[摘 要] 目的：探究地塞米松联合阿比特龙对去势抵抗性前列腺癌（CRPC）患者尿流动力学、外周血循环肿瘤细胞雄激素受体剪切变异体7（AR-V7）、人同源盒基因B13（HoxB13）水平及生存预后的影响。方法：回顾性选取本院收治的114例CRPC患者病历资料，根据治疗方案分为对照组（予以0.5 mg地塞米松治疗，n = 51）和观察组（予以0.5 mg地塞米松联合1 000 mg阿比特龙治疗，n = 63）。比较两组疗效、尿动力学、外周血循环肿瘤细胞AR-V7、HoxB13水平以及生存预后。结果：观察组63例，对照组51例。治疗8周后，观察组疾病控制率与客观缓解率（分别为42.86%与96.83%）均显著高于对照组（分别为23.53%与86.27%）（P < 0.05）。观察组的最大尿流率[（14.58 ± 1.02）mL/s vs （11.18 ± 1.16）mL/s）]、平均尿流率[（12.92 ± 1.21）mL/s vs （9.83 ± 0.59）mL/s）]均显著高于对照组，而剩余尿量[（24.12 ± 1.96）mL vs （28.03 ± 1.68）mL）]显著低于对照组（均P < 0.05）。观察组与对照组的AR-V7 mRNA表达水平相近[（1.78 ± 0.32） vs （1.68 ± 0.46）]，差异无统计学意义（P > 0.05）；但观察组的HoxB13 mRNA表达水平显著低于对照组[（1.21 ± 0.27） vs （1.57 ± 0.37），P < 0.05]。观察组的中位无进展生存期[6.22个月（95%CI：5.63~6.63）]显著长于对照组[3.66个月（95%CI：3.01~3.74）]（P < 0.05）；观察组的3年总生存率为12.70%，显著高于对照组的0.00%（P < 0.05）。结论：地塞米松联合阿比特龙治疗CRPC患者具有显著疗效，能明显改善患者尿流动力，下调外周血循环肿瘤细胞中HoxB13的表达，未显著影响AR-V7的表达，还能延长患者PFS，提高3年总生存率。

Objective:To explore whether or not radioactive wastewater leakage or overflow exists in the nuclear medicine decay pool after the 7·20 extraordinary rainstorm disaster and to analyze its causes, so as to provide scientific basis for the design, construction and maintenance of the nuclear medicine decay pool and the radiation protection management of nuclear medicine in the future.Methods:Three hospitals A, B and C where 131I therapy are being performed were selected in Zhengzhou city, Henan province. Sampling points were set based on the monitoring result of the environmental radiation level around the nuclear medical decay pool in line with the relevent standard method. Soil samples were collected at different depths. The 131I radioactivity level in the soil was measured using HPGe gamma spectrometer, with the measured result being processed and analyzed. Results:Except for Hospital B where no 131I was detected, different 131I activity concentrations were detected in the soil samples collected around the nuclear medicine decay pool at Hospitals A and C. The 131I activity concentrations ranged from 16.4 to 98 111.8 Bq/kg at Hospital A and from 10.6 to 7 176.6 Bq/kg at Hospital C. After a time period of decay, the repeated detection has shown that the 131I activity concentrations ranged from 1.3 to 17.0 Bq/kg at Hospital A and from 3.9 to 7.1 Bq/kg at Hospital C. The 131I activity concentration in the soil at the depth of 0-5 cm was higher than that at the depth of 5-10 cm soil at the same sampling point. The ratios of activity concentration of 131I between different depths ranged from 1.3 to 13.1, with the median value of 5.9. Conclusions:After the 7·20 extraordinary rainstorm disaster, the surrounding environment of nuclear medicine decay pools at a few hospitals was contamminated by 131I to some extent. To prevent the risk of leakage of radioactive wastewater, the safety evaluation and management of radiation protection should be made better with increased awareness during the design, evaluation, construction and use of nuclear medicine decay pools.

