放射性肺损伤的研究

由于在放疗过程中部分肺组织不可避免的受到照射,致使许多患者发生急、慢性放射性肺损伤(包括放射性肺炎和肺纤维化),从而严重影响了患者的生活质量,同时也限制了肿瘤靶区辐射剂量的提高而使肿瘤的控制率下降。因此,研究放射性肺损伤的发病机理及其防治对策对于放射肿瘤临床实践具有重要意义,对于核辐射的防护和意外辐射的治疗亦具有一定的指导意义。     

放射性肺损伤机制与防治新进展

胸部肿瘤患者在接受放射治疗过程中,常发生放射性肺损伤（放射性间质性肺炎和肺纤维化）,严重影响其生活质量。因此,放射性肺损伤的发病机制及防治研究对于肿瘤的放射治疗具有重要意义。本文就其研究进展进行综述,以期为进一步研究提供理论基础。     

放射性肺损伤防治措施研究进展

放射性肺损伤是核辐射事故、骨髓移植预处理及胸部肿瘤放疗常见的并发症。糖皮质激素常被用于减轻放射性肺损伤的症状,但疗效并不理想。许多学者致力于评估一些防治措施在减轻辐射所致动物和人肺损伤的作用。本文就其研究进展进行综述,以期阐明防治现状,并在一定程度上对临床有所帮助。     

16例放射性肺损伤的X线观察

通过对16例放射性肺损伤资料的总结，讨论了照射剂量、照射野面积等因素与肺放射性损伤的发生及时间的关系，分析了肺损伤X线改变的动态表现，认为：（1）放射性肺损伤与放疗剂量及照射野面积关系密切，照射野面积大，能产生肺损伤的剂量相对就小，（2）急性放射性肺损伤多在放疗后1个月内出现；慢性肺纤维化平均在放疗后4.23个月出现，半年内纤维化发生率约为85.7%。（3）肺损伤的临床表现与X线征象不平行，临床表现程度一般较X线征象轻，此外，依据放射性肺损伤的X线表现及动态发生，还对肺损伤与肿瘤的间质性肺转移、普通肺炎及肿瘤放疗后复发的鉴别诊断进行了分析。     

放射性肺损伤防治的研究进展

放射性肺损伤是胸部肿瘤放疗、骨髓移植预处理、核辐射事故、核武器损伤的常见症状，其发生机理常与活性氧自由基和肿瘤坏死因子-α(TNF-α)、转化生长因子-β(TGF-β)等细胞因子的产生、表达及其信号传导有关，临床上一般表现为早期放射性肺炎和后期放射性肺纤维化两个阶段，由此造成的呼吸衰竭是放射性损伤的主要致死原因之一。放射性肺损伤一旦发生，临床上目前没有令人满意治疗措施，因此，     

三维适形调强放疗致急性放射性肺损伤的CT表现

目的:探讨胸部肿瘤三维适形调强放疗所致急性放射性肺损伤的CT表现。方法:回顾性分析24例三维适形调强放疗所致急性放射性肺损伤患者的胸部CT征象。结果:96例行三维适形调强放疗的胸部恶性肿瘤患者中,24例发生急性放射性肺损伤,发生率25%,CT表现为放射野内条索状、片絮状阴影20例,双肺弥漫性磨玻璃状阴影4例。结论:急性放射性肺损伤的CT表现有一定特征性,早期诊断可指导早期治疗。     

放射性肺改变相关因素高分辨CT表现与预后的关系

目的 分析引起放射性肺损伤的相关因素，高分辨CT(HRCT)表现与预后的关系。方法 对580例胸部肿瘤中放射性肺损伤的86例行HRCT检查，观察其征象与预后的关系。结果 总结7种引起放射性肺损伤的相关因素。将HRCT表现分为4种类型：片状渗出型(8例)，补丁实变型(18例)，含气不全型(27例)和浓密纤维化型(33例)，其HRCT表现不可逆，治疗只能缓解症状。结论 阐述引起放射性肺损伤的相关因素及HRCT表现与各型放射件肺炎预后的关系。正确使用肺组织的放射剂量，定期HRCT检查对早期诊断和治疗有指导意义。     

ATM单核苷酸多态性与放射性肺损伤的研究现状

放射性肺损伤是胸部肿瘤患者放疗后常见的毒副反应.研究发现,放射性肺损伤除了与放疗剂量等临床因素相关外,还与患者遗传因素密切相关.ATM (ataxia telangiectasia mutated,ATM)是重要的双链DNA修复蛋白,在放射线损伤细胞DNA双链时参与同源重组修复.ATM基因在人群中的遗传多态性与放疗后发...     

