胃癌组织TAM、MC和LV计数及其临床病理意义

[目的]研究胃癌组织中肿瘤相关巨噬细胞(TAM)、肥大细胞(MC)及淋巴管(LV)计数及相互关系和临床病理意义.[方法]60例胃癌组织常规制作石蜡包埋切片,TAM、MC和LV染色方法均为SP免疫组化法.[结果]60例胃癌TAM、MC和LV计数分别为18.4±5.6、15.2±4.3和13.5±4.8;高分化、侵袭肌层、无淋巴结转移及无远处转移病例TAM、MC、LV计数明显低于分化或未分化、侵袭浆膜层或浆膜外、淋巴结转移及远处转移病例(P＜0.05或P＜0.01);LV计数与TAM计数(r=0.43,P＜0.01)及MC计数(r=0.38,P＜0.01)均存在密切正相关,TAM计数与MC计数存在密切正相关(r=0.32,P＜0.05).[结论]TAM、MC和LV计数可能是反映胃癌进展、生物学行为和预后的重要标记物,TAM和MC可能具有促肿瘤淋巴管生成作用.     

乳腺浸润性导管癌ER、PR表达的临床病理意义

目的 :探讨乳腺浸润性导管癌ER、PR表达的临床病理意义。方法 :采用免疫组织化学Envision二步法检测乳腺浸润性导管癌ER、PR表达情况。结果 :6 0例乳腺浸润性导管癌ER、PR阳性表达在乳腺癌发病年龄、肿瘤大小、有无淋巴结转移和肿瘤分级间差异均有显著性 (P <0 0 5 )。结论 :ER、PR阳性表达与乳腺浸润性导管癌的病理组织学分级、有无腋窝淋巴结转移和患者预后相关。     

钙化灶在超声诊断乳腺肿块中的意义

【目的】探讨钙化灶在超声诊断乳腺肿块中的价值。【方法】检查 2 5 6例乳腺肿块 ,其中乳腺癌 130例 (A组 ) ,乳腺良性肿块 12 6例 (B组 )。使用配备高频线阵探头 (12MHz和 10MHz)的电脑彩色超声仪 ,注意观察乳腺肿块中的钙化灶。所有病例诊断均经病理检查证实。【结果】在乳腺癌组和乳腺良性肿块组中钙化灶的检出率分别为 5 2 %和 9.5 % ,两者比较差异有非常显著性意义 (P <0 .0 1)。乳腺癌组以微小钙化灶最多 ,占76 % (5 2例 ) ,微小钙化灶在乳腺良性肿块中仅占 33% (4例 ) ,两组差异亦有非常显著性意义 (P <0 .0 1)。【结论】超声检出乳腺肿块内钙化灶有助于对肿块良恶性的判断 ;密集分布的微小钙化灶常提示乳腺癌。     

乳腺癌彩色多普勒血流成像及淋巴结转移与HIF-1α表达的相关性研究

目的 探讨乳腺癌彩色多普勒血流成像及腋窝淋巴结转移与缺氧诱导因子-1α (hypoxia inducible factor-1α,HIF 1α)表达的相关性.方法 病理证实为乳腺癌患者38例,伴同侧腋窝淋巴结转移18例,无转移20例.术前CDFI检测乳腺肿块内血流,并进行分级,术后应用免疫组织化学技术检测HIF-1α表达的光密度(optical density,OD)值,分析血流分级、组织学分级及腋窝淋巴结转移与HIF 1α表达的相关性.结果 HIF-1α表达在肿块内不同血流分级、不同组织学分级间差异均有统计学意义(P＜0.001),HIF-1α在淋巴结转移阳性组中表达高于阴性组(P＜0.05).结论 乳腺癌肿块内血流分级可反映HIF 1α表达的程度,可作为判断肿块的组织学分级及腋窝淋巴结转移提供重要的影像学信息.     

