动态三维超声在腹部肿瘤鉴别诊断的研究应用

目的探讨动态三维超声在腹部肿瘤鉴别诊断的研究应用。方法应用动态三维超声对172例腹部肿瘤进行超声探查,并对超声图像进行分析,分类。结果 1动态三维超声图像上腹部肿瘤的内部回声,边界,形态,立体效应,侵润程度与二维图像有明显差异。2三维超声彩色能量图（3D-CDE）技术能够清晰显示肿瘤内部滋养血管走行,形态,分支及分布范围,富有立体感,明显优于二维超声彩色能量图（2D-CDE）。虚拟组织计算机辅助分析（VOCAL）技术能够客观地反映肿瘤空间形态,并且对肿瘤体积测量更加准确。结论动态三维超声的三维图像能够在动态状态下观察肿瘤在三维空间的形态,三维内部结构,与正常组织空间关系,提供了丰富的诊断信息。动态三维超声的三维图像,三维超声彩色能量图（3D-CDE）技应用及三维超声虚拟组织计算机辅助分析（VOCAL）技术在对腹部脏器肿瘤的鉴别诊断中有着重要的临床价值。     

实时三维多普勒超声心动图定量测量正常人血流量

目的应用实时三维多普勒超声心动图技术评价正常人血流量。方法对50例正常人应用三维多普勒超声心动图测量主动脉瓣血流量。同时应用三维超声心动图测量左室舒张末期容积、收缩末期容积和每搏量。结果实时三维多普勒超声心动图测量的血流量与三维超声心动图测量的每搏量相关性良好,主动脉瓣相关系数r=0.90。结论实时三维多普勒超声心动图能够准确测量心脏血流量。     

正常移植肾三维超声成像特点

为探讨应用三维超声研究正常移植肾形态学特点、血流灌注及体积精测，将移植肾90例按血肌酐浓度分成3组，分别进行二维、彩色多普勒、三维数据采集，脱机后行肾脏结构及血流的三维图像重建及显示。二维图像测量肾脏的长、宽、厚径；彩色多普勒显像观察肾血流情况；三维重建用VOCAL法精测移植肾的体积，结合三维能量多普勒计算血流指数（vascularization index，VI）。结果表明，三维超声成像可以从不同角度、层面连续观察移植肾的形态，重建的血管树可以立体显示血管分布。3组测得的移植肾体积及VI差异无统计学意义（P均〉0．05）。结论：三维成像显示的移植肾图像较二维图像信息更丰富，还可以进行体积精测及定量研究肾灌注，是对二维图像很好的补充和完善，但不能取代二维超声。     

三维超声彩色多普勒能量图技术在膀胱癌诊断中的应用

目的探讨三维超声彩色多普勒能量图（3D-CDE）技术在膀胱癌诊断中的意义。方法对29例经膀胱镜活检,病理证实为膀胱癌患者,进行3D-CDE检查。结果 3D-CDE技术对膀胱癌内部及周边血流显示逼真清晰,富有立体感,明显优于二维超声彩色多普勒能量图（2D-CDE）。结论 3D-CDE技术不仅能显示膀胱癌内部及周边血流信号,并且能清晰显示癌体内部滋养血管走行、形态、分支及分布范围,对膀胱癌的诊断有重要意义。     

实时三维超声心动图半自动边界检测法测量体外模型容积的研究

在三维超声技术从出现到不断完善成熟的发展过程中,国内外从体外模型、动物实验及临床实验等方面对容积测量的准确性均有报道。为了熟练掌握这一技术,在临床应用中做到保证测量的一致性将测量误差降到最小,我们于最近应用实时三维超声心动图（RT-3DE）的全容积成像半自动边界描记技术测量类似于左心室形状体外模型容积,并与实际容量相比较,报告如下。     

