改良单图像法手工测量髌骨不稳患者胫骨结节-股骨滑车沟间距的可行性分析

目的 探讨改良单图像法手工测量髌骨不稳患者胫骨结节-股骨滑车沟（tibial tuberosity-trochlear groove，TT-TG）间距的可行性。 方法 选取髌骨不稳患者30例。高年资手术医师A、B，使用改良单图像法手工测量髌骨不稳患者TT-TG间距，对比高资年影像学医师C，使用双图法测量髌骨不稳患者TT-TG间距。应用Cronbach′s alpha系数评价结果的可信度。应用组内相关系数（intraclass correlation coefficient，ICC）评价结果的可重复性。使用Bland-Altman分析图评价结果的一致性。 结果 高年资手术医师A、B使用改良单图像法手工测量髌骨不稳患者TT-TG间距分别和高年资影像学医师C使用双图法测量髌骨不稳患者TT-TG间距比较，Cronbach′s alpha系数分别为0.913和0.959，组内相关系数分别为0.913和0.958。Bland-Altman分析图显示，TT-TG间距差值（mm）的均值为-0.276（95%CI：-3.526~2.974）和0.143（95%CI：-3.110~3.397）。A、B医师之间使用改良单图像法手工测量髌骨不稳患者TT-TG间距比较，Cronbach′s alpha系数为0.891，组内相关系数为0.891。Bland-Altman分析图显示TT-TG间距差值（mm）的均值为-0.276（95%CI：-3.526~2.974）。 结论 改良单图像法手工测量髌骨不稳患者TT-TG间距操作简单，可以准确测量出髌骨不稳患者的TT-TG间距，该方法和双图法可以相互替换使用。     

实时超声引导微波消融术治疗子宫腺肌瘤的临床应用研究

目的 探讨实时超声引导微波消融术治疗子宫腺肌瘤的临床应用。方法 选取2015年1月～2019年1月收入我院子宫腺肌瘤患者37例为研究对象。采用超声造影评价患者的腺肌瘤消融率,常规超声评价瘤体缩小率。采用临床疗效评定标准来评价患者临床症状改善情况。结果 痛经改善率为78.9%(15/19),月经失调改善率为42.9%(9/21),贫血改善率为55.6%(10/18)。超声造影显示仅3例出现消融不完全,消融有效率为91.9%,术后行补充消融治疗,37例局限性子宫腺肌瘤平均消融率均达90%以上。与治疗前比较,治疗后3、6、12个月患者瘤体缩小率分别为60.8%、78.1%、93.1%,差异有统计学意义(P0.05)。与治疗前比较,治疗后临床症状有改善。结论实时超声引导微波消融术治疗子宫腺肌瘤患者,能够减小腺肌瘤体积,且能够明显改善患者临床症状,为子宫肌瘤患者提供新的治疗手段。     

乳腺癌缺氧诱导因子-1α、Ki-67表达与超声声像特征的关系

目的探讨乳腺癌患者乳腺癌组织中的缺氧诱导因子-1α(HIF-1α)、Ki-67蛋白的表达与超声声像特征的关系。方法对110例乳腺癌患者进行超声检查,观察患者的毛刺征、肿块形态、钙化灶形态和血流显像分级等。取110例乳腺癌患者的乳腺癌组织,免疫组化法检测HIF-1α、Ki-67蛋白的阳性表达率。分析不同超声声像特征乳腺癌患者乳腺癌组织中HIF-1α、Ki-67蛋白的表达情况。结果110例乳腺癌患者中,43例既存在Ki-67蛋白阳性表达又存在HIF-1α蛋白阳性表达,35例仅存在Ki-67蛋白阳性表达,13例仅存在HIF-1α蛋白阳性表达,Ki-67、HIF-1α蛋白阴性表达患者共19例。乳腺癌患者乳腺癌组织中Ki-67蛋白的阳性表达率为70.91%(78/110),HIF-1α蛋白的阳性表达率为50.91%(56/110)。不同肿块形态、钙化灶形态、血流显像分级乳腺癌患者乳腺癌组织中Ki-67蛋白阳性表达率比较,差异均有统计学意义(P﹤0.05)。不同血流显像分级乳腺癌患者乳腺癌组织中HIF-1α蛋白阳性表达率比较,差异有统计学意义(P﹤0.05)。结论乳腺癌患者乳腺癌组织中HIF-1α的表达可能与血流显像分级有关,Ki-67的表达可能与肿块形态、钙化灶形态及血流显像分级有关。     

Immune checkpoint inhibitor-induced inflammatory arthritis: identification and management

ABSTRACT

Introduction

Immune checkpoint inhibitors (ICIs) have proved to be groundbreaking in the field of oncology. However, immune system overactivation from ICIs has introduced a novel medical entity known as immune-related adverse events (irAEs), that can affect any organ or tissue. ICI-induced inflammatory arthritis (ICI-IIA) is the most common musculoskeletal irAE and can lead to significant morbidity and limitation in anti-cancer therapy.     

