89例巨块型原发性肝癌介入化疗栓塞治疗体会

目的探索巨块型原发性肝癌介入栓塞治疗的疗效。方法89例巨块型原发性肝癌患者,经皮股动脉穿刺插管至肝动脉,化疗栓塞治疗肝癌;碘油用量为20～50ml。再注入明胶海绵颗粒栓塞治疗。发现肝外肿瘤供血动脉,超选择捅管化疗栓塞后,注入适量明胶海绵栓塞治疗。结果本组病例中首次DSA造影发现11例存在肝外动脉供血;64例出现肝外供血动脉共计67支。术后甲胎球蛋白下降均〉50％。术后4～6周复查田,肿瘤最大直径缩小3．5～5．9cm。1、2、3年累计生存率分别为73．8％、48．3％和28．5％。结论巨块型原发性肝癌大剂量碘油栓塞联合肝外肿瘤供血动脉介入治疗,对于提高巨块型原发性肝癌的介入疗效具有重要意义。     

碳酸氢钠+载药微球经肝动脉化疗栓塞治疗中晚期肝癌的临床效果

目的:探讨碳酸氢钠+载药微球经肝动脉化疗栓塞治疗中晚期肝癌的临床效果及安全性。方法:选择2015年2月到2018年6月在我院诊治的中晚期肝癌患者78例,根据随机数字表法将其均分为两组,每组各39例。对照组给予载药微球经肝动脉化疗栓塞治疗,实验组给予碳酸氢钠+载药微球经肝动脉化疗栓塞治疗,比较两组的临床疗效,治疗前后CD3~+CD4~+、CD3~+CD8~+T细胞比例的变化,治疗期间不良反应的发生情况及预后。结果:治疗后,实验组与对照组的治疗总有效率分别为74.4%和43.6%,实验组显著高于对照组(P0.05)。实验组治疗期间的发热、腹痛、腹胀、呕吐等不良反应发生情况与对照组的对比差异无统计学意义(P0.05)。两组治疗前后CD3CD4~+T比例对比差异无统计学意义(P0.05),两组治疗后的CD3~+CD8~+T比例显著低于治疗前,且实验组明显低于对照组(P0.05)。治疗后,实验组的躯体功能、心理功能、社会功能、共性症状及副作用评分都低于对照组(P0.05)。结论:碳酸氢钠+载药微球经肝动脉化疗栓塞治疗中晚期肝癌能提高治疗效果,改善机体的免疫功能,提高患者的生活质量,且不会增加不良反应。     

超声引导下肝动脉栓塞化疗治疗晚期肝癌的临床疗效分析

目的:探讨超声引导下肝动脉栓塞化疗治疗进展期大肝癌的疗效和临床应用价值.方法:对我院2009年收治的60例原发性肝癌晚期患者进行超声引导下肝动脉栓塞化疗治疗.并通过彩色多普勒复查肿瘤的血供情况.结果:60例晚期肝癌患者在经过治疗后肝功能有了明显的改善,肿瘤内部及周边血流明显减少,肿瘤血供≥Ⅱ级者由TACE治疗前的90%(54/60)降为术后的71.67%(43/60).结论:在超声引导下准确定位,经肝动脉化疗是晚期肝癌的有效治疗手段,具有较高的安全性和依从性.     

放疗联合肝动脉化疗栓塞治疗原发性肝癌的临床效果分析

目的:探讨放疗联合肝动脉化疗栓塞治疗原发性肝癌的临床效果.方法:选取2009年2月至2011年2月入住我院的60例已确诊且不能进行手术切除的Ⅲ、Ⅳ期原发性肝癌患者,采用三维适形放疗(3D-CRT)联合肝动脉化疗栓塞(TACE)治疗.结果:近期疗效有效率为76.67％.0.5、1、2年的生存率分别为87.4％、65.2％、38.7％.平均生存时间为25.6个月.结论:将放疗联合肝动脉化疗栓塞应用到原发性肝癌的治疗中,能够有效地控制患者病情,提高患者生活质量,延长患者生存期,对于不能进行手术治疗的中晚期患者具重要的实践与运用价值,值得推广.     

