The Efficacy of Cytokine-Induced Killer Cell Infusion as an Adjuvant Therapy for Postoperative Hepatocellular Carcinoma Patients

Background

Even after surgery, hepatocellular carcinoma (HCC) has poor prognosis; adjuvant therapy is needed to improve effectively the outcome of HCC patients. We evaluated the efficacy of cytokine-induced killer (CIK) cell infusion as an adjuvant therapy for postoperative HCC patients.

Methods

A total of 410 patients were studied retrospectively (January 2002 to January 2007): 206 received surgery alone; 204 received surgery and at least four cycles of CIK cell transfusion (CIK group). Kaplan–Meier and Cox regression analyses were used to explore differences in OS between two groups.

Results

The CIK group overall survival rates were significantly higher than that of the surgery-alone group (log-rank test; p = 0.0007). Multivariate survival analysis showed that CIK cell treatment was an independent prognostic factor. In subgroup analysis, patients who received ≥8 cycles of CIK cell transfusion exhibited significantly better survival than the <8 cycle group (p = 0.0272). There was no significant difference in overall survival in patients with ≤5-cm tumors between the CIK and surgery-alone groups (p = 0.7567). However, in patients with >5-cm tumors, the CIK group displayed significantly better overall survival than the surgery-alone group (p = 0.0002).

Conclusions

Postoperative immunotherapy with CIK cell transfusion may be an effective adjuvant treatment for improving the outcomes of HCC patients; >8 cycles of CIK cell transfusion may ensure that patients derive maximal benefits. Moreover, patients with large tumors might benefit more from CIK cell adjuvant treatment than patients with small tumors.     

胰十二指肠切除术中胰肠吻合方式与术后胰漏及吻合口出血的相关性研究

目的分析胰十二指肠切除术（PD）中胰肠吻合方式与术后胰漏及吻合口出血的关系。方法回顾性分析2008年1月至2012年9月期间我院行PD的526例患者的临床资料。526例PD患者行胰肠吻合的方式：胰管空肠端侧黏膜对黏膜吻合（简称黏膜对黏膜吻合）359例,其中149例硅胶引流管内置（简称引流管内置）,130例硅胶引流管引流至体外（简称引流至体外）,80例硅胶引流管未放置（简称引流管未置）;胰腺空肠端侧套入式吻合165例（简称套入式吻合）,均未放置硅胶引流管;胰肠侧侧吻合2例（简称侧侧吻合）,均未放置硅胶引流管。结果526例PD患者术后共发生胰漏34例（6.46%）,胰肠吻合口出血8例（1.52%）,死亡32例（6.08%）。①黏膜对黏膜吻合的胰漏发生率明显低于套入式吻合〔4.18%（15/359）比11.52%（19/165）,χ2=10.029,P=0.002〕;黏膜对黏膜吻合与套入式吻合的吻合口出血发生率比较差异无统计学意义〔1.67%（6/359）比1.21%（2/165）,χ2=0.159,P=0.691〕。②黏膜对黏膜吻合术式中,引流管内置者和引流至体外者的胰漏发生率均分别明显低于引流管未置者〔2.68%（4/149）比11.25%（9/80）,χ2=7.132,P=0.008;1.54%（2/130）比11.25%（9/80）,χ2=9.410,P=0.002〕;引流管内置者与引流至体外者的胰漏发生率比较差异无统计学意义〔2.68%（4/149）比1.54%（2/130）,χ2=0.433,P=0.510〕。引流管内置者与引流至体外者的吻合口出血发生率比较差异无统计学意义〔2.68%（4/149）比1.54%（2/130）,χ2=0.433,P=0.510〕。结论黏膜对黏膜吻合方式胰漏的发生率明显低于套入式吻合方式,但吻合口出血的发生率无明显差异。胰管内硅胶引流管内置或引流至体外均能降低术后胰漏的发生率,但是对于吻合口出血的发生率无明显影响。     

合并其他消化道恶性肿瘤的胃肠间质瘤临床病理特征及其诊治

目的探讨合并其他消化道恶性肿瘤的胃肠间质瘤（GIST）患者的临床病理特征及诊治方法。方法回顾性分析2004年9月至2012年11月间在上海仁济医院接受手术治疗的525例原发性GIST的临床资料,其中合并其他消化道恶性肿瘤者46例．未合并其他消化道恶性肿瘤者479例。结果合并其他消化道恶性肿瘤的46例GIST患者术前诊断率仅为2．2％（1／46）,按NIH术后危险度分级,极低危患者36例（78-3％）,低危患者9例（19．6％）,高危患者1例（2．2％）。与未合并其他消化道肿瘤的GIST患者相比,合并者多见于老年患者（P=0．001）,多发生于胃（P=0．000）,肿瘤直径更小（P=0．000）,核分裂像更少（P=0．000）,危险度更低（P=0．000）。46例患者5年生存率为36．1％,显著低于未合并者的82．2％（P=0．000）。结论合并其他消化道恶性肿瘤的GIST大多为低危或极低危险度,对预后影响较小,其预后主要取决于合并的消化道恶性肿瘤,故对其治疗主要针对合并的恶性肿瘤,同时在不明显增加手术风险和术后并发症的情况下可考虑一并切除GIST。     

