FOLFOX方案化疗对晚期结直肠癌患者免疫功能的影响

目的 研究FOLFOX方案化疗对晚期结直肠癌患者免疫功能的影响.方法 43例晚期结直肠癌患者中22例接受了FOLFOX方案化疗（化疗组）,21例未接受化疗（对照组）.分别于化疗前、化疗结束时和化疗结束3个月后,取患者外周静脉血,采用抗体标记流式细胞仪检测外周血CD4＋T细胞中CD4＋CD25＋Foxp3＋T细胞所占比例;并通过ELISA法检测外周血中Th1/Th2细胞因子（IL-2、IFN-γ、IL-4和IL-10）水平.结果 化疗结束时,相对于化疗前和对照组,化疗组CD4＋CD25＋Foxp3＋T细胞比例显著降低 [（4.15±0.56）%比（5.60±0.88）%和（5.38±0.92）%,均P＜0.01];外周血IL-4和IL-10水平亦显著降低,IFN-γ和IL-2水平则明显升高（均P＜0.01）.化疗结束后3个月,CD4＋CD25＋Foxp3＋T细胞比例略微升高 [（4.53±0.58）%],但仍低于化疗前和对照组（P＜0.01）;而IFN-γ、IL-2、IL-4和IL-10则恢复到化疗前和对照组同期水平（均P＜0.01）.结论 FOLFOX化疗可降低晚期结直肠癌患者的调节性T细胞的比例,引起Th1/Th2细胞因子平衡向Th1漂移,从而有利于患者肿瘤免疫抑制的解除.     

直肠腔内滴注化疗药物治疗晚期直肠癌

目的 研究直肠腔内滴注化疗药物对未能手术切除的晚期直肠癌患者的治疗效果。方法 对８６例未能切除的晚期直肠癌患者分为肠腔内化疗组（肠化组）和对照组。４３例肠化组患者采用直肠腔内滴注化疗药物氟脲嘧啶溶液或复方氟脲嘧啶多相脂质体口服液的给药方法,辅以中药治疗。４３例对照组口服化疗药物呋喃氟脲嘧啶片或复方氟脲嘧啶多相脂质体及中药治疗。结果 肠化组平均生存期为１８．２个月,比对照组平均增加８．４个月（ＳＤ＝０．６７,ｔ＝１２．５４,Ｐ〈０．０１）,同时患者的症状有所改善。结论 直肠腔内滴注化疗药物可延长晚期不能行手术治疗的直肠癌患者的生存时间。     

三联新辅助治疗对局部进展期低位直肠癌细胞免疫功能的影响

目的探讨三联新辅助治疗对局部进展期低位直肠癌患者细胞免疫功能的影响及其可行性。方法综合应用放疗、热疗及化疗作为低位直肠癌术前新辅助治疗的干预措施,治疗37例不同临床分期的低位直肠癌患者,观察辅助治疗前后及术后的细胞免疫功能,包括T细胞亚群百分率（总T细胞、CD4＋、CD8＋、CD4/CD8）和NK细胞活性以及C-反应蛋白（CRP）、各免疫球蛋白和补体的变化。结果全部病例均施行根治性切除术。所有病例治疗前、治疗后及术后T细胞亚群的百分率、NK细胞活性、C-反应蛋白（CRP）、各免疫球蛋白和补体等各项指标无明显变化,差异无统计学意义（P〉0.05）。结论三联新辅助治疗对局部进展期低位直肠癌患者机体免疫功能无明显影响,是一种安全合理可行的新辅助治疗配伍。     

腹腔化疗对老年结直肠癌病人手术后细胞免疫功能的影响

目的：探讨老年结直肠癌病人手术后腹腔化疗对免疫状况的影响。方法：对1998年1月至2002年12月60岁以上行根治性手术的52例结直肠癌病人进行腹腔化疗前后细胞免疫检测，并将之与我院同期健康老年对照组和行静脉化疗病例进行比较。所有病人于化疗前1d和化疗后1周早晨空腹时静脉采血，测定血清中NK细胞和T细胞亚群。结果：老年结直肠癌病人手术后CD4^＋和NK细胞水平明显低于健康老年人群；老年结直肠癌病人化疗后CD4^＋、CD4^＋／CD8^＋和NK细胞水平低于化疗前，其中静脉化疗病人化疗后较化疗前明显降低，存在统计学意义（P〈0．05）；而腹腔化疗组病人化疗前后上述指标的变化不大，无统计学意义（P〉0．05）。结论：针对老年病人的免疫特点，采用细胞免疫抑制较轻的腹腔化疗方式进行化疗，对老年结直肠癌病人有一定的临床价值。     

结直肠癌术后化疗联合DC—CIK细胞治疗的效果评价

目的探讨结直肠癌术后化疗联合DC-CIK细胞治疗的临床价值。方法选择无锡市第三人民医院收治的结直肠癌84例患者,随机分为观察组和对照组。对照组采取单纯化疗方案治疗,观察组在化疗的基础上联合使用DC—CIK细胞治疗方案,观察两组的临床治疗效果。结果观察组治疗后外周血CD3＋、CD3＋CD4＋、CD3＋CD8＋、CD3-CD56＋与对照组治疗后比较,差异有统计学意义（均P〈0．01）。观察组患者临床治疗有效率优于对照组,差异有统计学意义（P〈0．01）。观察组患者生活质量评分明显高于对照组,差异有统计学意义（均P〈0．01）。观察组患者不良反应发生率低于对照组,差异有统计学意义（均P〈0．01）。结论化疗联合DC—CIK细胞治疗可以明显改善结直肠癌术后患者的免疫功能,提高总体疗效,改善患者的生活质量,降低化疗不良反应的发生。     

