单纯胆道支架与125I粒子支架腔内照射治疗恶性梗阻性黄疸

目的 探讨单纯胆道支架与支架联合125I粒子条植入腔内照射治疗恶性梗阻性黄疸的临床价值.方法 对62例恶性阻塞性黄疸患者行经皮经肝胆管引流(PTCD)后随机分组:A组31例行胆道支架联合125I粒子条植入(实验组),B组31例行单纯胆道支架植入(对照组).比较两组患者术前、术后黄疸消退、复发情况、T淋巴细胞亚群变化以及生存时间.结果 A、B两组患者PTCD术前及支架植入术后1周血清总胆红素测定差异无统计学意义(P＞0.05).术后1个月、3个月血清总胆红素测定,A组优于B组(P＜0.05).随访期内,A组再次发生胆道梗阻1例,B组12例(P＜0.05).对比PTCD术前,A组术后1～2周CD4及CD4/CD8比值明显升高(P＜0.05),CD3变化无差异(P＞0.05).B组术后1～2周CD3、CD4及CD4/CD8比值变化无明显差异(P＞0.05).A组患者中位生存时间10.9个月,B组患者中位生存时间7.1个月,两组差异有统计学意义(P＜0.05).结论 125I粒子条联合胆道支架植入腔内照射治疗恶性梗阻性黄疸在黄疸消退、改善机体免疫机能及延长患者生存时间等方面均优于单纯胆道支架植入治疗.     

125I粒子条联合胆道支架治疗恶性梗阻性黄疸初步疗效评价

目的探讨125I粒子条联合胆道支架治疗恶性梗阻性黄疸的安全性及有效性。方法收集55例梗阻性黄疸患者,随机分为治疗组(支架+125I粒子条组)28例,对照组(单纯支架组)27例。均采用DSA引导下经皮肝穿刺途经行胆道支架植入术,治疗组同时将125I粒子条植入至支架与胆道壁间。观察两组患者介入术前及术后肝功能指标、术后并发症、支架通畅率及生存时间。结果 55例患者支架释放位置良好,手术过程成功,未出现支架移位现象。术后两组患者临床症状明显改善、均未出现胆道穿孔、出血等严重并发症。术后3、6个月时,两组患者间血清总胆红素、直接胆红素、间接胆红素、丙氨酸氨基转移酶、门冬氨酸氨基转移酶、胆汁酸的差异有统计学意义(P均0.05)。术后随访12个月,治疗组未发现放射粒子脱落。治疗组中位生存期为8个月,95%可信区间6.1~9.9个月,对照组中位生存期为5个月,95%可信区间3.3~6.7个月,二者差异有统计学意义(χ2=19.39,P0.05)。结论采用125I粒子条联合胆道支架治疗恶性梗阻性黄疸能够明显提高支架通畅时间,延长患者生存期。     

内镜下双支架引流治疗肝门部癌

目的探讨内镜下对无手术条件的肝门部癌行左右肝管引流的方法及疗效。方法回顾性分析25例无法手术切除的肝门部癌患者行左右肝管双支架引流的病例资料,其中肝门部癌的分型参照胆管癌的Bismuth分型法。结果25例BismuthⅢ或Ⅳ型恶性胆道梗阻行左右肝管双支架引流后黄疸迅速消退,皮肤瘙痒消失,血清胆红素从术前(240.5±142.8)μmol/L下降至术后1周(110.7±42.6)μmol/L。结论BismuthⅢ或Ⅳ型肝门部癌导致的恶性胆道梗阻行内镜下左右肝管双支架引流具有减黄确切、安全性高和创伤性小等优点。     

