原发性肺癌^99Tc^m—MIBI显像与谷胱甘肽S转移酶π及DNA拓朴异构酶Ⅱa表达的关系

目的探讨原发性肺癌^99Tc^m-甲氧异丁基异氰（^99Tc^m-MIBI）显像与肺癌组织中谷胱甘肽s转移酶π（GST-π）、DNA拓扑异构酶IIa（TopoⅡa）表达的关系。方法对34例原发性肺癌患者术前行早期与延迟^99Tc^m-MIBI显像,应用免疫组织化学方法检测术后标本中多药耐药蛋白GST-π、TopoⅡa的表达水平。比较早期摄取比值（EUR）、晚期摄取比值（DUR）及放射性清除指数（WR）与GST-π、TopoⅡa表达的关系。结果^99Tc^m-MIBI早期、延迟显像阳性率分别为89．5％、82．4％,GST-π、TopoⅡa表达阳性率分别为78．5％、61．7％,GST-π、TopoⅡa表达阳性组和阴性组间EUR、DUR、WR差异均无统计学意义（P〉0．05）。结论^99Tc^m-MIBI显像与肺癌组织中GST-π、TopoⅡa表达无相关性,不具有检测肺癌患者肿瘤组织中GST-π、TopoⅡa表达的价值。     

乳腺癌99m Tc-MIBI显像与P-gp、Survivin表达的相关性研究

[目的]探讨乳腺癌中9m鍀-甲氧基异丁基异腈(99m Tc-MIBI)的摄取、滞留与多药耐药相关蛋白P-gp、survivin表达的相关性.[方法]对52例乳腺癌患者进行99m Tc-MIBI乳腺显像:静脉注射显像剂99m Tc-MIBI1110Mbq(30mci),30 min、120min后分别行99m Tc-MIBI乳腺显像,采用感性趣区(ROI)技术计算早期摄取比(Early uptake ratio,EUR)和延迟摄取比(Delay uptake ratio,DUR),计算肿瘤滞留指数(Retension index RI)、洗脱率(wash out ratio,WOR),采用免疫组化法检测乳腺癌组织P-gp、survivin表达水平,并与TUR、RI、WOR进行相关性分析.[结果]P-gp表达阳性率57.7％(30/52)与survivin 51.9％ (27/52)比较差异无显著性(x2=0.50,P＞0.05);P-gp的表达与WOR成正相关,与DUR、RI成负相关,而与EUR无相关性;survivin的表达与99m Tc-MIBI肿瘤显像无相关性.[结论]99m Tc-MIBI双时相显像(30 min和120 min)能较准确地预测乳腺癌多药耐药蛋白P-gp的功能状态,清除指数与P-gp表达呈正相关,99m Tc-MIBI显像具有检测乳腺癌患者肿瘤组织内P-gp表达的价值.     

氧介入99mTc-MIBI SPECT/CT同机融合鉴别诊断孤立性肺结节

目的探讨氧介入99mTc-MIBI SPECT/CT同机融合鉴别诊断孤立性肺结节(SPN)的价值。方法收集34例SPN患者,令其于注射99mTc-MIBI前吸氧。分别于注射99mTc-MIBI后10min、2h进行早期和延迟SPECT/CT断层同机融合显像,分析良、恶性SPN早期摄取比值(EUR)和延迟摄取比值(DUR),并对其诊断效率进行ROC曲线分析。结果 34例SPN患者中,10例为原发性肺癌;24例良性肺部病变。氧介入99mTc-MIBI SPECT/CT同机融合显像定性分析鉴别诊断良、恶性SPN的敏感度为90.00%(9/10),特异度为87.50%(21/24),准确率为88.24%(30/34),阳性预测值为75.00%(9/12),阴性预测值为95.45%(21/22)。恶性SPN的EUR为2.13±0.62(95%CI 1.68～2.57),良性SPN为1.31±0.42(95%CI 1.13～1.48);恶性SPN的DUR为2.40±0.47(95%CI 2.07～2.74),良性SPN为1.37±0.64(95%CI 1.09～1.64)。恶性肺部病灶EUR和DUR均显著高于良性肺部病灶(t=4.53、4.59,P均<0.001)。半定量ROC分析显示,以EUR≥1.50为界值,敏感度90.00%,特异度79.20%;以DUR≥1.47为界值,敏感度100%,特异度79.20%。结论氧介入99mTc-MIBI SPECT/CT同机融合显像对鉴别良、恶性SPN具有较高的临床价值。     

