目的 探讨PAD方案治疗初发多发性骨髓瘤(MM)有效性及安全性。方法 统计54例接受PAD方案治疗的初发MM患者临床资料,采用回顾性分析方法。PAD方案:P(硼替佐米)1.3 mg/m²,第1、4、8、11天皮下注射,A(脂质体阿霉素)25～30 mg/m²,第1天静脉滴注,D(地塞米松)40 mg,第1～4 天静脉滴注或口服,每21天为1个疗程。采用IMWG疗效标准判定疗效,按NCICTCAE(第3版)标准判断不良反应。结果 ①总体疗效:平均4(2~8)个疗程后,47例(87.0%)患者获部分缓解(PR)以上疗效,其中完全缓解(CR)20例(37.0%),很好的部分缓解(VGPR)19例(35.2%),部分缓解(PR)8例(14.9%),疾病稳定(SD)5例(9.3%),病情进展率(PD)2例(3.7%)。②亚组疗效:54例患者中,35例治疗4个以上疗程,19例小于4个疗程,ORR分别为97.1%(34/35)、68.4%(13/19)(P=0.003)。按照年龄、肾功能、骨破坏数目、骨髓浆细胞比例、ALB、LDH、β2-MG、细胞遗传学、ISS分期、临床分型进行队列亚组疗效比较,结果提示亚组疗效差异无统计学意义(P＞0.05);③总体安全性:中性粒细胞减少8例(14.8%),血小板减少8例(14.8%),周围神经病变16例(29.6%),腹泻2例(3.7%),便秘2例(3.7%),带状疱疹4例(7.4%),细菌感染5例(9.3%),以上不良反应经对症治疗后症状减轻或消失。④亚组安全性:按照年龄和疗程数进行亚组比较,年龄大于60岁患者和年龄小于60岁患者总不良反应发生率和3/4级不良反应发生率分别是47.4% vs 60.0% 和15.8% vs 20.1%,(P=0.404和P=1.00);治疗4个以上疗程患者和小于4个疗程患者总不良反应发生率和3/4级不良反应发生率分别是57.9% vs 54.3%和21.2% vs 17.1%,(P=1.00和P=0.728)。结论 PAD方案治疗初发MM效果显著,缓解率和疗程数有相关性,疗效与传统的生存预后因素无关,可作为MM诱导治疗的一线方案。脂质体阿霉素心脏毒性小,替代传统蒽环类药物阿霉素,不良反应可控,耐受性良好,更适用于老年MM患者。

Objective To investigate the efficacy and safety of PAD regimen in previously untreated patients with multiple myeloma(MM). Methods We retrospectively analyzed 54 patients with newly-diagnosed MM,who were treated with PAD regimen: Bortezomib 1.3mg/m² subcutaneously on day 1,4,8,11. Liposomal doxorubicin 25～30 mg/m² intravenously on the first day. Dexamethasone 40 mg/d intravenously or orally on days 1～4. Treatment was repeated every 21 days. Response was evaluated according to the International Uniform Response Criteria for MM.Adverse events were graded according to the National Cancer Institute Common Toxicity Criteria,version 3.0. Results ①Overall response:after median 4(2～8) courses of PAD,47patients(87.0%)responsed,including complete response (CR) in 20 (37.0%),very good partial response (VGPR) in 19 (35.2%),partial response (PR) in 8 (14.9%),stable disease (SD) in 5 (9.3%) and progressive disease (PD) in 2 (3.7%). ②Subgroups efficacy: among the 54 patients,35 patients received more than 4 therapeutic courses,and 19 patients received less than 4 courses.The ORR was 97.1% (34/35) and 68.4% (13/19) respectively (P=0.003). Subgroups efficacy were compared according to age,renal function,number of bone destruction,proportion of bone marrow plasma cells,ALB,LDH,β2-MG,cytogenetics,ISS staging and clinical classification. The results indicated that there was no statistical difference(P>0.05). ③Overall safety: adverse events included neutropenia in 8 (14.8%),thrombocytopenia in 8 (14.8%),peripheral neuropathy in 16 (29.6%),diarrhea in 2 (3.7%),constipation in 2 (3.7%),herpes zoster in 4 (7.4%) and bacterial infection in 5 (9.3%). The adverse events relieved or disappeared after symptomatic treatment. ④Subgroups safety: compared by age and courses of treatment,the incidence of overall adverse events and grade 3/4 adverse events in patients older than 60 years and ones younger than 60 were 47.4% vs 60.0% and 15.8% vs 20.1% respectively,(P=0.404,P=1.00). The incidence of overall adverse events and grade 3/4 adverse events in patients with more than 4 therapeutic courses and ones with less than 4 courses were 57.9% vs 54.3% and 21.2% vs 17.1% respectively,(P=1.00和P=0.728). Conclusion PAD regimen has really curative effect in treating patients with newly diagnosed MM. There is a correlation between remission rate and therapeutic courses. It can be used as the first selected protocol for the induction therapy of MM. Its efficacy is independent of traditional prognostic factors.Liposomal doxorubicin has almost no cardiotoxicity. Replacing traditional anthracycline doxorubicin,the adverse events are controllable and the tolerance is generally well. PAD regimen is more proper to be applied to older patients with MM.

