肿瘤营养教育下自我超越理论结合综合护理干预在老年胃癌患者中的应用效果

目的 探究肿瘤营养教育下自我超越理论结合综合护理干预在老年胃癌患者中的应用效果。方法 选择中国人民解放军空军军医大学第一附属医院2022年1月至2023年1月收治的180例老年胃癌患者为研究对象,按随机数字表法将其分为研究组(90例)与对照组(90例)。对照组接受综合护理干预,研究组在对照组的基础上采用肿瘤营养教育下的自我超越理论进行护理干预。比较两组症状改善情况;比较两组干预前后营养状况[患者主观整体评估(PG-SGA)]、心理状态[汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)];比较两组护理满意度。结果 研究组症状改善情况优于对照组(P<0.05)。干预后,两组PG-SGA评分低于干预前;且研究组低于对照组(P<0.05)。干预后,两组HAMA、HAMD评分低于干预前,且研究组低于对照组(P<0.05)。研究组护理满意度优于对照组(P<0.05)。结论 肿瘤营养教育下自我超越理论结合综合护理干预可有效缓解老年胃癌患者临床症状,改善营养状况与心理状态,提升临床满意度。

《金匮要略》中体现的肿瘤转移理论及治法方药特点

长期以来,在中医肿瘤学界的基础与临床研究工作中,有关癌瘤转移问题的研究一直是一个薄弱环节,且目前中医尚无相对完整系统的理论。《金匮要略》是古代中医治疗杂病的典范,其对杂病系统完整的治则治法论述,全面灵活地遣方用药思路,至今仍指导着临床。文章在研讨《金匮要略》有关论述,分析现代肿瘤转移机制的基础上,结合临床实践,从《金匮要略》中体现的肿瘤转移理论及肿瘤转移治则治法方药等方面进行初步探讨。

初探肿瘤免疫理论指导肺癌免疫治疗

肺癌传统上没有被列为免疫系统疾病,但肺癌似乎是最新进入免疫治疗范畴的疾病。肺癌和上皮来源的其他恶性肿瘤的免疫机制一样。肿瘤免疫系统有免疫监视预防肿瘤和抑制免疫防止自身免疫病的双重作用。预防肿瘤作用失败的主要机理包括分泌免疫抑制因子、失去MHC抗原的表达、通过Treg-CD4+细胞抑制免疫细胞的募集反应,以及通过免疫检验点途径调整诱导T细胞对肿瘤不发生反应。目前多个免疫检验点抑制剂在IgG类型和结合靶点专一性不同,并且全部实现了完全人源化。还发现肿瘤驱动基因促使免疫检验点过度表达,EGFR通路激活就促进了PD-L1表达,EGFR基因突变还在免疫微环境的改变中具有作用。免疫治疗将成为肺癌治疗的新的希望之所在。

利用中医肿瘤理论体系完善专科疾病的管理方案

目的:探讨利用中医肿瘤理论体系完善专科疾病管理方案的效果与意义。方法:研究为前瞻性研究,将2020年9月—2022年3月期间医院肿瘤科收治的70例患者纳入研究。根据医学管理方案不同分为对照组和观察组,每组35例。对照组患者接受基础管理内容。由本科室专科管理人员掌握疾病常见症状的病因与机制,设置管理目标,评估生理、病理、心理健康状况,结合辅助检查结果,为每位患者制定相应的管理方案。观察组患者在接受基础管理内容的同时,接受中医肿瘤疾病管理方案:从中医视角分析疾病病因(主要为三因、生活习惯、年龄、医药、医源性因素),利用中医辨证理念进行疾病的病理机制分析,并根据辨证结果进行中医药干预。总体上从调肝理气、健脾和胃、益气和血、益肾填精、散结开癖等方面进行中药内治。同时在结合中药外敷、针刺疗法等中医外治方案。内外结合,提升临床疗效。从临床症状、不良反应、患者生存质量、预后效果方面评价两种管理方案下的专科疾病干预效果。从内在信念、行动力、决策力、依从性方面,评价两种管理方案实施过程中患者的自我管理效果。结果:观察组临床症状、不良反应、患者生存质量、预后效果评分均显著高于对照组(P<0.05)。观察组患者的内在信念、行动力、决策力、依从性评分均明显高于对照组(P<0.05)。结论:中医学在整体观念和辨证思想指导下,对乳腺癌的病因病机有其独特的认识,总体上从调肝理气、健脾和胃、益气和血、益肾填精、散结开癖等方面进行中药内治,辅以中医适宜技术,能够提升专科管理效果,通过加强对患者的健康教育工作,患者的自我管理能力也得到了显著的提升。

