In recent years, potential health hazards associated with tritium radiation have received increased attention. The medical emergency response to tritium-related accidents requires highly specialized and technical expertise with broad coverage and significant impact. In China, nuclear- and radiation-related laws and regulations have a complete emergency system and rescue management plan for dealing with such emergencies. These provisions, combined with the specific characteristics of tritium radiation accidents, underscore the need for the implementation of a medical emergency response. This Account presents guiding opinions for the medical emergency response and management of tritium-related accidents by introducing a three-level rescue system and analyzing medical rescue and psychological assistance for people exposed to tritium in such accidents.
Objective:To prepare human vascular endothelial growth factor (hVEGF) radioimmunoassay (RIA) and chemiluminescence immunoassay (CLIA) kits and evaluate their clinical value in diagnosis of early lung cancer and colorectal cancer.Methods:A detection method was established according to the technical indices of the kits. The techniques for coating magnetic particles and 125iodine and acridine ester labeling with antibody were evaluated. Sensitivity, precision, and recovery of the kits were determined. The sensitivity and specificity of the kits in the diagnosis of early cancers (lung and colorectal cancers) were evaluated by testing cancer and normal serum samples. Independent sample t-test was used for inter-group comparison. Results:The optimal ratios were as follows: 1 mL of magnetic particles to 1 mg of the antibody, 55.5 MBq 125iodine to 0.1 mg of the antibody, and 25 μg acridine ester to 0.2 mg of the antibody. The detection sensitivities of RIA and CLIA kits were 17.6 and 9.2 pg/mL respectively. For precision, the CLIA kit had slightly higher intra-batch variability and lower inter-batch variability than the RIA kit. The mean recovery levels of the RIA and CLIA kits were 103.28% and 101.85% respectively, and the latter had higher detection accuracy. The clinical sensitivity and specificity in the diagnosis of lung cancer and colorectal cancer were all above 90%. RIA kit and CLIA kit showed that the specificity of hVEGF in normal serum samples was 98.11% (104/106) and 99.06% (105/106), respectively.. There were significant differences in hVEGF between cancer patients and normal subjects ( t=-16.695–-14.920, all P<0.01). Conclusions:The technical indices of the hVEGF RIA and CLIA kits were good. The CLIA kit had higher sensitivity and specificity than the RIA kit and has clinical value in screening and auxiliary diagnosis of early lung and colorectal cancers.
Objective:To investigate the value of MRI DWI-based radiomics models for evaluating the treatment response in osteosarcoma after neoadjuvant chemoherapy.Methods:A retrospective analysis was conducted on the medical records and imaging data of 41 patients with osteosarcoma (26 males and 15 females; aged (22.0±11.0) years, range of 11–49 years) who underwent MRI examinations before and after receiving neoadjuvant chemotherapy, and confirmed by postoperative histopathological examinations at the Third Hospital of Hebei Medical University from June 2015 to November 2017. In accordance with the postoperative histopathological examination results, patients with a tumor tissue necrosis rate of ≥90% were included in the good-efficacy group, and those with a necrosis rate of <90% were included in the poor-efficacy group. The apparent diffusion coefficient (ADC, denoted as ADC0, ADC1, and ADC2) were measured in all patients before neoadjuvant chemotherapy, within 5 days after the end of the first stage of chemotherapy, and after the completion of the entire chemotherapy. The differences in ADC were compared between the two groups. The region of interest of the lesion was manually delineated on DWI (b=1 000 s/mm 2) and ADC images after the end of the first stage of chemotherapy, and the radiomics features were extracted. Data were divided into training set and validation set by using random grouping at 6∶4. The SMOTE algorithm was used to expand the data on the training set. The variance threshold, SelectKBest, and least absolute shrinkage and selection operator (LASSO) algorithm were used to screen the radiomics features. A radiomics model was constructed using a logistic regression classifier. Independent sample t-test or Wilcoxon rank sum test was used to compare the two groups. Receiver operating characteristic (ROC) curves were used to