肠癌、胃癌化疗药物敏感性的研究

目的　研究胃、肠癌癌细胞在8种不同抗癌药物作用下的细胞抑制率,以筛选出敏感性较强的化疗药物。方法　用微量细胞培养———四氮唑(MTT)法对43例肠癌(包括直肠癌、结肠癌)、33例胃癌新鲜瘤组织进行顺铂(DDP)、卡铂(CBP)、氟尿嘧啶(FU)、丝裂霉素(MMC)、长春新碱(VCR)、羟基喜树碱(OPT)、环磷酰胺(CTX)和表阿霉素(EADM)8种化疗药物进行敏感性检测。结果　上述药物对肠癌细胞的抑制率由高到低依次为DDP、CBP、MMC、FU、CTX、VCR、OPT、EADM,对胃癌细胞依次为DDP、CBP、FUMMC、CTX、VCR、OPT、EADM。肠癌细胞中高度敏感率>50%的药物依次为MMC、FU、DDP、CBP;总敏感率>50%的药物依次为DDP、MMC、FU、CBP。在胃癌细胞中高度敏感率>50%的药物依次为DDP、CBP;总敏感率>50%的药物依次为DDP、CBP、MMC、FU、CTX、VCR。其中胃癌细胞对CTX、VCR的敏感率明显高于肠癌细胞。结论　同一类型肿瘤对抗癌药物的反应虽有一定的共性,但不同个体间存有显著差异。因此,体外检测人实体瘤细胞对化疗药物的敏感性可为临床化疗提供指导,而MTT法是目前临床检测化疗药物敏感性较为准确的方法。     

肿瘤组织CD71表达率与化疗药物敏感性的相关性研究

目的为探讨肿瘤组织转铁蛋白受体（CD71）表达率在指导化疗中的临床价值.方法采用流式细胞术（FCM）对193例各种肿瘤组织进行CD71表达率的检测,同时采用MTT比色法对8种化疗药物：5-氟脲嘧啶（5-FU）、阿霉素（ADM）、卡铂（CBP）、顺铂（DDP）、环磷酰胺（CTX）、丝裂霉素（MMC）、甲氨喋呤（MTX）、鬼臼（VP16）进行肿瘤细胞药物敏感试验,以相对抑制率和药物敏感率与CD71表达率作相关性分析.结果 CD71的表达率与5-FU、MTX、CTX、VP16、ADM及DDP相对抑制率具有明显的相关性（均P＜0.01及P＜0.05）.胃癌组CD71的表达率与5-FU、MTX、CTX及VP,大肠癌组与5-FU、CBP、DDP、MTX及VP,肺癌组与MTX及VP,乳腺癌组与5-FU、MTX及CTX,肝癌组与CBP的相对抑制率具有相关性;3组不同CD71的表达率中显示：CD71表达率越高,肿瘤组织对周期性化疗药物（5-FU、MTX及VP）的敏感率也越高.结论 CD71的表达率与化疗药物5-FU、MTX、CTX、VP及ADM、DDP的相对抑制率具有明显的相关性,但各肿瘤组之间的药物相关性存在一定差异;肿瘤组织对周期性化疗药物（5-FU、MTX及VP）的敏感率与CD71表达率呈正相关.CD71的表达检测率能反映细胞的增值状态,对指导选择化疗药物具有重要意义.     

DDP+5-Fu+BLM化疗方案用于舌癌的术前诱导化疗

目的 :探讨DDP +5 Fu +BLM化疗方案作为舌癌术前或放疗前的诱导化疗的临床价值。方法 :47例舌癌患者术前采用DDP +5 Fu +BLM联合诱导化疗。用法如下 :DDP 2 0mg/m2 × 5d ,5 Fu 5 0 0mg/m2 × 5d ,BLM15mg× 4。结果 :CR 7例 ( 14 9% ) ,PR 3 1例 ( 66 0 % ) ,总有效率 80 9%。结论 :DDP +5 Fu +BLM联合术前诱导化疗取得满意的临床效果 ,用法简单易行 ,具有较好的实用性     

MTT法测定大肠癌化疗药物敏感性

目的　运用MTT法测定大肠癌体外对化疗药物的敏感性及其适用价值。方法　采用改良的噻唑兰 (MTT)法测定 84例结直肠癌标本对 9种化疗药物的体外敏感性 ,并运用免疫组化法检测 30例肿瘤细胞的多药耐药基因 (MDR1)。结果　 84例结直肠癌细胞对化疗药物的敏感性 ,从高到低依次为 5 Fu >MMC >Ara C >HCPT >CBP >CDDP >MXT >MTX >ADM。 30例患者中 14例MDR1阳性。结论　以MTT法检测结直肠癌细胞对化疗的敏感性有助于指导临床选择肿瘤敏感的化疗药物 ,并可避免盲目选用肿瘤非敏感性化疗药对机体造成的毒性反应。在检测肿瘤对化疗药物敏感性的同时 ,建议检测多药耐药基因 ,及时发现耐药病人 ,以便采用其它有效的治疗方法。     

