原发性肝癌临床分期的对比探讨

原发性肝癌严重威胁着人类的健康,全球每年新增的病例数约为50万,其中54％发生在我国,且患者在3年内复发率高于60％,可见诊治形势十分严峻。肝癌的临床分期系统对于患者的预后评估以及选择何种治疗方案有着极其重要的意义。国内外虽有此类研究的相关内容,但将各种分期的评价及适用范围、发展趋势相结合进行分析的较少。本文对国际上多种常用的分期方案（TNM分期、Child-Pu曲分期、Okuda分期、CLIP评分、JIS分期、CUPI指标、CIS记分）进行探讨,论述各种方案间的差异及相互关系,并对未来可能发展方向进行展望。经本文分析多项研究发现：TNM分期更适用于外科病人,Child—Pugh对肝功能受损的患者具有较好的预后价值,而Okuda、CLIP、JIs分期适用于不适合手术治疗的进展期病人,CUPI指数则对慢性乙肝患者有疗效,CIS适用于非手术治疗的患者。随着肿瘤分子生物学技术的进步,肝癌分期有可能上升到分子病理学的水平,肝癌切除的根治程度将划分得更为细致,以反映患者肝癌切除后所处状态的多种可能性,分子指标也将更加客观、敏感,有利于患者早期的诊断与治疗。     

64层螺旋CT增强扫描对结直肠癌术前T分期的临床应用价值

目的:探讨64层螺旋CT增强扫描检查对结直肠癌术前T分期的临床应用价值。方法:对2012年3月~10月在我院行64层螺旋CT增强扫描,术后病理证实为结直肠癌的173例患者的CT成像结果进行回顾性分析。将CT分期的结果与术后病理分期结果进行一致性比较分析,并对肿瘤长度、CT值、病理分型等进行相关分析及比较。结果:CT术前T分期:T1-2期、T3期、T4期的灵敏度分别为60.90%(14/23)、89.92%(116/129)、95.24%(20/21),特异度为95.33%(143/150)、77.27%(34/44)、96.05%(146/152),准确率为66.67%(14/21)、92.01%(116/126)、76.92%(20/26),诊断一致性检验结果 Kappa=0.685,P=0.000,P0.05,有统计意义。不同病理分期中肿瘤长度及不同病理分型中肿瘤CT值方差分析结果,P0.05,有统计意义。不同病理分期中CT值方差分析结果,P0.05,没有统计意义。病理分期与病理分型的X2检验结果,P0.05,有统计意义。对T1-2过分期和T3低分期两组病例进一步分析,发现增强扫描后强化程度、管壁僵硬和浆膜不光整有助于鉴别T1-2过分期和T3期低分期,能够提高T1-2期和T3期的准确性。结论:64层螺旋CT增强扫描多种征象的相互结合有助于提高结直肠癌术前分期的准确性,对临床诊治有重要价值。     

Tracheal cancer: Role of radiation therapy

Purpose

To assess the results of tracheal cancer patients treatment and factors influencing prognosis.

Background

Primary malignant neoplasms of the trachea are rare. The treatment of choice for tracheal carcinomas is resection. Radiation therapy is recommended as a part of radical treatment or for palliation of symptoms.

Materials and methods

Between 1962 and 2006, 50 patients diagnosed with tracheal cancer were treated at the Centre of Oncology in Krakow. The analysis focused on locoregional recurrence-free survival (LRRFS), disease free survival (DFS) and overall survival (OS). Survival rates, univariate and multivariate analyses of prognostic factors were performed using the Kaplan–Meier method, the log rank test and Cox''s proportional hazard method, respectively.For over 40 years, patients were treated using different modalities: surgery followed by radiotherapy (6%), radiotherapy (78%), chemoradiotherapy (8%), and symptomatic treatment (8%).

