表浅食管鳞癌黏膜下深部浸润发生淋巴结转移的危险因素分析及风险分层

目的 探索表浅食管鳞癌黏膜下深部浸润淋巴结转移的危险因素,在此基础上构建预测淋巴结转移风险的评分系统,并初步评价评分系统的临床应用价值。 方法 2005—2017年南京大学附属鼓楼医院267例外科术后病理证实为黏膜下深部浸润（距黏膜肌层≥200 μm）的表浅食管鳞癌病例纳入回顾性分析,采用多元Logistic回归分析探索淋巴结转移的独立危险因素,选取P＜0.1的自变量建立危险因素评分系统并对自变量赋分,根据受试者工作特征(receiver operating characteristic,ROC)曲线分析的临界值对267例病例进行风险分组,淋巴结转移率行多组间对比分析。 结果 267例表浅食管鳞癌黏膜下深部浸润者中,71例（26.59%）术后病理证实存在淋巴结转移。多元Logistic回归分析显示：分化程度为中度或低度（P=0.015,OR=2.802,95%CI：1.225～6.409）、血管侵犯（P=0.043,OR=3.450,95%CI：1.040～11.445）、淋巴管侵犯（P＜0.001,OR=36.985,95%CI：13.699～99.856）为淋巴结转移的独立危险因素,黏膜肌层增生异常不是淋巴结转移的独立危险因素（P=0.081,OR=2.005,95%CI：0.918～4.380）,但P＜0.1。根据上述4个因素建立评分系统,黏膜肌层增生异常赋1分、分化程度为中度或低度赋1分、血管侵犯赋2分、淋巴管侵犯赋5分,ROC曲线分析显示淋巴结转移的最佳诊断界点为评分＞2分,将267例病例分为低危组（评分0～1分,n=143）、中危组（评分2～5分,n=79）和高危组（评分6～9分,n=45）,3组间淋巴结转移率比较差异有统计学意义（χ2=119.712,P＜0.001）,且趋势卡方检验结果显示3组淋巴结转移率具有线性上升趋势（χ2=109.298,P＜0.001）。 结论 中度和低度分化、血管侵犯、淋巴管侵犯为表浅食管鳞癌黏膜下深部浸润发生淋巴结转移的独立危险因素,上述3个因素结合黏膜肌层增生异常构建的淋巴结转移风险评估系统具有较好的临床应用价值,有助于个体化指导临床决策,对术后管理具有重要意义。     

Details determining the success in establishing a mouse orthotopic liver transplantation model

Liver transplantation(LT) is currently the only effective treatment option for endstage liver disease. The importance of animal models in transplantation is widely recognized among researchers. Because of the well-characterized mouse genome and the greater diversity and availability of both genetically modified animals and research reagents, mouse orthotopic LT(MOLT) has become an ideal model for the investigation of liver biology, tissue injury, regulation of alloimmunity and tolerance induction, and the pathogenesis of specific liver diseases. However, due to its complicated and technically demanding procedure, the model has merely been used by only a few research groups in the world for years. For a new learner, training lasting at least a couple of months or even years is required. Most of the investigators have emphasized the importance of elaborate techniques and dedicated instruments in establishing a MOLT model, but some details are often neglected. The nontechnical details are also significant, especially for researchers who have little experience in mouse microsurgery. Here, we review and summarize the crucial technical and nontechnical details in establishing the model of MOLT based on scientific articles and our experience in six aspects: animal selection, anesthesia, perioperative management, organ procurement, back-table preparation, and implantation surgery. We aim to enable research groups to shorten the learning curve and implement the mouse LT procedure with high technical success.     

