68Ga-PSMA-11 PET-CT对初诊前列腺癌患者阳性发现的效果评价

目的 探讨以68镓(68Ga)标记的靶向前列腺特异性膜抗原(PSMA)分子探针PSMA-11为示踪剂的PET-CT(68Ga-PSMA-11 PET-CT)检测初诊前列腺癌患者的阳性发现情况.方法 回顾性分析2019年1月至12月经前列腺活体组织穿刺病理学初次确诊、于海军军医大学(第二军医大学)长海医院行68Ga-PSMA-11 PET-CT检查的45例前列腺癌患者的影像学及临床资料.采用二分类判别法定性分析68Ga-PSMA-11 PET-CT图像,以诊断前列腺癌原发灶是否累及前列腺两叶、突破包膜、侵犯精囊和发生区域淋巴结转移.以根治性切除术标本的病理学结果为金标准,对影像-病理的配对样本进行McNemar检验,并计算Kappa系数.结果 68Ga-PSMA-11 PET-CT检测初诊前列腺癌患者的原发灶累及前列腺两叶、突破包膜、侵犯精囊和发生区域淋巴结转移的准确度分别为60.0％(27/45)、57.8％(26/45)、75.6％(34/45)和84.4％(38/45),Kappa 系数分别为0.075(P=0.375)、0.249(P=0.025)、0.409(P=0.003)和0.444(P=0.002).结论 68Ga-PSMA-11 PET-CT对判断初诊前列腺癌患者病灶是否存在侵犯精囊和发生区域淋巴结转移有一定价值,但对是否累及前列腺两叶和突破包膜的诊断价值较低.     

68Ga-PSMA-11 PET-CT与全身磁共振成像诊断前列腺癌远处转移的效能比较

目的 对比分析以68镓(68Ga)标记的靶向前列腺特异性膜抗原(PSMA)分子探针PSMA-11为示踪剂的PET-CT(68Ga-PSMA-11 PET-CT)与全身磁共振成像(WB-MRI)诊断前列腺癌远处转移的效能.方法 回顾性分析2019年1月至12月我院收治的行68Ga-PSMA-11 PET-CT及WB-MRI的52例前列腺癌患者的临床资料.由核医学科及影像医学科主治医师各2名分别对患者的68Ga-PSMA-11 PET-CT和WB-MRI检查结果进行盲法分析,并以最佳比较标准(BVC)为金标准对患者进行分组.根据结果绘制ROC曲线并计算AUC,对2种检查方法的灵敏度、特异度等进行统计分析.结果 入组的52例前列腺癌患者中20例无远处转移、32例发生远处转移.WB-MRI检测远处转移的 AUC 为0.844(95％CI0.719～0.968),灵敏度为93.75％(30/32)、特异度为75.00％(15/20);68Ga-PSMA-11 PET-CT 检测远处转移的AUC为0.959(95％CI0.893～1.000),灵敏度为96.88％(31/32)、特异度为95.00％(19/20),2种方法的灵敏度及特异度差异均无统计学意义(P均＞0.05).远处转移患者中有25例发生骨转移、29例发生淋巴结转移.68Ga-PSMA-11 PET-CT检测前列腺癌骨转移灶的灵敏度为92.00％(23/25)、特异度为100.00％(27/27),WB-MRI检测灵敏度为60.00％(15/25)、特异度为88.89％(24/27),2种方法灵敏度差异有统计学意义(P=0.04);2种方法对淋巴结转移检测的灵敏度[89.66％(26/29)vs 86.21％(25/29)]及特异度[95.65％(22/23)vs 91.30％(21/23)]差异均无统计学意义(P均＞0.05).结论 68Ga-PSMA-11 PET-CT与WB-MRI检测前列腺癌远处转移均具有较高的诊断效能.在骨转移的诊断方面,68Ga-PSMA-11 PET-CT的诊断效能优于WB-MRI.     

68Ga-PSMA-11 PET-CT与全身磁共振成像诊断前列腺癌远处转移的效能比较

目的 对比分析以68镓(68Ga)标记的靶向前列腺特异性膜抗原(PSMA)分子探针PSMA-11为示踪剂的PET-CT(68Ga-PSMA-11 PET-CT)与全身磁共振成像(WB-MRI)诊断前列腺癌远处转移的效能.方法 回顾性分析2019年1月至12月我院收治的行68Ga-PSMA-11 PET-CT及WB-MR...     

