目的 分析甲状腺切除术后病人血清钙、甲状旁腺激素(parathyroid hormone,PTH)及中央区引流液PTH水平的变化特点,探讨监测上述指标对甲状腺术后评估甲状旁腺功能的临床意义.方法 2018年1月～2021年1月就诊于我院普外科行甲状腺切除、中央区淋巴结清扫术病人112例,根据术中甲状旁腺原位保留0枚、1枚、2枚,分为A0、A 1、A2组,测定病人术前及术后1～4天血钙、血PTH、中央区引流液PTH水平.结果 112例病人发生低钙血症23例,其中A0组15例、A 1组6例、A2组2例.各组血钙较术前均显著下降,A0组下降最明显,且在术后1～4天无明显升高趋势,而A1、A2组呈逐渐升高趋势,A2组升高更快;各组血PTH较术前均显著下降,A0组下降最明显,且在术后1～4天无明显升高趋势,A1、A2组血清PTH水平呈上升趋势,但术后4天内,上述两组血PTH均未上升至术前水平.各组引流液PTH水平差异显著,A2组均值最高,A1组次之,A0组最低;随着时间的推移,A0组无明显变化,A1、A2组病人引流液PTH水平总体呈下降趋势,A1组较A2组下降更快.结论 甲状腺术后监测血钙、血PTH、引流液PTH可有效地评估原位保留甲状旁腺功能恢复情况,而中央区引流液PTH可直接反映原位保留甲状旁腺的活性,术后引流液维持在一个高水平是原位保留的甲状旁腺存活的直接证据.
Objective To explore the efficacy of lapatinib combined with trastuzumab in the treatment of patients with human epidermal growth factor receptor-2(HER2)-positive breast cancer and its effects on survival prognosis.Methods 86 patients with HER2-positive breast cancer who were treated with neoadjuvant chemotherapy from April 2016 to June 2018 were selected as the research subjects,and they were divided into observation group(lapatinib combined with trastuzumab treatment)and control group(trastuzumab treatment)by means of the random number table method,with 43 cases in each group.The therapeutic efficacy of the two groups was compared,and the changes in levels of vascular endothelial growth factor,inflammatory factors and apoptotic factors were recorded before and after treatment.All patients were followed up for 3 years or until their death,and the cumulative survival rate was compared between the two groups,and the occurrence of adverse events during treatment were counted.Results There were no significant differences in objective response rate(ORR)and disease control rate(DCR)between observation group and control group(72.09％vs 58.14％,86.07％vs 74.42％,P＞0.05).After treatment,the levels of vascular endothelial growth factor A(VEGFA),vascular endothelial growth factor B(VEGFB),vascular endothelial growth factor C(VEGFC),tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1 β),interleukin-6(IL-6)and interleukin-8(IL-8)in observation group were lower than those in control group,and the expression levels of decoy receptor 3(DcR3)and cyclooxygenase-2(COX-2)after treatment were also lower than those in control group(P＜0.05).The 3-year survival rates in observation group and control group were 46.51％(20/43)and 30.23％(13/43),and the median survival times were 34.5 months and 26.7 months(P＞0.05).There were no significant differences between the two groups in terms of incidence rates of adverse events(P＞0.05).Conclusion Lapatinib combined with trastuzumab in the treatment of patients with HER2-positive breast cancer can reduce the levels of vascular endothelial factors and inflammatory factors and inhibit the releases of apoptotic factors,but has little effect on the 3-year survival rate of patients.
病人,女,68岁.因二尖瓣置换术后6年余,心慌、气紧伴乏力1周于2021年5月21日入院.心脏彩超检查提示左房增大、二尖瓣位生物瓣、瓣架稳定,靠左前侧瓣上探及大小约6 mm ×7 mm的强回声团附着,随瓣叶开闭来回甩动;人工二尖瓣瓣口大量反流,肺动脉压力71 mmHg,考虑为人工生物瓣膜置换术后感染性心内膜炎(图1A).入院后予强心、利尿、控制心率、控制感染等对症支持治疗后转入心脏外科拟行手术治疗.
