Acetilcholin-receptor elleni autoantitestek vizsgálata és pathogenetikai szerepük meghatározása Sjögren syndromában = The examination of autoantibodies against acetylcholine-receptors and the determination of their pathogenic role in Sjögren`s syndrome

A humán muscarin acetylcholin receptor 3 második extracelluláris hurkát reprezentáló peptid antigenitását vizsgáltuk primer Sjögren syndromában (pSS) ELISA rendszerekben. A KRTVPPGECFIQFLSE (KRSE213-228) peptid és annak glutathion S-transferashoz kapcsolt formáját (GST)-KRSE használtuk antigénekként. A fúziós peptid immunológiai felismerése szignifikánsan jobb volt, mint a szintetikus megfelelője (p=0.0068). Ugyancsak vizsgáltuk az autoantitestek klinikai kösszefüggéseit és betegség-specificitását. Az anti-m3AChR213-228 antitest pozitivitás a pSS betegek 90%-ban volt megfigyelhető. Az antitest-szint az extraglanduláris szerv-manifesztációk számával pozitívan korrelált. Az antitest átlag-szintje és előfordulása szignifikánsan magasabb volt a pSS betegekben a többi betegcsoporttal összehasonlítva. Az immunreakció specificitása 65, 68, 71 és 50% volt a RA, SLE, sSS és a feltételezett SS betegekre. A klinikai vizsgálataink eredményei megerősítették azt a feltételezést, hogy az anti-m3AChR antitestek fontosak, mind a glanduláris diszfunkció, mind a szisztémás manifesztációk létrejöttében. Az antitest-pozitivitás együtt járt az autonóm idegrendszer diszfunkciójával, amely érintette a cardiopvascularis, a gastrointestinalis és az urogenitalis rendszereket. Az 5 cardiovascularis reflex-teszt eredményei a betegek 41%-ában voltak kórosak. Kórosan lassú volt a gyomorürülés a betegek 70%-ában, és csökkent detrusor izomtónust vagy contractilitást mértünk az esetek 56%-ában. | The antigenicity of a peptide of the human muscarinic acetylcholine receptor 3 (m3AChR) was examined with ELISA in primary Sjögren?s syndrome (pSS) . The KRTVPPGECFIQFLSE (KRSE213-228) peptide and its fusion form with glutathione S-transferase (GST)-KRSE were used as antigens. The immunological recognition with the recombinant fusion antigen was significantly better than that for the free peptide (p=0.0068). We also assess the clinical correlations and disease specificity of these autoantibodies. The anti-m3AChR213-228 antibody positivity was observed in 90% of the pSS patients. The antibody levels correlated positively with the number of extraglandular organ manifestations. Both the mean antibody levels and the occurrence of anti-m3AChR213-228 positivity were significantly higher in pSS than in the comparision groups with specificities of 65, 68, 71 and 50% for RA, SLE, sSS and suspSS, respectively. Results of our clinical examinations confirmed the hypothesis that anti-m3 AChR antibodies are essential for the elicitation of both glandular dysfunction and systemic manifestations. The antibody positivity was associated with signs of an autonomic nervous system dysfunction involving the cardiovascular, gastrointestinal and urinary systems. The results of 5 cardiovascular reflex tests were abnormal in 41% of the patients. Gastic emptying was abnormally slow in 70% of patient, and a decreased detrusor muscle tone or contractility were found in 56% of the cases

Validation of CT doses of SPECT/CT and PET/CT hybrid devices: lessons learned

Validation of CT doses of SPECT/CT and PET/CT hybrid devices: lessons learned Sera, Terez; Porubszky, Tamas; Papos, Miklos; Elek, Richard; Besenyi, Zsuzsanna; Gion, Katalin; Bartha, Andras; Pellet, Sandor; Pavics, Laszlo Abstract The aim of the study was to check the validity of computed tomographic (CT) doses exhibited by SPECT/CT and PET/CT hybrid devices. Dose measurements were taken from four SPECT/CT and four PET/CT cameras commercially available from different manufacturers. A calibrated ionization chamber was placed in whole-body or head phantoms for the acquisition of CT images with clinically used parameters. Computed tomography dose index (CTDIvol) values were calculated according to the IEC 60601-2-44:1999 formula. The measured CTDIvol doses were compared with those preprogrammed by the manufacturer. In the case of the whole-body phantom, the differences between the measured and displayed values varied between −31 and +24% [European document RP162 (2012) sets up the limit for acceptance criterion as ±20%]. The head phantom data showed either an agreement between −10 and +24%, or an underestimation by two-fold. The latter seemed to be because, while preprogramming the doses, the manufacturer had used the whole-body phantom instead of a proper head phantom. The results of the work demonstrate the need for individual dosimetric calibration of every single X-ray tube. Dosimetric checks should be included in the regular quality control programmes of the SPECT/CT and PET/CT devices. Special attention should be paid to head-and-neck and paediatric protocols, in which the use of a head phantom is recommended for dose calibration. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkin

Sentinel node detection in malignant melanoma patients: Radiation safety considerations

BACKGROUND. The surgical management of malignant melanoma necessitates correct sentinel lymph node localization. The highest reported sensitivities are those of lymphoscintigraphy and intraoperative gamma-probe detection combined with a vital blue dye technique. OBJECTIVE. Control of the radiation doses experienced by surgical personnel untrained in the use of unsealed radioactive materials. METHODS. Sentinel lymph nodes were localized, and biopsies were performed in 25 patients with malignant melanoma. Radiation doses during surgery were determined with energy-compensated silicon pin diode detectors and LiF thermoluminescent ring dosimeters. RESULTS. In 21 cases (24%), the measured doses were less than 1 muSv, but in 4 operations (16%), 1 to 4.5 muSv was received. The equivalent dose rate was generally less than 1 muSv/h. The finger-absorbed doses for the surgeon and the assistant surgeon were (mean+/-SD) 159+/-23 and 48+/-17 muGy per intervention, respectively. CONCLUSION. Personal dosimetric survey and limitation of the number of surgical interventions do not appear to be essential