99Tcm—MIBI显像预测小细胞肺癌化疗疗效的临床研究

目的探讨99Tcm-MIBI显像预测小细胞肺癌化疗疗效的价值。方法53例小细胞肺癌患者根据胸部CT结果分为化疗有效组（完全缓解＋部分缓解）39例和无效组（病情稳定＋疾病进展）14例,于化疗前行99Tcm-MIBI肺显像,静脉注射99Tcm-MIBI740MBq后10—30min及2—3h分别行早期及延迟显像,分别获得早期相肿瘤与正常肺组织摄取比值（ER）和延迟相肿瘤／正常肺摄取比值（DR）,计算滞留指数（RI）。采用t检验及秩和检验分析化疗有效组与化疗无效组ER、DR和RI之间的差别。结果99Tcm-MIBI显像结果中,化疗有效组的ER、DR分别为2．33±0．21、2．44±0．19,均显著高于化疗无效组的2．02±0．31、1．86±0．30,差异有统计学意义（t=-3．401、-6．724,P均〈0．05）。化疗有效组的RI中位值为5．31％,高于化疗无效组的-9．26％,差异有统计学意义（Z=-3．612,P〈0．05）。结论99Tcm-MIBI显像在预测小细胞肺癌化疗疗效方面具有重要的临床价值。     

99Tcm-HL91与99Tcm-MIBI肿瘤阳性显像在肺部肿块诊断中的对比研究

目的比较99Tcm-HL91和99Tcm-MIBI肿瘤阳性显像对肺部单发肿块的诊断效能和影像质量.方法 50例肺部结节或肿块患者,分为恶性组和良性组,术前分别行99Tcm-HL91和99Tcm-MIBI早、晚期平面及断层融合显像,对显像结果进行对照分析.结果①定性诊断HL91组的敏感性为97.30%(36/37例),特异性为69.23%(9/13例);MIBI组诊断的敏感性为83.78%(31/37例),特异性为76.92%(10/13例). 肺门及纵膈肿大淋巴结使用HL91检测的阳性率为91.30%(21/23个); MIBI法为73.91%(17/23个).② HL91法断层显像ROC曲线下的面积(0.953±0.034)较MIBI法(0.857±0.073)高约10%,以T/N值1.76为界点HL91诊断的敏感性为100%(37/37例),特异性为84.62%(11/13例);以1.66为界点MIBI组诊断的敏感性为86.49%(32/37例),特异性为76.92%(10/13例),以1.85为界点MIBI组诊断的敏感性为78.38%(29/37例),特异性为84.62%(11/13例).结论 99Tcm-HL91肺部病变亲肿瘤阳性显像在图像质量和诊断性能上均优于99Tcm-MIBI显像.     

99Tcm-MIBI SPECT与定位CT同机融合显像对肺部病灶的鉴别诊断价值

目的：探讨99Tcm-MIBI SPECT与定位CT同机融合显像对肺部病灶的鉴别诊断价值,为肺部病灶的良恶性鉴别建立一种高性价比方法。方法：对2008年12月—2011年6月45例可疑恶性肺部病灶患者进行前瞻性研究。所有受检者均于注射后10 min、2 h分别进行早期和延迟SPECT/CT断层同机融合显像。对良、恶性肺部病灶摄取比值（早期：EUR, 延迟：DUR）应用独立样本t检验统计分析,并分别对EUR、DUR的诊断效率进行受试者工作特征（ROC）曲线分析。结果：30例原发性肺癌,15例良性肺部病灶。99Tcm-MIBI SPECT与定位CT同机融合显像定性分析对肺部单发病灶诊断灵敏度96.7%、特异性73.3%、准确性88.9%、阳性预测值87.9%、阴性预测值91.7%。恶性肺部病灶EUR为2.80±2.21（95%CI：1.97,3.62）,良性肺部病灶为1.56±0.71（95%CI：1.17,1.95）,两者差异有统计学意义（t=-2.10,P=0.041）。恶性肺部病灶DUR为2.93±1.86（95%CI：2.24,3.63）,良性肺部病灶为1.64±0.81（95%CI：1.20,2.09）,两者差异有统计学意义（t=-2.56,P=0.014）。半定量ROC分析显示：以早期摄取比≥1.50为界值,对应灵敏度96.7%,特异性73.3%。以延迟摄取比≥1.459为界值,灵敏度100%,特异性66.7%。结论：99Tcm-MIBI SPECT与定位CT同机融合显像对肺部病灶的良恶性鉴别具有较高的临床应用价值,是中小城市中低收入肺部病灶患者较为实用的早期鉴别诊断方法。     

