人工肘关节置换史终末期肘关节疾病有效的治疗方法.其主要应用于类风湿、床上、骨肿瘤等原因破坏的肘关节.通过假体置换达到缓解疼痛,并恢复肘关节功能的目的.肘关节的解剖特点特殊,个体差异大.现有的肘关节假体存在解剖匹配度差,机械性能低等问题.3D打印技术在骨科的应用,给肘关节假体带来新的革新.本文拟对我院开展的世界首例3D打印肘关节做初步报告.

目的 探讨容积弧形调强放疗技术(VMAT)联合替莫唑胺与单纯VMAT治疗脑转移癌的临床疗效.方法 93例脑转移癌患者按照治疗方案分成两组,对照组予单纯VMAT放疗,观察组予VMAT联合替莫唑胺治疗,根据治疗结束后影像学检查病灶变化情况判断治疗效果.结果 对照组缓解率、总有效率显著低于观察组(P<0.05).两组不良反应发生率比较差异无统计学意义(P>0.05).结论 VMAT联合替莫唑胺化疗治疗脑转移癌临床疗效显著,不良反应轻且可耐受.

1病例资料患者,男,29岁,1年前无明显诱因出现左眼视力下降,左侧眼球突出,并且逐渐加重,左眼视物不见10余天。眼科检查:右眼视力0.4,左眼视力无光感。左眼球突出,角膜透明,瞳孔扩大,直径约6mm,直接对光反射消失,间接对光反射灵敏。左眼眼底视乳头色淡,界清,C/D=0.6,血管走行及比例大致正常,黄斑中心凹反射清。眼多排CT平扫:左侧额颞部颅板下方及眼眶内见不规则形软组织密度影,大小

病例介绍 男性患者,65岁,因"排粪困难、粪形变细伴血便2月,检查发现直肠癌伴多发肝转移" 于2012年8月13日收入吉林大学第一医院肿瘤中心肿瘤内科. 患者入院前2个月无明显诱因出现排粪困难、粪形变细,以为便秘,未特殊诊治;后逐渐出现粪便表面带血,呈鲜红色,无黏液或脓液.发病以来无恶心、呕吐、腹痛、腹泻等症状,体质量无明显减轻. 既往体健,无肿瘤家族史. 入院查体:一般状态尚可,浅表淋巴结未触及;腹部平坦,无胃肠型和蠕动波,无压痛,未触及腹部肿块,移动性浊音(-). 直肠指诊:距肛门6 cm处可触及一质硬肿物, 环周生长, 退指指套染血. 体力状况ECOG评分1分. 营养状态评估PG-SGA 2分,无明显营养不良. 实验室检查:血常规和血生化:未见异常.

Objective:To explore the dose distribution characteristics between RapidArc and five-field intensity modulated radiotherapy(5F-IMRT) plans in the treatment of locally advanced pancreatic carcinoma,and to provide reference for selecting the appropriate radiation technique in clinic.Methods:Ten patients with locally advanced pancreatic carcinoma were selected.The patients were scanned by simulation CT, and the targets and organs at risk were contoured. RapidArc plan and 5F-IMRT plan were designed respectively.The treatment time and the differences of dose distribution in the targets and organs at risk of RapidArc and 5F-IMRT plans were compared.Results:The conformal index (CI) of RapidArc plan was superior than that of 5F-IMRT plan(P=0.01).The homogeneity index (HI) of targets were similar between two plans (P>0.05).RapidArc plan decreased the maximum dose (Dmax) of the spinal cord(P=0.005);RapidArc plan decreased the mean dose(Dmean) of stomach(P=0.019);5F-IMRT plan decreased the V20 of kidney(P=0.043);RapidArc plan decreased the mean dose(Dmean) of small intestine(P=0.011).The small intestine V10 and V20 of RapidArc plan were lower than those of 5F-IMRT plan(P=0.015,P=0.14);the monitor unit (MU) of RapidArc plan was significantly lower than that of 5F-IMRT plan,with a 18% reduction from the MU level of the latter one,and the treatment time was reduced by 70.3%.RapidArc plan had the smaller doses at liver and kidney compared with 5F-IM RT plan.Conclusion:For the patients with locally advanced pancreatic carcinoma,RapidArc plan has higher CI. RapidArc plan shows the advantages in the protection of organs.Compared with 5F-IMRT,RapidArc plan has less treatment time and significantly improves the curative efficiency.In clinic, the RapidArc plan is recommended.

