IgG4阳性的上皮样血管瘤1例

患者男, 56岁, 因头皮反复出现肿物7年于2020年3月就诊。患者2013年头顶部外伤后出现1枚直径约0.5 cm的灰红色半球状结节, 不伴痛痒, 搔抓后皮疹增多。2016年头皮肿物切除后行病理检查, 诊断为上皮样血管瘤。2018年, 无明显诱因头顶部及颞部头皮再次出现类似皮损, 不伴痛痒, 于2020年3月就诊于我科。既往史:2016年左侧腮腺肿物行手术切除, 病理诊断为"乳头状淋巴囊腺瘤"。体检:一般状况可, 浅表淋巴结未触及肿大, 各系统检查无明显异常。皮肤科检查:左侧头顶部及颞部头皮共5个大小不一的灰红色半球形丘疹及结节, 最小约0.1 cm × 0.2 cm, 最大约1.0 cm × 0.8 cm, 彼此不融合, 表面光滑(图1)。2020年3月头顶部皮损病理检查:表皮轻度增生, 真皮全层不规则厚壁血管增生, 增生的上皮样血管内皮细胞突入管腔, 真皮内见淋巴细胞、浆细胞及少量嗜酸性粒细胞为主的炎症细胞呈结节状浸润, 可见淋巴滤泡形成, 基质中黏蛋白沉积, 胶原纤维增生(图2)。免疫组化检查显示(图3), IgG阳性细胞较多, IgG4阳性细胞数>50个/高倍视野(× ...     

The effect of surgical repair of hiatal hernia (HH) on pulmonary function: a systematic review and meta-analysis

Hernia - Hiatal hernia is renowned for the symptom of reflux, and few physicians associate a hiatal hernia with pulmonary issues. It is widely acknowledged that a hiatal hernia can be treated with...     

功能MRI评估2型糖尿病早期肾损害研究进展

糖尿病肾病（DKD）是糖尿病微血管并发症，亦为导致终末期肾脏病的主要原因。早期诊断、及时干预可有效控制DKD病情进展并改善预后。近年来，功能MRI （fMRI）逐渐用于定量评估2型糖尿病（T2DM）患者早期肾损害。本文就fMRI评估T2DM早期肾损害研究进展进行综述。     

窄带成像放大内镜联合超声小探头在早期胃癌及癌前病变诊疗中的价值

目的 探讨窄带成像放大内镜（NBI-ME）联合超声小探头在早期胃癌（EGC）或癌前病变中的诊疗价值。方法 收集山西白求恩医院2015年1月至2020年12月收治的行内镜下黏膜剥离术（ESD）且术后病理证实为癌前病变或EGC的88例病人的临床资料。以ESD术后获得的标本组织病理学诊断结果为金标准，判断NBI-ME和超声内镜（EUS）检查的准确性、灵敏度及特异度；同时分析NBI-ME的判断结果、超声小探头对病变浸润深度的判断结果及NBI-ME靶向活检结果与ESD术后病理学结果的一致性，并计算Kappa值及总准确率。结果 NBI-ME诊断EGC的灵敏度为78.79%、特异度为90.91%，总准确率高达86.36%，与术后病理结果比较一致性较好（P<0.05,Kappa=0.706）;NBI-ME靶向活检病理诊断与术后病理诊断结果一致的共77例，总准确率为87.5%，与术后病理结果比较一致性较好（P<0.05,Kappa=0.755）;EUS预判结果与术后病理结果一致的共79例，总准确率高达89.77%，与术后病理结果比较一致性较好（P<0.05,Kappa=0.611）。结...     

