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Hemophagocytic syndrome (HPS) is a rare, life-threatening inflammatory response syndrome characterized by overactivation of the immune system, which leads to organ damage. Secondary HPS is usually triggered by infection, tumor and autoimmune disease. It has been clinically found that many HPS-like manifestations also occur during drug therapy. This article reviews the related progress of HPS induced by immune checkpoint inhibitors, ibrutinib and lamotrigine, in order to provide a guidance for clinical practice.
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In order to solve the problem of poor communication, low efficiency of consultation, and even affecting self-confidence caused by unskilled skills and insufficient cooperation with patients in the real clinic, and to solve the problem during the clinical thinking training that beginners do not know how to organize effective information and complete the process of diagnosis and differential diagnosis more efficiently. By applying the artificial intelligence (AI) virtual patient (VP) system to the process of teaching diagnostic knowledge and clinical thinking training. It provides the students with the experience of simulating the diagnosis and treatment of the clinical real scene. Let the students talk with the VP system for inquiry training and then go to the clinic to give the real patients inquiry and by simulating the process of treating the real patients, let the students take the initiative to complete the collection of medical records and clinical decision-making under the simulated scene to train the clinical thinking. This can not only solve the shortcomings of the previous simulation teaching and clinical teaching, but also stimulate students' interest in learning. According to the results of the questionnaire, students have a high acceptance of VP system simulation teaching. Through the results of homework and assessment and evaluation, the teaching results are better than before, and this teaching method should be further popularized.
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Objective To establish a modified dynamic 99Tcm-pertechnetate salivary gland scintigraphy(SGS) method,and to evaluate the value in the diagnosis of Sj(o)gren's syndrome(SS) by comparing SGS with labial gland biopsy (LGB).Methods A total of 204 patients (21 males,183 females,age range 20-85 years) with suspected SS who underwent the modified dynamic SGS and LGB were enrolled in this prospective study.Uptake ratio (UR) and excretion fraction (EF) of the left parotid gland (LPG),the right parotid gland (RPG),the left submandibular gland (LSG) and the right submandibular gland (RSG)were calculated.Two-sample t test was used for data analysis.The sensitivity,specificity,accuracy of the modified dynamic SGS and LGB were calculated,and x2 test was used for data analysis.Results SS was confirmed in 113 patients,including 79 patients with primary SS and 34 patients with secondary SS.SS was excluded in 88 patients.The UR and EF of the SS group (LPG:1.95±1.04 and (52.2±19.5)％,RPG:1.96±1.06 and (55.0±21.1)％,LSG:2.65±1.12 and (25.9±14.1)％,RSG:2.72±1.30 and (29.7± 14.7) ％) were significantly lower than those of the non-SS group (LPG:3.08± 1.10 and (65.9± 12.7) ％,RPG:3.26±1.16 and (66.4±12.6)％,LSG:3.71±1.31 and (43.2±12.3)％,RSG:3.74±1.39 and (46.6± 11.5) ％;t=4.40-9.00,all P＜0.05).The sensitivity,specificity,accuracy of the modified dynamic SGS were 99.1％ (112/113),72.7％ (64/88),87.6％ (176/201),respectively,while those of LGB were 83.2％ (94/113),96.6％ (85/88),89.1％ (179/201),respectively.The sensitivity and specificity of SGS method were significantly different from those of LGB (x2 =15.9,17.5,both P＜0.05).Conclusions The modified dynamic SGS can reduce the acquisition time and has a high sensitivity for SS.When combined with LGB,it will improve the diagnostic accuracy for SS.
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There were some limitations existed in current teaching mode of diagnostics,including simple evaluation methods,mechanical internship for body sign,tedious internship for laboratory diagnosis and unsustainable interest-stimulating.Interest teaching was proposed in the teaching reform and some concert measures were implemented including interesting inquiry,interesting skill examination,interesting teaching of laboratory diagnostics,simulated case discussion,interesting training of centesis as well as interesting clinical involvement and interesting medical community activities.The interesting teaching contributed to the improvement of students'comprehensive analysis ability,practical ability,adaptability,humanistic quality,English communication ability and doctor-patient communication,which is of grate importance.
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ObjectiveTo explore the effect of CQI on the teaching of physical diagnostics.MethodsThe theory and practice of CQI are discussed in accordance with specific conditions of the teaching of physical diagnostics.ResultsThe level of the teaching of physical diagnostics can be raised by applying CQI.ConclusionThere will be broad prospects in the application of CQI to quality teaching of physical diagnostics.
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Objective To investigate the relationship between helicobacter pylor (Hp) and primary carcinoma of the gallbladder (PCG), providing a theoretical basis for the treatment of PCG.Methods Mucosa and bile of gallbladder samples were collected from 18 patients with PCG (PCG group), 40 patients with chronic cholecystitis or cholelithiasis (CC group), and 20 patients with no PCG and CC (control group). 16S rDNA-based polymerase chain reaction (PCR) followed by DNA sequence analysis of the obtained PCR fragments was performed. A developed search for Hp was also carried out by PCR. Five genes specific for Hp were amplified. Results In the PCG group, 81% samples of mucosa and bile were positive for Helicobacter-specific 16S rRNA gene. The positive rate in PCG group was significantly higher than those of the CC group (50%) and the control group (20%).Of the 16S rDNA sequence of Helicobacter pylori positive samples of mucosa and bile, 52% of samples were positive in cagA, 86% were positive in 26 KDa, 48% were positive in ureA separately. The vacA and rps4 genes were never detected in any of the samples of mucosa and bile. At least one gene was positive in 93% of samples of musca and bile. The sequencing showed more than 99% homology of Helicobacter 16S rRNA in PCG and Hp groups. Conclusion A higher infection rate is present in bile and gallbladder mucosa from patients with PCG. Hp in the biliary system may be one of the risk factors for occurrence of PCG.
