Effects of enteral nutrition via jejunostomy catheter on immune response and intestinal mucosal barrier function after radical operation for esophageal cancer

Objective: To study the effects of enteral nutrition via jejunostomy catheter on immune response and intestinal mucosal barrier function after radical operation for esophageal cancer. Methods: A total of 90 patients who were diagnosed with esophageal cancer and received radical operation in Xishui People's Hospital between February 2015 and May 2017 were selected and randomly divided into the EN group who accepted enteral nutrition via jejunostomy catheter and the PN group who received parenteral nutrition. 1 week and 2 weeks after surgery, the expression of immune cell transcription factors in peripheral blood as well as the contents of intestinal mucosal injury markers and inflammatory stress markers in serum were measured. Results: 1 week and 2 weeks after surgery, T-bet expression intensity in peripheral blood of EN group was greatly higher than that of PN group while GATA3, RORγt and Foxp3 expression intensity in peripheral blood as well as DAO, Galectin-1, Galectin-3, Claudin, NE, E, Cor, CRP and CER levels were greatly lower than those of PN group. Conclusion: Enteral nutrition via jejunostomy catheter can improve the immune response and intestinal mucosal barrier function after radical operation for esophageal cancer.

Operative link on gastritis assessment stage is an appropriate predictor of early gastric cancer

AIM: To assess the predictive value of Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM) stages in gastric cancer.METHODS: A prospective study was conducted with 71 patients with early gastric cancer (EGC) and 156 patients with non-EGC. All patients underwent endoscopic examination and systematic biopsy. Outcome measures were assessed and compared, including the Japanese endoscopic gastric atrophy (EGA) classification method and the modified OLGA method as well as the modified OLGIM method. Helicobacter pylori (H. pylori) status was determined for all study participants. Stepwise logistic regression modeling was performed to analyze correlations between EGC and the EGA, OLGA and OLGIM methods.RESULTS: For patients with EGC and patients with non-EGC, the proportions of moderate-to-severe EGA cases were 64.8% and 44.9%, respectively (P = 0.005), the proportions of OLGA stages III-IV cases were 52.1% and 22.4%, respectively (P < 0.001), and the proportions of OLGIM stages III-IV cases were 42.3% and 19.9%, respectively (P < 0.001). OLGA stage and OLGIM stage were significantly related to EGA classification; specifically, logistic regression modeling showed significant correlations between EGC and moderate-to-severe EGA (OR = 1.95, 95% CI: 1.06-3.58, P = 0.031) and OLGA stages III-IV (OR = 3.14, 95%CI: 1.71-5.81, P < 0.001), but no significant correlation between EGC and OLGIM stages III-IV (P = 0.781). H. pylori infection rate was significantly higher in patients with moderate-to-severe EGA (75.0% vs 54.1%, P = 0.001) or OLGA/OLGIM stages III-IV (OLGA: 83.6% vs 55.8%, P < 0.001; OLGIM: 83.6% vs 57.8%, P < 0.001).CONCLUSION: OLGA classification is optimal for EGC screening. A surveillance program including OLGA stage and H. pylori infection status may facilitate early detection of gastric cancer.

CLINICAL SIGNIFICANCES OF THE EXPRESSION OF METALLO- THIONEIN IN FIVE TYPES EPITHELIUM CELL CANCER

Objective： To study the expressions of （CSC）, bladder transitional cell cancer metallothionein and the significances in cervical squamous cell cancer （BTC）, esophageal squamous cell cancer （ESC）, gastral tubular adenocarcinoma （GC） and large intestinal tubular adenocarcinoma （LIC）. Methods： lmmunohistochemical method was used to examine the expression rates of MT in five types of cancer tissue. Results： The expression rates of MT were 75.00% （24/32） in ESC, 52.27% （46/88） in GTC, 59.46% （44/74） in LIC, 64.86% （48/74） in BTC and 58.57% （41/70） in CSC respectively. The positive rates of MT expression were higher in low differentiation and deep muscular group than those in medium or high differentiation and superficial muscular invasion group （P〈0.05）. Conclusion： The expression of MT is related to differentiation degree and invasion degree.

