肠瑞灌肠剂对放射性直肠炎大鼠IL-1β及NF-κB表达的影响

目的 观察肠瑞灌肠剂对直线加速器诱导的放射性直肠炎大鼠直肠黏膜IL-1β和NF-κB表达的影响,探讨其黏膜修复作用及抗炎机制.方法 利用直线加速器单次大剂量盆腔局部照射,建立放射性直肠炎大鼠模型.70只大鼠随机分为7组,三个治疗组分别给予高、中、低不同剂量肠瑞灌肠剂,西药对照组给予地塞米松+庆大霉素,中药对照组给予八味锡类散,模型组与空白组给予生理盐水,给药途径均保留灌肠.观察治疗1周后处死全部动物.分别用RT-PCR方法、免疫组织化学方法检测直肠黏膜IL-1β mRNA、NF-κB表达,进行统计学处理.结果 照射后直肠黏膜出现IL-1β mRNA及NF-κB表达,治疗组IL-1β mRNA表达及NF-κB表达显著减少,与模型组、中西药对照组比较差异有统计学意义(P<0.05).治疗高剂量组优于低剂量组.结论 肠瑞灌肠剂能下调放射性直肠炎大鼠直肠黏膜IL-1β mRNA及NF-κB表达,以炎症因子为药物靶点,减轻放射性直肠炎炎症反应,促进肠黏膜修复.     

人参皂苷Rg3对大鼠急性放射性直肠炎的实验研究

目的 探究人参皂苷Rg3(GRg3)治疗大鼠急性放射性直肠炎效果。方法 将100只大鼠21.5Gy照后第7天分别分为对照组(生理盐水20只)、GRg3治疗组(GRg3 20、40、80mg/kg灌胃,每亚组20只)及混合液治疗组(思密达混合液灌肠20只)。2周后将5个组大鼠3ml/kg水合氯醛麻醉后腹主动脉采取血标本约5ml后处死。取直肠组织分成两部分,一部分做组织溶浆测Bax、NF-κB含量,另一部分做HE染色观察直肠组织病理改变。血标本离心后取上清液用ELISA检测各组大鼠血清中IL-2、IL-6、TNF-α及MPO水平。结果 GRg3治疗组显示GRg3浓度升高血清炎性因子、血清MPO浓度及大鼠肠组织Bax及NF-κB浓度呈降低趋势,且高剂量GRg3治疗组与对照组相比 P<0.05,混合液治疗组与高剂量GRg3组相比 P>0.05。表明GRg3对大鼠急性放射性直肠炎具有较好的治疗作用。结论 GRg3能降低血清炎性因子及放射性直肠炎大鼠肠组织中Bax及NF-κB浓度,且较正常对照组疗效好,GRg3可用于治疗大鼠急性放射性直肠炎。     

西妥昔单抗联合伊立替康治疗晚期胃癌对患者核因子κB、正常上皮细胞特异性1蛋白表达及生存期的影响

目的研究西妥昔单抗联合伊利替康治疗晚期胃癌对患者核因子κB(NF-κB)、正常上皮细胞特异性1(NES1)蛋白表达及生存期的影响。方法将80例晚期胃癌患者根据治疗方法不同分为研究组和对照组各40例,研究组利用西妥昔单抗联合伊立替康治疗,对照组单独利用西妥昔单抗治疗,比较两组患者癌胚抗原(CEA)NF-κB、NES1表达情况、治疗效果、不良反应发生情况和生存情况。结果研究组治疗后有效率为85.00%(34/40),与对照组的70.00%(28/40)比较,差异无统计学意义(P﹥0.05)。治疗前,两组患者CEA、NES1、NF-κB水平比较,差异均无统计学意义(P﹥0.05)。治疗后,研究组患者CEA水平明显低于对照组,NES1、NF-κB水平明显高于对照组,差异均有统计学意义(P﹤0.01)。研究组患者不良反应总发生率为20.00%(8/40),低于对照组的42.50%(17/40),差异有统计学意义(P﹤0.05)。研究组治疗后1年中位生存期为8.26个月(95%CI:6.154~9.985),长于对照组的6.54个月(95%CI:5.112~8.013),差异有统计学意义(P﹤0.05);研究组治疗后复发4例,少于对照组的10例,差异有统计学意义(P﹤0.05)。结论西妥昔单抗联合伊立替康治疗晚期胃癌具有良好的疗效,提高了NF-κB、NES1表达水平,降低了不良反应发生率并延长患者的生存期,对晚期胃癌患者的诊疗有指导意义。     

