99Tcm-3PRGD2 SPECT/CT评估非小细胞肺癌淋巴结转移

目的 观察⁹⁹Tc^m-3PRGD₂ SPECT/CT评估非小细胞肺癌（NSCLC）淋巴结转移的价值。方法 回顾性分析25例NSCLC患者⁹⁹Tc^m-3PRGD₂ SPECT/CT资料；以术后病理结果为金标准，观察SPECT/CT定性（目视观察）及半定量分析[计算病灶/本底放射性计数比值(T/B)]评估NSCLC淋巴结转移的效能。结果 肺内NSCLC病灶均呈明显⁹⁹Tc^m-3PRGD₂摄取阳性，其摄取程度差异无统计学意义（Z=－1.19，P=0.234）；伴与不伴淋巴结转移肺内原发灶之间T/B差异具有统计学意义（Z=－2.52，P=0.012）；以9.23为阈值，根据肺内原发灶T/B评估NSCLC淋巴结转移的AUC为0.79。共40个淋巴结区域存在转移，其中27个区域呈⁹⁹Tc^m-3PRGD₂明显阳性摄取、13个区域呈轻度摄取或无摄取；131个区域为良性淋巴结，包括15个区域呈阳性摄取、116个区域呈阴性摄取。转移性与良性淋巴结之间，摄取⁹⁹Tc^m-3PRGD₂程度差异具有统计学意义（Z=－7.19，P<0.001）；T/B差异亦有统计学意义（Z=－7.82，P<0.001）。淋巴结定性分析及半定量分析评估NSCLC淋巴结转移的曲线下面积（AUC）分别为0.78及0.91，差异具有统计学意义（Z=4.19，P<0.001）。结论 ⁹⁹Tc^m-3PRGD₂ SPECT/CT有助于评估NSCLC淋巴结转移。     

99Tcm-3PRGD2 SPECT/CT在肺部良恶性病变中的诊断价值

目的 探讨⁹⁹Tc^m-3PRGD₂ SPECT/CT对肺部良恶性病变的诊断价值。方法 回顾性分析于治疗前行⁹⁹Tc^m-3PRGD₂平面显像、胸部SPECT/CT显像,并最终获得病理结果的37例肺部病变患者资料,其中恶性病变27例,良性病变10例。将肺部病变对⁹⁹Tc^m-3PRGD₂的摄取灰度与肝脏对比,分为低度增高、中度增高、高度增高;计算病变（L）最高摄取值与对侧正常肺（N）、肝脏（H）、纵隔（Me）、对侧三角肌（Mu）平均摄取值的比值,并进行统计学分析,评价其诊断效能;选取肺良恶性病变各1例行免疫组织化学分析整合素α_vβ₃表达。结果 37例患者肺部病变对⁹⁹Tc^m-3PRGD₂摄取均增高,66.67%（18/27）恶性病变高度增高,90.00%（9/10）良性病变轻、中度增高;恶性肺部病变摄取比值均高于良性病变（P均<0.05）,以L/N=5.45或L/Mu=4.65为阈值,诊断肺恶性病变的敏感度、特异度和准确率均为77.80%、80.00%、78.40%;免疫组化结果显示肺恶性病变高表达整合素α_vβ₃,良性病变仅少量表达。结论 ⁹⁹Tc^m-3PRGD₂ SPECT/CT对肺部良恶性病变的鉴别具有诊断价值。     

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。     

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。     

99Tcm-SC SPECT与CT-LG同机融合显像检测兔VX2乳腺癌腋窝前哨淋巴结

目的 探讨锝^99m标记硫胶体（⁹⁹Tc^m-SC）SPECT与CT淋巴管造影（CT-LG）同机融合显像VX2乳腺癌兔腋窝前哨淋巴结（SLN）的价值。方法 取20只雌性新西兰大白兔建立VX2乳腺癌动物模型。对模型兔分别行CT-LG和⁹⁹Tc^m-SC SPECT与CT-LG同机融合检查显示腋窝SLN，并与常规SLN活检（SLNB）和淋巴结清扫手术结果进行对比。结果 20只实验兔建模成功率为95.00%（19/20）。19只实验兔均完成CT-LG和⁹⁹Tc^m-SC SPECT与CT-LG同机融合检查。CT-LG检查和融合显像清楚显示SLN及其引流淋巴管的比例为78.95%（15/19）和73.68%（14/19），差异无统计学意义（P>0.05）。CT-LG检出16枚SLN，7枚非SLN（n-SLN）；融合显像检出20枚SLN，12枚n-SLN；SLNB检出21枚SLN，17枚n-SLN；3种方法检出腋窝淋巴结的数目差异无统计学意义（χ²=1.497，P=0.454）。结论 ⁹⁹Tc^m-SC SPECT与CT-LG同机融合检查可有效检出和准确定位VX2乳腺癌兔腋窝SLN，有望为临床准确识别及定位SLN提供新的检查方法。     

