多层螺旋CT灌注成像在脑肿瘤的初步应用

目的初步评价多层螺旋CT脑肿瘤灌注成像方法以及其临床应用价值。方法28例已知全身肿瘤性病变患者在我院行MSCT灌注成像扫描。其中包括22例脑肿瘤和6例体部肿瘤患者。首先行CT平扫以确定肿瘤中心层面,然后采用CT电影扫描技术对肿瘤中心层面进行四层同层灌注扫描。扫描图像经ADW3。1工作站处理,计算并分析灌注图像和灌注参数。结果脑肿瘤的灌注参数有明显增高。但是,不同脑肿瘤的CBF值之间可有一定的交叉;CBV值有轻微增加;MTT值的临床价值不大,尚有待于进一步研究;PS值显著增加,垂体瘤>脑膜瘤>胶质瘤≈转移瘤。PS值可放大肿瘤的灌注特点并有临床意义显著。体部肿瘤的灌注参数也有明显增高。体部肿瘤容易受到呼吸运动的干扰。灌注参数有助于不同脑部和体部肿瘤的鉴别诊断。PS图像还有助于肿瘤瘤体真正范围的确定,以及发现小的可疑病灶。结论MSCT灌注成像提供了一种准确而相对简捷的定量评估全身肿瘤血流灌注状态的方法。这种技术很容易应用于临床。     

多层螺旋CT灌注成像在胸部肿瘤诊断和治疗中的应用

目的：探讨多层螺旋CT（MSCT）胸部肿瘤灌注成像方法及临床应用价值。方法：对11例胸部肿瘤患者进行MSCT灌注成像,先用常规CT平扫确定肿瘤中心部位,然后进行肿瘤灌注扫描,扫描部位以肿瘤中心为主,采用电影扫描技术（1r/0.75s）层厚0.6mm流速5ml/s剂量50ml,注射造影剂同时进行CT扫描,扫描总时间40s。扫描图象经工作站处理,计算并分析图象和灌注参数,包括：动脉灌注量AP（ArtPerf）,静脉灌注量PP（PortPerf）,总灌注量TP（TotalPerf）和灌注指数PI。结果：所有肿瘤的灌注图象均可以清晰直观的显示肿瘤大小和轮廓。所有肿瘤灌注参数均明显增高。可定量检测肿瘤内部组织灌注状态。图象清晰,分辨率高。结论：SSMSCT灌注成像检查是一种准确且简捷的定量评估肿瘤血流灌注状态的检查方法。     

128层螺旋CT全脑灌注诊断脑肿瘤的应用研究

目的 评价128 层螺旋CT 全脑灌注成像对脑肿瘤的诊断价值及其临床意义。方法回顾性分析经手术和病理组织学证实的36 例脑肿瘤患者的全脑CT 灌注成像资料。采用西门子128 层螺旋CT 行全脑CT 灌注成像,通过灌注分析软件获得时间-密度曲线（TDC) ,观测脑肿瘤和对侧脑组织的血流量（CBF）、血容量（CBV）、峰值时间（TTP）和毛细血管表面通透性（PS）等灌注参数,借助三点分级法评价单纯轴位图像与多维全脑灌注图像之间的差异,并对灌注参数进行统计学分析。结果在所有病例中,多维全脑灌注图像平均视觉评价分数明显高于单纯轴向灌注图（t＝-11.852,P＝0.000) ,且对病变定位更为精确。不同种类脑肿瘤TDC 具有各自不同特征,高级别胶质瘤TDC呈速升速降型,脑膜瘤与转移瘤均呈速升缓降型,有助于其鉴别诊断。统计学分析显示,肿瘤与对侧正常脑组织之间CBF、CBv 及PS值的差异均有统计学意义（P＜0.01),3种脑肿瘤之间CBF、TTP 和PS 值差异亦有统计学意义（P＜0.05）。结论 128 层螺旋CT 灌注成像结合CT 增强可用于全面评估脑血流灌注状态,有利于脑肿瘤的术前整体评估和精确定位;时间一密度曲线和灌注参数可用于量化分析和鉴定脑肿瘤的类型。     

