Objective To study the mechanism of high intensity focused ultrasound (HIFU) and discuss its clinical significance in the treatment of mid-late stage liver cancer. Methods The patients with mid-late stage liver cancer were treated with HIFU. The changes of photography, pathology and immunology after operation were evaluated. Results It was shown that the results of the photographic, pathologic and immunologic examinations changed during the treatment of the patients with HIFU. Conclusion HIFU is effective and safe for the treatment of mid-late stage liver cancer.
With the publication of several phase Ⅱ and Ⅲ clinical studies, the multidisciplinary diagnostic and therapeutic strategies for early resectable non-small cell lung cancer (rNSCLC) are rapidly evolving. These studies have elucidated the significant effects of neoadjuvant and adjuvant therapies on improving the prognosis of rNSCLC patients, while also highlighting the urgent need to revise and refine corresponding treatment protocols and clinical pathways. In response, the International Association for the Study of Lung Cancer has assembled a diverse, multidisciplinary international expert panel to evaluate current clinical trials related to rNSCLC and to provide diagnostic, staging, and treatment recommendations for rNSCLC patients in accordance with the 8th edition of the AJCC-UICC staging system. The consensus recommendations titled "Neoadjuvant and adjuvant treatments for early stage resectable non-small cell lung cancer: Consensus recommendations from the International Associationfor the Study of Lung Cancer" outline 20 recommendations, 19 of which received over 85% agreement from the experts. The recommendations indicate that early rNSCLC patients should undergo evaluation by a multidisciplinary team and complete necessary imaging studies. For stage Ⅱ patients, consideration should be given to either adjuvant therapy following surgery or direct neoadjuvant/perioperative treatment, while stage Ⅲ patients are recommended to receive neoadjuvant chemoimmunotherapy followed by surgery. Postoperatively, adjuvant immunotherapy should be considered based on the expression levels of programmed cell death ligand 1, along with testing for other oncogenic driver mutations. For patients with epidermal growth factor receptor or anaplastic lymphoma kinase mutations sensitive to tyrosine kinase inhibitors, corresponding adjuvant targeted therapy is recommended. These recommendations aim to provide personalized and precise treatment strategies for early rNSCLC patients to enhance the efficacy of neoadjuvant and adjuvant therapies. This article provides an in-depth interpretation of these consensus recommendations.
目的 探讨经脐单孔腹腔镜胆囊切除的可行性、安全性及实用性。 方法 回顾分析2010年11月－2011年2月27例行经脐单孔腹腔镜胆囊切除术患者的临床资料。其中男15例，女12例；年龄19～53岁，平均39.5岁。胆囊息肉样病变12例，病程6个月～8年；胆囊结石17例，结石数量1～9个，大小0.5～1.5 cm，均为非急性期患者，病程1个月～13年。 结果 27例手术均顺利完成，无1例中转开腹或转为传统三孔腹腔镜胆囊切除术，术中生命体征平稳。手术时间35～149 min，平均63 min；术中出血10～20 mL，平均15 mL。所有患者术后2～3 d出院。患者均获随访，随访时间6～24个月，平均13个月。术中及术后随访期间未发生任何并发症。脐部瘢痕不明显，患者满意度高。 结论 经脐单孔腹腔镜胆囊切除安全可行，具有创伤小、瘢痕不明显等优点。
通过与首都医科大学、南京医科大学、中山医科大学、四川大学的康复医学研究人员2000年1月至2008年3月止发表在康复医学主要五种杂志上的期刊论文,从论文年代分布、领域论文分布、核心期刊发文率、基金资助研究情况、主题分布情况等方面进行了全面的统计分析,比较客观地揭示和描述了新世纪初四川大学华西医院康复医学中心康复医学研究与发展的基本状况,并提出发展的可能策略。
