1例胃癌术后重症腹腔感染患者的药学监护

1例56岁女性患者,因反复胃痛加重、纳差、乏力入院。既往有甲亢病史,曾行胆囊摘除术,入院诊断为胃体印戒细胞癌,在抑酸、保护胃黏膜及对症治疗后行胃癌根治性切除术、胃空肠吻合术。术后抑制胰酶、肠液分泌和静脉营养支持,腹腔引流液送病原学检查和药敏试验。临床药师参与抗感染治疗方案的评估,结合细菌培养结果和药敏试验结果,先后采用降阶梯抗细菌治疗和抗真菌治疗。鉴于用药过程中患者病情变化,参考实验室检验指标和院内感染耐药菌监测结果选择抗菌药物,调整用药剂量,对应激性血糖升高给予监测和控制,加强肠外营养,观察用药中潜在不良反应,治疗一个月后,患者病情稳定出院。     

Twist蛋白在胃癌中的表达及其临床意义

目的 观察Twist蛋白在胃癌中的表达情况及其与预后的关系.方法 采用免疫组化PV-900法对110例患者的胃癌组织和癌旁组织分别进行检测.结果 Twist蛋白在胃癌组织和癌旁组织中的表达率分别为67.3％和9％;Twist蛋白的表达与肿瘤浸润深度（T）（P=0.03）、淋巴结转移（N）（P=0.02）、TNM分期（P=0.009）及肿瘤的复发或远处转移（P=0.009）有关;Twist蛋白阳性是胃癌患者术后预后不良的指征（P=0.003）,且是独立预后因素,具有比其他临床指标更强的预测作用（HR：2.893,95％CI：1.385～6.044）.结论 Twist蛋白是胃癌患者的独立预后因素,提示预后不良,并可应用于临床,以助于胃癌患者的早期诊断、有效治疗和预后判断.     

早期胃癌前哨淋巴结微转移临床分析

目的探讨亚甲蓝示踪法前哨淋巴结(SLN)活检术在早期胃癌外科诊疗中的临床意义。方法 39例早期胃癌患者,术中用亚甲蓝示踪SLN,对SLN及所有术后胃周淋巴结进行HE染色,对SLN进一步行细胞角蛋白20(CK20)的免疫组化染色(IHC)及逆转录聚合酶链反应(RT-PCR)检测。比较3种检测方法对SLN转移灶检出的差异。结果 39例患者中,亚甲蓝示踪成功检出37例,检出成功率达94.5%。IHC与RT-PCR微转移检出率均为18.9%。由SLN状态预测胃周淋巴结转移情况:HE切片病检组前哨淋巴结检测准确率97.3%(36/37),假阴性率为16.7%(1/6);CK-20行IHC及RT-PCR组检测准确率97.3%(36/37),假阴性率为14.3%(1/7)。结论亚甲蓝示踪法能有效检出早期胃癌SLN。HE染色结合IHC及RT-PCR检测能提高SLN中微转移的检出率。     

芪竹方中单体及配伍对人胃癌细胞MGC-803抑制作用研究

目的:观察芪竹方单体成分薯蓣皂苷、莪术醇及两者配伍对人胃癌细胞MGC-803的增殖抑制作用,初步探讨芪竹方复方在抗肿瘤治疗中的有效成分及作用机制。方法:选用5个剂量的薯蓣皂苷、莪术醇单药组,及2个剂量的两药配伍组在24h、48h 2个不同时间点作用人胃癌细胞MGC-803,采用MTT法检测药物对MGC-803的增殖抑制率。结果:一定浓度范围内,薯蓣皂苷及莪术醇均对MGC-803细胞的增殖有剂量、时间依赖性抑制作用,且两药配伍使用较单药能产生更好的抑制作用。结论:薯蓣皂苷及莪术醇可能为芪竹方抑制人胃癌细胞MGC-803增殖的有效成分。     

应用iTRAQ技术构建胃癌唾液的蛋白质组差异表达谱

目的：应用同位素标记相对和绝对定量（iTRAQ）技术标记定量蛋白组技术对胃癌患者唾液的全组蛋白进行鉴定和定量分析,初步获得胃癌患者唾液的蛋白组差异表达图谱。方法：胃癌患者与正常人唾液各10例,各组等量混合后利用iTRAQ8标试剂标记后的样本,采用Nano—LC—Ms／Ms分离、分析肽段,运用Proteinpilot4．0软件对蛋白进行鉴定和定量分析,并比较这些蛋白的表达差异。结果：对样品进行了2次Nano—LC—Ms／Ms,标记率〉95％,错误发现率〈1％,鉴定出符合假阳性率〈1％,共鉴定了747个蛋白。与正常对照组相比,胃癌组共出现了2倍以上表达差异的蛋白质21个,其中上调的12个,下调的9个。结论：iTRAQ联合NanoLC—MS／MS技术能高通量地筛选胃癌患者唾液中相关的蛋白,为胃癌患者早期诊断和预后提供可能的生物学标志物或治疗靶点,建立一种无创、简便、快捷实用的检测评估手段。     

