激光光动力学疗法治疗复发性鼻咽癌的研究——附191例分析

为提高复发性鼻咽癌的疗效，采用激光光动力学治疗（ＰＤＴ）１９１例复发性鼻咽癌和放射未控病例。方法是静脉滴注血卟啉衍生物（ＨｐＤ）５ｍｇ／ｋｇ后，于２４、４８和７２小时给予氩离子激光照射，输出为４８８．０～５１４．５ｎｍ多谱线，功率８００ｍＷ，通过石英导光纤维传导进入鼻咽腔。近期疗效是：完全效应率为５５．０％（１０５／１９１），明显效应率为３４．６％（６６／１９１），显著效应率为８９．５％（１７１／１９１）。随访１３０例，三年生存率４４．６％，五年生存率２５．４％。认为ＰＤＴ是鼻咽癌放射治疗的一种较好的综合治疗方法     

采用X射线间接激励光敏剂的光动力学疗法新设想

为了克服光动力学治疗（ＰＤＴ）的某些缺点，提出一种利用Ｘ射线间接激励光敏剂的新设想。其成败的关键，在于能否寻找到某种药物，它可能含有三价稀土离子，在Ｘ射线激发下，能产生可见的、峰值波长最好在光敏剂吸收峰附近的荧光，并且无毒性。本方法的核心，是以对Ｘ射线敏感的荧光药物在Ｘ射线作用下所发出的荧光，取代目前ＰＤＴ技术中的各种激发光，作为激发光敏剂（如ＨｐＤ）的光源。由于Ｘ射线在人体组织中的穿透性极好，本方法的优点是对人体任何部位和体积的、凡有光敏反应的肿瘤组织均可施行ＰＤＴ疗法，完全不存在现有ＰＤＴ技术中，诸如激光照射穿透深度十分有限、遗漏病灶以及组织间穿刺照射的种种问题。应特别指出，本方法可望同时治疗原发癌和已向深部浸润或远处转移的肿瘤。     

单脉冲半导体激光照射对犬声带形态学的影响

目的比较不同功率的单脉冲半导体激光照射后犬声带组织病理学的变化，为临床声带激光手术选择安全的操作参数。方法杂种犬8只，分别用6、8、10和12w的1s单脉冲半导体激光接触式照射犬声带前、中1／3交界处，每侧声带照射1次，光斑直径为400μm，术后每日对声带进行纤维喉镜检查并摄像，并于术后第1、7和30天取声带标本进行光镜、电镜观察和比较。结果术后急性期以炎症反应为主，表现为照射局部组织坏死、周围上皮及上皮下组织水肿、炎性细胞浸润等，并于72h达到高峰。术后第7天开始组织修复，并于第30天修复基本完成，重新覆盖鳞状上皮。不同功率的脉冲半导体激光照射部位的光镜和电镜下表现相似，但损伤程度随功率的加大而逐渐加重，主要影响上皮层或上皮下层，未伤及声韧带和肌层。结论8-12w的1s单脉冲半导体激光对于声带手术具有高度安全性。     

小鼠胶质瘤微血管光动力学损伤修复的超微结构研究

小鼠静脉注射血卟啉衍生物１０ｍｇ／ｋｇ后２４小时，红光１００Ｊ／ｃｍ２照射皮下接种的胶质瘤，全身灌注含硝酸镧的固定液。肿瘤超薄切片用电镜观察，对照组肿瘤中微血管内皮细胞的毛细血管内层（ｅｎｄｏｃａｐｉ－ｌａｒｙｌａｙｅｒ．ＦＬ）镧染阳性，厚而连续：ＰＤＴ后０～１２小时微血管内皮细胞损伤逐渐加重，ＥＬ消失．而２４小时后部分血管ＦＬ恢复，又呈镧染，至４８小时后约半数血管无明显损伤改变，镧染厚而连续，表明受损较轻的内皮细胞逐渐修复，这可能是ＰＤＴ后肿瘤夏发的重要原因之一。     

氩离子激光＋HpD照射血管瘤动物模型的组织学变化

本文用氩离子激光照射鸡垂（ｗａｔｔｌｅ）．分为注射ＨｐＤ和对照组，在１、３、７、１４、２８天取材，观察了肉眼和组织学变化，并对ＨｐＤ组的血清荧光进行了监测。组织学结果表明：ＨｐＤ组病变反应完全，坏死层、渗出层均较对照组显著，对血管的破坏更完全。血清中的荧光随时间衰减，至２４小时基本排泄完。鸡垂组织匀浆上清液中的荧光在２４小时内衰减较快，后趋于平缓。正常组的血清荧光和鸡垂组织匀浆上清液荧光在同样测试条件下均无荧光峰值出现，表现为一低水平的直线。     

