目的:分析儿童间变性大细胞淋巴瘤(ALCL)的临床特点、诊断标准和治疗方法,提高临床医生对该病的诊疗水平.方法:回顾性分析1例ALCL患儿的临床资料,包括临床症状、体征、辅助检查、诊断依据、鉴别诊断、治疗方案和疾病转归等,并结合文献复习总结该病的诊治要点.结果:该患儿以颈部淋巴结进行性增大为主要症状就诊,查体口唇殷红,表皮皲裂;周身皮肤干燥,以双手为著,掌心可见皲裂,指端可见膜状脱屑;双颈部见多个肿大淋巴结,边界不清,活动度差,伴压痛;舌乳头呈草莓舌.活检病理,ALK阳性ALCL;骨髓涂片未见异常;骨髓免疫分型、外周血免疫分型和脑脊液免疫分型均可见异常表型T淋巴细胞.按照《国际儿童非霍奇金淋巴瘤分期系统(2012年)》,该患儿明确诊断为ALK阳性ALCL(Ⅳ期,R3组).给予APO方案诱导化疗后评估患者病情达部分缓解(PR),更换治疗方案为B-NHL BFM 90方案;经过1个周期改良AA方案治疗后,患者骨髓和外周血免疫分型均转阴.结论:ALCL患儿的临床表现多样化,淋巴结活检是确诊ALCL的唯一依据,在明确诊断前不应盲目使用激素.

放射性肺损伤(RILI)是胸部肿瘤接受放疗时的主要并发症,临床上仍缺乏治疗该病的有效方法.脂肪间充质干细胞(AD-MSCs)具有多向分化潜能,体外较易分离、纯化和扩增,临床治疗中易实现自体移植.近年来研究证实:干细胞移植对各种肺损伤有较好的修复作用,但目前国内外学者就骨髓、脐带等干细胞治疗肺损伤的研究相对较多,而有关AD-MSCs治疗肺损伤的研究报道较少.本文就RILI发病机制、干细胞对肺损伤的修复机制及国内外研究现状做系统回顾,并对自体AD-MSCs在RILI治疗中的应用展望进行综述.

Objective To explore the effect of wortmannin (WM),an inhibitor of PI3K signalingpathway,on the radiation sensitivity of human malignant glioma cells (U251) and the underlyingmechanism.Methods U251 cells were pretreated with 10 μmol/L WM for 2 h and irradiated with 10 GyX-rays,then the activity of PI3K/Akt signaling pathway,the colony-forming ability and apoptosis weredetected to evaluate the effect of WM on radiosensitivity.The protein expressions of cleaved Caspase-3,Bax,Bcl-2 and XIAP were detected with Western blot assay.Results The expression of phospho-Akt wassignificantly inhibited by the pretreatment of cells with 10 μ mol/L WM (t =0.000 1,P ＜0.01).The ratioof apoptotic cells in the WM + IR group was significantly increased from (2.14 ± 1.32)％ of control groupand (11.5 ±2.9)％ of IR group to (22.6 ±3.8)％ (t =0.009 3,0.002 7,P＜0.01).The colony-forming rate of WM + IR group was decreased from (88.54 ± 4.76) ％ of control group and (56.31 ±4.05)％ of IR group to (12.25 ±9.59)％ significantly (t=0.000 03,0.000 2,P＜0.01) accompaniedwith the increases of Caspase-3 and Bax/Bcl-2 but decrease of XIAP.Conclusions WM significantlyincreased the radiation sensitivity of human malignant glioma cells by inhibiting the activity of PI3Ksignaling pathway and the expressions of Bcl-2 and XIAP and activating Caspase-3 and Bax.

