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??Laparoscopic resection for gastric stromal tumor LI Zi-yu*, XING Zhao-dong, WANG Jing, et al. *Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education of China), Beijing 100142, China
Corresponding author: LI Zi-yu, E-mail: ligregory@outlook.com
Abstract Objective To evaluate the indication and safety of laparoscopic resection for gastric stromal tumor.??Methods The clinical data of 58 cases of GIST performed laparoscopic gastric resection (LR) and 99 cases performed open gastric resection (OR) from July 2007 to September 2014 at Peking University Cancer Hospital and Institute were compared retrospectively. Results Compared with the OR group, the LR group showed no significant difference in postoperative hospital stay [8.5 d vs. 8.9 d, P=0.684] and operation time [118 min vs. 110 min, P=0.272]. However, the bleeding volume in the LR group was less [37 mL vs. 66 mL, P=0.000], incision length was shorter [5.1 cm vs. 15.7 cm, P=0.000], and tumor size was smaller [3.9 cm vs. 5.5 cm??P=0.000]. No severe complications such as bleeding and leakage were found in both groups. Median follow up time in the LR group and the OR group was 29 months and 36 months respectively. During the period, no recurrence was detected in the LR group, while recurrence was found in two cases of high risk in the OR group. Conclusion Laparoscopic resection is safe, feasible and minimally invasive for the small gastric stromal tumor and can get the same therapeutic effect as OR.     

全身型幼年特发性关节炎患儿合并巨噬细胞活化综合征早期预警量表建立的研究

目的　总结全身型幼年特发性关节炎（sJIA）合并巨噬细胞活化综合征（MAS）的早期临床特征、实验室及辅助检查特点，筛选对诊断MAS有预警作用的检测指标，并量化形成量表，以达到快速对疾病“早识别，早治疗，降低病死率”的目的。方法　回顾性分析2006年1月至2016年1月，北京儿童医院风湿免疫科收治sJIA合并MAS患儿的病例资料，在临床及辅助检查观测指标中筛选出对早期诊断MAS有评估意义的候选指标；通过ROC曲线的方法选择最佳的诊断界限值（Cut-off值）；采用多因素Logistic回归分析MAS独立危险因素，效果以优势比（OR）表示，计算95％置信区间；经过同行评议对上述因素进行权重分值量化并最终形成积分表。结果　390例sJIA患儿，其中141例合并MAS。临床表现全部患儿均有高热、肝脾和（或）淋巴结进行性增大、血液系统受累，中枢神经系统受累患儿19例。单因素Logistic回归及ROC曲线分析结果显示，MAS组和重症sJIA组比较，10个变量存在显著差异（P<0.05）。Logistic回归分析结果显示，Fib ≤3.11g/L、WBC≤11.0×109/L、SF/ESR≥99.4及PLT≤260×109/L为MAS的独立危险因素。绘制模型ROC曲线，灵敏度和特异度分别为92.42%、81.20%。经过30位同行专家评议并投票，分别对上述患儿进行MAS诊断，并对各项临床表现及检验检查项目进行权重值评分，形成早期预警量表。结论　临床表现结合辅助检查结果，利用积分量表的形式，快速判断重症sJIA是否合并早期MAS，对诊断窗口提前，提高MAS诊断率，降低漏诊及前瞻性研究提供参考。     

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??Objective    To explore the effect of calcitriol on IL-8 and IL-6 expression in Porphyromonas gingivalis lipopolysaccharide ??Pg-LPS??-induced human periodontal ligament cells. Methods    Primary cultures of hPDLCs were established and obtained from the extracted premolars of 3 patients for orthodontic treatment. hPDLCs of were respectively treated with 0.1% absolute ethyl alcohol ??control group???? 10 μg/mL Pg-LPS ??simple Pg-LPS group??A???? 10-10 mol/L 1??25D ??low 1.25 D group??B???? 10-8 mol/L 1??25D ??High 1.25 D group??C???? 10-10 mol/L 1??25D+10 μg/mL Pg-LPS ??group D???? 10-8mol/L 1??25D+ 10 μg/mL Pg-LPS ??group E?? for 24 h and 48 h. The supernatant fluid samples were collected and the IL-8 and IL-6 concentration was determined with enzyme-linked immunosorbent assay ??ELISA?? method. Results    ??1?? The 10 μg/mL Pg-LPS exerted the highest promotion effect on the expression level of IL-8 by 38.86-folds at 48 h ??P??0.001?? and that of IL-6 by 6.19-folds at 24 h ??P??0.001?? respectively. ??2?? 1??25D down-regulated the IL-8 level in a dose- and time- dependent manner. The highest inhibition effect occurred at 48 h?? the IL-8 level of cells treated with 10-8mol/L 1??25D was 49.94% of that of the control cells ??P??0.001??. ??3?? 1??25D significantly decreased the LPS-induced IL-8 and IL-6 production. At 48 h?? 10-8mol/L 1??25D combined with Pg-LPS significantly down-regulated the IL-8 level in hPDLCs?? 71.98% of that in the cells treated with Pg-LPS alone??P??0.001??. ??4?? At 24 h?? the level of IL-6 in cells treated with Pg-LPS combined with 10-8mol/L 1??25D was 84.51% of that in cells treated with Pg-LPS alone ??P=0.003??. Conclusion    Our results suggest that vitamin D may suppress the periodontal inflammation partly by inhibiting the expressions of innate IL-8 and Pg-LPS-induced IL-8 and IL-6 in hPDLCs.     

