纵隔镜手术在肺癌分期中的应用价值

目的:探讨纵隔镜手术在肺癌纵隔淋巴结分期中的应用价值.方法:回顾性总结1999年11月至2003年7月69例经纵隔镜检查肺癌患者的临床资料,其中颈部纵隔镜手术57例,胸骨旁纵隔镜手术7例,颈部加胸骨旁纵隔镜手术5例.术前所有患者胸部CT均发现纵隔淋巴结肿大(最小直径大于1.0cm).结果:本组69例患者,经纵隔镜检查证实纵隔淋巴结转移(阳性)者50例,未见纵隔淋巴结转移(阴性)者19例.阳性者放弃手术,予以化疗.阴性者中15例中转开胸行肺叶切除或肺楔型切除加纵隔淋巴结清扫,术后病理证实14例纵隔淋巴结未见转移,1例隆突后淋巴结可见癌转移(纵隔镜检查假阴性).纵隔镜手术敏感性、特异性和准确性分别为98.0%、100%和98.5%.全组术后发生声音嘶哑1例,并发症发生率为1.4%(1/69).无围手术期死亡.结论:纵隔镜手术安全、可靠,可作为明确肺癌分期的常规方法.     

p16和Rb在胆道良及其意义恶性病变中的表达及其意义

目的研究p16、Rb在胆道良恶性病变中的表达和临床意义.方法应用免疫组化S-P法测定41例肝外胆管癌中p16、Rb的表达,以13例慢性胆管炎作为对照.结果肝外胆管癌组p16阳性率为51.2%(21/41).其中,高中分化癌组、低分化癌组、转移组、无转移组阳性率分别为53.6%(15/28)、46.2%(6/13)、31.3%(5/16)和64.0%(16/25);胆管炎组阳性率为92.3%(12/13).肝外胆管癌组与胆管炎组间、无转移组与转移组间差异有显著性(P<0.01,P<0.05),高中分化癌组与低分化癌组间差异无显著性(P>0.05).肝外胆管癌组Rb阳性率为58.5%(24/41).其中,高中分化癌组、低分化癌组、转移组、无转移组Rb阳性率分别为71.4%(20/28)、30.8%(4/13)、37.5%(6/16)和72.0%(18/25);胆管炎组阳性率为92.3%(12/13).肝外胆管癌组与胆管炎组间、高中分化癌组与低分化癌组间、无转移组与转移组间差异有显著性(P<0.05).24例Rb阳性病例中,p16阳性率为37.5%(9/24);17例Rb阴性病例中,p16阳性率为70.6%(12/17),两者表达呈负相关(P<0.05),Kendall相关系数τb=-0.33.结论肝外胆管癌组织中存在p16、Rb异常表达,均与转移有关,Rb异常表达还与肝外胆管癌病理分级有关.上述两指标可作为判断患者预后的参考指标.     

反义寡核苷酸对Daudi细胞α2,6唾液酸的下调作用研究

 目的　研究反义寡核苷酸对Burkitt’s淋巴瘤Daudi细胞α2 ,6 唾液酸转移酶 (ST6GalI)的活性和细胞表面α2 ,6 唾液酸水平的下调作用。方法　以修饰后的ST6GalI的反义寡核苷酸处理Daudi细胞 ,以RT PCR检测Daudi细胞ST6GalImRNA的表达 ,荧光定量法测定ST6GalI的活性及以流式细胞仪检测细胞表面α2 ,6 唾液酸的含量。结果　和对照组比较 ,以反义寡核苷酸处理的Daudi细胞ST6GalImRNA的表达下调 ,ST6GalI酶活性下降 ,并导致细胞表面α2 ,6 唾液酸水平降低。结论　反义寡核苷酸可有效降低Daudi细胞表面α2 ,6 唾液酸化水平 ,内源性减少α2 ,6 唾液酸对Daudi细胞CD2 2受体的屏蔽作用     

腓肠肌肌皮瓣应用解剖和临床运用

腓肠肌肌皮瓣是临床比较常用的皮瓣之一，最早由Mccraw与Feldman于1978年首先报道。随着对其应用解剖研究的深入和实际运用经验的积累，其运用范围越来越广。现在，腓肠肌肌皮瓣的应用解剖研究和临床运用互相促进，使其在修复重建外科中发挥着重要的作用。     

大块骨组织体视学研究的图像采集与分析

大块骨组织由于不脱钙切片制作技术难度高,应用体视学对大块骨组织整体形态进行图像定量分析的研究资料较少。随着生物材料、人工金属植入材料在骨科临床的大量应用,如何获取高质量的大块骨组织整体图像,并应用体视学原理进行较为精确的图像分析变成了迫切需要解决的问题。目的:寻求大块骨组织实用和有效的数字图像采集方法,使之应用体视学原理进行较为精确的图像分析。材料与方法:普通玻片上的大组织标本、硬组织切片机切取的不脱钙塑料包埋大块骨组织标本及旋转切割机切取的含金属植入物的塑料包埋磨片标本。分别采用普通显微镜、大视野显微镜、自动显微镜及图像拼接软件采集,同时采用胶片扫描仪、台式背透扫描仪及高分辩数码相机进行采集比较。结果:上述各方法在一定程度均能满足大块骨组织图像采集及体视学分析需求,同时在标本适应性、视野规模、成像质量方面总结出各自优、缺点以及相应技术方法。     

The attitudes of cancer patients and their families toward the disclosure of terminal illness.

