乳腺导管内癌及其微浸润与乳腺浸润性导管癌的超声及病理特征

目的 分析乳腺导管内癌(DCIS)、乳腺导管内癌伴微浸润(DCIS-MI)与乳腺浸润性导管癌(IDC)的超声及病理特征.方法 回顾性分析2014年9月至2016年9月入住我院实施手术且术后病理检查确诊为乳腺癌的170例患者的超声检查结果及病理特征.结果 IDC组患者的淋巴转移率为45.85%,明显高于DCIS组患者的3.92%和DCIS-MI组患者的4.26%,差异均有统计学意义(P<0.05);DCIS-MI组患者在病灶形态、边缘、周边毛刺、回声类型、有无钙化及周边组织血流情况方面与DCIS组、IDC组比较差异均有统计学意义(P<0.05);DCIS-MI组患者粉刺型比例为76.71%,明显高于DCIS组的46.81%和IDC组和58.33%,差异均有统计学意义(P<0.05);DCIS-MI组患者的C-erbB-2阳性率为62.75%,明显高于DCIS组的57.45%和IDC组的41.67%,差异均有统计学意义(P<0.05).结论 DCIS、DCIS-MI和IDC三者存在不同的超声表现及病理特征,临床上可以此为依据进行疾病的诊断及分型,以便为患者提供更加准确有效的治疗.     

生长转化因子(TGF)基因型多态性与扩张型心肌病的相关研究

目的探讨中国北方地区汉族人生长转化因子(TGF)基因型别的多态性与扩张型心肌病(IDC)的相关性。方法对31例IDC患者采用顺序特异性引物-聚合酶链反应(PCR-SSP)方法检测TGF基因型别的多态性变化,并与35名健康献血者对照组进行对比分析。结果IDC组TGF(H)等位基因频率(38.71%)显著高于对照组(11.43%),P<0.05;提示该等位基因频率增高与IDC的发病相关;而TGF其它等位基因频率在IDC组和对照组中无明显差异。结论我国北方地区汉族人TGF(H)基因与IDC的易感性相关联。     

Fine needle aspiration cytology in young women with breast cancer: diagnostic difficulties

BACKGROUND: Breast carcinoma is the most common malignancy in women worldwide. Though fine needle aspiration cytology (FNAC) plays an important role in preoperative diagnosis, there may be diagnostic delays in affected young women due to a lower index of suspicion. METHODS: The files of the Departments of Pathology, Singapore General Hospital, Singapore, and Prince of Wales Hospital, Hong Kong, were searched for cases of breast carcinoma in women aged 35 years or less. Those with prior FNA procedures comprised our study group. The FNA smears were reviewed and classified into five categories: inadequate, benign, equivocal, suspicious, malignant. The findings were correlated with subsequent histology. RESULTS: Thirty-four women aged 35 years and below underwent 35 FNACs, with one woman having bilateral FNA procedures. Upon review, one (2.9%) was classified as inadequate, one (2.9%) benign, five (14.3%) equivocal, five (14.3%) suspicious, 21 (60%) malignant and slides were not available for review for two (5.6%) cases. For six benign and equivocal cytological diagnoses, subsequent histology disclosed pure ductal carcinoma in situ (DCIS, 1 case), mucocoele-like lesions with DCIS (2 cases), invasive and in situ ductal carcinoma with neuroendocrine features (1 case) and two cases of invasive ductal carcinoma. CONCLUSION: Diagnostic difficulties in cytological interpretation of aspirates from breast carcinoma in young women may lead to unwanted delays, which occurred in six (17.6%) of 34 women in our series. Low grade cancers posing a pitfall in cytological diagnosis have to be considered.     

CD11c和NLDC-145单克隆抗体标记的阳性细胞的观察

目的 探讨CD11c和NLDC145单克隆抗体标记胸腺内何种间质细胞,并是否具有特异性。方法 应用CD11c单克隆抗体及NLDC-145单克隆进行标记,采用免疫荧光双重染色法及免疫电镜法对胸腺内间质细胞进行观察。结果 CD11c阳性细胞为指状嵌入突起细胞(interdigitating cell,IDC)及少数巨噬细胞。NLDC-145阳性细胞为胸腺上皮细胞。结论 CD11c标记IDC,NLDC-145标记胸腺上皮细胞。胸腺巨噬细胞中存在不同亚群。     

Development and validation of a nomogram for predicting survival on the base of modified lymph node ratio in breast cancer patients

BackgroundAxillary lymph node status is one of the most important prognostic factors in breast cancer and previous studies indicated that lymph node ratio (LNR) could better predict the outcome than the counting of positive lymph nodes. In the current study, we evaluated the prognostic effect of modified LNR in breast cancer patients.MethodsA total of 3339 breast cancer patients undergoing axillary lymph nodes dissection were enrolled and respectively analyzed. Seventy five percent of participants were randomly selected as training cohort and the remaining 25% were as validation cohort. Univariate and multivariate analyses were performed and the prognostic impact of mLNR was compared with pN staging. A prognostic nomogram was established and externally validated in the validation cohort.ResultIn multivariate analysis, both the mLNR and pN staging were independent prognostic factors for breast cancer patients, and the mLNR manifested superior discrimination power than the pN stages regardless of the total number of lymph nodes retrieved and the lymph node status. The nomogram was built including the identified independent prognostic factors and the calibration curves indicated optimal agreement between nomogram prediction and actual observation. The Concordance index (C-index) of the nomogram was statistically higher than that of the TNM system (0.747 vs. 0.711 in training cohort, 0.789 vs. 0.760 in validation cohort, both p < 0.05).ConclusionModified LNR is an important prognostic parameter and can predict survival more accurately than pN staging. The novel nomogram could provide individual prediction for breast cancer patients and help clinicians in treatment option making and prognosis evaluation.     

三甲医院IDC机房整体迁移的研究与实践

以容灾思路构建一个新的IDC机房，新建核心网和核心业务系统，以容灾切换的方式从旧机房平滑切换到新机房，完善医院信息系统的架构，有效优化核心业务系统，解决架构缺陷，消除性能瓶颈。同时利用机房整体搬迁的机会，部署和构建AD域控制器、远程管理、虚拟化系统和测试平台等系统，为医院信息系统未来的容灾、备份、信息安全、身份管理、远程维护和瘦客户端的建设奠定坚实基础，从而更有力地支持医院医疗业务的进一步发展。