PM2.5通过上调颗粒酶B促进IL-18表达加重肺部炎症

目的颗粒酶B促进组织炎症的作用日益引起重视,但其在PM_2.5导致的肺部炎症中是否发挥作用还不清楚,本文对在PM_2.5导致的肺部炎症中颗粒酶B的作用进行了研究。 方法第一步构建经气管滴注PM_2.5混悬液诱导大鼠肺部炎症的动物模型,实验分组为PBS组、PM_2.5(2 mg/kg)组、PM_2.5(6 mg/kg)组、PM_2.5(18 mg/kg)组。通过设置PM_2.5滴注剂量梯度,检测不同PM_2.5暴露剂量下大鼠肺组织颗粒酶B表达、病理和炎症评分,以探讨颗粒酶B表达水平与肺部炎症严重程度间有无相关性。第二步通过阻断颗粒酶B,探究在PM_2.5导致的肺部炎症中颗粒酶B是否发挥促进作用。第三步通过阻断IL-18,探究在PM_2.5导致的肺部炎症中颗粒酶B是否通过IL-18发挥作用。 结果随着PM_2.5滴注剂量升高,肺组织颗粒酶B表达增加,肺组织病理切片炎症细胞浸润和肺水肿程度加重,炎症评分增加,PM_2.5促进了肺组织颗粒酶B表达和肺部炎症;阻断颗粒酶B抑制了IL-18表达和NF-κB磷酸化,改善了PM_2.5导致的肺部炎症;阻断IL-18抑制了NF-κB磷酸化,改善了PM_2.5导致的肺部炎症。 结论PM_2.5通过上调颗粒酶B促进IL-18表达加重肺部炎症,其机制可能与激活NF-κB信号通路有关。     

光动力治疗在食管肿瘤中的疗效及安全性分析

目的 观察光动力治疗在食管早癌及食管贲门恶性肿瘤中的疗效及安全性。方法 4例不符合ESD、手术、放疗指征、或不愿进行上述治疗的食管早癌及进展期食管贲门恶性肿瘤患者行内镜下光动力治疗,于治疗前及治疗后第2天,1周,1月,3月行内镜及并发症评估。结果 4例患者平均随访时间为3月, 2例进展期肿瘤患者肿瘤体积接近50%至少1个月,1例早癌患者在随访中病理检查保持阴性。所有患者术后无食管穿孔、出血、急性心包炎、肝肾功能损害发生。光敏反应和术后狭窄为主要并发症。结论 光动力治疗在食管早癌及食管贲门恶性肿瘤中疗效明确,不良反应少,可作为不适宜行ESD、手术或放疗人群的替代选择。     

经皮冠状动脉支架置入术中给予腺苷对缺血再灌注损伤的影响

背景:急性心肌梗死早期血管再通治疗可显著改善患者的症状及预后,但同时容易引起缺血再灌注损伤,对此尚缺乏有效的治疗手段.目的:观察经皮冠状动脉支架置入治疗急性心肌梗死中,冠状动脉内应用腺苷的心肌保护作用.设计:双盲随机对照实验.单位:河北医科大学第一医院及石家庄市第三医院.对象:选择2004-12/2006-04在河北医科大学第一医院和石家庄市第三医院心内科住院的年龄≥30岁的急性心肌梗死患者50例.均符合急性心肌梗死的诊断标准,即持续性胸痛≥30 min且不长于12 h、硝酸酯类药物不能缓解;体表心电图相邻两个导联ST段抬高＞0.1 mV,并且肌酸激酶升高＞正常高值的2倍.纳入患者或家属签属治疗方案知情同意书.采用双盲随机方法将患者分为腺苷组(n=23)和对照组(n=27),两组患者一般状况、冠脉造影及支架置入治疗特征比较,差异无显著性意义(P＞0.05).方法:患者入院后即给予常规的急性心肌梗死一般抢救及监护措施,同时应用阿司匹林300 mg和氯吡格雷300 mg 1次顿服并在进行急诊经皮冠状动脉支架置入治疗术前准备后直接入导管室行选择性冠状动脉造影术,术后行经皮冠状动脉支架置人治疗.先以球囊预扩张开通梗塞相关动脉,腺苷组患者即刻予以腺苷300μg 10 mL生理盐水,对照组患者给予生理盐水10 mL.持续1 min通过指引导管进行冠状动脉内注射完毕,再予以支架治疗.术毕按心肌梗死溶栓治疗临床试验血流分级对梗死相关动脉进行再通后血流评价.主要观察指标:①入院后第1天每4 h、术后第2天至出院每天检测心脏生物标记物.②术前、术后1 h进行12导联心电图检查,分析ST段抬高总和回落百分比.③分别于经皮冠状动脉支架置入治疗后的第3天及第4周应用改良Simpson氏法计算左心室射血分数,观察患者的左心室功能.结果:纳入的50例急性心肌梗死患者全部进入结果分析.①两组患者心脏标记物峰值及ST段抬高总和回落百分比分析比较:腺苷组患者心脏标记物肌酸激酶及其同功酶、心脏肌钙蛋白I峰值明显低于对照组,差异有显著性意义(t=2.31,z=2.83,2.22,P＜0.05);腺苷组ST段抬高总和回落百分比高于对照组,差异有显著性意义(z=2.10,P＜0.05).腺苷组心脏标记物峰值较低说明心肌损伤轻于对照组,ST段抬高总和回落百分比的增加说明腺苷组患者心电图ST段恢复较快.②两组患者心功能比较:术后4周时左心室射学分数均增加,与术后3 d比较,差异有显著性意义(t=1.45,2.30,P＜0.01),且腺苷组的改善更明显.对照组和腺苷组患者心肌梗死溶栓治疗临床试验血流分级3级者分别为22和19例,两组比较,差异无显著性意义(P＞0.05).③两组患者不良反应发生情况比较:腺苷组4例(17.3%)、对照组1例(3.7%)出现有意义的窦性心动过缓而可见起搏心律,两组比较,差异无显著性意义(Fisher确切概率P=0.129).结论:急性心肌梗死直接经皮冠状动脉支架置入治疗中,冠状动脉内注射腺苷可以明显缓解急性心肌梗死血管开通背景下发生的缺血再灌注损伤,有益于改善左心功能,且安全性较好.     

