Notch1在胆管癌细胞光动力疗法中的作用研究

目的:1、研究Photosan介导光动力疗法(Photodynamic Therapy,PDT)对胆管癌细胞的杀伤作用。2、探讨Notch1在胆管癌发生中的表达情况以及Notch1在PDT治疗胆管癌细胞中的作用。方法:1、体外培养人胆管癌QBC939细胞株,在细胞对数生长期用不同浓度Photosan处理,并用半导体激光治疗仪不同强度光照后,采用MTT法检测PDT对QBC939细胞的杀伤作用。观察不同的光敏剂孵育时间、光敏剂浓度及光照剂量对PDT效果的影响。2、采用免疫细胞化学方法和蛋白印迹法检测胆管癌细胞Notch1表达,经Photosan介导光动力作用胆管癌细胞后,检测胆管癌细胞内Notch1表达变化。结果:1、MTT结果显示Photosan介导的PDT对胆管癌细胞有杀伤作用(P0.05),而且这种杀伤作用在一定范围内随着光敏剂浓度增加、光敏剂孵育时间、光照剂量呈正相关。2、免疫细胞学检查发现Notch1在胆管癌细胞中高表达,其表达主要位于细胞膜及胞浆,并且经PDT处理后Notch1表达量较前减少(P0.05)。结论:Notch1与胆管癌细胞生长、增殖密切相关,且Notch1在PDT对胆管癌细胞产生的抑制、促凋亡和杀伤作用中有重要作用。     

胆管结石合并胆管癌的临床特征与诊治分析

目的：探讨胆管结石合并胆管癌的临床特征及诊治方法。方法：回顾性分析2000年1月-2009年12月我院收治的胆管结石合并胆管癌16例患者的临床病理资料。结果：胆管癌的发生率占同期胆管结石患者的3.1%,其临床表现以右上腹疼痛及反复的胆管炎发作为主,但缺乏特异性。术前胆管癌组患者AKP、γ-GT均有不同程度升高,ALT升高12例,总胆红素升高9例,与非胆管癌组相比,AKP、γ-GT、ALT、TBIL均显著升高（P〈0.01）,且胆管癌组术前血清CA19-9及CEA显著高于非胆管癌组（P〈0.01）,而两组间CA125及AFP水平比较无显著差异（P〉0.05）。16例患者中可进行手术治疗10例;其中根治性手术8例,姑息性手术2例。8例根治性手术患者的1、3年生存率分别为78.6%和36.4%;2例姑息性手术患者1、3年生存率分别为50.0%和0%,两组比较具有显著性差异（P〈0.05）。结论：胆管结石合并胆管癌的临床表现缺乏特异性,患者的疗效较差,对血清CA19-9和CEA显著升高者应行病理活检确诊,治疗手段应该力争实行根治性切除,有助于提高患者的生存期。     

光动力疗法对体外培养人胰腺癌细胞株PANC-1作用

目的:探讨血卟啉注射液(Hematoporphyrin Derivative,HPD)光动力疗法(Photodynamic Therapy,PDT)对体外培养的人胰腺癌细胞株PANC-1的生物作用。方法:实验分为4组,空白对照组、单纯HPD组、单纯光照组及HPD+PDT组。采用MTT法检测光动力作用后细胞的存活率,并用Annexin V-FITC/P I双染法检测其凋亡率。结果:在光敏剂浓度为5mg/L,光照剂量为10J/cm2时,光动力对PANC-1细胞达到最佳的实验效果,与对照组相比差异有显著性。在此实验参数条件下,流式细胞术(FCM)检测各组人胰腺癌细胞PANC-1凋亡率:HPD+PDT实验组达(36.40±4.21)%,明显高于单纯HPD(6.76±0.44)%,单纯PDT组(8.30±0.32)%及空白组(5.00±0.53)%三个对照组(P<0.05),三个对照组间差异无统计学意义(P>0.05)。结论:PDT光动力作用对体外培养人胰腺癌细胞PANC-1有明确抑制效应,并与HPD浓度及光照强度相关。     

