RNAi沉默STAT3基因对人前列腺癌PC3细胞裸鼠移植瘤生长的抑制作用

目的 探讨pSilencer1．0-U6-siRNA-STAT3重组质粒对人前列腺癌细胞PC3裸鼠移植瘤生长的抑制作用。方法 采用裸鼠前列腺癌模型模拟siRNA—STAT3基因治疗实验，观察siRNA—STAT3重组质粒的抗瘤疗效，Western blot法检测重组质粒对STAT3基因表达的影响，HE及Tunel染色方法观察肿瘤组织形态及细胞凋亡情况。结果 肿瘤接种后第49天重组质粒组肿瘤体积为（391±56）mm^3，盐水对照组为（1111±182）mm^3，空质粒对照组为（981±169）mm^3，与对照组相比，差异有统计学意义（P〈0．01）；重组质粒抑制瘤体内STAT3及pTyr-STAT3基因表达率分别为77％及68％，与对照组比较，差异有统计学意义（P〈0．01）。HE染色证实重组质粒组出现大片细胞核固缩、破碎等凋亡征象，Tunel染色显示癌组织出现大量细胞凋亡。结论 pSilencer1．0-U6-siRNA-STAT3重组质粒能明显抑制人前列腺癌细胞PC3裸鼠移植瘤的生长，具有良好的应用前景。     

后腹腔镜下根治性肾切除术并区域淋巴结清扫术40例报告

目的探讨后腹腔镜下肾癌根治性肾切除术并区域淋巴结清扫术的安全性和疗效。方法2002年1月至2006年7月,行后腹腔镜下肾癌根治区域淋巴结清扫术40例。男22例,女18例,年龄23～70岁,平均53岁。8例以无痛性全程肉眼血尿就诊,32例为体检时B超检查发现。B超检查肿物直径1．5～7．0 cm,平均5．0 cm;肿瘤位于肾上极16例,肾中部10例,肾下极14例。40例均行CT检查,31例行MRI检查,报告肿物大小与B超相符。术前临床分期：T1N0M09例, T2N0M025例,T3N0M06例。结果本组手术时间80～180 min,平均120 min。出血量20～300 ml,平均50 ml。无中转开放手术。术后肠道功能恢复时间（24±12）h,术后住院天数（7±2）d。术后无明显并发症。病理报告：肾透明细胞癌33例,囊性肾细胞癌4例,血管平滑肌脂肪瘤2例,嗜酸细胞瘤1例。送检清扫的淋巴结中,阳性4例,均为透明细胞癌,T21例、T23例。随访6～36个月,平均12个月,1例术后3个月局部复发,后因远处转移死亡,其余39例未发现局部复发和穿刺通道的种植性转移,未发现远处转移,均无瘤生存。结论后腹腔镜下肾癌根治性肾切除术并区域淋巴结清扫术安全可靠,疗效良好。     

羟基喜树碱预防膀胱肿瘤术后复发的系统评价

目的：评价膀胱灌沣羟基喜树碱预防国人膀胱肿瘤术后复发的疗效和副作用。方法：按设定的纳入杯准，检索国内已公开发表的关于羟基喜树碱膀胱灌注治疗国人膀胱肿瘤术后复发的研究资料，并应用Revman1．2软件进行数据处理和分析。结果：共有16个研究符合标准被纳入，涉及总病例数1671例．其中进行羟基喜树碱灌注治疗779例（193/779），对照组治疗892例（267/892）。Meta分析结果提示羟基喜树碱膀胱灌注可降低膀胱肿瘤复发风险（OR=0.76．95%CI[0.61．0.96]，P=0.02）；与13个研究主要副作用膀胱刺激痱化学性膀胱炎的文献比较，Meta分析结果提示羟基喜树碱膀胱灌注所致膀胱刺激症化学性膀胱炎发生率极低（OR=0.08.95%CI[0.03，0.19]P＜0.00001）。结论：羟基喜树碱膀胱灌注可以有效降低膀胱肿瘤术后复发率，虽然也可以引起一些副作用，但可以耐受，不影响患者继续治疗。     

尿Cox-2蛋白与CK20 mRNA诊断膀胱移行细胞癌的临床价值

目的：评价尿环氧化酶-2（Cox-2）蛋白、CK20 mRNA诊断膀胱移行细胞癌的临床价值。方法：选择78例膀胱移行细胞癌和30例非膀胱肿瘤患者,同时行尿Cox-2蛋白、CK20 mRNA和尿脱落细胞学检查,比较各种方法的敏感性、特异性和Youden指数。结果：尿Cox-2蛋白、CK20 mRNA和尿脱落细胞学的敏感性分别为89.7％．66.7％．26.9％;特异性分别为93.3％、86.7％和100％;Youden指数分别为83.1％、53.4％和26.9％。尿Cox-2蛋白和CK20 mRNA的敏感性和Youden指数均高于尿脱落细胞学（P＜0．05）,同时尿Cox-2蛋自的敏感性和Youden指数高于CK20 mRNA（P＜0．05）。结论：尿Cox-2蛋白和CK20 mRNA检测的高敏感性、高特异性为膀胱癌提供了一个简单无创的检测方法,非常适合于复发率很高的膀胱癌的诊断与随访。     

