高能聚焦超声在治疗晚期胰腺癌中的疗效分析

目的：通过对晚期胰腺癌患者行高强度聚焦超声治疗,观察其近期疗效,为晚期胰腺癌患者的临床治疗提供一种新的选择。方法：对15例晚期胰腺癌患者行高强度聚焦超声治疗,对比治疗前后的KPS评分,疼痛感受评分,CA199,三大常规,生化检查,B超观察肿瘤回声及血供,CT观察肿瘤大小改变。结果：HIFU治疗后,患者KPS评分升高,疼痛评分下降,肿瘤标志物下降,B超观察肿瘤回声,其中10例肿瘤回声增强,11例肿瘤血供减少或消失,CT示大部分患者治疗后肿瘤体积缩小或不变,治疗后三大常规、生化和电解质无明显改变。结论：运用高强度聚焦超声治疗晚期胰腺癌患者,在改善患者临床症状方面有明显疗效,并且能缩小肿瘤体积,减少或中断肿瘤血供,是一种很有发展前景的无创治疗方法。     

SPARC基因DNA甲基化与胰腺癌的研究进展

SPARC(Secreted Protein Acidic and Rich in Cysteine)蛋白是一种富含半胱氨酸(Cys)的酸性分泌蛋白,参与细胞增殖、迁移、凋亡及肿瘤血管生成等生物学过程。前期研究表明,DNA甲基化在胰腺癌中广泛地存在,其可能是胰腺癌等消化道恶性肿瘤中富含半胱氨酸的酸性分泌蛋白(SPARC)表达下调的机制之一。DNA甲基化通常导致某些抑瘤基因的高甲基化失活,SPARC基因是一种抑瘤基因,甲基化能够使其功能性的失活。而通过抑制DNA甲基化可以恢复SPARC的表达,DNA甲基化有望成为胰腺癌早期诊断的潜在生物学标记物以及治疗的靶点。因此,本文主要就SPARC的DNA甲基化在胰腺癌发生发展中的最新研究进展作一综述。     

胰腺癌相关肿瘤标志物研究进展

胰腺癌起病隐匿,进展快,预后差,发病率约等于死亡率。胰腺癌死亡率高的原因有发病机制不明,缺乏有效的早期诊断和预后的肿瘤标志物,进展期相关治疗效果不理想。近年来在血清标志物、基因标志物、表观遗传学标志物等分子生物技术及生物信息学方面的发展为胰腺癌的诊断,尤其是早期诊断、评估预后和监测早期复发提供了新的途径。本文就近期胰腺癌相关肿瘤标志物的研究进展作一综述。     

Inactivation of the Transcription Factor GLI1 Accelerates Pancreatic Cancer Progression

The role of GLI1 in pancreatic tumor initiation promoting the progression of preneoplastic lesions into tumors is well established. However, its function at later stages of pancreatic carcinogenesis remains poorly understood. To address this issue, we crossed the gli1 knock-out (GKO) animal with cre-dependent pancreatic activation of oncogenic kras concomitant with loss of the tumor suppressor tp53 (KPC). Interestingly, in this model, GLI1 played a tumor-protective function, where survival of GKO/KPC mice was reduced compared with KPC littermates. Both cohorts developed pancreatic cancer without significant histopathological differences in survival studies. However, analysis of mice using ultrasound-based imaging at earlier time points showed increased tumor burden in GKO/KPC mice. These animals have larger tumors, decreased body weight, increased lactate dehydrogenase production, and severe leukopenia. In vivo and in vitro expression studies identified FAS and FAS ligand (FASL) as potential mediators of this phenomenon. The FAS/FASL axis, an apoptotic inducer, plays a role in the progression of pancreatic cancer, where its expression is usually lost or significantly reduced in advanced stages of the disease. Chromatin immunoprecipitation and reporter assays identified FAS and FASL as direct targets of GLI1, whereas GKO/KPC mice showed lower levels of this ligand compared with KPC animals. Finally, decreased levels of apoptosis were detected in tumor tissue in the absence of GLI1 by TUNEL staining. Together, these findings define a novel pathway regulated by GLI1 controlling pancreatic tumor progression and provide a new theoretical framework to help with the design and analysis of trials targeting GLI1-related pathways.     

