目的 观察阿帕替尼联合吉西他滨治疗晚期肺癌的临床疗效及安全性.方法 选择2018年1月—2020年12月湖北省黄冈市中心医院收治的晚期肺癌患者100例,利用随机数字表法分为观察组和对照组,各50例.观察组患者采用阿帕替尼联合吉西他滨治疗,对照组患者采用吉西他滨治疗,21 d为1个治疗周期,连续治疗4个周期.比较2组患者临床疗效、治疗前后血清肿瘤标志物(癌胚抗原、糖类抗原、细胞角蛋白片段19)水平、生活质量评分及不良反应.结果 观察组患者治疗总有效率为96.00％,高于对照组的78.00％(χ2=7.161,P=0.007);治疗后,2组患者癌胚抗原、糖类抗原、细胞角蛋白片段19水平均低于治疗前,各项生活质量评分均高于治疗前,且观察组降低/升高幅度大于对照组(P<0.01);观察组患者不良反应总发生率为2.00％,低于对照组的40.00％(χ2=21.760,P<0.001).结论 阿帕替尼联合吉西他滨治疗晚期肺癌的疗效较好,可提高患者的生活质量,且不良反应发生率低,值得临床推广与应用.

目的 评价快速康复外科(FTS)护理在食管癌围术期中的应用效果.方法 采用计算机检索Co-chrane图书馆 、中国知网 、维普 、万方 、Pubmed数据库资源系统中关于食管癌患者在围术期应用FTS护理模式的随机对照试验(RCT)和临床对照试验(CCT),对纳入的研究进行质量评价,并提取有效数据,采用RevMan5.3软件进行Meta分析.结果 共纳入16篇研究(1篇RCT,15篇CCT),共计1969例患者.研究结果显示,FTS护理组与常规护理组在缩短患者住院时间 、降低患者住院费用 、缩短患者术后首次排气时间上比较,差异有统计学意义(MD=-2.48,95％CI:-3.00～-2.68,P<0.05;MD=-0.38,95％CI:-0.42～-0.35,P<0.05;MD=-0.26,95％CI:-0.28～-0.24,P<0.05).结论 FTS护理模式可缩短食管癌围术期患者的住院时间 、住院费用及术后首次排气时间,并减少术后并发症.

目的 探讨尼美舒利联合奥沙利铂对人胃癌移植瘤裸鼠肿瘤生长及淋巴转移的影响.方法 取裸鼠40只,将人胃癌SGC-7901细胞株移植于裸鼠胃壁,建立人胃癌移植瘤裸鼠模型,建模成功后随机将裸鼠分为对照组(0.9％氯化钠溶液灌胃)、尼美舒利组(尼美舒利20 mg·kg-1·d-1灌胃)、奥沙利铂组(奥沙利铂10 mg/kg灌胃,每3天1次)、联合组(尼美舒利+奥沙利铂),每组10只,给药30 d后处死裸鼠,测定瘤体积及瘤重量,计算抑瘤率,并采用免疫组化法、实时荧光定量聚合酶链反应法(RT-PCR)测定人胃癌裸鼠移植瘤组织环氧化酶-2(COX-2)、血管内皮生长因子受体3(VEGFR-3)、血管内皮生长因子C(VEGF-C)、生存素(survivin)、β-连环素(β-catenin)蛋白及mRNA表达水平,采用酶联免疫吸附法(ELISA)测定血清肿瘤标志物癌胚抗原(CEA)、细胞角蛋白19可溶性片段抗原(CYFRA21-1)、鳞状细胞癌抗原(SCCAg)水平.结果 与对照组比较,尼美舒利组、奥沙利铂组和联合组裸鼠瘤体积缩小,瘤重量减轻(P<0.05),奥沙利铂组和联合组裸鼠瘤体积、瘤重量低于尼美舒利组,抑瘤率高于尼美舒利组(P<0.05),联合组裸鼠瘤体积、瘤质量低于奥沙利铂组,抑瘤率高于奥沙利铂组(P<0.05);与对照组比较,尼美舒利组、联合组裸鼠肿瘤组织COX-2、VEGF-C、VEGFR-3、Survivin、β-catenin染色阳性率均降低,奥沙利铂组COX-2、VEGF-C、VEGFR-3、Survivin、β-catenin染色阳性率高于尼美舒利组(P<0.05),联合组COX-2、VEGF-C、VEGFR-3、Survivin、β-catenin阳性率低于奥沙利铂组、尼美舒利组(P<0.05);与对照组比较,尼美舒利组、联合组COX-2、VEGF-C、VEGFR-3、Survivin、β-catenin mRNA降低,奥沙利铂组COX-2、VEGF-C、VEGFR-3mRNA上升,Survivin、β-catenin mRNA降低(P<0.05),尼美舒利组、联合组COX-2、VEGF-C、VEGFR-3、Survivin、β-catenin mRNA低于奥沙利铂组(P<0.05),联合组COX-2、VEGF-C、VEGFR-3 mRNA高于尼美舒利组(P<0.05),Survivin mRNA表达低于尼美舒利组(P<0.05);与对照组比较,尼美舒利组、奥沙利铂组、联合组裸鼠CEA、CYFRA21-1、SCCAg降低(P<0.05),奥沙利铂组、联合组裸鼠上述指标低于尼美舒利组,联合组上述指标又低于奥沙利铂组(P<0.05).结论 尼美舒利联合奥沙利铂相比二者单独使用,可更有效地抑制人胃癌移植瘤裸鼠肿瘤生长及淋巴结转移.

