肝样腺癌的临床病理和免疫表型分析

目的 探讨肝样腺癌(HA)的临床病理和免疫表型的特点。方法 采用组织病理学和免疫组化S—P法，观察3例肝样腺癌(HA)组织形态学特点及肝样癌区的反应。结果 HA中肝样分化区的癌细胞与肝细胞癌有相似的形态特点，3例肝样腺癌中AFP(甲胎球蛋白)均呈强阳性。HA多见于中老年人，病人血清AFP明显增高，术后平均生存期为9个月。惠者预后差，属于高度恶性肿瘸。结论 3例肝样腺癌有特殊的形态结构及生物学行为。通过本研究，有助于临床和病理工作者提高对肝样腺癌的认识和诊断水平。     

胃的肝样腺癌的临床病理分析

目的报告胃的肝样腺癌（hepatoidadenocarcinomaofthestomach,HAS）的病理形态和临床传点。方法采用常规HE染色和免疫组织化学方法对3例胃的肝样腺癌进行了研究。结果3例HAS细胞浆内均有甲胎蛋白（AFP）,a-抗糜蛋白酶（ACT）和α-抗胰蛋白酶（AAT）表达。肿瘤的发病部位以胃窦多见,3例均有局部胃壁脉管浸润现象和局部淋巴结转移．其中2例有肝转移,患者分别死于术后3个月和1年。另外1例术后2个月复查未见肝转移．以后失访。结论胃的肝样腺癌是原发于胃粘膜腺体的肿瘤。形态上具有肝细胞样分化和腺样分化两种结构。因常伴有肝转移而预后较普通型胃癌差。     

12例胃肝样腺癌临床病理特征分析

目的 总结12例胃肝样腺癌(HAS)患者的临床资料，探讨HAS的临床病理特征、临床病理诊断经验，加深对该疾病生物学行为认识度。方法 回顾性分析本院病理科2010～2017年诊断的HAS患者临床病理资料，并结合已有文献及WHO(第5版)消化系统疾病分类对该疾病的归类进行讨论。结果 12例HAS患者中男11例，女1例，平均年龄(55.17±11.65)岁；临床表现为上腹部隐痛、黑便、乏力等；8例患者术前血清AFP升高；11例行根治性胃癌切除术(其中3例行全胃切除术),另1例行姑息性手术；病理组织学呈低分化表现，弥漫或片状排列，肿瘤细胞胞浆红染嗜酸性；常见脉管内癌栓及神经侵犯，多组淋巴结转移；4例患者术前即有肝脏占位；免疫组化：肝细胞分化标记AFP、Hepa、Glypican-3、GS、SALL-4不同程度表达；临床分期：Ⅱ期、Ⅲ期和Ⅳ期分别2例、4例、6例；经2～96个月随访，2例失访，10例在访患者4例死亡，中位生存期42.1个月，1、3、5年生存率分别为80%、80%、70%。结论 HAS临床表现缺乏特异性，常伴血清AFP升高，可表达部分肝细胞癌的标记，诊断需鉴别肝细胞癌转移可能。本病...     

结肠肝样腺癌的临床病理观察

目的 探讨结肠肝样腺癌(HAC)的临床病理特征。方法 回顾性分析3例HAC患者的临床资料、光镜特征及免疫组织化学染色特点。结果 患者均为男性,平均年龄70.3岁,发生于右半结肠2例,横结肠1例;3例在治疗前均有血清AFP显著升高;镜下肿瘤组织由分化较好的乳头状腺癌和肝样分化区构成,肝样分化区肿瘤组织呈实性排列,肿瘤细胞呈多边形,胞质丰富,嗜酸性,核圆形,可见核仁,类似肝细胞癌,脉管内见大量癌栓;免疫组化常表达AFP、hepatocyte、CK8、CK18、CK19、CEA,3例出现肠周淋巴结转移,2例出现肝转移。随访4~10个月,3例均死亡。结论 结肠HAC少见,免疫表型类似于肝细胞癌,常伴有血清AFP升高,其侵袭性及转移能力均较强,预后差。     

胃肝样腺癌1例

<正>胃肝样腺癌(HAS)是较为罕见且特殊的胃癌亚型,占胃癌的0.38%～0.73%.HAS的肿瘤病理学形态特点为胃癌组织由2种不同而又紧密相关的腺癌分化区和类似肝细胞癌(HCC)的肝样分化区组成,且二者相互有移行过渡.HAS的临床表现不典型,常以肝占位为首发症状,加之血清甲胎蛋白(AFP)水平升高及病理改变与HCC具有相似性,容易被误诊为 HCC,尤其发生在原发性HCC高发区时更容易被误诊.2018年6月延边大学附属医院肿     

