淋巴结转移度预测老年结直肠癌患者术后远处转移的价值

目的探讨淋巴结转移度(LNR)对老年结直肠癌患者术后远处转移的预测价值。方法选取2011年1月至2015年1月于该院普通外科行根治性手术的老年结直肠癌患者96例,按照有无术后远处转移将入组患者分为实验组(转移组,36例)和对照组(非转移组,60例),按照LNR水平高低将入组患者分为HLNR组和LLNR组,统计分析LNR的相关临床病理因素,单因素及多因素分析影响老年结直肠癌出现术后远处转移的临床病理因素,总结分析LNR与老年结直肠癌患者出现术后远处转移相关性。结果 HLNR组和低LLNR组在年龄、大体类型和分化程度等方面均有统计学差异(均P<0.05);Logistic多因素分析结果显示,大体类型及分化程度与老年结直肠癌LNR水平独立相关(均P<0.05)。实验组和对照组在大体类型、分化程度、淋巴结检出总数(ELN)及LNR等方面均有统计学差异(均P<0.05),Logistic多因素分析结果显示:LNR、分化程度及大体类型与老年结直肠癌患者术后远处转移独立相关(RR:2.098;CI%:1.050~4.192;P<0.05)。结论 LNR、分化程度及大体类型与老年结直肠癌术后远处转移独立相关,可联合预测老年结直肠癌术后远处转移情况。     

腹腔镜结直肠癌根治术治疗老年结直肠癌患者的疗效及对胃肠功能的影响

目的探讨腹腔镜结直肠癌根治术治疗老年结直肠癌患者的临床疗效及对胃肠功能的影响。方法选择101例老年结直肠癌患者,采用随机数字表法分为观察组51例与对照组50例,观察组实施腹腔镜结直肠癌根治术,对照组实施传统开腹手术,观察两组患者手术时间、术中出血量、住院时间,胃动素与胃泌素水平、胃肠功能恢复情况以及并发症。结果观察组手术时间明显长于对照组,术中出血量及住院时间均明显短于对照组;胃动素、胃泌素水平明显高于对照组;肠鸣音恢复时间、术后排气时间及开始进食时间明显低于对照组;术后并发症明显低于对照组(均P0.05)。结论腹腔镜结直肠癌根治术可明显减少术中出血量、降低术后并发症,促进胃肠功能恢复,缩短住院时间。     

老年结直肠癌患者腹腔镜与开放手术应激反应的临床对比研究

目的比较腹腔镜和开腹结直肠癌手术对老年患者机体应激反应的影响。方法选择南京医科大学第二附属医院胃肠外科自2012年5月至2013年7月收治的老年结直肠癌患者78例,随机分为腹腔镜组42例和开腹组36例。比较2组围手术期血糖、胰岛素、白细胞介素-6（IL-6）、C-反应蛋白（CRP）及相关临床指标的变化。结果腹腔镜组平均手术时间长于开腹组（P〈0.05）;开腹组术中平均出血量多于腹腔镜组（P〈0.05）。2组患者术后第1天血糖、IL-6和CRP均明显升高,胰岛素水平明显降低,术后第2天腹腔镜组血糖、胰岛素恢复到术前水平,开腹组于术后第3天恢复至术前水平。术后第3天腹腔镜组IL-6恢复至术前水平,开腹组明显高于腹腔镜组（P〈0.05）。术后第5天2组CRP仍显著高于术前水平（P均〈0.05）,且开腹组高于腹腔镜组（P〈0.05）。结论老年患者腹腔镜结直肠癌根治术具有良好的安全性和可行性,手术后应激反应比开腹手术轻,强度低,持续时间短。     