目的 观察5-氨基乙酰丙酸(5-ALA)光动力疗法调控肿瘤抑制因子(P53)/半胱氨酸蛋白酶9(Caspase9)通路抑制乳腺癌荷瘤裸鼠肿瘤生长的作用.方法 取40只裸小鼠,背部接种乳腺癌细胞株MCF-7制作荷瘤鼠模型,建模成功后随机分为5组,模型组(A组)、单纯激光照射组(B组)、低剂量5-ALA+激光照射组(C组)、中剂量5-ALA+激光照射组(D组)、高剂量5-ALA+激光照射组(E组).C组、D组、E组分别给予瘤内注射10 mg/kg、20 mg/kg、40 mg/kg的5-ALA生理盐水溶液,A组、B组给予瘤内注射无菌生理盐水溶液,2 h后,B组、C组、D组、E组应用半导体激光治疗仪局部照射瘤体治疗.对比各组干预前、干预14 d时肿瘤体积,并比较B组、C组、D组、E组抑瘤率;苏木精-伊红染色法(HE)观察各组肿瘤组织病理学变化;采用原位末端脱氧核苷酸转移酶介导的dUTP缺口末端标记(TUNEL)检测并对比各组肿瘤细胞凋亡率,分别采用实时荧光定量-聚合酶链反应法和蛋白免疫印迹法检测并对比肿瘤组织中P53、Caspase9 mRNA和蛋白表达情况.结果 干预前各组肿瘤体积比较,差异均无统计学意义(P>0.05),干预14 d各组肿瘤体积与干预前比较均显著较高(P<0.05),干预14 d后肿瘤体积从小至大依次如下,E组、D组、C组、B组、A组,每两组间比较差异均有统计学意义(P<0.05);抑瘤率从高至低依次如下,E组、D组、C组、B组,每两组间比较差异均有统计学意义(P<0.05);组织病理学观察发现,A组瘤细胞丰富、排列拥挤呈条索状、血供丰富,细胞大小不一、核大而深染伴有核分裂相,C～E组肿瘤细胞数量较A组明显减少,细胞排列紊乱,且细胞核固缩、染色质淡染,其中E组变化最为明显,B组变化不明显;肿瘤细胞凋亡率、P53、Caspase9 mRNA和蛋白相对表达量从高至低依次如下,E组、D组、C组、B组、A组,每两组间比较差异均有统计学意义(P<0.05).结论 5-ALA光动力疗法可显著抑制乳腺癌荷瘤裸鼠肿瘤生长、促进肿瘤细胞凋亡,其中20 mg/kg效果最佳,可能与上调P53、Caspase9 mRNA和蛋白表达、激活P53/Caspase9信号通路有关.

