目的 合成靶向突变表皮生长因子受体(EGFR)的特异性探针99m Tc-HYNIC-MPG,并用于实时、在体判定非小细胞肺癌EGFR突变情况.方法 一步法合成99m Tc-HYNIC-MPG,分为人非小细胞肺癌PC9(实验组,19外显子缺失)、人非小细胞肺癌细胞系H358(对照组,EGFR野生型)、人非小细胞肺癌H520(对照组,EGFR阴性)和人非小细胞肺癌H1975(对照组,T790M/L858R二次突变).四种细胞系行99m Tc-HYNIC-MPG探针的细胞摄取、释放及阻断实验.四种不同的细胞系构建荷瘤裸鼠动物模型,于1、2、4和6 h行单光子发射计算机断层显像(SPECT)成像和生物体内分布.使用PD153035(100 mg/kg)验证能否阻断PC9细胞系荷瘤鼠模型对探针的摄取.结果 99m Tc-HYNIC-MPG探针的标记率高达98％.PC9细胞系对99mTc-HYNIC-MPG摄取率最高,可达到(23.79±0.63)％.PD153035(100μmol/L)能够阻断摄取,摄取率降低为(1.90±0.06)％.生物体内分布实验表明PC9细胞系于2 h达到高峰(7.20±0.27)％ID/g,而H358、H520和H1975三种细胞系肿瘤摄取明显低.SPECT成像结果也表明PC9细胞系荷瘤鼠模型的肿瘤对99m Tc-HYNIC-MPG的摄取高.结论 99m Tc-HYNIC-MPG探针特异性、靶向性强,能够与19外显子缺失的EGFR突变特异性结合,有望真正实现肺癌在体分子分型.

原发性肝癌(Hepatocellular carcinoma,HCC)是肝脏最常见的恶性肿瘤,具有高发病率、死亡率及预后差的特点,大多数患者确诊时为进展期,已失去手术机会,严重危及患者生命.虽然目前相关的治疗方法较多,但预后仍较差,介入治疗作为一种微创疗法在提高患者生存期、改善患者生活质量等方面取得显著效果.本文就原发性肝癌的介入治疗现状与进展进行综述.

目的:探讨部分性脾动脉栓塞术(PSE)治疗原发性肝癌合并脾功能亢进的临床疗效及安全性.方法:选择2008年5月至2013年4月我科收治的160例原发性肝癌合并有脾功亢进患者为研究对象,患者在行肝动脉化疗栓塞术(TACE)的同时进行PSE,PSE栓塞面积在30％～60％之间,观察治疗后3天、7天、1个月、3个月、6个月患者白细胞(WBC)计数和血小板(PLT)计数的动态变化情况.结果:以外周血白细胞计数达到4.0～13× 109/L、血小板达计数到50× 109/L为治疗有效,160例患者术后3个月时外周血白细胞治疗有效为151例(94.38％),血小板治疗有效为155例(96.88％),术后6个月时白细胞治疗有效136例(85％),血小板治疗有效125例(78.13％).所有患者术后6个月均未发生严重并发症.结论:PSE联合TACE治疗原发性肝癌合并有脾功亢进患者具有良好的疗效,且安全性较高.

肝癌是世界范围内恶性程度最高的恶性肿瘤之一.门静脉癌栓的出现加速了肝功衰竭以及门静脉高压的发生概率,严重影响了肝癌患者的预后,临床上对于肝癌合并门静脉癌栓的诊疗尤为棘手.传统的治疗手段对于肝癌合并门静脉癌栓的疗效欠佳,且创伤大、住院时间长、并发症多.介入治疗因其创伤小、住院时间短、并发症少,疗效确切等优势逐渐被人们认可.以往单独应用经导管肝动脉化疗栓塞术(Transcatheter Arterial Chemoembolization,TACE)治疗肝癌取得了可喜的成果,随着介入治疗的发展,TACE联合其他介入手段治疗肝癌伴门静脉癌栓引起了越来越多的学者重视.本文回顾了近几年来国内外的相关文献,对TACE联合其他介入手段治疗肝癌合并门静脉癌栓的方式及疗效做一综述,以期对肝癌的临床诊疗工作提供一些帮助.

