ALK-negative anaplastic large cell lymphoma primarily involving the bronchus: a case report and literature review

Anaplastic large cell lymphoma (ALCL) is a mature T cell lymphoma with characteristic morphologic, immunophenotypic and cytogenetic features. Current WHO classification includes anaplastic lymphoma kinase (ALK)-positive and ALK-negative variants. ALCL rarely presents with obstructive symptoms of the main airway. In addition to reporting a HIV-associated bronchial ALK-negative ALCL in a 44 year-old female, our literature review identified eight cases of bronchial ALCL with several interesting clinicopathological features, including: 1) a female predominance (67%); 2) two thirds of patients younger than 18 years old; 3) uniformly presented with respiratory symptoms and progressed to respiratory failure; 4) the tumor involving the main airways; 5) often with localized disease at the initial presentation. This unusual presentation of ALCL may pose as a diagnostic pitfall and delay the treatment.     

Hybrid mechanical thrombectomy for acute ischemic stroke using an intermediate aspiration catheter and Trevo stent simultaneously

PurposeTo overcome the limitations of traditional mechanical thrombectomy (MT), including catheter aspiration and stent retrievers, such as thrombus fragmentation or migration, we designed hybrid MT using an intermediate aspiration catheter and a Trevo stent simultaneously. We retrospectively compared hybrid MT with the traditional MT.MethodsFrom January 2017 to January 2019, we performed MT on 91 occlusions, including internal carotid artery bifurcation (n = 17), M1 segment (n = 53) and M2 segment (n = 21), using hybrid MT (n = 42) and traditional MT (n = 49).ResultsHybrid MT had a shorter procedure time (52.4 ± 22.0 vs. 73.0 ± 36.2 min, p = 0.002) and fewer attempts (1.50 ± 0.86 vs. 1.92 ± 1.10 times, p = 0.049) than traditional MT did. Hybrid MT achieved more good clinical outcome (3-month modified Rankin Scale score, 2 or less) and better successful recanalization (Thrombolysis In Cerebral Infarction grade, 2b or 3) than traditional MT did, but the difference was not significant (61.9% vs. 55.1%, p = 0.531, 92.9% vs. 87.8%, p = 0.498). Hybrid MT showed a higher first pass successful recanalization rate than traditional MT did (69.0% vs. 40.8%, p = 0.011). Multivariable logistic regression analysis demonstrated that first pass successful recanalization is related to the M1 segment rather than other segments (adjusted odds ratio (OR); 3.277, confidence interval (CI); 1.227–8.749, p = 0.018) and hybrid MT rather than traditional MT (adjusted OR; 4.995, CI; 1.725–14.460, p = 0.003).ConclusionsHybrid MT can be used as a first-line MT modality, particularly in M1 occlusion, based on our high first pass successful recanalization results.     

caspase-8在支气管哮喘大鼠心肌细胞中的表达

目的 研究支气管哮喘心肌损害的机制及法医病理学实践中支气管哮喘猝死者的诊断指标.方法 建立大鼠支气管哮喘动物模型,运用免疫组化SP法染色,观察在不同实验条件下大鼠心肌细胞caspase-8表达的变化规律.结果 caspase-8在正常对照组及实验对照组心肌细胞中呈阴性或弱阳性表达,随着时间的延长免疫组化染色无明显的改变.各实验组第2周时caspase-8蛋白阳性面积和积分光密度比正常对照组及实验对照组明显升高(P＜0.01),随着时间的延长,阳性表达面积和积分光密度呈增加的趋势,第8周各实验组的阳性表达达到最高峰.肾上腺素氨茶碱联合给药组caspase-8表达阳性信号面积及积分光密度比不给药组低.组间比较,肾上腺素给药组caspase-8表达阳性信号面积及积分光密度比氨茶碱给药组在各时间段都明显增加.结论 支气管哮喘本身对心肌有一定的损害;肾上腺素药物可加重心肌损害;氨茶碱与肾上腺素联合使用可以减轻心肌损害;caspase-8可以作为支气管哮喘猝死的诊断辅助指标.     

心肌血流储备分数指导下药物治疗冠状动脉临界病变患者的远期疗效

目的研究心肌血流储备分数(FFR)指导下药物治疗冠状动脉临界病变患者的安全性。方法 2010年4月至2011年9月武汉亚洲心脏病医院介入中心行冠状动脉造影提示临界病变同时行冠状动脉内压力导丝测定FFR≥0.8的连续15例患者,规范冠心病二级预防药物治疗。随访≥1年,包括主要不良事件(包括死亡、心肌梗死、再次靶病变血运重建术、卒中)及再发心绞痛、再次住院、出血发生情况。结果 15例患者平均(61±7.49)岁。其中男性7例(46.7%),冠状动脉造影病变平均(1.2±0.5)支。15例患者冠状动脉造影提示19处临界病变:左前降支15处、回旋支3处,右冠状动脉1处;其中单支病变者11例(73.3%),双支病变者4例(26.7%),均合并前降支病变;FFRmyo均值(0.88±0.06)。15例患者平均随访(23.6±5.67)个月,其中1例(6.7%)失访。2例(13.3%)不稳定型心绞痛患者随访期间出现心绞痛,症状较前无明显加重,含服硝酸甘油可缓解,余心肌梗死、再次靶病变血运重建术、卒中、全因死亡、再次住院率、出血等不良事件无发生。对入选患者心绞痛发生情况采用Kaplan-Meier法做生存分析,FFR术后平均再发心绞痛时间为术后(29.12±0.67)个月。结论初步验证了FFR指导下药物治疗冠状动脉临界病变患者是可行的。     

