3-46 Heavy Ion Cancer Therapy-related Research in the Group of Medical Physics
重离子治癌技术和机理调研与血清素在旁效应中的作用的初步探索
重离子治癌调研与血清素在旁效应中的作用的探索刘朝巍指导老师;李强吴庆丰中国科学技术大学核科学技术学院10级本科班摘要：在近物所进行大学生研究计划的这一个月时间，主要通过文献和现场参观对重离子治癌的物理技术和医学应用做了大体的了解；还参与了医学物理研究室吴庆丰师兄对旁效应的研究工作，我们主要通过转培养基检验肿瘤细胞在碳离子束照射后血清素（5-HT）在旁效应中发挥的作用，最后利用细胞克隆存活计数检验旁效应的促进或抑制作用强度，通过检验，我们没有发现血清素对旁效应的明显影响。
关键词：重离子，治癌技术，旁效应，血清素一、重离子治癌技术和机理调研核向来都是敏感话题，自从它走出实验室，就在世界的各个领域大显身手。
原子弹让人领略到了它的威力，直至今日世界各大强国的核武之争都没有停止；核电让人看到了未来能源的新希望，老式的裂变反应堆早已普及，人们从各个方面提高它的安全性和稳定性，还在努力研究核废料的循环再利用，新式的商用聚变堆也在各国科研人员的努力中浮出水面。
核科学和相关领域的交叉更是大大扩展了人类的视野，与材料的结合提高了材料性能，与医学的结合拓展了医疗手段，很多癌症得到了攻克。
重离子治癌近些年来在全世界范围内兴起，它的基础研究和应用受到了各国政府和科研机构的重视。
⑴重离子治癌技术1895年X射线的发现打开了放射治疗的大门，在1946年，有人发现被加速的质子对深层肿瘤有很好的治疗作用，因为被加速的质子辐照在人体后有更好的剂量深度分布（见图一）。
（图一）从图中，可以看出X射线在人体表层释放的能量较多，而离子束则在布喇格峰处释放了大多能量，根据离子束的这一特性，就能通过不同的束流输送系统将粒子束的能量转移到靶向细胞中，实现癌症的治疗。
目前束流输送系统分为主动型和被动型。
（图二）在被动型束流输送系统（图二）中，束流先通过散射系统，扩展了光强宽度后，经过范围调制器和吸收盘将单能的布喇格峰展开以便覆盖整个靶向细胞，最后经过瞄准器的对准与补偿器对束流形状的勾勒通过皮肤，完成辐照。
一例淋巴管-静脉吻合术的围术期护理配合谭祯雯李豫通讯作者
一例淋巴管-静脉吻合术的围术期护理配合谭祯雯李豫*通讯作者发布时间：2023-07-03T02:26:08.071Z 来源：《护理前沿》2023年07期作者：谭祯雯李豫*通讯作者[导读] 目的探讨淋巴管-静脉吻合的手术护理配合要点。
方法对１例乳腺癌术后行上肢淋巴管-静脉吻合术患者进行术前准备、术中配合、术后护理处理，总结进行该项手术的患者的手术配合和围术期护理方法。
结果患者手术顺利完成，术后恢复均良好，切口处无淋巴瘘、感染、血肿等并发症。
结论护理人员术前参与讨论，对患者进行术前访视，加强心理护理，术中主动而有效的配合，能有效缩短手术时间，降低手术风险，保证手术顺利进行。
广西医科大学附属肿瘤医院手术室广西南宁 530021摘要：目的探讨淋巴管-静脉吻合的手术护理配合要点。
方法对１例乳腺癌术后行上肢淋巴管-静脉吻合术患者进行术前准备、术中配合、术后护理处理，总结进行该项手术的患者的手术配合和围术期护理方法。
结果患者手术顺利完成，术后恢复均良好，切口处无淋巴瘘、感染、血肿等并发症。
结论护理人员术前参与讨论，对患者进行术前访视，加强心理护理，术中主动而有效的配合，能有效缩短手术时间，降低手术风险，保证手术顺利进行。
关键词：淋巴管-静脉吻合；血管吻合；手术配合；护理乳腺癌是女性常见的恶性肿瘤之一。
有研究者[1] 认为，接近1/5的患者在接受完乳腺癌手术治疗后会继发上肢淋巴水肿，术后上肢淋巴水肿作为腋窝淋巴结清扫术后的常见并发症，可影响患者患侧上肢活动及生活质量，也成为长期困扰外科医生的一大难题。
显微镜下淋巴管-静脉吻合术是应用超显微技术[2]，吻合 0.3～0.8 mm 的微淋巴管-静脉，有效重建淋巴液的回流，达到缓解淋巴水肿的目的，提高患者生活质量；具有侵袭性小、有效率高的特点[3]，为乳腺癌术后上肢淋巴水肿的治疗提供一种较好的解决方案。
2020年10月我院对１例乳腺癌术后发生淋巴水肿患者实施上肢淋巴管-静脉吻合术，取得满意效果，现将该患者的手术配合及护理总结如下。
双硫死亡在胃肠道肿瘤中研究进展
[28] Ferchaud-Roucher V, Zair Y, Aguesse A, et al. Omega 3improves both apob100-containing lipoprotein turnover and their sphingolipid profile in hypertriglyceridemia[J]. The Journal of Clinical Endocrinology & Metabolism, 2020, 105(10): 3152-3164.[29] Arca M, Borghi C, Pontremoli R, et al. Hypertriglyceridemiaand omega-3 fatty acids: Their often overlooked role in cardiovascular disease prevention[J]. Nutrition, Metabolism and Cardiovascular Diseases, 2018, 28(3): 197-205.[2023-10-01收稿]胃肠道肿瘤包括胃腺癌、结肠腺癌、直肠腺癌等。
其中，结直肠癌是全球第三大常见癌症，也是癌症相关死亡的第四大原因[1-2]，而胃癌是全球第五大常见癌症，同时也是癌症死亡的第三大原因[3]。
近年来，我国胃肠道肿瘤的发病率逐年升高[4]。
胃肠道肿瘤的发病大多与遗传、不良的饮食习惯以及幽门螺杆菌感染有关[5]。
最新研究表明，吸烟也是胃肠道肿瘤发生的危险因素之一[6]。
目前，手术仍是胃肠道肿瘤的首选治疗方法[7]。
然而，高昂的费用和术后疼痛给胃肠道肿瘤患者带来了巨大的负担。
此外，胃肠道肿瘤患者复发也较常见，因此，探索其他潜在的治疗方案尤为必要。
半胱氨酸是人体20种氨基酸中含硫氨基酸之一，是蛋白质功能（调节、催化或结合）位点内高度保守的残基，因其独特的化学性质赋予其特殊功能，如与高亲和力金属结合、形成二硫键的能力[8]。
癌症中英文对照
癌症中英文对照Cancer - 癌症Cancer is a group of diseases characterized by the uncontrolled growth and spread of abnormal cells in the body. It is one of the leading causes of death worldwide, affecting millions of people each year. In Chinese, cancer is commonly referred to as "癌症" (ái zhèng).Types of Cancer - 癌症类型There are many different types of cancer, each with its own specific characteristics. Here are some common types of cancer and their corresponding Chinese translations:1. Breast Cancer - 乳腺癌(rǔ xiàn ái)2. Lung Cancer - 肺癌 (fèi ái)3. Prostate Cancer - 前列腺癌 (qián liè xiàn ái)4. Colorectal Cancer - 结肠直肠癌 (jié cháng zhí cháng ái)5. Skin Cancer - 皮肤癌(pí fū ái)6. Leukemia - 白血病 (bái xuè bìng)7. Ovarian Cancer - 卵巢癌(luǎn cháo ái)8. Pancreatic Cancer - 胰腺癌 (yí xiàn ái)Causes and Risk Factors - 引起癌症的原因和风险因素The development of cancer can be attributed to a variety of factors, including genetic mutations, environmental exposures, and lifestyle choices. Some common causes and risk factors for cancer include:1. Tobacco Use - 吸烟2. Alcohol Consumption - 饮酒3. Unhealthy Diet - 不健康的饮食4. Exposure to Carcinogens - 接触致癌物质5. Family History of Cancer - 家族癌症史6. Age - 年龄7. Obesity - 肥胖8. Chronic Infections - 慢性感染Early Detection and Treatment - 早期检测和治疗Early detection plays a critical role in improving the prognosis and survival rates of cancer patients. Regular screenings and tests can help identify cancer at an early stage when treatment is most effective. In Chinese, early detection is commonly referred to as "早期检测" (zǎo qī jiǎn cè).Treatment options for cancer vary depending on the type and stage of the disease. Common treatment modalities include surgery, chemotherapy, radiation therapy, immunotherapy, and targeted therapy. In Chinese, treatment is commonly referred to as "治疗" (zhì liáo).Prevention Strategies - 预防策略While not all cancers can be prevented, there are several strategies individuals can adopt to reduce their risk of developing cancer. These strategies include:1. Healthy Lifestyle Choices - 健康的生活方式选择2. Regular Exercise - 定期锻炼3. Healthy Diet - 健康饮食4. Avoidance of Carcinogens - 避免致癌物质5. Vaccinations - 接种疫苗6. Sun Protection - 防晒7. Regular Check-ups - 定期体检Support and Resources - 支持与资源Receiving a cancer diagnosis can be devastating for individuals and their families. However, there are numerous support groups, organizations, and resources available to provide emotional support, financial assistance, and educational materials. In Chinese, support is commonly referred to as "支持" (zhī chí), and resources as "资源" (zī yuán).Conclusion - 结论Cancer is a complex disease that affects millions of people globally. Understanding the terminology and concepts related to cancer in bothEnglish and Chinese is essential for effective communication, research, and patient care. By continuing to advance our knowledge, prevention strategies, and treatment options, we can work towards reducing the burden of cancer and improving the lives of those affected.。
不可切除胰腺癌的分子靶向药物治疗进展
不可切除胰腺癌的分子靶向药物治疗进展胡润，李俊蒽，姚沛，桂仁捷，段华新湖南师范大学附属第一医院，湖南省人民医院肿瘤科，长沙 410005通信作者：段华新，****************（ORCID： 0000-0001-9596-5013）摘要：胰腺癌作为消化系统最常见的恶性肿瘤之一，其发病率及死亡率正逐年上升，大多数胰腺癌患者因分期较晚而失去了手术机会。
尽管以吉西他滨、氟尿嘧啶为主的化疗方案在一定程度上延长了患者的生存期，但仍有部分患者因无法耐受化疗而失去治疗机会。
随着精准医疗时代的来临，分子靶向药物治疗展现出的优异疗效使其成为对抗肿瘤的重要治疗手段之一，但由于胰腺癌高度的异质性及复杂的免疫微环境，针对胰腺癌的分子靶向治疗并未取得显著效果，因此亟需探寻新的治疗靶点及药物攻克这一难题。
本综述基于胰腺癌常见分子靶点及肿瘤免疫相关靶点探究在不可切除胰腺癌中分子靶向药物治疗研究的最新进展，为胰腺癌患者提供新的治疗策略。
关键词：胰腺肿瘤；分子靶向治疗；免疫疗法基金项目：湖南省自然科学基金（2020JJ8084）Advances in molecular-targeted therapy for unresectable pancreatic cancerHU Run，LI Junen，YAO Pei，GUI Renjie，DUAN Huaxin.（Department of Oncology，The First Affiliated Hospital of Hunan Normal University， Hunan Provincial People’s Hospital， Changsha 410005， China）Corresponding author： DUAN Huaxin，****************（ORCID： 0000-0001-9596-5013）Abstract：Pancreatic cancer is one of the most prevalent malignant tumors of the digestive system， and its incidence and mortality rates are increasing year by year. Most patients with pancreatic cancer are unable to receive surgery due to the advanced stage. Although chemotherapy regimens based on gemcitabine and fluorouracil have prolonged the survival time of patients to some extent，some patients cannot tolerate chemotherapy and hence lose the opportunity for treatment. With the advent of the era of precision medicine， molecular-targeted therapy has exhibited an excellent therapeutic efficacy and has thus become one of the most important treatment techniques for tumors； however， due to the high heterogeneity of pancreatic cancer and its complicated tumor microenvironment， molecular-targeted therapy for pancreatic cancer has not achieved notable results. Therefore， it is imperative to seek new therapeutic targets and medications to overcome this issue. This article reviews the latest advances in the research on molecular-targeted therapy for unresectable pancreatic cancer based on common molecular targets and tumor immunity-related therapeutic targets， in order to provide new treatment strategies for patients with pancreatic cancer.Key words：Pancreatic Neoplasms； Molecular Targeted Therapy； ImmunotherapyResearch funding：Natural Science Foundation of Hunan Province of China （2020JJ8084）胰腺癌是一种起病隐匿、进展迅速、疗效及预后极差的恶性肿瘤，大多数患者确诊时已经属于晚期。
肺癌诊断及治疗英文版护理课件
Nursing care for lung cancer
Psychological care for lung cancer patients
01
Provide emotional support
It is essential to offer emotional support to lung cancer patients,
as they may experience anxiety, fatigue, and depression due to
the diagnosis
02
Inform and educate
It is important to provide information and education about lung
Epiology of lung cancer
Incident
Lung cancer is one of the most common cancers in the world, accounting for about 13% of all cancers The incidence rate is highest in developed countries and is increasing in developing countries
situation and provide resources for coping with stress and
negative emotions
