三阴性乳腺癌化疗后前瞻性记忆损害特征分析

目的 有关不同分子分型的乳腺癌患者化疗后前瞻性记忆(prospective memory,PM)损害是否存在差异,目前尚不清楚.本研究探讨三阴性乳腺癌(triple negative breast cancer,TNBC)患者化疗后基于事件的PM(event-based prospective memory,EBPM)与基于时间的PM(time-based prospective memory,TBPM)损害特征.方法 收集2013-01-01-2015-09-30安徽医科大学第二附属医院肿瘤中心接受化疗的乳腺癌化疗后患者244例.其中TNBC 80例,非三阴性乳腺癌(non-triple negative breast cancer,NTNBC) 164例.建立EBPM与TBPM的认知神经心理学试验范式,分别进行化疗前后的PM测查.结果 与NTNBC患者相比,TNBC患者化疗后EBPM得分0.89±0.86,明显低于NTNBC组的2.59±0.90,差异有统计学意义,Z=-10.61,P＜0.01;TNBC和NTNBC患者化疗后TBPM得分别为4.65±0.83和4.80±0.92,差异无统计学意义,Z=-1.48,P＞0.05.结论 乳腺癌患者化疗后存在不同程度的PM障碍,且TN-BC较NTNBC患者EBPM损害更为显著.     

脑转移瘤全脑放疗后前瞻性记忆与回顾性记忆功能损害的研究

[目的]了解脑转移瘤患者全脑放疗后前瞻性记忆(PM)与回顾性记忆(RM)的功能损害情况.[方法]以34例脑转移瘤患者为研究对象,在全脑放疗前1周、放疗后1个月分别进行简易精神状态量表(MMSE)测查及RM和PM问卷调查.[结果]放疗前后MMSE评分(27.26±1.86 vs 26.35±1.76)差异具有统计学意义(P＜0.05).放疗后PM成绩为12.18±2.74,低于放疗前(14.06±4.66)(P＜0.01);RM成绩放疗前后(14.26±4.60 vs 14.18±4.41)差异无统计学意义(P＞0.05).[结论]全脑放疗对脑转移瘤患者的总体认知功能有损害,但可改善患者PM功能,RM功能无明显影响.     

三阴性乳腺癌中VEGF、Ki-67的表达及临床意义

目的 探讨VEGF和Ki-67在三阴性乳腺癌(triple-negative breast cancer,TNBC)组织中的表达情况和临床意义.方法 采用免疫组织化学方法检测72例TNBC和72例非三阴性乳腺癌(non-triple-negative breast cancer,NTNBC)组织中VEGF和Ki-67的表达情况.结果 VEGF和Ki-67在72例TNBC中表达阳性率分别为62.5％ (45/72)和86.1％ (62/72),与在72例NTNBC中表达阳性率(分别为40.3％和70.8％)比较差异均有统计学意义(均P＜0.05).VEGF的过表达与TNBC的TNM分期、脉管浸润及淋巴结转移相关(均P＜0.05),而与患者的年龄、肿瘤大小无明显相关性(均P＞0.05).在TNBC组织中VEGF和Ki-67的表达之间呈正相关(P＜0.01).结论 VEGF、Ki-67与TNBC的发生、发展有着密切关系,二者联合检测对判断TNBC的预后有一定的价值.     

轻中度癌痛患者的回顾性记忆与前瞻性记忆功能损害的临床研究

目的 探讨轻中度癌痛患者的回顾性记忆（RM）与前瞻性记忆（PM）功能，了解癌痛对记忆功能的影响。方法 收集轻中度癌痛患者和健康对照者各37例，进行总体认知评估及RM和PM问卷调查。结果癌痛组简易精神状态量表得分为24.19±3.20，低于健康对照组的27.54±1.83（P＜0.01）；PM得分为14.76±4.53，高于健康对照组的9.59±1.38（P＜0.01）；癌痛组RM得分略低于健康对照组（12.78±4.27 vs. 12.91±5.12），差异无统计学意义（P＞0.05）。结论 轻中度癌痛患者存在总体认知功能的损害，以记忆功能损害较为明显，其中以PM损害为主。     

