接受日间乳腺肿物的糖尿病患者心理护理体会

目的研究分析接受日间乳腺肿物治疗的糖尿病患者心理护理体会。方法随机抽取2017年4月—2018年4月至该院接受治疗的乳腺肿物合并糖尿病带管出院患者59例作回顾性分析,所有患者在入院后接受乳腺肿物切除手术,对患者心理特征予以有效分析,把握其术前、术中、术后心理特性,实施针对性心理护理干预措施。并比较患者心理护理前后焦虑(SAS)、抑郁(SDS)情绪改善情况。结果经组间比较显示护理后患者焦虑、抑郁评分均明显优于护理前(P0.05)。且心理护理后54例患者心理压力及不良情绪得到有效消除,均以良好的心理顺利完成手术治疗,占比91.53%;其中5例患者因过度紧张、恐惧等,抗拒手术手术治疗,后续经护理人员及其家属安抚,手术顺利进行,术后正常出院,占比8.47%。结论将心理护理干预措施应用于接受日间治疗的乳腺肿物合并糖尿病患者围术期期间效果显著,可有效提升患者手术耐受及依从性,缓解心理压力与不良情绪,保障手术效果,促进患者身心健康,可大规模应用于临床中。     

介入性超声诊断后方衰减乳腺肿物良恶性的价值

目的探讨介入性超声诊断后方衰减乳腺肿物良恶性的价值。方法选择60例乳腺肿物患者,分别进行彩色多普勒超声、介入性超声检查,并与肿物切除后手术病理结果对照,比较其诊断乳腺肿物良恶性的价值。结果 60例患者均成功穿刺,术前经彩色多普勒超声检查均伴有后方衰减。其中包膜光整、内回声均匀的良性肿物30例,介入性超声诊断10例为恶性,阳性预测值为73.3%;包膜尚光整、内回声欠均匀的恶性肿物30例,介入性超声诊断8例为良性,阴性预测值为66.7%。经术后病理证实,彩色多普勒超声诊断的特异度为72.4%、灵敏度为71.0%、诊断符合率为71.7%、误诊率为27.6%、漏诊率为29.0%;介入性超声诊断的特异度为96.6%、灵敏度为100%、诊断符合率为98.3%、误诊率为3.4%、无漏诊。两种检测方法的特异度、灵敏度、诊断符合率、误诊率、漏诊率比较P均<0.05。结论介入性超声可作为诊断后方衰减乳腺肿物的良、恶性的检查手段。     

接受日间乳腺肿物治疗的糖尿病患者心理护理体会

目的以接受日间乳腺肿物治疗的糖尿病患者为研究对象,总结心理护理干预方法的临床应用价值。方法2017年6月—2019年6月以该院收治的42例接受日间乳腺肿物治疗的糖尿病患者,根据患者入院顺序分为实验组与对比组后,分别给予心理护理干预与常规护理干预,通过比较两组患者的心理状态评分,评价心理护理模式的临床应用价值。结果两组患者的护理后的SAS评分与SDS评分结果显示,实验组患者的整体心理状态显著优于对比组(P0.05)。结论心理护理干预方法满足乳腺肿物伴糖尿病患者的护理要求,有助于改善患者的不良情绪,因此有助于保证治疗依从性。     

横切面与纵切面联合定位法在乳腺肿物微创切除术中的应用效果研究

［摘要］　目的　探讨横切面与纵切面联合定位法在乳腺肿物微创切除术中的应用效果。方法　选择2021年3月至2022年4月于凉山州第二人民医院接受真空辅助乳腺微创旋切术的乳腺肿物患者648例。其中复杂性乳腺囊肿24例,单发乳腺纤维瘤489例,多发乳腺纤维瘤135例。根据手术定位方式不同,分为对照组（采用横切面定位法,306例）和观察组（采用横切面与纵切面联合定位法,342例）。比较两组手术时间、术中出血量,以及术后并发症发生情况和肿物残留情况。结果　观察组手术时间短于对照组［（6.14±1.86）min vs （8.90±2.86）min］,术中出血量少于对照组［（4.29±1.38）ml vs （6.94±2.15）ml］,差异有统计学意义（P<0.05）。对照组术后发生出血2例,血肿12例,皮下瘀斑13例。观察组术后发生出血1例,血肿8例,皮下瘀斑9例。观察组术后并发症发生率显著低于对照组（3.22% vs 8.82%;P<0.05）。术后3个月复查乳腺彩超,结果显示,对照组有肿物残留11例（3.59%）,观察组有肿物残留4例（1.17%）,两组术后肿物残留率比较差异有统计学意义（P<0.05）。结论　在乳腺肿物微创切除术中,横切面与纵切面联合定位法能让术者更准确地判断旋切探针与肿物的空间位置,有助于精准切除肿物,手术用时短,出血量少,并发症发生率及肿物残留率低,值得临床推广。     

