Pancreatic solid pseudopapillary neoplasm

Pancreatic solid pseudopapillary neoplasm (SPN) is a rare low grade malignant tumour. Distinguishing this entity from other pancreatic neoplasms is critical for therapeutic decision making and prognostication. It predominantly affects young female patients <40 years of age, with excellent clinical outcome following surgical removal. The gold standard diagnostic test is cytopathological or histopathological assessment of fine needle aspirate. There are two main difficulties with this. First, SPN can present with morphological and immunohistochemical appearances that can closely mimic other pancreatic tumours, in particular, pancreatic neuroendocrine tumour (NET). Second, the amount of diagnostic material from fine needle aspiration can be limited. Here, we present a cytopathological case with both challenges during the pre-operative investigation of SPN. The case exemplifies the importance of combining morphological features with a targeted panel of immunohistochemistry to arrive at the diagnosis.     

Comparison of functional outcomes among subtypes of Fraser’s typeⅡfloating knee

Purpose The poor prognosis in patients with floating knee injuries is mainly contributed to articular involvement(Fraser’s typeⅡ).This study aims to evaluate and compare the functional outcomes among different Fraser’s typeⅡfloating knee injuries after surgical management.Methods Twenty-seven patients with Fraser’s typeⅡfloating knee injuries(54 fractures)between September 2014 and December 2015 were enrolled prospectively in this study and were distributed according to Fraser’s floating knee classification into three different groups as typeⅡA(ipsilateral femoral shaft and tibial intra-articular involvement,n=11),typeⅡB(ipsilateral tibial shaft and femoral intra-articular involvement,n=9)and typeⅡC(both femoral and tibial intra-articular involvement,n=7).The differences among the groups were evaluated and compared.The functional outcomes of these injuries at one year were analyzed using Knee Injury and Osteoarthritis Outcome Score(KOOS)which covers 5 subscales of pain,other symptoms,activities of daily living,sports and recreation,and quality of life.The result was also compared with standardized age-sex matched healthy population using paired samples t-test.Results All the patients were male,and the injury mechanism was solely roadside accident.The mean age was 29.8 years and injury severity score 17.9(comparable in all the three groups).Most injuries were observed on the right side(20 cases,74.1%).Based on paired samples t-test,the KOOS score of patients with Fraser’s typeⅡA was found to be better than that of typeⅡB and typeⅡC.Compared with the reference age-sex matched control group,patients with Fraser’s typeⅡB andⅡC fractures had significantly lower mean score in all KOOS subscales(all p<0.01).However,Fraser’s typeⅡA only revealed significant difference regarding the subscales of activities of daily living(p<0.0001),sports and recreation(p<0.0001),and quality of life(p<0.0001).Conclusion The results of this study show that patients with Fraser’s typeⅡA fractures had a better functional outcome as compared to those with typeⅡB andⅡC fractures.This might be due to the open intra-articular involvement of the distal femur of the latter two fracture types.     

穿刺活检联合微波消融治疗高龄患者肺单发恶性倾向小结节

目的观察CT引导下经皮穿刺肺活检联合同步交叉法微波消融治疗高龄患者肺单发恶性倾向小结节的疗效。方法将48例肺单发恶性倾向小结节高龄患者随机分为2组,每组24例。试验组于穿刺活检后经异穿刺点交叉针道进行微波消融,对照组穿刺活检后经同轴套管同针道行微波消融,对比2组技术成功率、疗效、总有效率及并发症发生率。结果2组穿刺活检和微波消融操作成功率、总有效率及局部控制率均为100%。试验组中、重度气胸发生率为20.83%(5/24),对照组为58.33%(14/24);试验组中、大量胸腔积液发生率为8.33%(2/24),对照组为37.50%(9/24);试验组中、大量咯血发生率为12.50%(3/24),对照组为48.83%(11/24);组间差异均有统计学意义(P均<0.05)。随访6个月,2组患者均未出现并发症。结论CT定位下经皮穿刺肺活检联合同步交叉法微波消融治疗高龄患者肺单发恶性倾向小结节疗效确切,安全性较好。     

