Dukes D期大肠癌的手术治疗及疗效观察

目的 探讨DukesD期大肠癌手术治疗的意义及疗效。方法 对 1 991～ 1 998年间我科收治的行手术治疗的 82例DukesD期大肠癌患者进行回顾性分析。结果 2 1例患者行联合脏器切除术 ,2 9例行姑息性切除术 ,1 9例行改道手术 ,1 3例行剖腹探查活检术。行联合脏器切除术后患者生存期明显延长 ,71 .4%生活质量为优、2 3 .8%为良、4 .8%为中 ,明显优于其它三种术式 (P<0 .0 1 ) ;行姑息性切除术后患者生活质量为优者占 62 .1 % ,良为 1 7.2 % ,中为1 3 .8% ,差为 6 .9% ,优于改道手术及剖腹探查活检术 (P<0 .0 5) ;行改道手术及剖腹探查活检术后疗效较差 ,生存期短 ,生活质量评估多为差或中。

IL-6在不同Dukes分期结肠癌中的表达及临床意义

目的:探讨不同Dukes分期结肠癌组织及癌旁组织中的IL-6以及结肠癌患者外周血IL-6的表达情况。方法:收集56例结肠癌、癌旁组织的标本及15例正常结肠组织标本。收集结肠癌患者术前外周血标本和正常对照组外周血标本。采用免疫组织化学SP法检测IL-6蛋白的表达及用酶联免疫吸附(ELISA)法检测血清中IL-6的水平。结果:结肠癌患者组织IL-6阳性率显著多于癌旁对照组(P<0.05)及正常对照组(P<0.05)。阳性表达率与淋巴结转移、临床Dukes分期有关(P<0.05),与组织学分级、肿瘤大小无关(P>0.05);结肠癌外周血IL-6水平显著高于正常对照组(P<0.05)。结论:IL-6在结肠癌中表达明显增高,且与临床分期有关,可作为诊断结肠癌的预警信号和判断预后的有用指标。

Dukes'B期结直肠癌术后辅助化疗的Meta分析

背景与目的:Dukes'B期结直肠癌根治性手术后是否需要辅助化疗,各研究报道不一,本研究利用M eta分析探讨Dukes'B期患者术后是否需要辅助化疗。方法:收集国内外1985～2003年间关于Dukes'B期结直肠癌根治性手术后给予辅助化疗的文章,将术后辅助化疗组和单纯手术组5年生存率进行综合比较。结果:符合要求纳入分析的文献共8篇,8个随机对照试验研究,累计病例6518人。比较术后化疗组和单纯手术组的5年死亡率,其合并OR值为0.79(95%CI=0.7～0.9,P<0.01),化疗组可降低术后5年死亡率。结论:Dukes蒺B期结直肠癌术后化疗可提高5年生存率。

Ki-67表达与结直肠癌Dukes分期关系

目的检测ki-67在正常结直肠组织和结直肠癌中的表达情况,探讨其表达与结直肠癌Dukes分期关系,为临床结直肠癌的诊疗判断提供参考。方法收集临床病理资料完整的结直肠癌54例,正常结直肠黏膜组织28例。应用免疫组化法(SP法)检测正常结直肠组织和结直肠癌中ki-67蛋白的表达。结果Ki-67蛋白在结直肠癌及正常结直肠黏膜中的表达率分别为85.19%和10.71%,在结直肠癌组织中的表达高于正常结直肠黏膜的表达,差异有统计学意义(P<0.01)。ki-67蛋白的表达和Dukes分期无相关性,差异无统计学意义(P>0.05)。结论ki-67蛋白过表达与结直肠癌的发生发展密切相关,但不能作为结直肠癌预后的参考指标。

The Christian Doctrines of Salvation at the Earlier Stages of The Pilgrim's Progress

John Bunyan's The Pilgrim's Progress has been written to preach the Christian doctrines of salvation.Therefore its allegorical protagonists have gradually gone through four stages of development on the path to salvation.This paper is focused on the earlier two stages,that is,the repentance of sins and the temptations after conversion.