Results

The 5-year LRRFS was 18%, DFS was 15% and OS was 17%. gender (favoured females) was the only prognostic factor for LRRFS. For OS, the independent prognostic factors were performance status (favoured Karnofsky higher than 80), stage and year of start of the treatment (later than 1988 vs. earlier – 5-year OS 20% vs. 12%).5-year OS in the following (strongly differentiated over the time) treatment modalities were: surgery followed by radiotherapy (66%), radiotherapy (16%), chemoradiotherapy (0%), and symptomatic treatment (0%).Of 44 patients treated with radiotherapy symptomatic partial response was observed in 32 patients and follow-up imaging studies revealed complete response in 5 patients, partial response in 25, stable disease in 4 or progressive disease in 4.

Conclusions

Radical treatment in patients in early stage and good performance status seems to be correlated with the improvement of survival. However, despite the fact that results of treatment are poor, radiotherapy offers symptomatic improvement.     

Evaluation of Staging Systems for Colorectal Cancer

An alternative way to implement the Akaike Information Criterion (AIC) is proposed for the evaluation of staging systems for colorectal cancer.     

一期外固定联合锁定钢板内固定术治疗C型pilon骨折的临床疗效

目的：探讨外固定架联合锁定钢板分期治疗C 型pilon 骨折的临床疗效。方法：选取2010 年3 月至2011 年4 月在我院接受治疗的C型pilon 骨折患者17 例。按照分期治疗的原则,先行一期外固定架固定术,待局部软组织恢复后切开复位,再行锁定钢板内固定术进行治疗,术后对患者进行一年的随访,定期检查患者的踝关节功能,并借助影像学资料对临床疗效进行评价。结果：全部患者获得随访,平均愈合时间为（4.1± 1.6）月;平均AOFAS 评分为（83.1± 12.4）分,其中优6 例（35.2 %）,良8 例（47.1 %）,一般2 例（11.8 %）,差1 例（5.9 % ）,优良率为82.4 %;术后4 例患者出现出现轻度感染,通过局部换药、抗生素和钉道护理得到控制。结论：采用一期外固定联合锁定钢板内固定术分期治疗C 型pilon 骨折,可以有效地提高治疗效果,值得临床推广。     

3.0 T高分辨磁共振在直肠癌术前T N分期、环周切缘有无累及淋巴结转移的评估价值

摘要 目的：研究3.0 T高分辨磁共振（MRI）在直肠癌术前T N分期、环周切缘有无累及淋巴结转移的评估价值。方法：将我院从2018年1月～2019年12月收治的直肠癌患者120例纳入研究。所有患者均接受3.0 T高分辨MRI检查,以术后病理结果为金标准,分析其对术前T N分期、环周切缘有无累及淋巴结转移的评估价值。结果：直肠癌术前3.0 T高分辨MRI T分期与病理结果一致性较高,检验结果显示Kappa值=0.543,P值=0.000。直肠癌术前3.0 T高分辨MRI N分期与病理结果一致性较高,检验结果显示Kappa值=0.519,P值=0.000。以术后病理结果为金标准,直肠癌术前3.0 T高分辨MRI诊断环周切缘累及的灵敏度、特异度、准确度、阴性预测值、阳性预测值分别为92.50%（37/40）、93.75%（75/80）、93.33%（112/120）、96.15%（75/78）、88.10%（37/42）。直肠癌淋巴结转移者MRI边缘模糊、肠周围脂肪信号不均匀占比较无淋巴结转移者更高,且短径较无淋巴结转移者更长（均P＜0.05）。结论：3.0 T高分辨MRI在直肠癌术前T N分期、环周切缘有无累及淋巴结转移的评估价值较高,具有一定的临床应用价值。     

Ecdysteroids and juvenile hormones of whiteflies, important insect vectors for plant viruses

