伽玛刀治疗晚期胰腺癌的临床研究

目的探讨立体定向放射治疗(SRT)晚期胰腺癌的临床疗效. 方法采用OUK-QGD型立体定向伽玛射线体部治疗系统(体部伽玛刀)治疗了16例晚期胰腺癌患者.     

立体定向放射治疗配合化疗治疗非小细胞肺癌

目的观察立体定向放射治疗配合化疗治疗非小细胞肺癌的近期疗效。方法31例非小细胞肺癌患者均行NP方案(N：去甲长春花碱25mg／m^2第1．8天给予；P:顺铂60-80mg／m^2分2-3d给予；21d为1个周期)化疗加立体定向同步治疗。结果31例全部完成治疗计划，肺原发灶完全缓解(CR)占19．3％，部分缓解(PR)占74、2％，无变化和进展(NR PD)占6．5％，总有效(CR PR)率93．5％；纵隔淋巴结完全缓解(CR)占34、2％，部分缓解率为65．8％，无变化和进展(NR PR)占0％，总有效率(CR PR)为100％，白细胞下降率为96．8％，其中3．4级白细胞下降45.2％，放射性食管炎和放射性肺炎的发生率分别为54．8％和12．9％，均为1、2级。结论立体定向放射治疗配合化疗治疗非小细胞肺癌有较好的近期疗效。     

70岁及以上早期非小细胞肺癌患者立体定向放射治疗的临床研究

目的 观察立体定向放射治疗对70岁及以上早期非小细胞肺癌患者的近期疗效和放射反应。方法 对31例70岁及以上临床Ⅰ、Ⅱ期非小细胞肺癌患者行立体定向放射治疗,患者年龄70～88岁,中位年龄76岁;Ⅰ期21例,Ⅱ期10例;病灶<3 cm 14例,≥3 cm 17例。采用真空袋及体部定位架,CT模拟机定位和三维治疗计划。<3 cm病灶采用弧形照射,剂量10～15 Gy/次,共3～5次;≥3 cm病灶采用非共面适形野,剂量5～8 Gy/次,共6～12次。计划要求95％以上计划靶区(PTV)体积接受95％以上剂量。结果 近期疗效中完全缓解(CR)率为48％,部分缓解(PR)率为39％,无进展(NR)率为13％,总有效率(CR+PR)为87％。肿瘤直径<3 cm者CR率为71％,而≥3cm者CR率为29％,两者比较差异有显著性(P<0.05)。1、2年生存率分别为83.9％。52.6％。Ⅰ、Ⅱ期1年生存率分别为95％、60％,差异有显著性(P<0.05),2年生存率分别为54.5％、50.0％,两者比较差异无显著性(P>0.05)。放射性肺反应早期0级19例,Ⅰ级9例,Ⅱ级3例;晚期肺反应Ⅰ级25例,Ⅱ级6例,无Ⅲ级以上早期及晚期放射性肺反应。结论 立体定向放射治疗技术治疗老年人早期非小细胞肺癌是安全的,近期疗效满意,远期疗效有待进一步观察。     

后程加速超分割放疗非小细胞肺癌158例近期疗效分析

目的 观察后程加速超分割放射治疗非小细胞肺癌的近期疗效和急性放射反应。方法 165例非小细胞肺癌患者进入本研究，常规放射治疗40Gy后，改用后程加速超过分割推量治疗，1．5Gy／次，2次／d，5天／周，总剂量至70Gy。结果 165例中，158例按计划完成治疗，近期疗效为完全缓解13．9％(22／158)，部分缓解59．0％(109／158)，总有效率82．9％(CR PR)。放射性食管炎的发生率为82．3％(130／158)，放射性肺炎发生率为23．4％(37／158)。结论 后程加速超分割放射治疗非小细胞肺癌，近期疗效肯定，急性副反应绝大多数患者可以耐受，远期疗效和晚期并发症有待进一步的观察。     

立体定向放疗治疗早期非小细胞肺癌

目的探讨三维适形放射治疗早期非小细胞肺癌的疗效和放射反应。方法对51例临床I～Ⅱ期非小细胞肺癌行三维适形放射治疗，年龄45～81岁，临床I期29例（T1-2NOM0），Ⅱ期22例（T1-2N1M0），无T3N0M0病例。病灶〈3cm33例，3—5cm4例，〉5cm4例。采用剂量体积直方图评价靶区计划，要求95％以上明W体积接受50％以上剂量，放疗剂量：小于3cm病灶，8～10Gy／次，共4～5次；3cm以上病灶，5～7Gy／次，共7～10次。照射方法：每周3次。边缘剂量控制在40Gy／10次。结果全部患者近期疗效完全缓解（CR）率62．7％（32／51），部分缓解（PR）率31．4％（16／51），无稳定（SD）5．9％（3／51），进展（PD）0例。总有效率（CR＋PR）为94．2％（48／51）。肿瘤直径小于3cm，其CR率为81．8％（27／33），3cm以上者其CR率为50．0％（9／18），近期疗效与肿瘤大小T有关，两者差异有显著意义（r=5．78，P〈0．05）。结论立体定向放射治疗早期非小细胞肺癌是安全、有效的，具有较好的近期及远期疗效，毒副作用可耐受，失败原因主要为远处转移。     

