团块状巨大型尖锐湿疣继发皮肤鳞状细胞癌病例报告及文献复习

目的通过团块状巨大型尖锐湿疣继发皮肤鳞状细胞癌临床病例,分析其临床表现、组织病理特点及治疗和预后。方法报告临床收治团块状巨大型尖锐湿疣继发皮肤鳞状细胞癌一例临床资料。结合文献检索进行病例复习。结果组织病理:上皮增生,棘层增生,上皮脚下延,呈假上皮瘤样增生,伴角化不良,上皮中至高度异型增生,未见挖空细胞。HPV分型:高危亚型16,低危亚型6。该病例通过临床表现,结合组织病理,诊断为团块状巨大型尖锐湿疣继发皮肤鳞状细胞癌。手术切除治疗,随诊未再复发。结论巨大型尖锐湿疣具有独特的临床表现和组织病理学特征,容易癌变,临床工作中一定要引起重视,防止误诊和漏诊的发生。     

Comparison of ACUITY and CRUSADE Scores in Predicting Major Bleeding during Acute Coronary Syndrome

Background

The ACUITY and CRUSADE scores are validated models for prediction of major bleeding events in acute coronary syndrome (ACS). However, the comparative performances of these scores are not known.

Objective

To compare the accuracy of ACUITY and CRUSADE in predicting major bleeding events during ACS.

Methods

This study included 519 patients consecutively admitted for unstable angina, non-ST-elevation or ST-elevation myocardial infarction. The scores were calculated based on admission data. We considered major bleeding events during hospitalization and not related to cardiac surgery, according to the Bleeding Academic Research Consortium (BARC) criteria (type 3 or 5: hemodynamic instability, need for transfusion, drop in hemoglobin ≥ 3 g, and intracranial, intraocular or fatal bleeding).

Results

Major bleeding was observed in 31 patients (23 caused by femoral puncture, 5 digestive, 3 in other sites), an incidence of 6%. While both scores were associated with bleeding, ACUITY demonstrated better C-statistics (0.73, 95% CI = 0.63 - 0.82) as compared with CRUSADE (0.62, 95% CI = 0.53 - 0.71; p = 0.04). The best performance of ACUITY was also reflected by a net reclassification improvement of + 0.19 (p = 0.02) over CRUSADE’s definition of low or high risk. Exploratory analysis suggested that the presence of the variables ‘age’ and ‘type of ACS’ in ACUITY was the main reason for its superiority.

Conclusion

The ACUITY Score is a better predictor of major bleeding when compared with the CRUSADE Score in patients hospitalized for ACS.     

零球差非球面人工晶状体在高度近视眼中对比度视力与像差的研究

目的 研究高度近视患者晶状体摘除联合零球差非球面与球面人工晶状体植入术后暗环境对比度视力及波前像差差异.方法 在本前瞻性队列研究中,选择28例(44只眼)高度近视患者,按植入的人工晶状体类型分成2组,试验组23只眼,植入零球差非球面人工晶状体Akreos AO (Bausch&Lomb,Inc),对照组21只眼,植入球面人工晶状体(Rayner SuperflexTM 620H);于手术术后3个月时测量最佳矫正视力,角膜像差,全眼像差及暗环境下对比度视力.结果 (1)试验组与对照组各参数比较;年龄[(52.6±5.7)岁vs.(54.1±5.9)岁,P=0.281)]、眼轴长度[(30.21±2.06) mm vs.(31.03±2.03) mm,P=0.289]、手术前最佳矫正视力(4.68±0.10 vs.4.63±0.12 P=0.248)、人工晶状体度数[ (4.8±2.98)D vs (3.42±3.83)D,P=0.235]、术后等效球镜度数[(-2.53±1.25)D vs(-2.12±0.70)D,P=0.273]手术后最佳矫正视力(4.83±0.15 vs.4.76±0.15 P=0.211)均无统计学意义(P＞0.05).(2)像差比较(6 mm瞳孔直径):术后角膜球差[(0.27±0.18) μm vs (0.28±0.16) μm,P=0.905)]、全眼球差[(0.23±0.14)μm vs (0.32±0.16)μm,P=0.144)]、全眼总高阶像差[ (1.46±0.48)μm vs(1.14±0.50) μm,P=0.277]、彗差[(0.68±0.45) μm vs (0.73±0.48) μm,P =0.782]、三叶草[(0.55±0.15) μm vs (0.42±0.16) μm,P=0.377)]差异均无统计学意义(P＞0.05).(3)暗环境下对比度视力:100％对比度视力(0.16±0.19vs.0.19±0.17 P=0.64) 25％对比度视力(0.39±0.20 vs.0.47±0.22 P=0.31)、10％对比度视力(0.65±0.29vs.0.78±0.31 P=0.22)、5％对比度视力(0.90±0.24 vs.0.99±0.27 P=0.40)亦均无统计学意义(P＞0.05).结论 (1)零球差非球面低度数人工晶状体植入高度近视患者,与低度数球面人工晶体比较,术后球差和像差值无减少.(2)零球差非球面人工晶状体植入高度近视患者后,夜间对比度视力未好于球面人工晶状体.     