思密达-贯新克混合液保留灌肠治疗急性放射性直肠炎45例

[目的]探讨思密达—贯新克混合液保留灌肠治疗直肠癌放疗后急性放射性直肠炎的疗效。[方法]对80例直肠癌放疗后出现急性放射性直肠炎患者分为两组,治疗组45例给予思密达、贯新克、地塞米松、生理盐水混合液保留灌肠治疗,对照组35例给予口服思密达治疗,对两组的疗效及不良反应进行分析。[结果]治疗组45例患者治愈12例（27%）,有效31例（69%）,无效2例（4%）,总有效率96%;对照组35例患者治愈3例（8%）,有效17例（49%）,无效15例（43%）,总有效率57%。两组疗效比较差异有显著性（P〈0.05）。[结论]思密达—贯新克混合液保留灌肠治疗急性放射性直肠炎安全、有效。     

沙利度胺防治急性放射性直肠炎的临床观察北大核心CSCD

目的探讨沙利度胺防治急性放射性直肠炎的疗效及对患者放疗期间生活质量的影响。方法将90例行同步放化疗的宫颈癌根治术后患者随机分成两组:实验组(沙利度胺口服+同步放化疗)45例、对照组(同步放化疗)45例。观察两组急性放射性直肠炎的发生情况及KPS评分、睡眠、饮食及体重变化情况。结果实验组急性放射性直肠炎级别明显低于对照组,肠炎首次发生时受照射剂量明显高于对照组,差异均具有统计学意义(均P<0.05)。实验组患者的KPS评分改善率、睡眠改善率、饮食改善率、体重改善率均优于对照组,差异均有统计学意义(P<0.05)。结论沙利度胺防治急性放射性直肠炎安全、有效,并且可以改善患者放疗期间生活质量,保障放疗顺利进行。     

眼睑再造术治疗眼睑基底细胞癌的疗效及术后整合素αvβ3、核因子-κB65和E-cadherin的表达情况

目的 探究眼睑再造术治疗眼睑基底细胞癌的疗效及术后整合素αvβ3、核因子-κB65(NF-κBP65)和E-cadherin的表达情况.方法 将75例眼睑基底细胞癌患者按治疗方法不同分为对照组(n=35)和观察组(n=40),对照组患者实施标准化肿瘤切除术治疗,观察组在对照组基础上实施眼睑再造术,比较两组患者的视力情况,整合素αvβ3、NF-κBP65、E-cadherin阳性表达情况,治疗满意度和生活质量.结果 术后2周,观察组患者视力情况优于对照组(P﹤0.05);两组患者肿瘤组织中整合素αvβ3、NF-κBP65和E-cadherin阳性表达率均高于癌旁组织,差异均有统计学意义(P﹤0.05).不同肿瘤体积、脉管侵犯情况、脉管转移情况眼睑基底细胞癌患者肿瘤组织中整合素αvβ3、NF-κBP65和E-cadherin阳性表达情况比较,差异均有统计学意义(P﹤0.05).观察组患者满意度明显高于对照组,差异有统计学意义(P﹤0.01).术后,两组患者健康状况调查简表(SF-36)各维度评分均升高,且观察组均高于对照组(P﹤0.05).结论 眼睑再造术应用于眼睑基底细胞癌,可改善患者的视力水平,提高患者的治疗满意度和生活质量,整合素αvβ3、NF-κBP65和E-cadherin阳性表达可能与眼睑基底细胞癌发生发展有关.     

