【Abstract】Objective To study the effects of nitric oxide (NO) on the growth and metastasis of tumor.Methods The literatures of recent years were reviewed.Results NO had double effects on the growth and metastasis of tumor. NO promoted the growth and metastasis by regulating the expression of tumor proliferation gene and inducing tumor angiogenesis. On the other hand, NO had antitumor effects by interfering with the metabolism of tumor cells, inducing the damage of DNA, forming high toxic free radical, inducing apoptosis of tumor cells and mediating the antitumor action of endothelial cells and macrophages.Conclusion Selective blockage or induction of synthesis of NO may be a new way for tumor therapy.
Pelvic exenteration has become an important procedure for radical treatment of locally advanced/recurrent rectal cancer, and in recent years, with the advancement of surgical techniques and the improvement of perioperative management ability, the long-term prognosis of patients has been significantly improved. However, the high incidence of perioperative complications seriously impacts the quality of life of patients and the course of postoperative recovery, which remains a major problem for surgeons. Precise surgical levels and appropriate intraoperative position help to fully expose the surgical field, accurately identify major vessels, and reduce the risk of intraoperative bleeding. Biological mesh, myocutaneous flap and omentoplasty are common pelvic floor reconstruction methods, and combined repair of pelvic defects by two of them may further reduce the incidence of empty pelvic syndrome. Iliac revascularization could effectively prevent postoperative thrombosis and ventricular septal syndrome. The application of minimally invasive techniques and the implementation of pre-rehabilitation measures might help to reduce postoperative complications. This article reviews the prevention strategies of complications after pelvic exenteration in order to provide some reference for clinical practice and surgical promotion.
【Abstract】Objective To investigate the expression of inducible nitric oxide synthase (iNOS) and p53 protein in hepatocellular carcinoma (HCC) and their relationship with angiogenesis. Methods Immunohistochemical method and image analysis technique were used to detect the expression of iNOS and p53 protein in tumor tissue sections of 59 HCC patients. Microvessel density (MVD) was counted by immunohistochemical staining with anti-CD34 antibody.Results ①The expression rates of iNOS and p53 were 81.4%(48/59), 64.4%(38/59) in HCC patients, respectively. The expression intensities of iNOS and p53 were 5 635±1 287, 3 352±873 in HCC patients, respectively. ②MVD was 32.5±2.73 in the tumor tissue of HCC patients. ③The expression of iNOS was correlated with the expression of p53 and MVD in HCC patients (P＜0.05); The expression of p53 was also correlated with the MVD in HCC patients (P＜0.05). Conclusion iNOS and p53 are highly expressed in HCC and may play a key role in angiogenesis of HCC.
Objective To explore the effective method for treatmentof fracturesof scapular neck.Methods A retrospective analysis of 30 patients with fractures of scapular neck was done. The patients were treated by operation or by nonoperation from May 1994 to May 2003. According to the degree of displacement,30 cases included 9 mild displaced fractures(lt;10 mm) and 21 severe displaced fractures(gt;10 mm). According to the location of fractures, there were 24 cases of surgical neck fractures and 6 cases of anatomical neck fractures. Of all 30 patients, 12 were treated by nonoperation and 18 by operation. All fractured scapularnecks were exposed through posterior approach and fixed with interfragmentary compression screws, reconstruction plates and so on after satisfactory reduction.Associated clavical fractures were exposed through Langer’s approach and fixed with Kirschner wire-tension band fixation construct, reconstruction plates and so forth. When followed up, the clinical examination was done and the X-ray filmswere taken to measure glenopolar angle(GPA). Herscovici’s score was adopted.Results Twenty-eight patients were followed up from 14 days to 9 years. Among 11 patients treated by non-operation, Herscivici score showed that 4 cases achieved the excellent result, 2 cases good, 2 cases fair and 3 cases poor and the X-ray film results showed that there were 6 cases of GPA＞20° and 5 cases of GPA＜20°. Of 17 patients treatedby operation, Herscivici score showed that 11 cases achieved the excellent result, 5 cases good and 1 case fair and the X-ray film results showed that there 16 cases of GPA＞20° and 1 case of GPA＜20°.Conclusion Fractures of scapular surgical neck with mild displacement can be treated by nonoperation, while fractures of surgical neck with severe displacement or associated with ipsilateral clavical fractures, and fractures of anatomical neck should be treated by operation to reconstruct the stabilityof shoulder and minimize the complications.
