进展期结直肠癌动脉灌注新辅助化疗临床疗效观察

目的 探讨术前动脉灌注化疗对进展期结直肠癌的远期临床疗效.方法 选择ⅡB、Ⅲ期的结直肠癌患者128例,随机分为2组:试验组68例行术前动脉灌注化疗,方案为:奥沙利铂(艾恒)130mg/m2、羟基喜树碱20 mg/m2、氟脲苷600 mg/m2,经股动脉插管灌注化疗1、2次,8～14 d后接受手术治疗;对照组60例直接手术治疗.观察动脉灌注化疗不良反应及组织学疗效,比较2组手术切除率、手术并发症、术后病理分期及远期生存率.结果 试验组动脉灌注化疗不良反应主要表现为胃肠道反应和骨髓抑制,均属Ⅰ、Ⅱ度.试验组手术切除率为97.1%(66/68)、根治性切除率为96.9%,分别高于对照组的73.3%(44/60)和79.5%(x2=14.848、8.906,P均＜0.05);试验组组织学有效率达72.7%,病理分期均较术前降低,其中Ⅱ期病例明显较对照组增多(P＜0.05);试验组中位生存期为53.0个月,1、3、5年生存率分别为95.3%、85.9%、44.6%;对照组的中位生存期为42.0个月,1、3、5年生存率分别为92.6%、75.9%、22.0%,试验组生存率高于对照组,但只有5年生存率差异具有统计学意义(x2=6.385,P＜0.05).术后并发症2组比较差异无统计学意义(P＞0.05).结论 术前动脉灌注化疗对进展期结直肠癌降低临床分期、提高手术切除率尤其是根治性切除率作用和疗效确切,并能提高患者的远期生存率.

Abstract：

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.     

Imaging features of central nervous system haemangiopericytomas

Intracranial and spinal haemangiopericytomas are uncommon, durally based tumours. They macroscopically resemble meningiomas but are distinct histologically, have a more aggressive natural history and require different management. We present a pictorial review illustrating the radiological manifestations of these tumours that will aid in their preoperative identification.     

心电图对急性心肌梗死相关血管的预计价值

对385例急性心肌梗死患者作选择性冠状动脉造影。心电图定位为前壁心梗的相关血管89%是左前降支动脉(LAD),下壁心梗的相关血管76.4%是右冠状动脉(RCA)。阻塞发生于 LAD、RCA及左迥旋支动脉(LCX)近端的分别占67%、58%与78%。近端病变90%以上为重度或完全阻塞。在下壁心梗早期心电图出现心前导联 ST 段下移,是病变广泛的一项指标。     

Purification of hemopoietic progenitor cells from human marrow using a fucose-binding lectin and cell sorting

Human peripheral blood granulocytes, but not lymphocytes, erythrocytes, or monocytes, bound the fucose-binding lectin from Lotus tetragonolobus (FBP), and this binding was competitively inhibited by the sugar alpha- L-fucose. The fluorescence-activated cell sorter was used to study the appearance of this receptor on human marrow cells during granulocyte differentiation and to prepare fractions enriched for granulocyte- macrophage progenitor cells (granulocyte-macrophage colony-forming cells--GM-CFC). Cell binding of fluoresceinated FBP increased for bone marrow cells in the sequence--lymphocytes, blast cells, promyelocytes and myelocytes, monocytes, and polymorphonuclear cells. Selection of cells with appropriate low-angle or high-angle light scatter characteristics achieved a 10-fold or 2-3-fold enrichment of progenitor cells, respectively. By selecting cells with intermediate fluorescence intensity, a further 2-3-fold enrichment for GM-CFC was obtained. Cell sorting using the optimal selection of these three parameters produced up to 36-fold enrichment of the progenitor cells from human bone marrow. The most enriched fraction was composed of 23% progenitor cells (colony- and cluster-forming cells) with a yield of 36%. In populations most highly enriched by GM-CFC, immature cells (blast cells, promyelocytes, and myelocytes) made up 95% of the cells present.     

Castleman病临床及病理类型与合并症关系分析:单中心大宗病例观察

目的 研究Cagtleman病(CD)的临床及病理类型与各种合并症的关系,推测各种合并症的发病机制,以提高对本病的认识.方法 回顾性分析北京大学第一医院自1977年以来共53例CD患者的临床特点,同时分析临床合并症与临床类型和病理类犁的关系.结果 53例CD患者中单中心型32例(60.4%),多中心型21例(39.6%);病理分型示透明血管型(HV)37例(69.8%),浆细胞型(PC)9例(17.0%),混合型(MIX)7例(13.2%).患者中32例有合并症,占60.4%.根据受累器官不同分为累及皮肤、内脏和血液系统.临床类型与某些合并症的发生密切相关,32例单中心型的主要合并症为副肿瘤性天疱疮(PNP)和闭塞性细支气管炎(BO),21例多中心型的主要合并症为肾脏、血液改变.病理类型与合并症的发生密切相关:透明血管型主要合并症为PNP和BO,浆细胞型和混合细胞型主要合并症为内脏和血液受累.合并PNP的CD患者的临床和病理分型均不同于其他CD.Kaplan-Meier分析显示:伴有合并症的患者生存率明显低于无合并症的患者(P=0.028).结论 CD患者的合并症与其临床、病理分型有关,合并PNP的CD患者应单独分型,有无合并症是影响CD患者预后的关键因素.     

