MR 3.0T磁敏感技术在隐匿性脑外伤中的临床应用价值

目的探讨3.0T磁敏感加权成像（SWI）技术在隐匿性脑外伤中的临床应用价值。方法搜集脑外伤患者24例,均行常规T1WI、T2WI、FLAIR及SWI。结果 24例头部CT平扫、MR平扫T1WI、T2WI、FLAIR像阴性,SWI清楚地显示了脑内微出血灶。结论在隐匿性脑外伤患者中,SWI较常规扫描序列更多的显示微出血状况,为临床提供更多的诊断信息,可作为隐匿性脑外伤常规扫描序列。     

siRNA沉默STAT3基因对人肝癌细胞的抑制及对相关生长调控基因的调节

目的: 探讨RNA干扰技术沉默STAT3基因表达对人肝癌细胞的抑制作用及对相关生长调控基因的调节.方法:构建pSilencer 3.0-H1-siRNA-STAT3重组质粒, 转染人肝癌细胞株SMMC 7721, 采用MTT法观察重组质粒对肝癌细胞的生长抑制, RT-PCR和Western blot及免疫组化法分别观察STAT3基因和蛋白水平的变化, 同时检测 survivin, c-myc, VEGF, p53, caspase3生长调控基因的mRNA, 并用流式细胞技术(FCM)及AO/EB染色方法观察细胞凋亡.结果: pSilencer 3.0-H1-siRNA-STAT3重组质粒对肝癌细胞的生长有抑制作用, 实验组48 h和72 h抑制率分别为59.32%, 76.49%, 与空白组及阴性组细胞相比有显著性差异(P<0.01);在重组质粒组, STAT3基因mRNA及蛋白水平表达降低, surviving, VEGF的mRNA表达下调, p53, caspase3的mRNA表达上调(P<0.01), c-myc的mRNA表达却无明显改变;重组质粒可诱导SMMC 7721细胞凋亡, 凋亡率达21.6%(P<0.01), 细胞周期分析显示细胞阻滞于G2期.结论:pSilencer 3.0-H1-STAT3-siRNA可能通过下调基因survivin和VEGF mRNA表达, 上调p53和caspase3 mRNA表达来抑制STAT3基因在人肝癌细胞中的表达.     

Validation of the Short-Form Esophageal Hypervigilance and Anxiety Scale

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High-Resolution Manometry Thresholds and Motor Patterns Among Asymptomatic Individuals

ObjectiveHigh-resolution manometry (HRM) is the current standard for characterization of esophageal body and esophagogastric junction (EGJ) function. We aimed to examine the prevalence of abnormal esophageal motor patterns in health, and to determine optimal thresholds for software metrics across HRM systems.DesignManometry studies from asymptomatic adults were solicited from motility centers worldwide, and were manually analyzed using integrated relaxation pressure (IRP), distal latency (DL), and distal contractile integral (DCI) in standardized fashion. Normative thresholds were assessed using fifth and/or 95th percentile values. Chicago Classification v3.0 criteria were applied to determine motor patterns across HRM systems, study positions (upright vs supine), ages, and genders.ResultsOf 469 unique HRM studies (median age 28.0, range 18–79 years). 74.6% had a normal HRM pattern; none had achalasia. Ineffective esophageal motility (IEM) was the most frequent motor pattern identified (15.1% overall), followed by EGJ outflow obstruction (5.3%). Proportions with IEM were lower using stringent criteria (10.0%), especially in supine studies (7.1%–8.5%). Other motor patterns were rare (0.2%–4.1% overall) and did not vary by age or gender. DL thresholds were close to current norms across HRM systems, while IRP thresholds varied by HRM system and study position. Both fifth and 95th percentile DCI values were lower than current thresholds, both in upright and supine positions.ConclusionsMotor abnormalities are infrequent in healthy individuals and consist mainly of IEM, proportions of which are lower when using stringent criteria in the supine position. Thresholds for HRM metrics vary by HRM system and study position.     

3.0T多体素磁共振质子波谱在常见颅内肿瘤鉴别诊断中的价值

目的 探讨3.0T多体素磁共振质子波谱(1H-MRS)对脑部肿瘤的诊断与鉴别诊断中的应用价值.方法 病理证实的颅内肿瘤患者29例:脑膜瘤8例,胶质瘤14例,转移瘤7例.所有患者均常规行3.0T MRI平扫及增强扫描,并运用1 H-MRS分析;检测肿瘤组织区、瘤周组织区和对侧正常脑组织区乙酰天门冬氨酸(NAA)、含胆碱类物质(Cho)和含肌酐类物质(Cr),比较NAA/Cho、NAA/Cr和Cho/Cr比值.结果 脑肿瘤的1H-MRS与正常脑组织明显不同,表现为NAA/Cr及NAA/Cho比值降低,Cho/Cr比值升高.在高级别胶质瘤区中NAA/Cho值比低级别下降明显(P＜0.05).脑膜瘤与胶质瘤实质区各项代谢比值均有统计学差异(P＜0.05).三组肿瘤瘤周区仅NAA/Cho比值差异有统计学意义(P＜0.05).结论 多体素1H-MRS可以在分子水平上有助于胶质瘤、脑膜瘤和转移瘤的鉴别诊断.     

