贝伐珠单抗导致心肌梗死一例

正贝伐珠单抗(Bevacizumab)作为首个用于临床的靶向血管内皮生长因子(vascular endothelial growth factor,VEGF)药物,目前已广泛应用于临床。随后的研究深入,贝伐单抗联合化疗对非小细胞肺癌、转移性乳腺癌及转移性肾癌等多种实体瘤有效。国内外众多临床研究显示贝伐单抗的严重不良反应发生率低,可用于晚期非小细胞肺癌的维持治疗。现将我科1例肺腺癌患者在使用贝伐珠单抗     

2009年SABCS大会精粹(一)————- 乳腺癌内分泌治疗和辅助化疗新进展

在第32届美国圣安东尼奥乳腺癌大会上,靶向治疗成为了大赢家,抗血管生成的靶向治疗研究取得了突破。RIBBON-2试验评价了贝伐单抗联合化疗用于HER2阴性转移性乳腺癌二线治疗的疗效及安全性。结果显示．化疗联合贝伐单抗组的无进展生存期和总生存期均优于联合安慰剂组,     

联用贝伐单抗可提高乳腺癌患者新辅助化疗的病理完全缓解率

近年来贝伐单抗在转移性乳腺癌辅助治疗中的应用备受争议。三项临床研究（E2100、AVADO、RIBBON-1）的结果均表明贝伐单抗联合化疗用于转移性乳腺癌的一线治疗有良好的疗效。然而,美国FDA则对贝伐单抗在乳腺癌中的疗效表示怀疑,并于2011年11月18日以贝伐单抗未能延长转移性乳腺癌患者的总生存期为理由撤销了其乳腺癌适应证的许可。     

贝伐珠单抗联合立体定向放疗治疗转移性肾癌的初步临床观察

目的 观察贝伐珠单抗联合立体定向放疗治疗转移性肾癌的临床疗效.方法 选取2018年1月至2019年12月本院收治的84例转移性肾癌患者,根据治疗方法的不同分为观察组和对照组,每组42例.对照组采用贝伐珠单抗治疗,观察组采用贝伐珠单抗联合立体定向放疗治疗.比较两组临床疗效、预后及临床风险事件情况.结果 观察组治疗总有效率为97.62％,高于对照组的85.71％(P<0.05);观察组临床风险事件发生率为7.14％,低于对照组的23.81％(P<0.05);观察组预后不良发生率为11.90％,低于对照组的33.33％(P<0.05).结论 贝伐珠单抗联合立体定向放疗治疗转移性肾癌临床效果显著,可有效提高临床疗效及预后质量,降低临床风险事件,值得临床推广应用.     

对贝伐珠单抗在TNBC新辅助化疗应用中的思考

从贝伐珠单抗特点及其在各种乳腺癌治疗中应用现状出发,探讨贝伐珠单抗应用于特定乳腺癌人群（如TNBC）或乳腺癌特定治疗阶段（如新辅助化疗）的获益可能性。     

紫杉醇联合贝伐珠单抗化疗治疗卵巢癌的临床效果

目的分析紫杉醇联合贝伐珠单抗化疗治疗卵巢癌的临床疗效。方法抽取2012年1月至2016年12月前来我院接受化疗的118例卵巢癌患者,根据化疗方案将其分为两组,各59例。研究组患者选择紫杉醇联合贝伐珠单抗化疗方案,对照组选择紫杉醇加卡铂,比较临床效果。结果研究组化疗总有效率高于对照组,随访三年,研究组患者生活质量评分及患者三年存活率均高于对照组,差异有统计学意义(P0.05);化疗期间不良反应发生率研究组低于对照组,但无统计学意义(P0.05)。结论紫杉醇联合贝伐珠单抗化疗治疗卵巢癌疗效显著,能提高化疗安全性,减少副作用,延长患者生存时间,值得推广应用。     

同步调强放疗联合紫杉醇与贝伐珠单抗注射液治疗老年局部晚期非小细胞肺癌患者的疗效评价

目的 探究同步调强放疗(IMRT)联合紫杉醇、贝伐珠单抗注射液治疗老年局部晚期非小细胞肺癌(NSCLC)患者的效果.方法 选取2016年2月至2017年8月本院收治的65例老年局部晚期NSCLC患者作为研究对象,均采用紫杉醇、贝伐珠单抗注射液进行化疗,根据治疗方法不同分为对照组(n=32)和观察组(n=33).对照组实...     

