目的 探讨孤独症谱系障碍(ASD)男童大脑白质网络中节点全局与局部效率属性值的改变,从脑网络信息传输效率角度分析与ASD男童发病相关的中枢机制.方法 共入组23例ASD男童(研究组)和17名正常发育儿童(对照组),收集其一般人口学与临床资料、大脑T1结构磁共振数据和弥散张量成像数据.分别使用FSL与Trackvis软件对大脑影像数据进行预处理和全脑白质纤维追踪.利用AAL模板将大脑分为90个区域,进一步结合纤维追踪结果构建脑白质网络.通过BCT软件包计算节点的全局与局部效率属性值.使用SPSS软件对组间节点效率属性值进行双样本t检验,同时使用FDR方法对结果进行多重比较校正.结果 节点局部效率属性值:研究组右侧海马、壳核、苍白球、丘脑(组间差异通过FDR校正)均较对照组下降,而左侧缘上回较对照组上升(P<0.05).节点全局效率属性值:研究组右侧额上回背外侧、额下回眶部、额上回内侧眶部、直回、岛叶、海马旁回、苍白球、丘脑(组间差异通过FDR校正)、颞横回及左侧额上回内侧、苍白球均较对照组下降(P<0.05).结论 右侧丘脑在ASD男童大脑白质网络中的信息传输效率发生下降,可能会导致其在大脑中的信息整合作用发生下降,进而导致男童出现一系列ASD相关的临床症状.

目的 探讨伴与不伴抑郁情绪孤独症谱系障碍(autistic spectrum disorder,ASD)患儿静息态脑功能磁共振成像特征的差异及与其临床特征的相关性,从脑功能角度了解ASD患儿伴发抑郁情绪的病理机制.方法 前瞻性地收集20例伴抑郁的ASD患儿、25例不伴抑郁的ASD患儿及25名正常发育(typical development,TD)儿童的一般人口学资料,并使用儿童孤独症评定量表和儿童抑郁量表对ASD症状和抑郁症状进行评估,采集所有被试的大脑T1像结构磁共振数据和静息态功能磁共振数据,计算自动解剖标记(automated antomical labeling,AAL)模板中90个脑区的局部一致性值(regional homogeneity,ReHo).比较三组脑区ReHo值并分析差异脑区的ReHo值与临床特征相关性.结果 基于ReHo值的比较分析显示:与TD组相比,伴抑郁ASD组额叶差异区域主要分布于默认网络、听觉网络、感觉运动区域、注意网络(P<0.001,经AlphaSim校正),颞叶差异脑区主要分布于听觉网络(P<0.001,经AlphaSim校正),顶叶差异区域主要分布于默认网络、感觉运动区域(P<0.001,经AlphaSim校正);与TD组相比,不伴抑郁ASD组额叶差异区域主要分布于听觉网络(P<0.001,经AlphaSim校正),顶叶差异区域主要分布于默认网络、注意网络(P<0.001,经AlphaSim校正);与不伴抑郁ASD组相比,伴抑郁ASD组差异脑区主要分布于感觉运动区域、注意网络(P<0.001,经AlphaSim校正).伴抑郁ASD组右侧额中回(眶部)ReHo值与儿童孤独症评定量表总分(r=0.631,P=0.003)和儿童抑郁量表总分(r=0.656,P=0.002)呈正相关.结论 伴抑郁情绪ASD的发生与大脑广泛区域功能下降相关,尤其是感觉运动区域及注意网络功能下降.

