阿帕替尼治疗胃癌和食管胃结合部腺癌伴肝转移患者的临床观察#br#

目的 探讨阿帕替尼治疗胃癌和食管胃结合部腺癌伴肝转移患者的临床疗效及安全性。方法 收集2011年3月至2017年2月病理组织学确诊为胃癌或食管胃结合部腺癌伴肝转移患者42例,其中18例初治患者,24例复发难治患者。阿帕替尼口服剂量为250～850 mg,同时根据患者体能状态及不良反应给予相应剂量调整;联合化疗方案包括单药替吉奥、XELOX、SOX方案和经导管肝动脉及胃动脉化疗栓塞（TACE）,采用 RECIST 11版标准评价近期疗效,NCI CTCAE 4.0版标准评价不良反应,分析临床疗效与临床病理特征的关系,随访预后并采用Cox回归模型进行多因素生存分析。 结果阿帕替尼联合化疗组的中位化疗周期数为4个（2～6个）,中位TACE次数为3次（1～3次）;其中PR 3例、SD 22例和PD 17例,有效率（RR）为7.14％,疾病控制率（DCR）为59.52％;中位生存期（OS）为7.0个月,中位无进展生存期（PFS）为2.0个月。患者性别、年龄、原发灶部位、是否行胃切除术、TACE、联合化疗和阿帕替尼不同初始剂量均与RR和DCR无关（P＞0.05）。单因素及多因素分析未发现与PFS相关的独立预后因素,是否联合化疗是影响OS的独立预后因素,其中阿帕替尼单药组较联合化疗组的OS差（HR=9.376,95%CI：2.178～40.361,P＜0.05）。不良反应包括白细胞减少、贫血、血小板减少、手足综合征、高血压、乏力及腹泻,多为1～2级,发生率低,可耐受。结论 阿帕替尼联合化疗治疗胃癌和食管胃结合部腺癌伴肝转移患者临床疗效确切,可明显延长该部分患者生存时间。     

术前血清白球比预测局限性和局部进展性肾透明细胞癌患者预后的单中心回顾性研究

目的:评估术前白蛋白球蛋白比值,即白球比（AGR）与局限性及局部进展性肾透明细胞癌（ccRCC）患者临床和病理特征的相关性,评估其预后价值。方法:回顾性收集苏州大学附属第三医院415例在2003年至2012年间经肾切除手术局限性和局部进展性ccRCC患者的临床病理数据及随访资料,整合系统炎性指标及传统预后评估系统,绘制ROC曲线。结果:AGR越小,肿瘤的恶性程度越高;AGR是研究对象的独立预后因素（HR:6.799,95%CI:3.215~14.377,P＜0.01）;与现有的系统炎性指标与传统预后评估系统相比,AGR对局限性及局部进展性ccRCC的预后预测能力更强。结论:AGR是一个预测局限性和局部进展性ccRCC患者术后总体生存期（OS）的可靠指标,是患者OS独立的危险因子,相较系统炎性指标与传统预后评估系统有更高的实用价值。     

History of childhood maltreatment augments dorsolateral prefrontal processing of emotional valence in PTSD

Posttraumatic stress disorder (PTSD) is characterized by conflicting findings of both increased and decreased amygdala and prefrontal reactivity to threat or trauma stimuli. Childhood maltreatment (CM), a potent risk factor for PTSD, exerts long-lasting influences on threat processing and prefrontal-amygdala function. This suggests that CM history may influence PTSD neural phenotypes related to threat processing. Here, we adapt a well-characterized emotional conflict paradigm to investigate CM effects on both emotional conflict and emotional valence processing within PTSD stratified by task relevance. Forty-two individuals with PTSD (22 reporting extensive CM history (PTSD-CM)) and 20 trauma-exposed healthy controls (TEHCs) underwent functional magnetic resonance imaging while identifying affect of emotional faces (fear and happy) overlaid with a goal-irrelevant emotional distractor word (“FEAR” or “HAPPY”). We examined effects of CM on conflict, conflict adaptation, valence-related activation (fear vs. happy) for goal-relevant (face) and goal-irrelevant stimuli (word), and valence effects in interaction with goal-relevancy (face vs. word). Though no activation differences between groups were observed for conflict contrasts nor for valence effects in the amygdala, CM status interacted with valence processing differences as a function of goal relevance in the left dorsolateral prefrontal cortex (dlPFC). Here, PTSD-CM displayed greater activation relative to PTSD to negative valence when stimuli were goal-irrelevant. CM history also moderated relationships between activation abnormalities and PTSD re-experiencing symptoms. These findings provide initial evidence that CM history augments dorsolateral prefrontal bias to implicitly processed stimulus valence in PTSD.     

