白及多糖外用水凝胶的制备与评价

目的以白及多糖为主要基质制备水凝胶并进行质量评价。方法采用水提醇沉法提取白及多糖并用酶解和Sevag法进行纯化。通过傅里叶变换红外光谱、热重分析、热差分析和X射线衍射分析对白及多糖进行表征。将白及多糖作为基质,交联卡波姆940制备得水凝胶。采用旋转流变仪测定水凝胶流变学特性,采用经皮水分散失速率仪测定水凝胶经皮促渗活性,并以止血时间和凝血4项为指标,测定了水凝胶的止血活性。结果白及多糖水凝胶具有较好的黏弹性和物理强度,且具有经皮促渗活性和止血活性。结论白及多糖水凝胶在药物透皮传送系统和伤口敷料应用方面具有巨大潜力。     

肿瘤表面刮片行第二代杂交捕获试验检测头颈部肿瘤人乳头状瘤病毒(HPV)感染分析

目的:分析使用肿瘤表面刮片技术检测头颈部肿瘤患者人乳头状瘤病毒(HPV)感染结果。方法:2010年1月至2011年6月间,在我院头颈放疗科就诊的经病理证实的头颈部肿瘤患者139例,采用肿瘤表面刮片第二代杂交捕获试验(HC-Ⅱ)技术分析测定HPV感染。结果:139例头颈部肿瘤患者中口咽癌及下咽癌22例,鼻咽癌107例,口腔癌2例,喉癌2例,其他恶性肿瘤6例。139例头颈部肿瘤组织中HPV感染共14例,感染率为10.1%。口咽及下咽癌、鼻咽癌患者HPV感染分别为5例(22.7%)、8例(7.5%)。HPV感染者中HPV-16型感染占44%。结论:头颈部肿瘤使用肿瘤表面刮片第二代杂交捕获试验(HC-Ⅱ)技术进行HPV检测有可行性,HPV感染可能是咽部肿瘤特别是口咽癌的重要致病因素之一。HPV感染与鼻咽癌致病原因的关系有待进一步确认。     

以双侧半球和前后循环脑梗死为首发症状的Trousseau综合征四例分析及文献复习

目的探讨以双侧半球、前后循环同时发生脑梗死为首发症状的Trousseau综合征的临床表现、辅助检查、影像学特点、治疗方法以及预后,以加深对该病的认识。方法回顾性分析2015年1月至2017年7月在首都医科大学附属北京友谊医院神经内科住院治疗的4例Trousseau综合征患者的临床资料,分析其既往病史、临床表现、治疗方法及预后。结果 4例患者均为男性,年龄分别为63岁、65岁、69岁和76岁。既往均有肿瘤病史,分别为肺癌2例,胃癌1例,胰腺癌1例。入院均为急性起病,有神经系统缺损的体征,明确诊断为急性脑梗死,梗死部位涉及前后循环、双侧半球。治疗过程中发现患者均合并深静脉血栓,其中有2例患者还出现了肺栓塞和心肌梗死。实验室检查显示高凝状态,相关肿瘤标志物CEA、CA125、CA199明显升高。4例患者早期均给予低分子肝素抗凝治疗,其中2例因并发急性肺栓塞死亡,另外2例病情稳定出院。结论 Trousseau综合征是肿瘤患者的第2位死因,以双侧半球、前后循环脑梗死为首发症状的患者,要特别注意肿瘤的筛查。提高对该病的认识,有效预防和治疗,对于延长患者生存期至关重要。     

Comparison of acute toxicities between two postoperative concurrent chemoradiotherapy regimens of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer

