血液白细胞图象的计算机自动分割方法研究

本文提出了一套血液白细胞图象的计算机自动分割方法。实际测试表明：该方法稳定可靠且有效。单个白细胞检出成功率达９６％，区域分割吻合率平均达９４％，现已将该方法装入作者研制的白细胞自动分类识别ＬＥＵＫ分析系统的分割模块中。     

615系小鼠自发乳腺癌的发病率及病理形态学观察

100对615系种鼠,常规饲养繁殖,观察33个月(终生),其乳腺癌发病率为5.5%(11例全部发生于经产雌鼠),低于肺腺癌(11%,22例,雌雄各半)而居第二位,故615系小鼠仍属低乳癌品系。对615系小鼠的46例自发乳腺癌进行了病理形态学检查分析:瘤细胞可分为小、中、大三类。组织分型属A型者18例,多由小细胞及少量中细胞构成;属B型者28例,除小细胞外往往可见较多的中细胞甚或主要由大细胞与中细胞构成。B型乳腺癌的分化程度似较A型者为低。转移主要发生于肺部。7例经镜检证实属乳腺癌的肺转移瘤,其原代瘤属A型者1例,属B型者6例。肺转移瘤的组织像与原发瘤基本相同者4例;而细胞变大,呈实心排列,显示分化程度低于原发瘤者3例。     

Peripheral blood CD3 and CD4 T-lymphocyte reduction correlates with severity of liver cirrhosis

Summary Immunological disturbances with impairment of immune function and a higher incidence of lymphoproliferative disorders and other malignancies have been described in liver cirrhosis patients. To investigate the pathogenetic mechanism(s) involved in such associated we looked for a possible imbalance in peripheral blood T-lymphocyte subpopulations in patients with liver cirrhosis of differing severity. Immunophenotyping and counts of peripheral blood T-lymphocyte subpopulations were carried out using monoclonal antibodies conjugated with different fluorochromes in 31 consecutive cirrhotic patients and 23 matched healthy volunteers. Univariate and multivariate analyses of lymphocyte phenotype counts were performed and odds ratios were computed. Statistically significant associations, according to both univariate and multivariate analyses, were found between case/control status and mean CD3 and CD4 T-lymphocyte counts (P<0.0001). A strong correlation was found between the Pugh’s index and CD3 and CD4 lymphocyte counts, with a clear reduction of these phenotypes with increasing liver cirrhosis. Median CD3 and CD4 values were 2,283 and 1,329/μl respectively among controls and 896, 801, and 492/μl and 515, 514, and 307/μl, respectively in categories A, B, and C of Pugh’s classification. Very high odds ratios were found using the median values of CD3 and CD4 as a threshold. There was a statistically significant decrease for each of the T-cell phenotypes studied (CD2, CD3, CD4, CD8, CD16, CD19, CD20, CD56, CD57) between patients and controls (P<0.0001). The progressive and severity-related decrease in mean peripheral blood CD3 and CD4 counts in liver cirrhosis suggests a progressive impairment of protective immune function and may be a factor facilitating malignancy in cirrhotic patients.     

Primary Sjögren's syndrome: the challenge for classification of disease manifestations

A new model for classifying the clinical disease manifestations of primary Sjögren's syndrome is introduced. Three 'exocrine' and four 'nonexocrine' subgroups of disease manifestations are defined. Accordingly, 'surface exocrine disease' includes the diagnostic features from eyes, mouth, and the manifestations from the upper airways, skin and genital tract. Involvement of the excretory parenchyma of the lungs, hepatobiliary system, pancreas, gastrointestinal tract and kidneys is designated 'internal organ exocrine disease'. We suggest 'monoclonal B lymphocyte disease' to be an exocrine disease manifestation because it originates mostly from the immunoinflammatory foci of the autoimmune exocrinopathy. The nonexocrine manifestations are subgrouped into 'inflammatory vascular disease', 'noninflammatory vascular disease', 'mediator-induced disease' and 'autoimmune endocrine disease'.     

Hepatocellular carcinoma: Efficacy of transcatheter oily chemoembolization in relation to macroscopic and microscopic patterns of tumor growth among 100 patients with partial hepatectomy

Purpose: To evaluate the efficacy of transcatheter oily chemoembolization (TOCE) for hepatoceliular carcinoma (HCC) on the basis of microscopic and macroscopic findings postembolization. Methods: HCCs ranging in size from 0.5 to 13 cm (mean 3.6 cm) were obtained from partial hepatectomies of 100 consecutive patients who had undergone TOCE between 20 and 246 days (mean 59.5 days) prior to surgery. The efficacy of TOCE was assessed on the basis of the necrotic to live cell ratio of the tumors. The microscopic pattern of tumor growth was grouped into expanding type (complete capsule formation) and replacing type (incomplete or no capsule). There were five types of macroscopic groupings: single nodule, single nodule with extranodular growth (SNE), contiguous and noncontiguous multinodular, and massive growth type. Results: Among 79 cases with the expanding type, 29 (37%) had 100% HCC necrosis, but none with 100% necrosis were in the replacing type. By macroscopic grouping, the efficacy of TOCE decreased from the single nodule type (50% of patients had 100% necrosis) to the SNE type (21%), and the other types (9%).     

