101例早期胃癌个体化手术治疗的临床分析

目的研究早期胃癌个体化手术的淋巴结廓清效果。方法回顾性分析按日本胃癌治疗规范进行手术的101例早期胃癌的临床病理资料。结果16例伴有淋巴结转移的早期胃癌，均为下部癌，总的转移率为15．8％，第1站（N1）及第2站（N2）分别为10．9％及4．9％。淋巴结转移主要与肿瘤浸润深度、病灶大小、病理类型有关。黏膜下癌淋巴结转移率为27．9％，明显高于黏膜癌（6．9％，P〈0．05）。微小胃癌未见淋巴结转移，小胃癌淋巴结转移率为5．0％，随着肿瘤最大径的增加，1．1～2．0cm及〉2．0cm的淋巴结转移率分别增至14．8％及27．5％（P〈0．05）。高分化早期胃癌未见淋巴结转移；中分化及低分化的淋巴结转移率分别为17．2％及19．6％。在有淋巴结转移病例中，N1受累频率最高的是第3组淋巴结，受累频率为50．0％，其次为第6，4组及第5组淋巴结，分别为37．5％、31．3％及12．5％；在N2中，第7，8a组及第9组的受累频率依次递减为25．0％、12．5％及6．3％。黏膜癌仅累及N1淋巴结，而黏膜下癌转移至N2的频率明显增高；微小癌无淋巴结受累，小胃癌仅累及到N1淋巴结；而最大径在1．1cm以上的病例，累及N2淋巴结的几率明显增加；高分化早期胃癌未见淋巴结转移，随着分化程度的恶化，N2淋巴结受累的频率亦显著增加。结论早期胃癌的个体化手术治疗，在淋巴结廓清效果上和标准D2根治术是一致的。因此。个体化术式的选择达到了根治、低侵袭及改善患者生活质量的目的。     

颈浅淋巴结在大鼠角膜移植免疫中的作用

目的探讨颈浅淋巴结在角膜移植免疫中的作用,为抑制移植术后的免疫排斥反应提供新的思路。方法建立大鼠同种异体角膜移植模型,24只SD鼠为受体,12只Wistar鼠为供体,所有大鼠均为雌性。受体鼠再分为A、B、C、D4组,A组为正常角膜移植组,B组为正常角膜移植合并颈浅淋巴结切除组,C组为高危角膜移植组,D组为高危角膜移植合并颈浅淋巴结切除组。每组均为6只,其中1只于术后14d行植片病理学检查及巨噬细胞免疫组化染色。对各组角膜存活情况进行评分比较,评价疗效。结果各组植片存活时间分别是(10.40±1.14)d、(46.30±9.46)d、(7.00±1.58)d和(15.00±3.39)d。植片存活时间B组较A组、C组,D组较C组均明显延长,差异均具有显著性意义(P<0.05)。结论颈浅淋巴结在大鼠角膜移植免疫中起着非常重要的作用,颈浅淋巴结切除术能有效抑制正常及高危角膜移植术后的免疫排斥反应。     

乳腺癌淋巴结转移与转移相关因子CD44v6、MMP9、VEGF的关系

目的探讨乳腺癌病人淋巴结转移与转移相关因子:细胞粘附分子CD44变异型v6(CD44v6)、基质金属蛋白酶9(MMP9)、血管内皮生长因子(VEGF)的关系。方法应用免疫组织化(Elivision法)检测88例行手术切除乳腺癌患者手术标本CD44v6、MMP9和VEGF表达情况,探讨与淋巴结转移的关系。结果88例行手术切除乳腺癌病理标本81例(92％)CD44v6阳性,76例(86．4％)MMP9阳性,71例(80．7％)VEGF阳性。乳腺癌淋巴结转移组与非转移组CD44v6、MMP9表达的差异无统计学意义(P>0．05),VEGF表达的差异有统计学意义(P<0．05)。结论VEGF的表达可能与乳腺癌淋巴结的转移有关,检测CD44v6、MMP9、VEGF有助于判断乳腺癌患者淋巴结转移风险。     

右冠状动脉缺血再灌注致窦房结及其周围心房肌细胞的不均一凋亡

目的　观察右冠状动脉缺血再灌注(IR)致兔窦房结及其周围心房肌细胞的凋亡规律。方法　成年家兔2 2只,其中模型对照组10只,IR模型组12只用于在体右冠状动脉根部结扎或放松制作窦房结缺血6 0 min、再灌注6 0 min模型,采用末端标记TU NEL 法检测窦房结中央、窦房结周边及其周围心房肌细胞凋亡率及光、电镜下结构变化。结果　(1) IR组有8只(8/ 12 )窦房结及其周围心房肌均有细胞凋亡现象,其凋亡率(% )分别为11.3±3.7、15 .0±4 .5和2 4 .4±5 .9;(2 )光镜下,IR组窦房结起搏细胞边界不清,胞核固缩,胞浆嗜酸性增强,细胞呈腺样排列;电镜下,心房肌细胞呈明显凋亡征象。结论　IR可诱导窦房结及其周围心房肌细胞呈梯度不均一凋亡,且窦房结中央凋亡率最低。     

