胰腺癌诊治指南(2014)

<正>1前言2014年最新统计数据显示,发达国家(美国)胰腺癌新发估计病例数,男性列第10位,女性列第9位,占恶性肿瘤病死率的第4位。据《2013年中国肿瘤登记年报》统计,胰腺癌位列我国男性恶性肿瘤发病率的第8位,人群恶性肿瘤病死率的第7位,全球范围内均呈快速上升趋势。我国地域辽阔,各地经济及医疗水平差距较大,为了进一步规范胰腺癌的诊断与治疗,提高多学科综合诊治水平,中华     

Influences of Gender on Complication Rate and Outcome after Roux-en-Y Gastric Bypass: Data Analysis of More Than 10,000 Operations from the German Bariatric Surgery Registry

Background

Since 1 January 2005, bariatric surgery has been monitored in Germany. All related data are registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University Magdeburg.

Methods

Data collection regarding obesity and metabolic surgery was started in an online database in 2005. Follow-up data are collected once a year. Participation in the quality assurance study is voluntary.

Results

Since 2005, 10,330 Roux-en-Y gastric bypass (RYGB) procedures have been performed in Germany. In total, 8,013 patients were female and 2,317 were male. Male patients suffered significantly more comorbidities than female patients. The men also had higher body mass indexes (BMIs) and ages than the women at the time of operation. Data on the gender-specific aspects of RYGB from the Nationwide Survey of Bariatric Surgery in Germany (GBSR) showed a significant difference in anastomotic insufficiency at the gastro-entero-anastomosis. The leakage rate was 2.37 % (55/2,317) in men and 1.68 % (135/8,013) in women. Additionally, specific complication and mortality rates were significantly higher in male than in female patients.

Conclusions

Metabolic and obesity surgery is becoming increasingly popular in Germany. Data from the GBSR show significant differences in preoperative comorbidities and postoperative complication and mortality rates between male and female patients. There is a need for further evaluation of gender-specific aspects to optimize patient selection and reduce specific postoperative complications.     

French Spine Surgery Society guidelines for management of spinal surgeries during COVID-19 pandemic

Since the outbreak of coronavirus disease 2019 (COVID-19) in December 2019 in China, various measures have been adopted in order to attenuate the impact of the virus on the population. With regard to spine surgery, French physicians are devoted to take place in the national plan against COVID-19, the French Spine Surgery Society therefore decided to elaborate specific guidelines for management of spinal disorders during COVID-19 pandemic in order to prioritize management of patients. A three levels stratification was elaborated with Level I: Urgent surgical indications, Level II: Surgical indications associated to a potential loss of chance for the patient and Level III: Non-urgent surgical indications. We also report French experience in a COVID-19 cluster region illustrated by two clinical cases. We hope that the guidelines formulated by the French Spine Surgery Society and the experience of spine surgeons from a cluster region will be helpful in order optimizing the management of patients with urgent spinal conditions during the pandemic.     

乙型肝炎相关肝移植受体供肝植入前后乙型肝炎病毒标志物的变化

目的 了解乙型肝炎相关受体在拉米夫定或拉米夫定 乙型肝炎免疫球蛋白(HBIG)预防下供肝植入前后移植物乙型肝炎病毒(HBV)标志物的变化，探讨移植物HBV再感染的可能机制，为预防复发寻找切入点。方法用酶联放射免疫法、HBVDNA荧光定量法、免疫组织化学LSAB法定期检测78例受体手术前后血清及90例供肝活检组织，重点观察供肝植入前后HBV标志物在肝组织及血清中的动态变化。结果移植时无论受体为HBV活跃复制状态或非活跃复制状态，供肝植入后2h内活检肝组织既无HBVDNA又无HBsAg、HBcAg阳性证据。结论在现有预防措施下，无论受体术前HBV复制状态如何，健康供肝无术中HBV颗粒直接感染的证据，其机制及在远期HBV再感染中的意义尚待进一步研究。     

