乳腺癌术后局部复发因素的探讨

目的乳腺癌术后局部复发率为10%～30%,合并高危因素者可达34%～40%,其中以胸壁复发最为常见。本文探讨乳腺癌术后胸壁局部复发的相关因素,寻找预防和降低乳腺癌术后胸壁复发的有效措施。方法回顾性分析乳腺癌术后局部复发而无远处转移的39例患者的临床资料。结果本组患者占同期全部乳腺癌病例的3.8%,其中22例（56.4%）在手术后2年内复发。T1～T4复发率分别为1.9%、2.3%、9.5%和16.7%。腋窝淋巴结（-）与腋窝淋巴结（＋）患者的胸壁复发率分别为1.2%、5.6%,腋窝淋巴结转移≥3个者复发率高达13.5%,新辅助化疗、术后放疗的患者复发率分别为2.1%、8.1%。明显低于未予相应治疗者。结论腋窝淋巴结转移数目多、原发灶分期晚、未予恰当辅助治疗者易出现胸壁复发。对乳腺癌术后易复发的高危人群应规范化治疗,新辅助化疗、术后放疗是预防胸壁复发的有效措施。     

乳腺癌根治术后辅助治疗对胸壁复发的影响(附135例分析)

目的：探讨乳腺癌根治术后辅助治疗对胸壁复的影响，方法：我院1985年5月至1990年5月收治Ⅱ，Ⅲ期（TNM国际分期）乳腺癌病人135例，均行根治性手术治疗，其中术后辅助化疗例，主要为CMF方案，2年内完成4－6疗程，术后放疗109例，病灶同侧腋窝，涣骨上及内乳淋巴引流区DT各45－55Gy/23-28次／4．6－5．6周，由于放疗设备关系，全部病人未行术后胸壁放疗，结果：随访止于2000年5月，全组胸壁复发率31．1％（42／135），其中乳房原发肿瘤＞5cm及乳房原发肿瘤2－5cm,但腋淋巴结转移≥4个者胸壁复发率明显增高，乳房肿瘤外浸及二次手术治疗者亦有较高的胸壁复发率，术后化疗对预防胸壁复发率意义不大，结论：对前述高危复发病人，应行术后胸壁放疗，才能减少复发，提高病人生存质量。     

复发性乳腺癌的治疗及预后分析

目的：分析复发性乳腺癌的治疗方法及影响预后的因素。材料与方法∶我科１９８７年１月～１９９１年６月８７例乳癌根治术或改良根治术后局部或区域淋巴结复发，无明显远处转移；其中４０例单纯放疗，４７例在放疗前或后合并化疗。结果∶５年生存率２４．１％。放疗加化疗优于单纯放疗（Ｐ＜０．０５）。影响预后因素∶患者年龄，复发时间，复发灶的数量及控制情况皆与预后有关。     

复发性乳腺癌的治疗及预后分析

目的：分析复发性乳腺癌的治疗方法及影响预后的因素。材料与方法：我科１９８７年１月￣１９９１年６月８７例乳癌根治术或改良根治术后局部或区域淋巴结复发，无明显远处转移；其中４０例单纯放疗，４７例在放部前或后合并化疗。结果：５年生存率２４．１％。放疗加化疗优于单纯放疗（Ｐ〈０．０５）。影响预后因素：患者年龄，复发时间，复发灶的数量及控制情况皆与预后有关。     

乳腺癌改良根治术后放疗时机不同疗效对比观察

目的研究乳腺癌改良根治术后放疗开始时间不同对总体疗效的影响,探讨乳腺癌改良根治术后放射治疗的最佳时机。方法选择河南科技大学第一附属医院放疗科2001年4月初至2005年5月末收治乳腺癌改良根治术后、T1-T3,腋下淋巴结大于3枚的放疗患者的临床资料进行回顾性分析。327例患者中219例术5周内接受放疗(治疗组);108例大于12周后接受术后放疗(对照组),放疗范围为患侧胸壁+同侧腋下(部分)+同侧锁骨上野照射,总剂量为50Gy/25次。比较两组患者3年及5年总生存率、局部控制率和远处转移率。结果治疗组病例的3年和5年生存率分别为85.7%和71.1%,5年局部控制率及远处转移率为97.2%和19.3%。对照组的3年及5年生存率分别为86.3%和69.5%,5年局部控制率及远处转移率为90.3%和42.1%,差异有统计学意义。结论乳腺癌局部控制至关重要,局部扩大野放射治疗同时结合全身化疗是降低乳腺癌术后复发及转移的较好模式。     

