As2O3-碘油混悬剂与乳剂缓释性能的实验研究

目的探讨三氧化二砷(Arsenictrioxide,As2O3)在40%的普通碘油和超液化碘油混悬剂和乳剂中的物理性状与缓释性能,以指导临床药物的应用。方法分别将40%的普通碘油(LIP)和超液化碘油(UFL)与As2O3用“泵法”制成几种不同的乳剂和混悬剂,肉眼与显微镜观察各种制剂的物理稳定性,并将各种制剂分别经透析带,在37℃±0.5℃恒温条件下,于磷酸盐缓冲液中进行透析,测定不同时间释放到透析液中As2O3的浓度,计算释放率。结果40%的普通碘油和超液化碘油As2O3混悬剂静置后出现As2O3的分离沉淀,超液化碘油As2O3混悬剂的分离速度更快;2种As2O3碘油普通乳剂静置后均立即出现油水分层,加乳化剂的乳剂稳定性好;As2O3在普通碘油和超液化碘油乳剂中,具有缓释性,加乳化剂的乳剂药物缓释效应更好,而在其混悬剂中释放较快。结论40%的普通碘油和超液化碘油均可作为肝癌等的化疗栓塞剂和As2O3的载体,使用其乳剂能更好地发挥其缓释效应,增加药物剂量而不至于增加其副作用。     

碘油抗癌药乳剂与混悬剂的基础实验研究

将40%碘油(LIP)或超液态碘油(UFL)与丝裂霉素 C(MMC)用“泵法”配制成不同的乳剂与混悬剂.将各种制剂用肉眼与显微镜观察其物理稳定性,用溶出试验仪以桨叶法进行药物释放试验,释放的 MMC 浓度用分光光度法测定。结果表明,碘油抗癌药化疗栓塞剂的两类制剂中乳剂的稳定性较差,油水易分层,药物释放快;油水比对乳剂的稳定性有明显影响,4:1的乳剂比2:1者稳定;用 UFL 制成的乳剂优于用 LIP 制成者.混悬剂较稳定,考虑到碘油的粘稠度,以 UFL 制成的混悬剂更适合于临床使用.     

碘油抗癌药化疗栓塞剂的理化特性研究

分别将４０％碘油（ＬＩＰ）及超液态碘油（ＵＦＬ）与丝裂霉素Ｃ（ＭＭＣ）用“泵法”配制成几种不同的乳剂与混悬剂。将各种制剂用肉眼与显微镜观察其物理稳定性，用溶出试验仪以桨叶法进行药物释放试验，释放的ＭＭＣ浓度用分光光度法测定。结果表明，碘油抗癌药化疗栓塞剂的各种制剂中无乳化剂的乳剂最不稳定，油水易分层，药物释放很快；混悬剂其次；含乳化剂的乳剂稳定性最好。油水比对乳剂的稳定性有明显影响，４：ｌ的乳剂比２：１者稳定；用ＵＦＬ制成的乳剂优于用ＬＩＰ制成者，特别是加入乳化剂后乳剂很稳定，２小时ＭＭＣ的释放量仅１０％左右，据此可增加其中的抗癌药剂量，使抗癌药长期维持一定浓度作用于肿瘤细胞，又不致于增加副作用。     

兔VX2肝癌阿霉素热碘油栓塞的疗效观察

目的　评价阿霉素 (ADM)热碘油栓塞对兔VX2肝癌的抑瘤效果。材料与方法　将VX2瘤细胞接种于 6 0只新西兰白兔肝左叶 ,建立兔肝癌模型 ,随机分 4组 ,每组 15只。利用导管经肝动脉将生理盐水、超液态碘油、37℃ADM碘油、6 0℃ADM碘油分别给与不同组 ,1周后观察各组肿瘤体积及血清天冬氨酸转氨酶 (AST)水平 ,观察荷瘤兔的存活期。结果　 6 0℃ADM碘油组生长率 (0 .5 3± 0 .11)与对照组 (3.4 8± 1.17)相比有显著性差异 (P <0 .0 1) ,与超液态碘油组 (0 .99± 0 .2 1)、37℃ADM碘油组 (0 .89± 0 .16 )相比有差异 (P <0 .0 5 )。 6 0℃ADM碘油组存活期[(5 3.0± 3.0 )d]与其他处理组 [(4 6 .0± 2 .5 )d ,(4 7.5± 3.0 )d]相比有差异 (P <0 .0 5 )。 6 0℃ADM碘油组血清AST水平治疗前后变化与其他处理组相比无差异 (P >0 .0 5 ) ,与对照组相比有差异 (P <0 .0 5 )。结论　 6 0℃ADM碘油可大大降低肿瘤生长率 ,延长动物存活期 ,并对肝功能的损害是可逆的 ,其抑瘤效果更强     

