~（153）Sm－EDTMP对老年癌症骨转移病人造血系统和重要器官的影响

对７６例接受１５３Ｓｍ－ＤＥＴＭＰ治疗骨转移癌病人进行骨髓及其他重要生命器官损伤程度研究。结果表明，用药后（高剂量组７４ＭＢｑ／ｋｇ）２周骨髓轻度抑制，４周恢复正常；白细胞、血小板阵低程度与１５３Ｓｍ－ＤＥＴＭＰ注射量有关，剂量越大，白细胞、血小板降低越明显，其恢复至正常所需时间越长；红细胞和血红蛋白用药后与用药前基础值比较均无显著性差异（Ｐ＞０．０５）；用药前后肝功能、肾功能、电解质和酶学系统均无显著性变化（Ｐ＞０．０５）。９例高剂量组病人红骨髓吸收剂量范围均在ＷＨＯ推荐最大耐受剂量范围内。     

^153Sm—EDTMP治疗转移性骨癌骨痛28例近期疗效观察

应用＾１５３钐－乙二胺四甲撑膦酸治疗２８例转移性骨癌骨痛患者,总有效率８２．１４％,认为,＾１３２Ｓｍ－ＥＤＴＭＰ为一安全,有效的放射性核素,可用于转移性骨癌骨痛的治疗。     

153钐-乙二胺四甲撑膦酸治疗癌症转移患者骨痛疗效分析

目的探讨老年癌症骨转移患者内照射治疗的剂量效应。方法对用１５３钐－乙二胺四甲撑膦酸（１５３Ｓｍ－ＥＤＴＭＰ）治疗而缓解癌性骨痛的老年患者４０例作骨辐射吸收剂量分析和疗效观察，并以老年前期组４０例癌性骨痛治疗者为对照。结果老年组及老年前期两组在尿排泄率、骨摄取率及骨累积活度的差异无显著性；其疗效分别为４５％及６０％，老年组稍低于老年前期组，但差异无显著性（均为Ｐ＞０．０５）；红骨髓辐射吸收剂量相似，分别为２１９．９±６８．２及２０６．３±６４．７ｃＧｙ，均在安全剂量范围（２８５ｃＧｙ）内。结论增龄不影响老年人１５３Ｓｍ－ＥＤＴＭＰ治疗缓解癌性骨痛的剂量效应。     

顺铂鱼肝油酸钠伍治疗胃癌的实验研究

用ＭＴＴ法观察顺铂（ＣＤＤＰ０与鱼肝油酸钠（ＳＭ）配伍对人胃癌细胞ＳＧＣ－７９０１的体外杀伤效果，人胃癌细胞ＳＧＣ－７９０１被接种于裸鼠皮下以建立荷瘤裸鼠。ＣＤＤＰ每次３ｍｇ．ｋｇ＾－１．ｔｉｍｅ＾－１，ＳＭ：５０ｍｇ．ｋｇ＾－１．ｔｉｍｅ＾－１，容量：５０μＬ肿瘤组织中心注射。配伍组织肿瘤ＳＭ和ＣＤＤＰ交叉给药，两药间隔３０分钟，每３天１次，共３次，ＳＭ在体外对胃癌细胞有很强的杀伤作用，局部注射     

系列电药理研究筛选有效抗折返性室上性心动过速药物的临床意义

对６７例折返性室上性心动过速（ＲＳＶＴ）施行以单一抗心律失常药物（ＡＡＤ）为基础、异丙肾上腺素（Ｉｓｏ）和美托洛尔（Ｍｅｔ）为辅助的系列电药理研究（ＳＥＰＳ）（简称ＡＩＭ－ＳＥＰＳ）。结果表明，Ｉｓｏ能使普罗帕酮和莫雷西嗪的抗ＲＳＶＴ总有效率分别降低６６．７％～８０．０％和２０．０％，该效应能被Ｍｅｔ所抵消。随访资料提示，对于选择预防ＲＳＶＴ临床复发有效的长期口服ＡＡＤ，ＡＩＭ－ＳＥＰＳ明显优于单一ＡＡＤ的电药理研究。     

