洋葱伯克霍尔德菌致恶性肿瘤患者医院获得性感染的耐药性分析

目的分析我院恶性肿瘤患者医院获得性感染洋葱伯克霍尔德菌的临床特点及对常用抗菌药物的耐药性,为临床合理治疗提供依据。方法回顾性分析2011年1月至2013年12月,从我院恶性肿瘤感染患者送检的细菌培养标本;细菌鉴定用美国BD公司phoenix-100全自动细菌鉴定药敏系统,药敏试验采用纸片法,同时使用WHONET 5.6软件对相关资料进行统计。结果从检测部位分析主要分布在下呼吸道（74.1%）,其次为血液（9.4%）;药敏试验表明139株洋葱伯克霍尔德菌对米诺环素、氯霉素、美罗培南、头孢他啶和头孢哌酮/舒巴坦仍较敏感,可作为临床治疗洋葱伯克霍尔德菌感染的首选药物,其余15种抗菌药物的耐药率高达30.0%~100%。结论洋葱伯克霍尔德菌在恶性肿瘤患者中的耐药现象非常严重,临床应引起高度关注,及早进行微生物学检测,并根据药敏试验结果合理选用抗菌药物。     

Ca2+ Influx via the Na+/Ca2+ Exchanger Is Enhanced in Malignant Hyperthermia Skeletal Muscle

Malignant hyperthermia (MH) is potentially fatal pharmacogenetic disorder of skeletal muscle caused by intracellular Ca²⁺ dysregulation. NCX is a bidirectional transporter that effluxes (forward mode) or influxes (reverse mode) Ca²⁺ depending on cellular activity. Resting intracellular calcium ([Ca²⁺]_r) and sodium ([Na⁺]_r) concentrations are elevated in MH susceptible (MHS) swine and murine muscles compared with their normal (MHN) counterparts, although the contribution of NCX is unclear. Lowering [Na⁺]_e elevates [Ca²⁺]_r in both MHN and MHS swine muscle fibers and it is prevented by removal of extracellular Ca²⁺ or reduced by t-tubule disruption, in both genotypes. KB-R7943, a nonselective NCX3 blocker, reduced [Ca²⁺]_r in both swine and murine MHN and MHS muscle fibers at rest and decreased the magnitude of the elevation of [Ca²⁺]_r observed in MHS fibers after exposure to halothane. YM-244769, a high affinity reverse mode NCX3 blocker, reduces [Ca²⁺]_r in MHS muscle fibers and decreases the amplitude of [Ca²⁺]_r rise triggered by halothane, but had no effect on [Ca²⁺]_r in MHN muscle. In addition, YM-244769 reduced the peak and area under the curve of the Ca²⁺ transient elicited by high [K⁺]_e and increased its rate of decay in MHS muscle fibers. siRNA knockdown of NCX3 in MHS myotubes reduced [Ca²⁺]_r and the Ca²⁺ transient area induced by high [K⁺]_e. These results demonstrate a functional NCX3 in skeletal muscle whose activity is enhanced in MHS. Moreover reverse mode NCX3 contributes to the Ca²⁺ transients associated with K⁺-induced depolarization and the halothane-triggered MH episode in MHS muscle fibers.     

循环肿瘤细胞识别技术研究现状

循环肿瘤细胞(CTCs)对恶性肿瘤传播转移有重要影响,因此CTCs识别技术的出现与不断进步有着重要的临床意义,准确可靠的CTCs识别技术将为尽早确诊肿瘤、指导个性化治疗方案、诊断微小残留病变以及评估抗癌药物的敏感性提供强有力的工具。本文针对核酸检测法、免疫细胞化学术、流式细胞术和基于表征特性图像识别技术等CTC识别技术的发展情况进行了综述总结,比较各种技术的优缺点,对现阶段该领域存在的问题进行了讨论,并对CTCs识别的技术发展方向作了进一步的展望,为学者们提供更广的研究思路。     

恶性肿瘤胸腹水细胞学检验的探讨

目的探讨胸腹水细胞学检验在恶性肿瘤细胞诊断中的应用价值。方法回顾我院2014年1月~2016年6月376例胸腹水脱落细胞学的检验结果,分析胸腹水细胞学检验在恶性肿瘤诊断中的应用价值。结果 376例胸腹水脱落细胞学检验患者中,发现疑似肿瘤细胞3例,恶性肿瘤细胞74例,病理组织学证实恶性肿瘤患者79例,胸腹水细胞学检验的正确率高达97.47%,假阴性率为2.53%,假阳性率为0%。结论胸腹水脱落细胞学检验在恶性肿瘤诊断中具有重要的临床价值,值得临床推广。     

