目的:探讨肺腺癌患者中血管内皮生长因子-A(VEGF-A)蛋白表达与表皮生长因子受体(EGFR)基因突变的关系,以及VEGF-A蛋白表达水平与患者临床病理指标及预后的关系.方法:收集经病理检查确诊为肺腺癌且经过EGFR基因检测并进行靶向治疗的患者72例,采用免疫组织化学法检测VEGF-A蛋白在EGFR突变型中晚期肺腺癌患者中的表达情况,采用门诊或者电话随访,统计患者无进展生存期.采用χ2检验、Kaplan-Meier生存分析、单因素、多因素Cox回归分析和评估VEGF-A蛋白表达与各病理指标间的关系,及与EGFR突变型肺腺癌患者预后的关系.结果:72例EGFR突变型肺腺癌组织中VEGF-A蛋白高表达率为70.83％(51/72),主要位于肿瘤细胞的细胞质;VEGF-A蛋白高表达率在EGFR基因外显子19缺失和其他少见突变类型的肺腺癌患者间的差异无统计学意义(P>0.05),而在不同临床分期及淋巴结转移情况患者间的差异具有统计学意义(P<0.05);且与年龄、性别、吸烟史无明显相关(P>0.05).Spearman秩相关分析显示,EGFR突变型肺腺癌患者的无进展生存期(PFS)与VEGF-A蛋白表达水平呈显著负相关(r=-0.513,P=0.009).Kaplan-Meier生存分析结果显示VEGF-A高表达组患者的PFS明显小于VEGF-A低表达组;单因素分析结果显示淋巴结转移、临床分期及VEGF-A表达水平是影响患者预后的因素(HR分别为4.778、11.456、5.676),多因素Cox回归分析结果显示临床分期、VEGF表达(HR分别为2.054、4.949)是影响患者生存预后的独立危险因素.结论:VEGF-A在EGFR突变的肺腺癌患者中高表达,与淋巴结转移和临床分期有关;VEGF-A表达与EGFR突变型肺腺癌患者PFS呈负相关,可能作为判断肺癌患者预后的指标.

目的:探讨非小细胞肺癌(NSCLC)患者缺氧诱导因子(HIF)-2α、血管内皮细胞生长因子(VEGF)表达水平及临床意义.方法:选择接诊的86例NSCLC患者,收集所有患者的NSCLC组织标本及癌旁组织标本.比较NSCLC组织和癌旁组织,不同临床病理NSCLC组织中HIF-2α、VEGF阳性表达率,并分析HIF-2α和VEGF之间的相关性.结果:NSCLC组织中HIF-2α、VEGF阳性表达率分别为65.12％、69.77％,均明显高于癌旁组织的10.47％、16.28％,比较差异有统计学意义(均P<0.05);肿瘤直径≥5 cm、TNM分期Ⅲ-Ⅳ期、低分化、有淋巴结转移患者的HIF-2α、VEGF阳性表达率明显高于肿瘤直径<5 cm、TNM分期Ⅰ-Ⅱ期、中高分化、无淋巴结转移患者,比较差异有统计学意义(均P<0.05);经过Spearman等级相关性分析显示,HIF-2α和VEGF之间呈正相关(P<0.05).结论:NSCLC组织中HIF-2α、VEGF表达明显升高,且和肿瘤直径、TNM分期、分化程度、淋巴结转移之间密切相关.

目的 检测结肠黏液腺癌和正常结肠黏膜组织中CD44v6和Survivin的表达,分析二者的表达差别及相关性.方法 43例结肠黏液腺癌术后留取的新鲜组织为观察组,非肿瘤性结肠黏膜新鲜组织23例为对照组,均制备单细胞悬液后应用流式细胞术检测两组CD44v6和Survivin表达.结果 两组CD44v6和Survivin表达量差异有统计学意义(P<0.05),观察组CD44v6和Survivin表达量与肿瘤最大径、淋巴结转移和增殖指数均密切相关,CD44v6的表达与肿瘤是否浸出肌层相关.线性相关分析显示观察组中CD44v6和Survivin呈正相关.结论 结肠黏液腺癌中CD44v6和Survivin的表达异常,不仅可以促进病变形成,还对病变进展有重要作用.二者可能具有正向协同作用.

