Reproductibilité test–retest des mesures stabilométriques après reconstruction du ligament croisé antérieur du genou chez le sujet sportif

Objective

To define the 3 day interval test-retest reproducibility of stabilometric measurements in two- and one legged stance in sport subjects recently operated from a knee anterior cruciate ligament reconstruction.

Méthode

Ten subjects aged between 16 to 33 years (23 year ± 5); carried out at 15 days after the knee surgery two sessions to measure steadiness in two legged stance with opened and closed eyes; in one legged stance with opened eyes, in healthy and operated leg, with full knee extension and with 20 degrees knee flexion. The reproducibility was determined using the intraclass correlation coefficient and the standard error of measurement was calculated.

Results

In two legged stance and in one legged stance, knee in 20 degrees flexion, the 95% sway area and the average antero-posterior excursion of the centre of pressure are reproducible (ICC > 0,75).The stabilometric parameters are not reproducible in one legged stance, knee in extension.

Conclusion

The reproducibility of stabilometric parameters is good, in two and in one legged stance knee flexed at 20 degrees, to evaluate the postural progress after anterior cruciate ligament reconstruction.     

读者·作者·编者

尊敬的编辑老师:您们好!我一直是贵刊的忠实读者,太喜欢《人民军医》杂志了,我深感该刊内容丰富,资料详实,编辑校对严谨认真,不愧是医学界的核心期刊。作为一名基层军队医务工作者,我也曾在贵刊发表过几篇论文。而对于我的每一篇拙文,您们都能够逐字推敲、反复修改,无论刊用与否均给予认真笔答,并且指出哪方面不足,应该向哪方面努力。您们这种“为他人做嫁衣”的服务态度和敬业精神真是太令我感动了,这将永远激励我在基层医疗岗位上尽职尽责地工作、默默无闻地奉献。您们不愧是期刊编辑学方面的专家,通过认真考虑您们对稿件的修改意见,使我撰写论文的思路越来越清晰,同时,通过不断的修改,也使我的业务水平有了较大提高。借此机会,请允许我向您们表示崇高的敬意和衷心的感谢!相信“天道酬勤”、“厚德载物”,贵刊一定会越办越好!新疆拜城69223部队卫生队单文俊2007年10月23日读者·作者·编者     

读者·作者·编者

来稿中关于统计分析方法的叙述,要写出具体名称,如成组设计资料的t检验、两因素析因设计资料的方差分析、多个均数之间两两比较的q检验。统计量的具体值,如t值、χ^2值、F值等,应尽可能给出具体的P值;当涉及总体参数,如总体均数、总体率等时,在给出显著性检验结果的同时,还应给出95％可信区间。     

<Superscript>68</Superscript>Ga-labeled cyclic RGD dimers with Gly<Subscript>3</Subscript> and PEG<Subscript>4</Subscript> linkers: promising agents for tumor integrin α<Subscript>v</Subscript>β<Subscript>3</Subscript> PET imaging

Purpose  Radiolabeled cyclic RGD (Arg-Gly-Asp) peptides have great potential for the early tumor detection and noninvasive monitoring of tumor metastasis and therapeutic response. ¹⁸F-labeled RGD analogs ([¹⁸F]-AH111585 and [¹⁸F]Galacto-RGD) have been investigated in clinical trials for positron emission tomography (PET) imaging of integrin expression in cancer patients. To develop new RGD radiotracers with higher tumor accumulation, improved in vivo kinetics, easy availability and low cost, we developed two new RGD peptides and labeled them with generator-eluted ⁶⁸Ga (t_1/2 = 68 min) for PET imaging of integrin α_vβ₃ expression in tumor xenograft models. Materials and methods  The two new cyclic RGD dimers, E[PEG₄-c(RGDfK)]₂ (P₄-RGD2, PEG₄ = 15-amino-4,7,10,13-tetraoxapentadecanoic acid) and E[Gly₃-c(RGDfK)]₂ (G₃-RGD2, G₃ = Gly-Gly-Gly) were designed, synthesized and conjugated with 1,4,7-triazacyclononanetriacetic acid (NOTA) for ⁶⁸Ga labeling. The microPET imaging and biodistribution of the ⁶⁸Ga labeled RGD tracers were investigated in integrin α_vβ₃-positive tumor xenografts. Results  The new RGD dimers with the Gly₃ and PEG₄ linkers showed higher integrin α_vβ₃ binding affinity than no-linker RGD dimer (RGD2). NOTA-G₃-RGD2 and NOTA-P₄-RGD2 could be labeled with ⁶⁸Ga within 30 min with higher purity (>98%) and specific activity (8.88–11.84 MBq/nmol). Both ⁶⁸Ga-NOTA-P₄-RGD2 and ⁶⁸Ga-NOTA-G₃-RGD2 exhibited significantly higher tumor uptake and tumor-to-normal tissue ratios than ⁶⁸Ga-NOTA-RGD2. Conclusion  Because of their high affinity, high specificity and excellent pharmacokinetic properties, further investigation of the two novel RGD dimers for clinical PET imaging of integrin α_vβ₃ expression in cancer patients is warranted. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Prévalence des troubles du comportement alimentaire chez le sportif

