内镜黏膜下剥离术治疗消化系统早癌及癌前病变的临床疗效

目的:探讨内镜黏膜下剥离术(ESD)对消化道早癌及癌前病变的治疗效果。方法:选择2013年8月至2014年8月在我院接受治疗的消化道肿瘤患者79例作为研究对象,根据手术方法不同将所选患者分为ESD组(49例)和对照组(30例)。ESD组患者采用内镜黏膜下剥离术治疗,对照组采用传统手术治疗。观察并比较两组患者的手术时间、治愈性切除率、整块完整切除率、术后并发症的发生率及复发、转移情况。结果:ESD组患者的手术时间少于对照组,差异具有统计学意义(P0.05);两组患者手术治愈性切除率均为100%,差异无统计学意义(P0.05);ESD组手术整块完整切除率(63.27%)低于对照组(86.67%),差异具有统计学意义(P0.05)。ESD组患者术后并发症的发生率(4.08%)显著低于对照组(13.3%),差异具有统计学意义(P0.05)。两组患者术后一年内均未出现原发病灶转移及复发。结论:ESD治疗消化道早癌及癌前病变的临床疗效较好,与传统手术相比,ESD手术并发症较少、且安全性较高,更加适宜临床推广及应用。     

VEGF-A在食管鳞状细胞癌中的表达及临床意义

目的:探讨血管内皮生长因子A(VEGF-A)在食管鳞状细胞癌中的表达及临床意义。方法:收集2009年1月-2010年12月收治的45例食管鳞状细胞癌患者临床资料及病理标本,应用免疫组织化学法检测肿瘤组织VEGF-A表达及微淋巴管密度(MLVD),分析VEGF-A表达与食管鳞癌患者临床病理资料、MLVD及与患者生存期限的关系。结果:1有淋巴结转移的患者VEGF-A表达阳性率为66.67%,明显高于无淋巴结转移患者的38.10%(P0.05);2 VEGF-A阳性食管鳞状细胞癌患者MLVD为(8.35±2.45)明显高于阴性患者的(5.32±1.44),(P0.05);3VEGF-A阳性食管鳞状细胞癌患者3年存活率为41.67%明显低于阴性患者的61.90%(P0.05)。结论:VEGF-A表达在确定早期食管鳞状细胞癌淋巴结转移方面具有一定的应用价值,可以作为评价预后的有效指标。     

基于扩展起始节点和加权融合策略预测肺癌风险致病基因

肺癌风险致病基因预测有助于了解疾病发病机制、提高临床治疗效果.目前,以重启游走为框架的风险致病基因预测算法,普遍存在起始节点少、节点转移概率相同、信息源单一的问题.为此,本文提出一种基于扩展起始节点和加权融合策略的风险致病基因预测算法(命名为AFMFSC),并在肺癌中验证算法有效性.首先,基于增广模糊测量思想,计算疾病表型近似基因间的增广功能相似得分,从中选出重要基因与致病基因作为扩展起始节点;其次,采用节点拓扑相似度转移矩阵及基因表达差异相关性转移矩阵,分别在蛋白质网络中重启随机游走,并将两种结果加权融合排序;最后,通过富集分析排名靠前基因,得到有显著意义的风险致病基因.AFMFSC算法预测的73个肺癌风险致病基因,均与肺癌发生、发展有密切联系,生物学意义显著.与其他排序算法相比,AFMFSC算法的Top 1%、Top 5%和AUC值比较大,平均排名和受拓扑特性偏差影响程度小;融合策略排名性能优于单一转移矩阵或普通邻接矩阵游走排名.AFMFSC算法不仅能准确有效地预测肺癌风险致病基因,而且可推广预测其他疾病风险致病基因,为探索癌症致病机理提供新视角及依据.     

