自由基与工业化学物质的毒性关系及其损害的防护

自由基在生物体系中的作用已成为一个非常活跃的研究领域。在临床医学及职业中毒方面的许多问题都涉及自由基的作用。本文着重讨论自由基与工业化学毒物的毒性的关系以及有关自由基损害的防护。     

自由基和抗氧化剂生态网络系统理论模型及应用研究

目的 试图从理论上提出自由基和抗氧化剂生态网络系统理论模型,建立统一的自由基和抗氧化剂生物效应理论模型,解释和定量描述自由基、抗氧化剂生物效应的双相性或多样性,并应用于核化生损伤的医学防护等研究。方法 在总结自由基生物医学最新成果的基础上,提出有关自由基和抗氧化剂的10个基本原理,建立统一的自由基和抗氧化剂生态网络系统理论模型。结果 提出自由基和抗氧化剂生态网络系统理论模型,建立了3个自由基和抗氧化剂生态网络系统理论模型方程,可以解释和定量描述自由基和抗氧化剂生物效应的双相性或多样性,并提出了核化生损伤的统一的氧化还原应激损伤机理和防护措施。结论 提出自由基和抗氧化剂生态网络系统理论模型,解释和定量描述自由基和抗氧化剂生物效应的双相性或多样性。该理论模型适用于其他广义刺激的氧化还原应激:物理因子、化学因子、生物因子、心理、药物、毒物毒素等,可称为广义氧化应激和还原应激的生态网络系统理论模型。     

外源性化学物所致急性肺损伤机理研究的进展

外源性化学物所致急性肺损伤主要表现为肺水肿,严重时发展为成人呼吸窘迫综合征(ARDS),ARDS死亡率可高达50％以上。发生这种情况的关键是外源性化学物导致肺损伤发生和发展的机理不清楚,无法早期诊断和针对病因进行治疗。近年来,自由基在外源性化学物所致急性肺损伤中的作用,日益引起重视。本文拟就肺内自由基的形成和作用,自由基与外源性化学物所致急性肺损伤的关系作一综述。     

制备放射性药物99Tcm对工作人员手部的辐射影响研究

目的 探讨⁹⁹Tc^m药制备过程中工作人员的手部当量剂量情况。方法 对采用不同防护套和不同工作时间制备⁹⁹Tc^m药所致手部当量剂量进行估算。结果 按照年工作250天计算,采用3 mm铅防护套所致手部的当量剂量约为668.8 mSv/a,采用2 mm钨合金防护套所致手部当量剂量约为392.7 mSv/a;按照年工作100天计算,采用3 mm铅防护套所致手部的当量剂量约为267.3 mSv/a,采用2 mm钨合金防护套所致手部当量剂量约为157.1 mSv/a。结论 ⁹⁹Tc^m药制备过程中手部剂量的辐射影响不容忽视,应合理分配工作人员的工作时间或提高防护效果,保证工作人员手部的年受照当量剂量低于GB 18871—2002中四肢或皮肤的年剂量限值500 mSv/a的要求。     

X线机房空气自由基浓度测定及对人淋巴细胞DNA的损伤

本文采用核顺磁共振仪测定空气自由基的浓度及观察自由基对人淋巴细胞DNA合成速率的影响.结果表明,X线机房内空气自由基浓度明显高于室外空气,开机后高于开机前;X线机房空气飘尘浓度在33.6μg/ml时对人脐血淋巴细胞DNA合成造成模板型损伤,自由基浓度是兰州化工区(64μg/ml)的两倍和郊区(180μg/ml)的6倍,对其防护应予重视.     

