麻醉用药对氧输送影响的研究进展

氧输送是循环系统尤其是微循环系统的本质功能,全身氧输送的状态并不能真实反映局部器官组织氧输送的状态,国外已开始重视麻醉用药对脏器、组织氧输送的影响研究。本文综述其研究的一般动向,主要进展及存在的问题,供临床参考。     

胃癌转移淋巴结乏氧诱导因子-1α表达与多药耐药相关因子的关系

肿瘤乏氧时产生的乏氧诱导因子(HIF)-1不仅促进肿瘤的侵袭、转移,而且也参与肿瘤的放化疗抵抗[1-3].消化道肿瘤转移灶多药耐药性(MDR)的异质性促使我们关注胃癌转移灶中HIF-1α表达及其与MDR的关系[4].     

二乙胺控制性降压对氧供、氧耗及血乳酸浓度的影响

观察一氧化氮载体药物二乙胺控制性降压时对机体氧供，氧耗及乳酸浓度的影响。方法；健康杂种犬１２只随机分为两组，分别静滴０．００１％ＤＥＡ或０．０１％ＳＮＰ，进行控制性降压，使平均动脉压降低４０％并维持３０分钟。降压期间监测ＭＡＰ，心率，心输出量，及动脉血气，混合静脉血血气，动脉血乳酸值。     

体外膜肺氧合用于困难气道的研究进展

体外膜肺氧合(ECMO)是一套体外循环系统,通过对患者引出的血液进行体外氧合后回输,可以有效代替患者的心肺功能。作为一种辅助手段,ECMO常用于重症心肺功能衰竭患者的急救以及心肺手术的体外循环。而对于合并困难气道的患者,在常规氧合方法无法提供有效氧合的情况下,ECMO可以满足氧合需求。鉴于ECMO的诸多优势,建议将其纳入气道管理指南。本文就近年来ECMO用于困难气道患者的研究进展做一综述。     

体内脉搏氧饱和度的研究与应用现状

脉搏氧饱和度的监测是近20年来发展起来的新兴技术,已被临床广泛采用,成为麻醉和临床医疗不可缺少的监护手段之一.由于监测部位在外周,体表脉搏氧饱和度易受到组织低温、低灌注的影响.而体内脉搏血氧饱和度监测则是通过一种反射式脉搏氧饱和度探头借助人体的生理腔道如食道、气管、阴道等放入体内,直接获取中心部位的脉搏氧饱和度信号;从而避免了上述因素对脉搏氧饱和度信号的影响,成为了当今脉搏氧饱和度监测研究的一个热点,但仍存在着不少问题,需要进一步的研究.     

脓毒性休克中氧供与氧耗关系的研究及临床意义

脓毒性休克是危重病人主要的致死原因之一，以血流分布异常和组织对氧的摄取，利用功能降低为特征，研究氧供与氧耗的关系特别是病性氧供衣赖，对脓毒性休克的临床治疗，提高病人和主具有重要意义。     

高压氧治疗中直流给氧人数对舱内氧浓度的影响

为探讨高压氧治疗时 ,直流给氧对氧浓度升高的影响 ,将 18例神经外科术后进行高压氧治疗的病人分为A、B、C三组 ,每组 6例。直流给氧A组 3例 ,B组 2例 ,C组 1例 ;其他为面罩给氧。每组分别监测氧舱内氧浓度变化(均监测 5次 )。结果A组与B、C组比较 ,差异有显著性意义 (均P <0 .0 5 )。提示直流给氧的人数越多氧舱内氧浓度越高     

三苯氧胺预防乳腺癌

早期乳腺癌采用三苯氧胺和化疗是一种临床证实的可显著减少患者死亡的方法。现在 ,三苯氧胺和类似的物质 ,如雷诺昔芬 ,正在考虑用于预防乳腺癌的发展上。研究已显示 ,三苯氧胺治疗妇女 5年 ,乳腺癌发展总的可降低 38% ,在雌激素受体阳性的乳腺癌中 ,更可降低 4 8%。也就是说 ,     

血红蛋白携氧载体在心脏外科的应用

血红蛋白携氧载体(Hemoglobin-based oxygen carriers,HBOCs)是一类人工血液代用品,主要是将人或牛的血红蛋白分离、纯化和修饰而得到的制品。经过修饰后,其半衰期较长,不易产生肾损害,在低温、低pH值下仍能较好地向组织释放O2,并且保存时间长,应用时无需交叉配型。在心脏外科领域,该类制品不仅可以减少术后输血,还可用于体外循环预充和心肌保护,显示出较好的应用前景。     

高氧肺损伤的研究进展

高浓度氧对人体有一定伤害,尤其是在临床麻醉中使用纯氧对肺组织造成的高氧肺损伤受到人们的关注。本文 综述了近几年对高氧肺损伤的研究状况。     

PEG-PLGA纳米颗粒载体药物靶向治疗肿瘤的研究进展

肿瘤是近年来临床多发的难治性疾病,是导致死亡的主要原因之一,手术及放、化疗是常规治疗手段.但晚期转移者无法手术,传统放、化疗缺乏针对性,且多有严重不良反应,致使人们普遍关注靶向治疗,因此,其已成为一个热点问题.本文纳入大量相关中外文献,综述并讨论近年来以PEG-PLGA纳米粒子为载体治疗肿瘤的靶向给药系统的研究进展,并分析了存在的问题.     