Objective:To observe the effect of oral-facial muscle training applying virtual reality technology (VR) and of action observation therapy on the salivation of children with cerebral palsy (CP).Methods:Sixty CP children with uncontrolled salivation were randomly divided into a control group and an observation group, each of 30. In addition to conventional rehabilitation treatment, the control group received routine tongue muscle training, buccal lip muscle training, ice stimulation, and Masako swallowing training. The observation group received oral-facial muscle training based on action observation therapy in a virtual environment. Both groups were trained 30min per day, 5 times a week for 3 weeks. Before and after the treatment, drooling (DDSS) and swallowing function scores were evaluated. Integrated surface electromyography (iEMG) of the buccinator and orbicularis oris muscles was also performed.Results:After treatment, a significant decrease was observed in the average DDSS and the swallowing function scores of both the control and observation groups, along with a significant increase in the average root mean square values of the buccinator and orbicularis oris iEMGs of both groups. However, the average DDSS score of the observation group was significantly lower than that of the control group, while the average iEMG readings were significantly better.Conclusion:VR-based action observation oral-facial muscle training is a more effective supplement to conventional rehabilitation treatment than conventional oral-facial muscle training in improving the salivation of children with CP.

目的:针对传统活体体模和水模模拟脑出血的缺陷,研制一种注血凝胶模.方法:该注血凝胶模由填充物、血液、试管、盖体和模体5个部分组成.其中模体采用双层亚克力材料(或其他材料)的圆柱体(或球体)上开加盖设计,填充物采用凝胶物质吉利丁片和CuSO4·5H2O按一定比例制备而成.对该注血凝胶模进行磁共振磁敏感加权成像(susceptibility weighted imaging,SWI)和弥散加权成像(diffusion weighted imaging,DWI)扫描,观察出血情况模拟效果;将含铁浓度不同的测试液插入注血凝胶模中进行SWI扫描,观察随着含铁浓度的增加SWI信号的变化.结果:对该注血凝胶模进行SWI和DWI扫描,能清晰成像并呈现凝胶模中注血部位的范围及大小;SWI扫描能清晰分辨出凝胶模中含铁浓度不同的测试液,且随着含铁浓度的增加,SWI扫描信号逐渐变低.结论:该注血凝胶模制作简易、成本低且可反复利用,为模拟脑出血提供了可靠的保障.

目的:通过俯卧位和仰卧位磁共振成像(MRI),定量评估体位改变时乳腺肿瘤的位置及形态变化,以供保乳术参考.方法:选取医院收治的27例乳腺肿瘤患者,所有患者完成标准俯卧位MRI扫描后,立即进行仰卧位Dixon序列扫描.肿瘤分割后对两种体位上各肿瘤的体积和位置进行评估,测量两种体位上乳腺肿瘤的体积;以剑突中心点为原点,分析不同体位下肿瘤位置的变化;测量肿瘤中心到胸壁的距离,并评估此距离与肿瘤位置变化的相关性.结果:俯卧位和仰卧位肿瘤体积的平均值分别为(9.797±9.390)cm3和(9.795±9.4131)cm3,两者比较差异无统计学意义(t=0.711,P>0.05).从俯卧位到仰卧位,以剑突中心点为原点平均移动(63.1±26.2)mm,且与肿瘤中心至胸壁的距离密切相关(r=0.669,P<0.05).结论:由俯卧位向仰卧位移动时,以剑突中心点为原点,在冠状面上肿瘤趋向于从身体正中矢状线向外移动;在矢状面上向身体内侧移动;在横轴位上向外、向下移动并靠近体表.俯卧位MRI预测仰卧位乳腺肿瘤位置信息有助于外科医生利用标准俯卧位MR图像定位手术时肿瘤的位置.

