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<p><b>OBJECTIVE</b>To compare the accuracy of serological and molecular approaches to identification of RhD-negative patients waiting for kidney transplantation.</p><p><b>METHODS</b>A total of 103 RhD-negative blood samples by serological test were collected from patients waiting for kidney transplantation between January, 2006 and January, 2016. Quantitative PCR and sequencing were used to verify the results of RHD genotyping, and the false negative rates of the serological and molecular methods for RhD genotyping were compared.</p><p><b>RESULTS</b>Among the 103 blood samples, true RhD negativity (with all the 10 exons missing) was found in 56 samples (54.5%), and false RhD negativity (RhD positivity with loss, repetition, or missense mutation in the 10 exons) in 47 samples (45.6%). In the 47 false RhD-negative cases, weak D was detected in 1 case (2.1%), partial D in 13 cases (27.7%), and D-elution in 33 cases (70.2%). The detection rates of RhD negativity differed significantly between the serological and molecular methods (P<0.05).</p><p><b>CONCLUSION</b>Serological test is associated with a high false negative rate in detecting RhD blood group, and the use of the molecular approach has important clinical significance in accurate RhD genotyping for patients waiting for renal transplantation.</p>
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<p><b>OBJECTIVE</b>To investigate the value of evaluating 5 platelet parameters in predicting delayed graft function (DGF) in patients following kidney transplantation.</p><p><b>METHODS</b>We retrospectively analyzed the pre- and postoperative (within 2 months) data of 330 renal transplant recipients. The cases with DGF and those without were analyzed to assess the association between relationship between DGF following transplantation and the variations of blood platelet parameters including platelet count (PLT), large platelet ratio (P-LCR), mean platelet volume (MPV), platelet volume distribution width (PDW) and platelet hematocrit (PCT).</p><p><b>RESULTS</b>The DGF and non-DGF cases were comparable for the platelet parameters before the operation. On postoperative day 7 when the diagnosis of DGF was made, PLT (P<0.05) and PCT (P<0.02) were significantly lower while MPV (P<0.01), PDW (P=0.036) and P-LCR (P=0.01) significantly higher in DGF group than in non-DGF group. The AUCs of P-LCR (0.611±0.047), PDW (0.603±0.048) and MPV (0.762±0.037) were significantly higher than the reference area (P<0.05) with cut-off values of 34.80%, 12.95fl and 11.55fl, respectively. MPV showed a high sensitivity, specificity and Youden index for predicting DFG; PDW and P-LCR had a high sensitivity but a low specificity for predicting DFG with a modest diagnostic value. PLT and PCT, with AUCs of were 0.37 and 0.38, respectively, did not have a predictive value for DGF.</p><p><b>CONCLUSIONS</b>Significant variations in platelet parameters occur in the event of DGF in renal transplant recipients, and monitoring the postoperative changes in MPV, PDW, and P-LCR can help in early diagnosis and treatment of DGF. MPV has a moderate value (0.7-0.9) in predicting DGF, and a MPV>11.55 fl suggests the risk of DGF.</p>
Subject(s)
Humans , Area Under Curve , Blood Platelets , Delayed Graft Function , Kidney , Physiology , Kidney Function Tests , Kidney Transplantation , Mean Platelet Volume , Platelet Count , Postoperative Period , ROC Curve , Retrospective Studies , Sensitivity and SpecificityABSTRACT
