术后腹腔化疗对老年结直肠癌患者生存质量的影响

目的评价老年结直肠癌患者手术后腹腔化疗对生存质量的影响。方法调查1998年1月至2002年12月期间52例60岁以上进行术后腹腔化疗的患者的生存质量GLQI指数,并与同期、同年龄段44例静脉化疗患者和40名健康老年对照组进行比较。所有病人于术前和术后6个月期间调查患者的生存质量。结果老年结直肠癌患者手术前的生存质量GLQI指数明显低于正常老年人群(P<0.05)。而两组患者手术前的生存质量GLQI指数无显著差异(P>0.05)。腹腔化疗组患者手术后6个月期间的生存质量GLQI指数高于静脉化疗组患者,其差异存在统计学意义(P<0.05)。腹腔化疗组患者手术后3月、4月、5月和6月的生存质量GLQI指数与正常老年人群无显著差异(P>0.05);而静脉化疗组患者手术后3月、4月、5月和6月的生存质量GLQI指数仍低于正常老年人群(P<0.05)。结论针对老年结直肠癌患者的生理特点,手术后采用腹腔化疗,不仅有利于提高手术后的生存期;而且有助于提高患者的生存质量,是老年结直肠癌患者手术后首选的理想化疗方式。     

益气健脾方联合化疗对胃癌术后生存质量及细胞免疫功能的影响

[目的]观察中药益气健脾方联合化疗对胃癌术后的生存质量及其细胞免疫功能的影响。[方法]将符合诊断标准及纳入标准的患者,按照随机数字表法分为对照组(32例)和治疗组(32例),对照组给予OLF化疗方案,治疗组在对照组的基础上给予中药益气健脾方,3个月后评价2组患者的生存质量、毒性反应及自然杀伤(NK)细胞及T淋巴细胞亚群(CD~(~(3+))、CD~(4+)、CD~(8+)、CD~(4+)/CD~(8+))水平。[结果]治疗组在白细胞下降情况、贫血、恶心、呕吐、腹泻及末梢神经损伤方面明显优于对照组(P0.05);治疗组治疗后KPS评分未见明显变化,差异无统计学意义(χ2=0.268,P0.05),2组患者治疗后比较,差异有统计学意义(χ2=13.10,P0.01);治疗组治疗后CD~(3+)、CD~(4+)、CD~(8+)、CD~(4+)/CD~(8+)较前明显升高(P0.05),组间比较差异亦具有统计学意义(P0.05);治疗组治疗后NK活性较前明显升高(P0.05),组间比较差异亦具有统计学意义(P0.05)。[结论]益气健脾方联合化疗不仅能够明显提高胃癌术后患者生存质量,还能够明显可减轻化疗的毒性反应,提高患者免疫力及提高患者化疗耐受性和依从性,且价格低廉,实用范围广。     

博尔宁胶囊联合XELOX方案治疗结直肠癌术后的临床疗效

目的观察博尔宁胶囊联合XELOX方案治疗结直肠癌术后患者的临床效果.方法将64例结直肠癌患者随机分为治疗组和对照组,治疗组患者采取国产中药博尔宁胶囊联合XELOX方案治疗,对照组单纯应用XELOX方案,比较两组的疗效和不良反应.结果治疗组和对照组近期客观疗效(完全缓解+部分缓解)分别为53.1%和40.6%,差异无统计学意义(P0.05),治疗组化疗相关不良反应发生率低于对照组(P0.05),在生活质量和免疫功能改善方面两组差异均有统计学意义(P0.05).结论结直肠癌患者化疗过程中应用博尔宁胶囊,能提高生活质量,减少化疗相关不良反应.     

