病人,男,28岁.因发现右颈部肿物1 个月于2019 年9 月20 日入院.病人无意中发现右颈部肿物,约硬币大小,无疼痛,无吞咽困难及呼吸困难.体格检查:右颌下,胸锁乳突肌前方触及1 类圆形肿物,大小约2.5 cm ×1.5 cm,无压痛,质软,边界清.颈部B超检查见右颈动脉外侧混合回声,大小2.3 cm ×1.1 cm,边界清,实性成分内可见粗大钙化,可见血流信号,同时双叶甲状腺未见异常.颈部增强CT见颈部肿物为囊性,增强扫描囊性部分无强化,边缘可见结节样强化(图1).进一步行细针穿刺检查提示乳头状癌,怀疑淋巴结转移癌,结合影像学检查未见原发病灶.

目的 探讨不同的鼻饲营养途径对出血坏死性胰腺炎患者疾病发展状况的影响.方法 选择162例连续禁食、胃肠减压48 h以上,且肠蠕动恢复、腹痛已缓解的出血坏死性胰腺炎患者按入院时间先后分成两组,对照组行鼻胃管鼻饲(70例),观察组鼻空肠管鼻饲(92例).记录两组患者的并发症发生情况、淀粉酶恢复正常时间、白蛋白恢复正常时间、C反应蛋白恢复正常时间以及住院时间.结果 观察组患者在出现感染、消化道出血、腹泻、腹腔脓肿、多脏器功能不全及死亡例数均显著少于对照组,差异有统计学意义(P＜0.05).观察组患者的淀粉酶恢复正常时间、白蛋白恢复正常时间、C反应蛋白恢复正常时间、住院时间均显著短于对照组,差异有统计学意义(P＜0.05).结论 对出血坏死性胰腺炎患者护理中使用螺旋空肠管进行肠内营养优势明显,并发症显著减少,恢复时间短,护理难度低,值得临床推广.

[目的]探讨TRAIL与舒尼替尼(sunitinib)体外不同用药方式下对表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)抵抗的NSCLC A549细胞的抗肿瘤活性及其机制.[方法]实验分为对照组、TRAIL组、舒尼替尼组、TRAIL联合舒尼替尼组(T+S)、TRAIL序贯舒尼替尼组(T→S)和舒尼替尼序贯TRAIL组(S→T).CCK8法检测TRAIL和舒尼替尼对A549细胞的生长抑制作用;流式细胞术检测TRAIL和舒尼替尼作用后细胞周期变化及诱导的细胞凋亡;Western blot检测TRAIL和舒尼替尼作用后Akt、p-Akt蛋白表达的变化.[结果]T+S组及T→S组的抗增殖作用及诱导细胞凋亡的能力明显优于TRAIL组、舒尼替尼组及S→T组(P均＜0.05).细胞周期显示,TRAIL和舒尼替尼均能使细胞周期阻滞于G0/G1期,T+S组、T→S组对G0/G1期的阻滞作用明显增强.Western blot结果显示,TRAIL单独作用于A549细胞能明显上调p-Akt的表达,而舒尼替尼能下调p-Akt的表达;T+S组、T→S组、S→T组p-Akt的表达明显减少.[结论]舒尼替尼通过抑制TRAIL诱导的PI3K/Akt通路活化,增加TRAIL诱导的A549细胞凋亡.此外,两药物对A549细胞周期的特异性阻滞作用,也是诱导凋亡增加的原因之一.

Objective To investigate the preventive effect of OEC management model on lower limb deep venous thrombosis (DVT) among gastrointestinal tumor patients after tumor resection. Methods We chose the gastrointestinal examination data from June 2012 to January 2013 as a baseline, the survey results as the control group, and the results of the 6 months of the implementation of OEC management mode as the observation group. We compared the incidence of DVT, the DVT related knowledge control among patients and relatives, the file establishment of thrombosis prevention. Results There were 11 cases of observation group suffered DVT in all 873 patients of observation group, comparing with 31 cases of total 778 patients in the control group with statistical difference between two groups (χ2 = 12. 310,P < 0. 01). Because of DVT, the medical tangles were 7 cases in the observation group and 23 cases in the control group (χ2 = 10. 697,P < 0. 01). In the observation group, the DVT related knowledge and safe quality of DVT prevention acquired (94. 11 ± 3. 14), (95. 33 ± 3. 07) higher than (84. 51 ± 4. 08), (83. 19 ± 4. 62) in the control group (t = 14. 512, 19. 647, respectively;P < 0. 01). The cause of DVT forming were the same in two groups including advanced age, braking, medical history of thrombosis and surgery (P > 0. 05). Conclusions For patients with gastrointestinal tumor operation, OEC management model has good preventive effect on the formation of deep venous thrombosis of lower extremity.

非小细胞肺癌(non-small cell lung cancer,NSCLC)由于临床症状不明显,导致其确诊时已处于晚期,成为主要的致死性肿瘤之一.NSCLC传统治疗,包括手术切除、术后化疗或化放疗.铂类是治疗多种实体肿瘤的一线药物,以铂类为主的联合化疗方案目前仍是治疗NSCLC的主要方案.顺铂(cis-diamminedichloroplatinu, DDP)作为第一代铂类药物,广泛用于临床治疗.DDP进入细胞后,被水分子取代两个氯离子而激活,作用于DNA上N7嘌呤,形成链内或链间交联,导致DNA损伤,最终激活细胞凋亡途径引起细胞凋亡[1].大多数患者在化疗初期对化疗药物敏感,肿瘤体积缩小,但随着肿瘤细胞增殖速度加快,继续使用原方案治疗,肿瘤组织对化疗药物敏感性下降,肿瘤体积增大导致其复发.复发性肿瘤更有侵蚀性,也更容易发生转移,对传统药物产生获得性耐药.因此,耐药性是影响化疗效果和肿瘤根治的主要原因.