Objective:To explore the rational mode of hospital management under the trusteeship mode through the case study of a county-level hospital entrusted by a large general public hospital.Methods:Based on the system construction,the complete sinking of quality medical resources,the cultivation of talents and cultural integration,this paper analyzed the current situation of medical technology and service quality in hospitals before and after trusteeship by a retrospective control study.Results:The medical technology,quality and patient satisfaction of the hospital were improved significantly after trusteeship.Conclusions:The effective measures in the process of trusteeship of county-level hospitals are conducive to improve the level of medical technology and service of county -level hospitals,which can ensure the quality and safety of medical treatment,provide valuable suggestions for decision-making,and promote the development of hierarchical diagnosis and treatment.

Objective To explore the short and long-term efficacy of extralevator abdominoperineal excision (ELAPE)vs.conventional abdominoperineal excision (APE)on distal rectal cancer.Methods Relevant studies were identified by search of Medline,EMBASE,and Web of Science published between January 1,2008 and February 28,2015,and included in the systematic review and meta-analysis with Stata software (version 12.0). Results Our Meta-analysis included 14 studies involving 3278 patients,of whom 1843 (56.2%)underwent ELAPE and 1435 (43.8%)underwent APE.Compared with patients undergoing APE,those undergoing ELAPE had a significantly reduced risk of intraoperative bowel perforation (IBP)involvement (OR=0 .55 ,95% CI= 0 .37-0 .85 ),but no significant reduction in the occurrence of CRM positivity (OR=0 .81 ,95% CI=0 .52-1 .25 ), local recurrence (LR)(OR=0.49,95% CI=0.18-1.30),wound complications (WCs)(OR=0.93,95% CI=0.65-1.35)or in-hospital death (IHD)(OR=0.89,95% CI=0.47-1.71).Conclusion ELAPE can reduce the risk of IBP but not for CRM positivity or LR when compared with APE.Therefore,more higher-quality studies are needed to verify the short-and long-term effects of ELAPE procedure on distal rectal cancer.

目的:探讨骶前冲洗液类型、冲洗量与直肠癌前切除术后复发风险关系.方法:采用统计学软件对2013年10月18日前Medline(1980年1月至2013年10月),EmbaSe(1980年1月至2013年10月),Wiley Online Library(1980年1月至2013年10月)等数据库收录的相关文献进行分析.结果:共筛选出8篇相关文献,包含患者919例,其中骶前冲洗者431例(46.9％),未接受者488例(53.1％),冲洗组复发率显著低于未冲洗组(OR =0.47,95％ CI =0.26 ～0.85);亚组分析发现,生理盐水冲洗后局部复发率显著降低(3.0％,8/265vs 8.3％,20/242),差异显著(OR =0.34,95％CI =0.16 ～0.75);骶前冲洗容量在1 500ml及以上者,冲洗组患者局部复发率显著降低(OR =0.38,95％ Cl =0.17 ～0.86),而骶前冲洗容量在1 500ml以下者两组间局部复发率差异不显著(OR =0.60,95％CI =0.25～1.45).结论:充分的骶前冲洗可降低直肠癌前切除术后局部复发风险达50％以上,1 500ml的生理盐水或应成为直肠癌前切除术后常规骶前冲洗量.

目的:探讨吉西他滨联合卡铂方案治疗蒽环及紫杉类治疗失败的晚期乳腺癌的疗效和不良反应.方法:将56例蒽环、紫杉类治疗失败的晚期乳腺癌患者随机分为观察组(30例)和对照组(26例).观察组采用吉西他滨联合卡铂方案治疗,对照组采取CAF治疗方案.结果:治疗有效率观察组和对照组分别为73.33％和46.15％,观察组疗效显著优于对照组;不良反应的发生率两组之间没有明显差异.GC组及CAF组的中位肿瘤进展时间(TTP)分别为7.5个月和4.5个月,中位生存期分别为8.3个月和6.5个月,均无显著性差异(P＞0.05).结论:吉西他滨联合卡铂治疗蒽环及紫杉类治疗失败的晚期乳腺癌,具有很好的疗效和较低的毒副作用.

