卵巢交界性粘液性囊腺癌的MRI诊断及病理对照分析

目的卵巢交界性粘液性囊腺瘤的MRI诊断及病理对照分析。方法回顾性分析我院35例经病理证实的卵巢交界性粘液性囊腺瘤的临床资料及MRI检查资料,观察的肿瘤部位、形态、大小,分房数目、囊液信号、结节或乳头状突起、囊壁及分隔厚度等情况,将其结果与病理对照分析。结果经病理对照,MRI发现了全部肿瘤,共37个,对肿瘤检出率为100%;肿瘤以完全囊性及囊性为主。35例患者中,左侧16例,右侧17例,双侧2例;肿瘤呈类椭圆形30个,分叶状7个。MRI对肿瘤大小诊断结果与病理结果比较无统计学意义(P0.05)。结论 MRI可较好地诊断卵巢交界性粘液性囊腺瘤,显示其肿瘤位置、大小形态及病理特征,蜂窝状子房、T2WI含低信号囊液、T1WI含高信号囊液、结节或乳头状突起(≥5mm)及囊壁或分隔不规则增厚(≥5mm)5个MRI征象对其鉴别诊断有重要价值,可为临床治疗提供影像学依据。     

Role of neoadjuvant therapy for nonmetastatic pancreatic cancer: Current evidence and future perspectives

Pancreatic adenocarcinoma (PDAC) is one of the most common and lethal human cancers worldwide. Surgery followed by adjuvant chemotherapy offers the best chance of a long-term survival for patients with PDAC, although only approximately 20% of the patients have resectable tumors when diagnosed. Neoadjuvant chemotherapy (NACT) is recommended for borderline resectable pancreatic cancer. Several studies have investigated the role of NACT in treating resectable tumors based on the recent advances in PDAC biology, as NACT provides the potential benefit of selecting patients with favorable tumor biology and controls potential micro-metastases in high-risk patients with resectable PDAC. In such challenging cases, new potential tools, such as ct-DNA and molecular targeted therapy, are emerging as novel therapeutic options that may improve old paradigms. This review aims to summarize the current evidence regarding the role of NACT in treating non-metastatic pancreatic cancer while focusing on future perspectives in light of recent evidence.     

Targeting the Endocannabinoid System in Borderline Personality Disorder: Corticolimbic and Hypothalamic Perspectives

Borderline Personality Disorder (BPD) is a chronic debilitating psychiatric disorder characterized mainly by emotional instability, chaotic interpersonal relationships, cognitive disturbance (e.g., dissociation and suicidal thoughts) and maladaptive behaviors. BPD has a high rate of comorbidity with other mental disorders and a high burden on society. In this review, we focused on two compromised brain regions in BPD - the hypothalamus and the corticolimbic system, emphasizing the involvement and potential contribution of the endocannabinoid system (ECS) to improvement in symptoms and coping. The hypothalamus-regulated endocrine axes (hypothalamic pituitary – gonadal, thyroid & adrenal) have been found to be dysregulated in BPD. There is also substantial evidence for limbic system structural and functional changes in BPD, especially in the amygdala and hippocampus, including cortical regions within the corticolimbic system. Extensive expression of CB1 and CB2 receptors of the ECS has been found in limbic regions and the hypothalamus. This opens new windows of opportunity for treatment with cannabinoids such as cannabidiol (CBD) as no other pharmacological treatment has shown long-lasting improvement in the BPD population to date. This review aims to show the potential role of the ECS in BPD patients through their most affected brain regions, the hypothalamus and the corticolimbic system. The literature reviewed does not allow for general indications of treatment with CBD in BPD. However, there is enough knowledge to indicate a treatment ratio of a high level of CBD to a low level of THC. A randomized controlled trial investigating the efficacy of cannabinoid based treatments in BPD is warranted.     