The cathepsin-S/protease-activated receptor-(PAR)-2 axis drives chronic allograft vasculopathy and is a molecular target for therapeutic intervention

BackgroundCathepsin S (CatS) and proteinase-activated receptor (PAR)-2 are involved in the remodelling of vascular walls and neointima formation as well as in alloantigen presentation and T-cell priming. Therefore, we hypothesized that CatS/PAR-2 inhibition/deficiency would attenuate chronic allograft vasculopathy.MethodsHeterotopic aortic murine transplantation was performed from C57BL/6J donors to C57BL/6J recipients (syngeneic control group), Balb/c to C57BL/6J without treatment (allogenic control group), Balb/c to C57BL/6J with twice daily oral CatS inhibitor (allogenic treatment group) and Balb/c to Par2−/− C57BL/6J (allogenic knockout group). The recipients were sacrificed on day 28 and the grafts were harvested for histological analysis and RT-qPCR.ResultsAfter 28 days, mice of the allogenic control group exhibited significant neointima formation and massive CD8 T-cell infiltration into the neointima while the syngeneic control group showed negligible allograft vasculopathy. The mRNA expression level of CatS in allografts was 5-fold of those in syngeneic grafts. Neointima formation and therefore intima/media-ratio were significantly decreased in the treatment and knockout group in comparison to the allogenic control group. Mice in treatment group also displayed significantly fewer CD8 T cells in the neointima compared with allogeneic controls. Additionally, treatment with the CatS inhibitor and PAR2-deficiency decreased mRNA-levels of interleukins and cytokines.ConclusionIn conclusion, our data indicate that inhibiting CatS and PAR-2 deficiency led to a marked reduction of neointima formation and associated inflammation in a murine heterotopic model for allograft vasculopathy.     

The effect of pre-conditioning immunoglobulin and absolute lymphocyte count on the outcomes of allogeneic hematopoietic cell transplantation

IntroductionThe prevention of mortality and morbidity related to the increasingly used allogeneic hematopoietic cell transplantation (allo-HCT), along with the effects of pre- and post-transplant immune status on transplant outcomes, have become the focus of the studies conducted on this subject in recent years. In parallel, this study was designed to investigate the effects of pre-conditioning immunoglobulin (pre-conditioning-Ig) and pre-conditioning absolute lymphocyte count (pre-conditioning-ALC) levels on transplant outcomes.MethodsThis study was designed as a retrospective, observational and cross-sectional study. The objective of the study is to investigate the effects of pre-conditioning-Ig and ALC levels primarily on the rate of patients with febrile neutropenia (FEN) and the duration of FEN and length of hospital stay (LoS), and secondarily on acute graft-versus-host disease (aGVHD), cytomegalovirus (CMV) viremia, and mortality in the acute leukemia patients who underwent allo-HCT.ResultsA total of 104 acute leukemia patients, of whom 55 had acute lymphoblastic leukemia (ALL) and 49 had acute myeloid leukemia (AML), were included in the study. Compared to the AML group, the median pre-conditioning-IgG, IgA, and IgM levels were found to be significantly lower in the ALL group (11.3 vs. 6.6, p < 0.001; 1.8 vs. 0.9, p < 0.001; and 0.7 vs. 0.4, p < 0.001; respectively). But, there was no significant difference between the groups in pre-conditioning-Ig and ALC levels and transplant outcomes. However, subgroup analysis revealed that high pre-conditioning-ALC levels were significantly correlated with aGVHD levels (Odds Ratio: 1.02; p = 0.034) and low pre-conditioning-IgM levels were significantly correlated with increased mortality rate (Hazard Ratio: 0.08; p = 0.042) in AML patients.ConclusionThe significant difference determined between the ALL and AML groups in pre-conditioning-Ig levels was not reflected on the effects of pre-conditioning-Ig and ALC levels on transplant outcomes. However, we observed that pre-conditioning-IgM and ALC levels have an impact on transplant outcomes in AML patients.     