目的:探讨认知干预对肝癌介入患者焦虑和抑郁情绪的影响.方法:选取我院2013年01月-2014年06月于中心导管室行肝癌介入术患者86例,按随机数字表法分为对照组和实验组.对照组实施常规护理;干预组在常见护理基础上实施认知干预行为.采用焦虑自测评量表(SAS)、抑郁自量评量表(SDS)对两组患者于入院时、术前1天及术后1天和1周时进行焦虑状和抑郁态评估.结果:两组患者入院时SAS和SDS评分比较无显著性差异(t=0.24、-0.08,P＞0.05),与国内常模相比有明显差异(t=16.63、15.87、9.64、11.31,P＜0.05);与入院时比较,两组患者术前、术后1天和术后1周SAS和SDS评分明显下降(F=10.37、42.07、4.76、29.68,P＜0.05);与对照组同时段比较,认知干预后SAS和SDS评分相比均有明显降低(t=1.97、4.58、5.29、1.83、3.85、5.20,P＜0.05).结论:积极有效的认知干预行为对肝癌介入患者的焦虑、抑郁情绪障碍具有明显的缓解和减轻作用.

Rationale and Objectives: To assess patient radiation dose reduction and the image quality of a new Xray imaging technology during repetitive transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).Methods: Fifty HCC patients (36 men; 57 11 years) undergoing repetitive TACE were first randomly assigned to receive a TACE treatment on a reference X-ray system or a low-dose system with advanced real-time image processing. The alternate system was used for a repeated TACE (treatment interval, 0.5-6 months). Fluoroscopy time, number of digital subtraction angiography (DSA), air kerma (AK), and dose area product (DAP) were compared between the two systems and between the two repetitive TACE. Three interventional radiologists independently rated the image quality in blinded offline readings.Results: Fluoroscopy time (8.7 +/- 5.9 minutes vs. 8.7 +/- 7.9 minutes, P =.981), numbers of DSA runs (6 +/- 4 vs. 6 +/- 4, P =.735), and exposure images (173 +/- 86 vs. 168 +/- 91, P =.916) were equivalent between the two systems. No statistical difference in X-ray usage was found between repeated treatments. Compared to the reference system, the technology significantly reduced AK and DAP by 48.6% (0.17 +/- 0.13 Gy vs. 0.41 +/- 0.36 Gy, P <.0001) and 50.3% (77.3 55.2 Gy cm(2) vs. 195.0 +/- 155.5 Gy cm(2), P <.0001), respectively. Image quality was rated comparable between the new system and the reference, with average scores of 3.9 +/- 0.3 versus 4.4 +/- 0.3 in fluoroscopy and 4.5 +/- 0.2 versus 4.3 +/- 0.3 in DSA.Conclusions: Patient radiation exposure can be substantially reduced by a factor of approximately two with the novel X-ray imaging technology while maintaining image quality.

目的 探讨超选择性肝动脉栓塞术(TAE)治疗多囊性肝病(PLD)的安全性及临床疗效.方法 2011年10月至2013年10月,采用栓塞微粒球Embosphere(R)对14例有明显临床症状的PLD患者施行超选择性TAE术,其中女性11例,男性3例;年龄42～65岁,平均(48±5)岁.术前和术后每3个月行CT肝扫描,同时复查血常规、肝功能.结果 TAE技术成功率为100％.术后随访12～24个月,12例症状明显缓解,2例无效,有效率为85.7％.术后患者症状开始缓解时间平均为(3.2±1.1)个月.术后18个月时CT随访显示肝脏总体积、囊肿总体积较术前分别缩小(19.3±5.6)％、(20.4±7.8)％,差异有统计学意义(P＜0.05).术后患者转氨酶呈一过性升高,无严重并发症发生.结论 采用栓塞微粒球行超选择性TAE治疗PLD疗效可靠、安全性高,可作为传统治疗手段的补充,值得临床推广应用.

Polycystic liver diseases(PLD) represent a group of rare genetic disorders in which cysts occur in the liver(autosomal dominant polycystic liver disease) or in combination with cysts in the kidneys(autosomal dominant polycystic kidney disease). PLD is a benign disease,characterized by a continuous increase in the volume and the number of cysts while no influence on liver function,and most patients are asymptomatic. For these cases,it is no need of treatment or only conservative treatment. However,a minority of patients with severe symptoms including massive hepatomegaly with compression of the surrounding organs or cysts complications need treatments. The aim of treatments is to reduce liver volume for relieving symptoms. The means of therapies included aspiration-sclerotherapy,fenestration,segmental hepatic resection,hepatic artery embolization,liver transplantation and medical treatment. This paper reviewed the progess in the treatment of PLD.