目的 应用生物信息学的方法筛选参与星型胶质细胞瘤的预后生物标志物。方法 首先,下载GEO(gene expression omnibus,GEO)数据库中星型胶质细胞瘤的基因芯片数据,通过R语言将来自4个数据集的基因芯片数据进行合并,将合并后的194人来源的脑组织样本分为:星型胶质细胞瘤组和正常组。然后对原始基因芯片数据进行批次效应去除和标准化处理,并使用密度图和主成分分析监测处理前后的效果。利用R语言中的limma包对处理后的基因芯片数据进行差异表达分析,从而筛选得到星型胶质细胞瘤组和正常组中之间的差异表达基因(differentially expressed genes,DEGs)。接着对差异表达基因进行GO(gene ontology,GO)分析和KEGG(kyoto encyclopedia of genes and genomes,KEGG)分析,并对所有基因的表达矩阵进行GSEA(gene set enrichment analysis,GSEA)分析。通过STRING数据库构建差异表达基因的蛋白—蛋白相互作用网络(protein-protein interaction,PPI),通过Cytoscape中的cytoHubba插件筛选Hub基因。为了探索Hub基因在星型胶质细胞中的诊断价值和预后价值,我们下载TCGA(the cancer genome atlas,TCGA)数据库中的基因表达数据和临床预后资料,使用ROC曲线评价Hub基因的诊断价值,并对诊断价值较高的Hub基因进行COX回归,筛选HR值最有意义的基因进行总生存分析(overall survival,OS)。结果 通过limma包总共分析得到1 043个差异表达基因。GO分析结果表明差异表达基因主通过影响神经突触的功能而发挥作用。KEGG分析结果显示钙信号通路、cAMP信号通路、MAPK信号通路、PI3K-Akt信号通路、Rap1信号通路和Ras信号通路等通路等在星型胶质细胞瘤中发挥着重要的作用。GSEA富集分析结果主要富集于细胞因子-细胞因子受体相互作用、JAK-STAT信号通路、逆行内源性大麻素信号、神经活性配体-受体相互作用、GABA能突触和钙信号通路等通路。通过PPI网络总共分析得到ADCY1、ANXA1和PENK等20个Hub基因。通过对Hub基因的诊断价值和预后价值进行评价,发现SST在星型胶质细胞瘤既可作为诊断标志物,也可作为预后生物标志物。结论 我们通过生物信息学分析发现SST可作为星型胶质细胞的预后生物标志物,又预测了Rap1信号通路有可能成为星型胶质细胞分子机制中的新通路。

