系统化干预对急诊肝癌合并消化道出血患者心理状态及生活质量的影响

目的探讨系统化干预对急诊肝癌合并消化道出血患者心理状态及生活质量的影响。方法根据干预方式的不同将101例急诊肝癌合并消化道出血患者分为对照组(n=50)和观察组(n=51),对照组患者接受常规干预,观察组患者在对照组的基础上接受系统化干预。比较两组患者的止血效果、心理状态[抑郁自评量表(SDS)、焦虑自评量表(SAS)]、生活质量[欧洲癌症研究与治疗组织生命质量测定量表(EORTC QLQ-C30)]、不良反应发生情况及满意度。结果观察组患者的止血总有效率为98.04%,高于对照组患者的82.00%,差异有统计学意义(P﹤0.05)。干预后,两组患者SDS、SAS评分均低于本组干预前,EORTC QLQ-C30量表各维度评分均高于本组干预前,观察组患者SDS、SAS评分均低于对照组,EORTC QLQ-C30量表各维度评分均高于对照组,差异均有统计学意义(P﹤0.05)。观察组患者的并发症总发生率为3.92%,明显低于对照组患者的22.00%,总满意度为100%,明显高于对照组患者的80.00%,差异均有统计学意义(P﹤0.01)。结论系统化干预应用于急诊肝癌合并消化道出血患者,止血效果明显,能够改善患者的生活质量及心理状态,降低并发症发生率,患者满意度较高。

Lower Concentrations of Glucose or Insulin Decrease the Risk of Various Types of Cancer in the Long-Lived Ames Dwarf Mouse by Increasing the Expression of p27Kip1, a Cell-Cycle Repressor Protein

Introduction. The molecular biological mechanism of the increased incidence of the various types of cancer in obesity or type 2 diabetes in rodents or humans has largely been resolved in recent years. By contrast, the molecular biological mechanism of the decreased, not increased, incidence of the various types of cancer in the homozygous long-lived Ames dwarf mice still remains unresolved. Objective. The first objective of the present study was to investigate whether the decrease in the incidence of cancer in the homozygous long-lived Ames dwarf mice is due to the increase, not decrease, in the expression of p27Kip1, a cell cycle repressor protein. The second objective was to investigate whether the decrease in the incidence of cancer in the homozygous long-lived Ames dwarf mice is due to the decrease, not increase, in the levels of glucose or insulin. Methods. To achieve these objectives, we first performed western immunoblot analysis of the hepatic expression of p27Kip1 protein. We then performed, using a human breast cancer cell line in vitro, the luciferase reporter plasmid assay to determine whether the translation initiation activity of the p27Kip1 mRNA is increased when the concentrations of either glucose or insulin are decreased. Results and Conclusion. The results of the first objective indicated that the hepatic expression of p27Kip1 protein was up-regulated in the homozygous long-lived Ames dwarf mice as expected. We also found that the lower concentrations of glucose or insulin increased the translation initiation activity of the p27Kip1 mRNA.

大黄[庶虫]虫丸治疗肝癌的研究进展

大黄[庶虫]虫丸出自《金匮要略》,是治疗“虚劳干血”类疾病的经典名方,近年来广泛用于多种恶性肿瘤尤其是肝癌的综合治疗中。检索整理近20年文献,从中医组方特色、临床应用、分子机制三方面总结大黄[庶虫]虫丸治疗肝癌的相关研究,发现大黄[庶虫]虫丸在中医组方上具有虫类逐瘀、草本养虚,肝脾同调、两脏兼顾,蜜丸为剂、峻药缓图等特色,配伍严谨,用药精当。在临床上无论是联合经动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)还是联合静脉化疗,均可减轻治疗不良反应,提高临床有效率,延长患者生存时间;此外,对于晚期原发性肝癌患者以及肝转移癌患者,单药应用也可明显改善症状,提高生活质量,延长终末期患者带瘤生存时间,临床疗效确切,且可长期应用,安全性较高。机制研究中发现大黄[庶虫]虫丸具有抗肝癌前病变、保护肝细胞,调节肝功能,抗肝癌细胞转移、抑制肿瘤血管新生,促进血管正常化、调节免疫等相关机制,分子机制明确。通过以上三方面,全面详细阐述了大黄[庶虫]虫丸治疗肝癌的研究现状,并对目前的临床和实验研究提出不足与改进,以期为后续深入研究及抗肿瘤新药的研发提供思路和依据。

