睾丸神经内分泌癌的临床病理分析

目的探讨睾丸小细胞神经内分泌癌的临床病理特征和生物学行为。方法回顾分析睾丸小细胞神经内分泌癌1例并复习有关文献予以讨论。结果患者术前未得到明确的病理诊断,术后2周恢复良好,痊愈出院。出院3周后右腋窝淋巴结转移,7周后全身转移死亡。病理检查：肿瘤细胞表达神经内分泌标记物神经原特异性烯醇酶、嗜铬粒蛋白A和突触素。结论睾丸小细胞神经内分泌癌是一种比较少见的高度恶性肿瘤,有独特的病理形态,早期即可发生转移,预后凶险,死亡率高。     

经皮穿刺置管引流在重症急性胰腺炎治疗中应用时机的选择对患者预后影响

目的本研究旨在评估经皮穿刺置管引流(percutaneous catheter drainage,PCD)在重症急性胰腺炎(severe acute pancreatitis,SAP)治疗中应用时机的选择对患者结局和并发症方面的影响。方法回顾性分析2018年1月1日至2018年12月31日德阳市人民医院胰腺中心收治的75例接受PCD治疗的SAP患者的临床资料,研究患者的临床表现、PCD应用时期及其疗效。结果75例SAP患者中液体聚集期(ANC期)51例(68%),包裹坏死形成期(WON期)24例(32%),死亡0例(0%),治愈70例(93.3%),5例(6.7%)行进一步外科治疗。两期的平均PCD放置持续时间、并发症发病率(胰瘘、导管阻塞或脱落、出血)差异无统计学意义(P>0.05)。结论PCD在SAP不同阶段(ANC期和WON期)的应用不影响其安全性和疗效,延迟使用并不能取得较好的疗效。     

分次经尿道膀胱肿瘤电切术加化疗治疗高危晚期膀胱癌(附5例报告)

目的 探讨分次经尿道膀胱肿瘤电切术加化疗治疗高危晚期膀胱癌的治疗效果.方法 对2006年6月至2008年6月我院5例高危晚期膀胱癌患者行分次经尿道膀胱肿瘤电切术加化疗的综合措施进行分析.结果 全部患者治疗的短期效果好,能改善患者的生活重质量,延长患者的生命.结论 分次经尿道膀胱肿瘤电切加化疗是高危晚期膀胱癌的较好的治疗方法,有望降低瘤荷,降低肿瘤分期,可作为高危晚期膀胱癌的较好的治疗方法.     

糖尿病角膜内皮的定量分析

用非接触型角膜内皮显微镜,对18例(24眼)糖尿病患者和19例(20眼)年龄配对的非糖尿病人的角膜内皮进行检查并照像。内皮照片用计算机图像处理系统进行分析。与对照组比较,糖尿病人的角膜内皮细胞不仅密度显著下降,且呈现大小和形态多形性。研究表明,糖尿病角膜内皮不正常,角膜内皮显微镜联合计算机图像处理技术可早期对此作出诊断。     

经支气管针吸活检术在纵隔及肺部疾病诊断中的应用价值

目的探讨经支气管针吸活检术(transbronchial needle aspiration,TBNA)在纵隔及肺部疾病诊断中的价值。方法对68例CT提示肺占位或单纯纵隔淋巴结肿大患者行TBNA检查,再以毛刷在穿刺点处刷检,如果可见局部黏膜增厚或充血水肿需另行活检,取得的标本送病理学检查。比较TBNA与活检、刷检组的诊断阳性率,评价TBNA的有效性及安全性,分析其影响因素。结果 68例患者中阳性56例,诊断阳性率为82.4%,高于常规检查组(51.5%)(P<0.05)。隆突下淋巴结组阳性率高于非隆突下淋巴结(96.0%比63.2%)(P<0.05),淋巴结直径≥2 cm组阳性率高于淋巴结直径<2 cm组(92.6%比60.7%)(P<0.05)。22例少量出血,无其他并发症。结论 TBNA对纵隔及肺部疾病的诊断有较大的临床应用价值,且安全性较高     

Seizure Deterioration with Increased Levetiracetam Blood Concentration during the Postpartum Period in Refractory Temporal Lobe Epilepsy

We evaluated a 39-year-old pregnant woman with right temporal lobe epilepsy. During the second trimester, seizure deterioration was responsive to an increased daily dose of levetiracetam (LEV). However, immediately after delivery, new non-habitual seizures emerged along with a sharply increased LEV concentration. The frequency of habitual seizures also slightly increased. The non-habitual seizures completely disappeared, and the frequency of the habitual seizures improved to the baseline level after the LEV dosage was reduced. Thus, a paradoxical effect of an increased LEV blood concentration was assumed to be a potential cause of these events. Peripartum pharmacokinetic fluctuations in LEV levels should be monitored carefully.     

