Duration and outcome of persistent candidaemia in newborn infants

The aims of the study were to define the duration of candidaemia in newborn infants and to determine the incidence of persistent hospital-acquired candidaemia and its associated morbidity and mortality compared with non-persistent candidaemia. This retrospective study, included 56 neonates admitted to the neonatal intensive care unit from 1996 to 2000 who had one or more positive blood cultures for Candida spp. The most prevalent pathogen was Candida albicans (64.3%). Mean disease duration was 6.9 +/- 5.5 days (median 6 days). Twenty-nine patients (52%) had a positive blood culture for >5 days (persistent candidaemia). There were no statistically significant differences between the infants with persistent and non-persistent candidaemia in background or predisposing clinical factors. Fungal endocarditis was present in four patients (13.7%) with persistent disease and one patient (3.7%) with non-persistent disease (odds ratio 4.19), and uveitis developed in one patient. Ten patients (17.8%) died--five with persistent and five with non-persistent disease (P = 1.0). These findings indicate that persistent neonatal candidaemia may be associated with an increased risk of Candida endocarditis, but not with other complications or increased mortality.     

重症新生儿的应激性胃损伤:频率和风险因素

文献报道,在重症监护治疗的病人中高达20％有上消化道出血的症状,重症儿科病人也有继发于应激性溃疡所致的上消化道出血的危险,并且易于发生包括大出血和穿孔在内的严重并发症。胃肠损伤的症状在新生儿重症监护接受治疗的早产儿和足月儿中同样常见。     

Heterogeneity in the gingival fibromatoses

Forty-nine cases of isolated familial and idiopathic gingival fibromatoses, consisting of 12 cases from six families and 37 cases of idiopathic gingival fibromatosis, were reviewed. Pedigrees of five families revealed various penetrances and genetic heterogeneity as suggested by the presence of both autosomal dominant and autosomal recessive inheritances. Ultrastructurally, the lesions were composed of fibroblast-like cells and myofibroblast-like cells, with the former being the predominant cell type. The 267 cases of familial and idiopathic gingival fibromatoses were analyzed, and they with or without hypertrichosis, mental retardation, and/or epilepsy. These included 49 cases seen by the authors, 50 cases from the Japanese literature, and 168 cases from non-Japanese literature. Isolated gingival fibromatosis occurred more frequently after age of 12 years (P less than 0.0074). There was no significant difference in age of onset between generalized and localized forms of the idiopathic gingival fibromatosis. Gingival fibromatosis with hypertrichosis and mental retardation and/or epilepsy occurred frequently before 12 years (P less than 0.069). It has been shown that heterogeneity of the gingival fibromatosis is a result of either histologic heterogeneity, genetic heterogeneity, or a combination with other systemic disorders.     

非小细胞肺癌分子病理学的研究

目的　探讨上海地区人肺癌发生及发展过程中的分子病理学模式。方法　采用DNAslotblot、PCR、PCR SSCP等方法 ,先后检测 2 0 0例NSCLC组织DNA标本中C erbB2、C myc、EGFR癌基因扩增 ,抑癌基因中p5 3基因外显子 5～ 8点突变、p15基因的纯合性丢失 ,以及某些与肺癌相关的染色体 3p及 17p13 .3位点的杂合性丢失 (LOH)。结果　多种癌基因共扩增率与肺癌TNM分期呈正相关 (P <0 .0 0 1)。p5 3基因外显子 5～8点突变率为 49.2 % ( 3 1/63 ) ,其中以外显子 8为主。肺癌组织中p15基因出现高频率纯合性丢失 ,并与肺癌TNM分期密切相关 (P <0 .0 0 5 )。 17p13 .3杂合性丢失率为 40 % ( 8/2 0 ) ,并与p5 3基因的点突变相关联。 3p14及 3p2 5位点处的杂合性总丢失率可高达 66.7% ( 10 8/162 ) ,其中肺腺癌中 3p14及 3p2 5二位点的共丢失率明显高于鳞癌 (P <0 .0 5 )。结论　根据上述结果 ,提出上海市区居民的非小细胞肺癌分子病理学的初步模式 :癌前期病变时已可出现 3p丢失 ,原位癌时以p5 3基因突变及 17p13 .3丢失为主 ,浸润癌及向转移性癌过渡时有多种癌基因C myc、C erbB2及EGFR癌基因共扩增 ,并出现p15基因纯合性丢失。     

胃肠道间质瘤的临床病理研究

 胃肠道间质瘤（gastrointestinal stromal tumors，GIST）的概念提出后，其内涵几经变更，近年随着分子生物学研究的进展，才得以明确GIST是具有独特临床、病理及分子遗传学特征的肿瘤，不同于消化道真正的平滑肌或神经源性肿瘤。由于GIST分子靶向治疗的成功，GIST越来越受到人们的关注，因此，有必要对GIST的临床病理研究作一概述。     

胃肠道间质瘤病理学因素与预后的相关性研究

目的探讨胃肠道间质瘤（GIST）病理学因素与预后的相关性。方法应用免疫组织化学Envision法对91例GIST进行CD117、CD34、SMA、S-100、Ki-67的标记,应用SPSS12．0软件分析肿瘤的部位、大小、出血、坏死、间质黏液、核分裂象及Ki-67与预后的相关性。结果91例GISTCD117、CD34SMA、S-100的阳性率分别为：80．21％、73．63％、34．07％、7．69％,肿瘤大小、核分裂象、Ki-67的表达与预后差异有显著相关性,出血、坏死、间质黏液、CD117的表达与预后无显著相关性。结论肿瘤大小、核分裂象、Ki-67的表达与预后有相关性。Ki-67的表达相对于核分裂象在判断肿瘤生物学行为方面是一个更为准确的指标,Flecther分级法是一种值得推广的分级方法。     

