双侧腋静脉交替留置套管针替代PICC置管在NICU中的应用

目的研究双侧腋静脉交替留置套管针替代PICC置管的可行性,在保证安全、理想的静脉通道的同时尽可能地减低患者的医疗费用。方法40例病例中早产儿22例,重症新生儿18例。40例患儿分为2组,未开展本技术前置PICC管者20例作为对照组,随机抽取20例早产儿或重症新生儿作为实验组,采用左右腋静脉交替留置套管针的方法建立静脉通道。比较2组的临床效果和所耗费用。结果双侧腋静脉交替留置套管针完全可以达到PICC的理想静脉通道的效果且费用低。结论双侧腋静脉交替留置套管针替代PICC置管是科学、实用、可行的,值得在临床推广使用。     

骨桥蛋白检测用于乳腺癌诊断的临床价值

目的检测乳腺癌组织及血清中骨桥蛋白(OPN)表达水平,分析其用于乳腺癌诊断的临床价值。方法应用RT-PCR法检测45例乳腺癌病灶及其癌旁组织的OPN表达水平,分析其与临床病理特征之间的关系;ELISA检测乳腺癌(45例)、乳腺良性肿瘤(19例)以及正常体检女性(26例)血清中的OPN的水平,同时免疫化学发光法检测其血清CA153的浓度,ROC曲线分析OPN、CA153以及二者联合检测对乳腺癌诊断的价值。结果 45例乳腺癌病灶和相应的癌旁组织中OPN mRNA阳性表达率为分别77.78%(35/45)和37.78%(17/45),乳腺癌组OPN mRNA表达量(1.51±0.16)显著高于癌旁组织(1.12±0.10),差异均具有统计学意义(P<0.05);OPN的表达与临床分期,病灶钙化以及腋窝淋巴结转移均具有相关性(P<0.05);与正常对照组和乳腺良性肿瘤组比较,乳腺癌血清中的OPN含量显著升高;Ⅲ期+Ⅳ期血清OPN浓度显著高于Ⅰ期+Ⅱ期(P<0.05);转移组的OPN含量明显高于未转移组,差异具有统计学意义(P<0.01);血清中的OPN浓度与组织中OPN mRNA表达水平显著相关(r=0.653,t=4.91,P<0.05);OPN、CA153及二者联合检测诊断乳腺癌的灵敏度分别为:73.3%、60.0%和95.6%,特异性分别为82.2%、91.1%和66.7%。结论 OPN在乳腺癌病灶组织中高表达,与乳腺癌临床分期,病灶钙化以及腋窝淋巴结转移相关;血清中OPN浓度与组织mRNA表达显著相关,可能是来源于组织中的骨桥蛋白的分泌;血清OPN可以作为乳腺癌转移诊断的辅助指标,联合CA153检测诊断性能明显优于单独检测,可明显提高灵敏度,对乳腺癌早期诊断具有重要意义。     

乳腺癌改良根治术中保留肋间臂神经的临床价值

目的:探讨乳腺癌腋窝淋巴结清扫术保留肋间臂神经的方法与临床价值。方法:选择Ⅰ、Ⅱ期乳腺癌患者,随机分为2组,实验组78例保留肋间臂神经,对照组78例常规手术而切除肋间臂神经,术后对2组患者进行观察并随访。结果:实验组术后发生上肢感觉障碍及疼痛较对照组低,两者比较差异有显著性意义(P<0.01);且经随访两组均未发现局部复发。结论:对于Ⅰ、Ⅱ期乳腺癌行腋窝淋巴结清扫时保留肋间臂神经可以明显减少术后患侧上肢感觉障碍及疼痛的发生。     

Olfactory identification in non-demented elderly population and in mild cognitive impairment: a comparison of performance in clinical odor identification versus Boston Naming Test

Performance in olfactory identification was studied in mild cognitive impairment (MCI), using slightly expanded standard clinical approach to study the olfactory nerve. Four hundred and eighty-six cognitively normal individuals and 72 individuals with MCI underwent spontaneous and cued odor identification and delayed odor recall. Performance in these was compared with the performance in the CERAD version of the Boston Naming Test (BNT). The individuals with MCI scores significantly worse in all tests compared with controls, but the performance in tests assessing odor were less impaired than performance in the BNT. Standard assessment of olfactory nerve function is not sufficient to study cognitive impairment in MCI.     

