p53蛋白表达和肿瘤微血管生成与肝癌发展及预后的关系

目的探讨p53蛋白表达和肿瘤微血管生成与肝细胞癌(HCC)发展及预后的关系.方法采用免疫组化方法检测50例肝细胞癌组织中p53蛋白的表达,并用抗CD34抗体标记癌组织血管内皮细胞,计算肿瘤微血管密度(microvessl density,MVD).分析p53蛋白和MVD与HCC临床病理学特征之间的关系.结果 p53阳性表达为癌细胞核棕黄色着色,CD34染色定位在血管内皮细胞上,HCC的p53表达及MVD与肿瘤大小、病灶数目、病理分级、门静脉癌栓形成、包膜是否完整显著相关(P＜0.05).p53蛋白表达阳性者MVD值显著高于阴性者(P＜0.05);p53蛋白表达阳性或MVD≥148的肝癌患者术后生存时间比p53蛋白表达阴性或MVD＜148者短(P＜0.05).结论 p53与肿瘤血管生成密切相关,p53蛋白及MVD可作为肝癌预后判断的一个重要指标.     

大肠癌组织中p53蛋白和增殖细胞核抗原表达的临床意义

目的探讨增殖细胞核抗原(PCNA)和p53蛋白在大肠癌中的表达及临床意义.方法应用免疫组化S-P方法检测60例大肠腺癌中的PCNA及p53蛋白的表达.结果大肠癌中p53蛋白阳性表达率为63.3%,PCNA增殖指数为(78.2±24.5)%,p53蛋白表达阳性者其细胞增殖活性为(83.1±18.6)%,明显高于p53蛋白阴性组(61.2±11.3)%(P＜0.01).p53蛋白阳性表达率与PCNA增殖指数随着大肠癌病理分级的上升而增加,且与预后呈负相关.结论同时检测p53蛋白、PCNA对大肠癌的诊断、病理分级及预后的评估有重要的指导意义.     

胃癌、癌前病变组织中p53蛋白表达的临床意义

目的探讨胃癌及癌前病变组织中p53蛋白表达的临床意义.方法采用间接免疫荧光标记染色和流式细胞术,检测并比较10例正常胃粘膜、13例浅表性胃炎、10例肠上皮化生、11例不典型增生及16例胃癌组织中p53蛋白的表达水平.以DNA指数、增殖指数(PI)、荧光指数(FI)为分析指标.结果胃癌、不典型增生及肠上皮化生的FI值分别为1.866±0.096、1.143±0.060、1.050±0.074,与正常胃粘膜(0.602±0.077)比较,均有显著性差异(P＜0.05),与浅表性胃炎(0.898±0.052)比较,也有显著性差异(P＜0.05).胃癌组织的FI值高于不典型增生及肠上皮化生(P＜0.05).不典型增生组织p53蛋白阳性率为25.0%(2/8),胃癌为68.4%(13/19),在不典型增生及胃癌组织中,其异倍体的FI值、PI值和p53蛋白阳性率与二倍体者比较,均有显著性差异(P＜0.05).结论胃癌组织p53蛋白的表达水平高于癌前病变及正常胃粘膜组织;随病变向恶性转化,p53蛋白表达水平、PI值及异倍体率均增高.因此,检测p53蛋白表达水平对胃癌的诊断具有一定意义.     

胃癌p53蛋白表达及与细胞形态计量、DNA含量、增殖细胞核抗原(PCNA)表达的关系

探讨胃癌p53蛋白表达与胃癌生物学行为、细胞核形态、DNA含量及增殖细胞核抗原(PCNA)表达的关系.采用免疫组化S-P法、改良Feulgen染色法及图象分析技术对58例原发进展期胃癌进行p53、PCNA、DNA含量及细胞核形态检测.结果发现,p53蛋白表达与胃癌Lauren分型无关(p＞0.05),而与胃癌浸润深度、淋巴结转移有关(p＜0.05);p53蛋白表达阳性胃癌,癌细胞核面积大,核长径长,核周长长,PCNA表达高,DNA指数高,DNA2C细胞检出率低,DNA＞5C检出率明显增高(p＜0.05).上述结果表明p53蛋白检测对判断胃癌浸润深度、淋巴结转移及预后有重要意义;p53蛋白表达与胃癌癌细胞核形态关系密切;p53蛋白表达阳性胃癌具有更强的增殖活性,是它发生浸润、转移的基础.     

