Prognostic value of postoperative stimulated thyroglobulin levels on 131Ⅰ ablation therapy in papillary thyroid cancer

Objective Stimulated thyroglobulin (Tg) levels postablation was associated with disease recurrence in papillary thyroid cancer (PTC). The aim of this study was to evaluate the prognostic value of postoperative stimulated Tg level on future Tg positivity after 131Ⅰ ablation therapy in PTC. Methods One hundred and thirty-eight patients (28 men, 110 women; age range 6-70 years, mean age 39.4 years) with PTC were included in this study. All patients underwent total or near-total thyroidectomy, and 102 of these patients had lymphadenectomy. All patients had a documented PTC. 131Ⅰ ablation was performed in 3- 4 weeks after thyroidectomy. Sera levels of thyroid hormones (FT3, FT4), thyrotropin (TSH), anti-Tg anti-body (TgAb), and Tg were measured before and after 131Ⅰ ablation. Statistical analysis was performed with SPSS 13.0 software, and correlation anaysis and t-test were used. Results Postoperative stimulated Tg lev-el had a significantly positive association with pestablation stimulated Tg level (r = 0. 960, P < 0.01). Postoperative stimulated Tg level in positive postablation Tg group was significantly higher than that in nega-tive pestablation Tg group [(199.8±327.7) μg/L vs (3.5±5.6) μg/L, t =5. 567, P <0.01]. About 76% (78/102) patients had evidence of metastatic cervical lymph nodes on routine histological testing. And 41% (446/1088) resected lymph nodes were histologically positive for metastatic disease. The number of metastatic lymph nodes resected had a significantly positive relationship with stimulated Tg at pestopera-tion and postablation (r = 0. 697, 0. 633, both P < 0.01). Conclusions Postoperative stimulated Tg level was of better prognostic value on stimulated Tg level after 131Ⅰ ablation therapy. Total or near-total thyroidec-tomy simultaneously conjugated with lymphadenectomy might have a better result in lower postablation stimu-lated Tg pesitivity in patients with PTC.     

99Tcm-HYNIC-Annexin V的制备及其在健康小鼠体内的分布

目的制备人膜联蛋白V（Annexin V），应用联肼尼克酰胺（HYNIC）偶联后进行^99Tc^m标记，评价^99Tc^m-HYNIC-Annexin V在健康小鼠体内的分布。方法采用基因工程方法构建Annexin V的原核载体并诱导其表达，与自行合成的双功能螯合剂HYNIC偶联，并进行^99Tc^m标记。测定^99Tc^m-HYNIC-Annexin V的标记率、放化纯，并研究其在健康小鼠体内的生物分布特性。结果Annexin V在大肠杆菌中获得稳定表达，经十二烷基硫酸钠聚丙烯酰胺凝胶电泳（SDS-PAGE）及Western Blotting检测，得到纯度较高的蛋白质。Annexin V经HYNIC偶联后，其^99Tc^m标记率可达90％左右，放化纯〉90％。小鼠体内分布结果表明，^99Tc^m-HYNIC-Annexin V血液清除迅速，主要从肾脏和肝脏排泄。结论Annexin V可在原核生物中稳定表达。其与HYNIC偶联后，^99Tc^m-标记率和放化纯较高，方法简单，条件温和。     

Prognostic value of postoperative stimulated thyroglobulin levels on 131Ⅰ ablation therapy in papillary thyroid cancer

Objective Stimulated thyroglobulin (Tg) levels postablation was associated with disease recurrence in papillary thyroid cancer (PTC). The aim of this study was to evaluate the prognostic value of postoperative stimulated Tg level on future Tg positivity after 131Ⅰ ablation therapy in PTC. Methods One hundred and thirty-eight patients (28 men, 110 women; age range 6-70 years, mean age 39.4 years) with PTC were included in this study. All patients underwent total or near-total thyroidectomy, and 102 of these patients had lymphadenectomy. All patients had a documented PTC. 131Ⅰ ablation was performed in 3- 4 weeks after thyroidectomy. Sera levels of thyroid hormones (FT3, FT4), thyrotropin (TSH), anti-Tg anti-body (TgAb), and Tg were measured before and after 131Ⅰ ablation. Statistical analysis was performed with SPSS 13.0 software, and correlation anaysis and t-test were used. Results Postoperative stimulated Tg lev-el had a significantly positive association with pestablation stimulated Tg level (r = 0. 960, P < 0.01). Postoperative stimulated Tg level in positive postablation Tg group was significantly higher than that in nega-tive pestablation Tg group [(199.8±327.7) μg/L vs (3.5±5.6) μg/L, t =5. 567, P <0.01]. About 76% (78/102) patients had evidence of metastatic cervical lymph nodes on routine histological testing. And 41% (446/1088) resected lymph nodes were histologically positive for metastatic disease. The number of metastatic lymph nodes resected had a significantly positive relationship with stimulated Tg at pestopera-tion and postablation (r = 0. 697, 0. 633, both P < 0.01). Conclusions Postoperative stimulated Tg level was of better prognostic value on stimulated Tg level after 131Ⅰ ablation therapy. Total or near-total thyroidec-tomy simultaneously conjugated with lymphadenectomy might have a better result in lower postablation stimu-lated Tg pesitivity in patients with PTC.     

