乳腺癌化疗后前哨淋巴结活检术的临床探讨

目的探讨乳腺癌化疗后前哨淋巴结活检术（SLNB）的准确性及临床意义。方法用美蓝作为示踪剂，对90例临床分期为Ⅱ、Ⅲ期，并已行化疗后临床检查腋窝淋巴结阴性的乳腺癌患者进行SLNB，术中均同时行腋窝淋巴结清扫术。结果90例中前哨淋巴结成功检出82例，检出率91．1％。每例检出前哨淋巴结的数量为1～4枚，平均1．6枚。82例前哨淋巴结成功检出的患者中。45例患者有腋窝淋巴结转移，其中前哨淋巴结有转移者40例，前哨淋巴结未发现转移而非前哨淋巴结有转移者5例，8例只有前哨淋巴结为阳性淋巴结，前哨淋巴结预测腋窝淋巴结状态准确率为93．9％（77／82）。灵敏度为88．9％（40／45），阳性预测值为100％，阴性预测值为88．1％，假阴性率为11．1％（5／45）。原发肿瘤为T2、T3／T4组检出率分别为96．1％（49／51）、84．6％（33／39）；假阴性率分别为5．3％（1／19）、15．4％（4／26），差异无统计学意义。肿瘤对化疗反应为完全缓解（CR）、部分缓解（PR）、稳定（SD）的前哨淋巴结检出率分别为92．3％、93．1％、84．2％，差异无统计学意义；假阴性5例均发生在PR、SD患者。结论化疗后腋窝淋巴结阴性的Ⅱ、Ⅲ期乳腺癌患者，行SLNB可获得与早期未行新辅助化疗乳腺癌SLNB相似的结果；化疗前原发肿瘤为T2的乳腺癌患者，SLNB能较准确预测腋窝淋巴结的状态。     

乳腺癌根治术后预后分析

目的分析乳腺癌根治术后影响局部复发、远处转移及生存的预后因素，探讨乳腺癌综合治疗方式的选择。方法乳腺癌根治术后病例100例。全部病例术后均接受锁骨上、腋窝及内乳区域淋巴结放疗，DT40～53Gy／4．0～5．5周。其中36例合并胸壁放疗，DT35～52Gy／3．5～5．3周。进行局部复发、远处转移的多个因素Spearman相关分析及生存率影响的Cox回归分析。结果局部复发（包括胸壁复发和区域淋巴结复发）及远处转移发生与T、N分期、临床分期、腋窝淋巴结转移数目呈正相关；胸壁复发与放疗后合并化疗呈负相关；T、N分期、临床分期、腋窝淋巴结转移数目是影响生存的危险因素；放疗前合并化疗是影响生存的保护因素。结论肿瘤大小、腋窝淋巴结转移数目以及是否合并化疗是影响乳腺癌根治术后局部复发、远处转移及生存的重要预后指标。     

胃癌67例临床分析

目的观察胃癌的临床病理特点及其与预后的关系。方法回顾性分析经手术切除和病理确诊的67例胃癌患者临床资料。结果所有67例病例中，五年生存率：男性56．1％（23／41），女性50．0％（13／26），两组差异无统计学意义（P〉0．05）；年龄≤40岁者46．2％；年龄〉40岁者55．6％，两组差异无统计学意义（P〉0．05）；肿瘤部位：胃底部14例，有7例五年后存活（50．0％）；胃体22例，五年生存12例（54．5％），胃窦部31例中17例五年后存活（54．8％），三组间差异无统计学意义（P〉0．05）；组织学类型：腺癌者五年生存率为55．9％（33／59），与印戒细胞癌（40．0％，2／5）和未分化癌（33．3％，1／3）比较差异无统计学意义（X^2=0．36，P〉0．05）；治疗时已发生远处转移的40例患者五年生存率为40．0％（16／40），远低于未发生转移患者的74．1％（20／27）（X^2=7．53，P〈0．05）；根据国际抗癌联盟（UICC）制定的TNM分期系统分期显示I期和Ⅱ期的五年生存率为72．7％（8／11）和70．6％（12／17），显著高于Ⅲ期（46．2％，12／26）和Ⅳ期（30．8％，4／13）（x。=6．06，P〈0．05）。结论TNM分期和有无远处转移是影响胃癌患者预后的主要因素，早期发现胃癌将有助于胃癌的治疗和预后。     

