Pregnancy associated breast cancer

Pregnancy associated breast cancer (PABC) defined as breast cancer occurring during pregnancy or within the first 1‐2 years postpartum. Delay in diagnosis is common. Treatment is timed around gestational age. Surgery and chemotherapy are considered safe after the first trimester. Radiation, anti–her‐2, and endocrine therapy are delayed until after delivery due to adverse fetal effects. Iatrogenic prematurity likely causes most long‐term fetal sequelae. Multi‐disciplinary care and social support are critical for patients and families with PABC.     

腹腔镜全胃切除术后不同消化道重建方式对胃癌患者的临床疗效研究

目的探讨腹腔镜全胃切除术后不同消化道重建方式对胃癌患者的临床疗效。 方法回顾性分析2016年1月至2019年1月86例行腹腔镜全胃切除的胃癌患者资料,根据消化道重建方式不同,分为研究组和对照组各43例,对照组采用传统Roux－en－Y吻合术重建消化道,研究组采用双通道空肠间置消化道重建。数据采用SPSS17.0进行分析,并发症等计数资料行χ²检验;围手术指标、血液营养指标等计量资料采用( ±s)表示,独立t检验,P<0.05差异有统计学意义。 结果两组首次进食时间、消化道重建时间、首次排气时间、手术出血量和住院时间差异无统计学意义(P>0.05);研究组与对照组比较,围术期并发症(9.8%比27.5%)和术后并发症(21.9%比47.5%),研究组均低于对照组(P<0.05);研究组营养指标及体质量的变化优于对照组(P<0.05)。 结论胃癌全胃切除术患者采用双通道空肠间置消化道重建,可降低并发症发生率,改善患者预后。     

腹腔镜胃楔形切除术与经脐单孔腔镜胃楔形切除术的临床疗效对比分析

目的对比腹腔镜胃楔形切除术与经脐单孔腔镜胃楔形切除术的临床疗效。 方法回顾性选取2016年1月至2019年4月确诊为胃间质瘤且行腹腔镜胃楔形切除术的63例患者进行研究。根据手术方式不同36例行腹腔镜胃楔形切除术患者列为五孔组,将27行经脐单孔腔镜胃楔形切除术患者列为单孔组。采用SPSS 25.0统计学软件进行数据分析,围术期指标、营养指标、生活质量评分等计量资料采用( ±s)表示,组间比较采用独立样本t检验;术后并发症等计数资料组间比较卡方χ²检验;等级计数资料采用秩和检验。P<0.05差异有统计学意义。 结果两组均顺利完成手术,无死亡、中转开腹或转为开腹手术病例,术后病理证实均为R0切除。单孔组手术时间及术中出血量少于五孔组(P<0.05);术后排气时间、住院时间、术后并发症、术后营养指标等,两组差异均无统计学意义。术后3个月单孔组患者生理职(功)能、躯体疼痛优于五孔组(P<0.05),其他生活质量评分差异均无统计学意义。 结论经脐单孔腹腔镜胃楔形切除术疗效较常规腹腔镜胃楔形切除术近似,且具有术时短、出血少、更微创等优势,可在临床中逐步推广应用。     

腹腔镜下胆管癌手术患者的生存状况分析

目的探讨胆管癌行腹腔镜下手术患者的短期和长期生存状况。 方法回顾性分析2012年1月至2014年1月接受治疗的96例胆管癌患者(分型为Ⅲa、Ⅲb和Ⅳ)的临床资料,按照手术方法分为2组,引流组应用经肝胆道引流治疗,手术组应用腹腔镜下根治术治疗。采用SPSS23.0软件进行统计学分析。两组计量资料比较采用t检验。术后并发症和近期疗效比较用卡方检验(常规资料)和秩和检验(等级资料)。生存分析模型为Kaplan－meier乘积限模型,两组生存率比较为Logrank检验。P<0.05差异有统计学意义。 结果引流组共有10例完全缓解,21例部分缓解,手术组共有17例完全缓解,27例部分缓解,手术组近期疗效总有效率91.7%,显著高于引流组近期疗效总有效率64.6%(P<0.05)。手术组术后并发症发生率6.3%,明显低于引流组术后并发症发生率29.2%(P<0.05)。引流组1年、3年、5年生存率为39.6%、14.6%和10.4%低于手术组1年、3年、5年生存率为60.4%、22.9%和16.7%,差异有统计学意义(P<0.05)。 结论胆管癌行腹腔镜下手术患者近期疗效较经肝胆道引流治疗显著,且术后并发症发生较少,长期生存率较高,适合临床推广应用。     

