青年与老年结直肠癌临床病理特征的对比分析

目的 探讨青年与老年结直肠癌的临床病理特征及其与预后的关系.方法 回顾性分析1993年7月至2003年7月收治的68例35岁以下青年结直肠癌患者与322例65岁以上老年患者的临床资料,比较分析其临床表现、病理特征、肿瘤分期、误诊比例和随访结果.结果 青年组患者以腹痛为主,占69.1%(47/68);而老年组则以便血或黏液血便为主,占53.7%(173/322).青年组的肿瘤低分化比例为48.5%,明显高于老年组的20.5%(P＜0.01).青年组的肿瘤中晚期(Dukes分期C期 D期)比例为80.9%,明显高于老年组的50.3%(P＜0.01).青年组和老年组的误诊率分别为64.7%和14.O%,差异非常显著(P＜0.01).青年组3年生存率33.9%,明显低于老年组的67.3%(P＜0.01);其中肿瘤低分化患者的3年生存率在青年组和老年组分别为15.6%和43.4%,组间差异显著(P＜0.05);中晚期患者的3年生存率在青年组和老年组分别为25.0%和51.2%,差异非常显著(P＜0.01).结论 与老年患者相比,青年结直肠癌分化更差,侵袭性更强,且易贻误诊断,预后不良.因此,应充分加强青年结直肠癌的早期诊断.     

青年人大肠癌的临床病理特征

目的:分析青年人大肠癌的临床特点.方法:回顾性了解1990～2002年12年间本院住院的大肠癌患者,选择年龄≤40岁青年人57例,及年龄≥60岁中老年人57例,分析两组临床、病理等特征.结果:12年共有1332例大肠癌住院患者,其中年龄≤40岁青年大肠癌100例,占同期大肠癌检出率的7.51%;青年组就诊时间中位数2月,确诊时间中位数为4月,与中老年组无显著性差异(P＞0.05).青年组有癌家族史者10例(17.5%),显著多于中老年组(5.3%,P＜0.05).两组临床表现均以便血或粘液血便、腹痛为主要表现,发病部位均以直肠癌为多.青年组中粘液癌(粘液腺癌和印戒细胞癌)的发生率为40.4%,显著高于老年组(8.8%,P＜0.005),青年组低分化癌占17.5%,显著多于中老年组低分化癌比例5.3%(P＜0.05),肿瘤Dukes分期:青年组:A期1例,B期23例,C期24例,D期9例.青年组共误诊21例,误诊率为36.8%,显著高于中老年组的误诊率5.3%(P＜0.001).结论:大肠癌青年人占有一定比例,有癌家族史者易发生大肠癌,主要临床表现为便血或粘液血便、腹痛等,发病部位以直肠癌最常见,较老年人多误诊;病理以粘液癌、低分化癌较老年患者多见,早期诊断率低.     

青年与老年结直肠癌临床特点比较

目的:比较青年与老年结直肠癌临床特点。方法:回顾性分析2014年10月至2017年9月期间的141例青年(年龄<40岁结直肠癌和同期确诊的542例老年(年龄≥60岁且<80岁)结直肠癌患者的临床资料。比较两组癌胚抗原检出率、首发症状、家族史、误诊率、行根治性手术的例数、发病部位、分化程度、TNM分期、淋巴结转移和癌变类型等临床特点。结果:两组性别及癌胚抗原检出率比较,差异无统计学意义(P>0.05);首发症状,青年组以便血最多见,老年组以腹痛最多见,无症状患者明显多于青年组,差异均有统计学意义(P<0.05);青年组有家族史、误诊率、行根治性手术的例数均明显高于老年组,差异均有统计学意义(P<0.05)。两组的肿瘤分型及肿块直径比较,差异无统计学意义(P>0.05)。青年组发病部位最多的是直肠,老年组最多的是左半结肠;青年组最多的是中分化癌,老年组最多的是高分化癌;青年组TNM分期最多的是Ⅱ期,老年组最多的是Ⅰ期;两组无淋巴结转移和远处转移的患者均较多,且老年组明显多于青年组;组织学类型上,老年组更多的是腺癌,青年组更多的是印戒或黏液癌,以上数据差异均有统计学意义(P<0.05)。结论:青年结直肠癌患者误诊率高、恶性程度高,易早期淋巴结转移及远处转移;老年结直肠癌患者早期症状不明显,最终行根治性手术比例相对青年组低。     

