A comparative study of angiogenic and cytokine responses after laparoscopic cholecystectomy performed with standard- and low-pressure pneumoperitoneum

Background  Surgical procedures enhance production of pro- and anti-inflammatory cytokines and angiogenic factors that play a pivotal role in the immunological response to surgical trauma and take part in the pathogenesis of tumor growth and adhesions formation. The purpose of the study was to access the influence of low-pressure CO₂ pneumoperitoneum on the inflammatory and angiogenic responses during the postoperative period after laparoscopy. Methods  The study group consisted of 40 patients, operated on due to cholelithiasis using standard-pressure (n = 20) and low-pressure (n = 20) CO₂ pneumoperitoneum. Serum concentration of interleukin (IL)-6, IL-8, IL-10, vascular endothelial growth factor (VEGF)-A, and endostatin were measured before and at 6, 24, and 48 h after surgery with commercially available enzyme-linked immunosorbent assay (ELISA). Results  Concentrations of IL-6 increased significantly after the operations in both groups. No differences were observed between the groups in regards to IL-6, IL-8, and IL-10 levels. Concentrations of VEGF-A measured at 6 and 48 h were significantly lower in patients who underwent laparoscopies performed with low-pressure pneumoperitoneum. No significant variations were observed in endostatin serum concentration. Concentrations of the studied parameters were not influenced by duration of surgery or by age, gender, or body mass index (BMI) of the patients. Conclusions  The results obtained in our study do not show any significant differences between studied operative procedures with regards to systemic inflammatory response. Changes in the concentrations of VEGF-A and endostatin observed in the studied population may suggest this technique is more favorable with regards to angiogenesis process intensity, along with all its consequences and implications.     

Time-resolved fluorometric assay for the detection of endostatin in chromatographically separated extracts of natural peptides

We present a heterogeneous non-competitive immunological detection assay for peptide and protein antigens from crude extracts of biological sources. This time-resolved fluoroimmunoassay (TR-FIA) has been designed in a solid-phase mode using 96-well microtiter plates. Using the rare-earth metal europium as a fluorescent marker, a highly sensitive, selective and efficient procedure was developed. This technique prevents from interferences of intrinsic protein fluorescence which is highly important for antigen measurement in complex matrices. The TR-FIA has been applied for the detection of circulating forms of the potential anti-tumor agent endostatin, a C-terminal fragment of collagen XVIII, and its close homolog collagen XV (restin) from hemofiltrate. Endostatin was detected with a limit of detection of 3 ng (150 fmol/well) and a broad dynamic range from 10-1000 ng/well.     

内抑素(endostatin)对移植大肠癌新生血管密度影响的动物实验研究

目的：探讨内皮细胞生长抑素（内抑素endostatin）对裸鼠大肠血管生成的影响及其作用机理，为endostatin的临床应用提供理论依据。方法：采用免疫组化方法检测肿瘤新生血管密度，对用药过程中瘤 体积进行测量，对endostatin抑制肿瘤的效果进行分析。结果：endostatin能够抑制裸鼠大肠癌肿瘤血管生成，减轻肿瘤的血管密度。结论：endostatin通过抑制血管形成抑制肿瘤的生长。     

局部应用内皮抑素对小鼠Lewis肺癌抑瘤作用的研究

目的我们通过局部应用内皮抑素治疗小鼠Lewis肺癌,观察内皮抑素对小鼠Lewis肺癌的抑瘤作用,及内皮抑素对VEGF表达的影响.方法用小鼠Lewis肺癌细胞种植于15只C57小鼠体内,建立小鼠Lewis肺癌移植瘤模型,当移植瘤体积生长至400～600mm3时分组并开始给药.小鼠随机分为三组,A组为空白对照组,B组每日尾静脉注射内皮抑素20μg,C组每日于肿瘤部位局部注射内皮抑素20μg,共11天.测定抑瘤率及微血管密度评价疗效,免疫组化(S-P)法测定VEGF在各组的表达水平.结果试验组较对照组抑瘤率增高(P＜0.05),微血管密度降低(P＜0.05),试验组VEGF水平较对照组低(P＜0.01).结论内皮抑素对小鼠Lewis肺癌移植瘤的生长有明显抑制作用,局部用药较全身用药的作用增强,内皮抑素可以通过降低VEGF在肿瘤组织中的表达抑制肿瘤生长.     

