中国结直肠癌诊疗规范（2017年版）

<正>一、概述我国结直肠癌(colorectal cancer,CRC)的发病率和病死率均保持上升趋势。2015中国癌症统计数据显示:我国结直肠癌发病率、病死率在全部恶性肿瘤中均位居第5位,其中新发病例37.6万,死亡病例19.1万。其中,城市地区远高于农村,且结肠癌的发病率上升显著。多数患者发现时已属于中晚期。为进一步规范我国结直肠癌诊疗行为,提高医疗机构结直肠癌诊疗水平,改善结直肠癌患者预后,     

结肠镜辅助设备在提高腺瘤检出率方面的技术进展

结直肠癌是消化系统常见的恶性肿瘤,2012年全球癌症年度报告统计显示结直肠癌发病率居第三位,病死率居第四位,近年来呈现年轻化趋势[1]。2015年中国癌症年度报告统计显示,结直肠癌全国发病率居第五位(376.3/10万人)、病死率居第五位(191.0/10万人);中国城市居民发病率高居第二位(263.2/10万人)。     

肠造口患者延续护理的需求现状及研究进展

正结直肠癌位居我国恶性肿瘤发病第三位[1]。目前多采用永久性结肠造口术进行根治性治疗[2]。据统计,我国每年约有10万以上患者行永久性肠造口术,并呈快速增长的趋势[3]。在当前平均住院日缩短的背景下,肠造口患者在院期间适应和学习造口护理的时间有限,大部分的康复需要在院外进行[4]。而社区护理资源匮乏,家庭护理尚不能满足造口护理的需求。延续护理是指在患者出院后可以得到持续的健康照顾[5],是医疗护理服务的延续,在肠造口患者的     

RPS14在结直肠癌组织中的表达及意义

<正>结直肠癌作为癌症相关死亡的第四大原因，也是全球第三大最常诊断的恶性肿瘤。在东欧和亚洲地区，结直肠癌的发病率和死亡率上升迅速，预计到2030年，全球结直肠癌患者将新增220万确诊病例以及110万的死亡病例^[1]。在最近的研究报告中指出进行结直肠癌早期癌症筛查诊断能显著降低结直肠癌死亡率^[2],本实验初步通过二维色谱质谱联用技术及免疫印迹实验来分析RPS14蛋白在结直肠癌组织与癌旁组织的差异，为结直肠癌的筛查和诊断提供帮助。     

DNA甲基化检测在结直肠癌诊断中的应用

<正>结直肠癌(colorectal cancer,CRC)是全球男性第3、女性第2常见的恶性肿瘤,死亡率占全球癌症的第4位,每年约有69.4万人死于此病[1]。在中国,CRC的发病率呈现上升趋势,现已高居男女肿瘤发病率的第5位和第4位[2]。对于早期CRC患者,多数可以治愈,5年生存率可达90%,而对于晚期患者则不足10%[3],然而多数CRC患者确诊时已到中晚期,早期CRC缺乏典型临床症状不易察     

p16甲基化与结直肠癌关系的研究进展

结直肠癌是消化道常见的恶性肿瘤之一,其发病率和病死率呈上升趋势。有文献报道,2002年结直肠癌新病例102．3万,死亡52．9万,其发病率和病死率分别居所有癌症的第3位和第4位。在现有2460万癌症患者中,结直肠癌占11．4％。近年来,我国青年人（〈30岁）大肠癌呈上升趋势,但性别无差异。我国发病年龄普遍比西方国家平均提早10年左右。     

肿瘤患者延续性护理需求、方式及其影响因素研究进展

正肿瘤已严重地威胁着人类的健康和社会的进步,2018年,估计全球将有1810万新癌症病例和960万癌症死亡病例,肺癌是癌症死亡的主要原因,其次是乳腺癌[1]。我国2013年恶性肿瘤死亡数222.9万例,其中排在前5位的依次为肺癌、胃癌、肝癌、食管癌和结直肠癌[2]。2015年我国恶性肿瘤新发病例约392.9万例,发病率为285.83/10万,中     

基于数据库挖掘EIF2A在结直肠癌中的表达及意义

<正>结直肠癌(colorectal cancer, CRC)^[1]是一种常见的大肠黏膜上皮恶性肿瘤，发病率和死亡率高^[2],是全球相关癌症死亡的主要原因之一^[3]。在美国，2020年报告了近15万例结直肠癌病例和超过5万死亡病例，预计到2030年，结直肠癌将有超过220万新发病例和110万死亡病例^[4]。     

永久性结肠造口患者焦虑状况的研究进展

<正>据统计~[1],近年来国外结直肠癌新生病例数占据消化道肿瘤的1/2。近20年来,我国结直肠癌发病率约为20.6/10万人,发病患者数居恶性肿瘤的第5位~[2]。中低位直肠癌约占1/2~2/3,Miles手术切除仍然是治疗低位直肠癌普遍、有效的方法,但术后患者需要终身带有造口,即人工肛门~[3]。在有永久性肠造口患者约100万人的基础上,国内每     

直肠癌术后吻合口瘘影响因素及防治的研究进展

正直肠癌是目前最常见的恶性肿瘤之一,根据癌症研究中心统计,在世界范围内结直肠癌的发病率居男性发病率第3位,女性第2位,病死率占所有恶性肿瘤第2位[1]。自1982年Heald等首次提出全直肠系膜切除术(total mesorectal excision,TME)的概念[2],现在TME已经成为直肠癌手术的标准。近年来,随着对解剖结构的进一步深入研究及手术     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.