贝伐单抗联合培美曲塞加卡铂二线治疗晚期非小细胞肺癌的临床观察

目的:观察贝伐单抗联合培美曲塞加卡铂二线治疗晚期非小细胞肺癌(NSCLC)的疗效及不良反应。方法:30例晚期NSCLC患者采用随机数字表法分为试验组(10例,贝伐单抗15mg·kg-1+培美曲塞500mg·m-2+卡铂AUC6)与对照组(20例,培美曲塞500mg·m-2+卡铂AUC6),21d为1个周期。完成2个周期以上评价疗效和不良反应。结果:试验组与对照组的疾病控制率分别为80.0%、40.0%(P<0.05),中位无进展生存期分别为4.7、3.2个月(P<0.05),有效率分别为20.0%、5.0%(P>0.05),中位生存期分别为9.2、7.9个月(P>0.05)。2组主要不良反应比较,差异无统计学意义(P>0.05)。结论:贝伐单抗联合培美曲塞加卡铂二线治疗晚期NSCLC在疾病控制率和中位无进展生存期方面优于培美曲塞加卡铂方案,且未加重不良反应,患者能够耐受。     

评估转移性肾细胞癌对酪氨酸激酶抑制剂的反应性:CT质地参数是一个预测性生物标记物

目的评估转移性肾细胞癌接受酪氨酸激酶抑制剂(TKI)治疗两期后,肿瘤CT质地参数的变化是否与肿瘤治疗后变化有关。材料与方法此回顾性分析免除专业审查委员会的批准。39例转移性肾细胞癌病人TKI治疗前后均接受对比剂增强CT检查,测量其CT质地参数。共分析87处     

自身免疫性甲状腺功能减退患者肥胖及脂代谢的研究

目的:探讨自身免疫性甲状腺功能减退患者甲状腺球蛋白抗体(Thyroglobulin antibody TGAb)、甲状腺过氧化物酶抗体(Thyroperoxidase antibody TPOAb)与肥胖及脂代谢的关系.方法:选择桥本氏甲状腺炎(Hashimoto thyroiditis HT)女性239名,分为甲减组58例、亚临床甲减组69例、甲功正常组112例,测量腰围(waist circumstance WC)、臀围并计算腰臀比(waist hip ratio WHR),实验室检测促甲状腺素(thyroid stimulating hormone TSH)、TGAb和TPOAb,脂代谢相关参数总胆固醇(total cholesterol TC)、甘油三酯(triglyceride TG)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol LDL-C)等.结果:三组之间WC、TC与TG存在显著差异(P<0.05),WHR则无明显差异(P>0.05).三组WC均与TPOAb存在明显相关性(r=0.384,r=0.369,r=0.307,P<0.05),三组TPOAb与TC存在明显正相关(r=0.431,r=0.387,r=0.381,P<0.05),与HDL-C存在明显负相关(r=-0.356,r=-0.343,r=-0.312,P<0.05).结论:自身免疫性甲状腺功能减退患者存在明显的腹型肥胖及脂代谢异常,自身免疫的损伤程度可能与脂代谢紊乱有关.     

沈阳市东陵区2006～2010年主要疾病死亡分析

目的分析东陵区2006～2010年主要疾病的流行病学特征,为预防疾病提供依据。方法采用描述流行病学的方法对主要疾病的死亡情况进行死亡数统计、标化死亡率、死因顺位排序来分析主要疾病的死亡情况。结果位于死因前五位的是脑血管疾病、心脏病、恶性肿瘤、呼吸系统疾病、损伤与中毒,除心脏病外,男性死亡率高于女性。结论东陵区居民的死因主要以心脑血管疾病及恶性肿瘤为主,人口老龄化、环境及生活方式等的改变是导致这些疾病的危险因素,这些危险因素提示了我们制定慢病防治的工作方向。     

云南省鼠疫耶尔森菌多位点可变数目串联重复序列分析

目的 通过多位点可变数目串联重复序列分析(multiple-locus variable-number tandem-repeat analysis,MLVA)方法,对云南省鼠疫菌株进行基因分型。 方法 采用聚合酶链反应(PCR)和毛细管电泳,通过BioNumerics软件进行处理,分析云南省158株鼠疫耶尔森菌基因型。 结果 选取鼠疫菌的14个VNTR位点,5个VNTR位点对云南省鼠疫菌具有多态性分析意义,利用这5个位点对云南菌株进行分析,云南158株鼠疫菌可分为2个群,3个簇,5个基因型,野鼠鼠疫菌属于A簇,丽江玉龙鼠疫菌属于B簇,家鼠鼠疫菌属于C簇,与传统的生态分型结果吻合。 结论 本次试验筛选的5个位点可以用于云南省鼠疫菌的分型,云南家鼠鼠疫菌、野鼠鼠疫菌及玉龙鼠疫菌分属不同的基因簇,玉龙鼠疫菌与野鼠鼠疫菌同属一个群,聚类结果与实际的地理相关性很好。     

