骨原发性间变性大细胞淋巴瘤临床病理观察

目的探讨骨原发性间变性大细胞淋巴瘤（ALCL）的临床病理特点、鉴别诊断及预后。方法观察4例骨原发性ALCL的临床病理和免疫组化特点，随访7～45个月，并复习相关文献。结果骨原发性ALCL多见于中、青年男性。组织形态上，肿瘤细胞弥漫浸润骨组织，细胞高度异型，核分裂象多；免疫组化标记示CD30和EMA（＋），ALK-1和粒酶B（＋）较多。4例患者中，2例分别在随访7个月和11个月时死亡。结论骨原发性ALCL十分罕见，明确诊断依赖于组织形态学观察及免疫组化标记，其预后可能存在个体差异。     

食管癌根治切除术后辅助调强放疗胸腔胃照射剂量与急性放射性胸腔胃炎的关系

目的 研究食管癌术后调强放疗剂量学与胸腔胃放射性损伤的关系。方法 通过入组104例食管癌根治术后行调强放疗的患者,对其临床资料及放疗计划中胸腔胃剂量-体积参数与急性放射性胸腔胃炎的发生情况进行分析,ROC曲线分析与急性放射性胃炎发生可能相关的物理学指标,logistic法行单因素及多因素分析。结果 全组104例患者出现≥ 2级急性放射性胸腔胃炎者29例（27.88%）。与≥ 2级急性放射性胸腔胃炎相关的剂量-体积指标包括：胸腔胃D_max、D_mean、L₅~L₄₅、V₅~V₅₀。单因素分析显示,胸腔胃位置、胸腔胃D_max、D_mean、胸腔胃L₅~L₄₅和V₅~V₅₀均与≥ 2级急性放射性胸腔胃炎的发生显著相关（P<0.05）;多因素分析显示,胸腔胃位置、L₅、V₃₅与≥ 2级急性放射性胸腔胃炎的发生均显著相关（P<0.05）。ROC曲线所得L₅及V₃₅的最佳界值分别为14.00 cm和44.00%,胸腔胃L₅ ≥ 14.00 cm和L₅<14.00 cm发生≥ 2级急性放射性胸腔胃炎的概率分别为38.64%和20.00%（χ²=4.473,P<0.05）;V₃₅ ≥ 44.00%和V₃₅<44.00%发生≥ 2级急性放射胸腔胃炎的概率分别为57.58%和14.08%（χ²=7.263,P<0.05）。后纵隔胃患者≥ 2级急性放射性胸腔胃炎的发生率显著高于其他两组（χ²=12.881,P<0.05）。结论 胸腔胃剂量-体积参数对急性放射性胸腔胃炎的发生具有一定的预测价值,建议对术后需行放疗的食管癌患者慎重选择后纵隔胸腔胃手术方案。     

Influence of intimate partner violence during pregnancy and early postpartum depressive symptoms on breastfeeding among chinese women in Hong Kong

Numerous studies show that breastfeeding is beneficial to both mothers and babies. This study explores two understudied correlates that may influence breastfeeding initiation: intimate partner violence during pregnancy and early postnatal depressive symptoms. A cross-sectional comparative study design investigated the correlates of feeding modes of 1200 Chinese mother and infant pairs in a university-affiliated regional hospital in Hong Kong. The prevalence rates of breastfeeding and mixed feeding were 42.25% and 26.25%, respectively. Women who had no experience of intimate partner violence during pregnancy were significantly more likely to initiate breastfeeding (adjusted odds ratio = 1.84; 95% confidence interval, 1.16-2.91) after adjustment for demographic, socioeconomic, and obstetric variables. Early postnatal depressive symptoms were not significantly associated with feeding modes in a multinomial logistic regression model. Midwives are in a key position to identify and intervene to encourage more successful breastfeeding practice.     

