Gadobutrol:一种新型MR对比剂的理化特性及临床应用现状

Gadobutrol为一种细胞外分布、非组织特异的、电中性、非离子型水溶性含钆MR对比剂,具弛豫性高、稳定性好、黏滞性及渗透性较低等特点,主要经肾小球滤过清除,毒性低.其高浓度制剂(1mol/L)在需大剂量(>0.3mmol/kg)对比剂的MR成像中独具优势.     

新型MR对比剂长循环超顺磁氧化铁脂质体纳米微粒的体内外实验研究

目的 评价自制新型MR对比剂:长循环超顺磁性氧化铁(superparamagnetic iron oxide,SPIO)脂质体纳米微粒的药代动力学.方法 以加入SPIO为对照组,加入长循环SPIO脂质体纳米微粒为实验组.(1)巨噬细胞的体外吞噬实验:将巨噬细胞株RAW 264.7经复苏、培养,细胞达到80%～90%融合后,以每孔2.5×105个细胞接种于培养板,对照组和实验组细胞与不同浓度药物孵化后,分别测定细胞中Fe浓度和Fe染色情况,并用析因设计的方差分析对结果进行统计学处理.(2)小鼠体内药物分布实验:C57BL/6J雄性小鼠6只,每组2只,设为空白对照组、对照组、实验组,经尾静脉分别注射生理盐水、SPIO以及长循环SPIO脂质体后牺牲动物,经病理检查观察2组药物在体内的分布情况.(3)荷肺癌裸鼠MR成像实验:建立20只BALB/c裸鼠移植型肺癌模型,分为对照组和实验组,每组10只,分别经尾静脉注入SPIO和长循环SPIO脂质体纳米微粒后行MR扫描,测量增强前后2组实验动物各时间点肝脏和肿瘤ROI的信号强度,绘制信噪比(SNR)时间动态变化曲线,采用协方差分析比较2组动物肝脏及肿瘤增强12 h 后SNR差异有无统计学意义.(4)细胞毒性实验(噻唑蓝,MTT法):检查2种药物对人肝细胞株HL-7702细胞的毒性作用,用析因设计的方差分析对结果进行统计学处理.结果 (1)巨噬细胞的体外实验:析因分析结果表明,对照组细胞内Fe含量明显高于实验组,差异有统计学意义(F=296 839.9,P=0.000).普鲁士蓝染色显示对照组巨噬细胞染色较深,实验组巨噬细胞染色较浅.(2)小鼠体内药物分布实验:对照组肝、脾、肺、肾组织内蓝染颗粒多于实验组.(3)荷肺癌裸鼠MR成像实验:平扫对照组肝脏SNR为31.47±0.56,实验组为30.89±1.41;增强扫描12 h后对照组为17.00±0.96,实验组为22.29±0.73.平扫对照组肿瘤SNR为58.41±0.61,实验组为58.44±1.08;增强扫描12 h后对照组为58.50±0.63,实验组为52.47±1.18.经协方差分析表明增强12 h后对照组肝脏SNR显著低于实验组(F=167.022,P=0.000);而实验组肿瘤 SNR显著低于对照组(F=266.106,P=0.000).(4)细胞毒性实验:随着培养液中Fe浓度的增加,HL-7702细胞生存率均有下降趋势,但析因分析结果表明,实验组药物的细胞毒性较对照组低(F=2256.204,P=0.000).结论 长循环SPIO脂质体纳米微粒在体内外均有较好的抗巨噬系统吞噬功能,在体内实现了长循环,对非网状内皮系统的肿瘤也具有良好的T2负性被动靶向强化效果;同时还降低了SPIO对细胞的毒性作用.