目的探讨胃肠道间质瘤的临床病理特点及治疗方法。 方法回顾性分析我院2005年7月至2010年7月期间收治的35例患者的临床资料。 结果35例患者病变分别位于胃部18例（51.4%），其中胃体15例（42.9%）、胃窦3例（8.6%）； 回肠16例（45.7%）； 小肠系膜根部1例（2.9%）。 35例均进行手术治疗，其中行胃楔形切除术15例（42.9%），胃大部切除术3例（8.6%），小肠部分切除术16例（45.7%），肠系膜肿块切除加大部分小肠切除术1例（2.9%）。 术后病理报告均为间质瘤； 免疫组织化学染色结果： CD117阳性33例(94.3%)，CD34阳性26例(74.3%)。 35例术后均获随访，随访时间6个月至5年，平均25.6个月。 1例术后10个月死于肿瘤复发，1例术后4个月死于短肠综合征、营养不良，余33例无肿瘤复发。 结论胃肠道间质瘤确诊依赖于病理组织学检查及免疫组化染色，完整切除病灶是最有效的治疗手段。
Objective To explore the correlations of plasma D-dimer and fibrinogen levels with carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA21-1) in patients with non-small cell lung cancer (NSCLC). Methods The clinical data of 196 patients with NSCLC diagnosed for the first time in the Department of Respiratory and Critical Care Medicine, the 416 Hospital of Nuclear Indusry between July 2017 and December 2019 were analyzed retrospectively. There were 57 cases in early stage (stage Ⅰ-Ⅱ), 57 cases in medium stage (stage Ⅲ), and 82 cases in advanced stage (stage Ⅳ) according to TNM staging, 108 cases of adenocarcinoma, 87 cases of squamous cell carcinoma, and 1 case of unclassified type according to pathological classification, and 19 deaths and 177 survivals according to outcome. The levels of D-dimer and fibrinogen were determined by immunoturbidimetry and coagulation method, and the levels of CEA and CFYRA21-1 were determined by electro-chemiluminescence method. The non-normally distributed data were presented as median (lower quartile, upper quartile), and Spearman correlation analyses were performed. Results Among the early, middle and advanced stage patients, the levels of D-dimer [198.00 (133.00, 390.87), 279.00 (170.93, 520.89), 389.00 (196.25, 931.00) μg/L], CEA [3.20 (2.60, 5.17), 13.53 (5.07, 70.63), 15.69 (4.07, 123.46) μg/L], and CFYRA21-1 [4.79 (3.15, 8.84), 8.60 (4.83, 19.32), 7.19 (3.09, 15.05) μg/L] were significantly different (P<0.05); however, there was no statistical difference in the level of fibrinogen among the three stages (P>0.05). The level of CYFRA21-1 in the adenocarcinoma group was lower than that in the squamous cell carcinoma group [(5.39 (2.81, 12.71) vs. 6.86 (4.18, 12.29) μg/L, P<0.05], while there was no statistically significant difference in D-dimer, CEA, or fibrinogen between the two groups (P>0.05). The levels of D-dimer, CEA, and CFYRA21-1 in the death group [1176.00 (382.00, 2848.00), 135.34 (24.85, 403.50), 10.82 (7.41, 23.41) μg/L] were significantly higher than those in the survival group [270.00 (146.00, 481.50), 5.62 (3.05, 26.53), 6.28 (3.37, 12.30) μg/L], and the differences were statistically significant (P<0.01); but there was no statistical difference in the level of fibrinogen between the two groups (P>0.05). D-dimer was positively correlated with CEA and CFYRA21-1 (rs=0.450, 0.291; P<0.001), but fibrinogen was not correlated with CEA or CFYRA21-1 (P>0.05). Conclusion D-dimer was more valuable than fibrinogen in predicting the clinical stage and prognosis of NSCLC.