E-cad、Snail表达与Dukes B期大肠癌浸润、转移、预后的关系

目的研究E-cad、Snail表达与大肠癌侵袭、转移和预后的关系。方法采用免疫组化EnVision法,分别检测E-cad、Snail在正常大肠黏膜上皮、大肠腺瘤及大肠癌患者癌组织中的表达。结果 E-cad的表达与肿瘤分化程度、浸润深度、静脉、淋巴管侵犯、淋巴结转移与否及Dukes分期状况密切相关(均P<0.05),而与年龄、性别、肿瘤大小、肿瘤病理类型无相关性(均P>0.05)。45例Dukes B期的大肠癌患者中7例E-cad染色阴性,其1、3、5年生存率分别为85.71%、57.14%、0.00%;38例为中度阳性或强阳性,其1、3、5年生存率分别为97.37%、65.79%、39.47%,两者比较有统计学差异(P<0.01)。Snail表达与肿瘤病理类型、分化程度、浸润深度、静脉、淋巴管侵犯、淋巴结转移与否及Dukes分期明显相关(均P<0.05),而与年龄、性别、肿瘤大小无相关性(均P>0.05)。45例Dukes B期的大肠癌患者中26例Snail染色阴性,其1、3、5年生存率分别为100.00%、69.23%、42 31%;19例为中度阳性或强阳性,其1、3、5年生存率分别为89.47%、57.89%、26.32%,两者比较有统计学差异(P<0.01)。多因素分析结果显示:肿瘤淋巴结转移、Dukes分期、E-cad表达强度、Snail表达强度可预示患者术后生存情况(均P<0.05)。E-cad与Snail在大肠癌组织中的表达呈显著负相关(r=-0.508,P<0.01)。结论 E-cad与Snail可作为大肠癌患者的独立预后指标,预示患者术后生存情况。Dukes B期大肠癌患者中,E-cad阴性者预后明显较阳性者为差;Snail阳性者的预后明显较阴性者为差。

STAGE在C3I仿真测试系统中的应用

针对C3I系统面临的测试问题,提出一种将STAGE应用于C3I系统的仿真测试系统,并分析了STAGE的优点,介绍其组成结构、功能和STAGE在该系统中的应用。该系统已应用于某实际C3I系统的测试。

基于MRI影像组学构建PD-1/PD-L1抑制剂治疗dMMR/MSI-H直肠癌疗效的预测模型

目的:探讨MRI影像组学模型在程序性细胞死亡蛋白-1(PD-1)/程序性细胞死亡-配体1(PD-L1)抑制剂联合全程新辅助治疗(TNT)局部进展期直肠癌(LARC)的疗效预测价值。方法:收集河南中医药大学第一附属医院PD-1/PD-L1抑制剂联合TNT治疗的80例错配修复基因缺陷(dMMR)/微卫星高度不稳定(MSI-H)基因型中低位LARC患者的临床和影像资料。将入组患者按7∶3比例分为训练集和测试集,提取影像组学特征,从中筛选并构建影像组学模型。描绘影像组学模型的Rad-score与病理金标准之间的受试者工作特征(ROC)曲线,计算曲线下面积(AUC),并评价模型的诊断效能。采用决策曲线分析(DCA)计算风险阈值的范围,并评估临床获益情况。收集湖南省人民医院25例dMMR/MSI-H基因型LARC患者的影像资料作为外部验证集。结果:训练集、测试集及外部验证集三者之间的临床特征无统计学差异(P>0.05)。经过降维处理、t检验及一致性检验以及LASSO交叉验证后,筛选出一阶偏度特征和体积2个特征构建影像组学模型。训练集、测试集和外部验证集的影像组学预测模型ROC曲线的AUC、灵敏度、特异度、阳性预测值和阴性预测值分别为0.920、97.1%、85.7%、91.9%、94.7%;0.885、80.0%、88.9%、92.3%、72.7%;0.875、87.5%、88.9%、93.3%、80.0%。DCA曲线显示,当风险阈值范围为0%~82%时,采用影像组学模型预测LARC患者为病理完全缓解(pCR)的获益大于将所有患者都视为pCR或者无病理完全缓解(npCR)。结论:基于MRI影像组学构建的dMMR/MSI-H型局部进展期直肠癌PD-1/PD-L1抑制剂联合全程新辅助放化疗疗效预测模型,有较大潜力为不同基因分型的直肠癌患者制定个体化治疗策略提供量化依据。

