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摘要： Purpose/Objective(s) National Comprehensive Cancer Network guidelines recommend adjuvant systemic therapy with or without external beam radiation and/or intravaginal brachytherapy for high-risk endometrial cancer histologies. Being able to estimate the risk of pelvic/para-aortic lymph node (LN) involvement could assist in making clinical decisions regarding whether to treat with external beam versus brachytherapy alone. The National Cancer Data Base was queried to develop predictive nomograms based on primary uterine factors to estimate the risk of pathologic LN involvement. Materials/Methods Patients diagnosed with pathologic T1-T2 clear cell, uterine papillary serous (UPS), carcinosarcoma, or mixed endometrial cancer between 2004-2016 undergoing primary surgery with at least 10 LNs sampled in the National Cancer Data Base were identified. Logistic regression was performed to identify primary pathologic tumor predictors of LN positivity. Pathologic variables assessed included primary tumor histology, pathologic tumor stage, tumor size, and presence/absence of lymphovascular invasion (LVI). Nomograms were created to predict overall, pelvic only, and paraaortic and/or pelvic LN involvement. Results Among 7,918 patients included, 1,407 (18%) were node positive. On multivariable analysis, relative to carcinosarcoma, both clear cell (odds ratio [OR] 1.77, 95% confidence interval [CI] 1.34-2.32, P < 0.001) and UPS (OR 1.76, 95% CI 1.46-2.13, P < 0.001) histology were significantly associated with a higher risk of LN positivity while mixed histology was not (OR 1.14, 95% CI 0.95-1.37, P  = 0.16). Furthermore, increasing pathologic tumor stage (pT2 versus pT1a, OR 3.62, 95% CI 3.04-4.28, P < 0.001), increase in tumor size per centimeter (OR 1.09, 95% CI 1.06-1.11, P < 0.001), and presence of LVI (OR 5.23, 95% CI 4.58-6.02, P < 0.001) were predictive of overall LN positivity. Nomograms demonstrated that the impact of primary tumor pathologic variables was comparable for pre

摘要： Purpose/Objective(s) Intrahepatic cholangiocarcinoma (iCCA) remains a highly lethal disease. Biomarkers are needed to identify pts who may benefit from specific therapeutic strategies. Here, we hypothesized that imaging features derived from pre-therapy CT are associated with histopathological and clinical outcomes. Materials/Methods Retrospectively, we identified 60 pts with localized iCCA (24 M, 36 F, median age 65 [range 26-84]), who received upfront resection as a discovery cohort (D1) and 87 pts with locally advanced iCCA (49 M, 38 F, median age 64 [range 30-88]) who received chemo and radiation therapy as a validation cohort (D2). Using the pre-therapy CT, we contoured the tumors in the arterial phase and used a voxel-based method to quantify the tumors enhancing volume (normalized to liver parenchyma), and called this quantification: volumetric enhancement (VE). Using the training cohort only, we performed receiver operating characteristic (ROC) analysis to evaluate the classification ability of VE in differentiating long vs short (36 months) overall survival (OS), and to obtain an optimal cut-off for validation in D2. Corresponding slides from resection specimens of 38 pts from D1 were stained with H&E and digitally analyzed to quantify the tumor infiltration percentage. We used Pearson correlation coefficient, likelihood ratio, Kaplan-Meier and Cox-proportional hazard for statistical analyses. Results As a continuous variable, higher VE values were associated with better OS in D1 (RR = 0.97, 95% CI [0.95-0.99], P  = 0.0007) and D2 (RR = 0.96, 95% CI [0.95-0.98], P < 0.0001). On multivariate analyses, VE as a continuous variable was an independent prognostic factor for OS accounting for traditional covariates in D1 (RR = 0.97, 95% CI [0.95-0.99], P  = 0.002) and D2 (RR = 0.96, 95% CI [0.94-0.98], P < 0.0001). Using D1, VE demonstrated high accuracy in classifying pts with short vs. long term survival (Area under the curve (AUC) = 0.77), with an optimal thres

