患者女性，64岁，主因外院查体"发现胃体病变2个月余"于2022年9月20日入院。2022年7月10日患者在外院行胃镜检查显示：胃体前壁下部近胃角可见一大小约2.5 cm×3 cm黏膜隆起，超声提示病灶起源于固有肌层低回声病变，诊断：胃间质瘤。既往身体健康。查体：体温36.5 ℃，心率70次/min，呼吸18次/min，血压130/70 mmHg(1 mmHg＝0.133 kPa)。患者心肺影像及功能检查正常。患者入院后完善相关检查，结果显示无手术禁忌，签署术前知情同意书后，择期行内镜下黏膜肿物挖除术(endoscopic submucosal excavation，ESE)治疗。
Objective:To explore the predictive value of soluble immune checkpoints for the efficacy and prognosis of immunotherapy in patients with gastric cancer.Methods:From April 2021 to July 2022, clinical data of patients with gastric cancer who received first-line SOX chemotherapy combined with PD-1 inhibitor at the Cancer Center of Changzhou No.2 People′s Hospital Affiliated to Nanjing Medical University were collected.Concentrations of sIL-2Ra(CD25), s4-1BB, sCD86, sCTLA-4, Free Active TGF-β1, sPD-1, sPD-L1, sTIM-3, sLAG-3, sGalectin-9 were detected before treatment and at the time of disease progression.Mann-Whitney U test was used to compare the differences of soluble immune checkpoints concentration before treatment between patients with partial response(PR)and those without PR [disease stability(SD)+ disease progression(PD)]. Logistic regression analysis was used to explore independent factors of efficacy prediction.Kaplan-Meier and COX regression analysis were used to explore soluble immune checkpoints affecting prognosis, and Wilcoxon signed-rank test was used to compare the changes of soluble immune checkpoints before and after treatment.Results:A total of 40 patients with gastric cancer were incorporated into the analysis, with 17(42.5%)patients evaluated as PR, 17(42.5%)as SD, and 6(15.0%)as PD.Before treatment, the concentrations of sPD-1, sPD-L1, and sGalectin-9 in the PR group were significantly higher than those in the SD+ PD group(6.27 pg/ml vs.3.49 pg/ml, P=0.0043; 7.96 pg/ml vs.7.31 pg/ml, P=0.0014; 15 083.09 pg/ml vs.8533.77 pg/ml, P=0.0024). Patients with high serum sPD-1 concentration before treatment(sPD-1>4.21 pg/ml)showed significantly longer progression free survival(P<0.001, HR=0.18, 95% CI: 0.08-0.41, P<0.0001). sPD-1 was an independent predictor of best overall response(BOR)in the treatment of gastric cancer patients.Seventeen patients showed a significant increase in sCD86 at the time of disease progression compared to baseline(74.62 pg/ml vs.49.71 pg/ml, P=0.0038).Conclusion:sPD-1 can act as a predictive factor for BOR of immunotherapy in gastric cancer patients, and the increase in sCD86 after immunotherapy may be the reason for immunotherapy resistance.
Objective:To explore the incidence and remission of non-alcoholic fatty liver disease (NAFLD) in Binhai County, Jiangsu Province, and its influencing factors.Methods:The 5 916 people who underwent health examinations both in 2017 and 2019 were participated in the study, and the biochemical indicators results and liver color Doppler ultrasound results were collected.Results:The two-year cumulative incidence of NAFLD in the baseline population without fatty liver disease was 15.47%, and the two-year cumulative remission rate of baseline NAFLD patients was 29.64%. The incidence in males (20.18%) was higher than that in females (12.91%), with a statistically significant difference (P<0.001). The remission rate of females (32.27%) was higher than that of males (27.97%), with a statistically significant difference (P=0.010). With the increase of age, the incidence of NAFLD increased (P<0.001), but the remission rate didn′t change (P=0.81). The incidence of NAFLD increased (P<0.001) and the remission rate decreased (P<0.001) with increasing body mass index (BMI). Abnormal baseline BMI, total cholesterol, triglyceride and other indicators were risk factors of the NAFLD; while blood pressure and BMI were independent influencing factors for the remission of NAFLD.Conclusion:BMI is an important influencing factor for the incidence and remission of NAFLD, suggesting that weight control is an effective measure to reduce the incidence of NAFLD and increase the regression rate.
