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胆囊结石病理生理进展分期和个性化诊治 被引量:7
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作者 郑亚民 顾利国 许臣 《外科理论与实践》 2023年第2期94-99,共6页
胆囊结石(gallbladder stone, GS)是常见病、多发病。病人早期多无明显症状,发生梗阻会引起急性胆囊炎。GS继发梗阻性胆管炎、胆源性胰腺炎和胆囊癌等后果严重。世界各地专业组织发布过多个指南和共识,促进了GS的规范诊治,但仍存在许多... 胆囊结石(gallbladder stone, GS)是常见病、多发病。病人早期多无明显症状,发生梗阻会引起急性胆囊炎。GS继发梗阻性胆管炎、胆源性胰腺炎和胆囊癌等后果严重。世界各地专业组织发布过多个指南和共识,促进了GS的规范诊治,但仍存在许多争议问题。当前临床缺乏大样本全病程的相关研究,忽视GS的预防和早诊早治,造成个性化诊治不足。为了更好地开展预防、选择诊治方法、判断预后和随访,笔者根据疾病发生、发展和转归的病理生理学特点,将GS病程发展分为4期。(1)成石期;(2)无症状无梗阻期;(3)炎症感染期,包括梗阻炎症、化脓坏疽和穿孔脓肿3个阶段;(4)继发病变期,包括胆囊形态及功能异常阶段、结石移位阶段、继发胆囊癌阶段。依据病理生理的分期,有利于在规范基础上的个性化诊治,使病人获益更多。 展开更多
关键词 胆囊结石 病理生理 进展分期 个性化诊治
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斑块状银屑病严重程度评价及皮肤镜表现分析 被引量:7
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作者 杨正生 李力 戴秀荣 《医学综述》 CAS 2021年第5期1017-1021,1026,共6页
目的探讨不同发展分期斑块状银屑病的严重程度及皮肤镜表现。方法选取2018年1月至2019年3月在秦皇岛市第一医院接受诊疗的65例斑块状银屑病患者为研究对象,其中进展期23例、静止期21例、退行期21例。三组患者采用银屑病面积和严重程度指... 目的探讨不同发展分期斑块状银屑病的严重程度及皮肤镜表现。方法选取2018年1月至2019年3月在秦皇岛市第一医院接受诊疗的65例斑块状银屑病患者为研究对象,其中进展期23例、静止期21例、退行期21例。三组患者采用银屑病面积和严重程度指数(PASI)评价皮损严重程度,采用皮肤镜进行影像分析。结果进展期和静止期组PASI评分高于退行期[(20.60±5.23)分、(14.52±2.99)分比(6.54±1.50)分](P<0.01)。皮肤镜表现总体特征:进展期呈现更多的炎症表现和血管扩张形成的点状/球状血管;退行期则以炎症后期的色素沉着为特征,扩张的血管有所减轻;静止期的特点介于两者之间。进展期和静止期皮肤镜评分高于退行期[(7.69±1.01)分、(5.43±0.87)分比(2.33±0.96)分](P<0.01)。PASI评分预测诊断进展期患者的受试者工作特征曲线下面积(AUC)为0.863(P<0.01),皮肤镜评分预测进展期患者的AUC为0.948(P<0.01),皮肤镜评分与PASI评分预测进展期患者AUC比较差异无统计学意义(P>0.05)。PASI评分预测诊断静止期患者的AUC为0.994(P<0.01),皮肤镜评分预测静止期患者的AUC为0.990(P<0.01),皮肤镜评分与PASI评分预测静止期患者AUC比较差异无统计学意义(P>0.05)。结论皮肤镜评分与PASI评分对银屑病患者分期的预测价值相同,皮肤镜可以作为银屑病进展分期诊断以及疗效观察的有效手段。 展开更多
关键词 斑块状银屑病 皮肤镜 影像诊断 进展分期
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Treatment of Unresectable Carcinoma of Pancreas with ^(125)I Implantation and ^(125)I Plus Gemcitabine
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作者 丁昂 童赛雄 +2 位作者 靳大勇 张逖 吴肇光 《Journal of Nanjing Medical University》 2004年第2期78-84,共7页
Objective: To study the role of 125 I and 125 I plus gemcitabine (GEM) in treatment of unresectable carcinoma of pancreas. Methods: From April 2000 to April 2003, 38 untreated patients with locally advanced pan... Objective: To study the role of 125 I and 125 I plus gemcitabine (GEM) in treatment of unresectable carcinoma of pancreas. Methods: From April 2000 to April 2003, 38 untreated patients with locally advanced pancreatic cancer (LAPC) were collected and randomized into two groups: Arm A 125 I (18 patients) and Arm B 125 I+GEM (20 patients). Eligibility criteria were: cytologically and pathologically proven pancreatic carcinoma, Karnofsky performance status (kps) 60 80, age 18 75 years, adequate hematological, renal and liver function, and controllable pain. Arm A patients were treated with 125 I implants. Arm B patients started chemotherapy within 10 14 d post operatively following the implant procedure. Chemotherapy doses were as follows: GEM 1 000 mg/m 2 weekly × 3 followed by 1 week of rest for 3 cycles. In addition, all patients underwent laparotomy and surgical staging. The surgical procedures performed were biopsy, gastric bypass and biliary bypass. The total activity and number of seeds used were as recommended by Anderson. The mean activity, minimal peripheral dose (MPD), and volume of implants were 20 mCi, 14 000 cGy, and 53 cm 3, respectively. Results: Overall response rate (CR+PR) in Arm A was 37.6% and in Arm B