孤立肾肾癌保留肾单位手术(附8例报告)

目的:探讨孤立肾肾癌保留肾单位手术的治疗方法和疗效。方法:对1992年2月~2004年12月共8例经手术和病理证实为肾细胞癌的临床资料进行回顾性分析,8例均为孤立肾癌,8例中5例行肿瘤剜除术,2例行肾部分切除术,1例离体肾肿瘤切除加自体肾移植术。结果:本组术后无外科并发症,平均随访10个月,无局部复发和肿瘤转移。结论:孤立肾患者保留肾单位的肾癌手术安全可靠,疗效满意。     

囊性肾癌与肾囊肿间的误诊分析

目的:探讨囊性肾癌和肾囊肿间的误诊原因。方法:回顾性分析8例囊性肾癌术前影像学检查或术中冰冻切片,并进行分析。结果:4例囊性肾癌患者误诊为肾囊肿,4例术前不能明确诊断病例,术中行冰冻病理证实为囊性肾癌,行肿瘤剜出术或肾癌根治术。结论:肾脏囊性病变应警惕囊性肾癌的可能,术中冰冻是目前公认的确诊方法。     

基于腹腔镜超声的纹理分析鉴别诊断肾透明细胞癌和非透明细胞癌的价值初探

目的 探讨基于腹腔镜超声图像的纹理分析在鉴别诊断肾透明细胞癌与非透明细胞癌中的价值.方法 回顾性分析我院经病理证实的83例肾细胞癌患者的腹腔镜超声检查资料,其中肾透明细胞癌66例,非透明细胞癌17例.在腹腔镜二维超声图像上通过ITK-SNAP软件手工勾画感兴趣区,采用Pyradiomics工具包提取纹理特征.使用组内相关系数选择具有良好稳定性和可重复性的特征;使用最大相关最小冗余(mRMR)和最小绝对收缩和选择算子(LASSO)回归进行特征选择并构建预测模型;绘制受试者工作特征(ROC)曲线分析该预测模型的诊断效能.结果 基于6个纹理特征构建的预测模型为:Y=-1.452+0.329×wavelet.LL glszm SmallAreaLowGrayLevelEmphasis-0.187×wavelet.LH firstorder Mean-0.209×wavelet.HH glszm SmallAreaLowGrayLevelEmphasis-0.107×original gldm DependenceVariance+0.351×wavelet.LH glrlm RunEntropy+0.058×wavelet.HH glszm ZonePercentage.该模型鉴别肾透明细胞癌与非透明细胞癌的ROC曲线下面积、敏感性、特异性和准确率及其对应的95例可信区间分别为0.860(0.771～0.945)、0.765(0.529～0.941)、0.864(0.788～0.939)、0.843(0.747～0.914).结论 基于腹腔镜超声图像的纹理分析可以准确鉴别肾透明细胞癌与非透明细胞癌.     

Patient-Reported Symptom Severity Among 22,650 Cancer Outpatients in the Last Six Months of Life

ContextUnderstanding the magnitude and risk factors for symptom burden of patients with cancer at the end of life is critical to guiding effective patient- and system-level interventions.ObjectivesWe aimed to estimate the prevalence of severe patient-reported symptoms among cancer outpatients during the six months before death and to identify patient groups at a higher risk for reporting severe symptoms.MethodsThis was a retrospective cohort study of cancer decedents at regional cancer centers from 2010 to 2016. Patient-reported Edmonton Symptom Assessment System (ESAS) scores from the last six months of life were linked to administrative databases. The proportion of patients reporting severe symptom scores (≥7) for anxiety, depression, drowsiness, lack of appetite, nausea, pain, shortness of breath, tiredness, and overall well-being during the six months before death was described. Multivariable modified Poisson regression analyses were used to identify risk factors for reporting severe symptom scores.ResultsOf 39,084 cancer decedents, 22,650 had one or more symptom assessments recorded in the last six months of life, resulting in 92,757 ESAS assessments. Severe scores were highest for tiredness (56%), lack of appetite (46%), and impaired well-being (45%). The proportion of patients reporting severe symptom scores was stable before progressively increasing at three months before death. Elderly, women, patients with high comorbidity, immigrants, and living in urban areas or with high material deprivation were at increased risk of reporting severe scores.ConclusionsDespite an integrated symptom screening program, rates of severe patient-reported symptom scores before death were high for outpatients with cancer. Patient subgroups at increased risk of severe symptom burden may benefit from targeted interventions. Ongoing review of routinely collected symptom data may be used to assess the supportive care needs and guide targeted interventions at the health-system level.     

