目的 建立人胃癌耐药细胞,为研究人胃癌耐药细胞的耐药机制以及为耐药肿瘤细胞的治疗提供耐药肿瘤细胞模型.方法 体外培养人胃癌细胞SGC-7901,用50μmol/L顺铂多次反复冲击,对冲击4次和6次的SGC-7901分别检测对顺铂的抑制率和多药耐药基因(MDR)及多药耐药特异基因片段的表达,并计算药物对细胞的半数抑制浓度(IC50).结果 经4次和6次冲击后,受冲击的SGC-7901胃癌细胞对顺铂的抑制率明显高于亲本细胞,IC50为63.98μmol/L和66.34μmol/L,而亲本细胞SGC-7901的IC50则分别为20.55μmol/L和18.22μmol/L,冲击4次和6次的SGC-7901细胞有MDR基因和基因特异产物表达.结论 经顺铂反复冲击4次和6次的SGC-7901检测结果证明,SGC-7901对顺铂的耐受性明显增强,其抑制率较对照组高,IC50与对照组相比有明显差异(P<0.01),而且均有耐药基因表达,该细胞可以作为耐药细胞进行相关实验.

目的探讨携带甲胎蛋白（AFP）的重组腺相关病毒（rAAV）感染树突状细胞（DCs）对肝癌细胞株SMMC-7721的体外杀伤作用,为肝癌非手术治疗提供方法。方法首先确定AFP基因序列并合成AFP基因,将其转染至重组腺相关病毒rAAV,之后将转染AFP的rAAV感染树突状细胞,并将感染rAAV的DC与SMMC-7721共同培养,同时设未感染rAAV的DC作为对照组,用MTT法检测rAAV-DC及DC对SMMC-7721的杀伤活性。结果感染rAAV的DC对SMMC-7721的杀伤活性为89.00%,DC对SMMC-7721的杀伤活性为75.19%,两者比较有差异（P＜0.05）。结论携带AFP的rAAV感染DC后,能明显增强DC对SMMC-7721的杀伤活性。

恶性神经胶质瘤是成人中最常见和最具侵袭性的原发性脑肿瘤,其显著的神经系统症状和无法治愈的特性给患者及其家庭带来了巨大的痛苦和严重的医疗负担。由于当前标准治疗方案难以达到理想效果,患者中位数生存期不足15个月。血管生成是恶性胶质瘤的标志,现已成为重要的治疗新靶标。本文回顾了抗血管治疗的作用机制和抗血管药物在恶性胶质瘤治疗的临床应用探索,并简要讨论了恶性胶质瘤抗血管生成治疗药物的研究进展。

Objective To investigate the expression of glutathione peroxidase 4 (GPX4) in gastric cancer and to analyze its clinical significance. Methods The expression of GPX4 mRNA in common tumors was analyzed based on Oncomine and Gene Expression Profiling Interactive Analysis (GEPIA) databases, and its expression in gastric cancer tissues and relationship with prognosis were also analyzed. The RNA sequencing data of 1178 gastric cancer samples in The Cancer Geneome Atlas (TCGA) database were obtained via cBioPortal to analyze the mutations of the GPX4 gene and their relationship with prognosis. Proteins interacting with GPX4 were predicted using the String database. Results A total of 459 studies on GPX4 gene in common tumors and normal tissues were collected from the Oncomine database, 22 of which showed significantly differential GPX4 expression (P 0.05). Analysis of RNA sequencing results in the TCGA database revealed that GPX4 gene mutations occurred in 25 of 1178 gastric cancer samples, with a total mutation rate of 2.1%. Kaplan-Meier survival curve analysis showed that there was no significant correlation between GPX4 gene mutation and OS or PFS (P>0.05). Proteins such as GSR, GSS, GGT1/5/6/7, GSTO2, GRSF1, and SOD1/2 had obvious interactions with GPX4 (P=1.94×10-7). Conclusion The analysis of multiple tumor gene databases shows that the GPX4 gene has a low mutation rate in gastric cancer tissues, and its high mRNA expression is associated with a poor prognosis. Our findings provide an important theoretical basis for further exploration of the role for GPX4 in the development of gastric cancer. Key words: Glutathione peroxidase; Gastric cancer; Database

Primary splenic angiosarcoma is a rare highly malignant hematologic neoplasms. Based on the combination of PET/CT diagnosis of primary splenic angiosarcoma: 1 case was analyzed. The diagnosis and treat-ment of primary splenic angiosarcoma and the diagnostic significance of PET/CT in this disease were studied.

