Morphological spectrum of adenoid-cystic carcinoma of the breast: focus on diagnostic and prognostic features

Adenoid cystic carcinoma (AdCC) is a salivary gland-type of cancer that may also occur in the breast. Breast AdCC shows the same morphological spectrum as is observed in salivary glands, with recognition of individual subtypes that may differ in their clinical behaviour. AdCC classic variant (C-AdCC) is a slowly growing tumour, with a low rate of axillary node and distant metastases. Local recurrences may develop as a consequence of incomplete surgical excision. C-AdCC should be differentiated from the solid-basaloid variant of AdCC (SB-AdCC) that is characterized by nuclear atypia, frequent mitotic figures and necrosis, in addition to the solid architecture. SB-AdCC is a more aggressive tumour, with higher rates of axillary node and distant metastases. AdCC may also co-exist with more aggressive types of carcinoma including metaplastic and neuroendocrine carcinoma, referred to as AdCC with high grade transformation (HG-AdCC). This paper reviews the key diagnostic criteria of the different subtypes of breast AdCC with emphasis on differential diagnosis and prognostic parameters.     

An economic analysis of the cost of survival of micro preemies: A systematic review

ObjectiveThis study aimed to systematically review the current literature on the economic costs of micro preemie as well as evidence on the cost-effectiveness of interventions to improve outcomes for micro preemie babies with a birth weight of ≤500 g.MethodWe searched MEDLINE, CINAHL, Scopus, ECONLIT, Business Source Premier and Cochrane Library for studies reporting costs of micro preemie from January 2000. Costs were inflated to 2019 United States dollars (US$). All full-text articles were assessed for eligibility and a quality assessment of included articles was conducted using the Drummond and the Larg and Moss checklists.ResultsThe search identified three studies that met the inclusion criteria; two cost-of-illness studies and one cost-effectiveness study. Across studies, the mean healthcare spending per micro preemie survivor (in 2019 US$) ranged from US$61,310 (birth admission) to US$263,958 (inpatient and outpatient for the first six months of life). One modelling study reported exclusive human milk diet for micro preemies at birth was more cost-effective compared to the standard approach with cow milk diet from the third-party payer and societal perspectives.ConclusionDespite significant advances in perinatal care and expanded access to life-saving equipment to improve survival outcomes of micro preemie, there remains a paucity of research on economic costs associated with these babies. No study has utilised quality-adjusted life-years as an outcome measure. Given the chronic conditions and long-term neurologic disability associated with micro preemie survivors, an estimate of the lifetime cost to the individual, healthcare providers and society would provide a benchmark of the potential cost-savings that could accrue from cost-effective interventions to improve the survival rate of micro preemies.     

双歧杆菌四联活菌片联合四联疗法对HP阳性胃溃疡患者血清TGF-β1、G17、PGI的影响

目的探讨双歧杆菌四联活菌片联合四联疗法对幽门螺旋杆菌(HP)阳性胃溃疡患者血清转化生长因子-β1(TGF-β1)、胃泌素17(G17)、胃蛋白酶原I(PGI)的影响。 方法选取HP阳性胃溃疡患者98例,随机均分为对照组和联合组。对照组采用四联疗法,联合组采用双歧杆菌四联活菌片联合四联疗法治疗。比较两组临床疗效、胃黏膜组织学评分、血清TGF-β1、PGI、G17、胃动素(MTL)、不良反应等情况。 结果联合组治疗总有效率高于对照组(P＜0.05)。与治疗前比较,治疗后两组胃黏膜组织学各项评分、TGF-β1、G17、PGI均降低,MTL升高,且联合组较对照组更为显著(P＜0.05)。联合组不良反应总发生率低于对照组(P＜0.05)。 结论双歧杆菌四联活菌片联合四联疗法治疗HP阳性胃溃疡患者疗效满意,可调节胃肠激素水平,安全性良好,具有临床应用价值。     

针灸配合松龄血脉康胶囊治疗急性脑梗死疗效观察及对 APN、ET-1 水平的影响

目的:探究针灸配合松龄血脉康胶囊治疗急性脑梗死(ACI)的疗效及对脂联素(APN)、内皮素-1 (ET-1)水平的影响。方法:将62例ACI患者作为研究对象,按随机数字表法分成2组,每组各31例。对照组采用松龄血脉康胶囊治疗,观察组为针灸配合松龄血脉康胶囊治疗;观察2组临床疗效,并比较APN、ET-1、超敏C-反应蛋白(hs-CRP)及纤维蛋白原(FIB)。结果:观察组总有效率高达90.23%,显著高于对照组的64.52%,2组比较,差异有统计学意义(χ^2=5.905,P<0.05)。经治疗,2组治疗后APN显著升高(P<0.05),ET-1、hs-CRP、FIB均下降(P<0.05)。治疗后组间比较,观察组患者APN高于对照组(P<0.05),ET-1、hs-CRP、FIB均低于对照组(P<0.05)。结论:对ACI患者行针灸配合松龄血脉康胶囊治疗,能够显著增加APN水平,降低ET-1水平,且其炎性反应、凝血功能改善效果更为显著。     

