18FDG-PET/MR观察宫颈鳞状细胞癌ADC值与SUV的相关性

目的 应用¹⁸FDG-PET/MR一体机观察宫颈鳞状细胞癌ADC值与FDG-PET标准化摄取值（SUV）的相关性。方法 对30例宫颈鳞状细胞癌患者行盆腔PET/MR检查。采用随机自带软件,利用轴位像对PET图像、ADC图及T2WI进行自动配准,并在同一层面勾画ROI,测量感兴趣体积（VOI）内肿瘤最大SUV（SUV_max）和平均SUV（SUV_mean）、最小ADC值（ADC_min）和平均ADC值（ADC_mean）。结果 30例宫颈鳞状细胞癌的ADC_min与SUV_max、ADC_min与SUV_mean、ADC_mean与SUV_max、ADC_mean与SUV_mean均无明显相关性;中-高分化和低分化宫颈鳞状细胞癌的上述ADC和SUV指标间亦无明显相关性。中-高分化与低分化宫颈鳞状细胞癌ADC_min差异有统计学意义（t=-2.06,P=0.049）。结论 ADC和SUV是诊断宫颈鳞状细胞癌的相互独立的指标。恶性程度分级评价中,ADC可能较SUV敏感。     

对比PET/MRI与PET/CT检出肝转移癌效能

目的 对比观察PET/MRI与PET/CT检出肝转移癌的效能。方法 纳入78例共409个肝转移癌病灶,比较PET/CT及PET/MRI检出肝转移癌的阳性率。对A组50例283个病灶先行PET/CT后行PET/MR检查,B组28例126个病灶先行PET/MR后行PET/CT。采用Spearman秩相关分析和Wilcoxon秩和检验评价组内不同检查方法所获病灶最大标准摄取值（SUV_max）的相关性及其差异。结果 PET/MRI对肝转移癌的检出率（381/409,93.15%）明显高于PET/CT（285/409,69.68%,P<0.05）。A组PET/MRI的阳性率（266/283,93.99%）明显高于PET/CT（197/283,69.61%,P<0.05）;PET/MRI与PET/CT的SUV_max高度相关（r=0.84,P<0.05）,而PET/MRI的SUV_max显著高于PET/CT的SUV_max（P<0.05）。B组PET/MRI阳性率（115/126,91.27%）明显高于PET/CT（88/126,69.84%,P<0.05）;PET/MRI与PET/CT的SUV_max中度相关（r=0.74,P<0.05）,且差异无统计学意义（P>0.05）。结论 PET/MRI检出肝转移癌效果优于PET/CT;二者所获SUV_max相关性较好。     

TOF-PET/MR和TOF-PET/CT在体部恶性肿瘤SUVmax值的比较

目的 探讨时间飞行（TOF）技术PET/CT和PET/MR检查体部恶性病变SUV_max值的一致性。方法 回顾性分析接受TOF-PET/CT和TOF-PET/MR检查的体部恶性肿瘤患者20例,分为先PET/CT后PET/MR组和先PET/MR后PET/CT组,每组10例。采用Bland-Altman图评价两次检查病灶SUV_max值的一致性,采用多因素方差分析评价扫描顺序和机器类型对病灶的SUV_max测量值的影响。结果 TOF-PET/CT与TOF-PET/MR检查病灶的SUV_max值有较好的一致性 。扫描顺序对于恶性病灶的SUV_max有影响（F=46.00,P<0.001）,而机器类型对恶性病灶的SUV_max值无影响（F=0.005,P=0.95）。结论 TOF-PET/MR和TOF-PET/CT在体部恶性病变SUV_max值测量方面具有相当的诊断价值,且延迟显像SUV_max的增加与采集时间有关,而与检查机器类型无关。     

比较PET/CT与PET/MRI诊断成人淋巴瘤

目的 比较PET/CT与PET/MRI诊断成人淋巴瘤的效能。方法 前瞻性观察45例淋巴瘤患者，行全身PET/CT和PET/MR检查，分别由2名医师独立评估PET/CT和PET/MRI，获得病灶最大标准摄取值（SUV_max）及对应D值、D^*值和f值，分析两种模式的诊断效能及分期差异。结果 PET/CT与PET/MRI均测出55个淋巴结和5个结外病灶的SUV_max，基于体素内不相干运动（IVIM）模型测出39个病灶的对应值。医师间对阳性病灶检测率一致性极强（k=1.000），PET/CT与PET/MRI的一致性极强（k=0.956）；对于淋巴瘤分期，PET/CT与PET/MRI一致性极强（k=0.965）；PET/CT与PET/MRI的SUV_max呈高度相关（r=0.892，P<0.001），D值与SUV值低度相关（r=-0.312，P<0.050），f值与SUV值呈中度相关（r=0.520，P<0.001）。结论 PET/CT与PET/MRI对成人均有良好诊断效能，PET/MRI可提高淋巴瘤诊断及分期的准确率，多参数联合可预测和评估肿瘤异质性。     

