胃癌合并2型糖尿病患者术后肺部感染对机体巨噬细胞移动抑制因子、基质金属蛋白酶9及凝血功能的影响

目的 探讨胃癌合并2型糖尿病患者术后肺部感染对机体巨噬细胞移动抑制因子(MIF)、基质金属蛋白酶9(MMP9)及凝血功能的影响.方法 选取接受手术治疗的胃癌合并2型糖尿病患者83例,分析患者术后肺部感染发生情况及病原菌分布情况,并比较肺部感染患者(n=21)与无肺部感染患者(n=62)血糖控制情况、血清MIF及MMP9水平、凝血功能指标变化情况.结果 21例术后发生肺部感染患者中,共分离出病原菌29株,其中以革兰阴性菌感染为主,构成比为62.07％;其次为革兰阳性菌,构成比为34.48％;真菌感染1株,构成比为3.45％.肺部感染组患者空腹血糖(FPG)、餐后2 h血糖(P2hPG)、糖化血红蛋白(HbA1c)、MIF、MMP9、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)以及D-二聚体(D-D)水平均高于无肺部感染组患者,差异均有统计学意义(P﹤0.05).结论 胃癌合并2型糖尿病患者术后肺部感染发生率较高,术后肺部感染主要以革兰阴性菌为主,肺部感染的发生可引起机体炎性反应的增加以及凝血功能的紊乱,应加强对患者围手术期血糖控制,尽可能降低术后肺部感染风险.     

食管癌合并糖尿病患者术后营养支持的临床研究

目的探讨不同营养方式对合并糖尿病的食管癌患者术后血糖情况、营养状况及术后恢复情况的影响。方法选取2015年1月至2015年8月期间在江苏省肿瘤医院胸外科就诊的食管癌合并糖尿病患者32例,根据术后肠内营养开始时间随机分为术后第1天组(d1),术后第3天组(d3)和术后第7天组(d7)。每日监测7段血糖;术后第1、3和7天分别检测患者的营养指标(转铁蛋白、白蛋白和前白蛋白);观察术后相关并发症发生情况。结果所有手术患者术后血糖控制尚可,未出现严重糖代谢并发症。3组患者术后营养指标无显著差异(P0.05)。早期应用肠内营养能促进术后胃肠功能恢复(P0.05),并且可减少术后切口感染及肺部感染的发生率(P0.05)。结论术后第1天开始应用肠内营养有助于食管癌合并糖尿病患者控制血糖水平,提高机体营养状态,减少并发症发生,缩短患者术后恢复期。     

综合性健康管理对胰腺癌合并糖尿病患者血糖控制效果及负性情绪的影响

目的 研究综合性健康管理对胰腺癌合并糖尿病患者血糖控制效果的影响.方法 按照随机数字表法将80例胰腺癌合并糖尿病患者分为对照组和观察组,每组40例.对照组采用常规干预方式,观察组在常规干预治疗基础上采用综合性健康管理方式,两组患者均连续干预治疗1个月.比较两组患者临床疗效、负性情绪、血糖水平及术后并发症发生情况.结果 干预后,观察组患者的总有效率为90.00％,高于对照组的72.50％,差异有统计学意义(χ2=4.021,P=0.045).干预后,观察组患者的焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均明显低于对照组(P﹤0.01),空腹血糖水平及餐后2 h血糖水平均明显低于对照组(P﹤0.01),并发症总发生率低于对照组(P﹤0.05).结论 综合性健康管理干预治疗胰腺癌合并糖尿病患者,能改善患者负性情绪,降低血糖水平及术后并发症发生率,提高了患者的临床治疗效果.     

