患者,男,72岁,因"进行性排尿困难并肉眼血尿半年"就诊于我院泌尿外科.患者于2011年行经腹直肠癌根治术,术后按期化疗.2021年1月因直肠癌复发于我院行腹腔镜下腹会阴联合直肠癌根治术(Miles术)、结肠造口术,术后病理:直肠中-低分化腺癌,侵及直肠周围软组织.患者既往于2018年因冠心病行冠状动脉支架置入术,无家族遗传病史.

目的 比较超声引导足背动脉穿刺置管与触诊盲探穿刺置管的操作时间、首次穿刺成功率、穿刺次数、成功率和并发症发生率.方法 选取80例本院2016年6月至2016年11月住院,年龄18～60岁,ASA分级Ⅱ～Ⅲ级,神经外科择期手术需足背动脉穿刺置管的患者,按随机数字表法分为超声引导足背动脉穿刺组(U组)和触诊盲探穿刺组(P组),每组40例.穿刺前记录年龄、性别、身高、体重、无创血压和心率等一般信息.然后记录操作时间、穿刺次数、首次穿刺成功率和总体成功率、穿刺相关并发症发生率等参数.结果 两组患者的年龄、性别、体重指数、穿刺前的平均血压和心率等基本参数差异无统计学意义(P>0.05).虽然两组总体穿刺成功率和穿刺相关并发症比较,差异无统计学意义(P>0.05),但U组首次穿刺成功率(75％,95％CI 65.51％～84.48％)显著高于P组(50％,95％CI 39.04％～60.96％),且U组操作时间(35.5±8.6)s显著少于P组(50.2±22.5)s,差异有统计学意义(P<0.01).结论 与传统触诊盲探法相比,超声引导足背动脉穿刺置管可以缩短操作时间、减少穿刺次数、提高首次穿刺成功率,而不增加并发症发生率.

新型冠状病毒肺炎(简称新冠肺炎)定点医院和非定点医院有着不同的防控要求,为了适应新的防控形势,有必要对超声科的感染防控管理作相应调整.参考国家卫生健康委员会发布的新冠肺炎防控相关的文件,结合在新冠肺炎定点医院和非定点医院一线诊疗工作中积累的经验,笔者总结了下面几条工作建议,以供超声科医务人员参考.本建议主要根据疫情严重区域的实际情况而制定,非疫情严重区域的科室管理应结合当地的疫情特点进行相应调整.

目的 探讨基于腹腔镜超声图像的纹理分析在鉴别诊断肾透明细胞癌与非透明细胞癌中的价值.方法 回顾性分析我院经病理证实的83例肾细胞癌患者的腹腔镜超声检查资料,其中肾透明细胞癌66例,非透明细胞癌17例.在腹腔镜二维超声图像上通过ITK-SNAP软件手工勾画感兴趣区,采用Pyradiomics工具包提取纹理特征.使用组内相关系数选择具有良好稳定性和可重复性的特征;使用最大相关最小冗余(mRMR)和最小绝对收缩和选择算子(LASSO)回归进行特征选择并构建预测模型;绘制受试者工作特征(ROC)曲线分析该预测模型的诊断效能.结果 基于6个纹理特征构建的预测模型为:Y=-1.452+0.329×wavelet.LL glszm SmallAreaLowGrayLevelEmphasis-0.187×wavelet.LH firstorder Mean-0.209×wavelet.HH glszm SmallAreaLowGrayLevelEmphasis-0.107×original gldm DependenceVariance+0.351×wavelet.LH glrlm RunEntropy+0.058×wavelet.HH glszm ZonePercentage.该模型鉴别肾透明细胞癌与非透明细胞癌的ROC曲线下面积、敏感性、特异性和准确率及其对应的95例可信区间分别为0.860(0.771～0.945)、0.765(0.529～0.941)、0.864(0.788～0.939)、0.843(0.747～0.914).结论 基于腹腔镜超声图像的纹理分析可以准确鉴别肾透明细胞癌与非透明细胞癌.

