早期胃癌行内镜粘膜下剥离术应用研究

分别选取进行ESD治疗和外科手术的EGC患者分成标准组和对照组,观察术中并发症情况,并定期随访患者病灶有无残留和复发。结果经治疗和随访后,标准组中术后出现出现和穿孔2例,对照组中术后出现出现和穿孔10例,差异显著(P0.05),两组患者随访2年后,均为发现术后病灶残留或复发。内镜粘膜下剥离术是治疗早期胃癌的一种安全有效的方法,可以进行推广。     

胃早癌患者内镜黏膜下剥离术前后血清实验室相关指标水平及其意义

目的研究胃早癌(EGC)患者内镜黏膜下剥离术(ESD)前后血清胃蛋白酶原(PG)、胃泌素-17(G-17)和幽门螺杆菌抗体IgG(Hp-IgG)水平,计算胃蛋白酶原比值(PGR)并分析其临床意义。方法选取2013年2月-2015年2月326例在该院行ESD治疗的EGC患者作为研究对象,另选取该院同期健康体检者80例进行对照,检测各组血清PGⅠ、PGⅡ、G-17和Hp-IgG水平。根据术后随访结果,将ESD患者进行亚分组,分为复发组和对照组,比较两组检测结果差异,并分析其对肿瘤复发的影响及预测价值。结果EGC患者G-17水平和Hp-IgG阳性率均高于健康人群,PGⅠ和PGR均低于健康人群,两组比较,差异有统计学意义(P<0.05);复发组和对照组术后3个月血清PGⅠ和PGR水平明显升高(P<0.05),G-17水平明显降低(P<0.05),且复发组手术前后Hp-IgG阳性率高于对照组,术后血清PGⅠ和PGR水平低于对照组,血清G-17水平高于对照组,两组比较,差异均有统计学意义(P<0.05);二元Logistic回归分析显示,PGⅠ、Hp-IgG和PGR为影响EGC患者术后复发的重要因素(P<0.05);PGⅠ、Hp-IgG和PGR预测EGC患者术后复发的受试者工作特征曲线(ROC)的曲线下面积(AUC)分别为0.772、0.612和0.835(P>0.05)。结论ESD是治疗EGC的有效方法,监测手术前后PG、G-17和Hp-IgG变化,可为预测肿瘤复发提供参考信息。     

浅表食管癌及癌前病变内镜黏膜下剥离术后水平切缘阳性高危因素分析及随访研究

目的探讨浅表食管癌及癌前病变内镜黏膜下剥离术(ESD)后标本水平切缘阳性的高危因素及其残留复发情况。方法选取2012年1月-2017年12月该院消化内镜中心行ESD的浅表食管癌及癌前病变患者,收集相关临床、内镜及病理资料,分析食管ESD标本水平切缘阳性的高危因素,并通过术后随访,比较水平切缘阳性与阴性患者的ESD术后病灶残留复发情况。结果最终纳入患者186例病灶194处,水平切缘阳性组37处,水平切缘阴性组157处。水平切缘阳性组中,水平切缘为低级别上皮内瘤变(LGIN)累及病灶25处、水平切缘为高级别上皮内瘤变(HGIN)累及病灶10处、水平切缘为癌累及病灶2处,水平切缘阴性组157处病灶。单因素及多因素Logistic回归分析表明:食管ESD术后病理标本水平切缘阳性与ESD术中标记前是否碘染、术后标本面积具有相关性(P 0.05)。186例患者随访过程中,最终156例患者164处病灶纳入水平切缘阳性组与阴性组的残留复发率随访分析。其中,水平切缘阳性组内镜随访30处,残留复发4处(残留复发率13.3%),水平切缘阴性组内镜随访134处,7处残留复发(残留复发率5.2%),两者比较,差异无统计学意义(P 0.05)。结论食管ESD术中病灶标记前无碘染及大面积病灶的病理标本,水平切缘阳性发生率增加。对于食管ESD术后单纯水平切缘阳性、切缘阳性性质为癌前病变者,可先内镜下密切随访,暂不追加二次治疗。     