In recent years, there has been a trend towards of over-diagnosis in inflammatory bowel disease(IBD). Over-diagnosis, like under-diagnosis, also triggers endless consequences.In the clinical practice, most of the effort is focused on distinguishing IBD from the common diseases such as intestinal tuberculosis, intestinal Behcet′s syndrome, intestinal lymphoma and ischemic colitis.However, there is less awareness of the differential diagnosis between IBD and the rare intestinal diseases.Based on current literature and personal experience, this editorial introduces various rare intestinal diseases that are easily misdiagnosed as IBD, calling for vigilance in the differential diagnosis of IBD and rare IBD-like diseases.
Objective:To investigate the effects of C-X-C motif chemokine ligand 5(CXCL5)and C-X-C motif chemokine receptor 2(CXCR2)levels in tumor tissue of esophageal cancer patients on the condition and prognosis of esophageal cancer, and to provide a new direction for clinical diagnosis, treatment and prognosis evaluation of esophageal cancer.Methods:A total of 126 patients with esophageal cancer without radiotherapy and chemotherapy who were diagnosed at the Affiliated Hospital of Xuzhou Medical University from August 2013 to July 2015 and had complete clinical data were selected as the research objects.The expression levels of CXCL5 and CXCR2 in esophageal cancer tissues were detected by immunohistochemical staining, and the relationships between the expression levels of CXCL5 and CXCR2 and the clinicopathological classification and survival prognosis of esophageal cancer were explored.Results:The positive expression rates of CXCL5 and CXCR2 in esophageal cancer tissues were significantly higher than those in adjacent tissues(P<0.05), and there was a correlation between the two(P<0.05). CXCL5 and CXCR2 in esophageal cancer tissues were significantly correlated with TNM stage and lymph node metastasis of esophageal cancer(P<0.05). The survival curve showed that the 5-year survival rate and expected survival time of patients with CXCL5 and CXCR2 positive esophageal cancer tissues were significantly lower than those with negative esophageal cancer tissues, with a statistically significant difference(P<0.05). Cox multivariate analysis showed that the location of primary tumor, TNM stage of esophageal cancer, lymph node metastasis and the levels of CXCL5 and CXCR2 in esophageal cancer tissues were independent risk factors for the prognosis of esophageal cancer(P<0.05).Conclusion:The high expressions of CXCL5 and CXCR2 in tumor tissues of patients with esophageal cancer are related to the condition of esophageal cancer.CXCL5 and CXCR2 are independent risk factors affecting the prognosis of patients with esophageal cancer.
Objective:To analyze and compare the clinical efficacy and safety of irinotecan chemotherapy regimen and irinotecan combined with ubenimex chemotherapy regimen for the treatment of advanced gastric cancer.Methods:The clinical data of 104 patients with advanced gastric cancer admitted to Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2018 to January 2022 were retrospectively analyzed.According to the different treatment plans adopted by the patients, all the patients were divided into control group(irinotecan chemotherapy plan, n=61)and observation group(irinotecan combined with ubenimex treatment plan, n=43), and were treated with 21 days as 1 cycle for a total of 2 Cycle.The short-term clinical efficacy of the two groups at 1 week after treatment, the levels of CD3+, CD4+, CD4+ /CD8+ in the peripheral blood before and after treatment, the quality of life after treatment, the survival within 1 year after the end of treatment, and the incidence of adverse reactions during treatment were compared.Results:One week after the end of treatment, the partial response(PR), objective response rate(ORR)and disease control rate(DCR)of patients in the observation group were significantly higher than those of patients in the control group(P<0.05), and the stable disease(SD)and progressive disease(PD)were significantly lower than those of patients in the control group(P<0.05). Before treatment, there were no statistically significant differences in the levels of CD3+, CD4+ and CD4+ /CD8+ in the peripheral blood of the two groups(P>0.05), but after treatment, the levels of CD3+, CD4+ and CD4+ /CD8+ in the peripheral blood of the two groups increased, and the observation group was higher than the control group(P<0.001). After treatment, patients in the observation group had significantly lower scores in the symptom domains of dysphagia and feeding restriction than those in the control group(P<0.05). During the 1-year follow-up, disease progression-free survival was significantly longer in the observation group than in the control group [(7.42±0.89)months vs.(5.35±0.68)months, P<0.001). Comparing the total incidence of adverse reactions during the treatment period between the two groups, there was no statistically significant difference(P>0.05).Conclusion:The clinical efficacy of irinotecan combined with ubenimex in the treatment of advanced gastric cancer is more significant, which can improve the immunity function of the patients, improve the quality of life of the patients, prolong the progression-free survival time of the patients, with higher safety.
