阻塞性黄疸:PTC下胆管钳夹活检的技术方法学研究

目的探索切实可行的胆管病理学检查新途径.资料与方法连续92例阻塞性黄疸患者接受经皮肝穿刺胆管造影(PTC)和经皮肝穿胆管引流(PTCD)治疗.PTCD过程中,影像监测下经皮经肝胆管穿刺,向胆管内引入活检钳对梗阻段钳夹活检,行组织病理学检查.统计学分析用χ2检验或Fisher确切概率计算法,以α=0.05作为检验水准.结果 92例钳夹活检患者90例成功获得组织块,技术成功率97.83%(90/92).钳夹活检敏感性为88.04%,63例胆管癌性恶性肿瘤钳夹活检敏感性较25例非胆管癌性恶性肿瘤高(93.65%比72.00%,P＜0.05).结论PTC下胆管钳夹活检操作简单,创伤小,敏感性高,是一种值得推广的胆管病理学诊断新途径.     

1—氰基—2—苯甲酰—1,2—二氢异喹啉的合成

采用1,1,2-三氯乙烷作溶剂,三乙胺作相转移催化剂合成了吡喹酮的重要中间体1-氰基-2-苯甲酰-1,2-二氢异喹啉。本法单耗低,产物质量好。Reissert 反应收率由文献报道的82%提高至90%。     

Warthin-like tumour of the thyroid gland: RET/PTC expression indicates it is a variant of papillary carcinoma

AIMS: Three cases with features of so-called 'Warthin-like tumour' of the thyroid (WaLTT) are described, in order to evaluate its relationship with papillary carcinoma (PC). METHODS AND RESULTS: We performed an histological and immunohistochemical study with emphasis on RET/PTC expression. The most striking features are represented by marked lymphocytic infiltration in the stalks of papillae and by oxyphilic metaplasia of epithelium, resembling Warthin tumour of the salivary gland. In all cases, we found nuclear features reminiscent of PC. The neoplastic cells were strongly positive for Leu M1 and epithelial membrane antigen (EMA), less for thyroglobulin and negative for calcitonin. The lymphocytic infiltrate was composed of a mixed population of B and T-cells with sparse S100-positive Langerhans cells. An interesting finding was the strong positivity with the antibody against RET/PTC. CONCLUSION: All clinicopathological data along with the presence of the extensive lymphocytic infiltrate could imply a more favourable prognosis. The expression of RET/PTC fusion gene adds support to the hypothesis that this tumour is a variant of PC, probably related to the oncocytic variant of PC.     

海南汉族青年苯硫脲尝味能力测定

本文用阈值法对海南岛汉族青年７０６人的尝味能力进行了测试，并计算了尝味者与味盲者的基因型频率和基因频率。结果表明尝味者上８７．６８％，味 为１２．３２％。尝味基因（Ｔ）为０．６４９０，味盲基因（ｔ）为０．３５１０。经统计学处理，男女之间味盲盲率没有显著性差异（Ｐ〉０．０５），而尝味平均阀值在男女之间有极显著性差异（Ｐ〈０．０１）。     

Percutaneous transhepatic cholangiography for choledocholithiasis after laparoscopic gastric bypass surgery

INTRODUCTIONGallstones are a common condition in bariatric patients after a laparoscopic Roux-en-Y gastric bypass (LRYGB). The management of ductal stones is challenging due to the altered gastrointestinal anatomy. Various techniques have been reported to manage bile duct stones.PRESENTATION OF CASEWe present the successful percutaneous trans hepatic management of common bile duct stones after LRYGB.One year after a LRYGB for morbid obesity, a 59-year-old female presented with acute cholecystitis. One month after laparoscopic cholecystectomy a 1 cm calculus was found within the distal CBD and patient underwent a percutaneous trans hepatic cholangiography under local anesthetic. This involved a right sided anterior segmental duct puncture. With the sphincter dilated to 10 mm, a balloon catheter was used to push the stone into the duodenum leaving an internal- external drain. Patient recovered completely at follow up.DISCUSSIONPatients with morbid obesity have a higher incidence of gallstones. After LRYGB, the altered anatomy does not allow the conventional endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis.Various techniques have been reported as means of managing bile duct stones in LRYGB patients. These include a double balloon enteroscope-assisted ERCP, laparoscopic transgastric ERCP, laparoscopic or open biliary surgery and interventional radiology. We report a non-surgical approach using percutaneous transhepatic technique under local anesthetic that resulted effective and could be applied more extensively.CONCLUSIONDue to the increase of global obesity, bariatric centers need to strategically plan resources such as interventional radiology in order to manage post LRYGB choledocholithiasis safely, efficiently and in a cost effective manner.     

