老年浅表性膀胱癌病人尿道膀胱肿瘤电切术后即刻吡柔比星热灌注与常规灌注的临床观察

目的探究尿道膀胱肿瘤电切术(TURBT)后吡柔比星即刻膀胱热灌注化疗与常规膀胱灌注化疗对老年浅表性膀胱癌病人的疗效。方法选取2014年10月至2016年10月北京老年医院收治的老年浅表性膀胱癌病人74例,采用随机数字表法将研究对象分为观察组(38例)和对照组(36例),所有病人均行TURBT。观察组术后6 h内行即刻吡柔比星膀胱热灌注,并行长期膀胱热灌注化疗,对照组术后1周行长期吡柔比星常温膀胱灌注化疗,随访比较2组病人的肿瘤复发率和不良反应发生情况。结果全部病例随访24个月,观察组膀胱癌复发率显著低于对照组(P0.05),观察组总不良反应发生事件次数显著低于对照组(P0.05)。结论 TURBT后即刻吡柔比星膀胱热灌注化疗是预防老年浅表性膀胱癌病人术后复发的有效方法。     

消痔灵联合羟喜树碱术后膀胱灌注防治初发非肌层浸润性膀胱癌术后复发的临床疗效

目的探讨消痔灵联合羟喜树碱术后膀胱灌注防治初发非肌层浸润性膀胱癌术后复发的临床效果和安全性。方法将86例行膀胱肿瘤部分切除术的初发非肌层浸润性膀胱癌患者随机分为观察组和对照组各43例。观察组患者术后6 d内采用消痔灵联合羟喜树碱行膀胱灌注化疗,对照组单用羟喜树碱行膀胱灌注化疗。每次化疗后记录患者全身反应,并定期进行膀胱镜复查,观察两组患者术后肿瘤复发情况和不良反应情况。结果 86例患者术后随访2年,除对照组中1例患者因经济原因只用药1年外,其余患者均坚持用药。观察组(43例)中5例复发,复发率为11.6%,对照组(42例)中复发10例,复发率为23.8%,两组相比差异显著(P<0.05);两组患者KPS评分比较差异不显著(P>0.05),但与灌注化疗前相比,KPS评分均显著提高;两组术后治疗的不良反应主要包括发热、膀胱刺激症状、呕吐等,观察组不良反应发生率为30.2%,对照组为38.1%,两组相比差异不显著(P>0.05)。结论消痔灵联合羟喜树碱术后膀胱灌注可降低初发非肌层浸润性膀胱癌术后复发率,且毒副作用小,可有效提高患者的生活质量,值得推广。     

老年浅表性膀胱癌患者经尿道膀胱肿瘤电切术后吉西他滨与吡柔比星膀胱热灌注的临床观察

目的探究经尿道膀胱肿瘤电切术(TURBT)后吉西他滨与吡柔比星膀胱热灌注化疗对老年浅表性膀胱癌患者的疗效和安全性。方法回顾性分析2012年4月至2015年4月在北京老年医院泌尿外科行TURBT治疗的老年浅表性膀胱癌患者90例,根据膀胱热灌注化疗药物不同分为吉西他滨组和吡柔比星组,每组45例。吉西他滨组患者1000 mg吉西他滨加入到0. 9%氯化钠溶液500 ml软包装中加热至50℃,吡柔比星组患者40 mg吡柔比星加入到5%葡萄糖溶液500 ml软包装中加热至50℃,2组患者术后6 h内都以300 ml/min流量模式进行循环灌注,治疗1 h,以后每周以同样方法膀胱热灌注1次,共8次。然后每月1次,持续1年。随访比较2组患者的肿瘤复发率、无复发生存时间和不良反应发生情况。应用SPSS 17. 0统计软件对数据进行分析。组间比较采用t检验或χ2检验。无复发生存时间采用Kaplan-Meier生存曲线,比较用Log-rank检验。结果全部病例随访12~36个月,2组患者12个月[8. 89%(4/45) vs 15. 56%(7/45),P=0. 334]和36个月复发率[15. 56%(7/45) vs 28. 89%(13/45),P=0. 128]差异无统计学意义。吉西他滨组患者相比吡柔比星组患者的无复发生存时间长[(32. 99±1. 53) vs (27. 71±1. 95)个月,P=0. 047],总不良反应发生率低[42. 2%(19/45) vs 97. 8%(44/45),P 0. 05]。吉西他滨组患者血尿、尿痛、膀胱炎发生率与吡柔比星组患者差异具有统计学意义(P 0. 05)。结论 TURBT后吉西他滨膀胱热灌注化疗疗效满意,不良反应轻,是预防老年浅表性膀胱癌患者术后复发的有效方法。     

