子宫内膜功能亢进性疾病的“异病同治”诊治研究思路＊

笔者根据现代临床子宫内膜的病理演变过程结合中医“异病同治”理念，提出“子宫内膜功能亢进性疾病”概念，涵盖5种常见的子宫内膜疾病：无排卵性异常子宫出血（Abnormal Uterine Bleeding Ovulatory dysfunction，AUB-O），子宫内膜息肉（Endometrial Polyp，EP），子宫内膜异位症（Endometriosis，EMs），子宫腺肌病（Adenomyosis，AM），子宫内膜癌（Endometrial Carcinoma，EC）。基于文献的汇总，分析得到此类疾病的子宫内膜病理演变与中医病因病机的关联性，为寻找关键通路、创新性治疗此类疾病提供了重要的参考方向，对深化中医妇科学常见疾病的共性病因病机提供了理论依据和探索思路。     

微信小程序合并时间管理器在眼科患儿监护人出院宣教中的应用效果

目的 探讨微信小程序合并时间管理器在眼科患儿出院宣教中的应用效果,为眼科护士出院宣教干预提供借鉴。方法 采用便利抽样法,选取98例眼科患儿监护人作为研究对象,将2021年2月-5月住院的49例患儿的监护人作为对照组,进行眼科常规出院宣教,将2021年6月-9月住院的49例患儿的监护人作为观察组,使用微信小程序合并时间管理器进行出院宣教干预。比较2组患儿监护人对疾病相关知识知晓情况、满意度及按时复诊人数。结果 干预1个月后,观察组疾病相关知识问卷得分、满意度得分及按时复诊率均高于对照组(t=-5.223,P=0.001;t=-5.419,P=0.001;χ²=6.874,P=0.009)。结论 使用微信小程序合并时间管理器在眼科病房进行出院宣教,能有效提高患儿监护人出院后疾病相关知识水平、按时就诊率及监护人满意度,提升护理服务质量。     

呫吨酮并吡啶衍生物XP-15联合紫杉醇对耐药肝癌细胞QGY-7701 的体外抑制作用

目的:探索呫吨酮并吡啶衍生物XP-15联合紫杉醇对人肝癌QGY-7701耐药细胞株的体外抗肿瘤作用。方法:运用CCK8法、Transwell实验和流式细胞仪检测凋亡技术观察细胞功能学变化，运用Western Blot蛋白免疫印迹技术探索其可能的作用机制。结果:XP-15可明显增强紫杉醇对耐药QGY-7701细胞的抑制作用，XP-15联合紫杉醇作用于耐药QGY-7701细胞24 h后，QGY-7701细胞活力明显减弱，且其侵袭迁移能力明显降低，同时流式细胞仪凋亡检测提示细胞凋亡百分比明显增加。Western Blot蛋白免疫印迹亦证实细胞抗凋亡蛋白bcl-2表达明显降低，肝癌增殖分化相关PI3K及AKT蛋白分子表达减少。结论:XP-15具有增敏紫杉醇诱导耐药QGY-7701细胞凋亡同时抑制其增殖活力的作用，其作用机制可能与下调PI3K-AKT通路活性，同时减少bcl-2抑制凋亡蛋白表达相关。     

全腹腔镜、腹腔镜辅助与开腹胃癌根治术治疗Ⅱ、Ⅲ期胃癌的疗效对比

目的探讨全腹腔镜胃癌根治术（TLG）、腹腔镜辅助胃癌根治术（LAG）与传统开腹术（TOS）对Ⅱ、Ⅲ期胃癌的近期及远期疗效。 方法回顾性分析2013年1月至2016年6月陕西中医药大学附属医院行胃癌根治术的患者共136例，根据患者手术方式的不同分为TLG组（45例），LAG组（40例），TOS组（51例）。观察和比较3组患者手术时间、出血量、淋巴结清扫数、术后排气时间、住院时间、术后并发症发生情况，采用Kaplan-Meier法对患者术后5年远期疗效进行生存分析。 结果TLG组患者出血量、排气时间及住院时间低于TOS组及LAG组，LAG组患者手术时间高于TLG组及TOS组，差异均有统计学意义（P<0.05）；3组患者术后并发症发生率比较，差异无统计学意义。共129例获得随访，其中TLG组失访2例，LAG组2例，TOS组3例。TLG、LAG、TOS组平均无瘤生存时间为（53.4±2.1）个月（95%CI=50.45~58.22个月）、（54.3±2.0）个月（95%CI= 47.99~56.18个月）、（52.3±2.1）个月（95%CI=50.98~55.65个月），3组患者无瘤生存时间比较，差异无统计学意义（F=0.519，P=0.772）。 结论TLG术能够在保证患者术后疗效的同时，降低患者术中出血量、排气时间及术后住院时间，TLG术治疗Ⅱ、Ⅲ期胃癌安全可行，疗效显著，值得推广。     

