CT引导下放射性粒子125I植入治疗原发性肝癌的近期疗效和安全性

目的 观察CT引导下放射性粒子125I植入治疗原发性肝癌的近期疗效和安全性.方法 收集2010年4月至2011年3月在中山大学附属第一医院及解放军第四五八医院收治的原发性肝癌病例63例,接受研究病灶75个（其中16个病灶长径小于5 cm,其余病灶长径大于5 cm）,均行CT引导下放射性粒子125I植入治疗.术后2个月分别行CT检查评价粒子植入治疗效果.分别记录术前、术后3d、1个月、2个月肝功能变化及术后6个月内并发症发生情况.结果 所有75个病灶术后2个月CT检查评价治疗效果完全缓解（CR）4个,部分缓解（PR）10个,稳定（SD）39个,进展（PD）22个,总有效率为18.7％.然而对于长径小于5 cm的16个病灶,治疗效果评价完全缓解（CR）4个,部分缓解（PR）8个,稳定（SD）3个,进展（PD）1个,总有效率为75％.术后1、2个月复查肝功能丙氨酸氨基转移酶（ALT）及天门冬氨酸氨基转移酶（AST）与术前比较差异具有统计学意义（P＜0.05）,均较术前升高;术后3 d ALT、AST与术前比较及术后各时间点间比较差异无统计学意义.术前、术后各时间血清总胆红素及白蛋白水平变化差异无统计学意义.术后6个月内共出现粒子移位24例,针道种植转移2例,气胸2例,1例出现恶心、呕吐、纳差.结论 对于失去外科手术机会的原发性肝癌患者,放射性粒子125I植入治疗对于长径小于5 cm肿瘤病灶,有效率较高.放射性粒子植入会引起一些不良反应和并发症,但未发现有致命性并发症发生.     

食管恶性纤维组织细胞瘤2例

例1，女，53岁，因进行性吞咽困难2个月入院。外院胸部CT示食管癌，既往无手术史，其母亲死于食管癌。我院胃镜病理活检示小片高度异型细胞，疑为肉瘤或肉瘤样癌。例2，男，72岁，因上腹部间歇性隐痛9个月入院，外院钡餐检查示食管下段平滑肌瘤。后食欲欠佳，体重下降。半年后入院钡餐检查示食管下段充盈缺损约9cm×4cm大小，境界清晰，边缘光整，与外院检查相比增大明显。2例均作食管大部分切除。例1患者术后15天因严重感染而死亡，例2无随访记录。[第一段]     

复发性腹腔滤泡树突状细胞肉瘤一例

患者女,48岁.因乏力、腹胀3个月于2005年9月于外院就诊,B超示盆腔、腹腔多发占位,大量腹腔积液.术中发现3处肿块,术后病理诊断:符合滤泡树突状细胞肉瘤.术后未治疗.2007年10月患者出现腹胀、纳差,入我院治疗.B超示腹腔积液,肝血管瘤;CT:盆腔见多个大小不等的结节肿块,大者10 cm×12 cm;腹腔积液检查呈渗出液,未见肿瘤细胞.考虑术后复发,遂予化疗7个周期,4个周期后复查CT:右肝低密度影,腹腔积液消失,肿块缩小.2008年10月复查未见肿瘤复发及转移,2009年1月复查B超提示腹腔积液及腹腔占位,腹腔穿刺见少量血性腹腔积液(因量少未送检),考虑再次复发,化疗2个周期.     

中晚期食管癌光动力治疗联合化疗的回顾性研究

目的比较中晚期食管癌的单纯光动力治疗与光动力＋化疗联合治疗的短期疗效，探讨中晚期食管癌光动力＋化疗的治疗模式的优势。方法回顾性分析我院自2002年至2005年期间光动力治疗及光动力＋化疗治疗的食管癌患者60例（Ⅲ～Ⅳ期），其中单纯光动力治疗27例，光动力＋化疗治疗33例。光动力治疗使用光敏剂Photofrin 2mg／kg，48h后内镜引导下使用波长为630nm的激光照射，综合治疗组化疗方案为5-FU＋DDP，动力治疗后1周开始化疗，共化疗4周期。结果60例病人随访时间全部满2年，综合治疗组和单纯光动力治疗组症状缓解率分别为85．2％、93．9％，内镜评价有效率分别为85．2％、90．9％，无明显差异；2年生存率分别为54．5％、29．6％，综合治疗组中位生存期明显延长（Ⅲ期为22m、13m；Ⅳ期为7m、5m），差异有统计学意义（P=0．046）。结论光动力＋化疗治疗中晚期食管癌优于单纯光动力治疗，短期疗效相当，2年生存期有优势。     

