Secondary endoscopic submucosal dissection for locally recurrent or incompletely resected gastric neoplasms

AIM To investigate the feasibility and safety of secondary endoscopic submucosal dissection(ESD) for residual or locally recurrent gastric tumors. METHODS Between 2010 and 2017, 1623 consecutive patients underwent ESD for gastric neoplasms at a single tertiary referral center. Among these, 28 patients underwent secondary ESD for a residual or locally recurrent tumor. Our analysis compared clinicopathologic factors between primary ESD and secondary ESD groups. RESULTS The en bloc resection and curative rate of resection of secondary ESD were 92.9% and 89.3%, respectively. The average procedure time of secondary ESD was significantly longer than primary ESD(78.2 min vs 55.1 min, P = 0.004), and the adverse events rate was not significantly different but trended slightly higher in the secondary ESD group compared to the primary ESD group(10.7% vs 3.8%, P = 0.095). Patients who received secondary ESD had favorable outcomes without severe adverse events. During a mean follow-up period, no local recurrence occurred in patients who received secondary ESD. CONCLUSION Secondary ESD of residual or locally recurrent gastric tumors appears to be a feasible and curative treatment though it requires greater technical efficiency and longer procedure time.

Extrapancreatic malignancies and intraductal papillary mucinous neoplasms of the pancreas

Over the last two decades multiple studies have demonstrated an increased incidence of additional malignancies in patients with intraductal papillary mucinous neoplasms(IPMNs).Additional malignancies have been identified in 10%-52% of patients with IPMNs.The majority of these additional cancers occur before or concurrent with the diagnosis of IPMN.The gastrointestinal tract is most commonly involved in secondary malignancies,with benign colon polyps and colon cancer commonly seen in western countries and gastric cancer commonly seen in Asian countries.Other extrapancreatic malignancies associated with IPMNs include benign and malignant esophageal neoplasms,gastrointestinal stromal tumors,carcinoid tumors,hepatobiliary cancers,breast cancers,prostate cancers,and lung cancers.There is no clear etiology for the development of secondary malignancies in patients with IPMN.Although population-based studies have shown different results from single institution studies regarding the exact incidence of additional primary cancers in IPMN patients,both have reached the same conclusion:there is a higher incidence of extrapancreatic malignancies in patients with IPMNs than in the general population.This f inding has signif icant clinical implications for both the initial evaluation and the subsequent long-term followup of patients with IPMNs.If a patient has not had recent colonoscopy,this should be performed during the evaluation of a newly diagnosed IPMN.Upper endoscopy should be performed in patients from Asian countries or for those who present with symptoms suggestive of upper gastrointestinal disease.Routine screening studies(breast and prostate) should be carried out as currently recommended for patient's age both before and after the diagnosis of IPMN.

European vs 2015-World Health Organization clinical molecular and pathological classification of myeloproliferative neoplasms

The BCR/ABL fusion gene or the Ph^1-chromosome in the t(9;22)(q34;q11)exerts a high tyrokinase acticity,which is the cause of chronic myeloid leukemia(CML).The1990 Hannover Bone Marrow Classification separated CML from the myeloproliferative disorders essential thrombocythemia(ET),polycythemia vera(PV)and chronic megakaryocytic granulocytic myeloproliferation(CMGM).The 2006-2008 European Clinical Molecular and Pathological(ECMP)criteria discovered 3variants of thrombocythemia:ET with features of PV(prodromal PV),"true"ET and ET associated with CMGM.The 2008 World Health Organization(WHO)-ECMP and 2014 WHO-CMP classifications defined three phenotypes of JAK2^(V617F)mutated ET:normocellular ET(WHO-ET),hypercelluar ET due to increased erythropoiesis(prodromal PV)and ET with hypercellular megakaryocytic-granulocytic myeloproliferation.The JAK2^(V617F)mutation load in heterozygous WHO-ET is low and associated with normal life expectance.The hetero/homozygous JAK2^(V617F)mutation load in PV and myelofibrosis is related to myeloproliferative neoplasm(MPN)disease burden in terms of symptomaticsplenomegaly,constitutional symptoms,bone marrow hypercellularity and myelofibrosis.JAK2 exon 12mutated MPN presents as idiopathic eryhrocythemia and early stage PV.According to 2014 WHO-CMP criteria JAK2 wild type MPL^(515)mutated ET is the second distinct thrombocythemia featured by clustered giant megakaryocytes with hyperlobulated stag-horn-like nuclei,in a normocellular bone marrow consistent with the diagnosis of"true"ET.JAK2/MPL wild type,calreticulin mutated hypercellular ET appears to be the third distinct thrombocythemia characterized by clustered larged immature dysmorphic megakaryocytes and bulky(bulbous)hyperchromatic nuclei consistent with CMGM or primary megakaryocytic granulocytic myeloproliferation.

