激光共聚焦显微内镜在大肠疾病诊断中的应用现状及进展

激光共聚焦显微内镜(confoeal laser endomicroscopy,CLE)是20世纪80年代发展起来的一种新的内镜成像技术,它的出现把一些疾病的内镜诊断与组织学诊断科学地结合起来,能够在内镜检查同时完成组织学诊断,这种新的诊断方法是内镜影像技术的一次革命性飞跃.本文就CLE在大肠疾病诊断中的临床应用现状作一综述,总结CLE在大肠疾病诊断中的优势及实用价值.     

Monitoring Pancreatic Carcinogenesis by the Molecular Imaging of Cathepsin E In Vivo Using Confocal Laser Endomicroscopy

The monitoring of pancreatic ductal adenocarcinoma (PDAC) in high-risk populations is essential. Cathepsin E (CTSE) is specifically and highly expressed in PDAC and pancreatic intraepithelial neoplasias (PanINs), and its expression gradually increases along with disease progression. In this study, we first established an in situ 7,12-dimethyl-1,2-benzanthracene (DMBA)-induced rat model for PanINs and PDAC and then confirmed that tumorigenesis properties in this model were consistent with those of human PDAC in that CTSE expression gradually increased with tumor development using histology and immunohistochemistry. Then, using in vivo imaging of heterotopically implanted tumors generated from CTSE- overexpressing cells (PANC-1-CTSE) in nude mice and in vitro imaging of PanINs and PDAC in DMBA-induced rats, the specificity of the synthesized CTSE-activatable probe was verified. Quantitative determination identified that the fluorescence signal ratio of pancreatic tumor to normal pancreas gradually increased in association with progressive pathological grades, with the exception of no significant difference between PanIN-II and PanIN-III grades. Finally, we monitored pancreatic carcinogenesis in vivo using confocal laser endomicroscopy (CLE) in combination with the CTSE-activatable probe. A prospective double-blind control study was performed to evaluate the accuracy of this method in diagnosing PDAC and PanINs of all grades (>82.7%). This allowed us to establish effective diagnostic criteria for CLE in PDAC and PanINs to facilitate the monitoring of PDAC in high-risk populations.     

Probe-based Confocal Laser Endomicroscopy of the Urinary Tract: The Technique

Probe-based confocal laser endomicroscopy (CLE) is an emerging optical imaging technology that enables real-time in vivo microscopy of mucosal surfaces during standard endoscopy. With applications currently in the respiratory¹ and gastrointestinal tracts,^2-6 CLE has also been explored in the urinary tract for bladder cancer diagnosis.^7-10 Cellular morphology and tissue microarchitecture can be resolved with micron scale resolution in real time, in addition to dynamic imaging of the normal and pathological vasculature.⁷The probe-based CLE system (Cellvizio, Mauna Kea Technologies, France) consists of a reusable fiberoptic imaging probe coupled to a 488 nm laser scanning unit. The imaging probe is inserted in the working channels of standard flexible and rigid endoscopes. An endoscope-based CLE system (Optiscan, Australia), in which the confocal endomicroscopy functionality is integrated onto the endoscope, is also used in the gastrointestinal tract. Given the larger scope diameter, however, application in the urinary tract is currently limited to ex vivo use.¹¹ Confocal image acquisition is done through direct contact of the imaging probe with the target tissue and recorded as video sequences. As in the gastrointestinal tract, endomicroscopy of the urinary tract requires an exogenenous contrast agent—most commonly fluorescein, which can be administered intravenously or intravesically. Intravesical administration is a well-established method to introduce pharmacological agents locally with minimal systemic toxicity that is unique to the urinary tract. Fluorescein rapidly stains the extracellular matrix and has an established safety profile.¹² Imaging probes of various diameters enable compatibility with different caliber endoscopes. To date, 1.4 and 2.6 mm probes have been evaluated with flexible and rigid cystoscopy.¹⁰ Recent availability of a < 1 mm imaging probe¹³ opens up the possibility of CLE in the upper urinary tract during ureteroscopy. Fluorescence cystoscopy (i.e. photodynamic diagnosis) and narrow band imaging are additional endoscope-based optical imaging modalities¹⁴ that can be combined with CLE to achieve multimodal imaging of the urinary tract. In the future, CLE may be coupled with molecular contrast agents such as fluorescently labeled peptides¹⁵ and antibodies for endoscopic imaging of disease processes with molecular specificity.     

