目的 观察培美曲塞+奈达铂联合贝伐珠单抗治疗后培美曲塞联合贝伐珠单抗维持治疗方案在晚期非鳞非小细胞肺癌患者中的疗效和安全性,并探讨影响该化疗方案疗效的相关因素.方法 收集2015年6月—2018年6月经病理确诊的50例晚期非鳞非小细胞肺癌患者,所有患者均接受培美曲塞+奈达铂联合贝伐珠单抗治疗,并对治疗后疾病未进展的患者给予培美曲塞联合贝伐珠单抗维持治疗,直至疾病进展或出现不可耐受的不良反应.对患者的近期疗效和不良反应进行分析.结果 50例患者的客观缓解率(ORR)和疾病控制率(DCR)分别为42％(21/50)和86％(43/50),中位无进展生存期(PFS)为11个月(95％CI:8.1～13.9).治疗相关不良反应主要为骨髓抑制,但均可耐受,无不良反应相关性死亡.结论 培美曲塞+奈达铂联合贝伐珠单抗治疗后培美曲塞联合贝伐珠单抗维持化疗方案在晚期非鳞非小细胞肺癌患者中有较好的疗效和安全性.

Objective:To establish the xenografts in chicken chorioallantonic membrane (CAM) model with sorafenib-induced drug-resistant hepatocellular carcinoma cell lines.Methods:Applying continuity induction in vitro to obtain hepatocellular carcinoma sorafenib resistant cell lines. Using chicken CAM model to gain xenografts tumors in vivo. Exploring the characteristics of xenografts tumors, analyzing the expression of related target genes and signaling pathway included. For statistical analyses, t-test was used, and the results were considered significant at P<0.05. Results:Sorafenib-resistant HepG2 cell line was screened, named sHepG2, which half maximal inhibitory concentration (IC 50) [(88.7±7.6) μmol/ml] was higher than that of HepG2 significantly ( t=16.416, P<0.01). 5 cases of chick CAM models of HepG2 and sHepG2 cells were established respectively, and the xenograft tumor formation rate was 70% [(3+ 4)/(5+ 5)]. The fresh weight of xenograft tumors in HepG2 group [(0.093 2±0.012 2) g] was significantly lighter than that in sHepG2 group ( t=3.709, P<0.05). ComparedsHepG2 with HepG2, the expression of phosphoinositide 3-kinase (PI3K) ( t=9.336, P<0.01) and phospho-protein kinase B (p-Akt) ( t=7.123, P<0.01) werehigher, while phosphatase and tensin homolog deleted on chromosome ten (PTEN) ( t=6.164, P<0.01) and fibroblast growth factor receptor 1 (FGFR1) ( t=6.297, P<0.01), lowersignificantly. Conclusion:The establishment of sorafenib-induced HepG2 drug-resistant cell lines in vitro, the constructing xenografts in chicken CAM model with HepG2 drug-resistant cells, the exploration growth of xenografts tumors and relative protein expressions indicate that the chicken CAM model could be useful for HCC sorafenib-resistant research in vivo.

China has a heavy burden of hepatocellular carcinoma, which is a serious threat to people′s life and health. However, the available drugs for advanced hepatocellular carcinoma in the past are limited and the efficacy is not satisfactory. In recent years, immunotherapy has a significant effects in some tumors. The authors introduce the efficacy of restart immunotherapy on an advanced hepatocellular carcinoma patient undergoing interruption of treatment due to corona virus disease 2019, in order to provide references for the diagnosis and treatment of this kind of patients.