PEG-PLGA纳米颗粒载体药物靶向治疗肿瘤的研究进展

肿瘤是近年来临床多发的难治性疾病,是导致死亡的主要原因之一,手术及放、化疗是常规治疗手段.但晚期转移者无法手术,传统放、化疗缺乏针对性,且多有严重不良反应,致使人们普遍关注靶向治疗,因此,其已成为一个热点问题.本文纳入大量相关中外文献,综述并讨论近年来以PEG-PLGA纳米粒子为载体治疗肿瘤的靶向给药系统的研究进展,并分析了存在的问题.     

PEG-PLGA纳米颗粒载体药物靶向治疗肿瘤的研究进展

肿瘤是近年来临床多发的难治性疾病,是导致死亡的主要原因之一,手术及放、化疗是常规治疗手段.但晚期转移者无法手术,传统放、化疗缺乏针对性,且多有严重不良反应,致使人们普遍关注靶向治疗,因此,其已成为一个热点问题.本文纳入大量相关中外文献,综述并讨论近年来以PEG-PLGA纳米粒子为载体治疗肿瘤的靶向给药系统的研究进展,并分析了存在的问题.     

靶向治疗大肠癌的纳米药物及其载体进展

大肠癌是目前世界发病率第四位的恶性肿瘤,发病初期临床表现不明显,因此早期较难发现,诊断出时大多属于进展期.进展期的治疗多用化疗、介入治疗、放疗等方法,其中化疗在杀伤肿瘤细胞的同时,对正常机体细胞也有杀伤作用.近年来,各类新兴纳米靶向递送系统不断发展,由于纳米粒子可靶向定位于肿瘤组织,因而其在肠道肿瘤尤其是伴有转移的肠道肿瘤治疗中的应用越来越受到人们的重视.笔者针对目前纳米药物载体材料的类型、研究现状及其在大肠癌研究中的应用做一综述.     

Usefulness of quantitative H-MR spectroscopy for the differentiation between radiation necrosis and recurrence of anaplastic oligodendroglioma

We report a case, in which quantitative 1H-MR spectroscopy (MRS) was useful for the differentiation between radiation necrosis and a recurrent tumor. The present case is a 44-year-old man who underwent the subtotal removal of a mass lesion in the left frontal lobe. The histological diagnosis was anaplastic oligodendroglioma (WHO grade III). Postoperatively, a fractionated radiotherapy (total 64Gy) and chemotherapy were performed. MRI after the radiotherapy showed no contrast enhancing lesion. MRI, 5 years after the radiotherapy, showed a growing enhancing lesion and a T1 hypointensity lesion without enhancement, both of which indicated a recurrent tumor. MR spectroscopy was performed for the differential diagnosis of these lesions. The spectrum was acquired by the point resolved spectroscopy (PRESS) method by TR/TE=2,000 ms/68 ms, 136 ms, and 272 ms and evaluated with peak pattern and quantification value of metabolite. MRS of the enhancing lesion demonstrated a decrease of the Choline-containing compounds (Cho) concentration, disappearance of N-acetylaspartate (NAA), decrease of Creatine/ Phosphocreatine (t-Cr) and presence of Lipids (Lip) and Lactate (Lac), all of which are characteristic finding of a radiation necrosis. The histological diagnosis of this lesion showed evidence also of radiation necrosis. On the other hand, MRS of the T1 hypointensity lesion without enhancement showed, a marked high peak of the Cho concentration, which is characteristic for a recurrent tumor. The histological findings of this lesion showed a diffuse proliferation of recurrent tumor cells. Quantitative 1H-MRS is a useful tool for the differentiation between radiation necrosis and recurrent tumors.     

Pseudoprogression and treatment effect

The standard of care for newly diagnosed malignant glioblastoma entails postoperative radiotherapy and adjuvant chemotherapy with temozolomide. There has been an increase in the incidence of enhancing and progressive lesions seen on magnetic resonance imaging (MRI) following treatment. Conventional MRI with gadolinium contrast is unable to distinguish between the effects of treatment and actual tumor recurrence. New modalities have provided additional information for distinguishing treatment effects from tumor progression but are not 100% sensitive or specific in diagnosing progression. Novel radiographic or nonradiographic biomarkers with sensitivity and specificity verified in large randomized clinical trials are needed to detect progression.     

