Nipple leiomyoma: A rare neoplasm with a broad spectrum of histologic appearances

Cutaneous leiomyomas are rare benign smooth‐muscle tumors. These lesions are distinguished based on their cell of origin and are subclassified as pilar leiomyoma, angioleiomyoma, and genital‐type leiomyoma. Nipple leiomyoma is the least common genital‐type leiomyoma, arising from the dartoic muscle cell of the nipple. Histologic examination of the lesion is necessary for definitive diagnosis, and these uncommon tumors can pose a diagnostic challenge. We describe herein a series of six nipple leiomyomas with a spectrum of histologic appearances.     

Animal Models of Barrett's Esophagus and Esophageal Adenocarcinoma–Past,Present, and Future

Esophageal adenocarcinoma is the fastest rising cancer in the United States. It develops from long‐standing gastroesophageal reflux disease which affects >20% of the general population. It carries a very poor prognosis with 5‐year survival <20%. The disease is known to sequentially progress from reflux esophagitis to a metaplastic precursor, Barrett''s esophagus and then onto dysplasia and esophageal adenocarcinoma. However, only few patients with reflux develop Barrett''s esophagus and only a minority of these turn malignant. The reason for this heterogeneity in clinical progression is unknown. To improve patient management, molecular changes which facilitate disease progression must be identified. Animal models can provide a comprehensive functional and anatomic platform for such a study. Rats and mice have been the most widely studied but disease homology with humans has been questioned. No animal model naturally simulates the inflammation to adenocarcinoma progression as in humans, with all models requiring surgical bypass or destruction of existing antireflux mechanisms. Valuable properties of individual models could be utilized to holistically evaluate disease progression. In this review paper, we critically examined the current animal models of Barrett''s esophagus, their differences and homologies with human disease and how they have shaped our current understanding of Barrett''s carcinogenesis.     

米非司酮联合宫瘤消胶囊对子宫肌瘤治疗效果

目的分析米非司酮和宫瘤消胶囊的联合应用对子宫肌瘤的临床治疗效果。方法本研究对象为80例子宫肌瘤患者,收治时间均在2017年3月—2018年3月期间。将上述子宫肌瘤患者随机分成两组,各40例。给予对照组患者口服米非司酮进行治疗,研究组患者在上述治疗的基础上增加宫瘤消胶囊口服治疗,记录2组患者治疗效果,性激素水平及子宫体积及肿瘤体积变化。结果(1)研究组患者的总体有效率显著高于对照组;(2)研究组患者的P、E2、LH及FSH均显著低于对照组;(3)研究组患者子宫体积及肿瘤体积均显著低于对照组。结论米非司酮片和宫瘤消胶囊的联合治疗对子宫肌瘤患者的治疗效果较显著。     

Effects of probiotics on gastrointestinal complications and nutritional status of postoperative patients with esophageal cancer: A protocol of randomized controlled trial

Background:Gastrointestinal complications and malnutrition are common problems that affect postoperative rehabilitation and survival of patients with esophageal cancer. Evidence has shown that probiotics have a positive effect on improving gastrointestinal complications and nutritional status of patients with esophageal cancer after surgery, but there is a lack of prospective studies on this topic. We designed this prospective randomized controlled trial to evaluate the effects of probiotics on gastrointestinal complications and nutritional status in patients with postoperative esophageal cancer.Methods:This is a prospective, randomized, double-blind, placebo-controlled trial. It was approved by the Clinical Research Ethics Committee of our hospital. 192 patients will be randomly divided into probiotics group and the placebo group in a 1:1 ratio. After operation, probiotics and placebo will be given orally for 8 weeks. The indexes of nutritional status and incidence of digestive tract complications will be recorded and the data will be analyzed by SPSS 18.0 software.Discussion:This study will evaluate the effect of probiotics on gastrointestinal complications and nutritional status of postoperative patients with esophageal cancer. The results of this study will provide clinical basis for the use of probiotics in postoperative treatment of esophageal cancer.Trial registration:OSF Registration number: D DOI 10.17605/OSF.IO/QHW86     

