Predictors of disease recurrence after radical resection and adjuvant chemotherapy in patients with stage IIb-IIIa squamous cell lung cancer:A retrospective analysis

BACKGROUND Lung cancer(LC)is a global medical,social and economic problem and is one of the most common cancers and the leading cause of mortality from malignant neoplasms.LC is characterized by an aggressive course,and in the presence of disease recurrence risk factors,patients,even at an early stage,may be indicated for adjuvant therapy to improve survival.However,combined treatment does not always guarantee a favorable prognosis.In this regard,establishing predictors of LC recurrence is highly important both for determining the optimal treatment plan for the patients and for evaluating its effectiveness.AIM To establish predictors of disease recurrence after radical resection and adjuvant chemotherapy in patients with stage IIb-IIIa lung squamous cell carcinoma(LSCC).METHODS A retrospective case-control cohort study included 69 patients with LSCC who underwent radical surgery at the Orenburg Regional Clinical Oncology Center from 2009 to 2018.Postoperatively,all patients received adjuvant chemotherapy.Histological samples of the resected lung were stained with Mayer's hematoxylin and eosin and examined under a light microscope.Univariate and multivariate analyses were used to identify predictors associated with the risk of disease recurrence.Receiver operating characteristic curves were constructed to discriminate between patients with a high risk of disease recurrence and those with a low risk of disease recurrence.Survival was analyzed using the Kaplan-Meier method.The log-rank test was used to compare survival curves between patient subgroups.Differences were considered to be significant at P<0.05.RESULTS The following predictors of a high risk of disease recurrence in patients with stage IIb-IIa LSCC were established:a low degree of tumor differentiation[odds ratio(OR)=7.94,95%CI=1.08-135.81,P=0.049];metastases in regional lymph nodes(OR=5.67,95%CI=1.09-36.54,P=0.048);the presence of loose,fine-fiber connective tissue in the tumor stroma(OR=21.70,95%CI=4.27-110.38,P=0.0002);and fragmentation of the tumor solid component(OR=2.53,95%CI=1.01-12.23,P=0.049).The area under the curve of the predictive model was 0.846(95%CI=0.73-0.96,P<0.0001).The sensitivity,accuracy and specificity of the method were 91.8%,86.9%and 75.0%,respectively.In the group of patients with a low risk of LSCC recurrence,the 1-,2-and 5-year disease-free survival(DFS)rates were 84.2%,84.2%and 75.8%,respectively,while in the group with a high risk of LSCC recurrence the DFS rates were 71.7%,40.1%and 8.2%,respectively(P<0.00001).Accordingly,in the first group of patients,the 1-,2-and 5-year overall survival(OS)rates were 94.7%,82.5%and 82.5%,respectively,while in the second group of patients,the OS rates were 89.8%,80.1%and 10.3%,respectively(P<0.00001).CONCLUSION The developed method allows us to identify a group of patients at high risk of disease recurrence and to adjust to ongoing treatment.

Endoscopy-based management decreases the risk of postoperative recurrences in Crohn's disease

AIM: To investigate whether an endoscopy-based management could prevent the long-term risk of postoperative recurrence.METHODS: From the pathology department database, we retrospectively retrieved the data of all the patients operated on for Crohn's disease(CD) in our center(1986-2015). Endoscopy-based management was defined as systematic postoperative colonoscopy(median time after surgery = 9.5 mo) in patients with no clinical postoperative recurrence at the time of endoscopy. RESULTS: From 205 patients who underwent surgery, 161 patients(follow-up > 6 mo) were included. Endoscopic postoperative recurrence occurred in 67.6%, 79.7%, and 95.5% of the patients, respectively 5, 10 and 20 years after surgery. The rate of clinical postoperative recurrence was 61.4%, 75.9%, and 92.5% at 5, 10 and 20 years, respectively. The rate of surgical postoperative recurrence was 19.0%, 38.9% and 64.7%, respectively, 5, 10 and 20 years after surgery. In multivariate analysis, previous intestinal resection, prior exposure to anti-TNF therapy before surgery, and fistulizing phenotype(B3) were postoperative risk factors. Previous perianal abscess/fistula(other perianal lesions excluded), were predictive of only symptomatic recurrence. In multivariate analysis, an endoscopy-based management(n = 49/161) prevented clinical(HR = 0.4, 95%CI: 0.25-0.66, P < 0.001) and surgical postoperative recurrence(HR = 0.30, 95%CI: 0.13-0.70, P = 0.006).CONCLUSION: Endoscopy-based management should be recommended in all CD patients within the first year after surgery as it highly decreases the long-term risk of clinical recurrence and reoperation.

