胃肠道交界性病变/肿瘤和相关病变的临床病理特点及其治疗原则

交界性病变／交界性肿瘤是目前诊断病理面临的最大难题之一。病理和临床医师应正确认识胃肠道的一些交界性病变／交界性肿瘤及相关病变如胃肠道间质瘤、胃肠道淋巴组织增生和粘膜相关淋巴组织淋巴瘤、免疫增生性小肠病、胃肠道腺瘤和阑尾类癌。     

EXPRESSION OF p16,CYCLIN D1 AND RB PROTEIN IN GASTRIC CARCINOMA AND PREMALIGNANT LESIONS

Gastric carcinoma is one of the most serious diseases in mankind. Its pathogenesis has not been understood very clearly. Recent researches suggested that oncogenes (such as cyclin D1), antioncogenes (ie., p16, Rb) and cell cycle played an important role in the pathogenesis of gastric carcinoma. But there are few reports about the relationship between these genes in gastric carcinoma and gastric premalignant lesions. In this study, we will discuss these problems. MATERIALS AND METHO…     

食管鳞状上皮非典型增生细胞核的形态计量研究

本文用计算机图像分析仪对73例食管鳞状上皮非典型增生的细胞核进行形态计量测量，检测了胞核面积、周长、形态因子、异形指数、园球等5个指标，并与正常组相对照，结果表明，传统的组织学分级与形态定量分级基本一致，有其客观性。同时发现组织学诊断与形态计量诊断间有一些病例交叉，即下级病变的测量指标高于上级病变均值或上级病变的测量指标低于下级病变均值的情况。如果具体到某一病人，多指标形态定量可能比组织学诊断更准确，更能代表病变的现状。本文从食管鳞癌发生学的角度，对组织学诊断、细胞学诊断及形态定量诊断相互之间的关系及意义作了深入的分析，认为对食管非典型增生细胞核进行多指标形态分析，可为临床诊疗及估计预后提供帮助。     

Phenotypic shift in human differentiated gastric cancers from gastric to intestinal epithelial cell type during disease progression

Background. The phenotypic expression of tumor cells is widely thought to resemble that of the tissue of origin. In the present study, to assess phenotypic changes that occur with disease progression, we investigated human differentiated gastric cancers at different depths of invasion for component cancer cell types. Methods. Using a combined mucin histochemical and immunohistochemical approach, we classified surgical specimens of 301 differentiated gastric cancers into three types: gastric epithelial cell (G) type, intestinal epithelial cell (I) type and mixed gastric and intestinal (GI) type, according to the phenotypic differentiation of the component cancer cells. The relation between the phenotypic type of cancer and their depth of invasion was evaluated. Results. The proportion of G type cancers was 41.4% in early (tumor invasion of mucosa or submucosa) cases, decreasing to 22.2% in advanced (tumor invasion of muscularis propia or deeper) cases, whereas the proportion of I type cancers increased with progressive disease from 23.5% to 31.1% (P < 0.01). Cancers invading the subserosa or deeper included more I type cases and fewer G type than cancers limited to the mucosa (P < 0.01). In most cases of each phenotypic type, intestinal metaplasia was recognized in the surrounding background mucosa, but no clear relation was shown between the phenotype of cancers and the degree of intestinal metaplasia in the background mucosa, suggesting that intestinal metaplasia is not always a preneoplastic lesion. Conclusions. A phenotypic shift from G to I type expression was observed with the progression of human differentiated gastric cancers. Intestinalization may occur independently in cancerous and noncancerous gastric mucosa. Received for publication on May 1, 1998; accepted on Oct. 22, 1998     

一种简便快捷的微小病变基因变异分析方法的建立

目的建立一种简便快捷的微小病变和微量细胞基因变异的检测分析方法。方法HE染色病理诊断后,在立体显微镜或生物显微镜下对病理诊断组织细胞进行显微解剖,直接回收组织细胞,进行DNA模板抽提,以目的基因为引物,进行PCR-SSCP分析。结果1例胆石症病例,显微解剖结合PCR-SSCP法成功获得了K-ras和P53基因产物,并且检测到在过度增生胆囊上皮细胞有K-ras基因变异。结论显微解剖结合PCR-SSCP法取材少、病变部位确定,省时、省力,是分子病理研究的可靠手段。     

The expression of the calcium binding protein calretinin in the rat striatum: effects of dopamine depletion and L-DOPA treatment

The activity of the striatum is regulated by glutamate and dopamine neurotransmission. Consequent to striatal dopamine depletion the corticostriatal excitatory input is increased, which in turn can raise intracellular calcium levels. We investigated changes in the neuronal expression of the calcium binding protein calretinin related to dopamine depletion and l-DOPA administration. Immunohistochemical methods were used to assess calretinin in the striatum of rats with unilateral lesions of the nigrostriatal system. In these animals we observed a loss of the patchy distribution of calretinin fibers. Moreover, after dopaminergic depletion we detected two new, not previously described, calretinin cell types, the presence of which could be related to morphological changes induced by loss of a dopaminergic input. We also found an increase in the number of calretinin-labeled cells in the striatum ipsilateral to the lesion compared to the contralateral striatum or to the striatum of normal rats. This increase was mostly evident at 3 weeks postlesion and tended to decrease toward normal levels at 6, 10, and 18 weeks postlesion. In unlesioned animals, l-DOPA administration did not induce changes in the expression of calretinin. In unilaterally lesioned animals, l-DOPA reversed the increase in the number of calretinin-positive cells induced by the lesion. However, chronic l-DOPA administration was less effective than acute l-DOPA in reversing the effect of the lesion. The present data suggests that striatal calretinin neurons are sensitive to dopamine depletion. Increased expression of calretinin in striatal cells may be consequent to enhanced striatal excitatory input.     

