缓释BCNU对GL261胶质瘤治疗作用分析

目的 研究卡氮芥( BCNU)聚乳酸-羟基乙酸(PLGA)缓释微球(BCNU-PLGA)对GL261胶质瘤模型的治疗作用及化疗耐药机制.方法 利用溶剂挥发萃取法制备BCNU-PLGA缓释微球.将36只C57BL/6小鼠随机等分为假手术组、治疗组与非治疗组,借助动物立体定向仪,将体外培养小鼠GL261胶质瘤细胞接种于小鼠颅内,治疗组于术后第2 w立体定位植入BCNU-PLGA缓释片剂,观察小鼠生存期,MRI了解瘤体变化.获取标本行HE染色,并行胶原纤维酸性蛋白(GFAP)、甲基鸟嘌呤DNA甲基转移酶(MGMT)免疫组化检查检测其表达情况,相关数据采用统计学方法进行分析.结果 治疗组与对照组生存期有明显差异(P＜0.05),治疗组与对照组凋亡MGMT无明显差异(P＞0.05).GFAP表达为阳性.结论 BCNU-PLGA局部缓释制剂可延长荷瘤小鼠生存期,且不改变其MGMT表达.     

尼莫司汀与替尼泊苷联合化疗治疗恶性胶质瘤的疗效观察

目的 评价盐酸尼莫司汀与替尼泊苷联合化疗方案对恶性脑神经胶质瘤的治疗效果和不良反应.方法 选择合格病例38例,随机分为两组:实验组(18例)为盐酸尼莫司汀加替尼泊苷(NV)组,2～6个周期;对照组(20例)为司莫司汀加替尼泊苷(SV)组,2～6个周期.第1周期化疗后同步行常规局部外放疗.结果 38例患者有效26例,其中实验组14例有效,对照组12例有效;经X2检验,两种化疗方案有效率差异无统计学意义.两组主要不良反应均为骨髓抑制,特别是中性粒细胞减少.病人每2个月随访1次.1年生存率:NV组为72%(13/18);SV组为65%(13/20);两组比较差异无统计学意义(P=0.60).结论 盐酸尼莫司汀与替尼泊苷联合化疗治疗恶性胶质瘤,安全、有效.为脑神经胶质瘤辅助化疗提供了新方案.     

Ommaya囊置入及囊内化疗治疗颅内囊性胶质瘤的临床应用研究

目的探讨Ommaya囊置入术及尼莫司汀(nimustine,ACNU)囊内化疗对颅内囊性胶质瘤的治疗效果。方法对诊断明确的31例颅内囊性胶质瘤患者,置入Ommaya囊后,再进行穿刺引流囊液和Ommaya囊内注射尼莫司汀。结果 18例恶性程度高的胶质瘤近期(2～3个月)随访结果:临床症状消失11例,好转4例,死亡3例。13例低度恶性胶质瘤中远期(6～42个月)随访结果:临床症状消失9例,好转2例,加重1例,死亡1例。结论本组结果表明立体定向置入Ommaya囊结合尼莫司汀囊内化疗是临床治疗颅内囊性胶质瘤一种简便、经济、有效、创伤小的好方法。     

原代胶质瘤细胞化疗药物敏感性研究

目的 观察不同抗肿瘤药物在体外对原代人胶质瘤细胞的敏感性,为临床筛选化疗药物、制订个体化方案提供指导.方法 46例经手术后病理证实的胶质瘤新鲜组织标本进行体外原代培养,流式细胞术Annexin V-FITC/PI双染法榆测替尼泊苷、尼莫司汀、甲氨蝶呤和替莫唑胺在体外对原代胶质瘤细胞的敏感性;分析不同化疗药物敏感性与患者性别、年龄和肿瘤病理分级之间的关系.结果 人胶质瘤细胞对4种化疗药物敏感性的强弱程度依次为替尼泊苷(39.13%)、替莫唑胺(34.78%)、尼莫司汀(26.09%)和甲氨蝶呤(6.52%),组间差异具有统计学意义(x2=14.770,P=0.002);甲氨蝶呤组患者对化疗药物敏感性最低,与其他各组比较差异有统计学意义(x2=13.883,11.210,6.452;均P＜0.05).亚组分析提示,性别和年龄对化疗药物敏感性无显著影响(均P＞0.05),但不同WHO病理分级对替莫唑胺化疗敏感性存在差异并具有统计学意义(x2=4.305,P=0.038).结论 不同胶质瘤个体对化疗药物的敏感性不同,以替尼泊苷抗胶质瘤作用较强,替莫唑胺对高级别胶质瘤药物化疗效果更佳.流式细胞术可作为快速化疗药物敏感性检测方法,为胶质瘤筛选化疗药物并制订个体化方案.     

