中性粒细胞胞外诱捕网与Virchow′s triad的联系及其在静脉血栓栓塞症中的研究进展

静脉血栓栓塞症(VTE)包含深静脉血栓形成(DVT)与肺血栓栓塞症,是常见的一种心血管疾病。其中,DVT的Virchow三要素包括血管内皮损伤、血液高凝状态和静脉血流滞缓。此外,激活的中性粒细胞释放中性粒细胞外诱捕网(NETs)也参与VTE的发病过程。NETs由解聚的染色质和各种蛋白质组成,它可以参与血管内皮损伤、促进血液达到高凝状态并导致静脉血流滞缓,从而影响VTE的进展。因此,更好地理解NETs在VTE病理生理过程中的作用对于其早期诊断、预防和治疗具有重要意义。

Chiari三联征(Chiari's triad)

指各种原因所致的主动脉食管瘘发病时的一组特异性临床表现，首先是胸痛（一般为胸中部疼痛），随即出现前兆性动脉出血，一段时间间隔后出现致命性大出血，这一时间间隔可以是数小时至数天不等。Dubrueil于1818年第一次描述了主动脉食管瘘这一病症[1]。Chiari于1914年首先描述了主动脉食管瘘三联征并因之得名[2]，当时Chiari的描述是胸中部疼痛或吞咽困难，前兆性出血和致命性出血。Carter等于1978年对24例主动脉食管瘘的尸检研究发现[3]：80%的患者在致命性大出血前有前兆性出血。有关Chiari三联征的发生机制， Amin等认为[4]，胸痛可能是由于主动脉壁的扩张、腐蚀或局部切割，纵隔炎，食管穿孔，或肿瘤侵犯主动脉、胸膜等所致。前兆出血暂时停止可能是由于动脉壁痉挛，血管内压力下降或主动脉周围血肿等因素而致瘘口暂时闭塞。随后闭塞的瘘口被感染或胃肠道消化液再次腐蚀掉，出现致命性大出血。Chiari三联征可发生于任何原因所致的主动脉食管瘘患者，包括主动脉夹层动脉瘤，食管及气管的恶性肿瘤，手术后并发症，食管异物等。Chiari三联征的提出对我们进一步认识主动脉食管瘘这一高度致命性疾病的发病机制及发病规律具有重大的理论意义和临床价值。在前兆性出血后的数小时至数天的时间内，外科医生有了较充足的诊断及处理时间，使得主动脉食管瘘的手术治愈成为可能[5]。

选择性前路或后路手术治疗Lenke5型AIS胸弯自发矫正比较及策略分析

[目的]比较选择性前路或后路手术治疗Lenke5型青少年特发性脊柱侧凸未融合胸弯术后自发矫正情况。[方法]1997年5月～2005年10月，共72例接受手术的Lenke5型青少年特发性脊柱侧凸患者，其中40例采用选择性前路手术（A组），32例采用选择性后路手术（B组），随访时间最少2年。[结果]末次随访发现，两组患者无1例发生术后相关并发症，A组术前胸弯平均30°，术后平均16°；B组术前33°，术后18°。两组患者术后未融合胸弯大多得到了明显改善，且两组患改善率没有差别，但末次随访发现，72例患者中，4例患者（C组）术后胸弯加重，躯干发生了失平衡，A组、B组各2例。该4例患者（TL／L：T）Cobb’s比率均值为1．09，其余68例（D组）比率均值为1．59。C、D组患者胸弯柔韧性也有差别，C组较D组僵硬（分别34．2％和57．3％）．[结论]选择性前路或后路手术治疗Lenke5型青少年特发性脊柱侧凸，未融合胸弯自发矫正效果相当，但术前对患者（TL／L：T）Cobb’s比率和胸弯柔韧性进行评估非常重要。

NUMERICAL STUDY FOR RESONANT TRIAD INTERACTION AND SECONDARY INSTABILITY IN TWO-DIMENSIONAL SUPERSONIC BOUNDARY LAYER

By direct numerical simulation, a supersonic boundary layer was studied to see whether the mechanism for the generation of sub-harmonic waves, similar to those for the incompressible flows, existed in the process of laminar-turbulent transition. The results showed that mechanisms of both resonant triad and secondary instability did exist. Discussions were made on whether these two mechanisms are really important in laminarturbulent transition.

