Blood supply of the sinus node artery in beagle dogs

Summary Postmortem coronary angiography was performed in 20 beagles and 15 mongrels, and the origin and distribution of the sinus node arteries (SNAs) were subsequently investigated using soft X-ray radiography, the tissue clearing method, and histological examination. In 19 of 20 beagles, the SNAs consisted of a single atrial branch originating from the right coronary artery, and the distribution pattern of the atrial branch seemed to be uniform. In contrast, the following three different patterns were recognized in the atrial branches forming the SNAs of mongrels: (1) distribution by two atrial branches, i.e., one originating from the right coronary artery and the other from the left circumflex artery, (2) dual distribution by two atrial branches originating from the right coronary artery, and (3) distribution by a single atrial branch originating from the right coronary artery or from the left circumflex artery. In 26 of the 30 dogs which were histologically examined, the SNAs ran outside of the sinus node and were not centrally located. In the beagles, the proximal atrial branch from the right coronary artery reached the atrioventricuolar node area and supplied blood to the atrioventricular node together with the arterial branches derived from the anterior septal artery and posterior septal artery. In addition, the arterial branch of the SNAs reached the atrioventricular junction area. These findings should contribute to clinical, pharmacological, and pathological studies of the cardiovascular system, including studies on cardiac arrhythmias in beagles.     

Modifiable Failures in the Colorectal Cancer Screening Process and Their Association With Risk of Death

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PsTg对甲状腺乳头状癌术后功能性淋巴结转移患者131I最佳治疗反应的预测价值

目的:探讨¹³¹I治疗前刺激性甲状腺球蛋白(psTg)水平对甲状腺乳头状癌(PTC)术后功能性残留淋巴结转移且无远处转移患者¹³¹I最佳治疗反应(ER)的预测价值。 方法:回顾性纳入2011年3月至2015年6月间于郑州大学附属肿瘤医院行甲状腺双侧叶全切+淋巴结清扫术后首次行¹³¹I治疗时确诊为功能性残留淋巴结转移且无远处转移的PTC患者72例[男22例、女50例,年龄14~76(46.5±14.4)岁;血清甲状腺球蛋白抗体(TgAb)水平均正常]。根据治疗反应评估体系将患者分为ER组和非ER组。采用两独立样本 t检验、 χ²检验、Mann-Whitney U检验比较2组患者的一般临床特征,再进行多因素logistic回归分析;采用ROC曲线评估psTg、转移淋巴结大小(短径)对ER的预测价值。 结果:ER组44例,非ER组28例,2组患者的性别、年龄、临床分期、术后转移淋巴结个数和位置差异均无统计学意义( t=0.82, χ²值:0.16~2.60,均 P>0.05);而美国甲状腺协会(ATA)初始风险分层( χ²=33.38)、转移淋巴结大小( U=296.50)和psTg( U=111.00)差异均有统计学意义(均 P<0.001)。多因素回归分析显示,psTg[比值比( OR)=0.047, 95% CI: 0.004~0.500, P=0.011]和转移淋巴结大小( OR=0.146, 95% CI: 0.032~0.666, P=0.013)是影响ER的独立因素,而ATA初始风险分层不是独立因素( OR=0.266, 95% CI: 0.051~1.390, P=0.116)。PsTg、转移淋巴结大小的ROC AUC分别为0.904、0.873;当psTg以20.05 μg/L为界值时,其预测ER的灵敏度和特异性分别为96.4%(27/28)和75.0%(33/44);当转移淋巴结大小以0.75 cm为界值时,其预测ER的灵敏度和特异性分别为78.6%(22/28)和81.8%(36/44)。 结论:PsTg可以较好地预测PTC术后功能性残留淋巴结转移患者¹³¹I疗效,转移淋巴结大小对疗效也有重要影响。     