内镜黏膜下剥离术和挖除术治疗上消化道肿瘤的疗效及安全性分析

目的:分析内镜黏膜下剥离术(ESD)和黏膜下挖除术(ESE)治疗上消化道肿瘤的疗效及安全性。方法:回顾性分析2017年1月至2019年4月我院消化内科接受ESD或ESE治疗的68例上消化道肿瘤住院患者的临床资料,收集患者基础疾病、手术时间、病变部位大小、整块切除率、并发症等资料,同时采用Logistic回归分析对术中穿孔进行危险因素分析。结果:64例患者完整切除瘤体(94.12%),肿瘤平均直径(16.98±8.29)mm。食管病灶病理类型以高级别上皮内瘤变为主,有15例(22.06%);胃部病灶分布以胃体、胃底和胃窦居多,分别有18例(26.47%)、16例(23.53%)和12例(17.65%),病理类型以间质瘤最多,占36.76%;11例患者发生并发症(16.18%),4例患者出现术后出血(5.88%),经过内镜下止血后好转,8例患术中穿孔(11.76%),均行内镜下尼龙绳联合钛夹行荷包缝合,其中1例患者术中穿孔合并术后迟发性出血;病灶最大直径(≥25 mm,P=0.036)和病灶部位(胃底,P=0.015)是导致ESD或ESE术中穿孔的独立危险因素。结论:ESD和ESE治疗上消化道肿瘤安全有效,但需注意病灶大小和胃底病变,因其是导致术中穿孔的独立危险因素。     

早期子宫颈恶性肿瘤腹腔镜手术中两种示踪剂前哨淋巴结活检结果的对比分析

目的:通过在早期子宫颈恶性肿瘤患者中应用吲哚箐绿(ICG)及纳米炭混悬液为示踪剂行腹腔镜下前哨淋巴结(sentinel lymph node,SLN)切除术,对比两种示踪剂的示踪效果,寻找临床更适宜普遍使用的示踪剂。方法:选取仁济医院妇瘤科2016.8～2019.10期间诊断明确的122例早期子宫颈恶性肿瘤患者为研究对象。随机采用ICG或纳米炭为前哨示踪剂。对两种示踪剂的显影情况和SLN的示踪效果进行分析。结果:在122例子宫颈恶性肿瘤病例中,宫颈注射ICG64例,检出SLN385枚,平均每个患者检出6.02枚SLN,检出率100%(64/64),特异度96.77%,敏感度75%。宫颈注射纳米炭混悬液58例,检出SLN265枚,平均每个患者检出4.57枚SLN,检出率96.9%(56/58),特异度96.36%,敏感度66.67%。两种示踪剂都有较好的示踪效果(P=0.9356)。结论:早期子宫颈恶性肿瘤行宫颈注射ICG或纳米炭混悬液,腹腔镜下显影的SLN均具有较高的检出率与准确率,是一种较为可行的方法,可普遍开展,值得推广。     

混合甲醛固定液固定大肠癌淋巴结标本的最佳免疫组化效果研究

目的:探讨混合甲醛固定液固定大肠癌淋巴结标本的最佳免疫组化效果。方法:采用不同pH值(6.0、7.0、8.0)的混合甲醛固定液对39枚大肠癌淋巴结标本进行不同时间(6 h、6 h-12 h、1 d-7 d)的固定处理。以细胞角蛋白20(CK20)为目标抗原,运用OIympusdp 70图像采集分析仪抽选出混合甲醛固定液最佳免疫组化染色的pH值及固定时间。结果:经pH值为7.0混合甲醛固定液处理后,阳性率为92.31%,高于经pH值为6.0、8.0的混合甲醛固定液处理后的76.92%、74.36%,且经pH值为7.0、8.0处理后的阳性率比较有统计差异(P0.05)。混合甲醛固定液的固定时间在6 h-12 h时的阳性率为94.87%,高于固定时间为6 h、1 d-7 d处理的30.77%、76.92%(P0.05)。结论:对于大肠癌淋巴结标本,以CK20为目标抗原,选择pH值为7.0的混合甲醛固定液固定6 h-12 h能够得到质量较佳的免疫组化染色效果。     

两种内镜手术对消化道神经内分泌肿瘤的切除效果及安全性评价

目的:探讨内镜下两种手术方法对消化道神经内分泌肿瘤的切除效果和安全性。方法:选取64例消化道神经内分泌肿瘤患者,随机分为A组和B组,每组各32例。A组接受内镜下黏膜切除术,B组接受内镜下黏膜剥离术。分析和比较两组所切除组织的病理学检查结果、手术时间、切除肿瘤的直径和厚度、治疗费用、住院时间、肿瘤完全切除率、垂直切缘阴性率以及并发症的发生率。结果:A组的手术时间为(8.95±1.63) min,治疗费用为(2127.70±468.31)元,均显著少于B组(P0.05);两组患者切除肿瘤直径和厚度、住院时间、垂直切缘阴性率对比差异均没有统计学意义(P0.05);B组的肿瘤完全切除率为93.75%,显著高于A组(P0.05);A组并发症发生率为3.13%,显著低于B组(P0.05)。结论:两种内镜下手术方式均可有效清除消化道神经内分泌肿瘤病灶。内镜下黏膜切除术的手术时间、费用及并发症的发生率更少低,而内镜下黏膜剥离术能够更彻底地清除肿瘤组织。     

