Fetal lung adenocarcinoma (FLAC) is a rare malignant tumor with a relatively good prognosis, and the probability of mutation with KRAS is very low. We report a middle-aged female patient with FLAC with KRAS mutation. The primary lesion was implanted with radioactive iodine 125 particles, and the lesion was smaller than before. However, the metastatic lesions progressed rapidly. After chemotherapy with pemetrexed disodium and cisplatin combined with bevacizumab to prevent angiogenesis, the primary lesions continued to shrink, and the metastatic lesions were significantly smaller than before. The patient has been followed up for 5 months and is generally in good condition. We report a case of H-FLAC with KRAS mutation, and its development and prognosis seem to be significantly abnormal from that of ordinary H-FLAC. It also provides a possible effective treatment for unresectable H-FLAC, but further research is needed.

OBJECTIVE:To establish the diagnostic accuracy of RASSF1A (Ras association domain family 1 isoform) methylation using bronchial aspirates as an auxiliary method for diagnosing lung cancer through a systematic review and meta-analysis. METHODS:Studies published prior to October 30, 2022, were retrieved from the Embase, PubMed, Web of Science, and Wan Fang databases using the keywords "lung cancer", "RASSF1A", "methylation", and "bronchial aspirates". A fixed or random effect model was used to calculate the combined sensitivity, specificity, positive likelihood ratios (LR), negative LR, diagnostic odds ratio (DOR), along with the respective 95% confidence intervals (CIs) and the area under the curve (AUC) with Q index. The threshold effect was defined by using the Spearman correlation coefficient, and the Deeks funnel plot was generated to evaluate publication bias. RESULTS:Among the 12 trials that met the inclusion criteria, a total of 2388 participants were involved. The pooled results for the diagnosis of lung cancer were as follows, when compared to the pathological diagnosis: sensitivity of 0.47 (95% CI: 0.45-0.50), specificity of 0.96 (95% CI: 0.95-0.97), positive LR of 12.18 (95% CI: 8.96-16.55), negative LR of 0.56 (95% CI: 0.52-0.61), DOR of 24.05 (95% CI: 17.29-33.47), and AUC of 0.78 (Q index = 0.72), respectively. The sensitivity of the RASSF1A methylation assay was relatively low in a detailed subgroup analysis, fluctuating between 0.39 and 0.90, indicating a limitation in its diagnostic value for lung cancer. The RASSF1A methylation assay, on the other hand, demonstrated excellent specificity, suggesting a high exclusion value. Of note, the diagnostic sensitivity, specificity, DOR, and AUC for small cell lung cancer were 0.90 (0.84-0.94), 0.95 (0.94-0.97), 249.5 (103.94-598.8), and 0.98, respectively, showing that RASSF1A methylation was a promising biomarker for diagnosing small cell lung cancer with both high diagnostic and exclusion value. Furthermore, RASSF1A methylation using bronchial washings and bronchial aspirates showed a high AUC of 0.998 and 0.93, respectively, indicating excellent diagnostic performance. CONCLUSIONS:The methylation of RASSF1A in bronchial aspirates demonstrated a high level of diagnostic accuracy and has the potential to be a valuable supplementary diagnostic method, especially for identifying small cell lung cancer.

