手术对Ⅳ期胆囊癌预后的影响

目的分析不同手术方式对Ⅳ期胆囊癌预后的影响.方法对1997年6月～2001年5月间上海市172例Ⅳ期胆囊癌病例进行临床病理分析,并对获得随访的164例的预后与手术方式的关系进行探讨.数据分析采用Kaplan-Meier法.结果 172例中未手术者44例(25.6%),手术者128例(74.4%),其中包括单纯胆囊切除术45例(35.1%)、胆囊癌根治性切除术17例(13.3%)、胆囊癌扩大根治性切除术5例(3.9%)和剖腹探查术61例(47.7%).在行根治性切除者中,Ⅳa和Ⅳb期的1年生存率分别为69.2%和40.7%,明显好于胆囊未切除或单纯切除者,在Ⅳa和Ⅳb期中各有2例存活期超过5年.结论有选择地进行Ⅳ期胆囊癌病例根治性或扩大根治性手术,有助于改善预后.     

术后后装放疗、吉西他滨化疗治疗原发性肝癌(英文)

目的探讨术后后装放疗加吉西他滨全身化疗对原发性肝癌的治疗效果。方法 1999年10月～2001年12月,将44例行肝癌切除术的原发性肝癌患者随机分为综合治疗组和对照组,每组22例。综合治疗组术中放置施源管3～6根,确定驻留点3～8个,术后3～10天行后装放疗,单次剂量10Gy,照射2～4次,总剂量20～40Gy。放疗结束3周后,开始吉西他滨化疗,静滴1.4g每周1次,4周为1周期,每周期3次,共6个周期。对照组手术后不放、化疗。手术前后定期查血常规、肝功能、AFP、胸片、B 超或 CT。结果综合治疗组后装放疗后 AFP 转阴率100%(17/17),对照组62.5%(10/16)(P<0.05);6月复发率0,低于对照组27.3%(6/22)(P<0.01);综合治疗组1年复发率18.2%(4/22)、转移率0和1年生存率100%(22/22),与对照组的45.5%(10/22)、13.6%(3/22)和77.3%(17/22)均有显著差异(p<0.05)。结论术后后装放疗加吉西他滨全身化疗是提高原发性肝癌近期治疗效果,降低复发率和转移率的有效手段。     

Responsiveness and minimal clinically important difference of the Chinese version of the Low Vision Quality of Life Questionnaire after cataract surgery

AIM: To investigate the Chinese version of the Low Vision Quality of Life Questionnaire (CLVQOL) as an instrument for obtaining clinically important changes after cataract surgery. METHODS: Patients underwent cataract surgery in Shanghai General Hospital, Shanghai Jiao Tong University, who fit the inclusion criteria were recruited. Two CLVQOLs were administered, including a preoperative CLVQOL and a CLVQOL at the end of the 3mo follow-up period, and were completed using face-to-face interviews or phone interviews conducted by trained investigators. The minimal clinically important difference (MCID) was calculated using an anchor-based method and a distribution method. In addition, the responsiveness of the questionnaire was measured. RESULTS: A total of 155 residents were enrolled. The average visual acuity (VA) preoperatively was 0.08 (SD=0.05), and it increased to 0.47 (SD=0.28) at the end of follow-up. Statistically significant positive changes in the CLVQOL scores indicated significant improvement of vision related quality of life after cataract surgery. With the larger value between the two results as the final value, the MCID values of the CLVQOL (scores of the four scales as well as the total score) were 8.94, 2.61, 4.34, 3.10 and 17.63, respectively. The CLVQOL has both good internal and external responsiveness. CONCLUSION: CLVQOL scores are appropriate instruments for obtaining clinically important changes after cataract surgery. This study is an effective exploration for establishing cataract surgery efficacy standards, which helps clinical and scientific research workers in ophthalmology to gain a more in-depth understanding when using CLVQOL.     

Diabetic nephropathy: Is dietary protein harmful?

The suggested harmful effect of dietary protein on renal function in diabetic nephropathy was tested in three groups of insulin-dependent diabetic patients: 1) 10 patients without signs of nephropathy in spite of at least 30 years of diabetes; 2) 11 patients with nephropathy and reduced but stable glomerular filtration rate (GFR) (decline<4 ml/min per year [mean 1.8] during the last 2 years); 3) 10 patients with progressive nephropathy with GFR declining by an average of 11 ml/min per year. Dietary protein intake was estimated from a dietary history interview, as well as from urinary excretion of nitrogen (mean=4.7 samples). Both methods showed a wide range of protein intake in all three groups of patients (0.6–2.3 g/kg body weight [BW]). The mean values did not differ betwen the groups, 1.30, 1.34, and 1.24 g/kg BW by interview, and 1.20, 1.10, and 1.13 g based on urinary nitrogen levels. There was no correlation between rate of decline of GFR and protein intake, even in those patients with no or minimal decline. These results do not support the hypothesis that dietary protein is a factor of importance in the development or progression of human diabetic nephropathy.     

