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Background: Axillary lymph node status is one of the most important prognostic factors for breast cancer. Sentinel lymph node biopsy (SLNB) after mastectomy is highly controversial. There is not enough data about SLNB in the early period after nipple?sparing mastectomy (NSM). This study investigated the feasibility of SLNB in the early postoperative period of NSM. Materials and Methods: Patients who were operated on for breast cancer in Acibadem Maslak Hospital between 2009 and 2018 were searched retrospectively. Results of SLNB as the second session in patients whose final pathology report revealed breast carcinoma after contralateral/bilateral prophylactic mastectomy and mastectomy for benign lesions were evaluated. Results: In the early period (median 14 days) after NSM, SLNB was performed by intradermal radioisotope injection in five patients with occult breast cancer in contralateral/bilateral prophylactic mastectomy and in one patient with preoperatively suspicious mass which yielded breast cancer at final pathology. In five (80%) patients, SLNB was performed, whereas in one patient axillary lymph node dissection (ALND) was performed due to the undetectability of SLN. In one patient, micrometastasis was observed, whereas no metastasis was observed in other patients including the one who underwent ALND. No complication due to SLNB was detected. No recurrence and distant metastasis were detected in a mean follow?up of 42.82 (19�) months. While SLNB did not change the treatment of patients with contralateral occult carcinoma, other patients had hormonal therapy due to negative SLNB. Conclusion: SLNB in the early postoperative period of NSM can be performed by intradermal radioisotope injection. However, further studies are needed to determine the feasibility of SLNB in the early postoperative period of NSM
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Objective:To investigate the significance of B-Raf proto-oncogene, serine/threonine kinase (BRAF) V600E mutation in the prediction of response to apatinib treatment in advanced radioactive iodine-refractory differentiated thyroid cancer (RAIR-DTC). Methods:Twenty patients (10 males, 10 females, age: 51.5(46.3, 65.0) years) with advanced RAIR-DTC from Peking Union Medical College Hospital between March 2016 and March 2023 were retrospectively enrolled, and all patients were treated with apatinib and underwent genetic sequencing (including BRAF V600E and telomerase reverse transcriptase (TERT) promoter). The serological and imaging data, progression-free survival (PFS) and overall survival (OS) data were collected during apatinib treatment. The Kaplan-Meier survival analysis (log-rank test) was performed, and Mann-Whitney U test were used to analyze the differences of duration of response (DOR) between mutation group and wild-type group. Then univariate and multivariate Cox regression analyses were conducted. Results:The PFS (35.3 vs 9.2 months, χ2=7.53, P=0.006) and DOR (25.8(7.4, 35.2) vs 8.2(2.5, 13.4) months, U=23.00, P=0.046) of the BRAF V600E mutation group were longer than those of the wild-type group. Univariate Cox regression analysis showed that the BRAF V600E mutation group had better PFS benefit (hazard ratio ( HR)=0.22 (95% CI: 0.06-0.72), P=0.013), and the risk of disease progression or death in patients with lung metastasis and bone or brain metastasis was 3.06(95% CI: 1.10-8.54, P=0.033) times higher than that in patients with lung metastasis alone. Further, multivariate cox regression analysis showed that only BRAF V600E mutation was an independent predictor of PFS ( HR=0.23 (95% CI: 0.07-0.80), P=0.021), suggesting that RAIR-DTC patients with BRAF V600E mutation might have better efficacy of apatinib. There was no significant difference in PFS ( χ2=1.34, P=0.247) and OS ( χ2=0.19, P=0.664) between TERT promoter mutation group and wild-type group. Conclusion:RAIR-DTC patients with BRAF V600E mutation have longer PFS and DOR after apatinib treatment than those with BRAF V600E wild-type, suggesting that BRAF V600E may be a potential biomarker to guide tyrosine kinase inhibitor (TKI) therapy and help to refine TKI treatment indications.
