儿童支气管类癌的病理诊断(附2例报告)

目的探讨儿童支气管类癌的临床病理学特征及病理诊断。方法结合我院2例临床资料及组织学观察和免疫组化研究复习有关文献进行分析讨论。结果2例均为中央型支气管类癌,瘤细胞排列成实性片状、小梁状及乳头状;细胞大小一致,胞浆嗜酸性,胞核圆形,核分裂罕见。免疫组化标记CK、Syn、CgA及NSE均阳性。结论儿童支气管典型类癌为高分化神经内分泌癌。由于支气管肿瘤在儿童较罕见,临床症状缺乏特异性,极易引起临床误诊,延误治疗,须引起高度重视。     

复方单硝酸异山梨醇酯缓释片人体生物等效性研究

目的 :评价试验制剂复方单硝酸异山梨醇酯缓释片 (T)与参比制剂单硝酸异山梨醇酯缓释片和阿司匹林肠溶片 (R)的生物等效性 ,以及缓释制剂释放特点、稳态血浓度和波动度。方法 :采用高效液相色谱法分别测定单剂和多剂交叉给药单硝酸异山梨醇酯和阿司匹林代谢物水杨酸经时血浓度 ,计算药物动力学参数 ,并进行方差分析和双单侧t检验。结果 :单剂给药试验制剂和参比制剂单硝酸异山梨醇酯半衰期 (t1 2 )分别为 8.3± 0 .6、8.2± 0 .6h ,血浓度峰值 (Cmax)分别为 0 .5 1± 0 .0 9、 0 .5 3±0 .0 9mg·L-1,达峰时间 (tmax)分别为 4 .8± 0 .4、4 .6± 0 .3h ,药时曲线下面积 (AUC0 -t)分别为 4 .90±0 .6 1、5 .2± 0 .8mg·h-1·L-1,相对生物利用度 (F)为(96 .1± 10 .8) % ;试验制剂和参比制剂阿司匹林代谢物水杨酸t1 2 分别为 2 .4± 0 .3、2 .5± 0 .3h ,Cmax分别为 3.4± 0 .5、3.0± 0 .4mg·L-1,tmax分别为 1.7±0 .2h和 4 .9± 0 .3h ,AUC0 -t分别为 13.4± 2 .5和13.0± 2 .5mg·h-1·L-1,以水杨酸计阿司匹林F为(10 3.6± 9.6 ) %。多剂给药试验制剂和参比制剂单硝酸异山梨醇酯Cmax 分别为 0 .6 8± 0 .14、0 .6 7±0 .13mg·L-1,Cmin 分别为 0 .17± 0 .0 3、 0 .17±0 .0 4mg·L-1,波动系数 (DF)     

Tumor necrosis factor alpha suppresses osteogenic differentiation of MSCs by inhibiting semaphorin 3B via Wnt/β-catenin signaling in estrogen-deficiency induced osteoporosis

The proinflammatory cytokines, especially tumor necrosis factor alpha (TNF-α), have been shown to inhibit osteogenic differentiation of mesenchymal stem cells (MSCs) and bone formation in estrogen-deficiency-induced osteoporosis, but the mechanisms of TNF-α impaired bone formation remain poorly understood. Semaphorins have been shown to regulate cell growth, cell migration, and cell differentiation in a variety of tissues, including bone tissue. Here, we identified a novel mechanism whereby TNF-α, suppressing Semaphorin3B expression contributes to estrogen-deficiency-induced osteoporosis. In this study, we found that TNF-α could decrease Semaphorin3B expression in osteogenic differentiation of MSCs. Overexpression of Semaphorin3B in MSCs attenuated the inhibitory effects of TNF-α on MSCs proliferation and osteoblastic differentiation. Mechanistically, activation of the Wnt/β-catenin signaling markedly rescued TNF-α-inhibited Semaphorin3B expression, suggesting that Wnt/β-catenin signaling was involved in the regulation of Semaphorin3B expression by TNF-α. Taken together, our results revealed a novel function for Semaphorin3B and suggested that suppressed Semaphorin3B may contribute to impaired bone formation by elevated TNF-α in estrogen-deficiency-induced osteoporosis. This study may indicate a therapeutic target gene of Semaphorin3B for osteoporosis.     

