GDC栓塞术中颅内动脉瘤再破裂的原因、对策与结果

目的探讨电解脱弹簧圈(Guglialm i detachab le coil,GDC)颅内动脉瘤栓塞术中动脉瘤再破裂的发生率、原因、对策及结果。方法302例颅内动脉瘤破裂患者行GDC栓塞术,其中8例发生术中动脉瘤再破裂。结果2例由微导丝穿破动脉瘤壁引起,3例由微导管穿破动脉瘤壁引起,2例由置放首枚弹簧圈时顶破动脉瘤壁引起,l例术中自发破裂,所有病例均继续行GDC动脉瘤填塞。2例死于动脉瘤破裂后大出血,其他6例均康复没有留下后遗症。本组术中动脉瘤再破裂发生率为2.6%,死亡率为25%。结论GDC血管内栓塞术中引起动脉瘤再破裂是十分少见的,但大部分病例经过继续填塞GDC可达到完全填塞动脉瘤,且不留下后遗症。     

S100P as a marker for poor survival and advanced stage in gallbladder carcinoma

AimsGallbladder carcinomas usually present in advanced stages and has a dismal prognosis despite modern imaging techniques and aggressive surgical intervention. Identification of biologic markers for early diagnosis and improved therapeutic strategies is thus of paramount importance. S100P has been identified in a variety of malignant neoplasms of the gastrointestinal and pancreaticobiliary systems, but it is not yet known if S100P expression is associated with clinically-relevant characteristics of gall bladder carcinoma. The aims of the present study were: 1) to investigate the relationship between S100P expression and histological type, grade, tumor-node-metastasis stage, presence of vascular invasion, perineural invasion and necrosis; and 2) to evaluate for any S100P-defined difference in the risk for tumor recurrence or death.MethodImmunostains for S100P were performed on 4 tissue microarray blocks containing 91 cases of gall bladder carcinoma.ResultThe intensity of S100P staining was significantly associated with pathological T stage 4 (p = 0. 0238). Staining intensity ≥3 in ≥25% tumor cells was associated with pathological T stage 4 (p = 0.0005). A higher S100P immunoreactivity score (IRS) was significantly associated with higher TNM stage (p = 0.0341). Age (p = 0.0485), presence of vascular invasion (p = 0.0359), pathological T stage (p = 0.0291) and TNM stage (p = 0.0153) were significantly associated with tumor recurrence. Intense S100P reactivity was associated with decreased overall survival [hazard ratio = 9.614; 95% confidence interval (CI), 1.873–49.338; p = 0.0067].ConclusionOur findings indicate that S100P over-expression is a potential prognostic marker for gall bladder carcinoma and is significantly associated with advanced tumor stage and poorer survival.     

肝细胞肝癌组织中B细胞淋巴瘤因子9的表达及临床意义

目的 :探讨B细胞淋巴瘤因子9(B-cell lymphoma 9,BCL9)在肝细胞肝癌(hepatocellular carcinoma,HCC)组织中的表达情况及临床意义。方法:采用Western Blot法检测8对新鲜冰冻HCC和对应癌旁组织中BCL9的蛋白表达;采用免疫组织化学法检测100例HCC和对应癌旁组织石蜡切片中BCL9的表达情况,并分析HCC中BCL9的表达与临床病理参数之间的关系。结果:Western Blot结果显示BCL9在HCC中的表达显著高于对应癌旁组织;免疫组化结果显示BCL9在HCC中主要定位于细胞核和细胞质,呈高表达,而在对应癌旁组织中主要定位于细胞质,表达较低或缺失;BCL9在HCC中的表达与肿瘤的分化程度和淋巴侵犯相关(P<0.05),与患者的性别、年龄、肿瘤直径、包膜完整、门静脉癌栓、血清HBs Ag、甲胎蛋白及肝硬化无关(P>0.05)。结论:BCL9在HCC中高表达,可能参与了HCC的发生、发展及转移。     

江苏省南通地区丙型肝炎病毒的分子流行病学分析

目的 :调查南通地区丙型肝炎病毒(hepatitis C virus,HCV)的亚型分布特征。方法 :2012年5—9月间,在南通市第三人民医院收集到109例全血样本用以病毒的RNA提取,RT-PCR扩增和测序。所得的病毒序列与HCV参考序列构建系统发育树。结果:在收集到的109例HCV抗体(Anti-HCV Ig G)阳性样本中,有49例HCV RNA阳性,基于NS5B和C/E2片段构建的进化树显示,南通地区至少流行有1b、2a、3a、3b、6a 5个亚型病毒株。其中,1b是最主要流行的病毒株,占阳性样本中的63.3%;2a次之,占20.4%;3a、3b、6a 3个亚型分别占4.1%、8.2%和4.1%。相较于在普通人群中1b(68.9%)和2a(22.2%)为主要流行的病毒株,6a(50.0%)是静脉吸毒人群中最流行的亚型。结论:多个亚型的HCV病毒株共流行于南通地区,其中1b和2a是最主要流行的病毒株。     

