目的:评估新型智能三维脑血流成像系统诊断颅内动脉病变与常规经颅多普勒(TCD)诊断结果的一致性,验证三维成像系统检查方法作为筛查颅内血管狭窄的有效手段.方法:在通过伦理学审查及中国临床试验中心注册后,选取医院神经内科脑血流图室就诊的57例脑血管病患者,使用三维脑血流成像系统共采集患者双侧114支大脑中动脉(MCA)的三维图像及血流频谱,评估三维成像系统采集成功率,根据测得血流频谱判断其狭窄情况,并与TCD诊断的狭窄结果进行对比,采用一致性检验评估三维成像系统与TCD诊断结果的一致性.结果:三维成像系统采集的114支MCA中采集成功93支,采集成功率为81.6％;三维成像系统诊断MCA无狭窄73支,TCD诊断MCA无狭窄71支;三维成像系统诊断MCA轻-中度狭窄12支,TCD诊断MCA轻-中度狭窄14支;三维成像系统诊断MCA重度狭窄-闭塞8支,TCD诊断MCA重度狭窄-闭塞8支;三维成像系统与TCD诊断MCA狭窄具有较好的一致性(Kappa=0.942,P<0.05).结论:智能三维脑血流成像系统与TCD诊断一致性均在中等以上,在一定程度上可以作为MCA狭窄有效的筛查方法.

There is a consensus that central compartment lymph node dissection or modified radical lateral neck dissection should be performed in papillary thyroid microcarcinoma (PTMC) patients with lymph node metastases. Prophylactic central lymph node dissection (PCLND) in patients with clinically node-negative (cN0) PTMC to reduce locoregional recurrence (LRR) rate and improve prognosis remains controversial. The present study aimed to analyze the effect of PCLND on LRR and postoperative complications of PTMC in cN0 patients. We reviewed a cohort of patients with cN0 PTMC who underwent surgery between January 1997 and October 2019. The patients were divided into the PCLND and no lymph node dissection (NLND) groups. Kaplan–Meier curves were constructed to estimate 15-year locoregional recurrence-free survival rate of the two groups, and the difference was compared by the log-rank test. Three Cox regression models were performed to evaluate the correlation between PCLND and LRR. All patients underwent thyroidectomy, and 25 patients developed LRR; of whom, 23 underwent PCLND at initial surgery and 2 went without lymph node dissection. Cox regression analysis showed that PCLND had no effect on LRR. Postoperative hematoma and permanent recurrent laryngeal nerve injury did not occur in the NLND group, and their incidences were 0.5% and 0.3% in the PCLND group, respectively. PCLND had no significant correlation with LRR in patients with cN0 PTMC, and the absolute benefit for PTMC was small.

患者,男性,56岁,因"间断发热2年余,再发10 d"于2020年3月入院。患者于2018年4月无明显诱因出现发热,体温最高39℃,伴畏寒、寒战,全身肌肉关节痛,遂就诊首都医科大学附属北京友谊医院,实验室检查虎红平板凝集试验呈阳性,结合症状及病史诊断为布鲁氏菌病。2020年3月患者无明显诱因再次出现发热,体温最高38℃,伴畏寒、寒战,全身肌肉关节痛,右大腿根部剧烈疼痛,伴尿频、尿急、尿痛,无头痛、咳嗽、咳痰等症状,