2016年 · 第96卷第08期

Obstructive sleep apnea (OSA) is a condition characterized by periodic or complete upper airway occlusion resulting in intermittent hypoxia, hypercapnia, and elevated intrathoracic pressure under ineffective breathing efforts. Repeated hypoxemia and hypercapnia occur at night, and then chemoreceptors are activated, resulting in excessive sympathetic nerve excitation and increased blood pressure. If it is not effectively treated for a long time, it will lead to the occurrence of atrial fibrillation (referred to as atrial fibrillation for short) or increased susceptibility to atrial fibrillation. The development of atrial fibrillation induced by OSA and the underlying mechanism of continuous positive airway pressure (CPAP) against atrial fibrillation are described below.

Prompt diagnosis and treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) can improve patients' symptoms and reduce related complications. Polysomnography (PSG) is the gold standard for diagnosing OSAHS, but because of its time-consuming, labor-intensive and long waiting time outside the hospital, many patients can't get timely diagnosis and treatment, and it is unrealistic to use its repeated monitoring to judge the progression and efficacy of the disease. Therefore, it is imperative to explore the biomarkers of OSAHS and find convenient indicators.

Major medical malpractice (which leads to the death of the patient or may be a medical malpractice above Grade II or leads to personal injury of more than 3 people is a major medical negligence act) causes serious damage to the patient, has profound lessons and great social impact, and the medical staff involved in the case will face the possibility of medical malpractice crime, which should be paid attention to by medical institutions and medical staff^[1]。 This article summarizes and analyzes the cases of major medical accidents and full liability identified by the National Medical Association in 2014, understands the occurrence law of major medical accidents, grasps their characteristics, finds out the key prevention links of medical risks, finds corresponding countermeasures, further improves medical treatment and prevents the occurrence of major medical accidents.

Adrenocorticotropic hormone (ACTH) is an important hormone for maintaining the normal morphology and function of the adrenal gland, and its function is regulated by the pituitary adrenal system. At the same time, the function of adrenal cortex is regulated by the adrenal medulla. Under physiological conditions, hypothalamus, pituitary gland and adrenal gland (HPA axis) are in relatively dynamic balance. HPA axis is the most important self-stabilizing system in the body, and HPA axis is active under stress state, which promotes the body to produce stress response^[1,2]。 The clinical detection of ACTH is an important indicator for the diagnosis of Cushing's disease and anterior hypopituitary function^[3,4]Therefore, the accuracy of patient test results directly affects clinicians' diagnosis and treatment of diseases. According to the experimental requirements and relevant data report of ACTH detection^[5]Immediately after blood collection, dipotassium ethylenediaminetetraacetate (EDTA-K₂) The sampling tube was stored in ice water, centrifuged at low temperature, and the plasma samples were separated and tested within 22 ℃ for 2 h. It can be seen that the storage time and temperature of specimens after collection are very important for ACTH detection. In actual work, due to workflow and other factors, the submission of specimens for inspection may be delayed, and the requirements stipulated in the experiment cannot be met. The purpose of this study is to understand the influence of clinical specimen storage time and temperature on ACTH determination.

A 48-year-old female patient went to the Department of Gastroenterology of a hospital in Beijing in February 2013 due to weight loss. Blood test routine: white blood cells 99×10⁹/L, hemoglobin 88 g/L, mean erythrocyte volume 78 fl, mean erythrocyte hemoglobin 24.2 pg, mean erythrocyte hemoglobin concentration 311 g/L, platelet count 249×10⁹/L, considering hematological diseases, visited the Institute of Hematology of Peking University. Morphology of bone marrow cells: bone marrow hyperplasia grade III, active granulocyte hyperplasia, 4% blast cells, high proportion, high proportion of middle and late granulocytes, 21% middle and late granulocytes, 20% late granulocytes, eosinophils and basophils can be seen, and 1% mature plasma cells can be seen. Bone marrow cell immunotyping: Abnormal myeloid phenotype. Myelocytes accounted for 83.38%, and some cells expressed CD56 with abnormal phenotype; Basophils accounted for 6.30% and eosinophils for 2.82%. Bone marrow cell genotyping: BCR-ABL (P210) fusion gene =102.0% (normal value is negative), PRAME gene =0.7% (normal value is<0.3%), WT1 gene =6.7% (normal value is<0.6%), JAK2-617 site mutation was negative, and MPLW515L/K mutation tested negative. Karyotyping G banding: 46, XX, t (9; 22) [20]。 He was diagnosed as chronic myeloid leukemia (CML) in the chronic phase and started oral imatinib mesylate (trade name: Gleevec) 400 mg daily treatment in May 2013.

