Novel and Effective Almagate Enema for Hemorrhagic Chronic Radiation Proctitis and Risk Factors for Fistula Development

Radiation proctitis is a common complication after radiotherapy for pelvic malignant tumors. This study was conducted to assess the efficacy of novel almagate enemas in hemorrhagic chronic radiation proctitis (CRP) and evaluate risk factors related to rectal deep ulcer or fistula secondary to CRP. All patients underwent a colonoscopy to confirm the diagnosis of CRP and symptoms were graded. Typical endoscopic and pathological images, risk factors, and quality of life were also recorded. A total of 59 patients were enrolled. Gynecological cancers composed 93.1% of the primary malignancies. Complete or obvious reduction of bleeding was observed in 90% (53/59) patients after almagate enema. The mean score of bleeding improved from 2.17 to 0.83 (P<0.001) after the enemas. The mean response time was 12 days. No adverse effects were found. Moreover, long-term successful rate in controlling bleeding was 69% and the quality of life was dramatically improved (P=0.001). The efficacy was equivalent to rectal sucralfate, but the almagate with its antacid properties acted more rapidly than sucralfate. Furthermore, we firstly found that moderate to severe anemia was the risk factor of CRP patients who developed rectal deep ulcer or fistulas (P= 0.015). We also found abnormal hyaline-like thick wall vessels, which revealed endarteritis obliterans and the fibrosis underlying this disease. These findings indicate that almagate enema is a novel effective, rapid and well-tolerated method for hemorrhagic CRP. Moderate to severe anemia is a risk factor for deep ulceration or fistula.     

宫颈癌放射性直肠炎的诊治进展

放射性直肠炎是宫颈癌患者放射治疗后常见的并发症,严重影响患者的生活质量,目前尚缺少公认有效的治疗措施。近年来对放射性直肠炎的治疗做了大量研究,药物治疗如中药保留灌肠、甲醛、硫糖铝、三乙醇胺等,其他治疗方法有高压氧治疗、内镜下氩离子凝固术以及外科手术治疗等,这些方法各具优缺点。     

Possible Risk Factors Associated with Radiation Proctitis or Radiation Cystitis in Patients with Cervical Carcinoma after Radiotherapy

Radiation proctitis and radiation cystitis are major complications for patients with cervical carcinomafollowing radiotherapy. In the present study, we aimed to determine the potential risk factors for the developmentof radiation proctitis and radiation cystitis after irradiation. A total of 1,518 patients with cervical carcinomareceived external beam radiotherapy (EBRT) followed by high-dose-rate intracavitary brachytherapy (HDRICB)in our hospital. The incidences of radiation proctitis and radiation cystitis were recorded and associations withdifferent factors (age, time period, tumor stage) were analyzed with c2 (chi-squared) and Fisher exact tests. Wefound that 161 and 94 patients with cervical carcinoma were diagnosed with radiation proctitis and radiationcystitis, respectively, following radiotherapy. The prevalence of Grade I-II radiation proctitis or radiation cystitiswas significantly lower than that of Grade III (radiation proctitis: 3.82% vs. 6.76%, P < 0.05; radiation cystitis:2.31% vs. 3.87%, P < 0.05) and was significantly enhanced in patients with late stage (IIIb) tumor progressioncompared to those in early stage (Ib, IIa) (P < 0.05). Moreover, the incidence of radiation proctitis and cystitiswas not correlated with age or, time period following radiation, for each patient (P > 0.05). These observationsindicate that a late stage of tumor progression is a potential risk factor for the incidence of radiation proctitisand cystitis in cervical carcinoma patients receiving radiotherapy.     

