99Tcm-甲氧基异丁基异腈双时相平面显像和SPECT/CT断层显像诊断原发性甲状旁腺功能亢进症

目的 观察⁹⁹Tc^m-甲氧基异丁基异腈（⁹⁹Tc^m-MIBI）双时相平面显像和SPECT/CT断层显像诊断原发性甲状旁腺功能亢进症（PHPT）的价值。方法 收集术前接受⁹⁹Tc^m-MIBI双时相平面显像和SPECT/CT断层显像的疑似PHPT患者40例,所有患者均接受手术治疗。以术后病理诊断为金标准,计算并比较⁹⁹Tc^m-MIBI双时相平面显像和SPECT/CT断层显像诊断PHPT的灵敏度。结果 40例中,38例经病理确诊为PHPT,⁹⁹Tc^m-MIBI双时相平面显像灵敏度为89.47%（34/38）,⁹⁹Tc^m-MIBI SPECT/CT断层显像灵敏度为94.74%（36/38）,差异无统计学意义（P>0.05）。对不同病灶大小及不同甲状旁腺素水平PHPT,⁹⁹Tc^m-MIBI双时相平面显像与SPECT/CT断层显像诊断灵敏度差异均无统计学意义（P均>0.05）。结论 ⁹⁹Tc^m-MIBI双时相平面显像和SPECT/CT断层显像诊断PHPT灵敏度高。     

99m锝-甲氧基异丁基异腈SPECT/CT显像对慢性肾病继发甲状旁腺功能亢进甲状旁腺病灶的诊断效能

目的 探讨SPECT/CT术前准确定位慢性肾病（CKD）继发性甲状旁腺功能亢进（sHPT）患者甲状旁腺病灶的价值。方法 52例甲状旁腺切除术sHPT患者均于术前2周内接受^99m锝-甲氧基异丁基异腈（⁹⁹Tc^m-MIBI）双时相平面显像和延迟相SPECT/CT检查。以病理结果为金标准,计算并比较⁹⁹Tc^m-MIBI平面显像、SPECT、CT和SPECT/CT术前检出甲状旁腺病灶的灵敏度、特异度和准确率。结果 经手术病理证实,52例共检出172个甲状旁腺病灶,其中甲状旁腺瘤（PM）13个、腺瘤样增生（AH）26个、甲状旁腺增生（PH）133个。⁹⁹Tc^m-MIBI平面显像、SPECT、CT、SPECT/CT诊断甲状旁腺病灶的灵敏度分别为55.81%（96/172）、70.35%（121/172）、79.65%（137/172）和81.40%（140/172）,特异度分别为92.05%（81/88）、90.91%（80/88）、76.14%（67/88）和93.18%（82/88）,准确率分别为68.08%（177/260）、77.31%（201/260）、78.46%（204/260）和85.38%（222/260）。SPECT/CT的灵敏度明显高于SPECT（χ²=17.053,P<0.001）及⁹⁹Tc^m-MIBI平面显像（χ²=44.000,P<0.001）,特异度明显高于CT（χ²=10.316,P=0.001）,准确率高于CT（χ²=13.136,P<0.001）、SPECT（χ²=14.815,P<0.001）和⁹⁹Tc^m-MIBI平面显像（χ²=39.706,P<0.001）。结论 SPECT/CT术前定位诊断sHPT患者甲状旁腺病灶的价值明显优于单一⁹⁹Tc^m-MIBI平面显像、SPECT或CT。     

