Subgrouping and grading of soft-tissue sarcomas by fine-needle aspiration cytology: a histopathologic correlation study

To evaluate the accuracy and reproducibility of subgrouping and grading soft-tissue sarcomas by fine-needle aspiration biopsy (FNAB), a blind review was conducted of 84 FNAB specimens from 77 malignant and 7 benign soft-tissue lesions. Cytomorphologic subgroups included 31 spindle-cell, 24 pleomorphic, 11 myxoid, 7 epithelioid/polygonal, 3 small round cell, and 8 nondiagnostic cases. Malignancies included one lymphoma and 41 primary, 15 recurrent, and 20 metastatic soft-tissue sarcomas. Adequacy was defined as a majority of slides with at least 5 clusters of 10 unobscured cells. Five originally false-negative cases were considered nondiagnostic on review. Sarcoma was recognized in 59 of 64 adequate cases (92%) with available histology; however, the specific histopathologic subtype was identified in only 9 cases (14%). Benign myxoid and spindle-cell lesions were difficult to separate from low-grade sarcomas in 4 cases, and a B-cell lymphoma with sclerosis mimicked a low-grade myxoid sarcoma. The assigned cytologic grade accurately reflected the histologic grade in 90% of sarcomas when segregated into high and low grades. Pleomorphic, small round cell, and epithelioid/polygonal subgroups corresponded to high-grade sarcomas in all cases with only minor noncorrelations. Major grading noncorrelations occurred in 50% of myxoid and 9% of spindle-cell sarcomas. Therefore, attention should be given to specimen adequacy, and caution should be exercised when attempting to grade myxoid and spindle-cell sarcomas by FNAB.     

Tumor nuclear grade,estrogen receptor,and progesterone receptor: Their value alone or in combination as indicators of outcome following adjuvant therapy for breast cancer

Summary Previous reports by us have shown that the outcome of breast cancer patients who have received systemic adjuvant therapy is influenced by tumor estrogen or progesterone receptor (ER or PR) content or by nuclear grade. This publication provides information regarding the relative merit of those three markers. Findings from patients receiving L-PAM plus 5-FU (PF) or PF plus tamoxifen (PFT) indicate that the disease-free survival and survival within each regimen was almost identical when related to either ER, PR, or nuclear grade. Those having tumors with either of the receptors 10 fmol or a good nuclear grade had a better outcome through five postoperative years than did those with ER or PR 0–9 fmol or poor nuclear grade. The magnitude of the difference was similar for each of the three discriminants. Since they were found to be of equal predictive value, one marker might well serve as a substitute for another. Cox regression analyses, however, clearly indicate that ER, PR, and nuclear grade have an independent influence on outcome and that a more accurate assessment of outcome is obtained when more than one marker is employed. Thus, information should be obtained on as many markers as possible. This conclusion is supported by observations presented which indicate that nuclear grade in combination with either or both of the receptors is a better predictor than either marker alone and that, as indicated by life table probability values and relative odds ratios, an increasing number of favorable tumor prognostic indicators results in a better patient outcome particularly in PFT-treated patients. A possible explanation is considered for why the separation of receptor/nuclear grade categories is more orderly and pronounced in PF-treated patients receiving tamoxifen than in those given PF alone. See Appendix I     

长链非编码RNA AGAP2-AS1在胶质瘤增殖过程中作用机制的研究

目的探究长链非编码RNA AGAP2-AS1在胶质瘤增殖过程中的作用机制。方法选取2018年12月-2019年11月期间的30例胶质瘤患者为观察组,同时期的30例脑外伤患者为对照组。比较两组的组织AGAP2-AS1 mRNA表达量、Ras及ERK1/2蛋白表达情况,并比较观察组中不同分级胶质瘤的AGAP2-AS1 mRNA表达量、Ras及ERK1/2蛋白表达情况,比较转染siRNA AGAP2-AS1与siRNANC的U87及U251细胞克隆数。结果观察组的RNA AGAP2-AS1 mRNA表达量、Ras及ERK1/2蛋白表达显著高于对照组,不同分级胶质瘤的RNA AGAP2-AS1 mRNA表达量、Ras及ERK1/2蛋白表达比较,差异有统计学意义(P<0.05),转染siRNA AGAP2-AS1的U87及U251细胞克隆数显著低于siRNA-NC,差异有统计学意义(P<0.05)。结论长链非编码RNA AGAP2-AS1可通过调控ERK/MAPK信号通路影响胶质瘤的增殖,下调AGAP2-AS1可显著影响胶质瘤细胞的克隆形成能力。     

中药材及饮片质量等级标准研究思路和方法

中药质量评价作为保障中药材及饮片质量安全有效的有力手段,对维护人民群众身心健康、促进中药产业高质量发展具有重要意义。长久以来,中药质量多以法定检验标准为准入门槛进行低限控制,质量等级标准缺乏,致使中药质量仅能满足基本要求,而“优质优价”未能得到充分体现,导致“劣币驱逐良币”,市场公平严重受损,这很大程度影响了中药产业高质量发展。因此,开展中药质量优劣评价研究,构建中药质量等级标准体系对于全面落实“四个最严”要求、促进中医药传承创新发展、规范市场秩序、引导产业健康发展具有深远而重大的意义。对中药材质量评价现状进行概述,针对目前中药材质量评价的瓶颈问题,提出符合中医药特点的质量等级标准研究思路,包括关键质量控制指标确立、综合质量评价方法建立、质量等级标准验证等内容,以期为建立中药质量等级评价体系提供参考,助力中药产业高质量发展。     

Narrative review of prostate cancer grading systems: will the Gleason scores be replaced by the Grade Groups?