目的 探讨基于腹腔镜超声的不同影像组学机器学习模型预测最大直径≤4 cm的肾脏肿块良、恶性的价值.方法 回顾性分析201 2年12月至2019年12月在华中科技大学同济医学院附属同济医院行腹腔镜手术肾脏实质性肿块患者的术中腹腔镜超声检查资料,根据病理结果分为恶性组(n=80)和良性组(n=62),随机选取60％的病例为训练组(n=84),40％的病例为验证组(n=58).采用Pyradiomics包提取良性组和恶性组病灶的107个影像组学特征.采用独立样本t检验或Mann-Whitney U检验对训练组中的特征进行筛选,基于支持向量机(SVM)、随机森林(RF)、逻辑回归(LR)、极限学习机(ELM)和K最近邻(KNN)这5种机器学习方法建模,采用ROC曲线评估模型诊断效能,并通过验证组数据验证模型的稳定性.结果 一共142个病灶纳入研究,影像组学方法初步提取107个特征,筛选出在肾脏肿块良、恶性分类中起主要作用的10个高度重复且非冗余的稳定特征.5种机器学习模型的预测性能分别为:SVM(ROC下面积、敏感度、特异度、准确度分别为0.816、0.882、0.750、0.828)、RF(ROC下面积、敏感度、特异度、准确度分别为0.881、0.971、0.792、0.897)、LR(ROC下面积、敏感度、特异度、准确度分别为0.866、0.794、0.708、0.759)、ELM(ROC下面积、敏感度、特异度、准确度分别为0.808、0.824、0.792、0.810)和KNN(ROC下面积、敏感度、特异度、准确度分别为0.831、0.912、0.750、0.845).结论 基于腹腔镜超声影像组学的机器学习模型可以区分肾脏小肿块的良、恶性.

目的 探讨可转换型滤器的置入和转换技术以及管理经验.方法 回顾性分析2018年1-12月期间笔者所在医院肝脏外科中心/血管外科收治的115例有随访资料的可转换型滤器置入病例的临床资料.结果 115例下肢深静脉血栓患者中男74例,女41例;年龄22～87岁、中位年龄54岁.可转换型滤器置入技术成功率为100％,无手术相关并发症.置入后随访4～ 455 d、中位随访时间90 d,有9例复发下肢深静脉血栓(7.8％),其发生时间为转换型滤器置入后16～104 d、中位复发时间42 d,其余均未发生任何不良事件.23例(20.0％)接受滤器转换手术,其中1例转换失败,22例成功转换,技术成功率为95.7％ (22/23).转换手术时间22.8～51.4min、中位时间27.4 min.转换手术距置入手术时间为4～455 d、中位时间为159 d.22例成功转换患者中,20例使用辅助技术,辅助技术使用率为90.9％.转换后随访30～180 d、中位随访时间90 d,随访中未发生任何不良事件.结论 可转换型滤器置入和转换手术安全性高,滤器转换技术成功率高,长期留置体内仍有机会转换成功,可作为临床滤器使用时的重要选项.

目的 探讨超声引导下透析用动静脉内瘘经皮腔内血管成形术中采用不同的麻醉方式的镇痛效果.方法 纳入2017年10月至2019年7月行超声引导下经皮腔内血管成形术共93例患者进行研究,患者采用随机分组的方式分为4组,其中无麻醉组20例,采用表面麻醉组27例,采用局部浸润麻醉组22例,采用高选择性局部神经阻滞麻醉组24例,观察其麻醉效果、实施麻醉的操作时间及术后并发症.结果 无麻醉组和表面麻醉组疼痛评分显著高于局部浸润麻醉组和神经阻滞组.无麻醉组疼痛评分最高,显著高于其他麻醉组;表面麻醉组疼痛评分居中,显著高于高选择性局部神经阻滞麻醉组和局部浸润麻醉组.高选择性局部神经阻滞麻醉组和局部浸润麻醉组疼痛评分差异无统计学意义.在实施麻醉的操作时间上,高选择性局部神经阻滞麻醉组操作时间最长,显著延长了手术时间.在术后并发症的观察中,表面麻醉组出现了1例局部红斑,局部浸润麻醉组出现了2例血管损伤,高选择性局部神经阻滞麻醉组出现了1例肌间血肿.结论 局部浸润麻醉和高选择性局部神经阻滞麻醉对于患者的手术疼痛耐受度较好,但是需要避免并发症的发生.高选择性局部神经阻滞麻醉和局部浸润麻醉的镇痛效果最好,但是高选择性局部神经阻滞麻醉显著延长了手术时间.表面麻醉有一定的镇痛效果,可以适用于疼痛不敏感的患者.3种麻醉方式都无严重并发症的发生.

