甲状旁腺癌的研究进展

甲状旁腺癌是少见的内分泌恶性肿瘤之一,其主要表现是甲状旁腺激素水平升高导致的高血钙症状和由于高钙血症引起的各种代谢紊乱以及相应组织器官的损害。完善的实验室检查、准确的影像学定位和可靠的组织病理学特征是甲状旁腺癌诊断的重要依据。甲状旁腺癌对放疗、化疗不敏感,肿瘤及其周围受侵组织的完整切除是首选的治疗方式。PTH诱导的免疫治疗作为一种新的治疗方法备受关注,预后主要取决于初次手术时肿物的完全切除及术后高钙血症的控制及监测。     

原发性甲状旁腺癌伴功能亢进1例的护理

原发性甲状旁腺功能亢进症是由于甲状旁腺本身病变引起的甲状旁腺激素(PTH)合成与分泌过多而引起的钙磷代谢失常[1],主要表现为骨骼改变、泌尿系结石、高血钙和低血磷等,症状严重者     

原发性甲状旁腺功能亢进症诊断及手术治疗进展

原发性甲状旁腺功能亢进症(primary hyperparathyroidism, PHPT)是引起高钙血症的最常见病因, 由一个或多个甲状旁腺病理性过量分泌甲状旁腺激素(parathyroid hormone, PTH)所致。随着血钙及PTH检查的普及, PHPT的发病率明显增加, 成为影响人类健康的常见内分泌疾病, 其诊治理念也在不断更新。绝大多数PHPT为散发性, 约5%~10%的病例以遗传性PHPT的形式发病。本文讨论PHPT的诊断及手术治疗进展, 以期为临床提供借鉴。     

1例甲状旁腺功能亢进致高钙危象合并消化性溃疡病人的护理

正甲状旁腺功能亢进症是一组由于甲状旁腺分泌过多甲状旁腺激素(PTH)而导致骨质吸收及高钙血症引起的具有特殊症状和体征的临床综合征[1]。成人血清钙的正常值为2.25mmol/L~2.74 mmol/L,当血清钙2.75 mmol/L为高钙血症,3.5mmol/L为高钙危象。高钙危象是临床少见且严重的急症之一,病情凶险,病死率高达60%[2]。2012年11月我院内分泌科收治1例甲状旁腺功能亢进致高钙危象病人,由于顽固性高钙,病人入院后又合并消化道溃疡,病情复杂凶险,经手术治疗并配合精心护理,成功挽救病人生命。现将护理总结如下。1病例介绍     

以高钙血症为首发症状的弥漫大B细胞淋巴瘤一例报告附文献复习

非霍奇金淋巴瘤(NHL)是血液系统常见恶性肿瘤,其中＜1%患者表现为原发骨损害~([1]),＜5%患者首发伴高钙血症~([2]),以高钙血症及多发骨损害为首发症状的NHL临床罕见,现报道我院诊治的1例弥漫大B细胞淋巴瘤(DLBCL),并就NHL的高钙血症问题作文献复习.     

早期发现和诊断原发性甲状旁腺功能亢进症

原发性甲状旁腺功能亢进症(原发性甲旁亢,primary hyperparathyroidism,PHPT)是主要由于病变的甲状旁腺自主合成和分泌过多甲状旁腺激素(parathyroid hormone,PTH)而导致钙、磷和骨代谢紊乱的一种全身性疾病。本病在欧美国家多见,在内分泌疾患中,其发病仅次于糖尿病和甲状腺疾病,居第三位。自20世纪70年代多频谱自动生化分析仪应用以来,越来越多的患者因其他无关原因查出高钙血症,进而发现PHPT,发病率较以往增加了4～5倍,成人中为1%,≥55岁人群达2%,女性为男性的2～3倍[1]。我国尚无PHPT发病率的报道,其发病较欧美等西方国家少见,但近…     

以恶心、呕吐为首发症状的原发性甲状旁腺功能亢进症1例

原发性甲状旁腺功能亢进症(PHPT)是甲状旁腺激素(PTH)分泌过多引起的钙磷和骨代谢紊乱所致的一系列症候群,包括高钙血症、肾钙重吸收、尿磷排泄增加、肾结石、肾钙质沉着症和以皮质骨为主的骨吸收增加等[1].以单个甲状旁腺腺瘤最常见,少数为甲状旁腺增生或甲状旁腺癌.     

