MRI在宫颈癌诊疗中的应用价值

目的明确MRI在宫颈癌诊疗中的应用价值。方法对我院2008年1月至2010年3月期间收治的72例宫颈癌患者于术前2周内行盆腔和腹膜后MRI扫描,直接或经新辅助治疗后行广泛子宫切除术＋盆腔淋巴结清扫术,2例病理可疑早期浸润癌患者行冷刀锥切术,将术前MRI结果与术后病理比较,评价术前MRI的诊断价值。结果人组的72例患者病理类型包括：宫颈鳞状上皮内瘤变2例（2．8％）,鳞癌61例（84．7％）,腺癌6例（8．3％）,腺鳞癌1例（1．4％）,小细胞癌2例（2．8％）。IB期以前患者4例,MRI未见明确宫颈肿物。IB1期39例,IR2期17例,ⅡA期11例,ⅡB期1例。MRI诊断淋巴结转移、宫旁扩散、阴道受累、深肌层浸润的敏感性和特异性分别为85．71％和84．92％,100％和97．01％,37．5％和89．47％,96．15％和80．00％。其中诊断困难的内生型宫颈癌2例,MRI均提示深肌层浸润。结论MRI对宫颈癌淋巴结转移和宫旁受累具有较好诊断价值,为诊断困难的内生型宫颈癌患者选择最适治疗方案提供了客观依据．     

早期子宫颈癌宫旁转移相关危险因素探讨

目的 探讨早期子宫颈癌宫旁转移的相关危险因素,为其手术切除范围的缩小提供一定理论基础.方法 回顾性分析890例子宫颈癌患者的临床资料,临床分期均为ⅠA2～ⅡA2期,均行广泛性子宫切除+盆腔淋巴结清扫术,对资料进行单因素分析和多因素分析,找出与早期子宫颈癌宫旁转移相关的危险因素.结果 术后病理检查提示,宫旁转移率为6.0％(53/890).通过单因素分析发现,临床分期、肿瘤大小、血SCC-Ag水平、肿瘤浸润深度、脉管浸润、手术切缘状态、淋巴结转移、累及宫体、累及阴道是早期子宫颈癌宫旁转移的危险因素(均P＜0.05).多因素分析发现,肿瘤间质浸润深度、脉管浸润、淋巴结转移是早期宫旁转移的独立危险因素(均P＜0.01).结论 肿瘤子宫颈浸润深度、脉管侵犯、淋巴结转移为子宫颈癌早期宫旁转移的独立危险因素.     

多层螺旋CT判断宫颈癌宫旁侵犯的价值

目的探讨多层螺旋CT判断宫颈癌宫旁侵犯的价值。方法收集30例经手术治疗的Ⅱ期宫颈癌患者的临床资料,对其CT表现及FIGO分期进行回顾性分析。结果 FIGO分期对宫颈癌宫旁侵犯判断准确17例(56.7%),过低判断8例(26.7%),过高判断5例(16.7%);CT对宫旁侵犯判断准确21例(70.0%),过低判断5例(16.7%),过高判断4例(13.3%)。FIGO分期与CT分期均与手术分期一致者17例,FIGO分期与手术分期不一致者13例,CT分期与手术分期不一致者9例,CT纠正FIGO分期判断结果者5例。结论多层螺旋CT在判断宫颈癌宫旁浸润方面比FIGO分期更加准确,是FIGO分期的一个重要补充。     

子宫颈深间质侵犯对子宫颈癌预后的影响

目的：观察子宫颈深间质侵犯对子宫颈癌预后的影响及辅助腔内放射治疗的作用。方法：分析449例盆腔淋巴结阴性的IB，ⅡA期子宫颈癌的治疗结果。观察子宫颈深间质侵犯对生存率影响及腔内放射治疗的作用。结果：子宫颈深间质侵犯者的5年生存率及IB，ⅡA期患者的生存率的分别为86．1％，90．2％和84．6％，均较无宫颈深间质侵犯者低，子宫颈深间质侵犯辅助腔内放射治疗者的5年生存率为89．8％，IB了7／9，ⅡA92．0％，较单纯手术者高，结论：子宫颈深间质侵犯是子宫颈癌重要的预后因素，这些患者术后应辅助治疗，高剂量率后装腔内放疗操作简便，副反应少，是一种治疗的选择。     

