Systemic treatment of patients with gastrointestinal stromal tumor: Current status and future opportunities

Imatinib mesylate is considered the standard first-line systemic treatment for patients with advanced gastrointestinal stromal tumor (GIST). Results from recent research have expanded the knowledge of tyrosine kinase inhibitors in management of GIST. In the setting of unresectable and metastatic GIST, long-term follow-up of the B2222 study showed that imatinib 400 and 600 mg/d produced objective responses in 68% of patients and clinical benefit in 84%; it also extended median survival from 19 months in historical controls to 57 months. The MetaGIST analysis in two large phase 3 trials consisting of more than 1600 patients with metastatic and/or unresectable GIST showed that imatinib 800 mg/d compared with the standard 400-mg/d dose conferred a progression-free survival advantage in patients with KIT exon 9 mutations but not in other subpopulations. The higher starting dose does not significantly improve overall survival. The BFR14 trial demonstrated that interrupting imatinib is associated with a high risk of rapid disease progression. For patients with imatinib-intolerant or imatinib-resistant GIST, sunitinib or a variety of investigational agents, including the next-generation kinase inhibitor nilotinib, may be viable options for achieving disease control. In the setting of primary localized GIST, function- sparing surgical resection is the standard treatment approach, but some patients may be at substantial risk of disease recurrence and metastasis depending on tumor size, mitotic count, and possibly other factors. Initial results from ACOSOG Z9001 indicate that adjuvant imatinib for 1 year prolongs recurrence-free survival following surgical resection of larger (at least 3 cm) KIT-expressing GIST. Other ongoing studies are further exploring the role of imatinib in both adjuvant and neoadjuvant therapy. Recent updates to clinical practice guidelines and recommendations now incorporate some of these new findings.     

UF-100尿沉渣分析仪原理

阐述了UF-100尿细胞全自动分析仪应用流式细胞方法结合荧光染色技术和电阻抗方法检测尿有形成分和化学成分。从检测方法、主要组成部分、检测系统的组成部分及检测信号的产生和处理等几方面介绍了尿细胞的测量原理,最后指出了尿沉渣分析仪对于临床诊治和科研工作具有重要的意义。     

上肢动脉闭塞性病变的病因分析与综合介入治疗

目的探讨上肢动脉闭塞性病变的病因及治疗方法。方法22例以上肢无脉不适为主诉入院的患者,20例行血管造影,14例行血栓抽吸并留置导管溶栓,1例行球囊扩张结合溶栓治疗,5例行球囊扩张及支架置入,2例单纯抗凝治疗。结果造影患者中15例为腋动脉闭塞,5例为锁骨下动脉起始部闭塞,另2例超声证实为肱动脉闭塞。所有患者中急性起病16例(72.7%),均伴有心房纤颤。全部22例患者经综合介入手段治疗1～3d后肱、桡动脉均恢复搏动,缺血症状明显改善,动脉开通率达100%。结论上肢动脉闭塞性病变以急性起病为主,多为心原性栓塞。综合介入治疗效果好,无严重并发症。     

多支架植入治疗恶性高位梗阻性黄疸

目的:评价高位恶性梗阻性黄疸多支架治疗的疗效及临床价值。材料与方法:26例高位恶性梗阻性黄疸。经单侧穿刺放置2枚支架18例,双侧穿刺放置支架8例,其中5例放置2枚支架,3例放置3枚支架,共植入支架51枚。结果:所有病例均一次完成支架植入,技术成功率100%。治疗后总胆红素由318.5±67.7μmol/L降至142.6±49.3μmol/L,无严重并发症发生。结论:多支架植入有利于提高高位恶性梗阻性黄疸的减黄效果,有利于进一步提高病人的生存质量和延长生存期。     

急性脑卒中后抑郁血清单胺类递质的变化

目的：探讨急性脑卒中后抑郁血清单胺类递质浓度的变化。方法：选择85例急性脑卒中患者，经美国流行病学调查中心抑郁量表（CES－D）筛选及17项汉密尔顿抑郁量表（HAMD）评定，按精神障碍诊断与统计手册第4版（DSM－Ⅳ）标准确定诊断，入选脑卒中后抑郁患者34例（PSD组），脑卒中后无抑郁患者51例（无抑郁组），正常对照20例（正常对照组）。采用荧光分光光度仪测定三组空腹血清单胺类递质的浓度。结果：脑卒中后抑郁组血清单胺类递质浓度显著下降。结论：脑卒中后抑郁与血清单胺类递质浓度降低有关。     

