多项指标联合鉴别诊断肺鳞癌与腺癌的病理研究

目的探讨多项指标包括癌胚抗原（CEA）、P63蛋白、天门冬氨酸蛋白酶A（Napsin A）联合在肺鳞癌与腺癌的病理学鉴别诊断中意义。方法分析我院自2011年1月至2013年1月收治的92例肺癌患者,其中鳞癌49例及腺癌43例,采用酶联免疫吸附法（ELISA）和免疫放射分析法（IRMA）检测CEA、P63蛋白、Napsin A。结果①CEA、P63蛋白、Napsin A在鳞癌与腺癌中的阳性率显著不同,在统计学上具有显著性意义（P〈0.05,0.005）。②腺癌转移癌中P63蛋白阳性率在原发性、转移性中比较,在统计学上具有显著性差异（P〈0.005）。③CEA、P63蛋白、Napsin A三者联合检测腺癌的敏感性为95.9%,联合检测腺癌的敏感性为90.7%。结论 CEA、P63蛋白、Napsin A三种肿瘤标志物用于病理学鉴别诊断肺腺癌与鳞癌,三者联合检测敏感性高,在检测肺癌中具有一定的应用价值。     

A variant form of hairy cell leukemia resistant to alpha-interferon: clinical and phenotypic characteristics of 17 patients

We describe the clinical and laboratory features of 17 adult patients with a variant form of hairy cell leukemia (HCL-V) studied over the last 7 years. The main findings were: splenomegaly, moderate anemia, thrombocytopenia, and a raised white blood cell count (median 116 x 10(9)/L; range 15 to 482). The circulating lymphoid cells had abundant villous cytoplasm and a round, occasionally bilobed nucleus, with a prominent nucleolus. Monocytopenia, a feature of typical HCL, was not seen; neither was tartrate-resistant acid phosphatase demonstrated in eight cases tested. HCL-V cells had a mature B-cell phenotype: CD19+, CD20+, CD22+, FMC7+, CD11c+, CD10-, CD5-, with light chain isotope restriction in 15 cases. In contrast to typical hairy cells, HCL-V cells were negative with the monoclonal antibodies anti-HC2 and anti- TAC (CD25). Immunoglobulin (Ig) was not detected in two cases and IgG was expressed in the cell membrane of 73% of cases. Bone marrow histology was different from HCL, showing interstitial infiltration by cells clumped together and a moderate amount of reticulin, but the spleen showed the typical red pulp expansion of HCL. HCL-V patients did not respond to splenectomy (5 of 7) or alpha-interferon (7 of 7); 2 of 3 patients had a partial response to 2'deoxycoformycin. The clinical course was benign with 15 patients alive with a median survival greater than 4 years. We confirm that HCL-V is a distinct clinico-pathologic entity with intermediate features between HCL and B-prolymphocytic leukemia.     

NICE thromboprophylaxis guidelines are not associated with increased pericardial effusion after surgery of the proximal thoracic aorta

IntroductionIn 2010 the National Institute for Health and Clinical Excellence (NICE) released guidelines on venous thromboembolism. Strategy focused on risk assessment, antiembolic stockings, sequential compression devices, subcutaneous high dose enoxaparin (40mg), early mobilisation and hydration. The 40mg enoxaparin dose over the previous 20mg regimen was worrisome, and its effect on pericardial effusion rates and mortality in proximal aortic surgery was investigated.MethodsProximal aortic reconstructions performed between December 2008 and April 2011 were identified from prospectively collected data in a tertiary centre database. Retrospective analysis of patient notes was performed. Proximal aortic surgery patients were categorised as low dose (20mg) enoxaparin and high dose (40mg) enoxaparin, and compared for confounding variables. In-hospital, early and one-year readmission rates for pericardial effusion were ascertained from echocardiography reports. The primary outcome was total pericardial effusion rate. Secondary outcomes consisted of 30-day and 1-year mortality.ResultsA total of 198 patients underwent proximal thoracic aortic surgery. Nine patients were excluded due to early postoperative death (n=5) and missing patient records (n=4). This left 189 cases for analysis. There were 93 patients in the low dose group and 96 in the high dose group. Groups were comparable for age, cardiopulmonary bypass time, aortic cross-clamp time, postoperative warfarin and antiplatelet agents. Pericardial effusion rates up to one year were comparable (low dose 19% vs high dose 21%). Thirty-day mortality was lower in the low dose group (0 vs 3 deaths). There were four deaths up to one year but these were not attributable to increased enoxaparin.ConclusionsIncreased perioperative thromboprophylaxis dosage does not increase pericardial effusion rates or mortality in proximal aortic surgery.     

