目的 分析总结非哺乳期乳腺炎(Non-Lactation Mastitis,NLM)不同病理类型和乳腺超声影像报告与数据系统(Breast Imaging Reporting and Data System-Ultrasound,BI-RADS-US)分类偏差的原因,以加深超声医师对NLM诊断的认识,提高诊断的准确率.方法 回顾性分析本院经穿刺或手术证实为NLM的患者84例,记录病灶的BI-RADS分类、病理类型和超声分型,统计各组BI-RADS分类的准确度并进行对比分析.结果 84例患者的NLM病理类型为急慢性炎、化脓性炎、肉芽肿性小叶炎以及慢性炎;根据NLM的超声声像图特点,将NLM分为导管扩张型、结节型、弥散型.不同病理类型的NLM的BI-RADS分类的准确度分别为急慢性炎65.0％、化脓性炎100％、慢性炎61.1％、肉芽肿性小叶炎85.7％,不同组别间差异无统计学意义(P>0.05).不同超声分型的NLM的BI-RADS分类准确度为导管扩张型100％、结节型44.8％,弥散型90.9％,不同组别间差异有统计学意义(P<0.001).结论 NLM的不同病理类型和超声分型是造成BI-RADS分类偏差的主要原因,病灶内出现的弥散分布的有流动感的点状回声可能是NLM的特征性超声表现.

目的 探讨非小细胞肺癌(NSCLC)患者血清外泌体微小RNA-744-5p(miR-744-5p)、血清巨噬细胞抑制因子-1(MIC-1)水平与临床病理特征的关系及对预后的预测价值.方法 回顾性收集2018年1月至2019年12月唐山市人民医院收治的126例NSCLC患者为观察组,126例体检健康者为对照组.比较两组外周血外泌体miR-744-5p水平和血清MIC-1水平.随访3年,将126例NSCLC患者分为生存组(94例)和死亡组(32例),比较生存组与死亡组的miR-744-5p及MIC-1水平,采用受试者工作特征(ROC)曲线分析miR-744-5p及MIC-1水平在预测患者预后中的临床价值.根据ROC曲线分析的miR-744-5p水平截断值将观察组分为高表达组(miR-744-5p≥0.016,74例)与低表达组(miR-744-5p<0.016,52例),血清MIC-1水平截断值将观察组分为高表达组(MIC-1≥1013.21 pg/ml,48例)与低表达组(MIC-1<1013.21 pg/ml,78例),比较不同临床病理特征患者的miR-744-5p和MIC-1表达情况.用Logistic回归分析miR-744-5p低表达和MIC-1高表达的影响因素.结果 观察组的miR-744-5p水平低于对照组(0.013±0.008 vs.0.091±0.013),MIC-1水平高于对照组[(1247.59±120.42)pg/ml vs.(215.13±40.05)pg/ml],差异有统计学意义(P<0.001).生存组的miR-744-5p水平高于死亡组(0.018±0.004 vs.0.009±0.002),MIC-1水平低于对照组[(915.13±40.05)pg/ml vs.(1547.59±120.42)pg/ml],差异有统计学意义(P<0.001).ROC曲线结果 显示,当miR-744-5p的截断值为0.016时,其预测NSCLC患者预后的ROC曲线下面积AUC为0.875;当MIC-1截断值为1013.21 pg/ml时,其预测NSCLC患者预后的AUC为0.821(P<0.05).不同肿瘤大小、TNM分期、分化程度及淋巴结转移患者的miR-744-5p和MIC-1水平差异有统计学意义(P<0.05).Logistic回归分析结果 显示,肿瘤≥3 cm、有淋巴结转移及低分化是影响miR-744-5p低表达和MIC-1高表达的独立危险因素.结论 NSCLC患者miR-744-5p水平呈低表达,血清MIC-1水平呈高表达,二者均与患者病情程度存在一定联系,且在预测患者预后中具有一定临床价值.肿瘤≥3 cm、有淋巴结转移及低分化是影响miR-744-5p水平低表达和MIC-1水平高表达的独立危险因素.

