经皮穴位电刺激联合颈丛神经阻滞麻醉在甲状腺手术中的应用研究

目的:观察经皮电刺激合谷、内关穴联合颈丛神经阻滞麻醉在甲状腺手术中的应用效果。方法:将68例行甲状腺手术的患者随机分为观察组和对照组各34例,对照组采用颈丛神经阻滞麻醉,观察组采用经皮电刺激合谷、内关穴联合颈丛神经阻滞麻醉。比较两组麻醉前后平均动脉压和血氧饱和度,以及两组术后麻醉效果、疼痛数字量表(NRS)评分和不良反应情况。结果:两组麻醉后各时点平均动脉压较麻醉前均升高,差异有统计学意义(P<0.05);观察组手术全程血压变化幅度小于对照组,差异有统计学意义(P<0.05)。观察组麻醉前后血氧饱和度无明显变化,差异无统计学意义(P>0.05);对照组麻醉后血氧饱和度低于麻醉前,差异有统计学意义(P<0.05)。两组患者全部麻醉成功,但对照组Ⅲ级麻醉患者比例高于观察组,差异有统计学意义(P=0.001)。观察组术后1 h、4 h、12 h的NRS评分均低于对照组,差异有统计学意义(P<0.001)。观察组不良反应发生率低于对照组,差异有统计学意义(P=0.031)。结论:在甲状腺手术中采用经皮穴位电刺激联合颈丛神经阻滞麻醉,具有麻醉效果好、循环干扰小、并发症少等优点。     

Imaging-guided brachytherapy for locally advanced cervical cancer: the main process and common techniques

Brachytherapy (BT) delivers integrated boost doses to the central tumor while sparing the surrounding organs at risk (OARs) efficiently. It’s a mandatory treatment component for locally advanced cervical cancer (LACC) because it results in excellent overall survival and local control compared with other dose boosting modalities. Currently, BT is undergoing a transition from 2-dimensional (2D) to 3-dimensional (3D) treatment planning. Imaging-guided BT (IGBT) employing computed tomography (CT) or magnetic resonance imaging (MRI) can provide exact individual delineation of target and OARs meanwhile prescribe the dose to the target volume instead of “point A” for X-ray-based BT. There are three main techniques for BT: intracavitary (IC), interstitial (IS), and intracavitary/interstitial (IC/IS) combination. The applicator choice depends on the specific tumor extension. The real-time transabdominal ultrasound (US)-guided applicator placement technique is strongly recommended to ensure ideal applicator positioning. MRI is the ideal standard imaging for BT owing to its superior soft tissue visualization than CT. However, CT-based BT is more often performed because of the availability. In developing countries, US-based BT can be adopted. For treatment planning, the applicator reconstruction is easier on CT than on MRI, because the applicator image is more clearly visible. Individual treatment planning should be performed for every single applicator insertion to ensure dose accuracy. In this review article, we explain the main clinical process and common techniques, including the applicator choice and placement, imaging techniques, target delineation, and treatment planning; asthose will help to improve the efficiency of 3D BT.     

DVH预测模型在VMAT计划培训中的应用

目的:以宫颈癌为例，探索使用剂量体积直方图（DVH）预测模型培训放疗物理师容积旋转调强（VMAT）计划设计的可行性及其效果。方法:随机选取20例宫颈癌测试病例对3名见习物理师进行两个阶段培训（第一阶段15例，第二阶段5例）。每位物理师分别采用两种方法设计VMAT计划:传统人工计划（MP）和基于DVH预测模型引导的自动计划（KBP）。对比不同阶段两种计划靶区和危及器官的各种剂量学参数，并做相应统计分析。结果:与人工计划相比，自动计划在明显提高PGTV靶区V60覆盖（P<0.001），改善高剂量控制（V66）（P=0.027）的情况下，显著降低膀胱（P<0.001）、直肠（P<0.001）、左右肾（P=0.001和P<0.001）以及左右侧股骨头（P<0.001和P<0.001）等绝大部分正常组织器官的受照剂量。在提高计划合格率的同时，亦减小了计划者间的质量差异。结论:DVH预测模型有助于深化物理师对VMAT初始优化参数设置的理解，加快培训进度，提升VMAT计划设计水平。     

Vaccination against HPV: boosting coverage and tackling misinformation

The availability of human papillomavirus (HPV) vaccines and screening tests has raised the possibility of globally eliminating cervical cancer, which is caused by HPV. Cervical cancer is a very common malignancy worldwide, especially among deprived women. High vaccination coverage is key to the containment and eventual elimination of the infection. Public HPV vaccination programmes in Italy and Denmark were swiftly established and are among the most successful worldwide. Still, in both countries, it has been challenging to achieve and maintain the recommended coverage of > 80% in girls. In a well‐studied Italian region, vaccination coverage in girls at age 15 years (World Health Organization''s gold standard) reached 76% in 2015 but decreased to 69% in 2018, likely due to work overload in public immunization centres. In Denmark, doubts about safety and efficacy of the HPV vaccine generated a decline in coverage among girls age 12–17, from 80% in 2013 down to 37% in 2015, when remedial actions made it rise again. Insights from these two countries are shared to illustrate the importance of monitoring coverage in a digital vaccine registry and promptly reacting to misinformation about vaccination.

