急性期放射性脑损伤磁共振扩散张量成像的定量研究

目的 利用磁共振扩散张量成像(DTI)定量分析,探讨正常脑组织不同部位急性期放射损伤的敏感性。方法 44例欲行全颅放疗的颅内肿瘤患者,在放疗前及放疗后3周行磁共振常规扫描、增强扫描及扩散张量成像,测量非肿瘤侧大脑半球接受总放射剂量为27 Gy时的等剂量区域内脑回灰质、脑回白质、深部灰质、深部白质的表观扩散系数(ADC)、部分各向异性(FA)、相对各向异性(RA)、容积比率(VR)等指标,并进行对比分析。 结果 所有患者常规及增强磁共振扫描非肿瘤侧大脑半球均未发现异常信号,而放疗后脑回灰质ADC值升高(t=-3.819,P<0.05),脑深部灰质核团ADC、容积比率值升高(t=-3.31、-2.810,P<0.05),脑深部灰质核团FA、RA值降低(t=2.906、2.349,P<0.05),其余部位放疗前后DTI各指标差异无统计学意义。结论 在急性期脑灰质较白质对放疗损伤敏感,DTI能从组织细胞功能水平对放射性脑损伤急性反应进行评价。     

直肠癌调强放疗中固定铅门技术和分野技术的剂量学比较

目的 研究直肠癌患者应用固定铅门技术(FJT)和分野技术(SFT),分析比较2种不同的调强放疗技术的剂量学差异。方法 选择15例直肠癌患者,进行CT模拟定位,勾画靶区及危及器官,对同一CT图像设计FJT计划和SFT计划。评估靶区及危及器官的剂量分布。结果 FJT计划组PTV₉₅覆盖度降低(t=-2.24,P<0.05);D_mean升高(t=2.54,P<0.05);HI较差(t=3.09,P<0.05),CI无差异。小肠V₅升高(t=4.76,P<0.05),骨髓V₂₀和V₅₀优于SFT计划组(t=-2.66、-3.36,P<0.05),而D_max高于SFT计划组(t=3.30,P<0.05);全身的V₂₀高于SFT计划组(t=2.48,P<0.05)。MU的数量和子野数量明显低于SFT计划组(t=-9.38、-6.46,P<0.05),计划验证通过率优于SFT计划组(t=10.46,P<0.05);治疗时间由原来的平均12 min缩短至6 min,缩短50%。结论 与SFT技术比较,直肠癌患者采用FJT技术,其靶区、危及器官受量均能满足临床治疗要求。患者治疗时间缩短,MU数量降低,单位时间内每天每台机器治疗患者的数量增加,减少患者的等待时间,降低加速器质量保证的难度。     

食管癌患者放化疗中病理反应与血清VEGF变化的关系及其对疗效和预后的影响

目的 观察食管癌同期放化疗中肿瘤组织病理反应与血清血管内皮生长因子(VEGF)表达水平的相关性及其对疗效和预后的影响。方法 46例年龄≤75岁,KPS评分≥80,首次治疗的食管癌患者,同期行放化疗。放化疗前及放化疗第4周胃镜活检,放化疗前、放化疗第4周及放疗结束后1周作食管X射线钡剂造影,检测血清中VEGF表达水平,分析肿瘤组织病理反应与血清VEGF表达水平的相关性及两者对疗效和预后的影响。结果 治疗后重度反应组、中度反应组和轻度反应组中分别有18例(85.7%)、7例(53.8%)及6例(50.0%)患者的血清VEGF水平较治疗前下降,3组比较差异有统计学意义(χ²=6.072, P<0.05)。重度反应组、中度反应组、轻度反应组近期疗效有效率分别为90.5%、38.5%、33.3%,3组比较差异有统计学意义(χ²=14.289,P<0.05);重度反应组与轻度反应组总生存期(OS)差异无统计学意义。治疗后血清VEGF水平下降及上升的患者中,分别有22人(71.0%)、6人(40.0%)近期疗效评价为有效,两组比较差异有统计学意义(χ²=4.070,P<0.05)。结论 放化疗过程中的病理反应程度与血清VEGF水平变化可预测食管癌患者的治疗疗效,监测治疗中病理反应和VEGF水平变化对临床个体化治疗有指导意义。     

