吉西他滨在转移性乳腺癌中的一线治疗地位

乳腺癌是女性最常见的恶性肿瘤,也是癌症死亡的主要原因。一旦发生转移,其中位生存期仅2-3年,5年生存率约为15%-25%。对于发生转移的患者来说,治愈已无可能,延长生存期、提高生活质量是该人群的治疗目标。因此,寻找高效低毒的药物一直是临床工作者的努力方向。     

高龄患者主动脉瓣置换的手术风险及疗效分析

 目的 总结高龄患者主动脉瓣置换的手术风险和远期疗效,探讨同期手术的处理原则。方法 回顾性分析61例75岁以上行主动脉瓣置换术患者的临床资料,其中男44例,女17例,年龄75~84岁［(77.5±2.1)岁］,术前心功能分级(采用美国NYHA分级) Ⅱ级11例,Ⅲ、Ⅳ级50例。根据是否合并其他手术(冠脉搭桥术等)分为单纯组和合并组。单纯组33例,合并组28例。结果 全组住院死亡率6.6% (4/61),术后低心排是住院死亡的独立危险因素,术后主要并发症发生率45.9%。合并组体外循环时间、主动脉阻断时间长于单纯组,使用血浆的量多于单纯组;两组在住院死亡率、术后并发症发生率、术后住院时间、ICU时间、远期生存情况等方面无显著差异。出院后的随访率92.9%,随访时间2~105个月［(34±28)个月］,1、3、5、8年生存率分别为93.9%、88.7%、69.4%、41.6%。合并组与单纯组1、3、5、8年生存率分别为100%、87.5%、52.5%、52.5%与89.2%、80.3%、80.3%、40.2% (P=0.796)。结论 75岁以上高龄患者主动脉瓣置换手术死亡率及术后并发症发生率较高,但术后远期疗效满意,同期处理合并手术并不明显增加手术风险,也不影响远期疗效。     

Oncometabolite 2-hydroxyglutarate is a competitive inhibitor of α-ketoglutarate-dependent dioxygenases

IDH1 and IDH2 mutations occur frequently in gliomas and acute myeloid leukemia, leading to simultaneous loss and gain of activities in the production of α-ketoglutarate (α-KG) and 2-hydroxyglutarate (2-HG), respectively. Here we demonstrate that 2-HG is a competitive inhibitor of multiple α-KG-dependent dioxygenases, including histone demethylases and the TET family of 5-methlycytosine (5mC) hydroxylases. 2-HG occupies the same space as α-KG does in the active site of histone demethylases. Ectopic expression of tumor-derived IDH1 and IDH2 mutants inhibits histone demethylation and 5mC hydroxylation. In glioma, IDH1 mutations are associated with increased histone methylation and decreased 5-hydroxylmethylcytosine (5hmC). Hence, tumor-derived IDH1 and IDH2 mutations reduce α-KG and accumulate an α-KG antagonist, 2-HG, leading to genome-wide histone and DNA methylation alterations.     

四藤方对SGC-7901胃癌Caspase-3、剪辑型PARP及Livin表达影响

目的：观察四藤方对人胃癌SGC-7901裸小鼠皮下移植瘤Caspase-3、剪辑型PARP及Livin蛋白表达的影响。方法：人胃腺癌SGC-7901细胞BALB／C裸小鼠皮下移植瘤模型,随机分为3组,每组10只。对照组予生理盐水0．3mL灌胃,1次／d;四藤方组予四藤方煎剂0．3mL灌胃,1次／d;5-Fu组予5-Fu腹腔注射,1mg／次·周。免疫组织化学法检测胃癌组织Caspase-3、剪辑型PARP及Livin蛋白表达。结果：四藤方治疗后,SGC-7901裸小鼠移植瘤Caspase-3及剪辑型PARP蛋白表达升高（P〈0．05）;Livin蛋白表达降低（P〈0．01）。结论：四藤方可上调SGC-7901裸鼠移植瘤Caspase-3,促进PARP剪辑,下调Livin蛋白表达。     

节段性阻断选择性腹腔灌注全胸腹主动脉替换术

目的小结应用节段性阻断、选择性腹腔灌注全胸腹主动脉替换体外循环（CPB）管理经验。方法自2007年1月至2011年6月,连续行全胸腹主动脉替换术11例（男8例,女3例）,年龄35～53（46±11）岁,其中马凡综合征合并慢性Stanford B型夹层4例（均为支架术后）,马凡综合征合并慢性Stanford A型夹层3例（其中1例Bentall术后）,慢性Stanford B型夹层3例（支架术后）,慢性Stanford A型夹层1例。其中仅3例上半身停循环,降温至膀胱温25℃左右,余采用浅低温（鼻咽温33℃左右）节段性阻断,停循环期间行选择性腹腔脏器灌注（双泵双管）,四分支人工血管行全胸腹主动脉替换。结果全组CPB时间145～201（167±51）min,住院时间20～35（27±7）d。3例采用了上半身停循环,停循环时间分别为16 min、19min、21 min;余8例上半身未停循环,选择性腹腔脏器灌注时间为26～37（平均32±4）min。术后出现暂时性神经功能障碍3例;肾功能衰竭1例,透析后痊愈;出现液气胸1例,治疗后痊愈;术后1年出现巨大腹壁切口疝1例。术后无死亡病例,无下肢截瘫及腹腔其他脏器功能不全病例。结论应用节段性阻断、选择性腹腔灌注CPB是要特别注意上、下肢不同血压的维持、引流差与容量不足的判断、选择性腹腔脏器灌注中流量与压力维持等问题。     

