超声引导下瘤内注射MAA和32P胶体治疗肝癌的临床应用研究

观察瘤内注射MAA和32P胶体治疗不能手术肝癌的有效性和毒副作用。 方法B超引导下瘤内注射MAA和32P胶体治疗30例原发性肝癌(PHC),观察治疗前后病人的临床表现、组织病理学、彩色多普勒超声、病灶体积变化、血清AFP水平以及肝肾功能、血常规和免疫指标。 结果治疗后,96.7％PHC临床症状减轻,血清AFP水平明显下降;肿块缩小率≥50％者占75.6％,平均肿块缩小率53.3％,彩色多普勒显示81.9％的肿块血供减少或消失。20例组织学检查发现治疗区内肿瘤组织出现完全或部分坏死、纤维化。30例PHC6个月、1年、2年、3年生存率分别为100％、90％、76.7％、43.3％,平均生存期19.5月。局部无并发症,治疗前后ECG、肝肾功能、血常规和免疫功能均无变化。结论超声引导下经皮肝穿瘤内注射MAA和32P胶体对不能手术的PHC是一种简单、安全和有效的新方法,副作用低,适应证广。     

碘131配合选择性颈淋巴结清除术对甲状腺癌的疗效及唾液腺功能的影响

目的:探讨I131配合选择性颈淋巴结清除术治疗甲状腺癌(TC)的疗效和对患者唾液腺功能的影响。方法:选取2009年1月—2013年9月期间确诊治疗的TC患者60例,随机分均分为对照与观察组,对照组患者给予常规甲状腺切除术,观察组患者在此基础上给予选择性颈淋巴结清除术与I131治疗,其中又根据I131摄入量均分为高剂量亚组(3 500 m Bq)和低剂量亚组(1 000 m Bq),分析患者疗效和唾液腺功能指标及术后生存情况。结果:观察组首次清甲成功率与治疗总有效率均明显高于对照组(均P0.05);唾液腺功能参数方面,手术组优于低剂量亚组,低剂量亚组优于高剂量亚组(均P0.05);观察组中高、低剂量亚组5年生存率无明显差异,但均高于对照组(均P0.05)。结论:I131配合选择性颈淋巴结清除术治疗可有效提高对TC手术患者的疗效并改善预后,虽有唾液腺功能方面不良反应,但低剂量治疗症状较轻,在患者接受范围内。     

Methodological characterization of the 2-keto [1-13C]isocaproate breath test to measure in vivo human mitochondrial function: application in alcoholic liver disease assessment

BACKGROUND: The 2-keto[1-13C]isocaproate oxidation measurement has been shown as a helpful tool in the in vivo assessment of liver mitochondrial function. METHODS: The aim of this work was to study the variability of the 2-keto[1-13C]isocaproate breath test in 24 healthy controls (8 men and 16 women) and to evaluate its clinical usefulness in 20 patients (14 men and 6 women) with liver disease (7 men with history of alcoholism). Breath test was performed by measuring 13CO2 enrichment in breath before and after the oral administration of the tracer and by using isotope ratio mass spectrometry. RESULTS: The intrasubject and intersubject variability of the percentage of tracer oxidized were 8 and 14%, respectively. The 2-keto[1-13C]isocaproate oxidation in women was faster (p = 0.004) and tended to be higher (p = 0.050) than in men. The percentage of oxidized tracer was lower in those patients with alcoholic liver disease than in healthy volunteers (p = 0.001) and in nonalcoholic patients (p = 0.003). CONCLUSIONS: The percentage of tracer oxidized appears as a convenient parameter to detect impairment in liver mitochondrial oxidation related to alcoholism by the 2-keto[1-13C]isocaproate breath test, establishing different cutoff values depending on gender.     

Pathophysiology of renal function and its effect on isotope studies in the workup of hydronephrosis

Understanding renal maturation and growth is essential before adequate interpretation of radionuclide renal studies can be done. The expectation that an immature kidney draining into a dilated renal pelvis will show good washout on a diuretic renogram within 20 or 40 min is unreasonable. A physiological explanation for this is given.     