PVSG and WHO vs European Clinical,Molecular and Pathological Criteria for prefibrotic myeloproliferative neoplasms

The Polycythemia Vera Study Group(PVSG),World Health Organization(WHO) and European Clinical,Molecular and Pathological(ECMP) classifications agree upon the diagnostic criteria for polycythemia vera(PV) and advanced primary myelofibrosis(MF). Essential thrombocythemia(ET) according to PVSG and 2007/2008 WHO criteria comprises three variants of JAK2V617 F mutated ET when the ECMP criteria are applied. These include normocellular ET,hypercellular ET with features of early PV(prodromal PV),and hypercellular ET due to megakaryocytic,granulocytic myeloprolifera-tion(ET.MGM). Evolution of prodromal PV into overt PV is common. Development of MF is rare in normocellular ET(WHO-ET) but rather common in hypercellular ET.MGM. The JAK2V617 F mutation burden in heterozygous mutated normocellular ET and in heterozygous/homozygous or homozygous mutated PV and ET.MGM is of major prognostic significance. JAK2/MPL wild type ET associated with prefibrotic primary megakaryocytic and granulocytic myeloproliferation(PMGM) is characterized by densely clustered immature dysmorphic megakaryocytes with bulky(bulbous) hyperchromatic nuclei,which are never seen in JAK2V617 F mutated ET,and PV and also not in MPL515 mutated normocellular ET(WHO-ET). JAK2V617 mutation burden,spleen size,LDH,circulating CD34+ cells,and pre-treatment bone marrow histopathology are mandatory to stage the myeloproliferative neoplasms ET,PV,PMGM for proper prognosis assessment and therapeutic implications. MF itself is not a disease because reticulin fibrosis and reticulin/collagen fibrosis are secondary responses of activated polyclonal fibroblasts to cytokines released from the clonal myeloproliferative granulocytic and megakaryocytic progenitor cells in ET.MGM,PV and PMGM.

Epithelioid Angiosarcoma of Bone: A Neoplasm with Potential Pitfalls in Diagnosis

Angiosarcoma of bone is an exceedingly rare primary bone malignancy that can present as an aggressive osteolytic lesion. This subset can radiologically mimic non-vascular neoplasms and impose serious challenges in reaching the correct diagnosis. Meanwhile histological diagnosis can be extremely challenging too, as the pathological features often resemble that of aneurysmal bone cysts. We present an unusual case of a 22-year-old woman who presented with a rapidly growing humeral tumor of 8 months’ duration. The case of intraosseous angiosarcoma presented as a diagnostic dilemma and the relevant radiological and pathologic findings were discussed. We describe the clinical, radiological and pathological features of this unique case, and review the literature concerning Angiosarcoma of bone. Our case highlights the diagnostic difficulties for such very rare tumours and clinico-pathological correlation is of paramount importance to differential diagnosis.

Bone Dysmorphia-Induced Blindness Following a Secondary Hyperparathyroidism: A Case Report

