蛋白质组学——军事医学发展的新前沿

蛋白质组学是生物医学研究的热点,具有大规模、高通量的特点和优势,有利于推动军事医学的基础创新,有利于建立以发现为驱动创新研究模式,有利于完成新时期的特殊军事任务.以军事医学项目为牵引,通过军民结合,充分利用我国蛋白质组学研究已有的良好学术、技术、人才基础,将有助于解决新时期的军事医学新课题,推动军事医学的全面变革,打造军事医学发展的新前沿.     

A new frontier of blood imaging using susceptibility effect and tailored RF pulses.

In MRI, image contrast can be controlled by use of the susceptibility effect if an object contains paramagnetic substances. The localized linear gradient dephases spins in the voxel, leading to phase cancellation and thus reduced signal. This signal void phenomenon, can be exploited if the intrinsic linear gradient is either enhanced or compensated by externally applied RF generated phase distributions. In this paper, a new concept which utilizes the susceptibility effect through the use of tailored RF pulses is proposed. As potential applications of the method, two different types of tailored RF pulses are introduced: one for the enhancement of the susceptibility effect and the other for the correction of the susceptibility artifact, respectively. The former, for example, can be applied to angiography utilizing the paramagnetic property of deoxygenated blood, suggesting a new avenue for the angiography which, for the first time, is not based on flow, although the method is currently limited to imaging of venous blood or venography. Both a theoretical study of the method and experimental results are reported.     

A new diagnostic method of spondylodiscitis. Magnetic resonance imaging

Twenty four patients who were hospitalized for a suspicion of spondylodiscitis were prospectively evaluated with magnetic resonance imaging (MRI), radiology and radionuclide studies. Fifteen patients had an infectious spondylodiscitis, four had a vertebral degenerative disease, four had a rheumaticus spondylodiscitis, one had a chemical spondylodiscitis. The microbiological examinations and the clinical development bore the diagnosis out. Seven patients underwent Indium 111 scanning. The results of this scanning were correlated with MRI results. The MRI was performed with a 0.35 T whole body superconducting unit using spin echo technique. All patients were studied in the sagittal plane with two pulse sequences and more often with a surface-coil: TR 500 msec./TE 28 msec. and TR 2,000 msec./TE 60 msec. In all cases of true infectious spondylodiscitis the MRI results finding were characteristics. On the image obtained with the TR 500 msec./TE 28 msec., there was a confluent decreased signal intensity from the vertebral bodies and the intervertebral disk space. On the image obtained with TR 2,000 msec./TE 60 msec. there was an increased signal intensity from the vertebral bodies and the intervertebral disk space. The other spondylodiscitis have given a different MRI imaging, it was a confluent decreased signal intensity from the vertebral bodies and the intervertebral disk space on the twice pulse sequences. different images were obtained during the evolution of the infectious: first we observed a modification of the vertebral signal then the typical image that we described then a normal signal of the vertebral bodies with a pathological signal from the intervertebral disk space at last a degenerative intervertebral disk.(ABSTRACT TRUNCATED AT 250 WORDS)     

Diffusion-weighted magnetic resonance imaging: new perspectives in the diagnostic pathway of non-complicated acute pyelonephritis

Objectives

The diagnosis of acute pyelonephritis (APN) requires demonstration of parenchymal involvement. When no predisposing conditions are found, non-complicated APN is suspected and CT or MRI should be performed. Diffusion-weighted (DW) MRI might be useful, quicker and cheaper than the standard gadolinium-enhanced (GE) MRI. The aim of this study is to compare DW-MRI with GE-MRI to test its diagnostic accuracy in APN.

Methods

Of 318 consecutive patients hospitalised for APN, 279 underwent MRI. Four hundred and fourteen MR studies (first test and follow-up examinations) were gathered and data were processed using Diffusion Analysis software. DW-MRI has been compared with GE-MRI for evaluating diagnostic agreement.

