南岭山区红砂岭生态环境修复的遥感监测——以南雄市为例

粤北南岭山区是华南地区重要的生态屏障和水源涵养区。其在南雄市特有的红砂岭地貌,在自然条件和人为活动的影响下生态风险日渐凸显。探索红砂岭生态环境的修复监测,对粤北山区的生态保护有着重要意义。文章结合无人机高分航拍影像,基于U-Net卷积神经网络模型解译生态要素,并参照2017年遥感影像进行历史变化分析,对研究区域的红砂岭地貌生态修复现状进行监测。结果表明:(1)草地是和红砂岭地貌共存的典型生态要素类型,灌乔木的生长条件要求较高,难以在红砂岭地貌近距离生存;(2)当前是研究区的生态修复改造的初期,生态修复的初步成效已经展现。在后续的工作中,需针对砂岭地貌周边植被生长情况,实施综合治理措施。

第8版日本《大肠癌诊疗规范》解读

结直肠癌诊治经历了从早期的经验医学到现在的规范化多学科综合诊治过程。国内的结直肠癌诊治受到美国NCCN指南、欧洲ESMO指南以及日本大肠癌诊疗规范的影响。然而,同样作为东亚人群,日本大肠癌诊疗规范对于我国结直肠癌诊治工作则更具参考价值。近年来,随着结直肠癌诊治研究的不断深入,在此形势之下的结直肠癌诊疗规范也应根据相应研究结果做出调整。日本大肠癌研究会在2009年制定第7版规约之后的第7个年头再次进行更新并推出第8版规约。第8版《大肠癌诊疗规范》做出的一系列调整也会为我国的结直肠癌诊治带来新的启发和指导。本文解读新版日本《大肠癌诊疗规范》,试图从理论和技术上进一步认识新形势下结直肠癌外科实践的规范与转变。

青年与中年胃癌临床病理学特征、手术治疗及预后的差异分析

目的比较分析青年与中年胃癌的临床病理学特征、手术治疗与预后的差异。方法纳入自1994年8月至2010年12月在中山大学附属第一医院胃肠外科收治的年龄<60岁并接受手术治疗的胃癌患者851例,按年龄分为青年组(0~44岁)、中年组(45~59岁),比较两组的临床病理学特征、手术治疗及预后的差异。结果纳入患者男526例,女325例。青年组(269例)与中年组(582例)的恶性肿瘤家族史、肿瘤直径、肝转移率、肿瘤Borrman分型、WHO组织分型、CEA阳性率等比较,差异均无统计学意义(均P>0.05)。青年组与中年组的女性比例(52.4%vs.31.6%)、肿瘤部位(上部癌11.9%vs.27.8%;中部癌32.3%vs.21.6%)、脏器浸润(33.8%vs.26.5%),淋巴结转移(N3转移率21.2%vs.11.5%)、远处转移(32.0%vs.19.1%)、腹膜种植(25.3%vs.13.6%)、TNM分期(Ⅳ期比例43.5%vs.28.9%)、肿瘤分化程度(低分化癌比例87.7%vs.70.7%)、根治性切除(80.7%vs.89.2%)差异均有统计学意义(均P<0.05)。回归分析表明,邻近脏器浸润及远处转移为影响根治性切除率的独立因素。青年组与中年组1、3、5年生存率分别为61%、43%、38%和65%、52%、46%,差异有统计学意义(P<0.05)。多因素分析表明肿瘤直径、T分期、N分期、M分期、Borrmann分型、分化程度、手术方式为独立预后因素。分层分析结果显示在胃上部癌患者中,青年组与中年组的中位生存期分别为28、40个月;在淋巴结转移阳性患者中,两组中位生存期分别为22、30个月,差异均有统计学意义(均P<0.05)。结论与中年胃癌患者相比,青年胃癌患者女性、中部癌、脏器浸润、淋巴结N3转移、腹膜种植、低分化癌等比率显著升高,而根治率显著下降。对胃上部癌、淋巴结转移阳性患者,青年胃癌的预后显著不良。

