Objective To investigate the results of human amniotic membrane(HAM) which are loaded with marrow mesenchymal stem cells(MSCs) and epidermis cells in treating fullthickness skin defect combined with radiation injury. Methods Eight minipigs were used in this study. Three round fullthickness wounds（Ф3.67cm）, which combined with radiation injury, were created on the dorsum of each side close to the vertebral column in each animal. Among 48 wounds, 24 left side wounds were treated with HAM loaded with MSCs and epidermis cells as experimental group (group A), 16 right side wounds with simple HAM (HAM group, group B) and 8 right side wounds with oil gauze as control (group C). The granulation tissue, reepithelization and wound area were observed after 1,2 and 3 weeks. Immunohistochemistry was performed using vWF as a marker for blood vessels.Image analysis was employed to test new area of wound at different interval time and healing rate of wound.Results The healing time of group A was 6 to 7 days faster than that of group C and 5 to 6 days faster than that of group B. After 15-17 days of graft, there were significant differences in new area of wound and healing rate between group A and groups B,C(Plt;001). New epidermis fully covered whole wound surface in group A, and their granulation tissue, which contained a lot of vWF, fibroblasts, capillaries and collagen, grew well. Many inflammatory cells still were seen in groups B and C, and their contents of vWF, fibroblasts, capillaries and collagen in granulation tissue were smaller than that in group A.Conclusion The graft of HAM loaded with MSCs and epidermis cells played an effective role in promoting healing of wound combined radiation injury with high quality.
摘要:目的: 评估手术、栓塞及γ刀综合治疗脑动静脉畸形的疗效。 方法 :回顾性分析了我科自2002年3月至2009年7月期间综合治疗的43例脑AVM患者,分析评估这43例脑AVM的临床特点及治疗效果,随访患者并对其进行GOS评分。 结果 :本组病例采取栓塞＋手术治疗3例、栓塞＋γ刀治疗26例、手术＋γ刀治疗11例、栓塞+手术＋γ刀治疗3例。术后随访28例,随访时间4月至7年6月,GOS评分5分者25例,患者均能重新回到工作或学校;GOS评分4分者2例,患者生活能够自理;GOS评分1分者1例,患者死亡。 结论 :对大型、功能区、有深部静脉引流的脑AVM综合治疗有一定的优越性,它不仅使脑AVM治愈率明显提高,而且与治疗相关的各种并发症和病死率也明显降低。Abstract: Objective: To evaluate the efficacy of multimodality treatment of cerebral arteriovenous malformations(AVMs) with surgery, embolization and γknife radiation. Methods : A retrospective analysis of 43 cases of cerebral AVMs applied with multimodality treatment in our department From March 2002 to July 2009 has been made, meanwhile we have analyzed and assessed the clinical characteristics and treatment outcome of these 43 patients with cerebral AVMs. Results : Patients received multimodality treatment with embolization followed by surgery(n=3), embolization followed by γknife radiation(n=26), surgery followed by γknife radiation(n=11), or embolization, surgery, and γknife radiation(n=3). Postoperative followup of 28 cases, the followup time is 4 months to 7 years and 6 months. GOS score 5 in 25 cases, who can be able to return to work or school. GOS score 4 in 2 cases, who can be able to live independently. GOS score 1 in 1 case, who is dead. Conclusion : In the cerebral AVMs which are large, or located within or immediately adjacent to eloquent regions of the brain, or have deep venous drainage, multimodality treatment has some superiority. It can not only improve the cure rate of cerebral AVMs significantly, but also reduce the treatmentrelated complications and mortality.