舒胃汤联合复方消化酶胶囊治疗肝胃不和型功能性消化不良临床效果观察

目的:探讨分析舒胃汤联合复方消化酶治疗肝胃不和型功能性消化不良(Functional Dyspepsia,FD)的临床效果。方法:选取2016年2月-2019年2月收治的108例肝胃不和型功能性消化不良患者随机分为观察组和对照组,观察组给予舒胃汤联合复方消化酶胶囊治疗,对照组给予复方消化酶胶囊治疗,比较两组临床疗效,治疗前后中医症状评分、胃功能指标。结果:观察组临床疗效总有效率为94.44%较对照组显著提高(P<0.05),治疗前两组中医症状评分无统计学差异(P>0.05),治疗后两组早饱、上腹灼烧感、餐后饱胀不适、上腹痛评分均显著下降,且治疗后观察组早饱、上腹灼烧感、餐后饱胀不适、上腹痛评分下降更显著(P<0.05),治疗前两组胃功能指标无统计学差异(P>0.05),治疗后两组胃排空、胃动素、胃泌素指标水平均显著提高,且治疗后观察组胃排空、胃动素、胃泌素指标水平改善更显著(P < 0.05),观察组不良反应发生率为5.56%,较对照组显著性降低(P < 0.05)。结论:舒胃汤联合复方消化酶胶囊治疗肝胃不和型功能性消化不良可显著提高临床疗效,改善患者临床症状,促进胃功能提高,降低不良反应发生率,值得应用。     

芪苈强心胶囊配合保元汤加减治疗慢性心力衰竭临床研究

目的:观察芪苈强心胶囊配合保元汤加减用于慢性心力衰竭的治疗效果。方法:选取收治的慢性心力衰竭患者104例作为研究对象,运用随机数字表法将其分为观察组(52例)和对照组(52例),两组患者均接受常规治疗,对照组采用保元汤治疗,观察组同时应用芪苈强心胶囊联合保元汤治疗。观察患者治疗前及治疗后6个月的6 min步行试验的步行距离(6MWD)及纽约心脏病学会心功能分级(NYHA)、血清学指标N末端B型利尿钠肽原(NT-proBNP)、半乳糖凝集素3(Galectin-3)及白介素6(IL-6)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)、心脏指数(CI)、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室重量指数(LVMI)和室壁运动指数(WMI)、左室间隔厚度(IVST)变化情况。结果:治疗前后,两组患者比较心功能指标、Galectin-3、炎性因子指标、心室重构指标差异有统计学意义(P<0.05); 观察组与对照组患者相比,6 min步行距离、CI、LVEF、升高更为显著(P<0.05); 观察组患者NYHA分级、NT-proBNP、Galectin-3、IL-6、hs-CRP、TNF-α、LVEDD、LVESD、LVMI、WMI、IVST降低更为显著(P<0.05)。结论:芪苈强心胶囊辅助保元汤加减能够有效改善慢性心力衰竭患者心脏功能,有利于患者体内炎性因子及Galectin-3水平降低,抑制心室重构进展,患者心脏舒缩功能改善效果更佳。     

复方倍他米松注射液联合泛昔洛韦胶囊、普瑞巴林胶囊治疗带状疱疹的临床疗效观察

目的 对复方倍他米松注射液联合泛昔洛韦胶囊、普瑞巴林胶囊治疗带状疱疹的临床疗效进行观察并探讨。方法 选取2018 年1 月～2019 年12 月我院收治的118 例带状疱疹患者为研究对象，采用随机抽签的方式将患者分为对照组（泛昔洛韦胶囊+普瑞巴林胶囊+甲钴胺片+维生素B1 片）与观察组（联合复方倍他米松注射液），比较两组治疗总有效率、VAS 评分、QS 评分、C 反应蛋白、无新发皮疹时间、结痂时间及疼痛停止时间、随访2 个月后带状疱疹后遗神经痛发生率以及不良反应发生率。结果 观察组与对照组治疗总有效率分别为94.92%及76.27%，组间对比差异有统计学意义（P＜0.05）；治疗后，观察组VAS 评分显著低于对照组；观察组QS 评分低于对照组（P＜0.05）；治疗后，观察组C 反应蛋白显著低于对照组（P＜0.05）；观察组无新发皮疹时间、结痂时间及疼痛停止时间分别显著短于对照组（P＜0.05）；随访2 个月后，发现观察组带状疱疹后遗神经痛发生率显著低于对照组（P＜0.05）；观察组不良反应发生与对照组比较，差异无统计学意义（P＞0.05）。结论 复方倍他米松注射液联合泛昔洛韦胶囊、普瑞巴林胶囊治疗带状疱疹不仅效果好且安全性高，值得使用。     