磁转染MUC1/Y基因入树突状细胞抗膀胱肿瘤的免疫效应研究

目的：研究体外磁转染人MUC1/Y基因至人树突状细胞（DC）的可行性,以及在体外诱导特异忡抗MUC1／Y膀胱癌的免疫效应。方法：以葡聚糖磁性纳米颗粒（DMN）作为载体,在多聚赖氨酸（PLL）的辅助下,通过静电作用结合MUC1／Y基因的真核表达载体pEGFP-C1—MUC1／Y．在铜-硼-锡磁块的固定磁场作用下转染至人DC中,荧光显做镜下以及流式细胞仪观察其转染效率;再将这种转基因DC与自体T细胞共培养,观察其致敏的细胞毒性T淋巴细胞（CTL）对MUC1／Y特异性抗膀胱癌（膀胱肿瘤BIU87细胞系）的杀伤活性,即分别用LDH释放法检测CTL杀伤活性和透射电镜观察CTL诱导靶细胞凋亡情况：ELISA法测定基冈修饰后的DC刺激自体T细胞分泌IFN-γ了的能力。结果：pEGFP-C1／-MUC1／Y转染效率为15％左右,荧光显微镜下可观察到明显绿色荧光蛋白的表达;与自体T细胞混合培养后能诱导出湿著的MUC1/Y特异性的CTL对BIU87细胞的杀伤实验表明T-DC-MUC1的杀伤活性约为52％,显著高于埘照组T-DC诱导的CTL;住透射电镜下也可以清楚的观察到部分BIU87膀胱肿瘤细胞出现了细胞核核仁消失,染色质浓集于核膜周围等早期凋亡表现;基因修饰后的DC能刺激自体T细胞分泌高水平的IFN-γ,与未转染的DC相比差异有统计学意义（P〈0．05）。结论：葡聚糖磁性纳米颗粒（DMN）在固定磁场的作用下成功将MUC1/Y基因转入DC,并可有效诱导出特异性的抗MUC1/Y膀胱癌的免疫效应。     

MMP-2和MMP-9在膀胱移行细胞癌组织中的表达及临床意义

目的：探讨膀胱肿瘤组织巾MMP-2及MMP-9表达与膀胱移行细胞癌（TCCB）临床病理分期分级的关系。方法：选择同济医院2004年1～12月间手术治疗的TCCB患者38例作为实验组,以16例附带癌旁正常黏膜或膀胱镜下活检正常膀胱黏膜作为对照组。运用免疫组织化学SP法检测MMP-2及MMP-9在膀胱组织中的表达。结果：MMP-2和MMP-9在实验组的表达显著高于对照组（P〈0．01）,且与肿瘤临床分期呈显著正相关（r=0．51361,P〈0．01）,与肿瘤病理分级也呈正相关（r=0．59818,P〈0.05）。结论：TCCB患者膀胱组织中高表达的MMP-2及MMP-9与肿瘤细胞侵袭和转移密切相关,联合检测MMP-2及MMP-9,对TCCB的早期诊断及判断预后有参考价值。     

甲状腺乳头状微小癌36例临床分析

目的总结甲状腺乳头状微小癌的诊治体会。方法回顾性分析1996年1月至2005年12月经手术和病理诊实的36例甲状腺乳头状微小癌的临床资料。结果36例甲状腺乳头状微小癌,术前诊断9例（25％）,术中冰冻切片诊断22例（61．1％）,所有病例经石腊切片确诊,与良性结节并存20例。随访5个月至8年,无手术并发症,无手术死亡,复发1例。结论重视术前彩超及术中冰冻切片可减少本病的漏诊,甲状腺微小癌的外科治疗应根据病例的具体情况而定。     

Curative Laparoscopic Resection for Pancreatic Neoplasms: A Critical Analysis from a Single Institution

