南昌地区女性阴道微生态环境及HPV阳性与宫颈病变的相关性研究

目的探讨南昌地区女性阴道微生态环境及HPV阳性与宫颈病变之间的相关性。方法选取2017年1月—2018年6月于妇产科就诊的南昌地区有性生活史的126名女性作为研究对象,根据宫颈病变程度分为宫颈鳞癌组、CINⅢ组、CINⅡ组、CINⅠ组及慢性宫颈炎组共5组,检测各组HPV,阴道pH值及阴道乳酸杆菌、念珠菌、阴道滴虫。结果慢性宫颈炎组、宫颈CINⅠ组、CINⅡ组、CINⅢ组、宫颈鳞癌组患者HPV阳性率依次升高,差异均有统计学意义(P<0.05);慢性宫颈炎组、宫颈CINⅠ组、CINⅡ组、CINⅢ组、宫颈鳞癌组患者阴道pH值依次升高,差异均有统计学意义(P<0.05);慢性宫颈炎组、宫颈CINⅠ组、CINⅡ组、CINⅢ组、宫颈鳞癌组患者乳酸杆菌依次降低,念珠菌、阴道滴虫检出率依次升高,差异均有统计学意义(P<0.05);乳酸杆菌含量与宫颈病变有显著负相关关系(r=0.865,P=0.022),念珠菌、阴道滴虫、HPV检出率、pH值与宫颈病变有显著正相关关系(r=0.934,0.917,0.829,0.862,P=0.029,0.037,0.018,0.024)。结论南昌地区女性阴道微生态环境及HPV阳性与宫颈病变有相关性。

偶然发现弥散加权成像阳性病变在脑小血管病的研究进展

2023年更新的STRIVE-2将“偶然发现弥散加权成像阳性病变”这一名词列为潜在的脑小血管病影像征象。文中对偶然发现弥散加权成像阳性病变的发生与分布情况、潜在机制、演变规律、与脑小血管病进展的关联、临床特征等方面的研究进展进行综述,以期更进一步认识其在脑小血管病研究中的价值。

结肠镜后行胶囊内镜检查患者肠道准备方式的探讨

目的探讨结肠镜检查结束后行胶囊内镜检查患者肠道准备方式,在增加检查依从性的同时不影响肠道准备质量。方法回顾性分析重庆医科大学附属第二医院2014年1月-2017年12月结肠镜后行胶囊内镜检查的患者89例。对照组(n=41),结肠镜结束后立即行胶囊内镜检查;观察组(n=48),结肠镜结束后第2天服用1 L复方聚乙二醇电解质散(PEG),再行胶囊内镜检查。比较两组患者小肠黏膜质量、阳性病变检出率,观察依从性和不良反应等。结果观察组患者较对照组具有更好的小肠黏膜质量(64.6%和41.5%,P<0.05),两组患者阳性病变检出率和不良反应无明显差异,依从性均较好。结论结肠镜检查后第2天服用小剂量PEG后行胶囊内镜检查能达到更好的肠道准备效果,依从性好,值得临床推广。

鸡骨型白血病X线影像与电镜影像对比观察

为了揭示鸡骨型白血病(下称OP)的X线阳性病变与其超微病理变化之间的关系,采用人工诱发与天然自发的病例作研究对象,经X线胫骨摄片确定OP诊断后,选择有代表性的30例,按诊断结果分成5组:OP轻度阳性(+)14例,中度阳性(++)4例,重度阳性(+++)6例,OP可疑(±)3例,阴性(-)对照3例。取胫骨中段骨组织作超薄切片行透射电镜检查对比,以观察两者的相关性。结果3例X线OP阴性鸡电镜所见为正常,骨细胞和哈佛氏管等超微结构无异常改变。X线OP可疑组和各阳性(+、++、+++)组,每组均检出病毒粒子,其大小形态与超微结构都与C型肿瘤病毒相似,为放射学诊断提供了病原证据。X线诊断为OP可疑和各组阳性的病例电镜观察全部有超微结构上的改变,包括骨细胞破坏、骨陷窝间隙增宽、骨质毛细血管病变等等数十种超微变化,表明两者具有一致相关性,为OP的放射诊断提供了超微病理学上的依据。

一项激光诱导荧光内镜与标准电视内镜对Barrett食管早期瘤检测能力的随机、交叉研究

Background: Light-induced fluorescence endoscopy (LIFE)-may improve the detection of high-grade dysplasia (HGD) and early stage cancer (EC) in Barrett’s esophagus (BE). The aim of this study was to compare LIFE with standard endoscopy (SE) in a randomized crossover study. Methods: Fifty patients with BE underwent SE and LIFE in a randomized sequence (4 to 6-week interval between procedures). The two procedures were performed by two different endoscopists who were blinded to the findings of the other examination. Targeted biopsy specimens were taken from detected lesions, followed by random biopsy specimens with a 2 cm interval, 4-quadrant protocol. Biopsy specimens were routinely evaluated and subsequently reviewed by a single, blinded expert GI pathologist. Results: Targeted biopsy specimens had a sensitivity for the diagnosis of HGD/EC of 62%(8/13) for both techniques. The overall sensitivity (all biopsy specimens) was 85%for SE and 69%for LIFE (p = 0.69). All targeted biopsy specimens had a positive predictive value (PPV) for HGD/EC of 41%for SE and 28%for LIFE (p = 0.40); autofluorescence-targeted biopsy specimens had a PPV of 13%. False-positive lesions had a significantly higher rate of acute inflammation than random biopsy specimens. Conclusions: In this study, LIFE did not improve the detection of HGD or EC in patients with BE compared with SE.

