扶正治癌调控肿瘤免疫研究

中医学重视人体正气在恶性肿瘤防治中的关键作用,强调"调和阴阳,以平为期",刘嘉湘教授创建"以人为本"、"顾护正气"为核心特征的"扶正治癌"学术体系,强调调控机体内在抵抗力(含免疫功能)以防治恶性肿瘤;肿瘤免疫治疗的疗效已经在泛癌种范围内得以确认,被认为是"最有可能治愈癌症"的疗法.从肿瘤免疫学角度深入研究人体"正气"的...     

“邵氏保肺功”对肺癌术后老年患者生活质量影响的临床研究

目的 研究“邵氏保肺功”配合耳穴贴压对肺癌术后老年患者生活质量的影响。方法 选取符合纳入标准的肺癌术后老年患者96例,采用分层区组设计,将患者按自主意愿分入治疗组与对照组,剔除脱落病例后每组42例。治疗组采取“邵氏保肺功”功法锻炼共12周,对照组不进行功法锻炼。分别于入组时、干预12周后以及入组1年后对患者进行肺癌患者生活质量量表(FACT-L)、中医证候积分评估。结果 两组生活质量量表评分比较P<0.05,差异有统计学意义,治疗组在生活质量方面的改善优于对照组。两组中医证候评分比较P<0.05,差异有统计学意义,治疗组在中医证候评分的改善优于对照组。结论 邵氏保肺功可明显提高肺癌术后患者的生活质量,具有长期疗效,临床使用副作用少,治疗成本低,易于推广应用。     

Factors that affect early postoperative health-related quality of life in patients with gastrointestinal cancer: a three-center cohort study

[Purpose] In this study, we investigated the preoperative and early postoperative health-related quality of life in patients who underwent surgical treatment for gastrointestinal cancer and also the factors that affect postoperative health-related quality of life. [Participants and Methods] The study included 198 patients who underwent elective surgery for gastrointestinal cancer (129 males and 69 females, age: 65.4 ± 11.8 years). Health-related quality of life was evaluated using the Short-Form 36-Item Health Survey version 2 at the following time points: 1–2 days preoperatively (baseline) and 4 weeks postoperatively. [Results] Compared with baseline levels, physical functioning, bodily pain, vitality, as well as physical, social, and emotional role functioning significantly decreased 4 weeks postoperatively. In contrast, compared with baseline levels, mental health significantly improved 4 weeks postoperatively. Physical functioning and general health evaluated 4 weeks postoperatively were significantly associated with income, baseline health-related quality of life, and the 6-minute walk test. [Conclusion] It is important to consider baseline income and health-related quality of life and increase postoperative exercise capacity to improve health-related quality of life in patients who undergo surgical treatment for gastrointestinal cancer.     

Predictors of respiratory failure after thoracic surgery: a retrospective cohort study with comparison between lobar and sub-lobar resection

ObjectiveOnly approximately 15% of patients with lung cancer are suitable for surgery and clinical postoperative outcomes vary. The aim of this study was to investigate variables associated with post-surgery respiratory failure in this patient cohort.MethodsPatients who underwent surgery for lung cancer were retrospectively studied for respiratory function. All patients had undergone lung resection by a mini-thoracotomy approach. The study population was divided into two subgroups for comparison: lobectomy group, who underwent lobar resection; and sub-lobar resection group.ResultsA total of 85 patients were included, with a prevalence of lung cancer stage IA and adenocarcinoma histotype. Lobectomy (versus sub-lobar resection), the presence of chronic obstructive pulmonary disease (COPD), and a COPD assessment test (CAT) score >10, were all associated with an increased risk of respiratory failure. The partial pressure of arterial oxygen decreased more in the lobectomy group than in the sub-lobar resection group following surgery, with a significant postoperative between-group difference in values. Postoperative CAT scores were also better in the sub-lobar resection group.ConclusionsPost-surgical variations in functional parameters were greater in the group treated by lobectomy. COPD, high CAT score and surgery type were associated with postoperative development of respiratory failure.     

Pancreatic Exocrine Insufficiency in Intraductal Papillary Mucinous Carcinoma Presenting with Leg Edema Treated with Pancreatic Exocrine Replacement Therapy

An 89-year-old woman underwent examinations for leg edema. Blood tests indicated low nutrition and low pancreatic enzymes, and a stool examination indicated fatty stool. Computed tomography showed pleural effusion, ascites, and cystic lesions in the pancreatic head and mural nodules within the cysts. Pancreatic juice cytology revealed adenocarcinoma. The diagnosis was pancreatic exocrine insufficiency caused by intraductal papillary mucinous carcinoma. The patient did not wish to undergo surgery. Therefore, diuretics, component nutrients, and pancreatic exocrine replacement therapy using pancrelipase were initiated. After starting treatment, her leg edema, pleural effusion, and ascites disappeared, and her activities of daily living improved markedly.     