Objective To research the effect of γ-radiation released from 103Pd radioactive stent on the expression of Fas gene and its relation with apoptosis of bile duct cancer cells lines. Methods The cancer cells of bile duct were dissociated into suspension in culture flasks, and the number of cells was counted by hemacytometry. The suspension was then stored in 2 ml freezing tubes in the density of 1×105/ml. They were set in two stents: general stent （general stent group） and 103Pd radioactive stent (103Pd stent group). The expression of Fas gene and apoptosis of bile duct cancer cells in general stent group and 103Pd stent group were analysed with immunohistochemistry technique and TUNEL method, respectively. Results The expression level of Fas gene in 103Pd stent group was significantly higher than that in general stent group （P＜0.05）, and the number of apoptotic cancer cells in 103Pd stent group was also significantly more than that in general stent group （P＜0.01）. Conclusion There is a correlation between the expression of Fas gene and the apoptosis of bile duct cancer cells, which means that 103Pd radioactive stent may increase the expression of Fas gene and promote the apoptosis of cancer cells. It may be helpful for the further study of treatment for bile duct cancer using 103Pd radiative stent.
Image-guided radiation therapy using magnetic resonance imaging (MRI) is a new technology that has been widely studied and developed in recent years. The technology combines the advantages of MRI imaging, and can offer online real-time tracking of tumor and adjacent organs at risk, as well as real-time optimization of radiotherapy plan. In order to provide a comprehensive understanding of this technology, and to grasp the international development and trends in this field, this paper reviews and summarizes related researches, so as to make the researchers and clinical personnel in this field to understand recent status of this technology, and carry out corresponding researches. This paper summarizes the advantages of MRI and the research progress of MRI linear accelerator (MR-Linac), online guidance, adaptive optimization, and dosimetry-related research. Possible development direction of these technologies in the future is also discussed. It is expected that this review can provide a certain reference value for clinician and related researchers to understand the research progress in the field.
Objective To evaluate the effectiveness and prognosis of patients in advanced hepatocellular carcinoma (HCC) with portal vein (PV) tumor thrombus received external-beam radiation therapy (EBRT). Methods The clinical data of 126 HCC patients with PV tumor thrombus who were referred for EBRT at our institution from January 2000 to November 2009 were analyzed retrospectively. EBRT was designed to focus on the tumor thrombus with or without primary intrahepatic tumors， to deliver a median total conventional dose of 50 Gy (range of 30-60 Gy). Predictors of survival were identified using univariate and multivariate analysis. Results Unfavorable pretreatment predictors were associated by multivariate analysis with lower albumin and higher α-fetoprotein levels, poorer Child-Pugh liver function classification, poorer intrahepatic tumor control， lymph node metastases， and the two-dimensional EBRT technique. The dose of EBRT showed no significant in both univariate and multivariate survival analysis. Conclusions In patients with HCC， EBRT is effectively prevents progression in cases of PV tumor thrombus， but palliative dose of EBRT is not related to survival.EBRT is not related to survival.
ObjectiveTo observe the effects of endovascular radiation (ER) on the proliferation and apoptosis of medial smooth muscle cells (SMC) and to discuss the possible mechanisms of radiation in the prevention of vascular restenosis (RS) in rabbits after carotid endarterectomy (CEA).MethodsForty rabbits undergoing CEA were randomly divided into four groups (each group=10) and given a radiation dose of 0, 10, 20 and 40 Gy 32P respectively. Rabbits were killed on the 3rd, 7th, 14th, 28th and 56th day after operation. The specimens were collected and histopathologic examinations were done.ResultsProliferation apparently occurred in the intima and media of carotid the lumen became narrow in the control group on the 14 th, 28 th and 56 th day after operation. While in the radiation groups, proliferation was apparently suppressed and the lumen was much less narrowed (P＜0.05). The apoptosis rate of SMCs and PCNA positive cells increased on the 3rd day after operation and reached the peak on the 7th day. There was statistical difference between the ER groups and control group (P＜0.01). The effects were much more evident in 20 Gy and 40 Gy groups compared with 10 Gy group (P＜0.01).ConclusionER may prevent RS by suppressing SMC proliferation and migration as well as inducing SMC apoptosis. The effects are positively correlated with radiation doses. SMC proliferation and apoptosis occur in the early period after balloon injury, while hyperplasia of intima and medial happens later.
