不同化疗方案对初始诱导失败急性髓性白血病患者近期疗效、生存期及不良反应的影响

目的 探讨不同化疗方案对初始诱导失败急性髓性白血病（acute myeloid leukemia,AML）患者近期疗效、生存期及不良反应的影响。方法 回顾性纳入2017年1月～2019年12月华北石油管理局总医院收治的120例初始诱导失败AML患者,按照治疗方案的不同分为FLAG方案[氟达拉滨（fludarabine,Flud）联合阿糖胞苷（cytarabine,Ara-C）及粒细胞集落刺激因子（granulocyte colony stimulating factor,G-CSF）]组、CAG方案[阿柔比星（aclarubicin,Acla）联合Ara-C及G-CSF]组及MAC方案[米托蒽醌（mitoxantrone,MTZ）联合环磷酰胺（cyclophosphamide,CTX）及Ara-C]组,每组40例。比较3组的近期疗效、生存期及不良反应。结果MAC方案组的完全缓解率（complete response,CR）明显高于FLAG方案组及CAG方案组（52.50%vs. 32.50%、35.00%,P<0.05）,总缓解率（overall response rate,OR...     

VCD方案联合乌苯美司治疗多发性骨髓瘤疗效及患者预后影响因素分析

目的 探讨VCD方案联合乌苯美司治疗多发性骨髓瘤(MM)的临床疗效,并分析预后影响因素.方法 回顾性收集我院2015年4月～2019年6月收治的96例MM患者资料,根据治疗方法不同分为VCD组47例、联合组49例,均给予VCD方案(硼替佐米+环磷酰胺+地塞米松)化疗,联合组化疗期间连续服用乌苯美司.3个化疗周期后观察疗...     

Transcatheter closure of inferior sinus venosus defect using a patent ductus arteriosus occluder following simulation with a 3D-printed model

BackgroundTranscatheter closure of inferior sinus venosus defect (ISVD) is still contraindication. To explore whether transcatheter closure with patent ductus arteriosus (PDA) occluders is possible for ISVD.MethodsFrom June 2014 to March 2021, 12 patients were recruited diagnosed as <25 mm ISVD. The three-dimensional printing (3DP) heart model was produced based on multi-slice computed tomography (MSCT) scans. Preoperative closure simulation was planned on the personalized 3D model for each patient. Follow-up including electrocardiography (ECG), transthoracic echocardiography (TTE), and X-ray was traced.Results3DP models of 12 patients were successfully printed. Twelve patients had been diagnosed with <25 mm ISVD and 4 of them had another secundum atrial septal defect (ASD). All patients were produced interventional therapy successfully. PDA occluder was implanted to closed ISVD, and ASD was closed using ASD occluder simultaneously. The average diameter of ISVD measured by TTE was (12.67±3.80), and the average diameter of sagittal axes and longitudinal axes measured by the 3D-printed model was (17.08±3.20) and (18.42±4.62) mm, respectively. The average size of PDA (diameter of pulmonary artery side) was (28.17±3.35) mm. Compared with the preoperative, the X-ray cardiothoracic ratio (0.51±0.04 vs. 0.47±0.06, P=0.007) and the right ventricle anterior-posterior diameter (31.17±5.65 vs. 24.58±3.75 mm, P<0.001) of postoperative was significantly decreased. During the average (47.75±27.52) months follow-up, it has achieved satisfying results, and there were no severe adverse events such as device transposition, death, and pericardial tamponade occurred.ConclusionsAssisting by 3D heart model, transcatheter closure of ISVD with PDA occluder had an excellent outcome. This method provides a new considerable treatment strategy for ISVD.     

三磷酸腺苷-肿瘤体外药敏试验对宫颈癌临床化学治疗的指导作用

目的：研究三磷酸腺苷-肿瘤体外药敏试验（ATP-tumor chemosensitivity assay,ATP-TCA）对宫颈癌患者化学治疗（化疗）方案选择的指导性作用。方法：选择2007年7月至2009年10月宫颈癌住院患者72例,将其随机分为药敏组（35例）和对照组（37）例。采用ATP-TCA法检测药敏组宫颈癌组织对6种联合化疗方案的敏感性。药敏组患者根据药敏结果选择化疗方案,对照组根据临床经验制定化疗方案。随访3年,比较药敏组与对照组1年复发率和3年生存率。结果：3s例药敏组中有32例成功进行了ATP-TCA检测;体外有效例数分别为紫杉醇＋卡铂20例、紫杉醇＋奥沙利铂18例、博莱霉素＋异环磷酰胺＋顺铂17例、博莱霉素＋长春新碱＋顺铂18例、氟尿嘧啶＋顺铂17例、吉西他滨＋顺铂21例。1年复发例数药敏组与对照组比较差异无统计学意义（P〉0．05）;3年生存情况药敏组好于对照组（P〈0．05）。结论：ATP-TCA法可以为宫颈癌患者筛选出敏感、有效、个体化的化疗方案,值得临床推广。     

