混合型肝癌临床特点及近期预后分析

目的 探讨混合型肝癌(mixed hepatocellular carcinoma and cholangiocarcinoma,mHCCCC)的临床特点及近期预后.方法 回顾分析2009年4月至2010年2月在浙江大学医学院附属第一医院病理确诊为mHCC-CC的17例患者的临床资料,总结其临床特点并统计术后生存时间. 结果 患者平均发病年龄27～76岁;其中男性11例(64.7％);无临床症状10例(58.8％);乙肝表面抗原阳性12例(70.6％);甲胎蛋白阳性( ＞25 ng/ml) 12例(75.1％);糖类抗原199阳性(≥37 U/ml)4例(25.0％).17例患者中肿瘤均完整切除,即包括转移灶在内的肿瘤切除,切缘离肿瘤边缘1.5 cm以上,同时清扫肉眼可见或影像学提示的肿大淋巴结.术后6、12和18个月累积生存率分别为93.8％、86.5％、57.7％;术后100、200 d的无瘤生存率分别为65.3％、43.5％;中位无瘤生存期为161 d.结论 mHCC-CC术前诊断困难,确诊依靠病理诊断;手术切除是主要治疗手段,但总体预后较差.     

NorLeu3‐A(1–7) stimulation of diabetic foot ulcer healing: Results of a randomized,parallel‐group,double‐blind,placebo‐controlled phase 2 clinical trial

This randomized, double‐blind, placebo‐controlled Phase 2 clinical trial explored NorLeu³‐A(1–7) (DSC127) safety and healing efficacy in diabetic foot ulcers. Patients with chronic, noninfected, neuropathic, or neuroischemic plantar Wagner Grade 1 or 2 foot ulcers (n = 172) were screened for nonhealing. Subjects were randomized to receive 4 weeks’ once‐daily topical treatment with 0.03% DSC127 (n = 26), 0.01% DSC127 (n = 27), or Placebo (n = 24), followed by 20 weeks’ standard of care. DSC127 was assessed for safety (including laboratory values and adverse events), primary efficacy (% ulcers completely epithelialized at Week 12), and durability of effect. Baseline, demography, and safety parameters were compared between intent‐to‐treat groups and were comparable. Dose‐response curves for DSC127 effect on % area reduction from baseline at Week 12 (40% placebo; 67% 0.01% DSC127; 80% 0.03% DSC127) and 24 (23% placebo; 53% 0.01% DSC127; 95% 0.03% DSC127) followed a log‐linear pattern for both intent‐to‐treat and per‐protocol populations. Covariate analysis compared reduction in ulcer area, depth, and volume from baseline; reductions in the 0.03% DSC127 group were greater at Weeks 12 and 24. Placebo‐treated ulcers healed in a median 22 weeks vs. 8.5 weeks for 0.03%DSC127 (p = 0.04). This study provides preliminary evidence that DSC127 is safe and effective in accelerating the healing of diabetic foot ulcers.     

5-氟尿嘧啶纳米药膜的体外缓释及其对结肠癌细胞抑制作用研究

目的研究担载抗肿瘤药物5-氟尿嘧啶(5-FU)的左旋聚乳酸(PLLA)共混羊毛蛋白纳米纤维药膜的缓释功能及其对结肠癌细胞的体外抑制效果。方法将PLLA与羊毛蛋白共混交联,并加入抗肿瘤药物5-FU,利用高压静电纺丝技术将共混溶液制作成具有缓释效果的纳米纤维薄膜。通过扫描电镜(SEM)观察其形貌。以高效液相色谱法(HPLC)测定5-FU/PLLA羊毛蛋白药膜中5-FU的缓释效果。采用噻唑蓝(MTT)比色法,检测药膜对结肠癌细胞HCT116的体外杀伤效果。同时采用倒置相差显微镜、透射电子显微镜(TEM)观测实验组细胞的生长情况。结果由SEM可以看出5-FU能够均匀分布在纳米纤维药膜中,HPLC显示5-FU能够缓慢释放并基本符合零级动力学规律。采用不同处理因素后,通过显微镜观察,药膜浸泡时间越长的实验组细胞出现肿胀、凋亡、坏死的情况越明显。MTT检测纳米药膜实验组的细胞存活率为(47.5±2.8)%,而不含药物的纯膜组对细胞基本无影响,其存活率为(93.9±2.8)%,差异具有统计学意义(P<0.01)。结论 5-FU/PLLA羊毛蛋白纳米药膜有明显缓释效果,具有较好的肿瘤细胞抑制作用和潜在的医疗应用价值。     

人乳头状瘤病毒在中晚期宫颈癌患者同步放化疗疗效监测中的临床意义

宫颈癌的发病率在全世界女性恶性肿瘤中居第二位,在发展中国家居首位,尤其是年轻妇女宫颈癌发病率近年来有上升趋势。高危型人乳头瘤病毒（HPV）生殖道持续感染是宫颈癌发生和发展的重要因素。目前国内外研究较多的是HPVDNA在宫颈癌早期筛查中的应用及在宫颈上皮内瘤变手术前后的变化,     

Use of blood products and risk of stroke after coronary artery bypass surgery

Background

The impact of blood transfusion on the development of post-operative stroke after coronary artery bypass grafting (CABG) is not well established. We, therefore, investigated this issue.

