雷达辐射对精液质量的影响

目的:研究雷达辐射对男性精液质量的影响。方法:①以35例非海员职业正常男性为对照组1,分析252例接受雷达辐射的海员精液常规变化情况;②以252例海员(对照组2)和对照组1为对照组分析96例解除雷达辐射后6～12个月海员的精液常规变化情况。结果:在精子密度、精子活动率及a级精子百分率,雷达辐射组极显著低于对照组1(P<0.01),而d级精子百分率和畸形精子百分率极显著高于对照组1(P<0.01);解除雷达辐射后恢复极明显的是精子的形态(P<0.01),精子活动率也有显著的恢复(P<0.05),但与对照组1相比,精子密度仍有显著差异(P<0.05),精子活动率、a级精子百分率、d级精子百分率和畸形率仍有极显著差异(P<0.01)。结论:雷达辐射对男性精液质量有一定影响;其主要表现在精子运动能力降低和精子畸形率升高;停止雷达辐射后精子的形态较容易恢复。     

Clinical Course and Autopsy Findings of a Patient with Clival Chordoma Who Underwent Multiple Surgeries and Radiation during a 10-Year Period.

The management of clival chordoma remains problematic. We present the case of a 48-year-old woman with clival chordoma who underwent multiple surgeries and radiation therapy, including gamma knife stereotactic radiosurgery (GK-SRS), during a 10-year clinical course. The tumor was initially removed by gross total resection via the trans-sphenoidal approach, followed by external linac radiation therapy. The tumor recurred at the clivus 5 years after the initial operation. After repeated trans-sphenoidal removal of recurrent tumors, she twice underwent GK-SRS for a tumor remnant adjacent to the brainstem. Although this part of the tumor was controlled by GK-SRS, there was further tumor extension toward the sphenoid and maxillary sinuses. Ultimately, lower cranial nerve dysfunction developed due to tumor extension into the lower part of the clivus and the patient died of respiratory failure. Autopsy revealed the tumor to extend from the lower clivus to the bilateral middle fossae. The lower part of the tumor extended to the nasal cavity and to the posterior wall of the pharynx, resulting in compression of the upper pharyngeal region. The tumor around the jugular foramen compressed the lower cranial nerves bilaterally. Tumor cells did not, however, invade the intradural space microscopically. Although chordoma is not biologically malignant, this tumor can show massive extension with destruction of bony structures and extracranial invasion of connective tissues. Therefore, the optimal treatment strategy is to remove the tumor mass as extensively as possible, including normal bony structures and connective tissues surrounding the tumor, using skull base surgical techniques.     

四肢恶性黑色素瘤28例的治疗回顾分析

目的:讨论恶性黑色素瘤的治疗方法及预后。方法:回顾分析笔者科室2008年1月~2011年12月收治的28例四肢恶性黑色素瘤患者,其中男性13例,女性15例,年龄最大者68岁,年龄最小者25岁,平均年龄43岁,发生于上肢者10例,发生于下肢者18例。所有病例均经病理证实为恶性黑色素瘤。入院后未行手术治疗者先取活检,术中切口距病灶缘约1cm,病检结果证实为恶性黑色素瘤后即行扩大切除术。已行手术者行原切口缘扩大切除术,距原切口缘3~5cm,术后行放化疗。结果:28例患者术后切口均I期甲级愈合,术后随访2年,21例患者未出现病灶复发,生存质量良好。7例因肿瘤复发或转移死亡。结论:恶性黑色素瘤患者的治疗选择扩大切除,辅以术后放化疗是一种有效的方法。     

放射性肠炎继发肠梗阻特点及处理要点

放射性肠炎是腹、盆腔恶性肿瘤经放射性治疗后引起的常见消化道并发症,随着放疗病人的增多及生存时间的延长,放射性肠炎的发病率也有所增加。依据组织病理学和临床表现的差异,放射性肠炎可分为急性放射性肠炎和慢性放射性肠炎,其中约 1/3 的慢性放射性肠炎病人需要手术治疗,放射性肠炎继发肠梗阻的手术目的是解除梗阻、恢复肠道功能、防止复发。目前,放射性肠炎合并肠梗阻治疗的总体原则是行确定性的病变肠管切除和消化道重建手术。对于并发急性肠梗阻的病人,应积极采取非手术措施将急诊手术转化为择期或限期手术,降低手术风险、减少术后并发症。此外,由于慢性放射性肠炎病人出现营养不良风险较高,围手术期应进行合理的营养支持。     

Post‐mastectomy radiation in node‐positive breast cancer in Ontario

More recent guidelines are more supportive for post‐mastectomy radiation in all node‐positive breast cancer patients. We examined the rate and predictors of post‐mastectomy radiation receipt in Ontario Canada from 2010 to 2014. Of 6535 node‐positive post‐mastectomy patients, 73.9% received radiation. The rate was 68.7% (2903/4227) among women with 1‐3 positive nodes. Radiation was less likely to be administered to women who were older, had high levels of comorbidity, or presented with early stages of breast cancer. Regional practice variation was reassuringly modest.     