Pain management in lung cancer patients
01
Assess paint
Regularly assess patients' paint levels to identify and manage any paint they may be experiencing
沙库巴曲缬沙坦改善癌症治疗相关心功能障碍的研究进展
沙库巴曲缬沙坦改善癌症治疗相关心功能障碍的研究进展李文燕1,陈 明2摘要 癌症治疗相关心脏毒性临床关注的是心血管并发症,传统抗肿瘤药物(如蒽环类药物)和靶向治疗药物(如曲妥珠单抗)均可引起心脏毒性,使病人被迫减少或停止治疗恶性肿瘤所需的药物,病人病死率增加,心脏毒性中癌症治疗相关心功能障碍(CTRCD )常见㊂尽管早期采用神经激素阻断剂可预防或减轻心脏毒性引起的心功能下降,但同时可导致不可逆顽固性心力衰竭和病死率明显增加㊂沙库巴曲缬沙坦降低心力衰竭住院率和病死率已得到证实,近年来应用于CTRCD 已取得较好疗效,且相较于神经激素阻断剂有明显的优势㊂综述沙库巴曲缬沙坦改善CTRCD 的相关临床研究进展㊂关键词 癌症治疗相关心功能障碍;沙库巴曲缬沙坦;癌症;心力衰竭;综述d o i :10.12102/j.i s s n .1672-1349.2023.08.014 癌症发病率呈逐年增加趋势,由于早期发现和治疗的进步,癌症幸存者数量随之增加,尽管癌症治疗已取得了较大进展,但心脏毒性中癌症治疗相关心功能障碍(cancer therapy -related cardiac dysfunction ,CTRCD )是化疗副作用严重与结局不良的副作用之一㊂CTRCD 是一个逐渐发展的并发症,相较于其他类型的心肌病,CTRCD 病人预后较差[1-2]㊂传统抗肿瘤药物(如蒽环类药物)和靶向治疗药物(如曲妥珠单抗)均可引起心脏毒性㊂蒽环类药物心脏毒性发生率较高,并呈时间依赖性和剂量依赖性,使用时间越长㊁累积剂量越多,心脏毒性越严重,可直接影响病人心肌组织,造成不可逆㊁永久性的心肌损伤[3-6]㊂按照心力衰竭实践指南标准治疗CTCRD 可获得较好的预后,病人死亡风险与非缺血性扩张型心肌病相近㊂这些证据表明CTRCD 病人应采用与其他非缺血性扩张型心肌病相似的药物治疗[7]㊂综述近年来沙库巴曲缬沙坦改善CTRCD 的相关临床研究进展㊂1 沙库巴曲缬沙坦治疗心血管疾病的临床应用及作用机制沙库巴曲缬沙坦治疗心力衰竭可同时抑制血管紧张素和脑啡肽酶,与单独抑制肾血管紧张素系统相比,促进神经激素正常化的作用更强[8]㊂一项长达5年㊁双盲的前瞻性比较研究(PARADIGM -HF )比较了血管作者单位 1.重庆医科大学(重庆401334);2.重庆医科大学附属第一医院(重庆400042)通讯作者 陈明,E -mail :********************引用信息 李文燕,陈明.沙库巴曲缬沙坦改善癌症治疗相关心功能障碍的研究进展[J ].中西医结合心脑血管病杂志,2023,21(8):1437-1440.紧张素受体脑啡肽酶抑制剂与血管紧张素转换酶抑制剂对心力衰竭全球发病率和死亡率的影响,该研究纳入了8399例慢性射血分数降低心力衰竭(HFrEF )病人,结果显示,接受沙库巴曲缬沙坦治疗组病人较接受依那普利治疗组心血管死亡的风险降低了20%,且寿命延长了1~2年,同时降低了猝死风险,在2个治疗组中肾素-血管紧张素系统均得到抑制,且与脑啡肽酶抑制作用有关[9]㊂Wang 等[10]分析显示,与接受血管紧张素转换酶抑制剂(ACEIs )或血管紧张素Ⅱ受体拮抗剂(ARBs )治疗的病人相比,接受沙库巴曲缬沙坦治疗的病人左室射血分数(LVEF )得到改善,同时表现为可逆转的心脏重构㊂尽早接受沙库巴曲缬沙坦治疗,并持续至少3个月,病人获益更多㊂相较于传统的肾素-血管紧张素-醛固酮系统(RAAS )阻断剂,沙库巴曲缬沙坦不但可降低HFrEF 病人心力衰竭住院率和病死率,而且可能减轻射血分数中间值和射血分数保留的心力衰竭病人心力衰竭症状㊁降低住院率和血清肌酐水平[11-13]㊂心肌梗死模型研究表明,与单独抑制RAAS 相比,沙库巴曲缬沙坦可提供额外的心脏保护作用[14-15]㊂2 沙库巴曲缬沙坦在改善CTRCD 预后中的应用近年来,沙库巴曲缬沙坦改善CTRCD 病人预后研究也取得了一些进展㊂Camilli 等[16]研究显示,沙库巴曲缬沙坦可能是治疗肿瘤病人心脏毒性中的另一种药物㊂尽管现有的沙库巴曲缬沙坦治疗CTRCD 证据多为关病例报告或观察性研究,但已基本显示了沙库巴曲缬沙坦药理策略的良好作用㊂2.1 沙库巴曲缬沙坦改善蒽环类药物所致CTRCD 的疗效观察与作用机制2.1.1沙库巴曲缬沙坦改善蒽环类药物所致CTRCD动物的疗效观察蒽环类是乳腺癌一线化疗方案的主要类型药物㊂对胃癌和乳腺癌的晚期治疗,蒽环类化疗药具有重要作用,主要药物包括阿霉素㊁多柔比星㊁吡柔比星等㊂在高剂量阿霉素诱导小鼠的心肌损害动物模型研究中,沙库巴曲缬沙坦可减轻扩张型心肌病和高剂量阿霉素小鼠的细胞毒性[17]㊂Boutagy等[18]在阿霉素诱导心脏毒性的实验性啮齿动物模型研究中,应用心脏超声心动图检查和99m Tc-RP805评估心肌基质金属蛋白酶(MMP)活性,结果显示,沙库巴曲缬沙坦治疗维持了较好的LVEF,同时仅有轻度心肌毒性,而MMP活性无显著变化㊂另一方面,单独缬沙坦治疗只在细胞水平上减弱阿霉素诱导的心肌毒性和纤维化,但不能维持LVEF和抑制心肌MMP的活化㊂上述研究表明,使用沙库巴曲缬沙坦保护LVEF的机制可能与降低心肌MMP活性有关,而逆转心脏重构的作用可能依赖脑啡肽酶抑制剂促进修复的过程㊂与缬沙坦相比,沙库巴曲缬沙坦对左室重构和功能障碍提供了强大的保护作用㊂Sheppard等[19]对蒽环类诱导的心肌病病人在传统循证心力衰竭药物治疗的次优反应后应用沙库巴曲缬沙坦治疗,病人均表现出一定程度的心功能恢复和N末端脑钠肽前体(NT-proBNP)水平正常化㊂Martín-García等[20]连续纳入10例蒽环类药物诱导的心肌病癌症病人,在使用沙库巴曲缬沙坦治疗前及治疗后3个月接受了综合多参数心脏磁共振(CMR),以评估癌症治疗相关的心肌病病人LVEF㊁心肌逆转重构参数,结果显示,左室容积的逆重构㊁LVEF 的改善和NT-proBNP水平的降低一致㊂推测沙库巴曲缬沙坦可能是抑制癌症治疗性心脏毒性和LVEF降低的癌症幸存者肾血管紧张素系统的首选方法㊂闫竹梅等[21]使用包括阿奇霉素在内的化疗方案治疗后心肌损害病人70例,随机分为观察组和对照组,对照组采用常规治疗,观察组在常规治疗基础上加用沙库巴曲缬沙坦口服,持续治疗3个月,结果显示,沙库巴曲缬沙坦可显著提高堪萨斯城心肌病病人生活质量量表得分,改善心肌校正的背向散射积分均值㊁背向散射积分周期变异率和后间隔基底段收缩期峰值应变率峰值,降低血清抗心肌肌钙蛋白I自身抗体㊁可溶性信号素4D和miR-34a-5p水平等,与超声结果存在一定相关性㊂尽管相关研究中病例样本量有限,但结果提示沙库巴曲缬沙坦治疗可有效改善蒽环类药物所致心肌损害病人的心功能㊂Canale等[22]对4例化疗相关的严重心功能降低的急性心力衰竭病人进行了研究,结果显示,沙库巴曲缬沙坦可减轻蒽环类药物相关的心脏毒性,再次证明了在CTRCD治疗中早期使用沙库巴曲缬沙坦在LVEF恢复中的积极作用㊂2.1.2沙库巴曲缬沙坦改善蒽环类药物所致CTRCD动物的作用机制沙库巴曲缬沙坦在改善CTRCD病人的运动耐量㊁心脏逆重构㊁提高LVEF等方面的机制可能与其心肌保护作用有关系㊂Boutagy等[18]研究表明,使用沙库巴曲缬沙坦保存LVEF部分是由于降低了心肌MMP活性㊂对临床使用包括阿奇霉素化疗方案治疗后有心肌损害的70例病人研究结果提示,心肌的保护作用可能与血清cTnIAAb和sSema4D降低㊁miR-34a-5p表达抑制㊁左心室重构改善有关[21]㊂沙库巴曲缬沙坦对蒽环类药物诱导的严重心功能降低的急性心力衰竭病人治疗研究及大剂量的蒽环类药物诱导的啮齿动物研究显示,沙库巴曲缬沙坦对蒽环类药物所致相关心脏毒性治疗的有效保护和心脏逆重构效应可能依赖于脑啡肽酶抑制剂促进修复过程㊂脑啡肽酶是一种中性内肽酶,可影响多条与蒽环类诱导的心脏毒性相关的生物信号通路,从而改变脑啡肽酶表达[18,22]㊂2.2沙库巴曲缬沙坦改善曲妥珠单抗所致CTRCD病人的临床观察魏云杰等[23]分析了曲妥珠单抗所致心力衰竭的乳腺癌62例病人,分为常规治疗组及沙库巴曲缬沙坦组,持续治疗2个月后,与常规治疗组比较,沙库巴曲缬沙坦组可提高LVEF,改善6min步行距离,降低NT-proBNP;沙库巴曲缬沙坦组改善平均心率㊁P-R间期㊁QRS宽度㊁室上性期前收缩次数㊁室性期前收缩次数方面优于常规治疗组,结果表明,沙库巴曲缬沙坦可明显改善乳腺癌病人曲妥珠单抗所致心力衰竭症状,提高心功能,减少心律失常发生㊂2.3沙库巴曲缬沙坦改善多种药物联合抗癌症治疗CTRCD病人的回顾性研究对癌症病人进行的一项回顾性研究共纳入因癌症治疗导致HFrEF的67例接受沙库巴曲缬沙坦治疗的病人,所有病人均接受多种抗肿瘤药物的联合治疗,部分病人同时接受了胸部放疗,结果表明,无论沙库巴曲缬沙坦的剂量,均可显著提高CTRCD病人LVEF,减小左心室容积,降低NT-proBNP水平,且纽约心脏病协会(NYHA)心功能分级与运动耐量均有改善,证实了沙库巴曲缬沙坦可改善肿瘤病人超声心动图的功能和结构参数㊁NT-proBNP 水平及症状等;该研究预期沙库巴曲缬沙坦有助于优化CTRCD管理[24]㊂另一项回顾性研究中报道了蒽环类诱导的心肌病病人,使用沙库巴曲缬沙坦治疗后病人表现出一定程度的心功能恢复和NT-proBNP水平正常化[19]㊂2.4沙库巴曲缬沙坦在难治性CTRCD病人中的应用难治性CTRCD是指心力衰竭症状持续存在,且对传统抗心力衰竭药物等各种治疗反应较差,是心力衰竭的终末期㊂有研究纳入了635例乳腺癌病人,随访所有病人的超声心动图和NT-proBNP,使用传统抗心力衰竭药物治疗,治疗后仍有心力衰竭症状的难治性心力衰竭病人28例,使用沙库巴曲缬沙坦替代依那普利或缬沙坦治疗,中位随访时间为20个月,难治性心力衰竭病人中12例(42.85%)采用100mg剂量,16例(57.15%)采用200mg剂量,均无死亡报告,心功能得到明显改善,LVEF增加;左室舒张末期内径㊁舒张功能㊁6min步行距离和二尖瓣反流明显改善[25]㊂Duraes等[26]研究显示,沙库巴曲缬沙坦对改善难治性CTRCD病人的左心室功能是安全和有益的㊂上述研究进一步说明沙库巴曲缬沙坦可能是难治性CTRCD病人的优选治疗药物㊂2.5沙库巴曲缬沙坦治疗CTRCD病人的耐受作用沙库巴曲缬沙坦在CTRCD应用时表现出较小的副反应与良好的耐受性㊂Frey等[27]对接受沙库巴曲缬沙坦治疗的多种肿瘤心力衰竭病人进行了研究,有组织学证实的癌症包括乳腺癌(23.8%)㊁结直肠癌(14.3%)㊁非霍奇金淋巴瘤(14.3%)㊁骨肉瘤(9.5%)㊁肾细胞癌(9.5%),肺癌㊁霍奇金淋巴瘤㊁前列腺癌㊁膀胱癌㊁胰腺癌㊁多发骨髓瘤㊁急性白血病和骨髓异常增生各1例;其中76.2%的病人进行过手术,52.4%的病人接受过抗肿瘤治疗,42.9%的病人接受了放射治疗,中位随访时间为12个月,结果显示,沙库巴曲缬沙坦耐受性高达85.7%,仅3例(2例头晕和1例瘙痒)停用沙库巴曲缬沙坦,且沙库巴曲缬沙坦可改善NYHA心功能分级,提高LVEF,降低NT-proBNP,但肌酐无显著变化㊂Martín-García等[20,24]研究结果显示,沙库巴曲缬沙坦可改善癌症病人和化疗性心肌病病人心脏功能和结构,耐受性良好,且耐受性显著高于PARADIGM-HF 观察的比例㊂蒽环类诱导的难治性心肌病病人中,沙库巴曲缬沙坦治疗后不仅改善了心功能,而且耐受性良好,副作用小,观察期间无病人因心力衰竭需要住院或额外的临床干预,同时沙库巴曲缬沙坦治疗组基础和随访血清肌酐或血钾水平之间差异无统计学意义[19,25]㊂3小结与展望目前,CTRCD发病率呈逐年升高趋势,严重影响癌症病人的治疗和预后,是临床迫切需要解决的问题㊂尽管沙库巴曲缬沙坦预防或治疗CTRCD的证据主要来自观察研究(队列㊁病例对照㊁横断面和病例报告等),但较为一致的结果为沙库巴曲缬沙坦在临床的大量推广应用提供了良好的治疗前景㊂PRADAⅡ研究[28](注册号:NCT03760588)是一项正在进行的随机㊁安慰剂对照㊁双盲㊁多中心的临床试验,目的是评估沙库巴曲缬沙坦是否可预防蒽环类药物联合或不联合曲妥珠单抗治疗的早期乳腺癌病人CTRCD,研究对象包括挪威4所大学医院的乳腺癌病人,将病人1ʒ1随机给予沙库巴曲缬沙坦或安慰剂治疗,沙库巴曲缬沙坦目标剂量为97mg或103mg,每日2次,病人在基线时㊁蒽环类药物治疗结束时和入组后18个月进行CMR㊁超声心动图㊁循环心血管生物标志物和心功能测定;PRADAⅡ试验的主要研究终点是基线至18个月时使用CMR评估的LVEF变化,次要研究终点包括使用CMR和超声心动图检测左室整体纵向应变功能变化和循环心脏肌钙蛋白浓度改变,该研究可为沙库巴曲缬沙坦作为预防和治疗CTRCD的一线药物提供真实世界的临床依据㊂参考文献:[1]FELKER G M,THOMPSON R E,HARE J M,et al.Underlyingcauses and long-term survival in patients with initiallyunexplained cardiomyopathy[J].The New England Journal ofMedicine,2000,342(15):1077-1084.[2]TALLAJ J A,FRANCO V,RAYBURN B K,et al.Response ofdoxorubicin-induced cardiomyopathy to the current managementstrategy of heart failure[J].The Journal of Heart and 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[10]WANG Y W,ZHOU R,LU C,et al.Effects of the angiotensin-receptor neprilysin inhibitor on cardiac reverse remodeling:meta-analysis[J].Journal of the American Heart Association,2019,8(13):e012272.[11]VARDENY O,CLAGGETT B,PACKER M,et al.Efficacy ofsacubitril/valsartan vs enalapril at lower than target doses inheart failure with reduced ejection fraction:the PARADIGM-HFtrial[J].European Journal of Heart Failure,2016,18(10):1228-1234.[12]WACHTER R,SENNI M,BELOHLAVEK J,et al.Initiation ofsacubitril/valsartan in haemodynamically stabilised heart failurepatients in hospital or early after discharge:primary results of therandomised TRANSITION study[J].European Journal of HeartFailure,2019,21(8):998-1007.[13]NIE D,XIONG B,QIAN J,et al.The effect of sacubitril-valsartan inheart failure patients with mid-range and preserved ejectionfraction:a meta-analysis[J].Heart,Lung&Circulation,2021,30(5):683-691.[14]PFAU D,THORN S L,ZHANG J S,et al.Angiotensin receptorneprilysin inhibitor attenuates myocardial remodeling andimproves infarct perfusion in experimental heart failure[J].Scientific Reports,2019,9(1):5791.[15]KOMPA A R,LU J Y,WELLER T J,et al.Angiotensin receptorneprilysin inhibition provides superior cardioprotection comparedto angiotensin converting enzyme inhibition after experimentalmyocardial infarction[J].International Journal of Cardiology,2018,258:192-198.[16]CAMILLI M,BISCEGLIA I,CANALE M L,et al.Sacubitril/valsartanin oncologic patients with cardiotoxicity:another weapon in ourpharmacological armory?[J].Giornale Italiano Di Cardiologia(2006),2022,23(4):278-285.[17]XIA Y,CHEN Z W,CHEN A,et al.LCZ696improves cardiacfunction via alleviating Drp1-mediated mitochondrial dysfunctionin mice with doxorubicin-induced dilated cardiomyopathy[J].Journal of Molecular and Cellular Cardiology,2017,108:138-148.[18]BOUTAGY N E,FEHER A,PFAU D,et al.Dual angiotensinreceptor-neprilysin inhibition with sacubitril/valsartan attenuatessystolic dysfunction in experimental doxorubicin-inducedcardiotoxicity[J].JACC Cardio Oncology,2020,2(5):774-787. [19]SHEPPARD C E,ANWAR M.The use of sacubitril/valsartan inanthracycline-induced cardiomyopathy:a mini case series[J].Journal of Oncology Pharmacy Practice,2019,25(5):1231-1234.[20]MARTÍN-GARCÍA A,DÍAZ-PELÁEZ E,MARTÍN-GARCÍA A C,et al.Myocardial function and structure improvement with sacubitril/valsartan in cancer therapy-induced cardiomyopathy[J].RevistaEspanola De Cardiologia(English Ed),2020,73(3):268-269. [21]闫竹梅,王兰.沙库巴曲缬沙坦钠治疗蒽环类药物所致心肌损害临床疗效观察[J].