Objective To observe the efficacy and safety of apatinib combined with docetaxel based regimens as the second-line treat-ment for postoperative osteosarcoma with lung metastasis. Methods From April 2015 to March 2018, 28 patients with lung metastasis from osteosarcoma and failure from first line chemotherapy were selected in this research. All patients received the treatment of apatinib com-bined with docetaxel and cisplatin. Patients were given apatinib at the dose of 425 mg·d-1 until the disease progressed. They were currently given 75 mg·m-2 docetaxel at d1 and 30 mg·m-2 cisplatin at d1- d4, 21 days as a cycle. Patients were followed up till the disease progressed. The efficacy was evaluated and the side effects were observed. The time of progress free survival (PFS) and the overall survival (OS) were recorded. Results All patients finished 4~6 cycles of chemotherapy. After two cycles of chemotherapy, CT scan images showed that the tu-mors disappeared in 2 cases (7.14%), shrank in 10 cases (35.71%) and remained unchanged in 5 cases (17.86%), and progressed in 11 cases (39.25%). The response rate was 42.86%, and disease control rate 60.71%, and 1-year survival rate 78.57%. Patients were followed up for 5~16 months. The median PFS was 7.68 months and the overall survival was 9.62 months. The main toxicities in this study included gas-trointestinal reaction, bone marrow depression and hypertension. No death was found correlated with treatment. Conclusions The treatment of apatinib combined with docetaxel and cisplatin is effective and safe as the second-line regimen for postoperative osteosarcoma patients with lung metastasis. It is worthy of further clinical study and application.

目的:观察替莫唑胺不同服药方案法治疗脑胶质瘤术后复发患者的疗效及安全性.方法:选择住院治疗的57例脑胶质瘤术后复发的患者作为研究对象,其中标准组31例患者采用替莫唑胺剂量为150～ 200mg/(m2·d),一日一次,连用5天,每28天为一个周期;对照组26例患者应用替莫唑胺剂量为75～ 100 mg/(m2·d),一日一次,连用21天,每28天为一个周期,2个周期后评估两组之间的近期疗效及不良反应,并随访两组患者的无进展生存期(PFS)及总生存期(OS).结果:标准组患者治疗2个周期后影像学检查结果表明,肿瘤完全缓解3例(9.67％),部分缓解11例(35.48％),稳定12例(38.70％),进展5例(16.13％),疾病控制率为83.87％;而对照组患者分别为2例(7.69％)、9例(34.62％)、11例(42.31％)、4例(15.38％)及疾病控制率为84.62％,两组完全缓解率和疾病控制率比较差异无统计学意义(P＞0.05).入组患者随访结果表明,标准组31例PFS为2～14个月,中位PFS为8个月,OS为4～21个月,中位OS为13个月;对照组26例患者PFS为3～12个月,中位PFS为7个月,OS为5～19个月,中位OS为12个月.两组PFS及OS比较差无统计学意义(P＞0.05).不良反应为胃肠道反应、骨髓抑制及肝肾功损害为主,但两组之间比较骨髓抑制有差异.结论:替莫唑胺不同服药方案治疗脑胶质瘤术后复发的患者均可以取得较好的疗效,两种方案对患者的远期生存影响无明显差异,其不良反应可耐受.

Objective To investigate the clinical effect of Pemetrexed Disodium for injection combined with gamma knife in treatment of brain metastasis of non small cell lung cancer.Methods Patients (90 cases) with brain metastasis of non small cell lung cancer in General Hospital of Xuzhou Mineral Group Company from January 2012 to January 2016 were randomly divided into control and treatment groups, and each group had 45 cases. Patients in the control group were given gamma knife treatment. The doses ranged from 40％ to 60％, and the dose line was set 12 — 13 Gy. Patients were treated for 1 — 2 times according to the size of the tumor with an interval of 3 — 5 d. Patients in the treatment group were iv administered with Pemetrexed Disodium for injection on the basis of the control group, 500 mg/m2(soluble in normal saline), once every 21 days, treated for 3 times. After treatment, the clinical efficacies were evaluated, and the levels of CEA and CYFRA21-1 in two groups were compared.Results After treatment, the clinical efficacies in the control and treatment groups were 64.44％ and 84.44％, respectively, and the local tumor control rates in the control and treatment groups were 77.78％ and 93.33％, respectively, and there was difference between two groups (P < 0.05). After treatment, the levels of CEA and CYFRA21-1 in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05).Conclusion Pemetrexed Disodium for injection combined with gamma knife has clinical curative effect in treatment of brain metastasis of non small cell lung cancer, and can decrease CEA and CYFRA21-1 levels, with good safety and a certain clinical application value.

