Expression of Ki-67 and P16 proteins in cervical cancer and precancerous lesions of young women and the diagnostic value for cervical cancer and precancerous lesions were investigated. A total of 64 paraffin-embedded specimens of uterus tissue from young female patients who were admitted to Jiading District Central Hospital Affiliated to Shanghai University of Medicine and Health Sciences from January 2015 to December 2017 were selected. According to pathological examination, the specimens were divided into chronic cervicitis group (control group, 10 cases), low-grade squamous intraepithelial lesion (LSIL) group (12 cases), high-grade squamous intraepithelial lesion (HSIL) group (20 cases) and squamous carcinoma of the cervix (SCC) group (22 cases). Expression of Ki-67 and P16 protein was detected by immunohistochemistry and the diagnostic values were analyzed. Positive rates of Ki-67 and P16 expression in HSIL and SCC groups were significantly higher than those in LSIL and control groups (P<0.05), but there was no significant difference between LSIL and control groups (P>0.05). Spearman's analysis showed that the expression levels of Ki-67 and P16 were positively correlated with the degree of cervical lesions (rs=0.725; rs=0.829), and their expression levels were also positively correlated (rs=0.772). Sensitivity and specificity analysis showed that the Ki-67 diagnosis has higher sensitivity (95.2%), but the specificity is poor (86.7%). Diagnosis using P16 has high specificity (94.6%), but the sensitivity is poor (85.4%). When the two were combined for diagnosis, sensitivity (94.8%) and specificity (93.2%) were both at a high level. The combined detection of Ki-67 and P16 protein has a high application prospect as an auxiliary diagnosis of SCC.

Objective To investigate the clinical prognostic value of peripheral blood albumin and fibrinogen levels in advanced non-small cell lung cancer (NSCLC). Methods A total of 158 patients with advanced NSCLC who were admitted to Chest Hospital District of the Affiliated Brain Hospital of Nanjing Medical University from May 2010 to September 2015 were retrospectively analyzed. All patients received systemic chemotherapy plus or not local radiotherapy. The clinicopathological characteristics of patients and the results of peripheral serum protein and fibrinogen were collected, and the correlation between peripheral serum protein and fibrinogen levels and prognosis was analyzed. Results The median level of serum albumin and plasma fibrinogen was 40.8 g/L (27.6-46.9 g/L) and 3.4 g (2.4-5.2 g/L), respectively, and the median serum albumin and fibrinogen ratio (AFR) was 12.1 (6.2-17.0). The median overall survival (OS) time in the increased serum albumin group (≥40 g/L) and the decreased serum albumin group (<40 g/L) was 17.0 and 9.0 months, respectively, and the median OS time in the increased plasma fibrinogen group (≥40 g/L) and the decreased plasma fibrinogen group (<40 g/L) was 9.0 and 17.0 months, respectively. The median OS time in the increased AFR group (≥10) and decreased AFR group (<10) was 17.0 and 8.0 months, respectively, and there were significant differences between two groups (all P < 0.01). Multivariate analysis showed that serum albumin level (HR = 1.58, 95% CI 1.20-2.06, P = 0.003), plasma fibrinogen level (HR = 1.43, 95% CI 1.01-2.03, P = 0.046) and AFR (HR = 1.81, 95% CI 1.22-2.62, P = 0.001) were independent prognostic factors of OS. Conclusions In patients with advanced NSCLC, higher albumin level and/or lower fibrinogen level are associated with better clinical prognosis. Peripheral serum albumin, fibrinogen level and AFR are independent prognostic factors for advanced NSCLC. Key words: Cacinoma, non-small cell lung; Albumin; Fibrinogen; Prognosis

目的 探讨P16、Ki67在不同宫颈鳞状上皮内病变中的表达,分析其对LSIL转归的预测价值.方法 将160例宫颈病变患者根据阴道镜活检结果分组,采用免疫组化SP法检测P16、Ki67的表达水平.同时对LSIL组随访2年,观察其转归,分析P16、Ki67在不同LSIL转归组中的表达.结果 P16蛋白在对照组、LSIL组、HSIL组及宫颈癌组中的阳性表达率分别为3.3％、39.3％、65.6％、100.0％,Ki67在对照组、LSIL组、HSIL组及宫颈癌组中的阳性表达率分别为10.0％、50.6％、62.3％、100.0％,P16和Ki67的阳性表达率随宫颈病变程度加重而逐渐升高,差异均有统计学意义(P<0.05).LSIL组共89例,随访2年后,其中病变进展组9例,病变持续组43例,病变消退组37例.病变进展组P16阳性表达率(77.8％)高于病变持续组(32.6％)和病变消退组(37.8％),病变进展组Ki67阳性表达率(88.9％)高于病变持续组(55.8％)和病变消退组(35.1％),差异均有统计学意义(P<0.05).LSIL组中P16和Ki67的表达呈显著正相关(r=0.612,P<0.05).结论 P16、Ki67的检测对宫颈病变有重要的辅助诊断价值,且可作为LSIL转归结局的预警提示,对LSIL的分流管理具有指导意义.

