目的 评估多种气道湿化方法对喉癌患者术后气道湿化的效果。方法 检索PubMed、Cochrane、Embase、Web of Science、Ovid、中国知网、万方、CBM、Google Scholar等数据库和网站,检索时限为建库至2023年2月。搜集关于喉癌患者术后不同气道湿化方法的随机对照试验,采用JBI2016年随机对照试验RCT评价标准评价文献质量。使用ADDIS1.16.5软件进行网状Meta分析。结果 纳入18篇研究,共1 596例患者。结果显示,镇痛泵持续泵入与注射器间断滴入、喷雾瓶间断喷雾在痰痂形成方面比较差异有统计学意义[OR（95%CI）=537.70（4.18,124 511.88）、0（0,0.52）,P<0.05];湿化满意度方面,注射器间断滴入与喷雾瓶间断喷雾比较差异有统计学意义[OR（95%CI）=8.55（1.40,73.35）,P<0.05];其余比较差异无统计学意义（P>0.05）。概率排序显示,降低肺部感染、黏膜出血和痰痂形成、痰液黏稠度、咳嗽和湿化不满意的发生,最优方法分别为湿化泵持续泵入、镇痛泵持续泵入、MR400湿化器和输液器持续泵入。结论 综合网状Meta分析及概率排序结果,考虑到喉癌患者术后早期下床活动,推荐便携式持续湿化方法。

Objective To access the effects of multiple airway humidification methods for postoperative patients with laryngeal cancer．Methods PubMed,Cochrane Library,EMbase,Web of Science,Ovid,China National Knowledge Infrastructure,Wanfang database,CBM and Google Scholar were searched systematically from establishment to February 2023,respectively．Related randomized controlled trials on airway humidification for postoperative patients with laryngeal cancer was analyzed and the quality of the literature was assessed using the JBI 2016 RCT evaluation．The network Meta analysis was performed using ADDIS 1.16.5 softwares．Results A total of 18 articles and 1596 patients were inciuded．The results showed that the analgesia pump continued to pump into the airway compared with the syringe intermittently drip and the spray bottle intermittent spray was statistically different in the formation of sputum[OR（95%CI）=537.70（4.18,124 511.88）,0（0,0.52）,P<0.05]．In terms of satisfaction of wetness,the difference between the intermittent drop of the syringe and the intermittent spray of the spray bottle was statistically different[OR（95%CI）=8.55（1.40,73.35）,P<0.05],the others were not statistically different（P>0.05）．Probability ranking table shows that the optimal methods were the humidification pump continues to pump into the airway,the analgesia pump continued to pump into the airway,the MR400 humidifier and the infusion set continuously pumped into the airway,which were beneficial to the reduction in pulmonary infection,tracheal mucosal hemorrhage and formation of phlegm callus,the degree of sputum viscosity,cough and unsatisfactory wetness．Conclusions Based on the comprehensive mesh meta-analysis and probability ranking results,a portable continuous humidification method is recommended considering the early post-operative activities of laryngeal cancer patients．

目的 开发适合中国肾癌患者的生命质量测定量表的特异模块。方法 采用议题小组和核心小组的程序化决策方式,提出条目池,形成初步量表,采用医生及患者重要性评分法、相关系数法、变异度法、因子分析法和克朗巴赫系数α对20例肾癌患者和20名医护人员进行的数据进行统计分析。结果 经过上述方法进行筛检,结合专家小组的建议,最终得到含有11个条目的肾癌生命质量测定量表的特异模块。结论 肾癌的生命质量测定量表特异模块严格按照程序执行,具有较好的内容效度。

Objective To develop the specific module of the quality of life instruments for patients with renal cancer（QLICP-RE）．Methods With the structured group（nominal group and focus group）methods,the item pool was put forward and a preliminary instrument was formed．The data from 20 renal cancer patients and 20 doctors/nurses were analyzed by statistical procedures．Doctors and patients' importance rating procedure,correlation analysis,method of coefficient of variation,factor analysis,and Cronbach's α．Results By above statistical procedures and advises of expert panel,11-items of the specific module were formed finally．Conclusions The specific module of QLICP-RE developed on the strict procedures has good content validity and representativeness．