Discussion on the clinical application of colorectal cancer based on the theory of "Tongqixiangqiu"

Objective:To explore the application of the theory of"Tongqixiangqiu"and its application in traditional Chinese medicine in order to find out the clinical application of colorectal cancer.Methods:Referring to the ancient medical works and modern literature on the theory of"Tongqixiangqiu",combined with the disease characteristics of colorectal cancer and the clinical experience of famous doctors in ancient and modern times,to explore its application in the clinical treatment of colorectal cancer.Results:The theory of"Tongqixiangqiu"has rich connotations,among which"anti-adjuvant therapy"and"lung and intestine combined treatment"are the representatives of the specific application of the theory.The methods of cold and heat counteraction,compatibility and external treatment as well as the idea of spleen deficiency and Qi stagnation type colorectal cancer pay attention to tonifying Fei qi,nourishing Fei yin,and promoting Sanjiao Qi mechanism play an important role in the differentiation and treatment of colorectal cancer in TCM.Conclusion:The theory of"Tongqixiangqiu"is widely used in the treatment of colorectal cancer,which has the advantages of significant curative effect,synergism and toxicity reduction,prolonging the survival period and improving the quality of life of patients.

普芦卡必利在机器人辅助腹腔镜根治性膀胱切除+尿流改道术围手术期应用的效果分析

目的明确普芦卡必利(PRUC)在机器人辅助腹腔镜根治性膀胱切除(RARC)+尿流改道术围手术期对患者肠道功能的影响。方法回顾性分析2021年4—12月南京大学医学院附属鼓楼医院收治的75例行RARC+尿流改道术(原位膀胱术/回肠膀胱术)患者,根据围手术期是否服用PRUC分为PRUC组(28例)和常规组(47例)。分析比较两组患者术后肠道通气时间、通便时间、引流管留置时间、首次进食半流食物耐受时间、术后住院时间以及术后并发症的发生率,并比较两组患者术后C反应蛋白(CRP)和中性粒细胞/淋巴细胞比值(NLR)的变化。结果PRUC组较常规组患者肠道通气时间和通便时间均更短[(47.14±16.31)h vs.(74.04±35.33)h,P<0.01;(86.14±30.47)h vs.(123.57±79.12)h,P=0.02]。PRUC组较常规组术后CRP(ΔCRP)和NLR变化幅度(ΔNLR)均较小[(79.99±29.71)mg/L vs.(127.75±56.98)mg/L;(9.24±6.43)vs.(16.11±9.90),P均<0.01]。所有并发症均为次要并发症,PRUC组患者术后90 d内肠梗阻发生率有降低的趋势(P=0.38),两组间其他并发症差异均无统计学意义(P>0.05)。结论PRUC可促进RARC+尿流改道术患者术后肠道功能恢复。

基于虚实辨证的大肠癌血瘀证中医药治疗和作用机制研究进展

血瘀证是大肠癌患者常见的中医证型,血瘀贯穿于大肠癌发生发展的各个阶段,活血化瘀法是临床治疗大肠癌的常用方法。从因虚致瘀、由实成瘀两个角度探讨大肠癌血瘀证的病因病机和临床治疗,并从增殖凋亡、血管新生、细胞自噬、侵袭转移、免疫调节、微循环障碍等方面综述活血化瘀中药治疗大肠癌血瘀证的作用机制,以期为临床使用活血化瘀法治疗大肠癌提供依据。

81例改良Bacon术后外置肠管缺血坏死发生情况及对策分析

目的探讨改良Bacon术后外置肠管缺血坏死发生情况和相关因素以及处理措施。方法回顾性分析2018年11月至2024年3月郑州大学第一附属医院收治的81例低位直肠癌患者的临床资料。81例患者中伴外置肠管缺血坏死8例,不伴外置肠管缺血坏死73例。记录改良Bacon术后外置肠管缺血坏死发生情况及处理措施,分析影响改良Bacon术外置肠管缺血坏死的相关因素。结果术后发生并发症20例(24.69%),外置肠管缺血坏死8例中,3例出现腹膜炎急诊行乙状结肠造口术,5例患者外置肠管坏死在肛缘附近,无局部和全身症状,保守治疗成功;吻合口狭窄12例均行扩肛治疗。无切口感染、吻合口漏及术后30 d内死亡病例。年龄、体质量指数(BMI)、括约肌张力状态和直肠系膜张力状态与外置肠管缺血坏死具有关联性(P<0.05)。结论改良Bacon术后外置肠管缺血坏死的相关因素包括年龄、BMI、括约肌张力状态和直肠系膜张力状态。患者的选择、术前充分扩肛以及肉毒素注射、术后定期观察是预防外置肠管缺血坏死的有效措施。