结直肠癌生存者治疗结束3个月后重返正常生活现状调查

目的:调查结直肠癌生存者治疗结束3个月后重返正常生活水平,并分析其影响因素。方法:采用便利抽样法,选取2022年11月—2023年6月在常州市2所三级甲等综合医院肿瘤科、胃肠外科住院及门诊复查的130例结直肠癌生存者为研究对象,采用一般资料调查表、重返正常生活指数、社会支持评定量表、医院焦虑抑郁量表进行调查。结果:结直肠癌生存者治疗结束3个月后重返正常生活原始总分为(80.40±11.10)分,校正总分为(73.09±10.09)分。是否保肛、主观支持、焦虑、抑郁是结直肠癌生存者日常功能的影响因素,性别、客观支持、抑郁是结直肠癌生存者自我感知的影响因素。结论:结直肠癌生存者治疗结束3个月后重返正常生活受到中度限制,医护人员应重点关注未保肛、社会支持度较低、心理状况较差及女性结直肠癌生存者,实施个性化指导,促进结直肠癌生存者重返正常生活。

Secondary non-resectable liver tumors:A single-center living-donor and deceased-donor liver transplantation case series

Background: During the last decades, deceased-donor liver transplantation (DDLT) has gained a place in the therapeutic algorithm of well-selected patients harbouring non-resectable secondary liver tumors. Living-donor LT (LDLT) might represent a valuable means to further expand this indication for LT. Methods: Between 1985 and 2016, twenty-two adults were transplanted because of neuroendocrine ( n = 18, 82%) and colorectal metastases ( n = 4, 18%);50% received DDLT and 50% LDLT. In LDLT, 4 (36%) right and 7 (64%) left grafts were used;the median graft-to-recipient-weight ratios (GRWR) were 1.03%(IQR 0.86%- 1.30%) and 0.59%(IQR 0.51%- 0.91%), respectively. Median post-LT follow-up was 64 months (IQR 17–107) in the DDLT group and 40 months (IQR 35–116) in the LDLT group. DDLT and LDLT recipients were compared in terms of overall survival, graft survival, postoperative complications and recurrence. Results: The 1- and 5-year actuarial patient survivals were 82% and 55% after DDLT, 100% and 100% after LDLT, respectively ( P < 0.01). One- and 5-year actuarial graft survivals were 73% and 36% after DDLT, 91% and 91% after LDLT ( P < 0.01). The outcomes of right or left LDLT were comparable. Donor hepatectomy proved safe, and one donor experienced a Clavien IIIb complication. Bilirubin peak was significantly lower after left hepatectomy compared with that after right hepatectomy [1.3 (IQR 1.2–2.2) vs. 3.3 (IQR 2.3–5.2) mg/dL;P = 0.02]. Conclusions: The more recent LDLT series compared favorably to our DDLT series in the treatment of secondary liver malignancies. The absence of portal hypertension and the use of smaller left grafts make recipient and donor surgeries safe. The safety of the procedures and lack of interference with the scarce allograft pool are expected to lead to a more frequent use of LDLT in the field of transplant oncology.

