目的:探讨超声检查在腹部闭合性损伤内脏破裂出血的应用价值。方法:对92例腹部闭合性损伤内脏破裂出血患者进行全面、细致的超声检查,并收集其手术、病理结果。结果:本组病例超声与手术结果完全相符者83例(占90.2%),基本相符者6例(占6.5%),漏诊3例(占3.3%)。其中脾破裂49例,肝破裂16例,肾破裂14例,胰腺损伤1例,肠破裂6例,复合性内脏破裂6例。92例患者均伴有腹腔积液,超声检出率100％(92／92)。结论:超声能迅速、较准确地对腹部闭合性损伤内脏破裂出血作出诊断,尤其诊断实质性脏器破裂比空腔脏器破裂更有特异性,具有重要的临床价值。
ObjectiveTo evaluate the effects of multi-disciplinary diagnosis and treatment model based on doctor-patient shared decision making on treatment outcomes, quality of life and postoperative complications of breast cancer patients. MethodsA total of 100 breast cancer patients were included in this study through a prospective randomized controlled design, and were randomly divided into control group and intervention group, with 50 patients in each group. The control group received traditional treatment mode, while the intervention group implemented a multidisciplinary treatment mode based on doctor-patient sharing decision making. The results of treatment, quality of life and postoperative complication rate were compared between the two groups. ResultsThe completion rate of adjuvant radiotherapy and chemotherapy in the intervention group was 94.0%, which was higher than that in the control group (80.0%), and the difference was statistically significant (P=0.037). The satisfaction rate of postoperative breast appearance in the intervention group was 90.0%, which was higher than that in the control group (60.0%), with statistical significance (P<0.001). There was no significant difference in grade Ⅲ/Ⅳ toxicity between the two groups (P>0.05). After treatment, the scores of patients’ quality of life in the intervention group were higher than those in the control group, and the difference was statistically significant (P<0.05). The incidence of postoperative complications in the intervention group was 6.0%, which was lower than that in the control group (22.0%), and the difference was statistically (P=0.021). ConclusionsThe application of multidisciplinary diagnosis and treatment model based on doctor-patient sharing decision-making in the treatment of breast cancer patients has significantly improved the treatment effect and quality of life, and effectively reduced the rate of postoperative complications. This model provides a new approach to the treatment of breast cancer that is more personalized, comprehensive and efficient.
ObjectiveTo detect the expression of programmed cell death ligand 1 (PD-L1) in papillary thyroid carcinoma (PTC) and PTC with coexistent Hashimoto’s thyroiditis (HT) tissues, and to explore its clinical significance of its expression.MethodsThe PTC patients who underwent thyroidectomy at the Thyroid Surgery Department of the Affiliated Hospital of Guizhou Medical University from March 2017 to May 2019 were retrospectively collected. Immunohistochemical staining was used to detect the expression of PD-L1 in the PTC tissues, PD-L1 staining positive cells ≥20% was judged as positive expression, <20% was judged as negative expression. The relationship between PD-L1 positive expression rate and clinicopathologic characteristics of patients with PTC were analyzed, and the correlation between the presence of HT in PTC tissues and PD-L1 positive expression was studied.ResultsA total of 138 patients with PTC were included in this study, including 104 patients with PTC alone and 34 PTC patients with coexistent HT. The positive rate of PD-L1 expression in the 138 cases of PTC tissues was 35.5% (49/138), among which was 43.3% (45/104) in the pure PTC tissues, and 11.8% (4/34) in the PTC tissues with HT, the latter was significantly lower than the former (P=0.001). The results of univariate analysis showed that the positive rate of PD-L1 expression was related to the tumor size, the presence or absence of extraglandular invasion and HT in PTC patients (P<0.05), and the results of Spearman correlation analysis showed that the positive rate of PD-L1 expression was positively correlated with tumor size (rs=0.173, P=0.041) and extraglandular invasion (rs=0.197, P=0.021), and negatively correlated with whether TH was merged (rs=–0.284, P=0.001). The multivariate analysis results showed that the positive rate of PD-L1 expression was closely related to whether PTC with coexistent HT [OR=5.720, 95%CI (1.879, 17.411), P=0.002], and it was not found to be related to tumor size and presence of extraglandular invasion (P>0.05).ConclusionsPositive rate of PD-L1 expression has a certain relationship with tumor size and presence or absence of extraglandular invasion, and which in PTC patients with or without HT is significantly different, that is, positive rate of PD-L1 expression in PTC with HT is lower suggests that coexistent HT might be an inhibitory factor in occurrence of PTC, and immune microenvironment-related factors of PTC might be involved in occurrence and development of thyroid cancer.
ObjectiveTo investigate relationship of long non-coding RNA FoxP4-AS1 expression with lymph node metastasis (LNM) of papillary thyroid carcinoma (PTC).MethodsReal time fluorescent quantitative polymerase chain reaction was used to detect the expression level of FoxP4-AS1 in 52 cases of PTC tissues and corresponding adjacent tissues, PTC cells (TPC-1, B-CPAP, K1), and normal thyroid follicular epithelial cells (Nthy-ori3-1). Univariate and multivariate analysis were used to identify the influencing factors of LNM in PTC. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of influencing factors of LNM in PTC.ResultsThe expression level of FoxP4-AS1 in the PTC tissues was significantly decreased as compared with the corresponding adjacent tissues (t=7.898, P<0.001), which in the different cells had statistical difference (F=29.866, P<0.001): expression levels in the TPC-1 and K1 cells were lower than Nthy-ori3-1 cells (P<0.05) and in the B-CPAP cells and Nthy-ori3-1 cells had no statistical difference (P>0.05) by multiple comparisons. Univariate analysis showed that the extraglandular invasion (χ2=4.205, P=0.040)and low expression of FoxP4-AS1 (χ2=7.144, P=0.008) were the influencing factors of LNM in PTC. Binary logistic regression analysis showed that extraglandular invasion [OR=9.455, 95%CI (1.120, 79.835), P=0.039] and low expression ofFoxP4-AS1[OR=5.437, 95%CI (1.488, 19.873), P=0.010] were risk factors for LNM of PTC. The area under the ROC curve ofFoxP4-AS1,extraglandular invasion alone, and combination of the two were 0.679, 0.656, and 0.785, respectively.ConclusionsFoxP4-AS1 is down-regulated in PTC. Low level of FoxP4-AS1 is a risk factor for LNM of PTC. Combined detection of expression level of FoxP4-AS1 and extraglandular invasion has a high predictive value for LNM of PTC.