胰腺癌治疗进展

胰腺癌是高度恶性的消化系统肿瘤，约90%起源于腺管上皮的导管腺癌，其发病率和死亡率近几年明显上升，5年生存率<6%，是预后最差的恶性肿瘤之一。该病早期确诊率较低，手术死亡率较高。男女发病率之比约为(1.5～2)∶1，其治疗方案由单一手术治疗转为多学科综合治疗。近几年内外科治疗方案并无太多新的突破，分子靶向治疗的热度逐年上升，其重要性也越来越引起专家的重视，部分治疗靶点已经应用于临床，并取得可喜的治疗效果。     

老年非小细胞肺癌外科治疗216例临床分析

目的探讨老年非小细胞肺癌(NSCLC)手术治疗的临床疗效。方法回顾分析我院2002年1月至2006年5月手术治疗的216例老年NSCLC患者的临床资料,对手术方法、病理结果、术后生存率、并发症发生率以及围术期死亡率进行统计分析。结果手术方法:肺叶切除169例(78.2%)、全肺切除16例(7.4%)、复合肺叶切除14例(6.5%)、肺叶支气管袖状切除10例(4.6%)、楔形切除7例(3.2%);病理类型:鳞状上皮细胞癌125例(57.9%)、腺癌77例(35.6%)、腺鳞癌8例(3.7%)、肺泡细胞癌4例(1.9%)、大细胞癌2例(0.9%);TNM分期:Ⅰ期117例(54.2%)、Ⅱ期35例(16.2%)、Ⅲ期64例(29.6%);术后1、3、5年的生存率分别为70.8%、46.3%、28.7%,三年的生存率比较有显著性差异(P<0.05);Ⅰ期、Ⅱ期、Ⅲ期患者的5年生存率分别为42.7%,22.9%,6.3%(P<0.05);并发症发生率为22.2%,围术期死亡率为1.9%。结论对老年NSCLC患者行外科手术治疗时,一定要严格选择手术适应证和手术方式,以降低并发症发生率和死亡率。     

肺癌全肺切除655例临床分析

目的探讨全肺切除术在中晚期肺癌治疗中的作用。方法对1994年10月—2003年11月行全肺切除术的655例肺癌病例进行回顾性分析。结果全组1、3、5年生存率为88.0%、50.9%、24.1%。按照TNM分期5年生存率:Ⅰa期37.0%,Ⅰb期40.6%,Ⅱa期0%,Ⅱb期37.9%,Ⅲa期19.3%,Ⅲb期7.0%,Ⅳ期17.7%。不同病理类型5年生存率:非小细胞癌24.5%,小细胞癌22.0%。术后死亡率和并发症率分别为2.4%和10.4%。结论全肺切除术有可接受的术后死亡率和并发症率,在严格掌握手术适应症的基础上,术中操作熟练规范,重视围手术期的观察和处理,全肺切除术对于治疗中、晚期肺癌仍不失为一种有效的方法。     

肺癌全肺切除655例临床分析

目的 探讨全肺切除术在中晚期肺癌治疗中的作用.方法 对1994年10月-2003年11月行全肺切除术的655例肺癌病例进行回顾性分析.结果 全组1、3、5年生存率为88.0%、50.9%、24.1%.按照TNM分期5年生存率:Ⅰ a期37.0%,Ⅰ b期40.6%,Ⅱa期0%,Ⅱb期37.9%,Ⅲa期19.3%,Ⅲb期7.0%,Ⅳ期17.7%.不同病理类型5年生存率:非小细胞癌24.5%,小细胞癌22.0%.术后死亡率和并发症率分别为2.4%和10.4%.结论 全肺切除术有可接受的术后死亡率和并发症率,在严格掌握手术适应症的基础上,术中操作熟练规范,重视围手术期的观察和处理,全肺切除术对于治疗中、晚期肺癌仍不失为一种有效的方法.     

