Mammographic Screening Downstages Breast Carcinomas at Time of Diagnosis: A Community-Based Experience

Abstract: To determine the effectiveness of screening mammography in a community medical setting, data from a population-based, retrospective study was analyzed. Medical records of 827 patients with newly diagnosed breast cancer in California between October 1994 and March 1996 were reviewed. The primary care physician's record was abstracted for clinical history, including recommendation of screening mammography. The facility records where final diagnosis was made were abstracted for stage and treatment data. Among the patients who did not have previous screening mammography, 65.7% were diagnosed with "advanced" breast cancer (stages II, III, IV), while only 39.9% who had previous screening mammography were diagnosed with advanced breast cancer (p < 0.001). This study has reaffirmed that screening mammography of adult females generates downstaging at the time of diagnosis of breast cancer. Despite possession of a health insurance program and receiving educational materials, only 65% of patients over 50 years of age had screening mammography. As opposed to the once-a-year mailing of general reminders to all women 40 years old and older, developing a longitudinal electronic medical record in the managed care setting will support a more coordinated and individualized intervention based on age, date of last mammogram, and relative risk, among other factors. Continuing education efforts must also be directed to referring physicians, who may not yet recognize the value of screening mammography.     

MR扩散加权成像表观扩散系数与乳腺浸润性导管癌病理分级相关性研究

目的探讨表观扩散系数(apparent diffusion coefficient,ADC)值与乳腺癌病理分级是否具有相关性。材料与方法回顾性分析经病理证实并具有病理分级的66例乳腺浸润性导管癌,对病灶进行ADC值测量,取感兴趣区的ADC均值ADCmean及最小值ADCmin。依据治疗及预后(病理分级、淋巴结情况)分为病理分级、预后复发两组,采用SPSS19.0(One-way ANOVA、LSD检验、Spearman等级秩相关)进行统计学分析。结果 ADCmean值在病理分级1、2、3组内均数分别为0.993×10-3 mm2/s、0.969×10-3 mm2/s、0.926×10-3 mm2/s,ADCmin值的均数分别为0.849×10-3 mm2/s、0.660×10-3 mm2/s、0.535×10-3 mm2/s。ADCmean值在预后复发A、B、C组内均数分别为1.014×10-3 mm2/s、1.029×10-3 mm2/s、0.919×10-3 mm2/s,ADCmin值的均数分别为0.918×10-3 mm2/s、0.750×10-3 mm2/s、0.540×10-3 mm2/s。A D C m e a n与病理分级、预后复发分组间不具有相关性,A D C m i n与病理分级组(r=-0.615,P=0.000)、预后复发组(r=-0.754,P=0.000)间呈负相关。结论ADCmin值可以作为对乳腺癌术前治疗方案的制定及预后复发进行初步评估的一种指标。     

食管癌新辅助放化疗疗效预测分子标志物

局部晚期食管癌单纯手术治疗预后较差,新辅助放化疗并手术治疗的方案可明显延长食管癌患者的总体生存时间.目前,该治疗方案已成为欧美国家及我国对局部晚期食管癌进行规范化治疗的指南.然而,由于只有经新辅助放化疗后获得病理缓解的患者可从中获益,治疗无反应的患者预后可能比单纯手术更差.因此,预测食管癌新辅助放化疗的疗效,区分优势人群和耐受人群,从而实现个体化的治疗极为重要.分子标记物用于预测食管癌新辅助放化疗的疗效研究前景广阔,有望广泛应用于临床实践,指导局部晚期食管癌个体化治疗方案的决策.     

丹参联合葛根对糖尿病眼病模型大鼠的协同作用

目的:研究丹参联合葛根对糖尿病眼病模型大鼠的协同作用。方法:腹腔注射链脲佐菌素-弗氏完全佐剂联合喂饲高脂饲料以复制大鼠糖尿病眼病模型。实验分为正常对照(等容生理盐水)组、模型(等容生理盐水)组、葛根(33 g/kg)组、葛根丹参(33 g/kg+33 g/kg)组,灌胃给药,每天2次,连续15 d。于电镜下观察大鼠眼组织形态变化。分别灌胃葛根(33 g/kg)、葛根丹参(33g/kg+33 g/kg),给药0、10、20、30、45、60、90、120、240、360、480 min时取血,高效液相色谱法测定大鼠血浆中葛根素的血药浓度。色谱柱为Diamonsil C18(250 mm×4.6 mm,5μm),流动相为甲醇-水(25∶75,V/V),检测波长为250 nm,流速为1.0 ml/min,柱温为25Ⅸ,进样量为10μl。以WinNonlin软件分析药动学参数。结果:模型组大鼠眼组织视网膜细胞萎缩,脉络膜血管增生、扩张、充血,出现新生血芽,内皮细胞核数目增多,给药后上述病理状态均得到改善,其中葛根丹参组改善情况优于葛根组。葛根素质量浓度在0.1⁸.0 mg/ml范围内与其同内标峰面积比值呈良好线性关系,精密度试验RSD均小于3%,稳定性试验RSD均小于4%,回收率在86.02%8.0 mg/ml范围内与其同内标峰面积比值呈良好线性关系,精密度试验RSD均小于3%,稳定性试验RSD均小于4%,回收率在86.02%⁹0.28%。葛根组与葛根丹参组AUC分别为(156.49±32.62)、(462.27±119.86)mg·min/L,cmax分别为1.426 5、1.986 2 mg/ml,t1/2kα分别为(9.62±1.59)、(10.07±2.11)min。结论:丹参与葛根配伍,可明显促进葛根素的体内吸收、分布,减缓其消除,促进葛根素在血液中的富集且能改善模型大鼠眼组织病变。丹参对葛根改善模型大鼠糖尿病眼病具有较好协同增效作用。     

