在黑色素瘤组织中免疫细胞的形态学观察

目的　探讨肿瘤浸润树突状细胞 (tumorinfiltratingdendriticcell,TIDC)和肿瘤浸润淋巴细胞(tumorinfiltratinglymphocyte ,TIL)的形态学特征。 方法　采用光镜、透射电镜和免疫组织化学方法观察 9例人皮肤黑色素瘤中TIDC和TIL的分布及形态。结果　TIDC主要分布在乳头层和癌周区及癌巢内 ,病变早期TIDC浸润比晚期明显 (P <0 0 1)。电镜下 ,TIDC体积大 ,形态不规则 ,表面有许多树枝状突起 ,核不规则 ,有切迹。胞浆内有丰富的线粒体、核糖体、内质网。TIDC具有两种形态 ,一种表现为突起多 ,细胞器丰富 ,另一种表现为突起较少 ,细胞器也较少。TIDC与肿瘤细胞、TIDC与TIL、TIL与肿瘤细胞之间存在多种接触形式。同时可见TIL与TIL ,TIDC与TIDC之间也有密切接触。还可见树突状细胞 淋巴细胞环 ,淋巴细胞环绕癌细胞。结论　TIDC和TIL存在于黑色素瘤组织 ,TIDC有两种类型。     

含ω-3PUFA早期肠内营养对严重多发伤患者能量摄入、血糖波动、免疫状态及临床结局的影响

背景 严重多发伤患者处于高代谢状态,易发生营养不良,予以早期肠内营养尤为重要,ω-3多不饱和脂肪酸可为机体提供能量,可能通过调节严重多发伤患者免疫状态、能量代谢、血糖水平等,改善临床结局.目的 探讨含ω-3多不饱和脂肪酸(ω-3PUFA)早期肠内营养对严重多发伤患者能量摄入、血糖波动、免疫状态及临床结局的干预效果.方法...     

Muscle-strengthening activities and risk of cardiovascular disease,type 2 diabetes,cancer and mortality: A review of prospective cohort studies

The benefits of aerobic moderate-to-vigorous physical activity (MVPA) on major non-communicable diseases (NCDs) are well established. However, much less is known whether muscle-strengthening activities (i.e., resistance/weight/strength training) confer similar benefits. Herein, we conducted a narrative literature review and summarized the existing evidence from large prospective cohort studies on muscle strengthening activities and risk of major chronic diseases and mortality in adults generally free of major NCDs at baseline. Current epidemiologic evidence suggests that engagement in muscle-strengthening activities over 1–2 sessions (or approximately 60–150 min) per week was associated with reduced risk of cardiovascular disease (seven studies; approximately 20%–25% reduction), type 2 diabetes (four studies; approximately 30% reduction), cancer mortality (four studies; approximately 15%–20% reduction) as well as all-cause mortality (six studies; approximately 20%–25% reduction). For diabetes, the risk appears to lower further with even higher levels of muscle-strengthening activities, but some studies for cardiovascular and all-cause mortality suggest a reversal whereby higher levels (≥2.5 h/week) have less benefit, or are even harmful, relative to lower levels of activity. The likely mechanisms contributing to a benefit include improvement in body composition, lipid profile, insulin resistance and inflammation. The evidence supports engaging in 1–2 sessions (up to 2.5 h) per week, preferably performed complementary to the recommended levels of aerobic MVPA. Although data are limited, caution is suggested for training exceeding 2.5 h per week. Further studies are required to better understand the influence of frequency, duration and intensity of muscle-strengthening activities on major NCDs and mortality in diverse populations.     

阑尾杯状细胞腺癌临床病理学观察

目的探讨阑尾杯状细胞腺癌(goblet cell adenocarcinomas,GCA)的临床病理学特征及免疫表型特征,分析其生物学行为。方法收集北京大学第一医院2015—2018年诊断的7例GCA的临床资料,进行形态学观察,按照2019年WHO消化系统肿瘤分类第5版重新分级,并行免疫组织化学EnVision法染色及电镜观察,随访患者并复习相关文献。结果7例患者中男性2例,女性5例;年龄48~72岁,中位年龄58岁。1例为阑尾游离端出现局限性肿物,切面灰白实性,质地中等;其余6例阑尾弥漫增粗;镜下观察均可见低级别GCA,5例同时伴有高级别GCA,3例分级为1级,3例分级为2级及1例分级为3级。6例可见神经侵犯,1例可见脉管癌栓。免疫组织化学染色嗜铬粒素A、突触素、CD56、广谱细胞角蛋白、癌胚抗原、细胞角蛋白20、MLH1、MSH2、MSH6和PMS2均阳性,Ki-67阳性指数5%~50%,p53在高级别GCA的表达强度及阳性细胞数高于低级别GCA。随访14~46个月,6例患者生存,1例患者死亡。结论GCA为阑尾较少见的肿瘤,同时具有神经内分泌及腺上皮的分化,生物学行为从惰性到高度侵袭性均可。     

纤维软骨性间叶瘤一例

纤维软骨性间叶瘤(fibrocartilagenous mesenchymoma,FM)是一种罕见的骨内原发性交界性肿瘤。本文报道1例13岁男性,L3椎体肿物,组织形态学显示具有轻度不典型性的梭形细胞密集增生,软骨呈团巢状散在分布,部分似骺板样结构,局部有不规则新生骨形成。免疫组织化学结果:平滑肌肌动蛋白、S-100蛋白、结蛋白、CD34、上皮细胞膜抗原、p16及p53等均阴性,Ki-67阳性指数约2%。分子表型:GNAS、IDH1和IDH2基因无突变,MDM2基因无扩增。患者术后108个月无复发及转移。诊断时应着重与纤维软骨性结构不良、去分化软骨肉瘤及低级别中心性骨肉瘤等鉴别。     

急性下肢静脉血栓形成的双介入治疗

目的 探讨双介入溶栓疗法治疗急性下肢静脉血栓形成的溶栓效果和临床应用中的有关问题。方法 对24例急性下肢静脉血栓形成患者行介入溶栓治疗,其中17例行股静脉插管法,7例行股动脉插管法。平均尿激酶用量250万～500万U。结果 阻塞血管完全开通18例,部分开通3例,无效3例,总有效率87.8％。结论 急性下肢静脉血栓形成的双介入疗法效果显著。