目的：探讨宫颈微小偏离性腺癌的诊断与治疗。方法：按照WHO(2003)宫颈腺癌分类标准，回顾性分析我院收治的8例宫颈微小偏离性腺癌的临床病理资料。结果：宫颈微小偏离性腺癌占同期收治宫颈浸润腺癌的4.73％，临床表现为水样白带和/或生殖道出血、宫颈肥大变硬和赘生物，阴道B超检查示宫腔积液，宫颈细胞学诊断较困难，常需深部活检组织诊断。结论：诊断应结合临床表现，影像学检查，宫颈细胞学。当高度怀疑时应取深部组织或宫颈锥切组织诊断，早期诊治预后较好。
Patients with early Parkinson＇s disease should be treated rationally in order to improve their quality of life and reduce the motor complications. The early employment of drugs which provides sustained central dopamine agonism and dopaminergic neuroprotection may reach this aim to some extent. Evidence of effective therapy in early Parkinson＇s disease will be introduced including： dopamine agonists, monoamine oxidase inhibitor 13, coenzymeQ10, L-dopa and a gait training.
ObjectiveTo compare the current status of clinical studies regarding lung cancer between China and the United States in 2019, and to indicate the weakness, trend and future development direction of clinical studies drug treatment in China.MethodsThe data of lung cancer clinical studies from January 1st to November 30th, 2019 in China and the United States were retrieved and analyzed through Informa pharmaprojects database.ResultsThe United States was superior on the number of projects (128 vs. 156) and research institutions (743 vs. 2 250). Compared with the United State, there were more phase Ⅲ confirmatory researches (19.5% vs. 10.3%), bioequivalent drug researches (3.1% vs. 0%), and researches initiated by academic institutions (39.8% vs. 28.1%) in China. The United States exhibited advantages in phaseⅠ andⅠ/Ⅱstudies (25.8% vs. 60.3%), immunodrugs (49.2% vs. 60.3%), primary tested drug ratio (61.7% vs. 93.6%), targets abundance (32.9% vs. 69.6%), and chimeric antigen receptor-T (CAR-T, 0.7% vs. 7.1%).ConclusionCompared with the United States, China should pay more attention to innovative drug investigations in early phase of clinical studies, especially novel immune agents, vaccines, and CAR-T.
Objective To analyze the clinical characteristics of the Guang’an Omicron epidemic and summarize the management experiences and practices in pandemic prevention and control of major infectious diseases.Methods Retrospective analysis was performed on patients infected with coronavirus disease (COVID-19), afterwards treated and observed in the isolation ward of Guang’an People’s Hospital and the shelter of Guang’an City from May 9 to June 26, 2022. The characteristics of patients at different age stages and the related factors affecting the severity, re-positive and negative conversion was analyzed. Results Finally 1 278 patients were collected, including 508 males and 770 females, with an average age of 41.3±22.6 years. Among them, 1 054 patients were asymptomatic carriers. The overall severe rate was 0.86%, the severe rate of the high-risk group was 3.06%. The median negative conversion time was 10.0 days and re-positive rate was 7.36%. Patients aged＞60 years were 2.589 times more likely to have a longer negative conversion time than those aged≤60 years (95%CI 1.921-3.489, P＜0.001). Conclusion The clinical characteristics of Guang’an COVID-19 epidemic are mainly that the elderly with high risk factors are more likely to develop severe cases, have longer clearance time, and re-positve is more likely to occur.
Objective?To investigate the current status of new clinical medical postgraduate students on their learning goals and expectation of employment, and to provide the evidence and suggestions for improving the management of medical postgraduates’ training. Methods?We designed the questionnaire to investigate the current status of learning goals and expectation of employment of new clinical medical postgraduate students of Lanzhou University. We issued 164 questionnaires and took back 164 ones, among which 157 were effective, with the effective rate of 95.7%. Results?(1) The proportion of the postgraduates with working experience was less than 50%, and most of these worked in the municipal and county hospitals. (2) The 78.3% of them considered that clinical and research abilities were of the same importance. (3) The 65.6% of them expected to get Medical Science Degree; (4) The 96.8% of them wanted, after graduation, to engage in clinical work or the work in which clinical affairs and research were equally important, and only 3.2% hoped to engage in research-oriented work; (5) Although clinical skills and research capabilities of the first-year medical postgraduates were very poor at their entrance to the graduate school, their expectations of employment were very high. Conclusion?(1) The improvement and innovation of medical postgraduates’ clinical and research training are urgently needed. (2) The publicity and supporting policies should be enhanced for Clinical Medicine Degrees, and the postgraduates should be guided to comply their own expectations with social needs properly.