胃肝样腺癌CT影像特征及误诊分析

肝样腺癌是一种原发性恶性肿瘤,最常见于胃,称为胃肝样腺癌(hepatoid adenocarcinoma of the stomach,HAS),是一种较为罕见的特殊类型胃癌。在病理上可见肝细胞癌分化区和腺癌分化区,其恶性程度较高,预后较差。该病首次于1985年由Ishikura命名[1],查阅近5年国外文献,70%为个案报道。国内文献中,赵荣飞等[2]分析了24例HAS临床病理特征和预后,文章指出由于该病少见,诊断依靠病理学,目前手术切除是主要治疗手段。由于发病率低,影像诊断经验缺乏,常导致误诊。笔者回顾性分析了17例经手术病理证实的HAS,其中有8例术前由于经验缺乏而误诊为其他病变,误诊率近50%,可见影像科医生对该病认识不足。     

产生AFP的癌临床病理分析

目的：加深对产生AFP的癌（除外肝细胞癌和卵黄囊瘤）的临床病理特征、组织发生和类型、诊断和鉴别诊断、治疗和预后的认识。方法：对1例发生于女性胰腺产生AFP的癌的病理组织学、免疫表型进行观察，结合临床资料进行分析并复习相关文献。结果：诊断为胰腺内分泌癌合并肝样型癌，其组织学特点是肝样型癌与内分泌癌相互移行、交替排列。前者表达AFP，后者表达CgA和Syn。根治术后，发生肝转移。结论：产生AFP的癌分为四个亚型。各个亚型可以单独出现，也可以与该脏器的原发性癌合并出现。确诊依据病理组织学和免疫组织化学，并且主要与肝细胞癌和卵黄囊瘤鉴别。产生AFP的癌具有特殊的组织发生和临床生物学行为，由于AFP有免疫抑制作用，易发生肝转移，属高度恶性肿瘤。     

胃肝样腺癌2例的临床及病理特点分析

胃肝样腺癌(hepatoid adenocarcinoma of the stomach,HAS)是一种原发于胃粘膜具有腺癌和肝细胞癌样分化特征的胃癌,在肿瘤组织及患者血清中可检测出甲胎蛋白(AFP)增高,且预后差。它是近几年来新发现的一种胃癌亚型,比较罕见,并且本病的临床及病理特征还未被广泛认识,现就我院近5年来收     

GPC3、HSP70、SALL4和AFP联合表达对胃肝样腺癌诊断的意义

目的探讨磷脂酰肌醇蛋白聚糖3（glypican-3,GPC3）、热休克蛋白70（HSP70）、人类婆罗双树样基因-4（SALL4）及甲胎蛋白（AFP）联合表达对胃肝样腺癌（HAS）诊断的意义。方法选取经手术及病理诊断确诊的HAS患者10例,回顾性分析其临床资料。所有患者的手术标本均行HE染色和免疫组化染色检查,观察GPC3、HSP70、SALL4、AFP、精氨酸酶-1（Arginase-1）、hepatocyteparaffin1（HepPar1）、谷氨酰胺合成酶（GS）等蛋白表达情况。结果10例患者中男9例,女1例,年龄58~75（66.0±51.7）岁。其中7例治疗前血清AFP升高;肿瘤由肝样分化区组成,有或无常见普通型胃腺癌,肝样分化区与典型肝细胞癌的组织学特征相似;见广泛脉管内癌栓9例,淋巴结转移7例,肝转移1例。免疫组化结果显示GPC3、HSP70、SALL4、AFP、HepPar1、GS呈不同比例阳性。术后随访6~60个月,8例死亡,死亡患者平均生存期13个月。结论HAS是一种易转移、预后差、罕见的特殊类型胃癌,所以明确诊断尤为关键,通过一系列肝细胞相关抗原免疫组化检测,发现GPC3、HSP70、SALL4和AFP联合检测对明确诊断具有重要意义。     

原发性复合类型肺癌11例临床病理分析

目的探讨复合类型肺癌的病理与临床特征。方法复习11例原发性复合类型肺癌的临床、病理及免疫组化资料，观察其病理形态学及免疫组织化学特点。结果复合类型肺癌男性以鳞腺癌为主，女性以腺癌、细支气管肺泡癌为主，通过免疫组化可进一步证实。复合类型肺癌的混合形式多种多样，且恶性程度高，转移早。结论复合类型肺癌存在于同瘤体，反映了肺癌细胞的多能分化及异质性特征，为一种预后较差、具有独特生物学行为特性的低分化复合癌。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.