Recently,immunologists have payed the attention to the effects of ionizing radiation on tumor immunity,and attempted to induce and improve anti-tumor immune effects with it.More and more evidences showed that exact radiotherapy scheme and irradiation dose,particularly combined with immunotherapy,could induce or regulate systemic immune response and contributed to tumor control and inflammatory occurrence.This paper reviewed the effects and mechanisms of radiotherapy on tumor immune and the results in combination with immunotherapy here for guiding the effective combined application of radiotherapy and immunotherapy.

鼻腔－鼻窦恶性肿瘤的发病率相对较低，大约占全部头颈部恶性肿瘤的5％，在所有恶性肿瘤中≤1％〔1〕。这类肿瘤具有多病理类型，发病时往往表现为局部晚期，局部控制失败后常伴有高复发率，导致预后不良。鼻腔－鼻窦恶性肿瘤以上皮来源为主，其中鳞状细胞癌、微小涎腺肿瘤及未分化癌是最常见的肿瘤类型，而非上皮源性的病理类型包括鼻腔神经胶质瘤和恶性黑色素瘤等〔2〕。上颌窦和鼻腔是最易发病部位，其次是筛窦、蝶窦和额窦〔3，4〕，因鼻腔－鼻窦恶性肿瘤常毗邻重要组织结构如眼眶、大脑和颅神经等，同时该类肿瘤的发病原因尚不清楚，导致根除这类些肿瘤时非常困难〔5〕，尚无统一治疗方案。目前常用的治疗手段包括手术治疗、放射治疗及化学治疗等，本研究将鼻腔－鼻窦恶性肿瘤的治疗进展加以总结，以供临床治疗参考。

接受放化疗综合治疗的鼻咽癌患者是营养状态发生变化最高的群体之一[1-3]。恶性肿瘤会导致病人体内营养物质被大量消耗,加上放疗后产生的副反应,如咽喉炎、口腔黏膜损伤、唾液分泌减少等,使病人出现张口困难、摄食量下降;鼻咽癌患者同步铂类药物化疗也会引起恶心、呕吐、食欲下降等不良反应[4]。然而,临床实践中经常是在鼻咽癌患者出现进食受限后给予营养支持治疗,早期营养干预较少。为此,我们以本科收治的鼻咽癌同步放化疗患者为

Objective The purpose of this study is to discuss the regulation of IKKɑon the proliferation and differ-entiation of keratinocytes and its relationship with p63 pathway.Methods The keratinocytes was separated and cul-tured from wild-type (WT-KTC)and Ikkɑknockout mice (Ikkα-/-KTC),and p63 expression was detected by Western blot in those cells.WT-KTC and Ikkα-/-KTC were stimulated with the medium including high calcium (0.5 mM).It was observed and compared between WT-KTC and Ikkα-/-KTC that the expression of Zonula occludens-1 (ZO-1)and BrdU by immunofluorescence staining,as well as p63 expression by Western blot.The proliferation and differentiation of Ikkα-/-KTC under the high calcium condition were evaluated after infected with the lentivirus expressed the p63-spe-cific shRNA.Results Under the normal cultured condition,the BrdU positive ratio of Ikkα-/-KTC and p63 expression were significantly higher than that of WT-KTC.With the high calcium stimulation,the BrdU positive ratio was decreased and ZO-1 expression was detected in WT-KTC,however,there was no ZO-1 expression and no change of the BrdU positive ratio in Ikkα-/-KTC.When the Ikkα-/-KTC were infected with the lentivirus expressed p63-specific shRNA and stimulated with high calcium,the BrdU expression was inhibited,while there was still no ZO-1 expression.Conclusion IKKɑregulates the prolifera-tion and differentiation of keratinocytes,and the effect on proliferation is through p63 pathway.

