目的 应用极速脉搏波技术评价糖尿病前期患者颈动脉弹性功能.方法 选取颈动脉结构正常的糖尿病前期和2型糖尿病患者各40例,分为糖尿病前期组和糖尿病组;选取40例健康体检者作为对照组.记录3组的临床资料、内中膜厚度(CIMT)及UFPWV技术测量数值(PWV-BS、PWV-ES).对上述数据进行统计学分析.结果 三组间SBP、FPG、TG、TC和HDL-C差异有统计学意义(P＜0.05).糖尿病组的CIMT与对照组相比差异有统计学意义(P＜0.05),而糖尿病前期组CIMT与对照组相比较差异无统计学意义.三组间PWV-ES差异有统计学意义(P＜0.05),而PWV-BS与对照组相比较差异无统计学意义.PWV-BS、PWV-ES与年龄、SBP、FPG、TG、TC、CIMT均呈正相关(P＜0.05),与HDL-C呈负相关(P＜0.05).PWV-BS的影响因素均包括年龄、SBP、FPG,PWV-ES的影响因素均包括年龄、SBP、FPG、TC.结论 UFPWV可以早期、准确、敏感地检测糖尿病前期患者颈动脉的弹性变化.PWV-ES较PWV-BS能更好定量反映颈动脉弹性变化,为糖尿病前期患者动脉硬化的早期评估提供一种新的手段.

目的:探讨完全腹腔镜下经腹入路一站式肾脏-输尿管-膀胱袖状切除术治疗上尿路尿路上皮癌(UTUC)的手术技巧和临床效果.方法:2015年2月～2018年5月我院通过影像学检查或输尿管镜活检确诊的17例UTUC患者行完全腹腔镜下经腹入路一站式肾脏-输尿管-膀胱袖状切除手术.采取健侧60°卧位,放置5个Trocar,先行患侧根治性肾切除,然后沿输尿管向下游离至输尿管膀胱入口处,再将输尿管开口周围膀胱壁作袖状切除,缝闭膀胱切口.结果:17例手术均获成功,无中转开放,手术时间110～150 min,平均125 min;术中出血80～200ml,平均120ml;术后住院6～14 d,平均8 d;术后漏尿1例,引流后自愈.术后随访6～45个月,其中术后漏尿患者于术后9个月发现对侧输尿管口周围尿路上皮癌复发,行经尿道膀胱肿瘤电切术(TURBt),随访至今未见复发;失访3例,其余病例未见术中术后并发症,未见肿瘤复发及转移.结论:经腹入路一站式腹腔镜肾脏-输尿管-膀胱袖状切除术治疗UTUC安全可行,术中无需变换体位就能完成从肾脏到输尿管全段和膀胱袖状切除,是一种值得推广的手术方法.

目的 通过PCR-RFLP及PCR产物直接测序方法研究脂蛋白脂酶(LPL)基因多态性,观察其与老年2型糖尿病(T2DM)人群血脂代谢及冠心病(CAD)发生发展的关系.方法 试验分为正常对照组、糖尿病组及糖尿病合并冠心病组.对受试者进行问卷调查,测定血糖、血脂水平;采用酚/氯仿法提取外周血DNA,PCR-RFLP及PCR产物直接测序方法检测两组患者LPL基因HindⅢ、PvuⅡ及Ser447Ter酶切位点多态性.结果 DM组血清TG、SBP水平均显著高于健康对照组(P<0.05,P<0.01),而HDL水平显著降低(P<0.05).携带LPL HindⅢ等位基因H+及PvuⅡ等位基因P+的个体其CAD发病率较携带等位基因H-、P-的个体显著升高(P<0.05),且具有较高的TG水平(P<0.05).携带LPL Ser447Ter等位基因G的个体其冠心病发病率较携带等位基因CC的个体显著降低(P<0.01),且具有较低的TG水平(P<0.01).结论 糖尿病组血清TG和SBP水平均显著高于健康对照组,而HDL水平显著降低;LPL等位基因HindⅢ H+、PvuⅡ P+多态性是老年T2DM合并CAD发病的独立危险因素,而Ser447Ter G变异是冠心病的保护因素之一.

