Avoiding misdiagnosis of multilocular thymic cysts as malignant tumors on computer tomography

This editorial provides insights from a case report by Sun et al published in the World Journal of Clinical Cases.The case report focuses on a case where a multilocular thymic cyst(MTC)was misdiagnosed as a thymic tumor,resulting in an unnecessary surgical procedure.Both MTCs and thymic tumors are rare conditions that heavily rely on radiological imaging for accurate diagnosis.However,the similarity in their imaging presentations can lead to misinterpretation,resulting in unnecessary surgical procedures.Due to the ongoing lack of comprehensive knowledge about MTCs and thymic tumors,we offer a summary of diagnostic techniques documented in recent literature and examine potential causes of misdiagnosis.When computer tomography(CT)values surpass 20 Hounsfield units and display comparable morphology,there is a risk of misdiagnosing MTCs as thymic tumors.Employing various differential diagnostic methods like biopsy,molecular biology,multi-slice CT,CT functional imaging,positron emission tomography/CT molecular functional imaging,magnetic resonance imaging and radiomics,proves advantageous in reducing clinical misdiagnosis.A deeper understanding of these conditions requires increased attention and exploration by healthcare providers.Moreover,the continued advancement and utilization of various diagnostic methods are expected to enhance precise diagnoses,provide appropriate treatment options,and improve the quality of life for patients with thymic tumors and MTCs in the future.continued advancement and utilization of various diagnostic methods are expected to enhance precise diagnoses,provide appropriate treatment options,and improve the quality of life for patients with thymic tumors and MTCs in the future.

Analyze interleukin-1β,interleukin-6,and tumor necrosis factor-αlevels in dry eye and the therapeutic effect of cyclosporine A

BACKGROUND Dry eye is a common eye disease.Artificial tears supplements are widely used for the treatment of dry eyes.However,multiple adverse effects have been observed in patients receiving long-term treatment with artificial tears,which may affect the therapeutic effect.AIM To analyze the characteristics of interleukin-1β(IL-1β),interleukin-6(IL-6),and tumor necrosis factor-alpha(TNF-α)levels in patients with dry eye and the therapeutic effect of artificial tears combined with cyclosporine A.METHODS A total of 124 dry eye patients treated at The First People’s Hospital of Xining from April 2020 to April 2022 were selected as the observation group,while 20 healthy individuals served as the control group during the same period.Levels of inflammatory markers,including IL-1β,IL-6,and TNF-α,were analyzed.The observation group was further divided into a study group and a control group,each consisting of 62 patients.The control group received artificial tears,whereas the study group received a combination of artificial tears and cyclosporine A.Inflammatory markers,Schirmer’s test(SIT),tear break-up time(TBUT),corneal fluorescein staining(CFS),National Eye Institute Visual Function Questionnaire-25(NEI-VFQ-25)scores,and adverse events(AEs)were compared between the two groups.RESULTS The observation group exhibited significantly elevated serum levels of IL-1β,IL-6,and TNF-αin comparison to the healthy group.Following treatment,the study group demonstrated substantial reductions in IL-1β,IL-6,and TNF-αlevels relative to the control group.Moreover,after treatment,the study group experienced a marked decrease in CFS scores and significant increases in both SIT and BUT levels when compared to the control group.Additionally,significant improvements were observed in the primary symptom of dry eye and secondary symptoms such as photophobia,foreign body sensation,fatigue,red eye,and burning sensation within the study group.Furthermore,post-treatment NEI-VFQ-25 scores across all dimensions exhibited significant enhancements in the study group compared to the control group(P<0.05).It is noteworthy that significant AEs were reported in both groups throughout the treatment period.CONCLUSION Cyclosporine A combined with artificial tears is effective in treating dry eye,yielding enhanced outcomes by improving SIT and TBUT levels,reducing CFS scores,and ameliorating vision-related quality of life.

Fine needle aspiration analysis of misdiagnosis of 2 cases with skin singular leiomyoma

This article reported that 2 cases with skin singular leiomyoma confirmed by pathology were misdiagnosed by fine needle aspiration biopsy, and the combination analysis of clinical history and pathological features of cells was as follows.