紫杉醇联合贝伐珠单抗化疗治疗卵巢癌的临床效果

目的探究紫杉醇联合贝伐珠单抗化疗治疗卵巢癌的临床效果。方法选取我院2015年4月至2018年2月接受治疗的卵巢癌患者62例,其中31例采取环磷酰胺、洛铂联合紫杉醇化疗,为对照组;另外31例采用紫杉醇联合贝伐珠单抗化疗,为观察组。比较分析两组的近期疗效和不良反应发生率。结果观察组近期有效率(83.87%)高于对照组(54.84%),以不良反应III、IV级为主,其白细胞减少发生率(9.68%)、恶心呕吐发生率(3.23%)和腹泻发生率(6.45%)均低于对照组[(35.48%),(25.81%),(32.26%)],差异有统计学意义(P0.05);在神经毒性发生率上,两组差异(22.58%16.13%)无统计学意义(P 0.05)。结论紫杉醇联合贝伐珠单抗化疗应用于卵巢癌患者治疗中有利于提高其近期疗效,其安全性可靠,值得临床进一步实践。     

贝伐单抗联合多西环素治疗胶质瘤的疗效与机制研究

【摘要】 目的 探讨贝伐单抗联合多西环素治疗胶质瘤的疗效与相关机制。方法〓以胶质瘤原代细胞为模型,分别用生理盐水、贝伐单抗和贝伐单抗联合多西环素处理胶质瘤细胞,并分为生理盐水组、贝伐单抗组和贝伐单抗联合多西环素组。采用MTS法及克隆形成实验检测各处理组细胞的增殖情况;同时利用划痕及Transwell侵袭实验,检测不同处理组细胞的迁移及侵袭能力,并在裸鼠皮下注射胶质瘤原代细胞,15天后分别用生理盐水、贝伐单抗和贝伐单抗联合多西环素进行治疗处理,观察移植瘤大小、重量差异,并进一步通过免疫组化法验证各组移植瘤中CD34及Ki67的差异。 结果〓贝伐单抗组细胞增殖和克隆形成能力、迁移和侵袭能力明显低于生理盐水组（P＜005）,而贝伐单抗联合多西环素组抑制效果更显著且与贝伐单抗组比较,差异有统计学意义（P＜005）;贝伐单抗组处理后移植瘤的大小、重量和体积均抑制明显,与生理盐水组比较差异有统计学意义（P＜005）,而贝伐单抗联合多西环素组抑制更为明显,与贝伐单抗组比较,差异均有统计学意义（P＜001）;贝伐单抗组的CD34及Ki67表达较生理盐水组下降（P＜001）,贝伐单抗联合多西环素组下降更明显,与贝伐单抗组比较,差异均有统计学意义（P＜001）。结论〓贝伐单抗联合多西环素治疗胶质瘤,通过抑制细胞增殖、迁移和侵袭能力,药物产生叠加效应显著增强抗肿瘤作用,可减少肿瘤新生血管的形成,从而抑制胶质瘤的生长、重量和体积,为临床治疗胶质瘤提供了理论依据。     

贝伐珠单抗联合紫杉醇+顺铂对晚期卵巢癌腹腔积液患者腹水中VEGF和CA-125水平的影响

目的 探讨贝伐珠单抗联合紫杉醇+顺铂对晚期卵巢癌腹腔积液患者腹水中血管内皮生长因子(VEGF)、癌抗原-125(CA-125)水平的影响.方法 选取2017年1月至2019年11月于本院接受治疗的82例晚期卵巢癌腹腔积液患者作为研究对象,按照随机数字表法分为两组,各41例.对照组行紫杉醇+顺铂化疗,研究组在对照组基础上联合贝伐珠单抗治疗.比较两组临床疗效、腹水中VEGF和CA-125水平及不良反应发生情况.结果 研究组治疗总有效率高于对照组,腹水中VEGF、CA-125水平均低于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较差异无统计学意义.结论 晚期卵巢癌腹腔积液患者接受贝伐珠单抗联合紫杉醇+顺铂治疗,可有效提高化疗效果,清除腹腔积液,降低腹水中VEGF、CA-125水平,且不增加不良反应,值得临床推广运用.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.