间断性呕血纵隔肿物

1病历摘要患者男,52岁。因"间断呕血13 d,加重3 h"于2011-01-30入我院消化内科。患者于2011-01-17无明显诱因出现上腹部不适,伴有反酸,呕血约800 mL,为鲜红色血,无进食食物及胃内容物,呕血后出现一过性意识丧失,无抽搐。就诊于某市     

咳嗽 胸痛 肺部肿物

1病历摘要 患者男，47岁，干部，因咳嗽咳痰2个月余，左胸痛半个月余，于2006—02—18入院。自诉于发病前2个月因受凉后出现咳嗽，咳少量白痰，无咳血痰及咯血，无畏寒、发热、盗汗及胸闷、气促症状，在当地医院诊为“急性上呼吸道感染”，服用中草药后症状未见好转，于入院前半个月无明显诱因出现左季肋隐痛，与呼吸有关，当地医院诊断“左胸腔包裹性积液，肺结核？”。     

咳嗽胸痛肺部肿物

1病历摘要患者男,47岁,干部,因咳嗽咳痰2个月余,左胸痛半个月余,于2006-02-18入院。自诉于发病前2个月因受凉后出现咳嗽,咳少量白痰,无咳血痰及咯血,无畏寒、发热、盗汗及胸闷、气促症状,在当地医院诊为“急性上呼吸道感染”,服用中草药后症状未见好转,于入院前半个月无明显诱因出现左季肋隐痛,与呼吸有关,当地医院诊断“左胸腔包裹性积液,肺结核?”予丁胺卡那、异烟肼、利福平、吡嗪酰胺及乙胺丁醇抗痨治疗2个月后,仍有咳嗽、咳痰症状,X线胸片示左下叶背段炎症,包裹性积液。近2个月来精神、食欲尚可,体重无明显减轻。否认结核病史及结核病…     

右颈部无痛性肿物

病历摘要患者女,44岁。因右颈部无痛性肿物4 a,于2005年11月11日入院。患者于入院前4 a偶然发现右颈部肿物,约1 cm×2 cm,无疼痛、麻木等不适,“感冒”时自觉肿物增大。曾用抗生素(名称及剂量不详)治疗,效果欠佳。肿物生长缓慢。既往身体健康,无肝炎、结核病史,无输血史。入院查体:T36.0℃,P 80次/min,R 20次/min,Bp 130/80 mmHg。全身皮肤黏膜无黄染,浅表淋巴结未触及。头颅无畸形,无颅骨骨折。双侧瞳孔等大等圆,对光反射存在,视力正常。心、肺、腹部未见异常。专科检查:面型对称,开口度、开口型正常,面神经功能正常,口腔内未见明显异常,…     

右美托咪定和氟比洛芬酯合用对全麻乳腺良性肿物切除术后疼痛的影响

目的观察术前静脉滴注氟比洛芬酯联合不同剂量的右美托咪定超前镇痛对乳腺肿物切除术后镇痛和麻醉苏醒的影响以及术后不良反应的发生情况。方法将行乳腺肿物切除术的80例病人随机分成4组,每组20例,四组患者均在麻醉诱导前静脉持续泵注不同浓度的右美托咪定:A组0.6μg/kg,B组0.4μg/kg,C组0.2μg/kg,D组泵注生理盐水,以上每组均在切皮前静脉滴注总量为100 mg的氟比洛芬酯。记录麻醉结束后病人VAS评分、Ramsay镇静评分,应用流式细胞仪检测术毕患者血液中血小板蛋白酶活化受体(PAR)-4表达情况以及术后不良反应发生情况。结果 B组患者较C组、D组的VAS评分降低(P0.05),较A组的VAS评分升高(P0.05),而C组与D组的VAS评分无显著差异(P0.05);B组患者较C组、D组的Ramsay镇静评分升高(P0.05),较A组镇静评分降低(P0.05),而C组与D组的Ramsay镇静评分无显著差异(P0.05);A、B、C、D四组心动过缓的发生率分别是75%、10%、10%、0%,A组明显高于B、C、D组(P0.05)。A、B、C组PAR-4的表达明显高于D组(P0.05);A组与B组相比PAR-4表达水平无显著差异(P0.05)。结论应用0.4μg/kg(泵注时间为20min)的右美托咪定复合氟比洛芬酯超前镇痛对乳腺肿物切除术后镇痛和麻醉苏醒的效果显著,同时具有良好的安全性。     

The relationship of multifocality and tumor burden with various tumor characteristics and survival in early breast cancer

The presence of multifocality and the aggregate tumor size were retrospectively analysed in a database of 1071 operated breast cancers. Around a quarter of all these cancers involved multiple foci, while a tenth of the total demonstrated more than one invasive focus. Although the multifocal cancers were smaller and more often screen-detected than the unifocal cancers, their aggregate tumor size was larger, and they more frequently displayed casting-type calcifications in the mammogram and HER2 positivity. Lobular histology favoured larger tumor burden. The invasive multifocal cancers were more commonly lymph node-positive than the other tumors. In a subgroup of 584 patients with a median follow-up time of 5 years, the larger size of the invasive tumor, the presence of LVI or lymph node involvement, HER2 positivity and triple negativity were associated with a poorer RFS and OS, while the outcome of screen-detected tumors was superior to that of non-screen-detected or interval cancers. A large tumor size, lymph node positivity and HER2 positive or triple negative phenotypes were independent determinants of a poorer survival rate.     