Increasing access to allogeneic hematopoietic cell transplant: an international perspective

Allogeneic hematopoietic cell transplantation (allo-HCT) is a highly complex, costly procedure for patients with oncologic, hematologic, genetic, and immunologic diseases. Demographics and socioeconomic status as well as donor availability and type of health care system are important factors that influence access to and outcomes following allo-HCT. The last decade has seen an increase in the numbers of allo-HCTs and teams all over the world, with no signs of saturation. More than 80 000 procedures are being performed annually, with 1 million allo-HCTs estimated to take place by the end of 2024. Many factors have contributed to this, including increased numbers of eligible patients (older adults with or without comorbidities) and available donors (unrelated and haploidentical), improved supportive care, and decreased early and late post-HCT mortalities. This increase is also directly linked to macro- and microeconomic indicators that affect health care both regionally and globally. Despite this global increase in the number of allo-HCTs and transplant centers, there is an enormous need for increased access to and improved outcomes following allo-HCT in resource-constrained countries. The reduction of poverty, global economic changes, greater access to information, exchange of technologies, and use of artificial intelligence, mobile health, and telehealth are certainly creating unprecedented opportunities to establish collaborations and share experiences and thus increase patient access to allo-HCT. A specific research agenda to address issues of allo-HCT in resource-constrained settings is urgently warranted.

Learning Objectives

• Understand the panorama of allogeneic hematopoietic cell transplantation (allo-HCT) activity worldwide
• Review factors affecting the access to allo-HCT across the globe
• Discuss possible strategies for expanding allo-HCT activity in resource-constrained areas

     

糖尿病对冠状动脉旁路移植术围手术期影响的临床研究

目的探讨糖尿病对冠状动脉旁路移植术(CABG)的影响.方法1512例患者接受CABG,其中糖尿病患者(DM组)328例,非糖尿病患者(NDM组)1184例.单变量统计分析两组术前危险因素和术后并发症.结果两组患者住院费用[DM组(6.11±2.4)万元;NDM组(5.63±2.2)万元;P＞0.05]、切口并发症(DM组:10.1%;NDM组8.9%;P＞0.05)、输血量[DM组(807.6±654.3)ml;NDM组(814.6±662.2)ml;P＞0.05]等方面差异无显著意义.两组患者术后严重并发病:低心排(DM组:1.5%;NDM组1.9%;P＞0.05)、心律失常(DM组:14.6%;NDM组15.2%;P＞0.05)、围术期心肌缺血(PMI)(DM组:1.2%;NDM组1.5%;P＞0.05)以及死亡率(DM组:1.52%;NDM组0.84%;P＞0.05)差异无显著意义.结论糖尿病患者经适当控制病情以后,CABG可以如同非糖尿病患者一样安全地实施.     

西京-87型鼓泡式氧合器应用于70公斤以上患者临床评价

在心脏外科飞速发展的今天,人工心肺机的好坏直接影响心内直视手术的顺利进行及术后各种并发症的发生,我院1989年12月至1998年5月共施行体外循环手术3572例,其中70公斤以上者106例,有54例应用了西京-87型鼓泡式氧合器收到了良好的效果.54例患者,男48例,女6例,年龄平均41(19～59)岁;体重70～88kg,平均75.6kg;体表面积平均1.82m~2;冠状动脉阻闭时间10～142分钟,平均52分钟;灌注时间22～434分钟,平均104分钟;氧血比值为0.3～0.6:1;静脉血氧饱和度维持在65%～80%.用西京-87型鼓泡式氧合器,优选了适宜孔径的氧弥散器,从而解决了大体重病人氧合差的问题.体重最高者达88kg,氧血比例0.6:1～0.5:1,静脉血氧饱和度能维持在65%～80%.体现了该氧合器氧合性能好,而且携氧量高,既使应用于长时间或高流量灌注也能维持较稳定的氧合状态.而且热交换系统达到了降复温标准系数,在高体重患者降复温过程效果满意.本氧合器祛泡性能良好,对防止气栓的发生起到了保障.全组未见动脉气栓及脑缺氧症者.该氧合器氧血比值小,氧合性能好,而且集氧合、热交换、祛泡、过滤和贮血于一体,从而对血液有形成都份破坏程度减轻.对减少心、脑、肺、肾的并发症起到了良好的作用.西京-87型鼓泡式氧合器适用于不同体重患者的心内直视手术体外循环灌     

