EGCG影响TNF-α诱导的NF—KB／p65入核及促凋亡效应

背景与目的：研究表明，表没食子儿茶素没食子酸酯（epigallocatechin-3-gallate，EGCG）抗肿瘤作用机制尚不十分清楚，本研究旨在观察EGCG调节TNF—α诱导的胃癌SGC-7901细胞核转录因子KB／p65（NF—KB／p65）的入核并发挥诱导凋亡的作用。方法：Hoechst染色法检测EGCG处理SGC-7901细胞前后凋亡的形态学改变；Westemblot方法观察EGCG作用前后NF—KB／p65蛋白在胞质内及核内的变化；流式细胞术检测EGCG调节NF—KB／p65入核前后细胞凋亡的变化；DNA ladder方法观察EGCG诱导细胞DNA断裂情况。结果：Hoechst染色法显示EGCG处理后细胞形态改变：核致密浓染或呈碎块状、苍白色。Western blot方法检测发现，10ng／ml的TNF—d作为NF—KB／p65入核的诱导剂分别作用细胞30、60、90和120min后，核内NF—KB／p65明显增多并在60min达高峰；60斗g／ml的EGCG预处理细胞不同时间（0、12、24、36和48h）后，再以TNF—d处理60min，检测发现核内NF—KB／p65明显下降并在24h达低谷；不同浓度EGCG（40、60、80和100μg／m1）预处理细胞24h后，再加TNF—d处理60min，核内NF—KB／p65呈时间依赖性下降。流式细胞术显示，10ng／ml的TNF—α处理细胞60min后，细胞凋亡率为3．7％，60μg／mlEGCG处理细胞24h后再以TNF—α处理细胞，凋亡率为16．6％；NF—KB通路阻断剂吡咯啉烷二甲基硫脲（PDTC）100μmoL／L预处理30min后再以TNF—α处理细胞60min，细胞凋亡率为21．4％。EGCG60μg／ml处理细胞24h、PDTC处理细胞30min后再以TNF—α处理细胞60min，DNA凝胶电泳出现明显梯形条带。结论：EGCG能够抑制TNF—α诱导的NF—KB／p65入核，并可能通过此机制发挥诱导细胞凋亡的作用。     

乌骨藤制剂诱导人肝癌细胞Bel-7402凋亡的实验研究

目的:探讨乌骨藤制剂对人肝癌细胞Bel-7402株的影响并初步探讨其机制。方法:分别用不同浓度的乌骨藤制剂处理人肝癌细胞Bel-7402,未经药物处理的细胞为阴性对照组,采用MTT法检测肝癌Bel-7402细胞增殖、流式细胞术检测人肝癌细胞Bel-7402的凋亡情况以及p53蛋白的表达。结果:不同浓度的乌骨藤制剂(10mg/ml,20mg/ml,40mg/ml)处理肝癌Bel-7402细胞后,其增殖受到抑制,作用24h的抑制率分别为11.57%、21.09%、31.27%,48h的抑制率为27.55%、35.95%、45.13%,随着药物浓度的增加(20mg/ml,40mg/ml,80mg/ml)细胞凋亡显著增加,凋亡率分别为(12.2±0.67)%、(17.4±0.69)%、(22.9±1.38)%,而p53蛋白的表达也随着药物浓度的增加而增加。结论:乌骨藤制剂能够抑制人肝癌细胞的增殖,诱导其凋亡,作用机制可能与激活p53基因有关。     

