进展期结直肠癌动脉灌注新辅助化疗临床疗效观察

Objective To evaluate the curative effect of neoadjuvant chemotherapy via arterial infusion on advanced colorectal carcinoma. Methods One hundred and twenty-eight advanced colorectal carcinoma patients in stage Ⅱ B or Ⅲ were randomly divided into 2 groups. Sixty-eight cases received preoperative arterial infusion chemotherapy( the treatment group),and chemotherapy regimen consist of Oxaliplatin(L-OHP) 130 mg/m2, Hydroxycamptothecin (HCPT) 20 mg/m2 and Dexifluridine (FUDR)600 mg/m2. Femoral arterial infusion chemotherapy administrated 8 ～ 14 days preoperative. Sixty cases received surgery directly(the control group). The adverse reaction and histology effect after arterial infusion chemotherapy were observed, and resection rate,complications,pathology stage,together with long term survival were compared. Results Adverse reaction were mostly grade Ⅰ -Ⅱ gastrointestinal discomfort and bone marrow depression with arterial infusion chemotherapy. Resection rate was 97. 1% (66/68) ,and 64 cases(96. 9%) underwent raclical (R0) resection in the treatment group, which were higher than those in the the control group(73. 3%(44/60) and 79. 5%,respectively) (x2 = 14. 848,8. 906, Ps ＜ 0. 05). Histology effect of the treatment group was 72. 7%, and the pathology stage downstaged compared to preopeartion. Percent of patients in stage Ⅱ in the treatment group was higher than that in the control group( P ＜ 0. 05). The median survival time of test group was 53. 0 months, 1- ,3-,and 5-year survival rates were 95.3%,85.9% and 44.6%, respectively. In the control group, the median survival time was 42.0 months, 1-, 3-, and 5-year survival rates were 92.6%, 75.9% and 22.0%,respectively. There was significant difference in 5-year survival rate(x2 = 6. 385, P ＜ 0. 05). No difference in postoperative complications between two groups(P ＞ 0. 05). Conclusion The neoadjuvant chemotherapy via arterial infusion is of great significance on downstnging the pathology of advanced colorectal carcinoma, raising the excision rate, especially radical resection, and long term survival rate.     

组织多普勒成像心肌做功指数定量评价慢性肾衰患者左室功能

目的探讨组织多普勒成像(TDI)测定心肌做功指数(Tei指数)在定量评价慢性肾衰患者(CRF)左室功能中的价值。方法前瞻性连续纳入CRF患者40例,根据肾功能损害程度分为两组:氮质血症组18例,肾功能衰竭组22例,并选取40例健康人作为对照组。分别测量3组左心室常规超声心动图参数,并应用TDI技术测算左心室Tei指数并进行比较。结果①氮质血症组、肾功能衰竭组和正常对照组的Tei指数分别为0.46±0.12、0.53±0.15和0.41±0.09,组间比较均具有差异性(P0.05)。氮质血症组和肾功能衰竭组患者分别与正常对照组Tei指数比较差异有统计学意义(P均0.05),且肾功能衰竭组患者的Tei指数较氮质血症组患者显著增大(P0.05),临床表现为舒张功能障碍;②肾功能衰竭组左心室等容收缩时间(ICT)/左室射血时间(ET)明显高于正常对照组(P0.05),氮质血症组和肾功能衰竭组等容舒张时间(IRT)/ET显著高于正常对照组(P0.01)。结论 Tei指数是一种综合评估心功能敏感性、特异性和重复性较好的指标。应用Tei指数综合评价CRF患者心脏的整体功能,为CRF患者的心功能早期改变提供可靠诊断依据。     

淋巴瘤心脏浸润超声随访1例

患者女,38岁.主因胃痛、纳差3个月入院,曾于3个月前因胸闷行超声心动图检查,未见明显异常.入院当日行胃镜检查提示:胃多发性占位性病变.胃镜检查当日夜间患者突发胸闷、气促、呼吸困难,急诊超声心动图提示:左房增大,左心房壁、房间隔下段、房室瓣环上及肺静脉周边可见大量团块状低回声.心包腔内大量无回声区,心包脏层可见片状低回声,右心房室舒张受限.超声诊断:(1)左房内、心包脏层多发占位性病变,考虑转移;(2)心包积液(大量);(3)心包填塞.     

