Bexxar治疗非霍奇金淋巴瘤的研究现状

B细胞靶向特异性单克隆抗体的出现为惰性淋巴瘤的治疗提供了新的策略。由于淋巴瘤对辐射较为敏感，在过去的10年中，应用131I标记抗-CD20单克隆抗体(商品名：Bexxar)对化疗无效的非霍奇金淋巴瘤(NHL)患进行放射免疫治疗取得了长足的发展。     

Bexxar治疗非霍奇金淋巴瘤的研究现状

B细胞靶向特异性单克隆抗体的出现为惰性淋巴瘤的治疗提供了新的策略。由于淋巴瘤对辐射较为敏感,在过去的10年中,应用131I标记抗-CD20单克隆抗体(商品名:Bexxar)对化疗无效的非霍奇金淋巴瘤(NHL)患者进行放射免疫治疗取得了长足的发展。     

老年原发性结外非霍奇金淋巴瘤误诊1例

恶性淋巴瘤（malignant lymphoma,ML）是一组起源于淋巴组织的恶性疾病,分为非霍奇金淋巴瘤（NHL）和霍奇金淋巴瘤（HL）两大类。NHL的发病率是HL的6倍,而且NHL的高峰发病年龄是在老年。老年患者因基础疾病较多,当淋巴瘤起病于结外淋巴组织时,临床误诊、漏诊率多较高。我科1例老年患者误诊时间长达6年。现报告如下。     

恶性淋巴瘤病人CT和PET成像辐射暴露及死亡率风险

目的量化恶性淋巴瘤[霍奇金病(HD)或非霍奇金淋巴瘤(NHL)]病人CT和用18F-脱氧葡萄糖(18F-FDG)的正电子发射体层摄影(PET)的辐射暴露和死亡率风险。方法首先,用一个独特的诊断工作评估HD患儿和NHL成人的器官剂量。随后,编制寿命表评价辐射风险,还要考虑到疾病相关的死亡率。结果患HD的患儿进行医学成像累积的实际剂量为66mSv(新生儿)～113mSv(15岁儿童)。患NHL的成人进行医学成像累积的实际剂量为97mSv。辐射引起HD患儿中男孩的平均死亡率为0.4%[0.6%](方括号内的表示没有校正的与疾病相关的死亡率),女孩为0.7%[1.1%],在成人NHL中男性为0.07%[0.28%],女性为0.09%[0.37%]。结论考虑到与疾病相关的恶性淋巴瘤病人的预期寿命减少结果在于疾病本身较高的总死亡率,而辐射诱导的死亡发生率大幅度降低。来自CT和18F-FDGPET成像的适度辐射风险可以被认为是合理的,但成像过程应该注意,特别是对于儿童。     

131Ⅰ-rituximab治疗B细胞非霍奇金淋巴瘤

放射免疫治疗是将单克隆抗体(单抗)耦联放射性核素,在肿瘤局部产生足够的电离辐射生物学效应,达到高效、低毒的治疗效果.非霍奇金淋巴瘤(NHL)是最常见的淋巴系统恶性肿瘤之一,其绝大多数是B细胞来源,细胞分化抗原CD20是放射免疫治疗B细胞NHL的最佳靶点,用131Ⅰ标记rituximab(一种抗CD20单抗)在治疗B细胞NHL的临床研究中显示出良好的效果,但仍存在许多问题,人们正在进一步研究解决此类问题,以取得更好的治疗效果.     

椎管内非霍奇金淋巴瘤的MRI表现(附3例报告并文献复习)

非霍奇金淋巴瘤(non-Hodgkin's lymphoma,NHL)属于较常见病,但原发于椎管内非霍奇金淋巴瘤较为罕见.现将笔者所见的3例报道如下,并对本病的相关文献进行复习.     

非霍奇金淋巴瘤多系统侵犯的影像学表现

非霍奇金淋巴瘤(non-Hodgk in’s Lymphoma,NHL)是一组恶性程度不等、临床表现各异的恶性淋巴瘤,其病理组织学分型比较复杂,至今没有统一的意见[1]。目前应用较为普遍的是1982年国际专家组制定的NHL“供临床应用的工作方案”,主要分为低度恶性、中度恶性和高度恶性3大类[2]。NH     

脂质体阿霉素在恶性淋巴瘤患者中的应用效果及磁共振成像预后评估价值研究

淋巴瘤是起源于淋巴组织及淋巴造血系统的恶性肿瘤,非霍奇金淋巴瘤(non-Hodgkin′s lymphoma,NHL)在生活中常见,有较高的死亡率[1]。NHL患者的主要临床表现为无痛性淋巴结肿大,大多数患者为老年人且合并糖尿病、高血压等基础疾病,抵抗力下降,对今后的治疗均有负面的影响[2]。脂质体阿霉素在治疗淋巴瘤中被视为一线药物,但在其使用过程中有较大的不良反应,故其安全性有待研究。     

