荧光蛋白在肿瘤分子影像研究中的应用

绿色荧光蛋白（green fluorescent protein,GFP）是在水母中发现的新型报告分子,该蛋白及其衍生物能在多种生物体内表达并发出荧光,是目前在生物学中研究和开发应用得最广泛的蛋白质之一。尤其是在肿瘤的研究中,荧光蛋白的分子影像可为深入揭示肿瘤发生发展的病理过程的机制,以及对其治疗进行实时、动态、细致、无创、靶向性的探测和跟踪提供有效手段。     

分子影像技术在转化医学中的应用

基础医学、药物研发和临床医学是三个不同的的领域,因此这些领域的很多生命科学研究成果经常无法及时应用于临床实践。转化医学是以疾病为中心,加速将基础研究的成果用于,临床诊断和治疗中,旨在有效的将三个领域有机结合在一起。分子影像学（molecularimaging,MI）可在活体上、在细胞和分子水平对生物学过程成像并进行定性和定量研究,为转化医学的实现提供了保证。分子影像技术采用无创的医学影像技术使活体状态下组织细胞中的特殊分子生物学特性得以直观揭示,主要用于对疾病早期诊断、疾病分期（分层）、疗效监测、指导疾病的个体化治疗以及新药的研发等领域。本文主要介绍分子影像的技术特点、其在转化医学中发挥的作用以及其在个体化治疗中临床意义进行综述。     

分子影像技术在转化医学中的应用*

摘要：基础医学、药物研发和临床医学是三个不同的的领域,因此这些领域的很多生命科学研究成果经常无法及时应用于临床实践。转化医学是以疾病为中心,加速将基础研究的成果用于临床诊断和治疗中,旨在有效的将三个领域有机结合在一起。分子影像学(molecular imaging, MI) 可在活体上、在细胞和分子水平对生物学过程成像并进行定性和定量研究,为转化医学的实现提供了保证。分子影像技术采用无创的医学影像技术使活体状态下组织细胞中的特殊分子生物学特性得以直观揭示,主要用于对疾病早期诊断、疾病分期（分层）、疗效监测、指导疾病的个体化治疗以及新药的研发等领域。本文主要介绍分子影像的技术特点、其在转化医学中发挥的作用以及其在个体化治疗中临床意义进行综述。     

分子细胞遗传学在软组织肿瘤中的应用

软组织肿瘤是发生于纤维组织、脂肪组织、平滑肌、骨骼肌、滑膜等间叶组织的一组病因复杂,组织形态各异,临床表现多样的肿瘤.软组织肉瘤是此类肿瘤中的一小部分,以独特的临床袁现和特异性的遗传学改变为特点,虽然占人类所有恶性肿瘤的比例不到1%[1],但它们同样严重威胁着人类的生命并具有重要的诊断和治疗意义.随着组织化学染色、电镜技术和免疫组化技术等辅助手段的广泛应用,人们对软组织肿瘤的发生、发展和分类、诊断等方面有了更深刻的认识,特别是对其分子水平的研究表明除癌基因和抑癌基因的点突变之外,染色体易位和缺失所致的基因重排和丢失也是软组织肿瘤发生的重要分子机制.这使得分子细胞遗传学在软组织肿瘤研究中具有了重要作用和特殊意义.本综述通过分析分子细胞遗传学技术在软组织肿瘤的分类、诊断及预后等方面的应用,客观评价了此技术的作用、优缺点及未来的发展方向.     