经皮神经电刺激与穴位按压联合艾灸对减轻肺癌患者含顺铂方案化疗后胃肠道反应的对比研究

目的探讨经皮神经电刺激(TENS)与中医穴位按压联合艾灸对减轻肺癌患者含顺铂方案化疗所致胃肠道反应的疗效。方法将100例行含顺铂方案化疗的肺癌患者随机分为TENS组和中医组,每组50例,所有患者化疗期间均给予常规抑酸、止吐治疗;在此基础上,TENS组加用TENS治疗,中医组加用穴位按压及艾灸治疗,2次/d,化疗前1 d开始,至化疗后3d结束,比较两组患者化疗第1天至第6天胃肠道反应的发生率和症状分级情况。结果 TENS组患者恶心、呕吐的发生率及症状程度与中医组无明显差异(P0.05);TENS组患者食欲不振的发生率低于中医组,差异有统计学意义(P0.05),同时,TENS组食欲不振的症状程度也轻于中医组,差异有统计学意义(P0.05)。结论 TENS与中医穴位按压联合艾灸治疗均可减轻肺癌患者含顺铂方案化疗所致的胃肠道反应,在降低患者恶心、呕吐的发生率及症状程度方面两组无明显差异,但在改善食欲不振发生率和症状程度方面,TENS治疗有一定优势。     

奥沙利铂对晚期结直肠癌化疗的临床疗效及其对TNF-α、IL-2水平的影响

目的探讨奥沙利铂对晚期结直肠癌化疗临床疗效的影响及其对TNF-α、IL-2水平的影响。方法选取2012年1月至2016年1月在作者两院治疗的晚期结直肠癌患者98例,随机分为对照组和观察组,每组49例,对照组接受常规化疗,观察组在对照组基础上接受奥沙利铂治疗,比较两组的临床疗效以及化疗期间不良反应的发生情况,分别测定两组患者化疗前后IL-2、TNF-ɑ的含量水平。结果观察组的临床总有效率为59.18%,显著高于对照组的38.78%(P0.05);两组腹泻、恶心呕吐、骨髓抑制(白细胞、血小板、血红蛋白减少)、脱发以及肝功能损伤等不良反应发生率差异无统计学意义(P0.05);观察组出现神经毒性的发生率显著高于对照组(P0.05)。两组治疗后IL-2含量显著升高(P0.05),且观察组高于对照组(P0.05);而TNF-α的含量较治疗前明显受到抑制(P0.05),其中观察组抑制TNF-α的效应大于对照组(P0.05)。结论奥沙利铂治疗晚期结直肠癌患者的临床疗效显著,化疗期间出现不良反应的发生率除神经毒性外与对照组无统计学差异,安全性较好,显著改善患者的细胞免疫功能,值得临床推广应用。     

个性化护理干预对减轻癌症化疗呕吐的作用

目的观察个性化护理干预减轻癌症化疗患者呕吐的作用。方法将96例癌症化疗病人分为治疗组与对照组,采用恶心呕吐评估量表来调查化疗病人发生恶心呕吐的程度,治疗组给予个性化护理干预,对照组实施一般常规护理。结果治疗组发生恶心呕吐的病人人数明显降低,两组比较差异有统计学意义（P〈0.05）。结论个性化护理干预可以减少化疗病人恶心呕吐反应,提高他们的生存质量。     

盐酸帕洛诺司琼预防化疗所致恶心呕吐的临床研究

目的通过与盐酸托烷司琼注射液比较,观察和评价盐酸帕洛诺司琼注射液预防高度催吐危险化疗方案所致恶心、呕吐的疗效和安全性。方法将入选的使用高度催吐危险化疗方案的恶性肿瘤患者随机分入治疗组和对照组,治疗组于化疗前30min缓慢静脉注射帕洛诺司琼0.25mg,对照组于化疗前30min缓慢静脉注射托烷司琼5mg。观察患者化疗后5d内恶心、呕吐的情况,以及止吐药相关不良反应。结果帕洛诺司琼和托烷司琼对化疗后急性恶心的有效控制率分别是80%和72%,对化疗后迟发性恶心的有效控制率分别是60%和52%,对化疗后急性呕吐的有效控制率分别是72%和62%,以上差异均无统计学意义(P0.05);对化疗后迟发性呕吐的有效控制率分别是72%和40%,差异有统计学意义(P0.05)。两种止吐药相关不良反应发生率均较低,两种止吐药不良反应差异无统计学意义(P0.05)。结论帕洛诺司琼预防高度催吐危险的化疗方案所致的恶心和急性呕吐的疗效与托烷司琼相当,但预防高度催吐危险化疗方案所致的迟发性呕吐的疗效优于托烷司琼,且不良反应发生率低、程度较轻、安全性好。     