AimThe aim of the study was to determine the prevalence and relationships between disordered eating and psychological characteristics in 127 male and female elite athletes competing in 5 different sports and 31 non-competitive students matched for BMI and used as controls. All these parameters were assessed by a health/medical, dieting and menstrual history questionnaire, the Eating Attitudes Test (EAT-26), the Multidimensional perfectionism scale, the Body esteem scale, and the Self-Esteem scale.Results and discussion19% of female athletes had scores above the cut-off point on the Eating Attitudes Test questionnaire. 30.7% of female cyclists (30.7%), 25% of judoists and 22.3% of gymnasts (22.3%) would be "at risk" of EDs (EAT-26 > 20) and 0% in the male and female sedentary groups, basket- ball group and male athlete groups. The total frequency of menstrual dysfunction among females athletes was 33.1%. Females with eating disorders presented higher menstrual disturbances (71.4%) than the non-EDs (27.7%).ConclusionThe prevalence of disordered eating was higher in athletes than in sedentary groups, higher in female than in male athletes and more common among those competing in leanness-dependent and weight-dependent sports than in other sports. The prevalence of clinical eating disorders would increase when Self-oriented Perfectionism would be high and Body Satisfaction low.     

青春期男性的"三要""三不要"

要正确对待“面子”问题在进入青春期以后,男孩子的胡须开始生长,大多数人脸上还会长出许多“青春痘”,这本来是正常的生理现象,可有些男孩子最初对这种变化却不能接受,并往往因此而做出一些不正确的举动来:粉刺长出来了就去挤,胡须长出来了就去拔。岂不知,这样做是非常危险的。粉刺熟了自然会结痂脱落,如果在其结痂脱落前用手去挤,手上的细菌就有可能感染粉刺部位,造成发炎、红肿、甚至流脓,有的还会留下很难看的疤痕。男孩子的胡须是宜刮不宜拔的。这是因为人的面部(尤其是被称作“危险三角区”的口唇部位)是很容易被病菌感染的地方,即使…     

<Superscript>68</Superscript>Ga-labeled multimeric RGD peptides for microPET imaging of integrin α<Subscript>v</Subscript>β<Subscript>3</Subscript> expression

PURPOSE: We and others have reported that (18)F- and (64)Cu-labeled arginine-glycine-aspartate (RGD) peptides allow positron emission tomography (PET) quantification of integrin alpha(v)beta(3) expression in vivo. However, clinical translation of these radiotracers is partially hindered by the necessity of cyclotron facility to produce the PET isotopes. Generator-based PET isotope (68)Ga, with a half-life of 68 min and 89% positron emission, deserves special attention because of its independence of an onsite cyclotron. The goal of this study was to investigate the feasibility of (68)Ga-labeled RGD peptides for tumor imaging. METHODS: Three cyclic RGD peptides, c(RGDyK) (RGD1), E[c(RGDyK)](2) (RGD2), and E{E[c(RGDyK)](2)}(2) (RGD4), were conjugated with macrocyclic chelator 1,4,7-triazacyclononane-1,4,7-triacetic acid (NOTA) and labeled with (68)Ga. Integrin affinity and specificity of the peptide conjugates were assessed by cell-based receptor binding assay, and the tumor targeting efficacy of (68)Ga-labeled RGD peptides was evaluated in a subcutaneous U87MG glioblastoma xenograft model. RESULTS: U87MG cell-based receptor binding assay using (125)I-echistatin as radioligand showed that integrin affinity followed the order of NOTA-RGD4 > NOTA-RGD2 > NOTA-RGD1. All three NOTA conjugates allowed nearly quantitative (68)Ga-labeling within 10 min (12-17 MBq/nmol). Quantitative microPET imaging studies showed that (68)Ga-NOTA-RGD4 had the highest tumor uptake but also prominent activity accumulation in the kidneys. (68)Ga-NOTA-RGD2 had higher tumor uptake (e.g., 2.8 +/- 0.1%ID/g at 1 h postinjection) and similar pharmacokinetics (4.4 +/- 0.4 tumor/muscle ratio, 2.0 +/- 0.1 tumor/liver ratio, and 1.1 +/- 0.1 tumor/kidney ratio) compared with (68)Ga-NOTA-RGD1. CONCLUSIONS: The dimeric RGD peptide tracer (68)Ga-NOTA-RGD2 with good tumor uptake and favorable pharmacokinetics warrants further investigation for potential clinical translation to image integrin alpha(v)beta(3).     