Fazari’s Sign in Ultrasound Scan of Morbid Adherent Placenta/Placenta Accreta Spectrum (MAP/PAS) and Fazari’s Triad during (MAP/PAS) Surgery

Morbid Adherent Placenta (MAP)/Placenta Accreta Spectrum (PAS) is a serious diagnosis which has a risk of complications. Ultrasound scan helps in early diagnosis and has great value in further confirmation and follow up. Observed new clinical sign and associated clinical triad are discussed here.

散发性结直肠癌组织中FHIT、MSH2蛋白的异常表达及其临床意义

背景与目的:脆性组氨酸三联体(fragilehistidinetriad,FHIT)蛋白表达缺失是胃肠道肿瘤的频发事件,但在大肠癌却有争议;最近研究表明FHIT蛋白表达失活可能是错配修复蛋白,尤其是mutS同种组织蛋白2(mutShomolog2,MSH2)改变的结果。本研究旨在探讨FHIT、MSH2蛋白在散发性结直肠癌(sporadiccolorectalcarcinoma,SCC)组织中的表达情况及其临床意义。方法:采用免疫组化SP法检测手术切除的84例SCC及其对应癌旁正常结直肠组织和23例肠腺瘤组织标本中FHIT、MSH2蛋白的表达。结果:FHIT蛋白在SCC组织、结直肠腺瘤组织、癌旁正常结直肠组织中阳性率分别为48.81%、73.91%和100%,三者的阳性率差异有显著性(P<0.05)。FHIT蛋白表达水平与SCC患者的年龄、性别及肿瘤部位、组织学类型无关(P>0.05),而与肿瘤浸润深度、分化程度、Dukes分期和淋巴结转移有关(P<0.05),在浸润深度越深、分化程度越低、Dukes分期越晚和有淋巴结转移的癌组织中,FHIT蛋白低表达就越明显;而MSH2蛋白表达水平仅与Dukes分期有关(P<0.05)。SCC中FHIT蛋白表达与MSH2蛋白表达呈正相关(r=0.3728,P<0.01)。结论:(1)FHIT蛋白表达水平与SCC的恶性程度有关,可作为预测SCC浸润转移潜能的一项有意义的生物学指标;(2)SCC中FHIT、MSH2蛋白表达二者之间呈正相关。

Rare Case of Spontaneous Perinephric Hematoma with Two-Year Follow-Up

Background: Spontaneous perinephric hematoma with no associated pathology or provocation is a rare clinical phenomenon. The hematoma requires a two-year interval for a favorable hematoma resolution, and no associated hypertension or renal scarring. Aims: Evidence of the efficacy of conservative management for spontaneous perinephric hematoma with a 2-year follow up. Case Presentation: A previously healthy 38-year-old woman, presented with a sudden onset of left flank pain, associated with fatigue and pallor. The patient remained hemodynamically stable with no significant history or associated provocations identified. Conclusion: The acute management strategy is favorable in such condition, as the hematoma remains under tamponade in the retroperitoneal space, regardless of the size and organ displacement. Closed observation, serial blood investigation and repeated CT scans are vital to assist in the decision to intervene.

Anaphylaxis and Undiagnosed Aspirin Exacerbated Respiratory Disease in the Ambulatory Surgery Center: A Case Report

Severe bronchospasm and anaphylaxis are unanticipated emergencies that may occur in the ambulatory surgery setting. I present a case in which an asthmatic male with nasal congestion has anaphylaxis after induction, with severe bronchospasm as the primary manifestation. During the course of hospitalization, he was exposed to aspirin and a second episode of severe bronchospasm occurred. He was diagnosed with both anaphylaxis to an anesthetic medication and Aspirin Exacerbated Respiratory Disease, or Samter’s Triad.

