胰十二指肠切除术87例临床分析

目的　探讨胰十二指肠切除术指征 ,提高手术切除率及减少术后并发症的发生。方法　回顾性总结 1990～ 2 0 0 2年 8月间我院收治的 87例胰十二指肠切除术病例的临床资料 ,采用联合定性法和经十二指肠胰腺穿刺组织学检查提高诊断率。逆向胰腺切断 ,血管修补提高切除率。单层套入式胰十二指肠切除术胰肠重建。术前“减黄”等措施减少手术并发症。结果　 87例中 ,术后出现胰瘘 1例 ,胆瘘 2例 ,胃肠吻合口瘘 1例。住院期间死亡 3例。重度梗阻性黄疸术后并发症的发生率明显增高。结论　可能的诊断及合适的探查和适应证范围的扩大能提高手术切除率。术前“减黄”、单纯套入式胰肠吻合等正确手术操作 ,是降低术后并发症发生率的有效方法     

三种抗生素诱导生物被膜克雷伯杆菌产生β-内酰胺酶

目的 :探讨生物被膜 (BF)克雷白杆菌耐药机制 ,为临床选用抗生素提供理论依据。方法 :用改良平板培养法建立克雷白杆菌BF模型。用银染法及扫描电镜对BF进行鉴定。分别检测浮游克雷白杆菌 (A组 )、BF菌(B组 )、亚胺培南诱导BF菌 (C组 )、头孢西丁诱导BF菌 (D组 )、氧哌嗪青霉素诱导BF菌 (E组 )产生β 内酰胺酶的活性。结果 :B组β 内酰胺酶活性 (0 .5 496± 0 .0 99)U/mg高于A组 (0 .3 3 3 4± 0 .0 2 9) ,是A组 1.65倍 (P <0 .0 1) ;C组 (0 .772 8± 0 .0 3 79)、D组 (0 .663 4± 0 .0 5 5 8)、E组 (0 .60 70± 0 .0 465 )U/mg均高于B组 (P <0 .0 1) ;C组高于D组和E组 (P <0 .0 1) ;D组高于E组 (P<0 .0 1)。结论 :BF克雷白杆菌产生大量 β 内酰胺酶是其耐药主要原因之一 ,抑酶剂或含抑酶剂抗生素治疗BF克雷白杆菌相关感染可能有效     

Multiple Myeloma and Atopic Eczema in an Adult

Multiple myeloma is the fourteenth cause of cancer-related death. The symptoms of myeloma are mostly nonspecific, and there is significant delay between the first symptoms and diagnosis of myeloma. Atopic eczema is a common chronic inflammatory skin disease associated with dysregulation of the immune system. It generally develops in early childhood but can also occur in adults. Eczema is associated with a variety of hematological and solid malignancies, and possibly multiple myeloma. We report a patient with eczema that developed 5 years before the diagnosis of multiple myeloma but was mistaken for psoriasis.Key Words: Multiple myeloma, Atopic eczema, Early symptoms, Diagnostic criteria     

Elevated Erythropoietin and Multicystic Neoplasm of the Pancreas

Cystic lesions of the pancreas are more frequently recognized due to the widespread use of improved imaging techniques. There are a variety of pancreatic cystic lesions with different clinical presentations and malignant potentials, and their management depends on the type of the cysts. Although the early recognition of a cystic neoplasm with malignant potential provides an opportunity of early surgical treatment, the precise diagnosis of the cystic neoplasm can be a challenge, largely due to the lack of reliable biomarkers of malignant transformation. We report a case of a large, multicystic neoplasm within the body and tail of the pancreas complicated by elevated erythropoietin, which is likely related to the malignant transformation of the pancreatic neoplasm.Key Words: Cystic neoplasm, Pancreas, Erythropoietin, Biomarker     

Proteomic analysis of exosomes from nasopharyngeal carcinoma cell identifies intercellular transfer of angiogenic proteins

Exosomes, a group of secreted extracellular nanovesicles containing genetic materials and signaling molecules, play a critical role in intercellular communication. During tumorigenesis, exosomes have been demonstrated to promote tumor angiogenesis and metastasis while their biological functions in nasopharyngeal carcinoma (NPC) are poorly understood. In this study, we focused on the role of NPC‐derived exosomes on angiogenesis. Exosomes derived from the NPC C666‐1 cells and immortalized nasopharyngeal epithelial cells (NP69 and NP460) were isolated using ultracentrifugation. The molecular profile and biophysical characteristics of exosomes were verified by Western blotting, sucrose density gradient and electron microscopy. We showed that the C666‐1 exosomes (10 and 20 μg/ml) could significantly increase the tubulogenesis, migration and invasion of human umbilical vein endothelial cells (HUVECs) in a dose‐dependent manner. Subsequently, an iTRAQ‐based quantitative proteomics was used to identify the differentially expressed proteins in C666‐1 exosomes. Among the 640 identified proteins, 51 and 89 proteins were considered as up‐ and down‐regulated (≥ 1.5‐fold variations) in C666‐1 exosomes compared to the normal counterparts, respectively. As expected, pro‐angiogenic proteins including intercellular adhesion molecule‐1 (ICAM‐1) and CD44 variant isoform 5 (CD44v5) are among the up‐regulated proteins, whereas angio‐suppressive protein, thrombospondin‐1 (TSP‐1) was down‐regulated in C666‐1 exosomes. Further confocal microscopic study and Western blotting clearly demonstrated that the alteration of ICAM‐1 and TSP‐1 expressions in recipient HUVECs are due to internalization of exosomes. Taken together, these data strongly indicated the critical roles of identified angiogenic proteins in the involvement of exosomes‐induced angiogenesis, which could potentially be developed as therapeutic targets in future.     

