ALK 与儿童恶性肿瘤关系的研究进展*

近年来儿童恶性肿瘤的发病率有逐年增高的趋势，高危患儿预后差，且手术及放化疗等主要治疗手段的疗效已经达到平台期。靶向治疗以其可靠的疗效和轻微的毒副反应成为目前最受关注和最有前景的治疗手段之一。间变性淋巴瘤激酶（anaplastic lymphoma kinase，ALK ）是一种受体型酪氨酸激酶，近年的研究成果表明其异常与多种儿童肿瘤的发生发展密切相关。ALK 的异常形式主要包括基因融合、基因突变、基因扩增和蛋白表达增加。随着ALK 抑制剂在临床抗肿瘤治疗中的应用，针对ALK 异常的靶向治疗获得越来越多的关注。本研究主要针对ALK 在儿童恶性肿瘤中的异常以及与其发生发展关系的研究进展进行综述。      

腹腔镜肾部分切除手术研究进展

与传统的开放手术相比，腹腔镜手术具有创伤小、住院时间短及切口美观等优势，但仅少数医生能够掌握。术者手的灵活性和触觉反馈功能缺失是其主要缺点，导致术者学习曲线延长，手术普及困难，尤其以腹腔镜肾部分切除术为代表的腔镜下重建手术更是如此。腹腔镜技术通过规范腹腔镜医生培训制度、手术方式标准化、简化缝合、打结复杂性操作、术中应用止血物、CT影像和生物工程学技术（力和生物电阻抗技术）辅助术中操作等，可以有效减少术者对于人手灵活性和触觉反馈功能的依赖，降低围手术期并发症，使腹腔镜下保留肾单位的肾部分切除术得到更广泛开展。      

Association of plasma dipeptidyl peptidase-4 activity with non-alcoholic fatty liver disease in nondiabetic Chinese population

ObjectiveThe pathogenesis of non-alcoholic fatty liver disease (NAFLD) is attributed to a “multi-hits hypothesis” involving insulin resistance, oxidative stress and inflammation. Dipeptidyl peptidase-4 (DPP4) was identified as a novel adipokine capable of enhancing the“multi-hits”. Hence, we investigated the association between plasma DPP4 activity and NAFLD in nondiabetic Chinese population.Design and methodsWe performed a cross-sectional study using data from 1105 subjects (36–79 years) in Guilin between 2015 and 2016. Plasma DPP4 activity, homeostatic model assessment of insulin resistance (HOMA-IR), oxidative stress parameters, and inflammatory markers were measured in all participants. NAFLD and its severity were diagnosed by ultrasound after the exclusion of alcohol abuse and other liver diseases.ResultsParticipants in the highest quartile of DPP4 activity had higher HOMA-IR, nitrotyrosine, 8-iso-PGF2a, interleukin-6, CRP, alanine aminotransferase, aspartate aminotransferase and γ-glutamyltransferase compared with those in the lowest quartile (all P < 0.05). Plasma DPP4 activity gradually increased across the groups according to the ultrasonographic severity of steatosis (P < 0.001 for the trend). In the highest DPP4 quartile, NAFLD risk was higher (odds ratio 1.88; 95% CI 1.04–3.37) than in the lowest quartile after adjustment for confounders. The risk for NAFLD increased more with higher levels of DPP4 activity, HOMA-IR, nitrotyrosine, 8-iso-PGF2a, interleukin-6 and CRP.ConclusionsPlasma DPP4 activity is significantly associated with NAFLD. The underlying mechanisms may be partly attributed to the interactions between insulin resistance, oxidative stress, inflammation, and DPP4.     

15例胰腺腺泡细胞癌诊治分析*

目的:分析胰腺腺泡细胞癌的临床特点及诊治经过，以期指导临床，改善患者预后。方法:回顾分析天津医科大学肿瘤医院1994年12月至2014年3 月收治的15例胰腺腺泡细胞癌患者资料，分析其临床病理、治疗及预后特征。结果:15例患者中，男8 例，女7 例，发病中位年龄44岁。肿瘤位于胰头部8 例，胰体尾部 6 例，钩突部 1 例。肿瘤直径 3～18cm，平均直径 6.67cm。患者出现黄疸者少，肿瘤标志物多不升高。出现术前转移者6 例，12例行根治性切除，3 例行保守治疗。术前及术中均不能正确诊断，最终诊断需要靠术后病理或穿刺，行抗胰蛋白酶、抗糜蛋白酶检测均阳性。术后化疗多以吉西他滨为基础。平均生存期20.6个月。结论:胰腺腺泡细胞癌临床特点比较特殊，且现倾向于认为其属于低度恶性肿瘤，应积极治疗。