目的 目前临床上对于胆管癌的临床预后指标较少,Wnt信号通路被认为在胆管癌中起到重要的驱动作用,但其具体分子与临床表型及患者预后关系依然亟待探索.本研究基于TCGA数据库,分析Wnt信号通路核心成员WNT11在胆管癌中的表达及其临床意义.方法 获取TCGA数据库中胆管癌mRNA表达和临床数据,分析WNT11基因在胆管癌的表达情况,探究其与临床病理参数、预后的关系,以及WNT11的共表达模式在胆管癌中的潜在功能.结果 在胆管癌患者中,WNT11表达的高低与患者年龄、性别、临床分期及肿瘤分级无关(P＞0.05),与肿瘤分化程度、淋巴结转移显著相关(P＜0.05).WNT11高表达组患者的总生存率显著低于WNT11低表达组(HR=3.53,P=0.0094).在胆管癌中高表达的VANGL2,与WNT11在WNT11高表达组呈共表达,而在WNT11低表达组则相反.结论 WNT11的表达水平与胆管癌的肿瘤分化程度、淋巴结转移事件和患者的总生存率相关,WNT11与VANGL2的共表达或是胆管癌的发生、发展及侵袭转移过程中的重要特征.

目的 探讨阻塞性睡眠呼吸暂停低通气综合征(OSA HS)患者外周血血管内皮生长因子(VEGF)、补体C1q/肿瘤坏死因子相关蛋白5(CTRP5)水平和中性粒细胞/淋巴细胞比值(NLR)的变化及其与病情严重程度的关系.方法 选取OSA HS患者84例,依据低通气指数将其分为轻度OSAHS组(33例)和中重度OS-AHS组(51例),另选取35例体检健康者作为对照组.比较3组血清VEGF、CTRP5水平及NLR,以及2组OSAHS患者经鼻持续气道正压通气治疗前后上述指标变化情况;采用Pearson相关分析NLR与血清VEGF、CTRP5的相关性.结果 轻度OSA HS组 、中重度OSAHS组血清VEGF、CTRP5水平及NLR高于对照组,且中重度OSA HS组高于轻度OSAHS组(均P<0.05).2组OSAHS患者治疗后血清VEGF、CTRP5水平及NLR均低于治疗前(均P<0.05).2组OSAHS患者NLR与血清VEGF、CTRP5呈正相关(r=0.373、0.409,P<0.05).结论 OSAHS患者血清VEGF、CTRP5水平及NLR均升高,临床可能通过检测OSAHS患者血清VEGF、CTRP5水平及NLR评估患者病情的严重程度,并预测治疗效果.

目的 探讨非哺乳期乳腺炎(NLM)不同病理类型的超声表现.方法 选取经临床诊断NLM患者67例,行乳腺超声检查,经穿刺或手术病理证实,对比分析不同病理类型的NLM的超声表现.结果 (1) 67例NLM病理主要类型为:急、慢性乳腺炎16例,慢性乳腺炎14例,化脓性乳腺炎3例,肉芽肿性小叶性乳腺炎34例.(2) NLM的超声表现为:①导管扩张型9例;②结节型23例;③弥散型35例.(3)急、慢性乳腺炎超声表现以结节型为主75.0％,化脓性乳腺炎超声表现均为弥散型,慢性乳腺炎超声表现为导管扩张型57.1％和结节型42.9％,肉芽肿性小叶性乳腺炎的超声表现以弥散型为主82.3％.结论 NLM的不同临床进展阶段可能对应于不同的病理类型,从而展现出不同的超声表现.