肺癌MSCT灌注成像与病理分型的相关性研究

目的：对肺癌MSCT灌注成像及相关灌注参数进行分析,研究肺癌MSCT灌注成像与病理类型之间的关系,探讨其临床应用价值.方法：对32例肺癌患者,先行常规CT扫描,确定肿瘤的中心层面,然后采用电影技术对肿瘤中心层面进行连续扫描,以获得该层面内组织的时间-密度曲线,计算出血流量（BF）、血容量（BV）、平均通过时间（MTT）、表面渗透性（PS）,以此评价肿瘤灌注情况,并与病理分型进行对比分析.结果：中心型肺癌与周围性肺癌各灌注参数均无明显差异（P＞0.05）.对各型肺癌的灌注参数进行分析得出：各型肺癌BF、PS值大小关系为鳞癌＜腺癌（P＜0.05）,鳞癌＜小细胞癌（P＜0.05）,腺癌BF、PS值小于小细胞癌但两者之间的差异无统计学意义（P＞0.05）;各型肺癌BV值大小顺序为鳞癌＜腺癌＜小细胞癌（P＜0.05）;各型肺癌MTT值之间无明显差异.结论：肺癌MSCT灌注成像反映各型肺癌血流特点及肿瘤内部微血管密度变化,有利于肺癌病理分型诊断.     

多层螺旋CT灌注成像对胃癌血管通透性评估的价值

目的:探讨多层螺旋CT(multi-slice spiral CT,MSCT)灌注成像对胃癌血管通透性评估的价值。方法:对30例活检证实的胃癌患者术前行多层螺旋CT灌注成像,扫描图像经ADW4.0工作站处理,计算得到胃癌组织的表面通透性(permeability surface,PS)值,并分析其与胃癌临床病理特征和CT征象(CT轴位图像上瘤周低密度带厚度、肿瘤最大径和厚度)的关系。结果:胃癌病灶的PS值与淋巴结转移、TNM分期、组织学类型和肿瘤最大径均密切相关(P均<0.05),而与浸润深度、远处转移、性别、患者年龄和肿瘤部位无关。同时,胃癌PS值与CT轴位图像上瘤周低密度带厚度(r=0.417,P<0.05)和肿瘤最大径(r=0.557,P<0.01)均呈线性相关,而与肿瘤厚度无关。受试者工作特征(ROC)分析显示,胃癌PS值对胃癌组织学类型(分化型/未分化型)和TNM分期(Ia~IIIa/IIIb~IV)判断的准确率均较高[ROC曲线下面积(Az)分别为0.79和0.78]。结论:多层螺旋CT灌注成像对胃癌血管通透性的评估具有较大的临床应用价值。     

多层螺旋CT灌注成像对胃癌血管通透性评估的价值

目的：探讨多层螺旋CT（multi-slicespiral CT，MSCT）灌注成像对胃癌血管通透性评估的价值。方法：对30例活检证实的胃癌患者术前行多层螺旋CT灌注成像，扫描图像经ADW4．0工作站处理，计算得到胃癌组织的表面通透性（permeability surface，PS）值，并分析其与胃癌临床病理特征和CT征象（CT轴位图像上瘤周低密度带厚度、肿瘤最大径和厚度）的关系。结果：胃癌病灶的PS值与淋巴结转移、TNM分期、组织学类型和肿瘤最大径均密切相关（P均〈0．05），而与浸润深度、远处转移、性别、患者年龄和肿瘤部位无关。同时，胃癌PS值与cT轴位图像上瘤周低密度带厚度（r=0．417，P〈0．05）和肿瘤最大径（r=0．557，P〈0．01）均呈线性相关，而与肿瘤厚度无关。受试者工作特征（ROC）分析显示，胃癌PS值对胃癌组织学类型（分化型／未分化型）和TNM分期（Ⅰa -Ⅲa/Ⅲb -Ⅳ）判断的准确率均较高[ROC曲线下面积（Az）分别为0．79和0．78]。结论：多层螺旋cT灌注成像对胃癌血管通透性的评估具有较大的临床应用价值。 12—1796—04     

