MRI参数与三阴性乳腺癌组织病理学分级及淋巴结转移的相关性研究

目的:探讨三阴性乳腺癌(TNBC)的MRI表现、TIC类型、ADC值与肿瘤大小、组织病理学分级、淋巴结转移之间的相关性。方法:收集经病理证实的TNBC患者102例,均行乳腺MRI平扫、DWI和动态增强扫描。比较TNBC不同肿瘤大小、组织病理学分级、有无淋巴结转移的MRI表现和参数。肿瘤大小、组织病理学分级、淋巴结转移与TIC类型及ADC值的相关性行Spearman相关分析。结果:不同肿瘤大小(T1、T2、T3)、不同组织病理学分级(Ⅰ～Ⅱ级、Ⅲ级)、有无淋巴结转移患者的肿块形态、边缘、强化特征、T2WI信号差异均无统计学意义(均P 0.05)。组织病理学分级、淋巴结转移与TIC分型及ADC值均有相关性(均P0.05)。结论:TIC分型越高或ADC值越低,TNBC的组织病理学分级越高,淋巴结转移的风险越大。     

16层螺旋CT灌注成像强化指标和肿瘤微血管密度与肺癌淋巴结转移的关系

目的 应用16层MSCT灌注成像定量评价肺癌肿瘤血管生成,并探讨CT灌注成像强化指标和肿瘤微血管密度(MVD)与肺癌淋巴结转移的关系及其价值.方法 对53例周围型肺癌行CT灌注扫描,根据首过期肿块强化的时间-密度曲线(TDC)计算肿瘤的灌注强化指标,根据病理结果分为有淋巴结转移组和无淋巴结转移组,并对肿瘤MVD计数.淋巴结转移组与无转移组各观察指标的差异采用t检验或t'检验;将CT灌注强化指标分别与MVD做相关性分析;利用ROC曲线分析MVD和CT灌注强化指标评价肺癌淋巴结转移的诊断效能.结果 (1)肺癌淋巴结转移组(26例)MVD计数高于无淋巴结转移组(27例),MVD分别为(64.69±16.34)、(42.67±16.78)个/0.74 mm~2(t=4.84,P<0.01).淋巴结转移组肿块的强化峰值(PH)、肿块与主动脉PH之比(M/A)、灌注值(PV)均高于无淋巴结转移组[PH分别为(41.79±15.50)、(29.99±10.91)HU;M/A分别为0.24±0.09、0.15±0.06;PV分别为(2.14±1.09)、(1.27±0.53)ml·min~(-1)·ml~(-1)];差异均有统计学意义(t值分别为3.21、3.95、3.66,P均<0.01).(2)PH、M/A、PV均与MVD呈正相关,其中PV与MVD的相关系数最高(r=0.716,P<0.01).(3)利用ROC曲线分析,MVD、PV判断肺癌淋巴结转移有较高的诊断价值(曲线下面积分别为0.828、0.849,P>0.05);当以MVD>52个/0.74 mm~2或PV>1.52 ml·min~(-1)·m~l(-1)作为强烈提示肺癌淋巴结转移的可能性时,其敏感性、特异性、诊断符合率均较高(分别为80.8%、81.5%、81.1%和84.6%、85.2%、84.9%).结论 CT灌注强化指标PV及MVD与肺癌淋巴结转移存在密切关系,PV可作为术前判断肺癌淋巴结转移的重要指标之一.     

多效生长因子、基质金属蛋白酶2与浸润性乳腺癌临床病理特征的关系研究

目的研究多效生长因子(PTN)和基质金属蛋白酶2(MMP2)在乳腺癌中的表达与患者临床病理特征的相关性。方法收集103例浸润性乳腺癌初治病例的病理标本,其中三阴性乳腺癌(TNBC,即雌激素受体、孕激素受体和人类表皮生长因子受体2均为阴性表达)51例,非TNBC 52例,另取10例癌旁组织作为对照。利用免疫组织化学法检测PTN和MMP2的表达,分析其与乳腺癌患者临床病理特征(年龄、肿瘤大小、组织病理学分级和腋窝淋巴结转移)的相关性。结果 103例乳腺癌患者中,TNBC与非TNBC的发病年龄、肿瘤大小、腋窝淋巴结转移情况差异无统计学意义(P>0.05),组织病理学分级差异有统计学意义(P<0.05)。103例乳腺癌中PTN的阳性表达率为83.5%(86/103),MMP2的阳性表达率为68%(70/103),且二者在TNBC及非TNBC患者中的表达差异无统计学意义。PTN和MMP2的表达均与乳腺癌患者的发病年龄、组织病理学分级、腋窝淋巴结转移相关,但二者在乳腺癌中表达的一致性较弱(Kappa系数=0.1817,95%CI=-0.0091~0.3726;Z=2.0212,P=0.0433)。结论在浸润性乳腺癌中,PTN、MMP2的表达与TNBC无关,与年龄、组织病理学分级、腋窝淋巴结转移相关;PTN与MMP2表达的一致性较弱。     