目的 探讨多梳蛋白SUZ12对肝细胞肝癌（HCC）细胞增殖、血管生成拟态形成和人脐静脉内皮细胞（HUVECs）血管生成的影响。方法 分别利用MTT比色法及体外血管生成实验检测SUZ12表达水平改变对HCC细胞SMMC-7721、Hep3B增殖、血管生成拟态形成和HUVECs血管生成的影响。结果 MTT结果显示,在HCC细胞中分别敲低或过表达SUZ12均对HCC细胞的增殖能力无明显影响。将SUZ12低表达HCC细胞与HUVECs共培养后,HCC细胞的血管生成拟态管样结构形成增多。此外,将SUZ12敲低组HCC细胞的培养上清用于培养HUVECs后,HUVECs的血管生成拟态管样结构形成也明显增多。结论 SUZ12对HCC细胞的增殖无影响,其在HCC中可抑制HCC细胞和HUVECs的血管生成拟态管样结构形成。上述结果提示SUZ12可能通过调控HCC细胞及HUVECs的血管生成发挥抑癌作用。

Objective To investigate the effects of SUZ12 on cell proliferation of hepatocellular carcinoma（HCC）,vasculogenic mimicry formation and human umbilical vein endothelial cells（HUVECs）angiogenesis．Methods MTT assay was performed to detect the proliferation of SMMC-7721 and Hep3B cells．The effects of SUZ12 on the angiogenesis of HCC cells and HUVECs cells were studied by in vitro angiogenesis experiment．Results The result of MTT assay showed that SUZ12 knockdown or overexpression in HCC cells had no significant effect on the proliferation of HCC cells．We found that when HCC cells with low SUZ12 expression were co-cultured with HUVECs cells,the formation of vasculogenic mimicry tubular structures in HCC cells increased．In addition,we also found that after the culture supernatant of HCC cells in the SUZ12 knockdown group was used to culture HUVECs cells,the formation of vasculogenic mimicry tubular structures in HUVECs cells also increased significantly．Conclusions SUZ12 has no effect on the proliferation of HCC cells,but it can inhibit the formation of vasculogenic mimicry tubular structures in HCC cells and HUVECs cells．These results suggest that SUZ12 plays a role in cancer inhibition by regulating the angiogenesis of HCC cells and HUVECs cells．

目的 探讨转录因子E盒结合锌指蛋白1（ZEB1）、溶酶体相关膜蛋白5（LAMP5）在结直肠癌组织中的表达水平分析及预后预测价值。方法 选取驻马店市中心医院2018年1月—2020年1月收治的120例结直肠癌患者,分别采取所有患者的结直肠癌组织及癌旁组织进行免疫组化染色,对比ZEB1、LAMP5阳性率。对比不同病理特征结直肠癌患者ZEB1、LAMP5表达水平差异。对所有患者进行4年随访,依照随访结果将患者分为2个亚组,即预后不良组（n=35）和预后良好组（n=85）,对比两组患者一般临床特征及ZEB1、LAMP5表达水平,应用Logistic回归分析ZEB1、LAMP5对结直肠癌预后的预测价值。结果 结直肠癌组织ZEB1、LAMP5相对表达量（38.26±5.49、26.77±3.85）与ZEB1、LAMP5阳性率（86.67%、72.22%）高于癌旁组织（15.46±2.54、8.04±1.59、23.33%、15.56%],对比差异有统计学意义（t=41.280,χ²=25.437;t=49.255,χ²=16.071;P<0.05）。不同TNM分期[Ⅰ~Ⅱ期（35.55±4.13）、Ⅲ~Ⅳ期（42.32±4.75）]、淋巴结转移患者[是（44.37±4.28）、否（35.84±3.77）]、肿瘤分化程度[低分化（35.27±4.57）、中高分化（41.34±4.60）]ZEB1相对表达量对比差异有统计学意义（t=-8.281,P<0.001;t=10.746,P<0.001;t=-7.253,P<0.001）;不同TNM分期[Ⅱ期（24.88±3.37）、Ⅲ~Ⅳ期（29.61±2.57）]、淋巴结转移[是（30.72±2.19）、否（25.21±3.19）]、肿瘤分化程度[低分化（24.57±3.62）、中高分化（29.04±2.55）]患者LAMP5相对表达量对比差异有统计学意义（t=-8.254,P<0.001;t=9.227,P<0.001;t=-7.797,<0.001）;预后良好组与预后不良组患者性别、年龄、大体类型、肿瘤大小对比差异无统计学意义（P>0.05）,预后良好组与预后不良组患者TNM分期、淋巴结转移、肿瘤分化程度、ZEB1、LAMP5阳性比例对比差异有统计学意义（P<0.05）;Logistic回归分析显示：淋巴结转移、ZEB1阳性、LAMP5阳性为结直肠癌预后不良独立预测因素（P<0.05）。结论 ZEB1、LAMP5在结直肠癌组织中呈现高表达状态,且与结直肠癌的发生有关,同时ZEB1、LAMP5是结直肠癌预后的独立预测因素,两者有希望成为结直肠癌的治疗靶点。

