中性粒细胞蛋白-1、-2、-3在膀胱癌患者组织中的 表达及与预后的相关性

目的：研究中性粒细胞蛋白（HNP）-1、-2、-3 在膀胱癌患者组织中的表达及与预后的关系。方法：采用 免疫组织化学法检测膀胱癌组织中HNP-1、HNP-2、HNP-3 的表达情况，分析HNP-1、HNP-2、HNP-3 在膀胱癌 组织中的表达与膀胱癌临床病理特征的相关性及预后相关因素的关系。结果：HNP-1、HNP-2、HNP-3 蛋白在膀 胱癌患者组织中的阳性表达率分别为70.51%、72.66%、71.94%，均明显高于癌旁正常组织8.10%、3.23%、6.45%， 差异有统计学意义；HNP1、HNP2、HNP3在膀胱癌患者中的表达水平与肿瘤的病理分级、临床分期、淋巴结转 移及复发等生物学行为相关；生存曲线结果提示这3 种蛋白表达阳性的5 年生存率均显著低于表达阴性的患者。 Cox 比例风险模型分析结果提示HNP-1、HNP-2、HNP-3 的表达是影响膀胱癌预后的关键风险因素。结论：HNP- 1、HNP-2、HNP-3 在膀胱癌组织中高表达且表达程度随肿瘤发展进一步增加；HNP-1、HNP-2、HNP-3 是影响患 者预后的关键危险因素，阳性表达的患者５年生存率显著降低；HNP-1、HNP-2、HNP-3 与膀胱癌病情发展、炎 症程度及预后密切相关。     

Physiological determinants of residual cerebral arterial pulsatility on best medical treatment after TIA or minor stroke

Cerebral arterial pulsatility is strongly associated with cerebral small vessel disease and lacunar stroke yet its dependence on central versus local haemodynamic processes is unclear. In a population-based study of patients on best medical managment, 4–6 weeks after a TIA or non-disabling stroke, arterial stiffness and aortic systolic, diastolic and pulse pressures were measured (Sphygmocor). Middle cerebral artery peak and trough flow velocities and Gosling’s pulsatility index were measured by transcranial ultrasound. In 981 participants, aortic and cerebral pulsatility rose strongly with age in both sexes, but aortic diastolic pressure fell more with age in men whilst cerebral trough velocity fell more in women. There was no significant association between aortic systolic or diastolic blood pressure with cerebral peak or trough flow velocity but aortic pulse pressure explained 37% of the variance in cerebral arterial pulsatility, before adjustment, whilst 49% of the variance was explained by aortic pulse pressure, arterial stiffness, age, gender and cardiovascular risk factors. Furthermore, arterial stiffness partially mediated the relationship between aortic and cerebral pulsatility. Overall, absolute aortic pressures and cerebral blood flow velocity were poorly correlated but aortic and cerebral pulsatility were strongly related, suggesting a key role for transmission of aortic pulsatility to the brain.     

磁共振弥散张量成像在脑小血管病中的应用进展

随着人口老龄化进程的加速,脑小血管病(CSVD)的发病率也在不断上升,其导致的多种症状严重影响了患者的生活质量。MRI弥散张量成像(DTI)作为新近发展的影像技术,有无创显示白质纤维超微结构等优点,已被广泛用于疾病早期诊断、病情预测、治疗评估等多方面的研究。本文即就DTI技术在CSVD中的研究现状和未来发展前景进行综述。     

Immunotherapy as Single Treatment for Patients With NSCLC With Brain Metastases: A Systematic Review and Meta-Analysis—the META-L-BRAIN Study

IntroductionBrain metastases (BMs) occur in 40% of patients with lung cancer. The activity of immunotherapy in these patients, however, remains controversial, as the cornerstone treatment is radiotherapy (RT). Because RT is associated with adverse events that may impair the quality of life, the possibility of substituting it with a single systemic approach is attractive. Therefore, we performed a systematic review and meta-analysis to evaluate the potential benefit of immune checkpoint inhibitors (ICIs) in patients with NSCLC with untreated BM (unBM).MethodsStudies that enrolled patients with NSCLC treated with ICIs and specifically allowed for unBM were identified by searching the EMBASE, PubMed, Cochrane, and other databases. The outcomes evaluated were intracerebral overall response rate (icORR) and intracerebral disease control rate (icDCR) for unBM, and grades 3 and 4 toxicity rate.ResultsWe included 12 studies with a total of 566 individuals in the final analysis. Anti–programmed cell death protein-1 therapy seems to be active in the central nervous system, with an icORR of 16.4% (95% confidence interval [CI]: 9.8%–24%; I² = 33.17%) and an icDCR of 45% (95% CI: 33.4%–56.9%; I² = 46.91%). In the meta-analysis for icORR (risk ratio = 1.26, 95% CI: 0.57–2.79) and icDCR (risk ratio = 0.88, 95% CI: 0.55–1.43) we did not observe any difference among patients with BM who were treated with RT before ICI start and those who were treated with ICI only.ConclusionsICI seems to be effective as a single treatment for active BM in selected patients with advanced NSCLC.     