晚期食管癌化疗的进展

晚期食管癌的患者多数不能进行手术治疗，为延长病人的生存期、减轻病人的痛苦主要的治疗方法以化疗和放疗为主。化疗是治疗中晚期食管癌的主要手段。单药化疗效果较差，为提高疗效，联合化疗相继用于临床。自发现DDP、5-Fu和BLM等化疗药物具有放射增敏作用以来，有些学者探讨将化疗药物作为放射增敏剂与放疗联合应用治疗食管癌，取得了一些令人鼓舞的初步结果。形成了新的治疗方法联合化放疗。本文将对这几种治疗晚期食管癌的主要方法的发展情况进行综述。     

胃癌CyclinD1、PTEN表达及与化疗药物耐药性关系的研究

目的探讨胃癌组织中CyclinD1、PTEN蛋白的表达和与化疗药物敏感性的关系。方法取胃癌手术标本84例,用免疫组化检测CyclinDl、PTEN蛋白在胃癌组织中的表达。并用MTT比色法观察胃癌原代培养细胞在体外对化疗药物HCPT、CDDP、5-Fu、ADM和MMC的敏感性。结果胃癌组织中CyclinD1和PTEN蛋白的阳性率分别为67．86％和46．43％。胃癌细胞对不同化疗药物敏感性不同：5．Fu、MMC和DDP对胃癌细胞的抑制率显著高于ADM和HCPT（P〈0．05）。CyclinD1阳性者对5．Fu、HCPT的敏感性显著高于阴性者（P〈0．05）。PTEN蛋白表达与五种化疗药物的体外耐药无相关性（P〉0．05）。结论CyclinD1蛋白与胃癌对化疗药物敏感性相关,检测其表达对选择化疗药物有实用价值。     

体外药敏试验在乳腺癌中的应用

目的：探讨目前临床应用的化疗药物对乳腺癌的敏感性。方法：用MTT法对40例乳腺癌进行表柔比星、吡柔比星、紫杉醇、多烯紫杉醇、环磷酰胺、5氟尿嘧啶、长春瑞宾、顺铂8种化疗药物的敏感试验。结果：患者个体对化疗药物的敏感性均不同，单药的总体敏感率也不同。结论：MTT法简便易行，对乳腺癌的临床治疗药物选择具有重要参考价值。     

12种常用抗肿瘤药物对肝癌敏感性试验结果分析

目的比较12种常用抗肿瘤药物对原发性肝癌（HCC）药敏试验结果,探索肝癌化疗的合理用药。方法取95例HCC患者术中活体肝癌组织癌细胞与12种常用抗肿瘤药物共同培养：紫杉醇（FIX）49例,阿霉素（ADM）50例,平阳霉素（BLM）50例,环磷酰胺（CTX）59例,甲胺喋呤（MTX）16例,5-Fu95例,表阿霉素（ADM）90例,顺铂（DDP）90例,丝裂霉素（MMC）57例,吉西他宾（GEM）88例,奥沙利铂（OXA）58例,羟基喜树碱（HCPT）51例。以MTr法检测各种药物对HCC细胞抑制率,〈30％为不敏感,30％～60％为低度敏感,61％～90％为中度敏感,〉90％为高度敏感。结果不敏感药物有紫杉醇、阿霉素、平阳霉素、环磷酰胺、甲胺喋呤;低度敏感有5-Fu;中度敏感有丝裂霉素、奥沙利铂、羟基喜树碱、吉西他宾、表阿霉素、顺铂;高度敏感0。各组之间敏感差异性有统计学意义（P〈0．05）。结论本试验结果提示5-Fu为低度敏感药物,不宜作为常规用药,可选择敏感度较高的丝裂霉素、奥沙利铂。肝癌化疗药物最好根据药物敏感试验结果选择。     

妇科恶性肿瘤时辰化疗的护理

时辰化疗，是一种新的化学治疗方法，是根据人体24小时生物节律的变化选择化疗药物毒性最小的时间将高浓度的化疗药物输入体内的治疗方法，从而达到最佳化疗效果和最小毒副作用的目的。妇科恶性肿瘤疾病的化学治疗方法是其综合治疗的重要手段之一。氯氨铂（DDP）加5-氟尿嘧啶（5-FU）是目前治疗妇科恶性肿瘤较有效的单药之一，但在化疗过程中出现的恶心呕吐等不良反应，常常限制了化疗药物的使用剂量，从而最终影响治疗效果。     

针刺疗法结合心理暗示对化疗致胃肠道反应的疗效观察

大多数抗癌药物能引起程度不等的恶心呕吐，尤其是一些长期化疗的病人见到化疗药物即可产生恶心呕吐反应。引起恶心呕吐比较严重的化疗药物有顺铂（DDP）、亚硝脲类等。尤其是DDP更为严重，几乎为100％。2003年7月-2004年5月，我科护理人员对70例146人次DDP化疗病人所致呕吐，进行了针刺、穴位封闭结合心理暗示治疗，效果良好。现报告如下。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.