Objective To evaluate the efficacy and safety of transcatheter arterial chemoembolization(TACE)combined with per-cutaneous microwave ablation(MWA)in treatment of large-sized hepatic carcinoma.Methods A total of 84 patients with large-sized hepatic carcinoma were randomly and equally divided into the study group(n=42)and control group(n=42).TACE combined with MWA was carried out in the patients of the study group,while only TACE was performed in the patients of the control group.Results The effective rate of the study group and the control group was 71.4% and 42.8% respectively,and the difference between the two groups was statistically significant(P <0.05).In the study group,the survival rates at 6,12,18,24 months after the treatment were 88.1%,73.8%,52.3% and 33.3% respectively,while in the control group the survival rates were 76.2%,57.1%,30.9% and 9.5%respectively.There was no statistically significant differences in the postoperative complications between the two groups.Conclusion TACE combined with MWA appears to be an effective approach for the treatment of large-sized hepatic carcinoma.The effect of combined therapy is obviously superior to the only TACE.

目的探讨125I粒子植入治疗非小细胞肺癌（NSCLC）介入综合治疗的近期疗效、可行性、安全性。方法 2010年6月—2012年12月,治疗符合标准肺癌患者为56例,将其分成治疗组A组（24例）和对照组B组（32例）。A组给以支气管动脉化疗药物灌注术,术后给以125I粒子植入术。B组单纯给以支气管动脉化疗药物灌注术。结果 A组中位生存期（22.8±1.9）个月,B组中位生存期（14.2±1.3）个月。A组显著长于B组（P=0.006）。结论125I粒子植入联合动脉化疗治疗中晚期NSCLC与单纯动脉化疗相比能够明显的提高患者的生存质量和延长患者的生存期,是治疗中晚期NSCLC的一种有效的方法,值得临床广泛应用。

PURPOSE:To evaluate the performance of N-[2-(diethylamino)ethyl]-(18)F-5-fluoropicolinamide ((18)F-P3BZA) for visualizing porcine retinal pigment epithelium (pRPE) cells transplanted in the striatum for the treatment of Parkinson disease and to monitor the long-term activity of implanted pRPE cells by means of (18)F-P3BZA positron emission tomography (PET)/computed tomography (CT) in vivo.MATERIALS AND METHODS:Animal work was conducted in accordance with the administrative panel on laboratory animal care. In vitro cell uptake of (18)F-P3BZA was determined with incubation of melanotic pRPE or amelanotic ARPE-19 cells with (18)F-P3BZA. To visualize the implanted pRPE cells in vivo, normal rats (four per group) were injected with pRPE or ARPE-19 cells attached to gelatin microcarriers in the left striatum and with control gelatin microcarriers in the right striatum and followed up with small animal PET/CT. Longitudinal PET/CT scans were acquired in 12 rats up to 16 days after surgery. Postmortem analysis, which included autoradiography and hematoxylin-eosin, Fontana-Masson, and immunofluorescence staining, was performed. Data were compared with the Student t test, analysis of variance, and regression analysis.RESULTS:(18)F-P3BZA accumulated in pRPE cells effectively (3.48% of the injected dose [ID] per gram of brain tissue ± 0.58 at 1 hour after injection of the probe at 2 days after surgery in vivo) but not in control ARPE-19 cells (P < .05). Longitudinal PET/CT scans revealed that the activity of implanted pRPE cells decreased over time, as evidenced by a reduction in (18)F-P3BZA uptake (3.39% ID/g ± 0.18, 2.49% ID/g ± 0.41, and 1.20% ID/g ± 0.13 at days 2, 9, and 16, respectively; P < .05). Postmortem analysis helped confirm the results of in vivo imaging.CONCLUSION:(18)F-P3BZA PET/CT is a feasible technique for visualizing and detecting the activity of implanted RPE cells in vivo.

