乳癌术后局部复发再手术15例报告

目的探讨15例乳癌术后局部复发患者的治疗方法.方法15例乳癌患者中行单纯乳房切除加腋窝淋巴结清扫2例,乳癌根治术9例,改良根治4例.结果随访15例中,一年内死亡1例,生存2年3例,生存3年5例,生存5年以上6例.初步探讨了乳癌术后局部复发的手术治疗,提出了局部复发的特点、机制、手术治疗的原则及意义.结论笔者认为再手术对局部复发的控制优于其它的治疗方法.     

急性胰腺炎132例临床疗效观察

目的:探讨急性胰腺炎的治疗方法及手术方式、手术时机.方法:总结收治的急性胰腺炎132例,其中16例符合重症急性胰腺炎诊断标准.治疗采用单纯内科保守治疗124例,手术8例.手术方法有胰腺坏死病灶清创、切除,胰腺周围引流术,胰腺被膜切开减压加胰腺周围引流术,脓肿或囊肿引流术,单纯胆囊切除术;胆囊切除术加胆总管探查引流术,胆囊切除术、胆总管探查引流术加胰腺周围引流术等.结果:治愈好转率97.1%(129/132),其中重症急性胰腺炎治愈好转率81.3%(13/16);死亡或病情恶化自动出院3例,死亡率18.7%(3/16).结论:急性胰腺炎的治疗应全面而有系统,并在病程的各个阶段采取不同的治疗措施.应注意早期联合使用能穿透血胰屏障的抗生素.TPN虽不能改善重症急性胰腺炎本身的病理进程,但可帮助患者缩短恢复期.及时的手术可排出有害的酶性液体、清除胰腺周围坏死和感染组织,减少并发症的发生.对合并胆囊结石或胆总管结石者,应根据胰腺炎不同的病理类型选择适当的手术时机.     

十全补汤对肺癌辅助治疗的效果观察

我们于1992年11月-1993年10月对接受化疗,放疗的原发性肺癌患者20例合并应用十全补汤治疗并进行了临床观察,结果表明十全大补汤可以增加食欲、明显减轻消化道症状及改善全身状态,并有一定减轻疼痛的作用。现就我们所作的临床观察报告如下。     

小儿肾病综合征100例疗效观察及远期随访

本文报道中西医结合治疗小儿肾病综合征100例的疗效观察及远期随访。治疗上分初期治疗和巩固治疗二个阶段。初期治疗以西药为主,用糖皮质激素强的松,体重30公斤以下者按2mg/kg·d,30公斤以上者按1.5mg/kg·d口服,中药为辅原则温补肾阳,通阳利水。巩固阶段以中药为主,原则补气益肾、健脾,重用黄芪,西药强的松随病情好转逐渐减量,全程6-9个月为好。本文对全部病例进行随访,结果1次治疗3年未复发者80例,4-5年未复发者78例,6年未复发者76例,7年未复发表75例,8-9年未复发者73例,认为中西医结合治疗本病,其远期疗效是满意的。     

常用化疗方案对乳腺癌细胞抑制作用的观察

乳腺癌是我国妇女常见恶性肿瘤,也是对化学治疗比较敏感的癌瘤之一,因此,化学治疗是乳腺癌综合治疗的重要组成部分。由于乳癌患者对化疗药物反应的个体差异较大,因此预测乳癌细胞对化疗药物的敏感性,则是大家十分关注的问题。为此我们采用四氮唑盐法(MTT),观察了我区临床常用3种乳癌化疗方案对82例乳癌细胞的抑制作用,旨在指导临床优选化疗方案,不断改进治疗策略,提高治疗效果。1资料和方法1.1一般资料从2004·1~2006·7月收集我院乳癌切除标本82例,均为女性。年龄34~73岁,平均年龄49·5岁。1.2仪器与试剂美国生产全自动CO2孵箱,5430型,酶…     

进展期胃癌新辅助化疗疗效的Meta分析

针对进展期胃癌新辅助化疗的价值在临床中的应用仍有争论,本文采用Cochrane系统评价方法,查询了国内外有关的英文及中文随机对照试验研究,以对胃癌新辅助化疗的疗效进行Meta分析,为临床决策提供依据.     