Hepatocellular carcinoma ( HCC) is a common malignant tumor that seriously endangers human health. Surgical resection is the main radical treatment for early and mid-stage HCC, but the recurrence rate is high. At present, there is no effectively and universally accepted adjuvant therapy to reduce the high postoperative recurrence rate. With the development of precise radiotherapy technology, the safe and higher radiation doses can be used in tumors locally. Therefore, radiotherapy is increasingly applied to the treatment of HCC. At present, the position of radiotherapy in the treatment of advanced HCC has become more and more clear. However, the position in the adjuvant treatment of HCC has not been clear. This article will review the research of radiotherapy as adjuvant therapy for surgery in HCC, so as to provide reference for the application of clinical adjuvant therapy for HCC.

Objective To scale the frequencise of medical X-ray diagnosis based on the survey conducted in 58 hospitals to the all hospitals in Henan province,in order to make them available for providing the basis for reasonable application of diagnostic radiology.Methods Stratified sampling method was used to select medical institutions at different levels in 6 cities in the province as sample hospitals.The information of examined patients on sex,age,diagnostic type and exposure category were gathered and the results were analyzed.Results The sex ratio of male and female examined patients was close to 1∶1.The largest proportion,60.47％,of examined patients was from the age group of above 40 years old among the three age groups.Medical diagnositc medical X-ray examinations mainly include conventional X-ray photography and CT examination,accounting for 52.15％ and 40.31％,respectively.Chest examination contributed the largest propotions,23.84％,of conventional diagnositic X-ray examination and,13.25％,of CT examination respectively.CT examinations were mainly concentrated in the secondary and tertiary hospitals,accounting for 21.54％ and 72.99％ of the total CT examinations,respectively.Contrast examination,mammography and extracorporeal lithotripsy were concentrated in the tertiary hospitals,accounting for 77.82％,95.01％ and 100％ of the same type of examinations,respectively.Conventional photographic examinations were mainly conducted in primary hospitals,accounting for 74.56％ of all types of examinations in the primary hospitals.By using multiple linear regression model,the diagnostic examination frequency in 2016 was estimated to be 826 examinations per 1 000 population,of which the frequency of dianostic X-ray examination and CT examination were 541 per 1 000 and 285 per 1 000,respectively.Conclusions The frequency of diagnostic radiology in Henan has increased rapidly in recent years.All types of diagnostic radiology equipment are unevenly distributed in hospitals at different levels which posed a challenge for health care.Relevant departments should make efforts to reallocation of diagnostic radiology equipment in such hospitals and make utilization of health resources more reasonable.

Radiotherapy is one of the main therapeutic methods of lung cancer, whereas the lung injury induced by radiotherapy restricts the quality of life and clinical efficacy. It is a challenge to improve the clinical efficacy and reduce lung injury.Based upon clinical experience, certain measures can be taken to alleviate the lung injury after thoracic radiotherapy. The severity and complications of lung cancer and the concurrent chemoradiotherapy-induced injury should be comprehensively understood to establish individual therapeutic strategy. The diagnostic skills, biological characteristics of tumors, the diffusion, metastasis and recurrence of tumors and lymphatic drainage should be mastered and considered in the formulation of treatment target areas to minimize unnecessary radiation for every 1 mm. During the formulation and evaluation of radiotherapy plans, we should understand the biological characteristics of the lung and lung injury repair and stick to the principle of high-dose radiation for small-volume lung rather than low-dose radiation for large-volume lung. A better treatment plan should be established to reduce every 1% of lung DVH as possible even at the expanse of conformality. Simultaneous modulated accelerated radiotherapy and two-phase radiotherapy are employed to distinguish normal tissues from subclinical tumors from the dose and fractioned dose aspects, which further enhance the tumor control and alleviate lung injury. The lung ventilation function is lost at a dose of 20 Gy or higher. Extensive attention should be delivered to reduce the radiation dose to the lung, especially for the repair of non-functional lung fibrosis. Precise and individualized radiotherapy should be adopted to reduce unnecessary radiation and protect the normal lung tissues, which improve the clinical efficacy and enhance the quality of life.