Objective To compare the acute toxicities between two prospective, non-randomize phase Ⅱ trials on adjuvant radiochemotherapy of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer. Methods From March 2005 to November 2007,based on two fulfilled phase Ⅰ studies,two phase Ⅱ trials were launched respectively to further observe the tolerance and toxicity. In one tria1,118 patients were treated with concurrent capecitabine and radiotherapy (Cap-CRT trial), with radio-therapy of DT50 Gy/25 F/5 wks to the pelvis, and capecitabine at a dose of 1600 mg/m2/d(d1-d14,3 weeks per cycle). In the other trial, 90 patients received concurrent oxaliplatin, capecitabine and radiothera-py(Cap-Oxa-CRT trial), with the same radiotherapy schedule, while oxaliplatin at a dose of 70 mg/m2(d1, d8) and capecitabine of 1300 mg/m2/d(d1-d14,3 weeks per cycle). Results There was no significant difference in the delay of radiotherapy (10.2% vs 6.7%, X2=0.80, P=0.460) or chemotherapy (9.3% vs 19.1%, X2=4.80,P=0.090) between Cap-CRT and Cap-Oxa-CRT trials. Grade 1-4 leukopenia,diar-rhea and nausea were the most common acute side-effects in the both trials, accounting for 70.2%, 65.9% and 42.3%, respectively. When comparing with Cap-CRT trial, Cap-Oxa-CRT trial had significantly more grade 1-4 non-hemotological toxicities, mainly in Gl,including nausea (68.9% vs 22.0%, X2=46.90, P= 0.000), diarrbea(76.7% vs 57.6%, X2=13.50, P=0.009), fatigne(47.8% vs 13.7%, X2=18.90,P= 0.000), hand-foot syndrome (14.4% vs 4.2%, X2=7.10, P=0.029), and inappetence (50.0% vs. 27.9%, X2 = 25.70, P=0.000), but not in hematological toxities of leukopenia, anemia or thrombocytope-nia. Of all the patients,grade 3 and grade 4 toxicities were diarrhea(24.0% and 1.0%),leukopenia(4.3% and 0.0%),radiation-induced dermatitis(3.8% and 0.0%),cramping abdominal pain(1.0% and 0.0%) and fatigue(0.5% and 0.0%). Only grade 3 and 4 diarrhea was significantly more in Cap-Oxa-CRT trial than in Cap-CBT trial(33.0% vs 18.6%, X2=5.90,P=0.023). Conclusions For patients with stage Ⅱ and Ⅲ rectal cancer,both the postoperative concurrent radiochemotherapy regimens are tolerable,though Cap-Oxa-CRT trial has more grade 3 and 4 diarrhea.     

Comparison of acute toxicities between two postoperative concurrent chemoradiotherapy regimens of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer

Objective To compare the acute toxicities between two prospective, non-randomize phase Ⅱ trials on adjuvant radiochemotherapy of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer. Methods From March 2005 to November 2007,based on two fulfilled phase Ⅰ studies,two phase Ⅱ trials were launched respectively to further observe the tolerance and toxicity. In one tria1,118 patients were treated with concurrent capecitabine and radiotherapy (Cap-CRT trial), with radio-therapy of DT50 Gy/25 F/5 wks to the pelvis, and capecitabine at a dose of 1600 mg/m2/d(d1-d14,3 weeks per cycle). In the other trial, 90 patients received concurrent oxaliplatin, capecitabine and radiothera-py(Cap-Oxa-CRT trial), with the same radiotherapy schedule, while oxaliplatin at a dose of 70 mg/m2(d1, d8) and capecitabine of 1300 mg/m2/d(d1-d14,3 weeks per cycle). Results There was no significant difference in the delay of radiotherapy (10.2% vs 6.7%, X2=0.80, P=0.460) or chemotherapy (9.3% vs 19.1%, X2=4.80,P=0.090) between Cap-CRT and Cap-Oxa-CRT trials. Grade 1-4 leukopenia,diar-rhea and nausea were the most common acute side-effects in the both trials, accounting for 70.2%, 65.9% and 42.3%, respectively. When comparing with Cap-CRT trial, Cap-Oxa-CRT trial had significantly more grade 1-4 non-hemotological toxicities, mainly in Gl,including nausea (68.9% vs 22.0%, X2=46.90, P= 0.000), diarrbea(76.7% vs 57.6%, X2=13.50, P=0.009), fatigne(47.8% vs 13.7%, X2=18.90,P= 0.000), hand-foot syndrome (14.4% vs 4.2%, X2=7.10, P=0.029), and inappetence (50.0% vs. 27.9%, X2 = 25.70, P=0.000), but not in hematological toxities of leukopenia, anemia or thrombocytope-nia. Of all the patients,grade 3 and grade 4 toxicities were diarrhea(24.0% and 1.0%),leukopenia(4.3% and 0.0%),radiation-induced dermatitis(3.8% and 0.0%),cramping abdominal pain(1.0% and 0.0%) and fatigue(0.5% and 0.0%). Only grade 3 and 4 diarrhea was significantly more in Cap-Oxa-CRT trial than in Cap-CBT trial(33.0% vs 18.6%, X2=5.90,P=0.023). Conclusions For patients with stage Ⅱ and Ⅲ rectal cancer,both the postoperative concurrent radiochemotherapy regimens are tolerable,though Cap-Oxa-CRT trial has more grade 3 and 4 diarrhea.     