~(99m)锝扫描小儿消化系统出血468例应用分析

目的:探讨99m锝扫描对小儿消化系统出血,尤其是先天畸形的诊断意义。方法:对486例消化系统出血患儿行99m锝扫描检查,并对其检查结果与手术后病理检查结果作对照分析。结果:486例病人99m锝扫描阳性423例,阴性63例,经手术证实Meckel憩室382例,重复畸形38例,阳性率86.4%。63例扫描阴性的病人有5例再次出血,重复行99mTco4扫描,3例阳性,手术证实2例为Meckel憩室,1例为肠重复畸形。结论:99m锝扫描检查在对小儿消化道出血,尤其是先天畸形,具有简单,无创伤,可重复检查的优点,且阳性率较高。     

Changes in the lead isotopic composition of blood, diet and air in Australia over a decade: globalization and implications for future isotopic studies

Source apportionment in biological or environmental samples using the lead isotope method, where there are diverse sources of lead, relies on a significant difference between the isotopic composition in the target media and the sources. Because of the unique isotopic composition of Australian lead, source apportionment has been relatively successful in the past. Over the period of a decade, the 206Pb/204Pb ratio for Australian (mainly female) adults has shown an increase from a geometric mean of 16.8-17.3. Associated with this increase, there has been a decrease in mean blood lead concentration from 4.7 to 2.3 microg/dL, or about 5% per year, similar to that observed in other countries. Lead in air, which up until 2000 was derived largely from the continued use of leaded gasoline, showed an overall increase in the 206Pb/204Pb ratio during 1993-2000 from 16.5 to 17.2. Since 1998 the levels of lead in air were less than 0.2 microg/m3 and would contribute negligibly to blood lead. Over the 10-year period, the 206Pb/204Pb ratio in diet, based mainly on quarterly 6-day duplicate diets, increased from 16.9 to 18.3. The lead concentration in diet showed a small decrease from 8.7 to 6.4 microg Pb/kg although the daily intake increased markedly from 7.4 to 13.9 microg Pb/day during the latter part of the decade probably reflecting differences in demographics. The changes in blood lead from sources such as lead in bone or soil or dust is not dominant because of the low 206Pb/204Pb ratios in these media. Unless there are other sources not identified and analysed for these adults, it would appear that in spite of our earlier conclusions to the contrary, diet does make an overall contribution to blood lead, and this is certainly the case for specific individuals. Certain population groups from south Asia, south-east Asia, the Middle East and Europe (e.g. UK) are unsuitable for some studies as their isotopic ratios in blood are converging towards the increasing Australian values. The increases in blood 206Pb/204Pb ratio combined with globalization, which has resulted in the increases in 206Pb/204Pb ratio for diet, means that isotopic studies undertaken with a high degree of certainty of outcomes over a decade ago, are now considerably more difficult, not only in Australia but also in other countries where the isotopic differences are even less than in Australia.     

Cyclic GMP signaling in cardiomyocytes modulates fatty acid trafficking and prevents triglyceride accumulation

While the balance between carbohydrates and fatty acids for energy production appears to be crucial for cardiac homeostasis, much remains to be learned about the molecular mechanisms underlying this relationship. Given the reported benefits of cGMP signaling on the myocardium, we investigated the impact of its chronic activation on cardiac energy metabolism using mice overexpressing a constitutively active cytoplasmic guanylate cyclase (GC^+/0) in cardiomyocytes. Ex vivo working GC^+/0 heart perfusions with ¹³C-labeled substrates revealed an altered pattern of exogenous substrate fuel selection compared to controls, namely a 38 ± 9% lower contribution of exogenous fatty acids to acetyl-CoA formation, while that of carbohydrates remains unchanged despite a two-fold increase in glycolysis. The lower contribution of exogenous fatty acids to energy production is not associated with changes in energy demand or supply (contractile function, oxygen consumption, tissue acetyl-CoA or CoA levels, citric acid cycle flux rate) or in the regulation of β-oxidation (acetyl-CoA carboxylase activity, tissue malonyl-CoA levels). However, GC^+/0 hearts show a two-fold increase in the incorporation of exogenous oleate into triglycerides. Furthermore, the following molecular data are consistent with a concomitant increase in triglyceride hydrolysis: (i) increased abundance of hormone sensitive lipase (HSL) protein (24 ± 11%) and mRNA (22 ± 4%) as well as (ii) several phosphorylation events related to HSL inhibitory (AMPK) and activation (ERK 1/2) sites, which should contribute to enhance its activity. These changes in exogenous fatty acid trafficking in GC^+/0 hearts appear to be functionally relevant, as demonstrated by their resistance to fasting-induced triglyceride accumulation. While the documented metabolic profile of GC^+/0 mouse hearts is partly reminiscent of hypertrophied hearts, the observed changes in lipid trafficking have not been previously documented, and may be part of the molecular mechanism underlying the benefits of cGMP signaling on the myocardium.     

