miR-145调控肝癌腹水模型Th9细胞升高的机制研究

目的:探讨miR-145调控肝癌腹水模型Th9细胞升高的作用机制。方法:构建小鼠H22肝癌腹水模型。造模两周后处死小鼠并分离出脾脏组织，流式细胞术分析肝癌腹水组（MA组）与正常对照组（Control 组）小鼠脾脏Th9细胞表达水平。ELISA法检测脾脏IL-9表达水平。RT-PCR法检测脾脏miR-145表达水平。Western Blot法检测脾脏中PI3K/Akt/mTOR/P70S6K/HIF-1α相关蛋白表达水平。分选小鼠脾脏CD4+T细胞，随机分为miR-145 mimics组和NC组，分别应用miR-145-5P mimics、阴性对照寡核苷酸（negative control，NC）进行转染，RT-PCR检测各组miR-145、HIF-1α mRNA及IL-9 mRNA表达水平。结果:与Control 组相比，MA组Th9细胞及其细胞因子IL-9表达均升高（P<0.05），miR-145表达降低（P<0.05），p-PI3K、p-Akt、mTOR、p-mTOR、p-P70S6K、HIF-1α蛋白均升高（P<0.05）。与NC组相比，miR-145 mimics组miR-145显著升高，HIF-1α mRNA及IL-9 mRNA表达下降。结论:肝癌腹水中Th9细胞升高可能与miR-145下降导致的PI3K/Akt/mTOR/P70S6K/HIF-1α通路激活有关。     

奥施康定联合塞来昔布治疗妇科恶性肿瘤中重度疼痛的疗效观察

目的:观察奥施康定联合塞来昔布治疗妇科恶性肿瘤中重度疼痛的临床疗效。方法:选取我院收治的79例妇科中重度癌痛患者作为研究对象，随机分为两组，对照组患者（n=33）在一般治疗的基础上加用奥施康定进行镇痛，观察组患者（n=46）在此基础上加用塞来昔布进行镇痛。统计分析两组患者镇痛效果、5-羟色胺（5-HT）、去甲肾上腺素（NE）水平及不良反应。结果:经过治疗后，观察组患者NRS评分低于对照组患者，观察组患者治疗有效缓解率高于对照组患者，观察组患者5-HT、NE水平均低于对照组患者，差异具有统计学意义（P<0.05）；观察组患者便秘发生率低于对照组患者，差异具有统计学意义（P<0.05）。结论:奥施康定联合塞来昔布治疗妇科恶性肿瘤中重度疼痛具有确切的效果，可降低单纯应用奥施康定的不良反应，值得临床推广。     

恩度联合多西他赛序贯腹腔灌注治疗胃癌伴恶性腹水的临床观察

目的:回顾性分析恩度联合多西他赛序贯腹腔灌注治疗胃癌伴恶性腹水的疗效及不良反应。方法:收集72例胃癌伴腹水患者，曾接受过二线及以上方案化疗，观察组35例，采用恩度45 mg联合多西他赛35 mg/m2 d1，d5序贯腹腔灌注1周期；对照组37例，采用多西他赛35 mg/m2 d1，d5腹腔灌注1周期，统计患者腹水控制有效率、KPS改善率、腹水控制时间及不良反应。结果:治疗组中腹水控制有效率71.43%；对照组中腹水控制有效率48.65%，P=0.049，两组具有统计学差异；治疗组中KPS改善率77.14%，对照组中KPS改善率54.05%，P=0.04，两组具有统计学差异；观察组中腹水控制时间8~90天，中位控制时间44天，对照组中腹水控制时间5~66天，中位控制时间28天，两组控制时间比较，P=0.048，具有统计学差异；III级以上不良反应发生率低，无治疗相关性死亡，两组不良反应比较，P>0.05，无统计学差异。结论:恩度联合多西他赛序贯腹腔灌注治疗体力状况（performance status,PS）评分较差的胃癌伴恶性腹水患者，腹水控制较好，能明显提高患者生活质量，未见明显不良反应。     

Pleural Effusion after Hepatic Radiofrequency Ablation with Artificial Ascites: Clinical Spectrum and Significance

PurposeTo retrospectively investigate incidence, clinical outcome, and risk factors of iatrogenic pleural effusion in patients with hepatic tumors undergoing radiofrequency (RF) ablation using artificial ascites (AA).Materials and MethodsPatients (N = 163) who underwent RF ablation using AA were classified into pleural effusion and non–pleural effusion groups according to the presence of pleural effusion on immediate follow-up CT and chest radiograph after RF ablation. The pleural effusion group included asymptomatic and symptomatic subgroups. The incidence and subsequent clinical outcomes of patients developing pleural effusion after RF ablation were evaluated.ResultsOverall, 96 patients (58.9%) developed pleural effusion, which resolved in 4.4 d ± 3.1. Hospital length of stay in the pleural effusion group was longer than the non-pleural effusion group (6.5 d ± 2.6 vs 5.7 d ± 2.8, P < .01). The pleural effusion group had longer AA infusion time (P = .01), larger infused AA volume (P < .01), and longer ablation time (P < .01) than the non-pleural effusion group. Eighteen patients (18.8%) developed symptomatic pleural effusion and had a larger infused AA volume than asymptomatic patients with pleural effusion (P < .01). Pleural effusion duration and hospital length stay were also longer in the symptomatic pleural effusion subgroup than in the asymptomatic subgroup (P < .01). Infused AA volume was the only independent prognostic factor of pleural effusion duration in multivariate analysis (P = .038).ConclusionsPleural effusion frequently occurs after RF ablation using AA. Although generally considered negligible, pleural effusion could be a clinical problem and prolong hospitalization. Therefore, operators should be careful not to infuse too much AA when performing RF ablation.     