超声误诊为乳腺癌临床特征与风险预测模型构建

目的分析超声误诊为乳腺癌临床特征,并构建误诊风险预测模型。方法选取2021年1月至2023年12月行超声检查的乳腺肿块患者602例,按照误诊情况分为误诊组和诊断准确组,分析超声误诊为乳腺癌病例特征,并构建误诊风险预测模型。结果共有30例误诊为乳腺癌,误诊率为4.98%。诊断准确组与误诊组在病灶最大径、触诊、合并良性病灶、合并炎性病变、超声图像边缘、血流信号明显、腋下淋巴结回声、微钙化、病灶结构复杂多样方面比较差异有统计学意义(P<0.01)。经二元Logistic回归分析显示,病灶最大径(≥5 cm)、合并良性病灶、合并炎性病变、超声图像边缘(模糊)、血流信号明显、腋下淋巴结回声、微钙化、病灶结构复杂多样是超声误诊为乳腺癌的危险因素(P<0.05,P<0.01)。超声误诊为乳腺癌风险预测模型:2.623×病灶最大径(≥5 cm)+1.422×合并良性病灶+1.616×合并炎性病变+1.574×超声图像边缘(模糊)+1.134×血流信号明显+1.518×腋下淋巴结回声+2.027×微钙化+1.541×病灶结构复杂多样。Hosmer-Lemeshow拟合度检验显示,该模型拟合优度较好(χ^(2)=3.487,P=0.900);受试者工作特征曲线分析显示,预测模型预测超声误诊为乳腺癌风险的曲线下面积为0.921,约登指数为0.698,敏感度、特异度分别为83.3%、86.5%,95%CI为0.872,0.969,实际应用准确性为96.2%(579/602)。结论超声误诊为乳腺癌和多种因素有关,基于病灶最大径、合并良性病灶、合并炎性病变、超声图像边缘模糊、血流信号明显、腋下淋巴结回声、微钙化和病灶结构复杂多样危险因子构建的超声误诊为乳腺癌风险预测模型预测准确性较好。

胰腺浆液性囊腺瘤误诊病例的MSCT影像特征与病理分析

目的探讨胰腺浆液性囊腺瘤(PSC)的影像特征及病理基础,分析误诊原因,总结防范措施。方法回顾性分析2017—2023年经手术病理证实为PSC且术前多层螺旋CT误诊为其他病变22例的临床资料及CT影像特征,并与病理HE染色对照分析。结果本组22例中因腹痛就诊7例,恶心呕吐就诊1例,其余14例均为体检发现,其中微囊型10例,大囊型8例,混合型3例,实质型1例;8例位于胰腺头颈部,14例位于体尾部;分叶状13例,中央瘢痕2例,钙化5例,上游胰管扩张5例;增强后明显强化3例,中度强化5例,轻度强化6例,无强化8例。13例PSC呈分叶状轮廓、边界清晰、呈蜂窝或多囊状结构、与胰管不相通,2例PSC可见内部纤维瘢痕,5例可见钙化等特征性影像表现。误诊为黏液性囊腺瘤和神经内分泌瘤各5例,实性假乳头状瘤4例,未定性3例,假性囊肿2例,潴留囊肿、胰腺导管内乳头状瘤、胰腺癌各1例。误诊时间7~180 d。均手术治疗并经术后病理学检查确诊。随访均无复发。结论不同类型PSC影像表现存在一定差异,但同时存在一些共同影像特征,对于非典型病例,CT诊断困难,误诊率高,需提高对于本病的认知,同时密切结合临床病史,可提高其诊断准确率。