不同距离目标三维超声容积自动测量技术准确度的实验研究

目的：评价对不同距离目标三维超声容积自动测量（ virtual organ computer aided analysis ，VOCAL）技术的准确度。方法应用VOCAL技术对19个不规则不变形水囊模型在距离探头表面1 cm、3 cm、6 cm、9 cm、12 cm处分别作容积自动测量。结果 VOCAL测量不规则水囊在距探头1 cm、3 cm、6 cm、9 cm、12 cm处体积的准确度分别为（99.80±2.63）％、（95.06±3.34）％、（91.37±4.23）％、（88.65±4.44）％、（80.98±9.11）％。系统偏倚（测量差值的平均值）及一致界限（测量差值平均值±2SD）分别为（-0.66±5.18）ml、（-9.07±6.82）ml、（-14.36±6.96）ml、（-21.09±8.39）ml、（-28.37±10.51）ml，相关系数（r）分别为0.992、0.989、0.987、0.981、0.968。结论随目标距离探头数值增加，其测量准确度降低，误差加大，系统偏倚增大，相关系数减小。     

实时三维超声心动图在先心病介入治疗中的应用

目的探讨实时三维超声心动图在先心病介入治疗中的临床应用价值。方法应用实时三维超声心动图对58例先心病介入治疗患者进行术前、术后检查,观测结果与二维超声心动图及手术结果对比。结果实时三维超声心动图测量室间隔缺损和房间隔缺损患者的缺损最大直径与介入治疗选择封堵器直径无显著差异,而二维超声测量缺损直径低于选择封堵器直径(P<0.05),对于动脉导管未闭可观察整体病变情况。结论实时三维超声心动图能够在先心病介入治疗术前、术后提供更真实准确的评价。     

移植肾排异反应的三维超声成像特点

为探讨应用三维超声研究移植肾排异反应时形态学特点和血流灌注,定量计算体积及血流容积指数vascularization index（VI）,选择发生排异反应的移植肾30例,对照组30例,行移植肾二维及三维超声检查,脱机后行肾脏结构及血流的三维图像重建及显示,二维图像测量肾脏的长、宽、厚径,三维重建后用virtual organ computer aided analysis（VOCAL）法精测移植肾的体积,结合三维能量多普勒计算VI。结果显示三维重建图像测得的移植。肾体积改变有统计学意义（P〈0．05）,与二维测得的长、宽、厚径相比更敏感。VI改变有统计学意义（P〈0．05）。结论：在发生排异反应时,三维超声体积精测较二维超声显示移植肾大小改变更敏感,VI可以定量反映移植肾灌注减少。     

实时三维彩色多普勒超声检查在膀胱肿瘤诊断与分期中的应用

目的探讨实时三维彩色超声成像技术在膀胱肿瘤诊断与分期中的应用价值。方法应用GEVoluson530D三维彩色多普勒超声诊断系统,对92例膀胱肿瘤患者进行二维和实时三维彩色多普勒超声检查。所有患者经手术切除标本病理检查,并二维、三维彩色多普勒超声显像与分期结果进行对比验证。结果92例膀胱肿瘤患者共检出124个瘤体,二维与三维彩色多普勒超声显像对膀胱肿瘤的检出符合率分别为79．0％与95．2％,差异有统计学意义（Χ^2=14．35,P=0．00）;二维与三维彩色多普勒超声显像对膀胱肿瘤的术前分期准确率分别为80．6％与90．7％,差异有统计学意义（Χ^2=4．54,P=0．03）。结论实时三维彩色多普勒超声可明显提高膀胱癌诊断和分期的准确率,具有较高的临床应用价值。     

实时三维超声对胎儿畸形的诊断价值

目的:探讨实时三维超声成像在胎儿畸形诊断的临床价值。方法:利用实时三维超声仪,所有患者先常规作二维超声检查,之后再由同一操作者行三维超声检查,并将二维及三维超声检查结果相对照。结果:实时三维超声成像技术应用可使胎儿某些畸形诊断更为准确直观。结论:三维超声能直观显示胎儿结构,三维超声检查诊断胎儿畸形的敏感性、特异性及准确性高,是二维超声检查的重要补充,与二维超声联合应用,可提高胎儿畸形的检出率。     

