肝癌消融技术管理与多元化的肝癌消融治疗团队的构建

消融是肝癌治疗的重要手段之一。规范的消融技术、科学合理的治疗策略以及密切的团队合作是取得良好疗效的重要前提。尽管近年来肝癌消融治疗的效果随着消融技术的不断改进而逐渐提高,但肿瘤复发率仍较高,因此亟需能更好地提高肝癌消融治疗的效果和改善患者预后的治疗策略。多元化的肝癌消融治疗团队的构建是根据肝癌消融治疗的需求,在常规肝癌消融治疗团队的基础上提出的新概念。由于多元化的肝癌消融治疗团队较常规肝癌消融治疗团队具有更多的潜在优势,因此其是一个具有潜力的消融团队构建的新模式。     

较大肝癌局部消融的关键问题

近年来,超声、CT、MRI 引导下射频消融（RFA）和微波消融（MCT）作为微创热消融技术迅速发展,已证实热消融治疗肝癌安全、廉价、有效,且极具前景。对于小肝癌（〈3 cm）的疗效确切[1],目前被临床列为一线治疗方法[2]。对大于3 cm 的肝癌进行消融,虽有较高的坏死率[3],但由于受消融热场区限制,存在完全灭活困难,局部复发率高的问题[4]。鉴于在临床实际工作中,小肝癌比例较少,而3 cm 以上较大肝癌最常见,因此提高较大肝癌局部消融的疗效成为改善肝癌患者预后的关键。如何能做到穿刺次数少,又完全灭活肿瘤、减少消融治疗后肝癌的局部复发已成为重要的研究热点。     

原发性肝癌激光消融的有效性和安全性初步评估

目的初步评估我国原发性肝癌激光消融的应用状况及其疗效和安全性。方法通过PubMed、CBM和CNKI数据库的检索与文献筛选纳入符合要求的临床研究文献,分析激光消融或其联合治疗的安全性和有效性。结果激光消融及其联合治疗原发性肝癌有其特点和较好的有效性与安全性,但激光消融治疗原发性小肝癌与手术切除相比无明显优势。结论需要扩大激光消融治疗原发性肝癌的有效性和安全性研究。     

射频治疗原发性肝癌

射频消融是治疗原发性肝癌的新方法,其治疗小肝癌的价值已得到公认。近年其设备及治疗方法均有长足进步。多数学者主张,射频消融与其他疗法,如经导管动脉化学灌注栓塞治疗、氩氦刀冷冻消融、瘤内注射无水乙醇等联合,可用于治疗大肝癌。     

肝癌局部消融治疗的现状和进展

肝癌局部消融治疗取得了令人满意的临床疗效,成为肝癌综合治疗中的一种重要手段.目前,主要有温度消融和化学消融两种.温度消融包括微波消融、射频消融、激光消融、高强度聚焦超声(high intensity focus ultrasound,HIFU)和冰冻消融等;化学消融包括酒精消融和醋酸消融等.本文将从各种消融治疗的原理、适应证、疗效、并发症、禁忌证及各种方法优缺点等多个方面来评述局部消融治疗的现状和进展.     

超声引导下激光与射频消融治疗小肝癌的临床疗效差异

目的探讨激光消融与射频消融治疗不同大小和不同位置小肝癌的临床疗效是否存在差异。方法选择56例接受了激光消融治疗和57例接受了射频消融治疗的小肝癌患者,根据其癌灶直径大小和位置进行分组,以是否完全消融作为评价指标,对激光和射频消融的疗效进行分析,判断其是否存在差异。统计方法选用χ~2检验。结果对于不同大小的小肝癌和非高危位置的小肝癌,激光消融和射频消融均有较好的疗效,且疗效差异不存在统计学意义(P0.05)。但对于高危位置的小肝癌,激光消融的完全消融率为92.3%,射频消融的完全消融率为68%,差异具有统计学意义(P=0.0230.05)。此外,在不良反应的发生率上,射频消融的严重不良反应发生率要比激光消融高,且差异具有统计学意义。结论激光消融和射频消融均是治疗小肝癌的有效手段,对于不同大小小肝癌的消融都有着同样的疗效,但是对于高危位置的小肝癌以及在术后不良反应发生的情况上,激光消融则更具有优势。     

综合靶向消融治疗中晚期肝癌的临床研究

目的 探讨用氩氦刀冷冻 微波消融 化学消融等综合靶向消融治疗中晚期肝癌的疗效.方法 78例中晚期肝癌患者采用综合靶向消融治疗,先行肝动脉栓塞化疗,一周后行局部氩氦刀冷冻术、微波消融或化学消融术;56例单纯行动脉栓塞化疗.结果 治疗组1年生存率56.4%,对照组1年生存率36.9%;治疗组AFP平均值低于对照组,有显著性差异.结论 综合靶向消融治疗能提高中晚期肝癌患者的生存率,较单纯介入疗法治疗更为有效.     

影像引导原发性肝癌消融指南(2023版)

影像引导的原发性肝癌消融治疗具有疗效肯定、创伤小、操作简便、患者易耐受、住院时间短、恢复快、并发症少等优点, 其中又以射频和微波经皮消融应用最为成熟, 已被多个国内外指南认定为小肝癌的一线治疗方法。中国在消融治疗肝癌上积累了丰富经验, 取得了体系化研究成果。该指南规范了肝癌消融治疗的穿刺路径、引导技术、适应证、术前准备、操作方法、术后处理及随访、并发症防治策略等内容, 并就影像引导原发性肝癌消融方式进行技术对比及其在综合治理中的地位进行阐述。     

本期导读

影像引导的原发性肝癌消融治疗具有疗效肯定、创伤小、操作简便、患者易耐受、住院时间短、恢复快、并发症少等优点, 其中又以射频和微波经皮消融应用最为成熟, 已被多个国内外指南认定为小肝癌的一线治疗方法。中国在消融治疗肝癌上积累了丰富经验, 取得了体系化研究成果。本期刊登的《影像引导原发性肝癌消融指南(2023版)》规范了肝癌消融治疗的穿刺路径、引导技术、适应证、术前准备、操作方法、术后处理及随访、并发症防治策略等内容, 并就影像引导原发性肝癌消融方式进行技术对比及其在综合治理中的地位进行了阐述(第97～112页)。     

经肝动脉化疗栓塞术联合微波消融成功治疗晚期大肝癌伴肝-门静脉癌栓1例报告

随着影像学技术的不断发展,以射频消融（radiofrequency ablation,RFA）和微波消融（microwave ablation,MWA）为代表的热消融治疗,是继外科治疗后,近20年来应用最为广泛的肝癌治疗方式,不但能够完成早期肝癌的根治,还能够针对中晚期肝癌进行姑息治疗^（[1]）。相对传统的外科治疗,局部热消融具有适应证广、创伤小、可多次治疗、治疗效果好等优点,     

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.