老年重症糖尿病高危患者髋部骨折围术期风险分析

目的探讨老年重症糖尿病高危患者髋部骨折围术期的风险评估和治疗策略。方法回顾性调查1998年到2007年老年重症糖尿病高危患者合并髋部骨折85例,对术前血糖水平分期评估,检测不同血糖水平的糖尿病（DM）患者手术后FPG、2hPG,50例非糖尿病髋部骨折患者作为对照,对术前不同血糖水平患者术后低血糖、酮症酸中毒、切口感染、肺炎、泌尿系统感染和深静脉血栓以及肺栓塞等并发症进行统计分析和比较。结果85例老年糖尿病合并髋部骨折患者,随访8个月（5-13个月）,83例患者安全渡过围术期,2例死于肺栓塞。较高血糖DM组酮症酸中毒、泌尿系统感染和血栓术后并发症的发病率高于较低血糖DM组。结论应重视老年重症糖尿病高危患者合并髋部骨折围术期的评估,积极控制血糖能够预防酮症酸中毒、感染和血栓等术后并发症,提高患者生活质量。     

结肠癌合并2型糖尿病患者血清IGF-2、IGFBP-2升高与肿瘤复发的关系

摘 要：［目的］ 观察结肠癌合并2型糖尿病患者血清胰岛素样生长因子-2(IGF-2)及胰岛素样生长因子结合蛋白-2(IGFBP-2)升高与结肠癌复发的关系。［方法］ 选择结肠癌合并2型糖尿病患者90例为观察对象,以同期在院治疗合并2型糖尿病的良性结肠疾病患者90例为对照,在结肠癌术后1周时检测其血清IGF-2、IGFBP-2水平,与对照组进行比较,记录结肠癌患者在1年中复发的数据,按复发与否,描绘IGF-2、IGFBP-2水平与复发关系的ROC曲线图,观察IGF-2、IGFBP-2水平与复发的关系,统计IGF-2、IGFBP-2水平预测复发的灵敏度、特异性。［结果］ 结肠癌患者血清IGF-2、IGFBP-2水平明显高于对照组,具有统计学差异;IGF-2、IGFBP-2水平升高与结肠癌复发存在相关性,具有统计学差异（P<0.05）。［结论］ 结肠癌合并2型糖尿病患者血清IGF-2、IGFBP-2升高,并与结肠癌术后的复发相关。     

CIN2+患者高危型HPV感染情况及治疗方法分析

目的研究宫颈上皮内瘤变(CIN)2级及以上(CIN2+)患者高危型人乳头瘤病毒(HPV)持续感染的可能因素和治疗方法。方法249例CIN2+合并高危型HPV感染患者接受环形电切术(LEEP)治疗,依据术后1年高危型HPV检测是否转阴分为术后转阴组(n=160)和持续感染组(n=89),依据治疗方式将89例持续感染组患者分为对照组(n=41)和联合组(n=48)。对照组患者接受重组人干扰素α2b阴道泡腾片治疗,联合组患者在此基础上联合保妇康栓治疗。比较术后转阴组和持续感染组患者术前高危型HPV分型及持续感染的相关因素,以及对照组和联合组患者药物治疗后高危型HPV转阴情况。结果持续感染组患者术前多重感染率为24.72%,高于术后转阴组的21.88%,但差异无统计学意义(P﹥0.05)。持续感染组和术后转阴组患者高危型HPV亚型均以HPV16和HPV58为主。持续感染组和术后转阴组CIN2+患者切缘情况、性伴侣人数、避孕方式、人工流产次数和CIN分级情况比较,差异均有统计学意义(P﹤0.01)。治疗后,联合组患者高危型HPV感染转阴率为79.17%,高于对照组患者的58.54%,差异有统计学意义(P﹤0.05)。结论应加强对有不健康性行为史、宫颈锥切术切缘阳性、高级别CIN患者的术后随访,预防高危型HPV的持续感染,发现持续感染应及时行抗病毒治疗。保妇康栓联合重组人干扰素α2b阴道泡腾片可能使接受LEEP手术的CIN2+合并HPV持续感染的患者获益。     

