32例青年食管癌临床病理分析

目的：探讨青年食管癌患者的临床病理特点。方法：以病例对照方式对32例青年食管癌临床病理特点进行分析，选用同期50岁以上食管癌病例40例为对照组。结果：青年食管癌患者与老年者相比，病理分化程度低，恶性度高，早期诊断率低，生存期短。结论：青年食管癌症状隐匿，诊断率低，预后差。     

动态脑电图在昏迷病人中的应用

目的：探讨动态脑电图监测对昏迷病人的应用价值。方法：对107例昏迷患者采用多次动态脑电图监测，分析脑电图改变与临床结局的关系。结果：平坦波型昏迷死亡率较高(94．7％)，慢波型昏迷死亡率较低(30．3％)，且预后较好。结论：对昏迷病人实施动态脑电图监测，可提高对预后评估及脑死亡的正确判断率。     

nm23-H_1基因与突变型P~(53)基因在人乳腺病变组织中的表达

目的观察７６例乳腺病变组织中ｎｍ２３－Ｈ１及突变型Ｐ５３基因的表达情况,分析其与乳腺癌生物学行为及淋巴结转移的关系。方法应用ＳＰ免疫组织化学方法检测７６例乳腺病变组织中ｎｍ２３－Ｈ１及突变型Ｐ５３蛋白表达。结果ｎｍ２３－Ｈ１基因在５６例乳腺癌中表达率为４４．６４％,１０例乳腺纤维瘤均阳性,１０例纤维囊性病９例阳性,后二者均高于乳腺癌中阳性率（Ｐ＜０．００５,Ｐ＜０．０１）;Ｐ５３在乳腺癌中阳性率３５．７１％,在所有良性乳腺疾患中均阴性（Ｐ＜０．０２５）。同时发现ｎｍ２３－Ｈ１表达与乳腺癌组织分化程度及淋巴结转移呈负相关（Ｐ＜０．０２５,Ｐ＜０．０５）,与病理组织类型无关;Ｐ５３表达与乳腺癌淋巴转移正相关（Ｐ＜０．０５）,与组织类型及分化程度无关;ｎｍ２３－Ｈ１与Ｐ５３表达呈负相关（Ｐ＜０．０５）;另外,ｎｍ２３－Ｈ１表达缺失与Ｐ５３的阳性表达在乳腺癌淋巴结转移上有协同作用。结论ｎｍ２３－Ｈ１的表达缺失及Ｐ５３的阳性表达提示乳腺肿瘤恶性度高、淋巴转移潜能大,二者联合检测对乳腺癌患者预后的评价更为全面可靠。     

颅咽管瘤全切除术及术后并发症的防治

目的探讨颅咽管瘤全切除术的手术方法和术后并发症的防治措施。方法24例颅咽管瘤都位于鞍区。术前准备主要包括糖皮质激素的替代疗法和癫痫的预防。手术均采取翼点入路，采用显微技术从鞍区各个手术间隙分块切除肿瘤。术后处理主要包括严密观测病人的意识、尿量和血清电解质，及时防治尿崩症、电解质紊乱等并发症，预防癫痫和糖皮质激素替代治疗。结果22例病人显微镜下肿瘤全切，2例肿瘤有少部分残余，术后无明显的神经功能障碍。16例发生了尿崩症，12例发生了电解质紊乱，6例发生了体温失衡。经过处理后，电解质紊乱和体温失衡完全纠正，13例尿崩症痊愈，3例得到了缓解。结论根据肿瘤的扩展范围以选用最合适的手术入路，以及熟悉鞍区的各个手术间隙解剖并在术中充分利用之是完成颅咽管瘤全切除术的关键。术前采用糖皮质激素的替代疗法，术后严密监测尿量和血电解质，积极处理尿崩症、电解质紊乱等并发症，可以有效降低手术死亡率。     

