5-氨基酮戊酸光动力学诊断腹膜转移癌的研究进展

腹膜转移（peritoneal metastasis,PM）一直被视作癌症的终末阶段。20世纪90年代早期,外科肿瘤学界发展了细胞减灭术（cytoreductive surgery,CRS）加腹腔热灌注化学药物治疗（hyperthermic intraperitoneal chemotherapy,HIPEC）的综合治疗策略,可延长部分经谨慎选择的PM患者生存期。细胞减灭程度（completeness of cytoreduction,CCR）是该综合治疗后最重要的独立生存预测因子。然而,现行的手术技术容易遗漏肉眼难以发现的隐匿部位PM或微小癌灶,PM仍是常规CRS术后主要的复发形式。因此,近年来,光动力学诊断（photodynamic diagnosis,PDD）方法逐渐发展,并用于检测PM。本综述旨在总结5-氨基酮戊酸（5-aminolevulinic acid,5-ALA） PDD技术在PM中的应用进展。     

微波子宫内膜消除术治疗血液病引起的子宫异常出血的价值

目的探讨微波子宫内膜消除术(MEA)治疗血液病引起的子宫异常出血的疗效及影响因素。方法应用微波子宫内膜消除术治疗经药物治疗失败的23例血液病子宫异常出血患者,其中血小板减少性紫癜12例、再生障碍性贫血11例。结果手术时间180~410s,平均(284±70)s,术后第1、3、6、12、24个月进行随访,闭经率60.8%(14/23),满意率95.6%(22/23)。术中无并发症发生,无子宫切除患者。结论MEA治疗血液病患者的子宫异常出血效果可靠。     

Expression of 8-hydroxy-2’-deoxyguanosine in gastric carcinomas

Reactive oxygen species may be involved in the progression of gastric carcinomas. To clarify whether the pathology of gastric carcinoma are related to oxidative DNA damage, the expression of 8-hydroxy-2＇-deoxyguanosine （8-OHdG） was examined in 30 patients with gastric carcinomas. Methods： The expression of 8-OHdG and apoptosis in the gastric carcinoma were measured using the methods of immunocytochemistry and deoxynucleartididyl transferase-mediated dUTP-biotin nick end labeling （TUNEL）, respectively. Results： Of the 30 cases, 25（83%） showed stronger immunoreactivity than normal control. The patients with poorly differentiated gastric carcinoma had a larger tumor size and higher labeling indices of TUNEL- and 8-OHdG-positive cells than those with well and moderately differentiated gastric carcinoma. Conclusion： Our findings suggest that oxidative DNA damage is increased in association with necroinflammation in chronic gastric injuries and determination of 8-OHdG is useful in assessing high-grade malignancy in gastric carcinomas.     

1997-2006年浙江省桐乡市三镇恶性肿瘤发病情况及水砷浓度调查

目的调查研究1997—2006年间浙江省桐乡市洲泉、乌镇和石门三镇恶性肿瘤的发病情况,分析其与外环境水砷浓度的关系。方法调查桐乡市洲泉、乌镇和石门三镇各医院病案室所有恶性肿瘤病案资料,及省疾控中心年度人口统计年报表中的人口资料并对其进行统计学分析。结果1997—2006年间,桐乡市洲泉、乌镇和石门镇恶性肿瘤发病率有逐渐升高的趋势,特别是近三年（2004—2006）的发病率比前7年增加明显。其中肺癌、胃癌和肝癌是发生率最高的肿瘤。在40到79岁年龄段的发病人数占总发病人数的90％左右。男性发病率大约是女性的2倍。水砷浓度在0．01—0．049mg／L地区（乌镇）的恶性肿瘤发病率最高,而水砷浓度〉0．05mg／L的洲泉镇,恶性肿瘤发病率反而较乌镇低。结论浙江省桐乡市洲泉、乌镇和石门三镇恶性肿瘤的发病率和水砷浓度无明显相关性。     