ObjectiveTo investigate the effect of Yttrium-90 selective internal radiotherapy (90Y-SIRT) on tumor control and compensatory hyperplasia of left hepatic lobe in the treatment of right hepatic malignant tumor. MethodsThe clinical data of 134 patients with liver malignant tumor (primary or secondary) who were treated with 90Y-SIRT in the Department of Hepatobiliary and Pancreatic Surgery, Beijing Tsinghua Changgung Hospital from September 2022 to November 2023 were collected, and 29 patients who met the inclusion and exclusion criteria were analyzed retrospectively. The liver volume, tumor volume, postoperative future liver remnant (FLR) and the percentage of FLR proliferation before and after treatment were measured by CT or MRI, and the surgical resection rate and pathological necrosis rate of tumor focus after 90Y-SIRT treatment were analyzed. The liver volume, tumor volume, postoperative future liver remnant (FLR) and the percentage of FLR hyperplasia were measured by CT or MRI before and 1 and 3 months after 90Y-SIRT, and the surgical resection rate and pathological necrosis rate of tumor lesions after 90Y-SIRT treatment were analyzed. ResultsOf the 29 patients, 22 patients with hepatocellular carcinoma, 2 patients with cholangiocarcinoma and 5 patients with liver metastases from colorectal cancer received 90Y-SIRT of the right liver. At 1 and 3 months after treatment, the tumor volume average decreased by 149.2 mL (P=0.124) and 228.2 mL (P=0.012), the right liver volume was average reduced by 197.4 mL (P=0.026) and 318.6 mL (P=0.023), the left liver volume average increased by 64.9 mL (P=0.261) and 144.7 mL (P=0.124), and the percentage of FLR increased by 6.6% (P=0.018) and 13.4% (P＜0.001) of 29 patients, respectively. Three months after operation, mRECIST standard was used to evaluate the curative effect of tumor imaging. The results showed that the objective response rate of tumor was 79.3% and the disease control rate was 93.1%. Conclusions90Y-SIRT can effectively control the growth of malignant tumors in the right lobe of the liver and induce compensatory hyperplasia of the left liver. At the same time, high objective response rate and pathological necrosis rate of tumor lesions can be obtained.
ObjectiveTo investigate the short-term therapeutic effect of neoadjuvant immunotherapy combined with chemotherapy in the locally advanced esophageal squamous cell carcinoma. MethodsThe clinical data of patients with esophageal squamous cell carcinoma treated with neoadjuvant treatment in Gaozhou People's Hospital from August 2019 to October 2020 were retrospectively analyzed. According to the different treatments, the patients were divided into two groups: a neoadjuvant immunotherapy combined with chemotherapy group (NIC group) and a neoadjuvant chemoradiotherapy group (NC group). The baseline data, incidence of adverse events during treatment, perioperative indicators, postoperative pathological remission rate and incidence of postoperative complications were compared between the two groups. ResultsTotally 33 patients were enrolled, including 15 males and 18 females, with an average age of 62.37±7.99 years. There were 17 patients in the NIC group and 16 patients in the NC group. In the NIC group, the carcinoma was mainly located in the middle and lower esophagus, with 5 paitents in stage Ⅱ, 9 patients in stage Ⅲ, and 3 patients in stage Ⅳa. In the NC group, the carcinoma was mainly located in the upper-middle esophagus, with 1 patient in stage Ⅱ and 15 patients in stage Ⅲ. During the neoadjuvant treatment, there was no significant difference in the occurrence of bone marrow suppression or gastrointestinal reactions between the two groups (P>0.05). There were 4 immune-related rashes in the NIC group and 1 esophageal perforation in the NC group. Fourteen (82.35%) patients in the NIC group and 12 (75.00%) patients in the NC group completed the operation on schedule. The postoperative ICU stay time and chest tube indwelling time in the NIC group were shorter than those in the NC group (P<0.05). There were 5 patients of complete remission in the NIC group, and 6 patients in the NC group. There was no significant difference in the pathological regression grade or residual tumor cells between the two groups (P>0.05). There was no significant difference in the incidence of anastomotic fistula, thoracic gastric fistula, bronchial mediastinal fistula, abdominal distension, pulmonary infection, stroke, or hoarseness during the perioperative period between the two groups of patients who completed the operation (P>0.05). In the NC group, 2 patients died during the perioperative period because of thoracic gastric fistula complicated by severe infection. ConclusionNeoadjuvant immunotherapy combined with chemotherapy dose not significantly increase the occurrence of adverse events and shows a good rate of pathological remission, which indicates that the neoadjuvant immunotherapy combined with chemotherapy is a safe, feasible and potential new treatment model.