3-D Visualization and Quantitation of Microvessels in Transparent Human Colorectal Carcinoma

Microscopic analysis of tumor vasculature plays an important role in understanding the progression and malignancy of colorectal carcinoma. However, due to the geometry of blood vessels and their connections, standard microtome-based histology is limited in providing the spatial information of the vascular network with a 3-dimensional (3-D) continuum. To facilitate 3-D tissue analysis, we prepared transparent human colorectal biopsies by optical clearing for in-depth confocal microscopy with CD34 immunohistochemistry. Full-depth colons were obtained from colectomies performed for colorectal carcinoma. Specimens were prepared away from (control) and at the tumor site. Taking advantage of the transparent specimens, we acquired anatomic information up to 200 μm in depth for qualitative and quantitative analyses of the vasculature. Examples are given to illustrate: (1) the association between the tumor microstructure and vasculature in space, including the perivascular cuffs of tumor outgrowth, and (2) the difference between the 2-D and 3-D quantitation of microvessels. We also demonstrate that the optically cleared mucosa can be retrieved after 3-D microscopy to perform the standard microtome-based histology (H&E staining and immunohistochemistry) for systematic integration of the two tissue imaging methods. Overall, we established a new tumor histological approach to integrate 3-D imaging, illustration, and quantitation of human colonic microvessels in normal and cancerous specimens. This approach has significant promise to work with the standard histology to better characterize the tumor microenvironment in colorectal carcinoma.     

SNFYMPL荧光探针和共聚焦显微内镜在胃癌诊断中的应用

目的:探讨荧光探针SNFYMPLGGGSK-FITC与胃癌组织的结合能力,预测其在胃癌诊断中的应用价值。方法:收集我院2015年6月至10月收治的48例胃癌患者手术切除的肿瘤和癌旁组织,使用异硫氰酸荧光素FITC标记的线性七肽SNFYMPL及无关序列肽探针对其冰冻切片进行荧光染色,通过共聚焦激光扫描显微镜CLSM检测其结合能力,并与组织病理结果对比。结果:SNFYMPLGGGSK-FITC对胃癌组织荧光染色的阳性率为81.25%(39/48),明显优于无关序列肽探针的14.58%(7/48),差异有统计学意义(P0.001)。SNFYMPLGGGSK-FITC对癌旁组织荧光染色的阳性率为27.08%(13/48),明显低于对胃癌组织荧光染色阳性率,差异有统计学意义(P0.001)。结论:FITC标记的SNFYMPL短肽探针与胃癌组织较强结合能力,图像组织分辨率好,可以作为共聚焦激光显微内镜在胃癌诊断的潜在靶向分子进一步研究。     

贝伐单抗靶向治疗结直肠癌的临床试验研究进展

贝伐单抗作为一种血管内皮生长因子抑制荆,是近年来研究异常活跃的一种抗体.它主要通过与血管内皮生长因子结合抑制血管的生成从而阻止肿瘤的发展.目前的临床试验研究显示它可以有效地延长结直肠癌患者的生存期.本文主要介绍了血管内皮生长因子及其作用机制、贝伐单抗概况及其作用机理以及其在靶向治疗结直肠癌的临床试验研究进展和不良反应.     

Evaluation of Staging Systems for Colorectal Cancer

An alternative way to implement the Akaike Information Criterion (AIC) is proposed for the evaluation of staging systems for colorectal cancer.     

Histological Observations of Dental Tissues Using the Confocal Laser Scanning Microscope

To investigate the time course of mineralization in undecalcified dental tissues, calcein-and tetracycline-labeled rat maxillary molar sections were stained with Villanueva bone stain en bloc, embedded in methyl-methacrylate (MMA), ground to 50 μm thickness, and observed by confocal laser scanning microscopy (CLSM). This method allowed observation of dental structures including odontoblasts, pulp cells and periodontal ligament, and dentinal tubules and enamel rods at high resolution; labeled enamel, dentine, and cementum could be observed simultaneously regardless of section thickness. CLSM permitted simultaneous observation of both the components of calcified tissue and the cellular components of dental tissues, and assessment of the mineralization time course of hard tissues labeled by tetracycline or calcein. The technique is useful for both assessing the elements composing dental structure and observing the histological dynamics by which dental structure develops.     

Histological Observations of Dental Tissues Using the Confocal Laser Scanning Microscope

To investigate the time course of mineralization in undecalcified dental tissues, calcein-and tetracycline-labeled rat maxillary molar sections were stained with Villanueva bone stain en bloc, embedded in methyl-methacrylate (MMA), ground to 50 μm thickness, and observed by confocal laser scanning microscopy (CLSM). This method allowed observation of dental structures including odontoblasts, pulp cells and periodontal ligament, and dentinal tubules and enamel rods at high resolution; labeled enamel, dentine, and cementum could be observed simultaneously regardless of section thickness. CLSM permitted simultaneous observation of both the components of calcified tissue and the cellular components of dental tissues, and assessment of the mineralization time course of hard tissues labeled by tetracycline or calcein. The technique is useful for both assessing the elements composing dental structure and observing the histological dynamics by which dental structure develops.     