99Tcm-3PRGD2SPECT显像临床应用进展

整合素在肿瘤血管生成及转移中起着重要作用。精氨酸-甘氨酸-天冬氨酸(RGD)能够与整合素α_vβ₃亚型特异性结合。以RGD为基础开发的SPECT显像剂——⁹⁹Tc^m-联肼尼克酰胺-3聚乙二醇-精氨酸-甘氨酸-天冬氨酸环肽二聚体(⁹⁹Tc^m-3PRGD₂)可与细胞表面的整合素α_vβ₃受体相结合,主要用于诊断肿瘤和评估疗效等。本文就⁹⁹Tc^m-3PRGD₂显像临床应用进展进行综述。     

99Tcm-MDP骨显像腰椎标准摄取值与骨密度的相关性

目的 观察不同骨密度（BMD）患者⁹⁹Tc^m-亚甲基二磷酸盐（⁹⁹Tc^m-MDP）骨显像腰椎标准摄取值（SUV）的差异，并分析其与BMD的相关性。方法 回顾性分析62例接受⁹⁹Tc^m-MDP全身骨显像、腰椎SPECT/CT断层显像及双能X线腰椎BMD检测患者，根据BMD结果将其分为骨量正常组（n=18）、骨量减低组（n=24）和骨质疏松组（n=20），比较3组腰椎平均SUV（SUV_mean）、最大SUV（SUV_max）及BMD等的差异，分析其与腰椎平均CT值、患者年龄、体质量及身高的相关性。结果 腰椎SUV_max和SUV_mean分别为7.39±1.84和4.90±1.27，均与BMD呈正相关（r=0.64、0.63，P均<0.01）。腰椎SUV_max、SUV_mean和BMD均与年龄呈负相关（r=-0.33、-0.44、-0.43，P均<0.05），与体质量（r=0.42、0.30、0.35）及平均CT值（r=0.56、0.59、0.73）呈正相关（P均<0.05），与身高无明显相关（P均>0.05）。3组间腰椎SUV_max、SUV_mean、BMD和平均CT值差异均有统计学意义（F=24.09、30.50、94.85、30.24，P均<0.01）。骨量减低组腰椎SUV_max、SUV_mean、BMD和平均CT值明显低于正常组（P均<0.01）；骨质疏松组明显低于骨量正常组和骨量减低组（P均<0.01）。结论 ⁹⁹Tc^m-MDP骨显像腰椎SUV可用于评价骨质疏松及评估疗效。腰椎SUV_max及SUV_mean均与BMD呈正相关。骨质疏松患者腰椎SUV_max和SUV_mean明显降低。     

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。     

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。     

儿童肠重复畸形的99TcmO4-动态平面显像、CT和超声表现

目的 探讨儿童肠重复畸形的超声、CT及⁹⁹Tc^mO₄-动态平面显像表现。方法 回顾性分析18例经手术病理证实为肠重复畸形患儿的超声（n=14）、CT（n=10）及⁹⁹Tc^mO₄-动态平面显像（n=18）表现。结果 18例中2例为广泛管状肠重复畸形,15例为单发囊状或囊实性畸形,1例为双囊状重复畸形。18例中3例含异位胃黏膜,15例未见异位胃黏膜。14例行超声检查的患儿中,11例表现为形态较固定的厚壁肠管样无声团诊为肠重复畸形,1例表现为一大一小"葫芦"形两腔相通的厚壁囊性管腔结构,均正确诊断,余1例误诊、1例漏诊。CT检查可见7例均表现为厚壁囊性为主占位,与肠道关系较密切,1例诊断为其他囊性病变,2例肠管状分布畸形漏诊。⁹⁹Tc^mO₄-动态平面显像的3例均为阳性,2例表现为与小肠分布相对应的弥漫性异常放射性浓聚,均正确诊断,1例为小团状异常固定放射性浓聚灶,提示肠重复畸形可能。结论 超声、CT及⁹⁹Tc^mO₄-动态平面显像检查各有优势,超声检查因无辐射、操作简便,常作为筛查首选,CT显示解剖结构较全面,⁹⁹Tc^mO₄-动态平面显像有助于诊断临床高度怀疑肠重复畸形,尤其对于CT、超声无明确阳性表现者。     

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.