基于自动勾画和快速蒙特卡罗计算的放射治疗全身器官剂量数据库平台的可行性研究

目的:探讨建立一种放射治疗全身器官剂量数据库平台的可行性。方法:使用基于深度学习的自动勾画软件DeepViewer?1例食管癌患者的全身CT上勾画全身器官，然后利用基于GPU加速的蒙特卡罗软件ARCHER计算相应的器官剂量分布，最后利用Lyman-Kutcher-Burman（LKB）模型评估放疗患者正常组织并发症概率（NTCP）。结果:针对该病例，成功建立基于DeepViewer?ARCHER和LKB模型的全身器官剂量数据库，发现距离靶区越近的器官剂量越大，其中心脏与靶区间距离最小，剂量为14.11 Gy，但因其模型参数特殊，通过LKB模型计算的NTCP为0.00%；左、右肺的剂量分别为3.19和1.16 Gy，但是NTCP值却很大，分别为2.13%和1.60%。对于距离靶区较远的头颈部器官（视交叉、视神经和眼）和腹部器官（直肠、膀胱和股骨头）剂量分别约为9和2 mGy，并且NTCP均近似为0.00%。结论:研究结果证明通过自动勾画软件DeepViewer?蒙特卡罗软件ARCHER和LKB模型建立全身器官剂量数据库的可行性。     

电针复合TCI靶控输注在单肺通气食管癌开胸手术麻醉中的应用与安全性＊

目的 探讨电针复合靶控输注（Target Controlled Infusion， TCI）在单肺通气食管癌开胸手术麻醉中的应用价值。方法 选取于我院拟行单肺通气食管癌开胸切除手术患者60例作为研究对象。随机将其分为试验组与对照组，对照组30例采取气管插管全麻及TCI靶控输注维持麻醉深度，试验组30例则在对照组方案基础上辅助电针麻醉，记录两组患者手术麻醉时间、药物用量、苏醒时间、并发症；以及术前（T_Ⅰ）、插管前即刻（T_Ⅱ）、插管后1 min（T_Ⅲ）、切皮即刻（T_Ⅳ）、去骨时（T_Ⅴ）、拔管即刻（T_Ⅵ）时平均动脉压（MAP）、平均心率（HR）、BIS值；术前、术后1天、术后3天简易智能精神状态检查量表（MMSE）；并于麻醉诱导前（T₀）、手术开始2 h（T₁）、术后1天（T₂）、术后3天（T₃）时抽取患者外周静脉血检测IL-1β、IL-6、IL-10、TNF-α浓度。结果 试验组手术用时、麻醉时间略低于对照组，但差异无统计学意义（P>0.05），试验组异丙酚、舒芬太尼用量以及苏醒时间均明显低于对照组（P<0.05）；T_Ⅱ时两组平均动脉压（Mean Arterial Pressure， MAP）、心率（Heartrate， HR）较术前明显降低，且试验组MAP明显低于对照组（P<0.05），但两组T_Ⅱ时HR比较无显著差异（P>0.05）；T_Ⅲ、T_Ⅵ时对照组MAP、HR明显高于T_Ⅰ时，而试验组MAP、HR与T_Ⅰ比较无显著差异（P>0.05）。术后1天、3天试验组简易智能精神状态检查量表（Mini-Mental State Examination， MMSE）评分低于对照组，有显著性差异（P<0.05）。T₁、T₂、T₃时试验组白介素-1β（IL-1β）、白介素-6（IL-6）、肿瘤坏死因子（Tumor Necrosis Factor-α， TNF-α）水平明显低于对照组（P<0.05），白介素-10（IL-10）水平明显高于对照组（P<0.05）。结论 采用电针复合TCI靶控输注麻醉方案可有效提升单肺通气食管癌开胸手术麻醉效果，能够降低患者术后认知功能障碍发生风险。     

Anthropometric and reproductive factors and risk of esophageal and gastric cancer by subtype and subsite: Results from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort

Obesity has been associated with upper gastrointestinal cancers; however, there are limited prospective data on associations by subtype/subsite. Obesity can impact hormonal factors, which have been hypothesized to play a role in these cancers. We investigated anthropometric and reproductive factors in relation to esophageal and gastric cancer by subtype and subsite for 476,160 participants from the European Prospective Investigation into Cancer and Nutrition cohort. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox models. During a mean follow-up of 14 years, 220 esophageal adenocarcinomas (EA), 195 esophageal squamous cell carcinomas, 243 gastric cardia (GC) and 373 gastric noncardia (GNC) cancers were diagnosed. Body mass index (BMI) was associated with EA in men (BMI ≥30 vs. 18.5–25 kg/m²: HR = 1.94, 95% CI: 1.25–3.03) and women (HR = 2.66, 95% CI: 1.15–6.19); however, adjustment for waist-to-hip ratio (WHR) attenuated these associations. After mutual adjustment for BMI and HC, respectively, WHR and waist circumference (WC) were associated with EA in men (HR = 3.47, 95% CI: 1.99–6.06 for WHR >0.96 vs. <0.91; HR = 2.67, 95% CI: 1.52–4.72 for WC >98 vs. <90 cm) and women (HR = 4.40, 95% CI: 1.35–14.33 for WHR >0.82 vs. <0.76; HR = 5.67, 95% CI: 1.76–18.26 for WC >84 vs. <74 cm). WHR was also positively associated with GC in women, and WC was positively associated with GC in men. Inverse associations were observed between parity and EA (HR = 0.38, 95% CI: 0.14–0.99; >2 vs. 0) and age at first pregnancy and GNC (HR = 0.54, 95% CI: 0.32–0.91; >26 vs. <22 years); whereas bilateral ovariectomy was positively associated with GNC (HR = 1.87, 95% CI: 1.04–3.36). These findings support a role for hormonal pathways in upper gastrointestinal cancers.     

