血清细胞因子TGF-β1和IL-1β表达水平对急性放射性心脏损伤发生的影响

目的 研究胸部肿瘤放射治疗患者血清TGF-β1和IL-1β水平对急性放射性心脏损伤发生的影响。方法 接受常规适形或调强放疗的胸部肿瘤患者54例,PTV处方剂量为50~66 Gy,分析靶区剂量分布及危及器官受量。患者于放疗前及放疗结束后空腹采肘静脉血,应用酶联免疫吸附法检测血清中TGF-β1和IL-1β水平,并分别在放疗前后和放疗开始90 d内检测心肌酶、肌钙蛋白Ⅰ、心电图以及心功能指标评价患者心脏损伤状况,对急性放射性心脏损伤分级标准进行评价。分析血清TGF-β1和IL-1β水平对急性放射性心脏损伤的影响。结果 放疗前患者血清TGF-β1为(888.4±41.1)μg/L,放疗结束时为(926.1±23.1)μg/L,差异有统计学意义(t=-6.479, P<0.05);放疗后发生急性放射性心脏损伤患者血清TGF-β1为(900.6±34.5)μg/L,高于无急性放射性心脏损伤患者的(865.7±47.0) μg/L,差异有统计学意义(t=-2.646,P<0.05)。Spearman相关分析显示,TGF-β1放疗前基础水平、放疗前后差值与急性放射性心脏损伤相关(r=0.378、0.311,P<0.05)。患者放疗前与放疗结束时的血清IL-1β比较差异无统计学意义;放疗后发生急性放射性心脏损伤者与未发生急性放射性心脏损伤者血清IL-1β基础表达水平差异无统计学意义。患者放疗前IL-1β基础水平、放疗后表达水平、放疗前后差值与急性放射性心脏损伤无相关性。放疗前、后TGF-β1的表达水平与放疗后IL-1β的表达水平呈正相关(r=0.416、0.389,P<0.05)。结论 放疗后血清TGF-β1升高,放疗前基础表达水平及放疗前后差值与急性放射性心脏损伤相关。IL-1β与放射性心脏损伤无相关性。     

胸部肿瘤急性放射性心脏损伤临床研究

胸部恶性肿瘤放疗过程中,心脏不可避免受到一定剂量的照射,近年来的研究提示心脏的放射性损伤不容忽视［1-2］。随着放射治疗技术的不断发展和临床疗效的提高,一些肿瘤患者获得长期生存,放射性心脏损伤问题逐渐突出,对患者的长期生存率及生活质量有一定影响。本研究通过分析心电图、心肌酶谱、心肌肌钙蛋白I、心功能状况的改变,以期为指导临床预测和评价放射性心脏损伤提供一定参考。     

头颈部肿瘤放疗相关口腔并发症和治疗

放疗是头颈部肿瘤患者常见的治疗方式。头颈部放疗常会导致口腔颌面部并发症, 因该部位组织结构复杂, 发病机制多样, 现有的治疗方案和研究进展较为局限。本文重点对最常见的放射性口腔黏膜炎、放射性唾液腺损伤及放射性龋齿进行系统总结, 回顾了现有发病机制假说、治疗及研究进展, 以期为深入研究相关病理机制和新的预防、治疗手段提供一定的参考。     

间充质干细胞修复放射性肠损伤的机制探讨

放射性肠损伤在临床上常见。然而,针对放射性肠损伤的治疗手段有限。随着组织工程研究不断进展,现已证实间充质干细胞对放射性肠损伤具有修复作用,其中以脐带、骨髓来源的间充质干细胞应用研究居多^[1-6]。这些研究证实了间充质干细胞能够促进受损肠上皮细胞的再生,维持受照上皮的完整性。     

放射性肝损伤的MRI研究

放射性肝损伤的发生正随着腹部肿瘤的放疗、骨髓移植及肝脏恶性肿瘤三维适形放疗的开展而越来越受到重视.准确判断并评价肝脏放射性损伤的有无及其程度,对临床药物学治疗和/或肿瘤放疗方案的制定与修正均显得尤为重要.MRI虽然最近才被应用于该领域,却已显露出其令人瞩目的优越性.     

