ObjectiveTo investigate the clinical significance of levels of serum salivary Krebs von den Lungen 6 (KL-6) and matrix metalloproteinase-9 (MMP-9) in predicting the prognosis of patients with acute respiratory distress syndrome (ARDS). MethodsFrom January 2020 to December 2023, 100 ARDS patients who received treatment in our hospital were included as the study group, and 59 healthy professionals who underwent health checkup were selected as the control group. And the levels of serum KL-6 and MMP-9 were measured on the day of admission. According to the oxygenation index (OI) results, the study group was separated into mild group (38 cases), moderate group (33 cases), and severe group (29 cases); Based on 28-day intensive care unit (ICU) survival status, the study group was divided into a survival group of 69 cases and a death group of 31 cases. Enzyme-Linked Immunosorbent Assay (ELISA) method was applied to detect the levels of serum KL-6 and MMP-9. Pearson correlation was applied to analyze the correlation between serum KL-6 and MMP-9 levels and OI in the death group. Logistic regression was applied to analyze the influencing factors of prognostic mortality in ARDS patients. Receiver operating characteristic (ROC) curve was applied to analyze the predictive value of serum KL-6 and MMP-9 levels for prognostic mortality in ARDS patients. ResultsCompared with the control group, the levels of serum KL-6 and MMP-9 in the study group were notably increased, and the levels of serum KL-6 and MMP-9 in the severe ARDS group were notably higher than those in the moderate and mild groups. The levels of serum KL-6 and MMP-9 in the moderate group were notably higher than those in the mild group, the OI in the survival group was greatly higher than that in the death group, and the acute physiology and chronic health evaluationⅡ (APACHE II) score, KL-6, and MMP-9 in the survival group were greatly lower than those in the death group (P<0.05). Pearson analysis showed that serum KL-6 and MMP-9 levels were negatively correlated with OI (P<0.05). Logistic analysis showed that APACHE II score, KL-6, and MMP-9 were risk factors for prognostic mortality in ARDS patients (P<0.05). ROC curve showed that the AUC of serum KL-6 and MMP-9 levels in predicting prognostic mortality in ARDS patients was 0.809 and 0.816, respectively, with cutoff value of 510.44 U/ml and 317.15μg/L, respectively. The area under the ROC curve (AUC) predicted by the combination of the two was 0.935, greatly higher than that of KL-6 (Z=2.133, P=0.033) and MMP-9 (Z=2.164, P=0.030) alone. ConclusionsThe levels of serum KL-6 and MMP-9 in ARDS patients are greatly upregulated and increase with the severity of the disease. The combination of the two has certain predictive value for the prognostic mortality of ARDS patients.
Objective To explore the progress of the relationship between the tumor suppressor gene p53 and oncogene c-erbB-2 and gastric cancer in recent years. Methods Relevant literatures about p53 and c-erbB-2 in gastric cancer were collected and analyzed. Results The mutation of p53 gene and the over-expression of c-erbB-2 gene were a common event in gastric cancer. The mutation of p53 gene was correlated with the location of gastric cancer and its aggressive biological behavior. The over-expression of c-erbB-2 gene could be used as an independent prognostic parameter in gastric cancer. The drugs targeted on p53 and c-erbB-2 gene were being developed. Conclusion Further research on the role of p53 and c-erbB-2 gene in the development of gastric cancer is helpful to understand the biological behavior and provide theoretical basis for gene therapy.
Objective To evaluate the clinical, radiological and pathological manifestations of lipoid pneumonia, to improve the diagnosis of this rare disease. Methods Retrospective analysis of clinical data of 19 cases with confirmed lipoid pneumonia was conducted. Results There was 13 male and 6 female patients with an average age of 54. 4 years ranging from 24 to 71 years. Lipoid pneumonia presented a chronic clinical course with few physical signs. The main complaints included cough, expectation, bloody phlegmand chest pain. Finding of chest mass in routine physical examination was also a common reason for doctor visiting. Radiological features of lipoid pneumonia could be non-specific, usually presenting mass shadow in the chest, with lymph nodes enlargement in some cases. Eighteen cases were diagnosed by the histopathology of pulmonary tissue and one case was diagnosed through a combination of bronchoscopy, thoracoscopy and CT-guided percutaneous lung puncture biopsy. Histopathological finding showed accumulation of foamy macrophages in the alveolar spaces. Conclusions The clinical and radiological manifestations of lipoid pneumonia are non-specific. Histopathological examination for diagnosis is essential. If the medical therapy is not responsive, pulmonary lobectomy might be necessary.