Introduction: Conjunctival-corneal or choroidal calcifications are frequent in SHPT, blindness is however exceptional. We report a case of blindness secondary to compressive ischemic optic neuropathy. Case Report: Mr. B.E.K., 49 years old, has a chronic renal failure secondary to unlabeled glomerular nephropathy for 17 years. He has been on chronic hemodialysis for 12 years and has had SHPT for nine years. He secondarily developed disabling segmental osteoarticular deformities associated with kyphoscoliosis, “drumstick” fingers and facial dysmorphism. Five months before admission he developed eye pain and reduced visual acuity progressing within one month to blindness. Biology noted: serum creatinine at 726 umol/l (60 - 120 umol/L), azotemia at 14.3 mmol/l (2.5 - 7.5 mmol/L), serum calcium at 2.25 (2.25 - 2.55 mmol/L), phosphatemia at 1.13 (0.8 - 1.35 mmol/L), alkaline phosphatases at 2196 (5 - 270 IU/L) and parathyroid hormone level at 2257 (10 - 60 pg/mL). Retinal angiography revealed lesions suggestive of ischemic neuropathy. The orbit CT scan with 3D coronal reconstruction revealed narrowing of the caliber of the optical channels with dystrophic thickening of the skull base and cranial vault. Cranioencephalic and orbital MRI revealed diffuse brown tumors and pre-chiasmatic optic atrophy. Discussion: The most frequent ocular complications of SHPT are conjunctival-corneal or sclero-choroidal calcifications, asymptomatic, associated with hypercalcemia. Compressive manifestations are rarer, represented mainly by an amputation of the visual field, diplopia, ptosis or blindness, as described in our patient. The main cause is osteodystrophy and brown tumors of the skull base (1% - 2%). Conclusion: This case report underlines the importance of early detection of SHPT, in order to avoid its major complications, such as blindness, especially since current preventive and curative measures have proven their effectiveness.

骨质疏松性椎体压缩骨折二级预防失败患者骨代谢指标及骨密度的变化

目的了解骨质疏松性椎体压缩骨折二级预防失败患者骨代谢指标及骨密度的特点。方法选择2015年1月至2020年1月在我院骨科因骨质疏松性椎体压缩骨折行2次或2次以上手术治疗的患者为观察组研究对象,共65例,同时选择同时期行手术治疗的非多次脊柱压缩骨折患者219例作为配对资料对照组,回顾性分析这284例患者临床资料,记录其术前骨代谢标志物水平及骨密度(bone mineral density,BMD)结果并进行两组患者间比较。结果观察组患者骨代谢标志物中人血清和血浆中的总I型前胶原氨基端肽(tP1NP)、N⁃MID骨钙素(OCN)以及血清25⁃羟维生素D(25⁃hydroxy vitamin D,25OHD)水平与对照组相比差异无统计学意义(P>0.05),骨代谢标志物I型胶原羧基端肽β特殊序列(β⁃CTX)水平明显高于对照组(P<0.05)。两组患者髋部BMD值、股骨颈BMD值差异无统计学意义(P>0.05),观察组腰椎BMD值明显低于对照组(P<0.05)。结论骨质疏松性椎体压缩骨折二级预防失败患者具有更为活跃的骨吸收状态及更低的腰椎骨密度。

乳腺癌细胞条件培养基对骨髓间充质干细胞生物学行为的影响

目的探讨MCF-7乳腺癌细胞条件培养基对骨髓间充质干细胞(BMSC)增殖、凋亡和迁移的影响及分子机制。方法正常环境下培养的BMSC为对照组,以MCF-7细胞条件培养基培养的BMSC为MCF-7条件培养基组,向MCF-7条件培养基组添加10 nmol/L GSK690693(Akt抑制剂)为Akt抑制剂组,向MCF-7条件培养基组添加10µmol/L Reparixin(CXCR1/2抑制剂)为CXCR1/2抑制剂组。MTT实验检测各组BMSC增殖情况,Annexin V-FITC/PI双标记流式细胞凋亡实验检测各组BMSC凋亡率,Transwell细胞迁移实验检测各组BMSC的迁移能力,酶联免疫吸附试验检测两种细胞培养上清液和MCF-7细胞条件培养基中白细胞介素(IL)-8蛋白含量,Western blot检测各组BMSC的蛋白激酶B(Akt)/磷酸化Akt(p-Akt)和哺乳动物雷帕霉素靶蛋白(mTOR)/磷酸化mTOR(p-mTOR)蛋白表达。结果与对照组相比,MCF-7条件培养基组BMSC的细胞增殖水平、迁移数目以及p-Akt和p-mTOR蛋白相对表达量均增高,细胞凋亡率降低(P<0.05);与MCF-7条件培养基组相比,CXCR1/2抑制剂组和Akt抑制剂组BMSC的细胞增殖水平、迁移数目以及p-Akt和p-mTOR蛋白相对表达量均降低,细胞凋亡率增加(P<0.05);MCF-7细胞条件培养基和MCF-7培养上清液中IL-8蛋白含量均较BMSC培养上清液中IL-8蛋白含量高(P<0.05)。结论MCF-7细胞条件培养基通过激活Akt-mTOR信号通路促进BMSC增殖和迁移,抑制BMSC凋亡,其中IL-8-CXCR1/2轴发挥关键作用。