以高钙危象为首发表现的原发性甲状旁腺功能亢进症2例

原发性甲状旁腺功能亢进症（primary hyperparathyroidism,PHPT）是一种内分泌功能异常疾病，在欧美国家比较常见，发病率约为8／10万人。高钙血症危象是指某些内分泌代谢疾病或恶性肿瘤导致血清离子钙浓度异常升高而引起的临床综合征，当血钙≥3．75mmol／L称为高钙血症危象。近年来，我国PHPT病例也明显增多，且容易误诊和漏诊，直到症状严重甚至出现高钙危象，才得以确诊。近期我科收治2例，现报道如下。     

无功能性甲状旁腺癌一例报道及文献复习

目的探讨无功能性甲状旁腺癌的临床病理特征。方法对1例无功能性甲状旁腺癌进行临床病理特点分析和免疫组化标记,选用的抗体为上皮膜抗原(EMA)、细胞角蛋白(CK)、甲状腺球蛋白(TG)、甲状腺转录因子-1(TTF-1)、甲状旁腺激素(PTH),并进行相关文献复习。结果患者为老年女性,肿物位于右侧甲状腺近被膜处,呈灰白色实性,组织学见癌细胞呈梁状,胞浆较丰富,部分区域胞浆透明,免疫组化显示EMA(+)、CK部分(+)、TG(-)、TTF-1(-)、PTH(+)。结论无功能性甲状旁腺癌是一种罕见恶性肿瘤,其诊断和鉴别诊断主要依据组织形态学和免疫组织化学特征。     

1例原发甲状旁腺功能亢进合并多发泌尿系结石患者的护理

原发性甲状旁腺功能亢进症是由于甲状旁腺本身病变引起的甲状旁腺素(PTH)合成与分泌过多,通过其对骨与肾的作用,导致高钙血症和低磷血症。本病多见于20～50岁成年人,但也可见于儿童与老人,女性多于男性。2004年9月,我科收治1例泌尿系反复结石的患者,经检查及会诊,该患者系原发甲状旁腺功能亢进。现将护理体会介绍如下。     

Duchenne肌营养不良的临床表现及诊断治疗进展

Duchenne肌营养不良（Duchenne muscular dystrophy, DMD）是由编码抗肌萎缩蛋白（Dystrophy）基因突变所致的X 连锁隐性遗传病,主要表现为进行性对称性骨骼肌无力和萎缩,儿童DMD起病隐匿,临床表现多样,存在运动症状和非运动性症状,容易误诊为其他疾病。在过去的20年中,针对DMD发病机制的基因治疗取得了巨大的进展,其中外显子跳跃、无义突变通读、腺相关病毒介导的基因替代以及CRISPR 基因编辑技术等新型方法是目前治疗研究的热点,正在成为治疗 DMD 的最佳手段。     

Anaphylactic risk related to omalizumab,benralizumab, reslizumab,mepolizumab, and dupilumab

BackgroundMonoclonal antibodies (mAbs) are novel, effective therapeutics for the treatment of inadequately controlled severe asthma. Knowledge of the anaphylaxis risks related to different mAbs is essential for their appropriate and safe administration. This study aimed to evaluate the associations between different mAbs and anaphylactic reactions by applying statistical approaches to pharmacovigilance data.MethodsThis was a retrospective study using data from the US Food and Drug Administration Adverse Event Reporting System database from January 2004 to September 2020. A total of 2006 reports of anaphylaxis related to benralizumab, dupilumab, mepolizumab, omalizumab, and reslizumab were obtained through data mining. The clinical characteristics of the cases were analyzed, and the risk signals of anaphylactic reactions and corresponding outcomes were investigated in the five mAbs.ResultsThe patients were mainly young and middle‐aged adults, with markedly more women than men. Omalizumab, benralizumab, reslizumab, and mepolizumab showed positive signals for anaphylaxis, while only dupilumab showed a negative signal. The risk of initial or prolonged hospitalization due to anaphylaxis was significantly higher in the benralizumab group than in the omalizumab group (42.86% vs. 28.92%, p = 0.024). Further, when anaphylaxis to omalizumab occurred, patients with asthma were more likely to have life‐threatening outcomes than those with chronic urticaria (18.0% vs. 12.9%, p = 0.022).ConclusionIn the current real‐world study, the positive anaphylaxis signals related to omalizumab, benralizumab, reslizumab, and mepolizumab suggested the need for the close monitoring of patients after drug use, and dupilumab showed a negative signal for anaphylaxis.     