自体髂骨植骨带锁钢板内固定材料置入并一期前后路减压治疗多节段脊髓型颈椎病12例:临床资料回顾分析

目的:严重的多节段脊髓型颈椎病单纯前路或后路手术都有其局限性。观察一期前后路联合手术并自体髂骨植骨及带锁钢板内固定材料置入在治疗多节段脊髓型颈椎病中的应用价值。方法:选择2004-11/2006-12本院12例多节段脊髓型颈椎病患者,均采用一期前后路减压、自体髂骨植骨融合、带锁钢板内固定联合手术。其中男9例,女性3例,年龄49～75岁;3节段受累9例,4节段受累3例(突出节段分布:C3～66例,C4～73例,C3～73例)。全部病例进行临床随访,患者均对本试验知情同意。采用mJOA评分标准对患者神经功能改善情况进行评定;术前颈椎侧位片测量,以D值(C4椎体后下缘到齿突后缘与C7椎体后下缘连线的垂直距离)评价颈椎(C2～7)弧度;根据颈椎伸屈动态侧位片C2和C7椎体后缘切线相交所成的夹角之和评价颈椎(C2～7)活动范围。主要以电话随访和问卷填写的方式,分别从神经功能改善情况、颈椎弧度、活动范围及术后并发症等进行随访观察。结果:①12例患者全部得到随访,术后随访时间6～28个月,平均(16±6)个月。②所有植骨均获得骨性愈合;疗效结果中优4例(33.3%);良6例(50%);无效2例(16.7%);颈椎D值术前(3.9±1.4)mm,术后即刻(8.5±1.7)mm,随访时(8.1±2.5)mm。术前与术后差异有显著性(P<0.01),术后与随访时差异无显著性(P=0.251);颈椎活动范围术前(36.3±4.0)°,随访时(10.6±2.7)°,与术前相比差异具有显著性(P<0.01)。③术后C5神经根麻痹1例,为感觉及运动混合型,8个月随访时,感觉功能恢复,肩关节外展肌力从术后Ⅱ级恢复至Ⅳ级;1例术后6个月出现"S"畸形而再次压迫脊髓,神经功能改善停滞,目前处于随访中。结论:一期前后路手术并自体髂骨植骨及带锁钢板内固定材料置入减压充分、彻底,而且前路手术能重建颈椎稳定性,恢复颈椎生理前凸和椎间高度,并且后路减压术又能预防相邻颈椎退变引起的脊髓继发的压迫。     

Characteristics and prognosis of gastric cancer in patients aged ≥ 70 years

AIM:To elucidate the prognostic value of age for gastric cancer and identify the optimal treatment for elderly gastric cancer patients.METHODS:We enrolled 920 patients with gastric cancer who underwent gastrectomy between January 2003and December 2007 in our center.Patients were categorized into three groups:younger group(age<50years),middle-aged group(50-69 years),and elderly group(≥70 years).Clinicopathological features were compared among the three groups and potential prognostic factors were analyzed.The log-rank test was used to assess statistical differences between curves.Independent prognostic factors were identified by the Cox proportional hazards regression model.Stratified analysis was used to investigate the impact of age on survival at each stage.Cancer-specific survival was also compared among the three groups by excluding deaths due to reasons other than gastric cancer.We analyzed the potential prognostic factors for patients aged≥70years.Finally,the impact of extent of lymphadenectomy and postoperative chemotherapy on survival for each age group was evaluated.RESULTS:In the elderly group,there was a male predominance.At the same time,cancers of the upper third of the stomach,differentiated type,and less-invasive surgery were more common than in the younger or middle-aged groups.Elderly patients were more likely to have advanced tumor-node-metastasis(TNM)stage and larger tumors,but less likely to have distant metastasis.Although 5-year overall survival(OS)rate specific to gastric cancer was not significantly different among the three groups,elderly patients demonstrated a significantly lower 5-year OS rate than the younger and middle-aged patients(elderly vs middle-aged vs younger patients=22.0%vs 36.6%vs 38.0%,respectively).In the TNM-stratified analysis,the differences in OS were only observed in patients withⅡandⅢtumors.In multivariate analysis,only surgical margin status,pT4,lymph node metastasis,M1 and sex were independent prognostic factors for elderly patients.The5-year OS rate d     