快速康复护理理念在结直肠癌手术围术期中的应用价值

目的 研究快速康复护理理念在结直肠癌手术围术期中的应用价值。方法 回顾性分析2019年5月—2020年5月在本院进行结直肠癌手术治疗的116例患者资料,按护理方式的不同将其分为常规组（给予围手术常规护理干预）和研究组（给予围术期快速康复护理理念干预）,每组58例。比较两组干预前后的视觉模拟评分法（visual analogue scale,VAS）评分、胰岛素抵抗指数（homeostasis model assessment-insulin resistance index,HOMA-IR指数）、皮质醇、营养指标（白蛋白、前白蛋白）,并对比两组的首次排便时间、首次排气时间、首次进食时间、下床活动时间。结果 干预后,研究组的VAS评分、皮质醇水平以及HOMA-IR指数均低于常规组（P <0.05）;研究组的白蛋白、前白蛋白水平高于常规组（P <0.05）;研究组的首次排便时间、首次排气时间、首次进食时间、下床活动时间均早于常规组（P <0.05）。结论 在结直肠癌手术患者围术期护理中实施快速康复护理理念,能显著缓解疼痛,减少胰岛素抵抗,促进患者胃肠道功能恢复。     

升降汤加减治疗食管癌术后胃肠功能紊乱的疗效观察

目的 探讨对食管癌术后胃肠功能紊乱患者采用升降汤进行治疗的效果及对生活质量的影响。方法 选取2015年1月—2019年1月在我院进行食管癌手术的患者,遴选术后出现胃肠功能紊乱及符合纳入标准的患者60例作为本研究对象,根据随机原则分为对照组（30例,采用西药治疗）与观察组（30例,采用西药联合升降汤加减治疗）,比较两组患者的治疗效果及生活质量。结果 经过不同方案的治疗后,与对照组比较,观察组患者总有效率与生活质量更高,差异有统计学意义（P <0.05）;与对照组比较,观察组患者临床症状评分与并发症发生率的更低,差异有统计学意义（P <0.05）。观察组患者经治疗后肠鸣音恢复时间、首次排便时间及首次排气时间较对照组更短,差异有统计学意义（P <0.05）。结论 食管癌术后胃肠功能紊乱患者采用升降汤加减进行治疗后,能有效改善患者的临床症状,提高生活质量,且治疗后的并发症率较低,可在临床上进行推广使用。     

腹腔镜下微创修补术对胃穿孔术后胃肠动力的影响分析

目的 观察腹腔镜下微创修补术对胃穿孔术后胃肠动力的影响分析。方法 将在医院（2018年1月1日—2020年12月30日）收治胃穿孔患者60例拟手术治疗,以随机数字表法分组,每组各30例患者,其中30例实施传统开腹手术为对照组,另30例患者则实施腹腔镜下微创修补术治疗为研究组。比较围手术期相关指标、胃肠动力指标,术前、术后3 d的机体应激指标与胃泌素分泌水平及疼痛评分,统计围手术期不良事件发生率。结果 研究组患者的手术时间、首次下床时间与住院时长均短于对照组,而术中出血量则少于对照组,差异有统计学意义（P <0.05）。研究组患者的胃肠动力指标恢复时间均明显的短于对照组,差异有统计学意义（P <0.05）。两组患者术前机体应激指标与胃泌素分泌水平及疼痛评分相比,差异无统计学意义（P> 0.05）。两组患者术后3 d时机体应激指标中SOD指标与胃泌素分泌水平则较术前提升,研究组高于对照组,而术后3 d的机体应激指标中MDA指标及疼痛评分均较术前降低,研究组低于对照组,差异有统计学意义（P <0.05）。研究组患者围手术期不良事件发生率低于对照组,差异有统计学意义（P...     

Validation of a Patient-Reported Outcome Measure for Moist Desquamation among Breast Radiotherapy Patients

There has been an increasing interest in patient-reported outcome (PRO) measures in both the clinical and research settings to improve the quality of life among patients and to identify when clinical intervention may be needed. The primary purpose of this prospective study was to validate an acute breast skin toxicity PRO measure across a broad sample of patient body types undergoing radiation therapy. Between August 2018 and September 2019, 134 women undergoing adjuvant breast radiotherapy (RT) consented to completing serial PRO measures both during and post-RT treatment and to having their skin assessed by trained trial radiation therapists. There was high patient compliance, with 124 patients (92.5%) returning to the clinic post-RT for at least one staff skin assessment. Rates of moist desquamation (MD) in the infra-mammary fold (IMF) by PRO were compared with skin assessments completed by trial radiation therapists. There was high sensitivity (86.5%) and good specificity (79.4%) between PRO and staff-reported presence of MD in the IMF, and there was a moderate correlation between the peak severity of the MD reported by PRO and assessed by staff (rho = 0.61, p < 0.001). This prospective study validates a new PRO measure to monitor the presence of MD in the IMF among women receiving breast RT.