微创经皮椎体成形术治疗脊柱转移性肿瘤的临床疗效分析

目的:探讨微创经皮椎体成形术治疗脊柱转移瘤的临床疗效及安全性。方法:选取我院收治的60例脊柱转移瘤患者并随机分为两组,观察组(30例)行微创经皮椎体成形术治疗,对照组(30例)行开放性手术治疗。比较两组患者术后12、24、48 h的VAS评分、镇痛次数,术前及术后24、48 h的血清C-反应蛋白(CRP)水平,术前及术后3、6个月的Prolo评分。结果:术后12、24、48 h,两组患者的视觉模拟评分法(VAS)评分逐渐下降,且观察组VAS评分均显著低于对照组(P0.05),术后镇痛次数也明显少于对照组(P0.05)。术后24、48 h,两组患者血清CRP水平均明显低于术前,且观察组血清CRP水平显著低于对照组(P0.05)。术后3、6个月,两组患者的Prolo评分均较术前明显提高,且观察组Prolo评分显著高于对照组(P0.05);随访3个月期间,两组并发症的发生情况相比差异无统计学意义(P0.05)。结论:微创经皮椎体成形术可以明显减轻脊柱转移性瘤的疼痛,患者日常生活能力恢复较好,且安全性高。     

腹腔镜下头侧中间入路治疗直肠癌患者的近期疗效及对第253组淋巴结的清扫效果分析

摘要 目的：分析头侧中间入路对腹腔镜直肠癌患者的近期疗效及第253组淋巴结的清扫效果。方法：2017年6月到2020年6月选择在江苏省中医院诊治的80例直肠癌作为研究对象,根据手术入路方式的不同分为中间组42例与外侧组38例。所有患者都给予腹腔镜直肠癌根治术治疗,中间组采用头侧中间入路,外侧组给予外侧入路,记录与随访近期疗效及第253组淋巴结的清扫效果。结果：所有患者手术过程顺利,吻合后系膜、肠管均无张力;中间组的第253组淋巴结清扫时间少于外侧组(P<0.05),两组的第253组淋巴结清扫数量对比差异无统计学意义(P>0.05)。两组的手术时间、术中出血量对比差异无统计学意义(P>0.05),中间组的术后肛门首次排气时间、术后拔除引流管时间、术后住院时间显著少于外侧组(P<0.05)。中间组术后9个月的肠梗阻、吻合口漏、吻合口出血、切口感染等并发症发生率为4.8 %,显著低于外侧组23.7 %(P<0.05)。所有患者术后随访9个月,中间组的复发率为2.4 %,显著低于外侧组的15.8 %(P<0.05)。结论：头侧中间入路在腹腔镜直肠癌患者中的应用能提高第253组淋巴结的清扫效率,促进患者康复,减少术后并发症的发生,降低近期复发率。     

Effect of cerebrocrast on the lymphocyte blast transformation activity in normal and streptozotocin‐induced diabetic rats

Both IDDM and NIDDM are characterized by deviations in peripheral T and B lymphocyte count, T_helper:T_suppressor ratio, as well as by impaired T_suppressor function. These abnormalities may promote insulin antibody and other antibody production, contributing to overt diabetes mellitus development in early stage of the disease. In the present study we explored the effects of cerebrocrast (1,4‐dihydropyridine derivative) administration on Con A‐ and IL‐2‐stimulated tissue lymphocyte blast transformation activity and on the thymus and lymph node mass in normal and streptozotocin (STZ)‐induced diabetic rats. It was established that cerebrocrast, administered four times at the doses of 0·05 and 0·5 mg kg⁻¹, has long‐term (up to 14 days) effects on the immune system and protects against the toxic effect of STZ in STZ‐induced diabetic rats, preventing thymus and lymph node mass loss. We conclude that cerebrocrast administration leads to the increase in number and activity of T_helper and T_suppressor lymphocytes. Glycolysis and DNA synthesis in these cells is augmented under the influence of cerebrocrast administration. We propose that the increase in lymphocyte suppressive activity caused by cerebrocrast administration may prevent the development of IDDM and NIDDM in patients with pre‐diabetes, but in patients with early and overt diabetes mellitus the drug administration may prevent the overexpression of insulin antibodies and other antibodies. The effect of cerebrocrast on the de novo production of insulin and IL‐2 receptors may be beneficial for IDDM and NIDDM patients. Copyright © 1999 John Wiley & Sons, Ltd.     