SLE中的反抑制细胞与γδTCR阳性T细胞

对６０例ＳＬＥ细胞亚群表型分析发现，大部分ＳＬＥ患者处周血ＣＤ８阳性Ｔ细胞亚群数量未见降低，研究表明，尤以ＣＤ８＾＋ＶＶ＾＋、ＣＤ８＾＋γδ－ＴＣＲ＾＋和ＣＤ８＾＋ＶＶ＾＋γδ＾＋三类Ｔ细胞亚群高表达最明显，由于ＣＤ８＾＋ＶＶ＾＋、ＣＤ８＾＋γδ－ＴＣＲ＾＋和ＣＤ８＾＋ＶＶ＾＋γδ＾＋Ｔ细胞亚群均具有反抑制活性。因此在生ＳＬＥ患者中更为明显。可作为临床从免疫学角度分析ＳＬＥ活动与否，评估稳定期ＳＬ     

恶性疟原虫裂殖子表面蛋白1-17区基因的原核表达、纯化及表达产物鉴定

目的　为进一步研究和应用恶性疟原虫裂殖子表面蛋白１ 的１７区基因（ＭＳＰ１－ １７）,本文原核表达了ＦＵＰ株ＭＳＰ１ 的１７ 区基因,并纯化及鉴定了表达蛋白。方法　将ＭＳＰ１－ １７ 基因片段克隆入原核表达载体ｐＧＥＸ－ ４Ｔ－ １,形成ｐＧＥＸ－ ４Ｔ－ １／ＭＳＰ１－ １７。ＩＰＴＧ诱导ｐＧＥＸ－ ４Ｔ－ １／ＭＳＰ１－ １７ 转化的ＢＬ２１菌,纯化并用ＭＳＰ１－ １７ 特异性单克隆抗体鉴定表达产物。结果　成功地构建了ｐＧＥＸ－ ４Ｔ－ １／ＭＳＰ１－ １７,转化菌经诱导表达出与ＧＳＴ融合的蛋白（约４０ＫＤ）,纯化后纯度达７２％ ,ＭＳＰ１－ １７ 特异性单克隆抗体可识别表达蛋白。结论　成功表达并纯化了ＭＳＰ１－ １７ 蛋白,为深入研究和应用ＭＳＰ１－ １７ 打下基础     

小剂量多巴酚丁胺核素心室造影与^201铊再注射心肌显像对…

采用小剂量多巴酚丁胺（Ｄｏｂ）负荷试验与核素心室造影（ＲＮＶ）相结合的方法（ＤｏｂＲＮＶ）对２０例陈旧性心肌梗塞（ＯＭＩ）患者进行存活心肌的评估并与＾２０１铊（Ｔｌ）再注射心肌以显像（ＳＰＥＣＴ）相比较。结果显示：静态ＲＮＡ明显地低估存活民肌的程度，ＤｏｂＲＮＶ将静态ＲＮＶ对存活心肌的检出率增加６１．５％。以＾２０１Ｔ１再注射心肌ＳＰＥＣＴ为标准，ＤｏｂＲＮＶ检测存活心肌的阳性预测率为９３．８％，     

多平面经食管超声心动图测量房间隔缺损面积的研究

为了探讨新型多平面经食管超声心动图（ＭＴＥＥ）测量房间隔缺损（ＡＳＤ）面积的可行性和可靠性，在２３例ＡＳＤ患者中进行了ＭＴＥＥ检查。利用心电图门控于心动周期的Ｐ波顶点、Ｐ－Ｒ段、Ｒ波顶点、Ｊ点、Ｔ波起点、Ｔ波顶点、Ｔ波终点等７个时相，以ＭＴＥＥ技术每隔１０°扫查角度测量ＡＳＤ直径，由此绘出心动周期每一时相的ＡＳＤ图形，并计算其面积，然后与手术测量的ＡＳＤ面积进行比较。结果显示：（１）ＡＳＤ面积在心动周期中呈动态改变；（２）ＭＴＥＥ于Ｐ波顶点测量的ＡＳＤ面积与手术测值相关最佳（ｒ＝０．９２），余心动周期时相ＭＴＥＥ与手术测值亦相关良好（ｒ＝０．８２～０．８８），表明ＭＴＥＥ为ＡＳＤ面积的测量提供了可靠的新方法。     