Cardiac surgery presents specific challenges in conducting randomized controlled trials (RCTs). The American Heart Association made a scientific statement of methodological standards, with the purpose to review key concepts and standards in design, implementation, and analysis of cardiac surgery RCTs, and to provide recommendations. Recommendations include an evaluation of the suitability of the research question, clinical equipoise, feasibility of enrolling a representative patient cohort, impact of practice variations on the effect of the study intervention, likelihood and impact of crossover, and duration of follow-up. Trial interventions and study end points should be predefined, and adequate deliverability of the trial interventions should be ensured. Every effort must be made to keep a high completeness of follow-up. Trial design and analytic techniques must be tailored to the specific research question and trial setting. In this paper, the authors made an interpretation of this scientific statement based on their practical experience.
ObjectiveTo summarize the clinical manifestations, basic diseases, imaging features, drug sensitivity results and recovery of Mycobacterium Kansasii pulmonary disease patients to enhance understanding of the disease. Methods The clinical data of 116 patients with Mycobacterium Kansas pulmonary disease diagnosed in Guangzhou chest hospital from January 2019 to September 2024 were analyzed retrospectively. Results The 116 patients with Mycobacterium kansasensei lung disease were 67 males and 49 females, aged 27 to 92 years, with clinical manifestations of cough and sputum (102 cases) and hemoptysis (48 cases) as the predominant symptoms. There were 98 cases with history of bronchiectasis, 8 cases with cancer,18 cases with cardiovascular disease, 22 cases with chronic obstructive pulmonary disease, 10 cases with diabetes mellitus, 9 cases with rheumatoid immune system disease, 5 cases with pulmonary aspergillus infection, 2 cases with asthma, and 10 cases without underlying disease. All of them had lung shadows on imaging, including 30 cases with simple bronchodilatation manifestation, 48 cases with bronchodilatation combined with cavitation, 10 cases with patchy streak shadow, 18 cases with patchy streak shadow combined with cavitation, and 10 cases with nodules combined with cavitation. The results of drug sensitivity showed that the resistance rate of more than 50% was isoniazid (89.66%), streptomycin (75.87%), amikacin (72.41%), and isoniazid para-aminosalicylate (Likely Lung Disease) (56.90%); while the sensitivity rate of more than 50% was rifabutin (100%), moxifloxacin (94.83%), rifampicin (93.10%), prothioisonicotinamide ( 91.38%), levofloxacin (89.66%), ethambutol (84.48%), and linezolid (79.31%). 76 of the remaining 98 of 116 patients had negative sputum cultures within 1 year, with the exception of 12 who were left untreated and 6 who did not complete treatment. The 116 patients with Mycobacterium kansasensei lung disease presented with chronic cough, sputum, and hemoptysis, and most of them were combined with structural lung diseases such as bronchiectasis, or with underlying diseases such as chronic obstructive pulmonary disease and diabetes mellitus. Imaging features show pulmonary shadows. Moreover, Mycobacterium kansasii shows high sensitivity to most conventional antituberculosis drugs, which may result in a higher cure rate compared with other types of nontuberculous mycobacterial lung disease. Therefore, timely and well-conducted strain identification and drug sensitivity testing are essential for the development of a targeted treatment program that can significantly improve patient outcomes. Conclusions Clinical manifestations of 116 patients with Mycobacterium kansasense lung disease were characterized by chronic cough, sputum and hemoptysis, which were mostly combined with structural lung diseases such as bronchiectasis. The imaging features show pulmonary shadows. Mycobacterium kansasii exhibits a higher sensitivity rate to most conventional anti-tuberculosis drugs, which may result in a higher cure rate in treatment compared to other types of nontuberculous mycobacterial lung diseases. Therefore, timely and comprehensive species identification and drug susceptibility testing are crucial for formulating targeted treatment regimens, which can significantly improve patients' treatment outcomes.