99Tcm-MIBI SPECT/CT联合D-二聚体鉴别诊断口腔颌面部病变良恶性

目的 探讨⁹⁹Tc^m-MIBI SPECT/CT显像联合血浆D-二聚体检测鉴别诊断口腔颌面部病变良恶性的价值。方法 对57例经病理确诊的口腔颌面部肿块患者行⁹⁹Tc^m-MIBI SPECT/CT显像并测量血浆D-二聚体,以术后病理结果为金标准,计算并比较⁹⁹Tc^m-MIBI SPECT/CT显像与血浆D-二聚体两种方法单独及联合诊断口腔额面部恶性肿瘤的灵敏度（敏感度）、特异度及准确率。结果 ⁹⁹Tc^m-MIBI SPECT/CT显像和血浆D-二聚体检测单独及联合诊断口腔颌面部恶性肿瘤的灵敏度（敏感度）、特异度、准确率分别为72.73%（16/22）、82.86%（29/35）、78.95%（45/57）,68.18%（15/22）、74.29%（26/35）、71.93%（41/57）及95.45%（21/22）、94.29%（33/35）、94.74%（54/57）,联合诊断恶性肿瘤的敏感度和准确率高于⁹⁹Tc^m-MIBI SPECT/CT（P均<0.05）,联合诊断敏感度、特异度和准确率均高于D-二聚体检测（P均<0.05）。结论 ⁹⁹Tc^m-MIBI SPECT/CT显像与血浆D-二聚体检测联合应用可提高二者单独应用鉴别口腔颌面部病变良恶性的效能,具有重要临床价值。     

99Tcm-MIBI SPECT/CT诊断甲状腺乳头状癌术后彩色多普勒超声疑似颈部淋巴结转移

目的 评估⁹⁹Tc^m-MIBI SPECT/CT诊断甲状腺乳头状癌（PTC）术后彩色多普勒超声（CDUS）疑似颈部淋巴结转移的价值。方法 收集31例PTC术后CDUS疑似颈部淋巴结转移患者，均于术后1个月内接受颈部⁹⁹Tc^m-MIBI SPECT/CT扫描，之后15天内接受颈部¹³¹I SPECT/CT扫描。观察⁹⁹Tc^m-MIBI SPECT/CT对于PTC术后颈部淋巴结转移的诊断效率。结果 31例中，6例（6/31，19.35%）存在颈部淋巴结转移。⁹⁹Tc^m-MIBI SPECT/CT对PTC术后颈部淋巴结转移的敏感度、特异度、准确率、阳性预测值和阴性预测值分别为66.67%（4/6）、96.00%（24/25）、90.32%（28/31）、80.00%（4/5）和92.31%（24/26）。共确定14个颈部淋巴结转移灶，⁹⁹Tc^m-MIBI SPECT/CT诊断敏感度和阳性预测值分别为71.43%（10/14）和83.33%（10/12），首次¹³¹I SPECT/CT为28.57%（4/14）和100%（4/4），⁹⁹Tc^m-MIBI SPECT/CT的敏感度高于¹³¹I SPECT/CT（χ²=5.14，P<0.05），其阳性预测值与首次¹³¹I SPECT/CT差异无统计学意义（Fisher精确概率法，P>0.05）。结论 ⁹⁹Tc^m-MIBI SPECT/CT能确定大部分PTC颈部淋巴结转移灶，为判断¹³¹I SPECT/CT和CDUS疑似淋巴结转移提供更多信息。     

低剂量SPECT/CT对甲状腺良恶性结节鉴别的增益价值

目的 评价低剂量SPECT/CT在鉴别甲状腺良恶性结节中的增益价值。方法 收集触诊/彩色多普勒超声考虑甲状腺结节患者41例，分别行⁹⁹Tc^mO_4-平面显像和低剂量SPECT/CT融合显像，以病理结果为金标准，比较2者诊断效能。结果 低剂量SPECT/CT融合显像诊断甲状腺结节良恶性的灵敏度、特异度、准确率及受试者工作特征（ROC）曲线下面积（AUC）分别为61.90%、53.33%、63.41%和0.64；均高于^99mTcO_4-平面显像的19.05%、45.00%、31.70%和0.32（P均<0.05）。结论 低剂量SPECT/CT对恶性甲状腺结节的诊断效能优于⁹⁹Tc^mO_4-平面显像。     