胃癌组织端粒酶活性表达的临床意义

目的通过检测胃癌组织中端粒酶活性的表达,评价端粒酶活性阳性率在胃癌诊断及预后判断方面的价值。方法用多聚酶链反应-酶联免疫吸附法(PCR-ELISA)测定28例胃癌和12例良性胃病组织的端粒酶活性表达,并分析其与临床病理因素之间的相关性。结果28例胃癌、12例良性胃病组织中端粒酶活性阳性率分别为85.7%(24/28)、16.7%(2/12),两者比较有极显著性差异(P<0.01)。端粒酶活性表达与胃癌组织的组织分化、淋巴结转移均无相关性(P>0.05)。随着浸润深度、临床病理分期的提高,端粒酶活性阳性率有升高的趋势。结论检测端粒酶活性有助于胃癌的诊断,是否作为预后判断指标尚需进一步研究证实。     

Effects of dexamethasone on intracellular Ca 2 in its sensitive cells from neonatal mouse hippocampus and cultured cortical neurogliocytes

目的：研究地塞米松（Ｄｅｘ）对神经元和胶质细胞内钙浓度（［Ｃａ２＋］ｉ）的影响．方法：Ｆｕｒａ２ＡＭ负载小鼠海马细胞（ＮＭＨＣ）和培养的胶质细胞（ＣＣＮ）．单细胞内［Ｃａ２＋］ｉ由ＡＲＣＭＭＩＣ检测系统测定．结果：Ｄｅｘ使多数ＮＭＨＣ［Ｃａ２＋］ｉ浓度依赖地迅速升高,９６个ＮＭＨＣ中仅１０％出现［Ｃａ２＋］ｉ降低．［Ｃａ２＋］ｉ升高被无镁细胞外液阻滞、被氯化镧逆转,但不受氯化锂影响．无钙Ｈａｎｋｓ液悬浮、米非司酮（Ｍｉｆ）或河毒素均可阻断Ｄｅｘ４０－９０μｍｏｌ·Ｌ－１的升［Ｃａ２＋］ｉ效应,而Ｄｅｘ２００μｍｏｌ·Ｌ－１的效应仍被保持．４０个ＣＣＮ中５０％对Ｄｅｘ产生浓度依赖的［Ｃａ２＋］ｉ升高,并被无钙或无镁的细胞外液和Ｍｉｆ预处理抑制．结论：Ｄｅｘ快速改变海马神经元和胶质细胞内［Ｃａ２＋］ｉ．［Ｃａ２＋］ｉ的这种改变是由Ｍｇ２＋和受体相关的外钙内流及高浓度Ｄｅｘ诱发的内钙释放介导的．     

胰岛素对培养中兔动脉平滑肌细胞的影响

应用细胞培养技术,进行兔主动脉平滑肌细胞的传代培养,取3～7代细胞进行光学、电子显微镜鉴定后,用不同浓度的胰岛素进行刺激,结果经F检验表明:不同培养天数、不同浓度的胰岛素均能刺激平滑肌细胞增殖,且与正常对照组比较均有显著性统计学差异(P<0.01)。其细胞增殖速度与胰岛素浓度呈正相关,提示高胰岛素血症是促进动脉粥样硬化形成的原因之一。     

结直肠癌动脉灌注新辅助化疗后PCNA和MVD表达临床意义的观察

目的:探讨术前动脉灌注化疗对结直肠癌生存率的影响,评价PCNA和MVD对于其远期疗效的预测意义。方法:选择ⅡB、Ⅲ期的结直肠癌患者128例,随机分为试验组(动脉灌注新辅助化疗+手术)68例和对照组(直接手术)60例,并分别测定化疗前活检及手术切除后癌组织PCNA和MVD的表达情况,比较两组1、3和5年生存率及PCNA及MVD的表达变化。结果:试验组患者术后13、和5年生存率分别为95.3%、85.9%和44.6%,对照组分别为92.6%、75.9%和22.0%,1和3年生存率差异无统计学意义,5年生存率差异有统计学意义,P<0.05。试验组与对照组术后平均生存时间分别为48.0与40.8个月,中位生存期分别为53.0与42.0个月,差异有统计学意义,P<0.05。试验组术后局部复发和远处转移共37例,对照组共43例,差异有统计学意义,P<0.05;试验组复发转移者PCNA及MVD表达高于无复发转移者,差异有统计学意义,P<0.05。试验组生存时间≥36.0个月的患者化疗后PCNA及MVD表达明显下降,P<0.05。结论:结直肠癌动脉灌注新辅助化疗安全可行,能提高远期生存率;PCNA及MVD的检测可以作为动脉灌注新辅助化疗后远期疗效的客观评价指标。