关键词： 林木病理学   线上线下混合式教学模式   教学改革  

摘要： "林木病理学"课程是林学专业的核心课程,主要讲授林木病害症状、病原、发生发展规律和防治的课程。为了提高课程教学质量,运用"线上+线下"混合式教学模式进行课程改革。主要措施为:线上教学视频和课件学习、线上随堂测验和单元测验、线上讨论区以及线下重难点知识复习、线下翻转课堂、线上线下课程思政融入和课程考核改革进行教学模式探索。通过"线上线下"混合式教学模式的应用,显著提高了学生学习的主动性和积极性,扩展了学生知识面,提升了林木病理学课程的教学质量。

摘要： Purpose/Objective(s) We aim to develop deep learning (DL) models to accurately detect and segment intraprostatic lesions (IL) on biparametric MRI (bp-MRI). Materials/Methods Three patient cohorts with ground truth IL delineated on different modalities were collected. 158 patients from two datasets had suspicious ILs delineated based on bp-MRI: 97 patients were from PROSTATEx-2 Challenge with biopsy result independent from bp-MRI based delineation, 61 patients were from IMPROD clinical Trial with biopsy done for each delineation; 64 patients from IMPROD clinical Trial had ILs identified and delineated by using whole mount prostatectomy specimen sections as reference standard; 40 private patients were unlabeled. We proposed a non-local Mask R-CNN to improve segmentation accuracy by addressing the imperfect registration issue between MRI modalities. We also proposed to post aggregate 2D predictions to estimate IL volumes within the whole prostatic gland and keep top-5 3D predictions for each patient. In order to explore the small dataset problem, we employed different learning techniques including transfer learning and semi-supervised learning with pseudo labelling. We experimented with two label selection strategies to see how they affected model performance. The first strategy kept only one prediction by referring to biopsy result, in order to minimize false positives; while the second strategy kept all top-5 predictions. 3D top-5 detection rate, dice similarity coefficient (DSC), 95 percentile Hausdorff Distance (95 HD, mm) and true positive ratio (TPR) were our evaluation metrics. We compared DL model prediction with prostatectomy-based ground truth delineation to accurately evaluate the boundary and malignancy level. We separately evaluated ILs of all Gleason Grade Group (GGG) and clinically significant ILs (GGG > 2). Results Main results are summarized in Table 1. Conclusion Our proposed method demonstrates state-of-art performance in the detection and segmentati

关键词： 乳腺癌   CEA   CA153   CA125   分子分型  

摘要： 目的:回顾性分析Ⅰ~Ⅲ期浸润性乳腺癌患者治疗前血清肿瘤标志物CA153、CA125、CEA水平与分子分型、临床病理特征之间的相关性。方法:选取2016年1月至2020年12月于内蒙古医科大学第一附属医院乳腺外科就诊的457例Ⅰ~Ⅲ期浸润性乳腺癌患者,检测其治疗前血清CA153、CA125、CEA的水平,收集患者的临床病理资料(包括患者的发病年龄,肿瘤大小,淋巴结转移,临床分期,组织学分级、激素受体表达、Her-2表达、Ki-67表达等),单因素分析肿瘤标志物血清学水平与分子亚型、临床病理特征间的相关性,多因素分析与各肿瘤标志物相关的独立危险因素。结果:457例Ⅰ~Ⅲ期浸润性乳腺癌患者中治疗前出现CEA、CA153、CA125血清学水平分别有20例(4.38%)、34例(7.44%)和25例(4.57%)呈阳性;单因素分析结果表明乳腺癌患者在接受治疗前检测到的CEA和CA153水平在不同分子亚型之间具有明显差异(P<0.05);当肿瘤大小≥2cm、伴淋巴结转移(N1)的患者出现CEA、CA153、CA125的血清学水平的升高更明显(P<0.05)。多因素分析结果表明,年龄(>50岁)、肿瘤大小(≥2cm)、淋巴结转移(N1)和HER-2(+)均是影响乳腺癌患者治疗前CEA水平变化的独立危险因素,并且患者年龄在50岁及以上者治疗前CEA血清学水平升高风险相对于50岁以下患者高4倍左右(OR=4.316、95%CI:2.262~9.443)。年龄(>50岁)、肿瘤大小(≥2cm)、淋巴结转移(N1)均是影响乳腺癌患者治疗前血清CA153水平变化的独立危险因素(P<0.05),其风险是50岁以下乳腺癌患者的3倍左右(OR=3.685、95%CI:1.133~6.912,OR=3.331、95%CI:1.034~6.746)。淋巴结转移(N1)和孕激素PR受体(-)是乳腺癌患者接受治疗前出现CA125血清学水平升高的独立危险因素(P<0.05)。结论:年龄(>50岁)、肿瘤大小(≥2cm)、淋巴结转移(N1)均为Ⅰ~Ⅲ期浸润性乳腺癌患者中治疗前出现CEA、CA153血清学水平升高的独立影响因素;分子分型检测结果中HER-2(+)独立影响CEA血清学水平,孕激素PR受体(-)独立影响CA125的血清学水平。