消化道癌术后局部复发的光动力学治疗

对探讨光动力学疗法对消化道癌术后局部复发癌的效果，对此类患者１０３例应用光动力学疗法。患者于照光前４８－７２小时静脉滴注ＨｐＤ，每公斤体重５ｍｇ。激光光源采用氩离子泵浦染料激光器，波长６３０ｎｍ，输出功率密度２００－４００ｍＷ／ｃｍ＾２，照射时间约１０－１５分钟。     

光动力疗法合并化学疗法治疗恶性肿瘤的实验研究

我们对人癌ＨｅＬａ细胞株的裸鼠接种瘤进行了光动力疗法（ＰＤＴ）联合应用肿瘤ＤＮＡ合成酶抑制剂，目的在于探讨增强ＰＤＴ作用的有效途径。观察到在本实验条件下，仅做激光照射或单纯采用抗癌剂，对这种移植癌均无抗肿瘤作用；ＰＤＴ组的肿瘤生长阻止率为３５．１％～４７．９％，而ＰＤＴ并用化疗组的肿瘤生长阻止率达８０％～９５％。研究表明，ＰＤＴ合并应用化学疗法比单独实施ＰＤＴ对抑制肿瘤生长、破坏肿瘤组织的效应显著     

Nd：YAG激光照射后嗅粘膜的损伤及再生的实验研究

为观察ＮｄＹＡＧ激光照射后嗅粘膜的损伤及再生情况，以输出功率为２．０Ｗ的ＮｄＹＡＧ激光连续照射日本大耳白兔鼻中隔嗅粘膜５秒，照射距离５ｍｍ。照射后即刻，１、２、３和４周，切取被照射的嗅粘膜，观察激光照射组和激光防护照射组的病理变化。结果发现：激光照射组嗅粘膜上皮层即刻坏死脱落，固有层间质明显水肿，兼有出血，大量嗜酸性和中性粒细胞浸润，Ｂｏｗｍａｎ氏腺结构紊乱，第四周嗅上皮仍未恢复，固有层中瘢痕形成，Ｂｏｗｍａｎ氏腺萎缩，且数量减少，兼有分泌物贮留，而形成小囊肿。激光防护照射组嗅上皮结构清楚，但支持细胞，嗅神经原及基底细胞可见核浓缩，空泡形成，并于第二周坏死脱落，所剩基底细胞开始转化为球基细胞，到第四周嗅上皮基本恢复。表明盐水棉片对激光损伤有一定防护作用。实验证明，可逆性激光损伤的嗅上皮具有再生能力，并支持“再生嗅神经原可能来源于基底细胞”这一结论。     

He-Ne激光穴位照射对带状疱疹患者T细胞亚群的影响

目的研究ＨｅＮｅ激光穴位照射对带状疱疹患者Ｔ细胞亚群的影响。方法将６０例发疹１～４天的带状疱疹患者分为两组。一组为激光照射组,在给予带状疱疹常规药物治疗的同时,以２５ｍＷＨｅＮｅ激光光针照射双侧拇指“大骨孔”穴,每穴照射５ｍｉｎ,每天照射１次,最长不超过７天;另一组为对照组,仅给予相同药物治疗。两组患者性别、年龄、发疹时间和病情基本相同,均分别在发疹早期和发疹后第１５或１６天检测外周血Ｔ细胞亚群。结果发疹早期两组病例的ＣＤ＋４、ＣＤ＋４／ＣＤ＋８比值均低于正常（Ｐ＜００１）,ＣＤ＋８则高于正常（Ｐ＜００１）,而在发疹后１５或１６天激光照射组Ｔ细胞亚群基本恢复正常,但对照组Ｔ细胞亚群仍显著异常。结论ＨｅＮｅ激光穴位照射对纠正带状疱疹患者Ｔ细胞亚群异常和缩短病程有显著疗效     

