188Re标记放射性药物在肿瘤治疗中的研究进展

随着188W-188Rc发生器的广泛应用,188Re成为近年来最常用的治疗型放射性核素之一,已经开发了许多188Re标记的放射性药物应用于肿瘤治疗,国内外相关的研究报道也逐渐增多,笔者参照最新资料,综述了其研究进展及应用前景。     

尖锐湿疣患者治疗前后血清MIF和HMGB1检测的临床意义

目的探讨尖锐湿疣患者治疗前后血清巨噬细胞移动抑制因子（MIF）和高迁移率蛋白-1（HMGB1）水平的变化及意义。方法采用酶联免疫（ELISA）法检测血清MIF和HMGB1含量;分别对62例尖锐湿疣患者进行了血清MIF和HMGB1检测,并与35名正常健康人作比较。结果在治疗前尖锐湿疣患者MIF和HMGB1水平均非常显著高于正常人组（P〈0．01）。经3个月治疗后血清MIF和HMGB1水平与正常人组比较无显著性差异（尸〉O．05）。患者组治疗前后血清MIF和HMGB1水平也有显著性差异（P〈0．01）。尖锐湿疣患者血清HMGB1浓度与MIF浓度呈正相关（r=033,P〈0．01）。结论检测尖锐湿疣患者血清MIF和HMGB1水平的变化对改病的治疗。预后观察有重要的临床价值。     

星形诺卡菌肺部感染1例并文献复习

[摘要]?诺卡菌广泛分布于外界环境中,由其引起的化脓性肺部感染称为肺诺卡菌病。临床感染常见致病菌为星形诺卡菌。肺诺卡菌病缺乏特异性临床表现和影像学特征,目前尚无特异性的诊断指标,临床极易造成误诊、漏诊。诺卡菌的分离与培养为诊断该病的金标准。本文现对1例星形诺卡菌肺部感染病例进行分析,并结合文献复习,对该病的临床特征、影像学特点、实验室诊断及治疗进行探讨,为临床诊治该类疾病提供借鉴和参考。     

Calcium oxalate monohydrate crystal binding substance produced from Madin-Darby canine kidney cells

BACKGROUND: The interaction between kidney urothelium and crystals is a critical event in the growth of renal calculi. When studying calcium oxalate monohydrate (COM) crystal binding to Madin-Darby canine kidney (MDCK) cells in culture, we observed that crystals also attached to areas on the coverslips devoid of cells. This phenomenon could be the result of substances produced by the cells that adhere to the glass and subsequently bind COM crystals. We investigated the characteristics of this COM binding substance. METHODS: Media was collected from cultures of MDCK cells (conditioned media) and proteins were separated by high performance liquid chromatography. The molecular weights and purity of isolated proteins were determined by polyacrylamide gel electrophoresis. The conditioned media and each separated fraction were applied to glass and to MDCK cells and COM-binding ability determined using 14C-labeled crystals. The binding of radio-labelled calcium oxalate dihydrate, brushite, uric acid, and apatite to coverslips were also studied. RESULTS: Fourteen times more COM bound to coverslips incubated with conditioned media than those with control media. The molecular weight of the protein bound to the glass was determined to be 200 kDa. The COM crystals binding to this protein was 1.5 micro g/ng. Other crystals bound to a lesser extent. The incubation of cells with this protein inhibited COM binding by 39%. CONCLUSION: The MDCK cells produce a 200-kDa protein that has a high binding affinity for COM crystals. This protein binds to glass and is responsible for crystal binding to areas devoid of cells. This protein also has an inhibitory effect on COM binding to MDCK cells in culture.     