PHLPP2在胃癌中的表达及其临床意义探讨

目的探讨PHLPP2在癌旁正常胃黏膜、胃癌原发灶和淋巴结转移灶中的表达差异。并分析PHLPP2表达水平和胃癌病人临床病例特征和总生存时间的关系。方法应用免疫组化方法检测PHLPP2在221例胃癌原发灶、30癌旁正常组织和175例淋巴结转移灶中的表达情况,并统计分析了PHLPP2表达与胃癌临床病理特征及其对生存预后的关系。结果癌旁正常胃黏膜、胃癌原发灶和淋巴结转移灶中的PHLPP2的阳性表达率分别为:70.0%、31.3%和18.3%,组间差异均有统计学意义(31.3% vs. 70.0%, 18.3%vs. 70.0%,31.3%vs. 18.3%, P值均<0.001);并且,PHLPP2的表达与远处转移和TNM分期存在显著相关性;PHLPP2阳性表达的胃癌患者5年生存率为57%,阴性表达胃癌患者5年生存时间仅为35%,差别有统计学意义,P=0.03。多因素生存分析发现PHLPP2是胃癌的独立预后因素(HR 0.56, 95%CI 0.37～0.85, P=0.006).结论 PHLPP2在胃癌及转移淋巴结中呈低表达, PHLPP2阴性与肿瘤远处转移及更差的预后相关。PHLPP2蛋白有可能成为胃癌预后预测的标志物。

circ-ITGA7上调ASXL1抑制结直肠癌细胞的增殖

目的探讨circ-ITGA7是否通过上调ASXL1抑制结直肠癌细胞增殖。方法采用RT-qPCR检测结直肠癌及癌旁组织中circ-ITGA7和ASXL1 mRNA表达水平,并用皮尔森相关性分析检测其相关性。RT-qPCR检测结直肠癌细胞株与正常肠道粘膜细胞株circ-ITGA7表达差异。采用质粒转染法在HCT116细胞中过表达circ-ITGA7,以RT-qPCR和western blot检测ASXL1的mRNA与蛋白表达水平。Cck-8对比circ-ITGA7过表达与否的HCT116细胞7天内的增殖活性。通过转染siRNA与质粒,以HCT116细胞集落形成实验对比过表达circ-ITGA7和沉默ASXL1对HCT116细胞集落形成数量的的影响。结果 RT-qPCR结果显示,circ-ITGA7在结直肠癌组织与细胞株中表达显著低于癌旁组织和正常肠道粘膜组织细胞株,且其在结直肠癌组织中与ASXL1的表达呈正相关性。过表达circ-ITGA7组的ASXL1蛋白及mRNA的表达水平显著高于对照组。Cck-8检测示,过表达circ-ITGA7组的吸光度于第5、6、7天显著低于对照组。细胞集落形成实验示,过表达circ-ITGA7组HCT116细胞的集落形成数量显著低于对照组,circ-ITGA7过表达且si-ASXL1沉默组与对照组差异无统计学意义。结论 Circ-ITGA7通过上调ASXL-1抑制结直肠癌细胞增殖。

小肠系膜覆盖实现浆膜化解决盆腔手术残腔并一例盆腔手术创面浆膜化病例报告及文献复习

目的结合1例病例报告及文献复习,探讨盆腔手术后巨大手术残腔的处理方法。方法2018年1月中山大学附属第一医院胃肠外科中心收治1例小肠肉瘤并不完全性小肠梗阻患者,经及时有效诊疗后康复出院。通过介绍其手术经过、术后恢复过程并结合相关文献总结探讨盆腹腔广泛病变切除术后巨大手术残腔的处理方法。结果(1)病例报告:35岁女性患者,既往因“宫颈腺癌Ib2期”行“广泛全子宫切除+左附件切除+右输卵管切除+盆腔淋巴结清扫+右卵巢移位术”,术后多次放、化疗,此次因“反复腹痛3月,再发加重3天”入院,在全麻下接受“盆腔病变及受累小肠切除、小肠系膜盆腔手术残腔填塞术”,手术填塞物为切除小肠的带蒂系膜。手术顺利,术后恢复良好,随访4月,无梗阻、腹盆腔积液等表现。(2)文献复习:现有的文献表明以自体组织,包括肝圆韧带或大网膜填塞手术残腔或覆盖重要手术创面能有效浆膜化腹内脏器,促进手术创面愈合,减少术后腹腔、盆腔粘连等并发症。目前尚无文献报道带蒂小肠系膜填塞腹腔手术残腔的文献报道。结论采用带蒂小肠系膜覆盖盆腔巨大手术残腔可安全、有效地浆膜化手术创面、促进局部积液吸收。同时可防止腹腔内容坠入残腔,进而为后续放疗或再次手术创造良好条件。

