局部晚期宫颈癌CT图像引导下192Ir三维腔内后装治疗剂量体积参数与疗效关系

目的 观察CT图像引导下192Ir三维腔内后装治疗的肿瘤靶区及危及器官受照射体积剂量参数与肿瘤局部控制率及晚期副反应之间关系.方法 10例局部晚期宫颈癌患者在完成盆腔外照射40 Gy及同期化疗后开始每周1次的CT图像引导下192Ir三维腔内后装治疗,每次治疗前进行CT扫描定位,勾画肿瘤靶区(GTV、CTV)和危及器官,利用PLATO治疗计划系统进行逆向治疗计划设计及优化,CTV单次处方剂量为6 Gy,治疗5～7次.结果 1年盆腔控制率为90%,1～2级放射性肠炎发生率为50%,无≥3级副反应.90%CTV等效生物剂量(BED)和相当于2 Gy分次的等效剂量(EQD2)分别为(95.50±7.81)Gy和(79.73±6.57)Gy(α/β=10).90%GTV的BED和EQD2分别为(101.86±7.27)Gy和(84.95±6.1)Gy(α/β=10).90%处方剂量对GTV、CTV的覆盖率分别为92%±4%、87%±7%.直肠、乙状结肠2 cm3体积受到的最小照射剂量分别为(74.97±1.64)、(67.93±4.30)Gy(EQD2,α/β=3).与二维治疗计划相比,三维治疗计划在没有改变A点剂量、直肠参考点剂量情况下提高了GTV、CTV的90%体积受照射剂量及90%处方剂量对GTV、CTV的覆盖率.结论 CT图像引导下192Ir三维腔内后装治疗提高了处方剂量对肿瘤靶区的覆盖率,1年盆腔控制率为90%且无严重副反应,远期疗效观察中.

Abstract：

Objective To investigate the correlation between dose volume histogram(DVH)of tumor targets and organs at risk(OAR)at CT-image based 192Ir brachytherapy and effects and complications for patients with locally advanced cervical cancer. Methods Ten patients with FIGO stage ⅢB cervical cancer received CT image-based 192Ir intracavitary brachytherapy after 54 Gy of three-dimentional four-field pelvic external beam radiotherapy and concurrent weekly cisplatin chemotherapy. Before each brachytherapy,CT images were acquired with applicators in place. Gross tumor volume(GTV), clinical target volume (CTV)and OAR were contoured and inverse treatment planning was designed and optimized by using PLATO treatment planning system. Conventional two-dimensional plans were also designed for comparison.The total intracavitary brachytherapy dose was 30 -42 Gy in 5 -7 fractions. The patients were followed, and the local control and complications were analyzed. The biologically equivalent dose(BED)and biologically equivalent dose in 2 Gy fractions(BED2)for GTV, CTV and OAR were calculated. The minimum dose in the most irradiated tissue volume 2 cm3(D2 cm3)adjacent to the applicator of the sigmoid colon, rectum,bladder and small bowel was determined from the DVH. Results The 1-year local pelvic control rate was 90% and grade 1-2 late complication of sigmoid colon and rectum was 50%. No grade 3 or more complications developed. On CT-image based planning, the BED and BED2 to 90% of the CTV(D90)were 95.50 Gy ± 7. 81 Gy and 79. 73 Gy ± 6. 57 Gy. The BED and BED2 to 90% of the GTV(D90)were 101.86 Gy ± 7.27 Gy and 84. 95 Gy ± 6. 1 Gy. The volume enclosed by 90% of prescribed dose(V90)for GTV and CTV were 92% ±4% and 87% ±7% respectively. The D2cm3 for rectum and sigmoid colon were 74. 97 Gy ±1.64 Gy and 67. 93 Gy ± 4. 30 Gy(EQD2, α/β = 3). Comparing with 2D brachytherapy plans , CT - image based planning has improved D90 and V90 for GTV and CTV with similar dose at point A and rectum reference point. Conclusions Computer tomography-image based 192Ir brachytherapy has resulted in the better dose distribution to the tumor targets with excellent tumor control and acceptable toxicity.     