吡柔比星与羟基喜树碱膀胱灌注预防膀胱癌术后复发的有效性及安全性比较

目的：比较膀胱癌在保留膀胱术后或电切术后膀胱灌注吡柔比星与羟基喜树碱对预防患者复发的有效性及安全性。方法采用Meta分析,检索Cochrane Library、PubMed、Embase数据库、中国生物医学文献数据库、万方医学网、中国期刊全文数据库、维普网关于膀胱癌经尿道电切术或部分膀胱切除术后膀胱灌注羟基喜树碱或吡柔比星治疗的比较研究,检索时间截止至2014年7月,采用Cochrane系统评价软件RevMan5．0对符合纳入标准的同质研究进行系统评价。结果共纳入17篇文献1426例膀胱癌患者,其中行保留膀胱术后或电切术后膀胱灌注吡柔比星的患者757例,膀胱灌注羟基喜树碱患者669例。保留膀胱术后或电切术后膀胱灌注吡柔比星的有效率高于羟基喜树碱（OR值为1．31,95％CI为1．02～1．67,P＜0．05）;膀胱灌注吡柔比星的复发率低于羟基喜树碱（OR值为0．76,95％CI为0．59～0．97,P＜0．05）,膀胱灌注吡柔比星的膀胱刺激症状发生率高于羟基喜树碱（OR值为1．54,95％CI为1．13～2．12,P＜0．05）,膀胱灌注吡柔比星的血尿发生率高于羟基喜树碱（OR值为2．46,95％CI为1．24～4．88,P＜0．05）。结论膀胱癌在保留膀胱术后或电切术后膀胱灌注吡柔比星较灌注羟基喜树碱有效率高、复发率低、不良反应发生率高。     

经尿道膀胱肿瘤电切术联合吡柔比星膀胱灌注化疗治疗非肌层浸润性膀胱癌的效果及对钙黏蛋白13甲基化率、Ki-67高表达率的影响

目的探究经尿道膀胱肿瘤电切术(TURBT)联合吡柔比星膀胱灌注化疗治疗非肌层浸润性膀胱癌(NMIBC)的效果及对钙黏蛋白(CDH)13甲基化率、Ki-67高表达率的影响。方法 100例NMIBC患者按照随机数字表法分为对照组及观察组,每组50例。观察并记录两组CHD13、Ki-67高表达率、疗效及术后并发症发生率。结果两组术前CDH13甲基化率差异无统计学意义(P0.05),术后两组CDH13甲基化率明显下降(P0.05),观察组术后3、6个月CDH13甲基化率明显低于对照组(χ~2=4.94,χ~2=5.32,均P0.05);两组术前Ki-67高表达率差异无统计学意义(P0.05),术后两组Ki-67高表达率明显下降(P0.05),观察组术后3、6个月Ki-67高表达率明显低于对照组(χ~2=5.91,χ~2=13.41,均P0.05),经秩和检验,两组疗效差异有统计学意义(U=8.52,P=0.00),观察组总有效率明显高于对照组(χ~2=6.84,P=0.01)。两组术后感染、出血、发热等并发症发生率差异无统计学意义(P0.05)。结论 TURBT联合吡柔比星膀胱灌注化疗能有效降低NMIBC患者CDH13、Ki-67高表达率,提高治疗效果,且不增加术后并发症。     

