非小细胞肺癌18F-FDG PET显像与增殖细胞核抗原表达的关系

目的　探讨非小细胞肺癌 (NSCLC)标准摄取值 (SUV)与肿瘤增殖细胞核抗原 (PCNA)表达的关系。方法　 3 0例经术后组织病理检查证实为NSCLC患者于术前行全身1 8F 脱氧葡萄糖 (FDG)PET显像 ,测定SUV ,随访预后 ;手术获得肿瘤标本经常规石蜡切片 ,用免疫组织化学技术检测肿瘤组织PCNA表达 ,计算肿瘤细胞PCNA表达阳性百分数 (即PCNA指数 ) ,取肿瘤周围正常肺组织作对照。结果　正常肺组织肺泡细胞PCNA指数均小于 5 % ,肺癌细胞PCNA指数为 (4 9.49± 2 1.2 4) % ,且PCNA指数与SUV之间具有明显的相关性 (r =0 .82 6,P <0 .0 1) ,PCNA表达高的肺癌细胞有高FDG摄取趋势 ;随SUV及PCNA指数的升高 ,肺癌出现复发或转移的几率升高 ,且与未出现复发或转移者之间差异有显著性 (P <0 .0 1)。结论　SUV可间接评价NSCLC细胞的增殖能力 ,亦可作为评价肺癌患者预后的重要参考指标     

PET显像评价头颈部肿瘤放射治疗疗效的研究现状

PET能无创、动态、定量地从细胞分子水平观察肿瘤组织特有的生化代谢等生物学特征,因此,其对肿瘤病变的定性诊断有较高的特异性和准确性。最常用的测定方法为标准摄取值(SUV),如通常认为18F脱氧葡萄糖(FDG)显像时SUV>2.5(2～3)者恶性肿瘤的可能性大,且肿瘤细胞的恶性程度越高,倍增时间越短,肿瘤细胞生长越活跃,SUV也越高。现就PET在评价头颈部肿瘤放疗疗效方面的研究进展综述如下。一、18F FDG显像机理及其影响因素18F FDG是目前最常用的PET显像剂,其为葡萄糖类似物,通过细胞膜上的葡萄糖转运蛋白(Glut)转运至细胞内,经己糖激…     

18F-FDG PET显像对胰腺良恶性病变鉴别诊断的作用

目的探讨18F-脱氧葡萄糖(FDG) PET显像对胰腺良恶性病变鉴别诊断的价值.方法临床疑胰腺病变患者30例,其中胰腺恶性肿瘤20例胰腺癌15例,胰腺癌切除术后复发3例,低恶性胰岛细胞瘤、癌肉瘤各1例;胰腺良性病变10例,均为慢性胰腺炎,其中3例并假性囊肿形成.除8例慢性胰腺炎为临床、放射学随访3～12个月外,余均由组织病理学检查证实.静脉注射18F-FDG 222～296 MBq 1 h后行PET显像.测定肿瘤体积和标准摄取值(SUV),并与PET检查前2周内CT(25例)、MRI(8例)结果对照.结果 20例胰腺恶性肿瘤中19例肿瘤明显摄取18F-FDG,平均SUV 4.91±3.65.10例慢性胰腺炎中9例病灶轻度或无摄取18F-FDG,平均SUV 1.70±1.12(t=2.69,P=0.012).4例肿瘤病灶直径≤3 cm,SUV 2.75±0.63;6例3.1～5 cm,SUV 4.59±3.06;10例>5 cm,SUV 5.46±2.29(χ2=9.02,P=0.011).1例PET假阳性为慢性胰腺炎并假性囊肿,SUV 4.82;1例PET假阴性为胰头癌术后复发,病灶SUV 2.1.以SUV 2.5为胰腺良恶性病变的判断阈值,18F-FDG PET显像诊断胰腺癌灵敏度、特异性和准确性分别为95.0%、90.0%、93.3%,明显高于CT(75.0%、55.6%、68.0%,χ2=5.89,P=0.015).结论 18F-FDG PET显像诊断胰腺癌灵敏度、特异性较高,尤其适于胰腺癌术前分期和术后复发、转移的探查.     