Abbreviations

CC

cervical cancer

FVG

Friuli Venezia Giulia

HICs

high‐income countries

HPV

human papillomavirus

LMICs

middle‐income countries

WHO

World Health Organization

     

神经营养因子家族与宫颈癌

近年研究中，神经营养因子家族及其受体在肿瘤发生发展中的作用日益受到重视。神经营养因子家族在宫颈癌中高表达，在肿瘤发展进程中，被视为宫颈癌进展的早期事件；同时，神经营养因子促进宫颈癌细胞的增殖，增强肿瘤细胞的转移能力，并作用于宫颈癌细胞，诱导肿瘤细胞合成血管内皮生长因子，从而促进肿瘤癌灶中血管生成。本文就神经营养因子在宫颈癌发生发展中作用的最新研究进展作一综述。     

Health Literacy,Knowledge on Cervical Cancer and Pap Smear and Its Influence on Pre-Marital Malay Muslim Women Attitude towards Pap Smear

Background: Cervical cancer is preventable. In Malaysia, women are found to have good awareness of the disease and yet, the Pap smear uptake is still poor. Measuring health literacy level could explain this discrepancy. This study aims to determine the relationship between health literacy, level of knowledge of cervical cancer and Pap smear with attitude towards Pap smear among women attending pre-marital course. Methods: A cross sectional study was performed in three randomly selected centres that organised pre-marital courses. All Malay Muslim women participants aged 18 to 40 years old were recruited while non-Malaysian, illiterate, and had hysterectomy were excluded. Validated self-administered questionnaires used were European Health Literacy Questionnaire (HLS-EU-Q16 Malay) and Knowledge and attitude towards Cervical Cancer and Pap Smear Questionnaire. The mean percentage score (mean± SD) was calculated, with higher scores showed better outcomes. Multiple linear regression was used to measure the relationship of independent variables with attitude towards Pap smear. Results: A total of 417 participants were recruited with a mean age of 24.9 ± 3.56 years old. Prevalence of awareness of cervical cancer was 91.6% (n=382, 95% CI: 89.0%, 94.2%) and mean percentage score was 74.7%±7.6. Prevalence of awareness of Pap smear was 59.0% (n=246, 95% CI: 54.2%, 63.8%) and mean percentage score was 80.2% ± 6.5. The health literacy mean score was 13.3±3.6, with minimum score 0 and maximum score 16. The mean percentage score of attitudes towards Pap smear was 64.8%±9.3. Multiple linear regression analysis demonstrated significant relationship between health literacy (p=0.047) and knowledge of Pap smear (p<0.001) with attitude towards Pap smear. Conclusion: A higher health literacy with high knowledge of Pap smear improves the attitude towards Pap smear. Pre-marital course is an opportunistic platform to disseminate information to improve health literacy and knowledge of cervical cancer and Pap smear screening.     

HPV检测原发灶不明颈淋巴结转移癌的诊断作用初探(附6例报告)

目的 初步探讨HPV检测在诊断原发灶不明的颈淋巴结转移性鳞癌中的价值。方法 收集复旦大学附属肿瘤医院6例首诊为原发灶不明的颈淋巴结转移性鳞癌,最终确诊为HPV相关口咽鳞癌,分析确诊过程。结果 首诊时6例患者均被确诊为颈淋巴结转移性鳞癌,且p16表达阳性和HPV-16亚型阳性,而EBER表达阴性。经全面检查均未发现明显的原发病灶。随后对其中4例予同侧扁桃体盲检(2例)和切除(2例),病理均证实为扁桃体鳞癌。另2例分别在随访第149天、545天MRI检查发现同侧口咽侧壁和舌根增厚伴强化,经活检分别证实为扁桃体鳞癌、舌根鳞癌。结论 对于原发灶不明的HPV阳性颈淋巴结转移性鳞癌,应高度怀疑原发病灶来源于口咽部位的可能性,特别是扁桃体和舌根部位。     

靶向PSCA的CAR-NK-92细胞对宫颈癌的抗瘤作用

目的：构建并验证靶向前列腺干细胞抗原（prostate stem cell antigen，PSCA）的嵌合抗原受体（chimeric antigen receptor，CAR）修饰的NK-92细胞对宫颈癌的抗瘤活性。方法：构建PSCA靶向的CAR慢病毒表达载体，利用慢病毒感染法获得PSCA CAR-NK-92细胞。用流式细胞术及Western blotting实验检测宫颈癌细胞中PSCA的表达水平。通过体外效靶细胞共孵育实验以及体内裸鼠移植瘤模型中的治疗情况，验证PSCA CAR-NK-92细胞对宫颈癌Hela及MS751细胞杀伤能力及其裸鼠移植瘤生长的抑制能力。结果：成功构建 PSCA CAR-NK-92 细胞，PSCA 在宫颈癌细胞中高表达（均 P<0.01）。体外共孵育结果显示，PSCA CAR-NK-92细胞可以以剂量依赖的方式裂解PSCA+的宫颈癌细胞；体内抗肿瘤数据表明，PSCA CAR-NK-92细胞较转染空载体的NK-92细胞显著抑制宫颈癌移植瘤的生长（P<0.01），并且可以有效地浸润肿瘤组织并高水平分泌TNF-α和IFN-（γ 均P<0.01）。结论：靶向PSCA的CAR-NK-92细胞在体内外都显示出了良好的对PSCA+肿瘤细胞的杀伤能力，有潜力成为一种针对宫颈癌的潜在治疗策略。