Adult-to-adult living-donor liver transplantation: The experience of the Université catholique de Louvain

Background: Liver transplantation is the treatment for end-stage liver diseases and well-selected malignancies. The allograft shortage may be alleviated with living donation. The initial UCLouvain experience of adult living-donor liver transplantation(LDLT) is presented. Methods: A retrospective analysis of 64 adult-to-adult LDLTs performed at our institution between 1998 and 2016 was conducted. The median age of 29(45.3%) females and 35(54.7%) males was 50.2 years(interquartile range, IQR 32.9–57.5). Twenty-two(34.4%) recipients had no portal hypertension. Three(4.7%) patients had a benign and 33(51.6%) a malignant tumor [19(29.7%) hepatocellular cancer, 11(17.2%) secondary cancer and one(1.6%) each hemangioendothelioma, hepatoblastoma and embryonal liver sarcoma]. Median donor and recipient follow-ups were 93 months(IQR 41–159) and 39 months(22–91), respectively. Results: Right and left hemi-livers were implanted in 39(60.9%) and 25(39.1%) cases, respectively. Median weights of right-and left-liver were 810 g(IQR 730–940) and 454 g(IQR 394–534), respectively. Graft-to-recipient weight ratios(GRWRs) were 1.17%(right, IQR 0.98%-1.4%) and 0.77%(left, 0.59%-0.95%). One-and five-year patient survivals were 85% and 71%(right) vs. 84% and 58%(left), respectively. Oneand five-year graft survivals were 74% and 61%(right) vs. 76% and 53%(left), respectively. The patient and graft survival of right and left grafts and of very small( < 0.6%), small(0.6%–0.79%) and large( ≥0.8%) GRWR were similar. Survival of very small grafts was 86% and 86% at 3-and 12-month. No donor died while five(7.8%) developed a Clavien–Dindo complication IIIa, IIIb or IV. Recipient morbidity consisted mainly of biliary and vascular complications; three(4.7%) recipients developed a small-for-size syndrome according to the Kyushu criteria. Conclusions: Adult-to-adult LDLT is a demanding procedure that widens therapeutic possibilities of many hepatobiliary diseases. The donor procedure can be done safely with low morbidity. The recipient operation carries a major morbidity indicating an important learning curve. Shifting the risk from the donor to the recipient, by moving from the larger right-liver to the smaller left-liver grafts, should be further explored as this policy makes donor hepatectomy safer and may stimulate the development of transplant oncology.

Living-donor or deceased-donor liver transplantation for hepatic carcinoma:A case-matched comparison

AIM:To compare the surgical outcomes between living-donor and deceased-donor liver transplantation in patients with hepatic carcinoma.METHODS:From January 2007 to December 2010,257 patients with pathologically confirmed hepatic carcinoma met the eligibility criteria of the study.Forty patients who underwent living-donor liver transplantation(LDLT)constituted the LDLT group,and deceaseddonor liver transplantation(DDLT)was performed in217 patients.Patients in the LDLT group were randomly matched(1:2)to patients who underwent DDLT using a multivariate case-matched method,so 40 patients in the LDLT group and 80 patients in the DDLT group were enrolled into the study.We compared the two groups in terms of clinicopathological characteristics,postoperative complications,long-term cumulative survival and relapse-free survival outcomes.The modified Clavien-Dindo classification system of surgical complications was used to evaluate the severity of perioperative complications.Furthermore,we determined the difference in the overall biliary complication rates in the perioperative and follow-up periods between the LDLT and DDLT groups.RESULTS:The clinicopathological characteristics of the enrolled patients were comparable between the two groups.The duration of operation was significantly longer(553 min vs 445 min,P<0.001)in the LDLT group than in the DDLT group.Estimated blood loss(1188 mL vs 1035 mL,P=0.055)and the proportion of patients with intraoperative transfusion(60.0%vs 43.8%,P=0.093)were slightly but not significantly greater in the LDLT group.In contrast to DDLT,LDLT was associated with a lower rate of perioperative gradeⅡcomplications(45.0%vs 65.0%,P=0.036)but a higher risk of overall biliary complications(27.5%vs 7.5%,P=0.003).Nonetheless,21 patients(52.5%)in the LDLT group and 46 patients(57.5%)in the DDLT group experienced perioperative complications,and overall perioperative complication rates were similar between the two groups(P=0.603).No significant difference was observed in 5-year overall survival(74.1%vs 66.6%,P=0.372)or relapse-free survival(72.9%vs 70.9%,P=0.749)between the LDLT and DDLT groups.CONCLUSION:Although biliary complications were more common in the LDLT group,this group did not show any inferiority in long-term overall survival or relapse-free survival compared with DDLT.