E-钙黏蛋白在人非小细胞肺癌细胞多西他赛耐药中的作用

目的:探讨非小细胞肺癌(non-small cell lung cancer,NSCLC)A549、H1299、H358、H441多西他赛（docetaxel，DTX）耐药细胞株与上皮间质转化（epithelial-mesenchymal transition,EMT）的关系，并初步研究逆转E-cadherin的表达对NSCLC细胞多西他赛耐药性的影响。方法:应用Real-time PCR 和Western blot 方法检测上皮间质转化相关标志物E-cadherin、Vimentin、N-cadherin、Snail在亲本细胞和多西他赛耐药细胞之间的表达差异；应用慢病毒载体介导构建稳定表达E-cadherin的NSCLC多西他赛耐药细胞；MTS法检测NSCLC细胞多西他赛耐药特性。结果:与A549、H1299、H358、H441四株亲本细胞相比，多西他赛耐药细胞（A549DTX，H1299DTX，H358DTX，H441DTX）形态呈长梭形，呈上皮间质转化（EMT）样改变。多西他赛耐药细胞中E-cadherin表达下调，Vimentin、N-cadherin、Snail表达上调。成功构建了过表达E-cadherin的NSCLC多西他赛耐药细胞。过表达E-cadherin细胞株细胞形态与空载对照细胞株以及亲本耐药细胞株相比呈间质上皮转化(MET)样改变。MTS结果显示四种不同E-cadherin过表达的NSCLC多西他赛耐药细胞对多西他赛的敏感性均强于其亲本耐药细胞和空载对照细胞。结论:NSCLC多西他赛耐药细胞发生EMT样改变，上调E-cadherin能增加NSCLC多西他赛耐药细胞对多西他赛的敏感性。     

Predictive factors analysis of the efficacy of cyclophosphamide combined with glucocorticoids in the treatment of idiopathic membranous nephropathy

Objective To investigate the predictive factors affecting the efficacy of cyclophosphamide (CTX) combined with glucocorticoids in the treatment of idiopathic membranous nephropathy (IMN), and to evaluate the efficacy of calcineurin inhibitor (CNI) adjustment due to poor treatment. Methods A retrospective cohort study was conducted. Two hundreds and twenty-eight patients with IMN diagnosed by renal biopsy in the People's Hospital of Guangxi Zhuang Autonomous Region from January 1, 2007 to December 1, 2016 were enrolled. All subjects were treated with CTX in combination with glucocorticoids. The patients were divided into two groups: remission group and no remission group. Multivariable logistic regression analysis was used to determine the baseline clinical-pathological influencing factors for the remission of IMN in the enrolled patients. Results The number of total remission (including complete and partial remission) of the first CTX combined with glucocorticoid treatment in 228 patients with IMN was 188(82.5%). Among them, 141 patients (61.8%) had complete remission (CR), the median time for CR was 8(6, 12) months, and the median time for partial remission (PR) was 3(1, 4) months. The median follow-up time for this study was 25(13, 43) months. Compared with the remission group, the serum albumin level was lower in the non-remission group, the 24-hour urine protein content, the blood complement C3 and C4 levels were higher, and the pathological stage was milder (all P﹤0.05). Multivariate logistic regression analysis suggested that the levels of baseline serum albumin, complement C4, and pathological stage were independent predictors of clinical remission in IMN patients. Twenty-four non-remission patients were treated with CNI. The overall response rate was 66.7%(16/24) at 6 months and 77.3%(17/22) at 12 months. Conclusions The levels of baseline albumin, blood complement C4, and pathological stage were independent predictors of clinical remission in IMN patients treated with CTX plus glucocorticoids. The non-remission patients with CTX combined with glucocorticoid therapy can still achieve a higher response rate after adjusting for CNI.     

Prenatal diagnosis of caudal regression with heterotaxy syndrome: “A mermaid with a broken heart”

Caudal regression syndrome (CRS) is a rare congenital malformation with varying degrees of early gestational developmental failure. It is characterized by agenesis of the sacrum and lumbar spine, with lower limb neurological deficit and accompanying deformities of the pelvis, lower extremities, genitourinary, and gastrointestinal systems. We report a case of CRS associated with rare complex congenital heart defect, that is, heterotaxy syndrome, diagnosed prenatally.