胃肠道类癌临床病理与免疫组织化学研究

应用免疫组织化学ＡＢＣ法，对５２例胃肠道类癌进行８种多肽／胺类神经内分泌激素、２ 种上皮细胞性标记物的研究。结果：胃肠原位激素胰多肽、生长抑素、蛙皮素、胃泌素、五羟色胺较多 表达于组织形态分化好的类型。血管活性肽的表达随肿瘤组织形态分化降低而上升显著（１５．０％、 ２５．０％、５８．３％、Ｐ＜０．０５），并与肿瘤的浸润和转移有关（Ｐ＜０．０５）。异位激素降钙素的表达主要分 布于肿瘤组织形态分化较低的类型（２０．０％、５０．０％、６６．７％、Ｐ＜０．０５）。癌胚抗原的表达随肿瘤组 织形态分化的降低呈大幅度上升（１０．０％、５５．０％、８３．３％、Ｐ＜０．００１），且与肿瘤的浸润有关（Ｐ＜ ０．０５）；神经特异性烯醇化酶与角蛋白的表达与组织分化无相关性。提示应用多种抗原标记对胃肠 道类癌的良恶性判断很有帮助。     

Clinical Experience in Application of the Point Zhaohai

Zhaohai (KI 6) is a point on the Kidney Channel of Foot Shaoyin, and it is one of the eight confluent points, connecting with the Yinqiao Channel. It is located in the depression of the lower border of the medial malleolus, indicated for the disorders along the distributing courses of the Foot Shaoyin Channel and Yinqiao Channel. Connecting with the kidney and bladder collaterally, it gives the effect of reinforcing the kidney and strengthening qi, and promoting the function of the bladder.     

Differential Growth of IFN-beta-Engineered Tumor Cells in Nude and IFN Receptor-Null Mice.

The purpose of this study was to investigate the therapeutic potential of interferon-beta (IFN-beta) against tumors that resist its antiproliferative effects. Mouse fibrosarcoma cells (UV-2237m-P) and their counterparts, transfected with either IFN-beta cDNA (UV-2237m-IFN-beta) or its control vector (UV-2237m-neo), were used in the study. UV-2237m-IFN-beta cells, still expressing functional IFN receptors, were resistant to the antiproliferative effects of IFN-beta. UV-2237m-P and UV-2237m-neo cells produced progressive tumors in both nude and IFN receptor-null nude (IFNAR-/-nude) mice. In contrast, growth of UV-2237m-IFN-beta cells was significantly delayed in nude mice. UV-2237m-IFN-beta tumors from nude mice contained fewer microvessels, fewer proliferating cells, and more apoptotic cells than did UV-2237m-P and UV-2237m-neo tumors. They expressed high levels of inducible nitric oxide synthase (iNOS) and were densely infiltrated by macrophages. Incubation with macrophages from nude mice, but not those from IFNAR-/- nude mice or iNOS-null/nude mice, led to more significant killing of UV-2237m-IFN-beta cells than that of control cells, which was blocked by iNOS inhibitor N-methylarginine. Similarly, more UV-2237m-IFN-beta cells were killed when they were incubated with spleen lymphocytes from nude mice. These data indicate that IFN-beta can inhibit growth of IFN-beta-resistant tumors by T cell-independent host-mediated mechanisms, including the role of macrophages, natural killer (NK) cells, and iNOS activity.     

人胎儿脊髓神经肽Y样神经元及其纤维的发育和分布的免疫细胞化学研究

人工流产胎儿标本２３例，孕龄１０～４１周，用免疫组织化学ＡＢＣ法，研究人胎儿脊髓神经肽Ｙ样神经元的发育和分布。结果在胎龄第１０周，发现脊髓后角浅层（ＲｅｘｔｄⅠ、Ⅱ层）已有神经肽Ｙ样免疫阳性神经元胞体存在，且阳性神经元总数随胎龄的增加而递增，并向后角深层（ＲｅｘｅｄⅢ～Ⅳ层）扩展神经肽Ｙ样阳性纤维，在胎龄第１０周，不仅出现于脊髓的灰质和白质，而且见于脊髓的被膜。随胎龄的增长，免疫阳性反应纤维相对集中于脊髓的植物性神经中枢的所在部位，揭示在妊娠早期，神经肽Ｙ可能与脊髓植物神经元的发育及其功能的调节有关。     

Immunohistochemical diagnosis in fine-needle aspiration cytology

This paper reports 25 kinds of polyclonal or monoclonal antibodies by ABC immunohistochemical technique used for 253 cell smears by fine-needle aspiration. The results were,1. Immunohistochemical diagnosis were classified into 136 metastatic cancers ( K12 EMA CEA LCA-),92 lymphomas (LCA k12- EMA- CEA-), 4 mesenchymal tumors (Vimentin ), 3 melanomas (S-100 NSE ). 15 reactive proliferations (k λ4 CD CD8 ) and 3 unspecified.2. The origin of 70 metastatic cancers were classified into 36 lung (HLC3-AB ), 4 gastrointestinal tract (MG7 ), 8 thyroid (TGB ), 1 prostate (PSA ), 3 liver (AFP ) and 14 unknown. 3. Immunologic phenotype of 87 lymphomas wereclassified into 66 cases of B-cell, 4 T-cell, 3 hsitocyte, 7 Hodgkin' s diseases and 7 unclear. The above results suggest that immunohistochemlcal method may be used as a new method of diagnosing and differentiating epithelial and non-epithelial tumors, detecting primary focus of metastatic cncer, differentiating between reactive proliferation adn lymphome a     

