人巴贝虫病的临床特征及诊疗研究进展

巴贝虫病是一种重要的蜱传人兽共患血液寄生虫病,在全球分布较广泛.对人致病的巴贝虫主要有田鼠巴贝虫、分歧巴贝虫、猎户巴贝虫和邓肯巴贝虫等12种.巴贝虫感染人体后主要临床症状为发热、头痛、寒战、肌痛和疲劳等,严重时可致死.巴贝虫病主要通过实验室检测结合临床特征、流行病学调查进行诊断,诊断技术主要包括血涂片镜检、血清学检测和...     

Small cell lung cancer in young patients: trends in sociodemographic factors,diagnosis, treatment,and survival

BackgroundSmall cell lung cancer (SCLC) in patients <50 years old has unique socioeconomic and clinical implications. We aimed to examine the demographics, treatment patterns, and survival of young patients with SCLC and compared them to older adults.MethodsThe National Cancer Database (NCDB) was queried to identify SCLC cases diagnosed from 2004 to 2016. Patients were divided into three age groups: ≥18–<50, ≥50–<70, and ≥70 years. Patient characteristics were evaluated for survival within each age group. Kaplan-Meier and Cox regression analyses were used to assess survival.ResultsOf the 172,453 evaluated SCLC patients (median age 66 years), 8,792 were ≥18–<50 years old. Compared to the older groups, patients under 50 were more likely to be Black, uninsured or on Medicaid, have household income <$30,000, and present with stage III or IV disease (P<0.0001 for all). While young patients were more likely to receive guideline-concordant care (GCC), the hazard of death increased to 1.96 (95% CI: 1.80–2.14; P<0.0001) with receipt of nonstandard therapy. Private insurance, female gender, non-White race, Hispanic ethnicity, and higher income were associated with better survival. The youngest cohort had significantly better survival overall when compared to the older patients (P<0.0001), but the survival advantage was reduced with the advancing stage.ConclusionsSCLC patients under 50 years old represent a socioeconomically disadvantaged group with advanced disease at presentation. Despite having fewer comorbidities and being offered guideline-concordant treatment, younger patients with SCLC have only marginally better survival than older patients in advanced stages.     

Bioinformatics-based identification of key genes and pathways associated with colorectal cancer diagnosis,treatment, and prognosis

Colorectal cancer (CRC) is known to display a high risk of metastasis and recurrence. The main objective of our investigation was to shed more light on CRC pathogenesis by screening CRC datasets for the identification of key genes and signaling pathways, possibly leading to new approaches for the diagnosis and treatment of CRC. We downloaded the colorectal cancer datasets from the Gene Expression Omnibus (GEO) database site. We used GEO2R to screen for differentially expressed genes (DEGs) of which those with a fold change >1 were considered as up-regulated and those with a fold change <-1 were considered as down-regulated on the basis of a P < .05. “Gene ontology (GO)” and “Kyoto Encyclopedia of Genes and Genomes (KEGG)” data were analyzed by the “DAVID” software. The online search tool “STRING” was used to search for interacting genes or proteins and we used Cytoscape (v3.8.0) to generate a PPI network map and to identify key genes. Finally, survival analysis and stage mapping of key genes were performed using “GEPIA” with the aim of elucidating their potential impact on CRC. Our study revealed 120 intersecting genes of which 55 were up- and 65 were downregulated, respectively. GO analysis revealed that these genes were involved in cell proliferation, exosome secretion, G2/M transition, cytosol, protein binding, and protein kinase activity. KEGG pathway analysis showed that these genes were involved in cell cycle and mineral absorption. The Cytoscape PPI map showed 17 nodes and 262 edges, and 10 hub genes were identified by top 10 degrees. Survival analysis demonstrated that the AURKA, CCNB1, and CCNA2 genes were strongly associated with the survival rate of CRC patients. In addition, CCNB1, CCNA2, CDK1, CKS2, MAD2L1, and DLGAP5 could be correlated to pathological CRC staging. In this research, we identified key genes that may explain the molecular mechanism of occurrence and progression of CRC but may also contribute to an improvement in the clinical staging and prognosis of CRC patients.     

