颈部淋巴结核96例诊断分析

目的 分析探讨颈部淋巴结核(CTL)的诊断方法.方法 回顾性分析青岛市胸科医院2012年4月至2013年12月收治的128例颈部肿块患者(其中96例确诊为颈部淋巴结核,作为观察组;32例为非颈部淋巴结核患者,作为对照组)的诊断过程,比较128例患者PPD试验、结核抗体检测、标本浓缩集菌抗酸杆菌检测、颈部CT增强扫描检查、结核感染T淋巴细胞斑点试验(T-SPOT.TB)(其中观察组60例进行了检测)、结核分枝杆菌DNA-PCR共6种方法的诊断阳性率.采用SPSS 13.0统计软件进行处理,对组间和观察组样本率采用x2检验进行比较,P＜0.05为差异有统计学意义.结果 对照组与观察组结核抗体检查阳性率分别为46.88％(15/32)、56.25％(54/96),两组比较差异无统计学意义(x2=0.849,P=0.357).对照组PPD试验、浓缩集菌抗酸杆菌检测、CT增强扫描、T-SPOT.TB、结核分枝杆菌DNA-PCR检查阳性率分别为25.00％(8/32)、0％(0/32)、15.63％(5/32)、9.38％(3/32)、0％(0/32),观察组各阳性率分别为84.38％(81/96)、13.54％(13/96)、92.71％(89/96)、98.33％(59/60)、97.92％(94/96),5项组间比较差异均有统计学意义(分别为x2=39.938,P＜0.01;x2=4.823,P=0.028;x2=73.105,P＜0.01;x2=75.154,P＜0.01;x2=117.961,P＜0.01).结论 CT增强扫描、血清T-SPOT.TB和结核分枝杆菌DNA-PCR在临床上对于颈部淋巴结核的检查阳性率较高;结合多种检查方法有助于辅助诊断颈部淋巴结核,同时有助于颈部肿块的鉴别诊断.     

结核病临床诊治进展年度报告（2013年）（第一部分 结核病临床诊断）

近一年来,结核病的诊断方面继续深入进行相关方面的研究,取得了不少进步.在细菌学诊断方面,使用新技术如新型移动数字化荧光显微镜痰检涂片技术可清晰显示并保存图像,发光二极管（LED）性能的荧光显微镜（FM）检查能够明显缩短常规涂片的染色时间,明显提高检出率.影像学诊断在结核病诊断的难点方面进行了详细的研究,如肺癌合并肺结核的临床分期、耐多药结核病与非结核分枝杆菌病的鉴别等.γ干扰素释放试验诊断结核分枝杆菌感染具有很大优势,今年对其诊断价值进行再评价.分子生物学诊断发展迅速,继续对XpertMtb/RIF诊断系统进行深入研究,超支化滚环扩增（hyperbranched rolling circle amplification,HRCA）技术简单、经济、省时,在贫困地区具有广泛的应用前景.介入诊断方面,将气管镜、腔镜技术与分子生物学、超声引导技术、细菌学、病理学检测技术相结合,使得结核病的诊断效率得到显著的提高,如气管镜下支气管冲洗液进行XpertMtb/RIF的检测等.病理学诊断方面以分子病理技术的发展较引人注目,使用活检标本行基因检测提高了结核病的检出率.     

三氧化二砷对大鼠肺纤维化模型的干预作用及其机制的探讨

目的观察三氧化二砷(arsenictrioxide,AS2O3)对博莱霉素-A5(bleomycin-A5,BLM-A5)所致大鼠肺纤维化有无治疗作用并探讨其作用机制。方法50只SD大鼠分为空白对照组、肺纤维化模型组和三氧化二砷治疗组。其中对照组10只,气管内给予生理盐水后,连续7天腹腔内注入生理盐水;模型组20只,气管内给予BLM-A5后,连续7天腹腔内注入生理盐水;治疗组20只,气管内给予BLM-A5后连续7天腹腔内注入AS2O3。每组再随机均分成2个亚组,分别于实验第7天、第28天处死。检测以下项目:①支气管肺泡灌洗液(bronchoalveolarlavagefluid,BALF)经流式细胞仪行细胞分类和炎性细胞凋亡率检测;②ELISA法检测BALF中细胞因子γ-干扰素(interferon-gamma,IFN-γ)的含量。③光镜下观察肺组织肺泡炎和肺纤维化程度;④实验第28天肺组织羟脯氨酸(hydroxyproline,HYP)含量的测定。结果与模型组相比,治疗组:①BALF中中性粒细胞和淋巴细胞百分比总和降低(P<0.05);炎性细胞凋亡率增加(P<0.05);实验第7天组IFN-γ含量降低(P<0.05)。②肺组织炎症和纤维化程度减轻;HYP含量降低(P<0.05)。结论AS2O3能减轻BLM-A5诱导的肺纤维化大鼠肺组织炎症和纤维化程度,作用机制可能与其诱导肺内炎性细胞凋亡有关。     

Results of a phase-II clinical trial on treatment of rheumatoid arthritis with recombinant interferon-gamma

Summary In an open, non-randomized clinical trial conducted at multiple centres, 49 patients with rheumatoid arthritis were treated with recombinant interferon-gamma for 20 days. The study was carried out in two sub-studies. In the first, the total daily dose of interferon-gamma was 50 g; in the second, 100 g. Of the 49 cases, 40 were evaluable for statistical analysis; 24 of these patients (60%) responded to therapy, according to the criteria of a successful outcome laid down in the study protocol, and were classified as responders. In responders, the clinical parameters investigated improved with both dosages. The lower dosage differed from the higher one in having a markedly lower incidence of side-effects. The results lead to the conclusion that a randomized double-blind phase-III clinical trial should be performed.     

