某大学放射性同位素32P应用项目辐射环境监测与评价

目的 评价某大学放射性同位素³²P应用项目对周围环境的辐射影响。方法 依据国家相关标准规定的限值及监测方法作为评价标准和监测手段。结果 该放射性同位素³²P应用项目γ空气吸收剂量率为62.8~108 nGy/h，处于该市天然本底水平范围内。该³²P应用项目工作间，控制区β表面污染监测结果为0.057~0.235 Bq/cm²，符合《电离辐射防护与辐射源安全基本标准》（GB 18871-2002）。该³²P应用项目衰变池水中总α放射性为0.039 Bq/L，低于《医疗机构水污染物排放标准》（GB 18466-2005）中规定的1 Bq/L的标准限值；总β放射性为9.37 Bq/L，低于《医疗机构水污染物排放标准》（GB 18466-2005）中规定的10 Bq/L的标准限值。结论 该项目对职业工作人员和公众是安全的，对周围环境产生的影响较小。     

基于政策工具视角的中医院发展政策文本分析

目的：从政策工具视角对我国中医院发展政策文本进行分析，揭示现有政策工具存在的问题。方法：基于政策工具和中医院发展评价维度构建二维分析框架，采用内容分析方法对28份中医院发展政策文本进行分析。结果：供给型政策、环境型政策、需求型政策分别占总数量的40.79%、36.84%、22.37%。中医院发展评价维度分为资源配置、能力建设、职能落实、外部评价4部分。应用于这4个评价维度的政策工具的文本比例分别为35.53%、21.05%、39.47%、3.95%。结论：政策工具的选择和使用存在一定失衡，建议重视并丰富需求型政策工具，优化政策工具内部结构，提高群众对中医院的认知，完善中医院发展政策体系，提升中医院政策工具科学化水平。     

Pre-clinical use of isogenic cell lines and tumours in vitro and in vivo for predictive biomarker discovery; impact of KRAS and PI3KCA mutation status on MEK inhibitor activity is model dependent

Studies to identify predictive biomarkers can be carried out in isogenic cancer cell lines, which enable interrogation of the effect of a specific mutation. We assessed the effects of four drugs, the PI3K–mammalian target of rapamycin inhibitor dactolisib, the PI3K inhibitor pictrelisib, and the MEK (MAPK/ERK Kinase) inhibitors PD 0325901 and selumetinib, in isogenic DLD1 parental, KRAS^+/−, KRAS^G13D/−, PIK3CA^+/− and PIK3CA^E545K/− colorectal carcinoma cell lines. Importantly, we found substantial differences in the growth of these cells and in their drug sensitivity depending on whether they were studied under 2D (standard tissue culture on plastic) or 3D (in vitro soft agar and in vivo xenograft) conditions. DLD1 KRAS^+/− and DLD1 PIK3CA^+/− cells were more sensitive to MEK inhibitors than parental, DLD1 KRAS^G13D/− and DLD1 PIK3CA^E545K/− cells under 2D conditions, whereas DLD1 KRAS^G13D/− and DLD1 PIK3CA^E545K/− xenografts were sensitive to 10 mg/kg daily ×14 PD 0325901 in vivo (p ≤ 0.02) but tumours derived from parental DLD1 cells were not. These findings indicate that KRAS and PIK3CA mutations can influence the response of DLD1 colorectal cancer cell lines to MEK and PI3K inhibitors, but that the effect is dependent on the experimental model used to assess drug sensitivity.     

Abnormal expression of FLOT1 correlates with tumor progression and poor survival in patients with non-small cell lung cancer

Recent studies have revealed that flotillin-1 (FLOT1) plays important roles in cancer progression. However, the role of FLOT1 in development and progression of non-small cell lung cancer (NSCLC) remains largely unknown. The objective of the current study was to investigate the expression pattern and clinicopathological significance of FLOT1 in patients with NSCLC. Real-time quantitative polymerase chain reaction was applied to examine FLOT1 mRNA expression in 52 pairs of NSCLC tissues and adjacent noncancerous tissues. Immunohistochemistry was performed to examine FLOT1 protein expression in paraffin-embedded tissues from 106 NSCLC patients. Statistical analyses were applied to evaluate the diagnostic value and associations of FLOT1 expression with clinicopathological characteristics. FLOT1 mRNA expression was evidently upregulated in NSCLC tissues compared with that in the adjacent noncancerous tissues. In the 106 cases of tested NSCLC samples, FLOT1 protein level was positively correlated with tumor size, tumor stage, and lymph node metastasis. Patients with higher FLOT1 expression had shorter overall survival time, whereas those with lower FLOT1 expression had longer survival time. Taken together, our findings indicate that FLOT1 may play an important role in NSCLC tumorigenesis. Further elucidation of the molecular mechanisms underlying the role of FLOT1 is warranted.     