“女运动员三联征”的研究现状及进展

"女运动员三联征"是女运动员参加剧烈运动所遇到的特殊医学问题,由于其具有隐蔽性,可能给女运动员机体带来一系列潜在和远期的危害,因而成为近年来相关领域研究的新热点。就"三联征"对女运动员健康的影响进行了综述,对其病因及发病机理进行了分析,并对其预防和治疗提出了相应的措施及方法。

胰岛素瘤的诊断与治疗(附25例报告)

胰岛素瘤在临床上较为少见，作者通过对我院收治２５ 例患者的总结，进而探讨该病的定性、定位诊断及手术治疗。其中１０ 例患者具有 Ｗｈｉｐｐｌｅ 三联征表现并因此而得到早期诊断；１２ 例行选择性腹腔动脉造影，１０ 例明确肿瘤的部位，准确率为８３ ％ ，而Ｂ 超、ＣＴ 检查分别为１６ ％ （４／２５） ，４０ ％ （８／２０） 。２５ 例患者均实施手术治疗，５ 例行胰体尾切除，２０ 例行肿瘤摘除。１５ 例行术中血糖监测，切除肿瘤１ 小时后，血糖值均达到正常水平。因此我们认为，Ｗｈｉｐｐｌｅ 三联征是胰岛素瘤定性诊断的主要依据； 选择性腹腔动脉造影对定位诊断有重要价值；诊断一旦成立，应及时手术切除肿瘤，术中血糖监测是判断肿瘤是否完全切除的有效方法。

如何让囚徒走不出困境——三人博弈理论及其应用

以囚徒困境为代表二人博弈模型在学术界已经被广泛研究并加以应用。囚徒困境理论往往容易形成一种简单化和两极化的固定思维模式。囚徒困境的二人博弈模型实际上是三人博弈模型的简化。而三人博弈模型在现实生活中比二人博弈模型更加贴近现实,更具有解释力。分析三人博弈模型的结构及其理论意义,并以刑事诉讼法为例对三人博弈模型的应用进行探讨很有必要。

二维超音速边界层中三波共振和二次失稳机制的数值模拟研究

通过直接数值模拟的方法,探讨在超音速边界层的转捩问题中,是否存在和不可压缩流情况相似的产生亚谐波的机制.结果表明,三波共振和二次失稳这两种机制都存在.讨论了这两种机制在层流至湍流的转捩中的重要性是否的确很大的问题.

Movable typing of full-lumen personalized Vein-Chips to model cerebral venous sinus thrombosis

Cerebral venous sinus thrombosis(CVST)is a type of stroke associated with COVID-19 vaccine-induced immune thrombotic thrombocytopenia.The precise etiology of CVST often remains elusive due to the highly heterogeneous nature of its governing mechanisms,specifically,Virchow’s triad that involves altered blood flow,endothelial dysfunction,and hypercoagulability,which varies substantially amongst individuals.Existing diagnostic and monitoring approaches lack the capability to reflect the combination of these patient-specific thrombotic determinants.In response to this challenge,we introduce a Vein-Chip platform that recapitulates the CVST vascular anatomy from magnetic resonance venography and the associated hemodynamic flow profile using the“Chinese Movable Type-like”soft stereolithography technique.The resultant full-lumen personalized Vein-Chips,functionalized with endothelial cells,enable in-vitro thrombosis assays that can elucidate distinct thrombogenic scenarios between normal vascular conditions and those of endothelial dysfunction.The former displayed minimal platelet aggregation and negligible fibrin deposition,while the latter presented significant fibrin extrusion from platelet aggregations.The low-cost movable typing technique further enhances the potential for commercialization and broader utilization of personalized Vein-Chips in surgical labs and at-home monitoring.Future research and development in this direction will pave the way for improved management and prevention of CVST,ultimately benefiting both patients and healthcare systems.

