新辅助化疗对乳腺癌组织病理学及免疫组织化学的影响

目的:探讨新辅助化疗对乳腺癌组织病理学及免疫组织化学的影响。方法:观察术前经粗针吸活检(core needle biopsy,CNB)确诊的80例乳腺癌新辅助化疗后肿瘤标本的组织病理学改变,并分析其手术前后ER、PR、HER2等免疫表型的变化。结果:新辅助化疗对乳腺癌总显效率为67.5%,手术前后肿瘤组织的ER、PR、HER2总阳性表达率差异无显著性(P>0.05),但ER、PR、HER2均出现较高的不符合率,依次为45.0%、37.5%、12.5%。结论:新辅助化疗能有效地作用于肿瘤组织,并能帮助寻找术后有针对性的化疗方案;但对ER、PR、HER2等免疫标记有较大影响,可能会对术后选择内分泌治疗及靶向治疗造成不确定因素。     

胃癌术后辅助化疗药物研究现状

胃癌发病率最高的地区集中在东南亚和中国[1,2].手术是目前唯一可能治愈胃癌的手段,但近2/3的患者确诊时已是进展期,术后复发和转移率较高,5年生存率不足50％.术后辅助化疗是改善患者远期生存的主要方法,大量研究显示Ⅲ期胃癌术后辅助化疗可以明显提高患者的生存率,降低术后复发和转移风险[3,4].晚期胃癌辅助化疗研究(GASTRIC)协作组2010年发表的荟萃分析再次证实了辅助化疗的价值[5].本文就辅助化疗常用药物进行简要综述.     

新辅助化疗联合完全腹腔镜下胃癌D2淋巴结清扫对老年胃癌患者临床疗效分析

目的探讨新辅助化疗联合完全腹腔镜下胃癌D2淋巴结清扫对老年胃癌患者的临床疗效。方法选自2014年12月至2017年12月收治的97例胃癌患者,按照随机数字表法分为2组,对照组(52例)接受D2淋巴结清扫胃癌根治术治疗;观察组(45例)术前采用XELOX化疗方案,化疗完2周后行完全腹腔镜下胃癌D2淋巴结清扫胃癌根治术。比较2组患者近期疗效,包括手术时间、手术中出血量、淋巴结清扫数目、术后并发症及随访1年复发情况及远处转移情况等。结果观察组患者近期总有效率显著高于对照组,1年复发率显著低于对照组(P0.05);两组患者其他指标,包括手术时间、术中出血量、淋巴结清扫数目和术后并发症比较差异无统计学意义(P0.05)。结论老年胃癌患者采用新辅助化疗联合完全腹腔镜下胃癌D2淋巴结清扫有很好的临床疗效,值得推广。     

胃癌HER2异质性的研究进展

胃癌的发病率和病死率较高,目前治疗多以外科手术辅助化疗为主。近年来,以人类表皮生长因子受体2(human epidermal growth factor receptor-2,HER2)为靶点的靶向治疗改善了胃癌患者的生存期,但由于胃癌HER2存在较大的异质性,使得HER2的测定产生一定的假阴性,因此可能使部分能够从中获益的胃癌患者失去靶向治疗的机会。     

新辅助化疗时加用曲妥珠单抗对HER2阳性乳腺癌的临床疗效观察

目的探讨新辅助化疗加用曲妥珠单抗对HER2阳性乳腺癌的疗效。方法回顾性研究了我院2013年5月~2015年3月,对224例HER2阳性可手术乳腺癌病例,主要有两组:术前仅蒽环类化疗组(对照组),共120例;术前蒽环类化疗加用曲妥珠单抗组。两组化疗结束后再予手术。结果两组的手术难度,手术时间,术中出血量,术后引流量及平均住院天数均无显著性差异(P0.05)。但是术前加用曲妥珠单抗组生存率明显高于术前仅蒽环类化疗组。结论对HER2阳性乳腺癌患者行术前新辅助化疗时加用曲妥珠单抗可以提高术前化疗的疗效,尤其能延长患者远期生存率。     

辅助化疗在不同分期胃癌治疗中的意义

目的:分析根治术后辅助化疗在各期胃癌根治术后患者中应用的临床意义.方法:回顾性分析2006年4月至2008年4月胃癌根治术后患者的临床病理资料,以COX多因素回归分析辅助化疗、TNM分期、年龄、性别、分化程度等多因素对患者预后的影响;分层分析研究辅助化疗在不同分期患者中对2年生存率的影响.结果:101例患者中,共有51例患者接受化疗,所使用的化疗方案均以氟尿嘧啶类药物为基础.Ⅲ期患者54例,化疗与未化疗患者2年生存率分别为85.70%和58.70%,差异有显著意义(P=0.01),COX多因素回归的方法分析发现辅助(P=0.008)及分化程度(P=0.001)是Ⅲ期患者生存的独立预后因素.结论:Ⅲ期胃癌术后的患者应常规接受辅助化疗,以氟尿嘧啶为基础的方案安全有效.     

