目的分析PTGD后择期LC治疗对GradeⅡ急性胆囊炎ACTH、MPO及Cor水平的影响。方法选取2021年12月至2023年5月安徽中科庚玖医院收治的急性胆囊炎患者121例,根据治疗方案分为三组,即甲组(急诊行LC治疗,未行PTGD)38例、乙组(PTGD引流管拔出后...目的分析PTGD后择期LC治疗对GradeⅡ急性胆囊炎ACTH、MPO及Cor水平的影响。方法选取2021年12月至2023年5月安徽中科庚玖医院收治的急性胆囊炎患者121例,根据治疗方案分为三组,即甲组(急诊行LC治疗,未行PTGD)38例、乙组(PTGD引流管拔出后72 h后行LC,早期)43例和丙组(PTGD引流管拔出后14~30 d后行LC,晚期)40例。对比三组手术情况、炎症因子、肝功能、ACTH、MP、Cor水平及并发症发生率。结果甲组LC手术时长、术后卧床时长及住院天数均长于丙组、乙组,失血量、中转开腹率高于丙组、乙组,差异有统计学意义(P<0.05);丙组LC手术时长、术后卧床时长及住院天数均长于乙组,差异具有统计学意义(P<0.05)。LC术后1 d hs-CRP、PCT、IL-6、ST、ALT、ALP、ACTH、MPO及Cor:甲组>丙组>乙组,差异有统计学意义(P<0.05)。并发症发生率:甲组>丙组>乙组,差异有统计学意义(P<0.05)。结论PTGD后择期LC治疗对GradeⅡ急性胆囊炎ACTH、MPO及Cor水平影响小,且并发症低;而PTGD后早期行LC能有效改善肝功能、炎症因子,且术后应激反应更低,值得临床推广。展开更多
Background:The dysregulation of Isocitrate dehydrogenase(IDH)and the subsequent production of 2-Hydroxyglutrate(2HG)may alter the expression of epigenetic proteins in Grade 4 astrocytoma.The interplay mechanism betwee...Background:The dysregulation of Isocitrate dehydrogenase(IDH)and the subsequent production of 2-Hydroxyglutrate(2HG)may alter the expression of epigenetic proteins in Grade 4 astrocytoma.The interplay mechanism between IDH,O-6-methylguanine-DNA methyltransferase(MGMT)-promoter methylation,and protein methyltransferase proteins-5(PRMT5)activity,with tumor progression has never been described.Methods:A retrospective cohort of 34 patients with G4 astrocytoma is classified into IDH-mutant and IDH-wildtype tumors.Both groups were tested for MGMT-promoter methylation and PRMT5 through methylation-specific and gene expression PCR analysis.Inter-cohort statistical significance was evaluated.Results:Both IDH-mutant WHO grade 4 astrocytomas(n=22,64.7%)and IDH-wildtype glioblastomas(n=12,35.3%)had upregulated PRMT5 gene expression except in one case.Out of the 22 IDH-mutant tumors,10(45.5%)tumors showed MGMT-promoter methylation and 12(54.5%)tumors had unmethylated MGMT.All IDH-wildtype tumors had unmethylated MGMT.There was a statistically significant relationship between MGMT-promoter methylation and IDH in G4 astrocytoma(p-value=0.006).Statistically significant differences in progression-free survival(PFS)were also observed among all G4 astrocytomas that expressed PRMT5 and received either temozolomide(TMZ)or TMZ plus other chemotherapies,regardless of their IDH or MGMT-methylation status(p-value=0.0014).Specifically,IDH-mutant tumors that had upregulated PRMT5 activity and MGMT-promoter methylation,who received only TMZ,have exhibited longer PFS.Conclusions:The relationship between PRMT5,MGMT-promoter,and IDH is not tridirectional.However,accumulation of D2-hydroxyglutarate(2-HG),which partially activates 2-OG-dependent deoxygenase,may not affect their activities.In IDH-wildtype glioblastomas,the 2HG-2OG pathway is typically inactive,leading to PRMT5 upregulation.TMZ alone,compared to TMZ-plus,can increase PFS in upregulated PRMT5 tumors.Thus,using a PRMT5 inhibitor in G4 astrocytomas may help in tumor regression.展开更多