ObjectiveTo study the protective effect of hepatocyte growth factor(HGF) on grafted mucous membrane of transplanted small bowel.MethodsTotal small bowel transplantation was made in inbred Wistar (RT1k) rats heterotopically,either total parenteral nutrition (control group,n=10) or hepatocyte growth factor supplemented TPN (HGF group,n=10) was given to the recipients from the 2nd day to the 10th day postoperatively. Morphological parameters of the transplanted intestinal mucosa, such as mucosal villous height, villous width, crypt depth, mucosal thickness and villous surface area were observed. Variation of ultrastructure of transplanted epithelial cells was observed. Composition of mucosal protein and DNA content were tested. ResultsComparison between HGF group and the control group were as follows. Mucosal villous height (298.79±22.31） μm vs （176.45±14.62） μm, P=0.001, villous width (107.46±12.34） μm vs （74.20±16.85） μm, P=0.004, crypt depth (104.56±11.17） μm vs （74.45±8.34） μm, P=0.000 5, mucosal thickness (409.53±35.83） μm vs （259.38±24.65） μm, P=0.003, and villous surface area (0.101±0.011) mm2 vs (0.041±0.005) mm2, P=0.001 were found significantly increased in HGF group compared with control group, there were no obvious difference decrease as compared to pretransplant parameters.Mucosal protein composition was higher in HGF group than that in control group （89.65±9.28) mg/g wet wt vs (53.73±11.45) mg/g wet wt, P=0.012, baseline (92.64±10.52) mg/g wet wt, nearly equal to baseline; DNA composition was also high in HGF group （0.89±0.09) mg/g wet wt vs (0.51±0.06) mg/g wet wt, P=0.008, baseline (0.91±0.09) mg/g wet wt. Nearly normal ultrastructure of the graft was maintained in HGF group, atrophied microvilli and broken mitochondrial crista were observed in control group.ConclusionHepatocyte growth factor can improve mucosal structure, preserve enterocyte ultrastructure of isograft after small bowel transplantation in rat.
【摘要】 目的 探讨胰管结石的诊断和治疗方法。 方法 回顾性分析2000年1月－2009年1月收治的50例胰管结石患者临床资料。其中男37例，女13例；年龄36~70岁，平均49岁。病程7 d~10年，平均6.8年。46例出现腹正中及左上腹间歇疼痛，伴腰背部放射痛。50例均行B型超声和CT检查，诊断阳性率分别为90%（45/50）和96%（48/50）；27例行磁共振胰胆管成像检查，诊断阳性率为92.6%（25/27）。所有患者均行手术治疗，包括胰十二指肠切除术8例；胰管切开取石、胰空肠Roux-Y吻合术42例，同时行胆囊切除术12例，Oddi括约肌切开、T管引流术6例，胆肠Roux-Y吻合术2例。 结果 所有患者均取出胰管结石，结石大小为0.2~2.0 cm，结石数目为1~50枚。1例患者术后发生切口感染，经积极抗感染及伤口换药处理后治愈。46例治愈出院，2例好转出院， 2例术后出现并发症死亡。术后40例获随访，随访时间1~48个月，平均24个月。随访期间2例胰管结石伴胰头癌患者因术后胰头癌复发死亡。余38例中有8例术后胰管结石复发，再次行手术治疗后治愈；其中有2例术后仍有腹痛，但较术前有明显好转。 结论 影像学检查是诊断胰管结石的重要手段，准确率高，一旦诊断应根据合并症和胰管扩张程度选择合适的手术方式，可取得良好治疗效果。【Abstract】 Objective To investigate the diagnosis and treatment methods for pancreatolithiasis. Methods The clinical data of 50 patients with pancreatolithiasis from January 2000 to January 2009 were retrospectively analyzed. Among them, there were 37 males and 13 females aged between 36 and 70 averaging at 49.3. The course of the diseases ranged from 7 days to 10 years with an average time period of 6.8 years. Forty-six patients had intermittent pain in the median abdomen and left upper quadrant combined by ectopic pain in the back. Various image examinations including abdomen ultrasonography, CT scan, and magnetic resonance cholangiopancreatography (MRCP) were performed in 50, 50, and 27 patients, respectively. Pancreatic duct stones were found in 45 of 50 cases (90％) with ultrasonograhy, 48 of 50 cases (96%) with CT scan, and 25 of 27 cases (92.5%) with MRCP. All patients received surgeries including 8 cases of pancreatodudenectomy, 42 cases of pancreatolithotomy plus side to side pancreatojejunostomy. At the same time, there were 12 cases of cholecystectomy, 6 cases of sphincterotomy and T-duct drainage, and 2 cases of Roux-Y anastomosis. Results Pancreatic duct stones were successfully removed in all cases, and the size of the stones ranged from 0.2 to 2.0 cm in diameter. The number of stones removed from each patient ranged from 1 to 50. Symptoms of all patients ameliorated obviously. One