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Objective:To explore the clinical value of 68Ga-pentixafor PET/CT targeting for CXCR4 in the diagnosis and prognosis evaluation of primary aldosteronism (PA). Methods:Retrospective analysis was performed on information of 72 patients diagnosed with PA who received operations according to the results of 68Ga-pentixafor PET/CT in our hospital. There were 37 males and 35 females, with the average age of (48.3±9.5) years old. The average lesion diameter was (1.60 ± 0.54)cm. The preoperative systolic and diastolic blood pressure were (177.3 ± 23.9)mmHg and (107.6 ± 13.2)mmHg, respectively. The average preoperative potassium level was (2.62 ± 0.56)mmol/L. The average aldosterone concentration was (17.98 ± 4.66)ng/dl, and the median plasma renin activity was 0.01 (0.01, 0.09) ng/(ml·h). All patients underwent 68Ga-pentixafor PET/CT examination, which lead to the decision of surgical strategies. For those patients with single lesion, multiple lesions in one side or positive lesion in one side but negative in the opposite side, surgical resection of the positive side lesion or total adrenalectomy was considered. For those patients with bilateral positive lesions, surgical resection of the side with more significant positive lesions or total adrenalectomy was considered. For those with negative multiple lesions, the surgical strategy was designed according to the results of CT examination or AVS. The positive rate of 68Ga-pentixafor PET/CT and its relationship with the clinical characteristics and prognosis of patients were analyzed. Results:The results of 68Ga-pentixafor PET/CT were positive in 62 of 72 patients diagnosed with PA (86.1%), and the median SUVmax value was 11.1 (7.1, 16.2). The SUVmax value was positively correlated with the maximum diameter of adrenal lesion ( r=0.468) and negatively correlated with blood potassium levels ( r=-0.437), while not significantly correlated with other clinical characteristics. The positive rate of adenoma by 68Ga-pentixafor PET/CT was higher than that of nodular hyperplasia [90.5%(57/63) vs. 55.6%(5/9), P=0.018], and the SUVmax value in adenoma was also higher than that in nodular hyperplasia [11.9(7.8, 16.2) vs. 4.3(3.4, 11.3), P=0.022]. 32 cases were cured after operations, and 37 cases were improved. And 3 cases were not cured. The SUVmax value of lesions in the cured patients was higher than that in the improved patients [15.4(8.1, 22.7) vs. 10.1(6.8, 13.3), P=0.013]. Among 59 cases of PA patients with single adrenal lesions, 50 cases represented positive results of 68Ga-pentixafor PET/CT. 23 cases in 50 positive cases were cured and 27 cases were improved after resection of positive lesions. In the 13 PA patients with multiple adrenal lesions who underwent surgery according to the results of 68Ga-pentixafor PET/CT, 12 patients (92.3%) showed postoperative prognosis in line with preoperative expectations. Conclusions:68Ga-pentixafor PET/CT showed high positive rate in the diagnosis of PA, especially for adenoma.The SUVmax value of the adrenal lesion was correlated with the blood potassium level, the size of the lesion and the postoperative prognosis. In addition, 68Ga-pentixafor PET/CT could effectively guide the surgical decision of PA.
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Objective:To determine the analytical performance of a candidate reference measurement procedure for 17α-hydroxyprogesterone in human serum by liquid chromatography-tandem mass spectrometry (LC-MS/MS).Methods:The serum spiked with a deuterium-labeled internal standard was extracted from serum from individual undergoing physical examination by liquid-liquid extraction with n-hexane/ethyl acetate (3∶2, v/v), separated by C18 reversed-phase chromatography and detected by positive electrospray ionization mass spectrometry. According to the Clinical and Laboratory Standards Institute (CLSI) C62-A documents, the analytical performance including linearity, limit of detection,limit of quantitation,relative matrix effect,precision and trueness,carry-over and specificity was evaluated.Results:The linear range of 17α-hydroxyprogesterone by LC-MS/MS was 0.21-119.67 μg/L. The limit of detection and limit of quantitation were 5.218 ng/L and 0.116 μg/L. The relative matrix effects were -0.02%, -0.40% and -0.90% for sera and solution mixtures in 3 different ratios (50∶50, 80:20 and 20∶80). The coefficients of variation ( CVs) of intra-assay were 1.73%-2.11%, 0.98%-1.71%, 0.47%-0.87% at 0.164 μg/L, 14.81 μg/L, 81.63 μg/L and the CVs of inter-assay were 1.82%, 1.03%, 0.80% at above three concentrations. The average recovery rates of 3 levels (0.5, 20 and 100 μg/L) were 100.4%, 101.7%, 102.8%, respectively. The measured values of GBW09829 of National Institute of Metrology were within the specified uncertainty range. Conclusion:The candidate reference measurement procedure for 17α-hydroxyprogesterone in human by LC-MS/MS is established with good accuracy and precision, which can be clinically used for measurement traceability.
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Objective · To investigate the curative efficacy and influential factors of 131I treatment for pulmonary metastases from differentiated thyroid carcinoma (DTC). Methods · A total of 95 DTC patients (33 males and 62 females) with pulmonary metastasis who underwent 131I treatment in Department of Nuclear Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, from April 2012 to May 2016 were retrospectively analyzed. The efficacy of 131I treatment was assessed using determination of serum thyroglobulin level and 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (～ (18) F-FDG PET/CT). The possible factors affecting efficacy included gender, age, pathological classification, wheteer pulmonary metastasis diagnosed before treatment, the iodine and 18F-FDG uptake of pulmonary lesions, the size and number of lung lesions, extrapulmonary distant metastasis.Univariate analysis was performed using Rank test and χ2 test, the critical value was obtained through receiver operating characteristic (ROC) curve and Logistic regression was also performed. Results · The rates of efficacy and inefficacy of 131I treatment were 53.68％ and 46.32％, respectively. Univariate analyses showed that maximum standardized uptake value (SUVmax) evaluated by 18F-FDG PET/CT (P=0.004), the size of lung metastases (P=0.000), age＜45 years (P=0.004), 131I uptake (P=0.022), whether pulmonary metastasis diagnosed before treatment (P=0.000), extrapulmonary distant metastasis (P=0.014) were the factors influencing outcome of 131I treatment. The critical value of 18F-FDG uptake for patients obtained by ROC curve was 1.45 (sensitivity of 56.8％ and specificity of 76.5％) and the critical value of lung lesion diameter was 9.63 mm (sensitivity of 43.2％ and specificity of 88.2％). Multivariate Logistic regression analysis showed that the influential factors included the age of patients, the size and 18F-FDG SUVmax of lung metastases and whether pulmonary metastasis diagnosed before treatment. Conclusion · 131I treatment is an effective method for pulmonary metastases from DTC. The patients aged less than 45 years, with the lung lesion size less than 9.63 cm, low 18F-FDG SUVmax and diagnosed before treatment may have good response to 131I treatment.
