FOLFOX和FOLFIRI方案治疗转移性结直肠癌效果比较

52例晚期结直肠癌患者,随机分为FOLFOX组和FOLFIRI组。FOLFOX方案包括奥沙利铂、亚叶酸钙、氟尿嘧啶;FOLFIRI方案包括伊立替康、亚叶酸钙、氟尿嘧啶。14d为1个周期。分别于化疗第1天及第14天采血检测细胞免疫功能;完成4周期化疗者评价近期疗效和卡氏评分。结果FOLFOX组和FOLFIRI组患者治疗前后免疫功能指标均无明显变化;近期总有效率分别为40．4％、41．7％,无统计学差异（P〉0．05）;FOLFIRI方案成本及不良反应较高。提示FOLFOX方案更适合于转移性结直肠癌患者。     

贝伐单抗联合化疗治疗进展期转移性结直肠癌临床观察

目的评价贝伐单抗联合IFL方案（伊立替康、氟尿嘧啶、亚叶酸钙）治疗进展期结直肠癌的疗效及安全性。方法回顾性总结2007年6月～2009年8月期间分别给予贝伐单抗联合IFL方案（A组,40例）和单独IFL方案（B组,37例）进行化疗患者治疗后有效率、不良反应、治疗前后肿瘤标志物的变化和随访情况。结果A组和B组的有效率分别为40．0％和21．6％;所有患者治疗前后肿瘤标志物浓度均有明显变化（P〈0．05）,A组和B组比较差异具有统计学意义（P〈0．05）,两组不良反应为Ⅰ～Ⅱ度,无严重不良反应,且差异无统计学意义（P〉0．05）;A组患者1年存活率为27．5％,其中生存期（OS）最长者达15．6个月,中位疾病进展期（TTP）为4．9个月,中位OS为10．5个月。B组患者1年存活率为18．9％,其中OS最长者达12．3个月,中位TTP为3．4个月,中位OS为8．8个月。两组1年存活率、中位TTP、中位OS比较,差异均具有统计学意义（P〈0．05）。结论与单独使用IFL方案相比,贝伐单抗联合化疗对于进展期转移性结直肠癌治疗具有良好的效果,多数患者不良反应为轻到中度,毒副作用发生率低,患者能够耐受,能明显延长患者的生存期。     

FOLFOX、XELOX、SOX 方案用于局部进展期胃腺癌的疗效及安全性比较

目的：比较FOLFOX、XELOX、SOX方案用于局部进展期胃腺癌患者新辅助化疗的临床疗效及安全性。方法将106例局部进展期胃腺癌患者随机分为A、B、C三组,分别给予FOLFOX（奥沙利铂＋甲酰四氢叶酸钙＋5-氟尿嘧啶）、XELOX（奥沙利铂＋卡培他滨）、SOX（奥沙利铂＋替吉奥胶囊）进行化疗,化疗2个周期后复查胃镜及64排螺旋CT,比较其临床疗效及不良反应。结果 A、B、C组的总有效率分别为51．43％、62．86％、66．67％,B、C组的总有效率均高于A组（P均＜0．05）,B、C组比较无统计学差异（P＞0．05）。 B、C组药物不良反应发生率较A组降低,特别是Ⅲ度以上不良反应发生率更低（P均＜0．05）,B、C组比较无统计学差异（P＞0．05）。结论 FOL-FOX、XELOX、SOX方案用于局部进展期胃腺癌患者新辅助化疗均有效、安全,XELOX、SOX方案的疗效更佳,安全性更高。     

贝伐单抗联合化疗一线治疗转移性结直肠癌疗效的Meta分析

目的系统评价贝伐单抗联合化疗一线治疗转移性结直肠癌患者对生存期的影响。方法利用万方、维普、CNKI、PUMED、EMBASE数据库,收集贝伐单抗联合化疗一线治疗转移性结直肠癌的随机对照试验,对纳入研究的方法学质量进行评价,以文献为基础采用固定效应模型或随机效应模型对中位总生存期（OS）、无进展生存期（PFS）进行Meta分析。结果共纳入5篇文献,包括1778例。Meta分析显示,与未联合贝伐单抗对照组比较,贝伐单抗联合化疗组的0s（Z=2．55,P=0．01）和PFS（Z=11．96,P〈0．01）明显延长。结论贝伐单抗联合化疗一线治疗转移性结直肠癌可延长患者OS、PFS。     

