Cover Story
Click to View核医学技术:开启个性化诊疗的新时代
北京协和医学院临床医学(八年制)2017级 曹增涵
近二十年来,随着设备和放射性药物的革新、临床需求的不断增加、国家政策的大力扶持以及全球化合作的开启,核医学技术取得了长足进步。本期《协和医学杂志》主题为:核素诊疗与临床转化,旨在阐述放射性核素(即核医学技术)在临床诊疗中的重要价值。封面创作亦围绕该主题展开。
本期封面由背景与中心人物轮廓两部分组成。背景涵盖脑、心肌、肝脏、前列腺以及骨骼5种组织/器官。这些靶组织及靶器官均来源于本期重点选题论文,是放射性核素应用的典型代表。中心人物及镶嵌于其中的黑色脏器轮廓模拟了核医学显像。经多位临床专家的提点,我意识到特定核素并非仅可用于单一靶器官的诊疗,而是可在各种疾病中广泛应用,同理,每种脏器相关的疾病也可通过不同核素显像。因此,图中各种常见核素也散在标注于人体各个部位。在不同组织/器官中,我采用了不同颜色进行标注,展示核素可在不同靶组织/器官中发挥其定位或辐射功能。
人体从宏观上看疑点重重,核医学技术成为黑白疑团中引人注目的彩色亮点,将微观的病生理变化较为直观地展现出来,推动了人类对医学的进一步认知。放射性核素在临床中的应用是多元的,不断创新的,相信随着核医学技术的蓬勃发展,其在未来的临床诊疗中必将发挥更大的价值,助力个性化诊疗的高效实施。
Chinese Bimonthly
CN 11-5882/R
ISSN 1674-9081


Articles in press have been peer-reviewed and accepted, which are not yet assigned to volumes /issues, but are citable by Digital Object Identifier (DOI).
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2023, 14(4): 669-672.
doi: 10.12290/xhyxzz.2023-0236
Abstract:
Nuclear medicine is a novel technique of theranostics that uses radiopharmaceuticals. Nuclear medicine dated back to a century ago. Owing to the development of nuclear medicine devices and radiopharmaceuticals, increasing clinical demand, government support, and global cooperations, nuclear medicine has witnessed a rapid development. Nowadays, nuclear medicine has played an important and unique role in diagnosis and therapy. There are opportunities and challenges in future development of nuclear medicine, and more progress will be made in nuclear medicine imaging, radionuclide therapy, and artificial intelligence.
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Abstract:
Issues related to the impact of ChatGPT-like artificial intelligence generated content (AIGC) and artificial general intelligence (AGI) technologies on medicine and medicare have been presented and discussed. We believe that advances in medical foundation models, scenarios engineering, and medical operations with operating systems would lead to parallel doctors in parallel hospitals, i.e., digital, robotic, and human doctors working in parallel within cyber-physical-social spaces under three modes: autonomous, parallel, and expert/emergency operations. Under decentralized/distributed autonomous organizations/operations (DAO) and DeSci, as well as DeMed and DeHospitals, the vision for individual patients with her/his personalized digital hospital could be a reality in the future.
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Abstract:
Targeted radionuclide therapy (TRT) provides an immunogenic microenvironment for immune checkpoint inhibitor (ICI) therapy by inducing DNA double-strand break, activating the cGAS-STING, NF-κB/IRF3 and STAT1/3-IRF1 pathways, up-regulating the expression of PD-L1, and increasing the infiltration of pro-inflammatory cytokines, CD8+ T cells and CD4+ T cells in tumors. The combined therapy could increase the infiltration of memory effector T cells, M1 macrophages and dendritic cells which positively regulate immune response, and downregulate immunosuppressive regulatory T cells, M2 macrophages and myeloid-derived suppressor cells. Partial complete remission and immune memory were achieved in tumor-bearing mice treated with combined therapy. It is worth noting that radiodiagnostic agent 2-[18F]FDG combined with anti-PD-L1 mAb could also reprogram the immune microenvironment and significantly improve therapeutic effect. This review presents typical combination therapy strategies, emphasizes the time window of combination therapy and different combinations of therapy that may improve the therapeutic effect, and proposes that radiodiagnostic agents combined with tumor immunotherapy are expected to become a new paradigm and a direction for further research in the future.
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Abstract:
Myocardial perfusion single photon emission computed tomography (SPECT) imaging is an important routine diagnostic modality for coronary artery disease. In recent years, there have been continuous advancements in cardiac SPECT imaging instrument technology and image algorithm techniques, with a growing focus on quantitative assessment of myocardial blood flow, a research hotspot that integrates technical and clinical research. This article provides an overview of the development path of cardiac SPECT systems in terms of detector technology, system structure, collimation techniques, as well as SPECT image reconstruction algorithms and myocardial blood flow quantification methods. We briefly discuss the recent research hotspots and progress, highlighting the clinical value enhancement made possible by advancements in instrument technology.
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2023, 14(4): 698-705.
doi: 10.12290/xhyxzz.2023-0120
Abstract:
Boron neutron capture therapy (BNCT) is an advanced radiation therapy technique that is rapidly developing in the field of cancer treatment. This technique, an atomic-level binary targeted therapy, kills cancer cells by causing a 10B(n, α)7Li nuclear reaction within the cancer cells, and its clinical implementation requires professional technology and device support. The core elements of BNCT include appropriate neutron sources and neutron capture drugs. Compared with traditional radiotherapy techniques, BNCT shows outstanding advantages in treating locally recurrent tumors, such as central nervous system tumors and head and neck tumors. Furthermore, it can better protect normal organs, especially for tumors that have already significantly invaded surrounding organs, demonstrating its promising future prospects. This article mainly elaborates on the technical principles, core elements, and clinical applications of BNCT, in hope of providing reference for clinical diagnosis and treatment.
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2023, 14(4): 706-733.
doi: 10.12290/xhyxzz.2023-0315
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Abstract:
The 2023 Chinese Expert Consensus Statement for Prevention and Management of Perioperative Hypothermia is an update of the 2017 Chinese Expert Consensus Statement for Prevention and Management of Perioperative Hypothermia. It is intended to provide patient-centric recommendations for clinicians to prevent and manage inadvertent hypothermia. It offers advice on assessing patient's risk of hypothermia, measuring and monitoring temperature as well as preventing patients from hypothermia before, during and after surgery. It also provides new evidence on hypothermia and adverse outcomes, and temprature management for special patients care considerations including pediatric, pregnancy, trauma, liver transplantation and sepsis.
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2023, 14(4): 744-757.
doi: 10.12290/xhyxzz.2023-0207
Abstract:
Bartter syndrome (BS) is a rare inherited salt-losing renal tubular disorder characterized by secondary hyperaldosteronism with hypokalemia and hypochloremic metabolic alkalosis, and normal or low blood pressure. In severe cases, preterm delivery, hypovolemia, ventricular arrhythmia, rhabdomyolysis, renal failure, growth failure and sensorineural deafness may occur. In recent years, research on BS has made significant progress. The Bartter Syndrome Consensus Working Group has performed a systematic literature review, and based on evidence-based medicine, summarized aspects related to BS, including clinical manifestations and classification, diagnosis, treatment strategies, and management of complications. This consensus provides an important reference for the better diagnosis and treatment of BS.
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