临床病理学是一门重要的医学桥梁课程.为了提高临床病理学教学质量,文章探讨了线上与线下相结合的创新BOP-PPS教学模式在临床病理学理论教学中的效果,选择首都医科大学临床医学专业2017级定向班学生共34人为研究对象,其中神经系统病理章节采用创新BOPPPS教学法,其余章节采用传统教学法,并通过期末成绩及问卷调查的形式对两种教学法进行研究和比较,评价创新BOPPPS教学与传统教学的教学效果差异.结果显示,采用创新BOPPPS教学的课程理论考试成绩明显优于传统教学的课程考试成绩(P<0.05),且学生普遍认可创新BOPPPS教学.这提示创新BOPPPS教学模式可提升临床病理学的教学质量,培养学生自主学习能力,提高学生分析和解决问题的能力.

目的:探讨住院老年患者营养状况与体成分变化的关系.方法:收集北京市石景山医院老年医学科2020年9月—2021年2月收住院的老年患者共227例,使用简易营养评估(MNA-SF)进行营养评估,使用InbodyS10体成分分析仪进行人体成分检测.根据营养评估结果将入选患者分为两组,分别为营养正常组(n=75)、营养不良风险及营养不良组(n=152),对比两组的体成分相关参数.结果:入组患者227例,其中男性93例,女性134例.通过统计分析发现,营养不良风险及营养不良组的年龄大于营养正常组,差异显著(P ＜

Objective: To investigate the effect of sarcopenia on disability and quality of life in elderly patients with stable chronic obstructive pulmonary disease (COPD). Methods: 80 elderly patients with stable COPD admitted to the Department of Geriatrics in Shijingshan Hospital of Beijing, from July 2020 to May 2022 were selected for the study. The quantity of muscle was determined by bioelectrical impedance method, and the observation group (n=30) was combined with sarcopenia, and the control group (n=50) was not combined with sarcopenia. The baseline characteristics and severity of COPD, risk of disability, whether they were disabled, and quality of life were assessed in both groups. Results: The percentage of forced expiratory volume in the first second in the observation group was lower than that in the control group, and the grade of modified dyspnea questionnaire was higher than that in the control group, and the difference was statistically significant (P＜0.05). The scores of Simplified Physical Function Scale and Aged Disability Assessment Scale in observation group were lower than those in control group, and the scores of Quality of Life Scale in patients with chronic obstructive pulmonary disease were higher than those in control group, and the differences were statistically significant (P＜0.05). Conclusion: The occurrence of sarcopenia in COPD patients may increase the risk of disability and aggravate the degree of disability, making patients'' quality of life decrease. Targeted interventions are needed to prevent disability and improve the quality of life in elderly stable COPD patients.

目的 探讨具有梭形细胞特征的高级别乳腺肿瘤的临床病理特征、组织学特征、免疫表型、诊断及鉴别诊断.方法 应用光学显微镜观察、免疫组化染色对4例高级别梭形细胞乳腺原发性肿瘤(血管肉瘤、梭形细胞化生性癌、恶性叶状肿瘤、混合性化生性癌)进行临床病理学分析.结果 乳腺高级别梭形细胞肿瘤可能来源于乳腺上皮细胞,也可能来源于间叶细胞;可能是乳腺原发性肿瘤,也可能是转移性肿瘤.不同来源的肿瘤在形态上都可以表现为高核级梭形细胞,需要仔细观察组织形态,寻找诊断线索;同时,需结合免疫表型进行分析,以避免错误诊断.结论 不同类型的乳腺高级别梭形细胞肿瘤,临床治疗方法 不同,正确诊断十分重要.仔细观察组织形态并结合免疫表型分析是正确诊断的前提.

目的:分析老年危重症患者实施肠内联合肠外营养治疗的临床价值.方法:回顾性分析北京市石景山医院老年科2019年10月—2020年10月收治的48例危重症患者的基础资料,随机分为研究组和对照组,各24例.研究组患者给予肠内联合肠外营养治疗,对照组患者给予肠外营养治疗,观察两组患者的营养指标(白蛋白、血红蛋白、前白蛋白)、并发症发生率.结果:治疗前,研究组与对照组营养相关指标比较差异无统计学意义(P>0.05),治疗后,研究组白蛋白、血红蛋白以及前白蛋白指标高于对照组,治疗效果优于对照组,差异均有统计学意义(P<0.05);研究组并发症发生率低于对照组,差异有统计学意义(P<0.05).结论:老年危重症患者临床治疗过程中肠内联合肠外营养治疗优于单纯肠外营养治疗,可更好改善患者营养状态以及相关营养指标.