肾脏嗜酸细胞腺瘤影像学误诊分析

目的探讨肾脏嗜酸细胞腺瘤(RO)的临床特点、影像学表现,总结其误诊原因及防范措施。方法回顾性分析2例术前曾误诊的RO临床及影像学资料。结果2例均为女性,年龄分别为45岁、67岁,皆因体检发现肾脏占位性病变,术前均行肾脏超声及增强CT检查,病灶位于左、右肾各1例,呈类圆形,边界清晰,凸向肾外,超声检查1例呈稍高回声,1例呈囊实性混合回声,2例彩色多普勒血流成像均于肿瘤内及周边见血流信号;CT平扫2例均为稍低密度,增强扫描1例明显强化,1例轻度强化,强化呈“快进慢出”方式,2例均无静脉瘤栓,肾门旁及腹膜后无增大淋巴结。术前误诊为肾嫌色细胞癌、肾透明细胞癌各1例。误诊时间2~5 d。1例行根治性右肾切除术,1例行左肾部分切除术,术后病理检查确诊为RO,2例随访至今均未见复发或转移。结论RO较少见,临床表现缺乏特异性,影像学表现与肾癌存在较多重叠,术前易误诊。遇到边界清楚的圆形或类圆形肾脏孤立性肿物患者,当肿物呈“快进慢出”强化方式,尤其当肿瘤出现延迟强化的星芒状中央瘢痕及“节段增强反转”等特征时应高度怀疑本病可能。

原发于宫角的子宫内膜癌临床误诊原因探讨

目的探讨原发于宫角的子宫内膜癌误诊为子宫肌瘤变性的原因及防范误诊措施,以降低误诊率。方法回顾分析2022年3月收治原发于宫角的子宫内膜癌误诊子宫肌瘤变性1例临床资料。结果本例因绝经3年、左下腹痛半年就诊,彩超提示左宫角囊实性占位性病变(子宫肌瘤变性?),查癌抗原125和癌胚抗原正常。后行宫腔刮出物病理学检查考虑子宫内膜样腺癌,手术病理示左宫角子宫内膜样腺癌Ⅲ级伴部分梭形细胞分化,结合免疫组化结果诊断为子宫内膜样腺癌Ⅲ期。误诊时间6 d。给予手术治疗,术后予紫杉醇联合卡铂化疗2个疗程,患者一般状态尚可,未见复发或转移,尚在随访中。结论原发于宫角的子宫内膜癌临床症状及影像学表现不典型,早期容易误诊为子宫肌瘤变性等疾病。对于绝经期宫角占位性病变者应考虑到多种疾病的可能,结合患者病史(包括现病史、既往史)、实验室检查、影像学检查及病理检查有助于降低误诊率。

Rare esophageal carcinoma-primary adenoid cystic carcinoma of the esophagus: A case report

BACKGROUND Esophageal adenoid cystic carcinoma(EACC)is an exceedingly rare malignant tumor of the esophagus,posing significant challenges in the clinic.CASE SUMMARY This report detailed the case of a 72-year-old male whose diagnosis of EACC was confirmed through postoperative histopathological examination.The patient underwent thoracoscopy-assisted radical resection of the esophageal tumor,coupled with lymph node dissection.Pathological findings revealed an adenoid cystic carcinoma infiltrating the entire layer of the muscularis propria,locally extending into the outer membrane of the esophageal fiber,involving the cardia and exhibiting no lymph node metastasis.The patient’s condition was classified as primary EACC,T3N0M0,per the American Joint Committee on Cancer(2017;8th edition).One month after surgery,the patient received postoperative adjuvant radiation therapy.CONCLUSION In addressing the rarity and high potential for biopsy misdiagnosis of EACC,this study delved into its diagnostic methods and treatment.

