特殊染色技术在艾滋病合并真菌病理诊断中的应用

目的 探讨特殊染色技术在艾滋病合并真菌病理诊断中的应用价值.方法 选取2010年2月至2013年11月上海市（复旦大学附属）公共卫生临床中心确诊为艾滋病合并真菌感染的患者20例,回顾性分析经苏木素-伊红（HE）染色、过碘酸希夫染色（PAS）和六胺银染色的病理资料,观察常见真菌在光镜下的形态.结果 20例艾滋病合并真菌感染的患者中,肺部隐球菌2例,皮肤、肺、腹腔肠系膜淋巴结马尔尼菲青霉菌3例,会厌、颈部淋巴结、口腔、腹腔及皮肤组织胞浆菌5例,上颌窦、肺及声带曲霉4例（合并结核3例）,肝、咽、食道及胃部白色假丝酵母菌6例.HE染色组织中炎性细胞浸润,可见肉芽肿形成,凝固性坏死,真菌形态尚能辨认,但需仔细观察,否则易漏诊或误诊;PAS染色,真菌孢子和假菌丝呈亮丽的紫红色,细胞核紫蓝色;六胺银染色,真菌孢子和假菌丝呈清晰可辨的黑褐色.结论 除常规进行HE染色外,联合应用PAS染色和六胺银染色,有助于提高真菌的病理诊断率.     

Performance of sequential organ failure assessment, logistic organ dysfunction and multiple organ dysfunction score in severe sepsis within Chinese intensive care units

This study assessed the performance of Sequential Organ Failure Assessment, Logistic Organ Dysfunction Score and Multiple Organ Dysfunction Score in outcome prediction in severe sepsis. A total of 528 consecutive patients with a diagnosis of severe sepsis were enrolled from two surgical intensive care units of university hospitals in China. Clinical and laboratory data of patients were collected and admission and maximum values of each scoring system were calculated. Areas under the receiver operating characteristic curve, which were used to assess discrimination, were 0.80, 0.83 and 0.74 for admission Sequential Organ Failure Assessment, Logistic Organ Dysfunction Score and Multiple Organ Dysfunction Score respectively, and 0.91, 0.93 and 0.86 for corresponding maximum values respectively. Calibration assessed by the Hosmer-Lemeshow statistic was better with admission (chi2 = 18.2) and maximum Logistic Organ Dysfunction Score (chi2 = 19.6) than with admission (chi2 = 98.1) and maximum Multiple Organ Dysfunction Score (chi2 = 30.9). Brier Scores, indicating the overall performance of the scores, were 0.18, 0.17 and 0.22 for admission Sequential Organ Failure Assessment, Logistic Organ Dysfunction Score and Multiple Organ Dysfunction Score respectively, and 0.12, 0.10 and 0.15 for their maximum counterparts respectively. This study found good performance of both admission Sequential Organ Failure Assessment and Logistic Organ Dysfunction Score in severe sepsis, and a slightly weaker performance of admission Multiple Organ Dysfunction Score. Since poor calibration was observed in Logistic Organ Dysfunction Score and Multiple Organ Dysfunction Score, we suggest further study of customisation of these scores in critical illness with severe sepsis.     

Effects of ischemia-reperfusion injury on apolipoprotein M expression in the liver

The present study investigated the expression pattern of apolipoprotein M (apoM) mRNA in a rat model of hepatic ischemia-reperfusion injury (IRI). Animals were ischemic for 1 hour followed by various reperfusion times. As expected, serum alanine aminotransferase levels were significantly increased under IRI, which indicated the severity of liver injury. Hepatic mRNA levels of HSP70, which is the most common characterized protein within the family of heat-shock proteins (HSP), were significantly increased after 0.5 to 3 hours of IRI. Plasma C-reactive protein, high-density lipoprotein-cholesterol, and lipoprotein (a) levels were significantly increased after 1-hour ischemia followed by 0.5 to 3 hours of reperfusion. Interestingly, similar to HSP70, apoM mRNA levels in the liver were gradually increased after 0.5 to 3 hours of IRI, whereas it returned to a lower level after 6 or 24 hours of IRI, which indicated that hepatic apoM expression was significantly influenced by the acute phase of IRI. However, plasma apoM levels were not increased in parallel, even slightly decreasing after 0.5 or 1 hour of IRI. We concluded that apoM mRNA expression pattern, like HSP70, in the liver showed rapid, significant changes during hepatic local IRI.     

Low Expression of PAI-2 as a Novel Marker of Portal Vein Tumor Thrombosis and Poor Prognosis in Hepatocellular Carcinoma

Background

Plasminogen activator inhibitor (PAI)-2 was previously shown to be less frequently expressed in hepatocellular carcinoma (HCC). The present study was designed to investigate the clinical, pathological, and prognostic significance of PAI-2 expression in HCC.

