不同模式新辅助治疗食管癌的疗效分析

目的 探讨食管癌不同模式新辅助治疗的疗效分析。方法 回顾性分析2015年1月至2022年5月于安阳市肿瘤医院行新辅助治疗的食管鳞癌(ESCC)患者的资料,共纳入542例患者,其中放化疗(NCRT)组137例,化疗(NCT)组241例,免疫加化疗(NICT)组164例;女性198例,男性344例;≤65岁289例,＞65岁253例。首要研究终点包括主要病理缓解(MPR)率、病理完全缓解(pCR) 率,次要研究终点包括总生存(OS)、无进展生存(PFS)和安全性。生存分析采用Kaplan-Meier方法,并采用Log-rank检验进行组间比较。采用Cox比例风险回归模型进行预后因素分析。结果 NCRT组的MPR率和pCR率分别为66.4%(91/137)和35.8%(49/137),NCT组分别为35.3%(85/241)和6.6%(16/241),NICT组分别为63.4%(104/164)和31.1%(51/164)(χ²=1.67, P＜0.001)。NCRT组的1、2、3年的OS分别为89.8%、82.3%、72.3%,NCT组分别为85.9%、71.4%、61.4%,NICT组分别为91.9%、81.5%、77.8%,差异有统计学意义(χ²=9.20,P＜0.01);NCRT组的1、2、3年的PFS分别为81.5%、67.9%、66.6%,NCT组分别75.9%、61.0%、53.5%,NICT组分别为80.1%、65.5%、65.3%,差异有统计学意义(χ²=4.62,P＜0.05)。多因素分析显示,治疗方式、T分期、N分期是OS的独立影响因素(P＜0.05)。3组不良反应及术后并发症差异无统计学意义(P＞0.05)。结论 与NCT对比,NICT与NCRT有更高的pCR、MPR和生存获益,因此新辅助免疫可作为食管癌术前治疗手段之一,但仍需大型的随机对照研究进一步证实。     

Analysis of Esophageal Motility and Reflux Characteristics in Patients with Gastroesophageal Reflux Disease With or Without Extraesophageal Symptoms

Background: The pathogenesis of extraesophageal symptoms of gastroesophageal reflux disease is complex, and esophageal motility and reflux may be involved in it. In this study, we aimed to compare esophageal motility and reflux characteristics in gastroesophageal reflux disease patients with and without extraesophageal symptoms by high-resolution manometry and multichannel intraluminal impedance-pH monitoring.Methods: We retrospectively studied gastroesophageal reflux disease patients between January 2014 and December 2018. All patients had undergone high-resolution manometry and multichannel intraluminal impedance-pH monitoring. The results were compared and analyzed.Results: A total of 59 patients were included in this study. Patients were divided into 3 groups according to their main complaint: only typical symptoms (group A, n = 11), both typical and extraesophageal symptoms (group B, n = 33), and only extraesophageal symptoms (group C, n = 15). Compared with group A, the lower esophageal sphincter basal pressure, integrated residual pressure, and lower esophageal sphincter length were lower, and the proximal reflux percentages of a weak acid and non-acid reflux were higher in group B and group C (P < .017). The positive rate of esophageal motility disorders was lower in group A than in other groups (P < .05). The proportion of patients with multiple rapid swallows/single swallow—distal contractile integral ratio greater than 1—was higher in group A than in other groups (P < .05).Conclusions: Decreased lower esophageal sphincter pressure and lower esophageal sphincter length, increased proximal esophageal reflux of weak acid and non-acid reflux, esophageal motility disorders, and decreased peristaltic reserve are involved in the pathogenesis of extraesophageal symptoms of gastroesophageal reflux disease.     

β-Adrenoceptor activates endothelium-dependent release of nitric oxide in rat aorta

AIM:To examine the possible role of agents elevating cAMP to release NO from aortic en-dothelial cells. METHODS:NG-nitro-L-arg inine methylester (L-NAME) , an inhibitor of NO synthase, partially inhibited endothelium-dependent relaxation evoked in phenylephrine-precontracted rings by isoproterenol and abolished relaxation mediated by forskolin 0. 2 umol L-1.RESULTS: In rings without en-dothelium, isoproterenol and forskolin were less effective relaxants and L-NAME had no effect on the responses. In methylene blue-treated rings isoproterenol- and forskolin-induced relaxation were prevented in both en-dothelium-intact and -denuded rings, but the inhibitory effects of methylene blue were significantly more in rings with endothelium than in those without. On the other hand, relaxation induced by sodium nitroprusside was not inhibited by L-NAME, but was inhibited by methylene blue in both the endothelium-intact and -denuded rings. The concentration relaxation curves to sodium nitroprusside after methylene bl     

