Impact of lymphatic and/or blood vessel invasion in stage Ⅱ gastric cancer

AIM： To determine the prognostic value of lymphatic and/or blood vessel invasion （LBVI） in patients with stage 11 gastric cancer. METHODS： From January 2001 to December 2006, 487 patients with histologically confirmed primary gas- tric adenocarcinoma were diagnosed with stage 11 gas- tric cancer according to the new 7th edition American Joint Committee on Cancer stage classification at the Department of Gastric Cancer and Soft Tissue Surgery, Fudan University Shanghai Cancer Center. All patients underwent curative gastrectomy with standard lymph node （LN） dissection. Fifty-one patients who died in the postoperative period, due to various complications or other conditions, were excluded. Clinicopathologicalfindings and clinical outcomes were analyzed. Patients were subdivided into four groups according to the status of LBVI and LN metastases. These four patient groups were characterized with regard to age, sex, tumor site, pT category, tumor grading and surgical procedure （subtotal resection vs total resection）, and compared for 5-year overall survival by univariate and multivariate analysis. RESULTS： The study was composed of 320 men and 116 women aged 58.9 ± 11.5 years （range： 23-88 years）. The 5-year overall survival rates were 50.7% and the median survival time was 62 too. Stage Ⅱ a cancer was observed in 334 patients, including 268 T3N0, 63 T2N1, and three TIN2, and stage Ⅱb was observed in 102 patients, including 49 patients T3N1, 51 T2N2, one TIN3, and one T4aN0. The incidence of LBVI was 28.0% in stage II gastric cancer with 19.0% （51/269） and 42.5% （71/167） in LN-negative and LN- positive patients, respectively. In 218 patients （50.0%）, there was neither a histopathologically detectable LBVI nor LN metastases （LBVI-/LN-, group I）; in 51 patients （11.7%）, LBVI with no evidence of LN me- tastases was detected （LBVILN-, group 11）. In 167 patients （38.3%）, LN metastases were found. Among those patients, LBVI was not determined in 96 patients （22.0%） （LBVI-γLN, group Ⅲ）, and was determined in 71 patients （16.3%） （LBVI＋LN＋, group Ⅳ）. Correla- tion analysis showed that N category and the number of positive LNs were significantly associated with the presence of LBVI （P 〈 0.001）. The overall 5-year sur- vival was significantly longer in LN-negative patients compared with LN-positive patients （56.1% vs 42.3%, P = 0.015）. There was a significant difference in the overall 5-year survival between LBVI-positive and LBVI- negative tumors （39.6% vs 54.8%, P = 0.006）. Overall 5-year survival rates in each group were 58.8% （ Ⅰ）, 45.8% （Ⅱ）, 45.7% （Ⅲ） and 36.9% （Ⅳ）, and there was a significant difference in overall survival between the four groups （P=-0.009）. Multivariate analysis in stage 11 gastric cancer patients revealed that LBVI in- dependently affected patient prognosis in LN-negativepatients （P = 0.018） but not in LN-positive patients （P = 0.508）. CONCLUSION： In LN-negative stage 11 gastric cancer patients, LBVI is an additional independent prognostic markeF, and may provide useful information to identify patients with poorer prognosis.

Retrospective evaluation of lymphatic and blood vessel invasion and Borrmann types in advanced proximal gastric cancer

