Diagnosis and treatment of lymph node metastases of a rectal carcinoid tumor using In111-octreotide-scintigraphy and intraoperative gamma probe detection

Carcinoids represent 1–2% of the rectal cancer. We report the case of a woman with a rectal carcinoid and a hypogastric node metastasis. We propose a less invasive treatment of the metastase using In11-octreotide-scintigraphy and intraoperative gamma-probe detector.     

Performance of four published risk models to predict sentinel lymph-node involvement in Australian women with early breast cancer

BackgroundSentinel lymph-node biopsy has reduced the need for extensive axillary surgery for staging. It still exposes women to associated morbidity. Risk models that use clinical and pathology information of the primary tumour to predict sentinel lymph-node metastasis may allow further improvements in care. This study assessed the performance of four published risk models for predicting sentinel lymph-node metastasis in Australian women with early breast cancer; including one model developed in an Australian population.MethodsThe Sentinel Node Biopsy Versus Axillary Clearance (SNAC) trial dataset was used to assess model discrimination by calculating the area under the receiver-operating-characteristic curve (AUC) and the false-negative rate for sentinel lymph-node metastasis using model-predicted risk cut-points of 10%, 20%, 30%, and calibration using Hosmer-Lemeshow tests and calibration plots.ResultsThe sentinel node was positive in 248 of 982 (25.2%) women (158 macrometastasis, 90 micrometastasis). The AUCs of risk models ranged from 0.70 to 0.74 for prediction of any sentinel-node metastasis; 0.72 to 0.75 for macrometastasis. Calibration was poor for the three models developed outside of Australia (lack-of-fit statistics, P < 0.001). For women with a model-predicted risk of sentinel lymph-node metastasis ≤10%, observed risk was 0–13% (three models <10%), false-negative rate 0–9%; 1–17% of women were classified in this range.ConclusionAll four models showed good discrimination for predicting sentinel lymph-node metastasis, in particular for macrometastasis. With further development such risk models could have a role in the provision of reassurance to low risk women with normal nodes sonographicaally for whom no axillary surgery is contemplated.     

Small breast cancers: When and how to treat

Small (T1a, b), lymph node negative breast tumors represent an entity diagnosed with increasing frequency due to the implementation of wide-scale screening programs. Patients bearing such tumors usually exhibit favorable long-term outcomes, with low breast cancer mortality rates at 10 years, even in the absence of adjuvant chemotherapy. However, most available data derive from retrospective studies. Additionally, a subset of patients with these tumors experience recurrence of the disease, indicating that early tumor stage itself is not a sufficient prognosticator. It is of paramount importance to refine the prognosis of this population, identifying patients with high risk of recurrence, for whom adjuvant treatment is needed. The underlying biology of the disease provides relevant information, such as grade and status of hormone receptors and HER-2 (human epidermal growth factor receptor 2), with high grade, triple negative and HER-2-positive tumors having worse prognosis. Additionally, multigene signatures may improve further the prognostication of patients with small, node negative breast cancers. Further research for this increasingly frequent group of patients is urgently needed, so that better informed clinical decision making, in particular regarding adjuvant chemotherapy, can occur.     

电针预处理对急性心肌缺血再灌注损伤大鼠小脑顶核及下丘脑外侧区c-fos蛋白表达的影响

目的:观察电针预处理对急性心肌缺血再灌注损伤(MIRI)大鼠小脑顶核(FN)与下丘脑外侧区(LHA)c-fos蛋白表达的影响,探讨FN和LHA在电针心经抗急性MIRI效应中的作用及机制.方法:将70只Sprague-Dawley大鼠随机分为假手术组、模型组、电针心经组和电针肺经组,每组14只;以及损毁LHA+电针心经组(简称LHA+电针心经组)和损毁FN+电针心经组(简称FN+电针心经组),每组7只.除假手术组外,其余5组采用冠状动脉左前降支结扎法建立急性MIRI大鼠模型.采用电针心经治疗的3组针刺神门和通里;电针肺经组针刺太渊和列缺.所有电针组于造模前接受电针刺激,电流强度1 mA,频率2 Hz,每次20 min,每日1次,共7 d.假手术组及模型组不予电针.监测大鼠心电图,分析ST段位移和心律失常评分.采用免疫组织化学法检测FN及LHA中c-fos蛋白的表达.结果:与假手术组比较,模型组大鼠ST段位移、心律失常评分以及FN和LHA的c-fos蛋白表达明显升高(均P<0.05).与模型组比较,电针心经组大鼠ST段位移、心律失常评分以及FN和LHA的c-fos蛋白表达明显降低(均P<0.05).与电针心经组比较,电针肺经组、LHA+电针心经组和FN+电针心经组大鼠ST段位移和心律失常评分明显升高(均P<0.05);电针肺经组及LHA+电针心经组大鼠FN的c-fos蛋白表达明显升高(均P<0.05);电针肺经组及FN+电针心经组LHA的c-fos蛋白阳性表达明显升高(均P<0.05).结论:FN和LHA参与了针刺心经改善急性MIRI效应的作用机制,小脑可能是通过小脑-下丘脑投射参与了针刺改善心脏功能的作用.     