陀螺旋转式伽玛刀分次治疗颅内转移瘤的临床疗效观察

目的:评价大分割伽玛射线立体定向放射治疗对颅内转移瘤的临床疗效.方法:采用陀螺旋转式伽玛射线立体定向放射设备治疗颅内转移瘤患者91例.单纯伽玛射线立体定向放射治疗采取大分割分次方式,处方剂量3.2-5Gy,每周5次,计划靶区边缘(45％或65％等剂量线处)总剂量全程为35-50Gy.结果:近期有效率(CR+PR)颅内移瘤少于3个组为93.06％ (67/72),大于3个组为73.69％ (14/19);局部剂量与肿瘤复发的关系,照射剂量50GY者复发率为11.86％(7/59),照射剂量为40GY者复发率为31.25％(10/32);生存率陀螺刀治疗的中位生存期为11.9个月.6、12、24个月生存率分别为:76.92％ (70/91)、60.44％(55/91)、29.67％(27/91).结论:大分割伽玛射线立体定向放射治疗脑部和体部恶性肿瘤近期疗效满意.     

B lymphocyte differentiation in lethally irradiated and reconstituted mice

The recovery of the B lymphocyte compartments was investigated in lethally irradiated mice reconstituted with fetal liver cells. This was done by means of immunofluorescence on frozen sections of spleen, lymph nodes and Peyer's patches. The first B lymphocyte recovery in the spleen was observed on day 8, a few days earlier than in lymph nodes and Peyer's patches (day 13). These early B cells in the spleen were found in the central part of the periarteriolar lymphatic sheath (PALS). Later on, while increasing in number, the B cells formed growing follicles at the periphery of the PALS. Subsequently, brightly fluorescent B cells appeared in the marginal zone, which surrounded the follicles. Another two weeks later, around day 30, also germinal center formation was observed in the follicles of the spleen. B cell development in lymph nodes and Peyer's patches started somewhat later than in the spleen, but once started, the recovery of the different compartments was completed very fast. Germinal center reactions were found in lymph nodes and Peyer's patches already on day 25, and thus earlier than in the spleen, but later than the first occurrence of the strongly fluorescent cells in the marginal zone. Apparently, germinalcenter formation is not essential for the recovery of the population of brightly fluorescent B cells in the marginal zone after irradiation and reconstitution.     

A novel mouse model for liver metastasis of prostate cancer reveals dynamic tumour‐immune cell communication

ObjectivesIn contrast to extensive studies on bone metastasis in advanced prostate cancer (PCa), liver metastasis has been under‐researched so far. In order to decipher molecular and cellular mechanisms underpinning liver metastasis of advanced PCa, we develop a rapid and immune sufficient mouse model for liver metastasis of PCa via orthotopic injection of organoids from PbCre⁺; rb1^f/f;p53^f/f mice.Materials and MethodsPbCre⁺;rb1^f/f;p53^f/f and PbCre⁺;pten^f/f;p53^f/f mice were used to generate PCa organoid cultures in vitro. Immune sufficient liver metastasis models were established via orthotopic transplantation of organoids into the prostate of C57BL/6 mice. Immunofluorescent and immunohistochemical staining were performed to characterize the lineage profile in primary tumour and organoid‐derived tumour (ODT). The growth of niche‐labelling reporter infected ODT can be visualized by bioluminescent imaging system. Immune cells that communicated with tumour cells in the liver metastatic niche were determined by flow cytometry.ResultsA PCa liver metastasis model with full penetrance is established in immune‐intact mouse. This model reconstitutes the histological and lineage features of original tumours and reveals dynamic tumour‐immune cell communication in liver metastatic foci. Our results suggest that a lack of CD8⁺ T cell and an enrichment of CD163⁺ M2‐like macrophage as well as PD1⁺CD4⁺ T cell contribute to an immuno‐suppressive microenvironment of PCa liver metastasis.ConclusionsOur model can be served as a reliable tool for analysis of the molecular pathogenesis and tumour‐immune cell crosstalk in liver metastasis of PCa, and might be used as a valuable in vivo model for therapy development.     

