胆管癌组织的环状RNA circ?ITCH水平及临床意义

目的探讨胆管癌组织的环状RNA circ-ITCH水平及临床意义。方法收集本院2014年1月至2015年12月手术切除的95对胆管癌组织和癌旁组织,采用实时定量PCR(QPCR)检测上述组织的circ-ITCH水平,比较癌组织和癌旁组织的circ-ITCH水平差异,进一步分析circ-ITCH水平与胆管癌临床病理特征和预后的关系。结果胆管癌组织的circ-ITCH水平[中位数(四分位数)]为0.654(0.407~1.219),低于癌旁组织中的2.034(1.079~3.749),差异有统计学意义(P<0.05)。circ-ITCH水平与年龄、性别、吸烟、饮酒、HBV感染、肿瘤位置、分化程度和CEA水平无关(P>0.05),而与ECOG评分、T分期、N分期、TNM分期和CA199水平有关(P<0.05)。circ-ITCH高水平者的中位总生存期为35.0(95%CI:24.6~45.4)个月,长于低水平者的8.0(95%CI:7.3~28.7)个月(P<0.05);多因素分析显示circ-ITCH水平是影响胆管癌预后的独立因素(HR=0.535,95%CI:0.343~0.835,P=0.006)。结论胆管癌组织中circ-ITCH低表达,且与胆管癌患者的ECOG评分和临床分期有关,circ-ITCH低水平者的预后较差,在胆管癌诊断和预后预测上有一定价值。     

Gd-EOB-DTPA增强MRI评估功能性肝体积与肝功能Child-Pugh分级的相关性

目的：对比解剖性肝脏体积（ALV）和功能性肝脏体积（FLV）与肝功能Child-Pugh分级的相关性。方法：选择温州医科大学附属第二医院育英儿童医院2014年1月至2019年4月同时行增强CT和Gd-EOB-DTPA增强MRI扫描的肝硬化患者25例。对所有患者进行肝功能Child-Pugh评分，检测所有入组患者每个肝段的Gd-EOB-DTPA增强MRI平扫期和肝胆特异期的信号对比增强率（CER），以CT扫描的数据为基础利用MI-3DVS计算每个肝段的ALV和全肝的FLV。分析ALV和FLV与肝功能Child-Pugh分级的相关性。结果：肝功能Child-Pugh分级与ALV呈负相关（r=-0.792，P＜0.001），曲线拟合的决定系数（R2）=0.63；肝功能Child-Pugh分级与FLV亦呈负相关（r=-0.911，P＜0.001），曲线拟合的R2=0.80。FLV与肝功能Child-Pugh分级有更显著的负相关性。结论：结合Gd-EOB-DTPA增强MRI平扫期和肝胆特异期的信号CER和ALV计算所得的FLV较ALV能更好地反映肝脏的功能状态。     

腹腔镜与开腹胰十二指肠切除术临床疗效比较

目的 比较腹腔镜与开腹胰十二指肠切除术的临床疗效。方法 回顾性分析南充市中心医院2014 年6 月至2019 年8 月期间完成的104 例胰十二指肠切除术患者资料，其中包含胰头癌47 例，十二指肠乳头癌31 例，胆管下段癌26 例，根据已行的手术方式分为腹腔镜胰十二指肠切除组（A组，n=40）和开腹胰十二指肠切除组（B组，n=64）。比较两组的手术时间、术中出血量、平均排气时间、术后下床活动时间、住院时间及术后并发症发生情况。结果 两组手术时间和术中出血量无统计学差异（P＞0．05），平均排气时间、术后下床活动时间及住院时间A组小于B组（P＜0．05）。其中A组术后发生胰瘘5 例，胆漏4 例，腹腔内出血1 例，胃瘫综合征3 例；B组术后发生胰瘘9 例，胆漏5 例，腹腔内出血1 例，胃瘫综合征4 例，余无明显严重并发症发生；两组术后总并发症发生率无明显差异（P＞0．05）。结论 腹腔镜和开腹胰十二指肠切除术均安全有效，但腹腔镜胰十二指肠切除术后恢复优于开腹胰十二指肠切除术。     