it was 44.5% ( P >0.05). PR median duration in Arm A was 6.7 months and in Arm B it was 4.8 months ( P <0.05). Clinical benefit response was experienced by 11.7 % of Arm A compared with 42.1% of Arm B ( P <0.05). The incidences of hematological toxicity (such as neutropenia) between Arm A and Arm B were 5.8% and 21.1%, respectively ( P >0.05). The survival rates of 12 and 24 month were 32.5%, 16.3% for Arm A and 61%, 38.7% for Arm B ( P =0.04). The rate of complication of Arm A was lower than that of Arm B without statistical significance. Conclusion: To some extent, 125 I or 125 I plus GEM is able to lead to a moderate objective response for LAPC with obstructive jaundice on the base of biliary bypass or/and gastric bypass, but 125 I plus GEM is more effective than 125 I in improvement of the quality of life and survival rate in patients with LAPC. 展开更多
关键词 125I implantation brachytherapy carcinoma of pancreas gemcitabine/therapeutic survival rate
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Lnc-TCL6 is a potential biomarker for early diagnosis and grade in liver-cirrhosis patients 被引量:4
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作者 Lei-Jia Li Xiao-Ying Wu +8 位作者 Si-Wei Tan Zi-Jun Xie Xue-Mei Pan Shun-Wen Pan Wu-Ri-Na Bai Hai-Jiao Li Hui-Ling Liu Jie Jiang Bin Wu 《Gastroenterology Report》 SCIE EI 2019年第6期434-443,I0002,共11页
Background:Long non-coding RNAs(lncRNAs)have been applied as biomarkers in many diseases.However,scarce biomarkers are available in single lncRNA differential expression associated with different clinical stages of li... Background:Long non-coding RNAs(lncRNAs)have been applied as biomarkers in many diseases.However,scarce biomarkers are available in single lncRNA differential expression associated with different clinical stages of liver cirrhosis(LC).The aim of the study is to identify some lncRNAs that can serve as non-invasive sensitive biomarkers for early diagnosis and grade of LC.Methods:Blood lncRNA expression was evaluated in three independent cohorts with 305 participants including healthy controls,hepatitis B virus(HBV)carriers,and patients with chronic hepatitis B(CHB)or LC.First,candidate lncRNAs were screened by CapitalBiotech microarray to diagnose cirrhosis.Quantitative reverse-transcriptase polymerase chain reaction was then used to investigate the expression of selected lncRNAs in the whole group of cirrhosis and different Child–Pugh classes.Ultimately,the diagnostic accuracy of the promising biomarker was examined and validated via Mann–Whitney test and receiver-operating characteristics analysis.Results:Lnc-TCL6 was identified as a sensitive biomarker for early diagnosis of LC(Child–Pugh A)compared with healthy controls(area under the ROC curve[AUC]=0.636),HBV carriers(AUC=0.671),and CHB patients(AUC=0.672).Furthermore,lnc-TCL6 showed a favourable capacity in discriminating among different Child–Pugh classes(AUC:0.711–0.837).Compared with healthy controls,HBV carriers,and CHB patients,the expression of lnc-TCL6 was obviously up-regulated in Child–Pugh A patients and,conversely,significantly down-regulated in Child–Pugh C patients.Conclusions:Lnc-TCL6 is a novel potential biomarker for early diagnosis of LC and is a possible predictor of disease progression. 展开更多
关键词 long non-coding RNAs Lnc-TCL6 BIOMARKER liver cirrhosis Child–Pugh classification
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