FOLFOX-6与FOLFILI方案治疗转移性结直肠癌的效果比较

目的 比较FOLFOX-6方案与FOLFILI方案治疗转移性结直肠癌的临床疗效及不良反应.方法 将69例转移性结直肠癌患者随机分为观察组38例和对照组31例,观察组予FOLFOX-6(奥沙利铂+亚叶酸钙+5-氟尿嘧啶)方案、对照组予FOLFILI(伊立替康+亚叶酸钙+5-氟尿嘧啶)方案化疗,14 d为一周期,2周期后观察近期疗效、不良反应,随访2a记录患者的生存期、疾病进展时间.结果 两组有效率、控制率、平均生存期、疾病进展时间均无统计学差异;观察组骨髓抑制发生率明显高于对照组,延迟性腹泻、胆碱能神经综合征发生率明显低于对照组,P均＜0.05.结论 FOLFOX-6与FOLFILI方案治疗转移性结直肠癌效果相当,均有不良反应发生,但前者以骨髓抑制为主,后者以延迟性腹泻和胆碱能神经综合征为主;临床应根据患者具体情况选用化疗方案.     

EOX与FOLFIRI方案一线治疗晚期胃癌的疗效比较

目的:比较表柔比星、奥沙利铂和卡培他滨(mEOX)与伊立替康、5-氟尿嘧啶和亚叶酸钙(FOLFIRI)在晚期胃癌一线治疗中的疗效及不良反应.方法:将105例病理学诊断的进展期胃癌患者随机分为mEOX组及FOLFIRI组,mEOX组(n=55)给予表柔比星50 mg/m~2静推,d1;奥沙利铂130 mg/m~2静脉滴注,d1;卡培他滨625 mg/m~2,2次/d,d1-14,21 d为1周期,至少完成2个周期.FOLFIRI组(n=50)给予伊立替康180 mg/m~2,静脉滴注,d1;亚叶酸钙400mg/m~2静脉滴入2 h,d1;5-氟尿嘧啶注射液400 mg/m~2静推,d1;5-氟尿嘧啶1200 mg/m~2,持续22 h静脉滴注或泵入,d1-2,每14 d为1个周期,至少用4个周期.进展后行二线单药化疗.观察两组的疗效和不良反应.结果:mEOX组及FOLFIRI组客观有效率(objective response rate,ORR)分别为40.0%和48.0%,差异无统计学意义(P=0.409);mEOX组及FOLFIRI组一线化疗后的无进展生存期(progression-free survival,PFS)分别为7.3 mo和8.4 mo(P=0.07),进展后二线单药化疗中位PFS分别为2.4 mo和3.4 mo(P=0.098),总生存期(overall survival,OS)分别为13.5 mo和14.3 mo(P=0.40),无统计学差异.风险比(risk ratio,HR)为0.810(95%CI:0.501-1.163).均小于1.25界值,非劣效性检验成立.mEOX组Ⅲ-Ⅳ度粒细胞减少、血小板减少、贫血及腹泻发生率均明显低于FOLFIRI组,差异有统计学意义(P0.05),mEOX组因不良反应至化疗药物减量或延期使用的发生率也明显低于FOLFIRI组,差异有统计学意义(P0.05).结论:mEOX方案方便易用安全有效,可以成为局部晚期胃癌的标准方案,值得进一步研究.     

