新藤黄酸联合阿霉素诱导人乳腺癌MCF-7细胞凋亡的研究

目的研究新藤黄酸(gambogenic acid,GNA)与阿霉素(adriamycin,ADM)联合作用对人乳腺癌细胞MCF-7的影响。方法体外培养人乳腺癌细胞MCF-7细胞株,采用甲基噻唑基四唑(methyl thiazolyl tetrazolium,MTT)检测细胞存活率,倒置显微镜观察细胞形态变化;4′,6-二脒基-2-苯基吲哚(4′,6-diamidino-2-phenylindole,DAPI)细胞核染色实验观察GNA与ADM单独与联合作用对乳腺癌细胞MCF-7凋亡的影响;膜联蛋白Ⅴ(annexinⅤ,AV)-异硫氰酸荧光素(fluorescein isothiocyanate,FITC)/碘化丙啶(propidium iodide,PI)双染流式细胞仪检测给药后乳腺癌细胞MCF-7凋亡率。结果 MTT检测结果显示,在GNA浓度为0.125~4μmol/L和ADM浓度在0.5~16μmol/L范围内,人乳腺癌细胞MCF-7的细胞存活率随GNA和ADM剂量增加而降低,且联合用药组细胞存活率低于单独用药组。倒置显微镜和荧光显微镜下,与对照组比较,细胞明显缩圆变小,染色细胞核破碎,呈现凋亡状态,而联合用药组凋亡细胞数量明显高于单独用药组。AV-FITC/PI双染经流式细胞仪检测发现,GNA与ADM单独和联合作用均诱导MCF-7细胞凋亡,与单独用药组比较,联合用药组细胞凋亡率显著增加(P0.01)。结论 GNA与ADM单独和联合作用均能诱导人乳腺癌细胞MCF-7细胞凋亡,且两者联合作用可产生协同效应,其作用机制可能与诱导细胞凋亡相关。     

新藤黄酸通过内质网应激诱导人结肠癌HCT116细胞凋亡的研究

目的 研究新藤黄酸（gambogenic acid,GNA）诱导人结肠癌HCT116细胞凋亡的机制。方法 采用不同浓度的GNA作用细胞24 h,对照组是相同浓度GNA加内质网应激抑制剂4-苯基丁酸（4-phenylbutyric acid,4-PBA）共同作用HCT116细胞24 h。采用甲基噻唑基四唑（methyl thiazolyl tetrazolium,MTT）染色测定两组细胞增殖抑制率的差异,采用吖啶橙（acridine orange,AO）和溴化乙锭（ethidium bromide,EB）染色观察细胞的形态学变化,采用膜联蛋白Ⅴ（Annexin Ⅴ, AV）-异硫氰酸荧光素（fluorescein isothiocyanate, FITC）/碘化丙碇（propidium iodide, PI）双重染色检测细胞凋亡率。结果 内质网应激抑制剂4-PBA可以缓解GNA对HCT116细胞增殖的抑制作用;AO/EB染色后荧光显微镜观察发现GNA作用的细胞具有凋亡特征;流式细胞仪检测显示4-PBA可降低HCT116细胞的凋亡率。结论 GNA能抑制人结肠癌细胞HCT116增殖,诱导细胞凋亡,其诱导细胞凋亡的作用可能与内质网应激途径有关。     

加味小承气汤直肠灌肠促进食管癌术后早期胃肠功能恢复临床观察

目的 探讨加味小承气汤直肠灌肠对食管癌术后早期胃肠功能恢复的影响。方法 将60例施行食管癌手术的患者随机分为对照组（A组）、术后小承气汤空肠内营养管给药组（B组）和术后小承气汤直肠灌肠组（C组）,每组20例。A组按传统方法禁食至术后首次排便,B、C组术后第1天开始每隔12 h灌肠,至首次排便后停用。观察比较术后腹胀、腹痛缓解及术后首次肛门排气、排便时间和并发症。结果 与A组比较,B组、C组术后首次肛门排气、排便时间及术后腹胀、腹痛缓解时间均明显缩短（P<0.05）;B组、C两组比较,差异无统计学意义（P>0.05）,3组均无吻合口瘘、粘连性肠梗阻等严重并发症。结论 加味小承气汤直肠灌肠应用于食管癌术后早期治疗,可促进胃肠功能恢复,缩短治疗时间。     