CAG方案治疗中高危骨髓增生异常综合征和急性髓系白血病疗效观察

目的观察阿糖胞苷、阿克拉霉素和粒细胞集落刺激因子联合方案（CAG方案）治疗中、高危骨髓增生异常综合征（MDS）和初治急性髓系白血病（AML）的临床疗效及不良反应。方法应用CAG方案治疗中高危MDS28例和AML20例,完成1个疗程后评估疗效,治疗失败患者退出观察,有效者继续接受1个疗程治疗,并进行评估。结果28例MDS临床总有效率53％,其中完全缓解15例（53％）,部分缓解0例。AML临床总有效13例（65％）,其中完全缓解10例（50％）,部分缓解3例（15％）。大部分患者出现了可以耐受的轻微不良反应,主要表现为骨髓抑制。结论CAG治疗中、高危MDS和预后差的AML安全有效,长期疗效需进一步观察。     

联合方案与吉西他滨加顺铂单纯化疗方案治疗晚期非小细胞肺癌的对比研究

①目的 比较TM-GP方案、[timogpntin(胸腺五肽)、MA(megestrol acetate,甲地孕酮)、吉西他滨与顺铂(DDP)联合的生物化疗方案]与GP方案(即吉西他滨加DDP的单纯化疗方案)对初治Ⅲ～Ⅳ期非小细胞肺癌(NSCLC)患者的疗效、毒性及生活质量的改善情况.②方法 A组(33例)接受TM-GP方案治疗;B组(35例)接受GP方案治疗.两组均以4周为1周期,重复3个周期.客观疗效与毒性反应按世界卫生组织(WHO)标准进行评价,生活质量根据临床受益疗效来评价.③结果 A、B两组客观疗效总有效率(CR+PR)分别为27.3%及22.9%(P>0.05);中位生存期A组32周,B组27周(P<0.01);白细胞减少及恶心呕吐反应B组均较A组明显(P<0.01);短暂性寒战、发热症状多见于A组(P<0.01);两组均未发现其他严重的毒性反应.临床受益疗效A组高于B组(P<0.05).④结论 胸腺五肽、甲地孕酮配合GP方案与单纯GP方案治疗晚期NSCLC的客观疗效无明显差异性,但前者毒副反应小,中位生存期长,患者生活质量改善明显.     

FOLFOX4联合参麦注射液治疗中晚期肝癌术后存活质量的影响

目的探究FOLFOX4联合参麦注射液治疗中晚期肝癌术后存活质量的影响。方法选取2012年3月~2014年2月我院收治的90例原发性肝癌患者为研究对象,按随机数字表法分为观察组和对照组,每组45例,对照组患者单独给予FOLFOX4方案(奥沙利铂~+亚叶酸钙~+5-氟尿嘧啶)治疗,观察组在对照组基础上联合参麦注射液,治疗2个疗程后评价两组患者治疗疗效,同时分别检测治疗前后患者血液T淋巴细胞亚群(CD3~+、CD4~+、CD8~+)变化情况,比较两组患者治疗前后细胞免疫指标。观察两组患者治疗前后生存质量评分和KPS评分改善程度和毒副反应。结果观察组患者治疗总有效率为57.78%,对照组患者治疗总有效率为35.56%,两组差异具有统计学意义(P0.05)。治疗后两组患者CD3~+、CD4~+、CD8~+、CD4~+/CD8~+细胞免疫指标差异显著,观察组患者CD3~+、CD4~+、CD4~+/CD8~+细胞免疫指标明显明显高于对照组,CD8~+指标明显低于对照组,差异具有统计学意义(P0.05)。治疗后两组患者生活质量评分和KPS评分总改善率差异显著,观察组生活质量评分和KPS评分总改善率显著高于对照组,差异具有统计学意(P0.05)。两组患者在骨髓抑制、神经毒性、肝功能方面等毒副反应差异具有统计学意义(P0.05),而在胃肠道反应、口腔炎上差异不具有统计学意义(P0.05)。结论参麦注射液联合FOLFFOX4方案治疗中晚期原发性肝癌具有良好疗效,能够改善患者免疫力和提高患者生活质量,降低化疗引起的毒副反应,其疗效明显优于单独FOLFFOX4方案治疗。     