evaluate the predictive efficacy of traditional imaging (ADC) and radiomics models on the efficacy of neoadjuvant chemotherapy for osteosarcoma. Results:A total of 10 and 31 cases were included in the good-efficacy and poor-efficacy groups, respectively. No statistically significant difference was found in the ADC0 value between the two groups ((0.95±0.05)×10 -3 mm 2/s vs. (1.05±0.05)×10 -3 mm 2/s, t=1.14, P>0.05)). The values of ADC1 and ADC2 in the good-efficacy group were higher than those in the poor-efficacy group, with statistical significance ((1.44±0.10)×10 -3 mm 2/s vs. (1.10±0.06)×10 -3 mm 2/s, t=-2.92, P<0.05; 1.68 (1.55, 1.85)×10 -3 mm 2/s vs. (1.33±0.06)×10 -3 mm 2/s, Z=-2.61, P<0.01). ROC curve analysis showed that when ADC1 ≥1.34×10 -3 mm 2/s, the sensitivity for evaluating the efficacy of neoadjuvant chemotherapy in osteosarcoma was 80%, the specificity was 81%, and the area under the curve (AUC) was 0.797 (95% CI: 0.629-0.965). When ADC2 ≥1.51×10 -3 mm 2/s, the sensitivity for evaluating the efficacy of neoadjuvant chemotherapy in osteosarcoma was 90%, the specificity was 71%, and the AUC was 0.777 (95% CI: 0.588–0.967). A total of 1 409 radiomics features were extracted from the DWI and ADC images after the end of the first stage of chemotherapy. They were randomly divided into training set and validation set at a ratio of 6∶4 (24 (good efficacy: 6, poor efficacy: 18)∶17 (good efficacy: 4, poor efficacy: 13)). The training set data were expanded to 70 (good efficacy: 20, poor efficacy: 50). After the radiomics features were screened, five optimal radiomics features were ultimately obtained, including InterquartileRange, Skewness, Uniformity, Median, and Maximum. Logistic regression classifier was used to construct a radiomics model. The ROC curves showed that in the training set, the AUC of the model for predicting the efficacy of neoadjuvant chemotherapy in osteosarcoma was 0.881 (95% CI: 0.811-0.942), with sensitivity of 90% and specificity of 74%. Meanwhile, in the validation set, the AUC was 0.769 (95% CI: 0.515–0.933), with sensitivity of 75% and specificity of 69%. Conclusion:The radiomics model based on MRI DWI outperforms the traditional imaging (ADC) in evaluating the efficacy of neoadjuvant chemotherapy for osteosarcoma, showing great potential in clinical applications.
Objective:To investigate the clinical value of a combined model of enhanced CT-based entropy features and traditional imaging features for the differential diagnosis of risk status in patients with thymic epithelial tumor (TET).Methods:A retrospective analysis was conducted on the clinical data of 178 TET patients (83 males and 95 females; aged (52.7±12.4) years, ranged from 26 years to 83 years) confirmed by surgical and histopathological results at Jiangmen Central Hospital and the Fifth Affiliated Hospital of Sun Yat-sen University from October 2008 to May 2021 were retrospectively analyzed. They were divided into low-risk (A, AB, and B1 types) and high-risk (B2 and B3 types) groups according to histopathology subtypes. All patients were further divided into a training set ( n=86), an internal validation set ( n=51), and an external validation set ( n=41). The internal and external validation sets were called the total validation set ( n=92). The training and validation sets were used for the process construction and performance evaluation of the predictive model, respectively. The clinical characteristics of TET patients were recorded, and the traditional CT features of lesions were analyzed. Entropy features were extracted and selected from enhanced CT venous phase images by using software developed based on MATLAB R2016 platform. Mann-Whitney U test was used to select valuable entropy features. Extreme learning machine classification algorithm was adopted to calculate the different weights of entropy features and entropy signature value. Clinical model, entropy model, and combined model were constructed through Logistic analysis, and receiver operating characteristic curve was used to compare the diagnostic efficacy of the three predictive models. Results:A total of 83 cases were included in the low-risk group (38 males and 45 females; aged (52.8±12.4) years, ranged from 26 years to 83 years), whereas 95 cases were in the high-risk group (45 males and 50 females; aged (52.0±12.0) years, ranged from 27 years to 80 years). Univariate analysis showed that the difference in peripheral invasion between the two groups in the training set was statistically significant ( χ2=5.108, P=0.024). A total of 1 680 initial entropy features were extracted, and 