Factors affecting recurrence after surgery for Crohn's disease

Although in Crohn's disease post-operative recurrence is common, the determinants of disease recurrence remain speculative. The aim of this study was to examine factors affecting post-operative recurrence of Crohn's disease. A Medline-based literature review was carried out. The following factors were investigated: age at onset of disease, sex, family history of Crohn's disease,smoking, duration of Crohn's disease before surgery,prophylactic medical treatment (corticosteroids, 5-amino salicylic acid [5-ASA] and immunosuppressants),anatomical site of involvement, indication for surgery (perforating or non-perforating disease), length of resected bowel, anast-omotic technique, presence of granuloma in the specimen, involvement of disease at the resection margin, blood transfusions and postoperative complications. Smoking significantly increases the risk of recurrence (risk is approximately twice as high), especially in women and heavy smokers. Quitting smoking reduces the post-operative recurrence rate. A number of studies have shown a higher risk when the duration of the disease before surgery was short. There were, however, different definitions of 'short' among the studies. Prophylactic cortic-osteroids therapy is not effective in reducing the post-operative recurrence. A number of randomized controlled trials offered evidence of the efficacy of 5-ASA (mesalazine) in reducing post-operative recurrence. Recently, the thera-peutic efficacy of immunosuppressive drugs (azathioprine and 6-mercaptopurine) in the prevention of post-operative recurrence has been investigated and several studies have reported that these drugs might help prevent the recurrence. Further clinical trials would be necessary to evaluate the prophylactic efficacy of immunosuppressants.Several studies showed a higher recurrence rate in patients with perforating disease than in those with non-perforating disease. However, evidence for differing recurrence rates in perforating and non-perforating diseases is inconclusive.A number of retrospective studies reported that a stapled functional end-to-end anastomosis was associated with a lower recurrence rate compared with other types of anastomosis. However, prospective randomized studies would be necessary to draw a definite conclusion. Many studies found no difference in the recurrence rates between patients with radical resection and non-radical resection. Therefore, minimal surgery including strictureplasty has been justified in the management of Crohn's disease. In this review, the following factors do not seem to be predictive of post-operative recurrence:age at onset of disease, sex, family history of Crohn's disease, anatomical site of disease, length of resected bowel, presence of granuloma in the specimen, blood transfusions and post-operative complications. The most significant factor affecting post-operative recurrence of Crohn's disease is smoking. Smoking significantly increases the risk of recurrence. A short disease duration before surgery seems, albeit to a very minor degree, to be associated with a higher recurrence rate. 5-ASA has been shown with some degree of confidence to lead to a lower recurrence rate. The prophylactic efficacy of immunosuppressive drugs should be assessed in future.A wider anastomotic technique after resection may reduce the post-operative recurrence rate, though this should be investigated with prospective randomized controlled trials.

Risk factors for postoperative recurrence after primary bowel resection in patients with Crohn's disease

AIM To evaluate the risk factors for postoperative recurrence after primary bowel resection in a cohort of Korean Crohn's disease(CD) patients.METHODS This study included 260 patients with no history of previous bowel surgery who underwent primary surgery for CD between January 2000 and December 2010 at Asan Medical Center(Seoul, South Korea). The median follow-up period was 101 mo.RESULTS During the follow-up period, 66 patients(25.4%) underwent a second operation for disease recurrence.At 1, 5 and 10 years after the first operation, the cumulative rate of surgical recurrence was 1.1%, 8.3% and 35.9% and clinical recurrence occurred in 1.2%, 23.6% and 68.1%, respectively. In multivariate analysis, undergoing an emergency operation was a significant risk factor for surgical recurrence-free survival(SRFS) [HR = 2.431, 95%CI: 1.394-4.240, P = 0.002], as were the presence of perianal disease after the first operation(HR = 1.715, 95%CI: 1.005-2.926, P = 0.048) and history of smoking(HR = 1.798, 95%CI: 1.088-2.969, P = 0.022). The postoperative use of antitumor necrosis factor(TNF) agents reduced SRFS risk(HR = 0.521, 95%CI: 0.300-0.904, P = 0.02).CONCLUSION History of smoking, postoperative perianal disease and undergoing an emergency operation were independent risk factors for surgical recurrence. Using anti-TNF agents may reduce surgical recurrence.