上海市社区健身苑（点）使用情况及居民需求研究

目的评价上海市社区健身苑（点）的使用情况以及居民需求。方法采用客观观察法对七宝镇5个健身苑（点）进行实地观察,并采用拦截式问卷法调查了七宝镇居民175人。结果健身苑（点）使用者以中青年和女性略多,时段上早晨和节假日较多,不同年龄段经常使用的器材有差异,大部分居民对健身苑（点）的总体和效果评价持肯定态度,器材安全性和齐全度以及居民使用健身器械的科学性尚待提升。结论上海市社区健身苑（点）基本受到居民的认可,但在器材设计、健身苑（点）的设置和管理维护方面还存在可改进之处。     

血尿酸与代谢危险因素交互作用对高血压的影响

探讨血尿酸与高血压的关系,评估代谢危险因素与血尿酸交互作用对高血压风险的影响.检测8 415名健康体检人群的血压及其他相关指标,进行统计分析.高血压风险随血尿酸水平的升高而增加(P＜0.01).血尿酸与年龄、高密度脂蛋白胆固醇(HDL-C)交互作用对高血压风险的影响有统计学意义(交互作用P值分别为0.012,0.001).血尿酸水平与高血压风险有关,年龄和HDL-C水平可能影响这种联系.

Abstract：

The relationship between serum uric acid(SUA) and hypertension was investigated and the interactions of SUA with metabolic risk factors was assessed. Blood pressure and biomarkers features were evaluated for all the8 415 individuals from a community-based health examination survey in Xuzhou, and the statistical analysis was made. Raised blood pressure was associated with increased SUA concentration(P＜0.01). Age and high density lipoprotein cholesterol(HDL-C) significantly interacted with SUA(P for interaction=0.012 and 0.001, respectively). There is significant association between SUA and hypertension, which may be affected by age and HDL-C levels.     

基于da Vinci Xi?手术机器人的右半结肠切除术进展

新一代的da Vinci Xi^?手术机器人在可操作范围、对接流程、操作流畅度及可视化等方面均做出了优化，使其尤为适用于多象限的手术，在右半结肠切除术的应用中有望得到更多的获益。本文着重讨论da Vinci Xi^?手术系统相较于前代机器人在技术特点方面的改进，并回顾相关文献，简述基于该系统的右半结肠切除术在Trocar孔配置、手术入路上的进展，对其安全性、可行性做出讨论；与传统腹腔镜手术相比，在术中操作、术后恢复等相关临床数据的变化，分析da Vinci Xi^?手术机器人在右半结肠切除术中的临床获益。     

沙眼衣原体重组口服活疫苗的体液免疫学特性

目的检测所构建的沙眼衣原体(Ct)重组疫苗株口服免疫小鼠后,产生的体液免疫应答。方法将所构建的重组菌以5×108菌落形成单位(CFU)/只的剂量,口服免疫雌性Balb/c小鼠,随机分为7组,每组3只。于免疫后第2,7,14,21,28,35和42d各取1组,采集血清、小肠肠腔冲洗液和阴道冲洗液标本。分别以D型Ct和鼠伤寒杆菌临床分离株为抗原,检测各组血清、小肠冲洗液和阴道冲洗液标本中特异性IgG,IgA和IgM。取抗D型Ct血清IgG阳性标本和阴道冲洗液IgA阳性标本,分别用于检测与C型Ct的交叉反应。结果在血清标本中,有抗D型Ct和抗鼠伤寒杆菌特异性IgG和IgM,在小肠冲洗液和阴道冲洗液标本中有抗上述两种抗原特异性IgG和IgA。抗D型CtIgG阳性血清标本和IgA阳性阴道冲洗液标本与C型Ct均有交叉反应。结论所构建的疫苗株免疫小鼠后,能够诱导Ct特异性IgG及IgA产生。     

