超声内镜在直肠癌新辅助治疗后再分期的应用价值研究

目的 探讨超声内镜在直肠癌新辅助放化疗后再分期的准确性.方法 61例初诊直肠癌患者纳入研究,新辅助治疗后行超声内镜分期,并与手术后病理分期进行比较.结果放化疗后EUS对直肠癌T分期的总准确率为59.0%(36/61),36.1%(22/61)的病例分期过高,4.9%(3/61)的病例分期过低.EUS对直肠癌N分期准确率为68.9%(42/61),14.7%(9/61)的病例分期过高,16.4%(10/61)的病例分期过低.结论 EUS对新辅助治疗后的直肠癌进行再分期的准确率降低.     

Serum big endothelin-1 as a biomarker in oral squamous cell carcinoma patients: an analytical study

Detection of abnormally elevated levels of molecules in patients with oral cancer may be useful in early diagnosis. These markers can be included in current Histopathology grading and in TNM staging systems of Oral Squamous Cell Carcinoma (OSCC) to make it more efficient. Several pro-angiogenic molecules have been assessed for the same reason. Endothelin-1 (ET-1) is a vasoactive peptide associated with the development and spread of many solid tumors, including Squamous Cell Carcinoma (SCC), but its utility in OSCC has not been confirmed.

Objective

This study aims to evaluate the role of the serum big ET-1 as a biomarker of OSCC, by correlating it with the clinical staging and the histopathological grading.

Material and Methods

Serum levels of big ET-1 measured by the sandwich Enzyme-Linked Immunosorbent Assay (ELISA) in 40 OSCC cases were compared with the levels from the control group using independent t-test. Clinical stages and histopathological grades of OSCC cases were compared in relation to their mean levels of serum big ET-1, one using the Analysis of Variance (ANOVA) test and the other the independent t-test, respectively. The significance of the mean difference between the groups was evaluated by Tukey’s multiple comparison test. All statistical analyses were performed on GraphPad statistical software version 5.0.

Results

By comparing the mean of the big ET-1 concentrations of cases and controls, the independent t-test revealed significant higher big ET-1 concentration of OSCC cases when compared to controls (p<0.0001). Tukey’s multiple comparison test also revealed statistically significant difference among all OSCC stages in relation to the mean levels of serum big ET-1. However, the mean of the big ET-1 concentrations of cases of grade I and of grade II did not differ statistically (p=0.729).

Conclusion

Serum big ET-1 levels may be useful as a diagnostic tool in OSCC and as an adjunct to OSCC staging. However, its use as a prognostic marker warrants larger prospective studies.     

miRNA-212在乳腺癌的表达及其与临床病理特征的关系

目的分析miRNA-212在乳腺癌中的表达及其与临床病理特征的关系。方法选择90例乳腺癌患者的手术标本(癌组织及其癌旁组织)提取总RNA,采用TaqMan探针逆转、实时定量PCR检测miRNA-212在乳腺癌及其癌旁正常组织中的表达量,并分析其与临床病理特征关系。结果乳腺癌组织miRNA-212表达量为3.06(0.146-10.274),与癌旁正常组织相比显著上调;miRNA-212的表达与TNM分期相关,TNM分期越高,miRNA-212表达越高;miRNA-212的表达也与淋巴结转移相关,淋巴结转移患者miRNA-212表达增加。结论miRNA-212表达上调可能与乳腺癌的发生及其转移有关。     

温州地区新型冠状病毒肺炎中医分期分型诊治与实践

[目的]简述温州地区新型冠状病毒肺炎(以下简称新冠肺炎)中医分期分型诊治与实践,协助指导临床用药。[方法]通过中医临床诊治实践,结合中医伤寒、温病学说,对新冠肺炎的病因病机、分期分型、各期的辨证论治进行总结,观察疾病转归,并列举一例中期新冠肺炎患者验案加以佐证。[结果]温州地区新冠肺炎归属于“疫病”,本病病位主要在肺,涉及胃肠;病因为寒、热、湿、毒邪相抟,易耗气伤阴动血。结合肺炎患者分期分型论治,将其分为初期、中期、危重症期、恢复期,分别投以藿香正气散、麻杏石甘汤合小陷胸汤和苇茎汤、清瘟败毒散、参附汤或生脉散、参苓白术散合补肺汤加减治疗。验案中新冠肺炎患者辨为疫毒闭肺证,治以清热化痰、通腑泄热,予麻杏石甘汤合小陷胸汤和苇茎汤加减,疗效肯定。[结论]温州地区新冠肺炎中医分期分型方案可有效指导温州地区新冠肺炎的诊治工作,对于其他地区新冠肺炎的防治工作,也具有一定的借鉴意义。     