Polymorphisms of xenobiotic metabolizing enzymes in bladder cancer patients of the Semmelweis University Budapest,Hungary

ABSTRACT

Polymorphic xenobiotic metabolizing enzymes such as N-acetyltransferase 2 (NAT2) or glutathione S-transferase M1 (GSTM1) are known to modulate bladder cancer risk. As no apparent data were available from Hungary, a former member of the eastern European economic organization, a study was performed in Budapest. In total, 182 bladder cancer cases and 78 cancer-free controls were investigated by questionnaire. Genotypes of NAT2, GSTM1, GSTT1, rs1058396 and rs17674580 were determined by standard methods. Current smokers’ crude odds ratio (OR) (3.43) and former smokers crude OR (2.36) displayed a significantly increased bladder cancer risk. The risk rose by a factor of 1.56 per 10 pack years. Exposure to fumes was associated with an elevated bladder cancer risk (23% cases, 13% controls). Sixty-four % of the cases and 59% of controls were slow NAT2 acetylators. It was not possible to establish a particular impact of NAT2*6A and *7B genotypes (15 cases, 8%, 5 controls, 7%). GSTT1 exerted no marked influence on bladder cancer (negative 21% cases vs. 22% controls). The portion of GSTM1 negative bladder cancer patients was increased (63% cases vs. 54% controls). The SLC14A1 SNPs rs1058396[AG/GG] and the nearby rs17674580[CT/TT] occurred more frequently in cases (79% and 68%) than controls (77% and 55%). The portion of GSTM1 negative bladder cancer patients is comparable with portions reported from other industrialized areas like Lutherstadt Wittenberg/Germany (58%), Dortmund/Germany (70%), Brescia/Italy (66%) or an occupational case-control series in Germany (56%). Data indicate that GSTM1 is a susceptibility factor for environmentally triggered bladder cancer rather than for smoking-mediated bladder cancer.     

Comparison of the effects of dexamphetamine and 1-benzylpiperazine in former addicts

Summary The subjective, behavioural and autonomic effects of dexamphetamine 10 mg, 1-benzylpiperazine 100 mg and lactose dummy were compared in a group of 18 former amphetamine addicts. All subjects received the three preparations according to a balanced design under double blind conditions. 1-Benzylpiperazine and dexamphctamine produced indistinguishable subjective effects and both were liked. The effects of both compounds differed significantly from the effects following the dummy preparation. Increases in pulse rate and both systolic and diastolic blood pressure were similar following the two active compounds, but 1-benzylpiperazine produced pupillary dilation whereas no significant change in pupil size followed dummy or dexamphetamine. It was concluded that 1-benzylpiperazine is a compound liable to abuse by an addict population, and that this type of study might be of value in predicting abuse liability of other new drugs.     

mfn2和nm23在不同膀胱组织中的表达

【摘要】目的 探讨线粒体融合蛋白-2(mfn2)和肿瘤转移抑制基因（nm23）在膀胱癌组织中的表达及与临床病理特征间的关系。方法 选取65 例膀胱癌标本,其中男50 例,女15 例。TNM 分期：Ⅰ期47 例、Ⅱ期10 例、Ⅲ期5 例、Ⅳ3 例,另择正常膀胱组织、良性膀胱肿瘤标本各15 例作为对照。应用免疫组化SP 法检测mfn2 和nm23 的表达情况,并分析其在膀胱癌组织中的表达与临床病理特征之间的关系。结果 膀胱癌组织中mfn2 的阳性表达率均高于正常和良性膀胱组织,nm23 的阳性表达率均低于正常和良性膀胱组织（均P＜0.05）。膀胱癌组织中mfn2 的表达在不同分化程度、TNM 分期间的差异有统计学意义,在不同年龄、性别、淋巴结转移情况和临床分期间的差异无统计学意义。nm23 在不同TNM 分期、淋巴结转移情况和临床分期间的差异有统计学意义,在不同年龄、性别和分化程度间的差异无统计学意义。结论mfn2 在膀胱癌中高表达,mfn2 与膀胱癌的发生、发展密切相关;nm23 在膀胱癌中低表达,可作为预测膀胱癌转移及其预后的参考指标。     

