食管癌患者放疗前后血清血管内皮生长因子变化的临床意义

目的 检测食管癌患者放疗前、中、后血清血管内皮生长因子(VEGF)的水平,探讨其变化及临床意义。方法 采集67例食管癌患者和30例健康体检者(健康对照组)血清,应用酶联免疫吸附法(ELISA)测定VEGF水平,并对其变化与临床分期和患者放疗疗效的关系进行分析。结果 食管癌患者放疗前、中、后血清VEGF水平均较健康对照组升高,差异有统计学意义(F=11.65,P＜0.01);放疗后较放疗前VEGF水平明显降低,差异有统计学意义(F=10.72,P＜0.01)。T₃、T₄患者的平均VEGF水平与健康对照组比较显著升高,差异有统计学意义(F=14.10,P＜0.01)。N₁、N₂组患者的平均VEGF水平显著高于健康对照组,差异具有统计学意义(F=8.64,P＜0.01)。可评价疗效的62例患者中,有21例放疗后血清VEGF水平较放疗前升高,有41例较放疗前降低,升高组的放疗有效率为61.90%,降低组的放疗有效率为90.24%,两组比较差异有统计学意义(χ²=6.08,P＜0.05)。50例CR+PR患者放疗后及放疗中的血清VEGF水平均比放疗前显著降低,差异有统计学意义(F=7.98,P＜0.01)。结论 监测食管癌患者血清VEGF水平变化可判断患者放射治疗的敏感性,对临床预测放射治疗的预后有重要的意义。     

干扰血管内皮生长因子表达联合γ射线对食管癌细胞移植瘤的影响

目的 研究反义cDNA干扰血管内皮生长因子(VEGF)表达联合γ射线对裸鼠移植瘤的影响,并观察各组裸鼠肿瘤病理组织学和细胞生物学特征的变化,为VEGF基因治疗联合放射治疗食管癌提供理论依据。方法 将32只Balb/c/nu裸鼠随机分为4组:对照组、单纯照射组、反义组和反义+照射组,使用已转染和未转染反义VEGFcDNA TE-1食管癌细胞株,分别建立裸鼠爪垫移植瘤模型, 瘤体直径0.8~1.0 cm,⁶⁰Co γ射线18 Gy单次照射单纯照射组与反义+照射组裸鼠移植瘤,对比观察各组移植瘤生长情况,检测移植瘤组织中VEGF mRNA和蛋白的表达,并分析肿瘤组织中细胞凋亡情况。结果 与未转染两组比较,转染两组瘤体生长速度慢,成瘤潜伏期延长(t=13.898, P<0.01)。反义组肿瘤体积为(1207.50±97.07)mm³,反义+照射组为(1057.5±91.50)mm³,两者差异无统计学意义(t=1.124,P>0.05),而此2组与对照组(5442.50±185.08)mm³ 和单纯照射组(2922.50±152.773)mm³ 体积间差异有统计学意义(t=9.475~21.238,P<0.01)。反义组与反义+照射组VEGF mRNA和蛋白表达较对照组和单纯照射组差异有统计学意义(F=387.394、13.519, P<0.01)。结论 抗VEGF治疗可有效地抑制裸鼠移植瘤的生长,但单纯抑制VEGF表达对增加裸鼠移植瘤放射治疗增敏效果有限,需进一步研究。     