血管内皮生长因子在宫颈癌组织中的表达及其临床意义

目的：测定血管内皮生长因子（VEGF）在宫颈癌组织中的表达，并评估其临床意义。方法：应用LSAB免疫组织化学技术，检测42例宫颈癌及13例正常宫颈组织标本中VEGF的表达。结果：宫颈癌组织中VEGF的表达率为54．8％（23／42），而正常宫颈组织中VEGF均为阴性表达；肿瘤直径≥4cm或间质浸润≥1／2的宫颈癌病人VEGF阳性表达明显高于肿瘤直径＜4cm或间质浸润＜1／2。有宫旁浸润或盆腔淋巴结转移，VEGF的表达显高于无宫旁浸润和淋巴结转移。结论：VEGF与宫颈癌的局部发展和转移密切相关，可作为判断宫颈癌生物学行为的指标之一。     

宫颈癌宫旁浸润影像诊断研究进展

宫颈癌是最常见的妇科恶性肿瘤。宫旁浸润是指癌组织突破宫颈间质浸润到宫旁组织。临床FIGO分期Ⅱb期及以上的晚期宫颈癌患者通常不选择手术治疗而采用放化疗，而Ⅱb期分期的界限为是否存在宫旁浸润，换言之，是否宫旁浸润决定着治疗方式的选择，所以宫旁浸润的诊断显得尤为重要。本文就宫颈癌宫旁浸润的影像诊断方法进行总结综述。     

早期宫颈癌宫旁组织转移的相关危险因素

目的:探讨早期宫颈癌宫旁组织转移的相关危险因素。方法:回顾性分析2010年3月—2015年8月瑞安市塘下人民医院诊治的890例宫颈癌患者的临床病理资料,所有患者均进行了广泛性子宫切除+盆腔淋巴结清扫术,临床分期均为ⅠA2~ⅡA2期,对影响早期宫颈癌宫旁转移的相关危险因素进行单因素分析和多因素分析。结果:890例早期宫颈癌患者中共有53例患者出现宫旁转移,转移率为6.0%(53/890)。单因素分析结果显示,临床分期、肿瘤大小、血清鳞状细胞癌抗原(squamous cell carcinoma antigen,SCC-Ag)水平、肿瘤浸润深度、脉管浸润、手术切缘状态、淋巴结转移、累及宫体和累及阴道是早期宫颈癌宫旁转移的危险因素(P值均<0.01)。多因素分析发现,肿瘤浸润深度、脉管浸润和淋巴结转移是早期宫颈癌宫旁转移的独立危险因素(P值均<0.01)。结论:早期宫颈癌患者的宫旁转移率较低,肿瘤浸润深度、脉管浸润和淋巴结转移是早期宫颈癌宫旁转移的独立危险因素。     