基于烟草对癌变的影响探讨肺与大肠相表里

目的 通过分析烟草对人体各部位癌症发病率的影响,探讨肺肠轴理论与“肺与大肠相表里”的中医理论的关系。方法 收集从2017年—2021年来院就诊的137591人中的2477例肿瘤患者的一般信息、吸烟史、肿瘤原发部位等,对收集的资料进行肿瘤发病率统计分析和比较。结果 吸烟可提高消化系统癌症的病发率,仅次于呼吸道并远高于其他部位的癌症病发率。这一现象符合“肺与大肠相表里”的中医理论和现代医学中肺肠轴学说。结论 肺系疾病易引发肠道疾病,而肠道疾病也易引发肺系疾病,此现象可用中医“肺与大肠相表里”解释,肺-肠轴理论可作为“肺与大肠相表里”理论的翻译。

Comparison of operative link for gastritis assessment, operative link on gastric intestinal metaplasia assessment, and TAIM stagings among men with atrophic gastritis

BACKGROUND Gastric cancer is the world’s third most lethal malignancy. Most gastric cancers develop through precancerous states of atrophic gastritis and intestinal metaplasia. Two staging systems, operative link for gastritis assessment(OLGA)and operative link on gastric intestinal metaplasia assessment(OLGIM), have been developed to detect high gastric cancer risk. European guidelines recommend surveillance for high-risk OLGA/OLGIM patients(stages Ⅲ–Ⅳ),and for those with advanced stage of atrophic gastritis in the whole stomach mucosa. We hypothesize, that by combining atrophy and intestinal metaplasia into one staging named TAIM, more patients with increased gastric cancer risk could be detected.AIM To evaluate the clinical value of the OLGA, OLGIM, and novel TAIM stagings as prognostic indicators for gastric cancer.METHODS In the Helsinki Gastritis Study, 22346 elderly male smokers from southwestern Finland were screened for serum pepsinogen I(PGI). Between the years 1989 and1993, men with low PGI values(PGI < 25 μg/L), were invited to undergo an oesophagogastroduodenoscopy. In this retrospective cohort study, 1147 men that underwent gastroscopy were followed for gastric cancer for a median of 13.7 years, and a maximum of 27.3 years. We developed a new staging system, TAIM,by combining the topography with the severity of atrophy or intestinal metaplasia in gastric biopsies. In TAIM staging, the gastric cancer risk is classified as low or high.RESULTS Twenty-eight gastric cancers were diagnosed during the follow-up, and the incidence rate was 1.72 per 1000 patient-years. The cancer risk associated positively with TAIM [Hazard ratio(HR) 2.70, 95%CI: 1.09–6.69, P = 0.03]. The risk increased through OLGIM stages 0-Ⅳ(0 vs Ⅳ: HR 5.72, 95%CI: 1.03–31.77, P for trend = 0.004), but not through OLGA stages 0–Ⅳ(0 vs Ⅳ: HR 5.77, 95%CI:0.67–49.77, P for trend = 0.10). The sensitivities of OLGA and OLGIM stages Ⅲ–Ⅳ were low, 21% and 32%, respectively, whereas that of TAIM high-risk was good, 79%. On the contrary, OLGA and OLGIM had high specificity, 85% and81%, respectively, but TAIM showed low specificity, 42%. In all three staging systems, the high-risk men had three-to four-times higher gastric cancer risk compared to the general male population of the same age.CONCLUSION OLGIM and TAIM stagings show prognostic value in assessing gastric cancer risk in elderly male smokers with atrophic gastritis.

