陆金根运用拖线法治疗肛瘘经验探讨

介绍陆金根教授运用现代技术诊断肛瘘瘘管的走向、拖线的设置及术后创面的处理等临床经验。     

Preparation of clinical‐scale 177Lu‐Rituximab: Optimization of protocols for conjugation,radiolabeling, and freeze‐dried kit formulation

Rituximab is a monoclonal chimeric antibody, which has been approved by the US Food and Drug Administration for immunotherapy of non–Hodgkin lymphoma. Bexxar and Zevalin are the two other approved radiolabeled antibodies for radioimmunotherapy of non–Hodgkin lymphoma; however, they are of murine origin that reduces their treatment efficacy. So as to circumvent this, efforts have been made to radiolabel Rituximab with various therapeutic radioisotopes. In the present study, an effort has been made to optimize the conjugation (bifunctional chelating agent and antibody) and radiolabeling procedures for the preparation of clinical‐scale ¹⁷⁷Lu‐labeled Rituximab. An attempt was also made to prepare the freeze‐dried Rituximab kit for the easy and convenient clinical translation of the agent. Clinical‐scale ¹⁷⁷Lu‐Rituximab (40 mCi, 1.48 GBq) was prepared with >95% radiochemical purity using the kit. Biological evaluation of ¹⁷⁷Lu‐Rituximab was performed by in vitro cell binding studies in Raji cell lines, which showed satisfactory binding at 4°C and 37°C. Pharmacokinetic behavior of the agent, evaluated by biodistribution studies in normal Swiss mice, revealed high blood and liver uptake at the initial time points, although it exhibited slow and gradual clearance with time. The study indicates that clinical‐scale ¹⁷⁷Lu‐Rituximab could be conveniently formulated using the methodology described in the present article.     

陆灏运用温胆汤治疗痰热内扰型消渴经验

介绍陆灏教授运用温胆汤加减治疗痰热内扰型消渴的思路和方法,分析温胆汤应用指征与方证,并举验案1则。     

177Lu-奥曲肽治疗神经内分泌肿瘤肾脏吸收剂量估算

目的 估算¹⁷⁷Lu-奥曲肽（¹⁷⁷Lu-DOTA-TATE）治疗神经内分泌肿瘤肾脏所受吸收剂量,评估辐射安全并指导治疗。方法 ¹⁷⁷Lu-DOTA-TATE治疗患者行单光子发射断层扫描（single photon emission computed tomography,SPECT）平面显像,勾画计数全身和肾脏区域并转换为活度,构建时间-活度单指数曲线方程,计算全身/肾脏的有效半衰期和累积活度,以MIRD （medical internal radiation dose）方法估算肾脏的吸收剂量。结果 总共11名神经内分泌肿瘤患者进行了18例次¹⁷⁷Lu-DOTA-TATE药物治疗,全身和肾脏的有效半衰期分别为（20.0~99.8）和（38.2~75.2） h,平均有效半衰期分别为（57.3±21.4）和（53.1±2.5） h;肾脏所吸收的剂量为（0.25~1.48） mGy/MBq,平均吸收剂量为（0.90±0.31） mGy/MBq。患者单次疗程肾脏受到的吸收剂量最小1.8 Gy,最大9.6 Gy,多个疗程肾脏受到最大吸收剂量21.7 Gy。结论 准确估算¹⁷⁷Lu-DOTA-TATE治疗神经内分泌肿瘤患者危险器官肾脏吸收剂量,结果低于耐受剂量限值,有望为患者的精准化治疗提供指导。     

六安地区健康成人超敏Ｃ反应蛋白参考区间研究

目的：建立六安地区成人超敏C反应蛋白（hs-CRP）的参考区间。方法按照CLSI文件C28-A3《临床实验室如何确定和建立生物参考区间》要求,于2014年1～8月筛选前来六安市第二人民医院进行健康体检者137名,采用颗粒增强免疫透射比浊法测定血清hs-CRP浓度。结果去除3例离群值后,134例六安地区健康成人血清hs-CRP明显呈偏态分布,经对数转换,男女之间无组间差别（Z＜Z*）,参考上限为2.0664 mg／L。结论本研究为六安地区健康成人血清hs-CRP参考区间的建立提供了科学依据。     

Automated synthesis of 68Ga/177Lu-PSMA on the Trasis miniAllinOne

Prostate-specific membrane antigen (PSMA)-based radioligands for positron emission tomography (PET)/computed tomography (CT) studies represent the gold standard for detection of recurrent prostate cancer (PCa). [⁶⁸Ga]PSMA-HBED-CC is a PET radiotracer suitable for detection of PCa, and its clinical use has become widespread over the last few years. In this contribution, we detail our GMP-compliant production of [⁶⁸Ga]PSMA-HBED-CC using the Trasis miniAllinOne radiosynthesizer and report synthetic and clinical data for the first 100 productions of 2019. Additionally, we detail our efforts towards a GMP-compliant production of the radiotherapeutic [¹⁷⁷Lu]PSMA-I&T using the same synthesis module. PSMA-based radioligand therapy (RLT) offers a possible future treatment in cases of metastatic castration-resistant PCa, and GMP-compliant routine production methods are therefore called for. This report highlights how PSMA-based agents for theranostic purposes can be conveniently produced at a single radiochemistry Good Manufacturing Practice (GMP) site, thereby facilitating optimized detection and treatment of PCa.     

卢永兵主任医师治疗老年脑病经验

卢永兵主任医师是著名老年医学专家,他在治疗老年脑病方面具有独到的经验。他认为,治疗脑病应遵循以下原则,即探求病因、明察病机,着眼局部、立足整体,危急重症应中西结合,治脑安心、防治结合。用上述原则指导临床老年脑病的防治工作,往往能获得良效。     

路志正调理脾胃学术思想探讨

饮食失调、脾胃损伤,是现代常见的冠心病、糖尿病、高血脂、高血压、痛风等疾病发病的关键因素。脾胃损伤常见气虚血少、蕴湿、痰阻、血瘀、气机紊乱等病证,辨证要着眼于发病的根源,调理脾胃是其治本之道。