Prediction of lymph node metastasis in oral squamous cell carcinoma based on protein profile

Objective: Lymph node metastasis leads to high mortality rates of oral squamous cell carcinoma (OSCC). However, it is still controversial to define clinically negative neck (cN0) and positive neck (cN1-3).

Methods: We retrieved candidate biomarkers identified by proteomic analysis in OSCC from published works of literature. In training stage, immunohistochemistry (IHC) analysis was used to determine the expression of proteins and logistic regression models with stepwise variable selection were used to identify potential factors that might affect lymph node metastasis and life status. Furthermore, the prediction model was validated in validating stage.

Results: We screened eight highly expressed proteins related to lymph node metastasis in OSCC and found that the expression levels of SOD2, BST2, CAD, ITGB6, and PRDX4 were significantly elevated in patients with lymph node metastasis compared to the patients without lymph node metastasis. Furthermore, in training and validating stages, the prediction model base on the combination of CAD, SOD2 expression levels, and histopathologic grade was developed and validated in patients with OSCC.

Conclusions: Our findings showed that the developed model well predicts the lymph node metastasis and life status in patients with OSCC, independent of TNM stage.     

Bioimaging of multiple elements by high‐resolution LA‐ICP‐MS reveals altered distribution of mineral elements in the nodes of rice mutants

Inter‐vascular transfer in rice (Oryza sativa) nodes is required for delivering mineral elements to developing tissues, which is mediated by various transporters in the nodes. However, the effect of these transporters on distribution of mineral elements in the nodes at a cellular level is still unknown. Here, we established a protocol for bioimaging of multiple elements at a cellular level in rice node by laser ablation‐inductively coupled plasma‐mass spectrometry (LA‐ICP‐MS), and compared the mineral distribution profile between wild‐type (WT) rice and mutants. Both relative comparison of mineral distribution normalized by endogenous ¹³C and quantitative analysis using spiked standards combined with soft ablation gave valid results. Overall, macro‐nutrients such as K and Mg were accumulated more in the phloem region, while micro‐nutrients such as Fe and Zn were highly accumulated at the inter‐vascular tissues of the node. In mutants of nodal Zn transporter OsHMA2, Zn localization pattern in the node tissues did not differ from that of WT; however, Zn accumulation in the inter‐vascular tissues was lower in uppermost node I but higher in the third upper node III compared with the WT. In contrast, Si deposition in the mutants of three nodal Si transporters Lsi2, Lsi3 and Lsi6 showed different patterns, which are consistent with the localization of these transporters. This improved LA‐ICP‐MS analysis combined with functional characterization of transporters will provide further insight into mineral element distribution mechanisms in rice and other plant species.     

Numerical simulation of two-phase non-Newtonian blood flow with fluid-structure interaction in aortic dissection

The behavior of blood cells and vessel compliance significantly influence hemodynamic parameters, which are closely related to the development of aortic dissection. Here the two-phase non-Newtonian model and the fluid-structure interaction (FSI) method are coupled to simulate blood flow in a patient-specific dissected aorta. Moreover, three-element Windkessel model is applied to reproduce physiological pressure waves. Important hemodynamic indicators, such as the spatial distribution of red blood cells (RBCs) and vessel wall displacement, which greatly influence the hemodynamic characteristics are analyzed. Results show that the proximal false lumen near the entry tear appears to be a vortex zone with a relatively lower volume fraction of RBCs, a low time-averaged wall shear stress (TAWSS) and a high oscillatory shear index (OSI), providing a suitable physical environment for the formation of atherosclerosis. The highest TAWSS is located in the narrow area of the distal true lumen which might cause further dilation. TAWSS distributions in the FSI model and the rigid wall model show similar trend, while there is a significant difference for the OSI distributions. We suggest that an integrated model is essential to simulate blood flow in a more realistic physiological environment with the ultimate aim of guiding clinical treatment.