Intestinal metastasis from breast cancer:Presentation,treatment and survival from a systematic literature review

BACKGROUND Intestinal metastases from breast cancer(BC)arerare;available data depend mainly on case reports and case series.AIM To conduct a review of the literature regarding presentation,diagnosis,treatment and survival of patients with intestinal metastasis from BC.METHODS We identified all articles that described patients with intestinal metastasis(from duodenum to anum)from BC using MEDLINE(1975 to 2020)and EMBASE(1975 to 2020)electronic databases.RESULTS We found 96 cases of intestinal metastasis of BC.Metastasization involved large bowel(cecum,colon,sigmoid,rectum)(51%),small bowel(duodenum,jejunum,ileum)(49%),and anum(<1%).Median age of patients was 61-years.The most frequent histology was infiltrating lobular carcinoma followed by infiltrating ductal carcinoma.In more than half of patients,the diagnosis was made after the diagnosis of BC(median:7.2 years)and in many cases of emergency,for bowel obstruction,bleeding or perforation.Diagnosis was achieved through endoscopy,radiological examination or both.In most of the cases,patients underwent surgery with or without systemic therapies.Survival of patients included in this review was available in less than 50%of patients and showed an overall median of 12 mo since diagnosis of the intestinal metastasis.CONCLUSION Although,intestinal metastases of BC are considered a rare condition,clinicians should consider the possibility of intestinal involvement in case of abdominal symptoms even in acute setting and many years after the diagnosis of BC,especially in patients with a histology of lobular carcinoma.

针刺防治结直肠癌腹膜转移患者术后胃肠功能紊乱的临床疗效

目的:研究针刺防治结直肠癌腹膜转移患者术后胃肠功能紊乱的临床疗效。方法:选取2019年10月至2020年5月首都医科大学附属北京世纪坛医院收治的肿瘤细胞减灭术(CRS)术后的结直肠癌(Ⅳ期)腹膜转移术后患者73例作为研究对象,根据是否接受针刺分为对照组(n=32)和观察组(n=41),对照组仅采取西医围手术期治疗,观察组采用术后针刺治疗+西医围手术期治疗,比较2组患者首次自主排便时间、拔除胃管时间、胃管引流量、腹胀评分以及卡诺夫斯凯评分(KPS)。结果:观察组首次自主排便时间为(7.37±1.79)d,比对照组(8.97±2.55)d短,差异有统计学意义(P<0.05)。观察组拔除胃管时间为(6.07±1.35)d,比对照组(7.03±2.02)d短,差异有统计学意义(P<0.05)。术后3 d和术后7 d,2组患者术后胃管引流量差异均无统计学意义(P>0.05)。术后14 d,观察组腹胀评分为(1.17±0.714)分,比对照组腹胀评分低,差异有统计学意义(P<0.05)。2组患者于术前及术后1 d的KPS差异无统计学意义(P>0.05)。2组患者术后KPS评分均逐渐提高。术后14 d观察组评分(76.95±10.83)分比对照组(70.47±12.27)分高,差异有统计学意义(P<0.05)。结论:针刺治疗可以促进结直肠癌腹膜转移患者术后排便功能恢复,缩短拔胃管时间,改善腹胀症状和体力状态,具有积极的临床意义。

行开腹手术的肝癌患者术后早期下床活动的最佳方案探讨

目的探讨行开腹手术的肝癌患者术后首次下床活动的最佳时间及早期活动水平。方法将152例行开腹手术的肝癌患者分为4组:A1组(n=36)患者于术后第2天开始下床并进行低水平活动,第3天进行中水平活动;A2组(n=40)患者于术后第2天开始下床并进行中水平活动;B1组(n=39)患者于术后第1天开始下床并进行低水平活动,第2、3天进行低中水平活动;B2组(n=37)患者于术后第1天开始下床并进行低水平活动,第2天开始进行中水平活动。比较4组患者术后肠功能恢复情况、术后住院时间及40项恢复质量调查问卷(QoR-40)评分。结果4组患者术后肠鸣音恢复时间、术后住院时间差异无统计学意义(P>0.05);A1组患者的术后肛门排气时间长于其他3组,腹胀程度重于B1、B2组(P<0.05)。A2组、B2组患者的身体舒适度维度、情绪状态维度、疼痛维度、自理能力维度得分及QoR-40总分高于A1、B1组,且B1组患者的自理能力维度评分高于A1组(P<0.05)。结论对于行开腹手术的肝癌患者,在病情允许的情况下,术后第1天开始下床活动或术后第2天下床活动达中水平均有利于其术后恢复。