BACKGROUND:Compared with open oesophagectomy (OE), minimally invasive oesophagectomy (MIO) proves to have benefits in reducing the risk of pulmonary complications for patients with resectable oesophageal cancer. However, it is unknown whether MIO has superiority in reducing the occurrence of in-hospital mortality (IHM).OBJECTIVE:The objective of this meta-analysis was to explore the effect of MIO vs. OE on the occurrence of in-hospital mortality (IHM).DATA SOURCES:Sources such as Medline (through December 31, 2014), Embase (through December 31, 2014), Wiley Online Library (through December 31, 2014), and the Cochrane Library (through December 31, 2014) were searched.STUDY SELECTION:Data of randomized and non-randomized clinical trials related to MIO versus OE were included.INTERVENTIONS:Eligible studies were those that reported patients who underwent MIO procedure. The control group included patients undergoing conventional OE.STUDY APPRAISAL AND SYNTHESIS METHODS:Fixed or random -effects models were used to calculate summary odds ratios (ORs) or relative risks (RRs) for quantification of associations. Heterogeneity among studies was evaluated by using Cochran's Q and I2 statistics.RESULTS:A total of 48 studies involving 14,311 cases of resectable oesophageal cancer were included in the meta-analysis. Compared to patients undergoing OE, patients undergoing MIO had statistically reduced occurrence of IHM (OR=0.69, 95%CI =0.55 -0.86). Patients undergoing MIO also had significantly reduced incidence of pulmonary complications (PCs) (RR=0.73, 95%CI = 0.63-0.86), pulmonary embolism (PE) (OR=0.71, 95%CI= 0.51-0.99) and arrhythmia (OR=0.79, 95%CI = 0.68-0.92). Non-significant reductions were observed among the included studies in the occurrence of anastomotic leak (AL) (OR=0.93, 95%CI =0.78-1.11), or Gastric Tip Necrosis (GTN) (OR=0.89, 95%CI =0.54-1.49).LIMITATION:Most of the included studies were non-randomized case-control studies, with a diversity of study designs, demographics of participants and surgical intervention.CONCLUSIONS:Minimally invasive oesophagectomy (MIO) has superiority over open oesophagectomy (OE) in terms of the occurrence of in-hospital mortality (IHM) and should be the first-choice surgical procedure in esophageal surgery.

BACKGROUND:Rectal washout can prevent local recurrence after anterior resection of rectal cancer. Few studies have focused particularly on the association between irrigation fluids volume or agents and the risk of local recurrence after anterior resection of rectal cancer.OBJECTIVE:To estimate the association between irrigation fluids types, volumes of rectal washout and risk of local recurrence after anterior resection for cancer.DATA SOURCES:Relevant studies were identified by a search of Medline, Embase, Wiley Online Library, China National Knowledge Infrastructure, Cochrane Oral Health Group Specialized Register, Wanfang databases and Google Website from their inception until October 18,2013.STUDY SELECTION:Studies reporting the association between rectal washout types and volumes and risk of local recurrence after anterior resection for cancer were included.INTERVENTIONS:Eligible studies used rectal washout. Control groups were defined as no washout.STUDY APPRAISAL AND SYNTHESIS METHODS:Random-effects model were used to obtain summary estimates of RR and 95% CI, with Stata version 11 and RevMan 5.2.5 softwares used. The quality of report was appraised in reference to the MINORS item.RESULTS:Of the 919 rectal cancer patients in 8 included studies, a total of 61(6.64%) cases of local recurrence were reported, with a pooled RR 0.51 (95%CI = 0.28-0.92, P = 0.03). The RRs 0.37 and 0.39 in normal saline and washout volume (≥ 1500 ml normal saline) subgroup, respectively, indicated that rectal washout with normal saline, or ≥ 1500 ml in volume could significantly reduce local recurrence (LR) rate (95% CI = 0.17-0.79, P = 0.01; 95% CI = 0.18-0.87, P = 0.02) after anterior resection for cancer.LIMITATION:The included studies were non-randomized observational studies, with diversity of study designs.CONCLUSION:Rectal washout with normal saline alone can reduce the risk of local recurrence in patients with resectable rectal cancer, and 1.5 liters rectal washout in volume is recommended.