TSP-1在肾透明细胞癌与外周血中的表达及临床意义

目的 检测并分析凝血酶敏感蛋白-1(thrombospondin-1,TSP-1)在肾透明细胞癌患者肾癌、癌旁组织、正常肾组织及外周血中的表达及临床意义.方法 收集47例肾透明细胞癌患者的标本包括:47例肾癌组织、41例癌旁组织、38例正常肾组织、35例患者外周血标本,制备组织抽提液及外周血清.运用ELISA法检测三种组织及血清中TSP-1的表达,并结合临床资料分析其临床意义.结果 TSP-1在肾癌组织、癌旁组织、正常肾组织三者间的表达水平分别为36.44±4.80ng/mL、42.55±4.12ng/mL、46.55±1.55ng/mL,依次递增,三种组织间的表达水平,两两比较均有统计学差异(P均＜0.01).TSP-1在肾癌组织中的表达,随着肾癌TNM分期与Fuhrman分级的提高而均降低,且都呈负相关(r=-0.84,P＜0.01;r=-0.70,P＜0.01).结论 TSP-1在肾透明细胞癌组织中低表达,可能在抑制肿瘤血管形成过程中起重要作用;TSP-1在肾透明细胞癌组织中的表达与肾癌的TNM分期和Fuhrman分级关系密切,可作为评判肾透明细胞癌发展及恶性程度的指标.     

超声体检对无症状肾癌和小肾癌的临床诊断价值

目的评价超声体检在早期发现无症状性肾癌(RCC)和小肾癌(SRCC、直径≤3cm)中的临床诊断价值。方法对经手术病理证实的98例住院患者进行回顾分析,资料分为两组,A组63例无症状肾癌,在健康体检或因其它疾患就诊由超声检查首先发现计为无症状组;B组35例症状性肾癌,有血尿、腰部不适、腰痛的计为症状组,首先由门诊超声检查发现,CT、MRI、尿路造影等检查均在超声检查之后进行。结果无症状性肾癌明显多于症状性肾癌,分别占64.3%和35.7%(P<0.01),小肾癌多为无症状性,本组小肾癌26例,A组21例,B组5例。术后随访12～108个月,平均58.8个月。A、B两组间瘤体大小在>3.0～5.0cm,术后1、3、5年无瘤生存率分别为100%、100%、94.4%和100%、66.7%、50%;瘤体>5.0cm术后1、3、5年无瘤生存率分别为100%、83.3%、66.7%和100%、54.5%、27.3%,两组3年和5年生存率差异均有显著性意义(P<0.05)。小肾癌术后预后好,无1例转移,全部生存至今,为1～9年,平均5.2年。结论超声体检是筛查早期无症状性肾癌和小肾癌的有效方法,无症状患者的远期无瘤生存率显著高于有症状患者。     

EZH2和P57在肾细胞癌中的表达及临床意义

目的检测肾细胞癌（简称肾癌）组织中EZH2和P57的表达,探讨其与肾癌临床病理特征间的关系。方法采用免疫组织化学法检测肾癌组织（n=64）和正常肾组织（n=12）中EZH2和P57的表达,分析EZH2和P57表达与’肾癌临床病理特征间的关系及其二者表达的相关性。结果正常。肾组织EZH2及P57蛋白的阳性表达率分别为16．67％和75．00％：肾癌组织EZH2和P57的阳性表达率为78．13％和25．56％,肾癌组织EZH2阳性表达率高于正常肾组织,P57阳性表达率低于正常肾组织（均P〈0．01）。EZH2阳性表达率随肾癌临床分期和病理分级升高而增加,且淋巴结转移组EZH2阳性表达水平明显高于无淋巴结转移组;P57阳性表达率随肾癌临床分期和病理分级升高而呈下降趋势,且淋巴结转移组P57表达水平低于无淋巴结转移组。二者差异表达与患者的性别及年龄均无关（均P〉0．05）。相关性分析显示：P57和EZH2在肾癌组织中的表达呈显著负相关（r=-0．648,P〈0．05）。结论EZH2和P57异常表达与肾癌发生和临床进展关系密切,P57可能是EZH2的下游靶基因,但其靶向抑制的具体机制尚需要深入研究。     

