目的探究基于磁共振扩散加权成像(diffusion weighted imaging,DWI)的虚拟弹性成像(virtual magnetic resonance elastography,vMRE)在肝脏局灶性病变(focal liver lesion,FLL)的应用价值.材料与方法回顾性分析2021年11月至2022年6月于西安交通大学第一附属医院进行上腹部MRI检查的224例FLL患者临床及影像资料.所有患者的上腹部MRI检查序列包括常规抑脂T2WI(fat saturation T2WI,FS-T2WI)和多b值DWI,以病理或临床诊断结果将病例分为肝细胞癌、转移瘤、胆管细胞癌、血管瘤及肝囊肿五组.通过t检验或Mann-Whitney U检验比较各组间的测量值差异是否存在统计学意义,并绘制受试者工作特征(receiver operating characteristic,ROC)曲线评价vMRE的诊断效能.结果良恶性FLL的硬度值差异存在统计学意义(Z=-12.309,P<0.01),血管瘤与恶性病变的硬度值差异存在统计学意义(Z=-6.733,P<0.01).vMRE鉴别良恶性FLL的敏感度为92.2％,特异度为96.7％,曲线下面积(area under the curve,AUC)为0.981;vMRE鉴别血管瘤与恶性病变的敏感度为92.2％,特异度为88.0％,AUC为0.926.血管瘤分别与肝细胞癌(Z=-6.232,P<0.01)、转移瘤(Z=-5.975,P<0.01)、胆管细胞癌(Z=-4.313,P<0.01)三组之间差异具有统计学意义.在恶性病变中,肝细胞癌组与转移瘤组差异无统计学意义(K=1.231,P>0.05);转移瘤组与胆管细胞癌组差异具有统计学意义(K=-2.062,P<0.05);肝细胞癌组与胆管细胞癌组差异无统计学意义(K=-1.403,P>0.05).结论基于DWI的vMRE可作为一种无创性指标反映组织的硬度,有助于肝脏常见的良恶性病变鉴别诊断,可为临床中不典型血管瘤与恶性病变的鉴别诊断提供一种新型指标.

目的:在经超声内镜行胰腺检查患者中评价胰腺脂肪浸润与胰腺癌的相关性.方法:回顾性收集我院2019 年1 月至2021 年12 月行超声内镜胰腺检查的患者年龄、性别、胰腺超声内镜检查结果、胰腺占位性病变穿刺结果及临床生化指标并进行统计学分析.结果:本研究共纳入 1070 例患者,其中胰腺癌 93 例,占8.7％,胰腺脂肪浸润229 例,占21.4％,单因素相关性分析显示:年龄、性别、胰腺脂肪浸润均与胰腺癌显著相关,总胆固醇与低密度脂蛋白与胰腺癌患者中的胰腺脂肪浸润显著相关.Logistics多因素回归分析显示:年龄、性别、胰腺脂肪浸润均为胰腺癌的独立危险因素.结论:胰腺脂肪浸润与胰腺癌显著相关并是其独立的危险因素.

Objective:To investigate the clinicopathological features and surgical efficacy of primary hepatic angiosarcoma (PHA).Methods:Clinical data of 4 patients who were pathologically diagnosed with PHA and underwent surgical resection in the First Affiliated Hospital of Xi'an Jiaotong University from January 2000 to December 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Literature was retrieved in CNKI, Wanfang Data and PubMed using the keywords of "primary hepatic angiosarcoma" in both Chinese and English. 49 patients who were pathologically diagnosed with PHA and underwent surgical resection were included. The expression levels of CD31, CD34, Vimentin, coagulation factor Ⅷ (FⅧ) and Ki-67 in the tumor were quantitatively detected. Clinicopathological features and clinical prognosis of PHA were summarized and analyzed.Results:A total of 53 patients with PHA were included in the study, 26 male and 27 female, aged (57±3) years on average. Abdominal pain was observed in 28 cases, abdominal distension or upper abdominal discomfort in 5, fever in 1, abdominal mass in 1, lumbago in 1, costal region pain in 1, cough complicated with chest tightness and shortness of breath in 1, and no evident clinical symptoms in 15. 37 cases were diagnosed with single onset and 16 cases of multiple onset. The tumors of 12 cases were located in the left lobe, 32 in the right lobe, 1 in the middle lobe, 3 in the bilateral lobes, 2 in the whole lobe, and tumor location in 3 cases was not described. The maximum diameter of tumor was ranged from 1.7 to 25.0 cm. The tumor was solid, moderate texture and encapsulated. The tumor cells presented in oval or short-spindle shape, arranged in lamellar or staggered pattern, with significant cellular atypia. Immunohistochemical staining showed that the positive rate of CD31 was 78%(21/27), CD34 was 78%(21/27), Vimentin 58%(21/36), FⅧ 44%(12/27) and Ki-67 30%(8/27). Among 49 patients undergoing surgical resection, 13 cases were treated with preventive intravenous chemotherapy and 6 cases received preventive interventional therapy. 4 patients in our hospital were not treated with chemotherapy or interventional therapy. During the follow-up, 1 patient recurred, 2 cases developed liver failure and 1 metastasis.Conclusions:PHA is rarely seen in clinical practice and is lack of specific clinical manifestations and diagnosis parameters. It is difficult to deliver prompt diagnosis and easily misdiagnosed as other liver tumors. Surgical resection is the main treatment. The diagnostic confirmation relies on the pathological examination. Surgical resection combined with regular postoperative follow-up can yield definite efficacy and improve the clinical prognosis.