Objective To investigate the expression levels and prognostic value of transcription factor E-box binding to zinc finger protein 1（ZEB1）and lysosomal associated membrane protein 5（LAMP5）in colorectal cancer tissues. Methods A total of 120 colorectal cancer patients admitted to a hospital from January 2018 to January 2020 were selected．Immunohistochemical staining was performed on the colorectal cancer tissues and adjacent tissues of all patients,and the positivity rates of ZEB1 and LAMP5 were compared．The expression levels of ZEB1 and LAMP5 in colorectal cancer patients with different pathological characteristics were compared．All patients were followed up for 4 years and divided into two subgroups based on the follow-up results,namely the poor prognosis group（n=35）and the good prognosis group（n=85）．The general clinical characteristics and expression levels of ZEB1 and LAMP5 were compared between the two groups．Logistic regression analysis was used to evaluate the predictive value of ZEB1 and LAMP5 for the prognosis of colorectal cancer. Results The relative expression level of ZEB 1 and LAMP 5 in colorectal cancer tissues [（38.26±5.49）,（26.77±3.85）] and the positive rate of ZEB 1 and LAMP 5（86.67%,72.22%）were significantly higher than that of adjacent tissues [（15.46±2.54）,（8.04±1.59）,23.33%,15.56%],the contrast difference was statistically significant（t=41.280,χ²=25.437;t=49.255,χ²=16.071;P<0.05）．Relative ZEBI expression levels in different TNM stages [I-Ⅱstage（35.55±4.13）,Ⅲ-Ⅳstage（42.32±4.75）],lymph node metastasis[Yes（44.37±4.28）,No（35.84±3.77）],degree of tumor differentiation [hypodifferentiated（35.27±4.57）,and middle or high differentiated（29.04±2.55）],those differences were statistically significant（t=-8.254,P<0.001;t=9.227,P<0.001;t=-7.797,P<0.001）．The relative expression of LAMP 5 between different TNM stages [I-Ⅱstage（24.88±3.37）,Ⅲ-Ⅳstage（29.61±2.57）],lymph node metastasis [yes（30.72±2.19）,no（25.21±3.19）],degree of tumor differentiation [hypodifferentiated（24.57±3.62）,and middle or high differentiated（29.04±2.55）],the contrast was statistically significant（t=-8.254,P<0.001;t=9.227,P<0.001;t=-7.797,P<0.001）．There were no differences in gender,age,gross type,and tumor size between the good prognosis group and the poor prognosis group（P>0.05）,while there were differences in TNM stages,lymph node metastasis,tumor differentiation degrees,ratio of ZEB 1 and LAMP 5（P<0.05）．Logistic regression analysis showed that TNM stage,lymph node metastasis,ZEB 1 positive,and LAMP 5 positive were independent predictive factors of poor prognosis in colorectal cancer（P<0.05）. Conclusions ZEB1 and LAMP5 are highly expressed in colorectal cancer tissues and closely related to the occurrence and development of colorectal cancer．ZEB1 and LAMP5 are independent prognostic factors for colorectal cancer,and they have the potential to become therapeutic targets for colorectal cancer．