脑微出血部位和负荷与脑梗死抗血小板治疗的相关分析

目的探讨脑微出血(CMB)发生部位和负荷对脑梗死抗血小板治疗风险及获益的影响。方法选择伴CMB的急性脑梗死患者214例,根据CMB发生部位分为单纯脑叶组39例,深部/幕下组62例,混合部位组113例,随访各组新发脑梗死、脑出血情况,并比较各组治疗前及治疗1年后CMB的变化。结果深部/幕下组既往脑梗死、高血压和糖尿病比例明显高于单纯脑叶组和混合部位组(P<0.05)。混合部位组基线CMB数高于单纯脑叶组和深部/幕下组[(8.69±2.75)个vs(6.65±2.47)个、(6.58±3.17)个,P<0.05]。单纯脑叶组脑出血比例明显高于深部/幕下组和混合部位组(12.8%vs 3.2%、2.7%,P<0.05),且发生脑出血患者中4例基线CMB数>5个。深部/幕下组再发脑梗死比例明显高于单纯脑叶组和混合部位组(24.2%vs 7.7%、9.7%,P<0.05)。3组治疗1年后仅部分患者复查头颅MRI,其中单纯脑叶组28例,深部/幕下组40例,混合部位组56例。单纯脑叶组CMB进展比例明显高于深部/幕下组和混合部位组,差异有统计学意义(35.7%vs 12.5%、10.7%,P<0.05),且病灶以脑叶为主。结论抗血小板治疗风险与CMB部位和负荷相关,单纯脑叶CMB抗血小板治疗的脑出血风险增加,治疗后CMB更易进展。深部/幕下CMB患者脑梗死复发风险更高。     

The association of lipopolysaccharide and inflammatory factors with hepatopulmonary syndrome and their changes after orthotopic liver transplantation

Background

The level of lipopolysaccharides (LPS) and inflammatory factors were higher in end stage liver disease patient than in normal person for the damage of intestinal mucosal barrier function. Hepatopulmonary syndrome (HPS) was a common pulmonary complication in end stage liver disease. But the association of LPS and inflammatory factors such as toll like receptor 2 (TLR2), TNF-α and ET-1 with the development of HPS was undefined.

Methods

Thirty-one HPS patients were researched (26 patients were performed liver transplantation, five were not). Ten healthy volunteers were recruited as negative control. Blood was collected from the 26 HPS patients before and 3, 7, 14, 21 and 28 days after orthotopic liver transplantation (OLT), and from five HPS patients without OLT and ten healthy volunteers once to detect TLR2 mRNA and iNOS mRNA in peripheral blood monocytes and plasma LPS, TNF-α and ET-1 level. Their levels before and after OLT were compared.

Results

TLR2 mRNA, iNOS mRNA, LPS, TNF-α and ET-1 before OLT in HPS patients were 336,594.1±366,901.1, 63,982.2±74,127.5 copies/ugRNA, 4.3±3.3, 90.1±76.0 and 319.9±124.4 ng/L, respectively. They were 10,338.3±3,814.6, 19,168.5±2,417.4 copies/ugRNA, 0.94±0.69, 2.7±0.1 and 84.2±10.6 ng/L in normal control group. They were significantly higher in HPS patients than those in control group (P<0.05). After OLT, liver function improved to normal. Also TLR2 mRNA, TNF-α and ET-1 decreased in HPS patients after OLT compared with those before OLT. And PaO₂ and PaO₂/FiO₂ improved greatly with intrapulmonary shunt decreased to normal after OLT.

Conclusions

Lipopolysaccharides at the end stage of liver disease with the release of series of inflammatory factors may be associated with the development of HPS.     

Infrequent ERBB2 mutations in Chinese patients with non-small cell lung cancer

ERBB2 mutations have been reported to occur in a subset of patients with lung adenocarcinomas or lung squamous cell carcinomas for some ethnicities, but it is unclear for Chinese patients with lung squamous cell carcinomas up to now. We retrospectively evaluated the status of ERBB2 mutations in a large cross-sectional cohort of 212 Chinese patients with non-small cell lung cancer (NSCLC) diagnosed in several hospitals from southern China during a time period of 1.5 years by polymerase chain reaction (PCR)-based direct sequencing and PCR-single strand conformation polymorphism (PCR-SSCP) analysis. ERBB2 mutation was found in 1 of 49 lung adenocarcinomas (2.0%) and none in lung squamous cell carcinomas and lung adenosquamous carcinomas. It implies the occurrence of ERBB2 mutations is infrequent in Chinese patients with NSCLC, especially in lung squamous cell carcinomas.     

Predictive risk factors for lymph node metastasis in patients with small size non-small cell lung cancer

Background

Accurate clinical staging of non-small cell lung cancer (NSCLC) is essential for developing an optimal treatment strategy. This study aimed to determine the predictive risk factors for lymph node metastasis, including both N1 and N2 metastases, in clinical T1aN0 NSCLC patients.