乳腺癌组织中VEGF-C的表达与淋巴结转移及骨髓微转移的相关性的研究

【目的】探讨乳腺癌组织中血管内皮生长因子-C（VEGF-C）的表达及其与淋巴结转移和骨髓微转移的关系。【方法】应用免疫组织化学SP法,检测59例乳腺癌组织和10例乳腺良性病变组织中VEGF-C的表达情况;同时抽取相应的骨髓血标本,应用实时定量反转录聚合酶链反应（qRT-PCR）方法检测标本中细胞角蛋白19（CK19） mRNA 的表达水平,并进行相关性分析。【结果】乳腺癌组织中 VEGF-C 阳性表达率62．71％（37/59）及表达程度均明显高于乳腺良性病变组（0％）,差异有统计学意义（ P ＜0．05）。乳腺癌淋巴结转移阳性组VEGF-C表达阳性率及表达水平均高于淋巴结转移阴性组（ P ＜0．05）。VEGF-C表达水平与发病年龄、肿瘤大小、病理分型、临床分级、雌激素受体（ER ）水平、孕激素受体（PR ）水平无关,但其表达水平与人类表皮生长因子受体2（HER-2）表达水平显著相关（ P ＜0．05）。CK19 mRNA在乳腺纤维腺瘤患者骨髓标本中未见表达,在乳腺癌患者骨髓血中有34例57．6％（25/59）阳性表达,乳腺癌骨髓微转移阳性组VEGF-C阳性表达率及表达水平均高于骨髓阴性表达组（ P ＜0．05）。骨髓CK19 mRNA表达水平与VEGF-C蛋白表达水平呈正相关（ P ＜0．05）。【结论】乳腺癌患者VEGF-C表达水平与淋巴结转移及骨髓微转移密切相关,提示V EG F-C可能参与了乳腺癌细胞的侵袭和播散。     

血管内皮细胞生长因子-C在乳腺癌肿瘤相关巨噬细胞内的表达及临床意义

目的研究乳腺癌组织中的肿瘤相关巨噬细胞计数（TAM）及血管内皮细胞生长因子-C（VEGF—C）在TAM中的表达．探讨莫临床病理意义。方法观察乳腺癌组织免疫组织化学双重染色镜下表现,并检测75例乳腺癌组织中TAM计数及TAM中的VEGF—C的表达率与临床病理因素间的关系。结果免疫组织化学双重染色显示：VEGF—C阳性表达的TAM中可见在紫黑色胞浆内有深红色颗粒存在,且VEGF—C在肿瘤内呈弱阳性表达．而在肿瘤周围间质的TAM中表达呈强阳性．在乳腺癌组织中TAM计教以及TAM中VEGF—C表达率随临床分期（0-Ⅰ期、Ⅱ期和Ⅲ-Ⅴ期）递增,且三者之间比较,差异均有统计学意义（F=24．56、28．64,P均〈0．05）。淋巴结无转移病例中TAM计数和TAM中VEGF—C表达率明显低于淋巴结转移病例,雌激素阳性病例中TAM计数低于阴性病例,差异均有统计学意义（t分别=2．99、2．66、2．55,P均〈0．05）。TAM计数与THM中VEGF—C蛋白表达率之间呈正相关（r=-0．95．P〈0．05）。结论TAM计数及TAM中VEGF—C表达率与反映乳腺癌进展、淋巴结转移和预后有关．     

人乳腺珠蛋白在乳腺癌中的表达

目的 探讨人乳腺珠蛋白(mammaglobin A,MGA)在乳腺癌中的表达及其临床意义.方法 采用免疫组化EnVision法检测MGA在87例原发性乳腺癌及其癌旁乳腺组织、20例转移性乳腺癌中的表达,并观察其与临床病理指标的关系.结果 MGA在87例原发癌和癌旁乳腺组织的阳性率分别为70.1%和74.7%(P＞0.05),但原发癌中强阳性者显著高于癌旁乳腺(P＜0.01).MGA的表达与淋巴结转移、ER和PR状态有显著相关性(P＜0.05).MGA在原发或转移癌的不同年龄组、组织学类型、组织学分级、TNM分期、c-erbB-2中的表达差异均不显著.结论 MGA表达于原发和转移乳腺癌,可用于临床病理辅助诊断.MGA表达与腋窝淋巴结、ER和PR状态相关,可用于辅助判断预后.     