Objective To analyze the positive expression levels of p16 ( p16ink4a), cell cycle factor geminin and Ki-67 in low-grade squamous intraepithelial lesions ( LSIL),and to further explore the ability of these indicators to evaluate the progression of LSIL patients. Methods From January 2015 to June 2018,276 cervical specimens from Jiading District Central Hospital of Shanghai were retrospectively studied, and 148 LSIL patients were selected. According to the results of the second examination,LSIL patients were divided into three groups: (1) no lesion (natural regression) group 90 cases; (2) LSIL persistent group 38 cases; (3) high-grade Squamous Intraepithelial Lesion (HSIL) group 20 cases. Immunohistochemistry was performed on the first biopsy tissues and the relative positive ratios of p16, geminin and Ki-67 were calculated. Spearman correlation analysis identified the correlation between the above indicators and the progress of the disease; ROC curve was used to calculate the best diagnostic value of each indicator,and multivariate logistic regression analysis was included to explore the ability of the above indicators to assess the risk of patients progressing to HSIL. Results In the HSIL group, p16 ( 51. 26 ± 17. 15)%, geminin relative positive ratio ( 45. 92 ± 15. 70)% was higher than those in the LSIL group(( 43. 71 ± 11. 84)%, (21. 68± 14. 47)%) and regression group (( 17. 92 ± 9. 60)%, ( 0. 16 ± 0. 03)%) . The difference were statistically significant ( F＝2. 922, 2. 751, all P＜0. 05) . Spearman correlation analysis showed that the relative positive ratio of p16 ( r＝0. 27,P＝0. 014) and geminin ( r＝0. 44,P＜0. 001) presented a notable positive correlation with the progression of the disease. Under the ROC curve,the best diagnostic values of p16, geminin and Ki-67 were 38. 9%, 32. 5% and 18. 6%, respectively. Multivariate logistic regression analysis showed that the relative positive ratio of p16 was higher than 38. 9%(OR＝4. 366,P＝0. 006),and geminin was higher than 32. 5%( OR ＝ 5. 392, P ＝ 0. 011 ) had a higher risk of progression to HSIL. Conclusion p16 and geminin may be effective biomarkers for identifying patients with advanced LSIL.

Objective To detect the expressions of 7 kinds of β-tubulin isotypes in patients with non small cell lung cancer ( NSCLC) and the correlation with taxane sensitivity. Methods 55 tumor tissue specimens were collected from patients with chemo-naive and unoperable metastatic or recurrent NSCLC, who accepted regimen of platinum plus taxane in first line therapy. The efficacy was assessed after two cycle therapy. 55 patients were divided into three groups according to their efficacy. Patients with CR or PR were classed as the taxane sensitive group, and patients with SD were the taxane less sensitive group, and patients with PD were the taxane resistance group. The ex-pressions of mRNA of 7β-tubulin isotypes in tumor tissues were detected by RT-RCR. The expression ofβⅢ-tubulin protein was detected by IHC. The expressions of 7 β-tubulin isotypes and its correlation with taxane sensitivity were anlyzed. Results The expression of mRNA of 7 β-tubulin isotypes were all detected in 55 patients with NSCLC. ΒⅡ-tubulin and βⅣ-tubulin were the highest ones. The expression of mRNA of βⅢ-tubulin in the taxane sensitive group and the taxane less sensitive group were both lower than that in the taxane resistance group (P<0. 05). How-ever, there was no difference in the other 6 β-tubulin isotypes (P>0. 05). The expressions of β Ⅲ-tubulin in the taxane sensitive group and the taxane less sensitive group were 16. 67% (3/18) and 20. 00% (4/20) respectively, which were lower than that in the taxane resistance group (52. 94%, 9/17, P<0. 05). Conclusion The mRNA expressions of 7 β-tubulin isotypes can be all detected in tumor tissue of NSCLC, in which the expressions of mRNA and protein of βⅢ-tubulin show a correlation with taxane sensitivity. The high expression of βⅢ-tubulin shows cer-tain resistance to taxanes.

