Utilization of Ultrasonography in Dermatology: Two Case Reports of Calcinosis Cutis

Development of newer generation of cost-effective ultrasonic devices in recent years has increased the use of ultrasonography in dermatology. Several lesions can be diagnosed and managed using ultrasonography. Calcinosis cutis involves the deposition of insoluble calcium salts in the cutaneous and subcutaneous tissues. On ultrasonography, it specifically presents as hyperechoic deposits with a posterior acoustic shadowing artifact due to the acoustic properties of calcium. A 62-year-old female patient presented with a solitary, skin-colored, palpable nodule on the inner side of the right lower leg. The lesion was beneath the intact skin and detectable only on palpation. However, ultrasonography demonstrated a clear delineation of the lesion, showing hyperechoic deposits with a posterior acoustic shadow (15 MHz, linear probe). Skin biopsy and curettage were performed, revealing histological features consistent with calcinosis cutis. Four weeks after the procedure, ultrasonography performed to evaluate the outcome of treatment, showed recurrence. Another 18-year-old female patient presented with a skin-colored deep-seated nodule on the left temple. On ultrasonography, linear hyperechoic deposits with a posterior acoustic shadow were visible. Skin biopsy was performed, and histopathologic features showed calcified material in the subcutaneous tissue. These two cases of calcinosis cutis highlight the diagnostic value of ultrasonography in dermatology.     

水疱型毛母质瘤一例

患者,女,23岁。1年前蚊虫叮咬后右上臂出现两处皮下结节伴疼痛,3个月前两处皮损均增大为红色囊性肿物。病理特征符合水疱型毛母质瘤。MRI提示：脂肪层见椭圆形乳头状长T1短T2信号,凸向皮肤表面,外缘长T2信号。手术完整切除,创面愈合良好。目前随访未复发。     

CD34弥漫阳性表达的成年型孤立性肌纤维瘤1例

患者女, 44岁, 因左侧头皮肿物3年于2019年3月20日就诊于我院。患者3年前无意中发现左侧额颞部发际线边缘皮肤肿物, 当时约枣子大小, 突出于皮面, 可活动, 表面无红肿破溃, 无压痛。3年来肿物逐渐增大至鸡蛋大小, 为寻求手术治疗入住我院。入院后头颅CT检查发现左侧额颞部头皮处团块状软组织密度影, 较大截面约5.3 cm × 1.9 cm, 密度尚均匀。完善术前检查后于2019年3月22日行肿物切除术。术中见肿物深达皮下, 带包膜, 但基底边界欠清楚, 沿肿物边缘完整切除后, 转移切口周边头皮带蒂皮瓣缝合切口。术后随访20个月无复发。     

体检人群使用NOSAS评分作为阻塞性睡眠呼吸暂停初筛工具的可行性分析

  目的  比较NOSAS评分与STOP-Bang问卷的预测值，对体检人群使用NOSAS评分作为OSAHS初步筛查工具的可行性进行探讨。  方法  回顾性分析2018年1月至2019年8月来北京航天总医院健康管理中心疑似OSAHS患者135例的多导睡眠图(PSG)监测结果，包括NOSAS评分及STOP-Bang问卷各项目及患者资料。按呼吸暂停低通气指数(AHI)分组。计算NOSAS评分和Stop-Bang问卷的敏感度、特异性、阳性预测值和阴性预测值，并绘制ROC曲线。比较2个评分筛查OSAHS的价值。  结果  在135例患者中，男性占75.6%，女性占24.4%。以AHI ≥ 5次/h、15次/h、30次/h为诊断标准，NOSAS评分敏感度和特异性分别为:0.891和0.720、0.910和0.587、0.814和0.553；STOP-Bang问卷的敏感性和特异性分别为:0.873和0.560、0.910和0.435、0.949和0.329。当以AHI ≥ 5次/h、15次/h、30次/h为诊断标准，NOSAS评分ROC曲线下面积分别为:0.847、0.773、0. 693，差异有统计学意义（P < 0.001）；STOP-Bang问卷的ROC曲线下面积分别为:0.784、0.711、0.694，差异有统计学意义（P < 0.001）。以AHI为5次/h、15次/h及30次/h为临界点时，NOSAS评分ROC曲线下面积大于或等于STOP-Bang问卷评分。NOSAS评分具有良好的预测价值。  结论  NOSAS评分作为一种简单有效的初筛工具，在健康体检人群可有效的帮助医师快速筛查OSAHS患病高风险者。     