白藜芦醇联合TRAIL抑制乳腺癌细胞抗凋亡蛋白Bcl-xl表达

目的:探讨白藜芦醇(Resveratrol,RES)联合TRAIL对乳腺癌细胞凋亡及凋亡相关蛋白Bcl-xl表达的影响。方法:50μmol/L RES、100ng/ml TRAIL及二者联合分别处理乳腺癌MDA-MB-231和MCF-7细胞,MTT法检测细胞增殖抑制率,Annexin V-FITC/PI法检测细胞凋亡,Real time PCR检测Bcl-2、Bcl-xl和Mcl-1的mRNA表达,Western blot检测Bcl-xl、Bcl-2和Mcl-1蛋白表达。结果:MTT结果显示RES、TRAIL均能明显抑制乳腺癌细胞增殖,且联合组抑制率高于单独处理组(P<0.05)。RES、TRAIL单独或联合能诱导MDA-MB-231细胞凋亡,凋亡率分别为(16.34±0.34)%,(43.52±0.99)%和(73.60±2.80)%,与对照组的(4.13±0.25)%比较有统计学意义(P<0.05);而对MCF-7凋亡影响不明显。Realtime PCR结果显示RES联合TRAIL能明显抑制MDA-MB-231细胞Bcl-xl mRNA表达,联合组与对照组比较有统计学意义(P<0.05)。Western blot结果显示RES联合TRAIL能抑制Bcl-xl蛋白的表达而对Bcl-2和Mcl-1抑制不明显。结论:RES能增强TRAIL诱导乳腺癌细胞凋亡敏感性,这可能与二者抑制抗凋亡蛋白Bcl-xl的表达有关。     

EGCG影响TNF-α诱导的NF-κB/p65入核及促凋亡效应

背景与目的:研究表明,表没食子儿茶素没食子酸酯(epigallocatechin-3-gallate, EGCG)抗肿瘤作用机制尚不十分清楚,本研究旨在观察EGCG调节TNF-α诱导的胃癌SGC-7901细胞核转录因子κB/p65(NF-κB/p65)的入核并发挥诱导凋亡的作用.方法:Hoechst染色法检测EGCG处理SGC-7901细胞前后凋亡的形态学改变;Western blot方法观察EGCG作用前后NF-κB/p65蛋白在胞质内及核内的变化;流式细胞术检测EGCG调节NF-κB/p65入核前后细胞凋亡的变化;DNA ladder方法观察EGCG诱导细胞DNA断裂情况.结果:Hoechst染色法显示EGCG处理后细胞形态改变:核致密浓染或呈碎块状、苍白色.Western blot方法检测发现,10 ng/ml的TNF-α作为NF-κB/p65入核的诱导剂分别作用细胞30、60、90和120 min后,核内NF-κB/p65明显增多并在60 min达高峰;60 μg/ml的EGCG预处理细胞不同时间(0、12、24、36和48 h)后,再以 TNF-α处理60 min,检测发现核内NF-κB/p65明显下降并在24 h达低谷; 不同浓度EGCG(40、60、80和100 μg/ml) 预处理细胞24 h后,再加TNF-α处理60 min,核内NF-κB/p65呈时间依赖性下降.流式细胞术显示,10 ng/ml的TNF-α处理细胞60 min后,细胞凋亡率为3.7%,60 μg/ml EGCG处理细胞24 h后再以TNF-α处理细胞,凋亡率为16.6%;NF-κB通路阻断剂吡咯啉烷二甲基硫脲 (PDTC) 100 μmol/L预处理30 min后再以TNF-α处理细胞60 min,细胞凋亡率为21.4%.EGCG 60 μg/ml处理细胞24 h、PDTC处理细胞30 min后再以TNF-α处理细胞60 min,DNA凝胶电泳出现明显梯形条带.结论:EGCG能够抑制TNF-α诱导的NF-κB/p65入核,并可能通过此机制发挥诱导细胞凋亡的作用.     