目的：探讨预注右美托咪定在老年患者麻醉诱导中的应用。方法美国麻醉医师协会（ ASA）Ⅰ～Ⅲ级肺癌患者30例，随机分为右美托咪定组和对照组各15例。右美托咪啶组患者入室后给予复合剂量右美托咪定0．6μg／kg，10 min内泵入。对照组持续泵入等量生理盐水。随后全麻诱导，两组患者全麻诱导方法相同，当脑电双频谱指数（BIS）＜45时插入双腔管，经纤支镜定位后行机械通气。观察给药前（T0）、插管前（T1）、插管后1 min（T2）、插管后3 min （T3）、插管后5 min （T4）各时间点的心率、血压情况；记录两组维持相同麻醉深度的丙泊酚用量，观察并记录麻醉诱导期间的不良反应。结果两组患者T0时间点各项指标无统计学差异（P＞0．05）；与T0比较，两组T1时点收缩压（SBP）、舒张压（DBP）、心率（HR）降低（P＜0．05）；对照组T2～T3时点 SBP 、DBP、HR升高（P＜0．05）；与对照组比较，右美托咪定组T1时点SBP 、DBP升高（P＜0．05），T2～T3时点SBP 、DBP、HR降低（ P＜0．05）；右美托咪定组插管时丙泊酚用量较对照组明显减少（ P＜0．05）；低血压、高血压等不良反应明显减少（ P＜0．05）。结论预注右美托咪定可有效减轻老年患者双腔管插管时心血管反应，维持血流动力学稳定，并缩短丙泊酚诱导的插管时间和减少丙泊酚的用量。

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.

淋巴管肌瘤病（ lymphangiomyoma ，LAM）是一种少见的，由淋巴管及其周围增生的淋巴管及细胞所组成的进行性肿瘤性疾病。 LAM常发生于肺，肺外LAM可见于肠系膜、子宫、阔韧带、网膜及纵隔、腹膜后等部位沿淋巴管分布的淋巴结。累及多部位或广泛发生者，则称为淋巴管肌瘤。原发于肺外的LAM十分罕见，我们报道1例行子宫内膜癌分期手术后偶然发现的、原发于盆腔淋巴结内的肺外LAM，并结合文献对该病的临床病理特点进行总结。

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.

>小细胞肺癌（SCLC）约占肺癌总体发病率的15%[1],其分化程度低,侵袭性强,易早期出现转移。脑转移常是SCLC治疗失败的主要原因。有文献报道,生存期超过2年的SCLC患者,发生脑转移的概率高达50% 8 0%[2]。对放化疗后完全缓解的SCLC患者,行全脑预防性照射（PCI）可降低脑转移的发生率[3]。然而,PCI可能会带来明显的急慢性放疗不良反应,严重影响患者的生活质量[4],常见的有脱发、口干、中耳炎及听力障碍等。如何降低PCI的不良反应,

Objective To evaluate the therapeutic effect of adipose-derived mesenchymal stem cells on radiation enteritis.Methods A total of 52 male Sprague-Dawley rats were used in the present study.Herein,46 rats were randomly selected and irradiated with a dose of 15 Gy at their abdomens.Two hours post-irradiation,23 rats were randomly selected and infused intraperitoneally with adipose-derived mesenchymal stem cells in passage 6 from young-female donor.The other 23 rats were intraperitoneally infused with PBS.The rest 6 rats were set as normal control.During the first 10 days post-irradiation,peripheral blood-samples from irradiated rats were harvested for testing the levels of IL-10 in serum using ELISA assay.Additionally,after isolating the thymic cells and peripheral blood mononuclear cells,the percentages of CD4/CD25/Foxp(3)-positive regulatory T cells in thymus and peripheral blood were tested by flow-cytometry.Finally,infiltration of inflammatory cells and deposition of collagens within irradiated small intestine were analyzed by H&E staining and Masson Trichrome staining,respectively.Based on the MPO-immunohistochemistry staining,the type of infiltrated cells was identified.The Kaplan-Meier method was used for analyzing the survival rate of irradiated rats.Results During a period of 30 days post-irradiation,the irradiated rats receiving adipose-derived mesenchymal stem cells survived longer than those receiving PBS (t =4.53,P ＜ 0.05).Compared to the irradiated rats with PBS-treatment,adipose-derived mesenchymal stem cells could elevate the level of IL-10 in serum (7 d:t =13.93,P ＜ 0.05) and increase the percentages of CD4/CD25/Foxp(3)-positive regulatory T cells in both peripheral blood (3.5 d:t =7.72,7 d:t=11.11,10 d:t =6.99,P ＜0.05) and thymus (7 d:t =16.17,10 d:t =12.12,P＜ 0.05).Moreover,infiltration of inflammatory cells and deposition of collagens within irradiated small intestine were mitigated by adipose-derived mesenchymal stem cells.Conclusions Adipose-derived mesenchymal stem cells were capable of curing radiation enteritis.