Targeted Cancer Therapy with a Novel Anti-CD37 Beta-Particle Emitting Radioimmunoconjugate for Treatment of Non-Hodgkin Lymphoma

¹⁷⁷Lu-DOTA-HH1 (¹⁷⁷Lu-HH1) is a novel anti-CD37 radioimmunoconjugate developed to treat non-Hodgkin lymphoma. Mice with subcutaneous Ramos xenografts were treated with different activities of ¹⁷⁷Lu-HH1, ¹⁷⁷Lu-DOTA-rituximab (¹⁷⁷Lu-rituximab) and non-specific ¹⁷⁷Lu-DOTA-IgG₁ (¹⁷⁷Lu-IgG₁) and therapeutic effect and toxicity of the treatment were monitored. Significant tumor growth delay and increased survival of mice were observed in mice treated with 530 MBq/kg ¹⁷⁷Lu-HH1 as compared with mice treated with similar activities of ¹⁷⁷Lu-rituximab or non-specific ¹⁷⁷Lu-IgG1, 0.9% NaCl or unlabeled HH1. All mice injected with 530 MBq/kg of ¹⁷⁷Lu-HH1 tolerated the treatment well. In contrast, 6 out of 10 mice treated with 530 MBq/kg ¹⁷⁷Lu-rituximab experienced severe radiation toxicity. The retention of ¹⁷⁷Lu-rituximab in organs of the mononuclear phagocyte system was longer than for ¹⁷⁷Lu-HH1, which explains the higher toxicity observed in mice treated with ¹⁷⁷Lu-rituximab. In vitro internalization studies showed that ¹⁷⁷Lu-HH1 internalizes faster and to a higher extent than ¹⁷⁷Lu-rituximab which might be the reason for the better therapeutic effect of ¹⁷⁷Lu-HH1.     

人膀胱癌细胞纤维肌动蛋白共聚焦激光扫描显微镜观察

探讨膀胱癌细胞纤维肌动蛋白（F－actin)的空间结构。采用共聚焦激光扫描显微镜光学切片技术结合异硫酸氢荧光素－鬼笔环肽（FITC－phalloidin)标记纤维肌动蛋白和碘化丙啶（PI）和标记核酸的荧光探针双重标记技术对膀胱癌细胞纤维肌动蛋白进行形态学观察,结果可见膀胱癌细胞内纤维肌动蛋白微丝形态完整,成细束或细丝状,平行排列地整个细胞或细胞突起,在胞质边缘处较密集。     

结直肠癌诊断方法的应用与评价

结直肠癌(colorectal cancer,CRC)是人类常见肿瘤之一,早期诊断对预防CRC的发病显得尤为重要.随着医学技术的发展,CRC的常规诊断方法已取得了很大进展,目前用于诊断CRC的检查方法主要有粪便排泄物检查、结肠镜检查、CT结肠成像检查、肿瘤分子标记物等,然而各诊断方法的敏感性和特异性存在一定差异.本文主要对目前CRC的常见诊断方法进行分析和评价,以期为CRC的临床预防和早期诊断提供更多的理论依据.     

人类股骨断面面积与形状的不对称性——基于三维激光扫描的形态测量分析

人类股骨横断面面积、形状及其左右侧差异记载的人类演化、人群差异及生存活动的重要信息一直为古人类学研究所关注。多年来, 对股骨断面的研究通常采用破坏性地切割或者制作模型的方法。本文利用三维激光表面扫描技术, 无损、快捷、方便地获取了20对现代中国人左右侧股骨外轮廓的三维数据, 采用CAD软件及几何形态测量方法对两侧股骨断面轮廓的大小及形状进行了对比和分析。初步研究结果发现: 两侧股骨的横断面相对面积差异极其显著, 绝对面积差异不显著, 不对称方式表现为波动不对称性, 而不是偏向不对称性; 个体之间两侧股骨横断面外轮廓形状的波动不对称性极其显著, 偏向不对称性虽有差异但不显著; 平均形状和面积分析结果似乎表明股骨稍有偏左侧优势。虽然本文所采用的标本量有限, 所得出的结论需要更多标本的进一步验证, 但是, 本文的研究结果提示利用三维激光扫描技术获取股骨横断面外轮廓数据, 并采用形态测量方法分析确实能够揭示出一些以往研究方法不能发现的重要信息, 这种研究骨骼不对称性的新方法值得进一步的应用。     

Human Monoclonal Antibodies: On the Menu of Targeted Therapeutics Against COVID-19

Virologica Sinica - Coronavirus disease 2019 (COVID-19), reminiscent of the severe acute respiratory syndrome (SARS) outbreak in 2003, has been a tragic disaster to people all over the world. As...     