With the publication of several phase Ⅱ and Ⅲ clinical studies, the multidisciplinary diagnostic and therapeutic strategies for early resectable non-small cell lung cancer (rNSCLC) are rapidly evolving. These studies have elucidated the significant effects of neoadjuvant and adjuvant therapies on improving the prognosis of rNSCLC patients, while also highlighting the urgent need to revise and refine corresponding treatment protocols and clinical pathways. In response, the International Association for the Study of Lung Cancer has assembled a diverse, multidisciplinary international expert panel to evaluate current clinical trials related to rNSCLC and to provide diagnostic, staging, and treatment recommendations for rNSCLC patients in accordance with the 8th edition of the AJCC-UICC staging system. The consensus recommendations titled "Neoadjuvant and adjuvant treatments for early stage resectable non-small cell lung cancer: Consensus recommendations from the International Associationfor the Study of Lung Cancer" outline 20 recommendations, 19 of which received over 85% agreement from the experts. The recommendations indicate that early rNSCLC patients should undergo evaluation by a multidisciplinary team and complete necessary imaging studies. For stage Ⅱ patients, consideration should be given to either adjuvant therapy following surgery or direct neoadjuvant/perioperative treatment, while stage Ⅲ patients are recommended to receive neoadjuvant chemoimmunotherapy followed by surgery. Postoperatively, adjuvant immunotherapy should be considered based on the expression levels of programmed cell death ligand 1, along with testing for other oncogenic driver mutations. For patients with epidermal growth factor receptor or anaplastic lymphoma kinase mutations sensitive to tyrosine kinase inhibitors, corresponding adjuvant targeted therapy is recommended. These recommendations aim to provide personalized and precise treatment strategies for early rNSCLC patients to enhance the efficacy of neoadjuvant and adjuvant therapies. This article provides an in-depth interpretation of these consensus recommendations.
ObjectiveTo study the examinees' cognitive level of the X-ray radiation, and to provide references for popularizing radiation protection knowledge. MethodWe chose patients who were checked in the Department of Radiology in our hospital between August 30 and October 29, 2013 as our study subjects, and carried out investigation by anonymous questionnaires. The investigation content included the respondents' basic information, ways to obtain the radiation knowledge, how well the patients knew about the fundamental radiation knowledge and their attitudes towards radiological examination and so on. A total of 2 315 patients were investigated, and 2 315 questionnaires were issued. Finally all questionnaires were retreated. ResultsAmong the 2 315 patients, 2026 (87.52%) knew the radiation symbol and 1 821 (78.66%) knew that X-ray radiation was harmful to the human body. Different age, gender, occupation, educational level and previous X-ray examination made significant differences in the fundamental knowledge on X-ray (P<0.05) . Attitudes towards X-ray examination was significantly different due to different age, occupation, and educational level (P<0.05) . Most examinees got the X-ray fundamental radiation knowledge from the publicity and medical staff in hospitals. ConclusionsTo make the examinees keep right attitudes and behaviors in radiographic examination, further effective methods of popularizing the basic knowledge of radiation should be carried out. Those publicity and medical staff in hospitals are the main force in the popularization of radiation knowledge.