不同年龄段女性三阴性乳腺癌化疗患者的认知功能水平分析

目的:探究不同年龄段女性三阴性乳腺癌化疗患者的认知功能水平。方法:收集2016年5月至2017年8月期间在我院接受化学治疗的三阴性乳腺癌患者96例,作为实验组,另收集同时间段内在我院进行治疗的非三阴性乳腺癌患者96例,作为对照组。将实验组及对照组患者按照年龄分为A组(≤40岁),B组(41~65岁),C组(>65岁),A组、B组、C组的例数分别为53例、62例、77例。比较实验组患者与对照组患者的MMSE量表、PM问卷、RM问卷得分,并采用SPSS 19.0统计学软件进行数据分析。结果:实验组患者与对照组患者的年龄、教育程度资料比较差异不具有统计学意义（P>0.05）;实验组患者的MMSE量表得分低于对照组,PM量表、RM量表得分高于对照组,数据差异具有统计学意义（P<0.05）。在A组中,实验组患者的PM量表、MMSE量表、RM量表得分与对照组比较差异具有统计学意义（P<0.05）,两组的教育程度比较差异不具有统计学意义（P>0.05）;B组、C组中,实验组患者的PM量表、MMSE量表、RM量表得分与对照组比较差异不具有统计学意义（P>0.05）。Logistic回归分析结果显示,患者年龄、三阴性乳腺癌均是影响乳腺癌患者发生认知障碍的独立危险因素(P<0.05)。结论:乳腺癌化疗能够使患者的认知障碍呈现异质性;三阴性乳腺癌患者认知障碍的严重程度高于非三阴性乳腺癌患者;患者年龄是影响三阴性乳腺癌发生认知障碍的独立危险因素。     

Ki67在三阴性和非三阴性乳腺癌中的表达及疗效预后分析

目的比较Ki67在三阴性乳腺癌(TNBC)和非三阴性乳腺癌(NTNBC)中的表达,探讨Ki67表达与不同分子亚型新辅助化疗(NCT)疗效及预后。方法选取2010年1月至2014年1月间收治的320例乳腺癌患者NCT的资料。比较Ki67表达在TNBC和NTNBC中的区别。结果320例患者中,TNBC 41例,NTNBC 279例,TNBC中Ki67增殖指数(42.56±26.55)明显高于NTNBC(26.44±19.5),差异有统计学意义(P<0.001)。Ki67高表达组病理完全缓解(p CR)率(18.0%)明显高于低表达组(8.7%),差异有统计学意义(P=0.037)。TNBC化疗后p CR水平(22.0%)高于NTNBC(14.3%),差异有统计学意义(P=0.206)。TNBC和NTNBC的3年无病生存期(DFS)分别为79.4%和82.3%(P=0.719);总生存期(OS)分别为85.7%和91.8%(P=0.127)。TNBC的p CR率(22.0%)显著高于Luminal A型(1.4%,P<0.001),但预后明显差于Luminal A型,3年OS分别为85.7%和97.3%(P=0.008)。NCT Ki67下降组p CR率为19.8%(48/243),明显高于未下降组的1.3%(1/77),差异有统计学意义(P<0.001),且预后明显优于未下降组。结论 Ki67表达在TNBC中最高。Ki67高表达组对化疗更敏感,近期疗效好,但预后较差,化疗后Ki67下降组疗效更好。     

三阴性乳腺癌异质性的研究进展

三阴性乳腺癌（triple-negative breast cancer,TNBC）是一种特殊类型的乳腺癌,因缺乏有效的治疗标靶,故临床预后较差。TNBC也是一种高度异质性的疾病。基于基因表达谱分析的结果,TNBC可分为六种不同的亚型,每种亚型均具有独特的分子生物学特性,常规化疗作为目前TNBC标准治疗方案仅能使部分患者获益。因此,以TNBC异质性为基础探究疾病个体化治疗策略显得尤为重要。本文重点探讨TNBC异质性及相应的治疗策略。     

乳腺癌化疗相关认知障碍的前瞻性记忆损害的特征

目的 探讨乳腺癌患者出现化疗相关认知障碍（CICI）中基于事件的前瞻性记忆（EBPM）和基于时间的前瞻性记忆（TBPM）损害的特征。方法 分别建立EBPM和TBPM的神经心理学测验方法,选取27例乳腺癌术后辅助化疗患者（观察组）以及年龄、教育程度相匹配的30例健康者（对照组）进行测试,记录两组数据并比较。结果观察组的EBPM得分为1.11±1.09,明显低于对照组的2.23±0.77（P＜0.01）;观察组和对照组的TBPM得分分别为4.33±1.24和4.83±1.09,差异无统计学意义（P＞0.05）。结论 乳腺癌患者出现CICI中存在前瞻性记忆损害,主要表现为EBPM损害,而TBPM损害不明显。     

淋巴结阴性的早期三阴性乳腺癌不同辅助治疗策略的预后分析

背景与目的早期三阴性乳腺癌(triple-negative breast cancer,TNBC)是否进行术后辅助化疗仍存有争议.本研究探讨不同术后辅助治疗策略对淋巴结阴性的早期TNBC预后的影响.方法 我们对本研究中心的乳腺癌数据库进行病例筛选,根据术后是否进行辅助治疗,将淋巴结阴性的浸润性TNBC患者分为3组:4次...     