目的:研究多参数MRI与肝体积相结合的肝功能定量评价模型.方法:收集101例钆塞酸二钠增强MRI肝硬化患者的影像数据.测量钆塞酸二钠增强前后20 min肝脏、脾脏和竖脊肌的信号强度,获得相应参数.基于体素内不相干运动获得扩散系数(D)、假扩散系数(D*)和灌注分数(f).使用三维图像软件获得肝体积的相关参数(V肝、V脾和V肝/V脾).从3种方法中选择评估肝功能效能最优的参数,建立肝功能评价的多元回归模型并验证.结果:建模组中,相对增强度(RE)、D*、V肝/V脾在不同肝功能组间差异显著,区分Child-Pugh A和Child-Pugh B、C组具有最高的AUC值.经多元回归得到肝功能定量评估模型:F(x)=3.96-1.243XRE-0.034XD*-0.080×V肝/V脾.结论:多参数MRI联合肝体积可对肝功能进行分级,有望用于肝功能的无创定量评估.

目的:探讨溃疡性结肠炎(UC)患者生存质量与应对方式、心理状态的关系,并分析生存质量的影响因素.方法:选取2018年4月～2020年8月期间我院收治的183例UC患者.采用中文版医学应对问卷(MCMQ)评估患者对疾病的应对方式.采用炎症性肠病生存质量问卷(IBDQ)对患者生存质量进行评价.采用焦虑自评症状表(SAS)、抑郁自评症状表(SDS)评估患者心理状态.Pearson相关性分析UC患者生存质量与应对方式、心理状态的关系,应用单因素及多因素Logistic回归分析生存质量的影响因素.结果:UC患者全身症状、肠道症状、社会能力、情感能力、IBDQ总分均低于国内常模(P＜0.05).UC患者SAS、SDS评分均高于国内常模(P＜0.05).UC患者回避、屈服评分均高于国内常模,面对评分低于国内常模(P＜0.05).Pearson相关性分析结果显示:IBDQ总分与SAS、SDS以及回避、屈服评分均呈负相关,与面对评分呈正相关(P＜0.05).单因素分析结果显示:UC患者的生存质量与病情严重程度、婚姻状况、饮酒史、文化程度、性别、家族史、吸烟史、饮食习惯、家庭月均收入、肠道手术史有关(P＜0.05).多因素Logistic回归分析结果显示:病情严重程度为重度、性别女、有家族史、有吸烟史、不良饮食习惯、家庭月均收入≤5000元均是影响UC患者生存质量的危险因素(P＜0.05).结论:UC患者生存质量下降,其生存质量与应对方式、心理状态有关,且受到性别、家族史、病情严重程度等多种因素影响,临床可考虑针对上述影响因素进行相关防治,以改善UC患者生存质量.

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 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:研究炎症性肠病(IBD)患者希望水平与应对方式、心理韧性和社会支持的关系.方法:选取我院于2018年10月～2020年10月期间收治的IBD患者137例.采用Herth希望量表(HHI)评价患者希望水平;采用医学应对方式问卷(MCMQ)评估患者面对疾病时所选取的应对方式;采用心理韧性量表(CD-RISC)对患者心理韧性进行评估;采用社会支持评定量表(SSRS)评价患者社会支持情况.将上述评分与国内常模进行对比,采用Pearson相关性分析IBD患者希望水平与应对方式、心理韧性和社会支持的关系.结果:IBD患者与他人保持亲密的态度关系、现实和未来的积极态度、采取积极的行动评分及总分均低于国内常模(P＜0.05).IBD患者面对评分低于国内常模,回避、屈服评分均高于国内常模(P＜0.05).IBD患者力量、乐观和坚韧评分均低于国内常模(P＜0.05).IBD患者主观支持、客观支持和对社会支持的利用度评分均低于国内常模(P＜0.05).Pearson相关性分析结果显示,HHI总分与面对、力量、乐观、坚韧、主观支持、客观支持和对社会支持的利用度呈正相关,而与回避、屈服呈负相关(P＜0.05).结论:大多数IBD患者处于中等希望水平,良好的应对方式、心理韧性和社会支持有助于患者希望水平的提高.

