单孔胸腔镜下肺癌术后胸腔引流时间的影响因素分析北大核心

目的:探讨单孔胸腔镜下肺癌手术术后胸腔引流时间的影响因素。方法:本研究采用回顾性分析方法,回顾我院2018年01月至2019年12月原发性肺癌患者经单孔胸腔镜手术治疗的病例199例。按照术后胸腔引流时间分为两组,Ⅰ组(术后胸腔引流时间<5天)和Ⅱ组(术后胸腔引流时间≥5天)。对于影响术后胸腔引流时间的可能因素在两组间先采用单因素分析的方法筛选,再将筛选出来的对术后胸腔引流时间可能有意义的影响因素进行二项Logistic多因素回归分析。结果:经单因素分析及二项Logistic多因素回归分析结果显示:年龄≥60岁、手术部位、肺段切除术、胸膜粘连、手术时间≥180 min、术后早期下床活动是术后胸腔引流时间的独立影响因素(P<0.05)。结论:对于具有多个延长术后胸腔引流时间的独立影响因素的患者,应制定个体化管理方案,尽可能减少术后胸腔引流时间,减少住院天数,加快患者康复。     

神经外科教学中虚拟现实技术、Seminar模式应用

目的探讨神经外科教学中虚拟现实技术、Seminar模式的应用效果。方法选取本院2014级临床专业实习学生24人,随机选取12人作为对照组,采用传统教学法;12人为观察组,采用虚拟现实技术、Seminar模式教学法。比较两组学生的病理分析能力,多学科协作能力,临床操作能力。结果观察组理论考试和操作考试评分分别为(84.5±3.9)分、(86.3±2.7)分,对照组分别为(80.2±2.8)分、(80.0±2.1)分,观察组理论考试和操作考试评分均高于对照组(P<0.05)。观察组病情分析、临床操作、手术胜任和多学科协作能力评分分别为(1.8±0.7)分、(1.7±0.5)分、(1.6±0.4)分、(1.5±0.5)分;对照组分别为(1.2±0.4)分、(1.1±0.2)分、(1.0±0.3)分、(1.1±0.2)分,观察组病情分析、临床操作、手术胜任和多学科协作能力评分均高于对照组(P<0.05)。结论虚拟现实技术、Seminar模式教学法联合应用提高学生的学习主动性、理论知识水平和实践技能操作水平,提高了神经外科教学效果。     

宣威地区与非宣威地区肺癌患者临床流行病学特征及病理类型特点分析

目的:分析宣威地区与非宣威地区的肺癌临床流行病学与病理特征。方法:以云南省肿瘤医院（昆明医科大学第三附属医院）2015年3月至2015年5月手术治疗的肺癌患者为研究对象，共295例，收集患者相关信息。将其分为宣威地区、非宣威地区进行统计。对患者的临床资料进行回顾性分析，包含病理类型、年龄、性别、吸烟史等。结果:宣威地区、非宣威地区肺癌患者男女比例为1.19∶1和1.69∶1。宣威地区患者平均年龄为［53.41±8.74(34~85)］岁，中位年龄53岁。非宣威地区肺癌患者平均年龄为［58.68±8.63(38~78)］岁，中位年龄59岁。宣威地区肺癌高发年龄为40~59岁段。宣威地区I期肺癌患者占比、T1期肺癌患者占比、N0期肺癌患者占比均高于非宣威地区。宣威地区男性腺癌鳞癌比远高于非宣威地区，差异有显著统计学意义。结论:宣威地区女性肺癌发病率更高，发病年龄更趋年轻化，腺癌比例高，吸烟与宣威地区男性腺癌高发关系不密切。     

完全腹腔镜下与开腹胰十二指肠切除术治疗壶腹周围肿瘤近期疗效比较

目的探讨完全腹腔镜下胰十二指肠切除术(TLPD)与开腹胰十二指肠切除术(OPD)治疗壶腹周围肿瘤的近期疗效。方法回顾性分析山西医科大学第一医院2016年6月至2019年3月收治的50例壶腹周围肿瘤患者的临床资料,根据手术方式不同分为TLPD组(22例)及OPD组(28例),比较两组患者围术期及术后各项指标情况。结果两组患者均顺利完成手术,TLPD组手术时间[(665±213)min]长于OPD组[(447±215)min],差异有统计学意义(t=-0.356,P=0.001);TLPD组术中出血量[100 ml(50~325 ml)]少于OPD组[300 ml(100~500 ml)],差异有统计学意义(Z=-2.230,P=0.026)。TLPD组与OPD组术中输血者比例、淋巴结清扫数量、切除肿瘤长径、术后禁饮食时间、术后拔管时间、术后住院时间及术后并发症发生率比较,差异均无统计学意义(均P>0.05)。结论TLPD与OPD治疗壶腹周围肿瘤临床近期疗效相近,TLPD手术时间较OPD长,但可有效控制术中出血量。     