Anaplastic thyroid cancer: prevalence, diagnosis and treatment

Anaplastic thyroid cancer (ATC) is a rare aggressive tumor arising from the follicular cells of the thyroid gland (as does well differentiated thyroid cancer, WDTC), but ATC cells do not retain any of the biological features of the original follicular cells, such as uptake of iodine and synthesis of thyroglobulin. Prognosis is almost invariably fatal. In this article the Authors review the pathology, epidemiology, clinical presentation, diagnosis and treatment options of ATC. ATC incidence typically peaks at the 6-7th decade of life (mean age at diagnosis 55-65 years), women representing 55-77% of all patients. ATC represents 2-5% of all thyroid tumors, with a decreasing trend with respect to the incidence of WDTC. The histologic patterns of ATC include giant-cell, spindle-cell and squamoid-cell tumors; these subtypes frequently coexist and are not predictive of patients' outcome. Immuno-cyto-chemistry for thyroglobulin is usually negative or weakly positive and some cases are also negative for keratin, particularly in the spindle-cell areas. ATC may arise de novo, but in most cases it develops from a pre-existing WDTC, especially the follicular subtype. Most ATC patients complain of local compressive symptoms, such as dysphagia, dysphonia, stridor and dyspnea in addition to neck pain and tenderness; in over 70% of the patients the tumor infiltrates surrounding tissues, such as fat, trachea, muscle, esophagus, and larynx. The clinical course of a rapidly enlarging mass that is firm and fixed to surrounding structures in an elderly patient is quite suggestive for ATC. Diagnosis can be confirmed by fine needle aspiration cytology or, in doubtful cases, by histology on core biopsy. Computed tomography (CT) scan and magnetic resonance imaging (MRI) are useful for defining the local extent of disease and for identifying distant metastases, as is also positron-emission tomography (PET) with [(18)F]FDG. Tracheoscopy and esophagoscopy should be performed every two months, or whenever patients refer the appearance or worsening of local symptoms. Bone scintigraphy may be included in the follow-up of patients with a longer survival and relatively good health. Because of its aggressive behavior, the latest American Joint Committee on Cancer Staging Manual classifies all ATCs as T4 and Stage IV tumors, regardless of their actual overall tumor burden. Treatment of ATC has not been standardized because it is not clear whether or not therapy is effective in prolonging survival; most patients die within six momths from diagnosis, primarily because of asphyxiation caused by local tumor invasion. When employed alone, surgery, radiotherapy, or chemotherapy are seldom adequate to achieve overall control of the disease, but a combination of these treatments may improve local control. Surgical treatment of local disease offers the best opportunity for prolonged survival if the tumor is intrathyroidal. When the tumor is extrathyroidal, the surgical approach to ATC is controversial. Some favourable results have recently been reported with newly developed chemotherapy agents and hyper-fractioned radiation therapy. Tracheostomy should be performed in patients with impending airway obstruction when death is not imminent from other sites of disease, and if patients are not candidates for local resection or chemoradiation. Interventional bronchoscopy, including Nd-YAG laser and airways stenting are alternatives to surgery in inoperable ATC-induced tracheal obstruction. Gene therapy is under investigation. Although very rare, ATC is a highly aggressive tumor that belongs to the group of killer tumors with median survival time not longer than 6-8 months. Surgery, chemotherapy and radiotherapy are the conventional therapeutic strategies performed in the attempt to improve survival. Unfortunately, very often they do not succeed any clinical benefit but only palliative RESULTS: New therapeutic strategies based on molecular approaches are desirable.     

Imaging in the diagnosis and treatment of non-small cell lung cancer

The available tools for diagnosing and staging lung cancer patients can be broadly categorized into non-invasive, minimally invasive and invasive (surgical) modalities. Non-invasive modalities include CT and PET. Minimally invasive modalities are endoscopic approaches, including endoscopic ultrasound, endobronchial ultrasound and transbronchial fine needle aspiration without ultrasound guidance. This review focuses on the non-invasive and minimally invasive techniques involving imaging. Application of Bayesian principles indicates that tests with a high sensitivity and specificity for detection of both systemic metastases and mediastinal nodal involvement are required for treatment selection and planning in patients with non-small cell lung cancer who would be considered for treatment with curative intent. Combined PET/CT using the glucose analogue fluorine-18 fluorodeoxyglucose currently provides the best diagnostic performance for this purpose and should now be considered the standard of care for staging non-small cell lung cancer. Endoscopic ultrasound and endobronchial ultrasound have important complementary roles to allow further evaluation of equivocal nodal abnormalities on PET or CT and to allow pathological samples to be obtained. Diagnostic CT has an important role in defining tumour relations for patients deemed suitable for surgical resection and as the initial investigation for patients with potential symptoms of lung cancer or proven lung cancer that would not be considered for curative treatment on medical grounds.     