Acute kidney injury in ovarian cancer patients undergoing cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy

Background: Cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (CRS-HIPEC) prolongs survival in patients with metastatic peritoneal disease. We look at the incidence of acute kidney injury (AKI) in patients who have received cisplatin during CRS-HIPEC in the treatment of peritoneal carcinomatosis from an ovarian primary, and identify possible peri-operative risk factors.

Methods: Between 2005 and 2013, we performed CRS-HIPEC on 47 patients with ovarian primaries and peritoneal metastasis. Retrospective data were collected on the patient’s demographics, treatment details and outcomes. Renal impairment was graded according to the NCI-CTCAE 3.0 criteria.

Results: There were 47 patients, with a median age of 50 (24–74) years. The median baseline creatinine was 53?μmol/L (23–102) and median baseline albumin of 39?g/L (13–45). All underwent pre-operative chemotherapy for a median of six cycles (0–22) with a median of 15?days between chemotherapy and surgery. They received intra-operative cisplatin at a temperature of 40?°C for 60?min at a median dose of 90?mg/kg. 19 (40.4%) experienced post-operative AKI, of which 5 (8.5%) developed grade 3 and 4 impairment. Two (4.3%) required long-term dialysis. Univariate analysis showed that risk factors for AKI included age, baseline creatinine, baseline estimated glomerular filtration rate, pre-operative albumin, number of cycles of pre-operative carboplatin, time interval between pre-operative chemotherapy and CRS-HIPEC and volume of blood transfusions.

Conclusions: Identification of risk factors for AKI post-CRS-HIPEC helps improve pre-operative patient selection and optimisation, facilitate tailoring of chemotherapy, and foster closer peri-operative monitoring and fluid management in at-risk patients.     

Optimal treatment increased survival of hepatocellular carcinoma patients detected with community‐based screening

Background and Aim: The early detection of hepatocellular carcinoma (HCC) and opportunity to select appropriate treatment are important benefits of HCC screening. Our aim in the present study was to investigate the survival rate, prognostic factors and treatment effects in HCC patients of community‐based screening. Methods: Community‐based ultrasound (US) screening for HCC in adults with platelet counts (< 150 × 10³/mm³) and/or alpha fetoprotein (AFP) > 20 ng/mL was conducted in 2002 and 2004. As per the Barcelona Clinic Liver Cancer (BCLC) stage, 90 cases of intermediate or earlier stage HCC were detected and 88 cases had sufficient information for analysis (49 men and 39 women, aged 65.8 ± 9.6 years). The tumor diameter was mostly less than 5 cm (76.1%). The follow up was continued until June 2008. Results: The 4‐year overall survival rate was 46.8%. Old age (≥ 70 years) (P = 0.046), later stage of HCC (intermediate vs earlier) (P = 0.012), low platelet count (< 100 × 10³/mm³) (P = 0.013) and refusal of modern treatment (P = 0.026) were independent poor prognostic factors. Curative treatment increased survival in patients of all ages. Both curative treatment and transcatheter arterial embolization (TAE) increased survival in cases of intermediate HCC. However, treatment benefits were not found for patients with (very) early stage HCC. Conclusions: Early detection and prompt treatment of HCC leads to increased survival. For elderly patients this benefit was seen only for early stage cases receiving curative treatment. Differences between treatment types for patients with (very) early stage HCC might emerge with a longer follow‐up period.     

Low accuracy of the national reporting system of acute hepatitis C infection in Taiwan, 1995–2004