OBJECTIVE:To ascertain the epidemiology and clinical characters of female breast cancer patients in Northwest Region in China.METHODS:We analyzed retrospectively the clinicopathologic data of 431female cases with breast cancer in ten years,between 1999and 2008,in the First Hospital of Xi'an Jiaotong University,locating in the northwest region in China.RESULTS:The media age at diagnosis was(50.5±10.8)years old,with the rate of early stag breast cancer(pathologic stageⅠandⅡ)being 57.5%(248/431),rate of mammography,ultrasound,aspiration cytology,histologic biopsy and infiltrating ductal carcinoma being 25.9%(110/424),12.4%(53/427),8.2%(35/426),15.7%(67/426)and 86.5%(365/422),respectively.The rate of modified radical mastectomy,breast-conserving treatment and sentinel lymph node biopsy was 88.6%(382/431),1.4%(6/431)and 2.1%(9/431),respectively,with the endocrine,radiotherapy,and chemotherapy ratio being 19.0%(82/431),21.4%(92/431)and 58.5%(252/431),respectively.CONCLUSIONS:The status of delayed diagnosis,advanced tumor stages and less auxiliary diagnosis measures northwest region should be improved.Adjuvant therapies,especially radiotherapy and endocrine therapy are of the great unmet needs,with modified radical mastectomy being the first choice of surgical treatment and lower breast-conserving treatment and sentinel lymph node biopsy rate.

目的 探讨不同年龄段乳腺癌患者的临床病理特征.方法 回顾性分析我院10年间、随机月份抽取的484例女性乳腺癌患者的临床病理资料,自21岁开始10年为一组分组并做统计.结果 ①乳腺癌发病年龄高峰为41～50岁；②各年龄组之间T分期差异显著(x2＝16.478,P＝0.006＜0.05),31～40岁组T分期高于41～50岁组(Z＝-3.315,P=0.002＜0.05)和61～70岁组(Z＝-3.104,P＝0.002＜0.05),51～60岁组高于61～70岁组(Z＝2.205,P=0.027＜0.05)和41～50岁组(Z=-1.969,P=0.049＜0.05)；③各年龄组局部浸润程度、病理类型、N分期、M分期差异均无统计学意义(P＞0.05).结论 乳腺癌患者的发病年龄段为41～50岁,年轻组患者具有肿瘤直径较大的趋势,各年龄组肿瘤原发部位、肿瘤象限、局部浸润程度、病理类型、N分期、M分期、pTNM分期相同.

Objective:To study the fluctuation rule of leukocyte counting and preventive strategy for patients with grade Ⅳ myelosupression after conventional dosage of Docetaxel involved chemotherapy.Methods: The clinical data of 28 cases,whose leukocyte count were less than 1.0×109/L after conventional dosage of Docetaxel involved chemotherapy,from October 2008 to December 2010,were analyzed retrospectively.Results: The fluctuation of leukocyte count and neutrophile granulocyte count were both declined as a U type.The declining period appeared to be 5 to 8 days after the application of Docetaxel,with the recovery time 6 to 8 days.The valley duration of neutrophile granulocyte's would last for about 1 to 4 days,with the median time of 2 days,the mean time 2 days.Conclusion: The fluctuation of leukocyte count and neutrophile granulocyte count were both declined as a U type after the use of Docetaxel.5 to 8 days after the application of docetaxel might be the golden time for detection of grade Ⅳ myelosupression.