Objective To investigate the effect of resveratrol on the growth activity of lung cancer cells and its possible mechanism. Methods The lung cancer cell line H292 was stably cultured, and the medium containing resveratrol of different concentrations was added for intervention. CCK-8 test, flow cytometry and cell colony formation test were used to detect the effects of resveratrol on the growth activity of H292 cells. Immunofluorescence and Western blotting were used to detect the effects of resveratrol on the expressions of Akt/mTOR signaling pathway-related proteins in H292 cells. Results（1）CCK-8 results showed that resveratrol significantly inhibited the proliferation of H292 cells（P＜0.05） in a time-and dosedependent manner. At the same time, resveratrol had a significant effect on the cell cycle of H292, which could arrest the cell cycle at G2/M phase.（2） Resveratrol significantly inhibited the colony formation of H292 cells in a dose-dependent manner（P＜0.05）.（3） Western blotting showed that resveratrol induced the accumulation of LC3-Ⅱ in H292 cells in a dose-dependent manner. Immunofluorescence assay showed that resveratrol induced a significant increase of GFP-LC3 in the nucleus and mitochondria.（4） Autophagy inhibitor 3-MA effectively weakened the inhibitory effect of resveratrol on the viability of H292 cells. Lysosomal acidification inhibitor Bafilomycin A1 promoted the accumulation of LC3-Ⅱ which was induced by resveratrol.（5） Resveratrol down-regulated the expressions of p-Akt, p-P70S6K and p-mTOR proteins in H292 cells（P＜0.05）, but had no significant effects on the expressions of Akt, P70S6K and mTOR proteins（P＞0.05）. Conclusion Resveratrol can inhibit the proliferation of lung cancer cells by suppressing the Akt/mTOR signal pathway activity.

目的:探讨透析设备规范化管理模式在肺癌伴慢性肾衰患者血液透析中的应用价值.方法:选取医院收治的116例肺癌伴慢性肾衰透析患者,根据入院时间的不同分为对照组(52例)和观察组(64例),对照组患者治疗中的透析设备采用以日常检测和阶段检测为主的检测式管理模式;观察组采用规范化管理模式,从电气安全、供水质量、设备监测、制度建设和人员培训5方面构建规范化管理路径,组织实施循环式质量改进和提高活动.对比两组透析设备感染控制质量、透析治疗质量和并发症控制质量.结果:观察组患者透析设备的消毒合格率和供水污染控制率优于对照组,肝炎发病率低于对照组,差异有统计学意义(x2=9.388,x2=14.717,x2=5.049;P<0.05);观察组患者透析治疗的尿素清除率(UCL)控制率、尿素下降率(URR)控制率、体重增长控制率和动静脉内瘘控制率高于对照组,差异有统计学意义(x2=7.330,x2=6.723,x2=7.098,x2=12.193;P<0.05);观察组患者高血压、贫血、低蛋白血症和慢性肾脏病-矿物质与骨异常(CKD-MBD)并发症比例低于对照组,差异有统计学意义(x2=4.680,x2=11.897,x2=11.555,x2=11.359;P<0.05).结论:透析设备规范化管理可降低设备相关的感染比例,提高血液透析临床效果,有效控制透析相关并发症发病率.

临床资料 患者男,22岁,未婚,某高校大四学生,新材料专业.因"反复干咳3+年,加重伴活动后气促1年余"于2020年3月18日入我院.入院前3+年患者因反复干咳多次于外院就诊,行胸部CT及气管镜检查未发现异常,先后诊断为"普通感冒"、"急性支气管炎",口服抗生素等药物咳嗽稍有减轻.1+年前患者逐渐出现活动后气促,院外查呼出气一氧化氮40 ppb,诊断"支气管哮喘",予以抗感染解痉平喘(具体不详)等治疗气促有缓解.

