系统评价方法：汇总分析及其在流行病学研究中的应用

在进行具体评价时, 所选择的评价因素应该是在各研究中存在的差异, 且是能够影响总效应量大小的那些因素。质量评价贯穿PA的始终, 几乎在每个步骤均可应用到, 可作为选择分析所纳入研究的标准,在计算总效应量时作为协变量纳入方程, 减少异质性的作用, 也可以从评分的高低确定异质性来源等。     

Aberrant Expression of Notch1 in Cervical Cancer

OBJECTIVE To investigate the putative role of the Notch1 receptor in cervical cancer carcinogenesis and progression. METHODS The expression of the Notch1 protein was analyzed by a Western-blotting approach in 40 cervical cancer and 30 normal cervical tissues. Some tissues were examined using RT-PCR to determine mRNA levels. Celluar localization of the Notch1 protein in the paraffin-embedded cervical tissues was also analyzed by immunohistochemistry. RESULTS The Notch1 protein was detected in all 30 normal cervical tissues. In contrast, only 6 samples of 40 cervical cancer tissues showed Notch1 expression. The level of the Notch1 protein expression was significantly lower in cervical cancer tissues than that in normal tissue samples. In agreement with these observations, levels of Notch1 mRNA were found to be substantially down-regulated in cervical cancer tissues. In the immunohistochemistry staining assay, the Notch1 protein was shown to localize predominantly in the cytoplasm and nucleoli of the normal cervical squamous epithelium of the cervix, but no staining was observed in the cervical cancer cells. Notch1 expression was observed to correlate with the clinical disease stage, but there were no correlations with age, tumor size, grade or lymph node metastasis （P〉0.05）. The levels of Notch1 protein expression were significantly higher in early stages （Ⅰ-Ⅱa, 66.7%） compared to those in the advanced stages （Ⅱb～Ⅳ,12.6%）（P=0.001）. CONCLUSION Notch1 may play a role as a tumor suppressor in cervical tumorigenesis. Determination of Notch1 expression may be helpful for preoperative diagnosis and accuracy of staging. But its clinical use for cervical cancer requires further investigation.     

肢体和躯干体壁软组织肉瘤患者术后IMRT疗效分析

目的 分析术后IMRT对肢体和躯干软组织肉瘤患者疗效。方法 回顾分析2005—2011年收治的80例肢体和躯干体壁软组织肉瘤患者资料。全组患者功能保全手术后均行IMRT,其中原发肢体的51例,原发躯干体壁的29例。71例患者获得阴性手术切缘。中位放疗剂量为64 Gy。Kaplan-Meier法计算生存率并Logrank法检验,Cox模型多因素预后分析。结果 5年样本数为43例,5年LC率为88%、DMFS率为75%、PFS率为73%、OS率为84%。手术切缘阴性者5年LC率显著高于阳性切缘者(90%比65%,P=0.023),原发肿瘤≤5 cm者的5年OS率显著高于>5 cm者(95%比69%,P=0.041)。多因素分析显示阳性切缘是LC率的影响因素(HR=5.33,95%CI为1.19~23.86,P=0.029)。随访期间水肿和关节僵硬总发生率分别为18%和10%。结论 肢体和躯干体壁软组织肉瘤患者行术后IMRT可获得良好LC率,远期不良反应发生率低。     

MRI指导骨髓保护IMRT对直肠癌同期放化疗血液不良反应影响

目的 通过IMRT降低直肠癌患者放疗区域造血活性骨髓的受照射剂量,以其减轻在同期放化疗期间的急性血液不良反应。方法 前瞻性入组直肠癌初治患者,根据盆腔核磁图像确定造血活性骨髓分布并勾画,并对其进行剂量限定(V₅<95%,V₁₀<90%,V₂₀<80%,V₃₀<65%),新辅助治疗方案为IMRT同期化疗(95%PTV₅₀ Gy分25次,2 Gy/次),同期每周奥沙利铂50 mg/m²,卡培他滨每天1650 mg/m²(放疗期间每天2次)。结果 共 35例Ⅱ、Ⅲ期患者完成入组和治疗方案。2-4级血液学不良反应发生率为31%,其中白细胞减少发生率为26%(9例)、中性粒细胞减少发生率为17%(6例)、红细胞减少发生率为3%(1例)、血小板减少发生率为3%(1例)。多元Logistic线性回归分析表明造血活性骨髓 V₅与白细胞、中性粒细胞和血小板最低值均显著相关(P=0.005、0.002、0.017)。结论 根据MR确定的骨盆造血活性骨髓受量与直肠癌患者新辅助同期放化疗急性血液不良反应发生率和严重程度明显相关。临床试验注册 ClinicalTrials.gov,注册号:NCT01863420。     

Detection of recent HIV-1 infections among men who have sex with men in Beijing during 2005–2006

Background Men who have sex with men （MSM） have become one of the most risky populations for HIV infection in China. Though several cross-sectional sero-prevalence studies have been conducted, the annual HIV incidence remains unknown in this population.
Methods We applied IgG-capture BED-enzyme immunoassay （BED-CEIA） to define the recent HIV-1 infections among MSM in Beijing in the years 2005 and 2006 and the annual HIV incidence was estimated.
Results Overall, 1067 MSM samples were collected, including 526 samples in the year 2005 and 541 in 2006. In 2005, of 17 HIV seropositive samples, 7 were identified as recent HIV-1 infections and the estimated HIV infection incidence was 2.9% per year （95% CI, 0.8%-5.0%）. In 2006, of 26 HIV seropositive samples, 9 were identified as recent HIV-1 infections and the estimated annual incidence was 3.6% （95% CI, 1.3%-5.9%）, which was 0.7% higher than that in 2005. Individuals engaging in male group sexual intercourse （5.17% vs 0.87%, P=0.019） and having receptive anal sexual intercourse more than five times （2.79% vs 0.33%, P=0.047） in the past 6 months significantly increase the risk of being infected by HIV-1.
Conclusions A high level of annual HIV-1 infection incidence was observed among MSM in Beijing for the consecutive years 2005 and 2006 with a continuous increasing trend. The rising incidence and related high risk behavior among MSM alarmed the health authorities and calls for more effective intervention strategies among this population.     