二维超声联合超微血管成像技术在宫颈癌 术前分期诊断中的价值

目的 探讨经阴道二维超声联合超微血管成像（SMI）在宫颈癌术前分期诊断中的应用价值。 方法 选取2018 年11 月—2019 年12 月广西壮族自治区人民医院收治的经病理检查确诊为宫颈癌拟手术治 疗的76 例患者。所有患者术前行阴道二维超声联合SMI 及磁共振成像（MRI）检查。以术后病理结果为金 标准,分析2 种检查方法对宫颈癌分期的准确率及敏感性。结果 76 例宫颈癌患者中,Ⅰ A 期3 例,Ⅰ B 期 57 例,Ⅱ期16 例。二维超声联合SMI 诊断宫颈癌分期总的准确率为77.6%（59/76）,MRI 为73.7%（56/76）, 差异无统计学意义（P >0.05）。二维超声联合SMI 诊断Ⅰ B1、Ⅰ B2 期的准确率均高于MRI（P <0.05）。肿瘤 直径<2 cm、2 ～ <4 cm 时,二维超声联合SMI 诊断敏感性为87.5% 和93.8%,优于MRI 的84.0% 和87.5%。 结论 二维超声联合SMI 在早期宫颈癌术前分期诊断上具有价格低廉、可反复操作、无创等优势,可为宫颈 癌治疗方案的制定提供重要依据。     

Lung cancer staging: the value of PET depends on the clinical setting

Background

Although positron emission tomography (PET) imaging is widely recommended in the evaluation of patients with lung cancer, randomized controlled trials (RCTs) assessing this have demonstrated inconsistent results. We asked whether differences in the clinical context and endpoints could explain these discrepancies.

Methods

We used realist synthesis methods to analyze how contextual differences among RCTs affected the results. We focused on RCTs to minimize confounding yet permit evaluation of differences by comparing across studies.

Results

This analysis suggests that the impact of PET depends on the clinical setting. PET is of greatest benefit in identifying M1 disease in patients with a high chance of such involvement and when little traditional imaging [e.g., abdominal/pelvis computed tomography (CT) and bone scan] is used. Identification of N2,3 involvement by PET prior to resection is seen primarily when there is at least a moderate probability of such and the rate of invasive staging is high. The rate of N2 disease not identified preoperatively appears to increase if PET is used to avoid invasive mediastinal staging in clinical settings in which the risk of N2,3 involvement is moderately high. There is both a potential benefit in avoiding stage-inappropriate resection as well as a risk of missed (stage-appropriate) resection if PET findings are not evaluated carefully.

Conclusions

A blanket recommendation for PET may be too simplistic without considering nuances of the clinical setting.     

超声内镜对126例胃癌术前TNM分期的临床分析

目的 评价超声内镜(EUS)对胃癌患者术前TNM分期的准确性.方法 126例行外科手术治疗的胃癌患者,于术前1周行EUS和腹部螺旋CT检查,确定肿瘤浸润深度(T)、淋巴结转移(N)、远处转移(M)等分期情况,并与术后病理TNM分期进行对照,以评价EUS对TNM分期的准确性.数据处理采用配对x2检验.结果 与术后病理结果比较,EUS对胃癌T1、T2、T3、T4分期的准确率分别为84.6％、14/18、82.0％、85.7％;EUS对胃癌N0、N1、N2、N3分期的准确率分别为74.2％、75.0％、57.9％、5/17.螺旋CT对胃癌N0、N1、N2、N3分期的准确率分别为80.6％、75.0％、73.7％、12/17.EUS与螺旋CT对N0和N1分期判断的准确率接近,而对N2和N3分期的判断,螺旋CT较EUS有明显优势(x2=4.89,P=0.027;x2=13.88,P＜0.01).对于胃癌远处转移M1分期的比较,EUS与螺旋CT的准确率分别为36.4％、95.5％,螺旋CT对M1的判断优于EUS(x2=7.90,P=0.001).结论 EUS对胃癌术前T分期具有较高的临床应用价值,而对淋巴结转移的N2、N3分期及远处转移的M分期的准确性有待提高.为获得较准确的术前TNM分期以指导治疗方案的选择,有必要联合螺旋CT检查.