Background and Aim: This study attempted to clarify accuracy of acute hepatitis C (AHC) and its clinical characteristics. Methods: We reviewed 632 reported cases from national surveillance data of the Taiwan Center for Disease Control between 1995 and 2004, and reclassified diagnoses. A definite case was defined as alanine aminotransferase (ALT) > 10 × the upper limit of normal (ULN) with seroconversion of anti‐hepatitis C virus antibody (anti‐HCV). A probable case was defined as (i) seroconversion of anti‐HCV and/or elevated ALT levels; or (ii) anti‐HCV(+) but titers increased (from < 40 S/CO to ≥ 40 S/CO) and ALT > 10 × the ULN. A suspected case was defined as initial anti‐HCV(+) and ALT level > 10 × the ULN and/or jaundice. Excluded cases were defined as ALT levels less than 10 × ULN with initial positive anti‐HCV Ab. Results: A total of 310 (49%) cases were confirmed as AHC; these included 95 (15%) definite and 215 (34%) probable cases. Higher incidence rates and accuracy of AHC were demonstrated in the southern area significantly if compared with northern, eastern and central areas, respectively (all P < 0.05). On comparison between blood centers and hospitals, more AHC cases were found in Southern Taiwan than in other areas (157/73 vs 24/40, P < 0.001), younger mean age (33.3 ± 11.1 vs 49.3 ± 16.4, P < 0.001), lower ALT levels (263.1 ± 200.9 vs 1264.2 ± 706.8, P < 0.001) and male predominance (191/39 vs 46/18, P = 0.046). Conclusions: This study showed our reporting system over‐estimated the AHC diagnosis, which is also a common issue worldwide. Greater efforts are needed to establish appropriate reporting systems, as well as more supplemental methods to distinguish between prevalent and incident cases.     

A systematic review of physiological reactivity to stimuli in autism

Objective: The prevalence of abnormal behavioural responses to a variety of stimuli among individuals with autism has led researchers to examine whether physiological reactivity (PR) is typical in this population. This article reviewed studies assessing PR to sensory, social and emotional, and stressor stimuli in individuals with autism. Methods: Systematic searches of electronic databases identified 57 studies that met our inclusion criteria. Studies were analysed to determine: (a) participant characteristics; (b) physiological measures used; (c) PR to sensory, social and emotional or stressor stimuli; (d) the relation between PR and behavioural or psychological variables and (e) baseline physiological activity. A novel measure of methodological quality suitable for use with non-randomized, non-interventional, psychophysiological studies was also developed and applied. Results: Individuals with autism were found to respond differently than typically developing controls in 78.6%, 66.7% and 71.4% of sensory, social and emotional, and stressor stimulus classes, respectively. However, this extant literature is characterized by variable and inconsistent findings, which do not appear to be accounted for by varying methodological quality, making it difficult to determine what specific factors differentiate individuals with autism who present with atypical PR from those who do not. Conclusions: Despite this uncertainty, individual differences in PR are clearly present in autism, suggesting additional research is needed to determine the variables relating to PR among those with ASD and to examine the possible existence of physiological subtype responders in the population.     

Early cognitive development in children born to women with epilepsy: A prospective report

Purpose: In this prospective study the early cognitive development of children born to women with epilepsy (n = 198) was assessed and compared to a group of children representative of the general population (n = 230). Methods: The children were assessed when younger than the age of 2 years using the Griffiths Mental Development Scales, either in their local participating hospital or in their home. The assessments were completed by an assessor who was blinded to whether the child’s mother had epilepsy and to antiepileptic drug type. Results: Children exposed to sodium valproate had a statistically significant increased risk of delayed early development in comparison to the control children. Linear regression analysis showed a statistically significant effect of sodium valproate exposure on the child’s overall developmental level that was not accounted for by confounding variables. Delayed early development is also noted for children within an ad hoc group of less commonly utilized antiepileptic drugs, although conclusions cannot be drawn due to the size of this group (n = 13). Children exposed to either carbamazepine or lamotrigine in utero did not differ significantly in their overall developmental ability. Differences noted in specific developmental areas for these two groups were not statistically significant after the control for confounders such as socioeconomic status and maternal IQ. Discussion: Women with epilepsy should be informed of the risks posed to their potential offspring prior to pregnancy to allow for informed decisions regarding treatment. Children exposed in utero to antiepileptic drugs should be monitored throughout childhood to allow for early intervention when necessary.