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目的:分析军事训练致热射病的临床特点和易感因素，提出预防和应对策略。方法:回顾分析2020年4月18日至4月27日期间某部队医院参与某部军事训练考核保障过程中出现劳力性热射病（exertional heat stroke, EHS）患者的相关资料，分析这些患者的临床特点和相关因素，探讨总结相关治疗经验。结果:此次军事考核共持续10 d，共有2 652名战士参加，其中发生热射病的108例患者全部出现在武装5 km考核阶段，年龄为18~34（21.5±5.3）岁。1~5年军龄阶段患者发生EHS的数量要高于其他军龄组。患者以晕厥或意识障碍为主要表现（80.6%），并可同时伴有行为异常（6.5%）、头晕头痛（23.1%）、肢体痉挛（13.9%）、恶心呕吐（5.6%）等一种或者多种表现。经现场治疗后，多数患者在1 h内达到目标体温（75.0%），73.1%的患者在2 h内完全清醒，93.5%患者完全治愈顺利归队，出现后遗症及死亡患者为0人。EHS的发生与气温密切相关，气温升高时EHS的发生显著增多。结论:EHS发生率高，普及相关人员疾病知识，加强医务人员对EHS的识别和积极救治培训，合理安排训练计划，可有效保证官兵生命健康。

目的:探讨右美托咪定联合舒芬太尼自控静脉镇痛(patient-controlled intravenous analgesia,PCIA)对老年直肠癌根治术患者术后镇痛效果、炎症应激反应和早期恢复的影响.方法:选取2019年1月至2020年12月在中国人民解放军陆军第七十三集团军医院择期行腹腔镜直肠癌根治术的患者100例为研究对象,随机分为对照组(n=50)与观察组(n=50);两组术后均予以PCIA,对照组配方为舒芬太尼3.0μg/kg+托烷司琼10 mg,观察组配方为舒芬太尼3.0μg/kg+右美托咪定1.0μg/kg+托烷司琼10 mg,均经生理盐水稀释至100 mL,维持疼痛视觉模拟(Visual Analogue Scale,VAS)评分≤3.比较两组镇痛效果、术后3 d恢复质量量表(15-item Quality of Recovery Questionnaire,QoR-15)评分、炎症因子[白细胞介素-6(interleukin-6,IL-6)、IL-1β、肿瘤坏死因子-α(tumor necrosis factor-alpha,TNF-α)]水平及不良反应.结果:相比对照组,观察组术后4 h、12 h、24 h、48 h的VAS评分及术后补救镇痛率均降低,术后24 h舒芬太尼用量减少,且术后下床时间、首次排气时间均提前,术后3 d的QoR-15评分增高,差异均有统计学意义(P<0.05);术后,两组血清IL-6、IL-1β、TNF-α水平均增高,但观察组相比对照组较低,差异均有统计学意义(P<0.05);观察组术后恶心呕吐、总不良反应发生率分别为10.00％、18.00％,均低于对照组的28.00％、44.00％,差异均有统计学意义(P<0.05).结论:右美托咪定联合舒芬太尼PCIA可提高老年直肠癌根治术患者术后镇痛效果,减轻炎症应激反应,减少不良反应,有利于术后恢复.

目的 探讨重度溃疡性结肠炎(UC)患者合并巨细胞病毒(CMV)感染的临床特点及疾病转归.方法 纳入2017年1月至2021年6月西安交通大学第二附属医院消化科收治的重度UC患者,根据患者CMV感染的情况将其分为感染组和对照组,分别总结两组患者的临床特征、实验室检查和治疗方案等,并回顾性分析其预后.结果 共纳入重度UC患者167例,包括感染组21例(12.6％)和对照组146例(87.4％).感染组患者中男性9例(42.9％),女性12例(57.1％),年龄15～69岁,平均(42.7±18.3)岁,中位病程10.0(0.5,64.3)个月,感染组病程明显短于对照组.感染组和对照组均以慢性复发型为主,感染组中初发型比例高于对照组,而对照组中的慢性复发型比例高于感染组.两组的病变范围均以广泛结肠型为主.实验室检查方面,感染组的血红蛋白水平明显低于对照组,C反应蛋白水平明显高于对照组,而白细胞计数、血小板计数和血沉水平与对照组相比差异无统计学意义.感染组的住院时间明显长于对照组,器官衰竭率较高.而激素、免疫抑制剂和生物制剂的使用率、激素依赖/抵抗率和手术率虽高于对照组,但差异无统计学意义.结论 重度UC患者容易并发CMV感染,病程短可能增加其感染的风险.CMV感染可加重UC病情,增加住院时间和急诊手术率,与预后不良相关.

