Assessment of optic nerve and optic tract alterations in patients with orbital space-occupying lesions using probabilistic diffusion tractography

AIM: To investigate the diffusion changes in both the optic nerve and optic tract in orbital space-occupying lesion patients with decreased visual acuity, and its clinical significance using probabilistic diffusion tractography(PDT). METHODS: Twenty patients with orbital space-occupying lesions and 25 age-and gender-matched healthy persons were included. All patients and controls underwent routine orbital magnetic resonance imaging and diffusion tensor imaging(DTI), using a 3.0 T magnetic resonance scanner(Trio Tim Siemens). After the image data were preprocessed, each DTI parameters of the optic nerve and optic tract was obtained by PDT, including fractional anisotropy(FA), mean diffusivity(MD), axial diffusivity(AD) and radial diffusivity(RD). The asymmetry index(AI) of each parameter was calculated. Compared the parameters of the affected side optic nerve and ipsilateral optic tract with the contralateral side by paired sample t-test;compared AI of parameters of optic nerve and optic tract between the patient group and the control group by independent sample t-test. Patients were divided into threesubgroups according to the low vision grade standard of WHO, compared the FA and AI of FA between the three subgroups by single factor variance analysis. RESULTS: The affected side optic nerve presented significantly decreased FA, increased MD, AD, and RD values compared to the unaffected side(P<0.05). The AI of FA, MD, AD, and RD of optic nerve in the patients was significantly higher than that of the controls(P<0.05). The comparison results of the optic tract showed that there was no significant difference between the patient group and control group in terms of the bilateral optic tracts in patients(P>0.05). The AIs of the FA value of the optic nerve in the eyesight <0.1 subgroup was significantly higher than that in the other groups(P<0.05). CONCLUSION: FA, MD, AD, and RD of the affected side optic nerve of the orbital space-occupying lesions have significantly changed, the FA value is the most sensitive. The PDT could be a useful tool to provide valid quantitative markers of optic nerve injuries and evaluate the severity of orbital diseases, which other examinations cannot be acquired.

Recurrent orbital space-occupying lesions:a clinicopathologic study of 253 cases

Objective：To analyze the clinical features,histopathologic classification and frequencies of various types of recurrent orbital space-occupying lesions.Methods：A retrospective study was carried out in 253 consecutive patients with recurrent orbital spaceoccupying lesions treated by surgical excision in the Institute of Orbital Diseases,the General Hospital of the Armed Police Force from January 2009 to December 2010.Results：The patients included 123 males and 130 females aged 2 to 78 years（mean,36.2 years）,and the last recurrence interval after operation ranged from 1 month to 40 years（median,4.75 years）.Of all the cases,159（62.8%）,65（25.7%）,20（7.9%）,8（3.2%） and 1（0.4%） had previously experienced once,twice,three,four and six times of surgeries,respectively.Among them,29（11.5%） cases had recurred 3 times or over,and 37（14.6%） cases got recurrence in 10 or more years postoperatively.Most of the patients with local recurrence presented with various clinical manifestations,while 31（12.3%） cases were symptom-free.Two hundred and thirty-one（91.3%） cases underwent surgical removal of the recurrent orbital lesions,and another 22（8.7%） cases had to receive the exenteration of orbit.Categories of these recurrent orbital lesions after operation were as follows：lacrimal gland tumors,65（25.7%） cases;vasogenic diseases,54（21.3%） cases;neurogenic tumors,42（16.6%） cases;secondary tumors,24（9.5%） cases;orbital inflammation,21（8.3%） cases;myogenic tumors,14（5.5%） cases;fibrous and adipose tumors,12（4.7%） cases;lympho-hematopoietic tumors,7（2.8%） cases;bone or cartilage tumors,7（2.8%） cases;orbital cysts,6（2.4%） cases;and indefinitely differentiated tumor,1（0.4%） case.The 10 top histopathologic diagnoses were lacrimal gland pleomorphic adenoma,hemangiolymphangioma,lacrimal gland adenoid cystic carcinoma,meningioma,inflammatory pseudotumor,neurofibroma,sebaceous gland carcinoma,vascular malformation,rhabdomyosarcoma and hemangioma.Conclusions：The variety of recurrent orbital lesions after operation includes mainly of tumors except for vascular malformation and orbital inflammatory lesions.The lacrimal gland epithelial tumor is most prone to relapse after resection,and early and longer-term postoperative follow-up is needed.

