Liver is the most common site of metastasis for colorectal cancer (CRC), which is highly malignant, aggressive and has poor prognosis. About 50% of patients develop liver metastases during the course of the disease, and liver metastases are also a major cause of death. Surgical resection is still the main cure method for colorectal cancer liver metastases (CRCLM), but only less than 20% of patients have access to radical surgery. Therefore, non-surgical local treatment combined with comprehensive treatment is essential. With the concept of individualized treatment and Multiple disciplinary team (MDT), as well as the rapid development of non-surgical local treatment, the survival time of patients with liver metastases of colorectal cancer has been significantly prolonged, and even some patients with initial inoperable resection have been successfully converted to R0 resection through non-surgical local treatment. This article reviews the research progress on non-surgical local treatment of CRCLM in recent years.

The effects of exogenous protease pre-enzymolysis treatment on the degree of gastrointestinal digestion and antioxidant activity of earthworm proteins were examined following gastrointestinal digestion. Five proteases were used to prepare different hydrolysates of earthworm proteins, and changes in the degree of hydrolysis, molecular weight distribution, and in vitro antioxidant activities of these enzymatic hydrolysates were investigated based on simulated gastrointestinal digestion in vitro. Among these hydrolysates, the degree of hydrolysis of the alkaline protease hydrolysate was the highest at 40.81%. The rates of DPPH and ABTS free radical scavenging were 27.36 and 175.46 μmol TE/g, respectively, and the ORAC value was 0.70 μmol TE/mg. Following gastrointestinal digestion, the degree of hydrolysis, rate of DPPH free radical scavenging, and ORAC value of the alkaline protease hydrolysate increased by 94.06%, 72.21%, and 120%, respectively, compared with the products obtained via direct gastrointestinal digestion of earthworm proteins. A total of 10 823 peptides with molecular weight ＜3 ku were identified in GHEWP, and 11 peptides with the highest activity scores were screened using bioware.ucd.ie to determine their activity threshold score for synthesis and verification. Among these, the peptides ATSGFFVY, HCFVLY, HLASGWY, HRYSDF, and HYANMY had the highest comprehensive antioxidant capacities. The quantum chemical calculation results revealed that the active sites of ATSGFFVY, HCFVLY, HRYSDF and HYANMY might be located at Tyr-8, Tyr-6, Tyr-3, and Tyr-2, respectively, and the active site of HLASGWY may be located at Trp-6. The findings of this study indicate that pre-enzymatic hydrolysis using alkaline protease can enhance the degree of digestion of earthworm proteins and also the antioxidant activity of their gastrointestinal digestion products.

完全植入式静脉输液港（totally implantable venous access ports，TIVAP）是临床常用的用于化疗的深静脉置管装置，具有留置时间长、感染机率低、美观度高、维护周期间隔长、并发症少等优点。TIVAP植入过程中要求导管尖端位于上腔静脉下1/3与右心房交界处。永存左上腔静脉（persistent left superior vena cava，PLSVC）是最为常见的一种体静脉回流畸形，发生率占所有先天性心脏病患者的3.0%~10.0%[1]。本科室自2018年9月至2021年12月共行TIVAP植入术1 037例，仅出现1例PLSVC，术后静脉港正常使用，现将病例要点报告如下。

肺部是结直肠癌发生远处转移的第二大好发器官，与结直肠癌肝转移相比，结直肠癌肺转移生物学行为相对较好，肿瘤生长缓慢，临床关注程度往往不及结直肠癌肝转移。手术切除是治疗结直肠癌肺转移主要的根治性治疗手段，但临床实际中仅有不足20%的患者可根治性切除，不可根治性手术切除的结直肠癌肺转移患者5年生存率不足20%，预后仍很差。近年来，局部治疗逐渐应用于临床，包括射频消融、微波消融及立体定向放射治疗等成为手术以外的重要局部治疗手段。然而，目前对手术以外局部治疗的疗效和选择时机尚存在一定争议，本文就结直肠癌肺转移局部治疗手段应用现状及前景进行综述。

目的 对比经桡动脉途径(TRA)和股动脉途径(TFA)对肺鳞癌患者行支气管动脉介入的可行性.方法 选取122例肺鳞癌患者,采取经左侧桡动脉入路行支气管动脉介入治疗58例(行BAI患者47例,行BAE患者5例,行BACE患者6例),经股动脉入路行支气管动脉介入治疗64例(行BAI患者51例,行BAE患者10例,行BACE患者3例).结果 2种入路均成功实施经支气管动脉介入治疗,术后无明显并发症.经左侧桡动脉入路手术时间少于经股动脉入路.结论 经桡动脉途径(TRA)行支气管动脉介入治疗是安全、快速和可行的,为肺部肿瘤介入提供更多可选择的介入路径.