便秘患者242例精神心理特点及相关因素分析

为探讨便秘患者的精神心理特点及相关因素分析,本研究应用症状自评量表SCL-90对242例功能性便秘患者的精神心理情况进行评价,并应用SPSS17．0软件对便秘患者异常精神心理状态的相关因素进行分析。结果显示,精神心理正常77例,异常165例。异常精神心理类型依次为：焦虑89例,抑郁49例,强迫11例,躯体化7例,人际关系5例,敌对3例,偏执1例。无恐怖、精神病性。异常精神心理与患者性别、年龄、职业均有一定关系,P〈0．05。结果表明,大多数功能性便秘患者都存在异常精神心理,临床中应根据患者性别、年龄、职业等给予有针对性的心理干预。     

Herodontics – is there a place for maintaining the apparently hopeless tooth?

The population is ageing and people are keeping their own teeth for much longer due in part to the efforts of the dental profession in restoring teeth and reducing the number of teeth being extracted. Along with this there is now an increasing expectation by patients that they will retain their own teeth as they age and that dental practitioners will have the knowledge and skills to help them retain their own teeth. Contemporary restorative materials and techniques have increased the range of options available to assist with maintaining the dentition, and many of these procedures enable minimally invasive and cost effective management of the teeth as an alternative to complex and expensive procedures. This paper discusses the restoration of compromised and failing teeth in the ageing patient, and looks at the various issues facing the ageing dentate patient and the dilemma of when to restore or when to extract. Ultimately it is hoped that maintaining healthy teeth for life may not only improve oral function and quality of life, but may in fact reduce the impact of the physical and psychological aspects of ageing.     

牙周病与糖尿病关联性的Meta分析

目的用Meta分析方法评价牙周病与糖尿病之间的关联性。方法检索中国知网、维普及万方数据库,以“糖尿病”和“牙周病”为检索词,对国内1999—2012年公开发表的牙周病与糖尿病相关性的文献进行筛选,根据RevMan5．0进行Meta分析,计算纳入文献数据的合并效应比值比（oddsratio,OR）。结果共检索到591篇文献,经严格筛查,符合纳入标准的文献8篇,异质性检验P〈0．00001,采用随机效应模型,Meta分析显示,牙周病合并糖尿病的OR值为2．36,95％可信区问为1．51～3．69,差异有统计学意义（P=0．0002）。结论牙周病患者并发糖尿病的患病率高于非牙周病患者,是非牙周病患者的2．36倍。     

脊柱颈胸交界段的MRI测量及其临床意义

目的:探讨有利于术前选择脊柱颈胸交界段手术入路的颈胸段MRI测量方法。方法:随机抽取95例颈椎MRI片,测量胸骨上切迹向后水平延长至相应椎体前缘的距离(AO)和对应的椎体或椎间隙,同时测量胸骨上切迹向后上方至C7/T1椎间隙前缘中点的距离(BO),测量AB间的距离及两线之夹角(称为颈胸手术角)。结果:AO距离平均为50.40mm,BO距离平均50.97mm,AB距离平均为41.41mm,夹角平均为47.64°。胸骨上切迹相对应的椎体最常见的为T3椎体的上1/3,其次为T2/3椎间隙。结论:颈胸段手术入路的选择可结合患者脊柱颈胸段的MRI表现,判断颈胸结合部与胸骨上切迹以及胸骨角水平面的关系,估计常规的下颈椎低位前方入路或经仅劈胸骨柄的手术入路能否到达颈胸结合部的病灶,从而便于选择损伤最小、手术时间最短、手术并发症较少、利于患者康复的手术入路。     

Improved arterial oxygenation in children with the adult respiratory distress syndrome: the prone position

Seven ventilated children with the adult respiratory distress syndrome (ARDS) were studied. While supine and haemodynamically stable, baseline arterial blood-gas analyses and haemodynamic measurements, including cardiac output, were performed. Each child was then turned prone and 30 min later a repeat set of measurements were made. Following this, the children were returned to the supine position and 30 min later a final set of measurements were performed. Ventilation and inotropic support remained unchanged during these positional changes. No significant effect on heart rate, mean systemic arterial blood pressure and cardiac output occurred following these positional changes ( p < 0.05; Friedman's ANOVA). Arterial oxygen saturation significantly improved, however, when nursed in the prone position ( p < 0.02). Similarly, oxygen delivery significantly increased ( p < 0.02). The prone position improves arterial oxygenation and oxygen delivery in children with ARDS. By adopting the prone position, in ventilated children with ARDS, we surmise that realistic gas exchange targets may be reachable with lower levels of inspired oxygen and/or peak airway pressures.     

An assessment of behavioural characteristics in infants who died of sudden infant death syndrome using the Early Infancy Temperament Questionnaire

An assessment of the behavioural peculiarities of infants dying of sudden infant death syndrome (SIDS) was carried out using the Early Infancy Temperament Questionnaire (EITQ). Thirty-six infants (25 boys and 11 girls aged 14 months) in whom the diagnosis of SIDS was confirmed by full necropsy and who died in St Petersburg from 1990 to 1992 entered the study, and the families were approached contemporaneously. A control group consisted of an equal number of age, sex, geographic distribution and date of birth matched live infants from the same city. The infants who died of SIDS had significantly lower estimates of activity in comparison with the babies from the control group. Behavioural defects may be a contributory factor and a sign of increased risk in some babies presenting with SIDS.