13N-NH3 PET脑血流灌注显像诊断缺血性脑血管病变

目的探讨13N-NH3 PET脑血流灌注显像对缺血性脑血管病变的诊断价值.方法对5例健康志愿者,20例缺血性脑血管病变患者静脉注射13N-NH3 740～925 MBq,3～5 min后行T+E 二维方式脑血流灌注显像.图像分析采用视图分析和脑皮质标准摄取值(SUV)半定量分析,镜像比值法测量左/右两侧相应脑区SUV比值(SUV_r).其中9例短暂性脑缺血发作(TIA)行乙酰唑胺(ACZ)脑负荷试验,观察口服ACZ前后脑区影像、SUV和SUV_r变化.结果正常左/右脑区平均SUV_r为0.99±0.15,患侧/健侧(L/N)比值<0.85为稀疏区,<0.7为缺损区.13例TIA 13 N-NH3 PET显像示7例阳性,8例行MRI 2例阳性,6例行CT 1例阳性.7例TIA13N-NH3 PET显像阳性患者发现29个缺血灶,平均SUV 1.78±0.41,低于对照组(2.51±0.52,t=8.78,P<0.05).脑梗死(CI)患者共发现13个梗死灶,平均SUV 1.05±0.23,明显低于对照组和TIA组(t=5.9,P<0.001).9例ACZ脑负荷试验,缺血灶由静息29处增至35处,检出率提高17.1%;TIA阳性率由53.8%提高到62.5%;静息平均SUV_r为0.87±0.11,口服ACZ后减低至0.77±0.07(t=6.47,P<0.05).结论 13N-NH3PET脑灌注显像安全、无创伤性,灵敏度高且病灶定位准确.口服ACZ脑负荷试验安全、简便、可靠,对评价局部脑血流储备功能有重要价值.     

双时相PET显像在肺良恶性病变鉴别诊断中的应用

目的　评价双时相显像在肺部结节良恶性鉴别诊断中的应用价值。方法　对 3 2例肺癌患者和 15例肺良性病变患者进行1 8F 脱氧葡萄糖 (FDG)PET双时相显像 ,早期显像于注射FDG后40～ 65min ,延迟显像于注射后 1.5～ 2 .5h进行 ,测定两次显像病灶的标准摄取值 (SUV) ,并计算两次显像SUV变化率 (ΔSUV)。结果　肺癌组早期显像SUV为 4.3 2± 2 .5 9,延迟显像为 6.71± 4.2 6,ΔSUV为 ( 5 4.5 9± 2 8.96) %。而肺部良性病变早期显像SUV为 2 .83± 1.3 6,延迟显像为 3 .3 1± 1.95 ,ΔSUV为 ( 18.11± 2 5 .3 9) %。结论　双时相显像方法简便 ,在临床上具有一定的实用价值。肺恶性病变延迟显像SUV升高的幅度高于良性病变 ,但结核及炎性肉芽肿延迟显像SUV可增高     

18F-FDG PET显像诊断肾上腺肿瘤

目的　评价1 8F 脱氧葡萄糖 (FDG)PET显像对肾上腺肿瘤的诊断价值。方法　对 2 1例肾上腺肿瘤患者共 2 2个肾上腺病灶行1 8F FDGPET显像 ,对显像结果进行定性和半定量分析 ,并与CT和 (或 )MRI、针刺活组织检查、术后病理检查结果进行对比研究。结果　 9例肾上腺病灶处无明显FDG浓集 ,PET显像诊断为良性病变 ;12例病灶处FDG明显浓集 ,诊断为恶性病变。与病理检查结果比较 ,PET显像定性准确性为 10 0 % ,CT和 (或 )MRI为 6 4 %。良性病变与周围正常组织 (T N)放射性比值为 0 3～ 1 3,平均为 0 7,标准摄取值 (SUV)为 0 98～ 3 89,平均为 1 89;恶性病变T N比值为 3 1～15 1,平均为 6 9,SUV为 3 10～ 15 5 2 ,平均为 6 4 1,两组间差异均有显著性 (P均 <0 0 0 1)。病变性质与肿块大小无相关性。其中 4例PET显像发现了CT和 (或 )MRI未发现的局部淋巴结和远处转移灶12处。结论　1 8F FDGPET显像对肾上腺肿瘤定性诊断的准确性明显高于CT和 (或 )MRI。     