IFN-γ在骨髓增生异常综合征发病中作用

目的 研究骨髓增生异常综合征(MDS)患者骨髓内T细胞亚群水平，T细胞产生IFN-γ能力，及与造血干细胞凋亡的关系，探讨T细胞、IFN-γ在MDS发病中作用。方法 骨髓单个核细胞经短期培养并激活T细胞，采用细胞内因子测定技术，用流式细胞术测定骨髓内T细胞亚群，T细胞IFN-γ水平，RT-PCR技术测定BMMNC凋亡基因Fasm-RNA水平。结果 MDS患者骨髓内异常活化的T细胞(CD3^ CD45RO^ 、CD4^ CD45RO^ 、CD8^ CD45RO^ 细胞)增多，活化的T细胞产生IFN-γ增多，并与Fas-mRNA存在相关性。结论 MDS患者骨髓内活化的T细胞增多，这些细胞产生的IFN-γ可能增加凋亡基因Fas的表达。     

彩色多普勒超声诊断睾丸附件扭转的价值

目的探讨彩色多普勒超声诊断睾丸附件扭转的价值。方法对37例经彩色多普勒超声检查并经临床确诊为睾丸附件扭转患者的超声声像图表现进行回顾性分析。结果37例患者中,超声诊断为睾丸附件扭转者35例,超声误诊2例,诊断准确率为94.6%（35/37）。彩色多普勒超声显示睾丸上极或附睾头旁大小不等的不均质高回声结节,内无血流;25例患侧睾丸呈不同程度增大,血流增多;29例显示睾丸鞘膜腔内积液;30例显示阴囊壁不同程度增厚。结论睾丸上极或附睾头旁无血流的高回声结节是睾丸附件扭转的特征性声像图表现。彩色多普勒超声对睾丸附件扭转诊断准确性高,可作为诊断睾丸附件扭转的最佳检查方法。     

曲美他嗪对稳定型心绞痛血管内皮功能的影响

目的 :探讨曲美他嗪对稳定型心绞痛血管内皮功能的影响。方法 :稳定型心绞痛 6 0例 ,随机分为 2组 ,对照组常规服用硝酸酯类、钙离子拮抗剂、β受体阻滞剂、血小板抑制剂 ;曲美他嗪组在服用以上药物的基础上加用曲美他嗪 （2 0 m g） ,每日 3次 ,服 4周。采用高分辨超声技术检测肱动脉舒张功能 ;测定两组基础状态和治疗后的血浆一氧化氮 （NO）、内皮素 - 1（ET- 1）水平。结果 :1反应性充血引起肱动脉内径变化 ,曲美他嗪组显著增强 （P<0 .0 1）。两组含服硝酸甘油后的血管舒张反应无显著差异 （P>0 .0 5 ）。 2治疗后 ,曲美他嗪组与对照组比较 NO显著升高 ,ET- 1水平下降 ,有非常显著性差异 （P<0 .0 1）。结论 :曲美他嗪对稳定型心绞痛血管内皮功能具有保护作用。     

Target Temperatures of 48°C versus 60°C During Slow Pathway Ablation:

INTRODUCTION: The relationship between temperature at the electrode-tissue interface and the loss of AV and ventriculoatrial (VA) conduction is not established, and the optimal target temperature for the slow pathway approach to radiofrequency ablation of AV nodal reentrant tachycardia (AVNRT) is unknown. Therefore, the purpose of this study was to compare target temperatures of 48 degrees C and 60 degrees C during the slow pathway approach to ablation of AVNRT. METHODS AND RESULTS: The study included 138 patients undergoing ablation for AVNRT. Patients undergoing slow pathway ablation using closed-loop temperature monitoring were randomly assigned to a target temperature of either 48 degrees C or 60 degrees C. The primary success rates were 76% in the patients assigned to 48 degrees C and 100% in the patients assigned to 60 degrees C (P < 0.01). The ablation procedure duration (33 +/- 31 min vs 26 +/- 28 min; P = 0.2), fluoroscopic time (25 +/- 15 min vs 24 +/- 16 min; P = 0.5), and mean number of applications (9.3 +/- 6.5 vs 7.8 +/- 8.1; P = 0.3) were similar in patients assigned to 48 degrees and 60 degrees C, respectively. The mean temperature (46.1 degrees +/- 24.8 degrees C vs 48.7 +/- 3.2 degrees C; P < 0.01), the temperature associated with junctional ectopy (48.1 degrees +/- 2.0 degrees C vs 53.5 degrees +/- 3.5 degrees C, P < 0.0001), and the frequency of VA block during junctional ectopy (24.6% vs 37.2%; P < 0.0001) were less in the patients assigned to 48 degrees C compared to 60 degrees C. The frequency of transient or permanent AV block was similar in each group (2.8% vs 3.6%; P = 0.2). In the 60 degrees C group, only 12% of applications achieved an electrode temperature of 60 degrees C. During follow-up of 9.9 +/- 4.2 months, there was one recurrence of AVNRT in the 48 degrees C group and none in the 60 degrees C group. CONCLUSIONS: Compared to 48 degrees C, a target temperature of 60 degrees C during radiofrequency slow pathway ablation is associated with a higher primary success rate and a higher incidence of VA block during junctional ectopy induced by the radiofrequency energy. AV block is not more common with the higher target temperature, but only if VA conduction is aggressively monitored during applications of radiofrequency energy.     