Radiofrequency ablation and microwave ablation are commonly used thermal ablation techniques in clinical practice. With the advantages of minimally invasive, strong repeatability, fast postoperative recovery and accurate efficacy, they are commonly used as important means for the treatment of primary lung tumors and metastatic tumors, especially for the elderly who cannot tolerate surgical operations. Although the incidence of complications of thermal ablation is low and the symptoms are mild, for some elderly people the risk of serious postoperative complications is increased due to the combination of pulmonary basic diseases, even threatening the life of patients. Therefore, how to scientifically prevent and effectively treat related complications is crucial.This paper systematically reviewed the literature and combined with the experience of our center, expounded the causes, prevention and treatment measures of the complications of thermal ablation of lung tumors, hoping to attract the attention of clinicians, reduce the occurrence of related complications, and effectively improve the clinical efficacy.

目前新型冠状病毒肺炎疫情形势严峻，而肝癌是我国常见恶性肿瘤，且大多数肝癌患者确诊时已处于肝癌中晚期，预后差，在疫情期间肝癌患者无法完成常规诊断与治疗流程。在特殊时期，如何最大限度维持肝癌患者诊断与治疗的正常化成为肝癌领域临床医师的艰巨任务。本文汇集国内多学科领域9位著名专家结合其团队临床经验，分别从外科、介入和肿瘤内科等角度阐述新型冠状病毒肺炎疫情下肝癌的多学科诊断与治疗策略。

茶多酚为油茶果中主要的生物活性提取物之一,具有显著的抗氧化、清除自由基、保护细胞膜的结构、抑制炎症和抗肿瘤等多种生物学作用.本文就茶多酚在肿瘤方面的作用及机制进行综述.

肝血管瘤作为最常见的肝脏良性肿瘤,随着影像学检查设备和技术的逐步发展,近年来,肝血管瘤的诊断率也逐步的提高.本文回顾了目前肝血管瘤的临床表现、诊断、手术治疗.本文主要对近段时间来肝血管瘤的外科手术治疗作一综述.

随着全球稀土的不断开采研发和利用,稀土元素广泛应用于生产生活中的各个方面.环境中稀土含量不断增加,它能够通过呼吸,食物链和皮肤等途径进入体内并在相关器官蓄积.蓄积在体内的各种稀土可能对机体产生有利或者损害作用,这些作用及作用可能机制一直是相关研究的焦点.相对稀土对于生殖方面的研究在上世纪90代开始断断续续有国内外学者们提出,但目前还是缺少类似研究的总结与综述.本文就几种稀土元素(镧、钐、铈、钇)对生殖系统各方面的影响作一综述,以期给予相关疾病的防治提供一定理论依据.

输尿管支架在泌尿外科的临床应用已有数十年,在此过程中,输尿管支架的制作材料和外形设计均有不少的改良和优化.随着泌尿外科术式的微创化、手术条件的提升以及患者对生活质量要求的提高,输尿管支架在临床中的应用也发生了相应的变化.本文就输尿管支架管的适应症、使用方法、放置时间以及相关并发症防治等作一综述.

目的:探讨高脂饮食对小鼠前列腺癌(PCa)肿瘤生长的影响.方法:建立PCa小鼠模型,随机分成正常饮食组和高脂饮食组,每组20只,分别用正常饲料和高胆固醇饲料,连续喂养30 d.通过检测小鼠血脂了解高脂饮食对小鼠胆固醇的影响;通过计算肿瘤系数了解高胆固醇对肿瘤生长的影响;通过肿瘤组织HE染色,了解高胆固醇对肿瘤形态学的影响;通过绘制小鼠生存曲线,了解高胆固醇对小鼠生存时间的影响;通过检测超氧化物歧化酶(SOD)和丙二醛(MDA)水平,了解高脂饮食对PCa小鼠抗氧化能力的影响.结果:高脂饮食可以诱发前列腺癌小鼠产生高胆固醇血症,增加小鼠体重,增加肿瘤系数.形态学观察显示,高脂饮食组肿瘤组织间隙血管分布增多,组织间隙增宽,肿瘤细胞核质比更高,核分裂相更明显.高脂饮食组前列腺癌小鼠血清胆固醇水平明显升高,抗氧化应激能力降低.结论:高脂饮食可能通过降低前列腺癌小鼠抗氧化能力,增加氧化应激产物等方式,促进肿瘤细胞生长.