Bone marrow mesenchymal stem cell-derived exosomal miR-34c-5p ameliorates RIF by inhibiting the core fucosylation of multiple proteins

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大黄素对全身炎性反应综合征时中性粒细胞凋亡异常治疗的研究

目的研究大黄素对全身炎性反应综合征(SIRS)时中性粒细胞即多形核白细胞(polymorphonuc lear neutro-ph il,PMN)凋亡异常的治疗作用。方法32例SIRS患者(均为急性胰腺炎)提取外周血PMN后分为四组,即对照组、大黄素治疗组、白细胞介素(IL)-10治疗组、地塞米松治疗组,分别培养24 h后观察两组的PMN凋亡情况(采用流式细胞仪和TUNEL方法定量检测)。结果对照组外周血PMN细胞凋亡率为(42±8)%,大黄素治疗组PMN细胞凋亡率为(54±10)%,两组比较差异有统计学意义(P<0.05);对照组凋亡指数(AI)为25±7,大黄素治疗组外周血PMN的AI为33±9,两组比较差异有统计学意义(P<0.005)。而IL-10治疗组、地塞米松治疗组与对照组比较则无明显变化。结论大黄素对SIRS患者外周血的PMN凋亡延迟有治疗作用。     

多层螺旋CT灌注成像对肺脏疾病诊断的研究现状

进入21世纪,功能性影像诊断发展很快。放射性核素肺灌注闪烁显像可观察局部肺灌注情况,但是时间和空间分辨率较局限[1];肺脏MRI灌注扫描是研究肺部疾病最具潜力的方法,但质子密度低、空间分辨率低、检查时间长等因素限制     

定量组织速度及应变率成像评价犬不同程度心肌缺血的实验研究

目的评价定量组织速度(QTVI)及应变率成像(SRI)对冠脉狭窄的诊断价值。方法11只开胸犬结扎左冠状动脉前降支(LAD)建立心肌缺血模型。分别于基础状态、缺血状态(LAD狭窄50%,75%,100%)。采集连续3个心动周期的组织速度图,用QTVI及SRI软件分析左室各节段纵轴方向上收缩期QTVI及SRI曲线的变化。结果非LAD节段:缺血状态下各项指标较基础状态无显著改变。LAD节段:与基础状态比较,LAD狭窄50%时收缩期峰值速度(Vs)略有减少,但无统计学意义(P>0.05),而心尖段收缩期峰值应变率(SRpeak)显著减少或矛盾运动(P<0.05)。LAD狭窄75%时Vs及SRpeak明显减少,差异有显著意义。LAD狭窄100%时,SRpeak几乎接近基线水平。结论QTVI及SRI可以作为定量评价心肌缺血导致的心肌局部功能异常的方法。     

软组织肿瘤的MSCT灌注成像初步研究

目的:探讨MSCT灌注成像对软组织肿瘤的良恶性鉴别诊断价值。材料与方法:对软组织肿瘤26例(良性15例,恶性11例)行MSCT灌注成像,用CT Perfusion 2软件分析灌注参数BV、BF、MTT、PS。结果:MSCT灌注成像结果,11例恶性肿瘤BF平均值为14.98±14.49,15例良性肿瘤BF平均值为1.98±1.19;PS平均值恶性肿瘤为14.64±1.89,良性肿瘤为2.40±0.38。良恶性软组织肿瘤的BF、PS值差异统计学上具有显著性(P<0.05);BV、MTT值差异统计学上则无显著性(P>0.05)。MSCT灌注成像诊断恶性肿瘤的灵敏度为90.9%(10?蛐11),特异度为86.7%(13?蛐15),准确度为88.5%(23?蛐26),阳性预测值为83.3%(10?蛐12),阴性预测值为92.9%(13?蛐14)。结论:MSCT灌注参数有助于软组织肿瘤的良恶性鉴别。