放射性食管炎发病相关因素的研究进展

摘 要：放射治疗是胸部肿瘤的主要治疗手段之一,放射性食管炎是胸部肿瘤患者放疗时常见的不良反应,其发生及严重程度影响患者放射治疗的依从性及疗效。目前研究发现,放射性食管炎的发生与患者临床特征、放疗物理剂量学参数、基因分子标志物等有关。根据放射性食管炎发生相关因素,识别发生放射性食管炎的高危患者,对于制定合理的治疗策略、减少放射性食管炎的发生风险、提高治疗疗效至关重要。文章就放射性食管炎发病相关因素的研究进展作一综述。     

A Randomized Controlled Trial of Novel Treatment for Hemorrhagic Radiation Proctitis

Background: Various methods have been used for treatment of hemorrhagic radiation proctitis (HRP) with variable results. Currently, the preferred treatment is formalin application or endoscopic therapy with argon plasma coagulation. Recently, a novel therapy with colonic water irrigation and oral antibiotics showed promising results and more effective compared to 4% formalin application for HRP. The study objective is to compare the effect of water irrigation and oral antibiotics versus 4% formalin application in improving per rectal bleeding due to HRP and related symptoms such as diarrhoea, tenesmus, stool frequency, stool urgency and endoscopic findings. Methods: We conducted a study on 34 patients with HRP and randomly assigned the patients to two treatment arm groups (n=17). The formalin group underwent 4% formalin dab and another session 4 weeks later. The irrigation group self-administered daily rectal irrigation at home for 8 weeks and consumed oral metronidazole and ciprofloxacin during the first one week. We measured the patients’ symptoms and endoscopic findings before and after total of 8 weeks of treatment in both groups. Results: Our study showed that HRP patients had reduced per rectal bleeding (p = 0.003) in formalin group, whereas irrigation group showed reduced diarrhoea (p=0.018) and tenesmus (p=0.024) symptoms. The comparison between the two treatment arms showed that irrigation technique was better than formalin technique for tenesmus (p=0.043) symptom only. Conclusion: This novel treatment showed benefit in treating HRP. It could be a new treatment option which is safe and conveniently self-administered at home or used as a combination with other therapies to improve the treatment outcome for HRP.     

放射性脑损伤实验兔模型的建立

 目的 建立能用于科学研究的放射性脑损伤动物模型。方法 选用40只新西兰兔作为动物实验模型，随机分为4组：10Gy、15Gy、20Gy和30Gy组。分别在CT定位下建立三维重建图像资料，应用三维适形放射治疗系统（3D-TPS）精确设计治疗计划、优化照射靶区剂量分布，照射体积约1cm×1cm×1cm，6MVX线单次大剂量照射。结果 3D-TPS的剂量分布曲线显示，受照区域剂量分布均匀，95％的等剂量曲线包绕100％靶区体积，受照体积为（1±0．03）cm3。结论 动物模型受照区域产生剂量均匀、准确，可用于研究放射性脑损伤。     

可移植性小鼠肺腺癌（LA795）细胞增殖动力学研究

本文对可移植性小鼠肺腺癌(LA-795)细胞增殖动力学的研究采用~3H-TdR单次脉冲标记的方法进行。腹腔注射~3H-TdR后不同时间解剖小鼠取新鲜瘤组织,制成病理切片,做放射自显影试验,置4℃条件下暴光16天,然后显影定影,H、E染色。结果进行银颗粒计数,并以数学方程进行计算求出有关细胞动力学参数:Li32.3％Mi1.7％LMi10％,Tg_1 2.83小时 Te_2 4.8小时Tm0.37小时 Tc15小时 Ts7小时 GF69.2％。     

中药保留灌肠治疗放射性直肠炎的近期疗效观察

目的 探讨中药保留灌肠治疗放射性直肠炎的近期疗效.方法 75例放射性直肠炎患者随机分为两组.治疗组37例:选用三七参10 g、黄芪10 g、黄连30 g、仙鹤草30 g炮制,加水制剂100 mL,保留灌肠,5～7 d.对照组:庆大霉素16万单位,思密达6 g,地塞米松10 mg加生理盐水至30～50 mL,保留灌肠,5...     