Background: The selection of patients for immunotherapy remains challenging given the lack of highly specific and highly sensitive biomarkers. Kirsten rat sarcoma (KRAS) mutation is the most frequent molecular alteration found in advanced non-small cell lung carcinoma (NSCLC). We explored whether KRAS mutation status predicted the effects of first-line immune checkpoint inhibitor (ICI) treatment and platinum-based chemotherapy in Chinese patients with advanced NSCLC. Methods: Clinical data were extracted from medical records of patients with advanced NSCLC at the First Affiliated Hospital of Guangzhou Medical University in China between January 2019 and March 2020. Overall survival (OS) and progression-free survival (PFS) rates were compared via log-rank tests, and independent prognostic factors were identified via Cox regression. Results: Patients with advanced NSCLC without driver alterations who were treated with ICI and platinum-based chemotherapy (N=80) were identified, including 28.7% with KRAS mutations and 71.3% with non-KRAS mutations. Tumor programmed death-ligand 1 (PD-L1) expression was analyzed using a 1% cutoff, and 32.5% of patients were negative and 67.5% were positive. The median tumor mutational burden (TMB) was 7.29 mutations per megabase (muts/Mb) (range, 0.08–44.8 muts/Mb), with 32.5% of cases <5 muts/Mb and 67.5% ≥5 muts/Mb. The median PFS and OS for the entire cohort were 9.8 (95% CI: 9.1–10.5) and 17.6 (95% CI: 14.4–20.8) months, respectively. The 6-month PFS rate was 67.5% and the 1-year OS rate was 72.5%. Thirty-five patients survived until the last follow-up. The OS and PFS of patients with KRAS mutations were significantly higher than those in the non-KRAS mutant group (P<0.05). The Cox multivariate analyses showed that brain metastasis [hazard ratio (HR) =0.232, 95% CI: 0.102–0.530; P=0.001], TMB (HR =5.675, 95% CI: 1.948–16.535; P=0.001), KRAS mutation (HR =2.552, 95% CI: 1.141–5.708; P=0.023) were independent predictors of OS in patients treated with ICIs and platinum-based chemotherapy. Liver metastasis (HR =0.344, 95% CI: 0.191–0.619; P<0.001) and KRAS/tumor protein p53 (TP53) co-mutation (HR =0.220, 95% CI: 0.067–0.725; P=0.013) were the prognostic factor for PFS of qualified patients. Conclusions: This work provides evidence that KRAS mutation in advanced NSCLC may be served as a potential predictive biomarker for immunotherapeutic efficacy.

目的 探讨微波消融联合GP方案对非小细胞肺癌(NSCLC)患者肺功能、Th1、Th2细胞因子及肿瘤标志物水平和预后生存的影响.方法 回顾性选择2018年1月至2020年1月广元市中心医院收治的NSCLC患者124例,按照药物治疗方案不同分为对照组(n=62)与观察组(n=62),对照组采取GP方案(吉西他滨+顺铂)治疗,观察组在对照组基础上联合微波消融.比较两组患者肺功能、Th1细胞因子[γ干扰素(IFN-γ)、白细胞介素(IL)-2]、Th2细胞因子(IL-4、IL-10)、肿瘤标志物水平和预后生存情况.结果 治疗后,两组患者的FEV1、FEV1、PEFR比较,差异均无统计学意义(P>0.05).治疗后,两组患者IFN-γ和IL-2水平较治疗前显著增加,IL-4和IL-10水平均显著降低,且观察组患者血清IFN-γ和IL-2水平为(5.62±0.69)、(3.39±0.26)pg/mL,均显著高于对照组[(4.99±0.57)、(2.87±0.24)pg/mL],而IL-4和IL-10水平为(3.11±0.29)、(3.09±0.72)pg/mL,均显著低于对照组[(3.74±0.28)、(3.98±0.61)pg/mL],差异均有统计学意义(P<0.05).治疗后,两组血清CYFRA21-1、CA125、NSE水平较治疗前明显降低,且观察组血清CYFRA21-1、CA125、NSE水平为(2.13±0.09)ng/mL、(52.35±8.16)U/mL、(15.23±2.87)ng/mL,均低于对照组[(3.43±1.10)ng/mL、(70.41±9.12)U/mL、(19.64±3.42)ng/mL],差异均有统计学意义(P<0.05).观察组治疗后1、2年复发率为9.67％、38.70％,低于对照组(45.16％、59.67％),且观察组治疗后1、2年生存率为80.64％、67.74％,高于对照组(62.90％、48.38％),差异均有统计学意义(P<0.05).结论 微波消融联合GP方案对NSCLC患者肺功能影响不大,但有利于维持免疫功能稳定,降低肿瘤标志物水平和改善预后生存状况,可用于临床.

