三维适形放疗联合化疗同步治疗局限期小细胞肺癌

目的研究三维适形放疗联合化疗同步治疗局限期小细胞肺癌的生存疗效、耐受性、不良反应。方法放疗方案为每次照射1.8Gy,每周5次DT61.2Gy/34次。化疗方案为EP方案(DDP25～30mg/m2d1-3 vp16100mgd1-5)每3周重复1次,从第1周期始即同步放、化疗,放疗完成后继续3疗程EP方案化疗,每3周重复1次,若CR后可行全脑预防性照射。结果中位生存时间25个月,局部复发率29%,完全缓解率(CR)71%(15/21),部分缓解PR率20%(4/21),无变化和进展(NR PD)率9%(2/21),放射性食管炎38%(8/21),2例发生Ⅰ～Ⅱ级放射性肺炎,18例白细胞下降,但经G-CSF治疗后恢复正常,后期并发症2例出现I级肺纤维化。结论三维适形放疗联合化疗同步治疗局限期小细胞肺癌,提高了局控率和生存率,耐受性好,达CR的患者建议行PCI。     

非小细胞肺癌单发脑转移患者手术治疗效果观察

目的：探讨手术联合放化疗治疗非小细胞肺癌单发脑转移患者手术治疗的临床效果。方法将67例非小细胞肺癌同时单发脑转移的患者随机分为观察组34例和对照组33例。对照组行放疗联合吉西他滨、替莫唑胺化疗。观察组在对照组基础上行肺部肿瘤切除及脑转移瘤切除术。对比观察2组生存期和生存率。结果观察组死亡28例,存活6例。对照组死亡32例,存活1例。观察组生存期为6．8～39．4（19．64±1．68）个月。对照组生存期为4．7～38．2（16．00±1．58）个月。2组生存期差异有统计学意义（X2＝9．756,P＝0．002,＜0．01）。观察组1年生存率为97．1％（33／34）,2年生存率为35．3％（12／34）,3年生存率为17．6％（6／34）,对照组1年生存率为69．7（23／33）％,2年生存率为18．18％（6／33）,3年生存率为6．01％（2／33）,2组生存率差异有统计学意义（P＜0．05）。结论手术切除肺部原发肿瘤及脑转移瘤对改善非小细胞肺癌单发脑转移患者的预后具有一定作用。     

37例肺小细胞未分化癌的综合治疗及预防性全脑照射

对肺小细胞示分化癌进行综合治疗，同时给予预防性全脑照射，可控制颅内隐蔽的亚临床病灶，降低脑转移率，提高生存率，可列为常规应用。     

同步放化疗治疗局限期小细胞肺癌的近期效果观察

目的探讨同步放化疗治疗局限期小细胞肺癌的近期效果。方法选择患者100例,分为两组,各50例,观察组采用同步放化疗,对照组则实施交替放化疗,比较两组的不良反应发生率,1年局部复发、远处转移率及1年生存率。结果观察组治疗后发生骨髓抑制、放射性食管炎、放射性肺炎和放射性皮炎的比例显著低于对照组（P〈0.05）,观察组的1年局部复发及远处转移率均显著低于对照组（P〈0.05）,观察组的1年生存率为78%,显著高于对照组的50%。结论同步放化疗治疗小细胞肺癌可显著减少不良反应的发生,提高临床治疗效果,延长患者的生存时间。     

全脑照射联合三维适形放疗治疗非小细胞肺癌脑转移瘤的疗效观察

目的探讨全脑照射联合三维适形放疗（3D-CRT）治疗肺癌脑转移瘤的疗效。方法回顾性分析我院治疗的非小细胞肺癌合并脑转移瘤患者100例,所有患者均先行先行全脑照射,然后缩野至脑转移灶行三维适形放疗全脑放疗方法为2—3Gy／次。每周5次,总剂量为40～60Gy／3～4周。之后行三维适形放射治疗单次靶区平均周边剂量3～5Gy,总剂量16～32Gy。观察患者的近期疗效和远期疗效、放疗后不良反应。结果患者局部控制率（CR＋PR）为79．0％,所有患者中位生存期为9．3个月;1年生存率为41．0％;15例发现与放疗有关的并发症。结论全脑照射联合三维适形放疗（3D-cRT）能有效提高患者局部控制率,改善生活质量及一定程度上延长生存期。     

