脊柱外科术后手术部位感染的原因及对策

手术部位感染(surgical site infection,SSI)是脊柱外科手术的严重并发症。深部组织(深筋膜以下)感染是导致手术失败及术后脊柱内置物翻修的重要原因。SSI不仅给患者带来极大的躯体、精神及经济负担,而且给外科医生带来了巨大的压力,尤其在脊柱内置物翻修手术中,操作难度大、手术风险高。据报道,脊柱外科术后SSI发生率约为2.1%~10.9%[1-9]。因此,及早探索及总结SSI原     

儿童脊柱术后手术区域感染的临床现状

正在儿童脊柱畸形手术矫形后出现的并发症中,手术区域感染(surgical site infection,SSI)会引起较高的死亡率[1]。相关研究表明,SSI会使患儿住院时间延长,并且静脉使用抗生素治疗的疗程延长及清创、内固定去除以及伤口探查都会对患儿、患者家庭、手术医生以及医疗保障机构带来巨大负担[1-3]。目前,关于儿童脊柱畸形进行手术矫形后出现SSI的相关研究较少,既往综述尚未就儿     

Halo牵引技术在重度脊柱畸形中的应用进展

重度脊柱畸形的治疗一直是脊柱外科面临的挑战,由于该类患者多合并心肺功能障碍,严重畸形又导致脊柱僵硬,使得手术矫形难度大、手术时间长和失血量大,患者围手术期各种并发症发生率明显增加[1]。由于术前牵引不但可以增加脊柱、胸廓和脊柱前方结构的柔韧性,还可以改善患者心肺和消化功能、了解牵引状态下脊髓耐受能力及神经并发症的发生情况,因此越来越多的学者采用牵引技术辅助治疗重度脊柱畸形[2-3]。现就目前临床上应用最多的Halo牵引技术综述如下。     

45例骶骨肿瘤患者的护理要点探讨

骶骨肿瘤是脊柱原发性骨肿瘤的常见类型,手术切除为主的综合治疗是治疗此类疾病的重要手段[1-2]。但因骶骨血运丰富,周围有许多大的血管,术中及术后易出现致命性大出血,手术风险极高,围手术期的护理是保证手术安全的重要手段[3-4]。此外,术后患者局部血运常被破坏,甚至局部神经功能出现缺失,此类患者的术后并发症不容忽视[5-7]。术后的精心护理是减少骶骨肿瘤患者并发症的重要保证。     

PKP治疗强直性脊柱炎患者的A型胸腰椎骨折一例

正强直性脊柱炎是一种病因未知的慢性疾病。常累及骶髂关节、脊柱等,造成脊柱强直、骨质脆性增加。轻微外力即可造成强直性脊柱炎患者的胸腰椎骨折[1-2]。其骨折处应力较为集中,骨折相对不稳定,治疗较为棘手。常见的治疗方式包括保守治疗、前路内固定手术、后路内固定手术等。但其因骨折处应力过于集中、骨质质量差等原因,常出现骨折不愈合、内固定松动、骨折移位等并发症[2-3]。目前尚未见对其采取经皮椎体后凸成形术     

采用合理手术方式减少成人脊柱畸形三柱截骨术后并发症

<正>脊柱后路三柱截骨术,包括全脊柱截骨术(vertebral column resection,VCR)和经椎弓根椎体截骨术(pedicle subtraction osteotomy,PSO)等被广泛应用于严重成人脊柱畸形的矫正,术后畸形矫正和冠状面及矢状面平衡恢复满意[1]。但上述术式存在大出血、神经损伤、感染、内固定失败、交界区并发症等[2]。随着手术策略和手术操作技术的完善,围手术期并发症的发生率已明显降低。但术后中远期随访会发生内固定     

食管癌术后恶性狭窄的危险因素分析

[目的]探讨食管癌术后患者恶性狭窄发生的危险因素。[方法]回顾性分析198例在我院施行食管癌切除并行食管重建手术患者的资料。对性别、年龄、高血压史、病灶部位、术前白蛋白、术前血红蛋白、手术时间、病灶最深浸润深度、手术医生职称、病理类型、输血、淋巴结转移、淋巴结数目、淋巴结转移度、病理分期、手术径路、术后白蛋白、术后血红蛋白、吻合口瘘、切口感染情况与食管癌术后恶性狭窄的关系行单因素及多因素Logistic回归分析。[结果]术后出现恶性狭窄13例（6.6%）。多因素分析显示淋巴结转移度是狭窄发生的独立危险因素。[结论]淋巴结转移度≥0.5的食管癌患者术后易发生恶性狭窄。     