目的:探讨基于二维超声图像的纹理分析对桥本甲状腺炎背景下甲状腺结节良、恶性的鉴别诊断价值.方法:回顾性分析2018年2月-8月在本院经病理证实的合并桥本甲状腺炎的甲状腺结节的二维超声图像.根据病理结果将甲状腺结节分为良性组和恶性组.采用ITK-SNAPE软件在甲状腺结节的二维超声图像上手工勾画兴趣区,通过python的Pyradiomics包提取纹理特征,采用独立样本t检验或Mann-Whitney U检验、Lasso回归对特征进行筛选和建模,采用受试者操作特征(ROC)曲线评估模型诊断效能.结果:共纳入合并桥本甲状腺炎的甲状腺结节93例(良性组45例,恶性组48例).筛选出3个纹理特征.构建的模型鉴别合并桥本甲状腺炎的甲状腺结节的良、恶性的ROC曲线下面积为0.842(95％CI:0.764～0.920),敏感度为0.791(95％CI:0.667～0.896),特异度为0.778(95％CI:0.667～0.889),符合率为0.785(95％CI:0.688～0.863).模型的诊断效能高于单一纹理特征的诊断效能.结论:基于二维超声图像的纹理分析可用于桥本甲状腺炎背景下甲状腺结节的良、恶性的鉴别诊断.

目的 评价基于腹腔镜超声的纹理分析在鉴别最大径≤4 cm的肾透明细胞癌与肾血管平滑肌脂肪瘤的诊断价值.方法 回顾性分析我院经病理证实的124例最大径≤4 cm的肾脏占位病灶(肾透明细胞癌患者66例和肾血管平滑肌脂肪瘤患者58例)的腹腔镜超声检查资料,将其随机分为训练组87例和验证组37例.通过ITK-SNAPE软件手工勾画感兴趣区,采用Pyradiomics工具包提取纹理特征.使用组内相关系数(ICC)选择具有良好稳定性和可重复性的特征;使用最大相关最小冗余(mRMR)和最小绝对收缩和选择算子(LASSO)回归方法进行特征选择和建模,采用受试者工作特征(ROC)曲线评估该模型鉴别肾透明细胞癌与肾血管平滑肌脂肪瘤的诊断效能.结果 预测模型由2个纹理特征构成,分别为glszm_GrayLevelNonUniformity和firstorder_90 Percentile,构建模型的计算公式为:Y=0.185+0.387×glszm_GrayLevelNonUniformity-0.319×firstorder_90 Percentile.在训练组和验证组中鉴别肾透明细胞癌与肾血管平滑肌脂肪瘤的ROC曲线下面积、敏感性、特异性分别为0.911、0.891、0.854和0.900、0.950、0.647.结论 基于腹腔镜超声的纹理分析可以准确鉴别最大径≤4 cm的肾透明细胞癌与肾血管平滑肌脂肪瘤.

Objective:To investigate the value of radiomics in discriminating benign and malignant renal masses based on laparoscopic ultrasound imaging.Methods:One hundred and nineteen patients undergoing laparoscopic surgical resection and histopathological analysis of renal masses in Tongji Hospital of Huazhong University of Science and Technology were retrospectively included from December 2012 to December 2018. All patients underwent preoperative laparoscopic ultrasound examinations. According to pathology, the patients were divided into benign group and malignant group, and all patients were randomly divided into training group ( n=84) and verification group ( n=35). One hundred seven radiomics features were extracted respectively in benign group and malignant group using pyradiomics. The independent sample t-test or Mann-Whitney U test and Lasso regression were used for features selection and model establishment in the training group. The performance of the model was evaluated by ROC curve, and the stability of the model was verified in the validation group. Results:A total of 119 patients met inclusion criteria (benign: n=54; malignant: n=65), and 5 radiomics features with statistical significance were selected to establish predictive model for discrimination of malignant and benign renal masses. The area under the ROC curve, sensitive, specific and accurate were 0.92, 0.96, 0.79, 0.88 in the training group and 0.91, 0.89, 0.88, 0.89 in the validation group, respectively. Conclusions:The predictive model based on radiomic features of laparoscopic ultrasonographic imaging provides a new approach for the discrimination of malignant and benign renal masses and lays a foundation for its application.

目的 探讨阴囊超声对于选择梗阻性无精子症治疗方式的价值.方法 前瞻性收集梗阻性无精子症患者93例行阴囊超声检查,观察附睾、输精管是否完整可见、有无扩张及钙化,测量扩张附睾管及输精管内径;根据后续治疗方式将其分为取精组(27例)和重建组(66例),比较2组病因及超声征象.采用ROC曲线评价超声参数用于筛选梗阻性无精子症治疗方式的临界值、敏感度、特异度、阳性预测值、阴性预测值和准确率.结果 2组间附睾形态异常、输精管细小或缺失、钙化及附睾管内径差异存在统计学意义(P均＜0.05),睾丸体积及输精管内径差异均无统计学意义(P均＞0.05).以附睾管内径0.55 mm为临界值筛选梗阻性无精子症治疗方式,其敏感度87.47％,特异度86.70％,阳性预测值77.82％,阴性预测值92.76％,准确率87.03％.结论 阴囊超声对于选择梗阻性无精子症治疗方式具有重要临床意义.

