早期乳腺癌的钼靶X线表现及误诊分析

目的探讨早期乳腺癌的钼靶X线表现,进一步提高该病的影像诊断水平,减少误诊。方法回顾性分析68例经手术或穿刺活检病理证实的早期乳腺癌的钼靶X线片。结果 68例早期乳腺癌发生于致密腺体型14例,多量腺体型21例,少量腺体型23例,脂肪型10例。X线表现为微小钙化25例(36.76%),肿块影23例(33.82%),结构紊乱9例(13.23%),局部密度增高影5例(7.35%),乳管造影异常3例(4.41%),血管增粗3例(4.41%)。其中有15例发生误诊(22.06%)。结论早期乳腺癌的钼靶X线征象不典型,诊断易受腺体类型的影响,影像与临床紧密结合可有效减少误诊。     

Autoimmune Polyglandular Syndrome Type 3c with Ectodermal Dysplasia,Immune Deficiency and Hemolytic-Uremic Syndrome

Autoimmune polyglandular syndrome (APS) is a disorder which is associated with multiple endocrine gland insufficiency and also with non-endocrine manifestations. The pathophysiology of APS is poorly understood, but the hallmark evidence of APS is development of autoantibodies against multiple endocrine and non-endocrine organs. These autoantibodies are responsible for the dysfunction of the affected organs and sometimes may also cause non-endocrine organ dysfunction. The hemolytic-uremic syndrome (HUS) is a serious and life-threatening disease which develops due to many etiological factors including autoimmune disorders. Here, we present an unusual case of APS. Ectodermal dysplasia with immune deficiency and HUS occurred concomitantly in the same patient with APS type 3c. Once the autoantibody generation was initiated in the human body, development of multiple disorders due to organ dysfunction and also autoantibody-related diseases may have occurred.     

The Effects of Passive Smoking on the Six-Minute Walk Test in Obese Pediatric Cases

Objective: The aim of this study was to evaluate whether exposure to second-hand smoke affected the six-minute walk test (6MWT) of obese non-asthmatic pediatric cases.Methods: Obese pediatric patients (body mass index >95th p) with no existing co-morbidities were included in the study. Smoke exposure was assessed with a self-reported questionnaire completed by the parents. The subjects were divided into two groups: Group 1 consisting of obese children exposed to passive smoking and Group 2 of obese children not exposed to passive smoking. In addition to 6MWT, spirometric flow and volume, including forced expiratory volume in 1 s and peak expiratory flow rate, were also measured in all subjects. The results of the 6MWT were assessed to determine any association with passive smoking.Results: The study included 75 obese pediatric cases (40 male, 35 female) with a mean age of 9.06±0.97 years. The 6MWT results in Group 1 was 501.88±62.12 meters and in Group 2 559.63±72.93 meters. The difference was statistically significant (p=0.001).Conclusions: Passive smoking may negatively affect the respiratory and cardiovascular capacity in obese children, who are already at risk of lower cardiopulmonary function. The evaluation of 6MWT in these pediatric patients may be useful for monitoring and families should be warned about potential problems due to smoking.     

ROHHAD Syndrome: Reasons for Diagnostic Difficulties in Obesity

A very rare syndrome of rapid-onset obesity with hypoventilation, hypothalamic dysfunction and autonomic dysregulation (ROHHAD) has been recently described as causing morbidity due to hypothalamic dysfunction and respiratory arrest. Its prognosis is poor and often cardiac arrest occurs due to alveolar hypoventilation. This disorder can mimic genetic obesity syndromes and several endocrine disorders. We present a 13-year-old female patient who was reported to be healthy until the age of 3 years. She was admitted to our emergency department, presenting with respiratory distress. Features matching ROHHAD syndrome such as rapid-onset obesity, alveolar hypoventilation, central hypothyroidism, hyperprolactinemia, Raynaud phenomenon and hypothalamic hypernatremia were detected in the patient. In addition to these features, the patient was found to have hypergonadotropic hypogonadism and megaloblastic anemia. Because of its high mortality and morbidity, the possibility of ROHHAD syndrome needs to be considered in all pediatric cases of early- and rapid-onset obesity associated with hypothalamic-pituitary endocrine dysfunction.     