乳腺癌术后局部复发因素探讨

目的:分析乳腺癌术后局部复发因素,以便更有效地减少乳腺癌术后局部复发.方法:对2000-01～2002-06哈尔滨医科大学附属三院,乳腺癌术后资料1230例进行回顾分析,总结肿瘤的自身因素和治疗因素对术后局部复发的影响.结果:三年复发率为6.7%,总复发率为7.4%.临床分期、病理类型、腋淋巴结转移数目、激素受体、CerB-2结果、化疗、放疗完成情况是影响复发的主要因素.结论:临床分期、组织病理类型、腋淋巴结数目、CerB-2阳性是影响局部复发主要因素,放、化疗及内分泌治疗可减少术后局部复发.早期诊断规范治疗是减少乳腺癌局部复发的有效措施.     

妇女乳腺癌术后胸壁复发22例多因素临床分析

目的探讨妇女乳腺癌改良根治术后胸壁复发的临床特点及防治方法。方法回顾性分析22例乳腺癌改良根治术后胸壁复发而无远处转移患者临床资料。结果22例胸壁复发总的1年、3年、5年生存率分别为90．1％、50．4％、36．3％。结论手术切除彻底,化疗及放疗等综合治疗可以明显减少复发率,是预防和治疗胸壁复发的有效措施。     

放射治疗乳腺癌术后胸壁复发64例临床分析

目的总结乳腺癌改良根治术后胸壁局部复发的临床特点及放疗疗效。方法回顾性分析64例乳腺癌改良根治术后胸壁复发患者的临床资料。结果放射治疗对于局部病灶直径<2 cm的疗效较好,64例无一例先出现锁骨上淋巴结转移,5例局部晚期乳腺癌胸壁复发在术后半年内。结论 (1)单个病灶直径≥2 cm放疗效果差,建议手术;(2)照射胸壁须照射锁骨上;(3)锁骨上淋巴结转移,不必作胸壁预防照射;(4)对于局部晚期的,放疗时间不应晚于术后3月。     

早期乳腺癌保留乳房手术治疗42例临床分析

目的 观察早期乳腺癌保乳综合治疗的效果.方法 对42例早期乳腺癌患者实行保乳手术.其中Ⅰ期26例,Ⅱ期16例.所有患者行单纯肿瘤切除加腋窝淋巴结清扣,术后辅助放疗和化疗.结果 术后患者全获随访6～60个月,35例无局部复发和远处转移,4例发生肺远处转移,3例局部复发带瘤生存.美容效果优良率达90.4%(38/42).结论 保乳手术加术后放疗、化疗可提高早期乳腺癌患者的生存率,且美容效果满意.     

腺癌保乳手术与改良根治术效果比效

目的通过早期乳腺癌保乳治疗和改良根治术的比较,探讨乳腺癌保乳治疗后的疗效及美容效果等问题。方法将188例同期行乳腺癌手术的患者,根据手术方式分为保留乳房根治术组(73例)和改良根治术组(115例),两组手术后均给予常规放疗和化疗,定期随访,比较两组之间的局部复发、远处转移和3、5年生存率情况。结果本组保乳术后美容效果良好45例,一般21例,差7例。保乳组局部复发率4.11%(3/73),其中乳腺局部复发2例,腋窝淋巴结转移1例,均及时再次手术,病情得到控制,3例分别发生肝和脑转移而死亡。改良组局部复发率6.09%(7/115),3例局部肿瘤复发和4例腋窝淋巴结转移。7例分别死于肝、肺、胸膜、骨转移。两组复发、远处转移和3、5年生存率差异均无统计学意义(P>0.05)。结论保乳手术与根治术在生存率、局部复发等方面无差异,但生活质量明显提高。包括局部广泛切除、术后放疗和全身辅助治疗的早期乳腺癌规范化的保乳治疗是可行的。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.