CD+4自然杀伤T细胞在慢性乙型肝炎病毒感染中的作用

目的 了解ＣＤ４＾＋、ＣＤ８＾＋自然杀伤（ＮＫ）Ｔ细胞在慢性ＨＢＶ感染外周轿中的分布情况,并对其细胞毒性进行分析,阐明其在慢性ＨＢＶ感染中的作用。方法 常规分离外周上核细胞（ＰＢＭＣＳ）,用重组人白细胞介素－１２／２诱导１４ｄ,以鼠抗人ＣＤ４单克隆抗体或抗人ＣｍＡｂ与抗人ＣＤ５６ｍＡｂ分别标记细胞样品,流式细胞术（ＦＣＭ）分析,ＣＤ４＋ＣＤ５６＾＋同时阳性的细胞,即为ＣＤ４＾＋－ＮＫ－Ｔ细胞;Ｃ     

The benefit of bone-seeking radiopharmaceuticals in the treatment of metastatic bone pain

Purpose The surface bone-seeking radiopharmaceuticals rhenium-188-HEDP (¹⁸⁸Re-HEDP) and samarium-153-EDTMP (¹⁵³Sm-EDTMP) were investigated to determine the efficacy and toxicity in pain palliation in bone metastases.Method The effect of treatment with ¹⁸⁸Re-HEDP and ¹⁵³Sm-EDTMP on pain symptoms, life quality, and bone marrow function were obtained in 46 patients with prostate and breast cancer. There were 31 patients treated with ¹⁸⁸Re-HEDP (3194±387 MBq) and 15 patients with ¹⁵³Sm-EDTMP (2940±545 MBq). The ¹⁸⁸Re-HEDP group included 6 patients and 25 patients, and the ¹⁵³Sm-EDTMP group 6 patients and 9 patients with breast and prostate cancer, respectively. All patients had an interview using standardized sets of questions before and after therapy for 12 weeks. Blood counts were taken weekly for 6 weeks and after 12 weeks.Results After treatment with ¹⁸⁸Re-HEDP, 77% of patients reported pain relief and 73% after ¹⁵³Sm-EDTMP. Sixteen percent of the patients treated with ¹⁸⁸Re-HEDP and 13% of those given ¹⁵³Sm-EDTMP could discontinue their analgesics and were pain free. Patients described an improvement on the Karnofsky performance scale from 73±7 to 85±8% 12 weeks after ¹⁸⁸Re-HEDP (p<0.05) and from 68±9 to 74±9% after ¹⁵³Sm-EDTMP (p=0.217). Only 3 patients post-¹⁸⁸Re-HEDP and 2 patients post-¹⁵³Sm-EDTMP showed a thrombocytopenia below 100×10³/µl. The maximum nadir of platelet and leukocyte counts were observed between the second to fourth week after treatment in both and was reversible within 12 weeks. There were no significant differences in pain palliation, Karnofsky performance scale and bone marrow toxicity between the lower beta energy ¹⁵³Sm-EDTMP and the higher beta energy ¹⁸⁸Re-HEDP (p=0.098–0.442).Conclusion Both radiopharmaceuticals were effective in pain palliation, without induction of severe side effects or significant differences in therapeutic efficacy or toxicity.     

骨转移癌的^153Sm—EDTMP止痛效果研究

采用~(153)Sm—EDTMP治疗76例骨转移癌疼痛患者(男57例,女19例;年龄56～82岁)。首次或疗程内用药后疼痛完全缓解27例(35.5％,27/76),部分缓解43例(56.5％,43/76),总有效率为92％。影响因素研究表明:76例病人中,年龄、性别、剂量等对止痛效果无明显影响(P>0.05)。~(153)Sm—EDTMP对全身各部位的骨转移癌疼痛均有良好的止痛效果,该药对减少临床麻醉剂用量,提高病人生存质量,延长病人寿命均有临床推广和应用价值。     

Successful treatment of POEMS syndrome with autologous hematopoietic progenitor cell transplantation

POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) is a plasma cell dyscrasia that differs substantially from classic multiple myeloma. It is often associated with disabling polyneuropathy in younger patients. Current therapeutic approaches are frequently inadequate and leave many patients wheelchair-bound with significant deterioration in quality and length of life. We present the case of a young man with progressive disease despite conventional therapeutic approaches. We describe a novel approach to treatment with a bone-seeking radiopharmaceutical, samarium-153 ethylene diamine tetramethylene phosphonate ((153)Sm-EDTMP), followed by myeloablative chemotherapy with autologous hematopoietic progenitor cell reconstitution. This approach resulted in regression of the organomegaly and skin changes and in neurologic improvement both clinically and electrophysiologically. The patient progressed from being wheelchair-bound to independent ambulation. An aggressive approach should be considered in patients with POEMS syndrome in whom standard therapeutic measures fail.     

Detection of liver metastases secondary to pancreatic cancer: utility of combined helical computed tomography during arterial portography with biphasic computed tomography-assisted hepatic arteriography

Background

This study was designed to define the diagnostic advantage of computed tomography during arterial portography (CTAP) combined with computed tomography?Cassisted hepatic arteriography (CTHA) for the preoperative detection of liver metastases secondary to pancreatic cancer compared with that of multidetector computed tomography (MDCT).

Methods

From January 2002 to December 2007, we retrospectively studied 197 consecutive patients with pancreatic cancer. MDCT was performed on 192 patients prior to preoperative visceral angiography; 153 patients underwent CTAP?+?CTHA at the time of preoperative angiography.

Results

Liver metastases were identified in 39 patients by means of MDCT. Of the 153 patients who had no evidence of liver metastases on MDCT, 129 patients underwent CTAP?+?CTHA, and 53 of these 129 patients (41.1%) were diagnosed as having liver metastases that could not be detected by MDCT. These tumors missed by MDCT ranged from 3 to 15?mm in size. On CTAP?+?CTHA, a solitary nodule in the liver was detected in 11 patients, 2 nodules were detected in 6 patients, 3 lesions were detected in 2 patients, and ?R4 lesions were detected in 34 patients. The sensitivity and specificity of CTAP?+?CTHA versus MDCT were 94.2 versus 48.4% and 82.7 versus 97.9%, respectively.

Conclusions

The combination of CTAP and CTHA is useful to confirm liver metastases and can potentially offer more accurate staging of pancreatic cancer compared with MDCT.     

Transbronchial needle aspiration cytology of subcarinal lymph nodes for the staging procedure in the diagnosis of lung cancer

OBJECTIVE AND BACKGROUND: The aim of this study was to improve the staging of lung cancer with or without lymphadenopathy on chest CT by using transbronchial aspiration cytology (TBAC). METHODS: TBAC of the subcarinal lymph nodes was performed on 153 consecutive patients with lung cancer, with or without subcarinal lymphadenopathy on chest CT. RESULTS: Thirty-four patients had enlargement of the subcarinal lymph nodes (>1 cm). Eighteen of these had TBAC confirmation of metastases. Another seven patients with no mediastinal involvement on CT were positive for metastases on TBAC. TBAC was the only way to confirm lung cancer in two patients. Therefore, routinely performed subcarinal TBAC contributed to an improved non-operative staging of the patients and diagnosis in 16% (25/153) of the patients with lung cancer. Forty-nine patients with NSCLC had surgical resection of the tumour. Surgical procedure revealed metastases to the subcarinal lymph nodes in three patients in whom the preoperative TBAC diagnosis was normal. No significant complications due to TBAC occurred in any of the patients. CONCLUSION: TBAC of the subcarinal lymph nodes is a minimally invasive technique for staging of lung cancer and can provide useful information for the diagnosis of metastases to the subcarinal lymph nodes.     