Objective:To investigate the effect and value of perioperative nursing intervention on postoperative recurrent grade II-I left frontal astrocytoma.Method:Nursing care procedures:left frontal lobe of the patient was oc...Objective:To investigate the effect and value of perioperative nursing intervention on postoperative recurrent grade II-I left frontal astrocytoma.Method:Nursing care procedures:left frontal lobe of the patient was occupied by a large space.Clinical teaching of nursing was strengthened.Preoperative,intraoperative and postoperative care and ward patrol were enhanced.Close attention was paid on consciousness,pupil,vital signs,body temperature,lungs condition,cranial and nerve function of the patient.Extra care was taken in keeping the incision clean and dry.Blood diffusion condition in wound was observed.Active cooperation with doctor was taken to prevent occurrence of pulmonary infection,urinary tract infection,pressure ulcer and other complication.Results:After operation,the patient had stable condition,clear mind and consciousness.There was no occurrence of epilepsy but intracranial hemorrhage.Pneumatosis was relieved.There was no infection and other complication.Conclusion:Application of comprehensive nursing intervention could effectively improve quality of life of patient and reduce incidence of postoperative complication in patients with brain tumor.展开更多
Monitoring the long-term radiotherapy-associated molecular changes in low-grade gliomas(LGGs) facilitates the understanding of LGG response to radiotherapy.In this study,we used immunohistochemistry to analyze the exp...Monitoring the long-term radiotherapy-associated molecular changes in low-grade gliomas(LGGs) facilitates the understanding of LGG response to radiotherapy.In this study,we used immunohistochemistry to analyze the expression of Ki-67,tumor protein P53(TP53),P21,and P27 in 8 paired WHO grade II astrocytoma samples.The interval between radiotherapy(RT) and the second surgery was more than 3 months in all cases.The average Ki-67 labeling index(LI) was 5.3% in pre-RT samples and 11.54% in post-RT samples.Ki-67 LI was higher in the primary tumors that underwent malignant transformation observed at the second surgery after radiation.Post-RT Ki-67 LI decreased in 2 cases with an interval of less than 12 months between RT and the second surgery.TP53 expression was found in 3 out of 4 pre-RT samples with malignant transformation and in 1 out of 4 pre-RT samples without malignant transformation.Post-RT TP53 increased in 2 cases in which increased expression of P21 or P27 was also observed.Our study suggests that radiotherapy can inhibit WHO grade II astrocytoma proliferation as reflected by Ki-67 LI,but the effect attenuates with time.In addition,there is a tendency of malignant transformation for WHO grade II astrocytomas with a high Ki-67 level or TP53 expression in initial samples.展开更多
