Clinical impact of integrated PET/CT on the management of suspected cervical cancer recurrence

OBJECTIVES: To assess the value and clinical impact of integrated PET/CT using (18)F-FDG in the diagnosis and management of women with suspected cervical cancer recurrence. METHODS: Fifty-two patients with cervical cancer with suspected recurrence because of clinical, cytological, biochemical and radiological findings were retrospectively evaluated. A final diagnosis of recurrence was confirmed by histologic tissue biopsy or by further clinical or radiological evidence. The clinical impact of information provided by PET/CT on patient management was assessed on the basis of clinical follow-up data concerning further diagnostic or therapeutic approach. RESULTS: Twenty-eight of 32 positive PET/CT scans (87.5%) were proven to have recurrent disease. Seventeen of 20 negative PET/CT scans (85.0%) had no evidence of disease. The sensitivity, specificity, and accuracy of PET/CT for detecting recurrence were 90.3%, 81.0%, and 86.5% respectively. PET/CT changed the management of 12 patients (23.1%) by changing treatment plan (5 patients), by initiating unplanned treatment strategy (4 patients), or by obviating the need for planned diagnostic procedures (3 patients). Median duration after performing PET/CT and last follow-up was 12 (range: 6-27) months, and the 2-year disease-free survival rate of patients with negative PET/CT scan for recurrence was significantly better than that of patients with positive PET/CT (85.0% vs. 10.9%, P=0002). CONCLUSIONS: In patients with a suspected recurrence of cervical cancer, integrated PET/CT using (18)F-FDG provides good anatomic and functional localization of suspicious lesions, and the better diagnostic interpretation has an impact not only on clinical management and treatment planning of patients, but also on disease-free survival.     

Decrease and dysfunction of endothelial progenitor cells in umbilical cord blood with maternal pre-eclampsia

BACKGROUND: The pre-eclampsia is characterized by placental defective angiogenesis and maternal vascular/endothelial dysfunction. Recently, the decrease and senescence of endothelial progenitor cells (EPC) has been observed in maternal circulation with pre-eclampsia. Given the essential involvement of EPC in neovascularization and reendothelialization, we investigate whether or not the depletion of EPC is existent in placental/fetal circulation with maternal pre-eclampsia. METHODS: Samples of venous cord blood were collected during the labor of preeclamptic mothers (n = 14) and normotensive controls (n = 10). Circulating EPC were enumerated as AC133+/KDR+ cells via fluorescence-activated cell sorting (FACS) analysis. Additionally, EPC were expanded in vitro and identified by DiI-acLDL uptake and lectin staining by direct fluorescent staining under a laser scanning confocal microscope. EPC proliferation, migration and vasculogenesis activities were determined by MTT, modified Boyden chamber assay and in vitro vasculogenensis assay. RESULT: The placental/fetal circulating EPC numbers were significantly decreased in the pre-eclampsia group compared with the control (median, 200; range, 100-440 cells/mL vs 390; 270-440 cells/mL, P < 0.001), and after in vitro cultivation the numbers of EPC also decreased in pre-eclampsia group (19.5; 5.0-32.0 vs 39.5; 31.2-52.0 EPC/x200 field; P < 0.001). Both circulating EPC and cultivated EPC were inversely correlated with cord blood level of soluble fms-like tyrosine kinase 1 (sFlt-1). In addition, the EPC from patients with pre-eclampsia were significantly impaired in their proliferation, migration and vasculogenesis capacities. CONCLUSION: The present study documented the decrease and dysfunction of placental/fetal circulating EPC in patients with pre-eclampsia. The alteration is probably associated with the increased sFlt-1 levels in the umbilical cord blood.     

泛发性无菌性脓疱病长期随访1例

报告1例随访观察26年的疱疹样脓疱病。患者女,37岁。3岁开始发病,反复发作,1980—2005年共发病15次。1992年妊娠期间皮损加重,未予特殊处理,顺产一健康男婴。1993—2005年共发病8次。发作不重时仅予对症处理,一般2～3周皮损消退;发作严重时则采用雷公藤多苷、糖皮质激素治疗,疗效显著。诊断倾向于疱疹样脓疱病。     

甲真菌病临床评分指数计算公式的推导和计算尺的研制

目的：建立甲真菌病临床评分指数（SCIO）的计算公式和计算尺。方法：根据甲真菌病的发展规律和系统抗真菌治疗甲真菌病的原理,按Sergeev评分规则,应用数学分析方法进行推导和设计计算尺。结果：SCIO计算尺由一直尺和其上的一游标组成。直尺上刻有两组带有刻度的直线,滑动直尺上的游标,即可通过游标上的垂直线读出所要求的SCIO值。结论：SCIO计算游标尺具有使用方便、便于携带的优点。     