PURPOSE:To ascertain the attitude of cancer patients and their families toward disclosure of terminal illness to the patient. PATIENTS AND METHODS: We constructed a questionnaire that included demographic and clinical information and delivered it to 758 consecutive individuals (433 cancer patients and 325 families that have a relative with cancer) at seven university hospitals and one national cancer center in Korea. RESULTS: 380 cancer patients and one member from each of 281 families that have a relative with cancer completed the questionnaire. Cancer patients were more likely than family members to believe that patients should be informed of the terminal illness (96.1% v 76.9%; P <.001). Fifty percent of the family members and 78.3% of the patients thought that the doctor in charge should be the one who informs the patient. Additionally, 71.7% of the patients and 43.6% of the family members thought that patients should be informed immediately after the diagnosis. Stepwise multiple logistic regression indicated that the patient group was more likely than the family group to want the patient to be informed of the terminal illness (odds ratio [OR], 9.76; 95% CI, 4.31 to 22.14), by the doctor (OR, 4.00; 95% CI, 2.61 to 6.11), and immediately after the diagnosis (OR, 3.64; 95% CI, 2.45 to 5.41). CONCLUSION: Our findings indicated that most cancer patients want to be informed if their illness is terminal, and physicians should realize that the patient and the family unit may differ in their attitude toward such a disclosure. Our results also reflect the importance of how information is given to the patient.     

PET在肺癌诊断和分期中的应用

本文介绍正电子发射断层显像(PET)在肺癌诊断和分期中的应用概况，肯定了其临床应用价值。并简要叙述我国PET目前现状及今后展望。PET系大型医疗设备，我国未纳入医疗保险，其发展要根据社会经济发展和病人承受能力，合理布局，有限量地增加。作者指出，加强核医学科人员培训与临床各科医师(包括放射科，肿瘤科，胸外科，放射治疗等)的合作是提高PET临床应用和研究水平的关键因素。     

Loss of beta-catenin expression in metastatic gastric cancer.

PURPOSE: Beta-catenin (beta-catenin) participates in intercellular adhesion and is an integral part of the Wnt signaling pathway. The role of beta-catenin in the pathogenesis of gastric cancer and its metastasis is largely unknown. PATIENTS AND METHODS: Immunohistochemistry and Western blot analysis were used to analyze the expression of beta-catenin in 87 human gastric cancers, in metastasis and cancer cell lines. The beta-catenin and the adenomatous polyposis coli (APC) genes were analyzed for gene mutations. Furthermore, methylation of the beta-catenin promoter in cell lines was assessed by treatment with 5'-azadeoxycytidine and sodium bisulfite genomic sequencing. RESULTS: beta-Catenin expression was present at either the cell membrane or the cytoplasm in 34 of 75 primary gastric cancers. Expression of beta-catenin was significantly more frequent in intestinal-type (P =.0049) and well-differentiated gastric cancers (P <.001). There were no quantitative differences between gastric cancers and the nonmalignant gastric tissues, as determined by Western blot analysis. One of 18 metastatic cancer lesions and four of five gastric cancer cell lines expressed beta-catenin protein. N87 cells, derived from the liver metastasis of a gastric cancer, did not express beta-catenin. Treatment with 5'-azadeoxycytidine restored beta-catenin protein levels in this cell line, which exhibited significantly more 5-methylcytosines in the beta-catenin promoter compared with the other cell lines. CONCLUSION: beta-Catenin expression is lost in a subgroup of primary gastric cancers, is frequently absent in metastases, and exhibits nuclear localization in cancers with either beta-catenin or APC gene mutations. Interestingly, the loss of beta-catenin expression in metastatic gastric cancers may result from hypermethylation of the beta-catenin promoter.     

Thalidomide metabolites in mice and patients with multiple myeloma.

PURPOSE:This research examines the profile of metabolites of thalidomide that are formed in refractory multiple myeloma patients undergoing thalidomide therapy in comparison with those that are detected in healthy mice. EXPERIMENTAL DESIGN: Urine or plasma samples from patients during thalidomide therapy (100-400 mg daily), or from mice treated i.p. (100 mg/kg) or p.o. with thalidomide (50 mg/kg) were analyzed using liquid chromatography-mass spectrometry. Metabolites in each of the peaks observed in the UV- and mass spectrometry-detected high-performance liquid chromatography traces were identified by comparison of retention times and spectra with those of authentic standards. RESULTS: Plasma and urine samples from mice 4 h after treatment with thalidomide contained eight major metabolites formed by hydroxylation and/or hydrolysis of thalidomide. In contrast, urine samples from seven multiple myeloma patients at steady state levels of thalidomide therapy showed the presence of only three hydrolysis breakdown products and no hydroxylated metabolites. CONCLUSIONS: Our results show that thalidomide metabolite profiles in multiple myeloma patients differ considerably from those in mice. The lack of measurable hydroxylated metabolites in urine and in 1 case plasma of these patients suggests that such metabolites are not responsible for the therapeutic effects of thalidomide in multiple myeloma. We suggest that thalidomide may act directly, down-regulating growth factors essential for multiple myeloma growth.