磁共振成像技术在宫内诊断中的应用

随着磁共振成像技术(MRI)的改进,目前越来越多地应用于宫内诊断。MRI能够准确、清晰地提供胎儿结构信息,不仅是超声有用的辅助诊断手段,更能有效避免超声的局限性。一些MRI新技术如弥散加权成像、磁共振波谱和功能成像也逐渐应用于胎儿的MRI诊断。该文将详细介绍MRI用于宫内诊断的安全性、相关技术及胎儿各系统的临床应用。     

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??Proteinuria measurement is used to identify and monitor kidney damage. Accurate assessment of proteinuria is essential to clinical practice. This review focuses on the current status and question of proteinuria measurement. We also addressed standardization of preanalytical??analytical??and postanalytical issues including urine sample collection??urine protein and albumin measurement??and reporting of test results.     

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??The multimodal imaging method can be used to asseses hemopiliac arthropathy in different periods?? different degree and even different areas of the joints.In order to comprehend the understanding on pathological changes of hemophilic osteoarthropathy and clinical treatment strategy needs?? and to provide accurate imaging diagnosis and prognosis evaluation??we need to know the characteristics and evaluation range in different imaging methods and the selection and put this into the clinical application and scientific research qualitatively and quantitatively. The imaging examination and evaluation system can evaluate early changes objectively and comprehensively and provide individual assessment for hemophilic arthropathy??which plays an important role in the diagnosis??staging?? treatment and follow-up of hemophilic arthropathy.     

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??Objective??To investigate the value of serum intestinal fatty acid binding protein??I-FABP?? and serum amyloid A??SAA?? in the diagnosis of necrotizing enterocolitis??NEC??in the newborn. Methods??Fifty-six preterm infants with a confirmed diagnosis of NEC from October 2014 to October 2015 were recruited as case group??stage??26 cases??stage??/??30 cases??. Thirty children diagnosed with non-digestive diseases in the same period were recruited as the control group. Serum levels of I-FABP and SAA were determined by enzyme-linked immunosorbent assay.The diagnostic value of I-FABP and SAA for severe NEC was assessed using the receiver operating characteristic??ROC??curve. Results??Stage??/?? cases in the case group had significantly higher serum I-FABP levels and SAA levels than the control group and Stage??cases??P??0.05??. The area under the ROC curve for serum I-FABP was 0.80??95%CI??0.69-0.92????with the optimal cut-off point of 21.8 μg/L. Under this cut-off point??the sensitivity and specificity were 70.0%and 81.0%??respectively. The area under the ROC curve for SAA was 0.76??95%CI??0.63-0.89????with the optimal cut-off point of 1657.8 μg/L. Under this cut-off point??the sensitivity and specificity were 67.0% and 80.0%??respectively. Conclusion??In newborn infants with NEC??serum I-FABP and SAA l can be used as biomarkers for the diagnosis of severe NEC.     

甲状腺术前选择性喉镜检查替代常规喉镜检查可行性分析

目的 探讨甲状腺手术病人术前选择性喉镜检查替代常规喉镜检查的可行性。方法 回顾性分析2018年1—12月北京协和医院收治的行术前喉镜检查的1906例甲状腺手术病人的临床资料,分析术前声带麻痹的影响因素。结果 仅18例（0.9%）病人发现术前声带麻痹。多因素分析表明,术前声音嘶哑（OR=19.094,95%CI 6.270~58.146,P<0.001）、结节位于后被膜（OR=27.976,95%CI 2.995~261.368,P=0.003）、既往有颈部手术史（OR=12.032,95%CI 2.058~261.368,P=0.006）为甲状腺术前声带麻痹的独立危险因素。术前有619例（32.5%）病人至少具备1个独立危险因素,其术前声带麻痹的发生率为2.9%（18/619）。如以选择性喉镜替代常规喉镜,1287例（67.5%）病人不必行术前喉镜检查,同时未遗漏术前声带麻痹的病人。结论 甲状腺手术病人术前声带麻痹的发生率较低,可选择性针对有独立危险因素的病人行术前喉镜检查。     

自身免疫性胰腺炎22例临床诊治分析

目的 探索自身免疫性胰腺炎（AIP）的临床特点及诊疗方法。方法 回顾性分析2017年9月至2020年7月在复旦大学附属中山医院胰腺外科诊治的22例AIP病人临床资料。通过记录分析AIP病人初诊及治疗阶段的临床表现,血清IgG4变化情况等辅助检查结果,激素治疗等情况,探索其诊治策略。结果 病人最初就诊时血清IgG4中位数为5.56（0.34～30.30）g/L,其中单纯胰腺受累者2.52（0.34～5.73）g/L,合并其他器官受累者7.59（0.66～30.30）g/L,合并胰腺外器官受累的AIP病人IgG4水平高于单纯胰腺受累的AIP病人（Z= 5.693,P=0.045）;22例病人中有9例接受激素治疗,治疗期间IgG4水平 3.7 （0.99,18.3）g/L,激素治疗2个月后IgG4水平中位数1.63（0.76,8.31）g/L,较未行激素治疗时明显下降（Z=-2.093,P=0.038）。8例病人（激素治疗5例,未激素治疗3例）复发时,IgG4较前均有不同程度升高（8/8,100%）,中位升高数值4.14（0.61,14.81）g/L;4例停药病人中,2例病人IgG4水平未恢复到正常（2/4,50%）。另有13例病人未接受激素治疗,治疗随访时10例（10/13,76.9%）病人处于临床缓解期。结论 在AIP病人中,血清IgG4在多器官受累时升高更为显著。使用激素治疗的AIP病人,开始激素治疗2个月后,复测IgG4较治疗前显著降低。部分轻症的AIP病人,经对症治疗后,可自行缓解。