自1932年 Warren和 Gates详细报道了1259例多原发恶性肿瘤( multiple primary neoplasms, MPN ) [1]后,关于 MP N 的研究逐渐开展起来. 在 MP N 病人中,通常观察到双癌,三重癌的发生率为0. 5％,四重或五重癌的发生率<0. 1％[2]. 绝大部分MPN发生在老年人群,而衰老可能改变治疗方案. 虽然MP N的文献报道日益增多,很少文献阐述如何管理此类病例问题. 本文报道我科1例先后患有非霍奇金淋巴瘤、前列腺癌、肺瘢痕癌、膀胱癌4种原发恶性肿瘤病人的诊断和治疗,重点探究对高龄MP N 病人的多学科管理方法.

Objective To explore the efficacy of Getong Tongluo capsule combined with defibrase injection in the elderly patients with acute cerebral infarction. Methods A total of 128 elderly patients with acute cerebral infarction in our hospital from June 2016 to April 2018 were enrolled. The control group was treated with defibrase injection on the basis of routine treatment,and experimental group was treated with Tongluo capsule on the treatment of control group,the course of treatment was 15 days.The efficacy,the levels of angiopoietin-1 (Ang-1), endothelin-1, vascular endothelial growth factor (VEGF),and the incidence rate of adverse reactions in two groups were observed and compared. Results The total effective rate of experimental group was significantly higher than that of control group (95.31％ vs 78.13％,P＜0.05). There were no significant differences in levels of ANG-1,endothelin-1,VEGF,and neurological deficit score between the two groups before treatment.After treatment,the levels of ANG-1 and endothelin-1,and the neurological deficit score in the experimental group were significantly lower, the level of VEGF was higher than those in the control group (P＜0.05). The incidence rate of total adverse reactions was 6.25％ in both experimental group and the control group (P＞0.05). Conclusions Getong Tongluo capsule combined with defibrase injection can regulate the cytokine levels and promote the recovery of neurological function in the elderly patients with acute cerebral infarction.

Objective: To study the relationship between repair of vascular endothelial cell function loss and atherosclerosis. Methods 3400, patients with atherosclerosis treated in different hospitals from August 2012 to August 2015 were studied, adopting corresponding detection methods to study vascular endothelial cell function loss. Results: Occurrence of atherosclerosis is mainly due, to damage of vascular endothelial cells caused by viruses, immune complexes and oxidized low -density lipoprotein, which leads to serious chronic inflammatory reaction of load vessels. Conclusion: To treat patients with atherosclerosis, we need to coordinate the relationship between vascular endothelial tissue function and atherosclerosis, then provide some guidance for clinical treatment and promote health.

目的 分析中老年男性高胰岛素血症(hyperinsulinemia,HINS)患者的临床特征、胰岛功能及其合并疾病.方法 以北京地区中老年男性为研究对象,根据血浆胰岛素水平分为4组:空腹高胰岛素血症(空腹HINS)、负荷后2h高胰岛素血症(负荷后HINS)、联合受损(空腹/负荷后HINS)以及非高胰岛素血症(非HINS),对比各组间的代谢特征、胰岛素抵抗和胰岛β细胞分泌功能.所有受试对象均行75 9口服葡萄糖耐量(oral glucose tolerance test,OGTT)试验,根据美国糖尿病协会(American Diabetes Association,ADA) 2003年标准再将各组分为糖耐量正常(normal glucose tolerance,NGT)组、糖调节受损(impaired glucose regulation,IGR)组和新诊断糖尿病(newly diagnosis diabetes,NDM)组;评估合并代谢综合征相关疾病的差异.结果 共931名中老年男性纳入本研究,空腹HINS组22例、负荷后HINS组109例、空腹/负荷后HINS组49例以及非HINS组751例.①空腹/负荷后HINS组糖化血红蛋白(glycosylated hemoglobin,HbA1c)显著高于负荷后HINS组(P＜0.01),空腹HINS组介于二者之间;②空腹/负荷后HINS组胰岛素抵抗指数(HOMA-IR)最高,其次为空腹HINS组、负荷后HINS组和非HINS组,4组间两两比较差异有统计学意义(F=344.25,P＜0.05);③经HOMA-IR校正后,空腹/负荷后HINS组的HOMAβ细胞功能指数(HBCL/IR)和空腹β细胞功能指数(FBCI/IR)较非HINS组均明显降低(F=5.08,P＜0.05);负荷后HINS组FBCI/IR与非HINS组比较,差异无统计学意义;④不同糖耐量高胰岛素血症组合并代谢异常疾病的构成比均较相应正常胰岛素组明显升高(P＜0.05);随着糖调节受损程度的逐渐加重,代谢异常的构成比逐渐升高.结论 ①空腹与负荷后均表现为高胰岛素血症的患者胰岛素抵抗严重,胰岛功能明显受损,糖代谢紊乱程度重;②空腹胰岛素是高胰岛素血症大规模临床筛查的推荐指标;③高胰岛素血症更易合并多种代谢紊乱,尤其是空腹/负荷后HINS患者,需要综合干预.