A wideband low noise amplifier (LNA) with integrated balun for 0.05-2.5 GHz frequency band was designed.The circuit was designed based on the paralleled cascade amplification structure which converted the single-ended input signal received from the antenna into a pair of differential signals for output to the post link.Aiming at the problem that the noise figure of the LNA with balun structure was not low enough and its output was unbalanced,the scaling technology,noise elimination technology and the two-stage fully differential output buffer were adopted to effectively reduce the noise figure of the circuit and improve the gain and output balance.The circuit was designed,simulated and fabricated with the TSMC 0.18 μm 1P6M RF CMOS process.The test results show that within the bandwidth of 0.05-2.5 GHz,the LNA achieves a maximum power gain of 24.5 dB,a noise figure of 2.6-4 dB in the whole frequency band,an input reflection coefficient of less than-10 dB,and an output differential signal amplitude and phase difference of less than 0.6 dB and 1.8°,respectively.

Objective To develop a probe for photoacoustic imaging and fluorescence imaging targeting integrin αvβ6 . Methods The probe was separated by RP‐HPLC .Molecular weight and the maximum absorption wavelength of the probe were detected by mass spectrum instrument and optical spectrum instrument . Various concentrations of the probe were detected by photoacoustic imaging and fluorescence imaging . The stability of the probe was evaluated when exposed under laser . Targeting of the probe on integrinαvβ6 was evaluated in cell uptake assay with integrinαvβ6 positive and negative cells . The minimum number of cells that could be detected by photoacoustic imaging and fluorescence imaging was also evaluated . Results The probe ICG‐peptide was separated from reaction mixture by RP‐HPLC .The probe had a retention time of 21 .4 minutes and m/z of 4 727 . The labeling ratio of the probe was 1∶1 . The maximum absorption wavelength of the probe was 790 nm . The photoacoustic signal was linearly dependent on the concentration of the probe . The fluorescence signal was linearly dependent on the concentration of the probe when the concentration was smaller than 1 .5 × 10 -5 mol/L . The lowest concentration of the probe that could be detected above the background by photoacoustic imaging and fluorescence imaging was 0 .09 × 10-5 mol/L and 0 .05 × 10-5 mol/L ,respectively . No obvious decrease of the photoacoustic signal was observed after the probe was scanned 20 times ( each time lasted for 1 min) by laser . There existed differences ( P <0 .001) in cell uptake of the probe with various concentrations and reaction time between A431 cells (αvβ6 positive) and 293T cells (αvβ6 negative) . Cell uptake was inhibited by the addition of 5μmol/L unlabeled peptide in A431 cells ( P = 0 .001 ) . The lowest number of the labeled A431 cells detected by photoacoustic imaging and fluorescence imaging was 0 .4 × 106 and 0 .05 × 106 ,respectively . Conclusions The dual functional photoacoustic and fluorescence probe targeting integrin αvβ6 was successfully developed . The targeting and sensitivity of the probe makes it potentially useful in early detection of αvβ6 positive tumors .

目的 探讨彩色多普勒超声在肾移植术后并发症中的临床应用价值.方法 整群选取该院2010年1月—2014年12月间收治的156例患者作为研究对象,所有患者均行肾移植手术治疗,并在术后的1周、1个月、3个月、半年、一年采用彩色多普勒超声进行复查,观察患者的二维超声声像图和彩色多普勒血流频谱变化情况,计算其并发症发生率,以多项临床检查结果为依据,计算彩色多普勒超声诊断的符合率.结果 156例实施肾移植手术治疗的患者,经彩色多普勒超声诊断,共检出42例并发症患者,并发症发生率为26.90%,以移植肾急性排斥所占比例最高,为12.18%,显著高于其他并发症发生率,比较差异有统计学意义(P<0.05).彩色多普勒超声诊断结果与临床资料的符合率为92.86%(39/42).结论 通过彩色多普勒超声可以对肾移植术后的并发症发生情况进行诊断,操作操作简便、无创、重复性良好、准确度高,可以作为肾移植术后并发症筛查的首选方法,值得临床推广应用.