胆道支架联合~(125)I粒子植入治疗恶性梗阻性黄疸临床效果分析

目的:分析胆道支架联合~(125)I粒子植入治疗恶性梗阻性黄疸临床效果。方法:将98例行经皮肝穿刺胆管引流术后要求行胆管支架植入术的恶性梗阻性黄疸患者分为联合组(n=53)和单纯组(n=45),联合组患者采取~(125)I粒子条联合胆道支架植入,单纯组患者仅接受胆管支架植入。所有患者随访4~28个月,记录两组患者经皮肝胆管引流术前及胆道支架植入术后7 d、30 d和90 d总胆红素变化;记录两组患者再次发生胆道梗阻情况;分别于经皮肝胆管引流术前、胆道支架植入术后7 d,检测患者外周血T淋巴细胞亚群变化;比较两组患者术后生存时间。结果:两组患者均顺利完成胆道支架植入,手术成功率100%,联合组患者支架植入术后30 d和90 d时血清总胆红素水平均显著低于单纯组,差异有统计学意义(P0.05);术后7 d时,联合组患者CD4水平和CD4/CD8比值均较术前升高,而单纯组患者CD4水平和CD4/CD8比值均较术前降低,差异有统计学意义(P0.05);与单纯组相比,联合组患者术后7 d时CD4水平和CD4/CD8比值均升高(P0.05);联合组中2例(3.8%)再次发生胆道梗阻,显著低于单纯组(37.8%),差异有统计学意义(P0.001);联合组中位生存时间10.6个月,显著长于单纯组(7.5个月),差异有统计学意义(P0.05)。结论:~(125)I粒子支架腔内照射治疗恶性梗阻性黄疸可缓解胆道梗阻症状,有助于改善患者细胞免疫功能,减少胆道梗阻的再次发生,对提高患者生存质量、延长生存时间具有重要意义。     

载125Ⅰ粒子胆管支架植入治疗恶性梗阻性黄疸的临床观察

目的 观察经皮肝穿刺载125 I粒子胆管支架植入治疗恶性梗阻性黄疸的疗效.方法 对15例接受载125I粒子胆管支架植入治疗的恶性梗阻性黄疸患者,观察血清总胆红素(TBIL)和碱性磷酸酶(ALP)的变化,以及治疗后的生存时间和生存率.结果 术后2周,TBIL和ALP较术前明显下降(P＜0.01);术后4周,TBIL和ALP恢复正常者7例.15例的中位生存时间为12个月,半年、1年及2年生存率分别为73.3％(11/15)、40.0％(6/15)及13.3％(2/15).结论 无法外科手术治疗的恶性梗阻性黄疸,经皮肝穿刺载125I粒子胆管支架植入治疗能明显提高患者的生活质量及生存率.     

胆道支架联合125I粒子条植入治疗恶性梗阻性黄疸

目的探讨胆道支架联合125I粒子植入治疗恶性梗阻性黄疸的疗效及安全性。方法收集我科收治的无法手术切除的恶性梗阻性黄疸患者47例,20例患者接受胆道支架植入治疗,另外27例给予胆道支架联合125I粒子条植入治疗,对所有患者随访1~20个月,记录患者的生存时间,并进行生存分析,于术后1、2周检测肝功指标水平变化。结果所有患者手术成功率100%,术后出现急性胰腺炎患者2例、胆道感染1例、胆汁性腹膜炎2例,未发生放射性泄漏、放射性肠炎等并发症,1个月后复查粒子条移位2例。单纯支架植入和支架联合125I粒子条植入患者的中位生存时间分别是158天(95%CI 135.96~180.04),279天(95%CI 189.59~368.41);平均生存时间分别是172天(95%CI 115.29~228.47)和284天(95%CI 224.53~342.80),两组差异均有统计学意义(P均0.05)。结论胆道支架联合125I粒子条植入安全可靠、疗效肯定,能有效延长患者的生存期。     

经皮肝胆管穿刺金属内支架植入治疗恶性梗阻性黄疸(附32例报告)

目的探讨经皮肝胆管穿刺金属内支架植入治疗恶性梗阻性黄疸临床应用价值。方法2000年10月～2004年10月,对32例恶性梗阻性黄疸患者施行经皮肝胆管穿刺金属内支架植入。其中胆管癌17例,胰腺癌5例,肝门部转移癌10例。梗阻部位:肝总管肝门区20例,胆总管12例。结果金属内支架植入成功率100%(32/32)。2例出现胆汁性腹膜炎,胆道出血1例。28例术后血清胆红素3～4周降至正常,黄疸完全消失率87.5%(28/32)。生存期3～18个月,平均8个月。3例分别于术后6、8、13个月出现梗阻性黄疸,再梗阻发生率9%(3/32)。结论经皮肝胆管穿刺金属内支架植入是治疗恶性梗阻性黄疸安全、有效的姑息性治疗方法。     