肺癌中p53和p63 蛋白表达的高通量组织微阵研究

目的探讨p53和p63蛋白在肺癌中的表达及意义,并比较两者之间的表达关系.方法组织微阵(tissue microarray,TMA)技术和免疫组化S-P方法(immunohistochemistry,IHC).结果p53蛋白IHC染色中,TMA有价值的肿瘤标本为234(72.9%),总的表达率(+、++、+++)率为48.3%(113/234).随着肺鳞状细胞癌(squamous cell carcinoma,SCC)和腺癌(adenocarcinoma,Ad)分级升高,p53蛋白表达增强,与肺SCC及Ad病理分级有明显相关性(P＜0.05).p53蛋白表达与生存期呈明显负相关性(P＜0.05).p53蛋白表达与病理分型和临床分期等无明显相关性(P＞0.05).p53蛋白表达在肺癌原发肿瘤和转移淋巴结之间无明显差异(P＞0.05).p63蛋白IHC染色中,TMA有价值的肿瘤标本为264(82.2%),总的表达率(+、++、+++)为67.8%(179/264).p63蛋白在小细胞肺癌(small cell lung carcinoma,SCLC)表达最低16.0%(4/25),非小细胞肺癌(non-small cell lung carcinoma,NSCLC)与SCLC之间表达存在明显差异(P＜0.05).p63蛋白表达与病理组织分级、临床分期、生存期等无明显相关性(P＞0.05).p63蛋白表达在肺癌原发肿瘤和转移淋巴结之间无明显差异(P＞0.05).结论1.p53是肺癌的独立预后指标;2.p63蛋白在肺癌的不同病理类型的不同表达,说明肺癌的不同病理类型分子机理有所不同;3.p53蛋白和p63蛋白表达之间无明显相关性;4.TMA可以有效分析比较组织中肿瘤标记物的表达情况.     

鼻咽癌组织中P53和PCNA表达与临床分期、VCA/IgA、EA/IgA、放射敏感性和预后的关系

背景与目的:P53和增殖细胞核抗原(proliferating cell nuclear antigen,PCNA)与恶性肿瘤的发生发展和预后有一定关系.有关P53和PCNA与鼻咽癌临床分期、VCA/IgA、EA/IgA、放射敏感性和预后关系的文献报道不多.本研究检测鼻咽癌组织中P53和PCNA的表达强度,并探讨其与上述临床指标的关系.方法:用免疫组化的方法检测80例单纯放疗的鼻咽癌组织中P53和PCNA的表达强度,通过卡方检验分析其与临床分期、VCA/IgA、EA/IgA、放疗剂量36Gy时鼻咽肿物和颈淋巴结的消退情况及随访5年生存率的关系,探讨其临床意义.结果:80例单纯放疗鼻咽癌组织中P53阳性表达率92.5%,PCNA阳性表达率100%,PCNA表达强度与放疗中剂量达36Gy时鼻咽肿物和颈淋巴结的消退情况Mr和Pr有差异显著性(0.05＞P＞0.01),而P53则没有差异显著性(P＞0.05);P53和PCNA表达强度与临床分期、VCA/IgA、EA/IgA、以及三组生存期＜3年、＜5年、≥5年均无差异显著性(P＞0.05).结论:P53和PCNA与鼻咽癌的发生有一定相关性;PCNA与鼻咽癌放射敏感性有关,而P53则与之无关;P53和PCNA与鼻咽癌的临床分期、VCA/IgA、EA/IgA以及预后无关.     

