来那度胺联合自体造血干细胞移植治疗POEMS综合征1例及文献复习

POEMS综合征(POEMS syndrome)是一种罕见的克隆性浆细胞病,Bardwick等[1]于1980年根据该疾病主要症状的首字母:多发性神经病(polyneuropathy)、脏器肿大(organmegaly)、内分泌异常(endocrinopathy)、M蛋白(mprotein)、皮肤改变(skin changes),提出了POEMS综合征的命名方式。POEMS综合征的临床表现复杂,涉及多个学科,并且没有特定的检查方法,所以POEMS综合征早期容易漏诊或误诊。该病发病机制尚不清,可能与细胞因子失衡相关。

一例POEMS综合征报道及分析

目的通过展示1例临床罕见病的诊断过程,体现检验医师在疾病诊断中的重要作用。方法结合病史及实验室检查、影像学检查及病理学检查多种手段对该病例进行剖析,辅助诊断。结果该病例最后被诊断为POEMS综合征。结论检验报告包含重要的临床信息,检验医师审核报告时应紧密结合临床,积极参与临床诊疗。

变异型POEMS综合征1例并文献复习

POEMS综合征是一种罕见的综合征,1980年由Bardwick及其同事首次提出。近期,青海大学附属医院血液科诊断变异型POEMS综合征1例,现报告如下1病例资料患者,男,53岁,于1年前无明显诱因发现双侧乳房大小略增,体毛增多变硬,性功能减退.

不典型POEMS综合征1例报告并文献复习

POEMS综合征是一种罕见的由单克隆浆细胞异常增殖导致的副肿瘤综合征,主要表现为脱髓鞘性周围神经病及多系统受累。Bardwick等于1980年根据该疾病主要症状的首字母:多发性神经病、脏器肿大、内分泌异常、M蛋白、皮肤改变,提出了POEMS综合征的命名方式[1-2]。日本在2003年的全国范围调查,其发病率大约为0.3/100000[3]。其发病率低,已被列入我国首批罕见病目录。由于其罕见性、多系统受累和临床高度异质性,有着较高的误诊率和漏诊率,从发病至诊断中位时间约为12个月[4-5]。POEMS综合征患者临床症状不典型国内少有相关文献报道,本研究报道1例POEMS综合征患者资料(患者及家属表示知情同意),同时对该病文献进行复习学习,以期为POEMS综合征患者的治疗提供临床指导和参考。

达雷妥尤单抗联合方案治疗POEMS综合征1例并文献复习

POEMS(polyneuropathy,organomegaly,endocrinopathy,M-protein and skin changes)综合征是一种单克隆浆细胞异常增殖的副肿瘤综合征,患病率约为0.3/10万[1]。该病累积神经、内分泌、骨骼、免疫及造血等系统,临床上诊断需要2个基本要素:多发性周围神经病和单克隆浆细胞病[2]。周围神经病变是超过60%的POEMS综合征患者的首发症状,不少患者早期就诊于神经内科并被误诊为慢性炎性脱髓鞘性多发性神经根神经病(chronic inflammatory demyelinating polyneuropathy,CIDP)等原发性神经系统疾病[3]。由于神经病变进展缓慢、致残率高,多数患者就诊时症状严重且已造成神经不可逆性损伤,给患者生活带来极大不便,因此早识别、早诊断、及时治疗至关重要。本文报告1例采用达雷妥尤单抗(Daratumumab,Dara)联合方案治疗伴有严重周围神经病变的POEMS综合征,分析了神经病变的发病机制,并强调了POEMS综合征诊断的复杂性以及Daratumumab作为新一代药物在治疗中的潜在优势。

UpToDate临床顾问在疑难病诊断中的应用--以POEMS综合征为例

以一例POEMS综合征为例,展示如何使用UpToDate临床顾问辅助疑难病的诊断。详细描述一位54岁女性患者的临床资料、检查结果和治疗过程,根据病例特点,借助UpToDate临床顾问梳理包括糖尿病性多发性神经病的筛查、库欣综合征确诊、低促性腺激素性性腺功能减退症病因、慢性炎症性脱髓鞘性多发性神经病的诊断等专业知识和临床诊断思路,在多学科合作基础上,逐渐明晰诊断证据,并通过UpToDate临床顾问和PubMed数据库的互补合用,实现对临床病情全面解读。

