放射性心脏损伤动物模型相关实验研究进展

当利用放射线对胸部恶性肿瘤进行治疗时，位于纵隔的心脏会不可幸免受到照射，从而诱发放射性心脏损伤（radiation-induced heart disease, RIHD）。随着手术以及放化疗技术的提升，肿瘤患者生存时间得到延长，使得RIHD这一放疗远期并发症被越来越多的报道。因此，学者们对于RIHD的研究逐渐升温。目前国内外学者关于该疾病尚未形成统一的认识，临床上缺乏有效阻止其发生的方法。动物模型研究可为临床该疾病治疗及预防提供可靠证据，为此本文回顾分析近年来放射性心脏损伤动物模型实验研究情况，旨在为后续实验开展及临床应用提供参考。     

结直肠癌化疗患者营养状况及营养治疗研究进展

结直肠癌是常见的消化道肿瘤，其营养不良发生率高且严重。化疗是结直肠癌常见治疗方式之一，并与营养不良独立相关，化疗后患营养不良风险增大且营养不良进一步加重。同时，营养不良可导致患者化疗疗效差及预后不良，并增加化疗相关不良反应、影响患者生活质量及降低生存率等。营养治疗能够有效改善患者营养状况，在肿瘤综合治疗中有重要作用，且多学科团队合作是有效的营养干预模式。目前营养治疗主要包括营养咨询、口服营养补充剂、肠内营养和肠外营养等，相关指南和研究表明在营养治疗时应首选口服营养补充剂及肠内营养，仅在采用以上治疗后仍存在营养不足或无法进行肠内营养时行肠外营养。本文主要对结直肠癌患者营养状况与化疗之间关系、营养治疗的最新研究进展及相关指南进行综述，以期引起临床上对结直肠癌化疗患者营养治疗方面重视并提供参考。     

非活动性结核性胸膜炎与活动性结核性胸膜炎的CT扫描影像特征分析

目的: 探讨非活动性结核性胸膜炎与活动性结核性胸膜炎CT扫描影像表现。方法: 对2012年6月1日至2021年3月30日在首都医科大学附属北京胸科医院就诊的单纯非活动性结核性胸膜炎患者68例和同期活动性结核性胸膜炎44例的CT扫描影像表现进行比较。结果: (1) 68例非活动性结核性胸膜炎患者 CT扫描影像表现中胸膜粘连62例(91.2%),胸膜有钙化者28例(41.2%),叶间裂受累22例(32.4%),胸腔积液12例(17.6%),包裹性胸腔积液8例(11.8%)。(2)44例活动性结核性胸膜炎患者CT扫描影像表现中胸膜粘连30例(68.2%),未见胸膜钙化,叶间裂受累32例(72.7%),胸腔积液43例(97.7%),包裹性胸腔积液26例(59.1%)。(3)非活动性与活动性结核性胸膜炎CT扫描影像比较:胸膜粘连、胸膜钙化发生率高,差异均有统计学意义(χ²=9.630,P=0.002;χ²=23.737,P=0.000);叶间裂受累、胸腔积液、包裹性胸腔积液的发生率低,差异均有统计学意义(χ²=12.692,P=0.000;χ²=68.548,P=0.000;χ²=28.301,P=0.000)。结论: 非活动性结核性胸膜炎的CT扫描影像与活动性结核性胸膜炎比较胸膜粘连、胸膜钙化的发生率高,胸腔积液、包裹性胸腔积液、叶间裂受累的发生率低。识别非活动性和活动性结核性胸膜炎的CT扫描影像特点,对患者临床治疗有指导意义。     

1.318 μm近红外激光视网膜损伤阈值研究

目的研究1·318μm激光对视网膜的损伤效应,确定其损伤阈值。方法用输出波长1·318μm的Nd∶YAG激光为照射光源,固定照射时间0·2s,以不同剂量的激光照射散瞳后的家兔(25只)和大鼠(28只)眼睛,照射光斑直径分别为5mm和2mm,于照后1h和24h观察视网膜损伤发生率,用加权概率单位法计算损伤发生率为50%时所对应的激光剂量,即损伤阈值ED50。并于照后24h对损伤视网膜做病理切片观察。结果1·318μm激光致家兔和大鼠视网膜损伤的阈值角膜剂量分别为13·7J/cm2和10·4J/cm2,阈值角膜能量分别为2·69J和0·33J。受损视网膜可见清晰的白色凝固斑,损伤重者累及视网膜全层。结论1·318μm激光可导致家兔和大鼠视网膜损伤,损伤阈值ED50分别为13·7J/cm2和10·4J/cm2。     