食管癌放疗后达完全缓解患者的失败模式分析

目的 分析食管癌放疗患者近期疗效为完全缓解（CR）患者的治疗失败模式,并分析影响近期疗效的因素。方法 选取260例行根治性放疗的食管癌患者进行研究,分析治疗后的失败模式及影响患者近期疗效和预后的影响因素。结果 全组患者治疗后完全缓解（CR）91例（35.0%）,部分缓解（PR）158例（60.8%）,无缓解（NR）11例（4.2%）。患者性别（χ²=7.647,P<0.05）、T分期（χ²=33.548,P<0.05）、N分期（χ²=13.365,P<0.05）、TNM分期（χ²=27.792,P<0.05）、病变X射线长度（χ²=20.851,P<0.05）和大体肿瘤体积（GTV）（χ²=41.772,P<0.05）为近期疗效的影响因素。全组患者局部复发75例（28.8%）,远处转移66例（25.4%）,复发伴远处转移16例（6.2%）。复发患者1、3、5年生存率分别为71.4%、15.4%、7.7%,显著低于无复发患者的78.1%、43.2%、33.1%（χ²=23.330,P<0.05）;转移患者1、3、5年生存率分别为68.3%、12.2%、4.9%,显著低于无转移患者的79.2%、43.3%、33.1%（χ²=29.350,P<0.05）。治疗后达CR者出现复发/转移的比率显著低于PR者和NR者（χ²=11.248、20.301,P<0.05）,CR总生存率、局部控制率、无远处转移生存率及无瘤生存率高于PR者和NR者（χ²=83.080、41.340、72.640、40.010,P<0.05）。T分期、N分期及近期疗效为独立性预后影响因素（HR=1.197、2.309、2.149,P<0.05）。结论 近期疗效为食管癌患者长期生存预后的影响因素,且与治疗后复发/转移密切相关,治疗后达CR者预后明显优于PR者及NR者。     

食管癌放化疗中血清血管内皮生长因子连续检测及其临床意义

目的 观察食管癌患者放化疗中血清血管内皮生长因子(VEGF)的变化规律,探讨其与预后的关系。方法 回顾性收集76例行根治性放疗的食管癌患者,其中53例行同期化疗,23例行单纯根治性放疗;放疗前、放疗中每周、放疗后1周内连续采集患者血清并测定VEGF水平,VEGF的变化分为上升组、不变组和下降组。另采集30例健康体检者血清并检测其VEGF水平为健康对照组。结果 全组患者1年总生存(OS)率、1年无进展生存(PFS)率分别为55.7%、51.4%,中位OS和PFS分别为13.4和12.5个月,复发13例。放疗中患者血清VEGF水平与放疗前比较呈逐渐下降趋势,差异有统计学意义(F=6.806,P=0.001);患者各时间点VEGF水平均高于健康对照组,差异均有统计学意义(t=2.165~3.896,P<0.05)。上升组、不变组和下降组1年OS率、1年PFS率比较,差异有统计学意义(χ²=6.811、6.602,P<0.05);3组患者局部控制(LC)率比较,差异无统计学意义(P>0.05)。OS、PFS、LC与放疗前血清VEGF无相关关系(r=-0.033、-0.056、0.090,P>0.05)。19例患者血清VEGF较放疗前升高,升高时间大多在放疗第2、3周或放疗后。结论 放化疗过程中血清VEGF变化可预测食管癌患者预后,放疗第2、3周和放疗后1周内检测可能对指导临床个体化治疗有重要意义。     

磁共振扩散加权成像预测与评价宫颈癌放化疗疗效的研究

目的 探讨磁共振扩散加权成像(DWI)在预测与评价宫颈癌放化疗疗效中的应用价值.方法 收集282例经病理检查证实为宫颈癌的患者,分别在治疗前、治疗结束后行DWI检查,测量肿瘤最大径和表现扩散系数(ADC)值.治疗结束后,依据实体肿瘤疗效评价标准(RECIST)将患者分为缓解组、无效组.根据治疗结束后2年的随访复查情况将患者分为复发组、无复发组.比较两组间的治疗前和治疗结束后ADC值,并分析疗效及复发情况与治疗前ADC值、治疗结束后的ADC升高值之间的相关性. 结果 缓解组223例,无效组59例.复发组70例,无复发组212例.缓解组治疗前ADC值明显低于无效组(t=3.274,P<0.05),无复发组治疗前ADC值明显低于复发组(t=1.031,P<0.05).治疗前ADC值低的患者复发率明显低于治疗前ADC值高的患者(χ²=5.175,P<0.05).治疗结束后的疗效及治疗结束后2年的复发情况与治疗前ADC值均呈负相关(r=-0.571、-0.675,P<0.05),与治疗结束后的ADC升高值均呈正相关(r=0.641、0.547,P<0.05).缓解组、无复发组治疗结束后ADC值升高明显(t=2.031、4.011,P<0.05),无效组、复发组ADC值升高不明显.结论 治疗前的ADC值有助于预测宫颈癌放化疗疗效,治疗结束后的ADC变化值有助于评价宫颈癌放化疗疗效.     