目的 探讨全自动细胞DNA定量分析、细胞病理学检查及两法联合在良恶性浆膜腔积液中的诊断价值.方法 回顾性收集230例浆膜腔积液患者的积液标本的细胞病理学检查结果及全自动细胞DNA定量分析结果,以活检病理结果结合临床最终诊断为"金标准",统计两种方法单独及两法联合在良恶性浆膜腔积液诊断中的符合率.结果 全自动细胞DNA定量分析技术诊断恶性浆膜腔积液的灵敏度略高于细胞病理学检查(73.5％vs.72.3％),特异度低于细胞病理学检查(89.8％vs.96.6％).两法联合诊断恶性浆膜腔积液的约登指数和受试者工作特征曲线(ROC曲线)的曲线下面积均高于单一细胞病理学检查(约登指数为0.733 vs.0.689,ROC曲线下面积为0.892 vs.0.853,P<0.001)或全自动细胞DNA定量分析(约登指数为0.733 vs.0.633,ROC曲线下面积为0.892 vs.0.832,P<0.001),差异均有统计学意义.结论 全自动细胞DNA定量分析技术联合传统的细胞病理学检查可明显提高恶性浆膜腔积液的检出率.

Objective: This study investigated the efficacy and safety of a combination of lenalidomide, bortezomib, and dexametha-sone (RVD) in patients with newly diagnosed multiple myeloma (NDMM). Methods: The clinical features and responses of 48 patients with NDMM who were treated with RVD from January 2015 to May 2019 in Beijing Chaoyang Hospital were retrospectively analyzed. Results: The median age of the 48 patients was 59 years (range: 34-79). Among these, 44 patients were Durie-Salmon stageⅢ, 15 were ISS stageⅡ, 19 were ISS stageⅢ, and 12 had plasmacytoma; 32.5% of all patients were cytogenetic high-risk. All patients re-ceived a median of four cycles (range: 1-9) of the RVD regimen as induction treatment. The overall response rate was 97.9%, with 35.4% of patients achieving complete response (CR) or better. The rate of very good partial remission (VGPR) or better was increased from 64.1% (after two cycles) to 84.6% (after four cycles). The mean collection of CD34+cells was 4.2 (± 2.6)×106/kg. Negative minimal residual disease (MRD), as indicated by next-generation flow (NGF), was achieved in 20.6% of patients after induction. Two patients with positive MRD after induction became MRD negative after transplantation. Two patients developed grade 3 or 4 hematologic toxic-ity. No nonhematologic toxicity of grade 3 or 4 was observed. Conclusions: In patients with NDMM, RVD treatment resulted in signifi-cantly improved response rates and exhibited an acceptable risk-benefit profile, with no adverse impact on stem cell collection. RVD combined with transplantation significantly improved the negative rate of MRD, as indicated by NGF.

目的 探讨浆细胞骨髓瘤(PC M)的临床病理特征、免疫表型、诊断及鉴别诊断.方法 回顾性分析10例PCM患者临床病理资料、组织学形态及免疫表型.结果 PCM患者常因贫血、骨痛、乏力等原因就诊,骨髓穿刺活检是诊断PCM的重要方法.肿瘤性浆细胞在骨髓中的分布可呈间质型、结节型或塞实型3种模式.根据细胞形态将PC M分为高、中、低分化3种类型.结论 PCM临床症状复杂多样,当患者出现贫血、骨痛、乏力等症状时应注意排查PCM,而骨髓穿刺活检并结合免疫组织化学检查是诊断PCM必不可少的手段.

