北京市三级甲等医院结直肠癌患者就医流向规律分析

目的 分析不同特征的结直肠癌患者就医行为选择在中医院（含中西医结合医院）、西医院及肿瘤专科医院间的差异，为合理引导结直肠癌患者适宜就医及制订相关政策提供依据。方法 收集北京地区2018年1月-2019年12月17家三级甲等医院21894例首诊结直肠癌成年住院患者的病案首页数据，采用EmpowerStats 2.0对数据进行描述性分析。结果 21894例结直肠癌患者中就诊于中医院的有862例（3.93%），西医院的有8723例（39.85%），肿瘤专科医院的有12309例（56.22%）。对于不同医疗机构，男性占比均大于女性，58-68岁患者占比最大。且结直肠癌患者年龄、医疗付款方式及肿瘤分期在不同医疗机构间的分布存在差异（P<0.001）。西医院及肿瘤专科医院结直肠癌Ⅲ期患者占比最大，而就诊于中医院患者中结直肠癌Ⅳ期最多。从地域分布来看，异地就诊比例（57.32%）大于本地，且就诊于肿瘤专科医院的患者中73.66%来自外地。患者来源前三名分别是北京市、河北省及内蒙古自治区。而在北京市内，西医院患者主要来源于朝阳区、海淀区及西城区，中医院患者主要来源于海淀区、朝阳区及丰台区，肿瘤专科医院则主要来源于朝阳区、海淀区及丰台区。结论 应大力倡导年轻以及早期结直肠癌患者向中医院分流，充分施展中医药在结直肠癌患者中的治疗优势；发挥三级医院带动作用，建立对口帮扶医院，减少不必要的跨省流动及提倡结直肠癌的早筛早治，以降低结直肠癌死亡率。     

China special issue on gastrointestinal tumors-Radiological features of pathological complete response in mismatch repair deficient colorectal cancer after neoadjuvant PD-1 blockade: A post hoc analysis of the PICC phase II trial

Neoadjuvant programmed cell death protein 1 (PD-1) blockade exhibits promising efficacy in patients with mismatch repair deficient (dMMR) colorectal cancer (CRC). However, discrepancies between radiological and histological findings have been reported in the PICC phase II trial (NCT 03926338). Therefore, we strived to discern radiological features associated with pathological complete response (pCR) based on computed tomography (CT) images. Data were obtained from the PICC trial that included 36 tumors from 34 locally advanced dMMR CRC patients, who received neoadjuvant PD-1 blockade for 3 months. Among the 36 tumors, 28 (77.8%) tumors achieved pCR. There were no statistically significant differences in tumor longitudinal diameter, the percentage change in tumor longitudinal diameter from baseline, primary tumor sidedness, clinical stage, extramural venous invasion status, intratumoral calcification, peritumoral fat infiltration, intestinal fistula and tumor necrosis between the pCR and non-pCR tumors. Otherwise, tumors with pCR had smaller posttreatment tumor maximum thickness (median: 10 mm vs 13 mm, P = .004) and higher percentage decrease in tumor maximum thickness from baseline (52.9% vs 21.6%, P = .005) compared to non-pCR tumors. Additionally, a higher proportion of the absence of vascular sign (P = .003, odds ratio [OR] = 25.870 [95% CI, 1.357-493.110]), nodular sign (P < .001, OR = 189.000 [95% CI, 10.464-3413.803]) and extramural enhancement sign (P = .003, OR = 21.667 [2.848-164.830]) was observed in tumors with pCR. In conclusion, these CT-defined radiological features may have the potential to serve as valuable tools for clinicians in identifying patients who have achieved pCR after neoadjuvant PD-1 blockade, particularly in individuals who are willing to adopt a watch-and-wait strategy.     

情景模拟教学在护生患者安全教育的应用进展

综述情景模拟教学法在护生患者安全教育中的应用形式及测评方法，提出可在课程设计、模拟技术发展、教学模式创新和师资培养等方面进行研究探索，以增强情景模拟教学法在患者安全教学中的应用效果。     

Silencing KLF16 inhibits oral squamous cell carcinoma cell proliferation by arresting the cell cycle and inducing apoptosis

Krüppel-like factor 16 (KLF16), a member of the Krüppel-like factor (KLF) family, has been extensively investigated in multiple cancer types. However, the role of KLF16 in oral squamous cell carcinoma (OSCC) remains unknown. Thus, we conducted this study to investigate its related mechanism. KLF16 expression in OSCC cell lines was quantified by western blotting. Then, OECM1 and OC3 cells were divided into Blank, siCtrl, siKLF16#1 and siKLF16#2 groups. Subsequently, cell proliferation was detected using 3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) assays, cell migration and invasion were detected with wound healing and Transwell assays, and cell cycle distribution and cell apoptosis were detected via flow cytometry. KLF16, p21, CDK4, Cyclin D1 and p-Rb expression was detected by western blotting. Finally, xenograft models were established in nude mice to observe the in vivo effects of KLF16 on OSCC. KLF16 protein expression was upregulated in OSCC cells. Compared to the cells in the Blank group, the OECM1 and OC3 cells in the siKLF16#1 group and siKLF16#2 group exhibited a sharp decrease in proliferation but a remarkable increase in apoptosis. Moreover, the proportion of cells in the G0/G1 phase notably increased and that in the S phase decreased, with evident decreases in cell invasion and migration. Moreover, KLF16, cyclin-dependent kinase 4 (CDK4), Cyclin D1 and p-Rb protein expression was upregulated, but p21 expression was downregulated. The mice in the siKLF16#1 and siKLF16#2 xenograft model groups exhibited slower tumour growth and smaller tumours with evident downregulation of Ki67 expression compared to the mice in the Blank group. KLF16 expression was upregulated in OSCC cells, and interfering with KLF16 led to cell cycle arrest, inhibited OSCC cell growth and promoted cell apoptosis.     