Longitudinal study of diffusion tensor imaging properties of affected cortical spinal tracts in acute and chronic hemorrhagic stroke

This study investigated the clinical value of diffusion tensor imaging (DTI) in predicting the motor outcome in patients with basal ganglia hemorrhage. This prospective study included 23 patients assessed with DTI to measure the fractional anisotropy (FA) value in affected cortical spinal tract (CST) at three time points: day 0, day 30 and day 90 after onset. The motor function score (MFS) was applied to evaluate motor function and patients were divided into good and poor outcome groups according to the MFS on day 90. The mean FA value on day 0 was significantly lower in the poor outcome group than in the good outcome group (p < 0.01). FA value gradually decreased in the poor outcome group until day 90 after onset, while it continuously increased in the good outcome group. The MFS obtained at day 90 after onset was significantly correlated with the initial FA value in the affected cerebral peduncle (r = −0.926, p < 0.01). Receiver operating characteristic curve analysis showed that the FA value on day 0 could predict motor function outcome with a sensitivity of 88.89% and specificity of 92.86% at the initial FA value of 0.45. The FA value of affected CST in acute cerebral hemorrhage may valuably predict the motor function outcome and its dynamic change may represent the Wallerian degeneration in motor tracts after hemorrhagic stroke.     

Utility of CD127 combined with FOXP3 for identification of operational tolerance after liver transplantation

Loss of cell surface expression of CD127 on CD4⁺ CD25⁺⁺ regulatory T-cells (Tregs) may be a useful marker to efficiently isolate Tregs. As FOXP3 was specifically used to identify Tregs, combining these two markers could give better identification for patient with operational tolerance (OT) after liver transplantation. To testify this mixed lymphocyte reaction (MLR), the function of circulating CD4⁺ CD25⁺⁺ CD127^dim cells (CD127^dim cells) was examined in immunosuppression (IS)-free pediatric recipients after liver transplantation (LTx) (group operational tolerance: OT) (Gr-tol n = 25) compared to recipients who could not stop IS due to clinically overt rejection (group intolerance) (Gr-intol n = 18), recipients who were weaning IS (Gr-weaning n = 11) and age-matched healthy volunteers (Gr-vol n = 11). In addition, the frequencies of CD127^dim cells vs CD4⁺ CD25⁺⁺ CD127^dimFOXP3⁺ (CD127^dimFOXP3⁺) cells were compared in these four groups by FACS analyses. Our results showed that The proliferation of CD4 cells to donor antigens was reduced compared to third-party antigens only in Gr-tol (P = 0.022) but not in other groups (P = NS). Depletion of CD127^dim cells resulted in a donor antigen-specific abrogation of this MLR hyporesponsiveness in Gr-tol (P < 0.001) but not other groups (P = NS). This implied that CD127 efficiently isolated donor antigen-specific Tregs. The frequencies of CD127^dim cells were significantly lower in Gr-intol (5.2% ± 1.9%) compared to those in Gr-tol (7.8% ± 1.8%) (P < 0.001) as were the frequencies of CD127^dim FOXP3⁺ cells (Gr-tol: 5.4% ± 1.7% vs Gr-intol: 2.9% ± 1.0%, P < 0.001). Of interest, there were fewer CD127^dimFOXP3⁺ cells in Gr-intol (2.9% ± 1%) than in Gr-weaning (5.1% ± 1.8%) (P = 0.002), but no difference in CD127^dim cells (Gr-intol: 5.2% ± 1.9% vs Gr-weaning: 6.7% ± 2.0%) (NS). Thus, combining FOXP3 with CD127 for phenotype analysis demonstrated an unequivocal difference between Gr-intol and Gr-weaning that was not detected by CD127 alone. In conclusion CD127 was a useful surface marker to isolate donor-antigen-specific-Tregs in OT after LTx. The additive effect of its combination with FOXP3 is important in phenotypical Treg analyses of OT patients.     

Short-course preoperative radiotherapy with immediate surgery versus long-course chemoradiation with delayed surgery in the treatment of rectal cancer: A systematic review and meta-analysis

BackgroundLong-course chemoradiotherapy (LCRT) with delayed surgery or short-course radiotherapy (SCRT) with immediate surgery is probably the most frequent regimen in the treatment of rectal cancer. Debate is still going on whether SCRT or LCRT is more effective. So we performed this meta-analysis to evaluate the safety and efficacy of SCRT with immediate surgery versus LCRT with delayed surgery for the management of rectal cancer.MethodsLiterature were searched from PubMed, Embase, Web of science, Cochrane Library up to May, 2014. Quality of the randomized controlled trials (RCTs) was evaluated according to the Cochrane's risk of bias tool of RCT. RevMan 5.3 was used for statistical analysis. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated. Subgroup analysis and sensitivity analysis were employed to explore heterogeneity.Results16 trials were included in the qualitative systematic review. 12 trials were included in meta-analyses. 4 of them were RCTs; other 8 were non-RCTs. Meta-analysis demonstrated that there were no significant differences in overall survival (OS), disease free survival (DFS), local recurrence rate (LRR), distant metastasis rate (DMR), sphincter preservation rate, R0 resection rate and late toxicity. Compared with SCRT, LCRT obviously increased pCR rate [RR = 0.15, 95%CI (0.08, 0.28), P = 0.003], while LCRT obviously increased the grade 3–4 acute toxicity [RR = 0.13, 95%CI (0.06, 0.28), P < 0.00001].ConclusionsSCRT with immediate surgery is as effective as LCRT with delayed surgery for treatment of rectal cancer in terms of OS, DFS, LRR, DMR, Sphincter preservation rate, R0 resection rate and late toxicity. Though LCRT increased pCR rate, LCRT also increased acute toxicity compared with SCRT. SCRT is a better choice in centers with a long waiting list or lack of medical resources.     