Objective To observe the effect of calycosin on cisplatin?induced inhibition of human gastric BGC823 cells. Methods BGC823 cells were treated with different drugs:saline,cisplatin,calycosin and cisplatin combined with calycosin. MTT assays were used to detect the prolif?eration rate of BGC823 cell. Then the protein level and RNA level of cyclin D1,CDK4 and CDK6 were detected by Western blotting and Real?time PCR. Results The proliferation inhibition rates of BGC823 cells treated with 20μg/mL cisplatin,10μg/mL meperoflavone,and combina?tion of the 2 drugs were 56.44%± 2.08%,9.52%± 2.77%and 74.44%± 0.82%,respectively. The inhibition rate of the combination of drugs was significantly higher than that of the single drug treatment group(P<0.05). In addition,we found that calycosin can significantly enhance the inhi?bition of Cyclin D1,CDK4 and CDK6 by cisplatin in protein level and RNA level. Conclusion Calycosin can significantly increase the inhibitory rate of cisplatin on BGC823 cell proliferation,and the combination of the two drugs can reduce the side effects of cisplatin.

Objective To study the expression and significance of vascular endothelial growth factor(VEGF) and pigment epithelium derived factor(PEDF) in non-small cell lung cancer(NSCLC).Methods The protein and mRNA expressions of VEGF and PEDF were detected by immunohistochemical staining and RT-PCR in 30 cases of primary NSCLC tissues and tumor-adjacent normal tissues.Then the correlation between the expressions and clinicopathologic characteristics was analyzed.Results The mRNA expression of VEGF in NSCLC tissues was higher than that in tumor-adjacent normal tissues(P<0.01),while which of PEDF in NSCLC tissues was lower than that in tumor-adjacent normal tissues(P<0.01).The expressions of VEGF and PEDF were correlated with lymph node metastasis,tumor differentiation and clinical stage (P<0.05).The expression of PEDF was negatively correlated with that of VEGF in NSCLC tissues(R2=0.6245,P<0.01).The survival rate was lower in the patients with positive expression of VEGF than that in those with negative expression of VEGF,while the survival rate was higher in the patients with positive expression of PEDF than that in those with negative expression of PEDF(P<0.05).Conclusion The expression of PEDF is negatively correlated with VEGF in NSCLC tissues.PEDF and VEGF in NSCLC tissues may be taken as the indicators in evaluating the prognosis of patients with NSCLC.

目的 探讨磁共振弥散加权成像(DWI-MR)与增强CT在老年中央型肺癌合并肺不张组织中的显影效果.方法 收集53例中央型肺癌合并肺不张患者的临床资料,分析DWI-MR与增强CT下肺癌及肺不张组织影像学特点.结果 增强CT、T1WI、T2WI、DWI、T2WI+DWI下分别有23例、11例、28例、42例、48例中央型肺癌与肺不张组织可鉴别,T2WI+DWI鉴别能力最高,其次为DWI,高于增强CT鉴别能力,T2WI+DWI鉴别能力高于DWI(P<0.05);DWI图像信号强度比(SIR)及噪声比(CNR)均高于T2WI图像(P<0.05);DWI图像下肺癌组织(ADC)值低于肺不张组织,信号强度高于肺不张组织(P<0.05).结论 DWI-MR对老年中央型肺癌合并肺不张患者两种组织的显影效果明显优于增强CT,可通过图像边界、信号强度及ADC值等对两种组织进行鉴别,DWI-MR联合T2WI可进一步提高老年中央型肺癌与肺不张组织的鉴别能力.