目的:探讨供血动脉化疗栓塞联合氩气刀及冷冻治疗中晚期中央型肺鳞癌的疗效、安全性和对肺功能改善影响.方法:161例中晚期中央型肺鳞癌随机分为供血动脉化疗栓塞联合氩气刀及冷冻治疗组(干预组)和单纯全身静脉化疗组(对照组),两组化疗方案均为GP方案(吉西他滨+顺铂).比较两组患者治疗6月后的临床疗效、不良反应发生及肺功能改善情况.结果:随访6个月,干预组和对照组治疗有效率分别为58.62％和36.48％,生存率分别为93.1％(81/87)和79.7％(59/74),两组差异统计学有意义(P<0.05).治疗后两组患者FEV1、FVC指标均有所改善,干预组改善情况更显著(P<0.05).两组患者不良反应的发生情况有所差异,干预组化疗常见副作用发生率较单纯全身静脉化疗组低.结论:供血动脉化疗栓塞联合支气管镜下氩气刀及冷冻治疗中晚期中央型肺鳞癌在近期疗效、肺功能改善及安全性方面皆优于传统化疗,临床应用价值大,值得推广应用.

目的:探讨荧光支气管镜活检诊断小细胞肺癌的临床价值.方法:回顾性分析经荧光支气管镜活检诊断的84例小细胞肺癌患者的临床资料,观察小细胞肺癌患者镜下表现、钳取技巧和临床特点.结果:经荧光支气管镜钳检阳性率(97.62％)高于刷检阳性率(90.05％),差异有统计学意义(P<0.05).84例小细胞肺癌的影像学表现为胸腔积液4例、阻塞性肺炎21例、肺周结节或团块29例、纵膈以及肺门团块影45例;病灶位置为左侧44例、右侧40例;镜下分型为混合型6例、管腔外压型10例、管壁浸润型28例、管内增生型40例.结论:小细胞肺癌影像学表现缺乏明显特征,结界、肿块是小细胞肺癌的主要表现;经荧光支气管镜钳检诊断小细胞肺癌阳性率较高,可为临床诊治提供参考依据.

目的 探讨晚期非小细胞肺癌(NSCLC)患者酪氨酸激酶抑制剂(TKI)靶向治疗与肿瘤组织表皮生长因子(EGFR)基因突变的关系.方法 回顾性分析广元市中心医院2015年1月～2017年1月180例接受TKI靶向治疗的NSCLC患者的临床资料,所有患者均经病理证实为NSCLC,治疗前对所有患者血浆样本EGFR突变进行检测,然后接受TKI靶向治疗.分析EGFR突变与患者一般资料的关系,并探讨EGFR突变对TKI靶向治疗效果及预后的影响.结果 180例NSCLC患者中,118例为野生型,62例为突变型,突变率为34.44％.性别、无吸烟史、组织学类型与EGFR突变有关(P＜0.05);其余一般资料与EGFR突变无关(P＞0.05).EGFR突变患者有效率高于EGFR野生型患者,差异有统计学意义(P＜0.05).EGFR突变型患者1年生存率高于EGFR野生型,差异有统计学意义(P＜0.05).结论 NSCLC患者EGFR基因突变与性别、无吸烟史、组织学类型有关,EGFR突变型患者接受TKI靶向治疗的效果较好,有利于提高患者1年生存率.