目的 检测晚期非小细胞肺癌患者化疗前后血清EGFR基因外显子19和外显子21的突变状态,探讨化疗药物对血清ECFR基因突变状态的影响. 方法 48例非小细胞肺癌患者均接受了至少4-6周期的全身化疗,应用磁珠法提取患者化疗前后的血清游离DNA,RT-PCR技术扩增患者血清游离DNA中EGFR外显子19和外显子21,所有扩增样本均经基因测序法验证EGFR基因突变状态,分析EGFR基因外显子19和外显子21化疗前后突变状态. 结果 48例肺癌患者化疗前后血清EGFR的突变以外显子21为主,化疗前后外显子19和外显子21的突变率无显著性差异(P＞0.05),血清EGFR的突变状态与患者病理类型具有相关性(P＜0.02),但与性别无关(P＞0.05),化疗前血清EGFR基因突变率为35.4％(17/48),化疗后血清EGFR基因突变率为43.8％(21/48),化疗前后患者EGFR基因突变的一致率为62.5％(30/48),化疗前后EGFR基因的突变率无统计学差异(P＞0.05),在不一致的18例患者中,7例患者由化疗前的EGFR突变阳性变为阴性,11例患者由化疗前的EGFR突变阴性变为阳性. 结论 化疗药物可能导致肺癌患者血清EGFR基因突变的改变,对于一线化疗后拟应用EGFR-TKI治疗的患者宜动态观察血清EGFR基因的变化,避免患者治疗的盲目性.

目的 探讨进展期大肠癌患者采用卡培他滨联合奥沙利铂化疗方案的临床效果.方法 58例进展期大肠癌患者,按照接受化疗方案的不同分为XELOX组和5-FU/LV组,各29例.XELOX组采用卡培他滨联合奥沙利铂化疗方案;5-FU/LV组采用5-氟尿嘧啶联合亚叶酸钙方案,两组均接受2个以上周期的化疗.第1年每6个月进行1次随访复查,此后每年随访复查1次,评价两组的化疗疗效和不良反应.结果 XELOX组总有效率、3年无病生存率、中位生存时间分别为89.7%、86.2%、(41.72±5.65)个月均优于5-FU/LV组的65.5%、62.1%、(37.48±4.35)个月,差异有统计学意义(P<0.05).XELOX组发生外周神经病变明显多于5-FU/LV组,而胃肠道反应、骨髓抑制明显少于5-FU/LV组,差异有统计学意义(P<0.05).两组患者不良反应均为Ⅰ~Ⅱ级,行对症处理后均好转,对化疗不构成影响.结论 进展期大肠癌患者采用卡培他滨联合奥沙利铂化疗方案疗效较好,不良反应较少,患者耐受性好.

Objective:To explore the clinical effect of vinorelbine and paclitaxel combined chemotherapy containing cisplatin for treatment of advanced non-smal cel lung cancer.Methods:64 cases of advanced non-smal cel lung cancer from 2012 to 2016 were selected and divided into observation group and control group randomly.The cases in observation group were taken paclitaxel combined cisplatin chemotherapy (TP chemotherapy).The cases in control group were taken vinorelbine combined cisplatin chemo-therapy (NP chemotherapy).After 2 cycles of chemotherapy,the clinical effect,complications and intergroup difference of the two groups were compared.Results:there was no significant difference of response rate,complete remission,1-year survival rates and median survival time between the two groups (P>0.05).The complicants included nausea,emesis,leucopenia and weak.The incidence of adverse reactions in observation group was lower than control group (P<0.05).Conclusion:there was no obvious difference of short-term effects between TP chemotherapy and NP chemotherapy for treatment of advanced non-smal cel lung cancer.But TP chemotherapy has less com-plication and is wel tolerated.