Although diagnosis and treatment of gastric cancer have improved, the prognosis of patients remains poor. The majority of patients should be treated with chemotherapy or other follow-up treatment. However, the drug resistance of chemotherapy and heterogeneity of tumor itself lead to differences of sensitivity of chemotherapy drugs for different patients. Therefore, it is mandatory to develop better methods of treatment for treatment of gastric cancer. Calycosin has been used in several types of cancer cells. Cisplatin, 5-fluorouracil (5-FU), and adriamycin (ADM) are most widely used drugs for chemotherapy, and they improve the overall survival of cancer patients. To study whether and how calycosin enhances their inhibition of gastric cancer cells, we detected the signaling pathway in which calycosin and cisplatin, 5-FU, and ADM play role in human gastric cells lines. We found that calycosin can enhance the suppression of cisplatin to gastric cell line by inhibiting the phosphorylation of protein kinase B (Akt). So, when cisplatin/5-FU/ADM is combined with calycosin, it can achieve better therapeutic effect in lower concentration.

Objective To analyze the mechanism of pigment epithelium?derived factor(PEDF)regulation in lung cancer cell proliferation and migration by vascular endothelial growth factor(VEGF). Methods VEGF expression was observed after overexpression or silencing of PEDF. Proliferation and migration were analyzed by MTT and transwell assays. Real?time PCR and Western blotting were performed to investigate the mechanism underlying PEDF regulation of the VEGF/SRC/FAK pathways. Results PEDF could inhibit the proliferation and migration of A549 cells by VEGF. Conclusion PEDF can be considered as a potential therapeutic target for lung cancer.

Objective To detect the expression levels of RAD21(S.Pombe RAD21 homolog)in lung cancer,and assess its clinical significance and potential functions. Methods The expression level of RAD21 in lung cancer was determined by Western blot and immunohistochemistry meth?ods;the RAD21 mRNA expression in lung cancer was analyzed through Oncomine database;the relationship between the RAD21 expression levels and prognosis in patients with lung cancer was studied by Kaplan Meier curve;the RAD21 functions in lung cancer were predicted by using gene set enrichment analysis. Results Compared with adjacent normal tissue,the protein level of RAD21 in lung tissues were upregulated . The data from Oncomine database showed that RAD21 mRNA levels were significantly higher than the normal control groups in multiple lung cancer datasets(P<0.01);in addition,Kaplan?Meier survival curves showed that the RAD21 expression levels was correlated with the survival of patients with lung can?cer(P<0.05);gene set enrichment analysis indicated that RAD21 was mainly enriched in apoptotic signaling pathways and cell cycle regulation gene sets. Conclusion The downregulated RAD21 could be used as a biomarker to assess the prognosis of lung cancer patients. In addition, RAD21 may be involved in the regulation of cell cycle and apoptosis,which affects the development and progression of lung cancer.

目的：检测结肠腺癌中富含亮氨酸重复序列G-蛋白耦联受体（LGR）5、组织蛋白酶-D（Cath-D）和白细胞分化抗原133（CD133）的表达，探讨其关系及临床意义。方法选择130例结肠腺癌术后留取的蜡块及患者的临床资料作为观察组，77例结肠黏膜上皮内瘤变的患者作为对照组，77例正常结肠黏膜组织作为正常对照组，采用免疫组化方法检测3组中LGR5、Cath-D和 CD133的表达。结果3组 LGR5、Cath-D和 CD133表达的阳性率差别有统计学意义（ P＜0.0001）。观察组中LGR5、Cath-D和CD133的表达均与肿瘤的分化程度、浸润深度、淋巴结转移和 TNM 分期密切相关，线性相关分析显示观察组中LGR5和CD133的表达具有正相关性，而其他指标之间无相关性。结论结肠腺癌中LGR5、Cath-D和CD133高表达，LGR5和CD133具有的协同正向作用，对肿瘤进展具有明显的促进作用。联合检测LGR5、Cath-D和CD133的表达可能对判断预后和协助临床分期有一定价值。