目的:探讨白藜芦醇(Res)对结肠癌恶性生物学行为的抑制作用.方法:通过CCK-8细胞增殖实验、流式细胞仪分别检测不同剂量Res对结肠癌细胞增殖和细胞周期的作用.构建结肠癌模型大鼠,随机分为对照组、模型组、Res低剂量组(20 mg/kg)和Res高剂量组(40 mg/kg).采用HE染色法观察结肠癌组织形态.采用TUNEL法检测结肠组织凋亡细胞的发生.结果:体外实验发现,Res抑制体外结肠癌细胞增殖,呈剂量依赖性;随着Res剂量的增高,S期和G2/M期结肠癌细胞比例增加,G0/G1期细胞比例减少(均P<0.05).体内实验发现,Res组大鼠结肠组织病理改变较模型组减轻,肿瘤仅局限于黏膜层和肌层;与模型组相比,Res低剂量组和Res高剂量组凋亡细胞数明显增多(均P<0.05).结论:Res可抑制体外结肠癌HT-29、SW480和LoVo细胞增殖,促进体内结肠癌细胞凋亡,且呈剂量依赖性,为结肠癌的新型药物治疗提供了新的思路.

Objective:To investigate the effects of adherent-invasive Escherichia coli ( E. coli) LF82 on the structure and function of intestinal barrier in mice with ulcerative colitis (UC). Methods:Twenty-four specific pathogen free (SPF) C57BL/6 mice were divided into UC with E. coli LF82 group, UC group and healthy control group with eight mice in each group. The UC mice model was induced by dextran sulfate sodium (DSS). One week before modeling, the mice of UC with E. coli LF82 group were intragastric administrated with 1×10 9 colony-forming unit (CFU) E. coli LF82 to colonize the bacteria strain. The effects of E. coli LF82 on colitis of mice with UC were evaluated by disease activity index (DAI), gross morphological injury score, colonic mucosal injury index (CMDI), myeoloperoxidase (MPO) activity and pathological features. The ultrastructure and the changes of cytoskeleton F-actin of mice colonic tissues were detected by transmission electron microscope (TEM) and direct immunofluorescence. The ability of colonic mucin production and degree of fibrosis were estimated by periodic acid Schiff reaction (PAS) stain and sirius red stain. T test, least significant difference, repeated measurement analysis of variance and one-way analysis of variance were used for statistical analysis. Results:On the fourth, fifth, sixth and seventh day after the modeling, the DAI scores of UC with E. coli LF82 group were all higher than those of UC group ((2.53±0.38) points vs. (2.01±0.53) points, (3.02±0.62) points vs. (2.67±0.24) points, (3.13±0.61) points vs. (2.20±0.24) points, (3.27±0.28) points vs. (2.20±0.69) points, respectively), and the differences were statistically significant ( t=3.37, 2.25, 9.56 and 10.24, all P<0.05). The gross morphological injury score of mice colon of UC with E. coli LF82 group was higher than that of UC group ((6.17±1.94) points vs. (2.83±0.98) points), and the difference was statistically significant ( t=-3.75, P<0.05). The CMDI and MPO activity of UC with E. coli LF82 group were both higher than those of UC group ((16.80±2.79) points vs. (11.80±3.11) points, (729.3±77.5) U/mg vs. (594.4±31.9) U/mg), and the differences were statistically significant ( t=-2.83; mean difference=134.82, 95% confidence interval ( CI) 72.12 to 197.51; both P<0.05). The results of TEM showed that the E. coli LF82 could invade the submucosa of colon and caused further injury of colonic tissues in mice. The distribution of cytoskeleton F-actin of mice colonic tissues changed. The results of PAS staining showed that the percentages of PAS positive cells of UC with E. coli LF82 group and UC group were both lower than that of healthy control group ((32.40±8.02)% and (41.90±8.99)% vs. (57.70±11.52)%), and the difference was statistically significant ( F=17.63, P<0.01). The percentage of PAS positive cells of UC with E. coli LF82 group was lower than that of UC group, and the difference was statistically significant (mean difference=-9.50, 95% CI -18.33 to -0.67, P<0.05). The results of sirius red staining showed that the villous epithelium of colon mucosa of UC with E. coli LF82 group was partially injured and collagen fibers hyperplasia was serious. The area ratios of collagen fiber of UC with E. coli LF82 group and UC group were both higher than that of healthy control group ((51.83±5.78)% and (37.11±5.59)% vs. (15.41±2.25) %), and the difference was statistically significant ( F=86.72, P<0.01). The area ratio of collagen fiber of UC with E. coli LF82 group was higher than that of UC group, the difference was statistically significant (mean difference=14.83, 95% CI 8.91 to 20.76, P<0.05). Conclusions:E. coli LF82 can aggravate DSS-induced colitis in UC mice, leading to changes in colon ultrastructure and cytoskeleton, it can also reduce the ability of mucus secretion of colon of mice and increase the degree of colonic tissues fibrosis.