硫糖铝佐治急性放射性肠炎38例临床观察

目的:临床研究硫糖铝佐治急性放射性肠炎的疗效和不良反应。方法:治疗组38例用硫糖铝1.0g及思密达3.0g,每日3次;对照组51例用思密达3.0g,每日3次,1周为1疗程。采用卡方检验进行疗效比较。结果:治疗组有效率为92.1%;对照组有效率为84.3%。两组间疗效比较差异有显著性(χ2=6.2,P<0.05)。结论:硫糖铝可加速受损肠粘膜的修复功能,并具有良好的止痛、止血效果,无明显毒副作用,使用方便,故应用其佐治急性放射性肠炎具有进一步研究和应用价值。     

β-受体阻滞剂治疗慢性心衰的远期疗效观察

目的：观察β-受体阻滞剂治疗慢性心力衰竭的远期临床疗效。方法：选择慢性心衰患者56例，随机分为治疗组与对照组，两组常规治疗方法相同，治疗组加用β-受体阻滞剂，观察其心率、血压、左室射血分数（LVEF）、左室舒末内径（LVDD）、生活质量、再住院率等，虽访两年。结果：临床症状体征方面，治疗组基本治愈8例，显效17例，无效3例，总有效率为89．3％，对照组基本治愈5例，显效13例，无效10例，总有效率为64．3％，两组比较有显著性差异（P〈0．01）。治疗组血液动力学改善亦明显高于对照组。结论：β-受体阻滞剂治疗慢性心力衰竭可改善生活质量，延长寿命，疗效可靠。     

急诊介入治疗急性心肌梗死150例临床疗效观察

急性心肌梗死(AMI)发病初期病死率较高,而再灌注治疗是急性心肌梗死的关键。选择正确的再灌注策略才能达到最佳的治疗效果,急诊直接冠脉介入(PCI)治疗可有效地开通梗死相关血管(IRA)从而使死亡率、再梗死率下降,提高生存率和改善生活质量[1]。本文对150例AMI患者急诊PCI治疗结果进行了描述及分析。1资料与方法1.1一般资料2002·9~2006·3月我院心血管内科对150例AMI患者行急诊PCI治疗。所有病例均符合WHO关于AMI的诊断标准。均符合急诊PCI适应证。其中男109例,女41例。年龄30~84岁,平均62·6±7·9岁。体表心电图诊断心肌梗死部…     

HER2 over-expression and response to different chemotherapy regimens in breast cancer

Purpose To exam the relationship between HER2 over-expression and different adjuvant chemotherapies in breast cancer. Patients and Methods A total of 1625 primary breast cancer patients who received post-surgery adjuvant chemotherapy in Tianjin Cancer Hospital, China, from July 2002 to November 2005 were included in the study. Among them, 600 patients were given CMF (CTX MTX 5-Fu) regimen, 600 given CEF (CTX E-ADM 5-Fu) regimen, and 425 given anthracyclines plus taxanes regimen, with mean follow-up time of 42 months. Results In CMF treatment group, the 3-year disease free survival (DFS)in HER2 over-expressed patients was lower than that of the HER2-negative ones (89.80% vs 91.24%, P=0.0348); in node-positive subgroup, the 3-year DFS was 84.72% in HER2 over-expressed patients, and 90.18% in the HER-2-negative ones (P=0.0271).Compared to CMF regimen, anthracyclines and anthracyclines plus taxanes regimens are more effective (P＜0.05) in node-positive HER2 over-expression than those in the node-negative. Conclusion HER2 over-expression is an independent index for predicting poor prognosis and short DFS for breast cancer patients. HER2 over-expressed patients are resistant to CMF regimen chemotherapy, but sensitive to anthracyclines-based or anthracyclines plus taxanes regimen. HER2 expression can be taken as a marker for therapies in breast cancer.     

Fractionated evaluation of immunohistochemical hormone receptor expression enhances prognostic prediction in breast cancer patients treated with tamoxifen as adjuvant therapy

Objective:To compare the prognostic prediction between dichotomized and fractionated evaluations of hormone receptor expressions. Methods: Patients with stages I-III breast cancers, who received adjuvant tamoxifen, were enrolled. The expression of estrogen receptor (ER) and progesterone receptor (PR) was evaluated by immu-nohistochemistry (IHC). A fractionated score (F score), the percentage of positive-staining nuclei (0=none, 1=1%-10%, 2=11%-30%, 3=31%-50%, 4=51%-70%, and 5=71%-100%), was assigned to each...     

