Sarin Induced Lung Pathology and Protection by Standard Therapy Regime

The effects of atropine, diazepam and pralidoxime were studied for their ability to block the pathological lesions induced by sarin. Rats were exposed to an aerosol of sarin at a concentration of 51.2mg-m for 15 min following the pretreatment with one of the following combinations: atropine (10 mg/kg, i.m.) and diazepam (0.5 mg/kg, i.m.); atropine and pralidoxime (25 mg/kg, i.m.); diazepam and pralidoxime; atropine, diazepam and pralidoxime. Lung exposed to sarin aerosols revealed an increased cellular proliferation with progressive diffused interstitial thickening on the 4th day following exposure. On the 16th day, loss of alveolar space and consolidation of large areas of all lobes were observed. Sarin also caused damage to the respiratory bronchioles. All the therapy regime blocked the development of lung lesions in the descending orders: atropine, diazepam and pralidoxime, atropine and diazepam > diazepam and pralidoxime > atropine and pralidoxime. The result suggests that diazepam in combination with atropine and pralidoxime could be an effective drug combination regime for the lung lesions.

Rheumatoid arthritis: pathological mechanisms and modern pharmacologic therapies

Rheumatoid arthritis（RA） is a chronic systemic autoimmune disease that primarily affects the lining of the synovial joints and is associated with progressive disability, premature death, and socioeconomic burdens. A better understanding of how the pathological mechanisms drive the deterioration of RA progress in individuals is urgently required in order to develop therapies that will effectively treat patients at each stage of the disease progress. Here we dissect the etiology and pathology at specific stages：（i） triggering,（ii） maturation,（iii） targeting, and（iv） fulminant stage, concomitant with hyperplastic synovium, cartilage damage, bone erosion, and systemic consequences. Modern pharmacologic therapies（including conventional, biological, and novel potential small molecule disease-modifying anti-rheumatic drugs） remain the mainstay of RA treatment and there has been significant progress toward achieving disease remission without joint deformity. Despite this, a significant proportion of RA patients do not effectively respond to the current therapies and thus new drugs are urgently required. This review discusses recent advances of our understanding of RA pathogenesis, disease modifying drugs, and provides perspectives on next generation therapeutics for RA.

Clinicopathological predictors of long-term benefit in breast cancer treated with neoadjuvant chemotherapy

AIM To investigate the survival impact of clinicopathological factors, including pathological complete response(p CR) and tumor-infiltrating lymphocytes(s TIL) levels according to subtypes, in breast cancer(BC) patients who received neo-adjuvant chemotherapy(NAC).METHODS We evaluated 435 BC patients who presented and received NAC at the Instituto Nacional de Enfermedades Neoplasicas from 2003 to 2014. s TIL was analyzed as the proportion of tumor stroma occupied by lymphocytes, and was prospectively evaluated on hematoxylin and eosin-stained sections of the preN AC core biopsy. p CR was considered in the absence of infiltrating cancer cells in primary tumor and axillary lymph nodes. Analysis of statistical association between clinical pathological features, s TIL, p CR and survival were carried out using SPSSvs19.RESULTS Median age was 49 years(range 24-84 years) and the most frequent clinical stage was ⅢB(58.3%). Luminal A, Luminal B, HER2-enriched and(triple-negative) TN phenotype was found in 24.6%, 37.9%, 17.7% and 19.8%, respectively. p CR was observed in 11% and median percentage of s TIL was 40%(2%-95%) in the whole population. p CR was associated to Ct1-2(P = 0.045) and to high s TIL(P = 0.029) in the whole population. There was a slight trend towards significance for s TIL(P = 0.054) in Luminal A. s TIL was associated with grade Ⅲ(P < 0.001), no-Luminal A subtype(P < 0.001), RE-negative(P < 0.001), PgR-negative(P < 0.001), HER2-positive(P = 0.002) and p CR(P = 0.029) in the whole population. Longer disease-free survival was associated with grade Ⅰ-Ⅱ(P = 0.006), cN 0(P < 0.001), clinical stage Ⅱ(P = 0.004), ER-positive(P < 0.001), Pg R-positive(P < 0.001), luminal A(P < 0.001) and p CR(P = 0.002). Longer disease-free survival was associated with grade Ⅰ-Ⅱ in Luminal A(P < 0.001), N0-1 in Luminal A(P = 0.045) and TNBC(P = 0.01), clinical stage Ⅱ in Luminal A(P = 0.003) and TNBC(P = 0.038), and pC R in TNBC(P < 0.001). Longer overall survival was associated with grade Ⅰ-Ⅱ(P < 0.001), ER-positive(P < 0.001), PgR-positive(P < 0.001), Luminal A(P < 0.001), cN 0(P = 0.002) and p CR(P = 0.002) in the whole population. Overall survival was associated with clinical stage Ⅱ(P = 0.017) in Luminal A, older age(P = 0.042) in Luminal B, and pC R in TNBC(P = 0.005).CONCLUSION Predictive and prognostic values of clinicopathological features, like p CR and s TIL, differ depending on the evaluated molecular subtype.

