Objective To evaluate the efficacy of medroxyprogesterone acetate(MA)plus metformin as the primary fertility-sparing treatment for atypical endometrial hyperplasia(AEH)and early-stage grade 1 endometrial adenocarcinom...Objective To evaluate the efficacy of medroxyprogesterone acetate(MA)plus metformin as the primary fertility-sparing treatment for atypical endometrial hyperplasia(AEH)and early-stage grade 1 endometrial adenocarcinoma(G1 EAC)and the recurrence rate after treatment.Methods Sixty patients(aged 20-42 years)with AEH and/or grade 1 EAC limited to the endometrium were enrolled prospectively and randomized into two groups(n=30)to receive oral MA treatment at the daily dose of 160 mg(control)or MA plus oral metformin(850 mg,twice a day)for at least 6 months.The treatment could extend to 12 months until a complete response(CR)was achieved,and follow-up hysteroscopy and curettage were performed every 3 months.For all the patients who achieved CR,endometrial expressions of IGFBP-rP1,p-Akt and p-AMPK were detected immunohistochemically.Results A total of 58 patients completed the treatment.After 9 months of treatment,23(76.7%)patients in the combined treatment group and 20(71.4%)in the control group achieved CR;two patients in the control group achieved CR after converting to the combined treatment.The recurrence rate did not differ significantly between the control group and combined treatment group(30.0%vs 22.7%,P>0.05).Ten(35.7%)patients in the control group experienced significant weight gain of 5.7±6.1 kg,while none of the patients receiving the combined treatment exhibited significant body weight changes.Compared with the control group,the patients receiving the combined treatment showed enhanced endometrial expressions of IGFBP-rP1 and p-AMPK with lowered p-Akt expression.Conclusion Metformin combined with MA may provide an effective option for fertility-sparing treatment of AEH and grade 1 stage IA EAC,and the clinical benefits of metformin for controlling MA-induced weight gain and promoting endometrial expressions of IGFBP-rP1 and p-AMPK while inhibiting p-Akt expression warrants further study.展开更多
This report describes a hepatocellular carcinoma (HCC) with concomitant focal nodular hyperplasia (FNH) in a 56 years old Chinese man. There were two well circumscribed tumours measuring 3×2.5×2 cm and 2...This report describes a hepatocellular carcinoma (HCC) with concomitant focal nodular hyperplasia (FNH) in a 56 years old Chinese man. There were two well circumscribed tumours measuring 3×2.5×2 cm and 2×1.5×1.5 cm. The larger mass was grey and soft with a small area of bleeding and necrosis and an intact capsule. The smaller mass was yellow and had no capsule. Clonal analysis was carried out to clarify the relation between the HCC and the adjacent FNH. The clonal analysis was based on the methylation pattern of the polymorphic X chromosome linked androgen receptor gene (HUMARA). In FNH, after Hpa Ⅱ digestion, the allelic bands showed two well defined peaks. The intensity of the two peaks in the DNA from cirrhotic tissue did not differ significantly, consistent with a random pattern of X chromosome inactivation. However, in HCC, after Hpa Ⅱ digestion, the allelic bands differed significantly in intensity. Therefore, there was a typical polyclonal pattern of inactivation in FNH but the HCC was interpreted as being monoclonal.展开更多