^(18)F-氟脱氧葡萄糖正电子发射断层扫描术在肝细胞性肝癌肝外转移检测中的应用

Background:Positron emission tomography(PET)with 18F - fluoro-2-deoxy-D-glucose (18F-FDG) is useful in detecting distant metastases from a variety of malignancies. However, its efficiency in detecting distant metastases from hepatocellular carcinoma (HCC) has not been investigated. The aim of this study was to evaluate the usefulness of 18F-FDG PET for the detection of extrahepatic metastases from HCC. Methods: Nineteen patients suspected of having extrahepatic HCC underwent 18F-FDG PET. Fourteen patients (group A) had extrahepatic lesions, which were detected by conventional studies. In five patients (group B), conventional imaging showed no extra-or intrahepatic lesions, but the tumor marker levels were elevated. The PET results were compared with those obtained by histopathology or by clinical follow-up. Results: The detection rate of 18F-FDG P ET was 83%(24 of 29 metastases) for extrahepatic metastases larger than 1cm in greatest diameter and 13%(1 of 8 metastases) for lesions less than or equal to 1cm. PET revealed two bone metastases not depicted by bone scan, and detected the nodal metastasis and intestinal metastases inconclusive on computed tomography. Extrahepatic lesions were resected in 5 patients of group A on the basis of PET findings. In all patients of group B, PET results were true negative for extrahepatic metastases, but HCCs were detected in the liver within 4 months in 4 patients. These were no falsepositive lesions in either group. Conclusions: This preliminary study suggested that 18F-FDG PET could provide additional information and contribute to the management of HCC patients suspected of having extrahepatic metastases.

Efficacy of the revised Vienna Classification for diagnosing colorectal epithelial neoplasias

AIM： To prospectively investigate the efficacy of the revised Vienna Classification for diagnosing colorectal epithelial neoplastic lesions in cold biopsy specimens.METHODS： Patients were selected for inclusion if they had colorectal epithelial lesions that were not considered suitable for direct endoscopic resection,These included colorectal polyps ≥ 10 mm and lesions suspected of being carcinomas capable of invading the colorectal submucosa or beyond, including strictures, based on the cold biopsies obtained from each lesion prior to resection. We investigated the relationship between diagnoses based on cold biopsy samples using the revised Vienna Classification and resected specimens of the same lesions, and the therapeutic implications of diagnoses made using the revised Vienna Classification. The same cold biopsy specimens were also examined using the Japanese Group Classification guidelines, and compared with the resected specimens of the same lesions for reference.RESULTS： A total of 179 lesions were identified. The sensitivity, specificity, positive and negativepredictive values of the revised Vienna Classification for distinguishing between intramucosal lesions and submucosal invasive carcinomas in cold biopsy specimens was 22.2%, 100%, 100%, and 71.4%,respectively, and for distinguishing between intramucosal lesions and those invading the submucosa or beyond was 59.7%, 100%, 100%, and 37.6%,respectively. The sensitivity, specificity, positive and negative predictive values of the Japanese Group Classification for distinguishing between intramucosal lesions and submucosal invasive carcinomas in cold biopsy specimens was 83.3%, 91.4%, 83.3%. and 91.4%, respectively, and for distinguishing between intramucosal lesions and those invading the submucosa or beyond was 95.1%, 91.4%, 97.9%, and 82.1%, respectively. A total of 137 of 144 carcinomas that had invaded the submucosa or beyond and three high-grade intraepithelial neoplasias were diagnosed as ＂carcinoma＂ using the Japanese Group Classification system.CONCLUSION： The revised Vienna Classification for cold biopsy specimens has high positive predictive value in the diagnosis of colorectal carcinoma invasive to the subrnucosa or beyond.

宫颈环形电切术后切缘病变残留呈阳性宫颈上皮内瘤变患者的诊治研究现状

目前治疗宫颈上皮内瘤变(CIN)的常用方法包括物理治疗及手术治疗,在手术治疗中,以宫颈环形电切术(LEEP)应用相对较广。但是,部分CIN患者接受LEEP治疗后,对切缘活组织样本的检查发现切缘CIN残留,即切缘呈阳性,而且切缘阳性率可达4.51%~23.40%。研究证实,切缘呈阳性,与LEEP治疗后CIN残留及CIN复发密切相关。对于LEEP治疗后切缘呈阳性患者的处理策略,国内外迄今尚未达成共识。研究认为,CIN患者接受LEEP治疗后,CIN残留,并且切缘呈阳性患者的后续处理,需要综合评估,采取合适的治疗措施。其中,对内切缘及外切缘均呈阳性的患者,需要采取积极的治疗措施。笔者拟就CIN患者采取LEEP治疗后,发生切缘呈阳性的高危因素及其处理策略的最新研究进展进行阐述,旨在为CIN患者的规范化临床诊治提供参考。