吉西他滨联合奥沙利铂经肝动脉化疗栓塞对肝癌术后复发的预防作用探究

目的：探讨吉西他滨联合奥沙利铂经肝动脉化疗栓塞对肝癌术后复发的预防作用及其疗效分析。方法：回顾性分析2006年1月～2011年10月我院收治入院的97例晚期原发性肝癌患者的临床资料,将患者随机分为观察组（48例）和对照组（49例）,观察组采用吉西他滨联合奥沙利铂,对照组采用阿霉素灌注进行肝动脉化疗栓塞治疗,观察两组不同患者对肝癌术后复发的预防作用及其临床疗效。结果：两组患者疾病控制率及1年、2年的生存率比较上差异有统计学意义（P〈0.05）。结论：在肝癌治疗中给予吉西他滨联合奥沙利铂经肝动脉化疗栓塞治疗,疗效确切,不良反应较轻,耐受性好,帮助患者改善生活质量,是晚期原发性肝癌的有效治疗方案。     

TACE联合RFA疗法可有效提高原发性肝癌患者的疗效

为了探讨肝动脉栓塞化疗(TACE)联合射频消融(RFA)对原发性肝癌患者疗效的影响,本研究选取了2016年1月至2016年12月我院收治的原发性肝癌患者60例,随机分为两组,对照组应用TACE治疗,研究组应用TACE联合RFA治疗。通过对比两组患者治疗效果及Th1、Th2细胞因子水平,我们发现研究组患者的治疗有效率显著优于对照组(p0.05);治疗前两组患者的Th1、Th2型细胞因子的水平无明显区别(p0.05),治疗后均得到一定改善,研究组显著优于对照组(p0.05);治疗前两组患者的免疫细胞因子的水平无明显区别(p0.05),治疗后两组均得到一定改善,且研究组显著优于对照组(p0.05)。本研究表明,TACE联合RFA治疗原发性肝癌患者,有利于提高近期有效率,改善患者的Th1、Th2细胞因子水平。我们的研究为肝动脉栓塞化疗联合射频消融疗法在原发性肝癌患者临床治疗中的应用提供了一定的理论依据。     

三氧化二砷栓塞联合肝动脉介入治疗转移性肝癌的疗效并33 例 临床观察*

摘要目的：观察并探讨三氧化二砷碘油栓塞联合置管介入化疗治疗转移性肝癌的临床效果。方法：选取辽宁省肿瘤医院介入治 疗科2008-2010 年收治的转移性肝癌患者33 例,进行肝动脉造影及间接门脉造影,根据肝动脉造影或门脉造影结果,根据肝动脉 供血情况分别采取肝动脉化疗栓塞及肝动脉灌注化疗方法治疗,3-4 周为1 治疗周期,共完成4 个治疗周期,治疗结束后评价患 者临床有效率,随访半年、1 年、2 年患者生存率。结果：①介入治疗后,患者临床症状均改善,KPS得分明显高于化疗前（P＜ 0.05）,临床总有效率81.82%。②随访半年、1 年、2 年生存率分别为90.91%、66.67%、33.33%,肝动脉化疗栓塞组患者中远期生存 率明显高于肝动脉灌注化疗的患者。结论：三氧化二砷可从多角度抑制癌细胞,临床应用安全有效;对于不能手术和不适宜手术 的转移性肝癌患者,根据肝动脉供血情况和特点选择合适的介入治疗,可获得满意疗效。     

三氧化二砷栓塞联合肝动脉介入治疗转移性肝癌的疗效并33例临床观察

目的：观察并探讨三氧化二砷碘油栓塞联合置管介入化疗治疗转移性肝癌的临床效果。方法：选取辽宁省肿瘤医院介入治疗科2008-2010年收治的转移性肝癌患者33例,进行肝动脉造影及间接门脉造影,根据肝动脉造影或门脉造影结果,根据肝动脉供血情况分别采取肝动脉化疗栓塞及肝动脉灌注化疗方法治疗,3．4周为1治疗周期,共完成4个治疗周期,治疗结束后评价患者,陆床有效率,随访半年、1年、2年患者生存率。结果：①介入治疗后,患者,临床症状均改善,KPS得分明显高于化疗前（P〈0．05）,临床总有效率81．82％。②随访半年、1年、2年生存率分别为90．9l％、66．67％、33.33％,肝动脉化疗栓塞组患者中远期生存率明显高于肝动脉灌注化疗的患者。结论：三氧化二砷可从多角度抑制癌细胞,临床应用安全有效;对于不能手术和不适宜手术的转移性肝癌患者,根据肝动脉供血情况和特点选择合适的介入治疗,可获得满意疗效。     