应用内镜黏膜下剥离术处理食管黏膜病变疗效评价

目的应用内镜黏膜下剥离术(ESD)处理食管早癌及癌前病变,评价其疗效和安全性。方法回顾性分析2008年10月至2009年10月分别于复旦大学附属中山医院和新疆医科大学第六附属医院内镜检查及病理诊断为早期食管癌及癌前病变35例患者,其中男性24例,女性11例;年龄38～78岁,平均年龄60岁。对患者行内镜下治疗,观察术中出血、穿孔及术后食管狭窄的发生情况,统计病灶完整大块切除率与组织学完全切除率,通过随访评价复发或转移情况,对内镜治疗短期效果进行初步评价。结果完成ESD操作28例,7例(20.0%)改为内镜下黏膜切除术(EMR)切除,手术耗时20～125min,平均耗时65 min。颈部气肿1例,术中穿孔2例(5.7%),术中少量出血8例(22.9%),术后延迟性出血1例。组织学治愈26例(74.3%)。除2例手术治疗外,32例完成随访,1例(3.3%)失访。随访4～26个月,中位随访时间10个月。随访中,3例复发,复发率9.4%(3/32),3例发生术后食管狭窄包括1例复发病例。结论 ESD治疗早期食管癌及癌前病变具有较好的疗效和安全性。     

60岁以上高危食管异物患者手术治疗体会

目的 探讨60岁以上高危食管异物患者安全手术治疗的经验。方法 回顾性分析2009年1月—2013年5月60例60岁以上高危食管异物患者的临床资料,重点分析本组病例的临床特点及治疗经验。结果 40例在全麻下经食道镜取出异物,8例在表麻下经胃镜取异物（其中2例经胃镜推入胃内）,4例在表麻下经食管镜取出异物,3例在全麻下经颈径路取出异物,1例开胸取出异物,1例胸腔镜取出异物,3例手术探查未发现食管异物。41例患者术后恢复良好或经X线复查无异常后痊愈出院;1例手术后第3天死于肺栓塞;16例未复查自动出院,其中1例术后第7天死于纵膈感染;2例因恢复时间较长,回当地医院继续治疗。除2例死亡病例外所有患者随访1～2个月,进食良好,无特殊不适。结论 根据异物的种类、形状、大小、停留部位及周围组织损伤程度以及患者的一般情况,尽早（24 h内）选择合适的治疗方案取出异物,术后还需根据患者的年龄和食管损伤的程度预防肺栓塞和纵膈感染等严重并发症的发生。     

双镜联合微创治疗食管平滑肌瘤36例临床分析

目的 探讨电视胸腔镜(VATS)联合胃镜在食管平滑肌瘤治疗中的可行性及临床价值.方法 采用电视胸腔镜(VATS)联合胃镜行食管平滑肌瘤摘除术36例,位于食管下段24例,食管中段10例,食管上段2例.肿瘤大小1.0 cm×1.2 cm～ 4.0 cm×4.5 cm.结果 本组36例患者均在全胸腔镜下完成手术.1例术中发生食管黏膜破裂,全组患者术中手术时间(62.7±16.2)min,出血量(60.5±24.6)ml.术后胸腔引流管放置时间(2.1±1.3)d,开始进食时间为术后(2.4±1.8)d,术后住院时间(5.4±1.8)d.术后36例患者病理均为平滑肌瘤.除l例术中发生食管黏膜破裂外,余患者均无手术并发症和死亡发生.结论 胸腔镜联合胃镜治疗食管平滑肌瘤的方法安全、有效,可作为食管平滑肌瘤外科治疗的首选手术方式.     