乳腺癌腋淋巴结转移的特征

目的 探讨乳腺癌腋淋巴结转移的临床特征．为保乳手术提供理论依据。方法 收集手术治疗的乳腺癌病例200份．将其分为腋淋巴结转移组及无转移组。登记肿瘤大小、时间及手术情况和腋淋巴结扪及等资料。结果当肿瘤〈2cm时，腋淋巴结无转移占71．4％．肿瘤〉5cm时，无转移下降到26.8％（P〈0．05）；肿瘤发现后在3个月内手术．其腋淋巴结无转移占57．1％．如超过6个月．则下降为20．9％（P〈0．01）。腋淋巴结无扪及者淋巴结转移为7．5％。结论 肿瘤小、腋淋巴结转移少、手术切除后淋巴结转移率低。     

食管癌术后复发转移的预后及影响因素探讨

目的探讨食管癌术后复发转移的预后及其影响因素和治疗效果。方法回顾性分析食管胸段鳞癌根治术后复发转移患者312例临床资料。结果术后复发转移时间为2～56个月，平均17．8个月。复发转移类型：淋巴性转移188例，血行性转移42例，混合型转移60例，吻合口复发22例。全组半年及1、2、3年生存率依次为未治疗组（68例）63．5％、35．2％、16．3％、13．1％；单纯放疗组（110例）75．6％、49．2％、32．7％、14．8％；单纯化疗组（72例）65．7％、52．3％、11．9％、9．2％；放疗＋化疗组（32例）为90．1％、72．5％、26．7％、17．2％。与未治疗组比较，单纯放疗（P=0．02）和放疗＋化疗（P=0．01）的生存率较高．单纯化疗差异无显著意义（P=0．185）。多因素分析显示：肿瘤浸润深度、淋巴结转移、手术方式及不同治疗方案是影响生存率的预后因素。结论食管癌手术方式的选择以颈部吻合术为宜，颈清扫术仅限于少数患者。放疗和（或）化疗可提高食管癌术后复发转移的生存率。     

乳腺癌组织中P-糖蛋白表达及临床意义

目的 探讨复发转移性乳腺癌mdr-1基因表达产物P-糖蛋白（P-glycoprotein，P-gp）表达及其与联合化疗疗效的关系。方法应用SABC法检测40例转移性乳腺癌术后组织中P-gp表达，使用环磷酰胺、吡喃阿霉素和5-氟尿嘧啶联合方案化疗，对比分析P-gp表达与疗效的关系。结果40例患者mdr-1基因表达产物P-gP阳性表达率52．5％，肝或肺转移者阳性表达明显高于皮肤或淋巴结转移者。40例患者化疗有效率57．5％；P-gP阴性组疗效（84．2％）明显优于P-gP阳性组（33．3％）（P〈0．01），有肝或肺转移者有效率（35．2％）明显低于皮肤或浅表淋巴结转移者（78．5％）（P〈0．05）。术后曾接受辅助性CAF或CMF方案化疗者复发转移后化疗疗效33．3％和73．6％，差异有统计学意义（P〈0．05）。结论mdr-1基因表达产物P-gp表达阳性者应选择非多药耐药型药物的联合方案化疗。     

Survivin在肺癌细胞定位表达与临床病理特征的关系

目的：探讨survivin在肺癌细胞定化表达与临床病理特衙的关系，方法：以免疫组化方法测定2004年1月～2007年5月手术获得的50例肺癌标本survivin细胞定位情况，用SPSS软件X^2检验分析survivin细胞定位与患者年龄、性别、癌组织学类型、分化程度、TNM分期、淋巴结转移的关系。结果：50例肺癌标本中snrvivin总阳性率为62．0％（31／50），其中单纯胞质阳性占51．61％（16／31），单纯胞核阳性占25．8％（8／31），胞质和胞核共同阳性者占22．58％（7／31）；survivin在肺癌细胞定位表达与淋巴结转移比较差异有显著性（P〈0．005）；而与患者年龄、性别、癌组织学类型、分化程度、TNM分期比较差异无显著性（P＞0．005）。结论：survivin在肺癌细胞定位表达与肺癌淋巴结转移有关。     