淋巴结阳性的食管癌患者术后预防性放射治疗的回顾性研究

目的 回顾性分析淋巴结阳性的食管癌患者术后放射治疗的意义。方法 自1999年9月至2005年10月,选择260例代表不同淋巴结转移状态的食管癌根治性手术切除患者进行研究。其中, 单纯手术组(A组)130例,术后放疗组(B组)130例。根据淋巴结转移的个数分为3个亚组,A1组(无淋巴结转移)42例,A2组(淋巴结转移个数1~3枚)43例,A3组(淋巴结转移个数≥4枚)45例;B1组(无淋巴结转移)43例,B2组(淋巴结转移个数1~3枚)44例,B3组(淋巴结转移个数≥4枚)43例。结果 (1) A和B组的1、3、5年总生存率分别为71.5％、35.4％、20.0％和76.2％、48.5％、36.2％(χ²=7.822,P<0.05)。A1和B1组、A2和B2组及A3和B3组的1、3、5年生存率分别为83.3％、52.3％、38.1％和81.3％、58.1％、46.5％(χ²=0.283,P>0.05),69.8％、34.9％、18.6％和77.3％、47.7％、40.9％(χ²=4.188,P<0.05)及62.2％、20.0％、4.4％和69.8％、39.5％、20.9％(χ²=6.168,P<0.05);B2和B3组生存率分别为40.9％与20.9%(χ²=4.213,P<0.05)。(2)A1和B1组、A2和B2组及A3和B3组的5年累计淋巴结转移率分别为30.9％和11.6％(χ²=4.753,P<0.05),53.4％和22.7％(χ²=8.741,P<0.05)及 66.7％和30.2％(χ²=11.682,P<0.05)。(3)A1和B1组、A2和B2组及A3和B3组的5年血行转移率分别为11.9％和13.9％(χ²=0.079,P>0.05),20.9％和20.4％(χ²=0.003,P>0.05)及31.1％和25.6％(χ²=0.203,P>0.05)。结论 术后放疗可以提高淋巴结阳性患者的生存率,降低放疗部位的淋巴结转移率,血行转移随淋巴结转移数的增加而增加。     

肺癌骨转移放疗止痛效果临床分析

目的 分析骨转移癌放疗止痛疗效。方法 将189例原发灶为肺癌的骨转移癌计221个病灶的放疗结果进行回顾性分析。放疗方案分为2种剂量分割组:(1)常规分割组:2Gy/次,5次/周,总剂量30～50Gy,共163个病灶;(2)中～低分割组:3～5Gy/次,2～3次/周,总剂量20～40Gy,共58个病灶。对不同病理类型和原发灶控制情况下的放疗结果进行分层分析。结果 常规分割、中-低分割组有效率分别为90.7%和87.9%(χ²=1.229,P>0.05),总有效率为90.0%。小细胞癌、非小细胞肺癌的有效率分别为92.4%和89.0%(χ²=0.668,P>0.05)。原发灶控制与未控制的有效率为88.4%和91.7%(χ²=0.787,P>0.05)。结论 放疗是一种有效止痛方式,可作为骨转移癌首选治疗方法。不同分割剂量放疗对骨转移疼痛的缓解程度无影响,放疗疗效与原发灶病理类型及原发灶控制与否关系不明显。     

甘氨双唑钠对恶性肿瘤放射增敏的临床研究

目的 评价甘氨双唑钠(sodium glycididazole, CMNa)在恶性肿瘤的放射增敏作用及安全性。方法 对符合CMNa Ⅳ期临床研究的80例诊断明确的实体瘤患者采用三维适形放疗(three dimensional conformal radiotherapy, 3D-CRT)或常规放疗,2 Gy/次,5次/周,中位照射剂量60Gy,同期应用CMNa 800 mg/m²,每周3次;观察肿瘤近期疗效和毒性作用。结果 宫颈癌的近期疗效最好,有效率91.7%,其后依次是鼻咽癌85.7%、食管癌66.7%、肺癌54.5%、肝胆癌40%,全部有效率(CR+PR)62.6%,疾病控制率(CR+PR+SD)达到100%;黏膜、皮肤的不良反应最常见,但多为1～2级轻度反应,分别为51.3%和46.3%;血液毒性白细胞下降最明显,但与治疗前相比差异无统计学意义(χ²=3.329,P=0.061),对肝肾功能、心电图变化均无明显影响。结论 放疗结合CMNa治疗恶性肿瘤有满意的近期疗效,无明显毒性反应。     