目的 评价不同间变性淋巴瘤激酶（ALK）抑制剂联合安罗替尼治疗非小细胞肺癌（NSCLC）的疗效。方法 收集ALK突变阳性NSCLC患者的临床资料,筛选服用ALK抑制剂疗效不佳再加用安罗替尼的病例。根据不同的用药方案分为阿来替尼+安罗替尼,塞瑞替尼+安罗替尼和克唑替尼+安罗替尼三个组别。记录患者联合用药前最近一次的影像学检查结果,并以此为基线按Recist1.1评价疗效,以病情进展、患者死亡、停药、改变治疗方案为终点计算各组患者的无事件生存期（EFS）,收集肿瘤标志物、血常规和肝功、心功能、肾功能生化检测等指标数据,统计分析患者联合用药前后各项指标的变化。结果 经筛选,共纳入49例患者的临床数据。阿来替尼+安罗替尼组有23例,疾病控制率（DCR）为86.96%;平均EFS为（10.8±3.6）个月,中位EFS为8.3个月;塞瑞替尼+安罗替尼组有14例,DCR为71.43%;平均EFS为（6.5±2.9）个月,中位EFS为5.6个月;克唑替尼+安罗替尼组有12列,DCR为66.67%;平均EFS为（7.7±3.2）个月,中位EFS为7.2个月。阿来替尼+安罗替尼组的平均EFS长于另外两组（P<0.05）。各研究组肿瘤标志物仅有CyFra21-1在克唑替尼+安罗替尼组在联合用药后升高（P<0.05）,生化检测和血常规指标在用药前后差异无统计学意义（P>0.05）。结论 ALK抑制剂与安罗替尼联用,疗效最好为阿来替尼,其次为塞瑞替尼,最后为克唑替尼。三种ALK抑制剂与安罗替尼联用后,均未导致心、肝、肾功能和血细胞损害。

Objective To evaluate the efficacy of different anaplastic lymphoma kinase（ALK）inhibitors combined with anlotinib in the treatment of non-small cell lung cancer（NSCLC）. Methods Clinical data of drug resistant NSCLC patients with ALK positive mutation was collected who were treated with ALK inhibitors and anlotinib synchronously．According to different regimens,three groups were set,alectinib+anlotinib,ceritinib+anlotinib,and crizotinib+anlotinib．The latest imageological examination results of the patient before the synchronous therapy was set as the baseline to evaluate the therapeutic effect according to Recist1.1．The event free survival（EFS）of each group was calculated with disease progression,patient death,treatment discontinuation and changing regimen as endpoints．Data of tumor markers,hematology test,liver function,cardiac function,renal function biochemical examination was collected and analyzed statistically before and after the combination therapy,with P<0.05 as the statistically significant difference. Results After screening,clinical data of 49 patients were collected．Twenty-three patients in the alectinib+anlotinib group,with a disease control rate（DCR） of 86.96%;mean EFS was（10.8±3.6）months,median EFS of 8.3 months;14 patients in the ceritinib+anlotinib group,with a DCR of 71.43%,mean EFS was（6.5±2.9）months,median EFS was 5.6 months;12 patients in the crizotinib+anlotinib group,with a DCR of 66.67%,mean EFS was（7.7±3.2）months,median EFS was 7.2 months．EFS of alectinib+anlotinib group was longer significantly than the other two groups（P<0.05）．Only CyFra21-1,increased significantly after the combination of crizotinib and anlotinib（P<0.05）．No statistically significant difference in biochemical test and hematology test before and after the treatment（P>0.05）． Conclusions The therapeutic effect of ALK inhibitors with anlotinib was ordered,alectinib being the most effective,followed by ceritinib and finally crizotinib．The combination of ALK inhibitors with anlotinib did not cause any abnormal results in the examination of heart,liver,kidney and blood cells．

目的 研究核磁共振（MR）引导的海马保护技术应用于小细胞肺癌全脑放射治疗（放疗）的效果。方法 对确定行全脑放疗的30例小细胞肺癌脑转移患者,行常规放疗CT定位后以定位体位行全头颅MR平扫,将计算机断层扫描（CT）和MR的T1加权像在Monaco 5.1计划系统上进行精准融合,勾画全脑放疗及海马区域,在海马区域三维方向上分别外扩5、15 mm作为海马与计划靶区之间的剂量跌落,每一例患者在Monaco 5.1计划系统上按照不保护海马组织以及外扩5、15 mm进行保护设计3个容积旋转调强技术（VMAT）放疗计划,观察海马组织的平均及最大放疗剂量。结果 增加保护海马组织之后,3个放疗计划的D100均≥95%,每例的3个放疗计划间D100比较差异无统计学意义（P>0.05）;设置外扩5、15 mm的剂量跌落区后,左、右海马的平均剂量、最大剂量均明显降低,而且3个放疗计划的海马平均剂量、最大剂量之间对比差异有统计学意义。结论 小细胞肺癌脑转移患者进行全脑放疗时,利用MR引导的海马保护技术并设置外扩15 mm的剂量跌落区,能够显著降低海马的剂量,达到保护目的。