65名放射工作人员高受照剂量原因分析

对65名高受照剂量放射工作人员调查发现,误照是造成高剂量的主要原因,故意照射所致剂量最高;介入放射工作者的防护和工业探伤人员的防护知识培训应成为今后放射防护工作的重点。     

接触X射线人员血液内GSH-Px、SOD、MDA、Se的多因素分析

国内外学者通过动物实验发现，大剂量电离辐射可以导致动物组织中丙二醛（MDA）含量增加，而活性氧系列清除剂如超氧化物岐化酶（SOD）、谷胱甘肽过氧化物酶（GSH—Px）活力下降。从而间接证明，MDA含量增加与大剂量电离辐射所致自由基累积有关。从事X线作业人员受到的职业照射，往往属于长期低水平照射，其体内SOD、GSH—Px活力改变情况，以及MDA含量改变情况，迄今为止报道较少。本次研究旨在揭示人体长期受小剂量电离辐射照射后，对机体自由基及酶活力是否产生影响。并通过这次调查，为今后从事X线工作人员受辐射损伤的诊断、个人防护及如何补充微量元素等提供科学依据。     

运动对机体自由基的影响及某些营养素的保护作用

本文综述了运动应激、有氧代谢训练和某些营养素对机体自由基代谢的影响。运动应激可导致机体自由基产生增加，抗氧化能力降低；有氧代谢训练和某些营养素对运动所致的抗氧化能力降低具有保护作用。     

几种制剂抗氧化与清除自由基效应的比较研究

利用改良的硫代巴比妥酸（ＴＢＡ）分光义法研究知母宁、单宁酸怀螺旋藻对电离辐射所致小鼠组织脂质过氧化物（ＬＰＯ）含量升高的抑制作用;采用ＥＳＲ技术研究上述三种制剂清除电离辐射所致自由基的作用。研究发现,知母宁与螺旋藻的抗氧化作用较单宁酸佳,而对于清除自由基作用以知母宁与单宁酸比螺旋藻好。     

中药方剂"三生养阴饮"的抗氧化和清除自由基作用

目的 观察“三生养阴饮”对^60Coγ射线整体照射所致小鼠某些组织中脂过氧化物（LPO）含量和小鼠存活率的影响以及它在体外清除自由基的作用。方法 改良的硫代巴比妥酸（TBA）分光光度法测定LPO含量,电子自旋共振（ESR）技术测定羟自由基清除率。结果 “三生养阴饮”能明显抑制辐射所致组织中LPO含量的升高,能显著提高受照小鼠30d存活率和延长存活天数,并对羟自由基具有良好的清除作用。结论 “三生养阴饮”在辐射损伤救治及放疗辅助治疗中具有较好的应用前景。     

肿瘤患者首次放疗前后抑郁症状的比较研究

目的:比较首次放射治疗前后肿瘤患者抑郁症状评分,并寻找导致评分增高的危险因素。方法:纵向比较126例接受放射治疗的肿瘤患者,比较化疗前后SDS评分升降情况。结果:3(2.38%)例患者治疗前后SDS评分相同,77(61.11%)例患者治疗后SDS评分高于治疗前,而46(36.51%)例患者治疗后SDS评分低于治疗前。平均年龄较小(20-29岁)、高龄或者接受头颈部放射治疗患者容易出现疲惫、焦虑及胃肠道等症状。结论:首次放射治疗会增加患者抑郁评分,但不是唯一因素。     

Radiation related morbidities and their impact on quality of life in head and neck cancer patients receiving radical radiotherapy

Although 50-70% of head and neck cancer patients in India receive radiotherapy (RT), radiation-related acute and late morbidities and their impact on quality of life (QOL) are infrequently reported. Acute and late radiation morbidities and QOL were assessed in a prospective longitudinal study of 45 patients with head and neck cancers receiving radical RT to a dose of 7000 cGy in conventional fractionation. Grade II acute morbidities experienced by the largest percent of the sample during the course of RT pertained to the mucosa (66.4%), salivary gland (84%), and oesophagus (53%). These morbidities led to an increase in the symptom scores of appetite loss (76.46), fatigue (65.75) and pain (44.77). This increase in the symptom scores consequently led to a significant decline in physical, social and emotional functioning as well as global health status score during the course of RT (p < 0.001). Scores improved after 1 month of RT but did not reach the pre-RT value. Future studies may consider correlating QOL assessment to significant patient and disease related parameters such as performance status, weight loss, stage and site of disease.     