上海市浦东新区2002至2010年胰腺癌发病、死亡及生存情况分析

目的 分析上海市浦东新区胰腺癌发病、死亡及生存情况.方法 利用2002年至2010年浦东新区居民胰腺癌的登记资料,分性别组和年龄组计算发病率、死亡率.用世界标准人口计算标化率,采用对数直线回归法估算发病率及死亡率的年度百分比变化（APC）,应用Kaplan-Meier法和COX多元回归模型计算患者1～5年生存率,分析不同TNM分期和是否手术的胰腺癌患者的生存情况.结果 2002年至2010年上海市浦东新区胰腺癌新发患者3089例,其中男性1707例,女性1382例,平均发病年龄分别为（69±12）岁和（73±12）岁;合计粗发病率为13.32/10万,其中男性粗发病率为14.71/10万,高于女性的11.93/10万,男女性标化发病率之比为1.57：1.胰腺癌患者死亡2963例,其中男性1627例,女性1336例,合计粗死亡率为12.78/10万,其中男性为14.02/10万,高于女性的11.53/10万,男女性标化死亡率之比为1.55：1.男性在35岁、女性在40岁以后发病率和死亡率均明显升高,男性80岁以上、女性85岁以上发病率和死亡率达到高峰.胰腺癌患者1～5年生存率分别为16.59％、7.31％、5.23％、4.33％和3.87％.手术治疗组1～5年生存率均高于非手术组,差异有统计学意义（P值均＜0.05）.TNM分期为0～Ⅱ期、Ⅲ期、Ⅳ期患者的中位生存时间分别为（250.00±33.37）、（224.00±15.82）、（86.00±4.52）d.Ⅳ期患者与0～Ⅱ期及Ⅲ期患者生存时间的差异均有统计学意义（X2值分别为72.41、104.40,P值均＜0.001）.结论 上海市浦东新区男性胰腺癌发病率和死亡率均高于女性.患者的生存时间与确诊时的TNM分期及是否手术切除肿瘤有关.     

食管癌的外科治疗

中国是食管鳞癌高发国家之一,手术是首选治疗手段.随影像学检查方法的发展和外科技术的进步,肿瘤的切除率显著提高,手术并发症和围手术期死亡率明显降低.食管癌切除后的总体5 a生存率为30%~50%,早期（0～Ⅰ期）食管癌患者5 a生存率可达90%以上.     

肺癌外周血微转移研究进展

肺癌是发病率和死亡率增长较快,对人类健康和生命威胁较大的恶性肿瘤.近年来,尽管局部晚期肺癌经过综合治疗,总体疗效有所提高,但到目前为止,肺癌患者的预后仍没有明显改善,即便是认为可完全切除的Ⅰ～Ⅲa期患者,其五年生存率仍在30%～40%之间[1],绝大多数患者最终死于复发和转移.     

胰十二指肠切除147例

目的提高胰十二指肠切除术生存率,降低死亡率.方法对全部病例的手术方法、术后并发症及采取的措施进行分析.结果手术死亡率近11%(16/147);乏特壶腹、胰头癌3年生存率为46%,30%,5年生存率为15.4%,12%.结论早期诊断、早期治疗、适当的手术术式及方法,及时、正确地处理术前及术后并发症是提高生存期、降低死亡率的重要步骤.     

我国胰腺癌诊治策略的研究

胰腺癌是一种凶险的恶性肿瘤,严重危及人类的健康.近年来发病率逐年上升.美国胰腺癌发病率10年间升高了3倍,占恶性肿瘤的第十位、死亡率的第四位.我国胰腺癌的年发病率为5.1/10万人,较20年前升高了3倍.上海市男性胰腺癌发病率已经接近欧美国家.只有10%～15%的患者有手术切除的机会,其中能根治者仅为5%～7.5%.胰腺癌的预后极差,美国国家卫生研究院报告,胰腺癌1年生存率为8%,5年生存率为3%,中位生存期仅2～3月.我国外科的统计资料5年生存率在5%左右.因此,可以看出胰腺癌的诊断和治疗水平急切需要提高.     

大肠癌药物预防研究进展

大肠癌是临床常见病。近年来在美国大肠癌的发病率和死亡率均明显增高,在我国大肠癌的发病率也呈逐年上升趋势。尽管在大肠癌的诊断和治疗方法上有所进步,但患者的长期生存率并没有明显的提高。大肠癌的生存率与分期密切相关,早期大肠癌5年生存率可达到90%,而晚期则明显降低。为了提高大肠癌的生存率和降低其发生率,需要将目前和将来的临床策略集中在大肠癌的预防、早期诊断、改进当前治疗方案等方面[1]。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.