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COVID-19, caused by SARS-COV-2, has the characteristics of world epidemic, highly infectious and large base of death. In China, transmission route of SARS-COV-2 has been contained so effectively that COVID-19 has been well controlled due to the proactive national prevention and control strategy. However, not only does it bring a huge impact on the existing medical structure model, but also an objective impact on the treatment of patients with chronic diseases such as malignant tumors. Based on the progress reported in the domestic and international literatures and the actual management experience of our team, this paper reflects on the treatment strategies for patients with gastrointestinal stromal tumor (GIST) during the epidemic period of COVID-19. We focus on risk stratification for primary GIST and forming treatment strategies accordingly. Major considerations include the impact of delayed operation, the burden of medical resources, the waiting time for elective operation, and the principle of emergency operation. In addition, we focus on the level of evidence for non-surgical approaches with a view to developing a holistic strategy of "priority management principles" to guide clinical treatment in the context of limited resources and different GIST priorities.
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Humans , COVID-19 , China , Gastrointestinal Stromal Tumors , SARS-CoV-2ABSTRACT
Objective:To analyze the diagnosis of renal injury caused by chronic arsenism by color Doppler ultrasound and the observation of renal hemodynamics.Methods:From January 2018 to April 2019, 74 patients with occupational chronic arsenism admitted to Binzhou People's Hospital were selected and divided into two groups according to whether the patients were complicated with renal injury or not, 26 patients in renal injury group and 48 patients in non-renal injury group. The renal function indexes [serum creatinine (SCr), blood urea nitrogen (BUN), urine and blood β2-microglobulin (β2-MG)] were measured and the renal hemodynamics [peak blood flow velocity during systole (Vmax), minimum blood flow velocity during diastole (Vmin), resistance index (RI)] of the two groups were analyzed by color Doppler ultrasound, and the correlation between renal function indexes and renal hemodynamics was analyzed.Results:The levels of SCr, BUN, urine β2-MG and blood β2-MG in renal injury group were significantly higher than those in non-renal injury group [(136.28 ± 21.05) vs (108.42 ± 26.49) μmol/L, (8.03 ± 1.04) vs (5.36 ± 0.97) mmol/L, (157.48 ± 25.63) vs (127.42 ± 18.95) μg/L, (3.97 ± 1.12) vs (2.35 ± 0.84) mg/L, t = 4.625, 11.022, 5.740, 7.028, P < 0.05]. The Vmax and Vmin of the main renal artery and interlobular artery in renal injury group were significantly lower than those in non-renal injury group [cm/s: (50.34 ± 13.42) vs (75.32 ± 16.52), (18.13 ± 5.21) vs (29.83 ± 7.05), (12.31 ± 3.82) vs (17.22 ± 5.07), (4.08 ± 1.15) vs (6.03 ± 1.93), t = 6.833, 7.084, 4.657, 4.775, P < 0.05], and the RI of the main renal artery and interlobular artery in renal injury group was significantly higher than that in non-renal injury group [(0.71 ± 0.06) vs (0.62 ± 0.08), (0.68 ± 0.10) vs (0.56 ± 0.08), t = 5.017, 5.634, P <0.05]. Vmax and Vmin of the main renal artery and interlobular artery were negatively correlated with SCr, BUN, urine β2-MG and blood β2-MG ( P < 0.05). RI of the main renal artery and interlobular artery were positively correlated with SCr, BUN, urine β2-MG and blood β2-MG ( P < 0.05). Conclusions:Color Doppler ultrasound can effectively reflect the status of renal injury in chronic arsenism patients. The renal blood flow perfusion in renal injury patients is decreased, and the blood flow resistance is increased, which is closely related to the degree of renal injury and deserves clinical attention.