经尿道电切联合围术期膀胱热灌注治疗老年膀胱癌的疗效

目的观察经尿道膀胱原位癌电切术(TURBT)联合膀胱热灌注治疗老年膀胱癌的临床疗效。方法老年膀胱癌行经尿道电切手术患者76例,随机分成两组。观察组于围术期内即手术前24 h内应用吡柔比星50 mg膀胱灌注,保持60 min,术后即刻采用吡柔比星30 mg+生理盐水30 ml灌注,保留2 h,留置F18三腔气囊尿管3～8 d,术后1 w左右拔除导尿管,行长期灌注化疗方案治疗,予吡柔比星30 mg灌注,第1个疗程为8 w,1次/w,共8次;第2个疗程1次/2 w,共8次。对照组行常规膀胱灌注,术后1 w行吡柔比星30 mg膀胱灌注,1次/w,共8次。观察两组临床疗效、复发率和不良反应的发生情况。结果观察组生活质量改善及症状控制方面均高于对照组,两组相比较有显著性差异(χ2=4.286,P=0.038)。2年复发率观察组3例(7.9%)低于对照组10例(26.3%),差异具有统计学意义(χ2=4.547,P=0.033)。药物毒副反应,观察组稍高于对照组,两组比较没有统计学意义(χ2=2.0166,P=0.156)。结论 TURBT切除结合围术期膀胱热灌注治疗老年浅表性膀胱癌近期生活质量提高,复发率低,不良反应小。     

表浅性膀胱癌TURBT术后吉西他滨和吡柔比星交替膀胱灌注预防复发的疗效

目的探讨经尿道膀胱肿瘤电切术(TURBT)后吉西他滨(GEM)和吡柔比星(THP)交替膀胱灌注化疗预防膀胱癌术后复发的疗效。方法 92例膀胱尿路上皮癌(BUC)患者TURBT术后经尿道插管定期交替膀胱灌注GEM和THP,总时限19个月。分别在术后第3、6、12个月时用膀胱镜或CT复查随访。治疗结束后,根据前次检查情况每6个月或12个月时继续复查,连续5年。结果 5年期间局部复发23例,复发率为26.4%(23/87),局部复发+转移4例,复发转移率4.6%(4/87),死亡2例,死亡率2.3%(2/87),死于与本病不相关9例,失访5例。结论 GEM和THP作为表浅性膀胱癌TURBT术后辅助化疗药物,对于改善预后、减少复发转移和降低死亡率疗效确实,且副作用小,可能成为提高术后疗效的重要手段之一。     

优质护理在老年糖尿病病人行经尿道膀胱肿瘤电切术后膀胱灌注化疗中的应用

正膀胱肿瘤是泌尿系统最常见的肿瘤,其中表浅性膀胱癌占全部膀胱肿瘤的75%～80%[1]。表浅性膀胱癌具有容易复发的特性,术后5年内肿瘤复发率高达24%～84%[2]。研究证明经尿道膀胱肿瘤电切术(TURBT)术后早期辅助性膀胱灌注化疗可有效降低表浅性膀胱癌复发。因此术后定期应用膀胱抗癌药物灌注,已成为膀胱癌整体治疗的有     

吡柔比星联合IFN-α黏膜下注射加膀胱灌注防治浅表性膀胱癌术后复发(附33例报告)

68例浅表性膀胱癌患者随机分为A、B两组。A组33例术中予吡柔比星＋IFN-α黏膜下多中心注射,术后定期膀胱灌注;B组35例仅在术后定期行吡柔比星＋INF-α膀胱灌注。随访1～3a,A组复发率9．09％（3／33）,B组25.71％（9／35）,P〈0.05。认为吡柔比星与IFN-α术中黏膜下多中心注射加术后定期膀胱灌注预防浅表性膀胱癌术后复发疗效显著。     

THP、HCPT序贯膀胱灌注辅助手术治疗非肌层浸润性膀胱癌临床观察

目的观察吡柔比星（THP）、羟基喜树碱（HCPT）序贯膀胱灌注辅助手术治疗非肌层浸润性膀胱癌的临床效果。方法非肌层浸润性膀胱癌121例,均行经尿道膀胱肿瘤切除术（TUR-BT）。术后分别行HCPT（HCPT组,41例）、THP（THP组,49例）和THP、HCPT序贯（序贯组,31例）膀胱灌注治疗,观察三组膀胱癌复发、进展和不良反应情况。结果全部病例随访24个月,序贯组膀胱癌复发率低于HCPT组和THP组（P均〈0.05）,HCPT组与THP组复发率无明显差异,各组膀胱癌进展率无明显差异（P均〉0.05）。HCPT组、THP组、序贯组分别有2、8、6例出现轻度膀胱刺激症状,无其他不良反应。结论 THP、HCPT序贯膀胱灌注辅助手术治疗中度危险性的非肌层浸润性膀胱癌可降低2 a内的复发率,但不能改变膀胱癌的进展。     

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.     

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.     

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.     

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.