Involvement of macrophages in the pathology of toxic epidermal necrolysis

In toxic epidermal necrolysis (TEN), as in the 'epidermal type' of erythema multiforme, the necrotic epidermis is infiltrated with mononuclear cells. We studied the epidermal infiltrate in seven cases of TEN. About half the cells obtained from pieces of cleaved epidermis dissociated by trypsin were non-epithelial. On cytologic analysis, 80% of these foreign cells exhibited markers of macrophages, 15% were granulocytes and only 5% were lymphocytes (almost exclusively OKT8 T lymphocytes). Semi-thin sections of early prenecrotic lesions showed exocytosis of mononuclear cells within the epidermis with features of satellite cell necrosis and formation of colloid bodies. Almost all these mononuclear cells were macrophages as evidenced by endogenous peroxidase-positive granules. These findings suggest that some kind of macrophage-mediated cytotoxicity may play a role in the necrosis of epidermal cells during TEN.     

军队文职人员护理骨干执行卫勤保障任务现状的调查

目的了解军队文职人员护理骨干在执行卫勤保障任务中存在的问题。方法采用自制的调查问卷对参加全军第3批文职人员护理骨干任职教育培训班的83名文职人员进行调查。结果文职人员护理骨干在执行卫勤保障任务中存在的主要问题排在前三的依次是:执行大型卫勤保障任务的机会太少、平时科室工作繁忙、工作与训练矛盾突出,对卫勤保障任务的目的、目标及自身的职责范围不是很明确。结论相关部门应适当增加文职人员执行大型卫勤保障任务的机会,部门之间搞好协调工作,缓解工作和训练的矛盾,在卫勤保障中明确任务的目的、目标和参训人员的职责范围,以提高文职人员的卫勤保障能力。     

Clinical predictors of cardiovascular implantable electronic device-related infective endocarditis

Background: Cardiovascular implantable electronic device (CIED)‐related infective endocarditis (CIED‐IE) is a serious complication of cardiac device infection and is associated with increased mortality. At present, there exist no criteria to predict CIED‐IE in patients who present with CIED infection. Methods: We retrospectively reviewed all cases of CIED infection seen at Mayo Clinic Rochester between 1991 and 2008. CIED‐IE was classified using pathologic and clinical criteria. Clinical predictors of CIED‐IE were identified using logistic regression, and quantified using a summary score and plotted against the distribution of CIED‐IE. Results: Ninety‐three (22.4%) of the 416 patients with CIED infection had CIED‐IE. Host factors including chronic immunomodulator therapy exclusive of corticosteroid (odds ratio [OR], 3.79 [confidence interval (CI) 1.10, 13.04]), chronic corticosteroid therapy (OR, 2.15 [CI 0.93, 5.00]), hemodialysis (OR, 3.24 [CI 1.39, 7.55]), or remote infection (OR, 1.77 [CI 0.99, 3.14]) were associated with increased odds of CIED‐IE. Patients with CIED‐IE were at increased odds of presenting with fever (OR, 3.78 [CI 1.93, 7.40]), or malaise (OR, 1.87 [CI 1.02, 3.41]), and have findings of leukocytosis (OR, 3.61 [CI 1.51, 8.62]). In marked contrast, they were at decreased odds of exhibiting signs/symptoms of infection at the generator pocket site (OR, 0.19 [CI 0.10, 0.36]). Summary scores of 6 and 11 predicted CIED‐IE in approximately 50% and 90% of cases, respectively. Conclusions: Certain comorbid conditions and systemic manifestations of infection were associated with CIED‐IE. In contrast, pocket site infection was negatively associated with CIED‐IE. These findings should assist clinicians in identifying patients who would more likely benefit from further investigation of CIED‐IE with transesophageal echocardiography. (PACE 2011; 34:450–459)     

