Pediatric Acute Severe Hepatitis of Unknown Origin: What is New?

Globally, there are emerging cases of acute severe hepatitis of unknown origin in children. These cases have gathered increasing attention, owing to the development of acute liver failure in some cases that resulted in liver transplantation. This review briefly summarizes the outbreak and diagnostic criteria of the disease. We further discuss the possible causes and related mechanisms underlying its occurrence and progression, and analyze the challenges in management. Finally, this review emphasizes patient management in clinical settings and a combination of efforts to unmask the disease.     

睾丸感染性和肿瘤性病变的CT表现及鉴别

目的 提高对睾丸感染性和肿瘤性病变的CT认识及诊断、鉴别诊断能力.方法 回顾性分析经病理证实的40例睾丸感染性和肿瘤性病变患者的临床和CT资料.结果 睾丸化脓性炎症8例,3例合并脓肿形成.CT表现为患侧睾丸明显肿大,实质内密度明显减低,增强扫描睾丸内坏死液化区无强化,周围包膜明显环形强化,同时累及附睾和周围皮肤软组织.睾丸结核7例,2例合并结核性脓肿形成.CT表现为患侧睾丸肿大,形态不规则,实质密度不均,可见结节及坏死区,增强扫描实性结节持续明显强化,合并脓肿者可见多发环状厚壁强化,与附睾及阴囊隔粘连、分界不清.睾丸肿瘤25例,精原细胞瘤(13例)CT表现为患侧睾丸稍低密度的均匀或不均匀密度肿块影,轻中度持续强化,散在少许坏死;淋巴瘤(4例)表现为边界清楚的类圆形睾丸肿块,密度均匀,呈中度均匀强化;另有腺泡状横纹肌肉瘤2例,畸胎瘤1例,表皮样囊肿1例,内胚窦瘤2例,胚胎性癌1例,神经内分泌癌1例.结论 睾丸感染性病变(化脓性炎症、结核)和肿瘤性病变的CT表现具有一定的特征性,结合临床表现如发病时间、年龄、血清肿瘤标志物等有助于正确诊断和鉴别.     

PET and PET/CT in endocrine tumours

Functional information provided by PET tracers together with the superior image quality and the better data quantification by PET technology had a changing effect on the significance of nuclear medicine in medical issues. Recently introduced hybrid PET/CT systems together with the introduction of novel PET radiopharmaceuticals have contributed to the fact that nuclear medicine has become a growing diagnostic impact on endocrinology. In this review imaging strategies, different radiopharmaceuticals including the basic mechanism of their cell uptake, and the diagnostic value of PET and PET/CT in endocrine tumours except differentiated thyroid carcinomas will be discussed.     

类风湿关节炎早期诊断的影像学方法研究进展

类风湿关节炎(RA)是一种病因不明的以慢性、对称性、侵袭性关节炎为主要特征的全身性自身免疫疾病.患者可出现严重的关节畸形及功能丧失,致残率及病死率较高.目前,临床上尚无有效措施可逆转其已经发生的关节骨质破坏.因此,对RA进行早期诊断是改善RA预后的关键.近年来,影像学检查在RA早期诊断中发挥着越来越重要的作用,成为国内外学者研究的热点.笔者对近年来RA的早期影像学诊断方法研究进展进行综述.     

张世明教授运动性疲劳中医分型诊断标准

张世明教授及其研究团队在传统中医理论基础上,对运动性疲劳进行中医辨证分型研究。经过多项课题研究和备战奥运会、亚运会的科技攻关服务经验积累,提出了运动性疲劳中医证候诊断标准。早期归纳出运动疲劳的三种类型、九种常见证,经后期实践和研究,总结为三个类型、十二种常见的运动性疲劳证型。     

GP strategies to avoid imaging overuse. A qualitative study in Norwegian general practice