Robotic surgery and liver transplantation: A single-center experience of 501 robotic donor hepatectomies

BackgroundOver the past two decades robotic surgery has been introduced to many areas including liver surgery. Laparoscopic liver surgery is an alternative minimally invasive approach. However, moving on to the complexity of living donor hepatectomies, the advantages of robotic versus laparoscopic approach have convinced us to establish the robotic platform as a standard for living donor hepatectomy.MethodsFrom November 2018 to January 2022, 501 fully robotic donor hepatectomies, including 177 left lateral donor lobes, 112 full left lobes and 212 full right lobes were performed. Grafts were donated to 296 adult recipients and 205 pediatric recipients. Donor age, sex, body weight, body mass index (BMI), graft weight, graft to body weight ratio (GBWR), operative time, blood loss, first warm ischemic time, pain score, length of intensive care unit (ICU) stay and hospital stay, and complications were retrospectively analyzed based on a prospectively kept database. Recipients were evaluated for graft and patient survival, age, sex, BMI, body weight, model of end-stage liver disease score, blood loss, transfusions, operative time, cold ischemic time, length of hospital stay and complications.ResultsThere was no donor mortality. Two cases needed to be converted to open surgery. The median blood loss was 60 mL (range 20-800), median donor operative time was 6.77 h (range 2.93-11.53), median length of hospital stay was 4 days (range 2-22). Complication rate in donors classified following Clavien-Dindo was 6.4% (n = 32) with one grade III complication. Three-year actual recipient overall survival was 91.4%; 87.5% for adult recipients and 97.1% for pediatric recipients. Three-year actual graft overall survival was 90.6%; 87.5% for adult recipients and 95.1% for pediatric recipients. In-hospital mortality was 6%, 9.1% (27/296) for adult recipients and 1.4% (3/205) for pediatric recipients. The recipients’ morbidity was 19.8% (n = 99). Twenty-eight recipients (5.6%) had biliary and 22 (4.4%) vascular complications. Six (12.0%) recipients needed to be re-transplanted.ConclusionsWith growing experience it is nowadays possible to perform any donor hepatectomy by robotic approach regardless of anatomical variations and graft size. Donor morbidity and quality for life results are encouraging and should motivate other transplant centers with interest in minimally invasive donor surgery to adopt this robotic technique.     

甲状腺内胸腺癌临床病理学分析

目的探讨甲状腺内胸腺癌(ITTC)的临床病理学特征、免疫表型和预后。方法回顾性分析ITTC患者的临床资料,包括一般临床资料、大体检查、组织学特征、免疫表型及EB病毒编码的小mRNA(EBER)原位杂交检测情况。结果纳入的9例患者肿瘤均为单发性病变,呈结节状。镜下可见肿瘤内大小不等的实性巢状、梁状结构,被间质致密的纤维组织分割成小叶状结构。肿瘤细胞呈多角形或短梭形,细胞界限不清。细胞质淡红染,细胞核圆形或卵圆形,空泡状,核仁明显。9例患者肿瘤均弥漫高表达CKAE1/AE3和CK5/6,不同程度表达CD5(弥漫表达或片状表达),8例患者表达CD117。5例患者肿瘤标本行EBER原位杂交检测,结果均为阴性。随访期间,1例患者失访;其余患者随访9~91个月,仅2例发生复发或转移。结论ITTC是一种罕见的甲状腺低度恶性肿瘤,具有独特的组织病理学特征和免疫表型,预后较好。CD5和CD117可作为ITTC诊断和鉴别诊断的标记物。     