The patient, a 58-year-old male, went to the local hospital on April 26, 2013 due to "cough, expectoration and fever for 3 months". CT examination showed "multiple nodules in both lungs, considering the possibility of metastasis", but he was not admitted to hospital for treatment. After returning home, he received intravenous "anti-infective treatment" in the local infirmary, and his symptoms improved significantly. In order to confirm the diagnosis, the patient was admitted to Zhejiang Cancer Hospital on May 7th of the same year. Positron emission computed tomography (PET-CT) examination showed that "multiple round nodules were scattered in both lungs, which were considered to be multiple metastases in the lungs". Fine needle puncture was performed in the left lung, and the pathological report was "a small number of columnar epithelial cells; no tumor basis was found". He came to our hospital on July 24th, and underwent "thoracoscopic exploration + thoracotomy wedge resection of right lung nodule" on July 31st. Intraoperative observations: dense thoracic adhesions with pleural calcification and multiple nodules in both lungs. Postoperative pathological examination: A piece of wedge-shaped lung tissue, about 6.0 cm ×3.0 cm ×2.0 cm in size, multiple gray-white nodules with a diameter of 0.1~0.5 cm were seen on the section, with medium quality and clear boundary. Microscopic observation: The tumor cells were round or polygonal, with abundant cytoplasm, translucent or eosinophilic, round or elliptical nucleus, no mitotic image, no obvious abnormality, interstitium rich in thin-walled blood vessels, and no necrosis (Figure 1)。 Immunohistochemical test results: Anti-melanoma specific monoclonal antibody (HMB-45) (FIG. 2A), vascular endothelial cell marker (CD34) (Figure 2B), vimentin were all positive, melanin A (Figure 2C), common acute lymphoblastic leukemia antigen (CD10) is partially positive; Broad-spectrum cytokeratin (CK), thyroid transcription factor 1 (TTF-1), acid calcium binding protein (S-100), chromaffin A, neuronal adhesion factor (CD56), neuron-specific enolase (NSE) and synaptophysin were all negative; Proliferating cell nuclear antigen (Ki-67) is low proliferative activity (Figure 2D)。 Periodate Schiff staining (PAS staining) was partially positive (Figure 3)。 Pathological diagnosis: Multiple clear cell tumors of the lung (CCTL).

With the widespread use of imaging technology, the detection rate of adrenal calcification is increasing, and a variety of adrenal diseases such as tumor and hemorrhage can cause secondary adrenal calcification^[1]Primary adrenal calcification is clinically rare. In June 2015, a patient with primary giant adrenal calcification was admitted to the Department of Urology, the First Affiliated Hospital of Guangxi Medical University. The diagnosis and treatment results are reported below.

Macrophages are important components of human body's natural immune system, usually originating from peripheral blood mononuclear cells, circulating to tissues through blood, and having functions such as phagocytosis, antigen presentation, cytotoxicity and tissue remodeling. Some macrophages are distributed in the interstitial of lymphoma tissues, which are the main components of lymphoma microenvironment, and are called lymphoma-associated macrophages (Lymphoma-Associated macrophage, LAM). LAM promotes tumor growth by promoting lymphoma cell proliferation, invasion, and angiogenesis; It can also secrete cytokines such as interleukin (IL) 10 to induce immune tolerance to tumor cells.

Organ transplantation is the preferred treatment option for end-stage liver disease. However, the lack of donor liver has prompted many transplant medical institutions to turn back to cardiac death donor (DCD) donors in an attempt to expand the scope of donor liver access. The first DCD donor liver transplantation was carried out long before Harvard announced the definition of brain death, but the recipient survival rate was low at that time. It was not until the early 1990s that occasional liver transplantation with DCD donor livers began, but the results were poor. In view of the lack of brain dead donors and the high risk of living donor liver transplantation, it is urgent for people to re-discuss and weigh the advantages and disadvantages of DCD donor liver transplantation, so as to make it an important way to obtain donor liver in the future.