超声成像在急性下肢深静脉血栓机械性清除治疗中应用价值

目的 探讨超声在急性下肢深静脉血栓(DVT)机械性血栓清除(PMT)治疗中应用的有效性和安全性。方法 132例急性期DVT患者置入滤器后分为82例超声组和50例造影组进行PMT及导管溶栓治疗,术后评估并比较两组静脉通畅情况、患肢周径差、血生化指标、手术时间、并发症及疗效随访。结果 超声组、造影组术后静脉通畅率较高,分别为82%、77.7%,术后两组静脉通畅情况组间对比差异均无统计学意义( P均＞0.05) 。平均手术时间超声组(1.08±0.32h)少于造影组(2.36±0.25h)(P=0.000)。并发症发生率超声组(12.2%)低于造影组(26%)(P=0.016)。术后血红蛋白含量超声组(125.66±15.48g/L)高于造影组(91.53±11.73g/L)(P=0.004)。两组术后患肢周径差、D-二聚体浓度、Villalta评分及VEINES-QOL评分组间对比差异均无统计学意义( P均＞0.05)。 结论 超声监测对急性DVT行PMT治疗安全有效,与传统静脉造影模式相比具有无辐射、手术时间短及并发症低的优点。     

评价骨质状况及骨质疏松症的超声方法

超声方法评价骨质状况及诊断骨质疏松症是近年来医学超声领域内的研究前沿,并已取得了较大的进展。本文将近年来超声纵波评价松质骨和超声轴向传播技术评价皮质骨以及超声诊断质疏松症的研究进展进行综述,在此基础上提出了当前研究中存在的主要问题及努力的方向。     

妇科腹腔镜手术70例临床分析

目的：探讨腹腔镜手术在妇科的临床应用价值。方法：2005年1月～2006年2月我院共完成妇科手术1246例,其中腹腔镜手术70例,均采用全麻,异位妊娠术式为输卵管切除术、输卵管注药术;卵巢囊肿手术采用剔除术、剥除术,主要器械为双极电凝。结果：腹腔镜手术占同期妇科手术的5．62％,70例腹腔镜手术均成功,无并发症发生。结论：适应证掌握得当,妇科大部分手术可在腹腔镜下完成,腹腔镜对机体、内外环境干扰少、出血量少、术后恢复快。     

不同剂量静脉滴注丙种球蛋白治疗川崎病临床疗效观

目的：观察丙种球蛋自治疗川崎病（KD）的临床疗效。方法：将108例患儿分为3组：A组46例,单服阿司匹林;B组32例,静脉滴注丙种球蛋白400mg／（kg·d）连用3天,C组30例,予丙种球蛋白mg／kg单剂静脉滴注。B、C两组均同时联用阿斯司林,方法同A组。3组患儿其他用药基本一致。观察其退热时间、冠状动脉病变（CAD）发生率及其恢复时间。结果：A组517均退热时间（4．6±1．4）天,C曲的发生率为39．1％（18／46）,CAD平均恢复时间为（149．7±16.5）天;B组平均退热时间（2．0±0．4）天,CAD发生率为18．8％（6／32）,CAD平均恢复时间（81．5±22．5）天;C组病例平均退热时间（1．0±1．2）天,CAD的发生率为20．0％（6／30）,CAD平均恢复时间为（60．3±13．8）天。结论：静脉滴注丙种球蛋自治疗KD能减少CAD的发生率,减少CAD的恢复时间,同时能减少KD的退热时间,且1g／kg单剂静脉滴注较400mg/（kg·d）连用3天更有效。     

视网膜神经节细胞复合体厚度检测对原发性开角型青光眼的诊断意义

目的比较视网膜黄斑区神经节细胞复合体(GCC)厚度和视盘周围视网膜神经纤维层(p RNFL)厚度各单项指标及两者联合后指标对原发性开角型青光眼(POAG)的诊断价值。设计诊断方法评价。研究对象挪威特罗姆瑟眼病中心2013年10月至2014年3月就诊者的正常人40眼,POAG 66眼。其中早期青光眼(EG)34眼、中晚期青光眼(AG)32眼。方法所有受试眼均进行频域相干光断层扫描(i Vue 100 SD-OCT)GCC模式及ONH模式扫描检测。通过比较各参数受试者曲线下面积(AUCs)来评估其诊断能力。主要指标黄斑区GCC厚度及p RNFL厚度的AUCs值。结果所有眼全周GCC厚度与全周p RNFL厚度具有强相关性。青光眼组全周GCC厚度(EG 81.03±6.37μm,AG 76.28±9.39μm)和p RNFL厚度(EG 80.47±9.02μm,AG 69.84±11.74μm)较正常组(GCC 92.90±6.07μm,p RNFL 96.98±8.09μm)显著变薄(P均<0.05)。校正年龄后,具有最高诊断能力的指标在EG组是上方GCC厚度(AUC=0.929),AG组是全周p RNFL厚度(AUC=0.988)。以全周p RNFL厚度为参照,EG组中全周GCC厚度及全周p RNFL厚度回归联合后诊断能力提高,但无统计学意义;AG组中,全周GCC厚度及全周p RNFL厚度并联后灵敏度显著提高(P<0.05)。结论采用SD-OCT测量法,GCC厚度在各期POAG中均具有与p RNFL厚度相当的、较高的诊断能力。AG组中,全周GCC厚度及全周p RNFL厚度联合可能提高诊断灵敏度。     