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Objective • To investigate the curative efficacy and influential factors of 131I treatment for pulmonary metastases from differentiated thyroid carcinoma (DTC). Methods • A total of 95 DTC patients (33 males and 62 females) with pulmonary metastasis who underwent 131I treatment in Department of Nuclear Medicine, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, from April 2012 to May 2016 were retrospectively analyzed. The efficacy of 131I treatment was assessed using determination of serum thyroglobulin level and 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT). The possible factors affecting efficacy included gender, age, pathological classification, wheteer pulmonary metastasis diagnosed before treatment, the iodine and 18F-FDG uptake of pulmonary lesions, the size and number of lung lesions, extrapulmonary distant metastasis. Univariate analysis was performed using Rank test and χ2 test, the critical value was obtained through receiver operating characteristic (ROC) curve and Logistic regression was also performed. Results • The rates of efficacy and inefficacy of 131I treatment were 53.68% and 46.32%, respectively. Univariate analyses showed that maximum standardized uptake value (SUVmax) evaluated by 18F-FDG PET/CT (P=0.004), the size of lung metastases (P=0.000), age<45 years (P=0.004), 131I uptake (P=0.022), whether pulmonary metastasis diagnosed before treatment (P=0.000), extrapulmonary distant metastasis (P=0.014) were the factors influencing outcome of 131I treatment. The critical value of 18F-FDG uptake for patients obtained by ROC curve was 1.45 (sensitivity of 56.8% and specificity of 76.5%) and the critical value of lung lesion diameter was 9.63 mm (sensitivity of 43.2% and specificity of 88.2%). Multivariate Logistic regression analysis showed that the influential factors included the age of patients, the size and 18F-FDG SUVmax of lung metastases and whether pulmonary metastasis diagnosed before treatment. Conclusion • 131I treatment is an effective method for pulmonary metastases from DTC. The patients aged less than 45 years, with the lung lesion size less than 9.63 cm, low 18F-FDG SUVmax and diagnosed before treatment may have good response to 131I treatment.
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Standardization of ~(131)I treatment following thyroidectomy for DTC patients tends to be compulsory in clinical practice. However, many remains controversies concerning with the indications for ~(131)I treatment since it takes definitive effects mostly in parts of DTC patients with unresectable lesions or metastases. Standardization of ~(131)I treatment also requires proper management of radiation protection for in-patients taking high dose ~(131)I,objective and complete evaluation of treatment outcomes as well as side effects related with ~(131)I therapy, and above all, the establishment of long-term follow-up database.
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Cutaneous leishmaniasis (CL) is a parasitic disease caused by the protozoan Leishmania spp. Pentavalent antimonial agents have been used as an effective therapy, despite their side effects and resistant cases. Their pharmacokinetics remain largely unexplored. This study aimed to investigate the pharmacokinetic profile of meglumine antimoniate in a murine model of cutaneous leishmaniasis using a radiotracer approach. Methods: Meglumine antimoniate was neutron-irradiated inside a nuclear reactor and was administered once intraperitoneally to uninfected and L. amazonensis-infected BALB/c mice. Different organs and tissues were collected and the total antimony was measured. Results: Higher antimony levels were found in infected than uninfected footpad (0.29% IA vs. 0.14% IA, p = 0.0057) and maintained the concentration. The animals accumulated and retained antimony in the liver, which cleared slowly. The kidney and intestinal uptake data support the hypothesis that antimony has two elimination pathways, first through renal excretion, followed by biliary excretion. Both processes demonstrated a biphasic elimination profile classified as fast and slow. In the blood, antimony followed a biexponential open model. Infected mice showed a lower maximum concentration (6.2% IA/mL vs. 11.8% IA/mL, p = 0.0001), a 2.5-fold smaller area under the curve, a 2.7-fold reduction in the mean residence time, and a 2.5-fold higher clearance rate when compared to the uninfected mice. Conclusions: neutron-irradiated meglumine antimoniate concentrates in infected footpad, while the infection affects antimony pharmacokinetics.(AU)
Subject(s)
Animals , Mice , Pharmacokinetics , Leishmaniasis, Cutaneous , Meglumine Antimoniate , Infections , Leishmania , Antimony , NeutronsABSTRACT
Aims: To audit the extent of evaluation of neonates with antenatal hydronephrosis. Methods:Records of all neonates with antenatal hydronephrosis between January 2013 andDecember 2016 were audited to look for patient factors and investigation results. Results:290 records were evaluated, 93 (32%) of which had abnormalities detected on voidingcystourethrogram. In the presence of hydroureter, 65% had an abnormality while in theabsence only 11% were abnormal. In the presence of pelvis ?20 mm, 93% had abnormaldiuretic renogram, while with pelvis <20 mm, only 1.5% were abnormal (P=0.001). Numbersneeded to harm calculation revealed 1 in 2 patients would receive an unnecessary voidingcystourethrogram in the absence of hydroureter, and unnecessary diuretic renogram whenpelvis <20 mm. Conclusions: While evaluating neonates with antenatal hydronephrosisinvasive tests can be limited, if evaluation is guided by ultrasonographic criteria.
