子宫内膜癌中错配修复蛋白与ER、PR、p53表达的临床病理意义及其对预后的影响

目的 通过分析错配修复(mismatch repair, MMR)蛋白与ER、PR及p53在子宫内膜癌中的表达情况,探讨其临床病理意义及其对预后的影响。方法 收集2017年1月至2020年10月在十堰市太和医院确诊的226例子宫内膜癌患者的临床病理资料,采用免疫组织化学法对肿瘤组织进行MMR蛋白、ER、PR及p53检测,分析其表达与临床病理的关系及其对患者预后的影响。结果 226例子宫内膜癌组织中MMR蛋白的缺失率为18.6%(42/226),ER及PR的阴性表达率分别为6.6%(15/226)、11.9%(27/226),p53突变型表达率为59.7%(135/226)。MMR蛋白缺失在肿瘤分级、肌层浸润深度、淋巴脉管浸润(LVSI)及术后辅助治疗中差异具有统计学意义(P<0.05)。p53突变型表达多为非子宫内膜样腺癌,且多为高级别子宫内膜癌(P<0.05)。ER与PR的表达呈正相关,ER阴性表达与组织学类型、肿瘤分级、术后辅助治疗相关(P<0.01),而PR阴性表达还与国际妇产科联盟(FIGO)分期、LVSI及淋巴结转移有关(P<0.05)。p53突变型在...     

紫杉醇联合奈达铂对子宫内膜癌患者血清肿瘤标志物、MMP-9、VEGF水平的影响

目的评估紫杉醇联合奈达铂对子宫内膜癌患者血清肿瘤标志物、MMP-9、VEGF水平的影响。方法选取2018年1月至2019年1月南京医科大学附属妇产医院诊治的104例子宫内膜癌患者的临床资料作回顾性分析。根随机数字法分为两组,研究组(54例)行紫杉醇+奈达铂(TP)化疗方案干预,对照组(50例)行传统顺铂+阿霉素+环磷酰胺(CAP)方案化疗。对比患者化疗前后肿瘤标志物变化,MMP-9、VEGF水平变化及化疗后不良反应发生情况。结果经化疗后,两组患者血清肿瘤标志物及MMP-9、VEGF水平均得到一定降低,但研究组化疗后总体水平明显低于对照组,差异具有统计学意义(P0.05);且研究组化疗过程中发生的药物毒副反应明显少于对照组,差异具有统计学意义(P0.05)。结论紫杉醇+奈达铂可显著降低子宫内膜癌患者MMP-9、VEGF及肿瘤标志物水平,并可有效预防毒副反应出现,值得推广。     

紫杉醇联合卡铂对卵巢癌患者的有效性及患者血清TNF-α、CA125水平的影响

目的探讨紫杉醇联合卡铂对卵巢癌患者的治疗效果及患者血清肿瘤坏死因子-α(TNF-α)、糖类抗原125(CA125)水平的影响。方法选取南京医科大学附属妇产医院(南京市妇幼保健院) 2016年1月至2019年1月临床妇产科诊治的80例卵巢癌患者作为研究对象。据随机数字法分为两组,对照组(40例)行紫杉醇+顺铂化疗,研究组(40例)行紫杉醇+卡铂化疗。观察两组患者疗效及化疗期间不良反应发生率,并分析化疗对患者血清TNF-α、CA125等水平的影响。结果研究组化疗后临床有效率相比对照组明显更高,差异具有统计学意义(P0.05);研究组血清TNF-α、CA125等相比对照组明显更低,差异具有统计学意义(P0.05);研究组化疗期间并发症发生率明显低于对照组,差异具有统计学意义(P0.05)。结论紫杉醇+卡铂可有效缓解卵巢癌患者临床症状,控制肿瘤生长,有效降低血清TNF-α、CA125水平,临床疗效显著,并可有效减少不良反应,值得推广。     