光动力疗法防治损伤性血管内膜增生的实验研究

目的 :观察光动力疗法 (PDT)防治损伤性血管内膜增生的近期疗效 ,并筛选PDT参数。方法 :首先筛选PDT参数。兔 2 4只 ,按L4 ( 2 3)正交实验方案分为四组 ,处理因素为血啉甲醚 5或 10mg/kg、功率密度 30或 90mw/cm2 、照射时间 15或 30min。球囊法损伤髂总动脉内膜 ,随后进行PDT处理 ,2 1天后取材 ,以中膜与内膜面积的比值为指标分析各处理因素的作用。其次观察PDT疗效。兔 2 4只 ,随机分成 4组 :( 1)单纯损伤组 ;( 2 )PDT对照组 ,内膜损伤后先激光照射 ,后注射血啉甲醚 ;( 3)低PDT剂量组 ,内膜损伤后先注射血啉甲醚 5.0mg/kg ,然后以 30mw/cm2 照射 15min ;( 4 )高PDT剂量组 ,以 90mw/cm2 照射 ,其余同低剂量组。以内膜与中膜面积的比值为指标分析PDT疗效。结果 :预选参数的最优搭配为 :功率密度为 30mw/cm2 ,照射时间为 15min ,血啉甲醚剂量为 5mg/kg。低剂量组与高剂量组的S1/S2 比值分别比单纯损伤组低 71.9% (P <0 .0 1)和 59.4 % (P <0 .0 5) ,比PDT对照组低 63.1% (P <0 .0 1)和 4 6.5% (P <0 .0 5)。结论 :经皮血管内光动力疗法可能成为防治损伤性血管内膜增生的有效方法。     

新型光敏剂在肝癌中的应用

肝癌晚期,手术切除往往效果不佳,5年生存率低。因此,通过新的辅助治疗方式提高患者生存期是必要的。光动力疗法作为晚期肝癌的姑息性治疗方法,光敏剂是光动力疗法中至关重要的因素。几十年来,光敏剂经过不断发展,如今已出现了许多新型光敏剂,它们具有靶向性高、脂溶性强、生物利用度高等特点,随着肝脏肿瘤多学科合作模式的逐渐开展,新型光敏剂及光动力疗法也将在其中扮演重要的角色。     

光动力治疗在各类恶性肿瘤病人姑息治疗中的应用探讨

光动力治疗(photodynamic therapy,PDT)是近二十年来新兴的肿瘤治疗方法,与肿瘤传统手术、化疗和放疗方法相比,能选择性地消灭局部的原发和复发肿瘤,而不伤及正常组织。大多数肿瘤出现临床症状时,已是肿瘤晚期,丧失了肿瘤治疗的最佳时机。光动力治疗作为新兴的肿瘤治疗技术,能够以较小创伤为代价改善患者的生活质量,并提高患者生存时间,有望成为恶性肿瘤姑息性治疗的首选。     

光动力治疗光源的研究新进展

光动力疗法(PDT)是一种联合利用治疗光源、光敏剂和氧分子,选择性治疗恶性肿瘤和良性疾病的精准靶向疗法。光源作为PDT治疗的关键要素之一,其发光波长、照光方式和剂量直接影响疗效。本文详细介绍了太阳光、近红外光、X射线、在体发光和发光二极管等5种PDT光源的研究新进展,并分析了这五种治疗光源在生物组织穿透深度上的不同特性以及所存在的不足。随后,重点讨论了以提高PDT治疗精度为目标的体表照光和体内照光等两种个性化照光模式。研发操作简便、价格低廉、性能优异的新型PDT光源是未来的发展方向。     

辐射诱导对犬胆管平滑肌细胞凋亡中BCL-2活性的影响

目的:探讨γ射线对BCL-2基因在犬胆管壁增殖平滑肌细胞凋亡中的活性影响。方法:实验犬24只(15～18kg),随机分为普通支架组和~(125)I支架组各12只。用切断吻合法,造成胆总管损伤。术后30天胆道狭窄形成后,分组将普通支架及125I支架从胆总管末端开口处释放到胆总管内。置入支架后60d分别行病理形态学检测,用免疫组织化学方法进行凋亡细胞,BCL-2蛋白基因检测,并用计算机图像检测系统检侧两组胆管腔面积。结果:~(125)I支架组犬胆管组织中BCL-2基因表达较普通支架组减弱,且BCL-2基因低表达组犬胆管出现明显增殖平滑肌细胞凋亡,而且犬肝外胆管无明显狭窄;而普通支架BCL-2基因高表达,且犬胆管未出现增殖平滑肌细胞明显凋亡,而且犬肝外胆管有明显狭窄。结论:~(125)I放射性支架通过抑制BCL-2基因,促进犬胆管增殖平滑肌细胞凋亡,可以抑制犬肝外胆管狭窄。     