大肠息肉癌变的影响因素

目的探讨大肠息肉癌变的影响因素,提高结直肠癌的早诊早治,降低发病率。方法回顾性选取2020年1月至2022年12月在昆明医科大学第一附属医院消化内科住院期间明确诊断为肠息肉的患者,收集临床资料:性别、年龄、身高、体重、吸烟史、饮酒史、糖尿病史、高血压史,肠癌家族史及个人史、息肉的部位、形态、大小、数量、病理类型,分析大肠息肉癌变的影响因素。结果共调查4700例患者,发生癌变665例,癌变率为14.1%。不同性别、不同BMI组、是否患糖尿病、是否饮酒、有无肠癌家族史的患者肠息肉癌变率的差异均无统计学意义(P>0.05)。不同年龄组、是否患高血压、是否吸烟、有无肠癌病史、不同息肉部位、不同息肉形态、不同息肉表面情况、不同息肉数量(单发或多发)、不同息肉直径的患者肠息肉癌变率的差异均有统计学意义(P<0.05)。非条件二分类Logistic回归分析结果显示年龄、高血压、吸烟、息肉部位、息肉形态、息肉表面情况和息肉大小是影响肠息肉癌变的因素(P<0.05)。在对病理类型与癌变的关系分析时,调查的4700例患者中绒毛状腺瘤5例,例数太少没有纳入分析,有69例结果是“腺癌”,无法查到癌变前的病理类型故没有纳入分析,最终纳入4626例患者,分析发现不同病理类型的癌变率差异有统计学意义(P<0.05)。进一步两两比较,两两间均有差异(P<0.001):管状绒毛状腺瘤组癌变率最高(42.0%),其次是管状腺瘤组(6.1%),最低是非肿瘤性息肉(0%)。结论大肠息肉病理类型以管状腺瘤多见,随着绒毛成分的增多息肉癌变风险增加。高危息肉的内镜下特征包括:位于直肠及乙状结肠、表面分叶、山田分型为Ⅱ型及Ⅲ型、息肉直径较大。大肠息肉癌变风险和年龄呈正相关,随着年龄增加,息肉癌变风险加大,特别是年龄超过60岁。吸烟和高血压是肠息肉癌变的影响因素。

倪海雯应用芪苓白头翁汤治疗脾虚湿热型原发肠道弥漫大B细胞淋巴瘤临证经验

总结倪海雯治疗原发肠道弥漫大B细胞淋巴瘤的经验。原发肠道弥漫大B细胞淋巴瘤病情凶险,预后差,临床表现缺乏特异性,治疗棘手。倪海雯以周仲瑛癌毒学说及病机十三条理论为指导,从“虚、毒、湿、热”复合病机论治,归纳本病核心病机为“脾虚癌毒,挟杂湿热”,并结合不同治疗阶段采用分期论治、病证结合的中西整合模式,在经典名方白头翁汤基础上结合癌毒病机加以创新,创立验方芪苓白头翁汤以健脾益气,燥湿清肠,标本兼治。临床随访观察发现,其可明显改善患者临床症状,减少复发,提高患者生活质量。

基于“肺与大肠相表里”探讨“肺病治肠”与肠道微生物的关系

在肠道微生态学进一步发展的背景下,发现中医“肺与大肠相表里”与肠道微生物在肺病治肠上有一定的关联性。中医认为,肺主宣发肃降,大肠传化糟粕,两者功能相辅相成,气机升降有序,能使卫气布达周身肌表,五脏安定。现代研究发现肺与大肠相表里的关系主要体现在组织来源、黏膜免疫、神经内分泌与肠道微生物等方面。从“肺病治肠”角度出发,治疗肺病与调节肠道微生物的菌群结构、代谢产物等关系密切,故以“肺与大肠相表里”为框架,研究分析“肺病治肠”与肠道微生物的关系,为“肺病治肠”的临床治疗提供新思路。

基于“肝与大肠相通”理论对结直肠癌相关性情绪障碍的病机探讨

基于脏腑、经络、五行等中医基础理论、现代医学、“肝与大肠相通”理论视角分析肝与大肠的联系,从脏腑别通、五行生克及肝寄腑于大肠等方面探讨结直肠癌相关性情绪障碍的病机,旨在丰富中医药治疗结直肠癌相关性情绪障碍的中医理论及方法,在此前提下促进情志疾病的中医治疗理论体系完善,为治疗癌症相关性情绪障碍提供新的诊疗思路。