67Ga-Citrate和99Tcm-MIBI核素显像与CT诊断头颈部肿瘤的评价

目的探讨67Ga-Citrate(Cit) 和99Tcm-MIBI显像与CT诊断头颈部肿瘤的价值.方法 48例头颈部肿瘤患者术前接受67Ga-Cit和99Tcm-MIBI显像及CT检查.结果 23例良性肿块,67Ga-Cit、99Tcm-MIBI显像和CT检查阴性者分别为18、19、20例;25例恶性肿瘤,67Ga-Cit、99Tcm-MIBI显像和CT检查阳性者分别为24、13、12例;67Ga-Cit、99Tcm-MIBI显像和CT的灵敏度分别为96.0%、52.0%、48.0%,特异度78.3%、82.6%、87.0 %,准确度 87.3%、66.7%及66.7%.结论 67Ga-Cit诊断头颈部肿瘤较99Tcm-MIBI、CT有较高的灵敏度和准确度.     

乳腺癌99mTc-MIBI显像与MRP,Ki-67表达的关系

目的:探讨99mTc-MIBI乳腺显像与人类乳腺癌组织中耐药蛋白MRP、Ki-67表达之间的关系。方法:对36例未经治疗的乳腺癌患者实施99mTc-MIBI早期(10min)与延迟(180min)平面显像,并根据99mTc-MIBI乳腺显像计算肿瘤部位99mTc-MIBI放射性清除指数(WI),应用免疫组织化学方法检测术后标本中耐药蛋白MRP、Ki-67表达。比较MRP阳性组与阴性组、Ki-67阳性组与阴性组患者间肿瘤部位放射性清除指数的差异。结果:MRP阳性组清除指数(16.72±10.17)明显高于阴性组(1.76±2.38),两者差异有显著性(t=3.020,P<0.005);Ki-67阳性组清除指数(12.47±11.26)与阴性组清除指数(13.06±12.63)间差异无显著性(t=0.249,P>0.50)。结论:99mTc-MIBI乳腺显像清除指数与乳腺癌MRP表达水平呈正相关(r=0.738,P<0.001),99mTc-MIBI乳腺显像清除指数分析可用于乳腺癌MRP表达水平的评估,而99mTc-MIBI乳腺显像清除指数与Ki-67表达之间没有发现有意义的相互关系。     

99mTc-MIBI肺肿瘤显像对肺癌化疗敏感性预测的研究

目的:探讨99mTc-MIBI肺肿瘤摄取与P-糖蛋白(Pgp)在肺癌多药耐药(MDR)表达之间的关系,以及99mTc-MIBI肺肿瘤显像在预测抗肿瘤药物化疗敏感性的价值。方法:回顾性分析38例肺癌的99mTc-MIBI肺肿瘤图像,计算T?Ne、T?Nd和RI,并根据Pgp的表达与否(阳性和阴性)及化疗方案的有效性与否(好转和加重)分组,对各组数据进行相关性分析。结果:32例患者的肿瘤组织进行了免疫组化分析,其中9例Pgp表达阳性(阳性组),23例表达阴性(阴性组),两组的T?Ne、T?Nd和RI值未见统计学差异。有完整化疗数据的20例中,病情好转与加重分别有10例,统计显示两组仅在T?Ne间有差异(P<0.05),分别是1.76±0.50和1.28±0.51。结论:99mTc-MIBI肺肿瘤显像可以预测肺癌对化疗的敏感性,但是确定其肺癌化疗敏感性的机制和标准化的方法,还有待于进一步的研究。     