21世纪抗癌策略改变给中西医结合肿瘤防治带来的思考

20世纪抗癌战取得了长足的进展,层出不穷的新手段也给肿瘤患者带来了希望,然而其"消灭肿瘤"的治疗模式所带来的负面效应,使之出现了瓶颈。基于此,21世纪抗癌策略的改变——调控肿瘤,给中医及中西医结合肿瘤防治带来了思考,亦带来了契机。中医药着眼于肿瘤干细胞、细胞间质及其微环境研究具有广阔的前景,以"肿瘤痰证理论"为主中西医肿瘤的综合治疗策略,将会对世界医学做出我们民族的贡献。

未来医学的五个猜想

本文提出五个有关未来医学的猜想。(1)甲状腺乳头状癌被重新命名,不再被称为癌;(2)幽门螺杆菌被用于治疗疾病,如反流性食管炎;(3)通过激活癌基因促进肿瘤细胞的存活治疗肿瘤,使患者生存受益;(4)抑制肿瘤的免疫反应治疗肿瘤;(5)癌症理论发生革命性变化,被彻底重写。

肿瘤绿色治疗理论指导下的中药外敷法治疗癌痛的思考与实践

癌痛严重影响患者的生存质量及生存期,是目前肿瘤治疗领域需要重点关注的问题之一。阿片类药物在镇痛的同时,易引起严重的消化道反应、中枢神经系统反应,治疗作用和副反应相当。肿瘤绿色治疗理论以提高患者生存质量,延长生存期为目标,以最小的治疗伤害获得最大的治疗效果为落脚点,以中医寒热辨证为纲领,运用中药针对病因治疗,综合运用消瘤、大毒、清解伏阳之中药,通过外敷直达病所,既针对整体病因治疗,又针对局部疼痛治疗,并通过案例说明运用上述理论指导中药外敷切实可行。今后的研究拟通过适当改良来延长贴敷的止痛时间及皮肤过敏问题,并根据中医寒热理论研制出针对性更强的中药癌痛贴敷剂。

Intravoxel incoherent motion magnetic resonance imaging for diagnosis of cervical cancer and evaluation of response of uterine cervical cancer to radiochemotherapy: A pilot study

Objective The aim of this study was to investigate the ability of intravoxel incoherent motion(IVIM) diffusion-weighted magnetic resonance imaging(MRI) to diagnose cervical cancer and to evaluate the response of uterine cervical cancer to radiochemotherapy(CRT).Methods This prospective study was approved by the institutional review board, and informed consent was obtained from all patients. A total of 23 patients with primary cervical cancer who were undergoing CRT and 16 age-matched healthy subjects were prospectively recruited for IVIM(b = 0–800 s/mm2) and standard pelvic MRI. Bi-exponential analysis was performed to derive f(perfusion fraction), D*(pseudo-diffusion coefficient), and D(true molecular diffusion coefficient) in cervical cancer(n = 23) and the normal cervix(n = 16). The apparent diffusion coefficient(standard ADC) was calculated. The independent-samples t-test and paired-samples t-test were used for comparisons.Results Pre-treatment cervical cancer had the lowest standard ADC(1.15 ± 0.13 × 10-3 mm2/s) and D(0.89 ± 0.10 × 10-3 mm2/s) values, and these were significantly different from the normal cervix and posttreatment cervical cancer(P = 0.00). The f(16.67 ± 5.85%) was lowest in pre-treatment cervical cancer and was significantly different from the normal cervix and post-treatment cervical cancer(p = 0.012 and 0.00, respectively). No difference was observed in D*.Conclusion IVIM is potentially promising for differentiating between the normal cervix and cervical cancer because pre-treated cervical cancer has low perfusion and diffusion IVIM characteristics. Further, the standard ADC, D, and f of cervical cancer showed a tendency to normalize after CRT; thus, IVIM may be useful for monitoring the response to CRT in cervical cancer.