Objective:To investigate the diagnosis and therapy of occult cancer of the thyroid(OCT).Methods: The clinical data of 68 cases with PTMC treated and confirmed by pathology from 1995 to 2000 were retrospectively analyzed.Results: Eleven patients were male and fifty-seven female,with the media age 43.5 years(range from 15 to 69 years).Forty-one(60.2%)cases were first treated for thyroid nodules,of which sixteen patients(39.0%)were found with tiny thyroid nodules by ultrasound and surgical exploration but not physical examination.Seventeen cases(25%)were first treated for deradenoncus.Of the sixty-eight patients sixty-six cases were followed up,of which forty-four patients underwent a lobectomy and twenty-two got modified radical neck dissection,were successfully followed-up,and the follow-up rate was 97.1%;five patients(7.6%) dead,two cases were lost for follow up and the lost rate of follow up was 2.9%.Conclusion: The onset of OCT is latent and is hard to diagnose preoperatively.It is necessary to establish diagnosis by physical examination and accessary examinations.Surgical operative procedure is the major treatment for OCT.

Objective To investigate the effect of rectal washout(WO) for the prevention of local recurrence(LR) in patients with resectable rectal cancer. Methods Relevant studies that compared rectal WO with no washout(NWO) for rectal cancer resection and were published between January 1980 and January 2011 were retrieved.Random-effect meta-analysis was used and subgroup analysis was performed. Results Of the six studies that matched the selection criteria,one reported 10 patients with LR and 67 patients without LR within 5 years,who were unknown to belong to WO group or NWO group,with an overall LR rate of 7.7 percent(367/4 776).LR rate in the WO group was 6.4 percent(240/3 732) as compared with 12.2 percent(127/1 044) in the NWO group,with a significant difference(OR=0.51,95 percent CI=0.41-0.69,P0.01).When incorporating the 10 patients with LR into the WO group or into the NWO group,LR rate was higher in the NWO group than in the WO group,with an overall LR rate of 7.8 percent(377/ 4 852),12.2 percent(127/1 044) vs.6.6 percent(250/3 808) or 12.3 percent(137/1 111) vs.6.4 percent(240/3 732),respectively,and there were significant differences between them(OR=0.51,95 percent CI=0.40-0.65,P0.01;OR=0.49,95 percent CI=0.39-0.62,P0.01). Conclusion As a relatively risk-free procedure,rectal washout during anterior resection can effectively prevent the local recurrence rate of rectal cancer.

Objective:To explore the diagnosis and treatment of primary gastric lymphoma.Methods: The diagnosis,treatment and prognosis of twenty-eight cases with primary gastric lymphoma were analyzed retrospectively.Results: The main clinical features are disorder of abdomen,abdominal mass and emaciation.The preoperative misdiagnosis rate was 35.7%,5-year survival rate was 89.5% in mild malignant gastric lymphoma and 55.6% in highgrade.Conclusion:Misdiagnosis occur frequently in primary gastric lymphoma.Comprehensive and individualized treatment can elevate the survival rate.The pattern and stage of pathology,individualized treatment may be more important in the various factors of influencing the prognosis of primary gastric lymphoma.

Objective: To explore the risk factors for clinical anastomotic leakage after resection of rectal cancer in China. Methods: By meta-analysis we made a comprehensive analysis of the risk factors for clinical anastomotic leakage after resection of rectal cancer based on 19 articles published in China between January 1999 and January 2009. Results: The anastomotic leakage rate was higher in the patients aged 60 years old and above than in those younger, with the combined odds ratio (OR) value being 0.50 (95% CI: 0.33 -0.76) (P<0.01). The incidence rate was higher in the male patients than in the female ones, with the combined OR value being 2.17 (95% CI: 1.38 -3.42) (P<0.01). The incidence rate in the patients with the distance of tumor from the lower margin to anal verge being 7 cm and shorter was higher than that with longer distance, with the combined OR value being 1.79 (95% CI: 1.37-2.35) (P<0.01). The incidence rate in the patients who had received radiotherapy preoperatively was higher than that in those who had not, with the combined OR value of 3.66 (95% CI: 2.19-6.09) (P<0.01). The incidence rate in the patients who had received stapler anastomosis was higher than that in the patients who had received manual anastomosis, with the combined OR value being 0.70 (95% CI: 0.47-1.05), but there was no significant difference between them (P>0.05). The incidence rate was higher in the patients with diabetes mellitus than in the healthy ones, with the combined OR value being 3.16 (95% CI: 2.27-4.39) (P<0.01). The incidence rate was lower in the patients with Dukes A and B stages than in those with Dukes C and D stages, with the combined OR value being 0.61 (95% CI: 0.45-0.83) (P<0.01). The incidence rate in the patients with high malignance degree in clinicopathological types was higher than that with low malignance degree, with the combined OR value being 2.17 (95% CI: 1.38-3.42) (P<0.01). The incidence rate was lower in the patients who had received preventive colostomy than in those who had not, with the combined OR value being 0.39 (95% CI: 0.14-1.05), but there was no significant difference between them (P>0.05). The incidence rate was higher in the patients who had got selective operation than in those who had got emergency operation, with the combined OR value being 0.27 (95% CI: 0.13-0.56). Conclusion: The risk factors of anastomotic leakage after resection of rectal cancer are as follows: 60 years old and above, male patients, diabetes mellitus, preoperative neoadjuvant radiotherapy, the distance of tumor from the lower margin to the anal verge being shorter than 7 cm, Dukes C and D stages, high malignance degree in clinicopathological types, and emergency operation.