国产支架型人工血管的实验研究与临床应用

目的研究和开发国产支架型人工血管经腔内治疗动脉疾病.方法1993年6月至1999年8月,用北京地区杂种狗24条,分别制作了腹主动脉瘤(8条)、降胸主动脉瘤(6条)、升主动脉瘤(4条)、主动脉弓瘤(4条)和动静脉瘘(2条)模型,用自制的支架型人工血管置入.置于腹主动脉的支架是编织式镍钛合金记忆金属,长3cm,直径8cm;胸主动脉支架是联体不锈钢“Z“型支架,长3cm,直径2cm.覆膜均为国产超薄涤纶人工血管.临床应用20例,男17例,女3例.主动脉夹层11例,肾下腹主动脉瘤7例和创伤性动静脉瘘2例.结果17条狗术后存活,分别于2、4、8周获取标本,支架型人工血管通畅良好,无血栓形成.临床病例中,有1例腹主动脉瘤并发肾功能不全,于术后20天血液透析中死于心肌梗塞,其余病人均被成功治疗.随访2个月至5年,除1例夹层动脉瘤术后3个月支架移位外,所有病人恢复良好.结论自制的支架型人工血管费用低,操作简便,应用前景可观.     

EB病毒LMP1在鼻咽癌细胞系中通过NF-κB、AP-1促进IL-8分泌

目的：探讨EB病毒LMP1分子致瘤机制，在已证实鼻咽癌细胞系中LMP1有效激活NF－κB 或AP－1的基础上，对LMP1是否通过NF－κB 或AP－1促进IL－8分泌进行探讨。方法：以稳定表达LMP1及其3种突变体，空白载体的鼻咽癌细胞系[HNE2-LMP1,NHE2-MLP1(1-185),HNE2-LMP1(1-231),HNE2-LMP1Δ187-351和HNF3－pSG5]及antisense-LMP1处理的HNF2－LMP1鼻咽癌的细胞系为材料，将IL－8报道质粒瞬时导入这些细胞系中，通过测定luciferase值以反映LMP1是否促进IL－8转录；将mut AP-1/IL-8-luc或IκB α（S32A／S36A）表达质粒导入HNE2－LMP1细胞系中，比较其IL－8报道活性，以确定LMP1是否通过AP－1或NF－κB 诱导IL－8转录；利用ELISA方法测定HNE2－LMP1，HNE2－pSG5,anti-sese-LMP1处理的HNE2－LMP1鼻咽癌细胞系中的IL－8浓度，进一步从蛋白水平上确定LMP1是否促进IL－8分泌。结果：与HNE2－pSG5相比，在HNE2－LMP1，HNE2－LMP1Δ187－351和HNE2－LMP1（1－231）细胞系中IL－8报道活性分别升高了原来水平的11．5，8．6和3．4倍，而HNE2－LMP1（1－185）对IL－8报道活性不影响。在HNE2－LMP1细胞系中IL－8蛋白水平提高了17．4倍，而antisense-LMP1则使HNE2－LMP1细胞的IL－8报道活性及蛋白水平分别下降到原来水平的18．3％和9．2％，导入mutAP-1/IL-8-luc或IκBα（S32A／S36A）的HNE2－LMP1细胞中IL－8报道活性分别下降到原有水平39％和26％，结论：鼻咽癌细胞系中LMP1可能通过NF－κAP－1促进IL－8表达。