Nonresectable Low-Grade Astrocytomas (LGA) can compromise function and threaten life. For the majority of patients, the most appropriate strategy is initial chemotherapy followed by Radiation Therapy (RT). Since curat...Nonresectable Low-Grade Astrocytomas (LGA) can compromise function and threaten life. For the majority of patients, the most appropriate strategy is initial chemotherapy followed by Radiation Therapy (RT). Since curative treatment is not available for most of these patients, it is reasonable to conduct clinical studies to evaluate new agents. This Phase II study evaluates efficacy and safety of Antineoplastons A10 and AS2-1 (ANP) in LGA. Sixteen children diagnosed with LGA were treated. They included 12 males and 4 females, ages 1.6 - 17.4 years (median 10.6). Efficacy was evaluated in 16 patients. The majority of patients were previously treated, but 1 patient had stereotactic biopsy only. Out of the remaining 15 patients, 6 patients received chemotherapy, and 7 patients had surgery, and 2 patients received RT and chemotherapy after surgery. The patients received treatment with ANP administered daily every 4 hours (median dose of A10 was 7.71 g/kg/d and AS2-1 was 0.26 g/kg/d) until objective response or stable disease was documented and for 8 months thereafter. The duration of ANP IV ranged from 1.4 to 286 weeks with a median of 83 weeks. A complete response was documented in 25.0%, partial response in 12.5%, and stable disease in 37.5%. Overall survival was 67.7% at 5 years, and 54.2% at 10 and 15 years. Progression-free survival was 48.1%, 34.4% and 34.4% at 5, 10, and 15 years respectively. The treatment was associated with grade 3 or grade 4 Adverse Drug Experiences (ADE) in 6 patients. There were two hypernatremias of grade 4 (12%). Grade 3 ADE included urinary frequency (6%), fatigue (6%) and hypernatremia (6%). There were no chronic toxicities, and there was a high quality of survival. ANP shows efficacy with a very good toxicity profile in this cohort of children with low-grade astrocytoma.展开更多
目的探讨经皮胆囊穿刺引流(PTGD)后择期腹腔镜胆囊切除术治疗GradeⅡ急性结石性胆囊炎患者的效果。方法回顾性选取2017年8月至2020年6月尉氏县中心医院收治的52例行急诊腹腔镜胆囊切除术GradeⅡ急性结石性胆囊炎患者(对照组)及52例行PTG...目的探讨经皮胆囊穿刺引流(PTGD)后择期腹腔镜胆囊切除术治疗GradeⅡ急性结石性胆囊炎患者的效果。方法回顾性选取2017年8月至2020年6月尉氏县中心医院收治的52例行急诊腹腔镜胆囊切除术GradeⅡ急性结石性胆囊炎患者(对照组)及52例行PTGD后择期腹腔镜胆囊切除术GradeⅡ急性结石性胆囊炎患者(观察组),比较两组手术时间、术中出血量、术后肛门排气时间、术后引流时间、术后住院时间、炎症指标[白细胞(WBC)、中性粒细胞、C反应蛋白(CRP)]、血清淀粉酶(AMY)、肝功能指标[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、直接胆红素(DBIL)、间接胆红素(IBIL)]、中转开腹及安全性。结果观察组手术时间、术中出血量、术后引流时间、术后住院时间短于对照组(P<0.05);观察组术后72 h WBC、中性粒细胞、CRP低于对照组(P<0.05);观察组术后72 h AMY低于对照组(P<0.05);观察组无中转开腹发生,中转开腹率低于对照组(P<0.05);观察组并发症发生率为3.85%(2/52),低于对照组的15.38%(8/52)(P<0.05)。结论PTGD后择期腹腔镜胆囊切除术治疗GradeⅡ急性结石性胆囊炎,能减少术中出血量,缩短术后引流时间和住院时间,降低中转开腹率,并能促进胆囊炎症消退,安全性高。展开更多
文摘目的分析PTGD后择期LC治疗对GradeⅡ急性胆囊炎ACTH、MPO及Cor水平的影响。方法选取2021年12月至2023年5月安徽中科庚玖医院收治的急性胆囊炎患者121例,根据治疗方案分为三组,即甲组(急诊行LC治疗,未行PTGD)38例、乙组(PTGD引流管拔出后72 h后行LC,早期)43例和丙组(PTGD引流管拔出后14~30 d后行LC,晚期)40例。对比三组手术情况、炎症因子、肝功能、ACTH、MP、Cor水平及并发症发生率。结果甲组LC手术时长、术后卧床时长及住院天数均长于丙组、乙组,失血量、中转开腹率高于丙组、乙组,差异有统计学意义(P<0.05);丙组LC手术时长、术后卧床时长及住院天数均长于乙组,差异具有统计学意义(P<0.05)。LC术后1 d hs-CRP、PCT、IL-6、ST、ALT、ALP、ACTH、MPO及Cor:甲组>丙组>乙组,差异有统计学意义(P<0.05)。并发症发生率:甲组>丙组>乙组,差异有统计学意义(P<0.05)。结论PTGD后择期LC治疗对GradeⅡ急性胆囊炎ACTH、MPO及Cor水平影响小,且并发症低;而PTGD后早期行LC能有效改善肝功能、炎症因子,且术后应激反应更低,值得临床推广。