Web3.0环境下的图书馆信息服务

介绍了Web3.0及Web3.0环境下"用户主导式"信息服务的特点,指出了Web3.0环境下实现"用户主导式"信息服务的实现途径。     

中文版胃肠神经内分泌肿瘤患者生活质量量表的信效度评定

目的验证中文版胃肠神经内分泌肿瘤患者生活质量量表(QLQ-GI.NET21)的信度及效度。方法在征得欧洲癌症治疗研究组织同意后,获得原始量表。邀请国内6名医护专家对量表内容进行评分,计算内容效度。应用癌症患者生存质量核心量表(QLQ-C30)和QLQ-GI.NET21分别对235例胃肠神经内分泌肿瘤患者进行问卷调查。并于2周后随机抽取60例进行再次问卷调查。结果共回收有效问卷220份,46例完成2周后的重测。QLQ-GI.NET21总量表内部一致性信度0.913;重测信度为0.899;内容效度指数为0.889;与QLQ-C30量表总分的相关性为0.417(P0.01),探索性因子分析提取出5个公因子,累积贡献率63.10%,具有良好的结构效度。该量表各条目有良好的区分度(P0.05)。结论中文版QLQ-GI.NET21量表具有良好的信效度,可用于胃肠神经内分泌肿瘤患者生活质量的测评。     

高分辨薄层直肠核磁共振新序列（3.0T RESOLVE-DWI）在直肠癌临床分期中的价值评估

目的探讨高分辨薄层直肠MRI新序列（3.0T RESOLVE-DWI）在直肠癌术前临床分期中的准确性。 方法回顾性分析四川大学华西医院75例行术前高分辨薄层直肠MRI新序列扫描的直肠癌根治性切除术的病例,分析MRI影像中肿瘤浸润深度（T）,并测量肿瘤及周围淋巴结（N）的表观弥散系数（ADC）值。以术后病检结果为金标准,分析MRI评估T分期的准确性,ADC值与肿瘤T、N分期及分化程度的相关性。 结果MRI从T1到T4期的诊断准确性在未行新辅助治疗的患者中分别为0%、38.1%、72%、14.3%（κ=0.200）,在行新辅助治疗的患者中分别为50%、33%、75%、0%（κ=0.270）。肿瘤ADC值与T分期（F=0.074,P=0.929;F=0.737,P=0.496）、肿瘤分化程度（F=1.889,P=0.783;F=4.385,P=0.627）在两组均无显著相关性。在未行新辅助治疗的患者中,淋巴结ADC值在术后病理淋巴结阳性组高于淋巴结阴性组（F=0.073,P=0.012）,而在新辅助治疗组差异无统计学意义（F=0.035,P=0.793）。 结论直肠癌高分辨薄层MRI新序列对T3期直肠癌的诊断准确率高,整体准确率较低;新序列ADC值对于直肠癌N分期的评估具有一定价值,还需进一步研究验证。     

伽玛刀3.0T磁共振定位降低皮肤灼伤与感染发生率的方法

目的 控制磁共振射频能量(SAR)影响参数,以降低头部伽玛刀治疗时,在3.0T磁共振定位中局部皮肤的灼伤与感染发生率.方法 对200例伽玛刀3.0T磁共振定位患者进行临床随机分组研究,试验组100例患者选择合适扫描序列、调整TR参数等措施以控制射频能量进行磁共振定位,对照组100例患者采用常规方法磁共振定位.结果 试验组手术后7例患者有头架固定头钉部的局部轻度灼伤,发生率为7.0％;对照组常规方法定位有28例患者头架固定头钉部的局部轻度灼伤,发生率为28.0％,两组间感染发生率差异有统计学意义(P＜0.01).结论 合理调整SAR影响参数,控制射频能量,可以明显控制伽玛刀3.0T磁共振定位中的局部灼伤与感染,使患者缩短住院床日,早日康复出院.     

Predicting the risk of chemotherapy toxicity in older patients: the Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score

BACKGROUND:

Tools are lacking to assess the individual risk of severe toxicity from chemotherapy. Such tools would be especially useful for older patients, who vary considerably in terms of health status and functional reserve.

METHODS:

The authors conducted a prospective, multicentric study of patients aged ≥70 years who were starting chemotherapy. Grade 4 hematologic (H) or grade 3/4 nonhematologic (NH) toxicity according to version 3.0 of the Common Terminology Criteria for Adverse Events was defined as severe. Twenty‐four parameters were assessed. Toxicity of the regimen (Chemotox) was adjusted using an index to estimate the average per‐patient risk of chemotherapy toxicity (the MAX2 index). In total, 562 patients were accrued, and 518 patients were evaluable and were split randomly (2:1 ratio) into a derivation cohort and a validation cohort.

RESULTS:

Severe toxicity was observed in 64% of patients. The Chemotherapy Risk Assessment Scale for High‐Age Patients (CRASH) score was constructed along 2 subscores: H toxicity and NH toxicity. Predictors of H toxicity were lymphocytes, aspartate aminotransferase level, Instrumental Activities of Daily Living score, lactate dehydrogenase level, diastolic blood pressure, and Chemotox. The best model included the 4 latter predictors (risk categories: low, 7%; medium‐low, 23%; medium‐high, 54%; and high, 100%, respectively; P_trend < .001). Predictors of NH toxicity were hemoglobin, creatinine clearance, albumin, self‐rated health, Eastern Cooperative Oncology Group performance, Mini‐Mental Status score, Mini‐Nutritional Assessment score, and Chemotox. The 4 latter predictors provided the best model (risk categories: 33%, 46%, 67%, and 93%, respectively; P_trend < .001). The combined risk categories were 50%, 58%, 77%, and 79%, respectively; P_trend < .001). Bootstrap internal validation and independent sample validation demonstrated stable risk categorization and P_trend < .001.

CONCLUSIONS:

The CRASH score distinguished several risk levels of severe toxicity. The split score discriminated better than the combined score. To the authors' knowledge, this is the first score systematically integrating both chemotherapy and patient risk for older patients and has a potential for future clinical application. Cancer 2011. © 2011 American Cancer Society.