首荟通便胶囊预防肝胆胰恶性肿瘤化疗后便秘的疗效观察

目的:探讨首荟通便胶囊预防肝胆胰恶性肿瘤化疗后便秘的临床疗效。方法:选取2016年8月至2018年8月河北医科大学第二医院肝胆外科收治的老年肝胆胰恶性肿瘤化疗患者80例作为研究对象,按照随机数字表法随机分为对照组和观察组,每组40例。对照组口服乳果糖口服液,观察组在对照组基础上加服首荟通便胶囊。治疗14 d后,比较2组的临床疗效。结果:中医病症临床疗效观察,对照组总有效率达到75%;观察组,总有效率达到90%,2组比较差异有统计学意义(P<0.05)。临床症状评分观察,对照组总有效率达到77.5%;观察组总有效率达到92.5%,2组比较差异有统计学意义(P<0.05)。排便评分(VAS评分)观察,治疗后对照组排便间隔时间和每次排便时间均长于观察组,2组VAS评分比较,差异均有统计学意义(P<0.05)。结论:首荟通便胶囊可以有效预防肝胆胰恶性肿瘤化疗后的便秘,有效缓解患者排便疼痛程度,减少排便时间,效果显著,值得临床推广。     

腹腔镜直肠癌前切除术肠系膜下动脉不同结扎平面对患者预后的影响

目的分析腹腔镜直肠癌前切除术中肠系膜下动脉不同结扎平面对患者预后的影响。 方法选取2007年6月至2014年6月间青岛市市立医院收治的行腹腔镜直肠癌前切除术136例患者为研究对象，根据肠系膜下动脉不同的结扎平面，分为保留左结肠动脉的低位结扎组（LL组）76例和不保留左结肠动脉的高位结扎组（HL组）60例。比较两组患者围手术期指标，随访并评价两组的预后。 结果两组手术时间、术中出血量、术后肛门排气时间、淋巴结清扫总数和第253组淋巴结清扫个数差异无统计学意义（t=6.109、4.339、8.386、0.233、0.198，P=0.318、0.416、0.512、0.821、0.669）；LL组术后吻合口瘘的发生率明显低于HL组（χ²=5.186，P=0.029）。HL组术后3、5年总体生存率分别为80.00%和73.33%，LL组分别为77.63%和72.37%，两组比较差异无统计学意义（χ²=1.536、2.156，P=0.863、0.698）。 结论腹腔镜直肠癌前切除术中肠系膜下动脉不同结扎平面可获得相近的淋巴结清扫效果，保留左结肠动脉的低位结扎平面术后吻合口瘘的发生率更低，其他围手术期指标没有差异，联合第三站中央淋巴结清扫值得应用推广。     

Computed tomography features of acinar cell carcinoma of the pancreas

PurposeTo report the computed tomography (CT) features of pancreatic acinar cell carcinoma (ACC) and identify CT features that may help discriminate between pancreatic ACC and pancreatic ductal adenocarcinoma (PDA).Materials and methodsThe CT examinations of 20 patients (13 men, 7 women; mean age, 66.5 ± 10.7 [SD] years; range: 51–88 years) with 20 histopathologically proven pancreatic ACC were reviewed. CT images were analyzed qualitatively and quantitatively and compared to those obtained in 20 patients with PDA. Comparisons were performed using univariate analysis with a conditional logistic regression model.ResultsPancreatic ACC presented as an enhancing (20/20; 100%), oval (15/20; 75%), well-delineated (14/20; 70%) and purely solid (13/20; 65%) pancreatic mass with a mean diameter of 52.6 ± 28.0 (SD) mm (range: 24–120 mm) in association with visible lymph nodes (14/20; 70%). At univariate analysis, well-defined margins (Odds ratio [OR], 7.00; P = 0.005), nondilated bile ducts (OR, 9.00; P = 0.007), visible lymph nodes (OR, 4.33; P = 0.028) and adjacent organ involvement (OR, 5.67; P = 0.02) were the most discriminating CT features to differentiate pancreatic ACC from PDA. When present, lymph nodes were larger in patients with pancreatic ACC (14 ± 4.8 [SD]; range: 7–25 mm) than in those with PDA (8.8 ± 4.1 [SD]; range: 5–15 mm) (P = 0.039).ConclusionOn CT, pancreatic ACC presents as an enhancing, predominantly oval and purely solid pancreatic mass that most frequently present with no bile duct dilatation, no visible lymph nodes, no adjacent organ involvement and larger visible lymph nodes compared to PDA.     

术前NLR、LMR、PNI值对胰十二指肠切除术后胰瘘发生的预测价值

目的:探讨术前预后营养指数(PNI)、中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、淋巴细胞/单核细胞比值(LMR)对患者因壶腹周围癌而行胰头十二指肠切除术后发生胰瘘的预测价值。方法:回顾性分析中国医科大学附属盛京医院收治的140例手术切除治疗的壶腹周围癌病例资料。采用受试者工作特征曲线(ROC)、多因素回归分析确定术前NLR、PLR、LMR、PNI对术后胰瘘的预测价值。结果:共筛选出30例术后临床胰瘘(B级瘘和C级瘘)患者,累积发生率为21.43%(30/140)，其中C级瘘为8例，发生率为5.71%(8/140)。术前NLR、PLR、LMR、PNI预测术后胰瘘的最佳截断值分别为3.49、150.79、2.48、44.8。进一步行多因素回归分析得出术前合并糖尿病、NLR≥3.49、LMR<2.48及PNI<44.8是胰头十二指肠切除术后并发胰瘘的独立危险因素(P＜0.05)。术前高NLR(≥3.49)、低PNI(<44.8)的患者术后发生严重的C级胰瘘的可能更大(P＜0.05)。应用胰瘘风险评分系统(FRS)对患者进行分层,其中21例处于高风险层次，进一步分析得到处于高风险层次的患者当同时合并术前高NLR、低PNI与低LMR中多项不良因素时，术后胰瘘的发生率可显著升高(78.57%,P=0.016)。结论:术前高NLR、低LMR、低PNI对胰头十二指肠切除术后患者并发胰瘘具有一定的预测价值；术前NLR、PNI水平与胰瘘的严重程度等级(B级瘘、C级瘘)具有相关性；处于FRS评分高风险层次的PD患者，当同时合并术前高NLR、低PNI与低LMR中多项时，术后发生胰瘘的风险增高。     