Expression of c-erbB-2 and PCNA in cervical adenocarcinoma and its signification

Objective: To investigate the significance of c-erbB-2 and PCNA expression in adenocarcinoma. Methods: Expression of c-erbB-2 and PCNA in 74 cases of adenocarcinoma of the uterine cervix was examined by immunohistochemistry. Results: The expression of c-erbB-2 was detected in 34 cases. The positive staining of c-erbB-2 was associated with increased lymph node metastasis (57.1% Vs 24.0%, P=0.041) and lower 5-year survival rate (32.4% Vs 58.9%, P=0.008). The average PCNA labeling index (PCNA LI) was 40.6% (0.1%–91.4%). High PCNA LI was associated with lymph node metastasis (56.4% Vs 38.5%, P=0.016) and lower 5-year survival rate (28.7% Vs 64.4%, P=0.005). Positive staining of c-erbB-2 were associated with high PCNA LI (44.7% Vs 34.6% P=0.003). Conclusions: c-erbB-2 and PCNA LI were associated with malignant biological behavior and poor prognosis of patients with cervical adenocarcinoma.     

Legitimising and rationalising in talk about satisfaction with formal healthcare among bereaved family members

While there is a fair amount of knowledge regarding substantive features of end of life care that family members desire and appreciate, we lack full understanding of the process whereby family members formulate care evaluations. In this article we draw on an analysis of interview data from 24 bereaved family members to explicate how they interpret their experiences and formulate evaluations of end of life care services. Most participants wove between expressing and legitimising dissatisfaction, and qualifying or diffusing it. This occurred through processes of comparisons against prior care experiences and expectations, personalising (drawing on personal situations and knowledge), collectivising (drawing on conversations with and observations of others) and attempting to understand causes for their negative care experiences and to attribute responsibility. The findings suggest that dissatisfaction might be diffused even where care is experienced negatively, primarily through the acknowledgement of mitigating circumstances. To a lesser extent, some participants attributed responsibility to the ‘system’ (policy and decision‐makers) and individual staff members. The findings are discussed in relation to the theoretical understanding of satisfaction and evaluation processes and how satisfaction data might inform improvements to care quality.     

Cutaneous Innervation and Itch in Keloids

Abstract is missing (Letter).     

Acetabular fractures,anatomy and implications for treatment

Acetabular fractures are relatively uncommon and their definitive treatment tends to be focused on specialist major trauma centres. This can make both accurate diagnosis and management challenging, particularly in hospitals where they are rarely seen. Contemporary management of these injuries owes a lot to the work of Judet and Letournel undertaken in the 1970s. The key to understanding these injuries is to know the embryology and development of the pelvis and then be able to appreciate its three-dimensional structure from two-dimensional X-rays. This can then be overlaid with the Judet classification and the action of force vectors encountered in various mechanisms of injury. It is also important to realise the ageing demographics of this group of patients and the complexities this adds to classification and ultimately treatment. Finally, the presence of an acetabular fracture is often seen in association with a number of other injuries. It is imperative that these are appropriately and contemporaneously diagnosed so that a comprehensive management plan may be instituted to give the best outcomes. However, even with optimal management the prognosis is guarded with a majority of patients suffering some degree of functional loss and this must be made clear to the patient from the outset.     

Implementation and Preliminary Clinical Outcomes of a Pharmacist‐managed Venous Thromboembolism Clinic for Patients Treated With Rivaroxaban Post Emergency Department Discharge

Objective

The objective was to describe the implementation, work flow, and differences in outcomes between a pharmacist‐managed clinic for the outpatient treatment of venous thromboembolism (VTE) using a non‐vitamin K oral anticoagulant versus care by a primary care provider (PCP).

Methods

Patients in the studied health system that are diagnosed with low‐risk VTE in the emergency department are often discharged without hospital admission. These patients are treated with a non‐vitamin K oral anticoagulant and follow‐up either in a pharmacist‐managed VTE clinic or with their PCP. Pharmacists in the VTE clinic work independently under a collaborative practice agreement (CPA). An evaluation of 34 patients, 17 in each treatment arm, was conducted to compare the differences in treatment‐related outcomes of rivaroxaban when managed by a pharmacist versus a PCP.

Results

The primary endpoint was a 6‐month composite of anticoagulation treatment‐related complications that included a diagnosis of major bleeding, recurrent thromboembolism, or fatality due to either major bleeding or recurrent thromboembolism. Secondary endpoints included number of hospitalizations, adverse events, and medication adherence. There was no difference in the primary endpoint between groups with one occurrence of the composite endpoint in each treatment arm (p = 1.000), both of which were recurrent thromboembolic events. Medication adherence assessment was formally performed in eight patients in the pharmacist group versus no patients in the control group. No differences were seen among other secondary endpoints.

Conclusions

The pharmacist‐managed clinic is a novel expansion of clinical pharmacy services that treats patients with low‐risk VTEs with rivaroxaban in the outpatient setting. The evaluation of outcomes provides support that pharmacist‐managed care utilizing standardized protocols under a CPA may be as safe as care by a PCP.