原发性肝癌患者体质类型与复发关系的Cox回归分析

目的探讨原发性肝癌患者复发的危险因素及与中医体质的关系,为预测和预防肝癌的复发提供依据。方法总结2009年1—12月上海长海医院中医科、介入科收治的109例原发性肝癌术后患者的临床特征,并分析其中医体质分布规律。用单因素及多因素Cox回归分析原发性肝癌术后复发的相关影响因素。结果 Cox回归分析结果显示,截至2010年4月1日,原发性肝癌术后出现复发患者的年龄、临床分期、肝功能分级、既往饮酒史与未出现复发患者相比较,差异具有统计学意义(P0.05)。年龄、临床分期、乙型病毒性肝炎病史、阳虚质、血瘀质进行入Cox回归模型。结论年龄、临床分期、乙型病毒性肝炎病史、既往饮酒史是原发性肝癌术后复发的危险因素,阳虚质、血瘀质得分越高的患者,术后出现复发的时间越短。     

止痛散离子导入法合羟考酮控释片治疗中重度癌痛临床研究

目的 观察止痛散离子导入法合羟考酮控释片治疗中重度癌痛的临床疗效。方法 〖JP2〗将中重度癌性疼痛患者56例随机分为治疗组和对照组,每组28例,对照组给予羟考酮控释片口服,治疗组在对照组疗法基础上联合止痛散离子导入,两组均以10 d为1个疗程,连续治疗3个疗程,观察并比较两组镇痛疗效、平均镇痛持续时间、羟考酮控释片最终滴定剂量、卡氏功能状态评分（Karnorfsky'' s performance scale, KPS）及不良反应。结果 治疗组镇痛疗效显著优于对照组 (P<0.05), 在提高平均镇痛持续时间及KPS评分方面均显著优于对照组(P<0.01),羟考酮控释片最终滴定剂量和不良反应显著低于对照组 (P<0.05)。结论 止痛散离子导入法合羟考酮控释片治疗中重度癌痛安全有效。     

加味乌梅丸抑制非肥胖糖尿病/重症联合免疫缺陷小鼠胰腺癌移植瘤的蛋白组学研究

目的 采用蛋白组学方法研究加味乌梅丸治疗胰腺癌的分子机制。方法 对非肥胖糖尿病（non-obese diabetes,NOD）/重症联合免疫缺陷（severe combined immune deficiency,SCID）小鼠接种人胰腺癌SW1990细胞,复制胰腺癌移植瘤模型。将20只荷胰腺癌移植瘤的NOD/SCID小鼠分为对照组、加味乌梅丸组,每组10只。加味乌梅丸组每日灌胃加味乌梅丸煎剂,对照组每日给予等容积无菌注射用水。给药20 d后处死小鼠,取移植瘤组织,提取细胞总蛋白,运用iTRAQ技术进行蛋白组学分析。结果 蛋白组学分析结果显示,与对照组比较,加味乌梅丸组有12个差异蛋白质点,其中10个表达下调,2个表达上调,这些蛋白按照功能可分为细胞骨架相关蛋白、代谢相关蛋白、硒结合蛋白、酶类物质等。结论 加味乌梅丸抑瘤是多靶点、多途径的,肌球蛋白调节轻链2、脂肪细胞型脂肪酸结合蛋白、碳酸酐酶3、硒结合蛋白、高迁移率蛋白-17可能是其最主要的作用靶点。     

原发性高血压中医证型分布规律及其危险因素研究

目的 探讨原发性高血压中医证型的分布规律及其与危险因素的相关性。方法 收集290例原发性高血压患者的一般资料,采用无序多分类Logistic回归分析原发性高血压中医证型与性别、年龄、体质量指数、饮食偏嗜、吸烟史、饮酒史、高血压病家族史的相关性。结果 原发性高血压中医证型以痰湿壅盛证为主。单因素分析结果显示,原发性高血压中医证型与年龄、饮酒史、高血压家族史及饮食偏嗜具有相关性（P<0.05）。无序多分类Logistic回归分析显示,以阴阳两虚型为对照组,年龄≤65岁（P<0.05,OR=29.328）和高血压病家族史（P<0.05,OR=9.499）与肝火亢盛型相关;年龄≤65岁（P<0.05,OR=9.241）和饮食偏咸（P<0.05,OR=4.840）与痰湿壅盛型相关;年龄≤65岁（P<0.05,OR=10.304）和高血压病家族史（P<0.05,OR=8.312）与阴虚阳亢型相关。结论 痰湿壅盛型是原发性高血压的主要证型,饮食偏咸是痰湿壅盛型的危险因素;家族史是肝火亢盛型、阴虚阳亢型的危险因素。     

