简介：Activationofthephosphoinositide3kinase(PI3K)/Akt/mammaliantargetofrapamycin(mTOR)pathwayiscommoninbreastcancer.Thereispreclinicaldatatosupportinhibitionofthepathway,andphaseⅠtoⅢtrialsinvolvinginhibitorsofthepathwayhavebeenorarebeingconductedinsolidtumorsandbreastcancer.Everolimus,anmTORinhibitor,iscurrentlyapprovedforthetreatmentofhormonereceptor(HR)-positive,humanepidermalgrowthfactorreceptor2(HER2)-negativebreastcancer.Inthisreview,wesummarisetheefficacyandtoxicityfindingsfromtherandomisedclinicaltrials,withsimplifiedguidelinesonthemanagementofpotentialadverseeffects.Educationofhealthcareprofessionalsandpatientsiscriticalforsafetyandcompliance.WhilethereissomeclinicalevidenceofactivityofmTORinhibitioninHR-positiveandHER2-positivebreastcancers,thebenefitsmaybemorepronouncedinselectedsubsetsratherthanintheoverallpopulation.FurtherdevelopmentofpredictivebiomarkerswillbeusefulintheselectionofpatientswhowillbenefitfrominhibitionofthePI3K/Akt/mTOR(PAM)pathway.

简介：目的回顾性分析Pauwels3型股骨颈骨折的手术疗效。方法2011年1～11月手术治疗Pauwels3型股骨颈骨折46例,采用空心螺钉（cannulatedscrews,CS）固定的35例,动力髋螺钉加空心螺钉（DHS＋CS）固定8例,近端股骨锁定加压钢板（lockingcompressionplates,LCP）固定3例。根据Haidukewych标准评价复位质量,术后定期影像学检查观察骨折愈合和髋关节一般情况,分析骨折移位、断端粉碎、内固定方式与股骨颈骨不连和股骨头坏死发生的关系。结果46例中,31例有完整的随访资料。1例DHS＋CS治疗的患者术后发生深部感染,经清创、抗感染治疗,术后6个月骨折畸形愈合后取出内固定。其它30例随访（20.1±5.9）个月,其中CS固定的22例,DHS＋CS固定5例,LCP固定3例。29例复位质量为优良,1例一般。8例出现股骨头坏死,2例骨不连,1例同时存在股骨头坏死和骨不连,19例骨折愈合且维持了良好的髋关节形态（63.3%）。不同的骨折移位、断端粉碎程度及内固定方式与股骨头坏死、骨不连的发生率之间,差异均无统计学意义。结论股骨头坏死和骨不连是Pauwels3型股骨颈骨折术后常见的并发症,CS、DHS＋CS、LCP均可作为Pauwels3型股骨颈骨折的治疗方案。骨折移位、断端粉碎和内固定方式对股骨头坏死、骨不连是否有影响,需要更大样本的病例验证。

简介：Objective:ToinvestigatetheeffectsofCAL-101,particularlywhencombinedwithbortezomib(BTZ)onmantlecelllymphoma(MCL)cells,andtoexploreitsrelativemechanisms.Methods:MTTassaywasappliedtodetecttheinhibitoryeffectsofdifferentconcentrationsofCAL-101.MCLcellsweredividedintofourgroups:controlgroup,CAL-101group,BTZgroup,andCAL-101/BTZgroup.TheexpressionofPI3K-p110σ,AKT,ERK,p-AKTandp-ERKweredetectedbyWesternblot.TheapoptosisratesofCAL-101group,BTZgroup,andcombinationgroupweredetectedbyflowcytometry.Thelocationchangesofnuclearfactorkappa-B(NF-κB)of4groupswasinvestigatedbyNF-κBKitexploring.Westernblotwasappliedtodetectthelevelsofcaspase-3andthephosphorylationofAKTindifferentgroups.Results:CAL-101dose-andtime-dependentlyinducedreductioninMCLcellviability.CAL-101combinedwithBTZenhancedthereductionincellviabilityandapoptosis.WesternblotanalysisshowedthatCAL-101significantlyblockedthePI3K/AKTandERKsignalingpathwayinMCLcells.ThecombinationtherapycontributedtotheinactivationofNF-κBandAKTinMCLcelllines.However,cleavedcaspase-3wasup-regulatedaftercombinedtreatment.Conclusion:OurstudyshowedthatPI3K/p110σisanoveltherapeutictargetinMCL,andtheunderlyingmechanismcouldbetheblockingofthePI3K/AKTandERKsignalingpathways.ThesefindingsprovidedabasisforclinicalevaluationofCAL-101andarationaleforitsapplicationincombinationtherapy,particularlywithBTZ.