以肾上腺功能减退为首发表现的POEMS综合征1例报道并文献复习

老年男性患者,无明显诱因出现乏力、纳差,并进行性加重,伴双下肢水肿,入院检查存在多发性神经病,缺乏单克隆浆细胞证据,存在Castleman病及VEGF升高,有淋巴结增大、皮肤色素沉积、浆膜腔积液及肾上腺皮质功能减退,可诊断为变异型POEMS综合征。这个患者以肾上腺皮质功能减退为首发及突出表现,较少见,故对POEMS综合征的内分泌病变发病机制进行文献复习。

POEMS综合征1例报道并文献复习

目的对POEMS综合征的临床特征及治疗进行总结,以提高临床对该病的诊疗能力。方法对广东医科大学附属医院收治的1例POEMS综合征患者的临床表现、相关辅助检查结合既往文献复习进行分析。结果本例患者以四肢麻木、无力起病,逐渐出现肢体水肿、器官肿大、皮肤色素沉着等症状,曾查M蛋白阴性,历时5 a方确诊。结论POEMS综合征临床表现多样,早期极易误诊,临床应提高对该病的认识,从而降低误诊率及漏诊率。

A Study on the Symbol-Based Narrative in the International Communication of Cities

Cultural symbols,a manifestation of cities’cultural resources,are not only signs that frame concepts but also forms that express meanings.Exploring the international communication of cities from the perspective of symbols,this paper analyzes in depth how cities create their cultural symbols in the dynamic process of international communication in an era of symbol-based digital media,and how they develop their narratives and explain meanings through the dissemination of symbols when telling their stories to international audiences,thus enhancing the efficiency and effectiveness of their international communication efforts.

Nursing effect of narrative nursing intervention on postoperative patients with severe lung cancer

BACKGROUND Lung cancer is a common disease with high mortality,and psychological support is very important in the diagnosis and treatment of postoperative patients with cancer pain.AIM To explore the application effect of the narrative nursing method in postoperative lung cancer patients in the intensive care unit.METHODS A total of 120 patients diagnosed with lung cancer and experiencing cancer-related pain were randomly allocated into two groups:an observation group and a control group,each consisting of 60 cases.The control group was given routine analgesic and psychological care,while the research group applied the five-step narrative nursing method based on routine care,comparing the visual analogue scale scores,sleep status,anxiety and depression status,and quality of life of the two groups of patients before and after the intervention.RESULTS The pain scores,anxiety scores,and depression scores of the study group were lower than those of the control group after the intervention using the narrative nursing method,and the difference was statistically significant(P<0.05).CONCLUSION Using narrative nursing methods to intervene in patients with lung cancer combined with cancerous pain can help patients to correctly recognize their disease,adjust their mentality,establish confidence,alleviate patients'subjective pain feelings,and improve their adverse emotions.

^(18)F-FDG PET/CT显像及血管内皮生长因子对POEMS综合征放化疗联合自体干细胞移植的疗效

目的探讨^(18)F-FDG PET/CT显像、血管内皮生长因子(VEGF)在POEMS综合征放化疗联合自体干细胞移植治疗中的价值。方法回顾性分析2012年6月~2022年12月本院123例临床高度怀疑POEMS综合征患者临床及影像资料,最终纳入25例患者,经临床及病理确诊POEMS综合征21例,惰性淋巴瘤1例,多发性骨髓瘤3例。21例POEMS综合征患者分为单纯放化疗组(n=12)和放化疗联合自体干细胞移植治疗组(n=9),分析两组患者PET/CT影像特点、最大标准化摄取值(SUV_(max))、VEGF、白细胞介素6(IL-6)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)水平,随访观察两组患者的治疗效果。结果21例POEMS综合征患者均伴有不同程度的多发性神经病变与单克隆浆细胞增殖性改变,皮肤病变10例。^(18)F-FDG PET/CT显像21例患者94个部位形态或代谢异常,SUV_(max)与VEGF水平呈正相关性(r=0.590,P=0.005),而SUV_(max)与FT3、FT4、TSH、IL-6水平均无相关性(P>0.05)。随访55.5±17.6月,治疗后VEGF水平较治疗前基线水平降低(1670.7±309.1 pg/mL vs2051.0±458.8 pg/mL,P<0.05);放化疗联合自体干细胞治疗组中位生存期与单纯放化疗组的差异无统计学意义(P=0.612)。结论PET/CT显像联合血清VEGF水平检测可作为POEMS综合征诊断、活动度监测及预后评估的无创方法,自体干细胞联合放化疗未明显延长POEMS综合征的中位生存期。