Pathological response measured using virtual microscopic slides for gastric cancer patients who underwent neoadjuvant chemotherapy

BACKGROUND Although pathological response is a common endpoint used to assess the efficacy of neoadjuvant chemotherapy (NAC) for gastric cancer, the problem of a low rate of concordance from evaluations among pathologists remains unresolved. Moreover, there is no globally accepted consensus regarding the optimal evaluation. A previous study based on a clinical trial suggested that pathological response measured using digitally captured virtual microscopic slides predicted patients’ survival well. However, the pathological concordance rate of this approach and its usefulness in clinical practice were unknown. AIM To investigate the prognostic utility of pathological response measured using digital microscopic slides in clinical practice. METHODS We retrospectively evaluated pathological specimens of gastric cancer patients who underwent NAC followed by surgery and achieved R0 resection between March 2009 and May 2015. Residual tumor area and primary tumor beds were measured in one captured image slide, which contained the largest diameter of the resected specimens. We classified patients with < 10% residual tumor relative to the primary tumorous area as responders, and the rest as non-responders;we then compared overall survival (OS) and relapse-free survival (RFS) between these two groups. Next, we compared the prognostic utility of this method using conventional Japanese criteria. RESULTS Fifty-four patients were evaluated. The concordance rate between two evaluators was 96.2%. Median RFS of 25 responders and 29 non-responders was not reached (NR) vs 18.2 mo [hazard ratio (HR)= 0.35, P = 0.023], and median OS was NR vs 40.7 mo (HR = 0.3, P = 0.016), respectively. This prognostic value was statistically significant even after adjustment for age, eastern cooperative oncology group performance status, macroscopic type, reason for NAC, and T- and Nclassification (HR = 0.23, P = 0.018). This result was also observed even in subgroup analyses for different macroscopic types (Borrmann type 4/non-type 4) and histological types (differentiated/undifferentiated). Moreover, the adjusted HR for OS between responders and non-responders was lower in this method than that in the conventional histological evaluation of Japanese Classification of Gastric Carcinoma criteria (0.23 vs 0.39, respectively). CONCLUSION The measurement of pathological response using digitally captured virtual microscopic slides may be useful in clinical practice.

Pathologic tumor response to neoadjuvant therapy in borderline resectable pancreatic cancer

Background:Previous studies have demonstrated the prognostic significance of pathologic tumor response in pancreatic adenocarcinoma following neoadjuvant therapy(NAT).The aim of this study was to determine the incidence of significant pathologic response to NAT in borderline resectable pancreatic cancer(BRPC),and association of NAT regimen and other clinico-pathologic characteristics with pathologic response.Methods:Patients with BRPC who underwent NAT and pancreatic resection between January 2012 and June 2017 were included.Pathologic response was assessed on a qualitative scale based on the College of American Pathologists grading system.Demographics and baseline characteristics,oncologic treatment,pathology,and survival outcomes were compared.Results:Seventy-one patients were included for analysis.Four patients had complete pathologic responses(tumor regression score 0),12 patients had marked responses(score 1),42 had moderate responses(score 2),and 13 had minimal responses(score 3).Patients with complete or marked responses were more likely to have received neoadjuvant gemcitabine chemoradiation(62.5%,38.1%,and 23.1%of the complete/marked,moderate,and minimal response groups,respectively;P=0.04).Of the complete/marked,moderate,and minimal response groups,margins were negative in 75.0%,78.6%,and 46.2%(P=0.16);node negative disease was observed in 87.5%,54.8%,and 15.4%(P<0.01);and median overall survival was 50.0 months,31.7 months,and 23.2 months(P=0.563).Of the four patients with pathologic complete responses,three were disease-free at 66.1,41.7 and 31.4 months,and one was deceased with metastatic liver disease at 16.9 months.Conclusions:A more pronounced pathologic tumor response to NAT in BRPC is correlated with node negative disease,but was not associated with a statistically significant survival benefit in this study.