Risk factors for recurrence after bowel resection for Crohn’s disease

BACKGROUND Complications of Crohn’s disease such as intestinal obstruction,fistula or perforation often need surgical treatment.Nearly 70%-80%patients with Crohn’s disease would receive surgical treatment during the lifetime.However,surgical treatment is incurable for Crohn’s disease.The challenge of recurrence postoperatively troubles both doctors and patients.Over 50%patients would suffer recurrence postoperatively.Some certain risk factors are associated with recurrence of Crohn’s disease.AIM To evaluate the risk factors for endoscopic recurrence and clinical recurrence after bowel resection in Crohn’s disease.METHODS Patients diagnosed Crohn’s disease and received intestinal resection between April 2007 and December 2013 were included in this study.Data on the general demographic information,preoperative clinical characteristics,surgical information,postoperative clinical characteristics were collected.Continuous data are expressed as median(inter quartile range),and categorical data as frequencies and percentages.Kaplan-Meier method was applied to estimate the impact of the clinical variables above on the cumulative rate of postoperative endoscopic recurrence and clinical recurrence,then log-rank test was applied to test the homogeneity of those clinical variables.Multivariate Cox proportional hazard regression analysis was performed to identify the risk factors of postoperative endoscopic recurrence and clinical recurrence.RESULTS A total of 64 patients were included in this study.The median follow-up time for the patients was 17(9.25-25.75)mo.In this period,41 patients(64.1%)had endoscopic recurrence or clinical recurrence.Endoscopic recurrence occurred in 34(59.6%)patients while clinical recurrence occurred in 28(43.8%)patients,with the interval between the operation and recurrence of 13.0(8.0-24.5)months and 17.0(8.0-27.8)mo,respectively.In univariate analysis,diagnosis at younger age(P<0.001),disease behavior of penetrating(P=0.044)and preoperative use of anti-tumor necrosis factor(TNF)(P=0.020)were significantly correlated with endoscopic recurrence,while complication with perianal lesions(P=0.032)and preoperative use of immunomodulatory(P=0.031)were significantly correlated with clinical recurrence.As to multivariate analysis,diagnostic age(P=0.004),disease behavior(P=0.041)and preoperative use of anti-TNF(P=0.010)were independent prognostic factors for endoscopic recurrence,while complication with perianal lesions(P=0.023)was an independent prognostic factor for clinical recurrence.CONCLUSION Diagnostic age,disease behavior,preoperative use of anti-TNF and complication with perianal lesions were independent risk factors for postoperative recurrence in Crohn’s disease.

Recurrence of autoimmune liver diseases after liver transplantation

Liver transplantation(LT) is the most effective treatment modality for end stage liver disease caused by many etiologies including autoimmune processes. That said, the need for transplantation for autoimmune hepatitis(AIH) and primary biliary cirrhosis(PBC), but not for primary sclerosing cholangitis(PSC), has decreased over the years due to the availability of effective medical treatment. Autoimmune liver diseases have superior transplant outcomes than those of other etiologies. While AIH and PBC can recur after LT, recurrence is of limited clinical significance in most, but not all cases. Recurrent PSC, however, often progresses over years to a stage requiring re-transplantation. The exact incidence and the predisposing factors of disease recurrence remain debated. Better understanding of the pathogenesis and the risk factors of recurrent autoimmune liver diseases is required to develop preventive measures. In this review, we discuss the current knowledge of incidence, diagnosis, risk factors, clinical course, and treatment of recurrent autoimmune liver disease(AIH, PBC, PSC) following LT.

