吉非替尼联合培美曲塞治疗老年NSCLC患者的效果及其对肿瘤生物学指标、血流动力学的影响

目的:探究吉非替尼与培美曲塞联合应用于老年非小细胞肺癌(Non-small cell lung cancer,NSCLC)患者的效果观察.方法:选取本院我科85例老年中晚期NSCLC患者作为研究对象,采用抽签法分成两组,对照组42例采用培美曲塞治疗,观察组43例加用吉非替尼治疗,观察两组患者的临床疗效,肿瘤生物学指标、...     

直径<1cm肺腺癌浸润进展影响因素及临床预后探讨

目的:探讨直径<1cm肺浸润性腺癌发生独立影响因素及临床预后。方法回顾性分析我院2013年1月-2018年3月收治直径<1cm肺腺癌患者共364例临床资料,根据胸部影像学特征分组,其中pGGN(A组)122例,mGGN(B组)136例,SN(C组)106例,比较三组基线临床特征和手术相关指标,分析结节直径亚组病理相关指标和分期差异,采用Logistic回归模型评价直径<1cm肺浸润性腺癌发生独立影响因素。结果①364例患者均胸腔镜手术治疗,其中楔形切除,切缘距病灶均<2cm。C组肺叶切除比例显著高于A组、B组(P<0.05);男性吸烟比例显著高于女性(P<0.05);②122例pGGN患者中1~5mm病灶术后病理均为原位/微浸润腺癌;A组6~10mm病灶Ia1期比例显著高于1~5mm病灶(P<0.05)。mGGN中6~10mm病灶共92例,包括胸膜侵犯6例,脉管癌栓2例;SN中6~10mm病灶共78例,包括胸膜侵犯10例,脉管癌栓4例,淋巴结转移4例。③单因素分析结果显示,AIS+MIA和IAC组吸烟史、既往癌症罹患史、病灶影像学特征及病灶直径比较,差异有统计学意义(P<0.05);多因素分析结果显示,吸烟史、既往癌症罹患史、mGGN、SN及病灶直径>5mm,均是直径<1cm肺浸润性腺癌独立危险因素(P<0.05)。④364例患者中肺叶切除术后住院期间因肺栓塞死亡1例,随访时间为20~81个月,中位随访时间为43.0个月;随访过程中Ia1期患者中1例在术后14个月因肺炎死亡;随访总生存率为99.72%(362/363)。结论直径<1cm肺浸润性腺癌患者中mGGN和SN如病灶直径达6~10mm,更易累及胸膜或淋巴结;吸烟史、既往癌症罹患史、mGGN、SN及病灶直径>5mm均与直径<1cm肺浸润性腺癌发生独立相关。     

从三焦辨治小儿咳嗽

咳嗽是小儿常见病,针对小儿特殊的生理病理特点,结合三焦定位辨证法来辨证治疗小儿咳嗽,如上焦咳嗽,主要定位在肺,治宜疏风散寒,解表宣肺,润燥止咳;中焦咳嗽,主要定位在脾胃,治宜健脾燥湿,滋阴润肺,化痰止咳;下焦咳嗽,主要定位在肾,涉及肺,治宜补肺益肾。     

产科常见易错手术操作编码案例分析

在ICD-9-CM-3中产科系统的手术操作因临床书写相同,手术操作过程相似,但编码往往不同,编码员在编码时常有误编。列举某院病案质控发现的产科手术操作编码错误较多的几种编码,例如催产素静滴、人工破膜引产术、会阴切开术、会阴裂伤修补术、剖宫产术、子宫球囊置入术等,探讨分析其编码要点及查找方法,总结产科中催产素静滴编码时需要注意是否药物增强分娩;人工破膜引产术根据操作时是否进入产程编码于73.01、73.09;会阴切开术根据是否伴有产钳或真空吸引操作编码于73.6、72.1、72.21、72.31、72.71;会阴裂伤修补术根据疾病性质编码于71.71、75.69、71.79;剖宫产术根据目的不同编码于74.1、74.91;子宫球囊置入术根据置入球囊目的不同编码于69.91、73.1、75.8;分娩后清宫术根据术式编码于69.02、69.52。编码员需提升临床基础知识和病案专业技能,熟练掌握产科手术操作编码规则,并与临床保持良好沟通,才能提高编码准确性。     

论金匮心系疾病诊断思维

通过心系研究现状的分析得出金匮心系由心脏、心经、心脏与其他脏器相联系的血管与经脉、心包之膜组成。同时从善于鉴别,同中求异;注重脉诊,四诊合参;重视辨病,与辨病机结合;注重三因,体现整体;善于两种笔法四方面探讨金匮心系疾病诊断思维,并以曾经治愈一个扩张型心肌病初愈的病案为例。     

