射频热疗联合化疗治疗恶性消化道肿瘤的疗效和安全性探讨

目的探究射频热疗联合化疗治疗恶性消化道肿瘤的临床疗效及安全性,分析其对患者消化道症状、血清肿瘤标志物的影响。方法选取2014-05~2015-12该院收治的恶性消化道肿瘤患者82例,随机分为对照组(n=41)和观察组(n=41)。对照组给予常规化疗方案治疗,观察组在对照组的基础上联合射频热疗治疗,4周为1个疗程。治疗3个疗程后,比较两组临床疗效以及治疗前后两组消化道症状改善情况,另检测两组治疗前后血清肿瘤标志分子水平的变化,统计并分析治疗期间两组不良反应发生情况。结果观察组临床疗效优于对照组(P0.05)。与治疗前比较,治疗后两组食欲减退、恶心呕吐、吞咽不适、胃腹痛及腹泻等症状评分均明显降低(P0.05或P0.01),但治疗后两组间上述症状评分差异均无统计学意义(P0.05)。治疗后两组血清癌胚抗原(CEA)、糖类抗原125(CA125)、糖类抗原19-9(CA19-9)及癌抗原72-4(CA72-4)水平均显著降低(P0.01),且观察组显著低于对照组(P0.01)。治疗后两组神经毒性、白细胞减少、胃肠道反应及肝功能损害等不良反应发生率比较差异均无统计学意义(P0.05)。结论射频热疗联合化疗可显著改善恶性消化道肿瘤患者消化道不适症状,有效降低患者血清肿瘤标志分子水平,且不会增加不良反应,具有明显协同作用,疗效显著优于单用化疗。     

消化道恶性肿瘤肺转移患者纤支镜消融与保守化疗的存活期及生活质量随访

目的探讨经纤支镜射频消融与保守化疗对消化道恶性肿瘤肺转移患者存活期及生活质量的影响。方法选取90例消化道恶性肿瘤肺转移患者为研究对象,随机分成两组,各45例。对照组予以保守化疗方案,研究组则予以纤支镜下射频消融方案。比较两组3年存活率、临床疗效及不良反应发生情况,分析治疗前后Karnofsky功能状态评分(KPS评分)、体力状况(performance status,PS)评分及症状评分差异。结果 1研究组治疗总有效率为66.7%,显著高于对照组的44.4%(P0.05);2治疗后,两组KPS评分均较治疗前显著提升,PS评分则较治疗前显著降低(P0.05);其中研究组各指标改善幅度均大于对照组(P0.05);3治疗后,两组患者乏力、咳嗽、气短、咯血、胸闷、胸痛等症状积分均较治疗前显著降低,其中研究组降幅大于对照组(P0.05);4研究组3年存活率为53.3%,显著高于对照组的31.1%(P0.05);研究组不良反应发生率均显著低于对照组(P0.05)。结论纤支镜消融疗法利于消化道恶性肿瘤肺转移患者提高3年生存率、改善存活质量,治疗安全性理想。     

经导管动脉栓塞化疗为基础的多烯紫杉醇联合方案治疗结直肠癌肝转移效果分析

目的探讨经导管动脉栓塞化疗(TACE)为基础的多烯紫杉醇联合方案对结直肠癌肝转移的治疗效果。方法随机将82例结直肠癌术后肝转移患者分为两组,实验组41例给予多烯紫杉醇联合方案TACE+全身化疗,对照组41例给予多烯紫杉醇联合方案全身化疗,治疗3个周期。评估两组临床疗效及Ⅱ~Ⅲ度化疗毒副反应、功能状态(KPS)评分、肿瘤病人生活质量评分量表(QOL)评分;出院后第1天采用电话或门诊随访至2015年6月,记录肝外转移率、肝外转移时间。结果实验组治疗总有效率为70.73%,显著高于对照组的39.02%(P0.05);实验组肝外转移率为17.07%,显著低于对照组的39.02%,肝外转移时间显著慢于对照组(P0.05)。实验组治疗后KPS评分和QOL评分显著高于对照组(P0.05);两组化疗毒副反应无显著差异(P0.05)。结论多烯紫杉醇联合方案TACE+全身化疗治疗结直肠癌肝转移,能够提高有效率、延缓肝外转移时间、改善生活质量。     

