肺癌组织中DNA聚合酶β基因突变的研究

背景与目的 DNA聚合酶β是参与DNA损伤修复的关键酶之一,国外有学者认为其编码基因Polb在30%的肿瘤中存在遗传突变,但受到所用标本量的限制,这一结论是否准确尚无定论。本研究基于基因测序技术,通过对69例肺癌患者组织标本的基因筛查,旨在明确DNA聚合酶β的基因突变在中国汉族人群肺癌患者中的发生频率。方法利用盐析法提取69例肺癌患者的癌及癌旁组织基因组DNA,并用于扩增Polb基因全部14个外显子区及启动子区。通过与NCBI数据库中野生型基因序列进行比对,系统分析肺癌组织中的Polb基因突变及其频率。结果相对于野生型,本研究共发现5种突变类型,其中3种(-196G>T,-188_-187insCGCCC,-168C>A)位于启动子区,2种(587C>G, 612A>T)位于外显子区,突变类型-188_-187insCGCCC和587C>G尚未见文献报道,后者可引起第196位氨基酸由苏氨酸突变为丝氨酸。另一方面,癌和癌旁组中均可检测到所有5种突变类型,提示这些突变并非肺癌组织所特有。结论肺癌组织中未发现特异性表达的Polb基因突变位点,Polb基因突变可能不是中国汉族肺癌患者的肿瘤标志物。

单操作孔胸腔镜胸腺扩大切除治疗重症肌无力:附45例报告

背景与目的胸腺切除已成为重症肌无力(myasthenia gravis, MG)治疗的重要组成部分,近年来,经电视胸腔镜(video-assisted thoracoscopic surgery, VATS)胸腺扩大切除得到广泛应用。传统VATS术式多需3个经肋间切口,本研究改良了手术入路和操作方式,现总结单操作孔VATS胸腺扩大切除治疗MG的效果。方法回顾性分析2017年7月-2018年12月北京医院胸外科应用单操作孔VATS行胸腺扩大切除术的45例MG患者资料,总结其手术安全性和疗效。结果本组45例均顺利完成胸腺扩大切除,无中转开胸、增加切口和围术期死亡,平均手术时间(141.3±39.2)min,平均术中出血量(64.2±45.5)m L,中位胸腔引流管留置时间3 d,平均胸腔引流量(890.4±439.1)m L,中位术后住院时间6 d。围术期并发症13例(28.9%),其中肌无力危象5例(11.1%),肺部并发症6例(13.3%),切口愈合不良4例(8.9%),房颤4例(8.9%),迟发性心包积血1例(2.2%)。中位随访时间18.5个月,统计术后1年的疗效,药物缓解1例(2.2%),微小症状表现18例(40.0%),改善23例(51.1%),无变化1例(2.2%),加重2例(4.4%)。结论单操作孔胸腔镜下胸腺扩大切除术治疗MG的手术安全性和疗效良好,围术期应注意预防肌无力危象、肺部并发症和切口并发症。

高级别胎儿型肺腺癌1例

胎儿型肺腺癌属极其罕见的肺恶性肿瘤,2011年由国际肺癌研究协会、美国胸科学会和欧洲呼吸学会共同制定的国际多学科肺腺癌新分类将胎儿型肺腺癌归为浸润性腺癌的变异型,并将其分为低级别、高级别两类,二者临床病理特点和生物学行为不尽相同。本文报道高级别胎儿型肺腺癌1例,并结合文献总结胎儿型肺腺癌的临床病理特点。

肺癌合并间质性肺病的外科治疗

背景与目的间质性肺病(interstitial lung disease,ILD)是一组主要累及肺间质和肺泡腔导致肺泡-毛细血管功能单位丧失的弥漫性肺疾病,常导致限制性通气功能障碍和弥散功能障碍。ILD基础上肺癌发病率增高,肺癌合并间质性肺病(lung cancer combined with ILD,LC-ILD)的手术风险明显增加。本研究旨在探讨LC-ILD外科治疗的安全性,总结围术期诊治经验。方法回顾性分析2012年1月-2019年12月北京医院胸外科收治的LC-ILD行肺切除术的患者资料,总结其临床表现、影像、病理、手术安全性、围术期并发症和诊治经验。结果本研究共纳入23例患者,男性20例(87.0%),平均年龄(69.1±7.8)岁,吸烟者19例(82.6%)。ILD类型包括特发性肺纤维化14例(60.9%)、特发性非特异性间质性肺炎7例(30.4%)、结缔组织病相关ILD 2例(8.7%)。肺癌病理包括腺癌7例(30.4%)、小细胞癌7例(30.4%)、鳞癌6例(26.1%)、小细胞癌混合鳞癌1例(4.3%)、大细胞癌2例(8.7%)。手术入路包括经电视胸腔镜16例(69.6%)和前外侧开胸7例(30.4%),切除方式包括肺叶切除13例(56.5%)、双肺叶切除1例(4.3%)和亚肺叶切除9例(39.1%)。术后90 d并发症11例(47.8%),其中肺部并发症8例(34.8%),ILD急性加重(acute exacerbation of ILD,AE-ILD)4例(17.4%),心房纤颤6例(26.1%),急性左心功能不全1例(4.3%)。术后90 d死亡2例(8.7%),死因均为AE-ILD。结论LC-ILD以合并症多、肺功能差的高龄患者居多,手术风险明显增高。术前应充分控制ILD病情,术中尽量降低手术创伤,术后应特别关注肺部并发症和AE-ILD。AEILD预后差,治疗难度大,糖皮质激素有助于改善病情,早诊早治是治疗关键。