Objective To explore the application of MR guided hippocampal avoidant whole brain radiotherapy（WBRT）for small cell lung cancer（SCLC）．Methods Thirty SCLC patients with brain metastases who underwent WBRT were enrdled．After routine CT localization was performed,and a head MR was performed in a the same position．T1 weighted images of MR and CT images were accurately fused on the Monaco 5.1 planning system．The entire brain tissue and hippocampus region were delineated． The dose drop areas between the hippocampus and the planned target area were expanded 5mm and 15mm in the three-dimensional direction of the hippocampus,respectively．Three volumetric modulated arc therapy（VMAT）radiotherapy plans were designed for each patient on the Monaco 5.1 planning system based on whether the hippocampal tissue was avoid．The average and maximum doses of hippocampal tissue were observed．Results After the avoidance of hippocampal tissue,the D100 of the three radiotherapy plans reached ≥95%,and there was no significant difference in D100 between the three radiotherapy plans in each case．After setting dose drop areas of 5mm and 15mm for external expansion,the average and maximum doses of the left and right hippocampus were significantly reduced,and there was a significant difference in the comparison between the average and maximum doses in the hippocampus of the three radiotherapy plans．Conclusions MR guided hippocampal avoidant technology and the setting of a 15 mm dose drop area can significantly reduce the dose to the hippocampus in patients with SCLC undergo whole brain radiotherapy．

目的 探讨CT增强延迟扫描技术在非小细胞肺癌术前诊断中的应用价值。方法 对2021年5月—2024年5月商丘市第一人民医院收治的82例非小细胞肺癌手术治疗患者进行回顾性分析,将其分为观察组,另选取82例肺部良性肿瘤患者作为对照组,收集其术前CT增强延迟扫描结果,以术后病理诊断结果为金标准,分析CT增强延迟扫描技术在非小细胞肺癌术前诊断中的应用价值。并对比不同临床病理特征非小细胞肺癌患者CT增强延迟扫描的CT增强值,采用Spearman相关性分析法分析CT增强值与非小细胞肺癌病理特征的关系。结果 CT增强延迟扫描显示观察组患者分叶征（12.50% vs 53.57%）、内部空泡征数量（6.25% vs 39.29%）低于对照组（χ²=26.560、24.680,P<0.05）,观察组患者边缘毛刺（56.25% vs 17.86%）、胸部凹陷征（59.38% vs 14.29%）、高于对照组（χ²=43.330、64.600,P<0.05）;82例非小细胞肺癌通过CT增强延迟扫描共确诊79例,CT增强延迟扫描诊断对非小细胞肺癌的准确率为96.34%（79/82）,与病理诊断结果100.00%对比差异无统计学意义（χ²=3.060,P=0.080）;82例非小细胞肺癌平均CT增强值为（39.14±7.31）,不同性别、年龄、肿瘤最大直径、淋巴结浸润情况患者CT增强值对比差异无统计学意义（P>0.05）,不同病理类型[腺癌（43.75±7.15）vs 鳞癌（34.74±6.12）]、细胞分化程度[中、低分化（45.71±7.21）vs 高分化（32.81±5.11）]、临床分期[Ⅰ期（31.03±2.12）vs Ⅱ期（36.61±3.13）vs Ⅲa期（46.32±6.83）]患者、淋巴结转移[是（42.75±4.21）vs 否（35.77±8.13）]CT增强值对比差异有统计学意义（t/F=5.243、8.804、84.828、4.378,P<0.05）;Spearman相关分析结果显示：病理类型、细胞分化程度、临床分期、淋巴结转移与非小细胞肺癌患者CT增强值呈正相关（r=0.431,P=0.021;r=0.511,P=0.009;r=0.586,P=0.005;r=0.579,P=0.008,P<0.05）。结论 CT增强延迟扫描技术对非小细胞肺癌术前确诊具有重要价值,其诊断准确率与病理诊断并无显著差异,且可通过CT增强延迟扫描技术确定患者CT增强值,从而为非小细胞肺癌患者术后病理特征判断提供参考。