关节镜下肘关节松解术后加压冷敷的效果研究

目的 探讨关节镜下肘关节松解术后加压冷敷缓解疼痛和肿胀的治疗效果。方法 将2011年9月—2014年6月期间在我院收治的肘关节镜下行神经松解术的40例患者,随机分为两组,实验组和对照组,每组分别为20例患者。其中,对实验组的20例患者在术后第二天开始采取对患肢进行冰袋加压冷敷;对对照组的20例患者在术后进行常规的手外科护理。将两组患者术后疼痛及肿胀消退情况进行统计分析。结果 通过不同的护理,对比分析两组患者,实验组患者术后使用加压冷敷与对照组只进行常规的手外科护理相比显著差异,具有统计学意义(P＜0.05)结论 肘关节镜下关节松解术后及时对患肢进行加压冷敷可以有效地减轻患肢疼痛及肿胀,值得在临床上推广。     

GVHD after transfusion of stored RBC concentrates in a solution of mannitol, adenine, phosphate, citrate, glucose, and NaCl following trauma

BACKGROUND: It has not previously been reported that WBC-reduced RBC preparations can cause transfusion-associated GVHD, even in an immunocompetent individual. CASE REPORT: A 74-year-old man suffered a hemorrhage from the mesentery of the transverse colon after a traffic accident. During surgery, he received 10 units of RBCs from 10 donors in a solution containing mannitol, adenine, phosphate, citrate, glucose and NaCl (MAP). MAP RBCs had been stored for 7 to 8 days before use. On the 27th day after surgery, an erythematous, pruritic rash appeared over the face, neck, and trunk, which was associated with low-grade fever and pancytopenia. Transfusion-associated GVHD was strongly suspected and was confirmed by skin biopsy. To determine the origin of lymphocytes causing GVHD, several microsatellite loci were amplified from DNA of the patient's nails and blood and from blood samples of all 10 RBC donors by using PCR. Amplified alleles derived from the patient's blood were identical to those from one of the 10 samples. CONCLUSION: These findings indicate that transfusions of MAP-RBCs can cause transfusion-associated GVHD in an elderly but immunocompetent host.     

Management of Type 2 Diabetes: Current Strategies,Unfocussed Aspects,Challenges, and Alternatives

Type 2 diabetes mellitus (T2DM) accounts for >90% of the cases of diabetes in adults. Resistance to insulin action is the major cause that leads to chronic hyperglycemia in diabetic patients. T2DM is the consequence of activation of multiple pathways and factors involved in insulin resistance and β-cell dysfunction. Also, the etiology of T2DM involves the complex interplay between genetics and environmental factors. This interplay can be governed efficiently by lifestyle modifications to achieve better management of diabetes. The present review aims at discussing the major factors involved in the development of T2DM that remain unfocussed during the anti-diabetic therapy. The review also focuses on lifestyle modifications that are warranted for the successful management of T2DM. In addition, it attempts to explain flaws in current strategies to combat diabetes. The employability of phytoconstituents as multitargeting molecules and their potential use as effective therapeutic adjuvants to first line hypoglycemic agents to prevent side effects caused by the synthetic drugs are also discussed.     

