Standardized uptake values of uterine leiomyoma with <Superscript>18</Superscript>F-FDG PET/CT: variation with age,size, degeneration,and contrast enhancement on MRI

OBJECTIVE: To assess the effect of age, size, the degree of degeneration, and contrast enhancement on magnetic resonance imaging (MRI) on 18F-fluoro-2-deoxyglucose (18F-FDG) uptake in uterine leiomyomas using quantitative standardized uptake values (SUVs). METHODS: A total of 61 leiomyomas of 41 patients, who underwent combined positron emission tomography/computed tomography (PET/CT) using 18F-FDG and contrast-enhanced MRI were included in this study. Sixty-one leiomyomas were divided into two groups: "non-degenerated" leiomyomas showing distinct low signal intensity on T2-weighted images and intermediate signal intensity on T1-weighted images, and "degenerated" leiomyomas showing other types of signal intensity. Sixty-one leiomyomas were also divided into two groups of "strongly enhancing" leiomyomas and "weakly enhancing" leiomyomas in terms of their degree of contrast enhancement on MRI. RESULTS: The mean values of the maximum and average SUVs for the total of 61 leiomyomas were 2.34 +/- 0.75 (range 1.59-5.15) and 1.74 +/- 0.50 (0.66-3.95), respectively. There was a moderate negative correlation between the maximum and average SUVs and age (r = -0.43 and P = 0.00016, r = -0.31 and P = 0.029, respectively). Although there was a mild positive correlation between maximum SUV and size (r = 0.35 and P = 0.011), there was no significant difference between average SUV and size. Although there was no significant difference in average SUV between "degenerated" and "non-degenerated" leiomyomas, the maximum SUV of "degenerated" leiomyomas was significantly higher than that of "non-degenerated" leiomyomas (P = 0.0012). The degree of contrast enhancement on MRI was not significantly correlated with 18F-FDG uptake. CONCLUSIONS: Mild or moderate uptake of 18F-FDG is often observed in uterine leiomyoma and declines with age, and should not be confused with malignant accumulation.     

Dual time point fluorine-18 fluorodeoxyglucose positron emission tomography: a potential method to differentiate malignancy from inflammation and normal tissue in the head and neck

Fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) studies imaging FDG PET imaging is used to detect and stage head and neck cancers. However, the variable physiologic uptake of FDG in different normal structures as well as at inflammatory sites may either obscure a tumor focus or be falsely interpreted to represent tumor activity. Twenty-one patients (9 men, 12 women, median age 59) were scanned serially at two time points, one at 70 min (range 47–112) and the second at 98 min (77–142) after the intravenous injection of 4.3 MBq/kg of FDG. The mean interval between emission scans was 28 min (13–49). Transmission scans were performed and regions of interest (ROIs) were overlayed on the fully corrected images. Standardiued uptake values (SUVs) were generated for the cerebellum, tongue, larynx, every lesion, and a matched contralateral site. Follow-up and pathologic studies revealed 18 squamous cell carcinomas and nine inflammatory or infectious lesions. Tumor SUVs were 4.0±1.6 (mean ± SD) for the first scan and 4.5±2.2 for the second scan. Contralateral SUVs were 1.2±0.5 and 1.1±0.5 for the two scans. Tumor SUVs increased by 12%±12% as compared with a 5%±17% decrease for contralateral sites (P<0.05). SUVs for inflammatory sites (2.0±0.7 and 2.0±0.9), cerebellum (4.2±1.3 and 4.3±1.4), tongue (1.8±0.4 and 1.9±0.5) and larynx (1.5±0.6 and 1.5±0.6) remained constant over time (+0.6%, +2.8%, +1.4%, and –2.4%; P<0.05 when compared with tumor SUV changes). The ratio tumor/contralateral SUV increased by 23%±29% over time while this ratio for inflamed sites increased by only 5%±15% (P=0.07). The time interval between scans correlated with increase in SUV for tumors (r=0.55, P<0.05) but not for any of the other ROIs. Separation was superior when studies were performed more than 30 min apart (P<0.05). These preliminary data suggest that dual time point imaging compatible with a clinical study protocol is helpful in differentiating malignant lesions from inflammation and normal tissues, especially when separated by a sufficient time interval. Received 22 March and in revised form 29 April 1999     

Effects of smoking on pulmonary uptake of technetium-99m methoxyisobutylisonitrile during myocardial perfusion imaging

Background  To determine the influence of smoking on ^99mTc-labeled methoxyisobutylisonitrile (^99mTc-MIBI) lung uptake during myocardial perfusion imaging, we examined 60 subjects with normal myocardial perfusion scans, normal coronary angiograms, and no evidence of left ventricular hypertrophy. Methods and Results  The subjects were divided into 2 groups: Group 1 subjects had smoking histories of at least 10 pack-years and Group 2 subjects were nonsmokers. ^99mTc-MIBI lung to heart ratios (L/H ratios) from anterior planar images were obtained for all subjects during exercise and resting states. ^99mTc-MIBI L/H ratios in smokers were significantly higher than in nonsmokers in both exercise and resting states. However, no significant difference in L/H ratios was found between exercise and resting states in smokers and nonsmokers. In addition, no significant correlation was found between smoking pack-years and either rest or exercise L/H ratios. Conclusions   ^99mTc-MIBI L/H ratios in smokers are higher than in nonsmokers. This must be considered when ^99mTc-MIBI L/H ratios are used clinically.     

