目的:探讨长链非编码RNA BLACAT1(lncRNA BLACAT1)调控microRNA-29a-3p(miR-29a-3p)对甲状腺癌细胞恶性生物学行为的作用及其可能机制.方法:收集2018年06月至2019年03月在我院行甲状腺癌切除术的31例患者的肿瘤组织和相应的癌旁组织.采用qRT-PCR检测lncRNA BLACAT1、miR-29a-3p在甲状腺癌组织、癌旁组织、5种甲状腺癌细胞系(SW579、PDTC-1、HMGA1、TPC-1、KAT-5)及正常甲状腺细胞Nthy-ori 3-1中的表达水平;调控TPC-1甲状腺癌细胞系中lncRNA BLACAT1、miR-29a-3p的表达,采用CCK-8法检测细胞增殖情况,Transwell法检测细胞的迁移和侵袭能力.用生物信息分析和双荧光素酶报告基因法预测和验证lncRNA BLACAT1与miR-29a-3p的靶向关系.结果:与癌旁组织和正常甲状腺细胞相比,甲状腺癌组织和细胞系中lncRNA BLACAT1的表达水平显著上调,miR-29a-3p的表达水平显著下调(P<0.05);过表达lncRNA BLACAT1促进TPC-1细胞的增殖、迁移和侵袭;在甲状腺癌组织中lncRNA BLACAT1的表达水平与miR-29a-3p的表达水平呈负相关(r2=0.492,P<0.001);双荧光素酶分析证实lncRNA BLACAT1能特异性结合miR-29a-3p,并能降低其表达;过表达miR-29a-3p抑制TPC-1细胞的增殖、迁移和侵袭,且miR-29a-3p可以抑制由lncRNA BLACAT1过表达引起的TPC-1细胞增殖、迁移和侵袭能力的增强.结论:lncRNA BLACAT1通过靶向调控miR-29a-3p表达影响甲状腺癌细胞的增殖、迁移和侵袭,从而促进甲状腺癌的发展.

目的 探讨半乳糖凝集素3(Gal-3)在乳腺癌患者中的表达水平及其与上皮间质转化(EMT)的关系.方法 选择86例女性浸润性乳腺癌患者的癌组织和癌旁组织作为研究对象,其中发生肝转移者32例.采用免疫组化法检测Gal-3、波形蛋白(Vim)、E-钙黏附蛋白(E-cad)表达,采用Western blot法检测Gal-3的表达,分析Gal-3的表达与临床病理参数的关系.构建siRNA-Gal-3-vector和lentivirus-Gal-3-vector,转染SKBR-3细胞,用Western bolt法检测转染后细胞中Gal-3、E-cad及Vim的表达,并观察细胞的迁移及侵袭情况.结果 86例患者癌旁组织Gal-3和Vim阳性表达率为0,E-cad表达阳性率为100％;86例患者乳腺癌组织Gal-3、Vim、E-cad阳性表达率分别为81％、57％和26％,与癌旁组织均有非常显著差异(均P＜0.01).发生肝转移者乳腺癌组织Gal-3、E-cad、Vim阳性表达率与未发生肝转移者有非常显著差异(分别为100％ vs.70％,47％vs.13％,69％ vs.48％,P＜0.01).Gal-3的阳性表达与TNM分期、腋窝淋巴结的转移及肝转移存在显著的相关性(P＜0.05).lentivirus-Gal-3-vector组乳腺癌细胞中Gal-3的表达显著增加,乳腺癌细胞的迁移与侵袭能力显著增加(P＜0.01);EMT标志分子E-cad表达显著降低、Vim表达显著增加(P＜0.01).结论 Gal-3在浸润性乳腺癌患者中呈现高表达,可能通过调控EMT促进乳腺癌细胞的浸润与转移.

目的 分析甲状腺癌术后碘131联合甲状腺激素应用效果.方法 回顾性分析2016年6月至2019年7月间收治的196例甲状腺癌患者的临床资料.按术后围术期不同治疗方案分为两组,即联合组(n=98),采用碘131联合甲状腺激素治疗;常规组(n=98),采用甲状腺激素治疗;采用SPSSS23.0统计软件处理数据,两组肿瘤相关因子、乳腺癌转移抑制基因1(BRMSl)和细胞缝隙连接蛋白43(Cx43)阳性表达率等计量资料以(x-±s)表示,采取独立t检验;残余甲状腺组织清除率等计数资料采取χ2检验;P<0.05为差异有统计学意义.结果 联合组用药3个月后残余甲状腺组织清除率62.2％高于常规组的46.9％;P53、Fas及TNF-ɑ表达高于常规组(P<0.05).联合组用药后BRMSl和Cx43阳性表达率分别为92.9％、94.9％高于常规组的81.6％、80.6％(P<0.05).两组不良反应发生率差异无统计学意义(P>0.05).结论 甲状腺癌手术患者采用碘131联合甲状腺激素治疗,能够提高BRMS1和Cx43蛋白表达阳性率,促使残余甲状腺组织清除,临床价值高,值得应用.

