分层解剖在分化型甲状腺癌功能性颈清术中应用

目的多功能保留颈淋巴结清除术是治疗分化型甲状腺癌(differentiated thyroid cancer,DTC)颈部淋巴结转移的主要方法,较传统的功能性颈清除术更美观性,颈部功能保留更完善。如何更好的完成该手术,降低术后并发症,一直是外科医师探讨的问题。本研究主要探讨分层解剖在DTC多功能保留颈淋巴结清除术中应用的可行性及意义。方法回顾性分析沧州市中心医院2008-05-01—2019-03-31因DTC行甲状腺切除加Ⅱ~Ⅵ区多功能保留颈淋巴结清除术的457例患者临床资料,分为分层解剖法多功能保留手术组(A组,235例)和常规多功能保留手术组(B组,222例)。记录2组的手术学指标、术后并发症和出院时间等。采用χ^2检验及t检验对数据进行分析。结果2组患者基线资料比较,差异均无统计学意义,均P>0.05。A与B组手术时间分别为(127.85±14.65)和(136.80±14.65)min,t=-6.529,P<0.001;出血量分别为(34.38±14.44)和(48.02±18.88)mL,t=-8.705,P<0.001;术后住院时间分别为(8.57±1.41)和(11.59±2.21)d,t=-17.469,P<0.001;差异均有统计学意义。术后并发症发生率A组比B组更少,声音嘶哑发生率分别为1.28%(3/235)和4.50%(10/222),χ^2=4.304,P=0.038;皮缘坏死发生率分别为0.43%(1/235)和4.05%(9/222),χ^2=7.022,P=0.008;低血钙发生率分别为5.11%(12/235)和13.51%(30/222),χ^2=9.668,P=0.002;差异均有统计学意义。结论分层解剖法多功能保留手术不破坏解剖层次界限,明显缩短手术时间,减少术中出血,降低术后并发症发生率。因此其在甲状腺癌多功能保留的颈淋巴结清除术中合理可行。     

放化疗结合治疗10例肺癌脑转移临床体会

目的探讨放化疗对肺癌脑转移患者的治疗效果。方法10例肺癌脑转移患者接受放射治疗,放化疗期间应用激素、脱水药物以及必要的支持治疗。结果1年以上生存率为40%(4/10);有效病例中位生存8.5个月(4.5~28个月)。无效病例中位生存3.1个月(1.5~5.3个月)。结论化疗配合放疗能提高肺癌脑转移患者的生存期。     

64例下咽癌患者术后生存分析

目的分析行开放性手术下咽癌患者生存时间的影响因素。方法回顾性分析2010年12月~2018年12月行开放性手术的64例下咽癌患者临床资料,根据2010AJCC TNM分期：T1期3例（4.7%）,T2期11例（17.2%）,T3期15例（23.4%）,T4期35例（54.7%）。随访所有患者术后生存情况;Kaplan Meier法进行单因素生存分析并行Log rank检验,Cox回归模型对生存预后影响因素进行多因素分析。结果64例患者失访3例,随访率95.3%。27例死亡患者中病理淋巴结阳性者23例（85.2%）,术后咽瘘者10例（37.0%）,淋巴结复发者18例（66.7%）;34例存活患者中病理淋巴结阳性者17例（50%）,术后咽瘘者6例（17.6%）,淋巴结复发者1例(3.0%)。单因素分析显示淋巴结转移、咽瘘及淋巴结复发是影响下咽癌患者术后生存时间的因素差异具有统计学意义（P＜0.05）;Cox回归模型多因素分析显示术前淋巴结转移及术后放/化疗是影响下咽癌患者术后淋巴结复发的危险因素差异具有统计学意义（P＜0.05）。结论下咽癌早期临床症状不明显,发现时多已处于中晚期,预后较差,对影响下咽癌患者术后生存时间因素的淋巴结转移、咽瘘以及淋巴结复发应予以重视,淋巴结转移及术后同步放化疗是淋巴结复发的影响因素。     

Excessive activation of IL-33/ST2 in cancer-associated fibroblasts promotes invasion and metastasis in ovarian cancer

Ovarian cancer is highly prevalent and has high mortality rates due to metastasis and relapse. The cross communication between cancer-associated fibroblasts (CAFs) and cancer-associated macrophages (CAMs) in the ovarian tumor microenvironment leads to cancer cell invasion and metastasis. However, the role of overproduction of IL-33/ST2 in the CAFs of ovarian cancer is still unclear. The expression of IL-33, ST2, apoptosis-related proteins and epithelial-mesenchymal transition (EMT) markers was measured by western blotting. Primary normal fibroblasts and CAFs from ovarian cancerous tissue were isolated and cultured in vitro, and the medium was used to stimulate blood-derived monocytes. Flow cytometry analysis was used to detect the frequency of M2-like macrophages in blood-derived monocytes from patients with ovarian cancer. Cell invasion were evaluated using Transwell assays. A xenograft model was used to study tumor growth in ST2-knockout and wild-type NOD-SCID mice. The results demonstrated higher expression of IL-33 and ST2 in carcinoma tissues compared with in para-carcinoma tissues, and there was a survival improvement associated with elevated IL-33. IL-33 and culture supernatants from CAFs, rather than normal ovarian fibroblasts, led to a higher expression of M2 macrophage marker genes in human blood-derived monocytes. Invasion and migration were aggravated in COC1 cells co-cultured with CAF-induced CAMs, and the EMT marker genes were upregulated. It was reported that EMT marker genes were downregulated and tumor volumes were significantly reduced in ST2-deficient mice. Overall, the IL-33/ST2 axis in ovarian cancer might integrate IL-33-expressing CAFs with M2 type-like CAMs, which aggravated invasion and metastasis by promoting EMT.     

血小板数与巨核细胞、转化生长因子β1在川崎病动物模型中的动态变化

[目的]动态观察血小板数(PLT)、巨核细胞、转化生长因子β1(TGF-β1)在幼兔免疫性血管炎中的变化.[方法]用牛血清白蛋白复制幼兔免疫性血管炎的川崎病(KD)动物模型,每隔4 d分别检测血小板数、巨核细胞计数及分类、TGF-β1;并于d17、d28取冠状动脉、肝、脾、肾、脑等组织作病理学分析.[结果]PLT、巨核...     

Isolation of myelinoid Marchi-positive bodies from normal rabbit spinal cord

Normal rabbit spinal cord was homogenized in sucrose and fractionated by centrifugation in a sucrose density gradient system slightly modified after the Norton-Poduslo method for the isolation of myelin. The following fractions were recovered: the fraction floating on 0.32 M sucrose, the myelin fraction at the 0.32 M/0.85 M interface and the pellet. After fixation in glutaraldehyde the fractions were subjected to Marchi staining, a histochemical method used for the demonstration of degenerating myelin. The floating fraction was enriched in Marchi-positive bodies as compared to the homogenate while the myelin fraction and the pellet contained low amounts. No esterified cholesterol was found in the floating fraction. Since histochemical and electron microscopical studies have shown that Marchi-positive myelinoid bodies in the normal CNS are associated with node-paranode regions our results indicate a possibility to isolate and biochemically characterize a presumably closely myelin-related fraction of known anatomical origin. The absence of esterified cholesterol in the floating fraction shows that biochemical or biophysical properties other than a content of esterified cholesterol may give rise to a positive Marchi reaction.