沙利度胺联合放疗治疗食管癌长期生存分析

目的 研究沙利度胺下调食管癌患者放疗中血清血管内皮生长因子(vascular endothelial growth factor,VEGF)水平对食管癌患者长期生存的影响。方法 根据81例食管癌患者放疗中血清VEGF水平分为用药组(沙利度胺)32例和未用药组49例,通过随访观察分析其总生存率(OS)和无进展生存率(PFS),根据32例使用沙利度胺处理后的血清VEGF水平变化,又分降低组20例和升高组12例,分析其OS和PFS。对预后因素进行单因素和多因素分析。结果 用药组和未用药组的中位生存期及1、3年生存率分别为17.0个月、59.4%、31.5%和18.7个月、56.4%、28.6%;两组的OS和PFS分别比较,差异均无统计学意义。VEGF水平降低组和升高组的中位生存期及1、3年生存率分别为19.7个月、65.0%、42.1%和10.7个月、43.3%、8.3%;两组OS和PFS比较,差异均有统计学意义(χ²=4.345、4.157,P<0.05)。多因素分析显示,临床分期是食管癌患者总生存率的独立预后因素,性别、病变部位对患者预后没有影响。结论 对于用药后VEGF水平降低患者,沙利度胺联合放疗能够增加食管癌患者远期疗效。     

低剂量电离辐射对雄性糖尿病模型大鼠生殖损伤的影响

目的 探讨75 mGy照射对12周糖尿病(DM)大鼠睾丸生精细胞凋亡及抗氧化和性激素水平的影响。方法 随机将Wistar大鼠分为3组:健康对照组、75 mGy＋DM组及DM组,12周末记录其存活率和体重。采用流式细胞术和TUNEL染色法检测生精细胞凋亡率,应用试剂盒分别检测血清及睾丸抗氧化和激素水平的变化。结果 12周后,DM组大鼠存活率为25%,健康对照组为100%(χ²=15.938, P<0.01);75 mGy＋DM组大鼠存活率为56.25%,与DM组比较差异有统计学意义(χ²=4.00,P<0.05)。糖尿病大鼠生精细胞凋亡率较健康对照组明显增加,亦高于75 mGy+DM组(F＝5.496,P<0.05)。与健康对照组比较,糖尿病大鼠血清和睾丸组织中丙二醛(MDA)及NO含量不同程度增加,而75 mGy＋DM组大鼠血清和睾丸MDA含量显著低于单纯DM组,以睾丸组织中尤为明显(F=10.644,P<0.01);75 mGy照射显著降低了DM组大鼠血清NO含量(F=14.379, P<0.05),同时增加了DM组大鼠血清中的一氧化氮合酶(NOS)活性及睾丸酮(TS)和促滤泡激素(FSH)含量(F值分别为9.676、43.194和5.282,P<0.05或P<0.01)。结论 低剂量辐射显著降低睾丸组织及血清MDA和NO含量,增加抗氧化酶活性和TS及FSH含量,可能与其抑制糖尿病大鼠生精细胞凋亡增多所致生精障碍有关。     

Physiologic and pathologic calcifications and ossifications in the face and neck

The aim was to give a systematic presentation of physiologic and pathologic calcifications and ossifications in the face and neck with a special emphasis on clinical relevance. In a sometimes subacute setting one should recognize specific calcifications which often lead to important diagnoses such as fungal sinusitis or sclerosing labyrinthitis. In a more chronic situation intraocular calcifications in small children are pathognomonic for retinoblastoma. Juxtatumoral sclerosis of the laryngeal cartilage in laryngopharyngeal carcinoma is usually caused by tumor infiltration of the cartilage resulting in a higher tumor stage and, this way, has a major impact on the therapeutical strategy. Calcified lymph nodes are mainly unspecific but can be the result of tuberculosis or metastases of thyroid cancer. Cross-sectional imaging methods, most of all computed tomography, are ideally suited to reveal head and neck calcifications and ossifications, especially those which are clinically relevant.     