Results

Two hundred and forty-four patients were diagnosed as having APN; 35 were negative. One hundred and sixty-three APN cases were considered non-complicated and selected for the study. Among the 414 MR examinations, comparing DW-MRI with GE-MRI, positive correlation was found in 258 cases, negative in 133. There were 14 false-negatives and 9 false-positives. DW-MRI achieved sensitivity 95.2 %, specificity 94.9 %, positive predictive value 96.9 %, negative predictive value 92.3 % and accuracy 94.6 %.

Conclusions

DW-MRI is reliable for diagnosing non-complicated APN. The high diagnostic agreement between DW-MRI and GE-MRI offers new perspectives in diagnostic management, enabling diagnosis of non-complicated APN without using ionising radiation or contrast media.

Key Points

? The diagnosis of acute pyelonephritis (APN) requires demonstration of renal involvement. ? Hitherto magnetic resonance imaging required gadolinium enhancement (GE-MRI) to establish this diagnosis. ? But diagnostic agreement between diffusion-weighted and GE-MRI offers new diagnostic opportunities. ? Quantification of ADC values can help diagnose and monitor APN. ? DW-MRI avoids ionising radiation and paramagnetic contrast medium administration.     

Impact of new diagnostic imaging methods on pancreatic angiography.

The results of 100 consecutive pancreatic arteriograms performed in concert with a combination of other diagnostic procedures (gray scale ultrasonography, computed tomography, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography) were evaluated to determine the value of angiography in diagnosis and management of patients with known or suspected pancreatic disease. Angiography was found to be valuable for diagnosis in 68% (68/100) of cases and was considered helpful for management in 81% (57/70) of patients with pancreatic neoplasm, pancreatitis, or a nonpancreatic abnormality.     

Pediatric bone imaging: diagnostic imaging of osteoid osteoma

OBJECTIVE: Osteoid osteomas are benign painful skeletal neoplasms that preferentially afflict young male patients and are readily treatable. This article focuses on the various imaging manifestations of the tumor, while also discussing its clinical presentation, pathogenesis, and treatment. CONCLUSION: Knowledge of the common imaging features of osteoid osteomas will improve our diagnosis of this condition, subsequently facilitating treatment and reducing morbidity.     

Molecular imaging of rheumatoid arthritis by radiolabelled monoclonal antibodies: new imaging strategies to guide molecular therapies

The closing of the last century opened a wide variety of approaches for inflammation imaging and treatment of patients with rheumatoid arthritis (RA). The introduction of biological therapies for the management of RA started a revolution in the therapeutic armamentarium with the development of several novel monoclonal antibodies (mAbs), which can be murine, chimeric, humanised and fully human antibodies. Monoclonal antibodies specifically bind to their target, which could be adhesion molecules, activation markers, antigens or receptors, to interfere with specific inflammation pathways at the molecular level, leading to immune-modulation of the underlying pathogenic process. These new generation of mAbs can also be radiolabelled by using direct or indirect method, with a variety of nuclides, depending upon the specific diagnostic application. For studying rheumatoid arthritis patients, several monoclonal antibodies and their fragments, including anti-TNF-α, anti-CD20, anti-CD3, anti-CD4 and anti-E-selectin antibody, have been radiolabelled mainly with ^99mTc or ¹¹¹In. Scintigraphy with these radiolabelled antibodies may offer an exciting possibility for the study of RA patients and holds two types of information: (1) it allows better staging of the disease and diagnosis of the state of activity by early detection of inflamed joints that might be difficult to assess; (2) it might provide a possibility to perform ‘evidence-based biological therapy’ of arthritis with a view to assessing whether an antibody will localise in an inflamed joint before using the same unlabelled antibody therapeutically. This might prove particularly important for the selection of patients to be treated since biological therapies can be associated with severe side-effects and are considerably expensive. This article reviews the use of radiolabelled mAbs in the study of RA with particular emphasis on the use of different radiolabelled monoclonal antibodies for therapy decision-making and follow-up.