复发性无菌性脑膜炎

复发性无菌性脑膜炎系指有≥2次的脑膜炎发病,发病间期患者无临床症状而且脑脊液检查正常。依照病因学的不同,每次发作持续时间(从数天至数周)、发病间期(数天至数年)和发作次数均有很大变化。所谓无菌性脑膜炎则是指通过脑脊液标本革兰染色或分离培养均不能发现病原微生物。事     

三七农药残留研究进展

三七为多年生中药材,具有严重的生产障碍问题,生长过程中易发多种病虫害,当前主要的防治方法为化学农药防控,因而三七农药残留问题备受关注。该文综述了1981—2021年40年间三七中常见农药残留种类、检测方法,并比较了国内外有关三七农药残留的限量标准,以期为指导三七合理用药、控制药材质量提供参考,从而推动中国三七产业的持续发展。当前三七药材农药残留研究仅40篇公开发表文献,存在严重的研究不足问题。目前利用色谱-串联质谱技术可同时检测出三七中上百种农药残留,农药检出从早期的双对氯苯基三氯乙烷(滴滴涕)、六氯环己烷(六六六)、对硫磷等禁用农药逐步转变为烯酰吗啉、腐霉利、丙环唑、苯醚甲环唑等低毒农药,来自三七中农药残留的膳食风险较低,不会对食用者造成健康危害。该研究认为积极开展三七农药残留质量标准的研制工作,在保留标准中已有农药的基础上,增加生产实际中应用的农药,指导农户科学使用农药,将是未来工作的重点方向。     

局部晚期喉癌颈部淋巴结转移规律及相关因素分析

目的 分析局部晚期(T3、T4期)喉癌颈部淋巴结转移(LNM)规律,为喉癌放疗颈部靶区勾画提供参考。方法 回顾分析2000-2017年中国医学科学院肿瘤医院初治局部晚期喉癌患者,所有患者至少行双颈Ⅱ-Ⅳ区淋巴结清扫,计算颈部各区LNM率。采用Logistic回归分析LNM相关因素。结果 共272例患者纳入研究,全组患者LNM率为57.1%(156/272)。根据原发病变部位分3个组:A组(72例),原发灶局限于一侧;B组(86例),原发灶主体偏于一侧但侵犯过中线;C组(114例),原发灶为巨大或中央型病变。各组不同颈部分区LNM率:A组同侧颈部Ⅱ区36.3%、Ⅲ区26.4%、Ⅳ区6.9%,对侧分别为13.9%、8.3%、1.4%;B组:同侧颈部Ⅱ区41.9%、Ⅲ区29.1%、Ⅳ区11.6%,对侧分别为18.6%、14.0%、1.2%;C组:左侧Ⅱ区24.6%、Ⅲ区 23.7%、Ⅳ区2.6%,右侧分别为21.9%、26.3%、6.1%。局限单侧(A组)与中线受侵(B、C组)双侧LNM率相近(15.3%、25.0%,P=0.093)。同侧Ⅲ区是否转移和临床淋巴结分期与对侧颈是否LNM相关(OR=2.929,95%CI为1.041~8.245,P=0.042)和OR=0.082,95%CI为0.018~0.373,P=0.001)。同侧Ⅱ区、Ⅲ区转移是同侧Ⅳ区转移的危险因素(P=0.043、0.009)。结论 双侧颈部Ⅱ、Ⅲ区是高危LNM区,Ⅳ、Ⅴ区转移较少见;同侧Ⅱ、Ⅲ区转移是同侧Ⅳ区及对侧颈LNM的相关因素,cN0期患者少见对侧颈LNM。     

Postmastectomy hypofractionation radiotherapy in high-risk breast cancer patients: A phase Ⅰ/Ⅱ clinical trial

目的 探讨乳腺癌改良根治术后大分割放疗的近期疗效和副反应.方法 38例高危乳腺癌患者改良根治术后化疗后,同侧胸壁和锁骨上下放疗43.5 Gy分15次3周完成,观察急性放疗反应发生率和肿瘤的局部区域控制率.结果 中位随访13个月,入组38例患者全部生存,无照射野内复发,远处转移率为13%(5例).5例患者出现3级放射性皮炎,均发生在放疗结束后2～3周.3例患者出现2级放射性肺炎.结论 乳腺癌改良根治术后43.5 Gy分15次3周完成的大分割放疗方案的急性副反应可以接受,近期疗效较好.     

Postmastectomy hypofractionation radiotherapy in high-risk breast cancer patients: A phase Ⅰ/Ⅱ clinical trial

目的 探讨乳腺癌改良根治术后大分割放疗的近期疗效和副反应.方法 38例高危乳腺癌患者改良根治术后化疗后,同侧胸壁和锁骨上下放疗43.5 Gy分15次3周完成,观察急性放疗反应发生率和肿瘤的局部区域控制率.结果 中位随访13个月,入组38例患者全部生存,无照射野内复发,远处转移率为13%(5例).5例患者出现3级放射性皮炎,均发生在放疗结束后2～3周.3例患者出现2级放射性肺炎.结论 乳腺癌改良根治术后43.5 Gy分15次3周完成的大分割放疗方案的急性副反应可以接受,近期疗效较好.