Rosai-Dorfman disease (RDD) is a non-malignant condition mainly manifesting as a proliferation of histiocytes in lymph nodes. Endotracheal RDD (ERDD) with an acute onset presentation is extremely rare. There are few case reports of ERDD mainly concerning its pathology, diagnostics and bronchoscopic treatment, without providing sufficient clinical information from a comprehensive perspective. As a novel and challenging technique, tracheal resection and reconstruction (TRR) with spontaneous-ventilation video-assisted thoracoscopic surgery (SV-VATS) has been reported as feasible and safe in highly selected patients, but few centres have shared their experience with this approach. This case-based discussion includes not only practical issues in the management of a life-threatening ERDD patient, but also specialists' views on the management of acute obstructive airway, and the surgeons' reflection on TRR with SV-VATS.

Abstract Background The associations between short- and long-term exposure to ambient fine particulate matter with an aerodynamic diameter ≤ 2.5 µm (PM2.5) and allergic symptoms in middle-aged and elderly populations remain unclear, particularly in China, where most cities have severe air pollution. Methods Participants (n = 10,142; age = 40–75 years) were recruited from ten regions in China from 2018 to 2021 for the Predictive Value of Inflammatory Biomarkers and Forced Expiratory Volume in 1 s (FEV1) for Chronic Obstructive Pulmonary Disease (PIFCOPD) study. Short-term (lag0 and lag0–7 day) and long-term (1-, 3- and 5-year) PM2.5 concentrations at residences were extracted from the air pollutant database known as Tracking Air Pollution (TAP) in China. Multivariate logistic regression models were used to estimate associations for short- and long-term PM2.5 exposure concentrations and long-term exposure models were additionally adjusted for short-term deviations. Results A 10 µg/m3 increase in PM2.5 on the day the allergic symptoms questionnaire was administered (lag0 day) was associated with higher odds of allergic nasal (1.09, 95% CI 1.05, 1.12) and eye symptoms (1.08, 95% CI 1.05, 1.11), worsening dyspnea caused by allergens (1.06, 95% CI 1.02, 1.10), and ≥ 2 allergic symptoms (1.07, 95% CI 1.03, 1.11), which was similar in the lag0–7 day concentrations. A 10 µg/m3 increase in the 1-year average PM2.5 concentration was associated with an increase of 23% for allergic nasal symptoms, 22% for eye symptoms, 20% for worsening dyspnea caused by allergens, and 21% for ≥ 2 allergic symptoms, similar to the 3- and 5-year average PM2.5 concentrations. These associations between long-term PM2.5 concentration and allergic symptoms were generally unchanged after adjustment for short-term deviations. Conclusions Short- and long-term exposure to ambient PM2.5 was associated with an increased risk of allergic nasal and eye symptoms, worsening dyspnea caused by allergens, and ≥ 2 allergic symptoms. Trial registration Clinical trial ID: NCT03532893 (29 Mar 2018).

病人,男性,53 岁.因阵发性腹痛3年,伴间断黑便 1 年于2020 年 10 月入院.病人3 年前起,无明显诱因出现腹痛,以脐周为著,呈阵发性钝痛,无放散痛,无反酸、烧心,无恶心、呕吐.既往无其他慢性疾病史,无烟酒等不良嗜好;否认家族遗传病史.2020年3 月起出现间断黑便,伴乏力,诊断为炎症性肠病,给予对症治疗,症状缓解.2020 年9 月上述症状复发,腹部CT检查:右下腹部分肠系膜内见增大淋巴结,右下腹部分小肠肠壁改变,考虑炎性肠病可能性大,建议进一步检查除外肿瘤性病变.

