吲哚美辛对转移性乳腺癌患者免疫功能及凝血状态的影响

目的观察吲哚美辛对转移性乳腺癌患者免疫功能及凝血状态的影响。 方法选取2015年7月至2017年12月期间复旦大学附属中山医院闵行分院乳腺外科收治的转移性乳腺癌女性患者27例进行前瞻性研究,给予口服吲哚美辛50 mg/次,每日3次,连用2周。另选在本院体检的健康女性30例作为对照组。流式细胞仪检测转移性乳腺癌患者用药前、后及对照组外周血T淋巴细胞亚群;血栓弹力图描记对照组及患者用药前、后凝血状态;记录转移性乳腺癌患者用药后的不良反应。以CD4^＋细胞比率、CD8^＋细胞比率、CD4^＋细胞数/CD8^＋细胞数及自然杀伤(NK)细胞活性作为免疫功能评价指标;以血栓弹力图的反应时间(R值)、α角(ANG)、最大振幅(MA)等参数为凝血状态指标。乳腺癌组患者用药前、后指标的比较采用配对t检验;乳腺癌组与健康对照组指标的比较采用独立样本t检验。 结果转移性乳腺癌患者外周血中CD4^＋细胞比率、CD4^＋细胞数/CD8^＋细胞数及NK细胞活性低于健康对照组[(28.76±4.03)%比(46.28±4.92)%,t＝－14.596,P<0.050; 0.78±0.22比1.65±0.34,t＝－11.303,P<0.050; (16.28±7.41)%比(34.73±16.39)%,t＝－5.370,P<0.050],CD8^＋细胞比率则高于对照组[(36.35±3.76)%比(27.41±2.63)%,t＝10.483,P<0.050];R值降低,ANG、MA升高[(3.52±0.84) min比(5.26±2.05)min,t＝－4.128,P<0.050;(75.74±8.41)°比(68.84±7.50)°,t＝3.270,P<0.050;(72.63±11.69) mm比(62.89±6.61) mm,t＝3.926,P<0.050]。口服吲哚美辛2周后转移性乳腺癌患者外周血中CD4^＋细胞比率、CD4^＋细胞数/CD8^＋细胞数及NK细胞活性分别为(37.55±3.64)%、1.20±0.18、(25.62±9.8)%,较用药前明显提升(t＝36.926、23.995、12.818,P<0.05], CD8^＋细胞比率为(31.42±2.58)%,较用药前明显下降(t＝－20.087,P<0.050);R值、ANG、MA分别为(4.33±1.57) min、(67.12±9.36)°、(64.52±6.32) mm,R值较用药前升高,ANG、MA则降低(t＝5.210、－14.351、－6.677,P<0.050)。转移性乳腺癌患者用药期间3例出现头晕,7例胃部不适伴恶心呕吐,腹泻2例,未观察到严重不良反应。 结论转移性乳腺癌患者免疫功能严重受损,并处于病理性高凝状态。吲哚美辛应用可增强患者免疫功能,改善其凝血状态。     

Norcantharidin combined with ABT-737 for hepatocellular carcinoma: Therapeutic effects and molecular mechanisms

AIM: To study the therapeutic effect of norcantharidin(NCTD) combined with ABT-737 on hepatocellular carcinoma cells and the molecular mechanism. METHODS: Two hepatocellular carcinoma(HCC) cell lines, Hep G2 and SMMC-7721, were selected. ABT-737 and NCTD were allocated into groups to be used alone or in combination. Hep G2 and SMMC-7721 cells were cultured in vitro. Liver cancer cells in the logarithmic phase of growth were vaccinated and cultured to the cell wall stage; these cells were treated for 48 h with different concentrations of NCTD, or ABT-737, or NCTD combined with ABT-737. The cell proliferation inhibition rate was detected by methyl thiazolyl tetrazolium. The expression of Mcl in HCC cells was detected by Western Blotting, and the cells in each group after treatment had apoptosis detected by flow cytometry. The proliferation inhibition rate, the expression of Mcl-1 in cells and the apoptosis inducing effect of treatment were observed in each group, and the effect of NCTD on ABT-737 in the treatment of HCC and its mechanism of action were analyzed.RESULTS: As the concentration of NCTD increased, the cell proliferation inhibition rate gradually decreased; and the treatment effect of ABT-737 1-3 μm combined with NCTD on cell proliferation inhibition was stronger than that of ABT-737 alone. The difference was statistically significant(P 0.05). In observing the expression of Mcl-1 in cells after the treatment of different concentrations of NCTD, this was partiallyinhibited after treatment with NCTD 15 μm, and the expression of Mcl-1 was almost undetectable after treatment with NCTD 30 μm and 60 μm. The effect on inducing apoptosis with the treatment of ABT-737 or NCTD alone for 48 h was lower than that of the control group. The difference was not statistically significant(P 0.05). The effect on inducing apoptosis in Hep G2 and SMMC-7721 cells with the treatment of ABT-737 combined with NCTD for 48 h was greater than that of ABT-737 or NCTD alone. The difference was statistically significant(P 0.05). CONCLUSION: NCTD combined with ABT-737 has a positive role in the treatment of HCC, and it has great value in clinical research.     