全球范围内恶性肿瘤所导致的死亡原因，肝细胞癌居第二，且发病率逐年上升，据报道每年约有750000例新增病例［1］。肝细胞癌的死亡率接近发病率［2］。肝癌的治疗已受到全球的极大关注。现对肝癌的治疗新进展做一综述。<br>　　1 肝脏移植<br>　　肝脏移植被认为是大多数情况下治疗癌症和肝脏潜在疾病最有效的方法。肝脏移植的准则是基于肿瘤的大小和数量，且建立如下标准使具体的肝脏移植治疗肝癌达到最优化。全世界最常用的标准是Milan标准：3个病灶<3cm或单个<5cm肝癌患者符合肝移植的标准［3］。这些患者的5年生存率（75%）与没有接受移植的肝癌患者相近。一些研究中心如加州大学旧金山分校，拓宽了标准一个肿瘤<6.5cm或2~3肿瘤，单个肿瘤不>4.5cm的，总肿瘤直径<8cm，而其研究结果表明是否有严格的肝脏移植入组标准对整体的生存率影响不大［4］。随着治疗肝癌方法的改善，依据Milan或者UCSF标准争取对患者进行降期，已成为选择患者的一种合理方法。显而易见的是，尽管对于肝脏有直接的治疗，但是疾病进展期患者的肝脏移植后复发风险高。在行肝移植前对肝脏直接保护治疗并监测其疗效有助于筛选更适合肝移植的患者，减少排斥反应发生和降低肝脏负荷，能够提高肝移植成功率，降低死亡率。

目的:探讨血管成形术治疗下肢动脉硬化闭塞症的临床应用价值.方法:对我院78例下肢动脉硬化闭塞患者的临床资料进行回顾性分析.78例患者(98条血管)术前经CTA诊断后,行腔内血管成形术(PTA)和血管支架植入术治疗,治疗后随访1～18个月,分析踝/肱指数(ABI)、血管内径、皮温及足背动脉搏动的变化.结果:成功完成77例(98.7％)患者、97条(99.0％)患肢的PTA和支架植入术,除1例下肢动脉完全闭塞患者导丝未能成功通过病变导致介入失败外,其余病例经介入治疗后均开通,术中所有病例均未发生血肿、血管壁破裂、穿孔或内支架移位,远端血管血栓栓塞等并发症.术后,患者下肢缺血症状消失或明显减轻,踝/肱指数(ABI)由术前(0.39± 0.23)恢复至(0.86± 0.26),下肢血管内径及足背动脉搏动均明显改善.结论:PTA和血管支架植入术是一种治疗下肢动脉硬化闭塞症安全有效的方法,成功率高,并发症少,再狭窄率低.

Objective:To evaluate the clinical efficacy of percutaneous transluminal angioplasty(PTA) by Deep balloon combined in patients with diabetic foot.Methods:Ninety-six patients with diabetic foot between august in 2007and august in 2011 in our hospital were randomly divided into two groups-test group(n=74),the patients underwent PTA by deep balloon combined with TAI and control group(n=22),the patients underwent routine treatment,such as anticoagulant therapy,antibiotics and insulin.Followed up all the pa-tients for 10 months with skin color,temperature,rest pain and dorsalis pedis artery fluctuations.Results:First,the vascular lesions of the diabetic foot,are the arteries under kneejoint,including the anterior tibial,posterior tibial,peroneal artery,and the following branches.It is often involving the bilateral number of arteries,and distribution by stepwise.The effective rate was 88.32% in test group and 48.63% in control group,There was a significant difference between the two groups(P<0.05).The ulcer healing situation:the 0-2 stage group A:100%,group B:83.72%;The 3-4 stage group A:56.25%,group B:18.46%,it was a significant difference between the two groups(P<0.05) in the efficiency of the ulcer treatment.Conclusion:The curative effect of PTA by deep balloon combined was better than the routine treatment.It could give a satisfactory prognosis,recovery of lower extremity arterial,promote the healing of ulcers and decrease of the disability rate.

Lung cancer is a kind of commonly seen malignant tumor around the world,and it seriously threatens people′s health.Recent years have witnessed the increase of incidence and mortality of lung cancer.Many patients have already been in advanced stage with metastasis when diagnosed,missing the best operation time.Over the past few years,many treatments were used for advanced lung cancer,including the combined using of radiotherapy,chemotherapy,ablation and immunotherapy etc.This article summarizes the combined treatments for advanced non-small cell lung cancer that were commonly used in clinic.