衰减校正在18F-FDG SPECT显像中的价值

目的评价衰减校正(AC)在18F-脱氧葡萄糖(FDG) SPECT显像中的临床价值.方法对病理检查证实的36例恶性肿瘤和4例良性肿物患者进行18F-FDG SPECT显像,进行迭代法重建AC和非衰减校正(NAC),并计算两者的肿瘤与本底比值(T/B).28例正常人进行了胸部18F-FDG SPECT显像.将左室心肌分为9个节段,用5分法(0正常;1分轻度减少;2分中度减少;3分明显减少;4分缺损)对AC与NAC图像的各心肌节段进行评分.结果 36例恶性肿瘤患者中34例AC与NAC均诊断为恶性,两者均检出55个病灶,2例(6%)AC与NAC均为假阴性,4例良性病变AC与NAC均为阴性.肺部肿瘤T/B在AC后增加(P<0.01),肺外肿瘤T/B AC后降低(P<0.05),不同部位肿瘤T/B在AC与NAC间呈显著正相关(P<0.01).AC对病变的解剖位置、周围组织受累情况及深部病变显示更加清晰.全部28例心肌显像者的左室前、后间壁,下、后壁在NAC影像均出现明显放射性衰减伪影,AC后显著改善(P<0.01);17例(60.7%)心尖、6例(21.4%)前壁心尖段放射性分布在AC后有轻度减低(P<0.01);AC后平均左室总分由NAC时的10.82±2.14下降为3.64±2.23(P<0.01).结论 AC虽未能增加肿瘤检出率,但可更清晰地显示肿瘤的位置、范围以及深部病灶,并可显著改善心肌衰减伪影,具有一定的临床价值.     

18F-FDG PET显像在胃恶性肿瘤治疗后随访中的应用

目的评价18F-脱氧葡萄糖(FDG)PET显像在胃恶性肿瘤治疗后随访中的价值.方法回顾性分析1999年1月～2004年11月做18F-FDG PET检查的52例经病理检查确诊为胃恶性肿瘤的PET图像,其中49例患者有同期CT检查结果.PET显像结果均由病理或临床及其他影像学检查随访证实.结果①23例患者治疗后胃局部18F-FDG摄取增高,其中9例证实有肿瘤残余或局部复发,标准摄取值(SUV)为4.24±2.98.14例为生理性摄取或胃炎、吻合口炎、胃动力异常等良性摄取,SUV 2.72±0.62.两组比较差异有显著性(t=1.87,P＜0.05).②对转移灶的检出,18F-FDG PET显像和CT检查的灵敏度分别为90.0%(27/30例)、50.0%(15/30例),两者差异有显著性(X2=11.43,P＜0.005).PET显像9例与CT检查结果相符;6例PET发现的病灶多于CT;10例PET发现转移灶而CT未见异常,其中2例B超检查阳性而CT检查阴性,PET显像证实了B超所见;2例PET否定了CT提示的转移灶,但发现其他部位转移.5例仅血清肿瘤标志物水平升高,其他检查阴性,而PET显像发现转移灶.25例PET显像未发现转移灶者中有3例假阴性.结论18F-FDGPET显像对胃肿瘤治疗后残余或复发及转移灶检出率高于其他影像学检查,但特异性差.     

18F-FDG PET-CT显像在肺癌诊断分期与定位中应用的初步研究

目的 :探讨18F 脱氧葡萄糖 (FDG)进行正电子发射计算机扫描与CT扫描融合显像 (PET CT)对肺癌诊断、定位与分期的价值。方法 :对经临床或其他显像等相关方法证实的 2 6例患者进行18F FDGPET CT显像 ,其中肺恶性病变 15例 ;良性病变 11例 (肺结核 6例 ,肺炎 5例 )。分析其CT影像学特点 ,包括病灶大小、形态、密度、CT值、与周围组织的关系。利用CT对PET进行衰减校正 ,并对相应位置PET影像的代谢情况分析 ,测定其标准摄取值SUV值。对良、恶性病变的SUV值进行比较。通过CT与PET图像融合 ,对病灶进行准确地诊断与定位。结果 :15例恶性肿瘤中 14例PET CT阳性 ,其中纵膈淋巴结转移者 6例 ,最小淋巴结大小为 0 .7cm× 0 .5cm ,骨转移者 3例。 11例良性肺显像中 8例为阴性 ,3例放射性摄取轻度增高。结论 :18F FDGPET CT显像对肺良、恶性病变的诊断有一定的临床价值 ,对病灶的形态学特点及准确定位更为突出。     

