多层螺旋CT低剂量扫描在肺磨玻璃结节检查中的应用

目的：探讨多层螺旋CT（MSCT）低剂量扫描在肺磨玻璃结节（GGN）检查中的应用价值。方法对379例志愿者进行肺部常规剂量和低剂量MSCT扫描,观察GGN的形态、大小、密度、内部特点和结节边缘等情况。结果常规剂量MSCT扫描发现21个GGN,低剂量MSCT扫描发现20个GGN,GGN直径为4-15 mm,其中8例GGN患者诊断为原发性肺癌。结论 MSCT低剂量扫描对于GGN有较高的检出率,可应用于早期肺癌的筛查。     

Effects of Low-Dose-Gamma Rays on the Immune System of Different Animal Models of Disease

We reviewed the beneficial or harmful effects of low-dose ionizing radiation on several diseases based on a search of the literature. The attenuation of autoimmune manifestations in animal disease models irradiated with low-dose γ-rays was previously reported by several research groups, whereas the exacerbation of allergic manifestations was described by others. Based on a detailed examination of the literature, we divided animal disease models into two groups: one group consisting of collagen-induced arthritis (CIA), experimental encephalomyelitis (EAE), and systemic lupus erythematosus, the pathologies of which were attenuated by low-dose irradiation, and another group consisting of atopic dermatitis, asthma, and Hashimoto’s thyroiditis, the pathologies of which were exacerbated by low-dose irradiation. The same biological indicators, such as cytokine levels and T-cell subpopulations, were examined in these studies. Low-dose irradiation reduced inter-feron (IFN)-gamma (γ) and interleukin (IL)-6 levels and increased IL-5 levels and the percentage of CD4⁺CD25⁺Foxp3⁺Treg cells in almost all immunological disease cases examined. Variations in these biological indicators were attributed to the attenuation or exacerbation of the disease’s manifestation. We concluded that autoimmune diseases caused by autoantibodies were attenuated by low-dose irradiation, whereas diseases caused by antibodies against external antigens, such as atopic dermatitis, were exacerbated.     

Non-problematic risks from low-dose radiation-induced DNA damage clusters

Radiation-induced DNA damage clusters have been proposed and are usually considered to pose the threat of serious biological damage. This has been attributed to DNA repair debilitation or cessation arising from the complexity of cluster damage. It will be shown here, contrary to both previous suggestions and perceived wisdom, that radiation induced damage clusters contribute to non-problematic risks in the low-dose, low-LET regime. The very complexity of cluster damage which inhibits and/or compromises DNA repair will ultimately be responsible for the elimination and/or diminution of precancerous and cancerous cells.     

低剂量螺旋CT在肺结核中的诊断价值

目的:探讨低剂量螺旋CT在肺结核诊断中的应用价值。材料与方法:采用东芝公司Active 16排螺旋CT对98例胸部DR平片怀疑肺结核的患者进行常规剂量螺旋CT扫描,同时对病变部位行低剂量螺旋CT扫描。所得图像由3名从事影像诊断工作主治医师以上的医生进行判读,分别就肺结核在螺旋CT上的主要征象进行逐一判定,最后做出定性诊断。结果:98例胸部DR平片怀疑肺结核患者,最后通过查痰、活检或肺结核菌阴性确诊的肺结核患者有80例。对以上确诊的80例肺结核患者的两种扫描方式所得图像进行判定,低剂量螺旋CT与常规CT在肺结核征象的检出率差异无统计学意义(P0.05)。结论:低剂量螺旋CT大幅度降低患者的辐射剂量,能获得常规剂量CT扫描相同的诊断效果,在肺结核的诊断中具有临床应用价值。     