碘油与表阿霉素配制比例的实验研究

目的量化研究介入化疗碘油乳剂栓塞后化疗药物的药动学特征,得出碘油与化疗药物之间的最佳配制比例. 材料与方法以表阿霉素为工具药,以兔为研究对象,用反相高效液相色谱法测定表阿霉素的血药浓度,拟合药动学参数作统计学比较. 结果对照组血浆中表阿霉素的浓度显著高于其他各组(P＜0.05),而碘油与表阿霉素2∶5(ml∶mg)配制比例组血浆中表阿霉素浓度显著低于其他配制比例组(P＜0.05). 结论碘油与表阿霉素的最佳配制比例是2∶5(ml∶mg),这样可降低外周循环血浆中游离表阿霉素的浓度,既提高了靶向疗效,同时又降低了药物的毒副作用.     

自制碘油混合乳剂肝癌的联合化疗及栓塞的疗效分析

目的 :观察自制碘油混合乳剂经肝动脉栓塞术 (TAE)对中晚期肝癌的疗效和肝功能指标变化 ,并与常规TAE的疗效对比。方法 :79例中、晚肝癌分常规组和对照组经股动脉途径插管进行周期性治疗 ,灌注化疗物药 :AMD +5 FU +MMC +CDDP +羟基喜树碱 ,并进行碘油明胶海绵栓塞 ,常规组 :超液化碘油 +明胶海绵 ,对照组 :超液化碘油、阿霉素、5 氟脲嘧啶、无水酒精抽吸乳化 +明胶海绵 ;治疗前后检测血清ALT、AST水平 ,并随访生存期。结果 :治疗后 6个月、12个月、18个月生存率对照组 (10 0 %、76 .9%、6 4 .1% )较常规组 (82 .5 %、5 7.5 %、30 % )有明显增高 (P <0 .0 5 ) ,治疗后两组血清ALT、AST水平无显著差异 (P >0 .0 5 )。结论 :使用自制碘油混合乳剂经股动脉途径插管进行周期性栓塞治疗中晚期肝癌 ,可有效地提高患者的生存期。     

中晚期肝癌热灌注TAE疗效与毒副作用评估

目的　观察经肝动脉热灌注TAE对中晚期肝癌的疗效和毒副作用。方法　选取 1996-0 1～ 2 0 0 1-0 1中晚期肝癌患者 80例 ,随机分为 2组 ,A组 40例为热灌注TAE组 ( 60℃ ) ,B组 40例为普通灌注TAE组 ( 37℃ ) ,均采用经股动脉途径 ,插管至肝动脉用ADM MMC 5 -Fu CDDP方案 ,并用适量碘化油栓塞 ,间隔 40d再次治疗。检测治疗前后肝功血清酶 (ALT、AST、GGT、D -BIL)及甲胎蛋白 (AFP)水平 ,观察化疗毒副反应 (恶心、呕吐症状、白细胞水平 ) ,并随访患者生存期。结果　A组 0 .5、1、1.5、2年生存率( 10 0 %、85 .0 %、70 .0 %、47.5 % )较B组 ( 87.5 %、67.5 %、42 .5 %、2 7.5 % )均有提高 (Ρ <0 .0 5 )。A组恶心、呕吐等副反应较轻。A组较B组治疗后AFP水平明显下降 (Ρ <0 .0 5 )。A、B 2组治疗后血清ALT、AST、GGT、D -BIL水平均增高 ,但无明显差异 (Ρ >0 .0 5 )。A、B2组治疗后白细胞水平下降 ,但无明显差异 (Ρ >0 .0 5 )。结论　经肝动脉热灌注TAE可有效地延长中晚期肝癌患者的生存期 ,恶心、呕吐等副反应较轻 ,对肝功能无明显的损害     