Abstract Background Pelvic solitary fibrous tumor is a rare spindle-cell tumor arising from mesenchymal tissue, usually benign. However, its malignant form is an extremely rarer, and more aggressive disease. Our review of previous literature found that it has not been reported in adolescents younger than 18 years. Herein, we describe a case of pelvic giant solitary fibrous tumor with rectum and bladder invasion in a 16-year-old girl and summarize the diagnosis and treatment experience to further improve the existing management of solitary fibrous tumor. Case Description Retrospectively analyzed a 16-year-old girl admitted to our department with irregular menstruation and increased menstrual bleeding for 2 months. A computed tomography scan of the abdomen demonstrated an 11.2×7.5×8.9 cm isodense space-occupying lesion in the pelvis. Contrast-enhanced computed tomography showed heterogeneous enhancement, which was considered a tumor of mesenchymal origin. Pelvic mass resection, bladder repair, and right ureteral stent placement were performed. It was confirmed that the mass invaded the upper rectal and the right bladder wall during the operation. After complete resection of the tumor, malignant solitary fibrous tumor was diagnosed in combination with histopathology and immunohistochemistry. The patient survived well with no tumor metastasis or recurrence in 4 months of postoperative follow-up. Conclusion This case report suggests that pelvic solitary fibrous tumor is rarely seen clinically. Because of its non-specific clinical manifestation and imaging, definite diagnosis is mainly based on histopathology and immunohistochemistry. Complete resection of the tumor is the first-line treatment, and most patients have a good prognosis.

胃印戒细胞癌(SRC)因其细胞膜表面葡萄糖转运蛋白-1 低水平表达导致对18 F-FDG 摄取低, PET/CT显像假阴性较多,临床易漏诊误诊.近期收治胃印戒细胞癌术后腹膜转移 1 例,PET/CT检查显像假阴性,现报道如下.

气管支气管异物嵌顿常发生于儿童,在成人中出现相对较少.吸入异物的种类,多与不同地区饮食、习惯、年龄等有关,最常见的吸入异物是食物.大多数患者会出现咳嗽、咳痰、咯血、呼吸困难等急性呼吸道症状,部分成年人患者呼吸道症状轻微,临床起病隐匿,因此会导致治疗延误.当异物嵌顿于呼吸道时,支气管镜是异物取出的首选手段.气管内嵌顿异物时间过长,周围多有肉芽组织增生,连接牢固,不易取出,一般首先考虑手术治疗.随着Nd:YAG激光广泛应用于临床,在治疗支气管包裹嵌顿性异物方面起到了巨大作用.

肺多形性癌( pulmonary pleomorphic carcinoma, PPC)是一类至少含有10％梭形细胞和/或巨细胞成分的低分化NSCLC,或仅含有梭形细胞和巨细胞成分的癌[1].1994年,Fishback初次提出了多形性癌这一概念[2].2004年WHO肺肿瘤分类将肺癌分为鳞状细胞癌、小细胞癌、腺癌、大细胞癌、腺鳞癌、肉瘤样癌、类癌以及唾液腺型肿瘤 8 种主要类型.2015年WHO将其中的肉瘤样癌分为多形性癌、梭形细胞癌、巨细胞癌、癌肉瘤和肺母细胞瘤[1].PPC非常罕见,在肺癌中占0. 4％ ～1. 6％ [3] ,好发于老年男性,男女比例为1. 5 : 1 ,年龄59 ～71 岁,平均年龄63. 7 岁,吸烟者多见[4-6] ,相比于其他类型NSCLC,侵袭性强、恶性程度高,五年生存率约20％ [7] ,早期手术治疗后,五年生存率36％左右[8].临床症状和影像学缺乏特异性表现,明确诊断主要依靠组织病理学与免疫组化检查.对于此类疾病的研究多为个案报道或小规模回顾性分析,治疗方案尚无统一标准,主要参考 NSCLC 的治疗.目前NSCLC分子靶向和免疫治疗取得显著成效,然而有关PPC的相关研究报道较少,本文通过查阅文献,总结PPC的发病机制、临床及影像学表现,重点阐述诊断、治疗方面的进展,以期为临床诊治提供参考.