星形细胞肿瘤DEK的表达及其与病理分级的关系

目的:检测星形细胞肿瘤组织中DEK的表达,分析其与病理分级之间的关系。方法:应用免疫组化技术并用图像分析系统检测各级别星形细胞肿瘤组织及脑组织中DEK的表达水平。结果:各组免疫组化染色阳性率分别为:肿瘤组织（86.6%）,其中毛细胞型星形细胞瘤(WHO I级66.7%),弥漫性星形细胞瘤（WHO II级84.2%）,间变性星形细胞瘤（WHO III级93.3%）,胶质母细胞瘤（WHO IV级100.0%）;脑组织（33.3%）。各组免疫组化染色强度分别为:肿瘤组织 23.57±8.12,其中毛细胞型星形细胞瘤14.23±5.31,弥漫性星形细胞瘤19.52±6.68,间变性星形细胞瘤32.12±13.56,胶质母细胞瘤36.92±15.61;脑组织11.61±1.85。DEK在肿瘤组织中的表达显著高于其在脑组织中的表达（P<0.05）。结论:DEK的过表达与星形细胞肿瘤的发生密切相关,并且与肿瘤的病理分级也密切相关;DEK表达改变,为星形细胞肿瘤临床诊断、治疗和预后判断提供了新思路。     

胃原发性恶性淋巴瘤临床病理及免疫组化研究

作者应用细胞学、组织学及免疫组织化学标记技术研究了１２例胃原发性恶性淋巴瘤。结果表明其中无核裂细胞型４例，核裂细胞型３例，淋巴浆细胞样型５例。免疫组化标记证实１２例均系Ｂ细胞性淋巴瘤。本文讨论了原发性恶性淋巴瘤的诊断和鉴别诊断。     

脑膜瘤的临床病理及PCNA标记的研究

目的：为能准确预见脑膜瘤的生物学行为，并对术后辅助治疗与否提供参考依据。方法：对35例脑膜瘤组织行增殖细胞核抗原（PCNA）免疫组化染色，并结合图像定量分析及常规病理分型进行研究。结果：PCNA标记指数随肿瘤恶性程度而增高。结论：PCNA免疫组化检测方法能较好地反映脑膜瘤的增殖活力，可作为术后辅助治疗及定期复查与否的可靠指标。     

星形细胞肿瘤组织COX-2的表达及其与病理分级关系的研究

目的:检测星形细胞肿瘤组织中COX-2的表达,分析其与病理分级之间的关系。方法:应用免疫组化技术并用图像分析系统检测各级别星形细胞肿瘤组织及非肿瘤(脑)组织中COX-2的表达水平。结果:各组免疫组化染色阳性率分别为:肿瘤组织80.0%(36/45),其中毛细胞型星形细胞瘤60.0%(6/10),弥漫性星形细胞瘤76.9%(10/13),间变性星形细胞瘤90.0%(9/10),胶质母细胞瘤91.7%(11/12),非肿瘤(脑)组织28.6%(2/7);免疫组化染色强度(IODA值)分别为:肿瘤组织(6.38±3.68),其中毛细胞型星形细胞瘤(3.54±1.29),弥漫性星形细胞瘤(5.58±2.78),间变性星形细胞瘤(6.88±2.70),胶质母细胞瘤(9.19±4.62),非肿瘤(脑)组织(2.18±0.94)。COX-2在肿瘤组织中的表达显著高于其在非肿瘤(脑)组织中的表达(P=0.017)。结论:COX-2的过表达与星形细胞肿瘤的发生密切相关,并且与肿瘤的病理分级也密切相关;毛细胞型星形细胞瘤与弥漫性浸润性星形细胞肿瘤的遗传基础不同,是一种在生物学和形态学上所发生的基因改变不同于其它胶质瘤的星形细胞肿瘤;COX-2表达改变,为星形细胞肿瘤临床诊断、治疗和预后判断提供了新思路。     

Molecular pathology in sarcomas

Abstract Bone and soft tissue sarcomas are an infrequent group of tumours. Their prevalence is 4 in 100 000 people/year, making the disease quite rare. Some of these tumours, such as synovial sarcoma, Ewing tumour and osteosarcoma, are more usual in adolescents or in young adults; there are, though, some neoplasias such as leiomyosarcoma or liposarcoma that are more frequent in patients over 55 years. There are more than a hundred different types of sarcomas from the histological point of view. This is the main limitation at the time of finding major clinic essays on patients with specific types of sarcomas. From the molecular point of view, these neoplasias are grouped into two main types: (a) sarcomas showing specific genetic alterations and relatively simple karyotypes, and translocations which originate gene fusions (e.g., EWS-FLI1 in Ewing tumour); or specific genetic mutations (e.g., c-kit in the gastrointestinal stromal tumour), and (b) sarcomas showing unspecific gene alterations and very complex karyotypes, and very numerous gains and losses. This review describes diverse types of molecular alterations as well, their utility in the clinical domain, as well as implications for the pathologist in translational research in sarcomas. *Supported by an unrestricted educational grant from Sanofi-Aventis.     

Obliterative pathology in otosclerosis

A retrospective study was done in 176 stapedectomy patients where there was obliterative pathology of the footplate. The technique and care during stapes surgery in order to obtain satisfactory results and minimise the risk of cochlear losses is emphasized. Revision surgery should be avoided.