转录抑制因子Snail表达与胃癌Lauren分型的关系研究

目的探讨转录抑制因子Snail表达与胃癌Lauren分型的关系。方法Western印迹检测肠型胃癌细胞系（N87）和弥漫型胃癌细胞系（AGS）中Snail和上皮型E钙黏蛋白（E-cadherin）的表达。将糖原合酶激酶．3B（GSK-3B）质粒转染胃癌细胞系,检测Snail和E-cadherin的表达变化。收集2000年2月至2005年12月间在复旦大学附属中山医院行胃癌根治术的77例术后组织标本．采用免疫组织化学染色检测Snail在胃癌组织中表达．并分析其与胃癌Lauren分型之间的关系。结果Snail在N87中低表达,在AGS中高表达;E-cadherin表达与Snail相反。转染GSK-3B后,胃癌细胞Snail表达显著下调,E-cadherin表达显著上调（P〈0．01）。使用不同浓度的GSK-3B抑制剂氯化锂处理后．胃癌细胞Snail表达显著上调,且具有明显浓度依赖性（P〈0．01）。21例肠型胃癌中Snail低表达16例,高表达5例;56例弥漫型胃癌中Snail低表达21例,高表达35例;肠型胃癌中Snail表达明显弱于弥漫型,差异有统计学意义（P〈0．01）。结论Snail的表达与胃癌Lauren分型有关．是一种潜在的确定胃癌分型的分子标志物。     

肝移植术后胆道并发症的Clavien分级及高危因素分析

目的 探讨肝移植术后胆道并发症(biliary complication,BC)发生高危因素及Clavien 分级在BC分类中的意义.方法 逐步回归法筛选BC发生的高危因素;对BC进行Clavien分级,筛选ClavienⅢb级以上BC发生的高危因素.结果 14.4％ (26/181)的肝移植患者发生BC,其中ClavienⅢb级以上BC占84.6％ (22/26).BC组的回归分析表明:T管留置(P=0.0090,OR=31.177),术后1d肝动脉阻力指数(RI1d)(P=0.0094,OR＜0.001),术后1周肝动脉阻力指数(RI1w)(P=0.0013,OR＞999.999)的差异有统计学意义,且对该疾病的发生作用显著.ClavienⅢb 以上BC组的回归分析表明:RI1d(P=0.0065,OR＜0.001)、RIlw(P=0.0022,OR＞999.999)的差异有统计学意义,且对该疾病的发生作用显著.结论 Clavien分级系统对胆道并发症的分类具有重要指导意义.T管的放置增加了BC发生的风险,但并不会增加ClavienⅢb以上BC的发生.术后肝动脉血流异常的存在是BC尤其是ClavienⅢb以上BC发生的独立危险因素.     

BosniakⅠ型肾囊性病变发生癌变的诊治经验(附5例报告)

目的:总结BosniakⅠ型肾囊性占位病变发生癌变的诊治经验。方法:回顾性分析5例BosniakⅠ型肾囊性恶性病变的B超、CT、病理特征、治疗方法和随访结果:男3例,女2例;年龄42～72岁,平均54岁。患侧腰酸1例,体检发现4例。囊腔直径5.5～8.0cm。术前B超及CT均诊断为肾囊肿。结果:5例均行腹腔镜下肾囊肿去顶术,术后病理检查诊断为透明细胞癌,再次行根治性肾切除术。5例随访6～33个月,4例无瘤存活,1例因心血管疾病死亡。结论:重视BosniakⅠ型肾囊性病变的影像学和病理学特征,术中行冷冻切片病理检查是提高BosniakⅠ型囊性肾癌诊治水平的关键。     

