颈部呈胸腺样分化癌一例报告并文献复习

1病例报告患者男,43岁,2007-10-28体检发现右颈前区肿块3cm×3cm,B超示甲状腺右叶峡部实质生肿块,考虑甲状腺肿瘤,于2007-11-09在嘉兴市第一医院行甲状腺肿瘤切除术。术中发现双侧甲状腺肿大,右侧肿大明显,肿块质地硬,边界不清,侵犯肌肉,周围淋巴结未见肿大。冷冻切片报告:甲状腺未分化     

嗜酒者血脂分析及临床应用

目的：探讨嗜酒者脂代谢紊乱合并冠心病和其他动脉硬化性血管病的患病危险因素。方法：对50例年龄在35～55岁的男性嗜酒者进行血脂分析，并与50例无饮酒史的健康查体者做对比分析。结果：嗜酒者脂质异常率(28％)明显高于对照组健康例查者(12％)。结论：嗜酒是引起继发性脂代谢紊乱合并冠心病和其他动脉粥样硬化性血管病的重要因素。     

抗环瓜氨酸肽抗体检测新进展

类风湿关节炎（rheumatoid arthritis,RA）是一种病因不明的系统性慢性自身免疫性疾病,主要临床特征为对称性、反复性多滑膜关节炎,最终可导致不可逆的骨关节损伤。RA 的早期诊断、治疗对提高患者的生活质量和生存率有重要意义。1987年美国风湿病协会（American Rheumatism Associa-tion,ACR）首次制定了 RA 的诊断标准,包括临床表现、影像学特征以及类风湿因子（rheumatoid fac-tor,RF）测定等方面,但是,RA 患者在达到该标准时可能早已发生骨关节损伤。此外,RF 也可见于其他自身免疫性疾病、慢性感染患者或老年人的血清中,因此其用于诊断 RA 的特异性较差。2009年ACR 和欧洲抗风湿病联盟（The European League Against Rheumatism,EULAR）提出,将抗环瓜氨酸肽（cyclic citrullinated peptide,CCP）抗体纳入RA 的新的诊断标准中。     

食管癌分次放疗期间靶区不确定性初步研究

Objective To investigate the changes of target during fractionated radiotherapy for e-sophageal cancer, and to assess their impact on the implementation of radiotherapy. Methods Fourteen pa-tients with unresectable esophageal cancer were enrolled to receive full course conformal radiotherapy. CT scans were performed after every ten fractions. New targets (GTV) were delineated on repeated CT scans. Then the pretreatment radiotherapy plans were copied to the new targets to investigate the conformity between the new GTV and the plans. Results The majority of the GTVs decreased with the increasing fractions dur-ing radiotherapy. However, GTVs of 35.7% (5/14) patients increased by 2.0%-37.7% at the tenth frac-tion. The PTVs covered by 95% isodose curve at the time of pretreatment,tenth fraction,twentieth fraction and thirtieth fraction were 97.81%±1.53%, 91.95%±5.25%, 94.27%±4.23% and 94.03%±6.45%, respectively. Moreover, at tenth, twentieth and thirtieth fraction, there were 6,5, and 4 patients whose PTVs covered by 95% isodose curve were below 95%, respectively. Conclusions There are signifi-cant target changes during fractionated radiotherapy for esophageal cancer, which may result in uncertainties of radiotherapy implementation.     

食管癌分次放疗期间靶区不确定性初步研究

Objective To investigate the changes of target during fractionated radiotherapy for e-sophageal cancer, and to assess their impact on the implementation of radiotherapy. Methods Fourteen pa-tients with unresectable esophageal cancer were enrolled to receive full course conformal radiotherapy. CT scans were performed after every ten fractions. New targets (GTV) were delineated on repeated CT scans. Then the pretreatment radiotherapy plans were copied to the new targets to investigate the conformity between the new GTV and the plans. Results The majority of the GTVs decreased with the increasing fractions dur-ing radiotherapy. However, GTVs of 35.7% (5/14) patients increased by 2.0%-37.7% at the tenth frac-tion. The PTVs covered by 95% isodose curve at the time of pretreatment,tenth fraction,twentieth fraction and thirtieth fraction were 97.81%±1.53%, 91.95%±5.25%, 94.27%±4.23% and 94.03%±6.45%, respectively. Moreover, at tenth, twentieth and thirtieth fraction, there were 6,5, and 4 patients whose PTVs covered by 95% isodose curve were below 95%, respectively. Conclusions There are signifi-cant target changes during fractionated radiotherapy for esophageal cancer, which may result in uncertainties of radiotherapy implementation.     