p21^waf1、p53和PCNA在肺癌组织中的表达

目的了解肺癌组织中p21waf1、p53和PCNA蛋白表达情况,研究肺组织良恶性增殖的不同机制.方法运用免疫组织化学方法,检测76例肺癌组织p21waf1、p53及PCNA的表达情况,分析三种蛋白表达与肺癌临床特征的关系,并与59例肺良性疾病组织相关指标进行比较.结果(1)肺癌组织p21waf1和p53蛋白表达阳性率分别为75%和47.37%,PCNALI值为0.44±0.32,均显著高于肺良性疾病组织(分别为35.59%、3.39%和0.09±0.14).(2)肺癌组织p21waf1、p53和PCNA蛋白表达与肺癌临床分期及细胞分化程度无关.各型肺癌之间p21waf1、p53蛋白表达也无明显差异.(3)肺鳞癌PCNALI值为0.51±0.32,明显高于小细胞肺癌(0.30±0.36).(4)肺癌组织p21waf1和p53蛋白表达与PCNA无关,p21waf1和p53蛋白表达之间也未发现相关性.而肺良性疾病组织p21waf1和p53蛋白表达与PCNA相关.结论(1)肺癌组织p21waf1与p53蛋白表达明显上调.(2)肺癌细胞增殖程度很高.(3)肺鳞癌细胞DNA损伤修复能力可能高于小细胞肺癌.(4)肺良性疾病细胞增殖过程中,p21waf1、p53及PCNA三种蛋白有协调作用,而在肺癌细胞则否.     

肺癌中p16及pRB与cyclinD1和PCNA基因蛋白的表达及预后意义的评估

目的:研究抑癌基因蛋白p16、pRB、细胞周期素D1(cyclinD1)及PCNA在肺癌中的表达及与预后的关系.方法:应用免疫组织化学方法检测p16、pRB、cyclinD1及PCNA的表达,结果由COX回归模型与Kaplan-Meier单因素分析处理.结果:1)65例肺癌标本均示PCNA阳性,但表达程度不同,非小细胞肺癌(NSCLC)＞小细胞肺癌(SCLC),P＜0.05.PCNA高表达与p16-、pRB 、PT状况、远处转移呈正相关.增殖指数(PI)Ⅰ～Ⅱ级的生存时间≥24个月为81.82%,Ⅲ～Ⅳ级为18.18%,P＜0.01.2)p16阳性率为50.77%,p16的表达与腺癌分化程度有关,高分化＞中分化＞低分化,P＜0.01,与鳞癌分化无关.p16 与p16-患者生存期≥24个月的比率分别为72.73%和27.27%,P＜0.05.pRB阳性表达率为58.46%,鳞癌、腺癌较高,SCLC较低,与生存期无关.cyclinD1阳性表达率为60.00%,其中磷癌72.41%,腺癌58.33%,SCLC 25.00%,P=0.05.3)p16-/pRB 细胞增殖活性较强,生存期较短;cyclinD1 /p16-/pRB 生存期较短,增殖活性较强.结论:PCNA及p16分别是肺癌进展及预后判断的独立指标;PCNA、p16、pRB、cyclinD1联合检测对肺癌的预后评估更有价值和更客观;小细胞肺癌pRB表达的缺失具有鉴别诊断意义.     

食管癌VEGF与p53蛋白表达的临床意义

目的探讨食管癌VEGF与p53蛋白表达在食管癌的病理学意义及其与血管新生的关系。方法选择40例手术切除的食管癌标本,确定其病理学特点,并对其VEGF与p53蛋白和微血管进行免疫组织化学染色,明确VEGF与p53蛋白表达和血管新生的强度。结果VEGF表达阳性率为67.5％,p53蛋白表达阳性率为50.0％。MVD值为29.00±24.56。有淋巴结转移者与无淋巴结转移者VEGF表达的阳性率有明显差异(P<0.05)。VEGF表达阴性、弱阳性及强阳性者间MVD值比较均有显著差异(P值均<0.05)。p53蛋白表达阴性、弱阳性及强阳性者间MVD值比较无显著差异(P值均>0.05),与VEGF表达阳性率也无显著差异(P值均>0.05)。结论食管癌VEGF表达与血管新生密度及与淋巴结转移均有显著相关。p53蛋白表达与VEGF表达及血管新生强度均可能无密切关系。     

