目的 分析对比肺部受累的惠普尔病与初治菌阴肺结核患者的临床特征,提高对肺部受累的惠普尔病的认识、诊断及鉴别水平。方法 回顾性收集20例肺部受累的惠普尔病为病例组,并随机选取同期56例初治菌阴肺结核患者为对照组进行对比,探讨肺部受累的惠普尔病的临床特征。结果 病例组中老年（>37岁）、急性或亚急性的病程比例高于对照组（P<0.05）。CT影像学中,从病灶分布来看,病例组的病灶分布在下叶的病例比例高于对照组（P<0.05）,病灶分布在上叶的病例比例低于对照组（P<0.05）;从形态上看,病例组中表现为网状病灶、间质性肺炎的比例高于对照组（P<0.05）,病例组中表现为空洞、纤维条索、实性影、结节影、树芽征、肺门淋巴结肿大的比例低于对照组（P<0.05）,而性别、合并免疫力低下疾病、咳嗽、咳痰、发热、咳血、关节痛、腹泻等在组间比较差异均无统计学意义。病例组全部病例的肺泡灌洗液宏基因测序结果显示：惠普尔养障体是唯一菌19例（95.0%）或主要菌1例（5.00%,合并结核菌1序列）,而对照组肺泡灌洗液宏基因测序结果显示：21例（37.5%）检测出结核分枝杆菌（TB）复合群是唯一菌或主要致病菌,18例TB-RNA（+）,15例TB-LAMP（+）。结论 惠普尔病在临床可表现为急性或亚急性病程,好发中老年男性,以发热和（或）呼吸道症状为主,可伴或不伴有腹泻、关节痛;肺部影像学以下肺网状、间质性肺炎改变为主,可以单独累及肺部;与初治菌阴肺结核患者临床症状极其相似。应尽快完善支气管镜检查,肺泡灌洗液的宏基因检测对早期、快速诊断此病尤为重要。

Objective To analyze and compare the clinical features of patients with pulmonary involvement of Whipple disease and primary treated bacteriological negative pulmonary tuberculosis,so as to improve the recognition,diagnosis and differentiation ability of pulmonary involvement of Whipple disease．Methods Clinical features of Whipple disease with pulmonary involvement were investigated by retrospectively collecting 20 cases as a case group,comparing with 56 randomly selected patients with primary treated bacteriological negative pulmonary tuberculosis as a control group during the same period．Results The case group had a significantly higher proportion of older patients（>37 years）,acute or subacute disease courses than the control group （P<0.05）．On CT imaging,in terms of lesion distribution,the proportion of cases with lesions in the lower lobe was significantly more in the case group than in the control group（P<0.05）,and the ratio of cases with lesions in the upper lobe was considerably less than in the control group（P<0.05）．Regarding morphology,significantly more of the case group showed reticular lesions and interstitial pneumonia than the control group（P<0.05）．Significantly fewer of the case group showed cavities,fibrous bands,solid shadows,nodular shadows,tree-bud signs,and enlarged hilar lymph nodes than the control group（P<0.05）．No statistically significant differences existed between the two groups in gender,combined immunocompromising diseases,cough,sputum,fever,coughing up blood,arthralgia or diarrhea. At the same time,the differences of gender,combined immunocompromised disease,cough,sputum,fever,coughing up blood,arthralgia,and diarrhea were not statistically significant．The metagenomic sequencing of alveolar lavage fluid in the case group revealed Tropheryma whipplei as the sole pathogenic bacteria in 19 cases（95%）or the primary pathogenic bacteria in 1 case（5.00%,combined TB 1 sequence）．In contrast,metagenomic sequencing of alveolar lavage fluid in the control group detected Mycobacterium tuberculosis complex as the sole or primary pathogenic bacteria in 21 cases（37.5%）,TB-RNA（+）in 18 cases and TB-LAMP（+）in 15 cases．Conclusions Clinical presentation in Whipple disease can be of an acute or subacute course,preferably in middle-aged and older men,with fever or/and respiratory symptoms,either with or without diarrhea and arthralgia．Its pulmonary imaging dominates with reticular,interstitial pneumonia changes in the lower lungs,which can involve the lungs alone in the disease．At the same time,the clinical symptoms are highly similar to those patients with primary treated bacteriological negative pulmonary tuberculosis．Therefore,it is vital to complete bronchoscopy and metagenomic sequencing of alveolar lavage fluid as soon as possible for early and rapid diagnosis of this Whipple disease．Treatment with sensitive antibacterial drugs can result in significant improvement and save patients' lives．