BRAFV600E突变对甲状腺乳头状癌HMGB1及MMP-9表达的影响

目的探究BRAF^V600E突变对甲状腺乳头状癌(PTC)高迁移率族蛋白1(HMGB1)及基质金属蛋白酶-9(MMP-9)表达的影响。方法选取2018年1月至2019年11月在本院行甲状腺全切除术或次全切除术的116例PTC患者及匹配癌组织标本作为PTC组,另择同时期体检正常的30例健康人作为对照组。检测PTC患者BRAFV600E基因类型,免疫组化法及Western blot法检测PTC患者甲状腺癌组织中HMGB1、MMP-9表达情况,酶联免疫吸附法检测受试者血清HMGB1、MMP-9水平,并收集PTC患者临床资料。结果 116例PCT患者检出59例BRAF^V600E突变型、57例为BRAFV600E野生型,PTC患者BRAF^V600E突变型为50.86%(59/116)。免疫组化法分析结果显示BRAFV600E突变型HMGB1、MMP-9阳性表达率均显著高于BRAFV600E野生型,差异有统计学意义(P<0.05);Western blot法检测结果显示BRAFV600E突变型HMGB1表达量、MMP-9表达量显著高于BRAF^V600E野生型,差异有统计学意义(P<0.05)。PTC组BRAF^V600E突变型及BRAF^V600E野生型血清HMGB1、MMP-9水平均显著高于对照组,差异有统计学意义(P<0.05),PTC患者BRAFV600E突变型与BRAF^V600E野生型在血清HMGB1、MMP-9水平上比较,差异无统计学意义(P>0.05)。BRAF^V600E突变型TNM分期Ⅲ~Ⅳ期、包膜浸润、多发病灶、淋巴结转移占比显著高于BRAF^V600E野生型,差异有统计学意义(P<0.05)。二元Logistic结果显示,合并包膜浸润、多发病灶、组织HMGB1阳性、组织MMP-9阳性均是BRAF^V600E突变型的影响因素(P<0.05)。结论 PTC患者BRAF^V600E突变型组织HMGB1、MMP-9阳性表达率显著高于BRAF^V600E野生型,且组织HMGB1阳性、MMP-9阳性是BRAF^V600E突变型的影响因素。     

An examination of associations between the inability to taste phenylthiocarbamide (PTC) and clinical characteristics and trait markers in first-episode,nonaffective psychotic disorders

Research findings are mixed as to whether or not the inability to taste phenylthiocarbamide (PTC) might represent an endophenotypic trait marker for schizophrenia. We hypothesized associations between PTC-tasting status and select clinical characteristics and trait markers in patients with psychotic disorders that, if present, would provide support for the inability to taste PTC as a trait marker. In a first-episode psychosis sample (n=93), we measured PTC tasting, family history of psychosis, age at onset of prodrome and psychosis, severity of positive and negative symptoms, global impairment in functioning, neurological soft signs, and four neurocognitive domains (verbal learning/memory, visual learning/memory, verbal working memory, and spatial working memory). Associations between PTC-non-tasting and clinical/neurocognitive variables were examined with χ² tests and independent samples t tests. Among participants, 67.7% tasted PTC in comparison to a strip of control paper, and 25.8% were non-tasters. Tasters and non-tasters did not show statistically significant differences with respect to family history, age at onset, severity of symptoms, neurological soft signs, or the four neurocognitive domains. In conjunction with other findings, it is unlikely that PTC-non-tasting is a trait marker of schizophrenia, though a conclusive study is warranted.     

Cervical spine computed tomography utilization in pediatric trauma patients

Background

Guidelines for evaluating the cervical spine in pediatric trauma patients recommend cervical spine CT (CSCT) when plain radiographs suggest an injury. Our objective was to compare usage of CSCT between a pediatric trauma center (PTC) and referral general emergency departments (GEDs).

Methods

Patient data from a pediatric trauma registry from 2002 to 2011 were analyzed. Rates of CSI and CSCT of patients presenting to the PTC and GED were compared. Factors associated with use of CSCT were assessed using multivariate logistic regression.

Results

5148 patients were evaluated, 2142 (41.6%) at the PTC and 3006 (58.4%) at the GED. Groups were similar with regard to age, gender, GCS, and triage category. GED patients had a higher median ISS (14 vs. 9, p < 0.05) and more frequent ICU admissions (44.3% vs. 26.1% p < 0.05). CSI rate was 2.1% (107/5148) and remained stable. CSCT use increased from 3.5% to 16.1% over time at the PTC (mean 9.6% 95% CI = 8.3, 10.9) and increased from 6.8% to 42.0% (mean 26.9%, CI = 25.4, 28.4) at the GED. Initial care at a GED remained strongly associated with CSCT.

Conclusions

Despite a stable rate of CSI, rate of CSCT increased significantly over time, especially among patients initially evaluated at a GED.