Pyogenic liver abscess (PLA) is a rare but severe complication of interventional therapy that has been little studied. We aimed to find the risk factors for PLA after transarterial chemoembolization (TACE) or microwave ablation (MWA), further explore its clinical significance and summarize our experience with its treatment. Twenty-two patients with PLA and 118 randomly selected patients without PLA after TACE/MWA were enrolled. Logistic regression was used to analyze risk factors, a nonparametric test was used to compare recovery duration, the log-rank test was used to compare progression-free survival, and Spearman correlation coefficient was calculated between the time from fever to drainage and the total duration of fever. The disease process and treatment were summarized. Sphincter of Oddi manipulation increased the risk of PLA by 70.781-fold. The PLA group took longer to recover (36.56 ± 16.42 days) than the control group (5.54 ± 4.33 days), and had a shorter progression-free survival. Escherichia coli was the major pathogenic bacterium, and multidrug resistance was found in 8 patients with E coli or Enterococcus faecium. The time from fever to drainage was 15.89 ± 13.78 days, which was positively correlated with the total duration of fever (24.29 ± 18.24 days). Overall, 18 patients recovered, and 4 patients died of PLA, for a mortality rate of 18.18%. The fever of 10 patients (45.45%) was controlled by cefoperazone sodium and sulbactam sodium or piperacillin sodium and tazobactam sodium; the fever of 7 patients (31.81%) was controlled by imipenem and cilastatin sodium; and the fever of 3 patients (13.63%) was controlled by tigecycline. Sphincter of Oddi manipulation is a high-risk factor for PLA after TACE or MWA. PLA can accelerate cancer progression and even lead to death. E coli was the major pathogenic bacterium, and multidrug resistance was most common in E coli and E faecium. Timely drainage and appropriate antibiotics are the key primary measures for treating PLA. Cefoperazone sodium and sulbactam sodium or piperacillin sodium and tazobactam sodium is a good choice for the first treatment of PLA, especially before pathogenic bacteria are identified. With the emergence of drug resistance, imipenem and cilastatin sodium, and tigecycline can be used for posterior treatment.

结膜恶性黑色素瘤是一种罕见的眼部恶性肿瘤,患者预后差,常见转移器官有肺、脑、肝、骨等,尚无胃转移的报道.本文报道1例结膜恶性黑色素瘤胃转移的病例(男性,76岁),结膜恶性黑色素瘤术后1.5年,因"乏力、纳差、心悸"就诊,胃镜病理诊断为恶性黑色素瘤.治疗方案:PD-1抑制剂联合化疗;具体用药:替雷利珠单抗200 mg d0+替莫唑胺胶囊240 mg d1～d5 q3w.治疗后评估患者症状明显改善,血红蛋白恢复正常,腹部CT示:胃底部软组织肿块明显缩小,疗效显著,至目前病情稳定,控制时间达17个月以上.本例诊治经验或能为结膜恶性黑色素瘤胃转移这一罕见病例提供一种新的治疗选择.

目的:对可定与海舒严治疗老年冠心病合并高脂血症的疗效及安全性进行对比.方法:分别于2019年5月-2019年10月、2022年7月-2022年12月选取老年冠心病合并高脂血症患者各120例,设为对照组与观察组.对照组给予瑞舒伐他汀钙片(商品名:可定)治疗,观察组给予仿制药瑞舒伐他汀钙片(商品名:海舒严)治疗,比较两组患者的临床疗效、血脂水平及安全性指标.结果:两组的临床疗效无显著性差异(P>0.05).治疗后两组患者的血脂水平指标总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度