Abstract：

Objective To evaluate pharmacodynamics of prepared long-circulating superparamagnetic iron oxide (SPIO) liposomes. Methods Control and experimental groups were established after adding SPIO or long-circulating SPIO liposomes as agents. (1)Macrophages experiment in vitro: the RAW 264.7 macrophage cell strains were recovered, cultured and seeded in the culture plate at a density of 2.5×105 cells/well until they reached 80%-90% confluence. The intracellular Fe uptake of control and experimental group cells were quantified by Ferrozine assay after incubation with different concentrations of drugs. Factorial design analysis of variance was used as statistics method. Prussian blue staining method was used to detect staining of experimental cells.(2)Drug biodistribution in mice: C57BL/6J(n=6) were classified into blank control group (n=2), control group(n=2) and experimental group(n=2).Saline, SPIO and long circulating SPIO were injected via the tail vein in the blank control group, control group and experimental group respectively. Then distribution of drugs in the body was observed by pathological examination.(3) MR imaging of tumor-bearing nude mice: 20 BALB/c nude mice bearing lung cancer models were established and classified into control group and experimental group. After administration of drugs, all animals underwent MR scanning. Signal intensities of livers and tumors were measured, SNR-time dynamic curves were drew. Covariance analysis was used to compare post-enhanced SNR at the 12th hour. (4)Cytotoxicity studies (MTT): cytotoxicity of both drugs on human liver cell line HL-7702 was studied, and statistically analyzed using factorial design analysis of variance. Results (1) Macrophages experiment in vitro: The nanoparticle uptake by macrophage cells evaluated by ferrozine assay showed the uptake of blank SPIO was higher than long-circulating SPIO liposomes. Compared with the blank control group, there was strong blue staining in the macrophages with Prussian staining in the control group and little blue staining in the experimental group. (2) Drug biodistribution in mice: for blue stained cells composed of iron particles, the amounts in the liver, spleen, lung, kidney of the control group were more than those in the experimental group. (3) MR imaging of tumor-bearing nude mice: the non-enhanced SNR of livers and tumors in the control group and experimental group were 31.47 ± 0.56, 30.89 ± 1.41, 58.41 ± 0.61, 58.44 ± 1.08, respectively. After injecting of contrast agents, SNR of livers and tumors in the control group and experimental group were 17.00 ± 0.96, 22.29 ± 0.73, 58.50 ± 0.63, 52.47 ± 1.18, respectively. The covariance analysis showed that SNR of the livers in the control group after 12 hours was significantly lower than the experimental group (F=167.022, P=0.000); while the SNR of the tumors in the experimental group was significantly lower than the control group (F=266.106, P=0.000).(4) Cytotoxicity of nanoparticles by MTT method: the viability of HL-7702 cells tend to decrease with the increase of Fe concentration. Cytotoxicity in the long-circulating SPIO liposomes was lower than the SPIO(F=2256.204,P=0.000). Conclusions Long-circulating SPIO liposomes we prepared reveal suitable sizes, even distribution, and good anti-macrophage ability in vitro and in vivo. They have long circulation characteristic and T2 negative enhancement effect in the transplanted lung cancers, while they still maintain low cytotoxicity.     

多层螺旋CT对肺类癌的诊断及鉴别诊断

目的：探讨多层螺旋CT（MSCT）对肺类癌的诊断和鉴别诊断的价值。方法：回顾性分析经病理证实的9例类癌患者的临床和MSCT资料。结果：9例中8例表现为边界清楚单发类圆形或不规则形肿块影,1例表现为右肺中叶不规则高密度影,边缘模糊,类似于大叶性肺炎。3例病灶密度均匀,4例可见浅分叶,1例可见深分叶,3例有细短毛刺,3例有胸膜凹陷征,4例可见钙化灶,3例有胸腔积液。8例肿块表现为＂冰山征＂（支气管腔外部分大于腔内部分）。增强扫描后5例中度以上（20~40 HU）强化,3例轻度（1~20 HU）强化,1例病灶内窄带状强化。本组病例均未见空洞、囊变、坏死。结论：肺类癌的MSCT的影像特点为肺内单发边缘清楚类圆形肿块,多为明显均匀强化,以及＂冰山征＂和/或特征性钙化。若见因支气管狭窄或闭塞导致的类似于大叶性肺炎的表现,应高度注意本病可能。     

腮腺肿瘤MSCT灌注扫描结果:入选动脉和病灶ROI选择的影响

目的探讨入选动脉和病灶ROI选择对腮腺肿瘤多层螺旋CT（MSCT）灌注扫描结果的影响。 方法使用Philips ADW4.5工作站自带的灌注扫描软件对12例腮腺肿瘤患者进行MSCT灌注后处理分析。记录选择不同入选动脉和病灶ROI时的血流量（BF）、血容量（BV）和增强幅度（PEI）等灌注参数;采用方差分析法分析并比较上述各组参数值;采用独立样本t检验比较腺淋巴瘤和非腺淋巴瘤灌注参数之间的差异性。 结果选取颈外动脉（ECA）、颈内动脉（ICA）和颈总动脉（CCA）为入选动脉时,BF、BV和PEI值在各组之间的差异无统计学意义（F=0.012、0.007和0.233,均P>0.05）;当肿瘤取不同面积ROI时,上述各灌注参数值之间的差异同样不具有统计学意义（F=0.220、0.033和0.283,均P>0.05）。选择ECA作为入选动脉、ROI为80%瘤体面积（S80%）时,PEI对腺淋巴瘤的鉴别诊断效能最高。 结论入选动脉和病灶ROI的大小对腮腺肿瘤灌注结果无明显影响;但选择ECA作为入选动脉、ROI取S80%可能有助于提高腮腺腺淋巴瘤的诊断效能。     