目的 探讨表皮生长因子受体-酪氨酸激酶抑制药(EGFR-TKI)靶向治疗对是否伴恶性胸腔积液非小细胞肺癌(NSCLC)患者的疗效差异.方法 回顾性分析120例晚期NSCLC患者的病历资料,根据患者是否伴有恶性胸腔积液分为A组66例(伴有胸腔积液)和B组54例(不伴有胸腔积液),两组均采用基础治疗+EGFR-TKI治疗,比较两组患者的疗效差异及治疗前和治疗3个月后的KPS评分、血清癌胚抗原(CEA)、鳞状上皮细胞癌抗原(SCC)、神经元特异性烯醇化酶(NSE)、血管内皮细胞生长因子(VEGF)水平的变化.结果 A组患者的缓解率为50.00％、总有效率为81.82％,均低于B组的70.37％、94.44％,两组比较,差异均有统计学意义(P﹤0.05).治疗前,A组和B组患者的血清CEA、SCC、NSE、VEGF水平比较,差异均无统计学意义(P﹥0.05);治疗后,两组患者的血清CEA、SCC、NSE、VEGF水平均较本组治疗前降低(P﹤0.05),且A组患者的血清CEA、SCC、NSE、VEGF水平均明显高于B组,差异均有统计学意义(P﹤0.01).治疗前、治疗后两组患者的KPS评分比较,差异均有统计学意义(P﹤0.05),但A组患者治疗前后的KPS评分差值明显低于B组患者,差异有统计学意义(P﹤0.01).结论 EGFR-TKI靶向治疗对是否伴恶性胸腔积液NSCLC患者均具有一定的临床效果,但是对不伴恶性胸腔积液的患者效果更好,患者的KPS评分提高的更多.

Objective To investigate the relationship between the mutation of epidermal growth factor receptor (EGFR) gene and the biological behavior of lung cancer patients with malignant pleural effusion. Method 100 patients with lung cancer, including 43 cases with malignant pleural effusion (study group), and 57 patients without pleural effu-sion (control group), were observed for the EGFR mutation status. Result The overall EGFR mutation rate in the study group was 72.09%, significantly higher than that of the control group at 19.30%(P<0.05);the EGFR mutation rate of pa-tients with high, moderate and low differentiation in study group was 69.23%, 71.43%and 77.78%, which were signifi-cantly higher than those in the control group, respectively (P<0.05);gender, age, smoking status and differentiation de-gree were independent of the EGFR mutation rate in study group (P>0.05);the Kappa value of the EGFR gene test results obtained from pleural effusion and biopsy specimens was 0.466 (P<0.05), indicating a moderate consistency. Conclusion EGFR mutation rate is higher in lung cancer patients with malignant pleural effusion, but is not associated with gender, age , smoking status and differentiation degree.

Objective: To improve the interventional treatment of bronchial artery malformation feeding artery embolization intractable hemoptysis better therapeutic effect. Methods: From May 2009 - December 2013 DSA angiography confirmed cases of hemoptysis caused by bronchial artery malformation, 54 cases were randomly divided into treatment group and control group, treatment group gelatin sponge (GS) joint polyvinyl alcohol particles (PVA) and / or coils of 32 patients in the control group was simply GS22 cases. All patients 1d, 1 week, 1 month, 6 months, 1 year follow-up data variance, rank sum test for analysis.Results:Follow-up treatment group were cured 28 cases, effective in three cases, one case effectively. In the control group were cured 14 cases, effective in 5 cases, 2 cases. Treatment group was higher efficiency, lower relapse rate than the control group, the two groups and testP<0.05, the difference was statistically significant.Conclusion: Feeding artery embolization for the treatment of bronchial artery malformation intractable hemoptysis significant effect, method is safe, durable, bleeding quickly, recurrence rate, effective intervention to improve hemoptysis.Effectively improve the success rate of interventional treatment of hemoptysis.

Objective To explore the of the clinical curative effect and the analysis of recurrence comparing gelatin sponge( GS) in combination with yvinyl alcohol( PVA) particles with single application of GS and PVA to big haemoptysis blood supply artery embolization. Methods To 95 cases of large hemoptysis patients,randomly divided into treatment group and control group,treatment group GS joint PVA,a total of 52 cases,control group 1 application PVA21 example,22 cases of control group 2 application of GS. Some follow-up surveys took 3 months others took 12 months. Results There were immediate hemostasis 52 cases,effective rate of treatment group was 100%,the recurrence rate was 7. 7%( 4 /52). In the control group 1the rate of immediately stop bleeding was 90%( 19 /21),the recurrence rate was 19%( 4 /21); In the control group.( 2) the rate of immediate bleeding was 82%( 17 /22),the recurrence rate was 23%( 6 /22); effectiveness in treatment group is higher than the control group 2 the recurrence rate was lower than those of control group,the difference was of statistically significant( P<0. 05). Conclusion GS joint PVA completely radical embolization all big hemoptysis patients participate in lesions of blood vessels and treatment of primary disease,curative effect is distinct,the method is safe,durable,stop bleeding quickly,postoperative recurrence rate is low,improve successful rate effectively with the treatment of the big haemoptysis interventional.

