Giant cell tumor of soft tissue of the breast: Case report with H3F3A mutation analysis and review of the literature

Giant cell tumors of soft tissue (GCT-ST) arising in the breast are extremely rare. We report a unique case of breast GCT-ST coincident with ductal carcinoma in situ (DCIS), diagnosed with histological, immunohistochemical, and H3F3A (Histone H3.3) mutation analyses. A 59-year-old woman preoperatively diagnosed with DCIS underwent total mastectomy for a cystic mass. Histology revealed a tumor composed of mononuclear cells interspersed with numerous osteoclast-like giant cells, resembling giant cell tumor of bone (GCT-B), with apocrine DCIS in proximity to the tumor. The mononuclear and giant cells were immunoreactive for CD68 and negative for cytokeratins. Granulomatous diseases, carcinomas with giant cells, and giant cell-type sarcomas were excluded by histological and immunophenotypic features. Lack of H3F3A mutation eliminated the possibility of GCT-B metastasizing to the breast. These findings were consistent with GCT-ST of the breast. To our knowledge, this is the ninth reported case of breast GCT-ST, but the first case that accompanied DCIS or involved H3F3A mutation status investigation. For correct diagnosis of this rare tumor, it is important for pathologists to raise the possibility of GCT-ST when encountering giant cell-rich breast lesions and to exclude other differential diagnoses by combining the results of histological, immunohistochemical, and genetic analyses.     

红细胞分布宽度与慢性阻塞性肺疾病继发肺动脉高压的相关性研究

目的探讨红细胞分布宽度（RDW）与COPD继发肺动脉高压相关性。方法回顾性分析2012年9月至2013年10月期间入住皖南医学院第一附属医院呼吸科病房COPD的患者临床资料。根据入选标准及排除标准,将72例入选病例分为肺动脉压正常组和增高组,比较两组一般情况、基础疾病情况、RDW和住院时间。结果肺动脉压增高组RDW明显高于肺动脉压正常组RDW[15．98±1．78）％VS（14．46±1．36）％],差异具有统计学意义（P〈0．001）。而年龄、性别、高血压、糖尿病、冠状动脉粥样硬化性心脏病、血红蛋白、PaO2、PaCO2及住院时间两组之间差异均无统计学意义。Pearson相关性分析结果示RDW与肺动脉高压呈正相关,差异具有统计学意义（r=0．577,P=0．01）。结论在COPD继发肺动脉高压患者体内RDW明显增高,并与肺动脉高压严重程度呈正相关。RDW可作为反应COPD继发肺动脉高压严重程度的有用指标。     

早产预测多因素logistic回归模型的建立及预测价值的评价

目的建立多因素logistic回归模型来预测早产。方法对孕24~35周有先兆早产症状的孕妇检测阴道分泌物中胎儿纤维连接蛋白(fFN),经腹部超声测量宫颈长度,记录妊娠终止的孕周。经单因素logistic回归分析筛选与早产有相关性的因素建立多因素logistic回归模型。结果逐步回归分析得出以双胎妊娠、受孕方式、fFN检测及宫颈长度为自变量的早产预测的logistic回归模型,拟合优度检验P=0.99,ROC曲线下面积为0.97,以P=0.25为分界点预测早产灵敏度为91.3%,特异度为90.3%。结论本研究建立的多因素logistic回归模型对早产具有较好的预测价值。     

斜外侧腰椎椎间融合术后脊柱-骨盆矢状位参数变化与临床疗效的相关性研究

目的 :探讨斜外侧腰椎椎间融合术(oblique lumbar interbody fusion,OLIF)手术前后脊柱-骨盆矢状位参数变化以及与其临床疗效的相关性。方法:回顾性分析2017年7月至2018年7月采用OLIF (Stand-Alone)手术治疗的65例腰椎退行性疾病患者的临床资料,男26例,女39例;年龄33～79(62.72±10.23)岁。评估患者术前及末次随访时Oswestry功能障碍指数(Oswestry Disability Index,ODI)与视觉模拟评分(visual analogue scale,VAS)。测量术前及末次随访时手术节段椎间隙高度(disc height,DH)及脊柱-骨盆矢状位参数,包括骨盆入射角(pelvic incidence,PI),骨盆倾斜角(pelvic tilt,PT),骶骨倾斜角(sacral slope,SS),腰椎前凸角(lumbar lordosis,LL)。根据PI-LL的差值判断PI与LL是否匹配并将患者进行分组,PI-LL数值位于-9°～9°之间设为匹配组,数值<-9°或>9°设为失匹配组。分析腰椎...     

