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不稳定性心绞痛的治疗

以右踝局部炎症反应为首发表现的肺癌孤立性骨转移一例

p38丝裂原活化蛋白激酶抑制剂对葡聚糖硫酸钠诱导的溃疡性结肠炎大鼠结肠传输功能的影响

目的探讨p38丝裂原活化蛋白激酶（p38MAPK）抑制剂在葡聚糖硫酸钠（DSS）诱导的溃疡性结肠炎大鼠肠道动力障碍中的作用。 方法34只Sprague-Dawley大鼠用随机数字表法随机分成4组：正常对照组（正常组，n=8），DSS模型组（DSS组，n=8），DSS+生理盐水（NS）组（DSS+NS组，n=9），DSS+SB203580干预组（SB203580组，n=9）。除正常组外，所有大鼠每日饮用5% DSS溶液，SB203580组大鼠在饮用5%DSS溶液72 h以后，每天予以SB203580（1 mg/kg体质量）进行腹腔注射，观察各组大鼠的疾病活动指数（DAI），以酚红法测定大鼠结肠传输功能。 结果①DSS组和DSS+NS组大鼠的DAI评分明显高于正常组，SB203580组DAI评分明显降低，但仍然高于正常组（P＜0.05），DSS组和DSS+NS组之间差异无统计学意义（P＞0.05）。②与正常对照组比较，DSS组和DSS+NS组大鼠的结肠传输功能明显延迟，经SB203580干预后，其结肠传输功能明显改善（P＜0.05），DSS组和DSS+NS组之间差异无统计学意义（P＞0.05）。 结论SB203580能阻断p38MAPK信号转导通路，改善DSS诱导的结肠炎症，从而改善结肠传输功能。

Effect of triple viable bifidobacterium lactobacillus tablets combined with polyethylene glycol 4000 on elderly patients with chronic constipation

Objective To explore the effect of triple viable bifidobacterium lactobacillus tablets combined with polyethylene glycol 4000 on elderly patients with chronic constipation. Methods This pilot study was conducted at the Center of Gerontology and Geriatrics, West China Hospital. A total of 120 patients with chronic constipation, aged 60 years or older, treated between April 2015 and April 2016 were enrolled, and randomly assigned into group A (polyethylene glycol 4000) and group B (triple viable bifidobacterium lactobacillus tablets combined with polyethylene glycol 4000) with 60 patients in each. All the patients were estimated before and after the treatment with Bristol Stool Form Scale (BSFS), Patient Assessment of Constipation Symptom (PAC-SYM) and Constipation Related Disability (CRDS), and the adverse drug reactions were observed. Results In group A, before the treatment, the scores of BSFS, PAC-SYM and CRDS were 1.98±0.77, 37.87±4.12 and 31.03±3.19, respectively; while after the treatment, the scores were 3.87±0.82, 28.55±2.15 and 18.56±1.80, respectively, which were all significantly improved (P<0.05). In group B, before the treatment, the scores of BSFS, PAC-SYM and CRDS were 2.03±0.78, 36.25±4.98 and 30.28±3.56, respectively; while after the treatment, the scores were 4.80±0.75, 19.73±3.42 and 13.80±2.36, respectively, which were all significantly improved (P<0.05). The improvement of constipation in group B was significantly better than that in group A after treatment (P<0.05). There was no adverse drug reaction observed. Conclusion Triple viable bifidobacterium lactobacillus tablets combined with polyethylene glycol 4000 may be an effective therapy for elderly patients with chronic constipation.

枯草杆菌二联活菌肠溶胶囊预防老年人抗生素相关性肠道菌群失调的临床研究

目的　观察枯草杆菌二联活菌肠溶胶囊对老年人抗生素相关性肠道菌群失调的防治作用。 方法　选择2011年7月－2012年5月80例老年重度下呼吸道感染患者随机分配至A组（单用头孢哌酮舒巴坦）和B组（头孢哌酮舒巴坦+枯草杆菌二联活菌肠溶胶囊），疗程14 d，治疗结束后判定疗效和菌群失调的情况。 结果　头孢哌酮舒巴坦对老年重度下呼吸道感染患者有理想效果，两组有效率分别为70%和75%（P＞0.05）；B组患者肠道菌群失调的发生率、继发真菌的发生率显著低于A组（P＜0.05）。 结论　枯草杆菌二联活菌肠溶胶囊能有效预防老年人抗生素相关性肠道菌群失调的发生。

Relationship between SUVmax in 18F-FDG PET/CT and PD-L1 expression in invasive lung adenocarcinoma

ObjectiveTo investigate the relationship between the expression of programmed cell death ligand-1 (PD-L1) and the maximal standardized uptake value (SUVmax) in 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and the correlation of clinical factors between SUVmax values and PD-L1.MethodsThe clinical data of 84 patients with invasive lung adenocarcinoma diagnosed pathologically in West China Hospital, Sichuan University from August 2016 to November 2018 were analyzed retrospectively, including 38 males and 46 females, aged 60 (32-85) years. The tumor was acinar-predominant in 37 patients, papillary in 20, lepidic in 19, solid in 5 and micropapillary in 3. Multivariate analysis of the relationship between SUVmax value and other clinicopathological features was performed by linear regression. Logistic regression analysis was used to analyze the relationship between PD-L1 protein expression and other pathological features.ResultsThe SUVmax of the PD-L1 expression group was significantly higher than that of the non-PD-L1 expression group in the whole invasive lung adenocarcinoma group (P=0.002) and intermediate-grade histologic subtype (P=0.016). The SUVmax cut-off value of PD-L1 expression in the whole invasive lung adenocarcinoma group and intermediate-grade histologic subtype was 5.34 (AUC: 0.732, P=0.002) and 5.34 (AUC: 0.720, P=0.017), respectively. Multivariate analysis showed that pleura involvement, vascular tumor thrombus and the increase of tumor diameter could cause the increase of the SUVmax value, while the SUVmax value decreased in the moderately differentiated tumor compared with the poorly differentiated tumor. The SUVmax cut-off value between low-grade histologic subtype and intermediate-grade histologic subtype, intermediate-grade histologic subtype and high-grade histologic subtypes was 1.54 (AUC: 0.854, P<0.001) and 5.79 (AUC: 0.889, P<0.001), respectively. Multivariate analysis of PD-L1 expression showed pleura involvement (P=0.021, OR=0.022, 95%CI 0.001 to 0.558) and moderate differentiation (opposite to poor differentiation) (P=0.004, OR=0.053, 95%CI 0.007 to 0.042) decreased the expression of PD-L1.ConclusionThe SUVmax of the PD-L1 expression group is significantly higher than that of the non-PD-L1 expression group in the whole invasive lung adenocarcinoma group and intermediate-grade histologic subtype. The level of SUVmax and the expression of PD-L1 in invasive lung adenocarcinoma are related to many clinical factors.