核素显像鉴别颈前区包块来源的临床价值

目的:回顾分析甲状腺核素显像在颈前区包块鉴别诊断中的临床价值。方法:对69例耳鼻咽喉科门诊首诊发现颈前区来源不明包块的患者行过锝酸盐(99mTcO4-)显像,根据结果选择行99mTc-甲氧基异丁基异腈(99mTc-MIBI)肿瘤阳性显像和甲状腺灌注显像。显像结果结合随访及病理诊断结果进行分析。结果:69例中33例(47.8%)包块位于甲状腺内,36例(52.2%)包块位于甲状腺外。甲状腺包块中发现亚急性甲状腺炎12例,2例临床诊断为甲状舌管囊肿者发现为异位甲状腺;甲状腺外包块中甲状舌管囊肿27例。结论:甲状腺包块的99mTcO4-、99mTc-MIBI阳性显像及血流灌注显像对于鉴别诊断颈前区病变是否来源于甲状腺及甲状舌管囊肿与异位甲状腺的鉴别具有良好的应用价值。     

人膜联蛋白Ⅴ的表达及核素标记

目的 构建人膜联蛋白Ⅴ（Annexin Ⅴ）表达载体并诱导其表达．应用双功能螫合剂联肼尼克酰胺（HYNIC）偶联后应用核素^99mTc标记。方法PCR扩增含Annexin Ⅴ编码基因序列．将扩增产物克隆至His融合表达载体pET-28a（＋）．以异丙基硫代-β-D-半乳糖苷（IPTG）诱导His融合Annexin Ⅴ的表达．应用Ni-NTA Superflow纯化并经测序、SDS-PAGE及Western blot确证。表达的蛋白通过HYNIC偶联后进行^99mTc标记，考察标记物的特性。结果琼脂糖凝胶电泳示PCR扩增产物碱基数量与目的片段大小一致。对重组质粒的分析表明，插入片段的序列与发表的Annexin Ⅴ基因编码序列一致。在IPTG诱导下．经Western blot及SDS-PAGE证实，重组大肠埃希菌DH5α高效表达分子母约36kD的目的产物。…99mTc-HYNIC-Annexin Ⅴ标记率及放化纯均达到90％以上，稳定性在6h以上．可以满足核素显像的要求。结论 人Annexin Ⅴ编码序列已被克隆至His融合表达载体pET-28a（＋）上．并在大肠埃希菌DH5α中高败、大量表达。经HYNIC偶联后^99mTc标记．可以得到较高的标记率和放化纯。^99mTc-HYNIC-Annexin Ⅴ有望成为一种行良好临床应用前景的凋亡显像剂。     

临床常见诊疗错误汇编(28)

患儿男,12岁,因发热,右髂窝疼痛,走路困难1周入院。检查:体温38.5℃,右髂窝部红、肿、触痛明显,有波动感,右侧托马氏征阳性。诊断为右髂     

四聚乙醛现场杀灭钉螺效果的观察

四聚乙醛现场杀灭钉螺效果的观察施越云，曹国祥，蒋怀育，宣旭辉，徐兴国，周望恒，施长嵩，花友香江苏省东台市血地防办公室东台２２４２００江苏省东台市卫生防疫站东台市六灶乡卫生院四聚乙醛是一种杀灭钉螺的新药．我们在六灶乡进行了现场试验观察．结果如下：ｌ材料...     

局麻小切口血肿清除术治疗高血压性脑出血

近两年来我院采用局麻小切口血肿清除术治疗高血压性脑出血22例,取得较好效果,报告如下。临床资料一般资料:本组22例高血压脑出血,男12例,女10例,年龄36～79岁。既往均有高血压史1～15年。临床表现:急性起病19例,缓慢发病3例。发病时头痛、呕吐21例,失语9例,二便失禁6例,抽搐3例,面瘫9例,半身瘫22例,其中肌力0级15例,Ⅰ～Ⅱ级6例,Ⅲ～Ⅳ级1例,Babinsk′s 征( )22例,入院时收缩压16～28kPa,其中16～20kPa1例,     

Gates’分析法测定肾小球滤过率的影响因素研究

目的:探讨Gates’分析法测定肾小球滤过率(GFR)过程中的影响因素。方法:针对γ照相机或SPECT测定GFR中常见的影响因素,在规范操作的基础上人为改变某些因素,观察其对GFR值的影响。结果:身高值变化会引起GFR值反向的差异性变化,而体重值变化,GFR值出现同向的变化(P<0.01);注射前后注射器测量条件不一致,可影响结果的准确性:注射器放置的几何学位置会引起GFR值的偏差,尤其是注射后用错注射器进行测量,GFR值会出现明显的误差(P<0.01);注射时显像剂血管外渗漏,导致进入体内净计数的减低,会造成GFR值增高;图像处理时本底感兴趣区(ROI)位置对结果影响较大,其中位于外上方或内下方,所得GFR值明显降低(P<0.01)。结论:在用Gates’分析法测定GFR值的整个过程中,有诸多因素可影响到最终结果,尤其是药物注射的质量和本底ROI的选择,对GFR的测定值有着明显的影响,规范的操作才能获得较为准确可信的GFR值。