目的 探讨虚拟现实技术联合案例教学法在肿瘤康复治疗师教学中的应用效果.方法 选取2018年1—12月在华中科技大学同济医学院附属同济医院肿瘤科和康复医学科接受肿瘤康复培训的48名康复治疗师为对象,根据随机数字表法分为试验组(24例)和对照组(24例),试验组采用虚拟现实技术联合案例教学法进行教学,对照组采用传统讲授式教学.课程结束后,对两组学员进行理论考核和操作考核、问卷调查教学满意度,综合评价虚拟现实技术联合案例教学法在肿瘤临床康复治疗师教学中的应用效果.结果 试验组康复治疗师的理论考核成绩和操作考核成绩明显高于对照组[试验组理论基础知识(82.48±6.98)分,操作考核如运动治疗(16.62±2.89)分等](P<0.05).同时,试验组在教学满意度多维度调查评估表各项评分均明显高于对照组[试验组兴趣吸引力(4.28±0.62)分、理解记忆力(4.14±0.66)分、沟通能力培养(4.09±0.60)分等](P<0.05).结论 虚拟现实技术联合案例教学法在肿瘤康复治疗师教学中的应用能提升教学质量和教学满意度,培养全面的理论基础知识、操作实践能力和沟通能力.

目的 探讨3D打印技术联合案例教学法在头颈肿瘤临床教学中的应用效果.方法 选取2016年1月-2017年12月在某大学附属医院肿瘤科接受住院医师规范化培训的60名学员为教学对象,随机分为实验组(30例)和对照组(30例),实验组采用3D打印技术联合案例教学法教学,对照组进行传统讲授式教学.课程结束后,对两组学员进行统一考试统计成绩,发放调查问卷评估教学满意度,综合评价3D打印技术联合案例教学法的教学应用效果.结果 实验组和对照组学员性别、年龄和全省规范化培训学员统一招录总成绩差异无统计学意义(P>0.05);实验组学员的理论基础知识、典型病例分析、临床操作技能和常见影像阅片成绩均明显高于对照组,差异有统计学意义(P<0.05).同时,实验组在兴趣吸引力、理解记忆力、培养临床思维、知识层面扩展、医患沟通能力培养等教学满意度调查评估表各项评分均明显高于对照组,差异有统计学意义(P<0.05).结论 3D打印技术联合案例教学法在头颈肿瘤临床教学中的应用,有益于提升头颈肿瘤教学课程的教学质量和教学满意度,培养良好的临床思维和临床实践能力.

[目的]探讨颅内生殖细胞肿瘤的初次临床诊断特征,以期提高肿瘤的初次诊断率.[方法]收集华中科技大学同济医学院附属同济医院于2012年1月至2017年12月期间,诊断为颅内生殖细胞肿瘤的42例患者临床资料,分析其临床表现、组织类型、病理类型和影像学资料,研究治疗前临床诊断的特点.[结果]42例颅内生殖细胞肿瘤患者中,40例初次临床诊断为肿瘤相关性病变,包括19例影像学诊断(47.50％)、14例临床表现诊断(35.00％)、7例辅助检测诊断(17.50％);影像学诊断生殖细胞性肿瘤的敏感性为45.24％.[结论]对于出现特异性临床表现的青少年患者,应结合异常血清学指标,辅助中枢神经系统影像学特征,进行综合诊断,可提高颅内生殖细胞肿瘤的初次诊断率.

目的 研究肝癌免疫细胞的浸润模式,探索免疫细胞浸润与预后的关系.方法 从TCGA数据库下载肝细胞癌转录本数据及相关临床数据,通过Cibersort软件的反卷积法计算22种免疫细胞的占比.采用K-M生存分析Log-Rank法计算每种免疫细胞与生存的相关性.结果 从TCGA数据库中得到基因转录本数据共424例,包含肝癌组织374例、正常肝组织50例.每个样本检测基因位点60483个,包含mRNA 19658个.数据校正后使用Cibersort软件"反卷积法"得到22种免疫细胞的占比数据,采用P<0.05筛选样本,得到肝细胞癌组织40例、正常肝组织2例.K-M生存分析显示活化的肥大细胞、未活化的自然杀伤细胞、嗜酸性粒细胞组成比例高者预后差,活化的自然杀伤细胞比例高者预后更好.结论 肝癌中存在各类免疫细胞不同程度的浸润,浸润性免疫细胞可以作为影响肝癌患者预后的因素.