Conduction Properties of the Crista Terminalis in Patients with Typical Atrial Flutter: Basis for a Line of Block in the Reentrant Circuit

Conduction Properties of the Crista Terminalis . Introduction: Previous mapping studies in patients with typical atrial flutter have demonstrated the crista terminalis to he a posterior harrier of the reentrant circuit forming a line of block. However, the functional role of the crista terminalis in patients with or without a history of atrial flutter is not well known. The aim of this study was to determine whether the conduction properties of the crista terminalis are different between patients with and those without a history of atrial flutter. Methods and Results: The study population consisted of 12 patients with clinically documented atrial flutter (group 1) and 12 patients with paroxysmal supraventricular tachycardia as well as induced atrial flutter (group 2). A 7-French, 20-pole, deflectable Halo catheter was positioned around the tricuspid annulus. A 7-French, 20-pole Crista catheter was placed along the crista terminalis identified by the recording of double potentials with opposite activation sequences during typical atrial flutter. After sinus rhythm was restored, pacing from the low posterior right atrium near the crista terminalis was performed at multiple cycle length to 2:1 atrial capture. No double potentials were recorded along the crista terminalis during sinus rhythm in both groups. In group 1, the longest pacing cycle length that resulted in a line of block with double potentials along the crista terminalis was 638 ± 119 msec. After infusion of propranolol, it was prolonged to 832 ± 93 msec without change of the interdeflection intervals of double potentials. In group 2, the longest pacing cycle length that resulted in a line of block with double potentials along the crista terminalis was 214 ± 23 msec. After infusion of procainamide, it was prolonged to 306 ± 36 msec with increase of interdeflection interval of double potentials. Conclusion: The crista terminalis forms a line of transverse conduction block during typical atrial flutter. Poor transverse conduction property in the crista terminalis may be the requisite substrate for clinical occurrence of typical atrial flutter.     

Nonlinear Analysis of Fibrillatory Electrogram Similarity to Optimize the Detection of Complex Fractionated Electrograms During Persistent Atrial Fibrillation

Nonlinear Analysis of Atrial Fibrillation . Introduction: Currently, the identification of complex fractionated atrial electrograms (CFEs) in the substrate modification is mostly based on cycle length‐derived algorithms. The characteristics of the fibrillation electrogram morphology and their consistency over time are not clear. The aim of this study was to optimize the detection algorithm of crucial CFEs by using nonlinear measure electrogram similarity. Methods and Results: One hundred persistent atrial fibrillation patients that underwent catheter ablation were included. In patients who required CFE ablation (79%), the time‐domain fibrillation signals (6 seconds) were acquired for a linear analysis (mean fractionation interval and dominant frequency [DF]) and nonlinear‐based waveform similarity analysis of the local electrograms, termed the similarity index (SI). Continuous CFEs were targeted with an endpoint of termination. Predictors of the various signal characteristics on the termination and clinical outcome were investigated. Procedural termination was observed in 39% and long‐term sinus rhythm maintenance in 67% of the patients. The targeted CFEs didn't differ based on the linear analysis modalities between the patients who responded and did not respond to CFE ablation. In contrast, the average SI of the targeted CFEs was higher in termination patients, and they had a better outcome. Multivariate regression analysis showed that a higher SI independently predicted sites of termination (≥0.57; OR = 4.9; 95% CI = 1.33–18.0; P = 0.017). Conclusions: In persistent AF patients, a cycle length‐based linear analysis could not differentiate culprit CFEs from bystanders. This study suggested that sites with a high level of fibrillation electrogram similarity at the CFE sites were important for AF maintenance. (J Cardiovasc Electrophysiol, Vol. 24, pp. 280‐289, March 2013)