DynaCT对肝转移瘤介入治疗具有指导意义

为了探讨锥形束CT (DynaCT)在肝癌患者实施经导管肝动脉化疗栓塞(TACE)手术治疗中的指导作用、栓塞效果评估中的价值,本研究选取了2012年3月至2015年5月在本院实施TACE手术治疗的102例原发性肝癌或转移性肝癌患者进行研究。通过对102例患者病灶进行手术前螺旋CT检测、术中数字减影血管造影(DSA)及DynaCT检测,并对比DSA与DynaCT对肝癌病灶、供血动脉、术后栓塞效果的检测结果。本研究发现术前普通螺旋CT共计检出病灶105个,术中DSA检出病灶数目176个,DynaCT术中检出肿瘤病灶285个;DynaCT和DSA的平均检出病灶数目均显著的高于普通螺旋CT (p<0.05),DynaCT平均检出病灶数目均显著的高于DSA (p<0.05);DynaCT的病灶供血动脉检出率为86.67%,显著地高于DSA (55.68%)(p<0.05);DynaCT检出的285个病灶对栓塞效果评估结果与实际栓塞效果一致的有271个病灶(95.09%),DSA评估结果与实际结果一致的有138个病灶(78.41%),DynaCT对于TACE术后效果评估的一致性高于DSA (p<0.05)。本研究表明,DynaCT在肝癌患者实施TACE手术治疗中能够更有效的发现病灶,指导栓塞操作。     

TACE 联合其他介入手段治疗肝癌伴门静脉癌栓

肝癌是世界范围内恶性程度最高的恶性肿瘤之一。门静脉癌栓的出现加速了肝功衰竭以及门静脉高压的发生概率,严重影响了肝癌患者的预后,临床上对于肝癌合并门静脉癌栓的诊疗尤为棘手。传统的治疗手段对于肝癌合并门静脉癌栓的疗效欠佳,且创伤大、住院时间长、并发症多。介入治疗因其创伤小、住院时间短、并发症少,疗效确切等优势逐渐被人们认可。以往单独应用经导管肝动脉化疗栓塞术(Transcatheter Arterial Chemoembolization,TACE)治疗肝癌取得了可喜的成果,随着介入治疗的发展,TACE联合其他介入手段治疗肝癌伴门静脉癌栓引起了越来越多的学者重视。本文回顾了近几年来国内外的相关文献,对TACE联合其他介入手段治疗肝癌合并门静脉癌栓的方式及疗效做一综述,以期对肝癌的临床诊疗工作提供一些帮助。     

院前明胶海绵栓塞治疗肾血管损伤的动物研究

目的：探讨在新型综合手术救治方舱中明胶海绵栓塞治疗肾血管损伤的可行性和疗效。方法：在新型综合手术救治方舱中构建3例动物肾腹（背）干动脉损伤模型、3例肾段动脉损伤模型,先用1mm×1mm×1mm明胶海绵颗粒对损伤血管进行栓塞治疗,若未能止血,改用2mm×2mm×2mm颗粒栓塞,观察栓塞后15分钟、1月后的肾动脉造影,栓塞后1月的组织病理表现。结果：3例肾段动脉和1例肾腹干动脉使用1mm×1mm×1mm明胶海绵颗粒一次栓塞成功;1例肾腹干动脉和1例肾背干动脉用1mm×1mm×1mm颗粒栓塞未能完全止血,改用2mm×2mm×2mm颗粒栓塞成功。6例动物术后生命体征平稳,全部存活,一个月后造影复查见栓塞动脉来再通,但其余分支动脉血供得到保留。大体标本观栓塞侧肾明显缩小,来见脓腔和脓性分泌物,病理切片示栓塞后局部肾组织有不同范围缺血性梗死。结论：野战方舱中明胶海绵栓塞治疗出血效果明确,对于一般肾血管损伤定位准确,止血迅速、彻底,有良好的可行性和疗效。     

Effects of Cellulose Nanofibers Filling and Palmitic Acid Emulsions Coating on the Physical Properties of Fish Gelatin Films

In this preliminary study, fish gelatin films with improved strength and water resistance were prepared from a dispersion of fish gelatin and carboxylated cellulose nanofibrils (CNF) by using the casting method, followed by subsequent coating with palmitic acid emulsion. The surface topography displayed a uniform distribution of the CNF particles in the gelatin films, but aggregation occurred at a CNF dosage of 4 wt% or higher. Due to the reinforcing effect of CNF, a dosage-dependent increase in the Young’s modulus and tensile strength was observed for the CNF-reinforced films. The addition of CNF also led to an obvious increase in thermal stability. Via surface coating, the emulsion at the 60:40 (w/w) ratio of palmitic acid to water showed excellent layer-forming and high adhesion properties, contributing to the significant improvement of water resistance. The enhanced properties of these fish gelatin films would promote their practical applications in edible packaging.     