HUMAN PAPILLOMAVIRUS TYPE 16 L1 PROTEIN CAN BE EXPRESSED IN LIVE ATTENUATED SHIGELLA FLEXNERI 5A STRAIN SH42

Objective Attenuated strains of Shigella are attractive live vaccine candidates for eliciting mucosal immune responses which is a suitable carrier for the prophylactic human papillomaviruses (HPV) vaccine development, To examine the potential of a live Shigella based prophylactic HPV vaccine, HPV16L1should be expressed in attenuated shigella strain. Methods A Shigella large invasive plasmid (icsA/virG) based prokaryotic expression plasmid pHS3199 was constructed. HPV16L1 gene was inserted into plasmid pHS3199 to form pHS3199-HPV16 L1 construct, and pHS3199-hpv16L1 was electroporated into a live attenuated shigella strain sh42. The expression of HPV16L1 protein was demonstrated by Western blotting with monoclonal antibody to HPV16L1, The genetic stability of recombinant strain sh42-HPV16 L1 was monitored by consecutive passage culture. Invasive ability of sh42-HPV16L1 was evaluated by Hela cell infection assay. Results HPV16 L1 protein can be expressed in recombinant strain sh42-HPV16 L1, and the protein stably expressed over 140 generations. The invasive ability of sh42-HPV16L1 was diminished dramatically compared to its parent strain, but not abolished completely. Conclusion HPV16L1 protein was constitutively expressed in the attenuated strain of shigella flexneri sh42, and maintained partial invasive ability. Our strategy may represent a promising vaccine candidate against genital HPV16 infection.

信息化延续性护理对结直肠癌造口患者独立生活能力及生活质量的影响

目的探究信息化延续性护理对结直肠癌造口患者独立生活能力的影响。方法选取2021年1月—2022年8月期间出院的结直肠癌造口患者100例为研究对象,按照组间基线特征均衡可比的原则分为对照组和观察组,各50例。对照组采取常态化干预,观察组实施延续护理干预。比较两组结直肠癌造口患者生活质量、独立生活能力、疾病知识掌握及并发症发生情况。结果观察组患者生活质量评分及独立生活能力评分均高于对照组,差异具有统计学意义(P<0.05);观察组患者造口护理流程、造口并发症防治、健康生活习惯、延续复诊等疾病知识掌握率均高于对照组,差异具有统计学意义(P<0.05);观察组与对照组并发症的发生率无差别(P>0.05)。结论结直肠癌造口患者接受延续性护理干预,可提高其生活质量和独立生活能力,掌握造口相关知识。

围手术期肺康复对胸腔镜下肺癌根治患者日常生活能力及生活质量的影响

目的 探讨围手术期肺康复对胸腔镜下肺癌根治患者日常生活能力(ADL)和生活质量的影响。方法选取中南大学湘雅医院心胸外科2019年1—6月胸腔镜下行肺癌根治的94例患者为对照组,接受心胸外科围手术期常规治疗;选取2019年7—12月由同一组医生行肺癌根治的患者100例为试验组,在常规治疗基础上实施呼吸锻炼和循序渐进活动为主的围手术期肺康复训练。于入院时、术后第1天、术后第3天、出院前收集患者ADL(Barthel指数量表)评分,于入院时和出院后一个月收集患者生活质量评估量表(EORTC-QLQ-C30)评分,比较两组患者ADL和生活质量状况。结果 试验组患者术后第1天、术后第3天和出院前ADL评分均高于对照组,差异有统计学意义(P <0.05);出院后1个月除疼痛、失眠外,试验组生活质量其他指标均优于对照组,差异有统计学意义(P <0.05)。结论 围手术期肺康复可以提高胸腔镜下肺癌根治患者的ADL,提高生活质量。

Is Victory over Pancreatic Cancer Possible, with the Help of Tuned Non-Invasive Physiotherapy? A Case Study Says Yes