孕激素受体膜成分1在子宫内膜癌中表达及对细胞增殖的影响

目的:检测子宫内膜癌组织中孕激素受体膜成分1(PGRMC1)的蛋白表达特点,分析其临床意义;并探讨PGRMC1对子宫内膜癌细胞增殖调控的影响。方法:采用蛋白质免疫印迹法(Western blot)检测70例子宫内膜癌组织及28例对照子宫内膜组织中PGRMC1蛋白表达水平;应用细胞免疫组化方法检测三种人子宫内膜癌细胞系中PGRMC1的表达定位;将PGRMC1的小分子抑制剂Ag205以不同浓度分别刺激人子宫内膜癌细胞Ishikawa、Hec-1A、KLE 72小时,应用CCK-8(cell counting kit 8)方法检测Ag205对细胞活力的影响。结果:子宫内膜癌组织中PGRMC1表达较正常内膜显著升高(P=0.038);PGRMC1在各期子宫内膜癌组织中的表达无差异,但在Ⅰ期患者中,PGRMC1在Ⅰa期表达较Ⅰb期显著高(P=0.019);PGRMC1表达与子宫内膜癌组织中ER表达水平相关(P=0.015),但与分化程度、淋巴结转移及脉管癌栓无关,与PR、p53、Ki-67及bcl-2表达亦无显著相关性;20μM Ag205显著抑制三种子宫内膜癌细胞的增殖活力,其中以KLE细胞的抑制作用最明显,从最低浓度(5μM)即出现抑制效应,并随浓度增加抑制作用逐步增强。结论:子宫内膜癌内膜中PGRMC1表达显著增高;增高的PGRMC1参与调控子宫内膜癌细胞的增殖活性。     

子宫内膜癌患者雌激素受体、孕激素受体、Ki-67的表达及其临床意义研究

目的:分析子宫内膜癌患者雌激素受体(ER)、孕激素受体(PR)、Ki-67的表达及其临床意义。方法:按照数字表法随机选取2013年1月至2015年6月60例医院收诊子宫内膜癌患者(观察组)、60例子宫内膜非典型增生患者(对照组)与60例正常增生体检者(正常组),三组均采用免疫组化表达法测得ER、PR以及Ki-67。结果:正常组ER及PR远高于观察组与对照组,对照组则显著高于观察组,差异有统计学意义(P0.05);正常组Ki-67表达例数非常少,仅有3例,观察组显著高于对照组(P0.05)。60例子宫内膜癌患者中,不同分化程度、病理分期和肌肉浸润的患者ER表达率均无显著差异(P0.05)。不同分化程度中,低分化组的PR表达率显著低于中、高分化组,而Ki-67的表达率显著高于中、高分化组(P0.05),中、高分化组之间比较无显著差异(P0.05)。各病理分期的PR表达率无显著差异(P0.05),Ⅰ期患者的Ki-67表达率显著低于Ⅱ、Ⅲ期患者(P0.05),Ⅱ期、Ⅲ期组间比较,无显著差异(P0.05)。无肌肉浸润与≥50%肌肉浸润者的PR及Ki-67表达率均无显著差异,此两组患者的PR及Ki-67表达率均显著低于50%肌肉浸润组(P0.05)。结论:ER、PR以及Ki-67表达与子宫内膜癌有一定的关系,其能够反映子宫内膜癌的病变程度以及预后情况,同时能够作为临床治疗子宫内膜癌的依据。     

