隐球菌性脑膜炎的诊断与治疗

隐球菌性脑膜炎是由隐球菌属,特别是新生隐球菌及格特隐球菌引起的机会性感染,在免疫抑制者及正常人群均可发病。隐球菌性脑膜炎早期诊断困难,即便接受治疗,患者死亡率仍然很高。在过去几年中,快速及时的检测及早期隐球菌抗原检查取得了重大进展。对晚期HIV感染者行血隐球菌荚膜抗原筛查并进行抢先治疗,有望阻止其进展为临床感染。目前抗真菌药物主要包括多烯类、唑类及氟胞嘧啶,未来药物研究的重点是疗效更好、毒性更小的新型口服抗真菌药。本文总结近几年隐球菌性脑膜炎的相关诊断及治疗进展,旨在对隐脑患者诊疗提供帮助。     

41例大面积脑梗死患者临床分析

脑血管病是神经内科常见病、多发病,而大面积脑梗死又是其中较为常见的一种类型,起病急、进展快、病情重、死亡率及致残率均较高是其特点.现对我科2007年4月~2013年1月收治的41例大面积脑梗死患者的临床资料进行分析,以探讨早期诊断及更有效的治疗方法.     

抑癌基因DLC-1的研究进展

DLC-1(肝癌缺失基因1)是近年来被发现的一种重要的抑癌基因,目前研究发现其在多种肿瘤的发生、发展过程中产生了重要的作用。随着基因技术及分子生物技术的飞速发展,关于DLC-1基因以及与之相关的上、下游靶基因,DLC-1基因的甲基化修饰及其相互作用的信号传导通路的研究将更深入、更彻底、更清楚。通过构建肿瘤动物实验模型,我们可以对人类各种肿瘤进行去甲基化药物治疗,分析实验结果,综合评估治疗指征,为临床上对肿瘤的治疗提供理论基础及实践指导。相信在不久的将来,针对DLC-1基因在肿瘤分子生物学研究有望成为多种肿瘤诊断、治疗的突破。     

肛周坏死性筋膜炎抗感染治疗12例报告

目的探讨坏死性筋膜炎诊断及有效治疗方法。方法回顾性分析总结12例坏死性筋膜炎的临床表现及治疗过程（包括彻底扩创引流,全身抗感染治疗及营养支持治疗）。结果12例患者痊愈。结论早期明确诊断,尽早切开引流,抗感染及营养支持的方法,是治疗坏死性筋膜炎的有效方法。     

胰性脑病的诊断治疗

胰性脑病是急性胰腺炎的罕见并发症,诊断治疗困难,死亡率极高。本文详细讨论该病的发病机制、临床表现、诊断、鉴别诊断、预防及治疗方面的进展。     

小儿脓毒症心肌损伤的临床诊断与治疗现状

脓毒症是由感染引起的严重威胁儿童生命的危重症之一,临床救治困难。近年,人们对其临床监测与诊断及治疗策略进行了深入探讨。本文从血流动力学监测与心电、心脏生物学标志物监测相结合、集束化与个体化相结合的治疗策略等角度,对脓毒症患儿心肌损伤的临床诊断与治疗进展进行了综述。     

2型糖尿病继发Foumier坏疽的诊断及治疗

目的：总结2型糖尿病、糖尿病酮症酸中毒继发Foumier坏疽的诊断及治疗经验。方法：回顾性分析2型糖尿病、糖尿病酮症酸中毒继发Foumier坏疽患者的主要症状及诊治情况,结合文献对该病的临床表现、诊断、治疗及预后进行讨论。结果：患者经控制血糖、外科清创、抗感染等综合治疗后痊愈。结论：早期诊断,良好控制血糖,纠正酸中毒,彻底清创,联合应用抗生素治疗等全身综合治疗,是治愈本病的关键。     

2型糖尿病继发Fournier坏疽的诊断及治疗

目的:总结2型糖尿病、糖尿病酮症酸中毒继发Foumier坏疽的诊断及治疗经验.方法:回顾性分析2型糖尿病、糖尿病酮症酸中毒继发Foumier坏疽患者的主要症状及诊治情况,结合文献对该病的临床表现、诊断、治疗及预后进行讨论.结果:患者经控制血糖、外科清创、抗感染等综合治疗后痊愈.结论:早期诊断,良好控制血糖,纠正酸中毒,彻底清创,联合应用抗生素治疗等全身综合治疗,是治愈本病的关键.     

