MicroRNA -181a 对人宫颈癌细胞的铂类药物敏感性的调节作用

目的：观察不同铂类药物敏感性宫颈癌细胞中的 microRNA（miR）-181a 表达,提高宫颈癌的药物治疗效果。方法观察不同铂类药物敏感性人体标本与人宫颈鳞状癌细胞系中的 miR -181a 表达。通过聚合酶链式反应（PCR）与基因转染技术,在体内与体外试验中,对 miR -181a 表达与铂类药物的敏感性进行研究。结果在2株人宫颈鳞状癌细胞系与人体标本中对化学治疗（简称化疗）药物有耐受性的肿瘤细胞 miR -181a 高表达,在裸鼠移植瘤模型与经过转染的细胞系中 miR -181a 的过表达显著增强了化疗的耐药性,而转染了 miR -181a 抑制因子后,药物敏感性明显升高。结论 miR -181a 在调控肿瘤细胞化疗耐药性中有重要的协调作用,研究为预测人宫颈鳞状细胞癌的化疗耐药性提供了一种基因标志物。     

米非司酮配伍米索前列醇及一次性宫颈扩张棒终止12至18周妊娠100例

目的：观察米非司酮配伍米索前列醇及一次性宫颈扩张棒终止12~18周妊娠的临床效果。方法选取自愿来医院要求引产的正常孕妇100例,孕周在12~18周,入院后第1,2天均给予口服米非司酮,第2天晨起放置一次性宫颈扩张棒,第3天晨起取出扩张棒后在阴道后穹窿处放置米索前列醇,观察终止妊娠的效果。结果成功98例,成功率为98.00%,其中24 h 内成功终止妊娠94例,成功率为94.00%;终止妊娠后清宫率为30.00%,且孕周越小完全流产率越高,出血量越少。结论米非司酮配伍米索前列醇及一次性宫颈扩张棒终止12~18周妊娠,成功率高,操作简单,不良反应较少,值得临床借鉴。     

甲状腺乳头状微小癌合并桥本甲状腺炎的临床病理分析

目的研究甲状腺乳头状微小癌（PTMC）合并桥本甲状腺炎（HT）的临床病理特点,为临床诊治提供参考。方法：收集我院2010年10月-2013年9月收治并经手术病理证实为PTMC患者的临床病理资料,以是否合并HT分组比较,并进行回顾性分析。结果 119例PTMC中,男女比例1：2.6,年龄（44.4±12.4）岁,术前甲状腺功能正常者97例（81.5%）,肿瘤平均最大径（6.8±2.3）mm,有颈部淋巴结转移36例（30.3%）,合并HT 41例（34.5%）。与未合并HT组相比,合并HT组中女性更多,发病年龄较小,术前促甲状腺激素（TSH）较高,肿瘤最大径较小,相互比较存在统计学差异（P〈0.05）。合并HT组的颈部淋巴结转移率（36.6%）稍高于未合并HT组（26.9%）,且与年龄、肿瘤最大径显著相关。结论 PTMC合并HT在较年轻的女性、术前血TSH水平偏高者中较常见。起病年龄较小、癌灶最大径≥7.0 mm时更易发生颈淋巴结转移。     

颈前路减压植骨钛板内固定治疗脊髓型颈椎病临床研究

目的：分析脊髓型颈椎病治疗中应用颈前路减压植骨钛板内固定治疗的效果。方法50例脊髓型颈椎病患者,均采取颈前路减压植骨钛板内固定治疗,对治疗效果进行分析。结果50例患者住院时间为（10.3＆#177;1.7）d,椎间植骨均达到骨性融合;经随访治疗优良率为96.0%,患者治疗后JOA评分显著提高。结论在脊髓型颈椎病治疗中颈前路减压植骨钛板内固定治疗可发挥显著疗效,安全可靠,可提高患者生活质量,值得在临床中推广。     