Enhanced antitumour activity of doxorubicin and simvastatin combination loaded nanoemulsion treatment against a Swiss albino mouse model of Ehrlich ascites carcinoma

Doxorubicin (DOX) is the most commonly used anticancer drug; however, it has limited use because prolonged administration may result in severe cardiotoxicity. Simvastatin (SIM), generally prescribed for hypercholesterolaemia, has also shown salubrious results in the monotherapy or combinational drug therapy of different cancers in various models. Nanoparticle drug delivery systems are a novel way of improving therapeutics and also improving the absorption and specificity of drugs towards tumour cells. In this study, we exploited this technology to increase drug specificity and minimize imminent adverse effects. In this study, the antitumour activity of the combination formulas of DOX and SIM, either loaded in water (DOX‐SIM‐Solution) or nanoemulsions (NEs) (DOX‐SIM‐NE), was evaluated in a Swiss albino mouse model of Ehrlich ascites carcinoma. The anticancer effect was assessed by quantifying the change in body weight, mean survival time, and percent increase in lifespan (%ILS), determining haematological and serum biochemical parameters (liver function test, kidney function test and lipid profile parameters) as well as studying the histopathological alterations in liver tissues. We observed a clear increase in %ILS of the DOX‐SIM‐Solution group (265.30) that was double the %ILS of the DOX‐SIM‐NE group (134.70). However, DOX‐SIM‐NE had a non‐toxic effect on the haematological parameters, whereas DOX‐SIM‐Solution increased the levels of haemoglobin and lymphocytes. Furthermore, the encapsulation of SIM and DOX into NEs improved the levels of all serum biochemical parameters compared to the DOX‐SIM‐Solution. A reduction in the side effects of DOX‐SIM‐NE on the liver was also established using light microscopy, which revealed that the morphologies of the hepatocytes of the mice were less affected by administration of the DOX‐SIM‐NE treatment than with the DOX‐SIM‐Solution treatment. The study showed that incorporating SIM into the DOX‐loaded‐NE formulation remarkably improved its efficiency and simultaneously reduced its adverse effects.     

恩替卡韦联合前列地尔治疗乙型肝炎肝硬化腹水的效果观察

目的观察恩替卡韦与前列地尔联合治疗乙型肝炎肝硬化腹水的临床疗效。方法选取2012年5月-2014年2月德州市中医院收治的乙型肝炎肝硬化腹水患者100例,随机分为治疗组与对照组,每组各50例,两组均常规给予保肝、利尿、间断补充白蛋白(Alb)治疗,其中治疗组加用恩替卡韦0.5 mg口服,1次/d,联合前列地尔20μg+5%葡萄糖注射液100 ml静滴,1次/d,观察组只加用恩替卡韦0.5 mg口服,1次/d。住院治疗4周,观察两组治疗前后腹水消退情况、ALT、TBil、Alb、血液尿素氮(BUN)、肌酐(Cr)、凝血酶原活动度(PTA)、HBV DNA水平变化。出院后两组患者继续口服恩替卡韦0.5 mg,1次/d,随访3个月观察远期疗效。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果两组患者治疗后腹水量较治疗前均有不同程度降低,治疗组总有效率(84%)高于对照组(64%),差异有统计学意义(χ2=6.018,P0.05);两组患者肝肾功能各项指标(ALT、TBil、Alb、BUN、Cr)及PTA治疗后较治疗前均有不同程度改善,且治疗组疗效优于对照组,两组治疗后各项指标相比差异均有统计学意义(t值分别为7.567、6.875、-4.782、6.786、8.542、8.976,P值均0.01);两组患者治疗后HBV DNA水平均较治疗前有不同程度下降,差异均有统计学意义(t值分别为8.976、5.758,P值均0.01)),但两组间治疗后比较差异无统计学意义(P0.05);患者出院后随访3个月,治疗组在肝肾功能稳定、腹水反复方面优于对照组。结论恩替卡韦联合前列地尔治疗乙型肝炎肝硬化腹水疗效确切,远期疗效较好,值得临床应用与推广;恩替卡韦单用对肾功能改善不明显,但肝功能可获得明显改善。     

