微型种植体支抗与口外弓支抗对安氏Ⅱ类1分类错牙合畸形患者的矫治效果对比分析

目的:分析比较微型种植体支抗与口外弓支抗对安氏Ⅱ类1分类错牙合畸形患者的矫治效果。方法:收集笔者医院95例安氏Ⅱ类1分类错牙合畸形患者临床资料,根据其治疗方法将之分为口外弓支抗(MIA组)46例和微型种植体支抗组(HGA组)49例,比较其矫正前后头影测量结果和模型测量结果,矫治时间和不良反应。结果:治疗后,MIA组牙合平面与SN平面夹角(OP-SN)、上颌中切牙牙长轴与SN平面夹角(U1-SN)、上唇突度、下唇突度、上唇最凸点至E线垂直距离(E line-UL)、下唇最凸点至E线垂直距离(E line-LL)、覆牙合(OB)、覆盖(OJ)均小于HGA组(P<0.05),矫治时间短于HGA组(P<0.05),总不良反应发生率与HGA组差异无统计学意义(P>0.05)。结论:对比HGA,MIA对安氏Ⅱ类1分类错牙合畸形患者的矫治效果更佳,且能够缩短矫治时间。     

Dynamic Indicators That Impact the Outcomes of Thoracic Endovascular Aortic Repair in Complicated Type B Aortic Dissection

PurposeTo investigate dynamic variables obtained from retrospective computed tomography angiography for ability to predict thoracic endovascular aortic repair (TEVAR) outcomes in patients with complicated type B aortic dissection (cTBAD).Materials and MethodsSeventy-nine patients with cTBAD who received TEVAR from March 2009 to June 2018 were retrospectively enrolled. Relative true lumen area (r-TLA) was computed at the level of tracheal bifurcation every 5% of all R-R intervals. Parameters that reflect the state of intimal motion were evaluated, including difference between maximum and minimum r-TLA (D-TLA) and true lumen collapse. The endpoints comprised early (≤ 30 days) and late (> 30 days) outcomes after intervention.ResultsOverall early mortality rate was 13.9% (11/79), and early adverse events rate was 24.1% (19/79). Patients who received TEVAR within 2 days of symptom onset demonstrated the worst outcomes. A longer time of r-TLA < 25% in 1 cardiac cycle (P = .049) and larger D-TLA (P < .001) were correlated to an increased early death. In addition, D-TLA was an independent predictor of early mortality. Area under the curve of D-TLA was 0.849 (95% confidence interval 0.730–0.967) for predicting early mortality and 0.742 (95% CI 0.611–0.873) for predicting early adverse events. Survival and event-free survival rates during follow-up were decreased in the D-TLA > 21.5% group compared with the D-TLA ≤ 21.5% group (all P < .001).ConclusionsLarger D-TLA is correlated with worse postoperative outcomes and might be a crucial parameter for future risk stratification in patients with cTBAD.     

上市新型经皮递药系统的研究进展

对近几年来上市的经皮制剂进行文献整理和归纳，通过查阅相关文献，对贴剂、软膏剂、凝胶剂、乳膏剂、泡沫剂、洗剂等经皮给药制剂的特点、上市时间、作用、不良反应等进行总结。经皮制剂是药物通过皮肤吸收的一类外用递药给药系统，可以局部给药也可以全身给药，具有安全性高、毒副作用小、使用方便的优点，是目前国内外研究的热点。     

程序性死亡受体1和程序性死亡受体配体1在非小细胞肺癌组织中的表达情况及临床意义

目的探讨程序性死亡受体1(PD-1)和程序性死亡受体配体1(PD-L1)在非小细胞肺癌(NSCLC)组织中的表达情况及临床意义。方法选择150例NSCLC患者的NSCLC组织及其癌旁组织,采用实时荧光定量聚合酶链反应(PCR)检测两种组织中PD-1 mRNA和PD-L1 mRNA的相对表达量。采用免疫组织化学染色法检测NSCLC组织中PD-1和PD-L1的表达情况,分析PD-1和PD-L1表达情况与患者临床特征的关系。采用流式细胞术检测NSCLC组织和癌旁组织中CD4^+-PD-1、CD8^+-PD-1、CD14^+-PD-L1、CD68^+-PD-L1的表达水平。结果NSCLC组织中PD-1 mRNA和PD-L1 mRNA的相对表达量分别为(5.03±1.92)和(4.95±1.09),分别高于癌旁组织的(1.72±0.81)和(1.25±0.24),差异均有统计学意义(P﹤0.05)。TNM分期为Ⅲ~Ⅳ期、低分化、有淋巴结转移、有远处转移的NSCLC患者NSCLC组织中PD-1和PD-L1的高表达率均明显高于TNM分期为Ⅰ~Ⅱ期、高+中分化、无淋巴结转移、无远处转移的患者,差异均有统计学意义(P﹤0.01)。NSCLC组织中CD4^+-PD-1、CD8^+-PD-1、CD14^+-PD-L1、CD68^+-PD-L1的表达水平均明显高于癌旁组织,差异均有统计学意义(P﹤0.01)。结论PD-1和PD-L1在NSCLC组织中高表达,可能成为一种新的生物标志物,PD-1/PD-L1信号通路可能参与了NSCLC的免疫逃逸过程,对其逃逸机制进行研究可以为NSCLC患者的临床治疗提供新靶点。     