Objective To screen biomarkers involved in the prognosis of astrocytoma by bioinformatics. Methods Firstly,the gene chip data of astrocytoma in GEO database were downloaded. The gene chip data from four data sets were combined by R language. The combined 194 human brain samples were divided into astrocytoma group and normal group. Then,the original microarray data were processed by batch effect removal and standardization,and the effects before and after processing were monitored by density map and principal component analysis. The differentially expression genes (DEGs) between astrocytoma group and normal group were screened by using limma package of R language to analyze the differentially expression of the processed gene chip data. Then gene ontology(GO) analysis and Kyoto encyclopedia of genes and genes (KEGG) analysis were carried out for the differentially expressed genes,and gene set enrichment analysis (GSEA) was carried out for the expression matrix of all genes. The protein-protein interaction (PPI) network of differentially expressed genes was constructed by using string database,and the Hub gene was screened by using the cytohubba plug-in of Cytoscape. In order to explore the diagnostic value and prognostic value of Hub gene in astrocytes,we downloaded the gene expression data and clinical prognostic data in the Cancer Genome Atlas(TCGA) database,used ROC curve to evaluate the diagnostic value of hub gene,and Cox regression for Hub gene with high diagnostic value,and screen the most significant gene of HR value for overall survival(OS) analysis. Results A total of 1 043 differentially expressed genes were obtained by limma analysis. Go analysis showed that the differentially expressed genes played an important role by affecting the function of synapses. KEGG analysis showed that calcium signaling pathway,cAMP signaling pathway,MAPK signaling pathway,PI3K Akt signaling pathway,Rap1 signaling pathway and Ras signaling pathway played an important role in astrocytoma. The results of GSEA enrichment analysis were mainly enriched in cytokine cytokine receptor interaction,JAK-STAT signaling pathway,retrograde endogenous cannabinoid signaling,neuroactive ligand receptor interaction,GABAergic synapse and calcium signaling pathway. A total of 20 Hub genes such as ADCY1,ANXA1 and PINK were obtained by PPI network analysis. By evaluating the diagnostic and prognostic value of hub gene,we found that SST could be used as both a diagnostic marker and a prognostic biomarker in astrocytoma. Conclusion We found that SST could be used as a biomarker for the prognosis of astrocytes by bioinformatics analysis,and predicted that Rap1 signaling pathway may be a new pathway in the molecular mechanism of astrocytes.

目的 研究富血小板血浆联合强骨胶囊对大鼠骨质疏松性骨折骨愈合的影响。方法 80只未交配、3月龄雌性健康SD大鼠作为研究对象,将以上大鼠分为空白组(K组)、PRP组(P组)、强骨胶囊组(Q组),联合组(L组),每组大鼠20例,分析四组大鼠的骨痂显微形态、组织形态学以及生物力学指标之间的差异。结果 经过两两比较,联合用药组患者的骨小梁体积、数量、厚度、连接密度高于单独用药组,分离度、表面积体积比低于对照组(P＜0.05);联合用药组患者的最大载荷、结构能量吸收、材料最大应力、材料能量吸收高于单独用药组;经过两两比较,联合用药组患者的骨架面积及软骨或骨性骨痂面积比高于单独用药组。结论 富血小板血浆联合强骨胶囊通过对骨折部位骨质密度以及骨质强度的增强,大鼠骨质疏松性骨折骨愈合情况良好。

Objective To study the effect of platelet rich plasma combined with Qianggu capsule on osteoporotic fracture healing in rats. Methods 80 unmatched and 3-month-old female healthy SD rats were divided into blank group (group K),PrP group (group P),Qianggu capsule group (group Q),combined group (group L) and 20 rats in each group. The differences of callus morphology,histomorphology and biomechanical indexes among the four groups were analyzed. Results After comparing the two groups,the volume,quantity,thickness and connection density of trabecula in the combined group were higher than those in the single drug group,and the separation and surface area volume ratio were lower than those in the control group (P< 0.05); the maximum load,structural energy absorption,material maximum stress and material energy absorption in the combined group were higher than those in the single group; after comparing the two groups,in the combined group,skeleton area and area ratio of cartilage or osteotylus in the treatment group were higher than that in single-drug group. Conclusion Platelet rich plasma combined with Qianggu capsule may enhance the bone density and bone strength of the fracture site,and the osteoporotic fracture healing in rats is good.

