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乳腺癌前哨淋巴结微转移

【摘要】　乳腺癌是女性最常见的恶性肿瘤之一，腋窝淋巴结的转移状况是乳腺癌患者最有价值的预后因素。乳腺癌前哨淋巴结活检术的开展有望替代腋窝淋巴结清扫术，从而减少甚至避免腋窝淋巴结清扫带来的疼痛、麻木、水肿、运动障碍等并发症。常规病理技术无法确定存在于淋巴结的微转移灶，而这些微转移灶对乳腺癌的诊断、分期复发与预后判断、综合治疗的选择具有极其明显的意义。较高的假阴性率是前哨淋巴结活检的不利因素，不仅导致分期不准确，更重要的是影响了患者最佳治疗方案的制定。对前哨淋巴结微转移的检测可以提高分期的准确性，改变一部分患者的治疗决策。现就乳腺癌前哨淋巴结微转移的相关情况做一综述。

原钙粘蛋白与癫痫相关性研究进展

神经系统在人体发育中正常发挥着作用与许多因素有关，最为重要的是相互联系的神经细胞，当其结构和功能发生变化时可能导致癫痫等神经疾病的发生。原钙粘蛋白（Protocadherins，PCDH）是钙粘蛋白家族（Cadherin Super family）中最大的亚类，包括 14 个同源蛋白和四个反义长链非编码 RNA。PCDH 蛋白质在钙存在的情况下介导神经组织中的细胞粘附，广泛参与了突触形成、神经元间连接及大脑发育等过程。作为神经发育过程中结构和功能的基本单位，神经元通过特殊的细胞间连接与其他神经细胞组成功能性神经回路，其细胞连接方式对于正常的神经功能的发挥起到重要作用。包括 PCDH 蛋白在内的细胞粘附分子是神经元之间识别、连接和相互作用的分子基础，促进了功能性神经元回路的形成。已有研究表明编码 PCDH 蛋白的基因发生变异时可导致癫痫的发生，但具体的发病机制和致病过程尚不清楚。本文主要围绕 PCDH 蛋白与癫痫的关系，结合同源基因进化、基因表达和基因功能等方面的解析，梳理了近年来 PCDH 蛋白参与癫痫发病机制的最新进展。

Xq28区域新基因突变导致的智力残疾/共济失调癫痫一例并文献复习

Effects of Continuous Positive Airway Pressure on Serum Inflammatory Factors in Coronary Heart Disease Patients Complicated with Obstructive Sleep Apnea-Hypopnea Syndrome

Objective To investigate the changes and significance of serum inflammatory factors in coronary heart disease ( CHD) patients with obstructive sleep apnea-hypopnea syndrome ( OSAHS) , and the treatment effects of continuous positive airway pressure( CPAP) . Methods A total of 76 CHD patients in Renmin Hospital of Wuhan University from October 2007 to October 2008 were enrolled. Polysomnography ( PSG) was performed in these CHD patients to identify if they were complicated by OSAHS. The levels of inflammatory factors including TNF-α, IL-6, high sensitive C-reactive protein ( hs-CRP) in serum were determined in the CHD patients and 23 normal subjects. The CHD patients with moderate-severe OSAHS ( AHI≥15 episodes/hour) were treated by Auto-CPAP for 3 months and all parameters above were measured again. Results There were 41 /76 ( 53. 9% ) of CHD patients had moderate-severe OSAHS and were treated with CPAP. The levels of TNF-α, IL-6 and hs-CRP were significantly higher in the CHD patients than those in the normal controls ( all P lt; 0. 01) , and were significantly higher in moderate-severe OSAHS patients than those in the non-OSAHS CHD patients. Auto-CPAP ventilation significantly decreased the levels of inflammatory factors in the CHD patients with moderate-severe OSAHS. Conclusions An obvious proinflammatory state is detected in CHD patients, and is aggravated with OSAHS. CPAP is a useful treatment for CHD patients with mediate to severe OSAHS.

遗传性先天性视乳头大生理凹陷一家系

Influences of Inhaled Corticosteroids on CD4+ CD25+ Regulatory T Cells and Foxp3 mRNA of Asthmatic Patients

Objective To investigate the percentage of CD4 + CD25 + Treg cells and expression of Foxp3 mRNA in asthmatic patients and the impacts of inhaled steroids.Methods The percentages of CD4 +CD25 + Treg cells was assayed by flow cytometry and the expression of Foxp3 mRNA was detected by RT-PCR in peripheral blood mononuclear cells from the patients with chronic persistent asthma before and after steroids inhalation in comparison with healthy control. The forced expired volumin one second/predicted value( FEV1% pred) and peak expired flow( PEF) were measured by spirometry. Results The level of CD4 + CD25 + Treg cells and the expression of Foxp3 mRNA were lower in asthmatics before steroids treatment than those in control ( P lt; 0. 05) which were increased significantly after steroids treatment ( P lt; 0. 05) .FEV1% pred and PEF were declined significantly than those in control but improved markedly after treatment ( P lt; 0. 05) . Conclusions The insufficiency of amount and function of immue-suppressive CD4 + CD25 +Treg cells may play a role in the pathogenesis of asthma. Inhaled steroids can improve the lung function of asthmatics by upregulating the level of CD4 + CD25 + Treg and Foxp3.