目的 探讨胼周动脉动脉瘤(PAA)治疗方法及临床疗效.方法 回顾性分析2012年6月至2020年3月收治的42例PAA的临床资料.25例采用夹闭术治疗,17例行血管内栓塞治疗.结果 所有动脉瘤均成功完成夹闭或栓塞,夹闭术后并发症发生率为(48.0％,12/25),栓塞术后并发症发生率(17.6％,3/17).42例术后临床随访3～12个月,中位数6个月;夹闭术治疗25例末次随访改良Rankin量表(mRS)评分0～2分17例,3～6分8例;预后良好率为68.0％(17/25);栓塞治疗的17例末次随访mRS评分0～2分14例,3～6分3例;预后良好率为82.4％(14/17).42例术后影像随访4～21个月,中位数9个月;夹闭术后复发率为12.0％(3/25),栓塞术后复发率为5.9％(1/17).结论 夹闭术与血管内栓塞是治疗破裂PAA的有效方法,临床上需结合病人具体情况选择个体化的治疗方式以提高治疗效果.

Hepatitis B virus reactivation (HBV-R), which can lead to HBV-related morbidity and mortality, is a common and well-known complication that occurs during the treatment of non-Hodgkin lymphoma (NHL) patients with current or past exposure to HBV infection. HBV-R is thought to be closely associated with chemotherapeutic or immunosuppressive therapies. However, immunosuppressive agents such as anti-CD20 antibodies (e.g., rituximab and ofatumumab), glucocorticoids, and hematopoietic stem cell transplantation (HSCT) administered to NHL patients during treatment can cause deep immunodepression and place them at high risk of HBV-R. In this review, we explore the current evidence, the guidelines of several national and international organizations, and the recommendations of expert panels relating to the definition, risk factors, screening and monitoring strategies, whether to use prophylaxis or pre-emptive therapy, and the optimal antiviral agent and duration of antiviral therapy for HBV-R.

黏膜相关淋巴组织(mucosa-associated lymphoid tissue,MALT)淋巴瘤是一组低级别B细胞淋巴瘤,1983年由Isaacson和Wright首先提出[1].MALT淋巴瘤常表现为惰性临床过程,胃肠道是其最常见的发生部位.肺MALT淋巴瘤比较罕见,不到肺原发性恶性肿瘤的0.5％[2].由于肺MALT淋巴瘤发病率低,临床表现没有特征性,影像学不典型,极易漏诊、误诊.本文报道1例肺MALT淋巴瘤并复习相关文献,以提高对该病的认识.

•Dural arteriovenous fistula at the foramen magnum is extremely rare.•DAVF at the foramen magnum presenting with trigeminal neuralgia as the initial symptom has barely been reported.•This unique case is easily misdiagnosed and missed.

Objective:To investigate the clinical characteristics of myelodysplastic syndromes (MDS) with autoimmune hemolysis as early manifestation and to discuss the early diagnosis of MDS.Methods:The clinical features,diagnosis and treatment of 1 case of MDS with autoimmune hemolysis as early manifestation were analyzed retrospectively.Results:The patient was characterized with autoimmune hemolyis early,and treated with enough glucocorticoid for one month,but there was no response.Reexamination of bone marrow cytology suggested morphologic dyshematopoiesis in erythroid.The patient transformed rapidly into acute myeloid leukemia after one month.Conclusion:MDS may present with pure hemolysis during early stage.Analysis of bone marrow cells of dysplastic hematopoiesis in the diagnosis of MDS is very important.CD41 immune staining can improve the efficiency of micromegakaryocyte detection,and help the early diagnosis of MDS.