舒肝解郁胶囊联合礞石滚痰丸治疗精神分裂症肝郁痰结证临床研究

目的:观察舒肝解郁胶囊联合礞石滚痰丸改善精神分裂症肝郁痰结证的临床疗效。方法:选取精神分裂症患者120例,按随机数字表法分为2组各60例。对照组予奥氮平治疗;观察组在此基础上加用舒肝解郁胶囊联合礞石滚痰丸治疗。连续治疗8周后,比较2组住院精神患者社会功能评定(SSPI)量表、临床总体印象疗效总评量表病情严重程度(CGI-SI)、阳性与阴性症状量表(PANSS)评分以及临床疗效。结果:与治疗前比较,治疗后2组SSPI量表评分均显著升高,CGI-SI评分均明显降低(P<0.01);观察组治疗后SSPI量表评分明显高于对照组,CGI-SI评分显著低于对照组(P<0.01)。治疗后,2组阳性症状、阴性症状、一般精神病理、PANSS总分均显著减少(P<0.01);与对照组比较,观察组治疗后阳性症状、阴性症状、一般精神病理、PANSS总分下降更明显(P<0.01)。观察组总有效率81.67%,对照组63.79%,差异有统计学意义(P<0.05)。结论:舒肝解郁胶囊联合礞石滚痰丸改善精神分裂症肝郁痰结证疗效确切。     

lncRNA 178030.2通过TRPS1对三阴性乳腺癌细胞紫杉醇耐药的影响与机制研究

目的:探讨lncRNA 178030.2通过TRPS1对三阴性乳腺癌细胞紫杉醇耐药的影响与机制。方法:采用逐步增加剂量间歇作用的方法诱导三阴性乳腺癌紫杉醇耐药细胞系并命名为MDA-MB-231/R。采用定量PCR和Western blot检测耐药细胞和亲本细胞中lncRNA 178030.2和TRPS1的表达；应用Lipofectamine 2000将lncRNA 178030.2高表达质粒pcmv-178030.2和对照质粒pcmv转染至MDA-MB-231细胞，分别为高表达组和对照组，定量PCR检测lncRNA 178030.2水平的变化，分别用定量PCR和Western blot检测TRPS1 mRNA及蛋白水平的变化；RIP实验检测lncRNA 178030.2是否与TRPS1相结合；MTT法检测MDA-MB-231细胞对紫杉醇的敏感性及细胞增殖。应用Lipofectamine 2000将lncRNA 178030.2小干扰RNA si178030.2和对照siNC转染至MDA-MB-231/R细胞，分别为干扰组和对照组，定量PCR检测lncRNA 178030.2水平的变化，分别用定量PCR和Western blot检测TRPS1 mRNA及蛋白水平的变化；MTT法检测MDA-MB-231/R细胞对紫杉醇的敏感性及细胞增殖。应用Lipofectamine 2000将TRPS1过表达质粒pcmv-TRPS1和对照质粒pcmv转染至MDA-MB-231细胞，分别为高表达组和对照组，分别用定量PCR和Western blot检测两组细胞中TRPS1 mRNA及蛋白水平的表达情况，然后再分别应用Lipofectamine 2000将lncRNA 178030.2高表达质粒pcmv-178030.2转染入两组细胞，MTT法检测MDA-MB-231细胞对紫杉醇的敏感性及细胞增殖。结果:成功构建在3 μg/ml紫杉醇中稳定生长的三阴性乳腺癌耐药细胞系MDA-MB-231/R。定量PCR结果显示:lncRNA 178030.2在紫杉醇耐药细胞系MDA-MB-231/R中的表达明显高于在其亲本细胞MDA-MB-231中的表达；定量PCR和Western blot显示:TRPS1 mRNA和蛋白在紫杉醇耐药细胞系MDA-MB-231/R中的表达明显低于在其亲本细胞系MDA-MB-231中的表达；与对照组相比，高表达lncRNA 178030.2组的MDA-MB-231细胞中TRPS1表达下降，细胞对紫杉醇的敏感性降低，细胞增殖增强，且lncRNA 178030.2确实可以与TRPS1相结合；与对照组相比，低表达lncRNA 178030.2组的MDA-MB-231/R细胞中TRPS1表达升高，细胞对紫杉醇的敏感性升高，细胞增殖减弱；在MDA-MB-231细胞中过表达TRPS1后再过表达lncRNA 178030.2，其促进紫杉醇耐药、促进细胞增殖的作用也明显减弱。结论:lncRNA 178030.2促进三阴性乳腺癌细胞MDA-MB-231的紫杉醇耐药，促进细胞增殖，其发生机制可能与下调TRPS1的表达有关。