Focal FDG uptake in mediastinal brown fat mimicking malignancy: a potential pitfall resolved on PET/CT

OBJECTIVE: A potential source of false-positive FDG PET interpretations in oncologic imaging is FDG uptake in brown fat. The purpose of this study was to determine the prevalence, location, and appearance of hypermetabolic brown fat in the mediastinum. MATERIALS AND METHODS: All PET/CT scans obtained at our cancer institution from August to October 2003 were retrospectively reviewed for increased FDG uptake in the mediastinum localized to fat on CT. The following features were recorded: location, appearance, maximal standard uptake value (SUV(max)) of hypermetabolic mediastinal brown fat, and presence of extramediastinal brown fat. RESULTS: PET/CT scans were obtained in 845 oncologic patients. Fifteen patients (1.8%) with focal hypermetabolic mediastinal brown fat were identified: nine women and two men (age range, 27-79; mean, 55.1 years) and four children (age range, 5-16 years; mean, 10 years). Hypermetabolic mediastinal brown fat (mean SUV(max), 5.7) was more common in children (4/8) than in adults (11/837) and more common in women (9/372) than in men (2/465). Foci of hypermetabolic brown fat were localized to the paratracheal, paraesophageal, prevascular, and pericardial regions; interatrial septum; and azygoesophageal recess. Five patients had focal hypermetabolic brown fat isolated to the mediastinum. Ten patients also had extramediastinal hypermetabolic brown fat in the neck, thorax, and abdomen. There was no difference in the body weight (p = 0.876) or body mass index (p = 0.538) of patients with hypermetabolic brown fat compared with age- and sex-matched control subjects. CONCLUSION: Hypermetabolic brown fat can be localized to the mediastinum and manifests as focal increased FDG uptake. Knowledge of this potential pitfall and precise localization with fusion PET/CT are important in preventing misinterpretation as malignancy.     

The clinical development of new mitotic inhibitors that stabilize the microtubule

Microtubule-stabilizing agents are increasingly studied for cancer treatment based largely on the prior success of paclitaxel and docetaxel. In this review, we focus on the clinical development of epothilones and discodermolide, and we discuss salient preclinical and clinical highlights of these two novel natural products. These agents are distinguished by their biochemical features making them poor P-glycoprotein substrates and capable of inducing cytotoxicity in cell lines or in vivo tumor models harboring mutations in tubulin. There is now considerable data regarding the efficacy of the epothilones in human beings and discodermolide holds such promise, as well.     

中药抗疲I号对训练Wistar大鼠急进高原并运动力竭后心肌及其酶谱的影响

目的通过训练大鼠急进高原模型从心肌组织形态和酶谱改变,研究训练对心肌损伤的防护。方法于海拔1520m实地环境设实验组(EG)采用中药抗疲I号加入常规饲料中喂养,对照组(CG)常规饲料喂养,EG、CG各40只游泳训练4周后,各选35只3h急进海拔3850m实地静息1.5h,从中各选10只作为静息对照采集标本,EG、CG各20只游泳至力竭后1h、24h采集标本;测定比较各组心肌酶谱指标等,镜下观察比较各组心肌形态变化。结果EG血中心肌酶谱指标1h、24h指标均优于CG1h、24h结果;心肌组织学结构从纵断面看,EG心肌结构清晰,肌丝细密,横纹清楚,核周无空隙;横断面心肌纤维群间隙小,毛细血管平均为10～12个/HPF;CG心肌纤维界限不清晰,肌丝分散,横纹不清楚,横断面心肌纤维群间隙增宽,毛细血管平均为3～5个/HPF,毛细血管腔扩张,红细胞堆积,提示有水肿。结论急进高海拔地区运动后可使心肌纤维缺氧水肿,血中心肌酶谱增高,同时会使心肌营养不良而发生结构改变,对心肌的供氧能力好坏必然决定运动能力强弱,过度训练、改变运动集训环境或强体力劳动均可引起心肌供血能力下降,本研究是通过抗疲I号加入食品干预训练大鼠的,有利于改善心肌营养与供氧状况,并能降低心肌纤维水肿发生。     

Renal replacement therapies in pediatric intensive care patients: Experiences of one center in Turkey

BACKGROUND: Despite constant improvements in caring for critically ill neonates and infants with congenital cardiac disease, sepsis, bone marrow and solid organ transplantation, acute renal failure (ARF) is an important problem in these children. ARF, severe fluid overload and inborn errors of metabolism are some of the indications for acute dialysis in infants and children. METHODS: The authors had retrospectively evaluated the medical records of Pediatric Intensive Care Unit, Ankara University School of Medicine, Ankara, Turkey patients who had required acute renal replacement therapy between the dates of January 2002 to February 2005. RESULTS: Medical records of 332 patients were reviewed. Acute renal replacement therapy was performed in 21 patients (6.3%; mean age, 9.6 +/- 7.4 years). Dialysis modalities were peritoneal dialysis in 15 patients (71.4%; mean age, 3.9 +/- 5.6 years) and hemodialysis in six patients (28.6%; mean age, 12.1 +/- 3.2 years). A total of 90% of patients had severe systemic disease leading to ARF. A total of 95% of patients had multiple organ dysfunction syndrome. The most common cause of ARF was refractory shock. At the beginning of renal replacement therapy, 10 patients were anuric, nine patients had volume overload, seven patients had decompensated metabolic acidosis and nine patients had hypotension. The average dialysis period was 4.7 +/- 6.4 days. Mortality rate was 66.7%. Eight patients recovered from ARF and chronic renal failure had developed in one patient. CONCLUSION: In the Pediatric Intensive Care Unit, ARF is frequently seen together with multiple organ dysfunction syndrome and the mortality rate is high. Both peritoneal dialysis and hemodialysis are important renal replacement treatment modalities in patients with ARF. The age and hemodynamic status of the patients are important when choosing treatment modality; generally peritoneal dialysis is preferred in infants and toddler, while hemodialysis is preferred in older children.     

