迪利单抗对肺癌患者嗜酸性气道炎症的研究

目的 探讨信迪利单抗对肺癌患者嗜酸性气道炎症的影响。方法 选取2019年4月—2020年4月于徐州医科大学附属宿迁医院就诊的60例IV期非鳞非小细胞肺癌患者,随机分为对照组(单纯化疗组)和试验组(信迪利单抗联合化疗组);对照组给予培美曲塞500 mg/m2联合顺铂75 mg/m2静脉注射;试验组在对照组治疗方案基础上联合免疫检查点抑制剂信迪利单抗200 mg静脉注射,均21天为1个周期。6个周期治疗后检测两组患者呼出气一氧化氮(Fractional exhaled nitric oxide,FeNO)、外周血嗜酸性粒细胞计数、肺功能及动脉血气;分析信迪利单抗治疗组严重不良事件(SAE)及免疫相关性肺炎(CIP)的发生率。结果 ⑴试验组在第2、4、6周期治疗后FeNO水平、外周血嗜酸性粒细胞计数相较于基线水平出现升高趋势,但差异无统计学意义(PFeNO=0.536; PEos=0.762)。⑵两组患者经6个周期治疗后,第1秒用力呼吸容积(FEV1)、用力肺活量(FVC)、FEV1/FVC、一氧化碳弥散量占预计值百分比(DLco%)较治疗前均无明显变化(PFEV1=0.615; PFVC=0.473; PFEV1/FVC=0.637; PDLco%=0.598);动脉血气分析中PH、PaO2、PaCO2水平较治疗前均无明显变化(PPH=0.457; PPaCO2=0.242; PPaO2=0.631)。⑶试验组免疫相关SAE发生率和CIP的发生率均为0。结论 6周期治疗后信迪利单抗对肺癌患者的嗜酸性气道炎症、肺功能、动脉血气分析无明显影响,未出现免疫相关SAE及CIP。     

DOPS在外科实习医师技能操作考核中的应用探讨

目的探讨临床操作技能直接观察评估考核(DOPS)在外科实习医师"换药"操作考核中的应用价值。方法以徐州医科大学2017届和2018届在我院实习的临床医学专业46名本科实习医师为研究对象,将其随机分为研究组和对照组。研究组在第1周末、第2周末、第3周末、第4周末进行DOPS评估操作考核;对照组在第1周末、第2周末、第3周末进行传统操作考核,第4周末进行DOPS操作考核。比较研究组和对照组第4周末DOPS考核的平均分数及教师、实习医师对考核的满意度。结果研究组第4周末DOPS考核平均分高于对照组(85.25±2.57)分vs.(76.64±4.96)分;研究组教师满意度为高于对照组教师满意度(7.42±0.41)分vs.(5.76±1.12)分;研究组实习医师满意度为高于对照组实习医师满意度为(7.43±0.85)分vs.(6.17±1.26)分;差异均有统计学意义(P<0.05)。结论DOPS评价系统应用于外科实习医师的操作考核中,可有效提高实习医师的操作水平,增加教师与实习医师的满意度。     

PPH治疗出血性内痔128例临床观察

为探讨吻合器痔上黏膜环切术（PPH）治疗出皿性内痔的町行性，对128例出血性内痔行PPH。结果显示，128例患者手术顺利，手术时间30～45min，平均35min．住院时间4～7d．术后48h无疼痛，术后未见肛门有明显的出血；5例术后出现直肠刺激症状，肛门见异常。结果表明，PPH治疗出血性内痔疗效确切．并发症少，恢复快，值得临床推广。     

Prone position combined with high-flow nasal oxygen could benefit spontaneously breathing,severe COVID-19 patients: A case report

BACKGROUNDSince the outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China in December 2019, the overall fatality rate of severe and critical patients with COVID-19 is high and the effective therapy is limited. CASE SUMMARYIn this case report, we describe a case of the successful combination of the prone position (PP) and high-flow nasal oxygen (HFNO) therapy in a spontaneously breathing, severe COVID-19 patient who presented with fever, fatigue and hypoxemia and was diagnosed by positive throat swab COVID-19 RNA testing. The therapy significantly improved the patient''s clinical symptoms, oxygenation status, and radiological characteristics of lung injury during hospitalization, and the patient showed good tolerance and avoided intubation. Additionally, we did not find that medical staff wearing optimal airborne personal protective equipment (PPE) were infected by the new coronavirus in our institution.CONCLUSIONWe conclude that the combination of PP and HFNO could benefit spontaneously breathing, severe COVID-19 patients. The therapy does not increase risk of healthcare workers wearing optimal airborne PPE to become infected with virus particles.     

Does myeloma genetic have an effect on stem cell mobilization?

BackgroundAutologous stem cell transplantation (ASCT) after induction treatment is the standard of care. Our understanding of myeloma genetics has been very limited and its effect to stem cell mobilization is not widely investigated. We aimed to investigate the effect of genetic abnormalities on stem cell mobilization in myeloma.MethodsThe data of 150 MM patients who underwent stem cell mobilization at our center between 2009–2020 were included and analyzed retrospectively. Pre-treatment bone marrow cytogenetics and fluorescence in situ hybridization tests were performed for each patient.ResultsGroups were divided into two as patients with normal cytogenetic and abnormal cytogenetic. No difference observed between groups regarding age, gender and ECOG (p = 0.4; p = 0.2; p = 0.3). Groups were similar concerning myeloma characteristics, received treatment and treatment response. Median CD34+ cells/kg harvested was 444(2−11.29) in normal cytogenetic group whereas it was 4,8(2.4−8.6) in abnormal cytogenetic group(p = 0.2). Optimal CD34+ cells level achievement was 73 (67 %) in normal cytogenetic group while it was 25(71.4 %) in abnormal cytogenetic group(p = 0.6). Neutrophil and platelet engraftment durations were similar among cytogenetic groups (p = 0.7; p = 0.9). R-ISS based groups were also did not differ regarding harvested CD34+ cells and achievement optimal CD34 level (p = 0.79, p = 0.74). Engraftment durations for neutrophil and platelet were comparable between R-ISS based groups (p = 0.59, p = 0.65)ConclusionsHere we were not able to find any impact of genetic abnormalities on stem cell mobilization in myeloma patients. Expanded studies can aid to identify the effect of particular genetic anomalies on the stem cell mobilization.     

