扶正散结方、三氧化二砷联合TACE治疗中晚期原发性肝细胞癌临床研究

目的:本研究采用单中心、前瞻性随机对照研究,观察TACE局部微创治疗基础上联合三氧化二砷、扶正散结方治疗BCLC B或C期原发性肝细胞癌的疗效及安全性。方法:选取符合标准的80例原发性肝细胞癌患者,按随机数字法随机分为治疗组和对照组,每组各40例。入组患者均接受常规抗病毒、保肝、营养支持等基础治疗。对照组在基础治疗基础上,行TACE治疗2次,每次为1个疗程,每个疗程间隔2个月,TACE术后第3天患者开始接受三氧化二砷注射液(哈尔滨伊达药业公司生产)治疗,1次/d,连续10d,间隔14d,连续2次为1个疗程。治疗组在对照组基础上加用扶正散结方。结果:对80例患者进行总生存率进行评价,随访时间4~18个月。治疗组和对照组一年生存率分别为75%和55%;2组生存率的差异有统计学意义(P<0.05);治疗后,治疗组中医证候积分明显低于对照组,KPS评分明显高于对照组,差异有统计学意义(P<0.05),治疗前后未见明显肝肾功能损害,无严重不良反应发生,对三氧化二砷的耐受性较好。结论:扶正散结方、三氧化二砷联合TACE可以提高中晚期肝癌患者的一年生存率及生活质量,无严重不良反应。     

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目的探讨与胎鼠颅骨细胞共培养时,无机三氧化物聚合物(MTA)对其细胞周期及增殖的影响。方法研究于2012年1月至2013年1月在湖北省十堰市人民医院临床研究所进行。用胰蛋白酶和Ⅱ型胶原酶混合多次消化获得原代胎鼠颅骨细胞,将细胞与MTA共培养(MTA组)4、7、14及21 d,细胞培养加入聚氯乙烯作为对照组。采用流式细胞仪(PI染色)及细胞增殖-毒性试剂盒法(CCK-8法)检测细胞周期中G0/G1、S和G2/M期的细胞数变化及细胞增殖情况。结果 G0/G1期第21天时MTA组细胞明显多于对照组(P<0.05);S期细胞数量在第4、14、21天时MTA组明显少于对照组(P<0.05);G2/M期细胞数量在第4、14天时MTA组明显多于对照组(P<0.05),在第7、21天时MTA组明显低于对照组(P<0.05)。细胞增殖指数(PI):MTA组在第4、7天时均略高于对照组,在第14天时开始降低,第21天时明显低于对照组(P<0.05)。CCK-8检测结果显示实验各组细胞均随培养时间延长而增殖,第14天达到峰值,后开始略有减弱。与对照组比较,MTA组在第4、7天细胞吸光度值略高,随着培养时间继续增加,MTA组吸光度值略低于对照组,但差异均无统计学意义(P>0.05)。结论胎鼠颅骨细胞可以在MTA表面很好地增殖,并且MTA可能通过调节细胞周期来决定细胞的增殖能力,并在7 d后降低细胞增殖速度,这可能对细胞的成骨分化存在一定推动作用。     

Effect of Different Irrigation Solutions on the Diffusion of MTA Cement into the Root Canal Dentin

(1) Aim: This study aims to analyze the in vitro infiltration of a silicate root canal sealer into dentinal tubules after using different endodontic irrigating solutions. (2) Methods: Twenty-nine teeth with single roots were separated into three groups according to the final irrigation protocol: G1 n = 10) = 17% EDTA (ethylenediaminetetraacetic acid) + 3.0% sodium hypochlorite (NaOCl), G2 (n = 10) = 17% EDTA + 2.0% chlorhexidine and G3 (Control group, n = 9) = 17% EDTA + saline solution. Root canals were filled using cold lateral compaction technique with MTA Fillapex sealer and gutta-percha. The sealer was labeled with rhodamine B. The teeth were segmented at the middle and third apical sections, which were visualized using 10× confocal laser microscopy to determine the sealer penetration percentage. (3) Results: In the apical section, no statistically significant differences were found between the groups regarding sealer penetration. In the middle section, Group 1 obtained the highest percentage, and Group 2 the lowest (p = 0.004). Group 1 also presented statistically significant differences in the Control Group (p = 0.031) and had close sealer penetration values. Meanwhile, the Control Group (p = 0.023) and Group 2 (p = 0.029) revealed a significant decrease of sealer penetration between the apical and middle sections. (4) Conclusion: The obtained results support that final irrigation with NaOCl promoted similar sealer penetration in the apical and middle sections. On the other hand, a significant decrease in the sealer penetration of the middle section was observed for the chlorhexidine and saline groups. Compared to other irrigant solutions, NaOCl promotes more uniform sealer penetration, which can correlate with better sealing and, consequently, higher endodontic treatment success.     