Objective:To analyze the expression and clinical significance of lymphoid enhancer factor-1 (LEF-1) and P53 protein in hilar cholangiocarcinoma.Methods:A total of 50 cases with hilarcholangiocarcinoma in the Tangshan People′s Hospital from March 2010 to December 2017 were retrospectively analyzed.P53 protein mutation was detected by immunohistochemistry.At the same time, the expression of LEF1 protein in cholangiocarcinoma and adjacent normal tissues was detected.The expression of LEF1 and its correlation with clinicopathological parameters were analyzed.At the same time, the relationship between p53 protein mutation and LEF1 protein expression and the prognosis of patients were discussed.Results:The positive expression rate of LEF1 in tumor tissues were 62.00%(31/50), which was higher than in adjacent tissues 36.00% (18/50). The difference was statistically significant (χ 2=6.763, P=0.016). There were 28 patients with TP53 protein mutation and 22 patients with wild type.The positive rate of LEF1 in TP53 mutant group was 75.00% (21/28), which was significantly higher than that in TP53 wild type group(45.45%, 10/22), and the difference was statistically significant(χ 2=4.565, P=0.03). The LEF1 expression was associated with tumor differentiation, TNM stage, lymph node metastasis and TP53 protein mutation (all P<0.05). LEF-1 expression was positively correlated with TP53 protein mutation ( r=0.294, P=0.04). The 1-year cumulative survival rate of patients with TP53 protein mutation was significantly lower than that of patients with TP53 protein wild type (60% vs.81%, P=0.0416). The 1-year cumulative survival rate of patients with LEF1 positive expression was also significantly lower than that of patients with negative expression (53% vs.82%, P=0.0180). Conclusion:LEF-1 is highly expressed in hilar cholangiocarcinoma, and patients with high expression have poor prognosis.The positive expression of LEF-1 in hilar cholangiocarcinoma patients with TP53 protein mutation was increased, and the prognosis of patients with TP53 protein mutation was poor.

目的:研究复方苦参注射液对原发性肝癌患者术后复发的预防作用及其生存时间函数分析.方法:选取本院2014年1月至2016年1月接受手术治疗的98例原发性肝癌患者,随机分为对照组与观察组,两组患者均在本院接受择期肝切除术,对照组患者于术后接受预防性肝动脉化疗栓塞术(TACE)治疗,观察组患者在对照组治疗基础上加用复方苦参注射液.术后3个月,对比两组患者临床疗效,并观察手术前后两组患者血清肿瘤标志物与免疫功能指标T细胞亚群的变化情况;随访不低于2年,统计两组患者6个月、1年、2年时的复发率,并以生存函数分析两组患者的无病情进展生存时间与总生存时间.结果:观察组患者临床控制率为95.92％,对照组为87.76％,观察组临床疗效较对照组理想(P＜0.05);治疗后两组患者IFN-γ、TNF-α、TAP、AFP水平均较本组术前改善(P＜0.05),且观察组患者各项指标水平均优于对照组(P＜0.05);术后,观察组患者NK细胞、CD4+、CD8+、CD4+/CD8+均较术前改善(P＜0.05),且均优于对照组同期,对照组患者CD4+与CD8+均较术前恶化P＜0.05,NK细胞与CD4+/CD8+与术前比较无差异(P＞0.05);观察组患者2年累积复发率为14.29％,对照组为32.65％,两者比较,(P＜0.05);观察组患者PFS与OS均长于对照组,(P＜0.05).结论:复方苦参注射液能有效降低原发性肝癌患者术后的复发率,改善患者免疫功能、进一步降低肿瘤标志物的表达水平,延长患者无病情进展生存时间与总生存时间.

目的:研究淋巴增强因子1 (lymphoid enhancer factor-1,LEF-1)及细胞周期蛋白D1 (cyclin D1,CCND1)在肝门部胆管癌(hilar cholangiocarcinoma,HC)中的表达及其临床意义.方法:应用免疫组织化学方法检测43例HC及对应癌旁正常组织中LEF-1及CCND1的表达,分析两者表达情况及其与临床病理参数的相关性.结果:LEF1在HC组织中的吸光度(OD)值为9 156±1 014,明显高于正常组织(2 132±906;P＜0.05);LEF1的表达与HC的肿瘤分化程度、TNM分期、淋巴结转移有关(均P＜0.05);CCND1在胆管癌组织中的OD值为11 204±9 075,明显高于正常组织(7 012±2 743;P＜0.05);CCND1的表达与HC的肿瘤分化程度、TNM分期、淋巴结转移有关(均P＜0.05);Spearman相关分析显示LEF-1与CCND1蛋白表达呈正相关(r=0.338,P=0.005).结论:LEF-1和CCND1在HC组织中高表达,LEF-1/CCND1信号通路可能在HC的发生发展中发挥重要作用.