Methods

We retrospectively evaluated clinical T1aN0M0 NSCLC patients who showed no radiologic evidence of lymph node metastasis, and who had undergone surgical pulmonary resection with systematic mediastinal node dissection or sampling at the First Affiliated Hospital of Zhejiang University between January 2011 and June 2013. Univariate and multivariate logistic regression analyses were performed to identify predictive factors for node metastasis.

Results

Pathologically positive lymph nodes were found in 16.2% (51/315) of the patients. Positive N1 nodes were found in 12.4% (39/315) of the patients, and positive N2 nodes were identified in 13.0% (41/315) of the patients. Some 9.2% (29/315) of the patients had both positive N1 and N2 nodes, and 3.8% (12/315) of the patients had nodal skip metastasis. Variables of preoperative radiographic tumor size, non-upper lobe located tumors, high carcinoembryonic antigen (CEA) levels and micropapillary predominant adenocarcinoma (AC) were identified as predictors for positive N1 or N2 node multivariate analysis.

Conclusions

Pathologically positive lymph nodes were common in small size NSCLC patients with clinical negative lymph nodes. Therefore, preoperative staging should be performed more thoroughly to increase accuracy, especially for patients who have the larger size, non-upper lobe located, high CEA level or micropapillary predominant ACs.     

季节性指数平滑法在预测某院儿科门诊人次中的应用

目的应用季节性指数平滑法预测某院儿科门诊人次,为儿科合理调配医疗资源提供科学依据。方法基于2013年1月1日-2018年12月31日某院儿科门诊人次数据,使用SPSS22.0软件建立季节性指数平滑模型,采用2016年1月1日-2018年12月31日各季度儿科门诊人次数据进行验证,并对2019年1月1日-2020年12月31日儿科门诊人次进行预测。结果季节性指数平滑法的最优预测模型为Winters相加模型,该模型在Gamma(趋势)、Delta(季节)均有统计学意义,平稳的R^2分别为0.76,R^2值为0.79,标准化的BIC为20.69,模型残差为白噪声序列,平均相对误差为8.85%;2019年1月1日-2020年12月31日某院儿科门诊人次的预测仍呈现出持续上升的季节性和周期性趋势。结论季节性指数平滑法的Winters相加模型能够较好的拟合该院儿科门诊人次的实际值,可用于儿科门诊量及变化趋势的预测,值得推广应用。     

YAG激光周边虹膜切开术对难治性青光眼治疗后眼内压的影响

分析钇铝石榴石晶体(YAG)激光周边虹膜切开术对难治性青光眼治疗后眼内压的影响。回顾性分析80例(116眼)行YAG激光周边切开术的难治性青光眼患者的临床资料,结果显示术后1 h不同能量患者眼压均有一过性升高(P<0.05),0~45 mJ组术后1 h眼压低于46~80 mJ组、＞80 mJ组(P<0.05);46~80 mJ组术后1 h眼压又低于＞80 mJ组(P<0.05);术后1 h ＞80 mJ患者高眼压发生率高于0~45 mJ组(P<0.05),其余各时间点比较差异无统计学意义(P>0.05);术后1 h,难治性青光眼房水闪光值上升(P<0.05),术后1周较术后1 h降低(P<0.05),术后4 周恢复至术前水平;激光能量、房水闪光值均与难治性青光眼患者术后1 h眼压呈正相关(r=0.485、0.612,P<0.05)。因此,激光能量、房水闪光值均与难治性青光眼YAG激光周边虹膜切开术后早期眼压变化有关,即随激光能量及房水闪光值的增加,患者术后早期眼压上升。     

火针治疗结节性痒疹的临床研究进展

结节性痒疹属于结节性损害,四肢分布较多,尤以小腿伸侧分布较为常见,女性居多,为临床上较难治疗的慢性炎症性皮肤病之一。 结节性痒疹瘙痒无比且病程较长,又具有损容性,给病人的生活和身心都带来了巨大影响。如何较好治疗结节性痒疹,在医学界仍是一个较难解决的问题。近年来,随着医疗技术的不断研究和发展,火针疗法在治疗结节性痒疹中因其止痒迅速、简便价廉、疗效确切,在临床上大力推广,成为比较热门的治疗方法。文章通过近些年关于火针治疗结节性痒疹的文献查阅,介绍了结节性痒疹的发病机制及治疗方法,为临床医生对结节性痒疹的治疗提供多种治疗方法和思路,从而更好地将火针疗法推广到临床。