乳腺肉瘤临床医学影像征象分析(附10例报告)

目的 结合献分析总结不同病理类型乳腺肉瘤的临床特点、钼钯X线、彩色多普勒B型超声影像征象。方法 随机搜集资料完整的乳腺肉瘤10例，每例患均行钼钯X线与彩色多普勒B型超声检查，患均经手术病理证实。结果 乳腺纤维肉瘤1例，钼钯片上病灶显示为巨大分叶状肿块。超声探及肿物呈囊实性；淋巴肉瘤2例，钼钯片上病灶表现形式为球形病灶与乳腺的弥漫性浸润；白血病乳腺浸润2例，钼钯片上表现为双乳的弥漫性浸润与多发球形灶；叶状囊肉瘤5例，钼钯片上病灶多表现为密度均匀、边缘光滑的巨大肿块。超声检查，病灶以不均匀中低回声为主。结论 乳腺肉瘤种类繁多，但不同病理类型的乳腺肉瘤具有其不同的临床影像特点。     

乳腺恶性叶状肿瘤的临床与超声特征研究

目的研究乳腺恶性叶状肿瘤（MPT）临床、超声声像图表现及其病理特征,为恶性叶状肿瘤诊断提供依据。方法对手术病理证实的12例恶性叶状肿瘤患者的临床、超声声像图表现、病理形态学特征、肿瘤复发转移与临床预后进行总结分析。结果 12例恶性叶状肿瘤患者超声声像图表现：肿瘤大小及部位：12例患者13个恶性叶状肿瘤位于左侧乳腺4例,右侧乳腺8例,其中8个肿瘤最大径≥5.0cm,5个肿瘤〈5.0cm。肿瘤形态及边界：13个恶性叶状肿瘤10个呈分叶状,2个形态不规则;11个边界清晰,2个边界不清晰。内部回声及后方回声：11个内部回声不均匀,2个内部回声均匀;9个后方回声增强,6个内部伴无回声。内部钙化：1个肿瘤内出现粗大钙化,12个内部无钙化。血流分级：彩色多普勒血流成像示2个肿瘤表现为Ⅰ级血流,3个表现为Ⅱ级血流,8个表现为Ⅲ级血流。第1次手术方式：12例患者中6例采用单纯肿瘤切除活检术,2例采用肿瘤扩大切除术,4例采用乳房切除术。术后临床随访结果：术后随访20～155个月,平均（69.9±46.4）个月,其中4例肿瘤局部复发（1例复发1次,1例复发2次,1例复发3次,1例复发15次,3例第1次手术为肿瘤单纯切除术,1例第1次手术为全乳切除术）,1例出现肺部转移。结论肿瘤体积较大,呈实性分叶状,内部回声不均伴无回声,血流丰富,易局部复发为乳腺恶性叶状肿瘤的临床超声表现。     

碱性成纤维细胞生长因子及WTp53在大鼠视网膜缺血再灌注损伤中的作用

目的:探讨碱性成纤维细胞生长因子(basicfibroblastgrowthfactor,bFGF)在大鼠视网膜缺血再灌注损伤中的作用及其机制。方法:随机将28只大鼠分为正常组和手术组,其中手术组大鼠左眼为缺血再灌注组,右眼为治疗组(玻璃体腔内注射bFGF),观察再灌注后不同时间段1,6,12,24,48,72h视网膜组织中细胞凋亡情况及WTp53的表达变化。前房加压法制作大鼠视网膜缺血再灌注损伤模型。应用末端脱氧核酸转移酶介导的脱氧三磷酸尿苷缺口末端标记(TUNEL)法检测视网膜组织中凋亡细胞数,免疫组织化学SABC法检测视网膜组织中WTp53蛋白的表达。结果:视网膜神经细胞的凋亡出现于再灌注后6h,并逐渐递增,24h达到高峰,48h开始下降,72h组不明显。WTp53蛋白表达改变与凋亡的神经细胞改变基本一致。治疗组各观察指标表达变化规律与缺血再灌注组基本一致,但凋亡细胞数目在6～48h犤6,12,24,48h分别为(358.3±43.4),(859.5±12.0),(1006.5±49.4),(695.7±72.2)个/mm2犦明显低于缺血再灌注组犤(444.8±89.7),(1053.0±96.1),(1254.0±164.8),(891.0±87.2)个/mm2犦(t=2.9131～4.299,P均<0.05);WTp53表达在6～48h缺血再灌注组显著下降(t=3.342～4.781,P<0.05;t=52.586,P<0.01)。结论:WTp53参与视网膜缺血-灌注损伤,促进神经节细胞的凋亡;bFG     