An Exploration of Traditional Chinese Cultural Programs:The Construction of Rituals,Narrative Strategies,and Experiential Insights

In the context of the cultural development of the new era and the burgeoning spiritual demands of the people,there has been a remarkable surge in the proliferation of traditional Chinese cultural programs.The“Chinese Festivals”series,produced by Henan TV,standing out as an engaging TV program that showcases traditional Chinese culture,has rapidly captivated a diverse audience across different age groups,creating a rich,multi-dimensional,and cross-media cultural communication ecosystem.The program strategically selects symbolic elements by systematically categorizing and organizing traditional Chinese cultural symbols to create a rich cultural space.It employs cutting-edge scientific and technological methods to enrich viewer immersion,crafting media rituals with both temporal significance and a profound sense of media ritual.This approach boosts the program’s popularity and sets a benchmark for industry innovation.By fostering an interactive narrative between mainstream media and the public,the program continuously broadens the scope of the“story world,”fostering a harmonious and structured national cultural community through the creative interpretation of traditional Chinese culture and the evocative crafting of the aesthetic sensibilities inherent in Chinese art.It is worth noting that the phenomenon of aesthetic fatigue besets the development of this serial program.To address this issue and further improve the appeal of the program,a comprehensive approach is required to develop a cohesive narrative mode for the“story world.”This involves harmonizing the interplay between artistic endeavors and technological advancements,synchronizing sensory experiences with the foundational ritualistic elements,and enhancing the effectiveness of the media communication matrix to construct a brand of media culture that has social significance,aesthetic value,and economic profits in the new era.

A Preliminary Exploration of Zong Baihua’s Aesthetic Character and the Creative Philosophy of Small Poems

Zong Baihua’s aesthetic character and the creative philosophy of small poems are integrated and intertwined with each other,with distinctive aesthetic characteristics and unique artistic concepts.Whether it is his“rounded and integrated aesthetics centered on Chinese art”,“vivid and charming natural cosmology”,or“personality aesthetics that mutually mirrors with the nature universe”,they all have extraordinary inspirations and guidance for us today to explore the reform of new literature and art,the reform of new poems,and even the contemplation of the cosmos,society,and life,with positive and profound significance.

The Exploration of Teaching Historical Narratives Through Edith Wharton’s The Age of Innocence

Wharton’s novels serve as compelling cases for understanding the complexities of late 19th-century American society.The paper uses The Age of Innocence as an example to examine detailed depiction of the era’s social hierarchy,fashion,architecture,and the intricate social rituals that defined New York’s upper class.It explores the constraints and dilemmas women faced within a patriarchal society,highlighting Wharton’s personal experiences and her critical stance on the social norms of her time.The characters of Newland Archer,May Welland,and Ellen Olenska are analyzed to reveal the pressures of societal expectations and the struggles for individual desires within a rigid social structure.Additionally,the paper proposes various teaching methods,including contextual understanding,literary analysis with a historical focus,and historical research projects,to enhance students’comprehension of the cultural and historical context of the novel.These methods aim to immerse students in the narrative and promote their understanding of the Gilded Age’s social dynamics.

Analysis of the Characterization of the Old Man in“The Law of Life”from the Narrative Perspective

“The Law of Life”is one of Jack London’s representative works,depicting the story of an elderly Native American abandoned by his family,alone and waiting for life to fade away.This paper,based on narrative theory,aims to explore how the author employs narrative techniques to present the image of the old man in the short story.The narrative techniques of dual focalization and dual narrative timelines in the text demonstrate the abandonment of the old man’s homeland and his inescapable death under a naturalistic view of life and reflect a desolate life picture of resignation towards death under naturalistic determinism,depicting a grim elderly world under the naturalistic concept of“survival of the fittest.”Studying this short story helps us reflect on the living conditions of the elderly and provides insights into how to better care for the elderly population amid the global trend of aging.