Objective:To summarize and analyze the clinical and genotype features of female-restricted X-linked syndromic mental retardation-99(MRXS99F, OMIM: 300968)caused by USP9 X gene mutation, and to improve the clinicians′ understanding of the disease. Methods:Clinical data and genotypes of 2 children with MRXS99F treated in the Children′s Hospital of Nanjing Medical University in March 2020 (case 1) and June 2020 (case 2) were analyzed, and the relevant databases at home and abroad were reviewed to summarize the clinical characteristics and gene variation characteristics of the disease.Results:The 2 cases were 6 months old (case 1) and 5 years old (case 2), both showed psychomotor retardation.Case 1 presented a short stature, pigment abnormality, characteristic facial features, hypotonia, recurrent respiratory tract infections, laryngeal cartilage hypoplasia, atrial septal defect, feeding difficulty, hearing loss and brain hypoplasia.Case 2 had abnormal electroencephalogram.As confirmed by whole-exome sequencing, two children carried c. 6972+ 1G>A, c.6437C>T of USP9 X, respectively.Neither of the 2 variations was previously reported.Twenty-two cases of MRXS99F caused by USP9 X gene mutation were reported in 4 literatures globally, and 24 cases were combined with this study.The clinical manifestations of 20/22 children had special faces.All of them accompanied mental retardation combined with motor and language retardation, and carried neonatal variation. Conclusions:This is the first case report of MRXS99F induced by USP9 X gene variation in China.MRXS99F caused by functional deletion and variation of USP9 X gene is mainly characterized by psychomotor retardation, language disorder, special face and multiple congenital malformations.For children with unexplained growth retardation, special face and multiple congenital malformations, genetic testing like high-throughput sequencing should be carried out as early as possible to determine the etiology.

OBJECTIVE:To investigate the correlation of the total testosterone (TT) level with insulin secretion and resistance in patients with acanthosis nigricans (AN) and non-acanthosis nigricans (NAN). METHODS:This study was conducted in a total of 639 overweight patients (body mass index ≥24 kg/m2), including 137 female AN patients, 277 female NAN patients, 129 male AN patients, and 146 male NAN patients. Each group was further divided into 4 subgroups according to the quartile of TT level for comparison of insulin secretion and insulin resistance parameters. RESULTS:Both female and male patients with AN showed obvious hyperinsulinemia with increased area under the curve for insulin (AUC-INS) (P < 0.05), increased homeostatic model assessment of insulin resistance (HOMA-IR) index (P < 0.05) and decreased whole-body insulin sensitivity index (WBISI) (P < 0.01) as compared with those in NAN groups, but these parameters did not show significant variations with the change of TT levels. In female patients with NAN, insulin secretion level increased progressively as the TT level increased; the AUC-INS increased (P < 0.01) and WBISI decreased significantly (P < 0.05) when the TT levels increased to Q4. In male patients with NAN, insulin secretion level increased progressively as the TT levels decreased, and the AUC-INS increased (P < 0.05) and the WBISI decreased significantly (P < 0.05) when the TT levels decreased to Q1. CONCLUSIONS:The TT level has a significant effect on insulin resistance and insulin secretion, but its effect varies between genders and is more significant in NAN patients than in AN patients.

目的:使用3D打印个性化导航仪(guide),辅助乳腺肿瘤切除术中精确定位肿瘤边缘,实现精准保乳治疗.方法:选择43例乳腺肿瘤患者MRI影像资料,将乳腺核磁共振图像导入mimics与3-matic软件,依据三维重建的乳腺及肿瘤位置关系进行个性化设计定位导航仪(guide),并将其导入熔融沉积法(FDM)的3D打印机中,实施个性化打印定位导航仪(guide)的应用,术中在导航仪(guide)的导向下注射亚甲基蓝,用于定位肿瘤.结果:通过对43例乳腺肿瘤病例MRI影像资料进行研究,使用MRI设备引导下定位导航仪(guide)能够对乳腺肿瘤精确定位,同时在保乳治疗中减少患者痛苦.结论:3D打印个性化导航仪为女性乳腺肿瘤的切除提供了精确、微痛和美观的保乳治疗途径,具有良好的临床应用前景.

Objective:To explore the understanding among medical rehabilitation staff about pain in children with cerebral palsy.Methods:A questionnaire was developed by referring to the literature on children′s rehabilitation and pain. It was used to survey 856 rehabilitation personnel including 110 doctors, 313 therapists and 433 nurses from 12 hospitals in 10 provinces using an online platform at overall rate of correct responses was (67.89±13.35) %. Doctors and therapists scored about 70% correct and nurses about 65%. There were significant differences in pain knowledge related with educational background, age, work experience and position. Gender, professional title and parent status were not significant predictors. About 93% of those surveyed thought it was necessary to provide pain-related training, and 95% were willing to receive such training.Conclusions:There is a lack of knowledge about pain in children with cerebral palsy among rehabilitation medical staff. It is urgent to provide more related training and guidance to those in clinical practice.

