表柔比星,奥沙利铂和卡培他滨二线方案治疗晚期胃癌的疗效

[目的]探讨表柔比星,奥沙利铂和卡培他滨二线方案治疗晚期胃癌的临床疗效及毒副作用.[方法]对本院收治的80例胃腺癌患者在一线方案治疗后效果不佳且病情进展时给予二线方案治疗,根据患者用药方式的不同分为A组与B组,A组给予表柔比星+奥沙利铂+卡培他滨(mEXO)治疗,B组给予伊立替康+氟尿嘧啶+亚叶酸钙(FOLFIRI)治疗,比较两组患者疗效以及化疗后产生的毒副作用情况.[结果]A组治疗后疾病控制率达42.5％(17/40),B组疾病控制率达47.5％(19/40),两组相比较差异无显著性(P＞0.05);但B组患者血液毒性反应、腹泻与外周神经毒性反应Ⅰ～Ⅱ度发生率显著高于A组,且差异有显著性(P＜0.05).[结论]晚期胃癌患者经一线化疗效果不佳后,若患者还能承受二线化疗,可采用表柔比星,奥沙利铂联合卡培他滨方案化疗,且效果确切,且毒副作用较小,值得临床治疗借鉴.     

人参皂苷Rg3联合新辅助放化疗对胃癌组织VEGF、MTA1蛋白表达及预后的影响

[目的]探讨人参皂苷Rg3联合新辅助放化疗对胃癌组织血管内表皮生长因子(VEGF)和肿瘤转移相关蛋白1(MTA1)表达、免疫功能及预后的影响.[方法]84例胃癌患者依据治疗方式的不同,随机分为两组,对照组术前给予新辅助同步放化疗治疗,治疗组在对照组治疗的基础上,同时服用人参皂苷Rg3治疗.比较两组治疗前后VEGF、MTA1蛋白表达,免疫功能变化及预后.[结果]治疗组根治性切除(RO)切除率,近期治疗总有效率均高于对照组(P＜0.05);与治疗前比较,两组VEGF和MTA1阳性率均显著降低(P＜0.05),且治疗组降低程度显著高于对照组(P＜0.05);治疗后治疗组患者CD3+、CD4+百分比、CD4+/CD8+值、T细胞转化率均显著上升(P＜0.05),CD8+百分比显著下降(P＜0.05),与对照组比较差异显著(P＜0.05);两组骨髓抑制发生率相比较差异无显著性(P＞0.05);治疗组复发率明显低于对照组71.4％(P＜0.05);治疗组1、3、5年存活率高于对照组(P＜0.05).[结论]人参皂苷Rg3联合新辅助放化疗治疗胃癌患者,RO切除率高,可显著降低患者VEGF和MTA1阳性率,提高患者免疫,降低肿瘤复发率,提高患者生存率,效果显著,具有重要临床意义.     

晚期胃癌患者组织中PVT1、Her-2基因表达水平与临床病理的关系

[目的] 探讨晚期胃癌患者组织中人浆细胞瘤转化迁移基因1(PVT1)、人表皮生长因子受体-2(Her-2)表达水平及其与胃癌临床病理特征的关系.[方法]采用免疫组织化学染色法检测分析本院收治的80例经病理确诊的晚期胃癌患者癌组织及癌旁正常组织中PVT1、Her-2表达水平.[结果] 胃癌组织标本PVT1高表达率、Her-2阳性表达率均明显高于较癌旁组织(P<0.05);印戒细胞患者PVT1高表达率(81.25%)、Her-2阳性率(75.00%)明显高于乳头状腺癌、管状腺癌、低分化腺癌(P<0.05);相关性分析显示PVT1高表达、Her-2阳性表达与胃癌TNM分期、淋巴结转移呈正相关(P<0.05),与细胞分化程度呈负相关(P<0.05),但与患者性别、年龄无相关性(P>0.05).[结论]晚期胃癌患者组织中PVT1、Her-2基因表达水平与胃癌TNM分期、淋巴结转移、细胞分化、临床病理有明显相关性,临床可据此为晚期胃癌患者选择合理手术方案.     

脾结核的CT诊断价值

目的探讨脾结核的CT表现及其病理学改变,评价CT对其诊断的价值。方法搜集8例经手术病理或临床追踪证实的脾结核,8例均作螺旋CT平扫及增强扫描。回顾性分析其CT表现,并与病理检查结果对照。结果8例中6例CT平扫表现为脾内多发性大小不等的类圆形、稍低密度或等密度灶,病灶高于水样密度。其中4例增强扫描病变无强化,与周围脾脏比较呈明显低密度,类似囊性病灶;2例增强扫描病变周边呈环形强化。1例CT平扫为单发类圆形低密度影,边缘不清,增强扫描边缘及内部分隔明显强化。1例CT表现为脾脏、腹腔淋巴结多发钙化影。8例中7例同时伴有肝门、胰周及腹膜后淋巴结肿大,少数有融合,增强扫描表现为周边环状强化而中央无强化。结论CT平扫脾脏内多发大小不等的结节状稍低或等密度(高于水样密度)病灶,而增强扫描却完全不强化,与周围脾脏比较呈明显低密度,类似囊性病灶的征象,是脾结核的相对特征性表现。     

从先后天之本初探儿童Duchenn型肌营养不良症病机与证治

儿童Duchenne型肌营养不良症属于遗传性疾病,对于该病的中医病因病机尚无统一的认识。作者认为该病与先天之本肾密切相关,结合小儿脾常不足,肾常虚的生理特点,提出从先后天之本论治该病。确立温补肾气,资助后天;补中益气,颐养先天;兼涤痰化湿,活血通络的治法,以飧同道。     