食管癌分次放疗期间靶区不确定性初步研究

Objective To investigate the changes of target during fractionated radiotherapy for e-sophageal cancer, and to assess their impact on the implementation of radiotherapy. Methods Fourteen pa-tients with unresectable esophageal cancer were enrolled to receive full course conformal radiotherapy. CT scans were performed after every ten fractions. New targets (GTV) were delineated on repeated CT scans. Then the pretreatment radiotherapy plans were copied to the new targets to investigate the conformity between the new GTV and the plans. Results The majority of the GTVs decreased with the increasing fractions dur-ing radiotherapy. However, GTVs of 35.7% (5/14) patients increased by 2.0%-37.7% at the tenth frac-tion. The PTVs covered by 95% isodose curve at the time of pretreatment,tenth fraction,twentieth fraction and thirtieth fraction were 97.81%±1.53%, 91.95%±5.25%, 94.27%±4.23% and 94.03%±6.45%, respectively. Moreover, at tenth, twentieth and thirtieth fraction, there were 6,5, and 4 patients whose PTVs covered by 95% isodose curve were below 95%, respectively. Conclusions There are signifi-cant target changes during fractionated radiotherapy for esophageal cancer, which may result in uncertainties of radiotherapy implementation.     

乳腺癌骨转移患者骨代谢指标PICP、β-CTx与治疗效果的关系

目的 探讨骨代谢指标Ⅰ型胶原羧基端前肽(carboxyl-terminal propeptide of type 1 procollagen,PICP)、β胶原降解产物(beta collagen degradation products,β-CTx)与乳腺癌骨转移患者治疗反应的关系.方法 测定56例乳腺癌骨转移患者治疗前后骨代谢指标PICP和β-CTx,比较治疗前后骨代谢指标与治疗效果的关系,并进行随访.结果 56例乳腺癌骨转移患者中,临床获益组36例,治疗3月后PICP和β-CTx明显下降(P=0.016,P=0.001);病情进展组20例,治疗3月后PICP和β-CTx有所升高(P=0.008,P=0.042).临床获益组中20例患者骨代谢指标先于影像学检查提示临床治疗有效.结论 PICP和β-CTx可作为乳腺癌骨转移患者评价疗效的辅助指标.     

上海地区肌酐检测一致性探索及估算肾小球滤过率的临床初步应用

目的 探索上海地区血清Cr临床检测结果的一致性,进行表面健康人群的分布调查,并通过改良的适用于中国人群的MDRD公式计算eGFR,了解其分布情况,进一步评估eGFR的临床适用性.方法 每次实验前将自动化分析系统校准品(c.f.a.s.)中含有的根据IFCC推荐方法测得的Cr值传递到1份新鲜人混合血清,以此校准各参加医院检验科的Cr检测系统.14家医院检验科先后进行6次试验,并在检测结果基本一致后进行6 837名(男3 289名,女2 132名,儿童及青少年1 416名)、年龄段为0～99岁的表面健康人群Cr值测定及调查,并依据文献发表的适用于上海人群的GFR估算公式[eGFR=175×(血清Cr)-1.154×(年龄)-0.203×0.742(女性)×0.827]估算表面健康人群的eGFR值.结果 校准前各参加医院检验科之间的Cr检测值CV为3.1%～9.1%,校准后各医院之间检测值具有良好的一致性,CV降至5%以下.Cr人群分布调查后,得到结果为:成年男性63.0～102.8 μmol/L、成年女性:45.0～76.0 μmol/L;儿童及青少年:0～1岁11.0～77.0 μmol/L,＞1～＜3岁15.5～33.3 μmol/L,3～5岁19.0～42.0 μmol/L,6～19岁41.4～62.0μmol/L.成年男女间Cr存在差异,男性为(82.1±10.9)μmol/L、女性为(59.4±8.4)μmol/L,差异有统计学意义(t=94.3,P＜0.01);eGFR值可减小性别间的差异[男性为(79.1±13.5)ml·(min·1.73 m2)-1;女性为(79.2±13.6)ml·(min·1.73 m2)-1,差异无统计学意义,t=0.266,P＞0.05].成年人按年龄每10岁分组,统计显示Cr及eGFR年龄组间均存在差异(x2值分别为2601、1105,P均＜0.01).结论 采用新鲜人混合血清,可以使不同医院(不同检测系统)之间的Cr检测值差异明显减小;Cr人群分布应按性别、年龄加以区分;使用eGFR可减小性别差异,但无法消除年龄间差异.     

标本前处理流程优化的评价

目的评价流程优化在标本前处理过程中的作用。方法应用“精益思想”分析中山医院检验科生化组目前的标本前处理流程并进行优化,评价流程优化前、后标本前处理的改善情况。结果在标本前处理流程中应用真空管和条形码,对离心起始位置的设置、离心步骤的顺序以及标本前处理的批次进行优化。通过以上改进措施,使中山医院检验科生化组完成100个血清标本的前处理时间由过去的56．0mn缩短为现在的21．5min,工作效率提高了61．6％。结论运用流程优化对实验室检验流程进行必要的改进,可以大大缩短标本的前处理时间,提高工作效率。