米非司酮调控乳腺癌细胞增殖的研究

目的研究米非司酮对乳腺癌细胞系MCF-7和T47D的增殖抑制作用。方法采用四甲基偶氮唑盐(MTT)法检测米非司酮对乳腺癌细胞系MCF-7和T47D的半数抑制浓度(IC50)。不同浓度米非司酮(0.25、2.5、25和50μmol/L)分别处理人乳腺癌细胞系MCF-7和T47D1、2、3d后,观察细胞形态变化,以及检测各组细胞生长曲线。结果米非司酮对乳腺癌MCF-7和T47D细胞均有抑制作用,其抑制率均随着米非司酮浓度的增加而变化,存在明显的量效关系。通过对两种细胞抑制率(IR)值直线回归分析,米非司酮对MCF-7细胞的IC50为51.21μmol/L,对T47D细胞的IC50为54.29μmol/L。形态学观察发现,各组细胞体积变小,细胞间的链接消失,细胞内明显有黑色小颗粒聚集。25和50μmol/L浓度米非司酮对MCF-7乳腺癌细胞株生长抑制作用明显,特别是50μmol/L干预24h后在高倍镜下可见明显的核质浓缩。结论米非司酮对病理分型、激素受体型不同的乳腺癌MCF-7和T47D细胞均具有抑制增殖的作用,并呈时间和剂量依赖效应。     

Correlation between pathological types of parathyroid and clinical manifestations in patients with renal secondary hyperparathyroidism

Objective To analyze the correlation between the pathological types of parathyroid and clinical manifestations in patients with renal secondary hyperparathyroidism (SHPT), so as to improve the efficacy and safety of treatment. Methods The pathological and clinical data of 130 patients with renal SHPT and maintenance hemodialysis (MHD) who had undergone total parathyroidectomy with autotransplantation (TPTX+AT) were collected. A total of 545 parathyroid glands were obtained and 998 slices were made and read. According to the pathological types of parathyroid hyperplasia, the patients were divided into diffuse hyperplasia (DH) group, diffuse between hyperplasia and nodular hyperplasia (DH/NH) group as well as nodular hyperplasia (NH) group. The clinical and biochemical characteristics of different groups before and after operation (1-, 3-, 6-, 9-, 12-month) were compared and analyzed by statistical tests. Results (1) The preoperative status: the dialysis age, serum calcium as well as incidence of bone pain, skin itching and shorten height in the NH group were significantly higher than those in the DH group (all P＜0.05), and the serum phosphorus and iPTH in the NH group were significantly higher than those in DH and DH/NH group (all P＜0.05). (2) The postoperative status: the serum calcium of the NH group at 1-month was lower than that of the DH group, and the incidence of hypocalcemia of the NH group at 1-month was higher than that of the DH group (P＜0.05); the serum phosphorus at 3-, 6-, 9-month and iPTH at 1-, 3-month of the NH group were significantly lower than that of the DH group (all P＜0.05), and the serum phosphorus at 3-month and iPTH at 1-month of the NH group were lower than that of the DH/NH group (all P＜0.05). Among the 3 groups the serum phosphorus change from 1 to 12 months had difference (F=3.241, P=0.042), while the differences of serum calcium and iPTH changes were statistically insignificant. Conclusions The clinical manifestations, serum calcium, phosphorus and iPTH in patients with renal SHPT before and after TPTX+AT are closely related to the pathological types of parathyroid hyperplasia. Compared with the DH patients, before the operation the NH patients have longer dialysis age, more serious the clinical symptoms such as bone disease, higher calcium, phosphorus and iPTH, while greater reduction of the serum calcium, phosphorus and iPTH in the short term after operation.     