Murine Liver Metastasis Model Using L5178Y-ML Lymphoma and the Effect of Antitumor Agents on the Metastasis

A reproducible tumor model for liver metastasis has been developed from murine L5178Y lymphoma line by sequential cycles of subcutaneous inoculation of liver tumor cells, that were originally generated in livers of female (BALB/c × DBA/2)F₁ mice by injecting the parental cells into the tail vein. This variant (L5178Y-ML) metastasized predominantly to the liver after intravenous or subcutaneous injection. The livers of the animals killed 9 days after intravenous implantation of 5 × 10⁵ tumor cells were about 3 times the weight of control livers. All tumor-bearing mice died 10 to 12 days after inoculation. Subcutaneous implantation of L5178Y-ML in the side flank of mice induced metastatic nodules spontaneously in the livers. The tumor cells proliferated more in livers than in the implanted sites, compared with the parental L5178Y cells. The effects of 5-fluorouracil, mitomycin C, cis -platinum and doxorubicin on the liver metastasis of L5178Y-ML were examined at subtoxic doses; 5-fluorouracil was the most effective in both inhibiting the tumor growth in livers and prolonging the survival period of mice. This model provides a useful tool for the experimental therapy of hepatic tumors in mice.     

~（131）I─抗胃癌单克隆抗体在胃癌病人体内的药代动力学研究

用碘标记抗胃癌单克隆抗体（（１３１）Ｉ－３Ｈ（１１））对１４例胃癌患者进行放射免疫导向手术中的药代动力学研究。静脉给药组（ＩＶ）（ｎ＝７）和胃镜粘膜下给药组（Ｅｎｄｏ）（ｎ＝７）其动力学模型经微机拟合均为两室模型。Ｔ１／２β分别为２２．６５±１．３８（ＩＶ）和２１．０２±２．１８（Ｅｎｄｏ），统计学差异不显著。两种给药方式消除规律相似，ＩＶ组并不比Ｅｎｄｏ组清除快。     

分段式放疗对放射性直肠炎预防作用的实验研究

目的：探讨分段式放疗对放射性直肠炎的预防作用。方法：45只SD大鼠随机分为空白对照组及腹盆腔放疗组。放疗组放疗方案为DT 44Gy／（22f·30d）,5f／w,间隔6周,再DT 46Gy／（23f·31d）,5f／w放疗。分别在d0、d30、d72、d86、d103、d143、d145、d159、d193及 d283于显微镜下观察直肠黏膜的变化。结果：在放疗前、中、后显微镜下可以观察到直肠黏膜炎性改变,修复,再次损伤,修复,未见Ⅲ－Ⅳ级放射肠炎发生。结论：给予根治剂量、分段式放疗可预防严重放射性直肠炎的发生,有潜在的临床应用价值。     

胞质分裂阻滞微核法研究ATM基因辐射防护功能

[目的]研究ATM基因对毛细血管扩张性共济失调症(AT)患者皮肤成纤维细胞系AT5BIVA(AT细胞)高辐射敏感性的纠正情况,以评价ATM基因的辐射防护功能。[方法]利用电穿孔技术,将含有ATM基因cDNA的真核表达载体PEBS7-YZ5转染到AT细胞,用潮霉素筛选以获得稳定表达细胞株,RT-PCR检测ATM cDNA的转录,Western blot验证ATM蛋白的表达;用胞质分裂阻滞微核法(CBMN),在PEBS7-YZ5-AT细胞、PEBS7-AT细胞和未转染AT细胞经60COγ射线0、1、2、3、4Gy照射后,观察比较三者间微核率及微核细胞率的差异。[结果]PEBS7-YZ5成功转进AT细胞,RT-PCR检测到ATM cDNA片段,Westernblot检测到ATM蛋白的表达。在0、1、2、3、4Gy剂量下,PEBS7-YZ5-AT细胞微核率及微核细胞率明显低于PEBS7-AT细胞和AT细胞,其差异具有显著统计学意义(P<0.01);而PEBS7-AT细胞和AT细胞间无明显差异(P>0.05)。[结论]AT细胞高辐射敏感性被ATM基因纠正,ATM基因具有辐射防护功能,含有ATM基因的真核表达载体PEBS7-YZ5有望成为辐射防护剂。     

中药青黛治疗慢性出血性放射性直肠炎

Objective:To evaluate the efficacy and safety of Qing Dai (indigo naturalis).a traditional Chinese medicine,in the treatmenl for chronic hemorrhagic radiation proctitis.Methods:Ten patients with chronic hemorrhagic radiation proctitis between January 2005 to January 2008 were Veated with Qing Dai.Qing Dai was administered orally at a dose of 1.5 g,bid for 5 consecutive days,every 2 weeks for two courses.Patients were followed up every 3 months.The clinical response and side-effects were evaluated.Results:Six patients showed improvement of rectal bleeding to grade 0-1 arer 1 course of Qing Dai therapy.Four patients had reduced rectal bleeding to grade 0-1 after 2 courses of the therapy.The median follow-up time was 10 months frange:6-24).During the follow-up period,1 patient experienced recurrent rectal bleeding and was managed with topical formalin dabbing.which controlled the symptom.No treatment toxidty was observed.Conclusion:Qing Dai may be a safe and effective treatment for chtonic hemorrhagic radiation proctitis.     