逍遥煎剂联合穴位贴敷治疗腹泻型肠易激综合征肝郁脾虚证临床观察

目的 观察逍遥煎剂联合穴位贴敷治疗腹泻型肠易激综合征（diarrhea predominant irritable bowel syndrome IBS-D)肝郁脾虚证的临床疗效。方法 将130例IBS-D肝郁脾虚证患者随机分为2组,每组65例。对照组患者接受酪酸梭菌二联活菌、匹维溴铵治疗;观察组患者在对照组疗法基础上,口服逍遥煎剂以及接受穴位贴敷治疗。两组均以4周为1个疗程。比较治疗前后以及停药4周后两组患者Bristol大便性状评分、中医症状评分、肠易激综合征生活质量(irritable bowel syndrome-quality of life, IBS-QOL)评分、肠易激综合征严重程度评分系统（irritable bowel syndrome-severity scoring system,IBS-SSS）评分。结果 与治疗前比较,治疗4周后和停药4周后,两组患者Bristol评分,IBS-SSS评分及腹痛、腹泻、便溏评分,症状总评分均显著降低（P＜0.05）,IBS-QOL的焦虑不安、日常生活、躯体意识、健康担忧、食物回避、社会功能、性生活、人际关系评分均显著升高（P＜0.05）。与对照组比较,观察组治疗4周后和停药4周后IBS-SSS评分,腹痛、便溏评分和症状总评分明显降低（P＜0.05）,IBS-QOL的焦虑不安、日常生活、躯体意识、健康担忧、食物回避、社会功能、人际关系评分均显著升高（P＜0.05）。结论 逍遥煎剂口服联合穴位贴敷可减轻IBS-D的严重程度,改善患者生活质量,具有较好的近期疗效和远期疗效。     

Fatal hemorrhage from a periumbilical wound: Stabbing or hemorrhage from a caput medusae?

Varices are the main clinical manifestation of portal hypertension, and their bleeding is the predominant cause of mortality from this condition. Periumbilical varices are known as “caput medusae.” Reports of their bleeding are rare, with only three fatal cases described in the literature. The antemortem diagnosis is relatively simple, while the postmortem diagnosis is more complex. This paper is the first report of fatal hemorrhage from a caput medusae for which the diagnosis was made postmortem, thanks to a complete diagnostic process including scene and circumstances, medical history, and autopsy with detailed histology. The circumstantial analysis showed the presence of a large amount of blood at the scene, blood which originated from a small abdominal wound; an analysis of the subject's clinical data reported that he was affected by portal hypertension. The autopsy revealed some dilated and convoluted veins in the subcutaneous tissue of the umbilical region; a fistula between these veins and the abdominal wound was detected. The histological study confirmed the presence of periumbilical varices, one of them ruptured and connected with the overlying skin. The cause of death was attributed to a massive hemorrhage generated by a periumbilical varix in a patient affected by portal hypertension.     

Gender differences in personality and cancer-related pain among older cancer patients

Indicators explaining gender differences in personality and pain among older cancer patients have not been adequately addressed. This study examined gender differences in cancer-related pain severity, the Five Factor Model of personality, and affect among older cancer patients (86 women, 64 men). No significant differences were found in pain severity between the gender groups. Analyses indicated that women scored significantly higher for the personality trait of neuroticism than men (p < .05). Further analyses showed that different demographic, health, and personality variables predicted pain severity in women and men. Gender was found to be a significant moderator in the association between the personality trait of neuroticism and average pain. These findings suggest that both gender and different personality types may influence reported pain severity. Specifically, the results suggest that how patients experience and report pain severity may be gender-specific, and that it may be inappropriate to assume that women and men experience, report, and manage their pain in similar ways. Future studies focusing on the influence of personality and gender on health outcomes are needed to assist healthcare providers in tailoring treatment, thereby promoting optimal symptom management.