目的 探讨局部晚期头颈鳞状细胞癌(head and neck squamous carcinoma,HNSCC)应用程序性细胞死亡蛋白-1(programmed death-1,PD-1)抑制剂诱导免疫治疗联合化疗的近期疗效及安全性.方法 选择2020年5月～2022年5月济宁医学院附属医院肿瘤科初诊不可手术切除的局部晚期HNSCC患者25例,所有患者接受PD-1抑制剂诱导免疫治疗联合化疗3个周期,具体用法:PD-1抑制剂200 mg,每3周为1个周期,化疗方案为铂类联合紫杉类化疗药物(不适合铂类或紫杉类患者调整为氟尿嘧啶、吉西他滨).3个周期诱导化疗后采用实体瘤疗效评价标准(RECIST1.1)评估近期疗效,根据PD-L1表达分层分析每亚组疗效分析,另外对治疗相关不良反应进行分析.结果 25例患者中疗效评价部分缓解(PR)21例(84%),其中肿瘤体积缩小≥50%为15例(60%),客观缓解率(ORR)为84%,疾病控制率(DCR)为88%.16例患者进行了联合阳性分数(combined positive score,CPS)检测评估PD-L1表达情况,CPS≥5占50.0%(8/16),其中CPS≥20占25.0%(4/16),另外9例患者未能行CPS检测而PD-L1表达不明.根据PD-L1表达分层分析来看,5≤CPS＜20和CPS≥20的患者,肿瘤体积缩小均≥50%,ORR为100%,而CPS＜5的所有患者中1例PR肿瘤体积缩小≥50%,PD为2例,ORR为62.5%(5/8).最常见的不良反应为恶心、白细胞减少和贫血.3例患者出现甲功异常,1例肾功能损害,2例肝功能损害,2例肺炎患者.无3～4级不良反应.结论 局部晚期HNSCC,尤其ⅣA/ⅣB期患者,诱导免疫治疗(PD-1抑制剂)联合化疗近期疗效明显,对于CPS≥5的患者疗效更显著,无严重毒副反应发生,有望成为局部晚期头颈部鳞癌新的治疗模式.

INTRODUCTION:Microwave ablation (MWA) is an effective local treatment for malignant liver tumors; however, its efficacy and safety for liver tumors adjacent to important organs are debatable.PATIENTS AND METHODS:Forty-three cases with liver tumors adjacent to important organs were the risk group and 66 cases were the control group. The complications between two groups were compared by chi-square test and t-test. Local tumor recurrence (LTR) was analyzed by log-rank test. Factors affecting complications were analyzed by logistic regression and Spearman analyses. Factors affecting LTR were analyzed by Cox regression analysis. A receiver operating characteristic curve predicted pain treated with drugs and LTR.RESULTS:We found no significant difference in complications and LTR between two groups. The risk group experienced lower ablation energy and more antennas per tumor than control group. Necrosis volume after MWA was positively correlated with pain; necrosis volume and ablation time were positively correlated with recovery duration. Major diameter of tumor >3 cm increased risk of LTR by 3.319-fold, good lipiodol deposition decreased risk of LTR by 73.4%. The area under the curve (AUC) for necrosis volume in predicting pain was 0.74, with a 69.1 cm3 cutoff. AUC for major diameter of tumor in predicting LTR was 0.68, with a 27.02 mm cutoff.CONCLUSION:MWA on liver tumors in at-risk areas is safe and effective, this is largely affected by proper ablation energy, antennas per tumor, and experienced doctors. LTR is primarily determined by major diameter of tumor and lipiodol deposition status.

目的 探讨弥漫大B细胞淋巴瘤(DLBCL)中SENEX基因表达与Rb/E2F1通路的相关性及临床病理意义.方法 选择2016年1月至2019年12月该院首次确诊的84例DLBCL患者作为DLBCL组,选择经病理诊断为淋巴结反应性增生的40例患者作为对照组,检测SENEX、pRb、E2F1的表达水平,分析SENEX、pRb、E2F1与DLBCL病理特征、预后的关系.结果 DLBCL组患者肿瘤组织中SENEX、pRb、E2F1表达水平均高于对照组(P<0.05),且三者之间均呈正相关(P<0.05);肿瘤最大径≥5 cm、有B症状、国际预后指数(IPI)为3～5、Ann Arbor分级为Ⅲ～Ⅳ级的患者肿瘤组织中SENEX、pRb、E2F1表达水平均高于肿瘤最大径<5 cm、无B症状、IPI为0～2、Ann Arbor分级为Ⅰ～Ⅱ级的患者(P<0.05);DLBCL组中SENEX、pRb、E2F1表达水平≥中位数的患者累积生存率均低于SENEX、pRb、E2F1表达水平<中位数的患者(P<0.05).结论 DLBCL中SENEX表达水平增加与疾病进展及预后不良有关,激活下游Rb/E2F1通路是SENEX发挥作用的可能分子机制.