肝癌TAE疗效与碘油乙醇乳剂用量的相关性研究

目的　探讨肝癌经皮肝动脉栓塞术 (TAE)的疗效与碘油乙醇乳剂用量的相关性 ,进一步提高TAE在肝癌治疗中的疗效。材料与方法　 3 5例肝癌患者 ,分成两组。第一组 17例 ,按肿瘤直径与碘油乙醇乳剂剂量等比例行TAE治疗 ;第二组 18例 ,按碘油乙醇乳剂最大剂量法进行治疗 ,并进行对比分析。结果　第一组和第二组 1、2年生存率分别为 5 8.82 %、2 3 .5 3 %和 77.78%、44.44% (P <0 .0 5 )。结论　对于适合TAE的肝癌患者 ,肝癌TAE疗效与碘油乙醇乳剂用量成明显正相关。     

肝动脉介入性热疗对犬肝、肾功能的影响及其病理学基础

目的　以犬为研究对象 ,研究不同温度 (4 5℃、5 0℃、5 5℃、60℃、65℃ )的热灌注液经肝动脉灌注对犬肝内温度 ,肝组织学及肝、肾功能的动态影响 ,为介入性热化疗的临床应用提供实验依据。方法　经犬肝动脉灌注入 45℃、5 0℃、5 5℃、60℃、65℃生理盐水 180ml,持续 3 0min。观察并比较热灌注前后肝脏穿刺活检及肝、肾功能的动态变化情况。结果　 (1)谷丙转氨酶 (alanineamin otransferase ,ALT)、谷草转氨酶 (aspartatetransaminase ,AST)于灌注 (60℃ )后 2 4h开始升高 ,72h达到高峰 (Ρ <0 .0 1) ,168h后逐渐下降 ,2 16h后恢复正常 ;总胆红素 (totalbilirubin ,T -BIL)、白蛋白 (albumin ,ALB)、γ -谷氨酰基移换酶 (γ -glutamyltransferase ,γ -GT)无明显变化 (Ρ >0 .0 5 ) ;(2 )肝组织可见一过性淋巴细胞浸润、肝细胞混浊肿胀 ,168h后恢复正常 ;(3 )肾功能尿素氮 (bloodureanitro gen ,BUN)、肌酐 (creatinine ,Cr)无显著性变化 (Ρ >0 .0 5 ) ,尿酸 (uricacid ,UA)呈一过性增高 (Ρ <0 .0 5 ) ;(4 ) 45℃～ 5 5℃热灌注对肝肾功无显著影响 ,65℃热灌注后肝肾功恢复缓慢。结论　经肝动脉 60℃灌注液介入性热疗是安全的 ,仅引起犬肝组织一过性损伤 ,对肝、肾功能产生一过性影响     

包膜结节型肝癌的经导管碘油化学栓塞治疗:CT和病理学表现

在27个月期间,作者对104例经手术的肝癌病人中的56例进行血管造影和碘油CT检查,对27例单发的经病理学检查有包膜的结节型肝癌选出作回顾性研究。男21例,女6例,年龄33～71岁。全部病例均进行了选择性腹腔动脉或肝动脉造影。血管造影后导管头进入肝固有动脉或选择性进入左或右肝动脉,并经导管缓慢注入5～10ml碘油阿霉素乳剂,碘油乳剂的配制是用5～10 ml碘油和20～30mg阿霉素,2～3 ml泛影葡胺混合而成,阿霉素和碘油用不断抽吸方法达到小的比重,以增加碘油的稳定性。用“手推”的栓塞方法将碘油送入靶血管,透视下观察碘油乳剂的返流情况,碘油和阿霉素平均用量分别为6.0±3 ml和26.0±10.2mg。     