Predictors of survival following surgical resection of limited-stage small cell lung cancer

BackgroundAdjuvant chemotherapy, postoperative radiation (PORT), and prophylactic cranial irradiation (PCI) have been individually examined in limited-stage small cell lung cancer (SCLC). There is a paucity of data on the effectiveness of each adjuvant treatment modality when used in combination after surgical resection of SCLC.MethodsData were collected from 5 cancer centers on all patients with limited-stage SCLC who underwent surgical resection between 1986 and 2019. Univariate and multivariable models were conducted to identify predictors of long-term outcomes, focusing on freedom from recurrence and survival benefit of adjuvant chemotherapy, PORT, and PCI.ResultsA total of 164 patients were analyzed. Multivariable Cox regression analysis did not identify any adjuvant therapies to significantly influence recurrence in this cohort. Specifically, PORT was not associated with a significant influence on locoregional recurrence and PCI was not significantly associated with intracranial outcomes. Adjuvant chemotherapy improved survival in all stage I through III disease (hazard ratio, 0.49; 95% confidence interval, 0.29-0.81; P = .005) and even in pathologically node negative patients (hazard ratio, 0.49; 95% confidence interval, 0.27-0.91; P = .024). Although PCI was found to improve survival in univariate analysis, it was not significant in a multivariable model. PORT was not found to affect survival on either univariate or multivariable analysis.ConclusionsThis is among the largest multi-institutional studies on surgically resected limited-stage SCLC. Our results highlight survival benefit of adjuvant chemotherapy, but did not identify a statistically significant influence from mediastinal PORT or PCI in our cohort. Larger prospective studies are needed to determine the benefit of PORT or PCI in a surgically resected limited-stage SCLC population.     

Endoscopic coblation treatment for congenital pyriform sinus fistula in children

Congenital pyriform sinus fistula (CPSF) is a very rare branchial apparatus malformation. Traditional open surgery for fistulectomy might fail to excise the lesion completely, leading to continual recurrence. Herein, we report our experience of endoscopic coblation technique for treatment of CPSF in children.To observe the clinical efficacy of endoscopic coblation treatment of CPSF in children, especially for those in acute infection stage.Retrospective case series with 54 patients (including 20 cases in acute infection stage and 34 cases in non infection stage) who were diagnosed with CPSF between October 2017 to November 2019, all patients were treated with endoscopic coblation to close the piriform fossa fistula, neck abscess incision and drainage performed simultaneously for acute infection stage cases. Data collected including age of diagnosis, presenting symptoms, diagnostic methods, prior and subsequent treatments, length of hospitalization, and recurrence were analyzed.Of the 20 cases in acute infection stage, there were 3 children with transient vocal cord paresis all of which resolved with 1 month. Four children of the 34 cases in non infection stage appeared reddish swelling of the neck on the 4th, 5th, 6th, and 7th days after coblation and then underwent abscess incision and drainage. All cases experienced no recurrence, vocal cord paralysis, pharyngeal fistula and massive hemorrhage after their first endoscopic coblation of the sinus tract in the follow up of 3 to 28 months.Endoscopic coblation is an effective and safe approach for children with CPSF, neck abscess incision and drainage could be performed simultaneously in acute infection stage. We advocate using this minimally invasive technique as first line of treatment for CPSF.     

小切口白内障囊外摘除手术治疗硬核白内障的临床效果

目的探讨小切口白内障囊外摘除手术治疗硬核白内障的临床效果。方法选择我院2019年5月至2020年5月收治的78例硬核白内障患者为研究对象,根据随机摸球法将其分成参照组(超声乳化白内障摘除术治疗)和研究组(小切口白内障囊外摘除术治疗),各39例。比较两组的治疗效果。结果术后1周、1个月、3个月,两组视力0.5~1.0的患者占比均高于术前(P<0.05)。术后1周、1个月、3个月,研究组的眼压、散光度均低于参照组(P<0.05)。术后,两组的角膜内皮细胞密度、六角形细胞比例均低于术前(P<0.05)。研究组的并发症总发生率低于参照组(P<0.05)。结论小切口白内障囊外摘除手术治疗硬核白内障的效果显著,可改善患者视力、眼压及散光度,促使瞳孔区角膜内皮细胞密度及六角形细胞比例下降,降低术后并发症发生率。     

非小细胞肺癌脑转移放射治疗进展

肺癌是目前世界上发病率第二、死亡率第一的恶性肿瘤。非小细胞肺癌（NSCLC）是其主要病理类型,且易发生脑转移。目前,NSCLC脑转移的主要治疗方式包括手术、放疗、化疗、分子靶向治疗和免疫治疗等。放疗是脑转移局部治疗的常用方法,随着技术和药物的不断发展更新,放疗与其他治疗手段如何联合是目前临床研究热点。本文将对NSCLC脑转移放射治疗进展进行综述,从而为临床工作中治疗方案的选择提供参考。