中药对食管癌患者放射性局部损伤的防治作用

放射治疗是食管癌的主要治疗手段之一,但放射治疗会不同程度地导致患者出现放射性食管炎、放射性肺炎及咽干、咽痛等咽部不适。为减轻食管癌患者放疗时的上述局部损伤,我科和放疗科协作,对中药防治食管癌患者放射性局部损伤的作用进行了临床观察,报道如下。     

基础心功能状况与急性放射性心脏损伤的相关性研究

目的 探讨胸部放疗基础心功能状况对急性放射性心脏损伤的影响,评价急性期内患者心功能的变化。方法 分析109例胸部肿瘤患者放疗后基础心功能状况对急性放射性心脏损伤的影响,并观察放疗前及急性观察期内心功能的变化。结果 全组患者急性放射性心脏损伤发生率为79.8%,患者临床因素及基础心功能各项指标与急性放射性心脏损伤发生均无明显相关(P>0.05)。放射治疗后急性期内出现左室收缩功能减低24例,舒张功能减低15例;瓣膜病变24例,全部为二尖瓣和(或)主动脉瓣改变,其中反流(轻、中度反流)23例、狭窄(轻度)1例,未见三尖瓣和(或)肺动脉瓣反流与狭窄。左房前后径、主动脉流速、E/A值在放疗前、放疗结束、自放疗开始3个月差异有统计学意义(F=8.552、0.017、0.003,P<0.05)。左房前后径、主动脉流速、E/A值放疗结束较放疗前分别下降了9.19%、7.56%、17.5%,自放疗开始3个月较放疗结束分别恢复7.05%、4.14%、7.58%,其中E/A下降和恢复变化幅度最大。结论 临床因素及基础心功能状况与急性放射性心脏损伤发生无明显相关。放疗导致的瓣膜病变以二尖瓣和(或)主动脉瓣轻、中度反流多见,并可引起左室收缩和舒张功能改变。左房前后径、E/A值放疗后首先降低,随着时间延长逐渐改善,但急性期内未能恢复到正常水平。急性观察期内放疗对心脏舒张功能的影响较收缩功能明显。     

放射性肝损伤的MRI研究

放射性肝损伤的发生正随着腹部肿瘤的放疗、骨髓移植及肝脏恶性肿瘤三维适形放疗的开展而越来越受到重视。准确判断并评价肝脏放射性损伤的有无及其程度，对临床药物学治疗和／或肿瘤放疗方案的制定与修正均显得尤为重要。MRI虽然最近才被应用于该领域，却已显露出其令人瞩目的优越性。     

头颈部肿瘤涎腺放射性损伤的防治研究进展

放射性涎腺损伤是头颈部肿瘤患者放射治疗后最常见的并发症之一,表现为口腔疼痛,说话、吞咽困难等症状,严重影响患者的生存质量。因此,涎腺放射性损伤的防治十分重要。本文从放疗保护药物、放疗技术、分子生物学等方面,针对头颈部肿瘤涎腺放射性损伤的预防与治疗予以综述。     

肤生软膏对慢性放射性皮肤损伤的治疗作用和毒性实验

肤生软膏对慢性放射性皮肤损伤的治疗作用和毒性实验吴淑荣陈强纪辉慢性放射性皮肤损伤在肿瘤放疗中常见，多为急性损伤治疗无效或处理不当继发感染所致。损伤形成溃疡，周围组织广泛纤维化，局部微循环障碍致使损伤经久不愈。本研究就肤生软膏对慢性放射性皮肤损伤的疗效...     

Angiographic patterns in experimental obstruction of the small bowel.

Mechanical obstruction of the small intestine was induced in 79 rabbits. Ligation and/or fixation of an intestinal loop with sutures was performed in order to produce simple obstruction, strangulation, intussusception and volvulus. The obstructed loop and the adjacent segments of the bowel were examined with microscopic, microangiographic and angiographic methods at fixed time intervals of 6, 12, 24 and 48 hours. Dynamics of arterial changes in the intestinal wall and mesentery were investigated. Angiographic patterns of obstruction in the exteriorized loop of a living animal are described. These findings may be of value in evaluating clinical cases.     