Adalimumab in prevention of postoperative recurrence of Crohn's disease in high-risk patients

AIM:To evaluate the effectiveness of adalimumab in preventing recurrence after intestinal resection for Crohn's disease in high-risk patients.METHODS:A multicenter,prospective,observational study was conducted from June 2009 until June 2010.We consecutively included high-risk Crohn's disease patients who had undergone an ileal/ileocolonic resection.High-risk patients were defined as two or more criteria:smokers,penetrating pattern,one or more previous surgical resections or prior extensive resection.Subcutaneous adalimumab was administered 2 wk(± 5 d) after surgery at a dose of 40 mg eow,with an initial induction dose of 160/80 mg at weeks 0 and 2.Demographic data,previous and concomitant treatments(antibiotics,5-aminosalicylates,corticosteroids,immunomodulators or biologic therapies),smoking status at the time of diagnosis and after the index operation and number of previous resections(type and reason for surgery) were all recorded.Biological status was assessed with C-reactive protein,erythrocyte sedimentation rate and fecal calprotectin.One year(± 3 mo) after surgery,an ileocolonoscopy and/or magnetic resonance enterography was performed.Endoscopic recurrence was defined as Rutgeerts score ≥ i2.Morphological recurrence was based on magnetic resonance(MR) score ≥ MR1.RESULTS:Twenty-nine patients(55.2% males,48.3% smokers at diagnosis and 13.8% after the index operation),mean age 42.3 years and mean duration of the disease 13.8 years were included in the study.A mean of 1.76(range:1-4) resections previous to adalimumab administration and in 37.9% was considered extensive resection.51.7% had previously received infliximab.Immunomodulators were given concomitantly to 17.2% of patients.Four of the 29(13.7%) developed clinical recurrence,6/29(20.7%) endoscopic recurrence and 7/19(36.8%) morphological recurrence after 1-year.All patients with clinical recurrence showed endoscopic and morphological recurrence.A high degree of concordance was found between clinical-endoscopic recurrence(k = 0.76,P < 0.001) and clinical-morphological recurrence(k = 0.63,P = 0.003).Correlation between endoscopic and radiological findings was good(comparing the 5-point Rutgeerts score with the 4-point MR score,a score of i4 was classified as MR3,i3 as MR2,and i2-i1 as MR1)(P < 0.001,r s = 0.825).During follow-up,five(17.2%) patients needed adalimumab dose intensification(40 mg/wk);Mean time to intensification after the introduction of adalimumab treatment was 8 mo(range:5 to 11 mo).In three cases(10.3%),a biological change was needed due to a worsening of the disease after the dose intensification to 40 mg/wk.One patient suffered an adverse event.CONCLUSION:Adalimumab seems to be effective and safe in preventing postoperative recurrence in a selected group of patients who had undergone an intestinal resection for their CD.

Crohn's disease presenting as acute gastrointestinal hemorrhage

Severe gastrointestinal(GI) hemorrhage is a rare complication of Crohn's disease(CD). Although several surgical and non-surgical approaches have been described over the last 2 decades this complication still poses significant diagnostic and therapeutic challenges. Given the relative infrequency of severe bleeding in CD, available medical literature on this topic is mostly in the form of retrospective case series and reports. In this article we review the risk factors, diagnostic modalities and treatment options for the management of CD presenting as GI hemorrhage.

A Pilot Study about Recurrence of Cancer： Impact ofPsychosocial Factors on Patients＇ Adjustment

The need to prevent cancer leads the authors to propose three innovative courses of cancer as categories of disease. Theobjectives of the research are to study the impact of different factors on adaptation to the recurrence of cancer and to assess the qualityof life, the anxiety as a state and the depression as a state and the evolution of the disease on a period of three months. During thislongitudinal and prospective study, the author met 32 subjects after announcing the recurrence of their cancer, and saw again 21 of them,three months later. In two times of the study, the author made fill out several questionnaires concerning various variables. The mainresults allow showing that the majority of the subjects did not present new recurrence of cancer and that the use of the Fighting spiritstrategy is representative of them. The author＇s linear regressions and the author＇s comparisons of averages allowed the authors severalrelations about to different categories of disease. Supporting therapies and management programs for stress would be beneficial for thepatients who have recurrence of their cancer.

