Objective To identify the short ( lt;30 days) and intermediate ( 30 days to 6 months) benefits and risks of tracheobronchial stents in patients with malignant airway stenosis. Methods 55 cases with malignant airway disease who underwent tracheobronchial stents placement from January 2006 to May 2008 were followed up for 6 months. The efficacy rate, complication rate, reintervention rate, and survival were analyzed. Results There were 61 self-expanding metal stents placed in 55 patients with malignant disease, with no intraoperative mortality. The immediate efficacy rate was 100% , the short-term( lt;30 days) efficacy rate was 94. 5% , and the survival rate in 6 months was 32. 7% . The complications included tumor ingrowth, excessive granulation tissue, stent migration, and restenosis. A total of 14 cases of complicationswere observed, in which two occurred during the short-term period ( lt; 30 days ) and the remaining complications occurred after 30 days. Conclusions Tracheobronchial stents can improve symptoms immediately for the patients with unresectable malignant central airway obstruction with fairly safety. The benefit of airway stents is particularly seen in the short-termperiod and the complications occur mainly after 30 days.
Abstract： Objective To investigate the expression and correlation of phosphatase and tensin homologue deleted on chromosome ten(PTEN)， epidermal growth factor receptor(EGFR) and Ki-67 in human thymic tumors, and their possible role in tumor genesis， infiltration and metastasis. Methods The expression of PTEN， EGFR and Ki-67 were detected by using SP immunohistochemical technique in 45 cases of thymic tumors and 5 cases of normal thymic tissues. Results In 5 cases of normal thymic tissues, the expression of PTEN was bly positive, whereas EGFR and Ki -67 were weakly positive or negative. In 45 cases of thymic tumors, the positive ratio of PTEN were significantly reduced from benign thymoma， invasive thymoma to thymic carcinoma (χ2=7.808, P=0.020), but the positive ratio of EGFR and Ki-67 were gradually increased(χ2=8.032, 0.018，7.006；P=0.030). The positive ratio of PTEN， EGFR and Ki-67 protein were significantly related to Levine classification, Masaoka staging and lymph node metastasis (Plt;0.05). PTEN positive cases were negatively correlated with EGFR and Ki-67(r=－0.632，－0.653；Plt;0.01), EGFR positive cases were positively correlated with Ki-67 in thymic tumors(r=0.807,Plt;0.01). Conclusions Reduced or absent PTEN and increased EGFR and Ki-67 expression might play an important role in the genesis， invasiveness and metastasis of thymic tumors. The expression of PTEN is bly associated with the expression of abnormal EGFR and Ki-67. Detection of the three protein expressions simultaneously might be more helpful in making an early diagnosis of the tumors jndgement of theirs malignant degree，invasiveness and metastasis capacity, as well as the prognosis.
目的 提高對多發性骨髓瘤合并動靜脈血栓形成的臨床診治水平。 方法 報道1例表現為反復胸腔積液，同時合并反復、多處靜脈和動脈血栓形成患者的臨床資料，并復習文獻。 結果 該例62歲老年女性患者，合并右側下肢靜脈、腎動脈、腦動脈、頸動脈、肺動脈血栓反復形成，檢查后明確診斷為多發性骨髓瘤IgG λ型、原發性淀粉樣變，合并多處動靜脈血栓形成，給予美法侖+潑尼松（MP）方案化療和抗血小板、抗凝治療后癥狀改善，隨訪13個月病情穩定，無新發血栓形成。 結論 多發性骨髓瘤可能合并動靜脈血栓形成等不典型表現，需要進一步提高認識。
Objective To investigate the effect of ginkgolide B (GB) on cysteinyl aspartate specific proteinase-3 (Caspase-3)/chromosome 10 deletion phosphatase-tension protein homologue (PTEN)/protein kinase B (Akt) pathway and cell proliferation and apoptosis in hypoxia/reoxygenation cardiomyocytes. Methods H9C2 cells were cultured in vitro. A control group was cultured in serum-free DMEM high glucose medium at 37°C and 5% CO2 for 28 hours. The remaining groups were prepared with hypoxia/reoxygenation models. A GB low-dose group and a GB high-dose group were treated with GB pretreatment with final concentration of 50 μmol/L and 200 μmol/L respectively at 1 h before hypoxia/reoxygenation. A carvedilol group was treated with carvedilol of a final concentration of 10 μmol/L at 1 h before hypoxia/reoxygenation. The proliferation and apoptosis of H9C2 cells were detected, and the levels of lactate dehydrogenase (LDH), malondialdehyde (MDA), reactive oxygen species (ROS), PTEN, Akt, phosphorylated Akt (p-Akt) and Caspase-3 in H9C2 cells were also detected. Results Compared with the control group, the proliferation rate of H9C2 cell, and the levels of PTEN, Akt and p-Akt in other groups decreased, and the apoptosis rate, and the levels of LDH, MDA, ROS and Caspase-3 increased (P<0.05). Compared with the hypoxia/reoxygenation group, the proliferation rate of H9C2 cell, and the levels of PTEN, Akt and p-Akt in all GB dose groups and the carvedilol group increased; the apoptosis rate, and the levels of LDH, MDA, ROS and Caspase-3 decreased, and the effect of GB was in a dose dependent manner; however, the effect of GB was not as strong as carvedilol (P<0.05). Conclusion GB can inhibit H9C2 cell apoptosis and promote H9C2 cell proliferation by activating Caspase-3/PTEN/Akt pathway.