Objective To compare the efficacy of 18F-FDG PET/CT, 99Tcm-MDP bone scintigraphy (BS), and combination of the two techniques (PET/CT + BS) for detecting bone metastasis by ROC curve analysis. Methods All 296 patients with various cancers, who underwent both 99Tcm-MDP BS and 18F-FDG PET/CT within two months, were retrospectively analyzed. These images were interpreted according to 5-point scale (0: definitely negative, 1: probably negative, 2: equivocal, 3: probably positive, 4:definitely positive for bone metastasis), and the scale of PET/CT + BS was the sum of PET/CT and BS. In light of the confirmed diagnosis derived from pathology or follow-up, ROC curve analysis was performed.The area under the ROC curve (AUC) was compared by z-test. Results Of 296 cases, 61 (20.6%) were confirmed as bone metastases and 235 (79.4%) were negative. The AUC were 0. 919 (95% confidence interval (95% CI) :0. 867 - 0. 971) for BS, 0. 949 (95% CI: 0. 906 - 0. 991) for PET/CT, and 0. 994 (95% CI: 0.988-0.999) for PET/CT + BS, rctrospectively. The AUC of PET/CT + BS was statistically significantly larger than that of BS (z=2. 866, P=0.004) or PET/CT (z =2.027, P=0.043), while the AUC of PET/CT was larger than that of BS, but no statistically significance (z = 0. 881, P = 0. 378) was showed. The optimal sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value(NPV) were 90. 2% (55/61), 85. 1% (200/235), 86. 1% (255/296), 61. 1% (55/90), 97. 1%(200/206) for BS, 88.5% (54/61), 97.0% (228/235), 95.3% (282/296), 88.5% (54/61), 97.0% for PET/CT, and 98.4% (60/61), 95.7% (225/235), 96.3% (285/296), 85.7% (60/70) for PET/CT + BS,respectively. The specificity (χ2 = 19.862, P<0. 001), accuracy (χ2 = 23. 361, P<0.001) and PPV (χ2 =11. 791, P =0.001) of PET/CT + BS were significantly higher than those of BS, the sensitivity of PET/CT +BS was significantly higher than that of PET/CT (χ2 =4.167, P=0.031). Compared with BS, PET/CT had a higher specificity (χ2 = 19.600, P<0. 001), accuracy (χ2 = 13. 755, P <0. 001), PPV (χ2 = 13. 608, P <0. 001), but their sensitivity showed no statistically significant difference (χ2 = 0, P = 1. 000). Conclusions The efficacy of 18F-FDG PET/CT for detecting malignant bone metastasis was superior to that of 99Tcm-MDP BS alone. The detection ability can be obviously improved by combination of the two techniques.
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Objective To determine the effect of histotype and histodifferentiation on the maximum standardized uptake value (SUV_(max)) of non-small cell lung cancer (NSCLC) ~(18)F-fluorodeoxyglucose (FDG) PET/CT imaging.Methods Two hundred and sixty patients with NSCLc underwent ~(18)F-FDG PET/CT imaging.They were classified according to (1) histotype:as adenocarcinoma (AC),squamous cell carcinoma(SQC),adenosquamous carcinoma (ASC) and other type carcinoma (OTC),and (2) histodifferentiation:as grade Ⅰ (well-differentiated),grade Ⅱ (moderate-differentiated) and grade Ⅲ (poor-differentiated).The SUV_(max) and size(long diameter)of the primary lesions were measured.Multivariate regression analysis was used to analyze the relationship between the SUV_(max) and variable factors including histotype,histodifferentiation,lesion size,age,sex,body height,body weight,body mass index (BMI),blood glucose level,dose,and rate of dose.Results Two hundred and sixty patients had 260 primary NSCLC tumors.There were 161 AC(15 grade Ⅰ,88 grade Ⅱ,58 grade Ⅲ),74 SQC(6 grade Ⅰ,39 grade Ⅱ,29 grade Ⅲ),15 ASC(7 grade Ⅱ,8 gradeⅢ)and OTC(8 large cell,2 carcinosarcoma).Only lesion size (F=87.046.P＜0.001),histodifferentiation (F=87.604,P＜0.001) and histotype (F=66.663,P＜0.001) were included for multivariate regression analysis with SUV_(max).After adjustment for lesion size,the SUV_(max)(mean and 95%confidence interval) in ascending order was AC Ⅰ:3.3(2.1-4.5),ACⅡ:6.0(5.5-6.6),SQCⅠ:6.1(4.2-8,0),ASC Ⅱ:6.6(4.8-8.4),SQCⅡ.7.8(7.0-8.6),OTC:8.1(6.6-9.6),AC Ⅲ:8.3(7.6-8.9),ASC Ⅲ:8.7(7.0-10.4),and SQC Ⅲ:8.9(8.0-9.8).11he SUV_(max) of AC Ⅰ was significantly lower than that of SQC Ⅰ(q=-2.786,P=0.017),same for AC Ⅱ and SQC Ⅱ(q=-1.776,P＜0.001),but no statistically significant differences were found among AC Ⅲ,ASC Ⅲ and SQC Ⅲ(q=-0.593,-0.422,0.171,P=0.288,0.642,0.860,respectively).For the same histotype lesions,the difference of SUV_(max) among AC Ⅰ,Ⅱ and Ⅲ was statistically significant(q=-2.720,-4.943,-2.223,all P＜0.001),as also for SQC Ⅰ and Ⅲ(q=-2.751,P=0.012).Conclusion Histotype and histodifferentiation are significant correlative factors for ~(18)F-FDG uptake of NSCLC,with histodifferentiation being the factor with greater impact.