冠心病患者经皮冠状动脉介入治疗后支架内再狭窄复发的危险因素及预测模型构建研究

目的:探索冠心病患者经皮冠状动脉介入治疗(PCI)后支架内再狭窄复发的危险因素,并初步构建支架内再狭窄复发的可视化风险预测模型。方法:收集中国医学科学院阜外医院2017年1~12月1 102例PCI后支架内再狭窄住院患者纳入分析。采用单因素Cox回归分析、LASSO回归及结合临床经验筛选支架内再狭窄复发的预测因子,多因素Cox回归分析建立预测模型。结果:中位随访1 264(1 169,1 334)d期间,111例(10.1%)患者支架内再狭窄复发。多因素Cox回归分析显示,年龄(HR=0.98,95%CI:0.96~0.99)、总胆红素(HR=0.95,95%CI:0.91~0.99)、载脂蛋白A1(HR=0.08,95%CI:0.02~0.42)、高敏C反应蛋白(HR=1.05,95%CI:1.01~1.10)和参照血管直径(HR=0.65,95%CI:0.44~0.98)是支架内再狭窄复发的危险因素,支架内再狭窄复发风险预测模型ROC曲线的AUC为0.70(95%CI:0.64~0.77)。结论:年龄、总胆红素、载脂蛋白A1和参照血管直径越小、高敏C反应蛋白水平越高,支架内再狭窄复发的风险越高;可视化的支架内再狭窄复发风险预测模型预测性能较好,但仍需进一步优化和验证。

Prediction of recurrence and prognosis in patients with hepatocellular carcinoma after resection by use of CLIP score

AIM: The survival time of patients with hepatocellular carcinoma (HCC) after resection is hard to predict. Both residual liver function and tumor extension factors should be considered. A new scoring system has recently been proposed by the Cancer of the Liver Italian Program (CLIP).CUP score was confirmed to be one of the best ways to stage patients with HCC. To our knowledge, however, the literature concerning the correlation between CLIP score and prognosis for patients with HCC after resection was not pubhshed. The aim of this study is to evaluate the recurrence and prognostic value of CLIP score for the patients with HCC after resection.METHODS: A retrospective survey was carried out in 174patients undergoing resection of HCC from January 1986 toJune 1998. Six patients who died in the hospital afteroperation and 11 patients with the recurrence of the diseasewere excluded at 1 month after hepatectomy. By the end ofJune 2001, 4 patients were lost and 153 patients with curativeresection have been followed up for at least three years.Among 153 patients, 115 developed intrahepatic recurrenceand 10 developed extrahepatic recurrence, whereas the other28 remained free of recurrence. Recurrences were classifiedinto early ( ＜ / = 3 year) and late ( ＞ 3 year) recurrence. TheCLIP score included the parameters involved in the Child-Pugh stage (0-2), plus macroscopic tumor morphology (0-2), AFP levels (0-1), and the presence or absence of portalthrombosis (0-1)o By contrast, portal vein thrombosis wasdefined as the presence of tumor emboli within vascularchannel analyzed by microscopic examination in this study.Risk factors for recurrence and prognostic factors forsurvival in each group were analyzed by the chi-square test,the Kaplan-Meier estimation and the COX proportionalhazards model respectively.RESULTS: The 1-, 3-, 5-, 7-, andl0-year disease-free survivalrates after curative resection of HCC were 57.2 %、 28.3 %、23.5 %、 18.8 % and 17.8 %, respectively. Median survivaltime was 28,16,10,4,and 5 mo for CLIP score 0,1,2,3, and 4to 5, respectively. Early and late recurrence developed in109 patients and 16 patients respectively. By the chi-squaretest, tumor size, micrusatsllite, venous invasion, tumortype (uninodular, muitinodular, massive), tumor extension( ＜ / = or ＞ 50 % of liver parenchyna replaced by tumor),TNM stage,CLIP score,and resection margin were the risk factors for early recurrence,whereas CLIP score and Child-Pugh stage were significant risk factors for late recurrence. in univariate survival analysis,Child-Pugh stages,resection margin,tumor size,microsatellite,venous invasion,tumor type,tumor extension,TNM stages,and CLIP score were associated with prognosis.The multivariale analysis by COX proportional hazards modes showed that the independent predictive factors of survival were resection margins and TNM stages. CONCLUSION:CLIP score has displayed a unique superiority in predictin the tumor early and late recurrence and prognosis in the patients with HCC after resection.