目的:探讨在对晚期肿瘤患者临床护理中实施安宁护理所发挥出的作用.方法:本次研究以我院接受治疗的 32 例晚期肿瘤患者为主,收治时间为 2018 年 11月-2019 年 7 月,将其分为两组,采用常规护理、安宁护理两种干预手段,分别作用于对照组和观察组.结果:观察组患者的疼痛评分和幸福感评分由干预前的(8.65±0. 14)分、(16.25±6.24)分改善至干预后 3 个月后的(4.56±0.42)分、(27.52±5.45)分,与常规护理干预后的对照组(6.02±0.48)分、(21.45±5.47)分相比较,组间差值具有可比性(P＜0.05).结果:在安宁护理模式下,对晚期肿瘤患者的饮食、生活、心理等方面给予相应的护理服务,在一定程度上可缓解患者身体上的疼痛,增加幸福感,使其安稳的度过最后的时光,在临床护理中具有较高的使用价值.

目的 讨论新辅助化疗联合同步放化疗对中晚期宫颈癌治疗疗效,为改善中晚期宫颈癌患者生活质量,提高存活率提供统计依据.方法 选取2016年8月～2018年12月来就诊的69例中晚期宫颈癌患者作为调查样本,并分为实验组和对照组,实验组采用紫杉醇联合顺铂新辅助化疗以及同步放化疗,对照组采用顺铂进行同步化疗,并通过回顾分析对比两组患者治疗情况.结果 实验组治疗效果优于对照组,差异有统计学意义(P<0.05),统计差异显著.结论 新辅助化疗联合同步放化疗对中晚期宫颈癌患者具有显著疗效,在临床推广中具有较高价值.

目的 探讨超声内镜(endoscopic ultrasonography,EUS)联合精细血流成像(fine flow imaging,FL)及细针穿刺术(fine needle aspiration,FNA)在诊断壶腹周围可疑占位病变的价值.方法 回顾性纳入2014年11月至2016年12月在西安交通大学第二附属医院消化内科的可疑壶腹部占位患者.对所有的纳入患者行EUS检查,最后诊断以术后病理与临床追踪为金标准.比较分析EUS及其辅助技术诊断壶腹周围可疑占位的准确率,并分析EUS及其辅助技术在诊断壶腹部恶性肿瘤中特殊价值.结果 共纳入52例壶腹周围可疑占位患者,单纯使用EUS的诊断准确率为40.4％(21/52),EUS联合FL后诊断准确率增加至57.7％(30/52),最后结合FNA结果,准确率上升至86.5％(45/52).对于诊断壶腹部恶性肿瘤,EUS联合FL技术的敏感性为30.4％,特异性为79.3％;EUS联合FL及FNA技术的敏感性为78.3％,特异性为89.7％.结论 EUS联合FL及FNA在诊断壶腹周围可疑占位病变中有较高的诊断价值.

目的 研究粒细胞巨噬细胞集落刺激因子(granulocyte macrophage colony-stimulating factor,GM-CSF)及其动员的骨髓源性细胞促进创伤愈合的作用途径.方法 采用正常小鼠及化疗、放疗引起的骨髓抑制小鼠模型,背部形成创面,分别给予皮下注射高、低剂量(50,17 μg·kg-1) GM-CSF,测量创伤愈合程度;采用MTT观察不同浓度下猪髋动脉内皮细胞(pig iliac endothelium cells,PIECs)增殖状况;采用Matrigel基质胶培养人脐静脉内皮细胞和小鼠动脉环,并给予100 ng·mL-1 GM-CSF,观察其微管结构形成情况.结果 在小鼠创伤愈合模型中,高剂量GM-CSF(50μg·kg-1)组创面修复较低剂量更为明显;在小鼠骨髓抑制模型中,低剂量GM-CSF促进骨髓抑制小鼠的创伤愈合;GM-CSF在0.01～781.25 ng·mL-1明显促进PIECs的增殖;GM-CSF 100 ng·mL-1明显促进人脐静脉内皮细胞和动脉环周围微管形成.结论 GM-CSF通过动员骨髓源性细胞和作用于内皮细胞促进创伤愈合.

