脂肪肉瘤是一种比较少见的软组织肉瘤,主要表现为无痛性肿块,生长缓慢,病程可长达数年,它们约占所有恶性软组织肿瘤的16％ ～18％.脂肪肉瘤通常见于成人,儿童很少发生.大约90％ ～95％的肿瘤发生在躯干、四肢或腹膜后,6％发生在头部和颈部区域,胸内起源的脂肪肉瘤很少见,占2. 7％ [1].当胸腔内发生时,最常发生在纵隔,起源于肺部的病例极为罕见,文献中报道约20 例,通常为转移瘤.黏液性脂肪肉瘤( Myxoid liposarcoma, MLPS)是脂肪肉瘤的一种亚型,肺部黏液性脂肪肉瘤极为罕见,目前国内外报道甚少.因其具有临床表现缺乏特异性、起病隐匿、进展缓慢、不易诊断、易复发等特点,易误诊,治疗尚不理想.为进一步提高对黏液性脂肪肉瘤的认识,避免临床漏诊及误诊,现结合相关文献,就我院呼吸与危重症医学科新诊断的1例肺部转移性黏液性脂肪肉瘤的临床病理学特征、诊断及治疗予以报道.

目的检测甲型H1N1流感病人外周血T淋巴细胞亚群的变化,探讨甲型H1N1流感对其细胞免疫功能的影响。方法总结2009年11月5日至2017年1月15日甘肃省人民医院及兰州大学第二医院所收治的73例临床资料完整且没有基础免疫疾病的甲型H1N1流感病人血清总T淋巴细胞、CD4抗原阳性的T淋巴细胞（CD4+T淋巴细胞）、CD8抗原阳性的T淋巴细胞（CD8+T淋巴细胞）活性的变化规律。结果甲型H1N1流感病人CD8+T淋巴细胞在诊断初期即已升高（42.27±11.13）cells/ul,并在恢复期基本恢复正常（29.26±12.99）cells/ul;总T淋巴细胞、CD4+T淋巴细胞则在诊断初期有不同程度下降（44.09±13.51）、（47.27±7.73）cells/ul,并随病情好转逐渐恢复,CD4+T淋巴细胞与CD8+T淋巴细胞比值在病程中没有统计学差异差异无统计学意义（F=0.294,0.415,0.618;P=0.892,0.106,0.082）,但随病情好转有升高趋势。结论甲型H1N1流感病人免疫功能低下。

目的 了解兰州市城关区白银路街道两社区烟民戒烟、尼古丁依赖程度等情况,为制定有效戒烟方式提供参考.方法 采用随机抽样方法,抽取兰州市城关区白银路街道18岁及以上烟民155人进行入户调查.分析烟民曾经戒烟、戒烟方式、尼古丁依赖及戒烟意愿情况.结果 曾经戒烟56人(36.1％),未戒烟99人(63.9％);戒烟人群中不同职业、烟龄者采用的戒烟方法不同,差异有显著性(P<0.05);不同职业、收入的烟民戒烟失败原因不同,差异有显著性(P<0.05);不同文化程度的烟民尼古丁依赖程度不同,差异有显著性(P<0.05),初中及以下学历者对尼古丁依赖程度较高;不同文化程度、职业、婚姻状况、烟龄的烟民戒烟意愿不同,差异有显著性(P<0.05).结论 兰州市烟民戒烟水平相对较低,失败原因主要为意志力不够,且人群戒烟意愿较低,但尼古丁依赖程度不高.

