桥本甲状腺炎和甲状腺乳头状癌miRNAs表达差异研究

<正>微小RNA是一类广泛存在于真核生物中非编码单链小RNA分子,通过降解靶基因mRNA或抑制其蛋白翻译,参与调控人体一系列重要生理病理过程。1资料与方法1.1组织样本采集选择2014年5月-2014年12月在吉林大学第二医院行甲状腺切除术的患者6名。男性2例,女性4例。其中HT患者3例(男性1例,女性2例);PTC患者3例(男性1例,女性2例)。另     

图象分析法检测乳腺癌细胞DNA含量及其意义

目的：检测乳腺癌及其癌变过程中细胞DNA的含量，探讨DNA含量在这一过程中的变化规律和临床意义。方法：对1988年63例在我院手术治疗的浸润性乳腺癌，以及1984～1992年间手术治疗的13例导管内癌（ductal carcinoma in situ,DCIS)、6例导管内癌伴早期浸润(DCIS Ca)、6例导管上皮高度增生(proliferative breast disease,PBD)的原发灶进行DNA图象分析(image cytometry，ICM)．结合临床资料，分析63例浸澜性乳腺癌细胞DNA含量与预后关系的观察。结果：发现浸润性乳腺癌与：DCIS及PBD相比，有较高的DNA指数(DNA index，DI)、异倍体检出率、核面积(nuclear area，NA）和5C细胞阳性率（P<0.05）。在DCIS与PBD两组病人中，DI、NA无明显差别（P<0．05)，而异倍体肿瘤，5C细胞出现在DCIS中(P<0.05)，且PBD中无5C细胞，异倍体出现。在乳脉癌病人预后的单因素分析中，发现5C细胞阳性、异倍体肿瘤等的无病生存率低(P<0．01)。结论：异倍体细胞群的出现是细胞癌变的早期标志，DNA含量随着乳腺癌恶性程度增加而发生显著改变。     

CT引导下带钩钢丝术前定位在胸腔镜下孤立性肺小结节切除术中的应用

Objective Video-assisted thoracoscopic surgery (VATS) provides a minimally invasive approach to resect small solitary pulmonary nodules (SSPN). The aim of this study is to evaluate the efficacy and safety of preoperative CT-guided hookwire localization for SSPN in VATS. Methods Hookwire was used to localize 26 SSPN under CT guidance in 24 patients (14 male, 10 female, age range 21-61 years, mean 52.3 years), preoperatively, and wedge resection was performed through VATS. The lesion size, distance from the lesion to parietal pleura, the time of localization and complications were evaluated. Results All the 26 pulmonary nodules were preoperatively detected and localized with hookwire under CT-guidance. The mean lesion size was 10.05 ± 3.08 nun in diameter, and the mean distance from lesion to parietal pleura was 10.09±2. 62 mm. The mean localization time was 20. 18±7.16 min, and then the nodules were removed by VATS within 18 ± 6. 65 min. The major complication of CT-guided hookwire localization was mild pneumothorax in 6 patients (25.0%), but no one needed chest tube drainage. The dislodgment of hookwire was found in only one patient (4.2%) during the operation, but the lesion was still successfully resected under VATS. Of those patients, 8 were confirmed to have a primary NSCLC by rapid pathologic diagnosis during VATS wedge resection, and then VATS lobectomies were performed. Condusion The preoperative CT-guided hookwire localization for small solitary pulmonary nodules is an effective and safe technique to assist VATS resection of the nodules.     