三种手术方式治疗cT1N0期甲状腺癌的近期疗效及安全性比较

目的对比三种手术方式治疗cT1N0期甲状腺癌的近期疗效及安全性。 方法回顾性队列研究2017年1月至2019年5月73例cT1N0期甲状腺癌患者资料,根据术式不同分为3组。25例患者纳入开放组,将实施全乳晕入路腔镜手术治疗的24例患者纳入全乳晕组,将经口腔前庭入路腔镜手术治疗的24例患者纳入经口腔组。采用SPSS23.0软件进行处理,围术期相关指标、视觉模拟评估量表(VAS)、Vancouver疤痕评定量表(VSS)评分以( ±s)表示,多组间采用单因素方差分析;疗效、并发症用χ²检验,P<0.05为差异有统计学意义。 结果经口腔组、全乳晕组治疗总有效率(91.7%、87.5%)均比开放组(64.0%)高(P<0.05);经口腔组、全乳晕组手术时间长于开放组(P<0.05),但术中出血量、术后引流量及术后住院时间均比开放组低(P<0.05);经口腔组术后3 d、1个月的VAS评分、VSS评分<全乳晕组<开放组(P<0.05);经口腔组、全乳晕组并发症发生率(8.3%、8.3%)比开放组低(32.0%),差异有统计学意义(P<0.05)。 结论相比开放手术,腔镜下甲状腺手术治疗cT1N0期甲状腺癌的疗效更佳、并发症更少、住院时间更短,可作为优选治疗方案。     

三种术式治疗肝细胞癌的近期临床疗效比较

目的比较腹腔镜切除术(LR)、开腹切除术(OR)与超声定位下的射频消融术(RFA)治疗肝细胞癌的近期临床疗效。 方法回顾性分析2010年6月至2018年6月接受手术治疗的152例肝细胞癌患者的病例资料,71例患者纳入LR组,52例患者纳入OR组,29例患者纳入RFA组。采用SPSS 25.0软件分析数据,手术相关指标、VAS评分等计量资料以( ±s)描述,行f检验;近期疗效、并发症等计数资料行χ²检验,P<0.05为差异有统计学意义。 结果三组患者术后3个月治疗总有效率比较,LR组(76.1%)>OR组(73.1%)>RFA组(72.4%),差异无统计学意义(P>0.05)。三组手术时间、术中总出血量及住院时间相比,OR组>LR组>RFA组(P<0.05);术后24 h及1周后VAS评分比较,OR组>LR组>RFA组(P<0.05);OR组并发症总发生率(36.5%)>LR组(29.6%)>RFA组(6.7%),差异有统计学意义(P<0.05);术后随访3个月的复发率比较,OR组(7.7%)0.05)。 结论对分期早且肿瘤小的肝细胞癌患者分别采用LR术、OR术与RFA术治疗,患者近期疗效相当,但RFA术具有损伤小、术后恢复快等优点,可减轻患者术后疼痛程度,安全性更高。但对于瘤体较大且靠近重要血管胆管的肝细胞癌患者,还需进行个体化治疗。     