乳腺癌组织中人乳腺球蛋白的表达水平及其与乳腺癌发生和发展的关系

目的研究乳腺癌组织中人乳腺球蛋白的表达水平及其与乳腺癌发生和发展的关系。方法收集该院2015年1月至2017年8月乳腺癌组织(A组)、癌旁正常组织(B组)及乳腺良性病变组织(C组)标本各40例,通过组织微阵列技术与免疫组化方法对3组中人乳腺球蛋白的表达水平进行测定,并通过反转录聚合酶链反应对3组中人乳腺球蛋白mRNA表达进行测定,比较3组人乳腺球蛋白及其mRNA表达情况。结果 A组人乳腺球蛋白阳性率明显高于B、C组,且其mRNA表达水平也明显高于B、C组,差异均有统计学意义(P0.05);而B组与C组人乳腺球蛋白阳性率及其mRNA表达水平比较,差异均无统计学意义(P0.05)。乳腺癌组织中人乳腺球蛋白的表达与组织学分级、淋巴结转移及雌激素受体(ER)密切相关(P0.05),而与病理类型、TNM分期、肿瘤大小及孕激素受体(PR)均无明显相关性(P0.05)。多因素Logistic回归分析发现,乳腺癌组织中人乳腺球蛋白的表达与组织学分级、PR及ER水平均存在明显关系(P0.05)。结论人乳腺球蛋白在乳腺癌组织中呈高表达水平,并且与组织学分级、PR及ER密切相关,可能参与乳腺癌的发病过程,可作为评估患者肿瘤侵袭能力及恶性程度的重要指标。     

乳腺癌组织中Galectin-3表达与淋巴转移关系的探讨

【目的】探讨半乳糖凝集素－3（Galectin－3）在乳腺良、恶性病变组织中的表达及其与淋巴转移的关系。【方法】采用免疫组织化学E1iVision法检测139例乳腺良、恶性病变组织中Galectin－3的表达情况,比较有、无淋巴结转移乳腺癌组织中Galectin-3的表达。【结果】Galeetin－3在乳腺恶性病变组织中阳性表达率（91．4％）明显高于良性病变（33．33％）,差异有显著性（P〈0．01）;伴有淋巴结转移乳腺癌组织的阳性表达率（97．83％）高于不伴有淋巴转移（81．82％）乳腺癌组织,差异有显著性（P〈0．05）;而且有淋巴结转移的Galectin-3阳性表达多呈中、强阳性,Galectin-3表达与淋巴结转移呈正相关（rs=0．521,P〈0．05）。【结论】Galectin-3在乳腺恶性病变中的表达明显高于良性病变中的表达,随着肿瘤的侵袭、淋巴转移,其表达强度逐渐增强。其对预测乳腺癌的发展及而后判断有泰者价值．     

乳腺癌P53、CA153的表达及意义

目的　研究乳腺癌P5 3、CA15 3表达与肿瘤分化、浸润转移的关系及其临床意义。方法　分别应用免疫组化法(IHC)及血清放射免疫分析法(IRMA) ,检测P5 3、CA15 3在6 3例乳腺癌及2 5例乳腺良性病变中的表达情况。结果　在6 3例乳腺癌中P5 3和CA15 3阳性率分别为33 3%和4 9 .2 % ,CA15 3血清含量为38. 3±2. 9 3U/ml,均明显高于良性对照组(P <0 . 0 1) ;乳腺癌P5 3阳性率与组织学分级、肿瘤大小、临床分期呈正相关(P <0 .0 5 ) ;乳腺癌CA15 3血清含量及阳性率与组织学分级、肿瘤大小、腋窝淋巴结转移呈正相关(P <0 .0 5 ) ,CA15 3含量还与临床分期呈正相关(P <0 . 0 5 ) ;乳腺癌P5 3阳性表达与CA15 3血清含量呈正相关(P <0 0 5 )。结论　乳腺癌P5 3、CA15 3的表达与肿瘤发生发展、生长分化或转移密切相关;检测这些指标,有助于临床对乳腺癌恶性程度及预后的判断或早期诊断、病情监测。     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.