淋巴细胞绝对数减少在非霍奇金淋巴瘤中的临床意义

目的:探讨非霍奇金淋巴瘤(NHL)患者初发时淋巴细胞绝对数(ALC)与其临床特征的相关性,并探讨其预后参考价值。方法:回顾性分析2007年1月-2010年10月间我院新确诊的210例NHL患者的临床特征,结合随访资料,分析不同ALC水平与NHL患者各临床特征及其预后的相关性。结果:在本组NHL病例中,中位年龄58岁,结外淋巴瘤占有一定比例(47.1%)。ALC中位数为1.2(0.1～13.9)×109/L,25%～75%的置信区间分界值为(0.7～1.8)×109/L。我们发现,ALC<1.2×109/L时,其与患者的年龄、性别、淋巴瘤类型、临床分期、IPI预后指数、骨髓浸润、贫血等临床特征并无显著相关性,但常伴有LDH水平的升高,且表现B症状,而此类患者临床缓解率相对较低,死亡率较高(P<0.05)。继续以ALC<1.0×109/L作为分界点时,除上述特点外,年龄差异开始具有统计学意义,ALC减少更多见于老年淋巴瘤患者(P<0.01)。最后以ALC<0.7×109/L作为临床分界点时,ALC减少的NHL患者除了涵盖上述临床特点外,T细胞淋巴瘤所占比例也明显升高(P<0.01),此类患者临床分期更晚,IPI积...     

上皮性卵巢癌组织中EGFR、KRAS的表达变化及意义

目的观察表皮生长因子受体（EGFR）、鼠Kirsten肉瘤病毒致癌基因（KRAS）蛋白在上皮性卵巢癌（下称卵巢癌）组织中的表达变化,并探讨其临床意义。方法采用免疫组化SP法检测45例卵巢癌组织中的EGFR、KRAS蛋白,另选18例卵巢良性肿瘤组织和30例正常卵巢组织为对照。结果卵巢癌组织中EGFR、KRAS蛋白表达明显高于卵巢良性肿瘤和正常卵巢组织（P均〈0．05）。EGFR阳性表达率与卵巢癌临床分期有关（P〈0．05）,KRAS蛋白阳性表达率与卵巢癌临床分期、分化程度有关（P〈0．05）;卵巢癌组织中EGFR与KRAS蛋白表达呈正相关（r=0．613,P〈0．05）。结论卵巢癌组织中EGFR、KRAS蛋白表达明显上调,且两者呈正相关关系,在卵巢癌的发生、发展中起重要作用;KRAS蛋白可能为卵巢癌发生发展的始动因素,可作为卵巢癌的早期诊断指标之一。     

普伐他汀联合髓芯减压术治疗激素性兔股骨头坏死的实验研究

目的研究普伐他汀联合髓芯减压术治疗激素性兔股骨头坏死对组织病理学、骨形态发生蛋白2(BMP2)和血管内皮生长因子(VEGF)mRNA表达水平的影响。方法 45只实验大白兔制作成激素性股骨头坏死模型后随机分为三组:髓芯减压术治疗组(A组),普伐他汀联合髓芯减压术治疗组(B组)和模型组(C组),每组各15只。观察各组各时期兔股骨头毛细血管数、管径、骨陷窝空缺百分比以及BMP2、VEGFmRNA表达水平。结果 A、B两组第4周BMP-2、VEGFmRNA表达水平(7.4±1.1,8.0±1.0;0.118±0.027,0.129±0.023)与C组比较无统计学差异(7.2±0.8;0.117±0.024)(P>0.05)。而B组第8周和第12周BMP-2、VEGFmRNA表达水平(10.5±2.4,13.8±3.2;0.341±0.047,0.562±0.059)明显高于A组(8.0±1.7,8.8±2.0;0.137±0.033,0.149±0.048)、C组(7.6±1.6,7.7±1.8;0.126±0.035,0.131±0.041)(P<0.05);且随治疗时间延长,B组BMP-2、VEGFmRNA表达水...     

颅外脑膜瘤的CT和MRI表现

目的:评价颅外脑膜瘤的CT和MRI表现特征及诊断价值.方法:回顾性分析6例经手术病理检查证实的颅外脑膜瘤的CT和MRI表现.其中,仅行CT检查者2例;仅行MRI检查者1例;CT及MRI均查者3例.结果:6例颅外脑膜瘤的CT及MRI表现为:①病变位于咽旁间隙者3例,咀嚼肌间隙者1例,眼眶者2例;②平扫CT上病变均表现为软组织密度肿块,其中3/5病变含有沙粒样钙化.平扫MRI上,病变在T2WI上均表现为不均匀高信号(“椒盐”征);③增强CT和MRI上,病变均呈明显强化表现;④位于咽旁间隙的病变推移(2例)或包绕(1例)颈内动脉,咽侧壁呈受压改变;⑤4/6例病变表现为与颅内脑膜瘤相连,相邻颅骨和眶壁表现为骨质增厚(4例)或吸收(1例).结论:颅外脑膜瘤的CT和MRI表现以软组织肿块内含钙化、“椒盐”征和邻骨受侵为特点.该病变的CT和MRI表现能为相关鉴别诊断提供有价值信息.     

