Objectives This study aimed to investigate the combined use of ultrasonography and clinical features for the differentiation of malignant peripheral nerve sheath tumors (MPNST) from benign peripheral nerve sheath tumors (BPNST) and to compare the efficacy of ultrasonography with that of magnetic resonance imaging (MRI). Methods This retrospective study included 28 MPNSTs and a control group of 57 BPNSTs. All patients underwent an ultrasound scan using the Logiq E9 (GE Health Care, Milwaukee, WI) or EPIQ7 equipment (Philips Medical System, Bothell, WA). A 3.0‐T MRI machine (Ingenia; Philips Healthcare, Best, the Netherlands) was used for scanning, and conventional MRI was performed on different regions based on the patient's clinical situation. The following variables were evaluated: palpable mass, pain, nerve symptoms, maximum diameter, location, shape, boundary, encapsulation, echogenicity, echo homogeneity, presence of a cystic component, calcification, target sign, posterior echo, and intertumoral vascularity of the tumors. The diagnostic efficacy of ultrasonography and clinical factors was compared with that of MRI. Independent factors for predicting MPNST versus BPNST were also assessed. Results The parameters of location, shape, boundary, encapsulation, and vascularity were significantly different between MPNSTs and BPNSTs. Multiple logistic regression analysis showed that shape, boundary, and vascularity were independent predictors of MPNSTs. The sensitivity, specificity, and Youden index of the three clinical and ultrasound factors (shape, boundary, and vascularity) were 0.89, 0.81, and 0.69, respectively, whereas those of MRI were 0.71, 0.89, and 0.61, respectively. No significant differences in the area under the curve (AUC) of the three combined clinical and ultrasound factors and those of MRI were found ( P > .05). Conclusions MRI was useful in the differential diagnosis between MPNSTs and BPNSTs. However, the combination of clinical and ultrasound diagnoses can achieve the same effect as MRI, including shape, boundary, and vasculature.

OBJECTIVESThis study aimed to investigate the combined use of ultrasonography and clinical features for the differentiation of malignant peripheral nerve sheath tumors (MPNST) from benign peripheral nerve sheath tumors (BPNST) and to compare the efficacy of ultrasonography with that of magnetic resonance imaging (MRI).METHODSThis retrospective study included 28 MPNSTs and a control group of 57 BPNSTs. All patients underwent an ultrasound scan using the Logiq E9 (GE Health Care, Milwaukee, WI) or EPIQ7 equipment (Philips Medical System, Bothell, WA). A 3.0-T MRI machine (Ingenia; Philips Healthcare, Best, the Netherlands) was used for scanning, and conventional MRI was performed on different regions based on the patient's clinical situation. The following variables were evaluated: palpable mass, pain, nerve symptoms, maximum diameter, location, shape, boundary, encapsulation, echogenicity, echo homogeneity, presence of a cystic component, calcification, target sign, posterior echo, and intertumoral vascularity of the tumors. The diagnostic efficacy of ultrasonography and clinical factors was compared with that of MRI. Independent factors for predicting MPNST versus BPNST were also assessed.RESULTSThe parameters of location, shape, boundary, encapsulation, and vascularity were significantly different between MPNSTs and BPNSTs. Multiple logistic regression analysis showed that shape, boundary, and vascularity were independent predictors of MPNSTs. The sensitivity, specificity, and Youden index of the three clinical and ultrasound factors (shape, boundary, and vascularity) were 0.89, 0.81, and 0.69, respectively, whereas those of MRI were 0.71, 0.89, and 0.61, respectively. No significant differences in the area under the curve (AUC) of the three combined clinical and ultrasound factors and those of MRI were found (P > .05).CONCLUSIONSMRI was useful in the differential diagnosis between MPNSTs and BPNSTs. However, the combination of clinical and ultrasound diagnoses can achieve the same effect as MRI, including shape, boundary, and vasculature.