关键词： 间叶性错构瘤   胸壁肿瘤   婴儿   临床病理  

摘要： 目的分析婴儿胸壁错构瘤的临床病理学特征、影像学特征、以及诊断与鉴别诊断,旨在提高临床医生对该罕见疾病的认识。方法对5例发生于婴儿的胸壁错构瘤的临床特征、病理组织学特点及免疫表型进行分析,并复习相关文献。结果5例患者均表现为逐渐增大的胸壁肿块,常伴呼吸道症状,男女比例为3∶2,左侧与右侧比例为3∶2,3例患儿累及一根肋骨,2例患儿病灶累及多根肋骨,中位年龄7个月。CT表现为来源于肋骨的肿块呈膨胀、筛网状结构,肿块内密度不均,呈不规则钙化密度影及软组织团块影。病理学大体上表现为囊性与实性相间的肿块,囊性区可有黏液、出血。镜下瘤组织实性区由透明软骨组织、胶原纤维组织增生为主,可见软骨内成骨;出血性囊性区见动脉瘤样骨囊肿样结构。所有标本中以上成份均以不同比例呈现,免疫组化可提示病变各组织成分来源。5例患者均行手术完整切除治疗。结论婴儿胸壁错构瘤是一种临床非常罕见的良性疾病,术前常被误诊为恶性肿瘤,具有特殊的临床病理学特征,治疗以手术完整切除为主。

关键词： 结直肠癌   微卫星稳定性   病理学  

摘要： 目的探析微卫星稳定性(MSS)结直肠癌患者的肿瘤类型、性别及年龄分布、好发部位和临床病理特点。方法对283例MSS结直肠癌患者的性别、年龄、好发部位及临床病理特点等进行回顾性分析。结果283例MSS结直肠癌患者中男164例(57.95%),女119例(42.05%);发病年龄51~80岁占85.51%;结肠癌占25.80%,其中左半结肠癌占4.95%右半结肠癌占10.60%;直肠癌占74.20%。组织病理学特点为癌细胞在肠壁内呈浸润性生长,伴有急慢性炎症细胞的浸润,使肠壁结构扭曲并增厚,导致肠腔变窄进而堵塞肠腔;肿瘤的大体类型主要表现为溃疡型(65.02%);其中85例(30.04%)出现淋巴结转移,出现脉管内癌栓占9.89%,而出现神经侵犯的较少(5.30%)。肿瘤的恶性程度较高,大部分患者处于TNMⅢ期(51.94%)。结论MSS结直肠癌的病理学分析可进一步明确MSS的临床诊断,这对于指导临床治疗和评估临床预后具有重要意义。