快速康复外科理念在结直肠癌合并糖尿病患者围手术期护理方面的应用体会

目的探讨快速康复外科理念在结直肠癌合并糖尿病患者围手术期护理方面的应用价值。方法采用回顾性方法分析,选取该院自2017年5月—2019年5月的65例结直肠癌合并糖尿病患者的临床资料,根据护理方法分为对照组(32例,给予常规护理)与研究组(33例,应用快速康复外科理念),比较两组患者血糖水平、炎症指标及并发症。结果研究组患者术后FPG、HbAIc水平均低于对照组,差异有统计学意义(P<0.05)。研究组术后CRP水平改善程度优于对照组,差异有统计学意义(P<0.05)。研究组术后并发症发生率(9.10%)明显低于对照组(28.13%),差异有统计学意义(P<0.05)。结论快速康复外科理念用于结直肠癌合并糖尿病患者围手术期护理方面可有效控制血糖水平,降低炎症水平及并发症发生率,值得临床推广应用。     

高龄结直肠癌合并糖尿病患者腹腔镜手术的围术期护理效果观察

目的研究高龄结直肠癌合并糖尿病患者开展腹腔镜手术及围术期护理的效果。方法于该院2018年1—10月收治的高龄结直肠癌患者中抽取62例,按照是否合并糖尿病分组,糖尿病组31例患者,非糖尿病组31例患者,均开展腹腔镜手术及围术期护理。结果对比非糖尿病组患者,糖尿病组患者并发症发生率略高,差异无统计学意义(P0.05);对比两组患者干预后血糖控制结果,差异无统计学意义(P0.05)。结论高龄结直肠癌合并糖尿病患者开展腹腔镜手术及围术期护理,效果显著,可对患者血糖水平、并发症发生率进行有效控制。     

脑出血合并糖尿病患者血糖水平与术后意识状态及预后关系观察

目的观察脑出血合并糖尿病患者血糖水平与术后意识状态及近期预后之间的关系。方法选取该院2013年2月—2016年7月收治的脑出血合并糖尿病患者61例为高血糖组,同期单纯脑出血无糖尿病患者63例为正常血糖组,比较两组血糖水平、神经功能缺损评分、意识状态和近期预后情况。结果高血糖组患者神经功能缺损评分较正常血糖组高(P0.05),高血糖组神经功能缺损评分与血糖水平呈正相关;高血糖组患者昏迷发生率及病死率明显高于正常血糖组(P0.05)。结论高血糖水平可加重脑出血患者神经功能损伤,增加昏迷发生率和病死率,临床应重视脑出血合并糖尿病患者的血糖水平控制。     

控制血糖护理在老年胃癌合并糖尿病患者围术期中的应用及效果观察

目的探究胃癌、糖尿病老年患者实施血糖控制护理后围手术期血糖情况以及治疗效果。方法选取2016年1月—2017年9月期间该院收治的82例胃癌、糖尿病老年患者为该次研究对象,根据临床护理方式不同分为两组,其中对照组39例(常规护理)、观察组43例(常规护理+控制血糖护理),检测老年患者术前、术中、术后空腹血糖水平,统计术后并发症发生,比较术后患者恢复(伤口愈合、下床、住院)情况,观察患者术后低血糖发生及手术耐受情况。结果观察组术后住院、伤口愈合、下床用时较短,术前、术中、术后血糖水平低,术后并发症发生率低,手术耐受性高(P0.05)。结论临床对老年胃癌、糖尿病者行控制血糖护理,其围手术期血糖水平控制理想,术后恢复快、术后并发症少、手术耐受性较高。     

腹腔镜辅助结直肠癌根治术在老年患者中的应用

目的 探讨腹腔镜辅助结直肠癌根治术在老年结直肠癌患者中的应用优势.方法 27例70岁以上结直肠癌患者,行传统开腹结直肠癌根治术者15例（A组）,行腹腔镜辅助结直肠癌根治术者12例（B组）.分别从手术时间与出血量、胃肠功能恢复时间及住院时间等方面对两组进行对比分析.结果 与A组比较,B组手术时间短、术中出血量少、术后住院天数少、术后胃肠道功能恢复时间短（P均＜0.05）.结论 腹腔镜辅助结直肠癌根治术应用于老年直肠癌,能预防和降低并发症的发生率,缩短住院时间,提高患者生活质量.     