Flow diverters, the specially designed low porosity stents, have been used to redirect blood flow from entering aneurysm, which induces flow stasis in aneurysm and promote thrombosis for repairing aneurysm. However, it is not clear how thrombus develops following flow-diversion treatment. Our objective was to develop a computation model for the prediction of stasis-induced thrombosis following flow-diversion treatment in cerebral aneurysms. We proposed a hypothesis to initiate coagulation following flow-diversion treatment. An experimental model was used by ligating rat’s right common carotid artery (RCCA) to create flow-stasis environment. Thrombus formed in RCCA as a result of flow stasis. The fibrin distributions in different sections along the axial length of RCCA were measured. The fibrin distribution predicted by our computational model displayed a trend of increase from the proximal neck to the distal tip, consistent with the experimental results on rats. The model was applied on a saccular aneurysm treated with flow diverter to investigate thrombus development following flow diversion. Thrombus was predicted to form inside the sac, and the aneurysm was occluded with only a small remnant neck remained. Our model can serve as a tool to evaluate flow-diversion treatment outcome and optimize the design of flow diverters.

Objective To discuss role of the rich sequence specific binding protein 1( special at rich sequence binding protein 1, SATB1)in initiating PI3K/Akt signaling pathway on the occurrence of thyroid cancer cells as well as invasion and metastasis. Methods The cul-tured thyroid cancer cells were divided into 4 groups:untreated group:in addition to DMEM without any treatment;LY294002 inhibited group:Cultured in DMEM with 10 μmol/L inhibitor LY294002;SATB1 inducer group:DMEM medium plus SATB1 antibody 200 μg/L;TSATB1 in-duced inhibition of group:DMEM medium plus SATB1L antibody 200μg/L and 10 μmol/L inhibitor LY294002. After 24 hours of culture acqui-sition cultivating base in thyroid carcinoma cells in serum by elase method to detect the expression of MMP9,IL-1 and IL-6 expression,on the cleavage of the thyroid cells using Western blotting were used to detect the expression of PI3K,Akt,p-Akt and PIP3,immunohistochemical de-tection cell SATB1 expression. Results The expression of SATB1 in different experimental groups was detected by immunohistochemical method. The expression of SATB1 was mainly in the cytoplasm of yellow,which was not expressed in cytoplasm. SATB1 expression was different in different treatment groups and the difference was statistically significant( P ﹤0. 05). The SATB1 induced agent histone SATB1 expression highest expres-sion of the lowest LY294002 inhibited group and the difference was statistically significant( P ﹤0. 05). Western blot results showed that different groups of PI3K,Akt,p-Akt and PIP3 expression was varied and the difference has statistical significance( P ﹤0. 05). The SATB1 induced a-gent group and the protein PI3K,Akt,p-Akt and PIP3 expression was the highest,the lowest was LY294002 inhibited group and the difference was statistically significant( P ﹤0. 05). Elase assays confirmed that different groups of MMP9,IL-1 and IL-6 expression was varied and the difference has statistical significance( P ﹤0. 05). SATB1 induced agent group and the protein PMMP9,IL-1 and IL-6 expression was the highest,the lowest was LY294002 inhibited group and the difference was statistically significant( P ﹤0. 05). Conclusion SATB1 is associated with invasion and metastasis of thyroid carcinoma;SATB1 has a role in the K PI3 / Akt signaling pathway,and SATB1 may be involved in the ex-pression of tumor microenvironment and inflammatory factors.

