目的:探讨青年人大肠癌临床表现、病理特点。方法:回顾性分析四川省成都市第五人民医院普外科1997年7月至2007年12月收治的23例35岁以下青年大肠癌患者临床资料。结果:23例青年大肠癌患者平均年龄24.5岁,男女比例为2.8∶1;病变部位以直肠多见,组织学分型以低分化腺癌与印戒细胞癌最多;Dukes分期:A期1例,B期3例,C期13例,D期6例。结论:青年大肠癌表现为病理分化程度低、Dukes分期晚,更具进展性。提高认识及早期行肠镜检查有助于早期诊断。
Objective To evaluate the efficacy of posterior approach discectomy with and without fusion in the treatment of lumbar disc herniation. Methods We searched MEDLINE (1950 to June 2007), OVID (1950 to April 2007), PUBMED, the China Biological Medicine Database (1978 to June 2007) and Wanfang Database (1981 to February 2007). We also handsearched several relevant journals for randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCTs) comparing posterior approach discectomy with and without fusion in the treatment of lumbar disc herniation. The quality of the included trials was assessed. The Cochrane Collaboration’s RevMan 4.2.8 software was used for statistical analysis. Results Nine eligible trials involving 1911 patients were included. The meta-analyses found no statistically significant differences between the two operative procedures in the incidence of postoperative leg pain [RR 0.94, 95%CI (0.69, 1.28)], the proportion of patients requiring re-operation [RR 0.77, 95% CI (0.57, 1.04)], the incidence of post-operative lumbar canal stenosis [RR 1.23, 95%CI (0.26, 5.86)], and the relapse rate at other intervertebral spaces [RR 1.05, 95%CI (0.49, 2.26)] (Pgt;0.05).There is statistically significant differences between the two group in the incidence of peri-operative complications [RR 1.46, 95%CI (1.06, 2.00)]. Discectomy plus fusion was superior to discectomy alone in incidence of postoperative back pain [RR 0.70, 95%CI (0.53, 0.94)], relapse rate at either intervertebral space [RR 0.30, 95%CI (0.18, 0.48)] and at the same intervertebral space [RR 0.12, 95%CI (0.04, 0.37)]. Conclusions Since all the included studies were controlled trials with a great potential for biases, high-quality, large-scale randomized controlled trials are required.
目的 总结我院35岁以下青年人胃癌43例的诊治经验。方法 对43例患者临床特征、诊断及治疗进行回顾性分析。结果 手术40例，根治性切除14例，姑息性切除9例，胃空肠吻合6例，单纯探查11例，切除率57.50%。术后3个月内死亡5例，4～12个月内死亡18例，12～24个月内死亡8例，生存2年以上9例，5年以上3例。误诊26例，误诊率60.46%。结论 青年人胃癌发病率低，恶性程度高，病程短，转移早，早期诊断率低，误诊率高，治疗关键是提高早期诊断率。
ObjectiveTo analyze the clinicopathologic features of thyroid tumors with RAS gene mutation.MethodThe clinicopathologic data of thyroid tumor patients who underwent surgical treatment or biopsy and were diagnosed pathologically at the Department of Pathology of the Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2021 to June 2023, were collected. ResultsA total of 798 patients with thyroid tumors who met the inclusion criteria were collected, including 747 cases of follicular epithelial tumors and 51 cases of medullary thyroid carcinoma (MTC). Among 798 patients, the RAS gene mutations were detected in 36 cases (4.5%), including 25 (69.4%) patients with NRAS mutations, 8 (22.2%) patients with HRAS mutations, 3 (8.3%) patients with KRAS mutations, and 4 (1.1%) patients accompanied with TERT promoter mutations. Among 36 patients with RAS mutant thyroid tumors, the male to female ratio was 7∶11, with a median age of 48.5 years, with an average tumor diameter of 2 cm. The mutation rate of RAS gene in different histological types of thyroid tumors, from high to low, was highest in the thyroid follicular carcinoma (FTC, 25.9%), followed by differentiated high grade thyroid carcinoma (20.0%), anaplastic thyroid carcinoma (20.0%), noninvasive follicular thyroid neoplasm with papillary like nuclear features (18.2%), follicular variant of papillary thyroid carcinoma (FVPTC, 16.0%), and well-differentiated thyroid tumour of uncertain malignant potential (WT-UMP, 12.8%), the mutation rates of RAS gene in the FTC, FVPTC, and WT-UMP were significantly higher than that of the classical papillary thyroid carcinoma (P<0.001 1), and the mutation rate of RAS gene was the lowest in the classical papillary thyroid carcinoma (1.5%). A total of 35 patients were effectively followed up with an average follow-up period of 21.4 months, 6 of whom had cervical lymph node metastasis, 4 patients developed distant metastasis, and 1 patient with anaplastic thyroid carcinoma died. ConclusionsRAS gene mutation can occur in thyroid follicular differentiated tumors and MTC. NRAS mutation is more common. The mutation rate is the highest in FTC, is the lowest in classical papillary thyroid carcinoma. Differential diagnosis combined with tissue morphology and other molecular changes can provide a reference for guiding treatment and evaluating prognosis.