ObjectiveTo investigate the prevalence of microalbuminuria (MAU) and its related factors in middle-aged and elderly population.Method1086 subjects were recruited. Health questionnairs and related laboratory indexes were investigated by cluster random sampling. Urine albumin to creatinine ratio (ACR) was used to screen for MAU. The data were analyzed with multivariate Logistic regression analysis to explore the related factors for MAU.ResultThe overall prevalence of MAU in middle-aged and elderly population was 12.80%(139/1086), with male as 12.18% (119/977) and female as 18.35% (20/109) (P>0.05). The independent risk factors of MAU in men were age (OR=1.038), fasting blood-glucose (OR=1.533), waist circumference (OR=1.033).ConclusionThe monitoring of related risk factors should be enhanced in middle-aged and elderly population. Intervention should be carried out as early as possible to delay the process of kidney disease.

目的 应用超声探讨早期定量评价糖尿病患者颈动脉血管弹性.方法 随机选取2013年度体检者168人,分为对照组36例及糖尿病组132例.测定体质量指数(BMI)、收缩压、舒张压、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、三酰甘油(TG)、空腹血糖(FPG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)、高敏C反应蛋白(hs-CRP)、同型半胱氨酸(Hcy)、尿微量白蛋白(U-MA)、餐后2h血糖(P2hBG)及餐后2h胰岛素(PINS)等指标.应用血管回声跟踪技术(ET)测量内-中膜厚度(IMT)、僵硬度(β)、弹性系数(EP)、顺应性(AC)、膨大指数(AI)以及脉搏波传导速度(PWVβ).比较对照组与糖尿病组、糖尿病组中正常与异常HbA1c的颈动脉弹性指标,Spearman分析糖尿病组中血糖相关指标与颈动脉血管弹性指标的相关性.结果 糖尿病组与对照组的双侧IMT、β、Ep、PWVβ差异有统计学意义;糖尿病组中HbA1c正常组与异常组的β、Ep、AC、PWVβ差异有统计学意义;糖尿病组颈动脉的β、Ep、PWVβ与FINS、PBG、PINS成正相关,β、PWVβ与HbA1c成正相关,AC与PBG成负相关.结论 ET可用于检测糖尿病患者的动脉弹性,对血管内皮功能作出早期评估,在糖尿病患者早期动脉粥样硬化的诊断、治疗和预防中有重要的应用价值.

Objective To summarize the medical service experience of "Harmony Mission-2014", and to explore the useful method and approach of infection control in department of intensive care unit ( ICU) at hospital ship .Methods Analyzing the problem of ICU department in hospital ship firstly , and then setting up the institution of infection control and practicing in the medical ser-vice of"Harmony Mission-2014".Results One hundred and nineteen patients was admitted to ICU department at hospital ship in the whole mission .Among them ,one patient had the concurrent infec-tion of human immunodeficiency virus , syphilis and hepatitis C virus , one patient with the serious postnatal infection , one patient with the acute serious gastroenteritis , and two patients with pulmonary infection.The process of therapy was smoothly , and nosocomial infections was not happened .Con-clusion Some proposals about infection control in ICU department at hospital ship have taken .

