卵巢肿瘤三维多普勒能量成像与病理MVD表达的相关性研究

目的探讨三维彩色血管能量成像（three-dimensional color power angiography,3D-CPA）术前观察卵巢肿瘤的血流特点与术后病理组织微血管密度（micro vessel density,MVD）之间的关系。 方法应用3D-CPA观察76个卵巢肿瘤的血管形态,判断血管分级并计算肿瘤内血管指数（vascular index VI）,采用免疫组织化学染色技术检测肿瘤内的MVD,并且进行相关性分析,评价三维能量多普勒成像与病理微血管密度的相关性。 结果三维多普勒能量成像所观测卵巢肿瘤的血管分级在良恶性肿瘤之间存在显著差异;级血管分型的血管分级与MVD相关;卵巢癌的血管指数与MVD有显著相关性（r=0.84,P〈0.005）。 结论应用3D-CPA对卵巢肿瘤的血供情况进行血管分型及VI的计算与免疫组化指标（MVD）有较好的相关性,综合分析可以从不同角度反应卵巢肿瘤的血管生成情况,为卵巢肿瘤的诊断及鉴别诊断提供有价值的信息。     

三维多普勒能量成像在卵巢肿瘤中的应用

目的评价三维多普勒能量成像在诊断卵巢肿瘤中的应用价值。方法65例患者76个卵巢占位性病变，进行三维能量多普勒重建，观察肿瘤形态、肿瘤内的细微结构及血管形态，且计算肿瘤内血管指数（VI），对比其术前诊断与术后病理结果。结果三维多普勒能量图所观测卵巢癌的血管形态及血管分级与卵巢良性肿瘤之间存在显著差异，以Ⅱ级血管分型诊断卵巢癌的敏感性为65％，特异性为100％；卵巢肿瘤内VI在良恶性之间存在显著差异，以VI≥0．02条／cm^3诊断卵巢癌敏感性为75．0％，特异性为80．9％。结论三维能量成像在术前能客观地反映卵巢肿瘤的血流情况，可为临床鉴别良恶性提供有意义的指标。     

卵巢肿瘤的三维彩色血管能量成像与病理微血管密度对比研究

目的：探讨上皮性卵巢肿瘤的三维彩色血管能量成像（three-dimensional color power angio,3D－CPA)特点及其血管病理学基础,评价3D－CPA鉴别卵巢肿瘤的临床应用价值。方法：对67例上皮性卵巢肿瘤患者（40例卵巢癌,27例良性上皮性卵巢肿瘤）术前应用3D－CPA检测肿瘤的血管分布类型并计算肿瘤血管指数（vascularity index,VI),术后分别应用抗血管内皮生长因子（VEGF）、抗CD34单克隆抗体对组织进行免疫组织化学染色,计数肿瘤的微血管密度（microvessel density,MVD)及VEGF染色强度。结果：卵巢癌的MVD及VEGF表达强度均显著高于良性上皮性卵巢肿瘤（P＜0．05）。以3D－CPA血管指数＞0．02条／cm^3诊断卵巢癌敏感性77．5％,特异性81．5％。卵巢癌的血管指数与MVD呈等级相关（rs= 0.503,P＜0．01）。结论：3D－CPA可用于术前间接评价肿瘤的血管生成,为卵巢肿瘤的诊断及鉴别提供有价值的信息。     

经阴道超声三维血管定量与病理微血管密度对卵巢癌临床分期及病理类型的应用价值

目的：评价经阴道超声血管定量指标与卵巢癌的血管病理学指标的相关性,探讨经阴道三维彩色血管能量成像（TR3D-CPA）对不同临床分期及不同病理类型的卵巢癌的临床应用价值。方法：术前应用TR3D-CPA检测48例卵巢癌患者,测定肿瘤血管指数（VI）。术后应用抗CD34单克隆抗体对病理切片进行免疫组织化学染色,计数肿瘤微血管密度（MVD）。根据FIGO 2000年标准确定临床分期;根据术后病理结果划分不同病理类型。统计分析上述超声指标在卵巢癌不同临床分期及不同病理类型中的差异。结果：48例卵巢癌VI值（0.087±0.045）条/cm3,MVD值（38.6±17.15）个/400×。VI与MVD呈正相关（rs=0.701,P<0.01）。VI随临床分期的升高而升高;临床Ⅲ、Ⅳ期VI明显高于Ⅰ、Ⅱ期（P<0.05）。在不同病理类型之间VI,MVD差异均无统计学意义（P>0.05）。结论：VI随临床分期增高而升高,可于术前评价卵巢癌血管生成,为术前诊断及预后评估提供有价值的信息。     