中药临床试验是中医药研究中发展较快的一个领域，临床研究协调员（CRC）在中药临床试验中有重要作用，其工作范围涉及到中药临床试验的各个方面。由于中药临床试验有着不同于西药临床试验的特点，CRC在中药临床试验中的作用也有其特殊性，对提高临床试验的安全性、科学性及试验数据的可信度方面起重要作用。
Objective To summarize the basic research and the cl inical appl ication of biodegradable interbody fusion Cage. Methods Recent l iterature concerning biodegradable interbody fusion Cage at home and abroad was extensively reviewed, and current developments of the basic research and the cl inical appl ication of biodegradable interbody fusion Cage were investigated. Results Basic research showes that the stiffness of biodegradable interbody fusion Cage is lower than that of metall ic Cage, so it can enhance interbody fusion. As interbody fusion proceeded, biodegradable interbody fusion Cage degrades constantly, but the speed of degradation can not keep in parallel with that of fusion. In addition, the tissue response to degradation products is controversy. Cl inical appl ication showes that the biodegradable interbody fusion Cage can enhance interbody fusion and maintain disc space height. The short term results are good, however, the long term results need further observation. Conclusion Biodegradable interbody fusion Cage can effectively enhance interbody fusion.
ObjectiveTo summarize clinical application progress of stereotactic radiotherapy for primary hepatocellular carcinoma. MethodsThe literatures about the research progress of the stereotactic radiotherapy for primary hepatocellular carcinoma were reviewed. ResultsRadiotherapy for hepatocellular carcinoma is importantly based on the radiation biology of the liver and the radiophysics of the liver cancer. Stereotactic precision radiotherapy is an effective and low toxic treatment for early hepatocellular carcinoma, moreover, it alone or in combination with microwave ablation, hepatic artery chemoembolization for unresectable hepatocellular carcinoma is safe and effective method for the treatment. ConclusionsThe optimal dose model for hepatocellular carcinoma, hepatocellular carcinoma radical dose level are problems that need further exploration, and radiobiology, radiation physics research must be strengthened to explore it, stereotactic precision radiotherapy treatment modalities in the treatment of hepatocellular carcinoma position will become increasingly people attention.
Background As part of the core outcome set (COS), the core traditional Chinese medicine (TCM) syndrome set can improve the consistency of syndrome efficacy evaluation outcomes in TCM clinical research. Previous studies proposed and empirically verified a method of developing core TCM syndrome sets based on complex syndromes under the disease-syndrome combination research model. However, this method is developed on the basis of syndrome types, which has the limitation that the finally included syndrome types are too single to adapt to the complexity of clinical syndromes. Therefore, it is urgent to optimize the existing development method to balance the complexity of clinical syndromes and methodological feasibility. Methods This study adopted qualitative research methods to obtain opinions from TCM clinicians and researchers on developing methods, efficacy evaluation criteria, and construction forms through expert steering committee meetings and semi-structured interviews. The sample size of semi-structured interviews was determined until data saturation was reached, and thematic analysis was used to analyze the transcription results. Results In the expert steering committee meeting, 60% (3/5) of the experts believed that developing in the form of syndrome elements was more operable; in the semi-structured interviews, 77.78% (7/9) of the experts supported developing in the form of syndrome elements, considering it convenient to use. Meanwhile, the research team added an expert semi-structured interview link in the development process, which complemented the cross-sectional survey used in previous studies to jointly improve the original list of TCM syndrome elements. Conclusion The method of developing core TCM syndrome sets based on syndrome elements formed in this study can consider clinical practice while improving the unity of TCM syndrome efficacy evaluation standards, which is helpful to promote the standardized development of TCM clinical research.