鼻咽癌调强放疗受照剂量分布特性研究

目的研究鼻咽癌调强放疗(IMRT)受照剂量分布特性。方法用拓能公司WiMRT放疗计划系统分别进行鼻咽癌常规放疗和调强放疗计划设计,对比分析不同放疗方式下正常组织受照剂量-体积直方图和所需照射的总跳数。结果调强放疗射野内正常组织受照剂量低于28Gy的体积是常规放疗的1.43~1.81倍,而高于35Gy时,受照体积仅为常规放疗的0.73~0.30倍。结论鼻咽癌调强放疗时靶区受照剂量高、正照组织受照剂量低,但正常组织受照体积大。鼻咽癌调强放疗剂量分布明显优于常规放疗。     

Treatment of Cervical Carcinoma with High-Dose Rate Intracavitary Brachytherapy: Two Years Follow-Up Study

Aims: This study focused on pelvic recurrence rate and late complications following treatment with high doserate brachytherapy with a three fractionation scheme. Setting and design: This retrospective observational studywas conducted from 1st November 2003 to 31st March 2005 at a tertiary care centre. Methods and materials:Women were treated with external beam radiotherapy and three fractions of high dose rate brachytherapy,divided into two broad groups IIB+ IIIA and IIIB+IVA. Duration of follow-up was 2 years and main outcomemeasures were recurrence and rectal and urinary bladder complications. Results were assessed with the Chisquare test and P-values using an alpha level of 0.05 for Type I error. Results: Of the total of 286 women, 72(25.4%) developed central-regional recurrence. Overall two year pelvic control rate was 74.6%, with values of78.1% and 72.8% for stages IIB+ IIIA, IIIB+IVA, respectively. Five women developed distant metastasis and21.5% suffered low grade rectal complications. After two years the prevalence of bladder complications wasonly 5.4%. Conclusion: Using a three fraction scheme, high dose rate brachytherapy is safe and effective in themanagement of cervix cancer.     

Effects of Radiation on a Model of Malignant Glioma Invasion

We sought to characterize the effects of radiation alone and in combination with BCNU and dexamethasone on malignant glioma invasion. A model of malignant glioma invasion into a gel matrix of collagen type I was used to characterize response to radiation treatment for four malignant glioma cell lines (C6, U251, U373, A172) and nine primary human glioblastoma explants. A radiation dose dependent inhibition of invasion was noted for the C6 astrocytoma cell line but not the other cell lines or explants. Addition of BCNU and dexamethasone to radiation produced additional inhibition of invasion among the cell lines and explants but could not suppress invasion entirely.     

c-Myc Interferes with the Commitment to Differentiation of Murine Erythroleukemia Cells at a Reversible Point

When murine erythroleukemia (MEL) cells, containing the transferred rat c-myc gene under the control of human metallothionein II gene promoter, are induced to differentiate with dimethyl sulfoxide, the level of differentiation is dependent on the c-Myc level, which is modulated by the addition of Zn ions. In this work, we examined the point of inhibition of differentiation by elevated levels of c-Myc in one (clone 38-2) of the typical transformants. Commitment assay indicated that elevated levels of c-Myc interfere with entry of the transformant into the commitment event, but when c-myc expression was reduced by removing Zn ions from the medium, the cells could reenter the commitment program. However, once the cells were committed, such cells could not return to the uncommitted state. In addition, time-dependent expression of two erythroid specific genes was inhibited by elevated levels of c-Myc in time-dependent manner. These results suggest that c-Myc modulates MEL cell differentiation at a reversible point of commitment.