目的:探讨西药临床合理用药管理对西药使用的价值.方法:2017年1月-2018年12月选取西药处方200张,分为两组,各100张.对照组采用常规管理干预模式;研究组给予临床合理用药管理.比较两组西药处方不合理使用率及患者用药后不良反应.结果:研究组患者用药不合理率低于对照组,研究组不良反应发生率低于对照组,差异均有统计学意义(P＜0.05).结论:通过规范化管理模式能促进西医临床用药合理性,还能够降低用药后不良反应.

随着影像技术本科教育的深入发展以及CT、MR等大型医疗设备的快速更新,传统的影像技术学教学模式特别是临床实习教学已经不能适应时代的发展.作为一门实践性很强的医学专业,为使学校理论授课更好地应用于临床实践,使医学影像技术学的教学更好地适应现代医学影像学的临床工作需要,进行医学影像技术学实习教学改革势在必行.

目的 通过进行患者俯卧位、仰卧位的磁共振成像(Magnetic Resonance Imaging,MRI),定量评估体位改变时乳腺肿瘤的位置及形态变化.方法 本研究以31例乳腺肿瘤患者为研究对象,先进行标准俯卧位MRI扫描,然后进行仰卧位Dixon序列扫描.肿瘤分割后,测量两种体位上肿瘤的体积;以乳头中心点为原点,分析不同体位下肿瘤位置的变化.结果 俯卧位和仰卧位肿瘤体积的平均值和标准差分别为(9797.3±9390.6)、(9795.5±9413.1)mm3,两者比较无显著差异(P=0.877).从俯卧位到仰卧位,以乳头为原点肿瘤平均移动(27.8±3.3)mm.而且,从俯卧位至仰卧位,在冠状位上乳腺外侧区域的肿瘤倾向于沿Z轴向外和向下移动;横轴面中所有区域的肿瘤都趋向于沿Y轴向外、向下移动.结论 在俯卧位MRI上位于外侧区的肿瘤,其在仰卧位的位置可以预测.本研究有助于外科医生利用标准俯卧位MR图像定位手术时肿瘤的位置进而指导手术计划制定.

目的 探讨常规乳腺钼靶摄影后加做局部点压放大摄影对乳腺疾病的诊断价值.方法 回顾性分析从2014年1月—2018年8月该院乳腺外科具有明确术后病理的肿瘤患者60例,将其常规乳腺头尾轴位(caudal,CC)、内外侧斜位(medio-lateral oblique,MLO)的诊断结果及加做局部点压放大摄影后的诊断结果,分别与病理结果进行比较.结果采用常规头尾轴位(caudal,CC)、内外侧斜位(medio-lateral oblique,MLO)摄影,能够明确检出50例,病灶检出率为83.3％(50/60),其中良性肿瘤29例,恶性肿瘤21例.加做局部点压放大摄影后能够明确诊断出58例,病灶检出率为96.7％(58/60),其中良性肿瘤35例,恶性肿瘤23例.其中加做局部点压放大摄影后多检出的8例患者中:3例呈现致密腺体中的微小病灶;3例病灶分界不清,内有微小钙化;另外2例病灶位置较深,靠近胸壁.结论 加做局部点压放大摄影有利于微小病灶和位置较深病灶的检出,对病灶的边缘结构显示更好,为临床对病灶进行良恶性分级及相关疾病的治疗提供可靠依据.