月 经 状 态 对 不 同 病 理 类 型 宫 颈 癌 表 观 弥 散 系 数 值 的 影 响

目的 观察月经状态对不同病理类型宫颈癌表观弥散系数（ADC）值的影响。方法 回顾性分析352例经病理证实的宫颈癌患者的MRI及DWI资料，其中317例鳞癌和35例腺癌；177例未绝经，175例已绝经。于ADC图像宫颈癌病灶最大层面测量并记录病灶的ADC最大值（ADC_max）、最小值（ADC_min）和平均值（ADC_mean）。比较宫颈鳞癌与腺癌ADC值差异、绝经与未绝经患者宫颈鳞癌和腺癌ADC值差异；分别比较宫颈鳞癌及腺癌中绝经与未绝经患者ADC值差异。结果 宫颈鳞癌ADC_mean和ADC_min均低于腺癌（t=-2.05，-2.28，P均<0.05）。未绝经患者中，宫颈鳞癌ADC_mean和ADC_min均低于腺癌（t=-4.40，-5.40，P均<0.05）；而绝经患者中，宫颈鳞癌ADC_mean、ADC_min和ADC_max均与腺癌差异无统计学意义（t=0.82，1.57，0.45，P均>0.05）。宫颈鳞癌及腺癌中，未绝经患者的ADC_mean、ADC_max和ADC_min均高于绝经患者（t=-3.96，-2.53，-2.78及t=-3.71，-1.15，-5.01，P均<0.05）。结论 不同病理类型宫颈癌的ADC值不同，且受患者月经状态影响；未绝经患者中腺癌的ADC值高于鳞癌，绝经患者中腺癌ADC值与鳞癌相仿。未绝经患者宫颈癌病灶ADC值均高于绝经患者。     

早期宫颈癌盆腔淋巴结转移危险因素及PET/CT诊断

目的 分析宫颈癌盆腔淋巴结转移危险因素,并探讨PET/CT定性及半定量诊断盆腔淋巴结转移的价值。方法 回顾性分析接受盆腔淋巴结清扫术的206例宫颈癌患者的临床资料,对年龄、BMI指数、病理类型、浸润深度、国际妇产科联盟（FIGO）分期、血清SCC水平、PET/CT淋巴结转移情况及原发灶SUV_max行单因素分析,并对上述有统计学意义的指标行多因素分析;计算PET/CT诊断宫颈癌盆腔淋巴结转移的准确率、敏感度及特异度;记录淋巴结SUV_max值（SUV_maxLN）及其与原发灶、肝脏、腹主动脉SUV_max的比值（SUV_maxL/T、SUV_maxL/H、SUV_maxL/A）。绘制ROC曲线,计算曲线下面积（AUC）,确定最佳诊断界值。结果 单因素分析显示,年龄、BMI指数、病理类型、浸润深度、FIGO分期、血清SCC水平、PET/CT提示淋巴结转移以及原发灶SUV_max为宫颈癌淋巴结转移的重要因素（P < 0.05）。多因素分析显示血清SCC水平、肿瘤浸润深度、PET/CT提示盆腔淋巴结转移及原发灶SUV_max值是宫颈癌淋巴结转移的独立危险因素（P < 0.05）。PET/CT诊断宫颈癌盆腔淋巴结转移的敏感度为54.90%（28/51）,特异度为91.61%（142/155）,准确率为82.52%（170/206）。SUV_maxLN=4.19的诊断准确率高于传统界值（SUV_max=2.5）。与SUV_maxLN相比,以SUV_maxL/T、SUV_maxL/H、SUV_maxL/A诊断宫颈癌盆腔淋巴结转移的ROC曲线差异无统计学意义。结论 血清SCC水平、肿瘤浸润深度、PET/CT提示盆腔淋巴结转移及原发灶SUV_max值是早期宫颈癌盆腔淋巴结转移的独立危险因素。PET/CT在定性及半定量评价宫颈癌盆腔淋巴结转移方面均具有一定价值。     