Nasopharyngeal carcinoma (NC) arises from the nasopharynx epithelium and the majority of NC cases globally are within China and Southeast Asia. Both short palate lung and nasal epithelium clone 1 (SPLUNC1) and myelodysplasia syndrome 1-ectopic viral integration site 1 (MDS1-EVI1) play an important role in carcinogenesis and have been found to be associated with nasopharyngeal carcinoma. In spite of their role in NC, the association between these genes and their polymorphisms in the development of NC has thus far not been studied. In the present study, the relationship between SPLUNC1 (rs2752903, T>C) and MDS1-EVI1 (rs6774494, G>A) polymorphisms and their role in the development of NC among the Chinese population were investigated. From a Chinese population of 1,059 patients with NC and 891 controls, genotype frequencies and the distribution of SPLUNC1 and MDS1-EVI1 polymorphisms were analyzed for possible susceptibility to NC. It was observed that those with MDS1-EVI1 CC (OR, 2.76; 95% CI, 1.96-3.81) and MDS1-EVI1 CT (OR, 1.51; 95% CI, 1.22-2.14) polymorphisms had an increased risk of developing NC. Those with SPLUNC1 AA genotypes also observed a higher risk for NC compared with SPLUNC1 GG genotypes (OR, 2.15; 95% CI, 1.62-3.15). When observing the gene-gene interaction between SPLUNC1 and MDS1-EVI1 polymorphisms, it was found that the presence of both SPLUNC1 CC and MDS1-EVI1 AA alleles was associated with a higher risk for NC compared with those who did not carry both alleles (OR, 6.75; 95% CI, 3.41-12.11). The present study suggested that the association between SPLUNC1 (rs2752903, T>C) and MDS1-EVI1 (rs6774494, G>A) polymorphisms may be a potent risk factor in the occurrence of NC.

Objective To explore the clinical efficacy and adverse effects of microwave ablation combined with chemoradiotherapy in the treatment of advanced metastatic non-small cell lung cancer (NSCLC).Methods From January 2013 to January 2015,100 patients with metastatic or recurrent NSCLC treated at Affiliated Hospital of Jining Medical University were selected.Patients were divided into an observation group and a control group according to a random number table.The observation group was treated with microwave ablation combined with chemoradiotherapy and the control group was treated with chemoradiotherapy alone.The clinical efficacy,survival rate,effecacy rate,recurrence rate and adverse effects were evaluated in the two groups after treatment.Results The clinical effecacy rate,disease control rate and survival rate were higher in the observation group than in the control group (P ＜ 0.05).The recurrence rate was lower in the observation group than in the control group (P ＜ 0.05).For the adverse effects,incidence of leukopenia,thrombocytopenia,nausea,vomiting and hair losswas lower in the observation group than in the control group (P ＜ 0.05).Conclusion Microwave ablation combined with chemotherapy for advanced metastatic non-small cell lung cancer shows good clinical efficacy and high security,which deserves clinical expansion.