Trousseau综合征相关性脑梗死的临床特征及误诊分析

目的分析Trousseau综合征(TS)相关性脑梗死的临床特点、实验室检查及MRI特征,以提高TS相关性脑梗死的诊治水平。方法收集2018年11月至2023年6月48例TS相关性脑梗死患者临床资料,分析其临床特点及MRI表现,探讨实验室检查及MRI特征在诊断TS相关性脑梗死的应用价值。结果48例TS相关性脑梗死患者中男25例,女23例,年龄40~78岁,肿瘤类型前三位依次是胃癌10例(20.83%),肺癌9例(18.75%),结肠癌7例(14.58%),所有患者均有不同程度的D-二聚体(D-D)升高,48例头部MRI均属于多个血管分布区、大小不等的病灶混合,可有不同期相的混合,颅脑磁共振血管成像梗死灶与供血血管狭窄不匹配。与非误诊组比较,误诊组存在较多的传统脑血管病危险因素及DWI单个病灶数,误诊组累及血管数量、存在多时期发作的急性缺血病灶相对较少(P<0.05)。结论MRI图像显示多血管区域梗死和/或不同脑梗死病灶阶段并存及血浆D-D水平明显增高,对早期发现TS相关性脑梗死可能有一定的作用。

中耳神经源性肿瘤8例的诊治体会

目的 探讨中耳神经源性肿瘤的临床特征、诊治方法及预后。方法 回顾性分析2010年1月—2023年3月收治的8例经病理确诊为中耳神经源性肿瘤患者的临床资料。8例患者首发症状中以耳流脓为主4例,听力下降3例,面瘫1例。5例肿物突入外耳道,3例鼓膜紧张部穿孔。纯音测听示8例患者均伴有不同程度的听力下降,其中混合性聋4例、传导性聋3例、极重度感音神经性聋1例。结果 所有患者均完善中耳CT及MRI,提示肿瘤累及中鼓室或鼓岬表面5例,累及面神经水平段3例,其中1例侵入中颅窝。8例患者均行乳突改良根治术,术后病理证实鼓室体副神经节瘤4例、面神经纤维瘤2例、面神经鞘膜瘤1例、中耳神经内分泌腺瘤1例;2例患者术前行活检分别诊断为中耳胆脂瘤和慢性化脓性中耳炎,术前病理误诊率为25%(2/8)。术后随访1个月至8年,目前尚无复发病例。结论 中耳神经源性肿瘤发病率较低且临床表现各异,存在一定的误诊率,术前完善CT和增强MRI检查以及术后病理及免疫组化有助于明确诊断。手术是治疗该病的有效手段。

乳腺淋巴瘤误诊乳腺癌超声表现及影响因素分析

目的探究乳腺淋巴瘤误诊乳腺癌的超声表现及误诊原因。方法选择2018年6月至2023年6月经手术病理确诊的乳腺淋巴瘤患者60例为研究对象,据术前超声诊断和手术病理结果分为正确诊断组32例和乳腺癌组28例,分析2组患者临床资料、超声影像特征、超声血流参数。采用多因素Logistic回归分析乳腺淋巴瘤误诊乳腺癌的影响因素。构建结构方程模型并验证,分析各因素对乳腺淋巴瘤误诊乳腺癌的影响及路径。构建乳腺淋巴瘤误诊乳腺癌的列线图预测模型并验证。结果2组肿块大小、肿块纵横比、肿瘤形态、肿瘤边界、后方回声、毛刺征、钙化灶比较差异均有统计学意义(P<0.05,P<0.01)。多因素Logistic回归分析结果显示:肿块纵横比、肿瘤形态、肿瘤边界、后方回声、毛刺征是乳腺淋巴瘤误诊乳腺癌独立影响因素(P<0.05,P<0.01)。结构方程模型各项指标均符合要求,模型拟合较好,各变量间的独立性较高,区分度较好,肿块纵横比>1、肿瘤形态不规则、肿瘤边界不清晰、毛刺征、后方回声衰减对乳腺淋巴瘤误诊乳腺癌有着显著的正向影响。构建列线图模型预测乳腺淋巴瘤误诊乳腺癌的风险,验证前后曲线下面积分别为0.925(95%CI:0.578,0.976)和0.912(95%CI:0.841,0.967),校准曲线平均绝对误差为0.014。结论乳腺淋巴瘤误诊乳腺癌患者超声检查显示肿块多≤2 cm,肿块纵横比多>1,肿瘤形态多不规则,肿瘤边界多不清晰,内部回声多为低/混合回声,后方回声多衰减,多为富血供,多出现毛刺征、钙化灶及皮肤橘皮样改变。肿块纵横比、肿瘤形态、肿瘤边界、后方回声、毛刺征是乳腺淋巴瘤误诊乳腺癌独立影响因素。肿块纵横比>1、肿瘤形态不规则、肿瘤边界不清晰、毛刺征、后方回声衰减对乳腺淋巴瘤误诊乳腺癌有着显著正向影响。