The Gleason grading system, proposed by Dr. Donald F. Gleason in 1966, is one of the most important prognostic factors in men with prostate cancer (PCa). At consensus conferences held in 2005 and 2014, organized by the International Society of Urological Pathology (ISUP), the system was modified to reflect the current diagnostic and therapeutic approaches. In particular, in the 2014 Conference, it was recognized that there were weaknesses with the original and the 2005 ISUP modified Gleason systems. Based on the results of a research conducted by Prof. JI Epstein and his group, a new grading system was proposed by the ISUP in order to address some of such deficiencies: i.e., the five distinct Grade Groups (GGs). Since 2014, results of studies have been published by different groups and societies, including the Genitourinary Pathology Society (GUPS), giving additional support to the prognostic role of the architectural Gleason patterns and, in particular, of the GGs. A revised GG system, taking into account the percentage of Gleason pattern (GP) 4, cribriform and intraductal carcinoma, tertiary GP 5, and reactive stroma grade, has shown to have some advantages, however not ready for adoption in the current practice. The aim of this contribution was to review the major updates and recommendations regarding the GPs and GSs, as well as the GGs, trying to give an answer to the following questions: “How has the grade group system been used in the routine?” and “will the Gleason scoring system be replace by the grade groups?” We also discussed the potential implementation in the future of molecular pathology and artificial intelligence in grading to further define risk groups in patients with PCa.     

蛛网膜下腔出血继发癫痫发作临床分析

目的：探讨蛛网膜下腔出血（SAH）继发癫痫的临床特点。方法：回顾性分析近17年来经CT证实的134例SAH患者中18例继发性癫痫患者的临床资料,重点观察癫痫发作类型与SAH之Fisher分级间的关系。全组均采用脱水降颅压、止血、抗感染等综合治疗,对于癫痫发作2次及以上的病人同时给予抗癫痫治疗。结果：于SAH72 h内继发癫痫发作12例,于病程第4～15天继发癫痫发作6例。18例中,全身性强直-阵挛发作（强直组）10例,简单部分性运动发作（简单组）4例,复杂部分性运动发作（复杂组）4例;除强直组与简单组Fisher分级比较,差异有统计学意义（P〈0.05）外,其余组间比较差异无统计学意义（P〉0.05）。根据GOS量表评定疗效,本组优9例,良2例,中2例,死亡5例。结论：SAH继发癫痫多发生在SAH早期,且以强直-阵挛发作为多见;其发作类型与SAH出血量和出血波及大脑皮质的范围密切相关。     

pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up

Morphological assessment of the degree of differentiation has been shown in numerous studies to provide useful prognostic information in breast cancer, but until recently histological grading has not been accepted as a routine procedure, mainly because of perceived problems with reproducibility and consistency. In the Nottingham/Tenovus Primary Breast Cancer Study the most commonly used method, described by Bloom & Richardson, has been modified in order to make the criteria more objective. The revised technique involves semiquantitative evaluation of three morphological features--the percentage of tubule formation, the degree of nuclear pleomorphism and an accurate mitotic count using a defined field area. A numerical scoring system is used and the overall grade is derived from a summation of individual scores for the three variables: three grades of differentiation are used. Since 1973, over 2200 patients with primary operable breast cancer have been entered into a study of multiple prognostic factors. Histological grade, assessed in 1831 patients, shows a very strong correlation with prognosis; patients with grade I tumours have a significantly better survival than those with grade II and III tumours (P less than 0.0001). These results demonstrate that this method for histological grading provides important prognostic information and, if the grading protocol is followed consistently, reproducible results can be obtained. Histological grade forms part of the multifactorial Nottingham prognostic index, together with tumour size and lymph node stage, which is used to stratify individual patients for appropriate therapy.     

High-dose thiotepa with autologous bone marrow rescue in recurrent malignant oligodendroglioma: A case report

High-dose thiotepa with autologous bone marrow rescue is a new and promising treatment modality in several kinds of solid tumors. We used this regimen in a pediatric patient who had the third recurrence of his malignant oligodendroglioma of brain that developed during 8 in 1 chemotherapy. We achieved complete response after a total dose of 1125 mg/m² of intravenous thiotepa. Good penetration into the CNS renders thiotepa potentially useful for chemosensitive brain tumors, and one course of high-dose thiotepa can be administered with acceptable toxicity by utilizing autologous bone marrow rescue.     

成人高分级脑胶质瘤术后放疗设野的探讨

目的：探讨用局部扩大野的设野方法照射成人高分级脑胶质瘤的可行性。方法：经术后病理证实为Ⅲ～Ⅳ级星形细胞瘤５３例,分为实验组（Ａ组,２５例）和对照组（Ｂ组,２８例）,放疗采用常规分割,总剂量ＤＴ５０～６５Ｇｙ,设野方法：Ａ组用局部扩大野,Ｂ组用全脑加局部照射野。随访其放疗后生存期及１、３年生存率,复发率。并行统计学处理。结果：Ａ、Ｂ组的中位生存期分别是１４个月,１５．５个月,１,３年生存率分别是８０     

三级肝硬化患者血浆中支链氨基酸与芳香氨基酸数值的变化及分析

目的;观察三级肝硬化患者血浆中支链氨基酸与芳香氨基酸数值的变化情况。方法：使用氨基酸分析仪检测三级肝硬化患者氨基酸数值。结果：随肝病加重,支／芳比值逐渐减低,各组间的差异具有显著性。结论：支／芳比值可作为了解肝硬化病情严重程度和判断预后的指标。