Pathology of flat bladder lesions with emphasis on putative precursors

Flat bladder lesions comprise a spectrum of morphologic changes ranging from reactive atypia to carcinoma in situ (CIS). Differentiating these lesions is important because of differences in patient management and clinical outcome. The precise nature of precursor lesions of bladder cancer remains incompletely understood. Urothelial CIS is the most definitely characterized precursor lesion of high grade bladder cancer. Atypia of unknown significance (AUS) is somewhat controversial. For practical purposes, AUS and reactive urothelial changes should be considered a single entity, since neither lesion has established preneoplastic potential. Simple hyperplasia and papillary hyperplasia are recently identified putative preneoplastic lesions. More recent molecular data also support the precursor nature of intestinal metaplasia and keratinizing squamous metaplasia. In this review, we also discuss the utility of molecular ancillary studies in establishing premalignant lesions, diagnosis, and differential diagnosis of flat bladder lesions.     

Long-term neurological outcome of term-born children treated with two or more anti-epileptic drugs during the neonatal period

Background

Neonatal seizures may persist despite treatment with multiple anti-epileptic drugs (AEDs).

Objective

To determine in term-born infants with seizures that required two or more AEDs, whether treatment efficacy and/or the underlying disorder were related to neurological outcome.

Design/methods

We included 82 children (born 1998-2006) treated for neonatal seizures. We recorded mortality, aetiology of seizures, the number of AEDs required, achievement of seizure control, and amplitude-integrated-EEG (aEEG) background patterns. Follow-up consisted of an age-adequate neurological examination. Surviving children were classified as normal, having mild neurological abnormalities, or cerebral palsy (CP).

Results

Forty-seven infants (57%) had status epilepticus. The number of AEDs was not related to neurological outcome. Treatment with three or four AEDs as opposed to two showed a trend towards an increased risk of a poor outcome, i.e., death or CP, odds ratio (OR) 2.74; 95% confidence interval (CI) 0.98-7.69; P = .055. Failure to achieve seizure control increased the risk of poor outcome, OR 6.77; 95%-CI 1.42-32.82, P = .016. Persistently severely abnormal aEEG background patterns also increased this risk, OR 3.19; 95%-CI 1.90-5.36; P < .001. In a multivariate model including abnormal aEEG background patterns, failure to achieve seizure control nearly reached significance towards an increased risk of poor outcome, OR 5.72, 95%-CI 0.99-32.97, P = .051. We found no association between seizure aetiology and outcome.

Conclusions

In term-born infants with seizures that required two or more AEDs outcome was poorer if seizure control failed. The number of AEDs required to reach seizure control and seizure aetiology had limited prognostic value.     

平板探测器-实质血容量检测评价颈动脉内膜剥脱术围术期脑组织血流灌注

目的 总结分析平板探测器(FPD)-实质血容量(PBV)检测技术在颈动脉内膜剥脱术(CEA)患者围术期脑组织灌注评价中应用的可行性及临床价值.方法 连续收治的40例明确诊断为单侧症状性颈内动脉重度狭窄(70％～99％)患者均经复合手术室头颈部经颅多普勒超声和(或)全脑DSA评估并接受CEA手术,术前、术后即刻作FPD-PBV检测,评估脑组织血流灌注变化.结果 FPD-PBV技术可很好地检测CEA围术期患者脑组织血流灌注.40例患者均为单侧症状性颈内动脉起始段重度狭窄(左侧18例,右侧22例),术前患侧脑血流灌注明显低于健侧(P＜0.05).顺利完成CEA术后DSA显示颈内动脉再通良好,颅内分支血流恢复,患侧脑血流灌注较术前增加(P＜0.05),其中22例术后脑灌注改善,但仍低于健侧(＜10％);15例高于健侧(＜5％);3例与健侧相等.术后患侧和健侧脑灌注间差异无统计学意义(P＞0.05).结论 FPD-PBV检测是一种可行的、有较高临床应用价值的成像技术,可用于半定量分析脑灌注变化,为围术期治疗决策和疗效评价提供更多有价值信息.     

导管室内平板探测器CT定量评估兔肝肿瘤血管生成研究

目的 探讨导管室内平板探测器CT(FDCT)技术定量评估肝肿瘤血管生成的可行性.方法 25只新西兰大白兔VX2肝肿瘤模型构建后行FDCT检查,重建肿瘤血容量(BV)灌注图,分别检测肝肿瘤和肝实质BV值.FDCT检查后处死所有实验兔,取相应部位肝肿瘤标本检测微血管密度(MVD)和血管内皮细胞生长因子(VEGF)表达,分析肝肿瘤BV值与MVD和VEGF表达的关系.结果 25只实验兔中22只兔(88％)成功完成FDCT检查,BV灌注图均清晰显示肝组织和肿瘤,肝肿瘤表现为高灌注环伴低灌注中心的环状强化模式.肿瘤BV值与MVD和VEGF分级均存在良好相关性(P值均＜0.05),MVD与VEGF分级呈正相关(r=0.504,P＜0.001).结论 导管室内FDCT检查可定量评估肝肿瘤血管生成情况,可能有助于肝肿瘤介入诊疗.     

