2016年 · 第96卷第26期

Atrial fibrillation (abbreviated as atrial fibrillation) is a risk factor for stroke, and patients can be found as stroke when they see the doctor because they have no obvious symptoms. Anticoagulation can reduce the incidence of stroke caused by atrial fibrillation, so early identification and management of patients with atrial fibrillation is very important for stroke prevention. Mobile medical care has the characteristics of convenient portability, anytime and anywhere operation, and a large amount of information storage. It can realize early identification and timely diagnosis and treatment of atrial fibrillation, thus achieving the purpose of preventing stroke.

In recent years, with the emergence of oral technology and new materials, patients with denture defects have more choices in restoration methods. However, due to the limitation of bone mass, general condition and economic conditions, removable partial dentures are still widely used in clinical practice. Most patients with dentition defects are accompanied by periodontal disease of varying degrees at the same time. Not only the tooth loss and extraction due to periodontal disease, but even the health of abutment after wearing removable partial dentures is still affected and threatened by periodontal disease. Whether denture itself promotes the progression and deterioration of periodontal disease is an urgent problem to be studied. In this study, the effects of removable partial dentures on the periodontal abutment were investigated by observing the periodontal changes of abutment after the restoration of removable partial dentures with Kennedy class I denture defects.

A 25-year-old male was admitted to the hospital on July 6, 2014 due to "repeated cough, hemoptysis for more than 1 month, chest pain and shortness of breath for 8 days". In early June 2014, the patient developed paroxysmal cough with blood in sputum without obvious trigger. CT pulmonary angiography (CTPA) in the local hospital showed pulmonary artery embolism in the left lower lobe of the lung, inflammation in the lower lobes of both lungs, and bilateral pleurisy. The international standardized ratio (INR) of monitoring was 2.00~4.88 after low molecular weight heparin, warfarin anticoagulant therapy and anti-infection therapy. On June 28th, chest pain, shortness of breath and low fever began to appear. Re-examination of CTPA showed that the filling defect in the pulmonary artery in the lower lobe of the left lung was still visible. He came to our hospital for further diagnosis and treatment.

The patient was a 52-year-old Han female with no smoking history. On August 17, 2015, he went to the Department of Respiratory Medicine, Affiliated Hospital of Putian University for "cough and expectoration for more than 1 month". Bronchoscopy after admission showed: nodular protrusion in the anterior wall of the upper main bronchus; The bronchial mucosa of the right upper lobe and middle lobe of the right lung was rough and hypertrophic. Chest CT showed high-density foci, metastasis or inflammation in the lingual segment of the left lung; Inflammation of the middle lobe of the right lung. Immunohistochemical biopsy specimens from right lung puncture biopsy (Fuzhou General Hospital, Nanjing Military Region) showed solid adenocarcinoma, partially micropapillary carcinoma (Figure 1)。 Twenty-nine gene mutation sites in exons 18, 19, 20 and 21 of epidermal growth factor receptor (EGFR) gene of chromosome 7 were detected by real-time quantitative fluorescence PCR. The results showed that the L858R gene mutation site in exon 21 of EGFR gene was detected (Figure 2)。

Patient, male, 68 years old. He was admitted to the Seventh People's Hospital affiliated to Shanghai University of Traditional Chinese Medicine on November 8, 2015 with "progressive enlargement of right scrotal mass for 1 month with pain and discomfort". Physical examination: The general condition is good, there are no abnormalities in the heart and lungs, the abdomen is soft, and the mass is not reached. The right scrotum is obviously enlarged, and a substantial mass about 9 cm ×8 cm in size can be palpable. It is hard in texture, and the surface is not smooth. It is fixed with the right testis and spermatic cord, with unclear boundary and slight tenderness. The mass cannot be returned to the abdominal cavity after lying down, and the light transmission test is negative. Serum tumor markers β-chorionic gonadotropin (β-hCG) 0.1 U/L and alpha-fetoprotein (AFP) 1.39 μ g/L were normal. B-ultrasound examination showed 8.2 cm ×7.8 cm ×7.1 cm heterogeneous mass echo in the right scrotum. CT showed a solid tumor of 7.0 cm ×7.5 cm ×7.0 cm in the right scrotum, and no obvious enlarged lymph nodes were found (Figure 1)。