老年结直肠癌患者开放性与腹腔镜手术近期疗效及术后并发症对比

目的对比开放性与腹腔镜手术的老年结直肠癌患者近期疗效及术后并发症。方法老年结直肠癌患者90例根据手术方式分为开放性手术组(开放组)44例和腹腔镜手术组(腹腔镜组)46例,对比两组临床疗效,免疫及应激,并发症。结果与开放组相比,腹腔镜组术中出血量明显减少,手术时间、肛门排气时间、术后卧床时间、住院时间均明显缩短(P<0.05);腹腔镜组治疗后的CD3+、CD4+、CD4+/CD8+均显著提高,而CD8+、一氧化氮(NO)、活性氧(ROS)强度则均显著降低(P<0.05);腹腔镜组吻合口漏,肺部感染,会阴部疝,肠梗阻等并发症总发生率明显降低(P<0.05)。结论腹腔镜手术治疗老年结直肠癌较开放性手术近期疗效好,免疫应激小,术后并发症少,应用安全性高。     

ERAS理念指导下术前口服麦芽糊精果糖液在老年结直肠癌中的应用效果

目的 分析老年结直肠癌患者在加速康复外科(ERAS)理念指导下术前口服麦芽糊精果糖液的应用效果。方法 依据随机数字表法将100例老年结直肠癌患者分为两组各50例。两组均在ERAS理念指导下进行术前干预，对照组常规术前禁食8～12 h,禁饮2 h,观察组在手术麻醉前2 h给予口服麦芽糊精果糖液2×200 ml。比较两组临床指标(术后排气时间、首次下床活动时间、术后恢复半流质饮食时间、住院时间)、术前及术后次日血糖相关指标[空腹血糖(FBG)、空腹胰岛素、胰岛素抵抗指数(HOMA-IR)],比较两组术前及术后出院时睡眠质量及并发症发生情况。结果 对照组术后排气、首次下床活动、术后恢复半流质饮食及住院时间明显长于观察组(P<0.001);术后次日，两组FBG、空腹胰岛素、HOMA-IR均明显高于术前，且对照组明显高于观察组(P<0.05,P<0.001);出院时，两组睡眠质量评分均明显低于术前，且与对照组比较，观察组评分明显降低(P<0.05);经Fisher精确检验得出，两组并发症总发生率差异无统计学意义(P>0.05)。结论 在老年结直肠癌手术患者中，采用E...     

Pancreatic invasion is a prognostic indicator after radical resection for carcinoma of the ampulla of Vater

Sixty-three patients who had undergone pancreatoduodenectomy for carcinoma of the ampulla of Vater were analyzed with respect to tumor extent and prognosis. The postoperative mortality rate was 3% and overall survival rates 3 and 5 years after surgery were 55% and 46%, respectively. pTNM stage did not reflect prognosis after resection in patients at stages 2 and 3, while pancreatic invasion and regional lymph node metastasis clearly reflected prognosis after resection. Of the 26 patients who had no pancreatic invasion, regional lymph node metastasis was seen in only 19%, whereas of the 37 patients with pancreatic invasion, 62% exhibited lymph node metastasis. These factors were significantly correlated (P<0.001). Pancreatic invasion appeared to be an indirect indicator of regional lymph node metastasis. We conclude that, to improve prognosis for patients with pancreatic invasion, extended resection including extended lymphadenectomy, is a preferable additional procedure.     