利多卡因对脓毒症大鼠肺组织高迁移率族蛋白B1mRNA表达的影响

目的 探讨利多卡因对脓毒症大鼠肺组织高迁移率族蛋白B1( HMGB1) mRNA表达的影响.方法 雄性Wistar大鼠50只,体重200 ～ 250 g,采用随机数字表法,将其随机分为5组(n＝10):假手术组(S组)、脓毒症组(L组)、低、中和高剂量利多卡因组(LL1组、LL2组和LL3组).除S组外,其他4组采用盲肠结扎穿孔术制备大鼠脓毒症诱发急性肺损伤模型.LL1组、LL2组和LL3组分别于术毕、术后1、2h时腹腔注射利多卡因5、10、20 mg/kg,S组和L组给予等容量生理盐水.分别于术后24、48 h时处死5只大鼠,取肺组织,测定HMGB1 mRNA表达、髓过氧化物酶(MPO)活性和NF-κB活性,光镜下观察肺组织病理学结果.结果 与S组比较,其他4组肺组织HMGB1 mRNA表达上调,MPO活性升高(P<0.05);与L组比较,LL1组、LL2组和LL3组肺组织HMGB1 mRNA表达下调,MPO活性降低(P<0.01);LL1组、LL2组和LL3组肺组织HMGB1 mRNA表达依次下调,MPO活性依次降低(P<0.05).LL1组、屿LL2和LL3组肺组织NF-κB活性逐渐降低,肺组织损伤程度逐渐减轻.结论 利多卡因减轻脓毒症大鼠急性肺损伤的机制与下调肺组织HMGB1基因表达有关,其下调HMGB1基因表达的机制与抑制NF-κB活化有关.     

血清前白蛋白和总胆汁酸联合检测在肝病中的临床价值

目的探讨血清前白蛋白（PAB）和总胆汁酸（TBA）在肝病中的临床价值。方法分别检测急性肝炎、慢性肝炎、肝硬化、肝癌患者及正常对照组的血清PAB和TBA,并进行统计学分析。结果血清前白蛋白在各肝病中均显著低于对照组（P〈0.01）,而血清TBA则明显高于对照组（P〈0.01）。结论可见联合检测血清PAB和TBA,有助于肝病的诊断、疗效的观察以及预后的判断。     

Decisional Support throughout the Cancer Journey for Older Women Diagnosed with Early Stage Breast Cancer: A Single Institutional Study

To determine if older women with early stage breast cancer have sufficient decisional support during their breast cancer journey, a questionnaire-based study was conducted at the Sunnybrook Odette Cancer Centre, in Toronto, Ontario, Canada. Women with stages I and II breast cancer, ≥60 years, were contacted upon completion of their adjuvant treatment. A questionnaire was developed based on focus groups, the literature, and consultation with patients and a multidisciplinary team of experts. The questionnaire was divided into six domains as follows: (1) information support surrounding diagnosis, (2) impact of cancer diagnosis on the patient, (3) quality of interaction with healthcare team, (4) decisional support from the healthcare team, (5) additional information needs surrounding treatment decision, and (6) information support during radiation treatment. Ninety-two of 137 patients approached were included in the analysis. Ninety percent were?>?60 years at the time of diagnosis and 65 % had stage I invasive breast cancer. The majority of women received adequate decisional support during their cancer journey. Approximately 90 % of women indicated that they received a high level of support during their cancer diagnosis. We found no significant differences in overall decisional support based on age at diagnosis, education level, ethnicity, or the presence of co-morbidities. However, participants desired additional educational resources such as a worksheet, consultation summary, or workbook to assist in making a treatment decision. The majority of participants felt that they had sufficient support while making a treatment decision for breast cancer.