烟雾病的临床研究进展

烟雾病是颈内动脉末端进展性狭窄、闭塞及脑底出现异常血管扩张网所致的脑出血性或缺血性疾病,伴脑底部异常血管网形成为其特点。此病在临床上主要有脑缺血和出血两类表现,成年患者经常表现为出血症状,而儿童患者多表现为短暂缺血发作或中风。数字减影血管造影（DSA）仍是诊断该病的金标准。血管重建手术是目前该病的主要治疗方法。     

Radiofrequency Ablation of Invasive Breast Carcinomas: A Phase II Trial

Background Local ablative therapy of breast cancer represents the next frontier in the minimally invasive breast-conservation treatment. We conducted a phase II trial to evaluate radiofrequency ablation (RFA) of invasive breast carcinomas. Methods Consecutive patients from two Mexican Institutions with invasive breast cancers < 4 cm, with no multicentric tumors and no previous chemotherapy were included in this trial. Under ultrasound guidance, the tumor and a 5 mm margin of surrounding breast tissue were ablated with saline-cooled RFA electrode followed by surgical resection. Routine pathologic analysis and viability evaluation with NADPH-diaphorase stain were performed to assess tumor ablation. Procedure-associated morbidity was recorded. Results Twenty-five patients were included. Mean patient age was 55.3 years (range 42–89 years). Mean tumor size was 2.08 cm (range 0.9–3.8 cm). Fourteen tumors (56%) were <2 cm. The mean ablation time was 11 minutes using a mean power of 35 W. During ablation, the tumors become progressively echogenic that corresponded with the region of severe RFA injury at pathologic examination. Of the 25 patients treated, NADPH stain showed no evidence of viable malignant cells in 19 patients (76%), with significant difference between tumors <2 cm (complete necrosis in 13 of 14 cases, 92.8%) vs. those >2 cm (complete necrosis 6 of 11 cases, 54.5%) (P < .05). No significant morbidity was recorded. Conclusions RFA is a promising minimally invasive treatment of small breast carcinomas, as it can achieve effective cell killing with a low complication rate. Further studies are necessary to optimize the technique and evaluate its future role as local therapy for breast cancer.     

Molecular strategies for the treatment of malignant glioma—genes, viruses, and vaccines

The standard treatment paradigm of surgery, radiation, and chemotherapy for malignant gliomas has only a modest effect on survival. It is well emphasized in the literature that despite aggressive multimodal therapy, most patients survive approximately 1 year after diagnosis, and less than 10% survive beyond 2 years. This dismal prognosis provides the impetus for ongoing investigations in search of improved therapeutics. Standard multimodal therapy has largely reached a plateau in terms of effectiveness, and there is now a growing body of literature on novel molecular approaches for the treatment of malignant gliomas. Gene therapy, oncolytic virotherapy, and immunotherapy are the major investigational approaches that have demonstrated promise in preclinical and early clinical studies. These new molecular technologies each have distinct advantages and limitations, and none has yet demonstrated a significant survival benefit in a phase II or III clinical trial. Molecular approaches may not lead to the discovery of a “magic bullet” for these aggressive tumors, but they may ultimately prove synergistic with more conventional approaches and lead to a broadening of the multimodal approach that is the current standard of care. This review will discuss the scientific background, therapeutic potential, and clinical limitations of these novel strategies with a focus on those that have made it to clinical trials.     

Liver resection for breast cancer metastasis: Does it improve survival?