CT灌注成像在肺部肿瘤诊断中的应用

20世纪80年代初Axel等[1]首次提出了动态CT灌注功能成像的理论设想。随着多层螺旋CT(MSCT)扫描技术和计算机软硬件的发展,这一理论逐渐成为现实。多层螺旋CT扫描可以一次获得多个生理参数,新式的对比剂能在血管内存留更长时间,以及与PET标准化摄取值类似的计算标准化灌注值的CT灌注软件包的开发[2],使CT灌注成像技术正日趋成熟,现已成为1种形态学与功能成像相结合的新型影像学方法,得到临床广泛应用。国内外对CT灌注成像在肺部肿瘤诊断及鉴别诊断中的应用研究相对较多,现作一概述。1肺部CT灌注成像的常用灌注参数目前,进行肺灌注成…     

MSCT灌注成像评价体部肿瘤解剖学靶区的实验研究

目的:探讨MSCT灌注成像在构建体部肿瘤三维适形调强放疗靶区中的应用.方法:建立兔大腿VX2软组织肿瘤模型34例,肿瘤接种后第14天左右行CT平扫和灌注扫描,扫描图像经飞利浦Brilliance 190P工作站处理,计算并显示能够反映肿瘤组织血流灌注状态的伪彩灌注参数图像,包括BV图、BF图、PE图、TTP图,测量肿瘤最大层面在CT增强图、BV图、BF图、PE图、大体病理标本的长径、短径上的最大值.标本进行常规HE染色,在光镜下测量亚临床病灶距瘤体边缘的浸润距离,每张切片记录一个最大值.结果:GTVCECT和GTVpathology基本一致.GTVBV、GTVBF、GTVPE的长径、短径均大于GTVpathology的长径、短径(P＜0.01).BV图与CTV的一致性最好,以BV图勾画CTV需外放的比例最小.结论:放疗靶区勾画时,GTVCECT可以代替GTVpathology;CT灌注成像能显示显微侵袭病灶,可以为CTV的勾画提供依据.     

MSCT灌注成像在肺鳞癌诊断中的临床价值

目的：通过肺癌MSCT灌注成像及相关灌注参数分析,研究MSCT灌注成像在肺鳞癌诊断中的应用价值。方法：对32例肺癌患者,先行常规CT扫描,确定肿瘤的中心层面,然后采用电影技术对肿瘤中心层面进行连续扫描,以获得该层面内组织的时间-密度曲线,计算出血流量（BF）、血容量（BV）、平均通过时间（MTT）、表面渗透性（PS）,以此评价肿瘤灌注情况,并与病理分型进行对比分析。结果：分别以BF≤37.51ml/（min×100g）、BV≤7.59ml/100g、PS≤8.43ml/（min×100g）为肺鳞癌的诊断阈值,则其灵敏度分别为69.23%、69.23%、76.92%,特异度分别为73.68%、78.94%、84.21%。结论：当BF≤37.51ml/（min×100g）、BV≤7.59ml/100g且PS≤8.43ml/（min×100g）综合判定时,肺鳞癌的诊断特异度明显提高达93.75%。     