肝外胆管神经内分泌癌属于神经内分泌肿瘤,临床极为罕见,占消化道肿瘤的0.1％～0.2％[1-3].近年针对消化道神经内分泌肿瘤已有系统研究,但由于肝外胆管神经内分泌癌相关病例报道较少,故该病尚无系统完善的研究.现通过介绍1例肝总管(肝外胆管)神经内分泌癌致梗阻性黄疸患者的病历资料,并结合国内外相关文献,系统复习该病的相关特点,以加强对该病的认识.

In recent years, the incidence of pediatric tumors is increasing, but the research on pediatric solid tumors lags behind. Neurological tumors were the most common solid tumors in children, while other solid tumors were mainly bone tumors, kidney tumors and liver tumors. Interventional therapy for the nervous system is still not widely used. Hepatocellular carcinoma (HCC) was the most frequently treated tumor. Interventional therapy can inhibit the growth of cancer tissue, and combined surgery can significantly improve the survival of patients. More importantly, interventional therapy provides new treatment ideas for patients who cannot receive surgical treatment and more patients have more treatment options. However, there are still many problems in the application of interventional therapy in pediatric tumors, which needs our continuous efforts and innovations in clinical work. Key words: Interventional therapy; Pediatric tumors; Transcatheter arterial; Chemoembolization; Intra-arterial chemotherapy; Hepatocellular carcinoma

目的 探讨联合血管切除重建在胰腺癌根治术中的临床疗效.方法 回顾性分析80例胰腺癌患者的病历资料.依据治疗方法不同将患者分为联合重建组和单纯手术组,每组40例.比较两组患者的手术指标、近期临床疗效、不良反应发生情况及术后1年生存情况.结果 联合重建组患者的手术时间明显长于单纯手术组,术中出血量明显多于单纯手术组,差异均有统计学意义(P﹤0.01);联合重建组患者的近期临床疗效优于单纯手术组(P﹤0.05);两组患者的不良反应发生情况比较,差异无统计学意义(P﹥0.05);两组患者的生存情况比较,差异有统计学意义(P﹤0.05).结论 联合血管切除重建在胰腺癌根治术中具有较好的临床疗效,其不良反应发生情况与单纯手术相当,较为安全可靠.在确定手术范围内的情况下,联合血管切除重建的胰腺癌根治术值得广泛应用于临床.

患者男性, 59岁, 因发现肝右叶占位4月余入院.患者乙型肝炎病史40年, 未行规范抗病毒治疗, 定期复查超声.入院4个多月前患者于当地医院常规体检行彩超检查提示:"肝硬化, 双肾囊肿, 肝内低回声-血管瘤?", 进一步行核磁共振提示:"肝右叶病变, 不典型血管瘤可能性大, 不完全排除恶性可能".患者无明显不适, 未行进一步治疗.入院1个月前再次行核磁共振复查提示:"肝右叶病变, 较前增大", 仍未行系统治疗.入院14d前再次核磁共振增强复查提示:"肝右后叶下段团片异常信号灶较前明显增大".遂就诊于吉林省肿瘤医院复查MRI显示"肝脏形态不整, 各叶比例失调, 肝右叶后下段可见异常信号肿块, 边界欠清, 部分突出于肝脏轮廓之外, 冠状位示病变长径约5.4cm, T1WI呈低信号, T2WI呈高信号, 内见分隔, 增强后动脉期见边缘明显环状强化, 门脉期及平衡期仍呈花环状强化, 内分隔强化, 病灶内可见片状无明显强化区, 病灶向下与结肠肝曲关系密切" (图1).MRI诊断意见:肝占位性病变, 不除外恶性.患者于全身麻醉下行肝肿物切除术.术中所见肝脏中度硬化, 肝段下缘肿物, 质硬, 菜花样, 大小约5cm×4cm×4cm, 见肿物来源于肝脏, 取部分肝肿物组织, 送检术中快速, 提示存在肝软骨肉瘤可能, 遂沿肿瘤外缘2cm切除肿瘤.患者术后恢复良好, 3个月后复查未见复发及转移.

目的:探讨改良腱鞘麻醉在小儿手外伤治疗中的优越性及其临床应用价值,为临床小儿手术麻醉方法的选择提供参考.方法:选择接受急、慢诊手部手术患儿102例(104指).采用随机数表法将患儿分为传统指根神经阻滞麻醉组(54例,54指)和改良腱鞘麻醉组(48例,50指).完成麻醉后5 min内间隔1 min对4个部位采用FLACC评分法(＜7岁)或视觉模拟评分(VAS)法(7～18岁)进行痛觉检测,注射后5 min内疼痛评分为0则表示麻醉成功.5 min以后患儿仍然感觉疼痛无法接受手术为麻醉失败,改用传统指神经阻滞麻醉完成手术.检测2组患儿麻醉成功率、麻醉起效时间、麻醉持续时间以及麻醉药剂量.结果:改良腱鞘麻醉组和传统指根神经阻滞麻醉组患儿麻醉成功率比较差异无统计学意义(P＞0.05).与传统指根神经阻滞麻醉组比较,改良腱鞘麻醉组患儿麻醉平均起效时间缩短(P＜0.05),平均麻醉药剂量减少(P＜0.05).结论:改良腱鞘麻醉具有使用麻醉药剂量小、麻醉起效快、操作简便和患儿痛苦小等优点,适用于小儿手外伤的麻醉.