组织芯片在筛选新型肿瘤分子标志物中的应用

组织芯片是一种新型的生物芯片技术,实现了对临床病理标本的高通量、平行化的分子标志物筛选,可同时在DNA、mRNA、蛋白质和组织形态学水平对分子标志物进行研究。本综述了近年来该项技术在筛选肿瘤分子标志物中的应用。     

肿瘤的分子分型在当代结直肠癌中的应用

以分子检测为基础的肿瘤分子分型及个体化治疗方案使当代的结直肠癌治疗逐步走向“同病异治”模式,结直肠癌同病异治两个最常见的应用,一是RAS基因突变与分子靶向药物的应用,二是微卫星不稳定(MSI)状态与林奇综合征的诊断和治疗。其中RAS基因野生型患者使用西妥昔单抗联合化疗方案获益显著,而林奇综合征的患者与微卫星稳定患者相比,显示了更好的预后,且其不能从化疗药物氟尿嘧啶中获益。然而,为了让更多的结肠癌患者获益,我们还需要继续探寻对结肠癌更有效更全面的分子分型标准。     

USP10的分子功能及在肿瘤中的研究进展

泛素特异性蛋白酶10(ubiquitin-specific protease 10,USP10)是去泛素化酶(deubiquitinating enzymes,DUBs)家族中的一个重要成员。近年来的研究发现USP10参与了细胞中多种生命活动的调节,如细胞增殖、细胞凋亡、DNA损伤修复、炎症应答等。同时,USP10在多种肿瘤的发生发展过程中表现出其重要作用。现就USP10的分子功能及其在肿瘤中的研究进展进行综述,以期发现与USP10相关的某些关键的分子机制,为肿瘤诊断与治疗提供参考。     

单分子测序技术在肿瘤诊断中的应用研究进展

肿瘤的发生发展通常与多个基因的遗传突变、表达异常有关,全面深入地分析肿瘤基因组、转录组及表观遗传组学对于快速剖析疾病特定基因簇及修饰位点至关重要。之前,研究者们主要采用第二代测序技术进行有效信息的挖掘,然而随着研究的不断深入,第二代测序技术表现出诸如序列拼接困难、低丰度难以检出等缺点。因此,单分子测序技术以其独特的优势应运而生,文中主要对单分子测序技术在几种常见肿瘤中的研究现状进行了综述,并展望了其在临床诊断中的应用前景。     

miRNA在肿瘤分子诊断和治疗中的研究进展

微小RNA(miRNA)是一类真核生物内源性、长18~25个核苷酸的小分子单链RNA,能够通过与靶mRNA特异性的碱基互补配对引起靶mRNA的降解或者翻译抑制,miRNA调节的紊乱将对细胞产生重要的影响。在肿瘤中,抑癌性miRNA的缺失会增加其靶向致癌基因的表达,而致癌miRNA(被称为oncomirs)的升高能够降低其靶向肿瘤抑制基因的表达。这一认识使得应用靶向致癌性miRNA与恢复抑癌性miRNA的功能来治疗肿瘤成为可能。随着临床研究的不断深入,miRNA不断为肿瘤分子诊断和治疗提供新的思路和治疗手段。     

长链非编码RNA在头颈部肿瘤中的研究进展

长链非编码RNA(long noncoding RNA,lncRNA)是一类长度大于200个核苷酸的、缺少特异完整的开放阅读框、极少有蛋白编码功能的非编码RNA。研究表明lncRNA是参与基因表达的关键调控分子,从表观遗传、转录及转录后等多种水平调控相关靶基因的表达。近年来lncRNA在头颈部疾病中的研究开始受到关注。现就lncRNA在头颈部肿瘤中的研究进展作一综述。     

头颈部放疗患者口腔假丝酵母菌感染的快速检测

目的通过对传统培养法和PCR法在假丝酵母菌感染检出率的比较,拟探索一种能够早期、快速、高效检测头颈部放疗患者假丝酵母菌感染的方法。方法收集120名头颈部放疗患者唾液,分别应用假丝酵母菌显色培养基（CHROMagar）进行分离、培养和鉴定;同时提取基因组DNA,通过假丝酵母菌通用引物、特异性引物、改良引物进行PCR扩增,结果与假丝酵母菌表型进行对比。结果与传统培养法相比,PCR法检出率更高（χ2=47.672,P=0.000）;改良特异性引物D扩增的检出率为77%,高于通用引物B（χ2=7.702,P=0.006）和特异性引物C（χ2=12.522,P=0.001）。结论本研究证实PCR技术耗时短,阳性检出率高,可用于头颈部肿瘤放疗患者假丝酵母菌感染的快速检测。     

Establishment of national diagnostic reference levels (DRLs) for radiotherapy localisation computer tomography of the head and neck

Aim

The aim of this research is to establish if variation exists in the dose delivered for head and neck (HN) localisation computed tomography (CT) imaging in radiation therapy (RT); to propose a national diagnostic reference levels (DRLs) for this procedure and to make a comparison between the national DRL and a DRL of a European sample.

