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重症肺炎患者血清前白蛋白的动态变化及临床意义

重症肺炎是造成重症加强治疗病房（ICU）患者死亡的主要原因之一[1]。前白蛋白（PA）是肝脏合成的负性急性时相蛋白，半衰期短，能准确地反映肝脏损害的程度，但在评价患者预后及严重性方面还存在有争议[2，3]。故此，本研究通过动态观测重症肺炎患者PA变化，探讨其与病情严重程度及预后的关系。

22例特发性小叶性肉芽肿性乳腺炎诊治分析

目的探讨特发性小叶性肉芽肿性乳腺炎（Idiopathic granulomatous lobular mastitis，IGLM）的临床特点、治疗方案及预后。 方法回顾性分析笔者所在医院2010年1月至2015年2月期间收治的22例IGLM患者的临床资料。 结果22例患者均为女性，年龄（35.48±11.99）岁（24～64岁）；72.7%（16/22）的患者处于育龄期，全部病例均已育；95.5%（21/22）的患者曾采用母乳喂养，其中19例患者为断乳后发病，距离末次断乳时间3个月～39年（中位时间2年）。以乳房肿块（19/22）和皮肤红肿（13/22）为最常见首发症状；全部病灶均位于单侧乳房，左侧16例，右侧6例；18例为单发病灶，3例为多发病灶，1例未扪及包块；1个病灶波及全乳，8个病灶位于乳晕区，余16个病灶位于乳腺周围区域。13例可扪及腋窝淋巴结肿大，其中11例位于患侧，2例位于双侧。20例患者经乳腺超声及乳腺钼靶X线摄影检查，10例（50.0%）诊断考虑为炎性病变。术前行抗生素治疗12例，有效3例，无效9例。行手术治疗17例：乳房肿块切除15例（其中乳头内陷1例同时行乳头成形术），乳腺脓肿切开引流术 1例，乳房单纯切除术1例；7例术后给予左氧氟沙星治疗，余10例术后未使用抗生素。另外5例行对症治疗。随访1～3个月无复发。 结论IGLM目前病因不明，临床表现提示IGLM可能与自身免疫反应相关。育龄非哺乳期女性如出现乳房肿物伴表面红肿，临床上应考虑IGLM可能。本病确诊依赖空心针活检及术后组织病理学检查。手术治疗可以彻底清除病灶，从而治愈本病。

以癫痫为主要表现的继发性甲状旁腺功能减退一例

Risk factors analysis of delayed gastric emptying after laparoscopic distal gastrectomy forgastric cancer: a historical cohort study

ObjectiveTo analyze the risk factors affecting delayed gastric emptying (DGE) after laparoscopic distal gastrectomy for gastric cancer. MethodsThe gastric cancer patients who underwent laparoscopic distal gastrectomy in the Jiaozuo People’s Hospital from January 1, 2013 to December 31, 2022 were retrospectively collected. The occurrence of DGE was recorded. Meanwhile, the multivariate binary logistic regression analysis was performed to screen the risk factors affecting the DGE. ResultsA total of 350 gastric cancer patients underwent laparoscopic distal gastrectomy and met the inclusion and exclusion criteria of this study were included, 17 (4.9%) of whom developed DGE. The multivariate binary logistic regression analysis results showed that the preoperative gastric outflow tract obstruction (OR=8.582, P=0.009), intraoperative jejunal nutrition tube indwelling (OR=14.317, P=0.010), more peritoneal drainage tube placement (OR=5.455, P=0.006), and intraoperative blood loss ≥140 mL (OR=4.912, P=0.018) increased the risk of DGE. ConclusionAccording to the results of this study, when patients undergoing laparoscopic distal radical gastrectomy for gastric cancer accompanied by preoperative gastric outflow tract obstruction, intraoperative jejunal nutrition tube indwelling, more peritoneal drainage tube placement, and more intraoperative blood loss, it should be paid more attention to prevention DGE, and early detection and treatment, so as to improve the prognosis of patients.

超声生物显微镜检查诊断老年性巩膜钙化三例

健康人群糖化血红蛋白参考范围的建立

目的建立实验室糖化血红蛋白（HbA1c）水平的参考范围，并验证其临床效果。 方法选取2013年4－5月行常规体检的健康成年人共218人。另选取20例首次诊断为糖尿病患者。采用日本TOSOH公司HLC-723G7全自动糖化血红蛋白分析仪测量HbA1c水平，验证参考范围的临床效果。 结果HbA1c的分布呈正态分布，其均数为5.44%，标准差为0.34%，＞35岁组HbA1c明显高于≤35岁组，差异有统计学意义（t=-3.952，P＜0.05）。两组参考范围分别是4.82%～6.24%和4.81%～5.90%。 结论年龄是是影响HbA1c的重要生理因素，应根据不同年龄建立HbA1c的参考范围。

Separation, Culture， and Identification of Breast Cancer Stromal Fibroblasts

ObjectiveTo explore the methods of separation， culture， and identification of breast cancer stromal fibroblasts (BCSFs), which could build up a good basis for the further research of function. MethodsBreast cancer tissues were obtained during breast cancer operation， and were cut into pieces with size of 1 mm×1 mm×1 mm under aseptic conditions， then the pieces of the tissues were digested by collagenase Ⅰ and hyaluronidase. Finally the cells separated from the tissues incubated at 37 ℃ with 5% CO2 and 95% air humidified incubator. Morphological characteristics of the fibroblasts were observed under light microscope. The certain proteins were examined by immunohistochemistry （using CK， Vimentin， α-SMA, and TE-7 antibody） and flow cytometric analysis (CD34 and CD45). ResultsThe separated cells begin to attach to the wall of flask within 24 h and reached almost confluency in about 7 d to 10 d . According to identification, the successful rate of separation and culture of BCSFs was 90%（18/20）, and the characteristics of cells showed that morphological characteristics of the fibroblasts was flat spindle， rich cytoplasm, and a flat ovoid cystic nuclear. The fibroblasts in breast cancer tissues showed negative staining for cytokeratin， positive staining for vimentin， alpha-smooth muscle actin, and TE-7， and negative for CD34 and CD45 by flow cytometric analysis. ConclusionsThe fibroblasts in breast cancer tissues could be easily obtained by tissues cuting combined enzyme digestion and rocking technology in vitro. The present study provide an experimental foundation for further studies on fibroblasts in breast cancer.

Surgical outcomes of severe aortic stenosis in infants

ObjectiveTo analyze the results of surgical treatment of severe aortic stenosis in infants.MethodsFrom August 2012 to December 2019, 28 infants undergoing aortic valvuloplasty in our hospital were selected, including 22 males and 6 females, aged 62.00 (47.00, 82.50) d. The baseline characteristics of the patients, postoperative complications and follow-up results were analyzed.ResultsTwenty (71.43%) patients had bicuspid aortic valves. Five (17.86%) patients had heart failure and two (7.14%) patients used prostaglandin before surgeries. Postoperative mechanical ventilation time was 25.00 (17.00, 62.75) h, ICU stay was 3.50 (2.00, 8.50) d and postoperative hospital stay was 10.00 (7.00, 16.50) d. Four (14.29%) patients got delayed recovery (ICU stay>14 d). One (3.57%) perioperative death was observed. The follow-up time was 55.00 (43.25, 82.25) months. No death was found during follow-up. Four (14.81%) patients underwent a second operation, including three (11.11%) patients with severe aortic stenosis, and one (3.70%) patient with severe regurgitation.ConclusionInfants with severe aortic stenosis are seriously ill and have a long postoperative recovery time, requiring early surgery. The postoperative follow-up results are satisfactory.