Objective: To provide the reference for smoking control and intervention by surveying current state of smoking of the smokers in two communities of Baiyin Road street of Chengguang district.Methods: All 160 smokers older than 18 years in two communities of Baiyin road street were chosen by using random sampling method,and household investigation was performed.The conditions of smoking consumption each day,smoking places and the provider for the first smoking of the smokers were analyzed.Results: In the study,160 persons were surveyed,155 pieces effective questionnaires were reclaimed.Among the respondents,there were 82 persons smoking between 20 and 25 years(52.9％),the difference had statistical meaning when smoking times were compared between different occupations(P＜0.05),the difference showed statistical meaning when mild,moderate and severe smoking consumption were compared(P＜0.05); the difference was statistically significant when smoking places,different ages,educational background and smoking time were compared between both groups(P＜0.05); the difference was statistically significant in the comparisons of smoking in public and different ages(P＜0.05).Conclusion: The smokers in the communities of Chengguang district are with longer smoking time and higher smoking consumption,the feelings of the smokers at different ages,with different occupations and educational background were various,smoking in the working place and public happen from time to time and the age is the main influencing factor.

目的 探讨龈下刮治和根面平整术对老年冠心病合并牙周炎患者血脂、血清和龈沟液肿瘤坏死因子(TNF-α)、基质金属蛋白酶.8(MMP-8)、单核细胞趋化蛋白-1(MCP-1)的影响.方法 选择2016年2月至2017年5月在我院诊治的老年冠心痛合并牙周炎患者68例,按随机数字表法分成对照组和观察组,每组34例.对照组患者给予常规冠心病治疗,观察组在常规冠心病治疗的基础上给予龈下刮治和根面平整术治疗.比较两组患者牙周茵斑指数(PI)、探诊深度(PD)、探诊出血(BOP)及临床附着水平(CAL);检测比较两组患者的甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)水平;检测比较两组患者血清和龈沟液TNF-α、MMP-8、MCP-1水平.结果 治疗后6个月,观察组患者的PI、PD、BOP、CAL显著改善,并且显著优于对照组(P＜0.01);观察组患者的TG、TC、LDL-C水平显著降低、HDL-C水平显著升高,TG、TC、LDL-C水平显著低于对照组、HDL-C水平显著高于对照组,差异有统计学意义(P＜0.05);观察组血清TNF-α、MMP-8水平显著降低,并且显著低于对照组,差异有统计学意义(P＜0.05);观察组患者龈沟液TNF-α、MMP-8、MCP-1水平均显著降低,并且显著低于对照组,差异有统计学意义(P＜0.05).结论 龈下刮治和根面平整术治疗老年冠心病合并牙周炎患者,能有效改善患者牙周组织生理状况,降低血脂,降低血清TNF-α、MMP-8水平,降低龈沟液TNF-α、MMP-8、MCP-1水平,有利于冠心病的治疗.

目的 分析慢性咳嗽患者就医行为及性别差异.方法 对符合纳入标准的慢性咳嗽患者进行问卷调查,分析其就医行为及性别差异.结果 共纳入患者356例,75.28％的患者有就医史,女性多于男性(P=0.032),24.72％的患者无就医史;51.69％的患者选择二级以下医院,23.59％的患者选择三级综合医院.选择基层医院以费用低为原因者女性高于男性(P=0.046);选择三级综合医院的原因中,认为技术好者男性高于女性(P=0.036).发病后未系统诊治的主要原因为“曾诊断支气管炎”、“没问题”和“咳嗽不严重”.此次就诊的原因在影响生活(P=0.000)、影响他人(P=0.035)和逐渐加重(P=0.021)方面女性多于男性.最终完成诊断程序的有173例,总依从性为48.60％,女性依从性低于男性.结论 多数患者虽然有就医史,但因受自身就医行为和/或医疗导向的影响,存在诊治延迟.女性对咳嗽感受更为敏感,比男性更早、更多地选择就医.就医者中,女性更关注诊疗费用,多选择基层医院,就医依从性更差.

