精准胆道外科手术治疗胆囊癌的近远期疗效研究

目的 研究精准胆道外科手术治疗胆囊癌的近远期疗效。方法 前瞻性分析陆军特色医学中心 2014年2月至2017年2月收治的胆囊癌患者104例,采用随机数字法将其分为对照组和观察组,每组52例。对照组接受胆囊癌传统经验式外科手术,观察组接受精准胆道外科理论引导下手术。比较两组患者的手术效果、术后恢复指标、并发症发生率。术后随访3 年,比较两组患者的1 年、2 年及3 年生存率,并绘制 Kaplan-Meier生存曲线。结果 观察组较对照组淋巴结清扫数目[（23.48±7.20） vs（ 15.86±5.93）,t=16.64, P＜0.001]和阳性淋巴结数目[（9.94±3.50） vs（ 5.27±4.39）,t=7.51,P＜0.001]更高,R0切除率（76.92% vs 36.54%,χ2=16.37,P＜0.001）、胆囊癌扩大根治术率（34.62% vs 11.54%,χ2=5.13,P=0.02）及联合胰十二指肠切除术率（17.31% vs 3.85%,χ2=4.98,P=0.02）更高,术后排气时间[（1.05±0.38）d vs（ 1.93±0.46）d, t=5.39,P＜0.001]和首次下床活动时间[（2.85±1.16）d vs（ 6.26±1.92）d,t=7.88,P＜0.001]均明显更早;并发症发生率（23.08% vs 30.77%,χ2=0.78,P=0.38）无统计学差异。观察组术后1 年（61.54% vs 40.38%, χ2=4.66,P=0.03）、2年（44.23% vs 19.23%,χ2=7.50,P＜0.001）及3年（26.92% vs 7.69%,χ2=6.72,P＜0.001）生存率比对照组高,中位生存时间[（17.37±8.64）个月 vs（ 8.95±4.59）个月,t=14.96,P＜0.001]更长。结论 精准胆道外科手术有助于胆囊癌患者选取最佳术式,提高手术切除质量和R0切除率,并能有效控制手术并发症,从而延长患者术后生存期。     

Association of age and response to androgen‐deprivation therapy with or without radiotherapy for prostate cancer: data from CaPSURE

Study Type – Therapy (prospective cohort)
Level of Evidence 2b

OBJECTIVE

To assess whether the response to primary androgen‐deprivation therapy (PADT) and radiotherapy (RT) plus adjuvant ADT would be muted in older men, as their tumours might already be relatively androgen insensitive, because serum testosterone levels decline with increasing age.

PATIENTS AND METHODS

Using the Cancer of the Prostate Strategic Urologic Research Endeavor database, we conducted an observational study evaluating two groups of men treated for prostate cancer from 1995 to 2006. One group of 1748 men was treated with PADT and the second group of 612 men was treated with RT (external beam RT or brachytherapy) with neoadjuvant and/or adjuvant ADT. We tested whether age was a predictor of disease progression in the PADT group and prostate‐specific antigen (PSA) recurrence in the RT + ADT group (Phoenix definition). Secondary outcomes were all cause (ACM) and prostate cancer‐specific mortality (PCSM).

RESULTS

In both univariate and multivariate analysis stratifying by clinical risk group, age (<65, 65–69, 70–74, and ≥75 years) was not associated with the risk of secondary treatment or PSA recurrence for the PADT and the RT + ADT groups, respectively. Age category had no relationship to increased ACM or PCSM for the RT + ADT group. However, for the PADT group the oldest category (>75 years) had an increased hazard ratio (2.26, 95% confidence interval 1.04–4.88; P = 0.02) for ACM, but a decreased ratio for PCSM (0.29, 0.21–0.42; P < 0.01).

CONCLUSION

If we assume that age is a valid proxy measure for free available testosterone levels, then these levels do not seem to affect the likelihood of response to ADT, either used alone or combined with RT.     

Long‐term compliance with endoscopic surveillance for familial adenomatous polyposis

Aim The study assessed compliance of patients with familial adenomatous polyposis (FAP) with endoscopic surveillance. Method In this nationwide, cross‐sectional study, individuals from FAP families registered with the Netherlands Foundation for the Detection of Hereditary Tumours were invited to complete a questionnaire on endoscopic screening experiences. Results A total of 328 individuals were eligible for the study of whom 85 were at risk for FAP, 108 had an intact rectum after a colectomy with ileorectal anastomosis (IRA), and 135 had had a pouch following a proctocolectomy with ileoanal anastomosis (IPAA). Based on medical record data, 20% of the at‐risk group and 26% of the IRA‐group were found to be undercompliant with surveillance advice which was associated significantly with perceived self‐efficacy, use of sedatives during surveillance, pain after surveillance and low perceived benefits of surveillance (P < 0.05). Conclusion One in five individuals at risk for FAP and one in four with a retained rectum are undercompliant with screening advice. We recommend that sedatives should be patient‐tailored for FAP individuals undergoing surveillance and that adequate pain medication be provided after endoscopy.     