多元实验室开放训练提升医学生临床技能的实践研究

目的 为提升医学生临床技能,探索多元实验室开放训练的实施方案及效果。方法 选取2015级808名临床医学本科生,在第5、6、7学期进行多元实验室开放训练。采取多元化预约方式：个人自主网络预约、书面预约、“挂号式”网络预约;多元化开放模式：学生自主练习、“工作坊”式专项操作培训、团队补课;多元化练习模块：基本技能、专科技能、综合技能。对学生多元实验室开放训练和实习结束后两阶段进行问卷调查的结果分析;比较2015级与2014级毕业技能考试成绩。采用SPSS 20.0软件进行t检验。结果 多元化实验室开放后,92.61%（664/717）的学生对开放模式满意;93.58%（671/717）的学生对预约方式满意;94.42%（677/717）的学生认为其能促进学习动力;97.35%（698/717）的学生认为其能激发学习兴趣;96.51%（692/717）的学生认为其能帮助知识和技能的掌握。实习后返校问卷显示：98.02%（741/756）的学生认为能提升临床技能;92.33%（698/756）的学生认为能培养临床思维;95.63%（723/756）的学生认为能增强实习自信心;94.18%（712/756）的学生认为能增加职业归属感。2015级临床医学生的毕业技能考试成绩[（90.33±5.59） vs. （82.22±7.19）]和单项技能成绩均优于2014级,差异有统计学意义（P<0.001）。结论 多元实验室开放训练可激发学生学习兴趣、提高学习动力,有助于提升学生临床技能和临床思维,能增强学生实习信心和职业归属感。     

中国肥厚型心肌病患者血栓栓塞事件风险预测模型的构建研究

背景 血栓栓塞（TE）事件是肥厚型心肌病（HCM）的重要并发症。目前针对HCM患者TE事件的风险预测,仅国外学者构建了两个模型：HCM Risk-CVA及French HCM score,然而,现有研究发现HCM Risk-CVA模型对于中国HCM患者的临床价值较为有限。目的 本研究拟构建适合中国HCM患者的TE事件风险预测模型。方法本研究系回顾性队列研究,收集2010—2018年在四川大学华西医院就诊的537例HCM患者的病例资料。本研究通过电话随访或电子病历系统查询患者就诊记录,每6～12个月随访1次,直至出现终点事件或死亡或研究拟定的评估日期（2019-12-31）,终点事件定义为复合性TE事件。采用单因素和多因素Cox回归分析构建风险预测模型,并使用自助重抽样的方法进行内部验证。结果 537例患者中,24例患者有不同程度的数据缺失,最终纳入513例患者。中位随访时间为4.2(1.3,6.2)年,随访过程中42例（8.18%）发生TE事件,年发病率为2.10%[95%CI(1.47%,2.73%)]。根据多因素Cox回归模型构建TE事件风险预测模型,最终纳入年龄、既往TE事件、心...     

肺癌组织分型与转化生长因子-βⅡ型受体和肿瘤相关性巨噬细胞计数的关系

目的 检测肺腺癌和肺鳞状细胞癌中转化生长因子-βⅡ型受体(TGF-βRⅡ)和肿瘤相关性巨噬细胞(TAMs)计数,探讨两者与肺腺癌和肺鳞状细胞癌的关系.方法 应用免疫组织化学法检测TGF-βRⅡ蛋白和TAMs在肺腺癌和肺鳞状细胞癌组织中的表达,并与癌旁正常肺组织中的表达进行比较.结果 (1)TGF-βRⅡ蛋白的表达在肿瘤组织中明显降低(P＜0.01),其表达下调与肺癌的组织学类型、淋巴结转移、临床分期相关(P＜0.05).(2)TAMs在肿瘤间质内浸润数量明显增多(P＜0.01),并与肺癌的组织学类型、肿瘤大小、淋巴结转移、临床分期密切相关(P＜0.05).结论 TGF-βRⅡ蛋白表达水平降低可促进肺癌的发生、浸润和转移,对肺腺癌发生或进展影响很大,并可能通过下调TGF-βRⅡ的表达、诱导TAMs至肿瘤间质,从而促进肿瘤的发生、发展,且这种作用在非小细胞肺癌中具有较普遍的意义.     

Chromogranin A,a Marker of the Therapeutic Success of Resection of Neuroendocrine Liver Metastases: Preliminary Report