BACKGROUND The Borrmann classification system is used to describe the macroscopic appearance of advanced gastric cancer,and Borrmann typeⅣdisease is independently associated with a poor prognosis.AIM To evaluate the prognostic significance of lymphatic and/or blood vessel invasion(LBVI)combined with the Borrmann type in advanced proximal gastric cancer(APGC).METHODS The clinicopathological and survival data of 440 patients with APGC who underwent curative surgery between 2005 and 2012 were retrospectively analyzed.RESULTS In these 440 patients,LBVI+status was associated with Borrmann typeⅣ,low histological grade,large tumor size,and advanced pT and pN status.The 5-year survival rate of LBVI+patients was significantly lower than that of LBVI– patients,although LBVI was not an independent prognostic factor in the multivariate analysis.No significant difference in the prognosis of patients with Borrmann typeⅢ/LBVI+disease and patients with Borrmann typeⅣdisease was observed.Therefore,we proposed a revised Borrmann typeⅣ(r-BorⅣ)as Borrmann typeⅢplus LBVI+,and found that r-BorⅣwas associated with poor prognosis in patients with APGC,which outweighed the prognostic significance of pT status.CONCLUSION LBVI is related to the prognosis of APGC,but is not an independent prognostic factor.LBVI status can be used to differentiate Borrmann typesⅢandⅣ,and the same approach can be used to treat r-BorⅣand Borrmann typeⅣ.

A Meta-Analysis of Lymphatic Vessel Invasion Correlated with Pathologic Factors in Invasive Breast Cancer

Objectives: The invasive breast cancer is divided into four clinical subtypes: Luminal A-like, Luminal B-like, HER-2 positive, and triple-negative according to the expression status of estrogen receptor (ER), progesterone receptor(PR), human epidermal growth factor receptor-2 (HER-2) and Ki-67. The prognosis and treatment strategy vary with subtypes. The current studies have reported the relation between lymphatic vessel invasion (LVI) and the expression status of ER, PR, HER-2, Ki-67 in invasive breast cancer, but the results were debatable. So the meta-analysis was conducted to confirm the relation between LVI and the four factors. Methods: Literature was searched by entering the terms: breast AND (neoplasm OR cancer OR carcinoma) AND (lymphovascular OR “lymph vessel” OR “lymphatic vessel” invasion OR carcinoma embolus) AND (ER OR estrogen receptor OR PR OR progesterone receptor OR HER-2 OR human epidermal growth factor receptor-2 OR Ki-67 OR clinicopathological) in Pubmed. The merged odds ratio (OR) and 95% confidence interval (CI) were estimated using fixed-effect model. Review Manager 5.2 was used to analysis the relation between LVI and the expression status of ER, PR, HER-2, Ki-67 in invasive breast cancer respectively. The fail-safe number was used to estimate publication bias. Results: The analysis included 5 studies, LVI positive rate was significant lower in ER positive, PR positive, HER-2 negative, low Ki-67 expression group statistically. The OR and 95% CI were 0.6(0.44 - 0.81), 0.64(0.43 - 0.95), 1.52(1.03 - 2.24), 5.29(1.53 - 18.35) respectively.Conclusions:?LVI was significantly correlated with the expression status of ER, PR, HER-2 and Ki-67 in invasive breast cancer. Furthermore, LVI was consistent with poor prognostic expression status of the four factors.

Detection of D2-40 monoclonal antibody-labeled lymphatic vessel invasion in esophageal squamous cell carcinoma and its clinicopathologic significance

Objective： This study aims to investigate the clinicopathologic significance of lymphatic vessel invasion （LVI） labeled by D2-40 monoclonal antibody in esophageal squamous cell carcinoma （ESCC）. Methods： Immunohistochemical assay was used to detect the expression of D2-40 and LVI in 107 ESCC patients. Then, the correlation between the clinicopathologic feature and the overall survival time of the patients was analyzed. Results： The lymph node metastasis rates were 70% and 21% in the LVI-positive and LVI-negative groups, respectively. The nodal metastasis rate was higher in the LVI-positive group than in the LVI-negative group. Multivariate regression analysis showed that LVI was related to nodal metastasis （P〈0.001）. The median survival time of the patients was 26 and 43 months in the LVI-positive and LVI-negative groups, respectively. Mthough univariate regression analysis showed significant difference between the two groups （P=0.014）, multivariate regression analysis revealed that LVI was not an independent prognostic factor for overall survival in the ESCC patients （P=0.062）. Lymphatic node metastasis （P=0.031）, clinical stage （P=0.019）, and residual tumor （P=0.026） were the independent prognostic factors. Conclusion： LVI labeled by D2-40 monoclonal antibody is a risk factor predictive of lymph node metastasis in ESCC patients.