Objective To investigate the clinicopathological characteristics, diagnosis and differential diagnosis of ovarian seromucinousborderline tumors (OSMBT), and review the related literature. Methods From 2005 to 2017, a total of 4 patients with OSMBT who underwent surgery at Beijing Shijingshan Hospital were selected as research subjects. The clinical data of the patients were collected by retrospective analysis method and the clinicopathological features, diagnosis of the patients were summarized. With the following keywords of ovarian seromucinous and borderline both in Chinese and English, literature related to OSMBT were searched from Wanfang Data Knowledge Service Platform, China National Knowledge Infrastructure database and PubMed database, and literature retrieval time was set from January 1 of 2010 to January 31 of 2019. Clinicopathological features and diagnosis of OSMBT in searched literature were summarized. This study was in line with the requirement of World Medical Association of Helsinki revised in 2013. Results ①The results of 4 patients with OSMBT in this study were as follows. General clinical data: the patients′ age were from 29 to 65 years old, with a median age of 40 years old. The major clinical manifestations included abdominal pain and masses in pelvic cavity. The stages of International Federation of Gynecology and Obstetrics (FIGO) of 4 patients all were stage Ⅰ. Surgical methods: patient 1 and 2 underwent ovarian cystectomy, and patient 3 and 4 underwent hysterectomy and bilateral salpingo-oophorectomy. Appearance observation of surgically removed specimens: the tumors of 4 patients ranged in diameter from 0.9-10.0 cm, and the average diameter of these tumors was 4.4 cm. Patient 2 was bilateral OSMBT. The masses of tumors were described as unilocular cyst with papillary architecture in patient 1 to 3, and as solid in patient 4. Histopathological results of surgically removed specimens: the OSMBT tissues showed complex branched papillary architecture, without stromal invasion. Significant neutrophil infiltration was observed in the tumor epithelium, stroma of papillary architecture and glandular lumen of tumor gland. The lining epithelium was stratified and composed mostly of endocervical-type mucous, serous epithelium and hobnail cells with eosinophilic cytoplasm, and the nuclei were mild and moderately heterogeneous, and karyokinesis was rare. Patient 2 with bilateral OSMBT was combined with endometriosis. Immunohistochemisty results of surgically removed specimens: the immunophenotype of these tumor tissues exhibited CK7+ /PAX8+ /CK20-/CDX2-. Follow-up results: none OSMBT recurrence or metastasis was found in 15 to 156 months (average of 78.8 months) follow-up of all the 4 patients. ②The results of literature review were as follows. A total of 9 literature related with OSMBT were retrieved, involving 86 cases of OSMBT patients. The main clinical manifestations of them were abdominal distension, abdominal pain, abdominal discomfort, and so on. The median age of them was 49 years old. The average diameter of these tumors was 7.9 cm. Among them, 13 cases (19.1%, 13/68) were bilateral OSMBT, 30 cases (34.9%, 30/86) were accompanied with endometriosis, and 62 cases (91.2%, 62/86) were FIGO Ⅰstage. The average follow-up time was 35.9 months among 66 patients in 8 pieces of literature and the recurrence rate of OSMBT was 6.1% (4/66). Conclusions OSMBT is a kind of rare ovarian neoplasm and mainly associated with endometriosis. Most OSMBT patients are young. Histopathological detection results as well as immunohistochemical marker may help in pathologic diagnosis of OSMBT. Attention should be paid to the differential diagnosis from ovarian borderline serous, mucinous tumor and carcinoma before final diagnosis. Most patients with OSMBT are FIGO Ⅰ stage and have a good prognosis. Unilateral oophorectomy and follow-up closely could be a valid proposal in young patients who wish to preserve their fertility. Key words: Ovarian neoplasms; Seromucinous tumor; Borderline tumor; Endometriosis; Mixed tumor, Mullerian; Diagnosis, differential; Female

目的 探讨细胞学、DN A倍体分析及细胞蜡块在胸腹腔积液病理诊断中的应用价值.方法 收集该院2015年9月至2017年3月送检查找瘤细胞的胸腹腔积液标本206例,进行离心涂片、细胞D N A倍体分析、细胞蜡块切片H E染色及相关免疫细胞化学染色.结果 恶性胸腹腔积液45例,其中,细胞涂片找到瘤细胞25例(55.56％);D N A倍体异常细胞阳性37例(82.22％);离心沉渣包埋细胞蜡块切片40例,细胞多而集中,细胞形态清楚并具有一定的组织结构,背景清晰,能较好地满足诊断.30例进一步行免疫细胞化学染色,均能明确肿瘤细胞来源.结论 常规细胞涂片结合DN A倍体分析及细胞蜡块技术可有效提高肿瘤细胞的检出率,免疫细胞化学染色在胸腹腔积液细胞病理诊断、鉴别诊断及确定肿瘤细胞来源方面具有重要价值.

