微波消融同步联合TACE治疗大肝癌和巨块型肝癌的临床疗效分析

 目的  评价微波消融(microwave ablation,MWA)同步联合经动脉化疗栓塞(transarterial chemoembolization,TACE)治疗大肝癌(直径>5 cm)和巨块型肝癌(直径>10 cm)的安全性和有效性。方法  回顾性分析2013年3月至2014年12月期间在复旦大学附属中山医院行经皮MWA同步联合TACE治疗的65例大肝癌或巨块型肝癌患者(肿瘤直径5~18 cm),治疗程序为先行动脉数字减影血管造影(digital subtraction angiography,DSA),接着超声引导下行经皮MWA,最后行再次血管造影并选择TACE治疗。结果  同步治疗耐受性好。造影剂外渗3例,经栓塞后消失。术后仅见轻微肝功能受损和血液毒性及少量的胸腔积液,未见脓肿、胆道损伤、肝功能衰竭及其他手术相关的严重并发症。TACE碘油栓塞剂用量平均为8 mL。随访2~21个月,65例患者无疾病进展生存时间为(6.3±1.5)个月,中位生存时间为14个月,6、12及18个月的生存率分别为91.3％、81.5％及48％。2例患者获得II期手术切除。结论  MWA联合同步TACE治疗大肝癌和巨块型肝癌安全、有效,既可扩大消融的适应证,又能减少TACE栓塞剂的用量,是值得推广的肝癌治疗新模式。     

难治性病毒感染和原发噬血细胞性淋巴组织细胞增多症相关基因突变研究

目的 研究难治性病毒感染或噬血细胞性淋巴组织细胞增多症(HLH)中免疫基因突变的发生率、类型及其临床特征.方法 采用基因测序方法 检测难治性病毒感染或HLH患者是否有原发性HLH相关的PRF1、UNC13D、STX11、STXBP2、SH2D1A和XIAP基因突变,并追踪其临床特点及转归.结果 共25例难治性病毒感染性疾病或HLH患者接受了基因突变筛查,其中13例检测到上述基因突变:PRF1突变6例,UNC13D突变3例,STX11、STXBP2、SH2D1A、XIAP突变各1例;其中6例起病表现为病毒相关性HLH,1例为原因不明HLH,4例为慢性活动性EB病毒(EBV)感染(CAEBV),2例为EBV相关性淋巴瘤.12例未检测出基因突变的患者中,4例为EBV相关HLH,其中1例发展为外周T细胞淋巴瘤,另8例为CAEBV.结论 原发性HLH相关免疫基因突变是难治性病毒感染或HLH的重要原因,大部分表现为HLH,部分患者以CAEBV或EBV相关淋巴瘤起病.基因检测是明确此类疾病诊断的有力证据.

Abstract：

Objective To study the type and corresponding clinical characteristics of primary hemophagocytic lymphohistocytosis (HLH) associated immune gene mutations in the refractory virus infection or HLH of unknown causes. Methods From December 2009 to July 2010, the patients with refractory virus infection or HLH of unknown causes were screened for the primary HLH associated immune genes mutations by DNA sequence analysis, including PRF1, UNC13D, STX11, STXBP2, SH2D1A and XIAP. The clinical characteristics and outcomes were followed up. Results Totally 25 patients with refractory virus infection or HLH of unknown causes were investigated for the 6 genes and 13 cases were found carrying gene mutations, composing of 6 of PRF1 mutation, 3 of UNC13D, and each one of STX11,XIAP, SH2D1A and STXBP2, respectively. Among the 13 cases with gene mutations, 5 suffered from Epstein-Barr virus associated HLH( EBV-HLH), 1 human herpes virus 7 associated HLH (HHV7-HLH),1 HLH without causes, 4 chronic activated EB virus infection (CAEBV) with 1 progressing to Hodgkin's lymphoma carrying abnormal chromosome of t ( 15; 17 ) (q22; q25 ) and hyperdiploid, 2 EBV associated lymphoma. Among the other 12 patients without gene mutation, 4 suffered from EBV-HLH with 1 progressing to peripheral T lymphoma, 8 suffered from CAEBV. Conclusions Primary HLH associated immune gene mutations are critical causes of refractory virus infection of unknown causes, most patients manifest as HLH,some cases appear in CAEBV and EBV associated lymphoma. DNA sequence analysis is helpful to early diagnosis and correct decision-making for treatment.     