骨化性气管支气管病(tracheobronchopathia osteochondroplastica,TO)是一种罕见的、病因不明的气管支气管病变,亦被称为气管支气管囊性纤维性骨软骨炎和骨形成性气管病[1].气道内可见大小、数量不等的颗粒样结节突向管腔,结节一般发生于气管内前外侧壁及近端支气管,这些结节起源于软骨,声门、声门上组织及气管后壁通常不受影响[2].随着病情的进展,气道管壁逐渐僵硬,管腔狭窄甚至阻塞.TO发病率低,发病机制不明,通常是良性进展,大多数患者无症状或仅出现非特异性症状,既往多数在尸检时偶然发现,易漏诊与误诊.目前越来越多的人通过支气管镜检查和/或胸部计算机断层扫描(CT)发现.本文综合国内外相关文献,从流行病学、发病机制、诊断方面进行总结,提高临床医生对该病的认识,降低漏诊、误诊率,为临床治疗提供依据.

转移性钙化(metastatic calcification,MC)是由于全身性的钙、磷代谢障碍,引起机体血钙或血磷升高,导致钙盐在未受损伤的组织内沉积,随血液循环异位于肾小管、肺泡壁等软组织或血管壁.转移性肺钙化(metastatic pulmonary cal-cification,MPC)是钙在肺组织中沉积,继发于无肺软组织损伤史的钙代谢异常.最常见的原因为慢性肾功能衰竭,血液透析,器官移植术后,原发性或继发性甲状旁腺功能亢进症,破坏性骨损害等[1-5].发病率低,国内外报道以个案病例为主.通过对 1 例不明原因肺部影像学改变快速进展的转移性肺钙化患者的临床表现、实验室检查、胸部影像学特点进行总结,结合有关文献进行回顾性分析,提高临床医生对转移性肺钙化的认识.

病人,男,22岁.因混合痔切除术后6天,便血4天于2016年2月22日入院.行经肛门缝扎止血术,术后再次便血.既往体健,未使用过抗凝药物.肛门检查(胸膝位):肛管可见6处手术切口,切口周围有缝扎的线结,周边组织质脆,呈暗红色,直肠下段可见凝血块.齿状线附近可见手术创面及多处出血点.指诊直肠黏膜光滑,未触及肿物,退指指套血染.检查后用油纱卷包裹引流管填塞肛门,压迫止血.

肺多性癌（Pulmonary pleomorphic carcinoma PC）是指鳞状细胞癌、腺癌或大细胞癌中含有梭形细胞和/或巨细胞成分（梭形细胞或巨细胞成分至少占整个肿瘤的10%）,或仅含有梭形细胞和巨细胞成分的癌,是一类分化较差的非小细胞肺癌[1]。肺多形性癌极少见,据报道其发病率仅占原发性

1临床资料患者,男性,44岁,因慢性咳嗽、咳痰半年,加重伴进行性呼吸困难1个月于2019年01月就诊于我院。既往:吸烟史15年,20支·d-1,否认大量饮酒史,无家族遗传史,肺部查体未见明显阳性体征。外院胸部CT提示:右肺上叶见结节影,可见毛刺及分叶,右肺上叶且见斑片、条索影,部分已实变,可见通气支气管征。右肺中轴间质及小叶间隔见结节样增厚,右肺多发粟粒结节,左肺上叶前段见微结节影,右侧胸膜增厚。胸腔未见积液;心包积液。2R、4R、6区、7区、11R见肿大淋巴结。心电图示:窦性心动过速、大致正常心电图。血常规:白细胞总数16.0×109/L,中性粒细胞百分

病例资料 患者女,56岁,因"间断咳嗽、咳痰1年,间断发热伴有胸痛半年"入院. 该患者缘于1年前无明显诱因出现咳嗽、咳痰,咳嗽剧烈,清晨为著,痰为白色、量少较易咳出,全身体格检查未见明显异常,未触及淋巴结肿大. 行三维CT(2017-09-19)示:图1. 胸部CT(2017-10 -30)示:右肺中叶支气管开口处截断,伴肺不张. 两肺多发结节影. 纵隔淋巴结增大. 右肺门影增大、肝内多发低密度影. 于我院行纤支镜检查( 2017 -09 -21 ):镜下表现:右肺中叶开口黏膜肿胀,表面覆盖坏死物质,管腔明显狭窄. 内镜诊断:右肺中叶恶性肿瘤/结核? 纤支镜病理诊断(2017-09-25):(右肺中叶开口)黏膜内有鳞状上皮增生,有轻度异型性,另见大部分坏死. 自服"克林霉素"(具体剂量不详)1周,自述症状有所缓解,未再复查.