高剂量化疗合并自体造血干细胞移植治疗睾丸肿瘤

报告高剂量化疗＋自体造血干细胞移植（ＨＤＣ＋ＡＨＳＣＴ）治疗４例睾丸非精原细胞瘤（ＮＳＧＣＴ）的结果。预处理方案由环磷酰胺（３．０～３．５ｇ／Ｍ２）、足叶乙甙（７００～１０００ｍｇ／Ｍ２）、卡铂（６００～７５０ｍｇ／Ｍ２）组成。治疗中骨髓抑制均达Ⅳ度，无Ⅳ度髓外毒性出现。３例初治进展期患者治疗后１例完全缓解，２例部分缓解，其中１例在移植后６个月病情进展，另２例已持续缓解１５个月；１例复发患者治疗后肿瘤进展。认为ＨＤＣ＋ＡＨＳＣＴ治疗ＮＳＧＣＴ的适应证仍有待进一步探索，使用的预处理方案的剂量强度尚可进一步提高     

诺维本加阿霉素在局部晚期乳腺癌新辅助化疗中的应用

目的：了解诺维本加阿霉素的新辅助化疗方案在局部晚期乳腺癌综合治疗中的作用。方法：３１例Ⅱｂ至Ⅲｂ期的乳腺癌病人,术前均经病理或细胞学检查证实。中位年龄４８岁,化疗用药为ＮＶＢ ４０ｍｇ ｄ１,８＋ＡＤＭ ４０ｍｇ ｄｌ,每３周为一疗程,术前用药２疗程,评估新辅助化疗后肿瘤的缓解情况和随访长期生存率。结果：本组总体化疗有效率为６７．７％,肿瘤原发灶完全缓解（ＣＲ）１例,部分缓解（ＰＲ）２０例,无变化（ＳＤ）１０例;腋淋巴结临床ＣＲ１２例,ＰＲ１４例,ＳＤ５例。术后中位随访期３６个月,术后死亡６例,复发９例,健在１６例。结论：诺维本加阿霉素的联合术前化疗能使局部晚期乳腺癌的原发灶和腋淋巴结缩小,肿瘤降期,亦能减少肿瘤复发和远处转移,且不良反应较轻。     

结直肠癌围手术期T细胞亚群,肿瘤坏死因子—α和可溶性白细 …

目的 观察结直肠癌患者围手术期外周血Ｔ细胞亚群，即所有Ｔ细胞的表面分子（ＣＤ３）、辅助Ｔ细胞表面分子（ＣＤ４）、抑制Ｔ细胞表面分子（ＣＤ８），肿瘤坏死因子－α（ＴＮＦ－α）和可溶性白细胞介素－２受体（ＳＩＬ－２Ｒ）表达的动态变化。方法 应用碱性磷酸酶－抗碱生磷酸酶法和酶免疫法动态检测了６０例结直肠癌患者围手术期外周血Ｔ细胞亚群、ＴＮＦ－α和ＳＩＬ－２Ｒ的表达。结果 结直肠癌患者术前ＣＤ３、ＣＤ４细     

892药液治疗支气管肺癌的临床和实验研究

研究８９２号药液对支气管肺癌的抑癌作用。用Ｔ７３９近交系小鼠肺腺癌细胞移植于小鼠右前肢，随机分为７组，分别给予中药、化疗、中药加化疗，观察各组癌重、病理改变及ＩＬ－２、ＮＫ细胞、ＴＮＦ的变化；将５６例中晚期肺癌病人随机分为２组，给予中药加化疗、单用化疗治疗，观察主症、近期疗效、生存质量等变化。本研究表明８９２药液可抑制移植性Ｔ７３９近交系小鼠肺腺癌癌细胞生长，使之离散、变性、坏死，癌组织周围大量淋巴细胞、单核细胞浸润，并可提高荷癌小鼠脾ＩＬ－２、ＮＫ细胞活性及血清ＴＮＦ水平；加化疗提高ＮＫ细胞活性效果更明显；中药加化疗组近期疗效ＣＲ１例、ＰＲ９例、Ｓ１７例，（对照组ＰＲ５例、Ｓ７例），总有效率（ＣＲ＋ＰＲ）为３３．３３％，高于化疗对照组的１９．２３；在改善临床主症，提高生存质量，延长生存期等方面亦明显高于化疗对照组。８９２号药液对支气管肺癌有一定治疗作用。     

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目的 探讨全植入式（ｄｒｕｇ ｄｅｌｉｖｅｒｙ ｓｙｓｔｅｍ，ＤＤＳ）灌注化疗在晚期胰头癌病例的使用方法和临床疗效。方法 将１９９５～１９９９年３０例晚期胰头癌病例分成２组，Ａ组（１２例）在行减黄、胃肠吻合等姑息性手术的同时，作ＤＤＳ灌注化疗；Ｂ组（１８例）不加做ＤＤＳ，两组进行对比观察。结果 Ａ组（ＤＤＳ组）疗效明显优于Ｂ组（非ＤＤＳ组），特别是带瘤存活率（Ｐ〈０．０１）。Ａ组术后的存活期最长达     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Immunomodulation in Transplantation with Photopheresis

Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.