目的 探討在恥骨后前列腺癌根治術中尿控功能和性功能保護的手術技巧和療效。 方法 2001年8月-2010年1月，行恥骨后前列腺癌根治術21例，其中2例經腹腔鏡施行。均早期控制縫扎背靜脈復合體，并妥善處理前列腺尖和尿道。21例通過保護控尿神經、保護尿道橫紋括約肌等措施，保護尿控功能；17例通過保留神經血管束技術（12例保留雙側，5例僅保留一側）保護性功能。 結果 手術均成功完成，無圍術期嚴重并發癥。2周拔出尿管后，排尿通暢，無尿道狹窄。手術后3、12個月內恢復尿控能力分別為：6例、13例，持續性輕-中度尿失禁2例。21例中，手術前勃起功能正常，并于手術中保留神經血管束17例，手術后3、12個月內勃起功能恢復分別為：2、8例，4例勃起功能減弱，3例不能勃起。手術后病理報告均為前列腺腺癌，未侵及精囊．膀胱頸，雙側淋巴結陰性。后尿道切緣陽性1例。手術后6、24、54個月各有1例出現生化復發。 結論 精細解剖并注意手術技巧，可有效保護性功能和尿控功能，并達到腫瘤根治的療效。
Assistant general practitioner training is an important way to provide qualified doctors for primary healthcare institutions, with a focus on the practical application of clinical knowledge and skills, as well as the diagnosis and treatment of common diseases. Panzhihua Iron and Steel Group General Hospital has introduced the electronic library in collaboration with clinical thinking and intelligent examination system based on the traditional training mode into the assistant general practitioner training. Compared to traditional training model, it can improve learning effectiveness, clinical theory, and practical skills of assistant general practitioners. Based on the above new teaching experience, this article deeply explores the advantages and problems faced by this teaching model, aiming to better promote it.
ObjectiveTo evaluate the safety, feasibility and short-term outcomes of single-direction gastric mobilization under 3D-laparoscopy in minimally invasive esophagectomy for the treatment of esophageal cancer.MethodsFrom February 2018 to December 2019, 118 consecutive patients who underwent minimally invasive McKeown esophagectomy for esophageal squamous cell carcinoma in our hospital were included. There were 94 males and 24 females with an average age of 53.7 (41–77) years. They were divided into two groups based on the methods of gastric mobilization: a traditional dissociation (TD) group (n=55) and a single-direction mobilization (MD) group (n=63). The clinical data of the two groups were compared.ResultsEnbloc resection and a negative resection margin were obtained in all patients. There was no postoperative mortality or incision complication. The rate of postoperative complications was 22.9%. There was no significant difference in the spleen injury, gastric injury, conversion to open surgery, abdominal reoperation as well as cervical anastomotic leakage between the two groups (P>0.05). It took significantly less time in the MD group compared with the TD group (P<0.05). There was an obvious statistical difference in the incidence of gastric mobilization related complications between the MD group (1.6%, 1/63) and TD group (12.7%, 7/55, P<0.05).ConclusionApplication of single-direction gastric mobilization under 3D-laparoscopy in minimally invasive esophagectomy for the treatment of esophageal cancer is safe and easy to perform with a satisfactory short-term outcome.