目的 探讨肝动脉灌注化疗栓塞术(transarterial chemoembolization,TACE)治疗原发性肝癌后肝功能损伤发生状况和影响因素.方法 回顾性分析120例经TACE治疗的原发性肝癌患者肝功能出现损伤的发生情况与病例的性别、年龄、肿瘤体积、手术前肝功能分级、TACE操作次数、选择肿瘤栓塞供血动脉和肝硬化分级的关系.结果 原发性肝癌患者在经过TACE治疗后,是否发生肝功能损伤与患者的性别、年龄、肿瘤体积和Child-Pugh分级关系之间的数据未见相关性(P＞0.05);出现肝功能损伤病例中:行TACE次数＞2次有15例(15/46),≤2次仅6例(6/74),两者比较,x2=11.794,P=0.001;肝硬化分级Ⅰ级、Ⅱ级、Ⅲ级及以上者分别是1 (1/36)、6(6/40)、14 (14/44)例,三者比较,x2=11.826,P=0.003;进一步分析,肝功能损伤与行TACE次数呈正相关(rs=0.403,P＜0.05);肝功能损伤与肝硬化分级呈正相关(rs=0.327,P＜0.05).结论 原发性肝癌在经过TACE治疗后,患者是否发生肝功能损伤与行TACE次数、患者肝硬化分级两个因素呈显著性相关,所以在治疗过程中,应该严格掌握患者本身的肝硬化情况,尽量减少TACE操作次数,减少肝功能损伤.

患者,女,69岁,因“顽固性腹泻4月余”入院.4个月前患者无明显诱因出现腹泻,解黄色稀水样便,每日7～8次,伴腹部阵发性绞痛,于外院就诊考虑为肠易激综合征,保守治疗无明显好转;3个月前于外院行阑尾切除术,术后腹泻仍无明显好转;后多次就诊于多家医院,给予对症支持治疗,停药后腹泻仍无好转.既往史:发现乙型病毒性肝炎20余年,否认高血压、糖尿病病史.体格检查:T 36.3℃,R15 次/分,P 72 次/分,Bp85/45 mmHg.腹平软,无压痛、反跳痛,未见明显胃肠型及蠕动波,下腹见陈旧性手术瘢痕.辅助检查:血常规、凝血功能、大便常规及隐血试验等均未见明显异常;白蛋白30 g/L(35～52 g/L,括号内为正常值范围,以下同),尿素12.0 mmol/L(3.1 ～8.0 mmol/L),肌酐88 μmol/L(59～104 μmol/L);血钾2.5 mmol/L(3.5～5.1 mmol/L),血钙2.58 mmol/L(2.15～2.55 mmol/L),校正钙2.91 mmol/L(2.15～2.57 mmol/L),血磷0.38 mmol/L(0.74～1.39 mmol/L),血镁1.17 mmol/L(0.80 ～1.00 mmol/L).肿瘤标志物全套(甲胎蛋白、癌胚抗原、糖类抗原125、糖类抗原153、糖类抗原19-9、糖类抗原724、神经元特异性烯醇化酶、前列腺特异性抗原、鳞状细胞抗原)均在临界值范围内;血去甲肾上腺素、肾上腺素、多巴胺及其代谢产物24h尿香草基杏仁酸水平均在正常范围内.胃镜检查示:反流性食管炎(A级);慢性糜烂性胃炎(Ⅰ级).

目的 分析不同来源胰腺组织中自噬标记蛋白Beclin-1和P62含量的差异及其相关性.方法 选取60例胰腺癌临床确诊患者、60例胰腺炎确诊患者和60例健康居民作为研究对象,应用免疫组织化学法检测胰腺组织中自噬相关蛋白Beclin-1和P62的含量差异,并分析不同病情的胰腺癌患者病理组织中Beclin-1和P62表达含量的差异,同时对2种标记物进行相关性分析.结果 4组不同来源胰腺组织中Beclin-1蛋白(F=1013.51,P=0.00),P62(F=355.72,P=0.00)含量的差异具有统计学意义;且两两比较发现,Beclin-1蛋白和P62含量的差异均显著(均有P＜0.05).不同病情(肿瘤大小、分化程度、病变部位、TNM分期、周围组织侵犯情况)胰腺癌患者病理组织中Beclin-1和P62表达含量的差异也显著(P均＜0.05);胰腺癌患者病理组织进行免疫组化分析,阳性物质中Beclin-1的平均积分光密度(252130.47±20147.33),P62表达强度评分(5.13±1.46),两者呈显著相关(Pearson=0.87,P=0.00).结论 Beclin-1和P62与胰腺癌的发生发展密切相关,且Beclin-1和P62呈显著相关性,不同病情胰腺癌患者亦存在差异性表达.