Is the L-tryptophan metabolite quinolinic acid responsible for eosinophilic fasciitis?

Abstract The eosinophilia-myalgia syndrome is accompanied by alterations in L-tryptophan metabolism with elevated levels of L-kynurenine and quinolinic acid having been recorded. It has been suggested that this is due to activation of indoleamine 2,3-dioxygenase by interferon-gamma. It is unknown whether these products of tryptophan metabolism play a role in the pathogenesis of this syndrome and the closely related condition of eosinophilic fasciitis. To explore this possibility, the principal author (RN) received a series of subcutaneous injections of quinolinic acid. A total of 1200 mg was administered over a 1-month period. Peripheral blood eosinophil counts were monitored and biopsies taken for H&E and immunohistochemical stains. Over the 1-month period the eosinophil count rose from 0.3x10⁹/l to 0.8x10⁹/l before falling to 0.4x10⁹/l approximately 5 weeks later. H&E sections showed a mixed infiltrate of eosinophils and neutrophils extending through the reticular dermis and septa of the panniculus. No deep fascia was obtained on biopsy. The immunohistochemical stain for transforming growth factor beta 1 showed staining of endothelial cells and dendritic cells. The interleukin-5 stain was negative. Our results suggest that quinolinic acid may play a role in cutaneous eosinophilic disorders.     

Pneumonia as a long-term consequence of chronic psychological stress in BALB/c mice

Recently, we have shown that female BALB/c mice are highly sensitive to chronic psychological stress. They develop systemic neuroendocrine disturbances, a hypermetabolic syndrome, behavioral alterations and severe immunosuppression with a reduced antibacterial response during experimental infection.Here, we show that chronically stressed mice spontaneously suffered from increased bacterial load in the liver and lung that sustained for up to 10 days after the termination of stress exposure. Immediately after the last chronic stress cycle, splenocytes had a reduced ability to produce IFNγ after ex vivo stimulation with LPS while showing enhanced inducibility of IL-10. When healthy animals were treated with anti-IFNγ antiserum the antibacterial response against the small numbers of endogenous bacteria that physiologically penetrate the intestinal barrier was reduced causing increased bacterial burden in the liver.Thus, a deficient antibacterial response to translocated commensals in chronically stressed animals can contribute to long-lasting pneumonia.     

细胞因子诱导的蛋白质巯基亚硝基化对大鼠成纤维细胞样滑膜细胞中CREB蛋白的DNA结合活性的影响

目的:观察重组白细胞介素-1β(rIL-1β)和重组干扰素-γ(rIFN-γ)联合诱导的亚硝基化反应对cAMP反应元件结合蛋白(CREB)的DNA结合活性的影响。方法:(1)分别用细胞因子(rIL-1β和rIFN-γ的混合物)、诱导型一氧化氮合酶抑制剂氨基胍(AG)及溶剂单独或联合孵育大鼠滑膜细胞12h,收集培养液上清进行一氧化氮(NO)含量测定;并提取各组总蛋白,其中细胞因子组的蛋白与巯基氧化修饰还原剂二硫苏糖醇(DTT)反应15min,采用生物素转化法与免疫印迹技术检测各组蛋白质的亚硝基化修饰水平。(2)分别用rIL-1β、rIL-1β和rIFN-γ的混合物、AG及溶剂单独或联合孵育滑膜细胞12h,提取各组核蛋白,其中rIL-1β+rIFN-γ组核蛋白与DTT反应15min,采用电泳迁移率改变分析技术观察各组CREB的DNA结合活性。结果:(1)细胞经rIL-1β和rIFN-γ孵育后,NO生成增多(P0.01),蛋白质的亚硝基化修饰水平升高,而AG降低了NO的水平(P0.01)并抑制了亚硝基化反应,DTT与总蛋白直接作用也可抑制亚硝基化反应。(2)rIL-1β和rIFN-γ共孵育明显抑制rIL-1β单独诱导的CREB的DNA结合活性(P0.01),而AG抑制了rIL-1β和rIFN-γ的作用,DTT与核蛋白直接反应也可逆转细胞因子共孵育的作用,使CREB的DNA结合活性增高(P0.01)。结论:IL-1β和IFN-γ共同孵育滑膜细胞可诱导细胞适度产生NO,使细胞内蛋白质的亚硝基化修饰水平升高,导致CREB发生可逆性巯基氧化修饰,抑制其DNA结合活性。     

成人型复发性呼吸道乳头状瘤病的综合治疗

目的:探讨成人型复发性呼吸道乳头状瘤病(adult-onset recurrent respiratory papillomatosis,Ao-RRP)的有效治疗方法。方法:回顾性分析1992-2004年32例成人型复发性呼吸道乳头状瘤病,根据病情分别采取支撑喉镜下钳除或激光切除术、喉造瘘口激光切除术及喉小部分切除 声带I期成形术,9例术后给予系统的干扰素治疗。结果:32例中伴中、重度不典型增生者11例,恶变者5例(恶变率为15．6％);28例术后拔除气管套管,拔管率87．5％,随访1年以上未见复发。全部病例恢复吞咽和发音功能。结论:成人型复发性呼吸道乳头状瘤病有恶变倾向,应根据病情选择相应的治疗方式:喉造瘘口激光切除术适用于反复复发或病变范围较大的病例,喉小部分切除 声带I期成形术适于伴有中、重度不典型增生或已恶变者;术后联合干扰素治疗可抑制或延缓复发。     

Type I interferon and proinflammatory cytokine levels in cerebrospinal fluid of newborns with rotavirus-associated leukoencephalopathy

Objective

The purpose of this study was to identify whether there is an increase in type I interferon and proinflammatory cytokine levels in the cerebrospinal fluid of newborns with rotavirus-associated leukoencephalopathy.