目的 本研究主要对消化内镜治疗上消化道出血的治疗价值进行分析.方法 选取2019年9月至2020年12月牡丹江医学院附属红旗医院收治的72例上消化道出血患者为研究对象,按照入院先后顺序分组,将36例先入院的患者作为对照组,后入院的36例患者作为试验组.对照组给予药物治疗,试验组行消化内镜治疗.比较两组治疗效果、并发症发生率和炎性反应情况.结果 试验组治疗有效率97.22％高于对照组的77.78％,并发症发生率2.78％低于对照组的16.67％,差异均有统计学意义?(P<0.05).治疗前,两组炎性指标情况比较,差异无统计学意义?(P>0.05);治疗后,试验组各炎性指标均低于对照组?(P<0.05).结论 应将消化内镜应用于上消化道出血的治疗中,治疗效果理想,安全性高.

目的:研究 ERCP 术后患者采用消化道清洁预防胆道感染的作用及机制.方法:此次研究选取我院 2016 年 10 月-2019 年 10 月期间接收的经内镜逆行胰胆管造影术(ERCP)诊疗患者 150 例,根据电脑随机选取方式将所有患者分成对照与观察两组各有 75 例,两组分别采用常规生理盐水和阿米卡星预防术后胆道感染,分别收集内镜操作初和内镜操作末的细菌标本,通过细菌培养以及菌落计数分析对比两组患者术后胆管炎发生率和细菌检测结果 .结果:通过最终分析对比发现,观察组患者术后胆道感染发生率、内镜操作初及操作末的细菌培养阳性率均与对照组数据比较均较低,两组数据差异有统计学意义(P<0.05).结论:对 ERCP 术患者通过加强口腔盐水漱口护理同时配合消化道冲洗清洁预防,能够有效降低微生物带入胆管,从而减少患者术后胆道感染的发生几率,确保患者 ERCP 诊疗安全性.

目的:通过免疫组织化学技术研究 TGF－β1、p27 蛋白、Hp 在胃癌中的表达及其与胃癌侵袭、转移之间的关系;探讨 TGF－β1、p27 蛋白、Hp 三者之间的相互关系.方法:采用免疫组化 S－P 法、Warthin－stary银染色法,对 46 例经手术治疗的胃癌病例和 15 例正常胃黏膜组织石蜡标本进行 TGF－β1、p27 蛋白、Hp 检测.结果:胃癌组织中 TGF－β1 呈强阳性,Hp 呈高表达,p27 蛋白呈弱阳性.正常黏膜组织中 TGF－β1 呈弱阳性、Hp 呈低表达,p27 蛋白呈强阳性.相关分析表明:①TGF－β1 的表达在胃癌不同分化程度、临床分期、有无淋巴结转移组间差异有显著性(P＜0.05 或 P＜0.01);②p27 蛋白表达与胃癌分化程度无关(P＞0.05),在临床病理分期Ⅲ/Ⅳ期表达率低于临床病理分期Ⅰ/Ⅱ期组,有淋巴结转移组表达率低于无淋巴结转移组,差异有显著性(P＜0.01);③Hp 表达在胃癌不同分化程度、临床分期、有无淋巴结转移组间差异有显著性(P＜0.05).结论:①TGF－β1、Hp 的阳性表达及 p27 蛋白的失表达与胃癌的发生、发展、转移有关;②联合检测 TGF－β1、p27 蛋白、Hp 为胃癌侵袭和转移的研究提供依据,对胃癌的诊断、治疗、预后判断有一定的价值.

The aim of the present study was to investigate the association between serum carbohydrate antigen (CA)19-9 and CA125 levels, and human epidermal growth factor receptor 2 (HER2) expression in patients with gastric cancer, as well as to identify any correlation between them and the risk of recurrence and metastasis. A total of 256 patients were enrolled in the present study, and 219 patients were followed-up to investigate recurrence and metastasis of gastric cancer. Immunohistochemistry was used to detect HER-2 in gastric adenocarcinoma and paracancerous tissues. The positive rate of CA19-9 and CA125 in stages III/IV was higher compared with that in stages I/II. The positive rate of HER2 in distinct stages of gastric cancer was not statistically different. Serum CA19-9 and CA125 were not associated with the positive expression of HER2. The recurrence and metastasis of CA19-9, CA125 and HER2-positive gastric cancer were increased compared with those experienced by CA19-9, CA125 and HER2-negative patients. Age, stage and preoperative tumor markers were associated with 3-year prognosis of gastric cancer. HER2 [odds ratio (OR)=2.55] and CA19-9 (OR=1.22) were independent prognostic factors in patients with gastric cancer. CA19-9, CA125 and HER2 may be used to predict the recurrence or metastasis of gastric cancer. The combined detection may be able to improve the sensitivity and efficiency of predicting the recurrence or metastasis of gastric cancer. Preoperative positive serum for CA19-9 and CA125 were associated with poor prognosis in patients with gastric cancer. CA19-9 and HER2 were independent prognostic factors of gastric cancer.