Natural organic matter (NOM) is a complex and non-uniform mixture of organic compounds which plays an important role in environmental processes. Due to the complexity, it is challenging to obtain fully detailed structural information about NOM. Although Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR-MS) has been demonstrated to be a powerful tool for providing molecular information about NOM, multiple ionization methods are needed for comprehensive characterization of NOM at the molecular level considering the ionizing selectivity of different ionization methods. This paper reports the first use of matrix assisted laser desorption/ionization (MALDI) method coupled with FT-ICR-MS for molecular characterization of NOM within a mass range of 200-800 Da. The mass spectral data obtained by MALDI were systematically compared with data generated by electrospray ionization (ESI). It showed that complementary molecular information about NOM which could not be detected by ESI, were provided by MALDI. More unsaturated and aromatic constituents of NOM with lower O/C ratio (O/C ratio<0.5) were preferentially ionized in MALDI negative mode, whereas more polar constituents of NOM with higher O/C ratio were preferentially ionized in ESI negative mode. Molecular anions of NOM appearing at even m/z in MALDI negative ion mode were detected. The results show that NOM molecules with aromatic structures, moderate O/C ratio (0.7>O/C ratio>0.25) and lower H/C ratio were liable to form molecular anions at even m/z, whereas those with higher H/C ratio are more likely to form deprotonated ions at odd m/z. It is speculated that almost half of the NOM molecules identified by MALDI may be aromatic or condensed aromatic compounds with special groups which are liable to absorb electron from other molecules to generate free radical anions during MALDI ionization.

Objective To study the influencing factors of serum uric acid levels and uric acid excretion in the officers at a military unit, in order to search the potential risk factors corre-sponding to the elevation of serum uric acid, and provide guidance to the control of uric acid levels. Methods In 1 096 cases, a questionnaire survey was provided for the retired officers in the military unit.Based on predefined inclusion and exclusion criteria, healthy officers or officers who took no drugs affecting uric acid metabolism were selected.Body mass index (BMI), urinary albumin creati-nine ratio (ACR) and uric acid to creatinine clearance rate (Cua/Ccr) were measured, and the data was analyzed.Results Men had higher serum uric acid levels compared with women [(330.9± 69.4)mmol/L vs.(249.4±55.2) mmol/L].There was no significant difference in the prevalence of hyperuricemia (HUA) between men and women (8.7% vs.5.6%).HUA group had higher BMI, systolic blood pressure, diastolic blood pressure, triglyceride (TG), creatinine (Cre), blood&nbsp;urea nitrogen (BUN), high-sensitivity C-reactive protein (hs-CRP), homocysteine (HCY), ACR, waist circumference and hip circumference, compared with non-hyperuricemia (NHUA) group;whereas high-density lipoprotein and Cua/Ccr were significantly lower.HUA was closely correlated to BMI, TG, Cre, hs-CRP, ACR and Cua /Ccr.The major influencing factors were Cua/Ccr, TG and BMI.Serum uric acid level was positively correlated with TG, BMI, waist circumference, hip circ-umference, or diastolic blood pressure, respectively; and was negatively correlated with Cua/Ccr. There was a significant negative correlation between Cua/Ccr and TG.Gender, TG, creatinine, uric acid,and ACR had a effect on Cua /Ccr,where TG and uric acid had a negative effect on Cua/Ccr. Conclusion Serum uric acid levels can be influenced by a number of factors.The key variable factors, including renal excretion, TG and body weight, are potential targets for prevention of hyperuricemia.