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OBJECTIVE@#To determine the expression of DLK1 gene in acute leukemias (AL) and its function in erythroid differentiation of K562 cells.@*METHODS@#We detected the expression of DLK1 gene in 65 different acute leukemia categories (a test group) and 34 normal bone marrow controls (a control group) with RT-PCR. DLK1 protein in 20 out of the 65 AL patients and 13 of the 34 controls was assayed by Western blot. The K562 cell line was induced to erythroid differentiation by hemin. We observed the relationship between its expression and erythroid differentiation.@*RESULTS@#Both leukemia cells and normal marrow cells expressed DLK1. The expression of DLK1 mRNA in patients in the test group was higher than that in the control group (P=0.018), while there was no significance between acute lymphoblastic leukemia and acute myelogenous leukemia (P>0.05).The expression of DLK1 mRNA in the test group at onset had no relation with the WBC and platelet count in the total peripheral blood, and the same was true for blast cell rates in bone marrow cells.The level of DLK1 protein in the test group was higher than that in the control group, which was consistent with the mRNA expression (P=0.042). The expression of DLK1 mRNA decreased gradually with K562 cells towards hemin-induced erythroid differentiation.@*CONCLUSION@#DLK1 gene may be involved in leukemia,but the mRNA level of DLK1 has no relation with some clinical characteristics of AL patients at onset. DLK1 may inhibit the erythroid differentiation of K562 cells.
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Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Young Adult , Acute Disease , Calcium-Binding Proteins , Case-Control Studies , Cell Differentiation , Genetics , Cell Transformation, Neoplastic , Genetics , Erythroid Cells , Pathology , Erythroid Precursor Cells , Pathology , Intercellular Signaling Peptides and Proteins , Genetics , Metabolism , K562 Cells , Leukemia , Genetics , Metabolism , Membrane Proteins , Genetics , Metabolism , RNA, Messenger , Genetics , MetabolismABSTRACT
BACKGROUND: The maximal problem of patient with serious hepatitis and surgical doctor is whether they can get donator and rational therapy timely. Looking for the suitable preoperative therapy method to enhance the success rate of operation and improve patient's prognosis is the focus of this domain.OBJECTIVE: To investigate the therapeutic effect of artificial liver support system (ALSS) combining with allotransplantation of the liver on patients with serious hepatitis.DESIGN: Retrospective case analysis. SETTING: Organ Transplantation Center, the Third Affiliated Hospital of Anhui Medical University.PARTICIPANTS: Five male patients with serious hepatitis who underwent allograft liver transplantation were selected from Organ Transplantation Center, the Third Affiliated Hospital of Anhui Medical University form June 2004 to May 2005. Their age ranged from 25 to 48 years. Inclusion criteria: The diagnosis was in accordance with phase standard established at the National Infectious Disease and Parasitology Academic Meeting in September 2000; all patients had signs of routine liver transplantation; their patients fiercely requested the operation.METHODS: Plasma exchange (PE) combined with continuous veno-venous hemofiltration (CVVH) technique was used in this study. Donor who supplied lives was from 20-38-year patients. All of them and their family agreed to donate their organ and signed the donate file before operation. All of 5 patients were used classical no-by-pass orthotopic liver transplantation (OLT). MAIN OUTCOME MEASURES: They were follow-up visited for 21-32 months for rechecking liver and kidney function,RESULTS: All of 5 patients' operation was succeeded. One continued coma postoperative and his serum creatinine and urea nitrogen raised up progressively and complicated by pulmonary infection 1 week after operation and died 2 weeks after operation although given medical treatment hemodialysis positively. The rest recovered well. All of them discharged one month after operation smoothly.CONCLUSION: Allotransplantation of the liver is an utilizable method to treat serious hepatitis. ALSS can be used as an effective method of supportive treatment preoperatively.
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Objective To study the roles of P-selectin and nitric oxide (NO) on the etiology of pregnancy induced hypertension (PIH). Methods The levels of plasma P-selectin and nitrite and nitrate (NO2-/NO3-) were determined in 36 patients with PIH. The data were compared with those of normal pregnant group (n=18) and healthy non-pregnant group (n=19). The levels of plasma P-selectin were measured by means of enzyme-linked immunosorbent assay (ELISA) and levels of plasma NO2-/NO3- were measured by Griess reaction after the nitrate was reduced by a Cadmium-reduction method. Results The results showed: （1）The level of P-selectin in the normal pregnant group (48.92±15.16) μg/L was higher than that in non-pregnant group ［(30.16±8.42) μg/L, P<0.001］. There was no significantly statistical difference in the levels of P-selectin between the normal pregnant group and the mild PIH group (P>0.05). The levels of P-selectin in the moderate and severe PIH group (70.11±17.65) μg/L were higher than those in the mild PIH group ［(47.33±17.95) μg/L, P<0.01］ and the normal pregnant group (P<0.001). （2）The concentration of NO2-/NO3- in normal pregnant group was higher than that in non-pregnant group (P<0.01). The concentration of NO2-/NO3- in PIH group were lower than was in normal pregnant group (P<0.001). The NO2-/NO3- in mild group was lower than that in normal pregnant group (P<0.001). The Plasma concentration of NO2-/NO3- in moderate and severe PIH group was lower than that of mild group (P<0.05). （3） There was a negative correlation between the plasma concentration of P-selectin and NO2-/NO3- in the PIH group. Conclusion The changes of plasma levels of P-selectin and NO are related to the occurrence and development of PIH.