乳腺癌的彩色多普勒血流特征与ER、PR、HER-2、P53和KI-67表达的相关性研究

目的探究乳腺癌的彩色多普勒血流特征同ER、PR、HER-2、P53和KI-67间表达的关联性,对乳腺癌预防和诊断提供理论依据。方法收集2016年3月～2017年7月,经病理学证实的35例乳腺癌患者作为观察对象,根据乳腺癌患者彩色多普勒特点与免疫组化指标,判断乳腺癌彩色多普勒血流特征与分子生物学之间的关系。结果乳腺恶性肿瘤ER、PR、HER-2、P53和Ki-67的阳性表达率在肿块大小2cm组都分别高于≥2cm组,且无统计学意义(P0.05),ER、PR的肿块血流组(血流2～3级)、无肿块伴钙化组和淋巴结转移组的阳性表达率分别高于肿块血流组(血流0～1级)、肿块伴钙化组和淋巴结转移组,且有无肿块伴钙化同PR阳性表达呈显著性差异(P0.05),HER-2、P53、Ki-67的周围侵犯组织的阳性表达率都分别低于无周围侵犯组织,HER-2的肿块血流组和淋巴结转移组,两者之间有显著性差异(P0.05),ER的有无侵犯组织间有显著性差异(P0.05)。结论乳腺恶性肿瘤的彩色多普勒血流特征与免疫组化指标之间有一定的关联性,可以在一定程度显示出一些病理特征,对肿瘤的诊断、治疗及预后提供有力的理论基础。     

肾癌组织中微血管密度检测及其临床意义

目的探讨肾癌微血管密度(MVD)与其组织学类型、肿瘤分级及转移之间的关系;评价MVD对肾癌预后估价的意义.方法应用Ⅷ因子相关抗原(FⅧ-RAg)单克隆抗体进行免疫组化SABC法染色,检测49例原发性肾癌根治性切除术标本中MVD.结果的例肾癌组织中平均MVD为58.62±23.86,明显高于正常肾组织(P＜0.01).MVD与其局部淋巴结转移无相关性(P＞0.05),而与肾癌的分级及远处转移呈正相关(P＜0.01),与5 a生存期呈负相关(P＜0.01).结论肾癌组织中MVD与其组织学类型、肿瘤分级、远处转移及生存期均密切相关,检测肿瘤组织中MVD可作为估价肾癌预后的一项重要指标.     

乳腺浸润性导管癌组织中Sox2的表达与临床病理因素及预后的相关性研究

 目的 探讨Sox2在乳腺浸润性导管癌组织中的表达及其与临床病理因素和预后的相关性。方法 采用免疫组织化学方法（Envision染色）检测138例乳腺浸润性导管癌及其配对癌旁正常乳腺组织中Sox2的表达水平,运用 χ 2检验和kaplan-Meier法分析肿瘤组织Sox2与临床病理因素及患者总生存时间的关系。结果 Sox2在乳腺癌组织和正常组织中的表达有显著性差异（ P <0.01）;Sox2在乳腺癌中的表达与组织学分级（ P =0.015）、淋巴结转移（ P =0.010）、肿瘤-淋巴结-远处转移分期（tumor-lymph node-metastasis stage, TNM）（ P =0.038）、人表皮生长因子-2（HER-2）的状态（ P =0.031）及术后5年生存率（ P =0.018）均有显著相关性;与患者年龄、肿瘤直径大小以及雌激素受体、孕激素受体的状态无显著相关性。结论 Sox2的表达可能参与了乳腺癌的发生、发展过程,其表达与临床病理因素及预后有一定关系,其很可能成为潜在的治疗靶点及判断乳腺癌预后的有价值的肿瘤标记物。     

