89例喉鳞癌患者术后生存的COX模型多因素分析

目的:探讨影响喉癌手术后生存的相关危险因素。方法:回顾1997年1月-2006年12月在我科行喉癌手术治疗的89例患者,分析肿瘤因素、宿主因素及辅助治疗因素对术后生存的影响。结果:全组术后5年生存率70.7%(63/89),肿瘤T分期、颈部淋巴结是否转移及手术切缘状态是影响喉癌手术预后的独立危险因素。对于进展期喉癌,如适应症选择合理,行全喉切除及根治性喉部分切除预后无统计学差异。结论:早期诊断并选择合理的术式,尤其一些保留或重建喉功能的术式加合理的颈淋巴结清扫,同时确保手术安全切缘是提高喉癌术后肿瘤和喉功能效果的关键。     

89例喉鳞癌患者术后生存的cox模型多因素分析

目的：探讨影响喉癌手术后生存的相关危险因素。方法：回顾1997年1月-2006年12月在我科行喉癌手术治疗的89例患者,分析肿瘤因素、宿主因素及辅助治疗因素对术后生存的影响。结果：全组术后5年生存率70．7％（63／89）,肿瘤T分期、颈部淋巴结是否转移及手术切缘状态是影响喉癌手术预后的独立危险因素。对于进展期喉癌,如适应症选择合理,行全喉切除及根治性喉部分切除预后无统计学差异。结论：早期诊断并选择合理的术式,尤其一些保留或重建喉功能的术式加合理的颈淋巴结清扫,同时确保手术安全切缘是提高喉癌术后肿瘤和喉功能效果的关键。     

喉癌患者术后感染的危险因素分析及干预对策探讨

目的:探讨喉癌患者手术部位发生感染(Surgical site infection,SSI)的相关危险因素及干预对策,为临床预防提供参考。方法:回顾性分析2012年7月-2013年11月因喉癌而在我院行喉切除术的83例患者的临床资料,根据术后是否发生SSI将患者分为感染组(n=12例)和非感染组(n=71例)。分析两组患者术后SSI的危险因素,并提出相应护理对策。结果:83例患者中,12例术后发生SSI,发生率为14.46%;单因素分析显示,感染组和非感染组在临床III期以上、术前气管切开、手术时间4 h、全喉切除等方面存在显著差异性(P0.05);多因素回归分析显示:患者的临床分期、术前气管是否切开、手术时间及手术切除方式是术后发生SSI的独立危险因素(P0.05)。结论:喉癌术后感染与临床分期、手术时间及切除方式等因素有关,采取有效的干预对策可减少术后SSI的发生率。     

低温等离子与CO_2激光微创治疗早期声门型喉癌疗效及安全性比较

目的:探讨低温等离子与CO_2激光微创治疗早期声门型喉癌的疗效及安全性。方法:收取2014年5月至2016年4月间我院收治的早期声门型喉癌患者79例作为研究对象进行回顾性分析,按照治疗方式的不同将其分为观察组42例及对照组37例。观察组行低温等离子射频消融治疗,对照组行CO_2激光微创治疗。比较两组患者手术时间、术中出血量及疼痛程度评分、嗓音学指标、声带形态学评分、术后生活质量以及并发症发生情况。结果:观察组手术时间明显短于对照组(P0.05);两组患者术中出血量及术后疼痛程度评分无显著差异(P0.05)。治疗后各声学指标较治疗前显著下降,差异均有统计学意义(P0.05)。观察组各指标均低于对照组,差异有统计学意义(P0.05)。手术后两组患者声带形态学评分均较治疗前显著下降,术后1个月时观察组评分显著低于对照组(P0.05)。观察组术后生活质量各维度均明显优于对照组,差异有统计学意义(P0.05)。所有患者术后均未发现严重并发症及复发。结论:低温等离子与CO_2激光微创治疗早期声门型喉癌均具有良好安全性,但低温等离子患者术后恢复情况优于CO_2激光治疗,值得临床推广应用。     

