原发癌灶定位与甲状腺微小癌颈侧区淋巴结转移关系研究

目的 探究原发灶定位与甲状腺乳头状微小癌（PTMC）颈侧区淋巴结转移的关系，评估超声检查预测颈侧区淋巴结转移的准确率。方法 回顾性分析2014年1月至2015年12月天津医科大学肿瘤医院收治的134例PTMC病人的临床资料，均行中央区淋巴结清扫+改良颈侧区淋巴结清扫。依据超声定位分组，分析癌灶位置与颈侧区淋巴结转移的关系。结果 颈侧各分区淋巴结转移发生率分别为：Ⅱ区30.6%、Ⅲ区50.7%、Ⅳ区57.5%、Ⅴ区11.3%。癌灶位于中上极者颈侧区淋巴结转移发生率高于癌灶位于下极者（89.7% vs. 75.7%，P=0.038），靠近外侧者较内侧者更易出现颈侧区淋巴结转移（93.7% vs. 81.4%，P=0.049）。超声检查判定Ⅱ、Ⅲ、Ⅳ、Ⅴ区淋巴结转移的敏感度分别为43.9%、85.3%、85.7%、14.3%；特异度为91.4%、57.6%、35.1%、99.1%。超声预测Ⅲ、Ⅳ区淋巴结转移敏感度较高，Ⅱ、Ⅴ区淋巴结转移特异度较高。结论 癌灶位置与甲状腺微小癌颈侧区淋巴结转移密切相关，超声可为临床确定颈侧区淋巴结的清扫范围提供依据。     

Hair shaft miRNA‐221 levels as a new tumor marker of malignant melanoma

miRNA‐221 (miR‐221) is known to be abnormally expressed in many human cancers. The serum levels of miR‐221 have been reported as a tumor marker for malignant melanoma (MM). We hypothesized that the hair shaft miR‐221 levels may be increased in patients with MM. We therefore assessed the possibility that hair shaft miR‐221 levels could be a marker for MM. The hair shaft miR‐221 levels were significantly higher in patients with MM than controls. The rates of increased hair shaft miR‐221 levels above the cut‐off value were comparable to those of serum 5‐S‐CD, which is a tumor marker commonly used for MM. Measurements of the hair shaft miR‐221 levels could have potential clinical value in the detection of MM. This is the first report investigating the hair shaft levels of an miRNA in patients with MM. Our investigations offer new insight into the relationship between miR‐221 and MM, and may provide a new, non‐invasive way to screen for melanoma.     

Does Outcome/Survival of Patients With Myelodysplastic Syndromes Should Be Predicted by Reduced Levels of ADAMTS-13? Results From a Pilot Study

IntroductionVon Willebrand factor (vWF) cleaving protease ADAMTS-13 has a key role for maintaining normal size of vWF. A deficiency or dysfunction of vWF cleaving protease is associated with ultra large vWF multimers and thrombotic microangiopathy. Patients with cancers have reduced levels of vWF cleaving protease. In this pilot study, we have evaluated whether or not deficiencies of ADAMTS-13 were present in myelodysplastic syndromes (MDS). Moreover, we assessed if a reduction in basal levels of ADAMTS-13 may play a role in the prognosis of MDS.Patients and MethodsWe measured and compared the levels of vWF cleaving protease ADAMTS-13 in 100 patients with MDS and 35 healthy controls. Patients were divided into 2 groups according to the International Prognostic Scoring System: group I consisting of 44 patients with low-risk MDS and group II of 56 patients with high-risk MDS. Patients with high-risk and low-risk MDS presented significantly lower levels of ADAMTS-13 than controls (P < .001 and P = .0177, respectively). High-risk patients had significantly lower levels of ADAMTS-13 when compared with the low-risk group (P < .001).ResultsWe found that reduced levels of ADAMTS-13 have a relationship with overall survival (P < .001). Statistical analysis showed that ADAMTS-13 correlates with cytogenetics (P < .001) and a tendency of slight correlation with platelet count and basal levels of ADAMTS-13 (R, 0.35; P value, 0.001). Moreover, we found that levels of ADAMTS-13 have correlation with response to treatment (P < .001).ConclusionsADAMTS-13 in MDS might represent a surrogate marker of prognosis, response to therapy, or disease progression. Further studies are needed.     

六西格玛在肿瘤标志物质量目标选择上的应用

目的应用6σ理论对肿瘤标志物项目的分析性能进行评价，并初步确定各项目的质量目标。 方法收集本实验室2018年1至12月室内质控数据和国家卫生健康委临床检验中心室间质量评价结果，以生物学变异导出的质量规范和国家室间质量评价标准作为允许总误差(TEa)计算6项肿瘤标志物的σ水平，并依据质量目标选择流程图和肿瘤标志物分析性能验证图评价肿瘤标志物的分析性能，进而为肿瘤标志物选择合适的质量目标。 结果应用不同层级的生物学变异导出的质量规范和国家室间质量评价标准，肿瘤标志物项目的σ水平存在显著差异；依据质量目标选择流程图：选择生物学变异导出的"适当的"质量规范作为CA125项目的质量目标，选择生物学变异导出的"最低的"质量规范作为t-PSA、CEA、AFP、CA199和CA153项目的质量目标。 结论6σ能够客观评价肿瘤标志物的分析性能，并为实验室质量目标的选择提供重要的参考价值。     