Application of endoscopic submucosal dissection in duodenal space-occupying lesions

BACKGROUNDEndoscopic submucosal dissection (ESD) has been advocated by digestiveendoscopists because of its comparable therapeutic effect to surgery, reducedtrauma, faster recovery, and fewer complications. However, ESD for lesions of theduodenum is more challenging than those occurring at other levels of thegastrointestinal tract due to the thin intestinal wall of the duodenum, narrowintestinal space, rich peripheral blood flow, proximity to vital organs, and highrisks of critical adverse events including intraoperative and delayed bleeding andperforation. Because of the low prevalence of the disease and the high risks ofsevere adverse events, successful ESD for lesions of the duodenum has rarelybeen reported in recent years.AIM To investigate the efficacy and safety of ESD in the treatment of duodenal spaceoccupyinglesions.METHODS Clinical data of 24 cases of duodenal lesions treated by ESD at the DigestiveEndoscopy Center of the Affiliated Hospital of Qingdao University from January2016 to December 2019 were retrospectively analyzed.RESULTS All of the 24 cases from 23 patients underwent ESD treatment for duodenal spaceoccupyinglesions under general anesthesia, including 15 male and 8 femalepatients, with a mean age of 58.5 (32.0-74.0) years. There were 12 lesions (50%) inthe duodenal bulb, 9 (37.5%) in the descending part, and 3 (12.5%) in the ball descending junction. The mean diameter of the lesion was 12.75 (range, 11-22)mm. Thirteen lesions originated from the mucosa, of which 4 were low-gradeintraepithelial neoplasia, 3 were hyperplastic polyps, 2 were chronic mucositis, 2were adenomatous hyperplasia, 1 was high-grade intraepithelial neoplasia, and 1was tubular adenoma. Eleven lesions were in the submucosa, including 5neuroendocrine neoplasms, 2 cases of ectopic pancreas, 1 stromal tumor, 1leiomyoma, 1 submucosal duodenal adenoma, and 1 case of submucosal lymphfollicular hyperplasia. The intraoperative perforation rate was 20.8% (5/24),including 4 submucosal protuberant lesions and 1 depressed lesion. The meanlength of hospital stay was 5.7 (range, 3-10) d, and the average follow-up time was25.8 (range, 3.0–50.0) mo. No residual disease or recurrence was found in allpatients, and no complications, such as infection and stenosis, were found duringthe follow-up period.CONCLUSION ESD is safe and effective in the treatment of duodenal lesions;however, theendoscopists should pay more attention to the preoperative preparation,intraoperative skills, and postoperative treatment.

Investigation of lacrimal sac space-occupying lesions using color doppler ultrasound, computed tomography, and computed tomography dacryocystography

AIM:To observe the imaging features of color Doppler ultrasound(CDU)and computed tomography(CT)or computed tomography dacryocystography(CT-DCG)in different types of lacrimal sac space-occupying lesions(SOLs).METHODS:This retrospective case series study included 21 patients with lacrimal sac SOLs who underwent lacrimal sac surgery between January 2018 and March 2022.The imaging features of CDU and CT or CT-DCG in these patients were extracted from the examination cloud system.The images were observed and analyzed.RESULTS:The detection rate of lacrimal SOLs between CDU(21/21,100%)and CT or CT-DCG(20/21,95.2%)had no statistically significant difference(P=1.0).CDU could detect the blood flow signals in all SOLs except mucocele and mucopeptide concretion.Among them,polyps had characteristic imaging changes on CDU and CT-DCG.The mucoceles and mucopeptide concretions had characteristic imaging changes on CDU,which could provide more information for differential diagnosis.CONCLUSION:The morphology and internal blood flow signals of lacrimal sac SOLs can be observed using CDU.CT or CT-DCG has advantages in observing structural damage around the lacrimal sac mass.Therefore,CDU may be used as a routine examination to exclude lacrimal sac SOLs before dacryocystorhinostomy in the absence of preoperative CT or CT-DCG.