中药保留灌肠预防宫颈癌放射性直肠炎的临床观察

目的:观察中药保留灌肠预防宫颈癌放射性直肠炎的疗效.方法:将86例宫颈癌放疗患者随机分为观察组40例和对照组46例,观察组采用中药保留灌肠配合放疗,对照组单纯放射治疗,观察两组放射性直肠炎的发生率.结果:所有患者中放射性直肠炎发生率18.6％,观察组出现放射性直肠炎3例(7.5％),对照组发生放射性直肠炎13例(28.2％),观察组放射性直肠炎的发生率明显低于对照组(P＜0.05),有显著性差异.结论:中药保留灌肠能明显降低宫颈癌放疗患者放射性直肠炎的发生率.     

熟地黄多糖治疗鼻咽癌对其STAT3通路相关生化指标的影响

目的:了解熟地黄多糖治疗鼻咽癌患者对血清中促炎因子和STAT3通路相关蛋白含量的影响。 方法:回顾性分析2015年2月至2016年11月,我院132例鼻咽癌确诊患者,其中条件对照组66例接受同步放化疗治疗,实验组66例在同步放化疗的基础上进行熟地黄多糖的药剂服用。比较两组患者治疗初（0天）、治疗15天、治疗30天、治疗60天促炎因子（TNF-α、IL-6、IL-1β、IL-8）和STAT3通路相关蛋白（NF-κB p65蛋白、P-STAT3蛋白）含量的差异。 结果:不同时点比较,实验组TNF-α、IL-6、IL-1β、IL-8、NF-κB p65蛋白、P-STAT3蛋白和条件对照组TNF-α、IL-6、IL-8、NF-κB p65蛋白、P-STAT3蛋白含量的差异具有统计学意义;两组临床治疗效果的差异有统计学意义（P<0.05）,实验组患者完全缓解和部分缓解例数多于对照组;实验组和条件对照组比较,0天时,各促炎因子和STAT3通路相关蛋白含量的差异均无统计学意义（均P>0.05）,15天、30天、60天时,各促炎因子含量的差异均有统计学意义（均P<0.05）;各促炎因子（TNF-α、IL-6、IL-1β、IL-8）和STAT3通路相关蛋白（NF-κB p65蛋白、P-STAT3蛋白）含量进行重复测量方差分析,其差异均由组别、时间、组别和时间的交互作用三者构成。 结论:在同步放化疗基础上,对鼻咽癌患者给予熟地黄多糖的药剂服用,可能对鼻咽癌患者STAT3通路存在显著影响,从而显著改善患者体内促炎因子和相关蛋白的具体表达量。     

化疗辅助放疗治疗宫颈癌患者的临床疗效和不良反应

目的探讨化疗辅助放疗治疗宫颈癌患者的临床疗效和不良反应。方法选取2013年10月至2014年10月间在河北大学附属医院确诊的60例宫颈癌局部晚期患者为研究对象,采用随机数字表法随机分为观察组和对照组,每组30例。观察组患者采用化疗辅助放疗联合甘氨双唑钠治疗,对照组患者采用放疗联合甘氨双唑钠治疗,评价两组患者的近期疗效、不良反应、6个月和1年的生存率。结果观察组患者总有效率为86.7%,对照组为63.3%,组间差异有统计学意义(P<0.05)。两组患者并发症主要为放射性直肠炎和放射性膀胱炎,观察组患者的并发症发生率低于对照组,差异均有统计学意义(均P<0.05)。两组患者的不良反应主要为脱发、贫血、发热、血小板下降、白细胞下降和消化道反应等,差异均无统计学意义(均P>0.05)。观察组患者6个月和1年的生存率分别为83.3%和76.7%,对照组分别为76.7%和63.3%,组间差异均无统计学意义(P>0.05)。结论放疗联合甘氨双唑钠治疗宫颈癌患者疗效较差,不良反应多,而化疗辅助放疗可提高患者的近期疗效,减少并发症发生率。     

