免疫抑制因子对佐剂关节炎的影响

目的；研究免疫抑制因子对佐剂关节炎发病的影响。方法：检测对照组与实验组对正常小鼠淋巴细胞转化的影响。结果：脑室注射ＩＬ１的关节炎大鼠在第０、７、１４、２８、３５ｄ的血清具有明显的抑制淋巴细胞转移化的作用。关节炎症状加重，病程延长。结论：免疫抑制蛋白可能参与佐剂关节炎的发病，有可能是造成关节炎的原因之一。     

Preoperative Chemotherapy Alone and Combined with Preoperative Radiotherapy in Small-Size Breast Cancer

Abstract: Breast conservation surgery is an effective and safe treatment for many breast carcinomas. It may be possible to further limit the extent of resection (or expand the indication for breast conservation) by the application of preoperative chemotherapy and radiotherapy. We explored the feasibility of this in a pilot study.
Seventy-three patients (mean age 48, 63% premenopausal) with confirmed breast cancer, less than 2.5 cm, received chemotherapy (Group A) or chemotherapy plus radiotherapy (Group B) prior to limited resection (tumorectomy). Axillary dissection was always performed. Results: In 6/31 (19%) Group A and 17/42 (40%) Group B patients the tumor was not palpable after preoperative treatment, with complete pathological remission in 1 and 3 cases respectively. Histologic grading, mitosis, cellular alteration, and cellularity evaluations indicated a consistently greater therapeutic effect with chemoradiotherapy than with chemotherapy alone.
In conclusion, radiotherapy appears useful in the preoperative treatment of breast cancer and its use in association with various drug combinations should be further explored.     

进展期霍奇金病经化疗达完全缓解后,巩固放疗的Meta分析

目的 应用Meta分析的方法评价进展期霍奇金病经化疗达完全缓解后巩固放疗的作用。材料和方法 在MEDLINE、CBMdisc数据库检索进展期霍奇金病化疗达完全缓解行巩固性放疗或不行巩固性放疗的前瞻性随机对照研究。对入选研究的总生存、无事件生存优势比进行Meta分析。结果 4项研究入选，以α=0．05为检验水准，巩固性放疗组与对照组(不作巩固性放疗)相比，5年总生存优势比=1．18，P=0．46；5年无事件生存优势比=1．05．P=0．83：巩固性侵犯野放疗组与对照组相比，5年总生存优势比=0．96，P=0．87。结论 进展期霍奇金病经化疗达到完全缓解后，巩固性放疗对总生存及无事件生存均无益处。     

Complete response, as determined by prostate-specific antigen level, to chlormadinone acetate withdrawal persisting longer than 2 years in patients with advanced prostate cancer: Two case reports

Antiandrogen withdrawal syndrome (AWS) is a well-established phenomenon in prostate cancer. However, responses to AWS are usually of limited duration, and a complete response (CR) is extremely rare. We present two patients who exhibited a chemical CR for more than 2 years after the discontinuation of steroidal antiandrogen chlormadinone acetate use. Whether patients who respond to antiandrogen withdrawal include a group of patients with a better prognosis remains uncertain. However, considering that the usual survival period of patients with hormone-resistant prostate cancer is approximately 12 months, both of the patients reported here, who are present in excellent physical condition, exhibiting an improved quality of life, and attending their hospital as outpatients, obviously acquired a prolonged survival because of AWS.     

99Tcm-MIBI显像评价乳腺癌新辅助化疗疗效

目的 探讨^99Tc^m-甲氧基异丁基异腈（MIBI）显像评价乳腺癌新辅助化疗（NCT）疗效的价值。方法 35例局部进展期乳腺癌（LABC）患者术前化疗前后分别触诊估测肿瘤最大垂直长径及行^99Tc^m-MIBI显像，术后对乳腺癌标本行病理检查及P-糖蛋白（P-gP）、增殖细胞核抗原（PCNA）免疫组织化学染色。观察注射^99Tc^m-MIBI后60min显像图。采用目测法和半定量法，以病灶／本底（T／N）放射性比值降低〉35％为有效。临床疗效按WHO标准评价。化疗后肿瘤细胞病理形态学改变以Ⅱ、Ⅲ级定为显效，Ⅰ级定为弱效。结果 病理检查显效与弱效组间，显像目测法分析NCT有效率分别为75％和9％，差异有显著性（P〈0．01），灵敏度、特异性和准确性分别为75％、91％和80％；半定量法评价NCT疗效的灵敏度、特异性和准确性分别为84％、80％和83％；临床测量肿瘤最大垂直长径则分别为50％、64％和54％。^99Tc^m-MIBI显像评价疗效的灵敏度、准确性明显高于临床确诊。24例病理检查示显效的患者中，^99Tc^m-MIBI摄取与PCNA水平相关，与P-gP水平无关。结论 ^99Tc^m-MIBI显像可有效监测LABC患者术前NCT疗效。     

Effect of Tripterygium Vilfordii on Adrenal Cortex in Rat with Adjuvant Arthritis

(张明敏)(刘沛霖)(叶望云)ＥｆｆｅｃｔｏｆＴｒｉｐｔｅｒｙｇｉｕｍＶｉｌｆｏｒｄｉｉｏｎＡｄｒｅｎａｌＣｏｒｔｅｘｉｎＲａｔｗｉｔｈＡｄｊｕｖａｎｔＡｒｔｈｒｉｔｉｓ￥ＺＨＡＮＧＭｉｎｇ－ｍｉｎ；ＬＩＵＰｅｉ－ｌｉｎ；ＹＥＷａｎｇ－ｙｕｎ（Ｔｏｎｇｊｉ...     

