Ultrastructural Changes Suggestive of Focal Segmental Glomerulosclerosis in Atypical Minimal Change Nephrotic Syndrome

In an attempt to recognize early stages of focal segmental glomerulosclerosis (FSGS) in patients with a clinical course suggesting a diagnosis other than minimal change disease (MCD) and normal histology, or minor, nondiagnostic changes on light microscopy (LM), we used a protocol for systematic and extensive electron microscopy (EM) examination of kidney biopsies obtained from such patients. By this method ultrastructural pathology was found in 8 patients. These changes were localized, involving only portions of single glomerular segments. The findings included mild to moderate increase of the mesangial matrix, focal wrinkling of the capillary basement membrane, and early obliteration of the normal architecture of individual capillary loops, as well as electron-dense deposits in a mesangial and subendothelial distribution. Of these 8 patients, 2 are at present in remission without therapy (in 1, following therapy with cyclophosphamide); 3 are in remission on steroid therapy; 1 developed massive proteinuria during pregnancy, after a spontaneous remission lasting almost 2 years; 1 patient advanced to terminal renal failure 3 1/2 years after biopsy; and 1 died of sepsis 1 month after biopsy. We believe that the ultrastructural changes found may represent early or mild FSGS and that the protocol described can add valuable information in clinically worrisome patients in whom renal histology appears normal.     

Hairy cell leukemia: clinical features and therapeutic advances

Hairy cell leukemia (HCL) is a rare chronic lymphoproliferative disorder which has been extensively studied over the past decade. Much has been learned regarding the diagnosis, natural history, biology, and treatment of this unique neoplasm. The disease most commonly affects middle aged men and characteristic clinical features include splenomegaly, cytopenias, and usually the presence in the peripheral blood of distinctive thairy cells with irregular cytoplasmic projections. Diagnosis can usually be confirmed by bone marrow biopsy. Although the natural history can be extremely variable among patients, complications are usually referable to the cytopenias, with anemia and infection being most frequent. In addition to pyogenic infections, patients are susceptible to unusual organisms including atypical mycobacterium, legionella, and fungi. The requirement of red blood cell transfusion, severe granulocytopenia or thrombocytopenia, frequent infections, or painful splenomegaly are all indications for treatment. Splenectomy is the standard initial treatment of choice. However, in the past few years there have been exciting major advances in the therapeutic modalities for HCL. Recombinant alfa-interferon is highly effective, with beneficial responses occurring in close to 90% of patients. The Food and Drug Administration has recently approved the use the interferon for HCL. This represents the first time a biological response modifier has been approved for the treatment of human disease. In addition, preliminary results with the adenosine deaminase inhibitor, 2 deoxycoformycin (def), have been encouraging. Further clinical trials are required in order to determine the optimal sequential treatment strategy for HCL. The exact mechanisms of action of both interferon and def in HCL remain to be elucidated. A better understanding of the unusual features of the hairy cell and the underlying biological effect of these two agents in HCL may have important applications in other hamatologic and non-hematologic malignancies.     

2011—2020年湖南省伤寒、副伤寒流行病学特征和菌株耐药分析

目的 分析2011—2020年湖南省伤寒、副伤寒流行特征和菌株耐药情况,为做好伤寒、副伤寒防控工作提供依据。方法 收集2011—2020年湖南省伤寒、副伤寒监测数据,采用描述性流行病学方法分析三间分布特征,对各市州分离上送的67株伤寒、副伤寒沙门菌采用梅里埃VITEK2 Compact 全自动细菌鉴定及药敏分析系统进行细菌鉴定和药敏分析。结果 10年间湖南省共报告伤寒、副伤寒病例9 888例,死亡0例,年均发病率1.47/10万。发病人群以农民、散居儿童、学生为主,5—9月为高发季节,主要集中在湘南和湘西地区。2011—2020年湖南省共报告4起伤寒、副伤寒暴发疫情,暴发场所均为学校,传播途径均为水型传播。67株伤寒、副伤寒菌对头孢他啶、氨曲南和厄他培南100%敏感;对哌拉西林/他唑巴坦、头孢吡肟和复方新诺明敏感率为98.5%;对氨苄西林/舒巴坦敏感率为97.0%;对头孢唑林、头孢替坦、阿米卡星、庆大霉素和妥布霉素敏感性较低（＜10%）。55.3%菌株对三类及以上抗生素耐药,发现1株同时对8种抗生素耐药。结论 湖南省伤寒、副伤寒发病呈持续低发状态,局部地区存在暴发。菌株多重耐药现象严重,应加强疫情及耐药监测。     