Antiangiogenesis beyond VEGF inhibition: A journey from antiangiogenic single-target to broad-spectrum agents

Although the inhibition of angiogenesis is an established modality of cancer treatment, concerns regarding toxicity and drug resistance still constitute barriers to be overcome. For almost a decade since the approval of bevacizumab in 2004, the efforts on antiangiogenic therapeutics have been mainly focused in inhibiting the VEGF pathway. The ongoing understanding of the complexity of the angiogenic process has broadened the spotlight to include concurrent and downstream players to the list of targeted inhibitors. In this review, we summarize the currently existing and the promising antiangiogenic treatments, envisioning an apparent evolutionary trend towards the development of angiogenesis inhibitors of three modalities: single-target, multi-target, and broad-spectrum agents. The clinical efficacy and some structural aspects of monoclonal antibodies, small molecules, endogenous and synthetic angiogenesis inhibitors and their molecular targets are discussed, and the targeting of endothelial cells with the use of cytotoxic drugs in a metronomic schedule is appraised. The reader is invited to revisit current expectations about antiangiogenic therapy in an attempt to set consistent clinical endpoints from which patients could gain real and lasting clinical benefits.     

顺铂等药物灌注化疗和恩度治疗恶性胸腹腔积液的研究

目的观察顺铂等灌注和恩度治疗恶性胸腹积液的临床疗效及安全性。方法 62例晚期恶性胸腹水患者,治疗组32例,胸/腹腔内灌注恩度和化疗药物DDP/5-FU,对照组30例,仅灌注化疗药物DDP/5-FU,均3次/周,连续4周为一疗程,休息4周后,评价疗效及不良反应。结果治疗组中12例CR,16例PR,3例SD,1例PD,有效率为87.5%;对照组6例CR,13例PR,7例SD,4例PD,有效率为63.3%,两组比较差异有统计学意义（P〈0.05）,不良反应发生率两组比较无统计学意义（P〉0.05）。结论顺铂等加恩度灌注治疗恶性胸腹腔积液有较好的疗效和安全性,并有效提高了晚期肿瘤患者的生活质量,值得临床进一步推广应用。     

恩度联合顺铂治疗晚期非小细胞肺癌临床分析

目的探讨恩度联合顺铂治疗晚期非小细胞肺癌的临床效果。方法选择2010年2月～2013年2月在本院肿瘤内科治疗的中晚期非小细胞肺癌患者117例患者,随机分为单纯化疗组（对照组）58例和恩度联合顺铂组（观察组）59例,观察两组患者的临床疗效及不良反应。结果观察组总有效率为59．32％,对照组总有效率为37．93％;两组比较,差异有统计学意义（P〈0．05）。两组不良反应比较,差异无统计学意义（P〉0．05）。结论恩度联合顺铂胸腔内注射治疗晚期非小细胞肺癌临床疗效显著,值得在临床推广应用。     

眼针对脑缺血再灌注模型大鼠脑组织VEGF、Ang-1及内皮抑素表达的影响

[目的]探讨眼针治疗脑缺血再灌注的血管新生机制。[方法]将40只大鼠随机分为假手术组、模型组、体针组和眼针组。线栓法复制大鼠局灶脑缺血再灌注模型。免疫组化法检测缺血区血管内皮生长因子(VEGF)、血管生成素-1(Ang-1)和内皮抑素(ES)的表达。[结果]与假手术组相比,其它三组的VEGF、Ang-1表达均显著增加;与模型组比较,体针组和眼针组VEGF、Ang-1表达明显增加,ES表达显著下降;与体针组相比,眼针组VEGF和Ang-1表达上升,ES表达下降。[结论]眼针可能通过上调缺血区VEGF、Ang-1的表达,下调ES来引导脑缺血再灌注后的血管新生。     

