Brachytherapy: An emblematic example of extreme hypofractionated regimen

In order to provide more convenient irradiation regimens for patient comfort, radiation facility organization and health expenses, new hypofractionated protocols have been evaluated. Moderately (dose/fraction: 2.3 to 3 Gy), then ultra (dose/fraction: 5.2 to 6.1 Gy) hypofractionated irradiations were first validated. The current question is: is it possible to go forward using extreme hypofractionated regimens (EHR) based on 1 to 3 fractions. Different irradiation techniques are under investigation. However, brachytherapy remains the smartest way to deliver a high dose in a small volume. We report prospective and retrospective study results which evaluated EHR for breast and prostate brachytherapy. While oncological outcome and toxicity profile appear extremely encouraging for low-risk breast cancer after a 1 to 4 fractions (6.25 to 20 Gy/fraction), the use of a single fraction of 19 to 23 Gy appears debatable for prostate cancer. Brachytherapy represents an emblematic example of EHR but longer follow-up and more mature results are awaited in order to specify the right indications and refine the EQD2 calculation method including new biological and technical factors.     

中西医结合要为妇女生殖健康创新页

45年来,复旦大学妇产科医院在中西医结合临床及科研方面取得了可喜的成就.针刺促排卵的研究,通过观察血雌激素和中枢β-内啡肽(β-EP)的关系,提出了针刺通过耗竭中枢β-EP而促排卵的新认识,认为针刺促排卵的主要适应症是青春期月经失调,并将针刺成功地应用于治疗神经性厌食;补肾化痰的俞氏温补方治疗多囊卵巢综合征(polycystic ovary syndrome, PCOS)被证实是通过提高血促卵泡激素(follicle stimulating hormone, FSH)并诱发排卵而起作用;益肾化瘀的天癸方是通过降低患者及动物模型的雄激素和胰岛素,引起以中枢阿片促黑激素皮质素原、神经肽Y和瘦素受体为主的神经-内分泌-代谢网络调节而发挥促排卵和减肥作用,对高胰岛素型PCOS有良效,并在研究中提出了对PCOS分类的新设想;益肾清火的更年春通过提高中枢与周围组织的雌激素受体及其mRNA表达来调节围绝经期妇女的神经-内分泌-免疫-代谢网络而获优越疗效.这些研究表明,疾病是外环境影响下患者生命网络的某些主脉失调所致,而且亚健康状态的妇女具有初步网络失控的现象,中西医结合将为女性生殖医学研究找到捷径,调控生命网络是防病治病的主要思路.     

Limites et dangers des DSM

The publication of the DSM-III rating scale in 1980 marked a definite turning point in the development of modern psychiatry. For those responsible for elaborating it, it appeared to have resulted in psychiatry being accepted as a science. However, this was at the expense of eliminating the subjective aspect, both that of the patient and that of the clinical practitioner. As a result of this, it was possible to utilize a common language which permitted high inter-scoring diagnostic accuracy. The success of the DMS-III and IV is based on their affinity with scientific ideals, and with their association with clinical medication. In focusing on target symptoms devoid of all dynamism, they implicitly relate them to bodily dysfunctions. Twenty years after the introduction of this approach presented as being atheoretical, its main justification, i.e. diagnostic accuracy, has been shown to be ill-founded, while the problems of diagnostic validity are eluded. The DSM scales have relegated mental disorders to being infinitized, and the pursuit of this approach could eventually lead to treatment by computerized psychiatry. These rating scales also lead to an impoverishment of clinical consultations; they do not take into account the possible reticence of the patient; and they generate implicit normative ideals. Even amongst their proponents, certain individuals are beginning to see that they could constitute a serious disadvantage to the progress of psychiatry.     