低浓度阿托品联合角膜塑形镜对青少年低中度近视患者治疗效果、泪膜功能及SF-36量表评分的影响

目的　探讨低浓度（0.1 g·L^-1)阿托品联合角膜塑形镜对青少年低中度近视患者治疗效果、泪膜功能及健康测量量表(SF-36)评分的影响。方法　病例对照研究。选取98例青少年低中度近视患者为研究对象,按照随机数字表法分为观察组（49例）、对照组（49例）;对照组患者仅使用角膜塑形镜治疗,观察组患者使用角膜塑形镜联合低浓度(0.1 g·L^-1)阿托品滴眼液进行治疗。治疗前和治疗后3个月、6个月、12个月随访两组患者裸眼视力(UCVA)、角膜曲率、等效球镜度、角膜厚度、屈光度、眼压及泪膜功能。采用量表SF-36对两组患者治疗前及治疗后12个月的生活质量进行评价,统计两组患者的并发症发生情况。结果　治疗后12个月,观察组患者UCVA、角膜曲率、等效球镜度、角膜厚度、屈光度分别为(0.16±0.10) logMAR、(40.04±0.69)D、(-2.28±0.51)D、(539±33)μm、(1.49±0.45)D,均明显优于对照组的UCVA［(0.22±0.08)logMAR］、角膜曲率［(43.33±0.47)D］、等效球镜度［(-2.77±0.45)D］、角膜厚度［(545±34)μm］、屈光度［(-1.60±0.42)D］（均为P<0.05）。治疗后12个月,观察组患者泪膜脂质层厚度、泪膜破裂时间分别为(55.42±5.07)nm、(5.14±1.72)s,均低于对照组的泪膜脂质层厚度［(62.17±5.38)nm］、泪膜破裂时间［(6.29±2.08)s］（均为P<0.05）;治疗后12个月,观察组患者客观散射指数为1.99±0.28,高于对照组(1.24±0.35)（P<0.05）;治疗后12个月,观察组患者SF-36量表各项评分均优于对照组（均为P<0.05）。两组患者治疗期间并发症发生率比较,差异均无统计学意义（均为P>0.05）。结论　低浓度阿托品联合角膜塑形镜治疗青少年低中度近视效果显著,有助于改善患者视力及屈光度,提高患者生活质量,安全性相对较高,值得临床上推广应用。     

1000IU hCG在控制性卵巢刺激过程中诱发卵泡成熟作用的初步研究

目的:评估1 000 IU低剂量hCG在控制性卵巢刺激(COS)过程中诱发卵泡成熟的作用。方法:35例接受IVF/ICSI-ET治疗的患者进行35个周期的COS。在诱发卵泡成熟日,肌肉注射hCG1 000 IU;并按照血E2水平分为卵巢正常反应组(E2<3 000 pg/ml,A组,12例)和卵巢高反应组(E2≥3 000 pg/ml,B组,23例),统计分析IVF/ICSI-ET结局。结果:35例患者均获得成熟卵母细胞并进行了胚胎移植,平均获卵数为13.5±7.7枚,平均成熟卵母细胞数为11.6±6.7枚,平均受精卵数为10.8±5.6枚,平均胚胎数为10.0±5.6枚,平均移植胚胎数1.9±0.2枚,平均冷冻保存胚胎数为4.3±3.3枚,临床妊娠率A组为50.00%,显示高于B组(30.43%)(P<0.05),继续妊娠率A组为41.67%,显示高于B组(26.09%)(P<0.05);所有患者均未发生无中/重度卵巢过度刺激综合征。A组与B组相比较,获卵率、受精率、优质胚胎率及早期流产率均无统计学差异(P>0.05)。结论:1 000 IU的低剂量hCG能够在COS过程中诱发卵泡成熟,不仅适应于卵巢反应高者,而且也适应于卵巢反应正常者。     

Ribociclib Plus Trastuzumab in Advanced HER2-Positive Breast Cancer: Results of a Phase 1b/2 Trial