目的 评价磁共振弥散张量成像(DTI)技术多个定量参数在脑淋巴瘤和高级别胶质瘤(HGG)鉴别中的应用价值.方法 回顾分析我院经病理证实的11例脑淋巴瘤(A组)和23例HGG(B组)患者的DTI数据.使用后处理软件测量病灶、瘤周水肿以及正常对侧脑组织(NC)的各项异性指数(FA)、表观弥散系数(ADC)和本征值(λ1、λ2、λ3).由本征值计算轴向弥散系数(DA)和径向弥散系数(DR).分析各参数值在病灶及瘤周水肿区的改变,并比较各参数值在两组间的差异.ROC曲线分析两组病灶ADC、DA和DR值在两组间的诊断效能.结果 DTI三维重建显示两组病灶区白质纤维束均以破坏为主.两组FA、ADC、DA和DR值由NC、瘤周水肿至病灶均呈逐渐下降(均P＜0.05).A组病灶ADC、DA和DR值均低于B组(均P＜0.05).两组病灶FA值和瘤周水肿的FA、ADC、DA和DR值均无统计学差异.ROC曲线示病灶DA值具有最高的鉴别诊断效能,曲线下面积0.824,最佳诊断界值1.060,约登指数0.553.结论 DTI技术定量参数ADC、DA和DR值有助于脑淋巴瘤与HGG的鉴别诊断,可辅助临床医师及早判断病情并选择合理的治疗方案.

目的:探讨多模态超声在评估乳腺癌新辅助化疗疗效中的价值,建立评估乳腺癌新辅助化疗的多因素Logistic回归模型.方法:回顾性分析54例乳腺癌新辅助化疗患者的常规超声、弹性超声及超声造影的图像特征.用单因素和多因素Logistic分析影响新辅助化疗疗效的因素.绘制各因素受试者工作曲线(receiver operating characterisric,ROC),计算ROC曲线下面积及准确度等评价指标.结果:新辅助化疗后肿瘤最长径缩小率、阻力指数(resistance index,RI)、收缩期峰值流速(peak systole velocity,PSV)、应变率比值(strain ratio,SR)、弹性评分、峰值强度(peak intensity,PI)和曲线下面积(area under curve,AUC)是影响新辅助化疗疗效的因素(P＜0.05),多因素Logistic回归模型显示肿瘤最长径缩小率,PI和SR是乳腺癌新辅助化疗的危险因素.多因素回归模型ROC曲线下面积是0.95,准确度、灵敏度和特异度分别为90.74％、93.94％、85.71％,较单因素模型有较高的准确性.结论:多模态超声的多因素回归模型能较好地评估新辅助化疗疗效,提高诊断符合率.

目的 应用虚拟现实技术(VR)缓解痉挛型脑瘫患儿治疗中的疼痛,并评价疼痛应激及康复治疗效果.方法 2018年9月至2019年6月,将痉挛型脑瘫患儿49例随机分为对照组(n=25)和观察组(n=24).两组均给予常规康复治疗,观察组在有痛治疗时给患儿佩戴VR头戴式显示设备,依据患儿智力水平选择合适的全景动画片播放或头控游戏等使其沉浸在虚拟环境中.每天1次,每周治疗5 d,连续3周,共15个治疗日.在第1、5、9、13个治疗日同一时点测定患儿唾液皮质醇水平.于治疗前、治疗3周后采用改良Ashworth量表(MAS)、中文版粗大运动功能测试量表(GMFM)和残疾儿童评估量表(PEDI)分别进行评定.结果 治疗各个时间点,唾液皮质醇水平均较治疗前升高(|t|>3.502,P<0.05),在第5、9、13个治疗日,观察组唾液皮质醇水平低于对照组(t>2.224,P<0.05).治疗后,两组MAS评分明显降低(|Z|>2.636,P<0.01),GMFM和PEDI评分均显著提高(|Z|>3.629,P<0.001),观察组GMFM和PEDI评分均高于对照组(|Z|>2.000,P<0.05).结论 VR有助于缓解痉挛型脑瘫患儿疼痛应激,提高康复治疗效果.