住院患者与医院环境耐甲氧西林金黄色葡萄球菌耐药性分析

[目的]了解耐甲氧西林金黄色葡萄球菌（MRSA）在医院内的流行及耐药特征,为预防和控制MRSA引起的院内感染提供科学依据。[方法]以上海某区一家综合性二级医院临床患者标本中分离的78株金黄色葡萄球菌（SA）和同时期该医院诊疗环境中分离的53株sA共131株sA为研究对象,分别用头孢西丁药敏纸片法和PCR法检测MRSA,K-B法检测该131株sA对15种抗菌药物的敏感性。[结果]131株SA中,MRSA构成比为55．73％（73／131）。其中,临床分离株和环境分离株中的MRSA构成比分别为52．56％（41／78）和60．38％（32／53）,两者相比差异无统计学意义（JP〉0．05）。临床MRSA株主要分布于痰液及伤口分泌物;环境MRSA株主要分布于床头柜、监护仪以及医护人员手。抗菌药物敏感性实验显示,MRSA对β-内酰胺类药物耐药率100％,对糖肽类药物、利奈唑胺、利福平高度敏感,对其他抗菌药物均呈多重耐药。[结论]MRSA在医院内有较高流行度,而且呈多重耐药性。应加强抗生素的合理使用,及时进行MRSA院内感染目标性监测,切实做好MRSA感染患者的消毒隔离工作。     

慢性阻塞性肺疾病患者血清和诱导痰中白细胞介素-32水平变化及意义

目的测定慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）急性加重期和稳定期患者血清和诱导痰中白细胞介素（interleukin,IL）-32水平,探讨IL-32在COPD发病中的作用。方法 60例COPD急性加重期患者（AECOPD组）,60例COPD稳定期患者（COPD稳定期组）及30名健康受试者（健康对照组）,分别进行痰细胞计数和分类,用ELISA法检测血清和诱导痰中IL-32和IL-8、肿瘤坏死因子-α水平,并分析IL-32水平与中性粒细胞、IL-8、肿瘤坏死因子-α及气流阻塞间的相关性。结果 AECOPD组血清及诱导痰中IL-32水平高于健康对照组和COPD稳定期组（P〈0.05）,COPD稳定期组高于健康对照组（P〈0.05）;血清及诱导痰中IL-32水平与IL-8、肿瘤坏死因子-α、中性粒细胞数及比例均呈正相关（P〈0.01）,与第1秒用力呼气容积占预计值百分比、第1秒用力呼气容积/用力肺活量和pa（O2）均呈负相关（P〈0.01）。结论 IL-32参与COPD的炎症过程,此过程与中性粒细胞、IL-8及肿瘤坏死因子-α等炎性因子有关。IL-32水平在一定程度上可反映COPD严重程度。     

曲美他嗪对冠状动脉介入术后心肌缺血再灌注损伤的保护作用研究

目的:评价曲美他嗪对冠状动脉介入术(PCI)后心肌缺血再灌注损伤的保护作用。方法:入选拟行PCI的稳定性或不稳定性心绞痛患者72例,随机分为曲美他嗪组38例和对照组34例,曲美他嗪组PCI术前7 d开始口服曲美他嗪20 mg,每天3次,术后继续服用3个月;所有入选患者给予阿司匹林及常规药物治疗。每例在PCI术前及术后6、24 h测定血清肌钙蛋白I(cTnI)、磷酸肌酸激酶同工酶(CK-MB);在PCI术前及术后1、3个月分别超声心动图测定左室射血分数。结果:术前2组患者cTnI、CK-MB水平差异均无统计学意义(P0.05),与对照组比较,PCI术后曲美他嗪组在各个测量时段均能显著降低患者cTnI、CK-MB水平(P0.01),PCI术后1、3个月曲美他嗪组左室射血分数值均高于对照组(P0.01)。结论:PCI术前应用曲美他嗪能显著降低手术诱导的心肌损害,进一步改善PCI术后的左心功能。     

白术黄连微丸结肠靶向胶囊的制备及体外释放研究

目的 将中药"白术黄连方"制备成以胃溶微丸和肠溶微丸为基础的结肠靶向胶囊,优化其处方组成和制备工艺,考察其体外释放特性.方法 采用单因素实验和正交实验法优化微丸的处方组成和工艺参数.用挤出-滚圆技术制备素丸,流化床底喷方式进行包衣,考察隔离衣增重、肠溶衣中聚合物比例、增塑剂用量和包衣增重对肠溶微丸释放行为的影响,并对其...     