揿针穴位埋针对社区H型高血压 痰湿壅盛证的临床疗效研究

摘 要：目的： 探讨揿针穴位埋针对社区 H型高血压痰湿壅盛证的临床疗效,为 H型高血压的治疗提供参考。方法： 将 80例H型高血压痰湿壅盛证患者按照随机单盲法分为对照组（n=40）和治疗组（n=40）。对照组给予含马来酸依那普利叶 酸片（依叶片）的降压方案进行治疗。治疗组在对照组基础上给予揿针穴位埋针法进行治疗,连续治疗 28天后进行临床疗 效比较。结果： 治疗后,治疗组患者Hcy水平、中医证候积分较对照组显著降低;且治疗组证候积分比对照组显著减少;治 疗组患者血脂水平较对照组显著改善。结论： 在依叶片降压方案治疗的基础上,给予揿针穴位埋针可显著改善 H型高血压 痰湿壅盛证患者的血压、Hcy和血脂水平,且安全性较高,对肝肾功能无影响。     

我国七省流动人口健康素养及其影响因素研究

目的 了解我国七省流动人口的健康素养情况及其影响因素,为开展有针对性的健康素养干预措施提供科学依据。方法 采用2016年全国流动人口卫生计生动态监测调查问卷数据,共纳入2 335名流动人口进行分析。t检验和SymbolcA@²检验用于组间比较。二元logistic回归模型用于分析流动人口健康素养的影响因素。结果 2016年七省流动人口总体健康素养水平为36.7％,其中健康生活方式与行为素养水平较低（36.5%）,传染病防治（33.0%）、基本医疗（27.8%）、慢性病防治素养（22.8%）水平较低。受教育程度更高（初中OR=1.625,P=0.001,高中OR=1.621,P=0.004,大专及以上OR=2.066,P<0.001）、流动次数较少（OR=0.919,P=0.049）、城市地区（OR=1.677,P<0.001）的流动人口健康素养水平更高。结论 流动人口健康素养水平有待提升。应针对受教育程度低、流动次数多的重点人群以及农村重点地区开展干预措施,加强传染病、慢性病防治等健康知识的宣传力度。     

流动人口职业病防治教育现状及影响因素分析

目的 了解流动人口职业病防治教育现状及影响因素。方法 运用SPSS 25.0软件对2017年全国流动人口卫生计生动态监测中的154586名流动人口的相关数据进行分析,主要分析方法有统计描述、χ2检验和二元logistic回归等。结果 154586名流动人口中,51578人接受过职业病防治教育,接受率为33.4%。二元logistic回归分析表明,男性（OR=1.165,95%CI:1.137~1.193）、30～44岁（OR=1.169,95%CI:1.088~1.256）、文化程度高中或中专（OR=1.278,95%CI:1.227~1.330）、在婚（OR=1.172,95%CI:1.134~1.211）、流动原因为经济性质（OR=1.283,95%CI:1.115~1.475）、流入西部地区（OR=1.749,95%CI:1.700~1.799）、有稳定工作（OR=1.071,95%CI:1.016~1.128）、机关或国企或股份联营企业（OR=1.765,95%CI:1.666~1.870）、自评状况为健康（OR=1.479,95%CI:1.363~1.606）的流动人口职业病防治教育接受率较高;未签订劳动合同（OR=0.684,95%CI:0.661~0.708）、未听过“国家基本公共卫生服务项目”（OR=0.231,95%CI:0.225~0.237）的流动人口职业病防治教育接受率较低。结论 流动人口职业病防治教育接受率较低,需加强流动人群职业病防治教育的宣传力度,提高职业病防治教育的覆盖面。     

Cytopathologic analysis of paraspinal masses: a study of 59 cases with clinicoradiologic correlation