一例双侧肾透明细胞癌患者与家系成员VHL基因的胚系突变分析

目的　对一例家族性双侧肾透明细胞癌患者家系VHL基因的胚系突变进行分析,结合其临床特点探讨可能的分子遗传学发病机制。方法　收集病人家族史、影像学、入院诊疗和随访资料,提取患者及家系直系成员外周血DNA和RNA,采用PCR-DNA测序、荧光定量PCR,RT-PCR片段长度和序列分析等方法进行VHL基因病理性胚系突变位点的筛查和验证。结果　PCR-DNA测序分析结果显示在这家系成员中均没有发现VHL基因编码区的点突变;VHL基因外显子拷贝数的定量分析数据显示VHL基因外显子2拷贝数减少;RT-PCR产物电泳和测序结果表明先证者与其兄二人存在VHL基因第2外显子杂合性缺失所致的病理性胚系突变。结论　家族性肾细胞癌家系中VHL基因的胚系突变筛查可作为一种有效的手段预测患者的预后,并可指导临床。     

Symptom Intensity of Hospice Patients: A Longitudinal Analysis of Concordance Between Patients' and Nurses' Outcomes

Context

Nearing death, hospice patients are increasingly unable or unwilling to self-report their symptom intensity and rely on nurses' assessments.

Use of the Functional Assessment of Cancer Therapy−Anemia in Persons with Myeloproliferative Neoplasm-Associated Myelofibrosis and Anemia

Background

Anemia is common in myeloproliferative neoplasm (MPN)−associated myelofibrosis. The Functional Assessment of Cancer Therapy (FACT) measurement system is a patient-reported outcomes instrument that documents symptoms of the diverse aspects of cancer treatment. One FACT version, FACT-Anemia (FACT-An), documents symptoms of anemia related to cancer. The FACT-An has been validated in diverse cancer populations, but not in MPN-associated myelofibrosis.

Objective

Our aim was to evaluate the relationship between anemia response to therapy with pomalidomide with or without corticosteroids and patient-reported outcomes using the FACT-An instrument.

Methods

Data were obtained from a Phase II, randomized, double-blind Bayesian pick-the-winner trial of prednisone and pomalidomide in patients with MPN-associated myelofibrosis and anemia (red blood cell−transfusion dependence). Details of the study, including definitions of anemia, anemia response, red blood cell−transfusion, red blood cell−transfusion dependence, and red blood cell−transfusion independence, are reported. Change in quality of life from randomization to the last cycle of therapy was evaluated using the FACT-An Physical Well Being, Functional Well Being, Trial Outcome Index, and Anemia domains. Clinically important differences were used to determine the smallest difference in scores that patients perceived as beneficial in the FACT-An domains of interest. Patients were classified as meeting clinically important differences for responsiveness if their change score from baseline was >1 SEM, indicating improvement.

Results

Eighty-five patients were studied. Thirty-one patients (37%) were classified as anemia responders by prospectively defined criteria. Across all FACT-An domains, anemia responders showed greater improvement in Physical Well Being, Functional Well Being, and Trial Outcome Index scores than did nonresponders. This improvement began at the second 28-day cycle of therapy and was sustained.

Conclusions

We show a correlation between anemia response and improved quality of life measured by the FACT-An instrument in patients with MPN-associated myelofibrosis and anemia.     

经皮穴位电刺激对肺癌化疗患者肝肾功能损伤的影响

目的探讨经皮穴位电刺激(transcutaneous acupoint electrical stimulation,TEAS)对肺癌化疗患者肝肾功能损伤的影响。方法 2014年7月至2015年7月,便利抽样法选取在上海市肺科医院进行初次化疗的非小细胞肺癌患者182例,按照入院时间先后分为常规组(62例)、穴位组(50例)和对照组(70例)。常规组患者给予化疗常规护理,穴位组患者在化疗常规护理基础上给予电刺激足三里、期门穴及太溪穴,对照组患者在化疗常规护理基础上仅将电极片贴在相同穴位上,不给予电刺激。观察3组患者总胆红素、直接胆红素、谷草转氨酶(AST)、谷丙转氨酶(ALT)、内生肌酐清除率(Cr)、尿素氮(BUN)等主要反映肝肾功能指标的变化。结果化疗第5天,穴位组患者直接胆红素、总胆红素及Cr指标低于常规组;化疗第8天,穴位组患者AST、Cr指标均低于常规组,差异均有统计学意义(均P0.05);化疗第14天,穴位组患者直接胆红素指标低于对照组,差异有统计学意义(P0.05)。结论穴位电刺激可减缓肺癌化疗后肝肾功能的损伤进程,进而确保患者化疗的顺利进行。     