术前CT和MRI检查对浸润性宫颈癌的诊断价值

目的探讨术前CT和MRI对浸润性宫颈癌的临床诊断价值。方法选取2016年3月至2017年12月间辽宁省阜新市第二人民医院收治的61例浸润性宫颈癌患者。观察浸润性宫颈癌患者术前CT和MRI与浸润性宫颈癌患者术后病理结果比较情况,以及两种诊断方式对患者术前分期的符合率。结果 CT在诊断子宫体侵犯和盆腔淋巴结转移与病理学结果的一致性高,Kappa值分别为0. 871和0. 850,在诊断阴道浸润的效果与病理学结果一致性较差,Kappa值为0. 258; MRI在诊断阴道浸润、子宫体侵犯与病理学结果的一致性较好,Kappa值分别为0. 796和0. 654,在诊断盆腔淋巴结转移效果与病理学结果一致性较差,Kappa值为0. 308。术前MRI在阴道浸润的敏感度和准确度均高于CT诊断,CT诊断子宫体侵犯的特异度和准确度,及CT诊断盆腔淋巴转移的特异度和转移准确度方面均高于术前MRI诊断,差异均有统计学意义(均P <0. 05)。CT在宫颈癌A期的诊断符合率为52. 4%,低于MRI的90. 5%,差异有统计学意义(P <0. 05)。但两者术前诊断方式在宫颈癌B期和C期的诊断符合率进行比较,差异无统计学意义(P> 0. 05)。结论在对于浸润性宫颈癌患者的术前诊断的准确度上,MRI要优于CT,且在病理分期上MRI诊断符合度要高于CT诊断,因此,MRI诊断具有更高的可靠性。但是在对浸润性宫颈癌患者进行术前分期的时候,不建议只采用一种诊断技术,建议MRI结合其他影像学诊断技术的术前诊断方式。     

B超对不同分期宫颈癌宫旁浸润和淋巴结转移的诊断价值

目的探究B超在诊断不同分期宫颈癌宫旁浸润和淋巴转移中的意义。方法将212例宫颈癌患者根据术前检查方式不同分为CT组和B超组,每组106例。对2组患者在术前的宫旁浸润和淋巴结转移的检出结果与术后病理结果进行比较。结果 CT组检查患者有无宫旁浸润的灵敏度为69.2%,特异性为89.2%,Youden指数为0.585,CT检查患者宫旁浸润有19例呈阳性,而病理检出13例,高估6例;B超组检查患者有无宫旁浸润的灵敏度为63.6%,特异性为95.8%,Youden指数为0.594,病理检查与B超检查结果一致。CT组检查患者淋巴结转移的灵敏度为69.2%,特异性为95.0%,Youden指数为0.642,CT检出22例,病理检出26例,低估4例,20例重合;B超组检查患者淋巴结转移的灵敏度为39.3%,特异性为96.2%,Youden指数为0.354,B超检出14例,病理检出28例,低估14例。结论 B超在诊断不同分期宫颈癌患者宫旁浸润时检出率高,临床应用价值高。     

综合评价CT、MRI及PET在子宫颈癌术前分期及术后随访中的作用

子宫颈癌分期对子宫颈癌的治疗与预后非常重要,目前,FIGO分期的依据并不包括CT、MRI、PET,但综合利用CT、MRI、PET检查方法可准确评价原发肿瘤、宫旁侵犯及远处淋巴结转移情况,MRI对显示原发肿瘤优于临床及其他检查手段,CT优势在于评价较晚期子宫颈癌,并且可以导向穿刺活检,PET对监测淋巴结转移与发现术后复发有较高的敏感性,对FIGO分期是一个重要补充。同时,这三种检查方法有助于判断术后复发与转移。     

Bacteria and cancer--antagonisms and benefits

There is considerable historical and recent evidence concerning the antagonisms between acute bacterial infections or their toxins and cancer and allied diseases. These data provide renewed incentives to undertake clinical programmes with mixed bacterial vaccines in many countries at the present time.     

Religiosity and physical and emotional functioning among African American and White colorectal and lung cancer patients

The literature suggests that religiosity helps cope with illness. The present study examined the role of religiosity in functioning among African Americans and Whites with a cancer diagnosis. Patients were recruited from an existing study and mailed a religiosity survey. Participants (N = 269; 36% African American, 56% women) completed the mail survey, and interview data from the larger cohort was utilized in the analysis. Multivariate analyses indicated that in the overall sample religious behaviors were marginally and positively associated with mental health and negatively with depressive symptoms. Among women, religious behaviors were positively associated with mental health and negatively with depressive symptoms. Religiosity was not a predictor of study outcomes for men. Among African Americans, religious behaviors were positively associated with mental health and vitality. Among Whites, religious behaviors were negatively associated with depressive symptoms. These findings suggest a mixed role of religious involvement in cancer outcomes. The current findings may have applied potential in the areas of emotional functioning and depression.     