恶性梗阻性黄疸介入治疗

目的 回顾性分析恶性梗阻性黄疸患者的介入治疗方法及近期疗效。方法62例患者,其中肝癌7例,胆囊癌10例,胆管癌15例,胰腺癌17例,肝门部转移癌13例。43例行内外引流,19例放置了胆道支架。结果 黄疸消退明显55例,不明显7例。内外引流者血清总胆红素由（450.12±113.51）μmol/L降至（240.25±107.81）L（1周）-（90.91±101.72）μmol/L（2周）。胆道内支架置入者由（410.53±98.13）μmol/L降至（270.23±115.64）μmol/L（1周）-（105.43±97.85）μmol/L（2周）。内外引流与内支架置入疗效无明显差别,早期并发症29例,死亡7例。结论 介入治疗恶性梗阻性黄疸方法简单、安全、疗效肯定。     

非外科处理的梗阻性黄疸:附五例病例分析

目的探讨非外科处理的梗阻性黄疸的诊断与治疗。方法分析5例非外科处理或外科处理无效的梗阻性黄疸病例的临床资料。结果 5例梗阻性黄疸病人占我科同期收治梗阻性黄疸病例(532例)的0.9%,5例病人入院时碱性磷酸酶(ALP)平均值为(242.1±80.1)U/L,谷氨酰转肽酶(GGT)平均值为(520.5±259.4)U/L,总胆红素(TBIL)平均值为(216.1±97.9)μmol/L,结合胆红素平均值为(120.5±64.7)μmol/L,均符合胆汁淤积的诊断。其中,1例病人肝门部胆管癌合并肝内胆道淤积,左半肝切除胆肠吻合术后黄疸不退;1例胆总管结石合并肝内胆管梗阻做了胆道探查手术黄疸不退,其余3例病人经过药物治疗缓解。结论肝外胆道梗阻合并肝内胆汁淤积的病人外科手术效果不佳;肝内胆汁淤积引起的梗阻性黄疸首选非手术药物治疗,多学科治疗可能是一种适宜的诊疗模式。     

PTCD并胆道支架治疗恶性梗阻性黄疸临床观察

目的 研究PTCD（经皮经肝胆管引流术）并胆道支架置入术对恶性梗阻性黄疸的治疗效果.方法 对19例行PTCD并胆道支架置入术的恶性梗阻性黄疸患者行回顾性分析.结果 技术成功率100％,术前血清总胆红素（228.9±30.2）μmol/L,术后2周时,血清总胆红素分别下降到（167.4 ±42.1）μmol/L （P＜0.05）.8例出现并发症,其中胆道出血2例,胆管炎4例,支架阻塞1例,胆汁漏1例,经治疗好均好转.结论 PTCD并胆道支架置入术是一种安全、有效的姑息治疗梗阻性黄疸的方法.     

Scintiscanning demonstration of thymoma: Comparative study on scintiscans using201Tl,67Ga and75Se

Thymus scintigraphy was performed using²⁰¹Tl-chloride,⁶⁷-Ga-citrate and⁷⁵Se-selenomethionine on 30 thymoma patients with or without myasthenia gravis. Mass negativity was observed in 6 out of 17 (35.3 per cent) and 3 out of 13 cases (23.1 per cent), respectively. A rate of 70 per cent (21 cases out of 30) of mass positivity was observed by thymus scan using²⁰¹Tl. With regard to the relation between thymus scan and cell type,²⁰¹Tl-scan exhibited a high rate of mass positivity, regardless of the cell type while the⁷⁵Sescan showed a trend toward mass positivity in epithelial cell predominant cases. With²⁰¹Tl, mass positivity was observed when the CPM/g ratio for tumors and blood exceeded 3.0. This trend can serve as an index for the suitability of supplementary chemo- and radiotherapies, as well as for prognosis in cases of relapse, and in those for whom excision was not complete.     