陕西医学杂志,2021,50(6):726-730. [22]CANALE M L,COVIELLO K,SOLARINO G,et al.Case series:recovery of chemotherapy-related acute heart failure by thecombined use of sacubitril valsartan and wearable cardioverterdefibrillator:a novel winning combination in cardio-oncology[J].Frontiers in Cardiovascular Medicine,2022,9:801143. [23]魏云杰,王俊峰,程飞,等.沙库巴曲缬沙坦改善乳腺癌患者曲妥珠单抗所致心力衰竭的效果研究[J].实用心脑肺血管病杂志,2020,28(10):93-97.[24]MARTÍN-GARCIA A,L PEZ-FERNÁNDEZ T,MITROI C,et al.Effectiveness of sacubitril-valsartan in cancer patients with heartfailure[J].ESC Heart Failure,2020,7(2):763-767.[25]GREGORIETTI V,FERNANDEZ T L,COSTA D,et e ofsacubitril/valsartan in patients with cardio toxicity and heartfailure due to chemotherapy[J].Cardio-Oncology(London,England),2020,6(1):24.[26]DURAES A R,DE SOUZA LIMA BITAR Y,NETO M G,et al.Effectiveness of sacubitril-valsartan in patients with cancertherapy-related cardiac dysfunction:a systematic review ofclinical and preclinical studies[J].Minerva Medica,2022,113(3):551-557.[27]FREY M K,ARFSTEN H,PAVO N,et al.Sacubitril/valsartan is welltolerated in patients with longstanding heart failure and history ofcancer and improves ventricular function:real-world data[J].Cardio-Oncology(London,England),2021,7(1):35.[28]MECINAJ A,GULATI G,HECK S L,et al.Rationale and design ofthe prevention of cardiac dysfunction during adjuvant breastcancer therapy(PRADAⅡ)trial:a randomized,placebo-controlled,multicenter trial[J].Cardio-Oncology(London,England),2021,7(1):33.(收稿日期:2022-10-06)(本文编辑薛妮)。
重离子的辐射生物效应及其在生命科学中的应用_贾蓉
和核技术的发展，人们在地面建立了重离子加速器 装置，这种装置的建立，不仅大大促进了核科学的 研究与相应技术的发展，也促进了核技术在生命科 学基础与应用领域的研究，更好的理解 DNA 团簇损 伤与修复机制及重离子在生命科学中的应用，能为 未来研究方向提供方便，促进对重离子辐射危害的 评估与防护策略的建立，以及其得到更好的应用。
电离辐射通过射线的直接作用和间接作用引起
Single break
অ䬮ᯝ㻲 SSBs
Chemical change
⻡สᦏՔ APs
Double break
DNA 分子发生多种类型损伤，包括如图 1 所示的碱 基 位 点 损 伤（Apurinic/apyrimidinic sites，APs） ，损 伤碱基（Oxidized purines or pyrimidines） ，单链断裂 （Single-strand breaks， SSBs） 或双链断裂 （Double-strand
重离子是指重于元素周期表中 2 号元素氦并被 电离的粒子。线性能量传递（Linear energy transfer， LET） ，又称为传能线密度，是描写射线性质的一种 物理量，单位为 J/m，常用 keV/μm 表示，指的是电 离粒子在其单位长度径迹上消耗的平均能量，即电 离辐射贯穿物质时，因碰撞而发生的能量转移。重 离子属于高 LET 类型的粒子，这种粒子在其穿透的 路径上， 产生很强的局部电离， 与传统的光子辐射 （如 X、γ 射线）相比，会诱导更严重的辐射损伤生物效 应。外太空中存在着高能量的质子和重离子，它们 对生命体细胞会产生严重的电离作用，导致细胞死 亡、染色体畸变和癌症发生，影响着外太空航天员 的健康安全
·综述与专论·
BIOTECHNOLOGY
乳腺癌患者疲劳程度测定量表(FACT-F)
乳腺癌患者疲劳程度测定量表(FACT-F)介绍
乳腺癌是一种常见的恶性肿瘤，患者在治疗过程中经常面临疲劳的问题。
为了衡量乳腺癌患者的疲劳程度，乳腺癌患者疲劳程度测定量表（Functional Assessment of Cancer Therapy - Fatigue，简称FACT-F）被开发出来。
FACT-F 是一种常用的乳腺癌患者疲劳程度测量工具，通过问卷形式收集患者的回答来评估他们的疲劳状况。
该量表由乳腺癌患者生活质量研究小组开发，用于评估乳腺癌患者的疲劳程度和对其生活质量的影响。
量表内容
FACT-F 由四个部分组成：
1. 乳腺癌疲劳测量（乳腺癌相关疲劳的频次和严重程度）
2. 乳腺癌相关的生活质量（乳腺癌对生活质量的影响）
3. 乳腺癌相关症状（与乳腺癌治疗相关的其他症状）
4. 乳腺癌治疗效果（对治疗的满意程度）
每个部分都包含了一系列相关问题，患者需要根据他们的感受回答每个问题。
使用和评估
FACT-F 量表可以通过纸质问卷或在线调查的形式进行填写。
填写过程通常需要患者花费一定的时间来回答所有问题。
根据患者的回答，可以计算出总分和各个分项的得分。
总分越高，表示患者的疲劳程度越低；分项得分越高，表示相关因素对患者的影响越大。
FACT-F 量表是一个广泛应用的工具，可用于研究和临床实践中评估乳腺癌患者的疲劳状况和生活质量。
结论
乳腺癌患者疲劳程度测定量表(FACT-F) 是一种评估乳腺癌患
者疲劳程度和生活质量的常用工具。
通过该量表，医生和研究人员
可以了解患者在治疗过程中的疲劳情况，从而采取相应的干预措施，提高患者的生活质量。
西医放射科术语英文翻译
西医放射科术语英文翻译以下是50个常见的西医放射科术语英文翻译：1. 放射学：Radiology2. 放射诊断：Radiologic Diagnosis3. 放射治疗：Radiation Therapy4. 影像学：Imaging5. X射线：X-ray6. 计算机断层扫描：Computed Tomography (CT)7. 核磁共振成像：Magnetic Resonance Imaging (MRI)8. 超声检查：Ultrasound Imaging9. 数字减影血管造影：Digital Subtraction Angiography (DSA)10. 正电子发射断层扫描：Positron Emission Tomography (PET)11. 单光子发射计算机断层扫描：Single Photon Emission Computed Tomography (SPECT)12. 荧光透视：Fluoroscopy13. X射线造影剂：X-ray Contrast Media14. CT灌注成像：CT Perfusion Imaging15. 分子影像学：Molecular Imaging16. 功能影像学：Functional Imaging17. 骨密度测量：Bone Density Measurement18. 乳腺摄影：Mammography19. 介入放射学：Interventional Radiology20. 放射性核素成像：Radioisotope Imaging21. 核医学：Nuclear Medicine22. 影像归档和通信系统（PACS）：Picture Archiving and Communication System (PACS)23. 放射剂量：Radiation Dose24. 辐射防护：Radiation Protection25. 放射性衰变：Radioactive Decay26. 辐射单位：Radiation Units27. 图像重建算法：Image Reconstruction Algorithms28. CT值：CT Density Values29. MRI信号强度：MRI Signal Intensity30. X射线滤过器：X-ray Filters31. 影像增强器：Image Intensifiers32. 闪烁器：Scintillators33. 高压发生器：High-Voltage Generators34. 血管造影导管：Angiographic Catheters35. 放射性示踪剂：Radioactive Tracers36. 正电子药物：Positron-Emitting Radiopharmaceuticals37. 单光子药物：Single Photon-Emitting Radiopharmaceuticals38. SPECT显像剂：SPECT Imaging Agents39. CT灌注成像剂：CT Perfusion Imaging Agents40. MRI对比剂：MRI Contrast Agents41. 介入治疗设备：Interventional Therapy Equipment42. 数字乳腺X光机：Digital Mammography Machines43. X射线透视系统：X-ray Fluoroscopy Systems44. 放射治疗计划系统：Radiation Therapy Planning Systems45. 放射治疗设备：Radiation Therapy Equipment46. 质子治疗系统：Proton Therapy Systems47. 重离子治疗系统：Heavy Ion Therapy Systems48. 光子治疗系统：Photon Therapy Systems49. 三维打印在放射科的应用：3D Printing in Radiology Applications。
2020高考英语语法填空10篇附解析 Day 14
2020高考英语语法填空10篇附解析Day 14Passage 1Agricultural experts say crop diversity is important to feed the____1____(increase) population of our planet. They say having a large variety of plants also____2____(help) to protect against possible crop diseases and future crises. But many experts say the number has decreased sharply during the past century.One of the world's ____3____(large) seed conservation projects has predicted further losses. The Millennium Seed Bank Partnership is warning that up to one hundred thousand plant species could ____4____ (permanent) disappear. The rich collection of genes____5____ decide their qualities would disappear with them.Many experts blame climate change and loss of habitat, normal growth area, for damaging plant life. They say human____6____(activity) and poorly planned, overly heavy use of land also are responsible. Modern business farming is responsible____7____loss of farmers' traditional crop varieties. The "Green Revolution" of the twentieth century changed agriculture. Some experts say the use of modern commercial farming methods saved millions of people from____8____(starve). Farmers planted, watered, and fertilized their crops with the help of machines. They treated their fields with chemicals____9____(control) diseases and insects. Harvests grew larger and higher quality, ____10____ another result wasthat some traditional crops were lost. Damage to the environment over the past century makes people believe that crop diversity also suffered.Passage 2Auckland, the capital city of New Zealand, is the largest and most populous (人口众多的) urban area in the country.When ____1____(plan) a trip to New Zealand, most people skip over Auckland as a destination. Everyone floods to Queenstown, or heads out____2____(spend) time enjoying themselves in nature. However, as anyone who has visited it knows, there are even ____3____ (many) things to do in Auckland, compared with those in Queenstown. All of these things make____4____ a great destination for all travelers.____5____ you are a backpacker, you will in, particular enjoy the huge range of free and cheap things to do in Auckland, especially in a country which is known____6____ its high living cost.The city's trendy neighborhoods can____7____(explore) on foot, and the skyline can be viewed from the water for the cheap price of a ferry ticket.____8____(particular), you will have the chance to taste____9____(variety) of snacks and the city doesn't shy away from a good happy hour. Give yourself____10____ couple of days to enjoy it, and check out some of our favorite things to do in Auckland. Auckland, you shouldn't miss it!Passage 3For a long time bats ____1____(be) one of the most feared creatures in the animal kingdom. Many pop culture associations with them are____2____(relate) to vampire. Though these associations are complete misunderstandings, bats do have a dark side as a ____3____(danger) disease vector (传播媒介). So there is good reason to be exceptionally cautious if you come into contact with bats. However, the fact is____4____bats play a significant role in keeping a balanced ecosystem.Many organic farmers have learned about the benefits of ____5____ (have) bats nearby to help manage the amount of pests that show up without pesticides. One brown bat - about ____6____size of a human thumb - can consume about 600 mosquitoes and other unwanted insects within an hour. They make for a fantastic, almost essential ____7____ (add) to pest management on any farm.Even large government organizations have realized the economic benefits of bats. The United States Geological Survey estimates that bat contributions____8____pest management save the country at____9____ (little) 3.7 billion dollars per year. Without them, we would likely experience a dramatic drop in food production, which would eventually make____10____(it) way into our weekly grocery bills.Passage 4What is art? It is very difficult to come ____1____ with a thorough answer. Tons of people have their own opinions and think they know what art____2____ (true) is. Most people’s answers are too