目的 分析川崎病(kawasaki disease,KD)患儿血脂代谢的变化及其与炎症指标的相关性,探讨其在KD患儿中的临床意义.方法 回顾性收集86例KD患儿、63例严重感染患儿、46例轻度感染患儿和44例健康儿童的血脂检测结果;同时收集KD患儿是否不完全性川崎病、是否8周内冠状动脉扩张,以及血常规检测结果;比较4组儿童的血脂差异并对KD患儿的血脂和炎症指标进行相关性分析.结果 总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、非高密度脂蛋白胆固醇(non-HDL-C)水平和APOB/LDL-C在4组儿童间比较差异均有统计学意义(P<0.05);KD患儿的HDL-C和APOA1水平与C反应蛋白(CRP)水平成负相关(r=-0.340、-0.383,P<0.05).结论 急性期KD患儿存在血脂代谢紊乱,且与炎症密切相关.

Objective:Radiation doses to the general public and nuclear medicine technicians from patients undergoing 99Tc m-methylenediphosphonate(MDP) bone scintigraphy were estimated. Methods:A total of 64 patients (38 males and 26 females, aged 24-82 (55.1±12.8) years) undergoing bone scintigraphy with 99Tc m-MDP were retrospectively enrolled in this study. Approximately at 15 minutes after injection of 99Tc m-MDP, whole-body dose-equivalent rate (DR) was measured with a radiation-survey meter at 0.3 meter and 1.0 meter from the patients with nuclear radiation monitoring detector. On the basis of the human social contact model defined by the National Council on Radiation Protection and Measurements and human 99Tc m-MDP metabolic rate suggested by the International Commission of Radiological Protection, the radiation doses to the general public and the nuclear medicine technicians after exposure to patients undergoing 99Tc m-MDP bone scintigraphy were calculated. Results:The whole-body DR values of 64 patients at 15 minutes after injection of 99Tc m-MDP were 70.8-154.2 (105.5 ± 20.9) and 15.9-32.7 (22.6±3.6) μSv/h, respectively, at 0.3 meter and 1.0 meter. The following radiation doses were estimated: to a family member contacting with a patient at daytime 13.3-27.4 (18.9±3.0) μSv; to a family member sleeping with a patient at night 78.2-170.3 (116.5±23.4) μSv, to a colleague 17.6-36.2 (25.0±4.0) μSv and to a adjacent passenger 219.9-478.8 (327.5±65.7) μSv. The radiation dose to a technician per 99Tc m-MDP imaging patient was estimated to be 3.9-8.5 (5.8±1.2) μSv. Conclusion:The predicted radiation doses to the general public and technicians from exposure to patients undergoing 99Tc m-MDP bone scintigraphy are significantly lower than the regulatory dose limits.

1 临床资料 1.1 一般资料:2019年10月至2020年7月甲状腺外科住院并行甲状腺切除合并上腔静脉置换术的3例甲状腺癌术后复发患者,其中男2例,女1例,年龄24 ～68岁.3例患者均为甲状腺癌术后1～4年内复发,术前甲状腺彩超提示3例患者均有残余甲状腺的包块与淋巴结的转移,穿刺病理显示其中2 例为甲状腺滤泡癌,1例为乳头状癌.

Objective:To systematically evaluate the rate of unplanned readmissions for children at 30 days after cardiac surgery, the causes and risk factors for unplanned readmissions for children at 30 days after cardiac surgery.Methods:We searched PubMed, Embase, Web of Science, CBM, CNKI, Wanfang Data, and VIP database to collect studies from inception to August 15, 2020 of unplanned readmission of children after cardiac surgery.RevMan5.3 software was used for Meta-analysis.Results:A total of 13 studies, involving 81 633 patients were included.Meta-analysis results showed that the unplanned readmission rate of children 30 days after cardiac surgery was 11.5%(95% CI 9.9%-13%). Cardiac complications[24%(95% CI 10.7%-45.7%)], infections[18.7%(95% CI 13.7%-25.3%)], respiratory complications[18.0%(95% CI 10.7%-27.5%)], pleural effusion[11.5%(95% CI 8.3%-16.7%)], and gastrointestinal complications[12.3%(95% CI 8.3%-17.4%)] were the main reasons for unplanned 30-day readmission, with statistically significant differences( P<0.001). Genetic syndrome( OR=1.25, 95% CI 1.18-1.33, P<0.05) and postoperative hospital stay >14 days( OR=1.62, 95% CI 1.05-2.50, P<0.05) were risk factors for unplanned 30-day readmission. Conclusion:The incidence rate of unplanned readmission among the children 30 days after cardiac surgery is relatively high.Cardiac complications, infection, respiratory complications, pleural effusion, and gastrointestinal complications are the main reasons for 30-day unplanned readmission.The genetic syndrome and postoperative hospital stay >14 days in children 30 days after cardiac surgery are the risk factors for unplanned readmission.