诱导痰在慢性阻塞性肺病气道炎症监测中的应用

目的　观察COPD患者诱导痰细胞学和痰上清液IL -8浓度的变化 ,探讨诱导痰在COPD气道炎症监测中的作用。方法　以 2 6例临床确诊的稳定期COPD患者为研究对象 ,分离诱导痰细胞 ,同时检测痰上清液IL -8浓度和肺功能。并以 15例健康志愿者作为对照组。结果　COPD稳定期组与正常对照组诱导痰细胞总数、巨噬细胞数及中性粒细胞数比较 ,差异有显著性 (P <0 0 1) ;COPD稳定期组中性粒细胞百分率高于正常组 ,(P <0 0 1)。稳定期组诱导痰上清液IL -8浓度与正常组比较差异有显著性(P <0 0 1)。诱导痰上清液IL -8的浓度与FEV1占预计值 %呈负相关关系 (r=-0 5 3 9,P <0 0 1) ;诱导痰PMN数与FEV1占预计值 %呈负相关关系 (r =-0 73 3 ,P <0 0 1) ;AM数与FEV1占预计值 %无相关关系 (r =-0 2 2 3 ,P =0 161)。结论　诱导痰技术无创、简便 ,是监测COPD气道炎症的较理想指标。     

鼻咽癌患者放疗后真菌感染的危险因素分析

目的探讨鼻咽癌患者经放疗后真菌感染的危险因素及相应的处理对策,以降低鼻咽癌放疗后真菌感染的发生率。方法选取2005年1月-2013年12月接受治疗的鼻咽癌放疗患者378例,对真菌感染的各可能危险因素进行统计分析,数据采用SPSS 17.0软件进行统计分析。结果 378例鼻咽癌患者放疗后发生真菌感染82例,感染率为21.69%;培养出真菌88株,以白色假丝酵母菌和热带假丝酵母菌为主,分别占56.82%、21.59%;当患者年龄>60岁、≥2种并发症、使用免疫抑制剂、伴皮肤或黏膜溃烂、住院时间>50d、口腔感染时真菌感染率明显上升,差异有统计学意义(P<0.05);鼻咽癌放疗后患者抗菌药物使用率为80.42%;使用抗菌药物≥35d、品种≥3种及选用头孢菌素类抗菌药物抗感染时,真菌感染率明显增加,差异有统计学意义(P<0.05)。结论高龄、≥2种并发症、使用免疫抑制剂、伴皮肤或黏膜溃烂、住院时间>50d、不合理使用抗菌药物是鼻咽癌放疗后发生真菌感染的危险因素,医院应继续加强监管力度,降低鼻咽癌放疗后真菌感染的发生。     

Laparoscopic versus open pancreatoduodenectomy: an individual participant data meta-analysis of randomized controlled trials

BackgroundRandomized trials have compared laparoscopic pancreatoduodenectomy (LPD) to open pancreatoduodenectomy (OPD) with conflicting results. An IPDMA may give more insight into the differences between LPD and OPD, and could identify high-risk subgroups.MethodsA systematic literature search was performed in the Pubmed, Embase, and the Cochrane library databases (October 2019). Out of 1410 studies, three randomized trials were identified. Primary outcome was major complications (Clavien-Dindo grade ≥ III). Subgroup analyses were performed for high-risk subgroups including patients with BMI of ≥25 kg/m2, pancreatic duct <3 mm, age ≥70 years, and malignancy.ResultsData from 224 patients were collected. After LPD, major complications occurred in 33/114 (29%) patients compared to 34/110 (31%) patients after OPD (adjusted odds ratio (OR) 0.62; 95% confidence interval (CI) 0.3–1.4, P = 0.257). No differences were seen for major complications and 90-day mortality LPD 8 (7%) vs OPD 4 (4%) (adjusted OR 0.2; 95% CI 0.02–1.3, P = 0.080). With LPD, operative time was longer (420 vs 318 min, p < 0.001) and hospital stay was shorter (mean difference ?6.97 days). Outcomes remained stable in the high-risk subgroups.ConclusionLPD did not reduce the rate of major postoperative complications as compared to OPD. LPD increased operative time and shortened hospital stay with 7 days.     

