新辅助化疗对宫颈癌微血管密度及血管内皮生长因子的影响

目的 :研究进展期宫颈癌新辅助化疗 (NACT)前后微血管密度 (MVD)及血管内皮生长因子 (VEGF)的改变 ,探讨新辅助化疗对宫颈癌治疗的意义。方法 :手术前行NACT的宫颈癌患者 37例为研究组 (NACT组 ) ,直接手术的 2 0例患者为对照组。应用免疫组化方法检测宫颈癌组织的MVD和VEGF的表达 ,分析其改变与NACT的关系和意义。结果 :(1 )NACT的总有效率为 62 .2 % ;(2 )NACT组在化疗前与直接手术组MVD和VEGF的表达差异无显著性 ;(3)NACT有效者的MVD和VEGF的表达明显降低 ,无效者则无明显变化 ;(4)NACT后宫颈腺癌和鳞癌的MVD和VEGF表达率无显著差异。结论 :NACT对进展期宫颈癌有效 ,NACT有效者的MVD和VEGF表达明显减低 ,MVD和VEGF可以作为NACT的客观评价新指标     

缺氧诱导因子-1在宫颈鳞癌及其新辅助化疗前后的表达及临床意义

目的:检测宫颈鳞癌及其新辅助化疗(NACT)前后宫颈鳞癌组织缺氧诱导因子-1α(HIF-1α)的表达变化,探讨其与宫颈鳞癌临床病理因素和NACT疗效的相关性,及其作为NACT疗效的预测指标的可行性.方法:采用免疫组化SP法检测宫颈鳞癌直接手术组、新辅助化疗前后、宫颈上皮内瘤变(CIN)及对照组的宫颈组织标本中HIF-1α的表达.结果:宫颈鳞癌组织中HIF-1α的表达明显升高;HIF-1α在宫颈鳞癌组织中的表达与深肌层浸润及局部病灶大小有关.NACT后,临床完全缓解3例(10%),部分缓解21例(70%),总有效率为80%.NACT后宫颈鳞癌组织中HIF-1α的表达显著下降(P＜0.05).HIF-1α的表达在临床有效组NACT后显著下降(P＜0.01),而临床无效组NACT前后的表达差异无统计学意义(P＞0.05).结论:宫颈鳞癌组织HIF-1α的表达与新辅助化疗疗效相关,说明宫颈鳞癌组织缺氧诱导因子-1(HIF-1)的表达可能成为NACT化疗疗效的预测指标.     

SCC-Ag在宫颈癌新辅助化疗前后的改变及临床意义

目的观察SCC-Ag在宫颈鳞癌新辅助化疗(neo-adjuvant chemtherapy,NACT)前后的表达变化,探讨SCC-Ag与宫颈鳞癌NACT之间的相关性及临床价值。方法采用化学发光法检测NACT宫颈鳞癌患者中不同阶段SCC-Ag的表达水平,探讨SCC-Ag与宫颈鳞癌NACT后患者近期疗效、治疗方案及手术时机选择、临床病理特征及预后的关系。结果宫颈鳞癌患者治疗前血清SCC-Ag水平与临床分期、局部病灶大小和有无淋巴结转移呈正相关,与年龄无关;SCC-Ag表达在NACT后明显降低,临床有效和无效病例中SCC-Ag的表达有差异。结论 SCC-Ag表达水平变化与NACT疗效显著相关,可作为宫颈鳞癌分期、疗效判断、治疗方案及手术时机选择和预后判断的参考指标。     

紫杉醇联合顺铂对局部晚期宫颈癌的疗效研究

目的:研究新辅助化疗(neoadjuvant chemotherapy,NACT)紫杉醇联合顺铂方案(TP)对局部晚期宫颈癌的近期疗效,分析化疗前后细胞核增殖抗原PCNA及凋亡抑制基因Survivin的变化,探讨其对宫颈癌的治疗意义.方法:手术前行新辅助化疗的宫颈癌患者30例为研究组,直接手术的20例患者为对照组,分析近期疗效.应用免疫组化方法检测宫颈癌组织的PCNA及Sur-vivin表达.分析其改变与化疗的关系和意义.结果:①研究组TP方案的总有效率为70%;②研究组TP方案盆腔淋巴结转移率(3.3%)显著低于对照组(25.0%);③临床有效组的PCNA高表达率及Survivin阳性率在NACT后明显降低(P<0.05),临床无效组则无明显变化(P>0.05).结论:新辅助化疗,TP方案对局部晚期宫颈癌有效,可降低盆腔淋巴转移率,化疗有效者的PCNA及Survivin表达明显降低,可能成为评价TP方案疗效的指标.     