女性盆腔非生殖系统肿物超声误诊分析

目的探讨女性盆腔非生殖系统肿物患者的超声特征、误诊原因及防范误诊措施,以提高超声检查对女性盆腔非生殖系统肿物诊断的准确率,减少临床误诊误治的发生。方法对2020年4月至2023年5月收治的12例女性盆腔非生殖系统肿物超声误诊患者资料进行回顾分析。结果12例中以恶心、呕吐、腹胀、突发性右下腹痛为主要表现就诊1例,以发热、消瘦为主要表现就诊4例,以腰背痛、下肢麻木疼痛为主要表现就诊4例,以不规则阴道出血、发热、乏力、食欲缺乏、体质量减轻为主要表现就诊3例。行超声检查后初步诊断卵巢囊肿恶性变3例,后经病理检查诊断为子宫血管平滑肌脂肪瘤;初步诊断女性生殖系统肿瘤1例,后经病理检查诊断为阑尾低级别黏液性囊腺癌;初步诊断为子宫内膜异位囊肿4例,后经病理检查诊断为腹膜后神经鞘膜瘤囊性变;初步诊断卵巢癌4例,后经病理检查诊断为盆腔结核。3例子宫血管平滑肌脂肪瘤确诊后行肿瘤切除术治疗,1例阑尾低级别黏液性囊腺癌确诊后行阑尾切除术治疗,4例腹膜后神经鞘膜瘤囊性变确诊后行完全性手术切除,4例盆腔结核确诊后予足疗程、规范抗结核药物治疗。随访至今,患者病情稳定,未复发。结论女性盆腔非生殖系统肿物来源复杂,超声声像图表现多样且常不典型,超声医师应注意结合临床及其他影像学检查结果,并对盆腔肿物全面扫查及观察细节,仔细判断肿物的来源及良恶性,最后通过病理检查明确诊断。

IgG4相关性硬化性胆管炎误诊为肝门部胆管癌原因分析

目的探讨IgG4相关性硬化性胆管炎(IgG4-SC)的临床特点、分型、临床表现、诊治要点及误诊为肝门部胆管癌(HCCA)的原因,并且总结防范误诊措施。方法回顾分析2021年3月—2022年6月收治的IgG4-SC误诊HCCA的2例病例资料。结果2例均为中老年男性,分别以皮肤、巩膜黄染伴皮肤瘙痒,上腹痛、食欲不振、黄疸为主要表现就诊,体质量减轻,查血肝功能、部分肿瘤标志物异常,影像学检查示肝门部梗阻征象,提示占位性病变,初步诊断为HCCA,行手术治疗。手术病理检查均未发现肿瘤细胞,均见胆管壁大量浆细胞和淋巴细胞浸润,完善IgG4检查均升高(分别为14.3 g/L、141.6 g/L),修正诊断为IgG4-SC。确诊后均予甲泼尼龙静脉冲击治疗,待黄疸症状消失,复查肝功能基本恢复正常后出院,院外均予泼尼松片口服并逐渐减量至维持剂量长期维持治疗,随访至今均无复发,血清IgG4均处于正常水平。结论IgG4-SC临床少见,临床表现与HCCA有相似之处,鉴别诊断较为困难,容易误诊;临床医生应加强对IgG4-SC临床特点、表现、诊断及鉴别诊断相关知识的学习,扩展诊断思维,全面分析病情,及时行血清IgG4检测、糖皮质激素试验性治疗,必要时可行组织病理学检查,以减少临床误诊误治的发生。