电离辐射对肺腺癌细胞A549线粒体的影响

目的 研究电离辐射对肺腺癌细胞A549线粒体的影响。方法 0、0.5、3和8 Gy ⁶⁰Co γ射线照射A549细胞后,利用JC-1探针检测照射后肺腺癌细胞A549线粒体膜电位的变化;使用ATP试剂盒检测辐射对A549细胞ATP生成的影响;利用实时定量PCR方法检测线粒体拷贝数。结果 在照射后24 h,各剂量组A549细胞膜电位出现明显改变（F=243.44,P<0.05）,与0 Gy照射组相比,0.5和3 Gy照射的A549细胞线粒体膜电位显著升高（t=-10.12、-5.59,P<0.05）,而8 Gy照射的线粒体膜电位显著降低（t=15.22,P<0.05）,照后48 h各照射组线粒体膜电位基本恢复正常（F=10.36,P<0.05）;照射后24 h ATP水平与膜电位变化趋势一致（F=97.08,P<0.05）,其中0.5和3 Gy A549细胞中ATP水平升高（t=1.66、7.27,P<0.05）,8 Gy照射组降低（t=-8.24,P<0.05）;照射后48 h,ATP水平也发生变化（F=39.49,P<0.05）,0.5和3 Gy照射后A549细胞中ATP水平显著高于0 Gy组（t=4.60、8.53,P<0.05）。照射后24 h线粒体拷贝数显著增加,其中0.5 Gy mtDNA拷贝数增加至对照组的12倍（t=0.02,P<0.05）,3和8 Gy组mtDNA拷贝数分别增加至对照组的7和10倍（t=9.68、15.10,P<0.05）。结论 大剂量电离辐射会导致A549细胞线粒体膜电位降低,从而影响ATP的生成,中等剂量以下的照射会导致A549细胞线粒体膜电位代偿性增高,从而使ATP的生成增多,8 Gy以内的电离辐射可使mtDNA拷贝数代偿性升高。     

妇科肿瘤后装逆向调强放疗的初步临床研究

目的 评价后装逆向调强放疗技术在妇科肿瘤治疗中的临床价值。方法 选取20例Ⅰ~Ⅲ期宫颈癌患者,采用随机数字表和余数分组的方法分为A、B两组,各10例。A组病例行后装逆向调强放疗,B组病例行三维适形后装放疗。分析两组患者的靶区剂量分布、危及器官受量、放疗并发症及近期疗效。 结果 A组靶区剂量均匀度指数（HI）为52.43±0.45,好于B组的46.37±1.45（t=0.92,P<0.05）;A组直肠、膀胱最大受量D_max分别比B组低37%、35%（t=1.34、1.39,P<0.05）,A组75%处方剂量的直肠、膀胱受照体积V₇₅约为B组的1/2（t=1.23、1.13,P<0.05）;A组局部控制率96%好于B组的 93%（t=1.25,P<0.05）。结论 后装逆向调强放疗优于三维适形后装放疗,值得在妇科肿瘤治疗中广泛应用。     

硫酸镁对大鼠神经干细胞辐射损伤保护作用的初步研究

目的 探讨硫酸镁对大鼠神经干细胞辐射损伤的保护作用。方法 取新生大鼠神经干细胞进行培养,用免疫荧光法进行神经干细胞的鉴定后,用含有不同浓度硫酸镁的培养基培养神经干细胞,选择出硫酸镁的合适浓度为1.25 mg/ml。将神经干细胞分为空白对照组、单纯照射组及照射+硫酸镁组,照射+硫酸镁组神经干细胞加入1.25 mg/ml的硫酸镁培养24 h后,分别用2和4 Gy ⁶⁰Co γ射线对单纯照射组及照射+硫酸镁组进行照射,分别于照射后24、48和72 h用CCK-8对各组进行神经干细胞增殖情况的检测,同时用流式细胞仪对各组神经干细胞凋亡率进行检测。结果 与空白对照组比较,单纯照射组各时间点反映神经干细胞增殖情况的吸光度值明显降低(t=5.33～8.44,P<0.05),神经干细胞的凋亡率明显升高(t=30.60～71.22,P<0.05)。与单纯照射组比较,照射+硫酸镁组除24 h时间点外余各时间反映神经干细胞增殖的吸光度值有所上升(t=2.45～4.71,P<0.05),各时间点神经干细胞的凋亡率明显降低(t=6.73～41.12,P<0.05)。结论 硫酸镁具有减轻电离辐射后神经干细胞增殖损伤,降低电离辐射所致的细胞凋亡率。     

