RTOG 0211:a phase 1/2 study of radiation therapy with concurrent gefitinib for newly diagnosed glioblastoma patients

PURPOSE: To determine the safety and efficacy of gefitinib,an epidermal growth factor receptor(EGFR) tyrosine kinase inhibitor,in combination with radiation for newly diagnosed glioblastoma(GBM) patients.METHODS AND MATERIALS: Between March 21,2002,and May 3,2004,Radiation Therapy Oncology Group(RTOG) 0211 enrolled 31 and 147GBM patients in the phase 1 and 2 arms,respectively.Treatment consisted of daily oral gefinitnib started at the time of conventional cranial radiation therapy(RT) and continued post RT for 18 months or until progression.Tissue microarrays from 68 cases were analyzed for EGFR expression.RESULTS: The maximum tolerated dose(MTD) of gefitinib was determined to be 500 mg in patients on non-enzyme-inducing anticonvulsant drugs(non-EIAEDs).All patients in the phase 2 component were treated at a gefitinib dose of 500 mg;patients receiving EIADSs could be escalated to 750 mg.The most common side effects of gefitinib in combination with radiation were dermatologic and gastrointestinal.Median survival was 11.5 months for patients treated per protocol.There was no overall survival benefit for patients treated with gefitinib + RT when compared with a historical cohort of patients treated with RT alone,matched by RTOG recursive partitioning analysis(RPA) class distribution.Younger age was significantly associated with better outcome.Per protocol stratification,EGFR expression was not found to be of prognostic value for gefitinib + RT-treated patients.CONCLUSIONS: The addition of gefitinib to RT is well tolerated.Median survival of RTOG 0211 patients treated with RT with concurrent and adjuvant gefitinib was similar to that in a historical control cohort treated with radiation alone.     

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随着高强度、高半透性玻璃陶瓷材料的研制成功,为临床超薄瓷贴面的应用提供了基础。本文介绍了超薄瓷贴面的临床适应证、制作工艺和粘接技术,并采用IPS e.max HT玻璃陶瓷成功地为1例年轻的牙列稀疏患者完成了美学修复。     

Degenerative lumbar disk disease: pitfalls and usefulness of MR imaging in detection of vacuum phenomenon

Magnetic resonance (MR) images of the lumbar spine from 150 patients were retrospectively reviewed. In 14 of these patients, at 18 disk levels, a vacuum phenomenon (VP) had been identified on plain radiographs and/or computed tomographic scans. The MR imaging appearance of these gas collections in 17 disks was an area without signal, best seen on spin-echo sequences with short repetition time and echo time in the sagittal view. MR imaging precisely located the VP in the anulus fibrosus, the nucleus pulposus, and Schmorl nodes. In all but one case, degeneration of the disk was complete and associated with adjacent changes in vertebral bone. Pitfalls of MR imaging detection of VP included chemical shift artifact, calcifications, and tears without gas in the disk.     

hp-MSCs对RSV引起小儿毛细支气管炎的保护作用及机制研究

目的 探讨人胎盘间充质干细胞（hp-MSCs）水平降低与毛细支气管炎发病的相关性及hP-MSCs防治毛细支气管炎的分子机制。方法 在滨州医学院附属医院产科招募志愿者,同时收集新生儿胎盘。毛细支气管炎患者由儿科医生根据临床诊断标准做出诊断;以毛细支气管炎患者为病例组,正常体检儿童为对照组,进行病例对照研究;胎盘hp-MSCs水平检测采用锥虫蓝染色计数法,hp-MSCs表面标记物的检测采用流式细胞仪方法;采用ELISA（酶联免疫吸附法）检测白细胞介素-9(IL-9)、白细胞介素-17(IL-17）、白细胞介素 10(IL-10）和转化生长因子 -1(TGFβ-1）水平,采用Real time PCR和Western blot法检测叉头框蛋白3(Foxp3）及维甲酸相关孤核受体γt(RORγt）基因和蛋白表达水平。结果 两组人群在是否存在特异性皮炎、毛细支气管炎1级和2级家族史有显著性差异（P＜0.05）。病例组hp-MSCs水平及其表面标记物CD44和CD29水平显著降低（P＜0.05）。呼吸道合胞体病毒（RSV）感染升高IL-17和IL-9等炎症因子水平,降低IL-10和TGFβ-1等抗炎因子水平;而hp-MSCs干预可以降低IL-17和IL-9水平而升高IL-10和TGFβ-1水平（均P＜0.05）。RSV感染可以下调Foxp3基因和蛋白表达,上调RORγt基因和蛋白表达;而hp MSCs干预可以上调Foxp3基因和蛋白表达,下调RORγt基因和蛋白表达。结论 胎盘hp MSCs水平降低是引起婴幼儿毛细支气管炎的独立危险因素,hp-MSCs通过上调Foxp3的蛋白和基因表达,以及下调RORγt蛋白和基因表达起到防治婴幼儿毛细支气管炎的作用。     