VAD方案治疗多发性骨髓瘤疗效观察

 目的 评估VAD方案治疗多发性骨髓瘤（MM）的疗效。方法 24例Ⅲ期MM,采用VAD方案,即长春新碱0.5 mg／d（或长春地辛1 ~ 2 mg／d）缓慢静脉注射,第1～4天;多柔比星（或表柔比星）10 ~ 20 mg／d缓慢静脉注射,第1～4天;地塞米松40 mg／d口服,第1～4天,第9～12天,第17～20天,28 d为1疗程。连续应用2疗程以上评估疗效。观察项目包括：血清M蛋白、肝肾功能、尿蛋白、骨髓穿刺、血象等,记录毒副反应。MM疗效标准,分为完全缓解（CR）、部分缓解（PR）、未缓解（NR）。结果 CR8例（33.3 %）,PR12例（50 %）,NR4例（16.7 %）,总有效率为83.3 %。结论 VAD方案治疗Ⅲ期MM的临床疗效显著,临床症状改善明显。     

Plasmodium falciparum synthetic LbL microparticle vaccine elicits protective neutralizing antibody and parasite-specific cellular immune responses

Epitopes of the circumsporozoite (CS) protein of Plasmodium falciparum, the most pathogenic species of the malaria parasite, have been shown to elicit protective immunity in experimental animals and human volunteers. The mechanisms of immunity include parasite-neutralizing antibodies that can inhibit parasite motility in the skin at the site of infection and in the bloodstream during transit to the hepatocyte host cell and also block interaction with host cell receptors on hepatocytes. In addition, specific CD4+ and CD8+ cellular mechanisms target the intracellular hepatic forms, thus preventing release of erythrocytic stage parasites from the infected hepatocyte and the ensuing blood stage cycle responsible for clinical disease. An innovative method for producing particle vaccines, layer-by-layer (LbL) fabrication of polypeptide films on solid CaCO₃ cores, was used to produce synthetic malaria vaccines containing a tri-epitope CS peptide T1BT* comprising the antibody epitope of the CS repeat region (B) and two T-cell epitopes, the highly conserved T1 epitope and the universal epitope T*. Mice immunized with microparticles loaded with T1BT* peptide developed parasite-neutralizing antibodies and malaria-specific T-cell responses including cytotoxic effector T-cells. Protection from liver stage infection following challenge with live sporozoites from infected mosquitoes correlated with neutralizing antibody levels. Although some immunized mice with low or undetectable neutralizing antibodies were also protected, depletion of T-cells prior to challenge resulted in the majority of mice remaining resistant to challenge. In addition, mice immunized with microparticles bearing only T-cell epitopes were not protected, demonstrating that cellular immunity alone was not sufficient for protective immunity. Although the microparticles without adjuvant were immunogenic and protective, a simple modification with the lipopeptide TLR2 agonist Pam₃Cys increased the potency and efficacy of the LbL vaccine candidate. This study demonstrates the potential of LbL particles as promising malaria vaccine candidates using the T1BT* epitopes from the P. falciparum CS protein.     

Dendritic cells: therapy and imaging

Background: Dendritic cells (DCs) play a major role in cell-mediated immunotherapy. In this approach, DCs are isolated from cancer patients and pulsed with exogenous and specific tumor antigens in vitro, and the antigen-loaded DCs are then transferred to the hosts to enhance the immune response against tumor targets. Clinical observations and animal studies have shown that tumors can elicit immune responses caused by tumor infiltration of T-lymphocytes. Several pilot clinical trials have been recently conducted using this strategy for treating several types of cancers. Objective: To optimize DC-based therapy with emerging molecular imaging techniques. Methods: A review of the most current literature on DCs and imaging work. Results/conclusion: The translational application of DC-based therapy can be supported greatly through molecular imaging. New discoveries on DC migration and behavior in vivo will lead to new advances in the treatment of a broad range of cancers.