Head and neck infection and inflammation

This article discusses the imaging manifestations of infectious and inflammatory conditions of the head and neck. Special attention is paid to the sites, routes of spread, and complications of neck infections. Because the clinical signs and symptoms and the complications of these conditions are often determined by the precise anatomic site involved, anatomic considerations are stressed. Familiarity with the fascial layers, spaces of the neck, and the contents of each space is helpful for this discussion. The fascial layers of the neck are important barriers to infection, and once infection is established, the fascial layers play a part in directing its spread.     

幽门螺杆菌分泌与重组表达的VacA蛋白的分离纯化及其致细胞空泡效应与凋亡的对比研究

目的：分离纯化幽门螺杆菌分泌和重组表达的细胞空泡毒素抗原（ VacA）蛋白,并评价其致细胞空泡效应及致细胞凋亡效应。方法分别从幽门螺杆菌ATCC26695菌株培养上清和重组表达VacA蛋白的pQE30-VacA-E．coliM15基因工程菌中分离纯化VacA蛋白,经酸化后,以不同终浓度（5,10 ng／ml）分别与人胃腺癌AGS细胞共孵24 h,观察致空泡效应,并通过流式细胞术检测细胞凋亡。结果成功分离纯化出幽门螺杆菌分泌和重组表达的VacA蛋白;幽门螺杆菌分泌的VacA蛋白能显著引起AGS细胞的空泡样改变及凋亡（P＜0．01）,而重组表达的VacA蛋白致细胞空泡样改变及凋亡不显著（ P＞0．05）。结论幽门螺杆菌分泌的VacA蛋白有良好的空泡毒性及致凋亡效应,而重组表达的VacA蛋白无致空泡及凋亡效应,幽门螺杆菌分泌的VacA蛋白可用于VacA作用机制的研究。     

化学和生物学融合对国际武器公约履约的影响

化学武器公约（ CWC）和生物武器公约（ BWC）是为禁止生产、发展、储存和使用化学武器和生物武器而制定的国际公约。近年来,科学技术快速发展,知识交叉渗透,学科之间出现整合和融合,促进了科技进步和经济发展。其中化学和生物学融合在有力促进制药、健康卫生、绿色化学和环境保护等产业进步的同时,也对化学和生物武器公约的履约产生了重要的影响。该文综述了与化学武器和生物武器公约相关的化学和生物学融合进展,并分析其对公约履约的影响。     

Oxygen uptake and ventilation during rowing and running in females and males

This study evaluated if the ventilatory response to exercise is impaired by the cramp position of rowing. Maximal oxygen uptake (VO2max), maximal expiratory volume (VEmax), and maximal heart rate (HRmax) during rowing and running were compared in 55 males (age, mean +/- SD, 21 +/- 3 years; height 176 +/- 5 cm; body mass 72 +/- 6 kg) and 18 females (age 20 +/- 2 years; height 164 +/- 5 cm; body mass 61 +/- 4 kg). VEmax was larger during rowing than during running (males, 157 +/- 16 vs. 147 +/- 13 L min(-1); 114 +/- 9 vs. 105 +/- 11 L min(-1), P<0.01). Also VO2max was larger during rowing than during running (males, 4.5 +/- 0.5 vs. 4.3 +/- 0.4 L min(-1); females, 3.3 +/- 0.4 vs. 3.2 +/- 0.4 L min(-1), P<0.01). However, HRmax was lower during rowing than during running (males, 194 +/- 8 vs. 198 +/- 11 beats min(-1); females, 192 +/- 6 vs. 196 +/- 8 beats min(-1), P<0.05). VEmax was correlated to body mass and fat-free mass, as was VO2max. Thus, the oxygen pulse (VO2max/HRmax) was larger during rowing than during running, while the ventilatory equivalent for oxygen (VEmax/VO2max) was similar. We showed that bending the body during rowing does not seem to impair ventilation either in males or in females. The results indicate that VEmax and VO2max relate to body size and fat-free mass for both females and males. The findings indicate that the involvement of more muscles, the entrainment, and the body position during rowing facilitates ventilation and venous return and lowers maximal heart rate.     