Objective The purpose of this study was to investigate the advantages of total thyroidectomy in the treatment of unilateral multiple papillary thyroid microcarcinoma (UMPTMC). Methods Retrospective analysis of 90 patients with UMPTMC who underwent first operation from September 2014 to September 2016. Of these, 53 underwent unilateral lobar thyroidectomy (HT). The other 37 cases underwent total thyroidectomy (TT). Pearson chi-square test, Student’s t test and Kaplan-Meier method were used to plot the survival curve, and logarithmic rank test was used to score the survival curve. Subsequently, Cox proportional hazard analysis was used to analyze disease-free survival (P<0.05). Results The total diameter of all tumors in the HT group was >10 mm more common than in the TT group (39.6% vs.18.9%; P=0.046); the positive rate of central lymph node metastasis was higher in the TT group than in the HT group (81.1% vs. 60.4%) ; P=0.046); the incidence of tumor recurrence in the HT group was higher than in the TT case (26.4% vs. 2.7%; P=0.007). Disease-free survival rates were 90.6% (48/53) and 73.6% (39/53) in the HT group at 6 months and 11 months, and 100% (37/37) and 91.9% (34/37) in the TT group, respectively. Disease-free survival was significantly shorter in the HT group than in the TT group (log-rank test P=0.0059). Univariate analysis of Cox’s proportional hazard analysis showed that men, all tumors with a total diameter > 10 mm and central lymph node metastasis were risk factors for recurrence in HT patients. Conclusion Total thyroidectomy for unilateral multiple UMPTMC patients can effectively reduce the recurrence rate of tumor and prolongs the disease-free survival period. Therefore, with the increase of recurrence risk, TT is more appropriate for the initial operation of UMPTMC, especially for male patients and patients with total tumor diameter greater than 10 mm. Key words: Carcinoma, papillary; Thyroid neoplasms; Thyroidectomy

Objective To investigate the results of laparoscopic exploration and treatment of recurrent incomplete adhesive intestinal obstruction . Methods 120 patients with intestinal obstruction treated in our hospital from May 2011 to September 2013 were enrolled in this study .The patients were divided into a laparoscopic group and an open group according to the time of admission , with 60 patients in each group.SPSS18.0 was used for data analysis , and the postoperative indexes and pain scores were expressed as mean ±SD and Student ’ s t test was used for data evaluation .The incidence of complications and the cure rate were tested by the Chi-square test.The satisfaction rates were compared using Wilcoxon ’ s rank-sum test.P<0.05 was considered statistically significant . Results of Operative time, postoperative off-bed time, and bleeding volume in the laparoscopic group were significantly different from those in the open group (P<0.05), and the recovery of intestinal peristalsis , the time of catheter removal and the length of hospital stay were also significantly shorter than those in the open group (P<0.05).The pain index and healing time of the laparoscopic group were significantly lower than those in the open group , and the cure rate (90.0%) was significantly higher than that (66.7%) in the open group.The differences between the two groups were statistically significant (t=57.179, P=0.000;t=19.713, P=0.000;χ2 =9.624, P=0.002). The incidence of complications in the laparoscopic group was 10.0%, which was significantly lower than that (33.3%) in the open group (χ2 =13.141, P<0.05).The satisfactory rate in thelaparoscopic group was 88.4%, which was significantly higher than that in the open group (u=3.824, P<0.05). Conclusion&nbsp;For patients with recurrent adhesive intestinal obstruction , laparoscopic treatment was effective, with fewer complications and faster recovery .Therefore, it is worth popularizing in clinical treatment .

甲沟炎是甲沟及其周围组织的感染,常因微小创伤引起[1].局部表现为红肿、疼痛,伴炎性渗出及肉芽组织增生,致病菌多为金黄色葡萄球菌,腐物寄生性真菌等.中医认为本病属“蛇眼疔”范畴[2].多由外伤染毒,毒邪阻于皮肉之间,致局部气滞血瘀,郁而化热而成.甲沟炎反复发作导致疼痛,影响正常行走功能,给患者生活、工作、学习带来很大不便,甚至产生心理压力,如不及时治疗去除病灶,复发率可达60％-80％[3].