general to distinguish what art is. Art is a creative form of work, ____3____ (design) to have a purpose and show emotion.There is a purpose to every piece of artwork. Therefore ____4____ artist had to start with a unique idea, or reason for ____5____ they’re creating. Historically, art has many different purposes for being made. Artists have made art for logical ____6____ (purpose) like entertainment, communication, and sometimes just to express ____7____ (they). The first time I made art, it was in kindergarten. I remember a mini house glued on paper for my family. Art has to have a connection between the artist and the actual art project itself. As is the case with the Statue of Liberty, and freedom.Art’s final goal is ____8____ (stir) up some type of emotion. Plenty of artists express their feelings in a piece of art. Then the artist’s feelings ____9____ (absorb) by the audience, causing them to have ____10____ (emotion) reactions to the visual.Passage 5One morning, I was waiting at the bus stop, worried about____1____ (be) late for school. There were many people waiting at the bus stop,____2____ some of them looked very anxious and____3____ (disappoint).When the bus finally came, we all hurried on board. I got a place next____4____ the window, so I had a good view of the sidewalk. A boy on a bike____5____ (catch) my attention. He was riding beside the bus and waving his arms. I heard a passenger behind me shouting to the driver, but he refused____6____ (stop) until we reached the next stop. Still, the boy kept____7____ (ride).He was carrying something over his shoulder and shouting. Finally, when we came to the next stop, the boy ran up to the door of the bus. I heard an excited conversation. Then the driver stood up and asked, “____8____ anyone lose a suitcase at the last stop?”A woman on the bus shouted, “Oh dear! It’s____9____ (I).” She pushed her way to the driver and took the suitcase thankfully. Everyone on the bus began talking about what the boy had done, and the crowd of strangers____10____ (sudden) became friendly to one another.Passage 6Austrian author Peter Handke collected the 2019 Nobel Prize in Literature while the 2018 award, which ____1____(postpone)last year, went to Polish author Olga Tokarczuk.Handke “has established himself as one of the most____2____(influence)writers in Europe after the Second World War”. His works are filled with a strong desire ____3____(discover)and make hisdiscoveries come to life by finding new literary expressions for them, the Swedish Academy said. He ____4____(write)many novels in the past decades, like Short Letter, Long Farewell, ____5____ a young Austrian writer travels across the United States in search of his wife. This novel is ____6____(general)considered as one of Handke’s typical confusing works.Tokarczuk became ____7____ winner of the 2018 award “for a narrative（叙事的）imagination that with encyclopedic（博学的）passion represents the crossing of ____8____(boundary)as a form of life”. Her first work came out in 1993, and ____9____ was believed that her third novel Primeval and Other Times marked her major breakthrough. In 2018, she was awarded the Man Booker International Prize for her novel Flights, ____10____(become)the first Polish writer to do so.Passage 7“A heavy ion (离子) cancer treatment system developed by Chinese researchers will soon be put into ____1____ (operate) in northwest China’s Gansu Province, ” researchers said.The system will be used in a hospital in Lanzhou, capital of Gansu, ____2____ is mainly devoted to treating cancer patients with the technology of heavy-ion accelerators.Cancer radiation treatments ____3____ (employ) heavy-ionaccelerators can attack ____4____ target with high-energy electrons (电子) to kill cancer cells.Compared to traditional therapy (治疗) such as radiation, heavy ion treatment ____5____ (consider) to have more balanced properties with ____6____ (little) radiation on healthy cells. The treatment period is shorter, ____7____ the therapy could more ____8____ (effect) control cancer cells, according to Wang Xiaohu, deputy director of the Gansu Provincial Cancer Hospital.Researchers with the Institute of Modern Physics under the Chinese Academy of Sciences started basic research ____9____ the technology in 1993 and developed the accelerators in 2015.A report published by the National Cancer Center in 2017 showed that China has nearly 25 percent of the world’s new cancer cases, with 10, 000 cancer patients ____10____ (add) per day. Every year, there are two million cancer-induced deaths. Lung, breast and stomach cancers are the most common types.Passage 8When you read a book, you’ve probably noticed that a brand new book has a rather special smell, ____1____ differs from that of an older book. Where does____2____ come from? Three sources — the paper, the ink and the glue.Around 200 AD, the Chinese first came up with paper, one of the greatest ____3____ (invent) in the world. It is made ____4____ wood. The wood must be processed with various chemicals ____5____ (add) to change its structure, to remove acid and to whiten the paper. Then comes the ink — there are many kinds. Some fade with time, while others get ____6____ (dark) than years ago. Finally, different glues are used to join the sheets together and attach the covers, whether hardcover ____7____ paperback. Therefore, you can smell different chemicals ____8____ (come) out of your new book.Today, the forms of books ____9____ (change) dramatically since the birth of eBooks. They might be ____10____ (convenience), but you can’t give your copy to others as a present, and they don’t smell as nice.Passage 9Tea culture is defined (定义) by the way tea is made and consumed, by the way the people interact (互动) with tea, ____1____ by the aesthetics (美学) of tea drinking. It includes tea production, tea brewing (冲, 沏), tea arts and ceremony, society, history, etc.Tea ceremony, with____2____ (it) roots in the Chinese tea culture, differs among eastern countries, However, it may also differ in preparation, such as in Tibet, ____3____ tea is commonly brewed with salt and butter.Different regions also like different ____4____ (variety) of tea —black, or oolong, and use different flavourings (调味品) such as milk, sugar or herbs, ____5____ (satisfy) people’s tastes. The temperature and strength of the tea likewise vary ____6____ (wide).Due to the importance of tea in Chinese society and culture, tea houses ____7____ (find) in most Chinese neighbourhoods and business districts nowadays.Tea culture in China is different ____8____ that of Europe, Britain or Japan in such things as preparation methods, tasting methods and the occasions for which it is consumed. Even now, on both casual and formal Chinese occasions, tea is consumed regularly. In addition to ____9____ (be) a drink, Chinese tea is used in ____10____ (tradition) Chinese medicine and in Chinese cuisine.Passage 10Mr. Johnson lived in the woods with his wife and children. He owned a farm, which looked almost abandoned. ____1____(lucky), he also had a cow which produced milk every day. He sold or exchanged some of the milk in the towns nearby____2____other food and made cheese and butter for the family with what ____3____(leave). The cow was their only means of support, in fact. One day, the cow was eating grass ____4____it began to rain heavily. While ____5____(make) great efforts to run away, she fell over the hill and died. Then the Johnsons tried make ____6____livingwithout the cow. In order to support his family, Mr. Johnson began to plant herbs and vegetables. Since the ____7____(plant) took a while to grow, he started cutting down trees ____8____(sell) the wood.Thinking about his children’s clothes, he started growing cotton too. When harvest came around, he was already selling herbs, vegetables and cotton in the market ____9____people from the town met regularly. Now it occurred to ____10____That his farm had much potential and that the death of the cow was a bit of luck.参考答案Passage 11. increasing2. helps3. largest4. permanently5. that/which6. activities7. for8. starvation9. to control10. but/while/yet1. 句意：农作物的多样性对养活地球上不断增长的人口很重要。
巨噬细胞胞葬功能在急慢性肝病中的作用机制及其靶向治疗
巨噬细胞胞葬功能在急慢性肝病中的作用机制及其靶向治疗杨焕焕，袁诗雨，唐映梅昆明医科大学第二附属医院消化内科，昆明 650101通信作者：唐映梅，************************.cn（ORCID：0000-0002-0731-4198）摘要：胞葬作用是指吞噬细胞（包括巨噬细胞、树突状细胞等专职吞噬细胞和上皮细胞等非专职吞噬细胞）吞噬并清除凋亡细胞的过程。
肝巨噬细胞是肝脏中具有胞葬功能的主要细胞。
近年来，越来越多的研究表明包括急性肝损伤、酒精性肝病、非酒精性脂肪性肝病、自身免疫性肝病、肝纤维化及肝细胞癌等在内的多种急慢性肝病均与肝巨噬细胞的胞葬作用有关。
本文通过阐述巨噬细胞胞葬相关分子的表达、胞葬过程及其胞葬功能在不同肝病中作用的最新研究进展，旨在为肝病治疗提供新思路。