Research progress of the role of HGF/c-Met in the proliferation, invasion, angiogenesis and metastasis of cancer

The HGF/c-Met pathway plays an important role in the proliferation, invasion, angiogenesis, and metastasis of tumors. With the successful development of small molecule c-Met kinase inhibitors, this signal pathway has become the focus of oncology research. In this review, we discuss the basic mechanism, targeted therapy, and early results of clinical trials of the HGF/c-Met pathway.

Preliminary clinical application of an adaptive iterative statistical reconstruction algorithm inhead and neck computed tomography angiography with low tube voltage and a low concentration of contrast medium

Objective To evaluate the feasibility of using a low concentration of contrast medium （Visipaque 270 mgl/mL）, low tube voltage, and an advanced image reconstruction algorithm in head and neck computed tomography angiography （CTA）. Methods Forty patients （22 men and 18 women; average age 48.7 ± 14.25 years; average body mass index 23.9 ± 3.7 kg/m^2） undergoing CTA for suspected vascular diseases were randomly assigned into two groups. Group A （n = 20） was administered 370 mgl/mL contrast medium, and group B （n = 20） was administered 270 mgl/mL contrast medium. Both groups were administered at a rate of 4.8 mL/s and an injection volume of 0.8 mL/kg. Images of group A were obtained with 120 kVp and filtered back projection （FBP） reconstruction, whereas images of group B were obtained with 80 kVp and 80% adaptive iterative statistical reconstruction algorithm （ASiR）. The CT values and standard deviations of intracranial arteries and image noise on the corona radiata were measured to calculate the contrast-to-noise ratio （CNR） and signal-to-noise ratio （SNR）. The beam-hardening artifacts （BHAs） around the skull base were calculated. Two readers evaluated the image quality with volume rendered images using scores from 1 to 5. The values between the two groups were statistically compared. Results The mean CT value of the intracranial arteries in group B was significantly higher than that in group A （P 〈 0.001）. The CNR and SNR values in group B were also statistically higher than those in group A （P 〈 0.001）. Image noise and BHAs were not significantly different between the two groups. The image quality score of VR images of in group B was significantly higher than that in group A （P = 0.001）. However, the quality scores of axial enhancement images in group B became significantly smaller than those in group A （P〈 0.001）. The CT dose index volume and dose-length product were decreased by 63.8% and 64%, respectively, in group B （P 〈 0.001 for both）. Conclusion Visipaque combined with 80 kVp and 80% ASiR provided similar image quality in intracranial CTA with 64% radiation dose reduction compared with the use of lopamidol, 120 kVp, and FBP reconstruc-tion.

Imaging features of alveolar soft part sarcoma

Objective The aim of this study was to analyze the imaging features of alveolar soft part sarcoma （ASPS）. Methods The imaging features of 11 cases with ASPS were retrospectively analyzed. Results ASPS mainly exhibited an isointense or slightly high signal intensity on Tl-weighted imaging （TlWl）, and a mixed high signal on T2-weighted imaging （T2Wl）. ASPS was partial, with rich tortuous flow voids, or ＂line-like＂ low signal septa. The essence of the mass was heterogeneous enhancement. The 1 H- MRS showed a slight choline peak at 3.2 ppm. Conclusion The well-circumscribed mass and blood voids, combined with ＂line-like＂ low signals play a significant role in diagnosis. The choline peak and the other signs may be auxiliary diagnoses.

