乳腺癌彩色多普勒血流分布类型与分子生物学的相关性研究

目的探讨乳腺癌彩色多普勒血流分布类型与肿瘤标记物ER、PR、C—erbB-2、VEGF、Ki-67和P^53之间的相关性研究。方法100例乳腺癌患者，分析其术前超声血流分布类型与术后肿瘤标记物（ER、PR、C—erbB-2、VEGF、Ki-67和P^53）的表达情况，并分析它们之间的相关性。结果100例乳腺癌患者，肿块共103个，其中血流周边型23个，穿入型46个，内部型30个，无血流4个。穿入型血流与VEGF和Ki-67阳性表达呈正相关（P〈0．01），与P^53阳性表达呈正相关（P〈0．05）。结论乳腺癌彩色多普勒血流分布类型与分子生物学之间存在一定相关性，可以根据其声像图中血流分布类型对乳腺癌的生物学行为和预后进行评估。     

乳腺癌的彩色多普勒血流分布特征与组织病理学对照研究

目的探讨乳腺癌彩色多普勒血流分布类型及其在乳腺癌诊断中的价值.方法前瞻性研究104例121个乳腺癌病变的彩色多普勒血流分布类型,分析血流特征与乳腺癌病理组织学之间的关系.结果121个乳腺癌中周边型血流62个(51.2%),内部型血流31个(25.6%),穿入型血流23个(19.0%),5个(4.1%)无血流.导管内癌、浸润性小叶癌和高、中分化的浸润性导管癌的血流多位于肿块的周边;而低分化的浸润性导管癌以穿入和内部血流为主(P=0.010);特殊类型浸润癌以内部血流为主(P=0.009).肿瘤表现为内部血流者,多血流丰富(P=0.003).结论彩色多普勒血流的分布部位是乳腺癌新生血管的一个重要特征.血流分布类型与乳腺癌生长、分化之间存在一定的关系,导管内癌、浸润性小叶癌和高、中分化的浸润性导管癌的血流多位于肿块的周边,分化差的浸润性导管癌以及特殊类型浸润癌则以穿人型和内部型血流为主.血流分布类型与血流数量有一定的关系,穿入型和内部型血流往往血流比较丰富.     

乳腺癌雌孕激素受体表达预测新辅助化疗敏感性的研究

目的探讨乳腺癌雌孕激素受体表达预测新辅助化疗有效性的可能性。方法应用免疫组织化学方法检测144例乳腺癌患者治疗前雌激素受体但R）表达、孕激素受体（PR）表达，评估对新辅助化疗的敏感性。结果144例新辅助化疗乳腺癌患者中，ER阴性者新辅助化疗有效率为83．91％，ER阳性者为57．89％，差异有统计学意义（x2=12．00，P〈0．05）；PR阴性者有效率为80．85％，PR阳性者为60．00％，差异有统计学意义（x2=7．30，P〈0．05）；ER、PR双阴性组与ER、PR单阳或双阳性组有效率差异也有统计学意义（X2=9．53，P〈0．05）。结论ER或PR阴性患者对化疗更敏感，ER、PR可作为乳腺癌新辅助化疗有效性的预测指标。     

乳腺癌超声征象与ER、PR、C-erbB-2表达的相关性研究

目的初步探讨乳腺癌超声特征与免疫组织化学因子ER、PR及C-erbB-2表达的相关性,为临床乳腺癌术前辅助治疗及预后判断提供更多的信息和科学依据。方法44例乳腺癌均经病理组织学证实,且所有病例在治疗前均行乳腺超声检查,术后测定ER、PR、C-erbB-2的表达。分析乳腺癌的超声表现与三因子表达的相关性。结果①乳腺癌三因子的表达与肿块直径无关(P>0.05)。②有毛刺征的肿块比边缘光整的肿块有更高的ER阳性表达(P<0.01)。③腋窝淋巴结转移组中C-erBb-2阳性表达率高(P<0.05),ER阳性表达率低(P<0.01)。④彩色多普勒显示血流越丰富,C-erBb-2阳性表达率越高(P<0.01)。结论乳腺癌的超声表现与免疫组织化学因子之间有一定的相关性。有毛刺征及无淋巴结转移的乳腺癌有更高的ER阳性表达率,更适合内分泌治疗;血流丰富、有淋巴结转移者C-erBb-2阳性表达率高,预示肿块恶性程度高,预后不良。     