目的 探讨非小细胞肺癌(NSCLC)患者外周血游离DNA中表皮生长因子受体(EGFR)基因突变与口服靶向药物疗效的相关性. 方法 应用RT-PCR技术检测31例晚期非小细胞肺癌患者外周血EGFR基因突变情况,根据检测结果将患者分为EGFR基因突变型组和野生型组,同时口服吉非替尼进行一线治疗,分析外周血EGFR基因突变状态与吉非替尼疗效之间的关系. 结果 31例患者的外周血游离DNA中检测出EGFR基因的突变率为41.9％(13/31),13例EGFR突变型患者和10例EGFR野生型患者接受了吉非替尼一线治疗,EGFR突变型和EGFR野生型有效率(RR)分别为61.5％ (8/13)和10.0％ (1/10);疾病控制率(DCR)分别为69.2％ (9/13)和10.0％ (1/10);中位PFS则分别为14和7.5个月,2年生存率分别为30.7％ (4/13)和0.统计学分析显示,外周血游离DNA中EGFR突变型的NSCLC患者应用靶向药物一线治疗能获得更好疗效. 结论 外周血游离DNA中的EGFR基因突变的NSCLC患者应用靶向药物治疗效果好,因此,检测外周血DNA中的EGFR基因突变状态可以作为肺癌患者选择靶向药物治疗的主要依据.

目的 检测非小细胞肺癌患者外周血游离DNA中表皮生长因子受体(EGFR)基因19和21外显子的突变情况,并与相应的肿瘤组织检测结果进行比较,探讨非小细胞肺癌患者应用外周血游离DNA检测EGFR突变的临床意义.方法 应用实时荧光聚合酶链反应(PCR)技术检测32例非小细胞肺癌患者术后肿瘤组织和术前外周血游离DNA中EGFR基因19和21外显子的突变,所有扩增标本均经基因测序法验证.结果 32份外周血标本中,共检测到13份EGFR基因突变,突变率达40.6％,肿瘤组织中有16份EGFR基因突变,突变率达50.0％,外周血和肿瘤组织EGFR基因同时突变的有13份,两者突变一致性达到81.2％,两者间差异无统计学意义(P＞0.05).结论 外周血游离DNA代替肿瘤组织进行EGFR基因突变检测具有可行性,为无法取得肿瘤组织的非小细胞肺癌患者提供一种更快捷、简便的EGFR基因突变检测方法,其检测结果可为临床选择靶向药物治疗提供依据.

Objective To explore the feasibility and safety of systemic chemotherapy concurrent whole brain radiotherapy (WBRT) for non-small cell lung cancer (NSCLC) with brain metastases.Methods Eighty cases of NSCLC patients with brain metastases were divided into observation group (40 cases) and the control group (40 cases) according to random number table.Patients were given systemic chemotherapy synchronous WBRT or sequential WBRT.Results The Ⅰ-Ⅳ degree leukocytopenia incidences of the two groups were 12.5％,25.0％,25.0％,0.0 and 30.0％,25.0％,12.5％,15.0％,and there was statistical significance (x2 =12.12,P ＜ 0.05).In the observation group,the total remission rate was 20％ (8/40),and it was 22.5％ (9/40) in the control group,with no significant difference (x2 =1.79,P ＞ 0.05).The median progression free survival of the observation group and of the control group were (3.5 ± 2.3) months and (3.6 ±1.1) months,respec-tively,with no significant difference (t =5.23,P ＞ 0.05).But the 1-years survival rate in the observation group was 37.5％ (15/40),significantly higher than that in the control group (17.5％,7/40),which had statistical significance (x2 =9.11,P ＜ 0.05).Conclusion The safety of systemic chemotherapy synchronous WBRT for NSCLC patients with brain metastases is higher,with good curative effect and strong application feasibility.

