颅脑肿瘤术后并发静脉血栓栓塞症危险因素的Meta分析

目的明确颅脑肿瘤术后患者发生静脉血栓栓塞症(VTE)的危险因素。方法检索中国知网、万方、维普、中国生物医学文献、PubMed、The Cochrane Library、Web of Science、EMbase等数据库建库至2021年11月1日颅脑肿瘤术VTE危险因素的队列研究或病例对照研究。由两名研究人员独立进行文献筛选、资料提取以及文献质量评价。使用RevMan 5.4软件对纳入文献进行Meta分析。结果共纳入14篇文献,合计样本量40 552例,发生VTE1 801例。Meta分析结果显示,年龄＞45岁、术前D-二聚体升高、肥胖、女性、术前日常生活活动能力处于依赖状态、术前呼吸机依赖、术前曾患脓毒血症、高级神经胶质瘤、手术时间＞3.05 h、术后D-二聚体升高、术后下肢运动功能障碍、术后卧床不起、术后并发尿路感染为颅脑肿瘤术后患者发生VTE的危险因素。结论颅脑肿瘤术后VTE发生与多种因素有关。建议构建颅脑肿瘤术后VTE风险预测模型,关注高风险人群,落实规范化静脉血栓风险评估,注重血栓评估过程管控。     

TT分析法在头颈肿瘤体外药敏试验中的应用

为了选择有效抗癌药提供临床使用以提高化疗疗效 ,用MTT分析 ,对 32例头颈肿瘤术后切下的标本进行体外细胞培养 ,再用 5 -Fu ,VCR ,MTX ,BLM ,DDP ,ADM ,PYM和CTX进行药敏试验 .结果 :对 5 -Fu敏感 2 7例 ,占 84 4% ,VCR敏感 7例 ,占 2 1 9% ;MTX敏感 2 0例 ,占 6 2 5 % ;BLM敏感 2 6例 ,占 81 3% ;DDP敏感 2 6例 ,占 81 3% ;ADM敏感 13例 ,占 40 6 % ;PYM敏感 2 1例 ,占 6 5 6 % ;CTX敏感 1例 ,占 3 1% .32例患者化疗效果满意 ,未出现明显的副作用 ,均存活 3a以上 ,术后常规检查及复查未见复发或转移 .结果表明 :MTT法用于肿瘤细胞药敏试验是一种准确、快速、简便、经济 ,不需放射性同位素 ,结果重复性好的方法 ,值得推广应用 .     

两种环磷酰胺冲击方案对狼疮性肾炎的疗效和肿瘤坏死因子的影响

目的：探讨大剂量环磷酰胺静脉冲击治疗狼疮性肾炎（LN）的合理方案及对肿瘤坏死因子（TNF）水平的影响,方法：将51例LN患者分为A,B两组,分别给予2周（A组）和4周（B组）一次环磷酰胺静脉冲击治疗（IV－CYC）,每次用量0．5－1．0g/m2,同时口服强的松1mg.kg^-1.d^-1。用ELISA双抗体夹心法检测LN患者血清和尿TNF水平。结果：A组病情缓解率显著高于B组（P＜0．05）,活动期LN患者血清和尿TNF水平显著高于稳定期,轻度肾功不全患者血清TNF水平显著高于肾功正常者（P＜0．05）,结论：IV－CYC加强的松治疗能显著降低LN患者TNF水平且2周方案优于4周方案,治疗中应根据病情,外周白细胞数和肾功能调整,重症和急进期LN每2周1次,病情轻者可每4周1次,血清和尿TNF的变化有助于监测狼疮活动和肾损害程度。     

肿瘤标记物CA_(125)、CA_(153)、CA_(199)与CEA在肺癌诊断中的意义

目的 :研究四种肿瘤标记物CA12 5、CA153 、CA199与CEA在肺癌诊断中的意义 ,并以常见的几种呼吸道炎症性疾病 (RIDs)作为对照。结果 :肺癌患者CA12 5、CA153 、CA199及CEA水平均显著高于RIDs患者 (P <0 .0 0 1) ,而CA12 5、CA153 、CA199及CEA水平在肺癌的三种组织学类型和各期肺癌中并显著性差异 (P >0 .0 5 )。采有四项指标的平均值作为标准 ,虽然并不能显著提高诊断的灵敏度 (P >0 .0 5 ) ,但可显著提高诊断的特异性 (P <0 .0 5或 0 .0 1)。结论 :CA12 5、CA153 、CA199及CEA可作为肺癌的标记物 ,检测这四项标记物在临床上具有一定的辅助意义     

