机化性肺炎患者的CT引导下经皮肺穿刺活检及其临床诊治分析

目的:探讨CT引导下经皮肺穿刺活检对机化性肺炎患者的诊断价值,并总结机化性肺炎的临床诊治经验。方法:回顾性分析2015年7月-2017年9月在南京医科大学附属常州第二人民医院住院行CT引导下经皮肺穿刺活检取得肺部病灶组织确诊为机化性肺炎的14例患者,所有患者行CT引导下经皮肺穿刺活检,总结机化性肺炎患者的临床诊治经验。结果:14例机化性肺炎患者平均年龄为59岁,平均起病时间为21天。主要临床症状以发热、咳嗽、咳痰为主。6例肺部听诊可闻及湿啰音。影像学检查主要表现为肺部斑片状不均匀密度增高影。所有患者初次就诊时均未首先诊断考虑机化性肺炎。所有患者入院后均行CT引导下经皮肺穿刺活检术,术后病理均确诊为机化性肺炎,术中3例出现少量气胸,4例出现少量出血,予吸氧止血等对症处理后好转。14例患者予糖皮质激素治疗后,主要临床症状改善,影像学检查均较前吸收好转。结论:对于持续性干咳、呼吸困难、发热病人,抗生素疗效差,影像学显示片状或块状影病灶,特别是游走性斑片阴影,需要高度警惕机化性肺炎。CT引导下经皮肺穿刺活检可作为明确机化性肺炎诊断的首选方法。机化性肺炎对糖皮质激素治疗敏感,可出现可逆性的好转,一旦确诊,建议及早使用糖皮质激素治疗。     

Targeted next-generation sequencing to diagnose disorders of HDL cholesterol

A low level of HDL cholesterol (HDL-C) is a common clinical scenario and an important marker for increased cardiovascular risk. Many patients with very low or very high HDL-C have a rare mutation in one of several genes, but identification of the molecular abnormality in patients with extreme HDL-C is rarely performed in clinical practice. We investigated the accuracy and diagnostic yield of a targeted next-generation sequencing (NGS) assay for extreme levels of HDL-C. We developed a targeted NGS panel to capture the exons, intron/exon boundaries, and untranslated regions of 26 genes with highly penetrant effects on plasma lipid levels. We sequenced 141 patients with extreme HDL-C levels and prioritized variants in accordance with medical genetics guidelines. We identified 35 pathogenic and probably pathogenic variants in HDL genes, including 21 novel variants, and performed functional validation on a subset of these. Overall, a molecular diagnosis was established in 35.9% of patients with low HDL-C and 5.2% with high HDL-C, and all prioritized variants identified by NGS were confirmed by Sanger sequencing. Our results suggest that a molecular diagnosis can be identified in a substantial proportion of patients with low HDL-C using targeted NGS.     

Toward Innovative,Cost-Effective,and Systemic Solutions to Improve Outcomes and Well-Being of Military Families Affected by Autism Spectrum Disorder

The burdens faced by military families who have a child with autism are unique. The usual challenges of securing diagnostic, treatment, and educational services are compounded by life circumstances that include the anxieties of war, frequent relocation and separation, and a demand structure that emphasizes mission readiness and service. Recently established military autism-specific health care benefits set the stage for community-viable and cost-effective solutions that can achieve better outcomes for children and greater well-being for families. Here we argue for implementation of evidence-based solutions focused on reducing age of diagnosis and improving access to early intervention, as well as establishment of a tiered menu of services, individualized to the child and family, that fit with the military ethos and system of health care. Absence of this new model of care could compromise the utility and sustainability of the autism-specific benefit.     

