胆囊肝样腺癌的临床影像病理分析

目的总结胆囊肝样腺癌临床病理学特征及影像学表现。 方法回顾性分析2010年1月至2019年10月海军军医大学第三附属医院收治的经手术病理诊断的6例胆囊肝样腺癌患者的临床资料、病理检查结果、影像学资料及术后随访资料。 结果本组6例胆囊肝样腺癌患者的发病年龄为49~69岁,男女发病率为2∶1,3例发生于肝脏或淋巴结转移。6例患者血清甲胎蛋白（AFP）水平均升高、肝细胞抗原（Hep-1）染色均呈阳性。1例患者MRI和CT表现动脉期呈中度-明显强化,门静脉期及延迟期强化减退,1例为轻度强化;1例为不均匀明显强化。6例患者中2例患者失访;2例患者术后5年未见复发,存活至今;1例患者术后2年发现肝转移,治疗后存活至今;1例患者术后1年复发,治疗6个月后死亡。 结论胆囊肝样腺癌好发于中老年男性,且容易发生肝脏或淋巴结转移,并通常伴有血清AFP水平升高,预后差,结合临床和影像学特征可提高对该病的诊断准确率。     

Kinetics changes in total cholesterol predict HBeAg seroconversion in chronic hepatitis B patients treated with pegylated interferon-alfa

There is no satisfactory standard for predicting HBeAg seroconversion during Pegylated interferon alpha (PegIFNα) treatment. Studies have shown that IFNα therapy in chronic hepatitis C patients could alter serum lipid profiles. However, there have been no studies on lipid changes that predict the outcome of PegIFNα monotherapy in treated-naive chronic hepatitis B (CHB) patients. This retrospective study included 130 treated-naive HBeAg-positive CHB patients receiving PegIFNα monotherapy. The relationship between serum lipid changes and HBeAg seroconversion was analysed. The TC-ALT-HBsAg-HBeAg-Genotype-Age (CASEGA) model was established to predict HBeAg seroconversion after PegIFN-α monotherapy. Among 130 patients, 33 achieved HBeAg seroconversion (SR) and 97 did not achieve HBeAg seroconversion (NR). The decrease in serum total cholesterol (TC) in the NR group was significantly higher than in the SR group at Week 24 (−9.59% vs. −0.31%, p < 0.001). Multivariate logistic regression analysis showed that the change in TC at Week 24 (odds ratio = 1.065, p = 0.009) was an independent predictor of HBeAg seroconversion. The area under the receiver operating characteristic curve for the CASEGA model was 0.883. The model score at the maximum Youden index was 90, and the specificity, sensitivity, positive predictive value and negative predictive value were 0.727, 0.794, 0.546 and 0.895, respectively. The HBeAg seroconversion rate at Week 72 in patients with scores >90 was significantly higher than that in patients with scores <90 (54.55% vs. 10.47%, p < 0.001). This study indicated that the change in the TC level at 24 weeks in CHB patients treated with PegIFNα was associated with HBeAg seroconversion. The CASEGA prediction model based on the TC change rate of 24 weeks has good predictive efficiency for HBeAg seroconversion.     

抗丙型肝炎药物波普瑞韦临床研究新进展

丙型肝炎病毒（HCV）感染人体后,病情进展隐匿,可发展成慢性肝炎、肝硬化、肝癌,严重危害人类身体健康。据估计目前全球约有1．6亿人感染HCV,给社会和家庭带来了沉重负担。     

超声引导下的深、浅静脉穿刺

目的：探讨超声引导下深、浅静脉穿刺在肿瘤患者中的临床应用价值。方法：对168例行颈内静脉、126例股静脉穿刺和63例常规浅静脉穿刺失败的肿瘤患者作超声引导穿刺法与传统盲穿法的对比观察。结果：颈静脉穿刺组采用超声引导法与传统盲穿的1次穿刺置管成功率分别为93.3%（84/90）和51.3%（40/78，P〈0.01），并发症发生率分别为0（0/90）和7.7%（6/78，P〈0.05）；股静脉组1次穿刺置管成功率分别为92.9%（65/70）和55.4%（31/56，P〈0.01），并发症发生率分别为0（0/70）和8.9%（5/56，P〈0.05）；63例常规浅静脉穿刺失败的患者在超声引导下1次穿刺成功率为76.2%（48/83），优良率为92.1%（58/63），无一例发生并发症。结论：超声引导下的深、浅静脉穿刺远较传统体表定位的盲穿法快速、准确、安全、有效，具有较高的临床应用价值。     

以循证护理为依托的信息化教学法在外科护理教学中的应用

[目的]探讨以循证护理为依托的信息化教学法在外科护理教学中的应用效果。[方法]将100名护生随机分为两组各50人,对照组采用传统教学模式授课,观察组护生采用信息化教学模式授课,比较两组教学效果及观察组护生对新型教学方法的评价。[结果]观察组88%护生认为新型教学模式优于传统教学模式,92%护生认为新型教学模式能够提高文献自主学习能力,94%护生认为新型教学模式能够提高文献检索能力;观察组护生的主观题理论考核成绩高于对照组护生(P0.01)。[结论]以循证护理为依托的信息化教学方法用于外科护理教学中有助于提高护生的综合能力。     