参苓白术复方提取物抗放射性肠损伤作用的实验研究

目的探讨中药参苓白术复方对放射性小鼠肠损伤模型的治疗作用。方法 MTT法检测复方对辐照后小肠上皮细胞的增殖作用。小鼠腹部局部照射后立即灌胃中药复方,测定小鼠体质量,记录腹泻和存活情况,取小鼠空肠切片进行HE染色,观察肠道病理改变。结果体外实验显示,参苓白术复方能明显促进辐照后小肠上皮细胞的增殖。治疗组小鼠一般状况和小肠病理切片明显得到改善,腹泻减少,小鼠存活率明显提高。结论中药复方参苓白术对辐射性肠损伤小鼠有明显的保护作用,为其应用于临床放射性肠损伤提供了实验依据。     

蜂产品对放射性损伤的防治研究进展

在军事、医疗和公共卫生方面,辐射暴露是一个持续而严重的威胁。针对辐射引起的损伤需要有效的预防或缓解治疗,但是目前这些问题尚未得到解决。临床上少数食品药品监督管理局（FDA）批准的辐射防护剂副作用大,限制其广泛使用。据报道,一些天然的无毒化合物（如蜂产品）可通过减轻辐射引起的氧化应激、细胞凋亡和DNA损伤来预防和治疗辐射引起的口腔黏膜炎、食管炎、皮肤损伤、肝损伤、肠道损伤和造血系统的损伤等。这表明这些蜂产品有作为辐射防护剂的潜力。本文就蜂产品对防治放射性损伤的实验及临床研究进行综述。     

57例小肠损伤的诊断与治疗

目的探讨小肠损伤的诊断与治疗方法。方法收集江苏省人民医院溧阳分院普外科2008—2017年收治的小肠损伤57例,其中男性50例,女性7例;年龄22~87岁,平均51岁。外伤性小肠损伤多见于中年男性,其中道路交通伤23例(44.23%),钝器伤10例(19.23%),坠落伤8例(15.38%),锐器伤6例(11.53%),重物砸伤5例(9.61%),其他不明原因5例(9.61%)。探查发现受伤部位位于空肠28例(49.12%),位于回肠29例(50.87%)。剖腹探查指征:腹腔穿刺抽出脓性液体或者不凝血,CT或X线发现腹腔游离气体,部分患者血流动力学不稳定,进行性加重的腹痛持续无缓解,出现腹膜刺激征,考虑空腔脏器或者实质性脏器受损。根据受损部位及受损程度选择小肠修补术46例(80.70%)和小肠部分切除+吻合术11例(19.30%)。结果 57例中共出现并发症10例。采用逐步Logistic回归,以预后为因变量,其他因素为自变量,结果显示失血量为术后并发症的影响因素。失血量越多,预后越差(OR值为8.625)。结论小肠损伤多见于交通事故、击打、坠落等暴力致伤因素。术后相关并发症可能与失血量有关,提示在处理小肠损伤时提高诊断成功率、缩短患者接受手术时间,可减少术后并发症的发生。     

肠道干细胞在放射性肠损伤防护中的作用

目前,对于电离辐射（ionizing radiation,IR）引起的放射性肠损伤尚无有效的治愈方法,临床上只能采用对症缓解治疗。肠道干细胞（intestinal stem cells,ISCs）更新能力强,是重构受损小肠结构的重要细胞,促进肠道干细胞数量和功能的恢复已是当前治疗放射性胃肠综合征的研究热点。本文从肠道干细胞的分类、干细胞的调节机制以及具有调控干细胞损伤、凋亡、修复作用的药物等方面介绍了ISCs在放射性肠损伤防护中的重要作用以及其临床应用意义,为未来肠道干细胞在辐射防护中的作用研究提供参考。     