奥曲肽治疗对食管胃底静脉曲张出血的肝静脉压力梯度及血流速度的影响观察

目的:观察奥曲肽治疗肝硬化门静脉高压食管胃底静脉曲张出血肝静脉压力梯度(HVPG)等的变化,探讨奥曲肽止血机制.方法:采用随机对照的方法,病例分为低剂量奥曲肽治疗组(A组,n=18);高剂量奥曲肽治疗组(B组,n=18)和对照组(C组,n =18).治疗肝硬化食管胃底静脉曲张出血,在基础治疗(禁食、输液、输血、对症处理)的基础上,全部病例予以奥美拉唑注射液40 mg,每12h1次静脉滴注抑酸.治疗组A、B组分别以奥曲肽注射液25、50 μg/h的速度微泵静脉维持治疗.观察治疗前后HVPG,门静脉内径,血流速度及呕血、黑便等的改变情况.结果:治疗前与治疗后24、72 h,两治疗组HVPG比较对照组显著降低,有统计学差异(P =0.00,P=0.00).而治疗组A、B治疗后24 h HVPG有统计学差异(P=0.00),治疗后72 h HVPG无统计学差异(P=0.14).治疗组比较对照组门静脉内径减小有统计学差异(P＜0.05);治疗组A、B与对照组在治疗24、72 h呕血,黑便量相比较明显减少,有统计学差异(P＜0.05).结论:奥曲肽能显著降低HVPG,减少门静脉内径,较高浓度奥曲肽在24 h内疗效更快,奥曲肽联合奥美拉唑比较单独奥美拉唑止血疗效更显著.     

当归芍药散活性部位DSS-A-N-30对大鼠离体子宫平滑肌收缩的影响

目的观察当归芍药散提取部位DSS-A-N-30对离体子宫平滑肌收缩的影响,并探讨其可能的作用机制。方法制备离体大鼠子宫肌条,观察DSS-A-N-30对子宫平滑肌自发性收缩,子宫收缩激动剂诱发的子宫平滑肌条剧烈收缩,KCl致子宫平滑肌条强直收缩及缩宫素(催产素)在无钙平衡盐溶液中致子宫平滑肌条持续收缩的影响。结果DSS-A-N-30(141.5,283和566mg.L-1)可以显著抑制子宫平滑肌的自发性收缩;对缩宫素(10IU.L-1)、前列腺素F2α(1mg.L-1)和乙酰胆碱(10μmol.L-1)引起的子宫平滑肌剧烈收缩有抑制作用;对KCl(60mmol.L-1)引起的子宫平滑肌强直收缩无明显作用;对缩宫素(10IU.L-1)在无钙平衡盐溶液中引起的子宫平滑肌条持续收缩有显著抑制作用。结论DSS-A-N-30可能主要通过抑制细胞内钙库释放而松弛子宫平滑肌,对子宫平滑肌收缩产生直接的抑制作用。提示DSS-A-N-30是当归芍药散的活性部位之一,有可能开发为新型痛经治疗药物。     

塞来昔布上调Cyclin D1基因甲基化水平对食管癌细胞增殖和凋亡的抑制作用

目的探究塞来昔布通过上调Cyclin D1基因甲基化水平对食管癌细胞增殖和凋亡的作用及机制。方法将细胞分为对照、转染和塞来昔布组,分别转染阴性对照载体、Cyclin D1过表达载体和Cyclin D1转染后给予60μmol/L塞来昔布。采用MTT法、流式细胞术分别检测细胞增殖、细胞周期和细胞凋亡率的变化,Western blotting法检测细胞周期和细胞凋亡相关蛋白表达水平;甲基化特异性PCR(MS-PCR)、qRT-PCR法用于检测Cyclin D1甲基化特异性扩增片段和Cyclin D1 mRNA表达水平。结果塞来昔布能够抑制Cyclin D1诱导的细胞体外增殖,阻滞细胞周期向S期转化,并促进食管癌细胞凋亡;MS-PCR结果显示塞来昔布能够上调Cyclin D1基因甲基化水平,在转录水平抑制细胞内Cyclin D1 mRNA的表达。结论塞来昔布能够通过上调Cyclin D1基因甲基化水平发挥抑制食管癌细胞增殖、促进其体外凋亡的作用。     