Case of stenosing tenosynovitis of the thumb in children: 儿拇指狭窄性腱鞘炎案

A female patient, 13 months old, suffering from limited extension of the right thumb for 7 days, diagnosed as stenosing tenosynovitis of the thumb in children. Tuina (Chinese massage) therapy was adopted, in which, stimulation was applied with fingers instead of needles, including pressing and kneading, twisting and kneading, plucking, dorsal extending, rotating as well as pushing and rubbing manipulations. The whole procedure of manipulation lasted around 15 min, once every two days, 3 times weekly. Meanwhile, the parents were advised to bath the child patient's right hand into warm water every day and fix the affected thumb with splint at night. After 12 treatments with tuina therapy, the flexion and extension function of the affected thumb were returned to normal and the thumb motor function was recovered. In 2 months of follow-up, the thumb motor function was normal and the stenosing tenosynovitis was not recurred. In this case, tuina therapy is adopted in treatment of stenosing tenosynovitis of the thumb in children. As an alternative method of surgery, tuina therapy has a satisfactory clinical effect.     

Measurement of oxidant and antioxidant levels in liver tissue obtained from patients with liver transplantation: A case-control study

ObjectiveThis study aimed to compare oxidant and antioxidant substance accumulation in the liver tissues of patients with chronic liver disease (recipients) who underwent liver transplantation (LT) with living liver donors (LLDs) who underwent living donor hepatectomy (LDH).MethodsThis prospective study included 160 recipients (LT group) and 40 LLDs (LLD group). During surgery, a piece of liver tissue measuring a minimum of 10 × 10 mm was obtained from the edge of the right lobe of the liver of recipients and LLDs, incubated for 10 min in saline to remove blood, and stored at −70 °C until biochemical analysis was performed. Catalase (CAT), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), myeloperoxidase (MPO), prolidase, reduced glutathione (GSH), malondialdehyde (MDA), total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), total thiol, native thiol, and disulfide levels were measured in stored liver tissues.ResultsThere was a statistically significant difference between LT and LLD groups in terms of age (p < 0.001), body mass index (p = 0.019), GSH-Px (p < 0.001), SOD (p = 0.001), MPO (p < 0.001), prolidase (p < 0.001), GSH (p < 0.001), and MDA (p = 0.003) values in favor of the LT group. Furthermore, there was a statistically significant difference between LT and LLD groups in terms of CAT (p < 0.001), TAS (p < 0.001), TOS (p < 0.001), OSI (p < 0.001), total thiol (p < 0.001), native thiol (p < 0.001), and disulfide (p < 0.001) values in favor of the LLD group. There were no differences between the groups in terms of sex.ConclusionThis study demonstrated that it is possible to assess the extent of oxidative stress in liver tissues by measuring the levels of antioxidant enzymes, oxidants, or the end-products of oxidative stress. With the use of optimum and minimally invasive methods, quantifying these molecules will potentially help evaluate the extent of liver disease and prognostication of liver cirrhosis.     

卵巢过度刺激综合征相关因素分析及中西医结合护理体会

目的 探讨卵巢过度刺激综合征（OHSS）相关因素及中西医结合护理体会.方法 选择2011年5月～2013年5月江苏省中医院采用辅助生殖技术的患者393例,分析并比较OHSS在年龄、体重指数、不孕时间、不孕原因、促排卵方案、HCG当日＞12 mm卵泡数等因素间的分布情况;采用Logistic回归分析对OHSS相关因素进行分析.结果 本组发生OHSS共11例,发生率为2.9％.OHSS患者及无OHSS患者在多囊性卵巢综合征（PCOS）或多囊卵巢（PCO）改变、人体绒膜促性腺激素（HMG）＋人绝经促性腺素（HMG）方案、HCG当日雌激素（E2）值、HCG当日＞12 mm卵泡数等方面差异有统计学意义（P＜0.05）.PCOS或PCO改变（OR=6.226,P＜0.05）、HCG＋HMG方案（OR=5.475,P＜0.05）、HCG当日E2值（OR=1.480,P＜0.05）、HCG当日＞12 mm卵泡数（OR=2.148,P＜0.05）与OHSS发生相关,且均为危险因素（OR＞1.000）.结论 OHSS是多种因素共同作用的结果,中医特色的舒适护理模式可提高护理服务质量,节约医疗成本,体现以人为本的护理内涵.