关键词：肝疾病；巨噬细胞；胞葬基金项目：国家自然科学基金（82360108）；云南省医学领军人才项目（L-2019013）；云南万人计划名医专项（YNWR-MY-2018-028）；云南省科技人才与平台计划（院士专家工作站202305AF150065）；昆明医科大学第二附属医院临床研究项目（2020ynlc010， ynIIT2021017）Mechanism of action of macrophage efferocytosis in acute and chronic liver diseases and related targeted therapy YANG Huanhuan，YUAN Shiyu，TANG Yingmei.（Department of Gastroenterology，The Second Affiliated Hospital of Kunming Medical University， Kunming 650101， China）Corresponding author： TANG Yingmei，************************.cn（ORCID： 0000-0002-0731-4198）Abstract：Efferocytosis refers to the process by which apoptotic cells are engulfed and cleared by phagocytes， including professional phagocytes， such as macrophages and dendritic cells， and non-professional phagocytes， such as epithelial cells. Liver macrophages are the main cells with the function of efferocytosis in the liver. In recent years，an increasing number of studies have shown that various acute and chronic liver diseases are associated with the efferocytosis function of liver macrophages，including acute liver injury， alcoholic liver disease， nonalcoholic fatty liver disease， autoimmune liver disease， liver fibrosis， and liver cancer. This article elaborates on the expression of molecules associated with the efferocytosis function of macrophages， the process of efferocytosis， and the role of efferocytosis function in different liver diseases， so as to provide new ideas for the treatment of liver diseases.Key words：Liver Diseases； Macrophages； EfferocytosisResearch funding：National Natural Science Foundation of China （82360108）； Medicine Leading Talents of Yunnan Province （L-2019013）； The Yunnan Wanren Project （YNWR-MY-2018-028）； Yunnan Province Science And Technology Talents and Platform Plan （The Yunan Academician Expert Workstation 202305AF150065）； Clinical Research Project of the Second Affiliated Hospital of Kunming Medical University （2020ynlc010， ynIIT2021017）成年人体内约有37.2万亿个细胞，每天死亡的细胞约占0.4%［1］。
阿尔茨海默病病人功能性沟通障碍评估与干预措施的研究进展
[26] F E R G U S O N R J ,S I G M O N S T ,P R I T C H A R D A J ,e ta l .Ar a n d o m i z e dt r i a l o f v i d e o c o n f e r e n c e -d e l i v e r e d c o g n i t i v e b e h a v i o r a l t h e r a p y f o rs u r v i v o r so fb r e a s tc a n c e r w i t hs e l f -r e p o r t e dc o g n i t i v e d ys f u n c t i o n [J ].C a n c e r ,2016,122(11):1782-1791.[27] Z A C HA R I A E R ,AM I D IA ,D AMH O L D T M F ,e ta l .I n t e r n e t -d e l i v e r e d c o g n i t i v e -b e h a v i o r a lt h e r a p y fo ri n s o m n i ai n b r e a s t c a n c e r s u r v i v o r s :a r a n d o m i z e dc o n t r o l l e d t r i a l [J ].J o u r n a l o f t h eN a t i o n a l C a n c e r I n s t i t u t e ,2018,110(8):880-887.[28] W I L L E M SR A ,M E S T E R SI ,L E C HN E R L ,e ta l .L o n g-t e r m e f f e c t i v e n e s s a n dm o d e r a t o r s o f aw e b -b a s e d t a i l o r e d i n t e r v e n t i o nf o r c a n c e r s u r v i v o r s o n s o c i a l a n d e m o t i o n a l f u n c t i o n i ng ,d e p r e s s i o n ,a n d f a t i g u e :r a n d o m i z e d c o n t r o l l e d t r i a l [J ].J o u r n a l o f C a n c e rS u r v i v o r shi p:R e s e a r c ha n d P r a c t i c e ,2017,11(6):691-703.[29] W I L L E M SR A ,B O L MA N C A ,M E S T E R SI ,e t a l .S h o r t -t e r me f f e c t i v e n e s s o fa w e b -b a s e d t a i l o r e di n t e r v e n t i o n f o r c a n c e rs u r v i v o r so n q u a l i t y o fl i f e ,a n x i e t y ,d e p r e s s i o n ,a n df a t i gu e :r a n d o m i z e dc o n t r o l l e dt r i a l [J ].P s y c h o -o n c o l o g y,2017,26(2):222-230.[30] A B R A H AM S H J ,G I E L I S S E N M F ,G O E D E N D O R P M M ,e t a l .A r a n d o m i z e d c o n t r o l l e d t r i a l of w e b -b a s e d c o gn i t i v e b e h a v i o r a l t h e r a p y f o rs e v e r e l y f a t i g u e db r e a s tc a n c e rs u r v i v o r s (C H A N G E -s t u d y ):s t u d ypr o t o c o l [J ].B M C C a n c e r ,2015,15:765.[31] W I L L E M SR A ,B O L MA NCA ,M E S T E R S I ,e t a l .T h eK a n k e rN a z o r g W i j z e r (C a n c e rA f t e r c a r eG u i d e )p r o t o c o l :t h e s ys t e m a t i c d e v e l o p m e n t o f a w e b -b a s e d c o m p u t e r t a i l o r e d i n t e r v e n t i o n p r o v i d i n gp s y c h o s o c i a l a n d l i f e s t y l es u p po r t f o r c a n c e r s u r v i v o r s [J ].B M CC a n c e r ,2015,15:580.[32] A B R A H AM S HJG ,G I E L I S S E N M F M ,D O N D E R SR R T ,e t a l .T h e ef f i c a c y o f I n t e r n e t -b a s e dc og n i t i v eb eh a vi o r a l t h e r a p yf o r s e v e r e l y f a t ig u e ds u r v i v o r so fb r e a s tc a n c e rc o m p a r e d w i th c a r e a s u s u a l :a r a n d o mi z e d c o n t r o l l e d t r i a l [J ].C a n c e r ,2017,123(19):3825-3834.[33] F O S T E R C ,G R I MM E T T C ,M A Y C M ,e t a l .A w e b -b a s e di n t e r v e n t i o n (R E S T O R E )t os u p p o r ts e l f -m a n a g e m e n to fc a n c e r -r e l a t e df a t i g u ef o l l o w i n gp r i m a r y c a n c e rt r e a t m e n t :a m u l t i -c e n t r e p r o o fo f c o n c e p t r a n d o m i s e dc o n t r o l l e dt r i a l [J ].S u p p o r t i v eC a r e i n C a n c e r :O f f i c i a l J o u r n a l o f t h eM u l t i n a t i o n a l A s s o c i a t i o n o f S u p po r t i v e C a r e i nC a n c e r ,2016,24(6):2445-2453.(收稿日期:2023-07-13;修回日期:2023-11-27)(本文编辑孙玉梅)阿尔茨海默病病人功能性沟通障碍评估与干预措施的研究进展刘红利1,2,朱宇航1,范彩丽1,齐家敏1,张 莉1*1.遵义医科大学附属医院,贵州563000;2.重庆市人民医院R e s e a r c h p r o g r e s s o n t h e e v a l u a t i o n a n d i n t e r v e n t i o nm e a s u r e s o f f u n c t i o n a l c o m m u n i c a t i o n d i s o r d e r s i nA l z h e i m e r 's d i s e a s e p a t i e n t sL I U H o n g l i ,Z H UY u h a n g ,F A NC a i l i ,QI J i a m i n ,Z H A N GL i A f f i l i a t e dH o s p i t a l o fZ u n y iM e d i c a lU n i v e r s i t y ,G u i z h o u 563000C h i n a C o r r e s p o n d i n g Au t h o r Z H A N GL i ,E -m a i l :z h l i 8523@163.c o m K e yw o r d s A l z h e i m e r 's d i s e a s e ;c o mm u n i c a t i o nb a r r i e r s ;a s s e s s m e n t t o o l s ;i n t e r v e n t i o nm e a s u r e s ;n u r s i n g ;r e v i e w 摘要 对阿尔茨海默病病人功能性沟通障碍的评估㊁干预方法及实施现状进行综述,旨在提高阿尔茨海默病病人功能性沟通能力及其生活质量㊂关键词 阿尔茨海默病;沟通障碍;评估工具;干预措施;护理;综述d o i :10.12102/j.i s s n .2095-8668.2023.24.013 基金项目 贵州省卫健委科技基金项目,编号:g z w k j 2021-471作者简介 刘红利,主管护师,硕士研究生在读*通讯作者 张莉,E -m a i l :z h l i 8523@163.c o m 引用信息 刘红利,朱宇航,范彩丽,等.阿尔茨海默病病人功能性沟通障碍评估与干预措施的研究进展[J ].循证护理,2023,9(24):4445-4450.㊃5444㊃循证护理2023年12月第9卷第24期(总第116期)阿尔茨海默病(A l z h e i m e r'sd i s e a s e,A D)是一种与年龄相关的慢性㊁进行性中枢神经系统退行性疾病,主要表现为进行性认知功能障碍(包括记忆㊁理解㊁语言㊁注意力等),同时伴有精神行为异常,也被称为 失智症 [1]㊂在A D中,最先累及的是大脑中负责记忆㊁语言和思考的部分神经元㊂因此,最初的症状往往是记忆㊁语言和思维障碍㊂功能性沟通被定义为一种在自然环境中,无论使用何种沟通方式(如语言㊁肢体语言㊁表情等),能够有效和独立地接收和传达信息的能力[2]㊂功能性沟通旨在帮助A D语言障碍者使用一些补偿性的策略和技术最大限度地利用他们现有的沟通能力,从而减少语言障碍对沟通能力的限制,以实现有效的沟通㊂语言和非语言的功能性沟通与认知功能紧密相关,随着A D疾病的进展,认知功能的损害会影响其功能性沟通的有效性和灵活性㊂A D病人的功能性沟通障碍,一方面使病人分享经验和加入群体变得困难,导致病人面临被社会孤立的风险,严重者还可能触发精神行为异常(如抑郁㊁焦虑等)[3-4];另一方面,功能性沟通障碍导致病人得不到最佳的照护,用餐时因沟通困难而拒绝进食,增加营养不良的风险[5];还可能洗澡或外出时,因沟通障碍而无法寻求帮助并采取措施,导致病人独自在房间时摔倒㊁外出时走失,造成严重的安全隐患[6]㊂因A D病人功能性沟通障碍进一步增加照护者的精神负担,长期遭受巨大压力及抑郁等负性情绪会恶化照顾者与A D病人的关系,甚至发生虐待行为[7]㊂目前,A D病人功能性沟通障碍尚无有效的治愈方法,但通过干预措施能明显提高功能性沟通能力,更好识别和满足A D病人的独特需求,有利于提高其健康及生活质量㊂良好的功能性沟通是保证治疗㊁护理和照顾有效的重要途径,因此,将对A D病人功能性沟通障碍的干预方法及实施现状进行综述,为改善A D病人功能性沟通能力提供参考㊂1 A D病人功能性沟通障碍的表现A D病人功能性沟通障碍包括以下几个方面:1)语言能力退化㊂语言退化是A D病人主要的核心症状之一,并与A D的严重程度呈正相关㊂A D无症状临床前阶段,主要表现为语义的缺陷,影响命名和语言流畅性[8]㊂随着疾病的进展,A D早期表现出来的是轻微找词困难及命名障碍,不能准确地说出熟悉的人或物的名字,造成信息传递困难而影响功能性沟通[9]㊂在疾病后期病人出现语言错误㊁语法不规范等现象,在发音㊁词汇或句子结构方面的能力受到严重影响,基本丧失了语言沟通能力,只能通过手势或眼神等身体信号进行非语言交流[10]㊂2)表达能力受损㊂在轻度A D病人中,口语表达能力受损表现为语速减缓㊁停顿时间延长㊁词汇量减少以及词不达意等,可导致病人在表达情感㊁意图或需求时出现困难,同时需要更长的时间来组织和表达自己的想法[11]㊂此外,A D病人大脑神经元损伤,导致学习㊁记忆和语言受到影响,进而影响其写作能力㊂在书写时句子不连贯㊁语义和文字错误,书写不规则或模糊,以及无法具体描述图像主题,病人的书面表达缺乏实际意义[12]㊂3)理解能力减弱㊂病变累及大脑皮层区域,导致理解能力减退[13]㊂病人难以理解和跟随复杂的指令,无法正确识别颜色㊁形状和大小等信息,并且不能理解它们之间的关系㊂随着疾病的进展,他们可能无法理解一些基本的日常活动,例如穿衣㊁洗漱和打电话等㊂4)沟通参与度下降㊂在交谈时,病人仅能提供简单的回答,难以进行深入的对话或提供更多信息㊂A D病人可能会存在不同程度的情感障碍,由于不安而避免与他人进行眼神接触,到后期变得沉默不语,不愿意与他人交流[14]㊂2功能性沟通能力的评估功能性沟通能力评估量表用于评估A D病人的功能性沟通能力水平,可以将病人的功能性沟通障碍具体化,并为选择行之有效的治疗方案提供前提条件㊂此外,这些工具也有助于指导照顾者与病人进行有效的功能性沟通㊂2.1普适性测评工具简易精神状态检查表(M i n iM e n t a l S t a t eE x a m i n a t i o n, M M S E)是国内外使用最广泛的测评工具,评估内容包括病人的记忆力㊁注意力与计算力㊁回忆能力㊁语言能力等[15]㊂由于测试语言的项目较少且敏感性较低,较难全面评估痴呆病人的沟通能力㊂蒙特利尔认知评估量表(M o n t r e a l C o g n i t i v eA s s e s s m e n t,M o C A)是由国外学者编制的一种筛查轻度认知障碍的工具,测试项目包括执行功能,记忆,语言,方向和注意力等,其敏感性为90%~100%,特异性为87%[16]㊂我国学者张立秀等[17]于2007年将M o C A量表汉化并进行信度与效度检验,结果表明其具有良好的内部一致性和可行性㊂但该研究中样本量较少,未提及评定者间的信度,应用上还需进一步验证㊂阿尔茨海默病评估量表(A l z h e i m e r'sD i s e a s eA s s e s s m e n t S c a l e,A D A S)[18]由R o s e n等编制,包括认知量表和非认知量表,其中阿尔茨海默病评估量表认知子量表(A l z h e i m e r'sD i s e a s e A s s e s s m e n t S c a l