目的 采用改良衰弱指数(mFI)探讨衰弱对老年胃癌患者围术期的影响.方法 选取2018年10月至2019年12月于我院择期行远端胃癌根治手术的老年患者90例,根据患者术前的mFI将其分为非衰弱组(mFI<3分,50例)和衰弱组(mFI≥3分,40例).比较两组的一般资料、入院时的各项生化指标及术后恢复情况;分析mFI与美国麻醉医师协会(ASA)分级的相关性.结果 衰弱组的年龄明显高于非衰弱组(P<0.05).Spearman秩相关性分析显示,mFI与ASA分级呈正相关(P<0.05).入院时,衰弱组的总蛋白、肌酐水平明显低于非衰弱组(P<0.05).衰弱组的瑞芬太尼、丙泊酚用量明显少于非衰弱组,血管活性药物使用率明显高于非衰弱组(P<0.05).衰弱组的术后苏醒时间、恢复室停留时间、术后下地时间、肛门排气时间、总住院时间明显长于非衰弱组,总花费明显多于非衰弱组(P<0.05).结论 衰弱患者术中管理相对困难,术后转归差.mFI与ASA呈正相关,是评估老年患者围术期风险程度的有力参考指标.

目的 探讨胶质瘤组织长链非编码RNA(lncRNA)HOXA反义转录物髓系异构体1(HOTAIRM1)、微小RNA-129-5p(miR-129-5p)表达变化及其临床意义.方法 选择胶质瘤患者83例(观察组)、因颅脑损伤接受手术治疗者55例(对照组),分别取手术切除的胶质瘤组织和正常脑组织,采用RT-qPCR法检测lncRNA HOTAIRM1、miR-129-5p表达,分析胶质瘤组织lncRNA HOTAIRM1表达与miR-129-5p表达的关系,以及二者表达与患者临床病理特征和预后的关系.结果 观察组lncRNA HOTAIRM1相对表达量高于对照组,miR-129-5p相对表达量低于对照组(P均<0.05).Pearson积矩相关分析显示,胶质瘤组织lncRNA HOTAIRM1相对表达量与miR-129-5p相对表达量呈负相关关系(r=-0.726,P<0.05).分别以胶质瘤组织lncRNA HOTAIRM1、miR-129-5p相对表达量的中位数为临界值,将患者分为lncRNA HOTAIRM1低表达者40例与lncRNA HOTAIRM1高表达者43例、miR-129-5p低表达者46例与miR-129-5p高表达者37例.lncRNA HOTAIRM1、miR-129-5p表达与肿瘤直径和WHO分级有关(P均<0.05),与患者性别、年龄、肿瘤位置、病理类型无关(P均>0.05).lncRNA HOTAIRM1高表达者累积生存时间低于lncRNA HOTAIRM1低表达者,而miR-129-5p高表达者累积生存时间高于miR-129-5p低表达者(P均<0.05).结论 胶质瘤组织lncRNA HOTAIRM1表达上调、miR-129-5p表达下调,二者表达变化与肿瘤直径、WHO分级和患者预后密切相关.

报告1例多发性基底细胞癌的临床表现、组织病理并结合相关文献做回顾性分析,探讨多发性基底细胞癌的临床特点及诊治方法.本例患者临床表现为面部多发性黑褐色斑丘疹,且逐渐增多20余年,皮损经组织病理检查确诊为多发性基地细胞癌.多发性基底细胞癌临床较为少见,但不能忽视,一般建议手术切除后送病理检查,并要重视随访.