Background and objective:Advances in high-resolution computed tomography(CT)scanning have increased the detection of small ground-glass opacity(GGO)nodules and also allowed such images to be investigated in detail.How...Background and objective:Advances in high-resolution computed tomography(CT)scanning have increased the detection of small ground-glass opacity(GGO)nodules and also allowed such images to be investigated in detail.However,it is difficult to differentiate atypical adenomatous hyperplasia(AAH)from adenocarcinoma in situ(AIS)with CT,even at follow-up,because they share many similar CT manifestations.While AAH is thought to be a precursor or even an early-stage lesion of lung adenocarcinoma,and the stepwise progression from AAH to AIS is thought to be reasonable.Therefore,the hypothesis that the attenuation of GGO is increased gradually from AAH to AIS is proposed.The aim of this study was to distinguish AAH from AIS with CT attenuation in patients with pure GGO nodules.Methods:Between January 2010 and December 2012,the CT findings in terms of the greatest diameter and mean CT attenuation(HU)were reviewed and correlated with pathology in 56 patients with AAH(n=21) and non-mucinous AIS(n=38) by two independent observers.All the 59 lesions were pure GGO nodules with size of 2 cm or smaller.To determine variability of measuring CT attenuation,we calculated the 95% confidence interval(CI)for the limits of agreement by using Bland-Altman analysis.Student t test was used to compare AAH and AIS in terms of diameter and CT attenuation.And receiver operating characteristic(ROC)curve was used to determine the optimal cut-off value of mean CT attenuation for differentiating AAH from AIS and obtain the diagnostic value.Two-tailed P value of less than 0.05 was considered to be significant.Results:For the manually measured CT attenuation,the 95% CI for the limits of agreement was-40 HU,50 HU for inter-observer variability.Although there was significant difference in nodule diameter between AAH and AIS(P=0.046),the overlap was considerable.The mean CT attenuation was (-718±53) HU(95%CI:-822,-604) for AAH,which was significantly smaller than(-600±35) HU(95%CI:-669,-531) for AIS(P=0.013).The area under curve(AUC)from ROC was 0.903 for differentiating AAH from AIS,and the cut-off value of-632 HU was optimal for differentiation between AAH and AIS,with sensitivity of 0.79,specificity of 0.95,and accuracy of 0.85.Conclusion:The mean CT attenuation can help the radiological differentiation between AAH and AIS.展开更多
目的观察并探讨“五步法”经尿道钬激光前列腺剜除术(Holmium laser enucleation of prostate,HoLEP)处理大体积前列腺增生对尿控及性功能保护的影响。方法回顾性分析自2021年6月至2024年5月合肥市第一人民医院收治的105例大体积前列腺...目的观察并探讨“五步法”经尿道钬激光前列腺剜除术(Holmium laser enucleation of prostate,HoLEP)处理大体积前列腺增生对尿控及性功能保护的影响。方法回顾性分析自2021年6月至2024年5月合肥市第一人民医院收治的105例大体积前列腺增生患者的资料,其中52例行“五步法”HoLEP术治疗;53例以双极等离子前列腺剜除术(transurethral plasma kinetic enucleation of the prostate,TUKEP)治疗。收集患者围手术期相关指标,并观察两组患者术后尿失禁发生率及性功能改变情况[逆行射精发生率及国际勃起功能指数-5(International Index of Erectile Function-5,IIEF-5)评分],比较两组患者术前与术后6个月最大尿流率(maximum flow rate,Qmax)、国际前列腺症状评分(International Prostate Symptom Score,IPSS)、生活质量评分(quality of life,QOL)、前列腺特异性抗原(prostate specific antigen,PSA)等指标变化情况。结果两组患者围手术期留置尿管时间、切除腺体质量的比较差异均无统计学意义;HoLEP组血红蛋白下降值、手术时间均少于TUKEP组(P<0.05)。两组患者术后5 d血清C反应蛋白均高于术前(P<0.05),但HoLEP组低于TUKEP组(P<0.05)。所有患者术后随访6个月,两组间Qmax、PSA、IPSS、QOL及IIEF-5差异均无统计学意义;短暂性尿失禁、逆行射精发生率比较,HoLEP组明显优于TUKEP组(P<0.05)。结论“五步法”HoLEP术式治疗大体积前列腺增生手术疗效良好,具有术后并发症少、恢复快等优点。在达到同样疗效的情况下,对尿控及性功能保护较好,值得推广。展开更多