BackgroundSignaling through the cyclin-dependent kinase 4 and 6 (CDK4/6) pathway can mediate therapeutic resistance in HER2-positive breast cancer. Preclinical studies have demonstrated that CDK4/6 inhibitors can resensitize resistant HER2-positive breast cancer to anti-HER2 therapies.Patients and MethodsWe conducted a phase 1b/2 study of ribociclib (400 mg per day on a continuous schedule) plus trastuzumab (6 mg/kg every 3 weeks) in patients with advanced HER2-positive breast cancer previously treated with trastuzumab, pertuzumab, and trastuzumab emtansine. There were no restrictions on the number of prior therapy lines. Primary objective was clinical benefit rate at 24 weeks, and secondary objectives included safety, objective response, rate and progression-free survival. The study was enrolled at ClinicalTrials.gov as NCT02657343.ResultsFrom March 2016 to March 2017, 13 patients were enrolled. One patient was found to have HER2-negative disease and did not receive treatment. Median number of prior lines in the metastatic setting was 5 (range, 0-14); 67% had hormone receptor–positive disease. No dose-limiting toxicities were observed during the safety run-in phase, and ribociclib was thus dosed at 400 mg per day continuously for the expansion cohort. Grade 3 adverse events were observed in 4 patients (33.3%) and included neutropenia (n = 2) as well as fatigue and pain in 1 patient each. No grade 4/5 adverse events or QTc prolongation were observed. One patient (8.3%) experienced stable disease > 24 weeks; no objective responses were observed, and median progression-free survival was 1.33 months (95% confidence interval, 0.92-2.57).ConclusionContinuous low-dose ribociclib (400 mg) plus trastuzumab is safe, with no new safety concerns. The limited activity observed in this study suggests that further study of CDK4/6 inhibitor/anti-HER2 combinations should focus on a less pretreated population.     

Low-Dose Whole-Body Irradiation (LD-WBI) Changes Protein Expression of Mouse Thymocytes: Effect of a LD-WBI-Enhanced Protein RIP10 on Cell Proliferation and Spontaneous or Radiation-Induced Thymocyte Apoptosis

Low-dose radiation (LDR) can potentiate cellular metabolic activitiesor immune functions in vivo (hormesis), and can render cellsresistant to DNA or chromosome damage caused by subsequent high-doseradiation (adaptive response). Protein synthesis was requiredfor these cellular responses to LDR. In the present study, theearly expression of proteins by thymocytes in response to low-dosewhole-body irradiation (LD-WBI) was investigated. The expressionof novel and previously existing proteins was found in the nucleus,cytoplasm, and extracellular fluid of thymocytes at 4 hoursafter WBI with 75-mGy X-rays. A 10 kD protein (RIP10) was seenin the cytoplasm of thymocytes after LD-WBI was further investigated.The fraction containing RIP10 separated by Sephadex G 100 gelfiltration potentiated spontaneous thymocyte, and mitogen-inducedsplenocyte proliferation. Western blotting demonstrated thatan anti-RIP10 antibody could react with a 10-kD cytoplasm proteinand also with a 13-kD nuclear protein in thymocytes at 4 h afterLD-WBI. Immunocytochemical staining showed the existence ofRIP10 in several immune tissues including thymus, spleen, andlymph node. RIP10 expression, as determined by immunocytochemicalstaining and flow cytometry, was enhanced at 4–8 h afterLD-WBI. Cell-cycle arrest (G₀/G₁ block with decreased percentageof S-phase cells), and increased levels of spontaneous or radiation-inducedapoptosis were observed in thymocytes incubated with RIP10 antibodyin vitro for 4 h or 24 h. These results directly demonstratedthe role of RIP10 in modulating cell proliferation and apoptosis.This finding is important to understand the mechanisms underlyingLDR-induced hormesis and adaptive response.     

小剂量盐酸罗哌卡因联合舒芬太尼用于剖宫产手术的临床研究

目的 观察小剂量盐酸罗哌卡因联合舒芬太尼麻醉用于剖宫产手术的临床效果.方法 将剖宫产产妇116例随机分为试验组58例和对照组58例,所有产妇均进行腰硬联合麻醉,蛛网膜下腔给药.试验组给予罗哌卡因1 mL,舒芬太尼0.5 mL麻醉,对照组给予罗哌卡因2 mL,舒芬太尼0.5 mL麻醉.比较2组产妇麻醉效果、手术情况、不同...