膀胱癌尿液肿瘤标志物的现状和研究进展

目前膀胱癌诊断和随访主要依靠尿细胞学检查、影像学和膀胱镜相结合的方法,但影像学检查无法明确诊断,膀胱镜检查属有创操作,尿脱落细胞学检查的灵敏度低。近年来很多尿液中膀胱肿瘤标志物被发现并应用于临床,本文概述了这些膀胱肿瘤标志物的应用现状及研究进展。     

UDP-glucuronosyltransferase 2B7 C802T (His268Tyr) polymorphism in bladder cancer cases

A study of Chinese benzidine workers indicated elevated levels of UDP-glucuronosyltransferase (UGT) 2B7 T/T activity in carriers for development of bladder cancer. The present study was designed to investigate the possible impact of the presence of UGT2B7 genotype on bladder cancer risk in Caucasians. UGT2B7 polymorphism at locus C(802)T (His(268)Tyr) was detected using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP)-based procedure. The study group consisted of 211 bladder cancer cases and 210 controls suffering from different urological diseases, but without any history of cancer. Both groups were recruited from a Department of Urology located in a center of former chemical and rubber industries in Germany. Furthermore, 171 bladder cancer cases with a history of occupational exposure to aromatic amines surveyed for compensation due to an occupational disease were investigated. T/T genotype frequencies in bladder cancer cases, urological controls, and exposed patients appeared similar (27 vs. 35 vs. 25%). This study indicated that there were ethnic differences between Caucasian and Chinese general populations with respect to the UGT2B7 genotype. Furthermore, in contrast to an earlier investigation in benzidine-exposed Chinese bladder cancer patients, no relevant differences between bladder cancer patients and urological hospital controls were observed in Germany.     

槲皮素通过Bim-Bak/Bax途径提高顺铂耐药膀胱癌细胞对顺铂敏感性的研究

目的 探讨槲皮素能否逆转膀胱癌细胞对顺铂的耐药性并研究其机制。方法 MTT法检测顺铂耐药T24膀胱癌细胞在顺铂和槲皮素处理下的细胞活力。流式细胞实验检测顺铂耐药T24膀胱癌细胞在顺铂和槲皮素处理下的细胞凋亡。Western blot试验检测顺铂耐药T24膀胱癌细胞在顺铂和槲皮素处理下Bim、活化caspase-9、活化caspase-3的表达水平以及细胞色素c、Smac/DIABLO的释放。免疫共沉淀实验检测顺铂耐药T24膀胱癌细胞在顺铂和槲皮素处理下Bim蛋白与Bak、Bax蛋白的相互作用。结果 相比于常规T24细胞,顺铂耐药T24细胞对顺铂的敏感性显著下降。MTT和流式细胞实验结果表明槲皮素能显著促进顺铂对耐药T24细胞的杀伤活性和凋亡诱导活性。免疫共沉淀和Western blot试验结果表明槲皮素能显著上调顺铂耐药T24细胞中Bim蛋白的表达,从而通过与Bak、Bax蛋白的相互作用促进顺铂对肿瘤细胞线粒体膜孔道的开放,诱导细胞色素c和Smac/DIABLO从线粒体中释放到细胞质中,最终引起caspase-9和caspase-3的活化。结论 槲皮素通过Bim-Bak/Bax途径提高顺铂耐药膀胱癌细胞对顺铂的敏感性。     

Gemcitabine in the treatment of bladder cancer

New agents are available for the treatment of metastatic transitional cell carcinoma of the bladder. In the US, the combination of methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) remains the standard chemotherapy regimen for advanced bladder cancer. Gemcitabine (2′,2′-difluorodeoxycytidine [dFdC]) is a relatively new agent with a favourable toxicity profile that has demonstrated activity against a number of solid tumours in both preclinical and clinical studies. Single-agent gemcitabine has shown activity in bladder cancer in both pretreated and chemotherapy-naïve patients. The combination of gemcitabine plus cisplatin is a regimen with significant activity and moderate toxicity in bladder cancer patients. A randomised trial of gemcitabine plus cisplatin versus M-VAC has completed accrual but has not yet been reported. New combination studies of gemcitabine with other chemotherapy agents, including the taxanes, are ongoing.     