Ecdysteroids and juvenile hormones (JHs) regulate many physiological events throughout the insect life cycle, including molting, metamorphosis, ecdysis, diapause, reproduction, and behavior. Fluctuation of whitefly ecdysteroid levels and the identity of the whitefly molting hormone (20-hydroxyecdysone) have only been reported within the last few years. An ecdysteroid commitment peak that is associated with the reprogramming of tissues for a metamorphic molt in many holometabolous and some hemimetabolous insect species was not observed in last nymphal instars of either the sweet potato whitefly, Bemisia tabaci (Biotype B), or the greenhouse whitefly, Trialeurodes vaporariorum. Ecdysteroids reach peak levels 1-2 days prior to the initiation of the nymphal-adult metamorphic molt. Adult eye and wing differentiation which signal the onset of this molt begin earlier in 4th instar T. vaporariorum (Stages 4 and 5, respectively) than in B. tabaci (Stage 6), and the premolt peak is 3-4 times greater in B. tabaci ( approximately 400 fg/microg protein) than in T. vaporariorum ( approximately 120 fg/microg protein). The JH of B. tabaci nymphs and eggs was found to be JH III, supporting the view that JHs I and II are, with rare exception, only present in lepidopteran insects. In B. tabaci eggs, JH levels were approximately 10 times greater on day 2/3 (0.44 fg/egg or 0.54 ng/g) than on day 5 (0.04 fg/egg or 0.054 ng/g) post-oviposition. Approximately, 1.4 fg/2nd-3rd instar nymph (0.36 ng/g) was detected. It is probable that the relatively high level of JH in day 2/3 eggs is associated with the differentiation of various whitefly tissues during embryonic development.     

Stages in the development of Parkinson’s disease-related pathology

The synucleinopathy, idiopathic Parkinsons disease, is a multisystem disorder that involves only a few predisposed nerve cell types in specific regions of the human nervous system. The intracerebral formation of abnormal proteinaceous Lewy bodies and Lewy neurites begins at defined induction sites and advances in a topographically predictable sequence. As the disease progresses, components of the autonomic, limbic, and somatomotor systems become particularly badly damaged. During presymptomatic stages 1–2, inclusion body pathology is confined to the medulla oblongata/pontine tegmentum and olfactory bulb/anterior olfactory nucleus. In stages 3–4, the substantia nigra and other nuclear grays of the midbrain and forebrain become the focus of initially slight and, then, severe pathological changes. At this point, most individuals probably cross the threshold to the symptomatic phase of the illness. In the end-stages 5–6, the process enters the mature neocortex, and the disease manifests itself in all of its clinical dimensions.Funding for this project was made available by the German Research Council (Deutsche Forschungsgemeinschaft)     

18F-FDG PET/CT 在宫颈癌诊断及分期中的临床价值

目的:探讨氟代脱氧葡萄糖(~(18)F-FDG)正电子发射断层显像/X线计算机体层成像仪(PET/CT)检查在局灶早期宫颈癌中的临床应用价值。方法:53例病理确诊为早期宫颈癌的患者行全身~(18)F-FDG PET/CT检查,并在检查结束10日内行广泛性全子宫切除术+双附件切除术+盆腔淋巴结清扫术,计算~(18)F-FDG PET/CT诊断宫颈原发部位肿瘤及盆腔淋巴结转移的敏感度,特异度与准确度。结果:~(18)F-FDG PET/CT检查诊断的宫颈原发部位肿瘤的敏感度为79.25%,特异度为86.79%,准确度为84.9%;以病人为单位诊断盆腔淋巴结转移的准确度为85.71%,特异度为97.87%;以淋巴结为单位诊断盆腔淋巴结转移的准确度为84.61%,特异度为99.00%。结论:PET/CT显像对宫颈癌诊断,分期诊断及盆腔淋巴结转移的检出具有重要临床意义。     

Estimating the size of a transient population

Migratory populations often stop over for short periods of time at predictable sites along their migration routes. These staging areas can be heavily used and are potentially critical to the survival of the migrants. This paper presents a method for estimating the number of individuals using such an area and their average residence time. The estimator is based on daily population estimates and records of repeat sightings of identifiable individuals. Its application is illustrated with observations on a population of migrating birds, some of which could be identified from bands that were readable from a distance.