化的基因网络是"细胞因子-细胞因子受体相互作用"和"辅助性T细胞表面分子".GeneMAPP分析得到最显著基因网络是核糖体蛋白、炎性反应基因网络和血红素合成基因网络.结论:乳杆菌肽聚糖刺激引起大量蛋白表达,引起保护性炎性反应,激活Th细胞,可能引起Th1免疫反应.     

护士主导全科团队服务对高龄独居老人心理干预的效果评价

目的 评价以社区护士为主导的全科团队服务对社区高龄独居老人抑郁、孤独等心理状况的影响.方法 将81例80岁以上的高龄独居老人随机分为干预组41例和对照组40例,干预组接受为期3个月、每月3次、每次30min,由社区护士为主导的高龄独居老人全科团队家访服务.对照组实施常规的社区卫生服务.两组在干预前后分别进行抑郁、孤独等观察指标评价.结果 干预前两组高龄老人抑郁、孤独显著低于我国常模水平(p＜0.05),两组间差异无统计学意义.干预后干预组抑郁、孤独得分均低于干预前水平和对照组同期水平(P＜0.01),对照组前后变化不明显(P＝0.858和0.785).结论 以社区护士为主导的全科团队家访服务可明显改善高龄独居老人的抑郁、孤独等不良心理状况.     

再次鼻中隔矫正术

目的 探讨鼻中隔矫正术失败而再次手术的技术方法。方法 对1992-2004年鼻中隔矫正术失败的32例患者进行鼻科检查,根据患者鼻中隔偏曲的部位、程度,原有软骨及骨质的残留状况和患者年龄,我们采用3种不同的手术切口（径路）进行矫正：①对5例鼻中隔前端偏曲,1例低位偏曲和14例高位偏曲的患者采用鼻中隔前端“U”形切口;②对8例鼻中隔后端偏曲和2例高位偏曲患者,在偏曲部位的前方作纵向切口,并辅助鼻内镜进行矫正;③对2例鼻中隔前端低位偏曲的青少年患者采用唇龈沟正中横切口,向上揭翻,辅助耳科电钻进行手术。结果 32例患者均获满意矫正,鼻中隔偏曲引起的临床症状消失或明显改善。随访6～36个月,无一例出现鼻中隔穿孔、鞍鼻、鼻腔粘连等并发症。结论 鼻中隔偏曲再次矫正术需针对不同的临床特点选择正确的手术方法,可获满意效果。     

孕妇营养状况与胎儿发育迟缓及新生儿视力发育障碍的关系

目的 了解孕妇营养状况与胎儿发育迟缓（IUGR）及新生儿出生后视力发育障碍的关系。方法 将60例住院产妇分为两组：即IUGR组与对照组,各30例。分析孕妇8种营养食品的摄取情况,用荧光法检测母血及脐血中维生素A含量,用吸收光谱法测定母血与脐血中铁、铜、锌含量,检测新生儿出生后3－7d及出生后10个月时的闪光视觉诱发电位。结果 与对照组相比,IUCR组孕妇的鸡蛋、猪肝与瘦肉的摄取量均明显减少（P＜0．05）,母血及脐血中维生素A、铁含量显著降低（P＜0．01）,脐血中锌含量降低（P＜0．05）,新生儿闪光视觉诱发电位检测提示,三相波中波峰向上主波（P100）的潜伏期延长,幅值降低。结论 孕期富含维生素A、铁与锌等营养成分的食物摄取减少与IUGR的发生密切相关,并可导致胎儿视觉发育障碍。