结核分枝杆菌MPT64抗原DNA疫苗在小鼠体内诱导的免疫应答

目的研究结核分枝杆菌MPT64抗原DNA疫苗在小鼠体内诱导的免疫应答。方法用表达MPT64的真核表达质粒pcDNA-M免疫BALB/c小鼠,ELISA法检测免疫小鼠的特异性抗体滴度和抗体亚类。分离免疫小鼠的脾淋巴细胞,检测淋巴细胞增殖、IFN-γ和IL-12产生水平、流式细胞仪计CD4+细胞和CD8+细胞数、脾淋巴细胞特异性CTL杀伤效应。结果MPT64基因免疫可诱导小鼠高水平的体液免疫应答,免疫小鼠脾淋巴增殖显著,IFN-γ和IL-12含量增加,CD4+细胞和CD8+细胞百分比明显增加,CTL杀伤效应明显。结论MPT64 DNA疫苗可诱导小鼠有效的体液和细胞免疫应答,有可能作为新型TB疫苗的组分。     

结核分支杆菌ESAT6-MPT64融合蛋白的构建及应用性初步研究

目的:构建表达结核分支杆菌ESAT6和MPT64融合蛋白,并评价其在血清学诊断中的价值。方法:PCR法扩增esat6和mpt64基因,构建原核表达载体pProEX HTb-EM,表达、纯化ESAT6-MPT64融合蛋白,Western-blot分析其抗原性。用该重组蛋白ELISA法检测结核病患者血清。结果:原核表达的ESAT6-MPT64融合蛋白约40 000,Western-blot证实重组蛋白与ESAT6和MPT64多克隆抗体特异结合。重组蛋白用于检测结核病患者血清,敏感性为67.7%,特异性为82%。结论:重组的ESAT6-MPT64融合蛋白有可能用于结核病免疫诊断试剂的制备。     

融合表达ESAT6-CFP10蛋白的重组耻垢分枝杆菌诱导小鼠的免疫应答及其保护力

目的研究融合表达ESAT6-CFP10蛋白的重组耻垢分枝杆菌诱导的小鼠体液和细胞免疫应答水平。方法以106CFU/0.1 mL重组M.S通过尾静脉途径免疫小鼠。用MTB培养上清滤液蛋白(CFP)作为抗原,用ELISA法测定免疫小鼠血清特异性抗体的滴度。取部分免疫小鼠脾淋巴细胞,体外用ESAT6-CFP10融合蛋白刺激后,以MTT比色法检测淋巴细胞增殖反应,同时检测免疫小鼠IFN-γ和IL-2水平及脾细胞杀伤效应。结果融合表达ESAT6-CFP10蛋白的重组耻垢分枝杆菌免疫小鼠血清特异性抗体的滴度为1∶6 400。淋巴细胞刺激增殖指数为2.8,明显高于生理盐水组(0.90);IFN-γ和IL-2的含量分别为2230±11 pg/mL和221±17 pg/mL,显著高于生理盐水对照组,但不及BCG免疫组;同时重组耻垢分枝杆菌诱导的脾细胞杀伤率为45%。结论融合表达ESAT6-CFP10蛋白的重组耻垢分枝杆菌能诱导小鼠产生特异性体液和细胞免疫应答,可作为结核新型疫苗使用。     

2型糖尿病与微量元素

2型糖尿病是一种常见的内分泌及代谢紊乱疾病,主要表现为β细胞功能不全和胰岛素抵抗引起的胰岛素分泌相对不足,而胰岛素分泌不足又会影响微量元素的体内平衡。目前发现,微量元素不仅对人体细胞代谢和生命功能的维持起重要作用,而且对胰岛素的合成、分泌、贮存、活性以及代谢都有着极大的影响。因此,研究微量元素与2型糖尿病的关系对糖尿病的预防和治疗有着独特的意义。