Microbiome changes in the gastric mucosa and gastric juice in different histological stages of Helicobacter pylori-negative gastric cancers

BACKGROUND The gastric microbiota in patients with gastric cancer(GC)has received increasing attention,but the profiling of the gastric microbiome through the histological stages of gastric tumorigenesis remains poorly understood,especially for patients with Helicobacter pylori-negative GC(HPNGC).AIM To characterize microbial profiles of gastric mucosa and juice for HPNGC carcinogenesis and identify distinct taxa in precancerous lesions.METHODS The 16S rRNA gene analysis was performed on gastric mucosa from 134 Helicobacter pylori-negative cases,including 56 superficial gastritis(SG),9 atrophic gastritis(AG),27 intestinal metaplasia(IM),29 dysplasia(Dys),and 13 GC cases,to investigate differences in gastric microbial diversity and composition across the disease stages.In addition,paired gastric mucosa and juice samples from 18 SG,18 IM,and 18 Dys samples were analyzed.α-Diversity was measured by Shannon and Chao1 indexes,andβ-diversity was calculated using partial least squares discrimination analysis(PLS-DA).Differences in the microbial composition across disease stages in different sample types were assessed using the linear discriminant analysis effect size.RESULTS The diversity and composition of the bacterial microbiota in the gastric mucosa changed progressively across stages of gastric carcinogenesis.The diversity of the gastric mucosa microbiota was found to be significantly lower in the IM and Dys groups than in the SG group,and the patients with GC had the lowest bacterial community richness(P<0.05).Patients with IM and those with Dys had similar gastric mucosa microbiota profiles with Ralstonia and Rhodococcus as the predominant genera.Microbial network analysis showed that there was increasing correlation strength between IM and Dys(|correlation threshold|≥0.5,P<0.05).GC and its precancerous lesions have distinguishable bacterial taxa;our results identified HPNGC-associated bacteria Streptococcaceae and Lactobacillaceae(P<0.05).Additionally,across precancerous lesion stages from AG to Dys in Helicobacter pylori-negative patients,Burkholderiaceae abundance continuously increased,while Streptococcaceae and Prevotellaceae abundance presented a continuous downward trend.Furthermore,the microbial diversity was higher in gastric juice(P<0.001)than in the mucosa,while PLS-DA revealed a statistically significant difference between the two groups(ANOSIM,P=0.001).A significant difference in the microbial structure was identified,with Proteobacteria being more prevalent in the gastric mucosa and Firmicutes being more abundant in gastric juice.CONCLUSION Our results provide insights into potential taxonomic biomarkers for HPNGC and its precancerous stages and assist in predicting the prognosis of IM and Dys based on the mucosal microbiota profile.

4种血清肿瘤标志物及粪便隐血的结合检测在Dukes B期结肠癌诊断中的应用

目的:评价在Dukes B期结肠癌4种肿瘤标志物联合粪便隐血检测的临床诊断价值。方法:选取本院2018-04~2020-03收治Dukes B期结肠癌、结肠息肉患者各40例以及40例健康体检者(对照组)作为检测对象。检测3组受检者CEA、AFP、CA125、CA199水平以及进行粪便隐血检测。对比3组受检者检测结果。结果:结肠癌组患者4种血清肿瘤标志物与粪便隐血相比对照组均明显更高(P<0.05);与结肠癌组患者粪便隐血、CA125、CA199以及CEA相比结肠息肉患者明显更高(P<0.05);结肠癌组患者CA125、CA199、CEA以及粪便隐血阳性率相比结肠息肉患者、对照组受检者均显著更高(P<0.05);结肠癌组患者各指标联合诊断的阳性率相比结肠息肉患者、对照组受检者均显著更高(P<0.05);通过Logistic回归分析显示,粪便隐血阳性、CA125、CEA、CA199以及AFP均作为结肠癌的高危因素(P<0.05);通过二项分类Logistic回归分析显示CA125、粪便隐血指标水平升高可作为结肠癌发生的独立危险因素(P<0.05)。结论:针对Dukes B期结肠癌患者的临床诊断中,CA125、CEA、CA199以及AFP等4种血清肿瘤标志物联合粪便隐血试验诊断阳性率较高。

Partial improvement in performance of patients with severe Alzheimer's disease at an early stage of fornix deep brain stimulation