化疗对高危因素子宫内膜癌患者预后及生活质量的影响

目的：分析化疗在子宫内膜癌预后及生活质量的影响.方法：将116例具有子宫内膜癌患者按照患者知情自愿原则分为对照组（n =69例）与观察组（n=47例）.对照组患者进行单独手术治疗,观察组患者在手术治疗基础上进行化疗,观察两组患者术前、术后3个月的CA-125水平、随访5年生存率及比较两组患者术前及术后6个月时的生存质量状况.结果：观察组术后3个月时的CA125水平为（21.4±8.9 U/mL vs 46.17±11.3U/mL）,术后1年时的CA-125水平为（22.60±9.3 U/mL vs 42.19±14.21U/mL）P＜0.05,观察组的5年生存率为87.2％,对照组为66.7％,两者比较,x2=4.766,P=0.029;观察组与对照组患者术后6个月时的FACT-G生存质量评分（64.89±8.60分vs 48.61±8.24分）,术后1年的FACT-G生存质量评分（61.89±7.03分vs 46.78±6.42分）,P＜0.05.结论：化疗对于具有高危因素的子宫内膜癌具有提升5年生存及改善生活质量作用,临床上对于高危因素的子宫内膜癌应尽可能推荐使用辅助化疗.     

血清糖类抗原153、125与子宫内膜癌患者病理特征及1年预后的关系

目的 分析血清糖类抗原153(CA153)、糖类抗原125(CA125)与子宫内膜癌患者病理特征及1年预后的关系。方法 回顾性分析2017年7月至2022年7月温州市人民医院收治的90例子宫内膜癌患者的临床资料,纳入子宫内膜癌组,并选取同期80例子宫内膜良性病变患者作为良性病变组。比较两组患者的血清CA153、CA125水平,并分析其与临床病理特征及1年预后的关系。结果 子宫内膜癌组的CA153、CA125水平显著高于良性病变组,且与临床分期、有无淋巴结转移、分化情况、有无肌层浸润有显著相关性(P<0.05)。1年内,子宫内膜癌患者病死率为8.89%,存活率为91.11%。血清CA153、CA125水平对患者存活率无显著影响(P>0.05)。结论 子宫内膜癌患者的血清CA153、CA125水平显著高于良性病变患者,且这两种标志物在疾病的发生、发展及预后中起到了一定的作用,可为临床提供参考,辅助子宫内膜癌的诊断与治疗。     

异常子宫出血与雌孕激素及其受体水平关系的探讨

目的:探讨雌孕激素及其受体水平与子宫异常出血的关系。方法:随机选取门诊异常子宫出血患者,采用化学发光免疫分析仪及试剂盒进行激素水平测定,同时行分段诊刮送病理检查及雌孕激素受体检测。结果:子宫内膜癌、子宫内膜不典型增生、子宫肌瘤、子宫内膜息肉患者E2含量明显高于对照组(P<0.05),子宫肌瘤及有排卵型功血患者P含量与对照组相比差异显著(P<0.05,P<0.01),除有排卵型功血外,其他各种类型子宫异常出血患者的子宫内膜中ER、PR阳性率均明显高于对照组,差异显著(P<0.05,P<0.01及P<0.005)。结论:子宫异常出血与E2、P水平及子宫内膜中ER、PR含量有明显相关性。     

MTA-1、HIF-1α、ER、PR在子宫内膜癌临床特征上的表达差异及相关性分析

目的 探究肿瘤转移相关基因-1(MTA-1)、缺氧诱导因子-1α(HIF-1α)、雌激素受体(ER)、孕激素受体(PR)在子宫内膜癌(EC)临床特征上的表达差异及相关性。方法 选取2017年6月至2020年6月保定市妇幼保健院收治的62例EC患者作为研究对象,设为研究组,获取其的病理标本。另选取同期于保定市妇幼保健院进行治疗的118例子宫肌瘤、子宫腺肌症、子宫内膜息肉等患者设为对照组,均行子宫全切术治疗并获取子宫内膜组织标本,其中56例为子宫内膜不典型增生患者,设为对照1组,60例为正常子宫内膜患者,设为对照2组。对纳入标本进行免疫组化检测,观察并比较MTA-1、HIF-1α、ER、PR阳性表达情况,分析MTA-1、HIF-1α、ER、PR在EC临床特征上的表达差异及相关性。结果 研究组MTA-1和HIF-1α阳性率高于对照组,对照2组高于对照1组(P<0.05);研究组ER和PR阳性率低于对照组,对照2组低于对照1组(P<0.05);EC患者在不同肌肉浸润程度、不同国际妇产科联盟(FIGO)分期、不同组织学分级及有无淋巴结转移中MTA-1、HIF-1α、ER、PR阳性率表达情况比较,差异具有统计学意义(P<0.05);MTA-1、HIF-1α阳性表达与肌肉浸润程度、FIGO分期及淋巴结转移呈正相关(r=0.316、0.254、0.347,0.376、0.412、0.269,P<0.05),与组织学分级呈负相关(r=-0.562、-0.447,P<0.05),ER、PR阳性表达与上述4个临床特征均呈负相关(r=-0.485、-0.226、-0.634、-0.215,-0.313、-0.664、-0.415、-0.532,P<0.05)。结论 MTA-1、HIF-1α在EC中的阳性表达率升高,ER和PR阳性表达率降低,MTA-1、HIF-1α、ER、PR与临床特征关系密切,具有一定相关性,上述指标的检测可对临床诊断和治疗EC患者提供有效依据。     

