CT与肿瘤标记物对非小细胞型肺癌N2淋巴结转移的预测作用探讨

目的：回顾性地探讨CT与肿瘤标记物结合能否提高对非小细胞性肺癌N2淋巴结转移的诊断率。方法：将1996～1999年支气管肺癌、CT诊断为N0-1淋巴结转移并行手术治疗的病人，术后根据病理结果重新分期为N0-1和N2；根据两组中血清β2-MG、CEA水平变化进行对照分析；结果：肿瘤的大小、β2-MG、CEA对CT诊断有一定的补充作用；结论：CT扫描对N2淋巴结转移有较高的预测作用，当不能确认N2转移时，肿瘤的大小、β2-MG、CEA是一种有效的补充。     

Effect of immune checkpoint inhibitors in patients with gastric hepatoid adenocarcinoma: a case report and literature review

Gastric hepatoid adenocarcinoma (GHAC) is a highly aggressive histological subtype of gastric cancer (GC) with similar tissue morphology to hepatocellular carcinoma. GHAC frequently produces alpha-fetoprotein (AFP) and has a poor prognosis; however, standardized treatment remains elusive. We report a male patient in his early 60s with GHAC who received immunotherapy, and the curative effect was evaluated. He was admitted because of progressive fatigue and dizziness for 2 months. He had experienced spontaneous epigastric pain with muscular defense of the epigastrium and accompanying tenderness 1 year earlier and underwent radical gastrectomy. Immunohistochemistry showed that hepatocyte-specific marker (Hep) was highly-expressed, indicating probable GHAC. Additionally, imaging suggested GC recurrence or gastric stump cancer. Radioimmunoassay indicated an AFP level of >1210.00 µg/L, and liver biopsy was performed following abdominal contrast-enhanced computed tomography. Pathology showed a few hepatocytes and proliferative fibrous connective tissue. The patient received three cycles of chemotherapy, with no obvious improvement. The possibility of surgical treatment was excluded, and immunotherapy or palliative treatment was selected. He received 11 cycles of a programed death-1 (PD-1) monoclonal antibody, and the effect of treatment was satisfactory. The mechanism of action of immunotherapy in GHAC warrants further investigation.     

美国FDA要求对用于睡眠障碍治疗的所有药品说明书进行更改

对已上市药品安全的管理工作是政府药品监管部门的重要工作,药品安全性信息的披露则是药品安全管理的重要工作内容。美国食品药品监督管理局(FDA)(以下简称FDA)于2004年11月宣布了启动"药品安全行动计划(Drug Safety Initiative)",加强对已上市药品的临床应用安全性管理,并对出现的临床安全性问题进行评估,及时对药品说明书、药品安全性信息进行修订和补充,是其中一项重要举措。     

肩胛骨骨折的手术治疗

目的探讨肩胛骨骨折的手术治疗方法、优点及术中应注意的事项。方法全麻侧卧,Judet后入路,切口自肩峰背侧偏内1 cm,沿肩胛冈向内侧延伸,下至肩胛体下角,离断三角肌,沿骨面剖离,将三角肌和冈下肌翻向外侧;骨折复位,用钢板和螺钉固定。结果术后随访8个月~2年,16例骨折全部愈合,愈合时间为1.5~4.5个月,平均2.5个月。按Dolfi评分系统评定:优9例,良5例,可1例,差1例。优良率87.5%。结论手术治疗肩胛骨折能及时清除积血,使骨折能达到良好复位、固定,减少粘连和畸形愈合。     