成人心肌致密化不全的研究进展

成人心肌致密化不全（NVM）是一种特殊少见的心肌病,是由于胚胎发育早期正常心内膜发育停滞所致的心脏病,特征是心内膜面有粗大的肌小梁和交错的深隐窝。临床表现为充力性心力衰竭、心律失常和系统性血栓栓塞等。目前以对症支持治疗为主,预后较差。现介绍其发病机制、病理解剖学、临床特点、诊断及诊断标准、治疗等方面进展,为临床诊断及治疗提供客观依据。近年来医师对该疾病认识的不断提高,使其误诊率和漏诊率有所下降,同时使患者的预后和生活质量得到明显改善,但还存在许多争议,需要进一步探讨。     

酶学诊断急性心梗的意义

酶学诊断急性心梗的意义总参第四门诊部李玉祯,张帆,张敏心肌梗塞急性期病势凶险。病死率高。其近期及远期预后在很大程度上取决于早期诊断和积极治疗。用于诊断ＡＭＩ的手段近十年虽有不少进展,但主要仍依靠临床表现、心电图及酶三方面。通常以此三者具备作为诊断依据...     

Molecular dysregulations underlying the pathogenesis of endometriosis

Endometriosis is a crippling disease characterized by the presence of endometrium-like tissue or scar outside the uterine cavity, commonly confined to the peritoneal and serosal surfaces of the pelvic organs. 10–15% of women in reproductive age are estimated to be affected by endometriosis. Most of these patients present with infertility and suffer from pelvic pain. The benign disease rarely progresses to malignancy. Regardless of its high prevalence, the pathogenesis of the disease is not fully understood. Treatment options for endometriosis are limited and are often based on a symptomatic approach. The unavailability of proper diagnostic approaches, fewer therapeutic options, and sparse understanding of molecular alterations are responsible for the continued disease burden. Exploring the molecular elements causing the pathogenesis of endometriosis may lead to a number of breakthroughs in the treatment of the illness, such as the discovery of new biomarkers for diagnosis and therapeutic targets that can be a guide to better prognosis and reduced recurrence. The goal of this review is to provide the reader a critical understanding of the disease by summarizing the genetic, immunological, hormonal, and epigenetic deregulations that support the molecular basis for development of endometriotic cyst, with a special focus on the study models needed to analyze these changes in the endometriotic microenvironment.     

Unique molecular markers in human endometriosis: implications for diagnosis and therapy

Endometriosis originates in the uterine lining and affects ~20% of reproductive-age women. The disease often causes chronic pelvic pain, affects ovulatory function and influences fertility. Although laparoscopic diagnosis of uterine endometriosis is quite specific, direct visualisation can be difficult or inaccurate in some circumstances, and it is not useful for diagnosing extra-abdominal disease. Laparoscopy is an invasive procedure, has significant morbidity and cannot be carried out frequently to monitor efficacy of therapy and the possibility of recurrence. Thus, a specific, non-invasive diagnostic test is required. One intriguing area of research uses the technology of radioimmunotargeting, which has previously been used for cancer detection. This technique could have potential for the specific detection and eventual treatment of endometriosis. A marker, eosinophil peroxidase (EPO), has been identified that is expressed in ~90% of endometriosis specimens, and is not expressed or only weakly expressed in normal endometrium. The US Food and Drug Administration has approved a monoclonal antibody to EPO for investigation as an immunoimaging agent in cancers that exhibit eosinophilia. EPO targeting using this antibody could be useful for detecting and/or treating endometriosis.     

Proteomic approaches in endometriosis research

To date, the quest to develop a noninvasive diagnostic test for endometriosis has mostly concentrated on the levels of cytokines and growth factors that are involved in inflammation, angioneogenesis and tissue remodeling, present in serum, peritoneal fluid, endometrium and endometriotic lesions. As this has not yet translated into the development of such a diagnostic test, proteomic techniques are now being employed to identify proteins that are potential biomarkers for the disease. As proteomics allows the comprehensive analysis of complex fluid and tissue samples with good sensitivity and resolution, it has promise in delivering markers associated with endometriosis. Once identified, the challenge will be in translating these markers into a clinically useful test for endometriosis, as the pathophysiology of this disease is unknown and likely to be complex and multifactorial. Also, with variation between individuals and the influences of steroid hormones during the menstrual cycle, it could be difficult to validate findings relating to a single protein or small groups of proteins differentially expressed in the disease state. Proteomic profiling, using mass spectrometry in combination with sophisticated bioinformatics software to identify protein patterns, may be where a significant clinical diagnostic contribution can be made.     