子宫颈癌中细胞凋亡增殖细胞核抗原表达及其诊断价值的探讨

目的采用细胞凋亡、增殖细胞核抗原的检测方法,探讨其在宫颈鳞癌、腺癌中的表达及其诊断价值。方法用细胞凋亡ＤＮＡ片断原位末端检测组织切片标记法及增殖细胞核抗原免疫组化染色法,检测２８例宫颈癌的档存蜡块切片,并与５例正常宫颈组织蜡块切片作对照统计。结果宫颈鳞癌及腺癌的两种方法检测结果与正常宫颈比较统计分析结果,差别都有显著意义（Ｐ＜００１）,宫颈鳞癌与腺癌之间两种方法检测结果统计处理差别无显著意义（Ｐ＞００５）。结论细胞凋亡、增殖细胞核抗原检测方法在不同类型的宫颈癌病例中都能表达。该两种方法将有助于判断肿瘤细胞生长的速度,为临床化疗药物的发展开拓一新前景     

细胞凋亡和P53在宫颈癌及宫颈上皮内瘤变中的表达

目的：探讨细胞凋亡和P53在宫颈癌及宫颈上皮内瘤变中的作用。方法：用DNA缺口末端标记技术(TUNEL)和免疫组化技术原位观察15例正常宫颈、22例CIN*"I/Ⅱ、16例CINⅢ和52例浸润性宫颈鳞癌(ISCC)组织中细胞凋亡标记指数(A-LI)、PCNA(增殖细胞核抗原)标记指数(PCNA-LI)和P53表达阳性率及P53标记指数(P53-LI)。结果：在正常宫颈上皮未检测到凋亡细胞,随着CIN病变的进展,A-LI增高(P＜005),在ISCC,A-LI明显低于CIN(P＜001);PCNA-LI随宫颈癌各级病变的进展逐渐增高(Ｐ＜005);在正常宫颈和CINI/Ⅱ均未检测到P53表达,在CINⅢ,P53-LI明显低于ISCC(P＜001)。结论：细胞凋亡在宫颈癌发生发展过程中发挥重要作用,P53蛋白的积聚可能对细胞凋亡起抑制作用。     

局部晚期宫颈癌新辅助超选子宫动脉化疗栓塞后的疗效研究

目的研究局部晚期宫颈癌超选动脉化疗栓塞后的临床疗效及安全性。方法对145例局部晚期宫颈癌病例进行回顾性分析,根据术前是否行超选动脉化疗栓塞(新辅助化疗Neoadjuvant chemotherapy NACT)分为两组,NACT组117例为观察组,其中Ib2期24例,ⅡA期49例,ⅡB期44例,术前行1~3疗程PVM(卡铂、长春新碱、丝裂霉素)方案化疗,化疗结束后3周评价疗效,行子宫广泛性切除及盆腔淋巴清扫术,同期直接手术(Direct operation DOR)组28例为对照组,其中ⅠB2期24例,ⅡA期4例,对比分析两组疗效、术后病理及不良反应发生情况。结果局部晚期宫颈癌术前行NACT后肿瘤直径均不同程度缩小、肿瘤标记物SCC-Ag均不同程度下降,较前有显著差异(P0.05);化疗总有效率91.5%;手术切除率100%,观察组患者术后病理:淋巴结阳性、宫旁累及、脉管浸润、阴道切缘阳性的发生率均显著低于对照组。结论术前NACT可提高局部晚期宫颈癌的近期疗效,为根治性手术创造条件,不增加手术困难程度及术后并发症,且有效降低术后淋巴结阳性、宫旁累及、脉管浸润、阴道切缘阳性发生率,值得临床推广。     

宫颈癌新辅助化疗临床应用及预后影响因素

宫颈癌的标准治疗为手术和放疗.近年来随着化疗新药的不断开发和化疗方案的改进,宫颈癌的化疗取得了突破性进展,尤其是新辅助化疗(NACT)的临床应用,对术前或放疗前缩小肿瘤体积,控制亚临床转移,改善无瘤生存期起重要作用.综述NACT的适应症、化疗方案及途径,及其对不同期别、不同病理类型宫颈癌的疗效等,并从临床和分子水平上分别阐述影响宫颈癌预后的因素.     