VSD治疗对胫骨骨折术后继发骨感染患者手术指标、炎性因子及功能恢复的影响

目的探讨负压封闭引流技术(VSD)治疗对胫骨骨折术后继发骨感染患者手术指标、炎性因子、功能恢复的影响。方法选取2020年12月至2022年6月河北医科大学第三医院收治的87例胫骨骨折内固定术后继发骨感染患者,均为胫骨干骨折;其中原开放骨折55例,一期均缝合伤口;32例在外伤发生时一期清创后行内固定手术;对患者采用手术清创、去除内固定物,行外固定架固定,经清创后局部均存在创面不能完全闭合,合并骨外露,随机选用VSD覆盖治疗(研究组,n=46)或骨水泥覆盖治疗(对照组,n=41),分析患者病原菌构成分布、比较两组手术指标、炎症因子[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、C反应蛋白(CRP)水平]、功能恢复情况[膝关节、踝关节功能以及肢体功能恢复情况]以及并发症情况。结果87例患者共87株病原菌,其中革兰阳性菌43株(49.42%),革兰阴性菌32株(36.78%),真菌12株(13.80%)。研究组换药次数少于对照组,控制感染时间、创面无菌时长、住院时间、行皮瓣转移手术时间均短于对照组,差异均有统计学意义(P<0.05);治疗后两组TNF-α、IL-6、CRP水平均下降,其中研究组变化最为显著,差异有统计学意义(P<0.05);治疗后两组HSS、Baird-Jackson评分均上升,其中研究组变化最为显著,差异有统计学意义(P<0.05)。研究组优良率为(95.65%)高于对照组优良率(80.49%),差异有统计学意义(P<0.05)。结论在创面不能闭合情况下,VSD治疗胫骨骨折内固定术后继发骨感染患者,可改善患者手术指标、炎性因子水平,促进患者肢体功能恢复,值得临床推广应用。

高载能超声骨刀的优化设计与性能评估

针对超声骨刀在手术过程中切割效率低和产生骨组织热损伤的问题,设计了具有二级放大结构的高载能超声骨刀。基于驻波理论的等效长度法,结合有限元仿真对其二级放大结构进行设计和优化,测试了其振动性能并进行了骨切割试验。结果表明:具有二级放大结构的超声骨刀的谐振频率为23306 Hz,振幅为140μm,骨切割表面平整且无损伤,满足临床手术需求。

结直肠癌肝转移患者的血浆胆汁酸谱特征及临床价值

目的分析不同转移情况结直肠癌患者血浆胆汁酸含量及胆汁酸谱分布的差异,并评估血浆胆汁酸含量比值联合肿瘤标志物对结直肠癌肝转移的诊断价值。方法纳入2021年4月至2022年1月于上海中医药大学附属曙光医院就诊的结直肠腺癌肝转移或无转移患者163例,其中无转移组82例、肝转移组81例。收集患者的临床资料,用Karnofsky功能状态(KPS)评分评估生存质量;收集患者外周血样本,检测总胆汁酸及肿瘤标志物[癌胚抗原(CEA)和糖类抗原125(CA125)]水平,用高效液相色谱-串联质谱法检测血浆中15种胆汁酸的含量。分析两组患者胆汁酸含量及胆汁酸谱分布的差异,并绘制ROC曲线分析胆汁酸含量比值联合肿瘤标志物对结直肠癌肝转移的临床诊断效能。结果两组结直肠癌患者年龄、性别、肿瘤位置、病理分化程度、KPS评分差异无统计学意义(均P>0.05)。肝转移组患者总胆汁酸、CEA、CA125均较无转移组患者升高(均P<0.001),血浆胆汁酸谱中甘氨胆酸、脱氧胆酸、牛磺脱氧胆酸、甘氨脱氧胆酸、甘氨熊脱氧胆酸、石胆酸和甘氨石胆酸含量均较无转移组患者升高(均P<0.05),血浆次级胆汁酸含量高于无转移组患者(P<0.001),次级胆汁酸与初级胆汁酸含量比值高于无转移组患者(P<0.001)。次级胆汁酸与初级胆汁酸含量比值联合CEA、CA125诊断结直肠癌肝转移的灵敏度为71.60%,特异度为80.49%,AUC为0.820(95%CI 0.754~0.885,P<0.001)。结论结直肠癌肝转移患者血浆胆汁酸含量升高,胆汁酸谱异于无转移患者;次级胆汁酸与初级胆汁酸含量比值联合CEA、CA125对结直肠癌肝转移有较高的诊断价值。