目的 探讨慢性淋巴细胞白血病（CLL）合并第二肿瘤临床特征和预后。方法 回顾性分析2015年8月—2021年10月我院收治的58例CLL患者,其中有11例合并第二肿瘤,47例无合并第二肿瘤,分析两组病例的临床特征及其对预后的影响。结果 CLL合并第二肿瘤和无合并第二肿瘤患者在年龄、性别、白细胞计数、血红蛋白水平、淋巴细胞计数、血小板计数、乳酸脱氢酶（LDH）、β₂-微球蛋白（β₂-MG）水平、分期、单个基因缺失类型之间比较差异无统计学意义,但CLL合并第二肿瘤患者基因缺失个数较无合并第二肿瘤CLL患者组高（χ²=11.17,P=0.03）,且总生存期较短。结论 CLL合并第二肿瘤患者常伴有多个基因缺失,且预后差,当CLL患者伴有多个基因缺失时,在诊治过程中需警惕有无合并第二肿瘤。

Objective To investigate the prognosis and clinical characteristics of chronic lymphocytic leukemia（CLL）patients with second tumor．Methods A retrospective analysis was performed on 58 cases of CLL patients who were diagnosed in our hospital from August 2015 to October 2021．The clinical data of 11 CLL patients with second cancer and 47 CLL patients without second cancer were compared and analyzed．Results There were no significant differences in age,sex,white blood cell count,lymphocyte count,platelet count,the level of serum β₂-microglobulin and lactate dehydrogenase between two groups．However,in CLL patients with second cancer,the incidence of multiple genetic deletions was higher than those without second cancer（χ² =11.17,P =0.03）．The overall survival time was shorter in CLL patients with second primary cancer．Conclusions CLL patients with second tumor have a frequent multiple gene deletions and poor prognosis．Physicians should pay attention to second cancers when diagnosing the CLL patients with multiple gene deletions．

目的 探讨非小细胞肺癌（NSCLC）组织中转化生长因子β激活激酶1（TAK-1）与T细胞因子-4（TCF-4）在 mRNA以及蛋白水平的表达情况及其相关性,并分析两者与NSCLC患者临床病理因素的关系。方法 收集NSCLC手术标本51例,每例均包含肺癌组织及配对癌旁组织,所有患者的术后诊断均经病理结果证实,通过RT-PCR以及Western blot法检测TAK1、TCF-4在癌组织及配对癌旁组织中的表达情况,并通过SPSS进一步分析两者的相关性及其与临床病理因素的关系。结果 TAK1与TCF-4 mRNA以及蛋白水平在NSCLC患者癌组织中均高表达,其中TAK1蛋白的表达与NSCLC的TNM分期（P=0.022）、淋巴结转移（P=0.014）相关,TCF-4蛋白的表达与NSCLC的TNM分期相关（P=0.045）。TAK1在NSCLC组织中的表达与TCF-4呈正相关（r=0.427,P=0.002）。结论 TAK1 mRNA及蛋白水平在NSCLC组织中均高表达,并与TCF-4呈正相关,TAK1有可能成为NSCLC诊断及预后的一个潜在靶标,并且TAK1与TCF-4的联合应用有可能成为一种更为理想的NSCLC辅助诊断及临床治疗方法。

Objective To investigate the mRNA and protein expressions of transforming growth factor β-activated kinase 1（TAK1）and T cell factor-4（TCF-4）in non-small cell lung cancer（NSCLC）tissues and their correlation,and to analyze the relationship between TAK1/TCF-4 and clinicopathological factors in NSCLC patients．Methods Cancer tissues and matched adjacent tissues of 51 NSCLC patients in our hospital were collected．The postoperative diagnosis of all patients was confirmed by pathological results．The expression of TAK1 and TCF-4 in cancer tissues and paired adjacent tissues were detected by RT-PCR and Western blot,then SPSS was used to further analyze the correlation between TAK1 and TCF-4 and clinicopathological factors．Results TAK1 and TCF-4 mRNA and protein were highly expressed in NSCLC tissues,and TAK1 protein expression was significantly correlated with TNM stage of NSCLC（P=0.022）and lymph node metastasis（P=0.014）;TCF-4 protein expression was significantly correlated with TNM stage of NSCLC（P=0.045）．TAK1 expression in NSCLC tissues was positively correlated with TCF-4（r=0.427,P=0.002）．Conclusions TAK1 mRNA and protein were highly expressed in NSCLC tissues and positively correlated with TCF-4．TAK1 may become a potential target for the diagnosis and prognosis of NSCLC,and the combined application of TAK1 and TCF-4 may become a more ideal method for the auxiliary diagnosis and clinical treatment of NSCLC．

