彩色多普勒超声引导下亚甲蓝边界定位法在乳腺癌保乳手术中的应用价值

目的探讨术前彩色多普勒超声引导下应用亚甲蓝定位肿瘤边界在乳腺癌保乳手术中的效果。方法收集2015年5月至2017年12月拟行保乳手术的乳腺癌患者120例,随机分为观察组和对照组各60例。观察组术前在彩色多普勒超声引导下行亚甲蓝定位,对照组采用传统手术方法。所有标本切除后进行病理检查,统计两组切缘情况。从精准性及微创性两方面比较两种方法的手术效果。结果观察组中,3例(5.0%)最大切缘>2 cm,57例(95.0%)最大切缘≤2 cm;对照组中,31例(51.7%)最大切缘>2 cm,29例(48.3%)最大切缘≤2 cm。两组比较差异有统计学意义(P=0.000)。观察组6例(10.0%)患者的手术标本镜下切缘阳性,54例(90.0%)切缘阴性;对照组15例(25.0%)镜下切缘阳性,45例(75.0%)切缘阴性。两组比较差异有统计学意义(P=0.031)。观察组和对照组分别有2例和3例在行二次扩切后切缘仍为阳性,改行乳腺全切手术。结论采用术前彩色多普勒超声引导下亚甲蓝定位肿瘤边界指导乳腺癌保乳手术的方法较常规方法在手术精准性及微创性两方面均有优势。     

Predictors of response and survival in patients with unresectable hepatocellular carcinoma treated with nivolumab: real-world experience

Real-world predictors of the treatment efficacy of immune checkpoint inhibitors for hepatocellular carcinoma (HCC) are unknown. This retrospective study enrolled 87 consecutive patients with unresectable HCC from May 2017 to December 2019 at two hospitals. Of the 87 patients, 7, 9, 60, and 11 patients had Barcelona Clinic Liver Cancer stages A, B, C, and D, respectively, and 45, 30, and 10 patients were Child-Pugh class A, B, and C, respectively. The median injection numbers of nivolumab and treatment duration were 6 (3-8) and 2.53 (1.47-4.23) months, respectively, and 64.4% of patients received combination therapy. Radiological imaging was not assessed for 25 patients. Objective response (OR) and disease control rates were 19.5% and 39.1%, respectively. A single tumor (odds ratio: 9.542, P = .015) and ≥20% decline in serum α-fetoprotein protein (AFP) levels within the first 3 months of treatment (defined as AFP response, odds ratio: 5.997, P = .042) were predictors of OR. Lack of macrovascular invasion, combination therapy, and AFP response were predictors of progression-free survival. A Cancer of the Liver Italian Program (CLIP) score of 0-2 (hazard ratio [HR]: 3.717, P = .004) and grade 1-2 immune-related adverse events (irAEs, HR: 2.217, P = .049) were predictors of overall survival (OS) in the entire cohort, and a CLIP score of 0-2 (HR: 3.257, P = .009) was a predictor of OS in evaluable patients. IrAEs ≥ grade 3 were noted in 14 patients, and three died as a result. Having a single tumor and AFP response were predictors of OR, and CLIP score was a predictor of OS.     

大鼠部分肝移植后自体骨髓干细胞动员的研究

目的 探讨大鼠部分肝移植后骨髓干细胞动员的情况。方法 建立大鼠性别交叉部分肝移植模型，分为部分肝移植组、全肝移植组和假手术组，分别与术后1、3、5、7d取标本。用流式细胞法检测骨髓中干细胞标记的细胞群体的数量变化，荧光原位杂交检测移植肝脏内Y染色体特异的Sry基因的表达，免疫组织化学法检测移植肝脏内干细胞标志CD34，c—kit和Thy-1．1的表达。结果 与全肝移植组相比，部分肝移植组术后第1天，骨髓细胞中，β2微球蛋白（β2m）／Thy-1．1^＋，CD45^＋／CD34^＋有不同程度的升高，然后呈递减趋势。免疫组织化学检测汇管区和炎性灶周围可见CD34、c—kit和Thy-1．1单个核细胞表达，并于第5至7天后减少。同时免疫组织化学双染可检出CD34^＋／CD45^＋细胞。全肝移植组汇管区CD34、c—kit和Thy-1．1表达较少，假手术组CD34、c-kit和Thy-1．1偶见表达。在部分肝移植物可检出Sry^＋细胞，但Srg^＋／CD34^＋，Sry^＋／Thy-1．1^＋细胞较少。全肝移植组Sry^＋偶见。结论 部分肝移植中，骨髓源性的干细胞发生动员；同时肝内有干细胞被激活，其中外源性干细胞较少。     

Successful retrieval of dislodged paclitaxel-eluting stent with a nitinol loop snare: a case report

Coronary stent dislodgment or embolization before deployment is a rare but challenging complication in interventional cardiology. Intracoronary embolization of the dislodged stent is associated with a high risk of coronary occlusion, due to thrombus formation and subsequent myocardial infarction. Furthermore, systemic embolization may cause severe cerebrovascular events. Nonsurgical retrieval strategies for this complication have been suggested, but bailout cardiac surgery may be indicated if percutaneous retrieval attempts fail. To our knowledge, this is the first case report of intracoronary drug-eluting stent dislodgment, and successful retrieval was accomplished by a loop snare technique. With the increasing trend of using drug-eluting stents in percutaneous coronary intervention, the likelihood of stent dislodgment or embolization may increase. It should be kept in mind, especially by coronary interventionists, how to manage this complication.     

Prevalence and associated metabolic factors of fatty liver disease in the elderly

Objective

The aim of this study was to investigate the metabolic risk factors for fatty liver disease in the elderly, and determine the prevalence of fatty liver disease in the elderly in Wuhan, central China.