第二届中国肿瘤介入与微创治疗大会将在上海召开

第二届中国肿瘤介入与微创治疗大会暨上海第三届肝癌综合介入诊疗国际会议(2011 CCIO)将于2011年4月15～17日在上海召开。本次会议由中华医学会放射学分会介入学组主办;复旦大学附属中山医院、上海市影像医学研究所、北京大学第一医院、中国医学科学院肿瘤医院及天津肿瘤医院承办;《当代医学-中国介入放射学》杂志协办。     

全脾弥漫性巨大血管瘤-血小板减少综合征2例

1临床资料 例1男,3岁5个月。因“皮肤瘀斑、PLT减少4个月”入首都儿科研究所附属儿童医院（我院）。 外院病史：入我院前2d舌部轻微咬伤后渗血不止。曾按“PLT减少、脾肿大原因待查”多次就诊,但未能明确诊断。外院多次行骨髓穿刺检查示：骨髓增生活跃,巨核细胞增多。骨髓流式细胞计数检查未见异常。     

累积Logit模型对农村留守居民抑郁症状影响因素的分析

目的探讨累积Logit模型在农村留守居民抑郁症状影响因素分析中的应用。方法采用多阶段分层随机抽样的方法,使用中文版流调用抑郁量表对514名沈阳市农村留守居民的抑郁症状进行调查。非参数秩和检验用于农村留守居民抑郁症状的分层单因素分析,并以单因素分析有统计学意义的变量拟合农村留守居民抑郁症状影响因素的累积Logit模型。结果单因素分析显示,农村留守居民抑郁症状分类在不同年龄、文化程度、年人均收入、患慢性病、债务负担、睡眠状况和疲劳状况之间差异均有统计学意义(P<0.05)。多因素分析显示,对累积Logit模型贡献有统计学意义的变量是患慢性病、债务负担、睡眠状况和疲劳状况。结论累积Logit模型是有序反应变量有效的分析方法。患慢性病、债务负担、睡眠状况差和过度疲劳增加了沈阳市农村留守居民抑郁症状发生的风险。     

超声造影定量分析技术在早期鉴别兔VX2肝肿瘤消融后残癌与炎症带中的应用价值

目的 探讨超声造影定量分析技术在早期鉴别兔VX2肝肿瘤激光消融后癌残留与灶周炎症带中的价值.方法 取新西兰大白兔16只,在兔肝种植VX2瘤后制作肿瘤部分消融模型.在消融后1、3、7、14天对肿块区进行超声造影检查,超声检查仪器为东芝Aplioi900超声诊断仪,造影剂为SonoVue.参照最终病理结果,回放定帧图像,分...     

