抗磷脂抗体和子痫前期的研究进展

抗磷脂抗体是一类能与磷脂或磷脂结合蛋白结合的自身免疫性抗体,与血栓形成、不良孕产史密切相关。抗磷脂抗体中高滴度阳性的患者易有子痫前期等不良妊娠结局。子痫前期发生于妊娠期,可导致全身多脏器的损伤,严重危及母儿生命和健康。子痫前期的发病机制目前还不是很清楚,研究提示抗磷脂抗体可能通过诱导氧化应激,促进血管内炎症等作用参与子痫前期的发病;对于抗磷脂抗体阳性的患者,早期发现和早期干预对获得良好的妊娠结局至关重要。     

改良早期预警评分在胸外科手术病人护理中的应用

[目的]探讨改良早期预警评分(MEWS)在胸外科临床护理中的应用价值。[方法]分析2013年1月—2013年12月胸外科手术后618例病人的MEWS评分结果,筛选出≥4分的病人及转入ICU的病人,分析MEWS评分与病人转归的关系。[结果]618例中146例MEWS评分≥4分;转入ICU病人12例,MEWS评分均≥5分,11例血氧饱和度(SpO2)90%;死亡1例,转ICU前MEWS评分6分,SpO272%。[结论]MEWS评分可以帮助胸外科护士判断手术后病人病情的严重程度,但必须同时关注病人的SpO2。建议以评分≥4分为提高监护级别的指标。     

巨大型腰椎间盘突出症两种手术方案的疗效比较

目的对比观察椎板切除、椎间盘切除加cage植骨椎间融合结合椎弓根系统内固定术与椎板切除加髓核摘除术治疗巨大型腰椎间盘突出症的临床疗效。方法 106例单间隙、巨大型腰椎间盘突出症根据手术方式不同分为两组(各53例),A组行椎板切除、椎间盘切除加cage植骨椎间融合并椎弓根系统内固定术,B组行椎板切除加髓核摘除术,应用Macnab标准评定疗效,观察腰腿痛复发及骨性融合情况。结果两组患者出血量、手术时间、卧床时间差异有统计学意义(P<0.05);手术效果按照改良Macnab标准评定:术后6个月:A组优良率为90.57%,B组优良率为66.04%,两组差异有统计学意义(P<0.05)。末次随访:A组优良率为84.91%,B组优良率为50.93%,两组差异有统计学意义(P<0.05)。结论在严格选择手术适应证的情况下,行椎板切除加cage植骨椎间融合结合椎弓根系统内固定术的近中期临床疗效满意,该方法具有固定可靠、术后恢复快、复发腰腿痛少等优点。     

Uncut Roux-en-Y reconstruction after distal gastrectomy for gastric cancer

Introduction: Uncut Roux-en-Y gastrojejunostomy is a modification of the Billroth II procedure with Braun anastomosis, in which a jejunal occlusion is fashioned to avoid the Roux Stasis Syndrome. This review aimed to summarize the current knowledge about the uncut Roux-en-Y anastomosis operation, so that surgeons may be able to make informed decisions about its clinical application. Additionally, we hope that our findings will guide future research on this topic.

Areas covered: The original uncut technique was associated with dehiscence or recanalization of the jejunal occlusion, and was therefore not widely applied. However, with recent improvements in the method of jejunal occlusion, the uncut Roux-en-Y reconstruction may be an appropriate alternative for digestive tract reconstruction after distal gastrectomy. This review summarizes the basic research on and clinical applications of uncut Roux-en-Y gastrojejunostomy from the following several aspects: origin of the uncut reconstruction technique, rationale for uncut reconstruction based on data from animal experiments, clinical results of the uncut reconstruction, recanalization and its countermeasures, and so on.

Expert commentary: The uncut Roux-en-Y gastrojejunostomy is a controversial yet promising method of gastrointestinal reconstruction after distal gastrectomy. Prospective randomized controlled trials and long-term follow-up outcomes are required to support the modified technique in the future.     