32例腔镜下乳腺癌腋窝淋巴结清扫术临床分析

目的 探讨腔镜下乳腺癌腋窝淋巴结清扫手术方法、可行性及临床效果.方法 回顾性分析32例乳腺癌腔镜下腋窝淋巴结清扫手术(腔镜组)的临床资料,并与46例同期临床分期类似而行传统腋窝淋巴结清扫(传统组)资料比较.结果 两组均为Ⅰ～Ⅱ期乳腺癌.腔镜组无中转开放手术,未发生大出血、皮下气肿、脂肪栓塞等并发症.腔镜组淋巴结数目(15.5枚)、平均手术时间(80min)与传统组比较差异均无统计学意义.但缩短了引流时间(3～5d)、减少了出血量(380ml)和术后并发症发生率(仅1例).结论 在选择性乳腺癌患者行腔镜下腋窝淋巴结清扫术能够达到传统腋窝淋巴清扫治疗效果,可在保证腋窝淋巴结清扫质量的同时降低手术并发症发生率,达到了生理、心理的微创化,提高了患者的生活质量.腔镜下腋窝淋巴结清扫术是可行的.     

Management of the axilla in patients with breast cancer

This article reviews the changes in management of the axilla in patients with breast cancer in the last decade. It discusses the recent advances, existing controversies and provides evidence-based guidelines for use in clinical practice. Sentinel lymph node (SLN) biopsy has replaced the more morbid axillary lymph node dissection (ALND) and four node sampling for axillary nodal staging. Blue dye guided four node sampling is an acceptable alternative when radioisotope facilities are not available. ALND is reserved for patients with proven axillary lymph node involvement.     

Olfactory neophobia and seizure susceptibility phenotypes in an animal model of epilepsy are normalized by impairment of brain corticotropin releasing factor

PURPOSE: The present study explored the causal relationship between stressor exposure/stress neuropeptide activation and avoidant exploratory phenotype/enhanced seizure susceptibility in an animal model of epilepsy. METHODS: The olfactory detection and investigation phenotype of seizure susceptible El (epilepsy) strain and nonsusceptible ddY control mice was first evaluated in untreated mice. In a second series of experiments, the olfactory exploration phenotype, food intake/body weight regulation, circadian locomotor activity, and seizure susceptibility were assessed over a 14-day period following central administration of the neurotoxin saporin alone or a conjugate of the stress neuropeptide, corticotropin releasing factor (CRF), and saporin (CRF-SAP) which impairs CRF system function following central administration. RESULTS: In support of the main experimental hypothesis, administration of CRF-SAP in El mice reduced handling-induced seizure susceptibility by 75% for up to 2 weeks following treatment. Similarly, El mice were slow to detect a cache of buried food pellets relative to ddY controls and this exploratory deficit was reversed 3 days following administration of CRF-SAP. Efficacy of CRF-SAP treatment was confirmed using CRF immunohistochemistry, which revealed suppression of brain CRF content in El mice treated with CRF-SAP relative to El controls. Other functional and persistent effects of CRF-SAP included increased locomotor activity and hyperphagia. CONCLUSIONS: Taken together, these results support strongly the possibility that activated brain stress neuropeptide systems are necessary for the expression of motivational and neurological perturbations in seizure susceptible El mice.     

Solitary positive sentinel lymph node accompanied by negative sentinel lymph node(s) is predictive of a negative completion axillary lymph node dissection

BACKGROUND: Many patients with a positive sentinel lymph node (SLN) have a negative axillary lymph node dissection (ALND). We hypothesized that a solitary positive SLN associated with at least 1 negative SLN is predictive of a negative completion ALND. Omission of ALND may be possible in these patients. METHODS: A retrospective review of 392 consecutive patients who underwent SLNB was performed. The 78 (20%) SLN-positive patients were divided into 4 groups: group 1: solitary positive SLN associated with at least 1 negative SLN; group 2: more than 1 positive SLN with at least 1 negative SLN; group 3: solitary positive SLN with no additional SLNs; and group 4: more than 1 positive SLN and all SLNs positive. RESULTS: Excluding extracapsular extension, only 3% of group 1 patients had a positive ALND. Positive ALND was found in 15% of group 2, 29% of group 3, and 77% of group 4. CONCLUSIONS: A solitary positive SLN accompanied by additional negative SLN(s) is predictive of a negative completion ALND.     

Role of axillary ultrasound examination in the selection of breast cancer patients for sentinel node biopsy

BACKGROUND: Sentinel node biopsy (SNB) is a time-consuming procedure that can be avoided in presence of axillary metastases. The aim of this study was to assess the accuracy of ultrasound scan (US) in the prediction of axillary nodes status in patients scheduled for SNB. METHODS: Axillary US was performed and when feasible, a core biopsy of suspicious nodes was taken. The nodal status as assessed by US and/or core biopsy was compared with final histology. RESULTS: Of the 132 patients enrolled, 31 (23.5%) had suspicious axillary nodes according to US; 19 (61.3%) were true positive, whereas 12 cases (38.7%) were not. In 14 of 31 suspicious cases an US-guided core-biopsy was taken, which in 11 of 14 cases (78.5%) confirmed the neoplastic involvement. Overall, core biopsy of the nodes correctly predicted the final histology in 13 of 14 cases (92.8%). CONCLUSIONS: The US of axillary nodes, possibly associated with core biopsy, improved the preoperative evaluation of breast cancer patients scheduled for SNB.