Development of enzyme-linked immunosorbent assay for acidic fibroblast growth factor and its clinical application.

We have developed, for the first time, an enzyme-linked immunosorbent assay (ELISA) system for the measurement of human acidic fibroblast growth factor (aFGF). Anti-bovine aFGF rabbit IgG was conjugated with N-hydroxysuccimidobiotin, and the resulting IgG-biotin conjugate was used as the second antibody. This assay was highly specific and reproducible, enabling us to detect aFGF at a concentration as low as 1 microg/l without any prior processing of samples. With this method, it was possible to determine human aFGF up to 833 x 10(3) ng/l, with the use of anti-bovine aFGF IgG as the first and second antibody. There was no significant cross-reactivity of the antibody with other growth factors, such as basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF). The aFGF concentration in pericardial fluid was significantly higher in patients with unstable angina than in those with other heart diseases, suggesting that the aFGF plays an important role(s) in the course of collateral growth in coronary artery disease. Therefore, our ELISA system may be useful in determining unknown biological function(s) or pathological role(s) of aFGF in various disease entities.     

急性脑干梗死165例危险因素、临床特点及血管病变分析

目的探讨急性脑干梗死患者临床特点、危险因素及血管病变特点。方法回顾性收集2013年8月至2016年3月首都医科大学附属北京友谊医院收治的165例急性脑干梗死患者的临床资料及头颈部CT血管成像(CTA)结果。分析比较脑干梗死的临床特点、危险因素及血管病变特点。结果①脑干梗死的最常见危险因素依次为高血压(83. 03%)、吸烟(55. 76%)、糖尿病(50. 91%)、高脂血症(50. 30%)和饮酒史(47. 88%)。各项危险因素在不同梗死部位患者之间差异无统计学意义(P> 0. 05)。②脑干梗死常见症状和体征依次为肢体无力(69. 70%)、头晕/眩晕(58. 79%)、感觉障碍(41. 82%)、共济失调(35. 15%)和构音障碍(34. 55%)。③脑干梗死多发于脑桥(73. 94%),其次为延髓(10. 91%)、中脑(4. 85%);合并脑干外多病灶患者占10. 91%。④头颈部CTA结果显示,165例患者中,椎动脉狭窄患者79例,占47. 88%;基底动脉狭窄患者13例,占7. 88%;椎动脉发育不良患者30例,占18. 18%。不同梗死部位患者椎动脉狭窄及椎动脉发育不良发生率差异无统计学意义(P> 0. 05)。基底动脉狭窄发生率在不同梗死部位患者中差异具有统计学意义(P <0. 05)。结论脑干梗死最易发生于脑桥,其最常见的危险因素是高血压。脑干不同部位梗死的患者基底动脉狭窄发生率有显著差异。     

p73、p63和p53蛋白在口腔鳞癌中的表达及其意义

目的　研究口腔鳞癌组织中p73，p63和p53蛋白表达以及与临床生物学特性和细胞增殖的关系。方法　采用免疫组化方法检测48例原发性口腔鳞癌组织及20例正常口腔黏膜组织中p73，p63和p53蛋白的表达水平。结果　p73，p63和p53蛋白在口腔鳞癌中阳性表达率显著高于正常口腔黏膜组织(P<0.05) ；p73、P63、p53蛋白在口腔鳞癌临床Ⅰ、Ⅱ期的过表达明显低于Ⅲ、Ⅳ期(P＜0.05) ；p73蛋白过表达与淋巴结转移有关(P＜0.05) ；p73蛋白与p53蛋白,p63蛋白与p53蛋白之间存在着正相关(r= 0.368,0.342,P＜0.05)。结论　在口腔鳞癌的发生发展过程中，p73，p63和p53的过表达三者可能单独或共同参与。p73和p63之间的交互作用，在口腔鳞癌的发生过程中起重要作用。     

Insulinoma: clinical and diagnostic features of 60 consecutive cases.

