三维血管容积显像在慢性移植肾肾病中的诊断价值

目的探讨三维血管容积显像在慢性移植肾肾病（CAN）中的诊断价值。方法85例移植肾患者,彩色多普勒超声检测其血流指数、搏动指数,三维血管容积显像检测其血管指数、血管血流指数、灰阶指数及体积指数。结果与44例移植肾肾功能稳定组比较,41例CAN组彩色多普勒能量显像血流分级I～Ⅲ级,阻力指数和搏动指数均升高;三维血管能量血流分级2—4级,血管指数、血流指数、血管血流指数均降低,灰阶指数、体积均升高（P〈0．05）。ROC曲线分析表明血管指数与血管血流指数诊断CAN的特异性、敏感性均高于阻力指数和搏动指数（P〈0．05）,其最佳临界点分别为23．18％、11．05％,对CAN的阳性预测值分别为90．0％、90．5％。结论三维血管容积显像诊断CAN的特异性和敏感性较彩色多普勒高,可能为早期诊断CAN提供新的有用指标。     

定量分析多普勒血流信号评价甲状腺功能亢进症的血流变化

目的探讨定量超声能量多普勒血流信号对甲状腺功能亢进症的诊断价值。方法采用“DFY型超声图像分析仪”对30例实验组（甲亢患者）和30例对照组（健康志愿者）的超声能量多普勒图像提取彩色信号,定量分析多普勒信号与总感兴趣区面积比以及平均彩色信号强度,并进行两组间对比分析。结果实验组与对照组的多普勒信号与总感兴趣区面积比分别为64．80±7．17和6．03±1．83,实验组与对照组的平均彩色信号强度分别为78．60±3．73和57．43±5．15,组间比较差异具有统计学意义,P〈0．01。结论“DFY型超声图像分析仪”可定量甲状腺功能亢进症的血流增多情况,可为该疾病提供更多有价值的诊断信息。     

多普勒超声评价老年肾脏结构及血流动力学改变的应用价值

【目的】探讨多普勒超声在评价老年肾脏结构及血流动力学中的应用价值。【方法】随机选取老年慢性肾病患者85例（观察组）,肾功能正常者85例（对照组）,观察并比较两组双肾大小、形态、肾内结构、肾实质厚度及实质回声,并通过彩色血流图测量肾脏叶间动脉收缩期最高流速（PSV）、舒张期最低流速（EDV）、平均血流速度（Vm）、阻力指数（RI）、搏动指数（PI）等肾叶间动脉血流动力学参数。【结果】观察组肾脏长径和短径分别为（72．1±8．1）mm、（33．5±2．8）mm,均远短于对照组,肾实质较对照组明显增厚,实质回声显著增强,其差异均有统计学意义（P＜0．05）;观察组的 PSV、EDV、Vm 分别为（22．56±4．58）mL/s,（6．78±1．59）mL/s,（14．70±3．05）mL/s,均显著低于对照组（31．69±5．17,11．56±2．01,21．58±3．58）,差异有显著性（P＜0．05）,而 RI及PI为0．69±0．28和1．07±0．65,均显著高于对照组（0．63±0．18和0．93±0．40）,差异有显著性（P＜0．05）。【结论】彩色多普勒超声在检测老年肾脏结构及血流动力学改变方面具有较高的临床价值。     

原发性高血压病患者眼球后动脉血流变化的多普勒超声观察

目的探讨高血压病患者眼动脉和视网膜中央动脉血流动力学变化,以寻找最敏感、重复性最好的血流参数指标。方法彩色多普勒超声检查55例原发性高血压病患者110只眼及50例正常对照组100只眼的眼动脉、视网膜中央动脉的血流参数,并对照分析。结果与对照组比较,高血压病患者眼动脉收缩期峰值流速（Vs）、舒张末期血流速度（Vd）降低,阻力指数升高（均P〈0．05）;视网膜中央动脉Vs、Vd降低,阻力指数、搏动指数升高（P〈0．05）;视网膜中央动脉与眼动脉血流速度比值降低（P〈0．01）。结论高血压病高眼球后动脉血流变化的多普勒超声参数为眼部病变的诊断和治疗提供可靠数据。     