三维适形放疗同期化疗综合治疗局限期小细胞肺癌的临床观察

目的 评价三维适形放射治疗同期化疗综合治疗局限期小细胞肺癌的疗效及不良反应.方法 33例局限期小细胞肺癌患者行EP方案化疗,3周为1个周期,共行6个周期.放疗在化疗第1个周期或第3个周期同期进行,照射野包括原发病灶和纵隔,照射剂量45 Gy/3周,每次1.5 Gy.每天2次.结果 33例入组患者同期放化疗毒性可耐受.总有效率(CR+PR)97%.随访3年,中位生存时间为21.9个月,中位局部无进展生存时间为18.5个月,1、2、3年局部无进展生存率分别为66.7%、45.5%、30.3%,1、2、3年总生存率分别为69.7%、51.5%、30.3%.结论 三维适形放射治疗同期化疗综合治疗局限期小细胞肺癌疗效较好,毒副反应患者能耐受,安全可行.     

小细胞肺癌靶向药物研究进展

小细胞肺癌（SCLC）占全部肺癌的15％-25％,从EP方案诞生至今,化疗进展缓慢,无论局限期还是广泛期,预后极差,局限期（LD）SCLC的5年生存率不足10％,广泛期（ES）SCLC的5年生存率微乎其微。靶向药物在肺癌治疗领域的快速进展,已经改变了非小细胞肺癌的治疗模式。虽然众多靶向药物在SCLC的临床研究仍然没有突破,但同样为我们认识SCLC提供了宝贵的科学信息。     

小细胞肺癌的治疗进展评价

目的:对小细胞肺癌的化疗、放疗、预防性全脑放疗及靶向治疗等方面的进展进行探讨。方法:收集国外相关文献进行归纳分析。结果及结论:小细胞肺癌恶性度高,常常快速播散和转移,联合化疗是主要的治疗方法,依托泊苷联合铂类的2药联合化疗4个～6个周期是标准的一线治疗;身体状况好的局限期患者推荐同步化放疗(EP方案),超分割放疗优于每日1次放疗,序贯治疗时患者也宜早期接受放疗,放疗可在化疗的第1或第2周期开始(1.5Gy,每日2次,总量45Gy;或是1.8Gy,每日1次,总量50Gy);预防性全脑放疗可使完全缓解的局限期患者生存延长;靶向治疗仍需要进一步探索。     

分析放化疗结合靶向治疗非小细胞肺癌脑转移的临床疗效

目的对放化疗结合靶向治疗非小细胞肺癌脑转移的临床疗效进行探究。方法选取2008年1月至2012年1月在我院确诊为非小细胞肺癌脑转移患者88例,随机分为对照组44例和观察组44例,对照组患者采用放化疗联合治疗,观察组患者采用放化疗结合靶向治疗,比较两组的治疗疗效。结果观察组治疗后的总有效率(72.73%)明显好于对照组的(45.45%),不良反应发生率(18.18%)明显低于对照组治疗后的不良反应发生率(43.18%),两组比较具有统计学意义(P<0.05);观察组患者的生存率(93.18%)、局部复发率(9.09%)、远处转移率(13.64%)明显好于对照组患者的生存率(65.91%)、局部复发率(36.36%)、远处转移率(40.91%),两组比较具有统计学意义(P<0.05)。结论对非小细胞肺癌脑转移的治疗采用放化疗结合靶向治疗效果较好,安全性高,提高患者的生活质量,值得在临床中推广应用。     

晚期非小细胞肺癌脑转移临床高危因素分析

<正>肺癌是最常见的恶性肿瘤之一,发病率和病死率在全球呈上升趋势。非小细胞肺癌(non-small cell lung cancer,NSCLC)约占肺癌的80%,近年来NSCLC的治疗方法和生存期都有了明显的改善和提高,但脑转移的发生率和病死率仍较高,据统计约50%的NSCLC在病程中最终会出现脑转移。肺癌脑转移的生存期很差,接受标准治疗全脑照射后的中位生存期仅4.5个月。近年来,小细胞肺癌(SCLC)的颅脑预防照射(PCI)使其生存率有了明显提高,而RTOG的一项研究提示,预防性全     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

---

Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.