Multiples in dermatology: markers for special considerations in diagnosis, therapy, and prognosis

Multiples of certain cutaneous lesions should alert the clinician to a wider differential diagnosis and possible systemic associations although the individual skin lesion is often benign in nature and banal in appearance. This article focuses on such findings in selected multiple cutaneous lesions that may be classified according to the primary cutaneous feature as vascular, pigmentary, nevoid hamartomas, and tumors/neoplastic conditions. The clinical presentation of each entity and its significance, appropriate diagnostic evaluation, therapeutic and prognostic considerations and pertinent differential diagnoses will be reviewed.     

HLA-G expression in cancers: potential role in diagnosis, prognosis and therapy

Human leukocyte antigen G (HLA-G) is a non-classic major histocompatibility complex (MHC) class I molecule that functions as an immune suppressive molecule. HLA-G has direct inhibitory effects on natural killer cells(NK), dendritic cells (DC), T cells and has long-term tolerogenic indirect effects by inducing regulator T cells (Treg). HLA-G has been reported to be involved in various physio-pathological conditions such as reproduction, transplantation, autoimmunity, infectious and malignant diseases. In this context, aberrant expression of HLA-G in malignant diseases including hematological and solid tumors has been extensively investigated and its relevance to clinicoparameters and potential significance in diagnosis, prognosis and immune target therapy has been postulated. We here summarized the HLA-G expression in malignancies and emphasis its clinical relevance to malignant disease diagnosis, prognosis, and its potential in target-based immunotherapy was also discussed.     

复发性卵巢上皮癌67例临床分析

目的探讨复发性卵巢上皮癌的治疗方法及预后。方法回顾性分析复发性卵巢上皮癌67例,分为三组:手术 化疗组22例,单纯化疗组38例,未治疗组7例。结果手术 化疗组、单纯化疗组的中位生存时间分别为17、15个月,其生存率相比较,相互间无显著性差异(P>0.05);未治疗组(中位生存时间5个月)与其他两组相比较,有显著性差异(P<0.05)。残存癌灶≤2cm的中位生存时间为23个月,而>2cm者为9个月,两组的生存率有显著性差异(P<0.05)。停药时间>6个月后复发者中位生存时间为18个月,≤6个月者为5个月,两组的生存率有显著性差异(P<0.05)。结论个体化、分阶段的综合疗法,对治疗复发性卵巢癌有一定效果,满意的二次肿瘤细胞减灭术和二线化疗,可改善患者预后。     

Markers of tumor angiogenesis: clinical applications in prognosis and anti-angiogenic therapy

Numerous studies in many tumor types have demonstrated that quantitation by microvessel as a measure of angiogenesis is a powerful prognostic tool. However, the ability to exploit tumor angiogenesis as a prognostic marker is limited by the methods currently used for capillary identification and quantitation. This report critically evaluates all aspects of the techniques and their associated problems used for assessing tumor angiogenesis in tissue sections including the area of tumor assessed, the vascular parameter measured, the method of quantitation, the stratification of patients and the practical utility of computer image analysis systems. The potential of angiogenic factors assays, proteolytic enzymes, and cell adhesion molecules as surrogate endpoints for quantifying tumor angiogenesis are discussed and other methods for quantifying tumor angiogenesis are described. The potential clinical applications of these angiogenic markers in prognosis, stratification for adjuvant treatments (both cytotoxic and anti-angiogenic/vascular targeting) and other aspects of patient management is also discussed, particularly design of phase I and II trials.     

溶栓与抗凝对中危肺血栓栓塞患者的影响

目的：中危肺栓塞的治疗方案是采用溶栓治疗还是抗凝治疗,学术界争议较大。该研究拟探讨溶栓与抗凝对中危肺血栓栓塞患者的疗效、安全性及长期预后的影响。方法回顾性分析2008年1月至2013年5月因中危肺血栓栓塞于该院治疗的患者48例,采用溶栓治疗25例,单纯抗凝治疗23例;比较两组患者的疗效、安全性及长期预后。结果溶栓组治疗总体有效率为96．00％,抗凝组总体有效率为60．87％（P ＜0．05）。溶栓组、抗凝组各有1例患者出现大出血事件;溶栓组5例出现小出血事件,抗凝组4例小出血事件（P ＞0．05）。长期随访,溶栓组肺血栓栓塞再发率为4．0％;抗凝组肺血栓栓塞再发率为8．7％（P ＞0．05）。结论针对无溶栓治疗禁忌证的中危肺血栓栓塞患者,尽管溶栓费用较抗凝治疗为高,但其疗效好,且副作用与单纯抗凝治疗类似,安全性良好,宜作为临床首选。     