全内镜下腰椎椎体间融合术的现状及争议

全内镜特指整合了照明、摄像、灌洗系统、工作通道的硬质杆状内镜。全内镜下脊柱手术把脊柱外科手术相关的关键要素如照明、手术视野及手术工具等进行最优化组合,使手术入路损伤最小化、手术视野照明最佳化、手术视野更清晰化及手术操作更精细化[1-5]。全内镜下腰椎椎体间融合术最早由Leu等[6-7]于1996年报道,此后该技术并没有得到快速改进及推广。     

比较胃癌手术单纯术中使用和术后延长使用预防性抗生素的Ⅲ期、开放、随机对照非劣性临床试验

背景尽管缺少术后预防性使用抗生素的证据,但实际上很多医院会对接受大手术后的患者常规使用预防性抗生素。美国疾病控制和预防中心建议对于清洁或清洁-污染切口手术,术中可使用第一代头孢菌素预防手术部位感染。美国一项大型的队列研究显示,32603例患者接受大手术后,仅14.5%在术后12h内终止使用预防性抗生素;且48h后仍在使用的比例达26.7%。在日本,由于胃肠道手术经常留置引流且存在手术部位感染的潜在风险,日本感染学会和化疗学会     

296例Ⅱ期胸段食管鳞癌术后患者的预后分析

[目的]探讨影响Ⅱ期胸段食管鳞癌术后预后的因素。[方法]回顾性分析南通市肿瘤医院胸外科2002年1月至2005年1月收治的296例单纯手术切除食管鳞癌患者的临床资料。[结果]全组总的1、3、5年生存率分别为86.8%（257/296）、54.0%（160/296）、42.9%（127/296）。ⅡA期和ⅡB期患者的5年生存率分别为51.3%（99/193）和27.2%（28/103）（P〈0.001）。患者的性别、淋巴结转移、手术切缘情况、肿瘤浸润深度及组织分化程度均为预后影响因素（P〈0.05）,而患者年龄、肿瘤部位及肿瘤长度与预后无关（P〉0.05）。[结论]影响Ⅱ期胸段食管鳞癌患者术后生存的主要因素有性别、淋巴结转移及手术切缘情况、肿瘤浸润深度及组织分化程度。     

Suicide gene therapy in cancer: Where do we stand now?

Suicide gene therapy is based on the introduction into tumor cells of a viral or a bacterial gene, which allows the conversion of a non-toxic compound into a lethal drug. Although suicide gene therapy has been successfully used in a large number of in vitro and in vivo studies, its application to cancer patients has not reached the desirable clinical significance. However, recent reports on pre-clinical cancer models demonstrate the huge potential of this strategy when used in combination with new therapeutic approaches. In this review, we summarize the different suicide gene systems and gene delivery vectors addressed to cancer, with particular emphasis on recently developed systems and associated bystander effects. In addition, we review the different strategies that have been used in combination with suicide gene therapy and provide some insights into the future directions of this approach, particularly towards cancer stem cell eradication.     

Repeated cycles of Clostridium-directed enzyme prodrug therapy result in sustained antitumour effects in vivo

The unique properties of the tumour microenvironment can be exploited by using recombinant anaerobic clostridial spores as highly selective gene delivery vectors. Although several recombinant Clostridium species have been generated during the past decade, their efficacy has been limited. Our goal was to substantially improve the prospects of clostridia as a gene delivery vector. Therefore, we have assessed a series of nitroreductase (NTR) enzymes for their capacity to convert the innocuous CB1954 prodrug to its toxic derivative. Among the enzymes tested, one showed superior prodrug turnover characteristics. In addition, we established an efficient gene transfer procedure, based on conjugation, which allows for the first time genetic engineering of Clostridium strains with superior tumour colonisation properties with high success rates. This conjugation procedure was subsequently used to create a recombinant C. sporogenes overexpressing the isolated NTR enzyme. Finally, analogous to a clinical setting situation, we have tested the effect of multiple consecutive treatment cycles, with antibiotic bacterial clearance between cycles. Importantly, this regimen demonstrated that intravenously administered spores of NTR-recombinant C. sporogenes produced significant antitumour efficacy when combined with prodrug administration.     