PI3K/AKT signaling pathway plays an important role in tumor occurrence by reducing cancer cell apoptosis through upregulating Bcl-2 expression. PTEN can negatively regulate PTEN/AKT signaling pathway, while DJ-1 is the negative regulator of PTEN. DJ-1 upregulation is associated with various tumor occurrences. MiR-155 is significantly declined in hepatoma tissue and related to prognosis. Bioinformatics analysis showed the complementary binding site between miR-365 and DJ-1. This study aimed to investigate the role of miR-365 in regulating DJ-1-PTEN/PI3K/ AKT signaling pathway and affecting hepatoma cell proliferation and apoptosis. Dual luciferase assay confirmed the targeted relationship between miR-365 and DJ-1. Hepatocellular carcinoma cell lines, HCCLM3, MHCC97-L, and HL-7702 cells were cultured in vitro. Cell proliferation was evaluated by EdU staining. Expressions of MiR-365, DJ-1, PTEN, p-AKT, and Bcl-2 expressions were measured. HCCLM3 cells were divided into five groups, including Scramble NC, miR-365 mimic, si-NC, si-DJ-1, and miR-365 mimic + si-DJ-1 groups. Cell apoptosis was determined by flow cytometry. MiR-365 targeted inhibited DJ-1 expression. MiR-365 and PTEN significantly downregulated, while p-AKT, Bcl-2 and cell proliferation obviously elevated in HCCLM3 and MHCC97-L cells compared with HL-7702 cells. MiR365 mimic and/or si-DJ-1 transfection markedly reduced DJ-1, p-AKT, and Bcl-2 levels, upregulated PTEN expression, attenuated cell proliferation, and enhanced cell apoptosis. MiR-365 downregulated, while DJ-1 increased in hepatoma cells. MiR-365 overexpression promoted hepatoma cell apoptosis and inhibited proliferation by targeted suppressing DJ-1 expression to elevate PTEN expression and alleviate PI3K/AKT signaling pathway activity.

目的 探讨SP结合PBL教学模式在消化内科临床见习课中的应用效果.方法 选取2014级五年制临床专业学生72名,随机分为实验组和对照组,实验组采用标准化患者(SP)结合以问题为中心(PBL)的教学模式,而对照组则采用传统的PBL教学模式.结果 将实验组和对照组见习学习效果进行比较,SP结合PBL教学模式优于单纯PBL教学模式,实验组学生对SP结合PBL教学模式的教学满意度及对自身能力提高的评价均高于对照组.结论 SP结合PBL教学模式可以提升消化内科见习课的见习效果,值得进一步推广和研究.

OBJECTIVE:To observe clinical efficacy and safety of Astragalus injection combined with neoadjuvant chemother-apy and three dimensional conformal radiotherapy in the treatment of colorectal cancer. METHODS:A total of 80 patients with me-dium and advanced colorectal cancer were selected from oncology department of our hospital during Jun. 2010 to Jun. 2014,and di-vided into observation group and control group according to random number table,with 40 cases in each group. Control group re-ceived neoadjuvant chemotherapy combined with three-dimensional conformal radiotherapy. Observation group was additionally giv-en Astragalus injection 10-20 mL added into 5％ Glucose injection 250-500 mL,ivgtt,qd,on the basis of control group. A treat-ment course lasted for 21 d,and both groups received 3 courses. Short-term efficacies as well as immune indexes [CD3+,CD4+, CD4+/CD8+ and NK cells] before and after treatment were observed in 2 groups. The occurrence of ADR and survival situation were compared between 2 groups. RESULTS:Clinical response rate of observation group was 87.5％,which was slightly higher than that of control group(77.5％),but there was no statistical significance(P>0.05). Before treatment,there was no statistical signifi-cance in immune index levels between 2 groups(P>0.05). After treatment,NK cells,CD3+,CD4+ and CD4+/CD8+ levels of con-trol group were decreased significantly,which was significantly lower than observation group,with statistical significance (P<0.05). There was no statistical significance in the incidence of ADR between 2 groups(P>0.05). Two-year survival rate of observa-tion group was significantly higher than that of control group;the recurrence rate and distant metastasis rate were significantly low-er than control group,with statistical significance(P<0.05). CONCLUSIONS:Astragalus injection not only can improve therapeu-tic efficacy of neoadjuvant chemotherapy in patients with colorectal cancer,balance inflammatory state,improve survival rate,re-duce recurrence rate and distant metastasis rate with good safety.