目的 评价放疗联合尼妥珠单抗治疗中老年局部晚期复发直肠癌的近期疗效及毒副反应.方法 收集2009年10月至2012年12月吉林大学第一医院放疗科治疗的局部晚期复发直肠癌患者48例,将其分为两组:观察组23例患者接受放疗联合尼妥珠单抗治疗,对照组25例患者接受放疗联合卡培他滨化疗,比较两组患者的有效率和毒副反应发生率来评价放疗联合尼妥珠单抗治疗中老年局部晚期复发直肠癌的临床疗效及耐受性.结果 观察组的缓解率率和有效率分别为47.8％、65.2％,略低于对照组的52.0％、68.0％(P＞0.05);观察组血液学及胃肠道毒副反应发生率分别为39.1％、34.8％,低于对照组的56.0％、44.0％(P＞0.05).结论 放疗联合尼妥珠单抗治疗晚期复发直肠癌的近期疗效与联合卡培他滨相似,但血液学和胃肠道毒副反应较低,中老年患者耐受性较好.

近年来,恶性肿瘤逐渐成为危害人类健康的主要杀手。目前,恶性肿瘤治疗已经进入综合治疗时代,据统计在全部恶性肿瘤中,45%的患者可以被治愈,其中22%经手术治愈,18%经放射治疗治愈,5%经化疗治愈[1]。而且,约70%的肿瘤病人需要接受不同程度的放射治疗,以治愈肿瘤、缓解症状或改善生活质量[2]。因此,放射治疗作为基本治疗手段之一,在恶性肿瘤治疗中的地位越来越重要。放射肿瘤学是放射学与肿瘤学的交叉学科,是研究射线

随着我国改革开放、教育事业的深入发展和我国经济、文化及对外交流水平的提高,外国医学留学生到我国留学的人数日渐增多,留学生教育己成为医学高等教育的重要组成部分,也成为反映学校教育水平的重要标志[1]。尤其在具有传统医学优势的我校,扩大留学生的招生提高学校声望的同时,也对教师的教学水平和教学质量提出了严峻的考验。病理学作为一门连接基础与临床的桥梁课程,是每名留学生必修的课程,其重要性不言而喻。如何提高

Objective To study the mechanism of wortmannin (WM) in enhancing radiosensitivity of malignant glioma cells.Methods Human glioma cells (U251) were pretreated with 10 μmol/L WM for 2 h and then irradiated with 10 Gy X-rays.The changes of cell cycle and apoptosis ratio were examined.Western Blot and immunofluorescence staining were used to detect the expression and function of ATM and its target genes as well as DNA-PKcs.Results The ratio of apoptotic cells in the WM combined with X-ray treatment group (WM + IR) was increased from (5.3 ± 0.66) ％ of control group and (11.5 ± 2.0) ％ of IR group to (21.8 ± 2.4) ％ significantly (F =57.38,P ＜ 0.05).Along with the increase of apoptosis,the expression of cleave-caspase-3 was significantly increased in IR or WM + IR group compared to control group (q =12.49,19.19,P ＜ 0.05),and its enhancement in WM + IR group was more significant than that in IR group (q =6.70,P ＜ 0.05).Compared to control group,the cell cycle assay showed that the amount of U251 cells in G2/M phase was increased in IR group (q =9.67,P ＜ 0.05),and further increased in WM + IR group (q =21.25,P ＜ 0.05),indicating an obvious G2/M phase arrest.Moreover,WM could effectively inhibit the phosphorylation of ATM kinase and the activity of ATM downstream target genes of p53 and SMC1.WM also suppressed the IR-induced expressions of DNAPKcs and phospho-γH2AX (Ser139).Conclusions WM effectively increased the radiation sensitivity of malignant glioma cells through down-regulating the activity of ATM kinase and DNA-PK.

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.