磁共振弥散加权成像评价鼻咽癌调强放疗唾液腺功能的损伤

目的 应用磁共振弥散加权成像技术（DW-MRI）评价鼻咽癌患者调强放疗后唾液腺功能损伤,并对相关因素进行分析。方法 入组28例初诊鼻咽癌患者,所有患者行IMRT治疗,分别在放疗前、放疗第4周、放疗结束、放疗后3、6和12月行DW-MRI扫描和口干评级。DW-MRI扫描包括静息状态和酸刺激后。结果 放疗后6和12月鼻咽癌患者口干分级与放疗后3月、放疗结束时比较,差异均有统计学意义（均P<0.05）。放疗前腮腺ADC值静息状态、酸刺激第3、6分钟两两比较差异有统计学意义（均P<0.05）。放疗第4周、放疗结束、放疗后3月ADC值总体升高,但酸刺激各时间段差异均无统计学意义（均P>0.05）。放疗后6、12月ADC值总体逐步降低,且再次出现先升高后下降,然后长时间缓慢升高的表现,酸刺激第3和第6分钟时比较差异有统计学意义（均P<0.05）。放疗前酸刺激状态下颌下腺和腮腺类似。分析结果显示：ADC值变化率和唾液腺体积变化率呈正相关;ADC值变化率、唾液腺体积变化率分别和平均剂量呈正相关。结论 DW-MRI在评价鼻咽癌调强放疗唾液腺功能损伤方面具有一定的价值。     

鼻咽癌调强放疗中再程计划保护腮腺对口干燥症影响的临床研究

摘 要：［目的］ 研究鼻咽癌调强放疗中再程计划改野对减轻腮腺损伤,降低口干燥症发生率的影响。［方法］ 入组117例拟行调强放疗的鼻咽癌患者,分单次计划放疗组（46例）和再程计划放疗组（71例）。对两组靶区受照射剂量和体积、双侧腮腺受照射剂量和体积、4年局部控制率和4年生存率进行比较。［结果］ 两组靶区受照射剂量及体积变化差异无统计学意义（P＞0.05）,但再程计划放疗组双侧腮腺受照射剂量和体积均较单次计划放疗组显著降低（P＜0.05）。再程计划放疗组口干燥症严重程度较单次计划放疗组低（P=0.015）。再程计划放疗组和单次计划放疗组的4年局部控制率分别为94.4%和82.6%（P=0.046）,4年总生存率分别为84.5%和80.4%（P=0.573）。［结论］ 鼻咽癌调强放疗中再程计划改野模式可减轻腮腺损伤,降低口干燥症的发生。     

鼻咽癌螺旋断层放疗与常规调强放疗剂量学及对唾液腺保护的分析

摘 要：［目的］ 比较鼻咽癌在螺旋断层放疗（helical tomotherapy,HT）与常规调强放疗（intensity modulated radiotherapy,IMRT）两种治疗计划中适形度指数（CI）、均匀性指数（HI）及唾液腺的剂量。［方法］ 收集2015～2016年行放疗的31例鼻咽癌患者,将定位数据及靶区勾画信息分别传输至Tomotherapy TPS工作站及Elekta Pinnacle TPS工作站进行调强计划设计,比较两个治疗计划的适形度指数、均匀性指数及唾液腺平均剂量、腮腺D50等指标。［结果］螺旋断层放疗计划与常规调强放疗计划比较,适形度指数（P<0.001）与均匀性指数（P<0.001）均有明显优势。腮腺的受照射剂量在常规调强放疗计划中更有优势（右侧P=0.01,左侧P=0.001）。腮腺D50在两组放疗计划差异无统计学意义（右侧P=0.671,左侧P=0.156）。螺旋断层放疗计划中颌下腺的平均剂量明显降低（右侧P=0.007,左侧P=0.007）。［结论］两组放疗计划均能满足临床要求,相较于传统调强放疗计划,螺旋断层放疗在鼻咽癌治疗中有更好的靶区剂量覆盖,剂量均匀性,在颌下腺保护优势明显。     