Giant condyloma acuminatum (Buschke-Lowenstein tumor) of the anorectal and perianal regions

PURPOSE: Giant condyloma acuminatum or Buschke-Loewenstein tumor of the anorectal and perianal regions is an uncommon entity that has not been extensively reviewed. We analyzed 42 known cases of giant condyloma acuminatum in the English literature and reviewed their behavior and management. METHODS: All reported cases of giant condyloma acuminatum in the English literature were selected. The relevant clinicopathologic features of this uncommon entity were examined and discussed. RESULTS: These tumors are generally large with the propensity to ulcerate and infiltrate into deeper tissues. The hallmark of the disease is the high rate of recurrence (66 percent) and malignant transformation (56 percent). No distant metastases have been reported. The overall mortality was 20 percent, all occurring in patients with recurrences. Fifty percent of the patients who were initially treated with radical surgery developed recurrences. The average duration of disease was longer in patients with recurrences than in patients without recurrences (9.6 years vs. 2.8 years). The median number of recurrences was two (range, one to seven) recurrences, and the median time before first recurrence was ten months. Recurrences were treated by radical surgery in 17 patients and chemoradiotherapy ± local excision in 5 patients. Follow-up information for the remaining five patients was not available. The cure rate in the radical surgery group was 61 percent compared with 25 percent in the chemoradiotherapy ± local excision group. CONCLUSIONS: Giant condyloma acuminatum of the anorectal and perianal regions is a highly aggressive tumor with the propensity for recurrences and malignant transformation, but without metastatic potential. A high rate of recurrence is seen in patients with long duration of the disease. Salvage of patients with recurrences can be achieved successfully with radical surgery.Read at the meeting of the New England Cancer Society, Boston, Massachusetts, November 12 to 14, 1993.     

电灼术联合干扰素封闭治疗肛周尖锐湿疣的疗效评价

目的：评价电灼术联合干扰素封闭治疗肛周尖锐湿疣的疗效。方法采用电灼术联合局部干扰素封闭治疗肛周尖锐湿疣51例（观察组）,单纯应用电灼术治疗肛周湿疣51例（对照组）,比较一次性痊愈率和12周复发情况。结果观察组比对照组治愈率高（P〈0.05）,观察组12周复发明显少于对照组（P〈0.05）。结论电灼术联合干扰素封闭治疗肛周尖锐湿疣治愈率高,复发率低,能明显减轻患者的痛苦,患者易于接受。     

子宫颈糜烂与生殖道人乳头瘤病毒感染关系

目的 探讨女性生殖道感染人乳头瘤病毒基因类型及与子宫颈糜烂关系,为宫颈癌防治提供依据.方法 收集454份子宫颈糜烂标本,分成尖锐湿疣(CA)组和非CA组,采用免疫组化法和PCR技术检测人乳头瘤病毒(HPV)基因类型.结果 免疫组化法检测宫颈糜烂感染HPV阳性率,CA组为67.8%,非CA组为47.7%.PCR检测宫颈糜烂Ⅰ°、Ⅱ°、Ⅲ°感染HPV阳性率,CA组Ⅰ°55.5%,Ⅱ°64.7%,Ⅲ°83.3%.非CA组Ⅰ°32.8%,Ⅱ°49.6%,Ⅲ°62.3%.HPV-DNA类型以6,11,16,18,58,45,33型为主.结论 本地区宫颈糜烂患者有较高的HPV感染率,并与糜烂程度呈正相关,监测和控制女性生殖道HPV感染对宫颈癌防治具有重要意义.     