Renal irradiation and the pharmacology and toxicity of methotrexate and cisplatinum

We used a rat model to study the effects of renal irradiation on the pharmacology of methotrexate (MTX) and cisplatinum (cis-Pt). Unanesthetized rats were given bilateral kidney irradiation (20 Gy in 9 fractions). At 9 months after irradiation, 3% of the animals had died and survivors showed moderately impaired renal function. At 15 months, 30% of the animals had died and survivors showed severely impaired renal function. Some animals were given i.v. MTX 1 week to 15 months after irradiation. In irradiated rats, the area under the MTX plasma clearance curve equaled that of controls through 6 months, and was significantly above controls from 9 months on. Other animals were given i.p. cis-Pt 1 week to 9 months after irradiation. The acute toxicity of cis-Pt was the same in control and irradiated rats when cis-Pt was given immediately before or after irradiation. Beginning 3 months after irradiation there was a progressive increase in cis-Pt toxicity and a simultaneous decrease in urinary platinum excretion. Irradiated animals that survived cis-Pt treatment showed increased radiation nephritis; the greatest effect occurred when cis-Pt was given 3 months or more after irradiation. MTX and cis-Pt clearance decreased when renal dysfunction was first observed and changes in renal function preceded changes in drug clearance and toxicity.     

VEGF及KDR在大肠腺瘤和腺癌中的表达及意义

目的：探讨VEGF和KDR在大肠腺瘤和大肠腺癌中的表达及临床病理特征的关系。方法：大肠腺瘤和大肠腺癌组织标本各100例,采用免疫组织化学染色法检测VEGF和KDR在标本中的表达情况。结果：VEGF和KDR在大肠腺癌组中的阳性表达明显高于大肠腺瘤组（P〈0.05）;在正常大肠黏膜均未见VEGF和KDR表达的阳性染色;VEGF阳性表达组中KDR的阳性表达率为70%,显著高于VEGF阴性表达组中KDR的阳性表达率16%,两组比较有统计学意义（P〈0.01）。结论：大肠腺癌组织中KDR的表达与肿瘤大小、转移情况、浸润深度密切相关;VEGF和KDR在大肠腺瘤中的表达与患者的年龄、性别及分型均无相关性,而与增生程度相关（P〈0.05）。在大肠腺癌患者中VEGF及KDR表达更高,二者具有协同效应。     

Morphine and tumor growth and metastasis

Morphine is an analgesic widely used to alleviate cancer pain. In addition, the perioperative management of pain in cancer surgery patients most often includes opioids. However, there are reports that these drugs may alter cancer recurrence or metastasis. Several mechanisms have been proposed, such as the modulation of the immune response or cellular pathways that control the survival and migratory behavior of cancer cells. The published literature, however, presents some discrepancies, with reports suggesting that opioids may either promote or prevent the spread of cancer. It is of great importance to determine whether opioids, in particular the most widely used, morphine, may increase the risk of metastasis when used in cancer surgery. This review examines the available data on the effects of morphine which influence cancer metastasis or recurrence, including immunomodulation, tumor cell aggressiveness, and angiogenesis, with special emphasis on recently published clinical and laboratory based studies. We further discuss the parameters that may explain the difference between reports on the effects of morphine on cancer.     

肾上腺素能β受体与肿瘤生长及转移

大量研究表明肿瘤细胞可表达β受体，而一些神经递质、药物和社会心理因素可能通过β受体影响肿瘤的生长和转移，β受体激动剂、β受体阻滞剂以及抑郁等社会心理因素可加强或削弱这种作用。这为表达β受体肿瘤的治疗开辟了新的道路，提供了新的治疗靶点。