吡咯替尼联合槐耳颗粒治疗人表皮生长因子受体2阳性晚期乳腺癌患者化疗耐药效果观察

目的探讨吡咯替尼联合槐耳颗粒治疗人表皮生长因子受体2(HER2)阳性晚期乳腺癌患者化疗耐药的效果。方法选取大连大学附属中山医院自2014年1月至2018年1月收治的HER2阳性晚期乳腺癌患者62例为研究对象。采用随机数字法将其分为A、B两组,每组各31例。A组患者仅服用吡咯替尼;B组患者在化疗开始时,服用吡咯替尼与槐耳颗粒。比较两组患者乳腺实体肿瘤的改善情况,CD4+、CD8+及CD4+/CD8+水平。测定并比较两组患者乳腺癌组织多药耐药蛋白P170、谷胱甘肽-S-转移酶-π(GST-π)及P-糖蛋白(P-gp)的表达阳性率,并采用生活质量综合评定量表评价患者的生活质量。结果 B组患者的乳腺实体瘤总缓解率为87.1%(27/31),显著高于A组的29.0%(9/31),差异有统计学意义(P<0.05)。B组患者的CD4+、CD8+及CD4+/CD8+水平均高于A组,差异均有统计学意义(P<0.05)。B组患者乳腺癌组织耐药蛋白P170、GST-π及P-gp表达阳性率均低于A组,差异均有统计学意义(P<0.05)。B组患者4个维度生活质量及总体健康评分均高于A组,差异均有统计学意义(P<0.05)。结论吡咯替尼联合槐耳颗粒对HER2阳性晚期乳腺癌患者具有良好疗效,可提高患者免疫功能,降低其化疗耐药,改善患者生活质量。     

乳腺癌患者局部复发与初次保乳术后淋巴结状态的关系分析

目的分析乳腺癌局部复发患者初次保乳术后的淋巴结状态,探讨局部复发与淋巴结状态的关系。方法选择2015年5月-2017年4月接受保乳术治疗的乳腺癌患者共81例,术后根据患者的腋窝淋巴结状态分为转移组(27例)与未转移组(54例)。对比两组患者的一般资料(年龄、肿瘤直径、病理分型、病理分期);术后随访2年,记录两组患者局部复发率,采用线性回归分析局部复发与淋巴结状态的关系。结果两组一般资料对比,差异无统计学意义(P>0.05);转移组的局部复发率比对照组高,差异有统计学意义(P<0.05);线性回归分析显示,乳腺癌初次保乳术后淋巴结转移可能是其局部复发的影响因素(P<0.05)。结论乳腺癌初次保乳术后淋巴结状况与局部复发具有密切关联,若发生淋巴结转移,则患者局部复发的风险会明显提升。     

右美托咪定结合羟考酮复合麻醉对肺癌根治术患者术后痛敏反应及免疫应答影响

目的探讨右美托咪定结合羟考酮复合麻醉对肺癌根治术患者术后痛敏反应及免疫应答的影响。方法选取南通大学附属肿瘤医院自2018年1月至2021年1月收治的160例肺癌患者为研究对象。采用随机数字表法将其分为A组(n=78)与B组(n=82)。A组给予右美托咪定结合丙泊酚复合麻醉,B组给予右美托咪定结合羟考酮复合麻醉。记录并比较两组患者术前、术后疼痛因子水平、炎症因子水平、视觉模拟量表(VAS)评分。采用流式细胞术检测两组患者术前、术后T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)水平。记录两组患者不良反应发生情况。结果 B组患者术后疼痛因子、炎症因子水平和术后VAS评分均低于A组,差异均有统计学意义(P<0.05)。B组患者术后CD3+、CD4+、CD4+/CD8+均高于A组,CD8+水平低于A组,差异均有统计学意义(P<0.05)。A组患者不良反应发生率为28.21%(22/78),显著高于B组的12.20%(10/82),差异有统计学意义(P<0.05)。结论右美托咪定结合羟考酮复合麻醉可有效减轻肺癌根治术患者术后的痛敏反应,对术后患者的免疫功能影响...     