原发性中枢神经系统淋巴瘤MRI影像特征及误诊分析

目的探讨原发性中枢神经系统淋巴瘤(PCNSL)的磁共振成像(MRI)影像特征及误诊原因。方法选取2020年7月至2023年2月20例PCNSL患者,其中10例误诊,通过分析误诊、未误诊患者的MRI影像学资料,探讨PCNSL患者易误诊的影像学原因。结果本组头痛15例、肢体无力11例、视力视野受损7例、头晕6例。20例共检出30个病灶,位于浅部脑组织19个,深部脑组织7个,脑室内4个;单发病灶14例,多发病灶6例;合并坏死6例。10例首诊误诊者纳入误诊组,误诊为转移瘤5例、脑胶质瘤5例。误诊时间10 d~2个月。诊断正确组和误诊组在多发病灶、出血、合并坏死方面比较差异有统计学意义(P<0.05)。后经立体定向活检手术对MRI增强扫描明显增强部位取材行病理检查后,确诊弥漫大B细胞型淋巴瘤,予大剂量甲氨蝶呤联合放疗。随访1年,病情稳定,无死亡病例。结论接诊PCNSL患者时,当MRI增强扫描未发现典型征象时,易误诊颅内其他疾病;颅内占位性多发病灶、出血、合并坏死是PCNSL影像学误诊的因素,仔细观察、认真鉴别,必要时多学科协作会诊并及早行手术病理检查有利于降低误诊率。

早期卵巢癌经阴道彩色多普勒超声误诊患者特征及潜在因素分析

目的分析早期卵巢癌经阴道彩色多普勒超声(TVCDS)误诊患者特征及潜在因素。方法回顾性选择2021年1月至2024年1月收治的160例疑似早期卵巢癌患者,术前行TVCDS,术后行病理学检查。根据术后病理学检查结果分为假阴性组与假阳性组,分析误诊患者特征。采用多因素Logistic回归分析早期卵巢癌诊断的影响因素。行潜在类别分析(LCA)比较影响因素分布特征差异。结果TVCDS发现卵巢癌阳性与阴性分别为127例、33例,病理学检查显示阳性与阴性分别为131例、29例,TVCDS与病理学检查阳性相符者104例,阴性相符者6例,假阳性23例,假阴性27例,共误诊50例。16例误诊为卵巢囊肿,11例误诊为子宫腺肌症,23例子宫内膜异位症误诊为卵巢癌。淋巴结转移、血流情况、包膜完整性、腹腔积液是早期卵巢癌诊断的影响因素(P<0.01)。LCA表明上述因素对早期卵巢癌误诊的影响具有异质性。结论早期卵巢癌特征不明显,易与卵巢囊肿、子宫内膜异位症等混淆,造成TVCDS误诊。淋巴结转移、血流情况、包膜完整性、腹腔积液是早期卵巢癌诊断的影响因素。

A CLINICAL ANALYSIS OF 38 PATIENTS WITH PRIMARY TRACHEO BRONCHIAL TUMORS

During a 17-year period, 38 patients with primary tracheobronchial tumors received surgical treatment in PUMC Hospital. Arnong the 38. 12 had low-malignancy tracheal tumors, 11 had benign tracheal tumors, 14 had low malignancy bronchial tumors and 1 had a benign bronchial tumor. Fifteen operations were perforrned on 12 patients with low-malignancy tracheal tumors, including local resection of the tumor and tracheal wall in 4 and curettage of the tumor plus electrical cauterization in 10. Postoperative radiotherapy was used as an adjuvant treatment in 8 patients with adenocystic carcinoma. Eight patients have survived for more than 5 years and 3 patients have survived for longer than 10 years postoperatively. All 11 patients with benign tumors received curettage of the tumor and were followed up for an average of 6. 5 years. Among them, 9 are still alive. Of the 14 patients with low malignancy bronchial tumors, 5 underwent curettage of the tumor plus electrical cauterization through incision of the main bronchus or intermedial bronchus, and 7 underwent lobectomy or pneumonectomy. The authors conclude that the correct diagnosis rate can be increased by enhancing recognition of this disease and applying tracheal tomography and bronchoscopy.