鼻内镜下治疗真菌性鼻窦炎93例

目的探讨真菌性鼻窦炎经鼻内镜手术治疗的方法及疗效.方法回顾性分析93例真菌性鼻窦炎病例,经鼻内镜下手术治疗的疗效及有关问题.结果93例患者术后经随访3月～2年,窦口引流通畅,无1例复发.结论非侵袭型鼻窦真菌病宜行鼻内镜手术,以彻底清除窦腔病变,术后应继续反复冲洗窦腔,术后不必全身应用抗真菌药物.     

高危型人乳头瘤病毒检测在宫颈癌筛查中的应用价值

目的探讨将HR-HPV检测作为宫颈癌筛查手段的意义和价值。方法2004-12-2005-04对301医院妇产科门诊就诊的1231例患者,进行HPVDNA的杂交捕获法二代(HPV-HCⅡ)和液基细胞学(Thinprepcytol-ogytest,TCT)的检测,作为宫颈癌及其癌前病变的初筛。131例因细胞学异常,或细胞学正常而HPV检测阳性,或细胞学正常HPV阴性、而临床高度怀疑病变的患者行阴道镜下多点活检,结合病理结果进行分析。结果(1)1231例样本中,经TCT检测正常者1077例(87·43%),ASCUS32例(2·60%),ASCUS-H34例(2·76),LSIL73例(5·93%),HSIL15例(1·22%)。131例阴道镜下多点组织活检,病理证实炎症68例(51·91%),CINⅠ20例(15·27%),CINⅡ18例(13·74%),CINⅢ16例(12·21%),浸润癌4例(4·35%),湿疣5例(3·82%)。(2)HPV总感染率34%,HPV阳性者418例,年龄平均(36·93±10·8)岁,HPV阴性者813例,年龄平均(39·68±11·8)岁,HPV阳性组的年龄明显小于HPV阴性组,P<0·01。各病理组HPV感染率分别为:炎症58·82%,CINⅠ80%,CINⅡ72·22%,CINⅢ100%,浸润癌100%,湿疣60%。(3)阴道镜下多点活检结果:TCT和HPV均(-)者,无高度病变的发生;TCT(-)和HPV( )者中,≥CINⅡ的检出率11·1%(1/9),TCT异常和HPV阳性同时存在的病例中,≥CINⅡ的检出率最高40·5%(32/79);仅TCT异常而HPV(-)者13·2%(5/38),且5例均为CINⅡ,无原位癌和浸润癌的发生。结论持续的HR-HPV感染与宫颈病变的演进有关;HR-HPV检测是有价值的辅助诊断技术,与细胞学联合检测,为最佳宫颈癌筛查方案。     

QRS破碎波与急性心肌梗死患者冠状动脉病变相关参数及病变严重程度相关性研究

目的探讨QRS破碎波(fQRS)与急性心肌梗死(AMI)患者冠状动脉病变相关参数及病变程度的相关性,为临床冠状动脉病变的诊断及治疗提供参考。方法选取自2017年2月至2020年5月亳州市人民医院收治的102例AMI患者为研究对象,根据标准12导联心电图检查是否检出fQRS将患者分为无fQRS组(n=37)与fQRS组(n=65)。记录并比较两组患者心功能指标、实验室检查指标、Gensini评分、病变支数及病变程度,并分析fQRS与冠脉病变相关参数的相关性。结果 fQRS组患者的左室舒张末期内径、肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)和低密度脂蛋白胆固醇(LDL-C)/高密度脂蛋白胆固醇(HDL-C)均高于无fQRS组,左室射血分数、血流储备分数(FFR)低于无fQRS组,差异有统计学意义(P<0.05)。fQRS组患者的Gensini评分高于无fQRS组;fQRS组患者的双支、多支冠状动脉病变患者比例高于无fQRS组,单支冠状动脉病变患者比例低于无fQRS组;fQRS组患者的中度、重度狭窄患者比例高于无fQRS组,轻度狭窄患者比例低于无fQRS组,差异均有统计学意义...     

幽门螺杆菌感染和胃液维生素C浓度关系研究

目的 研究幽门螺杆菌(Hp)感染和胃液中维生素C(VitC)浓度的关系,探讨Hp导致胃病的机制.方法 用高铁还原法测定胃液中VitC浓度,用尿素酶试验和病理Giemsa染色检测Hp.对部分Hp阳性患者进行Hp根除治疗,并比较其治疗前后胃液中VitC浓度的变化.结果 Hp阳性各实验组胃液中VitC浓度分别为:浅表性胃炎26.1 mg/L、萎缩性胃炎伴肠上皮化生13.4 mg/L,异型增生12.7 mg/L,与Hp阴性正常对照组35.2 mg/L比较差异均具有统计学意义(P＜0.05);Hp根除后其胃液中VitC浓度恢复正常,而Hp未根除者其胃液中VitC浓度无明显变化.结论 Hp感染可导致胃液中VitC浓度降低,这可能是Hp致病机制之一;根除Hp可以恢复胃液中VitC浓度,这有利于预防胃癌的发生.