目的 对胎儿中枢神经系统发育异常的患者进行回顾性分析,探讨处理及预后。方法 收集2016—2018年在本院因胎儿畸形就诊的275例患者行病案追踪和电话随访。结果 275例产前彩超提示胎儿神经系统异常中,侧脑室增宽比列最高,112例(40.73%,112/275)。其他类型的异常包括后颅窝池增宽、脉络丛囊肿、胼胝体发育不全、Dandy-Walker综合征、脊柱裂、小脑病变、蛛网膜囊肿、室管膜囊肿、复杂性畸形等,共163 例(59.27%,163/275)。112例胎儿侧脑室增宽病例中,产前或产后消退 80例(71.43%,80/112),引产25例(22.32%,25/112),其引产病例中15例(60%,15/25)为重度侧脑室增宽。结论 胎儿侧脑室增宽是一动态发展过程,产前超声发现轻中度胎儿侧脑室增宽,不用盲目引产,可定期追踪观察。对严重侧脑室增宽,或存在其他明显脑结构异常的胎儿,致残率和致死率很高,一旦发现,应给予高度重视,综合评估以明确诊断、评估预后,告知患者及家属保留胎儿可能存在的风险及近远期并发症,充分沟通,减少严重畸形儿的出生。

目的 探讨精神分裂症患者载脂蛋白E基因多态性与血清ApoE浓度、血脂、心血管疾病发生风险的相关性。方法 收集住院精神分裂症患者116例,记录一般资料和测定患者载脂蛋白E基因(APOE)、载脂蛋白E(ApoE)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、心血管疾病发生风险评分(Framingham risk score,FRS)等指标。结果 ①APOEε2、ε3、ε4不同等位基因组精神分裂症患者TC、载脂蛋白E、FRS评分差异有统计学意义(P=0.01,P=0.005,P=0.012)。②载脂蛋白E与TC、FRS评分存在负相关关系(r_s=-0.48,P=0.02;r_s=-0.52,P=0.04),APOE ε4等位基因组载脂蛋白E与TC、FRS评分存在更高的相关关系(r_s=-0.55,P<0.001;r_s=-0.63,P=0.04)。结论 精神分裂症患者ApoE基因多态性与载脂蛋白E、胆固醇、FRS评分存在关联,ApoE基因-载脂蛋白E-胆固醇代谢通路可能是精神分裂症患者心血管疾病的致病机制之一。

目的 从生物力学应力调控角度,探讨组织间质液压升高诱发肝纤维化的分子细胞机制。方法 人肝星状细胞随机分为3组,模型组:将其置于压力箱中施加恒定的高于大气压50 mmHg压力;实验组:加入ROCK抑制剂Y-27632(浓度10 μmol)置于与实验组相同条件;对照组:不加压置于相同培养箱中。应用RC-PCR检测其α-SMA、RhoA、ROCK mRNA的表达量,并应用免疫荧光染色分析其α-SMA、ROCK1、ROCK2蛋白表达情况。结果 间质液压变化对人肝星状细胞中α-SMAmRNA的表达量比对照组表达量增加,RhoA mRNA的表达先上升后下降,只对早期压力有变化,而 ROCK mRNA的表达量无明显变化。抑制剂组和压力组α-SMA 、ROCK1荧光强度较对照组增强,ROCK2荧光强度无明显变化,其中模型变化更显著。结论 细胞间质液压升高能通过RhoA/ROCK1信号通路引起肝星状细胞的活化。

目的 对比中成药镇痛活络酊和非甾体抗炎药(Nonsteroidal Anti-inflammatory Drugs,NSAIDs)治疗肱骨外上髁炎(lateral epicondylitis,LE)的短期临床疗效差异。方法 筛选后符合纳入标准的LE患者60例,随机分为镇痛活络酊组(n=30)和NSAIDs组(n=30)。镇痛活络酊组外用镇痛活络酊,NSAIDs组外用法斯通凝胶(酮洛芬),两组均连续用药3周,3次/d。用药后3 周、6 周和12 周连续随访,主要观测指标包括视觉模拟评分(visual analog scale,VAS);肩、肘和手的功能评分(Disabilities of the arm, Shoulder And Hand,DASH);无痛握力(Pain-free grip strength,PFGS)。VAS评分分别测量患者1周前用力活动时的VAS评分和正常休息时的VAS评分,记为VAS(活动时)和VAS(休息时)。运用统计学方法对比分析两组患者在VAS评分(活动时)、VAS评分(休息时)、DASH评分和PFGS上的差异。结果 两组患者在VAS评分(活动时)、VAS评分(休息时)和DASH评分上均未见组间差异(P>0.05)。两组患者在用药前、用药后3周、用药后6周的PGFS对比同样无组间差异(P=0.91,P=0.42,P=0.13)。但是,在用药后12周,镇痛活络酊组的PFGS高于NSAIDs组(P=0.02)。结论 镇痛活络酊缓解LE疼痛的效果与外用NSAIDs相当,对提升伸肌力效果则更优。