目的 探讨高敏心肌肌钙蛋白T(hs-cTnT)在重症监护室(ICU)患儿预后评估中的价值.方法 回顾性收集我院ICU住院治疗的非创伤和外科干预患儿的临床资料,根据出院时的结局分为存活组和死亡组.通过Logistic回归分析影响患儿住院期间死亡的危险因素,使用受试者工作特征(ROC)曲线评价hs-cTnT对ICU住院患儿预后的预测价值.结果 死亡组hs-cTnT水平显著高于存活组(P＜0.05);死亡组儿童危重病例评分(PCIS)的危重和极危重比例显著高于存活组(P＜0.05).多因素Logistic回归分析显示hs-cTnT(OR=9.590)和PCIS(OR=3.114)是ICU患儿临床不良预后的独立危险因素.hs-cTnT预测预后的ROC曲线下面积(AUC:0.816)大于PCIS的ROC曲线下面积(AUC:0.769).结论 hs-cTnT能很好地预测ICU非创伤和手术干预患儿的临床预后.

目的 研究非酒精性脂肪肝(non alcoholic fatty liver disease,NAFLD)对2型糖尿病患者发生室性心律失常的影响.方法 回顾性分析2019年1～12月接受24小时动态心电图检测的2型糖尿病患者308例,根据超声表现,合并NAFLD者203例为非酒精性脂肪肝组,其它105例纳入无NAFLD组.分析两组间室性心律失常的发生特点.结果 与无NAFLD相比,NAFLD组出现每小时室性早搏大于30次、非持续性室速,或两者均有的风险更高(P<0.05).合并NAFLD的2型糖尿病患者室性心律失常的概率增加(OR=3.35,95％CI:1.26～7.17,P=0.013),调整年龄、性别、体重指数、吸烟、高血压、缺血性心脏病、瓣膜性心脏病、血清谷氨酰转移酶水平、抗心律失常药物使用和左室射血分数后差异仍具有统计学意义.结论 合并NAFLD的2型糖尿病患者,室性心律失常发生的概率增加.

神经母细胞瘤( neuroblastoma, NBL)是儿童最常见的颅外实体瘤,放射性核素显像在欧美国家已较广泛地用于NBL的诊断、分期、疗效评价及随访监测,相关临床工作国内目前仍较少开展.现就放射性核素显像在NBL诊治中的应用综述如下,以期指导、规范国内NBL的诊治.