Risk factors for residual tumor after resection of hepatocellular carcinoma

AIM:To identify the clinicopathological risk factors correlated with residual tumor in hepatocellular carcinoma (HCC) patients after resection. METHODS:From January 2001 to April 2007,766 HCC patients who had undergone resection were included in this research. Lipiodol angiography was performed within 2 mo after surgery and followed by post-Lipiodol computed tomography (CT) 4 wk later for all 766 patients to monitor tumor in the remnant liver. Tumor detected within the first 3-mo postoperative period was de...     

改良根治性/根治性子宫切除在Ⅰ期子宫内膜样腺癌局控中的治疗价值

 目的 探讨改良根治性/根治性子宫切除在降低Ⅰ期子宫内膜样腺癌局部复发中的价值。 方法 对1996年1月至2008年12月在本院行改良根治性/根治性子宫切除的Ⅰ期子宫内膜样腺癌临床病理资料进行回顾性分析,并随访患者的复发和生存情况。应用Kaplan-Meier法对所有患者的复发、生存情况进行分析。结果 518例Ⅰ期子宫内膜样腺癌中474例行改良根治性/根治性子宫切除 + 双附件切除 ± 盆腔淋巴结清扫 ± 腹主动脉旁淋巴结清扫 + 腹水/腹腔洗液细胞学检查,12例（2.5%）患者术前接受放、化疗,73例（15.4%）患者术后补充放、化疗。中位随访30个月后,16例患者最终复发转移。8例远处转移,4例阴道残端复发,4例盆腔复发。3年、5年阴道残端累积复发率为1.4%和2.0%, 局部复发（阴道 + 盆腔）比率为2.5%和3.1%,3年和5年的总生存率均为98.1%。Ⅰa、Ⅰb、Ⅰc期5年局部复发率分别为3%、3.7%和0 （P=0.649）,5年生存率分别为98.3%、97.8%和100% （P=0.399）。淋巴结清扫与否不影响局部复发率以及生存率（P值分别为0.525和0.665）。中位手术时间为135 min,中位出血量300 mL,输血比率为15.4%,术中、术后手术相关并发症为7.0%,无手术相关死亡病例。结论 改良根治性/根治性子宫切除有效地提高了Ⅰ期子宫内膜样腺癌局控率,可望作为Ⅰ期子宫内膜样腺癌另一治疗选择,急需进行随机临床研究进一步证实其在Ⅰ期子宫内膜样腺癌治疗中的价值。     

Differentiation between cholangiocarcinoma and hepatocellular carcinoma with target sign on diffusion-weighted imaging and hepatobiliary phase gadoxetic acid-enhanced MR imaging: Classification tree analysis applying capsule and septum

ObjectivesTo assess the usefulness of classification tree analysis (CTA) for discrimination of hepatocellular carcinoma (HCC) with target sign on hepatobiliary phase (HBP) and/or diffusion-weighted image (DWI) from intrahepatic cholangiocarcinoma (ICC).MethodsThis retrospective study was approved by the institutional review board. From among the 811 patients with histopathologically proven 79 ICCs and 732 HCCs, 69 patients with 69 (87.3%) ICCs and 115 patients with 115 HCCs (15.7%) including 25 scirrhous HCCs and 10 HCCs with central scar that showed the target sign either on HBP or on DWI were included. Two radiologists evaluated the presence of capsule, septum, and arterial enhancement pattern on MR imaging. Capsule, septum, arterial enhancement pattern, and target sign on HBP or DWI were used to classify the tumors using CTA.ResultsOn CTA, capsule was the initial predictor for assessing the probability of tumors being HCC. The CTA model demonstrated a sensitivity of 86.1%, specificity of 76.8%, and accuracy of 82.6% for discriminating between ICCs and HCCs. In 115 HCCs, only 16 (13.9%) tumors were misclassified as high probability of ICC, and 64.0% (16/25) scirrhous HCCs and 90.0% (9/10) HCCs with central scar were correctly classified as high probability of HCC.ConclusionsTarget sign either on HBP or on DWI was shown in 87.3% (69/79) of ICCs and 15.7% (115/732) of HCCs. The CTA applying capsule and septum may be useful for guiding correct diagnosis of atypical HCCs with the target sign from ICCs.     

Distinct clinicopathological and prognostic features of insulinoma with synchronous distant metastasis

Background

The clinicopathological and prognostic features of insulinoma with synchronous metastases are unclear. This study aimed to verify the distinct clinicopathological and prognostic features of insulinoma with synchronous distant metastasis.