内镜黏膜下剥离术治疗早期胃癌及癌前病变的临床疗效

目的探讨内镜黏膜下剥离术(ESD)治疗早期胃癌(EGC)及癌前病变的临床疗效。方法收集2012年6月-2015年6月在郑州大学附属郑州中心医院消化内科接受ESD治疗的106例EGC或癌前病变患者的临床资料,统计分析ESD治疗效果、并发症、术后病理及远期疗效。结果病灶整块切除率为100.0%,平均手术时间为(61.8±17.3)min,病灶平均直径为(2.7±1.3)cm。无内镜下难以控制的大出血发生;术中穿孔及术后迟发性出血的发生率分别为6.6%及5.7%,均于内镜下处理后好转,无外科手术情况。术后病理结果提示胃早癌74例:高分化腺癌23例,中分化腺癌29例,低分化腺癌19例,印戒细胞癌3例;高级别上皮内瘤变32例;7例标本存在基底部肿瘤侵犯,无切缘阳性病例,R0切除率为93.4%,R1切除率为6.6%。7例R1切除患者经内镜下二次切除后达到R0切除。5例于术后1年内复发,复发率为4.7%,均接受根治性胃大部切除术。截至2016年12月,中位随访期为34个月,3年生存率达97.9%。结论 ESD治疗EGC及癌前病变安全可行,并具有创伤小、恢复快、并发症少和疗效可靠等优点,且临床疗效与外科手术相似。     

内镜黏膜下剥离术治疗早期胃癌复发及影响因素分析

目的分析内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗早期胃癌复发的影响因素。方法选取我院150例早期胃癌,均行ESD治疗。观察治疗效果,记录一般资料,分析影响病情复发的相关因素。结果本组11例失访,22例病情复发。单因素分析显示,早期胃癌患者ESD术后病情复发组肿瘤浸润深度达黏膜下层、术前未行超声内镜检查、手术切缘阳性所占比例显著高于病情未复发组(P 0. 05)。多因素logistic回归分析显示,肿瘤浸润深度达黏膜下层、术前未行超声内镜检查、手术切缘阳性是早期胃癌患者ESD术后病情复发的独立危险因素(P 0. 05)。结论 ESD治疗早期胃癌的临床效果较好,肿瘤浸润深度达黏膜下层、术前未行超声内镜检查、手术切缘阳性是早期胃癌患者ESD术后病情复发的影响因素,临床应采取相应措施以改善预后。     

内镜黏膜下剥离术对早期胃癌及癌前病变治疗价值的临床研究

目的 探讨内镜黏膜下剥离术(ESD)技术治疗早期胃癌及癌前病变的疗效及临床价值.方法 收集2007年11月～2010年12月兰州大学第二医院消化科应用ESD术治疗47例早期胃癌及癌前病变患者.并进行随访及内镜复查.结果 ESD平均时间84.72 min,剥离病变平均直径2.76 cm.术中5例患者出血量较大,术中穿孔患者1例.术后迟发型出血患者1例,术后穿孔患者1例.术后病检证实早期胃癌患者34例,重度不典型增生患者7例,中度不典型增生患者6例.病理活检准确率为95.7％.随访患者中早期胃癌复发1例,外科组术后44例患者复查内镜未发现复发患者.结论 ESD是治疗早期胃癌及癌前病变的安全、有效的内镜下治疗新技术.     