患者女，44岁，因“食欲减退，恶心、呕吐1个月”于2014年9月21日收住院。患者1个月前开始无明显诱因出现食欲减退，恶心，呕吐胃内容物，5～6次/d。病程中体质量明显减轻，大便干结，便秘，后期出现骨疼，尿频、尿急，尿量增多。当地医院胃镜检查提示：慢性非萎缩性胃炎。予以抗炎、抑酸治疗后，症状无明显缓解。入院后查体：体温36.8℃，脉搏70次/min，呼吸20次/min，血压120/80 mmHg （1 mmHg＝0.133 kPa）；神志清楚，精神差，全身皮肤干燥。颈软，气管居中，左侧气管旁可扪及1个大小3.0 cm ×2.0 cm肿块，下极深入锁骨后，未能触及，质地中等偏硬，表面尚光滑，可随吞咽上下活动。心肺无异常，舟状腹，全腹无压痛、反跳痛。双下肢无肿胀。生理反射正常，病理反射（－）。辅助检查：尿钙8.06 mmol/24h，血钙4.61 mmol/L，血钾3.34 mmol/L；肾功能：尿素8.44 mmol/L（1.70～8.30 mmol/L），肌酐129.2μmol/L（53～106μmol/L），尿酸594.9μmol/L（150～360μmol/L）；碱性磷酸酶385.5 U/L（40～150 U/L）；尿常规：白细胞2203.5/μl，尿蛋白（+），白细胞酯酶（+++）；血常规：白细胞11.80×109/L，中性粒细胞9.49×109/L，中性粒细胞百分比80.40%；全段甲状旁腺激素1883.0 ng/L（12～65 ng/L）；甲状腺功能五项在正常值范围。双肾彩超提示：海绵肾，双肾多发小结石，双肾囊肿。甲状腺彩超：左侧甲状腺切面大小7.6 cm ×1.8 cm ×2.4 cm，右侧约3.6 cm ×1.1 cm ×1.1 cm，左侧甲状腺中部可见一范围4.2 cm ×2.1 cm低回声区，边界尚清，其内回声不均，血流信号丰富，可见多个斑点状强回声堆积，后伴声影。甲状腺增强CT：左侧甲状腺受压，其后下方见一范围4.2 cm ×2.5 cm的软组织密度影，其内见点状及结节状钙化影，增强扫描明显强化，两期CT值分别约为71、53 HU。临床诊断：甲状旁腺功能亢进症，高钙危象，甲状旁腺腺瘤可能。给予大量补液、利尿、鲑降钙素注射液（密盖息）皮下注射及血液透析治疗，血钙控制不理想，波动在3.08～4.91 mmol/L。入院后第5日由肾内科转入本科。术中见左侧腺体被挤压萎缩，腺体量较少，肿块紧贴其下方生长，实性，暗灰色，大小4.5 cm ×4.0 cm ×2.5 cm，两者间轻度粘连，遂予以完整切除肿块及左侧腺体。术中冰冻快速病检提示为嗜酸性腺瘤可能，需常规石蜡切片进一步明确诊断。肿块切除后半小时，全段甲状旁腺激素降至130.50 ng/L。术后8 h 复查全段甲状旁腺激素20.80 ng/L，血钙2.54 mmol/L，血磷1.08 mmol/L。术后每日检测电解质，血钙波动在1.37～2.67 mmol/L，一度出现手足麻木、痉挛症状，经口服及静脉补钙后逐步缓解。术后第2天开始，骨痛逐渐缓解。常规病理检查：（左侧）甲状旁腺腺瘤。免疫组化：甲状旁腺激素（+），Ki-67LI＜1%，降钙素（－）。后因肾功能衰竭转回肾内科继续治疗，3周后肾功能恢复正常，血钙稳定在正常范围内，康复出院。

患者女,59岁,因发现左侧颈部肿块3月余于2014年9月18日收住院。患者诉3个多月前无意中发现左侧颈部有一核桃大小肿块,无红肿、疼痛,无发热,无吞咽、呼吸困难,无心慌、双手颤抖等不适。3个月来肿块较前明显增大。体格检查：颈部皮肤正常,未见怒张静脉。颈软,气管居中,双侧腺体质地不均,偏硬,左侧腺体较对侧明显增大(左侧8.0 cm ×3.5 cm,右侧4.5 cm ×2.3 cm),边界欠清,活动度较差,无压疼。左侧胸锁关节上方、气管旁可扪及多枚肿大淋巴结。未闻及异常血管杂音。影像学检查：彩色超声左侧腺体8.1 cm ×3.1 cm ×3.2 cm、右侧腺体4.3 cm ×2.1 cm ×1.1 cm,峡部厚0.85 cm。左侧腺体形态不规则,中下部包绕颈动脉,下极显示欠清。双侧腺体内部回声增粗增强,血流信号增多,双侧颈部淋巴结增大。甲状腺功能5项结果：促甲状腺激素18.71μIU/mL(0.34~5.6μIU/mL),游离三碘甲状腺原氨酸3.75 pmol/L (3.80~6.00 pmol/L),游离甲状腺素6.38 pmol/L(7.5~21.1 pmol/L),甲状腺球蛋白抗体511.7 IU/mL (<4 IU/mL),甲状腺过氧化物酶抗体879.7 IU/mL (<9 IU/mL)。左侧颈部肿块细针穿刺细胞学检查：考虑为桥本甲状腺炎合并坏死,甲状腺肿瘤(非霍奇金淋巴瘤)。

