课程文献中心 更多>>

摘要： Purpose/Objective(s) We investigated the efficacy of a combination of radiotherapy with antigen-capturing nanoparticles (AC-NPs; 123 ± 45 nm) containing digitoxin and anti-PODXL siRNA encapsulated in nanocapsules (567 ± 38 nm) that release their contents upon radiation exposure. We performed two radiotherapy sessions. Treatment with AC-NPs achieved successful immuno-radiotherapeutic effects on the primary tumors. An abscopal effect was also observed in the metastatic tumors by dendritic cell (DC)-mediated T-cell priming with PD-L1 blockade. New metastasis reduction was achieved by the dissociation of circulating tumor cell (CTC)-clusters by digitoxin and by reducing the extravasation of the dissociated CTCs via siRNA-mediated silencing of PODXL. Materials/Methods For session 1; nanocapsules were generated by mixing iopamiron and 400 μg anti-PD-L1 antibody (Ab) with a 1.0 mL solution containing 4.0% alginate , 3.0% hyaluronate , and 1 µg/mL P-selectin. This mixture was sprayed into 0.5 mmol/l FeCl 2 supplemented with 1 µg/mL anti-VEGFR-1/2 Ab. For session two, 400 nM digitoxin and 50 nM anti-PODXL siRNA were encapsulated in poly lactic-co-glycolic acid (PLGA) AC-NPs using the nanoprecipitation method. The particles were mixed with the above cocktail and sprayed into 0.5 mM/L FeCl 2 with 1 µg/mL anti-P-selectin Ab. This yielded encapsulated PLGA AC-NPs containing digitoxin. In session 1; 1 × 10 10 nanocapsules were intravenously injected in BALB/c mice exhibiting primary 4TI mammary carcinoma in the left hind leg and lung metastases . Tumor accumulation was monitored using CT imaging. Subsequently, 10/20 Gy 60 Co γ-radiation was locally administered to the primary tumors. In session 2; 1 × 10 10 nanocapsules were intravenously injected and allowed to interact with P-selectin for 9 h; 10/20 Gy 60 Co γ-radiation was locally administered. Results In session 1, CT revealed the accumulation of anti-VEGFR-1/2 nanocapsules around the primary and metastatic tumors. The microc

摘要： Purpose/Objective(s) Previous studies have shown a detrimental effect of postoperative radiation (PORT) in pN1 NSCLC patients after R0 surgery. High lymph node ratio (LNR = number of positive lymph nodes in the resected specimen/number of total lymph nodes resected) has been shown to correlate with worse outcomes. We hypothesize that PORT can improve survival outcomes in pN1 NSCLC patients with high LNR after R0 surgery. Materials/Methods The National Cancer Database was queried for cases of lung cancer from 2004-2016. Patients without neoadjuvant treatment , with at least a lobectomy with resection of at least 10 lymph nodes, with pN1 disease, with histology of squamous cell carcinoma, adenocarcinoma, adenosquamous carcinoma and large cell carcinoma were included. Exclusion criteria were neoadjuvant therapy, lack of pathological confirmation or lack of information about chemotherapy and metastatic disease . For patients with PORT, RT was directed to thorax with dose≥30Gy. Log-rank test and Cox proportional hazards models were used to compare survival adjusted for age, sex, CCI, pT, grade, chemotherapy, LNR, and PORT. Predictors for overall survival (OS) were identified. Results Among 13742 patients, 12542 (91.3%) did not have PORT, and 1200 (8.7%) had PORT. Median follow up was over 5 years. For years of 2004-2010 and 2011-2016, PORT was given to 8% (413 out of 5132) and 5.5% (423 out of 7622) of patients after R0 resection, respectively. PORT was given to 36.8% and 6.55% patients with non-R0 and R0 resection, respectively ( P < 0.001). PORT was given to 11.6% and 3.37% of patients with and without adjuvant chemotherapy , respectively ( P < 0.001). The average LNR for patients with and without PORT were 0.2 and 0.14 ( P < 0.001), respectively. In multivariate analysis (MVA) of patients with R0 resection, predictors of OS were listed in Table 1. In patients with intermediate LNR (15-29%), PORT was marginally correlated with better OS (HR, 0.80, P  = 0.07). In patien