Objective To explore the meaning of the expression of CXCL12/CXCR4, Topo Ⅱα,&nbsp;NF?κB in tissues of triple negative breast carcinoma ( TNBC) . Methods Fifty?three cases with TNBC were enrolled as TNBC group, and seventy?six cases with non?triple negative breast carcinoma ( N?TNBC ) as N?TNBC group. Immunohistochemical stainings were conducted with resection specimens, and proteins of CXCL12/CXCR4,Topo Ⅱ α, NF?κB were detected. Patients were followed up after surgery to record postoperative recurrence,metastasis and death.The death cases were recorded by censored data,and surviving cases were followed up for 3 years at least. Rates of recurrence and metastasis, mortality, and disease free survival time (DFS) were compared among different groups.Results Less than or equal to 50 years old, lymph node metastasis,invasive ductal carcinoma and Ⅲ stage were TNBC patients′ main features. Positive cells of CXCL12,CXCR4,TopoⅡ α,NF?κB were 66.04%,84.91%,69.81%,79.25% respectively in TNBC group,and were 40.79%,51.32%,40.79%,51.32% in N?TNBC group.Positive cells of CXCL12,CXCR4, Topo Ⅱ α,NF?κB in TNBC group were all higher than those in N?TNBC group ( χ2=7.97,15.51,10.55, 10.43;P <0. 05 ) . Metastasis rate, mortality and DFS were 20. 75%, 28. 30%, ( 24. 35 ± 3. 50 ) months respectively in TNBC group,and were 11.32%,13.16%,(32.02±4.00)months in N?TNBC group.Metastasis rate,mortality in TNBC group were both greater than those in N?TNBC group ( χ2=4.51,4.58;P<0.05) ,yet DFS was less than that in N?TNBC group ( t=5.29, P<0.05).Rates of recurrence and metastasis in positive expression groups of CXCL12, CXCR4, Topo Ⅱ α, NF?κB were 19. 70%, 17. 86%, 19. 12%, 18. 52%, and were 6.35%,4.44%,6.56%,4.17% in negative expression groups,and they were all more significant than those in negative expression groups ( χ2=5.02,4.61,4.43,5.43;P<0.05).Mortality was 27.27%,25.00%, 26.47%,24. 69% in positive expression groups, and was 11. 11%, 8. 89%, 11. 48%, 10. 42% in negative expression groups, and they were all bigger than those in negative expression groups ( χ2=5.39,4.87,4.63, 3.93;P<0.05).DFS were (23.17±3.30)months, (24.50±3.21)months,(23.51±3.65)months,(25.36± 3.65)months in positive expression groups, and were(32.25±3.55)months,(33.00±4.15)months,(35.00± 5.10)months,(31.86±4.57)months in negative groups,and the differences between the two groups were statistically significant (t =5.37,5.80,6.21,5.08;P<0.05).Conclusion There are high expression of CXCL12,CXCR4, TopoⅡα,NF?κB in tissue of TNBC,with early recurrence and metastasis and poor prognosis,and it may be related with increasing tumor cells′invasive ability and mediating specific metastasis of lymph node.

Objective To explore the opportunity choice of therapeutic effects of Kangfuxing Fluid spray inhalation in the radiotherapy of nasopharyngeal carcinoma related mucous membrane of mouth. Methods Clinical data of 60 cases of nasopharyngeal carcinoma received radiotherapy and Kangfuxing Fluid spray inha-lation,from May 2009 to May 2012,were collected and analysed retrospectively. Among which,23 case were re-ceived Kangfuxing Fluid spray inhalation at the beginning of radiotherapy,19 case received at the 10th of radio-therapy,18 case at the 15th. Application method of Kangfuxing Fluid spray inhalation: 10 ml one time,3 times a day. Results Therapeutic effects of Kangfuxing Fluid spray inhalation of the case received Kangfuxing Fluid spray inhalation at the beginning and the 10th were significantly better than the case at the 15th,but the case re-ceived Kangfuxing Fluid spray inhalation at the beginning and the 10th have not statistically significant differ-ence. Conculsion The best opportunity choice of therapeutic effects of Kangfuxing Fluid spray inhalation is at the 10th of nasopharyngeal carcinoma radiotherapy.

Objective To investigate the efficacy and toxicity of thalidomide plus irinotecan and cisplatin treatment for recurrent small cell lung cancer.Methods 62 Patients with recurrent small cell lung cancer in the same period were randomly divided into observation group and control group according to the principle of minimum distribution imbalance index.The observation group patients were treated with thalidomide plus irinotecan and cisplatin chemotherapy,and the control group patients were treated with irinotecan and cisplatin chemotherapy.The efficacy and toxicity of the two groups were compared.Results The overall response rate in the group observation was 86.7％ compared with 63.3％ in the control group,and the difference had statistical significance (x2 =8.52,P ＜ 0.05).The major toxicities were hematologic toxicity and gastrointestinal symptoms,and the side effects differences were not statistically significant (x2 =0.18,P ＞ 0.05).Conclusion The treatment of recurrent small cell lung cancer with irinotecan and cisplatin in combination with thalidomide has high efficiency,and the toxicity can be tolerated.