【摘要】 目的 評價早期巨塊型宮頸癌患者術前行新輔助化學療法的近期療效。 方法 回顧分析2005年10月-2010年6月收治的Ⅰb~Ⅱa期巨塊型宮頸癌患者90例患者的臨床資料。根據術前是否行化學療法將患者分為兩組；新輔助化學療法（neoadjuvant chemotherapy，NACT）組50例，術前予靜脈化學療法或子宮動脈灌注化學療法治療1～3個療程;直接手術組40例，直接行根治性手術。比較新輔助化學療法前后病灶大小變化，化學療法不良反應，手術情況及術后病理情況。 結果 NACT組總有效率86%（43/50），鱗癌療效優于腺癌，動脈與靜脈化學療法近期有效率比較，兩組差異無統計學意義（Pgt;0.05）。NACT不良反應小。NACT組術中出血少于直接手術組，兩者差異有統計學意義（Plt;0.05）。兩組深肌層浸潤、淋巴結轉移、脈管浸潤差異均無統計學意義（Pgt;0.05），NACT組宮旁浸潤率低于直接手術組。 結論 術前NACT對早期巨塊型宮頸癌患者近期療效顯著。【Abstract】 Objective To evaluate the short-term curative effect of preoperative neoadjuvant chemotherapy on the early-stage bulky cervical carcinoma. Methods We retrospectively analyzed the clinical data of 70 patients with bulky ⅠB-ⅡA cervical carcinoma treated in our hospital between October 2005 and June 2010. Based on whether the patients received chemotherapy, they were divided into two groups: neoadjuvant chemotherapy group (NACT group) and direct surgery group. In the former group, there were 50 patients who underwent surgery after 1 to 3 cycles of preoperative chemotherapy by uterus artery infusion or intravenous chemoembolization. For the 40 patients in the latter group, direct radical surgery was performed. The size of the tumor before and after chemotherapy, the operation conditions and the postoperative pathological conditions of patients between the two groups were compared and the adverse reactions of neoadjuvant chemotherapy were analyzed as well. Results The total effective rate of NACT group was 86% (43/50). The response to chemotherapy in squamous cell caner was significantly higher than adenocarcinoma. There was no statistical difference between arterial and venous chemotherapy in terms of immediate effect (Pgt;0.05). The incidence of adverse reactions of neoadjuvant chemotherapy was low. There was significant difference between the NACT group and the direct surgery group in intraoperative bleeding (Plt;0.05). There were no significant differences between the above two groups in deep muscularis infiltration rate, lymph node metastasis rate and vascular invasion rate. However, the parametrial infiltration rate for the NACT group was lower than that for the direct surgery group. Conclusion Preoperative neoadjuvant chemotherapy on patients with early-stage bulky cervical carcinoma has a remarkable immediate curative effect.
Objective To investigate the expressions of X-linked inhibitor of apoptosis protein （XIAP） and survivin in primary hepatocellular carcinoma tissues，and to explore the relationship between them. Methods The expressions of XIAP and survivin protein in 38 primary hepatocellular carcinoma tissues and 16 paracancerous tissues were detected by using immunohistochemistry and the expressions were scored. Results The positive expression rate of XIAP and survivin in primary hepatocellular carcinoma tissues was 81.6% （31/38）and 78.9% （30/38），respctively （P＜0.001）， and in paracancerous tissues was 12.5% （2/16）and 6.3% （1/16）， respectively （P＜0.001）. The score of XIAP expression in the well， middle，and low differentiated tissues of primary hepatocellular carcinoma was （2.91±1.31），（9.27±3.25）， and （13.08±2.26） score， respectively （F=118.948，P＜0.001）， and the score of survivin expression was （4.85±1.83）， （11.08±3.72），and （13.38±1.76） score， respectively （F=72.202，P＜0.001）. They both significantly correlated with the histological grade，but not with the size of tumor（P＞0.05）. There was significantly correlation between the expression intensity of XIAP and survivin in primary hepatocellular carcinoma tissues （r=0.764， P＜0.001）. Conclusions The expression intensity of XIAP and survivin in primary hepatocellular carcinoma tissues are both related with the differentiation of primary hepatocellular carcinoma. The expression intensity of XIAP is related with the survivin， and they may play an important role in the tumor progression and chemical resistances.
ObjectiveTo explore the possibility that GREM1, a bone morphogenetic protein (BMP) antagonist, is a mechanical explanation for BMP signal suppression in congenital heart disease associated pulmonary arterial hypertension (CHD/PAH) patients.MethodsSystemic-to-pulmonary shunt induced PAH was surgically established in rats. At the postoperative 12th week, right heart catheterization and echocardiography evaluation were performed to evaluate hemodynamic indexes and morphology of right heart system. Right heart hypotrophy index and pulmonary vascular remodeling were evaluated. Changes of BMP signal pathway related proteins and GREM1 in lungs and plasma GREM1 concentration were detected. The effect of GREM1 on the proliferation and apoptosis of pulmonary arterial endothelial cells (PAECs) was also explored.ResultsThe hypertensive status was successfully reproduced in rats with systemic-to-pulmonary shunt model. BMP signal pathway was suppressed but GREM1 was up-regulated with no change in hypoxia inducible factor-1 in lungs exposed to systemic-to-pulmonary shunt, while this trend was reversed by systemic-to-pulmonary shunt correction (P<0.05). Immunohistochemical staining demonstrated enhanced staining of GREM1 in remodeled pulmonary arteries. In vitro experiments found that BMP signal was down-regulated but GREM1 expression and secretion were up-regulated in proliferative PAECs (P<0.05). Furthermore, BMP2 significantly inhibited PAECs proliferation and promoted PAECs apoptosis (P<0.05), which could be antagonized by GREM1. In addition, plasma level of GREM1 in rats with systemic-to-pulmonary shunt was also increased and positively correlated with pulmonary hemodynamic indexes.ConclusionSystemic-to-pulmonary shunt induces the up-regulation of GREM1 in lungs, which promotes pulmonary vascular remodeling via antagonizing BMP cascade. These results present a new mechanical explanation for BMP pathway suppression in lungs of CHD/PAH patients.
ObjectiveTo investigate the prognostic value of serum procalcitonin (PCT) level and its change for patients with severe trauma and sepsis. MethodsEighty-two patients with severe trauma and sepsis treated between June 2013 and June 2014 were chosen to be our study subjects. According to the clinical outcome at day 28, they were divided into survival group (n=54) and death group (n=28). Serum procalcitonin levels at hour 0, 24, 48, 72, 96, and 120 after admitted to the emergency intensive care unit were detected in all the patients. Then we calculated the rate of procalcitonin change in each time points, injury severity score (ISS) score, acute physiology and chronic health evaluation (APACHE)Ⅱ score and white blood cells (WBC) count. ResultsProcalciton level at hour 24, 48, 72, 96 and 120 of the survival group was significantly lower than the death group (P<0.05); the rate of procalcitonin change at hour 24, 48, 72, 96 and 120 was significantly lower than the death group (P<0.05), and the APACHE Ⅱ score was significantly lower than the death group (P<0.01). There was no significant difference in the ISS score and WBC count between the two groups (P>0.05). ConclusionEarly procalcitonin level and its dynamic change are good indicators in judging the prognosis of patients with severe trauma and sepsis, especially the early dynamic change in the rate of procalcitonin.