Immune microenvironment of hepatocellular carcinoma,intrahepatic cholangiocarcinoma and liver metastasis of colorectal adenocarcinoma: Relationship with histopathological and molecular classifications

Tumor tissue is composed of tumor cells and tumor stroma. Tumor stroma contains various immune cells and non-immune stromal cells, forming a complex tumor microenvironment which plays pivotal roles in regulating tumor growth. Recent successes in immunotherapies against tumors, including immune checkpoint inhibitors, have further raised interests in the immune microenvironment of liver carcinoma. The immune microenvironment of tumors is formed because of interactions among tumor cells, immune cells and non-immune stromal cells, including fibroblasts and endothelial cells. Different patterns of immune microenvironment are observed among different tumor subtypes, and their clinicopathological significance and intertumor/intratumor heterogeneity are being intensively studied. Here, we review the immune microenvironment of hepatocellular carcinoma, intrahepatic cholangiocarcinoma and liver metastasis of colorectal adenocarcinoma, focusing on its histopathological appearance, clinicopathological significance, and relationship with histological and molecular classifications. Understanding the comprehensive histopathological picture of a tumor immune microenvironment, in addition to molecular and genetic approaches, will further potentiate the effort for precision medicine in the era of tumor-targeting immunotherapy.     

姑息性胃切除联合术后化疗评分在腹膜转移的胃癌患者预后评估中的临床意义

目的:探讨姑息性胃切除联合术后化疗评分在腹膜转移的胃癌患者预后评估中的临床意义。方法:回顾性分析2010年1月至2016年12月7年间收治的287例发生腹膜转移的胃癌患者的临床病理资料。通过χ2检验分析评分与患者临床病理因素间的关系。通过Kaplan-Meier法绘制生存曲线，Log-rank检验比较患者生存率的差异；采用Cox比例风险回归模型对患者进行预后分析。结果:与评分中得分为2分和1分的患者相比，得分为0分的患者肿瘤侵润至T4b 期的患者较少［31%(18/58)比50.8%(63/124)、56.2%(59/105)，P=0.039］。全组患者的中位生存时间仅为8.7月。对患者进行单因素预后分析结果显示，血清白蛋白浓度（≤40 g/L），腹水，腹膜转移范围较大，肿瘤T分期较晚，评分得分较高的患者预后较差（均P＜0.05）。将上述因素纳入Cox多因素分析结果显示:评分［HR（95%CI）:1.384（1.165~1.644），P=0.000］，血清白蛋白浓度［HR（95%CI）:0.759（0.593~0.971），P=0.028］，肿瘤T分期［HR（95%CI）:1.493（1.216~1.832），P=0.000］是患者预后的独立危险因素。结论:评分对于胃癌伴腹膜转移患者的预后生存评估具有重要的临床意义。     

甲状腺乳头状癌前上纵隔淋巴结转移临床病理特征初步分析

目的 探讨肿瘤位置、最大直径及甲状腺外浸等临床病理特征与甲状腺癌前上纵隔淋巴结转移的关系。 方法 研究分析初次手术治疗的60例甲状腺乳头状癌患者临床及病理资料,运用检验临床病理特征与前上纵隔淋巴结阳性率的相关性。 结果 肿块位置、最大直径、数量、腺体外侵、受累腺叶数及Ⅵ区淋巴结转移等特征,以及患者年龄等相关因素中,只有VI区淋巴结对前上纵隔淋巴结状态有影响;60例患者前上纵隔淋巴结转移率为10/60(16.67%)。相关因素的前上纵隔淋巴结转移率对比:≥55岁vs <55岁(20% vs 16.36%, P<0.05);肿块位于下极 vs 上极 vs 中极(P>0.05);最大直径≥1.5 cm vs 最大直径<1.5 cm(18.18% vs 15.79, P>0.05);单灶 vs 多灶(21.88% vs 10.71%, P>0.05);单叶 vs 多叶(17.5% vs 15%, P>0.05);男性vs女性(20% vs 15.55%, P>0.05); Ⅵ区淋巴结阳性vs 阴性(24.43% vs 3.57%, P<0.05); 结论 总体来说,甲状腺乳头状癌前上纵隔淋巴结转移率较低。本研究发现VI区淋巴结状态可能与前上纵隔淋巴结转移相关,未来仍需大样本前瞻性的研究验证。     

直肠癌淋巴结转移的深度神经网络评判研究进展

正目前,临床上对于直肠癌常用的影像评估方法有MRI、螺旋CT、PET-CT、直肠腔内超声(ERUS)等。而MRI作为首选检查方式,对肿瘤位置、浸润深度、淋巴结转移、血管侵犯、环周切缘及周围器官侵犯等方面的评估均具有明显优势~([1-2])。通过MRI诊断淋巴结的方法通常是影像科医师逐层浏览每一幅图像,从中识别淋巴结的形状、界限及密度来判断,这种传统方式耗时较长且存在主观偏倚,导致     

Gender,intoxication and the developing brain: Problematisations of drinking among young adults in Australian alcohol policy