Objective To discuss the clinical effect of non-invasive positive pressure ventilation in the treatment of severe pneumonia with respiratory failure. Methods 40 patients suffered from severe pneumonia admitted in Department of Respiratory Medicine of our hospital were divided into observation group and control group randomly. The control group were treated with continuous nasal catheter oxygen inhalation, and the observation group were treated with non-invasive positive pressure ventilation.The arterial blood gas improvement of the two groups was observed and the results were analyzed statistically. Results After the treatment, the results of arterial blood gas analysis of two groups' patients obtained improvement, compared with the results before the treatment, the differences were statistically significant(P<0.05). The improvement of the results of arterial blood gas indicators of the observation group was better than that of the control group, the difference was statistically significant(P<0.05). Conclusion Acute respiratory failure is a serious complication of severe pneumonia. Compared with traditional oxygen inhalation therapy, noninvasive positive pressure ventilation has a good effect in improving respiratory function of the patients, and is worthy of clinical promotion.

Objective To evaluate the clinical value of CT guided percutaneous lung biopsy.Methods Lung lesions of 153 patients underwent percutaneous lung biopsy by automatic cutting needle biopsy(18G).Results A total of 153 patients were punctured successfully,including 129 cases of cancer(48 cases had consistent pathologic and biopsy results),7 cases of inflammation,7 cases of necrotic tissue,5 cases of tuberculosis and 4 cases of fungus.Thirty-six patients had compilactions,including 32 cases of pneumothorax(20.9%),3 cases of hemoptysis or bloody sputum(1.9%)and 1 case of pleural bleeding.All the patients were discharged after treatment.Conclusion CT-guided percutaneous needle biopsy of lung lesions is safe and effective,with high diagnosis rate,fewer complications and high clinical value.

Objective To explore the prognosis factor of patients with severe pandemic H1N1 influenza.Methods To analysize manifestation and treatment of 6 cases with severe pandemic H1N1 influenza.Results 6 cases with severe pandemic H1N1 influenza recovered through active anti-virus and mechanical ventination treatment.Conclusion Anti-virus and mechanical ventination treatment can improve the prognosis of patients with severe pandemic H1N1 influenza.

Objective To explore the relationship between obstructive sleep apnea hypopnea syndrome (OSAHS) and airway hyperresponsiveness (AHR).Methods 197 subjects suspected for OSAHS were enrolled in the study.They were all performed overnight polysomnogram (PSG) monitoring and lung function test.Acoording to the results of FEV1%pred,they were performed bronchial provocation test(BPT) or brochial dilation test(BDT).The relation between apnea hypopnea index (AHI) and the degree of airway hyperresponsiveness (AHR,expressed as PD20-FEV1) was evaluated by linear correlation analysis.Results 117 patients were diagnosed as OSAHS,in which 28 cases were complicated with AHR(3 cases with positive BDT result,25 cases with AHR).In 80 non-OSAHS patients,7 cases were complicated with AHR.The incidence of AHR was higher in the OSAHS patients compared with the non-OSAHS patients(23.9% vs 8.8%,P<0.01).AHI of OSAHS patients with AHR was higher than OSAHS patients without AHR [(30.3±5.1)/h vs (23.7±2.4)/h,P<0.01].There was a positive correlation between AHI and degree of AHR in OSAHS patients with AHR(r=0.62,P<0.05,n=25).Conclusion OSAHS is associated with an increased risk of AHR.