热损伤对肝细胞肝癌细胞增殖及侵袭转移特性影响的实验研究

目的 体外实验评价热损伤对肝细胞肝癌(HCC)细胞增殖、侵袭转移能力及上皮-间质细胞转化(EMT)等特性的影响,探索热消融与HCC复发转移之间的关系.方法 通过体外加热构建McA-RH7777 HCC细胞热损伤模型.CCK-8法检测热损伤对HCC细胞增殖能力的影响,流式细胞技术检测细胞周期情况.Transwell实验研究热损伤对HCC细胞侵袭能力的影响.荧光定量-聚合酶链反应(RT-PCR)和蛋白印迹(Western blot)分析热损伤对HCC细胞侵袭及EMT相关分子标志物VEGF、MMP-9、Nm23、E-cadherin、vimentin的mRNA和蛋白表达的影响.结果 McA-RH7777 HCC细胞热处理条件为43.5C水浴30 min.热处理后2～5 d细胞增殖能力显著高于对照组(P＜0.05).热处理48 h及72 h后处于G1期细胞比例降低,S+G2期细胞比例增加,差异有统计学意义(P＜0.05).与对照组比较,热处理后24 h后HCC细胞侵袭能力差异不明显,而热处理72 h后细胞侵袭能力显著增加(22.3±2.46对14.2±1.82,P＜0.001).RT-PCR和蛋白印迹分析结果显示,热处理72 h后HCC细胞VEGF、MMP-9和vimentin表达水平显著增加,E-cadherin表达显著降低,差异有统计学意义(P＜0.05).结论 亚致死量热损伤诱导McA-RH7777 HCC细胞发生EMT并增加其增殖和侵袭转移能力,表现出更高的恶性潜能.     

经腔镜前列腺癌根治术的手术护理

目的:探讨经腹腔镜前列腺癌根治术(LPR)的手术护理方法,使外科手术的术中护理紧跟医疗新技术的发展.方法:回顾性分析我院2013年4月至2015年4月28例采用经腹腔镜下腹膜外前列腺癌根治术的临床资料及护理经验.结果:28例实施腹腔镜下前列腺癌根治手术患者在手术期给予全面细致的护理均顺利完成,无一例因护理配合不佳而增加手术风险,医患均满意.手术平均时间2.5-5小时,术中平均出血量700ml,与经腹腔前列腺癌根治手术出血量相比少了200ml左右.所有患者均于术后7-14天拔出尿管,自主排尿正常.     

131I-美妥昔单抗联合动脉内化疗栓塞治疗原发性肝癌的内照射吸收剂量估算

Objective Metuximab is a specific monoclonal antibody F(ab')fragment targeted to the hepatocellular carcinoma(HCC)associated antigen of HAb18G/CD147.131I labeled metuximab has shown to be effective response on HCC in phase Ⅰ/Ⅱtrails.To evaluate the feasibility of 131I-metuximab combined with transarterial chemoembolization(TACE)is the treatment of HCC,the anthors estimated the radiation absorbed dose to organs.Methods 131I-metuximab(27.75 MBq/kg)and the mixture of anticancer drug and Lipiodol with interval 20 min later were administered to 21 patients with HCC via a transfemoral catheter.The pharmacokinetie and desimetric data were collected by means of venous blood samples.urine collections,and 4 or 5 γ-scintigraphies (SPECT) over7 d.The total amount of activity in percent of iniected activity (%ID)of main organ and the total body were calculated by regions of interest(ROI).The cumulated activities were determined from integration of the time-%ID curves using the SPSS 12.0 software.Absorbed doses to organ and red marrow were estimated according to the medical internal radiation dose (MIRD) formalism and blood-based marrow estimation with a red marrow-to-blood activity concentration ratio.The tumorto-no tumor ratio was calculated as well.Results A mean administered aetivity was 1.89 GBq per session (range 1.47-2.23 GBq).SPECT scans showed the significant accumulation of the radioconjugate in liver tumor and faint uptake in other organs until 14 d.Organ absorbed dose(n=12):the total absorbed dose to liver,spleen,thyroid,lungs,kidney and total-body was(3.19±1.01),(3.65±2.41),(3.61±2.40),(0.97±0.23),(0.96±0.35)and(0.57±1.55)Gy,with(0.55±0.09)Gy to the red marrow(n=7),respectively.From 2.88±1.11 to 1.64±0.39 were observed in tumor-to-liver ratio at 3 h to 168 h.Conclusion Internal absorbed dose estimation based on MIRD formalism is not only to establish reliable dose-response relationships for target tissue and dose-toxicity relationships for normal tissue but also to improve treatment planning in individual patient.