子宫内膜样癌及卵巢浆液性癌中PR、P53、ER的表达及其临床病理学意义

目的:探究与分析传统子宫内膜样癌及卵巢浆液性癌中PR、P53、ER的表达及其临床病理学意义。方法:选取我院自2013年1月至2014年10月收治的120例子宫内膜样癌及卵巢浆液性癌患者作为研究对象进行回顾性分析,其中子宫内膜样癌患者45例,卵巢浆液性癌患者75例。采用免疫组化En Vision法分析所选的患者病理标本中PR、P53、ER的表达情况。对比在不同病理分型、组织分级、临床分期中PR、P53、ER的表达水平。结果:子宫内膜样癌PR、P53、ER的表达率与浆液性癌PR、P53、ER的表达率比较,组间差异显著(χ~2=5.49,P0.05;χ~2=4.76,P0.05;χ~2=4.23,P0.05)。中、高分化癌PR、P53、ER的表达率与低分化癌PR、P53、ER的表达率相比,组间差异显著(χ~2=5.33,P0.05;χ~2=4.23,P0.05;χ~2=4.57,P0.05)。临床分期Ⅰ~Ⅱ期患者PR、P53、ER的表达率分别与低分化癌PR、P53、ER的表达率相比,组间对比差异显著(χ~2=5.33,P0.05;χ~2=4.23,P0.05;χ~2=4.57,P0.05)。结论:子宫内膜样癌及卵巢浆液性癌中PR、P53、ER的表达存在较大差异,这对于卵巢癌病变诊断及鉴别诊断具有重要意义,值得在临床中推广PR、P53、ER的监测。     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Self‐resolving superficial primary cutaneous mucormycosis in a 7‐week‐old infant

A 7‐week‐old girl, born at 30 weeks' gestational age, presented to clinic for evaluation of a crop of vesicular lesions that were noted after removal of a bandage that had been in place for 4 days. A punch biopsy of the lesion revealed fungal elements that were later identified as Rhizopus spp. The lesion began to self‐resolve, and no further treatment was needed, with full resolution of the lesion by 1 month after presentation. Clinicians should be aware of the variable presentations of mucormycosis and consider fungal infection in the differential diagnosis when evaluating vulnerable patients with skin eruptions.     

Pathogenic role of IL-17 in psoriasis and psoriatic arthritis

Psoriasis is a chronic inflammatory skin disorder resulting from a complex network of cytokines and chemokines produced by various immune cell types and tissue cells. Emerging evidence suggests a central role of IL-17 and IL-23/T17 axis in the pathogenesis of psoriasis, giving a rationale for using IL-17-blocking agents as therapeutics.Three agents targeting IL-17 signaling are being studied in Phase III clinical trials: secukinumab and ixekizumab (IL-17 neutralizing agents), and brodalumab (IL-17 receptor antagonist). Preliminary results are highly promising for all anti-IL17 agents, creating fair expectations on this class of agents as the new effective therapeutic approach for the treatment of psoriasis.