Peritoneal carcinomatosis of colorectal origin: Incidence, prognosis and treatment options

Peritoneal carcinomatosis (PC) is one manifestation of metastatic colorectal cancer (CRC). Tumor growth on intestinal surfaces and associated fluid accumulation eventually result in bowel obstruction and incapacitating levels of ascites, which profoundly affect the quality of life for affected patients. PC appears resistant to traditional 5-fluorouracil-based chemotherapy, and surgery was formerly reserved for palliative purposes only. In the absence of effective treatment, the historical prognosis for these patients was extremely poor, with an invariably fatal outcome. These poor outcomes likely explain why PC secondary to CRC has received little attention from oncologic researchers. Thus, data are lacking regarding incidence, clinical disease course, and accurate treatment evaluation for patients with PC. Recently, population-based studies have revealed that PC occurs relatively frequently among patients with CRC. Risk factors for developing PC have been identified: right-sided tumor, advanced T-stage, advanced N-stage, poor differentiation grade, and younger age at diagnosis. During the past decade, both chemotherapeutical and surgical treatments have achieved promising results in these patients. A chance for long-term survival or even cure may now be offered to selected patients by combining radical surgical resection with intraperitoneal instillation of heated chemotherapy. This combined procedure has become known as hyperthermic intraperitoneal chemotherapy. This editorial outlines recent advancements in the medical and surgical treatment of PC and reviews the most recent information on incidence and prognosis of this disease. Given recent progress, treatment should now be considered in every patient presenting with PC.     

Ischaemic stroke as an initial presentation in patients with COVID-19: evaluation of a case series in an emergency in Brazil

The disease caused by the new coronavirus, initially described in China in December 2019, became known as coronavirus disease 2019 and quickly spread to countries on all continents, becoming a pandemic with an important global impact. Despite being a virus that typically affects the respiratory tract, some studies have already described neurological manifestations associated with this infection, including acute ischaemic vascular insult. We report a case series including 30 patients, who presented with neurological symptoms during admission to our service, being diagnosed with ischaemic stroke and, concomitantly, coronavirus disease 2019. In the subgroup of patients analysed, a state of hypercoagulability and pro thrombosis was observed through laboratory tests, probably related to the cytokine storm syndrome associated with infection by this virus. With that, we discussed the possibility of this finding being an aggravating factor in the occurrence of stroke in these patients.     

Pre-S_2、抗Pre-S_2和HBV DNA在乙型肝炎患者中的相关性分析

目的 :探讨Pre_S2 、抗Pre_S2 二对半和HBVDNA对乙型肝炎患者血清学的诊断意义。方法 :用ELISA法和PCR法分别检测 93例乙型肝炎患者和 2 8例健康人血清中的Pre_S2 ,抗Pre_S2 ,二对半和HBVDNA水平。结果 :93例乙肝患者HBsAg、HBeAg、HBcAb阳性 32例 ,HBsAg、HBeAb、HBcAb阳性 39     

脐血干细胞和胎盘间充质干细胞在妇产科应用中的前景

目的:介绍脐血干细胞和胎盘间充质干细胞的研究进展,以及干细胞在妇产科中的应用前景。资料来源:应用计算机检索Medline1996-01/2006-12与脐血干细胞和胎盘间充质干细胞、以及干细胞在妇产科中的应用相关的文章,检索词为“human cord blood,mesenchy malstem cell,placenta,gene therapy in the uterus”,限定文献语种为“English”;同时检索万方数据库2000-01/2006-12相关文章,检索词为“脐血,间充质干细胞,胎盘,宫内治疗,卵巢癌,子宫癌”,限定文献语种为中文。资料选择:共检索到相关文献500余条,进一步查找全文,优先选择与临床应用靠近的文章,无论观察对象是人还是动物均纳入,筛除干细胞的提取、分化或培养等基础类研究,明显重复和综述文献也排除,最后纳入31条文献进行综述。资料提炼:31条文献中论述脐血干细胞和胎盘间充质干细胞的特点及应用文章有26篇,关于宫内移植干细胞治疗的文章有2篇,其他为研究干细胞在妇产科中应用的文章。资料综合:①大量实验证明脐血是骨髓、外周血后的第3种非常有潜力的造血干细胞资源。目前应用脐血移植治疗的疾病有急(慢)性白血病、恶性淋巴瘤、多发性骨髓瘤、再生障碍性贫血、严重免疫缺陷症等,而且已经有一定疗效。②胎盘作为胚胎发育中维系母体和胎儿氧气及营养物质交换的重要暂时性器官,无论从解剖结构还是在发育行为上,都包含了较为幼稚的胚胎及趋于成熟的成体干细胞成分,而且胎盘不会涉及伦理道德问题,目前已成为寻找人类间充质干细胞新来源及提高临床应用效果的研究热点。③干细胞宫内移植为先天性疾病治疗开辟了一条新途径。另外干细胞在器官再造、男性不育治疗和保存生育能力等生殖医学领域的研究也取得了重大进展,在妇科肿瘤方面,如以化疗保护为目标的基因治疗已逐步应用于临床。结论:脐血和胎盘取材方便、安全,还能避免免疫排斥和伦理问题,已成为人类间充质干细胞新来源。干细胞在宫内治疗、生殖疾病和妇科肿瘤方面也有广泛的临床应用前景。     