This study’s aim is to describe the characteristics of perioperative acute cholecystitis in older patients with hip fracture. From January 1, 2018, to April 30, 2023, 7,746 medical records were retrospectively collected for patients aged ≥ 65 years who were hospitalised for hip fracture in Beijing Jishuitan Hospital, Capital Medical University. We reviewed 10 cases with confirmed diagnoses of acute cholecystitis. Of these 10 cases, five femoral neck fractures and five intertrochanteric fractures received orthopaedic surgery. The ratio of males to females was 2:8, the median age was 83.1 years (71–91 years), and there was a median BMI of 25.35 (15.56–35.16). 50

目的 探讨对胎儿胆囊腔内结石样回声的超声特点,并在后续产前及产后复查中对胎儿或新生儿胆囊腔内异常回声情况进行随访,讨论超声检查在此类疾病诊断中的意义和价值.方法 选取2014年1月至2020年12月于北京积水潭医院进行常规产前超声检查并发现胎儿胆囊结石样回声的孕妇共12例,总结分析胎儿胆囊内结石样回声的声像图特征及胆囊内结石样回声随孕周变化的特点,并对孕妇情况进行分析.产后随访胆囊结石样回声的存在与消退情况.结果 12例胎儿胆囊腔内结石样回声的声像图表现为单发点状强回声1例(8.3％),多发点状强回声9例(75.0％),细密中强回声2例(16.7％).4例于孕晚期超声复查自行消失,7例产后超声复查均消失,1例随访至出生后3年7个月仍未消失.12例胎儿胆囊内异常强回声除1例在孕中期(孕25周)发现,其余均于孕晚期(孕33周及以后)发现.结论 超声可用于探查胎儿胆囊腔内结石样回声,进而做出胎儿胆囊结石或胆泥淤积的初步诊断,为妇产科、儿科等临床科室提供直接、可靠的超声诊断依据.

Objectives The objectives were to identify the key features of malignant and benign peripheral nerve sheath tumors (PNSTs) and determine a strategy for differentiating them using sonography. Methods Forty‐six malignant peripheral nerve sheath tumors (MPNSTs) and 83 benign peripheral nerve sheath tumors (BPNSTs) confirmed by pathology from April 2010 to July 2021 were included. The general data and grayscale and color Doppler ultrasonic manifestations were compared between the two groups. We used single factor, multifactor, and area under the receiver operating characteristic (ROC) curve analyses to extract significant malignant risk factors and then established a scoring system with these factors. Results The significant variables identified in univariate analysis ( P < .05) were maximum diameter, location, shape, boundary, encapsulation, echogenicity, texture pattern, calcification, entering or exiting nerve, and vascularity. Shape, boundary and vascularity were significant risk factors, and a scoring system was established. The area under the ROC curve (0.925) confirmed the usefulness of the scoring system for differentiating MPNSTs and BPNSTs. Conclusions Ultrasonography is an effective method for differentiating MPNSTs from BPNSTs.

患者男,14岁,左上臂近端间断疼痛7年加重1个月就诊.查体:左上臂近端稍肿胀,触及质硬包块,按压时钝痛. 超声所见:左肱骨上段外侧骨膜抬高,骨皮质破损,骨膜下可见实性低回声肿物,大小约7.5cm×1.5 cm×0.8 cm,边界清,回声欠均,周围可见少量血流信号.超声提示:左肱骨上段外侧骨膜抬高,骨膜下实性低回声肿物.术后病理诊断为骨膜软骨瘤.镜下所见:肿瘤性软骨分叶状生长,局灶侵袭周围硬化骨,少部分肿瘤性软骨细胞较丰富,有轻微异型性.

目的:分析妊娠糖尿病(GDM)孕妇孕期各阶段体重增重情况,为GDM的预防及控制提供科学数据.方法:选取2018年10月-2019年10月在我院定期产检并分娩的孕妇700例.通过病历查询获取孕妇一般情况、妊娠期各时期体重以及妊娠结局和新生儿体重,与非GDM孕妇及IOM标准比较,分析不同孕前BMI的GDM孕妇妊娠期各阶段增重情况.结果:与非GDM孕妇相比,GDM孕妇其生产年龄、孕前BMI、有无糖尿病家族史、孕期各阶段增重及总增重差异均有统计学意义(P＜0.05).孕妇早孕期增重过快会增加GDM的发病风险(OR = 1.187,95％CI 1.090-1.293).不同孕前BMI的GDM孕妇其孕24周后增重及总增重均较非GDM组更少(P＜0.05),与IOM标准比较,两组增重不足、增重适宜及增重过度人数差异有统计学意义(P＜0.05).仅孕前体重正常组的GDM孕妇早孕期及孕12～24周增重与非GDM组差异有统计学意义(P＜0.05),与IOM标准比较后的各组人数差异有统计学意义(P＜0.05).按新生儿体重分组,排除早产的47例孕妇,发现各组间母亲孕期各阶段体重增长差异均无统计学意义(P＞0.05).结论:加强早孕期体重管理有助于降低GDM的发病风险.对于已确诊GDM的孕妇其24周后体重增长普遍低于非GDM组及IOM标准,其适宜增重范围有待进一步研究.