Could the conventional treatment of pancreatic cancer effectively be supplemented by a low level and non-invasive bio-electromagnetic treatment? A case study, based on the regular exposure of a patient to an electromagnetic field, EMF, emitted by a Rife-Bare technology device, suggests so. The plasma confined in a tube of this apparatus emitted radiofrequency solitons. These low level emissions were modulated by an “audio” frequency generator, pre-programmed for the treatment of this disease. After less than two months of exposure to these EMFs, the tumor completely disappeared in approximately two weeks. The explanation of the action mechanism includes a physics aspect relating to the properties of the dissipative soliton which is emitted-absorbed by any non-linear system, a biophysics aspect relating to the coherent structuring of the cellular bath by incident solitons, and finally a biological aspect. The latter is characterized by a critical resonance frequency leading the “unicellular” tumoral cell to adopt a self-destructive behavior. On the other hand EMFs with low level solitons have no effect on the tissues of complex multicellular organisms.

乳腺癌患者化疗后居家期间症状群特征及影响因素研究

目的:调查乳腺癌患者化疗后居家期间症状群的发生情况并分析其影响因素,为护理人员开展延续护理服务提供依据。方法:调查于湖南省8所医院化疗后出院、处于居家期间的乳腺癌患者353例,采用安德森症状评估量表调查乳腺癌患者居家期间症状的发生情况。结果:乳腺癌化疗患者居家期间存在2个症状群,分别为感知-知觉症状群、消化道-睡眠症状群;多元线性回归分析结果显示,年龄、照护需求满足程度、带药出院是影响症状群的因素。结论:乳腺癌患者化疗后居家期间受多种症状困扰,症状之间相互影响,以症状群的形式存在。在临床护理工作中,应加强对患者居家期间症状群的管理和干预,以提升患者的自我管理能力,提高患者的生活质量。

肠道菌群在原发性肝癌发生、发展中的研究进展

原发性肝癌是最常见的消化系统恶性肿瘤之一,其发展过程常遵循肝炎-肝硬化-肝癌这一过程。肠-肝轴是由肠道菌群与门脉系统、胆管系统组成的双向肠肝交流体系。越来越多的研究表明,肠道菌群基于肠肝交互循环,影响着肝炎、肝硬化和肝癌的发展过程。近年来,尽管在肝癌的诊断和治疗方面取得了一定进展,但患者的生存情况仍然不尽人意。病毒性肝炎、肝硬化患者均存在一定程度的肠道菌群紊乱,且与疾病的发生、发展相关,这也可能是慢性肝病向肝癌进展的主要因素。通过添加益生菌、合理使用抗生素、粪菌移植等方式调节肠道菌群,重塑肠道菌群稳态,能有效延缓肿瘤进展,提高治疗效果,改善预后及维持机体健康,为肝癌患者的治疗提供新的思路。本文就肠道菌群在肝炎-肝硬化-肝癌这一过程中的相关作用及其对肝癌的预防、诊断以及治疗等方面进行综述。

生活希望计划结合家庭赋权干预对脑肿瘤手术患者的应用效果

目的 研究生活希望计划结合家庭赋权护理对脑肿瘤手术患者心理状况及主要照顾者积极感受程度的影响。方法 选取2019年10月至2021年5月接受脑癌手术治疗的88例患者作为研究对象,采用随机数字表法将其分为常规组、研究组,各44例。常规组采用常规护理,而研究组在常规组基础上采用生活希望计划结合家庭赋权护理,对比护理前后2组患者的心理状况、希望水平、主要照顾者积极感受程度。结果 护理后,研究组的汉密尔顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)评分均低于常规组(P<0.05);研究组现实和未来积极态度、与他人保持亲密关系、在治疗过程中采取积极行为评分均高于常规组(P<0.05);研究组主要照顾者的自我肯定、生活展望、照顾者积极感受量表(PAC)总分均高于常规组主要照顾者(P<0.05)。结论 在脑癌手术患者中采用生活希望计划结合家庭赋权护理,能有效改善患者的心理状况,提高其希望水平以及主要照顾者积极感受程度。

