日本广岛原爆幸存者NK细胞的变化

本文报道126名原爆幸存者NK细胞的变化及其对IL-2刺激的反应能力。结果表明；同一年龄组内各剂量照射组NK细胞活性和数量,皆无明显差异。但比较不同受照年龄组,则反映出辐射对小年龄组(<14岁)主要起抑制作用,中间年龄组(15～24岁)变化不明显；大年龄组(>25岁)NK细胞活性有上升趋势。尤其是0.01～1Gy和>1Gy两组内上述年龄组间差异有显着性(P<0.05).说明儿童期受照可能对NK细胞活性产生明显的远后效应。     

MEDACT: A prescription to stop the spread of nuclear weapons

Many Koreans were forced to move to Japan while Korea was occupied by Japan. Consequently, when the atomic bombs were dropped on Hiroshima and Nagasaki an estimated 40,000 Koreans died and 30,000 survived. In 2004, 2,235 Koreans were registered as A-bomb survivors in South Korea. A mail questionnaire survey to evaluate the present status and self-reported diseases of the Korean survivors was conducted. In total, 1,256 questionnaires were returned and analysed. The most frequent chronic diseases reported by Korean survivors were hypertension (40.1 per cent), peptic ulcer disease (25.7 per cent), anaemia (23.3 per cent) and cataracts (23.1 per cent). The most frequent malignant diseases were stomach cancer (1.9 per cent), colon cancer (0.5 per cent) and leukaemia/multiple myeloma (0.4 per cent). This study suggests that further investigations are needed into the health concerns of the survivors and into health protection measures.     

Cataract in atomic bomb survivors

Purpose: Ophthalmologic examinations were conducted on atomic bomb (A‐bomb) survivors 55 years after exposure.

Materials and methods: A‐bomb survivors who had been exposed before 13 years of age at the time of the bombings in 1945 or who had been examined in a previous study between 1978 and 1980. The examinations, conducted between June 2000 and September 2002, included slit‐lamp examination, digital photography and a cataract grading system for three parts of the lens (nucleus, cortex and posterior subcapsule) as an outcome variable. Proportional odds logistic regression analysis was conducted using the lowest grading class as a reference and included explanatory variables such as age, sex, city, dose and various cataract‐related risk factors. When the grades in an individual differed, the worst grade was used.

Results: Results indicate that odds ratios (ORs) at 1 Sv were 1.07 (95% confidence intervals [CI] 0.90, 1.27) in nuclear colour, 1.12 (95% CI 0.94, 1.30) in nuclear cataract, 1.29 (95% CI 1.12, 1.49) in cortical cataract and 1.41 (95% CI 1.21, 1.64) in posterior subcapsular cataract. The same was true after excluding 13 people whose posterior subcapsular cataracts had been previously detected.

Conclusion: Significant radiation effects were observed in two types of cataracts in A‐bomb survivors.     

Prevalence of atherosclerosis in relation to atomic bomb radiation exposure: An RERF Adult Health Study

Purpose: To determine whether exposure to atomic bomb radiation altered the prevalence of asymptomatic atherosclerosis.

Material and methods: In a cross-sectional analysis, we examined aortic arch calcification by plain chest radiography and common carotid artery intima-media thickness (IMT) by ultrasonography among 1804 survivors of the atomic bombing in Hiroshima. We evaluated the association between atherosclerotic changes and radiation exposure, while adjusting for potentially confounding factors.

Results: Multivariate logistic regression analysis showed that aortic arch calcification was significantly associated with radiation exposure (p < 0.05). The odds ratio at 1 Gy was 1.30 (95% confidence interval [CI]: 1.05 – 1.53) for men and 1.31 (95% CI: 1.13 – 1.51) for women. Carotid artery IMT did not vary significantly with radiation dose (p = 0.18).

Conclusion: Radiation dose contributed to the prevalence of aortic atherosclerosis but not carotid artery atherosclerosis in atomic bomb survivors.     