Sequential Adjuvant CMF Chemotherapy Followed by Radiotherapy in the Treatment of Early-Stage Breast Cancer: The Lankenau Hospital Experience

Abstract: The optimal timing of systemic cyclophosphamide, methotrexate, 5-fluorouracil (CMF) chemotherapy and local radiation in adjuvant breast cancer has been a debatable subject. To evaluate the Lankenau Hospital experience with sequential CMF chemotherapy followed by radiation in the adjuvant therapy of stage I and stage II breast cancer we reviewed the records of patients at our center. This group of 34 patients was treated in a homogenous manner, all receiving standard CMF for six cycles followed by radiotherapy after lumpectomy with axillary lymph node dissection. The radiation course was 5040cGy to the entire breast (28 fractions in 45 elapsed days) followed by a boost to the tumor site of 1800cGy in 10 fractions. Thirty-four patients were identified and followed for an average of 5 years (range 1.5–11.5 years). One patient had local recurrence and with subsequent treatment is disease-free at 5 years postrecurrence (8 years from initial diagnosis). Two deaths were not breast-cancer related (1 myocardial infarction at year 3, 1 melanoma at year 7.5). The estimated probability of no relapse at 5 years and 8 years by Kaplan-Meier analysis is 79% and 60% respectively. Overall and disease-free survival in this group of patients treated with breast-conserving surgery and CMF chemotherapy followed by radiation is excellent. There appears to be no detriment to delaying radiotherapy until full doses of systemic treatment are given as local recurrence was rare (6%) and was amenable to further treatment.     

The influence of liver dysfunction on cyclosporine pharmacokinetics —A comparison between 70 per cent hepatectomy and complete bile duct ligation in dogs—

The influence of experimentally induced hepatic dysfunction on the pharmacokinetics of Cyclosporine A (CsA) was determined in dogs. The pharmacokinetics of oral (PO) and intravenous (IV) CsA were studied before and after 70 per cent hepatectomy or complete bile duct ligation (CBDL). Changes in liver function were monitored by serial measurements of serum bilirubin, and by the maximum removal rate (Rmax) and plasma disappearance rate (ICG-K) of indocyanine green (ICG). Concentrations of CsA in whole blood were measured by HPLC. Seventy per cent hepatectomy caused significant liver dysfunction: the ICG-Rmax decreased by 47.7±7.1 per cent (mean±SD) and the ICG-K decreased by 61.3±9.7 per cent during the first week after hepatectomy. At the same time, the systemic clearance (CLs) of IV-CsA decreased by 43.9±8.2 per cent, the area under the concentration curve (AUC) of IV-CsA increased by 35.4±20.8 per cent and the bioavailability of CsA decreased by 26.4±14.8 per cent. CBDL also induced significant liver dysfunction: the ICG-Rmax decreased by 39.1±12.8 per cent and the ICG-K decreased by 65.6±3.6 per cent in the second week after the operation. During the same period, the AUC of PO-CsA decreased by 69.9±10.7 per cent and the bioavailability of CsA also decreased markedly by 73.9±15.6 per cent. These data indicate that hepatic impairment significantly influences the pharmacokinetics of CsA, not only by the changes in intestinal absorption, but also by those in hepatic, metabolism. Dose adjustment is therefore necessary in the presence of hepatic dysfunction in order to maintain an adequate blood concentration of CsA without causing side effects. This research was performed in the Department of Surgery, University of Pittsburgh Health Center, University of Pittsburgh, USA     

Successful treatment of blunt trauma involving complete laceration of the pancreas and duodenum in a 7-year-old child: Report of a case

The acute onset of peritoneal signs and shock in a 7year-old boy who had been hit in the epigastrium by a log-seesaw mandated surgical treatment. Enhanced computed tomography (CT) demonstrated complete laceration of the pancreas as well as duodenal injury, and a duodenoduodenostomy with distal pancreaticogastrostomy was subsequently performed. Temporary external drainage of the stomach and distal pancreas led to an uneventful recovery in the early postoperative period. Although the patient's postoperative development was appropriate for his age, the orifice of the distal pancreas spontaneously closed 2.5 years following surgery. We present this report to stress the fact that every effort should be made to preserve the pancreas following abdominal injury in children.     

急非淋白血病完全缓解后巩固治疗的对照研究

目的探讨急非淋白血病完全缓解后巩固治疗与缓解期的关系。方法对３０例坚持与未坚持完全缓解后巩固化疗的急非淋患者（每组１５例）进行对照研究。比较两组患者的完全缓解期。结果两组患者入院时情况、治疗及达完全缓解时间经统计学处理无明显差异（Ｐ＞０．０５）；而坚持巩固化疗组平均持续完全缓解期（１９．８ｍｏ）明显长于对照组（８．４ｍｏ），统计学具有显著差异（Ｐ＜０．０１）。结论急非淋白血病达完全缓解后，坚持骨髓抑制性治疗对延长完全缓解期以达长期生存目的具有重要意义。