胰腺神经内分泌肿瘤诊治进展

胰腺神经内分泌肿瘤(pNET)是一种少见疾病,根据是否伴随相应的内分泌症状分为功能性和无功能性两类。手术是pNET最主要的治疗手段,近年来随着对pNET发病机制的了解,新的诊断技术和治疗手段的出现,以及多学科协作诊治模式的应用,pNET的诊断和治疗发生了巨大的变化,为pNET患者尤其是晚期患者带来了希望。     

胰腺神经内分泌肿瘤的药物治疗及其进展

胰腺神经内分泌肿瘤（pNENs）的发病率在不断升高。20%～64%的pNENs在确诊时已发生远处转移，而功能性肿瘤在pNENs中相对多见。因此，药物治疗在pNENs中具有非常重要的地位。生长抑素类似物（SSAs）是pNENs的主要治疗药物之一，新一代的SSAs尚不足以取代兰瑞肽水凝胶或长效奥曲肽用于治疗增殖指数较低且生长抑素受体表达阳性的胰腺神经内分泌瘤（pNET）；依维莫司和舒尼替尼是目前被推荐用于pNET的两种靶向药物，其他靶向药物在pNET中也已逐渐开展临床试验，部分药物已进入Ⅲ期临床试验；化疗主要用于生长速度较快的pNET及分化差的神经内分泌癌（NEC），新方案临床试验多针对NEC；肽受体放射性核素治疗（PRRT）在生长抑素受体表达阳性的pNET中可能具有重要治疗价值；pNENs的免疫治疗临床试验的初步结果并未显示出非常好的疗效；联合不同药物或方案治疗pNENs尚处于早期探索阶段。总之，pNENs药物治疗虽已取得较大的进展，但很多治疗药物尚处于试验阶段，距离临床应用尚远。     

胰腺神经内分泌肿瘤的非手术诊疗进展

胰腺神经内分泌肿瘤（pNET）是一种较为罕见的、具有高度异质性的内分泌肿瘤，占胰腺恶性肿瘤的约9.9%。然而由于其早期症状隐匿，多数患者临床就诊时已出现远处转移。因此，早发现、早干预尤为重要。目前，手术切除依然是治愈pNET的唯一方式，传统治疗方式如放、化疗虽然可以有效杀伤肿瘤细胞提高患者生存期，但是其治疗效果始终不如人意。近年来，随着一些新治疗方式如靶向治疗、免疫治疗、表观遗传药物治疗等手段的出现，让许多无法手术且对传统治疗方法不敏感的患者从中获益。笔者围绕pNET近年诊断、非手术治疗方面的研究进展展开综述。     

胰腺神经内分泌肿瘤肝转移的外科治疗现状与展望

胰腺神经内分泌肿瘤（pancreatic neuroendocrine tumor, pNET）是一组异质性肿瘤,其临床表现,生物学行为和预后各不相同,其最常见的转移部位是肝脏。对于同步可切除pNET肝转移原发灶的患者,建议分期或联合切除转移灶,以实现根治性切除。对于无法切除转移灶的患者,原发灶切除具有一定的争议性,在...     

胰腺神经内分泌肿瘤肝转移的外科治疗争议与展望

在过去的20年间, 胰腺神经内分泌肿瘤(pNEN)的发病率不断升高。肝脏是其最常见的转移部位, 肝转移是pNEN患者重要的预后因素。虽然对于pNEN肝转移有包括生物治疗、化疗、靶向治疗、肽受体放射性核素治疗、局部治疗在内的多种治疗方式, 但手术仍是唯一可能达到治愈目的的治疗方式。目前对于pNEN肝转移的外科治疗仍存在较多争议, 如胰腺神经内分泌瘤(pNET)G3合并肝转移患者能否接受手术治疗;术前如何更加全面且准确地对pNET肝转移患者进行分级诊疗、Ⅱ型pNET肝转移患者如何选择最佳的外科治疗策略、如何确定减瘤手术的最佳获益人群、如何进一步优化pNET肝移植的米兰标准等。本文对目前pNEN治疗的主要争议展开讨论, 并为后续的临床研究提出展望。     

胰腺神经内分泌肿瘤8例临床分析

目的:探讨胰腺神经内分泌肿瘤(pNET)的诊疗方法及预后。方法:回顾性分析2008年1月—2017年1月间内蒙古医科大学附属医院收治的8例p NET患者的临床资料。结果:8例pNET患者,男2例,女6例;年龄36~72岁,平均年龄53岁;均行影像学检查明确病灶;5例无功能性肿瘤主要表现为腹痛腹胀、腹部肿块、食欲不振、消瘦,3例功能性肿瘤以低血糖反应或高血糖为主要表现;均行手术治疗,其中1例行肿瘤局部切除术,2例行胰体尾联合切除术,4例行胰十二指肠切除术,1例行胰体尾+脾切除术+胰腺空肠吻合术。8例随访30~66个月,7例存活,1例死亡。结论:结合实验室和影像学检查,有助于该病的诊断;确定合理可行的综合治疗方法,可提高治愈率、改善患者生活质量和预后。     