Creation and testing of the Geriatric Self-Efficacy Index for Urinary Incontinence

OBJECTIVES: To report on the content development, construct validity, and reliability testing of the Geriatric Self-Efficacy Index for Urinary Incontinence (GSE-UI).
DESIGN: Prospective cohort study.
SETTING: Six UI outpatient clinics in Quebec, Canada.
PARTICIPANTS: Community-dwelling incontinent men and women aged 65 and older.
MEASUREMENTS: Thirty-eight items were generated using a literature search and interdisciplinary panel of experts. Item reduction was achieved through field-testing with 75 older men and women with UI attending an information session. The final 20-item draft, measuring older adults' level of confidence in preventing urine loss, was administered to a new group of consecutive patients 1 week before and at the time of their first visit to the UI clinic to enable evaluation of test–retest reliability. A 3-day voiding diary, quantifying the frequency of UI, and the Incontinence Quality of Life questionnaire were used to test construct validity.
RESULTS: One hundred sixteen of 300 eligible patients (39%) participated (mean age±standard deviation 74±6, range 65–87). The GSE-UI items showed normal distributions and no ceiling effects. Self-efficacy scores ranged from 16 to 193 (mean 104±41, possible range 0–200) and correlated positively with quality of life scores ( r =0.7, P <.001) and negatively with UI severity ( r =−0.4, P <.001). Internal consistency for the GSE-UI was 0.94 (Cronbach alpha). Initial test–retest reliability of the 20 items using intraclass correlations ranged from 0.50 to 0.86.
CONCLUSION: The GSE-UI will enable measurement of whether a person's confidence in their ability to prevent urine loss is an important mechanism contributing to improvements in UI.     

A research for the relationship between human papillomavirus and human uterine cervical carcinoma

Summary Biopsies from 318 cases with squamous cell carcinoma of the uterine cervix, 48 with cervical and vulvar condylomata, 14 with cervical intraepithelial neoplasia (CIN), 34 with chronic cervicitis and 24 with normal cervical epithelium were collected from different geographic regions with different cervical cancer mortalities. The DNA · DNA dot-blot and Southern blot hybridization results show that there is a close relationship between HPV-16 and the uterine cervical squamous cell carcinoma in China. One very interesting observation is that the finding of HPV-16-homologous DNA differs significantly among five geographic regions, and corresponds with the mortalities from cervical cancer of these five regions. HPV-11 was found mainly in benign lesions. The rate of detection of HPV-16 in Chinese women increased from 8.3% in normal cervical epithelium to 20% in chronic cervicitis, 28% in cervical condyloma, 50% in CIN and 60.4% in cervical cancer. It is suggested that HPV-16 infection may be an etiological factor in the development of human cervical carcinoma. From the results of Southern blot hybridization, it appeared that HPV-16 DNA had been integrated into the genome of the host cell in cervical cancer. Whereas the HPV-16 DNA sequence was only present as an episome in normal cervical epithelium and cervical benign lesions. The rate of occurence of E6-E7 genes is the highest (88.9%) compared with that of other subgenomic fragments of HPV-16 in specimens of human cervical cancer in China. This implies that E6 and E7 may be the oncogenic genes of HPV-16 and play an important role in the carcinogenesis of human cervical epithelial cells. The amplification and rearrangement of the c-myc protooncogene are closely associated with the occurrence of cervical cancer. The results presented here revealed that the activated c-myc oncogene may cooperate with HPV-16 in the carcinogenic processes.Abbreviations HPV Human papillomavirus - CIN cervical intraepithelial neoplasia - SSC standard saline citrate     

Treatment of acetaminophen-induced acute liver failure in the mouse with conditionally immortalized human hepatocytes

BACKGROUND/AIMS: Liver failure is a life threatening condition currently treated by palliative measures and, when applicable, organ transplantation. The use of a bioartificial organ capable of fulfilling the main functions of the liver would represent an attractive alternative. However, the shortage of suitable donor cells, and their limited growth ability have impeded the development of this strategy. We investigated whether lentiviral vectors allow for conditional immortalization of human hepatocytes and whether these immortalized hepatocytes could reverse lethal acute liver failure. METHODS: We exposed primary human hepatocytes to Cre-excisable lentiviral vectors coding for SV40T Antigen, telomerase, and/or Bmi-1 and tested the functionality of the resulting cell lines. Therapeutic potential of immortalized hepatocytes were tested in a murine model of acetaminophen-induced hepatic injury. RESULTS: The immortalized hepatocytes grew continuously yet were non-tumorigenic, stopped proliferating when exposed to Cre recombinase, and conserved defining properties of primary hepatocytes, including the ability to secrete liver-specific proteins and to detoxify drugs. The implantation of encapsulated immortalized human hepatocytes rescued mice from lethal doses of acetaminophen. CONCLUSIONS: Lentiviral vectors represent tools of choice for immortalization of non-dividing primary cells, and lentivirally immortalized human hepatocytes are promising reagents for cell-based therapy of acute liver failure.