肠内免疫营养联合微生态制剂对进展期胃癌术后辅助化疗的临床作用研究

目的评价肠内免疫营养联合微生态制剂对进展期胃癌术后辅助化疗患者营养状态、血液学毒性,消化道反应和免疫功能的影响。方法将2013年1月至2015年9月首都医科大学附属北康医院收治的76例进展期胃癌术后辅助化疗患者随机分为肠内免疫营养组(E组,27例)、肠内免疫营养联合微生态制剂组(E~+P组,25例)及对照组(C组,24例)。观察各组患者化疗前后的营养状态、血液学毒性,消化道反应和T细胞亚群的变化。结果与化疗前相比,对照组化疗后体重降低,PA和TF均显著降低(P0.05),化疗后E组和E~+P组体重较化疗前无明显变化(P0.05),前白蛋白(PA)和转铁蛋白(TF)显著高于对照组(P0.05),E组与E~+P组的PA和TF两组间无明显差异(P0.05)。对照组有11例(45.8%)出现Ⅲ度血液学毒性,而E组出现3例(11.1%),E~+P组仅出现2例(8.0%),差异有统计学意义(P0.05);E组和E~+P组中消化道反应的发生明显少于对照组(P0.05),其中E~+P组优于E组(P0.05)。对照组患者化疗前后辅助性T细胞(CD4~+)和CD4~+/CD8~+比值明显下降(P0.05),E组及E~+P组反而上升(P0.05),E组及E~+P组间差异无统计学意义(P0.05)。结论肠内免疫营养可减轻化疗引发的毒副反应,改善患者的营养状态,增强机体的免疫功能。肠内免疫营养联合微生态制剂可进一步减轻化疗过程中的消化道反应,提高患者治疗期间的生存质量。     

鸦胆子油乳注射液配合化疗治疗晚期非小细胞肺癌的临床观察

目的 探讨鸦胆子油乳注射液加化疗与单纯化疗对晚期非小细胞肺癌的疗效、毒副反应和免疫功能的影响.方法 将60例晚期非小细胞肺癌患者随机分为两组.（1）治疗组：化疗的同时加用鸦胆子油乳注射液或化疗前1～2天加用10%鸦胆子油乳20 ml加入250 ml 0.9%氯化钠溶液中稀释后静滴,每日1次,连用8～10天.（2）对照组：单用化疗方案为NP方案,即去甲长春花碱（NVB）联合顺铂（DDP）.3～4周为1周期,患者至少治疗2个周期.结果 治疗组有效率为46.7%,对照组为40%（P＞0.05）.两组胃肠道反应比较无差异（P＞0.05）.治疗组血液毒副反应,治疗前后免疫功能改变均明显低于对照组（P＜0.05）.治疗组临床受益率、临床症状改善率、生活质量KPS评分高于对照组（P＜0.05）.结论 鸦胆子油乳注射液配合化疗治疗晚期非小细胞肺癌,可降低化疗对患者免疫功能的影响和毒副反应,改善患者的生活质量.     

两组化疗方案治疗NSCLC临床疗效观察

目的观察并对比奥沙利铂(L-OHP)分别联合培美曲塞(PEM)、吉西他滨(GEM)化疗方案治疗晚期非小细胞肺癌(NSCLC)的临床疗效。方法将94例晚期NSCLC患者随机分为A、B两组,A组予LOHP+PEM方案,B组予L-OHP+GEM方案,对比两组临床疗效、药物毒性反应及2年生存率。结果①两组临床疗效构成、药物毒性反应发生率、化疗后2年生存率、病死者平均生存月数相近(P0.05);②A组腺癌患者化疗后KPS评分、2年生存率、病死者平均生存月数显著高于B组(P0.05)。结论两种化疗方案治疗晚期NSCLC疗效相当,L-OHP+PEM方案对腺癌疗效具有比较优势。     