目的 研究母代不同孕期巨细胞病毒（CMV）感染对自身精神及行为的影响。方法 72只BALB/c雌鼠随机分为12组（A1、A2、A3、B1、B2、B3、C1、C2、C3、D1、D2、D3,每组6只）,A为孕期再感染、B为既往感染、C为孕期原发感染、D为空白对照,1为孕早期、2为孕中期、3为孕晚期。母鼠腹腔注射小鼠CMV（murine CMV,MCMV）Smith株建立播散性感染模型,或注射无菌生理盐水建立对照模型。母鼠产仔后同笼合养,产后22 d分笼;母鼠做行为学试验。试验结束,每组随机处死3只母鼠;测量子宫、肝、脑脏器重量系数及唾液腺中MCMV含量。结果 A、B、C组母鼠产后次日体质量均低于D组（均P<0.05）,其中C2、C3组母鼠低体质量情况持续至产后22日（均P<0.05）。A、B、C组母鼠唾液腺组织均测出MCMV。与D组母鼠相比,A1、C1组母鼠活胎率降低（均P<0.05）,A、C组母鼠的子宫、肝、脑脏器系数升高（均P<0.05）且脑组织有病损表现。产后6天时,A3、B3、C组母鼠水平运动总距离和直立次数减少（均P<0.05）,糖水偏好量降低（均P<0.05）,悬尾不动时间延长（P<0.05）;其中,C2、C3组母鼠以上行为退缩情况至产后22天仍存在,且有逃避潜伏时间延长（均P<0.01）,穿越原平台位置次数减少（均P<0.01）情况。结论 孕期CMV感染损害母代身心健康,有可能增加子代不良抚养的风险。

Objective To investigate the effects of cytomegalovirus（CMV）infection in different stages of maternal pregnancy on its own spirit and behavior．Methods A total of 72 female BALB/c mice were randomly divided into 12 groups（each group had 6 mice）：A1-A3,B1-B3,C1-C3,D1-D3（group A had re-infection,group B had previous infection,group C had primary infection,group D was blank control,group 1 was in early pregnancy,group 2 was in middle pregnancy,group 3 was in late pregnancy）．The disseminative infection model was established by intraperitoneal inoculation of murine CMV（MCMV）Smith strain,and the blank control model was established by intraperitoneal inoculation of 0.9% sterile saline（NaCl）．After 21 days of parturition,the mothers and offspring were reared in separate cages,mothers were selected for the behavior experiments．At the end of all the behavior tests,3 mothers in each group were killed randomly．Weighed and calculated the organ coefficients of the uteri,livers and brains,and detected the expression levels of MCMV in salivary gland．Results On the first day after delivery,the weights of mothers in groups A,B and C were lower than those in group D（all P<0.05）,the low body weight of mice in C2 and C3 groups lasted to the 22th day（all P<0.05）．The MCMV in salivary gland tissue were found in groups A,B and C,but not in group D．The live fetus rates of groups A1 and C1 were significantly lower than that of group D．The organ coefficients of uteri,livers and brains in groups A and C were higher than those in group D（all P<0.05）．And the lesions of brain tissues in groups A and C were more serious than in the other groups．On the 6th day,compared with the other groups,the mothers of groups A3,B3 and C were significantly abnormal in the open field test,the tail suspension test and the sugar preference test（all P<0.05）．But on 22th day,only the mothers of groups C2 and C3 were significantly abnormal in those tests（all P<0.01）,and even in the water maze test（all P<0.01）．Conclusions Maternal CMV infection in different stages pregnancy have impacts on mother mice's physical and mental health．Those bad situations may bring poor parenting to the offspring．

自身免疫性肝炎（AIH）是由不明原因免疫异常引起的急性或慢性肝脏炎症性疾病,不分年龄或性别,影响所有种族群体。AIH如果没有得到及时的治疗,可能会发展为肝硬化、肝衰竭,甚至导致死亡。目前一些诊断评分系统和肝活组织病理检查已成为诊断的标准,然而由于疾病表现的高度异质性,AIH诊断仍很有挑战性。大多数患者最初对一线治疗（糖皮质激素与硫唑嘌呤的联合治疗）有应答,然而,应答欠佳和因不良反应引起的不耐受也不少见,需要二线和（或）三线治疗。本文总结阐述诊断困难、一线药物治疗应答欠佳或不耐受的疑难AIH诊断和管理的最新进展,并归纳了目前国内外关于AIH治疗的新方法,为AIH的临床诊疗提供参考。