三氧化二砷联合化疗治疗多发性骨髓瘤30例的临床观察

目的探讨三氧化二砷联合化疗治疗多发性骨髓瘤（MM）的疗效。方法回顾性分析2010年1月至2013年6月本院血液科收治的MM患者30例的临床资料,所有患者采用三氧化二砷与联合化疗交替进行治疗,每次化疗间隔21d。以三氧化二砷和VAD方案或COMP方案联合化疗交替治疗完成为1个治疗周期,所有患者治疗4～6个周期,治疗期及间隔期均服用沙利度胺。所有患者治疗前及治疗后检测血清M蛋白、肌酐、β2微球蛋白和血红蛋白水平,并进行骨髓细胞学检查。治疗结束后评价其疗效和不良反应。结果治疗结束后30例患者疗效评价显示,严格的完全缓解1例、完全缓解5例、很好的部分缓解8例、部分缓解10例、病情稳定3例、病情进展3例（其中1例患者死亡）,总有效率为80．0％（24／30）。与治疗前比较,患者治疗后骨髓浆细胞比例、血清M蛋白、肌酐、β2微球蛋白水平下降,血红蛋白水平升高（均P〈0．05）。应用三氧化二砷治疗时,患者不良反应轻微,对症治疗后均好转。结论三氧化二砷联合化疗治疗IN的疗效和安全性较好。     

Selective apoptosis of multiple myeloma cells in primary samples induced by arsenic trioxide

Objectives

Currently, multiple myeloma (MM) is an incurable disease. Despite the fact that arsenic trioxide (ATO) shows promising results in vitro, data from treatment of patients with MM are disappointing. Due to these discrepancies, we compared the efficacy and selectivity of ATO at two different concentrations in samples from MM patients.

Methods

The extent of apoptosis induced by 2 and 5 µM ATO was evaluated by flow cytometry using annexin V. 34 diagnostic bone marrow samples obtained from MM patients were analysed.

Results

5 µM ATO efficiently induced apoptosis in primary samples. Besides efficacy, also selectivity of action on MM cells in comparison to remaining haematopoietic cells was demonstrated for 5 µM ATO but not for 2 µM ATO.

Discussion

Our study on primary samples confirmed that ATO has a potential role in therapeutic management of MM. Further controlled studies on MM patients are needed.     

三氧化二砷对口腔鳞癌细胞系Nrf2通路的激活作用

目的探讨三氧化二砷(AS2O3)对人口腔鳞癌细胞系SCC-15中氧化应激Nrf2通路的作用。方法通过体外培养人口腔鳞癌细胞系SCC-15,采用细胞免疫荧光法检测不同浓度AS2O3对SCC-15中Nrf2及其下游基因Ⅱ相抗氧化酶—血红素氧合酶1(HO-1)和醌氧化还原酶(NQO1)表达水平的影响,计数平均光密度值。同时采用蛋白免疫印迹方法定量检测不同浓度AS2O3对SCC-15中Nrf2及其下游Ⅱ相抗氧化酶—血红素氧合酶1和醌氧化还原酶表达水平的影响。结果不同浓度的AS2O3对Nrf2、血红素氧合酶1和醌氧化还原酶均有一定的激活作用,并呈剂量依赖关系。结论 AS2O3可激活口腔鳞癌细胞系SCC-15的Nrf2信号通路,具有促进抗氧化基因表达的作用。     

MTA修补髓底穿孔的临床疗效观察

目的评价三氧化物多聚体(mineral trioxide aggregate,MTA)、磷酸锌水门汀(ZPC)和银汞合金(amalgam)应用于髓室底穿孔修补的临床疗效。方法选取髓底穿孔的患牙50颗,随机分成3组,均做严密的根管治疗,之后分别用MTA、ZPC、银汞合金修补髓空底,3组均定期复查,观察临床效果及X线片结果。结果经过1年后复查,MTA修补髓室底穿孔效果明显高于ZPC和银汞合金(P<0.05)。结论 MTA作为一种新型生物材料,具有良好的封闭性,组织相容性和生物活性,是修补髓室底穿孔良好修复材料,同时提高牙齿保存率,在临床广泛应用。