静脉输注丙种球蛋白防治川崎病冠状动脉病变的疗效

目的评价静脉输注丙种球蛋白(IVIG)治疗和预防川崎病(KD)冠状动脉病变(CAL)的疗效,探讨IVIG疗效的影响因素。方法对314例KD患儿的临床资料进行回顾性对比观察。按治疗将患儿分为阿司匹林(ASA) IVIG组和ASA组,观察两组CAL发生、恢复情况、不同时机不同剂量IVIG治疗KD疗效、临床及实验室指标,急性期出现CAL者分别于病程1,3,6,12个月复查。结果ASA IVIG组CAL发生率34.3%,ASA组56.0%,两组比较P<0.001。应IVIG2.0g/kg或1.0g/kg以及在病程3～10d应用IVIG,CAL发牛率低,P<0.05。22.2?L发生在IVIG治疗后;13.4?L在病程12个月仍不能恢复正常,多数为IVIG治疗开始时间超过10d者。ASA IVIG组住院时间、退热时间、总热程缩短,血小板计数、血沉、C反应蛋白显著降低(P<0.05)。IVIG耐药病例占10.5%。结论IVIG治疗可显著缩短KD病程和降低CAL发生,但对川崎病CAL防治并非人们所预期的那样有效,实际疗效需要再评价。     

不同年龄儿童房室结双径路电生理特征的变化

目的　探索房室结双径路 (DAVDP)电生理特征随年龄的变化 ,进一步探讨小儿房室结折返性心动过速 (AVNRT)的电生理机制。方法　对经食道心房调搏 (TEAP)诊断为DAVDP的 5 7例儿童的房室结双径路电生理参数进行回顾性分析。结果　 5 7例DAVDP儿童 ,学龄前组 (3～ 7岁 ) 16例 ,学龄组 (7～ 14岁 ) 4 1例。学龄组的FP ERP及FP FRP显著长于学龄前组的 (30 4 0 6± 73 0 6 )ms与(35 0 0 0± 6 8 4 8)ms ,(P <0 0 5 )和 (36 7 19± 6 2 4 5 )ms与 (4 10 2 4± 6 8 2 8)ms,(P <0 0 5 )。年龄与FP ERP间存在正相关 (r =0 4 6 3,P <0 0 0 1)。两组间SP ERP无显著性差异 ,但年龄与SP ERP间也存在正相关 (r =0 4 4 2 ,P <0 0 1)。两组儿童的快慢径前向传导时间均无显著差异 ;年龄与快径路前向传导时间之间存在相关性 (r =0 319,P <0 0 5 ) ,年龄与慢径路前向传导时间之间无相关性。结论　随年龄的增长 ,房室结双径路电生理特征发生了改变 ,这可能是随年龄增长AVNRT发病率增高的主要原因     

A Study on Ultrastructural Localization and Activity of the Lymphoprotease of Human Lymph Node

Objective To investigate the localizations and activities of the Mg^2＋-ATPase and G-6- Pase in lymphocytes of the human normal lymph nodes and lymph nodes around the cancer, Methods To determine the localization and activities of the Mg^2＋-ATPase and G-6-Pase in lymphocytes of the human lymph nodes and lymph nodes around the cancer by using the electron enzyme cytochemical method. Results 1. The reaction granules of Mg^2＋-ATPase could be seen clearly beneath the cell membrane and endoplasmic reticulum. 2. Granules of G-6-Pase were mainly observed on the surface of endoplasmic reticulum and mitochondria, 3. The activities of the Mg^2＋-ATPase and G-6-Pase became lower in lymphocytes of lymph nodes around the cancer. 4. The positive rates of lower differentiated cancer were lower than of high-differentiated cancer. 5. The positive rates of the Mg^2＋-ATPase and G-6-Pase in no lymph node metastasis were higher than that of lymph node lnetastasis. Conclusion The cytochemical investigation of lymphoprotease in lymphocytes of lymph nodes and lymph nodes around the cancer can be useful in determining its biologic behaviors and estimating prognosis indicator of the patients.     