ObjectivesThe aim of the study was to identify general practitioners’ (GPs) strategies to avoid unnecessary diagnostic imaging when encountering patients with such expectations and to explore how patients experience these strategies.Design, setting and subjectsWe conducted a qualitative study that combined observations of consultations and interviews with GPs and patients. A total of 24 patients visiting nine different GPs in two Norwegian urban areas were included in the study. Of these, 12 consultations were considered suitable for studying GP strategies and were therefore selected for a more thorough analysis.Main outcome measuresGPs’ communication strategies to avoid unnecessary medical imaging and patients’ experiences with such strategies.ResultsFive categories of strategies were identified: (1) wait and see – or suggest an alternative; (2) the art of rejection; (3) seek support from a professional authority; (4) partnership and shared decision-making and (5) reassurance, normalisation and recognition. The GPs often used multiple strategies. Factors related to a long-term doctor–patient relationship seemed to influence both communication and how both parties experienced the decision. Three important factors were evident: the patient trusted the doctor, the doctor knew the patient’s medical history and the doctor knew the patient as a person. The patients seemed to be generally satisfied with the outcomes of the consultations.ConclusionGPs largely combine different strategies when meeting patients’ expectations of diagnostic imaging that are not strictly medically indicated. Continuity of the doctor–patient relationship with good personal knowledge and trust between doctor and patient appeared crucial for patients to accept the doctors'' decisions.

Key points

• GPs usually combine a broad range of strategies to avoid unnecessary medical imaging
• The patients appeared generally satisfied regardless of the strategy the strategy used by the GPs and even where their referral request were rejected
• Factors related to a long-term doctor–patient relationship appeared decisive

     

Testing for anosmia and ageusia in patients presenting to the emergency department with suspected coronavirus disease 2019 in Saudi Arabia

ObjectiveThis study investigated the role of objective olfactory dysfunction (OD) and gustatory dysfunction (GD) testing among patients with suspected coronavirus disease 2019 (COVID-19) who presented with respiratory symptoms.MethodsA prospective, blinded, observational study was conducted in the emergency units of two tertiary hospitals. Participants were asked to identify scents in the pocket smell test (PST) and flavors in four different solutions in the gustatory dysfunction test (GDT). We assessed the level of agreement between objective findings and self-reported symptoms. We evaluated the diagnostic accuracy of chemosensory dysfunction for diagnosing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.ResultsOf 250 participants, 74 (29.6%) were SARS-CoV-2-positive. There was slight agreement between self-reported symptoms and objective findings (kappa = 0.13 and 0.10 for OD and GD, respectively). OD assessed by the PST was independently associated with COVID-19 (adjusted odds ratio = 1.89, 95% confidence interval, 1.04–3.46). This association was stronger when OD was combined with objective GD, cough, and fever (adjusted odds ratio = 7.33, 95% confidence interval, 1.17–45.84).ConclusionsNeither the PST nor GDT alone are useful screening tools for COVID-19. However, a diagnostic scale based on objective OD, GD, fever, and cough may help triage patients with suspected COVID-19.     

数字化口腔种植外科导板的精确度研究

目的 本研究通过分析种植体术前设计和术后的三维位置,来评估数字化口腔种植导板的精确度.方法 根据修复体的生物学功能和美学要求,使用3D种植软件对种植体位置进行设计.将设计的种植导板转化为手术用种植导板,指导47颗种植体植入合适位置.通过重叠术前和术后的CT扫描图像,分析植体肩部和根部的线性误差以及植体长轴的角度误差,比...     

Voxel‐wise quantification of myocardial perfusion by cardiac magnetic resonance. Feasibility and methods comparison

The purpose of this study is to enable high spatial resolution voxel‐wise quantitative analysis of myocardial perfusion in dynamic contrast‐enhanced cardiovascular MR, in particular by finding the most favorable quantification algorithm in this context. Four deconvolution algorithms—Fermi function modeling, deconvolution using B‐spline basis, deconvolution using exponential basis, and autoregressive moving average modeling —were tested to calculate voxel‐wise perfusion estimates. The algorithms were developed on synthetic data and validated against a true gold‐standard using a hardware perfusion phantom. The accuracy of each method was assessed for different levels of spatial averaging and perfusion rate. Finally, voxel‐wise analysis was used to generate high resolution perfusion maps on real data acquired from five patients with suspected coronary artery disease and two healthy volunteers. On both synthetic and perfusion phantom data, the B‐spline method had the highest error in estimation of myocardial blood flow. The autoregressive moving average modeling and exponential methods gave accurate estimates of myocardial blood flow. The Fermi model was the most robust method to noise. Both simulations and maps in the patients and hardware phantom showed that voxel‐wise quantification of myocardium perfusion is feasible and can be used to detect abnormal regions. Magn Reson Med, 2012. © 2012 Wiley Periodicals, Inc.