Objective To explore the application value of CT enhanced delayed scanning in preoperative diagnosis of non-small cell lung cancer（NSCLC）．Methods A retrospective analysis was conducted on 82 patients with NSCLC who underwent surgical treatment in a hospital from May 2021 to May 2024．They were included into an observation group and another 82 patients with benign lung tumors were included in the control group．The preoperative CT enhanced delayed scanning results were collected,and the postoperative pathological diagnosis was used as the “gold standard” to analyze the application value of CT enhanced delayed scanning in the preoperative diagnosis of NSCLC．And the CT enhancement values of delayed CT scans in NSCLC patients with different clinical and pathological features were compared,and Spearman correlation analysis was used to analyze the relationship between CT enhancement values and pathological features of NSCLC．Results CT enhanced delayed scanning showed that the number of lobular（12.50% vs 53.57%）and internal vacuolar signs（6.25% vs 39.29%）in the observation group was significantly lower than that in the control group（χ²=26.560,24.680,P<0.05）,while the edge spicules（56.25% vs 17.86%）and chest depression signs（59.38% vs 14.29%）in the observation group were significantly higher than that in the control group（χ²=43.330,64.600,P<0.05）．A total of 79 cases of 82 NSCLC were diagnosed by CT-enhanced delayed scan,and the accuracy of CT-enhanced delayed scan diagnosis for NSCLC was 96.34%（79/82）,with no significant difference from the pathological diagnosis result of 100.00%（χ²=3.060,P=0.080）．The average CT enhancement value of 82 NSCLC cases was（39.14±7.31）．There was no significant difference in CT enhancement values among patients of different genders,ages,maximum tumor diameter,and lymph node infiltration（P>0.05）．Patients with different pathological types [adenocarcinoma（43.75±7.15）vs squamous cell carcinoma（34.74±6.12）],degree of cell differentiation [moderate,and low differentiation（45.7±7.21）vs high differentiation（32.81±5.11）],clinical stage [I（31.03±2.12）vs II（36.61±3.13）vs IIIa（46.32±6.83）] and lymph node metastasis [yes（42.75±4.21）,vs no（35.77±8.13）] CT enhancement had significant difference（t/F=5.243,8.804,84.828,4.378,P<0.05）．The Spearman correlation analysis results showed that pathological type,degree of cell differentiation,clinical stage,lymph node metastasis were positively correlated with CT enhancement values in NSCLC patients（r=0.431,P=0.021;r=0.511,P=0.009;r=0.586,P=0.005;r=0.579,P=0.008）．Conclusions CT enhanced delayed scanning has important value in preoperative diagnosis of NSCLC．Its diagnostic accuracy is not significantly different from pathological diagnosis,and the CT enhanced value of patients can be determined through CT enhanced delayed scanning,providing reference for postoperative pathological feature judgment of NSCLC patients．

目的 基于SEER数据库分析三阴性乳腺癌（TNBC）的预后,并建立Cox回归临床预测模型且进行内部验证。方法 使用SEER*Stat软件（8.4.2版）筛选2010—2015年诊断为TNBC的病例,进行单因素和Cox多因素回归以及向后逐步回归分析,明确与生存相关的独立危险因素,构建预测TNBC患者3年和5年癌症特异生存（CSS）率的Nomogram图,并用受试者工作特征曲线,Harrell’s一致性指数,临床预测模型校准曲线以及决策曲线对该模型进行评估及内部验证,以评估该模型的临床预测效能。结果 共筛选出符合纳入标准的TNBC患者5 564例,按照7∶3的比例随机拆分为训练集（n=3 894）和验证集（n=1 670）。通过单因素,多因素分析显示TNM分期、放射治疗、化学治疗以及手术和其他治疗的先后顺序是与TNBC患者CSS显著相关的独立危险因素（P<0.05）。利用上述预后相关因素建立Nomogram图模型。训练集的C-index为0.731（95%CI：0.712~0.749）,验证集的C-index为0.719（95%CI：0.688~0.749）,训练集和验证集3年和5年生存ROC曲线的曲线下面积均>0.7,区分度较好,且校准曲线拟合良好。结论 TNM分期、放射治疗、化学治疗以及手术和其他治疗的先后顺序是TNBC的独立预后因素,基于此建立的Nomogram图临床预测模型区分度、准确度以及临床适用性较好,能较好地预测TNBC患者的生存预后。