Early gastric cancer: diagnosis, pathology, treatment techniques and treatment outcomes

Recent improvements in endoscopic techniques and technologies and an increased understanding and recognition of the importance of early gastric cancer (EGC) will result in increases in the detection and diagnosis of precancerous or early cancerous lesions. The incidences of nodal metastasis of intramucosal and submucosal EGC are 3 and 20%, respectively. Therefore, major surgery may be inappropriate in many of these patients, and many cases of EGC may be treated by endoscopic mucosal resection (EMR). EMR was first introduced in Japan 20 years ago. Most EMR have been performed by the so-called 'strip biopsy' or EMR-C methods. However, we have sometimes experienced local recurrence in cases that had been resected in multiple fragments by these methods. To obtain 'complete resection', we developed the endoscopic submucosal dissection (ESD) technique using a special endoscopic knife, the insulation-tipped diathermic knife (IT knife). The rate of complete resection, i.e. cut margin free from cancer and one-piece resection, was remarkably higher for the IT knife technique than conventional EMR. ESD cases are increasing rapidly in Japan. EMR including ESD is a good method for patients with gastric cancer to preserve the stomach. For EMR, it is necessary to find EGC. Both diagnosis and treatment are important, and scientific data regarding lymph node metastasis and clinicopathological features are required.     

Endoscopic diagnosis and treatment of esophageal verrucous squamous cell cancer

Verrucous squamous cell cancer (VSCC) of the esophagus is a variant of squamous cell carcinoma. This rare entity has been described in only a handful of case reports in the literature. We sought to evaluate the endoscopic features, treatment, and outcomes related to esophageal VSCC. The medical records of all patients with esophageal VSCC seen at our institution from January 1995 to December 2010 were reviewed retrospectively. A total of 11 patients (6 men; mean age 66 years [range 57–75 years]) were identified, with a mean follow up of 4 years (range 0.5–10 years) available in nine patients after diagnosis. About half the patients smoked or consumed alcohol on a regular basis. The median time interval from onset of symptoms to diagnosis of esophageal VSCC was 2.5 years (range 1–20 years), with dysphagia being present in all patients. The majority of tumors (8 of 11) exhibited a white, warty, plaque‐like appearance with superimposed Candida at endoscopy, which led solely to a diagnosis of Candida esophagitis on initial presentation. The disease was either extensive (n = 5) throughout the esophagus or localized (n = 6) often by tumor nodules or projections, with the lower third of the esophagus being most commonly involved. Initial pinch biopsies were nondiagnostic in eight (73%) of the patients. Six patients underwent esophagectomy; neoadjuvant chemoradiation therapy was provided in two. In patients treated solely with surgery and who had a preoperative endoscopic ultrasound, the latter tended to overestimate staging of the lesion relative to surgical pathologic staging. Two patients were deemed to be poor operative candidates and received only chemoradiation treatment. One patient with a T2N0 tumor by endoscopic ultrasound staging was managed symptomatically with intermittent endoscopic dilation because of significant comorbidities that precluded surgery and oncologic therapy. There has been no evidence for residual or recurrent neoplastic disease in the eight patients who received treatment with surgery and/or chemoradiation therapy. Five of six patients who underwent surgery have required intermittent endoscopic dilation of anastomotic strictures during follow up. One of the two patients who received only chemoradiation therapy has required periodic endoscopic dilation for radiation‐induced esophageal stricture. Two of the nine (22%) patients have died of causes unrelated to VSCC or its treatment at last follow up. In conclusion, a high index of suspicion for esophageal VSCC should be raised by the presence of long‐standing symptoms coupled with white, warty esophageal lesions seen on endoscopic evaluation. Candida overgrowth can be expected to confound the diagnosis. Despite the long duration of symptoms, surgical resection typically shows relatively low‐grade tumors, consistent with the rare propensity of this variant of esophageal squamous cell carcinoma to metastasize.     

Testicular germ cell tumors: pathogenesis, diagnosis and treatment

Testicular germ cell tumors represent the most common solid malignancy of young men aged 15-40 years. Histopathologically, testicular germ cell tumors are divided into two major groups: pure seminoma and nonseminoma. The pathogenesis of testicular germ cell tumors remains unknown; however, cryptorchidism is the main risk factor, and molecular studies have shown strong evidence of an association between genetic alterations and testicular germ cell tumors. In cases of suspicion for testicular germ cell tumor, a surgical exploration with orchiectomy is obligatory. After completion of diagnostic procedures, levels of serum tumor markers and the clinical stage based on the International Union Against Cancer tumor-node-metastasis classification should be defined. Patients with early-stage testicular germ cell tumors are treated by individualized risk stratification within a multidisciplinary approach. The individual management (surveillance, chemotherapy or radiotherapy) has to be balanced according to clinical features and the risk of short-term and long-term toxic effects. Treatment for metastatic tumors is based on risk stratification according to International Germ Cell Cancer Collaborative Group classification and is performed with cisplatin-based chemotherapy and residual tumor resection in cases of residual tumor lesion. High-dose chemotherapy represents a curative option for patients with second or subsequent relapses.     