Long-lasting alterations of the immune system by ionizing radiation exposure: implications for disease development among atomic bomb survivors

PURPOSE: The immune systems of the atomic-bomb (A-bomb) survivors were damaged proportionately to irradiation levels at the time of the bombing over 60 years ago. Although the survivor's immune system repaired and regenerated as the hematopoietic system has recovered, significant residual injury persists, as manifested by abnormalities in lymphoid cell composition and function. This review summarizes the long-lasting alterations in immunological functions associated with atomic-bomb irradiation, and discusses the likelihood that damaging effects of radiation on the immune system may be involved partly in disease development so frequently observed in A-bomb survivors. CONCLUSIONS: Significant immunological alterations noted include: (i) attrition of T-cell functions, as reductions in mitogen-dependent proliferation and interleukin-2 (IL-2) production; (ii) decrease in helper T-cell populations; and (iii) increase in blood inflammatory cytokine levels. These findings suggest that A-bomb radiation exposure perturbed one or more of the primary processes responsible for T-cell homeostasis and the balance between cell renewal and survival and cell death among naive and memory T cells. Such perturbed T-cell homeostasis may result in acceleration of immunological aging. Persistent inflammation, linked in some way to the perturbation of T-cell homeostasis, is key in addressing whether such noted immunological changes observed in A-bomb survivors are in fact associated with disease development.     

Aspirin for the Primary Prevention of Cardiovascular Events: Considerations Regarding the Risk/Benefit

Practice Pearl

This update of the 2002 US Preventive Services Task Force (USPSTF) recommendation on the benefits and harms of aspirin for the primary prevention of cardiovascular disease (including myocardial infarction and stroke) suggests that the benefits of aspirin are likely to outweigh the risks in middle-aged and older men and women at increased risk for cardiovascular events.     

B-type natriuretic peptide plasma level in 5-year breast cancer survivors after radiotherapy

Abstract

Background: Left-sided breast cancer patients treated with radiotherapy (RT) are at risk for late radiation-induced cardiovascular complications.

Aim: The aim of this study was to investigate the BNP plasma levels in long-term breast cancer survivors who received only RT as well to assess whether cardiac dose was associated with BNP values.

Methods: Plasma samples for BNP measurement were repeated in 29 patients (63?±?11 years) who were alive at 5 years after radiotherapy, free of heart disease and available to provide new blood sample. All patients had BNP measurements at baseline. The ΔBNP was measured to analyze the role of marker variations. No patients received chemotherapy.

Results: The mean cardiac and ventricle dose were 2.1?±?1.0 (range 0.02–4.5) Gy and 3.0?±?1.7 (range 0.02–7.6), respectively. Median value of BNP was 47?pg/mL (interquartile ranges, 26–58.2?pg/mL) at baseline, and 34?pg/mL (interquartile ranges, 17.5–54?pg/mL) at 5 years after radiotherapy. There was no significantly different between two measurements (p?=?ns). Fifteen (52%) reported an improvement in BNP levels, 1 (3%) no changes and 13 (45%) reported a worsening. There was no correlation between ΔBNP and age (p?=?ns).

When patients were stratified according to the median value of dose–volume data, ΔBNP was significantly higher in patients with increased cardiac D_mean (p?=?.02) and left ventricle D_mean (p?=?.009).

Conclusion: At 5 years after radiotherapy, median plasma BNP levels remained within the normal range, but the delta-BNP levels are directly related to the heart and ventricular dose received.     

中子弹核爆炸早期核辐射剂量的研究

目的：探讨中子弹核爆炸辐射场内瞬发中子和γ辐射的个人吸收剂Dp(10）空间分布情况。方法：对中子弹结构和原理分析的原理分析的基础上,通过建立模型,利用蒙卡罗方法（MC）粒子输运技术进行计算。结果：通过对所得数据进行系统分析,得出中子弹核爆炸瞬发中子和γ辐射的个人吸收剂量Dp(10)数值在空间分布上一些规律与特点。结：中子弹核爆炸不仅会产生高能中子辐射,而且也会产生强烈γ辐射,同时对1kt中子弹核爆炸后瞬发辐射的杀伤威力进行了评估。     

Cardiovascular computed tomography in pediatric congenital heart disease: A state of the art review

Cardiac computed tomography (CCT) has increasingly been used in the assessment of both children and adults with congenital heart disease (CHD), in part due to advances in CCT technology and an increased prevalence of adults with palliated CHD. It serves as a complimentary modality to echocardiography, cardiac magnetic resonance imaging and cardiac catheterization. CCT can provide unique diagnostic information, is less invasive and less likely to require sedation compared to other modalities. Detailed knowledge of individual patient cardiac anatomy, physiology, surgical repair and possible residual lesions are paramount to optimal CCT imaging. This comprehensive review details the use of CCT both pre- and postoperatively for the most common CHD diagnoses. We also aim to highlight some new and innovative technologies that have become available and can further optimize CCT imaging for CHD patients.     