Biomarkers in the prognostic evaluation of ischemic stroke: Is there benefit in the measurements of TREM-1 and TREM-2 in the acute phase?

Background and purposeTriggering receptors expressed on myeloid cells 1 and 2 (TREM-1 and TREM-2) are cell surface receptors important for modulation of microglia immune response. In this study, we evaluate serum levels of TREM-1 and TREM-2 as potential biomarkers in acute ischemic stroke (AIS).Material and methodsProspective cohort study of 50 patients with AIS admitted at our hospital. Serum TREM-1 and TREM-2 was evaluated within 24 h of the acute event and on the third and fifth days after the stroke. Neurological stroke severity and global disability were determined with the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) at the same three times and at the time of hospital discharge.ResultsTREM-1 and TREM-2 levels were elevated in stroke. TREM-1, but not TREM-2, exhibited correlations with NIHSS and mRS within 24 h (NIHSS and TREM-1: r_S = 0.31, p = 0.029; mRS and TREM-1: r_S = 0.32, p = 0.023). The serum level of TREM-1 within 24 h correlated with the neurological outcomes at hospital discharge (NIHSS and TREM-1: p = 0.021; mRS and TREM-1: p = 0.049). The serum concentrations of TREM-1 protein within 24 h after stroke was significantly higher in patients with poor outcome (mRS > 2) at hospital discharge (p = 0.021). After Exact Logistic Regression, large segmental stroke (O.R. = 4.14; 95CI = 1.07–16.09; p = 0.040) and initial sTREM levels (O.R. = 1.02; 95CI 1.00–1.04; p = 0.045) remained independent prognostic factors for AIS poor outcome (mRS > 2).ConclusionIn our study, TREM-1 and TREM-2 were significantly increased in AIS. Early elevation of TREM-1 correlated with stroke severity and it was an independent prognostic factor for stroke outcome.     

三维超声检查在评估CEA后再狭窄中的作用

目的 探讨三维超声在评估颈动脉内膜斑块切除术（CEA）后再狭窄中的价值。方法 回顾性分析2016年3月至2020年2月CEA治疗的272例颈动脉狭窄的临床资料。采用三维超声定量检测术前颈动脉斑块灰阶中位数值（GSM）、总体积（TPV）、GSM/TPV和最大横截面积,以及手术前后残余管腔面积。术后随访6~53个月,中位时间28.5个月,超声或CTA显示残余管腔面积小于术后50%定义为术后再狭窄。结果 272例中,术后发生再狭窄25例[再狭窄组;9.19%（25/272）];再狭窄程度55~89%,平均（74.6±10.3）%。247例未发生再狭窄（未狭窄组）。与未狭窄组相比,再狭窄组术前GSM明显降低（P<0.05）,术后残余管腔面积明显缩小（P<0.05）。两组术前TPV、GSM/TPV、最大横截面积和术前残余管腔面积无统计学差异（P>0.05）。ROC曲线分析结果显示,术前GSM和术后残余管腔面积判断术后再狭窄的曲线下面积分别为0.854（95%置信区间0.798~0.967;P<0.05）、0.866（95%置信区间0.802~0.946;P<0.05）,最佳临界值分别为36.8、139.7 mm2。术前GSM≤36.8预测术后再狭窄的敏感性和特异性分别为84.3%和76.8%。术后残余管腔面积≤139.7 mm2预测再狭窄的敏感性和特异性分别为86.9%和80.5%。结论 CEA治疗单发粥样斑块导致的颈动脉狭窄仍有一定的再狭窄率;三维超声检测颈动脉斑块的多个参数对评估术后再狭窄有较好的应用价值,尤其是GSM和术后残余管腔面积。