儿童禽流感肺炎与细菌性肺炎的胸部放射征象分析

[目的]探讨儿童H3N1型禽流感病毒性肺炎与细菌性肺炎的胸部放射表现特点。[方法]回顾性分析2例经世界卫生组织确认为H3N1型禽流感病毒感染患者胸部放射表现,并与65例儿童细菌性肺炎进行对比。[结果]本组2例H3N1型禽流感病毒性肺炎患者初期表现为单发片絮状渗出病变,密度高,边缘模糊,短期内病灶变化快;进展期由下至上扩展到多个肺叶、肺段,进展迅速;恢复期病变由弥漫性多发病变逐转变为局限病变;磨玻璃样密度病变影存在于各期。细菌性肺炎多无此特点,细菌性肺炎初期多为单发片状渗出病变,进展期病变局限于肺段、肺叶,恢复期多从近肺门侧开始吸收,病灶吸收较禽流感病毒性肺炎快,且吸收完全。[结论]儿童H3N1型禽流感病毒性肺炎的胸部放射表现具有一定特征性,放射动态观察则是与儿童细菌性肺炎鉴别诊断的重要手段。     

人感染H7N9禽流感病毒的胸部影像学表现

目的探讨人感染H7N9禽流感病毒性肺炎的影像学表现。方法回顾性分析笔者医院收治的4例确诊为人感染H7N9禽流感病毒性肺炎患者的临床及影像学资料。结果 2例患者行X射线和CT检查,另2例只做CT检查。3例患者呈多灶多肺叶分布,以两肺下叶及背侧最多;4例病灶呈磨玻璃密度影合并大片状实变;2例小叶间隔增厚、2例支气管血管束增粗;4例实变肺组织内见充气支气管征。其他征象:少量胸腔积液3例,未见肺门及纵隔淋巴结肿大。结论人感染H7N9禽流感肺炎具有一定的影像学特征,影像学检查有助于诊断及监测病情变化。     

H7N9型禽流感临床表现和影像学特征

目的 探讨H7N9型禽流感病毒性肺炎的临床表现和影像学特征。方法 回顾分析8例经逆转录-聚合酶链反应（RT-PCR）临床确诊为H7N9禽流感患者的临床及影像学资料。结果 患者均以发热、咳嗽、咳痰为首发症状,超敏C反应蛋白明显升高。8例中,5例表现为肺实变影,间质性改变1例,磨玻璃改变2例。两肺多叶、多段受累,可勾勒出肺段轮廓,未见病变跨越肺叶征象。病变具有游走性,进展期实变影出现或增多;病灶吸收缓慢,可出现肺纤维化。8例均见不同程度胸膜反应,3例可见胸腔积液;未见肺门及纵隔淋巴结肿大。结论 H7N9禽流感病毒性肺炎的临床及影像学表现有一定特点,但无明显特异性;影像学检查有助于指导临床及时进行治疗。     

甲型H1N1流感肺炎的胸部CT表现及动态变化特点

目的 探讨甲型H1N1流感肺炎的胸部CT表现及动态变化. 方法 对60例甲型H1N1流感确诊患者进行胸部CT扫描(含HRCT),回顾性分析、比较病变的影像学特点及动态变化并进行半定量CT评分. 结果 甲型H1N1流感胸部CT表现及动态变化特点:①主要表现为片状肺实质渗出病灶,早期和吸收期主要CT表现为磨玻璃密度影;②两肺小叶性或节段性散在分布,以胸膜下和支气管周围多见,下叶较重;③肺组织、胸膜及纵隔受累可同时存在;④病程早期CT评分4.41且逐渐下降,渗出性病灶短期内吸收较快,后期遗留纤维化病变CT评分1.64分. 结论甲型H1N1流感肺炎的动态胸部CT表现具有一定特征性.熟悉其胸部CT表现有助于该病的诊断、鉴别诊断与疗效观察,但确诊需依靠流行病学史及实验室检查.     

甲型H1N1流感病毒性肺炎的胸部X线和CT表现

目的总结甲型H1N1流感病毒性肺炎患者的胸部X线和CT表现特征。方法回顾分析2009年3月-11月3例经临床表现及病原学检查证实的甲型H1N1流感病毒性肺炎的胸部X线、CT表现。结果肺部病灶多呈散在小片状高密度影,边缘模糊,邻近胸膜;病变最常累及肺基底段;病灶多有少量胸腔积液;病灶有扩散迅速,合理用药后消失较快的特点;病灶吸收落后于临床表现。结论甲型H1N1流感病毒性肺炎的X线、CT表现具有一定的特点,总结并掌握这些特点,有利于早期诊断。其确诊有赖于实验室检查和流行病学调查。     