氟达拉滨与TRAIL联用诱导肺癌细胞凋亡及 其作用机制

目的：研究氟达拉滨（Fludarabine）在低浓度下与TRAIL联合处理是否能够诱导人肺癌A549细胞发生凋亡,并探讨其作用机制。方法：实验设对照组、Fludarabine组、TRAIL组、Fludarabine和TRAIL联合组,CCK-8法检测Fludarabine与TRAIL联合处理时对A549细胞及人脐静脉内皮细胞（HUVEC,人正常细胞作为对照）增殖活力的影响,流式细胞术检测A549细胞凋亡情况,Western blot法检测凋亡相关蛋白Survivin、Bcl-2、Bcl-xl、caspase-8、caspase-3、JNK和p38的表达情况。结果：25、50 μmol/LFludarabine或50 ng/mL TRAIL单独处理时对A549及HUVEC细胞增殖活力均无明显影响（P均>0.05）,两者联合处理后对A549细胞增殖活力抑制率分别为30.9%和44.9%。Fludarabine或TRAIL单独使用时对A549细胞凋亡无明显影响,联合处理时可使A549细胞凋亡率达到89.3%。与对照组、Fludarabine组和TRAIL组相比,Fludarabine与TRAIL联合处理可使A549细胞中Survivin、Bcl-2、Bcl-xl表达降低（P均<0.05）,促进caspase-8及caspase-3的激活,并能促进JNK和p38的磷酸化（P均>0.05）。结论：Fludarabine与TRAIL联合处理可促进A549细胞凋亡。     

TRAIL与阿霉素联用协同杀伤人结肠癌细胞SW480

背景与目的:肿瘤坏死因子相关凋亡诱导配体(tumornecrosisfactor-relatedapoptosisinducingligand,TRAIL)可选择性杀伤肿瘤细胞,而不影响正常细胞生长。当一部分肿瘤细胞对TRAIL不敏感时,特定的其它药物可增强其杀伤作用。本文旨在探讨结肠癌细胞SW480对TRAIL的敏感性,以及TRAIL与阿霉素联用对细胞的杀伤作用及可能作用机制。方法:常规培养结肠癌细胞SW480。利用MTT法检测细胞毒性作用,流式细胞术定量分析凋亡细胞比例,透射电镜在亚细胞结构形态上证实凋亡细胞,Westernblot分析p53及bcl-2蛋白表达变化。结果:(1)SW480细胞对TRAIL不敏感,100ng/mlTRAIL只能杀伤7.8%的细胞,IC50>1000ng/ml,且不存在浓度依赖性。(2)SW480细胞对阿霉素敏感,存在浓度依赖性作用,IC50=65μmol/L,0.86μmol/L的阿霉素对细胞不表现杀伤作用。(3)TRAIL与阿霉素合用表现出协同作用,亚毒性浓度TRAIL(100ng/ml)与亚毒性浓度阿霉素(0.86μmol/L)联用可杀伤80%SW480细胞。流式细胞学证实这种杀伤作用主要通过诱导细胞凋亡实现,透射电镜亦观察到大量凋亡细胞存在。药物作用前后,p53及bcl-2蛋白表达水平无明显改变。结论:结肠癌细胞株SW480对TRAIL不敏感,但TRAIL与亚毒性浓度阿霉素联用对癌细胞有协同杀伤作用,这种细胞毒性作用主要表现     

奥沙利铂通过上调死亡受体表达增强TRAIL诱导胃癌细胞凋亡的实验研究

目的:研究奥沙利铂对TRAIL诱导胃癌细胞凋亡的影响,探讨死亡受体5(DR5)在TRAIL诱导细胞凋亡中的作用.方法:采用MTT法测定细胞活力、采用流式细胞仪检测细胞凋亡,采用Western blot检测DR5蛋白表达.结果:100ng/ml的TRAIL导致轻度的增殖抑制,诱导不超过5%的细胞凋亡;TRAIL(100ng/ml)联合奥沙利铂(23.44μg/ml)引起明显的细胞增殖抑制和细胞凋亡(P＜0.05),TRAIL没有明显改变死亡受体5(DR5)的表达,而23.44 μg/ml奥沙利铂作用胃癌细胞24小时后,明显上调了DR5的表达.结论:奥沙利铂通过上调DR5的表达增强TRAIL诱导的胃癌细胞凋亡.     

