Comparison of 99mTc-DTPA renal dynamic imaging with modified MDRD equation for glomerular filtration rate estimation in Chinese patients in different stages of chronic kidney disease.

BACKGROUND: The renal dynamic imaging method (modified Gate's method) with (99m)Tc-diethylene triamine pentaacetic acid ((99m)Tc-DTPA) is simple and less time consuming for glomerular filtration rate (GFR) estimation than other methods. However, its diagnostic performance as a surrogate marker of GFR is questioned increasingly. Recently, the modified Modification of Diet in Renal Disease (MDRD) study equation based on data from Chinese patients of chronic kidney disease (CKD) showed significant performance improvement. In the present study, the renal dynamic imaging methods and the modified abbreviated MDRD equation were compared with the plasma clearance method. METHODS: Four hundred and eighty two patients with CKD were selected. GFR were estimated simultaneously using three methods: (i) modified Gate's method (gGFR); (ii) the modified abbreviated MDRD equation (c-aGFR) and (iii) dual plasma sampling method (rGFR). Using rGFR as the reference method, gGFR and c-aGFR were compared with rGFR in each stage of CKD. RESULTS: Both gGFR and c-aGFR were correlated well with rGFR (r(gGFR) = 0.81 and r(c-aGFR) = 0.90, P < 0.001). In the overall performance, c-aGFR had less bias (849.5 vs 933.1 arbitrary units), higher precision (57 vs 78.4 ml/min/1.73 m(2)) and higher accuracy than gGFR. For gGFR, the 15, 30 and 50% accuracies were 32.4, 56.0 and 79.1%, respectively; for c-aGFR, the corresponding accuracy rose to 43.2%, 75.5% and 90.9%, respectively. In each stage of CKD, the modified abbreviated MDRD equation also outperformed the modified Gate's method in the GFR estimation. CONCLUSION: Our results indicated that the performance of the renal dynamic imaging in total GFR estimation was not better than the modified abbreviated MDRD equation in our patient group, and should not be used as a surrogate marker of GFR, especially in clinical trials. We presume that the dynamic renal imaging methods for estimation of GFR can be improved by using proper reference GFR, more adequate background subtraction and soft-tissue attenuation correction, in a relatively larger sample size.     

膝十字韧带移植重建术中韧带末端缝合固定强度的生物力学测试

目的测试Krackow双锁边缝合法缝合固定韧带末端的强度,探讨膝十字韧带移植重建术中韧带末端缝合固定方法及固定强度。方法将24条髌韧带分为3组,对其末端分别采用Krackow双锁边缝合法缝合2针、3针以及Ethilon缝线、0.4mm直径钢丝两种缝合材料,分别进行拉伸力学检测以比较强度,探讨最佳的缝合针数和方法。结果Krackow双锁边缝合法缝合2针,固定强度超过钢丝材料强度,1号Ethilon缝线缝合两针,其强度达到80N以上,超过缝线材料强度,将第一针贯穿韧带缝合,不降低固定强度。Krackow双锁边缝合法缝合2针或3针的固定强度差异无显著性意义,第一针贯穿韧带,可减少缝线裸露但不降低固定强度,均超过缝合材料强度。结论若想增加固定强度应从改进缝合材料强度和增加缝线数目着手。     

Advances in the research of plant-derived natural products against retinoblastoma

Retinoblastoma (RB) is a highly aggressive ocular tumor, and due to socioeconomic and medical constraints, many children receive treatment only in the metaphase and advanced clinical stages, resulting in high rates of blindness and disability. Although several approaches exist in the treatment of RB, some children with the disease do not have satisfactory results because of various factors. Plant-derived natural products have shown definite therapeutic effects in the treatment of various tumors and are also widely used in the study of RB. We review plant-derived natural products used in the study of anti-RB to provide ideas for the clinical application of these drugs and the development of new therapeutic drugs.     

Clinical Study of TCM-WM on Aplastic Anemia Complicated with Hepatitis C

ＣｌｉｎｉｃａｌＳｔｕｄｙｏｆＴＣＭ－ＷＭｏｎＡｐｌａｓｔｉｃＡｎｅｍｉａＣｏｍｐｌｉｃａｔｅｄｗｉｔｈＨｅｐａｔｉｔｉｓＣＬＩＵＱｉｎｓ－ｃｈｉ（刘清池）；ＺＨＥＮＧＢｏ－ｒｏｎｇ（郑博荣）；ＺＨＡＮＧＣｈｕｎ－ｌｉ（张春丽）；ＬＩＵＳｕ－ｐｉｎｇ...     