21 core entropy features were ultimately selected. The entropy signature value of the low-risk group in the training set was 0.519±0.21, which was significantly lower than that of the high-risk group (0.997±0.23). The difference between the two groups was statistically significant ( t=-9.747, P<0.001). The area under curve (AUC) of the entropy model in the training set, internal validation set, external validation set, and total validation set were 0.929(95% CI: 0.876-0.983), 0.832(95% CI: 0.723-0.941), 0.802(95% CI: 0.666-0.939), and 0.803(95% CI: 0.715-0.890), respectively. Results of multivariate Logistic regression analysis showed that peripheral invasion ( OR=6.343; 95% CI: 1.009-36.604; P=0.039) and entropy signature value ( OR=20.145; 95% CI: 5.887-68.936; P<0.001) were independent risk factors for predicting TET risk status. The combined model constructed by the two together had AUCs of 0.941(95% CI: 0.894-0.987), 0.871(95% CI: 0.775-0.968), 0.819(95% CI: 0.689-0.949), and 0.840(95% CI: 0.761-0.919) in the training set, internal validation set, external validation set, and total validation set, respectively. Conclusions:The entropy feature based on enhanced chest-CT images can be used to assess the risk status of TET quantitatively. The combined model constructed by peripheral invasion and entropy signature value showed the highest diagnostic efficacy, which can accurately guide the preoperative treatment strategy of TET patients.
近年来，核威慑、核泄漏等危机事件倍受关注，更多社会目光聚焦到辐射损伤防护这一重大公共卫生问题上。骨髓是辐射损伤的主要靶器官之一，短时间内受照剂量超过一定阈值（>1.0 Gy）即可引起明显的骨髓造血系统损伤。大剂量辐射还可导致造血细胞数量显著减少，从而引发机体出血、感染甚至死亡。造血干细胞（hematopoietic stem cells，HSCs）是造血种子细胞，其损伤是骨髓造血功能衰竭的发生根源 [1]。因此，深入研究核辐射对HSCs的损伤特点、损伤机制及调控策略，可为辐射损伤防护和临床治疗提供新的思路。
Objective:To investigate the effect of different kidney depth estimation formulas modified using SPECT/CT renal dynamic imaging on the calculation of the glomerular filtration rate (GFR) in living kidney transplant donors.Methods:The clinical data of 127 healthy kidney transplant donors who underwent preoperative 99Tc m-diethylene triamine pentoacetic acid (DTPA) renal dynamic imaging in the First Affiliated Hospital of Xi'an Jiaotong University from October 2011 to December 2017 were retrospectively analyzed. Included 36 males and 91 females, aged (49.2±7.3) years. The computed GFR of kidney depth measured via CT was adopted as the standard reference standard. The T?nnesen and Itoh formulas were used to calculate kidney depth and the corresponding GFR and then compare them with the CT results. The measurement data that did not conform to the normal distribution were expressed as M ( Q1, Q2), and the Wilcoxon rank sum test was used to compare between the renal depth calculated by each formula. Spearman correlation analysis and linear regression analysis were used to analyze the correlation between renal depth and the corresponding GFR of lelf and right kidney by each formula. Results:The depth of the left and right kidneys from 127 healthy kidney transplant donors measured via CT [7.03(6.34, 7.67) cm, 7.21(6.51, 8.13) cm] was significantly higher than those obtained using the T?nnesen formula [5.66(5.30, 6.06) cm, 5.70(5.33, 6.10) cm] and the Itoh formula [6.70(6.33, 7.10) cm, 6.88(6.52, 7.26) cm], and the differences were statistically significant (left kidney: Z=-9.53, -3.77, both P<0.001; right kidney: Z=-9.73, -4.64, both P<0.001). The renal depth measured via CT was positively correlated with the renal depth calculated using the T?nnesen and Itoh formulas (left kidney: r=0.330, 0.331, both P<0.001; right kidney: r=0.359, 0.358, both P<0.001). The GFR of left and right kidneys that corresponded to the renal depth measured via CT [46.4(39.9, 52.0) ml/min, 46.0(40.5, 54.9) ml/min] was higher than those obtained using the T?nnesen formula [36.6(33.0, 41.9) ml/min, 36.2(32.1, 40.1) ml/min] and the Itoh formula [43.2 (39.4, 49.8) ml/min, 43.8 (39.4, 48.7) ml/min], and the differences were statistically significant (left kidney: Z=-9.52, -3.76, both P<0.001; right kidney: Z=-9.73, -4.75, both P<0.001). The CT measurement was positively correlated with the GFR values that corresponded to kidney depth estimates obtained using the T?nnesen and Itoh formulas (left kidney: r=0.476, 0.476, both P<0.001; right kidney: r=0.386, 0.539, both P<0.001). Conclusions:The GFR calculated using the T?nnesen and Itoh formulas are suitable for the routine screening and evaluation of kidney diseases. For kidney transplant donors with more stringent requirements for renal GFR, kidney depth measured via CT should be used to correct the GFR calculated using SPECT/CT.