结肠黑变病的临床特点及其对大肠息肉与大肠癌的影响分析

目的探究结肠黑变病的临床特点及其对大肠息肉、大肠癌的影响。方法回顾性分析2019年8月至2021年12月于苏州高新区人民医院经电子结肠镜检查确诊结肠黑变病的62例患者及同期接受电子结肠镜检查的确诊非结肠黑变病的62例患者的临床资料。比较结肠黑变病与非结肠黑变病患者性别、年龄及大肠息肉、大肠癌检出情况。结果结肠黑变病患者女性占比及大肠息肉、大肠癌检出率均高于非结肠黑变病患者,年龄大于非结肠黑变病患者,差异有统计学意义(P<0.05)。结肠黑变病患者主要累及肠道为右半结肠(45.16%),便秘者(80.65%)占比最高,大肠息肉主要为直径<10 mm者(92.86%),大肠息肉病理类型主要为增生性息肉(35.71%)、单纯腺瘤(35.71%)。结论结肠黑变病患者的大肠息肉、结肠癌检出率高于非结肠黑变病者,需引起足够的重视和积极干预。

基于数据挖掘分析国医大师李佃贵治疗结肠癌术后用药规律

目的:基于古今医案云平台探索国医大师李佃贵治疗结肠癌术后用药规律。方法:于河北省中医院门诊收集2020年1月1日至2022年7月31日经李教授治疗的结肠癌术后患者处方。通过Excel 2021建立数据库并导入古今医案云平台(V2.3.5),经过标准化后进行药物频次、药物属性、药物聚类、药物关联及复杂网络分析,探索李佃贵国医大师治疗结肠癌术后用药规律。结果:共纳入处方121首,通过数据挖掘得出高频用药为黄连、黄芩、半枝莲、白花蛇舌草等,用药以寒、温性为主,味多苦、甘、辛,归经以脾、肝、胃为主。聚类分析得到4组药物,复杂网络分析得到核心处方:黄芩、黄连、白花蛇舌草、半枝莲、当归、白芍、苦参、槟榔、川芎、白术。结论:李教授主张以化浊解毒、宣瘀通络治疗结肠癌术后患者。

肠癌康复汤对大肠癌患者术后免疫功能的影响

目的 :探讨肠癌康复汤对大肠癌患者术后免疫功能的影响。方法 :将 4 8例Dukes′B、C期的大肠癌手术后患者随机分为中药组 16例、化疗组 17例、中药加化疗组 (以下简称中化组 ) 15例 ,分别予服肠癌康复汤与 5 氟脲嘧啶 (5 FU)、丝裂霉素 (MMC)化疗 ,观察T淋巴细胞亚群、NK细胞及免疫球蛋白的动态变化并与健康人组作对比研究。结果 :手术前各组大肠癌患者的CD3+ 、CD4 + 及CD4 + /CD8+ 均明显下降 ,而CD8+ 明显增加 ,NK细胞活性亦明显低于健康人 (P <0 0 1) ,说明大肠癌患者的细胞免疫处于抑制状态。手术后 1周进一步下降 ,尤其是CD3+ 下降最为明显。而手术后 1个月 ,CD3+ 、CD4 + 及NK细胞活性在中药组首先恢复正常 ,术后 2个月中化组亦逐渐恢复正常 ,且这两组较治疗前均有不同程度的提高 ,但化疗组恢复较为缓慢。在体液免疫方面亦取得了相类似的结果。结论 :肠癌康复汤可显著提高大肠癌手术后患者的免疫功能。

大肠癌临床病理特征与血小板增多关系的探讨

目的:探讨大肠癌伴发血小板增多的临床规律及病理特征。方法:分析有完整资料和随访资料的383例大肠癌患者的临床病理资料,其中103例合并血小板增多。结果:大肠癌伴血小板增高103例,占26.9%。血小板增高与大肠癌患者的性别、年龄、病变部位无显著性差异,但与有无梗阻有显著性差异(P<0.005)。血小板增高与大肠癌患者肿瘤的大体形态、直径、分化程度、组织学、病理分期、肠壁浸润深度、淋巴转移均有显著性差异。结论:大肠癌伴血小板增多晚期患者多见,预后差。