Insulinoma is a rare tumor, occurring more often in women and in the older age range. Eighty percent of patients have a single benign tumor, usually less than or equal to 2 cm in diameter, located with about equal frequency in body, head, or tail of the pancreas and amenable to surgical cure. About 10% have multiple tumors; in this group there is a high incidence of multiple endocrine neoplasia type I syndrome. The remaining 10% of patients have metastatic malignant insulinoma. Symptoms are intermittent, recur at irregular intervals in the food-deprived state over a median of 1 1/2 years, and arise from varying degrees of neuroglycopenia. Symptoms often lead to misdiagnosis as a neurologic or psychiatric disorder. Transient neurologic deficits and EEG abnormalities can be observed during hypoglycemia. Diagnosis requires repeated demonstration of hypoglycemia (glucose less than or equal to 40 mg/dl) during spontaneous or provoked symptoms, relief with ingestion of carbohydrates, simultaneous hyperinsulinemia (serum insulin greater than 6 muU/ml), and absence of insulin antibodies. A useful diagnostic adjunct is the intravenous tolbutamide test, for which new diagnostic criteria are presented.     

Epignathus: clinical and sonographic observations of two cases.

The epignathus or mature pluritissued teratoma of the mid-line of the palate is a benign tumor for which the neonatal prognosis is related to the obstruction of the superior airway. This paper concerns observations of two cases, which developed in different ways.Echography enables diagnosis of this type of malformation which classically combines a heterogeneous polylobed mass, polyhydramnios and the absence of other morphological anomalies. It enables an accurate differential diagnosis to be made by eliminating the other masses of the cephalic region. Echographic diagnosis also allows a rational management decision to be made, i. e. termination of pregnancy if prognosis is poor, or continuation with multidisciplinary (neonatologist, obstetrician, surgeon) intervention at birth.     

应用引导组织再生膜与人工骨、碱性成纤维细胞生长因子等生物材料治疗牙周骨缺损

背景:引导组织再生已成功地应用到牙周病的治疗,应用生物相容性膜,依靠其机械屏障作用能阻止牙龈上皮根向生长,并形成一定的间隙以利于牙周膜细胞占据根面,进而重建牙周结构.目的:验证引导组织再生是否可促进牙周骨缺损的修复及增加新骨的形成,将引导组织再生和人工骨,生长因子等生物材料联合使用是否可获得更多牙周新组织.设计、时间及单位:动物实验观察,2006-02/2006-07在大连大学医学实验中心完成.材料:取碱性成纤维细胞生长因子冻干粉(50 mg/支),ddH2O彻底溶解,制成含碱性成纤维细胞生长因子5 g/L的溶液.将胶原膜剪为10 mm×10 mm大小,取1 mL溶液滴注胶原膜上完伞复合,使每张膜含5 mg碱性成纤维细胞生长因子.方法:刮取16只大耳白兔兔牙骨质,去骨高度为自牙槽脊水平至釉牙骨质界下6 mm制成缺损,右侧用加入碱性成纤维细胞生长因子的人工骨和引导组织再生含生长因子的引导组织再生膜包绕缺损,全瓣复位、缝合,作为实验组,左侧作为对照,制备方法及大小同,骨缺损直接全瓣复位、缝合.主要观察指标:光镜下观察载体材料吸收情况,结缔组织内炎症情况,结合上皮根向移行情况.结果:对照侧均呈现牙槽骨不愈合现象,实验侧有不同程度的牙槽骨骨愈合现象.与对照比较,实验组愈合效果较好.结论:引导组织再生膜与人工骨、碱性成纤维细胞生长因子等生物材料膜技术的应用有利于骨缺损的愈合.     