肺部病变18F-FDG PET显像的适应证

目的探讨18F-脱氧葡萄糖(FDG) PET显像鉴别诊断肺部病变良恶性的适应证.方法 86例患者先行X线胸片和CT检查,然后行胸部或全身PET检查,依据病灶形态、代谢水平[标准摄取值(SUV)]、有无肺外病灶等指标鉴别病变的良恶性.结果 6例肺不张和4例胸腔积液患者中,18F-FDG PET显像发现有隐匿性肿瘤灶7例,并区分出3例良性病变,鉴别准确性为100%.7例炎症和7例结核,FDG PET正确识别4例治疗后未见明显变化的肿瘤灶,区分7例良性病变,鉴别准确性分别为85.7%和71.4%.46例可疑肺癌但放射学征象不典型者,FDG PET正确鉴别41例,准确性89.1%.16例有典型肺癌放射学表现者FDG PET判断为恶性15例,并鉴别出1例良性病变.5例FDG PET假阳性者为肺结核2例、炎症1例和结节病2例;3例假阴性为腺癌1例和小细胞肺癌2例.结论未见肿块影的肺不张或胸腔积液、正规治疗后无明显变化的炎症或结核及可疑肺癌但放射学征象不典型肺结节者应行18F-FDG PET显像.     

成批煤气爆燃烧伤的救治体会

报道治疗因煤气泄漏爆炸烧伤病员7例，经应用MEBT技术积极救治，其中6例于伤后17天痊愈出院，另一例特重伤员也于伤后30天康复出院。作者认为：应严格按照MEBT／MEBO要求进行规范治疗，正确处理生命体征、休克、感染、脏器功能和创面的辨证关系。同时，不能忽视外科营养在过程中的重要作用，它是创面修复的物质保证。     

Glutamine supplementation in vitro and in vivo,in exercise and in immunodepression

In situations of stress, such as clinical trauma, starvation or prolonged, strenuous exercise, the concentration of glutamine in the blood is decreased, often substantially. In endurance athletes this decrease occurs concomitantly with relatively transient immunodepression. Glutamine is used as a fuel by some cells of the immune system. Provision of glutamine or a glutamine precursor, such as branched chain amino acids, has been seen to have a beneficial effect on gut function, on morbidity and mortality, and on some aspects of immune cell function in clinical studies. It has also been seen to decrease the self-reported incidence of illness in endurance athletes. So far, there is no firm evidence as to precisely which aspect of the immune system is affected by glutamine feeding during the transient immunodepression that occurs after prolonged, strenuous exercise. However, there is increasing evidence that neutrophils may be implicated. Other aspects of glutamine and glutamine supplementation are also addressed.     

Sex differences in neuromuscular fatigability in response to load carriage in the field in British Army recruits

Objectives

Women are resistant to neuromuscular fatigue compared to men in response to a range of exercise tasks. The sex differences in the neuromuscular responses to load carriage have yet to be investigated.

新疆石河子地区奶牛隐性乳房炎的调查与分析

采用LMT法对新疆石河子地区三个规模化奶牛场泌乳牛群进行了隐性乳房炎检测,共检测994头泌乳牛3976个乳区.结果表明:奶牛隐性乳房炎阳性率为81.9%,乳区阳性率为49.1%.数据分析表明,不同年龄、胎次以及有无卧床奶牛的隐性乳房炎阳性率差异显著(P<0.05),后乳区的隐性乳房炎感染率显著高于前乳区感染率(P<0.05),隐性乳房炎乳区发生数也明显影响当日产奶量(P<0.05).     