Objective To investigate the effect of heating on the cytokines secreted by liver cancer cells SMMC-7721,and to study the effect of these cytokines on cell microenvironment,to provide experimental evidence of hyperther-mia for tumor treatment.Method Human liver cancer cell SMMC-7721 were cultured in vitro to the logarithmic growth phase, and then were replaced with a serum-free medium, placed in constant temperature water bath and heated for 2 hours at 42℃.After heating,the human liver cancer cell line SMMC-7721 were placed to cool down to 37℃,and were cultured again in an incubator with 5% CO2by rewarming,the supernatant of the cultures at various time points after re-warming(0,24,48,72 h)were taken to detect TNF-α,IL-2,IFN-γ,VEGF and other cytokines,and were compared with unheated SMMC-7721 cell culture supernatant.Result After rewarming for different duration,the secretion of cytokines TNF-α,IL-2,and IFN-γ in human cancer cells SMMC-7721 were generally increased as compared with unheated cul-tures,while VEGF secretion gradually decreased.Conclusion Constant heating at 42℃for 2 h can promote the secre-tion of cytokines IL-2,IFN-γ,TNF-α,and other anti-tumor cytokines,while reduce the secretion of VEGF that can pro-mote tumor growth.

胶质母细胞瘤(glioblastoma,GBM)在世界范围内,是成人最常见且恶性程度最高的原发性脑肿瘤.尽管手术、常规放射治疗、化疗治疗,甚至三者联合治疗,均取得较大的进展,但是患者生存期仍未见明显提高.随着现代分子生物学和分子遗传学的发展,人们对胶质母细胞瘤的发病机制和诊断治疗的研究已经进入基因水平.目前P53基因、血管内皮生长因子(VEGF)、表皮生长因子受体(EGFR)是肿瘤研究的热点,它们在肿瘤发生、发展中起到不同的作用,为我们在GBM的靶向治疗中提供了方向.现就这三种基因在胶质母细胞瘤中表达情况、作用及以这三种基因为靶点的靶向治疗情况作以综述.

“让与担保”在《物权法草案》中曾经出现过,但最终通过的《物权法》并未采纳,但在现实的经济环境中,它已经成为一种普遍的融资手段,经常与借款合同相伴而生,已经成为一种习惯法上的非典型担保物权.《民间借贷规定》第二十四条对其进行了规范,在法律上进行了定位,使其能够更好地为经济发展服务,为企业的融资进行担保,以发挥其应有的作用.

目的 探讨游离腓动脉穿支皮瓣修复手足部皮肤软组织缺损的临床疗效.方法 对2011年4月-2014年2月采用游离腓动脉穿支皮瓣修复的8例手足部皮肤软组织缺损病例进行回顾性分析.切取皮瓣大小6.0 cm×6.0 cm～5.5 cm×11.0 cm.结果 本组8例全部成活,术后随访4～12个月.其中7例皮瓣外形良好,1例修复足(足母)趾皮瓣较臃肿.小腿皮瓣供区均直接缝合,对肢体活动无影响.结论 游离腓动脉穿支皮瓣供区损伤小,皮瓣质量好,是修复手足部中、小面积皮肤软组织缺损的理想方法之一.

合同自由是合同法的基本原则，所以合同应该充分表达当事人的意思，以要约和承诺为构成要件，学者认为这两个阶段是不可或缺的。随着经济的发展，社会交易的复杂化，以往的只以意思表示的方式已经不能有效保护交易秩序，尤其在一些设计公共利益、常规性的交易中；事实合同关系、强制合同、契约关系论等都对传统的合同的订立方式提出了挑战，尤其是事实合同的出现，引起了法学界的轰动，本文以探析事实合同理论为重点，明晰事实合同理论。