PCNA、p53基因与上皮性卵巢癌预后的研究

目的探讨与上皮性卵巢癌预后有关的因子.方法回顾性分析89例上皮性卵巢癌的临床及病理资料,并用p53和PCNA单克隆抗体分别检测p53和PCNA的表达水平,用Cox模型对上述因子作生存分析.结果p53蛋白表达阳性率为62.9%,PCNA表达阳性率为82.0%.经单因素Cox模型分析,与预后有关的因子有淋巴转移、血道转移、直接蔓延、残存病灶、临床分期、血红蛋白值(P＜0.05);多因素分析,影响预后的独立因子有血道转移、临床分期、化疗疗程、PCNA定量(P＜0.05).结论临床分期、血道转移、PCNA定量和化疗疗程均是影响上皮性卵巢癌生存期的因素.     

洛铂联合多西他赛行肿瘤细胞减灭术加腹腔热灌注化疗治疗腹膜癌的临床观察

目的 分析洛铂联合多西他赛行肿瘤细胞减灭术（cytoreductive surgery, CRS）加腹腔热灌注化疗（hyperthermic intraperitoneal chemotherapy, HIPEC）治疗腹膜癌（peritoneal carcinoma, PC）的围手术期安全性及疗效。 方法 PC患者行CRS+HIPEC治疗,药物为洛铂50 mg/m2、多西他赛60 mg/m²,加入12 000 ml 0.9%氯化钠溶液加热至（43±0.5）℃持续灌注60 min。记录术后6天体温和心率变化、围手术期不良事件、血常规及血生化指标、术后患者恢复情况及生存结果。结果 90例PC患者行95次CRS+HIPEC,手术时间180~450 min (中位数485 min）;术后6天最高体温、心率分别为36.4℃~38.6℃（中位数37.5℃）、76~124 bpm（中位数100 bpm）,严重不良事件16例,包括围手术期死亡2例。中位生存期20.8月（95%CI: 13.1~25.8月）,1、3、5年生存率分别为75.6%、45.6%、43.3%。 结论 洛铂联合多西他赛进行CRS+HIPEC治疗PC安全性可接受,有助于延长患者生存期。     

Endoscopic Endonasal Dacryocystorhinostomy: Best Surgical Management for DCR

EEDCR is a highly rewarding Endoscopic procedure for management of dacryocystitis when epiphora does not respond to medications or repeated syringing of nasolacrimal duct. It is a simple, less time consuming, safe but skilful, highly satisfying surgery both for the patients as well as the surgeons. There is very big advantage of EEDCR, it is close 100% successful procedure, even if there is recurrence of epiphora it is again correctable fully with no residual affects. EEDCR is far more superior to External DCR/Laser DCR and there are definite reasons for it. A total number of 578 cases have been operated by me from April 1, 2005 to March 31, 2011, only very few reoccurrences were there and they were corrected easily so much so that it can be said that it is a close 100% successful procedure and best surgical management of DACRYOCYSTITIS up to date. The successful outcome was defined as symptomatic relief from epiphora and dacryocystitis and a patent nasolacrimal duct upon syringing at the end of procedure and on follow up of patient.     

参麦注射液对阿霉素所致大鼠心肌损伤保护作用的实验研究

目的　观察参麦注射液 (SMI)对阿霉素 (ADM )诱导大鼠心肌损伤的保护作用和抗氧化作用。方法　选用ADM诱导大鼠心肌损伤模型。SD大鼠 60只 ,随机分为 3个组 ,每组 2 0只 ,分别为正常组、治疗组、对照组。正常组 :实验第 1～ 9天注射生理盐水 ,每天 3ml/kg ,1次 /天。治疗组 :实验第 1～ 9天注射参麦注射液 ,每天 3ml/kg ,1次 /天 ,第 4天注射阿霉素 ,隔天 1次 ,连用 3次 ,用生理盐水配置成 1mg/ml,每次 3mg/kg。对照组实验 1～ 9天注射生理盐水 ,每天 3ml/kg ,1次 /天。第 4天注射阿霉素 ,以后隔天 1次 ,连用 3次 ,用生理盐水配置成 1mg/ml,每次 3mg/kg。到期测定血丙二醛 (MDA )含量和超氧化物歧化酶(SOD )活性 ,并进行心肌病理检查。结果　对照组MDA水平明显高于治疗组 ,对照组SOD水平则显著低于治疗组 ,即加用SMI可提高SOD活性 ,降低MDA含量。SMI能明显减轻大鼠心肌损伤 ,对照组与治疗组比较 ,治疗组心肌损伤明显减轻 ,治疗组与正常组比较无显著性差异。参麦注射液有抗氧化作用 ,与对照组比较 ,血SOD水平升高 ,MDA水平降低 ,心肌病理计分下降。结论参麦注射液有抗氧化作用和对阿霉素所引起的心脏毒性具有保护作用 ,为临床寻找有效的阿霉素所致心肌损伤保护药物提供良好的客观依据 ,值得临床推广应用     