简介：Objective:Tofabricatepolymericnanocompositeswithexcellentphotoluminescence,magneticproperties,andstabilityinaqueoussolutions,inordertoimprovespecificityandsensitivityofcellularimagingunderamagneticfield.Methods:FluoridatedLn3+-dopedHAP(Ln3+-HAP)NPsandironoxides(IOs)canbeencapsulatedwithbiocompatiblepolymersviaamodifiedsolventexaction/evaporationtechniquetopreparepolymericnanocompositeswithfluoridatedLn3+-HAP/ironoxide.Thenanocompositeswerecharacterizedforsurfacemorphology,fluorescencespectra,magneticpropertiesandinvitrocytotoxicity.MagnetictargetedcellularimagingofsuchnanocompositeswasalsoevaluatedwithconfocallaserscanningmicroscopeusingA549cellswithorwithoutmagneticfield.Results:Thefabricatednanocompositesshowedgoodstabilityandexcellentluminescentproperties,aswellaslowinvitrocytotoxicity,indicatingthatthenanocompositesaresuitableforbiologicalapplications.Nanocompositesundermagneticfieldachievedmuchhighercellularuptakeviaanenergy-dependentpathwaythanthosewithoutmagneticfield.Conclusion:Thenanocompositesfabricatedinthisstudywillbeapromisingtoolformagnetictargetedcellularimagingwithimprovedspecificityandenhancedselection.

简介：我科于2013年12月手术治疗伴骶骨翼骨折、脱位的TileC3型骨盆骨折1例,随访半年,报告如下。临床资料一、一般资料患者,男,45岁。因车祸伤2h急诊入院。受伤机制：建筑物旁站立位被汽车挤压、上半身扭转受伤致腰-盆分离。入院情况：BP70/50mmHg,腰骶部及大腿皮下血肿,骨盆变形。右足屈伸肌力IV＋级,右下肢其余肌力0级,左侧肢体肌力、感觉正常。大小便失禁。CT：右侧L1～5横突骨折,双侧骶髂关节脱位、骶骨粉碎性骨折,其中右侧骶骨翼骨折、前脱位，双侧耻骨上下支等多处骨折（图1）。住院后外固定架临时固定，于ICU抗休克治疗，伤情稳定后于伤后第8天手术。

简介：目的探讨机械臂辅助3D系统在完全腹腔镜胃癌D2根治术中的临床应用，评估其安全性和可行性。方法回顾性分析2014年10月至2015年8月广东省中医院胃肠外科应用机械臂辅助3D系统实施完全腹腔镜胃癌D2根治术18例。分析患者基线资料、术中及术后结果。结果18例患者均完成3D腹腔镜手术。1例胃体癌患者行全胃切除术时术中因脾脏撕裂出血，中转为手助扶镜并顺利完成手术。术后并发症发生率为11．2％，包括1例（5．6％）肺部感染和1例（5．6％）炎性肠梗阻，均经保守治疗后痊愈出院。远端胃癌D2根治术平均手术时间为（232．8±58．3）min，全胃切除D2根治术平均手术时间为（287．3±67．9）min，术中失血量为（122．5±55．7）ml，首次排气时间为（47．9±19．7）h，恢复流质饮食时间为（74．6±20．9）h，术后住院时间为（10．224．7）d。平均淋巴结清扫数目为（29．8±11．3）枚。结论机械臂辅助系统在完全3D腹腔镜胃癌D：根治术中的临床应用是安全、可行的。