Decrease in eccentric hamstring strength in runners in the Tirol Speed Marathon

Background

The local muscular endurance of knee flexors, during eccentric work in particular, is important in preventing or delaying kinematic changes associated with fatigue during treadmill running. This result, however, may not be transferable to overground running.

Objective

To test the hypothesis that overground running is associated with eccentric hamstring fatigue.

Methods

Thirteen runners (12 male and one female) performed an isokinetic muscle test three to four days before and 18 hours after a marathon. Both legs were tested. The testing protocol consisted of concentric and eccentric quadriceps and hamstring contractions.

Results

There were no significant differences between peak torque before and after the race, except that eccentric peak hamstring torque (both thighs) was reduced.

Conclusion

Overground running (running a marathon) is associated with eccentric hamstring fatigue. Eccentric hamstring fatigue may be a potential risk factor for knee and soft tissue injuries during running. Eccentric hamstring training should therefore be introduced as an integral part of the training programme of runners.     

Oxalosis in primary hyperoxaluria in infancy

Primary hyperoxaluria (PH1) is a rare inborn autosomal recessive metabolic disorder due to the deficiency of hepatic alanine-glyoxylate-aminotransferase. This deficiency results in excessive synthesis and urinary excretion of oxalate, inducing renal stone formation and deposition of calcium oxalate in the kidney, bone, myocardium, and vessels (systemic oxalosis, SO) in the most severely affected individuals. We report renal and skeletal changes in a 3-month-old girl with PH1 and SO. Intense cortico-medullary hyperechogenicity and increased homogeneous radiopacity of normal-sized kidneys suggested the diagnosis of SO. Skeletal survey showed osteopenia and characteristic symmetrical metaphyseal transverse bands in long bones, progressively becoming more dense and migrating towards the diaphysis. Multiple pathological and slowly healing fractures of the limbs occurred at the dense band level. A radiopaque rim was then observed in flat bones, epiphyseal nuclei, and vertebral bodies. Inflammatory granulomatous reaction, induced by the presence of oxalate crystals in the marrow spaces, coexisted with progressively evident radiological signs of secondary hyperparathyroidism, with partially overlapping features. The patient was treated by peritoneal dialysis and hemodialysis until combined liver–kidney transplantation. There are no previous reports of infants treated with hemodialysis for more than 2 years.     

肺心病慢性呼吸性酸中毒合并代谢性酸碱失衡判断方法探讨(附80例次血气分析)

目的：对42例肺心病慢性呼吸性酸中毒患者的80例次血气测定结果。方法：用不同的酸碱图（卡）及代偿公式进行酸碱类型的初步差别分析。结果：结合临床表现、各种影响因素与治疗反应等作出综合判定。结论：比较二种判定的差异，并提出较为实用、可靠的判断建议，以助于复合型呼吸性酸碱失衡的临床诊断与处理。     

Interventional radiology in oncology in private practice

Interventional oncology in private practice requires expert training and can be performed in a stand-alone facility for type 1 procedures in a hospital setting for type 2 and 3 procedures where subspecialized radiologists, state-of-the-art equipment, and postprocedure hospital monitoring are available. A multidisciplinary effort with oncologists, internal medicine physicians and anesthesiologists is necessary. The practice of interventional oncology requires around the clock availability, meticulous and established protocols and procedures and a financial investment. On the other hand, it is professionally gratifying because of constant technical advances and the impact on patients.     

胎龄和日龄对新生儿局部脑血流的影响

目的探讨胎龄及日龄对新生儿局部脑血流(rCBF)变化的影响及规律.方法对早产儿组、足月早期新生儿组、足月晚期新生儿组进行99Tcm-双半胱乙酯(ECD)SPECT脑血流灌注断层显像,并作半定量分析和读片分析.结果早产儿组原始感觉运动区和枕叶rCBF低于足月早期新生儿组(P<0.05),显著低于足月晚期新生儿组(P<0.01),其额叶中份、顶叶rCBF也低于足月晚期新生儿组(P<0.05),其余各叶皮质rCBF随胎龄和日龄的增大有增加趋势.早产儿组脑血流显像图与足月早期新生儿组和晚期新生儿组比较有明显差异.结论早产儿与足月儿rCBF的变化可能与新生儿大脑皮质相应区域发育成熟度和时间顺序有关.