<Superscript>18</Superscript>F-labeled mini-PEG spacered RGD dimer (<Superscript>18</Superscript>F-FPRGD2): synthesis and microPET imaging of α<Subscript>v</Subscript>β<Subscript>3</Subscript> integrin expression

Purpose We have previously reported that ¹⁸F-FB-E[c(RGDyK)]₂ (¹⁸F-FRGD2) allows quantitative PET imaging of integrin α_vβ₃ expression. However, the potential clinical translation was hampered by the relatively low radiochemical yield. The goal of this study was to improve the radiolabeling yield, without compromising the tumor targeting efficiency and in vivo kinetics, by incorporating a hydrophilic bifunctional mini-PEG spacer. Methods ¹⁸F-FB-mini-PEG-E[c(RGDyK)]₂ (¹⁸F-FPRGD2) was synthesized by coupling N-succinimidyl-4-¹⁸F-fluorobenzoate (¹⁸F-SFB) with NH₂-mini-PEG-E[c(RGDyK)]₂ (denoted as PRGD2). In vitro receptor binding affinity, metabolic stability, and integrin α_vβ₃ specificity of the new tracer ¹⁸F-FPRGD2 were assessed. The diagnostic value of ¹⁸F-FPRGD2 was evaluated in subcutaneous U87MG glioblastoma xenografted mice and in c-neu transgenic mice by quantitative microPET imaging studies. Results The decay-corrected radiochemical yield based on ¹⁸F-SFB was more than 60% with radiochemical purity of >99%. ¹⁸F-FPRGD2 had high receptor binding affinity, metabolic stability, and integrin α_vβ₃-specific tumor uptake in the U87MG glioma xenograft model comparable to those of ¹⁸F-FRGD2. The kidney uptake was appreciably lower for ¹⁸F-FPRGD2 compared with ¹⁸F-FRGD2 [2.0 ± 0.2%ID/g for ¹⁸F-FPRGD2 vs 3.0 ± 0.2%ID/g for ¹⁸F-FRGD2 at 1 h post injection (p.i.)]. The uptake in all the other organs except the urinary bladder was at background level. ¹⁸F-FPRGD2 also exhibited excellent tumor uptake in c-neu oncomice (3.6 ± 0.1%ID/g at 30 min p.i.). Conclusion Incorporation of a mini-PEG spacer significantly improved the overall radiolabeling yield of ¹⁸F-FPRGD2. ¹⁸F-FPRGD2 also had reduced renal uptake and similar tumor targeting efficacy as compared with ¹⁸F-FRGD2. Further testing and clinical translation of ¹⁸F-FPRGD2 are warranted. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. Zhanhong Wu and Zi-Bo Li contributed equally to this work.     

[<Superscript>18</Superscript>F]FPRGD<Subscript>2</Subscript> PET/CT imaging of integrin α<Subscript>v</Subscript>β<Subscript>3</Subscript> levels in patients with locally advanced rectal carcinoma

Purpose

Our primary objective was to determine if [¹⁸F]FPRGD₂ PET/CT performed at baseline and/or after chemoradiotherapy (CRT) could predict tumour regression grade (TRG) in locally advanced rectal cancer (LARC). Secondary objectives were to compare baseline [¹⁸F]FPRGD₂ and [¹⁸F]FDG uptake, to evaluate the correlation between posttreatment [¹⁸F]FPRGD₂ uptake and tumour microvessel density (MVD) and to determine if [¹⁸F]FPRGD₂ and FDG PET/CT could predict disease-free survival.