Narrative Empathy and Patriotism--An Analysis of the Chinese“Main-Melody”Film My People,My Country

Narrative empathy is a relatively new theory and it can guide researchers in the studies of main-melody films so as to promote the communication of the core values of the society.The rhetorical mechanism of narrative empathy can be illustrated from five rhetorical elements,including rhetor,rhetorical goal,rhetorical situation,rhetorical strategy and audience.The theory of narrative empathy can be applied to the case study of the film My People,My Country.In the production of this film,the directors are the rhetors.The rhetors uphold the tenet of closeness,choose the right rhetorical situation as the 70th birthday of the People’s Republic of China,and use appropriate rhetorical strategies in order to realize the rhetorical goals of evoking empathy and inspiring patriotic feelings in the audience’s minds.An exploration and application of narrative empathy can be conducive to the empathic communication of Chinese main-melody films in order to achieve better communication effect.

Writing the Silenced Female Body, Scrutinizing the Grand Narrative of Colonization and Decolonization: The Body in Zoë Wicomb’s David’s Story

David’s Story by Zoë Wicomb addresses the complexities of representing female suffering and the limitations of traditional historical narratives in capturing the experiences of marginalized bodies.It challenges the grand narratives of national history by emphasizing the indispensable role of women’s experiences.Through characters like Dulcie and Rachael,Wicomb portrays the female body as a site of resistance and resilience,highlighting the need for more nuanced and inclusive ways of documenting history.Underscoring the inexpressibility of trauma and the limitations of language and representation,the novel self-reflexively acknowledges its own aporia of completing the narrative,embodying the ongoing struggle to capture the full breadth of human experience.

The “Panchatantra” Narrative Structure and the Writing of Indian Women’s Dilemma in Suraj Ka Satvan Ghoda

Dharamvir Bharati’s Suraj Ka Satvan Ghoda connects the text with the social reality,through the multiple narrative perspectives of the“Panchatantra”Narrative Structure and the love stories,and narrates the survival and spiritual dilemma of Indian women in the transformation of India’s modernization.The novel depicts in both content and form the plight of Indian women’s physical and spiritual dependence under the traditional concepts of arranged marriages,caste marriages,dowry system and patriarchal will,and shows the process of women’s body and self-consciousness gradually moving from vitality to extinction.

Experiencing the Abject Female Body and Writing the Female Self:Body Narrative of In the Heart of the Country

In the Heart of the Country,the second novel by J.M.Coetzee,has been traditionally read as a disembodied writing that focuses on the problem of writing per se instead of the reality.This paper contends that the work is actually a body narrative that explores the visceral pain suffered by Magda whose infertile body impedes her being a qualified subject.As the heroine in a postcolonial novel,Magda is not just a body that is restricted and constructed by the politics of the body,but also a thinking and writing body that consciously questions and resists the gendered bodily norms under whose yardstick her subjecthood is barred.Written in the metafictional manner,Magda’s narrative of the body is not just a record of her corporeal experience,but also a self-conscious negotiation with,and challenge of,the bodily norms under whose yardstick her body has been debased or,in terms of Judith Butler,abjected.Taking her female bodily experience as the starting point,Magda writes a feminine text that values passion,fluidity and non-linearity to disrupt the patriarchal discourse underpinned with logical reasoning.The feminine body narrative endeavors to achieve a new way of communication through which a reciprocal cross race/gender relationship might be established.

Research on Narrative Design of Creative Products Based on Regional Cultural Elements

The research explored the ways and means of narrative design in which regional cultural elements are integrated into cultural and creative products.It also researched a new way of thinking and methods of creative product design based on regional cultural elements in order to satisfy consumers’emotional and cultural experiences.Narrative theory takes the perspective of narrative expression in the design of cultural and creative products.The regional cultural elements were used for better interactive communication with consumers in the form of cultural and creative products.In the narrative of cultural and creative product design,intervening in the development of regional cultural and creative design from the perspective of narratology can better exert and create the cultural value of the region itself,with cultural and creative products playing an important role in“local cultural stories.”This research adopted a qualitative approach and provided ideas and guidance for the narrative design and expression of regional cultural elements in creative products through comparative analysis of case studies.The research highlighted the role of narrative design in creating multi-layered experiences,weaving regional cultural stories into products,and the importance of deep understanding and effective use of regional cultural elements in design.