Association between the fMRI manifestations of activated brain areas and muscle strength in patients with space-occupying lesions in motor cortex

BACKGROUND ： Functional magnetic resonance imaging （fMRI） studies have disclosed the changes of the motor function in the motor cortex of ipsilateral and contralateral hemispheres of tumor, which have special significance for making the surgical planning and most greatly minimizing the postoperative functional damages. OBJECTIVE： To analyze the association between the manifestation characteristics of hand functional area and motor dysfunction using fMRI in patients with space-occupying lesions of tumor in motor cortex. DESIGN ： A case-controlled observation SETTING： Department of Radiology, Second Affiliated Hospital, Shantou University Medical College .PARTICIPANTS： Twenty-three patients （13 males and 10 females） with space-occupying lesions of central sulcus area, aged 21-53 years with a mean age of （47±1） years were selected from the Second Affiliated Hospital of Shantou University Medical College. All the patients were diagnosed by MR scanning as space-occupying lesions of motor area, and pathologically confirmed that the lesions involved central sulcus and central Iobule; Lesions occurred in left and right hemispheres in 13 and 10 cases respectively. The tumor types were astrocytoma （n =8）, metastatic tumours （n =7）, meningiomas （n =5） and oligodendroglioma （n =3）. The muscle strength was normal in 11 cases （grade 5） and obviously decreased in 12 cases （grade 2-3 in 3 cases and grade 4 in 9 cases）; muscle strengths of both upper and lower limbs were decreased in 7 cases, and only that of upper limbs was decreased in 5 cases. Informed consents were obtained from all the subjects. Meanwhile, 9 healthy physical examinees （5 males and 4 females） of 20-56 years old with an average of （34±1） years were taken as controls. All the patients and healthy subjects were right-handed. METHODS： All the enrolled subjects were examined with MR scanning and functional imaging. Twenty cases whose clinical symptoms were mild in the patient group and 9 healthy volunteers adopted simple active finger-tapping movements, and for the 3 cases whose clinical symptoms were severe in the patient group, the simple passive finger-tapping movements were used. The manifestations in the activated brain areas were analyzed in the patients with brain tumor of different muscle strength and the controls. The motor deficit and activation of contralateral primary motor cortex （M1） in simple finger-tapping movements were observed in the patient group. MAIN OUTCOME MEASURES： （1） Brain areas activated by finger-tapping movements in each group： （2） Activated volumes in hemisphere by finger-tapping movements between groups. RESULTS： The contralateral M1 area could not be activated in 1 case in the patient group,, all the other 22 patients and 9 healthy subjects were involved in the analysis of results. （1） In the control group, unilateral finger tapping movement activated the contralateral primary motor cortex （M1）, bilateral SMA and bilateral PMC. The activation volume was the largest in contralateral primary motor cortex （M1）, smaller in the SMA, and the smallest in PMC. The finger tapping movement in healthy subjects could activate contralateral primary motor cortex （M1）, bilateral SMA and bilateral PMC, which had no obvious differences from the manifestations of brain functional area activated by active finger tapping. There was no significant difference in the volume of activated functional areas between right and left hands. In the patient group, the central sulcos around the tumor in the activated M1 area displaced towards dorsal or ventral side, also extended. The distance of displacement in the functional area was determined as compared with the contralateral central sulcus, and the results suggested the M1 displacement, including that there were 10 cases with the M1 displacement larger than 10 mm in the patients with motor deficit, which were obviously more than in those without motor deficit （n =1, P 〈 0.01）, and the activated volume in contralateral M1 area was obvious smaller in the patients with motor deficit than in those without motor deficit （P 〈 0.01）. （2） The M1 activation and changes were observed in contralateral hemisphere in the patient group, and the activated volume was obviously larger than that in the control group （P 〈 0.01）. The activated volumes of M1 and PMC in ipsilateral hemisphere were obviously larger than those in the control group （P 〈 0.05）, but that of SMA had no obvious difference between the two groups （P 〉 0.05）. CONCLUSION： fMRI can be used to observe the activation of the brain motor functional areas of patient with space-occupying lesions in motor area, and evaluate the state of their motor function. The larger the distance of displacement of M1 compressed by tumor, the more obviously the muscle strength decreases in the patients.