青年人结直肠癌临床病理特征分析

目的 探讨青年人结直肠癌的临床、病理特征与预后。方法 回顾性分析40岁以下青年人结直肠癌患者93例（青年组）的临床特点、病理特征和生存率，与同时期收治随机抽取的110例65岁及其以上（老年组）的结直肠癌患者的临床资料进行对比。结果 结直肠癌青年组与老年组患者在家族史、组织分型、病理分期、分化程度、淋巴结转移等方面差异有显著性（P〈0．05），两组在术根治率和5年生存率差异有显著性。结论 青年人结直肠癌以直肠癌多见，且恶性程度和误诊率较高，病理分期较晚，手术根治率和5年生存率较低。重新审视青年人结直肠癌发病率现状，运用早期诊断手段和及时积极的治疗，才能提高该肿瘤的临床疗效。     

青年人结直肠癌40例临床分析

目的 探讨青年人结直肠癌的临床特征。方法 回顾性分析40例青年人（≤40岁）结直肠癌患者的临床资料，与同期112例60岁及其以上（老年组）的临床资料进行对比。结果 结直肠癌青年组与老年组患者在误诊率方面差异有显著性意义（P〈0．05），在手术方式、侵袭程度等方面差异无显著性意义（P〉0．05）。结论 青年人结直肠癌临床症状不典型，恶性程度高，易误诊、漏诊，预后差。因此，早发现、早诊断、早治疗是提高生存率的关键。     

不同年龄组结直肠癌的临床特点分析

目的 比较不同年龄组结直肠癌患者在临床表现和肿瘤特征方面的差别,探讨各年龄组的发病特点以提高对结直肠癌临床特点的认识.方法 回顾性分析经病理确诊的结直肠癌617例,按年龄段分为青年组(≤35岁)、中年组(35～59岁)和老年组(≥160岁).就不同年龄组的性别分布、首发症状、临床表现等一般资料和肿瘤部位、病理组织学类型、大小、浸润深度等肿瘤特征性资料进行统计学分析.结果 结直肠癌以中、老年组多见(占全部结直肠癌的87.7%),性别构成比青年组几乎无差异,中、老年组中男性多于女性.青年组发病到确诊时间(8.72个月)略长于中、老年组(7.30、7.66个月).青、中年组临床症状多表现为大便带血和腹痛(占81.6%或82.3%),且多为剧痛;中年组首发症状为大便带血(占61.5%),比青、老年组常见(P<0.05);老年组以大便带血、腹痛和排便习惯改变为主(占87.6%),腹痛多为隐痛或胀痛.3组结直肠癌的好发部位基本一致,均以直、乙状结肠为最好发部位(均占70%以上).结肠癌中,各年龄组左、右半结肠癌无差异;直肠癌中,青年组肿瘤位置距肛门≥6 cm的比例比中、老年组高(P<0.01).不同年龄组肿瘤病理组织学类型差异有显著性(P<0.01);青年组中、低分化癌所占比例比中、老年组高(P<0.01).青、中年组位于浆膜层及浆膜外的比例比老年组高(P<0.01).青、中年组淋巴结转移率比老年组高(P<0.01).青年组Ducks C期和D期比例高于中、老年组(P<0.01).各年龄组采用的手术方式差异有显著性(P<0.01),青年组采用根治术的比例较中、老年组低(P<0.01).结论 结直肠癌中男性构成比高于女性,不同年龄组结直肠癌的临床表现、发病到确诊时间、病理组织学类型、浸润深度、淋巴结转移、Ducks分期和采用的手术方式均有差异.     