A dual‐specific anti‐IGF‐1/IGF‐2 human monoclonal antibody alone and in combination with temsirolimus for therapy of neuroblastoma

The insulin‐like growth factors (IGFs), IGF‐1 and IGF‐2, have been implicated in the growth, survival and metastasis of a broad range of malignancies including pediatric tumors. They bind to the IGF receptor type 1 (IGF‐1R) and the insulin receptor (IR) which are overexpressed in many types of solid malignancies. Activation of the IR by IGF‐2 results in increased survival of tumor cells. We have previously identified a novel human monoclonal antibody, m708.5, which binds with high (pM) affinity to both human IGF‐1 and IGF‐2, and potently inhibits phosphorylation of the IGF‐1R and the IR in tumor cells. m708.5 exhibited strong antitumor activity as a single agent against most cell lines derived from neuroblastoma, Ewing family of tumor, rhabdomyosarcoma and osteosarcoma. When tested in neuroblastoma cell lines, it showed strong synergy with temsirolimus and synergy with chemotherapeutic agents in vitro. In xenograft models, the combination of m708.5 and temsirolimus significantly inhibited neuroblastoma growth and prolonged mouse survival. Taken together, these results support the clinical development of m708.5 for pediatric solid tumors with potential for synergy with chemotherapy and mTOR inhibitors.     

国产5-氨基水杨酸肠溶片治疗溃疡性结肠炎多中心临床研究

目的　评价国产 5 氨基水杨酸 (5 ASA)肠溶片治疗溃疡性结肠炎 (UC)的疗效和安全性及该药的口服吸收情况。方法　采用多中心、随机、双盲、双模拟和对照方案 ,将 1 2 9例UC患者随机分为5 ASA肠溶片试验组 (6 5例 ,2 .4 g/d)和水杨酸偶氮磺胺吡啶 (SASP)对照组 (6 4例 ,4 .0g/d) ,疗程均为6周。治疗第 8天 ,随机抽取试验组 1 3例和对照组 1 2例UC患者血清 ,应用高效液相色谱分析法检测血清 5 ASA及其代谢产物Ac 5 ASA的稳态血药浓度。对两组患者治疗前后的临床症状、粪便检查和肠镜检查的情况进行比较 ,并记录治疗过程中的不良反应。结果　实际完成研究者 1 2 0例 (5 ASA组 6 1例 ,SASP组 5 9例 ) ,两组各有 4例失访 ,SASP组有 1例因严重胃肠道不良反应中途退出。 5 ASA肠溶片组和SASP组治疗UC的总有效率分别为 70 .0 5 %和 6 7.79% ,两组间差异无显著性 (P >0 .0 5 ) ,5 ASA肠溶片的完全缓解率明显高于SASP (2 9.5 1 %比 1 3.31 % ,P <0 .0 5 )。 5 ASA肠溶片组和SASP组的不良反应分别为 1 1 .4 8%和 2 3.33%。 5 ASA组和SASP组的血清 5 ASA浓度分别为 (0 .0 32± 0 .0 0 8) μg/ml和 (0 .0 4 1± 0 .0 0 5 ) μg/ml(P >0 .0 5 )。 结论　 5 ASA肠溶片治疗UC总有效率与SASP相仿 ,但对UC的完     

The effects of NOS1 gene on asthma and total IgE levels in Taiwanese children,and the interactions with environmental factors

Wang T‐N, Tseng H‐I, Kao C‐C, Chu Y‐T, Chen W‐Y, Wu P‐F, Lee C‐H, Ko Y‐C. The effects of NOS1 gene on asthma and total IgE levels in Taiwanese children, and the interactions with environmental factors.
Pediatr Allergy Immunol 2010: 21: 1064–1071.
© 2010 John Wiley & Sons A/S Asthma is a complex disorder, which is known to be affected by interactions between genetic and environmental factors. The aim of this study was to investigate the three microsatellite polymorphisms of GT repeats in intron 2, AAT repeats in intron 20, and CA repeats in exon 29 of the NOS1 gene in 155 asthmatic children and 301 control children, and the interaction with environmental factors in southern Taiwan. Total serum IgE, phadiatop test and genetic polymorphisms were measured. The genotype frequency of 14/14‐AAT repeats of the NOS1 gene was significantly higher in the asthmatic group (p = 0.01). Total IgE concentrations were higher in asthmatic children (p = 0.015) carrying the NOS1 14/14‐AAT genotype than in subjects with other polymorphisms. The gene and environmental interaction effects were 3.83‐fold, 6.86‐fold, and 8.04‐fold (all corrected p‐values <0.001) between subjects carrying at least one NOS1 14‐AAT allele and exposure to cockroaches, high levels of total IgE, and positive response against the phadiatop test in asthmatic children. The findings of this study provide strong evidence that NOS1 gene with 14‐AAT tandem repeats has a significant effect in asthmatic children. Environmental factors and atopic status will enhance the asthmatic risk for children who carry NOS1 susceptible allele.