Effectiveness of doxifluridine (5′-DFUR)/docetaxel against advanced/recurrent gastric cancer showing resistance to various anticancer drug regimens

A 58-year-old man was diagnosed as having type 3 gastric cancer (poorly differentiated adenocarcinoma). He underwent total gastrectomy with splenectomy, as well as D3 dissection, and received postoperative chemotherapy combining oral uracil and futrafur (UFT) with cisplatin (CDDP), but results showed recurrence of multiple abdominal lymph node metastases around the aorta. He therefore received various anticancer drug regimens (irinotecan [CPT-11]/CDDP; 1 M tegafur-0.4 M gimeracil-1 M oteracil potassium [TS-1], methotrexate (MTX)/5-fluorouracil); however, final results showed growth of lymph node metastasis and simultaneous worsening of his general condition. The patient then received combined administration of doxifluridine (5′-DFUR)/docetaxel (5′-DFUR, 1000 mg/body [666.7 mg/m ² ], given by consecutive daily administration, orally, for days 1–14; and docetaxel, 80 mg/body [60 mg/m ² ], on day 8, by venous drip, every 3 weeks). Three courses of this regimen resulted in approximately 90% reduction of the abdominal lymph node size, disappearance of the right cervical lymph node metastasis, reductions of the levels of two tumor markers (carcinoembryonic antigen [CEA] and carbohydrate antigen [CA]19-9), and improvement of his general condition. In total, seven courses of the regimen were carried out. The patient died on day 298 after starting this combined regimen and showed a response period of 126 days. The primary toxicity identified was neutropenia (grade 4), as well as other low-grade (grade 1, 2) hematological and nonhematological toxicities. In the field of gastric cancer treatment, especially for patients showing multiple resistance to anticancer drugs, an effective therapy is critically needed. Received: January 15, 2002 / Accepted: July 8, 2002 Offprint requests to: A. Sato     

Long noncoding RNA TMEM147-AS1 serves as a microRNA-326 sponge to aggravate the malignancy of gastric cancer by upregulating SMAD5

The abnormal expression of long noncoding RNAs (lncRNAs) is frequently observed in gastric cancer (GC) and considered an important driving force in GC progression. However, little is known regarding the involvement of TMEM147-AS1 in GC. Therefore, we examined TMEM147-AS1 expression in GC and determined its prognostic value. In addition, TMEM147-AS1 expression was depleted to identify the functional changes in response to TMEM147-AS1 deficiency. Using the cancer genome atlas dataset and our own cohort, we identified a strong expression of TMEM147-AS1 in GC. Increased TMEM147-AS1 levels in GC showed a significant association with poor prognosis. TMEM147-AS1 interference resulted in the inhibition of GC cell proliferation, colony-forming, migration, and invasion in vitro. Additionally, depletion of TMEM147-AS1 restricted the growth of GC cells in vivo. Mechanistically, TMEM147-AS1 functioned as a microRNA-326 (miR-326) sponge. Furthermore, SMAD family member 5 (SMAD5) was experimentally validated as the functional effector of miR-326. TMEM147-AS1 was demonstrated to sequester miR-326 away from SMAD5; consequently, knocking down TMEM147-AS1 downregulated SMAD5 levels in GC cells. The functional suppression of miR-326 or reintroduction of SMAD5 effectively reversed the attenuated behavior of GC cells caused by TMEM147-AS1 downregulation. In summary, TMEM147-AS1 exhibits tumorigenic activities in GC, which is likely the result of an altered miR-326/SMAD5 axis. Therefore, targeting TMEM147-AS1/miR-326/SMAD5 may represent a target for the treatment of GC.     

Effectiveness and safety of loop electrosurgical excision procedure in a low-resource setting

Objective

To evaluate the effectiveness and safety of the loop electrosurgical excision procedure (LEEP) to treat cervical intraepithelial neoplasia (CIN) in a low-resource setting.

Methods

Women participating in a cervical screening study in India with histologically confirmed CIN unsuitable for cryotherapy were advised to undergo LEEP. One year after treatment the cervix was visually inspected with acetic acid, followed by colposcopy and biopsy taken from abnormal areas. Cure was defined as no clinical or histologic evidence of CIN. Factors influencing cure rates were evaluated by ^χ2 tests.

Results

Of the 311 women who underwent LEEP, 283 reported for 1-year follow-up and 248 (87.6%) were disease free. Cure rates were 93.0% for CIN 1, 85.5% for CIN 2, and 72.7% for CIN 3. Minor adverse effects were observed in 34 women and complications were seen in 5 women.

Conclusion

LEEP was associated with minimal complications and acceptable cure rates in a low-resource setting, although women with larger lesions had lower cure rates.