超早期立体定向手术治疗高血压脑出血的疗效及对患者炎性因子和生活质量的影响

目的:探讨超早期立体定向手术治疗高血压脑出血(HICH)的疗效及对患者炎性因子和生活质量的影响。方法:选取2016年3月～2018年1月期间我院收治的HICH患者93例,两组均给予立体定向手术治疗,根据手术时机将患者分为早期组(n=45,发病6～24h内手术)和超早期组(n=48,发病6h内手术),比较两组疗效相关指标、炎性因子和生活质量,观察两组术后并发症发生情况。结果:超早期组病死率低于早期组,格拉斯哥昏迷评分(GOS)优良率高于早期组(P0.05),两组术后再出血率对比差异无统计学意义(P0.05)。两组患者术后2周白介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)水平均降低,且超早期组低于早期组(P0.05)。术后3个月、术后6个月超早期组心理健康、躯体健康、社会功能、物质生活等维度评分均高于早期组(P0.05)。超早期组术后并发症总发生率低于早期组(P0.05)。结论:超早期立体定向手术治疗HICH,疗效显著,可有效改善炎性因子水平及患者的生活质量,同时还可减少术后并发症的发生率。     

急性重症胰腺炎早期手术时机及术式探讨

目的：探讨急性重症胰腺炎手术治疗的时机和手术。方法：对24例急性重症胰腺炎（SAP）患者采用手术治疗的时机和术式及疗效进行回顾性分析。结果：24例SAP于入院后一周内行手术治疗,手术时清除坏死组织并充分低位引流;早期手术治愈率71%(17/24),疗效满意。结论：SAP经保守治疗无效后,可在一周内手术,手术方式以充分低位引流为目的。     

特发性声门下狭窄临床诊治附4例报道

目的:探讨特发性声门下型喉狭窄的发病机制及临床诊治方法。方法:对我科2012年5月-2014年1月收治的4例特发性声门下型喉狭窄患者的临床资料进行回顾性研究,在基本相同的手术方式、不同的术后用药下进行长期随访,电子喉镜下观察患者术前、后及随访2年的病灶区情况并进行相关统计学分析。结果:4例特发性声门下型喉狭窄患者多因呼吸困难就诊,均采用气管切开术及支撑喉镜下热器械切除病变,旷置创面的手术方式,术后短期内气道狭窄均得到解决、呼吸困难症状均得到缓解;配合小剂量激素中长期治疗效果尚可,患者声门下病灶无明显复发,气道症状能得到控制,其中2例患者治愈,1例患者因拒绝激素治疗术后未予激素治疗中期观察有效,1例患者术中术后未予激素治疗,术后短期复发,后经激素治疗治愈。结论:特发性声门下型喉狭窄是后天性声门下狭窄的非瘢痕性的特殊类型,为独特的喉狭窄炎症性疾病,病因不明或为某些因素引起了非特异的增生性炎症,表现为炎性细胞的浸润及淋巴组织增生。治疗上,手术能明显缓解其症状,但单纯手术治疗中长期效果不佳,极易复发;配合中长期小剂量激素治疗对病灶控制有重要的作用。     

探讨喉癌患者围手术期的护理体会

目的:探讨喉癌患者围手术期合理的护理措施,为临床治疗与护理提供一定的理论依据。方法:对我院82例喉癌手术患者的临床资料进行回顾性分析,总结其护理经验,并制定相应的护理措施。结果:所实施的术后患者均达到预期的治疗效果,82例喉癌病人均痊愈出院。结论:做好喉癌术后护理,能提高手术成功率,减少术后并发症的发生,提高患者生存质量。     

探讨喉癌患者围手术期的护理体会

目的：探讨喉癌患者围手术期合理的护理措施,为临床治疗与护理提供一定的理论依据。方法：对我院82例喉癌手术患者的临床资料进行回顾性分析,总结其护理经验,并制定相应的护理措施。结果：所实施的术后患者均达到预期的治疗效果,82例喉癌病人均痊愈出院。结论：做好喉癌术后护理,能提高手术成功率,减少术后并发症的发生,提高患者生存质量。     

早期乳腺癌保乳手术与改良根治手术的临床效果比较

目的:比较早期乳腺癌保乳手术与改良根治手术的临床效果,探讨治疗早期乳腺癌的最佳手术方案。方法:选择早期乳腺癌患者138例,根据自愿的原则,分为保乳组(BCS)和根治组(MRS),保乳组采取保乳手术方案,根治组采用改良根治手术方案,比较两组患者手术时间、术中出血量、切口长度、住院时间、术后并发症、美容效果满意率及患者预后情况。结果:两组患者手术时间、术中出血量、切口长度、住院时间、术后并发症、美容效果满意率比较,差异具有(高度)统计学意义(P<0.01,P<0.05);术后12个月、18个月和24个月复发或死亡例数比较,差异无统计学意义(P>0.05)。结论:早期乳腺癌患者外科手术治疗时,应首选保乳手术方式治疗。     