巨细胞动脉炎与风湿性多肌痛临床特征的对比分析

目的:通过比较风湿性多肌痛（PMR）和巨细胞动脉炎（GCA）的临床差异,总结GCA患者的临床特点。方法:收集皖南医学院附属弋矶山医院风湿免疫科2010年8月至2019年9月住院的12例巨细胞动脉炎患者临床资料,并选择同期住院的,与GCA组患者进行2∶1年龄、性别相匹配的PMR患者形成对照组,比较2组患者的临床表现、实验...     

快速解剖标测方式构建肺静脉对环肺静脉电隔离术中主要质量指标的影响

目的 探讨快速解剖标测方式构建肺静脉在环肺静脉电隔离术中应用价值。方法 收集2016年2月至2016年10月在皖南医学院弋矶山医院心内科接受导管消融治疗的60例房颤患者,依据肺静脉造影方式分为快速解剖标测组30例和非选择性肺静脉造影组30例。评价两组患者总手术时间、X线曝光时间、预定消融径线外消融点数、肺静脉隔离率等方面差异。结果 快速解剖标测组与非选择性肺静脉造影组相比：曝光时间减少[（16.18±4.26） min vs（45.64±6.48） min,P<0.05],总手术时间降低[（122.34±13.82） min vs（180.19±12.56） min,P<0.05）],预定消融径线外消融点数减少[（3±1）个vs（16±4）个,P<0.05],肺静脉隔离率差异无统计学意义（96.67%vs 93.33%,P>0.05）。结论 快速解剖标测方式构建肺静脉能明显提高肺静脉隔离术的手术质量。     

MRI纹理特征联合表现弥散系数鉴别诊断子宫肉瘤与细胞型子宫肌瘤

目的 观察MRI纹理特征联合表观弥散系数(ADC)鉴别诊断子宫肉瘤(US)与细胞型子宫肌瘤(CUL)的价值。方法 回顾性分析27例US(US组)及34例CUL(CUL组)患者盆腔MRI资料,于T2WI及弥散加权成像(DWI)中提取病灶纹理特征,测量ADC值,记录平均ADC值(ADC_mean)、最小ADC值(ADC_min)及标准ADC值(ADC_st);分别基于ADC值、最优纹理特征及二者联合构建鉴别US与CUL的逻辑回归(LR)模型,包括LR_ADC、LR_纹理及LR_ADC+纹理模型;绘制受试者工作特征曲线,计算曲线下面积(AUC),评估各模型鉴别诊断US与CUL的效能。结果 US组病灶ADC_mean、ADC_min及ADC_st均低于CUL组(P均＜0.05)。共基于盆腔T2WI及DWI提取3 750个纹理特征,经筛选后得到5个最优特征,以之构建的LR_ADC+纹理模型及LR_纹理模型鉴别US与CUL的效能相当(AUC=0.921、0.887;P＞0.05),且均高于LR_ADC模型(AUC=0.696;P均＜0.05)。LR_ADC+纹理模型的校准曲线与理想曲线走行基本一致,且临床净收益大于LR_ADC及LR_纹理模型。结论 MRI纹理特征联合ADC值可提高鉴别诊断US与CUL的效能。     