Glutathione S-transferase Polymorphisms in Head and Neck Squamous Cell Carcinoma Treated with Chemotherapy and/or Radiotherapy

Background/Aim: The Glutathione S-transferases (GSTs) are important carcinogen-metabolizing enzymes. Polymorphisms involved in these enzymes can modulate the development and treatment of head and neck cancer. To investigate the association of GSTs polymorphisms with head and neck cancer and risk factors, clinical-pathological features, and survival time of the patients treated with chemotherapy and/or radiotherapy. Methods: The GST gene polymorphisms were evaluated in 197 cases and 514 controls by PCR-RFLP-Polymerase Chain Reaction Restriction Fragment Length Polymorphism. Results: The GSTP-313 was associated with a decreased risk for HNSCC (p=0.050). The GSTP1 haplotype analysis revealed a higher frequency of the AC and AT haplotypes in the case group than in the control group (p=0.013 and p=0.019, respectively), and the opposite for G-C haplotype (p = 0.015). Yet, the different combinations between the genotypes were associated with an increased risk of cancer. The study showed no association between the polymorphisms and primary tumor site, clinical-pathological characteristics, treatment (chemotherapy and/or radiotherapy) and survival time of the patients. Conclusion: The GST polymorphisms combination showed an increased risk for carcinogenesis, and studies with larger casuistry can contribute to the clarification of the role in individual patient differences for the response to chemotherapy and/or radiotherapy and identify biomarkers of susceptibility.     

中性粒细胞与淋巴细胞比值及血小板与淋巴细胞比值变化在直肠癌新辅助治疗中的意义

目的探讨新辅助治疗前后中性粒细胞与淋巴细胞比值(NLR)及血小板与淋巴细胞比值(PLR)变化在直肠癌新辅助治疗中的意义。方法回顾性分析2013年11月至2015年1月山西省肿瘤医院收治的86例接受新辅助治疗的直肠癌患者资料,分析新辅助治疗前后NLR、PLR变化与患者临床病理特征及疗效的关系。结果86例患者治疗后NLR、PLR升高均为43例。直肠癌患者新辅助治疗前后的NLR及PLR变化与患者年龄、性别、TNM分期、淋巴结转移及癌结节数量、肿瘤长径均无关(均P>0.05),肿瘤与肛门距离<6 cm者治疗后NLR、PLR升高者比例均高于≥6 cm者[60.00%(30/50)比36.11%(13/36),χ^2=4.778,P=0.029;64.00%(32/50)比30.56%(11/36),χ^2=9.364,P=0.002];体质量指数≥28 kg/m2者治疗后NLR、PLR升高者比例均高于<28 kg/m2者[81.82%(9/11)比45.33%(34/75),χ^2=5.108,P=0.024;90.91%(10/11)比44.00%(33/75),χ^2=8.444,P=0.004]。治疗后NLR降低组患者的缓解率高于NLR升高组[72.09%(31/43)比51.16%(31/43),χ^2=3.983,P=0.046],而治疗前后PLR变化与患者新辅助治疗效果无关(P>0.05)。结论直肠癌患者新辅助治疗前后NLR变化与其疗效相关。     

MiRNA let-7a对人喉鳞癌细胞增殖的抑制作用CSCD

目的探讨miRNA let-7a调控高迁移率族蛋白2(HMGA2)对人喉鳞癌细胞株TU212增殖的影响。方法合成let-7a模拟体(let-7a mimics)并采用阳离子脂质体法瞬时转染入喉癌TU212细胞,裸鼠皮下注射TU212细胞,构建裸鼠移植瘤模型。RT-qPCR和Western blot法分别检测转染后TU212细胞及移植瘤内let-7a和HMGA2的表达。结果在过表达let-7a的喉癌TU212细胞中,HMGA2的转录和翻译水平下调,细胞增殖能力降低。体外成瘤实验证实,与let-7a NC组和空白对照组相比,转染let-7a mimics的喉癌细胞TU212成瘤组织的质量和体积均显著下降;let-7a过表达的TU212成瘤组织中HMGA2的mRNA和蛋白水平均明显下调。结论let-7a能显著抑制HMGA2的mRNA和蛋白表达,进而显著抑制喉癌细胞的增殖。     

Understanding the immune landscape and tumor microenvironment of pancreatic cancer to improve immunotherapy

Immunotherapy has revolutionized cancer treatment for several hematologic and solid organ malignancies; however, pancreatic cancer remains unresponsive to conventional immunotherapies. Several characteristics of pancreatic cancer present challenges to successful treatment with immunotherapy, including its aggressive biology, poor immunogenicity, and abundant desmoplastic stroma which can impede effector T cell infiltration and promote an immunosuppressive microenvironment. In this review, we evaluate the current understanding of the immune and stromal landscapes of pancreatic cancer, discuss the successes and failures of stroma-targeted therapies, and highlight how stroma-directed therapies may be synergistic with immunotherapy.