经验性抗真菌治疗血液病侵袭性真菌感染14例疗效分析

目的评价卡泊芬净在经验性抗真菌治疗中的疗效。方法对14例侵袭性真菌感染(IFI)血液病患者给予卡泊芬净(首日70mg/d,以后50mg/d)经验性抗真菌治疗后,评价其临床疗效。IFI诊断符合欧洲癌症研究和治疗组织(EORTC)及侵袭性真菌感染协作组(IFICG)的标准。结果14例患者中治疗有效者11例,有效率为78.6%,治疗起效时间5～7d。不良反应发生率为28.6%(4/14),为轻度、可逆的不良反应,患者耐受性较好。结论卡泊芬净是一种高效、低毒、作用迅速的抗真菌药,是血液病患者抗真菌经验性治疗的理想药物。     

宏基因组二代测序在恶性血液病并发感染患者中的诊断价值

目的:探讨宏基因组二代测序（mNGS）在恶性血液病并发感染患者中的诊断价值。方法:回顾分析2019年1月—2020年12月就诊于天津市第一中心医院血液科恶性血液病患者190例,对血浆mNGS检测到的致病菌种类、阳性率、检测时间及其与传统检测方法的结果进行分析。应用 SPSS22.0 统计学软件进行数据分析,通过Pearson χ2 检验或McNemar检验对离散变量进行比较分析。结果:血浆mNGS阳性率为77.37%,显著高于血培养（ χ2=13.36,P＜0.01）。细菌是mNGS检出率最高的病原体（43%）,最常见的依次为葡萄球菌属、不动杆菌属和肠球菌属。mNGS所需要的时间少于血培养（t =22.37,P＜0.05）。此外,mNGS的敏感性较血培养高（80.25% vs. 8.02%, χ2=10.83,P＜0.01）,但特异性低（47.06% vs. 100%, χ2=8.21,P＜0.01）。根据mNGS结果,75例（46.30%）患者调整抗感染治疗方案后,评价有效率为49.30%。结论:血浆mNGS联合传统的检测方法,能够快速且有效地提高对恶性血液病并发感染患者的病原学诊断能力,因而优化抗感染治疗。     

伴BCOR/BCORL1突变的髓系肿瘤共突变基因表达谱及实验室特征分析

目的 探讨BCOR/BCORL1突变的髓系肿瘤患者的共突变基因表达谱，分析其病理参数及临床意义。方法 回顾性分析2017年1月至2021年8月在上海交通大学附属第一人民医院确诊的47例BCOR/BCORL1突变的髓系肿瘤患者。运用二代测序技术分析患者的基因共突变表达谱，采用两独立样本秩和检验分析BCOR/BCORL1突变患者病理参数之间的差异。通过Kaplan-Meier分析突变位置和治疗方法对患者无病生存（DFS）时间和总生存（OS）时间的影响。结果 急性髓系白血病（AML）患者以点突变为主（51.1%）,骨髓增生异常综合征（MDS）和MDS/骨髓增殖性肿瘤（MPN）患者以移码突变、错义突变和无义突变为主（19.1%）,二者分布差异具有统计学意义（χ²=7.458,P=0.006）。伴代谢酶组突变患者白细胞计数（Z=-3.500,P=0.018）、血小板计数（Z=82.500,P=0.027）、血浆纤维蛋白原（Fib）含量（Z=-0.935,P=0.008）和凝血酶时间（Z=0.800,P=0.027）与野生型患者相比差异均有统计学意义；伴甲基化组突变患者血浆F...     

Association of HPV infections with second primary tumors in early-staged oral cavity cancer