缺血修饰性白蛋白在急性缺血性胸痛中的诊断价值

目的 评价缺血修饰性白蛋白（ischemia modified albumin，IMA）对急性缺血性胸痛（ICP）的早期诊断价值。方法 时206例发病〈12h、表现为急性胸痛的患者立即行12导联心电图（ECG）检查，并抽血进行IMA、肌钙蛋白I（cTnI）、肌酸激酶同工酶MB（CK-MB）测定。将ECG、IMA、cTnI、CK-MB的结果单独或结合与最终诊断为非缺血性胸痛（NICP）及ICP的相互关系进行比较。结果 最后诊断为ICP98例，NICP108例，ICP发病〈3h和3-6h组IMA水平明显升高，与NICP组比较差异有统计学意义（P〈0．001）；ICP发病〉6h组IMA水平与NICP组比较差异无统计学意义（P〉0．05）。IMA诊断发病〈3hICP的敏感性和阴性预测值（NPV）为89．1％和88．8％，明显高于ECG、cTnI和CK-MB，四者结合为97．6％和96．9％；IMA诊断发病3～6hICP的敏感性和NPV为71．7％和74．5％，也高于ECG、cTnI、CK-MB，四者结合为95．5％和94．2％；但IMA对于发病〉6h的ICP则无诊断作用。结论 IMA是诊断ICP的早期敏感生化指标，对于发病〈6h（尤其是〈3h）的ICP诊断具有较高的敏感性和NPV，优于ECG、CK-MB、cTnI；将IMA与其他指标结合，可进一步提高对ICP的诊断价值。     

Quantifying how location and dose of botulinum toxin injections affect muscle paralysis

Despite the widespread use of botulinum toxin to treat muscle dystonias, no method exists to quantify muscle paralysis in either human or nonhuman models. In this study we examined how the location, dose, and volume of botulinum injection affects paralysis in the rat tibialis anterior muscle. Paralysis was quantified by electrically stimulating the nerve to the tibialis anterior and then staining sections of the muscle for glycogen. The areas of glycogen-containing fibers represented regions of botulinum action. The results showed that the most important injection technique is to inject botulinum directly into the motor endplate region of a muscle. Injections only 0.5 cm from the motor endplate resulted in a 50% decrease in paralysis. Increases in dose increased paralysis, however, some of that increase was simply due to the increased volume of injection. Thus, delivering toxin in small volumes near the MEP band of a muscle should produce the most effectiveparalysis. © 1993 John Wiley & Sons, Inc.     

微卫星改变与肺癌发生发展的关系

目的 :研究肺癌组织中第 3号染色体短臂 (3P)和第 9号染色体短臂 (9P)上微卫星标志物的改变与肺癌发生发展的关系。方法 :应用聚合酶链反应 (PCR)结合微卫星银染法检测 5 6例肺癌和 2 3例良性肺部病变 3P和 9P上的微卫星标志物的改变。结果 :5 6例肺癌组织标本中 3P上有微卫星改变 2 6例 ,检出率 46% ,9P上有微卫星改变的 2 3例 ,检出率为 41% ,5 6例肺癌组织中 ,3P和 9P上有微卫星改变的 3 9例 ,检出率 69 6% ,2 3例肺部良性疾病组织中均未出现微卫星标志物改变。肺癌组织标本中 3P上的微卫星改变与肺癌的分化程度有关 ,低分化肺癌的微卫星改变较高、中分化肺癌的微卫星改变明显增多 (P <0 .0 1)。而 9P上的微卫星改变与淋巴结转移有关 ,有淋巴结转移的肺癌组织标本上微卫星改变较不伴淋巴结转移的微卫星改变检出率明显增多 ,(P <0 .0 5 )。结论 :3P和 9P上的微卫星改变与肺癌发生、发展和转移密切相关 ,检测肺癌组织 3P和 9P上的微卫星改变对肺癌的早期诊断和判断有无淋巴结转移有一定的价值     

肝细胞癌的相关血清标志物

HCC的早期诊断是其治疗的关键，HCC血清标志物的检测又为其诊断提供了有利的途径，并且操作简单，敏感性高和特异性强。目前常用的血清标志物为AFP、AFP变异体、AFP mRNA、AFU、GGT、DCP、AIF、GPC3等。这些标志物的联合使用有助于HCC的诊断及预后。     

Increased plasma cathepsin D concentration in hepatic carcinoma and cirrhosis but not in breast cancer

Using a sandwich enzyme-linked immunoassay, plasma total cathepsin D concentration was assayed in 40 breast cancer patients and 84 patients with various liver diseases and compared to that of 52 normal subjects. There were no significant variations found in breast cancer patients related to tumor size, node invasiveness or metastases. In normal women, cathepsin D levels were slightly but not significantly increased in the luteal phase and in pregnancy. By contrast, plasma cathepsin D concentration was significantly increased in 70-75% of patients with liver disease (cirrhosis, hepatocarcinoma, hepatitis), but not in those with liver steatosis. Cathepsin D was independent of most of the plasma hepatic function tests and was correlated with alpha-fetoprotein in cirrhosis and with alpha-fucosidase in primary hepatocellular carcinoma. We conclude that plasma cathepsin D is not a useful marker in breast cancer. However, since the cellular level of this protease is associated with risk of metastasis in breast cancer, clinical follow-up will be required to test whether high cathepsin D plasma concentration has any prognostic value in liver cirrhosis and primary hepatocarcinoma.