Laparoscopic pancreatic surgery (LPS) has seen significant development but much of the knowledge refers to small and benign pancreatic tumors. This study aims to evaluate the feasibility, safety, and long-term outcome of the laparoscopic approach in patients with benign, premalignant, and overt malignant lesions of the pancreas. This study, currently, is the largest single center experience worldwide. One hundred twenty-three consecutive patients underwent laparoscopic pancreatic surgery from April 1998 to April 2007, 20 patients with cysts or pseudocysts for acute and chronic pancreatitis, laparoscopic pancreatic drainage was performed, and were excluded from the analysis. The 103 patients were divided based on preoperative diagnosis: group I, inflammatory tumors for chronic pancreatitis (eight patients); group II, cystic pancreatic neoplasms (29 patients); group III, intraductal papillary mucinous neoplasms (10 patients); group IV, neuroendocrine pancreatic tumors (NETs) (43 patients); and group V ductal adenocarcinoma (13 patients). The median tumor size was 5.3 cm. Pathologic data include R ₀ or R ₁ resection (transection margins on the specimen were inked). Perioperative data, postoperative complications, and resection modalities were compared using statistical analysis. Long-term outcomes were analysed by tumor recurrence and patient survival. The overall conversion rate was 7%. Laparoscopic distal pancreatic resection was performed in 82 patients (79.6%). Laparoscopic spleen-preserving distal pancreatectomy (Lap SPDP) was performed in 52 patients (63.7%), but with splenic vessels preservation in 22% and without splenic vessels preservation in 41.5%. Laparoscopic en-bloc splenopancreatectomy (Lap SxDP) was performed in 30 patients (36.6%) and laparoscopic enucleation (Lap En) in 20 patients (19.4%). There was no mortality. The overall complication rate was 25.2, 16.7, and 40% after Lap SPDP, Lap SxDP, and Lap En, respectively. The overall morbidity rate was significantly higher (p > 0.05) in the group of Lap SPDP without splenic vessels preservation comparing with Lap SPDP with splenic vessels preservation because of the occurrence of splenic complications (20.6%). The overall pancreatic fistulas was 7.7, 10, and 35% after Lap SPDP, Lap SxDP, and Lap En, respectively; the severity of fistula was significantly higher in the Lap En group (p > 0.05). The mean hospital stay was within 1 week in all groups, except in the group of ductal adenocarcinoma, which is 8 days. In this series, 27 patients (26.2%) had malignant disease. R ₀ resection was achieved in 90% of ductal adenocarcinoma and 100% for other malignant tumors. The median survival for ductal adenocarcinoma patients was 14 months. This series demonstrates that LPS is feasible and safe in benign-appearing and malignant lesions of the pancreas.     

Metallothionein in bladder cancer: correlation of overexpression with poor outcome after chemotherapy

We examined metallothionein (MT) expression in bladder cancer and its relationship to clinicopathologic factors, survival data, and outcome of chemotherapy. In 97 patients who underwent radical cystectomy for bladder cancer, 34 of whom received cisplatin-based chemotherapy, MT expression was evaluated immunohistochemically. Results were correlated with histopathologic data, survival rates, and outcome of chemotherapy. MT overexpresison was present in 33 patients (34.0%): strong in 7 (7.2%) and focal in 26 (26.8%). Overexpression was an independent prognostic factor and was significantly associated with poor survival. Patients undergoing chemotherapy showed worse survival if their tumours were MT-positive than if they were MT-negative. MT overexpression predicts unfavorable survival in bladder cancer patients. In those treated with cisplatin chemotherapy, survival is significantly poorer if tumours express MT. Our results show that MT overexpression may mediate resistance to alkylating agents. Therefore, further studies are warranted to define those patients who need a more aggressive therapy.     

The relationship between the expression of E-cadherin and tumor recurrence and progression in high-grade stage T1 bladder urothelial carcinoma

Objective To evaluate the relationship between the expression of E-cadherin (E-CD) and tumor recurrence and progression in patients with high-grade stage T1 urothelial carcinoma of bladder. Methods Fifty-two patients who had primary high-grade stage T1 urothelial carcinoma were enrolled to the study. The pathologic specimens of patients were evaluated and staged as T1a and T1b according to muscularis mucosae involvement by the tumor. The immunohistochemical demonstration of E-CD was accomplished by using immunoperoxidase method and all the specimens were examined under light microscope for E-CD level. Results The mean age of the patients was 64.0 ± 7.7 (range 36–81) years. The mean follow-up period was 56.4 ± 19.4 (range 14–84) months. Among 52 patients, 27 (52%) of them were stage T1b and 25 (48%) were T1a tumors. The recurrence rates for T1a and T1b groups were 52% (n = 13) and 92.6% (n = 25), respectively (P < 0.05). The expression of E-CD was homogenous in 52% of pT1a and 14.8% of T1b tumors (P < 0.05). In T1a group with recurrence, homogeneous E-CD staining ratio was 30.7% (n = 4/13), but it was 75% (n = 9/12) in T1a patients without recurrence (P < 0.05). In T1b group with recurrence, the homogenous expression of E-CD was 12% (n = 3/25) and the expression of E-CD was heterogenous in 88% (n = 22/25) of them (P < 0.05). In T1a group, progression of the disease was detected in 28% (n = 7/25) of the patients, but disease progression was seen in 55.5% (n = 15/27) of T1b group patients (P < 0.05). In T1a group with progression, heterogeneous E-CD staining ratio was 85.7% (n = 6/7), but it was 80% (n = 12/15) in T1b patients with progression. The effects of tumor number, tumor size and carcinoma in situ presence on recurrence were evaluated within each group. It was determined that parameters such as tumor number and tumor size had no significant effect on recurrence of the groups. The mean survival rates were statistically different between the groups. On multivariate analysis only E-cadherin expression (P = 0.012, odds ratio 6.291, 95% confidence interval for odds ratio 1.303–4.72) and tumor stage (P = 0.003, odds ratio 11.58, 95% confidence interval for odds ratio 2.446–8.542) remained independently significant as predictors of recurrence. Conclusion E-CD expression was decreased in pathologic specimens of bladder tumor patients with muscularis mucosae involvement and this condition correlated well with tumor recurrence.