Pathology of spleen in chickens fed on a diet deficient in methionine

The purpose of this 42-day study was to investigate the effects of methionine deficiency on spleen by determining the relative weight, morphological changes of spleen, cell cycle and apoptosis of splenocytes, and oxidative markers of serum and spleen. One hundred and twenty one-day-old avian broilers were randomly divided into two groups and fed on a control diet (starter diet, methionine 0.50%;grower diet, methionine 0.40%) and methionine deficient diet (starter diet, methionine 0.26%;grower diet, methionine 0.28%) for 6 weeks. The relative weight of spleen was lighter in methionine deficiency than control group. Histopathologically, lymphopenia and congestion were observed. Ultrastructurally, there were more apoptosis lymphocytes in spleen and the mitochondria of lymphocytes were swelled in methionine deficiency. By flow cytometry, the G0/G1 phase of the cell cycle of the spleen was much higher (P < 0.01), and the S, G2+M phases and proliferating index were lower (P < 0.01) in methionine deficiency than in control group. And the percentage of apoptotic cells in the spleen was significantly increased in methionine deficiency (P < 0.01).The superoxide dismutase and glutathione peroxidase activities, and abilities to inhibit hydroxyl radicals were greatly decreased while the malondialdehyde contents were markedly increased in methionine deficiency. It was concluded that methionine deficiency could restraine the development of the spleen by cell cycle arrest and increased apoptosis, cause splenic lesions and reduce splenic antioxidant function. The splenic function should be finally impaired and then the immune function could be impacted in chickens.

从脾论治胃癌前病变的思路与方法

胃癌前病变(Precancerous lesion of gastric carcinoma,PLGC)是胃粘膜“炎-癌转化”发生发展的重要环节。中医以整体调节、辨证论治的独特诊疗模式,在改善临床症状、提高生活质量、逆转病理组织学病变方面显示出良好优势。PLGC病位在脾胃,脾胃虚弱为其发病基础,脾胃运化失常、气机升降异常是症状发生的主要机制,由其演化而生的湿、痰、瘀、毒等胶结积聚久留促发局部病变。脾虚与PLGC发生发展的胃粘膜微环境失衡有关,涉及胃黏膜炎症、胃内菌群、胃黏膜屏障、免疫功能、能量代谢、黏膜分泌等机制。本文从脾入手思考PLGC的病机、治法、用药思路等,对统一认识、开拓临床和科研思路有参考意义。

特应性皮炎脾虚湿蕴证患者的皮损表现特征分析

目的通过数据挖掘及临床横断面研究结合的方式,探讨特应性皮炎脾虚湿蕴证患者的皮损表现特征。方法现代文献研究方面,检索建库以来至2021年10月31日特应性皮炎脾虚湿蕴证的相关文献,提取并规范皮损特征,对所纳入皮损表现进行频数分析及关联分析;门诊招募于广东省中医院皮肤科就诊的特应性皮炎患者,分为脾虚湿蕴和非脾虚湿蕴2组,填写人口学资料及《特应性皮炎脾虚湿蕴证中医皮损特征采集表》,采用SPSS 27.0软件对数据进行非参数检验和二元Logistic回归分析,比较2组患者的皮损表现差异。结果文献研究共纳入符合要求的文献288篇,其中丘疹、鳞屑、瘙痒、糜烂及渗出等是特应性皮炎脾虚湿蕴证最常见的皮损表现;关联分析提示丘疹、瘙痒、糜烂、渗出、干燥与脾虚湿蕴证的关联性较强。门诊横断面研究共纳入受试者152例,差异分析提示2组患者在粗糙、鳞屑与潮红方面差异有统计学意义(P<0.05),其他皮损表现差异均未见统计学意义(P>0.05);单因素回归结果提示粗糙、鳞屑与潮红会显著影响患者是否为脾虚湿蕴证(P<0.05),而多因素回归结果提示,仅潮红为非脾虚湿蕴证的显著影响因素(P<0.05)。结论特应性皮炎脾虚湿蕴证患者的皮损表现以干燥、鳞屑、肥厚等干性皮损为主,符合亚急性、慢性期皮损表现;临床脾虚湿蕴证患者较少出现渗出、水疱、糜烂等湿性皮损。