简介：目的探讨苦参碱（Mat）对视网膜母细胞瘤细胞Y79细胞增殖、凋亡及PI3K/Akt信号通路的影响。方法Y79细胞经0.5、1.0、1.5g/LMat处理24h后,采用CCK-8试剂盒检测细胞增殖情况,磷酯酰丝氨酸结合蛋白-异硫氢酸荧光素/碘化丙啶（AnnexinV-FITC/PI）双标记流式细胞术检测细胞凋亡情况,Westernblotting免疫印迹检测各浓度Mat处理后凋亡相关蛋白Bcl-2及Bax、PI3K/Akt信号通路重要蛋白PI3Kp85亚基、Akt及其磷酸化形式p-Akt的蛋白水平。结果不同浓度Mat作用Y79细胞24h后,可呈浓度依赖性方式抑制细胞增殖,增加细胞凋亡率（P〈0.05）。Westernblotting检测发现,Mat可明显增加促凋亡蛋白Bax表达,降低抗凋亡蛋白Bcl-2水平并可降低PI3Kp85α亚基及磷酸化Akt的蛋白水平（P〈0.05）,对总Akt水平无明显影响。结论Mat可抑制人视网膜母细胞瘤增殖并诱导其凋亡,可能与抑制PI3K/Akt信号通路有关。

简介：Objective:Ameta-analysiswasperformedtoaugmenttheinsufficientdataontheimpactofmutativeEGFRdownstreamphosphatidylinositol-3-kinase(PI3K)andmitogen-activatedproteinkinase(MAPK)pathwaysontheclinicalefficiencyofepidermalgrowthfactorreceptortyrosinekinaseinhibitor(EGFR-TKI)treatmentofnon-smallcelllungcancer(NSCLC)patients.Methods:NetworkdatabaseswereexploredinApril,2015.PapersthatinvestigatedtheclinicaloutcomesofNSCLCpatientstreatedwithEGFR-TKIsaccordingtothestatusofK-rasand/orPIK3CAgenemutationwereincluded.Aquantitativemeta-analysiswasconductedusingstandardstatisticalmethods.Oddsratios(ORs)forobjectiveresponserate(ORR)andhazardratios(HRs)forprogression-freesurvival(PFS)andoverallsurvival(OS)werecalculated.Results:MutationinK-rassignificantlypredictedpoorORR[OR=0.22;95%confidenceinterval(CI),0.13-0.35],shorterPFS(HR=1.56;95%CI,1.27-1.92),andshorterOS(HR=1.59;95%CI,1.33-1.91)inNSCLCpatientstreatedwithEGFR-TKIs.MutantPIK3CAsignificantlypredictedshorterOS(HR=1.83;95%CI,1.05-3.20),showedpoorORR(OR=0.70;95%CI,0.22-2.18),andshorterPFS(HR=1.79;95%CI,0.91-3.53)inNSCLCpatientstreatedwithEGFR-TKIs.Conclusion:K-rasmutationadverselyaffectedtheclinicalresponseandsurvivalofNSCLCpatientstreatedwithEGFRTKIs.PIK3CAmutationshowedsimilartrends.InadditiontoEGFR,addingK-rasandPIK3CAasroutinegenebiomarkersinclinicalgeneticanalysisisvaluabletooptimizetheeffectivenessofEGFR-TKIregimensandidentifyoptimalpatientswhowillbenefitfromEGFR-TKItreatment.

简介：背景和目的至今为止何为胃癌的最佳外科治疗策略尚无定论。本研究意欲阐述以淋巴结清扫为目的的脾切除对改善残胃癌预后的意义。方法本研究为日本熊本地区医疗中心进行的回顾性队列研究,主要观察终点为术后总体生存率。对80例接受全胃切除的残胃癌患者的临床病理特征、手术治疗及远期预后进行回顾性分析。结果远端胃切除术后残胃癌患者共80例接受全胃切除,其中,38例行脾切除术,pT_1/pT_2肿瘤未发现脾门淋巴结转移,pT_3/pT_4者脾门淋巴结转移率为30.4%。对pT_3/pT_4者,脾切除患者的预后显著优于未切脾者。而对pT_1/pT_2患者,切脾与否与预后无关。同时,在接受R_0切除的pT_3/pT_4患者中,脾切除患者的预后显著优于未切脾者。结论通过脾切除方式进行的根治性淋巴结清扫对改善pT_3/pT_4残胃癌患者的预后有益。