腹腔镜全胃切除术两种消化道重建方式对肠道通透性影响研究

目的比较非离断式与传统式Roux-en-Y吻合在腹腔镜根治性全胃切除术重建中的疗效及对患者肠道黏膜通透性的影响。方法回顾性分析2017年1月至2019年2月收治的60例行腹腔镜根治性全胃切除术的胃癌患者。根据术中消化道重建方式不同,将行非离断式Roux-en-Y吻合的30例患者列为A组,传统式Roux-en-Y吻合的30例列为B组。应用SPSS23.0统计软件进行统计分析,围手术指标、肠道黏膜通透性指标等计量资料以(±s)表示,比较采用独立t检验;术后并发症采用χ^2检验,P<0.05表示差异有统计学意义。结果A组术中出血量少于B组,术后恢复排气时间短于B组(P<0.05)。B组发生RSS的发生率高于A组(P<0.05)。A组L/M数值、血浆D-乳酸水平、血清内毒素水平、DAO值均低于B组,血浆Gln水平高于B组,组间差异有统计学意义(P<0.05)。结论非离断式Roux-en-Y吻合较传统式相比具有出血量少、肛门恢复排气时间快、Roux瘀血综合征发生率低等临床优势,且对患者肠道通透性的影响较小,可推广应用。     

Using preference learning for detecting inconsistencies in clinical practice guidelines: Methods and application to antibiotherapy

Clinical practice guidelines provide evidence-based recommendations. However, many problems are reported, such as contradictions and inconsistencies. For example, guidelines recommend sulfamethoxazole/trimethoprim in child sinusitis, but they also state that there is a high bacteria resistance in this context. In this paper, we propose a method for the semi-automatic detection of inconsistencies in guidelines using preference learning, and we apply this method to antibiotherapy in primary care. The preference model was learned from the recommendations and from a knowledge base describing the domain.We successfully built a generic model suitable for all infectious diseases and patient profiles. This model includes both preferences and necessary features. It allowed the detection of 106 candidate inconsistencies which were analyzed by a medical expert. 55 inconsistencies were validated. We showed that therapeutic strategies of guidelines in antibiotherapy can be formalized by a preference model. In conclusion, we proposed an original approach, based on preferences, for modeling clinical guidelines. This model could be used in future clinical decision support systems for helping physicians to prescribe antibiotics.     

Synthesis and functionalization of chitosan built hydrogel with induced hydrophilicity for extended release of sparingly soluble drugs

Addressing the functional biomaterials as next-generation therapeutics, chitosan and alginic acid were copolymerized in the form of chemically crosslinked interpenetrating networks (IPNs). The native hydrogel was functionalized via carbodiimide (EDC), catalyzed coupling of soft ligand (1,2-Ethylenediamine) and hard ligand (4-aminophenol) to replace –OH groups in alginic acid units for extended hydrogel- interfaces with the aqueous and sparingly soluble drug solutions. The chemical structure, Lower solution critical temperature (LCST ≈ 37.88 °C), particle size (Z_h,app ≈ 150–200 nm), grain size (160–360 nm), surface roughness (85–250 nm), conductivity (37–74 mv) and zeta potential (16–32 mv) of native and functionalized hydrogel were investigated by using FT-IR, solid state-¹³C-NMR, TGA, DSC, FESEM, AFM and dynamic light scattering (DLS) measurements. The effective swelling, drug loading (47–78%) and drug release (53–86%) profiles were adjusted based on selective functionalization of hydrophobic IPNs due to electrostatic complexation and extended interactions of hydrophilic ligands with the aqueous and drug solutions. Drug release from the hydrogel matrices with diffusion coefficient n ≈ 0.7 was established by Non- Fickian diffusion mechanism. In vitro degradation trials of the hydrogel with a 20% loss of wet mass in simulated gastric fluid (SGF) and 38% loss of wet mass in simulated intestinal fluid (SIF), were investigated for 400 h through bulk erosion. Consequently, a slower rate of drug loading and release was observed for native hydrogel, due to stronger H-bonding, interlocking and entanglement within the IPNs, which was finely tuned and extended by the induced hydrophilic and functional ligands. In the light of induced hydrophilicity, such functional hydrogel could be highly attractive for extended release of sparingly soluble drugs.