e-C o g n i t i v eS u b s c a l e,A D A S-C o g)分别从记忆㊁命名㊁视空间㊁语言㊁定向力㊁注意力等方面评估认知功能,对语言的特定评估包括单词回忆,命名对象和手指单词识别等㊂MM S E和M o C A是目前用㊃6444㊃C H I N E S EE V I D E N C E-B A S E D N U R S I N GD e c e m b e r,2023V o l.9N o.24于评估整体认知功能和筛查A D病人最常使用的工具,A D A S-C o g量表通常被广泛用于测评抗痴呆症药物治疗后认知改善的效果㊂这3个量表条目清晰明了㊁简单易懂,使用方便,调查时病人依从性高,但都不足以对病人的语言功能性沟通障碍得出特异性的结论㊂2.2功能性沟通能力评估工具美国言语-语言-听力协会成人沟通技巧功能评估量表(F u n c t i o n a l A s s e s s m e n t o f C o mm u n i c a t i o n S k i l l s f o rA d u l t s,A S H A F A C S)由美国言语-语言-听力协会于1992年研发,该量表从以下4个领域评估病人的功能性沟通能力:1)社交沟通;2)表达需要;3)阅读㊁书写㊁数字概念;4)日常计划㊂此量表最初被开发用于成人左半球脑卒中后失语症和成人创伤性脑损伤,随后扩展应用于痴呆成年人群,评估A D病人的功能沟通能力[2]㊂D eC a r v a l h o等[19]将A S H AF A C S翻译成葡萄牙语,验证其对A D人群沟通技巧的功能评估,结果表明葡萄牙语版的A S H A F A C S是痴呆病人沟通能力评估的有效可靠工具㊂陈惠英等[20]将A S H AF A C S进行汉化,在结构效度方面,量表共提取2个公因子,即简单社交沟通㊁表达需要,该表具有较高的信度㊁效度,用于评估A D病人的功能性沟通能力,旨在为痴呆领域医护人员或照顾者提供客观的评估结果,以便他们根据此结果针对性地实施语言功能锻炼及其他非口语方面的代偿措施,从而满足病人在日常生活中的功能性沟通需求㊂A S H A F A C S是以照顾者作为信息提供者,通过提供观察到的情况㊁交流和语言障碍的表现以及其严重程度等方面的信息来帮助确定病人是否存在沟通和语言障碍㊂但该工具是一种代理措施,没有考虑到病人本人的观点,在使用照顾者提供的信息时应考虑病人自身的情况进行综合评估㊂3功能性沟通障碍干预措施及效果评价3.1药物干预目前,尚无治愈A D的药物,但乙酰胆碱酯酶抑制剂(如多奈哌齐㊁利瓦斯替明和加兰他敏等)和N-甲基-D-天冬氨酸受体(N-m e t h y l-D-a s p a r t i c a c i d r e c e p t o r,NM D A)拮抗剂(盐酸美金刚)两类药物被批准用于A D病人的治疗,以缓解症状㊂乙酰胆碱酯酶抑制剂可以通过增加体内的乙酰胆碱水平促进胆碱传导,改善早期A D病人的语言能力[21]㊂使用语言沟通有助于维持病人与其照护者或家人之间的情感联系,接受多奈哌齐治疗的病人在语言交流沟通方面受益更多,并且治疗后出现的语言障碍较少[22]㊂盐酸美金刚是另一种有效的抗痴呆药物,可以非竞争性阻断NM D A受体中的谷氨酸,从而维护神经系统结构和半胱氨酸代谢,减少有害的NM D A过度兴奋,改善认知和功能性沟通能力[23-24]㊂在一项使用语言和沟通工具作为主要结局指标的前瞻性㊁随机㊁双盲㊁安慰剂对照试验中,与安慰组相比较,盐酸金美刚治疗的病人在语言和功能性沟通能力方面明显优于安慰组[25]㊂盐酸美金刚虽然已被用于中㊁重度A D病人语言障碍治疗,但需进行更多的研究和评估,以确定其有效性和安全性㊂此外,张金枝等[26]采用多奈哌齐与盐酸美金刚联合使用的实验证明了对于中重度痴呆病人,两者的联合应用既可以降低兴奋性毒性保护神经,又可以增加脑内乙酰胆碱水平,比单一疗法更能有效改善病人的认知及沟通能力,且安全性更好㊂3.2物理干预3.2.1非侵入性脑刺激技术非侵入性脑刺激技术主要包括重复经颅磁刺激(r e p e t i t i v et r a n s c r a n i a l m a n e t i cs t i m u l a t i o n,r T M S)和经颅直流电刺激(t r a n s c r a n i a l d i r e c t c u r r e n t s t i m u l a t i o n,t D C S)㊂非侵入性脑刺激技术通过在目标靶区的头皮上方放置一个电磁线圈来产生瞬间磁场,使用法拉第电磁感应原理垂直于磁场方向上产生感应电流,作用于表层脑组织[27]㊂非侵入性脑刺激技术最初用于刺激人类大脑皮层运动,近年来已广泛应用于语言表现的临床研究中,包括准确预测语言半球优势㊁脑卒中或A D后失语症等语言障碍的康复或治疗[28-30]㊂r T M S是一种应用于A D认知障碍的非侵入性神经调控技术,通过刺激大脑左顶叶区域和海马体之间的网络连接,降低楔前叶静息状态活动,提高外周脑源性神经营养因子水平,进而改善A D病人的语言功能[31]㊂C o t e l l i等[30]研究发现,通过r T M S诱导大脑皮层突触的调节8周后,增强了大脑语言网络系统,病人的句子理解能力有所改善,从而提高病人功能性沟通能力㊂t D C S是通过弱直流电刺激来调节大脑功能㊂N a k a s h i m a等[32]对受试者的大脑左背外侧前额叶皮层采用t D C S方式,探究大脑左额叶在语言处理中的作用㊂结果显示,受试者在语言流畅性任务中的单词识别和记忆功能得到改善㊂非侵入性脑刺激技术通过刺激大脑皮层在受损的大脑功能网络中诱导新的㊁更健康的神经活动模式,进而促进A D病人的语言和非语言敏捷性㊂从安全㊁操作简单和可重复调节刺激的优势来看,非侵入性脑刺激技术受到了越来越多的关注,但治疗方式和疗效报㊃7444㊃循证护理2023年12月第9卷第24期(总第116期)道不尽相同,其使用效果还需要进一步验证㊂3.2.2认知刺激疗法(c o g n i t i v es t i m u l a t i o nt h e r a p y,C S T)C S T是一种针对痴呆病人的基于团体的㊁简单的非药物干预方法,采取问题解决㊁社交技能㊁复杂动作训练及其他类似的措施进行干预,可以改善认知功能和行为表现,同时提高病人生活质量和社交互动[33]㊂根据英国国家临床优化研究所发布的指南[34],C S T是一种成熟团体社会心理干预,已被证明可以改善AD 病人的生活质量和认知能力㊂C a r b o n e等[35]对意大利养老院的轻㊁中度痴呆病人进行C S T干预后发现, C S T可延缓轻度至中度痴呆症病人在沟通技能方面的缺陷㊂一项多中心试点研究发现,接受C S T治疗的受试者超过1/2的病人认知功能没有恶化,近1/4的病人认知功能改善,而语言使用在认知益处中起着核心作用[36]㊂但是由于文化背景的不同,建议对C S T 计划加以修订,克服保守或谨慎导致不积极地分享的缺陷,制定符合中国社会价值观方案的C S T㊂C S T是药物治疗的一种补充㊂在轻度A D病人中,采用r TM S与认知训练治疗的联合方案,通常被称为r T M S-c o g疗法㊂r T M S-c o g通过r T M S后对目标皮质区域进行认知训练来增加大脑皮质区域的可塑性,应用r TM S-c o g疗法的病人在记忆和语言领域的改善明显高于对照组,促进他们更好地与周围环境交流和互动[37]㊂r T M S-c o g的治疗方案是安全和有效的,在N e u r o A D系统中得到了正式与结构化的应用[38]㊂指南指出在A D的轻度或早期阶段,多部位r T M S-c o g疗法可有效改善A D病人的认知㊁记忆和语言等功能,证据等级达到C级[39]㊂3.2.3音乐疗法A D病人即使在其他功能都已经退化的情况下,通常还保留了对音乐的反应能力,他们不仅对歌曲的旋律或歌词等细节有记忆,而且对与歌曲相关的记忆和丰富的联想也有记忆㊂唱歌和听音乐有助于改善痴呆病人的发音㊁情绪㊁方向和情景记忆障碍,它能唤起长期被遗忘的情绪和联想,让病人获得情绪㊁记忆和思想,促进自我表达,音乐疗法作为沟通的桥梁为A D病人和照顾者创造新的沟通方式方面发挥着重要作用[36]㊂一项多中心研究将痴呆病人安排在一个安静的中等大小的房间里,由1名经过认证㊁专门训练的音乐治疗师指导病人进行每周2次,每次30m i n,持续10周的音乐治疗,结果显示,音乐的节奏可以有效地刺激病人的大脑神经,接受音乐疗法的痴呆病人沟通能力得到了显著的改善[40]㊂而另一项研究发现,在养老中心使用现场音乐不但可以减少痴呆病人的孤立感和增加乐趣,还能够使他们在多感官环境中建立和回应社交互动,以各种语言和非语言方式进行积极的沟通[41]㊂张婷婷[42]对痴呆病人进行音乐疗法干预后,实施对象可以主动地去进行沟通,同时言语的连贯性和清晰度也较治疗前有显著改善㊂A D病人的语言和书写能力受到疾病不同程度的影响导致沟通困难,音乐治疗中病人微笑㊁拍手㊁唱歌㊁言语互动等促进积极的情感表达,从而提高他们的沟通能力和社会参与度㊂早期A D病人,在语言能力还未完全消失的前提下,音乐治疗可以其延缓语言退化,甚至有助于保留病人最好的语言状态[42]㊂音乐疗法具有经济㊁有效㊁可操作性强㊁易被病人接受等优点,但目前国内对有关痴呆症病人音乐疗法的研究缺乏大样本㊁高质量的随机对照研究,感兴趣的学者可以在未来的研究中进行深入探讨㊂3.2.4辅助技术(a s s i s t i v e t e c h n o l o g y,A T)辅助技术是指用于改善病人的认知或沟通能力并保持其独立性的任何物品㊁设备㊁产品或系统[43]㊂机器人㊁智能手机㊁平板电脑㊁惯性导航高精度定位系统(G P S)和传感器等辅助技术,通过图片㊁文字与声音联合的技术实现更有效地沟通,被称为代偿性沟通支持㊂一项横断面调查显示,辅助技术设备可以帮助痴呆病人保持安全健康的生活,并提高与外界的沟通能力[44]㊂帕罗(P A R O)是国外使用较多的社交辅助机器人之一,它的形状像一只小海豹,由旋转的头,移动的腿㊁尾巴与扬声器等组成,可以发出真实的小海豹的声音㊂帕罗可以提高痴呆病人的沟通能力,而且也增加了病人的社会互动能力㊂自2003年以来已在多个国家成功用于痴呆护理,它被描述为沟通的媒介[45]㊂目前,人工智能在A D早期诊断和发展监测方面的应用较为广泛[46],而使用辅助技术的强大算法可以解读癌症㊁A D和其他神经退行性疾病的 生物语言 ,使A D病人以更具社交性㊁有效性和可接受性的方式进行沟通[47]㊂在脑卒中失语病人中,虚拟现实技术(v i r t u a l r e a l i t y,V R)通过模拟日常生活情境,使用简单有趣的文字㊁图形㊁指令等刺激病人的感官,结合语言训练来刺激大脑语言中枢,促进受损的脑神经功能恢复正常活动和大脑血液循环,提高病人的自发言语㊁命名㊁听理解㊁复述等语言功能,进而促进失语病人进行功能性沟通[48]㊂虚拟现实技术的不断发展和推广,为A D病人功能性沟通障碍的干预带来了潜在的发展空间㊂辅助技术与A D病人的语言研究的整合尚未完善,如何将这些复杂和多元的语言知识融入辅助技术㊃8444㊃C H I N E S EE V I D E N C E-B A S E D N U R S I N GD e c e m b e r,2023V o l.9N o.24中,开发个体化的辅助技术,同时控制经济成本对痴呆家庭的影响,需要我们不断地进行研究和实践㊂3.3其他干预措施创造性故事疗法㊁回忆疗法㊁体感互动游戏㊁有氧运动等其他疗法有助于改善痴呆病人的沟通能力㊂沈银萍等[49]通过对观察组持续创造性故事疗法的干预,病人由沉默不语或拒绝沟通慢慢地主动讲述自己的故事,并期待他人的回应,提高了功能性沟通能力㊂另有专家共识建议,根据痴呆病人自身具体情况选择合适的运动方式和时间进行运动,在预防和治疗认知和沟通能力方面有一定作用[50]㊂还可以使用一些辅助沟通的工具,如带有姓名㊁地址㊁电话号码等的卡片,家庭成员的照片以及简单的图片和短语,以改善与他人功能性沟通的效果㊂4小结功能性沟通障碍不仅降低了病人的生活质量,同时增加了照顾者㊁社区工作人员和医护工作者的压力和负担㊂国外对痴呆病人的功能性沟通研究较多,国内相对较少,以人为本的照护环境将更加注重满足病人的功能性沟通需求,以实现更好的照护效果㊂准确评估功能性沟通障碍及采取个体化的干预措施,可将功能性沟通障碍的影响或危害降至最低㊂在A D临床前期,病人主要症状之一是认知障碍,其功能性沟通能力障碍的微妙变化难以发现,同时病人的记忆㊁语言㊁注意力等紧密相连,以至于很难区分是轻度A D认知障碍引起的语言变化,还是正常衰老导致的语言变化㊂因此,量化功能性沟通障碍有助于增加早期诊断A D 敏感性,并提供重要的预后指标㊂但目前针对A D病人功能性沟通障碍缺乏标准的干预实施方案,且研究工具与评价指标也尚未统一㊂因此,未来的研究可进行前瞻性㊁大样本㊁多中心的随机对照研究,为增强他们的功能性沟通,改善他们的社会互动能力,引导人际关系更和谐,提升病人的生活质量提供依据㊂参考文献:[1] B R E I J Y E H Z,K A R AMA N R.C o m p r e h e n s i v e r e v i e w o nA l z h e i m e r's d i s e a s e:c a u s e s a n d t r e a t m e n t[J].M o l e c u l e s,2020,25(24):5789.[2]D E R U Y T E R F.R e p o r t o n t h e A m e r i c a n S p e e c h-L a n g u a g 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[37] B R E M A K,I O R I O R D,F R I E D P J,e t a l.C o r t i c o m o t o rp l a s t i c i t yp r e d i c t sc l i n i c a l e f f i c a c y o fc o m b i n e dn e u r o m o d u l a t i o na n d c o g n i t i v et r a i n i n g i n A l z h e i m e r'sd i s e a s e[J].F r o n t i e r si nA g i n g N e u r o s c i e n c e,2020,12:200.[38] Q I N Y Y,B AL,Z H A N GFX,e t a l.C e r e b r a l b l o o d f l o wc h a n g e si n d u c e d b y h i g h-f r e q u e n c y r e p e t i t i v e t r a n s c r a n i a l m a g n e t i cs t i m u l a t i o nc o m b i n e d w i t h c o g n i t i v et r a i n i n g i n A l z h e i m e r'sd i se a s e[J].F r o n t i e r s i nN e u r o l o g y,2023,14:1037864.[39] L E F A U C H E U RJP,A L E MA N A,B A E K E N C,e t a l.E v i d e n c e-b a s e d g u i d e l i n e s o n t h e t h e r a p e u t i cu s eo f r e p e t i t i v e t r a n sc r a n i a lm a g n e t i c s t i m u l a t i o n(r T M S):a nu p d a t e(2014-2018)[J].C l i n i c a lN e u r o p h y s i o l o g y:O f f i c i a l J o u r n a l o f t h e I n t e r n a t i o n a l F e d e r a t i o no fC l i n i c a lN e u r o p h y s i o l o g y,2020,131(2):474-528.[40] D A S S A A,AM I R D.T h e r o l e o f s i n g i n g f a m i l i a r s o n g si ne n c o u r a g i n g c o n v e r s a t i o na m o n gp e o p l ew i t hm i d d l e t o l a t e s t a g eA l z h e i m e r's d i s e a s e[J].J o u r n a l o fM u s i cT h e r a p y,2014,51(2):131-153.[41] R A G L I O A,B E L L A N D ID,B A I A R D IP,e ta l.E f f e c to fa c t i v em u s i c t h e r a p y a n d i n d i v i d u a l i z e d l i s t e n i n g t om u s i c o nd e m e n t i a:a m u l t i c e n t e rr a n d o m i z e d c o n t r o l l e d t r i a l[J].J o u r n a lo ft h eA m e r i c a nG e r i a t r i c s S o c i e t y,2015,63(8):1534-1539.[42]张婷婷.音乐治疗对言语障碍性老年痴呆症的质性研究[D].哈尔滨:哈尔滨师范大学,2017.[43]S R I R AM V,J E N K I N S O N C,P E T E R S M.I n f o r m a l c a r e r s'e x p e r i e n c eof a s s i s t i v e t e c h n o l og y u s e i n d e m e n t i a c a r e a th o m e:as y s t e m a t i c r e v i e w[J].B M CG e r i a t r i c s,2019,19(1):160.[44]S R I R AM V,J E N K I N S O NC,P E T E R S M.C a r e r s'e x p e r i e n c e s o fa s s i s t i v e t e c h n o l o g y u s e i n d e m e n t i a c a r e:a c r o s s s e c t i o n a l s u r v e y[J].B M CG e r i a t r i c s,2021,21(1):471.[45] WA N G R H,S U D H AMA A,B E G UM M,e t a l.R o b o t s t oa s s i s td a i l y a c t i v i t ie s:v i e w so fo l d e ra d u l t s w i t h A l z h e i m e r'sd i s e a s ea n d t h e i rc a r e g i v e r s[J].I n t e r n a t i o n a lP s y c h o g e r i a t r i c s,2017,29(1):67-79.[46] UM E D A-K AM E Y AMA Y,K AM E Y AMA M,T A N A K A T,e t a l.S c r e e n i n g o fA l z h e i m e r's d i s e a s e b yf a c i a l c o m p l e x i o nu s i n ga r t i f i c i a l i n t e l l i g e n c e[J].A g i n g,2021,13(2):1765-1772.[47]赵俊海.阿尔茨海默型痴呆症语言研究的进展及动向[J].当代外语研究,2022(3):102-112.[48]张远星,何磊,靳千胜,等.虚拟现实语言训练对卒中后失语患者干预效果的M e t a分析[J].中华护理杂志,2023,58(3):296-303.[49]沈银萍,陈海勤,刘敏,等.轻度老年痴呆患者创造性故事疗法干预效果观察[J].护理学报,2021,28(11):70-73.[50]I Z Q U I E R D O M,M E R C HA N T R A,MO R L E Y J E,e t a l.I n t e r n a t i o n a l e x e r c i s e r e c o mm e n d a t i o n s i no l d e r a d u l t s(I C F S R):e x p e r t c o n s e n s u s g u i d e l i n e s[J].T h e J o u r n a l o fN u t r i t i o n,H e a l t h&A g i n g,2021,25(7):824-853.(收稿日期:2023-05-22;修回日期:2023-11-29)(本文编辑孙玉梅)㊃0544㊃C H I N E S EE V I D E N C E-B A S E D N U R S I N GD e c e m b e r,2023V o l.9N o.24。