Vaccination against tumor cells expressing breast cancer epithelial tumor antigen.

Ninety-one percent of breast tumors aberrantly express an epithelial tumor antigen (ETA) identified by monoclonal antibody H23. Vaccinia virus recombinants expressing tumor antigens have considerable promise in the active immunotherapy of cancer, and we have evaluated the potential of vaccinia recombinants expressing the secreted (S) and cell-associated (transmembrane, T) forms of H23 ETA to elicit immunity to tumor cells expressing ETA. Tumorigenic ras-transformed Fischer rat fibroblast lines FR-S and FR-T, expressing the S or T form of H23 ETA, respectively, were constructed for use in challenge experiments. Expression of H23 ETA in these lines was confirmed by Western blotting and immunofluorescence. When challenged by subcutaneous seeding of tumor cells, 97% (FR-S) and 91% (FR-T) of syngeneic Fischer rats rapidly developed tumors that failed to regress. Vaccination with recombinant vaccinia virus expressing ETA-T prior to challenge prevented tumor development in 82% of animals seeded with FR-T cells but in only 61% of animals seeded with FR-S. The vaccinia recombinant expressing the S form was a less effective immunogen, and vaccination protected only 29-30% of animals from developing tumors upon challenge with either FR-S or -T cells. The increased immunogenicity of the recombinant expressing ETA-T was reflected in elevated levels of ETA-reactive antibody in vaccinated animals, confirming that secreted antigens expressed from vaccinia virus are less effective immunogens than their membrane-associated counterparts.     

Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications

The purpose of this study was to classify breast carcinomas based on variations in gene expression patterns derived from cDNA microarrays and to correlate tumor characteristics to clinical outcome. A total of 85 cDNA microarray experiments representing 78 cancers, three fibroadenomas, and four normal breast tissues were analyzed by hierarchical clustering. As reported previously, the cancers could be classified into a basal epithelial-like group, an ERBB2-overexpressing group and a normal breast-like group based on variations in gene expression. A novel finding was that the previously characterized luminal epithelial/estrogen receptor-positive group could be divided into at least two subgroups, each with a distinctive expression profile. These subtypes proved to be reasonably robust by clustering using two different gene sets: first, a set of 456 cDNA clones previously selected to reflect intrinsic properties of the tumors and, second, a gene set that highly correlated with patient outcome. Survival analyses on a subcohort of patients with locally advanced breast cancer uniformly treated in a prospective study showed significantly different outcomes for the patients belonging to the various groups, including a poor prognosis for the basal-like subtype and a significant difference in outcome for the two estrogen receptor-positive groups.     

Complex biochemical analysis of human breast tumor tissue

The quantitative biochemical analysis of tissue specimens from 76 human breast carcinomas consisted of examination for cytosolic estrogen receptors (cER), nuclear estrogen receptors (nER), progesterone receptors (PgR), 1,25-dihydroxycholecalciferol receptors (DR), carcinoembryonic antigen (CEA), alpha-lactalbumin (aLA), and gamma-glutamyl transferase (gGT). The highest incidence was found in CEA (76%), DR (70%), and aLA (62%). There was a high percentage of tumors containing only DR, in contrast to the tumors containing only cER or PgR. The simultaneous occurrence of DR and CEA was considerably high (61%). No statistically significant differences were observed in these biochemical parameters in relation to the grade of differentiation of the tumors. The values of aLA in tumors that invaded lymphatic or blood vessels were lower as compared to those tumors that invaded adipose or connective tissues. The level of statistical significance of this difference was close to 5%, the differences in other parameters were statistically insignificant. For prognosis assessed at the time of surgery, after a 2-3-year follow-up of 36 patients the level of gGT in the tumor seems to be the most promising prognostic factor. The values of gGT were significantly lower in those patients whose tumors were in progression during this time. The significance of nER and aLA was also taken into consideration.     