Oral Diseases (2012) 18 , 809–815 Objective: The infection of human papilloma virus (HPV) has been reported in head and neck cancer; however, the clinical significance of HPV infection on the pathogenesis of oral cavity squamous cell carcinoma (OSCC) is still uncertain. Materials and Methods: The study recruited 103 patients with pathological early‐stage OSCC between March 1997 and December 2003 from Chang Gung Memorial Hospital, Taiwan. Tumor specimens were HPV‐genotyped by the EasychipVR HPV Blot method. Clinical association study was performed by using chi‐square, Kaplan–Meier, and logrank tests. Results: Thirty‐one patients (30.1%) were positive for HPV infection. The most frequent HPV types were types 16 (16 patients, 51.6%) and 18 (seven patients, 22.6%). HPV infection was not associated with tumor aggressiveness (pathological tumor stage or differentiation status), risk exposure (alcohol, cigarette, or areca quid chewing habit), or the treatment outcome (disease‐free survival or overall survival). However, infection with HPV‐18 was associated with the occurrence of a second primary cancers (P = 0.033), indicating the infection of HPV in OSCC enhances the susceptibility of developing secondary malignancy. Conclusions: There are 30% of the patients with OSCC infected with HPV, with most high‐risk types. HPV‐18 infection may enhance the susceptibility of second primary tumors. Large scale of validation study will be needed to confirm this result.     

Xeroderma pigmentosum variant associated with multiple cancers

A 62-year-old Japanese man with xeroderma pigmentosum (XP) variant is reported. The patient had developed at least 6 basal cell carcinomas, a squamous cell carcinoma, and a malignant melanoma on sun-exposed areas, and an atypical carcinoid on the right lung. In vivo phototesting showed a normal response. The minimal erythema dose of ultraviolet B (UVB) was not lowered and no delayed peaking of the erythema reaction was observed. His skin fibroblasts exhibited higher sensitivity to UV irradiation, but a normal level of unscheduled DNA and RNA synthesis. Cell fusions with XP group A, C, D, E, F, and G cells after UV irradiation were all complemented. Previous reports together with this case suggest that older XP variant patients have a high frequency of not only skin cancers, but also internal malignancies.     

间充质干细胞治疗糖皮质激素耐药性慢性移植物抗宿主病临床疗效观察

Objective To assess whether treatment with mesenchymal stem cells (MSCs) is an effective adjunct therapy for refractory extensive chronic graft-versus-host disease (GVHD) resistant to conventional therapy. Methods 12 patients with steroid-resistant extensive chronic GVHD were treated with MSCs. One patient received one dose, 10 received two doses, and the remaining three doses. The MSCs were obtained from HI,A-identical sibling donors (n = 14), haploidentical donors (n = 2), unrelated mismatched donor (n = 1) and third-party HLA-mismatched donors (n = 7). Of the 11 patients treated with multiple infusions, 5 received cells derived from two donors. The median first dose of MSCs was 1.0 (0. 4-2. 1) × 106/kg , the median second dose was 1.2(0. 8-1.9) × 106/kg , and the third dose in one patient was 1.1 × 106/kg. Meanwhile the proportion of CD3+ ,CD4+,CD8+ ,CD19+,CD4+ CD25+ ,FOXP3+,FOXP3+CD4+ and FOXP3+ CD25+ was determined with double fluorescent-labeled antibodies and flow cytometry before and 4 weeks after the MSCs infusion. Results No patients had side-effects during or immediately after the infusions of MSCs. After a treatment course of one to three doses, 3 patients had complete response(CR), 6 showed partial response(PR) and 3 did not respond; the total effective rate was 75% (9/12). Complete resolution was seen in the involvement of skin (3/12), lung (1/3), joints (1/5), liver (3/10), oralcavity (4/12) and eye (2/7). Response rate was not related to donor HLA-match. 3 CR patients discontinued all of the immunosuppressive agents without relapse 100 to 292 days after the MSC infusion and 6 PR patients taped all immunosuppressive agents after 60 to 79 days. Mean follow-up period was 1152(795-1914) days, leukemia free survival rate was 91.7% (11/12) and the overall survival rate was 75% (9/12). The ratio of CD4/CD8 and the proportion of regulatory T cells were significantly higher than that before MSCs treatment. Conclusion Third-party MSCs were as effective as HLA-identical or haploidentical cells. This finding has practical implications and suggests that third-party cells can be prepared and stored frozen to be used for steroid-resistant extensive chronic GVHD therapy. It is concluded that MSCs may prevent the lethal cGVHD after allogeneic hematopoietic stem cell transplantation and raise the survival rate by increasing the ratio of CD4/CD8 and proportion of regulatory T cells in vivo.