In this study, a closed-loop controller for chest compression which adjusts chest compression depth according to the coronary perfusion pressure (CPP) was proposed. An effective and personalized chest compression method for automatic mechanical compression devices was provided, and the traditional and uniform chest compression standard neglecting individual difference was improved. This study rebuilds Charles F. Babbs human circulation model with CPP simulation module and proposes a closed-loop controller based on a fuzzy control algorithm. The performance of the fuzzy controller was evaluated and compared to that of a traditional PID controller in computer simulation studies. The simulation results demonstrated that the fuzzy closed-loop controller produced shorter regulation time, fewer oscillations and smaller overshoot than those of the traditional PID controller and outperforms the traditional PID controller in CPP regulation and maintenance.
Objective To analyze the distribution of pathogens, drug susceptibility and multi-drug resistant bacteria (MDRB) in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with pneumonia. Methods The clinical data of patients whose discharge diagnosis included AECOPD with pneumonia or pulmonary infection from January 2012 to December 2015 were retrospectively analyzed. Strain identification and drug sensitivity analysis were performed in the pathogenic bacterias isolated from sputum culture. Results A total of 1 978 patients were enrolled in this study, and pathogenic bacterias were isolated from the sputum of 708 patients, including 485 cases of community-acquired pneumonia (CAP) and 223 cases of hospital-acquired pneumonia (HAP); and 786 strains of pathogens were isolated (501 strains from CAP cases, 285 strains from HAP cases), including 448 strains of Gram-negative (G–) bacilli (57.0%), 117 strains of Gram-positive (G+) cocci (14.9%), and 221 strains of fungi (28.1%). Susceptibility testing results showed that G– bacilli were highly resistant to penicillins, third generation cephalosporins, ciprofloxacin, gentamicin, etc., and G+ cocci were highly resistant to penicillin, clindamycin and erythromycin. There were 238 strains of MDRB, mainly including 69 strains of Acinetobacter baumanii [multiple drug resistance rate (MDRR)=67.6%], 27 strains of Escherichia coli (MDRR=52.9%), 25 strains of Klebsiella pneumoniae (MDRR=34.2%), 33 strains of Pseudomonas aeruginosa (MDRR=33.0%) and 24 strains of Stenotrophomonas maltophilia (MDRR=100.0%). MDRR of Enterococcus genus and methicillin-resistant Staphylococcus aureus was 50.0% and 48.0%, respectively. Conclusions The pathogenic bacterias in elderly AECOPD patients complicated with pneumonia are mainly G– bacterias, and the proportion of fungal infection tends to increase. Bacterial drug resistance is serious and the MDRB tends to increase, especially in patients with HAP. Physicians should early find out the characteristics of local pathogenic bacteria and drug sensitivity, rationally select antibiotics, reduce the occurrence of drug-resistant strains and superinfection when treating the elderly patients with AECOPD complicated with pneumonia.
Objective To determine whether intravesically administered Adriamycin can prevent superficial bladder tumor to recur through assessing the efficacy of with intravesical Adriamycin and without intravesical Adriamycin after TURB-t. Method The search strategy was made according to the demand of Cochrane Collaboration. Medline, Embase，CBMdisc and the Cochrane Library were searched for RCTs. Data were extracted by two reviewers using the designed extraction form. RevMan were used for data management and analysis. Results Thirty three relevant trials were searched, of which eighteen trials were included and fifteen trials were excluded. Meta-analysis showed intravesically administered Pirarnbicin (THP), Epirubicin (EPI) and Adriamycin (ADM) can reduce the recurrence rate of superficial bladder cancer after operation during one or two years. Conclusions Intravesically administered THP, EPI and ADM can reduce the recurrence rate of superficial bladder cancer after TUPB-t’s operation during one or two years. In addition, the factors affecting the prognosis should be performed, such as the dosage of irrigation of bladder, reserving time and the course.