In this article, we draw on recent scholarly work in the poststructuralist analysis of policy to consider how policy itself functions as a key site in the constitution of alcohol ‘problems’, and the political implications of these problematisations. We do this by examining Australian alcohol policy as it relates to young adults (18–24 years old). Our critical analysis focuses on three national alcohol policies (1990, 2001 and 2006) and two Victorian state alcohol policies (2008 and 2013), which together span a 25-year period. We argue that Australian alcohol policies have conspicuously ignored young adult men, despite their ongoing over-representation in the statistical ‘evidence base’ on alcohol-related harm, while increasingly problematising alcohol consumption amongst other population subgroups. We also identify the development of a new problem representation in Australian alcohol policy, that of ‘intoxication’ as the leading cause of alcohol-related harm and rising hospital admissions, and argue that changes in the classification and diagnosis of intoxication may have contributed to its prioritisation and problematisation in alcohol policy at the expense of other forms of harm. Finally, we draw attention to how preliminary and inconclusive research on the purported association between binge drinking and brain development in those under 25 years old has been mobilised prematurely to support calls to increase the legal purchasing age from 18 to 21 years. Our critical analysis of the treatment of these three issues – gender, intoxication, and brain development – is intended to highlight the ways in which policy functions as a key site in the constitution of alcohol ‘problems’.     

Neuroendocrine,epigenetic, and intergenerational effects of general anesthetics

The progress of modern medicine would be impossible without the use of general anesthetics (GAs). Despite advancements in refining anesthesia approaches, the effects of GAs are not fully reversible upon GA withdrawal. Neurocognitive deficiencies attributed to GA exposure may persist in neonates or endure for weeks to years in the elderly. Human studies on the mechanisms of the long-term adverse effects of GAs are needed to improve the safety of general anesthesia but they are hampered not only by ethical limitations specific to human research, but also by a lack of specific biological markers that can be used in human studies to safely and objectively study such effects. The latter can primarily be attributed to an insufficient understanding of the full range of the biological effects induced by GAs and the molecular mechanisms mediating such effects even in rodents, which are far more extensively studied than any other species. Our most recent experimental findings in rodents suggest that GAs may adversely affect many more people than is currently anticipated. Specifically, we have shown that anesthesia with the commonly used GA sevoflurane induces in exposed animals not only neuroendocrine abnormalities (somatic effects), but also epigenetic reprogramming of germ cells (germ cell effects). The latter may pass the neurobehavioral effects of parental sevoflurane exposure to the offspring, who may be affected even at levels of anesthesia that are not harmful to the exposed parents. The large number of patients who require general anesthesia, the even larger number of their future unexposed offspring whose health may be affected, and a growing number of neurodevelopmental disorders of unknown etiology underscore the translational importance of investigating the intergenerational effects of GAs. In this mini review, we discuss emerging experimental findings on neuroendocrine, epigenetic, and intergenerational effects of GAs.     

Self-Mutilation in Neurodegeneration with Brain Iron Accumulation

Neurodegeneration with brain iron accumulation (NBIA) is the term applied to a heterogeneous group of disorders resulting in iron deposition in the basal ganglia. Well-known phenotypic features are progressive regression with extra pyramidal involvement and a variable course. A 10-year-old child born to consanguineous parents presented with progressive generalized opisthotonic dystonia, retrocollis, oromandibular dyskinesias, apraxia for swallowing, optic atrophy and severe self-mutilation of lips. MR imaging showed brain iron accumulation. Other causes of self-mutilation were excluded. Early infantile onset, ophisthotonic dystonia with oromandibular dyskinesias and characteristic MR images are suggestive of NBIA. There is only one case reported in the literature of self-mutilation in this condition.     

黄连解毒汤对重度颅脑损伤合并肺部感染患者血气指标和炎症因子影响分析

目的:观察黄连解毒汤对重度颅脑损伤合并肺部感染患者血气指标和炎症因子的影响,探讨其治疗效果。方法:随机抽签方式将77例重度颅脑损伤合并肺部感染患者分为两组。对照组35例接受常规治疗,研究组42例在常规治疗基础上,联合黄连解毒汤直肠灌注及全身擦浴治疗。评估两组临床效果,记录两组呼吸机使用时间、ICU入住时间及治疗费用,测定两组治疗前后血气指标和炎症因子。结果:两组临床治疗效果间差异无统计学意义(P>0.05)。与对照组比,研究组呼吸机使用时间和ICU入住时间明显缩短,ICU治疗费用显著减少(P<0.01)。治疗后两组SaO、PaO₂水平明显上升,PaCO₂及血清PCT、IL-1β、HMGB-1、CRP水平明显下降(P<0.05)。组间比较,研究组SaO、PaO₂水平高于对照组,PaCO₂及血清PCT、IL-1β、HMGB-1、CRP水平低于对照组(P<0.05)。结论:黄连解毒汤直肠灌注联合全身擦浴可明显控制重度颅脑损伤合并肺部感染患者感染病症,改善血气指标,调节炎症反应,缩短呼吸机使用时间和ICU入住时间,减少患者的治疗费用。