雌激素受体和孕激素受体表达与乳腺癌临床病理相关性分析

目的探讨乳腺癌雌激素受体（ER）、孕激素受体（PR）表达及其与乳腺癌各临床病理因素之间的关系。方法收集2011年9月-2012年9月乳腺癌患者105例,用免疫组织化学法检测ER、PR及表皮生长因子受体2（C-erbB-2）并分析其相互关系及与临床各因素之间的关系。结果ER、PR及C-erbB-2的阳性率分别为58．1％、49．5％、59．0％。ER表达与PR表达呈正相关（P〈0．05）,ER、PR表达一致率与C-erbB-2表达呈负相关（P〈0．05）。ER表达与淋巴结转移、组织学分级有相关性（P〈0．05）,与年龄、月经初潮年龄、肿瘤大小、部位、临床分期、病理类型及癌旁组织病理学形态无关。PR表达及ER不同阳性强度表达与临床病理各因素差异均无统计学意义（P〉0．05）。C．erbB．2在有淋巴结转移组中阳性表达率高于淋巴结未转移组（P〈0．05）。结论ER、PR在乳腺癌发生、发展中发挥着重要作用,联合检测ER、PR对评估乳腺癌患者内分泌治疗效果及预后有重要意义。     

自动乳腺全容积成像对乳腺癌新辅助化疗期间肿瘤大小的评估价值及其征象与ER、PR、Her-2的关系研究

目的：探讨自动乳腺全容积成像（ABVS）对乳腺癌新辅助化疗期间肿瘤大小的评估价值,分析其征象与雌激素受体（ER）、孕激素受体（PR）、人类表皮生长因子受体2（Her-2）表达的关系。方法：选择2015年1月至2017年1月我院收治的506例术前行新辅助化疗的乳腺癌患者,新辅助化疗前后均行ABVS检查,测量乳腺肿块大小、记录ABVS征象,术后采用免疫组化法检测ER、PR、Her-2表达情况。比较治疗前后、不同疗效组乳腺肿块大小差异,分析术前ABVS征象与ER、PR、Her-2表达的关系。结果：新辅助化疗后乳腺肿块长度、宽度、厚度、面积、体积均较化疗前减少（P＜0.05）,化疗有效组乳腺肿块长度、宽度、厚度、面积、体积低于化疗无效组（P＜0.05）。ER、PR阳性表达患者“毛刺征”、“汇聚征”检出率高于ER、PR阴性表达患者（2“毛刺征”=10.367、13.540,P＜0.05;2“汇聚征”=28.050、30.710,P＜0.05）,Her-2阳性表达患者钙化检出率高于Her-2阴性表达患者（2=26.646,P＜0.05）。结论: ABVS测量乳腺肿块大小可反映乳腺癌新辅助化疗疗效,ABVS“毛刺征”、“汇聚征”与ER、PR表达有关,钙化与Her-2表达有关。     

乳腺癌超声特征与免疫组化指标的相关性

目的探讨乳腺癌超声特征与免疫组化指标的相关性。方法回顾性收集710例经病理证实的乳腺癌肿块资料,记录肿块的超声特征:肿块最大径、位置、纵横比、内部回声、后方回声、边界、边缘、形状、钙化、Alder血流分级、淋巴结转移分析免疫组化指标:雌激素受体（ER）、孕激素受体（PR）、增殖细胞核抗原（Ki-67）、人表皮生长因子受体（HER-2）,分析超声特征与免疫组化指标之间的相关性。结果710例乳腺癌肿块中ER、PR、HER-2、Ki-67的阳性率分别为72.5%、64.1%、61.0%、80.3%,且ER与PR表达呈正相关（r=0.697,P < 0.001）,ER、PR与Ki-67表达均呈负相关（r=-0.218,P < 0.001;r=-0.216,P < 0.001）。ER、PR在肿块最大径≤2 cm中的阳性率更高,Ki-67在肿块最大径 > 2 cm中的阳性率更高。ER阳性时,肿块纵横比 > 1占比较高,PR阳性时,乳腺癌肿块的超声特征多表现为形状不规则、边界不清晰、后方回声衰减或消失。HER-2、Ki-67阳性时肿块纵横比≤1多见且更容易发生腋窝淋巴结转移。结论乳腺癌的超声特征与ER、PR、HER-2、Ki-67表达存在相关性,超声表现可以反映肿块的生物学行为,为患者的临床治疗方案选择及术后预后评估提供有力的参考依据。      