目的 探讨奥布卡因凝胶联合双氯芬酸钠栓在尿道扩张术中的应用效果.方法 选取2017年1月～2018年6月我院收治的100例尿道扩张术患者作为研究对象,按照随机数字表法分为对照组(50例)和观察组(50例).对照组单纯采用奥布卡因凝胶治疗,观察组采用盐酸奥布卡因凝胶联合双氯芬酸钠栓治疗.比较两组患者的临床治疗总满意度、治疗前后疼痛视觉模拟评分、心率、肾上腺素、去甲肾上腺素、主诉疼痛缓解时间、术后住院时间及不良反应发生情况.结果 观察组患者的临床治疗总满意度高于对照组,差异有统计学意义(P＜0.05);治疗前两组的疼痛视觉模拟评分、心率、肾上腺素、去甲肾上腺素水平比较,差异无统计学意义(P＞0.05);治疗后观察组疼痛视觉模拟评分、心率、肾上腺素、去甲肾上腺素水平低于对照组,差异均有统计学意义(P＜0.05);观察组主诉疼痛缓解的时间、术后住院时间短于对照组,差异有统计学意义(P＜0.05);两组患者未发生明显不良反应.结论 盐酸奥布卡因凝胶联合双氯芬酸钠栓治疗尿道扩张术,能显著提高患者的临床治疗满意度,可更好地改善疼痛视觉模拟评分、心率、肾上腺素、去甲肾上腺素等指标,值得推广应用.

目的 观察肝脏纤维化指数模型(FIB-4)、天门冬氨酸氨基转移酶与血小板计数模型(APRI)两种无创肝纤维化诊断模型在肝癌介入治疗后急性肝功能恶化(ALFD)风险中的预测价值.方法 纳入2016年11月至2018年11月于我院收治的行肝动脉化疗栓塞术(TACE)的168例肝癌患者为研究对象,开展回顾性分析.按照TACE术后是否存在ALFD风险,将其分为观察组(伴ALFD风险,31例)和对照组(不伴ALFD风险,137例).统计两组患者临床一般资料,分析两组术前实验室指标血清白蛋白(Alb)、总胆红素(TBil)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、血小板计数(PLT)、FIB-4、APRI及Child-Pugh评分,并采用受试者工作特征曲线(ROC)分析术前Child-Pugh评分、FIB-4、APRI对TACE术后ALFD的预测价值.结果 观察组术前Alb、PLT、Child-Pugh评分显著低于对照组(P＜0.05),TBil、AST、FIB-4、APRI显著高于对照组(P＜0.05),ALT较对照组比较差异无统计学意义(P＞0.05).经ROC曲线处理,结果显示术前Child-Pugh评分、FIB-4、APRI预测肝癌患者TACE术后ALFD的曲线下面积分别为0.788、0.818、0.789.结论 无创肝纤维化诊断模型FIB-4、APRI对肝癌介入治疗后ALFD风险具有一定预测价值,临床上应引起足够重视.

目的 探讨不同的栓塞材料治疗肝癌破裂出血的疗效对比.方法 回顾分析近3年收治的57例,经导管肝动脉不同的栓塞材料栓塞治疗原发性肝癌破裂出血患者的临床资料,其中使用明胶海绵19例,使用Embosphere微球21例,使用明胶海绵+Embosphere微球17例,评价各组术后肝功能变化以及即时止血和再次出血率.结果 明胶海绵组、微球组、明胶海绵+微球组之间术后肝功能指标差异无统计学意义(P>0.05);明胶海绵组栓塞术后1周内复发出血高于微球组、明胶海绵+微球组(P<0.05).结论 利用明胶海绵加Embosphere微球或者单独使用Embosphere微球经导管动脉栓塞术治疗肝癌破裂出血疗效确切,值得在临床上推广应用.

目的 探讨选择性肾周引流管代替肾造瘘管在微创经皮肾镜术后的应用效果.方法 选取江西省石城县中医院2012年1～12月收治的22例行经皮肾镜术的患者作为研究对象,根据引流方式分为对照组和观察组,每组11例.对照组采用肾造瘘管,观察组采用肾周引流管.比较两组患者的并发症发生率、继发出血量、住院时间和医疗费用.结果 观察组的并发症总发生率为18.2％,显著低于对照组的45.5％,差异有统计学意义(P＜0.05).观察组的继发出血量明显少于对照组、住院时间明显短于对照组、医疗费用明显低于对照组,差异均有统计学意义(P＜0.05).结论 与肾造瘘管比较,选择性肾周引流管的安全性高,临床效果好,可减少继发出血量、缩短住院时间和降低医疗费用.

