2014年 · 第94卷第34期

At present, most clinical microbiology laboratories in China still adopt traditional identification methods, such as API or Vitek system, but time consumption, high cost and limited identification capability are obvious bottlenecks. 16S rDNA sequencing can directly identify sterile specimens, but the standardization of the method, specimen pretreatment and timeliness have not been solved, so it is difficult to become a routine technology. In 2006, Fox^[1]InJournal of Clinical MicrobiologyPublished the first article on the application of mass spectrometry technology in clinical microorganisms, which attracted the attention of peers. He believes that there are still many technical difficulties to overcome in the identification of bacteria by this technology, and it is not easy to become a conventional method. However, after 2009, microbial mass spectrometry technology quickly swept into Europe, North America and some countries in Asia. Matrix-assisted laser desorption ionization ion source and time-of-flight mass analyzer mass spectrometry (matrix-assisted laser desorption ionization time of flight mass spectrometry, MALDI-TOF MS) The technology meets the expectations of microbiologists: simple operation, rapid identification, low running cost and automatically updated database^[2]。 It is particularly outstanding in the identification of microaerobic bacteria, anaerobic bacteria, fungi and mycobacteria, which are difficult to culture. The identification time is advanced from several days to minutes and seconds. New developments, such as direct identification of sterile fluids, drug-resistant phenotype identification, pathogenic toxin analysis and genetic tracing of nosocomial infection pathogens, are even more encouraging^[3,4]。

Obesity in children and adolescents has become a global public health concern^[1]And often to adulthood. The incidence of metabolic syndrome increases with increasing obesity rates. Habitual sleep length is associated with type 2 diabetes, epidemiological study finds^[2,3]Occurrence of heart disease^[4]And even related to case mortality^[5,6,7]。 The sleep length of children and adolescents declined continuously in the past 20~30 years, and the decrease of sleep length was parallel to the increase of body weight^[1,8]。 The relationship between children's sleep length and metabolic syndrome has become a hot topic. Recent research progress on sleep length and metabolic syndrome in children and adolescents is reviewed below.

A 46-year-old female was found to have two painless masses about the size of "broad beans" on her right neck in early April 2013, accompanied by fever and weight loss. She went to a local hospital and felt that the masses were smaller than before after 10 days of treatment. In June, the mass increased again as the size of a "ping-pong ball", without fever, nausea, vomiting, etc., and was not treated. In August, the supraclavicular, subclavicular, axillary and inguinal lymph nodes gradually swelled, accompanied by afternoon fever, and went to the local hospital again for cervical lymph node biopsy. The pathological report considered peripheral T lymphoma, and the bone marrow biopsy showed abnormal lymphocytes, which was considered lymphoma. On August 21st, he came to our department for consultation and performed cervical lymph node puncture again for examination to consider lymphoma. It was recommended that the patient take intact lymph nodes for examination. On September 28th, the patient had local pain in swollen lymph nodes in the neck, accompanied by anorexia, abdominal distension, fatigue, blood in sputum, etc., so he underwent bone marrow puncture and inguinal lymph node resection in our hospital on the same day.

A 71-year-old male was seen on November 8, 2010 due to painless full-course macroscopic hematuria for 10 days without obvious trigger. He has been in good health and has no symptoms of urinary system diseases such as frequent urination, urgency, painful urination, dysuria, low back pain, abdominal pain and abdominal distension. Serum prostate specific antigen (PSA) 1.7 μ g/L. B-ultrasound showed: bladder occupation, prostatic hyperplasia. CT showed that there was a nodule about 15 mm ×17 mm in size in the posterior wall of the bladder, which was enhanced followed by enhancement, and the CT value was about 60 HU (Figure 1), the prostate was slightly enlarged with calcification, there were no abnormalities in the seminal vesicles on both sides, no effusion in the pelvic cavity, and no obvious lymph node swelling around the pelvic wall and retroperitoneum. On November 23rd, transurethral plasma resection of bladder tumor was performed under general anesthesia. During the operation, a spherical pedicled mass with a diameter of about 20 mm was seen at 12 o'clock of the bladder neck, and the pedicle was connected to prostate tissue. The hyperplasia of both lobes of the prostate was obvious, and the bladder tumor resection plus prostate resection was immediately changed and sent for pathological examination. HE morphological characteristics: The bladder mass is similar in shape to prostate lesions under the microscope. The tumor consists of a small solid nest and a slightly larger nest with a nest-like structure with a single or multiple cystic cavities in the center. The tumor cells around the nest are arranged in a palisade shape (Figure 2)； The acinar cavity of the dysplastic prostate contains eosinophilic substances; Some nested structures contain multiple cystic cavities in the center, and the cystic cavities contain light blue mucoid substances, which are mesh-like structures, like adenoid cystic carcinoma; The tumor cells are round or oval, the size is more consistent, the nucleus is dark stained, the mitotic image can be seen, and necrosis is not seen. Immunohistochemistry showed that the expression of 34 β E-12 and p63 in basal-like tumor cells was strong (+), and the glandular epithelial cells near the lumen surface were weakly positive or negative; The expression of CK7 in glandular epithelial cells near the luminal surface was strong (+), but the expression of CK7 in basal-like tumor cells was negative; The remaining CK20, P504S, PSA and PSAP were all negative; The proliferation index of Ki-67 was 5%, and the pathological diagnosis: basal cell carcinoma of the prostate (BCC), infiltrated into the mucosal layer of the bladder. The patient was given postoperative radiotherapy, anti-tumor therapy with Xiaoaiping tablets and endocrine therapy with oral flutamide tablets. The patient was followed up for 27 months. The patient was in good condition, and no tumor recurrence or metastasis was observed.