Objective To investigate the value of basic fibroblast growth factor ( bFGF) on clinical stage, treatment response and prognosis of patients with NSCLC. Methods The level of serum bFGF was determined in 66 advanced NSCLC patients and 15 healthy controls by ELISA. Correlation between bFGF expression and clinical data was analyzed. Results The expression of bFGF was significantly higher in NSCLC patients than the control group (3. 2 vs 20. 1 pg/ml, P<0. 001), and it decreased gradually after the treatment (20. 1 vs 10. 6 pg/ml, P<0. 05). The elevated expression of bFGF >20 pg/ml at baseline was associated with a negative prognosis and shorter progres-sion-free survival (PFS) (5. 6 mon vs 9. 6 mon, P<0. 001). Conclusion There is significant correlation between bFGF expression and disease development, clinical stage and survival, which can be a potential biomarker for predic-ting angiogenesis and prognosis.

BACKGROUND AND OBJECTIVE:Gefitinib and Pemetrexed are drugs used as second-line therapy for advanced non-small cell lung cancer (NSCLC), although studies comparing the two drugs are limited. The aim of this study is to explore the effects, safety, and quality of life (QoL) of Gefitinib and Pemetrexed on patients with advanced non-squamous NSCLC.METHODS:Forty-six advanced non-squamous NSCLC patients who failed to first-line therapy were randomly divided into two groups with 23 patients each, one using oral Gefitinib (Gefitinib group) and the other using intravenous injection Pemetrexed (Pemetrexed group). The effects, safety, and QoL were determined and analyzed.RESULTS:For the Pemetrexed group, objective response rate (ORR) was 13.0% (3/23), disease control rate (DCR) was 30.4% (7/23), and median progression-free survival (mPFS) was 3.1 months. In the Gefitinib group, ORR was 17.3% (4/23), DCR was 39.1% (9/23), and mPFS was 4.4 months. Compared with the Pemetrexed group, the ORR, DCR, and mPFS in the Gefitinib group exhibited no statistical significance (P>0.05). Furthermore, the most common toxicities in the Pemetrexed group were neutropenia (n=9, 39.13%) and fatigue (n=8, 34.78%), whereas those in the in Gefitinib group were skin rash (n=8, 34.78%) and diarrhea (n=4, 17.39%). Compared with baseline, the QoL improved in both groups but to different degrees. Likewise, emotional, functional well-being, and QoL aspects specifically related to lung cancer were better improved in the Gefitinib group than in the Pemetrexed group (P<0.05).CONCLUSIONS:The effects of Pemetrexed and Gefitinib as second line therapy were similar, although with different AEs. Both drugs could improve the QoL, but Gefitinib showed better overall results than Pemetrexed.

目的探讨口服吉非替尼联合胸腔内注入力尔凡治疗晚期胸膜转移的肺腺癌的疗效和安全性。方法 48例晚期胸膜转移的肺腺癌患者,随机分为实验组(24例)和对照组(24例),实验组采取胸腔引流胸水后注入力尔凡400 mg,一周两次,给药后三天开始口服吉非替尼250 mg/d,直到病灶进展或其他原因停药;对照组待胸水引流后口服吉非替尼治疗,不予胸腔内注药。每个月复查CT及胸部B超。结果实验组胸水控制有效率为75%(18/24),肿瘤病灶治疗有效率为50%(12/24),3个月疾病控制率79.2%(19/24),临床受益反应为87.5%(21/24);对照组胸水控制有效率为33.3%(8/24),肿瘤病灶有效率为45%(9/24),3个月疾病控制率为66.7%(16/24),临床收益反应为66.7%(16/24)。两组胸水控制率、临床收益反应相比差异有统计学意义(P<0.05)。主要不良反应是轻度腹泻反应及Ⅰ、Ⅱ度皮肤毒性。结论吉非替尼口服联合胸腔内注入力尔凡治疗晚期胸膜转移的肺腺癌有较好的疗效和安全性。

Objective To observe the efficacy and adverse effect of pemetrexed single or plus carboplatin as second-line therapy in the treatment of elderly patients with advanced lung adenocarcinoma.Methods The clinical data of 56 patients with advanced lung adenocarcinoma were analyzed,27 patients recived the pemetrexed monotherapy,29 patients recived the pemetrexed plus carboplatin,and the efficacy and adverse effects were assessed.Results There were no case with CR in 56 patients.In pemetrexed monotherapy,there was 2 cases of PR,14 cases of SD,11 cases of PD,the DCR was 59.3%,median PFS was 3.5 months,and median OS was 9.1 months.;in combination group,there was 3 case of PR,16 case of SD,10 case of PD,the DCR was 65.5%,median PFS was 3.9 months,and median OS was 9.8 months.There were no significant differences in DCR,median PFS and median OS between two groups(P0.05).The common adverse effects were myelosuppression,gastrointestinal reactions and rashes.Conclusion Pemetrexed is efficacious and tolerable as a second-line therapy for elderly patients with advanced lung adenocarcinoma.