充血性心力衰竭治疗前后内皮素，肿瘤坏死因子和血管紧张素转化酶含量比较

目的探讨充血性心力衰竭(CHF)患儿不同心功能级数及分组治疗前后血浆ET、TNF和ACE含量的变化及其意义。方法用放免法和比色法分组测定充血性心力衰竭(CHF)80例患儿血中ET、TNF和ACE含量的变化。结果80例CHF患儿中血中ET、TNF和ACE含量分别为(141.33±8.56)ng/L、(168.25±35.14)ng/L和(429.45±61.33)IU,与正常对照组比较均明显升高(P＜0.05);心功能Ⅱ级与心功能Ⅲ级、心功能Ⅳ级TNF、ET含量间比较均有显著性差异(P＜0.05～0.01),相关有显著性意义;不同心功能级数CHF患儿血浆TNF、ET和ACE含量治疗后较治疗前明显降低,均有显著性差异(P＜0.05～0.01),而且心功能越差,血浆TNF、ET水平恢复越慢,洛汀新组心功能改善较常规组明显,两者含量间比较有显著性差异(P＜0.05)。结论血浆ET、TNP和ACE含量的测定有助于判断心力衰竭的程度,洛汀新组的疗效明显优于常规组。     

诊断卵巢恶性肿瘤最佳标志群的研究

目的研究22种肿瘤标志(TM)对诊断卵巢恶性肿瘤(OMN)的价值,选择最佳诊断标志群.方法用高压液相色谱法、自动生化仪检测法、酶联免疫法检测.结果单项TM的敏感性≥60%者分别为腐胺(100%)、精脒(84%)、CA125(80%)、唾液酸(SA)(70.4%)、铁蛋白(61.2%)、肿瘤特异生长因子(TS-GF)(60.9%)和CA153(60%).有效率≥80%者分别是TSGF(88.6%)、精胺(86.6%)、精脒(83.8%)、CA153(81.2%)、SA(81.1%)、腐胺(81.0%)和CA125(80%).最佳标志群为CA125、TSGF和SA.结论CA125是诊断OMN最敏感的TM,其次是SA、铁蛋白和TSGF.TM联合测定能提高诊断的有效性,其中以CA125、TSGF和SA联合测定效果较好.     

Utilidad de la embolización vascular prequirúrgica de tumores renales con trombo tumoral en la vena renal izquierda

Introduction and objectivesPreoperative renal artery embolization (PRAE) for large renal masses may be performed prior to nephrectomy in order to simplify the procedure and reduce intraoperative bleeding. The objective of this work is to determine the role of PRAE on intraoperative bleeding and postoperative complications in left renal tumors with tumor thrombus limited to the left renal vein (level 0).Material and methodsRetrospective analysis to evaluate 46 patients who underwent left radical nephrectomy and thrombectomy for the treatment of renal cell carcinoma with level 0 tumor thrombus during the period 1990-2020. PRAE was limited to those cases in which surgical access to the main renal artery was presumed a priori difficult in the preoperative imaging study (n = 9; 19.6%). Intraoperative bleeding was estimated based on the perioperative transfusion rate, and postoperative complications were categorized according to the Clavien-Dindo classification. The Chi-squared test was used for comparisons. A multivariate analysis was performed to identify predictors of transfusion and complications.ResultsThere were no significant differences in the overall complication rate (11.1% vs. 32.4%, P = .19), major complication rate (0% vs.8.1%, P = .51), or transfusion rate (11.1% vs. 19%, P = .49) between both groups (PRAE vs. non-PRAE). In the multivariate analysis, PRAE did not behave as a predictor of complications (OR:0.11, 95%CI 0.01-2.86; P = .18) nor transfusion (OR:0.46, 95%CI 0.02-7.38;P = .58).ConclusionsIn our study on left renal cell carcinomas with level 0 tumor thrombus and difficult access to the main renal artery, PRAE was not associated with increased bleeding or postoperative complications, and it did not behave as an independent predictor of these variables. Therefore, it could be used as a preoperative maneuver to facilitate vascular management in selected cases.     