彩色多普勒超声对正常老年人眼动脉和视网膜中央动脉血流速度测定

本文应用彩色多普勒超声测量正常老年人68例136只眼的眼动脉（OA）和视网膜中央动脉（CRA）血流速度。结果，正常老年人OA收缩期峰值血流速度32．54±7．69cm／s，舒张末期血流速度9．10±2．66cm／s，阻力指数0．72±0．06，搏动指数1．67±0．43。CRA收缩期峰值血流速度9．80±1．67cm／s，舒张末期血流速度4．10±0．90cm／s，阻力指数0．60±0．10，搏动指数1．15±0．21。老年人年龄组间OA和CRA的收缩期与舒张末期血流速度无差异而阻力指数和搏动指数随年龄增长有差异（P＜0．05）。     

彩色多普勒超声对肾囊肿硬化治疗的疗效及治疗前后的肾动脉血流的观察

目的：观察肾囊肿超声介入治疗的疗效及其治疗前后的血流动力学变化。方法：采彩色多普勒超声（CDFI）检测19例24个肾囊肿超声介入治疗前后的主肾动脉（MRA）及段动脉（SRA）的多普勒血流频谱。健康对照20例40个肾。结果：超声介入治疗前肾囊肿患者患肾的SRA收缩期最大峰值流速（Vmax）及阻力指数（RI）较正常对照组明显升高（P＜0．01）;治疗后患肾的Vmax及RI随囊肿缩小而降低。患肾的MRAVmax及RI在超声介入治疗前后差异无显著性（P＞0．05）。结论：超声介入治疗肾囊肿是一种简单、有效、安全的方法。多普勒超声检测肾血流为肾囊肿的诊断、鉴别诊断及治疗提供了一种有效的方法。     

甲状腺相关眼病眼部的声像图特征

摘要目的探讨彩色多普勒超声观测甲状腺相关眼病（TA0）的眼部特征价值。方法37例TAO患者和30例健康者为对照组,超声检测其眼外肌厚度和下直肌滋养动脉、眼动脉的血流参数：收缩期最高流速、舒张末期流速、阻力指数。结果TAO组眼外直肌厚度和下直肌滋养动脉、眼动脉收缩期血流最高流速和阻力指数较对照组增大（P〈0．01）。结论彩色多普勒超声观测TAO眼部特征,为临床诊断提供重要帮助     

二维超声结合彩色多普勒及增强型能量多普勒在乳腺肿块中的应用价值

【目的】探讨二维超声结合彩色多普勒血液显像（CDFI）及增强型能量多普勒血液显像（E‐flow ）在乳腺肿块中的应用价值。【方法】二维超声观察双侧乳房肿块数目、部位、形态、大小、边界、有无包膜、内部回声、后方回声、侧方声影、有无钙化及探头按压后是否变形等,然后采用彩色多普勒、E‐f lo w血流成像观察病灶周边及内部血流情况。【结果】二维超声结果显示96名患者共检出112个肿块,其中良性肿块73个,恶性肿块39个,73个良性肿块血流显示率为31．5％（23／73）,39个恶性肿块血流显示率为97．4％（38／39）,乳腺恶性肿块内部收缩期峰值速度（PSV）、舒张末期流速（EDV）、搏动指数（PI）、阻力指数（RI）均较良性肿块增高,其差异有统计学意义（ P ＜0．05）;二维超声＋CDFI ＋e‐flow诊断乳腺肿块性质的准确率为83．0％（93／112）,显著高于二维超声＋CDFI的72．3％（81／112）,其差异有统计学意义（ P ＜0．05）。【结论】二维超声结合CDFI ＋e‐flow在乳腺肿块中有较高的诊断价值。     

彩色多普勒超声对诊断早期糖尿病肾病的价值

目的：评价彩色多普勒超声在糖尿病早期肾损害诊断中的应用价值。方法：选取72例2型糖尿病患者,按尿蛋白的排泄率（UAER）分为3组,Ⅰ组（UAER<20 μg/min）、Ⅱ组（UAER 20～<200 μg/min）、Ⅲ组（UAER≥200 μg/min）。同时选取20例健康者为对照组（Ⅳ组）。以彩色多普勒超声分别检测肾脏体积及肾各级动脉的血流参数进行统计学分析。结果：随着肾功能损害的加重,肾彩色血流显像逐渐减少,肾动脉的收缩期峰值流速（Vs）、舒张末期血流速度（Vd）下降,血流阻力指数（RI）增高,以RI和Vd改变与肾功能损害程度最密切。Ⅲ组体积缩小,与各组差异显著,余各组间无显著差异。结论：彩色多普勒超声能显示肾脏大小、血流灌注情况及肾动脉血流参数,对早期糖尿病肾病有诊断价值。     