以疾病复发因素为主旨的思维导图式健康教育对过敏性鼻炎哮喘综合征患者的影响

目的:探讨以疾病复发因素为主旨的思维导图式健康教育对过敏性鼻炎哮喘综合征患者的影响。方法:选取2020年8月1日~2021年12月31日收治的100例过敏性鼻炎哮喘综合征患者,根据随机数字表法分为对照组和实验组各50例,对照组实施常规护理,实验组实施以疾病复发因素为主旨的思维导图式健康教育;比较两组护理前后生存质量[采用鼻结膜炎生存质量量表(RQLQ)]、哮喘控制情况[采用哮喘控制测评量表(ACT)]、肺功能(包括潮气容积、补呼气容积、补吸气容积及肺活量),并发症发生率。结果:护理后,两组肺功能指标及RQLQ功能维度得分均高于护理前(P<0.01),且实验组高于对照组(P<0.01);护理后,两组RQLQ症状维度得分及ACT评分均低于护理前(P<0.01),且实验组高于对照组(P<0.01);实验组并发症发生率低于对照组(P<0.05)。结论:以疾病复发因素为主旨的思维导图式健康教育干预能够最大限度改善患者临床症状,提高治疗效率,减少其并发症的发生,提升其生存质量。

神经内科门诊良性阵发性位置性眩晕发病与复发因素分析

目的分析良性阵发性位置性眩晕(Benign Paroxysmal Positional Vertigo,BPPV)发病的临床特征,探讨影响BPPV发病的影响因素及复发特点,为临床预防与治疗提供更多参考依据。方法回顾性分析2019年1月份至2020年12月份在浙江医院神经内科眩晕中心确诊、并完成仪器复位的1119例BPPV患者的一般人口学资料和病史信息。此外,跟踪记录BPPV患者的复发情况。采用Spearman秩相关性分析对BPPV发病和复发与月份的关系进行研究。按照年龄是否≥60岁分为老年组和非老年组,对高血压、糖尿病、偏头痛和听力损失行单因素方差分析,并采用Logistic回归分析探讨其复发因素。结果①1119例BPPV发病患者,其中男性401例(35.8%),女性718例(64.2%),平均发病年龄(55.0±15.7)岁。②1~12月份全年均可发病,月份/年发病例数最高是12月份(14.4%),最低是4月份(4.7%),相关性有统计学差异(P<0.05),复发例数最高是12月份(21.3%),最低是3月份(4.7%),相关性无统计学差异(P>0.05)。③高血压、糖尿病、偏头痛在老年组和非老年组间BPPV发病有统计学差异(P<0.05),是否存在听力损失在两组间发病无统计学差异(P>0.05)。④随访12个月内,老年组复发率(34.2%)高于非老年组(28.1%),两组间有统计学差异(P<0.05)。⑤高血压或糖尿病是BPPV复发的独立影响因素。结论BPPV发病存在月份相关性,高血压或糖尿病是BPPV复发的独立影响因素,对患有高血压、糖尿病和偏头痛的老年人更应注重预防和宣教。