硫普罗宁对晚期结直肠癌患者FOLFOX4方案化疗效果的影响

目的探讨硫普罗宁在晚期直肠癌FOLFOX4方案化疗中的临床应用价值。方法将60例晚期结直肠癌患者随机分为观察组和对照组,每组各30例。对照组患者采用FOLFOX4化疗方案治疗;观察组患者在应用FOLFOX4方案化疗的同时静滴硫普罗宁治疗。观察比较两组的疗效和毒副反应。结果观察组患者的近期疗效略高于对照组,但差异无统计学意义(P0.05)。观察组患者肝功能损害和中性粒细胞减少程度低于对照组,差异有统计学意义(P0.05)。结论硫普罗宁能减轻晚期结直肠癌患者化疗所致的肝功能损害和中性粒细胞减少,但不能明显提高化疗的近期疗效。     

阿瑞匹坦应用于肺癌化疗患者中的效果观察

目的观察肺癌患者采用阿瑞匹坦口服,化疗诱导性恶心和呕吐的效果及不良反应。方法采用随机对照,将160例患者随机分为A和B两组,阿瑞匹坦组(A组)采用阿瑞匹坦、托烷司琼联合地塞米松,标准方案组(B组)采用托烷司琼联合地塞米松,两组患者比较恶心、呕吐及治疗相关不良反应的发生率。结果阿瑞匹坦组患者恶心(Z=-2.028)及呕吐(Z=-2.151)反应程度明显低于和标准方案组(P0.05);阿瑞匹坦组对恶心、呕吐的有效控制率(96.2%、97.5%)明显高于标准方案组(81.2%、83.8%)(P0.05),差异有统计学意义。两种方案其它主要不良反应如厌食、便秘、疲倦、呃逆、头晕、口干等发生率差异均无统计学意义(P0.05)。结论肺癌患者化疗服用阿瑞匹坦胶囊,能减轻化疗引起的恶心、呕吐等不良反应,而且具有很好的耐受性。     

个体化营养护理方案对直肠癌前切除患者术后恢复作用效果

目的研究个体化营养护理方案对直肠癌前切除患者术后恢复作用效果.方法选取2015-01/2017-01在杭州市萧山区第一人民医院接受手术治疗直肠癌患者140例,依据随机数字表法将患者分成2组:试验组(70例)采用个体化的营养护理方案,对照组(70例)采用常规的护理方案;观察患者手术以后的恢复情况,包含排气时间、排便时间、住院时间、肠外的营养时间、引流管的拔出时间和拆线的时间等,患者手术以后的排便功能、并发症情况,患者手术前后体内营养变化情况.结果手术后试验组患者在排气时间、排便时间、住院时间和肠外的营养时间方面均低于对照组,对比差异有统计学意义(P0.05);试验组患者排便能力优的人数多于对照组,差的人数少于对照组,2组对比差异有统计学意义(P0.05);试验组手术以后共有10例患者出现并发症,对照组有30例出现并发症,2组对比差异有统计学意义(P0.05);2组患者手术后第1天血红蛋白水平、体重、总蛋白水平和体质量指数较治疗前均明显下降,对比差异有统计学意义(P0.05),2组患者手术后1 wk其血红蛋白水平、体重、总蛋白水平比手术后1 d有明显回升,且试验组患者恢复的更好,2组对比差异有统计学意义(P0.05).结论个体化的营养护理能够加快患者胃肠道的能力恢复,手术后的并发症降低,使患者的营养状况更快地恢复,排便功能也更好,值得在临床推广使用.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Angiographic diagnosis of the degree of serosal invasion of carcinoma of the colon

Angiography using Prostaglandin El^® was performed on 38 patients with carcinoma of the colon in order to diagnose the degree of serosal cancer invasion. The findings at angiography were classified into four groups:1) AG-S3, abnormal change (irregularity and/or encasement) up to marginal vessels; 2) AG-S2, abnormality up to vasa recta; 3) AG-S1, abnormality of penetrating branches of vasa recta within the wall of the colon; and 4) AG-S0, no distinct findings of abovementioned vessels. These angiographic findings were compared with both macroscopic and microscopic serosal cancer invasion. Angiographic diagnosis is in accord with the macroscopic findings in 84.2 percent of cases. Angiographic diagnosis is in accord with the microscopic findings in 32.4 percent of cases. Macroscopic findings confirm the angiographic diagnosis precisely but the conflict with microscopic findings should not be overlooked. This may be the result of inflammatory change, adhesion, and fibrosis around carcinoma of the colon.