脾肾论治炎症性肠病合并强直性脊柱炎探讨

炎症性肠病常合并强直性脊柱炎有肠外病变表现,现代医学目前对于该共病发病机制尚不明确,临床缺乏有效防治方法,无法从根本上改善疾病的预后和减少复发。中医学认为该共病发病多为脾肾失司,二者制化失常为其主要病机表现。临床表现或以脾胃升降失司为主,或以肾虚温煦不足为主。治疗从脾肾论治出发,在炎症性肠病合并强直性脊柱炎共病的临床诊断和治疗中具有良好的临床效果。通过探讨从脾肾论治炎症性肠病及其肠外表现强直性脊柱炎共病的中医治疗经验,并附临床验案一则,以供临床参考借鉴。

基于解痉多肽表达化生病证结合的小鼠模型探讨胃癌前病变脾胃虚实证候的本质

目的为了构建病证结合的小鼠模型及进行胃癌前病变(gastric precancerous lesions,GPL)脾胃虚实证候的本质研究。方法采用他莫昔芬(tamoxifen,TMXFR)诱导构建解痉多肽表达化生(spasmolytic peptide expression metagenesis,SPEM)小鼠模型,并在SPEM模型基础上分别模拟构建脾胃湿热证、脾气虚证模型,结合TMXFR诱导的SPEM模型具有自恢复的特性,以TMXFR组及生理盐水处理组作为对照组,监测小鼠一般情况,HE染色检测SPEM模型的构建及恢复情况,ELISA检测小鼠血清胃泌素水平,PCR检测各组小鼠胃黏膜中miR-7a-5p含量,免疫组化检测各组小鼠胃黏膜中白细胞介素-1β(interleukin-1β,IL-1β)、白细胞介素-13(interleukin-13,IL-13)表达。结果病证结合的脾胃湿热证、脾气虚证组较TMXFR组、SPEM组织恢复明显延迟;脾胃湿热证较对照组及TMXFR组的胃泌素表达异常升高(P<0.05),SPEM模型组小鼠胃黏膜中miR-7a-5p较对照组水平降低(P<0.05),病证结合的脾胃虚实组miR-7a-5p表达较TMXFR有下降趋势;病证结合的脾胃虚实组IL-1β表达较TMXFR组、对照组升高(P<0.05),脾胃湿热证、脾气虚证组中IL-13表达有升高趋。结论此项研究结果侧面证实了在癌前病灶已形成的前提下,虽无幽门螺杆菌感染,在外感湿热之邪、进食肥甘厚腻、饥饱失常、过劳伤脾等诱因下,机体可突破自身代偿修复能力,延缓SPEM恢复甚至使GPL进一步进展。这可能跟miR-7a-5p介导炎症因子IL-1β使得Th1/Th2细胞失衡相关,但具体机制尚待进一步研究。

胃癌前病变与“脾主卫”关系探讨

胃癌前病变是胃癌发生发展的关键环节,在防治胃癌方面具有重要研究价值,中医认为其病机关键在于脾胃虚弱。《黄帝内经》“脾主卫”理论认为,脾胃具有保证机体正常运转,不受外来邪气侵害的作用。近年来针对该理论的现代生物学研究多从免疫角度着手,认为脾胃是通过提高人体免疫功能达到防治疾病的目的,即为“脾主卫”。“脾主卫”与胃癌前病变发生机制关系密切,健脾在延缓胃癌前病变进展、逆转组织病理学改变方面具有重要作用。