局部晚期非小细胞肺癌患者调强放疗后发生急性放射性肺损伤的影响因素及风险预测模型研究

目的 探讨局部晚期非小细胞肺癌（NSCLC）患者调强放疗后发生急性放射性肺损伤的危险因素,并建立预测风险的列线图模型。 方法 回顾性分析2017年5月至2019年11月于南京医科大学附属脑科医院行调强放疗的216例局部晚期NSCLC患者的临床资料,其中男性94例、女性122例,年龄37~83（61.5±9.6）岁。根据急性放射性肺损伤的发生情况将患者分为急性放射性肺损伤组和无急性放射性肺损伤组。计数资料的比较采用χ2检验,采用LASSO分析和Logistic回归分析筛选局部晚期NSCLC患者调强放疗后发生急性放射性肺损伤的独立危险因素,采用R软件包建立预测局部晚期NSCLC患者调强放疗后发生急性放射性肺损伤的风险列线图模型,计算一致性指数,绘制校正曲线、受试者工作特征（ROC）曲线和决策曲线。 结果 216例局部晚期NSCLC患者调强放疗后有65例患者发生急性放射性肺损伤,发生率为30.09%。LASSO分析和Logistic回归分析结果显示,年龄、V₅、V₂₀、V₃₀、平均肺剂量、第1秒用力呼气容积（FEV₁）、放疗剂量分割模式及图像验证是局部晚期NSCLC患者调强放疗后发生急性放射性肺损伤的独立危险因素（OR=2.946~4.688,均P<0.05）。建立预测局部晚期NSCLC患者调强放疗后发生急性放射性肺损伤的风险列线图模型的一致性指数为0.819（95%CI:0.789~0.853）,校正曲线与理想曲线相接近,ROC曲线下面积为0.802,决策曲线显示阈值概率在6%~100%时,具有较高的净获益值。 结论 基于年龄、V₅、V₂₀、V₃₀、平均肺剂量、FEV₁、放疗剂量分割模式及图像验证建立的列线图对局部晚期NSCLC患者调强放疗后急性放射性肺损伤发生风险的预测具有较高的准确率。     

放射性肺损伤与脑Ⅱ型上皮细胞

从肺受照后Ⅱ型一皮细胞的形态、功能及放射生物学等指标的改变来提示肺Ⅱ型上皮细胞与放射性肺损伤的关系，论证了它是放射性肺损伤的关系，论证了它是放射性肺损伤的主要靶细胞。     

Increased bystander mutagenic effect in DNA double-strand break repair-deficient mammalian cells

Purpose : We have shown previously that when monolayer cultures of Chinese hamster ovary (CHO) cells are exposed to very low fluences of alpha-particles, HPRT mutations are induced in non-irradiated 'bystander' cells in the population. The present investigation was designed to examine the role of DNA repair in this process. Materials and methods : The DNA double-strand repair-deficient mutant cell line xrs-5 was exposed to mean doses of alpha-particles as low as 0.04 cGy whereby less than 1% of the nuclei were traversed by an alpha track and thus received any radiation exposure. Results : With this very low alpha-particle fluence, most of the cells in the xrs-5 population appeared to be at risk for the induction of mutations, indicating a much larger bystander effect than observed with wild-type CHO cells. Molecular structural analyses showed that xrs-5 mutants primarily involved partial and total gene deletions as opposed to wild-type cells where point mutations predominated in bystander cells. Conclusions : These results indicate a very large bystander effect in xrs-5 cells. They support the hypothesis that unrepaired or misrepaired double-strand breaks (DSB), arising from opposed DNA lesions, enhance the sensitivity of bystander cells in xrs-5 cultures to the induction of mutations.     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.