老年人多原发癌37例临床分析

目的 探讨老年人多原发癌的临床特点、术后辅助化疗对患者预后及后续肿瘤的影响.方法 选取220例老年恶性肿瘤患者,分析其中37例多原发癌的发病年龄、发病部位、术后辅助化疗状况、首癌与第2、第3癌的间隔时间、生存时间.结果 本组多原发癌37例,占老年恶性肿瘤的16.8%,其中异时性多原发癌35例,同时性多原发癌2例;首发癌、再发癌、第3癌发病的中位年龄分别为70、77、77.5岁;共有肿瘤病灶82个,胃肠道为好发部位,其中结直肠癌28例(34.2%),胃癌11例(13.4%).首癌术后化疗23例,未化疗14例,化疗组生存时间明显长于非放化疗组(x2=4.63,P=0.0427),两组生长次癌的时间分别为6年与4年(x2=1.63,P=0.207).次癌和第3癌发生的中位间隔时间化疗组7年,非化疗组2年,化疗组明显长于非化疗组(x2=4.255,p=0.043).第3癌术后化疗组中位生存时间3年6个月,非化疗组7个月(x2=4.62,P=0.0316).结论 对老年多原发癌患者,术后化疗可延长其生存时间,并可延迟后续肿瘤的发生.     

老年人多原发癌37例临床分析

目的 探讨老年人多原发癌的临床特点、术后辅助化疗对患者预后及后续肿瘤的影响.方法 选取220例老年恶性肿瘤患者,分析其中37例多原发癌的发病年龄、发病部位、术后辅助化疗状况、首癌与第2、第3癌的间隔时间、生存时间.结果 本组多原发癌37例,占老年恶性肿瘤的16.8%,其中异时性多原发癌35例,同时性多原发癌2例;首发癌、再发癌、第3癌发病的中位年龄分别为70、77、77.5岁;共有肿瘤病灶82个,胃肠道为好发部位,其中结直肠癌28例(34.2%),胃癌11例(13.4%).首癌术后化疗23例,未化疗14例,化疗组生存时间明显长于非放化疗组(x2=4.63,P=0.0427),两组生长次癌的时间分别为6年与4年(x2=1.63,P=0.207).次癌和第3癌发生的中位间隔时间化疗组7年,非化疗组2年,化疗组明显长于非化疗组(x2=4.255,p=0.043).第3癌术后化疗组中位生存时间3年6个月,非化疗组7个月(x2=4.62,P=0.0316).结论 对老年多原发癌患者,术后化疗可延长其生存时间,并可延迟后续肿瘤的发生.     

18例老年三原发癌临床分析

目的 探讨三原发癌的临床特点及多器官衰竭对预后的影响。方法 分析从1980年至2002年22年间收治的73例多原发癌中18例三原发癌发生部位、发病年龄、病因、间隔时间、预后。结果 65％的实体瘤发生在消化系统，首癌、次癌、第三癌发病年龄分别为66岁、72岁、78．5岁；第一原发癌和第二原发癌间隔中位时间为70个月，第二原发癌和第三原发癌间隔中位时间为36个月。首癌5年生存率89％；第三原发癌3年和5年生存率分别为44％，11％。死亡14例，其中7例死于多器官衰竭。结论 消化道是多原发癌好发部位，放、化疗是发生多原发癌的重要诱因；多器官衰竭致死是影响多原发癌患长期生存的重要原因。     

老年人三重原发癌18例临床分析

一、对象及方法　　 1.对象 :1980～ 2 0 0 2年我院共收治老年人三重原发癌18例 ,占同期 73例多原发癌的 2 5 %。男 17例 ,女 1例。首癌 (第一原发癌 )、次癌 (第二原发癌 )和三癌 (第三原发癌 )中位年龄分别为 6 6、72和 78岁 ,均经病理组织学确诊 ,符合Warren提出的诊断标准。首癌、次癌和三癌中位间隔时间分别为 70、36个月。异时性癌 14例 ,同时性癌 4例。　　 2 .肿瘤分布 :见表 1。表 1　肿瘤分布、带瘤状态及首癌、三癌生存时间 (月 )序号首癌次癌三癌带瘤　 生存时间 (月 )首癌　三癌　 1胃窦管状腺癌 直肠腺癌 残胃低分化腺癌 …     

34例与肺癌相关的多原发癌的临床分析

目的:探讨与肺癌相关的多原发癌的临床特点。方法:回顾性分析34例与肺癌相关的多原发癌患者的临床病历资料。结果:34例患者中,同时癌占38%(13/34),异时癌占62%(21/34)。在多原发癌中肺癌起病隐匿,首发症状以咳嗽、咯血、胸闷气促常见,无症状者16例。肺癌病理分型以腺癌最为常见。再罹患肺癌风险更高的是头颈部肿瘤,肺癌患者最易再罹患消化系统肿瘤。重癌切除率67.6%。第一原发癌中位生存期为4.5年,第二原发癌中位生存期为1年。多原发癌中肺癌发生的先后顺序与预后无明显相关性。结论:与肺癌相关的多原发癌有一定的临床特点,预后较好,应重视初诊肿瘤患者的随诊工作,早期发现,积极治疗,提高患者生存率。     

宁波市110例原发性肝癌患者生存情况及生存影响因素分析

[目的]分析宁波市110例原发性肝癌(PLC)患者生存情况及生存影响因素。[方法]描述宁波市110例PLC患者生存情况,计数资料采用χ~2检验,计量资料采用t检验,采用Kaplan-Meier法进行生存分析,采用Cox多元回归模型分析生存影响因素。[结果]宁波市110例PLC患者平均生存期为(5.3±1.3)个月,中位生存期为5个月。没有选择手术的患者组生存率显著低于选择手术的患者组(χ~2=32.214,P0.01);TNM高分期组患者生存率显著低于TNM低分期组(χ~2=10.496,P0.01)。多因素Cox分析显示肿瘤TNM分期(RR=5.675,P0.01)及是否手术(RR=2.750,P0.01)为影响PLC生存率的独立危险因素。[结论]宁波市PLC患者平均生存期较短,肿瘤TNM分期及是否手术为影响PLC生存率的独立危险因素     

