Z形皮瓣及推进皮瓣修复眼睑缺损的作用探讨

目的探讨眼睑恶性肿瘤切除术中应用Z形皮瓣及推进皮瓣I期修复眼睑缺损的临床效果。方法将50例眼睑恶性肿瘤切除术患者按不同缝合方法分为两组,即对照组25例,术中直接缝合;观察组25例,术中行Z形皮瓣及推进皮瓣I期修复;比较两组眼睑修复效果。结果观察组术后皮瓣成活率96.0%、切口Ⅰ期愈合率100%、修复满意率92.0%,均高于对照组的72.0%、68.0%、56.0%,差异有统计学意义(P<0.05)。观察组术后并发症发生率低于对照组,但差异无统计学意义(P>0.05)。结论眼睑恶性肿瘤切除术中眼睑缺损修复时,采用Z形皮瓣及推进皮瓣,眼睑修复良好,患者修复满意率高,值得推广应用。     

Defining the dimensions of circulating tumor cells in a large series of breast,prostate, colon,and bladder cancer patients

Circulating tumor cells (CTCs) in the blood of cancer patients are of high clinical relevance. Since detection and isolation of CTCs often rely on cell dimensions, knowledge of their size is key. We analyzed the median CTC size in a large cohort of breast (BC), prostate (PC), colorectal (CRC), and bladder (BLC) cancer patients. Images of patient‐derived CTCs acquired on cartridges of the FDA‐cleared CellSearch^® method were retrospectively collected and automatically re‐analyzed using the accept software package. The median CTC diameter (μm) was computed per tumor type. The size differences between the different tumor types and references (tumor cell lines and leukocytes) were nonparametrically tested. A total of 1962 CellSearch^® cartridges containing 71 612 CTCs were included. In BC, the median computed diameter (CD) of patient‐derived CTCs was 12.4 μm vs 18.4 μm for cultured cell line cells. For PC, CDs were 10.3 μm for CTCs vs 20.7 μm for cultured cell line cells. CDs for CTCs of CRC and BLC were 7.5 μm and 8.6 μm, respectively. Finally, leukocytes were 9.4 μm. CTC size differed statistically significantly between the four tumor types and between CTCs and the reference data. CTC size differences between tumor types are striking and CTCs are smaller than cell line tumor cells, whose size is often used as reference when developing CTC analysis methods. Based on our data, we suggest that the size of CTCs matters and should be kept in mind when designing and optimizing size‐based isolation methods.

Abbreviations

ACCEPT

Automated CTC Classification, Enumeration, and PhenoTyping software

BC

breast cancer

BLC

bladder cancer

CD

computed diameter

CEL

cultured tumor cell (cell line)

CK

cytokeratin

CRC

colorectal cancer

CTC‐L

circulating tumor cells derived from cerebrospinal fluid (liquor)

CTCs

circulating tumor cells

DAPI

4′6‐diamidino‐2‐phenylindole

EMT

epithelial–mesenchymal transition

EpCAM

epithelial cell adhesion molecule

IQR

interquartile range

KW test

Kruskal–Wallis test

MWU test

Mann–Whitney U test

NCR

nucleus/cytoplasm ratio

P2A

perimeter to area

PC

prostate cancer

TIF

tagged Image Format files

TXT

text file

μm

micrometer

µm²

square micrometers

     

刍议清络法论治特发性肺纤维化急性发作＊

本文通过对特发性肺纤维化急性发作病因病机的分析，认为其病因为外邪或内伤引动肺络虚火，从阳化热，病机为“肺热”、“络瘀”；并结合其病因病机，探究归纳《温病条辨》中清络法和中药复方清络饮在论治特发性肺纤维化急性发作时的理论基础，为临床中论治特发性肺纤维化急性发作，改善患者症状提供新方法，为肺络病证治体系构建及应用提供新思路。     

基于外邪理论探讨肿瘤的发病机制

肿瘤防控是当今世界性一大难题，目前我国每年新发肿瘤病例即将突破400万。近年来，我国肿瘤总体发病率和死亡率呈现逐年上升趋势，肿瘤的高死亡率和低治愈率已严重威胁我国居民健康，很大程度影响了患者的生存质量，大大降低患者的生活水平，危害患者的身心健康。中医认为，肿瘤发病的病因复杂，病机变化多端，是内外因相互影响、相互作用的结果。若在外邪作用于人体之初，及时辨证施治，防止伏邪入里发生传变，将大大减少肿瘤疾病的发生和发展。因此，外邪理论与肿瘤的发病机制亟待进一步探究。在中国知网（CNKI），Public Medline（PubMed）数据库中以外感、邪气、中医、肿瘤、发病机制等关键词进行检索，本文共纳入67篇中英文文献为参考，对外邪理论与肿瘤发病机制进行全面探讨。强调了外邪在肿瘤发病中的重要作用，以及中医药在早期防治肿瘤中具有显著的优势。外邪如风邪、寒邪、湿邪、火邪、从口鼻皮表而入的邪气等因素，使得肿瘤的发生更具复杂性。中医药可以在肿瘤发展早期进行有效的防护和干预，可大大提高防病抗肿瘤的目的，减少肿瘤的发生、发展、传变，使临床用药更有效、更精准、更具靶向性，不至使肿瘤的治疗错失良机，为临床治疗肿瘤提供更明确的指导方向。     

