In vivo perivascular implantation of encapsulated packaging cells for prolonged retroviral gene transfer

Long-term benefits of coronary angioplasty remain limited by the treatmentinduced renarrowing of arteries, termed restenosis. One of the mechanisms leading to restenosis is the proliferation of smooth muscle cells. Therefore, proliferating cells of the injured arterial wall, which can be selectively transduced by retroviruses, are potential targets for gene therapy strategies. A direct single-dose therapeutic application of retroviral vectors for inhibition of cell proliferation is normally limited by too low transduction efficiencies. Encapsulated retrovirus-producing cells release viral vectors from microcapsules, and may enhance the transduction efficiency by prolonged infection. Primary and immortal murine and porcine cells and murine retrovirusproducing cells were encapsulated in cellulose sulphate. Cell viability was monitored by analysing cell metabolism. Safety, stability, transfer efficiency and extent of restenosis using capsules were determined in a porcine restenosis model for local gene therapy using morphometry, histology, in situ betagalactosidase assay and PCR. Encapsulation of cells did not impair cell viability. Capsules containing retrovirus-producing cells expressing the beta-galactosidase reporter gene were implanted into periarterial tissue or a pig model of restenosis. Three weeks following implantation, beta-galactosidase activity was detected in the pericapsular tissue with a transduction efficiency of ~ 1 in 500 cells. Adventitial implantation of vector-producing encapsulated cells for gene therapy may, therefore, facilitate successful targeting of proliferating vascular smooth muscle cells, and allow stable integration of therapeutic genes into surrounding cells. The encapsulation of vector-producing cells could represent a novel and feasible way to optimize local retroviral gene therapy.     

Combination of a reduced dose of an intrathecal local anesthetic with a small dose of an opioid: A meta-analysis of randomized trials

We tested whether the combination of a reduced dose of a local anesthetic (LA) with an opioid compared with a standard dose of the same LA alone guaranteed adequate intraoperative anesthesia and postoperative analgesia and decreased LA-related adverse effects. We systematically searched (to November 2012) for randomized comparisons of combinations of a reduced dose of an LA with a concomitant opioid (experimental) with a standard dose of the LA alone (control) in adults undergoing surgery with single-injection intrathecal anesthesia without general anesthesia. We included 28 trials (1393 patients). In experimental groups, the median decrease in LA doses was 40% (range, 12%–70%). There was no difference between experimental and control groups in the need for intraoperative opioids or general anesthesia for failed block or in the duration of postoperative analgesia. With experimental interventions, there was evidence of a reduction in the duration of motor blockade postoperatively (average, −50 minutes), time to discharge from hospital or PACU (−33 minutes), time to ambulation (−28 minutes), and time to urination (−14 minutes). There was also evidence of a decrease in the risk of shivering (risk ratio [RR]: 0.26; 95% confidence interval [CI]: 0.12–0.56), nausea (RR: 0.45; 95% CI: 0.31–0.66), and arterial hypotension (RR: 0.52; 95% CI: 0.35–0.78). The risk of pruritus was increased (RR: 11.7; 95% CI: 6.2–21.9). Adding an opioid to a reduced dose of an intrathecal LA can decrease LA-related adverse effects and improve recovery from the spinal block without compromising intraoperative anesthesia or duration of postoperative analgesia.     

细胞黏附分子在肝癌复发转移中的作用研究进展

细胞黏附分子（CAMs）是位于细胞表面的糖蛋白,通过介导细胞与细胞、细胞与细胞外基质间的相互作用参与多种生理及病理过程。细胞黏附分子与包括肝癌在内的多种肿瘤的复发转移有着非常密切的关系。本文就细胞黏附分子在肝癌复发转移中作用的研究进展作一综述。     

Penetrating serosa in human T4aN0M0 gastric carcinoma correlates closely to patients’ worse prognosis after D2 gastrectomy