角质细胞生长因子2突变体对小鼠放射性肠黏膜损伤的治疗研究

目的：研究角质细胞生长因子2（keratinocyte growth factor－2,KGF－2）突变体对放射性肠黏膜损伤的治疗作用。方法将无特定病原体（specific pathogen free, SPF）C57BL／6J雌性小鼠随机分为模型组（A组）、静脉注射KGF－2突变体组（ B组）、KGF－2突变体加骨髓移植组（ C组）和单纯骨髓移植组（ D组）,用γ射线放射源60 Co对小鼠进行单次全身照射,总剂量为12 Gy,另设正常对照组（ E组）。通过分析小鼠照射后30 d存活率,照射后72 h小肠组织病理变化、凋亡与自噬情况,阐述KGF－2突变体对放射性肠黏膜损伤的治疗效果。结果 A组照射后9 d内小鼠全部死亡,C组30 d仍有70％存活。 HE染色显示,C组小肠组织各级结构最为完整,免疫组化发现C组小肠隐窝处自噬水平升高,凋亡水平降低。结论 KGF－2突变体对放射性肠黏膜损伤有显著的治疗作用。     

Radiation-Induced Skin Injuries to Patients: What the Interventional Radiologist Needs to Know

CardioVascular and Interventional Radiology - For a long time, radiation-induced skin injuries were only encountered in patients undergoing radiation therapy. In diagnostic radiology, radiation...     

MR灌注成像在鉴别胶质瘤复发与放射性脑损伤中的价值

目的 分析MR灌注成像在鉴别胶质瘤复发与放射性脑损伤中的作用.方法 选取15例脑胶质瘤术后、放疗后并出现新强化灶的患者.所有患者均经二次手术病理或随访(随访时间＞6个月)证实为胶质瘤复发或放射性脑损伤.15例患者均行常规MR平扫、增强扫描和MR脑灌注成像.灌注成像采用梯度回波-回波平面成像(GRE-EPI)序列,ROI放置在横断面T1WI异常强化区域和对侧相对正常的脑白质内,大小为20～40 mm2,每个病灶测量10～15次,取平均值,计算异常强化区与对侧正常区的参数比值,包括相对脑血容量(rCBV)、相对脑血流量(rCBF)及相对平均通过时间(rMTT),采用秩和检验比较胶质瘤复发和放射性脑损伤各灌注参数.并采用ROC曲线评价rCBV、rCBF及MTT鉴别诊断两者的灵敏度及特异度.结果 15例患者最终经手术和随访证实有9例胶质瘤复发,6例放射性脑损伤.胶质瘤复发rCBV、rCBF比值的M分别为2.87(范围0.70～4.91)、1.89(范围0.64～3.96),明显高于放射性脑损伤比值[rCBV 0.70(范围0.12～1.62)、rCBF 0.56(范围0.12～2.08)],差异有统计学意义(Z值分别为-2.55、-2.08,P值均＜0.05).rCBV和rCBF比值鉴别诊断为胶质瘤复发或放射性脑损伤的ROC曲线下面积为0.893和0.821.rCBV比值≤0.77时诊断放射性脑损伤灵敏度为100.0%,rCBV比值≥2.44时诊断胶质瘤复发特异度为100.0%.结论 MR灌注成像是鉴别胶质瘤复发和放射性脑损伤的有效方法,rCBV比值和rCBF比值在鉴别诊断中具有重要价值.