Objective To compare the short-term clinical effects difference between analgesic tincture and topical nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of lateral epicondylitis (LE). Methods 60 cases of LE patients were randomly divided into an analgesic tincture group (n=30) and a NSAIDs group (n=30). Analgesic tincture was chosen for the analgesic tincture group and topical ketoprofen gel for the NSAIDs group to treat LE. Two groups were treated continuously for 3w, 3 times/day. Clinical results of each drug were followed-up at the time point of 3w, 6w and 12w after usage. Observational indexes included the visual analogue scale (VAS), disabilities of the arm, shoulder and hand questionnaire (DASH) and pain-free grip strength (PFGS). The inter-group difference of VAS (at activity), VAS (at rest), DASH score and PFGS were compared subsequently. Results No difference of the VAS (at activity), VAS (at rest), DASH score were ascertained (P> 0.05) between groups. Inter-group difference of PGFS was also not discerned at the time points of pre-treatment and 3 weeks and 6 weeks (P=0.91, P=0.42, P=0.13) post-treatment. However, PFGS of the analgesic tincture group was found to be higher than that of the NSAIDs group (P=0.02) after 12 weeks post-treatment. Conclusion Effect of analgesic tincture in releasing pain is almost the same to that of tropical NSAIDs, but a better effect in improving muscle strength.

目的 分析AngioJet血栓抽吸联合髂静脉支架在下肢深静脉血栓合并髂静脉压迫的临床疗效。方法 2016年1月—2019年6月在揭阳市人民医院普外一科收治的首发髂股DVT并在AngioJet吸栓或联合导管溶栓后置入支架的患者,比较吸栓后直接支架置入和溶栓再分期支架置入的治疗效果。结果 本研究共纳入50例接受支架手术的DVT患者,其中治疗组29例,分期置入组21例。治疗组临床症状缓解率和住院时间优于对照组,差异有统计学意义(P＜0.05),且出血风险更低。 而置入支架长度和直径无差异,治疗组的3个月、6个月和12个月的通畅率、静脉返流时间和 Villalta评分均无差异(P＞0.05)。结论 AngioJet血栓清除后直接支架置入术是治疗合并髂静脉压迫的下肢深静脉血栓的有效方法,临床改善更快,住院时间显著缩短。

Objective To analyze the clinical effect of AngioJet thrombus aspiration combined with iliac vein stent in deep vein thrombosis of the lower extremity with iliac vein compression. Methods From January 2016 to June 2019, patients with first iliofemoral DVT and stent implantation after AngioJet thrombolysis or combined catheter thrombolysis were treated in the first department of general surgery, Jieyang People's Hospital. The therapeutic effects of direct stent implantation and stent implantation after thrombolysis were compared. Results A total of 50 patients with DVT who underwent stent surgery were included in this study, including 29 in the treatment group and 21 in the staging group. The clinical symptom relief rate and length of stay in the treatment group were better than those in the control group, the difference was statistically significant (P<0.05), and the risk of bleeding was lower. There was no significant difference in stent length and diameter. There were no significant differences in patency rate, venous reflux time, and Villalta score in the treatment group at 3 months, 6 months, and 12 months (P>0.05). Conclusion Direct stent placement after AngioJet thrombectomy is an effective method for treating deep venous thrombosis of lower limbs with iliac vein compression. The clinical improvement is faster and the length of hospital stay is significantly shortened.