目的 探讨洛铂或顺铂联合吉西他滨治疗晚期非小细胞肺癌(NSCLC)的疗效及不良反应.方法 晚期NSCLC患者109例,按随机数字表法分成两组,其中56例采用洛铂联合吉西他滨方案治疗(洛铂组),53例采用顺铂联合吉西他滨方案治疗(顺铂组),两组患者均接受至少2个周期的化疗,比较两组疗效及不良反应发生情况.结果 洛铂组总有效率为41.1％(23/56),顺铂组总有效率为45.3％(24/53),两组比较差异无统计学意义(P＞0.05)；两组白细胞下降、血小板下降、肾毒性、神经毒性等不良反应发生率比较差异无统计学意义(P＞0.05)；洛铂组恶心呕吐发生率明显低于顺铂组[33.9％(19/56)比52.8％ (28/53)] (P＜ 0.05),两组均无因不良反应影响治疗的病例.结论 洛铂或顺铂联合吉西他滨都是治疗晚期NSCLC的有效方案,两者疗效相似,但洛铂胃肠道反应发生率低于顺铂.

目的 探讨雷替曲塞联合奥沙利铂与5-氟尿嘧啶/亚叶酸钙联合奥沙利铂方案治疗晚期结直肠癌的疗效及不良反应.方法 选择晚期结直肠癌患者90例,按随机数字表法分为两组,A组42例采用雷替曲塞联合奥沙利铂方案治疗,B组48例采用5-氟尿嘧啶/亚叶酸钙联合奥沙利铂方案治疗.观察两组临床疗效和不良反应发生情况.结果 A组完全缓解2例,部分缓解14例,稳定14例,进展12例,总有效率为38.1％(16/42)；B组完全缓解0例,部分缓解15例,稳定11例,进展22例,总有效率为31.2％(15/48),两组总有效率比较差异无统计学意义(P＞0.05),两组中性粒细胞减少、血小板减少、疲劳、周围神经毒性、丙氨酸氨基转移酶增高、脱发及腹泻等不良反应发生情况比较差异无统计学意义(P＞0.05).B组呕吐例数明显多于A组(32例比14例),差异有统计学意义(P＜0.05).结论 雷替曲塞联合奥沙利铂方案治疗晚期结直肠癌的疗效等同于5-氟尿嘧啶/亚叶酸钙联合奥沙利铂方案,但不良反应较轻。

<正>老年患者开胸手术后常见呼吸系统并发症〔1〕。本研究拟分析老年开胸手术患者围术期内呼吸循环的变化特点及其与呼吸并发症的相关性。1资料与方法1.1一般资料2009年1月至2012年12月我院收治的开胸手术患者112例,按是否发生呼吸并发症分为观察组(发生呼吸并发症组)和对照组各56例(未发生呼吸并发症组)。开胸手术方式包含肺部、食道及其他位置手术,肺部手术主要有肺

目的检测老年慢性心力衰竭患者血清中亲环素A(CypA)和脑利钠肽(BNP)的表达,探讨二者在疾病中的意义。方法 90例慢性心力衰竭的老年患者作为观察组,72例体检证实为健康的老年人血清作为对照组,应用ELISA法检测两组中CypA和BNP的表达,探讨CypA和BNP在不同临床特征患者中表达的意义及相关性。结果观察组血清中CypA和BNP的表达量显著高于对照组(P<0.01),观察组中CypA和BNP的表达与慢性心力衰竭心功能分级密切相关,经线性相关分析显示观察组患者血清中CypA和BNP的表达呈正相关。结论 CypA和BNP在慢性心力衰竭老年患者血清中高表达,二者的协同作用在疾病的发展中具有重要促进作用,CypA和BNP的联合检测可能对判断慢性心力衰竭老年患者的病变程度及指导治疗具有一定作用。

骨巨细胞瘤为常见的骨肿瘤,多发于四肢长骨,但发生于骨盆者少见,据统计骨巨细胞瘤12.3%发生恶变,本文总结7例发生于骨盆的恶性骨巨细胞瘤,旨在提高对本病的诊断水平.