Objective:To explore the potential mechanism of Xianlian Jiedu decoction (XLJDD) in the treatment of stage Ⅲ colorectal cancer patients via transcriptome sequencing technology.Methods:This study focused on patients with stage Ⅲ colorectal cancer. Four tumor tissue samples were randomly selected from the XLJDD group and four from the control group who did not receive XLJDD. Full transcriptome sequencing was performed to identify differentially expressed genes, enrich functional pathway, and construct a miRNA-mRNA regulatory network.Results:By comparing samples of the two groups, it was found that there were multiple differentially expressed miRNA and mRNA in the samples of colorectal cancer patients taking XLJDD, including hsa-miR-105-5p, hsa-miR-129-1-3p and hsa-miR-135a-5p, as well as ANKRD31, ESPNL and DACT2. Functional enrichment analysis showed that membrane transport function, steroid hormone response, IL-4, IL-13 and other tumor-related pathways were significantly enriched after XLJDD treatment.Conclusion:XLJDD may interfere with the tumor progression of stage Ⅲ colorectal cancer patients by regulating the expression levels of miRNA and mRNA and affecting related pathways.
Objective:To explore the clinical diagnostic value of transperineal ultrasound(TPUS)and MR defecography(MRD)in female outlet obstruction constipation(OOC)by using X-ray defecography(XRD)as the gold standard.Methods:From January 2020 to December 2021, 41 female patients who were clinically diagnosed as OOC in the Department of Anorectal Diseases of Nanjing Hospital of Traditional Chinese Medicine were selected for XRD, TPUS and MRD.With XRD as the reference standard, the sensitivity and specificity of TPUS and MRD in the diagnosis of rectocele, perineal descent, rectal intussusception, enterocele and pelvic floor dyssynergia were evaluated, and the consistency of the three imaging results was tested.Results:Taking XRD as the reference standard, the sensitivity of TPUS in the diagnosis of rectal intussusception, rectocele, perineal descent, enterocele, and pelvic floor dyssynergia was 94.12%, 87.5%, 55.56%, 80%, and 100%, and the specificity was 100%, 88.89%, 100%, 100%, and 93.33%.The sensitivity of MRD in the diagnosis of rectal intussusception, rectocele, perineal descent, enterocele and pelvic floor dyssynergia was 70.59%, 81.25%, 55.56%, 60% and 63.64%, and the specificity was 100%, 77.78%, 75%, 100% and 96.67%.TPUS was highly consistent with XRD in the diagnosis of rectocele and perineal descent, and the Kappa coefficients were 0.682 and 0.661.TPUS has good consistency with XRD in the diagnosis of rectal intussusception, enterocele, pelvic floor dyssynergia, and the Kappa coefficients were 0.845, 0.875, 0.883.MRD was highly consistent with XRD in the diagnosis of enterocele and pelvic floor dyssynergia, and the Kappa coefficients were 0.725 and 0.660.Conclusion:TPUS can be used as a preliminary evaluation technique for female OOC; MRD can be used as an effective supplement to the etiological diagnosis of such patients.