多层螺旋CT灌注成像对部分颅脑肿瘤和瘤样病变的评估

目的探讨多层螺旋CT灌注成像在脑肿瘤和瘤样病变诊断与鉴别诊断中的临床价值。方法56例患者中,脑内肿瘤38例,其中胶质瘤29例(低级组12例,高级组17例),室管膜瘤2例,血管母细胞瘤2例,髓母细胞瘤1例,转移瘤2例,畸胎瘤和淋巴瘤各1例;脑外肿瘤8例,其中脑膜瘤5例,神经鞘瘤2例,生殖细胞瘤1例;非肿瘤性病变10例,其中海绵状血管瘤6例,非特异性炎性肉芽肿2例,结核瘤1例,脉络丛增生1例。采用GElightspeed 16 slice多层螺旋CT机,行头部横断面平扫确定病灶中心层面,采用电影模式5-10 mm/2～4层,120 kV,180 mA,使用高压注射器经肘静脉注射非离子型造影剂,50～70 ml(300 mgI/ml),速率3～5 ml/s,延迟7 s,数据采集50 s。研究数据采用Perfusion(GE)软件包(去卷积算法)处理。结果胶质瘤高级组肿瘤的T-D曲线多呈尖蜂状,低级组则较平滑;脑膜瘤灌注曲线为速升缓降型,有较长的高位平台期。各级胶质瘤平均脑血液量(CBF)、脑血容量(CBV)和表面通透性(PS)值随肿瘤分级的升高而呈增加趋势,其中PS值相对值最显著,在伪彩图上可以确定肿瘤的边界,特别是合并出血时,具有独特价值。脑膜瘤的CBF低于胶质瘤高级组,其他灌注值与胶质瘤高级组比较,差异均无统计学意义。颅内海绵状血管瘤的灌注具有多样性,MTT的大幅延长、灌注曲线的多样性及0灌注区的出现,是其区别于其他肿瘤的特征。生殖细胞瘤和松果体区畸胎瘤CBF和CBV相对较低,而PS显著增高,灌注曲线呈快速上升后继续缓慢上扬。神经鞘瘤的灌注特征符合病理学表现,炎性病变的灌注表现不具特征性。结论多层螺旋CT灌注成像可在一定程度上反映肿瘤和瘤样病变的组织学特征及血液动力学改变,为诊断与鉴别诊断脑肿瘤和瘤样病变提供有价值的信息。     

Dermatomycosis in Goats in India

Summary: In an extensive survey involving 2176 goats 1.56% of goats manifested clinical lesions of ringworm infection. Animals below the age of 6 months were affected most (4.20%). The incidence of infection was higher during the winter months. T. verrucosum, T. mentagrophytes and M. gypseum were isolated from the skin scrapings of 12, 4, and 2 goats respectively. It is suggested that the infected animals could be a source of disease to human population in which the zoophilic dermatophyte invasion is characterized by severe inflammatory lesions of the skin. The zoonotic importance of different dermatophytes is stressed.
Zusammenfassung: In einer ausgedehnten Untersuchung an 2176 Ziegen wurden bei 1,56% klinische Zeichen einer Hautmykose festgestellt. Tiere, die jühger als 6 Monate alt waren, zeigten mit 4,20% am häfigsten Krankheitssymptome. In den Wintermonaten war die Erkrankungshäufigkeit am gröBten. T. vermcosum, T. mentagrophytes and M. gypseum wurden jeweils von 12,4 bzw. 2 Ziegen isoliert. Die inflzierten Tiere köinnen eine Infektionsquelle für die menschliche Bevölkerung darstellen und dort Mykosen mit stark entzündlichen Veränderungen auslösen. Die Bedeutung verschiedener Dermatophyten als Erreger von Zoonosen wird hervorgehoben.     

Trends in zygomycosis in children

Zygomycosis, or mucormycosis, is associated with significant morbidity and mortality in both children and adults. Studies in adults have shown an increase in the incidence of zygomycosis, particularly among haemtopoietic stem cell transplant (HSCT) recipients and patients with haematologic malignancies. There is a paucity of data on the epidemiology of zygomycosis in children. We performed a retrospective analysis to describe trends in zygomycosis between 1 January 2003 and 31 December 2010. We used the Pediatric Health Information System (PHIS) database to identify paediatric patients who were diagnosed with zygomycosis during the study period. Administrative data on diagnoses, demographics, underlying conditions and clinical experiences were collected. Summary statistics were calculated and tests for trend were conducted. We identified 156 unique patients with zygomycosis. The prevalence of zygomycosis did not significantly increase over time (P=0.284). The most common underlying condition was malignancy (58%) and over half received intensive care. Voriconazole utilisation among all hospitalised children significantly increased during the period (P=0.010). Our study demonstrates that the incidence of zygomycosis is not significantly increasing. During the time period there was a significant increase in the use of voriconazole among children.     