基于蒙特利尔病变部位分型的克罗恩病患者临床特征分析

目的 探讨回肠末段型（L1）、结肠型（L2）及回结肠型（L3）克罗恩病（CD）患者的临床特征、实验室检查、疾病行为等方面的差异。方法 回顾性研究2021年1月—2022年6月武汉大学人民医院181例CD患者的临床资料,其中L1型CD患者66例,L2型CD患者20例,L3型CD患者95例。收集患者临床资料和实验室检查结果等,分析3组患者在临床特征和实验室检查结果等方面的差异。多因素二元Logistic回归分析L1、L2和L3型CD患者临床特征。绘制受试者工作特征（ROC）曲线,分析部分临床特征预测CD病变部位的效能。结果 L1组患者平均年龄大于L3组患者（P <0.05）。L1组患者黏液脓血便构成比低于L2和L3组患者（P <0.05）。L1组患者平均血小板计数低于L3组患者（P <0.05）。L1组患者肛周病变构成比低于L2和L3组患者（P <0.05）。多因素二元Logistic回归分析结果显示,L2型CD［O^R =1.017（95% CI：1.004,1.031）］和L3型CD［O^R =1.026（95% CI：1.016,1.037）］与CD疾病活动指数（CDAI）相关（P <0.05）,L3型CD［O^R =7.088（95% CI：2.390,21.018）］与肛周病变风险增加相关（P <0.05）。ROC曲线分析结果显示,与L1型CD比较,当血沉为29.50 mm/h时,L2型CD的ROC曲线下面积（AUC）为0.724（95% CI：0.579,0.868）,此时预测L2型CD敏感性为77.8%（95% CI：0.519,0.926）,特异性为64.1%（95% CI：0.510,0.754）;当血小板计数取临界值307×10⁹/L时,L3型CD的AUC为0.702（95% CI：0.618,0.785）,此时预测L3型CD敏感性为72.3%（95% CI：0.602,0.826）,特异性为65.2%（95% CI：0.554,0.752）。结论 L1型、L2型及L3型CD患者的临床表现、实验室检查、疾病行为等均存在差异,基于这些特征将有助于鉴别CD患者的不同病变部位。     

Prognostic and immunohistochemical validation of the capella classification of pancreatic neuroendocrine tumours: an analysis of 82 sporadic cases

AIMS: To study the clinical outcome of 82 cases of pancreatic neuroendocrine tumours classified according to the recent histological and prognostic classification of Capella. METHODS AND RESULTS: Eighty-two surgical cases of pancreatic neuroendocrine tumours were examined histologically with immunohistochemical staining of paraffin sections using streptavidin-biotin complex and application of antibodies against chromogranin A and 10 hormonal peptides. Classification in four groups correlated with long follow-up and outcome of these cases. Histological examination showed 30 group I, four group II, 41 group III and seven group IV tumours. Twenty-one (70%) of group I tumours were insulinomas, whereas 25% of group III tumours were glucagonomas and 25% were unclassified. Most group IV tumours were unclassified, showing no immunohistochemical staining with any of the 10 hormonal peptides tested. Outcome was clearly correlated with tumour group. Among the 14 patients who died of the disease, four had group IV and 10 group III tumours. Thus, unclassified asymptomatic tumours without immunohistochemical staining had a poorer prognosis than asymptomatic tumours with staining. CONCLUSION: This study validates the Capella classification as easy to apply and useful in predicting clinical outcome.     

Classification of Breast Masses Using Selected Shape,Edge-sharpness,and Texture Features with Linear and Kernel-based Classifiers

Breast masses due to benign disease and malignant tumors related to breast cancer differ in terms of shape, edge-sharpness, and texture characteristics. In this study, we evaluate a set of 22 features including 5 shape factors, 3 edge-sharpness measures, and 14 texture features computed from 111 regions in mammograms, with 46 regions related to malignant tumors and 65 to benign masses. Feature selection is performed by a genetic algorithm based on several criteria, such as alignment of the kernel with the target function, class separability, and normalized distance. Fisher's linear discriminant analysis, the support vector machine (SVM), and our strict two-surface proximal (S2SP) classifier, as well as their corresponding kernel-based nonlinear versions, are used in the classification task with the selected features. The nonlinear classification performance of kernel Fisher's discriminant analysis, SVM, and S2SP, with the Gaussian kernel, reached 0.95 in terms of the area under the receiver operating characteristics curve. The results indicate that improvement in classification accuracy may be gained by using selected combinations of shape, edge-sharpness, and texture features.     

How many lymph nodes are necessary to stage early and advanced adenocarcinoma of the sigmoid colon and upper rectum?

The lymph-node yields in specimens resected for colorectal adenocarcinoma show considerable variations, raising the question whether the minimum lymph-node number recommended by the UICC (International Union Against Cancer) for pN0 classification represents an appropriate quality standard for specimen work-up. The number of pericolic lymph nodes recovered from 568 archival surgical colorectal carcinoma specimens located in the sigmoid or upper rectum showed a highly statistically significant correlation with both the pT category and the presence of metastases (P<0.0005). The median lymph-node yield in standardized (i.e., resembling in size surgically removed cancer specimens) tumor-free specimens obtained during autopsies was 13 lymph nodes, compared with 20.5 when diverticula were present and more than 30 in specimens with chronic inflammation or from patients with systemic infections. In 48 pT2 and pT3 carcinoma specimens prospectively dissected in the same way, median numbers of 18 (pT2) and 23 (pT3) lymph nodes were detected (range between 8 and 39 nodes). The lymph-node numbers recommended in previous studies and by the UICC often seem to be too low to declare a specimen free of metastases. Although the great variation in lymph-node counts requires the recovery of all lymph nodes for pN0 classification, recommendations considering the pT status and additional factors like diverticula and inflammatory changes can be useful as a quality standard for specimen work up.