病人,男,57岁.因呕血、黑便1天于2018年6月20日入院.2016年因腹主动脉假性动脉瘤行腹主动脉覆膜支架腔内隔绝术,8天前行髂动脉支架置入术,术后恢复顺利出院.既往无消化道出血病史.体格检查:皮肤、巩膜苍白,腹部平坦,未见胃肠蠕动波,无腹壁静脉曲张,上腹压痛,无反跳痛及肌紧张,肝脾肋下未触及,墨菲征阴性,全腹叩诊呈鼓音,移动性浊音阴性,肠鸣音正常,未闻及气过水声.辅助检查:红细胞计数2.40×1012/L,血红蛋白67g/L.白细胞计数13.86×10/L,中性粒细胞百分比78.1％.给予输血、补液、抑酸、抗炎等对症治疗.复查血红细胞计数2.35×1012/L,血红蛋白67g/L,白细胞计数10.12×109/L,中性粒细胞百分比79.1％.

Objective To investigate the clinical values of the leukocyte count,D-dimer,histidine decarboxylase (HDC) and intestinal fatty acid binding protein (I-FABP) for diagnosing acute intestinal obstruction.Methods Sixty patients who treated in China-Japan Union Hospital of Jilin University from January 2017 to January 2018 were collected prospectively,and were divided into strangulated intestinal obstruction (STR-IO) group (n =20),simple intestinal obstruction (SIM-IO) group (n =20) and peritonitis group (n =20).Twenty healthy volunteers were collected as control group.Automatic blood cell analyzer was used to detecting the leukocyte count.The concentration of plasma D-dimer was detected by immune turbidimetry method.The concentration of serum HDC and I-FABP were measured by enzyme linked immunosorbent assay (ELISA) method.Compared the above indicators of four groups of samples.The measurement data are expressed as mean ± standard deviation (Mean ± SD).Tamhane's T2 and Dunnett's T3 methods were used to comparison between groups.Estimation of receiver operating characteristic curve(ROC) and area under curve (AUC) used logistic regressive model.Results The leukocyte count in control group,SIM-IO group,peritonitis group,and STR-IO group were (6.97 ± 1.68) × 109/L,(8.24 ± 2.78) × 109/L,(11.33 ±4.75) × 109/L,and(12.53 ± 5.96) × 109/L respectively.STR-IO group and peritonitis group were significantly higher than those of control group(F =12.74,P =0.01),but there was no significant difference between SIM-IO group and control group(P ＞ 0.05).The concentration of plasma D-dimer in control group,SIM-IO group,peritonitis group,and STR-IO group were (0.44± 0.30) μg/ml,(1.17 ± 0.67) μg/ml,(1.20 ± 0.72) μg/ml,and (1.67 ± 0.67) μg/ml respectively.The concentration of D-dimer in STR-IO group was significantly higher than those of control group (F =57.08,P =0.00),and there was no significant difference among other group (P ＞ 0.05).The concentration of serum HDC in control group,SIM-IO group,peritonitis group,and STR-IO group were (5.51 ±4.30) ng/ml,(14.33 ± 3.71) ng/ml,(11.53 ± 4.67) ng/ml,and (35.65 ± 21.15) ng/ml respectively.The concentration of HDC in STR-IO group was significantly higher than those of other three groups (F =39.03,P =0.00).The concentration of serum I-FABP in control group,SIM-IO group,peritonitis group,and STR-IO group were (0.20 ± 0.06) ng/m],(0.31 ± 0.17) ng/ml,(0.22 ±0.03)ng/ml,and (0.81 ±0.56) ng/ml respectively.The concentration of I-FABP in STR-IO group was significantly higher than those of other three groups (F =23.07,P =0.01).The AUC of HDC,I-FABP,D-dimer,and leukocyte count were 0.998,0.868,0.730,and 0.704 respactively.Conclusion Leukocyte count,D-dimer,and HDC or I-FABP combined detection may be a more effective index for diagnosing acute intestinal obstruction.