Objective: To investigate the effect of the standardized nursing in mini-invasive interventional embolization for acute renal bleeding.Methods: Retrospectively analyzed 38 cases of acute renal bleeding,which bleeding arteries were embolized with gelatin sponge particles,micro spring circles and polyvinyl alcohol(PVA) embolic agents,standardized nursing was carried out before,during and after the intervention.Results: Gross hematuria in all cases was changed to pink in 3 days and completely disappeared in 7 days after interventional embolization,except 2 cases continued for 10 days.Conclusions: Standardized nursing is an important point of minimally invasive embolization in acute kidney bleeding cases,re-bleeding rate after interventional therapy reduced greatly by standardized nursing before,during and after the interventional operations.

99  mTcN-MPO ([99  mTcN(mpo)(PNP5)]+: mpo = 2-mercaptopyridine oxide and PNP5 = N-ethoxyethyl-N,N-bis[2-(bis(3-methoxypropyl)phosphino)ethyl]amine) is a cationic 99  mTc-nitrido complex, which has favorable biodistribution and myocardial uptake with rapid liver clearance in Sprague Dawley rats. The objective of this study was to compare the biodistribution and pharmacokinetics of 99  mTcN-MPO and 99  mTc-Sestamibi in normal dogs, and to evaluate the potential of 99  mTcN-MPO as a myocardial perfusion agent in canines with acute myocardial infarction.

Objective The purpose of the present study is to compare the pharmacokinetic and biodistribution properties of 99Tcm N-mercaptopyridine-N-oxide (99 Tcm N-MPO) with 99 Tcm-sestamibi (99 Tcm-MIBI) in normal dogs, and to investigate the potential of 99TcmN-MPO as a myocardial perfusion agent in canines with acute myocardial infarction. Methods Twelve healthy mongrel dogs were injected intravenously with 99TcmN-MPO (n = 6) or 99Tcm-MIBI (n = 6). Tracer kinetics in body fluids were determined by collecting blood of 1 ml via a femoral vein catheter at 30 s, 1,2,3,4,5, 10, 20, 30, 40, 60and 90 min post-injection (p. i.). The collected blood samples were weighed and counted for radioactivity in a γ-counter. Anterior and posterior planar γ-camera images were collected at 10, 20, 30, 60, 90, and 120 min after injection, with organ uptake quantified by region-of-interest (ROIs) analysis. For comparison, 99Tcm-MIBI was also evaluated in the same twelve dogs. Canine infarct models were set up by micro-invasive interventional embolization. SPECT images in the canine infarct model were collected 24 hours after myocardial infarction at 30 min and 60 min after the administration of 99Tcm N-MPO (n = 5) or 99Tcm-MIBI (n = 5). Results Both of 99Tcm N-MPO and 99Tcm-M1BI had a rapid blood clearance with less than 50% of initial radioactivity remaining at 1 min [99TcmN-MPO: (35. 77 ± 6. 31)% ID/mg ,99Tcm-MIBI (34. 46 ± 6. 83) % ID/mg] and less than 5% at 30 min p. i. [99Tcm N-MPO(3. 11 ± 1.44) % ID/mg,99Tcm-MIBI (2.93 ±0. 39)% ID/mg] . After injection, 99TcmN-MPO showed significant accumulation in the myocardium and prolonged retention. This rapid liver clearance of 99TcmN-MPO led to favorable heart-to-liver ratios, reaching values of 0. 54 ±0. 06 at 10 min, 1.02 ±0. 06 at 30 min, and 1.38 ±0. 06 at 60 min p. i.In contrast, the heart/liver ratio of 99Tcm-MIBI remained low at all time points (0. 46 ± 0. 03 at 10 min,0. 63 ±0. 03 at 30 min, and 0. 62 ± 0. 12 at 60 min p. i.). SPECT imaging studies in canines with acute myocardial infarction indicated that good visualization of the left ventricular wall and perfusion defects could be achieved at 30 min after administration of 99TcmN-MPO, but not 99Tcm-MIBI. Conclusion The combination of high heart uptake and rapid liver clearance makes 99TcmN-MPO a promising new radiotracer for myocardial perfusion imaging.

目的 研究基因重组腺病毒转染人肺腺癌细胞AGZY后目的基因的表达效率及遗传稳定性.方法 以两种rAd分别转染AGZY细胞,RT-PCR半定量检测hIL-2和hGM-CSF基因mRNA表达.结果 rAd-hIL-2、rAd-hGM-CSF在人肺腺癌细胞AGZY内的表达量随时间的增长而增加,细胞传代对表达无明显影响.结论 rAd-hIL-2、rAd-hGM-CSF可在AGZY细胞内稳定表达外源基因,表达强度不受细胞传代影响.