Effect of epinephrine on epidural, intrathecal, and plasma pharmacokinetics of ropivacaine and bupivacaine in sheep

BACKGROUND: Local vasoconstriction induced by epinephrine added to epidural local anaesthetics has been shown to improve their quality and duration of action in several clinical reports. There are several assumptions on the mechanisms. This study was designed to evaluate the influence of epinephrine on transmeningeal uptake of epidurally administered ropivacaine and bupivacaine by measuring local anaesthetic concentrations in the epidural and intrathecal spaces and in plasma. METHODS: Ropivacaine (50 mg) and bupivacaine (30 mg) were administered epidurally in sheep with and without epinephrine (75 microg). A microdialysis technique was used to simultaneously measure epidural and intrathecal drug concentrations. Resulting dialysate and plasma concentrations were used to calculate pharmacokinetic parameters for ropivacaine and bupivacaine. RESULTS: Co-administration of epinephrine decreased epidural clearance for ropivacaine [0.6 (sd 0.1) vs 0.4 (0.1) ml min(-1)] but not significantly for bupivacaine [1.2 (0.4) vs 0.8 (0.3) ml min(-1)]. The resultant increase in epidural area under the concentration-time curves (31% for ropivacaine and 52% for bupivacaine) was also observed in the intrathecal space (21% increase for ropivacaine and 37% for bupivacaine). There was no significant influence of epinephrine on ropivacaine plasma pharmacokinetics. Plasma Cmax for bupivacaine was decreased. CONCLUSIONS: These results show that epinephrine decreases the clearance and distribution processes involved in epidural disposition of ropivacaine and bupivacaine, leading to an increased uptake into the intrathecal space with an apparent more pronounced effect for bupivacaine.     

Exercise Performance of Chronic Heart Failure Patients in the Early Period of Support by an Axial‐Flow Left Ventricular Assist Device as Destination Therapy

Axial‐flow left ventricular assist devices (LVADs) are increasingly used as destination therapy in end‐stage chronic heart failure (CHF), as they improve survival and quality of life. Their effect on exercise tolerance in the early phase after implantation is still unclear. The aim of this study was to evaluate the effect of LVADs on the exercise capacity of a group of CHF patients within 2 months after initiation of circulatory support. Cardiopulmonary exercise test data were collected for 26 consecutive LVAD‐implanted CHF patients within 2 months of initiation of assistance; the reference group consisted of 30 CHF patients not supported by LVAD who were evaluated after an episode of acute heart failure. Both LVAD and reference groups showed poor physical performance; LVAD patients achieved lower workload (LVAD: 36.3 ± 9.0 W, reference: 56.6 ± 18.2 W, P < 0.001) but reached a similar peak oxygen uptake (peak VO₂; LVAD: 12.5 ± 3.0 mL/kg/min, reference: 13.6 ± 2.9 mL/kg/min, P = ns) and similar percentages of predicted peak VO₂ (LVAD: 48.8 ± 13.9%, reference: 54.2 ± 15.3%, P = ns). While the values of the O₂ uptake efficiency slope were 12% poorer in LVAD patients than in reference patients (1124.2 ± 226.3 vs. 1280.2 ± 391.1; P = ns), the kinetics of VO₂ recovery after exercise were slightly better in LVAD patients (LVAD: 212.5 ± 62.5, reference: 261.1 ± 80.2 sec, P < 0.05). In the first 2 months after initiation of circulatory support, axial‐flow LVAD patients are able to sustain a low‐intensity workload; though some cardiopulmonary exercise test parameters suggest persistence of a marked physical deconditioning, their cardiorespiratory performance is similar to that of less compromised CHF patients, possibly due to positive hemodynamic effects beginning to be produced by the assist device.     

早产儿视网膜病变的相关影响因素分析

目的探讨早产儿视网膜病变的相关影响因素。方法本文选择我院2016年6月～2018年6月收治的2340例住院早产儿和低出生体重儿,描述研究对象的眼底检查结果 ,将所有研究对象根据眼底检查结果分为ROP组(n=384)和无ROP组(n=1956),比较两组儿童一般情况、临床治疗、并发症、孕母情况的差异及影响早产儿视网膜病变的多因素指标。结果 2340例早产儿中,男1334例,女1006例,诊断ROP为131例(5.6%),无ROP为2209例(94.4%)。其中男70例,女61例;1期83例,2期35例,3期9例,4期3例,5期1例。性别、胎龄、出生体重、头围、Apgar评分、窒息与ROP是否发病有统计学差异(P0.05);未发现单胎与ROP是否发病有差异(P0.05)。吸氧、输血、咖啡因、动脉导管未闭、颅内出血、胎儿宫内窘迫与ROP是否发病有统计学差异(P0.05);未发现EPO、氨茶碱与ROP是否发病有差异(P0.05)。母亲年龄、产前激素、硫酸镁、妊高征、妊娠期糖尿病与ROP是否发病有统计学差异(P0.05);未发现分娩胎次、受孕方式、贫血与ROP是否发病有差异(P0.05)。多元逐步Logistic回归分析显示,胎龄、吸氧、妊高征是早产儿患有ROP的危险因素(P0.05)。结论临床中对早产儿应给予视网膜病变的普遍筛查,加强高危孕产妇的管理,积极干预并发症,进而降低ROP疾病发生风险。     