甲状腺癌术后感染的风险预测模型构建及应用价值

目的 分析甲状腺癌(TC)术后感染的危险因素,建立Logistic回归风险预测模型。方法 回顾性分析确诊的TC术后患者120例,根据是否出现术后感染分为感染组(n=21)和未感染组(n=99)。采集所有患者血液标本,分离培养鉴定。采用二分类Logistic回归分析影响TC患者术后感染的因素,并建立风险预测模型,Hosmer-Lemeshow检验评估模型拟合度,ROC检测该模型的预测效能。结果 21例TC术后感染患者共分离出37株病原菌,分离菌株以革兰阴性菌铜绿假单胞菌(29.73%)为主;Logistic回归分析,年龄≥60岁、合并糖尿病、病理类型为低分化癌和住院时间≥14 d均为TC患者术后感染的独立危险因素(P<0.05);建立TC患者术后感染的Logistic回归风险预测模型模型预测概率P=1/[1+e⁽-0.783+0.925×(年龄)+0.891×(糖尿病)+1.039×(病理类型)+0.857×(住院时间))],Hosmer-Lemeshow 7.906,P=0.091;ROC分析显示,Logistic回归风险预测模型预测VAP的AUC为0.79...     

原发性肝癌合并2型糖尿病患者围手术期不同胰岛素控制方式的疗效评价

目的总结肝癌合并2型糖尿病围手术期处理的经验,提出该类患者使用胰岛素泵强化血糖控制的围手术期处理体会。方法37例原发性肝癌合并2型糖尿病患者随机分为胰岛素泵组和常规胰岛素组,比较2组患者的血糖水平变化及术后伤口愈合情况。结果2组患者术前、术中及术后禁食期血糖水平比较差异均有统计学意义（P均〈0．05）;2组患者进食恢复后血糖水平比较差异无统计学意义（P〉0．05）。2组患者血糖达标时间、平均胰岛素用量、低血糖发生率及切口延期愈合率比较差异均有统计学意义（P均〈0．05）。结论肝癌合并2型糖尿病患者围手术期血糖控制至关重要,严密监测血糖、尿糖水平,规范围手术期胰岛素的强化治疗是预防术后并发症的关键。     

腹腔镜辅助下大肠外翻拖出式手术对结肠癌VEGF-A、VEGF-C及VEGF-D表达的影响

目的探讨腹腔镜辅助下大肠外翻拖出式手术治疗结肠癌的临床效果及对表皮生长因子(VEGF)-(A、C、D)表达的影响。方法选择64例结肠癌患者作为对象,随机数字表分为对照组(n=32)和观察组(n=32)。对照组给予腹腔镜辅助下直肠前切除术治疗,观察组采用腹腔镜辅助下大肠外翻拖出式手术治疗,术后5 d对患者效果进行评估。2组手术前、手术后均采用酶联免疫吸附试验(ELISA)测定患者VEGF-A、VEGF-C及VEGF-D表达水平,比较2组手术参数、VEGF-A、VEGF-C及VEGF-D表达水平及术后并发症及复发率。结果 2组手术时间比较,差异无统计学意义(P> 0. 05);观察组日均排便次数,多于对照组(P <0. 05);观察组术后肠道恢复、住院时间、术中出血量,均短(少)于对照组(P <0. 05)。观察组手术后5 d VEGF-A、VEGF-C及VEGF-D水平,均低于对照组(P <0. 05)。观察组手术后吻合口瘘、切口感染、皮下气肿、腹腔出血发生率及术后6个月复发率,均低于对照组(P <0. 05)。结论将腹腔镜辅助下大肠外翻拖出式手术治疗结肠癌手术创伤较小,并能降低VEGF-A、VEGF-C及VEGF-D表达水平,且术后并发症、复发率较低,值得推广应用。     

强化血糖控制与糖尿病患者胃肠肿瘤手术并发症的关系

目的探讨胃肠肿瘤合并糖尿病的患者术前血糖是否得到强化控制与根治性手术并发症的关系。方法选取胃肠恶性肿瘤合并糖尿病的患者82例,根据其术前糖化血红蛋白水平,分为强化血糖控制组和一般控制组。比较两组患者术后并发症的发生率和术后恢复情况。结果术前强化血糖控制的患者术后切口延迟愈合的发生率（12.8%）显著低于一般控制组（31.4%）,术后平均住院时间为（10.5±2.9）天,亦显著少于一般控制组的（12.5±3.3）天（P〈0.05）。结论对于接受择期手术的糖尿病患者,术前宜强化血糖控制,以促进术后恢复。     

Bacteria and cancer--antagonisms and benefits

There is considerable historical and recent evidence concerning the antagonisms between acute bacterial infections or their toxins and cancer and allied diseases. These data provide renewed incentives to undertake clinical programmes with mixed bacterial vaccines in many countries at the present time.     