Objective To observe the clinical efficacy of treating senile patients with lung cancer-induced pleural effusion using intrathoracic injection of cisplatin and lentinan.Methods A total of 120 senile patients with malignant pleural effusion caused by lung cancer was equally randomized into three groups of A(treated with cisplatin),B(treated with lentinan) and C(treated with both cisplatin and lentinan).Intrathoracic administration was performed soon after drainage of pleural effusion.The curative effec was evaluated.Results The total effectiveness rate in group C was 77.5%,which was significantly higher than 55.0% in group A and 52.5% in group B(P0.05).Conclusion Compared to cisplatin or lentinan alone,combined intrathoracic administration of cisplatin and lentinan has better efficacy in the treatment of senile patients with lung cancer-induced pleural effusion with little adverse reactions.

目的探讨CT引导下经皮肺穿刺活检并发症的观察与护理。方法分析367例CT引导下经皮肺穿刺临床资料。结果 367例行穿刺术患者中,发生气胸88例(单纯性气胸83例;张力性气胸1例;交通性气胸4例),占23%;肺内出血102例,占28%,无大咯血的发生,无纵隔气肿的发生。结论 CT引导下经皮肺穿刺活检是一种准确度高,安全有效的获得组织学的好方法,严密观察病情变化和采取必要的护理措施是防治并发症的重要手段之一。

Objective To study the clinical significance of serum carcinoembryonic antigen(CEA) and cytokeratin 19 fragment(CYFRA21-1) on chemotherapy effect and prognosis in patients with non-small cell lung cancer.Methods 120 cases of NSCLC patients received 2 cycles of platinum-based combined chemotherapy.The measures were detected on the change of serum CEA and CYFRA21-1 expression level,and the evaluation of objective response(OR) by radiological examination.The role of CEA and CYFRA21-1 decline rates were evaluated in predicting chemotherapy effect by application of receiver operating characteristics(ROC) curves.Results The radiology OR rate was 36.4% after 2 cycles of the chemotherapy.The best cutoff points of CEA and CYFRA21-1 in predicting efficiency were 19.8% and 35.5%,respectively.There was significant correlation between the decline rates of serum CEA and CYFRA21-1 and radiology OR.(P0.05).Conclusion The decline rate of srum CEA and CYFRA21-1 is a confidence index to reflect chemotherapy response in patients with NSCLC.

Objective To observe the clinical effect of cisplatine and lentinan intrathoracic injection in senile patients with malignant pleural effusion.Methods 68 senile patients with malignant pleural effusion were randomly divided into two group.After drainage of pleural effusion,cisplatin and lentinan were intrathoracic injected in the therapeutic group,but cisplatin was given separately in the control group.Pleural effusion was detected weekly and the efficacy and side effects were evaluated weekly.Results The total response rate in the therapeutic treament group achieved 73.5%,but only 52.9 %in the control group,there was significantly difference between two groups(P0.05).The adverse effects,such as fever,nausea,vomiting and leucopenia,occurred in both groups,but no significant diffevence in two groups.Conclusion Thoracic tube installation with intrathoracic injection of cisplatin and lentinan for treatment of malignant pleural effusion is safe and effective.

Purpose To investigate the effect and mechanism of norcantharidin(NCTD) on invasion of human breast cancer cell line MCF-7 in vitro.Methods MTT assay was used to determine MCF-7 cell proliferation,Transwell kit was used to determine cell migration,treated with NCTD on 200,400,600 μmol/L,to detect the expression of CXCR4 and CXCL12 in the control and treatment groups by real time PCR and Western blot.Results NCTD had inhibitive effects on proliferation and invasion of human breast cancer cell line MCF-7 in a dose-dependent manner,with the IC50 value of 582 μmol/L at 24 h,and the expression of CXCR4 was decreased in NCTD groups in vitro.Conclusion NCTD in vitro inhibits invasion and metastasis of human beast cancer cell line MCF-7 through the down regulation to the expression of CXCR4.