目的 探讨循证护理干预在肺功能检查中对检查准确性的影响。方法 选取行肺功能检查患者80例,随机分为2组,分别记录为观察组40例和对照组40例,分别实施循证护理干预和常规护理干预,比较两组患者肺功能检查时间、肺功能检查结果及护理满意度。结果 观察组患者平均肺功能检查时间短于对照组(P<0.05);观察组患者肺功能检查正常率高于对照组;且观察组患者对护理服务的满意度高于对照组,组间对比差异有统计学意义(P<0.05)。结论 对行肺功能检查的患者实施循证护理干预效果显著,有利于缩短患者肺功能检查时间,并可提高检查的准确率,且有利于改善护患关系,值得在临床上推广应用。

Objective To investigate the influence of evidence-based nursing intervention on the accuracy of the examination in pulmonary function test. Methods 80 cases of patients with lung function examination, were randomly divided into 2 groups, were recorded in 40 cases of observation group and control group 40 cases, respectively. The implementation of evidence-based nursing intervention and routine nursing intervention were taken, to compare times of patients with pulmonary function test, pulmonary function test results and nursing satisfaction in two groups. Results In the observation group the average lung function examination time was shorter than that of the control group (P<0.05); normal pulmonary function tests was higher than that of the control group; satisfaction with nursing service was higher than the control group, there was statistical significance the differences between the two groups (P<0.05). Conclusion The pulmonary function test for patients with the implementation of evidence-based nursing intervention has significant effect. It can shorten the time in patients with pulmonary function examination, improve the inspection accuracy, and improve the relationship between nurses and patients, it is worthy of clinical application.

目的 探究分析基于互联网平台的健康管理模式对2型糖尿病患者血糖管理的效果及其临床价值。方法 选择2018年3月—2019年3月期间到我院进行治疗的120例2型糖尿病患者作为研究对象,用电脑随机法分为对照组和实验组各60例,对照组患者对其进行常规的护理干预,实验组患者给予基于互联网平台的健康管理模式,测试他们接受护理管理前后的血糖情况,邀请所有患者填写焦虑、抑郁自评量表评分并比较两组患者的心理状态评分,比较两组患者的生活质量和护理满意度。分析它们的护理要点及其结果。结果 实验组患者的护理后的血糖低于对照组;实验组患者焦虑自评量表(SAS)、抑郁自评量(SDS)表得分分别为(45.2±4.3)分和(42.8±6.3)分,这两个表均低于对照组的(56.3±7.5)分、(58.1±3.9)分;实验组患者的生活质量高于对照组;护理满意度高于对照组,差异有统计学意义(P＜0.05)。结论 应用基于互联网平台的健康管理模式有利于提高糖尿病患者血糖控制效果,对改善患者负面情绪、提高其生活质量及维持良好的护患关系也具有积极意义。

Objective To explore the effect and clinical value of health management model based on internet platform on blood glucose management in patients with type 2 diabetes(T2DM). Methods 120 patients with T2DM who came to our hospital for treatment from March 2018 to March 2019 were selected and they were randomly divided into the control group and the experimental group with 60 cases each. The patients in the control group were given routine nursing intervention. The patients in the experimental group were given health management mode based on the internet platform to test their blood glucose before and after receiving nursing management. All patients were invited to filled in the self-rating anxiety scale (SAS) and self-rating depression scale (SDS).The blood glucose level, the psychological state, the self-rating scales and nursing points in the two groups were investigated and compared after intervention. Results The blood glucose of the experimental group was lower than that of the control group, the scores of SAS and SDS were (45.2 ± 4.3) (42.8 ± 6.3) respectively, both of which were lower than those of the control group (56.3 ± 7.5) and (58.1 ± 3.9); the quality of life of patients in the experimental group was higher than that in the control group; nursing satisfaction was higher than that in the control group, the difference was statistically significant (P<0.05). Conclusion The application of health management model based on internet platform is conducive to improving the effect of blood glucose control in diabetes patients, relieving their negative emotions, improving their quality of life and maintaining a good nurse-patient relationship.