68Ga-PSMA-11 PET-CT辅助前列腺癌的全病程管理:单中心回顾性研究

目的 探讨以68镓(68Ga)标记的靶向前列腺特异性膜抗原(PSMA)分子探针PSMA-11为示踪剂的PET-CT(68Ga-PSMA-11 PET-CT)辅助前列腺癌全病程管理的应用效果.方法 收集2019年1月31日至12月31日于海军军医大学(第二军医大学)长海医院接受68Ga-PSMA-11 PET-CT检查的...     

正电子发射型CT图像融合示踪剂11C-胆碱对前列腺癌诊断价值的初步探讨

目的:探讨新型正电子发射型体层摄影术-X线计算机体层摄影图像融合(PET-CT)示踪剂11C-胆碱对前列腺癌的诊断价值。方法:回顾性分析24例前列腺病变患者的11C-胆碱PET-CT显像。前列腺癌12例,良性前列腺增生12例,均经组织病理学确诊,注射11C-胆碱后5min获取数据。对前列腺增生组织和前列腺癌部位分别计算标准摄取值(SUV)。结果:良性前列腺增生~(11)C-胆碱PET-CT表现为前列腺内放射性分布较均匀,轻度摄取增高或前列腺左右侧对称性结节状轻度摄取增高,平均SUV值为2.2(1.3～3.68)。前列腺癌11C-胆碱PET-CT表现为前列腺内局限性、灶状非对称性异常放射性浓聚或弥漫性不均匀性明显异常放射性摄取增高,平均SUV值8.7(2.3～29.61)。盆壁骨转移和盆腔内增大淋巴结均表现为异常放射性浓聚。结论:11C-胆碱PET-CT对前列腺癌的诊断、盆腔淋巴结转移及盆壁骨转移的检出具有较高的价值。     

初诊前列腺癌患者代谢体积参数与临床指标的相关性

目的 探索初诊前列腺癌(PCa)患者68镓标记的前列腺特异性膜抗原(68Ga-PSMA)-11 PET-CT的代谢体积参数与临床指标的相关性.方法 回顾性分析2019年1月至12月经前列腺活体组织穿刺病理学确诊,于海军军医大学(第二军医大学)长海医院行68Ga-PSMA-11 PET-CT检查的85例未经治疗PCa患者的影像学及临床资料.85例患者中未发生肿瘤转移的有46例(无转移组)、发生肿瘤转移的有39例(转移组).采用Spearman秩相关检验分别分析两组患者原发灶最大标准摄取值(SUVmax),原发灶平均标准摄取值(SUVmean)及病灶前列腺特异性膜抗原(PSMA)总量(TL-PSMA)等多个代谢体积参数与年龄、BMI、格里森评分(GS)、前列腺特异性抗原(PSA)等临床指标的相关性.结果 无转移组中,PSA与原发灶SUVmax、原发灶TL-PSMA呈中度正相关(rs=0.409,P=0.005;rs=0.587,P<0.001);而GS与原发灶SUVmax、原发灶TL-PSMA不相关(rs=0.181,P=0.229;rs=0.101,P=0.505).转移组中,PSA与原发灶TL-PSMA、转移灶TL-PSMA、全身病灶TL-PSMA呈中度正相关(rs=0.439,P=0.005;rs=0.588,P<0.001;rs=0.569,P<0.001),与原发灶SUVmax不相关(rs=0.255,P=0.117);而GS与原发灶SUVmax、原发灶TL-PSMA、转移灶TL-PSMA、全身病灶TL-PSMA均不相关(rs=0.069,P=0.675;rs=0.194,P=0.237;rs=0.299,P=0.064;rs=0.300,P=0.063).结论 反映初诊PCa患者全身肿瘤负荷的代谢体积参数TL-PSMA与血清PSA呈正相关,而与反映原发灶分化程度的GS不相关.     