Neutrophil-to-eosinophil ratio as a biomarker for clinical outcomes in advanced stage melanoma patients treated with anti-PD-1 therapy

Neutrophil-to-lymphocyte ratios (NLR) and eosinophil counts are associated with improved survival in melanoma patients treated with immune checkpoint inhibitors, but no study has investigated neutrophil-to-eosinophil ratios (NER) as a predictive indicator in this population. In this retrospective study evaluating anti-PD-1 treated patients with advanced melanoma, progression-free survival (PFS), overall survival (OS), objective response rates (ORR), and risk of high-grade (grade ≥3) immune-related adverse events (irAEs) were compared between groups defined by median pretreatment NLR and NER as well as median NLR and NER at 1-month post-treatment. Lower baseline NLR and NER were associated with improved OS [HR: 0.504, 95% CI: 0.328–0.773, p = .002 and HR: 0.442, 95% CI: 0.288–0.681, p < .001, respectively] on univariate testing. After accounting for multiple covariates, our multivariate analysis found that lower pretreatment NER was associated with better ORR (by irRECIST) (OR: 2.199, 95% CI: 1.071–4.582, p = .033) and improved OS (HR: 0.480, 95% CI: 0.296–0.777, p = .003). Baseline NLR, 1-month NLR, and 1-month NER were not associated with ORR, PFS, or OS outcomes; but 1-month NER correlated with lower risk of grade ≥3 irAEs (OR: 0.392, 95% CI: 0.165–0.895, p = .029). Our findings suggest baseline NER merits additional investigation as a novel prognostic marker for advanced melanoma patients receiving anti-PD-1-based regimens.     

肿瘤干细胞与肿瘤转移

近年来,肿瘤干细胞(cancer stem cell,CSC)学说研究认为CSC与肿瘤发生、发展、转移和复发关系极为密切。研究还发现CSC具有明显的异质性,即CSC可分为增生、耐药、侵袭和转移等行为不同的亚群细胞,其中具有转移生物学特性的CSC亚群细胞称为肿瘤转移干细胞(migrating cancer stem cell,MCSC)。目前认为,上皮-间质转变、趋化因子和靶器官微环境可能在肿瘤转移过程中起着重要作用。针对MCSC及其相关机制的靶向治疗有望能更有效地遏制肿瘤的转移。     

经皮穿刺椎弓根椎体成形术治疗胸腰椎椎体转移肿瘤的临床疗效

目的:进一步探讨经皮穿刺椎弓根途径椎体成形术与传统保守治疗方法的临床比较差异,从而为临床相关实践提供借鉴和参考依据。方法:2014年12月至2015年5月医院临床收治的胸腰椎椎体转移肿瘤患者共计88例,根据治疗方法分成研究组(经皮穿刺椎弓根途径椎体成形术组)和对照组(传统保守治疗方法组),每组患者44例。观察和比较两组患者实施不同治疗后的临床满意度。结果:研究组患者手术1d、1个月、3个月、6个月和1年后的临床满意度均显著的高于对照组,且组间比较差异均有统计学意义(P0.05)。结论:经皮穿刺椎弓根途径椎体成形术治疗胸腰椎椎体转移肿瘤的临床综合效果显著,与传统保守治疗方法相比较可有效改善和提高患者的生活质量。