碘-125粒子支架治疗晚期食管癌的疗效研究

目的探讨附有碘-125粒子的食管自膨式支架对晚期食管癌的治疗作用及效果。方法37例晚期(均为Ⅲ、Ⅳ期)食管癌患者分为2组,A组为应用普通自膨式支架治疗,B组应用附有碘-125粒子的自膨式支架进行治疗。术后随访观察支架置入成功率、并发症发生率及生存期。结果 A、B两组支架置入术的成功率均为100％,吞咽困难记分均从3.3分改善到1分,出血及支架移位并发症发生率分别为10.5％、11.1％,两组间无显著性差别(P>0.05)。碘-125粒子自膨式支架组的生存期为10.5个月,明显长于普通自膨式支架组的4.4个月(P<0.001)。结论碘-125粒子自膨式支架除能明显改善吞咽困难症状,还可对肿瘤进行组织间放疗,可明显延长患者的生存期。     

碘-125粒子支架对晚期食管癌的治疗

目的探讨碘-125粒子食管支架对晚期食管癌的治疗作用。方法本组共21例，病变分期为Ⅲ及Ⅳ期。所用支架为自膨式钛镍合金带膜支架，碘-125粒子支架为将每粒0．7～0．9mci的碘粒子附着在支架外。置入方法与普通支架置入方法相同。术后随访支架置入成功率、并发症及生存期。结果碘-125粒子支架置入术成功率100％。吞咽困难记分从3．3改善到1。出血及支架移位并发症发生率为9．5％。碘-125粒子支架组的平均生存期为11．5个月(5．5～16．5个月)。结论碘-125粒子支架除能明显改善吞咽困难症状外，还可对肿瘤进行组织间放疗，且可明显延长病人的生存期。     

食管内照射支架与普通支架治疗晚期食管癌的对比研究

食管癌是临床常见疾病,80％患者确诊时已属中晚期。置入普通覆膜食管支架只是解决患者的吞咽困难问题,而将放射性碘-125粒子与食管支架整合制成的食管内照射支架,能对癌肿组织进行放射性治疗,有望达到延长生存期的目的。为此,我们对晚期食管癌患者进行了普通自膨式钛镍合金支架和碘-125粒子自膨式钛镍合金支架的比较研究。     

125I同位素粒子介入治疗老年晚期食管癌的临床研究

目的 研究可携带125I同位素粒子食管内照射支架与普通食管支架临床疗效.方法 晚期食管癌患者37例,A组25例置入普通支架,B组12例置入可携带125I同位素粒子食管内照射支架.对比两组并发症发生率、成功率和生存期的差异.结果 B组平均生存期为9.5个月,明显长于A组5.5个月(P＜0.05).两组病人手术成功率、术后并发症发生率无统计学差异(P＞0.05).结论 可携带125I同位素粒子食管内照射支架较普通食管支架疗效显著,可显著延长患者生存期.     

碘-125放射性粒子支架置入治疗食管癌的临床疗效及对生活质量的影响

目的探讨碘-125放射性粒子支架置入治疗对治疗食管癌的临床疗效及对患者生活质量的影响。方法选择2011年6月至2014年9月在该院接受治疗的食管癌患者114例,按随机数字表法分成对照组(n=58)和实验组(n=56),其中对照组给予普通支架置入治疗,实验组给予碘-125放射性粒子支架置入治疗。观察两组患者支架置入术的成功率,比较术前及术后第1、2、3个月的Karnofsky功能状态评分(KPS)和吞咽困难指数变化情况,观察患者的术后并发症并及时对症治疗;统计术后患者的生存期与存活率,并采用生存质量核心问卷(QLQ-C30)和食管癌专用量表(OES-18)调查患者的生活质量。结果 (1)两组患者均一次性成功置入支架,手术成功率为100%;(2)两组患者术后第1、2、3个月的KPS和吞咽困难指数改善情况明显优于术前(P0.05);且实验组患者的第2、3个月的改善情况显著优于同期对照组(P0.05);(3)对照组患者的术后并发症发生率与实验组相比差异无统计学意义(P0.05);(4)实验组患者的生存期及存活率明显高于对照组(P0.05);两组患者术后的生活质量显著优于术前(P0.05),且实验组患者术后第2、3个月的生活质量明显高于同期对照组(P0.05)。结论碘-125放射性粒子支架置入治疗对食管癌具有良好的疗效,可以改善患者的行为能力和吞咽困难状况,延长患者的生存期,提高生存率和生活质量,值得在临床上推广使用。但其术后并发症发生率较高,远期疗效不确切,有待进一步改善。     

食管金属自膨式支架涂覆硅橡胶的组织相容性实验研究

对于食管癌患者,金属自膨式支架置入能立即改善吞咽困难、有效封堵食管-气管瘘且严重并发症发生率低,近年来已成为食管恶性梗阻主要姑息治疗方法。现在应用的金属支架大部分是覆膜支架[1],国内所采用的生物膜材绝大多数是医用级有机硅橡胶,但硅橡胶如与金属粘合不良,置入     