Autoimmune hepatitis（AIH）is an acute or chronic inflammatory disease of liver caused by unclear immune response that affects people from all ethnic groups irrespective of age or sex．If left untreated,AIH will lead to cirrhosis,liver failure,or death．A number of diagnostic scoring systems and histopathological examination of liver biopsies are now the standard for diagnosis．However,due to the high heterogeneity of the disease presentation,AIH diagnosing remains challenging．Most patients initially respond to first-line treatment,which is corticosteroids combined with azathioprine．However,insufficient response and intolerance due to side effects are also common,so some patients requires second-and/or third-line therapies．Here we summarized the latest progress in diagnosis and management of AIH with difficult diagnosis,poor response to first-line drug treatment or intolerance,as well as the new methods of AIH treatment worldwide,to provide reference for the clinical diagnosis and treatment of AIH．

本文综述近10年中医传统疗法中通过穴位刺激预防与治疗老年患者骨折术后谵妄的研究概况。术后谵妄是老年患者骨折术后常见的并发症,不仅延长患者住院时间、增加经济负担,同时与骨折术后死亡并发症的发生密切相关。但是本病机制尚未明确,在临床治疗上难以达成共识。针灸等穴位刺激是中医药治疗脑病的独具特色的疗法,近年来有关穴位刺激防治老年骨折术后谵妄的报道越来越多,本文主要探讨不同的穴位刺激方法干预对骨折术后谵妄发生率的影响,包括传统刺激方式如毫针、电针、穴位注射、穴位敷贴和新针疗法如耳针、头针等,认为穴位刺激能够较好预防骨折术后谵妄发生,在治疗上也有较好疗效。以期为进一步临床研究与应用提供参考。

This article summarized the research of acupoint stimulation in preventing delirium after fracture surgery in elderly patients in recent 10 years．Postoperative delirium is a common complication in elderly patients after fracture surgery, which affects life extremely and increases economic burden．However, the mechanism of this disease haven't been revealed, and it is difficult to reach consensus on clinical treatment．Acupoint stimulation, like acupuncture, is a unique treatment of encephalopathy with traditional Chinese medicine．In recent years, there are more and more reports on acupoint stimulation therapy to prevent and treat delirium after fracture surgery in the elderly．This article mainly study the influence of different acupoint stimulation therapy on treatment of delirium after fracture surgery, including electroacupuncture, auriculotherapy, scalp acupuncture, acupoint injection and acupoint application, etc．It is believed that acupoint stimulation can prevent delirium after fracture surgery, so as to provide reference for further clinical research and application．

我国结直肠癌的发病率与死亡率逐年增加,约10%~30%新发结直肠癌患者可表现为急性肠梗阻,其中梗阻发生率较高的主要部位是左半结肠。急性梗阻性左半结肠癌患者的主要治疗方式仍是急诊手术（ES）,但术后并发症发生率及围手术期死亡率较高,自膨式金属支架（SEMS）被一些指南推荐为梗阻性结肠癌的初始治疗选择,SEMS可将部分ES转变为择期手术,支架置入后择期手术（SBTS）与ES相比不仅可改善患者的短期生存结局,且支架置入后新辅助化疗为梗阻性结肠癌的治疗提供了新的途径;就长期生存结果而言,选择SBTS还是ES存在一定的争议。对于支架置入后手术时机的选择尚未达成共识,有指南表明大约两周的短桥接间隔可使患者最大程度获益,因而可有效指导临床工作。肠道支架置入术目前看来是一种简单、有效的临时性或永久性的治疗手段。

In recent years, the incidence and mortality of colorectal cancer in our country have been increasing year by year．Around 10% to 30% of newly diagnosed colorectal cancer patients showed acute intestinal obstruction, which the left colon cancer has higher incidence．Emergency surgery（ES）is still the main treatment for patients with acute obstructive left colon cancer, but the incidence of postoperative complications and perioperative mortality are high．Self-expanding metallic stents（SEMS）can convert some emergency procedures into stent as bridge to surgery（SBTS）, which is recommended by some guidelines as the initial treatment option for obstructive colon cancer．SBTS can not only improve the short-term survival outcome of patients compared with ES, but also provide a new approach for the treatment of obstructive colon cancer with neoadjuvant chemotherapy after intestinal obstruction stent placement．The choice of SBTS versus ES is somewhat controversial in terms of long-term survival outcomes．There is no consensus on the timing of surgery after stenting, and current guidelines suggest that bridging intervals of approximately two weeks strike a balance between potential adverse events and long-term outcomes．At present, intestinal stenting is still a simple, feasible and effective temporary or palliative permanent treatment with few complications．