Evaluation of oligonucleotide arrays for sequencing of the p53 gene in DNA from formalin-fixed, paraffin-embedded breast cancer specimens

BACKGROUND: Routine tissue processing has generated banks of paraffin-embedded tissue that could be used in retrospective cohort studies to study the molecular changes that occur during cancer development. The purpose of this study was to determine whether a p53 microarray could be used to sequence the p53 gene in DNA extracted from formalin-fixed, paraffin-embedded (FFPE) tissues. METHODS: DNA was extracted from 70 FFPE breast cancer tissue specimens. p53 was sequenced with an oligonucleotide microarray (p53 GeneChip; Affymetrix), and the results were compared with the results obtained from direct sequencing. RESULTS: DNA was extracted from 62 of 70 cases. We identified 26 mutations in 24 of the 62 cases by the p53 GeneChip. No polymorphisms were detected, and exon 4 could not be evaluated in 20 cases. There were 43 genetic alterations detected by direct sequencing in 35 of the 62 cases. These consisted of 26 polymorphisms and 17 mutations in exons or splice sites. Fifteen mutations were identified by both methods. Direct sequencing detected significantly more gene alterations (43 of 54) in DNA extracted from FFPE tissue than the p53 GeneChip (26 of 54; P = 0.018). However, if the changes in exon 4 were eliminated from this comparison, the p53 GeneChip detected 26 of 27 mutations compared with direct sequencing, which identified 16 of 27 mutations. (P = 0.016). CONCLUSIONS: A combination of oligonucleotide microarray and direct sequencing may be necessary to accurately identify p53 gene alterations in FFPE breast cancer. The p53 GeneChip cannot be used to detect exon 4 polymorphisms (codon 72) in FFPE breast cancer tissue.     

成纤维细胞生长因子信号分子的结构和功能

早期研究使用的成纤维细胞生长因子 (FGFs)主要来自牛脑和脑垂体的提取液 ,是大约 15 0个氨基酸结构的酸性或碱性成纤维细胞生长因子 (a FGF:FGF1或 b FGF:FGF2 )。其后分离的癌基因产物的细胞增殖因子与上述 FGFs结构类似 ,也被分类在 FGFs家族 ,并依次命名为 FGF3～ 9〔1〕。目前已发现 2 3种FGFs。现主要就多能 FGFs结构和相关功能机制的研究进展进行综述。1　发现和鉴定新的 FGFs结构FGFs作为细胞间信号分子在胚胎发生和分化过程中起重要作用。 FGFs是由约 15 0～ 2 0 0氨基酸组成的多肽 ,相互之间的氨基酸序列有 2 0 %…     

Delirium part one: clinical features, risk factors and assessment

Delirium is a common and under-reported problem in older adults. A lack of consensus over the terminology used to describe delirium may contribute to its underdiagnosis, and a number of predisposing factors are linked to it. This article, the first of two, aims to define delirium, describe the different types and identify risk factors associated with its development. Delirium is an important condition as it has a deleterious effect on patient outcomes and quality of life if it is not detected early and managed effectively. The detection of delirium and a variety of assessment tools are also considered. Part two, to be published in next week's Nursing Standard, examines the nursing management of delirium.     

Bcl-2、p16、p53及Ki-67在子宫平滑肌肿瘤中的表达及临床意义

目的 分析Bcl-2、p16、p53及Ki-67在子宫平滑肌肿瘤中的表达情况及其临床意义.方法 选取2018年2月至2020年2月我院收治的150例子宫平滑肌肿瘤患者作为观察组,另选取同期150例健康志愿者作为对照组.采用免疫组化法检测组织中Bcl-2、p16、p53及Ki-67蛋白的表达情况.比较Bcl-2、p16、...     