输液港与外周静脉置入中心静脉导管在乳腺癌术后辅助化疗患者中的应用分析

目的 比较输液港（IVAP）与外周静脉置入中心静脉导管（PICC）在乳腺癌术后辅助化疗患者中的应用效果。方法 回顾性分析2014年 1月至2016年12月南通市第三人民医院甲乳外科收治的60例早期乳腺癌术后辅助化疗的患者,按不同处理方法分为IVAP组30例和PICC组30例,观察两组患者的临床费用、并发症及生活自理能力的指标差异。结果 IVAP组患者总并发症的发生率（20.00%）低于PICC组（46.67%）;IVAP组患者在洗澡、穿衣、如厕及床椅移动等自理活动方面优于PICC组;但IVAP组患者平均每次化疗置管及维护费用[（1376.00±304.17）元]高于PICC组[（433.35±234.98）元],差异均具有统计学意义（P＜0.05）。结论 IVAP是乳腺癌患者术后化疗深静脉留置的有效方法。     

“一病一品”在乳腺癌患者围手术期护理中的应用

目的 探讨“一病一品”护理模式在乳腺癌患者围手术期护理中的应用效果。方法 采用便利抽样的方法,选取2015年1月至2017年12月于南通市第三人民医院乳腺外科手术治疗的乳腺癌患者91例为研究对象,其中2015年1月至2016年6月的43例患者为对照组,给予常规乳腺癌围手术期护理,2016年7月至2017年12月的48例患者为实验组,给予“一病一品”护理模式干预,比较两组患者对护理工作的满意度、住院时间、引流管留置时间。结果 住院期间实验组患者对护理工作的满意度高于对照组,住院时间以及引流管留置时间均少于对照组,差异均具有统计学意义（P＜0.05）。结论 通过“一病一品”护理模式在乳腺癌患者围手术期中的应用,能够使科室所有护理人员对患者实施专业化同质护理,使患者对护理工作的满意度得到显著提升,并且缩短了患者的住院时间以及引流管留置时间。     

Fetuin-A to adiponectin ratio is an independent indicator of subclinical atherosclerosis in patients with newly diagnosed type 2 diabetes mellitus

AimsThe purpose of this research was to explore the associations of fetuin-A, adiponectin, and fetuin-A/adiponectin ratio (F/A ratio) with subclinical atherosclerosis as evaluated by carotid intima-media thickness (CIMT) in cases with newly diagnosed type 2 diabetes mellitus (T2DM).MethodsA total of 283 newly diagnosed T2DM patients were enrolled in this study. Serum fetuin-A and adiponectin levels were determined with an ELISA method. Other clinical and biochemical parameters were also collected.ResultsSignificant linear increases in waist-to-hip ratio (WHR), systolic blood pressure (SBP), diastolic blood pressure, homoeostasis model assessment of insulin resistance, C-reactive protein (CRP) and F/A ratio, and a significant linear decrease in adiponectin with increasing tertiles of CIMT were observed (P for trends <0.05). However, no significant correlation between fetuin-A and CIMT was detected (P > 0.05). In multivariate logistic regression models, WHR, SBP and F/A ratio were independently correlated with higher CIMT. Receiver operating characteristic curve analysis indicated that F/A ratio had a better predictive power for higher CIMT than adiponectin and fetuin-A, with an area under the curve of 0.802, 0.713 and 0.646, respectively.ConclusionF/A ratio is an independent indicator of subclinical atherosclerosis in patients with newly diagnosed T2DM.     

钆塞酸二钠增强MRI肝胆期高信号病变影像表现与特征分析

目的 探讨钆塞酸二钠（Gd-EOB-DTPA）增强MRI肝胆期高信号病变的影像学特征并进行分型。 方法 回顾性纳入经手术病理或典型影像表现及临床随访证实为肝脏局灶性病变的病人124例,平均年龄（55.1±15.8）岁。分析肝脏局灶性病变124个,包括肝细胞癌（HCC）52个、胆管细胞癌（ICC）7个、混合型肝细胞癌-胆管癌（cHCC-CC）4个、转移瘤（HM）6个、局灶性结节增生（FNH）及FNH样变42个、肝腺瘤（HCA）2个、异型增生结节（DN）5个、肝海绵状血管瘤（CHL）6个。所有病人均行肝脏Gd-EOB-DTPA增强MRI检查,观察分析肝胆期高信号病变特征并对其进行分型。同一病变中不同分型间占比的比较采用Fisher确切概率检验。计算肝胆期病灶-肝脏信号强度比（LLR）,不同病变间LLR的比较采用Kruskal-Wallis检验。 结果 HCC、ICC、HM、FNH/FNH样变和DN病变中不同分型间占比的差异均有统计学意义（均P<0.05）。HCC病灶中28个可见包膜（53.85%）,各分型中Ⅱb型最多（23/52,44.23%）;ICC病灶中Ⅱa型和Ⅲ型最多（均为3/7,42.86%）;HM病灶中Ⅱa型最多（4/6,66.66%）,且均为胃肠道转移瘤;FNH/FNH样变中Ⅳa型最多（32/42,76.19%）;DN病灶中Ⅰa型最多（4/5,80.00%）。肝胆期不同高信号的病变间LLR的差异有统计学意义（P<0.05）,HCC的LLR低于FNH/FNH样变（P<0.05）。 结论 Gd-EOB-DTPA增强MRI肝胆期高信号病变的影像特征分型对肝脏局灶性病变的诊断具有一定价值。