连续性血液净化治疗重症脓毒症合并多器官功能障碍综合征的临床研究

目的:研究连续性血液净化(CBP)的作用机理及在重症脓毒症合并MODS患者治疗中的应用价值。方法:将样本容量为87例的重症脓毒症合并MODS患者予以随机分为JC组43例和JC+CBP组44例,JC组开展常规性的综合治疗,JC+CBP组在JC组的基础上联合开展CBP治疗。于治疗前后,分别检测免疫功能指标(CD4+、CD8+、CD14+)、血清炎症反应指标(hs-CRP、IL-6、TNF-α)、生命指证参数(HR、MAP、Lac),并评价临床预后。结果:治疗后,JC+CBP组CD4+、CD8+、CD14+均高于JC组(P<0.05),血清hs-CRP、IL-6、TNF-α均低于JC组(P<0.05);JC+CBP组HR、Lac均低于JC组(P<0.05),MAP高于JC组(P<0.05)。治疗后,JC+CBP组APACHEII评分低于JC组(P<0.05),SOFA评分高于JC组(P<0.05)。JC+CBP组治愈率为90.91%,高于JC组的72.09%(P<0.05)。结论:CBP可通过对重症脓毒症合并MODS患者免疫功能的提高及炎症反应的控制,而更好的控制病情,促进患者生命体征恢复平稳,改善预后。

Isotropic volumetric MRI for displaying cranial perineural spread of cranial nerve in nasopharyngeal carcinoma

Objective To observe the value of isotropic volumetric MRI for displaying perineural spread(PNS)of cranial nerve(CN)in nasopharyngeal carcinoma.Methods Eighty-seven patients with pathologically proven nasopharyngeal carcinoma were prospectively enrolled.MR scanning,including three-dimensional liver acquisition with volume acceleration-flexible(3D LAVA_Flex)image,T2WI with fat suppression(T2WI-FS),T1WI,contrast enhancement(CE)T1WI-FS of nasopharynx and neck region were performed.The displaying rates of CN PNS were evaluated and compared between 3D LAVA_Flex and T2WI-FS,T1WI,CE-T1WI-FS at patient level,CN group level and neural level,respectively.Results The displaying rate of CN PNS in all 87 nasopharyngeal carcinoma patients by 3D LAVA_Flex sequence was 49.43%(43/87),higher than that of conventional MRI(30/87,34.48%,P=0.001).Among 59 patients with advanced nasopharyngeal carcinoma diagnosed with conventional sequences,the displaying rate of CN PNS was 71.19%(42/59)by 3D LAVA-Flex sequence,higher than that of conventional MRI(30/59,50.85%,P=0.001).At both patient level and posterior CN level,significant differences of the displaying rate of CN PNS were found between 3D LAVA-Flex sequence and T2WI-FS,T1WI,CE-T1WI-FS,while at CN level,the displaying rates of mandibular nerve PNS,CNⅨ—ⅪPNS in jugular foramen(P<0.05)and CNⅨ—ⅫPNS in carotid space of 3D LAVA_Flex sequence were all significantly higher than that of T2WI-FS,T1WI and CE-T1WI-FS(all P<0.05),of PNS of CNⅢ—Ⅴin cavernous sinus were higher than that of T2WI-FS(P<0.05),while of PNS of hypoglossal nerve were significantly higher than that of T2WI-FS and T1WI(both P<0.05).Conclusion 3D LAVA_Flex sequence could be used to effectively display CN PNS of nasopharyngeal carcinoma.

多参数MRI征象对非钙化型乳腺腺病与非钙化型乳腺癌的鉴别诊断价值

目的 分析探讨非钙化型乳腺癌及腺病的多参数MRI表现,以提高二者在MRI诊断中的准确性。方法 回顾性收集分析经病理证实为105例乳腺癌及84例乳腺腺病患者,所有患者临床、病理及MRI影像资料完整,所有病灶均经乳腺钼靶及MRI检查,且病灶在钼靶上表现为无钙化。结果 对于表现为肿块型病变,乳腺腺病与乳腺癌在大小、分叶、毛刺、早期强化曲线、晚期强化曲线、内部强化方式及平均ADC值上具有统计学意义(均P<0.05),毛刺、Ⅲ型曲线、年龄、平均ADC值是两组病变鉴别的关键性因素,其OR值分别为7.122、6.151、1.167及0.996。对于对于表现为肿块型病变,两组病变在病灶分布、早期强化曲线、晚期强化曲线及平均ADC值上具有统计意义(均P<0.05),在内部强化特征上无统计学意义。结论 非钙化型乳腺癌及非钙化型乳腺腺病在MRI表现有一定的相似之处,形态、病灶分布、早期强化曲线、晚期强化曲线及平均ADC值可作为主要鉴别点。

林奇综合征相关性异时性结直肠癌的治疗

林奇综合征(LS)是一种常染色体显性遗传病,是最常见的遗传性结直肠癌综合征。LS相关性异时性结直肠癌(MCRC)是结直肠癌中的一种特殊类型,其发生风险因突变的错配修复(MMR)基因而异。节段性肠切除术可能导致MCRC累积发生风险增加。LS相关MCRC治疗仍以外科手术为主,但其具体手术范围仍存在争议,进行节段性结(直)肠切除或扩大的次全或全结(直)肠切除术,应综合考虑肿瘤位置,基因突变类型、分期、年龄、合并症和患者个人意愿等。近年来,免疫检查点抑制剂(ICIs)对局晚期或转移性的LS相关性MCRC的治疗具有积极疗效。对于LS患者,正确的随访和内镜监测及预防性治疗(包括生活方式干预、化学性药物预防、肿瘤疫苗等),可减少MCRC的发生风险。