Tumor-Associated Lymphatic and Venous Vessels in Medullary Thyroid Carcinomas

Objective: Medullary thyroid carcinomas (MTCs) invade local lymph node through lymphatic vessels and metastasize to distant organs hematogenously and account for a significant mortality. There are possibly increased lymphatic and venous vessels, through which the tumor spreads to lymph nodes and distant organs. Materials and Methods: By immunocytochemical staining for lymphatic and venous vessels, MTC lesions with adjacent normal thyroid and both normal and metastatic lymph nodes were studied for the peritumoral lymphatic and venous vessels, which were morphometrically compared with those of normal thyroid and lymph nodes. Sixteen cases of MTC cases with adjacent thyroid tissues and attached lymph nodes were immunocytochemically stained for lymphatic vessels using lymphatic vessel hyaluronan receptor (LYVE-1) and venous vessels for factor VIII (F-8). The immunostained sections of MTC lesions and metastatic lymph nodes were morphometrically compared for the number and sizes of the vessels with those of normal thyroid tissues and lymph nodes. Results: Significantly increased lymphatic vessels and markedly increased blood vessels were identified in many MTC cases at the peritumoral tissues and metastatic lymph nodes whereas a few lymphatic vessels and no venous vessels were identified in midst of MTCs. The irregular peritumoral lymphatic vessels resembled that of immature lymphatic vessels observed in papillary thyroid carcinomas and increased irregularly, entrapped venous vessels in peritumoral tissues resembled those observed in follicular thyroid carcinomas. Conclusion: The significantly increased lymphatic vessels and markedly increased venous vessels in the peritumoral thyroid tissue support a propensity of MTCs for providing an easy access of tumor cells to both lymphatic spread to the regional lymph nodes and venous spread to distant organs with further tumor spread through metastatic lymph nodes by moderately increased lymphatic and venous vessels.

Assessment of vascular invasion in gastric cancer: A comparative study

AIM: To evaluate and compare detection of lymphatic and blood vessel invasion (LVI and BVI) by hematox-ylin-eosin (HE) and immunohistochemistry (IHC) in gastric cancer specimens, and to correlate with lymph node status. METHODS: IHC using D2-40 (a lymphatic endothelial marker) and CD34 (a pan-endothelial marker) was performed to study LVI and BVI in surgical specimens froma consecutive series of 95 primary gastric cancer cases. The results of the IHC study were compared with the detection by HE using McNemar test and kappa index. The morphologic features of the tumors and the presence of LVI and BVI were related to the presence of lymph node metastasis. A χ2 test was performed to obtain associations between LVI and BVI and other prognostic factors for gastric cancer. RESULTS: The detection rate of LVI was considerably higher than that of BVI. The IHC study identified eight false-positive cases and 13 false-negative cases for LVI, and 24 false-positive cases and 10 false-negative cases for BVI. The average Kappa value determined was moderate for LVI (k=0.50) and low for BVI (k=0.20). Both LVI and BVI were statistically associated with the presence of lymph node metastasis (HE: P=0.001, P=0.013, and IHC: P=0.001, P=0.019). The mor-phologic features associated with LVI were location of the tumor in the distal third of the stomach (P=0.039), Borrmann's macroscopic type (P=0.001), organ inva-sion (P=0.03) and the depth of tumor invasion (P=0.001). The presence of BVI was related only to the depth of tumor invasion (P=0.003). CONCLUSION: The immunohistochemical identification of lymphatic and blood vessels is useful for increasing the accuracy of the diagnosis of vessel invasion and for predicting lymph node metastasis.