乳腺癌术后化疗相关的情景记忆损害的特征分析

目的 探讨乳腺癌术后化疗相关认知障碍（CICI）患者的情景记忆损害的特征。方法收集本院2012年1月至2014年2月收治的40例女性乳腺癌患者，均给予6个周期的术后辅助化疗，分别于化疗前后采用简易精神状态量表（MMSE）、词汇流畅性测试（VFT）和数字广度（DS）评价其神经心理学背景情况，采用源记忆与项目记忆的神经心理学测验方法测试化疗前后的源记忆与项目记忆情况。结果40例患者化疗前后的MMSE、VFT和DS评分的差异均无统计学意义（P＞0.05）；且化疗前后的项目记忆成绩分别为（0.69±0.06）分和（0.66±0.08）分，差异无统计学意义（P＞0.05）；但其化疗后的源记忆成绩为（0.51±0.08）分，低于化疗前的（0.70±0.06）分，差异有统计学意义（P＜0.05）。结论乳腺癌CICI患者存在情景记忆损害，主要表现为源记忆的损害，而项目记忆却相对保留。     

Analysis of Memory Deficits Following Chemotherapy in Breast Cancer Survivors: Evidence from the Doors and People Test

Studies of cognitive effects of chemotherapy among breast cancer patients show that not all women who are exposed to chemotherapy develop cognitive dysfunction and that the observed declines in cognitive functioning may be quite subtle. The use of measures that are sensitive to subtle cognitive decline are recommended yet rarely used among clinical populations. The purpose of this study is to specify the types of memory changes observed among breast cancer survivors treated with chemotherapy and tamoxifen, by using an analytic test of memory, the Doors and People test, which uses age-adjusted norms. The participants were 40 women who were survivors of breast cancer, 20 of whom had completed chemotherapy treatment and 20 women who were treated only with tamoxifen. There were no significant differences between the two groups in overall scores and in all four subtests: visual memory, verbal memory, recall, and recognition measured by age-adjusted scores. Forty percent of patients in both of the groups were classified as having mild impairment in episodic memory. No between-group differences were found in the frequency of subjective, cognitive complaints. Subjective complaints were reported by 69% of patients but were unrelated to objective performance. Memory deficits were observed in breast cancer patients who receive either chemotherapy or tamoxifen alone compared to age-adjusted norms. The Doors and People Test is a sensitive measure of memory deficits that is feasible for use with clinical populations of breast cancer patients in order to monitor changes in cognitive function.     

'Normal counterparts' of nodal peripheral T-cell lymphoma

Peripheral T‐cell lymphomas (PTCL) have been difficult to classify. A homogeneous principle of classification is still lacking, partly because lymph node compartments containing functionally distinct T‐cell subsets have not been identified. A correlation to differentiated T‐cell subsets, as CD4⁺ or CD8⁺ cells as well as cytotoxic populations has not revealed clinically meaningful entities. Upon antigen encounter, mature T‐cells pass through distinct stages characterized by their surface molecule expression. Naïve T‐cells are CD45RA⁺/CD45R0^?/CD27⁺/CCR7⁺, however, after antigen contact CD45RA expression is replaced by CD45R0. They differentiate to central memory cells, which retain CD27 and CCR7, or to effector‐memory cells, which loose expression of both molecules depending on the strength of the antigen interaction. Immunohistological analysis of PTCL showed an effector or effector‐memory cell phenotype (CD45RA^?/CD45R0⁺/CD27^?) for both angioimmunoblastic T‐cell lymphoma (AILT) and anaplastic large cell lymphoma (ALCL), but different cytotoxic and activation markers expressed by these tumours. A subset of CD4⁺ PTCL‐not otherwise specified (PTCL‐NOS) may correspond to a central memory cell phenotype (CD45RA^?/CD45R0⁺/CD27⁺). Thus, a correlation of PTCL to stages of differentiation, rather than to the direction of differentiation, may reveal homogeneous categories. A comparison between the lymphomas and their normal counterparts maycontribute to the understanding of the underlying transformation mechanisms. Copyright © 2006 John Wiley & Sons, Ltd.     