胸腺肽α1对重症肺炎患者T细胞表达及预后影响研究

目的探讨胸腺肽α1对重症肺炎患者T细胞表达及预后的影响。方法选取阜阳市人民医院自2015年9月至2017年8月收治的146例重症肺炎患者为研究对象。将患者随机分入A组和B组,每组73例。A组患者接受监测生命体征、吸氧、调节电解质紊乱、营养输入等治疗,并应用头孢他啶、诺氟沙星;B组在A组基础上联合应用胸腺肽α1。比较两组患者的辅助性T细胞17比例、调节性T细胞比例、辅助性T细胞17/调节性T细胞比值,CD3~+比例、CD4~+比例、CD8~+比例、CD4~+/CD8~+比值,以及预后情况。结果治疗后,两组患者的辅助性T细胞17比例、辅助性T细胞17/调节性T细胞比值均较治疗前下降,且B组低于A组,差异有统计学意义(P<0.05);两组患者的调节性T细胞比例均较治疗前升高,且B组高于A组,差异有统计学意义(P<0.05)。治疗后,两组患者的CD3~+比例、CD4~+比例、CD4~+/CD8~+比值均较治疗前升高,且B组高于A组,差异有统计学意义(P<0.05);B组CD8~+比例较治疗前降低且低于A组,差异有统计学意义(P<0.05)。B组不良反应发生率8.2%(6/73)低于A组21.9%(16/73),差异有统计学意义(P<0.05)。A组28 d病死率为20.6%(15/73),B组为15.1%(11/73),差异无统计学意义(P>0.05)。结论胸腺肽α1可调节重症肺炎患者T细胞表达,降低不良反应发生风险。     

微创根治术治疗早期胃癌疗效及对免疫功能影响

目的探讨微创根治术治疗早期胃癌的疗效及对患者免疫功能的影响。方法选取广东药科大学附属第一医院自2012年6月至2014年6月收治的100例早期胃癌患者为研究对象。采用随机数字表法将其分为A组(n=48)与B组(n=52)。A组患者行开腹胃癌根治术治疗,B组患者行微创胃癌根治术治疗。观察两组患者的临床疗效和不良反应发生情况。比较两组患者的超敏-C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)及T淋巴细胞亚群CD3+、CD4+、CD8+、CD4+/CD8+免疫功能指标。结果治疗后,B组总有效率为92.3%(48/52),高于A组75.0%(36/48),两组间比较,差异有统计学意义(P<0.05)。治疗后,B组患者的T淋巴细胞亚群水平显著优于A组,两组间比较,差异有统计学意义(P<0.05)。治疗后,两组患者血清炎性因子水平均显著升高,且B组患者的hs-CRP、IL-6水平均显著低于A组,IL-10水平显著高于A组,两组间比较,差异有统计学意义(P<0.05)。A、B两组不良反应发生率分别为56.3%(27/48)、36.5%(19/52),差异有统计学意义(P<0.05)。结论微创根治术治疗早期胃癌具有较好的临床疗效,可增强患者的免疫功能,改善血清炎性因子含量,具有恢复快、安全性高的特点。     

T淋巴细胞、锌及神经元特异性烯醇化酶在腹泻伴惊厥患儿体内表达水平研究

目的观察T淋巴细胞、锌及神经元特异性烯醇化酶在腹泻伴惊厥患儿体内的表达水平。方法将成都市第一人民医院自2014年11月至2016年9月收治的41例腹泻伴惊厥患儿纳入B组,将同期行健康体检的30例幼儿纳入A组。比较两组研究对象的T淋巴细胞、锌及神经元特异性烯醇化酶水平。结果 B组患儿的CD3+百分率、CD4+百分率、锌水平均显著低于A组,差异有统计学意义(P<0.05);神经元特异性烯醇化酶水平高于A组,差异有统计学意义(P<0.05)。惊厥发作次数≥2次患儿的CD3+百分率、CD4+百分率、锌水平均显著低于发作次数<2次患儿,差异有统计学意义(P<0.05);神经元特异性烯醇化酶水平高于发作次数<2次患儿,差异有统计学意义(P<0.05)。惊厥持续时间>5 min患儿的CD3+百分率、CD4+百分率、锌水平均显著低于持续时间≤5 min患儿,差异有统计学意义(P<0.05);神经元特异性烯醇化酶水平高于持续时间≤5 min患儿,差异有统计学意义(P<0.05)。结论发生腹泻伴惊厥时,患儿体内的T淋巴细胞和锌的表达水平会有所下降,而神经元特异性烯醇化酶的表达水平会上升。     