Religiosity and physical and emotional functioning among African American and White colorectal and lung cancer patients

The literature suggests that religiosity helps cope with illness. The present study examined the role of religiosity in functioning among African Americans and Whites with a cancer diagnosis. Patients were recruited from an existing study and mailed a religiosity survey. Participants (N = 269; 36% African American, 56% women) completed the mail survey, and interview data from the larger cohort was utilized in the analysis. Multivariate analyses indicated that in the overall sample religious behaviors were marginally and positively associated with mental health and negatively with depressive symptoms. Among women, religious behaviors were positively associated with mental health and negatively with depressive symptoms. Religiosity was not a predictor of study outcomes for men. Among African Americans, religious behaviors were positively associated with mental health and vitality. Among Whites, religious behaviors were negatively associated with depressive symptoms. These findings suggest a mixed role of religious involvement in cancer outcomes. The current findings may have applied potential in the areas of emotional functioning and depression.     

Renal irradiation and the pharmacology and toxicity of methotrexate and cisplatinum

We used a rat model to study the effects of renal irradiation on the pharmacology of methotrexate (MTX) and cisplatinum (cis-Pt). Unanesthetized rats were given bilateral kidney irradiation (20 Gy in 9 fractions). At 9 months after irradiation, 3% of the animals had died and survivors showed moderately impaired renal function. At 15 months, 30% of the animals had died and survivors showed severely impaired renal function. Some animals were given i.v. MTX 1 week to 15 months after irradiation. In irradiated rats, the area under the MTX plasma clearance curve equaled that of controls through 6 months, and was significantly above controls from 9 months on. Other animals were given i.p. cis-Pt 1 week to 9 months after irradiation. The acute toxicity of cis-Pt was the same in control and irradiated rats when cis-Pt was given immediately before or after irradiation. Beginning 3 months after irradiation there was a progressive increase in cis-Pt toxicity and a simultaneous decrease in urinary platinum excretion. Irradiated animals that survived cis-Pt treatment showed increased radiation nephritis; the greatest effect occurred when cis-Pt was given 3 months or more after irradiation. MTX and cis-Pt clearance decreased when renal dysfunction was first observed and changes in renal function preceded changes in drug clearance and toxicity.     

Morphine and tumor growth and metastasis

Morphine is an analgesic widely used to alleviate cancer pain. In addition, the perioperative management of pain in cancer surgery patients most often includes opioids. However, there are reports that these drugs may alter cancer recurrence or metastasis. Several mechanisms have been proposed, such as the modulation of the immune response or cellular pathways that control the survival and migratory behavior of cancer cells. The published literature, however, presents some discrepancies, with reports suggesting that opioids may either promote or prevent the spread of cancer. It is of great importance to determine whether opioids, in particular the most widely used, morphine, may increase the risk of metastasis when used in cancer surgery. This review examines the available data on the effects of morphine which influence cancer metastasis or recurrence, including immunomodulation, tumor cell aggressiveness, and angiogenesis, with special emphasis on recently published clinical and laboratory based studies. We further discuss the parameters that may explain the difference between reports on the effects of morphine on cancer.     

肾上腺素能β受体与肿瘤生长及转移

大量研究表明肿瘤细胞可表达β受体，而一些神经递质、药物和社会心理因素可能通过β受体影响肿瘤的生长和转移，β受体激动剂、β受体阻滞剂以及抑郁等社会心理因素可加强或削弱这种作用。这为表达β受体肿瘤的治疗开辟了新的道路，提供了新的治疗靶点。