微信公众号在结肠镜诊疗中肠道准备的应用

研究目的 探讨基于微信公众号“结肠镜检查准备须知”实时提醒对结肠镜诊疗患者的肠道准备执行的依从性,肠道准备清洁度及患者和医生满意度的影响。研究方法 将244例患者随机分为实验组122例,对照组122例。两组患者均在预约时给予口头及书面的肠道准备宣教。实验组在口头和书面指导的基础上使用公众号“结肠镜检查准备须知”,分别对饮食、服药、诊疗前后注意事项进行微信实时推送提醒和强化指导;对照组使用常规方法进行指导。在结肠镜诊疗前通过自行设计的问卷调查评估两组患者肠道准备的知晓度和执行度,使用Boston量表评价肠道清洁程度,同时评价患者和医生的满意度。研究结果 实验组肠道准备知晓度和执行度明显高于对照组（P<0.05）,实验组患者肠道准备清洁度优于对照组（P<0.05）,实验组患者和医生的满意度高于对照组（P<0.05）。结论 基于微信的“结肠镜检查准备须知”的运用对增强患者肠道准备依从性,提高肠道准备质量具有显著效果,提升了患者和医生的满意度。     

支气管动脉灌注化疗联合放射免疫治疗中晚期肺癌的护理

目的 探讨支气管动脉灌注化疗（bronchial artery infusion, BAI）联合放射免疫治疗（radioimmunotherapy, RIT）中晚期肺癌的护理方法。方法 对32例中晚期肺癌患者行BAI联合RIT治疗进行围手术期护理,随访4-26月。结果 32例患者均顺利完成1-4次BAI治疗及1次RIT治疗,无技术性差错及护理意外发生。结论 恰当的围手术期护理,可防止BAI联合RIT治疗肺癌护理差错的发生,避免放射性损伤。     

超声在脐尿管疾病中的应用价值

目的 脐尿管疾病是一种少见的泌尿系统疾病,本文主要通过回顾性分析脐尿管疾病的超声及超声造影表现,探讨超声在脐尿管疾病中的应用价值。方法回顾性整理分析本院2013年1月至2017年6月期间超声提示脐尿管异常或手术病理证实脐尿管异常的19例患者资料,病变主要位于膀胱前壁或顶部,所有病例均有超声检查结果,经CT或病理证实。结果 脐尿管囊肿8例,脐尿管憩室1例,脐尿管癌7例,脐尿管炎伴脓肿形成1例,粘液性囊腺瘤2例。脐尿管囊肿及脐尿管膀胱憩室通过病灶部位及典型的超声声图像较易诊断,脐尿管囊肿二维超声诊断准确率为62.5%,超声造影后准确率达到100%；7例脐尿管癌中有5例(71.43%)误诊为膀胱癌；脐尿管炎伴脓肿形成及1例粘液性囊腺瘤误诊为膀胱癌；另一例粘液性囊腺瘤误诊为脐尿管囊肿。结论 脐尿管疾病有较特征的超声声像图表现,超声造影可以明确病灶的性质及浸润范围,提高诊断准确性。     

受血者与供血者Rh(D、C、c、E、e)抗原相容情况的回顾性分析

目的了解我院受血者及其供血者Rh(D、C、c、E、e)抗原和表型分布,分析受、供者Rh抗原相容情况及其临床意义。方法收集交叉配血相合的受血者血样418例和供血者血样710例,进行Rh(D、C、c、E、e)抗原检测,比较分析受、供者抗原和表型分布差异及抗原相容性。结果受、供者Rh(D、C、c、E、e)抗原分布无显著性差异,受、供者CcDEe、CCDee表型分布比例差异有统计学意义(P<0.05)。受、供者Rh(D、C、c、E、e)抗原不相容性输血中以c、E抗原同时不相容占比最高(50.00%);ccDEE、ccDEe和CcDEE表型的受血者发生Rh抗原不相容性输血的概率较高;受血者输注多个供血者血液时,发生Rh抗原不相容性输血的概率最高(P<0.05)。结论临床输血中存在一定比例的Rh抗原不相容性输血,交叉配血前对受、供者进行Rh(D、C、c、E、e)抗原的检测并采取相容性输血,可有效提升临床输血治疗的安全性。