基于协同创新理念下的基础医学实验教学中心建设研究

随着国内高等医学教育管理体制改革的日益深化和素质教育的全面推进，医学院校的教学实验室建设从以往单一学科设置、传统的基础医学教学实验室逐步演变为按功能分类、按学科群布局的基础医学实验教学中心。在陆军军医大学基础医学实验教学中心建设过程中，从构建“大中心”、创建实验教学课程新体系、探索创新实践教育新模式、创建优秀实验教师队伍等方面进行了实践探索，相关工作为今后实验教学中心的建设提供了实践参考。     

Mutation status and burden can improve prognostic prediction of patients with lower‐risk myelodysplastic syndromes

Patients with lower‐risk myelodysplastic syndromes (LR‐MDS) as defined by the International Prognostic Scoring System (IPSS) have more favorable prognosis in general, but significant inter‐individual heterogeneity exists. In this study, we examined the molecular profile of 15 MDS‐relevant genes in 159 patients with LR‐MDS using next‐generation sequencing. In univariate COX regression, shorter overall survival (OS) was associated with mutation status of ASXL1 (P = .001), RUNX1 (P = .031), EZH2 (P = .049), TP53 (P = .016), SRSF2 (P = .046), JAK2 (P = .040), and IDH2 (P = .035). We also found significantly shorter OS in patients with an adjusted TET2 variant allele frequency (VAF) ≥18% versus those with either an adjusted TET2 VAF <18% or without TET2 mutations (median: 20.4 vs 47.8 months; P = .020; HR = 2.183, 95%CI: 1.129‐4.224). After adjustment for IPSS, shorter OS was associated with mutation status of ASXL1 (P < .001; HR = 4.306, 95% CI: 2.144‐8.650), TP53 (P = .004; HR = 4.863, 95% CI: 1.662‐14.230) and JAK2 (P = .002; HR = 5.466, 95%CI: 1.848‐16.169), as well as adjusted TET2 VAF ≥18% (P = .008; HR = 2.492, 95% CI: 1.273‐4.876). Also, OS was increasingly shorter as the number of mutational factors increased (P < .001). A novel prognostic scoring system incorporating the presence/absence of the four independent mutational factors into the IPSS further stratified LR‐MDS patients into three prognostically different groups (P < .001). The newly developed scoring system redefined 10.1% (16/159) of patients as a higher‐risk group, who could not be predicted by the currently prognostic models. In conclusion, integration of the IPSS with mutation status/burden of certain MDS‐relevant genes may improve the prognostication of patients with LR‐MDS and could help identify those with worse‐than‐expected prognosis for more aggressive treatment.     

Enteral Nutrition Support Does Not Improve PNI in Radiotherapy Patients with Locally Advanced Esophageal Cancer

Objective: The assessment of prognostic nutritional index (PNI) before and during radiotherapy is an important parameter for the prognosis in patients with cancer. In this study, enteral tube feeding (ETF) was used during radiotherapy in patients with EC. Dynamic changes of various nutritional indicators (including PNI) were monitored.

Methods: Patients with EC who underwent radiotherapy between June 2016 and July 2017 were enrolled. ETF was performing with the energy of 25?kcal?×?kg/d. Nutritional status were evaluated. Least significant difference (LSD) was used for multiple comparisons between groups.

Results: A total of 148 patients were admitted, including 51 patients fed via ETF. For patients who were not scheduled to nutritional support, significant difference were observed in albumin (ALB) (P?<?0.001), prealbimnin (PA) (P?=?0.05) and PNI (P?<?0.001) compared to levels before radiotherapy. In the patients fed via enteral tube, no significant difference were found in weight, BMI, ALB, retinol binding protein (RBP) and PA before and after radiotherapy, while PNI significantly decreased (P?<?0.001).

Conclusion: After preforming ETF with the energy of 25?kcal?×?kg/d in patients with EC during radiotherapy, PNI, the key nutritional index reflecting prognosis, significantly decreased.     

A novel lncRNA-LINC01116 regulates tumorigenesis of glioma by targeting VEGFA

Brain glioma is the most common malignant tumor of the central nervous system, and one of the leading causes of death in patients with intracranial tumors. The clinical outcome of glioma is usually poor due to abundant vascularity, fast growth and susceptibility of invasion to normal brain tissues. Our microarray study showed that lncRNA-LINC01116 was significantly upregulated in glioma tissues and played an important role in cell proliferation, cycle, migration, invasion and angiogenesis. In addition, vascular endothelial growth factor (VEGFA) may be the major target genes in the downstream of lncRNA-LINC01116. Dual luciferase assay showed that LINC01116 and VEGFA both contained a miR-31-5p binding site, and LINC01116 could regulate the expression of VEGFA through competitive absorption of miR-31-5p. RNA immunoprecipitation indicated that LINC01116 and VEGFA were present in the miR-31-5p-RISC complex, and biotinylated miR-31-5p pull-down assay suggested that there was a competitive relationship between LINC01116 and VEGFA to bind with miR-31-5p. Collectively, our study has identified a novel lncRNA-LINC01116 and clarified the role and mechanism of LINC01116 in the tumorigenesis of glioma. LINC01116 may prove to be a potential target for the clinical diagnosis and treatment of glioma.