肾癌三维彩色血管定量与病理组织学分级及微血管密度的相关研究

目的探讨肾癌三维彩色血管定量指标血管指数(vascularityindex,VI)与术后病理组织学分级、微血管密度(microsvesseldensity,MVD)的相关性。方法应用三维彩色血管能量成像技术(three-dimensionalcolorpowerangiography,3D-CPA)术前检查50例肾癌患者,计测VI值;术后对肿瘤组织标本HE染色,进行病理组织学分级,用抗CD105单克隆抗体及抗CD34单克隆抗体行免疫组织化学染色,计测MVD值,对结果进行统计学分析。结果50例肾癌患者VI与MVD呈正相关(r=0.554,P<0.05),术后病理组织学分级~级,各病理组织学分级之间VI与MVD比较,差异有统计学意义(P<0.05),箱式图显示肾癌病理组织学分级与VI、MVD呈相关趋势,随病理组织学分级的增高,VI、MVD亦增高。结论肾癌3D-CPA定量指标VI与肿瘤病理MVD相关密切,VI能在术前客观显示肾癌不同病理组织学分级的血管分布情况,可作为判断肾癌预后的定量指标。     

卵巢肿瘤患者三维直方图血管参数与微血管密度的相关性CSCD

目的评价三维直方图血管参数与卵巢肿瘤患者微血管密度(MVD)的相关性。方法收集2008年1月至2009年12月在首都医科大学附属北京妇产医院就诊的57例囊实性或实性卵巢肿物患者,术前1周行三维能量多普勒超声检查,对肿物感兴趣区的实性部分行三维血流采集,应用虚拟器官计算机辅助分析(VOCAL)程序中的三维直方图计算血管化指数(VI)、血流指数(FI)及血管化血流指数(VFI)。术后对肿瘤病理组织切片进行免疫组化染色,计算MVD及血管内皮生长因子(VEGF)表达强度。采用2个独立样本t检验比较MVD在卵巢良、恶性肿瘤间的差异,采用秩和检验比较VEGF在卵巢良、恶性肿瘤间的差异,采用Spearman等级相关分析法评价超声血管参数与MVD的相关性。结果 57例患者共62个卵巢肿物(5例患者为双侧),经病理证实,其中,良性22个,恶性40个(包括交界性8个)。共有54个卵巢肿瘤行免疫组化染色,卵巢恶性肿瘤组的MVD值及VEGF表达强度均明显高于良性肿瘤组,差异均有统计学意义(t=-5.255,Z=-3.868,P<0.01)。其中VI、VFI与MVD均呈正相关,差异均有统计学意义(r=0.295、0.280,P均<0.05)。结论三维直方图血管参数与卵巢肿瘤的MVD关系较为密切,可在术前反映卵巢肿瘤内血管的生成情况,为临床的早期诊断提供有价值的信息。     

甲状腺肿瘤彩色多普勒血流显像与微血管密度、血管内皮生长因子表达的研究

目的探讨甲状腺肿瘤的彩色多普勒血流成像特点及其血管病理学基础,评价CDFI鉴别甲状腺肿瘤的临床应用价值.方法对78例甲状腺肿瘤患者,术前应用彩色多普勒血流成像检测肿瘤的血管分类,术后分别应用抗血管内皮生长因子（VEGD）,抗F8多克隆抗体对组织进行免疫组织化学染色,记数肿瘤的微血管密度（microvessel density MVD）及VEGF染色强度.结果甲状腺癌MVD及VEGF表达强度均显著高于良性肿瘤（P〈0.05）.以CDFI Ⅲ型诊断甲状腺癌的敏感性为53.13%,特异性100%,CDFI与MVD间具有较好的一致性,K=0.3081（P〈0.01）.结论彩色多普勒血流成像可用于术前间接评价肿瘤的血管生成,为甲状腺肿瘤的诊断与鉴别诊断提供有价值的信息.     