腹腔镜肾部分切除术与腹腔镜冷冻消融术治疗小肾肿瘤的安全性和疗效的Meta分析

目的系统评价腹腔镜肾部分切除术(LPN)与腹腔镜冷冻消融术(LCA)治疗小肾肿瘤(SRMs)的安全性及疗效。方法计算机检索Pub Med、SCI、Ovid、The Cochrane Library、CNKI、CBM、VIP及万方数据库,全面收集有关LPN与LCA比较治疗SRMs的临床对照试验,检索时限截至2016年4月。由2名评价者按照纳入与排除标准选择试验、提取资料和评价质量后,采用Rev Man 5.3软件进行Meta分析。结果纳入9篇研究,共748例患者。Meta分析结果显示:LCA较LPN手术时间短[均数差(MD)=42.75,95%CI(12.19,73.31),P=0.006],术中出血量少[MD=190.73,95%CI(126.67,254.78),P=0.000],住院时间短[MD=2.23,95%CI(0.17,4.28),P=0.030],术式转换率低[比值比(OR)=3.54,95%CI(1.18,10.59),P=0.020],并发症少[OR=3.90,95%CI(1.84,8.24),P=0.000],术后肾小球滤过率(GFR)下降量低[MD=10.30,95%CI(5.38,15.24),P=0.000],局部复发风险高[OR=0.13,95%CI(0.04,0.44),P=0.000],远处转移风险高[OR=0.16,95%CI(0.03,0.78),P=0.020],而在术后血肌酐(Scr)上升量、输血率比较差异均无统计学意义(P0.05)。结论 LCA在围手术期结果、保护肾功能方面更有优势,但其有较高的肿瘤局部复发和远处转移风险,近期、中期疗效相当,远期疗效尚不明确,故在手术病例的选择上仍需谨慎。     

性医学领域护理专业学位研究生培养指标体系的构建

目的 构建新医科背景下护理专业学位研究生在性医学领域的跨学科人才培养指标体系,为今后临床应用提供参考依据。方法 通过文献检索、查阅资料、理论分析、专家访谈法和临床实践经验初步形成指标体系草案,运用德尔菲法对20名来自9个省市行政区且具有性医学、护理学、性咨询等高等教育背景的专家进行函询。结果 2轮问卷有效回收率分别为83.33%、100%，专家权威系数分别为0.81、0.81，肯德尔和谐系数分别为0.151、0.263。最终确立研究方案包括一级指标4项，二级指标12项，三级指标64项，四级指标28项，其重要性评分为4.250～5.000，变异系数为0～0.228。结论 本研究基于德尔菲法构建的指标体系符合科学性和可操作性原则，注重性医学领域护理硕士专业学位研究生有关理论和实践的培养,且专家积极性、权威性高、意见协调程度好,说明形成的指标体系对性医学领域护理硕士专业学位研究生培养的开展有指导作用。     