超声诊断乳腺癌

目的探讨二维超声及彩色多普勒超声在检查乳腺癌中的表现和特征，评价其在诊断乳腺癌中的应用价值。方法回顾性分析135例经手术及病理证实为乳腺癌患者的超声表现：包括二维声像图特征及彩色多普勒表现：肿块内部及周围的血供情况，血流峰值速度和阻力指数等血流动力学参数。结果135例乳腺癌中，乳腺浸润性导管癌128例，筛状癌3例，髓样癌1例，小叶癌原位癌2例和纤维腺瘤伴肉瘤变l例。超声所见：135例中超声发现肿块129例，大小为0．2em～3．4era不等，肿块纵横径比大于1占69％（89／129），肿块边界不整齐，约占70％（90／129），2例肿块不明显但局部可见沙粒样钙化点及局部血流信号异常。沙粒样钙化点占52．6％（70／129）；彩色多普勒发现血流信号占79．8％（103／129），频谱多普勒示血流峰值速度（PSV）为18-49ends，阻力指数（RI）为0．67～0．96，RI〉0．7占93．2％（96／103）。超声漏诊4例。结论当彩色多普勒超声在乳腺肿块内部或周围，或异常回声区内探及丰富血流信号，流速曲线显示为高速高阻时，要高度怀疑乳腺癌，彩色多普勒超声在乳腺良恶性肿瘤的诊断与鉴别诊断中发挥重要的作用。     

乳腺癌剪切波弹性模量最大值与其免疫组化相关性研究北大核心CSCD

目的应用剪切波弹性成像（swE）技术探讨乳腺癌剪切波弹性模量最大值（Emax）与乳腺癌免疫组化指标之间的相关性。方法选择经病理证实的乳腺癌患者160例（共171个病灶）,术前行常规超声及SWE检查,获得肿块Emax值和最大直径,术后记录肿块的组织分级、雌激素受体（ER）、孕激素受体（PR）、人表皮生长因子受体2（HER2）、Ki-67及分子亚型,分析Emax值与肿块大小、组织分级、ER、PR、HER2、Ki-67及分子亚型之间的相关性。差异有统计学意义的变量进一步纳入多元线性回归分析,选出对肿块Emax值影响有意义的变量。结果①肿块大小与肿块Emax值呈显著正相关（r=0．510,P〈0．05）;②HER-2阳性表达者肿块Emax值大于阴性表达者（P〈0．05）,Ki67高表达者肿块Emax值大于低表达者（P〈0．05）;③不同分子亚型肿块间Emax值差异均有统计学意义（P〈0．05）,其中HER-2阳性型肿块Emax值最大,其次顺序为Luminal B型、三阴性型、Luminal A型;④多元线性回归方程结果表明肿块大小、HER-2阳性表达对肿块Emax值的影响有统计学意义（P〈0．05）,肿块大小对肿块Emax值影响最大（P〈0．05）,标准化偏回归系数为0．500,HER2阳性表达对肿块Emax值影响次之（P〈0．05）,标准化偏回归系数为0．237。结论乳腺癌肿块Emax值与一些与预后相关的免疫组化表达有一定相关性,预后差的乳腺癌肿块常具有较高的Emax值,Emax值可以在一定程度上反映乳腺癌的生物学特性,SWE可能为乳腺癌的预后判断及治疗方案的选择提供一定的影像学依据。     

乳腺癌钼靶X线表现与ER、PR及Her-2因子表达的相关性研究

目的初步探讨乳腺癌钼靶X线表现与ER、PR与Her-2因子表达之间的关系。方法将93例乳腺癌患者钼靶X线表现肿块、钙化、病变区密度和结构扭曲与免疫组织化学测定的ER、PR和Her-2的表达进行对照研究。结果93例乳腺癌患者中,肿块边缘毛刺征者ER、PR阳性表达率高;病变区有钙化和结构扭曲者Her-2阳性表达率高;病变区高密度和结构扭曲ER、PR阳性表达率低;分支铸形钙化更倾向于Her-2高表达;肿块大小与ER、PR和Her-2表达均无关。结论乳腺癌钼靶X线征象和ER、PR及Her-2的表达有密切关系,在一定程度上反映了ER、PR及Her-2的表达状态,为乳腺癌的术前辅助内分泌治疗和预后评估提供更多信息。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