彩色多普勒超声对亚临床型甲状腺功能亢进症诊断价值的探讨

目的探讨彩色多普超声对亚临床型甲状腺功能亢进症（亚甲亢）的诊断价值。方法对亚甲亢患者和正常人各40例行甲状腺彩色多普超声检查,观察甲状腺的二维图像及彩色多普勒血流显像（CDFI）特点,测量甲状腺上动脉（STA）血流各参数,两组间并作对比分析。结果亚甲亢组甲状腺体积增大,17例患者甲状腺血供丰富或较丰富,腺体内结节血供呈3级表现,STA流速增大,左右STA的收缩期最大血流速度（Vmax）分别为（62．75±12．08）cm／s和（68．55±15．77）cm／s,搏动频率（81．63±5．05）次／min;与正常对照组比较差异有统计学意义（P〈0．01）。结论彩色多普勒超声对亚甲亢有着较好的诊断和鉴别诊断价值。     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

2017年呼吸疾病主要进展

2017年,国内外学者在呼吸系统疾病的临床和基础领域均进行了深入研究,不仅对相关指南进行了更新,并且针对一些临床热点、难点问题达成专家共识,现就2017年呼吸疾病相关进展作一简单介绍。     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

COVID‐19 and COVID‐19 vaccine‐related dermatological reactions: An interesting case series with a narrative review of the potential critical and non‐critical mucocutaneous adverse effects related to virus,therapy, and the vaccination

This narrative review article was conducted to lay out a summarized but exhaustive review of current literature over mucocutaneous manifestations in 4 dimensions of SARS‐CoV‐2 pandemic: virus itself, treatment‐related, vaccine‐induced, and alteration of chronic dermatologic diseases following infection. Virus and vaccine‐related were mainly self‐limited and non‐severe. Treatment‐related reactions could be life‐threatening.     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

Real‐life effectiveness of biological therapies on symptoms in severe asthma with comorbid CRSwNP

BackgroundWe aimed to evaluate the effectiveness of different antibody therapies on nasal polyp symptoms in patients treated for severe asthma.MethodsWe performed a retrospective analysis of patients with severe asthma and comorbid CRSwNP who were treated with anti‐IgE, anti‐IL‐5/R or anti‐IL‐4R. CRSwNP symptom burden was evaluated before and after 6 months of therapy.ResultsFifty patients were included hereof treated with anti‐IgE: 9, anti‐IL‐5/R: 26 and anti‐IL‐4R: 15 patients. At baseline median SNOT‐20 was similar among groups (anti‐IgE: 55, anti‐IL‐5/R: 52 and anti‐IL‐4R: 56, p = 0.76), median visual analogue scale (VAS) for nasal symptoms was 4, 7 and 8 (p = 0.14) and VAS for total symptoms was higher in the anti‐IL‐4R group (4, 5 and 8, p = 0.002). After 6 months SNOT‐20 improved significantly in all patient groups with median improvement of anti‐IgE: −8 (p < 0.01), anti‐IL‐5/R: −13 (p < 0.001) and anti‐IL‐4R: −18 (p < 0.001), with larger improvement in the anti‐IL‐4R group than in anti‐IgE (p < 0.001) and anti‐IL‐5/R (p < 0.001) groups. VAS nasal symptoms improved by median anti‐IgE: 0 (n.s.), anti‐IL‐5/R: −1 (p < 0.01) and anti‐IL‐4R: −3 (p < 0.001), VAS total symptoms by anti‐IgE: −1 (n.s.), anti‐IL‐5/R: −2 (p < 0.001) and anti‐IL‐4R: −2 (p < 0.001).ConclusionsTreatment by all antibodies showed effectiveness in reducing symptoms of CRSwNP in patients with severe asthma, with the largest reduction observed in anti‐IL‐4R‐treated patients.     

Recalcitrant giant orf recurrence after amputation: A case report and review of the literature

Orf is caused by a parapoxvirus. We present a recurrent, giant digital orf case in a female patient with a history of hairy cell leukemia. In spite of shave excision, the lesion progressed and recurred after digital amputation. Treatment with topical imiquimod cream and systemic subcutaneous interferon alfa‐2a was successful.