Keloid is a fibroproliferative disease, usually caused by abnormal wound healing, and it is easy to recur after surgical resection. In recent years, the application of radioactive adjuvant therapy has greatly reduced the recurrence rate of keloids after resection. This article reviews several brachytherapy methods commonly used in clinical practice, and provides references for clinicians and researchers in related fields in the treatment of keloids.
The authors reported a case of polyneuropathy, organomegaly, endocrinopathy, monoclonal protein and skin changes (POEMS) syndrome located in the right iliac bone by 18F-fluorodeoxyglucose (FDG) PET/CT. The authors summarized the diagnostic criteria and 18F-FDG PET/CT imaging manifestations of POEMS syndrome through literature review. Although 18F-FDG PET/CT in POEMS syndrome has been well reported, imaging manifestations involving only the right iliac bone are rare. Understanding the diagnostic criteria, clinical manifestations and laboratory findings of POEMS syndrome can help to obtain more information and make an accurate diagnosis.
18F-fluorodeoxyglucose (FDG) PET/MRI imaging of viable myocardium has always been concerned by clinicians, especially cardiologists. Both PET and MRI can play a unique value in the diagnosis and prognosis of ischemic cardiomyopathy. Integrated PET/MRI equipment provides a new platform for exploring its integrated value. By reviewing the pathophysiology of ischemic cardiomyopathy, the characteristics of PET myocardial imaging and the clinical application of MRI, and combing the research progress in related fields in the past ten years, the author reviews the characteristics and clinical value of PET/MRI viable myocardial imaging, so as to provide reference for the clinical scientific research of PET/MRI viable myocardial imaging.
Thyroid-associated ophthalmopathy (TAO) leads a significant negative impact on patients' quality of life, mental health and community economy. Treatment in the early active stage of the disease will achieve better efficacy. At present clinical activity score (CAS) is the mainly method of judging disease activity, but it has many shortcomings. Recent studies have suggested that 99Tc m-diethylene triamine pentaacetic acid (DTPA) orbital SPECT/CT shows important value in the early diagnosis, treatment and follow-up of TAO. It can complement with CAS and has a broad application prospect. The authors summarize the current research progress in this field and highlight the need for more research to establish a standardized consensus on collection method and result analysis. Investigating a new tool to judge disease activity which can combine 99Tc m-DTPA orbital SPECT/CT with the artificial intelligence will more accurately and conveniently guide the clinical practice.