Background: Hepatectomy and additional common bile duct exploration are required for the treatment of left-sided hepatolithiasis (LSH). Methods: Eligible LSH patients (n=62) scheduled for open left lateral segmentectomy or left hemihepatectomy with intraoperative biliary exploration via the left hepatic duct orifice (LHD group, n=35) or the common bile duct (CBD group, n=27) were retrospectively studied. T-tube insertion was performed on selected patients. Primary outcome measures included overall operative time, length of hospital stay, intraoperative complications, residual stones, and postoperative bile leaks. Results: There were no residual stones observed in the 2 groups. Ten patients in the CBD group received T-tube placement, whereas no patients in the LHD group received T-tube placement. There were more patients in the CBD group suffered intraoperative complications and postoperative bile leakage than LHD group (P<.05). The LHD group had a significantly shorter operative time and hospitalization than the CBD group (P<.05). Conclusion: For left-sided hepatolithiasis patients with a history of biliary tract surgery, LHD cholangioscopy is an accessible technique that simplifies the operation procedure by avoiding choledochotomy and subsequent T-tube insertion, which results in lower complication rates as well as shorter operative duration and length of hospitalization.

BACKGROUND:Gastric gastrointestinal stromal tumor (GIST), intro-abdominal and retroperitoneal neoplasms are distinct tumors arising from different cell layers; therefore, coexistence of such tumors is relatively rare.CASE PRESENTATION:A man complained of early satiety for 2 mouths, whose upper gastrointestinal (GI) endoscopy showed a tumor arising from the greater curvature of gastric body and extending into the lumen. Abdominal computed tomography (CT) revealed coexistence of gastric, intro-abdominal and retroperitoneal masses. Wedge resection for gastric tumor, resection for intro-abdominal and retroperitoneal tumors were done. The postoperative histological examination suggested simultaneous development of a gastric GIST, intro-abdominal and retroperitoneal myxoid liposarcomas.CONCLUSION:Although both GISTs and liposarcomas originate from mesenchymal tissues, simultaneous development of a gastric GIST, intro-abdominal and retroperitoneal liposarcomas is the first such case to be reported in the literature.

BACKGROUND:Hepatocellular carcinoma (HCC) is one of the main causes of cancer-related death. This study aims to explore the role and underlying mechanism of H19 in HCC.METHODS:qRT-PCR detected miR-15b-5p and H19 expression, as well as the mRNA level of EMT-associated genes. Western blotting detected protein level of EMT-associated genes. Immunohistochemistry (IHC) examined CDC42 in HCC tissues. Dual luciferase reporter assay verified the regulatory mechanism among H19, miR-15b and CDC42. Colony formation, wound healing assay, transwell, flow cytometry measured proliferation, migration, invasion and apoptosis, respectively.RESULTS:H19 and CDC42 were up-regulated while miR-15b was down-regulated in HCC cells and tissues. miR-15b interacted with H19 and CDC42 3'-UTR. H19 knockdown inhibited proliferation, migration and invasion, and increased apoptosis, which was rescued by miR-15b inhibitor. H19 knockdown suppressed CDC42/PAK1 pathway and EMT progress.CONCLUSION:H19 knockdown inhibited proliferation, migration and invasion, and promoted apoptosis of HCC cells via targeting miR-15b/CDC42/PAK1 axis.

Introduction Gastrointestinal stromal tumors (GISTs) are infrequently reported to cause gastroduodenal intussusception, especially in the cases with complete pylorus obstruction. GISTs comprise only 1 - 3 % of all gastrointestinal tract tumors, and most of them strongly express the c-KIT protein. Approximately 5 % of GISTs show negative staining of c-KIT. Case presentation A 69-year-old man complained of acute abdominal pain accompanied with nausea and vomiting for 6 hours. Emergency endoscopic examination, upper gastroenterography, and computed tomography scan suggested gastroduodenal intussusception and pylorus obstruction induced by a gastric GIST. Laparoscopic exploration and wedge resection of the tumor were performed in the patient. Postoperative histological examination showed a gastric GIST with c-KIT-negative expression. Conclusion Herein, we report the unique findings of a c-KITnegative gastric GIST presenting with gastroduodenal intussusception and pylorus obstruction. We also reviewed the English language literature of gastroduodenal intussusception induced by GISTs and put our case in the context of the previously reported cases.