目的:研究展开式教学法在肿瘤科临床带教实习教学中的应用效果.方法:取我院肿瘤科本科实习生36例为研究对象,随机分研究组(展开式教学法)与对照组(传统带教模式)各18例,比较考核成绩与带教满意度.结果:研究组较对照组理论成绩、实践成绩与总成绩均高,研究组学习能力、团队协作能力、沟通能力与病历书写能力的分值较对照组均高,P＜ 0.05(具统计学差异).结论:对肿瘤科本科实习生采用展开式教学法能提高教学质量,培养其学习能力与沟通能力,优化考核效果,值得借鉴.

目的:观察系统性康复训练对鼻咽癌患者放疗后吞咽困难 、张口受限的治疗作用.方法:选取鼻咽癌放疗后出现吞咽困难 、张口受限者共82例,随机分为观察组和对照组.2组患者均接受常规对症支持治疗,观察组接受系统性康复训练共3个月.分别采用洼田饮水试验和张口度测量比较2组患者治疗前后吞咽困难 、张口受限的缓解情况.结果:与对照组比较,观察组患者在接受康复训练后饮水试验总有效率显著提高(P<0.05),门齿间距显著增大(P<0.05).结论:系统性康复训练可以显著改善鼻咽癌放疗后患者出现的吞咽困难 、张口受限,值得在临床进一步推广.

目的:探究Sandwich教学法在临床肿瘤学教学中的应用.方法:在2016年3月—2017年9月,选取我院90例临床肿瘤学实习生,均分为对照组与观察组,对照组给予传统教学方法进行教学,观察组给予Sandwich教学法进行教学,观察学生考试成绩、教学效果及教学满意度.结果:观察组学生考试成绩比对照组高,教学效果比对照组高,教学满意度比对照组高,P<0.05.结论:在临床肿瘤教学中应用Sandwich教学法,能提高学生考试成绩及教学效果,学生对这种教学方式的认可度较高,值得借鉴.

Objective To evaluate the effect of regimens containing bevacizumab on platelet parameters of patients with metastatic non-small cell lung cancer (NSCLC). Methods A total of 58 patients with metastatic NSCLC were recruited, and all of them were given Beva-cizumab chemotherapy. Their clinical data were retrospectively analyzed. Their platelet counts (PLTs), platelet distribution width (PDW), mean platelet volume (MPV), platelet–large-cell ratio (P-LCR), and platecrit (PCT) values at baseline and after three months of chemo-therapy were recorded in the SPSS 18.0 program. Results PCT significantly decreased during treatment with bevacizumab (P=0.024). Subgroup analysis revealed that PLTs significantly decreased in the male group and ≥60-year-old group (P=0.022, 0.012). The PCT was significantly diminished in the male group and first-line chemotherapy group (P=0.015, 0.004). After treatment, one case of subcutaneous bleeding (3.03%) occurred in the first-line chemotherapy group, and one case of pulmonary hemorrhage (4.00%) occurred in the second line chemotherapy group. The total incidence of bleeding was 3.44%. Conclusion The chemotherapy regimens containing bevacizumab could decrease PCT of patients with metastatic NSCLC.

目的 观察TNX方案(多西他赛+奈达铂+卡培他滨)诱导化疗治疗局部晚期鼻咽癌患者的近期疗效和安全性.方法 对20例局部晚期鼻咽癌患者采用TNX方案化疗:多西他赛75 mg·m?2,d1;奈达铂90 mg·m?2,d1;卡培他滨1000 mg·m?2口服,d1～14;3周为1个化疗周期,至少治疗2周期.对患者的近期疗效和不良反应进行分析.结果 PR 15例(75％),SD 4例(20％),PD 1例(5％).最常见的血液学毒性为:Ⅲ～Ⅳ级中性粒细胞减少7例(35％),Ⅲ级贫血1例(5％),未发生Ⅲ～Ⅳ级血小板减少以及Ⅲ～Ⅳ级非血液学毒性.结论 对局部晚期鼻咽癌患者采用TNX方案诱导化疗具有较好的临床疗效,耐受性良好.