甲状腺肿瘤三维血管定量与病理微血管定量相关性研究

目的研究甲状腺肿瘤的三维血管定量与病理微血管密度的相关性,评价其临床应用价值.方法应用三维彩色血管能量成像技术(3D-CPA),术前检测38例甲状腺肿瘤血流信号(恶性22例,良性16例)计算3D-CPA血管指数(VI),术后对手术标本行抗CD34因子免疫组化染色,计数肿瘤微血管密度(MVD),行统计学对比分析.结果 22例甲状腺癌3D-CPA VI和MVD分别为(9.69±4.37)条/cm3和(51.33±12.86)/400倍视野,二者呈线性正相关(r=0.796,P＜0.01),16例良性甲状腺肿瘤3D-CPA VI和MVD分别为(4.96±1.19)条/cm3和(20.11±8.05)/400倍视野,二者呈线性正相关(r=0.814,P＜0.01),良、恶性两组3D-CPA VI、MVD分别对比差异有显著性(t=2.020,P＜0.001;t=2.016,P＜0.001).以VI大于6条/cm3诊断甲状腺癌,其敏感性、特异性分别为81.82%、87.50%.结论 3D-CPA能立体、直观显示甲状腺肿瘤血供,血管三维定量测值与肿瘤微血管密度相关性较好,血管三维能为良、恶性甲状腺肿瘤鉴别提供有效血流信息.     

兔VX2肿瘤的三维彩色多普勒超声成像与病理对照研究

目的探讨三维彩色多普勒超声成像技术定量评价兔VX2肿瘤血管及其灌注的价值。方法选用新西兰大白兔10只，用VX2瘤株种植于兔大腿股外侧浅肌层，2～3周后应用TomTec三维超声工作站采集肿瘤灰阶及彩色多普勒三维数据，计算肿瘤血管的容积指数（VI）。处死荷瘤兔，取出肿瘤行免疫组化染色，测定肿瘤微血管密度（MVD）及血管内皮生长因子（VEGF）的表达。分析VI与MVD、VEGF之间的相关性。结果兔VX2肿瘤血管的三维彩色多普勒参数VI与免疫组化参数MVD及VEGF之间均呈线性正相关（r=0．9199，P〈0．001；r=0．6871，P〈0．05）。结论三维彩色多普勒超声能够较敏感客观地反映肿瘤的血供，为在体无创性评价肿瘤血管及其灌注提供了一条新的功能成像方法。     

肝癌的三维彩色血管能量成像与临床病理

目的探讨肝癌的三维彩色血管能量成像特征及其临床病理意义。方法采用ATL-HDI3000超声仪,C4-2超宽频探头,对58例肝癌进行三维彩色血管能量成像(3D-CPA)检查,并对其进行TNM分期,以评价3D-CPA在肝癌预后评估中的价值。其中30例进行3D-CPA检测与病理结果对比,病理观察指标包括癌瘤大小,肿瘤周边及内部血管形态、分布、排列、血管类型及肿瘤血管密度。结果肿瘤周边弧形包绕血流和瘤内树枝状血流为肝癌3D-CPA特异性表现。肿瘤周边血管较肿瘤内部血管丰富;肿瘤直径越大,血管越丰富;3D-CPA肿瘤血管分级与病理肿瘤血管密度相关(P>0.1),肝癌3D-CPA血管成像特征与病理检查结果相一致。TNM分期不同的肝癌1年生存率不同（P<0.05）。结论3D-CPA能反映肿瘤微血管水平的血流状况,在肝癌的血管显示、血管受累描述、TNM分期及病情判断、预后评价方面,3D-CPA能做出与临床病理学因素相关的影像学判断。     

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。