不同节段食管~(125)I支架置入的并发症探讨

[目的]探讨食管恶性狭窄患者~(~(125))I支架置入食管位置不同,术后并发症的发生情况。[方法]选取诊断为食管癌患者102例,其中肿瘤口侧缘距离门齿约25cm以上43例(A组),距离25cm以下59例(B组),回顾性分析其接受~(~(125))I粒子支架置入术后生存期超过1年的患者,随访术后1、3、6、12个月的上消化道出血、反流性食管炎、支架移位、胸痛、白细胞减少、支架再狭窄和食管气管瘘并发症发生情况。[结果]102例均一次性成功置入。2组~(125)I支架置入术后患者均可明显改善其吞咽功能,但均有不同程度咽喉部及胸部不适感。在随访时间点,上消化道出血、反流性食管炎、支架移位并发症发生率,B组较A组高,差异有统计学意义(P0.01);而胸痛、白细胞减少、支架再狭窄、食管气管瘘等,2组比较差异无统计学意义(P0.05)。[结论]~(125)I支架治疗食管恶性狭窄是一种安全、可靠的方法。中下段食管置入~(125)I支架后上消化道出血、反流性食管炎、支架移位并发症发生较中上段高,针对性治疗可得到有效控制。     

碘-125粒子腔内置入治疗食管、贲门癌的临床应用

目的探讨放射性粒子支架腔内置入术治疗食管、贲门癌的可行性。方法在胃镜直视下对31例失去手术机会的中、晚期食管、贲门癌患者进行放射性粒子支架置入术。首先插入胃镜至狭窄段上缘，通过活检孔插入引导钢丝，使其通过狭窄段进入胃腔，退出胃镜，在钢丝的引导下，将带有。^125 Ⅰ粒子的拉线式支架准确置入狭窄段，术后进行随访。结果31例患者分别置入6、8、10、12cm的支架31根，每根覆^125 Ⅰ粒子10～20枚不等，平均每例置入粒子12．5枚，手术均安全顺利完成。31例置入支架后11例有胸骨后、两胁、背部疼痛，反酸、烧心。2例疼痛难忍，2月后取除支架。目前生存时间最长已超过18个月。结论胃镜下置入放射性粒子支架治疗晚期食管、贲门癌安全，易操作，效果可靠能够改善生活质量，延长生存期。     

门静脉支架及经动脉药物治疗栓塞联合或未联合血管内植入碘-125粒子条治疗肝癌合并门静脉主干癌栓的比较

目的 比较门静脉支架及经动脉药物治疗栓塞(TACE)联合或未联合血管内植入碘-125(125I)粒子条治疗原发性肝癌伴门静脉主干癌栓的疗效.方法 对106例(男94例,女12例,平均年龄53.23岁)在我院接受TACE治疗的原发性肝癌合并门静脉主干癌栓患者的资料进行回顾性分析,其中56例(A组)在门静脉内植入支架及125I粒子条,余50例(B组)仅在门静脉内植入支架.分别对两组患者的生存期、支架通畅率及相关不良事件进行分析.对治疗前后各测量值的改变采用配对样本t检验,计数资料采用x2检验,用Kaplan-Meier法分析生存时间及支架通畅期.结果 门静脉内植入支架及125I粒子条的技术成功率为100％,无严重相关不良事件发生.两组患者中位生存期分别为335 d(A组)及146 d(B组),P=0.001(P＜0.05)及HR=2.244;两组患者支架的中位通畅期分别为400d (A组)及190d(B组),P=0.005(P＜0.05)及HR=2.479.结论 门静脉支架及TACE联合血管内植入125I粒子条能显著延长原发性肝癌伴门静脉主干癌栓患者的生存期.     

放射性粒子支架治疗进展期肝外胆管癌的临床研究

目的 探讨125I放射性粒子支架治疗进展期肝外胆管癌的临床疗效.方法 回顾性分析15例不能外科手术切除的肝外胆管癌患者内镜下胆管放射性粒子支架置入治疗的资料,总结术后并发症发生情况和治疗效果、支架的通畅时间、患者生存期等.结果 15例患者共接受32次放射性粒子支架置入治疗,均顺利置入支架,没有发生消化道穿孔、出血、骨髓抑制等严重并发症.首次治疗平均实际吸收剂量为(56.55±17.42) Gy(7.86 ～ 82.48 Gy),粒子支架平均通畅时间为(117±105)d (8～295 d),患者中位生存期为420 d(90 ～ 1175 d),6例患者(40％)生存期超过了12个月.结论 125I放射性粒子支架治疗进展期肝外胆管癌是安全有效的治疗方法.     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

CagA-Hp抗体IgG与胃炎的组织学分析

研究幽门螺杆菌(Hp)感染与胃炎的关系。方法对204例慢性胃炎患者胃粘膜进行观察分析,并测定其中137例Hp阳性患者血清CagA-Hp抗体IgG水平,与组织学对照。结果慢性萎缩性胃炎伴肠上皮化生患者血清CagA抗体IgG明显高于对照组(P＜0.01);其他类型胃炎患者血清CagA抗体IgG水平无明显增高(P＞0.05)。结论CagA-Hp可能是导致慢性萎缩性胃炎伴肠上皮化生的因素之一,对这类患者应密切随访观察。     

慢阻肺急性加重期患者预后的影响因素分析

目的探讨慢性阻塞性肺病急性加重期(AECOPD)患者预后的相关危险因素。方法回顾性调查、收集58例AECOPD患者可能影响其预后的相关因素,并对其分别进行单因素分析。并进行Logistic多元逐步回归进行多因素分析,筛选影响AECOPD患者预后的独立危险因素。结果单因素分析后将结果 P0.1的因素纳入多因素Logistic回归,分析发现是否合并呼吸衰竭、气促程度、白细胞计数、APACHEⅡ、应用抗氧化剂、慢阻肺治疗依从性为影响AECOPD患者预后不佳的独立因素(P0.05)。结论根据AECOPD患者预后的独立危险因素,及早判断,选择合适的后续治疗方案,对提高其生存率及生存质量具有重要意义。