CT和MRI诊断恶性骨肿瘤软组织肿块的特征性分析

目的：研究分析CT和MRI影像学检查方法对于恶性骨肿瘤软组织肿块的特征性表现和临床诊断效果。方法选择该院2012年6月—2014年6月收治的恶性骨肿瘤并软组织肿块患者50例作为研究对象,将所有患者首先进行CT检查,再进行MRI检查,对比观察两种检查方法对于肿瘤的恶性诊断符合率和良性诊断符合率,并且分析恶性骨肿瘤软组织肿块的MRI表现情况。结果 CT诊断的恶性肿瘤诊断符合率为76%（38/50）,良性肿瘤诊断符合率为84%（42/50）;而MRI的恶性肿瘤诊断符合率为94%（47/50）,良性肿瘤诊断符合率为96%（58/50）,两者之间的差异具有统计学意义（P<0.05）。良性软组织肿块与恶性软组织肿块组在肿块范围、边缘以及信号均匀性情况的差异无统计学意义（P>0.05）。良性软组织肿块与恶性软组织肿块在水肿、侵袭性情况之间的差异具有统计学意义（P<0.05）。结论对于恶性骨肿瘤患者采用CT和MRI检查均具有较好诊断效果,CT能够很好的显示肿瘤的范围,而MRI能够更为准确的发现肿块和病变侵入的范围,其对于软组织肿块的诊断价值更具有临床意义。     

三级妇产专科医院羊水栓塞13例诊治及文献复习

 目的 总结羊水栓塞患者的临床资料,探讨羊水栓塞的发生机制,分享羊水栓塞救治经验。方法 回顾性分析2011-03至2018-11在北京妇产医院孕晚期分娩并发羊水栓塞患者的症状、体征、实验室等辅助检查、用药救治过程,以及母儿妊娠结局与预后。结果 在109 401次孕晚期分娩记录中,共发生13例羊水栓塞,发病率11.88/10万。高龄(超过35岁)产妇占比53.8%(7/13),经产妇占比53.8%(7/13),存在过敏性体质患者4例,胎盘高危因素4例,妊娠期高血压疾病患者3例。84.6%(11/13)的患者出现了危及生命体征的临床表现(至少低血压、低血氧、DIC之一),3例出现心脏呼吸骤停,5例并发DIC,产后出血(>1000 ml以上)者9例[1100~6000 ml,(2963±406)ml]。4例血液中查找羊水成分,其中3例阳性,9例使用大量血管活性药物时间超过3 h,5例行子宫切除术,无患者死亡。结论 羊水栓塞主要依靠临床表现进行诊断;典型的羊水栓塞是产科罕见而凶险的并发症;及时准确的诊断以及训练有素的多学科快速反应团队,及时足量的抗过敏和血管活性药物以及后续充分的生命支持治疗是挽救羊水栓塞患者生命的关键措施。     

褪黑素调控Nrf2/ARE信号通路延缓髓核间充质干细胞退变的实验研究

  目的  探讨褪黑素对氧化应激条件下的大鼠髓核间充质干细胞(NPMSCs)的影响及调节机制。  方法  使用差速贴壁法获取大鼠NPMSCs。显微镜下观察细胞状态,鉴定第三代细胞三系分化潜能和细胞表面免疫标志物;采用CCK-8法检测不同浓度过氧化氢和褪黑素诱导对大鼠NPMSCs活力的影响确定最佳浓度和实验分组;免疫荧光和流式细胞学技术检测NPMSCs活性氧水平;免疫印迹分析外基质标志蛋白(Ⅱ型胶原、糖胺聚糖)和通路核心蛋白(Nrf2、HO-1)表达情况。  结果  褪黑素在氧化应激下保护了NPMSCs的活性,且1 μmol/L浓度保护效应最为明显(0.717±0.018,t=7.102, P＜0.01)。褪黑素可抑制NPMSCs在H₂O₂诱导后的活性氧水平(阳性率70.0% vs. 32.7%)。此外,褪黑素还能显著提高Nrf2/ARE信号通路中关键蛋白核因子E2相关因子(1.925±0.024,t=13.150,P＜0.01)和血红素氧合酶-1(1.605±0.019,t=12.940, P＜0.01)的活性,改善NPMSCs的功能。褪黑素治疗后,细胞基质蛋白Ⅱ型胶原(0.850±0.010,t=25.200,P＜0.01)和糖胺聚糖(0.335±0.013,t=10.640,P＜0.01)表达增加。  结论  褪黑素通过调控Nrf2/ARE信号通路可以影响NPMSCs退变的生物学特性。      