神经细胞粘附分子在非霍奇金淋巴瘤中的表达

为探讨神经细胞粘附分子 (NCAM)在非霍奇金淋巴瘤 (NHL)发生中的作用 ,运用基因芯片和RT PCR技术检测 18例胃NHL细胞中NCAM基因的表达。基因芯片结果表明 ,NCAM基因在NHL中表达显著增高 (Cy3/Cy5 >2 0 ) ,半定量RT PCR结果与基因芯片检测结果相同 ,并且有远处扩散的患者NCAM基因表达值高于无扩散患者。提示NHL的发病与淋巴瘤细胞中NCAM表达升高有关     

非霍奇金淋巴瘤的CD20分子显像及靶向治疗研究进展

应用放射性核素标记B淋巴细胞分化抗原CD20单抗或其重组片段,在分子水平实现对非霍奇金淋巴瘤(NHL)显像和治疗,这将成为提高患者生存率的有效手段.该文介绍了CD20表面抗原的生物学特性及NHL抗CD20单抗的免疫治疗、放射免疫治疗以及放射免疫显像的研究进展.     

Current issues and actions in radiation protection of patients

Medical application of ionizing radiation is a massive and increasing activity globally. While the use of ionizing radiation in medicine brings tremendous benefits to the global population, the associated risks due to stochastic and deterministic effects make it necessary to protect patients from potential harm. Current issues in radiation protection of patients include not only the rapidly increasing collective dose to the global population from medical exposure, but also that a substantial percentage of diagnostic imaging examinations are unnecessary, and the cumulative dose to individuals from medical exposure is growing. In addition to this, continued reports on deterministic injuries from safety related events in the medical use of ionizing radiation are raising awareness on the necessity for accident prevention measures. The International Atomic Energy Agency is engaged in several activities to reverse the negative trends of these current issues, including improvement of the justification process, the tracking of radiation history of individual patients, shared learning of safety significant events, and the use of comprehensive quality audits in the clinical environment.     

Perception of Radiation Exposure and Risk Among Patients,Medical Students,and Referring Physicians at a Tertiary Care Community Hospital

Background

It is important for physicians to be aware of the radiation doses as well as the risks associated with diagnostic imaging procedures that they are ordering.

Methods

A survey was administered to patients, medical students, and referring physicians from a number of specialties to determine background knowledge regarding radiation exposure and risk associated with commonly ordered medical imaging tests.

Results

A total of 127 patients, 32 referring physicians, and 30 medical students completed the survey. The majority of patients (92%) were not informed of the radiation risks associated with tests that they were scheduled to receive and had false perceptions about the use of radiation and its associated risks. Physicians and medical students had misconceptions about the use of ionizing radiation in a number of radiologic examinations; for example, 25% and 43% of physicians and medical students, respectively, were unaware that interventional procedures used ionizing radiation, and 28% of physicians were unaware that mammography used ionizing radiation. Computed tomographies and barium studies were thought to be associated with the least ionizing radiation among physicians.

Conclusion

There is a need for educating the public, medical students, and referring physicians about radiation exposure and associated risk so that (1) patients receiving multiple medical imaging tests are aware of the radiation that they are receiving and (2) physicians and future physicians will make informed decisions when ordering such tests to limit the amount of radiation that patients receive and to promote informed consent among patients.     

中国人受电离辐射照射剂量份额研究

系统总结了各种电离辐射源对正常生活条件的中国人所致照射剂量，为评价剂量－效应关系提供有意义的背景材料。方法基于大量调查研究和监测数据进行分析对比研究。结果中国人受各种电离辐射源的照射剂量，年有效剂量为２．５ｍＳｖ／ａ，来自天然辐射的剂量占总剂量的９２％。结论至今我国广大公众所受到的电离辐射照射仍以天然辐射为主。本文给出了各种电离辐射源所致剂量份额     

Complete written/oral information about dose exposure in CT: is it really useful to guarantee the patients’ awareness about radiation risks?

Aims and objectives

According to the European directive 2013/59/Euratom, starting from February 2018, the information relating to patient exposure will be part of computed tomography (CT) reports, but the impact of this information on patients has not been deeply evaluated. Aim of our study was to evaluate patients’ perception of radiation exposure related to routine CT and their understanding after communication of their dose exposure.

Materials and methods

A survey, investigating patient’s knowledge of radiation dose, was given to all adult patients (>?18 years) undergoing a CT examination both before and after CT scan. The first survey was the same for all patients. After CT scan, a second questionnaire was administered (after receiving the CT dose bill report and medical written and/or explanation about ionizing radiation risk). Results of the pre- and post-CT questionnaires responses were compared according to demographics characteristics and among the four post-CT groups.

Results

For some questions, statistically significant differences were found between the two centres. Seventy per cent of the patients answered that the presence of CT parameters in the report is considered useful. Even if not always statistically significant there was a slight increase in awareness of ionizing radiation risk comparing the pre- and post-CT surveys. The group that had both written and oral explanations had a better comprehension of CT dose bill (group III vs. I, p?=?0.002).

Conclusion

The way of communication of ionizing radiation risks did not affect the results of the post-CT survey. Indeed, the interest in the topic did not rise in the post-CT survey in any of the group. Adequate information about ionizing radiation risks provided together with dose exposure information may be useful. However, there is not a standardized better way of communicating information on ionizing radiation risks due to CT.