宫颈癌18F-FDG PET/CT标准化摄取值与血管内皮生长因子、水通道蛋白1表达及临床病理特征的相关性

目的 探讨宫颈癌¹⁸F-FDG PET/CT标准化摄取值（SUV）与血管内皮生长因子（VEGF）、水通道蛋白-1（AQP-1）表达水平及临床病理特征之间的相关性。方法 回顾性分析56例宫颈癌患者术前PET/CT影像资料,测量肿瘤平均标准化摄取值（SUV_mean）、最大标准化摄取值（SUV_max）及标准化摄取值峰值（SUV_peak）。应用免疫组织化学方法检测宫颈癌组织的VEGF、AQP-1表达水平,分析SUV值与VEGF、AQP-1表达水平及临床病理特征间的相关性。结果 国际妇产科联合会（FIGO）不同分期间SUV_mean、SUV_peak、VEGF、AQP-1表达水平差异均有统计学意义（P均< 0.05）;肿瘤最大径≥ 4 cm者SUV_peak和VEGF表达水平均高于最大径< 4 cm者（P均< 0.05）;浸润深度≥ 1/2宫颈肌壁者SUV_peak、VEGF和AQP-1表达水平均高于浸润深度< 1/2宫颈肌壁者（P均< 0.05）;有淋巴结转移者VEGF和AQP-1表达水平均高于无淋巴结转移者（P均< 0.05）。SUV_peak与VEGF（r_s=0.529,P < 0.001）、AQP-1（r_s=0.356,P=0.007）表达水平的相关性相对较高。结论 宫颈癌术前PET/CT SUV_peak值与临床病理特征有相关性,可用于指导制定宫颈癌个体化治疗方案。     

一体化18F-FDG PET/MR评估缺血性脑血管病

目的 探讨一体化¹⁸F-FDG PET/MR显像对于慢性缺血性脑血管病的应用价值。方法 对10名成年健康志愿者及17例慢性单侧颈内动脉（ICA）或大脑中动脉（MCA）闭塞患者行一体化¹⁸F-FDG PET/MR检查。由2名医师分析图像，定量分析和比较健康志愿者左侧与右侧不同脑区、慢性缺血性脑血管病患者脑梗死患侧与对侧相应区域及脑梗死周围区与对侧相应区域间平均ADC值（ADC_mean）、平均标准化摄取值（SUV_mean）及最大标准化摄取值（SUV_max）的差异。结果 10名健康志愿者MRI均未见异常，¹⁸F-FDG脑代谢图像清晰，各脑区代谢分布对称；左侧与右侧额叶、顶叶、颞叶、枕叶ADC_mean、SUV_mean、SUV_max差异均无统计学意义（P均>0.05）。17例慢性缺血性脑血管病MRI均可见脑梗死灶，¹⁸F-FDG脑代谢图显示患侧均较对侧相应区域ADC_mean、SUV_mean、SUV_max明显减低（P均<0.01）；脑梗死周围区与对侧相应区域比较ADC_mean、SUV_mean、SUV_max亦明显减低（P均<0.01）。结论 利用一体化¹⁸F-FDG PET/MR检查可同时获得脑结构和脑代谢综合信息，全面评价慢性缺血性脑血管病。     

比较PET/CT显像中肝脏18F-FDG摄取半定量分析方法

目的 探讨PET/CT显像中影响肝脏¹⁸F-FDG摄取的因素,分析常规体质量（BM）、瘦体质量（LBM）及体表面积（BSA）校正最大标准化摄取值（SUV_max-B、SUV_max-L、SUV_max-S）的应用价值。方法 回顾性分析行¹⁸F-FDG PET/CT显像的67名健康受检者。测量肝脏SUV_max-B、SUV_max-L及SUV_max-S,分析年龄、空腹血糖水平、体质量指数（BMI）、肝脏CT值、性别、脂肪肝对上述参数的影响。结果 空腹血糖水平与肝脏SUV_max-B、SUV_max-L、SUV_max-S均呈正相关（r=0.329、0.336、0.353,P=0.012、0.010、0.007）。BMI与肝脏SUV_max-B （r=0.543,P<0.01）、SUV_max-L （r=0.328,P=0.07）呈正相关BMI与SUV_max-S无相关性（r=0.026,P=0.833）。受检者年龄、肝脏CT值与肝脏SUV_max-B、SUV_max-L、SUV_max-S均无相关性（P均>0.05）。男性肝脏SUV_max-B （t=2.608,P=0.011）、SUV_max-L （t=5.272,P<0.001）明显高于女性,男性与女性肝脏SUV_max-S无统计学差异（t=0.759,P=0.450）。脂肪肝受检者与非脂肪肝受检者肝脏SUV_max-B、SUV_max-L、SUV_max-S均无统计学差异（P=0.646、0.775、0.068）。结论 空腹血糖水平、BMI、性别是PET/CT显像中影响肝脏摄取¹⁸F-FDG的因素。BMI较大的受检者可采用SUV_max-L或SUV_max-S代替SUV_max-B,此外SUV_max-S可弥补性别间的差异,但校正技术无法减弱血糖水平对肝脏SUV_max的影响。     