腹腔灌注化疗联合内生场热疗治疗胰腺癌恶性腹水的疗效

目的:探讨腹腔灌注化疗联合内生场热疗治疗胰腺癌恶性腹水的临床疗效。方法:将50例晚期胰腺癌合并恶性腹水患者随机分为实验组与对照组,每组25例。实验组行腹腔灌注化疗联合内生场热疗治疗,对照组单纯行腹腔灌注化疗。比较两组患者腹水控制疗效、生活质量改善、疼痛程度和不良反应情况。结果:实验组患者治疗后腹水控制总有效率为68.0%,明显高于对照组的36.0%(P0.05);实验组生活质量改善率达60.0%,远高于对照组的40.0%(P0.05);实验组患者疼痛水平明显好于对照组(P0.05);两组患者不良反应发生率无明显差异(P0.05)。结论:腹腔灌注化疗联合内生场热疗治疗胰腺癌恶性腹水效果显著,能明显改善患者生活质量、缓解疼痛,值得临床推广。     

CVTP联合化疗方案对初治和复治难治恶性淋巴瘤的临床疗效研究

目的:比较环磷酰胺-西艾克-吡柔比星-泼尼松(Cyclophosphamidum-Vindesine-Tetrahydropyranyl-Prednisone,CVTP)联合化疗方案对初治和复治、难治恶性淋巴瘤的临床疗效。方法:按照化疗史将102例恶性淋巴瘤患者分为初治组59例和复治难治组43例,两组患者均给予CVTP联合化疗方案治疗,比较两组化疗效果、外周血淋巴细胞亚群、毒副反应差别。结果:初治组患者部分缓解(partial remission,PR)率和总有效率(overall response rate,ORR)均显著高于对复治难治组,差异具有统计学意义(P0.05);初治组患者治疗后CD3~+、CD4~+、CD4~+/CD8~++、NK细胞含量均显著高于复治难治组,CD8~+水平显著低于复治难治组,差异具有统计学意义(P0.05);初治组患者化疗期间白细胞下降、血红蛋白下降、血小板减少、恶心呕吐发生率均显著低于复治难治组,差异具有统计学意义(P0.05)。结论:CVTP联合化疗方案治疗初治恶性淋巴瘤近期疗效优于复治难治患者。     

Eosinophilic globule cells in mouse MFH-like sarcomas

Light and electron microscopic observations were made on eosinophilic globule (EG) cells found in 27 subcutaneous malignant fibrous histiocytoma (MFH)-like sarcomas in aged ICR mice. These tumors, which were composed of fibroblast-like cells as the major component, with small numbers of histiocyte-like cells and undifferentiated cells, showed one or more of five growth patterns: storiform, pleomorphic, fascicular, myxoid, and hemangiopericytoma-like. EG cells were interspersed among the tumor cells and were also present in metastatic lesions. They were pleomorphic in shape and contained various numbers of cytoplasmic globules, which were positive with the periodic acid-Schiff reaction and resistant to diastase digestion. Electron microscopic observation revealed that these cells had small finger-like and pseudopodia-like projections, and contained varied numbers of characteristic osmiophilic globules and glycogen particles in the cytoplasm which seemed to become more abundant as the cells differentiated. The osmiophilic globules consisted of a dense homogeneous core and a marginal area rich in small vesicular membranous structures. A small population of EG cells exhibited features suggesting differentiation to fibroblasts; these were characterized by an increased amount of rough endoplasmic reticulum. It is suggested that the EG cell is a neoplastic cell, perhaps derived from a primitive mesenchymal cell, although an inflammatory cell origin is also possible.     