Malnutrition and cachexia in patients with head and neck cancer treated with (chemo)radiotherapy

AimTo highlight the problems associated with nutrition that occur in patients with squamous cell carcinoma of the head and neck (SCCHN).BackgroundSCCHN is associated with weight loss before, during and after radiotherapy or concurrent chemoradiotherapy. Because of serious consequences of malnutrition and cachexia on treatment outcome, mortality, morbidity, and quality of life, it is important to identify SCCHN patients with increased risk for the development of malnutrition and cachexia.Materials and methodsCritical review of the literature.ResultsThis review describes pathogenesis, diagnosis and treatment of malnutrition and cancer cachexia. Treatment of malnutrition and cancer cachexia includes nutritional interventions and pharmacological therapy. Advantages and disadvantages of different nutritional interventions and their effect on the nutritional status, quality of life and specific oncological treatment are presented.ConclusionsNutritional management is an essential part of care of these patients, including early screening, assessment of nutritional status and appropriate intervention.     

间歇性呼吸肌训练对头颈部肿瘤放疗患者康复效果的影响

目的：探讨间歇性呼吸肌训练对头颈部肿瘤放疗患者康复效果的影响,以期为头颈部肿瘤放疗患者康复提供参考。方法：选取四川省肿瘤医院2022年5月至2023年5月92例头颈部肿瘤放疗患者为研究对象,依据随机抽签法分为对照组和观察组各46例。两组患者均采用相同的长程放疗方案及放疗剂量,对照组行常规吞咽康复训练,观察组在对照组基础上行间歇性呼吸肌训练,两组均训练2周。比较两组干预前后吞咽功能、肺功能、运动耐力、负性情绪及生活质量。结果：干预后,观察组吞咽功能各项评分高于对照组（P<0.05）,最大吸气压（MIP）、吸气峰流速（PIF）高于对照组（P<0.05）,6分钟步行试验（6MWT）距离长于对照组（P<0.05）;贝克焦虑量表（BAI）评分、贝克抑郁量表（BDI）评分低于对照组（P<0.05）,QLQ-H&N35评分低于对照组（P<0.05）。结论：头颈部肿瘤放疗患者实施间歇性呼吸肌训练能改善其吞咽功能、肺功能和运动耐力,能缓解患者的焦虑、抑郁情绪,提升其生活质量,是一种合理有效的康复方案。     

Smoking during radiotherapy for head and neck cancer and acute mucosal reaction

AimWe compared the incidence of RTOG/EORTC grade III and higher acute mucositis in patients with head and neck cancer who continued to smoke during radiotherapy with those who quit smoking.BackgroundThere are conflicting data on the relationship between smoking during radiotherapy and the severity of acute mucosal reaction. More studies dealing with this issue are needed.Materials and methodsAmong 136 patients receiving curative radio(chemo)therapy, 37 (27%) declared that they had not quit smoking during radiotherapy. The intensity of mucositis was scored daily by a nurse and weekly by a physician using the RTOG/EORTC scale. The main end-point of the study was the highest observed RTOG/EORTC grade of mucositis.ResultsPatients who smoked during radiotherapy (smokers) were younger than their counterparts who quit smoking (non-smokers), p = 0.06. There were no other differences in the baseline characteristics between smokers and non-smokers. Grade III/IV acute mucositis was observed in 43.5% of all patients. The percentage of patients with grade III/IV acute mucositis was similar in smokers and non-smokers (46% vs. 42%, p = 0.71). Nine patients (smokers [13.5%]; non-smokers [4%], p = 0.05) required prolonged hospitalization to heal mucositis.ConclusionsIn the whole group, smoking during radiotherapy was not related to acute mucosal toxicity evaluated as the rate of the highest observed grade of mucositis.     