Abstract：

Objective To evaluate the feasibility of perfusion weighted imaging (PWI) in the differentiation of recurrent glioma and radiation-induced brain injuries. Methods Fifteen patients with previously resected and irradiated glioma, presenting newly developed abnormal enhancement, were included in the study. The final diagnosis was determined either histologically or clinicoradiologically. PWI was obtained with a gradient echo echo-planar-imaging (GRE-EPI) sequence. The normalized rCBV ratio[CBV(abnormal enhancement)/CBV(contralateral tissue)], rCBF ratio[CBF(abnormal enhancement)/CBF(contralateral tissue)]and rMTT ratio[(MTT abnormal enhancement)/MTT(contralateral tissue)]were calculated, respectively. The regions of interest (ROIs) consisting of 20-40 mm2 were placed in the abnormal enhanced areas on postcontrast T1-weighted images. Ten to fifteen ROIs measurements were performed in each lesion and the mean value was obtained. Mann-Whitney test was used to determine whether there was a difference in the rCBV/rCBF/MTT ratios between glioma recurrence and radiated injuries. Results Nine of the 15 patients were proved recurrent glioma,6 were proved radiation-induced brain injuries. The mean rCBV ratio[2.87(0.70-4.91)]in glioma recurrence was markedly higher than that[0.70(0.12-1.62)]in radiation injuries (Z=-2.55,P＜0.05). The mean rCBF ratio[1.89(0.64-3.96)]in glioma recurrence was markedly higher than that[0.56(0.12-2.08)]in radiation injuries (Z=-2.08,P＜0.05). The areas under rCBV and rCBF ROC curve were 0.893 and 0.821. If the rCBV ratio ≤0.77, the diagnosis sensitivity of radiation-induced brain injuries was 100.0%;If ≥2.44, the diagnosis specificity of recurrent glioma was 100.0%. Conclusion PWI was an effective technique in distinguishing glioma recurrence from radiation injuries and rCBV and rCBF ratios were of great value in the differentiation.     

Quantification of radiation-induced genetic risk

Associated with technical advances of our civilization is a radiation- and chemically-induced increase in the germ cell mutation rate in man. This would result in an increase in the frequency of genetic diseases and would be detrimental to future generations. It is the duty of our generation to keep this risk as low as possible. The estimation of the radiation-induced genetic risk of human populations is based on the extrapolation of results from animal experiments. Radiation-induced mutations are stochastic events. The probability of the event depends on the dose; the degree of the damage does not. The different methods to estimate the radiation-induced genetic risk will be discussed. The accuracy of the predicted results will be evaluated by a comparison with the observed incidence of dominant mutations in offspring born to radiation exposed survivors of the Hiroshima and Nagasaki atomic bombings. These methods will be used to predict the genetic damage from the fallout of the reactor accident at Chernobyl. For the exposure dose we used the upper limits of the mean effective life time equivalent dose from the fallout values in the Munich region. According to the direct method for the risk estimation we will expect for each 100 to 500 spontaneous dominant mutations one radiation-induced mutation in the first generation. With the indirect method we estimate a ratio of 100 dominant spontaneous mutations to one radiation-induced dominant mutation. The possibilities and the limitations of the different methods to estimate the genetic risk will be discussed. The discrepancy between the high safety standards for radiation protection and the low level of knowledge for the toxicological evaluation of chemical mutagens will be emphasized.     

Dose dependence effects of ionizing radiation on bile acid metabolism in the rat.

PURPOSE: To study radiation dose-related changes of individual or total bile acids in various physiological fluids in order to identify potential bio-indicators of radiation-induced gastrointestinal injuries. MATERIALS AND METHODS: Wistar rats were sham- or whole-body gamma irradiated (1-12Gy). Total and individual bile acids were quantified, 3 days after exposure, in bile collected after catheterization of the bile duct. Total bile acid concentrations were also measured in plasma and colonic contents 1, 2 and 3 days after irradiation. These concentrations were determined by an enzymatic method whereas individual bile acids were quantified by HPLC. RESULTS: In bile, whereas total bile acid concentration remained unchanged after irradiation whatever the dose, the proportion of dihydroxy bile acids in the pool of total bile acids was gradually increased with the irradiation dose, especially from 8 Gy. In plasma samples, total bile acid concentrations fell for doses higher than 10 Gy. In colonic contents, bile acid concentrations increased progressively with time (from 1 to 3 days) and with irradiation dose (from 1 to 12Gy), reaching a plateau 3 days after exposure for doses higher than 10 Gy. CONCLUSIONS: These results show that changes in colonic bile acid concentrations which are reflected in faeces are perhaps a useful parameter to improve diagnosis and prognosis of radiation-induced gastrointestinal damage since it probably reflects directly intestinal bile acid malabsorption.