宫颈癌新辅助化疗前后BAG-1、MCM2的表达及其与化疗疗效的相关性

目的:探讨B细胞淋巴瘤基因2结合致癌基因1(BAG-1)及微小染色体维持蛋白2(MCM2)作为宫颈癌新辅助化疗(NACT)有效性预测指标的可行性。方法:收集2015年1月2018年6月甘肃省肿瘤医院收治的90例术前以铂类为基础NACT方案化疗并手术治疗的宫颈癌患者临床资料,并选择60例同期因子宫肌瘤手术切除的正常宫颈组织作为对照。运用免疫组织化学方法检测正常宫颈组织以及同一宫颈癌患者NACT前宫颈活检组织及NACT后手术切除标本中BAG-1及MCM2蛋白的表达,比较正常宫颈与宫颈癌组织及NACT前、后宫颈癌组织中表达差异及其与NACT临床疗效的关系。结果:NACT前宫颈癌组织中BAG-1及MCM2高表达率分别为67.8%(61/90)和81.1%(73/90),高于正常宫颈组织的11.7%(7/60)和6.7%(4/60),差异有统计学意义(χ^2分别为45.736和76.909,均P=0.000)。NACT后宫颈癌组织中BAG-1及MCM2高表达率分别为70.0%(63/90)和78.9%(71/90),NACT前、后比较差异无统计学意义(χ^2分别为0.104和0.139,均P>0.05)。NACT后,90例宫颈癌患者中有效59例(65.6%),无效31例(34.4%),NACT疗效与年龄、病理类型、分化程度、肿瘤最大径线及国际妇产科联盟(FIGO)分期均无关(均P>0.05)。化疗有效组的BAG-1高表达率低于化疗无效组,差异有统计学意义(54.2%vs.93.5%,χ^2=12.636,P=0.000),而化疗有效组和化疗无效组的MCM2高表达率比较,差异无统计学意义(79.7%vs.83.9%,χ^2=0.235,P=0.628)。结论:BAG-1表达水平有可能成为预测宫颈癌以铂类为基础NACT方案疗效的参考指标。     

宫颈癌新辅助化疗临床应用及预后影响因素

宫颈癌的标准治疗为手术和放疗。近年来随着化疗新药的不断开发和化疗方案的改进，宫颈癌的化疗取得了突破性进展，尤其是新辅助化疗（NACT）的临床应用，对术前或放疗前缩小肿瘤体积，控制亚临床转移，改善无瘤生存期起重要作用。综述NACT的适应症、化疗方案及途径，及其对不同期别、不同病理类型宫颈癌的疗效等，并从临床和分子水平上分别阐述影响宫颈癌预后的因素。     

Comparison of indications of pregnancy termination and prognosis of mothers and neonates in early- and late-onset preeclampsia

Objective: To compare the indications of pregnancy termination and prognosis between early-onset preeclampsia (EOP) and late-onset preeclampsia (LOP). Methods: In total, 100 patients diagnosed early-onset preeclampsia in our hospital from January 1, 2012, to June 30, 2014, were recruited for this retrospective cohort study. At the same time, we randomly chose another 100 late-onset preeclampsia as the contrast group. Criterion distinguishing early versus late was set at week 34 of gestation. Indications for pregnancy termination and prognosis of mothers and neonates were compared between the groups. Results: Significant differences were observed between the groups regarding indications for terminating pregnancy. The EOP indications to terminate the pregnancy were mainly fetal-related, while LOP were mainly maternal-related. Postpartum neonatal morbidity and mortality were significantly higher, mean gestational age onset and delivery were significantly earlier, latent period for delivery and postpartum hospitalization time were significantly longer, admission 24 h proteinuria was significantly higher in EOP than in LOP group (P < 0.05). Conclusion: EOP is a distinct and more severe clinical entity with earlier gestational age onset and delivery. EOP might be a fetal-related disease complicated by severe placental and perinatal injuries; LOP might be a maternal-related derived disease condition.     

Diagnosis and management of Candida of the nipple and breast

Diagnosis and treatment of ductal and/or nipple candidiasis in breastfeeding women is complicated by the variety of symptoms women experience. The differential diagnosis includes candidiasis of the nipple, candidiasis of the breast, bacterial infection of either nipple or breast, and other less common problems such as Raynaud's syndrome. Diagnosis and treatment are based on history, physical examination, and presenting symptomatology because cultures of breast milk are often inconclusive. Differential diagnoses and treatment options are reviewed.     

关于妇产科综合征的理解和应用

综合征(syndrome)来源于希腊语syn("一起"、"共同"之意)和drómos(事件),并起意为"同时发生或同时发生的事件"(concurrence).其实,这也是医学词汇里最古老的名词之一,可以追溯到希腊的波克拉底和盖伦时代,就已被用于描述同时发生的一组症状[1].     

