肝细胞癌切除术后复发行二次手术切除疗效研究

目的 评估二次肝切除手术（RHR）治疗切除术后复发型肝细胞癌（HCC）病人的安全性和有效性。方法 回顾性分析2007年1月至2011年12月第二军医大学东方肝胆外科医院HCC术后首次复发未行任何治疗的175例行RHR的病人临床资料,统计长期存活率并行预后相关因素分析。结果 RHR后严重并发症的发生率为7.4%,1、3、5年总存活率和无瘤存活率分别为92%、71%、51%和为75%、43%、36%。高龄（>65岁）、首发肿瘤巴塞罗那（BCLC）分期B期、肿瘤出现微血管侵犯、肿瘤直径和肿瘤包膜不完整是影响RHR后总存活率的风险因素。结论 RHR的适应证应严格掌握,经筛选可行者,其安全性较高且疗效理想。高龄（>65岁）、首发肿瘤BCLC分期B期、肿瘤出现微血管侵犯、肿瘤直径和肿瘤包膜不完整的HCC病人RHR后预后相对较差,考虑可否缩短随访时间或联合其他治疗。     

Primary malignant melanoma of the esophagus

Primary malignant melanoma of the esophagus is a rare but aggressive tumor that accounts for less than 0.1-0.2% of all esophageal malignancies. The aim of this study was to report a case of primary malignant melanoma of the esophagus in a 72-year-old woman. The diagnosis was histologically proven, but the patient died despite extensive surgical resection.     

Cognitive decline correlates with neuropathological stage in Parkinson's disease

Recently, the relationship between cognitive status and the neuropathological stages of a newly proposed staging procedure for Parkinson's disease (PD) was assessed in a cohort of 88 individuals. None of the patients had received the clinical diagnosis of dementia with Lewy bodies. The topographic distribution pattern of the cerebral Lewy body pathology was evaluated semiquantitatively in alpha-synuclein immunoreactions. MMSE scores from the last neurological examination prior to death were used to determine cognitive status and the degree of cognitive decline. Four subgroups of Mini-Mental State Examination (MMSE) scores ranging from nonsignificantly impaired to severely impaired cognition were analyzed statistically with nonparametric tests. Each of the 88 cases could be assigned to one of the PD stages 3-6, and MMSE scores correlated significantly with the aforementioned stages. Since the median MMSE scores decreased from stages 3-6, it is probable that the risk of developing dementia in PD becomes greater as the disease process in the brain progresses.     

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??Value of preoperative lymphoscintigraphy in sentinel lymph node biopsy of breast cancer SUN Xiao*, LIU Juan-juan, WANG Yong-sheng, et al. *Breast Cancer Center, Shandong Cancer Hospital, Jinan 250117, China
Correcponding author: WANG Yong-sheng, E-mail: wangysh2008@yahoo.com.cn
Abstract Objectives Background Although preoperative lymphoscintigraphy for sentinel lymph nodes biopsy (SLNB) in breast cancer patients is undergone commonly, its clinical significance remains controversial. Methods Firstly, a database containing 716 consecutive breast cancer patients who received preoperative lymphoscintigraphy before SLNB was retrospectively analyzed. Secondly, 565 consecutive breast cancer patients were prospectively randomized into groups with or without preoperative lymphoscintigraphy before SLNB. Results In the retrospective study, sentinel lymph nodes (SLNs) were well imaged by lymphoscintigraphy in 86.6% patients, and negative lymphoscintigraphy results were associated with axillary node metastases. Failure of identification of SLNs by isotope alone was associated with whether axillary hot spot was imaged by lymphoscintigram (P<0.001). There were no significant differences in the false negative rate (P=0.731) of SLNB by isotope alone, in the identification rate (P=0.174) and the false negative rate (P=0.947) of SLNB by combination of dye and isotope between patients who had axillary hot spot in lymphoscintigram and those who had not. In the prospective study, 290 patients were randomized into the group with preoperative lymphoscintigraphy (82.1% patients were well imaged by lymphoscintigraphy) and 275 patients without. There were no significant differences between two groups in the identification rate (P=0.757) and the false negative rate (P=1.00) of SLNB by isotope alone, also in the identification rate (P=1.00) and the false negative rate (P=1.00) of SLNB by combination of dye and isotope. Conclusion Preoperative lymphoscintigraphy could not improve the identification rate and reduce the false negative rate of SLNB in breast cancer patients, and it is not a prerequisite for SLNB.     