乳腺癌综合治疗 英语
乳腺癌综合治疗英语Comprehensive Treatment for Breast Cancer.Breast cancer is a leading cause of cancer-related deaths among women worldwide. It is a complex disease that requires a multifaceted approach for effective management. Comprehensive treatment for breast cancer typically involves a combination of surgical procedures, radiation therapy, chemotherapy, hormone therapy, and targeted therapy, depending on the stage and type of the tumor.Surgical Procedures.Surgical procedures play a crucial role in the treatment of breast cancer. The type of surgery recommended depends on the size and location of the tumor, as well as whether the cancer has spread to other parts of the body. Common surgical procedures include:1. Lumpectomy: This procedure removes only the tumorand a small amount of surrounding tissue. It is often combined with radiation therapy to ensure that all cancer cells are destroyed.2. Mastectomy: This surgery removes the entire breast, along with some surrounding tissue and lymph nodes. It may be recommended for larger tumors or when cancer has spread to the lymph nodes.3. Sentinel Lymph Node Biopsy: This procedure involves the removal of a few lymph nodes to check for cancer cells. If the sentinel lymph nodes are cancer-free, additional lymph node removal may not be necessary.Radiation Therapy.Radiation therapy uses high-energy radiation to destroy cancer cells. It can be used after surgery to kill any remaining cancer cells or to shrink tumors before surgery. Radiation therapy may also be used to treat breast cancer that has spread to other parts of the body.Chemotherapy.Chemotherapy involves the use of drugs to kill or slow the growth of cancer cells. It may be used before surgery to shrink tumors (neoadjuvant chemotherapy) or after surgery to destroy any remaining cancer cells (adjuvant chemotherapy). Chemotherapy may also be used to treat advanced breast cancer that has spread to other parts of the body.Hormone Therapy.Hormone therapy is used to block the effects of hormones, such as estrogen and progesterone, that can stimulate the growth of some breast cancers. This therapy is typically recommended for women with hormone-receptor-positive breast cancer. Hormone therapy may be used alone or in combination with other treatments.Targeted Therapy.Targeted therapy involves the use of drugs that targetspecific molecules or proteins on cancer cells, blocking their growth or spread. This type of therapy is often used in combination with other treatments for advanced breast cancer.Conclusion.Comprehensive treatment for breast cancer requires a team of healthcare professionals, including surgeons, radiation oncologists, medical oncologists, and other specialists. The goal of treatment is to destroy all cancer cells while minimizing side effects and preserving quality of life. By combining different treatment modalities, patients with breast cancer can achieve better outcomes and improved survival rates.。
质子重离子放射治疗 英文
质子重离子放射治疗英文English:Proton and heavy ion radiation therapy, also known as particle therapy, is an advanced form of cancer treatment that uses charged particles, such as protons and carbon ions, to target and destroy cancer cells. Unlike traditional radiation therapy, which uses X-rays, proton and heavy ion radiation therapy can deliver a highly concentrated dose of radiation directly to the tumor while minimizing damage to surrounding healthy tissues. This precision and effectiveness make proton and heavy ion radiation therapy particularly suitable for treating tumors located near critical organs or in sensitive areas, such as the brain. Additionally, proton and heavy ion radiation therapy has shown promise in treating certain types of cancer that are resistant to traditional radiotherapy, offering new hope to patients with challenging cases.中文翻译:质子和重离子放射治疗，也被称为粒子治疗，是一种先进的癌症治疗方法，使用带电粒子，如质子和碳离子，来瞄准和摧毁癌细胞。
cancer immunology research级别 -回复
cancer immunology research级别-回复Cancer Immunology Research: Understanding the Interplay between the Immune System and CancerIntroduction:Cancer remains a formidable global health challenge, affecting millions of lives each year. Traditional treatment modalities such as surgery, chemotherapy, and radiation therapy have made significant strides in managing various cancer types. However, these treatments often come with significant side effects and are not always effective. In recent years, there has been a growing focus on cancer immunology research, which aims to harness the power of the immune system to fight against cancer. This article will delve into the realm of cancer immunology research, exploring its significance, recent breakthroughs, and future directions.Understanding Cancer Immunology:Cancer immunology is the study of the interplay between the immune system and cancer cells. The immune system is designed to defend the body against foreign invaders, and cancer cells canexploit various mechanisms to evade this defense system. By deciphering the ways in which cancer cells interact with the immune system, researchers hope to develop innovative immunotherapies that can effectively target and eliminate cancer cells.Significance of Cancer Immunology Research:Cancer immunology research has gained immense significance due to its potential to revolutionize cancer treatment. Unlike traditional approaches, which directly target cancer cells, immunotherapies aim to enhance the body's natural defense mechanisms. This approach offers several advantages, including the ability to target cancer cells selectively, minimizing harm to healthy tissues, and generating long-lasting immune memory to prevent cancer recurrence. Moreover, immunotherapies have shown promising results in difficult-to-treat cancers like melanoma, lung cancer, and kidney cancer, offering hope to patients who previously had limited treatment options.Current Breakthroughs in Cancer Immunology:1. Checkpoint Inhibitors: One of the most significant breakthroughs in cancer immunology research has been the development of immune checkpoint inhibitors. These inhibitors target molecules that act as "brakes" on the immune system, preventing it from attacking cancer cells. By blocking these molecules, checkpoint inhibitors unleash the immune system's full potential, allowing it to recognize and attack cancer cells more effectively. Drugs such as pembrolizumab and nivolumab have shown remarkable success in various cancers, significantly extending patient survival rates.2. Adoptive Cell Transfer Therapy: Another breakthrough in cancer immunology research is adoptive cell transfer therapy, particularly chimeric antigen receptor (CAR) T-cell therapy. This approach involves genetically modifying a patient's immune cells to express receptors that can recognize specific cancer cell markers. The modified immune cells are then infused back into the patient, where they can target and destroy cancer cells. CAR-T cell therapy has shown remarkable success in blood-related cancers like leukemia and lymphoma, with some patients achieving long-term remission.Future Directions in Cancer Immunology Research:1. Personalized Immunotherapies: The field of cancer immunology is moving towards personalized immunotherapies that take into account an individual's immune profile and cancer characteristics. By tailoring treatment based on these factors, researchers aim to maximize therapeutic efficacy and minimize adverse effects. This approach involves identifying biomarkers that can predict immunotherapy response and designing treatment regimens accordingly.2. Combination Therapies: Combining multiple immunotherapies or combining immunotherapies with traditional treatments like chemotherapy is an emerging avenue in cancer immunology research. By targeting cancer cells from different angles, combination therapies have the potential to enhance treatment response and overcome resistance. Ongoing clinical trials are exploring the safety and efficacy of these approaches in various cancer types.Conclusion:Cancer immunology research is an exciting and rapidly evolvingfield that holds great promise in the fight against cancer. Recent breakthroughs in immune checkpoint inhibitors and adoptive cell transfer therapy have transformed treatment outcomes for many cancer patients. The future of cancer immunology research lies in personalized immunotherapies and combination therapies, which aim to optimize treatment response. Continued investments and collaborations in this field are crucial for translating research findings into clinically effective therapies that can benefit a broader range of cancer patients.。