肿瘤局部切除加125Ⅰ残瘤间植入治疗肝门部胆管癌

目的：探讨晚期肝门部胆管癌的治疗方法。方法：肝门部胆管癌9例,肿瘤局部切除,胆肠吻合,吻合口后壁采用血管吻合线无创吻合,残余肿瘤^125I组织间植入持续、精确、适形的放射治疗。结果：所有患者术后恢复良好,黄疸于1-2月后基本消退,未出现胆漏及胆管炎等并发症,随访2-18月,全部存活。结论：肝门部胆管癌肿瘤局部切除,胆肠吻合时后壁采用血管吻合线吻合,可以简化手术;^125I组织间植入治疗残余肿瘤安全,有效,操作简单,对于胆管癌行肿瘤姑息性切除者,可降低术后复发,提高生存率。     

肿瘤局部切除加125Ⅰ残瘤间植入治疗肝门部胆管癌

目的:探讨晚期肝门部胆管癌的治疗方法.方法:肝门部胆管癌9例,肿瘤局部切除,胆肠吻合,吻合口后壁采用血管吻合线无创吻合,残余肿瘤125I组织间植入持续、精确、适形的放射治疗.结果:所有患者术后恢复良好,黄痘于1-2月后基本消退,未出现胆漏及胆管炎等并发症,随访2-18月,全部存活.结论:肝门部胆管癌肿瘤局部切除,胆肠吻合时后壁采用血管吻合线吻合,可以简化手术;125I组织间植入治疗残余肿瘤安全,有效,操作简单,对于胆管癌行肿瘤姑息性切除者,可降低术后复发,提高生存率.     

布美他尼与光动力疗法联合应用对大鼠C6胶质瘤的治疗作用

目的：探讨布美他尼对PDT诱导加剧的大鼠C6胶质瘤瘤周水肿的治疗作用。方法：培养C6胶质瘤细胞,建立C6大鼠胶质瘤模型,分成：A：空白对照组,B：光动力治疗组,C：布美他尼治疗组,D：光动力和布美他尼联合治疗组。荷瘤21天后取材测量瘤重,瘤周水含量,微血管密度,NKCC-1和ZO-1的表达。另外MRI监测肿瘤生长,记录大鼠生存时间。结果：PDT能够抑制胶质瘤细胞生长增殖,杀伤肿瘤细胞,促使肿瘤细胞凋亡,下调紧密连接相关蛋白的表达来打开紧密连接,从而延长生存期,同时诱使NKCC-1过表达引起瘤周水肿加剧。结论：应用布美他尼联合治疗能抑制PDT单独应用引起的NKCC-1过表达,减轻PDT加重的瘤周水肿,增强PDT的杀肿瘤作用,而不减少ZO-1的表达。     

Photodynamic and Antibiotic Therapy Impair the Pathogenesis of Enterococcus faecium in a Whole Animal Insect Model

Enterococcus faecium has emerged as one of the most important pathogens in healthcare-associated infections worldwide due to its intrinsic and acquired resistance to many antibiotics, including vancomycin. Antimicrobial photodynamic therapy (aPDT) is an alternative therapeutic platform that is currently under investigation for the control and treatment of infections. PDT is based on the use of photoactive dye molecules, widely known as photosensitizer (PS). PS, upon irradiation with visible light, produces reactive oxygen species that can destroy lipids and proteins causing cell death. We employed Galleria mellonella (the greater wax moth) caterpillar fatally infected with E. faecium to develop an invertebrate host model system that can be used to study the antimicrobial PDT (alone or combined with antibiotics). In the establishment of infection by E. faecium in G. mellonella, we found that the G. mellonella death rate was dependent on the number of bacterial cells injected into the insect hemocoel and all E. faecium strains tested were capable of infecting and killing G. mellonella. Antibiotic treatment with ampicillin, gentamicin or the combination of ampicillin and gentamicin prolonged caterpillar survival infected by E. faecium (P = 0.0003, P = 0.0001 and P = 0.0001, respectively). In the study of antimicrobial PDT, we verified that methylene blue (MB) injected into the insect followed by whole body illumination prolonged the caterpillar survival (P = 0.0192). Interestingly, combination therapy of larvae infected with vancomycin-resistant E. faecium, with antimicrobial PDT followed by vancomycin, significantly prolonged the survival of the caterpillars when compared to either antimicrobial PDT (P = 0.0095) or vancomycin treatment alone (P = 0.0025), suggesting that the aPDT made the vancomycin resistant E. faecium strain more susceptible to vancomycin action. In summary, G. mellonella provides an invertebrate model host to study the antimicrobial PDT and to explore combinatorial aPDT-based treatments.     