Hyperthyroidism. Causes, clinical features, and diagnosis

The usual patient with hyperthyroidism has Graves' disease: If serum levels of thyroid hormone are clearly elevated, the presence of infiltrative ophthalmopathy or pretibial myxedema is probably sufficient for establishing the diagnosis. However, if the ancillary findings of Graves' are not present, the radioactive iodine uptake should be determined to rule out other possible etiologies of hyperthyroidism. Signs of hyperthyroidism may be subtle or misleading, particularly in the elderly; the well-informed clinician keeps the diagnosis in mind, and if the initial thyroid hormone tests are not definitive, employs additional tests that are cost-effective in the individual clinical situation.     

心肌内控制释放碱性成纤维细胞生长因子促进血管再生的作用

背景实验研究表明,生长因子能促进心肌血管再生,采用纤维蛋白胶心肌内控制释放碱性成纤维细胞生长因子的血管再生作用和机制尚不明确.目的评价纤维蛋白胶心肌内控制释放碱性成纤维细胞生长因子对急性心肌梗死犬局部相关血管生长因子表达与细胞增殖水平的影响,探讨心肌内控制释放碱性成纤维细胞生长因子对血管再生的治疗作用.设计完全随机分组设计,对照实验.单位首都医科大学附属北京安贞医院心内科、华中科技大学同济医学院附属协和医院心内科和上海新兴血液制品研究所.材料实验于2001-06/2003-03先后在华中科技大学同济医学院附属协和医院外科动物实验室和解放军总医院医学实验动物中心完成.选用清洁级健康成年杂种犬12只,雌雄不拘.随机将犬分为2组激光心肌血运重建组和碱性成纤维细胞生长因子组,每组6只.方法①将12只成年健康杂种犬于麻醉开胸后暴露心脏,结扎左前降支制作急性心肌梗死模型.动物随机分为2组激光心肌血运重建组于急性心肌梗死30 min后行透壁心肌打孔;碱性成纤维细胞生长因子组则于急性心肌梗死30 min后行非透壁心肌打孔,并随后向孔道内注射含有碱性成纤维细胞生长因子的纤维蛋白胶.②术后第8周,采用免疫组织化学染色和HPIAS-2000型彩色病理图文分析系统免疫组织化学分析程序分析缺血心肌局部血管内皮生长因子、转化生长因子β1和增殖细胞核抗原表达水平的变化.③均数间比较采用非配对t检验或方差分析.主要观察指标激光心肌血运重建组和碱性成纤维细胞生长因子组梗死区心肌血管内皮生长因子、转化生长因子β1和增殖细胞核抗原免疫组织化学染色的定量分析.结果激光心肌血运重建组和碱性成纤维细胞生长因子组分别有5只和6只犬进入结果分析,免疫组织化学定量分析发现,碱性成纤维细胞生长因子组梗死区心肌血管内皮生长因子、转化生长因子β1和增殖细胞核抗原染色的显色面积均高于激光心肌血运重建组(t=-7.505,-2.690与-6.895,P＜0.05),碱性成纤维细胞生长因子组增殖细胞核抗原染色的平均吸光度也高于激光心肌血运重建组(t=-5.271,P＜0.05).结论心肌内控制释放碱性成纤维细胞生长因子能提高缺血心肌局部相关血管生长因子(如血管内皮生长因子、转化生长因子β1等)的表达水平,增强细胞增殖,从而促进血管再生.     

