盐酸吉西他滨联合立体定向放疗治疗局部晚期胰腺癌的临床价值

目的:评价盐酸吉西他滨联合立体定向放疗治疗局部晚期胰腺癌的疗效.方法:118例不能手术切除的胰腺癌患者按治疗方法分为2组:A组盐酸吉西他滨联合立体定向放疗组,共56例,B组单独立体定向放疗组,共62例.立体定向放射治疗,单次剂量2.8-3.5Gy,50%-65%等剂量曲线包绕PTV,总剂量35-45Gy,每周治疗6 d,治疗次数10-13次.A组首程同步化疗,吉西他滨600 mg/m2,放疗开始第1、8天静脉输注,放疗结束后3 wk开始第2周期化疗,吉西他滨1000 mg/m2,21 d为1周期,共治疗4-6周期.结果:2mo后复查计算机断层扫描及磁共振,A组肿瘤病灶治疗有效率67.8%(38/56),中位生存时间12.8mo(范围4-70 mo),1年生存率58.9%(33/56),2年生存率28.6%(16/56).常见不良反应为白细胞、血小板下降及消化系反应.B组肿瘤病灶治疗有效率30.6%(19/62),中位生存时间8.5mo(范围5-56mo),1年生存率33.9%(21/62),2年生存率12.9%(8/62).治疗期间常见不良反应为恶心及呕吐,白细胞下降.盐酸吉西他滨联合立体定向放射治疗组的近期疗效及远期疗效均优于立体定向放疗组.结论:盐酸吉西他滨联合立体定向放疗具有较好的近远期疗效,不良反应能够耐受.     

吉西他滨联合强调放疗治疗晚期胰腺癌的效果观察

目的观察吉西他滨联合强调放疗(intensity modulated radiation therapy,IMRT)治疗晚期胰腺癌的疗效和安全性.方法选取2012-01/2015-01武警浙江总队嘉兴医院肝脏外科收治的局部晚期胰腺癌患者53例,随机分成2组,观察组(27例)采用吉西他滨(1000 mg/m~2,第1、8、15天静脉滴注,28 d为1疗程)化疗,同步联合IMRT治疗,同步治疗结束后1 mo用吉西他滨巩固化疗2-4个疗程.对照组(26例)直接给予吉西他滨(1000 mg/m~2,第1、8、15天静脉滴注,28 d为1疗程)化疗.结果观察组临床受益指数明显高于对照组(70.37%vs 42.31%),观察组明显高于对照组(χ~2=4.251,P=0.029);观察组总有效率和局部控制率均明显对照组,差异有统计学意义(P0.05),观察组27例有4例生存至今,对照组有1例生存至今.1年生存率观察组明显高于对照组(P0.05),2年生存率2组差异无统计学意义(P0.05);2组均无1例4级不良反应.结论吉西他滨联合IMRT治疗胰腺癌安全有效,并能显著提高疼痛缓解率,改善患者生活质量.     

吉西他滨单药治疗老年非小细胞肺癌疗效观察

将82例老年非小细胞肺癌(NSCLC)患者随机分成两组,A组单用吉西他滨治疗,B组采用吉西他滨 顺铂联合治疗,21 d为一周期,4个周期后评价疗效.观察两组近期疗效、毒副反应及1 a生存率.结果 B组有效率、毒副反应发生率均高于A组;1 a生存率A组高于B组(P均＜O.05).认为单用吉西他滨治疗NSCLC毒副反应轻,可改善老年患者生活质量,延长生存时间.     

高强度聚焦超声联合吉西他滨对老年中晚期胰腺癌肿瘤生长及预后的影响

目的探究老年中晚期胰腺癌采用高强度聚焦超声(HIFU)联用吉西他滨治疗的效果及患者的预后。方法 54例老年中晚期胰腺癌患者随机分为2组,观察组为HIFU+化疗组,采用HIFU联合静脉滴注吉西他滨治疗;对照组为单纯化疗组,采用静脉滴注吉西他滨治疗。比较两组患者治疗2个月后疼痛缓解程度、肿瘤体积变化、并发症的发生情况以及治疗后3、6个月的生存率。结果观察组患者治疗后疼痛缓解率明显高于对照组,治疗前后VAS评分、外周血CA199水平明显下降(P0.001)。观察组治疗后肿瘤体积明显缩小(P0.001)。治疗3个月后观察组生存率为100%,对照组生存率为92.0%,两组对比无统计学差异(P=0.121);治疗6个月后,观察组生存率为75.9%,对照组生存率为24.0%,两组生存率对比差异显著(P0.001)。观察组29例患者均未出现皮肤烧伤、胃肠道穿孔、胰瘘和出血等HIFU治疗并发症。结论 HIFU联用吉西他滨治疗老年中晚期胰腺癌可明显限制肿瘤生长,缩小肿瘤体积,减轻患者的疼痛症状,且并发症少,有效延长患者的生存期,具有良好的临床疗效。     

