1972—2016年江苏省启东市胃癌死亡流行特征分析

目的分析江苏省启东市1972—2016年胃癌死亡流行特征。方法收集启东市1972—2016年恶性肿瘤死亡登记数据库及历年人口资料, 计算死亡率、中国人口标化率(中标率)、世界人口标化率(世标率)、35～64岁截缩率、0～74岁累积死亡率、累积死亡风险、变化百分比、死亡率年均变化百分比。结果 1972—2016年启东市胃癌死亡例数为15 863例, 占全部恶性肿瘤死亡例数的16.04%, 胃癌死亡率为31.37/10万, 中标率为12.97/10万, 世标率为21.39/10万, 35～64岁截缩死亡率为28.86/10万, 0～74岁累积死亡率为2.54%, 胃癌死亡累积风险为2.51%。男性死亡10 114例, 男性死亡率、中标率、世标率分别为40.53/10万、17.98/10万和30.13/10万;女性死亡5 749例, 女性死亡率、中标率、世标率分别为22.45/10万、8.52/10万和13.92/10万。25岁以下各年龄组的死亡率<1/10万, 死亡率随年龄的增长而升高, 50～岁组达到并超过人群的平均死亡率水平, 80～岁组达到死亡高峰。1972—2016年间胃癌死...     

MCI的情志病机及疏肝法干预的可行性探讨＊

轻度认知障碍（Mild cognition impairment， MCI）是尚未达到阿尔兹海默病（Alzheimer’s disease， AD）的诊断标准且可逆转为正常脑老化状态的最佳窗口期。情志异常、肝失疏泄（肝失疏泄日久致肝郁）已被证实为MCI的重要情志病机，且“长期负性情绪积累肝失疏泄致衰加速脑老化”的科学假说已在本课题组前期研究中得到初步证实，疏肝法干预肝郁型MCI患者疗效显著，但以上作用机制尚未得到完全阐述。因此本研究系统总结了中医学对MCI的认识，长期情绪不调肝失疏泄对MCI的影响及可能机制，疏肝解郁方药及其成分改善肝郁型MCI的可行性，并提出使用无束缚性设计的眼动技术以探索疏肝法改善肝郁型MCI的可行性，为MCI的中医药干预及其神经机制探讨提供新思路，为中医情志衰老学说增添新内涵。     

预测年轻乳腺癌患者生存率列线图的建立和验证

目的:构建预测年轻乳腺癌患者生存情况的列线图，以期帮助临床诊疗。方法:收集SEER数据库中5 525例年轻乳腺癌患者的临床信息，通过单因素Log-rank检验和多因素Cox生存分析筛选出独立预后因素,用于构建预测患者3、5年总生存率(overall survival,OS)和癌症特异性生存率（cancer special survival,CSS)的列线图，将我院就诊的147例年轻乳腺癌患者作为验证集进行外部验证。结果:单因素和多因素分析结果显示，种族、病理类型、组织学分级、T分期、N分期、M分期、ER状态、HER-2状态、手术方式是与患者OS和CSS相关的独立危险因素，将这些因素纳入并建立预测患者OS和CSS的列线图模型。内部和外部验证结果显示模型具有良好的预测性能。基于建立的OS和CSS列线图模型对患者进行了风险分层，能够准确地将年轻乳腺癌患者分成预后有显著差异的三个风险亚组。结论:本研究构建的预测模型能较为准确的预测年轻乳腺癌患者的预后情况，为临床的诊疗提供科学依据。     

Use and Applicability of the Gail Model to Calculate Breast Cancer Risk: A Scoping Review

Objective: To perform a scoping review of the applicability of the Gail model in different countries for different ethnicities. Methods: The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist and search strategies based on the PICOS approach. The reviewed articles were included if they were published between 2013 and 2018 in English, Portuguese, or Spanish; were original articles available in full online; and described the use of the Gail model. The PubMed, Embase, and Web of Science data bases were searched. Results: A total of 38 articles eligible for analysis were identified, of which 16 used the Gail model to assess breast cancer risk in women, eight analyzed the applicability of this tool in their population, seven compared the tool and/or modified it according to the specific risk factors of their population, and seven cited the model in determining eligibility for chemoprevention. Conclusion: The Gail model has different applicabilities Greater effectiveness and breast cancer risk are found in developed countries.     

Patterns of Medical Care Cost by Service Type for Patients With Recurrent and De Novo Advanced Cancer

ObjectivesThere is limited knowledge about the cost patterns of patients who receive a diagnosis of de novo and recurrent advanced cancers in the United States.MethodsData on patients who received a diagnosis of de novo stage IV or recurrent breast, colorectal, or lung cancer between 2000 and 2012 from 3 integrated health systems were used to estimate average annual costs for total, ambulatory, inpatient, medication, and other services during (1) 12 months preceding de novo or recurrent diagnosis (preindex) and (2) diagnosis month through 11 months after (postindex), from the payer perspective. Generalized linear regression models estimated costs adjusting for patient and clinical factors.ResultsPatients who developed a recurrence <1 year after their initial cancer diagnosis had significantly higher total costs in the preindex period than those with recurrence ≥1 year after initial diagnosis and those with de novo stage IV disease across all cancers (all P < .05). Patients with de novo stage IV breast and colorectal cancer had significantly higher total costs in the postindex period than patients with cancer recurrent in <1 year and ≥1 year (all P < .05), respectively. Patients in de novo stage IV and those with recurrence in ≥1 year experienced significantly higher postindex costs than the preindex period (all P < .001).ConclusionsOur findings reveal distinct cost patterns between patients with de novo stage IV, recurrent <1-year, and recurrent ≥1-year cancer, suggesting unique care trajectories that may influence resource use and planning. Future cost studies among patients with advanced cancer should account for de novo versus recurrent diagnoses and timing of recurrence to obtain estimates that accurately reflect these care pattern complexities.     

乳腺对比增强能谱X线摄影的研究现状北大核心

对比增强能谱X线摄影(contrast enhancement spectral mammography, CESM)是在普通X线检查的基础上结合血管造影剂进行检查的一种新技术,是通过注射造影剂有效消除组织重叠对病灶的遮盖,实现对肿块真实形态显示,并提供血供信息。目前临床上对CESM进行了一系列的研究,本文就CESM成像原理、对乳腺癌的诊断、应用前景几个方面进行综述。     

Diagnostic pitfalls in needle core biopsy of the breast

Breast core biopsies are a standard component of the triple approach that includes clinical examination, imaging and tissue sampling. Conventional cores, diagnostic vacuum assisted biopsy and vacuum assisted excisions are established methods for sampling and managing breast lesions. It is important to be aware of the potential pitfalls in the technical handling and interpretation of the limited core biopsy samples. Here, we present a clinically oriented, well illustrated overview of the common diagnostic pitfalls based on the author's diagnostic and second opinion practice, emphasize the value of clinicopathological correlation and provide histological tips and clues with useful immunohistochemistry to aid the reporting pathologists in their daily interpretation of breast core biopsies.