Objective To investigate the clinical efficacy of bone filling mesh bag combined with pedicle anchoring for the treatment of Stage Ⅲ reducible Kummell disease.Method The 35 paients with Stage Ⅲ reducible Kummell disease were treated with bone filling mesh bag combined with pedicle anchoring from January 2018 to December 2022.The operation Time,intraoperative blood lose,bone cement injection volume and surgical complications were recorded.The VAS score,ODI value,kyphosis Cobb angle and midline height of the injured vertebral were compared at preoperative,postoperative 1 day and last follow-up.Results All patients were followed up for 12-24 months[(15±3.5)months].Operation time was 35-63 min[(45±5.8)min],intraoperative blood loss was 10-35 ml[(20±5)ml],bone cement injection volume was 4.5-7.8 ml[(5.5±1.8)ml].There were 4 cases of bone cement leakage,there were 1 case of intervertebral leakage,2 cases of lateral leakage,1 case of anterior leakage and no patient with intracanal leakage.All bone cement leakage did not lead to clinical symptoms,bone cement poisoning and pulmonary embolism.No cement mass slip.All patients were followed up for 12 to 24 months[(15±3.5)months].VAS scores and Oswestry Disability Index(ODI)values were significantly lower on the first day after surgery than before surgery,with statistical significance(P＜0.05).The 3-month follow-up was slightly higher than that on the first day after surgery,and the difference was not statistically significant(P＞0.05).The midline height and Cobb Angle of the injured vertebra were measured by imaging.The height of the injured vertebra recovered significantly on the first day after operation,and the Cobb Angle decreased significantly,the difference was statistically significant(P＜0.05).The midline height of the injured vertebrae decreased and the Cobb Angle increased slightly at 3 months after the operation,but the difference was not statistically significant(P＞0.05).Conclusion In the the treatment of Stage Ⅲ reducible Kummell disease,Bone filling mesh bag combined with Pedicle anchoring have good clinical efficacy,which can significantly reduce the pain of patients,relieve clinical symptoms,improve spinal function,improve quality of life,and reduce the incidence of bone cement leakage and slippage.
Objective To explore the clinical value of microsatellite instability(MSI)combined with tumor mutation load(TMB)in evaluating postoperative recurrence and metastasis in patients with non-small cell lung cancer(NSCLC).Methods A retrospective selection was performed on the 80 patients with NSCLC undergoing radical surgery in the hospital between March 2020 and March 2021.All underwent maintenance therapy after surgery.According to presence or absence of recurrence and metastasis at 1 year after surgery,they were divided into recurrence-metastasis group(47 cases)and non-recurrence-metastasis group(33 cases).The clinical data in both groups were collected.MSI and TMB detection of pathological tissues were conducted.The value of MSI and TMB in predicting recurrenceand metastasis of NSCLC patients after surgery was analyzed and compared.Results The univariate Logistic regression analysis showed that the recurrence and metastasis of lung cancer after radical resection were related to smoking history,high tumor staging,medium and low differentiation,lymph node metastasis,MSI negative,and high TMB(P＜0.05).The results of multivariate Logistic regression analysis showed that lymph node metastasis and high TMB were independent risk factors of postoperative recurrence and metastasis(P＜0.05),while positive MSI was a protective factor(P＜0.05).Both MSI and TMB were of evaluation value for postoperative recurrence and metastasis(P＜0.05).There was no significant difference in AUC between MSI and TMB(P＞0.05).There were significant differences in AUC between combined detection and MSI(P＞0.05),but there was no significant difference between combined detection and TMB(P＜0.05).Conclusion Both MSI and TMB have evaluation value for postoperative recurrence and metastasis.There are differences between combined detection and MSI,but there is no significant difference between combined detection and TMB,which indicates that single TMB has good detection value.