卵巢癌脾脏转移瘤18F-FDG PET/CT表现

目的 观察卵巢癌脾脏转移瘤的¹⁸F-FDG PET/CT表现。方法 回顾性分析经病理及临床随访证实的21例卵巢癌脾脏转移瘤患者的¹⁸F-FDG PET/CT表现,分析病灶最大标准摄取值（SUV_max）与最大径的相关性。结果 21例中,17例单发,4例多发,共28个病灶。13个病灶¹⁸F-FDG PET/CT表现为类圆形低密度影,其中9个病灶边界清晰,4个病灶边界不清;4个病灶密度不均匀,内见坏死、囊变,余9个病灶密度均匀。15个病灶表现为类圆形等密度影,边界不清,密度均匀。28个病灶均呈¹⁸F-FDG高摄取,其中21个病灶¹⁸F-FDG摄取均匀,7个病灶¹⁸F-FDG摄取不均匀。卵巢癌脾脏转移瘤的SUV_max为8.04±3.92,最大径为（2.23±1.02） cm,SUV_max与最大径呈正相关（r=0.687,P<0.001）。21例中,5例肿瘤仅累及脾脏;16例累及其他部位。结论 卵巢癌脾脏转移瘤的¹⁸F-FDG PET/CT表现具有一定特征性。     

CLUSTER, NEURALGIAS, AND TACS

A number of primary headache syndromes are marked by their short duration of pain. Many of these syndromes have their own unique treatment, so they must be recognized by practicing physicians. In this article, a number of the short-lasting headache disorders are reviewed, including chronic paroxysmal hemicrania, SUNCT syndrome, hypnic headache, exploding head syndrome, primary stabbing headache, and cough headache.     

COPD相关性疲劳的研究进展

疲劳是COPD患者的第二大常见的症状,发生率高,干扰了患者正常的工作生活。本文综述了疲劳的概念和发病机制,以及COPD 患者疲劳症状的诱因和治疗方法,为医务人员加深对疲劳的了解,以采取有效的措施,缓解患者疲劳,提高其生活质量提供参考。     

Efficient and stable transduction of dopaminergic neurons in rat substantia nigra by rAAV 2/1, 2/2, 2/5, 2/6.2, 2/7, 2/8 and 2/9

Dysfunction of the nigrostriatal system is the major cause of Parkinson's disease (PD). This brain region is therefore an important target for gene delivery aiming at disease modeling and gene therapy. Recombinant adeno-associated viral (rAAV) vectors have been developed as efficient vehicles for gene transfer into the central nervous system. Recently, several serotypes have been described, with varying tropism for brain transduction. In light of the further development of a viral vector-mediated rat model for PD, we performed a comprehensive comparison of the transduction and tropism for dopaminergic neurons (DNs) in the adult Wistar rat substantia nigra (SN) of seven rAAV vector serotypes (rAAV 2/1, 2/2, 2/5, 2/6.2, 2/7, 2/8 and 2/9). All vectors were normalized by titer and volume, and stereotactically injected into the SN. Gene expression was assessed non-invasively and quantitatively in vivo by bioluminescence imaging at 2 and 5 weeks after injection, and was found to be stable over time. Immunohistochemistry at 6 weeks following injection revealed the most widespread enhanced green fluorescence protein expression and the highest number of positive nigral cells using rAAV 2/7, 2/9 and 2/1. The area transduced by rAAV 2/8 was smaller, but nevertheless almost equal numbers of nigral cells were targeted. Detailed confocal analysis revealed that serotype 2/7, 2/9, 2/1 and 2/8 transduced at least 70% of the DNs. In conclusion, these results show that various rAAV serotypes efficiently transduce nigral DNs, but significant differences in transgene expression pattern and level were observed.     