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Abstract The cross sections of the 68Zn(p,2p)67Cu,68Zn(p,2n)67Ga and 68Zn(p,3n)66Ga reactions were measured at the ARRONAX facility by using the 70 MeV cyclotron, with particular attention to the production of the theranostic radionuclide 67Cu. Enriched 68Zn material was electroplated on silver backing and exposed to alow-intensity proton beam by using the stacked-foils target method. Since 67Cu and 67Ga radionuclides have similar half-lives and same γ-lines (they both decay to 67Zn), a radiochemical process aimed at Cu/Ga separation was mandatory to avoid interferences in γ-spectrometry measurements. A simple chemical procedure having a high separation efficiency (>99%)was developed and monitored during each foil processing, thanks to the tracer isotopes 61Cu and 66Ga.Nuclear cross sections were measured in the energy range 35-70 MeV by using reference reactions recommended by the International Atomic Energy Agency (IAEA) to monitor beam flux. In comparison with literature data a general good agreement on the trend of the nuclear reactions was noted, especially with latest measurements, but slightly lower values were obtained in case of 67Cu. Experimental results of the 68Zn(p,2p)67Cu,68Zn(p,2n)67Ga and 68Zn(p,3n)66Ga reactions were also compared with the theoretical values estimated by using the nuclear reaction code TALYS. The production yield of the theranostic radionuclide 67Cu was estimated considering the results obtained in this work.
Resumen Las secciones eficaces de las reacciones 68Zn (p, 2p) 67Cu, 68Zn (p, 2n) 67Ga y 68Zn (p, 3n) 66Ga se midieron en la instalación ARRONAX utilizando el ciclotrón 70 MeV, con especial atención a la producción del radionucleidos teranóstico 67Cu. El material enriquecido 68Zn se galvanizó sobre soporte de plata y se expuso a un haz de protones de baja intensidad utilizando un blanco de láminas apiladas. Como los radionucleidos 67Cu y 67Ga tienen periodos de semidesintegración y líneas γ similares (ambos se desintegran a 67Zn), un proceso radioquímico dirigido a la separación Cu / Ga fue obligatorio para evitar interferencias en las mediciones de espectrometría γ. Se desarrolló un procedimiento químico simple con una alta eficiencia de separación (> 99%) durante cada procesamiento de la lámina, gracias a los isótopos trazadores 61Cu y 66Ga. Las secciones eficaces nucleares se midieron en el rango de energía de 35-70 MeV utilizando reacciones de referencia recomendadas por el Organismo Internacional de Energía Atómica (OIEA) para monitorear el flujo del haz. Al comparar con los datos de la literatura, se observó una buena concordancia en general con la tendencia de las reacciones nucleares, particularmente con las últimas mediciones, pero se obtuvieron valores ligeramente inferiores en el caso de 67Cu. Los resultados experimentales de las reacciones 68Zn (p, 2p) 67Cu, 68Zn (p, 2n) 67Ga y 68Zn (p, 3n) 66Ga también se compararon con los valores teóricos estimados usando el código de reacción nuclear TALYS. El rendimiento de producción del radionucleido teranóstico 67Cu se estimó considerando los resultados obtenidos en este trabajo.
ABSTRACT
The cross sections of the 68Zn(p,2p)67Cu,68Zn(p,2n)67Ga and 68Zn(p,3n)66Ga reactions were measured at the ARRONAX facility by using the 70 MeV cyclotron, with particular attention to the production of the theranostic radionuclide 67Cu. Enriched 68Zn material was electroplated on silver backing and exposed to alow-intensity proton beam by using the stacked-foils target method. Since 67Cu and 67Ga radionuclides have similar half-lives and same γ-lines (they both decay to 67Zn), a radiochemical process aimed at Cu/Ga separation was mandatory to avoid interferences in γ-spectrometry measurements. A simple chemical procedure having a high separation efficiency (>99%)was developed and monitored during each foil processing, thanks to the tracer isotopes 61Cu and 66Ga.Nuclear cross sections were measured in the energy range 35-70 MeV by using reference reactions recommended by the International Atomic Energy Agency (IAEA) to monitor beam flux. In comparison with literature data a general good agreement on the trend of the nuclear reactions was noted, especially with latest measurements, but slightly lower values were obtained in case of 67Cu. Experimental results of the 68Zn(p,2p)67Cu,68Zn(p,2n)67Ga and 68Zn(p,3n)66Ga reactions were also compared with the theoretical values estimated by using the nuclear reaction code TALYS. The production yield of the theranostic radionuclide 67Cu was estimated considering the results obtained in this work.