Stem cell therapy in ocular pathologies in the past 20 years

Stem cell therapies are successfully used in various fields of medicine.This new approach of research is also expanding in ophthalmology.Huge investments,resources and important clinical trials have been performed in stem cell research and in potential therapies.In recent years,great strides have been made in genetic research,which permitted and enhanced the differentiation of stem cells.Moreover,the possibility of exploiting stem cells from other districts(such as adipose,dental pulp,bone marrow stem cells,etc.)for the treatment of ophthalmic diseases,renders this topic fascinating.Furthermore,great strides have been made in biomedical engineering,which have proposed new materials and threedimensional structures useful for cell therapy of the eye.The encouraging results obtained on clinical trials conducted on animals have given a significant boost in the creation of study protocols also in humans.Results are limited to date,but clinical trials continue to evolve.Our attention is centered on the literature reported over the past 20 years,considering animal(the most represented in literature)and human clinical trials,which are limiting.The aim of our review is to present a brief overview of the main types of treatments based on stem cells in the field of ophthalmic pathologies.

Effects of four regulating-intestine prescriptions on pathology and ultrastructure of colon tissue in rats with ulcerative colitis

AIM: To observe different histomorphologic changes of ulcerative colitis (UC) rats that were treated with four regulating-intestine prescriptions (FRIP), to investigate the curative effects of FRIP and to analyze their treatment mechanism.METHODS: The UC rat model was made by the method of 2,4-dinitro chloro benzene (DNCB) immunity and acetic acid local enema. Ninety-eight SD rats were randomly divided into seven groups, namely, the normal control group, model group, salicylazosulfapyridine (SASP) group,Wumeiwan (WMW) group, Baitouwengtang (BTWT) group,Senglingbaishusan (SLBSS) group, and Tongxieyaofang (TXYF) group. Each group had 14 rats (with equal ratio of male and female). The six animal model groups of UC-SASP, TXYF, WMW, BTWT, SLBSS, TXYF-were treated by distilled water except the normal control group. Changes of the rat's general conditions after treatment were respectively observed, the colon tissue damage scores were given out, the pathology of colonic mucosa and changes of ultrastructure were analyzed.RESULTS: Different pathological changes on histology were shown after treatment by FRIP. The colon tissue damage score in model group was higher than that of FRIP groups and SASP group (q = 4.59, 4.77, P＜0.05 or q = 5.48,6.25, 5.97, P＜0.01). The scores of WMW group, BTWT group and SLBSS group were lower than that of SASP (q = 4.13, P＜0.05 or q = 5.31, 5.12, P＜0.01). There was no remarkable difference between the damage score of TXYF group and SASP group (q = 3.75, P＞0.05). In addition, some apoptosis cells were found in the pathologic control group.CONCLUSION: The model made with DNCB and acetic acid was successful, and FRIP had better curative effect and WMW was the best curative effect, BTW, SLBSS and TXYF were similar to SASP, and we discovered that apoptosis was possibly related to UC.