patient had incision infection after surgery, and recovered through active antibiotic treatment. Forty-six patients were cured and discharged from the hospital; 2 patients had their conditions improved and were discharged from the hospital; and the other 2 patients died of postoperative complications. Forty patients were followed up for 1 to 48 months with an average time of 24 months. During the follow-up, 2 patients with pancreatolithiasis and carcinoma of head of pancreas died of the recurrence of the cancer. Eight patients had recurrence of pancreatic stones and were cured after a second operation. Among the 8 cured patients, 2 still had abdominal pain, but their conditions were greatly improved after surgery. Conclusion Imaging techniques are important methods in diagnosing pancreatolithiasis with a high precision. Once the diagnosis of pancreatolithiasis is made, surgical procedures should be selected according to the combined diseases and the level of pancreatic duct dilation.
ObjectiveTo evaluate the therapeutic effect of liver transplantation (LT) combined with adenovirus-mediated delivery of herpes simplex virus thymidine kinase / ganciclovir (ADV-TK/GCV) in treatment of patients with hepatocellular carcinoma (HCC), so as to benefit more patients with HCC beyond the Milan criteria. MethodsThe clinicopathologic data of patients with HCC underwent LT by the author team since 2007 were collected and analyzed. The patients were assigned into simple LT group and LT+ADV-TK/GCV group. The 5-year cumulative overall survival rate and relapse free survival rate of all LT patients and the patients with LT beyond the Milan criteria by simple LT and LT+ADV-TK/GCV therapy were compared. Meanwhile, Cox regression was used to analyze the risk factors affecting long-term overall survival rate and relapse free survival rate of all patients with HCC after LT. ResultsA total of 216 patients eligible for inclusion were collected in this study, including 134 patients in the simple LT group and 82 patients in the LT+ADV-TK/GCV group, 162 of whom beyond the Milan criteria, including 101 patients underwent the simple LT and 61 patients underwent the LT+ADV-TK/GCV. There were no statistical differences in the baseline data between the simple LT and LT+ADV-TK/GCV in all patients and patients beyond the Milan criteria (P>0.05). There were no statistical differences in 5-year overall survival rate and relapse free survival rate of all patients with HCC (P>0.05). The 5-year cumulative overall survival rate of the LT+ADV-TK/GCV group was better than that of the simple LT group in the patients beyond the Milan criteria (χ2=4.11, P=0.047), but it was not found that the 5-year cumulative relapse free survival rate had statistical difference (27-month survival time as the critical value, P=0.46, P=0.06). Cox regression multivariate analysis results showed that the larger cumulative tumor diameter, the preoperative elevated serum alpha fetoprotein (>400 μg/L), later TNM stage, and without combination of ADV-TK/GCV therapy increased the probability of shorter overall survival of patients after LT; and the patient’s older age, the larger cumulative tumor diameter, and later TNM stage increased the probability of shorter relapse free survival after LT, and it was not found that the combination of ADV-TK/GCV therapy had an impact on the relapse free survival. ConclusionLT combined with ADV-TK/GCV therapy can obviously improve overall survival among patients beyond the Milan criteria, more patients with advanced HCC will be candidates for LT combined with ADV-TK/GCV therapy.