医联体基层医疗机构人才培养SWOT分析

医联体是指一定地域内不同类型层级的公立医疗机构组合起来,成立协作联盟或组建医疗集团,成为利益共同体和责任共同体,即实现金字塔格局的分层诊疗模式。本文以人才流动理论着手,以XX医院医联体"送下去、请上来"的基层单位临床骨干人才的培养方式为例,结合SWOT分析法,SWOT分析法是是一种能够较客观而准确地分析和研究一个组织或单位发展现状的研究方法 ,对该模式的内外部资源以及环境展开分析,探寻为院医联体基层单位临床人才培养的相关制度,为医联体人才培养提供依据,同时探讨该举措在培养医联体成员单位临床骨干人才的作用及需要改进的方面,从积极争取支持、设立集团内绩效制度、实现文化理念相结合、加速信息共享平台的建设等方面进行改善。     

Maresin 1 alleviates dextran sulfate sodium-induced ulcerative colitis by regulating NRF2 and TLR4/NF-kB signaling pathway

ObjectiveUlcerative colitis (UC) is one of the most common gastrointestinal diseases, characterized as a chronic, relapsing inflammation that causes damage to the colonic mucosa. Maresin 1 (MaR1), a specialized proresolving mediator, has powerful anti-inflammatory activity that prevents the occurrence of various inflammatory diseases. The aim of this study was to explore the role and potential mechanism of MaR1 in DSS-induced ulcerative colitis.MethodsIn the present study, we established dextran sulfate sodium (DSS)-induced ulcerative colitis rat model in vivo. Rats with colitis received tail vein injection of MaR1, with or without intraperitoneal injection of ML385. The changes of body weight, colon length, disease activity index (DAI), colonic histopathology, inflammatory cytokines, the activity of myeloperoxidase (MPO) and reactive oxygen species (ROS), and infiltration of macrophages expressing F4/80 were analyzed for the evaluation of colitis severity. In addition, protein expressions were detected using western blot.ResultsMaR1 significantly reduced inflammatory cytokines production, and restored body weight, DAI and colonic histopathology. Besides, MaR1 improved the expression of tight junction (TJ) proteins and reduced the infiltration of neutrophil and macrophages, as well as a decreased activity of MPO and ROS. Meanwhile, MaR1 activated Nrf2 signaling and decreased toll-like receptor 4(TLR4)/nuclear factor-κB(NF-κB) activation. Furthermore, ML385, an inhibitor of Nrf2, significantly reversed the protective effect of MaR1.ConclusionMaR1 play a protective role in DSS-induced colitis by activating Nrf2 signaling and inactivating Nrf2-mediated TLR4/NF-κB signaling pathway, which mediate proinflammatory mediators and intestinal TJ proteins in rats, providing novel insights into the therapeutic strategy of colitis.     

Improving patient and staff safety by minimising radiation exposure during trauma surgery: A simple and validated predictive model

IntroductionMinimising radiation exposure, from fluoroscopic equipment during trauma surgery is crucial to safe-guarding patients and staff. This aim of this study was to identify variables associated with increased radiation exposure for 3 of the most common trauma procedures. Secondly, we aimed to derive an internally and externally validated mathematical model for predicting radiation exposure for these procedures.Materials and methodsWe prospectively recorded radiation exposure from 270 sliding hip screw (SHS), ankle and wrist fixation procedures. Patient demographics, fracture severity, surgeon and radiographer grade were assessed using univariate and multivariate analyses. A mathematical model was then created and externally assessed for validity from another unit.ResultsWith regards to the analysis of radiation exposure when fixing wrist fractures, a significant regression equation was found (F (3, 86) = 62.2, p < 0.001), with an adjusted R² of 0.69. Patients' predicted radiation exposure (cGY/cm2) was therefore equal to the positive result of: 81.916(Fracture severity) + 43.426(Surgical grade) + 23.490 (radiographer grade)-203.89.With regards to the analysis of radiation exposure when fixing ankle fractures, a significant regression equation was found, (F (3, 83) = 15.49, p < 0.001), with an adjusted R² of 0.34. Patients' predicted radiation exposure (cGY/cm2) was therefore equal to the positive result of: 39.541(Fracture severity) + 51.937(Surgical grade) + 37.702 (radiographer grade)-124.558 SHS (F (3, 89) = 25.29, p < 0.001), R² of 0.44.61.338(Fracture severity) + 60.945(Surgical grade) + 35.491 (radiographer grade)-105.501. These predictive models were successfully externally validated.ConclusionThis study has demonstrated a workable and externally validated model for accurately predicting the likely radiation exposure using common and easily collectable variables. These models could be used to modify practuce and minimise the radiation exposure to patients and staff.     