“5E”康复模式对脑卒中偏瘫病人焦虑和抑郁的影响

[目的]探讨"5E"康复模式对脑卒中偏瘫病人焦虑和抑郁的影响。[方法]选取脑卒中偏瘫病人100例,按入院先后顺序将研究对象随机分为试验组和对照组,对照组采用常规健康教育及康复护理,试验组采用"5E"康复干预,内容包括鼓励、教育、运动、工作、评估,应用焦虑自评量表(SAS)和抑郁自评量表(SDS)在干预前和干预1个月后、3个月后评估两组病人的焦虑和抑郁情况。[结果]治疗后两组病人SAS、SDS评分均显著低于治疗前。但试验组较对照组下降明显(P<0.01)。[结论]"5E"康复模式的应用能有效地改善脑卒中偏瘫病人焦虑和抑郁症状。     

品管圈在降低住院患者跌倒发生率中的应用

目的研究品管圈在降低住院患者跌倒发生率的价值。方法根据患者跌倒不良事件上报情况,确定2012年4月至6月的跌倒发生率,查看2012年8月该院住院患者跌倒状况,进行目标设定、原因分析、制定与实施对策等品管圈活动流程,确认运用品管圈管理(2012年7月至2012年10月)该院住院患者跌倒发生率。结果住院病人跌倒发生率由9.38‰降低至5.6‰,进步率达40.3%,P<0.05,差异具有统计学意义。结论应用品管圈能降低住院患者跌倒发生率,提高护理工作的质量。     

术前低PSA的Gleason 8~10分前列腺癌患者临床特点

背景与目的:前列腺癌的发病率逐渐上升,其中有些患者在诊断为高级别前列腺癌甚至转移性前列腺癌时,其前列腺特异性抗原(prostate-specific antigen,PSA)数值却处于很低的水平。探讨术前低血清PSA的Gleason 8~10分前列腺癌患者临床特点。方法:收集2013年1月-2018年1月江苏省苏北人民医院收治的72例接受前列腺癌根治术的高Gleason评分前列腺癌患者的临床资料。根据术前血清PSA水平分为4组:A组<4.0 ng/mL(9例)、B组4.0~10.0 ng/mL(12例)、C组10.0~20.0 ng/mL(15例)和D组>20.0 ng/mL(36例)。4组平均年龄分别为(68.8±8.6)、(68.9±6.0)、(71.6±6.0)和(68.4±6.4)岁。平均随访时间分别为(21.6±12.1)、(18.8±7.2)、(25.0±13.4)和(24.8±12.5)个月。切缘阳性例数分别为3例(33.3%)、5例(41.7%)、5例(33.0%)和15例(41.7%)。精囊侵犯例数分别为6例(66.7%)、2例(16.7%)、2例(13.3%)和14例(38.9%)。淋巴结转移例数分别为2例(22.2%)、3例(25.0%)、4例(26.7%)和13例(36.1%)。预后评价指标为无生化复发天数(biochemical progression-free day,bPFD)与前列腺癌特异性死亡(prostate cancer-specific death,PCSD)。4组平均PFD分别为(90.00±38.40)、(306.17±79.00)、(223.14±63.30)和(145.03±62.50)d。PCSD例数分别为4例(44.4%)、0例(0.0%)、1例(6.7%)和5例(13.9%)。组间年龄、随访时间、PFD使用单因素方差分析,进一步两两比较采用最小显著差别(least significant difference,LSD)法;组间临床病理学特征采用χ2检验、Fisher精确检验;PCSD使用Kaplan-Meier生存分析,生存曲线间比较使用log-rank检验。结果:A组与其余3组相比,年龄、随访时间、切缘阳性、淋巴结转移的差异均无统计学意义(P>0.05)。A组与B、C两组相比,精囊侵犯、PFD的差异均有统计学意义(P<0.05)。但A组与D组相比,精囊侵犯、PFD的差异无统计学意义(P>0.05)。生存分析显示,A组相较于B组在随访时间内生存状况更差,但差异无统计学意义(P=0.092),A组与C、D两组的生存差异有统计学意义(P<0.05)。结论:具有术前低血清PSA水平的高Gleason评分前列腺癌患者相较于PSA更高水平的患者预后更差,易出现精囊侵犯、术后生化复发快且PCSD例数多。     

Galectin-1 from cancer-associated fibroblasts induces epithelial–mesenchymal transition through β1 integrin-mediated upregulation of Gli1 in gastric cancer

Background

Gastric cancer (GC) is characterized by the excessive deposition of extracellular matrix, which is thought to contribute to this tumor’s malignant behavior. Epithelial-mesenchymal transition (EMT) is regarded as a crucial contributing factor to cancer progression. Galectin-1 (Gal-1), a β-galactoside-binding protein abundantly expressed in activated cancer-associated fibroblasts (CAFs), has been reported to be involved in GC progression and metastasis by binding to β1 integrin, which, in turn, can bind to matrix proteins and activate intracellular cascades that mediate EMT. Increasing evidence suggests that abnormal activation of the hedgehog (Hh) signaling pathway enhances GC cell migration and invasion. The purpose of our study is to explore the role of Gal-1 in the GC progression and metastasis as well as the regulatory mechanism.