LYVE1+巨噬细胞在RA患者关节滑膜组织中表达变化及对RA-FLS细胞迁移、侵袭、FMT的抑制作用

目的观察淋巴管内皮受体-1(LYVE1)+巨噬细胞在类风湿性关节炎(RA)患者关节滑膜组织中的表达变化及对RA成纤维样滑膜细胞(RA-FLS)迁移、侵袭、向肌成纤维细胞转化(FMT)的抑制作用。方法采用免疫荧光染色法对45例RA患者及45例骨关节炎(OA)患者滑膜组织LYVE1、CD68进行定性、定量检测。取对数生长期人单核白血病细胞THP-1,在培养液中加入LYVE1过表达慢病毒,培养48 h获得表达LYVE1的THP-1细胞,在表达LYVE1的THP-1细胞中加入100 ng/mL的佛波酯(PMA)诱导培养48 h,获得LYVE1+巨噬细胞;另取部分THP-1细胞,仅加入100 ng/mL的PMA诱导培养48 h获得LYVE1-巨噬细胞。取对数生长期人类风湿性关节炎成纤维细胞MH7A分为LYVE1+巨噬细胞组、LYVE1-巨噬细胞组,分别加入LYVE1+巨噬细胞、LYVE1-巨噬细胞,另将仅含培养基的小室设为空白对照组,采用划痕实验观察各组细胞的迁移能力。取MH7A细胞分为A组、B组,分别加入LYVE1+巨噬细胞、LYVE1-巨噬细胞,将仅含培养基小室设为C组,采用Transwell侵袭实验观察各组细胞的侵袭能力。取MH7A细胞分为一组、二组,分别加入LYVE1+巨噬细胞、LYVE1-巨噬细胞,将仅含培养基小室设为空白组,培养48 h时采用实时定量PCR法检测各组MH7A细胞FMT相关基因(COL1A1、fibronectin、α-SMA)的mRNA。结果RA与OA患者滑膜组织中LYVE1、CD68表达位置基本重叠;RA与OA患者滑膜组织LYVE1相对表达量分别为0.319±0.033、1.000±0.159,二者比较,P<0.05。与LYVE1-巨噬细胞组、空白对照组比较,培养24、48 h时LYVE1+巨噬细胞组细胞划痕愈合比低(P均<0.05);与B组、C组比较,培养24 h时A组细胞穿膜细胞数少(P均<0.05);与二组、空白组比较,培养48 h时一组细胞COL1A1 mRNA、fibronectin mRNA、α-SMA mRNA相对表达量少(P均<0.05)。结论RA患者关节滑膜组织中LYVE1+巨噬细胞低表达。LYVE1+巨噬细胞可抑制RA-FLS的迁移、侵袭及FMT。

术前CT评价壁外血管侵犯情况对胃癌患者预后的评估价值

目的探讨术前CT评价壁外血管侵犯情况对胃癌患者预后的评估价值。方法选择2016年1月-2018年12月于我院接受胃癌根治术的患者作为研究对象,术前进行CT检查并评价患者壁外血管侵犯情况,术后随访患者总生存期(OS)和无病生存期(DFS),采用K-M曲线及Log-rank检验分析壁外血管侵犯情况与患者OS、DFS的关系,采用COX回归模型分析患者OS和DFS的影响因素。结果肿瘤直径≥5 cm、TNMⅢ期胃癌患者术前CT评价壁外血管侵犯的发生率明显高于肿瘤直径<5 cm、TNMⅠ~Ⅱ期胃癌患者(χ^(2)=7.745、7.011,P<0.05);与术前CT评价壁外血管未侵犯的胃癌患者比较,壁外血管侵犯的胃癌患者DFS和OS均明显缩短(χ^(2)=6.245、5.388,P<0.05);壁外血管侵犯、TNM分期是胃癌患者DFS的影响因素,壁外血管侵犯、肿瘤直径、TNM分期是胃癌患者OS的影响因素。结论术前CT评价壁外血管侵犯情况对胃癌患者预后评估有较大的临床价值。