同步放化疗治疗中晚期宫颈癌的临床效果分析

目的：子宫颈癌（Cervical Cancer）是女性生殖系统常见的恶性肿瘤,严重影响女性的身体健康及生活质量。本研究通过观察单纯放疗与同步放化疗治疗中晚期宫颈癌的临床效果,探讨治疗宫颈癌的最佳方式,为后续临床研究提供参考。方法：选取我院2008年1月-2009年6月收治的中晚期宫颈癌患者124例,随机分为同步放化疗组和单纯放疗组,每组62例。单纯放疗组采取腔内或腔外照射的方式进行放射治疗,而同步放化疗组在此基础上采用多烯紫杉醇＋顺铂（DP）方案进行治疗。观察并比较两组患者的近期临床疗效、毒副反应发生率及随访情况。结果：同步放化疗组的治疗总有效率、毒副反应发生率均高于单纯放疗组,但患者经对症处理后均获得改善;同步放化疗组三年生存率高于单纯放疗组,差异均具有统计学意义（P〈0．05）。结论：在中晚期宫颈癌的临床治疗中,对患者实施放射治疗的同时选择合理的药物及给药方案进行化疗具有明显的近期疗效,患者的毒副反应可耐受,且治疗后的生存率较高,值得临床推广应用。     

立体定向适形放疗在早期肝癌治疗中的应用

目的:探讨立体定向适形放疗对早期肝癌患者临床疗效的影响。方法:回顾性分析我院2008年5月~2011年5月收治的190例早期肝癌患者,按照其治疗方式分为放疗组(n=95)及化疗组(n=95),2组患者分别接受立体定向适形放疗及肝动脉化疗栓塞治疗,比较患者的临床疗效。结果:2组患者治疗前后WBC、RBC、PLT、TBIL、ALT、PT指标均未见明显变化(P0.05);2组患者治疗后AFP、TMD均显著降低,放疗组降低程度更为明显(P0.05);放疗组总有效率为69.48%,显著高于化疗组的43.16%(P0.05)。2组患者治疗期间均发生胃肠道反应等并发症,经对症处理后症状消失,均未见其他严重并发症发生;2组患者1年复发率、1年生存率及2年生存率无明显统计学差异(P0.05);放疗组2年、3年复发率显著低于对照组,其3年生存率显著高于化疗组(P0.05)。结论:立体定向适形放疗能够有效降低早期肝癌患者AFP水平,缩小其肿瘤直径,具有良好的临床疗效,且该方案对患者血液指标、机体状态影响较小,具有良好的安全性,是保障医疗质量、改善患者预后的有效手段。     

Radiotherapy of early breast cancer. More than loco-regional tumor control

The authors review the value of radiotherapy in the multidisciplinary treatment of early (stage 0-II) breast cancer and describe past achievements, current scientific evidences and possible future prospects of clinical research. Results of randomized studies proved that conservative surgery with radiotherapy is equally effective to mastectomy for the treatment of in situ and invasive breast cancer, both in terms of local control and overall survival. In the nineties, findings of prospective clinical trials indicate that the use of irradiation in high-risk patients provides both a significant improvement in loco-regional control and survival rate. The magnitude of survival benefit with appropriate patient selection and radiotherapy technique is similar to that seen with adjuvant systemic therapy. Radiotherapy of early breast cancer is based on level I scientific evidences in the vast majority of cases. Remaining controversial issues are subjects of several ongoing international and Hungarian prospective randomized studies.     