Objective To analyze the prognosis of triple negative breast cancer（TNBC）based on the SEER database,and to establish a Cox regression clinical prediction model with internal validation．Methods Cases diagnosed with TNBC from 2010 to 2015 were screened using SEER*Stat software（version 8.4.2）,and univariate and Cox multifactorial regression as well as backward stepwise regression analyses were performed to identify the independent risk factors associated with survival,and to construct a clinical prediction model for predicting the three- and five-year cancer specific survival（CSV）of TNBC patients．Survival（CSS）rates of TNBC patients at 3 and 5 years,and the model was evaluated and internally validated using the ROC curve,Harrell’s consistency index（C-index）,clinical prediction model calibration curve,and decision-making curve（DCA curve）to assess the predictive efficacy of the model for clinical prediction．Results A total of 5 564 TNBC patients meeting the inclusion criteria were screened and randomly split into a training set（n=3 894）and a validation set（n=1 670）according to a 7∶3 ratio．By univariate,multivariate analysis showed that T-stage,N-stage,M-stage,radiotherapy,chemotherapy,and the sequence of surgery and other treatments were independent risk factors significantly associated with CSS in TNBC patients．The above prognostic-related factors were utilized to build a Nomogram plot model．The C-index was 0.731（95%CI：0.712-0.749）for the training set and 0.719（95%CI：0.688-0.749）for the validation set,and the areas under the curves of the 3- and 5-year survival ROC curves of both the training and validation sets were >0.7,which was a good differentiation,and the calibration curves were well-fitted．Conclusions T-stage,N-stage,M-stage,radiotherapy,chemotherapy,and the sequence of surgery and other treatments are independent prognostic factors for TNBC,and the Nomogram clinical prediction model based on this has good differentiation,accuracy,and clinical utility,and can better predict the survival prognosis of TNBC patients．

目的 分析贝伐珠单抗与化疗对晚期结直肠癌患者4种错配修复蛋白（MSH2、MLHI、MSH6、PMS2）水平影响。方法 选择2022年1月—2024年1月江苏省宿迁市中医院肿瘤科102例晚期结直肠癌患者,按抽签法分成两组,即化疗组及联合组,各51例。化疗组应用FOLFOX（亚叶酸钙+奥沙利铂+氟尿嘧啶）方案进行化疗,联合组采取贝伐珠单抗联合FOLFOX方案治疗。对比其肿瘤控制效果、免疫功能及MSH2、MLHI、MSH6和PMS2水平变化,并对比组间不良反应发生率。结果 联合组客观缓解率、疾病控制率高于化疗组（P<0.05）;治疗后联合组患者CD4⁺、CD3⁺、CD8⁺、和CD4⁺/CD8⁺数值高于化疗组,且两组治疗后均低于治疗前（P<0.05）;治疗后两组患者MSH2、MLHI、MSH6和PMS2缺失率对比无统计学意义（P>0.05）,但其阳性、阴性表达情况对比差异有统计学意义,联合组MSH2、MLHI、MSH6和PMS2阳性率低于化疗组（P<0.05）;两组不良反应发生率对比差异无统计学意义（P>0.05）。结论 对晚期结直肠癌在化疗基础上增加贝伐珠单抗抗肿瘤效果显著,改善其免疫功能,虽无法改善患者错配修复蛋白缺损,但可辅助降低其阳性率,且不影响安全性。