630nm半导体激光PDT促HNE1裸鼠移植瘤细胞凋亡及其对Bak和Bax基因mRNA表达影响

目的 :探讨光动力学治疗对促细胞凋亡相关基因表达的影响。方法 :本研究以鼻咽癌ＨＮＥ1裸鼠移植瘤为研究对象 ,待ＨＮＥ1移植瘤直径 7～ 9ｍｍ大小时 ,将裸鼠随机分为单纯对照 (生理盐水代替光敏剂 ,不接受激光照射 )、单纯激光照射、单纯光敏剂等三个对照组和一个实验组 (腹腔注射光敏剂后 2 4ｈ接受激光照射 )。荷瘤裸鼠实验组 5只 ,3个对照组各 3只。以 6 30ｎｍ半导体激光结合光敏剂进行光动力学治疗 ,ＰＤＴ前和ＰＤＴ后 6、12、2 4、48和 72ｈ分别取活检组织 ,应用ＤＮＡ末端标记方法 (ＩＳＥＬ)和ＲＴ ＰＣＲ法 ,进一步观察ＰＤＴ后…     

Evaluation of collagen alteration after topical photodynamic therapy (PDT) using second harmonic generation (SHG) microscopy--in vivo study in a mouse model

Topical photodynamic therapy (PDT) mediated by 5-aminolevulinic acid (ALA) has been used for the treatment of age-related skin lesions for therapeutic or cosmetic purposes. The modulation of collagen component and structure might play a significant role in influencing treatment outcomes of PDT. In this study, the effect of multi-session low dose ALA PDT on skin rejuvenation was examined in a hairless mouse model. Changes in collagen and skin texture were investigated by histological examination and in vivo second harmonic generation (SHG) microscopy. Results indicated that multi-session PDT could improve the collagen density and arrangement of skin tissue. SHG microscopy combined with quantitative collagen analysis could provide a useful tool for the evaluation of collagen alteration induced by ALA PDT.     

Radiofrequency ablation of the liver abutting stomach: in vivo comparison of gastric injury before and after intragastric saline administration in a porcine model

Purpose

To compare the in vivo gastric injury observed during radiofrequency (RF) ablation of the liver abutting the stomach before and after the intragastric administration of chilled saline.

Materials and methods

Twenty RF ablation zones were created in the livers of 10 pigs with a 1-cm-exposed active tip of an internally cooled electrode under ultrasound guidance for 10 min. Ten RF ablation zones were created before (non-saline group) and after (saline group) the intragastric administration of approximately 1000 mL of chilled saline, and 20 RF ablation zones were made in the posterior part of the left lobe abutting the stomach. The frequency and severity of the thermal injury observed in the stomach of the two groups were compared histologically.

Results

All the resected gastric specimens showed thermal injuries of varying degrees of severity. The largest diameter of the gastric injury was significantly smaller in the saline group (mean 1.5 cm; range 1.3-1.8 cm) than in the non-saline group (mean 2.1 cm; range 1.8-2.4 cm) (p = 0.000). The saline group showed significantly less thermal injury to the muscular layer of the gastric wall by the histopathology (p = 0.033).

Conclusions

The intragastric administration of chilled saline might be a useful technique for reducing the severity of gastric injury during RF ablation of the liver abutting the stomach.     

Chlorin e6-mediated photodynamic therapy promotes collagen production and suppresses MMPs expression via modulating AP-1 signaling in P. acnes-stimulated HaCaT cells

BackgroundPhotodynamic therapy (PDT) is a clinically approved therapeutic for cancers and non-neoplastic diseases, based on the use of a photosensitizer activated by light. The feasibility of PDT depends on several factors, such as PDT dose, photosensitizer efficacy, type of light source, and target tissue irradiated.MethodsIn this study, the second generation photosensitizer chlorin e6 (Ce6) and halogen light were used to investigate their PDT effect on the collagen production and MMPs expression of heat killed P. acnes-stimulated HaCaT cells. The mRNA levels of COL1A1, c-Jun, and c-Fos were detected by RT-PCR. The protein levels of MMPs, ERK and JNK were detected by western blot. The transactivation of AP-1 was detected by luciferase assay.ResultsCe6-based PDT markedly upregulated the mRNA level of COL1A1 and type I procollagen level; and at the same time downregulated the expression of MMPs in P. acnes-infected HaCaT cells. Moreover, Ce6-mediated PDT, in a dose dependent manner, inhibited P. acnes-induced phosphorylation of JNK and ERK, as wells as the phosphorylation of their downstream targets c-Jun and c-Fos. P. acnes-induced mRNA expression of c-Jun and c-Fos were also suppressed by Ce6-mediated PDT. The transactivation of AP-1 induced by P. acnes infection was also downregulated.ConclusionThese results indicated that Ce6-mediated PDT with halogen light enhanced collagen production, but inhibited the expression of MMPs in P. acnes-infected HaCaT cells, by regulating AP-1 signals. This investigation provided the first molecular basis for the increase in collagen production by Ce6-mediated PDT, suggesting its potential use for scar amelioration and skin rejuvenation in acne treatment.     