重组人p53腺病毒注射液逆转鼻咽癌化疗耐药的研究

目的:探讨重组人p53腺病毒(rAd-p53)瘤内注射前后的鼻咽癌原发灶中P糖蛋白(P-glycoprotein,P-gp)、多药耐药相关蛋白(multi-drug resistance-associated protien,MRP)和肺耐药蛋白(lungresistance-related protein,LRP)的表达情况及其意义。方法:71例确诊中晚期鼻咽癌的患者随机分为3组:基因治疗组(27例,行-rAd-p53瘤内注射+同步放化疗)、常规放化疗组(24例)和单纯放疗组(20例)。12例同期门诊活检病理为鼻咽黏膜慢性炎患者作为对照。分别收集治疗前、治疗中鼻咽部瘤体组织标本。采用免疫组化法检测鼻咽癌组织中P-gp、MRP和LRP的表达情况。结果:鼻咽癌组中P-gp、MRP及LRP阳性表达率分别为57.7%(41/71)、57.7%(41/71)、53.5%(38/71),黏膜慢性炎组未见P-gp、MRP及LRP表达。基因治疗组治疗前、后原发灶P-gp、MRP和LRP蛋白阳性表达率分别为55.6%和25.9%、63.0%和33.3%、59.3%和25.9%,差异有统计学意义。常规放化疗组治疗前、后鼻咽癌原发灶P-gp、MRP和LRP蛋白阳性表达率分别为62.5%和79.2%、58.3%和70.8%、50%和58.3%,差异无统计学意义。单纯放疗组治疗前、后鼻咽癌原发灶P-gp、MRP和LRP蛋白阳性表达率分别为55.0%和55.0%、50%和40%、50%和55%,差异无统计学意义。结论:P-gp、MRP和LRP与鼻咽癌的内源性耐药相关;p53基因治疗可一定程度逆转鼻咽癌耐药,可能是其治疗鼻咽癌的作用机制之一。     

癌症患者未成年子女心理行为问题的研究进展

随着恶性肿瘤的患病人群越来越年轻化以及晚婚晚孕的大趋势,越来越多的癌症患者不仅需要抗癌还需要照护未成年子女。研究显示,癌症患者未成年子女通常会存在各种生理、心理和行为问题,如焦虑、抑郁、社交恐惧、躯体疼痛、失眠和暴力倾向等,但我国研究者并未重视这一群体。青少年是国家的未来,青少年时期正是性格养成的重要阶段,同样也是心理行为问题出现的高发期。因此,研究癌症患者未成年子女的心理行为问题的成因,并开发符合我国文化背景的理论模型和干预措施至关重要。     

《2021年AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR胸痛评估与诊断指南》解读

美国心脏协会等七大协会于2021年10月28日首次联合发布了《2021年AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR胸痛评估与诊断指南》.此次指南强调了急性胸痛风险分层和诊断流程,考虑了低风险胸痛诊断检查的成本经济效益,并建议与患者共享决策.该指南主要涉及胸痛初始评估、以患者为中心的急性胸痛诊治流程和稳定型胸痛患者的评估.该文通过文献查阅,对指南推荐要点进行详细解读.     

Residual /s/ and /r/ distortions: The perspective of the speaker

Abstract

The purpose of this study was to investigate the impact of residual distortions from the perspective of the speaker. Eighty adult speakers of Brazilian Portuguese with a distortion of the alveolar fricative /s/, the alveolar tap , or both, completed a questionnaire that documented their therapy history, awareness of the speech distortion, and perceived impact of the disorder. Only a small number of the participants reported that they received negative reactions to their speech and only a minority were of the opinion that their speech interfered with work or social life. Yet a considerable number were of the opinion that their speech was different from that of other people and felt insecure in speech situations. The results suggest that there is a high tolerance toward minor speech errors in present day society that may be related to the fact that such disorders are not at all rare.     

