Metastatic incidence of (PET)CT positive lung hilar and retroperitoneal lymph nodes in esophageal cancer patients

BackgroundExtra-regional lymph node metastases strongly determine treatment options in patients with esophageal cancer. Staging modalities such as (FDG-PET) CT scanning frequently show activity in retroperitoneal and lung hilar lymph nodes. This study evaluated the incidence of histologically confirmed metastases, treatment approach and recurrence patterns in patients with (FDG-PET) CT positivity in these regions.MethodsAll patients with (FDG-PET-) CT positive hilar and/or retroperitoneal lymph nodes at primary staging or restaging discussed at a multidisciplinary tumor board meeting for staging of esophageal cancer between January 2012–December 2017 were included. Biopsies and follow-up were evaluated to determine the presence of metastases and progression rates.ResultsFrom 2012 to 2017, 65 of 857 patients (7.6%) were selected with positive retroperitoneal and/or hilar lymph nodes. A total of 47/65 (72.3%) patients had positive retroperitoneal lymph nodes, which contained metastases in 19 (29.2%). When no biopsy was performed and curative treatment was given (n = 14), 9 patients had progression or locoregional and distant recurrence. Positive hilar lymph nodes were identified in 21 (32.3%) patients; 4 were biopsied and none contained metastases. In these patients no recurrence of disease was seen during follow-up.ConclusionsThe majority of biopsied (PET)CT-positive retroperitoneal lymph nodes at staging contained metastases, while biopsied (PET)CT-positive hilar nodes did not. Histological evaluation of (PET)CT -positive retroperitoneal lymph nodes at staging imaging is recommended, while based on this small series, (PET)CT-positive hilar lymph nodes most likely represent reactive lymphadenopathy.     

CT动态增强鉴别肾上腺乏脂肪腺瘤与肾上腺结节样增生的价值

目的探讨CT动态增强对鉴别肾上腺乏脂肪腺瘤与肾上腺结节样增生的价值。方法回顾性分析经手术病理证实的12例肾上腺乏脂肪腺瘤和27例肾上腺结节样增生患者的病例资料,统计两组病例各期增强CT值,利用公式灌注值P=CT静脉期-CT平扫期、廓清值C=CT静脉期-CT延迟期、绝对廓清灌注指数APC=(C/P)×100%及相对廓清灌注指数RAPC=(C/CT静脉期)×100%得到相关参数,并通过绘制受试者工作特征曲线,鉴别两者的最佳价值。结果肾上腺乏脂肪腺瘤直径较结节样增生更大;肾上腺乏脂肪腺瘤病灶各期CT值均明显高于结节样增生,且两者灌注值P、廓清值C、APC及RAPC有明显的统计学差异。年龄、性别、高血压、病灶位置、对侧肾上腺萎缩及动脉期CT值对鉴别两者无显著意义。结论CT动态增强扫描有助于鉴别肾上腺乏脂肪腺瘤和肾上腺结节样增生。     

Study of electroacupuncture with different frequencies for the treatment of headache and anxiety-depression symptoms in patients with migraine: A randomized clinical trial: 不同频率电针改善偏头痛患者头痛及焦虑抑郁症状的差异性研究-随机临床试验