Cine magnetic resonance imaging for quantitative assessment of healthy volunteers and patients with organic small bowel disease

Objective The aim of the study was to use dynamic magnetic resonance imaging （MRI） to compare quantitative parameters of small bowel motility between healthy volunteers and patients with small bowel diseases in order to investigate the characteristics of normal and impaired bowel peristalsis. Methods A total of 44 healthy volunteers （20 men, 24 women; mean age： 36 years; range： 20-61 years） and 42 patients （28 men, 14 women; mean age： 44 years; range： 15-72 years） with organic small bowel disease were recruited in our hospital （Tongji Hospital, Tongji Medical College, Huazhong University of Sci- ence and Technology, Wuhan, China） in this prospective study approved by the hospital institutional review board. Imaging was performed using a 3.0-T scanner 45 minutes after standardized oral administration of 1500 mL non-absorbable fluid （2.5% mannitol）. A serial coronal scan was performed at selected planes for two minutes without breath-hold. Time-caliber curves were plotted at two well-distended small bowel loops in both healthy and patient groups regardless of location. Luminal diameter （LD）, contraction period （CP）, frequency of contraction （FC）, and amplitude-diameter ratio （ADR） were measured based on the graph. Results The characteristics of abnormal peristaltic parameters were assessed in different patients and compared to normal curves from healthy volunteers. A total of 37 segments with abnormal motility were confirmed by two readers in consensus, based on curve patterns and the presence of a stationary phase. Compared to normal peristalsis in healthy volunteers, five different patterns of impaired peristalsis were identified： Ⅰ, consecutive; Ⅱ, slow; Ⅲ, giant type; Ⅳ, uncoordinated; and V, akinetic. Dilated LDs were de- tected in all instances of abnormal peristalsis （P 〈 0.05）. Increased frequency was found in type Ⅰ [（8.73 ± 1.15）/min], while decreased frequency was detected in type Ⅲ peristalsis [（0.67 ± 0.29）/min]. There were no significant differences in frequency between type Ⅱ [（3.19 ±0.43）/min] and normal peristalsis [（3.45± 0.57）/min]. Apart from typeⅠ [（8.70± 0.75）/min], increased FCs were found in all other abnormal patterns. In type Ⅱ peristalsis, the average ADR value was 0.82 ± 0.08, comparable to the ADR value in the healthy group （0.83 ± 0.13）. Conclusion MR cine is an effective method for differentiating normal and abnormal small bowel peristal- sis. Plotting time-caliber curves and measuring quantitative MR cine parameters such as LD, CP, FC, and ADR offers more precise information about small bowel motility.

Antiangiogenic therapy for human pancreatic carcinoma xenografts in nude mice

AIM: To investigate the anti-tumor effects of antiangiogenic therapy (a combination of TNP-470, an antiangiogenic compound, with gemcitabine, an antimetabolite) on human pancreatic carcinoma xenografts and its mechanism. METHODS: A surgical orthotopic implantation (SOI) model was established by suturing small pieces of SW1990 pancreatic carcinoma into the tail of pancreas in nude male mice. Mice then received either single therapy (n = 24) or combined therapy (n = 32). Mice receiving single therapy were randomly divided into control group, G100 group receiving 100 mg/kg gemcitabine IP on d O, 3, 6 and 9 after transplantation, and T30 group receiving 30 mg/kg TNP-470 s.c on alternate days for 8 wk. Mice receiving combined therapy were randomly divided into control group, T15 group, G50 group and combination group (TNP-470 30 mg/kg and gemcitabine 50 mg/kg). Animals were killed 8 wk after transplantation. Transplanted tumors, liver, lymph node and peritoneum were removed. Weight of transplanted tumors, the T/C rate (the rate of mean treated tumor weight to mean control tumor weight), change of body weight, metastasis rate, and 9-wk survival rate were investigated. Tumor samples were taken from the control group, T30 group, G100 group and combination group. PCNA index (PI) and microvessel density (MVD) were investigated by immunohistochemical staining for PCNA and factor VIII, respectively. RESULTS: There was a significant inhibitory effect on primary tumor growth of pancreatic carcinoma in G100 group, compared to T30 group, whereas tumor metastasis was significantly inhibited in T30 group compared to G100 group. There was no significant improvement in survival rate in these two groups. No significant inhibitory effect on tumor growth and metastasis in T15 group and G50 group. However, significant anti-tumor and anti-metastatic effects were observed in the combination group with a significant improvement in survival rate. The inhibitory effect on tumor growth in combination group enhanced 2 times in comparison with G50 group and 5 times in comparison with T15 group. Moreover, 25% of the animals hearing tumors were cured by the combination therapy. The levels of MVD and PI were 14.50±5.93 and 0.41±0.02,12.38±1.60 and 0.30±0.07, 7.13±2.99 and 0.37±0.03, and 5.21±1.23 and 0.23±0.02 respectively in the control group, G100 group, T30 group and combination group. A significant inhibitory effect on PI level and MVD level was observed in G100 group and T30 group respectively whereas both MVD and PI levels were significantly inhibited in the combination group (P<0.05). CONCLUSION: Antiangiogenic therapy shows significant anti-tumor and anti-metastatic effects, and is helpful to reduce the dosage of cytotoxic drugs and the side effects. These effects are related to the antiangiogenic effect of TNP-470 and cytotoxic effect of gemcitabine.