目的:分析不同疾病所致继发性噬血细胞性淋巴组织细胞增生症(HLH)患者的临床特征,进一步加深对本病的认识.方法:回顾性分析65例继发性HLH患者的临床资料,将患者分为NK细胞淋巴瘤/白血病组、恶性肿瘤组、EB病毒相关组、风湿免疫相关组、重症感染组,比较5组患者的临床特点.结果:65例患者各种临床表现所占比例如下,100％发热,92.3％脾大,53.9％肝大,50.8％淋巴结肿大,30.8％存在水肿,20％出现皮疹.84.6％血细胞两系或三系减少,96.5％血清铁蛋白高,86.0％高甘油三酯血症,52.3％低纤维蛋白原血症,68.8％存在噬血现象,81.8％存在低或无NK细胞活性,93.9％肝酶异常,55.4％胆红素升高,96.9％低蛋白血症,72.3％低钠血症,96％高密度脂蛋白降低.5组患者在发热、脾大、淋巴结肿大、水肿、血细胞减少与否、血甘油三酯、铁蛋白水平、肝功能异常等方面无统计学差异(P＞0.05);而在肝大、皮疹、初诊时血常规、纤维蛋白原、噬血现象等方面有统计学差异(P＜0.05).结论:继发性HLH有共同临床表现,如发热、脾大、血细胞减少、肝酶异常、低蛋白血症、低钠血症等,但不同疾病所致继发性HLH有一定的特点,EB病毒相关HLH表现为发病年龄小、肝大、血细胞明显减少、CRP高、噬血现象少见,经积极治疗后预后较好.重症感染相关HLH常表现为初诊时血细胞减少不明显,甚至高于正常,且CRP明显升高.风湿免疫相关HLH常有皮疹、初诊时血细胞常不减少、无明显感染灶、抗核抗体阳性.故在临床工作中,应针对不同病因早期识别HLH,从而有效降低病死率.

弥漫大 B 细胞淋巴瘤（DLBCL）是最常见的非霍奇金淋巴瘤（NHL），占成人 NHL 的30％～40％。尽管淋巴瘤的治疗已经有很大的进步，仍然有40％的 DLBCL患者死于疾病复发。随着对 DLBCL 临床、病理及分子病理研究的深入，新药物引入 DLBCL 的治疗，需要大样本的随机临床研究来评估新方案的疗效。目前国际预后指数（IPI，表1）已经不能满足临床预后评估。我们将近年来新的对临床及预后有重要影响的预后因素进行概述，以更好地指导临床治疗。

Objective To determine the effect of Wuzhi capsule (WZ) on pharmacokinetics of Tacrolimus (Tac) in kidney transplant patients who have taken WZ to reduce the dose of Tac for a long term.Method Twenty stable renal transplant patients with similar trough level of Tac were divided into WZ group (n =10) and control group (n =10).Whole blood concentrations of Tac at 0,0.5,1,1.5,2,3,4,6,8 and 12 h after the morning dose was determined.Estimated pharmacokinetic parameters were calculated and compared.Additionally,CYP3A5 genotypes of each patient were analyzed using Polymerase Chain Reaction Restriction Fragment Length Polymorphism to compare the effect of CPY3A5 genotypes and WZ on Tac dose requirement.Result Pharmacokinetics data showed that Co of Tac was 6.3μg/L in WZ group and 5.9 μg/L in control group.The average peak time of Tac was similar (1.4 h in WZ group,and 1.3 h in control group,P＞0.05).Both the peak concentration of Tac and AUG0-12h of Tac were slightly higher in WZ group than in control group with the difference being not statistically significant.The frequency of CYP3A5 * 1/* 3 genotype was 60％ in both groups,while the average dose of Tac was reduced by 30％ in WZ group as compared with control group (0.042 mg·kg-1 ·day-1,and 0.067 mg·kg 1 ·day-1,P＜0.01).In WZ group,the average dose of Tac was even lower in carriers of * 1/* 1 genotype (0.036 mg·kg-1 ·day 1) than that in carriers of * 1/* 3 genotype,which was close to the lowest dose requirement in the carriers of * 3/* 3 genotype from the control group (0.034 mg·kg-1 day-1).Conclusion In kidney transplant patients with CYP3A5 * 1 genotype,a long-term application of WZ to reduce the required tacrolimus dose is a generally safe way without significant changes in regular pharmacokinetics of tacrolimus.For patients with genotype of CYP3A5 * 1/* 1,WZ is particularly suitable.