目的 探讨Episure TM AutoDetect TM注射器用于下胸段硬膜外穿刺的临床安全性及有效性.方法 本研究分两部分进行.第一部分:选择拟择期行腹部手术患者40例,随机分为玻璃注射器组(GS组)与Episure TM AutoDetect TM注射器组(EAS组),两组均采用正中入路法行硬膜外穿刺置管.第二部分:选择拟择期行腹部手术患者40例,随机分为超声引导玻璃注射器组(U+GS组)与超声引导Episure TM AutoDetect TM注射器组(U+EAS组),两组均采用超声引导旁正中入路法行硬膜外穿刺置管.两部分研究中,硬膜外穿刺置管成功者均采取全身麻醉复合硬膜外阻滞完成手术,术后行硬膜外镇痛.两部分研究均观察:成功定位硬膜外腔时间、穿刺并发症、操作成功率、测压次数、进针次数、破皮次数、操作时受试者满意度以及术中麻醉与术后恢复等数据.结果 第一部分研究:EAS组平均成功定位硬膜外腔时间显著短于GS组(P=0.002);EAS组中位测压次数显著少于GS组(P<0.05);EAS组未发生意外刺破硬脊膜,GS组2例意外刺破硬脊膜致穿刺失败(P=0.486);EAS组和GS组穿刺成功率分别为100％vs.89.5％(P=0.486);两组其它观察指标差异均无统计学意义(P>0.05).第二部分研究:U+EAS组平均成功定位硬膜外腔时间显著短于U+GS组(P=0.001);U+EAS组中位测压次数显著少于U+GS组(P=0.012);U+EAS组未发生意外刺破硬脊膜,U+GS组1例意外刺破硬脊膜致穿刺失败(P>0.05);U+EAS组和U+GS组穿刺成功率分别为100％vs.95.0％(P>0.05);两组其它观察指标均无统计学差异(P>0.05).结论 Episure TM AutoDetect TM注射器定位精准、安全性好、操作简便、节省时间,可较为安全、有效地应用于临床下胸段硬膜外穿刺.Episure TM AutoDetect TM注射器与超声引导技术结合应用时,二者优势互补并产生其他独特优势,因此仍可较为安全、有效地应用于临床下胸段硬膜外穿刺.

近年来,随着心脏外科和体外循环( extracorpo?real circulation, ECC)技术的提高,心脏术后死亡率有所下降,但中枢神经系统并发症、急性肾损伤(a?cute kidney injury, AKI)等依然是术后常见并且严重的并发症,直接影响患者的愈后. 这迫使人们优化ECC管理策略,保证机体灌注. 为此,一些专家将感染性休克治疗中的目标导向治疗概念引入ECC领域,并被定义为目标导向灌注( goal-directed perfusion, GDP)[1-2],以维持ECC中充分而合理的灌注,降低心脏手术死亡率和术后并发症.

纤维化是指机体受到各种因素刺激,多种纤维化相关信号通路被激活并共同介导,引起胶原蛋白、纤维连接蛋白、蛋白多糖、弹力蛋白等沉积导致靶器官和组织结构异常的过程.TGF-β1/Smads是公认的在纤维化过程中起关键调控作用的信号通路.研究发现紫杉醇能通过抑制TGF-β1/Smads信号通路而发挥抗纤维化作用.主要对紫杉醇在多种纤维化疾病中应用的研究进展进行综述.

目的 探讨18F-氟代脱氧葡萄糖(18F-fluorodeoxyglucose,18F-FDG)PET/CT在前列腺癌骨转移与多发性骨髓瘤(multiple myeloma,MM)鉴别诊断中的应用价值.方法 选取2014年3月至2019年1月本院收治的51例前列腺癌骨转移瘤患者和43例MM患者为研究对象,分别纳入前列腺癌组和MM组,分析两组患者18F-FDG PET/CT检查结果的差异.结果 前列腺癌组患者的骨转移多累及骨盆(96.1％),其次为脊柱(88.2％);MM组全部患者的肋骨均受累(100.0％),其次为脊柱(65.1％).前列腺癌组患者的骨盆、脊柱和股骨处病变发生率均明显高于MM组(均P<0.05),肋骨、颅骨和肩关节处的病变发生率均明显低于MM组(均P<0.05).前列腺癌组患者的病灶数显著多于MM组(P<0.05).MM组患者病灶的骨质破坏以溶骨性病变为主(70.5％),成骨性病变较少(3.9％),而前列腺癌组患者病灶溶骨性病变、成骨性病变和混合性病变的占比接近,两组患者骨质破坏类型比较差异有统计学意义(P<0.05).MM组患者骨质疏松发生率显著高于前列腺癌组(P<0.05).PET影像学特征:前列腺癌骨转移病灶以不均匀高代谢为主,MM病灶以弥漫性轻中度代谢为主.前列腺癌组的大标准摄取值(maximum standard uptake value,SUVmax)、18F-FDG高摄取、代谢不均匀的比率均显著高于MM组(均P<0.05).前列腺癌组病灶的CT正常而PET异常、CT和PET均异常的发生率均显著高于MM组(均P<0.05),CT异常而PET正常的发生率显著低于MM组(P<0.05).结论 18F-FDG PET/CT对前列腺癌骨转移和MM有较高的鉴别诊断价值,其能通过全面分析病灶的骨质结构和代谢活性来提高诊断效能.