病人,男,82岁.2011年5月12日年度体检时,行胸部透视未见明显异常.7月14日,行胸部CT平扫显示:右上肺尖后段直径约1 cm结节影.无咳嗽、咳痰、咯血,无胸痛、胸闷、气短,无发热、盗汗、消瘦、纳差等不适症状.当时考虑良性可能性大,随诊复查.9月1日复查胸部CT提示:右上肺结节影较前稍增大,边缘见有毛刺,考虑肺恶性肿瘤可能性大.

Objective To explore the impact of diabetes mellitus on immune functions in elderly pulmonary tuberculosis patients,for further understanding of the conditions to provide guidance for clinical practice.Methods A case-control study was adopted.Forty two cases of elderly patients with simple pulmonary tuberculosis and diabetes were enrolled as group A,30 patients with pulmonary tuberculosis as group B,and 30 healthy cases as group C.Clinical features of group A and B were observed,T cell subsets(CD4+,CD8+ and CD4+/CD8+) and immunoglobulin(IgA,IgM and IgG) levels in peripheral blood were detected with flow cytometry and immunoturbidimetry respectively.Results Compared with group B,in group A the incidence of fever and hemoptysis were increased,the proportion of initial treatment reduced,the ratio of smear positive increased,the tuberculous cavity and lesions involving more than 2 lungs increased,and CD8+ decreased,while the CD4+ level and CD4+/ CD8+ ratio were elevated in group A,B and C by turns.The levels of IgA,IgM and IgG in group A were lower than those in group B and group C,while IgA in group B was lower than those in group C.Within group A,as compared with patients with normal blood glucose,a higher CD8+ level,and lower levels of CD4+,CD4+/CD8+,IgA,IgM and IgG were observed in patients with blood glucose under standard.Conclusion The elderly patients with pulmonary tuberculosis combined with diabetes mellitus got worse,especially became aggravated when blood glucose was poorly controlled,that may be correlated with the immune dysfunction caused by diabeters mellitus.

1病例报告 患者男,67岁.主诉腰痛、活动受限20余年,伴晨僵及午后腰背部僵硬感,活动后可减轻.7年前曾在外院查HLA-B27阳性,X线片见脊柱呈"竹节样"改变,诊断为强直性脊柱炎,服用布洛芬缓释胶囊及柳氮磺吡啶1年余无效,自行停用柳氮磺吡啶,间断服用布洛芬或双氯芬酸钠治疗.因突发右侧剧烈腰痛2周就诊,无明显放散痛,无下肢麻木等感觉异常.

Objective To investigate the effects of pioglitazone,a peroxisome proliferator-activated receptor gamma(PPARγ) agonist,on calprotectin(S100A8/A9) mRNA expressions in synovium in rats with collagen-induced arthritis(CIA).Methods Expressions of S100A8/A9 mRNA were detected by reverse transcription polymerase chain reaction(RT-PCR) in synovium in rats 14 days after induction of CIA,and effects of pioglitazone were studied.Results Expressions of PPARγ mRNA and S100A8/A9 mRNA were elevated in arthritic synovium.S100A8/A9 mRNA expressions in pioglitazone treated rats were significantly lower than those in control group,and the reductions of S100A8 mRNA and S100A9 mRNA expressions in low-dose group [4 mg/(kg·d)] were 62.7% and 34.2%,and reductions in high-dose group [20 mg/(kg·d)] were 82.1% and 71.9%,separately.Conclusion Pioglitazone may exert its anti-inflammatory effects on CIA by suppressing the expressions of S100A8 mRNA and S100A9 mRNA.