动态增强MRI与CT对乙型肝炎肝硬化背景下原发性肝癌的诊断价值

目的评价在乙型肝炎肝硬化背景下原发性肝癌的诊断工作中应用动态增强MRI与CT的效果及价值。方法回顾性方式展开本研究,病例选取时段介于2019年1月-2022年5月,将本院50例乙型肝炎肝硬化背景下原发性肝癌患者视为研究对象,对所有患者均实施动态增强MRI及CT检查,并与病理组织诊断结果(诊断金标准)展开比较,分析疾病诊断效果及价值。结果(1)本研究共纳入50例乙型肝炎肝硬化背景下原发性肝癌患者,经检查后小肝癌、大肝癌分别有21、29例,病灶共有53个,小肝癌、大肝癌病灶分别为24、29个。(2)在MRI检查下,完整环状强化比例明显比无明显强化、不完全环状强化高(P<0.05),但两种方式下的无明显强化、不完全环状强化并无显著差异(P>0.05)。(3)与动态增强CT相比,动态增强MRI检查下,动脉期信号检出率明显较高(P<0.05),其余门脉期以及延迟期的病灶信号并无明显差异(P>0.05)。(4)与动态增强CT相比,动态增强MRI检查下,小肝癌检出率较高(P<0.05),大肝癌检出率无明显差异(P>0.05)。结论对乙型肝炎肝硬化背景下的原发性肝癌进行诊断,动态增强MRI及CT均可作为诊断方式,但与CT相比,动态增强MRI在清晰显示包膜强化、肝癌血供特点方面更具效果及优势,因此值得临床借鉴并推广。

中国癌症患者生前预嘱研究现状及伦理思考

2022年6月深圳首次在国内大陆出台生前预嘱相关法规,生前预嘱有利于减轻癌症患者痛苦,尊重其生命自主权、减少医疗资源浪费,但在逐年增多的癌症患者群体中推广实施仍处于困境。本文主要阐述了生前预嘱的概念、理论基础、国内外的发展进程;分析了我国癌症患者对生前预嘱的认知、实施、效果评价的研究现状及影响因素;最后从癌症患者、家庭、社会三个不同视角进行伦理思考,以期为我国癌症患者制定生前预嘱相关方案提供参考。

新型三孔胸腔镜技术对肺癌疗效及患者生活质量的影响分析

目的探讨新型三孔胸腔镜技术治疗肺癌患者的疗效及其是否影响日常生活。方法回顾性选取肺癌患者120例,根据手术方式分为两组,其中研究组60例均实施新型术式“双微孔”三孔胸腔镜肺叶切除术治疗,对照组60例均实施传统三孔式胸腔镜肺叶切除手术,对比2组患者的临床疗效等情况。结果除淋巴结清扫数目外,研究组其他围术期指标(如切口长度、引流管留置、手术、住院时间、术中出血量及术后并发症发生率)情况均较对照组更优(P<0.05);术后研究组患者的炎性相关血清指标(白细胞介素-6、肿瘤坏死因子-α和C反应蛋白)均较对照组改善明显(P<0.05);术后3个月,研究组患者的生活质量(身体状况、情感状况、功能状况及总分)较对照组改善明显(P<0.05)。结论新型术式“双微孔”三孔胸腔镜肺叶切除术治疗早期肺癌的疗效较传统三孔更为显著,同时还可减轻患者的术后疼痛及炎性反应程度,最终提高患者生活质量,值得推广使用。