Medical care-seeking and health-risk behavior in patients with head and neck cancer: the role of health value, control beliefs and psychological distress

Health behavior plays an important role in the development, detection and course of cancer of the head and neck. Relevant health behavior includes prompt medical care seeking, and smoking and drinking cessation after diagnosis. This study examines the relationship between these health behaviors and health value and control beliefs, as well as psychological distress. Two hundred and sixty-four recently diagnosed head and neck cancer patients were interviewed about their health behavior, and they filled in a questionnaire on health beliefs and psychological distress. The results showed that one-quarter (25%) of the patients had waited more than 3 months before seeking medical care, 50% had continued to smoke and 80% had continued to drink after the diagnosis. The patients, particularly those who smoked and drank before diagnosis, reported lower levels of health value and perceived health competence than a general population sample with which they were compared. Patients who engaged in patient delay reported a lack of perceived health competence. Psychological distress and lack of perceived health competence were found to be more common among patients who continued to smoke. The implications of these findings are discussed with regard to interventions aimed at promoting these specific health behaviors.     

42例头颈部肿瘤患者放疗临床护理应用

探讨整体护理再头颈部肿瘤患者放疗中的护理效果。选择42例头颈部肿瘤放疗患者作为研究对象，分为研究组与对照组，各21例。对照组实施常规医护引导与对症护理，研究组整体护理。护理后，研究组患者整体生活质量水平及满意度均明显高于对照组（P<0.05），具有统计学意义。整体护理对头颈部肿瘤放疗患者能进一步提升患者生活质量水平，满意度较高，值得广泛推广应用。     

锥形束CT图像引导系统在放射治疗中的应用

目的：研究锥形束CT（CBCT）图像引导系统在精确放射治疗中提高摆位的精度,减少摆位的不确定性的作用。方法：对头颈部肿瘤患者（30例）和胸部肿瘤患者（40例）用CBCT扫描,其中头颈部肿瘤患者扫描90次,胸部肿瘤患者扫描113次,统计患者前后、头脚及左右方向的摆位偏差。结果：对于头颈部肿瘤患者前后方向的最大偏差值为6 mm,3个方向中〉3 mm偏差的均在10%以下;对于胸部肿瘤患者的头脚方向摆位误差最大,〉5 mm的达21.51%。前后方向的误差≤5 mm,左右方向〉5 mm的为4.53%。结论：采用CBCT图像引导系统对患者体位实时修正,极大的提升了放射治疗的精度和疗效。相对于电子射野影像验证系统（EPID）,CBCT对患者的累积剂量的影响更小,图像分辨率更高,图像匹配更精确,但是和普通螺旋CT相比,其分辨率和扫描范围还需要更进一步的提高。     

放疗后复发宫颈癌介入栓塞治疗的研究

目的：探讨放疗后复发宫颈癌介入栓塞治疗的方式、时机、药物及栓塞剂的选择。方法：对于放疗后复发宫颈癌患者介入栓塞化疗的临床应用和研究进展进行归纳总结。结果：放疗后复发宫颈癌介入栓塞治疗应选择在手术或放疗前进行,选用以铂类为主的联合化疗及可以缓释药物的栓塞剂。结论：宫颈复发癌应给介入栓塞化疗先行的积极的综合治疗。     

