Is OSNA better than imprint cytology for intraoperative diagnosis of cancer involvement of axillary sentinel node in breast cancer?

ObjectiveThe study aim was to establish Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value (NPV), and Accuracy Values of both imprint cytology (IC) and the OSNA assay for intraoperative assessment of axillary sentinel node (SN) cancer involvement in breast cancer. Specifically, we wished to find out if true positive and false negative results of IC were associated to axillary lymphadenectomy (ALND). Also, we addressed a comparative cost analysis between techniques.Methods244 patients treated for breast cancer in the Breast Unit of Hospital Germans Trias i Pujol from 2011 to 2015 were prospectively included. A transversal, consecutive design was applied to assess IC compared to the reference test (OSNA). Inclusion criteria were: T1 and T2 tumors with negative nodes, both clinically and on ultrasound.ResultsSensitivity of IC for macrometastases was 70%. The NPV of IC for macrometastases was 95,75%. Accuracy of IC was 96,12%. In the comparative cost analysis, the release time of results for OSNA doubled that of IC and was associated with an increased cost of € 370.ConclusionsIC has been stated as a good technique for intraoperative cancer involvement SN with high sensitivity and NPV compared to the OSNA assay. It allows keeping the whole node tissue and thus the possibility of improved histopathological evaluation, which can be useful for adjuvant, and offers the advantage of being less time consuming. Cost analysis shows a higher cost for OSNA, which may exceed the benefit of sorting out false negatives from IC.     

Ultrasonographic assessment of liver fibrosis with computer-assisted analysis of liver surface irregularities

PurposeThe goal of this study was to evaluate the diagnostic accuracy of a software program that automatically analyzes the liver surface to diagnose significant fibrosis, by comparing it to the subjective analysis of a radiologist and to transient elastography (Fibroscan^®).Patients and methodsOne hundred fourteen patients with chronic liver disease were included in the study. They underwent liver biopsy, FibroScan^® and ultrasonographic examination of the liver surface. The liver surface was analyzed by a software program that gave a score of surface irregularities. This evaluation was compared to subjective analysis by a radiologist expert in liver imaging and by two general radiologists.ResultsFifty percent of the patients had significant fibrosis according to the METAVIR score. The AUROC for the diagnosis of significant fibrosis by the software program was 0.80 (95%CI: 0.71–0.87), which was equivalent (P = 0.86) to that of FibroScan^® (0.81; 95%CI: 0.71–0.89). Results of the subjective analysis by the expert radiologist were poorer than those of the software analysis (P = 0.02) (AUROC = 0.66; 95%CI: 0.56–0.75). Interobserver agreement among radiologists was poor (0.25 < kappa < 0.37).ConclusionComputer-assisted liver surface analysis was better than subjective analysis, and similar to that of the FibroScan^®. This method could be useful for the diagnosis of significant fibrosis in patients with chronic hepatitis and complementary to the other non-invasive diagnostic tests.     

Geometrical Measurement of Central Tumor Location in cT1N0M0 NSCLC Predicts N1 but Not N2 Upstaging

1. Download : Download high-res image (252KB)
2. Download : Download full-size image

     

表皮细胞生长因子和碱性成纤维细胞生长因子联合点眼对兔自体穿透性角膜移植伤口愈合的影响

目的 研究表皮细胞生长因子（EGF）和碱性成纤维细胞生长因子（bFGF)点眼对兔自体穿透性角膜移植（PKP）伤口愈合的影响。方法 18只白色家兔的36只眼采用分层随机方法分为9个组,利用兔自体PKP动物模型,采用点眼给药方法,通过伤口愈合强度测量,^3H-脱氧胸腺嘧啶 （^3H-TdR)掺入液闪计数和AgNORs、VGi染色以及透射电镜等方法,观察EGF和bFGF联合点眼对兔自体PKP术后伤口愈合的速度、强度及其质量的影响。结果 （1）EGF bFGF联合点眼在PKP术后8d能增加伤口愈合强度以及伤口处成纤维细胞的数量。（2）术后14,21dEGF和bFBGF联合点眼与阳性对照组间的伤口愈合强度、伤伤口处成纤维细胞的数量以及^H-TdR的掺入率比较,差异幸免无显著性意义。结论 EGF和bFGF联合点眼在PKP术后早期更能促进伤口的愈合,在术后14d以后,EGF和bFGF联合点眼对伤口愈合的促进作用仅相当于单独用bFGF点眼的水平。     