Las secciones eficaces de las reacciones 68Zn (p, 2p) 67Cu, 68Zn (p, 2n) 67Ga y 68Zn (p, 3n) 66Ga se midieron en la instalación ARRONAX utilizando el ciclotrón 70 MeV, con especial atención a la producción del radionucleidos teranóstico 67Cu. El material enriquecido 68Zn se galvanizó sobre soporte de plata y se expuso a un haz de protones de baja intensidad utilizando un blanco de láminas apiladas. Como los radionucleidos 67Cu y 67Ga tienen periodos de semidesintegración y líneas γ similares (ambos se desintegran a 67Zn), un proceso radioquímico dirigido a la separación Cu / Ga fue obligatorio para evitar interferencias en las mediciones de espectrometría γ. Se desarrolló un procedimiento químico simple con una alta eficiencia de separación (> 99%) durante cada procesamiento de la lámina, gracias a los isótopos trazadores 61Cu y 66Ga. Las secciones eficaces nucleares se midieron en el rango de energía de 35-70 MeV utilizando reacciones de referencia recomendadas por el Organismo Internacional de Energía Atómica (OIEA) para monitorear el flujo del haz. Al comparar con los datos de la literatura, se observó una buena concordancia en general con la tendencia de las reacciones nucleares, particularmente con las últimas mediciones, pero se obtuvieron valores ligeramente inferiores en el caso de 67Cu. Los resultados experimentales de las reacciones 68Zn (p, 2p) 67Cu, 68Zn (p, 2n) 67Ga y 68Zn (p, 3n) 66Ga también se compararon con los valores teóricos estimados usando el código de reacción nuclear TALYS. El rendimiento de producción del radionucleido teranóstico 67Cu se estimó considerando los resultados obtenidos en este trabajo.
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Introducción Actualmente, entre un 25 y un 35% de los cánceres de mama se diagnostican como lesiones no palpables. La detección de lesiones cada vez más pequeñas exige el desarrollo de nuevas técnicas prequirúrgicas de marcación y localización. Presentamos la experiencia del Hospital Italiano de Buenos Aires con la técnica de localización radioguiada de lesiones no palpables y ganglio centinela (snoll). Objetivos El objetivo de este trabajo es describir las características clínico-patológicas de las pacientes sometidas a dicha técnica y las ventajas, desventajas, complicaciones y resultados en términos de márgenes libres, tasa de retumorectomías, volumen tumoral resecado y tiempo quirúrgico. Material y método Se trata de un estudio observacional, retrospectivo. Se incluyeron todas las pacientes con carcinomas no palpables en quienes se llevó a cabo la técnica de snoll entre el 1 de agosto de 2016 y el 4 de mayo de 2017. Resultados Se incluyó un total de 25 pacientes, todas con diagnóstico previo de carcinoma de mama invasor a través de una punción histológica. Utilizando la técnica snoll, se logró identificar la lesión de mama en el 96% de las pacientes. En el 100% de las pacientes, los márgenes quirúrgicos estaban libres de lesión, por lo que no se realizaron retumorectomías. Se identificó el 100% de los ganglios centinelas, 76% mediante la técnica snoll y 24% mediante la inyección previa del colorante Azul Patente. Conclusiones La técnica snoll demostró ser una técnica sencilla, que mejora el confort de la paciente y que presenta resultados comparables con las técnicas tradicionales. Si bien se trata de una primera experiencia, son alentadores los resultados en términos de márgenes libres, tiempo quirúrgico y volumen resecados.
Introduction Currently, about 25 to 35% of all breast tumors are diagnosed at a nonpalpable stage. The increasing ability to detect small lesions consequently demands the development of novel technology for preoperative lesion identification and intraoperative localization. In this study, we present our initial experience using Sentinel Node Occult Lesion Localization (snoll) at the Hospital Italiano de Buenos Aires. Objectives The objective of this study is to describe clinical and pathological characteristics of patients who were submitted to snoll technique and the advantages and disadvantages, complications and results in terms of tumor-free margins, subsequent surgery rate, total specimen volume and surgical time. Materials and method This is a retrospective, observational study. We included all patients with non-palpable breast cancer who were submitted to surgery and snoll technique between August 1st, 2016 and March 14th, 2017. Results A total of 25 patients were included in this study. All patients had previous diagnosis of invasive breast cancer by core needle biopsy. The breast lesion was correctly identified in 96% of patients through snoll. Surgical margins were tumor-free in all patients. No patients required subsequent surgery. All sentinel nodes were correctly identified. In 76% of cases, snoll was sufficient and in 24% additional injection of patent blue was required. Conclusions In our experience, snoll has proven to be a simple technique that improves patient comfort and shows comparable results when compared to traditional identification methods. Although these are our initial results, we believe our findings to be promising in terms of adequacy of margins, surgical time and total specimen volume.