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<p><b>OBJECTIVE</b>To study the pattern of blood-brain barrier (BBB) permeability changes during whole brain radiotherapy (WBRT) for metastatic brain tumor.</p><p><b>METHODS</b>Twenty patients with metastatic brain tumors receiving WBRT by 6 MV X-ray underwent (99)mTc-DTPA brain SPECT before and during WBRT (20, 40 Gy) and at 2 weeks after the end of irradiation. A frame of transverse (99)mTc-DTPA brain SPECT image that best displayed the brain metastasis was chosen, and the regions of interest (ROI) were defined in the tumor foci (T), the contralateral normal brain tissue (N) and the background outside the soft tissues around the cranium (B). The radioactive counts of every ROI were measured and the ratios of the total counts (T/B and N/B) before and during WBRT (20 Gy, 40 Gy) and at 2 weeks after the irradiation were calculated.</p><p><b>RESULTS</b>The average T/B and N/B in the 20 patients with 30 brain metastases was 142.2-/+51.1 and 82.6-/+42.3 before WBRT, 260.3-/+121.5 and 150.7-/+72.5 during 20 Gy WBRT, 251.6-/+118.3 and 161.8-/+68.4 during 40 Gy WBRT, and 250.3-/+117.2 and 158.6-/+73.5 at 2 weeks after the irradiation, respectively. The measurements during WBRT (20 and 40 Gy) and at 2 weeks after the irradiation group underwent no significant variations (P>0.05), but showed significant differences from those before WBRT (P<0.05).</p><p><b>CONCLUSIONS</b>Irradiation causes direct damage of the BBB function, and the permeability of the BBB increases significantly during and within 2 weeks following 20 and 40 Gy WBRT, which provides the optimal time window for interventions with chemotherapy.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Blood-Brain Barrier , Diagnostic Imaging , Brain Neoplasms , Diagnostic Imaging , Radiotherapy , Capillary Permeability , Physiology , Cranial Irradiation , Sodium Pertechnetate Tc 99m , Tomography, Emission-Computed, Single-PhotonABSTRACT
<p><b>OBJECTIVE</b>To investigate the diagnostic value of dual-head (18)F-fluorodeoxyglucose ((18)F-FDG) imaging in metastatic lesion with unknown primary tumour (UPT).</p><p><b>METHODS</b>Seventy patients with UPT underwent dual-head (18)F-FDG imaging after iv (18)F-FDG 1.85 MBq/kg. The primary tumour was diagnosed according to the FDG uptake and T/N value.</p><p><b>RESULTS</b>Of the 70 patients, the primary tumour was identified by positive FDG imaging and finally confirmed pathologically in 58 patients (82.9%), and 12 patients had a negative FDG imaging (17.1%). Forty-two of the 58 positive patients were found to have lung cancer (72.4%). Among the 12 negative patients, their primary tumour was then identified by other diagnostic procedures in 5 patients (41.7%), in 1 patient, the primary site was detected during follow-up, however, the primary tumour was never detected in the rest 6 patients.</p><p><b>CONCLUSION</b>Dual-probe (18)F-FDG imaging is a simple, quick, non-invasive and sensitive technique with an accuracy over 80% in the diagnosis of unknown primary tumour. The lung is found to be the most frequent primary site. Dual-probe (18)F-FDG imaging can be recommended as the first diagnostic choice for UPT.</p>