D-二聚体、纤溶酶原激活物抑制物在急性肾衰竭患者血液净化中的临床意义

目的探讨急性肾衰竭(ARF)时D-二聚体(D-D)、纤溶酶原激活物抑制物(PAI)在不同的血液净化方法中的动态变化及临床意义。方法对我院2007年1月—2010年3月急诊住院58例ARF患者血液净化前、净化后4 h及38例健康人进行血浆中D-D含量及PAI水平测定。ARF患者血液净化方法随机采用血液透析(HD)(31例)、血液透析滤过(HDF)(27例)。结果 ARF患者D-D含量及PAI水平较对照组明显升高[D-D(0.83±0.04)与(0.48±0.03)mg/L,P=0.000 2;PAI(14.95±0.73)与(8.03±0.30)103kat/L,P<0.0001;]HD治疗4 h后D-D含量和PAI活性较治疗前升高[D-D(0.89±0.05)与(1.48±0.37)mg/L,P=0.018;PAI(14.89±1.78)与(22.10±3.56)103kat/L,P=0.025],而HDF治疗后D-D含量和PAI无明显变化[D-D(0.91±0.06)与(1.12±0.09)mg/L,P=0.65;PAI(15.81±1.98)与(16.10±2.56)103kat/L,P=0.86]。结论 ARF患者D-D、PAI水平升高,存在凝血-纤溶系统的紊乱,HD可以加重这种改变,而采用HDF治疗可避免对患者凝血机能的影响,在急性肾衰竭治疗中有一定临床价值。     

高压氧辅助治疗对卒中后抑郁患者血清5-HT、NE及神经功能的影响

目的：观察高压氧（HBO）辅助治疗对卒中后抑郁（PSD）患者血清5-羟色胺（5-HT）、去甲肾上腺素（NE）及神经功能的影响。方法70例PSD患者根据数字表法随机分为2组,对照组（n=35例）采用常规措施治疗,观察组（n=35例）待确定活动性出血已稳定或已趋于稳定后,在对照组治疗基础上加用HBO治疗。两组疗程均为30d,比较两组患者治疗前后血清5-HT、NE表达水平及汉密尔顿抑郁量表（HAMD）、中国脑卒中量表（CSS）,改良Barthel指数（MBI）评分变化。结果两组患者治疗后血清5-HT、NE表达水平均明显升高（P<0.05）,且观察组升高较对照组更为显著（P<0.05）;两组患者治疗后HAMD、CSS评分明显降低（P<0.05）,而MBI评分明显升高（P<0.05）,且观察组降低或升高较对照组更为显著（P<0.05）。结论 HBO辅助治疗可明显升高PSD患者血清5-HT、NE表达水平,改善抑郁状态和神经功能。     

Anterior interosseous nerve lession and distal myoclonus revealing a parsonage turner syndrome associated with hashimoto thyroiditys

Parsonage-Turner Syndrome (PTS), also known as brachial neuritis or neuralgic amyotrophy, is a rare disorder affecting 2 to 3 individuals per 100,000 each year. Abrupt onset shoulder pain, followed by motor weakness, paresthesia and hypoesthesia, is usually reported, lasting several months with variable recovery. The etiology of the disease may be idiopathic or triggered by an underlying autoimmune disease in genetically susceptible individuals. Our report addresses a unique case of Parsonage-Turner Syndrome in a patient suffering from concurrent Hashimoto Thyroiditis. A previously healthy A 22 year-old female was referred to the Department of Neurology after complaints of sudden-onset motor weakness in her left upper limb. On physical examination, the patient could not make an “Ok sign” with her thumb and distal phalanx or form a complete fist, revealing weakness within the anterior interosseous branch of the median nerve. Further testing with electromyography demonstrated muscular atrophy within the arm''s anterior compartment, forearm, and triceps brachii of the posterior compartment. Additional imaging and physical examination were unremarkable, confirming our diagnosis of PTS. Furthermore, lab reports revealed elevated levels of anti-thyroglobulin and anti-thyroid peroxidase antibodies and our patient was concurrently diagnosed with Hashimoto''s thyroiditis.This case aims to highlight the rare co-occurrence of Hashimoto''s thyroiditis with Parsonage-Turner Syndrome in an otherwise healthy patient. A 2014 study published by Nugent et al. had also shed light on brachial neuritis in a patient suffering from autoimmune connective tissue disease, and through this case study, we hope to add to the growing literature regarding the correlation between PTS and autoimmune diseases. Symptoms of PTS can easily be misdiagnosed given its similarity to other peripheral neuropathies, and careful assessment and thorough understanding of the disease is required to successfully distinguish it from other neurological pathologies.     