Subject(s)
Humans , Female , Breast Neoplasms , Sentinel Lymph NodeABSTRACT
Objective To determine the efficacy and long-term outcome of pyeloureteroplasty in the ureteropelvic junction obstruction (UPJO) patients with poor kidney function(＜ 10％).Methods The data of UPJO patients with poor kidney function treated from January 2006 to September 2016,was retrospectively analyzed.The renal function ＜ 10％ undergoing pyeloureteroplasty were included.Ipsilateral vesicoureteric reflux,ureterovesical junction obstruction and renal dysplasia were excluded.39 patients was enrolled.There were 31 boys and 8 girls.The mean age at surgery was 3.1 years old (range 7 months-14 years).There were 36 primary UPJO and 3 extrinsic vessel cases.Twenty-seven cases of UPJO in left side,9 cases in right side,and 1 case in bilateral side.The preoperative examination included ultrasound,intravenous pyelography (IVU) and 99 mTc DTPA renography.Mean anteroposterior diameter of pelvis was (5.5 ± 2.4) cm before operation (range 3.4-7.4cm);IVU showed non visualized kidney or rim sign.The ill kidneys' mean renal function was (3.25 ± 2.78) ％ (range 0-9％).Results Open pyeloureteroplasty were performed in the 38 patients,additional nephrectomy was required in 1 because of repeated urinary infection,while the other patients had good prognosis,nephrostomy was kept until 2-3 days' successful clipping.Laparoscope pyeloplasty were performed in one patient with double-J.The patient had urinary infection post operation and was cured.The postoperative examination included ultrasound,intravenous pyelography and 99mTc DTPA renography were performed after 3-6 months.Mean anteroposterior diameter of pelvis was (3.2 ± 1.9) cm (range 2.1-4.5 cm);Intravenous urography showed visualized kidney;Mean renal function was (18.16 ± 13.17)％ (9％-27％).There was significant difference between preoperational and postoperational evaluation of renography and pelvis (P ＜ 0.05).There was no correlation between the changed renal function and age (P ＞ 0.05).The mean follow-up time was 10.2 months (range 6-25 months).Conclusions Pyeloureteroplasty could be safe and feasible for the UPJO patients with renal function less than 10％,and could improve the renal function.
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Radioimmunotherapy (RIT) is a therapy that takes advantage of the “cross-fire” effect of emitted radiation by radionuclides conjugated to tumor-directed monoclonal antibodies (mAb) (including those fragments) or peptides. While RIT has been successfully employed for the treatment of lymphoma, mostly with radiolabeled antibodies against CD20 [⁹⁰yttrium (⁹⁰Y)-ibritumomab tiuxetan; Zevalin® and (131)iodine ((131)I)-tositumomab; Bexxar®], its use in solid tumors is more challenging, so far. Immuno-PET, a tool for tracking and quantification of mAbs with PET in vivo, is an exciting novel option to improve diagnostic imaging and guide mAbbased therapy. RIT in solid tumors including head and neck cancer may be an alternative treatment with advances in various biological, chemical, and treatment procedures, and it may help to reduce unnecessary exposure and enhance the therapeutic efficacy. Also, immuno-PET based on RIT might play an important role in cancer staging, in patients or targets selection of targeted therapeutics and in monitoring the response of targeted therapeutics as precision medicine. In this review, fundamentals of RIT/immune-PET and current knowledge of the preclinical/clinical trials in RIT for solid tumor including head and neck cancer are reviewed.
Subject(s)
Humans , Antibodies , Antibodies, Monoclonal , Carcinoma, Squamous Cell , Diagnostic Imaging , Head and Neck Neoplasms , Head , Lymphoma , Neoplasm Staging , Peptides , Precision Medicine , Radioimmunotherapy , RadioisotopesABSTRACT
El Tecnecio-99m es el radionúclido más utilizado en la actualidad en el campo de la medicina nuclear. El Centro Nacional de Seguridad Nuclear (CNSN) como órgano regulador de Cuba requiere la realización de análisis de riesgo a las instalaciones con peligro radiológico potencial asociado y preferentemente, que estos análisis sean realizados mediante el método de matriz de riesgo. Aunque existen varios métodos cualitativos o cuantitativos para realizar estos estudios, la existencia de bases de riesgo de partida y de códigos de análisis, así como la simplicidad de su empleo han privilegiado la matriz de riesgo como método semicuantitativo predominante. El artículo presenta los resultados de la aplicación de este método para la evaluación de los riesgos asociados a la producción de generadores de Molibdeno-99/Tecnecio-99m, que se realiza en el Centro de Isótopos (CENTIS). Empleando el código SECURE-MR Ver. 2.0 se realiza el análisis de riesgo detallado de la práctica. Se identificaron tres secuencias accidentales con nivel de riesgo alto y se determinó la importancia de barreras y reductores relacionados con factores humanos por suficiencia y capacitación de personal. Entre las aplicaciones derivadas del estudio se reportaron capacidades novedosas de análisis, así como posibilidades de monitoreo del riesgo. El modelo de riesgo desarrollado para el proceso de producción de generadores de Molibdeno-99/Tecnecio-99m unido a las capacidades de revisión, análisis y documentación ofrecidas por la herramienta permitieron la obtención de un documento coherente con el modelo, que constituye, además, una base de conocimientos efectiva para la evaluación de la seguridad de la instalación
Technetium-99m is the most commonly used radionuclide in the field of nuclear medicine. The National Center for Nuclear Safety (NCNS), as the regulatory body of Cuba, requires the carrying out of risk analysis for facilities with associated radiological hazard potential and, preferably, that these analyzes be performed using the risk matrix method. Although there are several qualitative or quantitative methods to perform these studies, the existence of basis risk starting and analysis codes and simplicity of use has been privileged the risk matrix as a predominant semi-quantitative method. The paper presents the results of the application of this method for the evaluation of the risks associated with the production of Molybdenum-99/Technetium-99m generators, which is carried out at the Isotope Center (Centis). Using the SECURE - MR Ver. 2.0 code a detailed risk analysis of its practice was carried out. Three accidental sequences of high-level risks were identified and the importance of barriers and reducers related to human factors associated to sufficiency and staff training was determined. Among the derived applications novel analysis capacities as well as risk monitoring possibilities are reported. The risk model developed for the production process of Molybdenum-99/Technetium-99m generators, joined with the ability to review, analyze and all the documentation provided by the tool, allow obtaining a completely and coherent document with the model, which constitutes an effective basis the safety of the facility
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Objective: To analyze the feasibility, efficacy and results of the use of 125Iodine seeds for intra-operative localization of nonpalpable breast lesions. Method: Retrospective review of 284 patients, referred by various breast specialist surgeons, with radiologically detected but clinically nonpalpable microcalcifications or nodules, submitted to pre-operatory 125Iodine seed implant, between July 2012 and September 2016. A total of 338 seeds were implanted in ordinary radiologic departments, supported by ultrasonography or mammography exams, chosen according to the morphologic aspect of the lesion. Radioguided surgical procedure took place on the same day or few days after the implant of the seeds, with the help of a radiation detector called Gamaprobe, which directs the surgeons towards the radioactive seeds and to the lesion to be resected. Results: All implants were performed as outpatient procedures, with patients immediately returning to their daily activities. No complications such as pain, bleeding, infeccion and haematoma were recorded. Pathologists had no difficulty in preparing the surgical specimens for histopathologic analysis. Surgical safety margins were considered adequate in all pathologic reports, with no need for re-operations. The healing process was not jeopardized by radiation, and the surgeons were pleased with the improvement on intraoperative lesions localizations and shortening on operatory time. Cosmetic results were well accepted by the patients. Conclusion: The 125Iodine seed implant is an effective alternative method for intraoperative localization of radiologically detectable and clinically nonpalpable breast lesions.