马尔他布鲁菌感染1例

患者男,47岁。因“发热伴腰痛3个月”入院。患者2011年3月无明显诱因下出现发热,一般下午3～4点钟发热,体温最高39．5℃,夜间体温能自行下降,伴大汗淋漓,同时感腰痛,疼痛不剧烈,平躺后疼痛可缓解,感乏力,伴食欲减退,无明显头痛、皮疹、肌肉酸痛,     

探讨HBV-DNA和AFP血清浓度的变化与HBV感染者转归的关系

目的探讨乙肝病毒感染者血清中HBV-DNA拷贝数与AFP浓度的变化对其转归的影响。方法收集2012年1月—2013年1月来该院就诊的400例乙肝病毒感染者血清,参照乙型肝炎和原发性肝癌的诊断标准进行如下分组：慢性乙型肝炎组200例,肝炎肝硬化组150例,肝癌组50例。对收集的标本采用实时荧光定量的方法检测出HBV-DNA水平,化学发光法检测AFP的浓度,然后对结果进行统计分析。结果在所有病例中,慢性乙型肝炎组HBV-DNA拷贝数为（5.38±1.66）,在3组中最高,而肝癌组HBV-DNA拷贝数为（4.41±1.43）在3组中最低。慢性乙型肝炎组与其他两组比较,P〈0.01,差异有统计学意义;3组间AFP浓度的变化进行比较,差异有统计学意义（P〈0.05）。3组中HBV-DNA拷贝数及AFP浓度变化和组别之间有明显的相关性,其中HBV-DNA的变化与病程呈反相关,而AFP的变化则呈正相关。结论乙肝病毒感染者应定期定量检测血清中HBV-DNA的含量,判断病毒的复制情况,并同时检测AFP浓度,以期尽早发现肝组织的损害程度及病情的演变过程,对乙肝病毒感染者病程转归的监测和预后判断具有重要的意义。     

醋蛋药理作用的实验研究

报告醋蛋液药理作用的动物实验研究。结果表明：醋蛋液能明显促进动物肠的蠕动，明显延长动物的游泳时间，提高细胞免疫功能，降低脑组织的脂质过氧化作用。醋蛋液尚有升高白细胞和肝脏Ｚｎ含量的明显趋势。动物实验结果未发现醋蛋液有任何不良的影响。     

Correlation between APOE -491AA promoter in epsilon4 carriers and clinical deterioration in early stage of traumatic brain injury

The objective of this work was to investigate the relationship between apolipoprotein E (APOE) promoters (G-219T, C-427T, A-491T) polymorphisms and the clinical deterioration in early stage of traumatic brain injury (TBI) in a cohort of Chinese patients. In this study, we used the cohort of patients which has been reported previously. A total of 110 subjects with TBI (80 males and 30 females, with mean age of 43.87 years) were admitted from December 2003 to May 2004, and demographic and clinical data were collected. The clinical deterioration of patient's condition in acute stage (<7 days after TBI) was judged by either of the following criteria: decrease of Glasgow Coma Scale (GCS) score (compared with initial admission GCS), increase in hematoma volume or delayed hematoma both detected by repeated computed tomography (CT) scanning compared to that on admission. Venous blood was collected from patients with TBI on admission to determine the APOE promoter polymorphisms. The APOE genotyping was performed by means of polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). chi(2) test and logistic regression analyses were done by SPSS. In 110 Chinese patients, the distributions of APOE genotypes and alleles matched Hardy-Weinberg Law, and 19 subjects presented with deteriorated clinical condition in acute stage after hospitalization. chi(2) test showed insignificant differences in association of APOE promoter polymorphisms with clinical deterioration (p>0.05). But logistic regression analyses, after adjusting patients' age, injury severity and injury mechanism etc, showed that -491AA (OR=11.681, p=0.009, 95%, CI 1.824-74.790) and APOE epsilon4 were all risk factors, with injury severity and alcohol-drinking as other risk factors. In Chinese population, as a significant but not independent risk factor, only APOE -491AA promoter in epsilon4 carriers is apt to the clinical deterioration and may contribute to the poor outcome after TBI.     

Reprimo基因在消化道肿瘤中的研究进展

Reprimo基因是一种新型的抑癌基因,定位于人类染色体的2q23,它由X线照射后的细胞分离产生并依赖于p53的表达.2000年之后,对Reprimo基因进行了深入的研究,为寻找肿瘤基因治疗的特异性靶点起到重要作用.但目前对它的认识仍不足,尤其对其在消化道肿瘤中的研究有限.本文就此做一综述,旨在阐述Reprimo基因的结构和功能,以及Reprimo基因在食管癌、胃癌、胰腺癌和结直肠癌等消化道肿瘤中的研究进展.