一种快速检测桉树焦枯病菌(Cylindrocladium scoparium)的LAMP体系的建立及应用

【目的】建立桉树焦枯病快速有效的环介导等温扩增反应LAMP,检测技术。【方法】以桉树焦枯病原菌Cylindrocladium scoparium为研究对象,利用Primer Explorer V4.0设计软件,针对C. scoparium的beta-tubulin gene特异保守区域设计了一套LAMP特异性引物组(内引物FIP/BIP,外引物F3/B3,环引物LooPF/LooPB),优化并建立了桉树焦枯病原菌的LAMP快速检测体系。【结果】LAMP反应体系为(50 μL)：Bst DNA polymerase (8 U) 1 μL;甜菜碱溶液(5 mol/L) 3.0 μL;dNTPs (2.5 mmol/L) 3.5 μL;10×Thermopol Ⅱ 2.5 μL;MgCl2 (100 mmol/L) 2 μL;FIP/BIP (40 μmol/L)各1 μL;F3/B3 (10 μmol/L)各0.5 μL;LooPF/LooPB (10 μmol/L)各1 μL;DNA模板2 μL;用ddH2O补足体积至50 μL。反应程序为：65 °C水浴锅中反应45 min,90 °C灭活5 min结束反应。特异性检测结果显示,供试的12个样本菌株LAMP产物可以采用肉眼观察、紫外灯照射、添加荧光染料SYBR Green I以及电泳检测条带4种不同的形式予以区分。DNA灵敏度检测结果显示,建立的LAMP体系检测灵敏度可达到40 μg/L,完全符合田间检测的要求。野外田间时效检测结果显示,无论是利用紫外检测还是电泳检测均可成功地检测出各地区不同生理小种的桉树焦枯病原菌C. scoparium,且检测效果明显。【结论】该LAMP检测是一项能够作为野外基层田间检测的重要技术。     

A Nested Polymerase Chain Reaction Protocol for in planta Detection of Fusicladium eriobotryae,Causal Agent of Loquat Scab

Scab caused by the fungus Fusicladium eriobotryae is the most serious disease affecting loquat in Spain. Isolation of F. eriobotryae from infected tissue on culture media can be difficult due to its slow growth. A polymerase chain reaction (PCR)‐based protocol was developed for F. eriobotryae‐specific identification from pure culture or infected loquat tissues. The primer set was designed in the elongation factor 1‐α gene (EF1‐α), and specificity and sensitivity for single and nested PCR were validated. The nested PCR assay resulted in 100% positive detection of F. eriobotryae in naturally and artificially infected tissues. This protocol can be useful for routine diagnosis, disease monitoring programmes and epidemiological research.     

黑龙江地区466例孕妇羊水穿刺产前诊断结果分析

目的:探讨羊水细胞染色体异常核型与各产前诊断之间的关系。方法:466例高危孕妇行羊膜腔穿刺术后羊水细胞培养及染色体核型分析。结果:异常核型66例,异常率14.16%,包括染色体数目异常27例,三体综合征22例(21-三体15例、18-三体6例、13-三体1例),占异常染色体核型的33.33%,占染色体数目异常的81.48%;染色体结构异常39例,主要包括染色体多态性、平衡易位、倒位和衍生等,占染色体异常核型的59.10%。异常核型检出率中血清学筛查高危组(14.44%)要高于高龄妊娠组(10.89%)和有不良孕产史组(11.11%)(P0.05);超声提示胎儿发育异常组(23.26%)要高于血清筛查高危组(P0.05)。结论:血清筛查高危和超声提示胎儿发育异常是黑龙江地区最主要的产前诊断指征,异常核型以21-三体综合征检出率最高。通过对高危孕妇羊水细胞染色体的核型分析可发现部分染色体疾病,从而避免此类出生缺陷儿的出生。     

