Long-term disease-free survival in three ovarian cancer patients with a single relapse

Recurrent ovarian cancer with long-term survival is uncommon and often associated with poor prognosis. We report three cases of patients with advanced ovarian cancer who have achieved long-term disease-free survival following a single prior relapse. Case 1 relapsed with a localized bulky tumor and received a complete surgical resection and chemotherapy. Case 2 had a persistent central pelvic tumor after debulking surgery and second-line chemotherapy, and yet achieved excellent control with concurrent chemoradiation to the true pelvis. Case 3 relapsed with paraaortic lymph node metastasis and probable lung metastasis (subsequently negated by positron emission tomography) and received chemotherapy alone. These three patients have since remained disease-free for 13, 12, and seven years, respectively, since their first relapse. We conclude that select patients can obtain long-term disease-free survival after the first relapse by accurate restaging and aggressive multimodality treatment.     

免疫毒素去除T细胞在异基因造血干细胞移植中的应用

观察应用免疫毒素部分去除T细胞(TCD)的方法进行人类白细胞抗原／混合淋巴细胞培养(HLA/MLC)不相合异基因造血干细胞移植的临床疗效。采用蓖麻免疫毒素部分去T细胞对13例恶性血液病患者行HLA-MLC配型不相合的造血干细胞移植，其中慢性髓性白血病(CP1)6例；急性淋巴细胞白血病CR1 1例，CR2 1例，复发1例；急性髓性白血病CR1 2例，CR2 1例；骨髓增生异常综合征转化成急性髓性白血病M4型(CR1)1例。结果表明：13例患者中8例成功植入，其中2例发生Ⅱ度急性移植物抗宿主病(aGVHD)，2例发生Ⅲ-Ⅳ度aGVHD。随访8-90个月，2例发生Ⅲ-Ⅳ度aGvHD患者早期死亡，另有1例患者死于迟发感染，其余5例均无病存活至今。5例未植活的患者中4例回输同一供者外周血造血干细胞后3例未植入，1例植活，但死于移植相关合并症；1例再次行同基因造血干细胞移植成功并无病存活至今。结论：采用蓖麻免疫毒素部分去T细胞的方法行HLA/MLC配型不相合的异基因造血干细胞移植可减少重度aGVHD的发生，但移植早期排斥率(HVG)较高，临床应用效果有待进一步评估。     

开放式心理科医护人员的心理状况及对策

[目的]了解开放式心理科医护人员的心理健康状况，并就现存和潜在的心理健康问题，提出相关的对策。[方法]应用自测健康评定量表对37名在开放式心理科工作的医护人员进行心理健康评分，以了解医护人员的心理状况。[结果]医生与护士正向情绪、心理症状与负向情绪、认知功能各因素的评分比较有统计学意义。[结论]护理人员应自觉维护自身的心理健康，在护理工作中发挥更大的作用。     

TGF-beta signaling potentiates differentiation of embryonic stem cells to Pdx-1 expressing endodermal cells

Embryonic stem (ES) cells have the capacity to differentiate to every cell type that constitutes fetal or adult tissues. To trace and quantitatively assess the differentiation of ES cells into gut endodermal cells, we used an ES cell line with the lacZ gene inserted into the pdx-1 locus. Targeted mutations of pdx-1 in mice demonstrate that pdx-1 is required for pancreatic and rostral duodenal development; therefore, pdx-1 serves as an excellent early gut regional specific marker. When these ES cells were differentiated by removal of leukemia inhibitory factor (LIF), only fractional cells turned into lacZ positive, which indicates pancreatic-duodenal differentiation. Co-cultivation of ES cells with pancreatic rudiments induced a significant increase in the proportion of lacZ positive cell numbers and this increase was further enhanced by forced expression of a chick putative endoderm inducer gene, cmix. Transforming growth factor (TGF)-beta2 mimicked the effects of pancreatic rudiments and this effect was enhanced by cmix expression. Expression analysis showed over-expression of cmix induced endodermal marker genes. These data indicate that one can make use of this knowledge on molecular events of embryonic development to drive ES cells to differentiate into pdx-1 expressing endodermal cells in vitro.     

Synchronous primary gastric cancer and renal cell carcinoma: A case report and literatures review

A 73-year-old woman was admitted and treated because of epigastric fullness, palpitation, and tarry stool for 2 days. Gastric cancer was found via panendoscopy. A preoperative abdominal computed tomographic scan revealed a hypervascular mass in the left kidney; renal cell carcinoma (RCC) was the initial impression. A concomitant surgery for subtotal gastrectomy and radical left nephrectomy was performed. The pathological examination confirmed gastric adenocarcinoma (T2a) and RCC (T2b). Convalescence was uneventful and she was discharged in stable condition. There was no evidence of tumor recurrence at a 20-month follow-up examination. Elderly people with early gastric cancers have a relative higher probability of developing a synchronous tumor than younger people. The incidence of synchronous gastric cancer and RCC is quite low, and concomitant surgery is rare. Surgeons need to be aware of the possibility of a synchronous second primary cancer when the initial gastric cancer is diagnosed. A concomitant surgery for gastrectomy and radical nephrectomy can be safely performed in selected patients, which can achieve feasible oncological control.