Japanese guidelines for adult asthma 2017

Adult bronchial asthma is characterized by chronic airway inflammation, and presents clinically with variable airway narrowing (wheezes and dyspnea) and cough. Long-standing asthma induces airway remodeling, leading to intractable asthma. The number of patients with asthma has increased; however, the number of patients who die of asthma has decreased (1.2 per 100,000 patients in 2015). The goal of asthma treatment is to enable patients with asthma to attain normal pulmonary function and lead a normal life, without any symptoms. A good relationship between physicians and patients is indispensable for appropriate treatment. Long-term management by therapeutic agents and elimination of the causes and risk factors of asthma are fundamental to its treatment. Four steps in pharmacotherapy differentiate between mild and intensive treatments; each step includes an appropriate daily dose of an inhaled corticosteroid, varying from low to high levels. Long-acting β₂-agonists, leukotriene receptor antagonists, sustained-release theophylline, and long-acting muscarinic antagonist are recommended as add-on drugs, while anti-immunoglobulin E antibody and oral steroids are considered for the most severe and persistent asthma related to allergic reactions. Bronchial thermoplasty has recently been developed for severe, persistent asthma, but its long-term efficacy is not known. Inhaled β₂-agonists, aminophylline, corticosteroids, adrenaline, oxygen therapy, and other approaches are used as needed during acute exacerbations, by choosing treatment steps for asthma in accordance with the severity of exacerbations. Allergic rhinitis, eosinophilic chronic rhinosinusitis, eosinophilic otitis, chronic obstructive pulmonary disease, aspirin-induced asthma, and pregnancy are also important issues that need to be considered in asthma therapy.     

Japanese guidelines for adult asthma 2020

Bronchial asthma is characterized by chronic airway inflammation, which manifests clinically as variable airway narrowing (wheezes and dyspnea) and cough. Long-standing asthma may induce airway remodeling and become intractable. The prevalence of asthma has increased; however, the number of patients who die from it has decreased (1.3 per 100,000 patients in 2018). The goal of asthma treatment is to control symptoms and prevent future risks. A good partnership between physicians and patients is indispensable for effective treatment. Long-term management with therapeutic agents and the elimination of the triggers and risk factors of asthma are fundamental to its treatment. Asthma is managed by four steps of pharmacotherapy, ranging from mild to intensive treatments, depending on the severity of disease; each step includes an appropriate daily dose of an inhaled corticosteroid, which may vary from low to high. Long-acting β₂-agonists, leukotriene receptor antagonists, sustained-release theophylline, and long-acting muscarinic antagonists are recommended as add-on drugs, while anti-immunoglobulin E antibodies and other biologics, and oral steroids are reserved for very severe and persistent asthma related to allergic reactions. Bronchial thermoplasty has recently been developed for severe, persistent asthma, but its long-term efficacy is not known. Inhaled β₂-agonists, aminophylline, corticosteroids, adrenaline, oxygen therapy, and other approaches are used as needed during acute exacerbations, by selecting treatment steps for asthma based on the severity of the exacerbations. Allergic rhinitis, eosinophilic chronic rhinosinusitis, eosinophilic otitis, chronic obstructive pulmonary disease, aspirin-exacerbated respiratory disease, and pregnancy are also important conditions to be considered in asthma therapy.     

Regenerative therapies in electrophysiology and pacing

The prevention and treatment of cardiac arrhythmias conferring major morbidity and mortality is far from optimal, and relies heavily on devices and drugs for the partial successes that have been seen. The greatest success has been in the use of electronic pacemakers to drive the hearts of patients having high degree heart block. Recent years have seen the beginnings of attempts to use novel approaches available through gene and cell therapies to treat both brady- and tachyarrhythmias. By far the most successful approaches to date have been seen in the development of biological pacemakers. However, the far more difficult problems posed by atrial fibrillation and ventricular tachycardia are now being addressed. In the following pages we review the approaches now in progress as well as the specific methodologic demands that must be met if these therapies are to be successful.     