目的 评价超声鉴别诊断恶性外周神经鞘瘤(MPNST)与神经纤维瘤的价值.方法 纳入经病理学证实的45例MPNST(MPNST组)与98例神经纤维瘤患者(神经纤维瘤组),比较组间一般资料及灰阶超声表现差异;构建二元Logistic回归分析模型用于鉴别MPNST与神经纤维瘤.绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价回归模型及各超声表现鉴别二者的效能,采用Delong检验评价诊断效能的差异.结果 MPNST组患者年龄显著大于神经纤维瘤组(P＜0.05);组间病灶位置、最大径、最小径、形态、边界、囊性成分、靶征及血流分级差异均有统计学意义(P均＜0.05).Logistic回归分析显示病灶位置、形态、边界及血流分级是鉴别MPNST与神经纤维瘤的独立因素(P均＜0.05);回归模型鉴别二者的AUC为0.895,准确率、敏感度及特异度分别为83.92％、86.67％及82.65％,鉴别效能显著高于单一超声表现(P均＜0.05).结论 超声可为鉴别诊断MPNST与神经纤维瘤提供依据.

目的 探讨产前超声检查对胎儿胆囊增大或缩小的诊断价值.方法 回顾性分析北京积水潭医院2003年2月至2020年2月进行产前超声检查的17859例孕妇的临床资料,均采用彩色多普勒超声对胎儿的胆囊进行检查,总结分析其超声图像特征.结果 共有17788例(99.6％)胎儿显示了胆囊,其中25例(0.14％)胎儿胆囊异常增大,4例(0.02％)胎儿胆囊缩小.胆囊异常增大胎儿中整倍体2例,18三体1例,13三体1例,全部引产终止妊娠,其余21例染色体正常,均活产;胆囊异常增大胎儿染色体异常率为16％.4例胆囊缩小胎儿染色体检查均正常,且胎儿均活产.结论 使用彩色多普勒超声在产前对胎儿胆囊进行检查,可较好地检出胆囊异常增大及缩小胎儿,能尽早提示染色体异常的可能性,对临床具有重要的意义.

患者女,26岁.5年前无明显诱因发现右手环指尺侧肿物,逐渐增大,于外院行手术切除,术后未进行病理检查.本次发现原手术部位肿物就诊.查体:右环指尺侧肿物,位于中节指骨远端,局部可见手术瘢痕,无明显红肿,肿物质中,边界清楚,无压痛.超声提示:右环指中节尺侧皮下实性低回声肿物,血流丰富——血管瘤可能性大(图1).术中见肿瘤蓝紫色,包膜菲薄,完整切除肿瘤.术后病理诊断:梭形细胞及卵圆形细胞增生,局灶形成血管瘤结构,结合免疫组化考虑肌性周细胞瘤.术后随访7年,未见复发及远处转移.

患儿男,1周岁.6d前无明显诱因突然出现右手环指红肿,3d前加重,伴发热,就诊于其他医院,给予外敷药物及口服头孢类抗炎药物治疗,未好转,来我院诊治.专科查体:患儿右手环指自远侧指间关节至掌指关节明显红肿,右手环指周径5 cm,皮肤颜色暗红;局部压痛(+),皮肤温度增高,指背侧可触及波动感;右手环指主动屈曲及伸直受限.超声所见:右环指中节指骨干骺端骨破损(箭号示),包绕环指近侧指间关节及中节指骨关节可见一中低回声包块,长约2.5 cm,宽约1.5 cm,厚约0.6 cm,包块内可见点状强回声及浓稠液体回声,周围软组织肿胀、回声增强.包块周边可见点状血流信号,内可探及高阻动脉型血流频谱,RI:0.72.