We report an acute myocardial infarction patient with respiratory cardiac arrest in whom conventional cardiopulmonary resuscitation was invalid and extracorporeal cardiopulmonary resuscitation (ECMO) was performed. During ECMO, bloodstream infections caused septic shock. With the assistance of ultrasound and other techniques, cardiac function and volume status were evaluated, which provided a basis for making rational clinical decision. After shock resuscitation and anti-infection treatment, the patient's condition improved.

本文报道1 例伴肠母细胞分化的胃黏膜内腺癌的病例。患者男，59 岁，胃镜检查示胃窦小弯侧见一直径约2 cm 不规则凹陷，周围黏膜隆起，中央见结节样隆起，行内镜黏膜下剥离术，肿瘤组织镜下为胃黏膜内中分化管状腺癌，伴有乳头状腺癌，免疫组化染色显示肿瘤细胞SALL4 弥漫（＋）、Hepatocyte 部分（＋）、AFP 局部（＋）、Ki-67 指数约70%；结合免疫组化染色结果，符合伴肠母细胞分化的胃腺癌。伴肠母细胞分化的胃癌少见，且以进展期胃癌为主，黏膜内癌发现率极低;免疫组化表达具有一定特异性；该肿瘤可以行内镜下治疗，预后较差。

目的

探讨羊水减量联合宫颈环扎术治疗孕中期无痛性宫口扩张的效果。

方法

报道1例成功行羊水减量联合宫颈环扎术治疗孕中期无痛性宫口扩张孕妇的临床治疗经过。

结果

1例在孕21⁺⁴周无痛性宫口扩张单胎妊娠孕妇，排除感染后行羊水减量联合宫颈环扎术，术中见宫口开全，羊膜囊膨出至近阴道口，可见胎儿双下肢在阴道内，在彩色多普勒超声引导下，经腹行羊水减量术，抽出羊水220 ml，并经阴道以双10号丝线行双重环扎术，术后保胎、抗感染及预防血栓形成治疗，成功延长孕周至36周，分娩一符合孕周活男婴。

结论

羊水减量联合宫颈环扎术可一定程度上改善中孕期无痛性宫口扩张孕妇的妊娠结局。

目的

探讨妊娠合并Gitelman综合征（Gitelman syndrome，GS）的临床特点、诊断、治疗及母儿结局。

方法

回顾性分析我院收治的1例经基因分析确诊为妊娠合并GS患者的临床资料，对该病的临床特点、治疗方案及母儿结局进行分析，并结合国内外相关病例报告总结妊娠合并GS的诊治要点。

结果

本例患者既往妊娠有不明原因的低钾血症，本次妊娠因“低钾血症、低镁血症”收住入院，予积极补钾、补镁治疗难以纠正，进一步行Gitelman/Bartter综合征相关基因测序，结果示SLC12A3基因16号染色体c.2521+253C＞T纯合突变，AR，致病性变异，诊断为妊娠合并GS。孕期规律监测电解质变化，口服补钾效果欠佳，多次入院静脉补钾治疗，至孕足月剖宫产分娩一活婴，母婴预后良好。

结论

GS临床罕见，重视孕早期电解质检查可避免漏诊，确诊需依赖基因检测。孕期需通过多学科协作制定包括阶梯式补钾、补镁的个体化治疗方案，以维持电解质平衡并预防心律失常、肌无力等严重并发症。GS患者妊娠期病情可能加重，但通过严密监测与积极干预，可获得良好母婴结局。

Objective

To investigate the clinical diagnostic characteristics and potential pathophysiological mechanisms of Guillain-Barré syndrome （GBS） manifesting with unilateral limb weakness as the initial presentation.

Methods

A retrospective analysis was conducted on the clinical data of a GBS patient with unilateral limb weakness who was admitted to the Department of Neurology of the Affiliated Hospital of Jining Medical University on July 24， 2024， and the relevant literature was reviewed.

Results

The patient was a 66-year-old female who was admitted mainly due to "left lower extremity weakness for 5 hours". Her past medical history included thoracic compression fracture （T₁₂） surgery and left breast cancer surgery.Four days before the onset of the disease， she had fever accompanied by diarrhea. No new infarction foci were found on the cranial MRI upon admission， and no improvement was noted after treatment with antiplatelet therapy， cerebral circulation enhancement， and mitigation of brain tissue injury. On the fourth day after admission， the weakness of the left lower extremity worsened， and weakness of the right lower extremity occurred. Cerebrospinal fluid analysis showed a white blood cell count of 4×10⁶/L and a protein concentration of 0.51g/L. Gram staining， acid-fast staining， fungal staining， and India ink staining of the cerebrospinal fluid revealed no abnormalities. Anti-ganglioside （GM1， GM1b， GalNAc-GD1a， GD1a， GD1b， GQ1b，and GT1a） IgG antibodies were negative. Electrophysiological studies of the lower limbs demonstrated a significant reduction in the amplitudes of the left tibial and left common peroneal nerves， with mildly decreased conduction velocity in the left tibial nerve. The patient was finally diagnosed with GBS. After plasma exchange， the patient′s symptoms were significantly relieved.

Conclusion

GBS that begins with unilateral limb weakness needs to be differentiated from cerebral infarction.

Objective

To explore the diagnostic characteristics of invasive pulmonary fungal infection（IPFI）caused by Alternaria spp.

Methods

The clinical data of a patient with IPFI caused by Alternaria spp. infection， diagnosed and treated in the Pulmonary and Critical Care Medicine Department of Western Theater General Hospital on May 31， 2024 were retrospectively analyzed， and relevant literature was reviewed.

Results

The patient was an 84-year-old female who presented with cough， sputum production，and left-sided chest pain. Chest CT showed multiple patchy and exudative lesions in both lungs. Conventional anti-infection treatment was ineffective， with no significant absorption of the lesions. Bronchoscopy revealed no abnormalities， but metagenomic next-generation sequencing （mNGS） of the lavage fluid identified Alternaria spp. as the pathogen. The patient was treated with nebulized amphotericin B combined with intravenous voriconazole for antifungal therapy. After 10 days of treatment， symptoms significantly improved，and follow-up chest CT showed slight absorption of the lesions. After discharge， the patient continued taking oral voriconazole. Three months later， the patient′s cough， sputum production， and chest pain completely resolved， with chest CT showed significant absorption of the lesions.

Conclusion

mNGS can effectively diagnose IPFI caused by Alternaria spp.， and the combination of amphotericin B and voriconazole can achieve favorable therapeutic outcomes.