伴有消化道出血胃肠间质瘤危险因素及预后分析

目的探讨伴有消化道出血的胃肠间质瘤患者的危险因素及预后。方法对241例胃肠间质瘤患者进行回顾性分析,根据是否合并消化道出血分为两组,分析两组患者的临床病理特点、实验室检查、预后。结果单因素分析显示:消化道出血组的性别、T分期、M分期、肿瘤部位、Ki-67、危险度分级与未出血组相比,差异有统计学意义(P0.05)。Logistic回归分析显示:Ki-67(OR=2.170,95%CI:1.236～5.043)、T分期(OR=1.773,95%CI:1.101～2.854)及肿瘤部位(OR=0.168,95%CI:0.051～0.548)是伴有消化道出血胃肠间质瘤的独立危险因素。生存分析显示,伴有消化道出血的胃肠间质瘤患者预后更差,高危组胃肠间质瘤患者伴有消化道出血对预后的影响更大。结论消化道出血与胃肠间质瘤预后不良有关。Ki-67、T分期及肿瘤部位是伴有消化道出血胃肠间质瘤的独立危险因素。     

胃、肠肿瘤凋亡治疗研究的现状及前景

胃肠道肿瘤是我国最常见的恶性肿瘤之一,尽管近10年对胃肠肿瘤的研究取得明显进展,但早期肿瘤的诊断率还很低,中晚期肿瘤目前尚缺乏有效的治疗手段,作为中晚期胃肠肿瘤的主要治疗手段的化疗和放疗,在杀灭肿瘤细胞的同时,也损伤正常的组织细胞,疗效低,毒副作用大,寻找新的治疗手段乃当务之急。诱导肿瘤细胞凋亡而不伤及或少伤及正常组织细胞,是肿瘤治疗的新思路。消化道肿瘤的发病与肿瘤细胞凋亡的异常有密切关系[1],消化道肿瘤的凋亡治疗研究方兴未艾,并已取得明显进展。一、胃癌诱导胃癌细胞凋亡的研究起步相对较晚,大多尚处于体外细胞的研…     

生化及物理指标联合评估放射性心脏损伤的研究现状

放射性心脏损伤是由胸部肿瘤放疗引起的常见不良反应,可明显增加冠状动脉疾病、心包疾病、瓣膜性心脏病及猝死的风险。研究发现,可通过血清肌钙蛋白I和心率变异性对放射性心脏损伤进行评价,但较难对其作出早期诊断。近年来的研究显示放射性心脏损伤的发生与心脏受照射体积和剂量有重要关系,因此可期待联合血清肌钙蛋白I、心率变异性及剂量体积直方图对放射性心脏损伤进行预测,并寻找早期预测胸部肿瘤放疗后心脏损伤有效的生化及物理指标,为临床治疗提供重要依据。     

Cajal间质细胞与胃肠道间质瘤

Cajal间质细胞(interstitial cells“Cajal,ICC)是一类特殊的胃肠道间质细胞,负责胃肠起搏和介导神经递质传递功能,多种胃肠动力障碍性疾病的发生都与ICC异常有关[1]。胃肠道间质瘤(gastrointestinal stromal tumor,GIST)是消化道间叶组织源性肿瘤,目前普遍认为起源于ICC或向ICC分化的多潜能干细胞[2]。     

放射性肺损伤防治的研究进展

当机体通过放射治疗胸部肿瘤、骨髓移植前进行预处理以及被核辐射过后,肺组织受到一定剂量照射通常会引发不同程度的放射性损伤。若机体放射性肺损伤严重,会在一定程度对放射治疗的剂量产生限制,且往往不可逆转,而患者的生活质量也大大降低。及时正确的防治措施至关重要,但是临床上尚没有有效治疗措施,故其引起越来越多学者的关注。笔者就国内外对放射性肺损伤防治的研究进展作一综述。     

内镜下注射吲哚菁绿及钛夹夹闭双重定位进展期胃癌1例

正近年来,随着腹腔镜、内镜技术及精准医疗理念的发展,如何在手触觉缺失的情况下,对肿瘤、切缘、前哨淋巴结进行准确定位,确保胃肠肿瘤的根治性,缩小手术范围,尽可能多的保留消化道的完整性及功能,一直困扰着腹腔镜医师,也成为了临床新的研究和探索方向[1]。在胃肠道肿瘤定位方式中,早期运用较多的是术中内镜透照方式,其直观、准确,能对大部分胃肠肿瘤进行定位[2],但术中内镜需消化内镜专用设备、专业消化内镜医生及护士配合完成,耗时繁琐,且充气后的胃肠道可影响腹腔镜手术操作,造成手术时间的延长。     

放射性肺损伤的预防和治疗进展

在肺部肿瘤以及其他临近肺组织肿瘤的放射治疗中,造成不同程度的肺放射损伤[1].一旦发生将严重影响患者的生活质量甚至威胁生命.放射性肺损伤的发生机制放射性肺损伤包括急性放射性肺炎和放射性肺纤维化.急性放射性肺炎常发生在放疗后1～3个月;放射性肺纤维化为放射性肺损伤慢性阶段,常发生在放疗结束后3～6个月甚至更长时间以后.放射性肺损伤的发生是由于放射使肺泡Ⅱ型细胞和表面活性物质减少,肺受照射部位发生急性渗出、炎细胞浸润,甚至肺泡崩溃胶原纤维增生形成肺损害.动物实验和临床研究表明,放射性肺损伤不仅仅是单一靶细胞损伤的结果,而是一个有多种细胞参与,多种细胞因子调控的复杂过程[3].发生不仅与放疗剂量、照射体积等因素有关,而且基础肺功能、化疗药物的使用以及年龄等都是促进临床放射性肺损伤发生的因素.     

中医药促胃肠动力作用的研究

胃肠动力异常与多种消化系统疾病以及其他系统疾病的消化道并发症密切相关.由胃肠动力异常引起的疾病在临床上发病率有逐年增高之势.因此对胃肠动力的研究一直是一个热点.中医在这方面的研究也在不断深入,一些探索研究显示,某些中药,包括单味药和中药复方对胃肠运动有促进作用,并提出了"胃肠动力中药"这一概念[1],现就有关这方面的研究作一综述.     

放射性心脏损伤及防护的研究进展

既往认为心脏是抗辐射性较强的器官,对放射线具有较高的抵抗力和耐受性。近年来的临床实践表明胸部放射治疗法（放疗）会引起放射性心脏损伤,尤其是随着胸部肿瘤放疗技术的推广和大剂量放疗的广泛应用,使肿瘤患者的生存期延长,放疗所致的心脏损伤,特别是迟发性心脏损伤问题更加突出。为此,本文综述了放射性心脏损伤的病理变化、临床表现、发病机制及防护措施。     

血管活性肠肽及NKG2D在胃腺癌组织中的表达及意义

胃癌是消化道最常见的恶性肿瘤,其中以腺癌更为常见.但目前为止胃癌的发病机制尚不十分清楚,尤其是在神经内分泌方面的发病机制研究甚少.许多肿瘤能分泌胃肠激素,血管活性肠肽(vasoactire intestinal peptide,VIP)属于胰泌素/VIP族的胃肠肽类激素,是最重要的脑肠肽和肽类神经递质之一,调节着多个系统的功能[1].     

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.     

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.     

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.     

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.