三种鼠脑胶质瘤模型的建立与比较

目的 ;建立GL261胶质瘤细胞C57BL/6小鼠、C6胶质瘤细胞SD大鼠及BALB/c小鼠皮下动物模型,比较其肿瘤生长特点。方法借助动物立体定向仪,将体外培养小鼠GL261、大鼠C6胶质瘤细胞分别接种于C57BL/6小鼠及SD大鼠右侧尾状核区,C6胶质瘤细胞接种于BALB/c小鼠左前肢皮下。接种后观察不同种实验鼠的生存状态及肿瘤的生长特性,颅内模型于接种后7d、14d、21d、28d进行MRI检查,皮下模型测量体积,并绘制生长曲线。解剖标本,做组织病理学和胶质纤维酸性蛋(GFAP)免疫组化检查。结果 GL261胶质瘤细胞C57BL/6小鼠模型较之后两种模型在组织病理学上接近人脑胶质瘤,而且颅内生长稳定,成瘤率高,未见颅外转移病灶,实验周期短,重复性好。结论 GL261胶质瘤细胞C57BL/6小鼠模型,其肿瘤生长特性及病理特征与人脑胶质瘤相似,可作为临床胶质瘤基础研究的理想模型。     

脑恶性胶质瘤经动脉超选化疗的初步观察

目的观察脑恶性胶质瘤采用尼莫司汀经动脉超选化疗的疗效及安全性。方法回顾性分析64例脑恶性胶质瘤病人的临床资料,其中多形性胶质母细胞瘤38例,间变性星形细胞瘤22例,胶质肉瘤4例。显微镜下尽量切除肿瘤,术后采用尼莫司汀(2.5 mg/kg)行经动脉超选化疗。结果肿瘤全切除56例,大部分切除6例,部分切除2例。所有病例随访3～18个月,平均8个月。术后复发8例(12.50%),其中再次手术2例。化疗前后KPS评分差异无统计学意义(P>0.05)。出现不同程度骨髓抑制40例(62.50%);胃肠道反应4例(6.25%);未见与介入操作相关的并发症、肝肾功能改变、眼部及神经系统并发症。结论脑恶性胶质瘤采用尼莫司汀经动脉超选化疗是一种安全、有效的辅助治疗方法,值得进一步研究。     

缓释BCNU对GL261胶质瘤细胞凋亡作用机制的研究

目的 研究BCNU-PLGA 对GL261 胶质瘤细胞凋亡的作用机制.方法 利用溶剂挥发萃取法制备BCNU-PLGA 缓释微球.将24 只C57BL/6 小鼠随机等分为治疗组与非治疗组,借助动物立体定向仪,将体外培养小鼠GL261 胶质瘤细胞接种于小鼠颅内,行MR 检查掌握颅内成瘤情况.治疗组于术后第2 周立体定位植入BCNU-PLGA 缓释片剂,观察小鼠生存期,MRI 了解瘤体变化.获取标本行HE 染色,并行GFAP、Bax、Bcl-2 免疫组化检查检测其表达情况,相关数据采用统计学方法 进行分析.结果 治疗组与对照组生存期有明显差异(P ＜0.05),治疗组与对照组凋亡相关基因Bcl-2 免疫组化检查提示明显差异性(P ＜ 0.05),Bax 基本无改变,Bax/Bcl-2 比值明显增加.GFAP 表达为阳性.结论 BCNU-PLGA 局部缓释制剂通过下调Bcl-2 蛋白表达,上调Bax/Bcl-2 的比值,从而使胶质瘤细胞发生凋亡.     