碘治疗工作场所空气中131I的监测结果与分析

目的 了解碘治疗工作场所空气中¹³¹I气溶胶的活度浓度,估算核医学科医务人员吸入¹³¹I所致内照射剂量。方法 使用CF-1001BRL型便携式大容量空气采样器,采用碘盒收集山东省6家医院核医学科碘治疗工作场所空气中的¹³¹I气溶胶,利用HPGe-γ能谱仪对样品进行测量,得到6家医院碘治疗工作场所中¹³¹I的活度浓度值,并估算医务人员的内照射剂量。结果 6家医院碘治疗工作场所空气中¹³¹I的活度浓度范围为3.64~2.94×10³Bq/m³,控制区（病房、患者通道、分装间、远程操作给药室）¹³¹I的浓度水平明显高于监督区,监督区¹³¹I的浓度最高的是医护通道,为2.62×10²Bq/m³。核医学科医务人员两种职业待积有效剂量估算值为0.07~5.68 mSv,均未超过国家规定限值。结论 医院核医学科碘治疗工作场所仍存在不可忽视的¹³¹I气溶胶污染现象,应面向全国各地区核医学科开展内照射监测,探索更加合理的防护标准和方法。     

基于PET/CT选定阈值与基于4D-CT呼气末时相所勾画非小细胞肺癌原发肿瘤靶区相关性分析

目的 探讨基于PET/CT图像选定阈值与基于4D-CT呼气末时相图像所勾画的非小细胞肺癌(NSCLC)原发肿瘤靶区相关性因素。方法 入组NSCLC患者序贯完成3DCT、4D-CT、¹⁸F-FDG PET/CT胸部定位扫描。基于4D-CT呼气末时相(50%)图像勾画原发肿瘤大体肿瘤体积(GTV_50%)。基于PET图像原发肿瘤标准摄取值(SUV)≥2.0、SUV最大值(SUV_max)的20%勾画内大体肿瘤体积(IGTV)分别命名为IGTV_PET2.0、IGTV_PET20%。分析IGTV_PET2.0、IGTV_PET20%与GTV_50%的体积比(VR_2.0、VR_20%)及适形指数(CI_2.0、CI_20%)与GTV_50%最大横径、GTV_50%体积大小、GTV头脚方向位移、GTV三维运动矢量及SUV_max的相关性。结果 VR_2.0和GTV_50%最大横径、GTV_50%体积大小、GTV头脚方向位移、GTV三维运动矢量及SUV_max均无相关性(P>0.05);VR_20%和GTV_50%体积大小、GTV_50%最大横径及SUV_max呈负相关(r=-0.663、-0.669、-0.752,P<0.05)。CI_2.0和GTV_50%体积大小、GTV_50%最大横径呈正相关(r=0.613、0.483,P<0.05)。结论 3D PET图像是包含了多个呼吸周期的中位图像,未能包含肿瘤的全部运动信息,基于3D PET/CT图像所构建的靶区不能准确地代表NSCLC的IGTV。     

预防性应用生长抑素对降低胰十二指肠切除术后并发症的Meta分析

目的:以循证医学证据评价胰十二指肠切除术预防性使用生长抑素的临床疗效。方法:通过计算机检索Pubmed数据库、EMBASE、万方数据库、中国全文期刊数据库和维普数据库,并结合文献追溯、网上查询(www.baidu.com;www.google.com)的方法,收集关于预防性应用生长抑素在胰十二指肠切除术后临床疗效的随机对照试验,并按Cochrane协作网推荐的方法对符合纳入标准的11个研究共1041例病人进行Meta分析,发表偏倚用漏斗图评估。结果:与对照相比,预防性应用生长抑素能降低胰十二指肠切除术后总并发症的发生率(P=0.04),但二者在术后胰瘘发生率(P=0.13)、围手术期病死率(P=0.69)、住院天数(P=0.52)方面均无统计学差异。结论:Meta分析结果显示术后预防性应用生长抑素,能在一定程度上降低术后并发症的发生,但是不能有效预防胰瘘的发生、降低围手术期病死率和缩短住院天数。由于纳入的样本存在选择偏倚、发表偏倚及测量偏倚的可能性,影响结果的论证强度,最终结论需要进行更多高质量的随机对照试验。