乳腺癌改良根治术患者血清CYFRA21 1、TK1及CA15 3水平变化及其与术后复发的相关性研究

目的探讨乳腺癌改良根治术患者血清细胞角蛋白19片段（cytokeratin 19 fragment,CYFRA21-1）、胸苷激酶1（thymidine kinase 1,TK1）及癌抗原15-3（cancer antigen 15-3,CA15-3）水平变化及其与术后复发的相关性。方法选取2015年1月—2017年8月成都医学院第一附属医院行乳腺癌改良根治术患者125例作为乳腺癌组,选取同期体检的年龄、性别匹配的健康体检者125例作为对照组,检测乳腺癌组改良根治术前后及对照组血清CYFRA21-1、TK1及CA15-3水平,根据乳腺癌术后有无复发分复发组和未复发组,比较2组患者血清CYFRA21-1、TK1及CA15-3水平。结果乳腺癌TNM-Ⅰ期患者CYFRA21-1、TK1、CA15-3水平低于TNM Ⅱ期、Ⅲa期患者（P＜0.05）;TNM Ⅱ期低于Ⅲa期患者,差异有统计学意义（P＜0.05）;乳腺癌组术后CYFRA21-1、TK1、CA15-3水平低于术前（P＜0.05）,乳腺癌组手术前后CYFRA21-1、TK1、CA15-3水平均高于对照组,差异有统计学意义（P＜0.05）;截止随访时间29例复发,复发率23.2%。复发组血清CYFRA21 1、TK1、CA15-3水平显著高于未复发组,差异有统计学意义（P＜0.05）,Logistic回归分析显示,血清CYFRA21-1、TK1、CA15-3水平与术后复发存在关联性（P＜0.05）;ROC曲线分析显示,CYFRA21-1、TK1、CA15-3联合预测乳腺癌术后复发的特异度、敏感度高于单一指标检测。结论乳腺癌改良根治术后血清CYFRA21-1、TK1、CA15-3水平与术后复发有关。     

羟考酮超前镇痛对妇科腔镜手术患者术后疼痛及炎性因子水平影响研究

目的探讨羟考酮超前镇痛对妇科腔镜手术患者术后疼痛及炎性因子水平的影响。方法选取广州医科大学附属第二医院2017年1—7月收治的80例择期行妇科腔镜手术的患者为研究对象。将患者随机分入4组:A组给予生理盐水;B、C、D组在气腹前分别给予盐酸羟考酮0.05、0.10、0.15 mg/kg静脉注射。术前1 h及术后6、12、24 h,记录并比较各组患者的疼痛视觉模拟评分、镇静评分,白细胞介素-6、肿瘤坏死因子-α、P物质水平,以及药物不良反应发生情况。结果随着术后时间的延长,A、B、C、D组患者的疼痛视觉模拟评分呈下降趋势,组间比较,差异均有统计学意义(P<0.05);B、C、D组疼痛视觉模拟评分低于A组,且随着盐酸羟考酮浓度的增加,疼痛视觉模拟评分呈下降趋势,组间比较,差异均有统计学意义(P<0.05)。随着术后时间的延长,A、B、C、D组患者镇静评分呈上升趋势,组间比较,差异均有统计学意义(P<0.05);B、C、D组镇静评分高于A组,且随着盐酸羟考酮浓度的增加,镇静评分呈上升趋势,组间比较,差异均有统计学意义(P<0.05)。A、B、C、D组患者术后6、12、24 h的白细胞介素-6、肿瘤坏死因子-α水平均高于术前1 h,差异有统计学意义(P<0.05);A组患者术后6、12、24 h的P物质水平均高于术前1 h,差异有统计学意义(P<0.05);B组患者术后12、24 h的P物质水平均高于术前1 h,差异有统计学意义(P<0.05)。B、C、D组患者术后6、12、24 h的白细胞介素-6、肿瘤坏死因子-α及P物质水平均低于A组,差异有统计学意义(P<0.05)。4组患者术后不良反应发生率比较,差异均无统计学意义(P>0.05)。结论羟考酮超前镇痛可明显缓解妇科腔镜手术患者的术后疼痛,抑制炎症反应,同时加强镇静效果。     

腹腔镜手术对胆囊结石合并急性胆囊炎患者机体应激及免疫功能影响

目的探讨腹腔镜手术对胆囊结石合并急性胆囊炎患者机体应激及免疫功能的影响。方法选取辽阳市中心医院自2015年3月至2017年10月收治的206例胆囊结石合并急性胆囊炎患者为研究对象。根据术式不同将患者分为腹腔镜组(n=101)和开腹组(n=105)。比较两组患者手术前后白细胞(WBC)、中性粒细胞百分比、白细胞介素-6(IL-6)、C反应蛋白(CRP)、皮质醇、促肾上腺皮质激素(ACTH)、T淋巴细胞亚群(CD3~+、CD4~+、CD8~+和CD4~+/CD8~+)、自然杀伤(NK)细胞水平。结果两组患者术后WBC、中性粒细胞百分比、IL-6、CRP、皮质醇和ACTH水平均较术前显著上升(P<0.05);腹腔镜组患者WBC、中性粒细胞百分比、IL-6、CRP、皮质醇和ACTH水平显著低于开腹组,两组比较,差异有统计学意义(P<0.05)。术后腹腔镜组CD3~+、CD4~+、CD8~+、CD4~+/CD8~+、NK细胞水平高于开腹组,两组比较,差异有统计学意义(P<0.05)。腹腔镜组各指标术后、术前差值低于开腹组,组间比较,差异有统计学意义(P<0.05)。结论与传统开腹手术相比,腹腔镜手术对胆囊结石合并急性胆囊炎患者机体应激及免疫功能影响较小。     

