胆管扩张术后癌变病例3例

胆管扩张症(biliary dilatation,BD),是一种临床上少见的胆道系统畸形,主要表现为原发性肝内外胆管单发或多发的扩张病变[1]。典型临床表现是腹痛、黄疸和腹部包块[2],部分患者无特异性症状。目前手术是治疗BD的唯一方法[3],常见的术后并发症有胆道结石、胆管炎、胰腺炎等,甚至发生癌变[4]。BD患者发生胆道系统肿瘤的概率约为2.5%~30%,明显高于健康人群的0.01%~0.38%[5,6]。BD患者发生胆道系统癌变的位置最常见有肝外胆管占50.0%~62.05和胆囊占38.0%~46.0%[1]。现报道我院3例BD患者术后癌变病例。     

Reprint of: Microglial toll-like receptors and Alzheimer’s disease

Microglial activation represents an important pathological hallmark of Alzheimer’s disease (AD), and emerging data highlight the involvement of microglial toll-like receptors (TLRs) in the course of AD. TLRs have been observed to exert both beneficial and detrimental effects on AD-related pathologies, and transgenic animal models have provided direct and credible evidence for an association between TLRs and AD. Moreover, analyses of genetic polymorphisms have suggested interactions between genetic polymorphisms in TLRs and AD risk, further supporting the hypothesis that TLRs are involved in AD. In this review, we summarize the key evidence in this field. Future studies should focus on exploring the mechanisms underlying the potential roles of TLRs in AD.     

Expression profiles of miRNAs in human pancreatic cancer cell lines

Objective： To analyze initially the differences of miRNAs expression profiles in human pancreatic cancer cell lines by microarray technique. Methods： A total of 743 probes were designed according to the known miRNAs sequences of human, mice, and rats. miRNAs microarray was manufactured and its credibility was verified. Total RNAs were extracted and miRNAs were separated from human pancreatic cancer cell lines （SW1990, Capan-2, BxPC-3, Aspc-1, and Pancl） and immortal human pancreatic duct epithelial cell line H6C7. They were labeled with T4 RNA ligase, then were hybridized with microarray. Through array scan and analysis, miRNAs expression profiles in pancreatic cancer were obtained. The results were verified by Northern blotting and RT-PCR. Results： A total of 63 rniRNAs related to pancreatic cancer were found to be differentially expressed in 5 pancreatic cancer cell lines, including 25 down-regulated and 38 up-regulated miRNAs. Expressions of mir-21 and let-7 were also confirmed： Conclusion： The results suggested that miRNAs expression profiles could be found in pancreatic cancer cells.     

MRI诊断腰椎间盘术后粘连和突出复发

失败的下腰椎手术是个复杂的问题，由于其症状和体征不典型，单靠临床检查很难明确诊断，而脊髓造影和常规ＣＴ等检查也很难区别突出复发和硬膜外粘连。本文分析了３２例再手术患者ＭＲＩ图象，并与第二次手术所见对比，发现２７例ＭＲＩ诊断准确，３例假阳性，２例因信号缺失不能明确诊断。     

Radiomics model based on preoperative gadoxetic acid-enhanced MRI for predicting liver failure