索拉非尼治疗转移性肾癌疗效与不良反应的关系

目的:探索索拉非尼在治疗转移性肾细胞癌（mRCC）患者中的不良反应与疗效之间的关系。方法:回顾性研究西京医院接受索拉非尼治疗的mRCC患者63例，利用卡方检验分析肿瘤控制率与不良反应的发生频率和严重程度的相关性，利用Kaplan-Meier方法分析16种不良反应，筛选出与患者PFS，OS相关的不良反应，将P＜0.05变量纳入多变量Cox比例风险回归模型进行进一步的多因素分析，确定独立预后因素。结果:63例接受索拉非尼治疗的患者中，完全缓解2例（3.2％），部分缓解16例（25.4％），疾病稳定37例（58.7％），疾病进展8例（12.7％）。中位PFS为12.0个月，中位OS为24.0个月。卡方检验结果示肿瘤控制率与不良反应的发生频率和严重程度相关（均P＜0.05）。多变量分析显示，更好的PFS的独立预后因素包括腹泻（OR 0.255,95％CI 0.130~0.500,P=0.000）和皮疹（OR 0.235,95％CI 0.114~0.482,P=0.000）。OS的独立预后因素包括腹泻（OR 0.454,95％CI 0.246~0.839,P=0.012），皮疹（OR 0.405,95％CI 0.211~0.776，P=0.006）和高血压（OR 0.373,95％CI 0.177~0.784,P=0.009）。结论:索拉非尼治疗mRCC患者的疗效与不良反应的发生频率和严重程度呈正相关。皮疹和腹泻是影响PFS的独立保护因素，皮疹，腹泻和高血压是影响OS的独立保护因素。这一结论仍需大量前瞻性研究证实。     

Design,synthesis and pharmacological evaluation of 4-(3-chloro-4-(3-cyclopropylthioureido)-2-fluorophenoxy)-7-methoxyquinoline-6-carboxamide (WXFL-152): a novel triple angiokinase inhibitor for cancer therapy

Angiokinases, such as vascular endothelial-, fibroblast- and platelet-derived growth factor receptors (VEGFRs, FGFRs and PDGFRs) play crucial roles in tumor angiogenesis. Anti-angiogenesis therapy using multi-angiokinase inhibitor has achieved great success in recent years. In this study, we presented the design, synthesis, target identification, molecular mechanism, pharmacodynamics (PD) and pharmacokinetics (PK) research of a novel triple-angiokinase inhibitor WXFL-152. WXFL-152, identified from a series of 4-oxyquinoline derivatives based on a structure–activity relationship study, inhibited the proliferation of vascular endothelial cells (ECs) and pericytes by blocking the angiokinase signals VEGF/VEGFR2, FGF/FGFRs and PDGF/PDGFRβ simultaneously in vitro. Significant anticancer effects of WXFL-152 were confirmed in multiple preclinical tumor xenograft models, including a patient-derived tumor xenograft (PDX) model. Pharmacokinetic studies of WXFL-152 demonstrated high favourable bioavailability with single-dose and continuous multi-dose by oral administration in rats and beagles. In conclusion, WXFL-152, which is currently in phase Ib clinical trials, is a novel and effective triple-angiokinase inhibitor with clear PD and PK in tumor therapy.     

FLAG方案治疗难治复发性急性白血病临床疗效

目的探究FLAG方案治疗难治复发性急性白血病的临床疗效。方法择取2017年3月—2018年12月期间医院收治的76例难治复发性急性白血病患者为研究对象,随机分为对照组与观察组,每组38例。对照组患者行MEA方案治疗,观察组患者行FLAG方案治疗,比较两组患者肿瘤控制效果以及不良反应发生率。结果观察组患者肿瘤控制效果73.68%高于对照组50.00%,差异有统计学意义(P<0.05);观察组患者总不良反应发生率31.58%低于对照组55.26%,差异有统计学意义(P<0.05)。结论FLAG方案治疗难治复发性急性白血病效果较为理想,同时具有较高的安全性。     

精神科护士在不良事件中成为第二受害者心理体验的质性研究

目的了解精神科护士在不良事件中成为第二受害者的心理体验。方法采用现象学研究方法,对15名成为第二受害者的护士进行半结构式访谈,对所获资料进行分析、整理、归纳并提炼主题。结果第二受害者的心理体验包括经历心身创伤、渴求情感支持及专业知识指导、创伤后成长3个主题。结论精神科护士在不良事件中成为第二受害者存在严重的心身创伤,护理管理者应重视涉事护士的心理体验,及时给予关怀与支持,维持其良好的心身健康。