Paraspinal masses (PSM) are uncommon and present a wide spectrum of differential diagnoses on fine-needle aspiration (FNA). We analyzed 59 cases of PSM on FNA in a 15-yr period, in the context of clinicoradiologic correlation. Radiologic findings, clinical data, and tissue biopsies were reviewed. Patients were 14-83 yr of age (mean 54.7) with a M:F ratio of 1.36:1. Of the 59 cases, 39 (66%) were deemed diagnostic. Of these, 8 (21%) revealed nonneoplastic lesions and 31 (79%) yielded neoplasms: 2 (6%) benign and 29 (94%) malignant. Of the malignant cases, 22 (76%) were metastatic tumors from various sites, while 7 (24%) were cancers from local spread, which included non-Hodgkin's lymphoma (NHL, 5) and myeloma (2). Benign neoplasms were nerve sheath tumors. Metastatic tumors consisted of adenocarcinoma, 9; squamous-cell carcinoma, 3; renal-cell carcinoma, 1; and non-small-cell carcinoma/not otherwise specified (NOS), 9. Twenty-four (41%) cases received further studies: immunoperoxidase (IPOX) alone, 17 (71%); special stains for microorganisms, 2 (8%); IPOX/other special stains, 4 (17%); and flow cytometry analysis, 1 (4%). Eight (14%) cases received follow-up biopsies. Half of these biopsies added information to previously "nondiagnostic" FNAs. Of the previously "diagnostic" FNAs, tissue biopsy yielded no additional information. Cytopathologic diagnoses were consistent with the pre-FNA radiology analyses in 13 (39%) cases. In instances of radiologic and cytopathologic discrepancy (4 cases, 12%), diagnoses made by FNA reversed the initial radiologic impression of neoplasm to infection, and vice versa. PSMs are rare lesions (0.26% of total FNAs done in 15 yr at our institution). The most common lesion encountered is metastatic adenocarcinoma, followed by NHL. Ancillary studies are helpful in difficult cases. In cases of radiologic/cytopathologic discrepancy, FNA diagnoses are more accurate and decisive for patient management. The sensitivity and specificity of a PSM FNA are 88% and 75% respectively.     

Dry tap bone marrow aspiration: clinical significance

Failure to obtain bone marrow on attempted marrow aspiration, "dry tap," has commonly been ascribed to faulty technique. All reports of simultaneous marrow aspirations and biopsies performed at the University of Virginia between January 1, 1983, and July 1, 1989, were reviewed to determine the frequency of dry taps, the diagnoses and pathologic findings in these cases, and the associated laboratory findings. Among 2,235 simultaneous bone marrow aspirations and biopsies, 87 were dry taps (3.9%). Of these 87 dry taps, only six (6.9%) showed normal marrow biopsies, whereas the majority showed significant marrow pathology, usually associated with fibrosis, or hypercellularity, or both. These conditions most likely account for the inability to aspirate marrow. The most frequent diagnoses were metastatic carcinoma (17.2%), chronic myelogenous leukemia (14.9%), idiopathic myelofibrosis (13.8%), and hairy cell leukemia (10.3%). The presence of peripheral blood nucleated red blood cells, thrombocytopenia, and elevation of the serum lactate dehydrogenase were frequent findings in patients who experienced dry taps. Methods to obtain sufficient marrow for rapid diagnosis in these cases are discussed.     

Transurethral microwave needle ablation for bladder cancer

Ｔｏｉｎｖｅｓｔｉｇａｔｅｔｈｅｒｏｌｅｏｆｔｒａｎｓｕｒｅｔｈｒａｌｍｉｃｒｏｗａｖｅｎｅｅｄｌｅａｂｌａｔｉｏｎ (ＴＵＭＷＮＡ)ｉｎｔｈｅｍａｎａｇｅｍｅｎｔｏｆｂｌａｄｄｅｒｃａｎｃｅｒ ,ＴＵＭＷＮＡｗａｓｃａｒｒｉｅｄｏｕｔｉｎ 2 4ｐａｔｉｅｎｔｓｗｉｔｈｂｌａｄｄｅｒｃａｎｃｅｒｓｉｎｃｅ 1989 ＦｒｏｍＪａｎｕａｒｙ 1989ｔｏＤｅｃｅｍｂｅｒ 1997,2 4ｐａｔｉｅｎｔｓｗｉｔｈｂｌａｄｄｅｒｃａｎｃｅｒｗｅｒｅｔｒｅａｔｅｄｗｉｔｈＴＵＭＷＮＡ Ｔｈｅ 15ｍｅｎａｎｄ 9ｗｏｍｅｎｗｅｒｅ 4 2…