Residual /s/ and /r/ distortions: the perspective of the speaker

The purpose of this study was to investigate the impact of residual distortions from the perspective of the speaker. Eighty adult speakers of Brazilian Portuguese with a distortion of the alveolar fricative /s/, the alveolar tap /[symbol: see text]/, or both, completed a questionnaire that documented their therapy history, awareness of the speech distortion, and perceived impact of the disorder. Only a small number of the participants reported that they received negative reactions to their speech and only a minority were of the opinion that their speech interfered with work or social life. Yet a considerable number were of the opinion that their speech was different from that of other people and felt insecure in speech situations. The results suggest that there is a high tolerance toward minor speech errors in present day society that may be related to the fact that such disorders are not at all rare.     

Articulatory characteristics of the occlusion phase of /t/ compared to /t/ in adult speech

This study used electropalatography (EPG) to investigate articulatory characteristics of /t/ and /t/ occlusion in order to provide normative data to be used for the diagnosis and treatment of individuals with speech disorders. EPG data from the EUR-ACCOR database were analysed for nonsense VCV sequences containing /t/ and /t/ in nine vowel contexts for seven English speaking adults. The main results of this study are that all speakers had a significantly more posterior placement for /t/ compared to /t/ and that placement was stable during the occlusion phase of both /t/ and /t/. For most speakers, the occlusion phase was longer for /t/ compared to /t/, the occlusion phase generally involved more EPG contact and was slightly more variable in /t/ compared to /t/, but these differences were not statistically significant for all speakers. The implications of the results for diagnosing and treating speech disorders are discussed.     

Comparative Absorption of Ferri-Haemoglobin-59Fe/Ferro-Haemoglobin-59Fe and 59Fe3+/59Fe2+ in Humans with Normal and Depleted Iron Stores*

Abstract. The intestinal ⁵⁹Fe absorption from ferri- and ferro-haemogIobin-⁵⁹Fe and ⁵⁹Fe³⁺ and ⁵⁹Fe⁺ was calculated from whole body-⁵⁹Fe-retention measurements in subjects with normal and depleted iron stores. A ferri-haemoglobin-⁵⁹Fe/ferro-haemoglobin-⁵⁹Fe absorption ratio of 1.03 ±0.11 was observed for the absorption of ferri-haemoglobin-⁵⁹Fe (8.6± 0.77%) and ferro-haemogIobin-⁵⁹Fe (8.7±0.94%) in persons with normal iron stores. Depletion of iron stores caused a slight but significant higher rise of ferri-haemoglobin-⁵⁹Fe absorption (22 ± 1.7%) than the increase of ferro-haemoglobin-⁵⁹Fe absorption (18 ±0.9%) so that the absorption ratio was 1.24±0.073.—This remarkable iron valence independence of haemoglobin iron absorption is in considerable contrast to the well-established valence dependence of inorganic iron absorption which favours ferrous iron absorption especially with rising iron doses. The ⁵⁹Fe³⁺/⁵⁹Fe²⁺ absorption ratio for a diagnostic 0.56 mg Fe dose increased from 0.43 in subjects with normal iron stores to 0.74 in persons with depleted iron stores, whereas this absorption ratio was augmented only from 0.21 to 0.28 for the therapeutic 50 mg Fe-dose.—The different influence of iron valence on iron absorption from inorganic and haemoglobin iron supports other evidence for the existence of two separate mechanisms for ferrous iron and haem iron absorption in humans.     

The Serology of Rho Variants (Rho)

Eighty-two Rh_o samples were tested with a battery of ten anti-Rh_o sera by the antiglobulin, bromelin and albumen replacement technics. The varying ability of different anti-Rh_o sera to react with Rh_o variant cells was clearly demonstrated. Anti-Rh_o used for the detection of Rh_o variants should be specially selected for this purpose. It is suggested that the Rh_o factor results from a genetically determined absence or abnormality of the primary Rh_o factor, and the serologic reactions characterizing it are dependent on the reactions of the subsidiary factors Rh^A, Rh^B, Rh^C, and Rh^D.