Sema7A干预钛微粒诱导鼠MC3T3-E1成骨细胞的凋亡

BACKGROUND: Semaphorin7A (Sema7A) is a kind of cell surface protein, which can promote the fusion of osteoclasts and the migration of osteoblasts at the same time, affecting the dynamic balance of the bone. It is speculated that Sema7A siRNA may inhibit osteoblast apoptosis induced by titanium particles.OBJECTIVE: To study the effect of Sema7A on the preosteoblast activity inhibited by titanium particles.METHODS:Mouse MC3T3-E1 preosteoblasts at passages 6 and 7 were divided into four groups: in blank control group, MC3T3-E1 cells were cultured alone; in standard control group, cell were cultured with titanium particles; in experimental groups 1 and 2, the cells were cultured with titanium particles+Sema7A overexpression plasmids and titanium particles+Sema7A siRNA, respectively. Apoptotic rate of MC3T3-E1 cells was detected by flow cytometry; the mRNA expression of bone sialoprotein, osteocalcin and type I collagen was detected by Q-PCR; western blot assay was adopted to detect the protein expression of bone sialoprotein, osteocalcin and type I collagen; alizarin red calcium nodule staining was taken to detect the degree of osteoblast mineralization.RESULTS AND CONCLUSION: The expressions of bone sialoprotein, osteocalcin and type I collagen were decreased in the standard control group and experimental group 1, but these expression were significantly increased in the experimental group 2 compared with the standard control group (P < 0.05). Flow cytometry results suggested that the apoptotic rate of osteoblasts in the experimental group 1 was significantly higher than that in the other groups (P < 0.05), and the apoptotic rate in the experimental group 2 was lower than that in the standard control group (P < 0.05). Alizarin red staining showed that there were no obvious mineralized nodules in the experimental group 1, but mineralized nodules formed in the experimental group 2. In brief, the genetic interference technique that inhibits the activity of Sema7A can interfere the process of mouse MC3T3-E1 preosteoblast differentiation inhibited by titanium particles, and thus provide a feasible way for the clinical treatment of wear particles-induced osteolysis using biotechnology.  中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

乳突成骨肉瘤CT表现一例

乳突成骨肉瘤ＣＴ表现一例赵云龙王晓彬李永才发生于颅骨肉瘤少见，仅占骨肉瘤的１％，本文报告１例经手术和病理诊断证实，发生于一侧乳突的成骨肉瘤。图１左侧内听道开口部后可见放射状骨针，同侧颈静脉凹消失，为骨样影所填充，天盖缘骨质稍示不整图２左外耳道后壁示一...     

应用脑CT扫描诊断小脑血吸虫病

一般X线检查诊断小脑血吸虫病,难度较大CT扫描有较高诊断价值。我院于1985年4月至1987年4月两年间,共收治脑血吸虫病42例,其中18例CT扫描诊断后经病理证实。18例中有小脑血吸虫病4例,现介绍如下。     

CYP3A4内含子10对CYP3A4基因表达的增强子作用

目的 探讨CYP3A4内含子10及其内SNP CYP3A4*1G对CYP3A4基因表达的调控作用.方法构建CYP3A4启动子启动转录的CYP3A4真核表达质粒, 将CYP3A4内含子10 (CYP3A4*1G野生型/突变型) 正向或反向插入该质粒的启动子上游, 从而构建出不同基因型、不同方向的CYP3A4内含子10调控的CYP3A4真核表达质粒.将构建好的各质粒分别转染入Hep G2细胞, 应用实时荧光定量PCR方法检测CYP3A4 m RNA表达水平.结果 构建的重组质粒经酶切验证与测序鉴定, 插入片段的序列和方向与预期完全一致.无论CYP3A4*1G野生型还是突变型, 反向组CYP3A4 m RNA表达水平均高于正向组 (P<0.01) ;而CYP3A4内含子10无论是正向还是反向, CYP3A4*1G野生型组CYP3A4 m RNA表达水平均高于突变型组 (P<0.01) .此外, 正向突变组CYP3A4 m RNA表达水平低于阳性对照组, 不但没有增强CYP3A4启动子的转录作用反而有所减弱.结论CYP3A4内含子10有类似于增强子的功能, 能够影响CYP3A4启动子对CYP3A4基因的转录, 且具有方向性和CYP3A4*1G等位基因依赖性.