Caspase-3和Livin在人脑胶质瘤中的表达及意义

目的:检测Caspase-3和Livin在人胶质瘤患者(观察组)、正常人(对照组)血清中的表达,以及不同病理分级的相关性。方法:采用双抗体夹心(ABC-ELISA)法检测54例人胶质瘤患者和32例正常人血清中Caspase-3、Livin的表达水平。结果:Caspase-3和Livin在人胶质瘤中的表达均高于正常人,差异有统计学意义(P<0.01),在低级别组与高级别组中的表达无统计学意义(P>0.05),Caspase-3和Livin在人胶质瘤中的表达呈负相关(r=-0.8326,P<0.0001)。结论:Caspase-3、Livin蛋白异常表达在人胶质瘤的发生、发展中起重要作用,且两者存在协同性。     

手术治疗为主的综合治疗在结直肠癌肝转移中的应用体会

目的探讨以手术治疗为主的综合措施治疗结直肠癌肝转移的疗效。方法对我科2005年12月～2011年10月收治的29例结直肠癌肝转移患者的临床资料进行回顾性分析,所有患者均接受以手术治疗为主的综合治疗。结果 29例患者共行33次肝切除术,均无围手术期死亡。术后成功随访20例,16例目前仍存活,存活时间为0.5～5.5年,其中4例再次出现肝转移并再次接受手术治疗,余12例无肿瘤复发;4例死于结肠癌复发。结论以手术治疗为主的个体化综合治疗是结直肠癌肝转移的有效治疗方法,对复发性肝转移癌选择性再手术有利于提高治愈率。     

Over-expression of CXCL2 is associated with poor prognosis in patients with ovarian cancer

Background:In the present study, we aimed to detect the expression of CXCL2 in epithelial ovarian cancer (OC) and explore its clinical significance.Methods:TCGA (The Cancer Genome Atlas) database was adopted to assess the significance of CXCL2. Tissue microarray and immunohistochemical staining were used to detect the expression of CXCL2 in epithelial OC, and its correlation with clinicopathological features and prognosis was statistically analyzed.Results:CXCL2 was highly expressed in epithelial OC tissues compared with the adjacent tissues. Such up-regulation of CXCL2 was significantly correlated with tumor differentiation (P = .001), tumor stage (P = .01), tumor location (unilateral or bilateral) (P = .003), and metastasis (P = .003). Kaplan-Meier and Cox proportional hazards regression analyses showed that high expression of CXCL2 was not an independent predictor of poor prognosis in epithelial OC.Conclusions:Collectively, the high expression of CXCL2 might be related to the invasion and metastasis of epithelial OC.     

台盼蓝着染兔晶状体后囊膜的观察

目的探索晶状体后囊膜被台盼蓝（TB）染色的可行性。方法选用健康成年新西兰白兔60只（120只眼）随机分为3组（实验1组,实验2组,对照组）,在手术显微镜下,完整取出晶状体,撕下前囊膜和后囊膜,分别置入不同浓度的TB溶液中染色后行光镜和电镜检查,并将所获数据进行统计学处理。结果各实验小组前后囊膜均见染色,并随染色液浓度的增加,囊膜染色加深;光镜下观察,各实验小组的前后囊膜的组织结构较对照组未见明显改变（P〉0.05）;电镜下前后囊膜中,台盼蓝染色阳性数实验1组,实验2组分别与对照组比较,差异均有显著性（均P〈0.01）;台盼蓝染色阳性数实验1组与实验2组比较,两组差异统计学意义（P〉0.05）。结论低浓度TB能有效地将晶状体后囊膜染色,起到保护透明晶体的作用。