高尿酸血症状态下低度炎症的病理特点研究

目的：探讨高尿酸血症（HUA）状态下低度炎症的病理特点。方法：根据体质量随机将迪法克鹌鹑分为正常组、模型组,每组10只。以普通饲料：酵母浸膏粉=4:1制备食饵,并以该食饵喂养模型组鹌鹑,正常组鹌鹑则自由饮食饮水。分别于造模第10、20、30天检测血清尿酸,血清炎症介质白细胞介素-1β（IL-1β）、IL-33、IL-2、IL-13、IL-8、IL-17、IL-6、IL-10、IL-12/P40、IL-16、IL-21、C反应蛋白（CRP）、粒细胞巨噬细胞集落刺激因子（GM-CSF）、肿瘤坏死因子-α（TNF-α）、趋化因子CC配体2(CCL2)及γ干扰素（IFN-γ）、神经突起生长导向因子2（Netrin-2）、五聚蛋白3（Pentraxin 3）,观察各炎症介质强度变化;造模第30天,取鹌鹑肝、回肠、肾各脏器组织,进行HE染色后观察组织病理形态变化;造模第20天,用基因本体（GO）和京都基因与基因组百科全书（KEGG）富集分析差异炎症介质功能及相关信号通路;用Pearson相关性分析方法分析差异炎症介质与血清尿酸水平的相关性。结果：与正常组比较,模型组鹌鹑血清尿酸水平高（P<0.05）,以血清IL-17、IL-6、IL-33等为主的白细胞介素类,以IL-8、CCL2为主的趋化因子类,IFN-γ、TNF-α、CRP及GM-CSF水平均升高（P<0.05）,而IL-13、IL-10水平降低（P<0.05）。造模第20天,GO/KEGG富集分析结果显示,HUA状态下的低度炎症可能是尿酸代谢靶点群,通过IL-17、Janus激酶信号转导和转录激活因子（JAK-STAT）等信号通路激活、细胞因子-细胞因子间相互作用,从而诱导IL-6、TNF-α等炎症介质产生。2组组织病理变化结果显示,与正常组相比,模型组回肠组织黏膜下层可见炎性细胞浸润,肝、肾组织未见明显差异。差异炎症介质与血清尿酸水平的相关性分析结果显示,鹌鹑血清中IL-6、TNF-α、CRP、IL-33、IL-17、IL-8、IFN-γ、CCL2、GM-CSF、IL-1β、IL-2、IL-6水平均与血清尿酸水平正相关,IL-10、IL-13水平与血清尿酸水平负相关。结论：HUA鹌鹑模型存在低度炎症,该低度炎症可能与尿酸代谢靶点群通过IL-17、JAK-STAT等信号通路的激活以及细胞因子间的相互作用,从而调控IL-6、TNF-α等炎症介质的产生有关。     

Impact of repeated operations for progressive low-grade gliomas

BackgroundMaximal, aggressive resection of diffuse low-grade gliomas (DLGG) is well established as the standard of care in neuro-oncology. The role of repeat resection for tumor progression is unclear.ObjectiveTo assess the role of repeated operation for DLGG, and the effect on malignant transformation and survival.MethodsWe conducted a historical cohort study in which all patients undergoing multiple resections of DLGG between the years 1995–2019 were evaluated for overall survival (OS) and time to transformation (TTT). We then compared the outcome of this group with that of a matched control group comprised of patients who underwent only one operation despite being eligible for repeat surgery at tumor progression, but had received non-surgical oncological therapy or declined additional treatment.ResultsOf 607 patients in our departmental DLGG database, 93 patients underwent 2 or more surgeries and had sufficient follow-up and imaging data to be included in the study group. Thirty-eight patients were included in the matched control group. Early (less than 1 year) progression was associated with decreased survival and shorter TTT in the study group. Patients undergoing multiple resections had significantly longer TTT and OS compared to patients who underwent a single surgery. This effect was especially noted in patients who had radiological evidence of tumor transformation.ConclusionsRepeated resections of LGG are safe and offer survival benefit in select patients. Early progression following resection is associated with worse prognosis. Patients with evidence of radiological transformation may benefit the most from re-resection.     

功能区低级别胶质瘤患者生存影响因素分析

目的 探讨功能区低级别胶质瘤(LGGs)患者生存影响因素.方法 回顾性分析2011年1月至2015年6月安徽医科大学第一附属医院神经外科新诊断的62例功能区LGGs患者的临床资料,统计分析患者生存影响因素.结果 单因素分析发现年龄<40岁、术前KPS≥70分、肿瘤全切、少突胶质细胞瘤、术后进行联合放化疗的功能区LGGs患者无进展生存期(PFS)和总生存期(OS)优于年龄≥40岁、术前KPS<70分、非全切、星形细胞瘤或混合性少突-星形细胞瘤、术后不放化疗或单独放疗/化疗患者,差异有统计学意义(P<0.05);多因素分析示年龄、术前KPS评分、手术切除程度、病理类型是影响生存的独立因素(P<0.05).结论 年龄较轻、术前高KPS评分及含有少突胶质细胞成分的功能区LGGs患者预后较佳,手术全切及术后放化疗能延长患者生存期.     

PET/CT in Disease Detection and Follow-up of Subcutaneous Involvement in Marginal Zone Lymphoma

BackgroundThe value of positron emission tomography/computed tomography (PET/CT) in the staging and assessment of treatment response in marginal zone lymphoma (MZL) lymphomas remains controversial. We investigated radiologic characteristics of subcutaneous MZL as imaged on PET/CT scans.Patients and MethodsFrom the records of a single medical center, for the years 2008 and 2017, we identified subcutaneous lesions in PET/CT scans of patients with histopathologically confirmed MZL in sites other than subcutaneous tissue.ResultsOf 571 scans of 178 patients, subcutaneous lesions were found in 20 (11%). Lesions were located in soft tissue structures, mainly along the lateral aspects of the buttocks, thighs and lower and upper back areas, the flank, and the shoulders. Median lengths of the long and short axes of the lesions were 2.0 (range, 1.1-6.0) cm and 0.8 (range, 0.3-2.0) cm, respectively. Median standardized maximum uptake value was 2.3 (range, 0.9-7.6). In 12 patients (60%), MZL was diagnosed at an early stage; 15 (75%) had lymph node involvement and 10 (50%) extranodal involvement. One had spleen and 2 had cutaneous involvement; none had gastric findings.ConclusionThe findings of this study support the usefulness of PET/CT in the detection of subcutaneous MZL as well as in staging and treatment decisions.