Denosumab in patients with cancer and skeletal metastases: A systematic review and meta-analysis

Background

We conducted a systematic review of the literature to determine the efficacy and safety of denosumab in reducing skeletal-related events (SRE) in patients with bone metastases.

Methods

A literature search using MEDLINE, EMBASE, Web of Science and The Cochrane Collaboration Library identified relevant controlled clinical trials up-to-March 14, 2012. Two independent reviewers assessed studies for inclusion, according to predetermined criteria, and extracted relevant data. The primary outcomes of interest were SRE, time to first on-study SRE, and overall survival. Secondary outcomes included pain, quality of life, bone turnover markers (BTM), and adverse events.

Results

Six controlled trials including 6142 patients were analyzed. Compared to zoledronic acid, denosumab had lower incidence of SRE with a risk ratio (RR) of 0.84 (95% confidence intervals (CI) 0.80–0.88), delayed the onset of first on-study SRE (RR 0.83; 95% CI 0.75–0.90) and time to worsening of pain (RR 0.84; 95% CI 0.77–0.91). No difference was observed in overall survival with pooled hazard ratio of 0.98 (95% CI 0.90–1.0). For total adverse events, denosumab was similar to zoledronic acid (RR 0.97; 95% CI 0.89–1.0). No significant differences were observed in the frequency of osteonecrosis of the jaw (RR 1.4; 95% CI 0.92–2.1). Patients on denosumab had a greater risk of developing hypocalcemia (RR 1.9; 95% CI 1.6–2.3).

Conclusions

Denosumab was more effective than zoledronic acid in reducing the incidence of SRE, and delayed the time to SRE. No differences were found between denosumab and zoledronic acid in reducing overall mortality, or in the frequency of overall adverse events.     

体内诱导艾氏腹水瘤细胞的耐药性研究

肿瘤细胞耐药性的存在是临床化疗失败的主要原因之一。本实验在小鼠体内用阿霉素（ADR）诱导艾氏腹水瘤细胞（EHR）的耐药性，探讨细胞产生耐药性的机理。HPLC法测定细胞内药物浓度．结果表明耐药细胞─—EHR/ADR细胞内ADR积聚低于EHR细胞，而对ADR外排快于EHR细胞；异博定（VER）增加EHR／ADR细胞对ADR的摄取并阻滞其外排．而对EHR影响不大，揭示EHR／ADR细胞具有MDR特性。     

Oxygen for relief of dyspnoea in mildly- or non-hypoxaemic patients with cancer: a systematic review and meta-analysis

The aim of this study was to determine the efficacy of palliative oxygen for relief of dyspnoea in cancer patients. MEDLINE and EMBASE were searched for randomised controlled trials, comparing oxygen and medical air in cancer patients not qualifying for home oxygen therapy. Abstracts were reviewed and studies were selected using Cochrane methodology. The included studies provided oxygen at rest or during a 6-min walk. The primary outcome was dyspnoea. Standardised mean differences (SMDs) were used to combine scores. Five studies were identified; one was excluded from meta-analysis due to data presentation. Individual patient data were obtained from the authors of the three of the four remaining studies (one each from England, Australia, and the United States). A total of 134 patients were included in the meta-analysis. Oxygen failed to improve dyspnoea in mildly- or non-hypoxaemic cancer patients (SMD=-0.09, 95% confidence interval -0.22 to 0.04; P=0.16). Results were stable to a sensitivity analysis, excluding studies requiring the use of imputed quantities. In this small meta-analysis, oxygen did not provide symptomatic benefit for cancer patients with refractory dyspnoea, who would not normally qualify for home oxygen therapy. Further study of the use of oxygen in this population is warranted given its widespread use.     