目的 观察单次术前静脉注射小剂量地塞米松对乳腺区段切除术后患者免疫细胞及炎症反应的影响.方法 择期行乳腺区段切除女性患者40例,随机分为两组:对照组和治疗组,每组20例.两组均采用喉罩通气下全身麻醉,治疗组术前静脉注射地塞米松4 mg,分别于术前(t1)、术后24 h(t2)、术后48 h(t3)检测血细胞分类计数、血糖、C反应蛋白(CRP)、白细胞介素(IL)-6、IL-8表达水平、CD+4、CD+8比例.结果 与治疗组比较,对照组t2时间点白细胞、中性粒细胞及嗜酸性粒细胞计数均明显下降(P<0.05),淋巴细胞计数显著下降(P<0.01),CRP水平显著增高(P<0.05).与t1、t3时间点比较,对照组t2时间点CD+4、CD+8比例及CD+4/CD+8明显下降(P<0.05).结论 术前静脉注射小剂量地塞米松可以减轻术后24 h炎症反应,改变术后24 h免疫细胞计数,对术后免疫系统有一定影响.

OBJECTIVE:To investigate the role of epidermal growth factor receptor (EGFR) and c-Met in the oncogenesis, development and prognosis of non-small cell lung cancer (NSCLC).METHODS:The relative copy numbers of EGFR and c-Met mRNA were detected in 61 cases of NSCLC by fluorescent RT-PCR, and the correlation between EGFR and c-Met as well as their correlation to the clinicopathological data of the patients were analyzed. A survival analysis was also performed in relation to EGFR and c-Met expressions.RESULTS:The relative copy numbers of EGFR and c-Met were positively correlated (r=0.352, P=0.005). The levels of these two genes in smokers were 0.15 and 0.14, respectively, significantly higher than those in non-smokers (P<0.05); their levels were 0.16 and 0.14 in adenocarcinoma, respectively, significantly higher than those in squamous carcinomas (P<0.05). In patients with squamous carcinomas, a higher level of EGFR and c-Met DNA copies was associated with poorer prognosis, and Log Rank analysis indicated a survival difference in relation to EGFR and c-Met DNA copies (P=0.015, P=0.046).CONCLUSIONS:EGFR and c-Met may interact in a synergistic manner in the oncogenesis and development of NSCLC, and may help in the prognostic evaluation of squamous carcinomas.

[Objective] To evaluate the efficacy and toxicity of two different regimens as neoadjuvant chemotherapy for local advanced breast cancer. [Methods] From January 2001 to January 2004, 68 patients with stage Ⅱb-Ⅲ breast cancer were treated with one of two different regimens: CEF, NEF, for 2 cycles every 28 days. Accroding to the effect standard and toxic grading standard suggested by WHO, efficacy and safety were evaluated after 2 cycles of neoadjuvant chemotherapy. Patients in CEF regimen received combination of cyclophosphamide (CTX) 500mg/m2, d1, 8; epirubincin (EPI) 50 mg/m2, d1, 8; 5-fluorouracil (5-Fu) 500 mg/m2, d1, 8. Patients in NEF regimen received vinorelbine (NVB) 30 mg/m2, d1, 5; EPI 50 mg/m2, d1; 5-Fu 500 mg/m2, d1, 5. [Results] For primary tumor in the breast, the overall response rate (RR) was 47.2 % (17/36) in CEF regimen and 71.9 % (23/32) in NEF regimen. There was no disease progressive(PD) and one patient showed pathologic complete response (pCR) in both groups. For axillary lymph nodes, the overall response rate (RR) was 63.9 % (23/36) in CEF regimen and 87.5 %(28/32) in NEF regimen. Clinically palpable axillary lymph nodes which had been found in all 68 patients before treatment, 30.6 % (11/36) in CEF regimen and 53.1% (17/32) in NEF regimen became impalpable. The major toxicity, including leukopenia, gastroenteric reactions and alopecia were similar in both groups, but neurotoxicity and milieu phlebitis were the unique side-effects of the NEF regimen. [Conclusion] Neoadjuvant chemotherapy with two different regimens was all effective to the primary tumor and axillary metastatic lymph nodes of local advanced breast cancer, and the side effects were tolerable. Comparing with CEF, NEF regimen has higher efficacy and equal side effects.