pSTAT3表达对胃癌患者预后影响的Meta分析

目的系统评估pSTAT3表达在胃癌患者预后评估的临床价值。方法在Pubmed、Embase以及Web of science三个数据库检索,纳入8篇相关研究,包括1 314例胃癌患者进行meta分析,评估pSTAT3表达在胃癌患者预后评估的临床价值,同时根据各文献研究所在地、出版年份、研究的患者数量以及文献质量评分,进行Meta回归分析以及亚组分析。结果 pSTAT3阳性患者相比pSTAT3阴性患者的死亡风险显著增加,差异有统计学意义(HR=1.87,95%CI:1.28~2.74,随机效应模型)。亚组分析结果表明,中国及日本的研究结果显示pSTAT3阳性与胃癌患者预后不良显著相关[中国(HR=2.61,95%CI:2.01~3.38),日本(HR=2.20,95%CI:1.24~3.93)],差异有统计学意义;而韩国地区的研究结果显示差异无统计学意义(HR=1.06,95%CI:0.54~2.11)。pSTAT3表达与胃癌临床病理特征(包括TMN分期、淋巴结转移、分化程度、Lauren分型以及远处转移)等无显著相关性。结论 Meta分析显示pSTAT3阳性与胃癌患者的不良预后相关。pSTAT3表达有望作为胃癌患者的一个独立预后指标。

Clinicopathologic features and survival of patients with colorectal mucinous, signet-ring cell or non-mucinous adenocarcinoma：experience at an institution in southern China

Background Previous studies have shown conflicting results on the relation between clinicopathologic features and prognosis of patients with colorectal mucinous, signet-ring cell, or non-mucinous adenocarcinoma; only few such studies have been performed in China. This retrospective study analyzed data from our department to investigate clinicopathologic characteristics, prognosis and possible correlations of three histologic types - colorectal mucinous, signet-ring cell, and non-mucinous adenocarcinoma, to clarify the bases for observed differences which may lead to development of targeted therapies Methods Of 2079 patients diagnosed with colorectal cancer between 1994 and 2007, 144 had mucinous, 25 had signet-ring cell, and 1837 had non-mucinous adenocarcinoma. Their clinicopathologic parameters and survival were analyzed using established statistical methodologies. Results Mucinous and signet-ring cell adenocarcinomas were common in younger patients （P 〈0.001）. Location, size and disease stage differed significantly among the three types. Signet-ring cell tumors were more commonly found in the rectum than mucinous and non-mucinous adenocarcinoma （P 〈0.001）. Mucinous and signet-ring cell tumors presented in a later stage in life more often than non-mucinous adenocarcinoma, with lymph node involvement, serosal infiltration, peritoneal dissemination, and adjacent organ invasion （P 〈0.01）. The rate of radical resection, hepatic metastasis and local recurrence did not differ among types （P 〉0.05）. Compared with patients with non-mucinous adenocarcinoma, patients with mucinous and signet-ring cell tumors who underwent potentially curative resections or stage Ⅱ/Ⅲ disease had poorer long-term overall survival. Survival did not differ by type for patients with either stage Ⅰ or Ⅳ disease （P 〉0.05）. Conclusions Mucinous and signet-ring cell adenocarcinoma have unique carcinogenesis and similar biologic behavior. Our study confirms that both histologic types, especially signet-ring cell tumors, are independent, negative prognostic factors for patients with colorectal cancer. Type does not appear to have a significant effect on survival when disease is either stage Ⅰ or Ⅳ at presentation.

Effects of diabetes mellitus on prognosis of the patients with colorectal cancer undergoing resection： a cohort study with 945 patients

Background Diabetes mellitus plays an important role in cancer prevalence and outcomes. The aim of this study was to evaluate the influence of DM on stages and outcomes among patients with colorectal cancer.Methods The study enrolled 945 patients who were diagnosed as having colorectal carcinoma from August 1994 to December 2002. In the cohort, 26 patients were diagnosed as having DM. With a median follow-up of 45.8 months,differences in overall survival and disease-free survival between the diabetes and non-diabetes groups were analyzed.Results Kaplan and Meier analysis showed that there were no significant differences between the two groups in overall survival rates at 3 years or 5 years. At 5 years, patients with DM, compared with patients without diabetes, experienced a significantly lower disease-free survival rate （34.2% diabetics vs. 55.1% non-diabetics; P=0.025）.Conclusions DM was associated with an increased risk of recurrence in patients with colorectal cancer.