盐酸吉西他滨治疗70岁以上晚期非小细胞肺癌患者的临床观察

目的　观察盐酸吉西他滨治疗 70岁及以上老年人非小细胞肺癌 (NSCLC)的疗效和毒副反应 ,并与同期单纯支持治疗的患者 (对照组 )比较 ,探索适于 70岁以上老年人NSCLC的治疗方案。　方法　治疗组 19例 ,采用盐酸吉西他滨单药化疗 ,剂量 12 5 0mg/m2 ,静脉滴注 ,第 1天和第 8天用药 ,每 2 1d为 1周期 ,共 4～ 6周期。对照组 2 5例不用任何化疗 ,单纯支持对症治疗。　结果　盐酸吉西他滨治疗组完全缓解 (CR) 2例 ,部分缓解 (PR) 5例 ,稳定 (SD) 8例 ,进展 (PD) 4例 ;对照组无CR和PR者。盐酸吉西他滨治疗组卡氏评分 (KPS)和体重增加都明显高于对照组 (P <0 0 1) ,临床症状改善明显优于对照组 (P <0 0 1)。盐酸吉西他滨治疗组和对照组中位肿瘤进展时间分别为 5 6个月和 3 8个月 (P <0 0 1) ,1年生存率分别为 4 7 4 %和 8 0 % (P <0 0 1) ,2年生存率分别为 2 1 1%和 0。盐酸吉西他滨化疗毒副反应轻微 ,仅有Ⅰ、Ⅱ级血小板减少和白细胞下降 ,未见Ⅲ、Ⅳ级毒副反应。　结论　盐酸吉西他滨治疗 70岁以上老年人NSCLC是有效和安全的。     

吉西他滨联合放疗治疗老年中晚期宫颈癌患者的临床研究

目的探讨吉西他滨联合放疗治疗老年中晚期宫颈癌患者的临床效果。方法选取2016年12月至2018年8月本院收治老年中晚期宫颈癌患者84例,按照随机、对照原则将其分为单纯放疗组和联合放疗组,其中联合放疗组在单纯放疗的基础上联合吉西他滨,对两组患者近期疗效、远期疗效和不良反应发生情况进行评估分析。结果两组患者经过治疗其肿瘤均得到有效控制,其中单纯放疗组患者总治疗有效率为67.6%,低于联合放疗组(87.2%)(χ2=4.756,P=0.029);联合放疗组患者生存率(89.4%和59.5%,χ2=10.204,P=0.001)、无局部复发率(83.0%和54.1%,χ2=8.286,P=0.004)、无远处转移生存率(83.0%和56.8%,χ2=6.975,P=0.008)均高于单纯放疗组;联合放疗组患者白细胞减少发生率高于单纯放疗组(38.3%和13.5%,χ2=8.396,P=0.011)。结论采用放疗联合吉西他滨治疗老年中晚期宫颈癌,可有效增强对患者癌变组织的控制效果,提高患者远期生存率,降低肿瘤局部复发风险。     

培美曲唑和吉西他滨作为一线药物治疗晚期非小细胞肺癌（3种方案）的随机Ⅱ期临床试验

目的进行随机的3组Ⅱ期临床试验。评价培美曲唑和吉西他滨治疗初治的非小细胞肺癌患者的最佳给药方案。病人与方法病人随机指定进入3个不同治疗组．给药方法：培美曲唑500mg／m^2＋吉西他滨1250mg／m^2，二者间隔90分钟，21天一个周期。A组，第1天，先用培美曲唑，后用吉西他滨，第8天，单用吉西他滨；B组：第1天，先用吉西他滨，后用培美曲唑，第8天，单用吉西他滨；C组：第1天，单用吉西他滨，第8天，先用培美曲唑．后用吉西他滨。结果共有152例病人（A组，n=59；B组，n=31；C组，n=62），接受治疗周期的中位数分别是：A组5个周期；B组2个周期；C组4个周期。总的情况是，66％的病人出现了Ⅲ或Ⅳ度中性粒细胞减少。     

动脉灌注吉西他滨治疗晚期胰腺癌临床研究

目的评价吉西他滨 (健择) 动脉灌注治疗晚期胰腺癌的疗效和安全性.方法对20例胰腺癌病人采用吉西他滨动脉灌注结合静脉化疗,并与9例采用5-氟尿嘧啶(1000mg)、阿霉素(40～50mg)、卡铂(200mg)经胰十二指肠动脉灌注治疗的胰腺癌病人为对照,对病人的疾病相关症状改善、疗效和毒副反应进行评价.结果吉西他滨组治疗后疼痛改善率为75%,对照组疼痛改善率为44.4%,两者比较无显著性差异.治疗后Karnofsky评分吉西他滨组好转率为60%,对照组为44.4%.吉西他滨组部分缓解率(PR)为30%,半年及1年生存率分别为85%及25%,中位生存时间为9.2个月;对照组PR为22.2%,半年生存率为66.7%,无1年生存者,中位生存时间为7.9个月(P>0.05).两组均有不同程度的胃肠道和骨髓抑制等不良反应(P>0.05),3、4级不良反应较少见.结论吉西他滨动脉灌注治疗晚期胰腺癌能够改善病人的生存质量,延长病人的生存期,无严重毒副反应.     