目的 探讨丙种球蛋白(IVIG)敏感型川崎病(KD)和耐药型KD患儿冠状动脉病变(CAL)的差异.方法 回顾性分析2013年6月至2018年7月西南医科大学第一附属医院收治的KD住院患儿的临床资料,采用x2检验比较IVIG敏感型KD和耐药型KD患儿的CAL差异.结果 1 003例KD患儿中,IVIG敏感型KD 894例(89.1％),IVIG耐药型KD 109例(10.9％).全部KD患儿的CAL发生率为29.7％,IVIG敏感组与耐药组CAL发生率分别为28.6％和38.5％,差异有统计学意义(P＜0.05);IVIG敏感组小型、中型、巨大冠状动脉瘤患儿所占比例分别为90.2％、8.2％、1.6％,IVIG耐药组分别为76.2％、21.4％、2.4％,差异有统计学意义(P＜0.05);IVIG敏感组CAL严重程度临床分级Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级所占比例分别为71.4％、19.9％、8.3％、0.4％,IVIG耐药组分别为61.5％、20.2％、17.4％、0.9％,差异有统计学意义(P＜0.05);IVIG敏感组与IVIG耐药组分别有78.1％和59.5％的患儿在随访3个月时CAL恢复正常,差异有统计学意义(P＜0.05).结论 与IVIG敏感型KD患儿相比,IVIG耐药型KD患儿的CAL发生率更高,病变程度更重,恢复更慢.

Objective:To observe the suction compound anesthesia with intravenous anesthesia and two different anesthetic methods for breast cancer postoperative neutrophils and lymphocytes. Methods:A prospec-tive study was conducted. 100 patients with breast cancer were randomly divided into two groups. Group A(n=50) received total intravenous anesthesia,group B (n=50) received static inhalation combined anesthesia. The changes of neutrophils count (N), lymphocyte count (L) and neutrophils / lymphocyte ratio (NLR) were compared before and after the operation. Results:There was significant difference in serum N, L and NLR values between the two groups before and after operation(P < 0.05). There was no significant difference in the value of N,L and NLR between the two groups after operation (P > 0.05). Conclusion:Two different ways of total intravenous anesthesia and intravenous inhalation combined anesthesia have slight effect on the N, L and NLR value of breast cancer after operation. It is suggested that anesthesia should be chosen accord-ing to the actual situation of patients.

目的探讨临时心脏起搏治疗在儿童缓慢性心律失常所致严重血流动力学紊乱中的作用。方法回顾分析3例以临时心脏起搏救治的缓慢性心律失常所致严重血流动力学紊乱患儿的临床资料。结果 3例患儿中1例男性12岁,2例女性均为5岁;均先以药物治疗,病情仍持续加重,在入院后10小时内安装临时心脏起搏器治疗,血流动力学障碍很快得到改善。1例男性患儿在术后10天、1例女性患儿在术后11天撤除临时心脏起搏器,经短期随访,均预后良好;1例女性患儿在术后21天家属放弃治疗,门诊随访1年,患儿存活,但有心功能不全表现。结论严重缓慢性心律失常所致血流动力学紊乱时,及时安置临时心脏起搏器装置效果良好。

目的:探讨平板运动试验与超声心动图负荷试验对青年冠心病的诊断价值.方法:回顾性分析符合入选标准的疑似冠心病青年患者63例,分析患者的临床资料,包括平板运动试验、超声心动图负荷试验结果.结果:与冠脉造影结果比较,平板运动试验与超声心动图负荷试验阳性检出率差异均无统计学意义(P>0.05).平板运动试验与超声心动图负荷试验对青年冠心病的诊断具有较高的敏感性、特异性、准确性以及阳性、阴性预测值,超声心动图负荷试验诊断价值更优;两种试验的阳性检出率均随着冠脉病变程度的加重而增加(P<0.05).结论:超声心动图负荷试验对青年冠心病患者具有较好的诊断效能.