Objective To analyze the effects of bevacizumab and chemotherapy on the levels of four mismatch repair proteins（MSH2,MLHI,MSH6,PMS2）in patients with advanced colorectal cancer. Methods A total of 102 patients with advanced colorectal cancer from the Oncology Department of Suqian Traditional Chinese Medicine Hospital in Jiangsu Province from January 2022 to January 2024 were selected,and were divided into two groups according to the drawing method,namely the chemotherapy group and the combination group,with 51 patients in each group．The chemotherapy group received FOLFOX（calcium folinate+oxaliplatin+fluorouracil）regimen for chemotherapy,while the combination group received bevacizumab combined with FOLFOX regimen for treatment．Tumor control effect,immune function,and changes in MSH2,MLHI,MSH6,and PMS2 levels,and its incidence of adverse reactions were compared．Results The objective remission rate and disease control rate of the combined group were higher than those of the chemotherapy group（P<0.05）．After treatment,the CD4⁺,CD3⁺,CD8⁺ and CD4⁺/CD8⁺ values in the combination group were higher than those in the chemotherapy group,and those after treatment were lower than those before treatment in both groups（P<0.05）．After treatment,there were no significant differences in the deletion rates of MSH2,MLHI,MSH6,and PMS2 between the two groups of patients（P>0.05）,but there was a significant difference in their positive and negative expression．The positive rates of MSH2,MLHI,MSH6,and PMS2 in the combination group were lower than those in the chemotherapy group（P<0.05）．There was no significant difference in the incidence of adverse reactions between the two groups（P>0.05）．Conclusions Adding bevacizumab on the basis of chemotherapy has a significant anti-tumor effect on advanced colorectal cancer,improving its immune function．Although it cannot improve the mismatch repair protein defect in patients,it can assist in reducing its positivity rate and has high safety．

目的 对比分析钝性分离扩皮法与常规扩皮法对乳腺癌术后患者经外周静脉置入中心静脉导管（PICC）置管应用效果。方法 选取2022年4月—2024年4月在天津肿瘤医院空港医院接受治疗的120例乳腺癌术后PICC置管患者,依据随机数字表法进行分组处理。对照组60例给予常规扩皮法,观察组60例给予钝性分离扩皮法,对比两组患者扩皮结果。结果 观察组患者满意度为96.67%,对照组患者满意度为86.67%（χ²=3.927,P=0.048）;观察组患者的穿刺点血液浸湿面积分别为穿刺后即刻（0.87±0.14）cm²、1 d后（4.89±0.94）cm²以及3 d后（0.21±0.05）cm²,均低于对照组的（2.74±0.63）（9.89±2.04）（0.44±0.12）cm²,对比差异有统计学意义（t=22.444、17.243、13.704,P<0.05）;观察组患者一次性送鞘成功率为98.33%,对照组患者一次性送鞘成功率为88.33%,观察组高于对照组（χ²=4.821,P=0.028）;扩皮前两组患者的VAS评分无差异（P>0.05）,扩皮后两组患者的VAS评分均降低,且观察组（1.75±0.54）分低于对照组（3.89±1.22）分,对比差异有统计学意义（t=12.425,P<0.001）;观察组患者不良事件发生率为5.00%,对照组患者不良事件发生率为16.67%,观察组患者不良事件发生率低于对照组（χ²=4.227,P<0.05）。结论 钝性分离扩皮法能够降低穿刺点血液浸湿面积及不良事件发生率,提高一次性送鞘成功率,减轻患者疼痛感,提高患者满意度。

Objective To analyze the effect of blunt separating skin expansion and conventional skin expansion in PICC catheterization of patients after breast cancer surgery. Methods From April 2022 to April 2024,120 patients with postoperative PICC catheterization for breast cancer were selected and grouped according to the random number table method．Sixty patients in the control group received conventional skin expansion,and 60 patients in the observation group received blunt separation skin expansion,which the results of the two groups were compared．Results The patient satisfaction was 96.67% in the observation group,86.67% in the control group（χ²=3.927,P=0.048,P<0.05）．In the observation group,the blood immersion area after catheterization,after 1 d and 3 d were（0.87±0.14）,（4.89±0.94）,（0.21±0.05）cm²,lower than those of the control group [（2.74±0.63）（9.89±2.04）（0.44±0.12）cm²],the comparative difference was statistically significant（t=22.444,17.243,13.704,P<0.05）．The success rate of disposable sheath delivery in the observation group was 98.33%,which was higher than 88.33% in the control group（χ²=4.821,P=0.028<0.05）．There was no difference in VAS scores between the two groups before the intervention（P>0.05）,VAS scores decreased in both groups after the intervention,the score of the observation group（1.75±0.54）was lower than that of the control group（3.89±1.22）,the difference was statistically significant（t=12.425,P<0.001）．The incidence of adverse events in the observation group was 5.00%,and in the control group was 16.67%,which difference was significant（χ²=4.227,P<0.05）．Conclusions Blunt separating skin expansion can reduce the area of blood immersion and the incidence of adverse events,improve the success rate of disposable sheath delivery,reduce patient pain,improve patient satisfaction,and have significant clinical application value．