影像组学在鼻咽癌中的研究

鼻咽癌是东南亚地区常见头颈部恶性肿瘤,早期诊断和合理治疗对预后情况极其重要.影像组学能从MRI、CT、PET等医学图像中高通量地提取影像学特征并建立预测模型,以辅助临床对疾病进行诊断与治疗.现就影像组学在鼻咽癌中研究进展作一综述.     

临床表现对鼻咽癌活检部位的指导意义

鼻咽癌是我国常见的恶性肿瘤,约占头颈部肿瘤的78％,虽治疗大多在肿瘤科,但确诊前鼻咽活检多在耳鼻咽喉科进行,为耳鼻咽喉科恶性肿瘤之首。文献报告鼻咽癌综合治疗的5年生存率为：Ⅰ期95％、Ⅱ期80％、Ⅲ期61％、Ⅳ期35％。因此鼻咽癌早期诊断,避免漏诊是提高疗效的关键。在鼻咽部有明显肿物突出的情况下活检确诊容易,在鼻咽肿物表现不明显的情况下,结合患者l临床症状对鼻咽相应区域有针对性的活检,可提高检出率,对早期诊断、提高患者生存率有明显意义。     

鼻咽癌相关固有免疫分子及其潜在临床转化前景

鼻咽癌是我国南方常见恶性肿瘤,目前其早期诊断仍面临巨大的困难。本课题组运用基因组学、转录组学、蛋白质组学和组织微阵列等高通量技术大规模筛选鼻咽癌分子标记物,发现在鼻咽上皮分泌的两类重要的固有免疫分子——腭、肺及鼻咽上皮克隆蛋白家族和乳转铁蛋白,不仅是构成机体天然防御系统的重要组成部分,还通过特定的信号转导通路引起一系列的生物学效应,影响鼻咽癌的发生、发展进程,有望应用于鼻咽癌的早期诊断、个体化治疗及临床预后。     

鼻咽部肿瘤的影像诊断

鼻咽部的恶性肿瘤绝大部分是磷状上皮癌，鼻咽部结构复杂，鼻咽癌与鼻咽部良性病变临床上常较难区别。鼻咽部病理组织学检查，由于活检部位或深度所限，有时出现假阴性。因此，从CT影像上及早诊断与鉴别诊断鼻咽癌，对于指导临床诊治具有重要意义。现搜集鼻咽癌患者33例，详细回顾性分析其影像特点，并复习相关文献以加深对其诊断及鉴别诊断的认识。     

重视MR成像在鼻咽癌分期中的作用

鼻咽癌是我国华南地区最常见的头颈部恶性肿瘤,是危及当地人民健康的重大疾病.数十年来广大医务工作者为攻克鼻咽癌进行了不懈的研究和探索.1957年中山医学院的谢志光和梁伯强教授在广州举行了关于鼻咽癌诊疗的学术研讨会,于1961年倡议在广州中山医学院召开了首届全国鼻咽癌学术会议,启动了对鼻咽癌诊断治疗的生物学、流行病学和分子生物学等全面的学术研究[1].随着现代医学水平的提高和科学技术的发展,特别是CT和MRI应用于鼻咽癌诊断以来,对鼻咽癌及其侵犯范围的显示准确率明显提高,因此,影像学检查在鼻咽癌的临床分期和治疗随访工作中发挥了不可取代的重要作用.近年来,精确放射治疗技术快速发展以及MRI技术进一步提高,目前鼻咽癌的5年总生存率由50%提高至68%～83%[24].为此,本刊组织了关于<鼻咽癌2008分期方案>的解读[5]和鼻咽癌影像学研究重点号,介绍鼻咽癌临床分期的历史和重要性.     