Role of ions and ion channels in capacitation and acrosome reaction of spermatozoa

Capacitation and acrosome reaction are important prerequisites of the fertilization process. Capacitation is a highlycomplex phenomenon occurring in the female genital tract, rendering the spermatozoa capable of binding and fusionwith the oocyte. During capacitation various biochemical and biophysical changes occur in the spermatozoa and thespermatozoal membranes. Ions and ion channels also play important roles in governing the process of capacitation bychanging the fluxes of different ions which in turn controls various characteristics of capacitated spermatozoa. Alongwith the mobilization of ions the generation of free radicals and efflux of cholesterol also plays an impo~.nt role in thecapacitation state of the spermatozoa. The generation of free radical and efflux of cholesterol change the mechano-dynamic properties of the membrane by oxidation of the polyunsaturated lipids and by generating the cholesterol freepatches. The process of capacitation renders the spermatozoa responsive to the inducers of the acrosome reaction. Theglycoprotein zona pellucida 3 (ZP3) of the egg coat zona pellucida is the potent physiological stimulator of the acro-some reaction; progesterone, a major component of the follicular fluid, is also an inducer of the acrosome reaction.The inducers of the acrosome reaction cause the activation of the various ion-channels leading to high influxes of calci-um, sodium and bicarbonate. The efflux of cholesterol during the process of capacitation alters the permeability of themembrane to the ions and generate areas which are prone to fusion and ve.siculation process during the acrosome reactioa. this review focuses mainly on effects of the ion and ion-channels, free radicals, and membrane fluidity changesduring the process of capacitation and acrosome reaction.     

Declaration of the 2^nd Meeting of the Committee on Clinical Application of Human Organ Transplantation of China and National Summit of Clinical Application and Management of Human Organ Transplantation

We, medical practitioners of human organ transplantation, met in the 2nd Meeting of the People＇s Republic of China Ministry of Health Committee on Clinical Application of Human Organ Transplantation and National Summit of Clinical Application and Management of Human Organ Transplantation in Guangzhou, Guangdong Province, People＇s Republic of China, on 13 and 14 November 2006.     

Androgens and male aging：current evidence of safety and efficacy

Many signs of aging,such as sexual dysfunction,visceral obesity,impaired bone and muscle strength,bear a close resemblance to features of hypogonadism in younger men. The statistical decline of serum testosterone in aging men is solidly documented. It has been presumed that the above features of aging are related to the concurrent decline of androgens,and that correction of the lower-than-normal circulating levels of testosterone will lead to improvement of symptoms of aging. But in essence,the pivotal question whether the age-related decline of testosterone must be viewed as hypogonadism,in the best case reversed by testosterone treatment,has not been definitively resolved. Studies in elderly men with lower-than-normal testosterone report improvement of features of the metabolic syndrome,bone mineral density,of mood and of sexual functioning. But as yet there is no definitive proof of the beneficial effects of restoring testosterone levels to normal in elderly men on clinical parameters. Few of these studies meet as yet rigorous standards of scientific enquiry：double-blind,placebo-controlled design of the study. The above applies also to the assessment of safety of testosterone administration to elderly men. There is so far no convincing evidence that testosterone is a main factor in the development of prostate cancer in elderly men and guidelines for monitoring the development of prostate disease have been developed. It is of note that there are presently no long-term safety data with regard to the prostate. Polycythemia is another potential complication of testosterone treatment. It is dose dependent and can be managed with dose adjustment.     

Osteochondral autograft transfer (mosaicplasty) for treatment of patients with osteochondral lesions of talus

Purpose:Osteochondral lesion of talus(OLT)is one of the common causes of ankle pain.This disorder is common in young athletes after ankle injury.There are various therapeutic options.One of the options is mosaic plasticizer.The purpose of this study was to investigate the effect of mosaicplasty on improvement of symptoms of patients with osteochondral lesions of talus.Methods:Nineteen patients with osteochondral lesions of talus participated in this study,who were treated with mosaicplasty.Before and after treatment,pain(visual analogue scale),function(American Orthopaedic Foot and Ankle Society),range of motion and radiographic signs were evaluated.Results:The results of this study showed that mosaicplasty could significantly reduce pain,increase function and improve radiographic symptoms.The range of motion increased after treatment,which was not significant.Conclusion:We can confirm the effect of mosaicplasty on the improvement of patients with osteochondral lesions of the ankle,suggesting it as a treatment option.