Objective To estimate the metabolic parameters in different tissues and organs,build the physiologically based pharmacokinetic (PBPK) model of rat and occupational population,and predict the toxic dynamic characteristics exposure to nickel.Methods The partition coefficients in different tissues and organs were estimated using vector datas of nickel by the optimization and statistics files of acslx software.The PBTK model of occupational population exposure to nickel was built according to the metabolic parameters by acslx software.Results The evaluated partition coefficient of nickel were kidney blood (0.668),lung blood (0.102),spleen blood (0.037),liver blood (0.028),heart blood (0.022),and brain blood (0.006).The constructed successful PBPK model of occupational population exposed to 0.1 mg,/m3 nickel for 8 hours showed that the nickel concentration is higher in kidney reached at 3.328 μg/kg,followed by the spleen (0.185 μg/kg),liver(0.140 μg/kg) and heart (0.110 μg/kg).The content of nickel is lower in the brain (0.030 μg/kg).The kidneys is the major metabolic organs for nickel.Conclusion The PBPK model can be used to convert the nickel levels from external exposure to internal exposure for each organ and to evaluate the time-dose relationship exposure to nickel in both rat and occupational population studies.

目的 了解兰州市城关区白银路街道某两个社区烟民的吸烟现状,进一步改善本地区吸烟状况.方法 采用随机抽样,抽取兰州市城关区白银路街道某两社区≥18岁的烟民共计155人进行入户调查.分析烟龄、吸烟后感受等情况.结果 本研究共调查155人,烟龄≥20年有119人(76.8％),吸烟量轻度105人(66.8％)、中度38人(24.5％)与重度12人(7.7％)者间差异有统计学意义(P＜0.05);吸烟后人际关系的变化不同年龄组间差异均有统计学意义(P＜0.05).结论 兰州市城关区社区烟民烟龄相对较长,吸烟量较轻,人际关系、食欲改变、身体状况等吸烟后感受不同人群存在差异.

病例资料 肺梭形细胞癌临床比较少见,其表现缺乏特异性,早期诊断困难,恶性程度高,发生转移早,缺乏有效的治疗手段,预后差.截至目前,国内报道不多,对该病的认识不足,现结合文献对我院近期诊断的1例进行报道. 患者男,27岁,主因"间断胸痛一年余,加重5天"入院.一年前无明显诱因出现左侧胸痛,呈阵发性,咳嗽、深呼吸及剧烈活动后疼痛加重,无畏寒、寒颤,发热,无胸闷气短,无咯血及痰中带血,无盗汗、午后低热、乏力等不适,患者未予重视.

OBJECTIVE:To explore the distribution characteristics of etiology and clinical feature of chronic cough in Lanzhou.METHODS:Based on the guidelines of the diagnostic process of chronic cough in China, data of medical history and physical examinations were collected, and chest X-ray, pulmonary function plus airway hyperresponsiveness, induced sputum eosinophils, sinus X-ray or CT, 24 h esophageal pH monitoring, chest high-resolution CT and bronchoscopy were performed accordingly for outpatients with chronic cough. The cause of chronic cough was identified by the test results and treatment response. The results were compared with those reported previously in other areas of China.RESULTS:A total of 173 patients with completed data were collected, including 90 males and 83 females.The causes were as follows: 45 cases (26.01%) of cough variant asthma, 35 (20.23%) upper airway cough syndrome, 20 (11.56%) allergic cough, 17 (9.83%) chronic pharyngitis, 14 (8.09%) gastroesophageal reflux, 14 (8.09%)postinfectious, 13 (7.51%) eosinophilic bronchitis, 8 (4.62%) chronic bronchitis, 4 (2.31%) cough associated with ACEI, 3 (1.73%) bronchial tuberculosis, 2 (1.16%) pulmonary fibrosis and bronchiectasis repectively. The causes of the remaining 14 patients (8.09%)were unknown. The causes of chronic cough were identified in 159 patients (91.91%), of which 141 (88.68%) with a single cause and 18(11.32%)with more than 2 etiological factors.The percentage of cough variant asthma in our series was significantly higher than that reported in Guangzhou (13.6%, χ(2)=5.60, P=0.018, P<0.05), but lower than that reported in Shenyang (39.4%, χ(2)=7.91, P=0, 004, P<0.01). The percentage of allergic cough was higher than that reported in Beijing (3.3%, χ(2)=6.66, P=0.010, P<0.05), and that of eosinophilic bronchitis was lower than those reported in Guangzhou(22.4%, χ(2)=22.38, P=0.000, P<0.01) and Shenyang (12.5%, χ(2)=8.09, P=0.005, P<0.01). The percentage of esophageal reflux cough was lower than that reported in Beijing (20.3%, χ(2)=9.40, P=0.002, P<0.01) but higher than that reported in Shenyang (1.9%, χ(2)=3.98, P=0.036, P<0.05).CONCLUSION:In Lanzhou, cough variant asthma, upper airway cough syndrome, allergic cough, chronic pharyngitis and gastroesophageal reflux were the main causes of chronic cough, and the etiological distribution was different from Guangzhou, Beijing, Shenyang and other areas.

