胆囊癌与妊娠关系的全人群病例对照研究

目的探讨胆囊癌与妊娠的关系.方法采用全人群病例对照研究,研究对象为1997年6月1日～2001年5月31日期间确诊、年龄在35～74岁的上海市区女性胆囊癌269例以及按年龄(5岁一组)频数配对的538名人群对照,采用非条件lo-gistic回归模型分析妊娠与胆囊癌的关系.结果胆囊癌合并胆石症者中,与妊娠次数≤2次者比较,妊娠次数(3次,4次,5次及≥6次)的各组调整OR分别为1.33(95%CI:0.59-2.99),1.34(95%CI:0.58-3.11),1.39(95%CI:0.57-3.43)和2.67(95%CI:1.12-6.41),趋势检验P=0.03.结论多次妊娠可能通过胆石症影响胆囊癌的发生,生育因素导致的女性体内雌、孕激素水平的升高可能在胆囊癌病因学中起一定的作用.     

身体质量指数及腰臀围比与胆道癌关系的探讨

目的:探讨身体质量指数(BMI)、腰臀围比(WHR)与胆道癌的关系.方法:采用非条件logistic回归模型分析身体质量指数、腰臀围比与胆道癌的关系.结果:与正常BMI组比较,胆囊癌女性20～29岁、30～39岁肥胖组的OR与趋势检验均达到或接近显著水平.与腰臀围比四分位最低组比较,胆囊癌和肝外胆管癌男女性最高四分位组OR和趋势检验均达到显著水平.结论:青年时期肥胖可能会增加胆囊癌的发病风险;腰臀围比也是胆囊癌和肝外胆管癌独立的危险因素.     

Signet-ring cell or mucinous histology after preoperative chemoradiation and survival in patients with esophageal or esophagogastric junction adenocarcinoma.

PURPOSE: The survival of patients with local-regional adenocarcinoma of the esophagus or esophagogastric junction (EGJ) treated with preoperative chemoradiation is much better in patients with pathologic complete response than those with residual tumor. Some adenocarcinomas have mixed patterns, including signet-ring cell and mucinous histology, but the clinical significance of these subtypes is unknown. EXPERIMENTAL DESIGN: We studied 412 consecutive patients with esophageal or EGJ adenocarcinoma treated with chemoradiation followed by esophagectomy (193 patients) or surgery alone (219 patients). We evaluated signet-ring cell and mucinous histology in the resection and pretherapy biopsy specimens and compared clinicopathologic features with overall survival. RESULTS: The fraction of signet-ring cell and mucinous histology was similar in evaluated specimens of patients treated with preoperative chemoradiation or surgery alone (17% and 18%, respectively). The overall survival rate at 5 years of patients treated with preoperative chemoradiation was significantly better if residual signet-ring cell or mucinous histology was present in the esophagectomy specimen (63% versus 28%; P = 0.02). All 13 patients with acellular mucin pools and no residual carcinoma are still alive after an average follow-up time of 36 months. By contrast, in patients treated with surgery alone, overall survival rate was significantly worse if signet-ring cell or mucinous histology was present (14% versus 30%; P = 0.05). In multivariate analysis, overall survival was independently predicted by presence of signet-ring cell or mucinous histology (P = 0.04). CONCLUSIONS: Our study showed that patients with esophageal or EGJ adenocarcinoma who have signet-ring cell or mucinous histology benefited substantially from preoperative chemoradiation and esophagectomy.     

手术对Ⅳ期胆囊癌预后的影响

目的分析不同手术方式对Ⅳ期胆囊癌预后的影响.方法对1997年6月～2001年5月间上海市172例Ⅳ期胆囊癌病例进行临床病理分析,并对获得随访的164例的预后与手术方式的关系进行探讨.数据分析采用Kaplan-Meier法.结果 172例中未手术者44例(25.6%),手术者128例(74.4%),其中包括单纯胆囊切除术45例(35.1%)、胆囊癌根治性切除术17例(13.3%)、胆囊癌扩大根治性切除术5例(3.9%)和剖腹探查术61例(47.7%).在行根治性切除者中,Ⅳa和Ⅳb期的1年生存率分别为69.2%和40.7%,明显好于胆囊未切除或单纯切除者,在Ⅳa和Ⅳb期中各有2例存活期超过5年.结论有选择地进行Ⅳ期胆囊癌病例根治性或扩大根治性手术,有助于改善预后.     

上海市胆道癌病理形态特征的初步观察:附487例分析

目的研究上海市区居民胆道癌病理形态特征和鉴别诊断.方法自1997年6月～2001年5月在上海市区开展基于全人群的胆道癌病例-对照研究,总共收集病理切片1 228例,包括胆道癌487例(其中胆囊癌322例,肝外胆管癌105例和壶腹癌60例),胆道结石和胆囊炎对照病例721例,胆道腺瘤20例,由中、美资深病理医师复查,按世界卫生组织1991年胆囊和肝外胆管肿瘤组织学分型进行分类.结果病理标本以切除标本为主,肿瘤大小为多数小于4 cm,组织学类型中70%以上为腺癌,肿瘤组织学分级以高分化和中分化占绝大多数,TNM分期中0～Ⅱ期的胆囊癌和肝外胆管癌约占1/3,壶腹癌近2/3.病理复查结果显示诊断过头占1.8%,诊断不足占0.6%,漏诊占0.1%;随访结果显示根治术后的5年生存率:胆囊癌40.7%、肝外胆管癌11.1%和壶腹癌26.9%.结论病理复查可以统一诊断标准,提高确诊率,为全人群病例-对照研究和多学科协作积累经验.     

Evaluation of inhibitory potential of some selective methanolic plants extracts on biological characteristics of Acanthamoeba castellanii using human corneal epithelial cells in vitro

Acanthamoeba is an opportunistic protozoan pathogen and known to be one of the most ubiquitous organisms, play a vital role in ecosystem, and recognized to cause blinding keratitis and rare but fatal granulomatous encephalitis involving the central nervous system with a very poor prognosis. This is due to limited availability of effective anti-Acanthamoeba drugs. The objective of the present study was to determine the efficacy of methanolic plants crude extracts on the viability and biological properties of Acanthamoeba castellanii (T4 genotype) and its cytotoxic effects on human corneal epithelial cells (HCEC). Using HCEC, it was observed that Acanthamoeba exhibited binding (>90 %) and cytotoxicity (>80 %) to host cells. However, plant crude extracts remarkably inhibited more than 70 and 60 % of Acanthamoeba binding and cytotoxicity to HCEC, respectively. It was further established that crude extracts (ranging from 0.1 to 1.5 mg/ml) exhibited amoebicidal effects, i.e., >50 % of trophozoites were killed/reduced at maximum dose (1.5 mg/ml) within 1 h incubation. However, the residual subpopulation remained static over longer incubations. Furthermore, growth assay demonstrated crude extracts inhibited >50 % Acanthamoeba numbers up to 7 days. Our results confirmed that plant crude extracts has inhibitory effects on Acanthamoeba growth and viability. Overall, these findings revealed that tested plant extracts is inhibitory to Acanthamoeba properties associated with pathogenesis. To the best of our knowledge, our findings demonstrated for the first time that selected methanol plant crude extracts exhibits inhibitory effects on biological properties of Acanthamoeba without any toxic effects on HCEC cells in vitro.     

An Embryonic Diapause-like Adaptation with Suppressed Myc Activity Enables Tumor Treatment Persistence

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