Objective:To explore the value of endoscopic ultrasound(EUS)and magnetic resonance cholangiopancreatography(MRCP)in the diagnosis of common bile duct sludge-like stones.Methods:A retrospective analysis was conducted on 192 patients with suspected sludge-like choledocholithiasis who were hospitalized in the First Central Hospital of Baoding from April 2020 to April 2023.After applying the inclusion and exclusion criteria, 182 patients were ultimately selected for the study.All patients first underwent MRCP examination.If MRCP results indicated sludge-like stones, they immediately underwent endoscopic retrograde cholangiopancreatography(ERCP). The remaining patients sequentially underwent EUS and then ERCP.ERCP radiography combined with endoscopic sphincterotomy(EST)for stone extraction was considered the gold standard for diagnosing sludge-like choledocholithiasis, and the results from various examinations were compared with the stone extraction results.Results:The positive detection rates of EUS, MRCP, and the combination of EUS and MRCP for sludge-like choledocholithiasis were 81.76%, 65.38%, and 86.49%, respectively.Among the positive results confirmed by ERCP with EST, the sensitivity, specificity, and accuracy of EUS in detecting sludge-like choledocholithiasis were 93.08%, 83.33%, and 91.89%, respectively.For MRCP, these values were 72.56%, 77.78%, and 73.08%.For the combination of EUS and MRCP, the values were 98.46%, 88.89%, and 97.30%.Conclusion:Both EUS and MRCP show potential in diagnosing sludge-like choledocholithiasis, with EUS displaying a superior accuracy advantage.Combining EUS with MRCP may be an effective strategy to enhance the diagnostic accuracy of common bile duct sludge-like stones.
Objective:To evaluate the clinical efficacy of bevacizumab and anlotinib combined with oxaliplatin in the treatment of advanced rectal cancer.Methods:A retrospective analysis was conducted on 88 patients with advanced rectal cancer admitted from January 2019 to January 2021.Patients were categorized into two groups based on their treatment regimens: the control group(treated with bevacizumab combined with oxaliplatin, n=47)and the observation group(treated with anlotinib combined with oxaliplatin, n=41). Clinical efficacy after treatment, serum tumor markers(CEA and CA19-9)levels, quality of life, and adverse reaction incidence were compared between the two groups.Both groups were also followed up for 2 years to observe survival status.Results:After treatment, the objective response rate(ORR)of the observation group was 46.34%, and the disease control rate(DCR)was 78.05%, both significantly higher than those of the control group(ORR 25.53% and DCR 57.45%, P<0.05). After treatment, serum tumor markers CEA and CA19-9 both showed significant improvement, and the improvement in the observation group was significantly better than that in the control group(P<0.001). During the 2-year follow-up period, the median progression-free survival(PFS)of the observation group was(19.88±5.12)months, significantly longer than that of the control group, which was(16.91±6.06)months(P<0.05). In terms of quality of life, the scores of physical condition, family/social situation, emotional state, functional status, and additional concerns in the observation group were all significantly higher than those in the control group(P<0.05). Moreover, there was no significantly significant difference in the incidence of adverse reactions between the two groups during treatment(P>0.05).Conclusion:Anlotinib combined with oxaliplatin demonstrates greater clinical efficacy for treating advanced rectal cancer than bevacizumab combined with oxaliplatin, which can further prolong the median PFS of patients and improve their quality of life.
Objective:To exploring risk factors for perioperative respiratory complications in minimally invasive esophagectomy esophagectomy for esophageal cancer.Methods:A total of 100 patients with squamous esophageal cancer who were underwent total laparoscopic radical esophageal cancer surgery in the Fourth Hospital of Hebei Medical University from January 2021 to October 2022 were retrospectively included as study subjects, and all patients were divided into no-complication group(n=73)and complication group(n=27)according to whether or not they developed respiratory complications during the perioperative period.The baseline and surgery-related data of the patients were pooled and analyzed, and unifactorial and multifactorial logistic regression were applied to analyze the independent risk factors for the occurrence of respiratory complications during the perioperative period of total laparoscopic radical esophageal cancer surgery.Results:Among the 100 patients with squamous esophageal cancer who were underwent total laparoscopic radical esophageal cancer surgery, 27 patients developed respiratory complications during the perioperative period, including 1 patient with tracheal and bronchial injury, 9 patients with hoarseness accompanied by lung infections, 17 patients with pneumonia.There were no statistically significant differences in gender, body mass index, disease duration, history of alcohol consumption, history of hypertension, tumor location, pathological stage, intraoperative bleeding volume, intraoperative intercostal nerve block, and number of lymph node dissection between the complication group and the non-complication group(P>0.05). There were statistically significant differences in age, smoking history, preoperative diabetes mellitus, preoperative chronic obstructive pulmonary disease(COPD), intraoperative fluid infusion volume, operation time, intraoperative thoracic adhesion, and intraoperative recurrent laryngeal nerve injury between the complication group and the non-complication group(P<0.05). The results of multifactorial logistic regression analysis showed that age≥65 years, history of smoking, preoperative diabetes mellitus, preoperative COPD, intraoperative thoracic adhesions, and intraoperative recurrent laryngeal nerve injury were the independent risk factors for the occurrence of perioperative respiratory complications in total laparoscopic radical surgery for esophageal cancer.Conclusion:Perioperative respiratory complications during total laparoscopic radical surgery for esophageal cancer are closely related to age≥65 years, smoking history, preoperative diabetes mellitus, preoperative COPD, intraoperative thoracic adhesion, intraoperative recurrent laryngeal nerve injury.We can better prevent the above risk factors, reduce the occurrence of perioperative respiratory complications, and improve the prognosis of patients by performing nebulization, control of blood glucose levels, and neuroprotection during operation.