目的:评估采用光纤铥激光前列腺剜除术(thulium fiber laser enucleation of the prostate,ThuFLEP)治疗超大体积(>200 mL)前列腺的有效性和安全性。方法:回顾性分析2022年1月至2024年5月,于北京大学第一医院由同一泌尿外科医师进行...目的:评估采用光纤铥激光前列腺剜除术(thulium fiber laser enucleation of the prostate,ThuFLEP)治疗超大体积(>200 mL)前列腺的有效性和安全性。方法:回顾性分析2022年1月至2024年5月,于北京大学第一医院由同一泌尿外科医师进行手术的485例良性前列腺增生(benign prostatic hyperplasia,BPH)患者的临床资料,患者均采用光纤铥激光,根据前列腺总体积(total volume of the prostate,TPV)将患者分为三组:A组TPV<100 mL、B组100 mL≤TPV<200 mL、C组TPV≥200 mL。三组患者的年龄[(69.38±7.79)岁、(69.64±8.69)岁、(70.32±7.44)岁]、国际前列腺症状评分(International Prostate Symptom Score,IPSS)[(22.7±1.9)分、(22.8±2.7)分、(25.8±3.7)分]、最大尿流率(maximum urinary flow rate,Qmax)[(7.9±2.7)mL/s、(9.3±4.3)mL/s、(9.9±3.3)mL/s]差异均无统计学意义(P>0.05);三组患者的前列腺体积[(103.49±46.19)mL、(75.73±30.69)mL、(273.49±49.19)mL]、前列腺特异性抗原(prostate specific antigen,PSA)[3.52(1.05,8.76)μg/L、6.78(1.61,7.45)μg/L、8.52(5.05,12.76)μg/L]差异均有统计学意义(P<0.05)。结果:所有患者的手术均顺利完成,三组患者的剜除时间[30.0(21.2,44.5)min、41.6(31.2,52.5)min、45.1(35.2,50.0)min]、住院时间[(6.06±1.21)d、(6.15±1.50)d、(7.71±1.74)d]差异均无统计学意义(P>0.05);而三组患者的术后留置导尿管时间[(4.0±1.4)d、(4.0±1.3)d、(6.6±1.1)d]、手术时间[61(42,89)min、82(62,105)min、115(96,142)min]、剜除效率[1.29(0.71,1.56)g/min、1.67(1.23,2.15)g/min、2.74(2.20,3.34)g/min]、血红蛋白下降值[12(7,19)g/L、17(11,24)g/L、27(19,35)g/L]差异均有统计学意义(P<0.05)。线性回归分析显示,剜除效率与剜除重量之间存在较强的正向线性相关(r=0.880,P<0.001),剜除效率随着前列腺体积增加而提高。术后三组患者之间的IPSS[(6.6±1.7)分、(6.2±1.4)分、(4.6±1.1)分]、Qmax[(18.9±3.1)mL/s、(16.8±3.8)mL/s、(22.9±7.1)mL/s]差异均无统计学意义(P>0.05)。术后的IPSS、Qmax与术前比较差异均有统计学意义,但术后C组Qmax的提高明显高于其他两组(P<0.05)。术后并发症以Clavien-Dindo并发症系统评分为标准,分为Clavien-DindoⅠ(尿潴留、持续性血尿)、Clavien-DindoⅡ(腺体残余、泌尿系感染、输血)和Clavien-DindoⅢ(尿道狭窄、膀胱颈挛缩、出血并再次手术),三组患者术后均随访3个月,Clavien-Dindo的并发症发生率分别为5.2%(13例)、6.7%(12例)和12.1%(7例),组间差异有统计学意义(P<0.05),其中,泌尿系感染、输血及出血并再次手术的组间差异有统计学意义(P<0.05),其他并发症的组间差异无统计学意义(P>0.05)。结论:前列腺体积越大,输血及再次手术的风险增高,剜除效率随着前列腺体积的增加而提高,光纤铥激光前列腺剜除术治疗超大体积的BPH安全、有效。展开更多
文摘Objective To evaluate the efficacy of medroxyprogesterone acetate(MA)plus metformin as the primary fertility-sparing treatment for atypical endometrial hyperplasia(AEH)and early-stage grade 1 endometrial adenocarcinoma(G1 EAC)and the recurrence rate after treatment.Methods Sixty patients(aged 20-42 years)with AEH and/or grade 1 EAC limited to the endometrium were enrolled prospectively and randomized into two groups(n=30)to receive oral MA treatment at the daily dose of 160 mg(control)or MA plus oral metformin(850 mg,twice a day)for at least 6 months.The treatment could extend to 12 months until a complete response(CR)was achieved,and follow-up hysteroscopy and curettage were performed every 3 months.For all the patients who achieved CR,endometrial expressions of IGFBP-rP1,p-Akt and p-AMPK were detected immunohistochemically.Results A total of 58 patients completed the treatment.After 9 months of treatment,23(76.7%)patients in the combined treatment group and 20(71.4%)in the control group achieved CR;two patients in the control group achieved CR after converting to the combined treatment.The recurrence rate did not differ significantly between the control group and combined treatment group(30.0%vs 22.7%,P>0.05).Ten(35.7%)patients in the control group experienced significant weight gain of 5.7±6.1 kg,while none of the patients receiving the combined treatment exhibited significant body weight changes.Compared with the control group,the patients receiving the combined treatment showed enhanced endometrial expressions of IGFBP-rP1 and p-AMPK with lowered p-Akt expression.Conclusion Metformin combined with MA may provide an effective option for fertility-sparing treatment of AEH and grade 1 stage IA EAC,and the clinical benefits of metformin for controlling MA-induced weight gain and promoting endometrial expressions of IGFBP-rP1 and p-AMPK while inhibiting p-Akt expression warrants further study.