初治急性白血病院内感染特征及防治策略

 目的 观察初治急性白血病诱导化疗合并感染特征。 方法 分析自2005年1月-2010年1月采用联合化疗方案治疗初治179例急性白血病患者医院感染的临床特征。 结果 179例患者,完全缓解151例,完全缓解率 84.4 %,AML完全缓解率77.4%。感染发生率 45.8%。感染部位主要为口腔、肛周、肺部等,以及原发感染灶不明确的菌血症。微生物总检出率17.5%。计分离出细菌38株,真菌5株,细菌学以G-菌为主。G-菌均对多种抗生素有不同程度的耐药,未检出产超广谱β-内酰胺酶(ESBLs)菌株。 结论 急性白血病化疗后易合并感染,院内感染的控制和预防应贯穿整个治疗过程,层流床的应用有利于降低初治急性白血病患者院内感染发生率。     

Transmembrane voltage potential of somatic cells controls oncogene-mediated tumorigenesis at long-range

The microenvironment is increasingly recognized as a crucial aspect of cancer. In contrast and complement to the field''s focus on biochemical factors and extracellular matrix, we characterize a novel aspect of host:tumor interaction – endogenous bioelectric signals among non-excitable somatic cells. Extending prior work focused on the bioelectric state of cancer cells themselves, we show for the first time that the resting potentials of distant cells are critical for oncogene-dependent tumorigenesis. In the Xenopus laevis tadpole model, we used human oncogenes such as mutant KRAS to drive formation of tumor-like structures that exhibited overproliferation, increased nuclear size, hypoxia, acidity, and leukocyte attraction. Remarkably, misexpression of hyperpolarizing ion channels at distant sites within the tadpole significantly reduced the incidence of these tumors. The suppression of tumorigenesis could also be achieved by hyperpolarization using native CLIC1 chloride channels, suggesting a treatment modality not requiring gene therapy. Using a dominant negative approach, we implicate HDAC1 as the mechanism by which resting potential changes affect downstream cell behaviors. Based on published data on the voltage-mediated changes of butyrate flux through the SLC5A8 transporter, we present a model linking resting potentials of host cells to the ability of oncogenes to initiate tumorigenesis. Antibiotic data suggest that the relevant butyrate is generated by a native bacterial species, identifying a novel link between the microbiome and cancer that is mediated by alterations in bioelectric signaling.     

Significance of interleukin-13 receptor alpha 2–targeted glioblastoma therapy

Glioblastoma multiforme (GBM) remains one of the most lethal primary brain tumors despite surgical and therapeutic advancements. Targeted therapies of neoplastic diseases, including GBM, have received a great deal of interest in recent years. A highly studied target of GBM is interleukin-13 receptor α chain variant 2 (IL13Rα2). Targeted therapies against IL13Rα2 in GBM include fusion chimera proteins of IL-13 and bacterial toxins, nanoparticles, and oncolytic viruses. In addition, immunotherapies have been developed using monoclonal antibodies and cell-based strategies such as IL13Rα2-pulsed dendritic cells and IL13Rα2-targeted chimeric antigen receptor–modified T cells. Advanced therapeutic development has led to the completion of phase I clinical trials for chimeric antigen receptor–modified T cells and phase III clinical trials for IL-13–conjugated bacterial toxin, with promising outcomes. Selective expression of IL13Rα2 on tumor cells, while absent in the surrounding normal brain tissue, has motivated continued study of IL13Rα2 as an important candidate for targeted glioma therapy. Here, we review the preclinical and clinical studies targeting IL13Rα2 in GBM and discuss new advances and promising applications.     

Role of Helicobacter pylori in gastric cancer: Updates

Helicobacter pylori (H. pylori) infection is highly prevalent in human, affecting nearly half of the world’s population; however, infection remains asymptomatic in majority of population. During its co-existence with humans, H. pylori has evolved various strategies to maintain a mild gastritis and limit the immune response of host. On the other side, presence of H. pylori is also associated with increased risk for the development of various gastric pathologies including gastric cancer (GC). A complex combination of host genetics, environmental agents, and bacterial virulence factors are considered to determine the susceptibility as well as the severity of outcome in a subset of individuals. GC is one of the most common cancers and considered as the third most common cause of cancer related death worldwide. Many studies had proved H. pylori as an important risk factor in the development of non-cardia GC. Although both H. pylori infection and GC are showing decreasing trends in the developed world, they still remain a major threat to human population in the developing countries. The current review attempts to highlight recent progress in the field of research on H. pylori induced GC and aims to provide brief insight into H. pylori pathogenesis, the role of major virulence factors of H. pylori that modulates the host environment and transform the normal gastric epithelium to neoplastic one. This review also emphasizes on the mechanistic understanding of how colonization and various virulence attributes of H. pylori as well as the host innate and adaptive immune responses modulate the diverse signaling pathways that leads to different disease outcomes including GC.     