Objective:To investigate the expression levels of microRNA-21-3p(miR-21-3p)and Runt-related transcription factor 3(RUNX3)in severe acute pancreatitis and their predictive value for the progression of the disease.Methods:One hundred patients with acute pancreatitis admitted to Shifang People′s Hospital between March 2020 and March 2022 were selected as research objects and divided into control group(n=50, mild acute pancreatitis)and observation group(n=50, severe acute pancreatitis)according to their disease conditions.Real-time fluorescence quantification polymerase chain reaction(PCR)was used to detect the expression level of miR-21-3p, and enzyme-linked immunoassay was used to detect the expression level of RUNX3.The differences in the expression levels of miR-21-3p and RUNX3 between the two groups were compared, and the relationships between miR-21-3p and RUNX3 and the deterioration of severe acute pancreatitis were analyzed by Logistic regression analysis.Receiver Operating characteristic(ROC)curve was drawn to analyze the application value of miR-21-3p and RUNX3 in predicting and diagnosing the deterioration of severe acute pancreatitis.Results:The level of miR-21-3p in the observation group was significantly higher than that in the control group, and the level of RUNX3 in the observation group was significantly lower than that in the control group, with statistically significant differences(P<0.05). The miR-21-3p level in survivors was lower than that in deaths, while the RUNX3 level in survivors was higher than that in deaths(P<0.05). Logistic results showed that the high expression of miR-21-3p was a risk factor for the worsening(death)of severe acute pancreatitis, and the high expression of RUNX3 was a protective factor for the worsening(death)of severe acute pancreatitis(P<0.05). ROC curve showed that the AUC(0.835, 95% CI: 0.742-0.928)of the combined diagnosis of miR-21-3p and RUNX3 in predicting the deterioration of severe acute pancreatitis was the largest, and the sensitivity and specificity were 83.33% and 93.18%(P<0.05), respectively.Conclusion:miR-21-3p is highly expressed in the worsening process of severe acute pancreatitis, and RUNX3 is lowly expressed in the worsening process of severe acute pancreatitis.The combined diagnosis of the two indexes can predict the development of severe acute pancreatitis, which can provide a certain auxiliary role for the early diagnosis of patients.