ICU呼吸机相关性肺炎病原菌的构成及耐药性分析

目的;分析医院综合ICU呼吸机相关性肺炎（VAP）病原菌的分布特点及其耐药性。为vAP治疗提供合理用药参考。方法：回顾性分析210例VAP患者的下呼吸道分泌物细菌培养及药敏结果。结果：210例VAP患者下呼吸道分泌物培养如瘸原菌394株．革兰阴性杆菌占784％．革兰阳性球菌占12.6％．真菌感染9．0％：各类病原燕混台感染者占83．8％：常见病原菌为鲍曼不动杆菌20,3％,铜绿假单胞菌188％。肺炎克雷伯菌16．2％,金黄色葡萄菌8,1％,耐甲氧西林金黄色葡萄球菌（MRSA）检出率87．5％,白色念珠菌7．6％。鲍曼不动杆菌仅对头孢碾酮／舒巴坦敏感,铜绿假单胞菌仅对头孢哌酮／舒巴垣和碳膏酶烯类药物敏感,肺炎克雷伯菌和大肠埃希菌对碳青酶烯类药物敏感,金黄色葡萄球菊耐药现象严重．对万古霉素和替考拉宁敏感,白色念珠菌对氟康唑、伊曲康瞪、伏立康唑敏感。结论：VAP的主要瘸原菌以革兰阴性杆菌为主,耐药现象严鬣．多数为混合感染。治疗困难。进行细菌培养和药物敏感性试验．对合理选用抗菌药物治疗VAP具有重要意义。     

皮肤软组织扩张术在头皮缺损伴颅骨外露修复中的应用

目的 探讨外伤致大面积头皮缺损后的肉芽组织创面伴颅骨外露的修复方法.方法 对外伤后头皮缺损肉芽组织创面伴颅骨外露8例患者,在形成新鲜肉芽组织创面后于正常头皮帽状腱膜下埋置皮肤软组织扩张器12只,术中以及注水扩张过程中严格无菌操作,适度扩张,保持扩张部位丰富的血液循环.扩张满意后取出皮肤软组织扩张器行扩张后皮瓣修复创面.结果 8例患者均完成头皮缺损创面的修复,扩张器埋置术后以及注水扩张过程中未见感染.结论 皮肤软组织扩张术可以修复外伤头皮缺损后肉芽组织创面伴颅骨外露.     

靶向CXCR1基因的shRNA真核表达质粒的构建及鉴定

目的：构建靶向化学趋化因子受体1（CXCR1）的短发夹小干扰RNA（shRNA）质粒表达载体。方法：针对人CXCR1基因的mRNA序列,按RNA干扰靶位点的设计原则,设计并构建靶向CXCR1基因的3个shRNA质粒表达载体和1个阴性对照质粒表达载体,经酶切和测序确认构建成功后,转染胃癌细胞MKN45,RT-PCR和Western blot检测CXCR1 mRNA和蛋白的表达。结果：经酶切和测序证实,3个靶向CXCR1基因的shRNA真核表达质粒均构建成功;与未转染和转染阴性对照质粒的MKN45细胞比较,转染3种shRNA质粒的MKN45细胞,CXCR1 mRNA和蛋白水平均明显下调（均P<0.05）。结论：靶向CXCR1基因的shRNA真核表达质粒的成功构建,为进一步研究CXCR1在胃癌中的功能和实验性靶向治疗提供了初步的基础。

     