不同影像学检查方法对原发性甲状旁腺功能亢进症患者甲状旁腺病灶的定位诊断价值

目的 探讨不同影像学检查方法对原发性甲状旁腺功能亢进症（PHPT）的诊断价值。方法 回顾性分析经病理学检查证实的109例PHPT患者的临床资料,将其超声、MRI、CT、⁹⁹Tc^m-MIBI检查定位诊断结果与手术后病理学结果比较分析。结果 109例PHPT中,甲状旁腺癌11例（11/109,10.09%）,增生16例（16/109,14.67%）,甲状旁腺瘤82例（82/109,75.23%）,包括单发病灶74例（74/109,67.89%）,双侧腺瘤8例（8/109,7.34%）。腺瘤、增生、腺癌组病灶发生部位的差异有统计学意义（χ²=36.151,P<0.001）。⁹⁹Tc^m-MIBI、MRI、CT、超声术前检查定位的准确率分别为83.50%（81/97）、72.22%（13/18）、68.51%（37/54）、67.67%（67/99）,差异无统计学意义（χ²=4.826,P=0.185）;超声明显低于⁹⁹Tc^m-MIBI检查（χ²=6.638, P=0.001）,CT明显低于⁹⁹Tc^m-MIBI检查（χ²=4.562,P=0.033）,CT与MRI的定位诊断准确率差异无统计学意义（χ²=1.153,P=0.283）。对于术后病理诊断直径<1 cm的病变,⁹⁹Tc^m-MIBI、超声、CT、MRI术前检查定位的准确率分别为77.27%（17/22）、35.00%（7/20）、61.53%（8/13）、66.67%（2/3）,差异有统计学意义（χ²=7.881,P=0.049）,⁹⁹Tc^m-MIBI的定位准确率高于超声（χ²=7.664,P=0.006）,但与CT、MRI的差异无统计学意义（χ²=2.154,P=0.175）。结论 对PHPT进行定位诊断时,超声仍是首选检查,⁹⁹Tc^m-MIBI双时相显像的诊断价值最高。     

比较18F-氟代胆碱PET/CT、99Tcm-甲氧基异丁基异腈SPECT/CT及超声诊断甲状旁腺功能亢进症

目的 比较¹⁸F-氟代胆碱（FCH） PET/CT、⁹⁹Tc^m-甲氧基异丁基异腈（MIBI） SPECT/CT及超声（US）诊断甲状旁腺功能亢进症（HPT）的效能。方法 回顾性分析34例HPT患者,术前2个月内均接受¹⁸F-FCH PET/CT、⁹⁹Tc^m-MIBI SPECT/CT及US检查;以术中及术后病理结果为参考,评估并比较各方法的诊断效能。结果 于34例共切除90处甲状旁腺病灶,病理证实其中81处为甲状旁腺增生或腺瘤组织,7处为甲状腺组织,2处为淋巴结。¹⁸F-FCH PET/CT诊断HPT的敏感度、特异度、阳性预测值、阴性预测值及准确率分别为85.19%（69/81）、100%（55/55）、100%（69/69）、82.09%（55/67）及91.18%（124/136）,⁹⁹Tc^m-MIBI SPECT/CT分别为74.07%（60/81）、90.91%（50/55）、92.31%（60/65）、70.42%（50/71）及80.88%（110/136）,US分别为65.43%（53/81）、98.18%（54/55）、98.15%（53/54）、65.85%（54/82）及78.68%（107/136）。¹⁸F-FCH PET/CT诊断HPT的效能高于⁹⁹Tc^m-MIBI SPECT/CT和US （Z=2.290,P=0.022;Z=2.496,P=0.013）。结论 ¹⁸F-FCH PET/CT、⁹⁹Tc^m-MIBI SPECT/CT及US 3种方法中,¹⁸F-FCH PET/CT诊断HPT的效能最高。     