Objective To assess the therapeutic effect of human adipose-derived mesenchymal stem cells on radiation-induced vascular injury in the small intestine of rat. Methods A total of 34 male Sprague-Dawley rats were enrolled in this study. To establish a model of radiation-induced intestinal injury, each rat was irradiated with 15 Gy in whole abdomen. 17 rats were randomly selected and infused intraperitoneally with passage 6 ( P6 ) Ad-MSCs, and the other 17 rats that received PBS were set as control. 10 days post-irradiation, the number of CD31+ endothelial cells in the small intestine villus was measured by flow-cytometry, the expressions of CD31, CD105 and isolectin-B4 in the na?ve endothelial cells with detected by IHC-staining, and the vascular integrity was evaluated by measuring VE-Cadherin. The origination of na?ve endothelial cells within injured intestine was also analyzed. In addition, total mRNA were extracted from irradiated small intestine to assay the expressions of VEGF, bFGF, Flk-1 and SDF-1 using quantitative Real-time PCR. Results Compared to the control, the amount of CD31-postive endothelial cells within irradiated intestine was significantly increased after Ad-MSCs infusion ( t=12?15, P<0?05). The microvascular density in the injured sites was also significantly increased by the infusion of Ad-MSCs (20 d:t=10?33, P<0. 05;30 d:t=32?85, P<0?05). Moreover, the expressions of VEGF, bFGF, Flk-1 and SDF-1 were significantly up-regulated after delivery of Ad-MSCs ( VEGF:t =10?34, bFGF:t=11?25,Flk-1:t=6?73, SDF-1:t=6?73, all P<0?05), which was beneficial in maintaining the integrity of intra-villus blood-vessels as well as promoting neovascularization in the injured sites. Conclusion Ad-MSCs had potentials in healing radiation-induced vascular injury in rat small intestine.

Objective To evaluate the therapeutic effect of human adipose-derived stem cells (ADSCs) on healing intestinal epithelium after abdominal irradiation.Methods A total of 40 SpragueDawley rats were irradiated to the whole abdomen with a single dose of 15 Gy.17 rats were randomly selected and infused intraperitoneally with 5 × 106 Passage 6 ADSCs,and 17 rats that received abdominal irradiation alone were set as control,6 rats were set as normal control.At 10 d post-irradiation,3 rats from each group were randomly selected and terminated.Freshly isolated small intestinal tissues were used for pathological analysis and EGF,KGF,E-cadherin,Bcl-2 and BAX mRNA levels analysis,and life-span and survival of rats were also analyzed.Results Compared to the control,infusion of ADSCs maintained the integrity of irradiated epithelium with more proliferative epithelial cells(t =18.30,P ＜ 0.05)and less apoptotic cells(t =-32.48,P ＜ 0.05).Besides,the rats receiving ADSCs-infusion survived longer than the control(t =5.99,P ＜ 0.05).Conclusions ADSCs can have therapeutic effect on healing radiationinduced intestinal epithelium injury.

1 病历摘要 患者,男,因髓母细胞瘤(MB)术后1年,放疗后7个月余,右侧臀部疼痛2个月入院.该患2011年8月因头晕、恶心及呕吐1个月就诊于我院,入院时意识清楚,查体配合,颈软,双侧瞳孔等大等圆,对光反射灵敏,指鼻试验左侧欠稳准,小脑性步态,左上肢不自主抖动.核磁提示小脑上蚓部见2.92 cm×3.46 cm×4.31 cm团块样高信号,轻中度强化,中心可见斑点状无强化区.遂于2011年8月11日行腰大池引流术+幕下开颅肿瘤切除术.术中见肿瘤位于小脑蚓都,约3.0cm ×3.5 crn ×3.5 cm,质软,血运丰富,边界欠清,将肿瘤完整切除.

Objective:To evaluate the performance of RapidArc technique on cervical cancer patients with various filling status of the bladder.Methods:Conventional fixed field intensity modulation radiated therapy(IMRT) is used as the benchmark.In 10 females suffering from cervical cancer,two CT scans were performed for treatment planning:one with an empty bladder and the other with filled bladder.The prescribed dose was 50 Gy.The images of that with an evacuated bladder and that with filled bladder were planned in the dual-arc RapidArc and the 7-field IMRT,respectively.The implementor of the plan was the Varian TrueBeam linear accelerator.Dose-volume histogram was used to evaluate the data from each plan.Results:When the bladder was filled,IMRT and RapidArc homogeneity were 1.05 and 1.04(P>0.05),respectively.When the bladder was emptied,the homogeneity was 1.04 for both plans(P>0.05).With or without bladder filling,the conformity index was 0.71 and 0.73 for IMRT and RapidArc(P>0.05),respectively.The effect of V30 and V40(volume for receiving doses of 30 and 40 Gy) on the intestine and the bladder was more favorable in a full than in an empty bladder.No significant difference between the two plans was observed.IMRT exhibited improved V30 on the rectum and on the bladder.RapidArc was much better in terms of monitor unit(MU) and deliver time.Conclusion:No significant differences in the homogeneity and conformity index between dual-arc RapidArc and 7-field IMRT were observed.Filled bladder is better than empty bladder in intestine and bladder protection in both RapidArc and IMRT.IMRT is better on V30 of the rectum and the bladder,whereas RapidArc improved MU and deliver time.