对比弥散张量成像与弥散加权成像评估子宫内膜样腺癌病理分级的价值

目的对比弥散张量成像(DTI)与弥散加权成像(DWI)评估子宫内膜样腺癌病理分级的效能。方法回顾性分析41例经病理证实的子宫内膜样腺癌患者,其中高分化(G1级)15例、中分化(G2级)14例、低分化(G3级)12例,术前均接受常规MR平扫及DTI、DWI,比较各级子宫内膜样腺癌的表观弥散系数(ADC)、平均弥散系数(MD)及各向异性分数(FA)值,分析各参数对病理组织学分级的诊断效能。结果 G1、G2、G3级子宫内膜样腺癌之间ADC值及MD值差异均有统计学意义(P均0.001),FA值差异无统计学意义(P0.05)。子宫内膜样腺癌ADC值(r=-0.589,P0.001)、MD值(r=-0.724,P0.001)均与其组织学分级呈负相关。将G3级归为高危组、G1和G2级归为低危组,高危组ADC值、MD值均低于低危组(P均0.01)。受试者工作特征(ROC)曲线结果显示,ADC、MD值鉴别诊断高、低危子宫内膜样腺癌的曲线下面积(AUC)分别为0.792和0.868(P均0.01)。结论 DTI和DWI均可用于评估子宫内膜样腺癌病理分级,且MD值效能较ADC值更高。     

基于纳米材料的肿瘤消融联合免疫治疗研究进展

影像学引导消融治疗已逐渐成为治疗不可切除实体肿瘤的重要方式,但消融治疗后存在肿瘤局部复发及全身转移风险。免疫治疗可通过增强机体自身免疫细胞功能间接清除肿瘤细胞,但多数实体肿瘤对免疫治疗的反应率较低。近年来,基于纳米材料的肿瘤消融技术发展迅速,为增强局部消融效果及提高系统免疫应答提供了新的可能。本文对基于纳米材料的消融联合免疫治疗肿瘤研究进展进行综述。     

胆管内超声用于胆总管结石内镜下取石

目的观察胆管内超声(IDUS)用于胆总管结石内镜下取石中的价值。方法回顾性分析148例接受内镜逆行胰胆管造影(ERCP)联合内镜下括约肌切开术(EST)的胆总管结石患者,对取石后胆总管造影显示结石完全清除者行IDUS,观察有无胆总管残石;对存在较大残石(≥3 mm)者重复行ERCP联合EST取石。术后随访,观察胆总管结石复发情况及其影响因素。结果 148例经ERCP联合EST取石后,胆总管造影均确认胆总管结石完全清除。IDUS发现其中61例仍存在残石,且21例残石≥3 mm;对该21例重复取石,直至结石完全清除。术中及术后均未见严重不良反应。术后随访3～24个月,IDUS显示108例结石完全清除者与40例存在残石者结石复发率分别为8.33%(9/108)、62.50%(25/40),差异有统计学意义(P0.01);术后24个月累积无复发率差异有统计学意义(88.40%、14.40%,P0.01)。多因素分析结果显示,IDUS所示胆总管残石、胆总管直径及角度均为结石复发的独立危险因素(P均0.05)。结论 IDUS能发现胆总管造影难以显示的胆总管残石、尤其细小结石(3 mm),用于辅助ERCP联合EST取石有助于减少术后结石复发。     

肝癌免疫治疗策略的进展与思考

中国是肝癌大国,全世界每年>50%的新发和死亡病例发生在中国。肝癌的化疗敏感性较低,以抗血管生成为主的靶向治疗是进展期肝癌的主要系统治疗手段,但能达到的有效率和生存延长作用十分有限。近年来,免疫检查点抑制剂在肝癌临床治疗中展现出较好疗效,正在改变肝癌治疗格局,但也面临诸多问题。如程序性死亡配体-1、肿瘤突变负荷、错配修复蛋白等临床常用生物标志物在肝癌的临床应用价值十分有限。与其他病因相关肝癌比较,中国乙型病毒性肝炎相关肝癌具有其独特的基因变异图谱,但基于分子分型的个体化治疗策略尚未建立。更加有效且多样化的系统治疗手段,可推动肝癌进入综合治疗新时代,相关诊断与治疗规范有待进一步探索和确立。笔者查阅相关文献,结合临床实践,探讨肝癌免疫治疗策略的进展与思考。     

Status,Sources and Potential Risk of Polycyclic Aromatic Hydrocarbons in Soils from Hexi Corridor in Northwest China

Bulletin of Environmental Contamination and Toxicology - The Hexi Corridor is the main commodity grain base in northwest China and plays a special role in ensuring food security in northwest China....     