MicroRNA在乳腺癌发展过程中的作用机制及临床应用分析

概搜集已报道的在乳腺癌发生发展过程中有重要作用的microRNA信息,结合相关肿瘤模型的实验数据,评估microRNA在乳腺癌诊断和治疗方面的应用前景。以“癌基因”和“癌抑制基因”为分类依据,全面地总结归纳乳腺癌相关microRNA的功能和作用机制,进一步从临床诊断标记物和治疗靶点的层面分析microRNA的潜在临床应用价值。表1和2总结了microRNA参与乳腺癌发展过程的具体事件及其调控的靶基因。同时,本文还深入探讨microRNA作为临床诊断标记物及治疗靶点的可行性,揭示已有研究的不足之处,为今后的相关工作方向提供一些建议。     

乳腺癌的免疫调节治疗(英文)简

Standard treatment options for breast cancer include surgery, chemotherapy, radiation, and targeted therapies, such as adjuvant hormonal therapy and monoclonal antibodies. Recently, the recognition that chronic inflammation in the tumor microenvironment promotes tumor growth and survival during different stages of breast cancer development has led to the development of novel immunotherapies. Several immunotherapeutic strategies have been studied both preclinically and clinically and already have been shown to enhance the efficacy of conven- tional treatment modalities. Therefore, therapies targeting the immune system may represent a promising next-generation approach for the treatment of breast cancers. This review will discuss recent findings that elucidate the roles of suppressive immune cells and proinflammatory cytokines and chemokines in the tumor-promoting microen- vironment, and the most current immunotherapeutic strategies in breast cancer.     

Binding of circulating autoantibodies in breast cancer to native and peroxynitrite-modified RNA

Peroxynitrite(ONOO) is a powerful oxidant and nitrosative agent and has in vivo existence.The half life of ONOO at physiological pH is less than 1 s.It can react with nucleic acids,proteins,lipoproteins,saccharides,cardiolipin,etc.,and can modify their native structures.Action of ONOO,synthesized in the authors’ laboratory by a rapid quenched flow process,on structural changes of commercially available RNA was studied by ultraviolet(UV),fluorescence,and agarose gel electrophoresis.Compared to native RNA,the ONOO-modified RNA showed hyperchromicity at 260 nm.Furthermore,the ethidium bromide(EtBr) assisted emission intensities of ONOO-modified RNA samples were found to be lower than the emission intensity of native RNA-EtBr complex.Agarose gel electrophoresis of ONOO-modified RNA showed a gradual decrease in band intensities compared to native RNA,an observation clearly due to the poor intercalation of EtBr with ONOO-modified RNA.Native and ONOO-modified RNA samples were used as an antigen to detect autoantibodies in sera of patients with clinically defined breast cancer.Both direct binding and inhibition enzyme-linked immunosorbent assay(ELISA) confirmed the prevalence of native and 0.8 mmol/L ONOO-modified RNA specific autoantibodies in breast cancer patients.Moreover,the progressive retardation in the mobility of immune complexes formed with native or 0.8 mmol/L ONOO-modified RNA and affinity purified immunoglobulin G(IgG) from sera of breast cancer patients supports the findings of the direct binding and inhibition ELISAs.The peroxynitrite treatment to RNA at a higher concentration appears to have damaged or destroyed the typical epitopes on RNA and thus there was a sharp decrease in autoantibodies binding to 1.4 mmol/L ONOO-modified RNA.It may be interpreted that cellular nitrosative stress can modify and confer immunogenicity on RNA molecules.Higher concentrations of nitrogen reactive species can be detrimental to RNA.However,the emergence of native as well as 0.8 mmol/L ONOO-modified RNA as a novel antigen/substrate for autoantibodies in breast cancer patients indicates that,in future,these molecules might find a place on the panel of antigens for early diagnosis of breast cancer.     