邻近腋窝的上皮样血管内皮瘤1例报道

We described a case of a 71-year-old woman with an epithelioid hemangioendothelioma (EHE) in her left axilla,a rare location which hasn't been reported yet. The patient suffered from numbness, pain and decreased muscle strength of her left upper extremity. Sonography revealed a hypoechoic mass surrounded the axillary artery and brachial artery. No obvious capsule was demonstrated. CT showed a soft-tissue mass with some calcifications and peripheral ring-like en-hancement. The MRI indicated a mass with mainly intermediate signal intensity on Tl-weighted imagine and intermediate signal intensity on T2-weighted imagine. The diagnosis was confirmed by histopathologic examination after surgery. There are some correlations of these imaging features with its histopathologic characters.     

GF方案与TP方案一线治疗晚期非小细胞肺癌的临床对照研究

Objective  

The aim of the study was to evaluate the efficacies of initial gemcitabine plus cisplatin (GP) and paclitaxel plus cisplatin (TP) 1st-line chemotherapies for advanced non-small cell lung cancer (NSCLC) and observe their side effects.     

鼻咽癌患者放射性骨坏死引起的正电子显像假阳性结果1例及文献复习

目的:探讨鼻咽癌(NPC)患者放射性骨坏死(osteoradionecrosis,ORN)引起正电子假阳性结果的原因及避免因此引发诊断错误的方法。方法:回顾性分析1例放疗后的鼻咽癌患者,行鼻咽部MRI及正电子显像后,再行组织病理学检查,对三种结果进行分析、比较。结果:MRI及正电子显像均诊断患者颅底区域肿瘤复发,组织病理学结果则显示鼻咽部病灶为放射性骨坏死。因此正电子扫描结果为假阳性结果。结论:鼻咽癌患者放疗后所致的放射性骨坏死容易引起正电子显像假阳性结果并可能引发不必要的治疗,因此NPC患者的正电子图像,对于可能的局限性肿瘤复发诊断,应该非常慎重。     

Bortezomib-related neuropathy may mask CNS relapse in multiple myeloma: A call for diligence

Background: Neuropathy is a common adverse effect of bortezomib. Isolated central nervous system (CNS) relapse in MM remains exceedingly rare and carries a dismal prognosis. We present an unusual case of bortezomib related neuropathy masking a CNS relapse of MM. Case presentation: A 57-year-old female was diagnosed with standard-risk MM with clinical and cytogenetic features not typically associated with CNS involvement. She was treated with 4 cycles of bortezomib/cyclophosphamide/dexamethasone (VCD) and achieved a VGPR, after which she underwent an autologous stem cell transplant (ASCT) followed by bortezomib maintenance. Six months after ASCT she developed symptoms suggestive of peripheral neuropathy which was attributed to bortezomib. However the symptoms persisted despite discontinuation of bortezomib. Imaging and cerebrospinal fluid analysis subsequently confirmed a CNS relapse. Discussion: CNS involvement in MM (CNS-MM) is uncommon and is considered an aggressive disease. Recently published literature has reported biomarkers with prognostic potential. However, isolated CNS relapse is even less common; an event which carries a very poor prognosis. Given the heterogeneous neurologic manifestations associated with MM, clinical suspicion may be masked by confounding factors such as bortezomib-based therapy. The disease may further remain incognito if the patient does not exhibit any of the high risk features and biomarkers associated with CNS involvement. Conclusion: In the era of proteasome inhibitor (PtdIns)/immunomodulator (IMID)-based therapy for MM which carries neurologic adverse effects, it is prudent to consider CNS relapse early. This case further highlights the need for more robust biomarkers to predict CNS relapse and use of newer novel agents which demonstrate potential for CNS penetration.