Recent publications indicate that life may be prolonged by surgical debulking of neuroendocrine tumors. A minimum 90% reduction of liver metastases has been suggested to alleviate symptoms of the carcinoid. We have used the tumor marker chromogranin A (CgA) to assess hepatic resection in patients with neuroendocrine metastatic tumor disease. Since 1998, seven patients (3 men) of median age 73 years (range 64–84 years) with carcinoid primary tumors in the ileum who had solitary (n = 2) or multiple (n = 5) liver metastases underwent hepatic resections. Two patients had synchronous small intestinal and liver resections; the rest had deferred hepatic resections after intestinal resection. Hormonal manifestations in the form of loose stools or diarrhea or flushing were observed in five patients, and five had abdominal symptoms from partial obstruction of the small bowel. The resection was deemed radical in five patients. Two patients with non-radical resection needed postoperative octreotide treatment, and symptoms were alleviated or improved in the others. All seven patients are alive with an observation period from 6 to 64 months (median 36 months). Median CgA (normal < 30 ng/ml) was 292 ng/ml (range 79-14,000 ng/ml) before liver surgery. Postoperatively, CgA became normal in three of the radically resected patients, whereas in two others, it decreased to a lowest median level of 79 ng/ml (range 52–105 ng/ml). In two palliatively resected patients, one had a near normalization to 65 ng/ml, and the last patient had a reduction from 14,000 to 2400 ng/ml following debulking surgery. A similar postoperative reduction was noted for 24 hr urinary 5-HIAA excretion. Postoperative octreotide scintigraphy suggested residual hepatic or extrahepatic tumors in three of the patients thought radically resected, whereas two had no clear sign of disease corresponding to a normal CgA value. The CgA values, however, reflected the extent of positive scintigraphy findings. Serum CgA levels monitored the extent and short-term course of the disease and corresponded well with scintigraphy findings and 5-HIAA excretion, but prolonged follow-up in more patients may be necessary before decisive conclusions are allowed to be drawn.     

Arthroscopic meniscal repair using T-fix

We evaluated the arthroscopic meniscal repair using T-fix and present our preliminary results. The series included 47 consecutive patients who underwent meniscal repair using T-fix. Mean follow-up was 26 months (range 12-42 months). The overall number of T-fixes used in the repairs was 163, with a mean of three (range two to five) per patient. Patients were evaluated according to the modified Marshall scoring system. Results were rated as excellent in 32, good in 10, fair in 2, and poor in 3 patients. Second-look arthroscopy was performed in 18 patients as the part of our protocol. In 15 patients meniscal tears were considered to be healed, according to Henning's criteria. Six of those who underwent anterior cruciate ligament reconstruction healed completely. There were no neurovascular complications. Repair of the menisci using T-fix proved successful and reliable. In view of satisfactory functional results and the observation of healing of tears on second-look arthroscopy, we believe that preservation and repair of menisci should be attempted in appropriate cases.     

Salivary function in patients with chronic renal failure undergoing hemodialysis

PURPOSE: The aim of this study was to evaluate the changes in salivary gland function in patients with chronic renal failure (CRF) undergoing hemodialysis. METHODS: The group consisted of 23 patients with CRF (13 female, 10 male; mean age: 40 +/- 13 yr) and 14 healthy control subjects (mean age: 40 +/- 13 yr). All underwent dynamic salivary gland scintigraphy with gustatory stimulation. After intravenous administration of 99mTc pertechnetate, first, perfusion images at 2 seconds per frame were acquired for 1 minute, then dynamic images at 1 minute per frame were acquired for 45 minutes. At 30 minutes after injection, 10 ml lemon juice was given for 15 minutes as a gustatory stimulus. We obtained time-activity curves derived from regions of interest centered over the four major salivary glands. The following functional indices were calculated for each gland: the time of maximum radioactivity (Tmax) for the prestimulated period, the time of minimum radioactivity (Tmin), as an indicator of velocity of secretion after stimulation, and the Lem E5% value as an indicator of the secretion function. RESULTS: When the patients with CRF undergoing hemodialysis were compared to the controls, there were statistically significant differences in Tmax, Tmin and Lem E5% values for bilateral parotid glands, and Tmin values for bilateral submandibular glands (p < 0.05), there were no statistically significant differences in Tmax and Lem E5% values for bilateral submandibular glands. There were also significant differences in Tmax and Lem E5% values for bilateral parotid glands between mild oral problems and severe oral problems in patients with CRF (undergoing hemodialysis). CONCLUSION: In this study, prolonged Tmax and Tmin values, and decreased Lem E5% values for parotid glands and prolonged Tmin values for submandibular glands on salivary scintigraphy pointed out decreased parenchymatous and excretory function in patients with CRF undergoing hemodialysis.     

Benign cervical thymoma masquerading as a malignant thyroid nodule

A thymoma in the neck region is a rare diagnosis involving a solitary neck nodule that moves with deglutition and is contiguous with the thyroid gland. The authors report an unusual case of a thymoma that accumulated both Tc-99m pertechnetate and Tc-99m MIBI. This is probably the first reported case of a benign neck thymoma concentrating these two radiopharmaceuticals. Thymoma should be added to the gamut of false-positive findings in the neck for thyroidal (with Tc-99m pertechnetate) and malignant (with Tc-99m MIBI) tissue.