OBJECTIVE:To study the effects of ginsenoside CK combined with 5-fluorouracil (5-FU) on the proliferation, apoptosis and epithelial mesenchymal transition (EMT) of human pancreatic cancer PANC-1 cells. METHODS:PANC-1 cells of logarithmic growth phase were randomly divided into blank control group,ginsenoside CK group (30 mg/L),5-FU group (25 mg/L)and combination group(ginsenoside CK 30 mg/L+5-FU 25 mg/L). MTT method was used to detect the cell proliferation in-hibition rate in each group after 24,48,72 h;flow cytometry was used to detect the cell apoptosis rate after 48 h;enzyme-linked immunosorbent assay was used to detect the fibronectin expression in cells after 24,48,72,96 h;and Western blot was used to detect the expressions of vimentin,N-cadherin,E-cadherin,protein kinase(Akt)and phosphorylated Akt(p-Akt)protein in cells after 48 h. RESULTS:Compared with blank control group,the cell proliferation inhibition rate,early and late apoptotic rates,pro-tein expression level of E-cadherin in ginsenoside CK group,5-FU group and combination group were obviously increased (P<0.05),while the protein expression levels of fibronectin,vimentin,N-cadherin,and p-Akt/Akt levels were obviously decreased (P<0.05);the effects of above-mentioned indexes in combination group were superior to ginsenoside CK group and 5-FU group (P<0.05). CONCLUSIONS:Both ginsenoside CK and 5-FU can inhibit the proliferation of PANC-1 cells,induce their apoptosis and inhibit EMT,which may be associated with inhibiting phosphatidylinositol 3-kinase/Akt pathway. In addition,the combination of ginsenoside CK and 5-FU can produce a better effect.

目的：探讨乳腺癌术后辅助化疗致转氨酶异常的有效防治方法。方法设立对照分析，两组均采用复方苦参注射液加异甘草酸镁注射液防治转氨酶异常，对照组实施化疗护理常规，观察组在其基础上加舒适护理，对比观察疗效。结果经过临床治疗和精心护理，两组患者经上述治疗及护理后，未出现转氨酶升高者，所有患者均完成既定化疗疗程。观察组中2例患者静点过程中有药液外渗；对照组有3例患者出现肺炎、1例口腔感染、4例出现静点药物外渗，其术后不良反应发生率为18.18%；明显高于观察组患者的4.54%，组间比较差异具有统计学意义。两组药液外渗及感染患者经对症治疗均治愈；观察组局患者对治疗和护理的满意率为44/44（100.00%），对照组患者对治疗和护理的满意率40/44（90.91%）。两组患者满意率比较差异具有统计学意义，P＜0.05。结论给予乳腺癌术后辅助化疗患者实施化疗护理常规加舒适护理配合药物防治转氨酶异常效果肯定，提高患者满意率。

目的：探讨乳腺癌术后化疗致白细胞减少的护理办法。方法选取2010年12月至2011年6月我院收治的78例乳腺癌患者，随机将其分为两组，各39例，对照组患者采用化疗常规护理，观察组在对照组的基础之上，进行血液系统疾病常规护理。结果经过一系列的细心护理和临床治疗工作，两组患者的白细胞均在短时间内恢复正常，有效地确保了化疗进行，均顺利治愈；对照组出现了11例感染（4例皮肤感染、4例口腔感染、3例肺炎）；观察组仅有2例出现皮肤感染和口腔感染。结论与化疗常规护理相比，血液系统疾病常规护理能够更好地避免患者在手术后出现辅助化疗感染。

目的研究优质护理服务模式在肿瘤内科住院病房的应用效果。方法将160例入住我院肿瘤内科住院病房患者的临床资料随机均分为对照组和观察组。对照组采用肿瘤内科常规护理;观察组采用优质护理服务模式,包括心理干预制度、社会干预制度、术后回访制度。比较两组护理缺陷发生率、并发症发生率、护患纠纷以及患者满意度。结果实施优质护理模式后,观察组肿瘤内科住院病房护理缺陷、并发症发生率、护患纠纷明显降低,组间比较具有统计学差异(P<0.05);观察组患者对护理满意度明显提高,组间比较具有统计学差异(P<0.05)。结论优质护理服务对肿瘤内科护理人员素质提高有很大帮助,降低了护理中的缺陷,提高了患者满意度。