Increased apoptosis in cancer cells in vitro and in vivo by ceramides in transferrin-modified liposomes

Lysosomes are a promising therapeutic target for induction apoptosis in cancer cells due to lysosomal membrane permeabilization (LMP) leading to leakage of hydrolytic enzymes, especially the cathepsins, into the cytoplasm. We hypothesized that with the modification of the ceramide-loaded liposomes with transferrin (Tf), we would achieve both tumor targeting and increased delivery of lysosome-destabilizing agents, such as ceramides to lysosomes, to initiate LMP-induced apoptosis. We prepared Tf-modified (TL) and plain (PL) liposomes and loaded with short (C6)- or long (C16) N-acyl chain ceramides. Uptake, intracellular localization of liposomes, stability of the lysosomal membrane and release of cathepsin D were investigated on Hela cells by fluorescence microscopy and flow cytometry. Apoptosis was evaluated by binding of fluorescently-labeled Annexin V. Antitumor and pro-apoptotic effects of C6Cer-loaded Tf-liposomes were demonstrated in vivo in an A2780-ovarian carcinoma xenograft mouse model. TL were internalized specifically via the TfR-dependent endocytic pathway and localized within the endosome-lysosomal compartment. Ceramide-loaded Tf-liposomes significantly increased apoptosis compared with ceramide-free and ceramide-loaded non-modified liposomes. The treatment of cancer cells with TL led to increased LMP and cytoplasmic relocation of the intralysosomal cathepsin D. A strong antitumor and pro-apoptotic effect of C6Cer-loaded TL was also demonstrated in vivo in an A2780-ovarian carcinoma xenograft mouse model. The lysosomal accumulation of ceramides delivered by Tf-liposomes initiates the permeabilization of the lysosomal membranes required for the release of lysosomal cathepsins into the cytoplasm and initiation of the cancer cell apoptosis both in vitro and in vivo.     

Ringworm in animals in a farm in Assiut

Bericht über das Auftreten von Hautmykosen bei Tieren auf der Farm der Landwirtschaftlichen Fakultät der Universität Assiut. Von 70 Kälbern waren 42 pilzkrank, davon 22 durch T. mentagrophytes, 20 durch T. verrucosum. Von 180 Kühen waren 8 pilzbefalien, sämtlich durch T. mentagrophytes. Von 2 kranken Bullen wurde T. verrucosum isoliert. Auch die 3 Pferde und 2 Maultiere der Farm waren pilzinfiziert; Erreger war in diesen Fällen T. equinum. Auch ein Kalb war von T. equinum befallen. Die gleiche Pilzart wurde ferner von 3 Tierpflegern isoliert, die Pilzherde am Hals und an den Armen aufwiesen.     

Socioeconomic factors in cancer in Sweden

It is well known that certain cancers have shown clustering in socioeconomic groups, but limited data are available on recent results and time trends in such clustering. We determined standardized incidence ratios (SIR) for cancer, adjusted for age, period, region, parity and age at first childbirth among men and women in 6 socioeconomic groups based on the Swedish Family-Cancer Database. Persons had to be identified with the same socioeconomic status in the census of years 1960 and 1970, or of years 1960, 1970 and 1980; the comparison group was all people according to the same censuses. Cancers were followed from years 1970 to 1998 or from 1980 to 1998. Both increased and decreased SIRs were found, and a consistent pattern emerged, although the overall SIRs for cancer did not differ much, the lowest being for farmers (0.85) and the highest for professional men (1.07) and women (1.11). At individual sites, manual workers were at risk of tobacco-, alcohol- and occupation- and human papilloma virus-related cancers and at a decreased risk at most other cancers. Manual workers and farmers showed an excess of stomach cancer; professionals had an excess of melanoma and squamous cell skin cancer. Male and female SIRs correlated highly for manual and blue-collar workers and for professionals. The overall population-attributable fraction for selected sites was 16.7% for men and 10.9% for women and it was highest, over 50%, for lung cancer in both genders.     