细胞外基质金属蛋白酶诱导分子(CD147)在胰腺癌细胞及胰腺星状细胞中的表达(英文)

目的:探讨细胞外基质金属蛋白酶诱导分子(CD147)在胰腺癌细胞(Panc-1)及胰腺星状细胞(PSCs)的表达。方法:应用QRT-PCR,免疫细胞化学和免疫印迹分析方法检测Panc-1和PSCs细胞中EMMRPIN的表达,应用脱糖基化试剂N-glycosidase F及Endoglycosidase H鉴定CD147糖基化形式。结果:CD147在Panc-1和PSCs细胞质膜及细胞质中高表达,通过脱糖基化法首次鉴定出胰腺癌细胞及胰腺星状细胞中CD147不同的糖基化修饰。结论:CD147的糖基化修饰具有细胞特异性,可能与细胞恶性程度相关。     

胰腺癌细胞株和胰腺癌组织中miRNAs的表达检测

目的:探明miRNAs在胰腺癌细胞株及组织中的表达情况,证实miRNAs的差异表达与胰腺癌的发生有相关性.方法:对胰腺癌细胞株和胰腺癌组织进行总RNA的提取,通过Real-time PCR方法检测17种miRNAs(miR-16、miR-20a、miR-21、miR-26a、miR-142-3p、miR-155、miR-210、miR-181a、miR-181b、miR-196a、miR-939、miR-223、miR-1202、miR-1207-5p、miR-1825、miR-1228、miR-1915)在胰腺癌细胞株及胰腺癌组织中的表达,分析miRNAs的表达与胰腺癌患者临床表现之间有无相关性.结果:胰腺癌细胞株和胰腺癌组织中miRNAs的表达明显较正常胰腺组织高.癌组织及癌旁组织中miRNAs表达量在不同性别的胰腺癌患者中差异不大(P＞0.05),并且miRNAs的表达与患者年龄及其血清CA19-9关系不大.结论:经筛选的miRNAs可以作为胰腺癌的诊断标志.胰腺癌组织中的miRNAs表达并不是一成不变的,而是随着肿瘤的生长而不断发生变化.     

细胞外基质金属蛋白酶诱导分子（CD147）在胰腺癌细胞及胰腺星状细胞中的表达

目的：探讨细胞外基质金属蛋白酶诱导分子（CD147）在胰腺癌细胞（Panc-1）及胰腺星状细胞（PSCs）的表达。方法：应用QRT—PCR,免疫细胞化学和免疫印迹分析方法检测Panc-1和PSCs细胞中EMMRPIN的表达,应用脱糖基化试剂N—glycosidase F及Endoglycosidase H鉴定CD147糖基化形式。结果：CD147在Panc-1和PSCs细胞质膜及细胞质中高表达,通过脱糖基化法首次鉴定出胰腺癌细胞及胰腺星状细胞中CD147不同的糖基化修饰。结论：CD147的糖基化修饰具有细胞特异性,可能与细胞恶性程度相关。     

抗菌肽的研究现状和挑战

抗菌肽(AMPs)广泛存在于生物体内,可以协助机体抵御外源微生物的侵害,是生物体先天性防御系统中的重要组成成分。普遍认为,抗菌肽通过膜损伤机制,破坏微生物细胞膜或细胞壁的完整性,达到抑杀微生物的目的。然而,越来越多的证据表明抗菌肽还存在非膜损伤机制,作用于胞内靶位点杀伤细胞。由于其独特的作用机制及广谱抗菌活性,抗菌肽被应用于各行各业。但是,抗菌肽的推广应用也面临着诸多难题,如生物稳定性、抗菌活性的维持和微生物耐受性等。主要对抗菌肽的种类、作用机制、微生物对抗菌肽耐受性的产生机制及抗菌肽的应用和挑战进行综述。     

Inhibition of Amyloid Precursor Protein Processing Enhances Gemcitabine-mediated Cytotoxicity in Pancreatic Cancer Cells

Pancreatic adenocarcinoma or pancreatic cancer is often diagnosed at a very late stage at which point treatment options are minimal. Current chemotherapeutic interventions prolong survival marginally, thereby emphasizing the acute need for better treatment options to effectively manage this disease. Studies from different laboratories have shown that the Alzheimer disease-associated amyloid precursor protein (APP) is overexpressed in various cancers but its significance is not known. Here we sought to determine the role of APP in pancreatic cancer cell survival and proliferation. Our results show that pancreatic cancer cells secrete high levels of sAPPα, the α-secretase cleaved ectodomain fragment of APP, as compared with normal non-cancerous cells. Treatment of cells with batimastat or GI254023X, inhibitors of the α-secretase ADAM10, prevented sAPPα generation and reduced cell survival. Additionally, inhibition of sAPPα significantly reduced anchorage independent growth of the cancer cells. The effect of batimastat on cell survival and colony formation was enhanced when sAPPα downregulation was combined with gemcitabine treatment. Moreover, treatment of batimastat-treated cells with recombinant sAPPα reversed the inhibitory effect of the drug thereby indicating that sAPPα can indeed induce proliferation of cancer cells. Down-regulation of APP and ADAM10 brought about similar results, as did batimastat treatment, thereby confirming that APP processing is important for growth and proliferation of these cells. These results suggest that inhibition of sAPPα generation might enhance the effectiveness of the existing chemotherapeutic regimen for a better outcome.     