Surveillance-Detected Hepatic Metastases From Colorectal Cancer Had a Survival Advantage in Seven-Year Follow-Up

PURPOSE Colorectal cancer is a common cause of cancer-related death. The liver is the most common site of distant metastases and the most amenable to potentially curative surgery. The aim of this study was to determine whether hepatic metastases detected by surveillance following colonic resection were associated with higher resectability rates and to determine whether there was any impact on survival rates.METHODS A retrospective study of 211 patients who presented to the liver unit between February 1990 and July 1996 with hepatic metastases following colonic resection for adenocarcinoma was performed. Patients were divided into two groups: Group A (n = 154), hepatic metastases diagnosed by carcinoembryonic antigen or by radiology; and Group B (n = 57), patients with symptomatic presentation.RESULTS Potentially curative operations were possible in 51.3 percent (79/154) of Group A patients and 28.1 percent (16/57) of Group B patients (P = 0.0043, chi-squared test). In Groups A and B, 24 percent (37/154) and 43.9 percent (25/57) of patients, respectively, were inoperable. The three-year and five-year survival rates after detection of liver metastases were 26.8 percent (41/153) in Group A and 12.5 percent (7/56) in Group B, and 5.9 percent (9/153) in Group A and 8.9 percent (5/56) in Group B, respectively. Log-rank analysis resulted in P = 0.05, Breslow test in P = 0.01.CONCLUSION Our study shows that patients with hepatic metastases from colorectal cancer detected by follow-up were significantly more likely to have a potentially curative operation. Our medium-term survival data show a statistically significant survival benefit in patients with surveillance-detected metastases.     

Avidin-biotin system pretargeting radioimmunoimaging and radioimmunotherapy and its application in mouse model of human colon carcinoma

AIM: To evaluate the multi-step pretargeting radioimmunoimaging (RII) and radioimmunotherapy (RIT) in nude mice bearing human colon carcinoma with avidin-biotin system labeled with 153Sm.METHODS: Two- and three-step strategies for avidinbiotin system pretargeting techniques were established.In a three-step procedure, human colon carcinoma bearing nude mice were first injected with biotinylated monoclonal antibody (McAb-Bt) followed by cold avidin (Av) 48 h later and then 153Sm-DB2 24 h thereafter;whereas the twostep procedure consisted of injection of 153Sm-SA 48 h after pretargeting with biotinylated anti-CEA monoclonal antibody (CEA McAb-Bt). SPECT imaging and biodistribution were performed at 4, 24, 48, or 72 h after injection of 153Sm-labeled compounds. Five groups of nude mice subcutaneously grafted with human colon carcinoma were treated 3 d after grafting. One group received the injection with 100 μg CEA McAb-Bt followed by cold avidin (80 μg)after 2 d and 11.1 MBq 153Sm-DB2 after 1d. Four control groups were treated respectively with 11.1 MBq 153SmCEA McAb, 11.1 MBq 153Sm-nmIgG, 11.1 MBq 153Sm-DB2,100 Μl normal saline. Toxicity was evaluated by changes of leukocyte count, and the efficacy by variation in tumor volume. Histological analyses of tumors were performed.RESULTS: The three-step procedure allowed faster blood clearance and yielded higher tumor blood ratios (5.76 at4 h and 12.94 at 24 h) of the 153Sm-DB2. The tumor was clearly visualized at 4 h in y-imaging after the injection of 153Sm-DB2, while a significant accumulation of 153Sm-SA in the tumor was observed only 24 h after the injection and tumor blood ratios at 4 and 24 h were 1.00 and 2.03,respectively, in the two-step procedure. Pretargeting RIT and 153Sm-CEA McAb had a strong tumor-inhibiting effect.The tumor inhibitory rate was 80.67% and 78.44%,respectively, five weeks after therapy. Histopathological evidence also indicated radioactive damage in tumor tissues as necrosis of tumor cells, while in the other organs such as liver and kidney no radioactive damage was observed. Leukocyte counts showed significant decrease after treatment in groups of 153Sm-CEA Mc Ab and 153SmnmIgG.CONCLUSION: The two kinds of pretargeting strategies can elevate the target-to-nontarget ratio, decrease the blood background and shorten the imaging time compared to 153Sm-CEA McAb. Three-step pretargeting RIT is as efficient as 153Sm-CEA Mc Ab, but markedly less toxic. This study provides experimental evidence for the clinical application of pretargeting RII and RIT.     