人T-bet基因的体外扩增及克隆和鉴定

目的:克隆人T-bet基因,构建其真核表达载体pEGFP-C1-T-bet。方法:实验于2005-07/2006-07在北京大学深圳医院中心实验室完成。①根据Genebank的人T-bet基因的全长cDNA序列,设计合成一对附加BglⅡ和SalⅠ两个限制性内切酶酶切位点的特异性引物。②分离人外周血单个核细胞,提取RNA,用反转录-聚合酶链反应方法将T-bet的编码序列cDNA扩增,装入pMD18-T载体并送去测序。③BglⅡ SalⅠ双酶切质粒pMD18-T-bet,经琼脂糖电泳切胶回收T-bet片段,将T-bet插入载体pEGFP-C1构建成重组真核表达载体pEGFP-C1-T-bet。④用双酶切和聚合酶链反应对插入片段进行分析和验证。结果:①反转录-聚合酶链反应产物经琼脂糖电泳结果显示在预期位置有相对分子质量为1608bp的特异性扩增带。②测序结果证实,T-bet的编码序列和Genbank中T-bet mRNA序列相同。③双酶切和聚合酶链反应结果证实插入片段序列正确。结论:实验成功扩增出人T-bet基因,构建了基因重组真核表达载体pEGFP-C1-T-bet,为探索T-bet基因对免疫细胞的调节作用和肿瘤基因治疗奠定了基础。     

The implementation of the Medical Regulation Office and Mobile Emergency Attendance System and its impact on the gravity profile of non-traumatic afflictions treated in a University Hospital: a research study

Background

The public health system of Brazil is structured by a network of increasing complexity, but the low resolution of emergency care at pre-hospital units and the lack of organization of patient flow overloaded the hospitals, mainly the ones of higher complexity. The knowledge of this phenomenon induced Ribeirão Preto to implement the Medical Regulation Office and the Mobile Emergency Attendance System. The objective of this study was to analyze the impact of these services on the gravity profile of non-traumatic afflictions in a University Hospital.

Methods

The study conducted a retrospective analysis of the medical records of 906 patients older than 13 years of age who entered the Emergency Care Unit of the Hospital of the University of São Paulo School of Medicine at Ribeirão Preto. All presented acute non-traumatic afflictions and were admitted to the Internal Medicine, Surgery or Neurology Departments during two study periods: May 1996 (prior to) and May 2001 (after the implementation of the Medical Regulation Office and Mobile Emergency Attendance System). Demographics and mortality risk levels calculated by Acute Physiology and Chronic Health Evaluation II (APACHE II) were determined.

Results

From 1996 to 2001, the mean age increased from 49 ± 0.9 to 52 ± 0.9 (P = 0.021), as did the percentage of co-morbidities, from 66.6 to 77.0 (P = 0.0001), the number of in-hospital complications from 260 to 284 (P = 0.0001), the mean calculated APACHE II mortality risk increased from 12.0 ± 0.5 to 14.8 ± 0.6 (P = 0.0008) and mortality rate from 6.1 to 12.2 (P = 0.002). The differences were more significant for patients admitted to the Internal Medicine Department.

Conclusion

The implementation of the Medical Regulation and Mobile Emergency Attendance System contributed to directing patients with higher gravity scores to the Emergency Care Unit, demonstrating the potential of these services for hierarchical structuring of pre-hospital networks and referrals.

     

Prolonged neutropenia resulting from antibodies to neutrophil-specific antigen NB1 following marrow transplantation

Marrow graft failure is a significant cause of morbidity following bone marrow transplantation. A case is reported of marrow graft failure due to neutrophil antibodies. A 13-year-old girl with a large granular lymphocytosis and chronic neutropenia was treated with granulocyte transfusions prior to undergoing a transplant with bone marrow from a partially matched, unrelated donor. Following the transplant, a bone marrow biopsy showed engraftment of donor myeloid cells, but the recipient remained neutropenic. Testing of the serum for neutrophil antibodies found that the recipient's serum had a high-titer neutrophil antibody. Immunoprecipitation studies using the marrow recipient's serum and 125I surface-labeled neutrophils showed that the antibody reacted to the neutrophil-specific antigen NB1. Phenotyping of neutrophils from the marrow donor found that they expressed NB1 antigen, and, in a crossmatch assay, the recipient's serum reacted with donor neutrophils. Despite treatment with granulocyte-macrophage– colony-stimulating factor, the marrow transplant recipient remained neutropenic and died of polymicrobial sepsis and aspergillosis 38 days after the transplant. The presence of high-titer antibodies to neutrophil-specific antigen NB1 in this patient following transplant likely prevented the recovery of her peripheral blood neutrophils and contributed to her death.