Unusual MR appearance of intracranial dissemination from cervical glioblastoma

We reported a rare case of cervical glioblastoma with intracranial dissemination at an early stage of clinical course and reviewed the literature. An 8-year-old girl presented with failure of vision 3 months prior to admission to our hospital. Neurological examination on admission disclosed no definitive abnormalities except for bilateral visual disturbance and optic atrophy. Cranial MR images revealed a homogeneously enhancing tumor in the left sylvian fissure. Multiple spotty T2-hyperintensity lesions without contrast enhancement were also disclosed in bilateral cerebellum. Spinal MR images showed an enhancing tumor at C7 and tiny enhancing lesions on the surface of T11. The patient underwent an uneventful excision of the exophytic tumor at C7. The histological diagnosis was glioblastoma. The enhancing tumor in the left sylvian fissure treated by Linac stereotactic radiotherapy with a marginal dose of 38.4Gy in 12 fractions has diminished, whereas the residual tumor at C7 remained unchanged after radiation of 44Gy. In contrast, the multiple spotty lesions without contrast enhancement dispersedly spread in the cerebellum and infiltrated into brain stem despite 4 courses of chemotherapy using ifosfamide, cisplatin, and etoposide. Stereotactic biopsy of the multiple spotty lesions in the cerebellum was performed. Histological examination revealed anaplastic astrocytoma. The patient died 2 weeks after the biopsy despite additional chemotherapy and focal irradiation to the cerebellum. Early detection and selection of optimal therapeutic strategies are important in management of spinal glioblastoma with subarachnoid dissemination, since neuroradiological findings and therapeutic sensitivity are varied according to differentiation of disseminated tumors.     

Medulloblastoma

OPINION STATEMENT: The mainstay of medulloblastoma treatment is high-quality interdisciplinary collaboration in diagnosis, treatment, and aftercare by all involved disciplines. The first step in treatment of medulloblastoma is a maximal safe surgery, followed by thorough staging. Surgery should only be performed in experienced neurosurgical centers, with age-appropriate postoperative care. As optimal risk stratification is based on histopathological and neuroradiological assessments, these should be performed or confirmed by experienced specialists. Central review of histopathological subtype, as well as review of staging evaluations is highly desirable. For young children with desmoplastic/nodular (DMB), or extensive nodular medulloblastoma, craniospinal or any radiotherapy should be avoided. For young children with classic medulloblastoma (CMB), large cell, or anaplastic medulloblastoma (LC/A MB) optimized strategies with high-dose chemotherapy and autologous stem cell rescue with or without local radiotherapy are under investigation. For older clinical standard risk patients (without metastases, without postoperative residual tumor >1.5?cm(2)) with CMB or DMB, craniospinal radiotherapy with 23.4?Gy and boost to the posterior fossa to 54?Gy, followed by maintenance chemotherapy can be regarded as a standard therapy besides other currently applied regimen, such as the use of intensified chemotherapy after irradiation. Older children with LC/A MB, metastatic medulloblastoma, and/or large residual tumor can be regarded as high-risk patients and should receive intensified treatment: intensified chemotherapeutic regimen before or after radiotherapy with increased dose (36-Gy CSI normofractionated, or 40-Gy hyperfractionated) is used. For treatment to be effective, quality control of radiotherapy is of high relevance. Information on long-term sequelae is essential and appropriate multidisciplinary follow-up and support, including rehabilitation and help for reintegration, is necessary. Whenever possible, patients should be included in prospective studies, and tumor material should be sampled to facilitate further research on medulloblastoma biology, which will significantly influence the stratification criteria and the introduction of targeted therapies in standard treatment recommendations in the future.     

光动力疗法治疗恶性肿瘤作用机制的研究进展

【摘要】 光动力疗法(PDT)是继手术、放化疗等传统治疗肿瘤手段外的一种新的抗肿瘤模式。PDT机制目前尚不完全清楚, 已知其利用肿瘤细胞高摄取光敏剂的特性, 使用相应波长的激光照射, 使光敏剂产生单线态氧或其他活性氧, 通过非细胞凋亡途径或直接高效诱导凋亡或导致肿瘤组织坏死杀死癌细胞。PDT也可损伤肿瘤组织的血管内皮细胞及介导自身免疫系统的激活。     

膀胱非上皮性肿瘤25例诊治报告

目的 总结膀胱非上皮性肿瘤的影像及临床诊断特点,探讨治疗方法与预后的关系.方法 回顾性分析25例膀胱非上皮肿瘤临床资料.男16例,女9例.年龄2～71岁.其中血尿6例,下腹部肿块2例,尿频14例,排尿困难2例,排尿晕厥1例.超声及CT检查发现22例膀胱占位病变,3例盆腔肿物及膀胱壁受累.均行膀胱镜检查,穿刺活检17例.结果 15例良性肿瘤行单纯肿瘤剜除术或膀胱部分切除术;10例恶性肿瘤行膀胱部分切除术或膀胱全切术.恶性肿瘤术后辅助化疗、放疗.随访3个月～11年.良性肿瘤均无复发,恶性肿瘤9例死于术后3年内,平均存活16个月;1例膀胱恶性淋巴瘤带瘤存活6年.结论 膀胱非上皮性肿瘤临床上少见,病理类型复杂,恶性居多,预后较差.膀胱部分切除术或膀胱全切术是本病的主要治疗方法,恶性肿瘤结合其病理特点辅助放化疗,疗效不理想,预后差别较大.