Oncentra近距离计划系统和MIM系统间DVH参数差异的分析

目的对近距离治疗计划的剂量参数在Oncentra治疗计划系统与MIM系统间产生的差异进行分析和研究。方法选取本院的43例妇科肿瘤患者近距离治疗计划,按照临床要求所有病例的靶区D₉₀达到处方剂量。评估参数包括:靶区体积和D₉₀,处方剂量总体积,靶区内的处方剂量体积以及危及器官包括:直肠,膀胱,小肠的D_0.01cc,D_1cc,D_2cc。结果计划系统中的靶区体积和处方剂量值均明显小于MIM系统中相应的值(P<0.05),两系统显示出的处方体积相差不大。MIM系统中的靶区D₉₀(676.74±54.82)cGy小于处方剂量,危及器官的受量则正好相反,即计划系统比MIM系统中相应的参数要小,其中直肠和膀胱的D_0.01cc,D_1cc,D_2c,小肠的D_0.01cc,D_2cc的在两系统显示的值的差异均有统计学意义(P<0.05)。结论不同系统间传输相同的剂量和轮廓文件,DVH参数存在一定的差异,其主要原因是在不同系统对已勾画的各种器官轮廓计算体积存在算法上的不同。基于此,建议近距离计划在CT扫描时,尽量小的层厚可以消除或减少这种差异。     

Intraoperative thalamocortical tract monitoring via direct cortical recordings during craniotomy

ObjectiveNeuromonitoring of primary motor regions allows preservation of motor strength and is frequently employed during cranial procedures. Less is known about protection of sensory function and ability to modulate movements, both of which rely on integrity of thalamocortical afferents (TCA) to fronto-parietal regions. We describe our experience with TCA monitoring and their cortical relays during brain tumor surgery.MethodologyTo study its feasibility and usefulness, continuous somatosensory evoked potentials (SSEP) recording via a subdural electrode was attempted in 32 consecutive patients.ResultsMedian and posterior tibial SSEP were successfully monitored in 31 and 17 patients respectively. SSEP improved lesion localization and prevented unnecessary cortical stimulation in 9 and 16 cases respectively. A threshold of ≥30% SSEP amplitude decrease influenced management in 10 patients while a decrement of ≥50 % had a sensitivity of 0.89 and specificity of 1 in detecting worsening of sensory function. Simultaneous motor evoked potentials (MEP) and SSEP monitoring were performed in 10 cases, 9 of which showed short-lived fluctuations of the former.ConclusionDirect cortical SSEP monitoring is feasible, informs management and predicts outcome.SignificanceEarly intervention prevents sensory deficit. Concomitant MEP fluctuations may reflect modulation of motor activity by TCA.     

Diffusion-weighted MRI and PET/CT reproducibility in epithelial ovarian cancers during neoadjuvant chemotherapy

PurposeTo investigate the reproducibility of diffusion-weighted (DW) MRI and ¹⁸F-Fluorodeoxyglucose (¹⁸F-FDG)-Positron emission tomography/CT (PET/CT) in monitoring response to neoadjuvant chemotherapy in epithelial ovarian cancer.Materials and methodsTen women (median age, 67 years; range: 41.8–77.3 years) with stage IIIC-IV epithelial ovarian cancers were included in this prospective trial (NCT02792959) between 2014 and 2016. All underwent initial laparoscopic staging, four cycles of carboplatine-paclitaxel-based chemotherapy and interval debulking surgery. PET/CT and DW-MRI were performed at baseline (C0), after one cycle (C1) and before surgery (C4). Two nuclear physicians and two radiologists assessed five anatomic sites for the presence of ≥ 1 lesion. Target lesions in each site were defined and their apparent diffusion coefficient (ADC), maximal standardized uptake value (SUV-max), SUV-mean, SUL-peak, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were monitored (i.e., 10 patients × 5 sites × 3 time-points). Their relative early and late changes were calculated. Intra/inter-observer reproducibilities of qualitative and quantitative analysis were estimated with Kappa and intra-class correlation coefficients (ICCs).ResultsFor both modalities, inter- and intra-observer agreement percentages were excellent for initial staging but declined later for DW-MRI, leading to lower Kappa values for inter- and intra-observer variability (0.949 and 1 at C0, vs. 0.633 and 0.643 at C4, respectively) while Kappa values remained > 0.8 for PET/CT. Inter- and intra-observer ICCs were > 0.75 for SUV-max, SUL-peak, SUV-mean and their change regardless the time-point. ADC showed lower ICCs (range: 0.013–0.811). ANOVA found significant influences of the evaluation time, the measurement used (ADC, SUV-max, SUV-mean, SUV-max, SUL-peak, MTV or TLG) and their interaction on ICC values (P = 0.0023, P< 0.0001 and P =0.0028, respectively).ConclusionWhile both modalities demonstrated high reproducibility at baseline, only SUV-max, SUL-peak, SUV-mean and their changes maintained high reproducibility during chemotherapy.     