Objective To analyze the risk factors of central regional lymphatic metastasis of patients with thyroid papillary microcarcinoma . Methods From June 2010 to June 2014, the clinical data of 50 patients with papillary thyroid microcarcinoma were retrospectively analyzed .Statistical analysis were performed by using SPSS 21.0 software.In present study, if patients with multiple lesions, maximum diameter of lesions was collected and analyzed by using chi square test and logistic regression .Risk factors of central regional lymphatic metastasis of patients with thyroid papillary microcarcinoma were evaluated .A P value of <0.05 was considered to be significant difference . Results Among 50 patients underwent central lymph node dissection , 42.1%of central regional lymphatic metastasis were observed in patients ≤45 years old, while 25.0%of central regional lymphatic metastasis in patients ≥45 years old (χ2 =15.38). 60.0%of central regional lymphatic metastasis were observed in 10 male patients, while 22.5%of central regional lymphatic metastasis were observed in 40 female patients (χ2 =9.76).When tumor diameter was less than 5 mm (including 5 mm), the was 22.7%, while 35.7%of metastasis rate in patients with tumor diameter more than 5 mm (χ2 =4.16), with statistically significant difference (P<0.05).However, there was no significant correlation between the number of tumors and metastasis rate (χ2 =0.049).By using logistic regression analysis, data showed risk factors of central regional lymphatic metastasis included ≤45 years old, male and the tumor diameter >5 mm. Conclusion Central regional lymphatic metastasis is common in patients with thyroid papillary microcarcinoma .When the tumor diameter more than 5mm, central&nbsp;lymph node dissection should be performed to improve the quality of life .

目的：探讨伴微浸润的乳腺导管内癌术后辅助化疗对患者预后的影响。方法将我院肿瘤科2003年12月至2008年12月收治的50例乳腺导管内癌术后患者根据化疗方案分为CEF组(28例，采用CEF方案)和FPC组(22例，采用FPC方案)，FPC方案为5-氟尿嘧啶+吡喃阿霉素+环磷酰胺，CEF方案为环磷酰胺+表柔比星+5-氟尿嘧啶+多西他赛，比较两组患者化疗期间的毒副反应及5年生存情况差异。结果 CEF组与FPC组仅血液系统毒性、皮肤黏膜系统损伤、心脏毒性发生率比较差异具有统计学意义(P<0.05)，CEF组的上述不良反应发生率显著低于FPC组；消化系统毒性、神经系统毒性、生殖系统毒性发生率在两组中比较差异均无统计学意义(P>0.05)。CEF组的无病生存中位期为41个月，FPC组为36个月，两组患者的无病生存中位期比较差异无统计学意义(P>0.05)；CEF组的生存中位时间为51个月，FPC组为46个月，两组患者的中位生存时间比较差异无统计学意义(P>0.05)。结论伴微浸润的乳腺导管内癌术后患者采用CEF方案进行辅助化疗较FPC方案的毒副反应发生率低，但是对患者的无病生存时间及总的生存时间不会显著延长。

Objective To investigate the significance of ER,PR and Ki67 in breast cancer treated by neoadjuvant chemotherapy,and to analyze the correlation between these factors and patient's prognosis. Methods The data about 120 patients with breast cancer treated by neoadjuvant chemotherapy from June 2012 to February 2014 in our hospital were retrospectively analyzed. The expression levels of ER,PR and Ki67 were detected by immunohistochemistry to evaluate the therapeutic effects of chemotherapy. Results There were no significant differences in the expression of ER,PR and Ki67 between positive group and negative group( P 0. 05). The pathological complete response( p CR) rates in ER-negative group were significantly higher than those in ER-positive group( P 0. 05). The p CR rates in PR-negative group were significantly higher than those in PR-positive group( P 0. 05). However there was no significant difference in p CR between Ki67-negative group and Ki67-positive group( P 0. 05). Moreover ER was closely related with PR( P 0. 01). Ki67 was negatively correlated to ER or PR( P 0. 01). After treatment the case number with high-expression of Ki67 was obviously decreased( P 0. 01). Conclusion ER,PR and Ki67 can be regarded as predictive indexes for evaluating the therapeutic effect of neoadjuvant chemotherapy on breast cancer.

目的 探讨情景互动教育模式在糖尿病患者中的应用效果.方法 将需笔型胰岛素注射的80例糖尿病患者,随机分为试验组和对照组,试验组采取情景互动健康教育模式,对照组采取传统健康教育方式,评价两组患者使用笔型胰岛素注射的掌握程度、糖尿病健康教育知识及患者的满意度.结果 试验组在糖尿病相关知识、胰岛素笔注射的操作技术及患者满意度均明显优于对照组(P＜0.01).结论 实施情景互动健康教育模式提高了糖尿病患者胰岛素治疗的依从性和自我管理能力,确保了患者院外注射的安全性,在临床值得推广应用.