腹腔镜肝切除治疗58例肝内胆管细胞癌的临床探讨

目的探讨腹腔镜肝切除治疗肝内胆管细胞癌(ICC)的安全性及可行性。方法采用回顾性研究方法。收集2016年1月—2018年12月湖南师范大学附属第一医院行腹腔镜肝切除治疗的58例ICC患者的临床资料。其中男性34例,女性24例;年龄34~71岁,中位年龄54岁。观察指标:(1)手术治疗情况:手术方式、手术时间、术中出血量、术中输血率、术中肝门阻断时间、中转率、术后并发症、术后住院时间、术后胃肠道恢复时间、围手术期有无死亡病例及非计划手术病例。(2)术后病理情况。(3)随访。采用门诊和电话方式进行随访,了解患者术后生存情况。随访时间截至2019年6月。正态分布的计量资料以均数±标准差(Mean±SD)表示,计数资料用频数和百分比(%)表示。结果本研究共纳入58例患者,其中48例患者在腹腔镜下完成ICC根治性外科切除手术,10例患者行腹腔镜中转开腹。(1)手术治疗情况:手术方式有腹腔镜下左半肝(Ⅱ、Ⅲ、Ⅳ段)切除,腹腔镜下右半肝(Ⅴ、Ⅵ、Ⅶ、Ⅷ段)切除,腹腔镜下右肝后叶(Ⅵ、Ⅶ段)切除,腹腔镜下扩大右后叶切除,腹腔镜下肝中叶(Ⅳ、Ⅴ、Ⅷ段)切除,腹腔镜下Ⅴ、Ⅵ段切除,腹腔镜下左半肝(Ⅱ、Ⅲ、Ⅳ段)联合肝尾叶(Ⅰ、Ⅸ段)切除,腹腔镜扩大左半肝切除,腹腔镜下Ⅵ段切除,腹腔镜下Ⅶ、Ⅷ段切除,腹腔镜左肝外叶(Ⅱ、Ⅲ段)切除,腹腔镜右肝肿块切除;手术时间(320.38±107.68)min;术中出血量(262.34±76.06)mL;术中输血率为0(0/58);术中肝门阻断时间(48±15)min;其中10例腹腔镜中转开腹手术,中转率17.2%(10/58);术后胆瘘发生率为6.9%(4/58),保守治疗、通畅引流(T管负压吸引)后痊愈出院;无其他严重并发症发生。术后住院时间(9.34±3.39)d;术后胃肠道恢复时间(1.84±0.57)d;围手术期内无死亡病例及非计划手术病例。(2)病理情况:术中32例行淋巴结清扫,术后26例病理结果提示胆管细胞癌未行淋巴结清扫;病理学检查结果显示,所有肿瘤切缘的病理报告均为阴性,4例淋巴结清扫并提示淋巴结转移阳性。(3)随访结果:58例ICC患者中,49例获得术后随访,随访时间为6~36个月,术后肿瘤生存时间为4~36个月,28例获得无瘤生存,17例患者出现肝内转移并多发淋巴结转移,4例患者发现肝内转移后行微波消融治疗,9例患者失访。结论腹腔镜肝切除经验丰富的中心,应用腹腔镜治疗肝内胆管细胞癌是安全及可行的。