Objective:To investigate the differences of MSI2and Numb expression in patients with leukemia or hematological non-malignant diseases,and explore its clinical significance.Method:Bone marrow samples of patiens with newly diagnosed acute leukemia or chronic myeloid leukemia in chronic phase patients were collected as the experimental groups,while bone marrow samples of healthy vonlunteers and patients with hematological non-malignant diseases were collected as a control group.Fluorescence quantitative PCR was performed to detect the expression of MSI2and Numb.Result:①The expression levels of MSI2in AML and ALL patients were significantly higher than those in CML patients and the control group.The differences between the ALL group and the latter two groups were statistically significant.However,the differences between AML group and the latter two groups were not statistically significant.②The expression levels of Numb in AML and ALL patiens were lower than those in CML patiens and normal controls.But those differences were not statistically significant.③There was no correlation between MSI2and Numb expression in patients with acute leukemia.④High expression of MSI2in ALL patients was positively correlated to the proportion of primitive cells.Conclusion:MSI2expression level is high in patient with acute leukemia,especially in those with ALL.Its expression level is associated with tumor burden.

Objective To recognize the characteristics of acute antibody-mediated rejection (AAMR) after kidney transplantation and to investigate the factors influecing the prognosis of AAMR after treatment.Method Three patients with negative cytotoxic cross-match developed early AAMR after kidney transplantation from Jan.2011 to Aug.2012.Pretransplant panel-reactive antibodies (PRA) were strong positive in 1 patient against class Ⅱ and negative in 2 patients who had positive PRA previously.All 3 patients had marked increase of PRA within 1 week post-transplantation and the renal allograft function deteriorated rapidly.After the diagnosis,plasmapheresis (PP)/intravenous immunoglobulin (IVIG) or combined with Bortezomib was used to treat AAMR.Result One patient underwent nephrectomy because of severe hemorrhage in the allograft at the time of diagnosis.One patient treated with PP/IVIG 4 times achieved a full recovery of renal function at postoperative day (POD) 50,while the rest failed to respond to PP/IVIG/Bortezomib treatments 5 times and the allograft had to be removed at POD 24 due to extensive hemorrhage and ischemic necrosis.Conclusion HLA sensitized patients are at high risk of AAMR after kidney transplantation,even with a negative pretransplant PRA.Immediate HLA antibody screening and allograft biopsy are needed to identify AAMR when the allograft represents non-function or early impaired function.PP/IVIG may be effective to treat AAMR,and the prognosis of AAMR depends on the time of when the treatment is started and the severity of antibody-mediated injury in the grafts.

由于移植肾功能的慢性减退,半数受者的移植肾存活时间不超过10年,因此近年来肾移植后恢复血液透析和等待再次移植的病例数明显增加.这些受者往往因前次移植而产生不同程度的致敏,其中高致敏者[群体反应性抗体(PRA)≥80％]不仅因广泛和高水平的抗HLA抗体而难以找到合适的供者,而且再次移植后更易发生排斥反应。