Objective To investigate the factors influencing the hypopituitarism and the difference of the expression of inflammatory factors in patients with craniopharyngioma (CP), and to strengthen the understanding of the diagnosis and treatment of the disease.Method The clinical data of 46 patients with CP were retrospectively analyzed,the influ-ence of different basic conditions on the incidence of hypopituitarism in patients with CP was studied,besides,the change of inflammatory factors(TNF-ɑ,IL-1,IL-6,IL-8,MCP-1)in hypopituitarism of dissimilar causes,and the impact of each inflammatory factor on the occurrence of hypopituitarism in patients with CP was determined. Result In 46 patients with CP,28 patients(60.87%)had hypopituitarism;there was statistically significant differences in the incidence of hypo-pituitarism among patients with different age,tumor diameter and calcification status(P<0.05);the occurrence of hypopi-tuitarism in patients with CP was of marked influence on the expression level of inflammatory factors of TNF-ɑ,IL-1ɑ, IL-6,IL-8,and MCP-1,with significant differences observed(P<0.01);multivariate Logistic regression was used to fit each inflammatory factor,and 5 factors were included in the equation,demonstrating statistically significant results(P<0.01),the degree of influence on the occurrence of hypopituitarism in patients with CP for the 5 factors were ranked as MCP-1 content(OR=6.619),IL-8 content(OR=5.641),IL-6 content(OR=4.759),TNF-ɑ content(OR=4.137),and IL-1α content(OR=3.857).Conclusion Hypopituitarism is commonly seen in patients with craniopharyngioma,while age,tu-mor diameter,and calcification are the main factors influencing the occurrence of hypopituitarism,which then impact sev-eral inflammatory factors,especially for the change of content of MCP-1,IL-8,and IL-6.

OBJECTIVE:To evaluate the pharmacoeconomic efficacy of Aidi injection,Xiaoaiping injection and Kangai injection in the differentiation treatment of non-small cell lung cancer(NSCLC).METHODS:A total of 120 NSCLC cases were randomized to receive Aidi injection,Xiaoaiping injection,Kangai injection or Kanglai injection plus chemotherapy of 30 cases each.The cost-effectiveness was compared among the four regimens.RESULTS:The effective rates,stability rate,and median survival time were 33.3%,26.7%,26.7% and 23.3%,respectively in Aidi injection group,86.7%,80%,73.3% and 73.3% in Xiaoaiping injection group and 357,285,238 and 246 days,respectively in Kangai injection group;the average costs per capita were 26 080.5 Yuan,27 005.7 Yuan and 26 459.9 Yuan and 26 665.7 Yuan,respectively;the costs for each 1% increment of effective rate were 783.19 Yuan,300.81 Yuan,1 011.45 Yuan,and 991.01 Yuan,respectively;the costs for each 1% increment of stability rate were 991.01 Yuan,360.98 Yuan,1 144.45 Yuan and 363.79 Yuan,respectively;the costs for every 1 year increment of median survival stood at 73.05 Yuan,94.76 Yuan,111.17 Yuan and 108.40 Yuan respectively.CONCLUSION:Aidi injection as the optimal auxiliary therapy in the differentiation treatment of NSCLC.

Objective To analyze clinical pathological types and characteristics of AFP level and prognosis of children malignant liver tumors.Methods 48 cases of malignant liver tumor were divided into hepatoblastoma group and hepatocellular carcinoma group based on pathology,two groups were compared in age,clinical manifestations,AFP positive,hepatitis B virus infection,complete surgical resection rate and so on.Results In 48 patients,26 patients were sent to hospital because of abdominal mass and the pathology classification was priority to hepatoblastoma.The average onset age and hepatitis B virus(HBV) infection in hepatoblastoma group were lower than those in hepatocellular hepatoblastoma group(P 0.05),but the complete resection rate and 1 year survival rate in hepatoblastoma group were higher than those in hepatocellular carcinoma group(P 0.05).Conclusion The main cause of children malignant liver tumors is abdominal mass.Hepatitis B virus infection was higher in hepatocellular carcinoma patients than that in hepatoblastoma patients;compared with hepatocellular carcinoma patients,the age of onset is smaller,the surgery removal rate is higher,the prognostic effect is better in hepatoblastoma group.