Prediction of two-sample99mTc-diethylene triamine pentaacetic acid plasma clearance from single-sample method

OBJECTIVES: To develop an equation to predict dual plasma sample method (DPSM) (99m)Tc-diethylene triamine pentaacetic acid ((99m)Tc-DTPA) plasma clearance from single plasma sample method (SPSM), and to clarify the condition in which DPSM can be substituted by SPSM in measurement of glomerular filtration rate (GFR). METHODS: Patients with chronic kidney disease (CKD) were selected. Watson modified Christensen and Groth equation was used to calculate (99m)Tc-DTPA plasma clearance by SPSM (sGFR). The equation recommended by the Nephrourology Committee of the Society of Nuclear Medicine was used to calculate (99m)Tc-DTPA plasma clearance by DPSM (tGFR) in each patient. The difference between sGFR and tGFR was expressed as percent of the average of these two methods, and tGFR was predicted from sGFR. Plasma creatinine was measured by the kinetic picrate method, and GFR estimated by abbreviated modification of diet in renal disease (MDRD) equation (aGFR) and Cockcroft-Gault equation (cGFR) were evaluated as criteria in selection of DPSM and SPSM. RESULTS: Three hundred and sixty-nine patients with CKD were selected (208 male and 161 female). The average age and body weight were 51.4 +/- 15.5 years and 67.2 +/- 12.5 kg, respectively. The causes of CKD were glomerular disease, renal arterial stenosis, chronic tubulointerstitial disease, and other causes or causes unknown. The average tGFR was 62.9 +/- 36.5 ml/min/1.73 m2, ranging from 1-180 ml/min/1.73 m2. sGFR was significantly correlated with tGFR (r = 0.9194, p < 0.001), but widely scattered when tGFR <30 ml/min/1.73 m2; in contrast, then tGFR was > or =30 ml/min/1.73 m2, the difference was constant (-1.1%, 95% confidence interval -18.3%, 16.1%), and tGFR could be predicted from sGFR using the equation: predicted tGFR (ml/min/1.73 m2) = 7.4244 + 0.7318 x sGFR + 0.0022 x sGFR2 (n = 299, r2 = 0.9428, p < 0.001), and the difference decreased to 0.1%, 95% confidence interval (-15.8%, 16.0%). aGFR was better than cGFR in diagnosis of tGFR <30 ml/min/1.73 m2, the diagnostic sensitivity of a cut off value of aGFR = 45 ml/min/1.73 m2 was 91.8%, and recommended as a criterion in the selection of DPSM and SPSM. CONCLUSION: When GFR > or =30 ml/min/1.73 m2, tGFR can be predicted from sGFR, which will simplify the reference GFR measurement in clinical trials. sGFR becomes widely scattered when tGFR is less than 30 ml/min/1.73 m2. To obtain reliable reference GFR values, it is recommended that DPSM be used in clinical trials when aGFR is less than 45 ml/min/1.73 m2.     

99m锝标记的二巯基丁二酸检测口腔癌颈淋巴结转移的研究

目的 探讨5价99m锝标记的二巯基丁二酸(99mTc(V)-dimercaptosuccinic acid，99mTc(V)-DMSA)寻找口腔癌颈部淋巴结转移灶的可行性，为制定合理的口腔癌颈淋巴清扫术式提供参考。方法 原发口腔鳞状细胞癌32例，行99mTc(V)-DMSA头颈部单光子发射型计算机断层(single photon emission computer tomography，SPECT)显像，寻找异常放射浓聚区域，将结果和术后病理比较。假阳性患者的淋巴结行半连续病理切片观察。结果 99mTc(V)-DMSA SPECT寻找颈部淋巴结转移灶的灵敏度为75．0％(9／12)，特异性为90．0％(18／20)，准确度为84．4％(27／32)。9例颈部有异常放射性浓聚的患者感兴趣区放射性摄取值：患侧147．4～627．8，平均387．6；健侧12．56～458．4，平均235．48，配对t检验，t=8．128，P=0．00004。假阳性患者淋巴结半连续病理切片未发现癌转移。结论 99mTc(V)-DMSA对头颈部恶性肿瘤和转移的淋巴结有较高的亲和性，其检测颈淋巴结转移准确度高，可检出颈部隐性转移的淋巴结，为制定颈淋巴清扫术提供参考。