人工腹水辅助超声引导射频消融治疗膈顶部原发性肝癌

目的 探讨人工腹水辅助超声引导射频消融(radiofrequency ablation,RFA)治疗膈顶部肝细胞癌(hepatocellular carcinoma,HCC)的可行性、安全性及临床应用价值.方法 回顾性分析2010年1月至2012年12月间于广西医科大学第一附属医院行人工腹水辅助超声引导RFA治疗膈顶部HCC的22例患者25个病灶的临床资料,参照Seldinger穿刺技术并进行改进,用5-F动脉鞘管置入肝与腹膜之间的膈顶部建立人工腹水,使得膈顶部肿瘤显示清楚或穿刺路径完全暴露.并对人工腹水辅助下射频消融治疗的成功率、安全性进行分析.结果 本组88.0％(22/25)病例成功建立人工腹水,膈顶部病灶位置及范围得以完全显示并显示穿刺路径.所有患者注入的人工腹水均于术后3天内完全自行吸收.本组未发生腹腔内出血、腹膜炎、血胸、气胸等严重的并发症,无手术相关死亡病例.术后一月增强CT/MR随访复查提示所有病灶消融完全,无肿瘤局部残留.结论 建立人工腹水后可使得原位于超声盲区无法进行RFA治疗的膈顶部肿瘤得以清楚显示,拓宽了RFA治疗适应证;人工腹水辅助超声引导射频消融治疗膈顶部HCC安全、简易、可行,有较高临床应用价值.     

Seasonal Variation of Phyto-Constituents of Tea Leaves Affects Antiproliferative Potential

Objective: Tea (Camellia sinensis Linn.; family: Theaceae) is popular as a stimulant beverage across the globe and is also utilized as a functional antioxidant in alternative medicine. This study has evaluated the impact of seasonal variation on phyto-constituents of tea.

Method: The antiproliferative potential of methanolic extracts of tea leaves collected in the rainy season (MECR) was compared with the extract of tea leaves collected in the autumn season (MECA) of the same mother plant. Evaluation of in vivo antitumor activity was carried out in adult female Swiss albino mice groups inoculated with Ehrlich ascites carcinoma (EAC) cells. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was used to compare efficacy of MECR with that of MECA in the EAC cell line. Both qualitative and quantitative tests for phytochemical constituents present in MECA and MECR were performed. Antitumor efficacy of both the extracts was determined by evaluating different tumor markers showing dose-dependent cytotoxicity.

Results: Statistically significant reduction in EAC-induced tumor was observed in MECR treated mice compared to MECA treated ones. Cell decimation was significantly higher with MECR treatment, where restoration of different parameters including tissue structures returned to normal. Moreover, gas chromatography–mass spectrometry (GC-MS) study revealed the presence of cyclobarbital and benzazulene derivative in MECR, which is thought to be a novel source of these chemicals.

Conclusions: To our knowledge, there is no report that has attempted to reveal nutritional changes in terms of efficacy and variation in anticancer constituents in tea leaves, plucked in two seasons. This study revealed a novel source of barbital and benzazulene derivative. The unique presence of cyclobarbital and benzazulene, as revealed from GC-MS data, in methanolic extract of tea leaves collected during the rainy season (MECR) may have contributed to its enhanced in vitro (adopting MTT assay) and in vivo (on EAC-infected Swiss albino mice) cytotoxicity vis-à-vis antiproliferative properties compared to methanolic extract of tea leaves collected during the autumn season (MECA). The nature of plucking leaves in the two selected seasons is different.     

ABCB1 C3435T、G2677AT基因形态与癌痛患者疼痛感知的相关性研究

目的:研究ABCB1 C3435T、G2677AT基因形态与癌痛患者疼痛感知的关系。方法:临床纳入2016年9月至2018年9月期间我院收治的185例恶性肿瘤患者组织病理学标本，将其中有癌痛的患者116例作为癌痛组，无癌痛的患者69例作为无痛组。应用三维聚丙烯酰胺凝胶DNA芯片技术检验患者ABCB1 C3435T、G2677AT基因分型情况，并分析ABCB1 C3435T、G2677AT基因形态与癌症患者癌痛的关系。结果:两组患者C3435T基因野生型、杂合子及突变型分布频率对比差异无统计学意义（P>0.05）。两组患者G2677AT基因野生型、杂合子及突变型分布频率对比差异无统计学意义（P>0.05）。疼痛程度不同的患者C3435T和G2677AT基因型分布频率无差异（P>0.05）。癌痛组患者C3435T与G2677AT不同基因型间组内对比NRS评分差异无统计学意义（P>0.05）；C3435T与G2677AT相同基因型对比NRS评分差异无统计学意义（P>0.05）。结论:ABCB1 C3435T与G2677AT基因形态与癌痛患者疼痛感知并无直接关联，尚需进一步进行深入研究。     

陆芷青教授治疗肝炎后肝硬化经验探析

陆芷青教授治疗肝炎后肝硬化辨证病机明确,治法独特,疗效显著。认为本病多因湿热疫毒伤及脏腑气血而成,早期气滞血瘀,瘀阻肝络,而成肝积;晚期正虚邪留,虚实错杂,血水不利,形成臌胀。陆芷青认为早期应着眼于化瘀消癥兼顾肝脾,晚期逐水祛邪兼以扶正,并辅以验案加以佐证。