Research on the cutoff tumor size of omitting radiotherapy for BCSS after breast conserving surgery in women aged 65 years or oder with low-risk invasive breast carcinoma: Results based on the SEER database

BackgroundRadiotherapy after breast-conserving surgery (BCS) is not always necessary in older women staged T1N0M0 with low-risk invasive breast cancer, but few studies have concluded the detailed tumor size as a reference for avoiding radiotherapy. The study was conducted to explore and identify the optimal cutoff tumor size.MethodsThe study population was from the Surveillance, Epidemiology, and End Results (SEER) database in 2010–2016. Propensity score matching was used to balance the confounders between groups. Predictors associated with survival were analyzed by Kaplan–Meier, X-tile, Cox proportional hazards model and competing risk model.ResultsA total of 52049 women and 3846 deaths were included in the cohort with a median follow-up of 34 months. Based on the cutoff value determined by X-tile analysis, the study population were divided into small tumor group (≤14 mm in diameter) and large tumor group (>14 mm in diameter). Small tumors and radiotherapy were correlated with better breast cancer-specific survival (BCSS). In subgroup analysis, the absolute benefit of BCSS in 6 years attributed to radiotherapy was only 0.90% (RT vs. non- RT:98.77% vs. 97.87%) for patients with small tumors but up to 3.33% (RT vs. non- RT:97.10% vs. 93.77%) for those with large tumors.ConclusionSmall tumors and adjuvant radiotherapy were associated with improved long-term prognosis, and 14 mm in diameter was the cutoff tumor size of omitting radiotherapy for patients aged 65 or older with T1N0M0 stage, ER+ and HER2-breast carcinoma after BCS.     

Transcriptomic and Immunophenotypic Characterization of Tumor Immune Microenvironment in Squamous Cell Carcinoma of the Oral Tongue

The tumor immune microenvironment of oral tongue squamous cell carcinoma may be accountable for differences in clinical behavior, particularly between different age groups. We performed RNA expression profiling and evaluated tumor infiltrating lymphocytes (TILs) and their T-cell subsets in order to assess the functional status of oral tongue squamous cell carcinoma tumor microenvironment and detect potentially clinically useful associations. Archival surgical pathology material from sixteen oral tongue squamous cell carcinoma patients was microscopically evaluated for TIL densities. RNA was extracted from macrodissected whole tumor sections and normal controls and RNA expression profiling was performed by the NanoString PanCancer IO 360 Gene Expression Panel. Immunostains for CD4, CD8 and FOXP3 were evaluated manually and by digital image analysis. Oral tongue squamous cell carcinomas had increased TIL densities, numerically dominated by CD4 + T cells, followed by CD8 + and FOXP3 + T cells. RNA expression profiling of tumors versus normal controls showed tumor signature upregulation in inhibitory immune signaling (CTLA4, TIGIT and PD-L2), followed by inhibitory tumor mechanisms (IDO1, TGF-β, B7-H3 and PD-L1). Patients older than 44 years showed a tumor microenvironment with increased Tregs and CTLA4 expression. Immunohistochemically assessed CD8% correlated well with molecular signatures related to CD8 + cytotoxic T-cell functions. FOXP3% correlated significantly with CTLA4 upregulation. CTLA4 molecular signature could be predicted by FOXP3% assessed by immunohistochemistry (R² = 0.619, p = 0.026). Oral tongue squamous cell carcinoma hosts a complex inhibitory immune microenvironment, partially reflected in immunohistochemically quantified CD8 + and FOXP3 + T-cell subsets. Immunohistochemistry can be a useful screening tool for detecting tumors with upregulated expression of the targetable molecule CTLA4.Electronic supplementary materialThe online version of this article (10.1007/s12105-020-01229-w) contains supplementary material, which is available to authorized users.