N-acetyltransferase-2 and medical history in bladder cancer cases with a suspected occupational disease (BK 1301) in Germany

In 187 bladder cancer cases reported to the employers' liability insurance association in Germany as suspected cases of an occupational disease produced by aromatic amines, N- acetyltransferase-2 (NAT2) activity status, occupational exposure data, period of latency, and clinical parameters were determined. In 83 out of 187 cases surveyed within the period 1991-1999, the NAT2 acetylator status was investigated by determining the molar ratio of an acetylated and a nonacetylated caffeine metabolite in urine (phenotyping) and/or by NAT2 genotyping according to standard polymerase chain reaction (PCR) protocol. The proportion of slow NAT2 acetylators in the surveyed 83 bladder cancer cases was 67%. In the entire group of surveyed 187 cases, mean duration of exposure was 17.6 yr and mean period of latency was 34.7 yr. Occupational exposures to potential bladder carcinogens were observed in 73 occupations, including chemical industry (25%), and occupations as a painter and/or varnisher (23%) were most often encountered. In 12% of the surveyed bladder cancer cases, a second primary malignancy was observed. The NAT2 distribution observed in the 83 cases is comparable to the proportion in 40 occupationally exposed bladder cancer cases in a Department of Urology located close to a former German production site of benzidine-based azo dyes, but higher than in most studies involving NAT2 genetic status in bladder cancer cases.     

The enhanced bladder cancer susceptibility of NAT2 slow acetylators towards aromatic amines: a review considering ethnic differences

Human bladder cancer may be caused by exposure to aromatic amines. The polymorphic enzyme N-acetyltransferase 2 (NAT2) is involved in the metabolism of these compounds. Two classical studies on chemical workers in Europe, exposed in the past to aromatic amines like benzidine, unambiguously showed that the slow acetylator status is a genetic risk factor for arylamine-induced bladder cancer. In the former benzidine industry in Huddington, Great Britain, 22 of 23 exposed cases with bladder cancer, but only 57% of 95 local controls without bladder cancer were of the slow acetylator phenotype. In Leverkusen, Germany, 82% of 92 benzidine-exposed chemical workers with bladder cancer were of the slow acetylator phenotype, whereas only 48% of 331 chemical workers who had worked at that plant were of the slow acetylator phenotype. This is in line with several smaller studies, which also show an over-representation of the slow acetylator status in formerly arylamine-exposed subjects with bladder cancer. Some of these studies included also subjects that were exposed to aromatic amines by having applied dyes, paints and varnishes. These European findings are in contrast to a large study on Chinese workers occupationally exposed to aromatic amines. In this study, only five of 38 bladder cancer cases occupationally exposed to arylamines were of the slow acetylator genotype. This is much lower than the ratio of slow acetylators to the general population in China. This points to different mechanisms of susceptibility for bladder cancer upon exposure to aromatic amines between European (Caucasian) and Chinese populations.     

Gemcitabine in the treatment of bladder cancer

New agents are available for the treatment of metastatic transitional cell carcinoma of the bladder. In the US, the combination of methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) remains the standard chemotherapy regimen for advanced bladder cancer. Gemcitabine (2',2'-difluorodeoxycytidine [dFdC]) is a relatively new agent with a favourable toxicity profile that has demonstrated activity against a number of solid tumours in both preclinical and clinical studies. Single-agent gemcitabine has shown activity in bladder cancer in both pretreated and chemotherapy-na?ve patients. The combination of gemcitabine plus cisplatin is a regimen with significant activity and moderate toxicity in bladder cancer patients. A randomised trial of gemcitabine plus cisplatin versus M-VAC has completed accrual but has not yet been reported. New combination studies of gemcitabine with other chemotherapy agents, including the taxanes, are ongoing.