Purpose To assess the outcome and prognostic factors of liver surgery for breast cancer metastasis. Methods We retrospectively examined 16 patients who underwent partial liver resection for breast cancer liver metastasis (BCLM). All patients had been treated with chemotherapy or hormonotherapy, or both, before referral for surgery. We confirmed by preoperative radiological examinations that metastasis was confined to the liver. The survival curve was estimated using the Kaplan-Meier method. Univariate and multivariate analysis were conducted to evaluate the role of the known factors of breast cancer survival. Results The median age of the patients was 54 years (range 38–68) and the median disease-free interval between the diagnoses of breast cancer and liver metastasis was 54 months (range 7–120). Nine major and 7 minor hepatectomies were performed. There was no postoperative death. The overall 1-, 3-, and 5-year survival rates were 94%, 61%, and 33%, respectively. The median survival rate was 42 months. Univariate analysis revealed that hormone receptor status, number of metastases, a major hepatectomy, and a younger age were associated with a poorer prognosis. The survival rate was not influenced by the disease-free interval, grade or stage of breast cancer, or intraoperative blood transfusions. The number of liver metastases was identified as a significant independent factor of survival according to the Cox proportional hazard model (P = 0.04). Conclusions Liver resection, when done in combination with adjuvant therapy, can improve the prognosis of selected patients with BCLM.     

Surgically Managed Gastrointestinal Stromal Tumors: A Comparative and Prognostic Analysis

BACKGROUND: Tyrosine kinase inhibitors have been shown to have marked clinical efficacy in patients with unresectable or metastatic gastrointestinal stromal tumors (GIST). We performed a comparative and prognostic analysis of our experience with surgically managed GIST to determine factors associated with adverse oncologic outcomes. METHODS: Oncologic outcomes of 191 patients with primary GIST surgically managed between 1978 and 2004 at a single institution were reviewed. Prognostic factors were analyzed by Cox analysis (hazard ratio [HR] and 95% confidence interval [95% CI]) and included age, sex, disease presentation (asymptomatic vs. symptomatic), tumor site (stomach, small bowel, colorectal), disease extent (localized vs. metastatic) and risk levels (high, intermediate, low, very-low) assigned on the basis of size and number of mitoses according to current National Institutes of Health recommendations. Primary end points were disease-free survival (DFS) and disease-specific survival (DSS). RESULTS: A total of 186 patients (97%) had c-kit-positive GIST. There were 54% high, 22% intermediate, 18% low, and 8% very low risk GIST originating from the stomach (54%), small bowel (36%), and colon and rectum (10%). Median patient age was 65 (range, 13-91) years, and 108 subjects (57%) were male. Seventy-two percent of patients had symptomatic local disease, and 21% patients had synchronous metastases. Most (95%) underwent R0 resections of their primary tumor. Among 146 patients (76%) with localized disease at presentation undergoing R0 resection, the 5-year DFS was 65%. High-risk GIST (HR 12, 95% CI, 5-32, P < .0001), symptomatic presentation (HR 2.5, 95% CI, 1.1-6, P = .04), and GIST in the small bowel (HR 2.8, 95% CI, 1-5, P = .003) were independently associated with decreased DFS. After a median follow-up of 63 months among survivors, the 5-year DSS was 68%. High-risk disease (HR 14.3, 95% CI, 5-41, P < .0001), symptomatic presentation (HR 3.1, 95% CI, 1.2-7.9, P = .02), and GIST in the small bowel (2.6,3 95% CI, 1-5, P = .006) were independently associated with decreased DSS. CONCLUSIONS: High-risk GIST are associated with increased disease recurrence and decreased survival despite complete surgical resection. These patients should receive adjuvant therapy in the form of tyrosine kinase inhibitors.     