Objective To find differentially expressed genes between glioblastoma and normal tissues by bioinformatics a-nalysis,and to investigate their molecular function and interactions from the transcriptional level.Methods The gene expression profile datasets GSE4290,including 81 samples of glioblastoma and 23 samples of normal tissue from epileptic patients,were downloaded from Gene Expression Omnibus(GEO).Differentially expressed genes between the two kinds of tissue were identi-fied by R package.The GO analysis,KEGG pathways,and protein-protein interactions were analyzed by DAVID,STRING data-base.Results A total of 823 differentially expressed genes were identified,including 214 up-regulated and 609 down-regulated genes.GO analysis showed that differentially expressed genes were mainly involved in cell attachment,synaptic chemical signal transduction,axon and synapse etc.KEGG pathways showed that it was enriched in 32 KEGG pathways,including nicotine ad-diction,morphine addiction,GABAergic synapses,synaptic vesicle cycle,ECM-receptor interaction,ErbB signaling pathway, HIF-1 signaling pathway,and RAS signaling pathway.The protein-protein interaction networks were analyzed by STRING da-tabase.Conclusion Bioinformatics can be effectively used to analyze glioblastoma microarray data to provide theoretical refer-ence for further exploration of tumorigenesis mechanism and help search for potential drug therapeutic targets.

目的 探讨内向整流钾通道J亚家族成员15(KCNJ15)在肺腺癌组织中的表达及其对肺腺癌A549细胞增殖和迁移的影响.方法 收集本院2006年7月至2015年10月经手术切除的肺腺癌组织1 17例和癌旁组织50例,采用实时定量PCR法检测以上组织中KCNJ15 mRNA水平,分析肺腺癌组织KCNJ15 mRNA水平与临床病理特征(性别、年龄、肿瘤大小、临床分期、肿瘤位置、淋巴结转移和病理分级)的关系,根据随访资料分析不同KCNJ15 mRNA水平的预后情况.构建过表达KCNJ15的载体并转染A549细胞,采用CCK-8法和Transwell试验分析KCNJ15基因在肺腺癌细胞增殖和迁移中的功能.结果 与癌旁组织相比,肺腺癌组织中KCNJ15 mRNA水平降低(P＜0.05);KCNJ 15表达与肺腺癌患者的肿瘤大小和临床分期有关(P＜0.05),与年龄、病理分级、性别、淋巴结转移和肿瘤位置无关(P＞0.05);KCNJ15高表达的肺腺癌患者的总生存期长于低表达者;获得性功能实验结果表明,KCNJ15基因过表达能够抑制肺腺癌细胞的增殖和迁移能力.结论 KCNJ15基因在肺腺癌中的表达明显降低,其表达与肺腺癌患者的肿瘤大小和临床分期有关,在肺腺癌患者生存中是一个重要的有利预后标志物,可作为潜在的肺腺癌临床治疗新靶标.

目的:探究高迁移率族蛋白B1(HMGB1)、人跨膜蛋白(Notch1)和增殖细胞核抗原(PCNA)在宫颈癌组织的表达及临床意义.方法:选取2015年1月-2018年1月于本院确诊为宫颈鳞癌并行手术治疗的患者60例宫颈组织(宫颈癌组),另取同期本院确诊为宫颈上皮内瘤变(CIN)Ⅲ期的患者40例(CIN组)和参加体检的健康志愿者20例(对照组)宫颈组织.采用免疫组化方法检测各组标本组织中HMGB1、Notch1和PCNA,探究宫颈癌组织不同临床病理特征下3种细胞因子的表达差异及相关性.结果:HMGB1、Notch1和PCNA的阳性表达率宫颈癌组＞CIN组＞对照组(P均＜0.05).宫颈癌组患者分化程度低、临床病理分期(TNM)高的标本HMGB1、Notch1和PCNA的阳性表达程度最高,且HMGB1、Notch1和PCNA在表达上两两间均呈正相关(P均＜0.05).结论:与对照组和CIN组宫颈组织相比,在宫颈癌组的HMGB1、Notch1和PCNA表达显著提高,其表达程度随分化程度下降、TNM分期增加而提高.