NOD2基因与原发性肝癌

核苷酸结合寡聚化结构域蛋白2（NOD2）可通过识别细菌细胞壁的肽聚糖及其裂解产物胞壁酰二肽,参与宿主对病原体的免疫应答,参与调节自然免疫和特异性免疫。NOD2作为一种新发现的细胞内模式识别受体,可通过基因变异、诱发肝脏炎症反应、激活相应信号通路在原发性肝癌的发生发展中发挥重要作用。     

Physical and chemical insults induce inflammation and gastrointestinal cancers

Chronic inflammation associated with viral and bacterial infections of the gastrointestinal tract (GI) and liver renders these organs susceptible to tumour development. There is also a growing body of evidence demonstrating that chemical and physical insults promote GI cancers by inducing inflammation. For example, excessive alcohol consumption and tobacco smoking induces inflammation and gastrointestinal carcinogenesis. Likewise, drinking hot beverages and intentional or accidental exposure to toxic substances leads to inflammation and GI cancer formation. However, further work needs to be undertaken using animal models to separate the direct carcinogenic effects of physical and chemical insults from the indirect effects of these insults to promote tumor formation through tissue inflammation.     

Internalization of Mycobacterium bovis, Bacillus Calmette Guerin, by bladder cancer cells is cytotoxic

Instillation of Bacillus Calmette Guerin (BCG) into the bladder is the standard treatment for superficial bladder cancer. It leads to a local inflammatory response due to the release of cytokines and influx of immune cells to the tumor site. Although the presence of an intact immune system is an essential criterion for successful therapy, attachment of the bacteria to the bladder urothelial is just as important. The purpose of our study is to determine the role of bacterial internalization by epithelial cells. Transfection of the alpha5 integrin gene into the BCG unresponsive bladder cancer cell line, RT4, caused an increase in bacterial uptake and also increased cell death. Treatment of cells with cycloheximide did not prevent bacterial internalization but blocked its cytotoxic effect suggesting that unlike cell death, the process of bacterial internalization does not require new protein synthesis. Our data also show that the bacteria secretory products can prevent its own internalization. The extract prepared from lyophilized BCG altered the phosphorylation status of the focal adhesion kinase which is responsible for cellular endocytosis. Therefore, bacterial phosphatases may be present in the bacterial extract. Their activity may inhibit BCG internalization. Thus washing the reconstituted bacteria to remove the enzymes before instillation into the bladder might improve the therapeutic outcome of intravesical BCG therapy.     

Helicobacter pylori associated Asian enigma: Does diet deserve distinction?

Helicobacter pylori(H. pylori) is one of the most widespread infections in humans worldwide that chronically infects up to 50% of the world’s population. The infection is involved in the pathogenesis of chronic active gastritis, peptic ulcer, mucosa-associated lymphoid tissue lymphoma and gastric cancer, therefore, it has been classified as class Ⅰ definite carcinogen by the World Health Organization. Despite the established etiological role of H. pylori, its actual distribution and association with related diseases is controversial and there is a large intercountry variation especially among Asian countries. H. pylori infection is more frequent in developing countries like India, Pakistan, and Bangladesh as compared to developed Asian countries like Japan, China and South Korea. However, the frequency of gastric cancer is comparatively lower in India, Pakistan, and Bangladesh with that of Japan, China and South Korea. Such phenomenon of clinical diversity, defined as enigma, is judged by genetic variability of the infecting H. pylori strains, differences in the host genetic background in various ethnic groups, and environmental factors such as dietary habits. Most of the studies have so far focused on the bacterial factor while environmental issues, including dietary components, were not given due attention as one of the factors related with H. pylori associated gastric carcinogenesis. The dietary factor has been suggested to play an important role in H. pylori related carcinogenesis, and in this respect several studies have corroborated the intake of various dietary components as modulatory factors for gastric cancer risk. In this review, such studies, from in vitro experiments to clinical trials, are being focused in detail with respect to enigma associated with H. pylori. It may be conceivably concluded from the available evidence that dietary factor can be a game changer in the scenario of Asian enigma, particularly in high risk population infected with virulent H. pylori strains, however further affirmation studies are desperately needed to achieve conclusive outcomes.