目的：探讨临床护理路径在颅脑损伤并发休克急救过程中的应用效果。方法将86例颅脑损伤并发休克患者随机均分为2组。正常组43例急救时辅以传统护理治疗，实验组43例则予以临床护理路径辅助急救。术后对2组患者的急救效果及临床疗效进行对比分析。结果护理治疗后，实验组患者的NDS评分、BI评分、HAMD评分均低于正常组，患者对本次护理的满意度高于正常组，在急救、卧床、住院时间与医疗费用与成功救治人数等方面也优于正常组，2组比较差异均有统计学意义（ P均＜0．05）。结论临床护理路径不仅能够提高颅脑损伤并发休克患者的救治效果，而且可降低患者的病死率，缩短急救时间，减少费用，值得推广应用。

骨科脊髓损伤截瘫的病人长期牵引的病人由于体位的制动,下肢不能自行活动,足跟部的皮肤直接接触床面,遭受持续垂直压力、摩擦力和剪切力作用,而又无肌肉包裹,缺乏脂肪组织保护,加之足部的血液循环较其他部位差,因此病人的足跟、内外踝等受压部位更容易发生压疮,目前临床上通常应用的足部防压用具有软枕、小气垫、水垫将足跟部托起架空进行预防,

目的：探讨持续护理质量改进对颅脑术后感染的预防作用。方法80例颅脑手术患者随机分为观察组和对照组，对照组术后采用常规护理，观察组采用持续护理质量改进，比较2组护理效果。结果观察组血氧饱和度高于对照组，出现感染的时间长于对照组，呼吸道、泌尿道、颅内感染的发生率低于对照组，差异有统计学意义（ P＜0.05）。观察组的病死率低于对照组，护理质量评分和满意度高于对照组，差异有统计学意义（ P＜0.05）。结论持续护理质量改进可有效预防颅脑术后感染的发生，提高护理质量。

目的探讨中医临床护理路径在肥胖型2型糖尿病患者中的应用效果。方法将60例肥胖型2型糖尿病患者随机分为对照组和观察组,各30例。对照组采用传统护理模式进行护理干预。观察组采用中医临床护理路径进行护理干预。并对两组健康知识掌握情况及护理质量满意度,体重指数、血压、血糖、血脂生化指标进行比较。结果两组健康知识掌握情况、护理质量满意度及体重指数、血压、血糖、血脂生化指标比较有显著性差异(P<0.05)。结论中医临床护理路径模式优于传统护理模式,能有效地提高护理效果。

目的 探讨胰十二指肠切除术治疗壶腹部肿瘤的临床经验.方法 回顾性分析2004年5月至2009年7月收治的24例壶腹部肿瘤的临床资料.结果 本组病例术后胰瘘2例(8.3%),上消化道出血3例(12.5%),腹腔感染1例(4.2%).结论 胰十二指肠切除术虽然创伤较大,但有经验的专业队伍治疗能预防和减少并发症和死亡率.

目的 探讨隐匿性乳腺癌的诊断、治疗及预后.方法 回顾性分析2000年1月至2009年1月我科行手术治疗的29例隐匿性乳腺癌患者的临床资料.结果 乳腺钼靶X线检查出原发灶16例,6例由MRI检查出原发灶,2例行PET检查出原发灶.行乳腺癌改良根治术治疗25例,腋窝淋巴结清扫术4例.3例患者术后出现复发,1例死亡.结论 乳腺钼靶及MRI是发现原发灶的重要检查方法.乳腺癌改良根治术是主要的治疗方法,保乳手术治疗选择性施行.

目的 探讨持续封闭负压引流治疗软组织大面积损伤的临床疗效及护理.方法 使用持续封闭负压引流对16例软组织大面积损伤患者进行治疗.结果 16例患者大面积软组织损伤全部治愈,无全身及局部并发症.其中12例在2周内治愈.结论 持续封闭负压引流是治疗软组织大面积损伤的一种简单、有效的治疗方法,加强持续封闭负压引流的观察、护理是治疗的关键。

Objective To explore the early diagnosis of periampullary tumors.Methods The clinical data of 54 cases of periampullary tumor without obvious symptoms from January 2003 to December 2009 were retrospectively analyzed.Results The diagnosis accordance rate of B-ultrasound was 31.5 %,which was significantly different from other imaging methods,including CT(61.1 %),MRI(55.6 %),ERCP(100%),EUS(95.0 %) and MRCP(57.4 %)(P<0.05).There was no significant difference between EUS and ERCP,but their diagnosis accordance rate was significantly different from other imagings.There was no significant difference among CT,MRI and MRCP(P>0.05).Conclusion The appropriate examination and sequence can save the time and expense,reduce the complication and increase the security of surgery.

患者女,36岁.以右侧腰痛、下腹胀痛、尿频、尿急来我院就诊.血常规未见明显异常.尿常规:白细胞+++,红细胞+.

患者女,54岁.活动后出现胸闷心慌2个月,无发热、晕厥, 无关节或肌肉疼痛,无肝肿大及下肢浮肿.体格检查:体温36℃,皮肤黏膜无黄染,无颈静脉怒张,心音低钝,未闻及明显杂音.