立体定向放疗综合治疗联合自拟清毒活血汤治疗局部胰腺癌晚期患者的生存时间对比观察

[目的]评估立体定向放疗综合治疗联合自拟清毒活血汤治疗局部胰腺癌晚期患者的临床疗效并随访观察患者生存时间。[方法]选择我院2013年1月~2014年6月收治的62例局部胰腺癌晚期患者作为本次研究对象。将全部患者随机均分为对照组与观察组,对照组采取常规立体定向放疗综合疗法治疗,观察组在对照组疗法的基础上给予本院自拟清毒活血汤治疗,1个疗程后评估2组临床疗效,统计治疗过程不良反应发生情况;随访3年,分别统计1年、2年时的复发率及生存率,随访至第3年统计2组患者无病情进展生存时间(PFS)及总生存时间(OS)并绘制生存曲线图。[结果]观察组总有效率为77.42%,对照组总有效率为51.61%,观察组整体疗效评估结果优于对照组,P0.05。观察组骨髓抑制发生程度整体优于对照组,P0.05。对照组治疗后第2年时复发率为51.61%,生存率为58.06%;观察组治疗后第2年时复发率为16.13%,生存率为90.32%;观察组治疗后第1年、第2年时的复发率与生存率均优于对照组,P0.05。观察组PFS、OS均长于对照组,P0.05;生存函数对比观察组PFS、OS均长于对照组,P0.05。[结论]立体定向放疗综合治疗联合自拟清毒活血汤能够有效提高局部胰腺癌晚期患者的临床疗效,延长患者的PFS、OS,具有临床推广价值。     

局部晚期胰腺癌放疗并同期5-FU对比吉西他滨的疗效分析

目的 比较放疗联合5-氟尿嘧啶（5-FU）与放疗联合吉西他滨治疗局部晚期胰腺癌的疗效及放、化疗不良反应.方法 回顾性分析第四军医大学西京医院放疗科2007年1月到2011年1月收治的56例局部晚期不可手术切除的胰腺癌患者的资料.入组患者均采用三维适形或三维适形调强放疗并同期给予单药5-FU或吉西他滨化疗.放疗剂量每次1.8 ～2 Gy,每周5次,总剂量45 ～ 50.4 Gy,共25～ 28次.同期吉西他滨化疗组共30例,在放疗期间的第1、8、15、22天以500 mg/m2体表面积的剂量、10 mg· （m2）-1·min-1微量泵泵入给药;放疗结束后休息3周,再以800 mg· （m2）-1·d-1的剂量静脉滴注,每周1次,连用3～4周.同期5-FU化疗组共26例,放疗期间以500 mg· （m2）-1·d-l剂量静脉滴注,每周第1～5天给药,14 d一个周期;放疗结束后休息3周,按照800 mg·（m2）-1·d-1的剂量静脉滴注,每周第1～5天给药,14 d一个周期,连用3～4个周期.观察疗效和不良反应,并对患者进行随访,随访截止日为2013年6月,计算患者中位生存时间和l、2年生存率.结果 全组客观有效率（CR＋ PR）为73.2％,放疗联合5-FU组总有效率为65.3％,放疗联合吉西他滨组总有效率80.0％（P＜0.05）.全组1、2年生存率分别为48.2％和14.3％,中位生存期为15.2个月,其中放疗联合5-FU组分别为42.3％、11.5％、13.3个月,放疗联合吉西他滨组分别为53.3％、16.7％、16.6个月,两组患者生存率差异无统计学意义（P=0.071）.治疗结束后全组疼痛客观缓解率（VAS评分＜4分）为83.3％,放疗联合5-FU组为75％,放疗联合吉西他滨组为90％.放疗联合吉西他滨治疗组发生3～4级骨髓抑制率显著高于放疗联合5-FU组,差异具有统计学意义（20.0％比7.6％,P＜0.05）.结论 手术不能切除的局部晚期胰腺癌患者采用放疗联合吉西他滨化疗在长期生存、疼痛缓解方面较放疗联合5-FU具有优势,但骨髓抑制的不良反应较强.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.