Background/Aims The role of DHRS3 in human cancer remains unclear. Our study explored the role of DHRS3 in gastric cancer (GC) and its clinicopathological significance and associated mechanisms. Materials Bisulfite-assisted genomic sequencing PCR and a Mass-Array system were used to evaluate and quantify the methylation levels of the promoter. The expression levels and biological function of DHRS3 was examined by both in vitro and in vivo assays. A two-way hierarchical cluster analysis was used to classify the methylation profiles, and the correlation between the methylation status of the DHRS3 promoter and the clinicopathological characteristics of GC were then assessed. Results The DHRS3 promoter was hypermethylated in GC samples, while the mRNA and protein levels of DHRS3 were significantly downregulated. Ectopic expression of DHRS3 in GC cells inhibited cell proliferation and migration in vitro, decreased tumor growth in vivo. DHRS3 methylation was correlated with histological type and poor differentiation of tumors. GC patients with high degrees of CpG 9.10 methylation had shorter survival times than those with lower methylation. Conclusion DHRS3 was hypermethylated and downregulated in GC patients. Reduced expression of DHRS3 is implicated in gastric carcinogenesis, which suggests DHRS3 is a tumor suppressor.

神经内分泌肿瘤(neuroendocrine neoplasms, NENs)是一种少见的以神经内分泌分化为主的肿瘤,可发生于呼吸系统、消化系统等各个部位.根据不同的生物学行为和恶性潜能,一般将NENs分为分化良好的神经内分泌瘤(neuroendocrine tumors,NETs)和分化不良的神经内分泌癌(neuroendocrine cancer, NECs).与其他小肠肿瘤一样小肠NECs因其病因复杂、临床表现非特异性、内镜检查困难等特点,通常难以诊断.在过去通常需要手术后才能确诊.近年来随着胶囊内镜和小肠镜的开展使小肠肿瘤的术前诊断更加准确.本文报道1 例以消化道出血为主要临床表现、小肠 CT 成像(computed tomographic enterography,CTE)提示回肠肿块伴回肠壁增厚,并在随后的胶囊内镜和双气囊小肠镜(double balloon enteroscopy,DBE)检查发现隆起凹陷性病变的病例,患者最终诊断为小细胞神经内分泌癌.

目的:研究胃癌患者应用心理干预联合早期肠内营养疗法对患者焦虑情况以及生命质量的影响.方法:选取2018年1月至2020年6月中国人民解放军第七十三集团军医院普通外科收治的胃癌患者60例作为研究对象,按照随机双盲法将患者分为观察组和对照组,每组30例.对照组为常规护理,观察组给予心理干预联合早期肠内营养治疗,观察不同方案对患者的影响.结果:干预前,2组患者的焦虑等指标评分比较差异无统计学意义,干预后,观察组患者的焦虑、抑郁评分较对照组低,生命质量评分更高,出现不良反应的例数更少,差异有统计学意义(P<0.05).结论:心理干预联合早期肠内营养疗法对胃癌患者的影响明显,能减轻患者的心理压力,改善患者的生命质量,减少不良反应的出现,需要引起重视.

目的 黏附侵袭性大肠杆菌(AIEC)可能与炎症性肠病(IBD)的发病及加重相关,本研究的目的 是研究最具代表性的AIEC菌株E.coli LF82对实验性结肠炎小鼠炎症因子及炎症通路的影响.方法 将24只清洁级C57BL/6小鼠随机分为DSS组、DSS+ LF82组和健康对照组,每组8只.分别给予DSS组和DSS+ LF82组小鼠蒸馏水和E.coli LF82灌胃一周,后建立葡聚糖硫酸钠(DSS)小鼠结肠炎模型,健康对照组小鼠不做任何处理.通过Bio-plex、real-time PCR和Westem blot测定血清及结肠组织中多个炎症因子及炎症通路相关分子的变化.结果 DSS组小鼠血清中的炎症因子肿瘤坏死因子-α、白介素-10、白介素-17A、白介素-1β、白介素-6、干扰素-γ和G-集落刺激因子分泌较健康对照组明显增加,定植E.coli LF82的DSS+ LF82组升高更明显.结肠组织中的上述炎症因子和IL-8的mRNA水平变化趋势与之类似.DSS+ LF82组小鼠结肠中磷酸化NF-KB P65和P38的表达明显高于DSS组和健康对照组.结论 E.coli LF82可增加小鼠血清和结肠组织炎症因子的释放,其机制可能通过NF-κB和MAPK信号通路实现.

目的 探讨乳腺整形外科技术在非哺乳期乳腺炎手术中的应用及临床疗效.方法 回顾性分析我院收治的67例非哺乳期乳腺炎患者的临床资料,根据手术方法 的不同将其分为研究组(n=45)和对照组(n=22).对照组患者行乳腺区段切除术,研究组患者在对照组的基础上结合隐匿性美容切口、随意腺体皮瓣转移等整形外科技术.比较2组患者术后并发症发生率、复发率及患者满意度.结果 研究组患者术后并发症发生率、复发率及患者满意度均优于对照组,差异有统计学意义(P<0.05).结论 结合乳腺整形外科技术进行非哺乳期乳腺炎手术安全、有效,术后患者满意度高,具有良好的临床应用价值.