Successful multidisciplinary therapy for a patient with liver metastasis from ascending colon adenocarcinoma:A case report and review of literature

BACKGROUND Liver metastasis is the most common form of distant metastasis in colorectal cancer,and the only possible curative treatment for patients with colorectal liver metastases(CRLM)is hepatectomy.However,approximately 25%of patients with CRLM have indications for liver resection at the initial diagnosis.Strategies aimed at downstaging large or multifocal tumors to enable curative resection are appealing.CASE SUMMARY A 42-year-old man was diagnosed with ascending colon cancer and liver metastases.Due to the huge lesion size and compression of the right portal vein,the liver metastases were initially diagnosed as unresectable lesions.The patient was treated with preoperative transcatheter arterial chemoembolization(TACE)consisting of 5-fluorouracil/Leucovorin/oxaliplatin/Endostar®.After four courses,radical right-sided colectomy and ileum transverse colon anastomosis were performed.Postoperatively,the pathological analysis revealed moderately differentiated adenocarcinoma with necrosis and negative margins.Thereafter,S7/S8 partial hepatectomy was performed after two courses of neoadjuvant chemotherapy.Pathological examination of the resected specimen revealed a pathologically complete response(pCR).Intrahepatic recurrence was detected more than two months after the operation,and the patient was then treated with TACE consisting of irinotecan/Leucovorin/fluorouracil therapy plus Endostar®.Subsequently,the patient was treated with aγ-knife to enhance local control.Notably,a pCR was reached,and the patient's overall survival time was>9 years.CONCLUSION Multidisciplinary treatment can promote the conversion of initially unresectable colorectal liver metastasis and facilitate complete pathological remission of liver lesions.

Vasopressin-induced hyponatremia in an adult normotensive trauma patient:A case report

BACKGROUND Arginine vasopressin is a neuropeptide produced in the hypothalamus and released by the posterior pituitary gland.In addition to maintaining plasma osmolarity,under hypovolemic or hypotensive conditions,it helps maintain plasma volume through renal water reabsorption and increases systemic vascular tone.Its synthetic analogues are widely used in the intensive care unit as a continuous infusion,in addition to hospital floors as an intravenous or intranasal dose.A limited number of cases of hyponatremia in patients with septic or hemorrhagic shock have been reported previously with vasopressin.We report for the first time a normotensive patient who developed vasopressin-induced hyponatremia.CASE SUMMARY A 39-year-old man fell off a forklift and sustained an axial load injury to his cranium.He had no history of previous trauma.Examination was normal except for motor and sensory deficits.The Imagine test showed endplate fracture at C7 and acute traumatic disc at C7 with cortical degeneration.He underwent cervical discectomy and fusion,laminectomy,and posterior instrumented fusion.After intensive care unit admission post-surgery,he developed hyponatremia of 121-124 mEq/L post phenylephrine and vasopressin infusion to maintain blood pressure maintenance.He was evaluated for syndrome of inappropriate secretion of antidiuretic hormone,hypothyroid,adrenal-induced,or diuretic-induced hyponatremia.At the end of extensive evaluation for the underlying cause of hyponatremia,vasopressin was discontinued.He was also put on fluid restriction,given exogenous desmopressin,and a dextrose 5%in water infusion to prevent osmotic demyelination syndrome caused by sodium overcorrection which improved his sodium level to 135 mmol/L.CONCLUSION The presentation of vasopressin-induced hyponatremia is uncommon in normotensive patients,and the most difficult aspect of this condition is determining the underlying cause of hyponatremia.Our case illustrates that,considering the vast differential diagnosis of hyponatremia in hospitalized patients,both hospitalists and intensivists should be aware of this serious complication of vasopressin therapy.