ObjectiveTo investigate the value of rectumaerated MSCT examination in diagnosis of mesorectal infiltration of rectal cancer and lymph node metastasis staging. MethodsFrom January 2010 to July 2010, the data of 68 patients with rectal cancer confirmed by pathology were analyzed in the First Affiliated Hospital of Liaoning Medical University. All the patients underwent rectumaerated MSCT preoperatively and postoperative pathology was taken as the gold standard for evaluation of the accuracy, sensitivity, specificity, positive or negative predictive values of MSCT in diagnosis of mesorectal infiltration and lymph node metastasis.ResultsIn rectum-aerated MSCT scanning, rectum and sigmoid colon was fully expanded, perirectal fat space was clear between perirectal fat space and relatively high density rectal wall and very low density enteric cavity. For mesorectal infiltration of degree Ⅰ, Ⅱ, and Ⅲ, the accuracies were 92.6%（63/68）, 91.1%(62/68), and 95.6%(65/68), respectively; sensitivities were 91.2%(31/34), 85.0%(17/20), and 92.9%(13/14), respectively; specificities were 94.1%(32/34), 93.8%(45/48), and 96.3%(52/54), respectively; positive predictive values were 93.9%(31/33), 85.0%(17/20), and 86.7%(13/15), respectively; negative predictive values were 91.4%(32/35), 93.8%(45/48), and 98.1%(52/53), respectively. For lymph node metastasis in N0, N1, and N2, the accuracies were 92.6%(63/68）,85.3%(58/68）, and 92.6%(63/68）, respectively; sensitivities were 86.2%(25/29), 90.0%(27/30), and 66.7%(6/9), respectively; specificities were 97.4%(38/39), 81.6%(31/38), and 96.6%(57/59), respectively; positive predictive values were 96.2%(25/26), 79.4%(27/34), and 75.0%(6/8), respectively; negative predictive values were 90.5%(38/42), 92.1%(35/38), and 95.0%(57/60), respectively. ConclusionsRectumaerated MSCT scaning can clearly show the depth of rectal carcinoma infiltration in the mesorectum, and N staging of mesorectal lymph node metastasis of MSCT has a higher consistency with that of pathological staging. Rectumaerated MSCT scanning is an important referenced method for clinical preoperative staging and individualized chemotherapy regimen.
目的 用保留十二指肠水平段的胰十二指肠切除术及Roux-Y同步吻合重建消化道的方法，达到降低手术并发症，促进患者恢复，提高其生存质量和时间。方法 在行胰十二指肠切除术时，保留十二指肠水平段、升段、屈氏韧带及空肠上段，用RouxY同步吻合的方法将胰、胆、胃、肠重建排列，术后胆肠吻合口不置T管及空肠不置造瘘管，腹腔置2 mm硅胶管用于灌洗。结果 28例中除2例切口裂开，行二期缝合外，均顺利恢复出院。平均住院25天。无胆、胰漏，无返流性胆管、胰管炎等。随访6个月~6年，1年生存24例（85.7%），3年生存15例（53.6%），5年生存5例（17.9%）。结论 保留十二指肠水平段，消化功能恢复快，不影响根治时相关淋巴结的廓清。用Roux-Y同步吻合重建消化道，并发症少。不置T管和空肠造瘘管，对患者侵扰小，恢复快，提高了患者生存率。
Abstract In order to determine the fasibility of reestablishment of circulation with cryopreserved microvenous allografts (1.0～1.4mm in diameter), 40 rabbits were divided into 2 groups. In the control group, the fresh autografts were used. In the experimental group, 20 rabbitsfemoral vein segments were treated by a two-step freezing procedure. After stored in liquid nitrogen for 48 hours, the segments were implanted into the femoral veins as allografts. The histological as well as the pathological studies were performed with light and electron microscope, and its patency was determined by angiography. The results showed that the preservation of vein was generally good. The rejective response was weak. The patency rates of 1 week and 12 weeks were 90% and 85% respectively, and there was no significant difference with that of the allogenic fresh autografts (Pgt;0.05). It was suggested that clinical use of cryoperserved allogenic microvein grafts instead of fresh autografts was possible.