贝伐单抗治疗转移性结直肠癌20例近期疗效观察

将病理学证实的60例转移性结直肠癌患者随机分为两组,观察组20例予贝伐单抗（Avastin）联合伊立替康（CPT-11）、醛氢叶酸（LV）和5-氟尿嘧啶（5-Fu）,对照组40例予CPT-11联合LV和5-Fu治疗,至少化疗2个周期。观察近期疗效、不良反应和血清肿瘤标志物变化。结果观察组和对照组有效率分别为45％和35％（P〉0．05）;疾病控制率分别为80％和50％（P〈0．05）;肿瘤标志物治疗后均明显降低（P〈0．01）;两组不良反应多为Ⅰ～Ⅱ度,发生率无统计学差异（P〉0．05）。认为贝伐单抗联合伊立替康治疗转移性结直肠癌效果好,不良反应轻,值得临床借鉴。     

不同新辅助化疗方案对结直肠癌患者生存质量的前瞻性非随机观察研究

目的探讨OLF和LF不同新辅助化疗方案对结直肠癌患者生存质量的影响。方法收集临沂市罗庄中心医院2009年3月-2012年12月收治的136例结直肠癌患者依据病情和意愿分组,分别采取OLF和LF新辅助化疗方案,以QLQC30生存质量核心问卷比较化疗前、手术前和手术后患者的生存质量。结果手术前,OLF组在总分、恶心呕吐和经济困难指标上与化疗前比较,差异有统计学意义(P0.05);LF组在总分、恶心呕吐症状上与化疗前比较,差异有统计学意义(P0.05);手术后,两组在总分、症状评分上与化疗前和手术前比较,差异有统计学意义(P0.05);两组前手术前恶心呕吐症状、手术后社会功能、腹泻、经济困难比较,差异有统计学意义(P0.05)。结论两种化疗方案均可以改善患者的生存质量,OLF化疗方案对患者功能和症状改善更为明显。     

FOLFOXIRI联合Kras基因靶向治疗方案对晚期结直肠癌预后的影响

目的研究FOLFOXIRI联合Kras基因靶向治疗方案对晚期结直肠癌(CRC)患者预后的影响。方法纳入2013年4月至2015年4月本院80例晚期CRC患者作为研究对象,采用随机数字表法将患者分为两组,每组40例。对照组行常规FOLFOXIRI化疗方案,观察组患者进行Kras基因测序,并在常规FOLFOXIRI化疗基础上根据Kras基因检测结果进行靶向治疗。比较两组近期化疗效果,记录化疗期间毒副反应发生情况,随访记录两组患者化疗后3年生存情况。结果观察组17例发生Kras突变,发生率42. 50%,化疗后肿瘤疾病控制率显著高于对照组,差异有统计学意义(P 0. 05)。两组化疗期间消化道反应、中心粒细胞减少、皮疹、贫血、血小板减少及神经系统症状严重程度比较,差异无统计学意义(P 0. 05)。两组化疗后3年总生存率差异无统计学意义(Log rank x~2=0. 679,P=0. 410)。观察组化疗后3年无进展生存率显著高于对照组,差异有统计学意义(Log rank x~2=5. 267,P=0. 022)。结论 FOLFOXIRI化疗联合Kras基因靶向治疗方案用于晚期CRC患者可显著改善治疗效果,延长无进展生存期,且具有较高的安全性。     

手卫生管理对预防结直肠癌术后腹腔感染的效果观察

目的探讨手卫生管理对预防结直肠癌术后腹腔感染的临床效果。方法选取2014年1月至2015年1月襄阳市中心医院收治的结直肠癌患者110例,按随机数字表法分为对照组和观察组,各55例,均择期行腹腔镜直肠癌根治术治疗,观察组患者同时进行手卫生管理,对照组患者常规手卫生消毒。比较两组手术时间、术后至化疗时间、住院时间、腹腔感染率、随访2年生存率、无进展生存期、复发率及生存质量量表(SF-36)评分。结果观察组术后至化疗时间、住院时间显著短于对照组(P 0. 05);观察组术后腹腔感染率为7. 27%,明显低于对照组的21. 82%(P 0. 05)。观察组术后2年随访生存率明显高于对照组,但术后1年复发率较对照组明显低,且无进展生存期较对照组明显长(P 0. 05)。此外观察组术后1、2年SF-36评分明显高于对照组,差异显著(P 0. 05)。结论手卫生管理系统通过有效预防结直肠癌患者术后腹腔感染,缩短术后至化疗时间及住院时间,从而明显降低患者复发率、延长无进展生存期并改善预后。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.