2008-2018年云南省人间布鲁菌病流行特征及灰色GM(1,1)模型预测

目的分析云南省布鲁菌病(简称布病)流行特征,建立灰色GM(1,1)模型,预测云南省布病病情。方法收集中国疾病预防控制信息系统和云南省统计局2008-2018年云南省布病疫情数据和人口资料,分析布病流行病学特征(包括时间、地区、人群分布),并以灰色GM(1,1)模型进行建模,预测2019、2020年云南省布病发病率。结果2008-2018年云南省共报告布病病例1216例,年均发病率为0.2374/10万,呈逐年递增趋势(χ²趋势=843.34,P<0.01)。病例报告主要集中在3-9月份,占总病例数的69.41%(844/1216)。病例报告数居前5位的州市分别为红河州(289例)、曲靖市(264例)、昆明市(258例)、大理州(160例)、玉溪市(134例),占总病例数的90.87%(1105/1216)。职业以农民为主,占79.03%(961/1216)。建立灰色GM(1,1)模型预测2019、2020年云南省布病发病率分别为0.4876/10万和0.4817/10万。结论云南省布病发病较以往上升,应对重点地区、重点人群进行针对性防控,并对预测结果进行前瞻性评价,逐步完善云南省布病预测模型。     

Clinical features and outcome of maintenance hemodialysis patients with COVID-19 from a tertiary nephrology care center in Romania

Background There is limited information about the clinical characteristics, treatment and outcome of maintenance hemodialysis patients with COVID-19. Moreover, regional differences are also conceivable since the extend and severity of outbreaks varied among countries.Methods In this retrospective, observational, single-center study, we analyzed the clinical course and outcomes of 37 maintenance hemodialysis patients (median age 64 years, 51% men) hospitalized with COVID-19 from 24 March to 22 May 2020 as confirmed by real-time PCR.Results The most common symptoms at admission were fatigue (51%), fever (43%), dyspnea (38%) and cough (35%). There were 59% mild/moderate patients and 41% severe/critical patients. Patients in the severe/critical group had a significantly higher atherosclerotic burden since diabetic kidney disease and vascular nephropathies were the most common primary kidney diseases and eighty percent of them had coronary heart disease. Also, Charlson comorbidity score was higher in this group. At admission chest X-ray, 46% had ground-glass abnormalities. Overall, 60% patients received hydroxychloroquine, 22% lopinavir–ritonavir, 11% tocilizumab, 24% systemic glucocorticoids, and 54% received prophylactic anticoagulation. Seven (19%) patients died during hospitalization and 30 were discharged. The main causes of death were cardiovascular (5 patients) and respiratory distress syndrome (2 patients). In Cox regression analysis, lower oxygen saturation, anemia and hypoalbuminemia at admission were associated with increased mortality.Conclusions In conclusion, we observed a high mortality rate among maintenance hemodialysis patients hospitalized for COVID-19. Anemia, lower serum albumin and lower basal oxygen saturation at admission were factors associated with poor prognosis.     

子宫腺肌症患者临床特点回顾性分析

目的研究子宫腺肌症患者临床特点,为子宫腺肌症患者的临床管理提供理论基础。方法收集2012年3月至2015年9月于北京协和医院妇产科手术且确诊的291例子宫腺肌症患者资料,对临床检查结果进行统计学分析。结果子宫腺肌症患者发病的中位年龄为[34(29.0,40.0)]岁,确诊的中位年龄为[40(35.0,44.0)]岁。所有纳入患者中,9.3%的患者无症状,17.5%的患者因不孕症就诊,39.5%的患者发现月经异常,71.8%的患者伴疼痛症状。38.8%的患者合并子宫内膜异位症,58.1%的患者合并子宫肌瘤。72.4%的患者术前发现血清糖类抗原125(CA125)升高,超声扫描结果显示85.6%的患者子宫肌层的回声不均匀。接受子宫病灶切除术的患者208位(71.5%),接受全子宫切除伴或不伴附件切除术的患者83位(28.5%);接受经腹手术、腹腔镜手术及宫腔镜手术患者的比例分别为37.8%、59.5%和2.7%。结论子宫腺肌症患者发病年龄较轻,多伴有月经异常、疼痛及不孕症状,合并症以卵巢的子宫内膜异位症多见。因此,应根据子宫腺肌症患者的临床表现及生育要求制定个体化治疗方案。     