BACKGROUND Postoperative liver failure is the most severe complication in cirrhotic patients with hepatocellular carcinoma(HCC) after major hepatectomy. Current available clinical indexes predicting postoperative residual liver function are not sufficiently accurate.AIM To determine a radiomics model based on preoperative gadoxetic acid-enhanced magnetic resonance imaging for predicting liver failure in cirrhotic patients with HCC after major hepatectomy.METHODS For this retrospective study, a radiomics-based model was developed based on preoperative hepatobiliary phase gadoxetic acid-enhanced magnetic resonance images in 101 patients with HCC between June 2012 and June 2018. Sixty-one radiomic features were extracted from hepatobiliary phase images and selected by the least absolute shrinkage and selection operator method to construct a radiomics signature. A clinical prediction model, and radiomics-based model incorporating significant clinical indexes and radiomics signature were built using multivariable logistic regression analysis. The integrated radiomics-based model was presented as a radiomics nomogram. The performances of clinical prediction model, radiomics signature, and radiomics-based model for predicting post-operative liver failure were determined using receiver operating characteristics curve, calibration curve, and decision curve analyses.RESULTS Five radiomics features from hepatobiliary phase images were selected to construct the radiomics signature. The clinical prediction model, radiomics signature, and radiomics-based model incorporating indocyanine green clearance rate at 15 min and radiomics signature showed favorable performance for predicting postoperative liver failure(area under the curve: 0.809-0.894). The radiomics-based model achieved the highest performance for predicting liver failure(area under the curve: 0.894; 95%CI: 0.823-0.964). The integrated discrimination improvement analysis showed a significant improvement in the accuracy of liver failure prediction when radiomics signature was added to the clinical prediction model(integrated discrimination improvement = 0.117, P =0.002). The calibration curve and an insignificant Hosmer-Lemeshow test statistic(P = 0.841) demonstrated good calibration of the radiomics-based model. The decision curve analysis showed that patients would benefit more from a radiomics-based prediction model than from a clinical prediction model and radiomics signature alone.CONCLUSION A radiomics-based model of preoperative gadoxetic acid–enhanced MRI can be used to predict liver failure in cirrhotic patients with HCC after major hepatectomy.     

残胃复发癌30例的外科治疗及其预后分析

目的分析残胃复发癌的外科疗效和影响预后因素。方法对本院1993年1月至2007年12月间因胃癌根治术后复发再次接受外科手术的30例临床资料进行回顾性总结。用Kaplan-Meier和Cox回归模型行生存分析,Long-rank行有效性检验。结果总体平均生存期30.52个月,中位生存期25个月。其中根治性切除19例(63.3%),平均生存41.43个月,非根治性手术11例(36.7%),平均生存16.85个月(P0.01)。Kaplan-Meier分析提示病理分期、病理类型、根治情况、有无腹膜种植、是否肝转移与生存期相关(P0.01),而性别、年龄、复发距初次手术时间、化疗与否与生存期无关。结论临床分期、腹膜种植及根治性手术是影响残胃复发癌预后的主要因素,残胃复发癌的个体化治愈性切除仍可获得较好的疗效。     

腹股沟疝前、后进路修补的随机对照研究

目的:比较前进路(常规疝手术)修补方法和后进路(腹膜前)修补方法治疗腹股沟疝病人的疗效、住院时间、总体费用、恢复工作时间、手术并发症等。方法:采用前瞻性随机对照方法,213例病人222侧疝(其中有9例同时患有双侧疝,男196例,女17例)随机分为前进路组(105例)和后进路组(108例)。前进路组采用常规修补,其中约1∕4病人(共27侧疝,Nyhus分型Ⅰ、Ⅲ型)用经典方法修补(Bassini术式21例和McVay术式6例)。3∕4病人(83侧疝,Nyhus分型Ⅱ、ⅢB、Ⅳ型)用假体的无张力修补(Lichtenstein术式21侧疝和Rutkow术式62侧疝);后进路组超过1∕3病人(38侧疝Nyhus分型Ⅰ、Ⅱ和ⅢA型)用不吸收缝线直接缝合修补,近2∕3病人(74侧疝,ⅢB、Ⅳ型)加用单层网片修补。结果:两组病人手术并发症的发生无明显差异。而平均住院时间、恢复日常生活时间前进路组要明显短于后进路组(P<0.01),在平均费用方面,后进路组明显少于前进路组(P<0.01),后术腹股沟区疼痛不适的发生率明显降低。结论:采用后进路方法进行腹股沟疝修补,可明显减少手术花费(不用人工假体或仅用单层平片),降低术后疼痛不适的发生率,改善疗效。因此,经后进路行腹股沟疝修补是一安全有效的方法,适合我国的国情,具有推广的价值。     