CT引导下胶原酶注射颈椎间盘溶解术的临床研究

目的:研究CT引导下胶原酶注射颈椎间盘溶解术治疗颈椎间盘突出症的价值。方法:对15例颈椎间盘突出症患者在CT引导下行胶原酶注射颈椎间盘溶解术。结果:15例均成功,随访1~16个月,优良率93.3%,未见并发症发生。结论:CT引导下行胶原酶注射颈椎间盘溶解术治疗颈椎间盘突出症安全有效,值得进一步研究。     

Dexamethasone treatment attenuates early seawater instillation-induced acute lung injury in rabbits.

There is very little evidence on the value of giving corticoids in cases of seawater drowning induced acute lung injury/acute respiratory distress syndrome (ALI/ARDS). Therefore, this study aimed to investigate whether dexamethasone treatment can attenuate seawater instillation-induced acute lung injury in rabbits. Seawater (4 ml/kg body weight) was instilled into the lower trachea of ventilated, anesthetized rabbits. Then these rabbits were assigned randomly 20 min later to receive intravenous injection of 1mg/kg body weight of dexamethasone (dissolving in 2 ml of normal saline) or 2 ml of normal saline. All animals demonstrated immediate drops in arterial oxygen tension (PaO2) and the total thoracic compliance, which were significantly improved after 2 h of dexamethasone treatment. Histopathological study also indicated that dexamethasone treatment markedly attenuated lung histopathological changes, alveolar hemorrhage and inflammatory cells infiltration with evidence of decreasing of myeloperoxidase (MPO) activity and tumor necrosis factor-alpha (TNF-alpha) concentration in lung tissue. In addition, dexamethasone treatment reduced extravascular lung water and lung epithelial-endothelial barrier permeability, up-regulated the expression of surfactant protein-A (SP-A) and alpha-epithelial Na+ channel, and increased Na+/K+-adenosine triphosphatase (Na+/K+-ATPase) activity and Na+/K+-ATPase-alpha1 protein abundance. Thus, these data indicate that dexamethasone treatment might be of benefit in patients with seawater aspiration-induced ALI.     

Effect of Induction Therapy Protocols on Transplant Outcomes in Crossmatch Positive Renal Allograft Recipients Desensitized with IVIG

Here we retrospectively examine the efficacy of two antibody induction regimens using Zenapax or Thymoglobulin in patients with positive complement-dependent cytotoxicity crossmatches (CDC-CMXs) desensitized with IVIG (intravenous immunoglobulin). Between January 1999 and March 2005, 97 patients with (+) CDC-CMXs received kidney transplants (43 deceased donors/54 living donors). All patients received at least 2 g/kg IVIG (maximum four doses) until an acceptable CMX was obtained. Patients were divided into two groups: 1. IVIG + Zenapax (n = 58), 2. IVIG + Thymoglobulin (n = 39). A total of 94% of patients in Group 1 and 84% in G2 have at least 2 years of follow up. Patient and graft survival was 96%/84% in Group 1 and 100%/90% in Group 2, p = NS. The number and severity of AR episodes were similar (36% Group 1 vs. 31% Group 2, p = NS) as was the incidence of C4d (+) antibody-mediated rejection (AMR) (Banff Grade II/III) (22% Group 1 vs. 21% Group 2). Mean serum creatinines (SCrs) at 24 months were similar (Group 1: 1.4 +/- 0.7 vs. G2: 1.5 +/- 0.7 mg/dL). Induction therapy with Zenapax or Thymoglobulin results in excellent patient, graft survival and graft function at 2 years. There was no increased risk of viral infections or malignancies with either agent. Neither agent was effective in reducing the incidence of AMR.