目的 研究基于"雨课堂"的混合式教学模式在消化内科实习教学中的效果.方法 选择2019年6月至2020年6月在我院实习的96名临床医学专业学生,按照随机数字表法将其分为试验组和对照组,每组48名.试验组采用"雨课堂"教学法,对照组采用传统教学法.比较两组的教学效果.结果 试验组的理论成绩和病例分析成绩均显著高于对照组,差异具有统计学意义(P<0.05).试验组对教师的教学内容、教学方法、教学效果和总体满意度评分均高于对照组,差异具有统计学意义(P<0.05).试验组的学习主动性、学习兴趣、表达能力、自学能力和解决实际问题的能力评分均高于对照组,差异具有统计学意义(P<0.05).结论 相比传统教学模式,基于"雨课堂"的教学法可提高学生的理论知识掌握、实践操作技能和教学满意度,并提升消化内科临床实习教学的教学效果、学生和患者满意度.

目的:建立结直肠癌病人来源的异种移植(PDX)模型,探讨氟尿嘧啶(5-fluorouracil,5-Fu)的药效、毒性与给药剂量之间的关系.方法:将新鲜的结直肠癌手术标本移植至免疫缺陷小鼠皮下,建立PDX模型并稳定传代,检测模型的溯源性;分别给予5、10、20、40、60 mg/kg浓度的5-Fu,测量肿瘤体积、小鼠体质量变化和死亡情况等.结果:成功建立PDX模型,溯源性高达99.96％.5-Fu 5、10、20、40、60 mg/kg剂量组对应的肿瘤抑制率分别为33％、49％、68％、92％、100％.其中,40 mg/kg剂量组小鼠体质量剧减,60 mg/kg剂量组死亡率达100％.结论:5-Fu的体内抑瘤效果及毒性与剂量密切相关,10～20 mg/kg剂量的5-Fu较适合PDX模型的药效评价.

目的 研究腹腔镜经腹腹膜前疝修补术(TAPP)治疗腹股沟疝的效果.方法 回顾性分析2016年1月～2019年1月我院收治的147例腹股沟疝患者的临床资料,按照不同的治疗方法将其分为腔镜组(69例)和开放组(78例),腔镜组采用TAPP术式,开放组采用疝环填充式无张力疝修补术.比较两组患者的手术时间、术中出血量、术后住院时间、术后疼痛、术后并发症总发生率.结果 两组患者的手术时间、术中出血量比较,差异无统计学意义(P＞0.05).腔镜组患者的术后住院时间短于开放组,差异有统计学意义(P＜0.05);腔镜组患者的术后疼痛率及术后并发症总发生率低于开放组,差异有统计学意义(P＜0.05).结论 腹腔镜TAPP术恢复快、并发症少,可作为首选的治疗方式.

Objective:To explore the application effect of color warning signs in prevention and control of nosocomial infection among nursing staff.Methods:Aiming at the high incidence of infection in general surgery, the self-designed color warning signs were used in the computer system of nurses’ workstations and the bedside information of patients to compare the changes of the standard compliance of nurses, the incidence of sharp instrument injury, the satisfaction of nurses, and the efficiency of nursing work before and after the use.Results:In the experimental group, nursing staff’s standard prevention compliance and nursing staff’s satisfaction were significantly improved, the incidence of sharp instrument injury decreased from 18.18% to 2.94%, with statistically significant differences (all P<0.05). Conclusion:The application of color warning signs can effectively control the occurrence of sharp instrument injury of nurses, which not only increases the compliance of standard prevention, improves the work efficiency and satisfaction of nurses.

Abstract Purpose: For stage II colon cancer, the efficacy of postoperative adjuvant chemotherapy remains controversial. It is well known that tumor-associated macrophages (TAMs) are important in tumor progression. In this study, TAMs were investigated as prognostic and predictive biomarkers for the efficacy of adjuvant chemotherapy for stage II colon cancer after radical resection. Experimental Design: This study enrolled two independent cohorts of consecutive patients from one medical center with pathologic stage II colon cancer after radical resections. Macrophages were detected using IHC staining of CD68 and CD206. Infiltration densities of CD68+ TAMs, CD206+ TAMs, and ratio of CD206+ TAMs/CD68+ TAMs (CD206/CD68 ratio) were calculated as prognostic and predictive biomarkers. Results: The primary and validation cohorts consisted of 521 and 314 patients, respectively. In both cohorts, high CD206/CD68 ratio was significantly associated with poor disease-free survival (DFS) and overall survival (OS). As an independent risk factor, CD206/CD68 ratio also had significantly better prognostic efficacy than CD68+ TAM density, CD206+ TAM density, and traditional clinicopathologic high-risk factors. Moreover, adjuvant chemotherapy significantly improved DFS and OS for patients with high CD206/CD68 ratio but not for those with low CD206/CD68 ratio. The interaction analyses were also significant for DFS. In subgroup analysis, CD206/CD68 ratio was still a significant predictor for adjuvant chemotherapy for patients in traditional high-risk group of recurrence (significant interaction for DFS). Conclusions: For stage II colon cancer, CD206/CD68 ratio is a better prognostic and predictive biomarker for postoperative adjuvant chemotherapy. Together with clinicopathologic high-risk factors, it will aid in precision treatment.