目的提高对银屑病关节炎(psoriatic arthritis,PsA)的认识,减少误诊。方法对3例皮疹隐匿的PsA诊治经过进行回顾分析,结合文献分析误诊原因。结果 3例均表现为关节疼痛,首诊查体均未发现隐匿皮疹,2例误诊为类风湿关节炎,1例误诊为痛风。转我院后经仔细查体,1例左侧肘关节伸侧发现颗粒样皮疹,1例脐周见小条状银屑病样皮疹,1例发际内见钱币大小银屑病样皮疹。3例均经皮疹检查确诊银屑病,符合PsA诊断。调整治疗方案后病情缓解。结论 PsA皮疹可能隐匿,对慢性关节炎患者应考虑PsA可能,认真查体,仔细寻找隐匿部位的皮疹,以纠正误诊。

An integrated cadre healthcare management system has been established after three years' reform in the hospital.Based on the practice,the methods and effects of this service system were analyzed,then expectations of this work in the future were discussed and some essential and new requirements concerned with cadre healthcare were put forward.

<正>心血管病是目前我国老年医学最重要的范畴,已成为最重要的公共卫生问题之一,也是保健工作的重点内容。总体上看,我国心血管病的致残率和病死率呈持续上升阶段,对健康和寿命影响越来越大。目前全国心血管病患者约2.3亿人,其中心肌梗死患者约200万人,每年350万人死于心血管病,占总死亡原因的41%,居各种死因的首位。2009年,我

目的分析国内外烟酸缺乏症发病原因新进展,及在我国的发病特点。方法回顾性研究1例85岁烟酸缺乏症患者的临床特点及发病原因,比较该患者治疗前后病情变化,并与国内外病例比较。结果病例符合烟酸缺乏症的诊断,对应治疗效果明显。发展中国家与发达国家发病年龄分布差异有统计学意义(P<0.05),与其主要病因不同相关。结论提高对烟酸缺乏症主要病因及临床表现的掌握,详细了解病史,并仔细观察病情变化是减少误诊、漏诊的关键。

异位促肾上腺皮质激素(ACTH)综合征(ectopic adrenocortico trophic homone syndrome,EAS)是垂体以外的组织分泌过量的ACTH导致肾上腺皮质增生并分泌过量的皮质醇引起的一种临床综合征.国外常见病因为肺或支气管肿瘤,其次是胸腺肿瘤,还有胰腺等[1].而我国关于异位ACTH综合征的研究多数为个案报道,少有大样本的临床统计分析,难以阐明国人患该病的临床特征.本组报道2例恶性肿瘤导致的异位ACTH综合征,并通过国内中文数据库,统计国内文献报道的病例并加以分析,研究国内异位ACTH综合征的病因学特点,旨在指导临床,以提高对异位ACTH综合征的诊治水平.

三级保健医师检诊是做好保健工作的重要制度保证.本文报告了在干部医疗保健工作中实施三级医师检诊制度的主要做法,并探讨了工作中面临的困难与对策.

目的研究过氧化物酶体增殖物活化型受体γ（peroxisome proliferator—activated receptor gamma，PPARγ）激动剂吡格列酮对大鼠胶原诱导关节炎（collagen—induce darthritis，CIA）滑膜表达S100A8mRNA和S100A9 mRNA的影响，探讨其作用及可能机制。方法Wistar雄性大鼠随机选择3只作为正常对照组；以Ⅱ型胶原免疫诱导大鼠，按发生关节炎时间先后顺序再随机入组，分为模型对照组、吡格列酮用药大剂量组[20rag／（kg·d）]和吡格列酮用药小剂量组[4mg／（kg·d）]，每组3只。以逆转录一聚合酶链反应法检测吡格列酮两种剂量对大鼠出现CIA 14d后滑膜表达S100A8 mRNA和S100A9 mRNA的影响。结果PPAγ、S100A8、S100A9 mRNA在关节炎后14d大鼠滑膜表达均明显增高；吡格列酮用药组滑膜表达S100A8 mRNA和S100A9 mRNA明显低于对照组，小剂量用药组S100A8 mRNA和S100A9 mRNA分别减低62．7％和34．2％，大剂量用药组S100A8 mRNA和S100A9 mRNA分别减低82．1％和71．9％。结论吡格列酮可能通过抑制CIA的S100A8 mRNA和S100A9 mRNA表达产生抗炎作用。