18F-FDG PET/CT在鼻咽癌综合治疗后患者随访及预后评估中的价值

鼻咽癌是一类发病率较高、早期发现困难、误诊误治率较高的头颈部恶性肿瘤。多数鼻咽癌患者对放疗敏感, 但仍有部分患者出现残留、复发或转移。PET/CT作为现代医学影像重要组成部分之一, 将PET的功能显像与CT的解剖成像有机结合, 不仅能有效显示肿瘤的增生、代谢、乏氧及细胞的凋亡状态, 而且能精确显示肿瘤与其周围脏器组织的解剖结构, 在鼻咽癌患者的临床诊断、分期、治疗及预后评估等方面具有重要价值。该文重点就PET/CT对鼻咽癌综合治疗后患者局部残留、复发或转移的诊断价值及预后评估效能进行综述。     

18F—FDGPET／CT在鼻咽癌综合治疗后患者随访及预后评估中的价值

鼻咽癌是一类发病率较高、早期发现困难、误诊误治率较高的头颈部恶性肿瘤。多数鼻咽癌患者对放疗敏感,但仍有部分患者出现残留、复发或转移。PET／CT作为现代医学影像重要组成部分之一,将PET的功能显像与CT的解剖成像有机结合,不仅能有效显示肿瘤的增生、代谢、乏氧及细胞的凋亡状态,而且能精确显示肿瘤与其周围脏器组织的解剖结构,在鼻咽癌患者的临床诊断、分期、治疗及预后评估等方面具有重要价值。该文重点就PET／CT对鼻咽癌综合治疗后患者局部残留、复发或转移的诊断价值及预后评估效能进行综述。     

鼻咽癌放疗诱发恶性肿瘤七例报道

放疗是鼻咽癌的首选治疗方法.随着放疗技术的进步,以及化疗在中晚期鼻咽癌患者中的应用,诱发恶性肿瘤的问题越来越受到重视.有文献报道,头颈部恶性肿瘤放疗后诱发恶性肿瘤的发病率为0.4％～0.7％[1-2].现将本科自1992年至今诊治的7例病例结合文献报道如下.     

鼻内镜下个体化手术治疗鼻咽癌放疗后颅底坏死9例报告

鼻咽癌是耳鼻喉头颈外科常见的恶性肿瘤,治疗以放、化疗为主,并辅以其他治疗方式,如免疫、靶向治疗等.但鼻咽癌放疗后会引起一系列并发症如分泌性中耳炎、慢性鼻-鼻窦炎、内分泌功能低下、颅底骨坏死等,其中放射性骨坏死是鼻咽癌放疗后最为严重的并发症之一,其主要临床表现为口腔、鼻恶臭,剧烈头痛,张口困难等,坏死骨质与组织可侵蚀颈内...     

同步放化疗治疗局部晚期鼻咽癌29例分析

鼻咽癌是一种常见的头颈部恶性肿瘤,目前对局部晚期的鼻咽癌在根治性放疗的同时联合化疗,以提高疗效.现有的证据表明,同步放化疗是目前中国局部晚期鼻咽癌标准治疗方式,但放化疗的最佳组合策略仍未确定,需要进一步研究.我们从2005-04～2007-09采用同步放化疗的方式治疗29例局部晚期鼻咽癌,现对其疗效、毒副作用进行分析,报告如下.     

机器学习在鼻咽癌影像分析中的研究进展

鼻咽癌的诊疗高度依赖临床医生对临床影像数据的分析处理,但人工分析处理影像主观、耗时。而机器学习用于鼻咽癌影像分析能够较好地实现肿瘤病灶自动或半自动分割、分类,有利于提高临床医生的诊疗效率和准确度。就机器学习在鼻咽癌的MRI、CT、鼻内镜影像分割中的应用及其在影像分类中的研究进展予以综述。     

Fibroadenomas: a multidisciplinary review of the variants

Fibroadenomas are the most common benign breast lesions in women. Hormonal activities, particularly an increase in oestrogenic activity, have an important role in the aetiology of fibroadenomas. They are commonly detected incidentally. Most fibroadenomas have similar imaging findings and these lesions can be defined as simple fibroadenomas (SFAs). However, due to different histopathologic characteristics and components, variants of fibroadenomas have been described. These variants include; juvenile, giant, complex, myxoid, cellular, and hyalinised fibroadenomas. The diagnoses of these variants are important. They have different clinical behaviours, potential for malignant transformation, and treatment strategies. We present imaging findings of SFAs and other variants of fibroadenomas. To our knowledge, there is no review in which imaging findings of all fibroadenoma variants are presented together.     