脑梗死患者急性期降压治疗对脑梗死预后的影响

目的 探讨脑梗死患者急性期降压治疗对患者预后的影响。方法 选取2013年5月~2016年1月期间我院收治的141例脑梗死患者作为研究对象分并为研究组和对照组,研究组65例给予急性期降压治疗,对照组76例给予常规降压治疗,比较两组NIHSS评分、心脑血管事件发生率、死亡率、残疾率。结果 两组治疗后NIHSS评分均出现明显降低,与治疗前比较差异有统计学意义(P0.05),研究组治疗后NIHSS评分明显低于同期对照组(P0.05)。研究组入院第7天及入院第14天心脑血管事件发生率、入院第14天死亡率/致残率明显低于对照组(P0.05)。结论 脑梗死患者急性期降压治疗有助于神经功能的恢复,可降低心脑血管事件发生风险,降低死亡率/致残率,但降压的过程避免过低、过快,在降压过程中需要密切监测血压的变化。     

影响三阴性乳腺癌疗效及预后的分子生物学因素

三阴性乳腺癌的治疗极为困难,疗效差。这部分患者除化疗外尚无其他有效的全身治疗措施,并且疗效和预后也存在差异,依靠现有的临床和病理指标难以对三阴性乳腺癌患者进行个体化治疗和预后分析。近年来,文献报道应用分子生物学指标,进行三阴性乳腺癌的分子病理分型和基因分型,以指导治疗及判断预后,从而改善三阴性乳腺癌患者的生存率。     

高压氧治疗对中重型颅脑损伤患者急性期脑脊液乳酸脱氢酶、肌酸激酶水平及预后的影响

目的观察高压氧治疗对中重型颅脑损伤患者脑脊液乳酸脱氢酶(LDH)、肌酸激酶(CK)的相关性及其治疗结果。方法对70例中重型颅脑损伤急性期患者随机分为对照组和观察组,对照组仅采取药物常规治疗,必要时神经外科手术治疗,观察组在对照组的基础上加用高压氧治疗,比较2组患者治疗前后脑脊液乳酸脱氢酶(LDH)、肌酸激酶(CK)及GCS评分变化情况。结果观察组脑脊液乳酸脱氢酶(LDH)、肌酸激酶(CK)明显低于对照组(P<0.05)。GCS评分明显提高,伤后6个月GOS评分明显增高。结论高压氧治疗可显著降低颅脑损伤急性期患者脑脊液LDH、CK水平,并有满意的近期及远期疗效。     

高压氧治疗脑膜瘤患者的磁共振表现与预后关系

目的：通过分析脑膜瘤磁共振表现与复发的关系，研究高压氧对脑膜瘤预后的影响。方法：140例经MRI检查并手术病理证实的脑膜瘤患者资料中有38例经高压氧治疗（高压氧组），余102例未做高压氧治疗（对照组）。分析两组患者中已复发和未复发病例MRI表现的异同以及两组复发率及复发时间的差异。结果：（1）复发组的MRI主要表现为在骨质改变、无包膜、囊性变、强化不均、尾征及瘤周水肿方面与无复发者有区别。高压氧组与对照组比较，各MRI表现无明显差异。（2）对照组102例中，有16例复发，死亡7例：高压氧组38例，有5例复发，2例死亡。P〉0．05。（3）两组平均复发时间为39个月和37．6个月。P〉0．05。结论：特定的影像学表现与脑膜瘤预后相关，高压氧治疗对脑膜瘤的预后无明显影响。     

负荷量瑞舒伐他汀对冠心病PCI术后预后的影响

目的 探讨负荷量瑞舒伐他汀钙对经皮冠脉介入治疗（PCI）围手术期心肌损伤发生率及PCI术后1年预后的影响.方法 91例接受择期PCI的冠心病（包括稳定型心绞痛和不稳定型心绞痛）,根据是否给予负荷量瑞舒伐他汀分为负荷量组和对照组,通过监测术后高敏肌钙蛋白水平,前瞻性观察两组患者围手术期心肌损伤的发生率及PCI术后1年主要心脏不良事件（major adverse cardiac events,MACE）发生率.结果 负荷量组术后围手术期心肌损伤的发生率（46.7％vs87.0％,P＜0.001）和围手术期心肌梗死的发生率（11.1％vs 37.0％,P=0.006）明显低于对照组,但总MACE发生率在两组患者未有统计学差异（2.2％ vs 8.7％,P=0.361）.结论 PCI术前给予负荷量的瑞舒伐他汀可减少围手术期心肌损伤的发生,但对PCI术后1年MACE事件的发生率未有明显影响.     