目的:介绍一种自制女性腹腔镜直肠癌根治术中的悬吊子宫装置,并分析其临床应用效果.方法:回顾分析2016年1月至2019年4月在厦门大学附属成功医院普通外科接受腹腔镜直肠癌根治术的60例女性患者的临床资料,分为观察组、对照组.观察组(28例)术中为解决因子宫的下垂遮挡导致盆腔手术视野暴露困难的问题,采用了自制悬吊子宫装置悬吊子宫.对照组未悬吊子宫,行常规腹腔镜直肠癌根治手术.比较2组患者术中、术后的情况,评价该装置的效果.结果:观察组较对照组手术时间和术后肛门排气时间明显缩短(P<0.05),但两组术中出血量、淋巴结清扫数量和术后并发症发生率的差异均无统计学意义.结论:自制女性腹腔镜直肠癌根治术中的悬吊子宫装置取材方便 ,操作安全简单 ,价格便宜 ,有利于盆腔术野暴露 ,降低手术操作的风险和难度 ,同时缩短手术时间和术后肛门排气时间 ,促进术后恢复.

Objective To investigate the expression levels of zinc finger proteins A 20 in breast cancer and analyze their correlation with clinical pathological .Methods Normal tissues adjacent to breast cancer were collected from 60 patients who were hospitalized in 174th Hospital of Chinese People’s Liberation Army from 2010 to 2012.The expression levels of zinc finger protein A 20 and mRNA in tissues were detected by immunohistochemistry and quantitative polymerase chain reaction ( qPCR ), respectively.Results The expression of zinc finger protein A 20 in breast cancer was significantly higher than that in normal tissue around cancer .The expression of zinc finger protein A20 was closely related to the differentiation degree of breast cancer cells ( P ＜0.05 ), and its expression increased with the decrease in differentiation degree of breast cancer tissue .In addition, the expression of zinc finger protein A20 was also closely related to estrogen receptor expression , breast cancer metastasis and tumor stage . Conclusions The expression level of zinc finger protein A 20 in breast cancer tissue is significantly increased, and the expression level is closely related to estrogen receptor expression , differentiation, metastasis and tumor stage .

[This corrects the article DOI: 10.7150/jca.35380.].

目的 分析腹腔“一管一球”联合皱襞肛管引流在预防腹腔镜辅助低位直肠癌Dixon术后吻合口漏的应用分析.方法 选取我院低位直肠癌行腹腔镜辅助Dixon手术治疗的患者128例,随机分为观察组(60例)与对照组(68例).观察组术后采用腹腔“一管一球”联合皱襞肛管引流的方法进行处置,对照组术后采用腹腔橡皮引流管+传统肛管自然引流的方法进行处置.比较两组手术时间、术后肛门排气时间、术后吻合口漏发生率及平均住院时间.结果 两组手术时间、术后肛门排气时间比较,差异均无统计学意义(P＞0.05).观察组术后吻合口漏发生率及平均住院时间均明显低于对照组,差异有统计学意义(P＜0.05).结论 腹腔“一管一球”联合皱襞肛管引流能够有效地预防低位直肠癌术后吻合口漏的发生,缩短平均住院时间.

Objective To investigate the treatment experience of rectal cancer patients with excessively extended surgery after neoadjuvant chemoradiotherapy.Methods Seven cases of rectal cancer patients admitted to our hospital from 2014 to 2016 with excessively extended surgical intervention (6 to 13 months) after neoadjuvant chemoradiotherapy were included in the present study.All of the patients were treated with radical surgery,and the operation effect and postoperative complications were observed.Results Three patients underwent anterior resection of the rectum (Dixon),including 2 cases of anastomotic leakage;3 cases occurred intestinal rupture during operation,1 of them complicated with postoperative pelvic abscess;there were 4 cases complicated with incision infection or liquefaction.No presacral venous plexus hemorrhage occurred.Conclusion Excessively extended surgery after neoadjuvant chemoradiotherapy increases the difficulty of operations and the occurrence of postoperative complications in patients with rectal cancer.