Objective:To investigate the prophylactic effect of silicone on radiodermatitis during the treatment of keloid by using 90Sr- 90Y applicator. Methods:The clinical data of 175 patients who received 90Sr- 90Y applicator for keloids at the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2019 to June 2021 were retrospectively analyzed. The patients included 81 males and 94 females, with ages of (27.2±3.7) years. The patients were divided into the control group (57 cases), the 1 mm-thick silicone protection group (55 cases), and the 2 mm-thick silicone protection group (63 cases) by using the envelope random grouping method. All the patients were treated with multiple small-dose radiation therapy by using a 90Sr- 90Y applicator. The skin around the lesion was respectively protected with 1 mm- and 2 mm-thick silicone in the 1 mm-thick and 2 mm-thick silicone protection groups. Radidermatitis for the three groups of patients was graded using the radidermatitis grading criteria of the Radiation Therapy Oncology Group. The incidence and severity of radiodermatitis were compared among the groups. The effects of the treatment course and silicone protection on the occurrence of severe radidermatitis were analyzed. Independent sample t-test (equal variances assumed) was used to compare the two groups for the measurement data in accordance with normal distribution. One-way ANOVA was adopted to compare the three groups. The chi-squared test was conducted to compare the count data in the three groups. Lastly, the factors that affected the efficacy of the treatment were analyzed via univariate Logistic regression analysis. Results:No statistically significant difference was found in the incidence of radiodermatitis between the 1 mm-thick silicone protection group and the control group (83.6% vs. 89.5%, χ2=0.815, P=0.367). The incidence of radiodermatitis was significantly lower in the 2 mm-thick silicone protection group than in the control group and the 1 mm-thick silicone protection group (89.5% vs. 83.6% vs. 54.0%), and the differences were statistically significant ( χ2=18.108, 11.738; both P<0.05). The severity of overall radiodermatitis was lower in the 1-mm thick silicone protection group than in the control group (1.05±0.65 vs. 1.37±0.75), and the difference was statistically significant ( t=-2.409, P<0.05). The severity of radiodermatitis in the 2 mm-thick silicone protection group (0.63±0.66) was lower than that in the control group and the 1 mm-thick silicone protection group, and the differences were statistically significant ( t=-5.749, -3.473; both P<0.05). The increase in the number of treatment courses augmented the risk of radiodermatitis ( OR=2.348, 95% CI: 1.524–3.618, P<0.001). Meanwhile, the use of silicone with different thicknesses can reduce the risk of radiodermatitis (1 mm-thickness silicone: OR=0.273, 95% CI: 0.109-0.685, P<0.01; 2 mm-thickness silicone: OR=0.099, 95% CI: 0.034-0.293, P<0.001). Conclusion:During the treatment of keloid with 90Sr- 90Y applicator, the use of 2 mm-thick silicone to protect the surrounding normal skin tissue can significantly reduce the incidence and severity of radiodermatitis.
自主功能性甲状腺结节(AFTN)是一种能引起甲状腺毒症的疾病,结节可单发也可多发,其中99％为良性,多发生在甲状腺的2个侧叶,峡部少见.AFTN的治疗方法有手术、131I治疗、抗甲状腺药物治疗、射频消融治疗等.其中131Ⅰ治疗是一种治疗AFTN的有效方法.笔者结合国内外文献报道,对AFTN的发病机制与诊断方法,以及131Ⅰ治疗的原理、临床应用与疗效等作一综述,为AFTN的临床诊疗提供参考.
人血清白蛋白(HSA)是一种多功能蛋白质,能结合和运输多种内源性和外源性化合物,也可作为药物载体用于肿瘤的靶向给药.通过在药物分子中添加功能性化学基团可实现药物与HSA的结合,增加药物在血液中的循环时间,同时不会显著影响药物的生物活性,这种方法可以提高放射性治疗药物在肿瘤部位的浓集程度并延长浓集时间,改善其靶向治疗的效果.HSA结合型分子探针还可用于心脏功能和血管通透性评价以及淋巴显像.笔者综述了近年来各种HSA结合型分子探针在核医学诊疗中的研究进展.