重组人血管内皮抑素心脏毒性作用的靶标及作用机制研究

目的探讨重组人血管内皮抑素（恩度）心脏毒性作用的靶标及作用机制。方法以H9c2心肌细胞为观察对象,进行以下实验：（1）将H9c2细胞分为对照组（不给予药物干预）和恩度100、200、400μ/ml组（加入相应浓度药物培养24、48h）,用流式细胞术检测各组各时点细胞凋亡率;（2）将H9c2细胞分为对照组和恩度400μg/ml干预24h实验组,用透射电镜观察细胞超微结构改变;（3）将H9c2细胞分为对照组和恩度100、200、400μ/ml组（加入相应浓度药物培养18h）,应用JC-1荧光探针检测细胞线粒体膜电位;（4）将H9c2细胞分为对照组和恩度400μg／ml干预24h实验组,用细胞免疫化学方法观察细胞色素C（Cyt-C）释放情况;（5）将H9c2细胞分为对照组和恩度100、200、400μml组（加入相应浓度药物培养24h）,用化学发光法检测各组细胞的ADP／ATP比值。结果（1）恩度200μg／ml组在药物干预24h、恩度400斗g／ml组在药物干预24、48h后,细胞凋亡率均明显高于对照组[24h：（16．34±3．72）％、（27．03±3．91）％比（6．99±1．72）％;48h：（24．89-4-4．77）％比（6．44±1．81）％,均P〈0．01];恩度200μg／ml组药物干预24h后的细胞凋亡率高于药物干预48h[（16．34＋3．72％）比（11．34±3．09）％,P〈0．01]。（2）对照组细胞超微结构正常;恩度400μg/ml干预24h实验组细胞核固缩碎裂、染色质块聚,细胞内空泡增多,内质网扩张,线粒体肿胀,出现凋亡小体。（3）与对照组相比,不同剂量恩度干预组细胞线粒体跨膜电位去极化程度随恩度浓度增加而下降。（4）对照组细胞Cyt-C主要分布于线粒体,恩度400μg/ml干预24h实验组细胞Cyt-C从线粒体释放至胞质。（5）恩度200、400μg/ml组细胞的ADP／ATP比值明显高于对照组（1．14±0．11、1．31±0．18比0．98±0．09,均P〈0．01）。结论心肌细胞线粒体可能是恩度心脏毒性作用的靶标,经线粒体依赖性途径诱导的心肌细胞凋亡是恩度致心肌损伤的机制之一。     

肝动脉化疗栓塞术中注入重组人血管内皮抑制素治疗中晚期肝癌的疗效及安全性分析

目的：观察重组人血管内皮抑制素经肝动脉灌注联合TACE治疗中晚期肝癌的近期及远期疗效。方法将64例中晚期肝癌患者分为对照组（n=30例),仅予以TACE治疗,和观察组（n=34例）,在行TACE治疗时,同时经肝动脉注入重组人血管内皮抑制素,比较两组近、远期疗效,观察治疗前后肿瘤直径、KPS评分及AFP变化,分析两组毒副反应。结果观察组治疗总有效率（64.7%）明显高于对照组（43.3%,P<0.05）;两组患者治疗后肿瘤直径[（4.0±1.2） cm和（4.9±1.3） cm]较治疗前[（6.7±2.0） cm和（6.6±2.2） cm]明显缩小（P<0.05）,KPS评分明显升高[（92.5±9.8）对（76.1±4.5）和（84.8±8.6）对（75.2±3.4）,P<0.05],AFP明显降低[（547.2±160.7）μg/L对（1275.3±316.8）μg/L和（558.5±176.4）μg/L 对（1218.8±337.9）μg/L,P<0.05],且观察组肿瘤直径[（4.0±1.2） cm、KPS评分（92.5±9.8）较对照组缩小（4.9±1.3） cm或升高（84.8±8.6）更为显著,P<0.05];两组毒副反应比较差异无显著性（P>0.05）;随访1年,观察组患者病死率（5.9%）和肝外转移率（14.7%）明显低于对照组患者（16.7%和26.7%, P<0.05）。结论在行TACE治疗时加用重组人血管内皮抑制素治疗中晚期肝癌患者可明显提高近期及远期疗效,缩小肿瘤直径和改善KPS评分,且不会加重毒副反应。