CXCR2在食管癌组织中的表达及其对食管癌细胞生物学行为的影响

目的:探讨CXC受体2(CXCR2)在食管鳞癌组织中的表达及其对食管癌细胞生物学行为的影响。方法:收集手术切除的食管鳞癌组织74例作为研究组,其配对的癌旁正常食管组织74例作为对照组,采用免疫组织化学染色检测CXCR2的表达,比较研究组与对照组间CXCR2表达水平的差异,分析CXCR2表达及其与临床病理特征的关系。并采用CCK-8试剂盒、平板集落形成实验、细胞迁移和侵袭实验检测CXCR2拮抗剂SCH527123对食管癌细胞KYSE30生物学行为的影响。结果:与对照组比较,CXCR2在食管鳞癌研究组中的阳性表达率为73.0%(54/74),明显高于对照组13.5%(10/74),差异具有统计学意义(χ^(2)=53.298,P=0.000)。CXCR2的表达与食管鳞癌分化程度和淋巴结转移密切相关(χ^(2)=5.515,P=0.019;χ^(2)=7.320,P=0.007);与患者性别、年龄、肿瘤部位、肿瘤大体分型、肿瘤直径、浸润深度、脉管瘤栓及神经侵犯均无明显相关关系(P>0.05)。在体外细胞实验中,与对照组相比,CXCR2拮抗剂SCH527123显著抑制食管癌细胞KYSE30的增殖、迁移和侵袭(均为P<0.05)。结论:CXCR2在食管鳞癌组织中表达上调且与患者的不良预后相关,CXCR2拮抗剂SCH527123可以抑制食管癌细胞的增殖、迁移和侵袭,推测CXCR2可能是食管癌潜在的预测和靶向治疗的分子标志物。

THP方案新辅助治疗HER-2阳性乳腺癌的真实世界研究

目的 了解THP方案在真实世界临床实践的应用状况,同时评价该方案的疗效、安全性和耐受性。方法 选择在保定市第一中心医院等河北省11家三级甲等医院接受THP方案新辅助治疗并完成序贯手术的HER-2阳性乳腺癌患者70例为研究对象,制订专用的患者资料信息收集表,专人负责收集符合纳入标准患者的临床病理资料。评估THP方案的有效性、安全性和耐受性。主要研究终点为病理完全缓解(pCR)率、≥3级不良反应的发生率、既定治疗方案完成率。结果 总人群pCR率为54.3%。亚组分析显示,cTNMⅠ-Ⅱ期、激素受体阴性、HER-2 IHC3+患者的pCR率分别显示出高于c TNMⅢ期、激素受体阳性、HER-2 IHC2+/FISH+患者的趋势,但差异无统计学意义(P>0.05)。4周期患者的pCR率显著高于4周期以上患者(P<0.05)。≥3级不良反应发生率为4.3%。既定方案完成率为98.6%。结论THP方案在河北省得到广泛应用,是HER-2阳性乳腺癌患者新辅助治疗的有效方案,安全性及耐受性良好,可以考虑作为激素受体阴性、肿瘤负荷较小、对联合化疗耐受性差患者的新辅助备选方案。

新生儿病理性黄疸血清总胆红素、AST、ALT、ALB水平与蓝光治疗效果的关系

目的 研究新生儿病理性黄疸血清总胆红素、谷草转氨酶(AST)、谷丙转氨酶(ALT)、白蛋白(ALB)水平与蓝光治疗效果的关系。方法 收集2020年6月至2022年12月期间于南阳市中心医院新生儿重症监护病区诊治的97例新生儿病理性黄疸的病历资料,根据患儿蓝光照射治疗效果评估结果分为有效组和无效组,其中有效组共57例,无效组共40例。两组患儿均接受蓝光照射治疗,并进行血清总胆红素、AST、ALT、ALB检测。比较两组治疗前黄疸指数、血清总胆红素、AST、ALT、ALB水平,并分析患儿治疗前血清总胆红素、AST、ALT、ALB水平与蓝光治疗效果相关性。结果 治疗前,有效组黄疸指数低于无效组,差异有统计学意义(t=3.346,P<0.05);有效组血清总胆红素、AST、ALT水平低于无效组,血清ALB水平高于无效组,差异有统计学意义(t=3.635、2.273、2.167、8.689,P<0.05);经Logistic多因素分析,总胆红素、AST、ALT水平变化均为影响新生儿病理性黄疸病情严重程度的独立危险因素,ALB水平变化为影响新生儿病理性黄疸病情严重程度的独立保护因素(P<0.05);经Spearman相关性分析显示,患儿治疗前血清总胆红素、AST、ALT与病情严重程度成正比,ALB水平与病情严重程度成反比(P<0.05)。结论 治疗前新生儿病理性黄疸血清总胆红素、AST、ALT水平越低,ALB越高,可提示患儿病情程度越轻,从而越有利于蓝光治疗效果。