脂肪来源干细胞促进放射损伤骨骼肌血管生成的实验研究

目的 观察新西兰兔脂肪来源干细胞(adipose-derived stem cells,ASCs)植入放射损伤骨骼肌后的微血管密度改变,分析组织中血管内皮生长因子(VEGF)和碱性成纤维生长因子(bFGF)的变化,探讨ASCs移植对兔放射损伤骨骼肌血管生成的影响.方法 64只实验动物单侧臀部予9 MeV电子线一次性照射80 Gy,采用随机数字表法分为ASCs组和磷酸缓盐冲溶液(PBS)组,每组为32只.照射后24 h,ASCs组和PBS组照射侧分别肌肉注射1 ml含5×10⁷个ASCs的细胞悬液及 PBS.免疫组织化学法检测照射后1、4、8和26周骨骼肌组织中CD31阳性的微血管、VEGF和bFGF的表达.蛋白印迹法检测骨骼肌组织中VEGF、bFGF蛋白表达.ELISA法检测ASCs在条件培养基中分泌的VEGF、bFGF浓度.结果 ASCs组受照射骨骼肌组织中CD31染色阳性的微血管密度较PBS组在照射后4、8和26周增高(t=8.14、7.44、18.58,P<0.05).ASCs组受照射骨骼肌组织VEGF、bFGF的累计光密度值(IOD)较PBS组在照射后1、4、8和26周增高(VEGF:t=3.13、4.66、2.19、6.79,P<0.05;bFGF:t=3.14、3.84、4.28、3.61,P<0.05).ASCs组VEGF蛋白的表达水平较PBS组在照射后1、4、8和26周增高(t=4.28、5.02、4.24、4.56,P<0.05).ASCs组bFGF蛋白的表达水平较PBS组在照射后4、8和26周增高(t=3.36、3.16、5.77,P<0.05).ASCs在放射损伤肌肉匀浆上清条件培养基中较在正常肌肉匀浆上清条件培养基中分泌的VEGF浓度在48、72和96 h增高(t=2.81,9.96,4.75,P<0.05),分泌的bFGF浓度在72和96 h增高(t=3.80,4.33,P<0.05).结论 ASCs能上调骨骼肌放射损伤组织VEGF和bFGF分泌、增加新生血管形成,可能是修复骨骼肌放射损伤的部分机制.     

2 Gy γ射线照射对小鼠调节性T细胞和Th17细胞及其免疫平衡的影响

目的 观察2 Gy γ射线照射对小鼠Treg/Th17免疫平衡的影响。方法 50只C57BL/6雄性小鼠随机数字表法分为对照组和照射组,照射组小鼠接受2 Gy γ射线一次性全身照射(剂量率为164.94 Gy/min),对照组行假照射。于照射后1、3、7、14和28 d检测外周血象的变化;流式细胞仪分析外周血、胸腺及脾脏调节性T细胞(Treg细胞)和脾脏Th17细胞数量的改变。结果 受照后小鼠外周血白细胞总数和淋巴细胞数降低(t=8.89～33.54, P<0.05)。小鼠外周血Treg略有升高;胸腺Treg在照后1、3 d显著高于对照组(t=-6.45和-10.59, P<0.05),至28 d明显低于对照组(t=5.34, P<0.05);脾脏Treg在照后1～14 d显著高于对照组(t=-6.82～-3.89, P<0.05)。脾脏Th17细胞于照后1 d出现显著增高,3 d达到最大值(t=-2.42, P<0.05),较脾脏内Treg增长更为明显。Treg/Th17比值在照后1～14 d降低,差异有统计学意义(t=4.02～8.04, P<0.05),导致Treg/Th17平衡模式向Th17方向明显偏移。结论 Treg/Th17免疫平衡失调在辐射所致免疫功能损伤中可能扮演重要角色。     