Thiolactomycin and related analogues as novel anti-mycobacterial agents targeting KasA and KasB condensing enzymes in Mycobacterium tuberculosis

Prevention efforts and control of tuberculosis are seriously hampered by the appearance of multidrug-resistant strains of Mycobacterium tuberculosis, dictating new approaches to the treatment of the disease. Thiolactomycin (TLM) is a unique thiolactone that has been shown to exhibit anti-mycobacterial activity by specifically inhibiting fatty acid and mycolic acid biosynthesis. In this study, we present evidence that TLM targets two beta-ketoacyl-acyl-carrier protein synthases, KasA and KasB, consistent with the fact that both enzymes belong to the fatty-acid synthase type II system involved in fatty acid and mycolic acid biosynthesis. Overexpression of KasA, KasB, and KasAB in Mycobacterium bovis BCG increased in vivo and in vitro resistance against TLM. In addition, a multidrug-resistant clinical isolate was also found to be highly sensitive to TLM, indicating promise in counteracting multidrug-resistant strains of M. tuberculosis. The design and synthesis of several TLM derivatives have led to compounds more potent both in vitro against fatty acid and mycolic acid biosynthesis and in vivo against M. tuberculosis. Finally, a three-dimensional structural model of KasA has also been generated to improve understanding of the catalytic site of mycobacterial Kas proteins and to provide a more rational approach to the design of new drugs.     

腹腔镜胃癌根治术的研究进展

胃癌是全球发病率较高的恶性肿瘤之一,且发病率呈逐年上升的趋势。传统的治疗方法是开腹胃癌根治术,但该方法对患者机体造成的创伤较大,不利于患者术后恢复,在一定程度上影响了手术治疗的效果。随着医学技术的发展及"微创外科"理念的不断深入,腹腔镜手术以其创伤小、术中出血量少以及术后恢复快等特点被广泛应用于外科手术治疗中。近年来,3D腹腔镜技术的出现使手术视野更加清晰,术中操作更加简便,在一定程度上提高了手术的安全性,但临床对于进展期胃癌根治术的远期疗效一直存在争议。因此,本文对腹腔镜在胃癌根治术中的作用及意义作以综述,为胃癌的微创治疗提供理论参考。     

全胸腔镜肺叶切除术治疗早期非小细胞肺癌患者的预后分析

目的:探讨全胸腔镜肺叶切除术治疗早期非小细胞肺癌(NSCLC)患者的疗效及预后状况。方法:选择2010年6月至2013年6月我院收治的早期NSCLC患者80例作为研究对象,随机分为对照组(n=40)和实验组(n=40)。对照组患者行常规开胸肺叶切除术,实验组患者行全胸腔镜肺叶切除术,所有患者于术后视具体情况给予化疗或放疗。记录两组患者术中及术后临床相关指标,术后并发症发生率,术后随访3年,比较两组患者3年生存率,并分析全胸腔镜肺叶切除术后患者预后影响因素。结果:实验组患者手术时间、术中出血量、胸腔引流时间及住院时间均明显低于对照组(P0.05)。实验组患者术后并发症发生率、术后3年生存率分别为12.50%、57.50%,与对照组的17.50%、50.00%相比,差异均无统计学意义(P0.05)。Cox多因素分析结果显示,肿瘤直径和术后是否放化疗是影响全胸腔镜肺叶切除术后患者预后的危险因素(P0.05)。结论:全胸腔镜肺叶切除术治疗早期NSCLC患者具有微创、安全及远期生存率较高的特点,术后辅以放化疗能够延长患者的生存率。     

Isorhamnetin Inhibits Proliferation and Invasion and Induces Apoptosis through the Modulation of Peroxisome Proliferator-activated Receptor γ Activation Pathway in Gastric Cancer

Gastric cancer (GC) is a lethal malignancy and the second most common cause of cancer-related deaths. Although treatment options such as chemotherapy, radiotherapy, and surgery have led to a decline in the mortality rate due to GC, chemoresistance remains as one of the major causes for poor prognosis and high recurrence rate. In this study, we investigated the potential effects of isorhamnetin (IH), a 3′-O-methylated metabolite of quercetin on the peroxisome proliferator-activated receptor γ (PPAR-γ) signaling cascade using proteomics technology platform, GC cell lines, and xenograft mice model. We observed that IH exerted a strong antiproliferative effect and increased cytotoxicity in combination with chemotherapeutic drugs. IH also inhibited the migratory/invasive properties of GC cells, which could be reversed in the presence of PPAR-γ inhibitor. We found that IH increased PPAR-γ activity and modulated the expression of PPAR-γ regulated genes in GC cells. Also, the increase in PPAR-γ activity was reversed in the presence of PPAR-γ-specific inhibitor and a mutated PPAR-γ dominant negative plasmid, supporting our hypothesis that IH can act as a ligand of PPAR-γ. Using molecular docking analysis, we demonstrate that IH formed interactions with seven polar residues and six nonpolar residues within the ligand-binding pocket of PPAR-γ that are reported to be critical for its activity and could competitively bind to PPAR-γ. IH significantly increased the expression of PPAR-γ in tumor tissues obtained from xenograft model of GC. Overall, our findings clearly indicate that antitumor effects of IH may be mediated through modulation of the PPAR-γ activation pathway in GC.     