Objective To investigate the biological characteristics and clinical significance of cuproptosis-related genes in lung adenocarcinoma (LUAD) based on the multi-omics data from The Cancer Genome Atlas. Methods The cuproptosis-related genes were obtained from a study published in Science in March 2022. The whole genome data were used to reveal the mutation spectrum and copy number variation landscape of cuproptosis-related genes in LUAD and analyze its effects on transcriptome expression. Cuproptosis-related genes were annotated using Metascape analysis to further understand the pathways or functions in which these genes were involved. Subsequent univariate Cox analysis and Kaplan-Meier methods determined the prognosis of these genes in LUAD patients, and CellMiner analysis were used to identify those potential anticancer drugs for potentially targeting cuproptosis-related genes. Results Cuproptosis-related genes were less frequently mutated in LUAD, and the effect of gene mutations on transcriptomic expression may depend on the type of mutation. Gene copy number variation was an important factor resulting in the disordered expression of cuproptosis-related genes. The 16 cuproptosis-related genes were mainly involved in glyoxylate metabolism and glycine degradation, copper ion entry, proteolitidylation, cellular amino acid catabolism process, oxidative stress response, etc. Among them, 6 genes (DLD, FDX1, DLAT, DLST, PDHA1, CDKN2A) were prognostic risk genes in LUAD. The CellMiner analysis suggested that 13 drugs were associated with 7 cuproptosis-related genes and they might be potential anticancer drugs for potentially targeting cuproptosis. Conclusion This study reveals the biological characteristics and clinical significance of cuproptosis-related genes in LUAD, and provides some reference and theoretical basis for the subsequent research of cuproptosis in cancer.
Objective To investigate the early diagnosis and treatment methods of primary duodenal papilla carcinoma. Methods The medical records of 54 patients with primary duodenal papilla adenocarcinoma underwent operation between January 2002 and December 2008 were reviewed. Results Thirty seven cases received fiberduodenoscopy and 35 cases received ERCP, and the accuracy of them were both 100%. Forty four patients received duodenopancreatectomy and 10 patients received jaundice-reducing operation. The 1-, 3-, and 5-year cumulation survival rate was 68%, 50%, and 29%, respectively. Conclusions Fiberduodenoscopy and ERCP are the effective diagnostic methods for duodenal papilla carcinoma. Early diagnosis and early rational radical operation are essential for successful treatment of duodenal papilla carcinoma.
ObjectiveTo explore the values of CA19-9, CA242, CEA, and CA125 single or combined detection on clinical diagnosis and prognosis for patients with pancreatic cancer. MethodsSerum tumor markers CA199, CA242, CEA, and CA125 of 63 patients with pancreatic cancer, 33 patients with cancer of bile duct, and 27 patients with benign pancreatic disease were detected, and those patients were followed up after operation. ResultsThe levels of CA19-9, CA242, CEA, and CA125 in patients with pancreatic cancer were significantly higher than those in patients with benign pancreatic disease and cancer of bile duct (Plt;0.05). The sensitivity of CA19-9 alone was the highest in the four tumor markers for the patients with pancreatic cancer 〔79.4% (50/63)〕, but the specificity (61.9%) was lower than that of CA242 (83.3%) and CEA (80.0%). The specificity of combined detection of CA199+CA242+CEA was the highest 〔93.3% (56/60)〕. The level of CA19-9 in carcinoma of body/tail of pancreas was significantly higher than that of carcinoma of pancreas head or whole pancreas (Plt;0.05). The serum levels of CA19-9 and CA242 in patients with stage Ⅳ were significantly higher than those in stage Ⅰ or Ⅱ/Ⅲ (Plt;0.05). Fifteen patients were lost to follow up, 48 patients were followed up 2－12 months with an average 6 months. The levels of CA242 and CA199 in patients with pancreatic cancer on 0.5 month and 3 months after operation were lower than those before operation (Plt;0.05). ConclusionsSingle detection of CA19-9 can improve the diagnostic sensitivity, and combined detection of tumor markers CA199+CA242+CEA can improve the diagnostic specificity. CA19-9 or CA242 is a valuable marker for evaluating treatment effects and estimating prognosis.