Objective To investigate polymorphisms of the lipoprotein lipase gene,and to elucidate the association between lipid metabolism and the pathogenesis of cerebrovascular disease(CVD) with type 2 diabetes mellitus.Methods All the subjects were divided into 2 groups: 120 subjects in the control group and 146 patients in the diabetic group.Then the diabetic group was sub-divided into two groups with or without CVD.A phenol/chloroform method was used to extract DNA from the peripheral blood.The PCR-RFLP method was used to amplify the aimed gene fragment.The amplified product was electrophoresised on 1.5% agarose gel with ethidium bromide,and the aimed strap was purified and sequenced.Results The level of serum TG and systolic blood pressure(SBP) in the diabetic group were higher than those in the control group(P0.05,P0.01),while the high density lipoprotein cholesterol(HDL-C) level was significantly decreased(P0.05) in the diabetic group.Subjects with theLPL H+ allele gene showed a significantly higher morbidity of CVD and a higher level of blood TG than those with the H-allele gene(P0.05).However,the PvuII P+ allele gene had no statistical significance between both groups.Subjects with the G allele gene showed a significantly lower morbidity of CVD and a lower level of blood TG than those with the C allele gene(P0.05).Conclusions Polymorphisms of LPL HindⅢ H+ are independent risk factors for the pathogenesis of CVD for diabetes.Mutation of the Ser447Ter G allele gene is considered to be a vasoprotector for CVD.

本研究通过回顾性分析37例乳腺癌患者治疗后的18F-脱氧葡萄糖(FDG)PET/CT检查资料,探讨其诊断乳腺癌复发和转移的应用价值,现报道如下.

[Purpose] To explore the possibility of radiolabeled tumor blood vessel specific polypeptide imaging in diagnosis for tumor with tumor blood vascular system as the target and radiolabeled ATWLPPR as the agent. [Methods] 99mTc-HYNIC-ATWLPPR was prepared and identified. Human breast cancer-bearing nude mice model was cultured. The images (experimental group) carried out after injected 99mTc-ATWLPPR at different time and the images (control group) carried out after pretreated with non-radiolabeled ATWLPPR. Regions of interest (ROI) were drawn and the radioactivity ratios of T/NT (tumor and opposite relevant region) were calculated in two groups. Organs of interest and tumor tissue in tumor-bearing nude mice were weighed. Radioactivity counts in different tissue were measured after injection of the agent 180min later. [Results] 99mTc-HYNIC-ATWLPPR was prepared with HYNIC as bifunctional chelating agent with labeling efficiency as 91.53%±2.39% and radiochemical purity as 94.14%±4.25%. The agent was stable in vitro. Images showed that tumors were clearly seen after injection of agent 180min later in experimental group, but no tracer could be found in tumors of control group. The radioactivity ratio of tumor/opposite upper limb site were 2.33±0.40 and 1.18±0.12, respectively (P0.05). The biodistribution of agent in breast cancer-bearing nude mice showed the most tracer accumulated in the liver and kidney, but the least in the brain. [Conclusions] The labeling method used in preparing 99mTc-HYNIC-ATWLPPR is simple and the agent has high radiolabeling yield, radiochemical purity and good stability. The agent is mainly excreted through liver and kidney. Tumor could uptake the agent specifically and the agent could be applied in diagnosis for tumor.

Objective:To evaluate the use of 18F-fluorodeoxyglucose(FDG) PET/CT in recurrence and metastasis of breast cancer. Methods: Thirty-seven patients after operation underwent 18F-FDG PET/CT whole body imaging for evaluation of recurrent breast cancer and metastasis. Visual and semiquantitative methods(standard uptake value, SUV) were used to analyze the images. The results of PET/CT imaging were compared with those of pathology or CT. Results: Twenty-seven malignant recurrent breast lesions in thirty-seven resected breast cancers detected by this modality were proven histopathology, biopsy, cytological examination, and clinical follow-up. Among the twenty-seven malignant breast lesions, the diagnostic sensitivity of PET/CT and CT imaging were 96.30% and 62.96% respectively. There were statistical differences in sensitivity between PET/CT and CT(χ2=9.247, P<0.05). Fourteen patients with breast cancer underwent PET/CT at 2 time points. Recurrence and metastasis were diagnosed in 9 patients, and all of their SUVs increased at time 2. Conclusions: 18F-FDG PET/CT makes the location and characterization of the lesions more accurate, and it is a useful diagnostic modality in the diagnosis of recurrent and metastatic breast cancer.

Integrated PET-CT scanner realized the fuse of functional and anatomic imaging in one device,and it is superior to traditional imaging in evaluating curative effect for malignant tumors.In this article we focus on the clinical applications of ~(18)F-FDG PET-CT imaging in evaluating curative effect and monitoring therapy for malignant tumors.