中国胆囊癌外科治疗现状与病理学特征多中心回顾性研究（附4345例报告）

目的 探讨中国胆囊癌病人的外科治疗模式、病理学特征和预后。方法 收集中国13个省市的26家医院自2010年1月至2017年12月收治的4345例胆囊癌病人临床资料,分析中国胆囊癌病人的地区、性别、年龄分布;基于病人的诊疗记录与检查结果对手术病人肿瘤的可切除性进行评估,分析可切除性肿瘤病人的外科治疗模式,参照术前检查、手术记录和术后病理学检查结果评估可切除性肿瘤手术治疗是否达到根治标准,分析行根治性手术胆囊癌病人的病理学特征。结果 4345例胆囊癌病人中,男性1664例（38.23%）,女性2681例（61.77%）。行外科手术治疗的病人3129例（71.01%）,其中可切除性肿瘤2074例（66.28%）。在可切除性肿瘤2074例病人中,仅1133例（54.63%）在术前即诊断为胆囊恶性肿瘤,1002例（48.31%）行根治性切除,1072例（51.69%）未达根治标准。胆囊癌根治性切除病人的病理学检查结果中,736例（73.45%）为腺癌,348例（34.73%）为低分化癌,376例（37.52%）伴肝侵犯,152例（15.17%）伴神经浸润,96例（9.58%）伴血管内癌栓,78例（7.78%）伴周围脂肪组织浸润,89例（8.88%）伴周围器官受累,328例（32.73%）活体组织病理学检查淋巴结阳性。获得生存随访资料的2357例手术治疗病人术后中位生存期为16.17个月,多因素Cox回归生存分析结果显示肿瘤TNM分期（P<0.001）、肿瘤分化程度（P<0.001）、肝脏侵犯（P<0.001）、R0切除（P=0.003）均为术后生存期的独立预后因素。结论 中国胆囊癌术前诊断率有待提高;胆囊癌外科治疗模式亟待规范;病理学检查报告中反映的多个因素与胆囊癌病人预后密切相关,其描述的规范化对指导胆囊癌病人的精准治疗有重要意义。     

基于术前MRI影像组学特征预测肝癌经肝动脉化疗栓塞治疗的反应性

目的 探索术前MRI影像组学特征预测肝细胞癌（hepatocellular carcinoma,HCC）对经肝动脉化疗栓塞（transcatheter arterial chemoembolization,TACE）治疗反应性的可行性。方法 回顾性收集2016年3月至2018年4月经临床或病理确诊、并在温州医科大学附属第五医院接受TACE治疗的中晚期HCC患者86例,采用随机数字表法分为训练组（n=59）及验证组（n=27）,基于ITK-SNAP软件在术前T2WI图像勾画肿瘤感兴趣区,使用GE AI-Kit软件提取影像特征;经最小绝对收缩与选择算子（LASSO）回归筛选最优的特征子集,并构建TACE反应性预测模型;利用受试者工作特征（ROC）曲线、校准曲线及决策曲线分析评价模型的诊断效能和临床应用价值。结果 共筛选出8个影像学特征与TACE反应性相关,并成功构建预测模型。训练组中,该模型的ROC曲线下面积（AUC）为0.838（95%CI 0.737～0.939）,灵敏度为74.1%,特异度为84.4%;在验证组中,AUC为0.794（95%CI 0.604～0.985）,灵敏度为75.0%,特异度为80.0%。校准曲线显示该模型在训练组和验证组的预测概率与实际概率拟合较好;决策曲线分析显示该模型在0.1～1.0的阈值范围内具有较高的净收益。结论 术前MRI T2WI图像影像组学特征可用于预测HCC的TACE 反应性,基于MRI T2WI图像影像特征的预测模型特异度和灵敏度较高。     

成都379例新型冠状病毒肺炎的临床分析

目的分析新型冠状病毒肺炎(COVID-19)患者的临床特征及预后。方法纳入成都市公共卫生临床医疗中心2020年1月16日至11月30日收治的379例COVID-19确诊病例,按照年龄分为老年组(42例,年龄≥60岁)和非老年组(337例,年龄<60岁),比较两组患者的流行病学、临床特征、实验室检查、治疗及预后。结果379例患者年龄2个月至87岁,平均41.2岁,其中男286例(75.5%),女93例。老年组平均年龄为69.5岁,女性更多见(占61.9%),大多为武汉输入和本土续发(占73.8%),以普通型和危重型为主(88.1%)。非老年组的平均年龄为37.8岁,男性更多见(80.1%),主要来自境外输入(75.7%),以轻型和普通型为主(95.0%)。179例患者(47.2%)合并一种或多种基础疾病,老年组以高血压病(15例,35.7%)及糖尿病(11例,26.2%)多见,而非老年组则以非酒精性脂肪性肝炎(132例,39.2%)多见。最常见的临床表现是发热(138例,36.4%)和咳嗽(129例,34.0%),但老年组的发热、咳嗽、呼吸困难及乏力等症状较非老年组更多见(P<0.05)。与非老年组相比,老年组的总淋巴细胞计数、CD4⁺及CD8⁺T淋巴细胞计数更低,而心肌损伤标志物及炎症指标更高(P<0.05)。139例患者(36.7%)的心脏彩色超声心动图异常,主要为左室舒张功能降低(22.7%)及心脏瓣膜反流(14.0%),且老年组患者的心脏彩色超声心动图异常率明显高于非老年组(85.7%vs.30.6%,P<0.05)。经治疗后,除老年组死亡3例外,其余均已治愈出院;但老年组的住院时间较非老年组更长(22.1 d vs.18.8 d,P=0.033)。结论成都老年COVID19患者主要来自武汉输入和本地续发,以普通型和危重型为主,常合并高血压或糖尿病等基础疾病;成都非老年COVID-19患者主要来自境外输入,以轻型和普通型为主,常合并非酒精性脂肪性肝炎;经治疗后,患者大多预后良好。