Purpose To investigate the effects of thalidomide on proliferation in vitro of human non small-cell lung cancer A549 cells,and to detect the effects on the expressions of VEGF and VEGF-C of A549 cells.Methods Culture the A549 cells in vitro and divide into two groups:control group and thalidomide group which used different mass concentrations(5,10,20,40,60 mg/L) thalidomide interfere for 24 h in the A549 cells.The cell growth inhibition was assessed by MTT-microculture tetrazolium,the expression of VEGF and VEGF-C mRNA and protein level were detected respectively by RT-PCR and Western-blot.Results Thalidomide can inhibit the growth of A549 cells in vitro in dose-dependent manner(P0.05).After different mass concentrations of thalidomide interfere for 24 h in the A549 cells,the mRNA and protein level expressions of VEGF and VEGF-C all decreased(P0.05).Conclusion Thalidomide can inhibit the growth of A549 cells in vitro in dose-dependent manner,mechanism of which might relate to the suppression of the expressions of VEGF and VEGF-C.

Objective To evaluate the function of the CT-guided percutaneous lung puncture in the qualitative diagnosis of peripheral pulmonary lesions.Methods To diagnosis the causes and treatment of complications based on the review and analysis of 367 cases of CT-guided percutaneous lung puncture clinical data.Results There were 172 cases with benign lesions in 367 patients(155 cases with pneumonia,17 cases with tuberculosis),and there were 186 cases with malignant lesions(86 cases with squamous cell carcinoma,71 cases with adenocarcinoma,11 cases with small cell carcinoma,15 cases with low-undifferentiated carcinoma,2 cases with large cell carcinoma,1 case with metastatic carcinoma),heterogeneous cells in 9 cases.Conclusion CT-guided percutaneous lung puncture is an accurate,safe and effective access to the histological diagnosis.

Objective:To evaluate the efficacy of DSA(digital subtraction angiograph) bronchial arterial embolizat in treatment of massive hemoptysis.Methods:Reviewed the data of 114 patients with massive hernoptysis treated by this technique,Results:After one year,only 8 patients' hemoptysis was recurrent.Conclusion:DSA bronchial arteral embolization is a safe and efficacious method in massive hemoptysis.

自20世纪90年代以来,全球结核病疫情回升.在造成全球结核病疫情升高的诸多因素中,耐多药结核病是主要原因之一.近年来据WHO估算,全球每年耐药结核病发病人数约30万至60万,实际耐多药肺结核患者数可能接近或超过100万[1],而中国的耐多药肺结核患者数占全球的1、4～1、3.遗憾的是目前全球对耐多药肺结核的发生的分子机制尚不清楚,缺乏快速的结核分枝杆菌耐药检测方法和治疗手段,使耐多药肺结核的不断产生和流行,成为当今全球亟待解决的难题之一.自从喹诺酮类药物应用于治疗肺结核后,给耐多药结核的治疗带来了新的希望.随着喹诺酮类药物在临床上的广泛应用,喹诺酮类药物的耐药情况日趋严重.现就我院近年来对结核杆菌培养后有左氧氟沙星耐药情况的菌株进行回顾性分析并将结果报告如下.

Objective To observe the toxic reaction of gefitinib to advanced non-small cell lung cancer after failed chemotherapy.Methods 41 cases with non-small cell lung cancer having experienced failure of chemotherapy orally took gefitinib 250 mg once per day until disease gets serious or they had intolerable adverse reaction,meanwhile efficacy and adverse drug reactions were evaluated.Results Of the 41 patients,the occurrence rate of skin rash was 60.98%,diarrhea was 26.83%,and one case caught serious interstitial lung disease.Conclusion The efficacy of gefitinib is very good in treating advanced non-small cell lung cancer,but there are such side effects as skin rash,diarrhea,liver and kidney impairment,pulmonary interstitial fibrosis and so on.

Objective To explore clinical effectiveness of macrolide antibiotics treatment in adult bronchial asthma.Methods Randomized 52 adult bronchial asthma patients into treatment group(conventional therapy plus macrolide antibiotics) and control group(conventional therapy plus penicillins antibiotics), then evaluated clinical effectiveness according to levels of asthma control.Results Both of two groups can improve the asthma patients lung function and clinical symptoms, but the treatment group had the better effectiveness than control group.Conclusion Macrolide antibiotics may become potential drug in treatment of adult bronchial asthma.