Cks1表达对人食管癌EC9706细胞辐射敏感性的影响

目的 通过多种转染方法改变人食管癌细胞EC9706中Cks1的表达,探究Cks1的表达对细胞辐射敏感性的影响。方法 通过3种转染方式构建人食管癌EC9706细胞模型,分别为Cks1正义转染组（以亲本组和空载组为对照）、Cks1 RNAi组（以亲本组和阴性对照组为对照）和Rescue组（转染了抗Cks1 RNAi的突变载体,以亲本组和RNAi组作为对照）。Western blot法检测转染后EC9706细胞中Cks1蛋白的表达量;6 Gy γ射线照射转染后的EC9706细胞,MTT法和克隆形成实验检测EC9706辐射敏感性的变化。结果 Western blot检测结果表明,转染成功改变了Cks1的表达量。正义转染实验中,相对于亲本组和空载组,Cks1正义转染组Cks1表达量提高（t=17.10、14.95,P<0.05）;RNA干扰实验中,相对于亲本组和阴性对照组,RNAi组表达量降低（t=3.85、6.37,P<0.05）;Rescue实验中,Rescue组较RNAi组表达量明显回升（t=7.72,P<0.05）,接近亲本组的表达水平（P>0.05）。MTT实验结果表明,6 Gy γ射线照射后,Cks1正义转染组细胞的增殖能力显著高于亲本组（t=3.42、4.74、4.02,P<0.05）和空载组（t=3.39、4.44、4.37,P<0.05）。RNAi组细胞的增殖能力显著低于亲本组（t=7.33、8.27,P<0.05）和阴性对照组（t=6.98、7.34,P<0.05）。Rescue组细胞的增殖能力显著高于RNAi组（t=11.61、9.99,P<0.05）,与亲本组相近（P>0.05）。克隆形成实验结果表明,Cks1正义转染组细胞克隆形成能力显著高于亲本组（t=13.95,P<0.05）和空载组（t=14.72,P<0.05）,RNAi组细胞的克隆形成能力显著低于亲本组（t=20.14,P<0.05）和阴性对照组（t=10.01,P<0.05）,Rescue组细胞的克隆形成能力显著高于RNAi组（t=10.57,P<0.05）,与亲本组相近（P>0.05）。结论 Cks1的表达与食管癌细胞辐射敏感性密切相关,Cks1表达量越高,食管癌细胞辐射敏感性越低。     

晚期非小细胞肺癌患者放疗前后肿瘤标志物变化与近期疗效的临床分析

目的 回顾性研究晚期非小细胞肺癌患者放疗前后血清CEA、CYFAR21-1、SCC、CA125的水平变化,探讨血清肿瘤标志物的改变及与放疗近期疗效的关系。方法 常规检查205例经确诊的晚期非小细胞肺癌患者放疗前、后血清CEA、CYFAR21-1、SCC、CA125等肿瘤标志物的水平(应用电化学发光法), 同时评估放疗的近期疗效,分析肿瘤标志物的变化及与近期疗效的关系。结果 205例患者放疗后近期有效113例,总有效率为55.1%。此113例患者放疗后血清CEA、CYFAR21-1、SCC、CA125水平均较放疗前发生了明显下降(t=3.224, 2.896, 3.137, 3.219, P<0.05),其中Ⅲ期及Ⅳ期患者血清肿瘤标志物CEA、CYFAR21-1、SCC、CA125放疗后与放疗前比较,差异均有统计学意义(Ⅲ期:t=2.484, 2.445, 2.148, 2.109, P<0.05;Ⅳ期:t=2.072, 2.857, 2.277, 2.436, P<0.05);而放疗后近期非有效的92例患者中,放疗后血清肿瘤标志物较放疗前明显上升(t=2.224, 2.005, 2.261, 2.545, P<0.05)。放疗后肿瘤标志物降低组的近期疗效明显好于肿瘤标志物升高组,差异有统计学意义(χ²=80.001, P<0.01)结论 血清肿瘤标志物CEA、CYFAR21-1、SCC、CA125水平或可用于晚期非小细胞肺癌患者放疗后的近期疗效评估。     

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.     

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.     

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).     

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.