早期胃癌的治疗现状与进展

胃癌是常见的消化道肿瘤之一,是我国死亡率最高的恶性肿瘤之一。与日本韩国等发达国家相比,我国胃癌患者多数在就诊时已处于进展期,早期胃癌所占比例不足10%。传统的开腹胃癌手术仍是治疗早期胃癌的主要手段。相较于传统开腹手术,腹腔镜手术对于早期胃癌的治疗优势是显而易见的。早期胃癌患者行腹腔镜手术,具有术后恢复快,生活质量好,近期疗效佳等优势。内镜黏膜下剥离术(ESD,endoscopic submucosal dissection)是近年来出现的一项新的治疗早期胃癌的手段。本文就传统开腹手术、腹腔镜手术及ESD分别在早期胃癌治疗中的应用进行了综述。微创手术治疗早期胃癌将逐渐代替开腹手术,成为早期胃癌治疗的主要手段。     

术后早期肠外联合肠内营养对老年进展期胃癌患者预后效果分析

目的:探讨术后早期肠外联合肠内营养对老年进展期胃癌临床早期预后的影响。方法:选择106例老年进展期胃癌患者,随机分为观察组56例和对照组50例,术后分别给予肠外联合肠内营养和肠外营养支持,观察2组患者术前术后C反应蛋白、血清清蛋白(ALB)、前白蛋白和血红蛋白(Hb)、肛门排气时间、并发症、住院时间及疲劳指数。结果:观察组在术后CRP水平下降优于对照组(P0.05),观察组肛门排气时间、并发症、住院时间及疲劳指数均优于对照组(P0.05),但术后血清清蛋白(ALB)、前白蛋白和血红蛋白(Hb)比较无明显差异。结论:术后早期肠外联合肠内营养减轻老年进展期胃癌患者术后的应激反应,减少并发症,促进恢复,改善早期预后。     

早期介入微弹簧圈栓塞治疗脑动脉瘤破裂的疗效及预后分析

目的:研究分析早期介入微弹簧圈栓塞治疗脑动脉瘤破裂的疗效及预后。方法:选取我院2011年至2014年期间收治的脑动脉瘤破裂患者96例作为研究对象。根据数字法随机分成观察组及对照组各48例,观察组患者在入院3d之内实施微弹簧圈栓塞形式介入治疗,对照组治疗时间为入院3 d后。对比两组患者临床治疗疗效、并发症发生情况、以及术后6个月的改良Rankin量表(m RS)、改良型日常生活能力(MBI)评分。结果:观察组的栓塞效果显著好于对照组,差异有统计学意义(P0.05)。观察组术后6个月的m RS评分显著低于对照组,且MBI评分显著高于对照组,差异均有统计学意义(均P0.05)。观察组的并发症发生率均显著低于对照组,差异均有统计学意义(均P0.05)。结论:入院3d之内利用微弹簧圈栓塞对脑动脉瘤破裂实施早期介入治疗,具有较好的疗效及预后,值得临床重视。     

Intravenous administration of equine-derived whole IgG antivenom does not induce early adverse reactions in non-envenomed horses and cows

Administration of antivenoms to treat snakebite envenomings has the potential risk of inducing early adverse reactions. The mechanisms involved in these reactions are unclear. In this study, polyspecific antivenom consisting of whole IgG purified from equine plasma by caprylic acid precipitation was administered intravenously to non-envenomed horses (n = 47) and cows (n = 20) at a dose of 0.4 mL/kg. It has been reported that, in humans, this formulation (administered at a dose of 0.4 mL/kg) induces mild noticeable early adverse reactions, such as fever, vomiting, diarrhea, urticaria, generalized rash, tachypnea or tachycardia, in about 15–20% of the patients. Unexpectedly, none of the animals receiving antivenom in our study showed any evidence of early adverse reaction. Moreover, no late adverse reactions, i.e. serum sickness, were observed during 40 days after antivenom administration. Unlike studies performed in envenomed humans, our present results were obtained in a group of non-envenomed individuals. It is concluded that, in addition to the physicochemical characteristics of the formulation, other unknown factors must determine the occurrence of adverse reactions in snakebite envenomed humans treated with equine-derived antivenoms.     