Preclinical and Clinical Experience with a Doxorubicin-Liposome Preparation

Abstract

Entrapment of doxorubicin in liposomes results in increased drug concentrations in liver and spleen and decreased uptake by the heart muscle. these pharmacologic changes can be exploited to reduce the drug's toxicity and increase its therapeutic index in selected neoplastic conditions. We review here our preclinical and phase I clinical data with liposome-associated doxorubicin. these studies, together with preliminary observations on the pharmacokinetics of the liposome-associated drug and on the imaging of radiolabeled vesicles in patients, suggest that the maximal tolerated dosage is significantly increased over that of the free drug and that the reticuloendothelial system is responsible for the rapid and dominant pathway of liposome clearance. the implications of various pharmacologic aspects of liposome behavior in the circulation are also discussed.     

通络救脑注射液对脑微血管内皮细胞活性影响的特征

目的：观察通络救脑注射液对培养的正常及缺血脑微血管内皮细胞的活性影响。揭示其通络作用的效应靶点与特征。方法：原代培养大鼠脑皮质微血管内皮细胞,传至第三代。分为正常及拟缺血组,采用培养基氧糖刺夺（OGD）法建立拟缺血模型。通过四甲基偶氮唑盐（MTT）比色分析法测定不同浓度的通络救脑注射液对正常及OGD内皮细胞的活性影响。结果：通络救脑注射液作用于正常脑微血管内皮细胞,与未加药组比较,小剂量药物抑制细胞活性趋势,大剂量促进细胞活性趋势,剂量总趋势呈反抛物线形;通络救脑注射液作用于OGD组脑微血管内皮细胞,小剂量范围促进内皮细胞的增殖活性,呈显著和极显著差异,而大剂量组则抑制细胞活性,剂量总趋势呈抛物线形。结论：通络救脑注射液对正常及缺血脑微血管内皮细胞具有双向调节作用,药物剂量与细胞增殖活性呈非线性关系。天剂量与小剂量可能是不同的作用机制,反映了中药复方药效的多维性。     

规范化护理在急性肾出血介入微创栓塞治疗中的价值探讨

目的:探讨规范化护理在急性肾出血介入微创栓塞治疗中的价值。方法:回顾性分析我科38例急性肾出血患者采用明胶海绵、微弹簧圈、聚乙烯醇(PVA)等栓塞剂栓塞出血动脉,规范性做好介入术前、术中、术后护理。结果:除2例肉眼血尿持续10天,其他36例病人全部在术后3天内尿液由介入前全血尿转为淡红色,并在7天肉眼血尿彻底消失。结论:规范化护理是确保介入微创栓塞治疗急性肾出血顺利完成及成功的重要环节,加强术前、术中、术后护理能明显减少介入微创栓塞治疗后再出血的发生,提高介入治疗效果。     

LncRNA FOXD2‐AS1 as a competitive endogenous RNA against miR‐150‐5p reverses resistance to sorafenib in hepatocellular carcinoma

The current study elucidated the role of a long non‐coding RNA (lncRNA), FOXD2‐AS1, in the pathogenesis of hepatocellular carcinoma (HCC) and the regulatory mechanism underlying FOXD2‐AS1/miR‐150‐5p/transmembrane protein 9 (TMEM9) signalling in HCC. Microarray analysis was used for preliminary screening of candidate lncRNAs in HCC tissues. qRT‐PCR and Western blot analyses were used to detect the expression of FOXD2‐AS1. Cell proliferation assays, luciferase assay and RNA immunoprecipitation were performed to examine the mechanism by which FOXD2‐AS1 mediates sorafenib resistance in HCC cells. FOXD2‐AS1 and TMEM9 were significantly decreased and miR‐150‐5p was increased in SR‐HepG2 and SR‐HUH7 cells compared with control parental cells. Overexpression of FOXD2‐AS1 increased TMEM9 expression and overcame the resistance of SR‐HepG2 and SR‐HUH7 cells. Conversely, knockdown of FOXD2‐AS1 decreased TMEM9 expression and increased the sensitivity of HepG2 and Huh7 cells to sorafenib. Our data also demonstrated that FOXD2‐AS1 functioned as a sponge for miR‐150‐5p to modulate TMEM9 expression. Taken together, our findings revealed that FOXD2‐AS1 is an important regulator of TMEM9 and contributed to sorafenib resistance. Thus, FOXD2‐AS1 may serve as a therapeutic target against sorafenib resistance in HCC.     