Exercise-induced changes in protein metabolism

Exercise has a profound acute effect on protein metabolism. Whereas reports on whole body responses to exercise have varied results, it is generally agreed leucine oxidation is increased during exercise, thus indicating increased net protein breakdown. Following endurance exercise, whole body protein breakdown is generally reduced from resting levels, while following eccentric exercise, both whole body protein breakdown and leucine oxidation are increased. Whole body protein synthesis, on the other hand, is either increased or unchanged. Much of the disagreement in the results of studies on the response of whole body protein metabolism to exercise may be attributed to the limitations of the available methods. Even if the methodology accurately reflects whole body metabolism, this may not reflect changes in the protein metabolism of muscle. Although endurance exercise has not been studied, muscle protein breakdown is increased following resistance exercise. There is a concomitant, and qualitatively greater, increase in muscle protein synthesis following resistance exercise, which may last for as long as 48 h. Increased muscle protein synthesis is linked to increased intramuscular availability of amino acids, and thus, to increased blood flow and increased amino acid delivery to the muscle, as well as increased amino acid transport. Administration of exogenous amino acids after exercise increases protein synthesis while ameliorating protein breakdown, thus improving net muscle protein balance. While it is clear that muscle protein synthesis and protein breakdown increase in a qualitatively similar manner following exercise, the mechanisms of stimulation have yet to be determined. However, we propose that the intracellular availability of amino acids is the link between these processes.     

Isotopic composition of river water across a continent

Isotopic composition of water across United States is available and also baseline data prepared for more than 4800 samples (with depth and width-integrated stream samples) from 391 selected sites within USGS National Stream Quality Accounting Network (NASQAN). Data had been analyzed with respect to arrival at National Meteoric Water Line (NMWL). Large number of NMWL water samples has much lower slopes than 8 and intercepts ranging from +10 to −39. These lower slopes and intercepts need a re-look to ascertain coherent δ²H and δ¹⁸O across USA in precipitation. A method is worked out by plotting slopes versus intercepts on δ²H axis to arrive at the isotopic composition of water on GMWL and also to look the regional pattern that reflects the origin of vapour mass.     

皮肤恶性黑素瘤的前哨淋巴结活检技术

目的:评估前哨淋巴结活检(sentinel lymph node biopsy,SLNB)应用于皮肤恶性黑素瘤诊断和治疗中的临床价值。方法:对18例临床评估无区域淋巴结转移的皮肤恶性黑素瘤患者,应用淋巴核素显像以及术中核素扫描等方法定位前哨淋巴结(sentinel lymph node,SLN);切除SLN后进行快速冰冻和常规石蜡切片病理检查,若SLN为阳性,则加行相应区域淋巴结清扫。结果:18例患者中共检出SLN34枚,其中阳性7枚(20.6%)。5例SLN阳性患者加行区域淋巴结清扫,包括3例腹股沟清扫、1例腋窝清扫和1例颈部清扫;除SLN以外,共清扫淋巴结84枚,其中阳性39枚(46.4%)。结论:SLNB有助于诊断皮肤恶性黑素瘤的淋巴转移,为实施区域淋巴清扫提供重要的临床依据。