目的 观察半胱氨酰白三烯D4(LTD4)及半胱氨酰白三烯受体1拮抗剂MK571对人结肠癌细胞株SW480、Caco-2增殖和凋亡的影响.方法 MTT法检测细胞生长活性;FITC Annexin V/碘化丙啶(PI)双染流式细胞术检测细胞的凋亡率;PI染色细胞,用流式细胞仪检测细胞周期.结果 12.5 ～ 400 μg/L的LTD4对结肠癌SW480细胞有促增殖作用,且存在时效和量效依赖性;而1.6～12.5μg/L的LTD4处理24、48 h,对SW480细胞的增殖抑制作用无明显影响,作用时间延长至72 h,可促进SW480细胞的增殖.50～ 400 μg/L的LTD4对结肠癌Caco-2细胞有促增殖作用,且存在时效和量效依赖性;而1.6-50 μg/L的LTD4对结肠癌Caco-2细胞的影响与对照组相比差异无统计学意义.6.25～200 μmol/L的MK571对结肠癌SW480细胞有抑制作用,且存在时效和量效依赖性;而0.8 ～ 6.25 μmol/L的MK571对SW480细胞的影响与对照组相比无明显差异.25～ 200 μmol/L的MK571对结肠癌Caco-2细胞有抑制作用,且存在时效和量效依赖性;而0.8～ 25 μmol/L的MK571对结肠癌Caco-2细胞的影响与对照组相比差异无统计学意义.与阴性对照组相比,25 ～ 100 μg/L的LTD4对2种结肠癌SW480细胞和Caco-2细胞有促凋亡作用,且存在时效和量效依赖性;而100、200 μmol/L的MK571对2种结肠癌的凋亡无明显作用.与阴性对照组相比,25 ～ 100 μg/L的LTD4可以降低2种结肠癌细胞株G0/G1期比例,增加G2/M及S期比例;而100、200 μmol/L的MK571增加2种结肠癌细胞G0/G1期的比例,降低G2/M及S期比例.结论 LTD4具有促进人结肠癌SW480、Caco-2细胞株增殖的作用,该作用可能的作用机制是抑制凋亡、增加G2/M及S期细胞比例.MK571可抑制2种结肠癌细胞株的增殖,但对凋亡无明显影响,其抑制增殖作用的可能机制是阻滞细胞于G0/G1期.

Objective ToobservetheeffectandtoxicitiesofwholebodyhyperthermiacombinedwithDCFregi-menchemotherapyinthetreatmentofpatientswithadvancedgastriccancer.Methods Sixty-sevenpatientswith advanced gastric cancer were randomly divided into two groups. Thirty-two patients of the treatment group was trea-ted by DCF regimen combining with whole body hyperthermia on the first day,and 35 patients of the control group wastreatedwithDCFregimenalone.Results Theresponserateandqualityoflifeinthetreatmentgroupwerebet-ter than those in the control group(P<0. 05). There was no statistical difference in the toxicities between the two groups(P>0.05).Conclusion WholebodyhyperthermiacanenhancetheeffectofDCFregimenchemotherapy for patients with advanced gastric cancer,improve the quality of life,do not increase the toxicities of chemotherapy.