目的:探讨国内直肠癌术后吻合口瘘的危险因素,为直肠癌患者术前护理决策的制定提供科学依据。方法:运用Meta分析方法对我国1999年1月份至2009年1月份公开发表的有关国内直肠癌术后吻合口瘘的危险因素的15篇文献资料进行综合分析。结果:年龄≧60岁直肠癌患者吻合口瘘的发生率高于﹤60岁者,合并OR值为0.50(95%CI:0.33-0.76)(P<0.01);男性直肠癌患者吻合口瘘的发生率高于女性,合并OR值为2.17(95%CI:1.38-3.42)(P<0.01);术前接受新辅助放疗直肠癌患者吻合口瘘的发生率高于未进行新辅助放疗者,合并OR值为3.66(95%CI:2.19-6.09)(P<0.01);术前患有糖尿病的直肠癌患者吻合口瘘发生率低于无糖尿病者,合并OR值为3.16(95%CI:2.27-4.39)(P<0.01);急诊手术直肠癌患者吻合口瘘发生率高于择期手术者,合并OR值为0.27(95%CI:0.13-0.56)(P<0.01)。结论:根据患者年龄、性别、是否糖尿病患者、术前是否进行新辅助放疗及可能的手术方式,术前进行有针对性更全面的护理,是可能降低直肠癌吻合口瘘发生率的有效途径。

Objective:To detect the expressions of CD44V9 mRNA and MTA1 protein,and investigate their relationship with breast cancer.Methods:Technique of immunohistochemistry and in situ hybridization were used to detect the expressions of MTA1 protein and CD44V9 mRNA among 45 breast cancer samples.Results:The positive rates of MTA1 protein and CD44V9 mRNA in breast cancer were 71% and 76% respectively.MTA1 over-expression was significantly correlated with the lymphatic metastasis(P0.05).CD44V9 mRNA over-expression was also positively correlated with the lymphatic metastasis(P0.05).There was no relationship between the positive expression of MTA1and CD44V9 mRNA(P=0.136).Conclusion:Over-expression of MTA1 protein and CD44V9 mRNA might play important role in invasion and metastasis of human breast cancer.

Objective To investigate the relationship between the expression of MTA1,MMP-9 protein and lymph node metastasis in breast cancer.The relationships between the expressions of MTA1,MMP-9 protein and the clinical parameters of breast carcinoma were analyzed.To initiatory explore the relationship between MTA1,MMP-9 protein.Methods SP immunohistochemical technique was used to detect the expressions of MTAI and MMP-9 protein among the 45 human breast cancer samples.Results The positive rates of MTA1,MMP-9 protein were 71.0%,64.0% respectively.Analysis of MTA1 over-expression indicated there hadn′t relationships between age,tumor size,ER,PR and c-erb-B2 and MTA1.But MTA1 was significantly correlated with lymphatic metastasis(P0.05).MMP-9 over-expression was significantly correlated with lymphatic metastasis(P0.05) and was inversely correlated with PR(P0.05).There had not relationships between MMP-9 and age,tumor size,ER and c-erb-B2.The co-expression of MTAI and MMP-9 was significantly correlated with lymphatic metastasis(P0.05).Conclusion The over-expression of MTA1 stimulates the lymph node metastasis of breast cancer and the orientation variety of MTA1 protein is related to the metastasis of breast cancer.The over-expression of MMP-9 stimulates the metastasis of lymph node of breast cancer and a negative correlation was found between MMP-9 and PR.The co-expression of MTAI and MMP-9 was the biological character of breast cancer high aggressiveness.