重离子治疗肿瘤的临床研究进展
•综述•重离子治疗肿瘤的临床研究进展王姗李萍张芮韩江龙胡钦勇付振明武汉大学人民医院肿瘤中心 430060通信作者：付振明，Email:davidfuzming@【摘要】重离子放疗，特別是碳离子放疗，由于其良好的放射物理学特性和生物学效应在肿瘤放疗中逐渐受到重视。
近年来研究发现，重离子放疗在不同实体瘤中均能取得较好的疗效。
在不远的将来，如果重离子放疗能克服现有的技术困难则有望成为下一代放疗的主流。
【关键词】肿瘤；重离子放射疗法；碳离子D0I ：10. 3760/cma. j. cn371439-20200117-00112Progresses in clinical research of heavy ion therapy for cancerWang Shan, Li Ping, Zhang Rui, Han Jianglong, Hu Qinyong, Fu ZhenmingCancer Center, Retimin Hospital of Wuhan University, Wuhan 430060, ChinaCorresponding author：Fu Zhenming, Em ail：********************.cn【Abstract】Heavy ion radiotherapy，especially carbon ion radiotherapy，has been paid more attention incancer radiotherapy because of its good radiophysical properties and biological effects. Recent studies show thatthe heavy ion is effective in treating solid tumors. In the near future，heavy ion radiotherapy is promising tobecome the mainstream of the next generation of radiotherapy if it overcomes the existing technical difficulties.【Key words】Neoplasms; Heavy ion radiotherapy；Carbon ionDOI：10. 3760/cma. j. cn371439-20200117-00112放疗作为一种物理治疗手段，已有i〇〇多年的历 史。
转移性去势抵抗性前列腺癌化疗后预后的影响因素
转移性去势抵抗性前列腺癌化疗后预后的影响因素庞华【摘要】Objective To investigate prognostic factors of metastatic castration-resistant prostate cancer ( mCRPC ) trea-ted with docetaxel chemotherapy .Methods Age,Gleason score ,prostate-specificantigen ,blood baseline condition and hormone-sensitive time of 46 patients with mCRPC were recorded .Results Overall survival time of all patients was 3-45 months,the aver-age survival time was (21.34 ±2.13) months,median survival time was 19.36 months;cox regression analysis showed that Glea-son score,hemoglobin,hormone-sensitive time were related with the patient's survival time,RR values were 1.782,2.363 and2.012,and P<0.05.Conclusion Gleason score,hemoglobinconcentration ,and hormone-sensitive time before chemotherapy are prognostic factors of metastatic castration resistant prostate cancer .%目的：探讨采用多西紫杉醇化疗的转移性去势抵抗性前列腺癌（ metastatic castration-resistant prostate canc-er，MCRPC）患者预后影响因素。
羟考酮与吗啡片用于中度癌症疼痛患者治疗效果比较
羟考酮与吗啡片用于中度癌症疼痛患者治疗效果比较刘玉华【摘要】目的通过Pain Vision法及NRS、KPS、QOL评分比较中度癌痛患者经过盐酸羟考酮缓释片和吗啡即释片两种不同滴定方式的治疗效果和不良反应. 方法回顾性分析60例中度癌痛患者,根据治疗方法不同分为羟考酮组及吗啡组,每组30例.羟考酮组患者进行盐酸羟考酮缓释片直接滴定治疗,吗啡组患者则口服即释吗啡片滴定后转换为盐酸羟考酮缓释片治疗,治疗后比较2组的PD值、NRS、KPS、QOL评分及不良反应情况. 结果羟考酮组疼痛缓解率明显高于吗啡组(P<0.05);两组患者24 h、72 h时PD值比较,差异无显著性;两组患者72 h时KPS及QOL评分与24 h相比均得到明显提高(P<0.05);羟考酮组总体不良反应低于吗啡组(P<0.05).结论恶性肿瘤患者,中度癌性疼痛治疗中,盐酸羟考酮缓释片相较于吗啡片起效快、毒副反应小.【期刊名称】《中南医学科学杂志》【年(卷),期】2017(045)004【总页数】4页(P374-377)【关键词】盐酸羟考酮缓释片;吗啡即释片;癌性疼痛【作者】刘玉华【作者单位】甘肃省肿瘤医院肿瘤内科甘肃兰州 730050【正文语种】中文【中图分类】R730.5结论恶性肿瘤患者，中度癌性疼痛治疗中，盐酸羟考酮缓释片相较于吗啡片起效快、毒副反应小。
癌性疼痛即癌痛，是癌症患者常见症状之一，其中50%患者有中至重度疼痛，30%是难以忍受的重度疼痛，因此镇痛是肿瘤姑息治疗的一个重要方面[1]。
根据WHO镇痛三阶梯原则，治疗中重度癌痛的首选方法即阿片类药物[2]，我国《癌痛诊疗规范2011版》[3]推荐使用吗啡进行快速滴定。
目前，吗啡虽然作为中重度癌痛一线止痛药被广泛应用于临床，但临床实际应用中随着病人使用吗啡时间的延长明显增加了服药次数及成瘾风险。
因此，临床需要一种更为适合的药物用于中度癌痛患者的剂量滴定。
盐酸羟考酮缓释片作为一类双相释放制剂，不仅具有迅速起效、立即镇痛的特点，其缓释成分能够维持平稳的血药浓度[4]。
肺癌国际生存质量量表与体能状态评定指标及中医症状量表的关系_游捷
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肺癌国际生存质量量表与体能状态评定指标及 中医症状量表的关系
游 捷 施志明
摘要 目的 从临床观察角度探讨国际生存质量量表与体能状态评估及中医症状量表之间的相互关 系。方法 采用欧洲癌症研究与治疗组织肺癌生存质量量表( EORT C QL Q L C43) 和癌症治疗功能评价量 表( FACT L) 两种国际生存质量量表测定 363 例肺癌患者生存质量, 同时记录其卡氏( KPS) 评分与体能状态 ( ECOG ) 及肺癌中医症状量表( L CSL T CM ) 计分, 并作相关性及一致性分析。结果 EORT C QLQ L C43 和 FACT L 计分与 KPS 评分、ECOG 及中医症状量表计分存在相关, 但相关系数较小; 各指标之间存在一致 性。中医症状量表与 KPS 评分、ECOG 之间不存在一致性。结论 生存质量测评应采用生存质量量表, 而 不能以体能状态指标代替, 但体能状态指标可作为生存质量的简易预测指标。中医症状量表与生存质量量 表及体能状态指标之间有一定相关性。
Key words QOL quest ionnaire; physical performance index es; symptoms lists questionnaire of T CM ; non small cell lung cancer
近年来肿瘤患者生存质量研究已成为肿瘤综合治 疗领域中日渐引人关注的研究方向, 国际癌症研究组 织已将其作为研究领域新药及新方法临床疗效评价体 系的必要指标之一。我国在该方面研究已开始得到重 视, 然而在生存质量评估测定中使用规范化国际生存 质量量表仍未广泛开展。我们以非小细胞肺癌患者为 研究对象, 采用国际上应用较广泛、评价较好的两种肺
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2015IMP&HIRFL Annual Report·145·
3-46Heavy Ion Cancer Therapy-related Research in the
Group of Medical Physics
Li Qiang,Liu Xinguo,Dai Zhongying,Jin Xiaodong,Li Ping,
Liu Xiongxiong,He Pengbo,Ye Fei,Chen Weiqiang and Liu Yan With the construction of the Heavy Ion Mecial Machine(HIMM)in Wuwei,more and more work related to the research and development of heavy ion cancer therapy have been done in the group of Medical Physics this year.On the one hand,we focused our work on setting up a heavy ion radiotherapy treatment planning system for the HIMM project,aiming at building a bridge between the HIMM facility and clinical application;on the other hand,we continued to explore the mechanisms underlying heavy ion radiation-induced biological effects in order to provide theoretical basis for heavy ion cancer therapy,trying either to improve the efficacy of heavy ion therapy or to reduce the radiation-induced damage to normal tissues as much as possible.The following summarizes the progress of the work achieved in the group of Medical Physics this year.A heavy-ion radiotherapy treatment plan-ning system ciPlan(carbon ion Plan,Fig.1),which will be used for the HIMM projects,has been developed.Heavy ion treatment plans under three different beam delivery modes(two-dimentional(2D)conformal,2D layer-stacking and three-dimensional(3D)spot scanning)could be designed in the ciPlan.Preliminary dose verifications for the plans derived from the ciPlan have been done and good agreement between planned and measured doses was ob-served.Additionally,devices such as range shifter,ridgefilter,primary collimator and scatterer have been designed and manufactured.These devices will be used for passive or active beam delivery in the HIMM projects through executing the instructions sended by the treatment control system,which are generated in the ciPlan for a specific patient treatment.To provide basic data for the ciPlan,Monte Carlo(MC)simulations using the Gate MC software package were conducted for carbon ion beams.Except the calculated data for the ciPlan,experimentally-measured data were partially obtained.Further machine data will be measured in the HIMM project in Wuwei.
Fig.1(color online)The main interface of ciPlan.
For the study of heavy ion radiation-induced autophagy and corresponding mechanisms,human glioblastoma SHG44and cervical cancer HeLa cells were irradiated with carbon ions of different linear energy transfers(LETs)and X-rays this year.Our experimen-tal results revealed that increased LC3-II and decreased p62levels in SHG44and HeLa cells post-irradiation, indicating marked induction of autophagy.The au-tophagic level of tumor cells after irradiation increased in a LET-dependent manner and was inversely corre-lated with the sensitivity to various qualities of radi-ation.Furthermore,we demonstrated that high-LET carbon ions stimulated the unfolded protein response
(UPR)and mediated autophagy via the UPR-eIF2α-CHOP-Akt signaling axis.High-LET carbon ions more severely inhibited Akt-mTOR through UPR to effectively induce autophagy.Thus,our data could serve as an important radiobiological basis to further understand the molecular mechanisms by which high-LET radiation induces cell death.
In the aspect of nanoparticle applied research,this year we have found that thioctyl tirapazamine(TPZs) modified gold nanoparticles(TPZs-AuNPs)had a synergistic radiosensitizing effect on human hepatoma HepG2 cells,which came from gold nanoparticles and tirapazamine moiety-induced reactive oxygen species(ROS)in HepG2 cells.More importantly,we found that radiation-induced cell division delay might provide a possible mechanism underlying the enhanced effect for the cellular uptake of AuNPs in irradiated cells.Ionizing radiation exposure might be a cell cycle phase-dependent targeting approach for intracelluar delivery of AuNPs in tumor cells.
The work and studies mentioned above provided a substantial basis for the medical application of heavy ion radiation,and further studies will be conducted in the next year.。