Inhibition of bone cell metabolism increases strontium-85 uptake

Summary Experiments have been performed on the canine tibia to investigate whether perturbation of the energy metabolism of bone cells can influence the short-term exchange of bone mineral. Simultaneous injection of three radioactive tracers,¹²⁵I-albumin,⁸⁵Sr, and⁸⁶Rb, into the tibial nutrient artery was followed immediately by measurement of the concentration of these tracers in the venous outflow from the bone for a period of 5 minutes. This procedure was performed before and after the injection of potassium cyanide into the bone. From the measured concentrations, extraction ratios for⁸⁵Sr and⁸⁶Rb with respect to¹²⁵I-albumin were calculated. It was found that net extraction after 5 minutes of⁸⁵Sr was significantly increased. This result indicates that efflux of ions from exchangeable mineral is dependent to a significant extent on the metabolic activity of bone cells.     

Resolving Erythrocytosis and Hypertension after Open Surgical Extirpation of Giant Renal Cyst Measuring 30 cm: Case Report

We previously described a method to measure GFR in conscious spontaneously voiding rats. This method circumvents the need for anesthesia and for bladder instrumentation. It's main principle is the correction of renal ¹²⁵I-iothalamate clearance for incomplete urine collection by the ratio of plasma and renal clearance of co-infused ¹³¹I Hippuran. A disadvantage of this technique is the requirement of an intra-arterial catheter for infusion of the renal function tracers. We therefore tested whether intraperitoneal infusion of ¹²⁵I-Iothalamate and ¹³¹I-Hippuran can be used for such a GFR measurement in conscious spontaneously voiding rats.

We found that during intraperitoneal administration, stable plasma levels of ¹³¹I-Hippuran could be obtained. However, urinary recovery of ¹³¹I-Hippuran was incomplete (66 ± 32%), leading to a significant overestimation of GFR by 140 ± 113% in comparison with the GFR measured by the intra-arterial technique. Thus intraperitoneal infusion of renal function tracers cannot replace intra-arterial infusion.     

Induction of transplantation tolerance by allogeneic donor-derived CD4(+)CD25(+)Foxp3(+) regulatory T cells

Several studies have shown that recipient-derived CD4(+)CD25(+)Foxp3(+) regulatory T cells (Tregs) are involved in transplantation tolerance. However, it is not clear whether allogeneic donor-derived Tregs are able to regulate T cell alloreactivity after solid organ allograft transplantation. Related studies in experimental bone marrow transplantation have shown that allogeneic donor-derived Tregs are capable of promoting early and long-term allogeneic hematopoietic engraftment, accompanied by tolerance to donor and recipient antigens. However, in these models, donor-derived Tregs are syngeneic with respect to the T responder cells. The role of Tregs in solid organ transplantation models where recipient-derived T responder and donor-derived Tregs are allogeneic has been scarcely studied. In order to determine whether allogeneic Tregs were able to regulate T cell alloreactivity, CD4(+)CD25(-) and CD8(+) T responder cells were cultured with stimulator dendritic cells in several responder-stimulator strain combinations (C57BL/6-->BALB/c, BALB/c-->C57BL/6 and C3H-->BALB/c) in the presence of responder-derived, stimulator-derived or 3rd-party-derived Tregs. Then, the frequency of IFN-gamma+ alloreactive T cells was determined by means of ELISPOT assay. The results of this study demonstrate that, regardless of the responder-stimulator strain combination, both responder-derived and stimulator-derived Tregs, but not 3rd-party-derived Tregs, significantly inhibited CD4(+) and CD8(+) T cell alloreactivity. The effect of allogeneic stimulator-derived Tregs was dependent on IL-10 and TGF-beta and reversed by exogenous IL-2. In vivo experiments in nu/nu recipients reconstituted with CD4(+)CD25(-) T responder and Tregs showed that recipient and donor-derived, but not 3rd-party-derived Tregs, significantly enhanced skin allograft survival. Importantly, T cells from both recipient-derived and donor-derived Treg-reconstituted nu/nu recipients exhibited donor-specific unresponsiveness in vitro. These results show that allogeneic donor-derived Tregs significantly inhibit T cell alloreactivity and suggest their potential use in the induction of transplantation tolerance.     