Differential effect of resuscitation on Toll-like receptors in a model of hemorrhagic shock without a septic challenge

It has been shown that the inflammatory response and cellular damage after hemorrhagic shock are influenced by resuscitation strategies. Toll-like receptors (TLRs) play an important role in signal transduction in inflammatory conditions. However, alterations in TLR expression following hemorrhagic shock and resuscitation have not been well documented. This study was conducted to measure the impact of different resuscitation strategies on TLR expression and downstream signaling in key organs. METHODS: Sprague Dawley rats (n=38) were subjected to a severe volume-controlled hemorrhage protocol. After 75 min of shock, they were resuscitated over 45 min as follows: (1) lactated Ringer's (LR, 81 ml/kg), (2) ketone Ringer's (KR, 81 ml/kg), (3) 7.5% hypertonic saline (HTS, 9.7 ml/kg), (4) 6% hetastarch (HEX, 27 ml/kg), (5) pyruvate Ringer's (PR, 81 ml/kg). Sham hemorrhage (NH) and no resuscitation (NR) groups served as controls. The KR and PR solutions were identical to LR except for equimolar substitution of racemic lactate with beta hydroxybutyrate and sodium pyruvate, respectively. At the end of resuscitation, the expression of TLRs (types 1-10), and cytokines (IL-10, IL-1beta and TNF-alpha) were measured in the lung and spleen using RT-PCR. Levels of phosphorylated and total IkB-alpha and NF-kappaB were detected by Western blotting. The systemic and lung protein levels of TNF-alpha were measured using ELISA and immunohistochemistry. RESULTS: Expression of TLRs in the lung was affected more than in the spleen by hemorrhagic shock and resuscitation. In the lung, hemorrhage increased TLR-2, -3 and -6 (but not TLR-4) mRNA expression, with an up-regulation of the ratio of phosphor-NF-kappaBp65 and total NF-kappaBp65, NF-kappaBp65 activation, and enhanced systemic and tissue TNF-alpha protein levels. Post-resuscitation, TLR mRNA profile and subsequent downstream proteins in the lung and spleen were affected by the choice of resuscitation strategy. CONCLUSIONS: Hemorrhagic shock activates TLR signaling in lung, but not the spleen, probably through an up-regulation of TLR gene expression, and activation of NF-kappaB pathway. Resuscitation modulates this response in a fluid- and tissue-specific fashion.     

Postgastrostomy tube deformity on upper GI series

Three cases are presented in which a focal concave deformity occurred along the greater curvature of the stomach on upper gastrointestinal (GI) series. These patients all had recent removal of a surgically placed gastrostomy tube from a similar location. This deformity appears to be related, at least in part, to invaginated gastric mucosa intentionally produced during surgical gastrostomy tube placement. This association and appearance should be noted as it may mimic other lesions.     

Heterotopic pancreas of the stomach: CT findings correlated with pathologic findings in six patients

Background: The purpose of this study was to characterize the computed tomographic (CT) findings of heterotopic pancreas of the stomach. Methods: CT scans of six surgically proven cases of heterotopic pancreas of the stomach were reviewed. Three were dynamic spiral CT scans, with both arterial dominant and late phase scans. In other three, both unenhanced and contrast-enhanced scans were obtained by using conventional techniques. Particular attention was given to the enhancement of the heterotopic pancreas. Pathologic and surgical findings were correlated with CT findings. Results: The locations were in the gastric antrum in five cases and in the mid-body in one. Size ranged from 1 cm to 3 cm (mean = 2.1 cm). Three cases showed homogeneous, strong enhancement similar to the pancreas and consisted mainly of pancreatic acini with the same histologic features as the normal pancreas. Two cases showed poor enhancement and consisted mainly of ducts and hypertrophied muscle; pancreatic acini were a minor component. In one case appearing as a cystic lesion on CT, a pseudocyst was found with many ducts and some nests of pancreatic acini. Conclusions: Heterotopic pancreas of the stomach showed a diverse spectrum of CT findings. Good understanding of these CT findings may be helpful in making a correct diagnosis. Received: 24 March 1999/Accepted: 19 May 1999     

caspase-3、bcl-2基因及Ki-67在胃癌前病变中的表达及意义

目的　探讨caspase 3、bcl 2基因及Ki 6 7在胃癌前病变不同转归中的作用。方法　采用免疫组化SP法检测 6 0例胃癌患者胃癌及癌前病变组织标本 [胃粘膜中度以上肠上皮化生和 (或 )异型增生 ]及其正常胃粘膜组织标本的Ki 6 7、caspase 3、bcl 2的表达。 结果　①Ki 6 7、caspase 3、bcl 2标记指数在癌前病变组表达明显高于正常组 ,差异有显著意义 (P <0 0 1) ;②caspase 3、bcl 2和Ki 6 7表达在胃癌组织均显著高于癌变前组织 (P <0 0 1)。结论　在胃癌发生发展过程中 ,caspase 3、bcl 2蛋白表达起重要作用 ,且发生癌变前细胞增殖活性已明显升高     

外伤性脾破裂中心静脉置管并发症及护理

目的探讨中心静脉置管术在脾破裂应用的并发症和护理。方法回顾性分析43例患者行中心静脉置管术。结果43例置管者中,共发生并发症21例,导管败血症7例,导管脱落6例,堵塞5例,出血2例,脑梗塞1例。结论中心静脉置管术是脾破裂急救的有效方式之一,同时作好置管后护理,可减少并发症的发生。