高效抗逆转录病毒治疗人类免疫缺陷病毒感染临床效果观察及血清白细胞介素-2、白细胞介素-16动态监测意义

目的观察高效抗逆转录病毒治疗人类免疫缺陷病毒(HIV)感染的临床效果,并探讨血清白细胞介素-2、白细胞介素-16的动态监测意义。方法选取秦皇岛市第三医院自2016年2月至2018年2月收治的98例HIV感染患者为研究对象。将患者随机分入A组和B组,每组各49例。A组给予齐多夫定+拉米夫定,B组给予依非韦伦+拉米夫定+替诺福韦。比较两组患者的临床治疗有效率,治疗前后白细胞介素-2、白细胞介素-16、CD4+T淋巴细胞计数,平均存活时间,以及不良反应发生率。结果 A组治疗有效率为51.0%(25/49),B组为93.9%(46/49),两组患者临床治疗有效率比较,差异有统计学意义(P<0.05)。治疗后,两组患者血清白细胞介素-2、白细胞介素-16水平均明显高于治疗前,且B组高于A组,差异有统计学意义(P<0.05);两组患者CD4+T淋巴细胞计数均明显高于治疗前,且B组高于A组,差异有统计学意义(P<0.05)。B组患者平均存活时间长于A组,差异有统计学意义(P<0.05)。A组不良反应发生率为57.1%(28/49),B组为32.7%(16/49),两组不良反应发生率比较,差异有统计学意义(P<0.05)。结论对HIV感染患者进行高效抗逆转录病毒治疗的临床效果显著,可有效改善血清白细胞介素-2和白细胞介素-16的表达水平,延长存活时间,降低不良反应发生风险。     

ED breast cases and other breast emergencies

Patients with pathologic processes of the breast commonly present in the Emergency Department (ED). Familiarity with the imaging and management of the most common entities is essential for the radiologist. Additionally, it is important to understand the limitations of ED imaging and management in the acute setting and to recognize when referrals to a specialty breast center are necessary. The goal of this article is to review the clinical presentations, pathophysiology, imaging, and management of emergency breast cases and common breast pathology seen in the ED.     

数字乳腺断层摄影在乳腺筛查中的应用进展

目前全数字化乳腺摄影（full-field digital mammography, FFDM）仍是乳腺癌早期发现、早期诊断的首选检查方法。而数字乳腺断层摄影技术能够克服常规FFDM中重叠纤维腺体组织干扰诊断这一主要局限性,增强对乳腺病变的可见性,显著提高诊断的敏感性和特异性,有效地降低了召回率。本文重点对于DBT在乳腺筛查中的优势及局限性进行综述。     

Lymphoscintigraphy in breast cancer: the value of breast lymphoscintigraphy in breast sentinel node staging

A 28-year-old woman with an infiltrating ductal carcinoma in the upper outer quadrant of the left breast diagnosed by excisional biopsy underwent lumpectomy, intraoperative lymphatic mapping, and sentinel node dissection. This was followed by an immediate completion axillary node dissection using a hand-held gamma probe and isosulfan blue to map the lymphatics. Preoperative breast lymphoscintigraphy showed drainage into the axilla and an apparent area of radiocolloid accumulation in the inferior hemisphere of the left breast. Because our protocol called only for removal of axillary sentinel nodes, the inferior hemisphere radiocolloid accumulation was not removed. The patient did not complete local regional therapy with breast irradiation and developed a mass in the inferior hemisphere of the left breast, which on biopsy was shown to be metastatic breast cancer in an intramammary lymph node. This case illustrates the potential value of breast lymphoscintograms to identify unusual sites of lymphatic drainage that may prove to be clinically relevant.     