脑胶质瘤经颈内动脉灌注ACNU的疗效观察

目的比较盐酸尼莫司汀（ACNU）经动脉灌注与经静脉灌注的疗效，并了解不同剂量的疗效。方法培养大鼠C6胶质瘤细胞株．建立大鼠C6胶质瘤模型。分为对照组及动、静脉灌注组，将ACNu按15、30、45mg／kg分别通过颈内动脉和股静脉注入荷瘤大鼠体内。10d后处死大鼠，取脑标本，行苏木精-伊红染色，测量肿瘤体积，比较不同给药方式和剂量对肿瘤生长的影响。结果ACNU治疗大鼠颅内肿瘤体积均小于对照组（P≤0．01）；ACNU颈内动脉灌注组肿瘤体积缩小较静脉灌注组更明显（P≤0．05）。结论单次经颈内动脉灌注ACNU较单次经静脉灌注能更有效地抑制脑胶质瘤的生长。     

高压氧治疗对兔脑内种植的VX2肿瘤生长的影响

目的探讨高压氧治疗对兔脑内种植VX2肿瘤生长的影响。方法随机将脑内种植VX2肿瘤的14只新西兰大白兔分为对照组和高压氧治疗组,每组7只,对比分析两组肿瘤的生长情况及荷瘤兔的生存期。结果肿瘤种植后第9天(高压氧治疗前)对照组和高压氧治疗组肿瘤体积分别为(301.2±50.4)mm3和(298.0±18.6)mm3,肿瘤种植后第15d分别为(563.7±75.0)mm3和(566.5±23.8)mm3,肿瘤种植后第21d分别为(1208.5±224.8)mm3和(1143.8±125.0)mm3以及荷瘤兔死亡时分别为(2446.8±384.7)mm3和(2520.4±302.7)mm3;对照组和高压氧治疗组荷瘤兔平均生存期分别为(35.6±5.2)d和(36.7±6.3)d。肿瘤种植后第9(高压氧治疗前)、15、21天及荷瘤兔死亡时肿瘤体积以及荷瘤兔的平均生存期两组之间均无明显差异(P>0.05)。结论高压氧治疗对兔脑内种植VX2肿瘤的生长及荷瘤兔生存期均无明显影响。     

经颈动脉灌注ACNU、VM-26联合治疗复发性脑胶质瘤的临床研究

目的研究经颈动脉灌注盐酸尼莫司汀（ACNU）和替尼泊苷（VM-26）联合治疗复发性脑胶质瘤的效果及相关问题。方法治疗组选择幕上颈内动脉供血范围的复发性脑胶质瘤164例，肿瘤同侧颈总动脉ACNU和VM-26联合灌注化疗。对照组选择复发性脑胶质瘤26例，口服司莫司汀治疗，并行疗效对比。结果治疗组完全缓解率和部分缓解率明显高于对照组（P〈0．05），恶化率明显低于对照组（P〈0.05），生存期明显长于对照组（P〈0.05）。结论经颈动脉灌注ACNU、VM-26治疗复发性脑胶质瘤疗效好，副作用小，安全可靠，可作为常规化疗手段。     

Satisfaction with quality of life varies with temperament types of patients with schizophrenia