Methods

We hypothesized that Gal-1 binding to β1 integrin would lead to paracrine signaling between CAFs and GC cells, mediating EMT by upregulating Gli1. Invasion and metastasis effects of the Gal-1 and Gli1 were evaluated using wound healing and invasion assay following transfection with mimics. Additionally, to facilitate the delineation of the role of the Hh signaling in GC, we monitored the expression level of associated proteins. We also evaluated the effects of β1 integrin on these processes. Furthermore, Gal-1 and Gli1 expression in GC patient samples were examined by immunohistochemistry and western blot to determine the correlation between their expression and clinicopathologic characteristics. The Kaplan-Meier method and Cox proportional hazards model were used to analyze the relationship of expression with clinical outcomes.

Results

Gal-1 was found to induce EMT, GC cell migration and invasion. Further data showed that Gal-1 up-regulated Gli1 expression. β1 integrin was responsible for Gal-1-induced Gli1 expression and EMT. In clinical GC tissue, it confirmed a positive relationship between Gal-1 and Gli1 expression. Importantly, their high expression is correlated to poor prognosis.

Conclusion

Gal-1 from CAFs binds to a carbohydrate structure in β1 integrin and plays an important role in the development of GC by inducing GC metastasis and EMT through targeting Gli1. This study highlights the potential therapeutic value of Gal-1 for suppression of GC metastasis.

     

S-1-based combination therapy vs S-1 monotherapy in advanced gastric cancer:A meta-analysis

AIM:To assess the efficacy and safety of combination therapy based on S-1,a novel oral fluoropyrimidine,vs S-1 monotherapy in advanced gastric cancer(AGC).METHODS:We searched PubMed,EMBASE and the Cochrane Library for eligible studies published before March 2013.Our analysis identified four randomized controlled trials involving 790 participants with AGC.The outcome measures were overall survival(OS),progression-free survival(PFS),overall response rate(ORR)and grade 3-4 adverse events.RESULTS:Meta-analysis showed that S-1-based combination therapy significantly improved OS(HR=0.77,95%CI:0.66-0.91,P=0.002),PFS(HR=0.58,95%CI:0.46-0.72,P=0.000)and ORR(OR=2.23,95%CI:1.54-3.21,P=0.000).Sensitivity analysis further confirmed this association.Lower incidence of grade 3-4 leucopenia(OR=4.06,95%CI:2.11-7.81),neutropenia(OR=3.94,95%CI:2.1-7.81)and diarrhea(OR=2.41,95%CI:1.31-4.44)was observed in patients with S-1 monotherapy.CONCLUSION:S-1-based combination therapy is superior to S-1 monotherapy in terms of OS,PFS and ORR.S-1 monotherapy is associated with less toxicity.     

Full robot-assisted gastrectomy with intracorporeal robot-sewn anastomosis produces satisfying outcomes

AIM:To evaluate the feasibility and safety of full robotassisted gastrectomy with intracorporeal robot handsewn anastomosis in the treatment of gastric cancer.METHODS:From September 2011 to March 2013,110consecutive patients with gastric cancer at the authors’institution were enrolled for robotic gastrectomies.According to tumor location,total gastrectomy,distal or proximal subtotal gastrectomy with D2 lymphadenectomy was fully performed by the da Vinci Robotic Surgical System.All construction,including Roux-en-Y jejunal limb,esophagojejunal,gastroduodenal and gastrojejunal anastomoses were fully carried out by the intracorporeal robot-sewn method.At the end of surgery,the specimen was removed through a 3-4 cm incision at the umbilicus trocar point.The details of the surgical technique are well illustrated.The benefits in terms of surgical and oncologic outcomes are well documented,as well as the failure rate and postoperative complications.RESULTS:From a total of 110 enrolled patients,radical gastrectomy could not be performed in 2 patients due to late stage disease;1 patient was converted to laparotomy because of uncontrollable hemorrhage,and1 obese patient was converted due to difficult exposure;2 patients underwent extra-corporeal anastomosis by minilaparotomy to ensure adequate tumor margin.Robot-sewn anastomoses were successfully performed for 12 proximal,38 distal and 54 total gastrectomies.The average surgical time was 272.52±53.91 min and the average amount of bleeding was 80.78±32.37 mL.The average number of harvested lymph nodes was 23.1±5.3.All specimens showed adequate surgical margin.With regard to tumor staging,26,32 and 46 patients were staged asⅠ,ⅡandⅢ,respectively.The average hospitalization time after surgery was 6.2 d.One patient experienced a duodenal stump anastomotic leak,which was mild and treated conservatively.One patient was readmitted for intra-abdominal infection and was treated conservatively.Jejunal afferent loop obstruction occurred in 1 patient,who underwent re-operati