胃癌卵巢转移诊断和治疗中国专家共识(2021版)

胃癌卵巢转移预后差,是女性胃癌患者治疗失败的重要原因。但目前胃癌卵巢转移机制尚不明确,病情复杂,单一治疗方式往往难以获得理想的效果。本指南由中国抗癌协会胃癌专业委员会发起,联合多学科专家,对胃癌卵巢转移进行分类管理,制定个体化、精准化治疗策略,进而指导临床实践,改善患者生存。

Meta-analysis of pancreaticoduodenectomy prospective controlled trials： pancreaticogastrostomy versus pancreaticojejunostomy reconstruction

Background Pancreaticogastrostomy （PG） has been proposed as an alternative to pancreaticojejunostomy （PJ）, assuming that postoperative complications are less frequent. The aim of this research was to compare the safety of PG with PJ reconstruction after pancreaticoduodenectomy.

Prospective study of reconstructing pelvic floor with GORE-TEX Dual Mesh in abdominoperineal resection

Background Mesh reconstruction has been proved to be an effective method in incisional hernia repairment. This study was designed to evaluate the effect of reconstructing the pelvic floor with the high-inlay expanded polytetrafluoroethylene （ePTFE） GORE-TEX Dual Mesh （WLGore And Associates, Flagstuff, USA） in abdominoperineal resection. Methods Sixty patients who underwent abdominopedneal resection for rectal cancer were assigned to 2 groups. The pelvic peritoneum was closed by routine sutures in group 1 and reconstructed with ePTFE in group 2. Postoperative complications and related items were evaluated and the patients were followed up. Results Time of confining to bed, bowel function recovery, fasting, and detaining drainage were significantly different between two groups （P 〈0.05）. In group 1, three patients developed bowel obstruction （10%）, while no bowel obstruction was observed in group 2. Conclusion Reconstruction of the pelvic floor using ePTFE results in quicker postoperative recovery and could decrease the risk of postoperative intestinal obstruction.

Spleen-preserving distal pancreatectomy with conservation of the spleen vessels

Background Distal pancreatectomy traditionally included splenectomy; the spleen, however, is an important organ in the immunologic defense of the host and is worthy of preservation. The aim of this research was to study the feasibility,safety and clinical effects of spleen and splenic vessel-preserving distal pancreatectomy.Methods A retrospective review was performed for 26 patients undergoing distal pancreatectomy for benign or low grade malignant disease with splenectomy （n=13） or splenic preservation （n=13） at the First Hospital of Sun Yat-sen University and Guangdong General Hospital in Southern China from May 2002 to April 2009.Results All 26 pancreatectomies with splenectomy or splenic preservation were performed successfully. There was no statistically significant difference between two groups in mean operative time （（172±47） minutes vs. （157±52） minutes, P ＞0.05）, intraoperative estimated blood loss （（183±68） ml vs. （160±51） ml, P ＞0.05）, incidence of noninfectious and infection complication and mean length of postoperative hospital stay （（10.1±2.2） days vs. （12.1 ±4.6） days, P ＞0.05）. The platelet counts examined one week after operation were significantly higher in the distal pancreatectomy with splenectomy group than the other group （（37.3±12.8）×109/L vs. （54.7±13.2）×109/L, P ＜0.05）.Conclusions Spleen-preserving distal pancreatectomy appears to be a feasible and safe procedure. In selected cases of benign or low-grade malignant disease, spleen-preserving distal pancreatectomy is recommended.

Images for diagnosis Giant epithelial splenic cyst

Splenic cysts are unusual in daily surgical practice and less than 1000 cases have been reported. Primary, true or epithelial splenic cysts, are even rarer. Usually, most of the cysts are asymptomatic until of significant size, at which time they are then detected incidentally on ultrasonography or CT scan. We report a case of a 25-year-old woman with giant epithelial splenic cyst with about 3000 ml of clear-yellow fluid was collected from the cyst. The splenectomy specimen measured 205 mmx192 mmx137 mm and weighed 4000 g.

不同外源激素对圆柏扦插育苗质量的影响

为提高圆柏育苗质量,试验采用扦插育苗方式,探讨了不同外源激素对扦插圆柏幼苗成活率、株高以及根系生长的影响。结果表明,在相同处理时间,300mg/L的IBA、IAA、NAA和ABT处理株高、生根数和根长均显著高于对照组,IBA处理成活率最高,NAA根系发育最好。其中以300 mg/L的萘乙酸(NAA)处理圆柏插条成活率最高,显著高于其他激素(p<0.05)。300mg/L和600 mg/L的NAA处理圆柏插条株高最高,分别较对照提高了1.2倍和1.1倍。600mg/L的NAA处理圆柏插条生根数和根长最佳。因此,采用NAA浸泡插条1h,有助于促进株高和根系生长,可应用于圆柏的扦插育苗。