老年肿瘤患者PICC导管相关性感染危险因素及病原菌分析

目的分析老年肿瘤化疗患者PICC导管相关性感染的感染病原菌分布及其危险因素,为临床工作中有效防治导管相关性感染提供参考。方法收集2013年1月至2014年12月行PICC置管的老年肿瘤化疗患者246例,分析PICC导管相关性感染的病原菌分布,对PICC导管相关性感染的危险因素进行分析。结果 246例老年肿瘤化疗患者中发生PICC导管相关性感染为28例,发生率为11.4%。病原菌分布为革兰阳性菌(55.9%),革兰阴性菌(26.5%)和真菌(17.6%)。单次穿刺次数、PICC留置时间、输液类型、使用激素、白细胞计数、糖尿病史及静脉炎史是导管相关性感染发生率的影响因素(P0.05,P0.01)。结论老年肿瘤化疗患者是导管相关性感染的高发人群。应采取PICC置管前充分评估,严格执行PICC置管无菌操作,规范PICC日常维护,加强患者免疫机能等措施,减少老年肿瘤化疗患者PICC导管相关性感染的发生。     

精索静脉曲张手术疑似失败一例报告及再手术指证探讨

本文报告一例精索静脉曲张手术疑似失败病例的处理经过。患者双侧精索静脉曲张(左侧Ⅲ度,右侧Ⅱ度)伴局部疼痛不适及精液质量严重异常,行腹腔镜双侧精索静脉高位结扎术,术后2个月自觉局部坠胀、疼痛症状明显缓解,但双侧阴囊的迂曲较术前更加明显,疑似手术失败并再次入院。经临床和实验室检查后,发现患者无明确手术失败证据,选择对症治疗而避免再次手术。观察等待3个月后复诊,患者临床表现(鞘膜积液及坠胀感)减轻,实验室检查精液质量改善,超声检查乏氏动作后双侧精索静脉未见返流,双侧睾丸鞘膜未见明显积液,进一步确诊术后症状为术后暂时性侧枝循环建立不佳所致,而这种情况在同类手术中比较常见。综合本病例及文献报道,我们建议要严格掌握再手术的指证:明确的复发征象(与体位相关的精索静脉曲张及血液返流);患者的原始诉求(疼痛不适、精液质量异常)仍然存在且无改善。难以判断者,建议观察等待,以避免不必要的再次手术。通常术后应观察3~6个月再进行综合判定。     

急性心肌梗死和心房纤维性颤动患者CD62P、CD63与vWF检测的意义

目的 探讨急性心肌梗死(AMI)和心房纤维性颤动(AF)患者血小板膜糖蛋白CD62P、CD63与vWF临床检测的意义。方法采用流式细胞技术和夹心酶免疫吸附试验检测AMI和AF患者CD63、CD62P和vWF的变化。结果 AMI和AF患者的CD62P分别为11．29％和8．72％、CD63分别为8．72％和2．66％，明显高于对照组(3．37％和1．32％)，AMI组的vWF为167．83％，明显高于对照组(102．71％)，AF组为117．05％，与对照组比较无显著性差异。结论急性心肌梗死和心房纤维性颤动患者CD62P和CD63的表达水平明显增高，进一步证实CD62P和CD63为血栓形成的血小板活性物质，参与血栓性疾病的促凝血作用。     

Purified CD34+ Lin- Thy+ stem cells do not contain clonal myeloma cells

High-dose therapy with autologous marrow or peripheral blood stem cell (PBSC) rescue has been extensively applied in the treatment of multiple myeloma (MM) patients during the past 10 years resulting in improved event-free and overall survival when compared with standard chemotherapy. However, relapses are common and cure is unlikely in the majority of patients. Because both bone marrow and PBSCs are contaminated with myeloma cells it is conceivable that relapse after autotransplantation originates at least in part from autografted tumor cells. In this study, mobilized PBSCs were examined for the presence of myeloma cells based on immunophenotyping and sensitive polymerase chain reaction (PCR)-based techniques. In addition, CD34+ Lin- Thy+ stem cells were purified from mobilized PBSC harvests of 10 MM patients by sequentially using counterflow elutriation centrifugation, treatment with phenylalanine methylester, and flow sorting, using 5-parameter gating (propidium iodide, forward scatter, side scatter, CD34+ v Lin- and CD34+ v Thy+). Virtually all mobilized unsorted PBSC preparations contained myeloma cells in sufficient quantities (range, < 0.01 to > 10%) potentially causing a disease relapse. Stem cell purification led to an overall enrichment by about 50-fold in all 10 patients; approximately 90% of the final cell population expressed CD34+ Lin- Thy+ with no evidence of myeloma cell contamination based on flow cytometric analysis of CD38bright cells (< 0.1%). Quantitative PCR amplification of patient-specific complementarity determining region III (CDRIII) DNA sequences showed depletion of clonal B cells by 2.7 to 7.3 logs, with the highest log reduction noted in the samples initially containing the most tumor cells. Our results show that purification of CD34+ Lin- Thy+ cells depletes myeloma cells to undetectable levels from up to 10% present in unsorted PBSCs, thus offering a tool to investigate whether MM relapse after autotransplantation can be reduced markedly.     