Circulating miRNAs Related to Epithelial–Mesenchymal Transitions (EMT) as the New Molecular Markers in Endometriosis

Endometriosis is a chronic gynecological disease defined by the presence of endometrial-like tissue found outside the uterus, most commonly in the peritoneal cavity. Endometriosis lesions are heterogenous but usually contain endometrial stromal cells and epithelial glands, immune cell infiltrates and are vascularized and innervated by nerves. The complex etiopathogenesis and heterogenity of the clinical symptoms, as well as the lack of a specific non-invasive diagnostic biomarkers, underline the need for more advanced diagnostic tools. Unfortunately, the contribution of environmental, hormonal and immunological factors in the disease etiology is insufficient, and the contribution of genetic/epigenetic factors is still fragmentary. Therefore, there is a need for more focused study on the molecular mechanisms of endometriosis and non-invasive diagnostic monitoring systems. MicroRNAs (miRNAs) demonstrate high stability and tissue specificity and play a significant role in modulating a range of molecular pathways, and hence may be suitable diagnostic biomarkers for the origin and development of endometriosis. Of these, the most frequently studied are those related to endometriosis, including those involved in epithelial–mesenchymal transition (EMT), whose expression is altered in plasma or endometriotic lesion biopsies; however, the results are ambiguous. Specific miRNAs expressed in endometriosis may serve as diagnostics markers with prognostic value, and they have been proposed as molecular targets for treatment. The aim of this review is to present selected miRNAs associated with EMT known to have experimentally confirmed significance, and discuss their utility as biomarkers in endometriosis.     

经阴道超声联合血清AFP、PAI-1及MMIF对子宫内膜异位症的诊断价值分析

摘要 目的：探讨经阴道超声联合血清甲胎蛋白（AFP）、纤溶酶原激活物抑制物1（PAI-1）及巨噬细胞移动抑制因子（MMIF）对子宫内膜异位症的诊断价值。方法：选取我院2021年8月到2023年8月收治的150例子宫内膜异位症患者进行回顾性分析,分析其经阴道超声检查图像特征,并以病理诊断作为"金标准",分析阴道超声对宫内膜异位症的阳性检出率。依照子宫内膜异位症分期,将其分为Ⅰ~Ⅱ期组（n=77）,Ⅲ~Ⅳ期组（n=73）,另选取同期来我院体检的150例健康女性作为对照组。分析三组受检者血清AFP、PAI-1及MMIF表达水平,并采用Spearman相关分析法分析AFP、PAI-1及MMIF与子宫内膜异位症的相关性。最后建立受试者特征（ROC）工作曲线分析经阴道超声联合血清AFP、PAI-1及MMIF对子宫内膜异位症的诊断效能。结果：150例子宫内膜异位症患者均经病理诊断确诊,通过经阴道超声检查确诊为子宫内膜异位症的患者128例,85.33%。其中75例患者为卵巢型,超声显示巨大巧克力囊肿,内部可见大量细密点状回声与分隔光带。53例患者为子宫型,超声显示后壁腺肌瘤,内部回声不均匀,可见片状无回声区域;三组受检者血清AFP、PAI-1及MMIF表达水平对比差异显著,Ⅲ~Ⅳ期组明显高于Ⅰ~Ⅱ期组和对照组,差异具有统计学意义（P＜0.05）;Spearman相关分析结果显示：AFP、PAI-1及MMIF与子宫内膜异位症呈正相关（P＜0.05）;诊断灵敏度和特异度从低到高依次为MMIF（52.58%、64.32%）、PAI-1（60.03%、67.53%）、AFP（65.24%、71.27%）、经阴道超声（73.25%、86.36%）、经阴道超声联合血清AFP、PAI-1及MMIF（84.26%、98.63%）。经阴道超声联合血清AFP、PAI-1及MMIF的诊断灵敏度明显高于单一指标诊断（P＜0.05）。结论：经阴道超声联合血清AFP、PAI-1及MMIF对子宫内膜异位症的诊断价值较高,其灵敏度和特异度分别为84.26%、98.63%,通过联合诊断可进一步辅助减少子宫内膜异位症的误诊和漏诊几率,为子宫内膜异位症的诊断与治疗提供重要参考。     

Towards endometriosis diagnosis by gadofosveset-trisodium enhanced magnetic resonance imaging