Methods

The study was a case–control study based on all 4226 adults above 60 years of age from a cohort investigated in 2010–11 at the medical examination center of Zhongnan hospital, using 3145 randomly selected adults under 60 years of age from the same cohort as controls. Fatty liver disease (FLD) was identified with ultrasound imaging. The risk factors measured were body mass index (BMI), and plasma concentrations of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL), low density lipoprotein (LDL) and serum uric acid (SUA). The probability of steatohepatitis with advanced fibrosis was predicted using a score based on BMI, age, ALT, and TG (BAAT),and using AST/ALT ratio (AAR).

Results

FLD was higher in the elderly (26.7%) than in the non-elderly (22.8%) and similar in the elderly between men and women (26.6% vs 27.0%, p > 0.05). BMI, TC, TG, LDL, SUA, AST and ALT were all significantly higher in FLD, whereas the level of HDL was markedly lower. Multiple regression analyses showed that obesity, high TC, TG, SUA, low HDL, and elevated ALT, AAR < 1 were closely related to the elderly FLD, while male sex, obesity, high TC, TG, low HDL, elevated ALT, AST and AAR < 1 were closely related to the non-elderly FLD. The prevalence of steatohepatitis with advanced fibrosis estimated as BAAT index ≥ 3 was 2.4% in all subjects, and was higher in the elderly FLD patients than in the non-elderly FLD patients.

Conclusion

The prevalence of FLD is higher in the elderly, and is broadly related to the same metabolic risk factors as in the non-elderly. However, female-sex is no longer protective with increasing age, and the prevalence of steatohepatitis with advanced fibrosis is estimated to be considerably higher in the elderly FLD patients than in the non-elderly FLD controls.     

Exhaled air dispersion and removal is influenced by isolation room size and ventilation settings during oxygen delivery via nasal cannula

Background and objective: We compared the exhaled air dispersion distances during oxygen delivery via nasal cannula to a human‐patient simulator (HPS) in two different isolation rooms. Methods: Airflow was marked with intrapulmonary smoke for visualization. Oxygen flow was gradually increased from 1 to 5 L/min, with the HPS sitting at 45°. The leakage jet plume was revealed by laser light‐sheet and images captured by high‐definition video. Smoke concentration in the plume was estimated from the light scattered by smoke particles. The experiments were conducted at a double‐door, negative pressure isolation room with a dimension of 4.1 × 5.1 × 2.6 m, pressure of ?7.4 Pa and 16 air exchanges/h (ACH) (room A). Results were compared with experiments repeated in a smaller isolation room with a dimension of 2.7 × 4.2 × 2.4 m, pressure of ?5 Pa and 12 ACH (room B). Results: Room A: an exhalation jet spread almost horizontally outward from the nostrils of the HPS to 0.66 m and 1 m towards the end of bed when oxygen flow was increased from 1 to 5 L/min respectively. Room B: there was interaction between the downward ceiling ventilation current and the exhaled air from the HPS, leading to deflection of exhaled smoke towards the head of the HPS at an oxygen flow rate of 1 L/min. As oxygen flow was increased gradually to 5 L/min, more room contamination with smoke was noted. Conclusions: Substantial exposure to exhaled air occurs within 1 m towards the end of the bed from patients receiving oxygen via nasal cannula. Room dimension and air exchange rate are important factors in preventing contamination in isolation rooms.     

终末期肝病患者乙型肝炎病毒感染与肝祖细胞激活的关系

目的探讨终末期肝病患者乙型肝炎病毒感染与祖细胞激活和扩增的关系。方法 16例终末期慢性乙型肝炎患者的肝活检标本,以细胞角蛋白(CK7)为标记做免疫组织化学,定量分析祖细胞数目和胆管反应面积的相关性。结果全部患者均从组织学证实为肝硬化,并且炎症反应严重(炎症活动度评分12～17分)。祖细胞数目和胆管反应面积呈显著正相关。血清HBVDNA水平与祖细胞数目和胆管反应面积均显著相关。结论在终末期慢性乙型肝炎患者中,祖细胞的激活和扩增明显,HBV感染可能参与肝祖细胞的激活和扩增。     

Esomeprazole with aspirin versus clopidogrel for prevention of recurrent gastrointestinal ulcer complications.

BACKGROUND AND AIMS: The role of clopidogrel in patients at risk for gastrointestinal complications is uncertain, although it has been recommended for patients who have gastrointestinal intolerance to aspirin. We tested the hypothesis that clopidogrel is as effective as esomeprazole and aspirin in preventing recurrences of ulcer complications. METHODS: This was a prospective, double-blind, randomized, controlled study of 170 patients who developed ulcer bleeding after the use of low-dose aspirin between November 2002 and January 2005. After healing of ulcers and eradication of Helicobacter pylori, if present, patients were assigned randomly to treatment with esomeprazole 20 mg/day and aspirin 100 mg/day (n = 86) or clopidogrel 75 mg/day (n = 84) for 52 weeks. The primary end point was recurrent ulcer complications. RESULTS: During a median follow-up period of 52 weeks, no patient in the esomeprazole group, as compared with 9 patients in the clopidogrel group, developed recurrent ulcer complications. The cumulative incidences of recurrent ulcer complications were 0% in patients receiving esomeprazole and aspirin and 13.6% in patients receiving clopidogrel (absolute difference, 13.6%; 95% confidence interval for the difference, 6.3-20.9; log-rank test, P = .0019). CONCLUSIONS: The combination of esomeprazole and aspirin is superior to clopidogrel in preventing ulcer complications in patients who have a past history of aspirin-related peptic ulcer bleeding.