Carbamazepine-induced immune thrombocytopenia confirmed by modified MASPAT test

A 76-year-old man suffering post-herpetic neuralgia developed severe thrombocytopenia 15 days after the administration of carbamazepine. Carbamazepine-dependent platelet antibodies were proved to be present in the patient’s serum by a modified Monoclonal Antibody Solid-phase Platelet Antibody Test (MASPAT), and the diagnosis of carbamazepine-induced immune thrombocytopenia was confirmed. For the patient, carbamazepine should be advised to be avoided permanently. The present report advocated the application of a modified MASPAT test for the detection of carbamazepine-dependent platelet antibodies.     

RFTVR术、新型光纤CO_2激光术对早期喉癌患者症状改善情况和QOL评分、VAS评分的影响

目的:研究RFTVR术、新型光纤CO_2激光术对早期喉癌患者症状改善情况和QOL评分、VAS评分的影响。方法:选择2015年1月～2016年12月诊断治疗的喉癌患者120例作为研究对象,随机分为观察组和对照组各60例,观察组采取RFTVR术治疗,对照组采取新型光纤CO_2激光术治疗。比较两组围手术期指标、吞咽功能、发音功能、生存期、QOL评分、VAS评分之间的差异。结果:两组术中出血量、手术时间以及住院时间之间比较,差异无统计学意义(P>0.05);观察组无误咽情况高于对照组,经过治疗后,两组jitter、shimmer、HNR均明显改善,且观察组jitter、shimmer低于对照组,HNR高于对照组(P<0.05);两组QOL评分、VAS评分均明显改善,且观察组的QOL评分高于对照组、VAS评分低于对照组(P<0.05);观察组的总生存期以及无瘤生存期高于对照组。结论:相比CO_2激光治疗,低温等离子射频消融手术治疗的患者吞咽功能以及发音功能明显改善,同时通过对患者生存期的延长,改善患者的生命质量。     

腹腔镜探查联合灌洗活检在进展期胃癌术前分期中的价值

目的:探讨腹腔镜探查联合腹腔灌洗活检对进展期胃癌术前分期及术式选择的临床意义.方法:回顾分析北京大学肿瘤医院43例胃癌患者腹腔镜探查经过,结果及治疗方案.结果:43例患者腹腔镜探查均获成功,探查操作时间为30-45min(平均32min),术中出血少.探查发现:腹膜转移者14例,肿瘤直接侵犯周围脏器1例.肿瘤突破浆膜者27例,未突破浆膜者16例,其中有4例镜下触诊不明显.所有患者行腹腔灌洗,其中阳性者16例,阳性率为37.2%.结论:胃癌患者术前预行腹腔镜探查和灌洗对于术前分期和选择合适的术式具有重要的指导意义.     

宿迁市2020年学龄儿童新发近视情况分析

目的：探究宿迁市2020年学龄儿童新发近视的情况及相关风险因素。

方法：采用分层整群抽样的方法,选取江苏省宿迁市42所小学,根据2019及2020年的体检信息纳入受试学龄儿童共12 452人; 基于其两年的视力、屈光度、身高和体质量信息,本研究分析了该地不同人口特征因素下学龄儿童的新发近视情况及其相关风险因素。

结果：本研究中学龄儿童总体新发近视率为24.63%,不同人口特征因素下的新发近视率均有差异(均P<0.01),其中城市高于乡镇(26.24% vs 21.31%)、女生高于男生(27.05% vs 22.91%)、超重的学龄儿童高于不超重的(25.82% vs 23.92%),且新发近视率随年龄增长呈递增趋势(χ²_趋势=236.421,P<0.01); 同时新发近视者的身高和体质量年增加量均大于维持正视者(均P<0.01); Logistic回归分析结果显示,城市(OR=1.541)、女生(OR=1.325)、高年龄段(OR=2.827)及超重(OR=1.191)的学龄儿童新发近视的风险更高(均P<0.01)。

结论：宿迁市2020年学龄儿童的新发近视情况不容乐观,其中城市、女性、高年龄段及超重的学龄儿童新发近视的风险较高,同时一段时间内身高、体质量的快速增加可能警示着近视的发展。     

颈前肌群胸骨端离断入路在双侧巨大甲状腺肿物切除术中的应用

目的探讨胸骨端离断颈前肌群翻转固定在双侧巨大甲状腺肿物切除术中的应用优势。方法采用胸骨端离断颈前肌群翻转固定法完成甲状腺手术53例(观察组),采用颈白线切口行甲状腺手术44例(对照组),手术均由同一组医师完成。分别对2组患者的手术时间、手术野显露效果、术中出血量、术后并发症及术后引流量进行比较。结果 2组患者在性别、年龄、疾病构成以及肿瘤大小方面的差异均无统计学意义(P>0.05)。观察组的手术时间、术中出血量及术后引流量短(少)于对照组(P<0.01),术后并发症发生率低于对照组(P=0.04);手术野暴露效果优于对照组(P<0.01)。结论经胸骨端入路行双侧巨大甲状腺手术是可行的,手术操作简便,手术野显露优于颈白线切口,术后并发症少,值得临床推广。