Materials and methods.

Complete data on peri-operative blood transfusion were available for 2,226 patients who underwent CABG in three Finnish hospitals.

Results

Stroke occurred post-operatively in 53 patients (2.4%). Logistic regression showed that pre-operative creatinine (OR 1.003, 95% CI 1.000–1.006), extracardiac arteriopathy (OR 2.344, 95% CI 1.133–4.847), pre-operative atrial fibrillation (OR 2.409, 95% CI 1.149–5.052), and the number of packed red blood cell units transfused (OR 1.121, 95% CI 1.065–1.180) were significantly associated with post-operative stroke. When the various blood product transfusions instead of transfused units were included in the multivariable analysis, solvent/detergent treated plasma (Octaplas^®) transfusion (OR 2.149, 95% CI 1.141–4.047), but not red blood cell transfusion, was significantly associated with postoperative stroke. Use of blood products ranging from no transfusion (stroke rate 1.6%) to combined transfusion of red blood cells, platelets and Octaplas^® was associated with a significant increase in post-operative stroke incidence (6.6%, adjusted analysis: OR 1.727, 95% 1.350–2.209). Patients who received >2 units of red blood cells, >4 units of Octaplas^® units and >8 units of platelets had the highest stroke rate of 21%. CART analysis showed that increasing amount of transfused Octaplas^®, platelets and history of extracardiac arteriopathy were significantly associated with post-operative stroke.

Conclusions

Transfusion of blood products after CABG has a strong, dose-dependent association with the risk of stroke. The use of Octaplas^® and platelet transfusions seem to have an even larger impact on the development of stroke than red blood cell transfusions.     

小剂量舒芬太尼联合曲马多用于术后静脉镇痛的观察

目的:评价小剂量舒芬太尼联合曲马多用于术后静脉自控镇痛(PCIA)的有效性和安全性。方法:选择90例下腹部横切口剖宫产手术患者,ASAⅠ~Ⅱ,无特殊病史。所有患者采用腰硬联合麻醉,按照PCI用药方法随机分为:T组,曲马多1000mg+格拉司琼5mg;S组,舒芬太尼150ug+格拉司琼5mg;S+T组,曲马多500mg+舒芬太尼50ug+格拉司琼5mg;均用生理盐水稀释到100ml。术毕给予首剂量5ml,背景输注2ml/h,PCA 1ml/次,锁定时间15min。记录术后4h、8h、12h、24h、36h、48h各时间点镇痛、镇静评分和不良反应。结果:镇痛、镇静评分在各时间点组间比较差异无统计学意义(P>0.05),S+T组不良反应发生率明显下降,组间比较有统计意义(P<0.05)。结论:小剂量舒芬太尼联合曲马多术后静脉镇痛不仅能减少药物用量而且能取得满意效果,降低不良反应的发生率,提高镇痛的安全性。     

周边虹膜切除术与超声乳化人工晶状体植入术治疗早期原发性闭角型青光眼的疗效比较

目的比较周边虹膜切除术与超声乳化联合人工晶状体植入术治疗早期原发性闭角型青光眼的临床效果。方法选择仅局部用药即可控制眼压在正常范围内的早期闭角型青光眼合并白内障患者48例(54眼),应用周边虹膜切除术对28例(32眼)早期闭角型青光眼进行手术治疗,其结果与同类病人(20例22眼)的超声乳化联合人工晶状体植入术治疗结果进行比较。术前,术后一个月内每周一次,半年内每月一次,半年后三个月一次做眼压、裂隙灯检查直至1年。比较两者在术后眼压控制、视力恢复及前房情况,并作统计学分析。结果应用周边虹膜切除术治疗组术后平均眼内压为15.2±3.1mmHg,而同类病人经超声乳化联合人工晶状体植入术治疗后平均眼内压为14.9±2.6mmHg。分别经周边虹膜切除术和超声乳化联合人工晶状体植入术治疗,两类病人眼内压在术后早期无明显差异(P>0.05)。经超声乳化联合人工晶状体植入术治疗,18眼(81.8%)最佳矫正视力提高,0.4者占63.6%,经周边虹膜切除术治疗术后最佳矫正视力无明显提高,其中8眼视力不增反降,最佳矫正视力0.4者占18.8%,两者差异有显著性(P<0.05)。经周边虹膜切除术治疗术后中央前房深度无明显变化,而经超声乳化联合人工晶状体植入术治疗术后中央前房深度显著加深,两者差异性明显(P<0.05)。结论原发性闭角型青光眼早期患者施行超声乳化联合人工晶状体植入术,术后房角显著加宽,中央前房深度显著加深,矫正视力也不同程度提高,且并发症少。