Baseline Karnofsky performance status is independently predictive of death within 30 days of intracranial radiation therapy completion for metastatic disease

IntroductionFor patients with brain metastases, palliative radiation therapy (RT) has long been a standard of care for improving quality of life and optimizing intracranial disease control. The duration of time between completion of palliative RT and patient death has rarely been evaluated.MethodsA compilation of two prospective institutional databases encompassing April 2015 through December 2018 was used to identify patients who received palliative intracranial radiation therapy. A multivariate logistic regression model characterized patients adjusting for age, sex, admission status (inpatient versus outpatient), Karnofsky Performance Status (KPS), and radiation therapy indication.Results136 consecutive patients received intracranial palliative radiation therapy. Patients with baseline KPS <70 (OR = 2.2; 95%CI = 1.6–3.1; p < 0.0001) were significantly more likely to die within 30 days of treatment. Intracranial palliative radiation therapy was most commonly delivered to provide local control (66% of patients) or alleviate neurologic symptoms (32% of patients), and was most commonly delivered via whole brain radiation therapy in 10 fractions to 30 Gy (38% of patients). Of the 42 patients who died within 30 days of RT, 31 (74%) received at least 10 fractions.ConclusionsOur findings indicate that baseline KPS <70 is independently predictive of death within 30 days of palliative intracranial RT, and that a large majority of patients who died within 30 days received at least 10 fractions. These results indicate that for poor performance status patients requiring palliative intracranial radiation, hypofractionated RT courses should be strongly considered.     

Photodynamic therapy of murine fibrosarcoma with topical and systemic administration of Hypericin

The in vivo antitumour activity of the natural photosensitizer hypericin was evaluated. C3H/DiSn mice inoculated with fibrosarcoma G5:1:13 cells were intraperitoneally or intratumourally injected with hypericin (5 mg/kg) and 2 hours later the mice were locally irradiated with laser light (488 nm, 150 mW/cm2, 180 J/cm2) when the tumour reached volume of 40-80 mm3 (approximately 17 days after inoculation). Tumours treated with hypericin alone as well as those irradiated with laser light alone have similar growth rates and none of these tumours regressed spontaneously. The mean tumour volume in hypericin-PDT treated groups was significantly lower in comparison to that found in the control group 3-5 weeks after the therapy. A higher proportion of animals with tumour volume less than 5-fold of the initial volume has been observed in both hypericin-PDT treated groups. Complete response to PDT has been observed for 44.4% of the animals with intraperitoneally administered hypericin and for 33.3% of the animals with intratumourally administered hypericin. Complete remission occurred in treated lesions with 3 mm or less in height. Hypericin-PDT significantly increased survival. However, no statistically significant difference in survival rate of animals has been found between the intratumoural and the intraperitoneal schedule of administration of hypericin.     

Docetaxel for the treatment of hormone-refractory prostate cancer

Chemotherapy has historically proven toxic and ineffective for the treatment of metastatic hormone-refractory prostate cancer (HRPC), a disease with substantial morbidity and mortality. Progress has been made in symptom relief, and the combination of mitoxantrone and prednisone is considered the palliative standard of care. The effects of a variety of chemotherapeutic agents, both alone and in combination, on prostate-specific antigen decline rates, measurable disease response, and survival have been examined in numerous phase I and II trials. Results suggest that combining vinblastine or paclitaxel with estramustine confers a survival advantage over either agent alone. In addition, docetaxel-based therapy has been found to be effective and well tolerated, and phase III trials will soon determine whether docetaxel-based therapy should replace mitoxantrone-based therapy as the standard of care for HRPC.     