Two autopsy cases with injuries to the stomach following cardiopulmonary resuscitation

We herein report two autopsy cases with gastric injury associated with cardiopulmonary resuscitation (CPR). Case 1 was a 36–year–old woman who was found in cardiopulmonary arrest possibly caused by a fall from a height of 8 m. She received continuous manual chest compression with artificial ventilation while being transferred to the hospital. Autopsy revealed bruises on her left upper arm with a fracture to the left humerus and advanced pneumohemothorax that was associated with laceration of the left lung due to fracture of the dorsal left costa. Furthermore, complete rupture of the gastric wall (25 cm) was found without hemorrhage. Case 2 was an 85–year–old man found unconscious on the road. He had a history of oral anticoagulant administration, cognitive impairment, and gait disorder. He also received cardiac massage and manual artificial ventilation during CPR. Autopsy revealed severe head injury, possibly caused by a backward fall. His stomach was markedly dilated by air and a fresh intramural hematoma had extended into all layers of the stomach and adjacent omentum; however, injury of the abdominal wall was not evident. Histopathological investigation of the brain revealed advanced Alzheimer’s disease and Lewy pathology, and the damaged neural tissue, which was positive for the amyloid precursor protein. We determined that the gastric injuries in both cases had been caused by CPR. We conclude that careful investigation is required for gastric injury cases to determine the etiology and correlation between gastric injury and cause of death when the victims receive CPR.     

光动力疗法治疗上消化道肿瘤的护理配合与疗效观察

目的 探讨光动力疗法治疗上消化道肿瘤的护理与疗效.方法 食管癌、胃癌和十二指肠癌患者21例行静脉注射癌光啉5mg/kg,4～48 h通过内镜孔插入光纤,以波长630nm的半导体激光照射病灶,功率密度100～150 mW/cm2、能量密度180～270 J/cm2、时间30 min的半导体激光照射病灶.同时密切注意患者心理治疗及个体化的术前、术中、术后护理.结果 术后1个月复查,完全显效4例(19.0%),明显显效5例(23.8%),部分显效12例(57.1%)无并发症发生.结论 术中的护理配合及术后的病情观察是治疗的重要组成部分.     

Quantification of distal antral contractile motility in healthy human stomach with magnetic resonance imaging

PURPOSE: To quantify healthy postprandial: 1) propagation, periodicity, geometry, and percentage occlusion by distal antral contraction waves (ACWs); and 2) changes in ACW activity in relationship to gastric emptying (GE). MATERIALS AND METHODS: Using 1.5-T MR scanner, nine healthy fasted volunteers were examined in the right decubitus position after ingestion of 500 mL of 10% glucose (200 kcal) with 500 microM Gd-DOTA. Total gastric (TGV) and meal volumes (MV) were assessed every five minutes for 90 minutes, in and interspersed with dynamic scan sequences (duration: 2.78 minutes) providing detailed images of distal ACWs. RESULTS: TGV increased by 738+/-38 mL after ingestion (t0), subsequently decreasing in parallel to GE. The mean GE rate and half-emptying time were 24+/-3 mL/5 minutes and 71+/-6 minutes, respectively. Accompanying ACWs reached a periodicity of 23+/-2 seconds at t35 and propagated at an unvarying speed of 0.27+/-0.01 cm/second. Their amplitude of 0.70+/-0.08 cm was constant, but the width decreased along the antral wall by 6+/-2%/cm (P=0.003). ACWs were nonocclusive (percentage occlusion 58.1+/-5.9%, t0 at the pylorus) with a reduction in occlusion away from the pylorus (P<0.001). No propagation and geometry characteristics of ACWs correlated with the changes of MV (mL/5 minutes; R2<0.05). CONCLUSION: Our results indicate that ACWs are not imperative for emptying of liquids. This study provides a detailed quantitative reference for MRI inquiries into pharmacologically- and pathologically-altered gastric motility.     

