Gastric Cancer and Paraneoplastic Pemphigus

Paraneoplastic pemphigus is a relatively rare but significant acquired autoimmune mucocutaneous disorder that is characterised by diffuse erythema, painful blistering and sores of the skin and mucus membranes. The underlying pathogenesis is believed to be triggered by altered immune system in response to underlying neoplasm. The manifestations can predate, occur at the same time or after the diagnosis of cancer. Associations with gastric cancer have only been reported twice. A 78-year-old lady presented with a month’s history of extensive skin lesions that started off as bullous lesions and biopsy revealed bullous pemphigus. Endoscopy for anemia revealed gastric cancer. This case reinforced the need to consider underlying malignancy in elderly patient with new onset dermatological presentation.     

肝内胆管结石行肝叶切除术患者应用循证护理的临床效果

目的探讨对接受肝内胆管结石行肝叶切除术的患者实施循证护理的临床效果。方法选择2014年5月至2015年11月期间在我院接受肝内胆管结石行肝叶切除术进行治疗的68例患者为研究对象,并随机分为对照组和观察组,每组各34例。对照组患者给予常规护理,观察组患者给予循证护理。观察比较两组的并发症发生情况和护理满意度。结果观察组的并发症发生率为5.88%,明显低于对照组的23.53%;患者护理满意度为97.06%,明显高于对照组的82.35%,差异均具有统计学意义(P<0.05)。结论循证护理应用于肝内胆管结石行肝叶切除术患者可降低并发症发生率,提高患者满意度,值得临床推广应用。     

Peripheral whole blood FOXP3 TSDR methylation: a potential marker in severity assessment of autoimmune diseases and chronic infections

Immune dysregulation is a cardinal feature of autoimmune diseases and chronic microbial infections. In particular, regulatory T cells are downregulated in autoimmune diseases while upregulated in chronic microbial infections. FOXP3 is the master regulator of Treg development. Treg-specific demethylated region (TSDR) is a highly conserved locus on the FOXP3 gene that is fully demethylated in natural Tregs but methylated in effector T cells. In our study, we used high resolution melt-polymerase chain reaction (HRM-PCR) to determine the FOXP3 TSDR methylation status in autoimmune diseases and chronic microbial infections. We found that FOXP3 TSDR to have the highest mean melting temperature (highly methylated) in active SLE patients compared to all the other groups (p?<?0.001). The psoriasis group also had a significantly high mean melting temperature (78.62?±?0.20) when compared with the inactive SLE group (78.49?±?0.29, p?<?0.05) and control group (78.44?±?0.25, p?<?0.01). There was no significant difference in melting temperature between inactive SLE and healthy controls. Disease activity in SLE was directly associated with methylation of the FOXP3 TSDR. On the other hand, patients with chronic microbial infections had significantly lower FOXP3 TSDR mean melting temperature (demethylated) when compared with healthy controls (78.28?±?0.21 vs 78.44?±?0.25, p?<?0.05). Our results suggest that the use of HRM-PCR to detect FOXP3 TSDR methylation status is a reliable and easy method to predict natural regulatory T cell levels in peripheral blood in different disease conditions. Determining FOXP3 TSDR methylation status can be a useful tool in diagnosis, and monitoring the severity of autoimmune diseases and chronic microbial infections.     