High‐Intensity Focused Ultrasonography and Radiofrequency Ablation of Renal Cell Carcinoma Arisen in Transplanted Kidneys: Single‐Center Experience With Long‐Term Follow‐Up and Review of Literature

The purpose of this article is to retrospectively evaluate the long‐term outcome of patients treated with percutaneous thermoablation for renal cell carcinomas that have arisen in kidney grafts. Between April 2008 and February 2011, we treated 3 patients with renal cell carcinoma on a transplanted kidney: 2 cases were treated with high‐intensity focused ultrasonography and 1 patient with radio frequency ablation. Postprocedural ultrasonography did not reveal any complications, and contrast‐enhanced ultrasonography showed an avascular area in the treated nodules. None of the patients had recurrent tumors during a long‐term clinical and radiologic follow‐up (81, 73, and 43 months, respectively).     

Comparison of Fatigue,Pain, and Depression in Patients With Advanced Kidney Disease and Cancer—Symptom Burden and Clusters

Context

Although symptom clusters have been studied in the context of cancer, few data exist in chronic and end-stage kidney disease (CKD/ESKD) patients.

Estimating glomerular filtration rate in hypertensive subjects: Comparison of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) Study equations

Abstract

Background.The Modification of Diet in Renal Disease (MDRD) Study equation is the most commonly used formula for estimation of glomerular filtration rate (eGFR). Recently, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) developed a new equation to provide a more accurate estimate of GFR among individuals with normal or mildly reduced renal function.

Aim. To compare the MDRD and CKD-EPI equations in hypertensive population treated in general practice.

Methods. The MDRD and CKD-EPI equations were applied to a cohort of 994 hypertensive subjects aged 45–70 years without cardiovascular or renal disease or previously known diabetes.

Results. The prevalence of CKD stage 3 (eGFR 30–59 mL/min per 1.73 m²) was 6.7% (95% CI 5.3–8.5) (67/994) according to the MDRD formula and 3.7% (95% CI 2.6–5.1) (37/994) according to the CKD-EPI formula. Of the 67 subjects classified as having CKD stage 3 according to the MDRD equation, 30 (44.8%) were reclassified as ‘no-CKD’ by the CKD-EPI equation. These subjects were mostly women 26/30 (87.7%).

Conclusion. Using the CKD-EPI equation leads to lower prevalence estimates for CKD than the MDRD equation in a hypertensive population treated in general practice.     

Development of a wearable bioartificial kidney using the Bioartificial Renal Epithelial Cell System (BRECS)

Cell therapy for the treatment of renal failure in the acute setting has proved successful, with therapeutic impact, yet development of a sustainable, portable bioartificial kidney for treatment of chronic renal failure has yet to be realized. Challenges in maintaining an anticoagulated blood circuit, the typical platform for solute clearance and support of the biological components, have posed a major hurdle in advancement of this technology. This group has developed a Bioartificial Renal Epithelial Cell System (BRECS) capable of differentiated renal cell function while sustained by body fluids other than blood. To evaluate this device for potential use in end‐stage renal disease, a large animal model was established that exploits peritoneal dialysis fluid for support of the biological device and delivery of cell therapy while providing uraemic control. Anephric sheep received a continuous flow peritoneal dialysis (CFPD) circuit that included a BRECS. Sheep were treated with BRECS containing 1 × 10⁸ renal epithelial cells or acellular sham devices for up to 7 days. The BRECS cell viability and activity were maintained with extracorporeal peritoneal fluid circulation. A systemic immunological effect of BRECS therapy was observed as cell‐treated sheep retained neutrophil oxidative activity better than sham‐treated animals. This model demonstrates that use of the BRECS within a CFPD circuit embodies a feasible approach to a sustainable and effective wearable bioartificial kidney. Copyright © 2016 John Wiley & Sons, Ltd.