Methods

Expression of PAI-2 was detected immunohistochemically for specimens from 78 patients with HCC after hepatic resection and correlated with clinicopathological features and patient survival. Risk factors of portal vein tumor thrombosis (PVTT) were also analyzed.

Results

Positive PAI-2 staining was observed in tumor and non-tumor tissues from 21 (26.9 %) and 56 (71.8 %) patients, respectively. Plasminogen activator inhibitor-2 negativity in tumor tissues was significantly associated with PVTT, with a high sensitivity not only in univariate analysis but also in multivariate analysis. In addition, positive PAI-2 staining was related to smaller tumor size and prolonged patient survival. The Cox regression model identified intratumoral PAI-2 staining as an independent prognosticator in patients with HCC after resection.

Conclusions

Our data demonstrated that low expression of PAI-2 serves as a novel marker of PVTT and poor prognosis in HCC.     

Facile synthesis of carbon and oxygen vacancy co-modified TiNb6O17 as an anode material for lithium-ion batteries

Titanium niobium oxides (TNOs), benefitting from their large specific capacity and Wadsley–Roth shear structure, are competitive anode materials for high-energy density and high-rate lithium-ion batteries. Herein, carbon and oxygen vacancy co-modified TiNb₆O₁₇ (A-TNO) was synthesized through a facile sol–gel reaction with subsequent heat treatment and ball-milling. Characterizations indicated that A-TNO is composed of nanosized primary particles, and the carbon content is about 0.7 wt%. The nanoparticles increase the contact area of the electrode and electrolyte and shorten the lithium-ion diffusion distance. The carbon and oxygen vacancies decrease the charge transfer resistance and enhance the Li-ion diffusion coefficient of the obtained anode material. As a result of these advantages, A-TNO exhibits excellent rate performance (208 and 177 mA h g⁻¹ at 10C and 20C, respectively). This work reveals that A-TNO possesses good electrochemical performance and has a facile preparation process, thus A-TNO is believed to be a potential anode material for large-scale applications.

Carbon and oxygen vacancy co-modified TiNb₆O₁₇ is synthesized through a facile sol–gel reaction. It possesses good electrochemical performance, thus is believed to be a potential anode material for large-scale applications.     

晚期肝门胆管癌的经腹减黄治疗

目的 总结晚期肝门胆管癌减黄治疗的经验。方法 对43例晚期肝门胆管癌施行不同的内引流术并进行分析及随访。结果 术后并发应激性溃疡出血37例，无胆瘘及腹腔感染，无死亡病例，术后两周黄疸明显减轻30例，完全消退7例，随访36例，术后生存期最短4个月，最长43个月，至今存活6例，生存期分别达21、16、11、9、8和7个月。结论 术前影像检查为术式的选择提供直接的依据；术式选择视患者营养状况及梗阻部位和术中探查情况而定，置管架桥内引流术操作简单，肝断面空肠Roux-Y吻合减黄效果好。     

Successful radiofrequency ablation of swallowing-induced atrial tachycardia arising from left superior ganglionated plexus

A man in his early 40s developed palpitations brought on by swallowing and was found to have short runs of atrial tachycardia induced by swallowing solid food. Atrial tachycardia during swallowing was documented on electrocardiography and 24-hour Holter monitoring. No structural heart disease or esophageal disorders were found by echocardiography. The patient then underwent an electrophysiological study and catheter ablation. We mapped the left atrium with a multipolar mapping catheter while the patient swallowed bread and found that the earliest endocardial breakthrough was on the left anterior superior atrium, where the left superior ganglionated plexus was located. We successfully eliminated the paroxysmal atrial tachycardia at this site. Interestingly, in the process of ablation, atrioventricular node reentrant tachycardia was triggered. After the slow-pathway ablation procedure, no further tachycardia was induced.     

比较两种营养评估工具在外科老年病人中的应用价值

目的:评价微型营养评定简表(MNA-SF)和营养风险筛查(NRS2002)工具在外科老年住院病人中的应用价值。方法:132例外科老年住院病人在入院后48 h内分别用MNA-SF和NRS2002进行营养评估和筛查,并进行营养相关指标检测,包括体质量指数、上臂围、小腿围、血清白蛋白和前白蛋白;评判两种营养评估工具对外科老年住院病人临床结局(感染性并发症发生率和住院时间)的预测能力。结果:MNA-SF评估得出外科老年住院病人营养不良发生率为8.3%,存在营养不良风险者达36.4%;NRS2002筛查提示存在营养风险者达65.1%,且随年龄增长而升高(r=0.33,P<0.001)。两种工具的评估和筛查结果与传统的单一营养指标均显著相关(P<0.001);MNA-SF和血清白蛋白水平则与住院时间无相关性。结论:MNA-SF和NRS2002的评估、筛查侧重点不同,但均可用于外科老年住院病人,与MNA-SF和血清白蛋白水平相比,NRS2002对于临床结局———住院时间的预测能力更强。