ObjectiveTo observe the effects of electroacupuncture (EA) with varied frequencies on headache and anxiety-depression symptoms in patients with migraine and to screen optimal frequency of EA for patients with such conditions.DesignSingle-center, randomized, controlled clinical trial was designed, and the outcome assessors and statisticians were blinded. The patients with migraine were randomized into 2 Hz EA group, 100 Hz EA group and sham-stimulation group. In each group, the changes in migraine attacks, days with headache, the scores of visual analogy scale (VAS), self-rating anxiety scale (SAS), self-rating depression scale (SDS) and migraine-specific quality-of-life questionnaire (MSQ), as well as the dosage of analgesics were observed at the baseline, during treatment, in 1, 2 and 3 months of follow-up separately.SettingPatients were enrolled in the Third Affiliated Hospital of Zhejiang Chinese Medical University, between 1^st August 2018 and 31^st July 2021.ParticipantsSixty-five migraine patients with or without aura.InterventionsIn the EA groups, the acupoints were bilateral Fengchi (GB20), Gongxue (Extra), Sizhukong (TE23), Taiyang (EX-HN5), Shuaigu (GB8), Waiguan (TE5) and Yanglingquan (GB34). Electric stimulation was exerted at GB20 and Gongxue (Extra), with 2 Hz and 100 Hz separately. In the sham-stimulation group, the shallow acupuncture was operated at the sites 1 cm lateral to GB20 and Gongxue (Extra), and on the radial side of TE5 and GB34. The output wires were cut off after attached to the acupoints. The patients in each group received the treatment 3 times weekly, once every two days, for consecutive 4 weeks. The complete intervention was composed of 12 treatments.Main outcome measuresChanges in numbers of migraine attacks at treatment phase (week 1 to week 4) from the baseline(week -4 to week 0) in patients of each groupResults(1) Changes in migraine attacks and days with headache: In the 2 Hz EA and 100 Hz EA groups, the changes for migraine attacks and days of headache were higher significantly when compared with that in the sham-stimulation group at the same time stage (P < 0.05). There was no statistical difference between two EA groups. (2) Changes of VAS score: In the 2 Hz EA and 100 Hz EA groups, the changes of VAS score were significantly higher when compared with that in the sham-stimulation group at the same time stage (P < 0.05). There was no statistical difference between two EA groups. (3) Assessment of anxiety and depression: The differences in the changes of SAS and SDS scores had no statistical significance in patients of each group at each assessment stage (P > 0.05). (4) Assessment on the quality of life: Compared with the sham-stimulation group at the same time stage, the improvement in MSQ score was increased significantly during treatment in patients of the 2 Hz EA and 100 Hz groups (P < 0.05). There was no statistical difference between two EA groups. (5) Assessment on safety and compliance: The patients of each group had sound compliance. There was no adverse events during trial, suggesting promising safety of treatment.ConclusionEA may effectively reduce the migraine attacks, and the days and intensity of headache, presenting promising safety. However, there was no significant improvement on anxiety-depression symptoms, and no significant difference between high and low frequencies of EA treatment in relieving headache and anxiety/depression symptoms in the patients with migraine.Trial registrationChiCTR1800017259     

Ferulic acid enhances insulin secretion by potentiating L-type Ca2+ channel activation

ObjectiveTo investigate the effect of ferulic acid, a natural compound, on pancreatic beta cell viability, Ca²⁺ channels, and insulin secretion.MethodsWe studied the effects of ferulic acid on rat insulinoma cell line viability using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide viability assay. The whole-cell patch-clamp technique and enzyme-linked immunosorbent assay were also used to examine the action of ferulic acid on Ca²⁺ channels and insulin secretion, respectively.ResultsFerulic acid did not affect cell viability during exposures up to 72 h. The electrophysiological study demonstrated that ferulic acid rapidly and concentration-dependently increased L-type Ca²⁺ channel current, shifting its activation curve in the hyperpolarizing direction with a decreased slope factor, while the voltage dependence of inactivation was not affected. On the other hand, ferulic acid have no effect on T-type Ca²⁺ channels. Furthermore, ferulic acid significantly increased insulin secretion, an effect inhibited by nifedipine and Ca²⁺-free extracellular fluid, confirming that ferulic acid-induced insulin secretion in these cells was mediated by augmenting Ca²⁺ influx through L-type Ca²⁺ channel. Our data also suggest that this may be a direct, nongenomic action.ConclusionThis is the first electrophysiological demonstration that acute ferulic acid treatment could increase L-type Ca²⁺ channel current in pancreatic β cells by enhancing its voltage dependence of activation, leading to insulin secretion.     

老年人脑微出血与收缩压晨峰的相关性

目的探讨收缩压晨峰对老年人脑微出血(CMB)的影响。方法 2008年4月~2009年10月于山东省医学科学院心脑血管病防治研究中心选择年龄≥60岁的健康体检的老年人408例。采用24h动态血压监测血压晨峰,根据收缩压晨峰,将受试者分为晨峰组169例[收缩压晨峰≥35mm Hg(1mm Hg=0.133kPa)]和非晨峰组239例(收缩压晨峰<35mm Hg)。分别于2008~2009年(基线)、2010~2012年(随访)和2013~2015年(随访)共进行3次头颅MRI检查评估CMB。患者随访39~72(62.04±6.80)个月,将随访与基线比较,有新发CMB定义为CMB进展。用logistic回归分析影响因素,用Kaplan-Meier生存函数曲线分析,用多元Cox生存回归分析。结果晨峰组诊室收缩压、24h平均收缩压、昼间平均收缩压、昼间平均舒张压、收缩压晨峰、舒张压晨峰和LDL-C水平及CMB患病率显著高于非晨峰组(P<0.05,P<0.01)。logistic回归分析在校正相关混杂因素后,晨峰组患CMB的危险显著高于非晨峰组(OR=2.561,95%CI:1.142~5.743,P=0.019)。晨峰组累积CMB进展率显著高于非晨峰组(18.5%vs 7.6%,χ^2=7.954,Plog-rank=0.005)。在校正包括基线有无CMB在内的相关混杂因素后,晨峰组发生CMB进展的风险显著增高,是非晨峰组的2.353倍(95%CI:1.317~3.197,P=0.002)。结论收缩压晨峰是CMB患病及进展的独立危险因素,过高的收缩压晨峰促进老年人CMB的发展。     

