放射性肺损伤的预防和治疗进展

在肺部肿瘤以及其他临近肺组织肿瘤的放射治疗中,造成不同程度的肺放射损伤[1].一旦发生将严重影响患者的生活质量甚至威胁生命.放射性肺损伤的发生机制放射性肺损伤包括急性放射性肺炎和放射性肺纤维化.急性放射性肺炎常发生在放疗后1～3个月;放射性肺纤维化为放射性肺损伤慢性阶段,常发生在放疗结束后3～6个月甚至更长时间以后.放射性肺损伤的发生是由于放射使肺泡Ⅱ型细胞和表面活性物质减少,肺受照射部位发生急性渗出、炎细胞浸润,甚至肺泡崩溃胶原纤维增生形成肺损害.动物实验和临床研究表明,放射性肺损伤不仅仅是单一靶细胞损伤的结果,而是一个有多种细胞参与,多种细胞因子调控的复杂过程[3].发生不仅与放疗剂量、照射体积等因素有关,而且基础肺功能、化疗药物的使用以及年龄等都是促进临床放射性肺损伤发生的因素.     

乳腺癌术后放疗致肺放射性损伤的临床分析

目的 研究乳腺癌术后放疗致放射性的肺损伤.方法 对106例乳腺癌术后放疗的患者行分析.结果 106例乳腺癌术后放疗患者发生放射性肺损伤22例,与年龄、肺部照射体积、照射剂量、联合化疗和肺部基础疾病有关.结论 乳腺癌术后放疗的老年患者随着照射体积和剂量增加、联合化疗和伴有肺部基础疾病会增加放射性的肺损伤.     

非小细胞肺癌调强放疗致放射性肺损伤风险的预测

目的分析非小细胞肺癌(NSCLC)调强放疗致放射性肺损伤(RILT)风险的预测。 方法选取2015年12月至2021年12月我院NSCLC患者59例为对象。根据放疗结束后3个月内是否发生放射性肺损伤分为放射性肺损伤21例、无放射性肺损伤38例，Logistic回归分析放射性肺损伤发生的因素。 结果59例NSCLC患者经调强放疗结束后3个月，发生放射性肺损伤21例(35.59%)，未发生放射性肺损伤38例(64.41%)；放射性肺损伤患者吸烟史、伴有COPD、双肺V20≥15%、双肺V30≥15%、MLD≥10Gy高于无放射性肺损伤患者(P<0.05)；Logistic多因素分析，吸烟史、合并COPD、双肺V20≥25%、双肺V30≥15%、MLD≥10Gy为放射性肺损伤发生的危险因素(P<0.05)。 结论吸烟史、合并COPD、双肺V20、双肺V30、MLD为NSCLC调强放疗患者发生放射性肺损伤的危险因素。     

Risk factors of acute pneamonitls caused by synchronous chemoradiation in pantients with advanced esophageal carcinoma

目的 观察三维适形放疗联合同期化疗治疗中晚期食管癌时急性放射性肺损伤的发生情况,并对临床及剂量学因素进行分析.方法 43例中晚期食管癌患者接受同期放化疗.放疗剂量5600～6000 cGy,共28～30次,同期化疗3个疗程,分析急性放射性肺损伤的发生情况.结果 临床因素中化疗周期数、肿瘤靶体积(GTV)、临床靶体积(PTV)、肺功能状况、照射野个数均与放射性肺炎有关:剂量学因素中受照500 cGy的靶体积占总体积的比例(V5)与受照2000 cGy的靶体积占总体积的比例(V20)是影响严重放射性肺炎预后的因素.结论 食管癌同期治疗中肺损伤的发生受多因素影响,剂量体积参数V5和V20与放射性肺损伤有关.     

放射性肺损伤的发病机制

放射治疗是肿瘤综合治疗的重要手段之一,肺是辐射中度敏感器官,在胸部肿瘤的放射治疗中,放射性肺损伤是常见的剂量限制因素.电离辐射损伤后各种因素参与的修复、再生过程的失控是最终导致肺纤维化的原因.氧化应激所致的自由基过度生成、炎症细胞及相关细胞因子参与的炎症反应过程是放射性肺损伤的关键因素,本文就相关研究作一综述.     

放射性肺损伤的研究进展

放射性肺损伤是胸部肿瘤放射治疗后常见的并发症，发生率约为5％～10％。主要包括放射性肺炎和放射性肺纤维化。目前，它已成为限制胸部肿瘤局部治疗的重要因素。本文就放射性肺损伤的发病机理、影响因素、临床表现、中西医防治等几个方面的研究现状加以阐述。     

β-七叶皂甙钠预防急性放射性肺损伤临床疗效观察

将64例放疗肺癌患者随机分为两组,单纯放疗对照组(RT)和放疗加用β-七叶皂甙钠观察组(RT Q).根据RTOG诊断标准将放射性肺损伤分为0～4级,以≥2级者为观察指标,同时观察肺功能、影像学变化,并比较两组KPS评分.发现急性放射性肺损伤(ARP)总发生率观察组15.63%,对照组46.88%;观察组肺功能明显改善,KPS评分优于对照组(P＜0.01).认为β-七叶皂甙钠能有效预防严重急性放射性肺损伤的发生,无激素类药物不良反应,可提高患者生活质量.     

EGFR在急性放射性肺损伤肺组织中的表达及意义

40只健康雄性Wistar大鼠随机分为对照组(C组)和照射组(R组),R组行6MV-X线全胸野照射,用HE和Masson染色观察病理改变,免疫组化法分析大鼠急性放射性肺损伤过程中表皮生长因子受体(EGFR)在肺组织中的表达.发现照射后的1周始肺泡腔有炎性细胞渗出,继而间质水肿,4、8周出现肺泡腔变小甚至结构破坏,局部实变,肺间质出现胶原纤维;R组各时间段肺泡灌洗液的细胞总数较C组增高;C组比R组在第4、8周EG-FR表达明显增强.认为EGFR参与放射性肺损伤的发生、发展过程,为进一步探讨放射性肺损伤的发病机制提供了实验依据.     

还原型谷胱甘肽减轻NSCLC放射性肺损伤的临床观察

目的　观察还原型谷胱甘肽对减轻 NSCL C患者放射性肺损伤的作用。方法　 174例 NSCL C患者随机分为治疗组和对照组。治疗组放疗同时加用还原型谷胱甘肽 ;对照组单纯放疗。结果　 174例患者全部完成放疗计划 ,有效率 (CR+PR)治疗组为 89.7% ;对照组为 92 .0 %。急性放射性肺炎和肺纤维化的发生率治疗组为 9.2 %和 36 .8% ,对照组为 2 1.8%和 5 4 .0 % (P<0 .0 5 )。结论　还原型谷胱甘肽可以减轻 NSCL C患者放射性肺损伤     

急性放射性肺损伤肺表面活性物质相关蛋白A的表达及视黄酸的调节作用

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射治疗后常见的并发症,发牛率为5%～10%,目前发病机制不清,治疗无特效方法.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.