微囊化重组CHO细胞移植促进大鼠心肌梗死后血管新生的实验研究

目的在大鼠心肌梗死部位植入微囊化重组中华仓鼠卵巢（chinese hamster ovary，CHO）细胞，观察其分泌的血管内皮细胞生长因子（VEGF）是否可以促进心肌梗死部位的血管新生，改善心功能。方法通过质粒转染的方法构建可以分泌VEGF的重组CHO细胞系，用微囊包裹，观察微囊内细胞的生长及分泌情况。制备大鼠心肌梗死模型，随机将48只8周龄SD雄性大鼠分成微囊化细胞移植组（MC—CHO组）、单纯细胞移植组（CHO组）、空微囊移植组（MC组）和无血清培养基移植组（对照组），每组12只。移植3周后检测心功能改善情况，病理切片观察微囊结构及囊内细胞存活情况，注射部位微血管计数比较促血管新生效果。结果体外检测可见重组CHO细胞在微囊生长迅速，第8d时培养上清中VEGF达3852pg／ml；移植3周后MC—CHO组左心室大小和心功能明显好于其它3组，差异有统计学意义（P〈0．05）；局部微血管密度MC—CHO组较CHO组、MC组和对照组明显增加（22．3±3．1vs．15．6±2．8，11．4±2．5和13．2±2．7个／每高倍视野，P〈0．05）；组织学检查可见微囊结构完整，内有存活且具有分泌功能的CHO细胞。结论微囊化重组CHO细胞移植可促进大鼠心肌梗死后血管新生，改善心功能。     

外伤性颈动脉海绵窦瘘的血管内栓塞治疗

目的 比较不同方法治疗外伤性颈动脉海绵窦瘘的临床效果。方法 治疗中应用球囊导管,复杂的5例使用了胶及弹簧圈等栓塞材料。结果 10例成功闭塞瘘口且保留载瘤动脉通畅,2例闭塞载瘤动脉．结论 外伤性颈动脉海绵窦瘘应首选血管内栓塞治疗。有时瘘口太小,弹簧圈也是有效方法。     

高强度聚焦超声热疗治疗晚期胰腺癌的初步临床应用

目的 了解高强度聚焦超声热疗（HIFU）治疗晚期胰腺癌的效果及安全性。方法 采用FEP－BY01型超声热疗机对21例晚期胰腺癌者进行HIFU治疗。结果 治疗后88％（15／17）患者疼痛症状明显缓解,癌组织超声回声都出现不同程度地增强,血供明显减少或消失,但是治疗后肿瘤大小及CT值无明显改变,正电子发射计算机断层显象检查提示癌组织已被杀死。本组未发生皮肤烧伤、胰瘘、出血、胰腺炎、胃肠道穿孔等并发症。HIFU后本组平均生存期为7．6个月。结论 HIFU可作为晚期胰腺癌的一种新的局部治疗方法。     

恶性肿瘤患者化疗及附加免疫治疗后淋巴细胞亚群的变化

目的：了解恶性肿瘤患者化疗和附加免疫治疗前后淋巴细胞亚群的变化及其临床意义。方法：利用流式细胞仪测定51例化疗前后和26例附加免疫治疗前后的淋巴细胞亚群及其活性。结果：化疗后1周患者CD3^ ,CD4^ 及NK细胞较化疗前明显降低（P＜0．05）,CD8^ ,CD19^ 细胞无明显变化（P＞0．05）,附加免疫治疗组治疗后1周CD8^ 及NK细胞较化疗前明显升高（P＜0．05及P＜0．01）,CD4^ 细胞,CD4^ /CD8^ 比值降低（P＜0．01）。结论：化疗对恶性肿瘤患者细胞免疫功能有明显抑制作用。附加免疫治疗对恶性肿瘤患者细胞免疫功能有明显改善作用。生物反应调节剂能增强化疗患者的细胞免疫功能,恶性肿瘤患者在化疗时应同时使用生物反应调节剂。     

不能切除的肝门胆管癌腔内放疗

目的 讨论不能切除的肝门胆管癌腔内放疗的经验和实践中存在的问题。方法 15例不能切除的肝门胆管癌手术扩张狭窄段胆管置管外引流后的腔内放疗。结果 腔内放疗15例随访中均因慢性胆汁性肝硬变肝功能衰竭死亡,但无狭窄再发生和肝内胆管再度扩张病例。死亡时间术后3－18个月,平均8个月。结论 腔内放疗的应用,使晚期不能切除的肝门胆管癌得到较好的姑息性治疗。