MIF和CerbB-2在子宫内膜癌中的表达及临床意义

目的:探讨MIF和Cerb B-2的表达与子宫内膜癌的关系,进一步探讨其表达与子宫内膜癌的发生、发展的关系,为早期诊断子宫内膜癌,判断预后和寻找子宫内膜癌的新的治疗方法奠定基础。方法:应用实时荧光定量RT-PCR和免疫组织化学技术检测正常子宫内膜、不典型增生和子宫内膜癌组织中MIF m RNA、Cerb B-2 m RNA和MIF蛋白、Cerb B-2蛋白的表达,其中免疫组化中子宫内膜癌组根据临床病理特征,如年龄,临床分期,组织学分级,肌层浸润深度和有无淋巴结转移进行分组。结果:正常子宫内膜、不典型增生内膜和子宫内膜癌组织中都有MIF和Cerb B-2的表达,子宫内膜癌中MIF m RNA和Cerb B-2 m RNA扩增含量显示高水平,其阳性表达率随着病变程度的加重而逐渐升高,差异具有统计学意义(P=0.037);MIF主要表达于子宫内膜腺上皮的细胞质中,少量表达于细胞质,在阳性表达的子宫内膜癌组织中,蛋白含量在I期(P=0.033)、G1期(P=0.034)、无淋巴结转移的组织中水平较高(P=0.041),差异具有统计学意义。Cerb B-2蛋白主要表达在子宫内膜的细胞质,少量在细胞膜中表达,阳性表达率子宫内膜癌不典型增生正常子宫内膜,差异具有统计学意义(P=0.013);Cerb B-2蛋白在III-IV(P=0.009)、G2-3期(P=0.033),有淋巴结转移(P=0.018)的子宫内膜癌中表达含量较高,与年龄和肌层浸润深度无关。结论:MIF和Cerb B-2在正常子宫内膜、不典型增生和子宫内膜癌中都有表达,提示着MIF和Cerb B-2与子宫内膜癌的发生和发展有关,MIF在子宫内膜癌的早期表达含量较高,可以作为子宫内膜癌的早期诊断指标,Cerb B-2在子宫内膜癌的晚期表达含量较高,可以促进肿瘤的侵袭转移,可作为判断疾病的严重程度和预后的指标之一。     

Molecular identification of four Panonychus species (Acari: Tetranychidae) in Korea,including new records of P. caglei and P. mori

Four species of the genus Panonychus are identified in Korea including two previously known species P. citri (McGregor) and P. ulmi (Koch) and two newly identified species P. mori Yokoyama and P. caglei Mellot. Morphological diagnostics were observed among the four species in the color of dorsal tubercles and in the shape of male aedeagus. The dorsal tubercles of P. citri, P. ulmi, P. mori and P. caglei are red, white, whitish red and light red, respectively. The aedeagi of male adults are diagnostic in sigmoid‐shaped at the distal end and its shape and length was different among four species. Molecular comparison of the internal transcribed spacer 2 (ITS2) sequence of nuclear DNA and cytochrome‐c oxidase subunit I (COI) nucleotide sequence of mitochondrial DNA among the four species showed divergences 8–12% and 9–12%, respectively. Molecular analysis of the ITS2 and COI sequences revealed their divergences were slightly different among four species. In addition, species‐specific primer sets were designed at the base on ITS2 sequences to precisely diagnose these four species at the molecular level.     

Tenascin-C in cardiovascular remodeling: potential impact for diagnosis,prognosis estimation and targeted therapy

Fetal variants of tenascin-C are not expressed in healthy adult myocardium. But, there is a relevant re-occurrence during pathologic cardiac tissue and vascular remodeling. Thus, these molecules, in particular B and C domain containing tenascin-C, might qualify as promising novel biomarkers for diagnosis and prognosis estimation. Since a stable extracellular deposition of fetal tenascin-C variants is present in diseased cardiac tissue, the molecules are excellent target structures for antibody-based delivery of diagnostic (e.g., radionuclides) or therapeutic (bioactive payloads) agents directly to the site of disease. Against the background that fetal tenascin-C variants are functionally involved in cardiovascular tissue remodeling, therapeutic functional blocking strategies could be experimentally tested in the future.     

Plasma hepcidin in early-stage breast cancer patients: no relationship with interleukin-6, erythropoietin and erythroferrone

Objective: Hepcidin-25 production is stimulated by systemic inflammation, and it interferes with iron utilization, leading to anemia. This study aimed to investigate the relationships between the plasma levels of hepcidin, interleukin-6 (IL-6), erythropoietin (EPO) and erythroferrone (ERFE) in patients with benign breast disease or cancer. Methods: Plasma samples from a cohort of 131 patients (47 with benign breast disease and 84 with breast cancer) were subjected to the evaluation of hepcidin, IL-6, EPO and ERFE using SELDI-TOF-MS or immunoassays. Results: An elevated hepcidin was observed in malignant breast tumors compared to benign ones. No correlation was observed between hepcidin and IL-6, EPO or ERFE. Conclusion: Since the study included a cohort of patients (87%) with breast cancers smaller than 2 cm, these results may support our previous evidence about the potential role of hepcidin in breast cancer disease.