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Objective:To investigate the value of ultrasound elastography combined with serum urokinase plasminogen activator (uPA) in differential diagnosis of benign and malignant thyroid nodules.Methods:From May 2018 to May 2019, 150 patients with thyroid nodules (160 nodules) were selected, 69 patients with benign nodules (76 benign nodules) and 81 patients with malignant nodules (84 malignant nodules) were diagnosed by postoperative pathology. In the same period, 40 healthy people underwent health examination were selected as the control group. All preoperative patients were subjected to ultrasound elastography. The results of pathological examination were diagnosed as "gold standard"; the characteristics of ultrasound elastography were observed and scored, and compared with the results of pathological examination. The level of serum uPA was measured by enzyme-linked immunosorbent assay (ELISA), the sensitivity, specificity, and the area under the receiver operating characteristic (ROC) curve (AUC) were compared among single real-time ultrasound elastography, serum uPA and combined diagnosis.Results:Among the 150 patients (160 nodules), for ultrasound elastography, the sensitivity was 97.37% (74/76), the specificity was 85.71% (72/84), the accuracy was 91.25% (146/160), and the Kappa value was 0.726. The ratio of 0 to 2 points in malignant group was significantly lower than that in the benign group, the ratio of 3 to 4 points was significantly higher than that in the benign group ( P < 0.05). Compared with the control group, the levels of serum uPA in the benign group and the malignant group increased significantly ( P < 0.05). Compared with the benign group, serum uPA level in the malignant group increased significantly ( P < 0.05). The AUC of combined diagnosis was 0.869, 95% confidence interval ( CI): 0.789 - 0.949, and the best cut-off point for the combined diagnosis was uPA = 982.16 mU/L, at this time, the diagnostic sensitivity was 0.646, and the diagnostic specificity was 0.575. The AUC of ultrasound elastography was 0.814, 95% CI: 0.721 - 0.907, and the AUC of combined diagnosis was higher than that of ultrasound elastography. Conclusion:The clinical value of ultrasound elastography combined with serum uPA in differentiating benign and malignant thyroid nodules is higher than that of ultrasound elastography.
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In December 2019, a new outbreak of coronavirus pneumonia began to occur. Its pathogen is 2019-nCoV, which has the characteristics of strong infectivity and general susceptibility. The current situation of prevention and control of new coronavirus pneumonia is severe. In this context, as front-line medical workers bearing important responsibilities and pressure, while through strict management strategy, we can minimize the risk of infection exposure. By summarizing the research progress and guidelines in recent years in the fields of colorectal cancer disease screening, treatment strategies(including early colorectal cancer, locally advanced colorectal cancer, obstructive colorectal cancer, metastatic colorectal cancer and the treatment of patients after neoadjuvant therapy), the choice of medication and time limit for adjuvant therapy, the protective measures for patients undergoing emergency surgery, the re-examination of postoperative patients and the protection of medical staff, etc., authors improve treatment strategies in order to provide more choices for patients to obtain the best treatment under the severe epidemic situation of new coronavirus pneumonia. Meanwhile we hope that it can also provide more timely treatment modeling schemes for colleagues.
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Objective To explore the clinical characteristics and treatment in elderly patients with gastric bezoars. Methods Totally 49 patients with gastric bezoars were retrospectively analyzed,and among them,36 patients were aged 65-77 years, 48 cases underwent sequential therapy,1 elderly patient underwent surgical operation. Results There were differences in etiology, medical histories, clinical manifestations and therapeutic efficacy between elderly and non elderly patients with gastric bezoars.There were 42％ (15/36) of elderly patients eating glutinous rice cakes,4 cases with gastric surgery histories,6 cases with diabetes in elderly patients,but in non eldcrly patients only 8％ (1/13) of patients eating glutinous rice cake,and there were no cases with surgery histories and diabetes. Gastric bezoars in 48 cases were cleared away by sequential therapy. 1 elderly patient developed intestinal obstruction after surgical operation and died of infectious shock. Conclusions There are some different characteristics between elderly and nonelderly patients with gastric bezoars.Sequential therapy is safe and effective for elderly patients with gastric bezoars.
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Objective To investigate the effects of ketamine on the voltage-gated sodium channels in hippocampal pyramidal neurons, trying to elucidate the possible mechanism of general anesthesia with ketamine.Methods Hippocampal pyramidal neurons were isolated from Wistar rats of 2 weeks old. Whole-cell patch-clamp recordings were made from cultured hippocampal pyramidal neurons before and after the application of ketamine The effect of ketamine on the sodium current amplitude and the kinetics of the channel were studied. Results The sodium channels were reversibly inhibited by ketamine in a dose-dependent manner. IC50 of ketamine was (794?21) ?mol/L.The hyperpolarizing shift of both steady-activation and steady-inactivation was observed.Conclusion Ketamine inhibits the voltage-gated sodium channels to some degree. Sodium channel inhibition may be involved in the mechanism of general anesthesia induced with ketamine.