胆囊颈部肉瘤样癌向胆总管腔内芽生致梗阻性黄疸1例报告

正胆囊肉瘤样癌临床罕见,本质属于上皮性癌,肉瘤样成份并非来源于真正的间叶组织,细胞形态呈梭形,但实际为一种未分化癌。其恶性度高,预后差,早期诊断困难,确诊需要癌组织免疫病理学检测~([1-2])。肝外胆管疾病引起梗阻性黄疸多系原发性胆管癌、胆管结石或胆管损伤性狭     

基于SEER数据库男性乳腺癌手术切除病人预后分析及列线图建立

目的 分析男性乳腺浸润性导管癌手术切除病人的独立预后因素及构建预后列线图，同时验证该模型的准确性。方法 从美国国立癌症研究监测、流行病学和最终结果（SEER）数据库中下载2010—2018年间诊断为男性乳腺浸润性导管癌且经过手术切除的1662例病人的临床病理特征及治疗信息。随机数字分组法将病人按照3∶1分为训练队列（1246例）和验证队列（416例）。 通过单因素及多因素 COX分析筛选出独立预后因素并构建预测1、3、5年的总生存率（OS）的列线图。一致性指数（c-指数）和校准曲线确定列线图预测的准确性和判别能力。结果 年龄、肿瘤直径、临床TNM、病理学分级、婚姻状态5个指标均是OS的独立预后因素（P均<0.05）。基于独立预后因素构建了1、3、5年OS的列线图。训练队列中列线图的c-指数为0.730（95%CI 0.694-0.766），高于美国癌症联合委员会（AJCC）临床TNM分期系统 0.628（95%CI 0.588-0.668）；验证队列列线图的c-指数为0.737（95%CI 0.680-0.794），高于AJCC 临床TNM分期系统 0.584（95%CI 0.516-0.652）。校准曲线表明列线图预测生存率与实际生存率具有良好的一致性。结论 基于年龄、肿瘤直径、临床TNM、病理学分级、婚姻状态的独立预后因素构建的列线图能较准确地显示男性乳腺癌手术切除病人预后，有利于进行临床个体化预后评估。     

家长陪同对口腔门诊患儿七氟烷全身麻醉苏醒期躁动的影响研究

 目的　研究家长陪同对口腔门诊患儿七氟烷全身麻醉苏醒期躁动的影响。方法　选取2017年6—12月于重庆医科大学附属口腔医院行七氟烷全身麻醉口腔治疗患儿120例，随机分为陪同组和未陪同组，每组60例。陪同组患儿在治疗前麻醉诱导期及治疗后苏醒期均有家长陪同，未陪同组患儿在麻醉诱导期及苏醒期均无家长陪同。采用小儿麻醉苏醒期躁动量化评分表（pediatric anesthesia emergence delirium scale，PAED）对患儿麻醉苏醒期躁动情况进行评分，并计算躁动发生率。结果　陪同组PAED评分为（9.18 ± 3.41）分，未陪同组PAED评分为（10.57 ± 3.62）分，两组PAED评分比较，差异有统计学意义（t = 2.04，P = 0.03）。陪同组躁动发生率（26.67%）明显低于非陪同组（50.00%），差异有统计学意义（χ2 = 6.91，P = 0.01）。结论　治疗前麻醉诱导期及治疗后苏醒期有家长陪同，可减少患儿躁动的发生，提高家长对口腔治疗的满意度，促进良好的医患关系。     