目的:探讨单纯性乳腺大汗腺癌(apocrine carcinoma,AC)及癌前病变的临床病理特点、免疫表型及预后特征.方法:收集2004至2014年10例单纯的乳腺AC患者的临床资料及随访资料,进行病理组织形态学观察和免疫组织化学染色,并复习相关文献.结果:10例患者平均年龄60.5岁,其中大汗腺型导管原位癌(apocrine ductal carcinoma in situ,ADCIS)3例,ADCIS伴浸润性大汗腺癌(invasive apocrine carcinoma,IAC)5例,大汗腺型包裹性乳头状癌1例,大汗腺型包裹性乳头状癌伴IAC 1例.镜下癌细胞均为高核级,细胞大,界清,胞质丰富,嗜酸或透明,颗粒状,核增大,核仁大而突出.10例均呈雌激素受体(estrogen receptor,ER),孕激素受体(progesterone receptor,PR)阴性和雄激素受体(androgen receptor,AR)阳性表达,9例囊泡病液体蛋白15(gross cystic disease fluid protein 15,GCDFP-15)弥漫阳性,4例人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)阳性.10例癌旁均可见大汗腺病变谱系化发展过程的不同阶段病变.9例患者随访12～46个月,均存活,无复发和转移.结论:单纯的乳腺AC罕见,细胞形态及免疫表型具有诊断意义,多合并其他良性和不典型大汗腺病变.预后可能相对较好,有待进一步证实.

随着人口老龄化加剧，老年人群健康问题受到广泛关注，骨骼肌减少症（肌少症）是与年龄相关的骨骼肌质量及力量降低，以机体活动功能下降引起相关跌倒、残疾等不良事件为特征的疾病。肌少症在老年人群发病率为10％～20％，随着年龄增长，发病率增高，是目前全球老年医学界研究的热点，本文对肌少症的国内外研究现状进行综述。

Background Choledocholithiasis can be managed by transcystic (TC) and transduct (TD) stone extraction or using cholangioscopy through the left hepatic duct orifice (LHD). Objective The aim of this study is to evaluate the safety and effectiveness of common bile duct exploration through the TC approach, TD approach, and LHD approach for choledocholithiasis, with a specific emphasis on the TC and LHD approaches versus the TD approach. Methods Between January 2011 and June 2014, a total of 172 choledocholithiasis patients accompanied by cholecystitis and/or left intrahepatic gallstones were scheduled for laparoscopic or open common bile duct (CBD) exploration using cholangioscopy through the CBD (TD group: n = 72), cystic duct (TC group: n = 63), or LHD orifice (LHD group: n = 37). T-tube insertion was performed in selected patients. Patients were regularly followed up at bimonthly intervals or more frequently in presence of any symptom. Primary outcomes measures included overall operative time, length of hospital stay, and postoperative bile leaks. Results Successful bile duct clearance was 100 % in the TD group, 93.6 % in the TC group, and 90.9 % in the LHD group. Sixteen cases in the TD group had T-tube placement in contrast to no cases in the TC and LHD groups. There were more bile leaks after TD stone extraction (12.5 %) than TC (3.2 %) and LHD stone extraction (0 %), which prolonged hospitalization in the TD group more than in the TC and LHD groups. For choledocholithiasis patients accompanied by cholecystitis, 2 groups (TC and TD groups) were comparable in operative time. However, for choledocholithiasis patients accompanied by left intrahepatic gallstones, the LHD group had a significantly shorter operative time than the TD group (121.1 +/- 16.9 minutes vs. 149.3 +/- 42.8 minutes, p < 0.05). Conclusion The TD group had a higher stone clearance rate but was associated with a higher risk of bile leaks. TC and LHD stone extraction, which seems to be the more effective approach with lower complication rates, is an accessible technique that simplifies the operation procedure by avoiding choledochotomy and subsequent T-tube insertion.

目的:研究综合护理干预对心脏手术后患者疼痛的影响.方法:选取2015年7月-2016年5月我院收治的140例心脏手术患者予以分组研究,按照抽签法将其分为参照组和观察组两组,各组均为70例患者,两组围手术期分别给予常规护理和综合护理干预,分析并比较两组术后心理状态、疼痛情况和住院时间.结果:术后24h两组VAS评分无明显差异(P>0.05);术后48h、72h的BVAS评分比较,观察组则显著低于参照组,组间差异明显(P<0.05);两组住院时间比较,参照组长于观察组(P<0.05);观察组术后焦虑、抑郁评分与参照组比较,差异存在统计学意义(P<0.05).结论:对心脏手术患者进行综合护理干预可显著减轻术后疼痛,缩短住院时间,具有积极的临床选择和推广价值.

Computed tomography (CT) scan of a patient showed a 20*15*12 cm retroperitoneal tumor with left inguinal lymph node metastasis. A surgical operation was performed to remove the tumor and metastatic lymph nodes. Postoperative histological examination showed a retroperitoneal GIST with inguinal lymph node metastasis. The patient started to take imatinib 400 mg/d. There were no signs of tumor recurrence at a follow-up period for 15 months.