患者女，33岁。因发现颈部肿物1年于2014年10月入院。查体：颈部增粗，双侧甲状腺Ⅱ°大，可触及多个大小不等结节，最大约2.0 cm ×1.0 cm ×1.0 cm，质中等，无压痛，随吞咽上下移动，未触及肿大淋巴结，未闻及异常血管杂音，双手颤征阴性。 CT显示：甲状腺肿大，右叶低密度影，符合占位性病变伴瘤体囊变，不除外恶性，请结合其他检查进一步诊断；两侧颈部多发肿大淋巴结。拟诊“甲状腺癌”行择期手术。送检部分组织行术中快速冷冻检查。

Objective To study the inhibition effects of chitosan-gelatin membrane on fibrous capsule of the expanded flap. Methods 60 Wistar rats were used to establish models of the expanded flap, gelatin- chitosan membrane was implanted, water was regularly injected.The fibrous capsule on the same part of the dilator was cut and made into pathological section. Capillary and collagen content of the fibrous capsule was measured. Results The fibrous capsule was mainly composed of collagen fibers and inflammatory cell infiltration and a small amount of capillary under the light microscope. The surface density in the experimental group at 6th weeks and 12th weeks was 0.22±0.08 and 0.27±0.05,respectively,which was lower than in the control group(0.37±0.07 and 0.34±0.07), showing statistically significant difference(P 0.05). Capillaries surface density(0.13±0.18)in the experimental group was lower than the control group(0.15±0.23)after 6th weeks, the difference was statistically significant(P 0.05); no statistical significant difference in capillary surface density(P 0.05)was observed between two groups at 12th weeks(t=1.98,P 0.05). Conclusions Gelatin-chitosan membrane can intervene the fiber capsule formation and reduced the collagen content in the membrane, and has inhibitory effect to the fiber coated but doesn't affect the flap nutrition.

<正>胸腔积液在临床上很常见,其中,恶性胸腔积液发生率约20%~30%[1]。恶性胸腔积液的发生率高,死亡率高,明确诊断后中位生存期仅4~9个月[2]。胸膜穿刺活检是目前临床公认的检测胸腔积液的金标准,其特异性高,但是具有创伤性,操作上也较繁琐,因此,临床上需寻求更简便、快速的方法进行检测,同时具有较高的特异性和敏感性,以减轻患者的痛

Objective: To evaluate the performance of image fusion technology in location of sentinel lymph nodes(SLN) in breast cancer.Methods: The information of 110 patients with breast cancer about99mTc-Sulfur colloid imaging was analyzed retrospectively.Results: The detection rate of plane scan mode was 88.2%(97 /110),and tomography 93.6%(103 /110).The former can't locate the SLN accurately,the latter can not only show the number and accurate position of SLN,but also provide 3D information.Conclusion: The application of imaging fusion technology can increase the positive detection rate of SLN,and provide accurate 3D positioning information.

<正>患者男性,73岁。因右腰部偶有不适,查体发现右肾占位入院。CT检查示右侧肾脏存在实性占位性病变,恶性肿瘤可能性大。专科检查无明显阳性体征。彩超示右肾体积增大,肾上极可见一8.4 cm×7.5 cm×7.3 cm大小的低等回声占位,边界尚清,占位可见血流信号;左肾大小正常,实质回声均匀,皮髓质界限清晰。术中见右肾增大,于肾上极见一肿物,直径约8 cm,手术切除右肾送病理检查。

目的探讨早期乳腺癌肿物切检术后前哨淋巴结活检(SLNB)的可行性、准确性及临床应用价值。方法采用锝-99m硫胶体(99mTc-SC)联合美蓝对26例T1～2N0M0乳腺癌患者进行SLNB,探讨联合示踪法SLNB在肿物切检术后早期乳腺癌中的临床应用价值。结果本组26例中共有9例SLN病理检测阳性并行腋窝淋巴结清扫(ALND),其中4例2种方法确定的前哨淋巴结不一致,1例术前显影失败,其余4例阳性及17例阴性病例两种方法确定的前哨淋巴结一致。联合示踪法灵敏度为88.9%,准确性为96.2%,假阴性率为11.1%,假阳性率为零。结论 99mTc-SC联合美蓝明显提高早期乳腺癌局部切检术后SLNB的成功率。