Olfactory outcomes in the management of aspirin exacerbated respiratory disease related chronic rhinosinusitis

Patients with aspirin exacerbated respiratory disease(AERD)experience a severe and recalcitrant form of chronic rhinosinusitis with nasal polyposis(CRSwNP)and asthma,which are exacerbated by aspirin/NSAID ingestion.As compared with aspirin-tolerant CRSwNP,patients with AERD experience more severe olfactory dysfunction,which is one of the key contributors to the observed decrease in quality of life(QOL)in this disease.The objective of this paper is to review the published olfactory outcomes observed with various treatment modalities.

Pathogenesis of NSAID-induced reactions in aspirin-exacerbated respiratory disease

It is well-established that following ingestion of aspirin or any other inhibitor of cyclooxygenase-1, patients with Samter’s disease, or aspirin-exacerbated respiratory disease (AERD) develop the sudden onset of worsening respiratory clinical symptoms, which usually in-volves nasal congestion, rhinorrhea, wheezing and bronchospasm. Gastrointestinal distress, nausea, a pruritic rash and angioedema can also occasionally develop. However, the underlying pathologic mechanism that drives these clinical reactions remains elusive. Pretreatment with medications that inhibit the leukotriene pathway decreases the severity of clinical reactions, which points to the involvement of cysteinyl leukotrienes (cysLTs) in the pathogenesis of these aspirin-induced reactions. Furthermore, studies of aspirin challenges in carefully-phenotyped patients with AERD have confirmed that both proinflammatory lipid mediators, predominantly cysLTs and prostaglandin (PG) D 2, and the influx of effector cells to the respiratory tissue, contribute to symptom development during aspirin-induced reactions. Mast cells, which have been identified as the major cellular source of cysLTs and PGD 2, are likely to be major participants in the acute reactions, and are an attractive target for future pharmacotherapies in AERD. Although several recent studies support the role of platelets as inflammatory effector cells and as a source of cysLT overproduction in AERD, it is not yet clear whether platelet activation plays a direct role in the development of the aspirin-induced reactions. To further our understanding of the pathogenesis of aspirin-induced reactions in AERD, and to broaden the pharmacotherapeutic options available to these patients, additional investigations with targeted clinical trials will be required.

The importance of timely diagnosis of aspirin-exacerbated respiratory disease for patient health and safety

Backgroud:Aspirin-exacerbated respiratory disease(AERD)is a difficult-to-treat syndrome where timely diagnosis and initiation of disease-specific therapies are pertinent to improved patient outcomes.Objective:To characterize the most common timeline for development of the clinical triad[asthma,nasal polyposis,and reactions to nonsteroidal anti-inflammatory drugs(NSAIDs)],identify barriers to prompt diagnosis of AERD,and describe indications for an aspirin challenge to facilitate accurate diagnosis.Methods:Six hundred ninety-seven patients with diagnosed AERD and history of at least one sinus surgery to remove nasal polyps were identified in the Brigham and Women’s Hospital AERD registry.Patient reported age at disease onset of asthma,nasal polyposis,and age of first NSAID reaction were obtained from 2013 to 2019 at enrollment.Results:Of the 697 patients identified,diagnosis of asthma preceded diagnosis of nasal polyposis and first NSAID reaction,although there was considerable variability between patients.Conclusions:Prompt diagnosis of AERD is important for patient and provider education and improved care of this difficult-to-treat population of patients.Consider diagnostic aspirin challenge in patients without historical reactions to NSAIDs who have an otherwise compatible clinical history,specifically in patients who take daily low-dose aspirin,leukotriene modifiers,avoid NSAIDs,or who are severely symptomatic at baseline where it would be difficult to identify an acute worsening of symptoms.