中医治疗尖锐湿疣的进展

近年来 ,就中医治疗尖锐湿疣的现状进行了综述和分析。表明目前治疗途径以外治熏洗坐浴和涂擦或内外治结合为主 ,治法和药物以祛湿清热解毒和化瘀散结类为主 ,适当辅以益气扶正 ,分析表明中医药利用调整机体全身的优势 ,结合外治 ,对尖锐湿疣进行综合治疗在提高治愈率和减少复发率方面有着重要的临床价值 ,同时指出了存在的问题。     

Proteomic and bioinformatic analysis of condyloma acuminata: mild hyperthermia treatment reveals compromised HPV infectivity of keratinocytes via regulation of metabolism,differentiation and anti-viral responses

Background: Hyperthermia has proved successful in treating cutaneous human papillomavirus infectious diseases such as plantar wart and condyloma acuminata (CA). Moreover, this treatment provides improved therapeutic efficacy in these conditions as compared with conventional therapies.

Objectives: To investigate the global proteome changes in CA in response to hyperthermia and achieve a better understanding of the mechanisms of hyperthermia therapy against HPV-infectious diseases.

Methods: CA tissue was obtained from patients undergoing pathological examinations. Diagnosis was verified as based on results of both HE staining and HPV-DNA PCR assay. Hyperthermia was achieved with a 44?°C water bath. Differentially expressed proteins (DEPs) were identified by iTRAQ labeling, SCX chromatography and LC-MS/MS assay. Validation of proteomic results was performed using real-time qPCR and western blot, while bioinformatic analysis of DEPs was accomplished by R 3.4.1, STRING and Cytoscape softwares.

Results: In response to hyperthermia, a total of 102 DEPs were identified with 37 being upregulated and 65 downregulated. Among these DEPs, hyperthermia induced proteins involved with anti-viral processes such as OAS1, MX1, BANF1, CANX and AP1S1, whereas it inhibited proteins that participated in cellular metabolism, such as GALT, H6PD, EXOSC4 and EXOSC6; protein translation, such as RPS4Y1; as well as keratinocyte differentiation, such as KRT5, KRT27, KRT75, KRT76 and H2AFY2.

Conclusions: Hyperthermia inhibited enzymes and molecules responsible for metabolism modulation and keratinocyte differentiation in CA tissue, whereas it promoted factors involved in anti-viral responses. Such effects may, in part, contribute to the efficacy of local hyperthermia therapy against HPV infection.     

A comparison of visual acuity measured by ETDRS chart and Standard Logarithmic Visual Acuity chart among outpatients

AIM:To compare the results of visual acuity(VA)measured by Early Treatment Diabetic Retinopathy Study(ETDRS)chart,5 m Standard Logarithm Visual Acuity(5 SL)chart,and 2.5 m Standard Logarithm Visual Acuity(2.5 SL)chart in outpatients of age 12-80 y.METHODS:Each patient(totally 2000 outpatients)had both eyes tested with ETDRS chart at 4 m,5 SL chart at 5 m,and 2.5 SL chart at 2.5 m in random order.The VA values of outpatients were categorized by ages.VA values were expressed by log MAR recording method.RESULTS:The mean VA results of ETDRS charts,5 SL,and 2.5 SL chart were 0.52±0.28,0.50±0.30,and 0.46±0.28 log MAR,respectively.There was a statistically significant difference in the three eye charts in the whole group(P<0.001).For all subjects,the correlation of VA tested with three charts was statistically significant(Spearman correlation coefficient=0.944,0.937,0.946,all P<0.001).Bland–Altman analysis shows the 95%limits of agreement between the 5 SL and 2.5 SL chart were-0.182 to 0.210,-0.139 to 0.251,and-0.151 to 0.235 log MAR,respectively.CONCLUSION:The agreement between the three eye charts is not high.The VA measured by 5 SL chart is slightly better than that by ETDRS chart and 5 SL chart would be a suitable alternative when ETDRS chart are not available in the clinical situation.The VA measured by 2.5 SL chart is about 0.5 line better than VA tested with ETDRS chart,which may overestimate VA.     

药物治疗尖锐湿疣127例对比分析

本文分别用三氯醋酸、新洁尔灭及５－氟尿嘧啶治疗１２７例尖锐湿疣，以观察分析其不同疗效。结果三氯醋酸组有效率（９４．４４％）显著高于新洁尔灭组（５５．００％）和５－氟尿嘧啶组（４７．０６％）（Ｐ均＜０．０１），并探讨了该病的病因、治疗、影响疗效的因素及预防。