乳腺癌X线摄影恶性钙化征象与其预后因素的相关性分析

目的 探讨乳腺癌X线摄影恶性钙化征象与雌激素受体(ER)、孕激素受体(PR)及人表皮生长因子相关基因(CerbB-2/HER-2/neu)表达、淋巴结转移及肿块大小的相关性.方法 回顾分析87例术后病理诊断为乳腺癌患者的乳腺X线摄影胶片,记录乳腺癌钙化情况,记录术后标本肿瘤细胞ER、PR及CerbB-2表达的免疫组化结果、记录术后病理淋巴结转移情况及肿块大小,分析乳腺癌恶性钙化灶与上述因素的关系.结果 乳腺癌恶性钙化灶与ER、PR表达、淋巴结转移情况及肿块大小无显著关联性(P>0.05),而乳腺癌恶性钙化灶与CerbB-2的表达有显著关联性(P<0.05).结论 乳腺癌恶性钙化征象与分子生物学指标CerbB-2之间存在一定的关联性.乳腺癌X线摄影从一定程度上反映了癌细胞的生物学行为.     

乳腺癌中P16基因改变及其生物学意义

采用聚合酶链反应——单链构象多态性分析(PCR—SSCP)法对30例乳腺癌及其癌旁组织和10例转移淋巴结标本中P16基因改变进行分析,并对P16基因改变与乳腺癌发生的年龄、病理类型及乳腺癌的分级与预后作了探讨。结果发现:①30例乳腺癌中有2例缺失,8例突变;②10例转移淋巴结标本中有6例突变;③癌旁组织中有2例突变。三者之间突变率相差显著(P<0.01);④P16基因改变与乳腺癌发生年龄、病理类型无关,与乳腺癌分级及5年生存率相关。结论:P16基因以突变、缺失方式参与乳腺癌发生发展,检测P16基因有无异常可辅助诊断病程及预后。     

肿瘤细胞标志物与乳腺癌预后的相关性研究

目的　探讨原癌基因C erbB 2蛋白、增殖细胞核抗原 (PCNA)、凋亡抑制基因 (Bcl 2 )、p5 3基因和转移抑制基因 (nm2 3 H1 )在乳腺癌患者接受简化根治术后几项指标同时检测对乳腺癌预后的指导作用。方法　对接受相同治疗方案 (改良根治术及术后放、化疗 )的 6 1例乳腺癌患者的术后石蜡切片标本进行免疫组织化学染色 ,检测C erbB 2、PCNA、Bcl 2、P5 3及nm2 3 H1 蛋白表达 ,并随访观察 5和 8年生存率。结果　不同的肿瘤大小、病理分级、淋巴结转移数 ,患者生存率差异有显著性 (P <0 0 5 )。雌激素受体 (ER)、孕激素受体 (PR)、C erbB 2、PCNA、Bcl 2、P5 3、nm2 3 H1 蛋白阳性及阴性表达组 5和 8年生存率差异均有显著性 (P <0 0 5 )。老年组和青壮年组生存率差异无显著性。结论　除传统的预后因素外 ,肿瘤细胞标志物 (C erbB 2、PCNA、Bcl 2、p5 3、nm2 3 H1 )均可作为判断乳腺癌预后的参考指标。     

HER-2、Syk在胃癌中的表达及其临床意义

 目的 探讨人表皮生长因子受体2(human epidermal growth factor receptor 2, HER-2)、脾酪氨酸激酶(spleen tyrosine kinase, Syk)在胃癌中的表达及与胃癌的相关关系.方法 采用反转录-聚合酶链反应(RT-PCR)和SP免疫组化技术,检测62例胃癌及癌旁组织中HER-2、Syk表达状况,与胃癌临床病理检测结果进行相关性统计分析.结果 胃癌组织中HER-2 mRNA、HER-2蛋白阳性率分别是11.29%和30.65%,均高于癌旁组织(P＜0.05);Syk mRNA、Syk蛋白阳性率分别为27.42%和22.58%,均低于癌旁组织(P＜0.05).淋巴结转移的胃癌组织中,HER-2 mRNA、HER-2蛋白阳性表达率均高于无淋巴结转移组(P＜0.05),Syk mRNA、Syk蛋白阳性表达率均低于无淋巴结转移组(P＜0.05).HER-2表达与胃癌患病年龄、性别、肿瘤大小、部位均无相关性(P＞0.05),与肿瘤浸润深度、病理分期相关(P＜0.05),Syk表达与胃癌上述临床病理结果均无相关性(P＞0.05).HER-2蛋白与Syk蛋白在胃癌组织中的表达呈负相关.结论 胃癌发生和转移与HER-2表达和Syk表达密切相关.检测HER-2、Syk对胃癌的治疗及其预后评估具有指导意义.     