Adoptive transfer of natural killer cells in combination with chemotherapy improves outcomes of patients with locally advanced colon carcinoma

Background

Despite the availability of multiple treatment strategies, patients with advanced colon carcinoma (CC) have poor prognoses. The aim of this study was to evaluate the efficacy and safety of natural killer (NK) cell therapy in combination with chemotherapy in patients with locally advanced CC.

Photodynamic therapy with Verteporfin in subfoveal choroidal metastasis of breast carcinoma (a controlled case)

A 55-year old woman with growing unilateral subfoveal choroidal metastasis of breast carcinoma was treated by photodynamic therapy (PDT) with verteporfin. Best corrected visual acuity remained stable during the whole follow-up of 6 months. Tumor flattened from 2.2 mm to 0 mm on ultrasound one month after the therapy. PDT with verteporfin appears to be the best tolerated method for palliative treatment of growing subfoveal choroidal metastasis of the breast carcinoma.     

Synergistic anti-tumor effects of combination of photodynamic therapy and arsenic compound in cervical cancer cells: in vivo and in vitro studies

The effects of As(4)O(6) as adjuvant on photodynamic therapy (PDT) were studied. As(4)O(6) is considered to have anticancer activity via several biological actions, such as free radical production and inhibition of VEGF expression. PDT or As(4)O(6) significantly inhibited TC-1 cell proliferation in a dose-dependent manner (P<0.05) by MTT assay. The anti-proliferative effect of the combination treatment was significantly higher than in TC-1 cells treated with either photodynamic therapy or As(4)O(6) alone (62.4 and 52.5% decrease compared to vehicle-only treated TC-1 cells, respectively, P<0.05). In addition, cell proliferation in combination of photodynamic therapy and As(4)O(6) treatment significantly decreased by 77.4% (P<0.05). Cell survival pathway (Naip1, Tert and Aip1) and p53-dependent pathway (Bax, p21(Cip1), Fas, Gadd45, IGFBP-3 and Mdm-2) were markedly increased by combination treatment of photodynamic therapy and As(4)O(6). In addition, the immune response in the NEAT pathway (Ly-12, CD178 and IL-2) was also modulated after combination treatment, suggesting improved antitumor effects by controlling unwanted growth-stimulatory pathways. The combination effect apparently reflected concordance with in vitro data, in restricting tumor growth in vivo and in relation to some common signaling pathways to those observed in vitro. These findings suggest the benefit of combinatory treatment with photodynamic therapy and As(4)O(6) for inhibition of cervical cancer cell growth.     

Klatskin tumor--results of surgical therapy

Between January 1st 1990 and December 31st 1999, 24 patients affected by Klatskin tumor underwent operation in our department of surgery. According to Bismuth's classification, there were 0 (0%) type I, 5 (21%) type II, 6 (25%) type IIIa, 4 (17%) type IIIb and 9 (37%) type IV tumors. Five patients (21%) were treated by curative resection (group I) while in 14 patients (58%) palliative surgical procedure was performed (group II). In 5 cases (21%) the extension of malignancy did not allowed any procedure (group III). Curative resection for malignant tumors of the hepatic duct bifurcation included wide tumor excision and bile duct resection at the liver hilum (with wedge hepatic resection in one patient) and creation of biliary-enteric anastomosis. Palliative surgical procedure included stent insertion. Jaundice was completely relieved in all patients undergoing resection, since 3 patients (21%) after stenting hadn't satisfactory biliary drainage. There was 1 (20%) perioperative death in the group 1, while in group 2, 5 patients (36%) died postoperatively. In this series, the mean postoperative survival of all patients was 16 months. The mean postoperative survival of patients undergoing localized tumor resection with curative intent was 38 months, in contrast to 10 months for those undergoing operative stent insertion. in addition, only 1 patient from group III, in whom only exploratory surgery were performed survived 7 months, while other 4 patients died in the hospital. This retrospective review suggests that aggressive surgical treatment could improve survival and quality of life in patients suffering from Klatskin tumor.