α粒子放射性药物在骨转移瘤治疗中的应用进展

骨骼是晚期恶性肿瘤的常见转移部位之一,骨转移瘤不仅会导致顽固性骨痛、病理性骨折等骨相关事件（SRE）的发生,还会导致医疗费用的增加和死亡风险的上升。放射性药物内放射治疗具有疗效好、靶向性好和毒性低等优点。常用于治疗骨转移瘤的放射性药物主要是释放β粒子和α粒子的药物,其中释放β粒子的放射性药物的临床应用较成熟,但也具有一定的局限性。近年来,释放α粒子的放射性药物越来越多地用于骨转移瘤的治疗,其在缓解骨痛、降低SRE发生率、延长总生存期等方面具有更大的优势。笔者仅就α粒子放射性药物在骨转移瘤治疗中的应用进展进行综述。     

定量MRI诊断直肠癌淋巴结转移的研究进展

评估直肠癌淋巴结转移对治疗和预后至关重要。常规MRI诊断直肠癌淋巴结转移主要依据淋巴结的短径和形态学特征,诊断效能较低。定量MRI包括动态增强MRI（DCE-MRI）、动态磁敏感增强MRI（DSC-MRI）、单指数模型扩散加权成像（DWI）、扩散峰度成像（DKI）、体素内不相干运动扩散加权成像（IVIM-DWI）等,可以对直肠癌淋巴结及原发灶进行定量分析,从而有助于诊断淋巴结转移。就常规MRI及定量MRI诊断直肠癌淋巴结转移的研究进展予以综述。     

18F-FDG PET/MRI对恶性肿瘤淋巴结转移的诊断价值：Meta分析

目的 系统评价¹⁸F-FDG PET/MRI对恶性肿瘤淋巴结转移的诊断价值。 方法 检索PubMed、EMbase、Cochrane Library、中国知网、万方数据、维普数据库从2010年1月—2020年5月公开发表的关于¹⁸F-FDG PET/MRI诊断恶性肿瘤淋巴结转移的中英文文献,根据纳入、排除标准筛选并提取数据,采用诊断准确性研究质量评价工具-2（QUADAS-2）评价纳入文献质量,应用Meta-Disc 1.4软件进行分析。采用不一致指数（I²）和Cochran-Q检验进行异质性分析,并计算合并敏感度、特异度、阳性似然比、阴性似然比及相应95%CI,绘制汇总受试者操作特征（SROC）曲线并计算曲线下面积（AUC）。采用阈值效应和亚组分析探讨异质性的来源。亚组分析根据研究类型、原发肿瘤类型、是否合并有增强MRI进行分组分析。 结果 共纳入25篇文献,包括1 347例肿瘤病人,¹⁸F-FDG PET/MRI诊断恶性肿瘤淋巴结转移的合并敏感度、特异度、阳性似然比、阴性似然比、AUC值分别为0.85（95%CI：0.81~0.88）、0.92（95%CI：0.90~0.93）、6.63（95%CI：4.50~9.79）、0.22（95%CI：0.16~0.29）、0.92。亚组分析结果显示,前瞻性研究中的¹⁸F-FDG PET/MRI对恶性肿瘤淋巴结转移的诊断效能高于回顾性研究,AUC值分别为0.92、0.88;无增强MRI的研究诊断效能高于有增强MRI的研究,AUC值分别为0.93、0.91;¹⁸F-FDG PET/MRI对胃肠癌淋巴结转移的诊断效能最高,其次为宫颈癌、肺癌、乳腺癌,AUC值分别为0.96、0.95、0.93、0.90。 结论 ¹⁸F-FDG PET/MRI对恶性肿瘤淋巴结转移具有较高的诊断价值。     

Metastatic hypopharyngeal and esophageal cancer to a percutaneous endoscopic gastrostomy site

The patient was a 63-year-old man who underwent percutaneous endoscopic gastrostomy (PEG) for nutritional management while undergoing radiochemotherapy for hypopharyngeal and esophageal cancer. At about 6 months after PEG, redness and swelling were seen around the gastrostomy site, and pathological testing confirmed the same poorly differentiated squamous cell carcinoma as the hypopharyngeal and esophageal cancer. The tumor caused symptoms associated with buried bumper syndrome to increase significantly.     

