目的:观察TP53、KRAS、KDR、APC、MLH1及PIK3CA等56个基因在消化道恶性肿瘤中的突变情况,探讨驱动基因的诊疗意义.方法:选择胃食管癌15例、结直肠癌21例患者组织石蜡标本,运用高通量基因测序技术检测56个肿瘤突变高频基因,并进行生物统计分析.结果:36例标本检出34例有已知基因突变,突变基因为TP53、KRAS、MLH1、PIK3CA、KDR、APC、SMARCB1、KIT、EGFR、NRAS、STK11、SMO、SMAD4、CDH1、ERBB2、JAK2和RET共17种.其突变率由高到低依次为:TP53(75.00％),KRAS(33.33％),MLH1、PIK3CA、KDR(均为13.89％),APC(11.76％),SMARCB1(8.82％),KIT、EGFR及NRAS(均为2.78％).KRAS在结直肠癌中的突变率(47.62％)显著高于在胃食管癌中的突变率(13.33％).TP53的突变率明显高于其他突变基因.在结直肠癌中KRAS的突变率显著高于KDR、APC、MLH1,未发现有统计学关联.结论:消化道恶性肿瘤TP53突变率较高,可能与病理组织分化程度低及淋巴结转移有关.KRAS在结直肠癌中较在胃食管癌中更易发生突变,存在部位差异.同时KRAS与KDR、APC、MLH1,在结直肠癌患者中存在共突变现象,提示结直肠癌的酪氨酸激酶通路和血管内皮生长因子受体基因在致癌过程中可能存在协同作用,导致肿瘤在结直肠中更易发生发展,选择靶向药物治疗时需考虑协同作用,以便科学精准用药.

Objective To investigate the correlation between serum vascular endothelial growth factor(VEGF)and the fac-tors of depression in patients with primary liver cancer(HCC).Methods The retrospective analysis was about 43 cases of primary liver cancer patients of Shaanxi Provincial People's Hospital,from September 2015 to September 2016.The self-rat-ing depression scale was used to evaluate the patients with depression and non-depression group.By ELISA kits,test VEGF levels,analysis of depression,age,gender and serum VEGF concentration.Results The level of VEGF in patients with de-pression was 86.21±19.52 pg/ml,which was significantly higher than that in patients without depression(48.31±9.16 pg/ml)by t test(t=-2.968,P=0.005).The levels of serum VEGF in patients with different gender groups were meas-ured by t test(t=0.079,P=0.938).And the serum levels of VEGF were measured in patients with different age groups by multiple sets of variance analysis(F=0.618,P=0.655).For age and gender,there was no significant difference in serum VEGF level between HCC.Conclusion By HCC,it was related between depression and the level of serum VEGF,and it suggests that serum level of VEGF may become the prognosis of primary liver cancer detection index for these patients.Giv-ing psychological interventions earlier,may improve the prognosis of cancer patients with depression.

Objective:Using NGS sequencing platform,study the distribution and characteristics of ovarian cancer gene mutations and look for targets of medicines;by analysis the mutation sites,types and frequency,com-bined with the tumor markers,predict the recurrence or metastasis,then screening,early intervention on a regular ba-sis.Methods:16 cases from ovarian tissue paraffin specimens by clinically confirmed,using the high-throughput se-quencing Ion torrent PGM platform,test the 2835 gene loci of 50 genes and the data analysis.Results:50 genes mu-tations were in the concentrated in EGFR,KDR,KIT,KRAS,NOTCH1 and SMAD4,TP53 seven 21 gene loci.TP53 mutations among the proportion were as high as 75％,and mutation of 4 exon c.215C>G has the highest percent-age.Conclusion:The patients with ovarian cancer can be according to the target gene mutations in accurate treat-ment,TP53 high mutation rate suggests it plays an important role in the occurrence of tumor development,combined with clinical study can provide the basis for recurrent branch predictions.

Objective To study the efficiacy of transurethral elecuovaperization prostatectomy (TUVP) for BPH. Method From Feb. 1998 TO Feb, 200 patients with benign prostatic hyperpiasia (BFH) had been treated with TUVP. Results A significant improvement of international prostatic symptom score(IPSS) ,quality of life (QOL) and a reduction of residual urine (RU) has been achieved following up 1-24 Months. Conclusion The benefits of TUVP therapy were simple, less blood loss,safe with less complications,effective with more resected prostate tissue,relatively shorter operation time and a quicker recovery.