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??Cathepsin-D and nm23 provide the predictive value of response to anthracycline-based neoadjuvant chemotherapy in breast cancer CHEN Yi-zuo*, CHEN Can-ming, FEI Fei, et al. *Department of Breast Surgery?? Cancer Hospital??Fudan University.Department of Oncology, Shanghai Medical College, Fudan University,Shanghai 200032??China Corresponding author: WU Jiong, E-mail: wujiong1122@vip.sina.com Abstract Objective To investigate the predictive value of biological markers for responsiveness to anthracyline-based regimen in neoadjuvant systemic therapy. Methods Post-operative paraffin-embedded tumor samples from 173 breast cancer patients were examined for expression of ER??PR??Her-2/neu??and other 15 markers by immunohistochemistry, to analyze the predictive value of these biological markers for response to neoadjuvant chemotherapy. Results For the primary tumor, the clinical objective response was 66.47%?? 29.48%SD,and 4.05% PD. Pathological complete response was found in 3 cases(1.73%).Negative nm23, and loss of Cathepsin-D were significantly predictive for an effective response to anthracycline-based neoadjuvant chemotherapy. In multivariate logistic regression analysis, only the Cathepsin-D status was found for independent predictive value. Conclusion Loss of Cathepsin-D independently predicts the response to anthracycline-based regimen.     

我国分娩镇痛现状和亟待解决的问题

好的产科镇痛管理模式应为：医院可以随时提供完成全身或区域阻滞麻醉的合格人员和设备。分娩镇痛的有效完成是产科与麻醉科通力合作的结果,双方都应该认识到有必要为所有患者提供高品质的服务,共同创建分娩镇痛医疗服务体系。     

白三烯D4对白细胞介素4诱导嗜酸性粒细胞趋化因子-3在支气管上皮细胞表达的影响

目的研究白三烯D4是否参与调节支气管上皮细胞表达嗜酸性粒细胞趋化因子-3(eotaxin-3，Eot-3)，探讨白三烯和支气管上皮细胞在气道变态 反应性炎症中的作用。 方法用白三烯D4预处理支气管上皮细胞1h，然后用白细胞介素-4(IL-4)刺激细胞24h，RT-PCR法检测Eot-3在mRNA水平的表达；ELISA法检测细胞 培养上清液中Eot-3蛋白的表达。 结果未经处理的支气管上皮细胞仅表达微量的Eot-3，用IL-4刺激细胞并培养24h后，在mRAN和蛋白水平的Eot-3表达明显增强，白三烯D4预处理 细胞1h，可以使IL-4的这种诱导作用加强。 结论支气管上皮细胞不仅是一种屏障细胞，也是一种效应细胞，在炎症介质的刺激下能表达Eot-3，参与支气管炎症的产生。白三烯D4通过上调 IL-4诱导Eot-3在上皮细胞的表达可能是其参与支气管哮喘嗜酸性粒细胞炎症的机制之一。     

肺隔离症12例诊断和治疗分析

目的总结12例小儿肺隔离症的诊断和治疗经验。 方法1994-01—2006-08，对温州医学院附属育英儿童医院收治的12例经手术和病理检查证实为肺隔离症的患儿临床资料进行回顾性分析。 结果12例肺隔离症患儿胸部X线均发现肺部异常阴影，7例呈圆形、类圆形或不规则实性块影，5例呈囊性及多囊性阴影改变；术前确诊5例，1例 经主动脉逆行造影证实，4例经螺旋CT三维重建、MRI检查发现胸主动脉与病灶之间有异常血管相通,术前高度怀疑肺隔离症3例，术前有4例误诊 ；8例叶内型肺隔离症患儿行肺叶切除术，4例叶外型肺隔离症行单纯隔离肺切除术。 结论临床医师应提高对肺隔离症的认知和重视程度。为降低肺隔离症误诊率，对可疑的肺隔离症患儿提倡螺旋CT三维重建和胸部MRI检查。