A practical method utilizing multi-spectral LiDAR to aid points cloud matching in SLAM

Light Detection and Ranging(LiDAR)sensors are popular in Simultaneous Localization and Mapping(SLAM)owing to their capability of obtaining ranging information actively.Researchers have attempted to use the intensity information that accompanies each range measurement to enhance LiDAR SLAM positioning accuracy.However,before employing LiDAR intensities in SLAM,a calibration operation is usually carried out so that the intensity is independent of the incident angle and range.The range is determined from the laser beam transmitting time.Therefore,the key to using LiDAR intensities in SLAM is to obtain the incident angle between the laser beam and target surface.In a complex environment,it is difficult to obtain the incident angle robustly.This procedure also complicates the data processing in SLAM and as a result,further application of the LiDAR intensity in SLAM is hampered.Motivated by this problem,in the present study,we propose a Hyperspectral LiDAR(HSL)-based-intensity calibration-free method to aid point cloud matching in SLAM.HSL employed in this study can obtain an eight-channel range accompanied by corresponding intensity measurements.Owing to the design of the laser,the eight-channel range and intensity were collected with the same incident angle and range.According to the laser beam radiation model,the ratio values between two randomly selected channels’intensities at an identical target are independent of the range information and incident angle.To test the proposed method,the HSL was employed to scan a wall with different coloured papers pasted on it(white,red,yellow,pink,and green)at four distinct positions along a corridor(with an interval of 60 cm in between two consecutive positions).Then,a ratio value vector was constructed for each scan.The ratio value vectors between consecutive laser scans were employed to match the point cloud.A classic Iterative Closest Point(ICP)algorithm was employed to estimate the HSL motion using the range information from the matched point clouds.According to the test results,we found that pink and green papers were distinctive at 650,690,and 720 nm.A ratio value vector was constructed using 650-nm spectral information against the reference channel.Furthermore,compared with the classic ICP using range information only,the proposed method that matched ratio value vectors presented an improved performance in heading angle estimation.For the best case in the field test,the proposed method enhanced the heading angle estimation by 72%,and showed an average 25.5%improvement in a featureless spatial testing environment.The results of the primary test indicated that the proposed method has the potential to aid point cloud matching in typical SLAM of real scenarios.

Effectiveness of post-COVID-19 primary care attendance in improving survival in very old patients with multimorbidity:a territory-wide target trial emulation

Objectives Older individuals with multimorbidity are at an elevated risk of infection and complications from COVID-19.Effectiveness of post-COVID-19 interventions or care models in reducing subsequent adverse outcomes in these individuals have rarely been examined.This study aims to examine the effectiveness of attending general outpatient within 30 days after discharge from COVID-19 on 1-year survival among older adults aged 85 years or above with multimorbidity.Design Retrospective cohort study emulating a randomised target trial using electronic health records.Setting We used data from the Hospital Authority and the Department of Health in Hong Kong,which provided comprehensive electronic health records,COVID-19 confirmed case data,population-based vaccination records and other individual characteristics for the study.Participants Adults aged 85 years or above with multimorbidity who were discharged after hospitalisation for COVID-19 between January 2020 and August 2022.Interventions Attending a general outpatient within 30 days of last COVID-19 discharge defined the exposure,compared to no outpatient visit.Main outcome measures Primary outcome was all-cause mortality within one year.Secondary outcomes included mortality from respiratory,cardiovascular and cancer causes.Results A total of 6183 eligible COVID-19 survivors were included in the analysis.The all-cause mortality rate following COVID-19 hospitalisation was lower in the general outpatient visit group(17.1 deaths per 100 person-year)compared with non-visit group(42.8 deaths per 100 person-year).After adjustment,primary care consultations within 30 days after discharge were associated with a significantly greater 1-year survival(difference in 1-year survival:11.2%,95%CI 8.1%to 14.4%).We also observed significantly better survival from respiratory diseases in the general outpatient visit group(difference in 1-year survival:6.3%,95%CI 3.5%to 8.9%).In a sensitivity analysis for different grace period lengths,we found that the earlier participants had a general outpatient visit after COVID-19 discharge,the better the survival.Conclusions Timely primary care consultations after COVID-19 hospitalisation may improve survival following COVID-19 hospitalisation among older adults aged 85 or above with multimorbidity.Expanding primary care services and implementing follow-up mechanisms are crucial to support this vulnerable population’s recovery and well-being.