Objective: To carry out a prospective cohort study of combined intra-operative radiotherapy for centrally located hepatocellular carcinomas (HCC) and to observe the safety and postoperative complications. Methods: A total of 79 patients with centrally located HCC who underwent hepatectomy were divided into two groups: experimental group (combined with targeted intra-operative radiotherapy, 32 cases) and control group (single surgical operation, 47 cases). Patients in the experimental group received intra-operative electron radiotherapy after tumor resection, while patients in the control group received to intra-operative electron radiotherapy.The haemorrhagia amount and operation time during the operation, intra-operative liver function and the recovery of liver and gastrointestinal tract of patients in these two groups were compared. Results: No postoperative 30-day mortality was observed in all of the patients. The average total operation time of patients in the experimental group was (319±76) min, significantly longer than (233±76) min of the control group (P<0.001). The average aspartate transaminase (AST) level of patients in the experimental group at postoperative day 1 was 562.5 U/L, significantly higher than 347.0 U/L of control group (P=0.031). However, the average prothrombin activity levels of patients in the experimental group at postoperative day 3 and day 7 were (68.3±17.9)% and (73.4±10.2)%, respectively, significantly lower than (78.9±15.9)% and (80.0±10.6)% of control group (both P<0.05). There were no significant differences of tumor volume, differentiation degree, satellite lesion, dorsal membrane invasion, microvascular invasion between these two groups (all P>0.05). There were no significant differences of hospital stay, ventilation time, the incidence of hepatic insufficiency, ascites, pleural effusion, infection, biliary fistula between these two groups (all P>0.05). There were no significant differences of alanine aminotransferase (ALT), albumin, total bilirubin between these two groups at postoperative day 1, 3, 5 and 7 (all of P>0.05). Conclusion: The resection of centrally located HCC combined with intra-operative radiotherapy may increase the total operation time, delay the early postoperative recovery of liver function, but it is still safe and feasible. Trial registration National Cancer Centre /Cancer Hospital, Chinese Academy of Medical Sciences, ChiCTR-TRC-12002802.

Objective To investigate the safety and acute toxicities of intraoperative electron radiotherapy for patients with abdominal tumors.Methods From May 2008 to August 2009, 52 patients with abdominal tumors were treated with intraoperative electron radiotherapy,including 14 patients with breast cancer,19 with pancreatic cancer,3 with cervical cancer, 4 with ovarian cancer, 6 with sarcoma, and 6 with other tumors.Fifteen patients were with recurrent tumors.The intraoperative radiotherapy was performed using Mobetron mobile electron accelerator, with total dose of 9 - 18 Gy.In all, 29, 4 and 19 patients received complete resection, palliative resection and surgical exploration, respectively.The complications during the operations and within 6 months after operations were graded according to Common Terminology Criteria for Adverse Events v3.0 (CTC 3.0).Results The median duration of surgery was 190 minutes.Intraoperative complications were observed in 5 patients, including 3 with hemorrhage, 1 with hypotension,and 1 with hypoxemia, all of which were treated conservatively.The median hospitalization time and time to take out stitches was 12 and 13 days, respectively.And the in-hospital mortality was 4% (2/52).Twentyfour patients suffered post-operative adverse events, including 3 postoperative infections.With a median follow-up time of 183 days, 20% of patients sufferred from grade 3 to 5 adverse events, with hematological toxicities being the most common complication, followed by bellyache.Grade 1 and 2 toxicities which were definitely associated with intraoperative radiotherapy was 28% and 4%, respectively.None of grade 3 to 5 complications were proved to be caused by intraoperative radiotherapy.Conclusions Intraoperative electron radiotherapy is well tolerable and could be widely used for patients with abdominal tumors, with a little longer time to take out stitches but without more morbidities and toxicities compared surgery alone.