Ⅱ期结肠癌患者术后3年生存情况及预后影响因素分析

目的:探讨Ⅱ期结肠癌患者术后3年生存情况及预后影响因素。方法:选取2018年6月—2020年11月于鞍山市中心医院普外科进行结肠癌根治术治疗的172例Ⅱ期结肠癌患者作为研究对象,根据术后3年是否存活分为3年死亡组和3年存活组,比较两组临床资料,分析Ⅱ期结肠癌患者预后影响因素。结果:随访3年,172例Ⅱ期结肠癌患者140例生存,3年生存率为81.40%。肿瘤分期、壁外血管侵犯情况、D-二聚体水平是Ⅱ期结肠癌患者预后的影响因素,差异有统计学意义(P<0.05)。以Ⅱ期结肠癌患者预后作为因变量,将单因素分析结果中差异有统计学意义的指标作为自变量,纳入多因素COX回归分析模型进行多因素分析,结果显示,壁外血管侵犯情况、D-二聚体水平为Ⅱ期结肠癌患者预后的独立影响因素(P<0.05)。结论:壁外血管侵犯情况、D-二聚体水平为Ⅱ期结肠癌患者预后的独立影响因素,建议临床对存在不良预后影响因素的Ⅱ期结肠癌患者给予相关干预措施。

经阴道彩超在卵巢癌周围血管受侵程度及可切除性中的评估价值

目的:研究经阴道彩超在卵巢癌周围血管受侵程度、可切除性中的评估价值。方法:选取2020年1月—2022年1月在泗水县人民医院确诊的卵巢癌患者80例为研究对象,对比周围血管侵袭、周围血管未侵袭患者的动脉血管舒张末期流速(EDV)、阻力指数(RI)、搏动指数(PI)、峰值流速(PSV)水平。对比可切除患者、不可切除患者的EDV、PSV、RI、PI水平。计算经阴道彩超评估卵巢癌周围血管受侵程度、可切除性的灵敏度、特异度。结果:根据病理检查结果,周围血管侵袭42例,周围血管未侵袭38例。周围血管侵袭EDV、PSV水平高于周围血管未侵袭患者,RI、PI水平低于周围血管未侵袭患者,差异有统计学意义(P<0.05)。经阴道彩超评估卵巢癌周围血管受侵犯的灵敏度与特异度分别为95.24%(40/42)和94.74%(36/38)。根据临床结果,切除卵巢癌45例,未切除卵巢癌35例。手术切除患者EDV、PSV水平低于手术未切除患者,RI、PI水平高于手术未切除患者,差异有统计学意义(P<0.05)。经阴道彩超评估卵巢癌可切除性的灵敏度与特异度分别为95.56%(43/45)和97.14%(34/35)。结论:经阴道彩超在评估卵巢癌周围血管受侵程度及可切除性中具有较高的价值。

术前256层螺旋CT双低剂量扫描对结肠癌肿瘤侵犯及肠系膜血管分布的评估价值

目的:探究术前256层螺旋CT双低剂量扫描对结肠癌肿瘤侵犯及肠系膜血管分布的评估价值。方法:选取在医院拟行腹腔镜结肠癌根治术的140例患者,采用随机数表法分为双低剂量组与常规剂量组,每组70例。双低剂量组与常规剂量组术前分别行256层螺旋CT双低剂量、常规剂量扫描。比较两组图像质量客观及主观评价、辐射剂量,以术后病理组织学诊断结果为“金标准”,分析常规剂量、双低剂量CT评估结肠癌肿瘤侵犯及肠系膜血管分布的准确率。结果:双低剂量组信噪比(SNR)、对比度噪声比(CNR)、噪声、CT值均低于常规剂量组,差异有统计学意义(t=14.415,t=16.045,t=2.163,t=30.096;P<0.05);2名医师对双低剂量组图像质量评分略低于常规剂量组,但两组间无明显统计学差异;双低剂量组剂量长度乘积(DLP)、容积CT剂量指数(CTDIvol)、有效剂量(ED)均低于常规剂量组,差异有统计学意义(t=20.227,t=21.355,t=24.207;P<0.05);双低剂量CT评估淋巴结转移、脉管侵犯、神经侵犯的准确率[(86.21%(25/29)和85.71%(18/21)和94.44%(17/18)]与术后病理比较,差异无统计学意义;双低剂量CT评估肠系膜上静脉组织、动脉分布于肠系膜上静脉背侧、动脉分布于肠系膜上静脉腹侧的准确率分别为98.57%(68/70)、90.32(28/31)和94.59%(35/37)与术后病理比较,差异无统计学意义。结论:结肠癌术前256层螺旋CT双低剂量扫描能提高图像质量,在降低辐射剂量及图像噪声方面具有明显优势,且能够准确评估结肠癌术前肿瘤侵犯及肠系膜血管的分布情况。