内镜黏膜下剥离术治疗早期胃癌及高级别上皮内瘤变的疗效分析

目的探讨内镜黏膜下剥离术(ESD)治疗早期胃癌(EGC)及高级别上皮内瘤变(HGIN)的价值及影响其治愈性切除的因素。方法回顾性分析2012年12月—2014年6月本院经ESD治疗的80例EGC及HGIN患者的临床病理资料,评估ESD治疗EGC及HGIN的效果,分析影响其治愈性切除的因素。结果经ESD治疗的80例患者,整块切除率、完整切除率、治愈性切除率分别为100%、86.25%、86.25%。术后复发率为1.25%,3年生存率为98.75%。EGC组治愈性切除率为75.76%,显著低于HGIN组的93.6%(P0.05)。单因素分析显示,黏膜下层病变、病灶长径≥2 cm、溃疡形成的患者非治愈性切除比例相对更高(P0.05)。多因素分析结果显示,黏膜下层病变(OR=6.300,95%CI:0.516-12.658,P0.001)、病灶长径≥2 cm(OR=12.193,95%CI:1.323~112.347,P=0.027)、溃疡形成(OR=5.679,95%CI:1.087~29.678,P=0.040)是胃黏膜早期肿瘤内镜非治愈性切除的危险因素。结论 ESD是治疗EGC及HGIN的有效方法。对于黏膜下层病变、病灶长径≥2 cm、溃疡形成的患者术前需严格评估,综合考虑治疗方案,以期获得治愈性切除效果。     

内镜下黏膜剥离术治疗胃间质瘤的有效性及安全性分析

目的探讨内镜下黏膜剥离术(ESD)治疗胃间质瘤的临床价值。方法回顾性分析2012年6月-2015年12月该院收治的胃间质瘤(直径≤3 cm)患者56例,所有患者均采用ESD方式治疗。分析病例的完整切除率、并发症发生率及术后有无复发等。结果 54例(96.4%)成功完成ESD,2例因出血、穿孔转外科行开腹手术。术后病理以及免疫组织化学结果显示CD117阳性51例(91.1%)、CD34阳性47例(83.9%)。术后随访3~48个月,随访期间无复发病例。结论 ESD是治疗相对小的胃间质瘤安全、有效的手术方式。     

内镜黏膜下剥离术治疗直肠巨大扁平病变的护理体会

目的 探讨采用内镜黏膜下剥离术(ESD)治疗直肠巨大扁平病变的护理配合体会.方法 回顾分析2010年3月～2011年12月该科肠镜检查发现的25例直径＞2 cm的直肠扁平病变进行ESD切除治疗的病例资料,总结ESD术前、术中及术后护理方法.结果 25例患者均顺利完成ESD切除治疗,2例术后当晚出现便血,予经内镜对症处理后血止.随访期(1～24个月)内除1例手术创面出现增生肉芽肿外,其余全部瘢痕愈合,无1例复发.所随访的患者术后复查肠镜示创面愈合良好,无复发.结论 随着ESD的不断开展及治疗器械和设备的不断改进,直肠巨大扁平病变可以得到1次、完整切除,充分体现“微创治疗”的优越性.护士在ESD过程中需要掌握各种配件的性能及熟练的操作,与医生配合默契,以保证手术顺利进行,减少并发症.     

老年单发早期胃癌内镜黏膜下剥离术的疗效

目的探讨老年单发早期胃癌(EGC)内镜黏膜下剥离术(ESD)的疗效。方法选取2010年1月-2015年2月山东省单县中心医院收治的126例单发EGC患者为研究对象,根据年龄分为老年组(≥65岁,n=50)和青中年组(65岁,n=76)。比较两组患者的基线资料、手术时间、失血量、术后住院天数、整块切除率、治愈性切除率和并发症等围术期状况及随访结果。结果老年组的年龄、高血压史、冠心病史的发生率明显高于青中年组,差异有统计学意义(P0.05)。两组患者的性别、糖尿病史、病灶形态、大小、病理结果和浸润深度等其余基线资料比较,差异无统计学意义(P0.05)。所有患者均成功完成ESD术,两组患者的围手术期资料比较,差异无统计学意义(P0.05)。全部患者均未出现肿瘤转移及死亡,共有3例出现复发,老年组与青中年组的复发率分别为2.0%与2.6%,两组比较差异无统计学意义(P0.05)。结论对于老年单发EGC患者而言,ESD术是安全有效的微创治疗方法,临床疗效与安全性与青中年患者无明显差异。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.