甲状旁腺功能减退性心肌病的系统综述

目的 甲状旁腺功能减退（甲旁减）性心肌病是一种罕见的心脏疾病,为扩张型心肌病中少数可逆转的一种,常被误诊为不明原因或难治性心力衰竭。本文旨在探寻甲旁减性心肌病的规律性特征。方法 检索Pubmed、SinoMed、万方数据库中符合标准的甲旁减性心肌病病例,采用统计分组法对纳入研究的文献进行分析,依据系统综述和meta分析优先报告条目（PRISMA声明）进行报告。结果 在我们筛查出的41例患者中,女性居多（68.29%）,平均年龄为45.5岁,各年龄段均有发病。甲旁减性心肌病最常见的病因为特发性甲旁减（78.05%）,颈部手术导致的甲旁减性心肌病次之（17.07%）。患者均以心力衰竭就诊,伴不同程度的低钙血症。51%的患者有神经肌肉兴奋性增加的病史,90%的患者左心室射血分数降低。该病误诊漏诊率较高,仅36%的患者于入院后即明确诊断为甲旁减性心肌病。低血钙的纠正是治疗的关键,90%的患者心脏功能在血钙浓度正常化后恢复至正常。结论 对所有不明原因或难治性心力衰竭患者都应警惕甲旁减性心肌病的可能。     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

Real‐life effectiveness of biological therapies on symptoms in severe asthma with comorbid CRSwNP

BackgroundWe aimed to evaluate the effectiveness of different antibody therapies on nasal polyp symptoms in patients treated for severe asthma.MethodsWe performed a retrospective analysis of patients with severe asthma and comorbid CRSwNP who were treated with anti‐IgE, anti‐IL‐5/R or anti‐IL‐4R. CRSwNP symptom burden was evaluated before and after 6 months of therapy.ResultsFifty patients were included hereof treated with anti‐IgE: 9, anti‐IL‐5/R: 26 and anti‐IL‐4R: 15 patients. At baseline median SNOT‐20 was similar among groups (anti‐IgE: 55, anti‐IL‐5/R: 52 and anti‐IL‐4R: 56, p = 0.76), median visual analogue scale (VAS) for nasal symptoms was 4, 7 and 8 (p = 0.14) and VAS for total symptoms was higher in the anti‐IL‐4R group (4, 5 and 8, p = 0.002). After 6 months SNOT‐20 improved significantly in all patient groups with median improvement of anti‐IgE: −8 (p < 0.01), anti‐IL‐5/R: −13 (p < 0.001) and anti‐IL‐4R: −18 (p < 0.001), with larger improvement in the anti‐IL‐4R group than in anti‐IgE (p < 0.001) and anti‐IL‐5/R (p < 0.001) groups. VAS nasal symptoms improved by median anti‐IgE: 0 (n.s.), anti‐IL‐5/R: −1 (p < 0.01) and anti‐IL‐4R: −3 (p < 0.001), VAS total symptoms by anti‐IgE: −1 (n.s.), anti‐IL‐5/R: −2 (p < 0.001) and anti‐IL‐4R: −2 (p < 0.001).ConclusionsTreatment by all antibodies showed effectiveness in reducing symptoms of CRSwNP in patients with severe asthma, with the largest reduction observed in anti‐IL‐4R‐treated patients.     

单核细胞/高密度脂蛋白胆固醇比值不能预测PCI术后对比剂肾病的发生

目的 探讨术前单核细胞与高密度脂蛋白比值(monocyte to high density lipoprotein cholesterol ratio, MHR)与经皮冠状动脉介入（percutaneous coronary intervention , PCI）治疗后发生造影剂肾病（contrast induced nephropathy, CIN）的相关性，为CIN的发生寻找其他可能的危险因素，为及早筛选CIN高危人群提供新的方向。方法 回顾性分析5P试验入选的我院心内一科行经皮冠状动脉介入治疗术的冠心病患者1 087例，根据在PCI术后是否发生造影剂肾病分为CIN组和非CIN组，研究CIN的相关危险因素，分析MHR与造影剂肾病的相关性，应用Logistic回归分析查看MHR是否为CIN发病的高危因素。结果 CIN组共57例，非CIN组1 030例。两组在高脂血症、BMI、左心室射血分数（LVEF）、术前尿酸及术前C 反应蛋白水平等方面比较差异有统计学意义（P＜0.05）。 Logistic回归分析显示LVEF及糖尿病与造影剂肾病的发生相关。结论 同以往研究结果不同，MHR并不能作为CIN的危险因素，但LVEF对于CIN可能具有更高的预测价值。     