探讨绝经过渡期、育龄子宫肌瘤患者异常阴道出血相关因素分析

目的: 探讨育龄、绝经过渡期子宫肌瘤患者异常阴道出血危险因素，为异常阴道出血临床精准诊断、治疗提供理论依据。方法： 选取2017年06月—2020年06月于内蒙古医科大学附属医院住院行手术治疗的子宫肌瘤患者。实验组设为非月经期异常阴道出血的子宫肌瘤患者，对照组为无异常阴道流血子宫肌瘤患者。根据第9版教科书年龄18-43岁定为育龄组；44-54岁定为绝经过渡期组（我国妇女平均绝经年龄为49.5岁，80%在44-54岁之间〔1〕）。 应用Excel双录入，核对无误后进行统计分析。计数资料的比较用R×C列联表卡方检验、四格表卡方检验及两独立样本秩和检验。非条件Logistic回归模型用于子宫肌瘤阴道异常出血危险因素的分析，并分别得到OR值与相应95%的可信区间。在此模型中，OR值＞1认为是危险因素，OR值＜1认为是保护因素。统计学显著性水平设定为双侧p≤0.05，即认为差异有统计学意义。全部统计分析选用SPSS19.0软件进行统计学分析。结果：1.将与子宫肌瘤阴道异常出血相关的33项临床指标纳入单因素分析得出，月经周期异常、肌瘤位置（子宫颈肌瘤）、肌瘤直径≥9cm、血红蛋白异常、子宫内膜癌、核分裂像＞5个差异有统计学意义（P≤0.05），均是子宫肌瘤阴道异常出血的危险因素；2.子宫肌瘤异常阴道出血核分裂像＞5个与子宫内膜病理性改变和异常阴道出血差异有统计学意义（P=0.019）。结论：1. 子宫内膜发生病理改变是子宫肌瘤患者引起异常阴道出血的原因之一。2.月经周期异常、子宫颈肌瘤、肌瘤直径≥9cm、血红蛋白异常、子宫内膜病理改变均是子宫肌瘤阴道异常出血的危险因素；子宫肌瘤核分裂像＞5个是子宫平滑肌瘤出现异常阴道出血的独立高危因素；3.子宫肌瘤核分裂像＞5与阴道出血、子宫内膜病理改变有统计学意义。进行单因素分析后得知，月经周期、肌瘤位置、肌瘤大小、血红蛋白、子宫内膜病理变化均子宫肌瘤阴道异常出血的发生有关。 关键词育龄；绝经过渡期；子宫平滑肌瘤；异常阴道出血；危险因素     

扬州地区肝硬化食管静脉曲张初次出血80例患者诊治分析

目的探讨扬州地区肝硬化食管静脉曲张初次出血患者诊治特点。方法回顾性分析2010年1月-2013年12月苏北人民医院消化内科收治的80例肝硬化食管静脉曲张初次出血患者病例资料。计数资料用率或构成比表示,率的比较采用χ2检验。结果由乙型肝炎导致肝硬化所引起的食管静脉曲张破裂出血所占比例最大;三腔二囊管临床运用可最大限度地挽救患者生命,为后期治疗提供时间;基础治疗包括止血、输血、抑酸、补液等,后期以硬化剂、套扎、硬化剂+套扎、手术、经颈静脉肝内门体分流术(TIPS)为主,但套扎运用最为广泛;患者出血初期各项指标变化有利于指导临床治疗,对患者预后具有良好的评估作用。结论扬州地区肝硬化引起的食管静脉曲张破裂出血病因呈现复杂交叉性,治疗方法仍需进一步完善,以达到个体化治疗水平;及时正确的救治,对提高临床疗效、降低病死率有重要意义;早期的健康体检,对疾病诊治起关键性的作用。