患者男性，41岁，因"纳差、消瘦1年，加重伴乏力2个月"于2018年12月13日至郑州大学第一附属医院血液内科就诊。患者1年前无明显诱因出现纳差，食量减少为原来2/3，体重较前减轻约4 kg，无恶心呕吐、腹痛腹泻等不适，未予特殊处理。近2个月来纳差加重，食量减少为原来1/2，伴乏力、盗汗、面色苍黄、腰背部疼痛，体重近1年减轻约10 kg，查体发现双侧乳房肿大及右腹部包块。实验室检查：白细胞计数12.00×109/L，D-二聚体5.94 mg/L，纤维蛋白原5.10 g/L，C反应蛋白99.90 mg/L，EB病毒抗体IgG 4.06(阳性)，肿瘤相关抗原199为47.76 U/mL，非小细胞肺癌抗原21-1 28.16 ng/mL，神经元特异性烯醇化酶67.66 ng/mL，泌乳素35.62 ng/mL，雌二醇26.33 pg/mL，β-绒毛促性腺激素(HCG) 937 268.00 mIU/mL。
Objective:To explore the application value of blood amylase, C-reactive protein, procalcitonin, and lactate dehydrogenase in the evaluation and prognosis prediction of acute pancreatitis patients.Methods:Clinical data of 240 patients with acute pancreatitis who were hospitalized in Affiliated Hospital of Xuzhou Medical University from January 2017 to December 2022 were retrospectively collected.According to the patient′s condition, they were divided into mild group, medium severe group, and severe group.Clinical characteristics and serum indicators were compared, and patients′prognosis was followed up and tracked.The value of multiple indicators in predicting the prognosis of acute pancreatitis patients was analyzed using multivariate logistic regression analysis and receiver operating characteristic(ROC)curves.Results:The incidence rate of severe acute pancreatitis was 13.33%.The differences in white blood cells, amylase, C-reactive protein, procalcitonin, and lactate dehydrogenase levels among patients with acute pancreatitis of different severity were statistically significant(P<0.05). The correlation analysis results showed that blood amylase, C-reactive protein, procalcitonin, and lactate dehydrogenase were positively correlated with the severity of acute pancreatitis(P<0.05). The mortality rate of acute pancreatitis patients was 5.83%.The results of multivariate logistic regression equation showed that amylase, C-reactive protein, procalcitonin, and lactate dehydrogenase were independent factors affecting the prognosis of acute pancreatitis patients(P<0.05). Age, alcohol consumption history, white blood cells, platelets, and triglycerides were not independent factors affecting the prognosis of patients with acute pancreatitis(P>0.05). The ROC curve was used to analyze the prognostic value of blood amylase, C-reactive protein, procalcitonin, lactate dehydrogenase, and the combination of four indicators in predicting acute pancreatitis.The areas under the curve were 0.829, 0.850, 0.890, 0.724, and 0.936, respectively(P<0.05).Conclusion:Blood amylase, C-reactive protein, procalcitonin, and lactate dehydrogenase are positively correlated with the severity of acute pancreatitis.Blood amylase, C-reactive protein, procalcitonin, lactate dehydrogenase, and their combination have good predictive value for the prognosis of acute pancreatitis.
Objective:To evaluate the clinical efficacy and adverse effects of oxycodone, hydromorphone and sufentanil on postoperative analgesia in gastric cancer patients.Methods:The gastric cancer patients who underwent radical surgery for gastric cancer in anesthesia analgesia system of the Fifth Affiliated Hospital of Sun Yat-sen University from June 1, 2020 to June 31, 2022 were retrieved.According to the postoperative analgesic plan, the patients were divided into hydromorphone group(n=108), oxycodone group(n=35)and sufentanil group(n=42). General baseline data such as age, gender, BMI, ASA classification, surgical approach, lymph node dissection, and postoperative complications were collected from all patients.Visual analogue scale(VAS)of rest and activity at 4-8 hours(T1), 10-14 hours(T2), 22-26 hours(T3), and 46-50 hours(T4), the number of presses of self-controlled analgesic pump and the incidence of postoperative adverse reactions were compared among the three groups.Results:There was no statistically significant difference in general information among the three groups of patients(P>0.05). In the postoperative T1, T2, T3 and T4 moments, the analgesic effects of the oxycodone group and the hydromorphone group were better than those of the sufentanil group, with statistically significant differences(P<0.05); the analgesic effect of the oxycodone group and the hydromorphone group was the same(P>0.05). The total number of self-control presses of the analgesic pump in the oxycodone group and the hydromorphone group was less than that of the sufentanil group in 48 h(P<0.05); the total number of self-control presses of the analgesic pump in the oxycodone group was not significantly different from that of the hydromorphone group(P>0.05). In addition, there was no significant difference in the total incidence of adverse reactions among the three analgesic regimens(P>0.05).Conclusion:Oxycodone and hydromorphone analgesic regimen have better analgesic effects than sufentanil regimen, which can significantly reduce postoperative pain in gastric cancer patients, and have higher safety.