不同发病部位结直肠癌患者的临床特点分析

目的比较不同发病部位结直肠癌患者的临床表现、病理学特征。方法采用Epidata软件建立大肠癌信息化数据库录入宁夏医科大学总医院2001年12月-2011年3月间收治的702例原发性结直肠癌住院患者临床资料,分析不同肿瘤部位患者的临床表现及肿瘤特征。结果本组资料近端结肠癌41.0%,远端结肠癌41.7%,直肠癌17.2%。不同发病部位结直肠癌患者的性别、年龄、城乡分布间的差异无统计学意义(P>0.05)。不同发病部位结直肠癌患者出现的食欲减退、贫血、腹痛、腹胀、血便、脓血便、便频、大便变细、肠梗阻等症状的差异有统计学意义(P均<0.05),不同发病部位结直肠癌患者出现的体重下降、腹泻、便秘、FOBT阳性、黏液便等症状的差异无统计学意义(P均>0.05)。近端结肠癌常出现腹痛、腹胀、食欲减退症状;远端结肠癌多见腹痛、血便、腹胀;直肠癌多见血便、便频、脓血便。不同发病部位结直肠癌间肿瘤浸润深度有差异(P=0.000),不同部位的结直肠肿瘤均浸及浆膜层最多。不同发病部位结直肠癌间肿瘤细胞分化程度差异有统计学意义(P<0.05),不同部位的结直肠癌均以中分化癌多见。淋巴组织增生在近端结肠癌最多(P=0.000)。淋巴、腹膜转移均在近端结肠癌最常见(P均<0.05)。结论不同发病部位结直肠癌的主要临床表现、分化程度、浸润深度、淋巴组织增生及转移途径不同,可为临床诊断及预后判断提供参考。     

老年与青年胃溃疡临床特点对比研究

目的 探讨分析老年与青年胃溃疡临床特点.方法 随机抽取158例胃溃疡患者,按照年龄分为老年组与青年组,各79例;比较两组临床表现及病因等.结果 老年组和青年组胃溃疡患者临床症状表现不同,黑便与呕血、贫血及消瘦的比例差异均有统计学意义(均P＜ 0.05),反酸嗳气、上腹部疼痛及牙痛的比例差异均无统计学意义(均P＞ 0.05).两组长期吸烟比例差异无统计学意义(P＞0.05);青年组不规律饮食与不合理作息比例明显高于老年组(P＜0.05).老年组幽门螺杆菌感染与服用非甾体抗炎药物比例明显高于青年组(P＜0.05).青年组溃疡部位多发生于胃窦部,直径一般＜2cm,而老年组溃疡部位同样好发于胃窦部,但胃底部与胃体部溃疡发生率明显高于青年组,胃窦部发生率明显低于青年组患者(P＜0.05),直径一般＞2cm,差异均有统计学意义(均P＜0.05).结论 青年组胃溃疡患者在不规律饮食与不合理作息方而更显著,而老年组患者在幽门螺杆菌感染与服用非甾体抗炎药物方面比例多于青年组,青年组溃疡部位多发生于胃窦部,直径一般＜ 2cm,而老年组胃底部与胃体部溃疡发生率明显高于青年组,直径一般＞ 2cm.     

食管癌临床病理学特征与年龄的关系

目的:探讨不同年龄段食管癌患者的临床和病理学特点.方法:对174例食管癌患者临床资料进行回顾性分析.174例患者中≤40岁(青年组)、41～46岁(中年组)、＞60岁(老年组)患者分别为26、74、74例,分析比较各组的一般临床及病理学特点.结果:各年龄组食管癌患者的性别、民族构成及发病部位差异均无统计学意义(P＞0.05).老年组术前合并症及术后并发症发生率均明显高于青年组和中年组(P＜0.05),随着年龄的增长,高、中分化所占的比例呈上升趋势,而低分化所占比例呈下降趋势,各组差异有统计学意义(P＜0.05);青年组区域淋巴结转移率明显高于老年组(P＜0.05);随着年龄的增长,临床TNM分期Ⅲ期以上者呈下降趋势,各组差异有统计学意义(P＜0.05).结论:不同年龄段食管癌临床、病理学特点存在明显差异,青年食管癌病情发展快,肿瘤分化程度低,区域淋巴结转移率高,TNM分期晚;而老年食管癌术前合并症多,术后并发症发生率高,但病情发展较慢,肿瘤分化程度高,区域淋巴结转移率低,TNM分期较早;中年食管癌居中.     

