目的:探讨影响噬血细胞综合症(HPS)患者预后的因素.方法:回顾性分析61例HPS患者的临床特征、实验室检查及预后,采用t检验进行单因素分析,使用Cox回归进行多因素分析,探究影响HPS预后的因素.结果:61例HPS患者中1年内死亡26例,生存中位时间为53.4d.其中血清铁蛋白、低白蛋白血症、低纤维蛋白原、血小板计数减少、乳酸脱氢酶和D-二聚体升高是影响患者生存的独立危险因素(P＜0.001,P=0.004,0.015,0.016,0.037,0.049).当血清铁蛋白≥10000ng/mL,纤维蛋白原＜1.5 g/L,血小板计数＜40 × 109/L,乳酸脱氢酶≥700U/L,D-二聚体水平≥2 000ng/mL时患者预后极差.结论:血清铁蛋白、纤维蛋白原、白蛋白、血小板计数、乳酸脱氢酶、D-二聚体水平是评估HPS预后的重要因素.

Objective:To investigate the neuroprotective effect of SF1670 on traumatic brain injury (TBI) rats and its underlying mechanisms.Methods:The TBI model was induced by Feeney’s weigh-drop method. The rats were randomly divided into sham group, TBI+ vehicle group, TBI+ SF1670 group. Rats were treated with SF1670 (10 μmol/L, 2 μL) 2 h before TBI by i. c.v. The brain tissues were taken at the indicated time point. Immunofluorescence staining, Western blotting, brain water content, Fluoro-Jade C staining and behavior test were used for evaluating the neuroprotective effect of SF1670 on TBI. Data were expressed as mean±standard deviation, SPSS 17.0 was used for statistical analysis, and one-way analysis of variance (ANOVA) was used for inter-group comparison.Results:The univariate ANOVA showed that as compared with TBI+ vehicle treatment group [(91.41±1.20)%], brain water content was significantly reduced in TBI+ SF1670 group [(82.90±0.96)%] ( n=6, F=300.896, P<0.05). The p-Akt/t-Akt was significantly reduced in TBI+ vehicle group (0.28±0.05) as compared with that in TBI+ SF1670 group (0.73±0.06) ( n=6, F=236.121, P<0.05). The number of FJC-stained neurons in TBI+ SF1670 group (199.63±16.11) was significantly reduced as compared with that in TBI+ vehicle group (309.18±17.20) ( n=6, F= 612.806, P<0.05) . On the 14th day of the online test, there was significant difference between TBI+ vehicle group [(3.40±0.46) points] and TBI+ SF1670 group [(4.50±0.47) points, n=6, SE=0.394, P<0.05)] or TBI+ IV+ SF1670 group [(3.18±0.52) points, SE=0.762, P<0.05]. On the 14th day of foot defect test, there was significant difference between TBI+ SF1670 group (0.10±0.04) and TBI+ vehicle group (0.21±0.04, n=6, SE=0.077, P<0.05) or TBI+ IV+ SF1670 group (0.24±0.04, n=6, SE=0.082, P<0.05). On the 14th day of the cylinder test, there was significant difference between TBI+ vehicle group (0.25±0.04) and TBI+ SF1670 group (0.09±0.04, n=6, SE=0.085, P<0.05) or TBI+ IV+ SF1670 group (0.27±0.04, n=6, SE=0.091, P<0.05). Conclusion:These results indicate that SF1670 can reduce neuroal death by increasing the level of p-Akt to confer neuropective effect in TBI rats.

1病例资料 45岁男性,因头位不正伴左颈部痉挛性抽搐、疼痛5年于2017年1月10日入院.2012年1月,出现颈部疼痛不适伴活动受限,并逐渐发展为颈部痉挛性疼痛,头位复位困难.当地医院诊断为寰枢关节半脱位,行枕颌牵引、颈部固定等治疗,无明显好转.2012年8月,在当地医院行"左侧胸锁乳突肌胸骨头离断术",术后症状仍无明显好转.之后,陆续行中医、按摩、针灸、肉毒素注射等治疗,均未见明显缓解.

目的 比较手术室及非手术室医护人员的血常规主要指标和脉搏血氧饱和度(SpO2)水平.方法 抽取81名健康手术室医护人员和83名健康非手术室医护人员,检测入选医护人员血常规主要参数,采用心电监护仪测定脉搏血氧饱和度(SpO2).结果 手术室及非手术室医护人员的白细胞计数、红细胞计数、血红蛋白、血小板计数、SpO2水平均在正常范围.手术室工作人员的红细胞计数高于非手术室医护人员,而SpO2低于非手术室医护人员(均P<0.05),但两组医护人员其他指标差异无统计学意义(均P>0.05).结论 手术室医护人员的红细胞计数高于非手术室人员,而SpO2低于非手术室医护人员,但均在正常值范围之内,提示手术室工作人员可能存在低氧或缺氧,应关注这一特殊人群的职业健康.

胶质瘤是颅内发病率最高的肿瘤,约占颅内神经组织原发性肿瘤的45%.世界卫生组织(World Health Organization,WHO)将胶质瘤按组织学分为Ⅰ~Ⅳ级,其中Ⅰ、Ⅱ级为低级别胶质瘤,Ⅲ、Ⅳ级为高级别胶质瘤[1].Ⅰ级预后最好,大部分经治疗后可以达到临床治愈,被认为是良性肿瘤;Ⅳ级恶性程度最高,又称作胶质母细胞瘤(glioblastoma,GBM),占所有胶质瘤的55%.根据2016年WHO中枢神经系统肿瘤分类,90%的GBM为原发性GBM,多为老年人(诊断中位年龄62岁);10%为继发性GBM,中青年常见(诊断中位年龄44岁).GBM的传统治疗方法为最大限度安全地切除肿瘤,术后辅以放射治疗和替莫唑胺等化学药物治疗.但是由于GBM侵袭性强,浸润到正常组织导致无法全部切除、容易复发,使得治疗效果仍然不理想,平均生存期只有16~19个月[2].

Cholestasis isn't an independent disease, but a syndrome with chiefly manifestations such as jaundice, itch of skin, dysfunction of liver.Since the etiology is complex, the diagnosis and treatment should be based on reasonable examination.