白藜芦醇保护缺血再灌注大鼠心肌作用与miR-21的相关性

目的 观察白藜芦醇预处理后大鼠心肌微小RNA(miRNA)的表达变化,分析白藜芦醇介导的心肌保护作用与miR-21之间有否关系.方法 通过miRNA芯片微阵列方法和qRT-PCR检测并验证白藜芦醇灌胃预处理后的大鼠心肌miRNA表达谱；建立大鼠心肌缺血再灌注损伤模型,检测各组心肌梗死面积、心肌细胞凋亡率以及miR-21的表达水平.结果 白藜芦醇预处理后,大鼠心肌的miR-21表达水平约为对照组的2.5倍;miR-21阻逼剂对白藜芦醇预处理引起的miR-21高表达产生了明显的抑制作用；过表达的miR-21显著降低了心肌细胞凋亡率,心肌组织梗死面积明显缩小.结论 白藜芦醇可以调控心肌多种miRNA的表达水平,通过促进miR-21的表达,白藜芦醇能够抑制心肌细胞的凋亡,从而减轻缺血再灌注对心肌的损伤.     

Percutaneous ultrasound and endoscopic ultrasound-guided biopsy of solid pancreatic lesions: An analysis of 1074 lesions

Backgrounds: Percutaneous ultrasound (US) and endoscopic ultrasound (EUS)-guided pancreatic biopsies are widely accepted in the diagnosis of pancreatic diseases. Studies comparing the diagnostic performance of US- and EUS-guided pancreatic biopsies are lacking. This study aimed to evaluate and compare the diagnostic yields of US- and EUS-guided pancreatic biopsies and identify the risk factors for inconclusive biopsies. Methods: Of the 1074 solid pancreatic lesions diagnosed from January 2017 to February 2021 in our center, 275 underwent EUS-guided fine needle aspiration (EUS-FNA), and 799 underwent US-guided core needle biopsy (US-CNB/FNA). The outcomes were inconclusive pathological biopsy, diagnostic accuracy and the need for repeat biopsy. All of the included factors and diagnostic performances of both US-CNB/FNA and EUS-FNA were compared, and the independent predictors for the study outcomes were identified. Results: The diagnostic accuracy was 89.8% for EUS-FNA and 95.2% for US-CNB/FNA ( P = 0.001). Biopsy under EUS guidance [odds ratio (OR) = 1.808, 95% confidence interval (CI): 1.083-3.019; P = 0.024], lesion size < 2 cm (OR = 2.069, 95% CI: 1.145-3.737; P = 0.016), hypoechoic appearance (OR = 0.274, 95% CI: 0.097-0.775; P = 0.015) and non-pancreatic ductal adenocarcinoma carcinoma (PDAC) diagnosis (OR = 2.637, 95% CI: 1.563-4.449; P < 0.001) were identified as factors associated with inconclusive pathological biopsy. Hypoechoic appearance (OR = 0.236, 95% CI: 0.064-0.869; P = 0.030), lesions in the uncinate process of the pancreas (OR = 3.506, 95% CI: 1.831-6.713; P < 0.001) and non-PDAC diagnosis (OR = 2.622, 95% CI: 1.278-5.377; P = 0.009) were independent predictors for repeat biopsy. Biopsy under EUS guidance (OR = 2.024, 95% CI: 1.195-3.429; P = 0.009), lesions in the uncinate process of the pancreas (OR = 1.776, 95% CI: 1.014-3.108; P = 0.044) and hypoechoic appearance (OR = 0.127, 95% CI: 0.047-0.347; P < 0.001) were associated with diagnostic accuracy. Conclusions: Both percutaneous US- and EUS-guided biopsies of solid pancreatic lesions are safe and effective; though the diagnostic accuracy of EUS-FNA is inferior to US-CNB/FNA. A tailored pancreatic biopsy should be considered a part of the management algorithm for the diagnosis of solid pancreatic disease.     

Widespread keratinocytic epidermal nevus with an associated chylous pericardial effusion

A 17-year-old male presented for review of a widespread keratinocytic epidermal nevus (KEN) in the setting of a chronic pericardial effusion. Biopsy of the epidermal nevus revealed a KRAS mutation. Pericardiocentesis revealed a chylous effusion and magnetic resonance lymphangiogram demonstrated an underlying lymphatic malformation. There are rare case reports of KEN with an associated KRAS mutation. This case highlights the importance of being alert to epidermal nevus syndrome, particularly in patients with a widespread nevus and seemingly unrelated pathology.     

Pathogenic variants in PIK3CA are associated with clinical phenotypes of kaposiform lymphangiomatosis,generalized lymphatic anomaly,and central conducting lymphatic anomaly

Complex lymphatic anomalies are debilitating conditions characterized by aberrant development of the lymphatic vasculature (lymphangiogenesis). Diagnosis is typically made by history, examination, radiology, and histologic findings. However, there is significant overlap between conditions, making accurate diagnosis difficult. Recently, genetic analysis has been offered as an additional diagnostic modality. Here, we describe four cases of complex lymphatic anomalies, all with PIK3CA variants but with varying clinical phenotypes. Identification of PIK3CA resulted in transition to a targeted inhibitor, alpelisib. These cases highlight the genetic overlap between phenotypically diverse lymphatic anomalies.