OBJECTIVE To investigate the anti-tumor effect of total saponins of Aralia white(TSAW) in vitro and in vivo.METHODS The cytotoxicity of TSAW to mouse B16 melanoma cells,H22 hepatoma cells and FBL3 erythroleukemia cells were tested by cell inhibitory assay.The inhibitory effect of TSAW on S180 and H22 tumor growth were observed in mice.RESULTS The proliferations of B16 cells,FBL3 cells and mice H22 cells were inhibited by TSAW in vitro.IC50 of B16 and FBL3 were 0.077 4 g·L-1and 0.199 g·L-1 respectively.The inhibitory rate of TSAW on H22 cells proliferation was more than 80% in the concentration range 0.02-3.2 g·L-1 in vitro.The inhibitory rates of TSAW on S180 tumor growth were 16.9%,37.1% and 27.0%,at 100,200 and 300 mg·kg oral dose respectively in vivo,and on H22 tumor weight were 23.7%,10% and 13.4% at the same dosage series.CONCLUSION TSAW showed anti-tumor activities in vitro in the concentration range 0.02-3.2 g·L-1 and in vivo with the oral dosage of 200-300 mg·kg-1 in mice.

OBJECTIVE To study the antitumor and immunological regulation effects of Qibai capsule on mice bearing uterine cervical carcinoma(U14).METHODS The mice bearing U14 model was made through injecting cancer cells in the right limb armpit,and the mice were administrated Qibai capsule for 8 days.Then we detached the tumors and counted the inhibitory rate of tumor growth.The phagocytosis ability of macrophage,serum hemolysin concentration and anoxia tolerance were measured.RESULTS Qibai capsule was proved to be effective in the mice bearing U14.The maximum inhibitory rate of the dose of 0.8 g·kg-1was 35.6%.Qibai capsule could strengthen the phagocytosis of macrophage,prompt the serum hemolysin concentration and improve the ability of toleration of oxygen deficit in the mice bearing U14.CONCLUSION Qibai capsule can inhibit the growth of transplanted tumor,and improve the immunological function in mice bearing U14.

OBJECTIVE To investigate the vasodilatative effect of Danhong injection on rat abdominal aorta,and elucidate its possible mechanism of actions.METHODS The effects of Danhong injection on norepinephrine or potassium chloride treated blood vessels were observed in vivo and in vitro.The effects on the flow rate of arterial perfusion of rat hindlimb and the tensile force of rat aorta ring were measured.The mechanism pf actions of Danhong injection in relaxation of rat aorta was explored with potassium channel blockers,caffeine and Ca2+-free-Krebs solution perfusion.RESULTS The reduction of flow rate caused by norepinephrine was significantly rescued by Danhong injection at a concentration of 0.3-3 mL·L-1.Menwhile,3 mL·L-1 of Danhong injection also mildly ameliorated the decrease of blood supply induced by 30 mol·L-1 of potassium.0.3-40 mL·L-1 of Danhong injection significantly decreased the tension of high level norepinephrine or K+perfusion solution treated rat abdominal aortic rings with or without endothelium.The amplitudes of relaxation in aorta rings with endothelium were more than that in aorta rings without endothelium perfused with 3-40 ml·L-1 of Danhong injection.No effects of potassium channel blockers TEA or 4-Ap on aorta ring tensile force were observed.20 mL·L-1 Danhong injection mildly inhibited vascular smooth muscle which was pre-contracted by NE in Ca2+-free-Krebs solution.But it significantly inhibited vascular smooth muscle pre-contracted by NE in Ca2+-Krebs solution.No effects of Danhong injective on caffeine preconstricted rat aortic rings were found.CONCLUSION Danhong injection showed a significant vasodilatation effect on vessels contracted by norepinephrine.Danhong injection inhibited norepinephrine-induced arterial contraction by reducing Ca2+ influx through receptor operated calcium channel and voltage-dependent calcium channel on smooth muscle cells in blood vessels.Danhong injection also showed a significant vasodilatative effect on aorta rings partly via endothelium.