老年子宫颈癌患者生存情况及其影响因素分析

目的:探讨影响老年子宫颈癌患者术后生存的影响因素.方法:对1980年1月～1998年12月诊治的老年子宫颈癌243例临床资料和随访结果进行回顾性分析.采用Kaplan-Meier法计算累积生存率,用Log-Rank法比较各因素不同水平生存分布的差异,进一步应用COX回归模型进行预后因素分析.结果:全组子宫颈癌术后5、10、15年累积生存率分别为87％、81％、75％,Log-Rank分析结果显示不同临床分期、不同组织分化程度、有无淋巴结转移、不同治疗方法患者生存差异存在明显差异(x2=23.172,P＜0.05;x2=32.766,P＜0.05;x2 =25.086,P＜0.05;x2 =28.906,P＜0.05).年龄、不同生长方式、肿瘤直径、有无辅助治疗水平间生存差异无统计学意义(P＞0.05),COX模型多因素分析表明:临床分期、组织分化程度、淋巴结转移是影响预后的独立因素(P＜0.01).结论:临床分期、淋巴结转移、组织分化是影响老年子宫颈癌预后的独立危险因素,及早发现和合理降低临床分期是治疗老年子宫颈癌以及提高预后的关键手段.     

子宫内膜微创技术对体外受精和胚胎移植妊娠结局影响的研究

目的探讨子宫内膜微创术对不孕症妇女体外受精-胚胎移植(IVF-ET)妊娠结局的影响。方法选择2010年1月-2012年6月在新疆医科大学第一附属医院生殖助孕中心74例接受IVF-ET/卵胞浆内单精子注射(ICSI)的不孕症患者,以采用子宫内膜微创术的41例患者作为治疗组,在促排周期月经来潮24h内进行子宫内膜微创术;以未进行子宫内膜微创术的33例为对照组,比较两组的胚胎种植率及临床妊娠率。结果治疗组与对照组胚胎种值率分别26.51%和11.43%,差异有统计学意义(P<0.05);治疗组与对照组临床妊娠率分别为43.90%和21.21%,差异有统计学意义(P<0.05)。结论不孕症妇女进行子宫内膜微创术后能够显著提高IVF-ET/ICSI周期的胚胎种植率及临床妊娠率,改善妊娠结局。     

米非司酮对不同月经周期异位和在位子宫内膜雌激素受体α和孕激素受体表达的影响

目的 探讨米非司酮对雌激素受体α(ERα)和孕激素受体(PR)在不同月经周期的子宫腺肌症中表达的影响.方法 47例行全子宫切除术的子宫腺肌症患者分为米非司酮组(n=24)和未用药组(n=23);无腺肌症的正常子宫内膜作为对照组(n=15).运用免疫组化的方法测定异位和在位子宫内膜及正常子宫内膜在不同月经周期的腺上皮及间质细胞中ERα和PR水平.结果 未用药组ERα和PR在异位子宫内膜腺上皮及间质细胞中的表达均低于在位内膜及对照组正常内膜(P<0.05).对照组及未用药组ERα和PR在在位内膜腺上皮细胞中的表达,增生期高于分泌期(P<0.05),而在未用药组异位内膜,差异无统计学意义(P>0.05).ERα和PR在异位和在位子宫内膜中的表达,米非司酮组低于未用药组(P<0.05).结论 ERα和PR在异位子宫内膜中的表达与在位子宫内膜不同;异位内膜丧失了正常内膜的周期性变化规律;米非司酮通过下调其性激素受体(ERα和PR)含量治疗子宫腺肌症.     

Coexistence of benign phyllodes tumor and invasive ductal carcinoma in distinct breasts: case report

This report describes a rare case of coexistence of benign phyllodes tumor, which measured 9 cm in the right breast, and invasive ductal carcinoma of 6 cm in the left breast, synchronous and independent, in a 66-year-old patient. The patient underwent a bilateral mastectomy due to the size of both lesions. Such situations are rare and usually refer to the occurrence of ductal or lobular carcinoma in situ when associated with malignant phyllodes tumors, and more often in ipsilateral breast or intra-lesional.     

Successful endoscopic ultrasound-guided overstenting biliary drainage through a pre-existing proximal migrated metal biliary stent

Biliary endoscopic drainage using metallic self-expanded stents has become a well-established method for palliative treatment of malignant biliary obstruction. However, its occlusion, mainly by tumor overgrowth, is still the main complication without a standard treatment. We here describe a new method of treatment for biliary metallic stent occlusion, through the echo guided biliary drainage. We present a 68-year-old patient with metastatic pancreatic cancer previously treated for jaundice with ERCP and self-expandable metallic stent insertion. Four weeks later, the patient developed jaundice and symptoms of gastric outlet obstruction. A new ERCP confirmed obstruction of the second portion of the duodenum, due to diffuse tumor growth. EUS was performed, and the previous metal biliary stent was seen occluded at the distal portion in the common bile duct. A EUS-guided choledocododenostomy was performed and then, an overlapping self-expanding metal enteral stent was placed through the malignant obstruction. There were no early complications and the procedure was also clinically effective in relieving jaundice and gastric outlet obstruction symptoms. If ERCP fails in the management of occluded biliary metallic stents, EUS biliary drain can provide effective biliary decompression and should be considered an alternative to other endoscopic techniques.     

Global vascular expression of murine CD34, a sialomucin-like endothelial ligand for L-selectin

Extravasation of leukocytes into organized lymphoid tissues and into sites of inflammation is critical to immune surveillance. Leukocyte migration to peripheral lymph nodes (PLN), mesenteric lymph nodes (MLN) and Peyer's patches (PP) depends on L-selectin, which recognizes carbohydrate-bearing, sialomucin-like endothelial cell surface glycoproteins. Two of these ligands have been identified at the molecular level. One is the potentially soluble mucin, GlyCAM 1, which is almost exclusively produced by high endothelial venules (HEV) of PLN and MLN. The second HEV ligand for L-selectin is the membrane-bound sialomucin CD34. Historically, this molecule has been successfully used to purify human pluripotent bone marrow stem cells, and limited data suggest that human CD34 is present on the vascular endothelium of several organs. Here we describe a comprehensive analysis of the vascular expression of CD34 in murine tissues using a highly specific antimurine CD34 polyclonal antibody. CD34 was detected on vessels in all organs examined and was expressed during pancreatic and skin inflammatory episodes. A subset of HEV-like vessels in the inflamed pancreas of nonobese diabetic (NOD) mice are positive for both CD34 and GlyCAM 1, and bind to an L-selectin/immunoglobulin G (IgG) chimeric probe. Finally, we found that CD34 is present on vessels of deafferentiated PLN, despite the fact that these vessels are no longer able to interact with L-selectin or support lymphocyte binding in vitro or trafficking in vivo. Our data suggest that the regulation of posttranslational carbohydrate modifications of CD34 is critical in determining its capability to act as an L-selectin ligand. Based on its ubiquitous expression, we propose that an appropriately glycosylated form of vascular CD34 may act as a ligand for L-selectin-mediated leukocyte trafficking to both lymphoid and nonlymphoid sites.