Objective To observe the effect of alprostadil combined with beraprost sodium tablet sequential therapy in early mutation and long term survival of arteriovenous fistula(AVF).Methods Weretrospectively analyzed 312 uraemia patients who received AVF operation first time between January 2013 and March 2014.All patients were given radialartery-cephalic vein standard fistulation.Forty-six patients were administered alprostadil(20 μg i.v.drip for 3 days in hospital) combined with beraprost sodium tablet(20 μg P.O.for 3 months for outpatient) sequential therapy as study group.Forty-six patients without treatment of alprostadil or beraprost sodium were included into control group.These two groups had the same clinical materials,such as age,the diameter of artery and vein before operation,primary disease constitution rate.The fistula dysfunctional rate in 1 year,fistula mutation time,average fistula flow volume and arterial end diastolic velocity 1 year postoperation were assessed.Results In study and control groups,the fistula dysfunctional rate was 10.9%and28.2%respectively(P=0.035 5),the mean maturation time was(42.1±6.5)and(55.5±5.8) days respectively(P<0.001),the mean blood flow was(789 ± 101) and(556 ± 132) mL/min respectively(P<0.001),and the arterial end diastolic velocity was(151.5 ± 14.5) and(113 ± 20.1) cm/s respectively(P<0.001).Conclusions Our data indicated that the sequential therapy of alprostadil combined with beraprost sodium tablet is effective and safe for the prevention of primary AVF failure in hemodialysis patients and early fistula dysfunction.

颈部假性动脉瘤（pseudoaneurysm，PSA）发病率非常低，但可能导致无法控制的出血甚至危及生命［1］。传统外科手术对于PSA动脉破裂口的直接修复和血管塑形难度很高，往往需要牺牲载瘤动脉或进行血管架桥手术，死亡率和致残率较高［2］。超声引导下小剂量凝血酶注射术因其简单、经济、便捷、有效、安全已成为外周动脉PSA 治疗的重要手段，临床报道较多［3］。而关于超声造影（contrast-enhanced ultrasonography，CEUS）和彩色多普勒超声（color dopple ultrasonography，CDUS）引导下凝血酶注射治疗颈部PSA 的病例还未见报道。笔者回顾分析了两例在本院诊治的颈部 PSA 患者的相关影像学资料和诊疗经过，旨在探讨 CEUS 及 CDUS 在凝血酶注射治疗颈部 PSA中的应用价值。

目的:探讨肾孤立性纤维性肿瘤的影像学特征、病理学特征。方法:对1例直径1cm肾孤立性纤维性肿瘤患者术前进行彩色超声、CT及MRI检查,术后进行病理学观察及免疫组化标记,并结合相关文献进行分析。结果:影像学检查提示为肾实质性肿瘤。术后病理检查显示梭形肿瘤细胞排列无明显特征,但含有较丰富的薄壁血管和灶性胶原纤维束;瘤细胞表现温和,界限不清晰,胞质红染,核仁不明显,核分裂象少见,免疫组织化学检查:CD34、vimentin、bcl-2、CD99、CD10均阳性,CD31、SMA、desmin、S-100、PCK、EMA、CD21、CD23均阴性,Ki-67增殖指数为5%。结论:原发性肾孤立性纤维性肿瘤临床十分罕见,小肿瘤的影像学表现可能有某些特征,但仍需要病理学检查确诊。

Objective: To analyze the significance of ultrasound diagnosis of type 2 diabetic patients with lower extremity arterial vascular lesions, and provide a theoretical basis for the ultrasound in the diagnosis of lower extremity arterial type 2 diabetes. Methods: 100 cases of type 2 diabetic patients who were treated in our hospital from April 2011 to October 2012 were selected to be the observation group, and another 100 healthy people were defined as the control group. Then to compare the difference of lower extremity arterial color Doppler ultrasound between two groups. Results: 85 cases with plaque in the observation group were detected, including 23 cases with stenosis, 13 cases with occlusion, while 21 cases, were detected in the control group, including 12 and 0 respectively. There were statistically significant differences of the lower extremity arterial lumen plaque, stenosis and occlusion between two groups, which in the observation group were higher than those of the control group(P0.05); the dorsal artery of foot diameter was(1.25±0.07) mm of patients with 10-15 years disease course which was significantly lower than that of the control group; the, all of lower extremity arterial diameter of patients with disease course more than 25 years were significantly lower than those of the control group(P0.05); Anterior femoral artery, posterior tibial artery and dorsalis pedis artery blood flow speed was significantly of observation group is lower than that of the control group(P 0.05); there were no obvious statistical difference about the femoral artery and popliteal artery blood velocity between two groups(P0.05). Conclusions: Ultrasound can effectively reflect the situation of type 2 diabetic patients with lower extremity arterial disease, and is noninvasive, repeated inspection and other advantages of lower costs that could reduce the medical burden of patients, provide favorable conditions for the early diagnosis of vascular disease and the prevention for foot complications.