阿尔茨海默病患者的执行功能障碍

目的了解阿尔茨海默病(A lzhe im er d isease,AD)患者执行功能损害状况及对于生活能力的影响,探讨执行功能障碍与记忆等AD常见认知功能损害的相关性。方法运用神经心理学测验的方法对40例AD患者及30例轻度认知功能损害(m ild cogn itive impairm ent,MC I)患者进行执行功能、记忆及其他认知功能检查,同时进行生活能力评定。另外选择40名健康老人作对照。结果AD组的执行功能测验成绩均显著低于健康对照组(P<0.01),其中额叶功能评定量表(FAB)(5.29±2.47)分,执行性画钟作业(CLOX1)(4.63±3.56)分,Stroop测验错误次数(Stroop1)(14.17±8.99)分,词语流畅性测验(RVR)(17.56±10.51)分。除Stroop测验反应时间(Stroop2)外,MC I组的其他执行功能测验成绩显著低于健康对照组(P<0.05),其中FAB为(7.67±2.44)分,CLOX1为(7.86±3.78)分,Stroop1为(7.21±8.07)分,RVR为(30.86±8.38)分。用多元逐步回归方法分析不同认知功能对生活能力的影响,结果为反映执行功能的FAB测验成绩处于第一位,独立与操作性日常生活能力(IADL)相关(β=-0.778,t=-7.079,P<0.01)。各项执行功能测验与年龄相关性不明显(r=0.026~0.250,P>0.05),与简易精神状态量表(MMSE)、记忆测验成绩相关性好(r=0.438~0.786,P<0.01)。结论AD患者具有明显的执行功能障碍;在尚未到达痴呆水平的MC I阶段也可发现执行功能损害。执行功能和整体认知功能及记忆等认知域功能具有良好的相关性。AD患者的执行功能障碍是导致生活能力下降的重要因素。     

外固定架治疗桡骨远端粉碎性骨折的疗效分析

目的:探讨闭合手法复位外固定架治疗桡骨远端粉碎性关节内骨折的临床疗效。方法:对29例桡骨远端粉碎性关节内骨折,通过外固定架的牵伸辅助复位,矫正桡骨的短缩、成角移位,恢复关节面的解剖关系,利用外固定架维持复位后的位置并进行功能练习。术后定期进行X线和腕关节功能的评价。结果:29例均获得随访,随访时间3~12个月,平均6.5个月。根据Aro功能评价:优9例,良17例,可2例,差1例,优良率89.66%。结论:外固定架能很好维持复位后的位置,恢复桡尺骨的相对长度和关节面的平整,使腕关节功能得到良好的恢复,因此是治疗桡骨远端粉碎性关节内骨折的有效方法。     

镍钛形状记忆合金环抱接骨板治疗桡骨近端1/3骨折

目的探讨治疗桡骨近端1/3骨折的理想内固定方法.方法 2001年8月～2004年4月,采用镍钛形状记忆合金环抱接骨板治疗24例桡骨近端1/3骨折.其中男19例,女5例.年龄16～48岁.摔伤9例,压砸伤5例,交通事故伤4例,直接暴力撞击伤3例,高处坠落伤3例.按照形状记忆合金环抱接骨板的安装方法进行骨折复位内固定.术后定期随访,观察骨折愈合及功能恢复情况.结果所有患者均获随访4～21个月,平均10个月.均无术中、术后并发症,切口Ⅰ期愈合;X 线片示骨折均于术后8～12周临床愈合,根据Anderson疗效标准,功能恢复优18例,良5例,可1例,优良率95.83%.结论应用镍钛形状记忆合金环抱接骨板治疗桡骨近端1/3骨折具有创伤小、操作简便安全、固定可靠、组织相容性好、并发症少等优点,有利于促进骨折愈合和肘、腕关节功能康复,是一种治疗桡骨近端1/3骨折的较好方法.     

犬双肺序贯性移植的研究

目的探讨犬双肺序贯性移植时供肺的采取及受体移植手术技巧。方法犬16条,体重差异<5%的随机配对作为供受体进行双肺序贯移植实验共8次,移植右肺钳夹左房时采用了‘v’钳夹技术,并检测左肺及右肺术后0.5、1、2 h各进行血气分析、肺水含量及电镜下超微结构,了解术后肺功能。结果移植右肺时采取的‘v’型钳夹术良好地解决了钳夹左房时因回心血量受阻而引起的心功能不全。术后检测结果表明移植后肺功能良好。结论掌握了犬双肺序贯性移植的全过程,"V"形双阻断钳夹左心房技术提高了犬肺移植的成功率。