结构MRI对青少年癫痫脑皮质厚度的研究进展

青少年癫痫发病率高，发作形式多样，对病人大脑皮质、认知能力的发育有较大影响。研究青少年癫痫大脑皮质厚度的变化对该病的早期诊断和治疗至关重要。大脑皮质厚度是癫痫诊断和治疗的重要生物特征指标，可为癫痫脑组织形态和病理特征研究提供依据。就结构MRI对青少年癫痫病人的大脑皮质厚度变化的检测及大脑皮质厚度与病程、临床症状和抗癫痫药的关系等方面的研究进展予以综述。     

Impact of isolated aerobic exercise in obese adolescents: systematic review

The juvenile obesity is currently one of the most serious public health problems. Changes in lifestyle, involving a combination of diet and physical activity, are essential elements in the management of obesity. However, it has been suggested that the prevention and treatment should emphasize the increase of physical activity rather than dietary treatments. To present the best available evidence from the controlled randomized studies to screen the impact of isolated aerobic exercise on cardiovascular and metabolic parameters in obese adolescents. Methods: Systematic review according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Were included randomized and controlled clinical trials of electronic databases: MEDLINE (via OvidSP), LILACS, and SciELO. Results: Four articles were identified, showing improvement in anthropometric measures, lipid and glycemic profiles. One of the articles demonstrated improvement in the systolic blood pressure (SBP) and diastolic (DBP), the maximum oxygen uptake. Conclusions: This systematic review has provided evidence on the impact of the interventions in isolated aerobic exercise in improving cardiovascular and metabolic parameters in obese adolescent population. Only four articles were identified, and further studies with greater scientific rigor are needed to confirm the scientific evidence.     

爆炸致冲烧毒复合伤的特点和紧急救治体会

目的　探讨爆炸致冲烧毒复合伤的特点和紧急救治策略。方法　总结 1994年 4月以来 ,5次参加抢救 12例爆炸致冲烧毒复合伤伤员的临床救治体会 ,并结合作者引用国内外公开发表的有关文献进行分析。结果　 12例爆炸冲烧毒复合伤伤员 ,死亡 8例 ,其中 7例死于致伤现场 ,1例死于后期的严重多器官功能衰竭 ,病死率高达 6 6 .6 6 %。结论　爆炸致冲烧毒复合伤是一种极难抢救的伤类 ,主要是难以诊断、难以把握救治时机。预防是最好的处理方法 ,一旦发生 ,快速正确地应急救援和综合治疗至关重要     

Nasopharyngeal carcinoma: treatments and outcomes in the 20th century

Nasopharyngeal carcinoma (NPC), although rare in Europe and North America, is not uncommon in parts of Asia such as southern China and Hong Kong. Consequently, very few oncologists in the Western world have extensive experience in treating this neoplasm. Treatment using external beam therapy and/or brachytherapy evolved greatly during the 20th century and is still evolving, particularly with the use of adjunctive chemotherapy regimes. Diagnosis of NPC has also improved with the availability of CT and MRI. This worldwide review is divided into historical, transitional and modern eras, with the latter concerning 1971-2000. Currently, the most controversial aspects of NPC are recommendations for treatment of recurrent disease and the role of chemotherapy in the overall framework of treatment. Comparison of results from different centres is not possible without an understanding of the various staging systems that are, and have been, used; a comparison is given in this review. In the future, early diagnosis, adequate radiation dose to the primary with boost to bulky disease, and regular follow-up with biopsy of any suspicious residual or recurrent disease, are likely to become key issues to improve outcome. Also, apart from direct/indirect nasopharyngoscopy, the role of follow-up CT needs to be studied for early detection of residual or recurrent disease. More clinical trials on chemo-radiation are also required, in order to study optimum doses and agents.     

