大鼠骨髓间充质干细胞培养鉴定及复方扶芳藤合剂含药血清对细胞增殖的影响

目的:建立SD大鼠骨髓间充质干细胞(BMSCs)的分离培养方法,观察不同浓度的复方扶芳藤合剂大鼠含药血清对大鼠BMSCs增殖的影响。方法:通过全骨髓贴壁法体外分离、培养、纯化BMSCs,对其进行细胞形态学观察,将BMSCs进行成骨、成脂定向诱导分化,采用流式细胞仪检测其表面标志物,分析其细胞周期,进行BMSCs鉴定;采用不同浓度(20%、10%和5%)的复方扶芳藤合剂含药血清和空白血清连续7 d对大鼠BM SCs进行干预,以CCK-8法检测其吸光度值,对比各组细胞生长情况。结果:BMSCs具有典型的成纤维样细胞形态,集落生长呈漩涡状。BMSCs成脂、成骨诱导后,油红O染色和茜素红染色均呈阳性。第3代BMSCs表型CD29、CD44、CD34、CD44表达分别为99.645%、99.677%、0.016%、0.133%;不同浓度的复方扶芳藤合剂含药血清和空白血清连续干预7 d后,CCK-8法检测显示:20%浓度的复方扶芳藤合剂含药血清组,其1~7 d的吸光度均值均高于20%浓度的空白血清组(P<0.05);10%的含药血清组的吸光度均值在3~7 d,高于10%的空白血清组(P<0.05);5%的含药血清组与5%的空白血清组比较无明显差异(P>0.05)。结论:全骨髓贴壁法分离、培养BM SCs,操作简单,方法稳定,可大量扩增BMSCs。扩增后的BMSCs具有间充质干细胞的生物学特性,具有多向分化潜能。复方扶芳藤合剂含药血清干预后的BMSCs增殖能力增强,其中20%浓度的复方扶芳藤合剂含药血清在本实验中为最佳干预浓度。     

Apatinib Monotherapy or Combination Therapy for Non-Small Cell Lung Cancer Patients With Brain Metastases

Apatinib, an oral small molecular receptor tyrosine kinase inhibitor (TKI) developed first in China, exerts antiangiogenic and antineoplastic function through selectively binding and inhibiting vascular endothelial growth factor receptor 2 (VEGFR-2). In this study, we aimed to explore the efficacy and safety profile of apatinib monotherapy, or combined with chemotherapy or endothelial growth factor receptor (EGFR)-TKI in heavily pretreated non-small cell lung cancer (NSCLC) patients with brain metastases. We performed a retrospective analysis for relapsed NSCLC patients with brain metastases from our institute, who received apatinib (250 mg or 500 mg p.o. qd) monotherapy, or combination with EGFR-TKI or chemotherapy as second or more line systemic therapy until disease progression or unacceptable toxicity occurred. The objective response rate (ORR), disease control rate (DCR), median progression-free survival (mPFS), median overall survival (mOS), and safety were analyzed. A total of 26 eligible patients were included: 24 patients diagnosed with adenocarcinoma, 2 with squamous carcinoma, and 14 patients harboring EGFR sensitizing mutations. The mPFS and mOS were 4.93 (range, 0.27−32.91; 95% CI 3.64−6.22) and 14.70 (range, 0.27−32.91; 95% CI 0.27−43.60) months for the whole group. The ORR and DCR were 7.7% (2/26) and 69.2% (18/26) for the entire lesions, and 7.7% (2/26) and 79.6% (20/26) for brain metastases, respectively. Compared with patients who received apatinib monotherapy, patients who received apatinib combination treatment had more favorable mPFS (11.77 vs. 2.27 months, p<0.05) and mOS (24.03 vs. 6.07 months, p<0.05). Treatment-related toxicities were tolerable including grade 1/2 hypertension, hand-and-foot syndrome, fatigue, nausea, liver dysfunction, myelosuppression, skin rash, and palpitation. In conclusion, apatinib exhibited high activity and good tolerance for NSCLC patients with brain metastasis, and it might become a potential choice for metastatic brain tumors in NSCLC patients.     

唑来膦酸对芳香化酶抑制剂辅助治疗乳腺癌患者骨密度的影响

目的观察唑来膦酸对芳香化酶抑制剂辅助治疗乳腺癌患者骨密度的影响。方法前瞻性评估了102例绝经后临床激素受体阳性乳腺癌I-III A期患者术后12个月内腰椎和双侧股骨颈的骨密度(bone mineral density,BMD)改变。患者术后接受芳香酶抑制剂作为辅助治疗且患有骨质疏松症(腰椎或双侧股骨颈BMD,相当于T值分类≤-2. 5)的女性。患者12个月内接受补充钙、维生素D和5 mg静脉注射唑来膦酸治疗。结果腰椎骨密度在6个月和12个月时分别增加了4. 9%和6. 6%。右股骨颈和左股骨颈的BMD分别为3. 3%和4. 1%。在该研究中未观察到低钙血症、颌骨坏死和非创伤性临床骨折。结论本研究表明,接受佐剂芳香酶抑制剂治疗的妇女接受一次唑来膦酸治疗后BMD大幅增加,无论其芳香酶抑制剂治疗的历史如何。     