We sought to explore the relationships of three temperament factors with domain-specific subjective quality of life (QOL) of patients with schizophrenia. Ninety patients with schizophrenia were evaluated using the Quality of Life Enjoyment and Life Satisfaction Questionnaire, the Tridimensional Personality Questionnaire, the Positive and Negative Syndromes Scale, the Distress Scale for Adverse Symptoms, the Insight and Treatment Attitudes Questionnaire, the Insight Self-Report Scale, and standardized questionnaires for self-reported emotional distress and stress process-related variables. Predictors of domain-specific QOL were identified using multiple regression techniques. Temperament factors explain 6% to 16% of variability in QOL domain scores among patients with schizophrenia after controlling for the remaining variables (emotional distress, social support, self-esteem, avoidance coping, age, side effects, and depression). We found that higher levels of novelty seeking are associated with better general QOL, physical health, and more positive subjective feelings, whereas higher levels of reward dependence are related to better satisfaction from social relationships. Higher levels of harm avoidance are associated with poorer satisfaction with general activities, and medication. Thus, temperament factors, as assessed by the Tridimensional Personality Questionnaire, substantially influence satisfaction with life quality in schizophrenia. Novelty seeking, reward dependence, and harm avoidance are associated with different domains of QOL.     

Treatment of patients with tardive dystonia with olanzapine

Tardive dystonia represents a complication of long-term use of neuroleptics and its treatment is often unsatisfactory. Atypical neuroleptics appear to improve tardive dystonia, and cases of tardive dystonia successfully managed with clozapine have been reported. The aim of this open-label video-blinded study was to evaluate the antidystonic efficacy of olanzapine, a new atypical neuroleptic with a low risk of agranulocytosis, in a group of four patients (one man and three women) with tardive cervical dystonia. They developed severe dystonia after several years of neuroleptic treatment. Extensive laboratory evaluations, as well as neurophysiologic and neuroradiologic investigations, were negative. Olanzapine was started at a dose of 5 mg/d and increased up to 7.5 mg/d. All patients were evaluated at baseline and after 2, 4, 8, and 12 weeks of treatment, using the Toronto Western Spasmodic Torticollis Rating Scale, and videotaped. At the end of the trial, the videotapes were reviewed and scored by a blind observer. A self-rating visual analog scale completed the disability evaluation.A moderate to marked improvement in dystonia was observed in all patients, and significant differences were observed in Toronto Western Spasmodic Torticollis Rating Scale scores and videotape ratings after 8 and 12 weeks of treatment compared with the basal values (p < 0.05). The average percentage of improvement in Toronto Western Spasmodic Torticollis Rating Scale score and visual analog scale was 26.4% and 42.6%, respectively. No serious side effects were reported at the maximum dosage reached (7.5 mg/d). This study warrants a larger controlled study to conclusively demonstrate the efficacy of olanzapine in tardive dystonia.     

Compliance with health regimens of adolescents with epilepsy

The purpose of this paper was to describe the compliance of adolescents with epilepsy and some factors connected to it. Altogether 300 individuals with epilepsy aged 13-17 years were randomly selected from the Finnish Social Insurance Institution's register. Every fifth person on the list was included in the sample. Seventy-seven per cent (n= 232) of the selected adolescents with epilepsy returned a questionnaire sent to them relating to compliance. The data were analysed using the SPSS software. Twenty-two per cent of the adolescents with epilepsy felt that they complied fully with their suggested health regimens, while 44% placed themselves in the category of "satisfactory compliance", and the remaining 34% reported poor compliance. Compliance with their recommended life-style was poorest, while the highest degree of compliance was recorded for medication. Background variables, such as the duration of the disease, exercise, smoking, alcohol-intake and the number of seizures, were statistically significantly related to compliance (P< 0.001). Good motivation, a strong sense of normality, experience of results, subjective outcome, energy and will-power, support from parents, physicians and nurses, and a positive attitude towards to the disease and its treatment, no threat to social and emotional well-being and no fears of complications and no fear of seizures explained good compliance (P< 0.001).     

Factors associated with stigmatization of persons with mental illness

Stigmatization of individuals with mental illnesses is widespread and serves as a major barrier to treatment. In a survey of 116 undergraduates, the authors examined the impact of diagnosis, attitudes about treatment, and psychiatric terminology on stigma associated with mental illness. Stigmatization of schizophrenia was significantly higher than stigmatization of depression. More positive attitudes toward treatment were associated with significantly less stigma. However, psychiatric terminology had no impact on attitudes toward mental illness. Significantly less stigmatization of mental illness was found among females than among males. Reducing the stigmatization of mental illness continues to be an important goal for mental health professionals.