胃癌靶向治疗过程中血清HER2-ECD检测1例报道

胃癌精准治疗的分子靶点中,临床意义最明确、应用最广泛的是人表皮生长因子受体2(HER2).胃癌中HER2阳性率为12％～20％[1].HER2阳性往往预示着肿瘤进展快、容易发生淋巴结或血道转移,对新辅助化疗不敏感,预后不佳.研究发现,分泌入血清中HER2胞外区(ECD)的水平可以有效反映组织学HER2表达情况[2],目前临床上检测患者HER2表达水平的方法为免疫组织化学染色和荧光原位杂交(FISH),由于其主观性、滞后性和难以取材的局限性,越来越多的研究者开始对血清HER2-ECD进行研究.在临床实践中,血清HER2-ECD的检测还没有被广泛使用,临床价值也尚未在胃癌患者中得到充分验证.本文搜集了1例HER2阳性晚期胃癌患者的整个治疗过程及相关检查的资料,分析血清HER2-ECD检测在胃癌靶向治疗过程中的应用价值.     

数字PCR检测循环肿瘤DNA中HER2基因扩增对胃癌的预后评估

目的 探讨基于数字PCR(d PCR)检测循环肿瘤DNA(ctDNA)中人类表皮生长因子受体2(HER2)基因扩增在胃癌进展监测及预后评估的临床应用价值。方法 选取2018年11月至2020年12月华中科技大学协和深圳医院收治的60例胃癌患者为病例组,以同期20名健康体检者为对照组。建立dPCR技术方法检测胃癌患者ctDNA中HER2基因扩增及阳性阈值,评价其与免疫组织化学（IHC）联合荧光原位杂交技术（FISH）病理诊断HER2表达结果一致性,分析胃癌患者术前ctDNA中HER2基因扩增与临床病理特征的关系。同时选择24例Ⅲ、Ⅳ期的进展期胃癌患者纳入随访研究,分析术后监测ctDNA中HER2基因扩增与无进展生存时间的关系。结果 HER2基因扩增比值的阳性阈值设为1.40,dPCR技术定量检测ctDNA中HER2基因扩增的敏感度、特异性分别达到0.90、0.94;胃癌患者dPCR检测HER2基因扩增、IHC与FISH联合检测HER2表达阳性率分别为20%(12/60)、16.7%(10/60),两种方法检测结果符合率一致性较好（k=0.778,P<0.01）。dPCR检测胃癌患者...     

奥沙利铂联合替吉奥用于胃癌术后辅助化疗的安全性分析

目的探讨奥沙利铂联合替吉奥用于胃癌术后辅助化疗的安全性。方法回顾性分析本院2008年1月—2012年12月采用奥沙利铂联合替吉奥方案进行胃癌术后辅助化疗的52例患者的临床资料,观察辅助化疗后的不良反应及耐受情况。结果胃癌术后辅助化疗最常见的不良反应依次为中性粒细胞降低(67.3%),恶心、呕吐(61.6%),白细胞降低(59.6%);3~4度不良反应依次为血小板降低(21.2%),中性粒细胞降低(19.2%),恶心、呕吐(7.7%)和食欲下降(5.8%)。结论奥沙利铂联合替吉奥用于晚期胃腺癌术后辅助化疗可提高患者生存率,但应注意术后化疗的耐受性和不良反应。     

新辅助化疗联合腹腔镜辅助胃癌根治术治疗进展期胃癌的效果

目的 探讨新辅助化疗联合腹腔镜辅助胃癌根治术治疗进展期胃癌的效果.方法 回顾性分析洛阳市中医院2019年11月至2020年11月收治的行腹腔镜辅助胃癌根治术的进展期胃癌患者90例.根据是否行新辅助化疗分为单纯根治术组和新辅助化疗+根治术组,每组45例.比较单纯根治术组和新辅助化疗+根治术组患者的近期疗效、围术期指标、术...     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.