Inflammatory Mechanism of Total Flavonoids of Chrysanthemum and Medicated Serum on Castrated Dry Eye Animal and Cell Models

Objective To observe the effects of total flavonoids of chrysanthemum and medicated serum on the expression of related proteins in the lacrimal tissue and dry-eye cell models of male rabbits with dry eye caused by castration.Methods(1)150 male Japanese rabbits were randomly divided into five groups,with 30 rabbits in each group:normal control group(group A),sham group(group B),model group(group C),androgen control group(group D)and total flavonoids of chrysanthemum treatment group(group E).The androgen deficiency dry-eye model was established by bilateral castration in groups C,D and E.Normal saline was administered to groups A,B and C by gavage;androgen(testosterone propionate)was injected into muscle in group D;and group E was given total flavonoids of chrysanthemum by gavage.All white rabbits were tested the Schirmer I test(SIT)and tear break-up time(BUT).After euthanasia,tear gland tissue was harvested so that we could observe pathological changes in the expression of related inflammatory factors in the lacrimal gland tissue.The expression of interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α)and transforming growth factor-β1(TGF-β1)was detected in the lacrimal gland tissue by immunohistochemistry.Reverse transcription PCR was used to quantitatively detect expression of TGF-β1 mRNA.(2)Male Wistar rat lacrimal epithelial cells were used to establish a model of eye stem cell apoptosis caused by androgen levels.The blank control group was set up without androgen culture,the control group with androgen culture,and the total flavonoids of chrysanthemum group without androgen.The MTT method was used to determine the optimal intervention dosage of drug-containing plasma.Western blot and QPCR were used to detect the expression of AR mRNA,NF-κB phosphorylated protein and TGF-β1 in lacrimal epithelial cells,and the androgen-like effect of total flavonoids of chrysanthemum was observed.Results(1)Immunohistochemistry showed that groups A,B,D and E had significantly lower expression of IL-1βand TNF-αthan group C(P<0.05);among these,group E had slightly higher expression than group D(P>0.05).RT-PCR results showed that the relative expression of TGF-β1 mRNA in groups A,B,D and E was significantly higher than in group C(P<0.05),and the relative expression of TGF-β1 mRNA in groups D and E was higher than that in groups A and B(P<0.05).(2)Using the MTT method,the final concentration of interfering cells was calculated to be 13.2%.The expression of AR protein,NF-κB and TGF-β1 in the chrysanthemum flavonoid plasma intervention and testosterone propionate intervention groups was enhanced,and there were significant differences relative to the blank group(P<0.01).The expression level of NF-κB in the total flavonoid containing plasma intervention group was lower than that in the testosterone propionate intervention group(P<0.01).Conclusions The total flavonoids of chrysanthemum can inhibit IL-1βand TNF-αexpression in the lacrimal gland tissue of castrated male rabbits with dry eye to increase synthesis of TGF-β1 mRNA and TGF-β1,thereby inhibiting the inflammatory response.The medicated plasma with total flavonoids of chrysanthemum promotes expression of AR mRNA,upregulating expression of NF-κB,further promoting upregulation of TGF-β1 protein expression in lacrimal epithelial cells,inhibiting inflammation by regulating related proteins,and ultimately alleviating the symptoms of dry eye.

Topical biological agents targeting cytokines for the treatment of dry eye disease

Because inflammation plays a key role in the pathogenesis of dry eye disease and Sjogren's syndrome, topical anti-inflammatory agents such as corticosteroids and cyclosporine A have been used to treat inflammation of the ocular surface and lacrimal gland. Systemic biological agents that target specific immune molecules or cells such as tumor necrosis factor(TNF)-α, interferone-α, interleukin(IL)-1, IL-6, or B cells have been used in an attempt to treat Sjogren's syndrome. However, the efficacy of systemic biological agents, other than B-cell targeting agents, has not yet been confirmed in Sjogren's syndrome. Several studies have recently evaluated the efficacy of topical administration of biological agents targeting cytokines in the treatment of dry eye disease. Topical blockade of IL-1 by using IL-1 receptor antagonist could ameliorate clinical signs and inflammation of experimental dry eye. Using a mouse model of desiccating stress-induced dry eye, we have demonstrated that topical application of a TNF-α blocking agent, infliximab, could improve tear production and ocular surface irregularity, decrease inflammatory cytokines and Th-1 CD4+ cells on the ocular surface, and increase gobletcell density in the conjunctiva. Although controversy still remains, the use of topical biological agents targeting inflammatory cytokines may be a promising therapy for human dry eye disease.