氟康唑联合乳杆菌对RVVC的疗效及免疫因子水平的影响

目的探究口服氟康唑联合乳杆菌阴道用药在复发性外阴阴道假丝酵母菌病(recurrent vulvovaginal candidiasis,RVVC)患者中的疗效及对炎性指标水平的影响。方法选取门诊确诊为RVVC的患者120例,并采用随机数字表法分为观察组和对照组,每组60例,对照组口服氟康唑,观察组在此基础上予阴道置乳酸杆菌胶囊,观察两组临床症状消失时间、疗效、不良反应和复发率,比较两组治疗前后外阴阴道假丝酵母菌病(vulvovaginal candidiasis,VVC)评分、生存质量评分、炎症指标[白细胞介素(interleukin,IL)-4、IL-10、肿瘤坏死因子(tumer necrosis factor,TNF)-α、IL-2、干扰素(interferon,IFN)-γ、CD4^(+)、CD8^(+)]水平。结果观察组总有效率明显高于对照组(P<0.05);观察组白带异常恢复的时间、总体不良反应发生率、复发率均较对照组明显减少(P<0.05)。与治疗前比较,两组患者治疗后复查VVC评分均降低(P<0.05),且观察组均较对照组低(P<0.05)。两组治疗后生存质量评分与治疗前比较均升高(P<0.05),且观察组的评分高于对照组(P<0.05)。两组患者治疗后IL-4、IL-10、CD8^(+)水平均低于治疗前(P<0.05),且观察组患者中以上指标水平低于对照组(P<0.05);TNF-α、IL-2、IFN-γ、CD4^(+)、CD4/CD8的水平检测在治疗后高于治疗前(P<0.05),且观察组水平高于对照组(P<0.05)。结论氟康唑联合乳杆菌阴道用药治疗RVVC临床疗效较好,安全性能高,可有效改善免疫细胞和相关细胞因子水平。

高血压性脑出血患者预后的危险因素研究

目的 探讨并分析影响高血压性脑出血(hypertensive intracerebral hemorrhage,HICH)患者预后不良的危险因素。方法 回顾性分析2020年8月—2021年8月广东药科大学附属第二医院收治的80例高血压性脑出血患者(均经临床表现与影像学资料阅片诊断)的临床资料,采用多因素分析探究影响HICH患者预后不良的危险因素。结果 多因素分析发现,年龄≥70岁(OR=3.703,P<0.05)、出血量≥30 mL(OR=3.618,P<0.05)、术前GCS评分≤5分(OR=4.396,P<0.05)、开颅手术(OR=5.774,P<0.05)、手术时机>72 h(OR=8.574,P<0.05)、未接受内科保守治疗(OR=3.847,P<0.05)、≥2种术后并发症(OR=2.598,P<0.05)均是高血压性脑出血患者预后不良的危险因素。结论 影响高血压性脑出血患者疾病预后不良的危险因素相对较多,例如年龄、出血量、术前GCS评分、手术方式、手术时机、内科保守治疗以及术后并发症等。为有效改善患者预后,促进其病情康复,临床在疾病治疗期间应针对可干预因素采取合理措施,提高患者的生活质量。

妇科千金胶囊联合康妇消炎栓治疗盆腔炎的临床效果

目的探讨妇科千金胶囊联合康妇消炎栓治疗盆腔炎的临床效果。方法选取2021年3月至2022年9月济南市长清区双泉镇卫生院收治的80例盆腔炎患者,按照就诊日期单双号分为对照组(n=40)与观察组(n=40)。对照组予以康妇消炎栓治疗,观察组予以妇科千金胶囊联合康妇消炎栓治疗。比较两组炎症因子水平、症状体征积分、临床疗效及复发率。结果治疗后,观察组C反应蛋白及肿瘤坏死因子-α水平均低于对照组(P<0.05)。治疗后,观察组症状和体征积分均低于对照组(P<0.05)。观察组总有效率高于对照组,复发率低于对照组(P<0.05)。结论盆腔炎患者采用妇科千金胶囊联合康妇消炎栓治疗可促进临床症状改善,显著降低炎症因子水平,临床效果较好且复发风险低,值得临床推广应用。

缺血性脑卒中患者复发相关危险因素分析研究

目的探究缺血性脑卒中合并高血压患者脑卒中复发的影响因素。方法选取蒙城县第一人民医院2015年1月至2023年7月住院治疗的200例缺血性脑卒中合并高血压患者为研究对象,根据脑卒中是否复发来分为复发组(n=43)和非复发组(n=157)。对比分析两组患者一般资料、既往史、血脂等。采用多因素Logistic回归分析探究缺血性脑卒中合并高血压患者脑卒中复发的影响因素。结果复发组高血压史、高脂血症史、吸烟史比例、甘油三酯(TG)水平、体力活动不足史比例高于非复发组(P<0.05)。多因素Logistic回归分析结果显示,高血压史(OR=3.150)、吸烟史(OR=1.544)是缺血性脑卒中合并高血压患者脑卒中复发的影响因素(P<0.05)。结论高血压史、吸烟史是缺血性脑卒中合并高血压患者脑卒中复发的影响因素。