Molecular events in the jaw vascular unit:A traditional review of the mechanisms involved in inflammatory jaw bone diseases

Inflammatory jaw bone diseases are common in stomatology,including periodontitis,peri-implantitis,medication-related osteonecrosis of the jaw,radiation osteomyelitis of the jaw,age-related osteoporosis,and other specific infections.These diseases may lead to tooth loss and maxillofacial deformities,severely affecting patients'quality of life.Over the years,the reconstruction of jaw bone deficiency caused by inflammatory diseases has emerged as a medical and socioeconomic challenge.Therefore,exploring the pathogenesis of inflammatory diseases associated with jaw bones is crucial for improving prognosis and developing new targeted therapies.Accumulating evidence indicates that the integrated bone formation and dysfunction arise from complex interactions among a network of multiple cell types,including osteoblast-associated cells,immune cells,blood vessels,and lymphatic vessels.However,the role of these different cells in the inflammatory process and the'rules'with which they interact are still not fully understood.Although many investigations have focused on specific pathological processes and molecular events in inflammatory jaw diseases,few articles offer a perspective of integration.Here,we review the changes and mechanisms of various cell types in inflammatory jaw diseases,with the hope of providing insights to drive future research in this field.

口腔癌VEGF-C mRNA表达和血管及淋巴管生成与淋巴道转移关系的研究

背景与目的:VEGF-C与癌周的淋巴管血管生成以及肿瘤的淋巴道转移可能有密切的关系,本研究探讨口腔鳞癌组织血管、淋巴管密度与VEGF-CmRNA表达及淋巴道转移的关系。方法:VEGF-C逆转录PCR(RT-PCR),血管、淋巴管酶组化染色、光镜及图像分析观察血管、淋巴管总体面数密度(TNa)。结果:VEGF-CmRNA表达阳性的淋巴管TNa(26.42±5.85)明显高于阴性淋巴管TNa(17.34±6.48)(P<0.01);VEGF-CmRNA表达阳性的血管TNa(35.16±15.55)略高于阴性的血管TNa(33.49±13.73)(P>0.05)。淋巴结转移组血管TNa(44.19±14.29)比无淋巴结转移组TNa(30.61±11.82)增加(P<0.01)、淋巴结转移组淋巴管TNa(30.67±5.76)比无淋巴结转移组TNa(21.94±5.84)增加(P<0.01)。结论:VEGF-C主要介导了癌周淋巴管生成,对血管生成有一定影响;血管、淋巴管密度的同时增加可能与VEGF、VEGF-C及其受体的协同表达有一定关系。