免疫应答类型的重新分类

过渡性免疫应答由原属固有免疫应答的原始B1细胞、γδT细胞和NKT细胞所组成.其中原始B1细胞承担过渡性免疫应答的体液免疫,γδT细胞和NKT细胞承担过渡性免疫应答的细胞免疫,主要识别和排除TI抗原.固有免疫应答的细胞包括吞噬细胞、树突状细胞、NK细胞等,体液免疫组包括补体、急性期蛋白、溶菌酶等,其主要作用是非特异性地清除或递呈抗原.适应性免疫应答的细胞由B2细胞和αβT细胞组成,B2细胞承担适应性体液免疫应答,αβT细胞承担适应性细胞免疫应答,主要识别和排除胸腺依赖性抗原(TD).免疫应答分为3种类型是对免疫系统进化的客观阐述,符合物种进化的基本规律,准确反映了免疫功能的发生和发展,对完善免疫学基础理论以及指导临床免疫学研究具有重要的意义.     

云南省传播广州管圆线虫病的螺类调查研究

目的了解云南省传播广州管圆线虫病的中间宿主螺类。方法野外调查采集贝类标本,分类鉴定,寄生虫检测。结果发现传播广州管圆线虫病的中间宿主螺类共12种。结论为广州管圆线虫病在云南省的防治提供科学依据。     

右肺下叶段支气管CT显示的应用解剖

目的：为给ＣＴ对右肺下叶作斜位扫描提供倾斜角度及对诊断提供参考数据。方法：以３０例标本制成支气管树和１３例ＣＴ影像观测叶、段支气管内径、段支气管与叶支气管的夹角。结果：叶支气管内径５．０±０．２ｍｍ。相邻底段支气管内径无显著差别。ＢⅥ、ＢⅦ、ＢⅧ、ＢⅨ和ＢⅩ的夹角分别为８８．１°±１．７°、１８．２°±３．５°、２０．２°±２．８°、１５．８°±２．６°和１６．７°±３．６°。结论：叶段支气管内径、管壁厚度可为ＣＴ诊断增加一个以数据为依据确定管腔狭窄或管壁增厚的方法以提高中心型肺癌的正确诊断率，依段支气管的倾斜角度将ＣＴ机架和体位作相应的倾斜和偏移使扫描层面与段支气管垂直可提高其ＣＴ显示率。     

The acute remedy of malignant central airway obstruction

Objective： To explore the palliative methods to patients with central airway obstruction due to advanced malignancies. Methods： Twenty-seven patients with carcinous airway obstruction and respiratory distress were emergency remedied, including 12 cases with atelectasis and 23 with pulmonary infection. Soft cryoablated probe of CO2 and/or reticulate endobronchial stent with filmed titanium alloy were placed to the neoplasm following by bronchofibroscope. Results： Totally there were 21 patients achieved completely remission, including airway obstruction, respiratory distress and pulmonary infection remission, and 3 cases got partial remission. Meanwhile there were 3 cases died, in which one was happened during the period of endobronchial stent making, another one with heavy airway obstruction died due to asphyxia 24 h after the operation of bronchofibroscope examination, and the last one with knob invaded died because of hemoptysis and asthema secondarily 36 h after stent placed. Conclusion： The emergency remedy using soft cryoablated probe of CO2 and/or reticulate endobronchial stent with filmed titanium alloy placed to the neoplasm following by bronchofibroscope to patients with malignant central airway obstruction was a effective salvage method and could prolong patients＇ lifespan for more subsequent therapeutic opportunities.     

腹腔镜辅助中位肛门闭锁成形术11例报告

目的 探讨腹腔镜辅助中位肛门闭锁成形术的可行性。方法 腹腔镜监视下,游离松解直肠;断离修补直肠尿道（阴道）瘘管,其中6例经腹腔镜离断修补,4例经会阴切口离断修补;然后在电刺激仪的引导下经会阴肌肉中心1.0cm左右小切口向盆底肌肉中心分离形成隧道,最后将直肠从隧道中拖出,与会阴皮肤吻合,同时关闭结肠造瘘口。结果 11例患儿均在腹腔镜辅助下完成肛门成形术,腹腔镜手术操作时间平均32.8min（25～78min）,出血量平均5.3ml（2～10ml）,无需要输血者。术后11d去除尿管或膀胱造瘘管,无尿道瘘或憩室出现,无切口感染发生。11例术后随访3～66个月,平均45个月。根据肛门功能临床评分标准评分（6分法）,排便优8例（72.7%）,良3例（27.3%）。结论 腹腔镜辅助中位肛门闭锁成形术处理直肠泌尿系瘘方便,辨认盆底肌中心准确及避免切口污染等优点,是治疗中位肛门闭锁有效方法。     

胆管反应在肝癌发生发展中的作用及其临床意义

胆管反应是指在肝祖细胞介导的肝脏修复过程中形成的局部细胞复合体.这种复合体包括有激活的肝祖细胞、中间型肝胆细胞和反应胆管细胞.胆管反应对肝癌发生发展具有重要作用.胆管反应中的肝干/祖细胞的恶性转化和迁移性是肝癌浸润和转移的基础,同时胆管反应又为肝癌的发生发展提供基质微环境.本文就胆管反应的分类、细胞多样性以及胆管反应在肝炎和肝癌发生发展中的作用研究进展进行综述,旨在研究胆管反应对阐明肝癌的发病机制,探索有效的治疗手段.