目的:分析慢性阻塞性肺疾病(COPD)稳定期患者的临床表型和中医证型,研究其相关性.方法:将COPD患者268例参照文献,将其临床表型分为支气管壁增厚型、肺气肿型、混合型;同时根据指南将中医证型分为肺气虚证、肺脾气虚证、肺肾气虚证、肺肾气阴两虚证.采用关联性研究分析临床表型与中医证型的相关性,采用复试条图描述中医证型占临床表型的分布频率.结果:临床表型和中医证型具有关联性(x2=17.793,r=0.25),差异具有统计学意义(P＜0.01);支气管壁增厚型以肺脾气虚和肺肾气阴两虚为主,各占27.586％,47.126％;肺气肿型以肺脾气虚和肺肾气虚占多数,分别占39.241％,32.911％;混合型以肺脾气虚和肺肾气阴两虚为主,分别占34.314％,40.196％.结论:COPD临床表型和中医证型相关性强,对临床治疗有指导意义.

OBJECTIVE:To study the expression of the epidermal growth factor receptor (EGFR) and the oncogene c-erbB2 on pulmonary fibrosis induced by bleomycin (BLM) in rats. METHODS:Fifty-four Wistar rats were randomly divided into three groups, the pulmonary fibrosis group (BLM), Iressa group and the control group. There were 18 rats in each group. Control group were injected with saline 0.2-0.3 ml in trachea. Iressa group and BLM group were injected with BLM intratracheal. After the fibrosis models were build, Iressa group were given orally Iressa (200 mg/kg)1 h before modeling in Iressa group, saline were fed 10 ml/kg in BLM group and control group. The three groups were fed 5 times per week; and were sacrificed after treatment on days 1, 14 and 28 respectively. The lungs were harvested for histological studies. RESULTS:The lung tissue in Iressa group showed fibrosis and inflammatory cell infiltration, the same as shown in the BLM group. The pulmonary fibrosis score was significantly lower than the BLM group on the 28 th day (2.17 +/- 0.41 vs 3.50 +/- 0.84, P < 0.01). Compared with the control group, c-erbB2 and EGFR were hyper expressed significantly both in BLM group and Iressa group at all time points (P < 0.01); c-erbB2 expression had no changes between the Iressa group and the BLM (P > 0.05), that were gradually decreased, and was significantly different at each time point (P < 0.01). EGFR expression was increased gradually on the 14th and 28th day (0.17 +/- 0.02 and 0.28 +/- 0.04) in Iressa group ,that was significantly lower than the BLM group (0.27 +/- 0.04 and 0.34 +/- 0.02) (P < 0.01). EGFR expression increased significantly on the 28th day than on the 14th day in the Iressa group (P < 0.01). CONCLUSION:The expression of C-erbB2 and EGFR are enhanced in different stages of alveolitis and pulmonary fibrosis, c-erbB2 and EGFR may be participated in different stages of pulmonary fibrosis.