荧光染色与过碘酸希夫染色对真菌性角膜炎诊断效果的比较

目的比较荧光染色和过碘酸希夫染色对真菌性角膜炎(FK)的诊断效果。方法收集2017年1月至2019年5月于山东第一医科大学附属眼科医院就诊且角膜刮片或真菌培养阳性的FK患者147例角膜标本147份,其中行穿透角膜移植术(PKP)患者84例,板层角膜移植术(LKP)患者42例,病灶切除患者21例;选取11例单纯疱疹病毒性角膜炎活检组织作为阴性对照。对角膜组织标本分别行真菌荧光染色和过碘酸希夫染色。将染色完成的切片分别置于荧光显微镜和光学显微镜下查找真菌菌丝或孢子。比较2种染色方法的阳性率、不同手术方式获得的FK角膜组织以及不同真菌菌株标本间2种染色方法的阳性例数。结果过碘酸希夫染色的阳性率为60.5%(89/147),真菌荧光染色的阳性率为79.6%(117/147),荧光染色法诊断FK的阳性率明显高于过碘酸希夫染色法,差异有统计学意义(χ2=28.00,P<0.01),2种染色方法的特异性均为100%。PKP手术切除标本荧光染色的阳性率为85.7%(72/84),明显高于过碘酸希夫染色的阳性率65.5%(55/84),差异有统计学意义(χ2=17.00,P<0.01);LKP手术切除标本荧光染色的阳性率为71.4%(30/42),明显高于过碘酸希夫染色的52.4%(22/42),差异有统计学意义(χ2=8.00,P<0.01);病灶切除标本分别采用荧光染色和过碘酸希夫染色法进行检查,阳性率分别为71.4%(15/21)和57.1%(12/21),差异无统计学意义(χ2=1.30,P=0.25)。不同真菌菌株标本间2种染色的阳性例数不同,其中茄病镰刀菌复合群、谲诈腐霉菌、烟曲霉复合群、季也蒙假丝酵母、木霉和铺叶沼兰褐莺真菌行荧光染色的阳性例数分别为19、5、5、1、1和1例,行过碘酸希夫染色的阳性例数分别为11、0、3、0、0和0例。11例阴性对照均为阴性结果。结论荧光染色技术应用于石蜡包埋角膜组织检查真菌成分较过碘酸希夫染色法敏感性高,可显著提高真菌检测的阳性率。     

