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支气管乳突状瘤一例并文献复习

目的探讨支气管乳突状瘤的临床表现、病理学特征，诊断要点及治疗方式。方法分析 1 例呼吸道乳头状瘤的临床特征、影像及病理学资料，同时进行文献复习对该病进行分析总结。结果患者男性，73 岁，务农。因“呼吸困难半年”入院。本例患者胸部增强 CT 提示左主支气管起始部内见软组织密度影，支气管镜下行病理活检提示为支气管鳞状上皮乳头状瘤，人乳头状瘤病毒（HPV）阴性，Ki67（MIB-1）阳性。行纤维支气管镜下切除并给予重组人干扰素 α2b 注射液（假单胞菌）300 万 IU 皮下注射，治疗 7 d 后再次行纤维支气管镜下治疗好转后出院。通过以“乳头状瘤”与“支气管、气管、肺”为关键词检索查阅 CNKI、万方、维普等数据库，截止 2019 年 3 月。文献报道 93 例，患者年龄 19～80 岁，表现为咳嗽咳痰 60 例，咯血 38 例，胸闷或呼吸困难 31 例；位于气管、主气管 48 例；外科手术 43 例，支气管镜治疗 32 例；65 例患者有病理分型，其中鳞状细胞乳头状瘤 35 例、腺性乳头状瘤 10 例、混合型乳头状瘤 20 例。结论支气管乳突状瘤好发于中老年男性，与吸烟、HPV 感染相关。临床表现可无特异性，表现为咳嗽、咯血及呼吸困难等，容易误诊，诊断主要依据活组织病理检查，鳞状细胞乳头状瘤相对较多。支气管镜下介入治疗或手术治疗是有效的治疗手段，预后好，但易复发，需长期随访。

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.

利用深度学习技术辅助肺结节的人工智能检测