从“中焦如衡”论治胃癌前病变

“中焦如衡”是清代医家吴鞠通基于脾胃的生理特点,提出的脾胃病治疗大法。后世医家在此论点基础上,结合大量临床实践不断深化,形成了以“中焦如衡”为切入点的论治脾胃病病因病机与治疗大法为一体的理论体系。胃癌前病变(PLGC)是具有较高癌变风险的病理改变。从“中焦如衡”理论探讨PLGC的病因病机,立足于脾胃的生理病理特点,以“中焦如衡,以平为期”为切入点,认为本病由多种因素叠加导致胃黏膜遭受持续损害,而在正邪交争中,胃黏膜的保护和防御机制被激活,动态平衡机制被打破,出现以脾胃虚损为本、毒瘀损络为要、升降失衡为主要表现的病机特点,随之而出现病理改变和临床表现。通过调和气血、虚实、气机等多种因素,以调和中焦为手段,以恢复脾胃平衡、气机升降为目的,从而防治PLGC。

芪术化积方治疗肝细胞癌癌前病变患者的随机对照研究

背景肝细胞癌(HCC)存在发病率高、死亡率高的特点,在癌前病变阶段进行早期诊断及时干预可有效降低HCC的发生率,对其防治具有显著意义。现代医学对于HCC癌前病变的治疗存在干预时机难以把握、治疗手段单一等问题,中医药防治HCC癌前病变或许是一种简单有效的新途径。目的观察芪术化积方治疗HCC癌前病变(肝郁脾虚、痰瘀互结证)的临床疗效及安全性。方法纳入2019年10月—2020年3月在山东中医药大学附属医院、威海市中医院、泰安市中医院肝病科门诊就医且符合中医证型“肝郁脾虚、痰瘀互结证”的HCC癌前病变初诊患者为研究对象。收集患者的一般资料[性别、年龄、乙型病毒性肝炎(HBV)后肝硬化史、HCC家族史、10年以上饮酒史],患者的中医证候积分、肝功能指标[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、白蛋白(ALB)、谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)]、肿瘤标志物指标[甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)、异常凝血酶原(DCP)]、影像学指标(病灶类型、病灶性质、病灶长径)、安全性指标、不良反应。采用随机数字表法将符合纳入标准且完成研究的64例患者分为观察组(n=34)和对照组(n=30),对照组予以抗病毒、抗炎保肝等常规治疗;观察组予以常规治疗联合芪术化积方治疗。疗程为48周,停药后随访48周,观察两组患者治疗周期及随访周期中HCC发生率及并发症的发生情况,比较两组患者治疗前后中医证候改善指标(中医证候积分、总有效率)、肝功能指标、肿瘤标志物指标、影像学指标(病灶长径、病灶稳定率、病灶改善率)、安全性指标(安全率)的差异。结果治疗后两组中医证候积分、ALT、AST、TBIL、GGT、ALP、AFP-L3均低于治疗前,ALB水平高于治疗前(P<0.05);观察组患者治疗后的DCP值、病灶长径均低于治疗前(P<0.05)。组间比较结果显示,观察组中医证候积分、AST、ALP水平低于对照组,ALB水平高于对照组(P<0.05)。治疗周期结束后观察组的中医证候总有效率(91.2%)高于对照组(63.3%)(P<0.05);观察组病灶改善率(35.3%)和病灶稳定率(50.0%)与对照组(20.0%,43.3%)比较,差异无统计学意义(P>0.05)。随访周期结束后观察组HCC发生率(8.8%)与对照组(16.7%)比较,差异无统计学意义(P>0.05);并发症发生率(8.8%)低于对照组(30.0%)(P<0.05)。安全性指标方面,观察组2例出现轻度不良反应,对照组3例出现轻度不良反应,两组均未出现安全性指标异常,观察组安全率(94.1%)与对照组(90.0%)比较,差异无统计学意义(P>0.05)。结论芪术化积方治疗HCC癌前病变(肝郁脾虚、痰瘀互结证),在改善中医证候、改善肝功能、缩小病灶结节、降低远期HCC发生率及减少肝硬化并发症等方面有较好的临床疗效及安全性。