Endometriosis is defined as the presence of endometrial tissue outside the uterus. It affects 10-15% of women during reproductive age and has a big personal and social impact due to chronic pelvic pain, subfertility, loss of work-hours and medical costs. Such conditions are exacerbated by the fact that the correct diagnosis is made as late as 8-11 years after symptom presentation. This is due to the lack of a reliable non-invasive diagnostic test and the fact that the reference diagnostic standard is laparoscopy (invasive, expensive and not without risks). High-molecular weight gadofosveset-trisodium is used as contrast agent in Magnetic Resonance Imaging (MRI). Since it extravasates from hyperpermeable vessels more easily than from mature blood vessels, this contrast agent detects angiogenesis efficiently. Endometriosis has high angiogenic activity. Therefore, we have tested the possibility to detect endometriosis non-invasively using Dynamic Contrast-Enhanced MRI (DCE-MRI) and gadofosveset-trisodium as a contrast agent in a mouse model. Endometriotic lesions were surgically induced in nine mice by autologous transplantation. Three weeks after lesion induction, mice were scanned by DCE-MRI. Dynamic image analysis showed that the rates of uptake (inwash), persistence and outwash of the contrast agent were different between endometriosis and control tissues (large blood vessels and back muscle). Due to the extensive angiogenesis in induced lesions, the contrast agent persisted longer in endometriotic than control tissues, thus enhancing the MRI signal intensity. DCE-MRI was repeated five weeks after lesion induction, and contrast enhancement was similar to that observed three weeks after endometriosis induction. The endothelial-cell marker CD31 and the pericyte marker α-smooth-muscle-actin (mature vessels) were detected with immunohistochemistry and confirmed that endometriotic lesions had significantly higher prevalence of new vessels (CD31 only positive) than the uterus and control tissues. The diagnostic value of gadofosveset-trisodium to detect endometriosis should be tested in human settings.     

ENDOMETRIOSIS

The cause of endometriosis is not known. The incidence of the disease is greater than was previously suspected and it probably is increasing. Nulliparous women are more likely to have endometriosis than are women who have had children.The commonest symptoms are lower abdominal pain, disturbance of menstruation, and dysmenorrhea, most often of the increasing or acquired type. Relative and absolute sterility are common partners of endometriosis.A better percentage of correct preoperative diagnoses should be obtained in view of present knowledge.Radical operation on women in the premenopausal age groups with endometriosis is resorted to in far too high a percentage of cases. The good results which can be attained with conservative therapy, including surgical and hormone therapy, should be stressed.There is some evidence that endocrine therapy may control endometriosis. The dangers attending these methods have not as yet been determined.     

Endometriosis

The cause of endometriosis is not known. The incidence of the disease is greater than was previously suspected and it probably is increasing. Nulliparous women are more likely to have endometriosis than are women who have had children. The commonest symptoms are lower abdominal pain, disturbance of menstruation, and dysmenorrhea, most often of the increasing or acquired type. Relative and absolute sterility are common partners of endometriosis.A better percentage of correct preoperative diagnoses should be obtained in view of present knowledge.Radical operation on women in the premenopausal age groups with endometriosis is resorted to in far too high a percentage of cases. The good results which can be attained with conservative therapy, including surgical and hormone therapy, should be stressed. There is some evidence that endocrine therapy may control endometriosis. The dangers attending these methods have not as yet been determined.     

Aproximación diagnóstica a la enfermedad de Alzheimer temprana. ¿De qué hablamos? Aspectos conceptuales

Progress in knowledge of the physiopathology of Alzheimer's disease over the last few decades has allowed much earlier diagnosis, even before the onset of clinical symptoms. Although the use of biomarkers is still far from being widespread and cannot be recommended outside research settings, their potential use has led to a review of the diagnostic criteria employed in the last few years. Among other criteria, asymptomatic and prodromal phases have been definitively incorporated into the spectrum of the disease and have been redefined. In future, the possibility of an earlier and more accurate diagnosis will allow the application of treatments acting in these phases, delaying progression to more advanced stages or even halting the disease before clinical manifestations develop. Currently, such treatments are still far from being a reality and interest in biomarkers centers on research since their detection could allow standardization of the samples used in clinical trials and exclusion of individuals showing signs of prodromal disease but who will never develop the disease.     

The diagnostic approach to early Alzheimer's disease. What are we talking about? Conceptual considerations

Progress in knowledge of the physiopathology of Alzheimer's disease over the last few decades has allowed much earlier diagnosis, even before the onset of clinical symptoms. Although the use of biomarkers is still far from being widespread and cannot be recommended outside research settings, their potential use has led to a review of the diagnostic criteria employed in the last few years. Among other criteria, asymptomatic and prodromal phases have been definitively incorporated into the spectrum of the disease and have been redefined. In future, the possibility of an earlier and more accurate diagnosis will allow the application of treatments acting in these phases, delaying progression to more advanced stages or even halting the disease before clinical manifestations develop. Currently, such treatments are still far from being a reality and interest in biomarkers centers on research since their detection could allow standardization of the samples used in clinical trials and exclusion of individuals showing signs of prodromal disease but who will never develop the disease.