交界性和恶性卵巢上皮肿瘤微血管生成的研究

目的探讨交界性和恶性卵巢上皮肿瘤微血管生成状态及肿瘤微血管生成与卵巢肿瘤发生、发展的关系.方法对10例交界性卵巢上皮肿瘤和45例上皮性卵巢癌石蜡组织切片采用F Ⅷ相关抗原,应用SABC法,检测上皮性卵巢肿瘤中的肿瘤微血管密度(MVD).结果①45例上皮性卵巢癌中MVD均值为31.7±11.2(400倍镜下),高于同时检测的交界性卵巢上皮肿瘤(P＜0.05).MVD在不同的卵巢癌临床分期中的差异有显著性意义(P＜0.05),并且临床Ⅲ～Ⅳ期肿瘤MVD高于临床Ⅰ～Ⅱ期(P＜0.05).②不同组织分级中MVD无显著性差异(P＞0.05).结论肿瘤血管生成是卵巢肿瘤发生、发展的早期事件,临床Ⅲ～Ⅳ期的MVD比Ⅰ～Ⅱ期高.MVD与组织分级无明显关系.     

Lecture des troubles de personnalité limite à travers la théorie de l’attachement

Borderline personality disorders concern clinicians and caregivers because of the violent and impulsive nature of their behavioral and affective reactions, which often confronts them to a feeling of helplessness and incomprehension. Indeed, it may be difficult to deal with self-harm, massive anxiety, intense affects and interpersonal ruptures, which are often present in the life course of the borderline patients. Their distress is particularly difficult to accept as it takes place in the therapeutic link, which reveals the core of the patient's attachment problematic. This paper aims to draw up an overview of borderline personality disorders, in light of attachment theory, which could help to clarify the involved mechanisms and gather the described behaviors in a coherent unit. Many studies relating to borderline personality disorder and attachment theory highlight what constitutes the specificity of these disorders through an integrative approach. Thus, the combination of an insecure attachment style, biological vulnerabilities and environmental stressors like traumatisms may induce the establishment of many defensive mechanisms, such as attachment system hyperactivation, emotional dysregulation or mentalization's failure. People suffering of borderline personality disorder activate these mechanisms as soon as they have to deal with real or imagined abandonments related to one of their attachment figures. However, in view of the massive anxiety and the severe disruption, those inefficient mechanisms cannot enable a good resolution of stressful situations. Consequently, borderline patients are likely to resort to new kind of emotional regulation such as suicidal, destructive and impulsive behaviors. Attachment based theories focus on these defensive mechanisms and inadequate attempts of emotional regulation, in order to propose an appropriate treatment for borderline personality disorder.     

The effects of oxytocin on social cognition in borderline personality disorder

Introduction

Deficits in social cognition and interpersonal difficulties are key features in borderline personality disorder. Social cognition refers to the function of perceiving and adequately dealing with social signals, leading to the establishment and maintenance of healthy and positive social relationships. Evidence suggests that oxytocin (OT) may improve social cognition and human social behavior. Recently, several studies have highlighted the beneficial effects of oxytocin in several psychiatric conditions involving social cognition deficits such as schizophrenia, autism or social phobia. However, despite growing interest, the effects of oxytocin in patients with borderline personality disorder are far from being clearly demonstrated.

Comparison of the Clinical and Anthropometric Features of Treated and Untreated Girls with Borderline Early Puberty