ROC Analysis of Detection of Metastatic Pulmonary Nodules on Digital Chest Radiographs with Temporal Subtraction

RATIONALE AND OBJECTIVES: The authors' purpose was to evaluate the effect of temporal subtraction on digital chest radiographs in the detection of metastatic pulmonary nodules. MATERIALS AND METHODS: The study included 21 cases with metastatic pulmonary nodule and 21 cases without metastatic nodule. Eleven radiologists, including eight residents and three certified radiologists, provided their confidence levels for the presence or absence of pulmonary nodules without and with temporal subtraction. Their performances without and with temporal subtraction were evaluated by means of receiver operating characteristic analysis with both independent and sequential tests. RESULTS: For the independent test, the radiologists' Az (area under the receiver operating characteristic curve) values were 0.871 without and 0.954 with temporal subtraction, compared with 0.882 and 0.955, respectively, for the sequential test. Diagnosis accuracy was significantly improved with the use of temporal subtraction. There was no significant difference in Az values between the independent and sequential tests. CONCLUSION: Temporal subtraction is useful in the detection of metastatic pulmonary nodules, and this technique augments the value of digital chest radiography.     

肝移植术中大量输血的影响因素分析及预测模型构建

目的探讨肝脏移植术中大量输血的影响因素,并建立大量输血的预测模型。方法回顾性分析南京大学医学院附属鼓楼医院2018年度肝脏外科同一肝移植小组进行的103例肝移植受者资料,根据受者术中红细胞输注量分为大量输血组(≥12 U)40例和非大量输血组(<12 U)63例,比较分析两组受者的一般情况和术前指标,用Logistic回归分析法得出肝移植术中大量输血的预测模型。结果大量输血组和非大量输血组在性别、年龄、血型等方面差异无统计学意义(P>0.05),而术前诊断、血红蛋白(Hb)、血细胞比容(HCT)、血小板计数(PLT)、国际标准化比值(INR)、凝血酶原时间(PT)、部分活化凝血活酶时间(APTT)、凝血酶时间(TT)、血清总胆红素(TBIL)、血清直接胆红素(DBIL)、终末期肝病模型(MELD)评分等指标与术中大量输血存在相关性(P<0.05)。通过Logistic回归分析,得出肝移植术中大量输血的预测模型为Y=3.545-0.112×HCT-0.009×PLT+0.005×DBIL。其预测值经受试者操作特征曲线曲线分析得出曲线下面积为0.813,灵敏度和特异度分别为80.0%和71.4%,约登指数(Youden's index)为0.514,即Y≥0.514时则可能发生术中大量输血。结论肝移植受者术前HCT、PLT和DBIL可以作为术中大量输血的独立预测因素,其预测模型有较好的灵敏度和特异度。     

Partin表对我国前列腺癌患者术后病理特征预测价值的验证性研究

目的 验证基于西方人样本资料的Partin表预测我国前列腺癌患者术后病理特征的准确性.方法 回顾性分析2006年1月到2010年2月所有接受前列腺癌根治术患者的资料,筛选出术前未接受内分泌治疗且影像学检查未见盆腔淋巴结增大及远处转移的病例,收集前列腺特异性抗原检测值、Gleason评分、临床分期及术后病理分期等数据.根据术前临床指标按照Partin表分别预测四种术后病理情况的发生概率,再与实际结果 进行对照,利用受试者工作特征曲线下面积评估Partin表的准确性.结果 与构建Partin表的基础样本人群相比,本研究组人群血清前列腺特异性抗原水平、Gleason评分偏高,临床分期偏晚.器官局限、包膜侵犯、精囊侵犯及淋巴结转移这四种术后病理情况的发生率分别为62.3%、16.7%、12.3%及8.8%.利用Partin表预测上述术后病理特征的4条受试者工作特征曲线下面积分别为0.735、0.653、0.601及0.845.结论 对于我国前列腺癌患者,Partin表预测淋巴结转移的准确性很高,预测器官局限性疾病的准确性尚可接受,而预测包膜侵犯及精囊侵犯的准确性则较差.     