1,25-dihydroxycholecalciferol in renal osteodystrophy. Epiphysiolysis--anticonvulsant therapy

Three children with azotaemic renal osteodystrophy were treated with 1,25-dihydroxycholecalciferol (1,25(OH)2D3). All showed clinical, biochemical, and radiological improvement within 6 months of starting treatment. There were no complications. The dose of 1,25(OH)2D3 required was 0-5 microgram per day for 2 children aged 22 and 30 months, and 2 microgram per day for a 15-year-old boy. 2 of the patients were receiving phenobarbitone and phenytoin and in one of them prior treatment with dihydrotachysterol 0-5 mg daily and 6 microgram 1alpha-hydroxycholecalciferol (1alphaOHD3) daily had failed to induce improvement. In one patient, in whom serial iliac bone samples were available, 2 microgram 1,25(OH)2D3 resulted in histological improvement in previously severe osteomalacia. 1,25(OH)2D3 appears to be an effective and safe drug in the treatment of uraemic osteodystrophy.     

注射用氨曲南与3种输液的配伍稳定性考察

目的:考察注射用氨曲南与果糖注射液、转化糖注射液和木糖醇注射液配伍后的稳定性,为糖尿病患者输液时溶媒的选择提供参考。方法:观察注射用氨曲南与3种输液配伍后在室温下6h内氨曲南的含量、微粒数量、溶液pH值及其他物理变化。结果:配伍液在6h内含量、pH值、微粒检查均符合要求。结论:注射用氨曲南在果糖注射液、转化糖注射液和木糖醇注射液中配伍稳定。     

2种用药方案治疗慢性丙型肝炎的药物经济学评价

目的:评价2种用药方案治疗慢性丙型肝炎(CHC)的经济学效果。方法:185例CHC患者按照治疗方案的不同分为长效组(聚乙二醇干扰素α-2a联合利巴韦林)与普通组(普通干扰素α-2a联合利巴韦林),针对不同基因型分别采用最小成本分析法和成本-效果分析法进行研究,效果指标采用持续病毒学应答率(SVR),成本指标采用直接医疗服务成本。结果:对于基因2型、3型的CHC患者,长效组与普通组的SVR分别为76.5%、63.5%(P>0.05),治疗成本分别为30235.20、36950.40元(P<0.05);对于基因1型、未分型的CHC患者,长效组与普通组的SVR分别为52.9%、25.8%(P<0.05),成本-效果比分别为114310.77、143218.60,长效组相对于普通组的增量成本-效果比为86789.67。结论:从药物经济学角度看,聚乙二醇干扰素α-2a联合利巴韦林治疗CHC优于普通干扰素α-2a联合利巴韦林方案。     

血管内超声对冠状动脉临界病变的临床应用

目的应用血管内超声(IVUS)对冠状动脉造影(CAG)提示冠状动脉临界病变的患者检查,评价IVUS在冠状动脉临界病变诊断及治疗中的应用价值。方法选择经CAG诊断为冠状动脉存在临界狭窄的78例患者,其中男性56例,女性22例;年龄34～71岁,平均年龄55.4岁。行IVUS检查和CAG,对照分析两种检查结果。结果CAG检测发现偏心性斑块31处,向心性斑块82处;而行IVUS检测发现偏心性斑块56处,向心性斑块57处。IVUS清楚显示软斑块54处,硬斑块23处,混合性斑块36例,其中探查血栓1处,溃疡2处;而CAG不能显示管腔形态及斑块特点。病变最窄处血管面积狭窄率IVUS所测值明显高于CAG,分别为68%±21%、58%±19%(P<0.05),两者比较差异具有统计学意义。结论对于CAG显示的临界狭窄病变,IVUS能更准确地判定管腔形态、病变性质及狭窄程度,对冠心病特别是有冠心病症状的患者的诊断及临床介入治疗有重要意义.     

Ad-GFP修饰MSCs静脉移植在严重烫伤延迟复苏大鼠体内的定向迁移

目的:观察携带目的基因的大鼠骨髓间充质干细胞(mesenchymal stem cells ,MSCs) 静脉移植在严重烫伤延迟复苏损伤体内的分布.方法:分离培养MSCs,用Ad-GFP转染MSCs,25只Wistar大鼠随机分为延迟复苏组(A组,10只)、即时复苏组(B组,10只)、假伤组(C组,5只).A、B两组大鼠背部造成Ⅲ度30%烫伤,制备A组为延迟复苏模型,B组为即时复苏模型,同时制备C组为假伤模型,经股静脉移植转染Ad-GFP 48 h后的MSCs.24 h,7 d后取小肠、肝脏、肾脏、烫伤皮肤创缘等组织,快速冰冻切片,荧光显微镜下观察在体内的分布.结果:MSCs 体外分离培养扩增5代,细胞数可达(1～2)×1011个,具有多态性和贴壁生长特性,MOI=100时,Ad-GFP转染MSCs效率可达86.4%.经股静脉移植24 h,在延迟复苏组烫伤皮肤组织创缘,小肠黏膜广泛可见绿色荧光,而在肝、肺等器官少见,即时复苏组荧光以烫伤皮肤创缘分布为主,小肠黏膜较少,假伤组中绿色荧光分布以肝脏为主.延迟复苏组小肠荧光强度明显强于即时复苏组和假伤组(P《0.05),而延迟和即时复苏组皮肤创缘荧光强度又强于假伤组(P《0.05).结论:导入目的基因可能不会改变MSCs归巢特性,并将为后续启动基因治疗烧伤延迟复苏后的损伤研究提供参考.