磁共振弥散加权成像参数ADC值与食管癌瘤体组织Sirtuin1蛋白表达的相关性

摘 要：［目的］ 探讨磁共振弥散加权成像（MRI-DWI）参数表观弥散系数（ADC）值与食管癌组织Sirtuin1（SIRT1）蛋白表达的相关性,寻找预测食管癌辐射抵抗的生物靶标。［方法］ 入组32例食管癌患者,收集所有患者治疗前肿瘤组织标本,行免疫组化检查,定量计算SIRT1蛋白表达情况。所有患者均接受根治性放疗,并于放疗前及放疗至第5次分割时接受两次MRI-DWI检查,利用脱机分析软件根据既定方法于食管癌瘤床区勾画感兴趣区域（ROI）,得出相应ROI区域ADC值,取三次测量平均值为相应参数值。测量得出治疗前及放疗至第5次分割时ADC值,分别标记为pre-ADC、intra-ADC,通过前后两次ADC值计算得出ΔADC值。分析上述各ADC值与SIRT1蛋白表达的线性相关性。［结果］ 32例患者中25例患者为影像学缓解反应组（完全缓解+部分缓解）,7例患者为影像学稳定组（疾病稳定）,缓解反应组和稳定组SIRT1表达水平分别为36.11%±4.66%和61.72%±4.08%（P=0.001）。治疗前32例食管癌瘤床区测量所得pre-ADC平均值为1.26±0.22（10-3mm2/s）;放疗至第5次分割时,食管癌瘤床区测量所得intra-ADC平均值为1.58±0.31（10-3mm2/s）;治疗前、放疗至第5次时ADC差值ΔADC为0.32±0.18（10-3mm2/s）。SIRT1表达水平与不同ADC值之间呈不同程度相关性（ΔADC：r=-0.967,P=0.002;intra-ADC：r=-0.746,P=0.002;pre-ADC：r=0.109,P=0.558）。［结论］ MRI-DWI检查功能参数ADC值与SIRT1表达水平之间具有不同程度相关性,可能在预测食管癌辐射抵抗中发挥重要作用。     

唾液腺显像对鼻咽癌放疗后腮腺功能的评价

目的探讨唾液腺显像对鼻咽癌放疗后腮腺功能的评价。方法对40例鼻咽癌行适形调强放疗（30例）及常规放疗（10例）的患者,分别于放疗前、放疗结束时及放疗后5个月作口干程度的比较及唾液腺功能显像榆查。结果放疗结束时患苦出现不同程度口干症状,放疗后5个月,部分患者口千症状有明显改善。唾液腺受损后腮腺显像图像征象及时问放射性曲线均有变化。放疗结束时腮腺定量分析摄取指数（UI）及分泌指数（E1）均比放疗前低（P〈0．05）,但适形调强放疗组的UI及EI均比常规放疗组高（P〈0．05）。结论适形凋强放疗可以有效保护腮腺功能,唾液腺显像可用于监测鼻咽癌放疗后腮腺功能变化。     

鼻咽癌IMRT中OAR实际受量与计划剂量差异研究

目的 观察鼻咽癌IMRT中OAR实际受量估算值与计划剂量的差异。方法 选取13例拟接受IMRT鼻咽癌患者,在放疗第10、20、30次时重新CT扫描,并勾画脑干、脊髓、左右腮腺和颌下腺,观察其体积在放疗中的变化。将放疗前治疗计划复制到每个新的CT图像上,计算整个放疗中估算增加的剂量(实际受量估算值减去物理计划剂量)。结果 放疗第10、20、30次时左、右腮腺及颌下腺体积在放疗过程呈进行性下降(P值均为0.000)。与计划剂量相比,整个放疗过程脑干、脊髓的D_max分别平均增加3.76、3.68 Gy (P=0.000、0.000),左、右腮腺的D₅₀分别平均增加5.11、3.54Gy (P=0.001、0.023),左、右颌下腺的D₅₀分别平均增加0.49、0.75 Gy (P=0.220、0.230)。结论鼻咽癌放疗过程后腮腺和颌下腺体积明显缩小。脑干、脊髓和腮腺实际受量较计划剂量显著增加,而颌下腺受量变化不明显。     