Characterisation of breast papillary neoplasm on automated breast ultrasound

Intraductal papillary neoplasms of the breast form a wide spectrum of pathological changes with benign intraductal papilloma and papillary carcinoma. They can occur anywhere within the breast ductal system. This review illustrates some characteristic appearances of breast papillary neoplasms on coronal planes reconstructed by automatic breast volume scan. Such manifestations are not uncommon in papillary neoplasms, and familiarity will enable confident diagnosis.Papillary lesions of the breast are a heterogeneous group of breast lesions, including intraductal papilloma, atypical papilloma and intraductal papillary carcinoma [1,2]. Although the management of intraductal papillomas is varied, surgical excision is generally recommended as a precaution against the risk of a subsequent carcinoma [3,4]. Recently, some studies have suggested that patients with a tumour measuring <1.5 cm and an ultrasound Breast Imaging—Reporting and Data System (BI-RADS) category of 3 or 4a can be potentially selected for vacuum-assisted biopsy, but only if the tumour does not extend into the branching ducts [5,6]. Ueng et al [2] recommended that localised papillary lesions should be excised completely with a small rim of uninvolved breast tissue without any prior needle instrumentation if and when the papillary nature can be determined by imaging. Therefore, a careful imaging evaluation is necessary because it could help to identify the papillary neoplasm nature and select the high-risk lesions for proper treatment.Ultrasound has a greater sensitivity for detecting all papillary lesions than mammography [7]. Recently, automated breast ultrasound scanners have been developed, and the ultrasound volume data set of the whole breast can be acquired in a standard manner [8]. They have already shown potential for characterisation of breast tumours [9,10]. However, these studies did not detail the ultrasound features of intraductal papillary neoplasms on automated breast ultrasound. The reconstructed coronal views are also expected to provide more information and thus help to differentiate these lesions from other focal breast abnormalities.     

Periductal mastitis mimicking breast cancer in a male breast

Periductal mastitis in a male patient rarely has been reported in the English literature. Herein, we now present a rare case of periductal mastitis mimicking breast cancer, both clinically and radiologically, in a 37-year-old man. Mammogram and sonogram showed a mass with irregular shape, spiculated margin and a nipple retraction, mimicking a male breast cancer. Radiologic and pathologic correlation is provided.     

Two-dimensional breast dosimetry improved using three-dimensional breast image data

Conventional mammographic dosimetry has been developed over the past 40 years. Prior to the availability of high-resolution three-dimensional breast images, certain assumptions about breast anatomy were required. These assumptions were based on the information evident on two-dimensional mammograms; they included assumptions of thick skin, a uniform mixture of glandular and adipose tissue, and a median breast density of 50%. Recently, the availability of high-resolution breast CT studies has provided more accurate data about breast anatomy, and this, in turn, has provided the opportunity to update mammographic dosimetry. Based on hundreds of data sets on breast CT volume, a number of studies were performed and reported which have shed light on the basic breast anatomy specific to dosimetry in mammography. It was shown that the average skin thickness of the breast was approximately 1.5 mm, instead of the 4 or 5 mm in the past. In another study, 3-D breast CT data sets were used for validation of the 2-D algorithm developed at the University of Toronto, leading to data suggesting that the overall average breast density is of the order of 16–20%, rather than the previously assumed 50%. Both of these assumptions led to normalized glandular dose (DgN) coefficients which are higher than those of the past. However, a comprehensive study on hundreds of breast CT data sets confirmed the findings of other investigators that there is a more centralized average location of glandular tissue within the breast. Combined with Monte Carlo studies for dosimetry, when accurate models of the distribution of glandular tissue were used, a 30% reduction in the radiation dose (as determined by the DgN coefficient) was found as an average across typical molybdenum and tungsten spectra used clinically. The 30% average reduction was found even when the thinner skin and the lower average breast density were considered. The article reviews three specific anatomic observations made possible based on high-resolution breast CT data by several different research groups. It is noted that, periodically, previous assumptions pertaining to dosimetry can be updated when new information becomes available, so that more accurate dosimetry is achieved. Dogmatic practices typically change slowly, but it is hoped that the medical physics community will continue to evaluate changes in DgN coefficients such that they become more accurate.     

The role of breast scintigraphy in detecting breast masses

127 breast scans were performed on 83 female patients using technetium-99m diphosphonate. 46 out of 48 patients with breast cancer had positive breast scans manifested by a focal increased uptake in 37 patients and a diffuse increased uptake in the remaining 9 patients. Benign breast lesions such as fibrocystic disease, fibroadenoma and fat necrosis may also concentrate the radioactive agent in a focal or a diffuse pattern. So breast scanning is a sensitive though nonspecific modality to detect malignant breast lesions and it is worthwhile performing it on all women referred for bone scan.