磷酸盐尿性间叶肿瘤误诊分析(附7例)

目的:分析磷酸盐尿性间叶肿瘤(PMT)误诊原因,明确影像学检查路径。方法:回顾性分析我院2017年7月至2022年3月经病理证实PMT患者临床、影像、病理资料。结合文献复习,总结误诊原因,提出影像学检查路径。结果:7例患者3例男性,4例女性,平均年龄为(50.29±15.66)岁(范围17~69岁)。患者表现为不同程度乏力、骨痛等,均伴随骨折,病程平均(5.00±3.25)年(范围1~12年)。患者术前血磷均减低,术后血磷均升高,6例患者血磷在术后7~15天恢复正常,1例失访。6例患者术前碱性磷酸酶升高,1例正常。肿瘤最大径(2.01±1.32)cm(范围0.8~2.5 cm),2例位于软组织,5例位于骨组织。6例行X线检查,显示全身或局部骨质不同程度骨软化和伴随骨折,3例病灶无法显示。6例CT检查中5例骨组织病灶显示为高密度,1例为软组织密度结节。6例MRI平扫T1WI为低、等信号为主,偶尔见高信号,T2WI混杂高信号,内部或边缘可见低信号区。4例MRI增强检查显示病灶中度至明显强化,强化不均匀。结论:PMT影像表现缺乏特异性,容易被误诊。骨质软化、骨痛、骨折以及低血磷、高碱性磷酸酶患者,需考虑此病。可先行OCT检查发现可疑病灶,再行解剖学检查(X线、CT,MRI)对可疑致病肿瘤进一步诊断和术前定位、评估切缘和治疗随访。

腹膜后肿瘤误诊为卵巢肿瘤的临床分析

目的探讨腹膜后肿瘤误诊为卵巢肿瘤的原因,降低腹膜后肿瘤的误诊率。方法回顾分析2015—2021年收治的误诊为卵巢肿瘤的腹膜后肿瘤14例临床资料。结果本组14例,伴腹胀6例,伴腹痛3例,同时具有腹痛和腹胀症状2例,下肢肿胀1例,伴腰痛1例。术前行妇科彩超检查14例均提示存在盆腔肿物;行癌抗原125(CA125)、CA199、人附睾蛋白4(HE4)检查9例,8例结果在正常范围内;仅行CA125、CA199检查3例,结果均在正常范围;仅行HE4检查1例,HE4升高;均未行CA125、CA199、HE4检查1例。术前均怀疑为卵巢肿瘤,拟行手术治疗。均经术中探查排除卵巢肿瘤,确诊为腹膜后肿瘤,行腹膜后肿物切除术9例,腹膜后肿物部分切除术3例,腹膜后肿物活检术1例,腹膜后肿瘤探查术1例;术后病理诊断为平滑肌瘤3例、肉瘤3例、孤立性纤维性肿瘤2例、神经鞘瘤2例、鳞癌1例、间叶源性良性肿瘤1例、子宫内膜间质肉瘤1例,仅行探查术者考虑肿瘤不除外间质瘤。结论腹膜后肿瘤易误诊为卵巢肿瘤,对附件区触诊不满意,肿物活动度差,CA125、CA199及HE4等卵巢肿瘤标志物无明显升高的患者,应警惕腹膜后肿瘤的可能,尤其是对于妇科彩超提示较大盆腔肿物的绝经后患者,应仔细三合诊查体,分辨肿物与子宫、盆腔壁的关系,完善CT、MRI等检查,提高诊断准确率。