非电离辐射对海马体的影响及研究方法进展

海马体作为神经系统的重要组织,与生物的学习、记忆、空间认知等功能密切相关。在研究非电离辐射对神经系统的影响过程中,探究其对海马体的影响格外重要。本文就非电离辐射对海马体的影响及其研究方法进行综述,以期为后续的研究提供借鉴。     

Nutrition on the Run

Abstract

Approximately 7.6 million high school students in the United States participate in sports. Although most sport-related injuries in adolescents are considered minor emergencies, life-threatening illnesses or injuries may occur, such as sudden cardiac arrest, heat stroke, status asthmaticus and exercise-induced asthma, catastrophic brain injuries, cervical spine injuries, heat- and cold-related illness, blunt chest/abdominal injuries, and extremity fractures resulting in compartment syndrome. Emergency preparedness in athletics involves the identification of and planning for medical services to promote the safety of the athlete, to limit injury, and to provide medical care at the site of practice or competition. Several national organizations have published guidelines for emergency preparedness in school-based athletics. Our article reviews guidelines for emergency preparedness put forth by the Sideline Preparedness collaboration (comprised of 6 major professional associations, including the American Academy of Family Physicians, American Academy of Orthopedic Surgeons, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine), the National Athletic Trainers' Association, the American Academy of Pediatrics' Committee on School Health, and the American Heart Association. Additionally, we review published data examining compliance of US high schools with these recommendations for emergency preparedness in school-based athletics, determine deficiencies, and provide recommendations for improvement based on these deficiencies.     

Puttin' on the Blitz

Abstract

Exercise-induced bronchoconstriction (EIB) is a condition in which vigorous physical activity triggers acute airway obstruction in asthmatic and nonasthmatic individuals with hyperresponsive airways. Studies have shown that inflammatory mediators and contraction of airway smooth muscle are central components in the pathogenesis of EIB, and it has long been recognized that leukotrienes and prostaglandins play an important role in the EIB response. Clinical responses to current therapy, such as leukotriene modifiers and corticosteroids are heterogeneous, and even with optimal treatment there is a substantial burden of unaddressed disease. While daily medications such as leukotriene modifiers provide only modest protection against symptoms, prolonged use of several medications can result in reduced effectiveness or tachyphylaxis. Although the treatment of EIB almost exclusively involves pharmacotherapy, there is now convincing evidence that dietary modification has the potential to reduce the severity of this condition. Omega-3 polyunsaturated fatty acids, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in fish oils, compete with arachidonic acid as substrates for the formation of proinflammatory mediators, such as leukotrienes, prostaglandins, and cytokines. Studies have shown that 3 weeks of fish oil supplementation, rich in EPA and DHA, reduces exercise-induced airway narrowing, airway inflammation, and bronchodilator use in elite athletes and asthmatic individuals with EIB. Based on the evidence to date, fish oil supplementation may represent a potentially beneficial treatment intervention for athletes and asthmatic individuals with EIB. From this, it follows that physicians should pay more attention to what their asthma/EIB patients eat, and incorporate dietary assessment and nutritional counseling in their everyday practice.     

Interobserver agreement on the radiological criteria of the International Panel on the diagnosis of multiple sclerosis

We assessed the interobserver agreement on the radiological part of the International Panel (IP) criteria for the diagnosis of multiple sclerosis (MS), comprising the assessment of dissemination in space (DIS) and time (DIT) based exclusively on MRI. Four radiologists trained and four radiologists naive in the application of the IP criteria scored the fulfillment for DIS (i.e., ≥3 periventricular, ≥1 infratentorial, ≥1 juxtacortical, ≥ 1 enhancing lesion or a total of ≥9 T2-weighted lesions) and DIT (presence of new or enhancing lesions at follow-up) in baseline and two follow-up scans from 20 patients suspected for having MS. The IP-trained radiologists agreed at least moderately on all assessments (κ>0.40), whereas the IP-naive radiologists showed fair agreement (κ<0.40) on five of 16 assessments. In the final conclusion on DIS and DIT, the IP-trained radiologists agreed substantially on both items (κ=0.62 and κ=0.60, respectively) compared with a fair agreement on DIS (κ=0.29) and moderate agreement on DIT (κ=0.52) among the IP-naive radiologists. Given the poor interobserver agreement among IP-naive observers, the new IP criteria for MS require additional training and should perhaps be simplified.