原发性肺透明细胞癌的影像学表现与临床病理对照

目的:探讨原发性肺透明细胞癌(PCCCL)的影像学表现与临床病理特点。方法:回顾分析经手术和/或病理证实的7例PCCCL影像学和临床病理的特点,并复习文献。结果:PCCCL影像学上主要表现为右肺周围性肿块或结节(6/7),结节边缘可见毛刺征,无胸膜凹陷征、空泡征;肿块较大时,边缘光滑,无棘状突起、空洞等征象,1例左肺上叶中心性分叶状肿块,边缘光滑,酷似其它类型肺癌。结论:PCCCL罕见,临床无特异性,病灶较大时,仅有相对影像学特征,确诊依赖病理检查。     

A Proposal for Reclassification of the Fuhrman Grading System in Patients with Clear Cell Renal Cell Carcinoma

Background

The conventional Fuhrman grading system, which categorizes renal cell carcinoma (RCC) with grades I, II, III, and IV, is the most widely used predictor assessment of RCC cancer-specific mortality (CSM).

Objectives

The aim of this study was to test the prognostic ability of simplified Fuhrman grading schemes (FGSs) that rely on two- or three-tiered classifications.

Design, setting, and participants

The current study addressed a population of 14 064 patients with clear cell RCC who were treated with partial or radical nephrectomy between 1988–2004, within nine Surveillance, Epidemiology, and End Results (SEER) cancer registries.

Measurements

Univariable and multivariable analyses as well as prognostic accuracy analyses were performed for various FGSs to test their ability to predict CSM rates. The conventional four-tiered FGS was compared to a modified two-tiered FGS in which grades I and II and grades III and IV were combined. A second simplified three-tiered FGS in which grades I and II were combined but grades III and IV were kept separate was also tested.

Results and limitations

The overall 5-yr CSM-free rate was 81.5%. All three FGSs achieved independent predictor status in multivariable analyses. Prognostic accuracy of multivariable models that relied on various FGSs was 83.6% for the modified two-tiered FGS and 83.8% for both the conventional four-tiered and the modified three-tiered FGS.

Conclusions

Our findings indicate that the simplified FGSs perform equally as well as the conventional four-tiered FGS. The use of simplified grading schemes may represent an advantage for pathologists as well as for clinicians caring for patients with RCC.     

96例葡萄胎临床分析

目的对葡萄胎的发病诱因、临床表现进行分析,加强对葡萄胎的早期诊断、正确处理、定期随访和预后的重视。方法回顾性分析1995年1月至2005年1月间96例葡萄胎患者的临床治疗。结果经过吸宫、二次诊刮、预防性化疗、宫切、化疗等治疗,无1例死亡,随访2—4年均健在,绒毛膜促性腺激素（HCG）测定正常,96例临床患者均获临床治愈。结论对葡萄胎宜早诊断、早治疗,对高危病例宜行预防性化疗及宫切,对葡萄胎患者出院后的定期随访工作更为重要。     

鼻腔鼻窦转移性透明细胞肾细胞癌7例临床病理分析

目的 分析鼻腔鼻窦转移性透明细胞肾细胞癌的临床病理特征、免疫表型及诊断与鉴别诊断。方法 回顾分析2010~2020年本院收治的7例鼻腔鼻窦转移性透明细胞肾细胞癌患者的临床病理资料,应用光学显微镜和免疫组织化学(简称免疫组化)方法对7例病变进行形态学观察、临床病理特征分析。结果7例患者中,男性6例、女性1例;年龄48~69岁,平均(59.86±7.22)岁。临床表现主要为鼻出血、鼻塞、眼痛及面部肿胀等。鼻内镜示鼻腔淡红色新生物,影像学检查显示鼻腔鼻窦软组织肿块,侵犯周围结构。光学显微镜下检查:肿瘤细胞界限清晰,胞质透亮,可见核仁,呈巢状、乳头状排列,间质富于血窦。根据2016版WHO/ISUP肿瘤细胞核分级,本研究2级5例,1级和3级各1例。免疫组化标志物广谱细胞角蛋白(Ckpan)、波形蛋白、碳酸酐酶-9 (CA-9)、PAX-8均为阳性,Ki-67增殖指数为5%~15%,其余标志物CK7、P63、P53、HMB-45、平滑肌肌动蛋白(SMA)、CD117及神经内分泌标志物(SYN)、CHG均为阴性。7例患者就诊后均接受手术治疗,术后3例辅助放射治疗,1例辅助化学治疗。随访截止2021年2月,6例死亡,1例失访。结论 透明细胞肾细胞癌转移至鼻腔鼻窦非常罕见,好发于中老年男性,临床以严重鼻出血和侵犯周围器官为主要特征。确诊依赖于临床病史、病理形态及免疫组化三者相结合。因此,对有肾癌病史且鼻腔鼻窦肿瘤在光学显微镜下形态上具有透明细胞特点应考虑转移性肾癌可能性,以避免漏诊或误诊。     