Variant analysis and genotype/phenotype association study in 42 Chinese patients with Bartter syndrome type 3

Objective To analyze the variants of 42 Chinese patients with Bartter syndrome type 3 (BS3) and explore the characteristics of genotype and phenotype. Methods Forty-two genetically diagnosed patients from 40 Han and one Hui families were collected in the Affiliated Hospital of Qingdao University and the Affiliated Qingdao Municipal Hospital of Qingdao University during the period of June 2012 to October 2018. The second-generation sequencing and multiplex ligase probe-dependent amplification (MLPA) technique were used to analyze the CLCNKB gene variation and its characteristics in children with BS3. The clinical data were collected, and the therapeutic effect and growth improvement were observed and followed up. Thirty eight patients were divided into severe (n=26) and light (n=12) groups according to the severity of genetic variation. The clinical phenotypic characteristics of the two groups were compared. Results Thirty-six variants including 16 novel ones of CLCNKB gene were found. The whole gene deletion of CLCNKB gene was the most frequent mutation (40%), and the rate of large deletions was up to 55%. The most common symptoms included development retardation (38/42), polydipsia and polyuria (35/42), constipation (31/42) and vomiting (27/42). All patients presented with hypokalemia, hypochloremia and metabolic alkalosis. After the medicine treatment that based on indomethacin and potassium chloride, most patients could achieve obvious recovery of growth rate and restoration of hypokalemia. The severe group showed more severe metabolic alkalosis than the light group. Conclusions Thirty-six variants of CLCNKB gene have been found in this study, including 16 novel ones, which enrich the human gene mutation database (HGMD) and provide valuable references to diagnosis, treatment and the genetic counseling of Chinese population.     

Association of gray matter volumes with general and specific dimensions of psychopathology in children

Childhood is an important time for the manifestation of psychopathology. Psychopathology is characterized by considerable comorbidity which is mirrored in the underlying neural correlates of psychopathology. Both common and dissociable variations in brain volume have been found across multiple mental disorders in adult and youth samples. However, the majority of these studies used samples with broad age ranges which may obscure developmental differences. The current study examines associations between regional gray matter volumes (GMV) and psychopathology in a large sample of children with a narrowly defined age range. We used data from 9607 children 9–10 years of age collected as part of the Adolescent Brain Cognitive Development^SM Study (ABCD Study^®). A bifactor model identified a general psychopathology factor that reflects common variance across disorders and specific factors representing internalizing symptoms, ADHD symptoms, and conduct problems. Brain volume was acquired using 3T MRI. After correction for multiple testing, structural equation modeling revealed nearly global inverse associations between regional GMVs and general psychopathology and conduct problems, with associations also found for ADHD symptoms (p_fdr-values ≤ 0.048). Age, sex, and race were included as covariates. Sensitivity analyses including total GMV or intracranial volume (ICV) as covariates support this global association, as a large majority of region-specific results became nonsignificant. Sensitivity analyses including income, parental education, and medication use as additional covariates demonstrate largely convergent results. These findings suggest that globally smaller GMVs are a nonspecific risk factor for general psychopathology, and possibly for conduct problems and ADHD as well.Subject terms: Human behaviour, Risk factors, Neuroscience     

血清标本溶血对自动生化仪检验指标的影响的研究观察

目的研究分析血液样本溶血对临床生化检验的影响。方法对2013~2014年我院78例健康检验患者来进行探讨分析,要求患者在晨时空腹状态接受血液采集,将这些血液样本分成两份,进行常规生化检验以及诱导溶血生化检验,对检验结果进行比较分析。结果经过检验后,两份血液样本中的ALT、AST、LDH以及K+含量等均是在经过诱导溶血后的样本中比较高,ALP含量在诱导溶血后的样本中比较低。结论临床进行血液检验的时候,如果样本发生了溶血情况,那么检验结果就会受到影响,导致检验结果不准确,所以应该要积极的避免血液样本发生溶血的情况。     

Femoral Stem Survivorship in Dorr Type A Femurs After Total Hip Arthroplasty Using a Cementless Tapered Wedge Stem: A Matched Comparative Study With Type B Femurs

Background

There is a lack of understanding on relationship between the femoral geometry and outcomes of total hip arthroplasty (THA). We investigated clinical and radiographic outcomes of THA using a cementless tapered wedge stem in patients with Dorr type A proximal femoral morphology and compared with those of type B femurs at a minimum follow-up of 5 years.