金属对金属大头径微创全髋关节置换术治疗青中年股骨头坏死的临床研究

目的探讨金属对金属（金对金）大头径假体微创全髋关节置换术（THA）治疗青中年股骨头坏死Ⅲ、Ⅳ期的临床疗效。方法本组32例（35髋）青中年股骨头缺血性坏死Ⅲ、Ⅳ期患者,年龄24～59岁,平均45岁,术前髋关节Harris评分平均（37．9±7．5）分;以改良后外侧小切口、肌间隙人路、充分保留关节动力性组织结构为特征的金对金大头径微创THA治疗。术中严格采取正确的假体植入技术,术中保留完整的软骨下骨和髋臼横韧带,击入臼杯时一次性安装成功,正确运用万古霉素预防感染。术后口服利伐沙班片抗凝,术后12h开放负压引流及卧床行功能锻炼,术后第2天拔除引流管后扶拐下地部分负重行走,术后2—3周患者即可弃拐完全负重行走。结果本组32例35髋患者均获随访,随访时间为12个月～6年,平均为4年。所有患者切口均一期愈合,无深静脉血栓形成、关节脱位、坐骨神经损伤、髋臼及股骨疲劳骨折、关节疼痛等严重并发症,X线片示髋关节假体位置均良好,无松动、移位、股骨柄下沉、假体周围骨折等表现。末次随访Harris评分由术前平均（37．9±7．5）分,提高至术后平均（92．2±4．6）分,前后比较有统计学意义（t=44．341,P〈0．05）。所有患者末次随访时髋关节功能明显优于术前,均对治疗效果满意,完全恢复正常生活及工作。结论采用金对金大头径微创THA治疗青中年股骨头坏死Ⅲ、Ⅳ期患者,能够明显降低手术风险,缩短卧床时问,迅速恢复髋关节功能,减少手术并发症,取得了满意的近期临床疗效。随着基础和临床研究的不断深入,金对金大头径髋关节假体的长期疗效还需要进一步探讨。     

Continuous measurement of oxygen consumption during cardiopulmonary bypass: description of the method and in vivo observations

BACKGROUND: Systemic oxygen consumption is not routinely measured during cardiopulmonary bypass, despite its potential benefits. We aimed to develop a noninvasive method to continuously measure oxygen consumption using respiratory mass spectrometry during hypothermic cardiopulmonary bypass in pigs. METHODS: Nine pigs weighing 18.5 (1.6) kg underwent hypothermic (32 degrees C) cardiopulmonary bypass for 180 minutes with 120 minutes of aortic cross clamping. An AMIS 2000 mass spectrometer (Innovision A/S, Odense, Denmark) was adapted for the on-line measurement of oxygen consumption by sampling the inlet and outlet gases of the membrane oxygenator together with measurement of the "expired" gas volume. RESULTS: Active cooling for 60 minutes reduced the venous blood temperature by 2.9 (0.8) degrees C and VO(2) by 0.70 (0.33) mL/kg/min. The 40-minute active rewarming restored the venous blood temperature by 4.4 (0.4) degrees C and oxygen consumption increased by 1.36 (0.33) mL/kg/min. There was wide interanimal variability, however, particularly at higher venous blood temperatures. Immediately after the release of aortic cross clamp, there was a noticeably acute increase in oxygen consumption in all the pigs (0.64 [0.21] mL/kg/min). CONCLUSIONS: A simple and safe adaptation of mass spectrometry allows continuous measurement of oxygen consumption during hypothermic cardiopulmonary bypass. The wide interindividual variations observed in this pilot study underscore the need to more accurately describe changes in oxygen consumption and how they are affected by temperature, oxygen delivery, and other interventions during cardiopulmonary bypass. As such, the technique may have an important role in clinical research and management of oxygen transport in patients undergoing cardiac surgery.     

用X射线CT扫描室剂量场分布测定

本文对西门子DR-3型全身扫描机扫描室的剂量场分布进行了全面测定, 并根据测定结果绘制出等剂量分布曲线。测定仪器为Mode450(victrecn)电离室型剂量仪, 测定时以扫描机架：开口中心为原点, 在标高1米平面上按不同角度测定。测量条件：工作电压125kV, 工作电流520mA·s, 扫描时间7秒, 层厚8mm, 滤片2.2mmAl+0.25mmCu。     

利多卡因对大鼠肠缺血再灌注所致急性肺损伤的保护作用

观察利多卡因对肠缺血再灌注（I／R）所致急性肺损伤（ALI）的保护作用。成年SD大鼠随机分为4组（n＝8）：对照组，只分离而不阻断肠系膜上动脉；I／R组，肠I／R（60／180min）；利多卡因组（2组），分别于再灌注即刻或再灌注60min后静脉给利多卡因2mg/kg。利多卡因再灌注即刻用药组MAP下降，肺通透性、血中TNF－α水平及肺组织TNF-α mRNA表达增高，与I／R组比较差异显著（P＜0.05）。肺组织病理损害亦明显减轻；再灌注60min，用药对MAP、血中TNF－α水平无明显影响（P＞0.05），病理损害也无明显改善。结果提示，预防性应用利多卡因可减轻肠I／R后肺损伤，可能与其减少PMN肺内聚集以及抑制TNF－α合成有关。