Vegetation succession among and within structural layers following wildfire in managed forests

Question: How does vegetation develop during the initial period following severe wildfire in managed forests? Location: Southwestern Oregon, USA. Methods: In severely burned plantations, dynamics of (1) shrub, herbaceous, and cryptogam richness; (2) cover; (3) topographic, overstory, and site influences were characterized on two contrasting aspects 2 to 4 years following fire. Analysis of variance was used to examine change in structural layer richness and cover over time. Non‐metric multidimensional scaling, multi‐response permutation procedure, and indicator species analysis were used to evaluate changes in community composition over time. Results: Vegetation established rapidly following wildfire in burned plantations, following an initial floristics model of succession among structural layers. Succession within structural layers followed a combination of initial and relay floristic models. Succession occurred simultaneously within and among structural layers following wildfire, but at different rates and with different drivers. Stochastic (fire severity and site history) and deterministic (species life history traits, topography, and pre‐disturbance plant community) factors determined starting points of succession. Multiple successional trajectories were evident in early succession. Conclusions: Mixed conifer forests are resilient to interacting effects of natural and human‐caused disturbances. Predicting the development of vegetation communities following disturbances requires an understanding of the various successional components, such as succession among and within structural layers, and the fire regime. Succession among and within structural layers can follow different successional models and trajectories, occurs at different rates, and is affected by multiple interacting factors.     

Locomotor anatomy and biomechanics of the Dmanisi hominins

The Dmanisi hominins inhabited a northern temperate habitat in the southern Caucasus, approximately 1.8 million years ago. This is the oldest population of hominins known outside of Africa. Understanding the set of anatomical and behavioral traits that equipped this population to exploit their seasonal habitat successfully may shed light on the selection pressures shaping early members of the genus Homo and the ecological strategies that permitted the expansion of their range outside of the African subtropics. The abundant stone tools at the site, as well as taphonomic evidence for butchery, suggest that the Dmanisi hominins were active hunters or scavengers. In this study, we examine the locomotor mechanics of the Dmanisi hind limb to test the hypothesis that the inclusion of meat in the diet is associated with an increase in walking and running economy and endurance. Using comparative data from modern humans, chimpanzees, and gorillas, as well as other fossil hominins, we show that the Dmanisi hind limb was functionally similar to modern humans, with a longitudinal plantar arch, increased limb length, and human-like ankle morphology. Other aspects of the foot, specifically metatarsal morphology and tibial torsion, are less derived and similar to earlier hominins. These results are consistent with hypotheses linking hunting and scavenging to improved walking and running performance in early Homo. Primitive retentions in the Dmanisi foot suggest that locomotor evolution continued through the early Pleistocene.     

Nubian Complex strategies in the Egyptian high desert

Systematic survey by the Abydos Survey for Paleolithic Sites project has recorded Nubian Complex artifact density, distribution, typology, and technology across the high desert landscape west of the Nile Valley in Middle Egypt. Our work contrasts with previous investigations of Nubian Complex settlement systems in Egypt, which focused on a small number of sites in the terraces of the Nile Valley, the desert oases, and the Red Sea Mountains. Earlier research interpreted the Nubian Complex, in particular, as a radiating settlement system that incorporated a specialized point production. Our high desert data, however, indicate that the Nubian Complex associated with early modern humans in this region of the high desert reflects a circulating, rather than a radiating, settlement system, and that point production has been over-emphasized. Data available from our work, as well as sites investigated by others, do not conclusively identify Nubian Complex behavioral strategies as modern. These data, however, do contribute to the understanding of landscape use by early modern human populations living along the Nile Valley Corridor route out of Africa.     

不同时间早期肠内营养对急性重症胰腺炎患者的影响

目的:通过观察不同时间早期肠内营养对急性重症胰腺炎患者的影响,探讨急性重症胰腺炎患者早期肠内营养的最佳时机。方法:将重症急性胰腺炎患者60例分为三组:A组、B组和C组,每组20例。A组为肠外营养组予以常规治疗,B组在常规治疗的基础上通过鼻空肠管在入院3-5天内予以早期肠内营养,C组在常规治疗的基础上通过鼻空肠管在入院5天后予以早期肠内营养。抽取所有患者入院时、入院后3天、7天、14天静脉血,ELISA法测定患者血清中TNF-α、IL-6含量,并记录患者住院期间感染率、病死率、并发症发生率、住院时间、住院费用等。结果:各组患者血清中TNF-α、IL-6含量逐渐下降,B组和C组下降较A组下降明显,差异有统计学意义(P<0.05),B组和C组比较B组予以肠内营养后下降较C组明显,差异有统计学意义(P<0.05)。B组和C组感染率、病死率、并发症发生率、住院时间、住院费用较A组明显低(P<0.05),B组与C组比较感染率、病死率、并发症发生率B组明显低于C组(P<0.05)。结论:早期肠内营养可改善急性重症胰腺炎早期炎症反应,从而减低感染率、病死率、并发症发生率。在患者循环稳定条件下,越早予以肠内营养对患者的预后越有...