奥沙利铂对人肝癌细胞HepG2放射增敏作用初探

目的 观察奥沙利铂对人肝癌细胞HepG₂放射后增殖的影响。方法 采用MTT法测定不同浓度奥沙利铂作用HepG₂细胞不同时间后的细胞半数抑制浓度(IC₅₀)。选择合适的奥沙利铂浓度行细胞克隆形成实验,分别给予3种不同处理:HepG₂空白组、单纯照射组(1、2、4、6、8、10 Gy单次照射)、奥沙利铂+照射组)。同期选取6 Gy照射组检测细胞凋亡情况。检测以上3组细胞中细胞增殖蛋白ERK1/2和DNA损伤修复蛋白Ku-70表达情况。结果 奥沙利铂对HepG₂细胞的6、12、24、48 h的IC₅₀分别为54.4、29.1、17.8、10.5 mg/L。3 mg/L浓度奥沙利铂的放射增敏比为1.59。细胞凋亡情况检测结果表明奥沙利铂+照射组存活细胞比例均低于照射组(P=0.005)、奥沙利铂组(P=0.008)和空白对照组(P=0.001)。照射组和奥沙利铂+照射组的ERK1/2表达水平被持续抑制,其中照射组的ERK1/2表达水平在处理后48 h开始升高,但低于对照组,奥沙利铂+照射组的ERK1/2表达水平一直为最低,且没有升高趋势。各组Ku-70的变化水平与ERK1/2类似。结论 奥沙利铂对于人肝癌细胞HepG₂的体外放射具有显著的增敏作用。     

卵巢恶性生殖细胞肿瘤的诊疗研究现况

卵巢恶性生殖细胞肿瘤相对少见,多发生于年轻女性,除无性细胞瘤外其他均为高度恶性。保留生育功能的手术联合有效的化疗方案明显提高了预后,多数患者治疗后能恢复月经周期并正常妊娠,但复发患者的治疗仍是难点。目前我们就卵巢恶性生殖细胞肿瘤近年来诊断和治疗现况作一阐述。     

确定成人腹部CT图像质量客观评价测量的最佳层面区域的比较性研究

目的确定成人腹部cT图像质量客观评价测量时的最佳层面区域。方法对144例受检者的个体化因素进行测量,选择与图像质量相关性高的个体化参数作为评价图像质量的基础水平。分别选择腹部常规cT检查图像的肝顶、第一肝门、肾门、’肾下极4个层面的腹主动脉区以及第一肝门层面出现的其他代表性的6个测量区（门静脉、肝实质周边、肝实质中心、脾、竖脊肌、前腹壁皮下脂肪）进行图像噪声测量。比较在相关性较高的个体化参数作为基础水平下所有测量区的噪声值与图像质量间的相关性系数,从而最终确定成人腹部常规cT检查图像的客观评价测量的最佳区域。结果在固定管电流扫描模式下,以腹平均径为基础水平,4个层面腹主动脉区测量的噪声值与图像质量的相关性系数R为0．522—0．765,第一肝门层面相关性最高。以相关性较高的个体化因素为不同的基础水平,第一肝门层面的肝实质周边测量区的噪声值与图像质量相关性最高（R0．74～0．802）,腹主动脉次之（R0．712～O．765）。前腹壁皮下脂肪与图像质量的相关性最差（R=0．412,P〉0．O5）。结论第一肝门层面的腹主动脉区是成人腹部常规CT检查图像质量客观评价测量的最佳区域,其噪声测量值在一定程度上可指标腹部常规cT扫描的客观图像质量。     

乳腺托架固定下全乳调强放疗摆位误差兆伏X线验证平片测定分析

目的 用兆伏(MV) X线平片测定乳腺托架固定下全乳放疗摆位误差,探讨自由呼吸状态下临床靶体积(CTV)外扩至计划靶体积(PTV)的边界。
方法 选取2010-2012年本科行保乳术后调强放疗的29例乳腺癌患者,其中17例行全乳照射,12例行全乳和锁骨上淋巴引流区照射。均采用乳腺托架体位固定,利用放疗计划系统数字重建图像与治疗期间拍摄正交MV验证平片比较,确定摆位误差。对接受锁骨上淋巴引流区照射与未照射的误差比较行成组t检验。
结果 全体患者共获得正交MV验证平片图像127套,平均每人(4.4±1.2)套。全组患者左右、上下、前后方向摆位误差分别为(0.9±3.1)、(0.7±3.0)、(1.2±2.1) mm,摆位误差的系统误差分别为3.1、3.0、2.1 mm,随机误差分别为2.7、3.3、3.5 mm;做与未做锁骨上淋巴引流区照射者的摆位误差无差异(t=0.02、0.20、0.20,P=0.98、0.85、0.85)。CTV至PTV边界左右、上下、前后方向分别为9.6、9.8、7.7 mm。
结论 用乳腺托架固定全乳调强放疗的CTV外放PTV在左右、上下、前后方向上应至少分别为9.6、9.8、7.7 mm。