紫杉醇提高胃癌MGC803细胞对TRAIL的敏感性

目的:研究紫杉醇对TRAIL诱导胃癌细胞凋亡的影响,探讨死亡受体5(DR5)在TRAIL诱导细胞凋亡中的作用。方法:采用MTT法测定细胞活力,流式细胞仪检测细胞凋亡,western blot检测蛋白表达。结果:在MGC803细胞中,100ng/ml的TRAIL导致轻度的增殖抑制和细胞凋亡,TRAIL(100ng/ml)联合紫杉醇(3.41g/ml)引起明显的增殖抑制和细胞凋亡(P<0.05)。TRAIL单药没有改变死亡受体5(DR5)的表达,而3.41g/ml紫杉醇作用MGC803细胞后明显上调了DR5的表达。结论:紫杉醇通过上调DR5的表达增强TRAIL诱导的胃癌MGC803细胞凋亡。     

TRAIL联合多柔比星作用于骨肉瘤的实验研究

背景与目的：肿瘤坏死因子相关的凋亡诱导配体（TNF related apoptosis inducing ligand，TRAIL）是近年发现的肿瘤坏死因子家族新成员，显著特点是它仅诱导肿瘤细胞凋亡，对正常细胞无毒性作用。TRAIL可作为骨肉瘤靶向治疗的潜在有效药物，但单独使用时已被证明作用有限。而多柔比星可对肿瘤细胞产生广泛的生化效应，为细胞周期非特异性药物，有强烈的细胞毒性作用，可嵌入DNA而抑制核酸的合成导致细胞死亡。本研究旨在探讨TRAIL联合低剂量化疗药物多柔比星对骨肉瘤MG-63细胞的凋亡诱导效应。方法：MTT法测定TRAIL和多柔比星对MG-63细胞单独及联合作用的细胞凋亡率，DNA凝胶电泳及流式细胞仪检测细胞凋亡。结果：1000ng／ml的TRAIL与4．3μmol／mL多柔比星合用于MG63细胞24h时后，测细胞抑制率为36．65％，明显高于单用TRAIL（1000ng／ml）时的21．67％及单用多柔比星（4．3μmol／ml）时的10.25％（P〈0．01）。细胞超微结构观察及凋亡率测定均显示，合用比单用有更多的骨肉瘤细胞凋亡。TRAIL联合应用多柔比星能显著增强对MG-63的杀伤、抑制增殖及诱导凋亡作用，明显高于单独应用TRAIL组或多柔比星组（P〈0．05），并且这种作用随培养时间延长及药物浓度增加而增强。结论：TRAIL是一种有望应用于临床的新型生物制剂。TRAIL与多柔比星对诱导骨肉瘤细胞凋亡具有协同作用，能高效杀灭骨肉瘤细胞。     

TRAIL联合白藜芦醇对乳腺癌MDA-MB-231细胞凋亡影响的研究

目的:探讨 TRAIL 联合白藜芦醇对乳腺癌MDA-MB-231 细胞株增殖及凋亡的影响.方法:MTT 法和软琼脂集落形成实验检测细胞增殖;DAPI染色法及流式细胞术检测细胞凋亡;流式细胞术检测细胞表面DR4、DR5蛋白表达.结果:50 ng/mL TRAIL与50和100 μmol/L白藜芦醇联合作用14 d后,MDA-MB-231细胞在软琼脂中集落形成率分别为(2.49±0.08)%和(1.38±0.07)%,与相应浓度TRAIL、白藜芦醇单独应用比较及组间比较,差异有统计学意义,P<0.01.50 ng/mL TRAIL与50和100 μmol/L白藜芦醇联合作用后,对MDA-MB-231细胞增殖抑制率为(62.43±2.07)%、(87.32±1.44)%;细胞凋亡率为(53.59±1.44)%、(73.72±1.96)%,与单独应用相应浓度TRAIL、白藜芦醇比较及组间比较,差异有统计学意义,P<0.01.50、100和200 μmol/L白藜芦醇作用后,细胞膜表面DR4、DR5的荧光指数分别为1.80±0.07、2.11±0.14、2.59±0.16和2.16士0.08、2.92±0.25、3.90±0.06,与对照组(FI 值分别为1.52±0.04和1.61±0.13)比较及组间比较差异有统计学意义,P<0.05.结论:TRAIL与白藜芦醇联合可协同抑制MDA-MB-231 细胞增殖并诱导其凋亡,DR4,DR5蛋白表达的上调可能是其协同效应的机制之一.     

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.