Vitamin and homocysteine status of mothers and infants and the risk of nonsyndromic orofacial clefts

OBJECTIVE: This study was undertaken to investigate the involvement of maternal and infant B vitamins and homocysteine as risk factors for orofacial clefting. STUDY DESIGN: Venous blood samples were taken from 96 infants with nonsyndromic orofacial clefts and 88 infants without a congenital malformation and from their mothers at approximately 14 months after the index pregnancy. Red blood cell and serum folate, serum vitamin B(12), whole blood vitamin B(6) as pyridoxal-5'-phosphate (PLP), and plasma homocysteine concentrations were measured. RESULTS: A vitamin B(12) concentration of 185 pmol/L or less and a PLP concentration of 44 nmol/L or less in mothers increased the risk of having a child with an orofacial cleft (odds ratio [OR]=3.1; 95% CI: 1.3-7.4, OR=2.9; 95% CI: 1.2-7.1, respectively). Infants with orofacial clefts had a 15% lower serum folate concentration compared with controls (P=.06). CONCLUSION: A low vitamin B(12) and PLP concentration in mothers increased the risk of orofacial clefts in the offspring. A possible role of the infant's folate status is suggested.     

Pharmacokinetics and endometrial and tubal tissue penetration of cefalotin and cefazolin

The pharmacokinetics and concentrations of the two antibiotics cefazolin and cefalotin were studied during gynecologic operations in endometrial and tubal tissue. The patients received 0.05 g/kg of the antibiotics by intravenous injection. Under the given conditions, pharmacokinetic calculation of the plasma elimination gave half-lives of 24.8 min for cefalotin and of 63 min for cefazolin. Fitting of the tissue levels to the Bateman function showed that the two antibiotics diffuse rapidly into both tubal and endometrial tissue and attain peak concentration levels between 10 and 25 min. In both tissues the concentrations of cefazolin were higher than those of cefalotin. Higher tissue concentrations of cefazolin could also be demonstrated in experiments of longer duration.     

植物雌激素与中老年女性骨质疏松症

大多数的临床试验结果提示植物雌激素可以增加中老年女性腰椎骨密度,降低骨吸收指标尿脱氧吡啶啉（urine deoxypyridinoline,DPD）水平,从而降低中老年女性骨折的风险。但是,现有的研究证据还不足以推荐植物雌激素作为治疗中老年女性骨质疏松症的标准方案,仅可作为个体化治疗的一种有益的选择。     

Accuracy and correlates of maternal recall of birthweight and gestational age

Objective  To determine the accuracy of maternal recall of children birthweight (BW) and gestational age (GA), using the Danish Medical Birth Register (DBR) as reference and to examine the reliability of recalled BW and its potential correlates.
Design  Comparison of data from the DBR and the European Youth Heart Study (EYHS).
Setting  Schools in Odense, Denmark.
Population  A total of 1271 and 678 mothers of school children participated with information in the accuracy studies of BW and GA, respectively. The reliability sample of BW was composed of 359 women.
Method  The agreement between the two sources was evaluated by mean differences (MD), intraclass correlation coefficient (ICC) and Bland–Altman's plots. The misclassification of the various BW and GA categories were also estimated.
Main outcome measures  Differences between recalled and registered BW and GA.
Results  There was high agreement between recalled and registered BW (MD =−0.2 g; ICC = 0.94) and GA (MD = 0.3 weeks; ICC = 0.76). Only 1.6% of BW would have been misclassified into low, normal or high BW and 16.5% of GA would have been misclassified into preterm, term or post-term based on maternal recall. The logistic regression revealed that the most important variables in the discordance between recalled and registered BW were ethnicity and parity. Maternal recall of BW was highly reliable (MD =−5.5 g; ICC = 0.93), and reliability remained high across subgroups.
Conclusion  Maternal recall of BW and GA seems to be sufficiently accurate for clinical and epidemiological use.     

Irisin与糖脂代谢性疾病的研究进展

Irisin是一种新发现的肌肉因子,其前体物质为Ⅲ型纤连蛋白结构域5(FNDC5)。运动使骨骼肌中的过氧化物酶体增殖活化受体γ(PPARγ)辅助激活因子1α(PCG-1α)的表达增加,PCG-1α能诱导FNDC5表达,FNDC5断裂后可形成分泌性的肌肉因子Irisin,从而诱导白色脂肪棕色化,导致能量消耗增多,体质量减轻,改善糖耐量和胰岛素抵抗,调节糖脂代谢和能量代谢。因此,Irisin有望成为治疗糖脂代谢性疾病的新靶点。本文对Irisin与糖脂代谢性疾病的相关性研究进行综述。