电子结肠镜下4％甲醛溶液治疗宫颈癌放疗后放射性出血性直肠炎的疗效观察

目的:放射性出血性直肠炎是盆腔恶性肿瘤放疗后的常见并发症,本研究旨在探索电子结肠镜下4%甲醛溶液治疗宫颈癌放疗后放射性出血性直肠炎的疗效。方法:选取我院于2012年5月至2014年5月确诊为宫颈癌并于接受放射治疗后出现放射性出血性直肠炎的患者104例,随机平均分为甲醛治疗组(52例)和对照组(52例),前组给予电子结肠镜下4%甲醛溶液局部治疗,后者给予思密达(3g)、地塞米松(5mg)和庆大霉素(8万单位)混合液保留灌肠治疗,比较该方法与传统方法治疗效果的差异。结果:甲醛组共治愈患者24例(46.2%),显效21例(40.4%),好转4例(7.7%),无效3例(5.7%),总有效率94.3%,未发现直肠溃疡和穿孔;对照组共治愈患者18例(34.6%),显效17例(32.7%),好转6例(11.5%),无效11例(21.2%),总有效率78.8%,甲醛组的疗效明显高于对照组(χ2=7.84,P<0.01)。结论:电子结肠镜下4%甲醛稀释液是治疗宫颈癌放射性出血性直肠炎的有效方法。     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

Costs associated with complications are lower with capecitabine than with 5‐fluorouracil in patients with colorectal cancer

BACKGROUND:

Capecitabine, an oral alternative to 5‐fluorouracil (5‐FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy‐related complications during treatment with capecitabine‐ and 5‐FU–based regimens.

METHODS:

Patients with CRC who received at least 1 administration of capecitabine or 5‐FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure.

RESULTS:

In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5‐FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5‐FU–based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5‐FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469‐$737). In addition, the mean predicted monthly complication cost for 5‐FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892‐$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5‐FU regimens.

CONCLUSIONS:

Capecitabine compared well with 5‐FU–based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009. © 2009 American Cancer Society.     

Second-line chemotherapy with cisplatin-ifosfamide in patients with ovarian cancer previously treated with carboplatin-cyclophosphamide.

In an effort to use antineoplastic drug combinations which are active in platinum resistant ovarian cancer or which can induce a second response after a platinum first-line treatment, we conducted a study on 30 ovarian cancer patients previously treated with carboplatin plus cyclophosphamide who were given ifosfamide 5 g/m2 i.v. divided over days 1 to 3 plus mesma combined with cisplatin 100 mg/m2 i.v. divided over days 1 to 3 every 4 weeks as second-line treatment. Eight patients had never entered remission with first-line chemotherapy while 22 patients had tumor recurrence within 6 to 18 months after the end of chemotherapy and their tumors were considered potentially platinum sensitive. Responding patients received 6 courses while palliative treatment for nonresponders was provided. Of the 22 patients with tumor recurrence, 8 patients responded with one partial response (PR) and 7 complete clinical responses (CCR). Two out of the 8 patients with platinum resistant disease demonstrated short lasting PR. Seven patients with CCR underwent second-look operation and in two a pathological CR was documented. Median time to progression was 6 mo (4-12). The median overall survival was 12 mo (4-20). Myelotoxicity despite G-CSF administration was significant with grade 4 leukopenia in 40% and grade 3 thrombocytopenia in 20% of patients. Central nervous system (CNS) toxicity was significant with 30% somnolence, 20% disorientation and an episode of grand-mal epilepsy ascribed to ifosfamide. With a 33% response rate the combination is as effective as new agents employed in relapsed ovarian cancer. Platinum-refractory disease may respond to a lesser degree. The most important determinant of response was the progression-free interval from first-line chemotherapy. Whether patients recurring after carboplatin plus cyclophosphamide have a greater chance to respond to cisplatin plus ifosfamide or vice-versa cannot be supported by the current data and therefore randomized studies should be performed to this end.     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs     

奥沙利铂联合羟基喜树碱治疗晚期胃癌临床分析

背景与目的体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用.本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比.方法采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性.结果治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19).治疗组有效率高于对照组,两组差异有显著性(P<0.05).两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内.结论L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受.