利用转座子构建靶向侵袭性抗肿瘤工程菌

转座子是一类在基因组上可以自由跳跃的移动序列,同时也是对微生物进行基因修饰和插入突变的有效工具,但尚未见有利用转座子导入革兰氏阴性菌E.coli Nissle1917菌株的报道.本研究通过构建p R6K转座载体,对肠道益生菌E.coli Nissle1917菌株进行了转座插入诱变,将假结核耶尔森菌的侵袭素基因inv和单核细胞增多性李斯特菌的溶血素基因hly随机整合至E.coli Nissle1917菌株的染色体上,从而使非致病性大肠杆菌E.coli Nissle1917获得侵袭哺乳动物细胞的能力.通过细胞体外侵袭实验发现,本研究所构建的工程菌对B16,HCT-116等肿瘤细胞有较好的侵袭活性,同时与抗肿瘤蛋白Azurin一起作用B16细胞,抗肿瘤效果显著增强,为进一步运用以大肠杆菌E.coli Nissle1917作为DNA疫苗或者基因治疗的载体开辟了新的技术途径.     

Multi-Determinants Analysis of Molecular Alterations for Predicting Clinical Benefit to EGFR-Targeted Monoclonal Antibodies in Colorectal Cancer

Background

KRAS mutations occur in 35–45% of metastatic colorectal cancers (mCRC) and preclude responsiveness to EGFR-targeted therapy with cetuximab or panitumumab. However, less than 20% patients displaying wild-type KRAS tumors achieve objective response. Alterations in other effectors downstream of the EGFR, such as BRAF, and deregulation of the PIK3CA/PTEN pathway have independently been found to give rise to resistance. We present a comprehensive analysis of KRAS, BRAF, PIK3CA mutations, and PTEN expression in mCRC patients treated with cetuximab or panitumumab, with the aim of clarifying the relative contribution of these molecular alterations to resistance.

Methodology/Principal Findings

We retrospectively analyzed objective tumor response, progression-free (PFS) and overall survival (OS) together with the mutational status of KRAS, BRAF, PIK3CA and expression of PTEN in 132 tumors from cetuximab or panitumumab treated mCRC patients. Among the 106 non-responsive patients, 74 (70%) had tumors with at least one molecular alteration in the four markers. The probability of response was 51% (22/43) among patients with no alterations, 4% (2/47) among patients with 1 alteration, and 0% (0/24) for patients with ≥2 alterations (p<0.0001). Accordingly, PFS and OS were increasingly worse for patients with tumors harboring none, 1, or ≥2 molecular alteration(s) (p<0.001).

Conclusions/Significance

When expression of PTEN and mutations of KRAS, BRAF and PIK3CA are concomitantly ascertained, up to 70% of mCRC patients unlikely to respond to anti-EGFR therapies can be identified. We propose to define as ‘quadruple negative’, the CRCs lacking alterations in KRAS, BRAF, PTEN and PIK3CA. Comprehensive molecular dissection of the EGFR signaling pathways should be considered to select mCRC patients for cetuximab- or panitumumab-based therapies.     

磁免疫电化学发光检测肺癌血清p53抗体

肿瘤抑制基因——p53基因的突变可能产生p53抗体.p53抗体在肿瘤的诊断、预后及监测等方面具有重要的临床价值.目前检测p53抗体的方法,如酶联免疫分析方法,需要多个步骤,比较费时,且大部分检测指标只能是半定量,具有一定的局限性.提出了一种磁免疫电化学发光(IM-ECL)分析方法定量检测人血清p53抗体.这种新的分析方法检测人血清p53抗体的最低检测极限可达到10 ng/L,标准曲线的动力学范围和线性范围达到5个数量级（0.01～1 000 μg/L）.我们应用IM-ECL分析法检测肺癌病人血清,只需要50 μl的样品量,30 min的孵育时间和少于50 s的采集时间,得出肺癌血清中p53抗体的阳性率为28.6 ％,然后通过标准曲线定量阳性血清中p53抗体的浓度.从肺癌血清的结果中发现,随着临床分期的升高,p53抗体浓度增加.IM-ECL分析方法在检测限、线性范围、分析时间等方面都优于酶联免疫分析,是一种可行的快速、灵敏、定量检测人血清p53抗体的分析方法.