New insights for pelvic radiation disease treatment: Multipotent stromal cell is a promise mainstay treatment for the restoration of abdominopelvic severe chronic damages induced by radiotherapy

Radiotherapy may induce irreversible damage on healthy tissues surrounding the tumor. It has been reported that the majority of patients receiving pelvic radiation therapy show early or late tissue reactions of graded severity as radiotherapy affects not only the targeted tumor cells but also the surrounding healthy tissues. The late adverse effects of pelvic radiotherapy concern 5% to 10% of them, which could be life threatening. However, a clear medical consensus concerning the clinical management of such healthy tissue sequelae does not exist. Although no pharmacologic interventions have yet been proven to efficiently mitigate radiotherapy severe side effects, few preclinical researches show the potential of combined and sequential pharmacological treatments to prevent the onset of tissue damage. Our group has demonstrated in preclinical animal models that systemic mesenchymal stromal cell (MSC) injection is a promising approach for the medical management of gastrointestinal disorder after irradiation. We have shown that MSCs migrate to damaged tissues and restore gut functions after irradiation. We carefully studied side effects of stem cell injection for further application in patients. We have shown that clinical status of four patients suffering from severe pelvic side effects resulting from an over-dosage was improved following MSC injection in a compationnal situation.     

Improved production of the tallysomycin H-1 in Streptoalloteichus hindustanus SB8005 strain by fermentation optimization

Tallysomycin (TLM) H-1, a novel TLM analog, is the major product isolated from Streptoalloteichus hindustanus SB8005, a genetically engineered strain from S. hindustanus E465-94 ATCC 31158. Based on the structural comparison and experimental assays, TLM H-1 represents a novel bleomycin (BLM) analog displaying DNA cleavage activity similar to its parent compounds TLM and BLM, both representatives of the glycopeptide anticancer antibiotics. The low titer of TLM H-1 in the engineered SB8005 strain has greatly limited its further study. In this paper, fermentation optimization for TLM H-1 production in the SB8005 strain is described; single-factor optimization and response surface methodology proved invaluable. The results indicated that three variables including distiller’s grains and solubles, copper sulfate, and maltose out of eight parameters could significantly influence the TLM H-1 production. With systematic comparison and evaluation, the final optimized fermentation medium was determined. The optimized yield of TLM H-1 in the bench-top fermentor was 249.9 mg/L, which is 26.8 times higher than reported using the original medium, and 12.9-fold higher than that of the parent compound TLM produced by the wild-type strain. This work provides important parameters for TLM H-1 production by fermentation and should facilitate further mechanistic studies and clinical developments of TLM H-1 as an anticancer agent.     

非小细胞肺癌免疫治疗的研究进展

肺癌(lung cancer)是全球发病率及死亡率最高的恶性肿瘤之一,非小细胞肺癌(non-small cell lung cancer,NSCLC)占肺癌的85%,其五年生存率只有15%,传统的抗肿瘤治疗方法(手术、放疗和化疗等)在抑制肿瘤进展中的作用有限,即使有手术机会,也有40%以上患者出现局部复发或远处转移。目前多学科治疗较大程度提高了晚期NSCLC的生存期,研究表明,免疫治疗(immunotherapy)可改善肺癌的预后,有望成为肺癌的重要辅助治疗方式。其中,治疗性肿瘤疫苗(vaccination)如MAGE-A3、L-BLP25、Belagenpum atucel-L等、免疫检查点抑制剂(immune checkpoint inhibition)如ipilimumab、nivolumab、pembrolizumab等得到广泛关注。一系列临床试验表明免疫治疗可以使非小细胞肺癌的死亡率得到缓解,本文就其原理、临床试验、不良反应及有待解决问题的临床研究作系统综述。