猪链球菌2型组氨酸三聚体蛋白原核表达

目的鉴定猪链球菌2型(Streptococcus suis serotype2,S.suis2)组氨酸三聚体蛋白(Histidine Triad Pro-tein,HTP),并研究该蛋白的免疫原性,为研究S.suis2保护性疫苗奠定实验基础。方法通过与相关家族蛋白进行同源性比较,在猪链球菌Z型05ZYH33全基因组序列中发现了编码HTP的基因。设计合成引物,进行PCR扩增,并将目的片段克隆到表达载体pET28a,表达并纯化出目的蛋白,通过蛋白印迹(Western blot)检测其免疫原性。结果PCR扩增出约2.7kb的片段,并成功表达分子量在110KD左右的目的蛋白。通过His-Tag亲和层析,获得纯度较高的融合蛋白。Western blot检测结果表明,该表达产物具有免疫原性。结论S.suis2中国强毒株中存在HTP,并具有良好免疫原性,可作为S.suis2免疫保护性疫苗候选分子。

慢性便秘继发肠系膜上动脉压迫综合征(李氏三联征)的诊断与治疗

目的归纳按“李氏三联征”概念指导诊断和治疗慢性便秘继发肠系膜上动脉压迫综合征(SMAS)的经验。方法“李氏三联征”的概念包括:(1)临床症状:便秘、营养不良、上消化道梗阻(呕吐、进食困难)三联症状;(2)解剖学表现:具有横结肠下垂、脾曲升高和肠系膜上动脉压迫三联解剖异常;(3)治疗:均给予肠内营养支持、胸膝位、菌群移植三联治疗。根据“李氏三联征”概念,采用描述性病例系列研究方法,前瞻性纳入2014年6月至2018年11月期间,同济大学附属第十人民医院和东部战区总医院收治的78例慢性便秘继发SMAS患者的病例资料,包括基本信息、症状体征、影像学资料、营养指标、胃肠生活质量指数和Wexner排粪评分,按上述“李氏三联征”的标准进行评估和治疗,对临床症状和解剖学特征指标进行随访,记录治疗后1、3、6和12个月的变化。结果治疗前所有患者均有“李氏三联征”特征,均存在严重便秘、营养不良及上消化道梗阻的临床表现,均具有肠系膜上动脉压迫征象和明显的脾曲升高的解剖学表现。经肠内营养支持、胸膝位及菌群移植三联治疗后,69例(88.5%)症状明显改善,9例治疗无效行手术治疗。69例非手术患者经12个月随访,结果显示,所有患者均恢复正常进食,1个月后便秘相关指标改善,至12个月后时,每周自主排粪次数从治疗前(1.0±0.8)次增加至(5.0±1.6)次,胃肠生活质量指数由治疗前(52.7±8.5)分增加至(93.2±7.5)分,Wexner排粪评分由治疗前(19.1±2.5)分下降至(6.2±2.1)分,差异均有统计学意义(均P<0.001)。随访1个月后营养指标改善,至12个月后时,体质指数从治疗前(17.9±1.8)kg/m2增加至(21.0±1.3)kg/m2,总蛋白由(65.2±5.7)g/L增加至(68.3±4.2)g/L,白蛋白从(32.1±5.1)g/L增加至(40.4±3.0)g/L,纤维蛋白原从(1.9±0.5)g/L增加至(2.4±0.5)g/L,前白蛋白从(163.2±5.3)mg/L增加至(259.1±45.6)mg/L;差异均有统计学意义(均P<0.001)。上消化道造影及肠系膜上动脉成像均显示十二指肠受压征象解除,肠系膜上动脉与腹主动脉夹角从治疗前(17.4±3.8)°增加至(37.8±5.8)°(t=-22.26,P<0.001)。结论慢性便秘继发SMAS患者具有“李氏三联征”的异常三联临床症状和解剖学表现时,应给予肠内营养支持、胸膝位及菌群移植三联治疗。