Endometrial cancer patients have a significant risk of harboring isolated tumor cells in histologically negative lymph nodes

In this study, we examine the prevalence of finding isolated tumor cells (ITCs) in negative lymph nodes of endometrial cancer patients using immunohistochemistry. Seventy-six endometrial cancer patients with lymph nodes histologically negative for metastatic disease were examined. Nodal tissue sections were stained with anticytokeratin antibodies AE-1 and CAM 5.2. Nodes with single or groups of cells (two to four cells) < or =0.2 mm and showing cytokeratin reactivity were positive for ITCs. Findings were compared to features of the primary tumor and patient outcome. ITCs were present in 31 of 1712 lymph nodes. Fifteen (19.7%) patients had ITC-positive nodes. ITCs involved only pelvic nodes in nine cases, only para-aortic nodes in five cases, and pelvic and para-aortic in one case. Tumor in adnexa was the only pathologic feature associated with nodal ITCs (P= 0.0485). All 15 patients with nodal ITCs were alive at follow-up. One (6.7%) patient suffered recurrent disease but was alive at last encounter. Disease recurred in 5 (8.8%) of 57 patients without nodal ITCs. Two are alive without disease, two alive with disease, and one died from her cancer. In summary, a significant proportion of endometrial cancer patients have ITCs detected by immunohistochemistry in histologically negative regional lymph nodes.     

A comparison of conventional and fast spin-echo sequences for the measurement of lesion load in multiple sclerosis using a semi-automated contour technique

Changes on serial assessments of brain MRI lesion load are used for monitoring therapeutic efficacy in patients with multiple sclerosis (MS). We assessed the accuracy and reliability of conventional spin-echo (CSE) and fast spin-echo (FSE) sequences for measurement of lesion volume using a semiautomated contour technique. Cranial CSE and FSE examinations of 18 patients with secondary progressive MS were studied. The mean lesion load was slightly higher with the CSE sequence (p = 0.002). Intraobserver variability was significantly higher for FSE than for CSE, according to both the coefficient of variation between two measurements (mean 2.48 % and 1.35 % respectively, p < 0.05) and back-transformed 95 % limits of agreement (1.005–1.060 for FSE; 0.988–1.019 for CSE). Although FSE sequences are quicker and the total lesion volume measurements are similar to those obtained with CSE, the poorer reproducibility raises doubts about the use of FSE to replace CSE in clinical trials. Received: 26 March 1996 Accepted: 4 April 1996     

补钙预防结直肠息肉及结直肠癌的作用

本文概述了人体补充钙后对大肠息肉及结肠癌发生的影响。     

Multiple sclerosis patients have reduced HLA class II-restricted cytotoxic responses specific for both measles and herpes virus

It has been previously demonstrated that the generation of measles virus (MV)-specific cytotoxicity (CTL) is reduced in patients with multiple sclerosis (MS). By contrast, CTL specific for influenza virus (FLU) and mumps virus is normal. It is uncertain if reduced CTL is limited to MV in MS patients, or if reduced CTL may be found to other viruses as well. Since MV-specific CTL is predominantly restricted by HLA class II molecules, while FLU-specific and mumps-specific CTL have large HLA class I-restricted components, reduced MV-specific CTL may reflect a broader reduction in HLA class II-restricted CTL in patients with MS. To examine this question we studied the generation of CTL specific for herpes simplex virus type I (HSV). HSV-specific CTL, like MV-specific CTL is predominantly restricted by HLA class II molecules. We found that patients with MS had reduced generation of CTL to both MV and HSV. Most, but not all patients who had reduced generation of CTL to one virus also had a similar impairment with respect to the second virus. Some patients, however, had a reduction in the generation of CTL only to MV or to HSV. These findings extend our earlier observations regarding reduced MV-specific CTL in patients with MS to a second HLA class II-restricted virus, HSV. Such a reduction may reflect discrete impairments in immune function to separate viruses, possibly those that are associated with viral persistence, or may reflect a more generalized defect in HLA class II-restricted CTL.     

HLA-DPB1 gene polymorphism and multiple sclerosis: a large case-control study in the southwest of France

The polymorphism at the HLA-DPB1 locus has been characterized in a large number of patients with multiple sclerosis (n = 112) and in healthy controls (n = 115). Both patients and controls lived in the southwest of France (in the Pyrénées Atlantiques) and had similar ethnic background. The typing procedure involved the selective amplification of the second exon of the DPB1 locus by polymerase chain reaction, followed by hybridization of the amplified DNA with 14 sequence-specific oligonucleotide probes. Individual alleles were identified by the pattern of hybridization of the different probes. The distribution of the DPB1 alleles was not significantly different in multiple sclerosis patients and controls (p = 0.11). This does not corroborate the reported association of multiple sclerosis with the primed lymphocyte typing (PLT)-defined DPw4 specificity and is not in favour of a role played by polymorphic residues of the DP molecule in susceptibility to multiple sclerosis.     