大黄联合肠内营养对胃癌围手术期外周血TNF-α水平的影响

目的:观察胃癌患者围手术期使用中药大黄和肠内营养对TNF-α水平的影响。方法:将56名胃癌围手术期患者随机分为对照组(A组)20例;肠内营养组(B组)21例;大黄加肠内营养组(C组)15例。A组术后常规补液的同时实施肠外营养支持;B组术后常规补液的同时术后42h始给予肠内营养能全力,一直持续到术后第8天;C组病人术前1天应用大黄10g,术后18、42h分2次各5g。B组和C组术后数日内每天的液体量、热量及氮量不足部分均由肠外途径予以补足。所有研究对象分别于手术前1天、手术后第1、3、7天检测外周血肿瘤坏死因子(Tumor Necrosis Factorα,TNF-α)浓度。结果:各组患者术后均有急性炎性反应的发生,但C组术后第3、7天的TNF-α水平较A有显著下降,术后排气、排便时间和肠鸣音的恢复显著提前。术后的营养指标B组、C组患者间无明显差异。结论:胃癌患者围手术期应用大黄可以有效降低外周血TNF-α水平,缓解手术创伤引起的急性炎性反应,促进术后胃肠道功能恢复,有利于实施术后肠内营养支持。     

老年腹主动脉瘤患者腔内隔绝围手术期脑保护

目的探讨老年腹主动脉瘤患者腔内隔绝围手术期脑保护及其临床意义。方法根据有无实施脑保护将69例老年腹主动脉瘤行腔内隔绝治疗的患者随机分成两组:保护组38例,对照组31例。对两组术后脑血管意外及脑功能障碍情况进行对比分析。结果两组的年龄、入院时血压、手术时间差异均无统计学意义。两组均未发生死亡和出血性脑卒中。保护组术后谵妄发生率低于对照组(分别为5.3%和41.9%,P<0.05),术后住院时间少于对照组(分别为9.1±3.2d和16.7±5.8d,P<0.05);术后缺血性脑卒中保护组0例,对照组3例,两组比较无统计学意义(0%和9.7%,P>0.05)。结论对老年腹主动脉瘤接受腔内隔绝治疗的患者围手术期采取脑保护能降低脑血管意外和维持大脑功能,有利于患者术后恢复。     

全方位护理干预对ERCP围术期患儿及家属应激及心理状况的影响

目的探讨全方位护理干预对ERCP围术期患儿及家属应激及心理状况的影响。方法选取2018年1月10日至2019年10月10日行ERCP患儿100例,采用抽签法分为观察组及对照组各50例,分别对两组.实施全方位护理及常规护.理干预,观察ERCP围术期患儿应激情.况和并发症发生率,对患儿家属进行.焦虑和抑郁评分。结果观察.组患儿轻度应激30例(6000%)、中.度应激2.0例(4000%),应.激程.度低于对照组患儿(P<005);观.察组患儿并发症发生率为400%,低于对照组患儿(P<005);观察组患儿家属的焦虑评分1401±011、抑郁评分1523±148,低于对照组患儿家属(P<0少ERCP围术期患儿应激,降低并发症发生率,改善患儿家属负面情绪,从而促进患儿早期康复。     

天荔汤对糖尿病大鼠肾脏氧化应激的影响

目的研究糖尿病大鼠肾脏氧化应激反应,观察天荔汤对氧化应激的影响。方法将大鼠随机分为5组,即天荔汤高、低剂量组,西药对照组(Capotril HB419),病理组和正常对照组。用四氧嘧啶(Alloxan)诱导糖尿病大鼠模型,8周后检测大鼠血糖、肾脏肥大、肾组织匀浆超氧化物歧化酶(SOD)、丙二醛(MDA)、谷胱甘肽过氧化酶(GSH-Px)的活性。结果与正常组相比,病理组血糖、血脂、尿蛋白、肾重、体重等指标明显增高,肾匀浆MDA含量亦增加,而肾脏抗氧化酶的活性则降低,天荔汤显著降低肾组织匀浆SOD、MDA含量。结论糖尿病大鼠肾脏存在氧化应激反应,肾组织抗氧化酶缺乏。经天荔汤治疗后上述变化明显被逆转。     

下瘀血汤干预肝硬化大鼠的蛋白质组学研究

目的基于肝组织差异蛋白质组表达,解析下瘀血汤对硫代乙酰胺诱导的肝硬化进展期大鼠的作用及其机制。方法48只SD雄性大鼠中的18只作为对照组,其余30只ip给予40 mg/mL的硫代乙酰胺水溶液200 mg/kg制备大鼠肝硬化模型,每周2次,连续8周;于开始造模后第4周分别随机处死对照组和造模大鼠各6只,进行药物干预前的动态观察。其余模型大鼠于开始造模后第5周首日随机分为模型组及下瘀血汤组,下瘀血汤组大鼠ig给予下瘀血汤0.626 g/kg,对照组和模型组大鼠ig生理盐水;于第8周末处死大鼠,双向凝胶电泳分离肝组织总蛋白,基质辅助激光解析电离飞行时间质谱分析鉴定部分差异表达蛋白;蛋白质免疫印迹法检测层粘连蛋白受体(67 LR)、DJ-1蛋白、Cu-Zn超氧化物歧化酶(Cu-Zn SOD)蛋白表达。结果鉴定的18个蛋白中有5个氧化应激蛋白、5个与物质代谢相关的蛋白、4个细胞骨架蛋白、2个与炎症反应相关的蛋白、2个与增殖凋亡相关的蛋白;验证的3个蛋白点(67 LR、Cu-Zn SOD、DJ-1)与双向电泳分析结果基本一致。结论过氧化损伤以及造成的物质代谢异常是硫代乙酰胺致大鼠肝硬化的重要病理环节,提高机体内在的抗氧化能力及逐步恢复物质代谢能力是下瘀血汤逆转大鼠肝硬化的主要机制之一。