Disclosure of a cancer diagnosis in Thai patients treated with radiotherapy

Although radiotherapy usually implies a cancer diagnosis, no available study has been reported as to what proportion of Thai patients treated with radiotherapy know their diagnosis and how they want related information revealed. We questioned 106 patients in order to determine the proportion who knew their cancer diagnosis, and interviewed patients who knew the diagnosis and relatives of patients both who knew and did not know it with semi-structured questionnaires concerning how they wanted to be told. Sixty-seven patients (63.2%) knew their cancer diagnosis. Multivariate analysis showed that the patients with the following characteristics were inclined to know their diagnosis: younger than 70 years old, head and neck or gynecological cancer, no previous treatment before radiotherapy, no accompanying relatives during the treatment, and patients with relatives who wanted to disclose the information. 97.0% of patients who knew the diagnosis indicated that they had really wanted to know, 89.5% and 73.3%, respectively of relatives who accompanied patients who knew and did not know it expressed the same wish. No demographic factors could predict who wanted to be told the diagnosis. The majority of patients and relatives who wanted the diagnosis disclosed wanted to know all related information before treatment. They wanted to hear this directly from the doctor in the presence of their relatives.     

Differences in immune status between well-nourished and malnourished head and neck cancer patients

Malnutrition is reported to occur in approximately 30% of head and neck cancer patients. Also, impaired immunocompetence is described as a common phenomenon in this patient group. The purpose of this study was to assess the possible relationship between malnutrition and some prognostically important immune parameters in head and neck cancer patients. Thirty-two malnourished (recent weight loss >/= 10%) and 34 well-nourished patients undergoing curative treatment for advanced head and neck cancer were studied prospectively, and six parameters of their immune status (leucocytes, lymphocytes, lymphocyte phenotyping, monocytes, HLA-DR expression on monocytes and serum interleukin-10) were determined on the day of panendoscopy. Reference values for monocytes, HLA-DR expression and interleukin-10 were obtained from 43 healthy controls. Although the number of monocytes was elevated in both patient groups, the HLA-DR expression on these monocytes was significantly lower in the malnourished than in the well-nourished and control groups. Tumor stage, tumor localization, recurrence after initial radiotherapy, age and gender were not correlated to HLA-DR expression. No relationships emerged between nutritional status and lymphocyte subsets. Malnourished head and neck cancer patients show a significantly lower HLA-DR expression on monocytes than well-nourished ones and healthy controls. According to the literature this would imply an increased risk for postoperative complications. Indeed, postoperative complications occur more frequently in malnourished than in well-nourished patients.     

Symptom distress,current concerns and mood disturbance after diagnosis of life-threatening disease

This study describes the level of symptom distress, current concerns and mood disturbance in persons with a diagnosis of one of two life-threatening diseases at two occasions. The sample included 56 lung cancer patients and 65 heart attack patients who completed interviews at 1 and 2 months post diagnosis. Data were obtained using a modified version of the McCorkle and Young Symptom Distress Scale, the Weisman and Worden Inventory of Current Concerns and the Profile of Mood States.One conclusion that can be drawn from the study is that the plight of newly diagnosed lung cancer patients appears to be bleaker than that of heart attack patients. Cancer patients experienced more symptom distress of all kinds than heart attack patients. They also reported more health and existential concerns and they suffered more mood disturbances, on the average, than heart attack patients did. The most striking finding of the mean differences analysis was that, although symptom distress remained the same between occasions for both groups, both kinds of patients reported fewer concerns and better mood at the second interview. Although the plight of neither type of patient improved, patients reported being in better spirits and less worried at the second measurement occasion. This reduction in concerns and mood disturbance between interviews suggests that patients assimilate that their situation is not as immediately life-threatening as they had feared.     

规范化护理评估在头颈部肿瘤放疗致毒副反应中的应用

目的 探讨规范化护理评估在头颈部肿瘤患者放疗致毒副反应中的应用效果。方法 选取2016年1月-2018年1月在我院肿瘤科行头颈部放疗的恶性肿瘤患者144例，随机分为观察组（n=72）和对照组（n=72），观察组应用规范化护理评估对病人进行预见性的护理，对照组采取常规护理；比较两组病人放射性损伤副反应。结果 观察组使用规范化护理评估，放射性口腔炎、放射性皮炎、张口困难、放射性食管炎和放射性鼻烟粘膜炎的发生率低于对照组（P<0.05）。结论 头颈部肿瘤患者放疗期间采用规范化护理评估给予相应预见性护理，患者放疗所致毒副反应程度显著降低。