前列腺导管腺癌临床病理和诊治特点分析

Objective To discuss the pathological and clinical features, diagnosis and treatment of prostatic duct adenocareinoma. Methods The clinical data of nine cases of prostatic duct adeno-carcinoma were retrospectively analyzed, with the average age of 76 (59-106) years. Six cases were presented with dysuresia and/or nocturia, and two of them had the painless gross hematuria. Two pa-tients presented painless gross hematuria as the first symptom. One case was detected the elevated ser-um PSA in a routine healthy examination. Radical prostatectomy (RP) was performed in 1 case;RP and bilateral orchidectomy and external beam radiotherapy (EBRT) were performed in 1 case;5 cases underwent transurethral resection of the prostate (TURP) combined with photoselective vaporization of the prostate (PVP) by green laser and bilateral orchidectomy;1 case underwent TURP combined with PVP;1 case underwent bilateral orchidectomy combined with EBRT. Eight cases took flutamide for 3-45 months. All patients were followed-up according to the scheduled time. Results The op-erations were successfully performed in all 9 patients. The papillary or cauliflower-like tumors infiltra-ted colli culus seminalis and prostate duct nearby. The glands were coated with tall pseudostratified columnar cells. The nuclei were large, dark stained with more frequent mitoses. The positive rates of immunolabelling antibody PSA, AR, PAP were found to be 89%(8/9), 100%(5/5), 100%(5/5) re-spectively. The distribution of Gleason score was 6-7(3 cases), and≥8(6 cases), and a coexisting acinar carcinoma component was identified in 5 cases of the group. Nine cases had a mean follow up for 20(3-48) months. Five cases have developed biochemical recurrence, of whom 3 died of bone metas-tasis and multiple organ failure, and 1 developed lung and bone metastasis. Three cases remained alive without recurrence. The remaining 1 case survives during the follow-up survey for 6 months until now, without examinations due to the old age. Conclusions Duct adenocarcinoma of the prostate presents the low incidence and lacks of typical symptoms in the early stage. Diagnosis was confirmed mainly on the basis of pathology. The tumors tend to have a more advanced stage and a very short term survival rate. The treatment options and management are similar to that of high-grade adenocar-cinoma of the prostate;meanwhile, close follow-up survey should be performed.     

下肢深静脉血栓形成83例的病因分析

目的：探索下肢深静脉血栓形成的发病原因。方法：回顾1994年1月至2003年1月10年来所收集病人资料83例。结果：48例(占58％)病人病因明确，35例(占42％)病因不明。结论：血液高凝状态、下肢静脉血流缓慢、静脉内膜损伤三个因素综合作用造成了下肢深静脉血栓形成的发生。术后早期下床活动、抗血小板聚集可预防下肢深静脉血栓形成的发生。     

“他山之石”——谈肝性脑病临床药物研究的启示

2009年12月出版的《新英格兰医学杂志》（N Engl J Med, NEJM）上刊载了一篇多中心观察性研究,题目为“利福昔明在肝性脑病治疗中的作用”。作者对所收集的病例进行了详细的分析,并得出与利福昔明治疗肝性脑病预后的相关因素。然而,文中所得出的预后因素中并未提及并发症和诱发因素,而事实上这两个因素对预后起着重要的作用。针对这一问题,我们提出了不同见解,并得到了作者的认可。我们所撰写的Correspondence于2010年6月发表在《NEJM》上。     

长期吸毒者脑FDG-PET表现

目的:使用PET观察长期吸毒者脑代谢变化,为研究吸毒者神经生理和行为改变以及吸毒治疗提供分子影像学资料。方法:对比吸食海洛因时间均超过10年的吸毒者7例与健康体检者11例的脑FDG-PET检查资料并导入PC机,通过自行研发的软件进行图像配准,在配准后的横断层图像上画左侧脑结构感兴趣区(ROI):顶叶、扣带前回、丘脑、尾状核头、纹状体、眶上回、直回、颞叶外侧皮质、海马、小脑皮质,再镜像生成对侧相应脑结构的ROI,每个脑结构画相邻两个层面的ROI,取两个ROI平均放射性计数的算术均数为该脑结构的平均放射性计数,将各脑结构与同侧小脑皮质平均放射性计数相比。结果:吸毒者全脑葡萄糖代谢均减低,有统计学意义的部位为双侧尾状核头、双侧纹状体、双侧眶上回、双侧直回和双侧颞叶外侧皮质(t<0.05)。结论:PET可探测吸毒者脑代谢的变化,为研究吸毒者神经生理、病理和行为改变以及吸毒治疗、预后评价提供分子影像学资料。     

免疫抑制剂细胞内浓度测定的研究进展

细胞外浓度测定作为目前器官移植临床免疫抑制剂治疗药物监测（TDM）的主要手段,与免疫抑制剂药效之间的相关性不理想。随着液相质谱技术的广泛应用,免疫抑制剂细胞内浓度检测技术逐渐成熟。由于细胞内浓度测定可直接检测靶细胞内的药物暴露水平,理论上能更好地反映免疫抑制剂的药效。本文总结了免疫抑制剂细胞内浓度测定的历史与现状,着重介绍免疫抑制剂细胞内浓度的测定方法及其与药效的相关性。免疫抑制剂细胞内浓度测定具有较好的临床应用价值,值得推广。     

多西紫杉醇联合贝伐单抗或安慰剂在HER2阴性转移性乳腺癌中的Ⅲ期临床研究

3背景 ·E2100研究显示贝伐单抗联合每周紫杉醇相对安慰剂在转移性乳腺癌中能显著提高无进展生存期（11．4个月VS．5．8个月）。·多西紫杉醇是乳腺癌领域广泛使用的化疗药,临床前研究显示多西紫杉醇和贝伐单抗有协同作用。