乳腺癌保乳手术66例临床观察

目的总结保乳手术治疗早期乳腺癌的临床经验及疗效观察。方法本院2003—2006年收治女性乳腺癌248例,选择临床0～Ⅱa期、非乳晕区单发肿瘤66例施行保乳手术。采用肿块局部广泛切除加腋淋巴结清扫或象限切除加腋淋巴结清扫术治疗,术后行辅助放疗、化疗及内分泌治疗。结果66例手术全部成功,无并发症发生。总保乳率22．61％（66／248）;美容满意率达93．61％。平均随访78个月,随访率78．8％（52／66例）。局部复发率1．92％（1／52例）,腋淋巴结复发率3．84％（2／52例）,复发时间为术后3年零2个月;远处转移率1．92％（1／52例）,术后4年1例肺转移,1例肝转移;随访期中,死亡2例,1例死因为心肌梗死,1例为肺转移;5年无病生存率82．69％（42／52例）,总生存率96．15％（50／52例）。结论早期乳腺癌患者接受保乳手术治疗可以取得满意的临床和美容效果。     

60例乳腺癌术后胸壁复发治疗及其预后分析

目的 探讨乳腺癌术后胸壁复发的预后因素及其治疗效果。方法 对60例乳腺癌术后胸壁复发患者进行回顾性分析。胸壁复发灶单发者24例，多发14例，伴区域性淋巴结转移或远处转移22例。复发时间距初治手术时间1年内为19例，1－2年15例，2年以上15例。复发治疗方法：未治1例，以手术为主的综合治疗（配合放疗和／或化疗）22例，非手术治疗37例。结果 总的1、3、5、10年生存率为63.3%(38/60)、33.3%(20/60)、23.3%(14/60)、12.5%(2/16)。复发病灶复发者3、5年生存率显著高于多发和／或多区域转移者（P＜0.01)；2年以内复发者3、5年生存率显著低于2年以上复发者（P＜0.01)；治疗结束肿瘤全消者3、5年生存率显著高于残留或进展者（P＜0.01)。结论 乳腺癌原发肿瘤分期、术后胸壁复发时间、复发病灶情况及治疗效果是影响预后的因素之一，以手术为主的综合治疗对胸壁复发者可提高其远期疗效。     

三阴乳腺癌临床病理特点及预后分析

目的：探讨三阴乳腺的临床病理特征及预后。方法回顾性分析我院2004年1月－2007年12月外科收治的病理确诊的89例乳腺癌患者资料,根据雌激素受体（ER）、孕激素受体（PR）和人表皮生长因子受体2（Her－2）的表达,将其分为2组：三阴组（ ER阴性、PR阴性、Her－2阴性）、非三阴组,比较2组患者的发病时月经情况、肿瘤部位、肿瘤大小、病理类型、淋巴结转移、临床病例分期、治疗结果和随访情况。结果2组患者肿瘤直径大小、病理类型、TNM分期、淋巴结转移情况上差异无统计学意义（P＞0．05）,其中浸润性导管癌所占比例最高,分别为85．2％、83．9％,肿瘤直径2～5 cm所占比例最高,分别为48．1％、53．2％;II期患者比例最高,分别为44．4％、51．6％;三阴乳腺癌患者绝经前确诊比例较非三阴乳腺癌组患者高,差异有统计学意义（ P＜0．05）;2组患者在Ki－67表达上差异有统计学意义（P＜0．05）。随访情况与非三阴乳腺癌患者比较,三阴乳腺癌组患者局部复发、远处转移多见,差异有统计学意义（P＜0．05）,死亡比例差异无显著性（P＞0．05）。结论三阴乳腺癌与非三阴乳腺癌均以浸润性导管癌为主,肿瘤多在2～5 cm,就诊时均以II期患者为主,淋巴结转移率接近。三阴乳腺癌较非三阴乳腺癌发病年龄更小,多在绝经前确诊,组织学分级更高,细胞增殖更活跃,更易出现复发、转移。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.