【摘要】 目的 分析異基因造血干細胞移植術（allogeneic hematopoietic stem cell transplantation，allo-HSCT）后出血性膀胱炎（hemorrhagic cystitis，HC）相關的危險因素，動態監測受者尿BK病毒（BK virus，BKV），分析其與HC發病的關系。 方法 回顧性分析2003年3月-2008年1月期間接受allo-HSCT的121例患者的資料，選擇8個臨床參數[年齡、性別、疾病類型、移植時疾病狀態、供者類型、預處理方案、急性移植物抗宿主病（acute graft-versus-host disease，aGVHD）、aGVHD的預防方案]作COX回歸分析。采用SYBR Green染料實時熒光定量聚合酶鏈反應法對2006年9月-2008年1月42例allo-HSCT患者尿BKV載量進行動態監測，分析被檢查者尿液BKV基因載量與HC發生以及嚴重程度的關系。 結果 121例患者中有24例發生HC，發病時間為術后0~63 d，中位時間40 d；持續時間7~150 d，中位時間22 d。Ⅱ~Ⅳ度aGVHD為HC的獨立危險因素[RR=8.304，95%CI（1.223，56.396），P=0.030]。allo-HSCT受者尿液中BKV檢出率為100%（42/42）。與正常人及未發生HC的allo-HSCT受者相比，HC患者尿中BKV基因載量具有更高平均峰值。 結論 Ⅱ~Ⅳ度aGVHD，尿中BKV DNA高載量與HC的發生有相關性。【Abstract】 Objective To identify the risk factors for hemorrhagic cystitis (HC) after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and define the quantitative relationship between BK virus (BKV) DNA load with HC. Methods The medical records of 121 patients undergoing allo-HSCT from March 2003 to January 2008 were retrospectively analyzed. Eight clinical parameters were selected for COX regression analysis, including age, sex, underlying disease, disease status at transplant, donor type, conditioning regimen, acute graft-versus-host disease (aGVHD), and GVHD prophylaxis. From September 2006 to January 2008, mid-stream urine samples were continuously collected from 42 patients with allo-HSCT. SYBR green real-time polymerase chain reaction, technique was utilized to define the quantitative relationship between BKV DNA load and HC. Results Twenty-four out of 121 patients developed HC. The median time of onset was 40 days after HSCT, ranged from 0 to 63 days. The disease lasted for 7 to 150 days, with a median duration of 22 days. Grade Ⅱ-Ⅳ aGVHD [RR=8.304, 95% CI (1.223,56.396); P=0.030] was identified as an independent risk factor for the occurrence of HC. BKV excretion was detected in 100% (42/42) of the recipients of allo-HSCT. When compared with asymptomatic patients and allo-HSCT recipients without HC, patients with HC had a significantly higher mean peak BKV DNA load. Conclusions Patients are at an increased risk of developing HC if they have grade Ⅱ-Ⅳ aGVHD. A correlation between the load of BKV and incidence of HC may exist.
Objective To study the related risk factors for recurrence of venous thromboembolism （VTE）. Methods The literatures about the related factors for recurrence of VTE were searched. The relationships between the factors and recurrence of VTE were determined by meta-analysis. Results A total of 12 literatures were included. The results of meta-analysis showed that factors such as males， age＜50 years old， malignant tumor， and antiphospholipid syndrome related with the recurrence of the first VTE after treatment， but there were no correlation between the recurrence of VTE， the type of first VTE， and causes of VTE. Conclusions The recurrence of VTE correlate with various factors. In order to avoid the recurrence of VTE， the patients with the risk factors for recurrence of VTE should be appropriate to extend the duration of anticoagulation
Objective To study the effects of pcDNA3/AFP/TK/Angio fusion gene targeting therapy for human primary liver cancer in nude mice implanted with SMMC-7721. Methods Human liver cancer cell line SMMC-7721 was implanted subcutaneously in nude mice to establish experiment model. Animals bearing liver cancer were randomly divided into five groups: control group， vector group， GCV (ganciclovir) group， pcDNA3/TK/Angio group; pcDNA3/AFP/TK/Angio group. Different plasmids were directly injected into tumors and GCV was intraperitoneally administrated simultaneously according to different groups. The growth of tumors was observed and the pathology was examined as well. Serum AFP level was measured by radioimmunology, the ultrastructural change of tumor cells was studied by using electron microscopy, the expressions of MVD and VEGF were respectively detected with immunohistochemistry and the cell apoptosis in situ was detected by TUNEL. Results The success rate to establish subcutaneous implanted liver cancer model in nude mice was 100%. The tumor volume, serum AFP level, VEGF and MVD expressions of pcDNA3/TK/Angio group and pcDNA3/AFP/TK/Angio group were lower than those in control group, vector group and GCV group (P＜0.05) and more apoptosis cells could be observed. While the tumor volume, serum AFP level, VEGF and MVD expressions of pcDNA3/AFP/TK/Angio group was lower than those in pcDNA3/TK/Angio group (P＜0.05); and apoptosis index was higher than that of the latter (P＜0.05).Conclusion pcDNA3/AFP/TK/Angio fusion gene inhibits the growth of tumor remarkably and becomes a promising new biological agent to treat human primary liver cancer.