中医治疗病理性瘢痕的研究进展

病理性瘢痕不仅影响美观,严重者还可引发功能障碍以及焦虑情绪。目前西医治疗方案众多,但因其增生力强、复发率高的特点,一直是国内外专家研究的热点和思考的难题。临床研究发现,中医治疗本病效果好,具有不良作用少、复发率低的优势。作者对中医治疗病理性瘢痕的研究进行综述,以期为治疗方案的选择提供参考,为患者制定个体化、科学有效的治疗方案。

薄型子宫内膜的病理生理特征和治疗的研究进展

良好的子宫内膜容受性对成功妊娠至关重要,子宫内膜过薄会导致内膜容受性受损,造成不良妊娠结局。如何治疗薄型子宫内膜、改善内膜容受性、提高胚胎种植率是生殖领域亟需解决的问题。研究薄型子宫内膜的病理生理特征能使临床治疗更具针对性。上皮细胞和巨噬细胞等增殖受损、卵巢类固醇激素及其受体表达减少、细胞外基质过度沉积和细胞衰老等共同参与了薄型子宫内膜的发生和发展。临床治疗薄型子宫内膜的方式较多,如使用雌激素、阿司匹林、他莫昔芬等辅助药物,盆底神经肌肉电刺激,干细胞移植,宫腔灌注粒细胞集落刺激因子和富血小板血浆等,但仍有部分顽固性难治性薄型子宫内膜患者对这些治疗方式反应不佳。现对薄型子宫内膜的病理生理特征及临床治疗进展进行综述。

宫颈子宫内膜异位症84例临床病例分析

目的:探讨宫颈子宫内膜异位症的临床特点、治疗和预后。方法:回顾2009年1月—2021年1月首都医科大学附属北京妇产医院收治的经组织病理学确诊为宫颈子宫内膜异位症的84例患者的临床资料,分析其临床表现、辅助检查、术中所见、病理特点及预后。结果:①84例患者中,临床无相关症状患者73例(86.9%),有痛经、接触性出血和间断高热患者各1例(1.2%),不规则子宫出血患者8例(9.5%),其中6例患者为阴道间断或持续少量出血,1例患者为绝经后少量阴道出血,1例患者为阴道大量出血;②术前盆腔超声检查提示宫颈异常回声19例(22.6%),11例行磁共振成像检查的患者中仅3例提示宫颈出血性囊性占位;③术中肉眼可见14例宫颈局部紫蓝色病灶和12例宫颈囊肿,58例肉眼未见明显子宫内膜异位病灶,患者术后病理均提示宫颈子宫内膜异位病灶,17例患者合并妇科恶性肿瘤,17例患者合并宫颈上皮内瘤变。84例患者随访时间36~180个月,均未见复发。结论:宫颈子宫内膜异位症发病隐匿,多数无临床症状,可出现感染、大量阴道出血等症状,因其可恶变或与妇科恶性疾病共存,需引起临床关注。

前列腺导管内癌对高危前列腺癌新辅助治疗效果的影响

目的探究在局部高危前列腺癌患者中存在前列腺导管内癌(IDC-P)成分的患者对于新辅助治疗的反应情况。方法对南京大学医学院附属鼓楼医院的确诊为前列腺癌的80例患者进行回顾性研究分析,通过穿刺中是否存在IDC-P成分以及患者接受6个月新辅助治疗后大病理中客观缓解情况,以评估IDC-P患者接受新辅助治疗的疗效。结果高国际泌尿病理协会分级ISUP(P=0.037)、临床T分期(P=0.036)、神经侵犯有关(P=0.041)与IDC-P有关。单因素分析显示存在IDC-P是病理客观缓解(OR=8.022,95%CI:1.550~41.515,P=0.013)的影响因素。结论局部高危前列腺癌患者中含IDC-P成分对新辅助治疗效果更差。