Recent Developments in the Determination of PM2.5 Chemical Composition

Bulletin of Environmental Contamination and Toxicology - Fine particulate matter (named PM2.5) has become a prominent and dangerous form of air pollution. The chemical composition of PM2.5 mainly...     

内蒙古自治区不同生态系鼠疫自然疫源地动物鼠疫流行现状及流行风险简析

内蒙古面临着多种类型疫源地鼠疫流行和复燃的风险。蒙古旱獭疫源地虽然暂未在国内发现动物间鼠疫流行,但过去检出过阳性血清,同时蒙古旱獭种群数量持续增加且分布范围不断扩大,毗邻的蒙古国和俄罗斯联邦的蒙古旱獭疫源地动物间鼠疫持续流行;达乌尔黄鼠疫源地动物间鼠疫时隐时现;长爪沙鼠疫源地动物间鼠疫流行猛烈,并频频波及人间。由于蒙古旱獭和达乌尔黄鼠鼠疫耶尔森菌菌株毒力明显高于长爪沙鼠鼠疫耶尔森菌菌株,且在历史上曾给当地带来深重灾难,因此内蒙古自治区鼠疫防控重点应在常规鼠疫监测的基础上,进一步加强蒙古旱獭和达乌尔黄鼠疫源地流行动态的监测,警惕该两个疫源地复燃并波及人间。     

中国农村地区现在吸烟者戒烟意愿及其影响因素研究

目的 了解中国农村地区现在吸烟者戒烟意愿,探索其影响因素,为控烟工作提供参考。方法 本研究数据来源于2018年中国慢性病及危险因素监测,采用多阶段分层整群抽样的方法抽取184 509名≥18岁居民,其中10 241名农村现在吸烟者纳入研究。采用χ²/F检验对戒烟意愿与人口学信息、烟草使用情况、烟草相关危害知识的认知、慢性病患病情况等因素进行单因素分析,多因素分析采用非条件多因素logistic回归分析。结果 3 453名（37.46%）考虑在未来12个月内戒烟。logistic回归分析显示,偶尔吸烟者的戒烟意愿高于每天吸烟者（OR=0.693,95%CI：0.494~0.971）,每天吸烟量<1包者的戒烟意愿高于≥1包者（OR=0.628,95%CI：0.511~0.771）,12个月内有戒烟经历者的戒烟意愿高于12个月内未戒过烟的现在吸烟者（OR=0.438,95%CI：0.357~0.537）,烟草危害认知程度高者戒烟意愿更高（OR=1.056,95%CI：1.028~1.086）,差异均有统计学意义（P<0.05）。结论 中国农村地区现在吸烟者戒烟意愿与吸烟状况、吸烟量、戒烟情况、烟草危害认知有关。建议加强对农村地区的健康教育宣传,提供简短的戒烟干预,提高农村现在吸烟者的戒烟意愿。     

Humeral Head Replacement in the Treatment of Comminuted Proximal Humeral Fracture

ObjectiveTo investigate the outcomes of humeral head replacement in the treatment of patients with comminuted proximal humeral fracture.MethodsBetween February 2013 and September 2016, 56 patients underwent humeral head replacement in our hospital. Of them, 18 cases were diagnosed as comminuted proximal humeral fracture before the operation. The mean age of the patients was 69.5 years old (ranging from 61 to 79 years old). Of them, there were six males and 12 females. All the patients in this group had fresh fractures. They were all treated by artificial humeral head replacements. After the prosthesis was fixed by bone cement reliably, the greater or lesser trochanter and prosthesis handle were sutured and fixed firmly. The interval time from injury to operation ranged from 1 to 5 days. The Constant Functional Score, operation time, blood loss, nerve injury, joint dislocation rate, and infection rate were recorded at the final follow‐up. The clinical data of these patients were retrospectively studied. All of the data were recorded in average form.ResultsIn this study, the mean duration of follow‐up was 4 years, ranging from 3 to 6 years. The operation time ranged from 75 to 120 min, with the average of 82 min. The blood loss ranged from 100 to 400 mL, with the average of 210 mL. The mean score of Constant Functional Score was 83.5 ± 3.1. Of them, 14 cases achieved excellent and good (scores of more than 80), and four cases achieved moderate and poor (scores of less than 80). No patient suffered from joint dislocation, unstable joint, or infection after the operation. There were two patients with axillary nerve injury before the operation. However, the function could be recovered within 3–6 weeks after the surgery.ConclusionThe artificial humeral head replacement could be applied for the treatment of patients with comminuted proximal humeral fracture. During the surgery process, the stable structure of shoulder joint could be completely restructured, and the rehabilitation plan should be adjusted reasonably and timely after the operation.