[Objective]To investigate differential gene expression in dendritic cell(DC) in response to human alloantigen and cytomegalovirus protein,and search target genes which can prevent graft rejection and eytomegalovirus (CMV) infection.[Methods]Genome-wide microarray analysis was performed to test gene expression in DC in response to human alloantigen and cytomegalovirus protein 3A(CMV3A).[Results]The Results showed that the difference of gene expression of DC induced by CMV3A and alloantigen was significant.The genes with differential expression included antigen processing and presentation,toll-like receptor signaling pathway and cell movement/migration, cytokine-cytokine receptor interaction and metabolism of xenobiotics by cytochrome p450,and several heat shock protein(HSP) family members including HSPA5,HSPA8,HSPA9B and HSP90AB1,in DC induced hy alloantigen were higher expression than that by CMV3A.[Conclusion]This study found several genes including heat shock protein family in DC induced by alloantigen were higher expression than that by CMV3A,these genes might play a valuable role in preventing graft rejection and CMV infection.

自治区党委常委、乌昌党委书记、市委书记朱海仑检查高新区(新市区)绿化亮化工作 6月15日,自治区党委常委、乌昌党委书记、市委书记朱海仑一行在乌鲁木齐高新区(新市区)区委书记邱树华等领导的陪同下,对高新区(新市区)的绿化亮化工作进行检查并给予了高度评价. 从北京路到河南路、太原路、江苏路、长春北路、喀什路、东站路再到城北主干道、北京路北延,朱海仑书记先后检查了道路绿化改造提升、夜景亮化和灯杆亮化、小区绿化和工业园绿化等情况.

Background Negative pressure drainage has been shown to be an effective treatment of chyle fistula. However, the optimal level of negative pressure has not been determined. We therefore conducted a prospective randomized trial to address this issue. Methods In all, 21 patients with chyle fistula were randomly assigned to a high negative pressure suction (HNPS) group (-600 mmHg, n = 10) or low negative pressure suction (LNPS) group (-125 mmHg, n = 11). The duration of drain leakage and hospital stay, and the incidence of complications were compared between the 2 groups. Results All patients were successfully treated with conservative management without surgical intervention. The median durations of chyle leakage and hospital stay were significantly shorter in the HNPS group compared with the LNPS group: 4 versus 7 days (p = .0048) and 5 versus 11 days (p = .0107), respectively. Conclusions Negative suction was demonstrated to be highly effective in the management of chyle fistula, and HNPS appeared to be more efficient than LNPS. (c) 2011 Wiley Periodicals, Inc. Head Neck, 2011

Objective To observe the effects of tamoxifen (TAM) and all-trans-retinoic acid (ATRA) on human differentiated papillary thyroid carcinoma cell line KAT5 and follicular carcinoma cell line FTC-133 in proliferation,apoptosis and invasion in vitro.Methods Cell lines KAT5 and FTC-133 were cultured with TAM (15 and 30μmol/L) and ATRA (0.5 and 1.0 μmol/L) respectively or in combination.MTT assay was used to detect the survival rate (SR) of cells at the indicated time points (12,24,48 or 72 h).The early apoptosis rate was determined by using flow cytometry (FCM) in the cell lines induced by the drug(s) for 48 h.After 24-h pretreatment withthe drug(s),the invasion ability of the cells was assessed using Transwell assay.Results The proliferation of KAT5 and FTC-133 cells could be inhibited effectively by TAM and RTRA in a dose-and time-dependent manner,and SR of KAT5 and FTC-133 cells in combined maximum concentration group at 72 h was 18.61％ and 28.35％ respectively (P ＜0.05).With the increase of the drug concentration,the early apoptosis and inhibition of invasive ability were increased obviously.The early apoptosis rate and penetrating cells in combined minimum/maximum concentration group were (15.46 ± 0.51)/(24.89 ± 0.42),(71.33 ± 4.31)/(47.00 ± 3.79),and (14.57 ± 0.41)/(20.54 ± 0.37),(102.33 ± 5.68)/(78.67 ± 4.26) respectively,with the difference being statistically significant (P ＜ 0.05).Conclusion Small doses of TAM combined with RTRA exert a synergic effect in differentiated thyroid cancer cells on the suppression of proliferation and invasion,and apoptosis induction.It shows a good clinical application in the treatment of thyroid carcinoma.