子宫颈鳞状上皮内病变患者LEEP后病变残留及复发的影响因素研究

目的探讨子宫颈鳞状上皮内病变(SIL)患者子宫颈环形电切术(LEEP)后病变残留及复发的影响因素。方法选取2021年6月至2022年8月就诊的子宫颈鳞状上皮内病变采取LEEP患者356例作为研究对象,收集所有研究者的资料,随访2年观察患者术后病变残留及复发情况,根据其是否有病变残留及复发分为两组:有残留/复发(94例)、无残留/复发(262例),采用Logistic回归分析疾病复发的影响因素。结果在356例接受LEEP术的子宫颈鳞状上皮内病变患者当中,无残留/复发例数为262例(73.60%),有残留/复发的患者94例(26.40%);通过分析发现,患者LEEP术后无残留/复发组与有残留/复发组比较,高危型人乳头瘤病毒(HR-HPV)、病理结果、受累象限差异有统计学意义(P<0.05);通过多因素Logistic分析显示,多重HR-HPV、腺体受累、多象限受累、宫颈上皮内癌变(CIN)Ⅲ、切缘阳性及人乳头瘤病毒(HPV)持续感染是残留及复发的独立危险因素(P<0.05)。结论子宫颈鳞状上皮内病变患者LEEP后病变残留及复发的因素与多重HR-HPV、腺体受累有关,还会受到切缘阳性、HPV持续感染的影响,在临床当中需及时复查和治疗,避免复发。

安珂微创旋切系统手术治疗乳腺良性肿块患者效果观察

目的 研究安珂微创旋切系统手术治疗乳腺良性肿块患者的临床效果。方法 选取2019年1月—2021年6月收治的322例乳腺良性肿块,据手术方式不同分为研究组(n=162,予安珂微创旋切系统手术治疗)和对照组(n=160,予传统乳腺肿块切除术治疗)。比较2组手术相关指标,手术前后应激指标[皮质醇(COR)、去甲肾上腺素(NE)、肿瘤坏死因子-α(TNF-α)],复发、美观程度及术后并发症。结果 研究组术中出血量少于对照组,手术时间、切口长度、切口愈合时间均短于对照组(P<0.01)。术后24 h 2组NE、COR、TNF-α均高于术前,且研究组低于对照组(P<0.05,P<0.01)。2组随访6个月均无复发病例;研究组术后乳房美观优良率(93.21%,151/162)高于对照组(76.25%,122/160)(P<0.01)。研究组术后并发症总发生率显著低于对照组(P<0.05)。结论 采用安珂微创旋切系统手术治疗乳腺良性肿块的效果显著,可缩短手术时间及患者住院时间,减轻应激反应和减少术后并发症的发生,且能提高术后乳房美观度。

内镜下黏膜切除术(EMR)治疗胃肠道息肉的临床效果分析

目的 探究内镜下黏膜切除术(endoscopic submucosal resection, EMR)在胃肠道息肉治疗中的临床应用效果与安全性。方法 方便选取2018年1月-2022年12月江苏省宿迁市中医院消化内科收治的86例胃肠道息肉患者为研究对象。以信封法分组,对照组43例患者接受电凝电切手术治疗,观察组43例患者接受内镜下黏膜切除术治疗。统计对比两组息肉成功切除、疾病复发、术后并发症情况,以及两组炎性因子水平和临床治疗效果。结果 与对照组相比,观察组息肉成功切除率更高,疾病复发率较更低,差异有统计学意义(P<0.05)。观察组术后腹胀、腹痛、便血并发症发生率(25.58%)低于对照组(6.98%),差异有统计学意义(χ^(2)=5.460,P<0.05)。术后,观察组的炎性因子水平均比对照组低,差异有统计学意义(P<0.05)。观察组治疗总有效率比对照组高,差异有统计学意义(P<0.05)。结论 针对胃肠道息肉患者,临床应用内镜下黏膜切除手术治疗的效果确切,可保证患者胃肠道息肉成功切除,避免疾病二次复发,对减少机体因手术而发生的炎症反应有重要意义,可提高临床疗效,还可保证患者安全。