目的 定量检测非小细胞肺癌(non-small cell lung cancer,NSCLC)患者血清游离DNA,评估其在肺癌治疗前后变化及临床应用价值. 方法 收集60例健康志愿者和65例非小细胞肺癌患者治疗前后血浆,所有非小细胞肺癌患者均经细胞病理学证实,其中32例早期肺癌患者接受肺癌根治术,33例晚期肺癌患者接受化疗治疗,采用磁珠法提取血清游离DNA,荧光定量PCR方法检测DNA含量. 结果 60例健康人血清游离DNA水平为(13.8±6.3) ng/ml,65例非小细胞肺癌患者血清游离DNA水平为(165.2 ±41.6) ng/ml,两者间差异有统计学意义(P＜0.01);进一步分析表明,在Ⅰ-Ⅱ期非小细胞肺癌患者血清游离DNA水平明显低于Ⅲ-Ⅳ的患者,差异具有统计学意义(P＜0.05);另外,手术的肺癌患者或化疗有效的肺癌患者其DNA含量在治疗后均有明显下降,与治疗前比较差异具有统计学意义(P＜0.01). 结论 非小细胞肺癌患者血清中游离DNA作为一类特异性的生物学标志物,在肺癌诊断及临床疗效的评价中具有一定的应用前景.

目的 观察来曲唑内分泌治疗对晚期卵巢癌中位无进展生存时间(PFS)的影响.方法 2010年1月至2012年1月收治的47例晚期卵巢癌患者在经全身化疗达CR后,随机分为两组,治疗组24例给予来曲唑口服2.5 mg/d,直至病情进展,对照组23例不做内分泌治疗.结果 随访截止时间为2013年10月30日,两组均无失访患者.治疗组来曲唑使用时间(24.5±7.4)个月,至随访截止时间治疗组有8例因病情进展而进入化疗治疗,其余患者继续采用来曲唑治疗;治疗组24例PFS为3～21个月,中位PFS为13个月;对照组23例患者PFS为1～15个月,中位PFS为10个月;两组PFS比较差异有统计学意义(P＜0.05).结论 来曲唑治疗晚期卵巢癌有一定疗效,有利于延长患者的PFS.

目的 研究半胱氨酰白三烯受体(CysLT1R)在大肠癌组织中的表达及其与大肠癌临床病理特征之间的关系.方法 选取46例大肠癌、32例癌旁组织、15例腺瘤性息肉手术切除标本,采用免疫组织化学法检测各组织中CysLT1R的表达水平.结果 CysLT1R在大肠癌组织、癌旁组织及腺瘤性息肉中的阳性表达率分别为67.39％,40.62％,40.0％,癌组织中CysLT1R的阳性表达率高于癌旁组织、腺瘤性息肉组织(P＜0.05).大肠癌组织中CysLT1R的表达程度与肿瘤大小、组织学分级、淋巴结转移及临床分期有关(均P ＜0.05).结论 CysLT1R表达与大肠癌分化程度、肿瘤大小、淋巴结转移及临床分期有关.CysLT1R可能参与大肠癌发生发展.

Objective To investigate the expression of Annexin A1 proteins in colorectal cancer tissues and the relationship be-tween it and clinicopathologic features of colorectal cancer.Methods The surgical specimens from 48 cases of colorectal cancer,36 cases of adjacent tissues,15 cases of adenoma polyp were used to be examined expression of Annexin A1 immunohistochemical method.Results The positive expression rate of Annexin A1 in cancer tissue(64.6%)was significantly higher than those in adja-cent tissues(38.8%)and adenoma polyp tissues(40.0%)(P<0.05).The adjacent tissues and adenoma polyp tissues with positive Annexin A1 expression showed mild to severe atypical hyperplasia.The positive rates of Annexin A1 were significantly lower in the well-differentiated adenocarcinoma,tumor size of <5 cm,with no metastasis to lymphnodes and no invasion to surrounding tissues of colorectal cancer than those in the moderately or poorly differentiated adenocarcinoma,tumor size of ≥5 cm,with metastasis to lymphnodes and invasion in surrounding tissues(P<0.05).Conclusion The expression levels of Annexin A1 may be an important index of occurrence,progression and biological behaviors of colorectal carcinoma.