Heart failure after allogeneic hematopoietic stem cell transplantation

Background

Heart failure (HF) occurring after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is rare but severe. We examine the role of pre-HSCT therapeutic exposures, conditioning regimens, pre-HSCT comorbidities, severe transplant-related complications, and post-HSCT cardiovascular risk factors in the development of heart failure after allo-HSCT.

Methods

A nested case-control study was designed. Cases with HF and controls matched for age, year of allo-HSCT, and length of follow-up were identified from a cohort of 2455 patients who underwent allo-HSCT between 2000 and 2011 for hematologic malignancies.

Results

Forty-two patients suffered from HF; mean age at presentation was 35 years (± 14 years) and mean time to presentation was 5 months (± 9 months) post-HSCT. The number of pre-HSCT cycles of chemotherapy was significantly greater (7 vs. 5 courses, P = 0.023). Cases were significantly more likely to have severe acute GVHD (≥ grade III), hemorrhagic cystitis (≥ grade 2), and multiple severe transplant-related complications compared with controls (42.9% vs. 20.4%, P = 0.008). Multivariate analysis revealed that pre-HSCT cycles of chemotherapy of ≥ 5 courses (OR = 3.5, P = 0.003) and two or more severe transplant-related complications (OR = 3.6, P = 0.003) were independently associated with HF.

Conclusions

These results identify the individuals who are at higher risk of developing HF after allo-HSCT. We should pay more attention to these patients and more active management would be reasonable.     

Localized esophageal ulcerations after CyberKnife treatment for metastatic hepatic tumor of colon cancer.

CyberKnife is an image-guided robotic system designed for stereotactic radiosurgery. It uses the combination of robotics and image guidance to deliver concentrated and accurate beams of radiation to intracranial and extracranial targets. Although the frameless nature of the CyberKnife allows tumors in the chest and abdomen to be treated as well, complications associated with CyberKnife treatment have not been established yet due to its short clinical experience. We describe a case of localized esophageal ulcerations after CyberKnife treatment for metastatic hepatic tumor of colon cancer.     

Prognostic factors and causes of death in Korean patients with idiopathic pulmonary fibrosis

The purpose of this study was to investigate the prognostic factors at initial presentation and the causes of death in Korean patients with idiopathic pulmonary fibrosis (IPF), which might be different report wise, in comparison to the western countries. A retrospective review of 88 patients (mean 60.3 years, 69 male) was carried out and they were diagnosed as IPF positive. After diagnosis, the survival rate was 57% and 41% for third and fifth year, respectively (mean follow-up 39.1 months). Mortality was closely correlated with severe dyspnea at presentation (Hazard Ratio [HR], 2.6 per grade; p=0.015), lower initial forced vital capacity (HR, 1.7 per 10% predicted; p=0.004) and lower initial diffusing capacity of the lung (HR, 1.5 per 10% predicted; p=0.033). Treatment with specific drugs was ineffective against the survival when compared with symptomatic supportive care. Thirty-four patients (68%) died of worsened respiratory failure, seven (14%) died of infection and only one patient showed cardiovascular death. In conclusion, our study suggests that the severity of dyspnea and lung function tests at the time of diagnosis are the predictive factors for the survival of patients with IPF. In comparison to the reports from western countries, we observed that respiratory failure and pulmonary infection were more frequent causes of death, while cardiovascular death was rare in Korean patients with IPF.     

The value of repeated cytology at the time of first colposcopy: a retrospective analysis of 1,087 cases

Papanicolaou tests are often repeated just before the procedure for women who have been referred for colposcopy. The validity and clinical usefulness of this practice, however, is unclear. We retrospectively assessed the value of repeated cytology in a cohort of 1,087 consecutive patients who underwent repeated Papanicolaou testing at first colposcopy. The repeated cytology was considered clinically useful if the results could conceivably have influenced the physician's decision about more invasive diagnostic/therapeutic evaluation based on contemporary practice guidelines. Repeated cytology provided potentially clinically useful information in only a small proportion (3.6%) of the cases analyzed overall, including 41% (26/63) and 1.8% of the high- and low-grade squamous intraepithelial lesions referral cytology cases, respectively. Our data indicate that repeated cytology provides potentially clinically useful information in only a small percentage of overall cases but a substantial proportion of high-grade squamous intraepithelial lesion referral cytology cases, suggesting that high-risk referral cytology case subsets can be defined wherein the routine performance of repeated cytology would be most efficacious.