Calcified primary tumors of the gastrointestinal tract

The dominant pattern and location of calcifications occurring within 23 primary gastrointestinal tumors have been analysed and correlated with the data from the literature. The provided guidelines for radiologic diagnosis of such calcified tumors include: (1) a retrocardiac mass containing amorphous calcifications is typical of leiomyoma of the esophagus; (2) calcific deposits similar to that in uterine fibroids may be the feature of gastric leiomyoma or intestinal leiomyosarcoma; (3) sand-like deposits within the wall of the stomach or colon are characteristic of a mucinous adenocarcinoma; (4) clusters of phleboliths in the gastrointestinal wall suggest a hemangioma particularly if recurrent intestinal bleeding and cutaneous hemangiomas are associated; (5) sunburst type of calcification in the pancreas indicates a cystadenoma or cystadenocarcinoma of that organ; and (6) aggregates of granular calcifications in the liver are diagnostic for metastatic adenocarcinoma of the colon but may rarely be seen in a primary malignancy of the liver.     

Effects of intravenous anesthetic agents on middle cerebral artery blood flow velocity during induction of general anesthesia

Objective. Our objective was to quantify the effects of intravenous anesthetics on values measured by or derived from transcranial Doppler sonography (TCD) during induction of general anesthesia.Methods. We recorded blood flow velocity in the middle cerebral artery (V-MCA) before, during, and after induction of general anesthesia in six groups of young patients without intracranial pathology (n=10 each) using TCD. Patients were randomized to receive either 2 mg/kg propofol, 1.5 mg/kg methohexital, 5 mg/kg thiopental, 0.3 mg/kg etomidate, 2 µg/kg fentanyl and 0.15 mg/kg midazolam, or 1.5 mg/kg ketamine and 0.15 mg/kg midazolam intravenously. At 2 min after injection, each patient was intubated and given isoflurane 0.8% and nitrous oxide 66% in oxygen. Ventilation was set to achieve an end-tidalPco ₂ of 40 mm Hg. V-MCA, arterial blood pressure, heart rate, hematocrit, andPco ₂ (venous samples) were measured before and 1, 3, 5, 10, and 30 min after induction of anesthesia.Results. The preinduction data were not different between groups. At 1 min after injection, propofol, thiopental, methohexital, and etomidate significantly decreased V-MCA. TCD values were only slightly affected following fentanyl/midazolam. Ketamine/midazolam induced a modest rise in V-MCA. After endotracheal intubation, V-MCA increased in all groups, and slowly declined thereafter.Conclusions. Under the circumstances of our study, values derived from TCD measurements responded differently to the agents used to induce general anesthesia in nonneurosurgical patients.     

广西百色壮族原发性高血压与β2肾上腺素能受体基因多态性的相关性

目的 探讨百色地区壮族人群受试者β2 肾上腺素能受体(β2 AR)基因多态性与高血压的关系和原发性高血压的遗传学特征。方法 98例高血压病例患者,患病史至少两年。同时还有109例健康的对照受试者。对所有受试者进行基本的体格检查及空腹血浆生化指标的测定,然后再使用多聚酶链反应技术（polymerase chain reaction,PCR）对DNA进行分析,以鉴定β2 AR基因rs6879202与rs2053044的位点的基因型和等位基因频率。并采用SPSS 19.0 软件中回归模块中的Logistic对有显著性统计学差异的位点的基因频率诱发高血压的危险性进行了一定的探讨。结果 病例组与对照组在性别比、肌酐、吸烟率、甘油三酯、尿酸等之间有统计学差异。病例组和对照组β2 AR基因rs6879202位点CC、CG、GG基因频率分别为3.10%,72.40%,24.50%;13.80%,57.80%,28.40%;两组的基因型频率分布之间有统计学意义（χ2=8.809,P=0.012）。Logistic分析结果表明对rs6879202位点而言CG较其他两个基因频率诱发高血压的风险更大。结论 百色地区壮族患者β2 AR基因rs6879202位点多态性与原发性高血压有相关性,而β2 AR基因rs2053044位点多态性与该地区该民族的原发性高血压没有相关性。