完全腹腔镜根治性膀胱切除术+邢氏原位回肠新膀胱的可行性和疗效

目的探讨完全腹腔镜根治性膀胱切除术+邢氏原位回肠新膀胱的可行性和术后临床效果。方法回顾性分析2013年7月至2019年8月41例行完全腹腔镜根治性膀胱切除术+邢氏原位回肠新膀胱患者的临床资料,其中北京朝阳医院31例,中国医学科学院肿瘤医院10例。年龄平均59(44~78)岁。体质指数平均25.3(20.1~34.7)kg/m^2。Charlson合并症指数评分平均3(2~6)分。术前检查均无尿道狭窄,无尿失禁。核素骨扫描、胸部X线片、B超等检查均未发现远处转移。所有患者行膀胱镜检查取活检或行经尿道膀胱肿瘤切除术,术前病理诊断:肌层浸润性膀胱癌30例(73.2%),非肌层浸润性膀胱癌9例(高危或反复复发)(22.0%),原位癌2例(4.9%)。41例均在全麻下先行腹腔镜根治性膀胱切除术+淋巴结清扫术,之后在体腔内采用邢式原位回肠新膀胱进行尿流改道。距回盲部约30 cm向近端截取末端回肠约60 cm,将已截取的回肠近端10 cm移至远端,作为右侧输入襻,之后将中间40 cm肠管去管化,U形缝合后反折缝合成球形,构建成顺蠕动双输入襻回肠新膀胱即邢式原位回肠新膀胱。记录围手术期相关资料、术后<30 d和30~90 d并发症情况、术后尿控恢复情况(日间、夜间控尿满意均定义为需要尿垫≤1个)及预后。比较手术开展的前21例和后20例患者手术时间、出血量的差异。结果本研究41例手术均顺利完成。总手术时间平均324.9(210~480)min。出血量平均177.6(50~700)ml。腹腔镜根治性膀胱切除术+淋巴结清扫术时间平均105.5(60~178)min,邢氏新膀胱构建时间平均179.7(121~298)min。前21例与后20例的总手术时间[(365.1±61.7)min与(290.9±41.8)min,P<0.01]、邢氏新膀胱构建时间[(211.7±44.5)min与(170.1±29.1)min,P=0.001]和出血量[(207.1±144.3)ml与(128.0±63.2)ml,P=0.001]比较差异均有统计学意义。术后病理诊断尿路上皮癌40例(2例合并原位癌),小细胞癌1例。清扫淋巴结数量中位值为19(11~58)枚。淋巴结阳性7例(17.1%)。切缘阳性3例(7.3%),分别为输尿管切缘阳性1例,膀胱切缘阳性2例。病理分期Ta^T1期16例,T2期10例,T3期13例,T4期2例。41例术后下地时间中位值为1(1~4)d,肠道功能恢复时间中位值为3(1~18)d,术后正常饮食恢复时间中位值为7(3~18)d,引流管留置时间中位值为9(3~23)d,输尿管支架拔除时间中位值为15(13~35)d,尿管拔除时间中位值为20(6~30)d,总住院时间中位值为21(11~35)d,术后住院时间中位值为14(7~29)d。术后1例进入ICU病房。术后<30 d Clavien 1~2级并发症19例(46.3%),分别为低白蛋白血症15例、感染2例、低钾血症1例、不全肠梗阻1例,对症处理后均好转;Clavien 3~4级并发症1例(2.4%),为空肠穿孔行手术治疗治愈。术后30~90 d Clavien 1~2级并发症2例(4.9%),分别为切口感染和低白蛋白血症各1例,对症处理后好转,无Clavien 3~4级并发症。术后随访时间平均17.6(2~64)个月。36例(87.8%)生存,其中2例(4.9%)转移,1例(2.4%)复发;5例(12.2%)死亡,死亡原因分别为骨转移1例、多发转移2例,心脏疾病2例。术后12个月复查血肌酐平均77.2(54.3~104.1)μmol/L;影像学检查40例无肾积水,1例出现肾积水。41例拔除尿管后均能自行排尿,无需导尿,术后12个月37例(90.2%)日间控尿满意,29例(70.7%)夜间控尿满意。结论完全腹腔镜根治性膀胱切除术+邢氏原位回肠新膀胱的构建方法简单,术后并发症少,尿控恢复较满意。     

基于栅藻延迟发光表征中药药性的方法学验证

对栅藻延迟发光定量化表征中药寒热药性的方法进行优化,并进行方法学验证。用YPMS-2生物光子测量仪检测栅藻激发延迟发光强度,对测得的激发延迟发光强度用Statistica 10.0软件进行线性拟合,得到表征栅藻性质的可靠参数K,用产自于道地产地的经典寒性中药黄芩作为样本,验证本研究方法的精密度、稳定性、重复性,并进行空白实验。栅藻最佳使用K值波动范围是2.81~3.89,本研究方法精密度高,重复性、稳定性良好,空白溶剂无干扰。     

须根水提液对白花丹参种子萌发幼苗光合作用及次生代谢的影响

目的:研究不同浓度白花丹参须根水提液对种子萌发、幼苗光合作用及次生代谢物质积累的影响,以期为白花丹参连作障碍的消减提供参考。方法:设置不同浓度白花丹参须根水提液处理组,测定不同处理组种子萌发率、幼苗多酚氧化酶活性、可溶性糖及可溶性蛋白含量;利用高效液相色谱法(HPLC)测定幼苗中水溶性及脂溶性有效物质含量。结果:白花丹参须根水提液低浓度对种子萌发有促进作用,高浓度有抑制作用;与对照组相比,处理组幼苗净光合速率、蒸腾速率、气孔导度均有不同程度下降;对照组多酚氧化酶活性及可溶性蛋白、可溶性糖总量分别比白花丹参须根水提液处理后低7.86%、8.47%、14.33%,但处理后幼苗水溶性有效成分(丹酚酸B、迷迭香酸)及脂溶性有效成分(二氢丹参酮、丹参酮Ⅰ、丹参酮Ⅱ_A、隐丹参酮)含量积累量均高于对照组。结论:白花丹参须根水提液通过影响种子的萌发率、抑制幼苗的光合作用、促进次生代谢产物积累影响丹参的产量及品质。