BACKGROUND AND OBJECTIVE: In both the 7th edition of the UICC staging system for gastric cancer and the 14th edition of the JGCA system, the definition of T4a is “Tumor perforates serosa (visceral peritoneum) without invasion of adjacent structures”. The aim of this study is to investigate the prognostic difference between T4aN0M0 patients with serosa-penetrating and without serosa-penetrating of gastric carcinoma. METHODS: A total of 221 patients with T4aN0M0 gastric carcinoma who underwent D2 resection at our Cancer Center between January 1990 and December 2008 were collected. The cohort included 42 patients with serosa-penetrating and 179 patients without serosa-penetrating. Average follow-up time was 85.5 months. Spearman’s rank correlation, Kaplan-Meier plots and Cox proportional hazards regression model were used to analyze the data. RESULTS: The 5-year survival rate for the patients serosa-penetrating and the patients without serosa-penetrating were 31% and 62% respectively (p<0.05). The relapse rates of these two groups after D2 radical surgery were 16.2% and 59.5%, respectively (p<0.05). The peritoneal dissemination and distant organ/lymph node metastatic rates were 44.8% and 55.2% versus 76.0% and 24.0%, respectively (p<0.05). CONCLUSION: Our findings provide a basis for the concept that serosa-penetrating in T4aN0M0 gastric carcinoma may be important in the acquisition of an aggressive phenotype, suggesting that serosa-penetrating, is an independent factor for poor prognosis of patients with gastric carcinoma.     

31 例局部复发性直肠癌的再手术治疗

 目的　总结直肠癌局部复发的手术治疗经验。方法　对 31例局部复发性直肠癌进行了再手术治疗。结果　无症状者和有症状者的手术切除率分别为 80 .0 %和 2 8.6% ,3年生存率分别为 60 .0 %和 2 3.8% ,5年生存率分别为 40 .0 %和 9.5% ,两者间均存在显著差异。另外 ,从复发部位来看 ,无论是切除率还是生存率 ,均以盆腔复发者最低。结论　外科手术是治疗局部复发性直肠癌切实有效的方法 ;而定期复查、早期诊断又是影响切除率和生存率的最重要因素。     

桂枝茯苓胶囊联合抗生素对慢性盆腔炎患者超敏C反应蛋白、白细胞介素-2及复发率的影响

目的:观察用桂枝茯苓胶囊联合抗生素治疗慢性盆腔炎患者的临床效果,并探讨其对患者超敏C反应蛋白、白细胞介素-2及复发率的影响。方法:选择2012年6月~2014年2月就诊于我院的118例慢性盆腔炎患者为研究对象,随机分为对照组和观察组患者各59例。对照组患者给予静脉滴注甲硝唑及青霉素常规西医抗生素治疗,1次/d;观察组患者则在对照组抗生素治疗的基础上给予桂枝茯苓胶囊内服治疗,3粒/次,3次/d,1w为1个疗程,连续治疗3个疗程。治疗后观察患者下腹部坠胀、疼痛、腰骶部酸痛等症状的缓解情况,统计临床治疗的有效率;治疗前后对患者的痛感采用疼痛视觉模拟评分VAS进行评价,观察痛感的缓解情况;检测2组患者炎性细胞指标C反应蛋白(CRP)、白细胞介素-2(IL-2)、肿瘤坏死因子(TNF-α)的变化情况;治疗后随访半年,统计患者复发率。结果:经治疗后2组患者下腹部坠胀、疼痛、腰骶部酸痛等临床症状均得到缓解,以观察组缓解程度更为明显,观察组的有效率91.5%明显高于对照组的有效率76.3%,差异有统计学意义(P0.05);2组患者经治疗后痛感有所缓解,VAS疼痛评分较治疗前有所降低,以观察组的降低幅度尤为突出,差异有统计学意义(P0.05);两组患者经治疗后炎性细胞指标CRP、IL-2、TNF-α均有所改善,以观察组的变化程度尤为明显,差异有统计学意义(P0.05);随访半年后,对照组患者的复发率23.7%明显高于观察组患者的复发率8.5%,差异性显著(P0.05)。结论:桂枝茯苓胶囊联合抗生素能有效缓解慢性盆腔炎患者的痛感,降低患者的炎性细胞水平,有良好的抗炎作用,疗效确切,是中西医结合论治妇科病的有效方式,值得临床广泛推广运用。     