术后导尿管相关膀胱不适的危险因素

目的探讨术后留置导尿管患者导尿管相关膀胱不适(CRBD)的危险因素。方法选取本院行外科手术并留置导尿管的住院患者183例,男113例,女70例,年龄16～77岁,体重20～80 kg,ASAⅠ或Ⅱ级,根据CRBD诊断标准将患者分为两组:无症状组(C组)和有症状组(U组)。收集患者麻醉方式、手术时间、手术类型、插入导尿管时机、插入导尿管型号、抗胆碱能药物使用情况、导尿管润滑剂类型等。记录术后CRBD的发生情况及严重程度,采用多因素Logistic回归分析术后患者CRBD的危险因素及其与CRBD严重程度的相关性。结果发生CRBD患者76例(41.5%),其中轻度28例(15.3%),中度35例(19.1%),重度13例(7.1%)。多因素Logistic回归分析显示,男性(OR=2.139,95%CI 1.096～4.172,P=0.026)、麻醉后插入导尿管(OR=2.553,95%CI 1.327～4.912,P=0.005)、碘伏润滑剂(OR=2.017,95%CI 1.053～3.863,P=0.034)是术后CRBD的独立危险因素。插入导尿管时机和导尿管润滑剂类型与CRBD的严重程度有明显相关性(P0.05)。结论正确的导尿时机和合理使用润滑剂可以减少术后CRBD的发生。     

预防性切开减压在急性下肢动脉栓塞取栓术中的应用

目的 观察预防性切开减压在急性下肢动脉栓塞取栓术中的应用效果。方法 回顾性分析2016年1月至2021年12月间皖南医学院附属弋矶山医院17例取栓术中行预防性切开减压处理急性下肢动脉栓塞患者的临床资料,观察其有效性和安全性。结果 17例患者均成功接受预防性切开减压,平均随访时间12个月,13例患者痊愈,2例轻度下肢感觉或运动功能障碍(不影响日常生活),2例重度下肢感觉或运动功能障碍(影响日常生活但未坏死),无坏死或截肢。切口愈合方面,1例自行愈合无需缝合,10例二期清创缝合,6例一期术中预留缝线,延期闭合减压切口,无患者需植皮或截肢。结论 对急性下肢动脉栓塞取栓患者预防性切开减压具有较好的安全性和有效性。     

Effectiveness and safety of Dabigatran 110 mg versus 150 mg for Stroke Prevention in Patients with Atrial Fibrillation at High Bleeding Risk

PurposeThe effectiveness and tolerability of a reduced dose (110 mg) of dabigatran versus the standard dose (150 mg) were evaluated in subgroups of patients with atrial fibrillation (AF) at high bleeding risk.MethodsEligible patients were adults with AF and a creatinine clearance rate ≥30 mL/min who were initiated on treatment with dabigatran (index) between 2016 and 2018. High–bleeding-risk subgroups were identified: (1) age ≥80 years; (2) moderate renal impairment (creatinine clearance rate 30–<50 mL/min); and (3) recent bleeding or a HAS-BLED score of ≥3. Fine-Gray subdistribution hazard regression models with inverse probability of treatment weights were used to investigate associations between dabigatran dose and three outcomes: stroke or systemic embolism, major bleeding requiring hospitalization, and all-cause mortality.FindingsAmong 7858 patients with AF and a high bleeding risk (age ≥80 years, 3472; moderate renal impairment, 1574; recent bleeding or HAS-BLED score ≥3, 2812), 32.3% received reduced-dose dabigatran. Compared with the standard dose, use of the reduced dose of dabigatran was not associated with an increased risk for stroke or systemic embolism but was associated with a lower risk for major bleeding (HR = 0.65; 95% CI, 0.44–0.95) and all-cause mortality (HR = 0.78; 95% CI, 0.65–0.92) in patients aged ≥80 years. The use of reduced-dose dabigatran was associated with a lower risk for major bleeding (HR = 0.54; 95% CI, 0.30–0.95) and all-cause mortality among patients with moderate renal impairment (HR = 0.53; 95% CI, 0.40–0.71).ImplicationsLower risks for bleed and mortality associated with reduced- versus standard-dose dabigatran in patients with AF and a high bleeding risk suggest a better dosing strategy.