Assessment of cardiac autonomic functions by heart rate recovery,heart rate variability and QT dynamicity parameters in patients with acromegaly

Cardiovascular complications are the most common causes of morbidity and mortality in acromegaly. However, there is little data regarding cardiac autonomic functions in these patients. Herein, we aimed to investigate several parameters of cardiac autonomic functions in patients with acromegaly compared to healthy subjects. We enrolled 20 newly diagnosed acromegalic patients (55 % female, age:45.7 ± 12.6 years) and 32 age- and gender-matched healthy subjects. All participants underwent 24 h Holter recording. Heart rate recovery (HRR) indices were calculated by subtracting 1st, 2nd and 3rd minute heart rates from maximal heart rate. All patients underwent heart rate variability (HRV) and QT dynamicity analysis. Baseline characteristics were similar except diabetes mellitus and hypertension among groups. Mean HRR1 (29.2 ± 12.3 vs 42.6 ± 6.5, p = 0.001), HRR2 (43.5 ± 15.6 vs 61.1 ± 10.8, p = 0.001) and HRR3 (46.4 ± 16.2 vs 65.8 ± 9.8, p = 0.001) values were significantly higher in control group. HRV parameters as, SDNN [standard deviation of all NN intervals] (p = 0.001), SDANN [SD of the 5 min mean RR intervals] (p = 0.001), RMSSD [root square of successive differences in RR interval] (p = 0.001), PNN50 [proportion of differences in successive NN intervals >50 ms] (p = 0.001) and high-frequency [HF] (p = 0.001) were significantly decreased in patients with acromegaly; but low frequency [LF] (p = 0.046) and LF/HF (p = 0.001) were significantly higher in acromegaly patients. QTec (p = 0.009), QTac/RR slope (p = 0.017) and QTec/RR slope (p = 0.01) were significantly higher in patients with acromegaly. Additionally, there were significant negative correlation of disease duration with HRR2, HRR3, SDNN, PNN50, RMSSD, variability index. Our study results suggest that cardiac autonomic functions are impaired in patients with acromegaly. Further large scale studies are needed to exhibit the prognostic significance of impaired autonomic functions in patients with acromegaly.     

无创心输出量测量系统指导下六分钟步行试验操作规范及临床应用专家共识

面对6MWT的困境,如干扰因素多、解读存在困难等,在6MWT时动态地监测血流动力学变化,可以更加精准的反映6MWT测试中心功能的变化,获取更多有用信息,使受试者获益更多。心力衰竭是多种心血管疾病（如缺血性心肌病、高血压病等）的终末阶段,均伴随着血流动力学变化。左心室充盈压力升高导致的充血是与心力衰竭相关住院最常见的因素,导致在住院前几天出现的呼吸困难、水肿和疲劳等症状。尽管住院期间的治疗减少了充血的症状和体征,在出院时仍有近一半的心衰患者表现出充血的体征,事实上,这部分患者被证明具有更高的再住院和长期死亡风险 [19, 20]。因此,对心衰患者在出院后进行血流动力学监测调整治疗方案尤为重要。近十年来,越来越多的血流动力学监测技术相继涌现,从有创到微创再到无创,尝试着用更准确、更无创、更便捷、成本更低的监测技术指导个体化治疗。 无创心脏血流动力检测技术中主要起源于20世纪60年代美国明尼苏达大学库比赛克（Kubicek）教授根据欧姆定律提出了胸腔电生物阻抗法（TEB）,用于无创心功能检查。随着心脏舒缩,血管内血流量发生变化,电流通过胸部的阻抗也产生相应变化。阻抗心动图（impedance cardiography, ICG）无创血流动力学监测正是利用胸阻抗原理,通过对心阻抗微积分血流图处理得到包括每搏输出量（stroke volume,SV）、心输出量（cardiac output,CO）、心指数（cardiac index,CI）、舒张早期充盈率（early diastolic filling rate,EDFR）、外周血管阻力（systemic vascular resistance,SVR）等参数。近年来,高清阻抗心动图（HD-ICG）技术开始得到广泛应用,可动态地监测无创心输出量（简称无创心排）,其准确性和便捷性已被认识[21]。因6WMT受非心脏因素影响较多,在HD -ICG无创血流动力学监测下同步进行6MWT,实时、连续、精准、动态监测血流动力学变化,综合进行静息评定和趋势变化分析,从而更加精准的反映6MWT测试中心功能的变化,可以更精准地评定心功能、制定更加安全的运动处方。基于此,中国健康促进基金会心脏康复发展专项基金邀请国内部分专家,经反复讨论,特制定本专家共识。