文摘Background:The dysregulation of Isocitrate dehydrogenase(IDH)and the subsequent production of 2-Hydroxyglutrate(2HG)may alter the expression of epigenetic proteins in Grade 4 astrocytoma.The interplay mechanism between IDH,O-6-methylguanine-DNA methyltransferase(MGMT)-promoter methylation,and protein methyltransferase proteins-5(PRMT5)activity,with tumor progression has never been described.Methods:A retrospective cohort of 34 patients with G4 astrocytoma is classified into IDH-mutant and IDH-wildtype tumors.Both groups were tested for MGMT-promoter methylation and PRMT5 through methylation-specific and gene expression PCR analysis.Inter-cohort statistical significance was evaluated.Results:Both IDH-mutant WHO grade 4 astrocytomas(n=22,64.7%)and IDH-wildtype glioblastomas(n=12,35.3%)had upregulated PRMT5 gene expression except in one case.Out of the 22 IDH-mutant tumors,10(45.5%)tumors showed MGMT-promoter methylation and 12(54.5%)tumors had unmethylated MGMT.All IDH-wildtype tumors had unmethylated MGMT.There was a statistically significant relationship between MGMT-promoter methylation and IDH in G4 astrocytoma(p-value=0.006).Statistically significant differences in progression-free survival(PFS)were also observed among all G4 astrocytomas that expressed PRMT5 and received either temozolomide(TMZ)or TMZ plus other chemotherapies,regardless of their IDH or MGMT-methylation status(p-value=0.0014).Specifically,IDH-mutant tumors that had upregulated PRMT5 activity and MGMT-promoter methylation,who received only TMZ,have exhibited longer PFS.Conclusions:The relationship between PRMT5,MGMT-promoter,and IDH is not tridirectional.However,accumulation of D2-hydroxyglutarate(2-HG),which partially activates 2-OG-dependent deoxygenase,may not affect their activities.In IDH-wildtype glioblastomas,the 2HG-2OG pathway is typically inactive,leading to PRMT5 upregulation.TMZ alone,compared to TMZ-plus,can increase PFS in upregulated PRMT5 tumors.Thus,using a PRMT5 inhibitor in G4 astrocytomas may help in tumor regression.
文摘Objective:To investigate the effect and value of perioperative nursing intervention on postoperative recurrent grade II-I left frontal astrocytoma.Method:Nursing care procedures:left frontal lobe of the patient was occupied by a large space.Clinical teaching of nursing was strengthened.Preoperative,intraoperative and postoperative care and ward patrol were enhanced.Close attention was paid on consciousness,pupil,vital signs,body temperature,lungs condition,cranial and nerve function of the patient.Extra care was taken in keeping the incision clean and dry.Blood diffusion condition in wound was observed.Active cooperation with doctor was taken to prevent occurrence of pulmonary infection,urinary tract infection,pressure ulcer and other complication.Results:After operation,the patient had stable condition,clear mind and consciousness.There was no occurrence of epilepsy but intracranial hemorrhage.Pneumatosis was relieved.There was no infection and other complication.Conclusion:Application of comprehensive nursing intervention could effectively improve quality of life of patient and reduce incidence of postoperative complication in patients with brain tumor.