500 Cases of High-intensity Focused Ultrasound (HIFU) Ablated Uterine Fibroids and Adenomyosis

ObjectiveClinical outcomes of 500 high-intensity focused ultrasound (HIFU)-treated uterine fibroids and adenomyosis are analyzed and presented.Materials and methodsThis is a retrospective cross-sectional analysis from a single tertiary medical center. From April 2015 to October 2018, 546 cases were enrolled for the study. After excluding 46 patients with less than 3 months of follow-up period, there were 404 fibroids, 149 adenomyosis and 53 mixed conditions entered for analysis. The patients’ uterine fibroids and adenomyosis were treated by HIFU according to Chongqing Haifu protocol, with 12 cm diameter transducer of focal length 10–16  cm at 0.8 or 1.6 MHz T2-weight MRI imaging was rendered prior to and 3 month post treatment to assess lesion volume change using non-perfusion volume, which was the primary outcome. Secondary outcomes including quality of life, subjective satisfaction, adverse events and pregnancy rate were determined using self-reported questionnaires. The mean follow up period ranged from 3 to 38 months with an average of 21 months.ResultsThree months after HIFU-treated uterine fibroids and adenomyosis, the lesion size reduced 40.2% and 46.3%, respectively. Symptoms all improved with better quality of life for the fibroid group, while those with adenomyosis or combined diseases benefit the most from pain control. Serum CA125 decreased significantly for all studied groups, and LDH only showed improvement for fibroids group. Number of adverse events is comparable to Chongqing data (approximately 10.2%), with mostly mild and self-resolving conditions. No permanent sequelae or death was documented. Twelve pregnancies are reported in this cohort.ConclusionHIFU is safe and effective in treating uterine fibroids and adenomyosis. The results are reproducible if standardized treatment schedules are followed. It is a promising treatment alternative with the advantages of precision, non-invasiveness, rapid recovery and readiness for pregnancy.     

不同影像检查在乳腺结构扭曲中的研究进展

我国乳腺癌的发病率占女性恶性肿瘤疾病的首位,结构扭曲病变(architectural distortion,AD)作为触诊阴性乳腺癌的第三最常见影像学表现,也是乳腺癌最早出现的征象,具有重要的临床价值。AD具有较高的漏诊率及假阳性率。本文通过查阅文献,针对超声、乳腺X线摄影、乳腺数字三维断层摄影技术及核磁共振成像技术在乳腺结构扭曲病变中的研究进展及优缺点进行分析,进一步指导科学研究及临床工作。     

Ultrasound-Assist Extrusion Methods for the Fabrication of Polymer Nanocomposites Based on Polypropylene/Multi-Wall Carbon Nanotubes

Isotactic polypropylenes (iPP) with different melt flow indexes (MFI) were used to fabricate nanocomposites (NCs) with 10 wt % loadings of multi-wall carbon nanotubes (MWCNTs) using ultrasound-assisted extrusion methods to determine their effect on the morphology, melt flow, and electrical properties of the NCs. Three different types of iPPs were used with MFIs of 2.5, 34 and 1200 g/10 min. Four different NC fabrication methods based on melt extrusion were used. In the first method melt extrusion fabrication without ultrasound assistance was used. In the second and third methods, an ultrasound probe attached to a hot chamber located at the exit of the die was used to subject the sample to fixed frequency and variable frequency, respectively. The fourth method is similar to the first method, with the difference being that the carbon nanotubes were treated in a fluidized air-bed with an ultrasound probe before being used in the fabrication of the NCs with no ultrasound assistance during extrusion. The samples were characterized by MFI, Optical microscopy (OM), Scanning electron microscopy (SEM), Transmission electron microscopy (TEM), electrical surface resistivity, and electric charge. MFI decreases in all cases with addition of MWCNTs with the largest decrease observed for samples with the highest MFI. The surface resistivity, which ranged from 10¹³ to 10⁵ Ω/sq, and electric charge, were observed to depend on the ultrasound-assisted fabrication method as well as on the melt flow index of the iPP. A relationship between agglomerate size and area ratio with electric charge was found. Several trends in the overall data were identified and are discussed in terms of MFI and the different fabrication methods.     

Characterization of Malignant Portal Vein Thrombosis with Contrast-Enhanced Ultrasonography

We prospectively evaluated the effectiveness of contrast-enhanced ultrasonography (CEUS) for differentiation of benign versus malignant portal vein thrombosis (PVT). We studied a total of 43 patients with chronic liver disease, hepatocellular carcinoma-suggestive nodules and confirmed PVT, in whom the nature of the PVT was confirmed by follow-up imaging (US, computed tomography and/or magnetic resonance imaging) performed up to 6 mo after CEUS. PVT was assessed by US, Doppler US and CEUS with respect to vessel wall disruption and/or invasion, color Doppler vascularization, pulsed Doppler vascularization pattern and CEUS enhancement and vascularization pattern, and thrombi were classified as benign or malignant based on these findings. Follow-up studies revealed malignant PVT in 22 of the 43 patients (51%) and benign PVT in 21 patients (49%). CEUS findings were consistent with follow-up studies in 41 of the 43 patients (95%), with κ?=?0.903 (p < 0.0001), sensitivity?=?91% and specificity?=?100%, indicating that CEUS can be confidently used to differentiate benign from malignant portal vein thrombosis in the setting of chronic liver disease.     

二维斑点追踪技术评价低温兔左室纵向功能

目的:探讨应用二维斑点追踪技术评价低温条件下兔左心室纵向功能的价值。方法:30只新西兰兔随机分成对照组(n=10),低温组A(n=10),低温组B(n=10)。先行常规心脏数据测量,然后采用组织多普勒(TDI),之后应用斑点追踪成像(STI)中的获取基底段、中间段、心尖段及整体水平SL、SrLs.SrL E,SrL A及分层应变技术获取3个长轴切面心内膜下、中层和心外膜下心肌收缩期纵向峰值应变(SL)。结果:①与对照组相比,A组心内膜下心肌LS值的减低,差异有统计学意义(P<0.05),B组3层心肌SL值的减低明显,差异有统计学意义(P<0.01)②与对照组相比,A组大部分纵向应变及应变率减低(P<0.05);B组基底段、中间段、心尖段及整体水平SL,SrL S、SrLE、SrLA均减低(P<0.01)结论:随低温时间延长,左室壁3层心肌SL值受累程度不同,心内膜应变较心外膜更加敏感,二维班点追踪技术比LVEF及TDI更早发现左室功能减低。