基于一年集中监测的盐酸胺碘酮注射液致急性肝损伤临床特点与危险因素分析

目的:探讨盐酸胺碘酮注射液致急性肝损伤(AHI)的临床特点与危险因素。方法:研究设计为集中监测,监测对象为2018年3月1日至2019年2月28日在山西白求恩医院住院并使用盐酸胺碘酮注射液的所有患者,但在进行该药致AHI临床特点和危险因素分析时,排除患有病毒性肝炎、自身免疫性肝病、原发性肝癌或恶性肿瘤肝转移以及用药前肝功能异常者。对用药后出现肝功能异常并经主诊医师和临床药师共同判定为盐酸胺碘酮注射液所致AHI者,由专人另行建立临床档案,并每个月通过医院信息系统对当月应用该药患者的实验室检查记录进行复核。监测期结束后,检索医院信息系统收集监测对象的电子病历,记录纳入分析患者的基本信息,基础疾病,盐酸胺碘酮注射液用药总剂量,联合用药情况,应用盐酸胺碘酮注射液前后血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBil)检测结果,用药至发生AHI的时间,以及AHI的临床表现、治疗和转归情况。将患者分为AHI组和无AHI组,比较2组患者的临床特征,将组间比较 P<0.2的指标纳入多因素Logistic回归分析,计算 OR及其95 %CI。 结果:纳入分析的患者共271例,其中发生AHI者34例,AHI发生率为12.5%。AHI组与无AHI组(237例)患者的性别分布、年龄、身高、体重、静脉用药总剂量、联用其他药物(包括抗血小板药物、他汀类药物、β肾上腺素受体阻滞剂、抗凝血药物、激素类药物和抗肿瘤药物等)情况差异均无统计学意义(均 P>0.05);AHI组冠状动脉粥样硬化性心脏病(冠心病)患者占比高于非AHI组[58.8%(20/34)比30.8%(73/237), χ 2=10.358, P=0.001]。2组患者应用盐酸胺碘酮注射液前ALT、AST、TBil水平差异均无统计学意义(均 P>0.05);用药后AHI组患者ALT、AST和TBil水平均明显高于用药前[341(176,1 175)U/L比25(16,31)U/L, P=0.014;439(167,1 586)U/L比36(24,56)U/L, P=0.029;36.0(15.31,42.1)μmol/L比18.6(14.8,22.1)μmol/L, P<0.001],且均明显高于用药后非AHI组( P=0.006, P=0.026, P<0.001)。34例AHI患者中,用药第2、3和5天出现肝功能异常者分别为19、14和1例,均无明显临床体征和症状。诊断AHI后,29例患者停用盐酸胺碘酮注射液,3例改用利多卡因,2例分别继续用药1和3 d后停药。34例患者均接受保肝对症治疗,32例(94.1%)好转,至出院时25例(78.1%)肝功能指标均在参考值范围内,7例(21.4%)ALT、AST水平恢复至参考值上限2倍以内,TBil水平在参考值范围内;2例(5.9%)患者进展为多器官功能障碍综合征,救治后1例肝功能恢复正常,1例死亡。多因素回归分析结果显示,冠心病、合并≥3种基础疾病、联用≥3种药物是盐酸胺碘酮注射液致AHI的独立危险因素( OR=3.209,95 %CI:1.537~6.704, P=0.002;OR=2.437,95 %CI:1.083~5.486, P=0.031;OR=3.172,95 %CI:1.507~6.677, P=0.002)。 结论:盐酸胺碘酮注射液致AHI多发生在用药3 d内,起病急,临床体征和症状均不明显,诊断主要依据肝功能检查;冠心病、合并≥3种基础疾病、联用≥3种药物是盐酸胺碘酮注射液致AHI的独立危险因素。     

Protective effect of Saxagliptin on diabetic rats with renal ischemia reperfusion injury by targeting oxidative stress and mitochondrial apoptosis pathway through activating Nrf-2/HO-1 signaling

Oxidative stress and apoptosis play vital role in diabetic rats suffering from renal ischemia reperfusion injury (IRI). As a dipeptidyl dipeptidase-4 (DPP-4) inhibitor, Saxagliptin(SAX)has been confirmed in the regulation of inflammation and apoptosis by targeting Nrf-2/HO-1signalling. The study was designed to explore the efficacy and potential mechanisms of SAX on inflammation and apoptosis for treating of IRI in diabetic rats. Through testing the expressions of Nrf-2, HO-1, Cleaved-Caspase9, Cleaved-Caspase3, Bax, BCL-2, Bak, Apaf-1, cytochrome C (Cytc), Cystatin C (CysC), β2-microglobulin (β2-MG), creatinine (Cr), urea nitrogen (BUN), TUNEL and pathological morphology, the effects of SAX on IRI diabetic rats have been investigatedg. The results has displayed SAX treatment significantly attenuate the cell apoptosis and pathological damage of kidney as well as lessening the expression of cleaved-caspase-9, cleaved-caspase3, Bax, cytoplasmic-Cytc, MDA, Bak, and Apaf-1 molecules, and the contents of ROS, Cr, CysC, β2-MG, and BUN. Furthermore, SAX therapy also increased the expression of Nrf-2, BCL-2, HO-1 and mitochondrial cytochrome Cytc, and enhanced the activity of SOD, CAT and GPx. Therefore, our study has indicated that SAX treatment alleviated IRI in diabetic rats by suppressing oxidative stress and mitochondrial apoptotic pathways by activating the Nrf-2/HO-1 signaling.