Insulin-like growth factor binding protein 3 chemosensitizes pancreatic ductal adenocarcinoma through its death receptor

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal human malignancies. Gemcitabine and doxorubicin are commonly used as the chemotherapy agents, but most of PDAC tumors eventually acquired resistance to chemotherapy. Accumulating evidence indicates that Insulin-like growth factor binding protein 3 (IGFBP-3) plays a key role against tumor growth but its expression has commonly suppressed. The present study was designed to evaluate IGFBP-3 effects in chemotherapy sensitization of PDAC cells. Here, we report that the re-sensitization of chemoresistant PDAC cells was occurred by IGFBP-3 through recruitment of its death receptor (IGFBP-3R). Using gemcitabine, doxorubicin-resistant PDAC cell lines, we found that IGFBP-3 sensitized chemoresistant cells by activating apoptosis (as evaluated by Bax up-regulation, Bcl-2 down-regulation as well as Caspase-3 and Caspase 8 activation). IGFBP-3R was also found to have higher expression level in resistant AsPc-1 and MIA PaCa-2 cells in comparison to parental cells. IGFBP-3R was also highly expressed in PDAC tumor which exposed to chemotherapy in comparison to un-treated PDAC tumors. In addition, we confirmed our finding by using specific siRNA to knocking down of IGFBP-3R which prevents IGFBP-3 Chemosensitization. Taken together, the present study for the first time indicates the clinical relevance for combining IGFBP-3 with chemotherapy to reduce chemoresistance in PDAC.     

社区早期健康干预对提高中青年妇女宫颈癌预防知识知晓率及依从性的影响

目的 探究社区早期健康教育对提高中青年妇女宫颈癌预防知识知晓率及依从性的影响。方法 选择2014年2月至2016年2月于上海市闵行区内各个社区接受普查且巴氏涂片异常的220例中青年妇女,随机分为观察组和对照组。对照组给于口头或发放健康宣传资料,并嘱进一步检查,观察组在此基础上同时给予其他早期健康干预措施,包括公益讲座、免费咨询、专人制定就诊计划、建立个人档案、予以定向转诊、实施转诊绿色通道。再对比两组宫颈预防知识知晓率与就诊、随访依从性。结果 干预后,观察组宫颈癌预防知识知晓率为100.0%显著高于对照组63.6%(P<0.05);观察组平衡饮食依从性为86.4%,规律生活依从性为85.5%,性生活卫生依从性为99.1%,定期检查依从性为99.1%,均高于对照组(P<0.05)。结论 社区中青年妇女给予早期健康教育,可显著提高其宫颈癌预防知识知晓率及依从性,有效保障了妇女身心健康,值得推广采用。     

子宫内膜细胞DNA定量分析对子宫内膜癌的筛查价值

目的探讨子宫内膜细胞DNA定量分析对子宫内膜癌的筛查价值。方法 选取2013年9月至2016年9月行子宫内膜细胞DNA定量分析及宫腔镜下诊断性刮宫的患者,共428例。采用子宫内膜细胞采集器直接获取子宫内膜细胞标本,结合液基薄层细胞学制片和Feulgen染色技术进行DNA定量分析,以宫腔镜下诊刮的组织病理学诊断为“金标准”,分析子宫内膜细胞DNA定量分析筛查子宫内膜癌及其癌前病变的符合度、灵敏度、特异度、阳性预测值和阴性预测值。结果子宫内膜DNA定量分析筛查子宫内膜癌及其癌前病变的符合度、灵敏度、特异度、阳性预测值和阴性预测值分别为86.92%、91.43%、86.03%、56.14%和98.09%。子宫内膜癌的发生、发展过程中可出现异倍体细胞,少数非子宫内膜癌的病例也可出现DNA异倍体细胞,但>5c细胞大都少于3个。结论子宫内膜DNA定量分析用于子宫内膜癌及其癌前病变的筛查,简单易行,安全无痛,准确性高,且具有客观性和可重复性。