多肽胰岛素正常转运经淋巴而非门脉途径:IGMEI胰组织注射SEM观察

探讨胰岛素等多肽激素在细胞外的正常转运途径或规律。对免疫金标记外源性胰岛素(IGMEI)注射的大鼠胰组织冷冻切片 ,进行了二次电子和背散射电子图像 (SEI BEI)的扫描电镜(SEM)示踪性观察。SEM观察SEI显示胰腺小叶和小叶间结缔组织 ,血管和淋巴管 ,胰腺导管和胰岛的结构特点清晰可见。根据管腔内是否存在红细胞和内皮细胞的结构特点 ,可以区别血管或淋巴管。SEM观察BEI表明 ,较强的背散射电子出现在胰结缔组织间隙、淋巴管或毛细淋巴管内 ;然而 ,胰的血管或毛细血管内 ,无标记金颗粒的背散射电子或BEI微弱。结果提示 ,注射或释放入胰组织液中的胰岛素等多肽激素或分泌颗粒 ,其正常转运途径或规律 。

D2-40标记的乳腺癌淋巴管浸润与淋巴结转移的关系

目的探讨D2-40标记乳腺癌组织淋巴管的可行性及淋巴管浸润(LVI)的临床病理学意义。方法采用二步法免疫组化染色检测72例乳腺癌和15例乳腺良性病变组织中D2-40的表达及淋巴管受癌细胞浸润情况,分析其与乳腺癌病理参数的关系。结果乳腺癌组织中的LVI阳性率为69.4%;腋淋巴结转移组LVI阳性率85.7%,未转移组了LVI阳性率54.1%,转移组高于未转移组,差异具有显著性(P<0.01);LVI与患者腋窝淋巴结转移呈正相关(r=0.382),淋巴结转移大于10个患者中,LVI阳性率最高(100%),淋巴结阴性组LVI阳性率最低(54.1%)。结论 D2-40可作为可靠的淋巴管标记物;LVI与乳腺癌淋巴结转移呈正相关,早于淋巴结转移出现,可作为临床病理学检测项目。

肿瘤侵犯大血管的外科治疗

目的 探讨累及大血管的肿瘤切除及受侵犯血管的处理方法 ,以提高肿瘤的切除率及术后生存率。方法 总结 1998年 10月～ 2 0 0 4年 2月的 2 6例累及重要血管的肿瘤切除及血管重建的经验。结果 2 6例患者均无术后人工血管感染 ,血肿形成等。获随访 2 3例 ,随访时间 2～ 65个月 ,平均 42 .8个月。术后随访分别行彩色超声或CT血管显影 (CTA )检查 ,5例胰头癌和 1例胆管癌患者下腔静脉、门静脉置换后 ,3例分别于术后 3～ 15个月并发癌栓形成 ,术后远期通畅率为 5 0 % ,肿瘤分别于术后 3～ 3 1个月复发。 7例盆腔和腹膜后肿瘤切除血管置换患者术后获随访 2年 ,1例复发 ,但血管通畅。 2例四肢肉瘤患者随访 1年未见复发 ,血管通畅。 11例颈部肿瘤切除、血管置换患者术后随访 3个月至 5年 ,目前血管通畅 ,肿瘤未见复发。结论 对累及重要血管的肿瘤患者行肿瘤切除并大血管切除重建手术是安全的 ,可明显提高切除率、降低复发率 ,延长存活时间。

免疫球蛋白超家族黏附分子在淋巴管和不同血管内皮细胞的表达

目的比较免疫球蛋白超家族黏附分子在淋巴管、大血管和微血管内皮细胞的表达特点,探讨免疫球蛋白超家族黏附分子在淋巴管内皮细胞表达的意义。方法从狗的胸导管、颈总动脉、颈内静脉、肺微血管分离内皮细胞,利用免疫荧光标记法检测PECAM-1I、CAM-1I、CAM-3、VCAM-1和CD44在各种内皮细胞的表达,在荧光显微镜和激光共聚焦扫描显微镜下观察,并用图像分析仪分析表达强度。结果动脉、静脉和肺微血管内皮细胞表达PECAM-1I、CAM-1I、CAM-3、VCAM-1和CD44。其中,ICAM-1和ICAM-3的表达较弱。VCAM-1在动脉和肺微血管内皮细胞的表达比静脉强。淋巴管内皮细胞表达PECAM-1、ICAM-1I、CAM-3和CD44,未观察到VCAM-1的表达。ICAM-3和CD44的表达比血管内皮细胞强。结论与动脉、静脉和微血管内皮细胞比较,淋巴管内皮细胞不表达VCAM-1,而ICAM-3和CD44表达较强,这有助于解释淋巴细胞和肿瘤细胞与淋巴管内皮的黏附以及淋巴管新生的机制。