Childhood maltreatment,psychological resources,and depressive symptoms in women with breast cancer

Childhood maltreatment is associated with elevated risk for depression across the human lifespan. Identifying the pathways through which childhood maltreatment relates to depressive symptoms may elucidate intervention targets that have the potential to reduce the lifelong negative health sequelae of maltreatment exposure. In this cross-sectional study, 271 women with early-stage breast cancer were assessed after their diagnosis but before the start of adjuvant treatment (chemotherapy, radiation, endocrine therapy). Participants completed measures of childhood maltreatment exposure, psychological resources (optimism, mastery, self-esteem, mindfulness), and depressive symptoms. Using multiple mediation analyses, we examined which psychological resources uniquely mediated the relationship between childhood maltreatment and depressive symptoms. Exposure to maltreatment during childhood was robustly associated with lower psychological resources and elevated depressive symptoms. Further, lower optimism and mindfulness mediated the association between childhood maltreatment and elevated depressive symptoms. These results support existing theory that childhood maltreatment is associated with lower psychological resources, which partially explains elevated depressive symptoms in a sample of women facing breast cancer diagnosis and treatment. These findings warrant replication in populations facing other major life events and highlight the need for additional studies examining childhood maltreatment as a moderator of treatment outcomes.     

表观遗传修饰和代谢重编程对乳腺癌干细胞的调控

概乳腺癌已居我国女性恶性肿瘤死亡率首位。近来研究表明,乳腺肿瘤组织内有少量具有自我更新和分化潜能的肿瘤干细胞,这些肿瘤干细胞在乳腺癌发生、发展、转移及复发过程中起关键作用。深入研究乳腺癌干细胞的调控机制对乳腺癌的预防和治疗具有十分重要意义。本文综合近期的研究成果,概括了表观遗传修饰和代谢重编程对上皮间质转化及乳腺癌干细胞的调控机制,且系统地分析与总结了表观遗传修饰、代谢重编程、上皮间质转化和乳腺癌干细胞之间的相互关系。     

Effects of childhood trauma exposure and cortisol levels on cognitive functioning among breast cancer survivors

Cognitive functioning difficultiesin breast cancer patients receiving chemotherapy are common, but not all women experience these impairments. Exposure to childhood trauma may impair cognitive functioning following chemotherapy, and these impairments may be mediated by dysregulation of hypothalamic-pituitary-adrenal (HPA) axis function and cortisol slope. This study evaluated the association between childhood trauma exposure, cortisol, and cognition in a sample of breast cancer survivors. 56 women completed measures of trauma exposure (the Traumatic Events Survey), salivary cortisol, and self-reported cognitive functioning (the Functional Assessment of Cancer Therapy – Cognitive). We examined correlations between childhood trauma exposure and cognitive functioning, then used linear regression to control for factors associated with cognition (age, education, time since chemotherapy, depression, anxiety, and insomnia), and the MacArthur approach to test whether cortisol levels mediated the relationship between trauma and cognitive functioning. 57.1% of the sample had experienced at least one traumatic event in childhood, with 19.6% of the sample witnessing a serious injury, 17.9% experiencing physical abuse, and 14.3% experiencing sexual abuse. Childhood trauma exposure and cognitive functioning were moderately associated (r = −0.29). This association remained even when controlling for other factors associated with cognition; the final model explained 47% of the variance in cognitive functioning. The association between childhood trauma and cognitive functioning was mediated by steeper cortisol slope (partial r = 0.35, p = 0.02). Childhood trauma exposure is associated with self-reported cognitive functioning among breast cancer survivors and is mediated by cortisol dysregulation. Trauma should be considered, among other factors, in programs aiming to address cognition in this population.     

Pharmacokinetics of gemcitabine in Chinese patients with non-small-cell lung cancer

INTRODUCTION Gemcitabine (2′,2′-difluorodeoxycytidine) is asynthetic pyrimidine nucleoside analogue with cyto-toxic activity in non-small-cell lung cancer (NSCLC)(Anderson et al., 1994; Abratt et al., 1994; Lund et al.,1994). Gemcitabine is a prodrug which, through de-oxycytidine kinase and other nucleotide kinases, ex-erts its cytotoxic effects through its active intracellu-lar metabolites, gemcitabine diphosphate andtriphosphate (Guchelaar et al., 1996;…     

肝癌患者血清SOD及MDA的变化研究

目的:探索肝癌患者血清SOD、MDA的变化。对肝癌患者26例和健康对照组30例。方法:对肝癌患者均应用改良TBA微量法测定血清丙二醛(MDA)、以黄嘌呤氧化酶法测定超氧化物歧化酶(SOD)水平的变化。结果:肝癌组患者血清MDA水平显著高于对照组(P<0.01),而血清SOD水平显著低于对照组(P<0.01)。结论:提示肝癌患者存在明显的抗氧化能力障碍,通过血清MDA、SOD水平的检测,可为肝癌的临床治疗及疗效观察提供一定的依据。