Further Observations on the Blood Factors RhA, RhB, RhC and RhD

The findings in 18 cases of individuals with Rh_o-positive blood who had antibodies in their serum resembling anti-Rh_o in specificity are briefly summarized. One interesting finding is the relatively high frequency of such individuals among Negroes, especially with the blood type Rh^d_o and Rh^abd_o. The significance of these findings is discussed.     

A New Rh Phenotype, Rhorh, G-Negative

A new Rh phenotype, Rh_orh, G-negative is described in a Negro woman who developed anti-G (rhG) antibodies during pregnancy. The baby was Rh_o, G-positive and had mild hemolytic disease with a positive direct antiglobulin test. The mother's titer was 1:1024 at delivery, dropping to 1:8 after 14 months. The baby's direct antiglobulin test became negative after two months. The mother most likely became sensitized alter a blood transfusion five years prior.     

A New Rh Allele, ryn (R-1,2,w3,w4)

The inheritance in a large Brazilian family of a new Rh allele r ^yn (R^{-1,2,w3,w4,-6,-7,-8,-10,-20,-27}) is described.     

Vaginal bleeding/spotting with conjugated estrogens/bazedoxifene,conjugated estrogens/medroxyprogesterone acetate,and placebo

ABSTRACT

Objective: In the 1-year phase 3 Selective estrogens, Menopause, And Response to Therapy-5 trial, cumulative amenorrhea rates with conjugated estrogens/bazedoxifene (CE/BZA) were similar to placebo and higher than with conjugated estrogens/medroxyprogesterone acetate (CE/MPA). This post hoc analysis reports bleeding/spotting rates in 4-week intervals (cycles) and 3-month intervals (quarters) with these therapies and the percentage of cases attributable to spotting only.

Methods: Generally healthy postmenopausal women with menopausal symptoms recorded vaginal bleeding/spotting in daily diaries while receiving CE 0.45 mg/BZA 20 mg, CE 0.625 mg/BZA 20 mg, CE 0.45 mg/MPA 1.5 mg, or placebo.

Results: A total of 1596 women in the modified intent-to-treat population contributed data. Incidence of bleeding/spotting was significantly (p < 0.001) lower with CE 0.45 mg/BZA 20 mg (0.54?4.44%), CE 0.625 mg/BZA 20 mg (1.26?5.02%), and placebo (1.55?4.82%) compared with CE 0.45 mg/MPA 1.5 mg (8.81?25.63%) in all 4-week cycles. Each quarter, <10% of women taking CE/BZA doses or placebo had bleeding/spotting, significantly (p < 0.001) less than the 21–36% with CE 0.45 mg/MPA 1.5 mg. Odds ratio for bleeding/spotting with CE 0.45 mg/BZA 20 mg vs CE 0.45 mg/MPA 1.5 mg was 0.1 in each quarter (95% CI, Q1–Q3: 0.1–0.2; Q4: 0.1–0.3). Across all treatments, most (88–100%) bleeding/spotting cases were spotting only. Mean days of bleeding/spotting were <1 per quarter with CE/BZA doses and placebo, which was significantly (p < 0.01) less than the 3–5 days per quarter with CE/MPA.

Conclusions: Bleeding/spotting with CE/BZA treatment was similar to placebo and significantly less frequent than with CE/MPA treatment. Most cases were spotting only across all treatments.     

Antibiotics--TAZ/PIPC, synercid, linezolid, everninomicin

The increasing resistance among Gram-positive cocci have been accompanied by their increasing frequency as cause of severe infection. Thus new antimicrobial agents, TAZ/PIPC, synercid and linezolid, are in various stages of development. TAZ/PIPC, a combination drug of a new beta-lactamase inhibitor tazobactam and piperacillin at ratio in 1 to 4 has a broad spectrum of antimicrobial activity. Evidence from randomized clinical trials in adults in Japan has shown that TAZ/PIPC is superior to PIPC as a drug for complicated urinary tract infection. Synercid is a streptogramin antibiotic. The spectrum of activity of synercid is similar to vancomycin. Furthermore, most of E. faecium were susceptible. The efficacy of synercid in clinical trials in patients infected with VREF was 65-70%. Linezolid is a member of the oxazolidinones. The antimicrobial spectrum of linezolid is similar to that of vancomycin. In the US, patients with significant infection caused by resistant Gram-positive organisms(mostly VREF) were treated with linezolid. The efficacy of linezolid was about 75%. The clinical trials for everninomicin had been discontinued because of insufficient clinical data supporting its efficacy and safety.