沙盘游戏疗法在肿瘤放疗患者中的应用

目的探讨沙盘游戏疗法对肿瘤放疗患者心理痛苦及生活质量的作用。方法采用便利抽样法,选取2019年1—12月于上海市质子重离子医院住院进行放疗的49例肿瘤患者为研究对象,采用分层随机分组方法,将患者随机分为对照组28例和试验组21例。对照组给予常规心理护理,试验组在此基础上给予沙盘游戏疗法。采用心理痛苦温度计和欧洲癌症研究与治疗组织生命质量核心量表中的5个功能维度比较两组患者干预前后的心理痛苦程度和生活质量水平。结果干预后,两组患者心理痛苦温度计得分均低于干预前,且试验组得分低于对照组,差异有统计学意义(P<0.01)。干预前后试验组患者的躯体功能、角色功能、认知功能、情绪功能、社会功能维度得分下降程度均小于对照组,差异有统计学意义(P<0.01)。结论沙盘游戏疗法对肿瘤放疗患者的心理痛苦和生活质量有一定改善作用。     

A comparison of efficacy and safety of complementary and alternative therapies for severe mycoplasma pneumonia in children: A protocol for systematic review and meta-analysis

Background:In recent years, the incidence rate of children with severe Mycoplasma pneumoniae pneumonia (SMPP) is increasing, which poses a great threat to children''s life and safety. There are some limitations in the existing drugs for the treatment of SMPP, and the supplementary and alternative therapy of SMPP plays an irreplaceable role in the treatment of this disease. This study will evaluate the efficacy and safety of various complementary and alternative therapies for SMPP by means of mesh meta-analysis. In order to provide the basis for clinical rational use.Methods:Two researchers will independently and comprehensively searched the Cochrane Central controlled trials registry, Cochrane Library, PubMed, web of science, EMBASE, CNKI, and Wanfang database to collect randomized controlled trials (RCT) studies on complementary and alternative therapies for SMPP. And the relevant references included in the systematic review/meta-analysis are screened. The retrieval time limit is from the establishment of the database to November 2020. We will use Revman 5.3 software for meta-analysis and use grade to grade the quality of evidence in the net meta-analysis (NMA).Results:The aim of this study was to compare the efficacy and safety of different complementary and alternative therapies in the treatment of SMPP, with a view to evaluating and ranking different interventions.Conclusion:The supplement and replacement therapy of SMPP can improve the clinical efficacy, relieve the clinical symptoms, improve the quality of life of children, and reduce adverse reactions, which can provide strong support for the rational use of clinicians.INPLASY registration number:INPLASY2020110079.     

骨质疏松症动物模型的构建及实验方法研究进展

骨质疏松症是一种全身性骨代谢病,由多种因素引起,其特点是骨量、骨密度和骨组织的显微结构恶化,骨脆性增强和易发生骨折。骨质疏松症已严重威胁人类健康,最终将导致患者日常活动减少,生活质量降低,死亡率增加。针对不同的研究对象,选择一个正确、理想的动物骨质疏松的模型和实验方法以尽可能再现人类骨质疏松的状态,是开展动物实验的关键。我们综述了当前原发性和继发性骨质疏松等动物模型的构建,以及利用这些模型进行给药实验的研究方法,并对研发治疗骨质疏松的新型药物的选择提供了一些参考建议,以期对后续关于药物的作用机制、研发新药、药物的改良等研究提供思路。     

钙离子通道蛋白TRPV6及其相关疾病的研究进展

瞬时受体电位亚家族V成员6 (Transient Receptor Potential Channel Subfamily V Member 6, TRPV6) 是一种钙离子高度选择性离子通道，在多种组织中均有表达，控制细胞顶端钙离子的进入，在维持钙稳态中发挥重要作用。TRPV6功能异常会影响体内钙稳态，进而引发新生儿骨骼发育异常、甲状旁腺功能亢进、骨与软骨代谢异常、肾结石和高尿钙症、 以及炎症性肠病和慢性胰腺炎等多种疾病。近年来研究也表明，TRPV6的上调与多种肿瘤的侵袭性增加有关，具有作为肿瘤检测的标志物以及治疗靶点的潜力。本综述将聚焦于TRPV6与其在相关疾病中发挥的作用，旨在为TRPV6作为药物靶点实现临床转化提供理论依据。