广东省首例高致病性H5N1人禽流感临床特点及救治体会

目的：通过对本例高致病性H5N1人禽流感患者的诊治过程进行分析，总结经验。提高诊治水平。方法：对2006年2月我院收治的1例高致病性H5N1人禽流感患者的临床特点、实验室检查、影像学检查及诊治过程等资料进行总结。结果：高致病性H5N1人禽流感初起临床表现为高热，迅速出现咳嗽、气促乃至呼吸衰竭、急性呼吸窘迫综合征；实验室检查表现为白细胞特别是淋巴细胞明显下降，尿常规检查出现蛋白尿及血尿，生化检查示肝功能异常，心肌酶学异常，低蛋白血症；影像学方面初起表现为普通肺炎，病变迅速进展为双肺弥漫性实变。治疗方面需要机械通气。临床确诊采用支气管吸取物（痰）进行H5核酸实时荧光定量PCR检测呈阳性反应。对H5亚型的HA和M蛋白基因进行RT-PCR检测呈阳性反应。结论：如果能在患者发生呼吸衰竭前或早期及时治疗，可能对患者的预后有改进，一旦发展到急性呼吸窘迫综合征并多器官功能障碍综合征．则预后不良．     

重症型甲型H1N1流感9例胸部X线与CT特征分析

目的探讨重症型甲型H1N1流感的X线平片与CT特征。方法回顾性分析9例临床确诊的重症型甲型H1N1流感的X线与CT表现。结果首次X线胸部平片示双肺受累8例,单肺受累1例,8例行CT检查两肺均受累,1例死亡未行CT检查。受累肺叶3~5叶,受累肺段5~8个。9例均表现在两肺多叶,以中外带及下叶为甚,2例病变进展迅速,1例死亡。结论重症型甲型H1N1流感的主要影像学表现为：（1）病变主要发生在肺的外周;（2）两肺多叶受累,下肺野多于上肺野;（3）病变变化迅速;（4）两肺出现磨玻璃影、大片实变影,可见支气管气相,伴有胸膜增厚或少量胸水;（5）CT比胸片能更好地显示肺内病变特征。熟悉其影像学表现,密切结合临床和实验室检查可以做出明确诊断。     

人高致病性H5N1亚型禽流感一例临床报告

目的探讨人感染高致病性H5N1亚型禽流感的临床特征及防治手段。方法对确诊的一例人感染高致病性H5N1亚型禽流感的临床资料进行回顾性分析。结果患者为16岁男性,发病前无明确病、死禽接触史,发病后,病变由右下肺片状影迅速蔓延至双肺,且并发纵隔、皮下气肿,发病第5天出现急性呼吸窘迫综合征（ARDS）,治疗上采用以机械通气为主的综合治疗措施。发病第6天,中国疾病预防控制中心对患者咽试子标本采用逆转录-聚合酶链反应（RT-PCR）、实时荧光定量PCR（Real—time PCR）方法检测,提示A／H5／N1病毒核酸呈阳性并分离出禽流感（H5N1）病毒。从发病至死亡约10d。结论人感染高致病性亚型H5N1禽流感是一种致命的传染病,如病变广泛,出现ARDS,预后不佳。     

不明原因肺炎一例影像学特点

目的 探讨不明原因肺炎的影像学表现.方法 对我院经治的1例不明原因肺炎的临床资料及影像学表现进行回顾性分析.结果 本例早期胸部X线平片表现为双肺间质性改变伴感染影像,以双下肺为著;CT为基本对称分布的双肺毛玻璃密度影,两肺下叶明显,两肺下叶空气潴留、马赛克或镶嵌性灌注及树芽征.随着病情的发展,CT见双肺毛玻璃密度影增重、肺实变及支气管充气征,肺实质与肺问质均受累.结论 空气潴留、马赛克或镶嵌性灌注征及病程中无胸腔积液影像是本例特征性影像学表现,与甲型H1N1、H5N1及SARS病毒感染所致肺部影像表现不尽相同.     

甲型H1N1流感并发肺炎的影像诊断

目的:探讨甲型H1N1流感合并肺炎的影像学表现.方法:回顾分析经我院诊治的59例甲型H1N1流感合并肺炎患者的临床及影像资料.结果:59例患者中,单侧发病9例,双侧发病50例;病灶呈单发或少许散在分布的10例,多发分布的32例,弥漫广泛分布的16例.其中以胸膜下或者肺野后部为主的19例,病灶常多种影像改变并存.结论:甲型H1N1流感合并肺炎表现多样,以斑片状实变影以及磨玻璃样影为主,可伴有间质改变、胸腔积液,以胸膜下或者肺野后部好发,具有一定的特点.影像检查可以早期发现甲型H1N1流感的肺部改变,并对动态观察病情变化有重要价值.     

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.     

经颅黑质超声诊断帕金森病的临床评价

目的 通过对帕金森病患者及正常对照组进行经颅超声(transcranial sonography,TCS)检查,结合帕金森病患者的Hoehn Yahr（H Y）分级及帕金森病统一评分量表评分结果,了解我国大陆地区帕金森病患者有无黑质(substantia nigra, SN)回声增强表现。方法 对入选对象进行TCS检查,并对检查结果进行评价。结果 帕金森病患者 SN阳性率明显高于正常对照者（P＜0.05）。帕金森病SN异常组 H Y 分期明显高于帕金森病SN正常组(P＜0.05),表明帕金森病患者SN高回声面积与H Y分期相关。TCS检查对帕金森病的敏感性为80.5%,特异性为79.9%。结论 我国帕金森病患者SN强回声检出率显著高于对照组,说明我国帕金森病患者也存在SN回声增强这一现象,与国内外报道相一致。TCS检查对帕金森病的诊断具有一定的意义,敏感性及特异性较高。