Methods

Baseline [¹⁸F]FPRGD₂ and FDG PET/CT were performed in 32 consecutive patients (23 men, 9 women; mean age 63?±?8 years) with LARC before starting any therapy. A posttreatment [¹⁸F]FPRGD₂ PET/CT scan was performed in 24 patients after the end of CRT (median interval 7 weeks, range 3 – 15 weeks) and before surgery (median interval 4 days, range 1 – 15 days).

Results

All LARC showed uptake of both [¹⁸F]FPRGD₂ (SUV_max 5.4?±?1.5, range 2.7 – 9) and FDG (SUV_max 16.5?±?8, range 7.1 – 36.5). There was a moderate positive correlation between [¹⁸F]FPRGD₂ and FDG SUV_max (Pearson’s r?=?0.49, p?=?0.0026). There was a moderate negative correlation between baseline [¹⁸F]FPRGD₂ SUV_max and the TRG (Spearman’s r?=??0.37, p?=?0.037), and a [¹⁸F]FPRGD₂ SUV_max of >5.6 identified all patients with a complete response (TRG 0; AUC 0.84, 95 % CI 0.68 - 1, p?=?0.029). In the 24 patients who underwent a posttreatment [¹⁸F]FPRGD₂ PET/CT scan the response index, calculated as [(SUV_max1 ? SUV_max2)/SUV_max1] × 100 %, was not associated with TRG. Post-treatment [¹⁸F]FPRGD₂ uptake was not correlated with tumour MVD. Neither [¹⁸F]FPRGD₂ nor FDG uptake predicted disease-free survival.

Conclusion

Baseline [¹⁸F]FPRGD₂ uptake was correlated with the pathological response in patients with LARC treated with CRT. However, the specificity was too low to consider its clinical routine use.

     

<Superscript>99m</Superscript>Tc-tetrofosmin or <Superscript>99m</Superscript>Tc-sestamibi for double-phase parathyroid scintigraphy?

Several years ago technetium-99m tetrofosmin was reported to localise parathyroid adenomas. The aim of this study was to compare the sensitivity of this radiopharmaceutical with that of (99m)Tc-sestamibi using a double-phase parathyroid scintigraphy protocol. Scans of 12 patients were evaluated visually and lesion to thyroid ratios were calculated. Nine of the patients were subsequently operated on; a total of eight parathyroid adenomas or hyperplastic glands were histologically confirmed in seven of the patients, while in one patient a parathyroid carcinoma was histologically proven. All of these patients had positive (99m)Tc-sestamibi scintigrams, whereas only two (99m)Tc-tetrofosmin scintigrams were positive. With (99m)Tc-sestamibi there was a significant increase in the lesion to thyroid ratio from 10 min to 90 min and 150 min p.i. which was not seen on scintigraphy with (99m)Tc-tetrofosmin. This makes (99m)Tc-tetrofosmin less suitable for double-phase parathyroid scintigraphy.     

In vivo imaging of tumour angiogenesis in mice with the α<Subscript>v</Subscript>β<Subscript>3</Subscript> integrin-targeted tracer <Superscript>99m</Superscript>Tc-RAFT-RGD