Radionuclide Therapy of Bone Metastases

The skeleton is a potential metastatic target of many malignant tumors. Up to 85% of prostate and breast cancer patients may develop bone metastases causing severe pain syndromes in many of them. In patients suffering from multilocular, mainly osteoblastic lesions and pain syndrome, radionuclide therapy is recommended for pain palliation. Low-energy beta-emitting radionuclides ((153)samarium-ethylenediaminetetrameth-ylenephosphonate (EDTMP) and (89)strontium) deliver high radiation doses to bone metastases and micrometastases in the bone marrow, but only negligible doses to the hematopoietic marrow. The response rate regarding pain syndrome is about 75%; about 25% of the patients may even become pain free. The therapy is repeatable, depending on cell counts. Concomitant treatment with modern bisphosphonates does not interfere with the treatment effects. Clinical trials using a new, not yet approved nuclide ((223)Radium) and/or combinations of chemotherapy and radionuclides are aiming at a more curative approach.     

Matriderm versus Integra: a comparative experimental study

Aim

To compare engraftment rates and vascularisation in a rat model using either Integra Artificial Skin^® or Matriderm^®.

Methods

Matriderm^® and the dermal part of Integra^® were compared in a two-step procedure including matrix implantation and subsequent epidermal grafting. Neonatal rat epidermis was used as coverage to test for rapid and complete take.

Results

Efficiency and quality of vascularisation expressed by take rate of epidermis, and thickness of resulting neodermis, were identical for both matrices.

Conclusion

This first comparison of Matriderm^® with Integra^® in a rat model revealed no major differences in engraftment rates or vascularisation.     

Bone resorption measurement with unusual bone markers: Critical evaluation of the method in phosphorus-deficient and calcium-deficient growing rats

An in vivo method to evaluate bone resorption in rats, by using unusual bone seekers not dependent on renal tubular transfer, is described and a critical evaluation of the method is made. In our experimental conditions,⁸⁵Sr and¹⁷⁷Lu are virtually exclusively localized in bone whereas²³⁷Np remains unchanged in different soft organs, so that the concomitant use of these markers can be used for measuring bone resorption. If osteolysis occurs 21 days after the injection of these markers, under our experimental conditions, any increase in the urinary excretion of¹⁷⁷Lu and²³⁷Np represents a rise in bone resorption, whereas an increase in Sr excretion reflects both bone and renal tubular events. According to our bone localization studies, the enhancement of Lu and Np excretion reflects primarily an increase in cortical bone resorption localized at the endosteal (Lu) and at the periosteal (Np) surfaces respectively. In addition, strontium is considered to be the marker of mineral resorption whereas Lu and Np, under our experimental conditions, would reflect the organic bone resorption. This method is tested in phosphorus-deficient rats and in calcium-deficient rats which exhibit disturbances of calcium metabolism at both the bone and kidney levels. In agreement with previous investigations, the use of these bone markers to evaluate osteolysis shows: (a) after a 1-week phosphorus deficiency, a slight increase in cortical bone resorption with a simultaneous fall in calcium and strontium renal tubular reabsorption, and (b) after a 1-week calcium deficiency, a high rise in cortical bone resorption with a simultaneous increase in the renal tubular reabsorption of calcium and strontium.     

Uptake of45calcium and85strontium by bone in tissue culture

Embryonic chick calvaria were cultured alive and after killing by various procedures. The uptakes of⁴⁵Ca and⁸⁵Sr were measured and it was found that both live and dead calvaria discriminated against strontium in favour of calcium. The discrimination in live bone at 37° was usually higher than that in dead bone or that in live bone cultured at 4°. However, discrimination did not approach the physicochemically predicted level, which suggests that discrimination against strontium is modified by the nature of the bone crystals and their environment.