摘要： Purpose/Objective(s) There is controversy about the need to target the mucosa of the larynx and hypopharynx during radiotherapy (RT) for squamous cell carcinoma of unknown primary site (SCCA-UP). By 1997, the policy in our department was to target only the oropharynx and nasopharynx in patients with SCCA-UP metastatic to the level II cervical nodes . The purpose of this study is to report the rate of cancer recurrence in the larynx or hypopharynx using an approach that excluded these areas from the RT target volumes. Materials/Methods We reviewed the medical records of patients who met the following inclusion criteria: received RT in our department for SCCA-UP between January 1, 1997, and December 31, 2019; no history of surgery that could disrupt the cervical lymphatics; predominant adenopathy in level IIA; and neck stage N1-2c. We excluded N3 because the incidental dose to the larynx and hypopharynx is usually high in patients with a > 6-cm nodal conglomerate. We calculated the following from the date of the last RT fraction: mucosal control to the date of first recurrence in a mucosal site in the head and neck; regional control with or without distant control to the date of first recurrence in ipsilateral or contralateral neck nodes with or without distant disease; distant control to the date of first documented metastatic lesion most likely originating from SCCA-UP; relapse-free survival to the date of recurrent disease at any site or death; cause-specific survival to the date of death due to SCCA-UP; and overall survival to the date of death from any cause. Results The study population included 50 patients with a median follow-up after RT of 7.1 years. No patient developed recurrent cancer in a mucosal site (0/50), 2% (1/50) developed a neck recurrence in a high-dose area with synchronous distant metastases , and 2% (1/50) developed distant metastases with no evidence of local or regional recurrence. At most recent follow-up, 70% (35/50) of patients were alive

关键词： 专业认证   临床技能   实践教学   功能分区  

摘要： 规范化的临床技能培训中心建设是培养医学人才临床实践能力的重要保障和有效手段之一。本文以临床医学专业认证为契机,通过对临床技能培训中心进行阶梯式的系统功能分区,探索以递进式、回归式、形成性评价为核心的临床技能培训考核模式,加强实践技能教师团队建设等措施,满足从医学生到临床医生不同结构、不同层次和不同阶段的教学、培训和考核需求,搭建了多学科、全方位、深层次、系统化的综合性临床实践教学平台,为建设集院校教育、毕业后教育及继续医学教育培训为一体的临床技能培训中心提供了一种参考模式。

关键词： 大脚趾   阳台   袜子  

摘要： 立冬后的这个周末,我盘坐在床上,拿起针穿上黑色的细线,缝娃娃的书包带子、翻穿的衣兜、大脚趾处破了洞的袜子。和煦的阳光从阳台洒进屋里,让我想起了母亲坐在炕上缝缝补补的样子。小时候,入冬前,母亲总会早早做好我们上学穿的暖鞋。她先要做格精,把破旧的衣裤剪开,用面粉打好的d糊把布片一片一片平粘在墙上,再往布上刷一层糅糊粘另一层布,贴墙上晾干之后,咨精就做好了。

关键词： 戏剧仪式化   荒诞   《阳台》  

摘要： 法国荒诞派剧作家热内将戏剧与宗教仪式进行“嫁接”,形成了他特有的戏剧仪式化风格。他的作品《阳台》中的扮演仪式展现了行为的荒诞,但是在荒诞的行为之下,体现的是人物真实的内心世界。本文将根据热内的《阳台》,对文本中的仪式性手法及其作用进行解读。