磁共振弥散加权成像在早期预测食管癌放疗敏感性中的应用价值

摘 要：［目的］ 探讨磁共振弥散加权（MRI-DWI）技术早期预测食管癌原发灶放疗近期疗效的临床价值,寻找食管癌放疗敏感性的“生物标记”。［方法］ 入组32例行放射治疗的食管癌患者,所有患者均于放疗前及放疗至第5次分割时接受两次MRI+DWI检查,观察者利用脱机分析软件根据既定方法于食管癌最大横径勾画感兴趣区域（ROI）,得出相应ROI区域ADC值。测量得出治疗前及治疗期间ADC值分别标记为pre-ADC、intra-ADC,通过前后两次ADC值计算得出ΔADC值。近期疗效评价遵循RECIST 1.1标准。分析不同近期疗效患者间上述参数的差异,并分析各参数与疗效之间的Spearman秩相关系数。构建受试者工作特征曲线（ROC）用于评价各参数评价治疗疗效。［结果］ 32例患者中9例获得影像学完全缓解(CR),16例获得影像学部分缓解(PR),7例获得影像学疾病稳定（SD）。治疗前32例食管癌瘤床区测量所得pre-ADC平均值为（1.26±0.22）10-3mm2/s,放疗至第5次分割时,食管癌瘤床区测量所得intra-ADC平均值为（1.58±0.31）10-3mm2/s,治疗前、放疗至第5次时ADC差值ΔADC为（0.32±0.18）10-3mm2/s,前后两次ADC值比较差异有统计学意义（P=0.03）。ΔADC与食管癌近期治疗反应呈正相关（P=0.776,P=0.023）。［结论］DWI检查功能参数ADC值有可能成为食管癌根治性放疗近期疗效预测的“生物标记”。     

分化型甲状腺癌131I固定剂量清甲治疗唾液腺功能影响评价

摘 要：［目的］ 探讨分化型甲状腺癌（DTC）患者使用固定剂量（100mCi）131I进行清甲治疗是否会在短期（6个月）对其唾液腺功能造成损伤。［方法］ 通过对40例接受131I清甲治疗的DTC患者给予100mCi 131I,99mTcO4-唾液腺动态显像对比治疗前后的唾液腺摄取指数及排泌分数,分析131I清甲治疗前后患者唾液腺（腮腺、颌下腺）摄取及排泌功能的变化。［结果］ DTC患者治疗前腮腺功能参数分别为：摄取指数：左（22.9±2.6）、右（24.5±2.7）,排泌分数：左（58.3±6.2）、右（60.7±7.1）;DTC患者治疗后腮腺功能参数分别为：摄取指数：左（22.1±2.4）、右（23.9±2.3）,排泌分数：左（57.0±7.6）、右（58.1±7.1）。DTC患者治疗前颌下腺功能参数分别为：摄取指数：左（23.5±2.2）、右（23.6±2.8）,排泌分数：左（56.2±7.4）、右（62.0±7.3）;DTC患者治疗后颌下腺功能参数分别为：摄取指数：左（22.9±2.0）、右（22.7±1.8）,排泌分数：左（55.1±6.7）、右（60.8±6.4）。［结论］ 使用固定剂量（100mCi）131I对DTC患者进行清甲治疗,短期（6个月）未对患者唾液腺功能造成明显损伤。     

鼻咽癌调强放疗后放射性颞叶损伤32例临床分析

摘 要：［目的］ 分析鼻咽癌调强放疗（IMRT）后放射性颞叶损伤的影像及临床特点。［方法］ 回顾性分析单治疗组2005年3月至2012年1月初治260例无远处转移鼻咽低分化鳞癌患者行IMRT中发生放射性颞叶损伤患者的临床特点。［结果］ 共有32例患者发生影像学放射性颞叶损伤,其中7例为双侧同时或者先后发生,25例为单侧,均位于病变侧;8例有记忆力减退、多语和（或）颅内压增高等临床表现,24例无明显临床症状;仅3例患者进行了激素加抗水肿等治疗,余29例未行特殊治疗;至2015年5月仅1例患者死亡。根据MRI损伤分型,2型28例,1型4例。［结论］ 与常规放疗相比,鼻咽癌行IMRT后放射性颞叶损伤发生较早,但临床症状不典型,影像表现程度较轻,有自愈倾向,体现了IMRT在鼻咽癌治疗中对颞叶保护的作用。     