Purpose The molecular imaging of tumour neoangiogenesis currently represents a major field of research for the diagnostic and treatment strategy of solid tumours. Endothelial cells from tumour neovessels overexpress the α_vβ₃ integrin, which selectively binds to Arg-Gly-Asp (RGD)-containing peptides. We evaluated the potential of the novel radiotracer ^99mTc-RAFT-RGD for the non-invasive molecular imaging of α_vβ₃ integrin expression in mice models of tumour development. Methods ^99mTc-RAFT-RGD, ^99mTc-cRGD (specific control) and ^99mTc-RAFT-RAD (non-specific control) were injected intravenously to mice bearing B16F0 or TS/A-pc tumours. In vivo whole-body tomographic imaging and post-mortem biodistribution studies were performed 60 min following tracer injection. Adjacent tumour slices were used to compare the localisation of neovessels from immunostaining and the pattern of ^99mTc-RAFT-RGD uptake from autoradiographic ex vivo imaging. Results Biodistribution studies indicated that ^99mTc-RAFT-RGD tumour uptake was significantly higher than that of ^99mTc-RAFT-RAD in B16F0 (2.4±0.5 vs 1.0±0.1%ID/g, respectively) and in TS/A-pc tumours (2.7±0.8 vs 0.7±0.1%ID/g, respectively). Immunohistochemical and autoradiographic studies indicated that ^99mTc-RAFT-RGD intratumoural uptake preferentially occurred in angiogenic areas. Tomographic imaging allowed tumour visualisation following injection of ^99mTc-RAFT-RGD and ^99mTc-cRGD with similar tumour-to-contralateral muscle (T/CM) ratios in B16F0 and in TS/A-pc tumours whereas ^99mTc-RAFT-RAD T/CM ratios did not allow tumour imaging. In accordance with the higher level of α_vβ₃ integrin expression on TS/A-pc tumours than on B16F0 tumours as determined from western blot and immunoprecipitation analyses, the ^99mTc-RAFT-RGD T/CM ratio was significantly higher in TS/A-pc than in B16F0 tumours. Conclusion ^99mTc-RAFT-RGD allowed the in vivo imaging of α_vβ₃ integrin tumour expression.     

Inter-heterogeneity and intra-heterogeneity of α<Subscript>v</Subscript>β<Subscript>3</Subscript> in non-small cell lung cancer and small cell lung cancer patients as revealed by <Superscript>68</Superscript>Ga-RGD<Subscript>2</Subscript> PET imaging

Purpose

Integrin α_vβ₃ is the therapeutic target of the anti-angiogenic drug cilengitide. The objective of this study was to compare α_vβ₃ levels in non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) patients, by using the positron emission tomography (PET) tracer ⁶⁸Ga-labeled dimerized-RGD (⁶⁸Ga-RGD₂).

Methods

Thirty-one patients with pathologically confirmed lung cancer were enrolled (21 were NSCLC and 10 were SCLC). PET/CT images were acquired using ⁶⁸Ga-RGD₂.¹⁸F-FDG PET/CT images were also acquired on the consecutive day as reference. The standard uptake values (SUV) and the tumor/nontarget (T/NT) values were quantitatively compared. Expression of the angiogenesis marker α_vβ₃ in NSCLC and SCLC lesions was analyzed by immunohistochemistry.

Results

The ¹⁸F-FDG SUVmax and the SUVmean were not significantly different between NSCLC and SCLC patients. The ⁶⁸Ga-RGD₂ uptake of SCLC patients was at background levels in both SUV and T/NT measurements and was significantly lower than that of NSCLC patients. The range value of ⁶⁸Ga-RGD₂ SUVmean was 4.5 in the NSCLC group and 2.2 in the SCLC group, while the variation coefficient was 36.2% and 39.3% in NSCLC and SCLC primary lesions, respectively. Heterogeneity between primary lesions and putative distant metastases was also observed in some NSCLC cases. Immunostaining showed that α_vβ₃ integrin was expressed in the cells and neovasculature of NSCLC lesions, while SCLC samples had negative expression.

Conclusions

The uptake of ⁶⁸Ga-RGD₂ in SCLC patients is significantly lower than that in NSCLC patients, indicating a lower α_vβ₃ target level for cilengitide in SCLC. Apparent intra-tumor heterogeneities of α_vβ₃ also exist in both NSCLC and SCLC. Such inter- and intra-heterogeneity of α_vβ₃ may potentially improve current applications of α_vβ₃-targeted therapy and diagnostic imaging in lung cancer.

     

"预防为主"方针溯源

我军革命建设发展的80年，也是我军卫生工作建设发展的80年。回顾我军卫生工作的光辉历程，无不与“预防为主”的方针联系在一起。     

正确使用"膏药"

在现实生活中,人们对"膏药"并不陌生,遇到跌打损伤时往往随便到药店买点膏药贴贴。实际上,膏药种类很多,应根据自己的具体情况去选择。掌握好适应证每种膏药都有其独特的药理作用,各不相同,不可"通