Relationship between phenotypes of cell-function differentiation and pathobiological behavior of gastric carcinomas

AIM To reveal the correlation between thefunctional differentiation phenotypes of gastriccarcinoma cells and the invasion and metastasisby a new way of cell-function classification.METHODS Surgically resected specimens of361 gastric carcinomas (GC) were investigatedwith enzyme-, mucin-, and tumor-related markerimmunohistochemistry. According to thedirection of cell-function differentiation,stomach carcinomas were divided into fivefunctionally differentiated types.RESULTS ① Absorptive function different-iation type (AFDT): there were 82 (22.7%)patients including 76 (92.7%) aged 45 years.Sixty-nine (84.1%) cases belonged to theintestinal type. Thirty-eight (46.3%) expressedCD44v6 and 9 (13.6%) of 66 male patientsdeveloped liver metastasis. The 5-year survivalrate of patients in this group (58.5%) was higherthan those with the other types (P<0.01). ②Mucin secreting function differentiation type(MSFDT): 54 (15%) cases. Fifty-three (98.1%)tumors had penetrated the serosa, 12 (22.2%)expressed ER and 22 (40.7%) expressedCD44v6. The postoperative 5-year survival ratewas 28.6%. ③ Absorptive and mucin-producingfunction differentiation type (AMPFDT): there were 180 (49.9%) cases, including 31 (17.2%)aged yanger than 45 years. The tumor was morecommon in women (62, 34.4%,) and expressedmore frequently estrogen receptors (ER) (129,81.7%) than other types (P<0.01). Ovarymetastasis was found in 12 (19.4%) out of 62female subjects. The patients with this type GChad the lowest 5-year survival rate (24.7%)among all types. ① Specific functiondifferentiation type (SFDT) : 13 (3.6%) cases.Nine (69.2%) tumors of this type derived fromAPUD system, the other 4 (30.7%) were ofdifferent histological differentiation. Sixty percent of the patients survived at least five years.⑤ Non-function differentiation type (NFDT): 32(8.9%) cases. Nineteen (59.4%) cases hadlymph node metastases but no one with liver orovary metastasis. The 5-year survival rate was28.1%.CONCLUSION This new cell-functionclassification of GC is helpful in indicating thecharacteristics of invasion and metastasis of GCwith different cell-function differentiationphenotypes, Further study is needed to disclosethe correlation between the cell-functionaldifferentiation phenotypes and the relevantgenotypes and the biological behavior of gastriccarcinoma.     

Randomized Trial of Ivabradine in Patients With Hyperadrenergic Postural Orthostatic Tachycardia Syndrome

BackgroundPostural orthostatic tachycardia syndrome (POTS) is a complex, multifaceted disorder that impairs functional status and quality of life. Current pharmacological treatments are limited.ObjectivesThis study investigated the effect of ivabradine (selective blocker of the I_funny channel in the sinoatrial node) on heart rate, quality of life (QOL), and plasma norepinephrine (NE) levels in patients with hyperadrenergic POTS defined by plasma NE >600 pg/ml and abnormal tilt table test.MethodsIn total, 22 patients with hyperadrenergic POTS as the predominant subtype completed a randomized, double-blinded, placebo-controlled, crossover trial with ivabradine. Patients were randomized to start either ivabradine or placebo for 1 month, and then were crossed over to the other treatment for 1 month. Heart rate, QOL, and plasma NE levels were measured at baseline and at the end of each treatment month.ResultsThe average age was 33.9 ± 11.7 years, 95.5% were women (n = 21), and 86.4% were White (n = 23). There was a significant reduction in heart rate between placebo and ivabradine (p < 0.001). Patients reported significant improvements in QOL with RAND 36-Item Health Survey 1.0 for physical functioning (p = 0.008) and social functioning (p = 0.021). There was a strong trend in reduction of NE levels upon standing with ivabradine (p = 0.056). Patients did not experience any significant side-effects, such as bradycardia or hypotension, with ivabradine.ConclusionIvabradine is safe and effective in significantly improving heart rate and QOL in patients with hyperadrenergic POTS as the predominant subtype.