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The Emergence of Rapid Counter Immunostaining in the Controlled Narrow Excision of Malignant Melanoma—How We Do It

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Journal of Cancer Therapy 2013年第6期4卷 1082-1084页

作者： Jordan troxel Grace Brummer Kristin Cox S. Ray Peterson Department of Dermatology Central Utah Clinic Provo USA

Mohs Micrographic Surgery (MMS) is widely employed in the treatment of non-melanoma skin cancer and is a preferred treatment for many cutaneous malignancies, particularly in high risk locations and tumors [1,2]. It has also been used in the narrow excision of malignant melanoma with local control rates equivalent to standard margins [3]. It has gained acceptance in the treatment of noninvasive melanoma where standard 0.5 cm margins may be inadequate for local control [4]. The frozen section processing used in MMS has been assumed by some to be inadequate in assessing melanocyte populations or residual melanoma within excision margins. This difficulty has likely led to a majority of surgeons with fellowship training to process margins with slow, permanent hematoxylin and eosin sections (“slowmohs”) or to simply resort to standard 0.5, 1.0, or 2.0 cm margins with traditional excision and outside pathology confirmation of clear margins. A recent survey of practicing fellowship-trained Mohs surgeons revealed roughly one-third (35.9%) of Mohs surgeons felt comfortable interpreting MART-1 immunostains, and far fewer were actually performing immunostains in their labs [5]. Some Mohs surgeons currently refer melanoma to a colleague experienced in processing and reading melanoma with available rapid immunostaining. The development of rapid immunohistochemistry, which can be implemented into a traditional frozen section laboratory, has greatly improved the ease of interpreting margins in the excision of melanoma. Although the process is considerably more complicated than staining with H&E or Toluidine Blue (T-Blue), it easily falls within the skill-set and equipment of most busy frozen section laboratories. The additional cost of biologic reagents may be fully recovered by proper billing of immunohistochemical laboratory work and interpretation of slides.

关键词： Moh’s Surgery Malignant Melanoma Rapid MART-1

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外科病理诊断中的错误

临床与实验病理学杂志 2005年第4期21卷 510-512页

作者： troxel DB 黄文斌（摘译）周晓军（摘译）不详南京军区南京总医院病理科南京210002

以往有文献报道,根据对所有病例进行的前瞻性研究或对部分病例随机抽样调查结果,外科病理诊断中有明显临床意义的诊断错误率为0.26％～12％.然而对5 000例连续活检标本进行"盲法"复习显示明显的临床诊断错误率仅为0.08%.因此,事实上外... 详细信息

以往有文献报道,根据对所有病例进行的前瞻性研究或对部分病例随机抽样调查结果,外科病理诊断中有明显临床意义的诊断错误率为0.26％～12％.然而对5 000例连续活检标本进行"盲法"复习显示明显的临床诊断错误率仅为0.08%.因此,事实上外科病理诊断错误率相对较低.如果考虑到病理医生采用的诊断标准比较模糊,带有较大的循证性和经验性(基于权威和主观性),在日常大量的"普通"病例中又随机混杂有少量少见的疑难复杂病例,而且有时临床提供的信息不完整,甚至令人误解,而如此之低的外科病理诊断错误率多少有些令人惊讶.……

关键词：外科病理诊断前瞻性研究错误率文献报道调查结果随机抽样临床意义临床诊断活检标本

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Antibiotic-loaded phosphatidylcholine inhibits staphylococcal bone infection

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World Journal of Orthopedics 2016年第8期7卷 467-474页

作者： Jessica Amber Jennings Karen E Beenken Robert A Skinner Daniel G Meeker Mark S Smeltzer Warren O Haggard Karen S troxel Department of Biomedical Engineering University of MemphisMemphisTN 38152United States Department of Microbiology and Immunology University of Arkansas Medical SciencesLittle RockAR 72205United States Jamesport NY 11947United States Zimmer Biomet WarsawIN 46581United States