目的 分析川崎病合并低钠血症患儿的临床表现、实验室检查特征及冠状动脉损伤情况.方法 回顾性分析191例川崎病患儿的临床资料,根据血清钠水平分为低钠血症组48例和非低钠血症组143例,比较两组临床表现、实验室检查结果 及冠状动脉扩张情况.结果两组皮疹、结膜充血、手足肿胀、淋巴结肿大、卡疤发红等临床表现的发生率比较差异均无统计学意义(均P>0.05).低钠血症组中性粒细胞比例、C反应蛋白高于非低钠血症组(均P<0.05).在入院3 d内及发病后1个月,低钠血症组冠状动脉损伤者比例均高于非低钠血症组(均P<0.05).结论 川崎病合并低钠血症患儿更容易出现冠状动脉损伤,低钠血症可能与严重的炎症反应有关.

The technical operation criteria and clinical application guidelines for pediatric nuclear medicine include information related to the preparations,precautions,responsibilities of nuclear personnel,dosage of radiopharmaceutical,history-taking,imaging protocol,as well as indication and safety,focusing primarily on the usual pediatric nuclear medicine examinations.The purpose of the criteria and guidelines is to offer nuclear medicine physicians a framework that could prove practical and helpful in daily clinical practice.

The clinical nuclear medicine can be used for disease diagnosis and treatment,however,in the diagnosis and treatment process,the patient becomes a source of radiation not only to him/herself,but also to the general public and medical staff,which has been a topical subject with the public awareness of radiation protection gradually.How we scientifically regard the radiation will help promote the development of nuclear medicine,and eliminate the fear of the public.The radiation protection and safety is an important part of clinical nuclear medicine and the development of fine disciplines.The new ideas and knowledge about radiation protection and safety of patients,public and nuclear medical staff in recent years were reviewed in this article.

v-raf murine sarcoma viral oncogene homolog B1 (BRAF) mutation represents the most common oncogenic event in papillary thyroid cancer(PTC).The value of BRAF mutation in the diagnosis and guiding treatment of PTC has achieved enthusiastic investigation since the initiation and progression of PTC has been correlated with BRAF mutation.However,existing evidence does not suggest BRAF mutation as an independent factor in guiding surgical approach,stratifying recurrence risk,or selecting postoperative radioiodine therapy for PTC patients.Although sorafenib and selumetinib have effectively improved the prognosis of patients with radioactive iodine-refractory PTC,such efficacy is independent of BRAF mutation status.

Objective To explore the inl uence of propofol as well as sevol urane on the histamine release induced by mivacurium chloride. Methods Forty patients with American Sociaty of Anesthesiologists stage Ⅰ- Ⅱ scheduled to receive ear-nose-throat surgery between March and October 2012 were recruited and were randomly assigned into two groups: propofol group and sevoflurane group. Patients in the propofol group were induced with targeted intravenous infusion with propofol. Patients in the sevol urane group was induced with sevol urane. The blood specimen was prepared before mivacurium chloride(0.16 mg/kg) infusion(T0), 1 minute(T1), 3 minutes(T2), and 5 minutes(T3) at er the infusion. Mean blood pressure(MBP) and heart rate(HR) were recorded at corresponding time points. In addition, we recorded the symptoms of anaphylactic reaction such as skin erythema or bronchospasm. Results Both MBP and HR decreased at er anesthesia induction. However, there was no signii cant dif erence from that before the induction in both groups, and no dif erence was found between the two groups(P 0.05). The concentration of histamine in both groups at T1 and T2 was signii cantly higher than that at T0(P 0.05). The concentration of histamine in both groups at T4 was signii cantly higher than that at T0(P 0.05). The concentration of histamine in the propofol group was higher than that in the sevol urane group. No skin erythema or bronchospasm was found in any of the two groups. Conclusion Mivacurium chloride at a dose of 0.16 mg/kg can be safely used in propofol anesthesia, as well as sevol uane anesthesia, with no clinically signii cant histamine release or adverse hemodynamic l uctuation.