新冠肺炎疫情防控期间医院防护物资管理实践探讨

新冠肺炎传染性强、扩散速度快,防护物资消耗量和需求量骤增,全国各级医院都面临医用防护物资紧缺问题。针对防护物资紧缺现状,通过建立组织架构,明确岗位防护标准,严格防护物资管理,完善物资请领审批流程等举措,对防护物资进行科学管控、合理调配,保证了诊疗工作正常开展,保障了医务人员安全     

“医联卡-册”在区域医疗服务中的推广

区域医疗中自费患者的“一院一卡”、互不通用的现象,是阻碍区域医疗卫生信息共享的重要瓶颈之一。通过申康对“医联卡-册”的推行,方便了自费患者在医联联网的市级医院就医,提高了医院服务效率,促进了医疗信息共享。     

High levels of interleukin-6 are associated with low tumor burden and low growth fraction in multiple myeloma

Interleukin-6 (IL-6) is a multifunctional cytokine postulated to play a central role as a growth factor for multiple myeloma (MM). We evaluated the spontaneous secretion of IL-6 in supernatants of Ficoll-Hypaque-- enriched bone marrow (BM) cultures from 35 patients with MM. The levels of IL-6 were correlated with biological and clinical characteristics of the disease. High levels of IL-6 production defined a subgroup of patients with low tumor burden as determined by lower serum beta 2- microglobulin (B2M) (P = .02) and lower percentage of myeloma cells infiltrating the bone marrow (P = .003), higher synthetic rates of monoclonal protein (P = .006), and low proliferative compartments as measured by the percentage of Ki-67--positive myeloma cells. Patients with high proliferative fractions (Ki-67--positive myeloma cells > 20%) had significantly lower levels of IL-6 when compared with patients with low proliferative fractions (P = .005). Our findings do not support IL- 6 as a major growth factor for MM, but demonstrate an association of high levels of IL-6 secretion with low tumor cell burden and low proliferative fraction.     

Platelet-dependent primary hemostasis promotes selectin- and integrin- mediated neutrophil adhesion to damaged endothelium under flow conditions

Co-localization of blood platelets and granulocytes at sites of hemostasis and inflammation has triggered an intense interest in possible interactions between these cellular processes and induction of vessel wall injury. Leukocyte adhesion to endothelial cells decreases with increasing shear and is dependent on an initial rolling phase mediated by selectins. We hypothesized that flow-dependent platelet adhesion at an injured vessel wall will lead to P-selectin expression by platelets, thus mediating leukocyte co-localization. A perfusion chamber was used in which flowing whole blood induced platelet adhesion to a subendothelial matrix (ECM) of cultured human umbilical vein endothelial cells (HUVEC). We compared neutrophil (polymorphonuclear leukocyte [PMN]) interactions with HUVEC and their ECM with and without adhered platelets. PMNs adhered predominantly to ECM-adhered platelets and not to endothelial cells. ECM alone did not support PMN adhesion under flow conditions. PMN adhesion to unstimulated HUVEC was only substantial at low shear (up to 200 cells/mm2 at shear stress 80 mPa). In marked contrast, PMN adhesion to ECM-adhered platelets was dramatically increased, and adhesion was demonstrated at much higher shear stress (up to 640 mPa). Studies with specific antibodies showed that the platelet-dependent neutrophil adhesion was selectin-mediated. Inhibition of P-selectin caused a marked inhibition of adhesion at high shear stress, whereas the role of leukocyte L-selectin was less pronounced. beta2-Integrin-blocking antibodies inhibited static neutrophil adhesion. fMLP induced L-selectin shedding from leukocytes, resulting in decreased leukocyte adhesion. In conclusion, platelet- dependent hemostasis at the ECM appears to be a powerful intermediate in neutrophil-vessel wall interactions at shear stresses that normally do not allow neutrophil adhesion to intact endothelium.