子宫动脉甲氨蝶呤灌注和栓塞治疗子宫腺肌病

目的探讨DSA引导下经导管子宫动脉内灌注甲氨蝶呤结合子宫动脉栓塞治疗不同类型子宫腺肌病的临床疗效。方法对33例根据临床症状、彩色B超初筛,在Seldinger方法完成子宫动脉超选择性插管造影,证实为弥漫型子宫腺肌病和局灶型子宫肌腺病的患者,用MTX50mg子宫动脉局部灌注,并加用PVA微球颗粒(直径350～560μm)栓塞治疗。比较两组病例月经量、痛经程度、子宫体积及性激素水平等的术后变化及两组间是否存在差异。结果MTX局部灌注结合子宫动脉栓塞术,无化疗药物不良反应;经治疗的全部病例,月经量减少,痛经程度减轻。弥漫型子宫肌腺病子宫体积进行性缩小,与局灶型子宫腺肌病比较,疗效更为显著(P<0.05)。结论微创介入技术和药物相结合的方法可用于弥漫型子宫腺肌病和局灶型子宫腺肌病的治疗,尤其适宜于弥漫型子宫腺肌病。     

乳腺癌保留乳腺手术后肿瘤复发及转移的相关因素

目的　探讨乳腺癌保留乳腺手术后局部复发及远处转移的相关因素。　方法　回顾性分析保乳治疗原发性女性乳腺癌 174例 ,随访 12～ 196个月 ,随访率 97 13% ( 16 9/ 174)。　结果局部复发9例 ,3年复发率 3 79% ( 5 / 132 ) ;远处转移 14例 ,5年转移率 10 99% ( 10 / 91) ;5年生存率92 31% ( 84/ 91)。保乳手术无放疗组 3年复发率 ( 12 12 % )显著高于手术加放疗组 ( 1 0 1% ) ,( χ2 =5 6 1,P <0 0 5 )。腋窝淋巴结阳性患者中保乳手术未化疗组 5年远处转移率 ( 44 4 4% )高于手术加化疗组 ( 6 6 7% ,P <0 0 5 )。切缘阳性与局部复发有关 (P <0 0 1)。乳腺癌诊断时年龄≤ 40岁、淋巴结阳性、组织学Ⅲ级与远处转移有关 (P <0 0 5 )。　结论　保乳术后应放疗 ;切缘阳性者应再切除至阴性或全乳切除术 ;年轻、淋巴结阳性、组织学分级Ⅲ级者应辅助化疗。     

经肛门内镜显微手术切除直肠肿瘤

目的评价经肛门内镜显微手术(TEM)切除直肠绒毛状腺瘤和早期直肠癌的应用效果。方法分析我院总结1995年11月至2001年12月27例TEM手术的临床资料。结果本组患者肿瘤直径中位值2.5cm,肿瘤下缘与齿状线距离(8.9±3.4)cm,肿瘤侵犯直肠周径范围(35.7±17.5)%。平均手术时间(109±46)min。平均住院日4.5d。无围手术期死亡。手术并发症有尿潴留、暂时性大便失禁和慢性阻塞性肺病(COPD)复发。术中2例切穿至腹腔,即刻内镜下修补成功。切缘100%瘤细胞阴性。病理示直肠绒毛状腺瘤14例、直肠腺癌13例,后者包括pTis2例,pT16例和pT25例。直肠癌腔内超声肿瘤T分期符合率为84.6%。5例pT2中2例中转前切除术,1例接受术后放疗,2例无附加任何治疗。平均随访18个月,所有病例无局部复发。死亡2例,但无复发迹象。结论TEM易行且安全,是直肠绒毛状腺瘤和部分T1直肠癌的治愈性手术,也可作为T2直肠癌的姑息性治疗手段。