Bone health and the female athlete triad in adolescent athletes

Peak bone mass (PBM) is a negative predictor of osteoporosis and lifelong fracture risk. Because osteoporosis is such a prevalent disease with life-threatening consequences, it is important to try to maximize PBM. Adolescence is a critical period for bone acquisition. This article discusses some of the differences in male and female skeletal development and modifiable factors that enhance bone accrual in this age group, particularly in athletes. Hormonal influences, effects of physical activity, and nutritional contributions are included, with a focus on the adolescent athlete. Emphasis is placed on the importance of appropriate energy availability in this age group. We also review prevention and treatment strategies for the female athlete triad (ie, the inter-relationship of decreased energy availability, menstrual irregularity, and low bone density) in adolescents and athletic women. Recommendations for maximizing bone density in both male and female adolescents are discussed.     

Surgical management of juvenile osteochondritis dissecans of the knee

Purpose

Operative management of osteochondritis dissecans (OCD) in the juvenile knee is generally indicated upon failure of conservative treatment, in unstable lesions, and in lesions nearing physeal closure. We hypothesized that juvenile OCD lesions have improved clinical and radiographic outcomes with surgical treatment following failed non-surgical management, in unstable lesions, and in lesions nearing physeal closure.

Methods

Multiple medical databases were searched for Levels I?CIV evidence with specific study inclusion and exclusion criteria. Length of mean follow-up was minimum 2?years. Studies were included if an analysis of clinical outcomes following surgical treatment of juvenile OCD was performed. All surgical techniques and defect classifications were potentially inclusive.

Results

Thirty studies (29 Level IV evidence) were included for analysis (783 subjects, 862 knees). Mean post-operative follow-up was 77?months. Nearly all studies within this review demonstrated significant clinical and radiographic improvements in outcomes in surgically treated juvenile OCD at short-, mid-, and long-term follow-up. Isolated excision of weight-bearing OCD lesions led to poorer clinical and radiographic results than other surgical techniques. Outcomes were significantly better with juvenile OCD versus adult OCD.

Conclusions

Surgical treatment of juvenile OCD has significantly improved clinical and radiographic outcomes at short-, mid-, and long-term follow-up. No difference in clinical or radiographic outcome was demonstrated in comparing different surgical techniques, with the exception of poorer results with isolated fragment excision.

Level of evidence

IV.     

Atypical metastasis of nasopharyngeal cancer: noncontiguous spread to the ipsilateral ear

ObjectivesNasopharyngeal carcinoma (NPC) is a rare form of squamous cell carcinoma. Primary NPC is generally treated with radiation and chemotherapy, though recurrence and distant metastases are common. Reports of noncontiguous metastasis to the middle ear and external ear canal (EAC) are rare.Materials and methodsCase presentation of a female patient previously treated for NPC, who developed an EAC metastasis. A literature review of all reported cases of metastatic NPC in the middle ear and EAC is also included.ResultsA patient presenting with noncontiguous metastasis of NPC to the EAC was treated with surgical resection followed by chemotherapy and radiation. The patient successfully completed treatment and is currently alive but with suspected distant metastatic disease at 11 months following treatment.ConclusionsNPC metastasis to the EAC is extremely rare. Treatment options are varied, and prognosis is generally poor. The case presented here shows better outcomes than many previous reports.     

Radiological appearances of appendicular osteosarcoma: a comprehensive pictorial review

Osteosarcoma is the most common primary malignant tumour of bone in adolescents and young adults. Hence, a comprehensive knowledge of the common and unusual imaging appearance of this tumour is essential. Correct diagnosis of the various varieties of osteosarcoma is important for optimal clinical management including staging, biopsy, treatment and follow-up of patients. This review article provides a comprehensive approach to the radiological diagnosis of the different types of appendicular osteosarcoma and illustrates the role of CT and MRI in further characterisation.