目的探讨预见性护理对中年乳腺癌患者术后乳房形态恢复的作用,并与常规护理的效果进行比较和评价。方法设立对照分析,预见性护理组(实验组)与常规护理组(对照组)各40例,观察术后一个月两组患者乳房形态恢复状况。结果实验组乳房形态恢复评估优良率高于对照组患者;实验组评估优例数显著高于对照组(P<0.01)。结论预见性护理有助于中年乳腺癌患者术后的乳房形态恢复,值得临床推广。

目的研究优质护理对肿瘤晚期患者疼痛的临床效果及其对患者生存质量的影响。方法将入住我院的160例晚期肿瘤患者的临床资料均分为对照组和观察组。对照组采用常规肿瘤护理方法,观察组根据患者疼痛进行评估,确定疼痛分值,在此基础上制定个性化治疗方案和针对性护理。结果采用优质护理的观察组患者疼痛评估和护理顺利完成,74例患者的疼痛得到有效控制;患者生存质量明显提高。结论优质护理对肿瘤晚期患者疼痛的临床效果及其生存质量有明显提高,将评估、治疗、护理三者有机结合,可以最大程度的发挥治疗效果,值得临床推广并应用。

目的探讨肿瘤住院患者常见的护理安全问题及护理管理对策。方法对非惩罚性自动上报系统呈报的100例不良事件进行了护理安全管理问题归纳分类及其分析。结果肿瘤患者安全管理不到位70例(占70.0%),护理规章制度落实不到位21例(占21.0%),护患沟通不足4例(占4.0%),器械物资管理不规范5例(占5.0%)。结论为了确保肿瘤住院患者处于一个安全的环境中,护理人员应高度重视对患者科学规范的护理,不断强化护理安全意识以及加强核心制度的落实,从而达到护患身心安全之目的。

胃食管反流病是指由于胃内容物反流,进而引起不适症状和(或)并发症的一种疾病,典型表现为烧心、反酸、胸骨后疼痛[1],症状严重时会对生活和工作造成一定影响。胃食管反流病的治疗主要包括非药物治疗,药物治疗,内镜下治疗以及外科治疗4个方面。本文主要就胃食管反流病的治疗做一浅显探讨。

目的:探讨治疗慢性粒细胞性白血病疗效显著、可延长患者生存期且不良反应发生率低的有效方法。方法:回顾性分析2001年～2009年我科治疗的99例慢性粒细胞性白血病病例,比较干扰素联合羟基脲化疗法(对照组Ⅰ)、清肝化瘀汤配合羟基脲化疗疗法(对照组Ⅱ)和中医辨证配合伊马替尼疗法(治疗组)的临床疗效,比较患者生存期并观察不良反应发生情况。结果:治疗组6个月内血液学完全缓解率90.9%,疗效显著优于2个对照组(P<0.01);治疗组血液学有效率及36个月生存率明显优于2个对照组(P<0.05);治疗组不良反应发生率明显低于2个对照组。结论:中医辨证配合伊马替尼疗法治疗CML疗效显著,可延长患者生存期,不良反应发生率低。

在内科综合治疗的基础上进一步行外科手术治疗是梗阻型胆源性胰腺炎的传统治疗方法[1]。但在近年,随着治疗性逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)、内镜下乳头括约肌切开术(endoscopic sphincterot-omy,EST)以及鼻胆管引流(endoscopic nasobiliary drainage,ENBD)等新兴技术以及不断成熟的腹腔镜技术,梗阻型胆源性胰腺炎的治疗方法得到了进一步的发展,即微创治疗[2]。对于急性胆源性胰腺炎的治疗,ERCP的治疗原则是针对病因,解除梗阻,引流胆汁,降低胰管内压力,该方法具有创伤小,恢复快以及并发症发生率低等优点,是ABP的理想治疗方法。下面我们就此做一浅显讨论。

炎症性肠病(IBD)是一类病因以及发病机制尚不能够完全明确的肠道慢性非特异性炎症性疾病,该疾病的发病涉及多种因素的共同作用。益生菌是近10余年用于IBD治疗的新兴药物,本文主要就益生菌在IBD治疗中的应用做一浅显探讨。