[目的]评价伽玛刀联合尼莫司汀治疗颅内脑转移瘤的疗效及安全性.[方法]选择65例脑转移瘤患者为研究对象,其中对照组30例单纯采用伽玛刀治疗,观察组35例在对照组治疗的基础上联合尼莫司汀化疗,比较两组的近期疗效及不良反应.[结果]观察组治疗后影像学检查结果表明完全缓解9例(25.71％),部分缓解15例(42.86％),稳定8例(22.85％),进展3例(8.57％),有效率为91.42％,对照组分别为2例(6.67％)、12(40.00％)、7例(23.33％)、9例(30.00％),有效率为70.00％,两组完全缓解率和有效率比较差异具有统计学意义(P＜0.05).不良反应以脑水肿及尼莫司汀引起的骨髓抑制为主,两组骨髓抑制的发生率具有明显的差异(P＜0.05).[结论]伽玛刀联合尼莫司汀治疗脑转移瘤可以获得较好的临床疗效,可推荐临床推广应用.

医学临床实习阶段是医学生从理论过渡到实践,完成医学生到医生角色转换的重要时期,其实习教学质量的优劣直接关系到学生毕业后的临床实践能力,影响到医学人才的培养.该文通过总结近年实习带教经验,分析影响临床实习质量的因素,并提出相应对策.

目的观察古拉定?(还原性谷胱甘肽)对化疗致肺癌患者肝肾功能损伤的临床疗效.方法选择我院2010年3月-2012年5月间收治的50名肺癌患者为研究对象,将其随机分为两组,每组25例.A组患者给予古拉定?与化疗药物联合治疗,B组患者给予肌苷与化疗药物联合治疗.化疗结束后,评价和比较两组患者的临床疗效,肝肾功能的变化以及不良反应的发生情况.结果 A组的有效率为40%,B组的有效率为36%,两组间无统计学差异(P>0.05).古拉定?辅助治疗组与肌苷辅助治疗组相比,患者的肝肾功能损伤程度较小,肝肾功能生化指标数值间有统计学差异(P<0.05).此外,两组相比,A组患者的化疗总有效率较为理想,且治疗期间的不良反应发生率明显低于B组,具有统计学差异(P<0.05).结论古拉定?能够有效预防化疗致肺癌患者肝肾功能的损伤,且具有较好的安全性,值得临床推广应用.

Objective To study the expression of Gli1 protein,a component of Hedgehog/Gli1 signal pathway,and its relationship with angiogenesis in human breast cancer.Methods The expression of Gli1 protein was investigated by immunohistohistochemical method in 79 cases of human breast cancer,68 cases of normal tissues adjacent to cancer and 42 cases of breast fibroadenoma tissues.The microvascular density(MVD) was examined by using immunohistochemical CD34 staining assay.Results The Gli1 expression was higher in breast carcinoma than that in adjacent normal tissues and in breast fibroadenoma(P<0.05).Expression of Gli1 was significant higher in TNM stage Ⅲ than that in TNM stageⅠ～Ⅱ(P<0.05) and also was higher with axillary lymphnode metastasis than without lymphnode metastasis(P<0.05).Expressions of Gli1 were positively correlated with MVD(r=0.325,P<0.05).Conclusion Gli1 protein is activated and plays an important role in development of breast cancer.Promoting angiogenesis might be one of its mechanisms.

Objective:To observe the expression of Ang-2 and its receptor Tie-2 in breast carcinoma,and to investigate the possible relationship between the expression of Ang-2,Tie-2 and the angiogenesis in breast carcinoma.Methods: The expression of Ang-2 and its receptor Tie-2 in 79 breast carcinoma tissues,68 normal tissues adjacent to cancer and 42 breast fibroadenoma tissues were detected by immunohistochemical technique and the microvessel density was determined by CD34 staining.Results: Ang-2 and Tie-2 expression was higher in breast carcinoma than that in adjacent normal tissues and breast fibroadenoma(P<0.05),significantly higher in TNM stage Ⅲ than that in TNM stageⅠ-Ⅱ(P<0.05) and higher with lympnode metastasis than without lymph nodemetastasis(P<0.05).Positively correlated with MVD(P<0.05).Conclusion: Ang-2/Tie-2 may play a critical role in promoting tumor angiogenesis and progression in human breast carcinoma.