心理干预对行体外受精病人的影响

体外受精(IVF)治疗对不育夫妇既是一种生理负担又是一种心理负担,在IVF各个时期均表现出心理应激,其中胚胎移植后至妊娠试验前和IVF失败后应激最强,出现负性心理反应,以焦虑、抑郁多见。研究表明,通过心理干预能有效缓解患者的负性心理,并可能提高妊娠率和降低治疗中断率。     

成都市2010、2014年社区成年居民肥胖和超重的比较与影响因素研究

目的：探讨成都市社区成年居民肥胖和超重情况的差异及影响肥胖和超重的主要因素。方法分别于2010、2014年在3个社区进行两次社区卫生服务的横断面调查。两次调查均采用多阶段随机抽样方法,在成都市某城区的3个社区进行入户问卷调查。结果2010年与2014年相比,社区成年居民超重率从27.9%上升至31.2%,其增加幅度为11.8%;肥胖率从6.9%上升至7.7%,其增加幅度为11.6%。年龄标化后,超重率由28.9%上升到30.4%,肥胖率由7.2%上升到7.5%。logistic 回归结果显示：男性超重、肥胖患病率和增长幅度均高于女性;45~<55岁超重率最高,而18~<25岁肥胖率最高且该年龄段居民超重和肥胖率增长最快;非再婚人群、低文化程度、锻炼、饮食口味重及静坐时间长的人群超重和肥胖率较高。结论成都市社区成年居民超重和肥胖率呈现逐年增加的趋势,应采取综合措施,运用健康促进理论与技术,以社区为平台,加强重点人群防治,促进不健康生活方式的改变,强化健康教育,增强自我保健意识。     

宜昌市2005-2014年18岁以下人群疫苗针对呼吸道传染病特征

目的 了解宜昌市近年来18岁以下人群疫苗针对呼吸道传染病的流行特征,为制定免疫策略提供科学依据.方法 收集2005-2014来宜昌市麻疹、流行性腮腺炎、风疹、流脑、流感疫情资料,用描述流行病学方法分析流行病学特征.结果 宜昌市2005-2014间共报告18岁以下人群麻疹、流腮、风疹、流脑、流感疫苗针对疾病17 532例,年均发病率依次为:0.17/10万、3.38/10万、0.25/10万、0.003/10万、0.48/10万;麻疹、流脑流行类型为散在发生,流行性腮腺炎、风疹、流行性感冒以暴发出现;各年间报告发病数差别较大,呈季节性分布,不同年份发生强度不尽相同,但近年来发病总体呈下降趋势;地区分布差异除流脑外有统计学意义(P均＜0.01);人群特征分布上差异有统计学意义(P匀＜0.01),男性平均发病率高于女性(男性发病率依次为:麻疹0.20/10万、流腮3.91/10万、风疹0.27/10万、流脑0.006/10万、流感0.53/10万;女性发病率依次为:麻疹0.14/10万、流腮2.71/10万、风疹0.22/10万、流脑0.001/10万、流感0.41/10万),麻疹发病集中在＜3岁的婴幼儿及中学生.结论 宜昌市疫苗针对性五种呼吸道传染病的控制效果不同,各年间发生数变化较大,需进一步加强宣传教育普及呼吸道传染病防治知识,提高未成年人疫苗接种率,有效建立人群免疫屏障,控制针对性疾病的发生率.