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Zusammenfassung Calvarien von Kückenembryonen wurden lebend oder nach Abtöten mittels verschiedener Techniken gezüchtet. Die Aufnahme von⁴⁵Ca und⁸⁵Sr wurde gemessen, und es zeigte sich, daß sowohl die lebenden wie die toten Calvarien Calcium gegenüber Strontium vorzogen. Die Bevorzugung war im allgemeinen im lebenden Knochen bei 37° höher als im toten Knochen oder im lebenden, bei 4° gezüchteten Knochen. Jedoch erreichte diese Bevorzugung nicht den anhand physikochemischer Überlegungen vorausgesagten Grad. Dies läßt vermuten, daß die Calciumbevorzugung gegenüber Strontium durch die Natur der Knochenkristalle und deren Umgebung modifiziert wird.

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Résumé Des calottes craniennes d'embryons de poulet sont cultivées à l'état vivant et après mortification selon divers procédés. L'absorption de⁴⁵Ca et⁸⁵Sr est mesurée et il apparait que les calottes vivantes et mortifiées prennent du calcium au détriment du strontium. Cette action au niveau de l'os vivant à 37°, est généralement plus intense que celle observée au niveau de l'os mortifié ou celle de l'os vivant cultivé à 4°. Cependant cette absorption préférenttielle n'avoisine pas les concentrations prévues par la physico-chimie, ce qui laisse penser que l'action anti-strontium est modifiée par la nature des cristaux osseux et leur environnement.

     

Prognostic value of peripheral blood T lymphocyte subsets in clear cell renal cell carcinoma

BackgroundTo date, few studies have evaluated the role of peripheral blood T lymphocyte subsets in patients with clear cell renal cell carcinoma (ccRCC). Here we measured the levels of peripheral blood T lymphocyte subsets and evaluated its prognostic value in ccRCC.MethodsData from 122 patients with RCC from January 2018 to January 2020 were collected. Preoperative peripheral blood T lymphocyte subsets and medical records were analyzed. Kaplan-Meier cures and log rank test were used for analyzing overall survival (OS). Univariate and multivariate survival analyses were underwent by performing the Cox proportional hazards models. Correlations were tested by Pearson’s correlation analysis.ResultsOf 122 patients, a total of 80 ccRCC patients was enrolled. Patients with low CD3⁺ T cells and low CD4⁺/CD8⁺ ratio displayed a worse OS than patients with high CD3⁺ T cells and high CD4⁺/CD8⁺ ratio (P=0.029 and 0.002, respectively). Multivariate analyses showed CD3⁺ T cells and CD4⁺/CD8⁺ ratio were independent predictive factors for the OS (HR: 0.295, 95% CI, 0.091–0.956; P=0.042 and HR: 0.244, 95% CI, 0.065–0.920; P=0.037, respectively). Moreover, NLR negatively correlated with both levels of CD3⁺ T cells and CD4⁺/CD8⁺ ratio (P<0.001, r=−0.398 and P=0.012, r=−0.280, respectively).ConclusionsThe findings of our study suggest that preoperative CD3⁺ T cells and CD4⁺/CD8⁺ ratio in peripheral blood are independent predictors for patients with ccRCC.     

Induction of transplantation tolerance—the potential of regulatory T cells

Solid organ transplantation is widely accepted as an effective treatment for end organ failure. Although the treatment with immunosuppressive drugs has undoubtedly greatly improved graft survival, chronic rejection still has considerable impact on long term outcome. This, together with the undesirable side effects associated with life long treatment with immunosuppressive drugs, have significant implications for long term outcomes.In a small number of patients, drug non-compliance as well as controlled reduction or removal of maintenance immune suppressive drug therapy has led to the uncovering of a tolerant state. The challenge of achieving improved monitoring of all transplant patients may allow tailoring of immunosupression in a proportion of recipients thereby increasing the opportunities for the induction of specific unresponsiveness to donor alloantigens in the future. The immune system using several mechanisms to both induce and maintain tolerance to alloantigens, including the deletion of allo-reactive T cells, the induction of anergy, clonal exhaustion, ignorance and active suppression (immunoregulation) of allo-responses. A minor subpopulation of CD4⁺ T cells, regulatory or suppressor CD4⁺ T cells that co-express the cell-surface molecule CD25 (IL2 α subunit) at a high level may play a major role in the maintenance of specific unresponsiveness and operational tolerance to donor antigens in vivo. Intensive investigation of these cells in recent years has started to uncover the mechanisms of active suppression by regulatory T cells in this setting.