A long-term surviving patient with cancer of papilla of Vater after local resection

We report successful local resection for cancer of papilla of Vater in an 86-year-old woman. She was referred to our hospital because of right hypochondralgia. Abdominal ultrasonography and computed tomography showed marked dilatation of the common bile duct (CBD). Endoscopic retrograde cholangiography disclosed a small shadow defect in the terminal of the dilated CBD. Biopsy of the papilla revealed well-to-moderately differentiated adenocarcinoma. Considering her extreme old age and keeping in mind her quality of life after the operation, and the finding that the tumor was localized within the papilla and highly differentiated, we performed local resection. In addition, the intrapancreatic portion of the CBD and part of the main pancreatic duct (MPD) were further resected to secure a negative margin, confirmed by frozen section. The MPD was reapproximated to the duodenal mucosa and a choledocho-duodenostomy was performed for CBD reconstruction. Histopathological examination showed the tumor was papillary adenocarcinoma, 10 × 15 mm in size; there was no invasion beyond the sphincter of Oddi, it had partly infiltrated the CBD, but had not invaded to the pancreas or duodenum. The patient's postoperative course was not eventful and she has had good quality of life for the past 6 years since the operation, without any evidence of recurrence. Although radical pancreaticoduodenectomy is now the standard procedure in patients with malignant tumor of the papilla of Vater, local resection is a reasonable alternative for high-risk patients with highly differentiated, apparently localized carcinomas.     

贮存式自体输血开展对优化妇科手术用血结构的影响

目的:总结本院2011-2013年贮存式自体输血开展前后,妇科手术用血异体少白细胞红细胞和自身贮血的应用情况。方法:对本院妇科手术台次,异体少白细胞红细胞及贮存式自体血液的使用人数、量及比例分别进行统计。结果:最近3年妇科手术台次逐年上升,异体少白细胞红细胞用量从463.5U下降至320.5U,自体输血量上升至161U。异体输血比例由手术人次的33.61%下降至19.80%,自体输血比例由0上升至22.61%。人均异体少白细胞红细胞使用量由0.783U下降至0.450U,人均自体全血用量由0上升至0.226U。结论:贮存式自体输血开展,使妇科手术用血结构得到优化,其对临床节约用血的影响,得到了规模性,量化体现。     

改水、服硒、食用蓬灰防治大骨节病的效果观察

本实验应用改水、服硒、食用蓬灰等措施在大骨节病区对3～13岁儿童进行现场防治实验。用现患率、健康儿童新发率、X线痊愈率作为其判定指标。 通过四年的实验观察,现患率由1980年的46.40％下降到1984年的20.30％,有非常显著的差异。36名健康儿童连续四年观察未有新发病人,而对照组出现新发病例,取得了较好的防治效果。本文还对防治措施的作用进行了分析讨论。     

Recent results: biomarkers of aging

This communication reviews recent papers attempting to identify Biomarkers of Aging (BoA). A BoA is a biological parameter that will predict functional capability at some later age. Few, if any, BoA have been found and this review describes the recent search for BoA. Among others that have been put forward are IL6 and other markers of inflammation, allostatic load, and corticosterone, which have been described primarily in humans. Work in model systems as well as theoretical work are also reviewed.     

Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation

This paper considers the argument for obesity as a chronic relapsing disease process. Obesity is viewed from an epidemiological model, with an agent affecting the host and producing disease. Food is the primary agent, particularly foods that are high in energy density such as fat, or in sugar‐sweetened beverages. An abundance of food, low physical activity and several other environmental factors interact with the genetic susceptibility of the host to produce positive energy balance. The majority of this excess energy is stored as fat in enlarged, and often more numerous fat cells, but some lipid may infiltrate other organs such as the liver (ectopic fat). The enlarged fat cells and ectopic fat produce and secrete a variety of metabolic, hormonal and inflammatory products that produce damage in organs such as the arteries, heart, liver, muscle and pancreas. The magnitude of the obesity and its adverse effects in individuals may relate to the virulence or toxicity of the environment and its interaction with the host. Thus, obesity fits the epidemiological model of a disease process except that the toxic or pathological agent is food rather than a microbe. Reversing obesity will prevent most of its detrimental effects.