碘-125籽源组织间照射患者和周围人员受照剂量的测量和估算

目的 测量碘-125籽源植入人体模型后患者和周围人员的受照剂量。方法 模拟前列腺癌治疗,用FD3101γ剂量仪测量体表、离体表30 cm和100 cm处的外照射剂量率,用LiF TLD探测器测量体模内各主要器官的剂量当量。结果 患者体表剂量与各主要器官剂量当量都较低。结论 碘-125籽源组织间放射治疗对患者和周围人员都是一种较安全的肿瘤治疗方法。     

洛美利嗪对大鼠脑微血管内皮细胞上P-糖蛋白功能的影响

目的：研究洛美利嗪对大鼠脑微血管内皮细胞上P-糖蛋白功能的影响。方法：使用荧光分光光度计和流式细胞术分析大鼠脑微血管内皮细胞内P-糖蛋白底物-罗丹明123的荧光强度。结果：环孢素A和洛美利嗪与大鼠脑微血管内皮细胞孵育后能明显提高胞内罗丹明123的荧光强度。人脐静脉内皮细胞内荧光强度则不受环孢素A和洛美利嗪的影响。结论：洛美利嗪能显著地抑制大鼠脑微血管内皮细胞上P-糖蛋白的活性,提高P-糖蛋白底物的胞内浓度。     

放射性标记氨基酸的肿瘤基础研究

随着代谢显像的不断发展,放射性标记氨基酸引起临床更多关注。弄清氨基酸代谢基础和标记氨基酸在肿瘤中的作用更显必要。目前临床最常用的氨基酸显像剂如11C-蛋氨酸、11C-酪氨酸和123I-碘代甲基酪氨酸等,与18F-FDG PET相比很少受炎症影响,对脑部肿瘤显像准确性更好,对其他类型肿瘤也显示出更多的临床意义。     

人卵巢癌紫杉醇耐药细胞株的建立和生物学特性评价

目的建立人卵巢癌紫杉醇耐药细胞株(Skov-3/PTX),并对其生物学性状进行检测和鉴定。方法采用紫杉醇浓度梯度递增法,建立人卵巢癌紫杉醇耐药株。通过细胞形态学观察、生长曲线和群体倍增时间测定、药物敏感试验、细胞内Rh-123和紫杉醇含量研究及MDR1、MRP和GST-πmRNA水平的测定,评价Skov-3/PTX生物学特性。结果成功建立了Skov-3/PTX耐药株,耐药指数为45.90,对吉非替尼、9-硝基喜树碱和阿霉素产生明显的交叉耐药性。与Skov-3细胞相比,Skov-3/PTX耐药细胞异形明显;耐药细胞倍增时间显著延长(P<0.05);耐药细胞内Rh-123和紫杉醇量显著减少(P<0.05),环孢菌素可以增加细胞内Rh-123和紫杉醇含量;耐药细胞的MDR1、MRP和GST-πmRNA水平显著增高。结论Skov-3/PTX细胞具有典型多药耐药特性,为进一步研究耐药逆转途径提供了实验基础。     

Efficacy and safety of CT-guided 125I seed implantation as a salvage treatment for locally recurrent head and neck soft tissue sarcoma after surgery and external beam radiotherapy: A 12-year study at a single institution

ObjectivesThe objective of this study was to evaluate the efficacy and safety of CT-guided radioactive ¹²⁵I seed implantation as a salvage treatment for locally recurrent head and neck soft tissue sarcoma (HNSTS) after surgery and external beam radiotherapy.Methods and MaterialsFrom December 2006 to February 2018, 25 patients with locally recurrent HNSTS after surgery and external beam radiotherapy were enrolled. All the patients successfully underwent CT-guided ¹²⁵I seed implantation. The primary end points included the objective response rate (ORR) and local progression-free survival (LPFS). The secondary end points were survival (OS) and safety profiles.ResultsAfter ¹²⁵I seed implantation, the ORR was 76.0%. The 1-, 3-, and 5-year LPFS rates were 65.6%, 34.4%, and 22.9%, respectively, with the median LPFS of 16.0 months. The 1-, 3-, and 5-year OS rates were 70.8%, 46.6%, and 34.0%, respectively, with the median OS of 28.0 months. Furthermore, univariate analyses showed that the recurrent T stage and histological grade were prognostic factors of LPFS, whereas only the histological grade was a predictor of OS. The major adverse events were skin/mucosal toxicities, which were generally of lower grade (≤Grade 2) and were well tolerated.ConclusionsRadioactive ¹²⁵I seed implantation could be an effective and safe alternative treatment for locally recurrent HNSTS after failure of surgery and radiotherapy. Recurrent T stage and histological grade were the main factors influencing the efficacy.     