Pancreatic Cancer Stem-like Cells Display Aggressive Behavior Mediated via Activation of FoxQ1

Subpopulations of cancer stem cells (CSCs) or cancer stem-like cells (CSLCs) have been identified from most tumors, including pancreatic cancer (PC), and the existence of these cells is clinically relevant. Emerging evidence suggests that CSLCs participate in cell growth/proliferation, migration/invasion, metastasis, and chemo-radiotherapy resistance, ultimately contributing to poor clinical outcome. However, the pathogenesis and biological significance of CSLCs in PC has not been well characterized. In the present study, we found that isolated triple-marker-positive (CD44⁺/CD133⁺/EpCAM⁺) cells of human PC MiaPaCa-2 and L3.6pl cells behave as CSLCs. These CSLCs exhibit aggressive behavior, such as increased cell growth, migration, clonogenicity, and self-renewal capacity. The mRNA expression profiling analysis showed that CSLCs (CD44⁺/CD133⁺/EpCAM⁺) exhibit differential expression of more than 1,600 mRNAs, including FoxQ1, compared with the triple-marker-negative (CD44⁻/CD133⁻/EpCAM⁻) cells. The knockdown of FoxQ1 by its siRNA in CSLCs resulted in the inhibition of aggressive behavior, consistent with the inhibition of EpCAM and Snail expression. Mouse xenograft tumor studies showed that CSLCs have a 100-fold higher potential for tumor formation and rapid tumor growth, consistent with overexpression of CSC-associated markers/mediators, including FoxQ1, compared with its parental MiaPaCa-2 cells. The inhibition of FoxQ1 attenuated tumor formation and growth, and expression of CSC markers in the xenograft tumor derived from CSLCs of MiaPaCa-2 cells. These data clearly suggest the role of differentially expressed genes in the regulation of CSLC characteristics, further suggesting that targeting some of these genes could be important for the development of novel therapies for achieving better treatment outcome of PC.     

Fungal Vaccines and Immunotherapeutics: Current Concepts and Future Challenges

Purpose of review

The remarkable advances in modern medicine have paradoxically resulted in a rapidly expanding population of immunocompromised patients displaying extreme susceptibility to life-threatening fungal infections. There are currently no licensed vaccines, and the prophylaxis and therapy of fungal infections in at-risk individuals remains challenging, contributing to undesirable mortality and morbidity rates. The design of successful antifungal preventive approaches has been hampered by an insufficient understanding of the dynamics of the host-fungus interaction and the mechanisms that underlie heterogenous immune responses to vaccines and immunotherapy.

Recent findings

Recent advances in proteomics and glycomics have contributed to the identification of candidate antigens for use in subunit vaccines, novel adjuvants, and delivery systems to boost the efficacy of protective vaccination responses that are becoming available, and several targets are being exploited in immunotherapeutic approaches.

Summary

We review some of the emerging concepts as well as the inherent challenges to the development of fungal vaccines and immunotherapies to protect at-risk individuals.

     

SELEX技术在胰腺癌分子诊断及靶向治疗中应用的研究进展

胰腺癌由于起病隐匿,早期诊断率较低,临床治疗效果差,是目前预后最差的恶性肿瘤之一。目前,临床上尚缺乏有效的非创伤早期筛查胰腺癌的手段,因而胰腺癌的早期诊断和治疗显得尤为重要。近年来,指数富集配基的系统进化(SELEX)技术以其在其他疾病中所表现的应用价值为疾病的诊治提供了一个新的途径。对于缺乏有效确诊手段,发病隐匿且病死率高的胰腺癌而言,SELEX技术基于胰腺癌发病的分子机制,可以筛选出特异结合于胰腺癌分子靶标的适配体,对筛选所得适配体进一步化学修饰,可以实现分子水平成像及靶向治疗,进而达到胰腺癌早期诊治的目的,具有重要的临床意义。本文就SELEX技术在胰腺癌分子诊断及靶向治疗中的应用研究进展进行了综述。     