目的 探讨Ⅰ～ⅢB期可切除周围型非小细胞肺癌(NSCLC)患者的临床及高分辨率CT(HRCT)影像特征与表皮生长因子受体(EGFR)基因突变的相关性.方法 回顾性分析2019年1月至2021年4月于惠州市中心人民医院行手术切除、术后行EGFR基因检测且临床分期为Ⅰ～ⅢB期的周围型NSCLC患者164例,其中男性86例、女性78例,年龄(60.3±9.3)岁.根据EGFR基因检测结果将患者分为EGFR基因突变型组和野生型组,分析患者的临床及HRCT影像特征并进行统计学分析.计量资料的比较采用两独立样本t检验,计数资料的比较采用x2检验或Fisher确切概率检验.筛选差异有统计学意义的指标纳入二元Logistic回归分析.采用受试者工作特征(ROC)曲线的曲线下面积对构建的回归模型的诊断效能进行评估.结果 164例NSCLC患者中,EGFR基因突变型组114例(69.51％)、野生型组50例(30.49％).与EGFR野生型组比较,EGFR基因突变型组多见于女性、年龄＜60岁、无吸烟史、病理类型为肺腺癌的患者,且2组间的差异均有统计学意义(x2=21.91、-4.71、34.64,Fisher确切概率法,均P＜0.05).HRCT影像特征中,EGFR基因突变型组肿瘤最大径小于野生型组[(2.52±1.51)cm对(4.12±6.07)cm],且肿瘤多位于右肺,密度类型多为磨玻璃影和(或)混合磨玻璃影,多伴有分叶征、支气管充气征和胸膜牵拉征,与EGFR野生型组相比,差异均有统计学意义(t=2.14,x2=10.13～19.05,均P＜0.05).2组患者在术后临床分期、癌胚抗原水平、肿瘤伴有毛刺征、坏死、血管集束征、空泡征、空洞征、胸腔淋巴结肿大中的差异均无统计学意义(x2=0.40～2.33,Fisher确切概率法,均P＞0.05).Logistic回归分析结果显示,患者无吸烟史(OR=0.225,95％CI:0.066～0.764)和肿瘤伴有分叶征(OR=3.344,95％CI:1.079～10.360)是EGFR基因突变的独立预测因子(均P＜0.05),回归模型的ROC曲线的曲线下面积为0.858.结论 Ⅰ～ⅢB期可切除周围型NSCLC的临床及HRCT影像特征与EGFR基因突变具有一定的相关性,对指导临床评估患者情况有重要意义.
1.论著类文章摘要的内容应包括研究目的、研究方法、主要发现(包括关键性或主要的数据)和主要结论,一般应写成四段式结构式摘要:"目的(Objective)"、"方法(Methods)"、"结果(Results)"和"结论(Conclusions)".临床试验研究论著结构式摘要的小标题也可以扩展,例如"背景"(Background)包括提供背景资料和研究目的(Objective),"方法"可包括研究设计(Design)、附属机构(Setting)、患者或研究对象(Patients or participants)、干预措施(Interventions)、主要结果测定(Main outcome measures)等,"结论"包括研究最终结论、应用前景和优缺点等.
吞咽障碍是头颈部肿瘤(HNC)放疗后常见的不良反应之一,随着时间的延长病情加重,会导致患者营养不良、发生误吸性肺炎甚至死亡.虽然吞咽功能训练对HNC患者有一定的疗效,但训练方法尚未统一.笔者对HNC患者放疗后吞咽障碍的发生机制、影响因素、评估方法等进行综述,以期为HNC患者放疗后吞咽障碍的防治提供思路.
国家自然科学基金:National Natural Science Foundation of China 国家自然科学基金面上项目:General Program of National Natural Science Foundation of China 国家自然科学基金重点项目:Key Program of National Natural Science Foundation of China 国家自然科学基金重大研究计划项目:Major Research Plan of the National Natural Science Foundation of China 国家自然科学基金国际合作与交流项目:NSFC Projects of International Cooperation and Exchanges 国家杰出青年科学基金:National Science Foundation for Distinguished Young Scholars 国家教育部科学基金:Science Foundation of Ministry of Education of China
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肝癌分为原发性肝癌和继发性肝癌两大类.肝细胞癌(HCC)是原发性肝癌中最常见的一种病理类型,其具有发病率高、病死率高的特点.90Y微球选择性内放射治疗(SIRT)可应用于HCC的多个阶段,兼有多重疗效,即可以缩小肿瘤、增大剩余肝脏体积、治疗门静脉癌栓和提高患者的生活质量.笔者介绍了90Y微球SIRT在HCC治疗中的临床应用价值及研究进展.
副肿瘤性天疱疮(PNP)是一种与肿瘤相关的皮肤黏膜自身免疫性疾病,其伴发纵隔巨大胸腺瘤在临床较罕见.笔者报道了 1例PNP患者,从临床、组织病理学、治疗、18F-氟脱氧葡萄糖(FDG)PET/CT显像等方面分析了 PNP的特点,通过文献复习加深了对该病的认识.多形性皮肤损害患者应考虑PNP的可能,其诊断基于临床表现、组织病理学检查以及免疫荧光检查.笔者通过PET/CT显像发现隐匿性的恶性肿瘤,辅助临床医师了解胸腺瘤与PNP的内在联系,提高术前的诊断准确率,并为治疗方案的选择提供重要依据.
