脊柱转移性肿瘤的诊断和治疗

脊柱是肿瘤骨转移的最常见部位,而脊柱转移性肿瘤在所有脊柱肿瘤中又最为常见：据统计大约有７０％因肿瘤而死亡的病例尸检时可发现脊柱转移性肿瘤。有３／４的脊柱转移性肿瘤来自乳腺、前列腺、肺或血液系统肿瘤,就发生节段而言则又按颈椎、胸椎、腰椎的顺序发生率逐渐...     

Regulation of alloantigen-mediated T-cell proliferation by endogenous interferon-gamma: implications for long-term allograft acceptance.

BACKGROUND: Recent data suggest that interferon (IFN)-gamma is not an essential mediator of acute rejection but, instead, is critical for the induction of long-term allograft acceptance. The in vivo mechanisms by which endogenous IFN-gamma regulates the alloimmune response and thus facilitates the induction of long-term allograft survival are not known. METHODS: We examined long-term cardiac and skin allograft survival, alloantigen-induced T-cell proliferation, and alloantigen-induced T-cell apoptosis in wild-type (IFN-gamma+/+) and IFN-gamma gene-knockout (IFN-gamma-/-) mice treated with either B7-CD28 T-cell costimulation blockade alone or B7-CD28 T-cell costimulation blockade combined with donor splenocyte transfusion. RESULTS: We found that IFN-gamma is essential for long-term allograft survival induced by treating mice with either B7-CD28 T-cell costimulation blockade alone or B7-CD28 T-cell costimulation blockade combined with donor splenocyte transfusion. Alloantigen-induced T-cell proliferation in vivo was significantly greater in IFN-gamma-/- mice than in IFN-gamma+/+ mice, and T-cell costimulation blockade abrogated alloantigen-induced T-cell proliferation in wild-type mice but failed to do so in mice that lack IFN-gamma. In contrast, alloantigen-induced T lymphocyte apoptosis in vivo did not differ between IFN-gamma+/+ and IFN-gamma-/- mice, and T-cell costimulation blockade enhanced alloantigen-induced T-cell apoptosis in both mouse strains. CONCLUSIONS: These data suggest that endogenous IFN-gamma facilitates the induction of long-term allograft survival by limiting the proliferation of alloactivated T lymphocytes. The data also suggest that B7-CD28 T-cell costimulation blockade exerts immunosuppressive actions by inhibiting the proliferation of activated T lymphocytes and by promoting their apoptosis.     

携带GJB2基因突变中老年人的听力学特点分析

目的 对中老年人进行GJB2基因突变筛查,探讨携带不同GJB2基因突变的中老年人的听力情况.方法 收集648例中老年人的听力学资料和血样,提取基因组DNA,经聚合酶链反应(polymerase chain reaction,PCR)扩增GJB2基因编码区,利用直接测序方法获得基因型,并应用统计学分析方法研究携带GJB2基因突变的中老年人在不同听力组间的分布情况及携带不同GJB2基因突变中老年人的听力情况.结果 根据听力学资料,将所有中老年人分为四组:正常对照组(A组,157人,24.23%)、轻度听力下降组(B组,199人,30.71%)、中度听力下降组(C组,226人,34.88%)、重度听力下降组(D组,66人,10.19%);通过直接测序的方法,共发现22例分别携带4种移码突变,包括235delC杂合突变(16例,2.78%)、299-300delAT杂合突变(3例,0.46%)、176-191del16杂合突变(1例,0.15%)、512insAACG杂合突变(2例,0.31%);所有突变携带者在不同组间的分布情况为:正常对照组3人(13.64%)、轻度听力下降组6人(27.27%)、中度听力下降组8人(36.36%)、重度听力下降组5人(占22.73%);对四种突变携带者的听力学情况进行分析,176-191del16突变携带者的听力下降程度最轻,而512insAACG突变携带者的听力下降程度最重,经统计学分析, 左耳0.25 kHz频率的平均听阈值在各种突变携带者间的差异具有统计学意义(P=0.03).结论 与整体中老年人群相比,携带GJB2 基因突变的中老年人在中度听力下降组和重度听力下降组间所占的比例增高;各种突变携带者听力下降程度不同.     