海洛因体内藏毒的CT准确检测

目的：探讨海洛因体内藏毒的CT检出以及评价CT在筛查这类案例中的作用。方法：搜集2005年9月5日～2008年4月23日所有疑犯的影像学资料（所有病例均行CT检查,其中42例加做了腹部平片X线检查）,回顾性分析最终确诊为海洛因体内藏毒罪犯的腹盆部CT影像学表现（形态、大小、数目、位置和密度）以及腹部X线平片的表现。结果：158例疑犯中124例最终确诊为海洛因体内藏毒者,这与CT检查结果一致。42例腹部平片检查中有2例假阴性结果。CT和腹部平片表现为腹盆部消化道和/或阴道内紧密排列的圆形或卵圆形肠道外异物影,此外还发现了“气环征”和“洋葱皮征”为海洛因体内藏毒的CT特征性表现,对检出这类罪犯有一定作用。结论：海洛因体内藏毒的CT表现具有一定特异性,常规腹盆部CT是检出体内藏毒疑犯的较为精确的一种影像学检查方法。     

概念图结合TBL对护理实习生考核成绩、评判性思维能力及教学满意度的影响

目的探究概念图结合以团队为基础的学习(team-based learning, TBL)教学法对护理实习生考核成绩、评判性思维能力及教学满意度的影响。方法选取2019年3月至10月广元市中心医院接受的护理实习生67名, 采用随机数字表法分为研究组与对照组;对照组采用TBL教学, 研究组采用概念图结合TBL教学;对比两组考核成绩、评判性思维能力及教学满意度。使用SPSS 22.0进行卡方检验和t检验。结果研究组理论知识与期末考试成绩均高于对照组, 差异有统计学意义(P<0.05);教学后, 研究组求知欲、寻找真相、系统化能力、自信心等4个维度评分及总分均高于教学前, 且高于对照组(P<0.05);研究组对临床实践有应用价值、提高学习主动性、有助于理解教学内容、培养合作学习能力及能够激发学习的竞争性满意度评分均高于对照组(P<0.05)。结论概念图结合TBL教学有利于护理实习生掌握理论知识, 提高评判性思维能力, 增加教学满意度。     

二氧化氯控制盐渍食用菌中厌氧亚硫酸盐还原梭菌行性分析

[目的]探讨将ClO2消毒剂应用于盐渍食用菌加工过程,以控制加工过程中污染菌,特别是抗逆力极强的厌氧亚硫酸还原梭菌的可行性.[方法]分别以产气荚膜梭菌标准菌株和野生菌株作为供试菌株,采用悬液定量杀菌试验、人工染菌模拟样品杀菌试验的方法观察ClO2杀菌效果;采用不同浓度的ClO2作用盐渍滑子蘑,研究其对盐渍食用菌感官的影响.[结果]悬液定量杀菌试验结果表明200-300mg/L的CIO2作用30min,对产气荚膜梭菌的芽胞的 杀灭绝对值可达4以上.人工模拟样品实验结果表明,ClO2浓度在400mg/L,作用30 min,杀灭绝对值可达到4以上.感官试验结果表明ClO2浓度低于300mg/L,对盐渍滑子蘑感官影响不大.[结论]ClO2消毒剂可应用于盐渍食用菌中,以控制和消除厌氧亚硫酸盐还原梭菌的污染.     

原发性弥漫性子宫淋巴瘤3例报告及文献复习

尽管淋巴瘤侵犯生殖系统不少见,然而,原发性子宫非何杰金氏淋巴瘤则相当罕见.本文报道3例该种少见恶性肿瘤,就其临床、病理及影像学表现进行了总结,并对相关文献进行回顾性分析,以提高工作中对本病的认识.     

SBAR沟通模式指导的情景模拟演练对提高实习护士交接班质量的作用

目的　分析SBAR[（即现状（situation）、背景（background）、评估（assessment）、建议（recommendation）]沟通模式指导的情景模拟演练对实习护士交接班质量及护理风险发生率的影响。方法　选择2017年5月至2018年12月在广元市中心医院心脏血管内科进行实习的46名护士作为对照组,并按照常规交接班模式进行实习指导;选择2019年1月至2020年6月同科室进行实习的46名实习护士作为研究组,并采取SBAR沟通模式指导的情景模拟演练后进行交接班。比较两组实习护士交班质量评价结果、接班质量评价结果、实习护士满意度。采用统计学软件SPSS 22.0进行t检验和卡方检验。结果　研究组实习护士交班质量的7个条目评价结果均优于对照组（P＜0.001）;研究组实习护士接班质量的6个条目评价结果均优于对照组（P＜0.001）;研究组实习护士交接班满意度评估量表的5个维度得分均高于对照组（P＜0.001）;结论　实施SBAR沟通模式指导的情景模拟演练,能够提高实习护士交接班质量和实习护士满意度。