骨桥蛋白在胰腺癌中的表达及其临床意义

目的:研究骨桥蛋白OPN在胰腺癌中的表达水平及其与临床病理特征的关系。方法:采用RT-PCR和免疫组织化学方法分别检测50例胰腺癌手术切除标本和20例癌旁正常胰腺组织中OPNmRNA及其蛋白水平的表达。结果:胰腺癌组织中OPNmRNA高表达率为90%(45/50)明显高于其在癌旁正常胰腺组织中的表达15%(3/20),差异有统计学意义(P<0.01);OPN蛋白的阳性率为86.0%(43/50),明显高于癌旁正常胰腺组织中的表达30%(6/20),差异有统计学意义(P<0.01);OPN在胰腺癌组织中表达与其淋巴结转移明显相关(P<0.05)。结论:OPN在胰腺癌中的过表达对胰腺癌的生长、浸润及转移起重要作用。     

胰腺内镜超声图像纹理特征提取与分类研究

提出了胰腺内镜超声图像的纹理特征提取与分类方法,可应用于胰腺癌内镜超声图像的计算机辅助诊断。对胰腺内镜超声图像采用数字图像处理算法提取9大类共69个纹理特征。使用类间距作为可分性判据,实现特征的初步筛选,之后使用顺序前进搜索算法进一步筛选特征,并由支撑向量机实现分类。对216例病例随机选取训练集和测试集,通过多次随机实验表明。本文提出的算法实现了较高的分类准确率,为胰腺癌的临床诊断提供有价值的参考意见。     

Progress and Challenges in Thyroid Cancer Management

The state of thyroid cancer in 2021 is reviewed including the prevalence of thyroid cancer, vulnerable patient groups such as women and young adults, and known and hypothesized risk factors for thyroid cancer. Understanding the overdiagnosis and overtreatment of thyroid cancer and recent efforts to reduce harms secondary to overdiagnosis and overtreatment are addressed with optimism that future work will continue to evaluate and improve the care of patients with thyroid cancer.     

基质金属蛋白酶-9 表达与胰腺癌生物学行为及预后的相关性研究

目的:探讨基质金属蛋白酶-9(matrix metalloproteinase-9,MMP-9)的表达与胰腺癌生物学特性及对患者预后的影响。方法:采用免疫组织化学法检测63例原发性胰腺癌及11例癌旁正常组织中MMP-9的表达.比较MMP-9的表达与胰腺癌患者生物学特性及预后的关系。结果:MMP-9阳性表达率为68.3%(43/63),而11例癌旁正常组织无MMP-9表达。MMP-9的表达与肿瘤大小(P=0.014)、分化程度(P=0.039)、TNM分期(P=0.001)、远处转移(P=0.011)及淋巴结转移(P=0.009)显著相关。MMP-9表达阳性者生存时间明显低于阴性表达者(Log-rank检验,x2=32.70,P=0.000)。Cox回归分析表明:分化程度(P=0.000)、TNM分期(P=0.006)、淋巴结转移(P=0.035)及MMP-9过表达(P=0.000)是胰腺癌预后的独立影响因素。结论:MMP-9过表达在胰腺癌的浸润转移中发挥重要作用,过表达提示预后不良.对MMP-9的检测可有效的评估胰腺癌患者的预后。     

基质金属蛋白酶-9表达与胰腺癌生物学行为及预后的相关性研究

目的：探讨基质金属蛋白酶-9（matrix metalloproteinase-9,MMP-9）的表达与胰腺癌生物学特性及对患者预后的影响。方法：采用免疫组织化学法检测63例原发性胰腺癌及11例癌旁正常组织中MMP-9的表达.比较MMP-9的表达与胰腺癌患者生物学特性及预后的关系。结果：MMP-9阳性表达率为68.3%（43/63）,而11例癌旁正常组织无MMP-9表达。MMP-9的表达与肿瘤大小（P=0.014）、分化程度（P=0.039）、TNM分期（P=0.001）、远处转移（P=0.011）及淋巴结转移（P=0.009）显著相关。MMP-9表达阳性者生存时间明显低于阴性表达者（Log-rank检验,x2=32.70,P=0.000）。Cox回归分析表明：分化程度（P=0.000）、TNM分期（P=0.006）、淋巴结转移（P=0.035）及MMP-9过表达（P=0.000）是胰腺癌预后的独立影响因素。结论：MMP-9过表达在胰腺癌的浸润转移中发挥重要作用,过表达提示预后不良.对MMP-9的检测可有效的评估胰腺癌患者的预后。