DTI、骨膜蛋白及溶血磷脂酸联合检测对心肌梗死后心室重构的预测价值

目的 探讨3.0 T MR扩散张量成像（DTI）、骨膜蛋白（Periostin）及溶血磷脂酸（LPA）联合检测在心肌梗死（MI）后左心室重构（LVR）中的预测价值。 方法 回顾性纳入100例MI病人并收集其临床及入院当天和出院后12个月的影像资料。通过病人出院后12个月复查超声心动图所得到的左室质量指数（LVMI）将病人分为LVR组（46例）和非LVR组（54例）,其中LVR组男30例,女16例,平均年龄（61.31±9.43）岁;非LVR组男35例,女19例,平均年龄（57.93±10.15）岁。收集接受3.0 T DTI扫描MI病人的影像特征,包括梗死区（CIZ）、边缘区（PIZ）及非梗死区（NIZ）的各向异性分数（FA）和平均扩散系数（MD）,采用ELISA法检测病人血清Periostin、LPA水平。采用t检验及卡方检验比较2组临床指标和MRI表现的差异,采用多因素Logistic回归分析各项临床指标对MI后心室重构的危险程度,采用受试者操作特征（ROC）曲线下面积（AUC）评估各临床因素对预后的预测价值。 结果 与非LVR组相比,LVR组的CIZ 区FA值及MD值存在差异（P<0.05）,而PIZ 区与NIZ区的FA值及MD值差异无统计学意义（P>0.05）。LVR组的Periostin、LPA显著高于非LVR组（P<0.05）。高血压、Periostin高水平、LPA高水平、FA降低及MD升高是影响MI病人左心室重构的独立危险因素（均P<0.05）;LPA、Periostin、FA及MD预测LVR的AUC分别是0.801、0.864、0.611、0.664,4种指标联合检测对LVR预测的AUC最大为0.904,敏感度为89.6%,特异度为82.4%。 结论 Periostin、LPA水平、DTI检查FA值及MD值均与MI后心室重构有关,可用于早期预测MI病人LVR。     

兔VX-2骨肿瘤早期骨膜反应的影像学研究及病理对照

目的研究兔VX-2骨肿瘤模型早期骨膜改变的影像学表现及其病理基础。材料与方法将VX-2肿瘤细胞悬液注入20只新西兰大白兔的右侧胫骨骨髓腔内制成骨肿瘤模型,种植后每隔5天对所有兔进行X线及MRI检查直至骨膜新生骨形成,每次影像检查之后处死4只实验兔取其胫骨制成病理标本,进行影像学与病理学观察及对照。结果肿瘤种植后第5～15天,MRI显示20只实验侧胫骨骨膜水肿;第20天,MRI发现8只实验侧胫骨骨膜增厚;第25～30天,MRI显示4只骨膜新生骨及其外缘增厚的骨膜。结论兔VX-2骨肿瘤中骨膜水肿及骨膜增厚是发生在骨膜新生骨形成之前的早期骨膜反应,MRI可显示这两种骨膜异常。     

舌侧缘淋巴引流与下颌骨舌侧骨膜淋巴管的关系及其临床意义

本文应用十二例新鲜成人尸体的舌－口底－下颌骨－颈部标本，采用淋巴含间接注射法，对舌侧缘淋巴引流及其与下颌骨舌侧骨膜淋巴管的关系进行了观察。初步发现：舌侧缘淋巴引流与下颌骨舌侧骨膜淋巴管没有关系，下颌骨舌则骨膜淋巴管不是舌侧缘向颌下和颈部淋巴结引流的通道因而，舌癌不会通过下颌骨舌侧骨膜淋巴管途径而转移至局部淋巴结。在临床上，对没有直接侵犯至下颌骨舌侧粘骨膜的舌癌病例，保留下颌骨或保持其连续性是可行的。     

Associations Between Periosteal Reaction of Proximal Tibial and Medial Compartment Knee Osteoarthritis