胃胃肠间质瘤合并胃癌患者的临床病理特点及预后影响因素

目的探讨胃胃肠间质瘤（GIST）合并胃癌患者的临床病理特点及预后影响因素。方法回顾性分析2000年4月至2010年6月间在福建医科大学附属协和医院接受手术治疗的122例原发性胃GIST患者的临床资料,其中合并胃癌者（合并组）26例,无合并胃癌者（无合并组）96例。比较两组患者中胃GIST的临床病理特点,并对全组患者的预后进行单因素及多因素分析。结果与无合并组相比,合并组患者GIST肿瘤最大直径更小（P〈0．01）、核分裂像更少（P〈0．05）、Fletcher分级更低（合并组76．9％为极低．低危者,P〈0．01）。合并组患者术前诊断率明显低于无合并组（23．1％比97．9％,P〈0．01）;5年生存率（58．0％）低于无合并组（79．4％）（P=0．027）。单因素预后分析显示,肿瘤最大直径（P〈0．01）、核分裂像（P〈0．01）、Fletcher分级（P〈0．01）、是否合并胃癌（P〈0．05）与患者预后有关：多因素预后分析显示,Fleteher分级（P〈0．05）和是否合并胃癌（P〈0．01）是影响患者预后的独立因素。结论胃GIST合并胃癌的患者其GIST的171etcher分级大多为极低或低侵袭危险度,对预后影响较小．其生存时间主要取决于胃癌。     

肱骨髁间骨折不同双钢板固定方式的有限元分析

目的利用有限元分析双钢板平行固定和垂直固定对不同类型肱骨髁间骨折的生物力学影响。方法 CT扫描获得肱骨远端断层图像,利用软件Mimics及Ansys建立正常肱骨远端有限元模型,并在此基础上制成六种肱骨髁间骨折模型（高T型、低T型、H型、Y型、内侧λ型和外侧λ型）。在骨折模型的内侧柱和外侧柱分别模拟7孔解剖型锁定钢板固定,根据其固定的方式分为平行固定组和垂直固定组。各模型均施加300 N压缩载荷。结果各模型加载后的最大位移均位于肱骨外侧髁。垂直固定均较平行固定的位移大,在低T型和H型骨折模型中更显著,垂直固定较平行固定的位移大44.47%和34.08%。von Mises应力在接近肱骨髁上骨折断端的螺钉及钉孔周围最高。在除Y型外的其余五种骨折模型中,平行固定均较垂直固定的最大应力值更小,应力分布相对均匀。结论两种不同双钢板固定方式对肱骨髁间骨折稳定性的影响与骨折的类型有关,低T型和H型骨折模型中,选用平行固定方式有更大优势。     

桡骨远端骨折的研究进展

桡骨远端骨折是临床最常见的骨折之一,尤见于年轻男性和中老年女性.因骨折形态和断位复杂,治疗后容易发生腕管综合征、肌腱损伤、关节炎等多种并发症.因此,把握桡骨远端骨折特点,根据个体情况设计合适治疗方案,预防并减少并发症的出现,提高病患生活质量是临床工作者面临的重要问题.     

Subclassification of pT3 urothelial carcinoma of the renal pelvicalyceal system is associated with recurrence-free and cancer-specific survival: proposal for a revision of the current TNM classification

Background

The clinical course of pT3 upper tract urothelial carcinoma (UTUC) is highly variable.

Objectives

The aim of the current study was to validate the clinical and prognostic importance of pT3 subclassification in the renal pelvicalyceal system in a large international cohort of patients.

Design, setting, and participants

From a multi-institutional international database, 858 renal pelvicalyceal tumors treated with radical nephroureterectomy (RNU) were systematically reevaluated by genitourinary pathologists. Category pT3 pelvic tumors were categorized as pT3a (infiltration of the renal parenchyma on a microscopic level only) versus pT3b (macroscopic infiltration of the renal parenchyma and/or infiltration of peripelvic adipose tissue).

Intervention

RNU.

Measurements

Associations of pT3 subclassifications with clinicopathologic features were assessed with the chi-square test. Prognostic impact was assessed with the log-rank test and multivariable Cox regression analyses.

