Search

支氣管乳突狀瘤一例并文獻復習

目的探討支氣管乳突狀瘤的臨床表現、病理學特征，診斷要點及治療方式。方法分析 1 例呼吸道乳頭狀瘤的臨床特征、影像及病理學資料，同時進行文獻復習對該病進行分析總結。結果患者男性，73 歲，務農。因“呼吸困難半年”入院。本例患者胸部增強 CT 提示左主支氣管起始部內見軟組織密度影，支氣管鏡下行病理活檢提示為支氣管鱗狀上皮乳頭狀瘤，人乳頭狀瘤病毒（HPV）陰性，Ki67（MIB-1）陽性。行纖維支氣管鏡下切除并給予重組人干擾素 α2b 注射液（假單胞菌）300 萬 IU 皮下注射，治療 7 d 后再次行纖維支氣管鏡下治療好轉后出院。通過以“乳頭狀瘤”與“支氣管、氣管、肺”為關鍵詞檢索查閱 CNKI、萬方、維普等數據庫，截止 2019 年 3 月。文獻報道 93 例，患者年齡 19～80 歲，表現為咳嗽咳痰 60 例，咯血 38 例，胸悶或呼吸困難 31 例；位于氣管、主氣管 48 例；外科手術 43 例，支氣管鏡治療 32 例；65 例患者有病理分型，其中鱗狀細胞乳頭狀瘤 35 例、腺性乳頭狀瘤 10 例、混合型乳頭狀瘤 20 例。結論支氣管乳突狀瘤好發于中老年男性，與吸煙、HPV 感染相關。臨床表現可無特異性，表現為咳嗽、咯血及呼吸困難等，容易誤診，診斷主要依據活組織病理檢查，鱗狀細胞乳頭狀瘤相對較多。支氣管鏡下介入治療或手術治療是有效的治療手段，預后好，但易復發，需長期隨訪。

Inquiry-small class model with online-merge-offline learning approach in medical education in post-epidemic era: analyses based on SWOT-CLPV matrix model

Taking the actual situation of the undergraduate medical education in West China School of Medicine, Sichuan University as the real-world reference, combining with literature review, this article analyzes the internal strengths and weaknesses, as well as the external opportunities and threats of the novel teaching system in medical education which combines the online-merge-offline (OMO) approach with inquiry-small class model, and provides deep insights into the opportunities and challenges of the teaching system after matching the influential factors based on the SWOT-CLPV matrix model. Based on these analyses, this article discusses the application of the teaching system combining the OMO approach with inquiry-small class model in medical education in the post-epidemic era, so as to provide a reference and guidance for further popularizing the teaching model and enhancing the quality of medical education to a new level.

Epidemiological and pathological distribution characteristics in 23 228 lung cancer patients

ObjectiveTo understand variations in clinical epidemiology of lung cancer and to help with early accurate diagnosis and treatment of lung cancer.MethodsThis research was based on the Lung Cancer Database of West China Hospital of Sichuan University. Clinicopathological data of inpatients with primary lung cancer from 2011 to 2018 was collected for analysis. Information regarding sex, age, smoking history, surgical resection modalities, TNM stage of tumor, and pathological subtypes was included.ResultsA total of 23 228 inpatients with primary lung cancer were included in this research. There were 1 932, 2 029, 2 162, 2 773, 2 975, 3 318, 3 993, and 4 046 patients in every single year from 2011 to 2018, respectively. The male-to-female ratio of patients had changed significantly from 2.00∶1 in 2011 to 1.34∶1 in 2018 (P<0.001). Statistically significant difference was found in age distribution of patients in different years, while elderly always accounted for the majority of all patients. More nonsmokers were among the group of lung cancer patients, the proportion of whom rose from 41.61% in 2011 to 52.47% in 2018 (P<0.001). The proportion of adenocarcinoma in all subtypes rose from 54.04% in 2011 to 71.73% in 2018, while the proportion of squamous carcinoma dropped from 29.04% to 17.67% simultaneously. From 2011 to 2018, the proportion of stage Ⅰ lung cancer rose from 15.68% to 40.79%. Patients with stage ⅠA1 accounted for 11.82% in 2018. In 2018, 60.78% of stage ⅠA patients had gone through surgical resection modalities, forming a stark contrast with the fact that only 26.48% of stage ⅠA patients adopted surgeries in 2011.ConclusionsFrom 2011 to 2018, the total number of lung cancer patients increased year by year. The proportions of female patients and nonsmokers rose significantly. Adenocarcinoma accounted for the highest proportion of all subtypes, followed by squamous cell carcinoma. There were more patients with early lung cancer and less with advanced lung cancer diagnosed, implying a gradual accumulation of weight on the early stages according to the TNM classification of lung cancer.

Effect of Bariatric Surgery on Male’s Erectile Function: A Meta-analysis

Objective To systematically review the effect of bariatric surgery for male’s erectile function. Methods We electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 5, 2016), CNKI, VIP and WanFang Data from inception to May 30th 2016, to collect randomized controlled trials and before-after studies about bariatric surgery therapies for erectile function in obese male. Two reviewers independently screened literature, extracted data, and assessed the methodological quality of included studies. Then RevMan 5.3 software was used for meta-analysis. Results A total of 7 before-after studies involving 270 patients were included. The results of meta-analysis showed that: compared with before treatment, bariatric surgery could significantly improve 1-year erectile function score (MD=5.05, 95%CI 3.52 to 6.59, P < 0.000?01), 1-year sexual desire score (MD=0.99, 95%CI 0.47 to 1.51, P=0.000?2), 1-year contact satisfaction score (MD=2.70, 95%CI 0.21 to 5.19, P=0.004) and 1-year total satisfaction score (MD=1.68, 95%CI 0.27 to 3.09, P=0.002), but there was no significant difference in orgasm function score (MD= –0.21, 95%CI –0.74 to 0.33, P=0.45) between before and after treatment. Conclusion Bariatric surgery is effective in improving the erectile function, sexual desire and sexual satisfaction in morbidly obese male. Due to the limited quality and quantity of the included studies, the above conclusion needs to be verified by more large-scale high-quality studies.

利用深度學習技術輔助肺結節的人工智能檢測