简化的功能性颈部淋巴结清除术治疗高危甲状腺乳头状癌的临床效果

目的探讨简化的功能性颈部淋巴结清除术治疗高危甲状腺乳头状癌的临床效果。方法对1994年2月-2013年5月收治的高危甲状腺乳头状癌患者80例手术治疗的临床资料进行回顾性分析,其中1994年2月-2011年10月施行功能性颈部淋巴结清扫术50例为FND组,2011年11月-2013年5月施行简化的功能性颈部淋巴结清除术30例为SFND组。术后坚持终生服用甲状腺素片,伴有腺体外浸润的6例给予131I内照射治疗。结果施行患侧腺叶全切除＋峡部切除＋对侧次全切除术71例,双侧甲状腺全切除9例。手术近期并发症共8例（10%）,其中声音嘶哑、乳糜漏、症状性低钙血症发生率,FND组分别为4.0%（2/50）、4.0%（2/50）和2.0%（1/50）,SFND组均为3.3%（1/30）,两组比较差异无统计学意义（P〉0.05）。以3个月-1年为随访期限记录手术远期并发症,FND组与SFND组患侧颈、肩及上肢感觉异常发生率分别为16.0%（8/50）和0,活动障碍发生率分别为14.0%（7/50）和0,两组比较差异有统计学意义（P〈0.05）。结论规范的手术治疗是改善甲状腺乳头状癌患者预后的关键因素,SFND用于高危甲状腺乳头状癌的治疗,有助于保护患侧颈、肩及上肢感觉和运动功能,减少癌复发和转移。     

不同手术方式治疗颈椎后纵韧带骨化症的并发症比较

目的探讨不同手术方式治疗颈椎后纵韧带骨化症的并发症。方法回顾性选取2011年1月~2012年12月入院经临床确诊为颈椎后纵韧带骨化症的患者60例,分为颈前路手术组和颈后路手术组各30例,分析两组的并发症发生情况。结果颈前路手术组出现并发症10例（33.33%）,其中脑脊液漏3例、植骨块滑脱2例、切口感染3例、术后血肿2例。颈后路手术组出现并发症5例（16.67%）,其中颈部疼痛3例、颈屈伸活动受限1例、脊髓损伤1例。两组并发症发生率比较,差异有统计学意义（P〈0.05）。结论颈后路手术治疗颈椎后纵韧带骨化症并发症发生率比颈前路低,可为临床工作的开展提供更好的方向。     

吉西他滨联合奈达铂治疗复发性宫颈癌的临床疗效

目的 研究吉西他滨联合奈达铂治疗复发性宫颈癌的疗效和安全性。方法 将2012年2月-2014年1月上海交通大学附属第六人民医院收治的98例宫颈癌复发患者作为研究对象,通过随机抽样分为治疗组和对照组,每组各49例。治疗组静脉滴注注射用吉西他滨1 g/m²加入0.9%生理盐水100 mL,持续30 min,每个化疗周期前3周的第1天使用;注射用奈达铂80 mg/m²用0.9%生理盐水稀释至500 mL后静脉滴注,滴注时间至少为60 min,每个周期的第1周第1天时使用。对照组吉西他滨使用方法与治疗组一致;注射用顺铂30 mg/m²注入0.9%生理盐水30 mL后静脉滴注,每个周期的第1周前3 d时每天使用。两组都以28 d为1个疗程,并至少治疗2个疗程。治疗结束后,比较两组的临床疗效和毒副作用情况。结果 治疗组和对照组治疗有效率分别为63.27%、55.10%,两组比较差异无统计学意义。在毒副作用方上,两组脱发、白细胞下降、心脏毒性、肺毒性、肝损害以及皮疹的发生率差异无统计学意义。治疗组血小板降低发生率高于对照组,但在恶心呕吐、血红蛋白下降和肾脏损害的发生率均明显低于对照组,两组比较差异有统计学意义（P<0.05）。结论 吉西他滨联合奈达铂或顺铂治疗复发性宫颈癌的临床疗效无差异,但吉西他滨联合奈达铂的毒副反应较小,有利于减少患者化疗痛苦,提高患者依从性。     

Quality assessment of robot assisted thoracic surgical resection of non-small cell lung cancer: nodal upstaging and mediastinal recurrence

BackgroundRobot assisted thoracic surgery (RATS) is the minimally invasive surgical technique of choice for treatment of patients with non-small cell lung cancer (NSCLC), at the Isala Hospital. The aim of this study is to compare clinical and pathological staging results and mediastinal recurrence after RATS for anatomical resections of lung cancer as surrogate markers for quality of mediastinal lymph node dissection (MLND).MethodsThis single institute retrospective study was conducted in patients who underwent RATS for NSCLC. Excluded were patients with a history of concurrent malignant disease, with other previous neoplasms, with small cell lung cancer (SCLC) and patients in whom the robotic technique was converted to thoracotomy, prior to lymph node dissection. Data were obtained from the hospital database. The difference between clinical and pathological staging was expressed as upstaging and downstaging. Computed Tomography scanning was used for follow-up, and diagnosis of mediastinal recurrence.ResultsFrom November 2011 to May 2016, 227 patients underwent RATS at Isala Hospital Zwolle, the Netherlands. Of those, 130 (mean age, 69.5±9.3 years) met the eligibility criteria. Preoperative mediastinal lymph node staging was done by endoscopic ultrasound/endobronchial ultrasound, by positron emission tomography (PET) or mediastinoscopy. In 14 patients (10.8%) unforeseen N2 disease was found, 6 patients (4.6%) were upstaged from cN0 to pN2 and 8 patients (6.2%) were upstaged from cN1 to pN2. Mediastinal recurrence was detected in 7 patients (5.4%) during a median follow-up of 54 months (range, 1.5–102 months).ConclusionsIn patients with NSCLC, who underwent anatomical resection by means of RATS, an unforeseen N2 disease rate of 10.8% was demonstrated and a mediastinal recurrence rate of 5.4%. It is concluded that robotic surgery provides an accurate lymph node dissection.     