文摘Monitoring the long-term radiotherapy-associated molecular changes in low-grade gliomas(LGGs) facilitates the understanding of LGG response to radiotherapy.In this study,we used immunohistochemistry to analyze the expression of Ki-67,tumor protein P53(TP53),P21,and P27 in 8 paired WHO grade II astrocytoma samples.The interval between radiotherapy(RT) and the second surgery was more than 3 months in all cases.The average Ki-67 labeling index(LI) was 5.3% in pre-RT samples and 11.54% in post-RT samples.Ki-67 LI was higher in the primary tumors that underwent malignant transformation observed at the second surgery after radiation.Post-RT Ki-67 LI decreased in 2 cases with an interval of less than 12 months between RT and the second surgery.TP53 expression was found in 3 out of 4 pre-RT samples with malignant transformation and in 1 out of 4 pre-RT samples without malignant transformation.Post-RT TP53 increased in 2 cases in which increased expression of P21 or P27 was also observed.Our study suggests that radiotherapy can inhibit WHO grade II astrocytoma proliferation as reflected by Ki-67 LI,but the effect attenuates with time.In addition,there is a tendency of malignant transformation for WHO grade II astrocytomas with a high Ki-67 level or TP53 expression in initial samples.
文摘Nonresectable Low-Grade Astrocytomas (LGA) can compromise function and threaten life. For the majority of patients, the most appropriate strategy is initial chemotherapy followed by Radiation Therapy (RT). Since curative treatment is not available for most of these patients, it is reasonable to conduct clinical studies to evaluate new agents. This Phase II study evaluates efficacy and safety of Antineoplastons A10 and AS2-1 (ANP) in LGA. Sixteen children diagnosed with LGA were treated. They included 12 males and 4 females, ages 1.6 - 17.4 years (median 10.6). Efficacy was evaluated in 16 patients. The majority of patients were previously treated, but 1 patient had stereotactic biopsy only. Out of the remaining 15 patients, 6 patients received chemotherapy, and 7 patients had surgery, and 2 patients received RT and chemotherapy after surgery. The patients received treatment with ANP administered daily every 4 hours (median dose of A10 was 7.71 g/kg/d and AS2-1 was 0.26 g/kg/d) until objective response or stable disease was documented and for 8 months thereafter. The duration of ANP IV ranged from 1.4 to 286 weeks with a median of 83 weeks. A complete response was documented in 25.0%, partial response in 12.5%, and stable disease in 37.5%. Overall survival was 67.7% at 5 years, and 54.2% at 10 and 15 years. Progression-free survival was 48.1%, 34.4% and 34.4% at 5, 10, and 15 years respectively. The treatment was associated with grade 3 or grade 4 Adverse Drug Experiences (ADE) in 6 patients. There were two hypernatremias of grade 4 (12%). Grade 3 ADE included urinary frequency (6%), fatigue (6%) and hypernatremia (6%). There were no chronic toxicities, and there was a high quality of survival. ANP shows efficacy with a very good toxicity profile in this cohort of children with low-grade astrocytoma.
文摘目的探讨经皮胆囊穿刺引流(PTGD)后择期腹腔镜胆囊切除术治疗GradeⅡ急性结石性胆囊炎患者的效果。方法回顾性选取2017年8月至2020年6月尉氏县中心医院收治的52例行急诊腹腔镜胆囊切除术GradeⅡ急性结石性胆囊炎患者(对照组)及52例行PTGD后择期腹腔镜胆囊切除术GradeⅡ急性结石性胆囊炎患者(观察组),比较两组手术时间、术中出血量、术后肛门排气时间、术后引流时间、术后住院时间、炎症指标[白细胞(WBC)、中性粒细胞、C反应蛋白(CRP)]、血清淀粉酶(AMY)、肝功能指标[丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、直接胆红素(DBIL)、间接胆红素(IBIL)]、中转开腹及安全性。结果观察组手术时间、术中出血量、术后引流时间、术后住院时间短于对照组(P<0.05);观察组术后72 h WBC、中性粒细胞、CRP低于对照组(P<0.05);观察组术后72 h AMY低于对照组(P<0.05);观察组无中转开腹发生,中转开腹率低于对照组(P<0.05);观察组并发症发生率为3.85%(2/52),低于对照组的15.38%(8/52)(P<0.05)。结论PTGD后择期腹腔镜胆囊切除术治疗GradeⅡ急性结石性胆囊炎,能减少术中出血量,缩短术后引流时间和住院时间,降低中转开腹率,并能促进胆囊炎症消退,安全性高。