经纤维支气管镜联合局部化疗治疗肺癌的效果分析

目的观察经纤维支气管镜联合局部化疗治疗中晚期中央型肺癌的临床疗效。方法选取2012年2月至2014年1月期间我院收治64例中晚期中央型肺癌患者作为研究对象,随机分为两组,对照组采取全身化疗,观察组在全身化疗的基础上进行经纤维支气管镜联合局部化疗,两组患者每周进行2次治疗,疗程8w,治疗结束后比较患者KPS和ZPS评分并评价两组患者的临床治疗效果。结果两组患者治疗后的KPS和ZPS评分较治疗前明显提高,对照组治疗后的KPS为(71.2±5.6),ZPS评分为(3.3±0.1);观察组治疗后的KPS和ZPS评分为(83.7±6.8),ZPS评分为(4.1±0.3),两者具有统计学差异(P0.05)。对照组治疗有效率,观察组治疗有效率,两者具有统计学差异(P0.05)。结论经纤维支气管镜联合局部化疗可有效控制中晚期中央型肺癌的进展,改善患者的阻塞性肺炎肺不张症状,疗效较为显著,值得在临床上推广应用。     

岩舒联合NP方案治疗晚期非小细胞肺癌近期疗效与毒性观察

目的观察岩舒注射液联合长春瑞滨（NVB）、顺铂（DDP）方案（NP方案）治疗晚期非小细胞肺癌（NSCLC）的近期疗效和毒副反应。方法68例晚期NSCLC患者分为对照组和观察组,均采用NP方案化疗,观察组加用岩舒注射液,完成2～4周期后进行疗效评价。结果两组近期疗效无明显差异,但观察组临床受益反应（KPS评分、体质量、止痛药用量等）优于对照组,毒副反应主要为轻微的血液毒性。结论岩舒注射液联合化疗具有改善NSCLC患者生活质量和明显协同、增效、减毒作用,可作为化疗的辅助用药。     

甲地孕酮联合TP方案治疗晚期非小细胞肺癌的临床观察

目的观察甲地孕酮在治疗晚期非小细胞肺癌（NSCLC）化疗中的辅助治疗效果。方法60例晚期NSCLE患者,随机分为治疗组与对照组,治疗组30例给予甲地孕酮联合TP方案[TAX（紫杉醇）＋DDP（顺铂）]治疗;对照组30例行单纯TP方案化疗。两组患者均以21天为1个周期,所有患者至少接受2周期治疗后评价疗效。观察两组患者的客观疗效、生活质量、化疗毒副反应的变化情况及甲地孕酮的不良反应。结果两组患者客观疗效（CR＋PR）分别为50％及46.7％,无显著性差异（P〉0.05）;治疗组患者在食欲改善、体重增加和提高Kamofsky评分,以及在保护骨髓功能和减轻消化道反应方面均优于对照组,差异非常显著（P〈0.01）,未见甲地孕酮引起的不良反应。结论甲地孕酮联合TP方案和单纯TP方案治疗晚期NSCLC的客观疗效无明显差异,但前者毒副反应小,患者生活质量明显改善。     

乌梅汤加味治疗中老年晚期胰腺癌的有效性及安全性

目的探讨乌梅汤加味治疗晚期胰腺癌有效性及安全性。方法 60例晚期胰腺癌患者随机分为治疗组与对照组,治疗组给予乌梅汤加味口服配合最佳支持治疗,对照组给予单药吉西他滨方案化疗配合最佳支持治疗,比较两组疗效、体能状态评分、血液学指标及不良反应。结果治疗组体能状态评分、不良反应发生率显著优于对照组(P0.05)。结论乌梅汤加味对晚期胰腺癌的疗效不劣于单药吉西他滨化疗,并能缓解疼痛、食欲下降等症状,同时提高患者体能状态评分,改善体力状态,改善患者的生活质量,且安全性较高,对机体损伤小,副反应轻微。     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.