乳腺癌前哨淋巴结活检中亚甲蓝与亚甲蓝、同位素联合示踪的比较研究

目的比较单用亚甲蓝或联合亚甲蓝及同位素示踪剂在乳腺癌前哨淋巴结活检中的价值及研究影响前哨淋巴结活检准确性的因素。方法收集2005年3月至2006年7月期间行前哨淋巴结活检的164例乳腺癌患者,单用亚甲蓝示踪剂组104例,活检前乳晕旁皮下注射亚甲蓝2ml;亚甲蓝和同位素联合示踪剂组60例,术前肿瘤周围实质中4点注射^99m锝-硫胶体2mCi/4ml,经淋巴显像,术中在γ探测仪引导下行腋窝前哨淋巴结活检。结果前哨淋巴结总的检出率为97.0%（159/164）,准确性为95.0%（151/159）,假阴性率为14.0%（8/57）;联合组检出率、准确率、敏感性、阴性预测值高于亚甲蓝组,联合组的假阴性率为8.7%（2/23）,较亚甲蓝组17.7%的假阴性率为低（6/34）,但差异均无统计学意义（P=0.453）。亚甲蓝组平均每例检测出2.2枚前哨淋巴结,联合组为平均2.5枚（P=0.223）。前哨淋巴结数目≥3和〈3枚的患者假阴性率分别为0%和24.2%（8/33）（P=0.016）。联合组中发现73枚无蓝染仅有热点的前哨淋巴结,故同位素的应用将本组患者的检出率从85.0%（51/60）提高至98.3%（59/60）,假阴性率从21.7%（5/23）降低至8.7% （2/23）。结论在取得一定经验的情况下,亚甲蓝示踪与联合染料、同位素示踪可获得相似的前哨淋巴结检出率、准确率;同位素示踪剂的应用对亚甲蓝示踪起到很好的补充作用;前哨淋巴结检出越多,假阴性率越低。     

MRI定位下立体定向活检术在颅内多发疑难病例诊断中的应用

目的探讨MRI定位立体定向活检术的优点及其在颅内多发疑难病例诊断中的应用价值。方法安装Leksell-G型定位框架,采用MRI扫描,确定靶点的位置。对22例临床表现不典型或影像学上较难诊断的多发疑难占位患者施行立体定向活检手术。结果22例患者均未出现因活检手术造成的颅内出血、偏瘫等严重并发症。所有患者均得到明确的病理诊断及相应的治疗。结论MRI定位立体定向活检手术具有准确性高的优点,能够有效的诊断颅内多发疑难病例。     

核心力量训练在脑瘫治疗中的应用

目的探讨核心力量训练在脑瘫患儿临床康复中的应用效果。方法选取我院收治的40例脑瘫患儿,采用随机分组的方法分为两组。对照组20例,给予常规的康复治疗;试验组20例,给予核心力量训练进行治疗。采用粗大运动功能量表（GMFM-88）评估两组患者治疗前后的效果。结果给予3个月的训练治疗后,两组患儿的GMFM评分高于治疗前,治疗后试验组的疗效要优于对照组,差异具有统计学意义（P〈0．05）;治疗后试验组的总有效率要高于对照组,差异具有统计学意义（P〈0．05）。结论核心力量训练能够提高脑瘫儿童的躯十及骨盘控制能力。提高粗大运动功能,促进患儿的运动及平衡协调的能力的发育,促进患儿康复,取得了较好的临床疗效。     

106例老年皮肤病变活检分析

本文报告106例老年皮肤病患者皮肤活检结果,发现皮肤肿瘤的患病率居首位,占41.56%,良、恶性肿瘤各占一半。结果提示:凡老年皮肤病患者均应警惕癌肿的发生。     

Banff移植肝病理学诊断标准及其进展

移植肝活组织检查(活检)病理学不仅在供肝病理学评估,而且在移植术后并发症的诊断和鉴别诊断中是不可缺少的。移植肝并发症的病理学诊断相关研究随着临床肝移植的扩展而日益深入,国际上逐渐制订了Banff移植肝活检病理学诊断标准,我国移植肝活检的病理学研究也逐步开展,并逐渐形成了适合我国肝移植临床实际的移植肝活检病理学诊断标准。本文对Banff移植肝活检病理学研究的历史和移植肝并发症的主要病变进行综述,旨在为我国更好地开展移植肝活检病理学诊断,协助临床进行肝移植术后并发症的明确诊断和针对性治疗,进一步提高移植肝和受者的良好存活提供参考依据。     

TGF-β信号通路促进小鼠乳腺癌活检相关性肺转移的实验研究

目的探讨空芯针穿刺活检(core needle biopsy,CNB)对乳腺癌远处转移的影响及其可能机制。方法 30只BALB/c小鼠采用乳腺癌4T1细胞乳腺脂肪垫接种,分成活检与非活检两组,活检组应用CNB建立活检相关肺转移模型,采用流式细胞术、qPCR及形态学等检测技术从肿瘤组织局部和整体水平评价其生物学行为。结果成功建立稳定而可靠的乳腺癌肺转移模型,活检组小鼠肺转移结节数显著高于非活检组(P0.05);与非活检组相比,活检组小鼠TGF-β1、SOX-4及EZH2的m RNA表达上调(P0.05),流式细胞术检测的NK细胞增加,但差异无统计学意义(P0.05)。结论 CNB可通过TGF-β信号通路介导的上皮-间质转化(epithelial-mesenchymal transition,EMT)等机制促进乳腺癌的肺转移。     

Mammographically Occult Asymptomatic Radial Scars/Complex Sclerosing Lesions at Ultrasonography-Guided Core Needle Biopsy: Follow-Up Can Be Recommended

An increasing number of radial scars are detected by ultrasound (US), but their management is controversial. This study investigated the upgrade rate in mammographically occult radial scars/complex sclerosing lesions without epithelial atypia at US-guided 14-gauge core needle biopsy in asymptomatic patients. Nineteen mammographically occult benign radial scars/complex sclerosing lesions (median size, 7 mm; range, 3–23 mm) were included. Patients underwent surgical excision (n = 10) or vacuum-assisted excision, with follow-up US at least 6 mo after benign vacuum-assisted excision results (n = 8), or underwent US follow-up for 2 y after core needle biopsy (n = 1). Any cases with change in diagnosis to high-risk lesions or malignancy at excision were considered upgrades. The upgrade rate was 0.0%. Based on US findings, 15.8% (3/19) were Breast Imaging Reporting and Data System (BI-RADS) category 3, 68.4% (13/19) were BI-RADS category 4a and 15.8% (3/19) were BI-RADS category 4b. Follow-up with US can be considered for mammographically occult benign radial scar/complex sclerosing lesions diagnosed by US core needle biopsy in asymptomatic patients.     

Comparison of Turkish Disability Policy,the United Nations Convention on the Rights of Persons with Disabilities,and the core concepts of U.S. disability policy

This article compares Turkey's Constitution and its Disabled Persons Act with the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) and the core concepts of United States (U.S.) disability policy. Conclusions are that Turkey's Constitution and statutes are remarkably congruent with the UNCRPD and the core concepts. They are not, however, identical. This fact suggests that Turkey can still improve its statutes to reflect more closely the UNCRPD and core concepts. The review of these policy documents suggests that there are other steps Turkey can take to improve disability policy and its implementation. They are to amend Turkey's laws, determine the status of individuals and families affected by disability, and pursue vigorous implementation of their rights.