ObjectiveTo evaluate and analyze the potential relationship between periosteal reaction and medial compartment knee osteoarthritis (KOA), and to assess the independent risk factors for the development of periosteal reaction associated with medial compartment KOA.MethodsThis is a retrospective comparative study. From January 2019 to December 2019 at the Third Hospital of Hebei Medical University, a total of 363 patients (726 knees) with medial compartment KOA were enrolled in this study according to our inclusion and exclusion criteria, including 91 males and 272 females, with an mean age of 57.9 ± 12.8 years (range, 18–82 years). Among these patients, 206 patients (412 knees) were allocated to the periosteal reaction group (44 males and 162 females) and 157 patients (314 knees) were allocated to the non‐periosteal reaction group (47 males and 110 females). The classification of KOA severity was based on Kellgren and Lawrence (K‐L) grading system. The malalignment of the lower extremities in coronal plane was evaluated as medial proximal tibial angle (MPTA), hip‐knee‐ankle angle (HKA), and lateral distal femoral angle (LDFA). Patients demographics and radiographic parameters were recorded in the two groups. Intra‐observer and inter‐observer reliabilities of all radiological measurements were analyzed by intraclass correlation coefficients (ICCs). Univariate analyses were conducted for comparison of differences with continuous variables between patients with periosteal reaction and without periosteal reaction. Multivariate logistical regression analysis was performed to determine the independent risk factors of radiographic parameters for periosteal reaction.ResultsThe overall incidence of periosteal reaction associated with medial compartment KOA was 56.7%. Furthermore, we observed that the incidence of periosteal reaction significantly increased with age and correlated with K‐L grade progression (P < 0.05). There was a statistically significant difference between the two groups. In the multivariate logistical regression analysis, HKA and JLCA were identified as independent risk factors of the development of periosteal reaction in patients with medial compartment KOA (odds ratio [OR], 0.594; 95% confidence interval [CI] 0.544–0.648; P < 0.05; OR, 0.851; 95% confidence interval CI 0.737–0.983; P < 0.05; respectively), with other radiographic parameters including MTPA (OR 0.959; 95% CI 0.511–0.648; P > 0.05), LDFA (OR 0.990; 95% CI 0.899–1.089; P > 0.05), and JSW (OR 1.005; 95% CI 0.865–1.167; P > 0.05).ConclusionsIn this retrospective study, patients with lower HKA and higher JLCA were identified as independent risk factors for the development of periosteal reaction, which occurred most commonly adjacent to the lateral of proximal tibia diaphysis, and thus we concluded that periosteal reaction may be an anatomical adaptation for medial compartment KOA based upon these results.     

扁平化排班责任包干制在优质护理实践中的成效

目的 探讨在“优质护理服务示范工程活动”中实施扁平化排班模式结合责任护士包干制护理患者的成效.方法 对骨科病区30名护士按扁平化排班模式优化排班、责任包干制护理患者,分别于实施前后对患者、护士、医生进行满意度调查.结果 实施后患者对责任护士满意度、护士对自身工作满意度、医生对护士满意度显著高于实施前(P＜0.05,P＜...     

人骨膜细胞体外成骨分化的基因表达和功能检测

目的 探讨并鉴定骨膜细胞经骨形成蛋白7(BMP7)诱导分化为成骨细胞的基因表达和细胞功能.方法 成人胫骨骨膜常规体外细胞培养法,分实验组和对照组,分别加入BMP7加成骨辅助剂和单纯成骨辅助剂进行体外培养.CCK-8法检测细胞增殖活性,第5、10、15和20天分别采用Real Time-PCR检测骨钙素基因表达,ELISA法检测上清液碱性磷酸酶(alkaline phosphatase,ALP)、骨钙素(osteocalcin,OCN)及骨桥蛋白(osteopontin,OPN)的水平,甲苯胺蓝染色检测糖胺聚糖(GAG),Real Time-PCR检测Ⅱ型胶原基因,比色法检测细胞ALP活性,ALP染色法检测ALP,Yon Kossa染色法检测钙结节.结果 两组骨钙素基因表达及上清液ALP、骨钙素、骨桥蛋白的含量均增高,实验组与对照组差异有统计学意义(P＜0.05).两组细胞的ALP和钙结节染色阳性率增高,实验组与对照组差异有统计学意义(P＜0.05).甲苯胺蓝染色阳性率及Ⅱ型胶原基因表达表现为先高后低,实验组与对照组差异有统计学意义(P＜0.05).结论 骨膜细胞在BMP7诱导下体外大量增殖和分化成骨,表达出明显的成骨特异基因,并具有合成分泌成骨特异蛋白的功能;成骨化过程中,除直接分化成骨外,还存在部分细胞先经软骨形成再钙化成骨的现象;经骨膜细胞-BMP7途径在体外获取大量成骨细胞可用于组织工程的体外构骨及临床应用.