目的:探讨频率选择法(frequency-selective fat saturation,FS)和优化短时间反转恢复法(short TI inversion recovery,STIR)两种脂肪抑制技术在含有金属节育环腰椎MR检查中图像质量的差别.方法:选取20例体内植入金属节育环的女性患者,做常规序列检查及加FS和优化STIR序列检查.对所得图像分别进行信噪比和对比噪声比测量,记录数据结果并做统计学分析;应用主观法对脂肪抑制均匀性、金属伪影大小进行评价.结果:FS和优化STIR两种脂肪抑制方法图像信噪比分别为:68.3±7.5、28.9±1.7(t=-23.9,P＜ 0.01);图像对比噪声比分别为:112.1±9.3、128.1±10.9(t=-5.4,P＜0.01);脂肪抑制均匀性评分分别为:3.0±0.7、3.5±0.5(t=4.8,P＜0.01);图像金属伪影评分分别为:2.9±0.7、3.7±0.6(仁6.8,P＜ 0.01).结论:对于带有金属节育环的患者,两种脂肪抑制技术成像对比发现,优化STIR脂肪抑制技术虽然信噪比有所下降,但其对比噪声比和脂肪抑制均匀性均优于FS脂肪抑制技术,并且还可以显著减少金属伪影,更有利于病灶检出及临床诊断.

Objective To observe the effect of supplementing constraint-induced movement therapy (CIMT) with virtual reality games in rehabilitating the motor function of hemiplegic children with cerebral palsy (CP).Methods Fifty hemiplegic children with CP were randomly divided into a control group and a treatment group,each of 25.All were given conventional rehabilitation.The children in the control group received CIMT for 4 hours,plus 1 hour of occupational therapy for the more-affected limb supported by therapists and 3 hours of daily training in life activities with their guardians' help.Those in the treatment group received occupational therapy for 1 hour,played virtual reality games for 1 hour and practiced daily life activities for 2 hours per day.All of the treatments were carried out five days a week for 3 weeks.Before and after the intervention the quality of upper extremity skills test (QUEST),the Chinese version of the gross motor function measuring scale (GMFM) and the pediatric evaluation of disability inventory (PEDI) were used to evaluate upper limb function,gross motor function and the social abilities.Results After the treatment,significant improvement was observed in the average QUEST,GMFM and PEDI scores of both groups,but the average scores in the treatment group were significantly higher than among the controls.Conclusions CIMT combined with playing virtual reality games improves the motor function and social abilities of hemiplegic children with CP.

本文主要是对医学影像技术学科的现状以及发展进行研究,首先,从医学影像学科教育的现状、医学影像技术人员在医院的工作现状以及医学影像技术的组织现状三个角度提出了医学影像技术学科的现状;其次,从医学影像学发展的整体趋势、医学影像技术的发展趋势以及我国医学影像技术人员的发展趋势三个方面提出了医学影像技术学科的发展趋势.

Objective To explore a safe and effective imaging method by the application of 3D contrast-enhanced MR Angiography (3D CE-MRA) with low-or conventional-dose contrast agent to the examination of lower extremity arterial disease.Methods Totally 31 patients suspected with lower extremity arterial stenosis or occlusion underwent 3D CE-MRA examination including one patient had right leg cut due to the disease,of whom,18 ones had conventional-dose contrast agent (38 ml) injected in 1.5T MR machine and 13 ones had low-dose agent (15 ml) injected in 3.0T MR machine.Quality evaluation was carried out for the images by different doses of agents.Results All the patients had no agent allergy occurred,and one patient had left tibia-fibula motion artifact due to involuntary movement.3.0T MR machine with low-dose agent behaved better than 1.ST MR machine with conventional-dose agent in leg imaging,while there were no significant differences between the quality of the images except that of popliteal artery (P＞0.05).Conclusion 3D CE-MRA is an effective and safe method in detecting lower extremity artery disease,and 3.0T MR machine with low-dose agent lays a foundation for clinical diagnosis and treatment.