心肌内控制释放碱性成纤维细胞生长因子促进血管再生的作用

背景：实验研究表明，生长因子能促进心肌血管再生，采用纤维蛋白胶心肌内控制释放碱性成纤维细胞生长因子的血管再生作用和机制尚不明确。 目的：评价纤维蛋白胶心肌内控制释放碱性成纤维细胞生长因子对急性心肌梗死犬局部相关血管生长因子表达与细胞增殖水平的影响，探讨心肌内控制释放碱性成纤维细胞生长因子对血管再生的治疗作用。 设计：完全随机分组设计，对照实验。 单位：首都医科大学附属北京安贞医院心内科、华中科技大学同济医学院附属协和医院心内科和上海新兴血液制品研究所。 材料：实验于2001-06／2003-03先后在华中科技大学同济医学院附属协和医院外科动物实验室和解放军总医院医学实验动物中心完成。选用清洁级健康成年杂种犬12只，雌雄不拘。随机将犬分为2组：激光心肌血运重建组和碱性成纤维细胞生长因子组，每组6只。 方法：①将12只成年健康杂种犬于麻醉开胸后暴露心脏，结扎左前降支制作急性心肌梗死模型。动物随机分为2组：激光心肌血运重建组于急性心肌梗死30min后行透壁心肌打孔；碱性成纤维细胞生长因子组则于急性心肌梗死30min后行非透壁心肌打孔，并随后向孔道内注射含有碱性成纤维细胞生长因子的纤维蛋白胶。②术后第8周，采用免疫组织化学染色和HPIAS-2000型彩色病理图文分析系统免疫组织化学分析程序分析缺血心肌局部血管内皮生长因子、转化生长因子β1和增殖细胞核抗原表达水平的变化。③均数间比较采用非配对t检验或方差分析。主要观察指标：激光心肌血运重建组和碱性成纤维细胞生长因子组梗死区心肌血管内皮生长因子、转化生长因子β1和增殖细胞核抗原免疫组织化学染色的定量分析。 结果：激光心肌血运重建组和碱性成纤维细胞生长因子组分别有5只和6只犬进入结果分析，免疫组织化学定量分析发现，碱性成纤维细胞生长因子组梗死区心肌血管内皮生长因子、转化生长因子β1和增殖细胞核抗原染色的显色面积均高于激光心肌血运重建组（t=-7．505,-2．690与-6．895，P〈0．05）。碱性成纤维细胞生长因子组增殖细胞核抗原染色的平均吸光度也高于激光心肌血运重建组（t=15．271。P〈0．05）。 结论：心肌内控制释放碱性成纤维细胞生长因子能提高缺血心肌局部相关血管生长因子（如血管内皮生长因子、转化生长因子β1等）的表达水平，增强细胞增殖，从而促进血管再生。     

76例眼肌麻痹的病因及其特点

目的：了解不同病因所致眼肌麻痹患者的临床特点,探讨其诊断及鉴别诊断方法。方法：回顾分析连续收治的76例以眼肌麻痹为主要症状患者的临床表现及辅助检查结果。结果：76例患者中54例（71.1%）诊断明确,其中病因以糖尿病最多见（20例,26.3%）;炎症性疾病次之（14例,18.4%）,包括Tolosa-Hunt综合征（THS）、Fisher综合征（FS）及眼肌麻痹性偏头痛（ophthalmoplegic migraine,OM）。糖尿病性眼肌麻痹患者最突出的临床特征为年龄大、最常累及动眼神经但无瞳孔改变。有22例（28.9%）眼肌麻痹患者未能明确诊断,包括不能排除动脉瘤及炎症性疾病者。在各种病因导致的眼动神经麻痹中,动眼神经最常受累,为49例（64.5%）,展神经次之,为38例（50.0%）。结论：眼肌麻痹的病因复杂,糖尿病性及炎症性疾病是眼肌麻痹患者最常见的病因。     

良恶性胃黏膜中p21ras、表皮生长因子受体和p53蛋白的表达及意义

目的研究p21^ras、表皮生长因子受体（EGFR）和p53突变蛋白在良恶性胃黏膜组织中的表达及其对胃癌早期诊断的意义。方法应用免疫组织化学方法对31例胃癌、49例癌前病变、21例萎缩性胃炎和28例正常胃黏膜组织中的p21^ras、EGFR和p53突变蛋白的表达进行检测。结果31例胃癌组中,p21^ras、EGFR和p53突变蛋白的阳性表达率分别为64．5％、54．8％和32．3％;49例癌前病变组中,p21^ras、EGFR和p53突变蛋白的阳性表达率分别为59．2％、53．1％和22．4％;癌前病变组和胃癌组间3种基因蛋白的阳性表达率差异均无显著性（均为P〉0．05）,但均显著高于正常胃黏膜组（P〈0．05或P〈0．01）。结论胃癌和癌前病变胃黏膜组织中存在多种基因的表达异常,检测胃黏膜中p21^ras、EGFR和p53蛋白对胃癌早期诊断的意义不大。