Close relationship between cardiovagal function and sural sensory nerve action potential in type 2 diabetes

ObjectiveBoth diabetic distal symmetrical polyneuropathy (DSPN) and cardiac autonomic neuropathy (CAN) indicate the length-dependent pattern of disease. Decreased parasympathetic activity has been found in the early phase of CAN and sural sensory nerve action potential (SNAP) imply axonal loss in DSPN.MethodAll patients with type 2 diabetes underwent cardiovascular autonomic function and nerve conduction studies (NCS). We constructed modified composite autonomic scoring scale (CASS) and composite score of NCS to measure the severity of CAN and DSPN, respectively.ResultsPatients with a longer duration of diabetes had a lower heart rate response to deep breathing (HR_DB), Valsalva ratio (VR), and baroreflex sensitivity (BRS), higher CASS, a higher percentage of CAN, lower sural SNAP, higher composite score of NCS, and a higher percentage of DSPN. Multiple linear regression analysis showed that only sural SNAPs were independently associated with mean HR_DB.ConclusionSural SNAP was closely correlated with parameters of cardiovagal functions in patients with different durations of diabetes. The percentage and severity of CAN and DSPN increase with longer duration of diabetes.SignificanceThe independent association of sural sensory nerve action potential amplitude and heart rate response to deep breathing with type 2 diabetes is important because combined testing increases diagnostic sensitivity and specificity.     

Importance of 123I-ioflupane SPECT and Myocardial MIBG Scintigraphy to Determine the Candidate of Deep Brain Stimulation for Parkinson’s Disease

¹²³I-ioflupane SPECT (DaTscan) is an examination that detects presynaptic dopamine neuronal dysfunction, and has been used as a diagnostic tool to identify degenerative parkinsonism. Additionally, myocardial ¹²³I-metaiodobenzyl guanidine (MIBG) scintigraphy measures the concentration of cardiac sympathetic nerve fibers and is used to diagnose Parkinson’s disease (PD). These exams are used as adjuncts in the diagnosis of parkinsonism, however, the relationship of these two examinations are not well-known. We investigated the relationship of these two scanning results specifically for determining the use of deep brain stimulation therapy (DBS). Subjects were Japanese patients with suspected striatonigral degeneration, including PD; DaTscans and myocardial MIBG scintigraphy were performed. The mean values of the left-right specific binding ratios (SBRs) from the DaTscan, and the early/delayed heart-to-mediastinum ratios (HMRs) from the MIBG scintigraphy were calculated. Using simple linear regression analysis, we compared the SBR and early/delayed HMR values. Twenty-four patients were enrolled in this study. Twenty-one patients were positive via the DaTscan, and the MIBG scintigraphy results showed 14 patients were positive. SBR and both early and delayed HMR were positively correlated in cases of PD, but negative in non-PD cases. A mean SBR value less than 3.0 and a delayed HMR value less than 1.7 indicated a Hoehn-Yahr stage 3 or 4 for PD, which is commonly regarded as a level appropriate for initiating DBS therapy. Our results indicate that performing both DaTscan and MIBG scintigraphy is useful for the evaluation of surgical intervention in PD.     

Clinical manifestations of Parkinson's disease harboring VPS35 retromer complex component p.D620N with long-term follow-up

IntroductionTo identify and investigate patients with Parkinson's disease (PD) harboring VPS35 variants in Japan.MethodsUsing targeted gene panel screening, we analyzed 393 familial, 294 young-onset, and 52 late-onset sporadic PD patients derived from the Juntendo PD DNA bank, and obtained clinical information from the medical records on each patient in whom we found VPS35 p.D620N variants.ResultsWe identified VPS35 p.D620N in three new patients: two patients with familial PD and one patient with sporadic PD. Additionally, we newly confirmed p.D620 from a patient of a family reported previously. The prevalence of familial PD was 0.7% (2/307), young-onset sporadic PD was 0.3% (1/294), and late-onset sporadic PD was 0% (0/52) in our cohort. Combining four patients with p.D620N from our previous reports, haplotype analysis indicated at least two founders in our cohort. Patients commonly showed a slow progression of parkinsonism with onset in middle or late age and mild parkinsonism with good response to levodopa and little cognitive decline even for more than 10 years of disease duration. Psychosis was occurred in two patients. One-half of patients required device-aided therapies such as deep brain stimulation or levodopa-carbidopa intestinal gel. Brain magnetic resonance imaging mostly showed normal findings, even at more than 10 years after onset. ¹²³I-metaiodobenzylguanidine myocardial scintigraphy indicated normal heart-to-mediastinum ratio values among three of four patients. Conclusions: Patients with VPS35 p.D620N showed distinctive symptoms and neuroimaging. Our findings expand the clinical findings of patients with VPS35 variants.     

Thyroid: nuclear medicine update

Nuclear medicine has been used in the evaluation and treatment of benign and malignant thyroid disease since the discovery of iodine 131 ((131)I) in the 1930s. Although traditional methods of imaging are routinely used, recent advancements such as SPECT/CT and PET/CT have greatly enhanced the ability of nuclear medicine to accurately detect and localize. Guidelines for the management of thyroid cancer continue to evolve, treatment regimens selected should balance the long-term risk of disease recurrence and cumulative risks of radiation exposure, and physicians should be aware of these updates and guidelines when caring for patients with thyroid disease.