文摘This report describes a hepatocellular carcinoma (HCC) with concomitant focal nodular hyperplasia (FNH) in a 56 years old Chinese man. There were two well circumscribed tumours measuring 3×2.5×2 cm and 2×1.5×1.5 cm. The larger mass was grey and soft with a small area of bleeding and necrosis and an intact capsule. The smaller mass was yellow and had no capsule. Clonal analysis was carried out to clarify the relation between the HCC and the adjacent FNH. The clonal analysis was based on the methylation pattern of the polymorphic X chromosome linked androgen receptor gene (HUMARA). In FNH, after Hpa Ⅱ digestion, the allelic bands showed two well defined peaks. The intensity of the two peaks in the DNA from cirrhotic tissue did not differ significantly, consistent with a random pattern of X chromosome inactivation. However, in HCC, after Hpa Ⅱ digestion, the allelic bands differed significantly in intensity. Therefore, there was a typical polyclonal pattern of inactivation in FNH but the HCC was interpreted as being monoclonal.
文摘Background and objective:Advances in high-resolution computed tomography(CT)scanning have increased the detection of small ground-glass opacity(GGO)nodules and also allowed such images to be investigated in detail.However,it is difficult to differentiate atypical adenomatous hyperplasia(AAH)from adenocarcinoma in situ(AIS)with CT,even at follow-up,because they share many similar CT manifestations.While AAH is thought to be a precursor or even an early-stage lesion of lung adenocarcinoma,and the stepwise progression from AAH to AIS is thought to be reasonable.Therefore,the hypothesis that the attenuation of GGO is increased gradually from AAH to AIS is proposed.The aim of this study was to distinguish AAH from AIS with CT attenuation in patients with pure GGO nodules.Methods:Between January 2010 and December 2012,the CT findings in terms of the greatest diameter and mean CT attenuation(HU)were reviewed and correlated with pathology in 56 patients with AAH(n=21) and non-mucinous AIS(n=38) by two independent observers.All the 59 lesions were pure GGO nodules with size of 2 cm or smaller.To determine variability of measuring CT attenuation,we calculated the 95% confidence interval(CI)for the limits of agreement by using Bland-Altman analysis.Student t test was used to compare AAH and AIS in terms of diameter and CT attenuation.And receiver operating characteristic(ROC)curve was used to determine the optimal cut-off value of mean CT attenuation for differentiating AAH from AIS and obtain the diagnostic value.Two-tailed P value of less than 0.05 was considered to be significant.Results:For the manually measured CT attenuation,the 95% CI for the limits of agreement was-40 HU,50 HU for inter-observer variability.Although there was significant difference in nodule diameter between AAH and AIS(P=0.046),the overlap was considerable.The mean CT attenuation was (-718±53) HU(95%CI:-822,-604) for AAH,which was significantly smaller than(-600±35) HU(95%CI:-669,-531) for AIS(P=0.013).The area under curve(AUC)from ROC was 0.903 for differentiating AAH from AIS,and the cut-off value of-632 HU was optimal for differentiation between AAH and AIS,with sensitivity of 0.79,specificity of 0.95,and accuracy of 0.85.Conclusion:The mean CT attenuation can help the radiological differentiation between AAH and AIS.
文摘目的观察并探讨“五步法”经尿道钬激光前列腺剜除术(Holmium laser enucleation of prostate,HoLEP)处理大体积前列腺增生对尿控及性功能保护的影响。方法回顾性分析自2021年6月至2024年5月合肥市第一人民医院收治的105例大体积前列腺增生患者的资料,其中52例行“五步法”HoLEP术治疗;53例以双极等离子前列腺剜除术(transurethral plasma kinetic enucleation of the prostate,TUKEP)治疗。收集患者围手术期相关指标,并观察两组患者术后尿失禁发生率及性功能改变情况[逆行射精发生率及国际勃起功能指数-5(International Index of Erectile Function-5,IIEF-5)评分],比较两组患者术前与术后6个月最大尿流率(maximum flow rate,Qmax)、国际前列腺症状评分(International Prostate Symptom Score,IPSS)、生活质量评分(quality of life,QOL)、前列腺特异性抗原(prostate specific antigen,PSA)等指标变化情况。结果两组患者围手术期留置尿管时间、切除腺体质量的比较差异均无统计学意义;HoLEP组血红蛋白下降值、手术时间均少于TUKEP组(P<0.05)。两组患者术后5 d血清C反应蛋白均高于术前(P<0.05),但HoLEP组低于TUKEP组(P<0.05)。所有患者术后随访6个月,两组间Qmax、PSA、IPSS、QOL及IIEF-5差异均无统计学意义;短暂性尿失禁、逆行射精发生率比较,HoLEP组明显优于TUKEP组(P<0.05)。结论“五步法”HoLEP术式治疗大体积前列腺增生手术疗效良好,具有术后并发症少、恢复快等优点。在达到同样疗效的情况下,对尿控及性功能保护较好,值得推广。