Effects of remedies made in patient setup process on residual setup errors and margins in head and neck cancer radiotherapy based on 2D image guidance

AimPatient setup errors were aimed to be reduced in radiotherapy (RT) of head-and-neck (H&N) cancer. Some remedies in patient setup procedure were proposed for this purpose.BackgroundRT of H&N cancer has challenges due to patient rotation and flexible anatomy. Residual position errors occurring in treatment situation and required setup margins were estimated for relevant bony landmarks after the remedies made in setup process and compared with previous results.Materials and methodsThe formation process for thermoplastic masks was improved. Also image matching was harmonized to the vertebrae in the middle of the target and a 5 mm threshold was introduced for immediate correction of systematic errors of the landmarks. After the remedies, residual position errors of bony landmarks were retrospectively determined from 748 orthogonal X-ray images of 40 H&N cancer patients. The landmarks were the vertebrae C1–2, C5–7, the occiput bone and the mandible. The errors include contributions from patient rotation, flexible anatomy and inter-observer variation in image matching. Setup margins (3D) were calculated with the Van Herk formula.ResultsSystematic residual errors of the landmarks were reduced maximally by 49.8% (p ≤ 0.05) and the margins by 3.1 mm after the remedies. With daily image guidance the setup margins of the landmarks were within 4.4 mm, but larger margins of 6.4 mm were required for the mandible.ConclusionsRemarkable decrease in the residual errors of the bony landmarks and setup margins were achieved through the remedies made in the setup process. The importance of quality assurance of the setup process was demonstrated.     

Squamous cell carcinoma of the head and neck in the elderly

The incidence of head and neck squamous cell carcinoma (HNSCC) peaks between the fifth and seventh decades of life. With prolongation of life expectancy, however, the proportion of elderly HNSCC patients is also increasing, which makes HNSCC in this life period an important issue for healthcare providers. With features characteristic to the older patient groups coupled with the inherent complexity of the disease, HNSCC in the elderly represents a considerable challenge to clinicians. Indeed, to expedite the progress and improve the healthcare system to meet the needs of this unique population of patients, several essential issues related to the clinical profile, diagnostics, optimal treatment and support are of concern and should be addressed in properly conducted clinical trials.In the present review, we analyzed a literature series comparing different age groups with regard to their clinical characteristics, therapy, outcome and quality of life in an attempt to determine their implications on treatment-decision-making for elderly patients with HNSCC.     

Targeting head and neck tumoral stem cells: From biological aspects to therapeutic perspectives

Head and neck squamous cell cancer(HNSCC) is the sixth most common cancer in the world. Effective therapeutic modalities such as surgery, radiation, chemotherapy and combinations of each are used in the management of the disease. In most cases, treatment fails to obtain total cancer cure. In recent years, it appears that one of the key determinants of treatment failure may be the presence of cancer stem cells(CSCs) that escape currently available therapies. CSCs form a small portion of the total tumor burden but may play a disproportionately important role in determining outcomes. CSCs have stem features such as self-renewal, high migration capacity, drug resistance, high proliferation abilities. A large body of evidence points to the fact that CSCs are particularly resistant to radiotherapy and chemotherapy. In HNSCC, CSCs have been increasingly shown to have an integral role in tumor initiation, disease progression, metastasis and treatment resistance. In the light of such observations, the present review summarizes biological characteristics of CSCs in HNSCC, outlines targeted strategies for the successful eradication of CSCs in HNSCC including targeting the self-renewal controlling pathways, blocking epithelial mesenchymal transition, niche targeting, immunotherapy approaches and highlights the need to better understand CSCs biology for new treatments modalities.