目的：探讨肝细胞肝癌患者组织中miR-21的表达水平及其预后意义。方法共收集50例肝细胞肝癌的患者，采用免疫组化法检测肝细胞肝癌及配对癌旁组织中miR-21的表达水平，分析miR-21蛋白的表达与患者临床病理特征及预后生存的相关性。结果肝细胞肝癌组织中miR-21表达水平显著高于癌旁组织（58.0％ vs 6.0％，χ2＝31.07，P＜0.0001）。 miR-21高表达与临床T分期相关（χ2＝8.043，P＝0.018）；但miR-21蛋白表达水平与患者年龄、性别、肿瘤大小、临床分期、N分期及分化程度均无显著关联（P＞0.05）。高表达miR-21的肝细胞肝癌患者总生存时间明显降低（P＝0.032），但患者无疾病进展生存期差异无统计学意义（P＝0.116）。结论肝细胞肝癌患者miR-21高表达可能作为肿瘤患者预后不良的重要标志物之一，而与肿瘤的发生及发展的机制性研究尚需进一步验证。

Objective Investigate the killing effect which Cytokines killer cells(cytokine induced killer cells,CIK) have on small cell lung cancer cell NCIH-446 in different effector target ratio and provide scientific data for reasonable clinical application of CIK in cancer treatment.Methods Culture CIK cells in vitro and make the identifition,then co-culture CIK cells with NCIH-446 cells in 50∶1,25∶1,12.5∶1 proporation,monitor their effect with xCELLigence RTCA S16 unmarked cell function analyzer in real-time for 48 hours.Results When CIK and NCIH-446 are in 50∶1, 25∶1,12.5∶1 proporation,the killing effect CIK has on NCI446 improves from 74.18%,67.98%,46.76% in the 2 hour to 95.00%,96.95%,93.82%in the 48 hour with the extension of time.at the same time,the killing activity in 3 different proporations differs between the 2 hour and the 6 hour(P<0.01),13 hours later,the killing activity has no significant differences but the killing effect improves obviously.95.00%,96.95%,93.82%in the 48 hour with the ex-tension of time.at the same time,the killing activity in 3 different proporations differs between the 2 hour and the 6 hour(P<0.01),13 hours later,the killing activity has no significant differences but the killing effect improves obvious-ly.Conclusion When CIK and NCIH-446 are in 50∶1,25∶1,12.5∶1 effector target ratio,the killing effect of cells has the number of dependencies in the 2nd and 6th hour,the higher cell number,the higher killing activity but with the extension of time,the dependency is not obvious and the killing effect of cells in different proporation is increasing.

Objective To investigate early experience of Da Vinci robot-assisted laparoscopic radical resection for colorectal carcinoma. Methods The clinical outcomes of 63 colorectal cancer patients undergoing robot-assisted laparoscopic radical resection from October 2014 to May 2016 were retrospectively collected and analyzed. Results All operations were completed successfully. There were no conversions to open surgery and no postoperative mortality. The robot docking time was (15.24±5.69) min. The operative time was (176.43±59.39) min. The blood loss was (28.65±22.36) ml. The number of lymph nodes harvested was (14.47±5.67). The recover time of bowel function was(51.43±12.96) hours. The postoperative hospital stay was (8.22±1.52) days. Conclusions Da Vinci robot-assisted laparoscopic radical resection for colorectal carcinoma is safe and feasible. The robotic system is suitable for clinical application.

Objective Extract of Fungi of Huaier(EFH),a traditional Chinese medicine,has been shown to possess anti-tumor effect.However, the role and mechanisms of EFH in colon cancer are still unknown.This study aimed to explore effects of EFH on colon cancer cell growth and migration.Methods HCT116 cells were cultured in vitro and treated with EFH.MTT method was used to detect growth of HCT116;Boyden chamber was used to test cell migration;Real-time PCR was conducted to analyze the expression of MMP-9;Flow cytometry was applied to detect cell cycle and apoptosis.Results Cell proliferation assay showed EFH significantly inhibited tumor cell growth compared with the control and inhibition effects were dose and time-dependent.Co-culture with tumor cells for 96 hours,EFH showed the strongest inhibitory effects compared with the control and the inhibitory effects of 10mg/mL,20mg/mL and 30mg/mL of EFH were 25%(P=0.025),42%(P=0.032)and 67%(P=0.018)respectively.Moreover EFH(10mg/mL) significantly inhibited the migration of tumor cells with inhibitory rate up to 63%( P =0.01).Expression of MMP-9 in tumor cells treated by EFH (8mg/mL and 11mg/mL) was decreased compared to control(2.73+0.32 vs 4.8+0.36,P=0.028;1.46+0.25 vs 4.8+0.36,P=0.004).In addition,EFH blocked cell cycle progression without triggering cell apoptosis.Conclusions EFH inhibits colon cancer cell proliferation and migration,and is likely due to down regulation of MMP-9 expression and blockage of cell cycle in S phase.