Objective:To summarize the clinical features, CT and MRI imaging findings of primary hepatic lymphoma(PHL), and investigate the diagnostic value of the imaging examination for PHL, so as to provide reliable basis for clinical diagnosis and treatment of PHL.Methods:A total of 15 patients with PHL confirmed by pathology and complete preoperative imaging data from January 2014 to December 2020 at Third Affiliated Hospital of Naval Medical University were retrospectively analyzed, including 8 cases with CT and 7 cases with MRI.The clinical features and imaging manifestations of PHL were analyzed.Results:All 15 patients with PHL had no specific clinical manifestations, 11 cases were single lesions and 4 cases were multiple lesions; 13 cases were mostly round, 8 cases had uniform density/signal; necrosis was seen in 7 cases; 9 cases showed progressive enhancement after enhancement scan, 7 of which were single nodules and 6 cases showed continuous enhancement. "Vascular floating sign" was seen in 11 cases, indicating no invasion of vessels.Conclusion:PHL is rare, and when the clinical presentation and laboratory diagnosis are not specific, the diagnosis of PHL should be considered when there is a single lesion in the liver with progressive enhancement and "vascular floating sign" on imaging.The diagnosis of PHL is suggested by the presence of multiple lesions with "vascular floating signs" .
Objective:To comprehensively analyze the survival status and prognostic factors of colorectal cancer patients with liver metastasis.Methods:The clinical and follow-up data of 84 patients with liver metastasis from colorectal cancer in the Central Hospital Affiliated to Chongqing University from January to June 2019 were analyzed retrospectively.The basic information of patients was collected, Kaplan-Meier method was used to calculate the median survival time, Log-rank test was used for univariate analysis, and Cox regression model was used to analyze the related factors affecting the prognosis of colorectal cancer patients with liver metastasis.Results:All 84 patients with liver metastasis from colorectal cancer were followed up, the median follow-up time was 25.5 months, the follow-up rate was 100.0%, and there was no loss of follow-up.The 1-year, 2-year and 3-year survival rates were 84.52%(71/84), 66.67%(56/84)and 51.19%(43/84), respectively.The median survival time was(25.16±5.48)months.The results of univariate analysis showed that whether the body weight decreased more than 20% in recent 6 months was related to the prognosis(P<0.05). There were statistically significant differences between groups in mrEMVI, pathological type, pathological grade, mrT stage, mrN stage, circumferential resection margin(CRM), invasion length, invasion depth, the distance from the lower end of the tumor to the anal margin, and the number of liver metastatic lesions, which were related to the prognosis(P<0.05). There were statistically significant differences in neoadjuvant chemotherapy, operation time and complications between groups, which were related to the prognosis(P<0.05). The influence of each factor on the prognosis of patients from high to low were: weight loss of more than 20% in recent 6 months(OR=2.264), number of liver metastases(OR=2.035), pathological type(OR=1.751), neoadjuvant chemotherapy(OR=1.382), pathological classification(OR=1.186).Conclusion:Over 20% weight loss, mrEMVI, pathological type, pathological grade, mrT stage, mrN stage, CRM, length of invasion, depth of invasion, distance from the lower end of the tumor to the anal margin, number of liver metastatic lesions, neoadjuvant chemotherapy, operation time and complications are the main factors affecting the prognosis of patients with colorectal cancer with liver transfer.Clinically, timely and effective preventive measures can be taken before and after the operation to benefit the survival of patients and improve the prognosis of patients.
Objective:To explore the effect of acupotomy regulation of sympathetic nervous on gastric function and ulcer healing in elderly gastric ulcer patients.Methods:A single center, prospective, randomized controlled cohort study was used.A total of 112 elderly patients with gastric ulcer in Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2021 to December 2022 were selected as the study subjects.They were divided into control group(56 cases)and research group(56 cases)according to the random number table method.The control group received conventional Western medicine treatment.On the basis of the control group, the research group received acupotomy regulation of sympathetic nerve therapy.The Helicobacter pylori(Hp)negative conversion, gastric function, ulcer healing, serum inflammatory factors, and adverse reactions between the two groups were compared.Results:The research group was significantly better than the control group in terms of treatment effectiveness, with statistically significant difference(94.64% vs.80.36%, P<0.05). The negative conversion rate of Hp in the research group(87.50%)was significantly higher than that in the control group(71.43%), with statistically significant difference(P<0.05). After treatment, the gastric emptying time, gastric antral contraction frequency, cholecystokinin, gastrin, motilin, ulcer healing indicators, inflammatory indicators TNF-α, trefoil factor 2(TFF2), IL-4 and IL-8 in the research group were significantly better than those in the control group(P<0.05). The incidence of adverse reactions in the research group was 16.07%, slightly higher than the control group′s 12.50%, but there was no statistically significant difference(P>0.05).Conclusion:The application of acupotomy regulation of sympathetic nerves in elderly gastric ulcer patients can improve treatment effectiveness, improve gastric function and ulcer healing, and promote the recovery of serum inflammatory factor indicators.