Skeletal muscle mitochondrial phospholipase A2 and the interaction of mitochondria and sarcoplasmic reticulum in porcine malignant hyperthermia

Comparative studies were carried out on the Ca²⁺-transport systems of mitochondria and sarcoplasmic reticulum from longissimus dorsi muscle of genetically selected malignant hyperthermia-prone and normal pigs in order to identify the biochemical lesion responsible for the enhanced release of Ca²⁺ in the sarcoplasm occurring in porcine malignant hyperthermia. Mitochondria isolated from longissimus dorsi muscle of malignant hyperthermia-prone pigs contained a significantly (P < 0.001) higher amount of endogenous long-chain fatty acids. Similar amounts of endogenous mitochondrial phospholipase A₂ were observed in both types of pigs, but the total activity in malignant hyperthermia-prone pigs was at least twice that of normal. Spermine, a phospholipase A₂ inhibitor, lowered the activity in both types of mitochondria to a similar final level. Mitochondria of malignant hyperthermia-prone pigs showed a significantly (P < 0.001) higher oligomycin-insensitive (Ca²⁺ + Mg²⁺)-ATPase activity, but the Mg²⁺-ATPase and the (Ca²⁺ + Mg²⁺)-ATPase activities were similar in both types of pigs. Sarcoplasmic reticulum isolated from longissimus dorsi muscle of malignant hyperthermia-prone pigs showed a significantly higher (Ca²⁺ + Mg²⁺)-ATPase activity and a lower rate of Ca²⁺ uptake; the maximal amount and the rate of Ca²⁺ uptake by sarcoplasmic reticulum of malignant hyperthermia-prone pigs were half that of normal. Mitochondria from longissimus dorsi muscle of malignant hyperthermia-prone pigs inhibited the Ca²⁺-transport system of the sarcoplasmic reticulum of longissimus dorsi from both normal and malignant hyperthermia-prone pigs, but mitochondria from normal pigs had no influence on the sarcoplasmic reticulum from either type. Experimental evidence favours the concept that long-chain fatty acids released from skeletal muscle mitochondria by endogenous mitochondrial phospholipase A₂ are responsible for the enhanced release of Ca²⁺ from mitochondria (Cheah, K.S. and Cheah, A.M. (1981) Biochim. Biophys. Acta 634, 70–84), and also additional release of Ca²⁺ from sarcoplasmic reticulum into the sarcoplasm during porcine malignant hyperthermia syndrome.     

Intérêt de la TEP/TDM au 18F-FDG dans la neurofibromatose de type 1, expérience du centre national de référence Henri-Mondor sur 10 ans

ObjectiveMalignant peripherals nerve sheath tumours (MPNST) are one of the leading causes of death in neurofibromatosis type 1 (NF1). Given the temporal and spatial multiplicity of suspicious lesions, the histological diagnosis of certainty might require iterative and decaying surgical procedure. Our objective was to determine the threshold values of metabolic metrics determined on ¹⁸F-FDG PET/CT (SUV_max, total lesion glycolysis [TLG], total metabolic tumour volume [TMTV], tumour-to-liver [T/L] ratio and heterogeneity index [HI]) in order to distinguish at best MPNST from benign lesion (simple neurofibromas [NF] or dysplastic NF).Patients and methodsHundred and seven patients from the national reference centre of NF1 Henri-Mondor, clinically suspects of TMGN, underwent 160 ¹⁸F-FDG PET/CT over a period of 10 years, between 2005 and 2015. The hypermetabolics lesions identified on ¹⁸F-FDG PET/CT were confronted with pathological analysis or clinico-radiological and metabolic follow-up of more than 6 months.ResultsFour hundred and eight hypermetabolics lesions were identified, of which 112 were histologically confronted with 38 simple NF, 29 dysplastic NF, 39 TMGN and 6 incidentalomas. The remaining 296 hypermetabolics lesions experienced a median follow-up of 40.4 months [13.5–137 months]. The optimal cut-off values for malignant lesions, determined by ROC curves, were in order of decreasing performance: T/L ratio > 2.03 (sensitivity 96%, specificity 88%); SUVmax > 4.74 (sensitivity 93%, specificity 86%); TLG > 172 (sensitivity 84%, specificity 76%); TMTV > 53.5 (sensitivity 83%, specificity 68%); HI > 1.63 (sensitivity 84%, specificity 54%).Conclusions¹⁸F-FDG PET/CT is a powerful diagnostic and prognostic tool in the management of TMGN. Metabolic metrics allow with good sensitivity and specificity to identify lesions transformed into TMGN. The advent of PET/MRI will undoubtedly allow in the near future to reinforce the diagnostic and prognostic performances for the detection of transformations of neurofibromas in TMGN.     

恶性胸腔积液的治疗现状

恶性胸液在临床上基本上都出现在肿瘤的中、晚期,治疗的主要目的是解决患者的痛苦、提高病人的生存质量、延长患者的生命,其治疗措施随着科技的进步也在不断地改进完善,远期效果将有待于进一步提高。