贞芪扶正胶囊联合耳穴压籽对原发性肝癌晚期患者的效果

目的 观察贞芪扶正胶囊联合耳穴压籽治疗晚期原发性肝癌的疗效,分析其对患者生活质量与生存状况的影响。方法 将100例原发性肝癌晚期患者作为研究对象,采用随机数字表法将患者分为常规治疗组与联合治疗组,每组50例。常规治疗组接受肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)治疗,联合组在此基础上采用贞芪扶正胶囊联合耳穴压籽治疗。连续治疗1个月后,分析比较2组的疗效差异、术后疼痛评分、肝功能指标、血清肿瘤标志物、生活质量与生存状况。结果 联合治疗组客观缓解率(overall response rate,ORR)显著高于常规治疗组(P<0.05);联合治疗组术后24、48、72 h视觉模拟疼痛评分(visual analogue scale,VAS)、治疗后肝功能指标胆红素(total bilirubin,TBIL)、天冬氨酸氨基转移酶(aspartate transaminase,AST)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、血清肿瘤标志物糖链抗原19-9(carbohydrate atigen 19-9,CA19-9)、肿瘤相关黏液抗原(carbohydrate atigen 242,CA242)和癌胚抗原(carcinoembryonic antigen,CEA)水平均显著低于常规治疗组(P<0.05);生活质量量表(short form 36 questionnaire,SF-36)各维度评分均显著高于常规治疗组(P<0.05);2组患者治疗3、6个月时生存率比较差异无统计学意义,联合治疗组治疗1年时生存率显著高于常规治疗组(P<0.05)。结论 贞芪扶正胶囊联合耳穴压籽可缓解患者术后疼痛,提高原发性肝癌晚期患者的临床疗效,改善肝功能,降低血清肿瘤标志物,提高患者的生活质量并延长生存期。

乳腺癌组织中Snail、DCTPP1的表达与临床病理特征和生存状况的关系

目的:探讨转录因子Snail(Snail)、dCTP焦磷酸酶(DCTPP1)在乳腺癌(BC)组织中的表达与临床病理特征和生存状况的关系。方法:2018年4月至2019年4月,手术治疗106例BC患者的标本及临床病理资料。Snail、DCTPP1在癌组织及癌旁组织中的表达应用免疫组化法检测,分析二者表达与BC临床病理相关特征间的关系;直接计算法计算和比较不同Snail、DCTPP1表达患者的3年生存率,并分别绘制其Kaplan-Meier生存曲线;COX回归考察BC患者生存状况的关键影响因素。结果:Snail在BC癌组织高表达为64例(63.37%),在癌旁组织中的高表达为35例(34.65%);DCTPP1在BC癌组织中高表达为79例(78.22%),在癌旁组织高表达仅23例(22.77%)。二者在不同组织中的表达均具有统计学差异(P<0.05)。在BC组织中,Snail和DCTPP1的高表达在不同分化程度、浸润深度、淋巴结是否转移、不同TNM分期及是否有侵袭性患者间具有显著差异(P<0.05)。至随访结束,67例患者存活,总生存率为66.34%(67/101)。其中,Snail高表达的患者有37例(57.81%)存活,低表达患者存活30例(81.08%),Snail高表达患者生存状况明显更差(P=0.017)。DCTPP1高表达患者存活47例(59.49%),低表达存活20例(90.91%),DCTPP1高表达患者生存状况明显更差。COX比例风险回归显示,分化程度、浸润深度、TNM分期、侵袭性、Snail及DCTPP1均是影响BC患者生存状况的独立危险因素。结论:Snail、DCTPP1在BC组织中的高表达与其临床病理特征及生存状况相关,有望成为预测BC预后的标志物。

围手术期快速康复外科护理对乳腺癌患者术后日常生活能力的影响

目的探讨围手术期快速康复外科(ERAS)护理对乳腺癌患者术后日常生活能力的影响。方法将我院实施乳腺癌改良根治术的260例患者依据入院编号的奇偶性分为对照组(130例,常规围手术期护理)与观察组(130例,围手术期ERAS护理)。比较两组的干预效果。结果观察组的术后禁饮、禁食时间、坐起时间、下床时间、置管时间短于对照组,上肢周径差值小于对照组(P<0.05)。观察组术后6个月内并发症总发生率低于对照组(P<0.05)。干预后,观察组的日常生活能力、生活质量评分高于对照组,睡眠质量、疼痛程度评分低于对照组(P<0.05)。干预后,观察组的C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平低于对照组(P<0.05)。结论围手术期ERAS护理可显著缩短患者的恢复时间,降低术后并发症发生率,提升术后日常生活能力。