Early gastric cancer: diagnosis, treatment techniques and outcomes

The detection of early gastric cancer is performed by endoscopic study with or without the dye-spraying method, which is useful in detecting small lesions or surface lesions. For the diagnosis of early gastric malignancy, magnification endoscopy, narrow-band imaging and optical coherence tomography are used for histological diagnosis and research. On the other hand, endoscopic ultrasonography is used to discuss the depth of carcinoma invasion, but cannot be used to detect the malignant lesions except for the rare cases of scirrhus-type gastric carcinoma, the histological results of which are sometimes difficult to obtain by biopsy study. The role of endoscopic ultrasonography diagnosis is to assist in making a decision of therapeutic strategy. Curative endoscopic treatment of early gastric cancer is common according to the development of various endoscopic techniques and accessories. Curative treatment is feasible using these techniques.     

Thromboembolic complications of cancer: epidemiology,pathogenesis, diagnosis,and treatment

The association between malignancy and clinical thrombosis has been recognized for nearly 140 years. The purpose of this review is to examine our current understanding of thrombosis as a complication of cancer and cancer therapy. The review includes a discussion of the epidemiology, pathophysiology, diagnosis and treatment.     

Immunological identification of human lymphoid cell populations.

Lymphocytes can be subdivided into two major groups according to origin and function (1,2). T lymphocytes are thymus dependent and are responsible for cell-mediated immunity while the B lymphocytes represent precursors of immunoglobulin-producing plasma cells and give rise to humoral immunity. Considerable knowledge concerning the biological properties of T and B lymphocytes and their mutual interaction has been obtained in the last few years. Recent data also demonstrate further heterogeneity within each of the two main lymphocyte populations. Certain lymphoid cells are capable of mediating cytotoxicity against target cells coated with specific antibody. These cells are termed K cells, and although some evidence seems to suggest that they comprise a subpopulation of B lymphocytes, their nature and localization in lymphoid organ is not well known. This article will attempt to cover the methodologies involved in assays of T, B, and K cells. The methods to be discussed are used to detect the presence of different lymphoid cell populations; the markers used are not necessarily related to cell function.     

Constitutive production of granulocyte colony-stimulating factor and interleukin-6 by a human lung cancer cell line, KSNY: gene amplification and increased mRNA stability.

A human lung squamous cell carcinoma cell line designated KSNY was established from a patient suffering from marked neutrophilia and polyclonal hyper-gamma-globulinemia. In our previous report, we demonstrated colony-stimulating activities in the culture supernatant of this cell line. To determine the exact molecules for the activities, we investigated the gene expression of various cytokines in KSNY cells and showed the mRNA expression of both granulocyte colony-stimulating factor (G-CSF) and interleukin-6 (IL-6). We also detected substantial amounts of G-CSF and IL-6 in the culture supernatant with sensitive enzyme-linked immunosorbent assays (ELISA). The amplification of the gene locus for G-CSF, but not for IL-6 was shown by Southern blot analysis. Furthermore, we also showed that the mRNAs for G-CSF and IL-6 were relatively stable in KSNY cells. These findings are thought to be related to the constitutive production of the cytokines in KSNY cells.     

Primary aldosteronism: diagnosis, localization, and treatment.

New diagnostic techniques have enhanced the detection of primary aldosteronism. However, the response of blood pressure after operation in unilateral and bilateral adrenal disease is different. We have compared four localizing techniques--adrenal venography, adrenal isotopic scanning, a modified adrenal venous sampling for steroid measurements, and the anomalous postural decrease in plasma aldosterone concentration--in 51 patients with primary aldosteronism, all of whom had undergone operative confirmation. Adrenalectomy resulted in normal blood pressure in 59%, improvement in 25%, and no change in 16%. Correct localization of the lesion was obtained in 47% by the adrenal isotopic scan, in 66% by adrenal venography, and in 91% by the modified adrenal venous hormone technique despite four false-positives. Of the 26 patients with an anomalous postural decrease in plasma aldosterone, 88% had a unilateral lesion.     

Gastroesophageal reflux: pathogenesis, diagnosis, and treatment.

Gastroesophageal reflux (GER) is a common problem confronting physicians involved in the care of children and adults. With the association of GER with asthma and chronic cough, physicians specializing in allergy/immunology require information on the pathogenesis, diagnosis, and management of GER. Eosinophilic esophagitis or eosinophilic gastroenteritis are poorly understood entities that may also lead to symptoms mimicking GER and are associated in many cases with underlying hypersensitivity of unknown immunologic mechanism.