消癌平胶囊联合顺铂和替加氟治疗晚期食管癌的临床研究

目的探讨消癌平胶囊联合顺铂和替加氟注射液治疗食管癌的临床疗效。方法选取2016年4月—2018年4月在重庆市开州区人民医院治疗的食管癌患者86例,根据用药方案的差别分为对照组(43例)和治疗组(43例)。对照组静脉滴注顺铂注射液,80 mg/m~2,1次/d,连续3周,休息1周,每4周为1个周期,同时静脉滴注替加氟注射液,15～20 mg/kg溶于生理盐水500 mL中,1次/d。治疗组在对照组基础上口服消癌平胶囊,4粒/次,3次/d。两组患者均治疗3个周期。观察两组患者临床疗效,同时比较治疗前后两组患者癌胚抗原(CEA)、鳞状上皮细胞癌抗原(SCC-Ag)、细胞角蛋白19的可溶性片段(CYFRA21-1)、糖抗原199(CA199)、血管内皮生长因子(VEGF)、基质金属蛋白酶-9(MMP-9)、骨桥蛋白(OPN)、可溶性白细胞介素-2受体(s IL-2R)及QLQ-C30和KPS评分。结果治疗后,对照组客观缓解率和临床获益率分别为41.86%、72.09%,均分别显著低于治疗组的69.77%、86.05%,两组比较差异均具有统计学意义(P0.05)。治疗后,两组患者血清CEA、SCC-Ag、CYFRA21-1、CA199、VEGF、MMP-9、OPN、sIL-2R水平均显著降低(P0.05),且治疗组患者这些因子水平明显低于对照组(P0.05)。治疗后,两组QLQ-C30量表和KPS评分均明显升高(P0.05),且治疗组患者QLQ-C30和KPS评分明显高于对照组(P0.05)。结论消癌平胶囊联合顺铂与替加氟治疗食管癌可有效改善患者症状,降低机体肿瘤标志物水平和侵袭细胞因子水平,有利于提高患者生活质量。     

Serial evaluation of segmental esophageal reconstruction using a polyurethane scaffold in a pig model

BackgroundMany esophageal pathologies are clinically treated by resection and reconstruction of the esophagus. Surgical esophagectomy remains a morbid procedure and despite minimally invasive advances, has changed little in decades. Novel approaches to esophageal segmental resection and reconstruction are an unmet need.MethodsCircumferential thoracic esophageal transection was performed in both male and female pigs and the defects reconstructed using 5 or 10 cm polyurethane (PU) tubular grafts and stented. A subset were treated with stent only. Animals were survived to 14, 30, 60, and 399 days. Tissues were evaluated histologically, and via non-invasive serial endoscopy and contrast swallowing studies in long-term animals.ResultsLuminal patency was achieved in all animals with no clinical evidence of leak. In short-term animals, there was healing noted in all cases with a variably sized region of ulceration remaining at the most central part of the repaired tube (between the proximal and distal anastomosis). In four long-term animals following stent removal, two resumed normal diet and thrived, while two animals were euthanized prior to the proposed endpoint because of stricture formation and inability to tolerate a normal diet. Re-epithelialization was observed in all groups, and more complete over time.ConclusionsThe PU scaffold provides a matrix across which formation of new tissue can occur. The mechanisms through which this happens remain unclear, but likely a combination of fibrosis and tissue contraction, in conjunction with new tissue formation.     

The effects of oral steroid duration on stricture prevention after extensive endoscopic submucosal dissection for superficial esophageal cancer

BackgroundEsophageal stricture is a major complication of endoscopic submucosal dissection (ESD) in patients with superficial esophageal cancer (SEC). Oral steroids have been used to prevent esophageal stricture in patients with more than 75% of the esophageal circumference resected. However, there are no established guidelines regarding the optimal duration of steroid use. This retrospective observational study aimed to compare the incidence of esophageal stricture according to the period of prophylactic oral steroid use and to identify the risk factors for esophageal stricture.MethodsEighty-one patients who were prescribed prophylactic steroid after undergoing ESD for SEC with more than 75% of esophageal circumference resected were enrolled. Patients were classified into the four-week steroid group (n=72) or eight-week steroid group (n=9) to compare the incidence of esophageal stricture. In addition, the patients were subdivided into those who developed esophageal stricture (n=24) and those who did not (n=57) to identify the risk factors for esophageal stricture.ResultsTwenty patients (27.8%) in the four-week oral steroid group and four patients (44.4%) in the eight-week oral steroid group developed esophageal stricture (P=0.44). The univariable analysis identified tumor size, longitudinal length of semi-circumferential resection, and proportion of circumferential resection as risk factors of esophageal stricture. The multivariable analysis identified the proportion of circumferential resection as an independent risk factor. After adjusting for the proportion of circumferential resection, the incidence of stricture was marginally higher in the eight-week steroid group [P=0.05; odds ratio (OR): 5.69; 95% confidence interval (CI): 1.01–32.15].ConclusionsEight weeks of oral steroid prophylaxis does not reduce the risk of stricture after extensive ESD more than four weeks of oral steroid prophylaxis. The proportion of circumferential resection is the strongest risk factor for stricture in patients with SEC undergoing ESD.     

食管贲门癌术后胃排空障碍的治疗效果

目的 探讨食管、贲门癌术后胃排空障碍的治疗效果。方法 对机械性胃排空障碍病人早期行手术探查,而功能性胃排空障碍则采取各种保守治疗。结果 机械性胃排空障碍治愈11例,死亡1例;功能性胃排空障碍治愈16例,死亡2例。结论 对不同原因引发的胃排空障碍应采取不同措施治疗。