PDT for Gastric Cancer — the view from China

The incidence rate and mortality of gastric cancer remain elevated. Traditionally, surgical treatment (including endoscopic surgery and traditional surgery), chemotherapy, targeted therapy, and immunotherapy were used for the treatment of gastric cancer. Although the emergence of targeted therapy and immunotherapy can effectively prolong the survival of some patients with gastric cancer and improve the quality of life of patients after chemotherapy or surgery, the overall survival rate of gastric cancer has not been significantly improved. Photodynamic therapy is a local photochemical therapy with the advantages of high safety, few adverse reactions, and repeatability, although it may cause some toxic reactions. There are some differences between East and West in the treatment of gastric cancer with PDT, and most earlier studies concentrated on using PDT alone. However, some studies have indicated that PDT may enhance the efficacy of chemotherapy and other medications. This paper summarizes the study on the use of PDT and its combination therapy in gastric cancer, which is anticipated to offer novel thoughts for the treatment of gastric cancer.     

光动力疗法治疗残胃复发癌的远期疗效

目的评价光动力疗法治疗残胃复发癌的远期疗效。方法胃癌术后残胃复发癌患者1例,于2000～2005年间先后进行4次光动力治疗。静脉推注光敏剂5mg/kg(前3次为HpD,第4次为PSD-007)后36～48h,在胃镜下应用金蒸气激光(波长627.8nm)以点状光纤进行照射,激光功率密度为100～200mW/cm2,照光时间20～30min,能量密度为120～360J/cm2。术后定期复查胃镜和长期随访,进行近期及远期疗效评价。结果术后4～5周胃镜及病理学检查局部癌灶消失,随访5～10年胃镜及病理检查均未发现局部肿瘤复发。术中及术后未见不良反应发生。结论光动力疗法对残胃复发癌是一种安全、有效、可以重复进行的微创治疗,不破坏组织器官的功能和完整性,能明显改善患者的生活质量,远期疗效较好。     

光动力疗法对大鼠类风湿性关节炎治疗作用的观察

目的　观察以血啉甲醚 (HMME)为光敏剂的光动力效应对类风湿性关节炎动物模型的治疗作用。方法　LEW大鼠 30只 ,随机分为正常对照组 5只、关节炎组 10只、治疗组 15只。关节炎组和治疗组用Ⅱ型胶原蛋白诱发关节炎 (CIA)。治疗组在大鼠出现踝关节红肿后 1周 ,炎症达到高峰时进行光动力治疗 (PDT)。随机治疗大鼠一侧的踝关节 ,对侧作为单纯HMME对照。治疗方法是大鼠麻醉后尾静脉注入HMME 10mg kg ,2 0min后踝关节照光 ,激光波长 6 2 7 8nm ,功率密度 10 0mW cm2 ,照射时间 10 0 0s,能量密度 10 0J cm2 。治疗后 2周取关节进行病理评分。结果　关节炎组滑膜细胞增生 ,血管翳形成 ,并侵蚀和破坏软骨和骨 ;治疗组滑膜细胞增生不明显 ,软骨和骨完整。病理评分治疗组滑膜增生、血管翳形成及软骨破坏、骨破坏和总分较关节炎组和HMME组低 ,统计学检验差异有显著意义 (P <0 0 1)。结论　在HMME 10mg kg,激光功率密度 10 0mW cm2 、能量密度 10 0J cm2 的条件下 ,光动力疗法能够有效地减轻CIA的滑膜细胞增生 ,减轻血管翳的形成及对软骨和骨的破坏 ,起到保护软骨和骨的作用。     

Endoscopic ultrasonographic findings in benign and malignant diseases of the stomach

Endoscopic ultrasonographic (EUS) imaging was performed to examine the depth, extent and tissue character of gastric lesions in nine patients. Two patients with linitis plastica had endoscopically normal gastric mucosa, but a thickened gastric wall showing loss of normal layer structure on examination with EUS. In four patients the internal structure of gastric polyps could be imaged, showing the relationship to the gastric wall layers. EUS demonstrated the depth of gastric ulcers in three patients. Abnormalities in the echogenicity of the gastric wall adjacent to the ulcers were observed. EUS provides a three-dimensional endoscopic and ultrasonographic picture of the gastric mucosal surface and underlying wall, providing structural information not otherwise obtainable without examining the resected tissue.