Multiple spike-train analysis using mutual interval matrix

The principal-component approach is applied to the analysis of sequences of neuronal action potentials (spike trains). Multiple spike trains are represented as a sequence of vectors of mutual interspike intervals and are considered to be part of the trajectory of a dynamic system. The trajectory matrix is decomposed into a number of ‘basic spike patterns’ and their relative magnitudes by singular-value decomposition. The representation provides a convenient framework for analysis of dynamic relations and cooperation between neurons in an observed network. Examples of applications to simulated and cerebellar data are presented.     

How far do patients with sensory ataxia benefit from so-called “proprioceptive rehabilitation”?

A rehabilitation program including foot sensory stimulation, balance and gait training with limited vision was performed in 24 patients with clinically defined sensory ataxia. There were 15 patients with bilateral somatosensory loss related to chronic neuropathy and nine patients with unilateral loss-related to multiple sclerosis. After training, balance control assessed using the Berg Balance Test improved similarly in both groups, and Romberg's sign disappeared in some patients, suggesting an improvement in dynamic balance and in the proprioceptive contribution. Conversely, balance assessed on a static force platform remained similar in the open-eyes condition and improved in the closed-eyes condition only in patients with unilateral sensory loss. These results show that ataxic patients can improve their balance with better results in dynamic conditions and that the relative contribution of proprioceptive and visual inputs may depend on the extent of somatosensory loss.     

Loss of heterozygosity alterations associated with progesterone therapy in endometrial hyperplasia and adenocarcinoma

Loss of heterozygosity (LOH) was analyzed in four patients with endometrial hyperplasia (EH) with atypia (two patients) and without atypia (two patients) and in five patients with endometrial adenocarcinoma (EAC) to clarify the clinicopathologic relationship between genetic alterations and hormone therapy. Each patient was initially administered high-dose medroxyprogesterone acetate (MPA) as a uterine-sparing treatment. The five microsatellite markers used to analyze LOH were at chromosomal loci 8p22.1, 8p21, 8p21.3, 8p22, and 8p22. DNA was extracted from paraffin-embedded sections before, during, and after MPA therapy using laser capture microdissection. As a result, LOH was more frequently detected after MPA therapy (overall ratios were 16, 17, and 29% before, during, and after MPA therapy, respectively). LOH is more easily detected in EH loci than in EAC loci before MPA. For EAC, initial LOH detection on chromosome 8 may be related to an incomplete response to MPA, but negative LOH does not guarantee a favorable treatment outcome. For EH or atypical endometrial hyperplasia, it is unknown whether LOH alteration associated with MPA therapy is related to atypia of the disease.     

产科危重患者多器官功能障碍综合征的临床分析

目的 :分析产科危重患者多器官功能障碍综合征 (MODS)的发病特点及诱因 ,以及与急性生理与慢性健康状况评分II(APACHEII)的关系。方法 :回顾分析 2 0 0 0年1月至 2 0 0 4年 4月转入GICU产科危重患者中发生MODS 6 6例的临床资料 ,并计算其A PACHEII评分。结果 :产科MODS患者诱因主要是产科因素 ,共 4 8例 (72 .73% ) ,死亡 7例 (14 .5 8% ) ,以重度子痫前期或子痫及产后出血为主 ;诱因 18例妊娠合并内外科疾病 ,死亡 11例 ,死亡率为 6 1.11% ,以妊娠合并心脏病和妊娠合并重症肝炎为主。产科MODS患者死亡率随着器官损害数的增多而上升 ,差异有显著性 (P <0 .0 5 ) ;随着器官损害数的增多 ,APACHEII评分逐渐升高 ,差异有显著性 (P <0 .0 5 ) ;APACHEII评分用于预测MODS死亡阳性率 ,2 ,3,4 ,5个器官受损害 ,其阳性率分别为 33.4 5 % ,5 7.12 % ,97.0 9% ,10 0 %。结论 :产科多器官功能障碍 /衰竭的产科主要诱因是重度子痫前期 /子痫 ,产后出血 ;产科MODS患者死亡率也随着器官损害数的增多而上升 ;APACHEII评分可在一定程度上作为评定产科MODS患者病情危重程度和预测预后的指标。     

Successful pregnancy after recurrent hysteroscopic polypectomy

This case demonstrates that hysteroscopic polypectomy can enhance fertility. A 35-year-old woman was being evaluated for assisted conception. She was referred from an in vitro fertilisation clinic for polypectomy, which she had undergone on two occasions. She conceived spontaneously, had an uneventful antenatal period, and delivered a healthy baby at 39 weeks' gestation.