Three-dimensional conformal radiotherapy plus concurrent DICE chemotherapy for early-stage nasal-type natural killer/T-cell lymphoma of Waldeyer's ring: A single-institution study

Objective Nasal-type natural killer/T-cell lymphoma of Waldeyer＇s ring （WR-NK/TL） has different clinico- pathological characteristics from those of other subtypes of NK/T lymphoma; thus, the optimal treatment remains unclear. To find a more effective treatment model for WR-NK/TL, we conducted a single-center study of concurrent radiochemotherapy. Methods Forty-five patients with newly diagnosed stage IE to liE WR-NKTL were randomly divided into two groups. The 23 cases in the concurrent radiochemotherapy group were treated with three-dimensional conformal radiotherapy （48-52 Gy） and 2 courses of DICE （dexamethasone, ifosfamide, cisplatin, and etoposide） synchronous chemotherapy. The 22 cases in the radiotherapy group only received three-dimen- sional conformal radiotherapy （50-54 Gy）. The primary end points were overall survival （OS）, progression- free survival （PFS）, and toxicity. Results The 1-, 3-, and 4-year OS and PFS rates were 95.5%, 65.6%, and 45.9%, and 86.4%, 56.0%, and 46.7% in the radiotherapy group, and 100%, 88.5%, and 88.5%, and 100%, 82.0%, and 73.8% in the concurrent radiochemotherapy group, respectively. The OS （P = 0.0477） and PFS rates （P = 0.0488） were higher in the concurrent radiochemotherapy group than in the radiotherapy group. The overall re- sponse rate was 100% in both the radiotherapy group [complete response （CR）, 18 cases] and concurrent radiochemotherapy group （CR, 22 cases）. The concurrent radiochemotherapy group had more severe side effects, especially grade 3 ＋ 4 events, such as leukopenia, anorexia, and stomatitis. However, side effects benefiting from excellent oral care were endurable. Conclusion Radiotherapy plus concurrent DICE chemotherapy may be an effective and safe compre- hensive treatment for patients with WR-NKTL.

Intestinal lymphangiectasia associated with chylothorax and multiple lower extremity arteriovenous malformation: A case report and literature review

Intestinal lymphangiectasia （IL） is an uncommon protein losing enteropathy, characterized by small intes- tinal mucosa or serosa lymphangiectasia and intestine lymph loss. Currently, IL is a very rare disease in children or adults, with typical clinical symptoms including hypoalbuminemia, absolute lymphocyte reduc- tion, ascites, edema, etc. We report a case of an adult with intestinal lymphatic ectasia accompanied by chylothorax and multiply arteriovenous malformations of the hip and lower extremity. CT and MRI revealed diffuse edema and thickening of the small intestine, accompanied by splenomegaly and pleural effusion. Extensive nodularity of lower ileum and the ileocecal region could be seen during intestinal endoscopy. Finally, small intestinal lamina propria lymphangiectasis was confirmed by pathological examination. To raise awareness of the disease, here we compare our case and those previously reported, and discuss the diaqnosis and manaqement of IL.