Deep brain stimulation is a therapy for Alzheimer＇s disease（AD） that has previously been used for mainly mild to moderate cases. This study provides the first evidence of early alterations in performance induced by stimulation targeted at the fornix in severe AD patients. The performance of the five cases enrolled in this study was scored with specialized assessments including the Mini-Mental State Examination and Clinical Dementia Rating, both before and at an early stage after deep brain stimulation. The burden of caregivers was also evaluated using the Zarit Caregiver Burden Interview. As a whole, the cognitive performance of patients remained stable or improved to varying degrees, and caregiver burden was decreased. Individually, an improved mental state or social performance was observed in three patients, and one of these three patients showed remarkable improvement in long-term memory. The conditions of another patient deteriorated because of inappropriate antipsychotic medications that were administered by his caregivers. Taken together, deep brain stimulation was capable of improving some cognitive aspects in patients with severe AD, and of ameliorating their emotional and social performance, at least at an early stage. However, long-term effects induced by deep brain stimulation in patients with severe AD need to be further validated. More research should focus on clarifying the mechanism of deep brain stimulation. This study was registered with ClinicalTrials.gov（NCT03115814） on April 14, 2017.

p16 gene methylation in colorectal cancers associated with Duke's staging

AIM: To explore the association of methylation of the CpG island in the promotor of the p16 tumor suppressor gene with the clinicopathological characteristics of the colorectal cancers. METHODS: Methylation-specific PCR (MSP) was used to detect p16 methylation of 62 sporadic colorectal cancer specimens. RESULTS: p16 methylation was detected in 42% of the tumors.Dukes'staging was associated with p16 methylation status.p16 methylation occurred more frequently in Dukes'C and D patients (75.9%) than in Dukes'A and B patients (12.1%). CONCLUSION: p16 methylation plays a role in the carcinogenesis of a subset of colorectal cancer, and it might be linked to poor prognosis.

Anodal transcranial direct current stimulation alleviates cognitive impairment in an APP/PS1 model of Alzheimer’s disease in the preclinical stage

Anodal transcranial direct current stimulation(AtDCS)has been shown to alleviate cognitive impairment in an APP/PS1 model of Alzheimer’s disease in the preclinical stage.However,this enhancement was only observed immediately after AtDCS,and the long-term effect of AtDCS remains unknown.In this study,we treated 26-week-old mouse models of Alzheimer’s disease in the preclinical stage with 10 AtDCS sessions or sham stimulation.The Morris water maze,novel object recognition task,and novel object location test were implemented to evaluate spatial learning memory and recognition memory of mice.Western blotting was used to detect the relevant protein content.Morphological changes were observed using immunohistochemistry and immunofluorescence staining.Six weeks after treatment,the mice subjected to AtDCS sessions had a shorter escape latency,a shorter path length,more platform area crossings,and spent more time in the target quadrant than sham-stimulated mice.The mice subjected to AtDCS sessions also performed better in the novel object recognition and novel object location tests than sham-stimulated mice.Furthermore,AtDCS reduced the levels of amyloid-β42 and glial fibrillary acidic protein,a marker of astrocyte activation,and increased the level of neuronal marker NeuN in hippocampal tissue.These findings suggest that AtDCS can improve the spatial learning and memory abilities and pathological state of an APP/PS1 mouse model of Alzheimer’s disease in the preclinical stage,with improvements that last for at least 6 weeks.

原发肿瘤部位、术前CEA水平及Dukes分期与结直肠癌术后肺转移的相关性研究

目的研究原发肿瘤部位、术前CEA水平及Dukes分期与结直肠癌术后肺转移的相关性。方法随机选取术后结直肠癌患者73例,对患者的不同临床病理特征进行统计分析。结果单纯性肺转移30例,肺转移原发肿瘤部位:21例患者为直肠癌,9例患者为结肠癌;在肺转移部位方面,18例患者为单侧,12例患者为双侧。原发肿瘤手术到肺转移确诊时间在2～39个月之间,中位时间为(11. 7±3. 6)个月。原发肿瘤部位、淋巴结转移、术前CEA水平≥5μg/L、Dukes分期C期患者的肺转移发生率均显著高于无淋巴结转移、术前CEA水平<5μg/L、Dukes分期B期患者(P <0. 05);不同肿瘤大小、原发灶病理类型、淋巴结清扫数目、脉管浸润患者的肺转移发生率之间的差异无统计学意义(P>0. 05)。多因素Logistic回归分析模型分析结果表明,肺转移危险因素包括原发肿瘤部位、术前CEA水平、Dukes分期(P<0. 05),但不包括淋巴结转移(P> 0. 05)。结论原发肿瘤部位、术前CEA水平及Dukes分期与结直肠癌术后肺转移显著相关。