摘要： Purpose/Objective(s) The recurrence risk for head and neck (H&N) cutaneous squamous cell carcinoma (cSCC) is higher than other sites, and current National Cancer Comprehensive Network (NCCN) and American Society of Radiation Oncology (ASTRO) guidelines encourage considering adjuvant radiation therapy (RT) for high-risk patients. Actuarial recurrence rates following R0 Mohs micrographic surgery have to our knowledge not yet been reported for high risk cSCC H&N patients, and we hypothesized that recurrence rates would be low for these patients regardless of the addition of RT. Materials/Methods Between 1/2011 and 1/2020, 362 consecutive H&N cSCC tumors in 325 patients underwent R0 Mohs also with eligibility criteria of size > 2 cm, 10 of whom underwent adjuvant RT (median 52.5 Gy/25 fractions & 6 with elective nodal RT). Kaplan-Meier analyses were performed to evaluate recurrence outcomes, and log-rank was used to compare survival distributions of 2 samples with P ≤0.05 considered significant. Results Median follow-up from Mohs was 33.4 months, and mean pre-operative size was 3.0 cm with scalp the most common site. Median age was 80.0 years, and 3-year overall survival for all patients was 52.2% with only 4 deaths attributable to cSCC. There were 24 cSCC with perineural invasion (PNI), 32 poorly differentiated, 50 with deep invasion defined as > 6 mm or through subcutaneous fat , 72 with immunosuppression , and 109 with high-risk location defined as ear/lip/temple. No patient received adjuvant systemic therapy and none had a distant failure. The hazard ratios and 95% confidence intervals for locoregional recurrence with classic high-risk features were: PNI (2.68; 0.55 – 12.9), deep invasion (3.02; 0.96 – 9.53), poorly differentiated (vs. well/moderately) (2.20; 0.52 – 9.32), immunosuppression (1.36; 0.50 – 3.69), and high-risk location (0.91; 0.39 – 2.14). High risk tumors defined as AJCC T3 (vs. T1-T2) (3.39; 1.49 – 7.75) and BWH classification T2b-T3 (vs. T2a) (3.16

摘要： Purpose/Objective(s) Primary tumor failure is common in patients treated with chemoradiation (CRT) for unresectable LA-NSCLC. Stereotactic body radiation therapy (SBRT) yields high rates of primary tumor control in Stage I NSCLC. This trial tested an SBRT boost to the primary tumor prior to the start of CRT to improve primary tumor control (PTC). Materials/Methods Patients with LA-NSCLC with primary tumor ≤10 cm were enrolled on a prospective phase II trial testing an SBRT boost in 2 fractions (central 6 Gy x 2, peripheral 8 Gy x 2) immediately followed by standard concurrent CRT (60 Gy in 30 fractions). Patients were staged with PET-CT, brain MRI , and underwent 4D-CT simulation for radiation planning using a customized immobilization device that enabled radiation planning for the sequential delivery of the SBRT boost and conventionally-fractionated radiation from the same CT dataset. Chemotherapy was carboplatin/paclitaxel (C/P) or cisplatin/etoposide. For patients receiving C/P, consolidation C/P for 2 cycles was given at the discretion of the medical oncologist. The trial was later amended to allow for consolidation durvalumab . The primary objective was to estimate PTC rate at 1-year with a hypothesis that the 1-year PTC rate is ≥90%. Secondary objectives were to establish the safety, feasibility, objective response rate (ORR; RECISTv1.1), and rates of regional & distant control, disease-free survival (DFS), and overall survival (OS). Exploratory functional MRI (fMRI) scans before and within the first 30 hrs of the first SBRT fraction were performed in 11 patients. Results The study enrolled 21 patients (10 male, 11 female), with median age 62 years (range 52-78). 16 patients received 6 Gy x 2 SBRT boost, while 5 patients received 8 Gy x 2 SBRT boost. 18 patients received C/P chemotherapy, of whom 9 patients received consolidation C/P. Six patients received consolidation durvalumab. Median pre-treatment primary tumor size was 5.0 cm (range 1.0-8.3). Median and

关键词： 公路桥梁   工程施工   伸缩缝施工   施工工艺   质控对策  

摘要： 在公路桥梁中运用伸缩缝施工工艺是非常重要的,但是由于整体施工环境较为复杂,存在诸多的影响因素,因此要加强对公路桥梁施工中伸缩缝施工模式的优化以及调整,推动公路建设行业的稳定发展。为此,结合伸缩缝施工在公路桥梁中的应用价值,以及主要的施工类型,总结了伸缩缝施工工艺中的质量控制措施,提出了伸缩缝施工的优化策略。在伸缩缝施工时,要严格按照施工流程和标准进行日常操作,并且还要加强对周边情况的全面分析,提高后续的施工效果。