帕米膦酸二钠对肺癌骨转移性疼痛及骨纤维结构的影响研究

目的观察帕米膦酸二钠对肺癌骨转移性疼痛的及骨纤维结构的影响。方法南阳医学高等专科学校附属中医院2021年1月至2022年12月收治的109例肺癌骨转移患者,所有患者均伴有不同程度的骨痛症状。采用随机数字表法对入组患者进行分组,即常规组(54例)和试验组(55例)。常规组予以内科综合止痛治疗,试验组在常规组的治疗基础上采用帕米膦酸二钠配合治疗,比较两组患者的骨纤维结构改善情况、疼痛介质变化情况、骨痛缓解情况及预后情况。结果治疗前,两组患者的骨纤维结构相关指标差异无统计学意义(P>0.05);治疗后,试验组的骨钙素、Ⅰ型胶原C端肽、Ⅰ型胶原氨基端前肽均低于常规组(P<0.05)。治疗前,两组患者的疼痛介质差异无统计学意义(P>0.05);治疗后,试验组的前列腺素、血清乳酸均低于常规组(P<0.05)。治疗前,两组患者的骨痛程度差异无统计学意义(P>0.05);在不同治疗方案下,试验组治疗1~3个周期后的视觉模拟疼痛量表评分均低于常规组(P<0.05)。在不同治疗方案下,两组不良反应发生率比较,差异无统计学意义(P>0.05);试验组的肺癌患者生存质量测定量表中,身体状况评分,社交/家庭状况评分,情感状况评分及功能状况评分均高于常规组(P<0.05)。结论帕米膦酸二钠能有效改善肺癌骨转移患者的骨纤维结构,可通过下调疼痛介质水平而缓解骨痛症状,用药安全性良好,对改善患者远期生活质量有积极意义。

双荧光标记的人高骨转移肺腺癌细胞株的建立及其转录组学特征分析

背景与目的骨是肺腺癌常见的转移部位,但肺腺癌骨转移的机制尚不明确。目前肺腺癌骨转移机制研究缺乏易于示踪且稳定高骨转移的肺腺癌细胞模型,因此,本研究旨在建立绿色荧光蛋白(green f luorescent protein,GFP)和萤火虫荧光素酶(firefly luciferase,LUC)双标记的人高骨转移肺腺癌细胞株,为肺腺癌骨转移的研究提供新的实验工具。方法人肺腺癌细胞系A549-GFP-LUC经左心室注射至裸鼠体内构建骨转移模型,经连续3次体内驯化,获取人高骨转移肺腺癌细胞株A549-GFP-LUC-BM3;CCK-8(cell counting kit-8)、克隆形成实验比较A549-GFP-LUC-BM3细胞株和亲本细胞的体外增殖能力,划痕实验、Transwell实验以及Western blot比较迁移和侵袭能力;并进一步将A549-GFP-LUC-BM3细胞和亲本细胞行测序转录组学分析。结果成功建立人高骨转移肺腺癌细胞A549-GFP-LUC-BM3,相较于亲本细胞,该细胞骨转移发生率显著提高,且体外增殖、迁移和侵袭能力显著增强。转录组学测序结果显示,相较于亲本细胞,A549-GFP-LUC-BM3细胞中共筛选到差异基因2954个,其中1021个基因上调,1933个基因下调;基因本体(Gene Ontology,GO)功能富集显示差异基因主要定位于细胞外周、质膜以及细胞外基质等细胞组分,分子功能主要富集在信号受体结合、钙离子结合和细胞外基质结构成分等,生物过程富集在细胞黏附和生物黏附等;京都基因与基因组百科全书(Kyoto Encyclopedia of Genes and Genomes,KEGG)富集分析显示差异基因在细胞色素P450(cytochrome P450,CYP)对外源性物质的代谢、视黄醇代谢、细胞黏附分子、CYP对药物代谢、类固醇激素的生物合成以及核因子κB(nuclear factor kappa B,NF-κB)信号通路上显著富集。结论成功建立GFP和LUC双标记的人高骨转移肺腺癌细胞株,该细胞株在生物学行为水平和转录组测序水平均提示具有高骨转移潜能。