Survey of changes in dietary preferences in cancer patients in China

Objective The aim of this study was to investigate the changes in dietary preferences in cancer patients in China and to determine the need for encouraging the adherence to a sensible diet among such patients.Methods A total of 468 cancer patients were interviewed using a self-designed questionnaire focusing on changes in the intake of specific foods. Data were analyzed using SPSS 16.0. Results Most patients completely avoided roosters and carp(73.1%), condiments(51.9%), and meat of aquatic species(40.4%). All other types of the specific foods were completely avoided by different subpopulations of the patients.Conclusion In addition to focusing on disease treatment, medical professionals need to help cancer patients overcome barriers associated with the customs of avoiding specific foods encompassed by the term ”fawu” and provide them with dietary guidance in order to prevent negative nutritional effects.     

Advances in cancer epidemiology in Japan

Epidemiologists in Japan have been performing calculations to estimate nationwide cancer incidence rates as well as 5‐year survival rates using population‐based cancer registry data. There have been remarkable changes in cancer incidence and/or mortality in cancers of the lung, liver and stomach, which were thought to be attributed to the changing impact of exposure to cigarette smoking, chronic hepatitis C virus infection and Helicobacter pylori infection, respectively. In systematic reviews providing evidence in risk/protective factors for cancer sites using case–control and cohort studies of the Japanese population, there were associations between cancer sites (esophagus, stomach, colo‐rectum, liver, pancreas, lung and breast) and various lifestyle factors. In the past 10 years, a hospital‐based case–control study at Aichi Cancer Center provided valuable evidence of gene‐environment interaction on the development of cancer [i.e., the effects of aldehyde dehydrogenase‐2 (ALDH2) polymorphism and heavy alcohol drinking on esophageal cancer, ALDH2 polymorphism and smoking on lung cancer, methylenetetrahydrofolate reductase polymorphism and heavy alcohol drinking on pancreatic cancer]. The database with stored DNA was also used and identified seven loci containing significant but low‐penetrance polymorphisms associated with the development of breast cancer. These findings together with established risk factors are likely to be useful to predict personalized breast cancer risk in East Asian women. In 2005, the Japan Multi‐Institution Collaborative Cohort (J‐MICC) study was launched to elucidate gene‐environment interactions as well as to confirm preclinical diagnostic biomarkers of cancer. J‐MICC, which has recruited 92,000 healthy individuals by the end of 2012, will follow the individuals until 2025.     

Foreign bodies in ENT in a teaching hospital in Eastern India

Objective

To evaluate the nature, common sites, modes of presentation of various foreign bodies (FB) in Ear, Nose and Throat (ENT).

Materials and methods

Observational retrospective study carried out at Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratishthan. The study period was between Jan 2006 to Jan 2007. The information obtained from the hospital record books.

Results

Four hundred and eighty-two patients presented in the Department of Otorhinolaryngology of Vivekananda Institute of Medical Sciences, in the study period with FB in their ENT. Out of 482 pts, the commonest location of FB was to be in throat with 302 pts (62%) followed by ear with 119 pts (25%) and nose 61 pts (13%). Amongst the FB in throat the commonest was fish bone and the commonest site being tonsils. Artificial denture accounted for a significant number of 13 (4.3%). External auditory canal was the commonest site of FB lodgment in ear found in 118 patients (99.16%). Nasal FB were found in 61 patients; more common in pediatric age group (98.36%).

Conclusion

From this study we have found that FB lodgement is a very common complaint with which patients come to otolaryngologist. The commonest site of FB lodgement is in the throat. Most of the FB could be removed in emergency room (ER) with or without Local Anesthesia.     

整合素在急性白血病中的研究进展

急性白血病是一种早期造血干/祖细咆的恶性克隆性疾病.微小残留病和耐药被认为是其复发和难治的根源.近来,越来越多的证据显示白血病细胞通过与骨髓微环境中的基质细胞或细胞外基质相互作用促进其存活,并增强其对常规化疗药物的耐药.整合素是介导细胞与细胞外基质（细胞与非细胞成分）粘连的最主要黏附分子,在细胞增殖、存活等生物学过程中发挥关键作用,但作用机制尚不完全清楚.现就目前揭示的整合素及肿瘤微环境在急性白血病发生、发展中的作用进行综述.