Ⅰ期、Ⅱ期非小细胞肺癌中血管和淋巴管浸润与预后的关系

为评价Ⅰ、Ⅱ期非小细胞肺癌（NSCLC）中血管浸润（BVI）和淋巴管浸润（LVI）的预后意义，随访76例Ⅰ、Ⅱ期NSCLC病人，HE切片中组织学观察各例NSCLC中的BVI和LVI，Pearsonx2检验分析组间差异，Kaplan－Meier乘积限法和Cox比例风险模型用于生存分析。病人平均年龄56．0岁±8.2岁，中位随访时间为51个月，3年、5年总体生存率分别为68％和64％；BVI（＋）占28％，LVI（＋）占0．7％，BVI（＋）／或LVI（十）占34％；单变量生存分析显示：BVI而非LVI与生存差显著相关（x2=8．66，p=0．003）；Cox回归多变量分析显示：脉管浸润（p=0．003）和淋巴结状况（p=0．01）是影响总体生存的独立预后因素。本研究提示：脉管浸润是评价Ⅰ、Ⅱ期NSCLC病人预后重要的病理因素。

痰瘀理论在医学研究中的应用

中医学是中华民族传统文化对世界文明在医学与哲学方面的重大贡献。痰瘀理论是中医学的重要组成部分,不但在临床诊疗工作中发挥了指导性作用,而且也为相关疾病的基础研究提供了关键思路。近年,淋巴管系统的研究在医学基础研究中逐渐成为热点,尤其在脑部淋巴管系统的结构与功能及脑相关疾病的研究中。施杞教授项目组深入探讨痰瘀理论指导骨伤科临床治疗的现代生物学基础,发现关节旁淋巴管系统对于关节病的治疗康复具有关键作用,阐释了痰瘀型关节病的主要病理机制及有效治疗方剂加味牛蒡子汤的作用机制。

宫颈癌癌前病变及早期癌组织中微淋巴系统的定量观察

目的:探讨宫颈癌前病变和宫颈癌组织中微淋巴管与宫颈癌发生、发展及转移侵袭的关系。方法:部分宫颈组织流式细胞仪检测LYVE-1阳性细胞和Prox-1阳性细胞。46例宫颈组织采用LYVE-1和Prox-1相关抗原免疫组化染色,统计微淋巴管密度及其面积百分比,结合临床资料进行分析。结果:(1)流式细胞检测宫颈组织中存在LY-VE-1(+)和Prox-1(+)细胞;(2)癌前病变LMVD(16.13±10.96)条/4HP,LVA(2.00±1.51)%与Ⅰ期宫颈癌LMVD(24.4±11.39)条/4HP,LVA(2.10±1.61)%相比无统计学差异(P>0.05),与Ⅱ期宫颈癌(28.58±12.29)条/4HP(P<0.01),LVA(3.12±1.77)%相比有显著差异(P<0.01);(3)有淋巴转移者LMVD为(29±11.42)条/4HP,LVA为(3.30±1.76)%相对无转移者(20.23±11.06)条/4HP(2.07±1.14)%均有显著差异(P<0.01);(4)细胞HG1级者LMVD(17.19±9.08)条/4HP,LVA(2.20±1.53)%相对HG3(37.43±8.54)条/4HPLVA(2.85±2.23)%有显著差异(P<0.05);(5)LMVD与LVA与病理类型和月经状态无明显相关。结论:宫颈癌前病变和早期癌组织中高淋巴管分布与淋巴转移,肿瘤病理分期,肿瘤细胞分化程度有关。