Avidin-biotin system pretargeting radioimmunoimaging and radioimmunotherapy and its application in mouse model of human colon carcinoma

AIM: To evaluate the multi-step pretargeting radioimm-unoimaging (RII) and radioimmunotherapy (RIT) in nude mice bearing human colon carcinoma with avidin-biotin system labeled with 153Sm. METHODS: Two- and three-step strategies for avidin-biotin system pretargeting techniques were established. In a three-step procedure, human colon carcinoma bearing nude mice were first injected with biotinylated monoclonal antibody (McAb-Bt) followed by cold avidin (Av) 48 h later and then 153Sm-DB2 24 h thereafter; whereas the two-step procedure consisted of injection of 153Sm-SA 48 h after pretargeting with biotinylated anti-CEA monoclonal antibody (CEA McAb-Bt). SPECT imaging and biodistribution were performed at 4, 24, 48, or 72 h after injection of 153Sm-labeled compounds. Five groups of nude mice subcutaneously grafted with human colon carcinoma were treated 3 d after grafting. One group received the injection with 100 μg CEA McAb-Bt followed by cold avidin (80 μg) after 2 d and 11.1 MBq 153Sm-DB2 after 1 d. Four control groups were treated respectively with 11.1 MBq 153Sm-CEA McAb, 11.1 MBq 153Sm-nmIgG, 11.1 MBq 153Sm-DB2, 100 μL normal saline. Toxicity was evaluated by changes of leukocyte count, and the efficacy by variation in tumor volume. Histological analyses of tumors were performed. RESULTS: The three-step procedure allowed faster blood clearance and yielded higher tumor blood ratios (5.76 at 4 h and 12.94 at 24 h) of the 153Sm-DB2. The tumor was clearly visualized at 4 h in γ-imaging after the injection of 153Sm-DB2, while a significant accumulation of 153Sm-SA in the tumor was observed only 24 h after the injection and tumor blood ratios at 4 and 24 h were 1.00 and 2.03, respectively, in the two-step procedure. Pretargeting RIT and 153Sm-CEA McAb had a strong tumor-inhibiting effect. The tumor inhibitory rate was 80.67% and 78.44%, respectively, five weeks after therapy. Histopathologicai evidence also indicated radioactive damage in tumor tissues as necrosis of tumor cells, while in the other organs such as liver and kidney no radioactive damage was observed. Leukocyte counts showed significant decrease after treatment in groups of 153Sm-CEA McAb and 153Sm-nmIgG. CONCLUSION: The two kinds of pretargeting strategies can elevate the target-to-nontarget ratio, decrease the blood background and shorten the imaging time compared to 153Sm-CEA McAb. Three-step pretargeting RIT is as efficient as 153Sm-CEA McAb, but markedly less toxic. This study provides experimental evidence for the clinical application of pretargeting RII and RIT.     

Diagnosis, treatment and outcome of pancreatoblastoma.

BACKGROUND: Pancreatoblastoma is a rare tumour mainly presenting in childhood but also in adults. OBJECTIVES: The aim was to determine the clinical course of pancreatoblastoma by an analysis of reported cases. METHODS: Patients with pancreatoblastoma were identified from Medline and combined with patients identified from the Royal Liverpool University Hospital. RESULTS: There were 153 patients with a median (range) age at presentation of 5 (0-68) years and a male:female ratio of 1.14:1. The most frequent site was the head of pancreas (48/123, 39%). The median and 5-year (95% CI) survival rates were 48 months and 50% (37-62%) respectively. At presentation there were 17 (17%) out of 101 patients with metastases, the liver being the commonest site (15/17, 88%). On univariate analysis, factors associated with a worse prognosis were synchronous (p = 0.05) or metachronous metastases (p < 0.001), non-resectable disease at presentation (p < 0.001) and age > 16 years at time of presentation (p = 0.02). On multivariate analysis, resection (p = 0.006) and metastases post-resection (p = 0.001) but not local recurrence influenced survival. CONCLUSIONS: Pancreatoblastoma is one of the pancreatic tumours with a relatively good prognosis. The treatment of choice is complete resection with long-term follow-up aiming to treat any early local recurrence or metastasis.