骨密度及骨代谢指标与同型半胱氨酸关系的研究进展

同型半胱氨酸(homocysteine,Hcy)是一种含硫氨基酸,以蛋氨酸为原料合成的,通过B族维生素,可以再循环生成蛋氨酸,或者通过转硫途径转化为半胱氨酸。通常同型半胱氨酸被认为是心脑血管的独立危险因素,现研究证实同型半胱氨酸也是骨质疏松的危险因素。目前Hcy引起骨质疏松甚至骨折的确切机制已研究出一小部分,仍有待于进一步研究。在机理上,同型半胱氨酸主要通过影响骨胶原的交联,刺激破骨细胞的形成和活性增加,及通过氧化应激产生活性氧促进成骨细胞的凋亡起作用。笔者将从同型半胱氨酸与骨密度及骨代谢指标、骨折的关系进行综述,通过提前干预Hcy的水平,预防骨折的发生,为骨质疏松症患者提供一种新的治疗方案。     

Executive summary from American Radium Society’s appropriate use criteria on neurocognition after stereotactic radiosurgery for multiple brain metastases

BackgroundThe American Radium Society (ARS) Appropriate Use Criteria brain malignancies panel systematically reviewed (PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses]) published literature on neurocognitive outcomes after stereotactic radiosurgery (SRS) for patients with multiple brain metastases (BM) to generate consensus guidelines.MethodsThe panel developed 4 key questions (KQs) to guide systematic review. From 11 614 original articles, 12 were selected. The panel developed model cases addressing KQs and potentially controversial scenarios not addressed in the systematic review (which might inform future ARS projects). Based upon quality of evidence, the panel confidentially voted on treatment options using a 9-point scale of appropriateness.ResultsThe panel agreed that SRS alone is usually appropriate for those with good performance status and 2–10 asymptomatic BM, and usually not appropriate for >20 BM. For 11–15 and 16–20 BM there was (between 2 case variants) agreement that SRS alone may be appropriate or disagreement on the appropriateness of SRS alone. There was no scenario (among 6 case variants) in which conventional whole-brain radiotherapy (WBRT) was considered usually appropriate by most panelists. There were several areas of disagreement, including: hippocampal sparing WBRT for 2–4 asymptomatic BM; WBRT for resected BM amenable to SRS; fractionated versus single-fraction SRS for resected BM, larger targets, and/or brainstem metastases; optimal treatment (WBRT, hippocampal sparing WBRT, SRS alone to all or select lesions) for patients with progressive extracranial disease, poor performance status, and no systemic options.ConclusionsFor patients with 2–10 BM, SRS alone is an appropriate treatment option for well-selected patients with good performance status. Future study is needed for those scenarios in which there was disagreement among panelists.     

Current surgical strategies for treating spinal tumors: Results of a questionnaire survey among members of the German Spine Society (DWG)

PurposeQuestionnaire survey among the members of the German Spine Society (Deutsche Wirbelsäulen-Gesellschaft, DWG) to objectify oncological infrastructure and current standard of care in spinal tumor treatment in Germany.MethodsAll DWG-members were contacted via the society's e-mail and asked to respond in anonymized form to a related questionnaire. Questions were asked regarding surgical specialty, type of institution involved, numbers of spinal procedures, as well as questions on treatment for primary tumors, whether the respondent belonged to a tumor center, decision-making procedures for surgery, and the type of procedure.Results84 centers providing surgical treatment for spinal tumors in their departments were identified. 52.6% were carrying out more than 500 spinal procedures per year. There was a significant association (P ≤ 0.05) between the numbers of spinal surgeries, the number of treated tumor patients per year, the organisation in a tumor center and the treatment of primary tumors. 76% are part of a local tumor center for interdisciplinary decision making (i.e.surgical treatment and adjuvant therapy). 74% of the institutions stated that conventional postoperative radiotherapy is standardly administered in the case of secondary lesions, with 24% of them referring patients to external services for radiotherapy.ConclusionIn spite of often large numbers of spinal operations, the centers perform relatively small numbers of tumor operations, particularly for primary tumors. A nearly three-quarter majority of the departments are integrated into interdisciplinary tumor care. However, there is a marked number that do not belong to an interdisciplinary organisation. Further advances in multidisciplinarity and oncology training are a continuous issue to increase treatment quality in spinal tumor patients.     

以骨折骨痛为首发症状的滤泡状甲状腺癌骨转移1例临床探讨并文献复习

目的:探讨滤泡状甲状腺癌骨转移的临床特征和治疗方法。方法:回顾性分析1例以左侧锁骨病理性骨折及骨痛为首发症状的滤泡状甲状腺癌患者的临床影像学资料、病理学资料，随访治疗效果，并复习相关文献。结果:患者左侧甲状腺肿物考虑为滤泡状甲状腺癌。C5、T10椎体、左侧锁骨考虑为转移癌。行左侧锁骨部分切除术，术后病理提示:滤泡状甲状腺癌骨转移。结论:对以病理性骨折和骨痛为主要症状的滤泡状甲状腺癌，影像学与组织活检相结合有利于降低误诊率，治疗方案取决于对患者局部病灶和全身状况的全面评估。     

从BMSCs探讨“肾主骨生髓”理论指导下中医药治疗骨质疏松症的研究

摘要：骨髓间充质干细胞(bone marrow mesenchymal stem cells, BMSCs)是在一定条件下能够向成骨细胞分化的多能干细胞，其增殖分化与中医“肾主骨生髓”理论及骨质疏松症(osteoporosis, OP)关系密切，大量研究表明传统补肾中药诱导BMSCs增殖分化治疗OP疗效显著。本文以中医“肾主骨生髓”理论为指导，探讨“肾藏精-主骨生髓-BMSCs-OP”之间的科学内涵，并探讨“补肾生髓”理论指导下传统补肾中药通过诱导BMSCs成骨分化与OP的关系，结合补肾中药及复方诱导BMSCs治疗OP的现代医学研究，为进一步探索有效的中医药治疗方案及发挥中医药独特优势提供依据。