Acquired renal arteriovenous malformation:the diagnostic value of three-dimensional multidetector-row computed tomography

Objective To evaluate the diagnostic value of three-dimensional multidetector-row computed tomogra- phy （MDCT） in detecting acquired renal arteriovenous malformation （RAVM） and to compare its perfor- mance with that of ultrasonography and digital subtraction angiography （DSA）. Methods The institutional review board approved this retrospective study and written informed consent was obtained from all patients before examination. All 14 patients with acquired RAVM underwent MDCT, including cortical and medullary phase enhancement angiography and three-dimensional （3D） reconstruc- tion. Five and nine patients were further examined and their diagnoses confirmed by DSA and surgery, respectively. The MDCT images, including 3D reconstructions, were analyzed for RAVM independently and in consensus by two observers using a workstation. Results Among the 14 patients with acquired RAVM, 12 with maximum lesion diameter 〉 10 mm, and one with a maximum lesion diameter between 5 and 10 ram, were correctly diagnosed with MDCT angiog- raphy. Among these patients, four diagnoses were confirmed by DSA. One patient with a lesion 5-10 mm in diameter was misdiagnosed with a renal aneurysm by MDCT angiography. The other one with the maxi- mum diameter of the lesion between 5 mm and 10 mm was misdiagnosed as renal aneurysm with MDCT angiography, which was diagnosed as renal arteriovenous malformation with DSA. Among 14 lesions in 14 patients, eight and six originated in the left and right kidney, respectively. Conclusion MDCT angiography can accurately diagnose RAVM and improve our understanding of the disease, which will allow clinicians to provide better care.

Dosimetric comparison of different multileaf collimators in volumetric modulated arc therapy for malignant pleural mesothelioma

Objective The aiom of the study was to compare the impacts of two types of multileaf collimators （MLC） [standard MLC with a width of 10 mm （sMLC） and micro-MLC with a width of 5 mm （mMLC）] on volumetric modulated arc therapy （VMAT） planning for malignant pleural mesothelioma. Methods VMAT for ten patients with inoperable malignant pleural mesotheliomas was retrospectively planned with the sMLC and mMLC. Histogram-based dose-volume parameters of the planning target vol- ume （PTV） [conformity index （CI） and homogeneous index （HI）] and organs-at-risk were compared for VMAT plans with sMLC （sMLC-VMAT） and mMLC （mMLC-VMAT）. Results The mMLC-VMAT plans were more efficient （average delivery time： 2.67±1.49 min） than the sMLC-VMAT plans （average delivery time： 4.21 ± 2.03 min; P 〈 0.05）. Moreover, compared to the sMLC plans, the mMLC plans demonstrated advantages in the dose coverage of the PTV （CI 0.75 ± 0.08 vs 0.73± 0.09; HI 1.09 ±0.02 vs 1.10± 0.02）, although the difference was not statistically significant （P 〉 0.05）. In addition, significant dose sparing in the fraction of the ipsilateral lung volume receiving 〉 20 Gy （V20; 54.72± 27.08 vs 58.52 ± 29.30） and 〉 30 Gy （V30; 42.74 ± 27.86 vs 46.86± 31.49） radiation, respectively, was observed for the mMLC plans （P 〈 0.05）. Conclusion Comparing sMLC-VMAT and mMLC-VMAT not only demonstrated the higher efficiency and better optimal target coverage of mMLC-VMAT, but also considerably improved the dose sparing of the ipsilateral lung in the VMAT plans for mali qnant pleural mesothelioma.

肺癌中医抗血管生成研究的几个关键问题

中西医尚缺乏公认的适用于抗肿瘤血管生成药物的临床疗效评价体系与标准,中医药抗肿瘤血管生成领域的研究仍处于实验研究阶段,临床研究报道更为罕见。主张结合现代肿瘤微环境理论、中医肺癌络病说,应用影像学血管功能多参数评价新技术与方法,深化中医药抗肿瘤血管生成领域临床与基础研究,探索适用中医药抗肿瘤血管生成的临床疗效评价标准与体系。