Image quality dependence on in-plane positions and directions for MDCT images

Objective

The present study was performed to examine the dependence of image quality on in-plane position and direction in computed tomography (CT) imaging using the modulation transfer function (MTF), noise power spectrum (NPS) and analysis of signal-to-noise ratio (SNR). For detailed analysis of SNR, the low-contrast detectability was compared using simulated small low-contrast objects.

Materials and methods

Three models of multidetector-row CT (MDCT) were employed. The measurement positions for MTF were set to the isocentre and several peripheral areas, and NPS and SNR were calculated for the isocentre and 128 mm off-centre. To evaluate directional dependence, the one-dimensional physical properties were measured separately in the radial and azimuthal directions. Seven radiological technologists also performed a perceptual detection study at the different in-plane positions using computer-simulated low-contrast images.

Results

The results of MTF and SNR differed between the isocentre and the peripheral area. The MTF values also tended to decrease with distance from the isocentre, and the SNR values in the low frequency range for the peripheral area were superior to those for the isocentre. In the detection study, the low-contrast detectability in the peripheral area was 13-40% higher than the value in the isocentre.

Conclusion

The results of the present study indicated that clinical CT images have remarkable non-uniformity of image quality. Therefore, the detailed analysis performed in this study will provide useful information for the development of advanced image processing applications, such as computer-aided diagnosis (CAD) and de-noising of CT images.     

Validity of apparent diffusion coefficient (ADC) value in diagnosis and follow-up of multiple sclerosis patients in different clinical subtypes

Background

Multiple sclerosis (MS) is a chronic disease with a wide range of pathologic changes that modify the apparent diffusion coefficient (ADC) value.

脑梗死患者血清同型半胱氨酸检测的临床意义

目的：探讨脑梗死患者血清同型半胱氨酸（Hcy）水平的变化及临床意义。方法：应用比色法对44例脑梗死患者（脑梗死组）进行血清Hcy水平测定,并与40例健康正常人（对照组）作比较。结果：脑梗死组血清Hcy水平（21.42±3.19μmol/L）明显高于对照组（12.04±2.46μmol/L）。结论：脑梗死患者血清Hcy水平明显升高,可作为预测脑梗死发生、发展的敏感指标。     

强直性脊柱炎80例临床研究

1985年,我院内科对800例患腰背痛,其中部分为外院疑有强直性脊柱炎(AS)的病人,进行了临床及HLA-B_(27)检查。根据纽约诊断标准,确诊为AS病者80例,其发病年龄多在12～30岁之间,男女之比例为6.3∶1;72例AS病人之HLA-B_(27)阳性,5例病人有家族史,提示本病与遗传因素有关。部分病人做到了早期诊断。我们认为,对患腰背痛的病人进行HLA-B_(27)检查,可提高医生对AS发病之警觉。     

Humane metapneumovirus (HMPV) associated pulmonary infections in immunocompromised adults—Initial CT findings,disease course and comparison to respiratory-syncytial-virus (RSV) induced pulmonary infections

Aim

To describe computed tomography (CT)-imaging findings in human metapneumovirus (HMPV)-related pulmonary infection as well as their temporal course and to analyze resemblances/differences to pulmonary infection induced by the closely related respiratory-syncytial-virus (RSV) in immunocompromised patients.

Materials and methods

Chest-CT-scans of 10 HMPV PCR-positive patients experiencing pulmonary symptoms were evaluated retrospectively with respect to imaging findings and their distribution and results were then compared with data acquired in 13 patients with RSV pulmonary infection. Subsequently, we analyzed the course of chest-findings in HMPV patients.

