肝癌致梗阻性黄疸时丹参对ICAM-1表达的影响

目的:建立恶性梗阻性黄疸模型,通过对模型鼠腹腔内注射丹参注射液,观察其对肝癌瘤体大小、抑癌率及抑转移率和肝癌、癌周、临近肝叶及肺组织中细胞间黏附分子(ICAM-1)表达的作用.方法:用Walker-256肝癌株近肝门部肝实质内种植致移植性肝癌侵袭高位胆管,造成胆道癌性狭窄,以建立SD大鼠恶性梗阻性黄疸模型.将模型鼠分成四组,通过对模型鼠腹腔内分别注射等量的生理盐水(n=24)、肌苷 维生素C(n=40)、丹参(n=40)和5FU(n=40).观察肝癌瘤体大小、抑癌率及抑转移率和肝癌、癌周、临近肝叶及肺组织中ICAM-1的表达,并对其结果进行统计学分析.结果:丹参组与生理盐水组和肌苷 维生素C组相比,肝癌平均瘤体减小、抑癌率及抑转移率增高(P<0.01);与5FU组相比,平均瘤体却较大(P<0.01).在抑癌率及抑肝转移率方面,丹参组除抑肺转移率外与5-FU组相比无显著性差异(P＞0.05).丹参组ICAM-1的表达明显低于生理盐水组(P<0.01)、肌苷 维生素C组(P<0.01)和5FU组(P<0.05).结论:在肝癌致梗阻性黄疸时,丹参通过促进肝癌细胞成熟分化、抑制肝癌细胞增殖,降低肝癌、癌周、临近肝叶及肺组织中ICAM-1的表达,而对肿瘤发展起抑制作用.     

腹腔镜胆囊切除术前联合应用EST和ENBD治疗27例

目的:探讨内镜下括约肌切开术(EST)和内镜鼻胆管引流术(ENBD)联合应用在腹腔镜胆囊切除术(LC)前的应用价值.方法:合并胆总管结石患者27例先行ERCP证实胆总管结石后行EST,用取石囊、取石篮、碎石器等器械取出胆总管结石,并留置ENBD管.1～3 d后行LC术.结果:有25例患者共取出胆总管结石45枚,取石成功率93%,另2例未成功,其中1例胆总管狭窄段大于2 cm,另一例结石嵌顿,导丝无法通过.1例EST后合并轻度急性胰腺炎,经积极治疗后仍行LC术,LC成功率100%,25例患者平均住院时间(8±3)d.结论:LC术前联合应用EST,ENBD微创治疗胆囊结石并胆总管结石具有良好的应用价值.     

Long-Term Cancer-Free Survival after Infusion of Autologous Cord Blood Cells for Rejection-Unrelated Cord Blood Graft After Myeloablative Conditioning for t-MDS: A Case Report

Autologous cord blood transplantations are rarely applied in patients with hematologic as well as metastatic solid cancers since contamination of malignant clones is a concern.We report a case of therapy-related myelodysplasia after metastatic neuroblastoma who suffered from graft rejection and life-threatening infections after a myeloablative unrelated cord blood transplantation.The patient experiences long-term survival, free from leukemia/neuroblastoma after infusion of autologous cord blood cells.It suggests that autologous cord blood transplantation after high dose therapy might be a curative strategy for certain hematologic or metastatic solid cancers.     

Unstratified chemotherapy for non-metastatic osteosarcoma of the extremities in children.

BACKGROUND AND PURPOSE: The superiority of changing postoperative chemotherapy of osteosarcoma based on histological response of the primary tumor over non-tailored chemotherapy has not been confirmed. This multicenter study evaluated the effectiveness of an intensive unstratified chemotherapy regimen in Taiwanese children with osteosarcoma. METHODS: Fifty patients younger than 18 years of age with previously untreated non-metastatic osteosarcoma of the extremities were enrolled. Patients were treated with pre- and postoperative chemotherapy, and surgery. Definitive surgery was scheduled in week 7 and postoperative chemotherapy was uniform without stratification regardless of histologic response. RESULTS: Chemotherapy toxicities were considerable, but manageable. Treatment delay and decreased dose-intensity were common. There was one treatment-related mortality. Forty three patients (86%) received limb salvage surgery and 14 patients (33%) had a good histologic response to preoperative chemotherapy. With a median follow-up of 47.1 months, the 7-year event-free and overall survival rates were 51.6% and 67.6%, respectively. CONCLUSIONS: This was the first multicenter study on the treatment of osteosarcoma from Taiwan. The results suggest that a non-tailored regimen may serve as an alternative treatment strategy in the management of osteosarcoma, particularly when histologic assessment of the tumor response is not available.     