关键词： 五丹胃福颗粒   胃癌前病变   气滞络瘀  

摘要： 目的:通过观察大鼠胃黏膜组织病理及黏膜中VEGF和HIF-1α的表达,探讨五丹胃福颗粒对PLGC大鼠的干预机制。方法:采用改良MNNG+复合法造模成功PLGC大鼠56只,随机分为模型组(A组)、五丹胃福低剂量组(B组)、五丹胃福中剂量组(C组)、五丹胃福高剂量组(D组)、理气组(E组)、祛瘀组(F组)、叶酸组(G组)。治疗12周后,采用Western Blot法检测各组VEGF、HIF-1α表达水平;采用HE染色观察各组大鼠黏膜组织病理学。结果:VEGF:治疗12周,与A组比较,其他组胃窦部黏膜VEGF显著降低(P<0.05)。B组、C组与D组比较,差异无统计学意义(P>0.05)。E组、F组与D组相比,差异无统计学意义(P>0.05),但VEGF降低趋势在F组比E组更明显。E组与F组比较,差异没有统计学意义(P>0.05)。HIF-1α:治疗12周,与A组比较,其他组胃窦部黏膜HIF-1α显著降低(P<0.05);B组、C组与D组相比,差异无统计学意义(P>0.05);E组、F组与D组相比,差异没有统计学意义(P>0.05),但HIF-1α降低趋势在E组比F组更明显。E组与F组比较,差异没有统计学意义(P>0.05)。病理:各组间炎症积分比较:B组、C组、D组、G组与A组比较,炎症积分减低(P<0.05)。B组、C组与D组比较,P>0.05。各组间萎缩程度积分比较:B组、C组、D组与A组比较,积分减低(P<0.05)。B组、C组与D组比较,P>0.05。各组间瘤变程度积分比较:D组、G组与A组比较,积分减低(P<0.05)。结论:五丹胃福颗粒通过降低PLGC大鼠的VEGF及HIF-1α表达,从而使胃黏膜病理积分显著降低,延缓了PLGC向胃癌的进展。

关键词： 肾集合管癌   影像学   病理学   临床表现   鉴别诊断   治疗与预后  

摘要： 肾集合管癌又称为Bellini导管癌,是起源于肾髓质的罕见恶性肿瘤[1],发病率低,但恶性程度很高,预后较差。本文就1例肾集合管癌进行病例报道并文献复习,现报告如下。1病例报告,患者女性,69岁,以“左下腹痛1周”于2019年07月05日入院。患者左下腹间断性绞痛,左腰部酸胀不适,下腹部不适,伴尿频尿急,无明显肉眼血尿。

关键词： 幽门螺杆菌   感染   组织病理学   遗传易感性   内镜征象  

摘要： 目的分析128例幽门螺杆菌(***)感染慢性胃炎患者的组织病理学、内镜征象,并研究其遗传易感性。方法选取2019年1月-2020年10月武汉市第八医院内镜中心128例***感染慢性胃炎患者为阳性组,128例***感染阴性的慢性胃炎为阴性组,比较两组患者胃镜检查、胃黏膜组织病理学检查、外周血TLR基因多态性检测结果。结果阳性组胃镜下规则排列集合静脉、线状红斑、胃底腺息肉、点状出血比例均小于阴性组(P<0.05),皱襞增生、点状红斑、渗出、萎缩比例均大于阴性组(P<0.05)。阳性组患者主要表现为慢性炎性改变,吉姆萨染色可见蓝色弯曲杆状物。阳性组轻度炎症发生率低于阴性组(P<0.05),重度炎症发生率高于阴性组(P<0.05),淋巴细胞阳性、淋巴滤泡阳性发生率高于阴性组(P<0.05)。阳性组TLR1 rs4833095 GG基因型、GA基因型、G等位基因、A等位基因频率与阴性组比较,均无统计学差异,AA基因型频率高于阴性组(P<0.05)。阳性组TLR10 rs10004195 TT基因型、TA基因型、T等位基因、A等位基因频率与阴性组比较均无统计学差异,AA基因型频率高于阴性组(P<0.05)。结论 ***感染患者胃镜表现主要为皱襞增生、点状红斑、渗出、萎缩,组织病理学显示重度炎性和淋巴细胞浸润表现较多,TLR1 rs4833095、TLR10 rs10004195 AA基因型可能是导致患者感染***的潜在影响因素。