Study ObjectiveRisks associated with precocious puberty might be observed in the rapidly progressive form of borderline early puberty (BEP). Differentiating the rate of progression is important for deciding treatment with gonadotropin-releasing hormone analogue (GnRHa). The aim was to examine the treatment characteristics and effect of treatment on predicted adult height (PAH).DesignRetrospective observational study.SettingSingle-center, a pediatric endocrinology unit.ParticipantsA total of 135 girls, pubertal findings starting between 7-10 years of age.InterventionsData were collected via chart review. Patient groups were defined as treated with GnRHa (n = 63) or untreated (n = 72) girls.Main Outcome MeasuresReferral characteristics and anthropometric and pubertal findings of the patients with BEP, effect of treatment on PAH, and final height of the groups were compared.ResultsThe mean (±SD) age of the patients at admission and for the first appearence of pubertal findings was 8.8 ± 1.0 and 8.0 ± 0.8 years, respectively. Target height and PAH-target height values at admission were similar. At initiation of treatment, PAH of the treated girls (157.8 ± 7.2 cm) were significantly lower compared with untreated girls (160.7 ± 6.5 cm). The age at menarche of patients in the treated and untreated groups were 12.3 ± 1.0 and 11.3 ± 1.1 years, respectively. The final height of the groups were similar (157.1 ± 6.6 vs 157.0 ± 5.9 cm; P = .922) despite a lower PAH of the treated group.ConclusionGnRHa treatment resulted in an increase in PAH and normalized the age of menarche in patients with BEP. In selected girls with rapidly progressive BEP, GnRHa treatment may be considered.     

合并与非合并边缘型人格障碍抑郁症患者的比较研究

目的 比较合并与非合并边缘型人格障碍(BPD)抑郁症患者(MD)的一般资料及其相关因素的差异.方法 采用自编一般资料调查表、贝克抑郁量表(BDI)、症状自评量表(SCL- 90)对30名合并BPD的MD患者、30名非合并BPD的MD患者施测.结果 共病与非共病组在生源地、婚姻、受教育年限无显著差异(P＞0.05),在年...     

青少年边缘型人格障碍倾向的早期家庭相关因素分析

目的:探讨早期有关成长经历与青少年边缘型人格障碍症状的关系。方法:使用人格诊断问卷(PDQ-4+)、父母教养方式问卷(PBI)、童年期创伤经历问卷(CTQ)、依恋问卷(AAQ)对67名工读学校学生和283名普通中职学校学生进行测量。结果:边缘型人格障碍阳性筛查率为26%;BPD阳性检出组与阴性组在PBI、CTQ和AAQ各因子(除性虐待、躯体忽视外)上得分存在显著差异;BPD症状与PBI、CTQ和AAQ各因子间除父亲角色倒置外均存在显著的相关;情感虐待、对母亲愤怒、母亲角色倒置、父亲控制因子对BPD有显著预测作用,共解释BPD总变异的28%。结论:童年期情感虐待、不良的亲子关系模式和父亲控制过严的教养行为是边缘型人格障碍的危险因素。     

Misreading the facial signs: specific impairments and error patterns in recognition of facial emotions with negative valence in borderline personality disorder

Patients with borderline personality disorder (BPD) exhibit impairment in labeling of facial emotional expressions. However, it is not clear whether these deficits affect the whole domain of basic emotions, are valence-specific, or specific to individual emotions. Whether BPD patients' errors in a facial emotion recognition task create a specific pattern also remains to be elucidated. Our study tested two hypotheses: first, we hypothesized, that the emotion perception impairment in borderline personality disorder is specific to the negative emotion domain. Second, we hypothesized, that BPD patients would show error patterns in a facial emotion recognition task more commonly and more systematically than healthy comparison subjects. Participants comprised 33 inpatients with BPD and 32 matched healthy control subjects who performed a computerized version of the Ekman 60 Faces test. The indices of emotion recognition and the direction of errors were processed in separate analyses. Clinical symptoms and personality functioning were assessed using the Symptom Checklist-90-Revised and the Young Schema Questionnaire Long Form. Results showed that patients with BPD were less accurate than control participants in emotion recognition, in particular, in the discrimination of negative emotions, while they were not impaired in the recognition of happy facial expressions. In addition, patients over-attributed disgust and surprise and under-attributed fear to the facial expressions relative to controls. These findings suggest the importance of carefully considering error patterns, besides measuring recognition accuracy, especially among emotions with negative affective valence, when assessing facial affect recognition in BPD.