AIM: To test antibiotic-loaded coating for efficacy in reducing bacterial biofilm and development of osteomyelitis in an orthopaedic model of implant infection. METHODS: Phosphatidylcholine coatings loaded with 25% vancomycin were applied to washed and sterilized titanium wires 20 mm in length. A 10 mm segment was removed from rabbit radius(total = 9; 5 coated, 4 uncoated), and the segment was injected with 1 × 106 colony forming units(CFUs) of Staphylococcus aureus(UAMS-1 strain). Titanium wires were inserted throughthe intramedullary canal of the removed segment and into the proximal radial segment and the segment was placed back into the defect. After 7 d, limbs were removed, X-rayed, swabbed for tissue contamination. Wires were removed and processed to determine attached CFUs. Tissue was swabbed and streaked on agar plates to determine bacteriological ***: Antibiotic-loaded coatings resulted in significantly reduced biofilm formation(4.7 fold reduction in CFUs; P < 0.001) on titanium wires and reduced bacteriological score in surrounding tissue(4.0 ± 0 for uncoated, 1.25 ± 0.5 for coated; P = 0.01). Swelling and pus formation was evident in uncoated controls at the 7 d time point both visually and radiographically, but not in antibiotic-loaded ***: Active antibiotic was released from coated implants and significantly reduced signs of osteomyelitic symptoms. Implant coatings were well tolerated in bone. Further studies with additional control groups and longer time periods are warranted. Antibiotic-loaded phosphatidylcholine coatings applied at the point of care could prevent implant-associated infection in orthopaedic defects.

关键词： Biofilm Implant Drug delivery coating Antibiotic Orthopaedic infection

数字乳腺X线摄影和中心组合断层投照对乳腺密度百分比的估算

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国际医学放射学杂志 2009年第5期32卷 483-483页

作者： P.R.Bakic A.K.Carton D.Kontos C.Zhang A.B.troxel A.Maidment 秦乃姗 Department of Radiology University of Pennsylvania

目的评价临床数字乳腺X线摄影与中心组合数字乳腺断层（DBT）投照成像估算乳腺密度百分比（PD）读片者间和同一读片者内的一致性。材料与方法本研究经学术委员会通过并符合健康医疗保险要求，所有病人均签署知情同意书。对39例女性（31... 详细信息

目的评价临床数字乳腺X线摄影与中心组合数字乳腺断层（DBT）投照成像估算乳腺密度百分比（PD）读片者间和同一读片者内的一致性。材料与方法本研究经学术委员会通过并符合健康医疗保险要求，所有病人均签署知情同意书。对39例女性（31～80岁．平均年龄51岁）的匿名数字乳腺x线摄影和中心DBT投照行乳腺PD估算。

关键词：乳腺X线摄影乳腺密度估算投照中心组合断层乳腺x线摄影学术委员会

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乳腺数字化断层摄影分析乳腺实质结构评估罹患乳腺癌风险:与乳腺数字化摄影比较

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国际医学放射学杂志 2011年第6期 587-587页

作者： D.Kontos L.C.Ikejimba P.R.Bakic A.B.troxel E.F.Conant A.D.A.Maidment 张小玲 Department of Radiology University of Pennsylvania Health System1 Silverstein Bldg HUP3400 Spruce StPhiladelphia PA 19104-4206

目的乳腺密度百分比(PD)是已被确认的罹患乳腺癌的风险因子,本研究目的是在筛查人群中评估数字化乳腺断层摄影(DBT)与数字化乳腺摄影显示的乳腺实质结构特征与PD的相关性。材料与方法本研究经专业委员会核准,受试者均签署书面知情同意... 详细信息

目的乳腺密度百分比(PD)是已被确认的罹患乳腺癌的风险因子,本研究目的是在筛查人群中评估数字化乳腺断层摄影(DBT)与数字化乳腺摄影显示的乳腺实质结构特征与PD的相关性。材料与方法本研究经专业委员会核准,受试者均签署书面知情同意书。回顾性分析2007年7月—2008年3月进行的一项经专业委员会批准的DBT筛查

关键词：乳腺癌 DBT 乳腺肿瘤乳腺实质数字化乳腺摄影断层摄影