Molecular heterogeneity in acute leukemia lineage switch

Six cases of acute leukemia that underwent lineage switch from acute lymphocytic leukemia to acute myelogenous leukemia are reported. The mean age of the patients was 24 years, time to conversion was 36 months, and survival after conversion was only 3 months. Of the three cases which showed abnormal metaphases at both diagnosis and conversion, two (cases 2, 5) showed related cytogenetic abnormalities, and the third showed (case 3) independent chromosomal changes. Molecular analysis for immunoglobulin heavy chain and T-cell receptor beta chain genes showed that five of the six cases had rearrangement of at least one of these lymphoid associated genes at conversion to acute myelogenous leukemia. The single case (case 3) in which there were no lymphoid gene rearrangements at conversion was also the only case in which independent karyotypic abnormalities at diagnosis and conversion were demonstrated. Our findings suggest that lineage switch can represent either relapse of the original clone with heterogeneity at the molecular level or the emergence of a second new leukemic clone without molecular heterogeneity.     

Cancer-protective effect of a synbiotic combination between Lactobacillus gasseri 505 and a Cudrania tricuspidata leaf extract on colitis-associated colorectal cancer

ABSTRACT

Previously, a synbiotic combination of probiotic Lactobacillus gasseri 505 (LG) and a new prebiotic, Cudrania tricuspidata leaf extract (CT) in fermented milk, designated FCT, showed an in vitro immunomodulatory effect and antioxidant activity. Although synbiotic combination might have cancer-protective effects, these activities have not been fully validated in vivo. Ten-week treatment of LG, CT, or FCT to azoxymethane (AOM)/dextran sodium sulfate (DSS)-induced colitis-associated colorectal cancer (CAC) mouse model reduced both the incidence of colonic tumors and damage to the colonic mucosa effectively, suggesting a cancer-protective effect. To understand these, biomarkers associated with inflammation, colon barrier, apoptosis, and cancer cell proliferation were monitored in AOM/DSS group versus LG/CT/FCT groups. A synbiotic combination (FCT) down-regulated pro-inflammatory cytokines (TNF-α, IFN-γ, IL-1β, and IL-6) and inflammation-associated enzymes (iNOS and COX-2), and up-regulated anti-inflammatory cytokines (IL-4 and IL-10). In addition, colon barrier experiment revealed that biomarkers of mucus layer (MUC-2 and TFF3) and tight junction (occludin and ZO-1) were up-regulated. Subsequent apoptosis experiment showed that pro-apoptotic factors (p53, p21, and Bax) were up-regulated and anti-apoptotic factors (Bcl-2 and Bcl-xL) were down-regulated. Furthermore, comparative metagenome analysis of gut microbiota revealed that Staphylococcus decreased but Lactobacillus, Bifidobacterium, and Akkermansia increased, supporting their protective effects, accompanied by increased short-chain fatty acids (SCFAs). Taken together, the FCT administration showed cancer-protective effects by reducing the risk of colitis-associated colon cancer via regulation of inflammation, carcinogenesis, and compositional change of gut microbiota. Consequently, the synbiotic combination (FCT) could be a novel potential health-protective natural agent against CAC.     

Two cases of pancreatic ductal adenocarcinoma, manifested as solid pseudopapillary tumor and intraductal papillary mucinous neoplasm]

Compared with other types of cancers, pancreatic cancer is one of the most dreadful malignancies and is fifth leading cause of cancer-related death in Korea. It is difficult to expect early diagnosis or improvement in prognosis due to lack of specific early symptoms and effective diagnostic methods. Whereas cystic neoplasm of the pancreas is a rare type of pancreatic tumor, surgical resection provides good prognosis because of its low possibility of local invasion or distant metastasis. In case of pancreatic cystic tumor, radiologic differentiation between benign and malignant lesions is crucial for the selection of appropriate treatment and the prediction of prognosis. And ductal adenocarcinoma of pancreas presenting in cystic form is an uncommon type of cystic tumor, making it extremely rare among all pancreatic malignancies. We report two cases of atypical pancreatic ductal adenocarcinoma presenting as solid pseudopapillary tumor and intraductal papillary mucinous neoplasm, respectively.