重组人胰岛素样生长因子I(rhIGF-I)对大鼠成骨细胞增殖和功能的影响

目的:观察胰岛素样生长因子I(IGF鄄I)对体外培养的大鼠成骨细胞的增殖、碱性磷酸酶(ALP)的合成和钙化结节形成的影响。方法:不同浓度IGF鄄I分别刺激培养的大鼠成骨细胞,采用噻唑蓝(MTT)法测定细胞增殖能力;采用对硝基酚磷酸盐法测定细胞裂解液中ALP活性;VonKossa染色测定钙化结节数目。结果:一定浓度IGF鄄I能明显增加大鼠成骨细胞数量(P<0.05),在0.1～100.0ng/ml这种作用与IGF鄄I的浓度呈正相关;经IGF鄄I刺激,大鼠成骨细胞ALP合成明显高于对照组(P<0.05);经IGF鄄I刺激,大鼠成骨细胞钙化结节数目明显高于对照组(P<0.001)。结论:IGF鄄I能增加体外培养的大鼠成骨细胞数量,促进成骨细胞ALP合成和钙化,提示IGF鄄I可能直接促进骨形成。     

Preoperative diagnosis of lymph node metastases in gastric cancer by magnetic resonance imaging with ferumoxtran-10

Background Knowledge regarding the presence and location of lymph node metastasis in gastric cancer is essential in deciding on the operative approach. Lymph node metastases have been diagnosed with imaging tests such as computed tomography (CT) and ultrasonography (US); however, the accuracy of such diagnoses, based on size and shape criteria, has not been adequate. Ferumoxtran-10 (Combidex; Advanced Magnetics) is a lymphotropic contrast agent for magnetic resonance imaging (MRI) whose efficacy for the detection of metastatic lymph nodes in various cancers has been reported by several investigators; however, its efficacy for this purpose has not been reported for gastric cancer. We investigated the efficacy of ferumoxtran-10-enhanced MRI for the diagnosis of metastases to lymph nodes in gastric cancer. Methods Seventeen consecutive patients who were diagnosed with a nonearly stage of gastric cancer were enrolled in the study. All the patients were examined by MRI (Signa Horizon 1.5 T; GE Medical; T2*-weighted images) before and 24 h after the intravenous administration of ultrasmall particles of superparamagnetic iron oxide — ferumoxtran-10 (2.6 mg Fe/kg of body weight) — and the presence or absence of metastasis was determined from the enhancement patterns. The imaging results were compared with the corresponding histopathological findings following surgery. Results Of 781 lymph nodes dissected during surgery, the imaging results of 194 nodes could be correlated with their histopathological findings. Fifty-nine lymph nodes from 11 patients had histopathological metastases. In nonaffected normal lymph nodes, we observed dark signal intensity on MRI caused by the diffuse uptake of the contrast medium by macrophages resident in the lymph nodes, which phagocytose the iron oxide particles of ferumoxtran-10. The number of phagocytic macrophages was decreased in metastatic lymph nodes, and they showed various patterns of decreased uptake of ferumoxtran-10. Three enhancement patterns were observed in lymph nodes: (A) lymph nodes with overall dark signal intensity due to the diffuse uptake of ferumoxtran-10; (B) lymph nodes with partial high signal intensity due to partial uptake; and (C) no blackening of lymph nodes due to no uptake of ferumoxtran-10. Patterns (B) and (C) were defined as metastatic. The sensitivity, specificity, positive predictive value, negative predictive value, and overall predictive accuracy of postcontrast MRI were 100% (59/59), 92.6% (125/135), 85.5% (59/69), 100% (125/125), and 94.8% (184/194), respectively. These parameters for predictive accuracy were much superior to these parameters previously evaluated by CT or US. Nodes in the retroperitoneal and paraaortic regions were more readily identified and diagnosed on the MR images than those in the perigastric region. Conclusion The present study confirmed that ferumoxtran-10-enhanced MRI is useful in the diagnosis of metastatic lymph nodes and that the use of this modality will be helpful in treatment decision-making for gastric cancer patients.     

Significance of the immunohistochemical detection of lymph node micrometastases in Stage II Colorectal Carcinoma

Background Survival results of stage II colorectal cancer patients have led to major efforts to identify the subset of patients at risk for disease relapse and adjuvant therapies benefit. Immunohistochemistry is being explored to detect undetectable microscopic lymph node micrometastases. Material and methods A retrospective analysis of a 105 consecutive stage II colorectal cancer patients was performed. Two four-micres sections were obtained from each lymph node. These slides were stained with AE1–AE3 monoclonal antibodies against cytoskeleton using DAKO EnVision^™ visualization system. Micrometastases were identified either as isolated cells or as well-defined glandular cell clusters with cytoplasm but not the nucleus stained with cytoskeleton antibodies. Results 665 lymph nodes isolated from 105 patients were analyzed. Lymph nodes micrometastases were assessed in 26 out of the 105 patients. 42 (6.3%) out of 665 lymph nodes were infiltrated. Most of these metastases consisted of isolated cell cluster localized in marginal and interfollicular sinus of lymph nodes. The relapse rate was 23.1% among the patients with immunohistochemical detected lymph node micrometastes and 20.3% for the patients without lymph node involvement. This result lacked statistical significance (p=0.759). Discussion AE1/AE3 lymph node immunohistochemical staining in stage II colorectal cancer is an interesting biological phenomenon but it fails to identify patients at higher risk of relapse who deserve a more aggressive adjuvant attitude.