高能聚焦超声治疗胰腺癌40例

为了观察FEP—BY01型肿瘤超声治疗机治疗胰腺癌的安全性及近期疗效，应用FEP—BY01型肿瘤超声治疗机治疗胰腺癌40例。结果表明：完全缓解率(CR)20％(8／40)；部分缓解率(PR)70％(28／40)；有效率90％(CR PR)；无效(PD)10％(4/40)。并且能明显缓解癌性疼痛，有效率达80％(32／40)。所有病例治疗时均未出现胰液漏、腹腔内出血、胃肠道穿孔、皮肤烧伤等并发症。高能聚焦超声治疗技术对胰腺癌的治疗安全有效。     

立体定向放射治疗胰腺癌206例

采用立体定向伽玛射线全身治疗系统治疗206例胰腺癌(PC)患者。根据肿瘤的位置、临床靶体积、患者的身体状况与治疗目的,制定放射治疗计划及调整剂量分布。等剂量曲线55%~90%,周边照射总剂量(3000-4000)cGy,分割处方剂量(400-550)cGy,重复治疗6-8次,隔日治疗,治疗结束后3至12个月,中位随诊时间6、12个月。79例治疗前梗阻性黄疸者,消退55例(69.6%)。146例患者治疗前伴腹背部疼痛,完全消失91例(62.3%),疼痛缓解42例(28.8%)。122例复查CT或MRI,肿瘤消失29例(23.8%),缩小70例(57.4%),无变化14例(11.5%),增大9例(7.4%)。治疗3个月后在治疗部位复发者6例。75例治疗期间出现轻度副反应,但可继续完成治疗。死亡63例(30.6%)。立体定向放射治疗PC对周围组织器官伤害轻微,具有定位精确、治疗时间短、副作用小的特点,近期疗效较为满意。     

高强度聚焦超声联合化疗治疗进展期消化系统恶性肿瘤临床观察

背景：我围消化系统恶性肿瘤发病率高，晚期患者预后较差。目的：评估高强度聚焦超声（HIFU）联合化疗治疗进展期消化系统恶性肿瘤的疗效和安全性。方法：予164例进展期消化系统恶性肿瘤患者行HIFU联合全身静脉化疗，另160例患者行单纯全身静脉化疗作为对照，观察两组临床疗效和不良反应。结果：单纯化疗组近期有效率为43．1％，其中完全缓解（CR）6．2％，部分缓解（PR）36．9％；HIFU联合化疗组近期有效率为55．5％，其中CR8．5％．PR47．0％，组间差异无显著性（P〉0.05）。单纯化疗组中位生存时间为9．7个月，HIFU联合化疗组为13．2个月，组间差异有显著性（P〈0．05）。主要不良反应有恶心、呕吐、骨髓抑制和神经毒性，单纯化疗组严重不良反应发生率为15．6％．HIFU联合化疗组为18．3％，组间差异无显著性（P〉0．05）。结论：HIFU联合化疗治疗进展期消化系统恶性肿瘤临床疗效较好，不增加化疗的毒副作用，患者可耐受，值得在临床上推广应用。     

立体定向放射治疗原发性肝癌的疗效分析

目的分析立体定向放射治疗原发性肝癌的疗效。方法采用γ射线立体定向放射治疗266例原发性肝癌患者,PTV周边照射总剂量为3200～4600eGy,分割处方剂量为300～600cGy,1次／日,6次,周,7～10次完成治疗。结果总有效率（CR＋PR）为79％,无变化（SD）18％,进展（PD）3％。1年、2年、3年生存率分别为71．2％、40．3％、22．8％。本组治疗无放射诱发的肝病（RILD）发生,主要反应为上腹部不适,食欲下降。结论立体定向放射治疗原发性肝癌是一种疗效确切、副作用较小的临床治疗方法。     

吉非替尼治疗老年晚期非小细胞肺癌57例临床分析

目的观察表皮生长因子受体酪氨酸激酶抑制剂吉非替尼单药治疗老年晚期非小细胞肺癌的疗效和毒副作用。方法2003年9月至2006年11月期间，57例65岁以上老年晚期非小细胞肺癌患者，单药口服吉非替尼250mg 1次／d。应用方差分析、t检验、Kaplan-Meier进行统计分析。结果男31例，女26例；年龄65～86岁，中位年龄71岁；Ⅲ期10例，Ⅳ期47例。近期疗效：完全缓解（CR）1例（1．8％），部分缓解（PR）14例（25．5％），有效率（CR＋PR）27．3％；疾病稳定（SD）24例（43．6％），疾病控制率（CR＋PR＋SD）70．9％；疾病进展16例（29．1％）；症状改善率63．6％，症状改善中位时间为8d（3-17d），症状改善持续中位时间为5．8个月；中位疾病进展时间5．3个月（27d至24个月），中位生存期7．8个月（18d至34个月），1年生存率33％。主要不良反应为皮疹42．1％、腹泻31．6％，大部分腹泻患者为轻度，经对症处理后可缓解，仅1例患者因腹泻停药。皮肤瘙痒4例（7．3％），皮肤干燥4例（7．3％），口腔疼痛伴溃疡1例（1．8％），还有1例（1．8％）患者因出现双足皮肤干燥、脱皮和趾甲皲裂而影响行走。结论吉非替尼单药治疗老年晚期非小细胞肺癌疗效肯定，毒副作用相对较小，患者耐受性好。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.