电离辐射对沉默ATRX的HeLa细胞DNA损伤修复的影响

目的：靶向沉默宫颈癌HeLa细胞中α-地中海贫血/精神发育迟滞综合征X染色相关蛋白（ATRX）,检测电离辐射对ATRX、γH2AX和Rad51蛋白表达及γH2AX和Rad51焦点数的影响,探讨ATRX参与辐射后HeLa细胞DNA损伤修复的作用。方法： 3条ATRX-shRNA和阴性对照（Control-shRNA）的慢病毒载体转染293T细胞,收集慢病毒并感染HeLa细胞,利用puromycin筛选获得稳定沉默ATRX的细胞系,分别命名为shA₁-HeLa、shA₂-HeLa、shA₃-HeLa和shCon-HeLa,采用Western blotting法检测沉默ATRX效率以及电离辐射后ATRX、γH2AX和Rad51蛋白的表达,采用免疫荧光技术观察shCon-HeLa和shA₁-HeLa组中γH2AX和Rad51焦点并计数其数量。结果： shCon-HeLa细胞中可见ATRX蛋白表达,而shA₁-HeLa、shA₂-HeLa和shA₃-HeLa细胞中均无ATRX蛋白表达,表明沉默效率较高。在2和8 Gy剂量照射后1、6和24 h,shCon-HeLa组ATRX蛋白表达量逐渐升高,24 h时表达量最高,且8 Gy照射后1、6和24 h表达量均较高。4 Gy照射后0~6 h,与shCon-HeLa组比较,shA₁-HeLa组γH2AX焦点数在1 h明显升高（P<0.05）,而后逐渐降低,但在6 h焦点数仍明显高于shCon-HeLa组（P<0.01）;Rad51焦点数与γH2AX焦点数变化相一致,与shCon-HeLa组比较,shA₁-HeLa组Rad51焦点数在1 h明显升高（P<0.05）,在6 h时shA₁-HeLa焦点数仍明显高于shCon-HeLa组（P<0.01）。4 Gy照射后0~16 h,shA₁-HeLa组细胞中γH2AX和Rad51蛋白表达量均较shCon-HeLa组增加。结论：成功获得稳定沉默ATRX的HeLa细胞模型,电离辐射可诱导ATRX蛋白表达量增加,且沉默ATRX的HeLa细胞中γH2AX和Rad51焦点数及蛋白表达量均高于对照组,提示ATRX参与了辐射诱导的DNA损伤修复过程。     

同步辐射X线相衬成像对裸鼠胰腺癌的早期诊断

目的 通过建立裸鼠胰腺癌模型,结合磁共振成像（magnetic resonance imaging,MRI）,探讨同步辐射X线相衬成像技术对胰腺癌的早期诊断。方法 32只nu/nu雌鼠,采用数字表法随机分为A、B两组：A组（n=24）为人胰腺癌细胞PANC-1胰腺原位移植瘤组,即于胰腺被膜下注射10⁸×2 μL单细胞悬浮液;B组（n=8）为空白对照组,即于胰腺被膜下注射2 μL 0.9%（质量浓度）氯化钠注射液。再根据术后1、2、3、4周处理时间的不同,将A、B两组分为4个亚组,即A1、A2、A3、A4（n=6）和B1、B2、B3、B4（n=2）。术后分别行MRI扫描、肿瘤标本相衬成像及病理学检查。结果 ①A组术后平均成瘤率73%（16/22）,术后4周成瘤率最高,达到100%,成瘤率随观察时间的延长而升高,二者之间存在线性趋势关系（χ_线性趋势²=4.718,P=0.030）;病理组织学检查为胰腺低分化腺癌。②同步辐射X线相衬成像可显示直径为0.5 mm的胰腺原位肿瘤,早期（两周）的灵敏度和特异度达到100%,明显高于MRI扫描（P=0.029）。结论 PANC-1细胞原位移植是建立裸鼠胰腺癌模型的可靠方法;与MRI相比,同步辐射X线相衬成像能发现胰腺癌微小病变,有可能为胰腺癌的早期诊断提供了一种全新的技术手段。