Magnetic resonance imaging in valvular heart disease: clinical application and current role for patient management

Noninvasive imaging provides important information on cardiac anatomy and function and is a key element in clinical management of valvular heart disease (VHD). Beside echocardiography, which is still considered the first-line modality for assessment of valvular anatomy and longitudinal evaluation of VHD, cardiovascular magnetic resonance (CMR) has evolved during the last two decades as an essential tool for evaluation of cardiac diseases. Today, CMR not only represents the reference standard for measuring cardiac volumes, function, and mass, but also enables accurate assessment of morphology and function of cardiac valves. It can play an important role in clinical decision-making for patients with VHD. This review addresses current applications and limitations of CMR imaging techniques that are used in VHD including cine-balanced steady-state free precession (b-SSFP), phase contrast MR (pcMR), gradient-recalled echo (GRE), and turbo-spin echo (TSE) sequences. Moreover, it describes their application for evaluation of valvular pathologies and gives an overview on the current role of valvular CMR in patient management.     

血清Hcy与Hs-CRP联合检测在心脑血管疾病中的应用

目的 探讨血清同型半胱氨酸(Hcy)、超敏C-反应蛋白(Hs - CRP)水平与脑卒中、冠心病的关系,评价Hcy、Hs - CRP测定对脑卒中、冠心病的临床价值.方法 Hcy测定采用酶法,Hs - CRP测定采用比浊法,对349例脑卒中(其中脑出血158例,脑梗死191例)、124例冠心病患者进行检测,并与113例健康体检者进行比较.结果 脑卒中组与冠心病组Hcy、Hs - CRP的水平均高于健康对照组(P＜0.05),脑出血组与脑梗死组比较无明显差异(P＞0.05).结论 脑卒中与冠心病患者血清Hcy、Hs - CRP水平明显增高,Hcy、Hs - CRP联合测定对脑卒中、冠心病的早期诊治和预后判断均有重要价值.     

冠心病介入诊疗中透视与电影辐射剂量率对比分析

目的：研究冠心病患者介入诊疗中DSA设备显示的实时辐射剂量率,为医务人员合理控制辐射剂量提供依据。方法随机抽取2014年9月采用美国通用公司DSA机介入诊疗的冠心病患者30例,对术中DSA机由透视模式转换为电影模式时各自序列显示的辐射剂量率进行对比分析。结果透视辐射剂量率为18．5～212．0 mGy/min,均值为（114．7±42．1） mGy/min;电影辐射剂量率为216～1691 mGy/min,均值为（970．1±298．4） mGy/min。透视与电影辐射剂量率总体均值之比为1︰8．5。数字平板探测器面积越大,辐射剂量率均值越大,电影辐射剂量率均值较透视辐射剂量率均值增高趋势越明显;透视辐射剂量率均值较电影辐射剂量率均值低,差异显著。结论医务人员在冠心病介入诊疗中应合理选择 DSA 设备类型,密切观察动态实时显示的辐射剂量率,及时调整检查模式及可控参数,即刻评估可能致患者放射损伤的剂量水平,合理控制辐射剂量,以降低电离辐射对人体健康产生的辐射效应。     

老年心血管疾病患者心理护理效果观察

目的　探讨心理护理对心血管患者的康复价值。方法　将 15 2例患者随机分为观察组与对照组 ,每组 76例 ,两组均采用常规治疗与护理 ,观察组同时实施心理护理。两组在入、出院时采用抑郁自评量表 (SDS) ,焦虑自评量表 (SAS)及A型性格问卷进行测评。结果　两组出院时SDS ,SAS均分比较 ,观察组明显优于对照组 (P <0 .0 1) ;两组A型性格均分虽均有降低但差异无显著性 (P >0 .0 5 ) ;平均住院日观察组比对照组明显缩短 (P <0 .0 1)。结论　心理护理有利于心血管病患者早日康复     

军队男性干部冠心病危险因素分析

目的探讨部队男性干部冠心病危险因素分布,比较老年干部与非老年干部冠心病危险因素的差异。方法选择2006-2009年在我院疗养的男性干部2670人,将60～92岁的1869人列为老年组,将35～59岁的801人列为非老年组。结果非老年组饮酒、吸烟、舒张期高血压、低高密度脂蛋白的检出率分别为48.4%、28.2%、32.5%、9.2%明显高于老年组的46.3%、19.9%、12.1%、3.4%(P<0.05),而老年组超重、收缩期高血压、高餐后血糖的检出率分别为50.2%、34.2%、62.1%,高于非老年组的24.1%、9.6%、27.4%(P<0.05)。两组高三酰甘油、高胆固醇的检出率相比无统计学意义(P>0.05)。结论军队非老年干部冠心病危险因素主要为吸烟、饮酒、舒张期高血压、低高密度脂蛋白胆固醇。老年干部冠心病危险因素主要为超重、收缩期高血压、高餐后血糖。     

Educating Athletes on HIV Disease and AIDS

In brief Team physicians are in a unique brief position to counsel athletes about HIV disease and AIDS—they may be the only medical resource that this predominantly healthy group regularly encounters. A team physician who establishes rapport with athletes and has a basic knowledge of the current information on HIV disease and AIDS has a unique opportunity to frankly discuss the issues surrounding HIV transmission, both on and off the field.     