混合型肝细胞癌-胆管癌的诊疗进展

混合型肝细胞癌-胆管癌(cHCC-CCA)是常见的原发性肝癌之一,其同时具有肝细胞癌(HCC)和肝内胆管癌(iCCA)的特征。在临床上,cHCC-CCA较HCC和iCCA更为少见。由于组织来源丰富以及缺乏特异性临床表现,cHCC-CCA的病理诊断和治疗方案选择往往难度加大。目前治疗cHCC-CCA的方法包括手术治疗、局部治疗、辅助治疗等,但不同治疗方法在cHCC-CCA中的应用价值仍有待探讨。随着cHCC-CCA的病理诊断及治疗方案的不断完善,明确其组织来源和表型将有助于进一步优化治疗方案,使患者得到更大获益。

乳腺癌新辅助治疗后乳房与腋窝病理学完全缓解影响因素分析

目的探讨乳腺癌新辅助治疗(neoadjuvant therapy,NAT)后乳房及腋窝病理学完全缓解(pathological complete response,pCR)的影响因素,为NAT后腋窝手术降级的可行性提供一定参考。方法按照纳入与排除标准,回顾性收集吉林大学中日联谊医院2015年至今收治的NAT乳腺癌患者,纳入患者为乳腺癌伴同侧腋窝淋巴结转移,均接受了标准NAT后行乳腺癌改良根治术。收集患者相关指标,采用χ2检验和多因素Logistic回归分析影响乳房和腋窝pCR的因素,并探讨NAT后乳房pCR指导腋窝手术降级的可行性。结果本研究共纳入符合条件的患者110例,其中达到乳房pCR42例(38.2%),达到腋窝pCR 59例(53.6%),总体pCR 37例(33.6%)。单因素分析结果发现,N分期、雌激素受体(ER)、人表皮生长因子受体2(HER2)、Ki67、分子分型和新辅助方案与乳房pCR有关(P<0.05);ER、孕激素受体(PR)、HER2、分子分型、新辅助方案和乳房pCR与腋窝pCR有关(P<0.05)。进一步多因素Logistic回归分析结果显示,接受化疗联合双靶方案的患者相较接受多药化疗方案的患者更容易得到乳房pCR(OR=6.957,95%CI=1.124,43.043,P<0.05);达到乳房pCR患者相较未达到患者更容易得到腋窝pCR(OR=11.954,95%CI=3.475,41.114,P<0.001)。结论NAT后接受化疗联合双靶方案的患者获得乳房pCR的可能性较大,达到乳房pCR的患者获得腋窝pCR的可能性较大,乳房pCR对腋窝手术降级具有参考价值。

额颞叶痴呆治疗进展

额颞叶痴呆(frontotemporal dementia,FTD)是一组临床表型多样,遗传因素复杂,神经病理高度异质的以进行性人格行为改变,执行功能障碍及言语障碍为特征的神经退行性疾病。目前尚无有效治疗方法可以治愈或者逆转FTD进展,临床常采用对症治疗策略改善FTD患者神经精神、运动及认知症状。随着FTD发病机制的深入研究,越来越多靶向FTD突变基因及神经病理的药物正进入临床试验,以实现疾病的早期管理,精准治疗。本文主要就FTD治疗进展进行综述,有助于临床医师了解FTD最新治疗信息,提高FTD疾病管理。

病理性瘢痕的注射治疗进展

皮肤伤口的愈合是一个相对复杂的生物学过程,此过程涉及成纤维细胞与巨噬细胞等多种细胞在不同愈合阶段的共同协调,包括细胞迁移和增殖、血管再生、细胞外基质沉积和重塑。修复过程中任何阶段的异常愈合都可能导致病理性瘢痕的发生,临床上根据病理性瘢痕的持续时间、瘢痕组织内胶原蛋白的排列以及是否侵犯周围正常皮肤,可将其分为增生性瘢痕与瘢痕疙瘩。目前的治疗手段包括病灶内注射疗法、手术切除以及放射治疗。注射疗法因其廉价与易操作性作为临床上主要的治疗手段,且随着药理学及细胞因子的深入研究,以及多种辅助注射手段与工具的开发,注射疗法的优势与可行性进一步得到了提高。本文围绕伤口愈合过程中病理性瘢痕最新的注射治疗相关进展等进行综述。