Ovarian clear cell carcinoma as a stress-responsive cancer: influence of the microenvironment on the carcinogenesis and cancer phenotype

Although it is well known that ovarian endometriosis occasionally gives rise to ovarian cancers with specific histology such as endometrioid and clear cell carcinomas, its etiology is not fully understood. We have shown that a stressful microenvironment within the endometriotic cyst may lead to cancer development by inducing unique gene expressions, which potentially serves as a molecular marker for treatment modality. In this review, by referring to other articles in this field, we explore how the carcinogenic microenvironment affects the phenotype and gene expression of a cancer, and how we can develop new treatment based on this concept.     

胆胃清解汤治疗胆汁反流性胃炎临床观察

目的：观察自拟胆胃清解汤治疗胆汁反流性胃炎的,临床疗效。方法：将60例患者随机分为治疗组30例和对照组30例。治疗组用胆胃清解汤加减,对照组口服西药。观察两组治疗前后临床症状及胃镜下胃粘膜征象的变化。结果：治疗组主要症状改善、临床疗效、胃镜下胃粘膜征象的变化均明显高于对照组（P〈0．05）。结论：胆胃清解汤加减治疗胆汁反流性胃炎有显著疗效。     

肺泡灌洗治疗高血压脑出血并发肺感染的临床观察

目的探讨肺泡灌洗治疗高血压脑出血并发肺感染的临床效果。方法选取67例重症高血压脑出血并发肺感染患者（GCS评分4～8分）随机分为对照组（33例）和观察组（34例）对照组患者采取常规气管切开术;观察组患者在对照组基础上于术后行支气管肺泡灌洗,对两组患者临床治疗效果进行对比和分析。结果观察组总有效率、治疗后白细胞数量及感染控制时间较对照组比较有差异显著性（P〈0．05）。结论对重症高血压脑出血并发肺感染患者治疗中,于气管切开术后行支气管肺泡灌洗,能够有效控制肺部感染症状,同时还能缩短患者住院时间,提高患者生存率     

Assessment of preparation time and 1-year Invisalign aligner attachment survival using flowable and packable composites:: A split-mouth clinical study

ObjectivesTo compare preparation time and 1-year Invisalign aligner attachment survival between a flowable composite (FC) and a packable composite (PC).Materials and MethodsFifty-five participants (13 men and 42 women, mean age ± SD: 24.2 ± 5.9 years) were included in the study. Ipsilateral quadrants (ie, maxillary and mandibular right, or vice versa) of attachments were randomly assigned to the FC group (Filtek Z350XT Flowable Restorative) and the PC group (Filtek Z350XT Universal Restorative) by tossing a coin. The primary outcome was preparation time. The secondary outcome was time to the first damage of an attachment. Preparation times were compared using the paired t-test, and the survival data were analyzed by the Cox proportional hazards model with a shared frailty term, with α = .05.ResultsThe preparation times were significantly shorter with the FC (6.22 ± 0.22 seconds per attachment) than with the PC (32.83 ± 2.16 seconds per attachment; P < .001). The attachment damage rates were 14.79% for the FC and 9.70% for the PC. According to the Cox models, attachment damage was not significantly affected by the attachment material, sex, arch, tooth location, attachment type, presence of overbite, or occurrence of tooth extraction.ConclusionsThe use of a FC may save time as compared with the use of a PC. With regard to attachment survival, there was no significant difference between the two composites. None of the covariates of attachment materials (sex, arch, tooth location, attachment type, presence of overbite, oir occurrence of tooth extraction) affected attachment damage.