Lung cancer: detection, prevention, and therapeutics

Lung cancer remains the leading cause of cancer death in the U.S. adult population, and the American Cancer Society estimates that cigarette smoking is responsible for about 83% of all lung cancer cases. It is unlikely that significant reductions in the incidence and mortality associated with lung cancer will be realized without effective antismoking campaigns. Surgery, radiation therapy, and chemotherapy all play a role in the management of lung cancer. At the current time, NSCLC is generally curable only if it is diagnosed while the tumor is small and localized and can be surgically removed. Radiation therapy may also be effective in localized cases. Combination chemotherapy regimens have not consistently produced quality responses in patients with advanced tumors; however, newer regimens utilizing high doses of cisplatin, mitomycin and vinca alkaloids, or cisplatin and etoposide have produced encouraging results. In contrast to NSCLC, SCLC is responsive to combination chemotherapy regimens. Although many different agents are effective in this disease, most small-cell tumors eventually become refractory to chemotherapy and most patients do not survive longer than two years. Although progress has been made in the understanding and management of lung cancer, effective therapies that consistently produce major and durable responses are still lacking. Clinical trials must continue to evaluate therapeutic modalities for all types of lung cancer.     

强化胰岛素治疗对脓毒症患者血清血管性假血友病因子、内皮素1和一氧化氮浓度及预后的影响

目的：探讨强化胰岛素治疗（IIT）对脓毒症患者血清血管性假血友病因子（v WF）、内皮素1（ET-1）和一氧化氮（NO）浓度及预后的影响。方法：将90例脓毒症患者随机分为强化胰岛素治疗组（IIT组）和常规胰岛素治疗组（CIT组）。在治疗前、治疗后3 d、7 d用酶联免疫吸附法（ELISA）检测2组患者血清v WF、ET-1和NO的浓度。同时记录2组患者ICU住院时间、机械通气时间、ICU最后1 d的APACHEⅡ评分、28 d病死率及低血糖发生率。结果：IIT组患者血清v WF、ET-1浓度较CIT组均明显降低（P〈0.05）,NO浓度较CIT组均明显升高（P〈0.05）,且IIT组患者ICU住院时间、机械通气时间、ICU最后1 d的APACHEⅡ评分、28 d病死率较CIT组均明显降低（P〈0.05）,但两组患者低血糖发生率相近（P〉0.05）。结论：IIT可以使脓毒症患者血清v WF、ET-1浓度降低及NO浓度升高,同时可以降低患者病死率,改善预后。     

KRAS突变非小细胞肺癌的靶向治疗研究进展

非小细胞肺癌(NSCLC)是目前最常见的恶性肿瘤之一,其存在被认为源于致癌启动基因的突变。目前认为表皮生长因子受体(EGFR)和一种鼠类肉瘤病毒癌基因(Kras)为两个主要突变基因。KRAS突变肺癌约占NSCLC的25%。研究发现KRAS突变肿瘤患者对EGFR酪氨酸激酶抑制剂存在抗性。因此,在NSCLC患者中,急需针对KRAS突变的治疗手段。靶向药物针对性更强,对正常细胞毒副作用更低,是目前NSCLC药物治疗的研究热点。本文概述了RAS生物学及KRAS靶点抑制剂的研究情况,并介绍了针对KRAS突变NSCLC治疗的近况。     

保乳治疗乳腺癌患者临床病理特征与预后的相关性

目的 分析行保乳治疗的乳腺癌患者临床、病理特征与预后的相关性。方法 回顾性分析2010年1月至2012年12月于安徽医科大学第二附属医院接受保乳治疗的206例女性乳腺癌患者临床资料,总结患者的临床、病理特征。通过Kaplan-Meier单因素分析患者临床、病理特征（年龄、月经状态、病理类型、肿瘤大小、淋巴结状态、激素受体状况、Ki-67指数、HER-2表达状况、神经脉管浸润情况等因素）对预后的影响,对单因素分析差异有统计学意义的因素进行Cox回归分析。结果 单因素分析显示,不同年龄患者5年生存率比较,差异无统计学意义（P>0.05）,不同月经状态、淋巴结状态、Ki-67指数及神经脉管浸润差异有统计学意义（P<0.05）;多因素分析显示,月经状态、淋巴结状态及Ki-67指数与保乳治疗的预后具有相关性（P<0.05）。结论 保乳治疗的乳腺癌患者的年龄与预后无相关性。绝经、淋巴结转移、Ki-67指数是影响保乳治疗的乳腺癌患者预后独立影响因素。