近红外自体荧光显像技术在甲状腺癌根治性手术中辅助甲状旁腺识别应用1例报告并文献复习

甲状腺癌(thyroid carcinoma)是一种起于甲状腺滤泡上皮或滤泡旁上皮细胞的恶性肿瘤,女性高发,发病率居女性恶性肿瘤的第4位[1],我国的发病人群以每年20%的速度持续增长,而根治性手术是治疗甲状腺癌疾病的主要手段。甲状旁腺体积小,位置较深,而且数目和位置常存在解剖学变异,给甲状腺和甲状旁腺手术术中探查并保护甲状旁腺造成了一定困难。尤其是在甲状腺癌根治术中,往往在中央区淋巴结的清扫容易误损伤甲状旁腺,致使术后暂时性或永久性低钙血症,极大地降低了病人的生活质量。因此,如何在甲状腺癌根治术中快速准确的识别甲状旁腺并予以保护,已经成外甲状腺外科医生重点关心的问题。     

敲除CIAPIN1基因提高白血病K562细胞对伊马替尼的敏感性

目的： 探讨靶向干扰细胞因子诱导凋亡抑制因子1 （cytokine induced apoptosis inhibitor 1,CIAPIN1）基因表达后慢性 粒细胞性白血病K562细胞对伊马替尼的敏感性。 方法 ：构建靶向CIAPIN1基因的shRNA干扰载体;使用实时定量PCR、West- ern blotting以及免疫荧光评价CIAPIN1-shRNA组（CIAPIN1-shRNA转染）和scramble-shRNA组（scramble-shRNA转染K562细 胞）干扰效率;伊马替尼（imatinib）处理两组K562细胞后,MTT法检测其增殖能力,集落形成实验检测细胞克隆形成能力,流式细 胞术和Western blotting检测细胞周期、凋亡及凋亡相关蛋白的变化。 结果： shRNA干扰可有效抑制CIAPIN1表达,CIAPIN1- shRNA组的CIAPIN1 mRNA表达量为scramble-shRNA组的(29.74±4.03)%、CIAPIN1蛋白表达量前者为后者的(21.57±2.18)%。 CIAPIN1表达下调能显著抑制伊马替尼对K562细胞的增殖和克隆形成,CIAPIN1-shRNA+imatinib组的细胞克隆形成数为 （15.60±1.03）个/视野,克隆半径为（2.63±0.55）μm,均小于scramble-shRNA+imatinib组（P<0.05或P<0.01）。CIAPIN1-shRNA+ imatinib组的细胞G1期细胞比例比scramble-shRNA+imatinib组明显增多,S期细胞比例较scramble-shRNA+imatinib组明显减少 （均P<0.01）。CIAPIN1-shRNA+imatinib组K562细胞凋亡率明显增加（P<0.01）。敲除CIAPIN1能抑制细胞周期相关蛋白Cyclin D1、Bcl-xl、Bcl-2、Mcl-1表达,诱导细胞内细胞凋亡相关蛋白p21、Bid、Bim表达,且与伊马替尼具有协同作用。 结论： CIAPIN1表 达下调可明显提高K562细胞对伊马替尼的敏感性,该作用主要通过阻滞K562细胞周期及诱导凋亡相关蛋白表达实现。     

B cell apoptosis accelerates the onset of murine lupus

To investigate whether the increased rate of lymphocyte apoptosis in systemic lupus erythematosus is involved in the onset of the disease, apoptotic or necrotic T or B lymphocytes from various cell lines were injected intraperitoneally into pre-autoimmune (NZBxNZW)F1 mice (BW) and non-autoimmune BALB/c mice. The intraperitoneal production of cytokines and chemokines, the specific T cell response in the spleen, and the production of anti-histone and anti-dsDNA Ab were investigated. The onset of the disease was characterized by creatinine levels and evaluation of glomerular IgG deposits. In BW, but not in BALB/c mice, injection of apoptotic and not necrotic cells up-regulated IL-6 and IL-10 in resident macrophages. Administration of apoptotic cells augmented the number of Th2 and B lymphocytes recruited in the peritoneal cavity. Only the treatment with apoptotic B cells promoted a systemic Th2 autoimmune response to H2 histones, associated with earlier occurrence of high levels of anti-dsDNA autoantibodies, higher creatinine levels and more numerous glomerular IgG deposits than in BW controls not injected with apoptotic B cells. In genetically susceptible mice exposure to apoptotic of B, but not T, lymphocytes can elicit a Th2 response to H2 histones that helps B cell production of anti-dsDNA Ab and finally triggers the onset of lupus.