Clinical pharmacokinetics: a comprehensive system for therapeutic drug monitoring and prescribing.

Clinical pharmacokinetics is an expanding scientific discipline which can make an impact on treatment in coronary care, intensive care, paediatrics, general medicine and surgery, and general practice. The aim of this study was to establish a rapid system of drug assay, to report the result, to assess the influence of pathological and clinical factors on the pharmacokinetics of certain drugs, and to use a computer to determine the optimum dosage of drugs. The clinical pharmacokinetics laboratory in Stobhill is available to all clinical departments and to general practitioners in the area. Digoxin, theophylline, and phenytoin have been assessed. Initial samples of these drugs showed that only about a third were in the therapeutic range; samples obtained after the issue of the laboratory report showed an improvement. The predictive performance of the computer program improved with feedback of one or two drug concentrations. Dosages of drugs chosen on an empirical basis may not lead to optimum treatment, and by testing samples early the dosage of the drug can be adjusted. It is hoped that the results achieved will encourage other clinical, pharmaceutical, and scientific colleagues to develop laboratories along similar lines.     

Fuzheng Jiedu Xiaoji formulation inhibits hepatocellular carcinoma progression in patients by targeting the AKT/CyclinD1/p21/p27 pathway

BackgroundHepatocellular carcinoma (HCC) is a common malignant tumor with limited treatment options. Conventional antitumor therapy combined with traditional Chinese medicine (TCM) to limit tumor progression has gradually become the focus of complementary and alternative therapies for HCC treatment. The Fuzheng Jiedu Xiaoji formulation (FZJDXJ) alleviates the clinical symptoms of patients and inhibits tumor progression, but its curative effect still requires extensive clinical research and mechanistic analysis.PurposeTo explore the effectiveness of FZJDXJ in HCC patients and investigate its biological function and mechanism underlying anticancer therapy.MethodsThis randomized controlled clinical trial enrolled 291 HCC patients receiving transcatheter arterial chemoembolization (TACE) therapy; patients received either FZJDXJ combined with standard treatment, or standard treatment alone, for 48 weeks. Statistical analyses were performed according to survival time at the end of the trial. The main constituents of the FZJDXJ extracts were identified and evaluated using high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) and molecular docking. The antitumor effects of FZJDXJ and its specific biological mechanism of action were studied.ResultsAfter 48 weeks of treatment, one-year overall survival (OS) and progression-free survival (PFS) were significantly different between the two groups. Co-administration of FZJDXJ and TACE prolonged the OS of HCC patients, especially in BCLC A or B stage. FZJDXJ and TACE treatment effectively extended the PFS of patients, especially in the BCLC B stage. HPLC-MS/MS identified 1619 active constituents of FZJDXJ, including formononetin, chlorogenic acid (CGA), caffeic acid, luteolin, gallic acid, diosgenin, ergosterol endoperoxide, and lupeol, which may function through the AKT/CyclinD1/p21/p27 pathways. Through molecular docking, CGA and gallic acid could effectively combine with Thr308, an important phosphorylation site of AKT1. FZJDXJ inhibited tumor growth in nude mice. In vitro, FZJDXJ-mediated serum inhibited the proliferation, migration, and invasion of liver cancer cells, and promoted cell apoptosis.ConclusionClinically, FZJDXJ combined with TACE therapy significantly prolonged OS and PFS and reduced the mortality rate of HCC patients. Mechanistically, FZJDXJ effectively inhibited the proliferation and migration of liver cancer cells through the modulation of the AKT/CyclinD1/p21/p27 pathways, and may be a promising TCM drug for anti-HCC therapy.