Results

In HMPV, 8/10 patients showed asymmetric pulmonary findings, whereas 13/13 patients with RSV-pneumonia presented more symmetrical bilateral pulmonary infiltrates. Image analysis yielded in HMPV patients following results: ground-glass-opacity (GGO) (n = 6), parenchymal airspace consolidations (n = 5), ill-defined nodular-like centrilobular opacities (n = 9), bronchial wall thickening (n = 8). In comparison, results in RSV patients were: GGO (n = 10), parenchymal airspace consolidations (n = 9), ill-defined nodular-like centrilobular opacities (n = 10), bronchial wall thickening (n = 4). In the course of the disease, signs of acute HMPV interstitial pneumonia regressed transforming temporarily in part into findings compatible with bronchitis/bronchiolitis.

Conclusions

Early chest-CT findings in patients with HMPV-related pulmonary symptoms are compatible with asymmetric acute interstitial pneumonia accompanied by signs of bronchitis; the former transforming with time into bronchitis and bronchiolitis before they resolve. On the contrary, RSV-induced pulmonary infection exhibits mainly symmetric acute interstitial pneumonia.     

Comparison of double inversion recovery magnetic resonance imaging (DIR-MRI) and dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) in detection of prostate cancer: A pilot study

IntroductionDCE-MRI is established for detecting prostate cancer (PCa). However, it requires a gadolinium contrast agent, with potential risks for patients. The application of DIR-MRI is simple and may allow cancer detection without the use of an intravenous contrast agent by differentially nullifying signal from normal and abnormal prostate tissue, creating contrast between the cancer and background normal prostate. In this pilot study we gathered data from DIR-MRI and DCE-MRI of the prostate for an equivalence trial. We also looked at how the DIR-MRI appearance varies with the aggressiveness of PCa.MethodDIR-MRI and DCE-MRI were acquired. The images were assessed by an experienced Consultant Radiologist and a novice reporter (Radiographer). The potential PCa lesions were quantified using a lesion to normal ratio (LNR). Radiological pathological correlation was made to identify the MRI lesions that represented significant PCa. A Wilcoxon sign rank was used to compare DCE-LNR and DIR-LNR for PCa containing lesions. Pearson's correlation was used to look at the relationship between DIR-LNR and PCa grade group (aggressiveness).ResultsDCE-LNR and DIR-LNR were found to be significantly different (Z = −5.910, p < 0.001). However, a significant correlation was found between PCa grade group and DIR-LNR.ConclusionDIR and DCE sequences are not equivalent and significant cancer is more conspicuous on the DCE sequence. However, DIR-LNR does correlate with PCa aggressiveness.Implications for practiceWith the correlation of PCa grade group with DIR-LNR this may be a useful sequence in evaluation of the prostate; stratifying the risk of there being clinically significant PCa before biopsy is performed. Furthermore, given that DIR-LNR appears to predict PCa aggressiveness DIR might be used as part of a multiparametric MRI protocol designed to avoid biopsy.     

递增负荷运动至力竭大鼠肾脏自由基产生及氧化抗氧化能力的研究

以大鼠增负荷力竭性运动为模型,利用低温电子自旋共振（ＳＥＲ）技术,分别于安静时、运动中、运动后即刻、运动后３０ｍｉｎ、２ｈ、４ｈ、８ｈ提取大鼠肾组织,测定氧自由基（ＯＦＲ）信号强度,同时测定ＳＯＤ活力和ＭＤＡ含量,结果表明：①运动后恢复期３０ｍｉｎ,肾脏ＯＦＲ信号强度升高明显,提示运动性肾缺血及恢复期再灌注诱导的黄嘌呤氧化酶机制可能是肾组织ＯＦＲ生成的主要来源;②在运动过程中及恢复期ＯＦＲ改变与ＳＯＤ变化趋势基本吻合,提示肾内源性ＳＯＤ在防止ＯＦＲ损伤中起重要作用;③肾脏ＭＤＡ于运动后２ｈ出现峰值,而ＯＦＲ则于恢复期３０ｍｉｎ升至最高,说明除肾脏自身产生活性氧诱导脂质过氧化以外,其它部位转移的ＭＤＡ也许占很大比重