不同途径输注鱼精蛋白对先天性心脏病合并肺动脉高压患者体外循环术后血流动力学的影响

目的探讨不同途径输注鱼精蛋白对先天性心脏病合并肺动脉高压患者体外循环术后血流动力学的影响。方法选择手术治疗先天性心脏病患者80例,根据不同给药途径（主动脉、中心静脉）及有无肺动脉高压分为4组,每组20例：A1组（无肺动脉高压、主动脉给药）、A2组（无肺动脉高压、中心静脉给药）、B1组（肺动脉高压、主动脉给药）、B2组（肺动脉高压、中心静脉给药）。记录术前（T0）、输注鱼精蛋白之前（T1）、输注后1min（T2）、3min（T3）、5min（T4）、10min（T5）、15min（T5）、25min（L）各时间点HR、SBP、MAP、CVP等参数,并采静脉血测血清中各时间点组胺的水平。结果输注鱼精蛋白后,经中心静脉给药A,组及B2组MAP、RPP（RHxSBP）均低于主动脉给药A1组（P〈0．05）及B1组（P〈0．01）;B2组CVP明显高于B1组（P〈0．05）。给药后（T2-T7）4组患者血中组胺浓度较术前（T0）均明显升高（P〈0．05）,经中心静脉给药Az组及B2组较主动脉给药A1组及B1组升高更为显著（P〈0．01）。结论先天性心脏病术后经主动脉输注鱼精蛋白可减少组胺的释放;主动脉给药对体外循环术后患者的血流动力学影响较小,特别是合并有肺动脉高压的患者。     

一位“老参试”的感言

目的 研究中国核试验中不同类型辐射对动物的近期和远期生物学效应,探讨辐射损伤效应机制。方法 1964—1976年间的6次核试验中,在核爆现场和下风向地区布放狗、恒河猴、大白鼠、小白鼠及家兔等哺乳动物,核爆后受到瞬时γ射线和中子外照射,落下灰γ射线、β射线外照射,落下灰¹³¹I、¹³³I内照射(食入及吸入),以及内外复合照射;此外,还有二次、三次重复照射,受照射动物的子代照射。动物回收后进行临床医学、病理学、血液学、生物化学、细胞化学、生殖遗传学、细胞遗传学与辐射剂量学等指标观察测试,前后持续22年。结果 核爆后3、7和12个月,受照0.39 Gy后,狗的外周血淋巴细胞染色体畸变率分别为8.60%、7.25%和8.70%,与对照组比较,差异有统计学意义(P<0.01)。在核爆后6个月,受照0.74 Gy的恒河猴的染色体畸变率为21%,高于对照组(P<0.01);核爆后8.5年,染色体畸变率为5.52%,高于对照组(P<0.01)。核爆后52 d,大白鼠受照0.65～4.4 Gy后,生殖率下降为30.8%～69.7%,每胎平均仔数减少,与对照组比较,差异有统计学意义(P<0.01)。狗受照0.75和1.73 Gy后,照后3～7个月精子数量和存活率降为零,且狗精子畸形率增加,达46.8%,高于对照组(P<0.01);精子和睾丸的超微结构出现严重的损伤变化。骨髓造血功能破坏,外周血白细胞、淋巴细胞持续减少,血清菲啶溴红络合物荧光强度(核酸含量测定)升高,达18.9%(P< 0.05)。受照2.0 Gy以上的狗5年后发生良性肿瘤53.3%、恶性肿瘤33.3%,高于对照组(P<0.01)。外照射后睾丸萎缩发病率升高,眼晶状体白内障发病率升高,内照射后甲状腺萎缩发病率升高。放射性灰尘的污染范围大、危害时间长,狗受到落下灰β射线照射后发生皮肤烧伤,恢复慢,可癌变。结论 核辐射损伤比单纯中子、γ射线、X射线等照射损伤严重、伤情复杂;核辐射后造血细胞、生精细胞敏感,损伤严重,损伤程度取决于受照剂量,且与照射后时间有关,有特殊规律性;放射性灰尘的危害范围大、持续时间长;落下灰β射线能造成皮肤烧伤。即使低剂量核辐射也会造成不容低估的危险。