前列腺基底细胞癌3例

探讨前列腺基底细胞癌（basal cell carcinoma,BCC）临床病理特点并提高诊疗认识。通过报道3例BCC患者的临床病理特点及诊疗经过,结合文献复习,提高对BCC诊疗特点的认识。3例BCC患者年龄为57~83岁,其中1例因血尿就诊,2例因排尿困难就诊。3例患者均合并前列腺增生,其中2例患者前列腺特异性抗原（prostate specific antigen,PSA）增高,1例PSA正常。病例1前列腺癌侵及膀胱、直肠前筋膜,伴淋巴结转移、骨转移、双肺多发转移,2014年11月2日行膀胱全切+双侧输尿管皮肤造口术+双侧闭孔及髂内淋巴结清扫术,术后病理诊断BCC,2015年1月8日复查盆腔增强MRI提示盆腔内复发,2015年7月11日复查腹部增强CT提示肝多发转移,胰腺转移,2015年10月因前列腺癌死亡。病例2于2015年3月27日行前列腺穿刺病理诊断为BCC,伴肺转移及骨转移,行化疗及内分泌治疗,后行局部放射治疗,2016年1月11日复查正电子发射断层显像与计算机断层显像（positron emission tomography and computed tomography,PET-CT）示患者肺转移瘤及骨转移瘤直径较前增大,数量增多,随访至2016年1月10日患者带瘤生存。病例3外院行经尿道前列腺电切术（transurethral resection of prostate,TURP）,术后病理考虑BCC可能,行PET-CT提示残余前列腺恶性肿瘤,伴双侧盆腔淋巴结转移可能,2016年4月20日复查PET-CT提示盆腔可见巨大不规则混杂密度影,临床考虑肿瘤复发,遂予局部放射治疗,随访至2016年1月10日患者带瘤生存。BCC临床罕见,是一种侵袭能力强、恶性程度较高、易发生转移的肿瘤,需要给予积极的治疗和密切的随访。     

血清PSA联合核素骨显像诊断前列腺癌骨转移的价值

目的探讨核素全身骨显像和血清前列腺特异性抗原(PSA)对前列腺癌骨转移诊断价值。方法对82例前列腺癌患者核素全身骨显像和PSA结果进行回顾研究,并对骨转移与PSA水平进行相关分析。结果前列腺癌患者骨转移率为79.3%,常见转移部位是骨盆、腰椎及股骨,随着PSA值不断增高,骨转移阳性率也增高,尤其当PSA>60μg/L时,发生前列腺癌骨转移率100%,而PSA<20μg/L时,发生前列腺癌骨转移的机率很小。结论核素全身骨显像是诊断前列腺癌早期骨转移的最佳检查手段,核素全身骨显像结合PSA结果可以提高判断骨转移准确性,尤其对单个病灶的性质判断更为重要。当PSA>20μg/L时,前列腺癌发生骨转移的可能性很大,应常规进行核素全身骨显像。     

11C-CHO PET/CT显像在前列腺癌诊断中应用的研究进展

¹¹C-CHO PET/CT 已被证实在前列腺癌的诊断中具有较好的应用前景,虽尚不适用于前列腺癌原发灶定性诊断和转移淋巴结分期的一线诊断,但其能提高复发
前列腺癌及转移淋巴结再分期的诊断准确率,并与血清前列腺特异性抗原(PSA)和去雄激素治疗密切相关。本文作者对¹¹C-CHO PET/CT对前列腺癌的原发灶和复发灶的定性诊断、转移淋巴结的分期与再分期及前列腺癌骨转移等领域中的应用情况以及¹¹C-CHO PET/CT与PSA及去雄激素治疗之间的关联性等进行综述。
     

80例前列腺癌骨转移的PSA、ECT骨显像诊断分析

目的:探讨前列腺特异抗原(PSA)、发射型计算机断层扫描(ECT) 99Tc.MDP骨显像诊断前列腺癌骨转移的临床意义.方法:对80例(骨转移组31例,非骨转移组49例)前列腺癌患者的PSA、ECT与骨转移的关系进行分析.结果:骨转移组与非骨转移组的血清测试PSA值差异有显著性(139.36μg/L和37.58μg/L,P＜0.01),与ECT全身骨显像,PSA与骨转移的程度正相关,血清PSA＜10μg/L,ECT全身骨显像骨转移率为15.38％;血清PSA＜ 20μg/L,ECT骨转移率为19.35％;血清PSA ＞20μg/L,ECT全身骨转移率为51.02％;血清PSA ＞ 100μg/L,ECT骨转移率为78.95％.结论:ECT 骨显像对前列腺癌骨转移有较高的敏感性,对未经治疗的前列腺癌患者,血清测定PSA＜10μg/L,前列腺癌骨转移的可能性极小;PSA＞100μg/L,者,骨转移的可能性极大.PSA＞ 20g/L,建议行ECT骨扫描.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.