近10年中医辨治胃癌前病变的研究进展

对近10年来有关中医辨治胃癌前病变(precancerous lesions of gastric cancer,PLGC)的研究进行综述。PLGC是指在慢性萎缩性胃炎基础上出现的胃黏膜肠上皮化生和异型增生,作为慢性萎缩性胃炎与胃癌的中间阶段,PLGC的病程较缓慢。中医辨治PLGC具有一定的优势。PLGC主要可分为脾胃虚弱证、脾胃湿热证、肝胃气滞证、胃络瘀阻证、胃阴不足证5种证型。胃镜技术的普及促进了胃病微观辨证的发展,微观辨证与宏观辨证的结合为PLGC的中医辨证论治提供了更加丰富的理论支持。PLGC根本病机为脾胃虚弱,脾胃气机不畅,兼有湿热、瘀毒、痰湿等病理因素蕴结,日久胃阴亏耗。中药治疗PLGC的临床研究开展较多,治疗主要采用以益气健脾为主,兼以疏肝活血、化湿消瘀、化瘀解毒、养阴益胃,从而防止PLGC向胃癌进一步发展。针灸治疗胃癌前病变的研究开展较少。今后需开展更多严格且规范的多中心、大样本的临床随机对照试验,深入研究针灸治疗胃癌前病变机制,以期为中医辨治PLGC提供更多高级别的循证依据。

高分辨CT在脾脏占位性病变诊断及鉴别诊断中的应用价值分析

目的 探讨高分辨CT在脾脏占位性病变诊断及鉴别诊断中的应用价值。方法 采用excel表格对2021年1月—2023年10月东莞市横沥医院放射科收治的60例病例资料(疾病:脾脏占位性病变)进行统计,均实施常规CT平扫、高分辨CT检查,以病理诊断结果为金标准,分析各个方案的检出情况、诊断效能。结果 以病理诊断结果为金标准,常规CT平扫检查恶性检出率为63.64%、良性检出率为81.58%;高分辨CT检查恶性检出率为90.91%、良性检出率为97.37%。常规CT平扫检查对各疾病检出率为75.00%,高分辨CT检查对各疾病检出率为95.00%,对比差异有统计学意义(P<0.05)。高分辨CT检查敏感度(95.24%)、特异度(94.87%)、准确率(95.00%)、阳性预测值(90.91%)、阴性预测值(97.37%)与常规CT平扫检查对比差异有统计学意义(P<0.05)。以病理诊断为金标准,常规CT平扫检查Kappa指数0.612,高分辨CT检查Kappa指数0.897。结论 在脾脏占位性病变诊断中应用高分辨CT进行检查既可明确疾病类型、性质,亦可提升诊断准确率及灵敏度,为临床医师制定治疗方案提供参考,值得借鉴。

芪竹健胃方治疗慢性萎缩性胃炎及癌前病变临床研究

目的研究芪竹健胃方治疗脾虚湿热血瘀型慢性萎缩性胃炎及癌前病变的临床疗效,并探讨该方药的作用机制。方法采用自身前后对照研究方法,纳入符合中西医诊断标准的患者31例作为治疗组,予芪竹健胃方中药汤剂进行治疗,疗程12 w,对比治疗前后中医症状疗效、胃镜征象、粘膜病理、癌变风险,血清胃功能三项的变化。另外,用蛋白免疫印迹法检测20例治疗组患者治疗前、治疗后胃粘膜Lgr5、Wnt1、C-myc蛋白表达情况,进行对比分析,对该方的作用机制开展探索性研究。结果治疗12 w后,治疗组患者的中医证候评分、胃镜病理改善情况具有统计学意义(P<0.01),降低癌变风险,血清G17、PGⅠ值升高,有统计学差异(P<0.01),PGR有升高趋势,且具有统计学差异(P<0.05);PGⅡ方面,结果不具统计学差异(P>0.05)。20例治疗组患者治疗前后胃粘膜Lgr5、Wnt1、C-myc蛋白表达情况皆呈逐渐下降的趋势。结论芪竹健胃方能明显改善慢性萎缩性胃炎及胃癌前病变患者的中医证候,促进胃黏膜的修复,降低癌变风险的机制可能与调控Wnt/Lgr5信号通路,抑制Lgr5标记的胃干细胞异常增殖分化有关。