Bases anatomiques de la mémoire

Résumé Les données cliniques et anatomo-pathologiques ont permis de suggérer le rôle du circuit hippocampo-mamillo-thalamique dans certains processus mnésiques. Récemment des critiques ont été apportées mettant en cause le rôle même de ce circuit et impliquant d'autres formations: hile du lobe temporal; noyau médio-dorsal du thalamus, amygdale. L'étude des relations anatomiques précises du circuit hippocampo-mamillo-thalamique permet de montrer l'importance dans le circuit lui-même de certaines formations comme le subiculum et l'aire entorhinale. Par ailleurs, ce circuit s'intègre totalement au sein du système limbique au sens large, tel que l'a défini Nauta (1961) et par là à des structures comme l'amygdale, le noyau médio-dorsal du thalamus, le cortex orbito-frontal, le septum et la réticulée mésencéphalique.Mais au sein même de ce système limbique, il semble exister une spécificité de relation des éléments en rapport avec le circuit hippocampo-mamillo-thalamique.Enfin, le circuit HMT ne peut pas se concevoir comme restreint au système limbique. Il est en relation étroite avec l'ensemble du cortex et particulièrement avec le cortex frontal, ce que rappellent les désordres mnésiques entraînés par les lésions de cette région.Le circuit HMT n'est donc pas la mémoire mais reste un modèle et un point de départ utile sinon indispensable dans son étude.     

精制蝮蛇抗栓酶加优降糖治疗Ⅱ型糖尿病临床观察

为使Ⅱ型糖尿病及有关并发症的治疗达到简便、适用和良好的效果 ,该研究采用了精制蝮蛇抗栓酶加优降糖治疗Ⅱ型糖尿病 ,并与优降糖治疗组对照 ,3wk一疗程 ,两组病例各 5 5例。结果治疗组总有效率 87 3% (48/5 5 ) ,对照组总有效率6 7 3% (37/5 5 )。经统计学处理 ,P <0 0 5 ,两组疗效有显著性差异 ,该疗法减少了口服降糖药的用量 ,避免了胰岛素的不良反应 ,有利于有关并发症的改善 ,无明显副作用发生 ,疗效确实。     

短期使用苯那普利对肾小球滤过膜通透性的影响

目的 :研究肾小球滤过膜对不同分子量蛋白质通透性能对苯那普利短期治疗的反应性。方法 :根据聚丙烯酰胺凝胶电泳和 2 4小时尿蛋白定量 ,计算出大分子量和中分子量尿蛋白排泄量。口服苯那普利 10mg/d ,共两天 ,测定用药前后2 4小时尿蛋白总量、尿蛋白圆盘电泳、平均动脉血压等。结果 :用药后大分子尿蛋白、平均动脉血压明显降低 ( 1.15± 0 .89)g/ 2 4hvs ( 0 .84± 0 .74)g/h ,P <0 .0 1;( 14 .19± 1.96)kPavs ( 12 .76± 1.12 )kPa ,P <0 .0 1) ,2 4小时尿蛋白总量、中分子尿蛋白数减少无显著性 ( 3 .16± 2 .2 4)g/ 2 4hvs ( 2 .83± 2 .2 7) g/ 2 4h ,P >0 .0 5 ;( 1.72± 1.2 2 )g/ 2 4hvs ( 1.62± 1.47) g/ 2 4h ,P >0 0 5 )。结论 :短期使用苯那普利可改善肾小球滤过膜对大分子蛋白的通透性。     

亚甲蓝注射前哨淋巴结活检对乳腺癌腋窝淋巴结转移状态的预测价值

目的 :探讨亚甲蓝法前哨淋巴结活检 (SLNB)对乳腺癌腋窝淋巴结 (ALN)转移状态的预测价值 ,为乳腺癌选择性腋窝淋巴结清扫 (ALND)提供科学依据。方法 :选择T1 2 N0 M0 、个别T3N0 M0 g乳腺癌患者 64例 ,1%亚甲蓝 2ml(总剂量 )四点法注射于肿瘤覆盖皮肤之皮内 ,5分钟后进行淋巴结活检 ,随后行不同方式根除术。所有前哨淋巴结 (SLN )术中冷冻病理检查 ,所有SLN和非SLN均再行常规病理学检查。结果 :SLN检出成功率为 85.9%(55/ 64) ;SLNB预测ALN转移的准确性为 96.4% (53 / 55) ,灵敏度为 90 .9% (2 0 / 2 2 ) ,特异性为 10 0 % (3 3 / 3 3 ) ,假阴性率为 9.1% (2 / 2 2 ) ,总的阳性、阴性预测值分别为 10 0 % (2 2 / 2 2 )和 94.3 % (3 3 / 3 5)。切除SLN和非SLN中转移淋巴结所占的比例分别为 2 9.4%和 8.3 % (χ2 =41.493 ,P <0 .0 1)。结论 :亚甲蓝法SLNB能准确预测ALN的转移状态 ;淋巴管示踪成功和学习曲线影响SLN检出成功率 ;SLN变异、肿瘤转移、检出不彻底等可使活检出现假阴性