99Tcm-MDP SPECT/CT诊断钳夹型髋关节撞击综合征

目的 探讨⁹⁹Tc^m-MDP SPECT/CT诊断钳夹型髋关节撞击综合征（FAI）的价值。方法 对临床疑似钳夹型FAI的85例患者（共96个发病髋关节）行⁹⁹Tc^m-MDP SPECT/CT检查,并进行图像分析。最终由手术或6个月以上的随访资料确诊。分别计算CT、SPECT和SPECT/CT评价钳夹型FAI的诊断效能,并进行统计学分析。结果 96个髋关节中,临床最终确诊有钳夹型FAI 87个。CT、SPECT和SPECT/CT显像对钳夹型FAI的诊断灵敏度分别为77.01%（67/87）、95.56%（84/87）、95.56%（84/87）,特异度分别为44.44%（4/9）、100%（9/9）、100%（9/9）,准确率分别为73.95%（71/96）、96.88%（93/96）、96.88%（93/96）。三种方法诊断钳夹型FAI的灵敏度、特异度和准确率差异均有统计学意义（P均<0.01）,SPECT/CT融合显像和SPECT显像之间差异均无统计学意义（P均>0.05）,SPECT/CT或SPECT显像与CT检查间差异均有统计学意义（P均<0.01）。结论 ⁹⁹Tc^m-MDP SPECT/CT可灵敏、准确地诊断钳夹型FAI,值得临床推广。     

99Tcm-MDP SPECT/CT显像诊断乳腺癌骨转移

目的 评价⁹⁹Tc^m-MDP SPECT/CT显像对全身骨显像难以确诊的乳腺癌骨转移的诊断价值。方法 回顾分析⁹⁹Tc^m-MDP全身骨显像难以确诊的132例乳腺癌患者共210个骨转移灶的影像资料。以临床随访及病理检查获得最终诊断结果,计算⁹⁹Tc^m-MDP SPECT/CT显像对骨转移灶的诊断准确率、灵敏度、特异度、阳性预测值及阴性预测值。并对比不同部位病灶的诊断准确率差异。结果 210个病灶中, ⁹⁹Tc^m-MDP SPECT/CT正确诊断骨转移灶82个,良性病灶112个,诊断准确率为92.38%(194/210),灵敏度为94.25%(82/87),特异度为91.05%(112/123),阳性预测值为88.17%(82/93),阴性预测值为95.72%(112/117)。⁹⁹Tc^m-MDP SPECT/CT对脊椎病灶的诊断准确率明显高于肋骨病灶(χ²=7.81,P<0.05)。结论 利用⁹⁹Tc^m-MDP SPECT/CT显像对全身骨显像难以诊断的乳腺癌骨转移灶进行诊断,具有较高的诊断效能。     

剪切波弹性成像与99Tcm-MIBI SPECT显像对比诊断甲状腺癌

目的 比较剪切波弹性成像与⁹⁹Tc^m-MIBI SPECT显像诊断甲状腺癌的价值。方法 以118个甲状腺结节作为研究对象,行剪切波弹性成像及⁹⁹Tc^m-MIBI SPECT显像。以病理为金标准,计算并比较两种方法对甲状腺癌结节的诊断敏感度（灵敏度）、特异度、准确度、阳性预测值及阴性预测值,并进行率的比较。结果 剪切波弹性成像与⁹⁹Tc^m-MIBI SPECT显像诊断甲状腺癌的敏感度（灵敏度）、特异度、准确率、阳性预测值及阴性预测值分别为88.57%（31/35）和62.86%（22/35）、89.16%（74/83）和65.06%（54/83）、88.98%（105/118）和64.41%（76/118）、77.50%（31/40）和43.14%（22/51）、94.87%（74/78）和80.60%（54/67）,差异均有统计学意义（P<0.05）。结论 剪切波弹性成像对甲状腺癌的诊断效能优于⁹⁹Tc^m-MIBI SPECT显像。     

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.