鼻咽癌调强放疗患者合并腮腺可疑淋巴结的临床分析

摘 要：［目的］ 分析合并腮腺可疑淋巴结的鼻咽癌调强放疗患者的临床特点,探讨鼻咽癌腮腺淋巴结转移的规律及合适的处理方法。［方法］ 收集初治鼻咽癌调强放疗病例,对合并有腮腺可疑淋巴结者,分析其表现形式;回顾比较对腮腺淋巴结采用不同的处理方法是否存在疗效差异。［结果］ 384例初治鼻咽癌患者中,64例初治前MRI发现合并有腮腺可疑淋巴结,按拟定标准,其中17例临床诊断为腮腺淋巴结转移,均为Ⅲ～Ⅳa期,颈淋巴结分期大多达N2以上（70.6%）,多伴有受累腮腺同侧颈部Ⅱ区大淋巴结（直径＞3cm）或包膜外侵犯,及同侧咽后淋巴结转移（88.2%）。全部64例患者中,34例患者不设腮腺靶区,其余30例予部分腮腺或全腮腺照射,均未发现腮腺或腮腺淋巴结复发/转移。［结论］ 基于MRI检查发现腮腺淋巴结的鼻咽癌患者,如有上述高危因素,应高度怀疑腮腺淋巴结为鼻咽癌转移可能,宜给予放疗干预;不具备高危因素的患者,严密的影像学观察或可以较好地降低腮腺受量,改善调强放疗后的生活质量。     

Cytologic classification of precancer and cancer of the endometrium and esophagus and of malignant lymphomas

The paper discusses cytological classifications of precancer and cancer of the endometrium, esophagus and malignant lymphomas presented by cytologists from five Soviet research institutes of oncology. The classifications were based on the data of 4400 cases in conformity with WHO histologic classifications.     

E-钙粘蛋白及PTEN基因编码蛋白与胃癌浸润转移

目的:观察抑癌基因PTEN蛋白和ECD在胃癌组织中的表达,探讨其与胃癌生物学行为及预后的关系。方法:以兔抗人PTEN多克隆抗体、鼠抗人ECD单克隆抗体,采用SABC免疫组化法,检测100例胃癌手术切除标本中拟测指标的表达。以χ2和Logrank检验对结果做统计学分析。结果:ECD、PTEN蛋白在非癌胃粘膜中均见表达;在胃癌组织中表达下调或缺失。ECD异常表达率为42.0%;弥漫型胃癌异常表达率(48.57%),明显高于肠型胃癌(26.67%),(P<0.05);ECD异常表达与浸润深度有关(P<0.05)。胃癌组织中PTEN蛋白缺失率为59%;弥漫型胃癌缺失率(65.71%)明显高于肠型胃癌(43.33%),(P<0.05);伴淋巴结转移的胃癌缺失率(64.47%)明显高于无淋巴结转移者(41.67%),(P<0.05);PTEN蛋白缺失的患者比阳性表达者预后差(P=0.0066)。65.85%PTEN阳性表达者同时伴ECD正常表达。结论:两种标志物与胃癌浸润转移有关,PTEN表达与胃癌患者预后密切相关。将两种指标联合检测,可作为正确判断胃癌患者预后,指导临床治疗的分子生物学指标。     

Schwannomas of Head and Neck and Review of Literature

Benign nerve cell tumours have been given various names like schwannoma, neurilemmoma, neurinoma, neurofibroma, spindle cell tumours etc. Extra cranial head and neck schwannomas usually present as solitary and well-demarcated lesions. The lesion can cause secondary symptoms, such as nasal obstruction, dysphasia, and hoarseness, depending upon the location of the lesion. Fine needle aspiration cytology, CT scans, and MRI may be of limited help in the diagnosis of schwannomas. The treatment is complete surgical excision of the benign tumour and postoperative histopathological examination establishes the final diagnosis.     

Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers

BACKGROUND: Frequent consumption of fruit and vegetables has been associated with a reduced risk of colorectal cancer in many observational studies. METHODS: We prospectively investigated the association between fruit and vegetable consumption and the incidence of colon and rectal cancers in two large cohorts: the Nurses' Health Study (88 764 women) and the Health Professionals' Follow-up Study (47 325 men). Diet was assessed and cumulatively updated in 1980, 1984, 1986, and 1990 among women and in 1986 and 1990 among men. The incidence of cancer of the colon and rectum was ascertained up to June or January of 1996, respectively. Relative risk (RR) estimates were calculated with the use of pooled logistic regression models accounting for various potential confounders. All statistical tests were two-sided. RESULTS: With a follow-up including 1 743 645 person-years and 937 cases of colon cancer, we found little association of colon cancer incidence with fruit and vegetable consumption. For women and men combined, a difference in fruit and vegetable consumption of one additional serving per day was associated with a covariate-adjusted RR of 1.02 (95% confidence interval [CI] = 0.98-1.05). A difference in vegetable consumption of one additional serving per day was associated with an RR of 1.03 (95% CI = 0.97-1.09). Similar results were obtained for women and men considered separately. A difference in fruit consumption of one additional serving per day was associated with a covariate-adjusted RR for colon cancer of 0.96 (95% CI = 0.89-1.03) among women and 1. 08 (95% CI = 1.00-1.16) among men. For rectal cancer (total, 244 cases), a difference in fruit and vegetable consumption of one additional serving per day was associated with an RR of 1.02 (95% CI = 0.95-1.09) in men and women combined. None of these associations was modified by vitamin supplement use or smoking habits. CONCLUSIONS: Although fruits and vegetables may confer protection against some chronic diseases, their frequent consumption does not appear to confer protection from colon or rectal cancer.     

世界卫生组织骨质疏松症防治工作报告和防治建议

引 言 作为对第51号综合处理非传染性疾病预防与控制的世界卫生组织决议的反应,1998年7月WHO成立了致力于不断完善对骨质疏松预防和治疗策略的工作小组。小组成员来自世界各国致力于骨质疏松研究的知名专家。Harry K.Genant为本届主席。这一项世界范围内的骨质疏松教育计划旨在通过世界范围的研究,不断改善对骨质疏松的诊断水平和发展并完善对骨质疏松病人的合理治疗。其重点将以发展中国家为主。并为各国政府及其卫生部门和病人群体提供世界性有关骨质疏松症的总体的、完整的指导性资料。该项研究、教育计划的实施将由世界各国的骨质疏松症研究和治疗机构共同完成,并经权威学术机构、政府和非政府组织进行有针对性的回顾研究,最终由WHO审议通过。     

A comparative study of knowledge and awareness of colorectal and breast cancerA comparative study of knowledge and awareness of colorectal and breast cancer

Aims: To assess and compare knowledge and awareness of colorectal cancer and breast cancer in a sample of the general population. Methods: Eleven hundred visitors to six different outpatient clinics, in a University Hospital, were given a study-specific questionnaire, based on educational material from the British Association of Cancer United Patients (CancerBACUP). The questionnaire consisted of 12 statements on the incidence, presentation, detection, treatment and prognosis of colorectal and breast cancer. Results: One thousand and sixty-eight individuals returned the questionnaire. One thousand and four completed questionnaires were analysed. The mean age (SD) of respondents was 50.1 (17.2) years, and the male to female ratio was 2:3. Respondents had read more about breast than about colorectal cancer (60.3%vs 32.4%,P <0.0001, McNemar's test). The proportion of correct answers for each statement on breast cancer was higher than for answers to corresponding items on colorectal cancer. Mean overall scores (95% CI) for breast and colorectal cancer were 88.1 (86.9, 89.2) and 64.4 (62.5, 66.3) respectively, the mean difference (95% CI) being 23.7 (22.0, 25.5). Scores were higher for breast cancer irrespective of age or gender. Conclusion: There is a low level of understanding of colorectal cancer in the general population when compared to breast cancer. This highlights the importance of public education in this common cancer.     

Quality of life and care in leukemia,myeloma and non-malignant disease. Opinions of patients and relatives,and effects of geography and time

In a questionnaire study 140 subjects answered 4200 questions in 1980 and 1986. They consisted of patients with myeloma, acute leukemia, lung carcinoma, and non-malignant disease and their relatives. In 22 additional cases the questionnaire was not answered. The results show that myeloma patients are less content with the general care than leukemia patients (P < 0.05). Similarly, relatives of deceased myeloma patients are less satisfied with the information given to them than relatives of deceased leukemia patients (P < 0.001). The information has improved with time, however, since the patients were more satisfied in 1986 than in 1980 (P < 0.001) and relatives of myeloma patients still alive were more satisfied than relatives of patients who had died earlier (P < 0.001).     

甲状腺手术的技巧及副损伤的预防和处置

鉴于甲状腺手术是普外科的常见手术，为求其日渐完美，以有益于病人，现根据作者的体会，并结合阅读相关文献，就其手术操作、喉返神经处理、甲状旁腺处理进行扼要阐述。