不可切除中晚期肝癌的转化治疗后肝切除术

多数肝癌起病隐匿,早期症状不明显,就诊时往往已属中晚期,预后不佳.转化治疗可使不可切除晚期肝癌病人获得手术治疗机会,并达到R0切除.在转化治疗后,对病人肿瘤、肝脏及其他器官细致全面的评估,将为安全肝切除的术前决策提供依据.转化治疗期间建议采用多学科综合治疗协作组模式定期评估转化治疗效果,并及时制定手术切除方案.     

TCT、阴道镜及病理组织学检查在宫颈病变中的临床分析

目的:以病理组织学检查作为金标准探讨TCT、阴道镜和病理组织学检查对宫颈病变的诊断价值。方法:2006年10月~2007年10月广州白云区妇幼保健院共有442例病人接受TCT技术行细胞学检查,再行阴道镜检查,并在阴道镜下取活检病理检查,以活检病理检查结果为诊断标准。结果:TCT检查的阳性病例42例,与组织学诊断的符合率为80%,该检测方法诊断子宫颈病变的敏感性为17%,特异性为93%,阳性预测值50%,阴道镜检查阳性病例121例,与组织学诊断的符合率为43%,该检测方法诊断子宫颈病变的敏感性为29%,特异性为65%,阳性预测值为43%。结论:①TCT检查敏感度和特异度较理想;阴道镜检查价格低廉,操作简单,二者效果明显优于任一单项检查。②TCT联合阴道镜检查的方法,比较适合经济状况较差的地区,可作为早期子宫颈癌及癌前病变的常规初筛方法。     

Evaluation of downstaging in the detection of cervical neoplasia in Kolkata,India

Unaided visual inspection or "downstaging" has been suggested as a potential alternative method for cervical cancer screening in developing countries. Our study was designed to evaluate the accuracy of downstaging to detect cervical neoplasia in a low-resource setting. A total of 6,399 women aged 30-64 years were screened with downstaging by trained nonmedical health workers. Two thresholds were used to define positive downstaging: "low threshold" when any visible abnormality on the cervix was considered positive and "high threshold" when selected abnormalities such as bleeding on touch, bleeding erosion, hypertrophied oedematous cervix, congested stippled cervix and growth or ulcer constituted the positive test. All women underwent a colposcopy examination. Biopsies were directed when colposcopy revealed abnormal lesions. True disease status was defined as histologically proven moderate dysplasia and worse lesions. Since all the participants received a diagnostic (reference) investigation (biopsy and/or colposcopy), sensitivity, specificity and predictive values were estimated directly. Low- and high-threshold downstaging were positive in 1,585 (24.8%) and 460 (7.2%) women, respectively. The sensitivities of low- and high-threshold downstaging to detect high-grade precursors and invasive cancers were 48.9% and 31.9%, respectively. The specificities were 75.8% and 93.3%, respectively. These results indicate that downstaging is not suitable as an independent primary screening modality for cervical neoplasia.     

An autofluorescence method for the diagnosis of early ischaemic myocardial lesions

Summary A systematic study of an autofluorescence method is described to improve the early histological diagnosis of myocardial ischaemia. Our results on 732 autopsy cases including 182 cases of sudden death show that the autofluorescence examination of haematoxylin and eosin stained sections of the myocardium is not only reliable in the identification of recent ischaemic lesions, but contributes to a better histological evaluation. In 24 cases undetected by white light examination it allowed recognition of ischaemic lesions.     

鸭肝炎病毒形态及接种鸡胚引起的病理变化观察

本文研究应用免疫电镜技术观察DHV形态,并对DHV接种鸡胚引起的病理变化进行观察。 DHV颗粒为球形,无囊膜,直径约为15～20毫微米。 将DHV接种10天龄鸡胚,接种后于一定的时间间隙,直至鸡胚死亡,取鸡胚的肝和脑分别制样,用光学显微镜和电子显微镜观察其病理变化。在光镜下,可见肝窦淋巴细胞浸润,肝细胞变性和坏死,肝脏充血出血,大脑脑软膜淋巴细胞浸润和大脑毛细血管充血。肝脏的电镜检查,可见肝细胞间隙有很多泡囊,肝细胞胞浆出现电子密度很高的颗粒状物和空泡,核固缩,最后,核膜皱曲和破裂,细胞膜裂开,细胞器减少或消失。脑的电镜观察,可见脑神经细胞的内质网扩张形成小圆泡,核膜皱曲和破裂。细胞膜也破裂,细胞器溢出。 在肝组织的狄斯隙中可见病毒样颗粒,在靠近细胞膜的胞浆中发现病毒样颗粒被包在由膜围成的泡囊中。