免疫细胞在肿瘤骨转移骨微环境调控中的作用研究进展

肿瘤的发生发展与其所在的微环境密切相关,在肿瘤发生骨转移的过程中,骨髓微环境中大量的免疫细胞对于肿瘤细胞的定植以及转移灶的形成,发挥了重要的作用,其中较为显著的就是协助肿瘤细胞发挥免疫逃逸作用。因此如何针对肿瘤的免疫逃逸进行有效干预显得尤为重要。本文就巨噬细胞、骨髓来源的抑制细胞以及淋巴细胞在肿瘤骨转移中的作用进行综述,为肿瘤免疫治疗的基础研究和临床治疗提供参考。

囊性为主成分的甲状腺鳞状细胞癌1例误诊分析

目的探讨囊性为主成分的甲状腺鳞状细胞癌(SCCT)误诊原因。方法分析1例囊性为主成分的SCCT误诊过程,并对其结局随访,结合相关文献进行讨论。结果男,67岁,发现甲状腺结节3年,颈部彩超发现甲状腺右叶囊实性包块,大小63 mm×49 mm×82 mm,因肿瘤较大且压迫气管,行右侧甲状腺腺叶切除术,术后病理报告为结节性甲状腺肿,伴囊性变及腺瘤样结构形成;遂按结节性甲状腺肿出院。术后1个月,病人颈部出现新生物,进行多项检查及多学科会诊后,取颈部新生物做病理活检,结果为原发性SCCT;第一次手术的诊断出现误诊;病人拒绝放疗并出院,随访结局为死亡,复发后生存期为2.5个月。结论原发性甲状腺鳞状细胞癌(PSCCT)是一种极具侵袭性的肿瘤,预后较差,以囊性结节为首发病例的更少见,容易误诊,需结合病史、临床检查及免疫组化等诊断。

定量测量前列腺周围脂肪组织对预测前列腺癌骨转移的临床价值

目的:建立新发前列腺癌患者骨转移风险列线图预测模型,探讨前列腺周围脂肪组织(PPAT)与前列腺癌骨转移的关系。方法:纳入160例患者(骨转移组、非骨转移组各80例),在MRI图像上定量测量耻骨联合层面腹部皮下脂肪厚度(NFSP)、耻骨联合至椎体前缘的最短直线距离(FNPF)、耻骨联合层面后背部皮下脂肪厚度(BSF)、耻骨联合至前皮下最大距离(PSSF)、耻骨联合至前列腺的最大垂直距离(MDSP)、耻骨联合上缘切线至椎体前缘的距离(PSPF)、前列腺面积(PA)、前列腺周围脂肪面积(PPFA),分析其与前列腺癌骨转移的相关性,筛选特征属性。采用分层随机抽样的方法将160例患者按照7∶3的比例分为训练集和测试集,建立脂肪定量测量回归预测模型,并测试集进行验证。结果:MDSP、PSPF、FNPF、PPFA/PA是前列腺癌骨转移的独立危险因素(均P<0.05)。测试MDSP、PSPF、FNPF、PPFA/PA及包含上述4种特征的联合模型的诊断效能,在训练集AUC分别为0.90、0.78、0.72、0.80、0.92,在测试集AUC为0.87、0.86、0.68、0.79、0.98。结论:基于脂肪定量测量的列线图可很好地预测前列腺癌患者的骨转移风险。