胸腔镜根治术对老年食管癌患者术后肺部感染与呼吸功能及炎症因子的影响

目的探讨胸腔镜根治术对老年食管癌患者术后肺部感染与呼吸功能及炎症因子的影响。方法选择100例行手术治疗的食管癌患者的临床资料进行回顾性分析,根据手术方法分为胸腔镜组60例与开胸组40例。比较2组术后肺功能、外周炎症因子水平以及肺部感染发生率。结果(1)2组术后24 h外周血炎症因子IL-6、IL-8、IL-10以及TNF-α均显著升高(P<0.05),但开胸组显著高于胸腔镜组(P<0.05);术后1周,2组外周血炎症因子水平均显著下降,2组间比较差异无统计学意义(P>0.05)。(2)术后1个月,开胸组患者FEV1、FEV1/FVC FVC均显著低于胸腔镜组,差异有统计学意义(P<0.05)。(3)术后3天开胸组CRP水平、WBC水平、体温以及呼吸频率均显著高于胸腔镜组,差异有统计学意义(P<0.05)。(4)胸腔镜组术后无肺部感染,开胸组有4例(10.0%)发生肺部感染,2组比较差异有统计学意义(P<0.05)。结论与传统开胸手术比较,胸腔镜食管癌根治术对老年患者呼吸功能、外周血炎症因子的影响相对较小,术后患者肺部感染发生率更低。     

Predicting osimertinib‐treatment outcomes through EGFR mutant‐fraction monitoring in the circulating tumor DNA of EGFR T790M‐positive patients with non‐small cell lung cancer (WJOG8815L)

The WJOG8815L phase II clinical study involves patients with non‐small cell lung cancer (NSCLC) that harbored the EGFR T790M mutation, which confers resistance to EGFR tyrosine kinase inhibitors (TKIs). The purpose of this study was to assess the predictive value of monitoring EGFR genomic alterations in circulating tumor DNA (ctDNA) from patients with NSCLC that undergo treatment with the third‐generation EGFR‐TKI osimertinib. Plasma samples of 52 patients harboring the EGFR T790M mutation were obtained pretreatment (Pre), on day 1 of treatment cycle 4 (C4) or cycle 9 (C9), and at diagnosis of disease progression or treatment discontinuation (PD/stop). CtDNA was screened for EGFR‐TKI‐sensitizing mutations, the EGFR T790M mutation, and other genomic alterations using the cobas EGFR Mutation Test v2 (cobas), droplet digital PCR (ddPCR), and targeted deep sequencing. Analysis of the sensitizing—and T790M—EGFR mutant fractions (MFs) was used to determine tumor mutational burden. Both MFs were found to decrease during treatment, whereas rebound of the sensitizing EGFR MF was observed at PD/stop, suggesting that osimertinib targeted both T790M mutation‐positive tumors and tumors with sensitizing EGFR mutations. Significant differences in the response rates and progression‐free survival were observed between the sensitizing EGFR MF‐high and sensitizing EGFR MF‐low groups (cutoff: median) at C4. In conclusion, ctDNA monitoring for sensitizing EGFR mutations at C4 is suitable for predicting the treatment outcomes in NSCLC patients receiving osimertinib (Clinical Trial Registration No.: UMIN000022076).

Abbreviations

CIs

confidence intervals

ctDNA

circulating tumor DNA

ddPCR

droplet digital PCR

EGFR

epidermal growth factor receptor

MFs

mutant fractions

NGS

next‐generation sequencing

NSCLC

non‐small cell lung cancer

ORR

overall response rate

OS

overall survival

PD

progressive disease

PFS

progression‐free survival

PR

partial response

SD

stable disease

TKI

tyrosine kinase inhibitor

     

血清p53抗体异常高水平对消化道肿瘤的早期诊断价值分析

目的:探讨血清p53抗体异常高水平对消化道肿瘤的早期诊断的价值。方法:选取2016年3月至2019年3月来我院检查确诊为消化道肿瘤的患者80例为消化道肿瘤组,选取来我院健康体检的67例健康志愿者为健康对照组。通过酶联免疫吸附实验检测血清中人体抑癌基因p53及其抗体水平;通过RT-qPCR检测血清中细胞凋亡相关基因Bcl-2、Bax和Caspase-3蛋白表达量。采用Pearson相关性分析明确消化道肿瘤p53、p53抗体水平和Bcl-2、Bax、Caspase-3蛋白表达水平的关系。结果:消化道肿瘤组p53水平降低,p53抗体水平异常升高(P<0.05)。与健康对照组相比,消化道肿瘤组Bcl-2表达量增加,Bax和Caspase-3蛋白表达量降低(P<0.05)。消化道肿瘤p53水平与Bcl-2蛋白表达水平呈负相关关系,与Bax、Caspase-3蛋白表达水平均呈正相关关系;p53抗体水平和Bcl-2蛋白表达水平呈正相关关系,与Bax、Caspase-3蛋白表达水平均呈负相关关系(P<0.05)。结论:消化道肿瘤患者血清p53抗体异常高水平,可作为临床辅助诊断消化道肿瘤的可靠指标之一。