Anticoagulation Bridging Around Device Surgery: Compliance with Guidelines

Background: Current guidelines recommend bridging anticoagulation in patients undergoing cardiac rhythm device surgery with a “moderate to high risk” of thromboembolism. Patients at “low risk” are advised to stop oral anticoagulation without bridging to the procedure. This study examines real world adherence to accepted guidelines and the clinical sequelae of nonadherence. Methods: We performed a review of all patients undergoing device surgery receiving chronic anticoagulation over a prespecified time period of 14 months. Patients were classified per American College of Chest Physician guidelines as “moderate/high risk” or “low risk” of thromboembolism. We then compared perioperative management of anticoagulation to guideline recommendations and assessed the rate of perioperative bleeding and thromboembolism. Results: One hundred and twenty‐nine patients were included in this study. Sixty‐two (48%) were classified as “moderate/high risk” and 67 (52%) “low risk.” In the “moderate/high risk” group 47/62 (76%) received perioperative anticoagulation but only 25/62 (40%) were bridged both pre‐ and postprocedure or maintained on uninterrupted warfarin. In the “low risk” group, 22/67 (33%) received bridging therapy. Device pocket hematoma or perioperative bleeding occurred in 10/129 (8%) with 4/10 receiving inappropriate bridging for a calculated low risk of thromboembolism. There were no perioperative thromboembolisms. Conclusions: Our study identified significant underutilization of bridging, particularly in the postoperative period, in patients at “moderate/high risk” of thromboembolism. Conversely, bridging was overused in “low risk” patients and associated with bleeding complications. Physicians should be urged to follow current expert guidelines in regard to bridging anticoagulation for cardiac rhythm device surgery. (PACE 2012;35:1480–1486)     

Laparoscopic extraperitoneal para-aortic lymphadenectomy in locally advanced cervical cancer: a prospective correlation of surgical findings with positron emission tomography/computed tomography findings

BACKGROUND:

Failure to detect metastasis to para‐aortic nodes in patients with locally advanced cervical cancer leads to suboptimal treatment. No previous studies have prospectively compared positron emission tomography (PET)/computed tomography (CT) with laparoscopic extraperitoneal staging in the evaluation of para‐aortic lymph nodes.

METHODS:

Sixty‐five patients were enrolled; 60 were available for analysis. Patients with stage IB2‐IVA cervical cancer without evidence of para‐aortic lymphadenopathy on preoperative CT or magnetic resonance imaging (MRI) were prospectively enrolled. All patients underwent preoperative PET/CT. Laparoscopic extraperitoneal lymphadenectomy was performed from the common iliac vessels to the left renal vein.

RESULTS:

The median age at diagnosis was 48 years (range, 23‐84). The median operative time was 140 minutes (range, 89‐252). The median blood loss was 22.5 mL (range, 5‐150). The median length of hospital stay was 1 day (range, 0‐4). The median number of lymph nodes retrieved was 11 (range, 1‐39). Fourteen (23%) patients had histopathologically positive para‐aortic nodes. Of the 26 patients with negative pelvic and para‐aortic nodes on PET/CT, 3 (12%) had histopathologically positive para‐aortic nodes. Of the 27 patients with positive pelvic but negative para‐aortic nodes on PET/CT, 6 (22%) had histopathologically positive para‐aortic nodes. The sensitivity and specificity of PET/CT in detecting positive para‐aortic nodes when nodes were negative on CT or MRI were 36% and 96%, respectively. Eleven (18.3%) patients had a treatment modification based on surgical findings.

CONCLUSIONS:

Laparoscopic extraperitoneal para‐aortic lymphadenectomy is safe and feasible. Surgical staging of patients with locally advanced cervical cancer should be considered before planned radiation and chemotherapy. Cancer 2011. © 2010 American Cancer Society.     

心包原发性恶性间皮瘤的临床特点及病理观察

目的：了解心包原发性恶性间皮瘤（primary malignant pericardial mesothelioma,PMPM）的临床病理特点。方法：收集2例PMPM患者的临床资料。切除组织HE染色光镜观察,免疫组织化学做CKp、CK18、EMA、MC、Vimentin、CEA、Calretinin、TTF1、Tg标记。结果：2例PMPM是以上皮细胞为主型,呈乳头状和腺管样排列。免疫组织化学标记瘤组织CKp、CK18、Vimentin、Calretinin阳性。MC例1阳性,例2阴性,EMA例1阴性,例2阳性。临床改变似心包炎和心包积液。结论：恶性心包间皮瘤临床改变似心包炎,只有病理检查才能确诊。     

2002～2007年上海市松江区肺癌发病情况分析

[目的]探讨上海市松江区肺癌发病现状和流行趋势,以掌握肺癌流行特征,为进一步控制肺癌发病提供理论依据.[方法]利用上海市恶性肿瘤报告系统收集肺癌患者发病资料,对2002～2007年上海市松江区肺癌发病情况进行描述,计算肺癌粗发病率、世界人口标化发病率,利用年度变化百分比对松江区1988～2007年男女性肺癌发病时间趋势进行分析.[结果]2002～2007年松江区新诊断肺癌共1 801例,总发病率58.11/10万,新发病例中男性1 354例,占75.18％;女性447例,占24.82％.肺癌是松江区男性发病第1位肿瘤,女性发病第2位肿瘤.73.13％的肺癌病例分布在60～80岁之间,65岁以上发病率最高.20年来松江区男女性肺癌发病率呈上升趋势,且诊断病例晚期居多.[结论]肺癌为上海市松江区主要恶性肿瘤之一,松江区人口老龄化可能是发病率上升的主要原因.应加强肺癌筛查及早诊早治.