Coracoclavicular and coracoacromial ligament calcification and ossification

Thirty-six patients with calcification or ossification at or around the coracoclavicular and coracoacromial regions were analyzed with regard to type, location, and configuration of the deposits and related clinical history. Calcification or ossification in the coracoclavicular region resulted largely from trauma (36%) or renal failure (28%). Trauma patients may develop punctate calcification or ossification but do not develop the tumoral type of calcification. About 5% of the renal failure patients had coracoclavicular ligament calcifications, one-half of which were of the tumoral type. Renal failure patients may have punctate or tumoral calcifications but do not develop ossification.     

CLIP相关技术的研究进展

在真核生物基因表达的转录后调节中,RNA结合蛋白（ RBP）起着关键作用,很多RBP的异常与人类疾病的发生密切相关。自2000年的RNA免疫沉淀和芯片分析方法（ RNA immunoprecipitation with differential display or microarray analysis , RIP-ChIP）出现以来,人们开始就RBP与RNA相互作用进行了系统而广泛的研究。经过改良和发展,基于体内实时紫外交联免疫沉淀法（ ultraviolet crosslinking and immunoprecipitation , CLIP ）、交联免疫沉淀cDNA文库高通量测序法（ high-throughput sequencing of CLIP cDNA library , HITS-CLIP）、光催化核糖核苷增强交联和免疫沉淀法（ photoactivatable-ribonucleoside-enhanced crosslinking and immunprecipitation , PAR-CLIP）以及提高个别核苷酸分辨率交联和免疫共沉淀法（ individual nucleotide resolution CLIP , iCLIP）等RIP-ChIP衍生方法相继产生,使用这些方法,可以解析RBP的RNA识别特异性,而且通过与高通量测序技术结合,可以实现转录组尺度的RBP的靶序列的鉴定,分辨率也得到极大提高。该文就RNA与蛋白的相互作用的基本原理及其研究进展、相关技术存在的问题以及发展趋势进行简要综述。     

Cross-sectional and longitudinal comparisons of self-reported and device-assessed physical activity and sedentary behaviour

ObjectivesTo examine the longitudinal associations and differences between self-reported and device-assessed physical activity (PA) and sedentary behaviour (SB), using a multifaceted statistical approach.DesignLongitudinal measurement burst.MethodsIn total, 52 university students (78% female) aged 18–38 years (mean = 21.94 ± 4.57 years) participated. The study consisted of three blocks of six days of measurement, during which participants wore an accelerometer on their wrist for the entire block, and self-reported their PA over the 6 days at the end of each block.ResultsMeaningful latent differences between methods were observed for moderate PA and SB across all three assessment periods, such that participants underreported the time spent in each activity. Bland–Altman plots revealed a positive mean difference for vigorous PA, with over-reporting increasing as mean levels increased. Negative mean differences were observed for all other intensities. Underreporting of moderate PA increased as the mean level increased, whereas for light PA and SB, underreporting decreased at high levels. Repeated measures correlations revealed a meaningful association for vigorous PA only, suggesting that as self-reported minutes increase so too do device-measured minutes.ConclusionsWe found evidence of cross-sectional and longitudinal differences and weak associations between self-reported and device-assessed PA and SB. Future work is needed to enhance the quality of self-reported methods to assess PA and SB (e.g., face and content validity), and consider improvements to the processing of device-based data.     

Old and dangerous: Prison and dementia

Older prisoners are the fastest growing group of prisoners in many countries. The purpose of this study is to explore the phenomenon of detention of persons suffering from dementia. Medline searches were conducted for relevant articles, chapters and books published until August 2016. Search terms included dementia, elderly, prison and criminal. Publications found through this indexed search were reviewed for further relevant references. As results, there is a lack of data about elderly with dementia in prisons. Given the rise in the average age, it is reasonable to hypothesize that the number of older prisoners is growing. Moreover, some elderly are imprisoned with a concomitant cognitive impairment or psychiatric disorder while others will develop such diseases once incarcerated. At the present time, legal and social systems seem unprepared to handle the phenomenon of dementia in prison. As proposal, health assessments for older first time offenders should become a practice inside the correctional facilities and include an evaluation for specific health issues, such as psychiatric comorbidity and cognitive impairment.