Objetivo: Avaliar a exequibilidade e a eficácia do método de implante de sementes de 125Iodo (ROLLIS) para localização intraoperatória de lesões impalpáveis da mama. Método: Trata-se de um estudo retrospectivo, incluindo 284 pacientes com nódulos ou microcalcificações mamárias, visíveis na mamografia e/ou ultrassonografia, porém, clinicamente impalpáveis, submetidas a implantes de sementes de 125Iodo, de julho de 2012 a setembro de 2016, sendo implantado um total de 338 sementes. As pacientes foram encaminhadas por diversos mastologistas que executaram cirurgias radioguiadas com auxílio de detector de radiação denominado Gamaprobe, realizadas no mesmo dia do implante ou vários dias após, seguindo a agenda do centro cirúrgico, da equipe médica e a conveniência da paciente. Resultados: Os implantes foram realizados em regime ambulatorial, com imediato retorno das pacientes às atividades cotidianas, não sendo registrada qualquer complicação como dor, hemorragia, infecção ou hematoma. Os patologistas não constataram prejuízo no processamento do espécimen cirúrgico. O processo cicatricial se efetuou normalmente, obtendo-se plena satisfação por parte dos cirurgiões, que referiram maior facilidade na localização intraoperatória das lesões e diminuição no tempo operatório. O resultado cosmético também foi beneficiado, sendo bem aceito pelas pacientes. As margens cirúrgicas foram consideradas adequadas em todos os casos, graças à avaliação feita pelo patologista e às ampliações executadas no momento da cirurgia, dispensando re-excisões. Conclusão: O implante de sementes de 125Iodo (ROLLIS) é uma técnica segura e eficaz para localização intraoperatória de lesões radiologicamente visíveis, porém clinicamente impalpáveis, da mama.
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Objective To investigate the effect and underlying mechanism of radioactive 125I seed implantation on the angiogenesis of transplanted human lung adenocarcinoma in nude mice.Methods An animal model of transplantd human lung adenocarcinoma was established by subcutaneous implanting A549 cells into nude mice.Twenty four tumor-bearing nude mice were randomly divided into 4 groups with different irradiation doses of blank control (without any treatment) and 0 MBq,22.2 MBq,29.6 MBq and by embedding radioactive 125I seeds with an 18 G implant needle.Tumor volumes were measured every 4 days until all mice were terminated 30 d later and the tumor growth curve was drawn.The microvessel density (MVD) in the tumor tissue was detected by immunohistochemistry S-P assay.The mRNA and protein levels of VEGF and HIF-1α of each group were detected by RT-PCR and Western blot,respectively.Results After embedding of 125I seeds,the tumor volumes of 22.2 MBq group (886 ± 97) and 29.6 MBq group (590 ± 107) were significantly smaller than those of control group (2 297 ± 149) at 54 d after administration (q =14.117,17.075,P ＜ 0.05),but there were no significant differences among 0 MBq group and control group,22.2 MBq and 29.6 MBq groups (P ＞ 0.05).The immunohistochemical CD34-positive staining demonstrated that MVD in 22.2 MBq group (522 ± 119) and 29.6 MBq group (491 ± 121) were decreased significantly compared with control group (922 ± 260) (q =4.826,5.197,P ＜0.05),but there were no significant differences among 0 MBq and control groups,22.2 MBq and 29.6 MBq groups(P ＞0.05).The mRNA expressions of VEGF and HIF-1α in 22.2 MBq group (0.279±0.0659,0.370 ±0.0857) and 29.6 MBq group (0.215 ±0.0620,0.278 ±0.0651) were significantly lower than those in the control group (q VEGFmRNA =18.881,17.211,q HIF-1αmRNA =15.376,14.733,P ＜0.05),but there were no significant differences among 0 MBq and control groups,22.2 MBq and 29.6 MBq groups(P ＞0.05).At the same time,the expression levels of VEGF and HIF-1α protein after 125I seed implantation were also obviously decreased in 22.2 MBq and 29.6 MBq groups (qvEGr =5.848,6.263,q HIF-1α =6.560,7.576,P ＜ 0.05),and no significant difference between 0 MBq and control groups(P ＞ 0.05) and between 22.2 MBq and 29.6 MBq groups (P ＞ 0.05).Conclusions Interstitial implantation with 125I seeds may potently inhibit angiogenesis in human lung adenocarcinoma xenografts of nude mice.