精子DNA在起生精过程中发生细胞凋亡、受运输过程中氧自由基的影响、包装过程中染色质异常等均可诱导使DNA双链断裂导致DNA损伤.其损伤的机制主要为DNA双链发生变性或者裂解为单链.含有DNA损伤的精子可在某种程度上回避体内精子的优化选择机制而将生殖缺陷遗传给后代.精子DNA的损伤可能导致其后代出现胚胎期发育不良、先天畸形和早期流产等不良后果.为此精子DNA损伤因素的研究成了不少男科生殖专家研究的热点之一.导致精子DNA损伤的因素很多,现结合近几年国内外相关研究成果对其作一综述,为进一步研究精子DNA损害的发生原因以及男性不育的预防、治疗以及辅助生殖技术的选用提供依据.

Objective:To evaluate the efficacy of laparoscopic cholecystectomy (LC) in the early stage of cholecystolithiasis with acute pancreatitis.Methods:The clinical data of 72 patients who underwent LC for cholecystolithiasis with acute pancreatitis from Aug.2016 to Jul.2017 were retrospectively analyzed.According to the operation time,72 patients received either early(n=34) or de-layed (n=38) LC.In the early surgery group,LC was performed within one week after onset,when patients' systemic condition stabi-lized and amylase decreased to lower than 3-fold of the normal level after therapy.In the delayed group patients were cured and dis-charged from hospital with the same condition,and then LC was executed 8~12 weeks after onset.Clinical records were analyzed,inclu-ding general information,amylase level,comorbidity,severity of pancreatitis,course of preoperative treatment,operation duration,intrao-perative blood loss,complications,total hospital stay and expenses.Results:LC was performed successfully in 72 patients,and no pa-tients were converted to laparotomy.No statistically significant differences were found in operation time,intraoperative blood loss and complications between the two groups (P>0.05).The early surgery group was better than the delayed group in total hospital stay and expenses,there were statistically significant differences(P<0.05).Conclusions:LC in the early stage is a safe and feasible method for cholecystolithiasis with acute pancreatitis.It can reduce total hospital stay and expenses,and deserves to be recommended in the clinical application.

目的 探讨钬激光碎石术后双J管留置时间对肾结石患者临床疗效的影响.方法 将2017年1月—12月赣南医学院第三附属医院泌尿外科接诊的70例肾结石患者纳入本研究,按照随机数字表法分为置管2周组和置管4周组,每组各35例.2组患者均经输尿管软镜行钬激光碎石术治疗,置管2周组患者双J管留置2周,置管4周组患者双J管留置4周,比较2组患者临床指标、 结石清除效果以及双J管拔管并发症发生情况.结果 2组患者手术时间、住院时间、术后恢复时间、结石排净时间、结石清除率比较差异无统计学意义(P>0.05).置管2周组患者下尿路刺激症、管壁钙盐沉积或拔管困难以及尿路感染发生率均低于置管4周组(P<0.05).结论 钬激光碎石术后双J管留置时间长短与结石排净时间、清除率无明显关系,但可影响并发症发生率.

目的:探讨微创经皮肾穿刺取石术治疗肾结石的疗效及其对应激反应的影响.方法:选取2017年2月—2018年2月由赣南医学院第三附属医院泌尿外科确诊的肾结石患者78例,按随机数字表法分为对照组和研究组,各39例.对照组采取开放式手术治疗,研究组采取微创经皮肾穿刺取石术治疗,比较两组患者临床疗效及手术前、后应激反应水平的变化.结果:研究组手术出血量相较对照组减少,手术时间、下床活动时间及住院时间均短于对照组,且结石清除率高于对照组(P<0.05).术后1d、3d研究组去甲肾上腺素(NE)、肾上腺素(AD)、皮质醇(Cor)水平较术前均有所升高(P<0.05);术后7d,研究组上述水平与术前比较差异无统计学意义(P>0.05);对照组术后1d、3d、7d的NE、AD、Cor水平均高于术前和研究组(P<0.05).结论:采取微创经皮肾穿刺取石术治疗肾结石疗效确切,可以减少机体应激反应,促进患者术后恢复.