Assessment of the response to chemotherapy in gestational trophoblastic neoplasia with vaginal metastases

Background and goals  This study is designed to survey gestational trophoblastic neoplasia with vaginal metastases (GTN + VM) manifestations, prognosis and chemotherapy response in order to consider appropriate chemotherapy regimen for these patients. There have been just a few studies about treatment of GTN + VM. Materials and methods  Patients with Stage III GTN with or without vaginal metastases who had referred to Vali-e-Asr Hospital during 1996–2006 have been selected to take part in this study and the size of metastases was measured. Then response and resistance to single and combination chemotherapy regimens have been compared in these two groups. The data were processed using SPSS system (release 10). Statistical analysis was done with X² to determine factors associated with complete clinical response. The level of significance was assigned at P < .05. Results  Forty-eight patients with stage III (with pulmonary metastases) GTN patients have been selected, 13 with vaginal metastases and 35 without vaginal metastases. Incidence of vaginal metastases in stage III was 26%. Metastases were mainly in distal part of vagina and suburethra. Chief complaint was severe hemorrhage in 25% of patients and was controlled by vaginal packing with just one exception. Group of vaginal metastases showed 66.6% resistance to first-line chemotherapy, compared to 28.6% in patients with no vaginal metastases (P-value = 0.010). Median of chemotherapy courses in low-risk vaginal metastatic patients was 5 (mean = 5.2), compared to three courses in the group without vaginal metastases. Resistance to single chemotherapy was significantly higher in GTN + VM versus GTN without VM patients and resistance was higher especially in patients with metastases with more than 3 cm (in diameter). Conclusions  Vaginal metastasis with more than 3 cm in diameter is an important prognostic factor in GTN patients. There have higher risks for severe hemorrhage and resistance to single agent chemotherapy, so in these patients combination chemotherapy, with no regard to staging and scoring, would be a better choice. An erratum to this article can be found at     

Magnetic resonance imaging and hysteroscopy to diagnose colo-uterine fistula: a rare complication of diverticulitis

Colo-uterine fistula of diverticular origin is an extremely rare disease due to the resistance of uterine tissue. Methods for diagnosis remain to be established. Non-invasive imaging like magnetic resonance imaging (MRI) may help to establish a proper diagnosis, but confirmation may be reached by diagnostic hysteroscopy or even surgical exploration. We report a 78-year-old female who presented with continuous dull aching pain associated with increasing constipation. MRI suspected a fistula between the posterior aspect of the uterine body and the sigmoid colon which contained extensive diverticulosis. Hysteroscopy confirmed the fistulous opening, but colonoscopy confirmed diverticular disease with no evidence of malignancy. The patient had en block surgical treatment of the uterus and the adjacent colon, followed by an uneventful recovery. The sensitivity and specificity of non-invasive imaging procedures to diagnose such cases remain to be established. As imaging procedures cannot rule out neoplasia, endoscopic procedures need to be added.     

近红外立体定向辅助导航大鼠模型研究

目的获取大鼠脑组织的近红外反射光谱,研究脑内灰、白质之间光谱曲线下面积的不同特征,探讨以此为指标判别脑内结构、辅助立体定向手术定位的可能性。方法将Y形双光纤探头步进插入大鼠脑内,采集穿刺轨迹不同位置的反射光谱,利用积分因子对采集结果进行统计分析。结果近红外光谱积分因子随探头前端脑组织性质发生明显变化,灰质内数值低,白质内数值高。结论采集光谱的积分因子能够有效的识别大鼠脑组织灰、白质,为脑组织光学定位的进一步研究提供了依据。     

病毒性脑炎患者BDVp24、p40基因片段的核酸检测

目的分别检测病毒性脑炎患者脑脊液有核细胞（CSFMCs）中博尔纳病病毒（BDV）p24、p40基因片段,探讨病毒性脑炎患者与BDV感染的关系及阳性患者的临床特征。方法用荧光定量巢式逆转录聚合酶链反应（FQ—nRT—PCR）方法检测病毒性脑炎患者及对照者CSFMCs中BDVp24、p40基因片段,将两个保守区p24和p40检测均为阳性的标本再做进一步分析,并总结阳性患者的临床特征,同时用β-肌动蛋白（B—actin）作为内参照。结果实验组102例病毒性脑炎患者CSFMCs中BDVp24基因片段检测中有11例阳性,BDVp40基因片段检测中有10例阳性,两个保守区p24和p40检测均为阳性标本10例,对照组84例中均为阴性,两者比较阳性率差异有统计学意义（P〈0．05）。阳性基因片段产物测序后与BDV标准病毒株V和马源的BDV病毒株H1766序列比较,同源性分别为96．35％和98．85％,在4个位点出现基因突变（nt1649T→C,nt1656G→A,nt1670C→T,nt1676C→T）;8例阳性患者主要以精神行为异常为起病方式,患者与动物关系密切,其他临床特征无特殊。结论病毒性脑炎的发生与BDV感染有关,主要以精神行为异常为临床特征。     

Klotho基因在慢性肾脏病中作用的研究进展

Klotho基因是一种与人类衰老密切相关的基因,其主要在肾脏和脑脉络膜中表达。许多研究证实klotho基因具有多种生物学功能,参与抗肾脏纤维化、钙磷代谢调节,调节离子通道活性,抑制氧化应激及Wnt信号转导等。本文就该基因与慢性肾脏病的关系进行综述,探寻其在慢性肾脏病发生、发展中所发挥的分子生物学机制。     

缺血性脑血管病患者颈动脉粥样硬化斑块与超敏-CRP关系

目的探讨脑梗死患者颈动脉粥样硬化性斑块与超敏C-反应蛋白（Hs-CRP）含量的关系。方法分别测定30名通过颈动脉超声检查发现有粥样硬化斑块的急性脑梗死（A组）、脑供血不足患者（B组）和无颈动脉粥样硬化斑块老年健康体检者（C组）血清中Hs-CRP含量。结果A组Hs-CRP含量明显高于B组和C组（P〈0.05）;而B组和C组之间无显著性差异。结论Hs-CRP与动脉硬化引起的急性脑梗死有关,Hs-CRP与稳定性颈动脉硬化性斑块患者的脑供血不足的症状无关。