Ⅲ期乳腺癌治疗进展

Ⅲ期乳腺癌治疗进展上海医科大学肿瘤医院（２０００３２）沈镇宙，张亚伟随着对乳腺癌的普查和诊断方法的改进，早期乳腺癌的检出率不断提高，在一些发达国家，临床上Ⅲ期乳腺癌约占１０％～１５％，而我国目前约占３０％。Ⅲ期乳腺癌治疗后的５年生存率为１５％～５０％...     

微探头超声内镜和CT在胸段食管癌术前分期中的应用

Objective： To compare mini-probe endoscopic ultrasonography （MCUS） with computed tomography （CT） in preoperative T and N staging of esophageal cancer, and to find out the MCUS parameters to judge lymph nodes metastasis for esophageal cancer. Methods： Thirty-five patients received both MCUS and CT preoperatively, on both of which the T and N stages were determined. The accuracy, sensitivity, specificity, positive predicting value and negative predicting value were compared with the postoperative pathological results. Results： The accuracy of MCUS was 85.7% in T staging and 85.7% and 80.0% in N staging by two different methods, which were 45.7% and 74.3%, respectively, by CT. Conclusion： MCUS is better than CT in preoperative staging for esophageal cancer. The ratio of short to long axis （S/L） combined with short axis is a useful way to determine lymph nodes metastasis.     

CT引导下带钩钢丝术前定位在胸腔镜下孤立性肺小结节切除术中的应用

Objective Video-assisted thoracoscopic surgery (VATS) provides a minimally invasive approach to resect small solitary pulmonary nodules (SSPN). The aim of this study is to evaluate the efficacy and safety of preoperative CT-guided hookwire localization for SSPN in VATS. Methods Hookwire was used to localize 26 SSPN under CT guidance in 24 patients (14 male, 10 female, age range 21-61 years, mean 52.3 years), preoperatively, and wedge resection was performed through VATS. The lesion size, distance from the lesion to parietal pleura, the time of localization and complications were evaluated. Results All the 26 pulmonary nodules were preoperatively detected and localized with hookwire under CT-guidance. The mean lesion size was 10.05 ± 3.08 nun in diameter, and the mean distance from lesion to parietal pleura was 10.09±2. 62 mm. The mean localization time was 20. 18±7.16 min, and then the nodules were removed by VATS within 18 ± 6. 65 min. The major complication of CT-guided hookwire localization was mild pneumothorax in 6 patients (25.0%), but no one needed chest tube drainage. The dislodgment of hookwire was found in only one patient (4.2%) during the operation, but the lesion was still successfully resected under VATS. Of those patients, 8 were confirmed to have a primary NSCLC by rapid pathologic diagnosis during VATS wedge resection, and then VATS lobectomies were performed. Condusion The preoperative CT-guided hookwire localization for small solitary pulmonary nodules is an effective and safe technique to assist VATS resection of the nodules.     

乳腺导管内癌52例分析

我院１９７２～１９９６年间共收治乳腺导管内癌５２例,约占同期乳腺癌１－６％,现就其临床特征和疗效分析报告如下。临床资料：（１）临床表现：５２例患者,年龄３２～７４岁,中位年龄４６岁。病期１个月至６年,中位时间为９个月,其中２０例１年以上。自觉症状为乳腺肿块３２例,乳头排液１４例,乳腺肿块伴乳头溢液４例,２例为乳腺钼靶片检查异常。乳腺肿块最小０－５ｃｍ,最大４ｃｍ;乳间溢液多为浆液性或血性;有３例腋淋巴结可能为转移。（２）治疗：手术方式选择：扩大根治术３１例,根治术９例,改良根治术１８例,单纯乳房…