Objective:To explore the risk factors of rebleeding in patients with gastric ulcer with hemorrhage after endoscopic treatment.Methods:From January 2020 to December 2022, 218 patients with gastric ulcer with hemorrhage admitted to the Hai′an People′s Hospital were retrospectively collected, all of whom underwent hemostasis under digestive endoscopy.Based on whether the patients experienced rebleeding after operation or not, the patients were divided into rebleeding group(n=34)and control group(n=184). The clinical characteristics between the two groups were compared, and the risk factors for postoperative rebleeding in gastric ulcer with hemorrhage patients treated with digestive endoscopy were analyzed.Results:There were statistically significant differences between the two groups in terms of ulcer size, ulcer depth, multiple lesions and Forrest grading(P<0.05). Ulcer size≥2 cm, ulcer depth≥5 mm, multiple lesions and Forrest gradeⅠwere independent risk factors for postoperative rebleeding in patients with gastric ulcer bleeding after endoscopic treatment(P<0.05). Compared with the control group, the discharge time of patients in the rebleeding group was significantly prolonged [(11.48±4.34)d vs.(9.45±4.12)d, P=0.009]; the blood transfusion rate significantly increased(82.35% vs.28.26%, P=0.000); the hospital mortality rate significantly increased(11.76% vs.0.54%, P=0.000).Conclusion:Ulcer size≥2 cm, ulcer depth≥5 mm, multiple lesions and Forrest gradeⅠare independent risk factors for postoperative rebleeding in patients with gastric ulcer with hemorrhage after endoscopic treatment, which can lead to poor prognosis.
Objective:To investigate the effect of Bifidobacterium Triple Viable Powder(Peifeikang)combined with compound Lactobacillus acidophilus tablets in the adjuvant treatment of rotavirus enteritis in children.Methods:A total of 120 children with rotavirus enteritis treated in Guangde People′s Hospital from August 2020 to September 2022 were included and randomly divided into control group, Peifeikang group and combined bacteria group according to random number table method, with 40 cases in each group.The control group was given conventional rehydration treatment, the Peifeikang group was given Peifeikang preparation on the basis of conventional treatment, and the combined bacteria group was given probiotic preparations such as Peifeikang and compound Lactobacillus acidophilus tablets on the basis of conventional treatment.After 1-5 days of treatment, the clinical therapeutic effect, the changes of intestinal probiotics and pathogenic bacteria, intestinal permeability function and serum inflammatory factors were compared among the three groups.Results:After treatment, the total effective rate of the combined bacteria group was significantly higher than that of the Peifeikang group and the control group(P<0.05). The disappearance time of clinical symptoms(diarrhea, abdominal pain, vomiting and dehydration)in the combined bacteria group was significantly earlier than that in the control group and the Pefikang group.Among the intestinal flora detected, Bifidobacterium intestinalis, Lactobacillus acidophilus and Enterococcus faecalis were increased in the three groups, and the increased proportion in the combined bacteria group was higher than that in the Peifeikang group and the control group(P<0.05). Enteric Escherichia coli and Perfringens were decreased in all three groups, and the reduction degree of the combined bacteria group was higher than that of the Peifeikang group and the control group(P<0.05). The decrease of serum D-lactic acid, DAO, ET and inflammatory factors(TNF-α, IL-1β, IL-6 and IL-17)levels in the combined bacteria group was higher than that in the Peifeikang group and the control group(P<0.05).Conclusion:On the basis of conventional treatment, combination of Peifeikang and compound Lactobacillus acidophilus tablets can improve the therapeutic effect of rotavirus in children.