Neutrophil/eosinophil-rich type of primary cutaneous anaplastic large cell lymphoma: a clinicopathological, immunophenotypic and molecular study of nine cases

Aims:  To elucidate the clinicopathological, immunophenotypic and molecular features of neutrophil/eosinophil-rich primary cutaneous anaplastic large cell lymphoma (CALCL), and to emphasize the cutaneous manifestations, differential diagnosis and prognosis of this peculiar entity.
Methods and results:  We described the clinical presentations, histopathology, immunophenotype, molecular features and follow-up courses of nine neutrophil/eosinophil-rich CALCL cases. Various clinical lesions including multiple nodules, plaques and solitary exophytic masses with or without ulceration or crusting were noted in nine patients. Two patients died of disease progression, with one developing multiple lymph node involvement. Histologically, cohesive sheets or small clusters of neoplastic cells were admixed with large numbers of neutrophils and/or eosinophils, representing 10–40% of cells per high-power field. All nine cases showed T-cell phenotypes. The frequency of rearranged TCRB , TCRG and TCRD genes in six cases with available paraffin-embedded tissue was 100%, 83% and 33%, respectively.
Conclusions:  Neutrophil/eosinophil-rich CALCL should be differentiated from various infectious and non-infectious diseases, especially from non-neoplastic cutaneous CD30+ infiltrates rich in neutrophils and eosinophils. Precise correlation of clinical presentation, morphological features, phenotypic and molecular analysis can help to establish the correct diagnosis. Whether this rare variant has a significantly different prognosis from classical CALCL needs further investigation.     

Comparison between a traditional single still image and a multiframe video image along the z‐axis of the same microscopic field of interest in cytology: Which does contribute to telecytology?

The limitation of cytologic still images is one of the reasons why telecytology has not met with widespread acceptance by the cytology community. Cytologic still image only displays a single depth of field, and this is a particularly acute problem in cytology where the specimen is often much thicker than a single microscopic depth of focus. In this article, we examine the validity of a “z‐axis” video of a microscopic field of interest. After observing videos of fields of interest from 10 cases, five cytotechnologists reached suitable cytologic findings and diagnosed the fields correctly in great majority of cases. Five other cytotechnologists, who looked only at a single representative still image, could not always make a correct diagnosis. The difference between two observer groups was statistically significant by Wilcoxon's matched pairs signed‐rank test. The results indicate that “z‐axis” video of microscopic field of interest provides a similar experience to “focusing through” observation of the specimen under a microscope and may improve an accuracy of primary telecytodiagnosis. And we expect that video image telecytology will strongly influence cytology, especially in education and training. Diagn. Cytopathol. 2009. © 2009 Wiley‐Liss, Inc.     

Assessment of cerebral oxygenation during prolonged simulated driving using near infrared spectroscopy: its implications for fatigue development

Information on cerebral oxygenation during prolonged driving in healthy humans may help to explain the cause and development of central fatigue and its effects on cortex activities. The objective of this study is to investigate the time course of cerebral oxygenation during a prolonged driving task. Forty healthy male subjects were randomly divided into two groups: task group (Task) and control group (CNL). All subjects were required to rest well prior to the experiment. For the task group, subjects were required to perform the simulated driving task for 3 h. Cerebral oxygenation signal was monitored from the left frontal lobe using near infrared spectroscopy throughout the entire experiment. Significant increases in the concentrations of HbO₂ (ΔCHbO₂) and HbT (ΔCHbT) were recorded at the start of driving task compared with the resting value (p < 0.01). The cerebral oxygen saturation in the Task group was found to be significantly lower following three hours of driving compared with that in the CNL (F = 16.95, p < 0.001). In addition, a significant difference in selective reaction time was observed between the Task group and CNL during the post-task period (p = 0.023). The results demonstrated that the cerebral oxygenation is closely related to the mental stress. The decrease in the cerebral oxygen saturation may indicate reduced cerebral oxygen delivery, and this may be an important factor affecting central fatigue development during prolonged driving.     

Professional Commitment, Patient Safety, and Patient-Perceived Care Quality

Purpose: To examine how professional commitment influences patient safety and patient-perceived care quality.
Design: Investigators for this study used a cross-sectional design with questionnaires. A total of 348 pairs of nurses and inpatients were contacted at two medical centers in Taiwan during the period from August 2007 to January 2008, yielding 284 pairs of completed questionnaires.
Methods: Frequencies of six adverse patient events were used to measure patient safety; and the Service Quality Scale was used to measure patient-perceived care quality. Four items of the Professional Commitment Questionnaire were used to measure professional commitment. Regressions were used for the analyses.
Findings: Professional commitment positively influenced overall patient safety (ß=.19, p =.00) and overall patient-perceived care quality (ß=.13, p =.03). Furthermore, professional commitment positively influenced all patient safety indicators (ß≥.12, p ≤.04), except frequency of nosocomial infections, the coefficient of which reached borderline significance (ß=.11, p =.07). Professional commitment also positively influenced care quality in terms of responsiveness (ß=.16, p =.01) and empathy (ß=.14, p =.03).
Conclusions: Professional commitment may enhance patient safety and patient-perceived care quality.
Clinical Relevance: This study indicates that nurse professional commitment can enhance patient safety and patient-perceived care quality.