Dukes'B期结直肠癌患者术后复发转移的临床相关因素分析

目的分析影响Dukes’B期结直肠癌患者术后复发转移的相关因素,为改善患者预后提供理论依据。方法通过医院病历系统,回顾收集2015年8月—2018年8月的120例结直肠癌手术患者的临床资料,术后随访3年(截至2021年8月),记录所有患者复发转移情况。结果随访3年间,120例Dukes’B期结直肠癌患者术后出现复发转移49例,复发转移率为40.83%。单因素分析结果显示,不同肿瘤活动程度、肿瘤直径大小、分化程度、肠壁侵袭层次、病理分级、切缘长度、术后化疗、术中输血情况、侵犯肠周程度及术前CEA水平的Dukes’B期结直肠癌患者间,术后复发转移情况差异有统计学意义(P<0.05)。多因素分析结果显示,分化程度、肠壁侵袭层次、术后化疗情况及术前CEA水平是Dukes’B期结直肠癌患者术后复发转移的独立危险因素(P<0.05)。结论分化程度、肠壁侵袭层次、术后化疗情况及术前CEA水平独立影响Dukes’B期结直肠癌患者术后复发转移,临床需加强对合并高危因素患者的针对性干预,以降低Dukes’B期结直肠癌患者术后复发转移率。

Disclosure of Duke's Power in My Last Duchess Through Analysis of Transitivity

This thesis attempts to analyze the presentation of Duke's power in Robert Browning's My Last Duchess through theory of transitivity in functional stylistics. Through transitivity analysis, Duke's dominating position will be revealed, and the thematic significance and language features of this poem would be shed light upon as well.

Unicentric Castleman's disease associated with end stage renal disease caused by amyloidosis

Castleman's disease(CD), also known as angiofolicular lymph node hyperplasia, is a rare heterogenous group of lymphoproliferative disorders. Histologically, it can be classified as hyaline vascular type, plasma cell type, or mixed type. Clinically two different subtypes of the CD are present: Unicentric and multicentric. Unicentric CD is generally asymptomatic and associated with hyaline vascular type, and its diagnoses depend on the localized lymphadenopathy on examination or imaging studies. However, multicentric CD presents with generalized lymphadenopathy and systemic symptoms including malaise, fever, night sweats, weight loss, and it is associated with the plasma cell type and mix type. Herein, we report a patient with unicentric CD of the plasma cell type without systemic symptoms, who developed end stage renal failure caused by amyloidosis 6 years after onset of CD.

Prey Predator Fishery Model with Stage Structure in Two Patchy Marine Aquatic Environment

In this paper, we propose and analyze a mathematical model to study the dynamics of a fishery resource system with stage structure in an aquatic environment that consists of two zones namely unreserved zone (fishing permitted) and reserved zone (fishing is strictly prohibited). In this model we introduce a stage structure in which predators are split into two kinds as immature predators and mature predators. It is assumed that immature predators cannot catch the prey and their foods are given by their parents (mature predators). It is also assumed that the fishing of immature predators prohibited in the unreserved zone and predator species are not allowed to enter inside the reserved zone. The local and global stability analysis has been specified. Biological and Bionomical equilibriums of the system are derived. Mathematical formulation of the optimal harvesting policy is given and its solution is derived in the equilibrium case by using Pontryagin’s maximum principle.

“Malaysia Has Certainly Benefited from China’s Prominence on the World Stage”——Exclusive Interview with See Chee Kong Leonard, Business Minister of Embassy of Malaysia in PRC

Relations between China and Malaysia have been developing steadily.Recently,See Chee Kong Leonard,Business Minister of Embassy of Malaysia in PRC,accepted an interview with Chinas Foreign Tradey and talked about the 45 years of economic and trade cooperation and achievements of the two countries.