手术治疗巴塞罗那B期肝细胞癌患者的生存状况

目的探讨手术治疗巴塞罗那(BCLC)B期肝癌患者生存状况的影响因素,旨在为BCLC B期肝癌患者选择治疗方案和预后评估提供依据。方法选择于我院2012年3月至2015年3月收治的126例行手术根除治疗的巴塞罗那B期肝癌患者,分析影响患者预后的临床因素。结果 126例BCLC B期患者1、3、5年生存率分别为82.5%(104/126)、52.4%(66/126)和41.3%(52/126),中位生存期为28(3～58)个月。单因素分析结果显示,年龄、肿瘤最大直径、肿瘤数目、合并糖尿病、AFP、AST及ALT与总生存期有关(P0.05),其他因素与总生存期无显著相关性(P0.05)。多因素分析显示,肿瘤最大直径、肿瘤数目、AFP、AST及ALT是影响BCLC B期患者预后的独立危险因素(P0.05)。根据上述危险因素将BCLC B期肝癌患者分为低危组(≤1个危险因素,n=46)和高危组(≥2个危险因素,n=80)。低危组1、3、5年生存率分别为87.0%(40/46)、73.9%(34/46)和65.2%(30/46),中位生存期为34(16～58)个月。高危组1、3、5年生存率分别为80.0%(64/80)、40.0%(32/80)和27.5%(22/80),中位生存期为22(2～46)个月。低危组和高危组的生存率比较差异有统计学意义(P0.05)。结论肿瘤最大直径、肿瘤数目、AFP、AST及ALT是影响BCLC B期患者预后的独立危险因素,监测上述指标对于预测临床结局有重要价值。     

北京市1272例原发性肺癌生存时间及影响因素调查分析

目的探讨影响原发性肺癌生存时间的因素,为预测预后提供科学依据。方法选择有病理及细胞学诊断分型的原发性肺癌1272例,定期随访并对死亡病例进行直系亲属调查,两种方法进行入户调查。采用EP12000、SAS软件进行数据的分析,分别计算暴露组和未暴露组的平均生存时间及1年、2年、5年生存情况。结果原发性肺癌的中位生存期为13．67个月,其中男性患者为14．85个月,女性患者为11．90个月,两者有显著性差异（P〈0．01）。男性患者中,吸烟者为14．01个月,不吸烟者为19．62个月,两者比较有显著性差异（P〈0．01）。有结核史者与无结核史者的中位生存期分别为11．76个月和15．30个月,有显著性差异（P〈0．05）。女性患者中,有肿瘤家族史者与无肿瘤家族史者的中位生存期分别为9．01个月和12．50个月,有显著性差异（P〈0．01）。肺癌已手术和未手术者的生存期有显著性差异（P〈0．01）。原发性肺癌的1年生存率为39．40％,2年生存率为14．78％,5年生存率为3．30％。结论影响肺癌生存时间的主要因素为男性吸烟。肿瘤家族史与女性原发性肺癌有关联。结核病仍为影响肺癌生存的重要原因之一。延长肺癌生存时间主要在于手术。吸烟、肿瘤史、结核病史是影响原发性肺癌的生存时间的重要因素。     

加味升降散治疗老年胰腺癌的疗效评价

目的评价加味升降散治疗胰腺癌的疗效。方法选择2012年1月-2014年12月在苏州市中医医院肿瘤科门诊及住院治疗的胰腺癌患者110例,根据患者的治疗方法分为2组:西医治疗组、中药+西医治疗组。以总生存期(OS)及卡式评分(KPS)作为2组疗效的主要评价指标。统计2组患者1、3、5年的生存率;采用Kaplan-Meier法计算各组中位生存期、平均生存期。对2组上述指标值进行分析比较。结果110例胰腺癌患者的平均生存期23.53个月,中位生存期13.65个月;1、3、5年生存率分别为60.90%、11.81%、10.9%;西医治疗组5年生存率为10.00%,中药+西医治疗组5年生存率13.33%;而在存活者的百分比例上,联合治疗组存活率为56.00%,高于西医治疗组;西医治疗组与中药+西医治疗组治疗后KPS评分z检验为-2.070,差异有统计学意义(P<0.05)。结论加味升降散治疗胰腺癌,能够延长患者生存期,提高患者生活质量。     

立体定向放射治疗原发性肝癌伴下腔静脉癌栓的疗效评价

目的评价立体定向放疗治疗肝细胞癌伴下腔静脉癌栓的疗效。方法在66例肝细胞癌伴下腔静脉癌栓患者中,36例接受立体定向放射治疗,30例未接受放射治疗。结果 36例接受伽玛刀治疗的癌栓患者,12例（33.3%）癌栓完全缓解,10例（27.8%）部分缓解,13例（36.1%）稳定,1例（2.8%）进展。癌栓治疗有效率为61.1%,1年生存率为27.8%,中位生存期为9.8个月;未放疗的30例患者1年生存率为11.5%,中位生存期为3.5个月。多因素分析显示,放疗组病人生存情况与肝内病灶单多发有关。Child-Pugh分级是影响预后的主要因素。结论立体定向放射治疗可明显延长肝细胞癌伴有下腔静脉癌栓患者的生存期。     

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.     

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.     

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.     

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.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.