基于数据挖掘的膝骨关节炎中药熏洗用药规律研究

目的:基于中医传承辅助平台V2.5(TCMISS V2.5)研究膝骨关节炎中药熏洗处方的用药规律。方法:通过收集中国期刊全文数据库(CJFD)、中国学术期刊数据库(CSPD)、中文科技期刊数据库(CCD)、PubMed数据库建库至2019年11月中药熏洗治疗膝骨关节炎的处方,输入中医传承辅助平台V2.5,分析处方中各种中药的应用频次、性味归经、关联规则和新方分析。结果:对筛选出的372首中药处方进行分析,应用最多的前3位依次为透骨草、红花、伸筋草,归经以肝、心、脾、肾经为主,药性以温为主,药味以辛、苦、甘为主,新方组合11条。结论:中药熏洗治疗膝骨关节炎以海桐皮汤为主方,治法主要是祛湿散寒、化瘀通络,治肝是关键,兼顾心脾肾。     

电针心经腧穴对急性心肌缺血大鼠自主神经活动的影响

目的:观察电针心经"神门-通里"经脉段对急性心肌缺血大鼠交感神经和迷走神经放电的影响,探讨两者在电针心经改善急性心肌缺血中的协同调节作用。方法:SD大鼠随机分为伪手术组、模型组和电针心经组,每组10只。冠状动脉左前降支结扎法复制大鼠急性心肌缺血模型。电针心经组给予电针刺激大鼠心经"神门-通里"经脉段,刺激20min。用两根铂金丝电极分别同步引导左侧交感神经和迷走神经,同时记录模型复制前5min,结扎后即刻,电针后1、3、5、15 min的心电图、交感神经和迷走神经放电频率。结果:急性心肌缺血模型复制后,与伪手术组比较,模型组大鼠各时相心率、心电图J点电压、交感神经放电频率显著升高(P0.01),迷走神经放电频率显著降低(P0.01);与模型组比较,电针心经组大鼠各时相心率、心电图J点电压、交感神经放电频率均显著降低(P0.01),迷走神经放电频率显著升高(P0.01)。结论:电针心经可通过同时抑制交感神经放电和促进迷走神经放电,发挥改善急性心肌缺血的协同调节作用。     

联合吲哚菁绿荧光法与蓝染法行乳腺癌前哨淋巴结活检的临床研究

目的:探讨联合应用吲哚菁绿(ICG)荧光示踪法与蓝染法行乳腺癌前哨淋巴结活检(SLNB)的可行性。方法:选择2014年3月―2015年10月期间276例乳腺癌患者,其中131例患者应用ICG联合美蓝行SLNB(联合组),145例患者以美蓝为示踪剂行SLNB(美蓝组)。所有患者SLNB结束后均行I、II水平腋窝淋巴清扫。结果:两组基本临床资料差异无统计学意义(均P0.05);联合组前哨淋巴结(SLNs)检出率明显高于美蓝组(96.9 vs.89.7%,P=0.017),平均检出SLNs数目明显多于美蓝组(3.0枚vs.2.1枚,P=0.011);假阴性率低于美蓝组(7.1% vs.10.9%),但差异无统计学意义(P=0.813)。全组数据统计分析显示,SLNs检出个数≤2时的假阴性率明显高于SLNs检出个数≥3时假阴性率(17.5% vs.2.1%,P=0.033)。结论:ICG荧光示踪法联合蓝染法行乳腺癌SLNB相对于蓝染法有检出率高、SLNs平均检出个数多、淋巴管实时显像的优势,在不具备核素法广泛应用条件时推荐使用。     

小型中医经络检测仪的研制

在传统中医经络理论的基础上，结合先进的电子技术设备，设计了一种小型中医经络检测仪。此检测仪通过采集人体穴位经电流测试(给一定电流刺激)所反射出来的信息，经微控制器处理后，能够精确显示或打印出人体的健康状况。检测仪具有方便、快捷等优势，易推广普及。     

血管树拓扑描述及匹配方法的研究

血管树的拓扑描述及匹配是由二维血管造影图像重建三维血管树的关键步骤,我们采用二叉树描述二维血管骨架树,提出“结点权值”和“相似结点”的概念,很好地描述了血管树的拓扑结构。同时根据二叉树的前序遍历结果匹配血管段,有效地提高了匹配的速度和准确度。     

术前外周血淋巴细胞比值对早期乳腺癌患者非前哨淋巴结转移的预测分析

目的 研究术前外周血淋巴细胞比值对早期乳腺癌患者非前哨淋巴结转移的预测价值。方法 回顾性选取杭州市妇产科医院及浙江大学医学院附属妇产科医院乳腺科2014年1月至2020年1月行前哨淋巴结活检的临床早期乳腺癌患者443例,将其中有前哨淋巴结转移的189例患者根据是否有非前哨淋巴结转移把研究对象分为转移组和未转移组,分析术前外周血淋巴细胞比值与非前哨淋巴结转移的相关性,并分析其他临床病理特征对非前哨淋巴结的预测价值。结果 非前哨淋巴结转移组共有99例,未转移组有90例。单因素分析显示肿瘤大小(p=0.006)、前哨淋巴结转移数量(p=0.026)、脉管浸润(p=0.003)和术前外周血淋巴细胞比值(p=0.003)是非前哨淋巴结转移的影响因素。多因素分析显示脉管浸润(p=0.016, OR：5.057, 95% CI：1.351-18.927)、肿瘤大小(p=0.038, OR：1.952, 95% CI：1.038 to 3.672)、术前NLR(p < 0.001, OR：2.213, 95% CI：1.426 to 3.432) 对于预测早期乳腺癌非前哨淋巴结转移具有统计学意义。术前外周血淋巴细胞比值的受试者工作特征曲线下面积为0.668(95%CI, 0.592-0.744),p < 0.001,最佳截断值2.7,敏感度62.6%,特异度87.8%。结论 术前外周血淋巴细胞比值是乳腺癌非前哨淋巴结转移的有效预测因素。