纤维结构不良的致病机制和治疗研究进展

纤维结构不良(FD)是一种由基因突变导致的罕见良性骨肿瘤,主要由鸟嘌呤核苷酸结合蛋白α刺激活性多肽基因突变导致骨骼矿化缺陷、局部破骨细胞增多,从而引起正常骨骼被纤维组织侵蚀。FD可累及各部位骨骼,尚缺乏针对性的分类系统,且难以制订标准术式,目前一般采用髓内钉、椎体切除内固定等手术方式治疗。FD的药物治疗常使用双膦酸盐以缓解骨痛,降低骨折风险。核因子κB受体活化因子配体(RANKL)抑制剂地诺单抗通过抑制FD患者体内RANKL的过量表达阻止病变进展,而生长激素受体拮抗剂培维索孟可降低生长激素水平,故用于伴有内分泌疾病FD患者的治疗。

The evaluation of Tracp5b as a marker for monitoring treatment results of bone metastasis in breast cancer patients

Objective ：To evaluate the sensitivity of serum tartrate-resistant acid phosphatase 5b（Tracp5b） activity in monitoring bisphosphonate treatment results of bone metastasis in breast cancer（BC） patients. Methods：The serum activities of Tracp5b, CEA, CA153 were measured in 58 BC patients, including 26 without bone metastasis, 32 with bone metastasis. The serum activities of TracpSb, CEA, CA153 were also measured in 19 patients with bone metastasis after 3 months of bisphosphonate treatment. Eighteen healthy women with age from 34 to 70 served as control. Results：Serum TracpSb was significantly elevated in patients with bone metastasis compared with that in all any other groups（P〈 0.05）. The sensitivity of TracpSb was 78.13% and the specificity was 86.36%. The sensitivity of CA153 was 37.50% and the specificity was 77.27%. The sensitivity of CEA was 21.88% and the specificity was 84.09%. The serum activity of TracpSb decreased significantly（P 〈 0.05） after 3 months of bisphosphonate treatment, while the levels of CA153 and CEA were unchanged. Conclusion：Serum Tracp5b activity is a useful diagnostic marker for bone metastasis in BC patients and can be used to evaluate the treatment results of bisphosphonate.

^(68)Ga-PSMA PET/CT versus CT and bone scan for investigation of PSA failure post radical prostatectomy

Objective:To evaluate the use of Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography(^(68)Ga-PSMA PET/CT),compared with conventional CT abdomen/pelvis(CTAP)and whole body single photon emission CT bone scan(BS),for detection of local or distant metastasis following biochemical failure/recurrence in post-prostatectomy patients.Methods:We conducted a review of our prospectively maintained,institutional database to identify 384 patients with post-prostatectomy biochemical failure/recurrence who underwent PSMA PET/CT,CTAP and BS from February 2015 to August 2017 in Nepean Hospital,tertiary referral centre.The results of the three imaging modalities were analysed for their ability to detect local recurrence and distant metastases.PSMA PET/CT and CTAP imaging were separately performed on the same day and the BS was performed within several days(mostly in 24 h).Difference in detection rates was determined between the modalities and the Chi square test was used to determine significance.Results:A total of 384 patients were identified with a median prostate-specific antigen(PSA)of 0.465 ng/mL(interquartile range =0.19-2.00 ng/mL).Overall,PSMA PET/CT was positive for 245(63.8%)patients whereas CTAP and BS were positive in 174 patients(45.3%).A total of 98 patients(25.5%)had local or distant metastasis detected on PSMA only,while 20 patients(5.2%)had recurrences detected on CTAP but not on PSMA PET/CT.Conclusion:The use of PSMA PET/CT has a higher detection rate of predicted local or distant metastasis compared to CTAP and BS in the staging of patients with biochemical recurrences after radical prostatectomy.

Imaging of bone metastasis: An update

Early detection of skeletal metastasis is critical for accurate staging and optimal treatment. This paper briefly reviews our current understanding of the biological mechanisms through which tumours metastasise to bone and describes the available imaging methods to diagnose bone metastasis and monitor response to treatment. Among the various imaging modalities currently available for imaging skeletal metastasis, hybrid techniques whichfuse morphological and functional data are the most sensitive and specific, and positron emission tomography(PET)/computed tomography and PET/magnetic resonance imaging will almost certainly continue to evolve and become increasingly important in this regard.