晚期食管癌患者食管内支架置入术的整体护理

目的：初步探讨整体护理对晚期食管癌患者食管内支架置入术后患者的临床效果。方法采用回顾性研究的方法,回顾2013年6月~2014年6月成功为20例晚期食管Ca患者在胃镜下行食管支架置入术后的整体护理。结果20例患者全部置入成功,术后2h可进流食,术后2w再进行吞咽苦难分级。未发生大出血穿孔等近期并发症,随访6~12个月,均未发生支架变形、移位及食物嵌塞等远期并发症。结论通过全方位的整体护理,晚期食管癌患者食管内支架置入术后能有效防治可能发生的并发症,值得推广应用。     

改良食管胃胸顶吻合法在食管癌手术中的应用

目的：探讨改良食管胃胸顶吻合法的临床应用效果。方法：对351例食管癌采用右胸上腹两切口食管癌切除＋胸腹两野淋巴结清扫术治疗，并行胃一食管胸顶吻合。采用单层宽边手工吻合，术中充气检查吻合口，对有渗漏者在渗漏处予以加密缝合，最后使用纵隔胸膜舌形瓣覆盖吻合口。结果：351例无一例发生术后吻合口瘘，5例（1．42％）术后继发1～2级吻合口狭窄，无一例出现严重吻合口狭窄。结论：改进的胃-食管胸内吻合法，操作简单，疗效满意，值得基层医院推广。     

早期食管癌患者胸腔镜手术后并发食管狭窄的Logistic回归分析

目的:分析早期食管癌患者胸腔镜手术后食管狭窄发生的影响因素.方法:前瞻性选择2020年5月至2021年7月在我院行胸腔镜食管癌根治术治疗的59例早期食管癌患者作为研究对象.术后门诊随访1 y,采用胃镜检查评估患者食管狭窄情况并根据狭窄情况的不同,将患者分别纳入狭窄组与未狭窄组.设计基线资料调查表,询问并记录患者基线资料,分析早期食管癌患者胸腔镜手术后食管狭窄发生的影响因素.结果:59例早期食管癌患者中发生术后食管狭窄10例(16.95％),未发生食管狭窄49例(83.05％).狭窄组患者病变长度高于未狭窄组,端端吻合、术后发生吻合口瘘占比高于未狭窄组(P<0.05).经多元Logistic回归分析,结果显示,病变过长、端端吻合、术后吻合口瘘是早期食管癌患者胸腔镜手术后发生食管狭窄的危险因素(OR>1,P<0.05).结论:早期食管癌患者胸腔镜手术后发生食管狭窄的影响因素为病变长度、吻合方式、术后吻合口瘘.     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

The universal muscular chain reaction,muscle spasm,Torsions, ruptures and extravasations. Chameleons of pathology and some manifestations of simple muscular disorders

Most bodily functions require the coordinated actions of complementary and supplementary paired muscle groups. Where this essential muscular cooperation is lacking, hollow organs may burst and others become literally screwed up, giving rise to many similar spastic diseases such as Torticollis, Twisted ovarian cyst, Torsion of the Testis, Volvulus of the intestines, Varicose Veins, Megacolon, Aortamegaly, Scoliosis, Erb's Palsy, Peyronie's Disease, Main-en-Griffe, Undescended Foot (Pes Cavus), Talipes, Strabismus. Spasm is “panenepidemic” and unclassified examples of Torsion Dystonia and Dyskinesia really are as common as debt and taxes.     

Class II HLA in Georgia Caucasus Tbilisi Georgians and their Mediterranean ancestry: The Usko Mediterranean languages

Georgia (or Sakartvelo in its own language) is a South Caucasus Mts. country with its easternmost part is enigmatically named Iberia, like the Iberian Peninsula, which may refer to rivers “Kura” and “Ebro” or their valleys respectively. Most of their inhabitants speak Georgian which is included within Dene-Caucasian group and Usko-Mediterranean subgroup of languages. The latter includes Basque, Berber, ancient Iberian-Tartessian, Etruscan, Hittite, Minoan Lineal A and others. In the present paper, HLA class II -DRB1 and -DQB1 alleles has been studied and extended haplotypes calculated. Most frequent haplotypes are also of Mediterranean origin (i. e.: (A*02-B*51)-DRB1*11:01-DQB1*03:01, (A*02-B*51)-DRB1*13:01-DQB1*06:03, or (A*24-B*35)-DRB1*01:01-DQB1*05:01) and DA genetic distances show that closest world populations to Georgians are Mediterraneans. Georgians also show common extended haplotypes ((A*02-B*51)-DRB1*11:01-DQB1*03:01, (A*02-B*13)-DRB1*07:01-DQB1*02:01 and (A*03-B*35)-DRB1*11:01-DQB1*03:01) with Svan people, a secluded population in North Georgia mountains. We can conclude that Georgians belong to a very old Mediterranean substratum according to both linguistics (Usko Mediterranean languages) and HLA genetics.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.