The correlation of CA15.3 and TPS with tumor course in patients with metastatic breast cancer

Purpose: This study was performed to deter mine the correlation of CA15.3 and TPS with disease course in patients with metastatic breast cancer.Methods: Levels of CA15.3 and tissue polypeptide antigen using the M₃ monoclonal antibody (TPS) were determined in the serum of 60 patients with metastatic breast cancer. CA15.3 and TPS were measured at two assay times.Results: A change of more than 25% in the serum level of CA15.3 or TPS was highly correlated with tumor response. The association between response and change in marker levels was stronger for CA15.3 (P=0.0001) than for TPS (P=0.0005). Distinct mismatches between marker changes and the tumor response were observed for both CA15.3 and TPS.Conclusion: CA15.3 and TPS are useful in the determination of response to treatment. Because of observed disagreement, marker changes can only be regarded as indicative of disease course.Abbreviations TPA tissue polypeptide antigen - TPS marker using mAb against epitope M₃ of TPA     

Centrosome amplification drives chromosomal instability in breast tumor development

Earlier studies of invasive breast tumors have shown that 60-80% are aneuploid and approximately 80% exhibit amplified centrosomes. In this study, we investigated the relationship of centrosome amplification with aneuploidy, chromosomal instability, p53 mutation, and loss of differentiation in human breast tumors. Twenty invasive breast tumors and seven normal breast tissues were analyzed by fluorescence in situ hybridization with centromeric probes to chromosomes 3, 7, and 17. We analyzed these tumors for both aneuploidy and unstable karyotypes as determined by chromosomal instability. The results were then tested for correlation with three measures of centrosome amplification: centrosome size, centrosome number, and centrosome microtubule nucleation capacity. Centrosome size and centrosome number both showed a positive, significant, linear correlation with aneuploidy and chromosomal instability. Microtubule nucleation capacity showed no such correlation, but did correlate significantly with loss of tissue differentiation. Centrosome amplification was detected in in situ ductal carcinomas, suggesting that centrosome amplification is an early event in these lesions. Centrosome amplification and chromosomal instability occurred independently of p53 mutation, whereas p53 mutation was associated with a significant increase in centrosome microtubule nucleation capacity. Together, these results demonstrate that independent aspects of centrosome amplification correlate with chromosomal instability and loss of tissue differentiation and may be involved in tumor development and progression. These results further suggest that aspects of centrosome amplification may have clinical diagnostic and/or prognostic value and that the centrosome may be a potential target for cancer therapy.     

A case of metastatic esophageal tumor from breast cancer

A 58-year-old woman was admitted to our hospital with the complaint of dysphagia that had developed 37 months after initiation of treatment for breast cancer. Endoscopy revealed severe stenosis 32 cm from the incisors through which the endoscope could not pass. No mucosal irregularities were observed, and biopsies of the stenotic lesion were negative for malignancy. Computed tomography showed wall thickening of the midthoracic esophagus and left pleural effusion, which had increased metabolic activity as detected by ¹⁸F-fluorodeoxyglucose positron emission tomography. Cytological examination of the pleural effusion showed adenocarcinoma compatible with metastasis from a prior lobular carcinoma of the breast. Vinorelbine effectively relieved her symptoms, and the disease stabilized for approximately 1 year. However, she died 16 months after the diagnosis of metastatic esophageal tumor from the preceding breast cancer.     

Aberrant expression of CD227 is correlated with tumor characteristics and invasiveness of breast carcinoma

Purpose

Increasing evidences demonstrate that CD227 plays a crucial role in the development and progression of breast cancer. However, the function of CD227 in breast carcinoma was still controversial and the investigation on CD227 in Asian race was scarce.

Methods

To investigate the relationship between CD227 and tumor characteristics of breast carcinoma, CD227, estrogen receptor (ER), progesterone receptor (PR), Her2?neu and Ki-67 were detected by immunohistochemistry in a series of 227 patients. The Kaplan–Meier method and log-rank tests were used to estimate the correlation between CD227 expression and patients’ prognosis. Furthermore, in vitro invasion assay was performed to examine the effect of CD227 on the invasiveness of breast carcinoma cells after transfection with CD227 cDNA or antisense phosphorothioate oligodeoxynucleotides (ASODN) against CD227 mRNA.

Results

Our data demonstrate that the cytoplasm staining and high expression of CD227 were positively related to the aggressiveness of breast cancer. Both circumferential membrane staining and cytoplasm staining were associated with lymph node metastasis. Moreover, the cytoplasm staining and overexpression of CD227 were found to be related to Her-2/neu positivity, higher Ki-67 positivity and poorer survival of patients. We further demonstrated that the invasion ability of breast carcinoma cells could be enhanced or inhibited by CD227 cDNA or ASODN, respectively.

Conclusions

We conclude that the aberrant expression of CD227, especially cytoplasm staining could be predictive for tumor aggressiveness, lymph node metastasis, poorer outcome of patients with breast cancers. And CD227 could promote the invasion ability of breast cancer cells, suggesting a potential role of CD227 as an oncogene in breast carcinoma.