miR-34a在膀胱癌中下调MTA2表达的研究

目的 研究微小核糖核酸34a（microRNA-34a,miR-34a）在膀胱癌中的表达及临床意义,确定转移相关基因2（metastasis-associated gene2,MTA2）是否为miR-34a调控的下游靶基因,探讨膀胱癌中miR-34a与MTA2的相互作用机制。方法 选取48对膀胱癌根治术后癌组织及癌旁组织,标本来源于2011年5月至2012年5月我科收治的膀胱癌患者。Real-time PCR检测miR-34a和MTA2在组织中RNA的表达情况;荧光素酶实验鉴定MTA2是否为miR-34a下游靶基因;膀胱癌细胞株T24及UMUC3中转入miR-34a后,琼脂糖凝胶电泳、免疫印迹实验检测MTA2的RNA及蛋白表达。结果 Real-time PCR检测表明,膀胱癌组织中miR-34a呈低表达,并且与肿瘤分期有关（P〈0.01）;MTA2在癌组织中表达明显上调。MiRanda、Mirwalk、Targetscan软件预测miR-34a与MTA2的mRNA有结合位点,荧光素酶实验结果表明MTA2可能是miR-34a的潜在靶基因。转染miR-34a后,分别检测MTA2的蛋白和mRNA表达情况,发现MTA2蛋白受到抑制,mRNA表达不受影响。结论 miR-34a在膀胱癌中可能通过作用于其潜在靶基因MTA2而发挥抑癌基因作用。     

GZ-2002急性淋巴细胞白血病化疗方案治疗非高危儿童急性淋巴细胞白血病多中心协作临床研究

目的探讨多中心合作开展小儿急性淋巴细胞白血病(ALL)化疗的可能性和提高ALL治愈率的新策略。方法协作组由广州市7家大型医院组成,各单位指定负责人1人,并设立专职资料管理员1人。协作组邀请香港中文大学威尔斯亲王医院为顾问单位。各单位对符合入选标准的新诊断标准危险型(SR)和中度危险型(IR)ALL患儿均采用GZ-2002 ALL化疗方案,所有病例按细胞形态学、免疫学和细胞遗传学分型。根据发病时的年龄、外周血白细胞、第8天的泼尼松反应、t(9:22)或t(4;11)、BCR/ABL和MLL/AF4融合基因,以及化疗第33天是否完全缓解确定临床类型。GZ-2002方案以BFM2002方案为基础,总疗程共104周,由诱导期、巩固期、再诱导期和维持期组成。结果 2002年10月~2009年6月,协作组共收治ALL患儿617例,随访至2009年10月31日,中位随访时间44.5个月(范围:4~84个月)。按协作组诊断标准,把儿童ALL分为SR、IR和高危型(HR)。入组采用GZ-2002 ALL化疗方案的SR和IR患儿共446例,男227例,女169例;年龄1~14岁(中位年龄6岁)。诱导期的总完全缓解率为99.8%(445/446)。SR组3年和5年无事件生存率(EFS)分别为(90.5±5.0)%和(82.0±4.0)%。IR组3年和5年EFS分别为(88.0±6.0)%和(78.0±5.0)%,两组差异均有显著性意义(P<0.05)。至随访终止日,共随访到回复病例413例,占总例数的92.6%。可随访例数中无事件生存者339例(82.1%),其中停药无病生存者267例(78.8%),进入维持阶段72例(21.2%)。有"事件"者78例(18.9%),其中复发47例(11.4%),非复发死亡20例(4.8%)。远期毒副作用8例(1.9%),第2肿瘤3例(0.7%);复发者已死亡24例(含6例复发后放弃),带病存活23例。死亡的中位时间为治疗后7.9个月(1.5~23个月)。失访33例,其中停药后失访5例,维持期间因出国、搬家、原联络地址变更和回原籍(广东省以外)等共28例。结论 GZ-2002 ALL化疗方案的疗效满意,广州地区多中心协作的模式是成功的,这种协作模式对推动我国开展更大规模的协作提供了宝贵的经验。