D2-40与nm23在结直肠癌中的表达及临床病理意义的探讨

目的:探讨D2-40和nm23在结直肠癌中的表达及其临床病理意义.方法:采用免疫组化Envision法对202例结直肠癌患者D2-40及nm23进行检测,分析结直肠癌淋巴管浸润(lymph vessel invasion,LVI)情况及nm23的表达情况与患者临床病理特征的相关性.结果:nm23在结直肠癌患者中阳性表达率为41.6％ (84/202),其表达在高、中分化组与低分化组之间、病理分期TNM Ⅰ～Ⅱ与Ⅲ～Ⅳ之间有统计学差异(P＜0.05);LVI在结直肠患者中阳性表达率为14.9％(30/202),其表达在直肠癌患者和结肠癌患者之间、高、中分化与低分化组之间、病理分期TNM Ⅰ～Ⅱ与Ⅲ～Ⅳ组之间有统计学差异(P＜0.05);LVI阳性组淋巴结转移数量水平高于LVI阴性组(P＜0.05);nm23的表达及表达的阳性程度与淋巴结转移存在负相关关系(P＜0.05);LVI与nm23的表达无相关性(P＞0.05).结论:LVI和nm23在结直肠癌中的表达与其发生发展及浸润转移有一定的相关性,其检测对结直肠癌的分级分期有重要的指导意义.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

CLINICAL SIGNIFICANCE OF SERUM CYTOKINES IL-1β,sIL-2R,IL-6,TNF-α,AND IFN-v IN ACUTE CORONARY SYNDROME

Objectives To explore serum cytokines levels (including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v) and their significance in patients with acute coronary syndrome (ACS) and the subsequent follow-ups, with attempt to estimate the role of various serum inflammatory markers in the diagnosis and assessment of ACS.Methods The study population include 40 patients with acute myocardial infarction (AMI), 40 patients with unstable angina pectoris (UAP), and 40 controls. Among the 80 patients, 60 patients attended a follow up 4 months later. Serum inflammatory markers including IL-1 β, sIL-2R, IL-6, TNF-α, and IFN-v were measured by enzyme linked immunosorbent assay.Results Serum IL- 1 β, sIL-2R, IL-6, TNF-α were significantly higher in AMI group or UAP group compared to the control group and became significantly lower 4 months later in the follow-up patients. Serum levels of IFN-v shows no significant difference between AMI group or UAP group and controls, also showing no significant change when measured in follow up patients. There was no correlation between serum creatine kinase-MB isoenzyme levels and serum inflammatory markers either in UAP or AMI group. Furthermore, when divided into two subgroups using Wagner's QRS scoring system in the AMI group, there is no difference of each serum inflammatory marker between ≤ 6 scores group and ＞ 6 scores group.Conclusion Serum levels of certain inflammatory markers may have some diagnostic value for ACS, and can be a useful marker reflecting disease stability.     

Possible Spread of adenovirus type 3 from poultry to humans ：indirect evidence from an outbreak in China

Objective:To explore the epidemiology and etiology for an outbreak of acute respiratory tract infection that occurred in one county of Jiangsu Province, China 2004. Methods: Only cases meeting the case definition were included in the study. We reviewed the medical records of the cases who were admitted to the local hospitals, interviewed cases by a standard questionnaire, and then described the epidemiotogic features and analyzed risk factors by means of a case-control study. We collected pharyngeal swab specimens and sent them to different laboratories for isolation and culture. The laboratory used different detection methods such as DIP, PCR, electron microscope examination and microneutralization assay, to identify and then type the positive specimens. Results:A total of 871 cases were reported during the period from April 18 to July 4,2004. The distribution of onset times presented two peaks, one in late May and another in middle June. The epidemic occurred mainly in the elementary and junior high schools in ten townships of one county, and the mean age of the cases was 12 years (range 7 months to 18 years). The course of the disease was acute, and was characterized by fever accompanied with sore throat and tonsillitis. The WBC count of cases was normal or elevated. The mean duration of illness was 5 days (range 2 to 12 days). No fatalities from illness were reported. A case-control study indicated that the possible risk factors were close contact with a case and/or poultry before onset and sharing of towels among members of the family. The typical CPE was observed through inoculating pharyngeal swab specimens into the HEP-2 cell cultures in different laboratories. An infection of adenovirus type 3 was verified by detecting positive specimens in different methods. Conclusion:This investigation demonstrated that the acute respiratory infection in cases was caused by adenovirus type 3. Cases occurred in over 70 schools in ten townships in 2004, and the route of transmission was possibly close contact with cases or droplet transmission.