甲状腺功能异常者摄碘率与血液中NIS-Ag甲状腺过氧化物酶的相关性研究*

目的 探讨甲状腺功能减退（甲减）和甲状腺功能亢进（甲亢）患者治疗前后摄碘率（RAIU）与甲状腺钠/碘同向转运体抗原（NIS-Ag）、甲状腺过氧化物酶（TPO）含量变化的相关性。方法 选取2015年2月— 2016年8月濮阳市安阳地区医院36例健康体检人员和108例甲状腺疾病就诊患者做为研究对象。电化学发光法检测血清中游离三碘甲状腺素原氨酸（FT3）、游离甲状腺素原氨酸（FT4）和促甲状腺激素（TSH）含量。用甲状腺摄碘功能仪分别检测各组的3?h RAIU、24?h RAIU,用酶联免疫吸附试验测定血浆中NIS-Ag、TPO含量,比较各组别RAIU、NIS-Ag、TPO含量,并分析患者药物治疗前后RAIU与NIS-Ag、TPO相关性。结果 FT3、FT4、TSH含量,除甲减摄碘率增高组和减低组之间比较无差异外,其余各组含量比较,差异有统计学意义（均P?<0.05）。甲减摄碘率增高组和减低组FT3、FT4含量最低,TSH最高;甲亢组FT3、FT4含量最高,TSH 最低。各组治疗前3?h RAIU、24?h RAIU、NIS-Ag及TPO含量比较,差异有统计学意义（P?<0.05）。24?h RAIU、 3?h RAIU、NIS-Ag及TPO在甲减甲状腺摄碘率减低组中最低,而在甲亢组中最高。各患病组3?h RAIU、24?h RAIU与NIS-Ag、TPO均呈正相关,差异有统计学意义（P?<0.05）,但在正常组该指标间无相关性（P?>0.05）。各组治疗后24?h RAIU、3?h RAIU、NIS-Ag及TPO值均较治疗前降低,差异有统计学意义（P?<0.05）。各患病组治疗后3?h RAIU、24?h RAIU与NIS-Ag、TPO均呈正相关,差异有统计学意义（P?<0.05）。结论 甲减患者和甲亢患者RAIU与NIS-Ag、TPO存在正相关性;药物治疗能降低RAIU、NIS-Ag及TPO。     

Axin1调节骨骼肌GLUT4蛋白表达的作用研究

目的：探讨体轴发育抑制因子（Axin1）调节骨骼肌葡萄糖转运蛋白4(GLUT4)蛋白表达的作用及其机制。方法：利用RNAi干扰的Axin1腺病毒（Ad-siAxin1）感染C2C12小鼠骨骼肌细胞敲低Axin1,荧光显微镜和MTS实验明确Ad-siAxin1最佳感染浓度和时间。分别用携带绿色荧光蛋白的腺病毒（Ad-GFP）、Ad-siAxin1、载体质粒（vector）和Axin1质粒转染C2C12小鼠骨骼肌细胞敲低或过表达Axin1蛋白,Western印迹检测Axin1、端锚聚合酶蛋白（TNKS）和GLUT4蛋白水平。结果：荧光显微镜和MTS实验结果显示,在C2C12小鼠骨骼肌细胞中Ad-siAxin1作用的最佳浓度和时间分别为160μL和48 h。Western印迹结果显示,与Ad-GFP组相比,Ad-siAxin1组中Axin1蛋白降低（t=6.746,P<0.01）。Ad-siAxin1组TNKS蛋白水平降低（t=4.019,P<0.05）,GLUT4蛋白水平下调（t=3.248,P<0.05）。与vector组相比,转染Axin1质粒后,Axin1蛋白水平上...     

Central nervous system control of the lower urinary tract: new pharmacological approaches to stress urinary incontinence in women

PURPOSE: Despite the prevalence of stress urinary incontinence in women there are no approved drugs for the disease. MATERIALS AND METHODS: Designing medical therapies requires a comprehensive understanding of how the internal and external sphincters are neurologically controlled. In this review recent advances in mapping storage and micturition reflexes, and the association of serotonergic and noradrenergic systems with these reflexes are discussed. RESULTS: Urine storage and micturition are controlled by a series of hard wired reflexes that are under the modulatory influence of serotonin and norepinephrine. Augmentation of the serotonergic and noradrenergic systems with duloxetine increases bladder capacity and urethral rhabdosphincter activity. The increase in sphincter activity is mediated by alpha1 adrenergic receptors and 5-hydroxytryptamine receptors. CONCLUSIONS: Increasing rhabdosphincter activity with duloxetine may offer a therapeutic benefit in women with stress urinary incontinence.