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Se presenta el caso clínico de una paciente que ingresó en el Hospital Clinicoquirúrgico Hermanos Ameijeiras con antecedentes de etilismo crónico y cuadro clínico progresivo de deterioro cognitivo-conductual, trastornos de la marcha y esfinterianos, a quien se le realizó una cisternografía radioisotópica con el objetivo de comprobar su eficacia en el estudio de la dinámica del líquido cefalorraquídeo para diagnosticar la hidrocefalia oculta normotensa. La resonancia magnética de cráneo evolutiva evidenció hidrocefalia y la cisternografía radioisotópica confirmó el diagnóstico de hidrocefalia oculta normotensa. A la paciente se le realizó una derivación ventrículo peritoneal con la que se obtuvo una respuesta clínica evolutiva favorable. Se concluye que la cisternografía radioisotópica continúa siendo una herramienta útil para confirmar este diagnóstico y predecir la respuesta al tratamiento derivativo(AU)
A female patient who was admitted to Hermanos Ameijeiras Clinical and Surgical Hospital is presented here. She had a history of chronic alcohol abuse and progressive clinical deterioration of cognitive behavioral, abnormal gait and sphincter disorders. This patient had a radioisotope cisternography in order to test its effectiveness in the study of the dynamics of cerebrospinal fluid, and to diagnose normotensive hidden hydrocephalus. This MRI revealed hydrocephalus and skull evolutionary radioisotope cisternography confirmed the diagnosis of normal pressure hidden hydrocephalus. This patient received a shunt with a favorable evolutionary clinical response. It is concluded that cisternography radioisotope remains a useful tool to confirm this diagnosis and predict response to derivative treatment(AU)
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Humans , Female , Middle Aged , Pneumoencephalography/methods , Hydrocephalus, Normal Pressure/diagnostic imaging , Cerebrospinal Fluid/diagnostic imaging , Hydrocephalus, Normal Pressure/diagnosisABSTRACT
Objective Some drugs can effectively improve the uptake of 131 I in dedifferentiated thyroid cancer .This study was to investigate the effect of all-trans retinoic acid (ATRA) combined with interferon-α2a (IFN-α2a) on the iodine uptake and re-tention rate of FTC-133 follicular thyroid carcinoma cells . Methods FTC-133 cells were cultured in the presence of 2 μmol/L AT-RA and/or 1500 IU/mL IFN-α2a for 72 hours.The the cells were collected for measurement of the uptake and retention rate of Na 125 I. Results The Na125 I uptake of the FTC-133 cells was significantly increased after 72-hour incubation with 2μmol/L ATRA and 1500 IU/mL IFN-α2a (2423.1 ±237.5) as compared with those of the control (1279.5 ±102.8), ATRA (1438.2 ±149.6), and IFN-α2a groups (1355.3 ±198.4) (P<0.05).Statistically significant differences were observed in the retention rate of Na 125I in the FTC-133 cells at different time points in the each of the blank control , 2μmol/L ATRA, 1500 IU/mL IFN-α2a, and combination groups (P<0.01), but not in that of Na125I among these groups (P<0.05). Conclusion ATRA in combination with IFN-α2a can promote the Na125 I uptake but cannot improve the Na 125 I retention rate in FTC-133 cells.
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Las tecnologías de radiotrazadores y de escaneo son herramientas bien consolidadas para el estudio, análisis y evaluación de los procesos industriales y medioambientales. En este trabajo se sintetizan los principales resultados alcanzados por el Grupo de Aplicaciones Industriales y Medioambientales de los Radiotrazadores en el Departamento de Radioquímica. La tecnología de radiotrazadores se ha empleado con éxito para la caracterización del mezclado en reactores discontinuos, los estudios sobre el comportamiento del 99mTc en aguas naturales y residuales, la calibración y validación del modelo de calidad de agua del río Almendares, la caracterización de un reactor anaerobio para el tratamiento de los residuales en el CAI Pablo Noriega, la verificación y validación del modelo DFC en un cristalizador azucarero, el desarrollo de un generador radisotópico de ? / ?, la modelación de la calidad del agua en el segmento medio del río Luyanó, y para la modelación de la calidad del agua en el río Guaire, Caracas, Venezuela. En los últimos años el grupo ha desarrollado y evaluado a nivel de laboratorio radiotrazadores para fluidos orgánicos, particularmente relacionados con la industria del petróleo y para sólidos, empleando como precursor al ?. Mientras la técnica de escaneo se ha utilizado para el perfilaje gamma en torres de destilación de alcohol de los CAI "Héctor MolinaHeriberto Duquesne" y "Jesús Rabí".