The significance of systematic lymph node dissection in surgery for early-stage non-small cell lung cancer patients aged ≤40 years

BackgroundSurgery remains the best option for treating early-stage non-small cell lung cancer (NSCLC), and lymph node dissection (LND) is an important step in this approach. However, the extent of LND in the general age population, especially in young patients, is controversial. This retrospective study aimed to investigate the correlation between systematic lymph node dissection (SLND) and prognosis in young (≤40 years) patients with stage IA NSCLC.MethodsClinicopathological data of 191 patients aged ≤40 years who underwent surgical pulmonary resection for stage IA NSCLC between January 2010 and December 2016 were retrospectively collected. Of the patients, 104 received SLND (SLND group), while the other 87 patients underwent sampling or no LND (non-SLND group). The disease-free survival (DFS) and overall survival (OS) curves of the patients from each group were plotted using the Kaplan-Meier method, and the correlations of the patients’ clinical factors with prognosis were also analyzed.ResultsThe median follow-up period was 55 months. During follow-up, 7 patients died, and recurrence or metastasis was detected in 16 patients. Kaplan-Meier analysis revealed no difference in DFS (P=0.132) between the SLND and non-SLND group, but a significant difference was found between the groups in OS (P=0.022). Additionally, there was no statistically pronounced difference in OS or DFS between male and female patients. Multivariate survival analysis showed that the type of SLND, as well as tumor size, is an independent prognostic factor for DFS (HR, 3.530; 95% CI, 1.120–11.119; P=0.031) and OS (HR, 13.076; 95% CI, 1.209–141.443; P=0.034).ConclusionsFor young (age ≤40) stage IA NSCLC patients with pathological invasive adenocarcinoma, intraoperative SLND can improve the DFS and OS. Further studies are needed to verify the most optimal degree of LND in young patients.     

Adolescent Health Series: HPV infection and vaccination in sub-Saharan Africa: 10 years of research in Tanzanian female adolescents - narrative review

Cervical cancer is the leading cause of cancer-related morbidity and mortality in many sub-Saharan African (SSA) countries, including Tanzania. Most cervical cancer cases worldwide are attributable to infection of the cervix with Human Papillomavirus (HPV), a vaccine-preventable sexually transmitted infection (STI). Over the past 10 years, we have conducted a programme of HPV research in pre-adolescents and adolescents in Mwanza, the second-largest city in Tanzania, which is situated in a malaria-endemic region. In this narrative review article, we summarise the contribution of our work, alongside work of others, to improve the understanding of HPV epidemiology in SSA and development of setting-appropriate, evidence-based intervention strategies. We present evidence for very high prevalence and incidence of HPV infection among female SSA adolescents around the time of sexual debut, describe risk factors for HPV acquisition, and discuss associations between HPV, HIV and other STIs, which are also highly prevalent within this population. We summarise findings from early clinical trials of HPV vaccines in SSA, the first of which was an immunogenicity and safety trial conducted in Mwanza, Tanzania, and Dakar, Senegal. Within the trial, we evaluated for the first time the potential impact of malaria and helminth infection on vaccine-induced antibody responses in Tanzanian girls. We describe research evaluating optimal HPV vaccine delivery strategies within this setting, perceived requirements for and barriers to vaccine implementation among key informants from LMIC, vaccine acceptability among girls and parents, and opportunities for co-delivery of interventions alongside HPV vaccination to an adolescent population. Finally, we discuss country-level barriers to vaccine uptake in LMIC, and ongoing studies in Tanzania and other SSA countries of reduced-dose HPV vaccination schedules that may alleviate cost and logistical barriers to vaccine implementation.