An anti-IgE monoclonal antibody that binds to IgE on CD23 but not on high-affinity IgE.Fc receptors

A new monoclonal antibody (mAb), specific for human IgE, the central mediator of immediate-type hypersensitivity reactions, has been shown to possess a unique set of binding specificities. The mAb, 8D6, binds to a conformational epitope on the CH3 domain of human e immunoglobulin and can compete with omalizumab for binding to IgE. Like omalizumab, it does not bind to IgE bound by the high-affinity IgE.Fc receptor (Fc?RI) on basophils and mast cells. It also does not cause activation and degranulation of IgE-pulsed, human Fc?RI-expressing rat basophilic leukemic cells (RBL SX-38). The mAb can inhibit IgE binding to recombinant α chain of human Fc?RI in ELISA and to human Fc?RI-expressing RBL SX38 cells in fluorescence flow cytometric analysis. However, unlike omalizumab, 8D6 can bind to IgE already bound by the low-affinity IgE.Fc receptors (Fc?RII, or CD23), as revealed in ELISA with recombinant CD23 and in flow cytometric analysis with human B cells. Since earlier investigators have shown that anti-CD23 mAbs can inhibit the synthesis of IgE in lymphocyte culture in vitro and can down-regulate IgE production in treated patients, 8D6 may offer pharmacological mechanisms in addition to those mediated by omalizumab, for controlling IgE in patients with allergic diseases.     

Hemophagocytic Syndrome in Epstein-Barr Virus-Associated T-Lymphoproliferative Disorders: Disease Spectrum, Pathogenesis, and Management

The Epstein-Barr virus (EBV) has been shown to infect T lymphocytes and is associated with two recently recognized human. T-lymphoproliferative disorders: childhood EBV-associated hemophagocytic syndrome (VAHS) representing a primary or active EBV infection of T cells in young children, and the EBV-containing T cell lymphoma in adults predominantly affecting the nose, skin and gastrointestinal tract. In both diseases, hemophagocytic syndrome (HS) accounts for the major cause of mortality. The patients developing HS share common clinicopathologic features such as fever, skin lesions, lung infiltrates, hepatosplenomegaly with jaundice, cytopenias, and coagulopathy. The liver, spleen, lymph nodes, and bone marrow usually show florid histiocytic proliferation with hemophagocytosis in addition to the proliferation of atypical T lymphocytes or immunoblasts.

The HS in T cell lymphoma may develop simultaneously with initial lymphoma presentation, at tumor relapse, or even during remission. The cytokines, in particular tumor necrosis factor-alpha, released from the EBV-infected T lymphocytes are presumed to cause the histiocytic activation and the subsequent hemophagocytic process. Chemotherapy or antiviral agents fail to arrest the hemophagocytic process in both diseases. Immunomodulatory treatment incorporating etoposide and intravenous immunoglobulin, however, has been effective in the control of the progression of the hemophagocytic process in a substantial number of VAHS patients. Preliminary data suggest that bone marrow transplantation may be a promising way for eliminating both the virus and the proliferating T cells. Further investigations are mandatory for combating this aggressive hemophagocytic process in EBV-associated T lymphoproliferative disorders.     

Human herpesvirus 8-related childhood mononucleosis: a series of three cases

Human herpesvirus 8 has been implicated in the pathogenesis of a limited subset of lymphoproliferative disorders in adults, but its role in children is unclear. A prospective evaluation of children with atypical lymphocytosis residing in the Hualien area, where the incidence of adult Kaposi sarcoma is high, revealed 3 cases caused by human herpesvirus 8.