The patient was a 60-year-old male. In January 2015, the patient developed yellowing of the skin sclera without obvious trigger, the color of the stool became lighter and white clay-like, and the color of the urine deepened. No abdominal pain, abdominal distension, skin itching, etc. Admission physical examination: moderate yellow staining of skin and mucosa throughout the body, and negative physical examination by oncology specialist. Liver and kidney function test on 21 January 2015: alanine aminotransferase 253 U/L, aspartate aminotransferase 172 U/L, total bilirubin 503.6 μ mol/L, direct bilirubin 380 μ mol/L, indirect bilirubin 23.60 μ mol/L, normal renal function. CT plain scan showed that there was a nodule with a size of 2.4 cm ×2.1 cm in the lumen of the common bile duct, which showed mild to moderate enhancement, and an irregular cystic-solid mass with a size of about 5.1 cm ×3.9 cm was visible at the lower pole of the left kidney, protruding from the contour of the kidney, and the solid components and partitions showed progressive enhancement. Due to the severe jaundice of the patient, percutaneous transhepatic biliary drainage was performed to reduce jaundice on January 27 of the same year. Liver function returned to normal after more than 1 month. Abdominal MR enhanced scan: An irregular mass of 5.1 cm ×5.1 cm in size was seen at the lower pole of the left kidney, with clear boundaries, T1WI/DUAL low signal and T2WI/FS mixed high signal. The enhanced scan showed obvious enhancement in the arterial phase, gradual clearance in the portal vein phase, and the mass convexed outside the renal contour. The inferior renal calyx was involved, which was considered kidney cancer. CT and magnetic resonance imaging (MRI) findings revealed ampullary tumor and left kidney tumor. Admission diagnosis: ampullary carcinoma, obstructive jaundice, left kidney cancer.

Stress ulcer (SU) refers to acute gastrointestinal mucosal erosion, ulcer and other lesions that occur under various stress states such as severe trauma, critical illness or severe mental illness, which can invade the submucosa, muscle layer and blood vessels, cause hemodynamic changes, thus leading to gastrointestinal bleeding and even perforation, which can aggravate and worsen the original disease and increase the mortality rate. Therefore, prevention of SU is a link that cannot be ignored in the treatment of critically ill patients. However, in recent years, there are some controversies about the necessity of prevention of SU and the choice of drugs. In this paper, the pathogenesis, epidemiological characteristics, prevention status of SU and the role of proton pump inhibitors in the prevention of SU are described.

Autoimmune hemolytic anemia (AIHA) is an anemia caused by the body producing antibodies against its own red blood cells and dissolving broken red blood cells. The incidence rate is 0.8% ~3.0%, and the mortality rate is about 11%. In recent years, some progress has been made in the treatment of AIHA, which is reviewed in this article.

Most patients with myelodysplastic syndrome (MDS) have anemia at the time of diagnosis and progressively exacerbate, eventually developing into transfusion dependence. The main causes of iron overload in MDS patients are transfusion dependence and ineffective hematopoiesis. Iron overload can significantly reduce the life expectancy of patients with MDS and increase their risk of conversion to acute myeloid leukemia (AML). Deferrotherapy significantly improves the prognosis of patients with MDS, prolongs their survival and reduces their risk of conversion to leukemia. This article expounds the causes of iron overload in MDS patients and the influence of iron overload on the prognosis of MDS.

Extracellular vesicles (EVs) are part of source cells and carry substances such as source cell-specific proteins and nucleic acids. Prostate-derived EVs are produced by prostatic epithelial cells through budding or secretion by storage granules, among other forms. If such a collective carrier carrying a part of the biologically active substance of the source cell can be separated from a body fluid such as blood, urine, prostatic fluid, or semen, the biological characteristics of the source cell can be detected non-invasively. Similarly, prostate cancer (Pca) cells can also produce specific EVs, which may provide direct evidence for the diagnosis, treatment selection, efficacy evaluation, prognosis evaluation and recurrence monitoring of prostate cancer after isolation and detection. The research progress of EVs liquid biopsy in the diagnosis and treatment of Pca is reviewed as follows.