Pneumocephalus Following Combined Spinal-Epidural Anesthesia: A Case Report Analysis

Background: Combined spinal-epidural anesthesia (CSEA) is widely used in clinical anesthesia due to its rapid onset, reliable anesthetic effect, and strong controllability. Although advancements in technique have reduced the frequency and severity of common complications, reports of rare and serious complications such as pneumocephalus, remain scarce. Case Report: This article presents a case of pneumocephalus following CSEA in a middle-aged female patient undergoing surgery for an intrauterine space-occupying lesion. The patient experienced severe headache postoperatively, and imaging confirmed the presence of intracranial air. After receiving active symptomatic treatment, the patient recovered and was discharged. Conclusion: This case underscores the importance of adhering to standard anesthesia protocols and increasing awareness of rare CSEA complications, particularly the risk of pneumocephalus. Early recognition and timely management are crucial. There is a need to further enhance training and research in anesthetic procedures to improve clinical anesthesia quality and ensure patient safety.

健脾祛湿汤联合川百止痒洗剂治疗小儿脾虚湿蕴型湿疹的临床研究

目的探讨小儿脾虚湿蕴型湿疹应用健脾祛湿汤联合川百止痒洗剂治疗的效果。方法选取2021年5月至2023年12月九江市第三人民医院收治的68例脾虚湿蕴型湿疹患儿为研究对象,采用随机数字表法分为对照组和观察组,各34例。对照组采用川百止痒洗剂治疗,观察组在对照组基础上加用健脾祛湿汤治疗,两组均连续治疗4周。比较两组的临床疗效、湿疹面积及严重度指数(EASI)评分、瘙痒程度积分、中医症状积分、炎症因子水平、复发率及不良反应。结果观察组的治疗总有效率高于对照组,复发率低于对照组,差异有统计学意义(P<0.05);两组治疗前的EASI评分、瘙痒程度积分、中医症状积分及白介素-4(IL-4)、白介素-10(IL-10)水平比较,差异无统计学意义(P>0.05);观察组治疗后的EASI评分、瘙痒程度积分、中医症状积分及IL-4、IL-10水平低于对照组,差异有统计学意义(P<0.05);两组均未见明显不良反应。结论健脾祛湿汤与川百止痒洗剂联合应用于小儿脾虚湿蕴型湿疹治疗效果确切,可缩小湿疹面积,减轻瘙痒程度及机体炎症反应,降低复发率,值得临床推广应用。

基于健脾培元法辨治脾胃虚弱型慢性萎缩性胃炎

慢性萎缩性胃炎是一种难治且易反复的消化系统疾病,属于胃癌前病变重要阶段。《素问·举痛论》有言:“百病生于气”,正气邪气相争作用于人体则发病,而脾胃为后天之本,是人体正气、卫气、营气、精气的化生之源,关乎人体一身之气的充盛与抵抗邪气的能力,慢性萎缩性胃炎病因虚实夹杂,脾胃之气虚弱是其根本病因,脾胃之气虚弱贯穿于慢性萎缩性胃炎的整个病程。健脾培元法以调补后天脾胃之气,培补人体真元,激发人体活力,激活自我修复能力,基于健脾培元法,从调理“脾胃之气”来论治脾胃虚弱型慢性萎缩性胃炎。从顾护脾胃之气以御邪气、充养脾胃之气以助元气、疏理脾胃之气以复气机、挽救脾胃之气以存生气四个方面入手,旨在建本固元、强健脾胃之气、补益机体亏虚、激活修复能力,从而改善慢性萎缩性胃炎患者疾病进展和预后。

DIFFERENTIAL ULTRASONIC DIAGNOSES OF PULMONARY BENIGN AND MALIGNANT SPACE-OCCUPIED LESIONS OF THE PERIPHERAL TYPE

87 patients with pulmonary space-occupied lesions of the peripheral type which were either adhesive of close to pleura were examined using ultuasonography.Of them,64 cases of lung cancers and 23 of bening lesions were then confirmed by