目的探讨小剂量紫杉醇加顺铂化疗同步放射治疗的近期疗效、生存期及生活质量。方法把40例局部晚期非小细胞肺癌随机分为小剂量紫杉醇加顺铂化疗与放射治疗同步组(同步组)和化疗与放射治疗序贯组(序贯组)2组,每组20例。2组病例放射治疗均采用直线加速器8MV-X线,常规剂量分割,临床靶区包括原发病灶、相应纵隔及锁骨上淋巴引流区,总剂量60~70Gy。同步组化疗用紫杉醇90 mg、顺铂30 mg在放射治疗开始时同步进行,每周1次,共用4~5次。序贯组化疗用紫杉醇135-175 mg/m2、顺铂80 mg/m2或卡铂300mg/m2在放射治疗前化疗2周期。结果2组完全缓解率、部分缓解率、KPS改善率经统计学检验差异均无显著性意义;同步组和序贯组的总有效率分别为75%和40%,P=0.025,差异有显著性;2组病人的生存曲线和治疗毒性相似。结论小剂量紫杉醇加顺铂化疗同步放射治疗在总有效率方面优于序贯组,且不增加毒性。

目的评价CT对骨盆恶性骨巨细胞瘤的诊断价值。方法回顾性分析7例经手术病理证实的骨盆恶性骨巨细胞瘤的CT表现。结果7例中发生于耻骨支2例,坐骨支2例,髂骨翼2例,同时发生于耻骨支、坐骨支1例,恶性骨巨细胞瘤呈溶骨性破坏伴有周围软组织肿块,其内可见瘤骨或钙化灶,邻近组织结构受压移位。结论CT对骨盆恶性骨巨细胞瘤的诊断具有重要诊断价值。最终诊断仍需经病理检查确定。

目的研究复方苦参注射液对直肠急性放射性反应的临床防治效果。方法将70例直肠癌、膀胱癌患者随机分为两组,每组各35例。观察组:在常规放射治疗的同时使用复方苦参注射液,每天20ml,10d为1个疗程,连用3个疗程,各疗程之间间隔3d。对照组:采用常规放射治疗。对两组患者直肠急性放射性反应的发生情况进行比较。结果观察组直肠急性放射性反应的发生时间推迟,各级直肠急性放射性反应的发生率降低,与对照组比较差异有统计学意义。观察组放射治疗毒性反应对生活质量的影响低于对照组,差异有统计学意义。结论复方苦参注射液对直肠急性放射性反应的防治效果是确切的,并且是安全的。

目的 研究奥沙利铂和顺铂在治疗晚期非小细胞肺癌疗效和毒性反应的差异.方法 晚期非小细胞肺癌患者109例随机分成2组,奥沙利铂加长春瑞宾组(奥铂组)56例,顺铂加长春瑞宾组(顺铂组)53例,两组每例患者至少完成两周期化疗再评价.结果 两组所有的患者都完成两周期以上的化疗,奥铂组总有效率41.1%,顺铂组总有效率45.3%,两组比较差异无显著性(P＞0.05);两组比较白细胞下降、血小板下降、血红蛋白下降、肾毒性差异均无显著性(均P＞0.05);奥铂组恶心、呕吐发生低于顺铂组,奥铂组神经毒性明显高于顺铂组,而且比较差异有显著性(P＜0.05).结论 奥沙利铂加长春瑞宾和顺铂加长春瑞宾都是治疗晚期非小细胞肺癌的有效方案,两者疗效相似,区别是奥沙利铂加长春瑞宾神经毒性高于顺铂加长春瑞宾,消化道反应低于顺铂加长春瑞宾.

对我院胸腔内留置中心静脉导管局部加静脉化疗治疗恶性胸腔积液32例分析如下.