In this series of 34 cases, 2 patients performed hepatic dect-jejunal anatomosis, 9 were PTCD external drainage, 8 were installation of internal drainage tubes through the PTCD, 9 were laparotories, 3 were cheemotherapeutic perfusison through artery and 3 were untreated. According to the follow-up results, the authors recommend that the internal drainage through PTCD is the better method to treat unresectable carcinoma of bile duct for proper patients.
目的 探讨胰腺囊腺瘤和囊腺癌的临床病理特点及其诊治。 方法 回顾性分析山东省菏泽市立医院及曹县人民医院1996年6月至2007年3月共收治的17例患者的临床病理资料。结果 本病临床表现无特征性。B超和CT检查能发现囊肿但不能确定类型。浆液性囊腺瘤7例均行肿瘤局部切除； 黏液性囊腺瘤6例，行胰十二指肠切除1例，胰体尾切除5例； 囊腺癌4例，行胰十二指肠切除加淋巴结清扫1例，胰体尾切除术2例，胰体尾加脾切除1例。光镜下浆液性囊腺瘤囊壁由扁平或立方上皮细胞组成； 黏液性囊腺瘤囊壁由高柱状上皮细胞组成，可见乳头状突起； 囊腺癌囊壁细胞核异形明显，可见核分裂象及间质浸润。15例获得B超随访，中位随访时间为42个月（1～129个月），除1例行胰体尾切除加脾切除的老年囊腺癌患者术后6个月死于营养衰竭和 1例胰十二指肠切除患者并发糖尿病外，其余患者生存满意，未见肿瘤复发。结论 B超和CT是本病的主要影像检查方法。加强对本病临床病理特征的认识是提高诊治率的关键。手术切除治疗本病疗效满意。
ObjectiveTo analyze the clinicopathologic features and prognosis of breast cancer patients with low human epidermal growth factor receptor-2 (HER2) expression. MethodsThe breast cancer patients underwent initially surgical resection in the First Hospital of Shanxi Medical University from October 2015 to October 2017 and met the criterion of this study were retrospectively gathered. Based on the immunohistochemical / in situ hybridization detection results, the patients were divided into three subtypes of HER2 zero, low, and positive expressions, and the differences in the clinicopathologic characteristics, overall survival (OS) and disease-free survival (DFS) of the three subtypes of breast cancer patients were compared. At the same time, the risk factors affecting the OS and DFS of breast cancer patients with low HER2 expression were analyzed. ResultsA total of 315 eligible patients were gathered in this study, including 68 patients with HER2 zero expression, 121 patients with low HER2 expression, and 126 patients with positive HER2 expression. There were no statistic differences in the menstrual status, T stage, and histological classification between the breast cancer patients with low HER2 and positive HER2 expressions (P>0.05), but the proportions of the patients with lymph node metastasis, histological grade Ⅲ, negative hormone receptor (HR) and high Ki67 expression in the low HER2 expression patients were lower than those in the positive HER2 expression patients. And compared with HER2 zero expression breast cancer patients, the proportions of premenopausal / perimenopausal, T2–4, N1–3, histological grade Ⅱ, ductal carcinoma, negative HR, and low Ki67 expression patients in the breast cancer patients with low HER2 expression were higher (P<0.05). While the survival curves of OS and DFS by Kaplan-Meier method had no statistic differences among the three subtypes of the breast cancer patients (χ2=0.070, P=0.966; χ2=0.362, P=0.835). The multivariate analysis results by Cox proportional hazards regression found that the low HER2 expression breast cancer patients with histological grade Ⅲ and negative HR had the higher risks of OS and DFS shortening (P<0.05). In addition, the risk of DFS shortening in the patients with T stage 2–4 and N stage 1–3 was increased (P<0.05). ConclusionsFrom the results of this study, breast cancer patients with low HER2 expression is different from the other two subtypes of breast cancer in terms of clinicopathologic characteristics. However, there are no statistical significances in comparing the OS and DFS of three types of breast cancer patients, but it is found that histological grading and HR are related to the OS and DFS of breast cancer patients with low HER2 expression, and it is also found that T stage and N stage are related to the DFS of breast cancer patients with low HER2 expression, so more attentions should be paid to the treatment plans.