     

Occupational radiation exposure: population studies

Occupational exposure to ionizing radiation in the medical setting differs from the acute exposure received by survivors of atomic bomb blasts. Yet, atomic bomb survivors' disease and mortality outcomes have been the standard data source on the effects of ionizing radiation on humans. Therefore, the prevailing estimated risks of ionizing radiation may not apply to radiologic technologists and other medical radiation workers. Carefully designed epidemiological trials provide evidence that helps determine the strength of association between exposure and onset of disease in selected populations. This article reviews radiation effects, explains some basic design concepts of epidemiologic trials and surveys the epidemiology literature related to radiation exposure to humans, with special attention to radiology staff.     

Radiation safety for radiologic technologists

Radiologic technologists and ancillary staff who work with or near ionizing radiation face possible short- and long-term effects of occupational radiation exposure. Further, radiologic technologists must minimize unnecessary exposure that risks the patient's safety, while achieving the best possible image or outcome. This article reviews occupational dose limits, dose calculation, devices used to measure exposure, and safety best practices that can help technologists keep radiation exposure "as low as reasonably achievable" for them and their patients. The article also discusses the appropriate use of mounted and mobile equipment, personal protective equipment, and safety features on imaging equipment to minimize unnecessary radiation exposure.     

Radiation protection in pediatric imaging

The effects of medical radiation exposure in childhood can last a lifetime. As more American children are exposed to repeated diagnostic imaging examinations, concerns have been raised about the potential harm from early medical irradiation. Diagnostic imaging personnel have a responsibility to ensure strict and consistent observance of the "as low as reasonably achievable" (ALARA) principle. Radiation risks are greater for children, which makes strict compliance with radiation protection practices a public health imperative. Radiologic technologists play a central role in radiation protection for children. This Directed Reading reviews the biologic effects and risks of ionizing radiation among children and the use of radiation protection to minimize medical radiation doses in the pediatric population.     

Therapy for prevention and treatment of skin ionizing radiation damage: a review

Abstract

Radiologic accidents or terrorist acts involving radioactive material, as well as radiation exposure in medical or industrial procedures are potential sources of risk for human health. All these risks share a common element, exposure to ionizing radiation. The extent of ionizing radiation injury will depend on a number of independent variables such as dose, type of radiation and tissue, etc. As a result of ionizing radiation exposure, biological effects can take place in acute or long-term manner. As in the case of other self-renewing tissues (e.g. hematopoietic system and intestinal epithelium), skin is also extremely sensitive to ionizing radiation. In this way, appropriate management of radiation skin effects might improve the therapeutic benefit of medical radiation therapy, as well as reduce the mortality associated with any radiological incident (e.g. accident or terrorist attack). For this reason, current and potential future treatment approaches for skin radiation injury are reviewed in this work. Unfortunately, there is no sufficient evidence for establishing a standard treatment to prevent or mitigate radiation-induced cutaneous injury. Thus, continued research is necessary to achieve effective therapies to address this important health problem.     

X-Ray Gogs: preliminary evaluation of a "new" imaging modality

"X-Ray Gogs," which apparently reveal internal anatomy without radiation, ultrasound, or magnetic fields, were compared with conventional imaging modalities in evaluating a variety of pediatric conditions. Conventional techniques were preferable in terms of diagnostic accuracy and image quality, and are thus recommended in most settings. Because of low cost and lack of ionizing radiation, "X-Ray Gogs" are recommended in cases where radiography is not indicated, or where the results of radiographic study will not influence patient management, or where the diagnosis has already been established by other means.     

Analysis of Common Deletion (CD) and a novel deletion of mitochondrial DNA induced by ionizing radiation

PURPOSE: In order to identify supportive evidence of radiation exposure to cells, we analyzed the relationship between exposure to ionizing radiation and the induction of deletions in mitochondrial DNA (mtDNA). MATERIALS AND METHODS: Using human hepatoblastoma cell line, HepG2 and its derivatives, HepG2-A, -89 and -400, established after long term exposure to X-ray, mtDNA deletions were analyzed by polymerase chain reaction (PCR) and real-time PCR after cells were subjected to radiation and genotoxic treatments. RESULTS: Common Deletion (CD), the most extensively studied deletion of mtDNA, was induced within 24 h after exposure to 5 Gray (Gy) of X-rays and was associated with replication of mtDNA. CD became undetectable several days after the exposure due to the death of cells containing mitochondria within which CD had been induced. Furthermore, we found a novel mtDNA deletion that consisted of a 4934 base-pair deletion (4934del) between nucleotide position 8435 and 13,368. A lower dose of ionizing radiation was required to induce the 4934del than for CD and this was independent of the quality of radiation used and was not induced by treatments with hydrogen peroxide (H(2)O(2)) and other genotoxic reagents including bleomycin. CONCLUSION: CD is induced by ionizing radiation, however, the amount of CD detected at a certain point in time after radiation exposure is dependent on the initial frequency of CD induced and the death rate of cells with mtDNA containing CD. The novel mtDNA deletion found in this study, therefore, will be used to determine whether cells were exposed to ionizing radiation.