表皮囊肿并发毛母质瘤

报告2例表皮囊肿并发毛母质瘤。例1,男,34岁。右侧大腿上方有一灰褐色肿块,直径4cm。皮损组织病理检查示表皮囊肿的囊壁不完整,囊肿中央和周边均为成片的影细胞,囊肿中央的影细胞内可见许多小而圆的嗜伊红角化中心,提示向毛母质分化,未见嗜碱性细胞。例2,女,20岁。右上臂暗蓝色、质硬的皮下结节,直径1cm。皮损组织病理检查示表皮囊肿与毛母质瘤同时存在于真皮内,相互独立,毛母质瘤内可见嗜碱性细胞和影细胞。2例患者均未出现加德纳综合征。     

获得性皮肤松弛症

患者男,21岁。 主诉：面部皮肤松弛、下垂4年。     

色素血管性斑痣性错构瘤病

报告1例色素血管性斑痣性错构瘤病。患儿男,12岁。面部、胸部鲜红斑痣、躯干、四肢散在蒙古斑,双眼虹膜、巩膜及结膜色素沉着,视力障碍,伴智力低下。     

两种质子泵抑制剂治疗幽门螺杆菌感染活动性胃溃疡的药物经济学评价

目的：应用药物经济学原理分析泮托拉唑与兰索拉唑治疗幽门螺杆菌（ Hp ）感染活动性胃溃疡成本-效果,寻找最佳治疗方案。方法：选择符合标准的患者100例,随机分为A组和B组各50例,A组应用泮托拉唑,B组应用兰索拉唑,其余治疗方案二者相同,疗程结束进行疗效评价。结果：A组患者临床治愈率80．00％,B组溃疡愈合率80．00％,差异无统计学意义（ P＞0．05）。 A组患者成本-效果比（C/E）为4．81,明显低于B组的5．81,增量成本-效果比（ΔC/ΔE）为68．33;敏感度分析A组患者C//E为4．33,明显低于B组的5．25,ΔC//ΔE为66．85。结论：泮托拉唑治疗幽门螺杆菌感染活动性胃溃疡较兰索拉唑具有更高的药物经济学价值。     

应用二维超声方法评价高血压血管内皮功能

目的:对高血压1～2级无心血管其他危险因素病人的血管内皮功能作一评估,并探讨高血压对内皮功能的影响及其可能机制。方法:研究对象30例,高血压病人和正常人各15例。应用高分辨二维超声方法检测反应性充血前后肱动脉直径,比较两组的血流介导血管舒张测定百分数(FMD)功能以及与血压之间的关系;同时比较两组血清氧化低密度脂蛋白(ox-LDL)、一氧化氮(NO)及内皮素-1(ET-1)的水平。结果:①高血压病人FMD(10.79%)明显低于对照组(19.61%),P<0.01。②相关分析显示,FMD%分别与收缩压(r=-0.446,P<0.01)、舒张压(r=-0.645,P<0.01)呈负相关。③高血压病人血清ox-LDL、ET-1显著高于对照组(P<0.01),而NO则明显低于对照组(P<0.01)。结论:高血压病早期虽无明显动脉硬化,但已存在血管内皮功能的损伤。     

猪抗人淋巴细胞免疫球蛋白联合环孢菌素A治疗重型再障的临床疗效

目的探讨使用国产猪抗人淋巴细胞免疫球蛋白（p-ALG）联合环孢菌素A（CsA）治疗重型再生障碍性贫血（SAA）的疗效及观察不良反应。方法应用p-ALG（30mg/kg/d,静脉滴注）联合CsA（起始量为5mg/kg/d）治疗SAA 8例,辅以促造血、成分血输注、造血生长因子等支持治疗。检测治疗前后外周血象及骨髓象变化,以流式细胞仪测定治疗前后外周血T淋巴细胞亚群的改变情况,观察不良反应及其处理效果。结果随访8例中,基本治愈2例,缓解3例,明显进步1例,早期死亡2例,总有效率75%。治疗显效时患者的外周血CD3＋CD4＋（Th）细胞比例升高,CD3＋CD8＋（Ts）细胞比例降低,Th/Ts比值升高,与治疗前比较,差异有统计学意义（P〈0.01）。结论使用国产p-ALG联合CsA作为初诊SAA的首次治疗方案效果良好,治疗费用较马或兔抗胸腺细胞免疫球蛋白（ATG）联合CsA方案更经济。