Results and limitations

Of 858 patients with renal pelvicalyceal tumors, 266 (31%) had pT3 disease. Of these, 146 (54.9%) were classified as pT3a and 120 (45.1%) as pT3b. Compared with pT3a, pT3b cancers were associated with higher tumor grade, nodal disease, and tumor necrosis. Ten-year recurrence-free (pT3a 58% vs pT3b 38%; p < 0.001) and cancer-specific (pT3a 60% vs pT3b 39%; p = 0.002) survival rates were lower for patients with pT3b disease. In multivariable analyses, classification pT3b was an independent predictor of both disease recurrence (hazard ratio [HR]: 1.8, p = 0.003) and cancer-specific mortality (HR: 1.7; p = 0.02). The major limitation is the retrospective character of the study.

Conclusions

Subclassification of pT3 renal pelvicalyceal UTUC helps identify patients who are at increased risk of disease progression and cancer-related death. Further research may help assess the value of subclassification and its inclusion in future editions of the American Joint Committee on Cancer–International Union Against Cancer TNM classification system.     

股骨颈骨折临床研究的若干问题与新概念

骨质疏松是引起股骨颈骨折的重要因素。骨质疏松的程度对于骨折的粉碎情况(特别是股骨颈后外侧粉碎)及内固定后的牢固与否有直接影响。年青人股骨颈骨折则多为严重创伤所致。Garden分型是目前应用最为广泛的股骨颈骨折分型。近年来许多医生发现Garden分型在临床应用中存在一些问题,建议将股骨颈骨折简单地分为无移位型(GardenⅠ、Ⅱ型)及移位型(GardenⅢ、GardenⅣ型)。人工关节置换术曾被广泛应用老年人移位型骨折。对于人工关节置换术的应用,不是简单根据年龄及移位程度来定,而应严格掌握适应证。股骨颈骨折后继发的股骨头缺血坏死尚无单独的诊断标准,目前仍然普遍借用股骨头无菌性坏死的Fi-cat-Arlet分期。核磁共振是目前唯一可以早期诊断股骨头缺血坏死并了解其病变范围和位置的方法。     

胫骨平台骨折52例临床分析

目的 比较胫骨平台骨折的几种治疗方法，选择治疗胫骨平台骨折的最佳方案。方法 本组总结胫骨平台骨折52例，按A0分型和塌陷程度分为B、C两种类型。B1、B2型骨折主要采用手法整复骨牵引或石膏外固定；B3、C1型骨折主要采用撬拨复位，植骨后采用松质骨螺钉固定；C2、C3型骨折主要采用坚强固定。结果 52例胫骨平台骨折获得随访47例，膝关节功能恢复按关节功能、活动范围、膝关节轴线、关节稳定性及骨折复位综合评定，膝关节功能优良41例(87.24％)，可及差6例(12.76％)。结论 胫骨平台骨折的治疗应以关节面损伤程度为中心，选择恰当的治疗方案，早期膝关节功能练习能够获得满意的治疗效果。     

Os calcis fractures: Analysis of interobserver variability in using sanders classification

The os calcis is the most frequently fractured tarsal bone. In 1992 Sanders developed a classification system based on coronal and axial computed tomography (CT) scans of the calcaneus. This classification is the one used most frequently today in treatment decision making and reporting of results. The objective of this study was to assess the degree of interobserver variability in using this classification system. Thirty CTs of calcaneal fractures were chosen randomly from the past 5 years in 2 tertiary care centers. The CTs were reviewed by 3 orthopedic surgeons and one senior orthopedic resident who classified the fractures according to Sanders' classification. The results were first tabulated and analyzed by using a weighted kappa test including the subcategories. The weighted kappa value achieved was.56, with a 95% confidence interval of.45-.67. The subcategories of the classification were then further combined and a second weighted kappa test was performed to assess agreement between general classes. The weighted kappa value achieved was.48, with a 95% confidence interval of 0.37-0.59. We concluded that Sanders' classification system did prove to achieve moderate agreement among users, thus representing a useful classification system.