目的 分析接受自体动静脉内瘘（AVF）维持性血液透析（MHD）尿毒症患者AVF使用寿命的影响因素,以期为临床延长AVF使用寿命提供可参考依据。方法 选取我院2019年1月—2021年2月期间收治的接受AVF的367例MHD尿毒症患者为研究对象,随访1年,统计AVF功能丧失状况,将AVF功能丧失患者纳入丧失组,AVF通畅患者纳入通畅组,分析AVF使用寿命的影响因素。结果 随访1年,AVF通畅率为80.65%（296/367）,功能丧失率为19.35%（71/367）;不同糖尿病、血液透析中低血压（IDH）、血磷、低密度脂蛋白、钙磷乘积、高凝倾向、前壁动静脉内径、血肿状况为AVF MHD尿毒症患者的AVF寿命存在差异（P<0.05）;经COX回归模型分析显示,糖尿病、IDH、血磷≥2.04 mmol/L、低密度脂蛋白>2.38 mmol/L、高凝倾向、血肿、前壁动静脉内径<2 mm为AVF MHD尿毒症患者AVF功能丧失的独立危险因素（P<0.05）。结论 AVF MHD尿毒症患者AVF使用寿命受糖尿病、IDH、血磷≥2.04 mmol/L、低密度脂蛋白>2.38 mmol/L、高凝倾向、血肿、前壁动静脉内径<2 mm等因素影响,临床可针对性制定干预措施以延长AVF使用寿命。

目的 探究3D打印数字化塑形聚醚醚酮（PEEK）材料在颅骨修补个体化重建中的应用效果。方法 收集我院90例行颅骨修补个体化重建手术患者（2019年1月—2021年1月）,按术中应用的颅骨修补材料不同分成PEEK组（n=30）、钛网（TM）组（n=60）。2组均行颅骨修补个体化重建术。对比2组围术期指标、手术前后简易智力状态量表（MMSE）、格拉斯哥预后评分（GOS）、颅骨缺损塑形满意度、并发症发生率、材料生物相容性及患者主观感觉情况。结果 与TM组相比,PEEK组住院时长更短、治疗费用更高（P<0.05）;与术前相比,2组术后、6个月、12个月、18个月MMSE、GOS评分均升高,其中PEEK组升高幅度比TM组更为多（P<0.05）;PEEK组总满意度为93.33%,与TM组的80.00%比较差异无统计学意义（P>0.05）;PEEK组并发症总发生率为6.67%,与TM组的15.00%比较差异无统计学意义（P>0.05）;PEEK组材料生物相容性及患者主观感觉情况与TM组比较差异无统计学意义（P>0.05）。结论 3D打印数字化塑形在颅骨修补个体化重建中,应用PEEK材料治疗费用更高,但可有效减少并发症,缩短住院时长,改善认知功能及预后,提升颅骨缺损塑形满意度,且材料生物相容性高,震动感和冷热感觉体验少。

目的 探讨K点刺激联合吞咽-摄食管理下颅脑外伤术后吞咽障碍患者康复的影响因素。方法 采用回顾性分析法,收集K点刺激联合吞咽-摄食管理下的516例颅脑外伤术后吞咽障碍患者临床资料,根据吞咽障碍疗效分为有效组和无效组,采用Logistic回归分析其影响因素。结果 516例患者中,有效者479例,占92.93%;无效者37例,占7.17%。2组在性别、年龄、文化程度、有无慢性病、有无留置鼻饲管、鼻饲管留置天数方面比较差异无统计学意义（P>0.05）;在吞咽障碍分级、有无并发症、管理依从性和知识掌握程度比较差异有统计学意义（P<0.001）。Logistic回归分析结果显示,吞咽障碍分级、有无并发症、管理依从性和知识掌握程度是影响康复效果的独立危险因素（OR分别为6.455、0.011、1.074、0.084,P<0.001）。结论 吞咽障碍分级、有无并发症、管理依从性和知识掌握程度是K点刺激联合吞咽-摄食管理下颅脑外伤术后吞咽障碍患者吞咽功能康复的影响因素,神经外科医护人员应根据上述因素制定干预措施,以进一步提高干预效果,改善患者生活质量。