Objective:To investigate etiology,clinical characteristics,examination,diagnosis of nonlactating mastitis and differential diagnosis and treatment.Methods:Clinical data of 51 cases with nonlactating mastitis were retrospectively analyzed.Results:Of all 51cases,26(51.1%) cases were diagnosed correctly as nonlactating mastitis,9(17.6%) cases were misdiagnosed as breast cancer or suspicious malignancy,7(13.7%) cases were misdiagnosed as mammary benign tumor,9(17.6%) cases were misdiagnosed as mammary hyperplasia.All cases received surgerical therapy,the pathological characteristics confirmed the diagnosis of nonlactating mastitis.Conclusion:The disease should use different treatment basing on the clinical characteristics,and the fistula and involvement of inflammatory should be excised as far as possible,in order to obtain reliable results.

BACKGROUND/AIMS:To review the available data on the efficacy of the measures that are directed towards prevention of anastomotic leakage after low anterior resection and introduce a promising method based on our own experience.METHODOLOGY:The Medline database was searched for studies on the prevention of anastomotic leak after low anterior resection in rectal cancers.RESULTS:Two meta-analyses of the results indicate that a routine defunctioning stoma reduces the rate of clinically relevant anastomotic leakages and is thus recommended in such patients. However, the morbidity of the stoma itself, as well as the morbidity and mortality of its closure should also be considered and pending further trials to clarify its role. Studies suggested that omentoplasty may reduce the leakage rate, but there is a paucity of large randomized trials. A non-randomized trial together with our clinical experience indicated Valtrac-secured intracolonic bypass (VIB) may be a promising method in prevention of anastomotic leakage in rectal cancers.CONCLUSIONS:VIB appears so far to be a promising method for the prevention of anastomotic leak after low anterior resection in rectal cancers. However, further randomized controlled studies are still required to determine its clinical efficacy.

过氧化物酶体增殖物激活受体γ(peroxisome proliferator activated receptorsγ,PPARγ)是Ⅱ型核激素受体超家族中一员,激活后可诱导乳腺癌、胃癌、胰腺癌等肿瘤细胞分化,并抑制其恶性增殖、诱导细胞凋亡、抑制血管生成和降低肿瘤侵袭能力,具有潜在的抗肿瘤作用,有望成为治疗的新途径。现就PPARγ和其配体与乳腺癌的关系进行综述。

Epithelioid hemangioendotheliomas are unique vascular tumors characterized by epithelioid or histiocytoid endothelial cells that mainly affect adults. This low-grade malignant vascular tumor was described as a distinctive condition in 1982 by Weiss and Enzinger. Although the tumor is classified in between an angiolymphoid hyperplasia with eosinophilia and an epithelioid angiosarcoma, it sometimes takes a clinical course resembling that of angiosarcoma. We describe that case of a 12-year-old boy who presented with an approximately 6-month history of a spontaneous chronic lesion in his right armpit and became a painful ulceration in the prior 2-month period. The histopathologic examination revealed small nests and cords of spindling epithelioid endothelial cells, intracytoplasmic lumina containing erythrocytes, pinocytotic vesicles and a necrotic area. Immunohistochemical staining was positive for the endothelial markers CD31, CD34, CK(+), and vim(+). On the basis of these findings the diagnosis of EHE was made. After surgery, pathologic examination revealed metastasis in the lymph nodes. So polychemotherapy was started. As our case report shows, it is possibility that cutaneous ulceration of a malignant tumor such as EHE should be considered, even in children.