Implication of chemo‐resistant memory T cells for immune surveillance in patients with sarcoma receiving chemotherapy

Chemotherapy has improved the prognosis of patients with sarcomas. However, it may suppress anti‐tumor immunity. Recently, we reported a novel CD8⁺ memory T cell population with a chemo‐resistance property, “young memory” T (T_YM) cells. In this study, we investigated the proportion and function of T_YM cells in peripheral blood of healthy donors and sarcoma patients who received chemotherapy and those who did not. The proportion of T_YM cells was significantly decreased in patients compared with that in healthy donors. In healthy donors, anti‐EBV CTLs were induced using mixed lymphocyte peptide culture, from not only T_YM cells but also T_CM and T_EM cells. No CTLs directed to tumor‐associated antigens were induced. In sarcoma patients who did not receive chemotherapy, in addition to anti‐EBV CTLs, CTLs directed to the tumor‐associated antigen PBF were induced from T_YM, T_CM and T_EM cells. In sarcoma patients who received chemotherapy, EBV‐specific CTLs were induced from T_YM cells but were hardly induced from T_EM cells. Interestingly, CTLs directed to the anti‐tumor‐associated antigen PBF were induced from T_YM cells but not from the T_CM and T_EM cells in sarcoma patients who received chemotherapy. The findings suggest that T_YM cells are resistant to chemotherapy and can firstly recover from the nadir. T_YM cells might be important for immunological memory, especially in sarcoma patients receiving chemotherapy.     

记忆性干细胞样T细胞在肿瘤治疗应用中的研究进展

记忆性干细胞样T细胞(stem memory T cells,TSCM)是最近几年发现的一个细胞亚群,约占外周血中总的CD4+T细胞和CD8+T细胞的2％～4％,是记忆性T细胞的早期分化阶段,具有记忆性细胞和干细胞的特点,基因谱介于初始T细胞和中央记忆T细胞之间.记忆性干细胞样T细胞具有自我更新和长期存活能力,这些特点使它们成为肿瘤领域关注的热点.本文将简述记忆性干细胞样T细胞的一些特点,以及它们在肿瘤治疗中的应用.     

Preliminary Assessment of Cognitive Function in Breast Cancer Patients Treated with Tamoxifen

Background. Tamoxifen is an anti-estrogen used in the treatment of breast cancer and to reduce the incidence of breast cancer in high risk women. Although the brain is an estrogen target organ and several studies have found a beneficial effect of estrogen on cognitive function, the effect of tamoxifen on cognition has not been reported. Therefore, we initiated a follow-up study of women who had participated in a study of breast cancer to assess the effect of tamoxifen treatment on cognitive function. Methods. We recruited previously interviewed patients who were cases in a population-based case-control study of 2,653 women with primary breast cancer diagnosed between 1987 and 1996 at ages 55–72 years in Los Angeles County, California, USA. In November 1997, each case was mailed a follow-up questionnaire. Cognitive function was assessed by (1) clock drawing, (2) copying a box drawing, and (3) narrative writing to describe a pictured scene. Women reporting treatment with tamoxifen were categorized as standard-term users (4–5 years), short-term users (<4 years) or long-term users (6+years) and compared to never users. Tamoxifen users were also classified as past or current users. Differences in the mean cognitive test scores were tested after adjusting for age, age at diagnosis, stage of disease, radiation therapy, chemotherapy, race, education, marital status, previous use of oral contraceptives, type of menopause, age at last menstrual period, previous use of hormone replacement therapy, and depressive symptoms using analysis of covariance. All p-values for differences in the proportion of women who had errors on the tests are 2-sided and adjusted for age, stage of disease at diagnosis, and chemotherapy. Findings. Information from 1,163 women aged 57–75 years of age was analyzed; 710 had taken tamoxifen. There was little difference between women who had used tamoxifen for the standard five years and never users on the three cognitive tests. However, more women who had used tamoxifen for the standard term reported seeing their physician for memory problems than non-users (3.8% vs 1.5%, p=0.04). This was especially true for current users of standard-term (8.0%, p=0.003). Current users also had a significantly lower mean complexity score (p=0.03) on the narrative writing task. No differences were seen between past users and non-users. Interpretation. Our study suggests that current use of tamoxifen may adversely effect cognition. Further study of tamoxifen and cognition is needed so that healthy women considering tamoxifen for the primary prevention of breast cancer have comprehensive information about the side effects of the treatment.     

吸入高－低氧对动物学习记忆能力的影响

目的探讨高低氧（ｈｉｇｈｃｏｎｃｅｎｔｒａｔｉｏｎｏｘｙｇｅｎ＋ｌｏｗｃｏｎｃｅｎｔｒａｔｉｏｎｏｘｙｇｅｎ,ＨＯ＋ＬＯ）放射治疗临床应用的可行性。方法跳台法检测昆明鼠吸入ＨＯ＋ＬＯ后,学习及记忆能力的影响。结果一次性吸入ＨＯ＋ＬＯ后１２,３６小时检测未见异常;连续吸入ＨＯ＋ＬＯ（每日１次,最长２０天）后２４,４８小时检测未见异常。结论呼吸ＨＯ＋ＬＯ对小鼠学习、记忆能力无影响。ＨＯ＋ＬＯ放射治疗具有临床应用的安全性和可行性。