人卵黄囊间质干细胞的分离纯化及诱导成脂的实验研究

目的:分离纯化及体外定向诱导人卵黄囊间质干细胞(YS-MSC)分化为脂肪细胞。方法:显微分离人卵黄囊, 经酶消化得到卵黄囊细胞, 卵黄囊细胞经贴壁培养、传代纯化得到人YS-MSC, 流式细胞仪检测YS-MSC表面抗原表达, 钙钴法测定碱性磷酸酶(AKP)活性;地塞米松、消炎痛、胰岛素定向诱导YS-MSC分化为脂肪细胞。油红O检测中性脂肪。结果:人卵黄囊间质干细胞易于分离、纯化, 体外培养增殖潜能大。卵黄囊间质干细胞CD29、CD44、CD166及CD105表达阳性, CD34、CD45和CD86为阴性;AKP弱阳性。卵黄囊间质干细胞经成脂诱导转化为大小不等的园形或椭圆形细胞, 可见胞浆内有少量微小脂滴形成, 随时间延长, 胞浆中脂滴相互融合, 胞核被挤于细胞的一侧, 经油红O染色脂滴染橘红色, 符合脂肪细胞的生物学特征。结论:人卵黄囊间质干细胞与成体间质干细胞表型一致, 在体外可以分化为脂肪细胞。     

Upregulation of group 1 CD1 antigen presenting molecules in guinea pigs with experimental autoimmune encephalomyelitis: an immunohistochemical study

In humans, group 1 CD1 glycoproteins present foreign and self lipid and glycolipid antigens to T-cells. Homologues of these molecules are not found in mice or rats but are present in guinea pigs (GPs). We examined CD1 and MHC class II expression in the central nervous system (CNS) of GPs sensitized for experimental autoimmune encephalomyelitis (EAE), an animal model of multiple sclerosis. In normal GPs and the uninflamed CNS, low-level MHC class II (MHC II) immunoreactivity occurred on vascular elements, meningeal macrophages and parenchymal microglial cells, whereas immunoreactivity for CD1 was absent. In the inflamed CNS, the majority of infiltrating cells were MHC II+ and microglia showed increased expression. CD1 immunoreactivity was detected on astrocytes and subsets of inflammatory cells Including B cells and macrophages. Minimal CD1 and MHC II co-expression was noted on inflammatory cells or glia. We conclude that group 1 CD1 molecules are strongly upregulated in the inflamed CNS on subsets of cells distinct from the majority of MHC II bearing cells. The expression of CD1 proteins in such lesions broadens the potential repertoire of antigens recognized at these sites and highlights the value of the GP as a model for studies of the relevance of CD1 molecules in host defense and autoimmune diseases.     

H‐ferritin and proinflammatory cytokines are increased in the bone marrow of patients affected by macrophage activation syndrome

Macrophage activation syndrome (MAS) is hyperinflammatory life‐threatening syndrome, associated typically with high levels of serum ferritin. This is an iron storage protein including heavy (H) and light (L) subunits, categorized on their molecular weight. The H‐/L subunits ratio may be different in tissues, depending on the specific tissue and pathophysiological status. In this study, we analysed the bone marrow (BM) biopsies of adult MAS patients to assess the presence of: (i) H‐ferritin and L‐ferritin; (ii) CD68⁺/H‐ferritin⁺ and CD68⁺/L‐ferritin⁺; and (iii) interleukin (IL)‐1β, tumour necrosis factor (TNF) and interferon (IFN)‐γ. We also explored possible correlations of these results with clinical data. H‐ferritin, IL‐1β, TNF and IFN‐γ were increased significantly in MAS. Furthermore, an increased number of CD68⁺/H‐ferritin⁺ cells and an infiltrate of cells co‐expressing H‐ferritin and IL‐12, suggesting an infiltrate of M1 macrophages, were observed. H‐ferritin levels and CD68⁺/H‐ferritin⁺ cells were correlated with haematological involvement of the disease, serum ferritin and C‐reactive protein. L‐ferritin and CD68⁺/L‐ferritin⁺ cells did not correlate with these parameters. In conclusion, during MAS, H‐ferritin, CD68⁺/H‐ferritin⁺ cells and proinflammatory cytokines were increased significantly in the BM inflammatory infiltrate, pointing out a possible vicious pathogenic loop. To date, H‐ferritin and CD68⁺/H‐ferritin⁺ were associated significantly with haematological involvement of the disease, suggesting biomarkers assessing severity of clinical picture.