活性氧在脊髓损伤中的作用

脊髓损伤(spinal cord injury，SCI)治疗的实验性研究在18世纪就已经开始，研究者发现兴奋性毒性、Ca2+超载、神经元凋亡与氧化应激参与了神经损伤病理过程。近期研究中活性氧学说在脊髓损伤中的作用越来越受到研究者的重视，并有研究表明线粒体呼吸链、炎症反应中的呼吸爆发等多种途径参与了SCI后活性氧生成。本文在阐述活性氧生物学作用的同时，并结合近年来以活性氧为靶点的SCI治疗策略做一小结。     

延迟小结追加反馈对基础护理操作技能学习的影响

目的 探讨基础护理操作技能教学中延迟小结追加反馈对教学效果的影响.方法 随机抽取护理专业2003级2个专科班的125名学生分为控制班(62人)、实验班(63人).在基础护理操作技能教学中控制班采用同步追加反馈,反馈频率为100%,反馈内容为操作错误的信息;实验班采用延迟小结追加反馈,反馈频率为25%～30%,反馈内容为操作错误以及正确操作的信息.结果 控制班在技能获得阶段操作成绩显著高于实验班(P＜0.01),但在随后保持阶段的测试中成绩逐渐下降并显著低于实验班(P＜0.01).结论 练习过程中追加反馈的内容、时机和频率对基础护理操作技能的教学效果有影响.同步追加反馈可以保证技能习得阶段的表现却不利于技能的保持;延迟小结性反馈最有利于基础护理操作技能的学习.     

中国居民颅内动脉粥样硬化性狭窄危险因素的meta分析

目的 探讨中国大陆地区居民性别、吸烟、饮酒、高血压、糖尿病、血脂代谢异常等危险因素与颅内动脉粥样硬化性狭窄(intracranial atherosclerotic stenosis,ICAS)的关系.方法 系统检索中国生物医学文献数据库、中国期刊全文数据库、MEDLINE和EMBASE数据库.综合效应分析采用RevMan 5.0.23版本软件进行meta分析.经异质性检验后对性别、吸烟、饮酒、高血压、糖尿病进行OR值的合并;血脂代谢异常(TG、TC、HDL-C、LDL-C)进行MD值的合并;绘制漏斗图和计算失安全系数判断发表偏倚;敏感性分析检验meta分析结果稳定性.结果 最后9篇文献纳入meta分析,均为病例-对照研究,研究论证强度中等.性别(男性)、吸烟、饮酒、高血压、糖尿病对ICAS影响的合并OR(95%CI)值分别为1.00(0.82～1.23,P=0.99)、1.04(0.82～1.33,P=0.74)、0.91(0.69～1.20,P=0.51)、1.35(0.73～2.50,P=0.33)和1.71(1.04～2.81,P=0.03);TG、TC、HDL-C、LDL-C对ICAS影响的合并MD(95%CI)值分别为0.12(0.00～0.25,P=0.05)、0.06(-0.09～0.20,P=0.43)、-0.12(-0.23～-0.01,P=0.03)和0.24(0.14～0.33,P<0.001).结论 基于目前的研究,中国大陆地区居民糖尿病、LDL-C是ICAS的危险因素;HDL-C是ICAS的保护因素;尚无证据显示男性、吸烟、饮酒、高血压、TG、TC是ICAS的危险因素.     

同期放化疗加辅助化疗治疗鼻咽癌的临床观察

目的:探讨放化疗同期治疗及辅助化疗对Ⅲ～ⅣA期鼻咽癌的临床疗效,评价鼻咽癌放化疗同期治疗及辅助治疗的毒副反应.方法:96例Ⅲ～ⅣA期鼻咽癌患者随机分为两组.A组为治疗组48例,采用常规放疗+同期化疗及辅助化疗;B组为对照组48例,单纯放疗.两组放疗方案相同,均采用6 MV X线外照射+6～12 MeV电子线,放疗技术为双面颈联合野DT 36 Gy后,改为双面颈联合小野避开脊髓加量放疗DT 34 Gy及下颈部切线野DT 50 Gy.鼻咽原发灶及阳性淋巴结区放疗DT 70～78 Gy,2 Gy/次,下颈部及锁骨上淋巴结预防区DT 50 Gy.A组同期及辅助化疗方案为DDP 30 mg/m2,静脉滴入,d1～d3,或CBP 60 mg/m2,静脉滴入,d1～d5;5-FU 600 mg/m2,静脉滴入,d1～d5.3～4周为1个周期,放疗同期化疗2个周期,放疗后辅助化疗1、2周期.结果:A组3年无瘤生存率(DFS)为79.2%,B组为52.1%,鳘2=7.804, P＝0.005;A组3年总生存率(OS)为83.3%,B组为64.6%,鳘2=4.381, P＝0.036.结论:同期放化疗加辅助化疗能提高中晚期鼻咽癌的无瘤生存率及总生存率,毒副反应可耐受.     

柘树黄酮体内外抗肿瘤作用研究

目的评价柘树黄酮的抗肿瘤活性。方法采用甲基噻唑基四唑比色法体外检测柘树黄酮对15种肿瘤细胞株的生长抑制作用;建立B16黑色素瘤小鼠肿瘤模型和SKOV-3卵巢癌裸小鼠移植瘤模型,评价柘树黄酮的体内抗肿瘤活性：建立S180肉瘤小鼠肿瘤模型,考察柘树黄酮与环磷酰胺、顺铂及5-氟尿嘧啶等化疗药物的协同作用。结果柘树黄酮对人胃癌细胞（BGC-823）株、人肺癌细胞（A549）株及小鼠淋巴细胞白血病细胞（L1210）株较敏感,半数抑制浓度（IC50）分别为611、12．20和12．73ug／mL,对其他12种细胞株的细胞毒作用较小。体内试验表明,柘树黄酮能有效抑制B16黑色素瘤（250mg／kg时抑瘤率为50．54％）,并对SKOV-3卵巢癌裸小鼠移植肿瘤的生长有很好的抑制作用（250mg／kg时抑瘤率为46．38％）;柘树黄酮与化疗药物有明显的协同作用。结论体内体外试验均表明柘树黄酮有较好的抗肿瘤作用,并且与环磷酰胺、顺铂及5-氟尿嘧啶等化疗药物具有协同效应。