病人,男,70岁.因腹痛、腹胀伴停止排便、排气3天入院.3天前无明显诱因出现腹痛、腹胀伴恶心、呕吐,呕吐物为胃内容物,伴停止排气、排便.1天前上述症状进行性加重,当地医院诊断为肠梗阻,给予对症治疗未见明显好转.急诊以肠梗阻收入我院.既往风湿性心脏病病史20年,否认家族性遗传病史.体格检查:腹部饱满,未见胃肠型及蠕动波,无腹壁静脉曲张,上腹部压痛,无反跳痛,无肌紧张;肝脾肋下未触及,Mur-phy征阴性;全腹叩诊呈鼓音,移动性浊音阴性;肠鸣音活跃,可闻及气过水声.

Background: Sarcoidosis is a multisystem granulomatous disorder characterized by the presence of non-necrotic granulomas pathologically. Tuberculosis belonging to the infectious diseases is caused by mycobacterium tuberculosis and characterized by granulomas with caseous necrosis. Although it is rare, tuberculosis and sarcoidosis may occur concomitantly. Case presentation: We report a rare case of a 49-year-old Chinese woman who presented with repeated low-grade fever and malaise that was initially diagnosed as tuberculous pleuritis. After the anti-tuberculosis treatment, the symptoms including fever and malaise were gone, and the pleural effusion did not relapse. However, the mediastinal lymphadenectasis did not lessen during the treatment. Later the patient felt dyspneic and the swollen superficial lymph nodes appeared. From the subsequent chest CT scans, a growing number of nodules were found in the lungs. Eventually the biopsy of lymph nodes in her right supraclavicular region confirmed the coexistence of sarcoidosis. Based on the result, corticosteroid therapy was introduced in the patient, and her swollen mediastinal lymph nodes shrunk and the pulmonary nodules were reduced obviously in the 2 month of follow-up. Conclusion: Rarely sarcoidosis and tuberculosis may coexist, and there remains a diagnostic challenge when tuberculosis and sarcoidosis occur concomitantly. If the possibility of tuberculosis can not be ruled out completely, tentative anti-tuberculosis treatment before the application of glucocorticoid is suggestive.

Epidemiological studies in recent years have found that the incidence of gastric signet ring cell carcinoma (SRCC) has increased significantly. In this paper, we first reviewed cell origin and biomarkers of SRCC, and the relationship between SRCC and various pathological types of gastric cancer. The early diagnosis rate of gastric SRCC is low, which may be due to the unclear mechanism of pathology and precancerous lesions. In clinical practice, SRCC has the characteristics of low differentiation and high degree of malignancy. Most of patients with gastric cancer Borrmann IV(diffuse infiltrative type) are gastric SRCC, and their prognosis is poor. The average age of gastric SRCC was 55 to 61 years old. Besides, in female, the incidence of SRCC was significantly higher than that of non-SRCC gastric cancer. It is found that the expressions of estrogen and progesterone receptors in SRCC tissues are high. The relationship between gastric SRCC and sex hormones may be the cause of gender differences in the pathogenesis of gastric SRCC. Due to the low risk of lymph node metastasis in early SRCC, endoscopic mucosal resection and endoscopic submucosal dissection can be performed for <3 cm, submucosal invasive, medium differentiated tumors, or <3 cm, highly differentiated, ulcerative and submucosal lesions. For non-metastatic advanced gastric SRCC, surgical resection and adequate lymph node dissection should be performed owing to the high risk of lymph node metastasis. Adjuvant chemotherapy is also considered to improve the long-term prognosis of patients. Taxane therapy may be more effective in gastric SRCC. Recent data show that gastric SRCC and diffuse gastric cancer are more sensitive to mitomycin C, doxorubicin and docetaxel than intestinal type gastric cancer, but are not sensitive to fluorouracil and cisplatin. These treatment perspectives still need to be confirmed in future studies.