目的 探讨高龄新型冠状病毒感染患者下肢静脉血栓和白细胞介素6(IL-6)、降钙素原、D-二聚体、C反应蛋白与预后的关系.方法 选取首都医科大学附属北京安贞医院2022年12月1日至2023年1月31日收治的新型冠状病毒感染患者223例,根据患者的预后分为死亡组(80例)和存活组(143例).比较死亡组与存活组患者静脉血栓情况、白细胞介素6(IL-6)、降钙素原、C反应蛋白水平及肺部炎症情况.并总结新型冠状病毒感染患者CT检查特征.结果 死亡组男性比例、IL-6、降钙素原、D-二聚体及重度肺炎比例均高于存活组,差异均有统计学意义(均P<0.001).下肢静脉血栓患者中,死亡组IL-6、降钙素原、D-二聚体水平高于存活组患者[338(143,901)ng/L比51(20,187)ng/L、0.82(0.23,4.96)μg/L比0.10(0.07,0.70)μg/L、7246(4515,14853)μg/L比2070(1182,4182)μg/L],差异均有统计学意义(均P<0.001).新型冠状病毒感染患者胸部CT显示病变主要位于两肺的外带区域及胸膜下,可跨越肺段的解剖分布,呈多叶浸润,CT主要表现为斑片状磨玻璃影,部分实变、纤维化.结论 高龄男性、存在下肢静脉血栓、伴有IL-6、降钙素原、D-二聚体升高的患者新型冠状病毒感染后有较高的死亡风险.

目的 比较彩色多普勒超声(CDUS)和对比增强磁共振血管造影(CE-MRA)在评价肾动脉狭窄(RAS)中的应用价值.资料与方法回顾性分析50例RAS患者共100条肾动脉的CDUS及CE-MRA资料.所有患者最终均经数字减影血管造影(DSA)检查确认诊断.比较CDUS与CE-MRA对RAS检出率的差异.采用受试者工作特征(ROC)曲线评价CDUS与CE-MRA对RAS的诊断效能.结果 CDUS与CE-MRA对RAS的检出率差异无统计学意义(57％比60.0％,P＞0.05).CDUS诊断RAS的ROC曲线下面积为0.88 (95％ CI 0.81～0.90),CE-MRA诊断RAS的ROC曲线下面积为0.79 (95％ CI 0.71～0.86),差异有统计学意义(Z=2.345,P＜0.05).结论 CDUS及CE-MRA均具有较高的RAS检出率,其中CDUS具有更高的诊断效能.

Objective To analyze the clinical value of two-dimensional and color Doppler ultrasound combined with elastography in diagnosis of papillary thyroid microcarcinoma.Methods Clinical data of 41 cases of papillary thyroid microcarcinoma with 56 malignant nodules confirmed by post-surgery pathological examination from January 2014 to December 2016 in Beijing Anzhen Hospital,Capital Medical University were retrospectively analyzed.The patients were divided into observation group and control group according to different ultrasonic examination methods.In observation group(21 cases),28 nodules were detected by elastography,two-dimensional and color Doppler ultrasound;the control group (20 cases) had two-dimensional and color Doppler ultrasound and 28 nodules were found.Diagnostic accuracy for thyroid malignant nodules was compared between groups.Results There were 34 unilateral single nodules (60.7％) and 22 bilateral single or multiple nodules(39.3％).The smallest nodule was 2.0 mm × 2.0 mm × 3.0 mm and the largest one was 9.0 mm × 9.0 mm × 10.0 mm.Among the 56 nodules,2 nodules(3.6％) showed very low echo,50 nodules(89.3％) showed low echo,3 nodules (5.4％) showed solid-cystic echo and 1 nodule(1.8％) was iso-echo;6 nodules(10.7％) had clear boundaries and 50 nodules (89.3％) were unclear;9 nodules (16.1％) presented regular morphology and 47 nodules (83.9％) were irregular;53 nodules(94.6％) had aspect ratio-1 and 3 nodules(5.4％) had aspect ratio ＜ 1;3 nodules(5.4％) had coarse calcification and 53 nodules(94.6％) had micro-calcification.Diagnostic accuracy in observation group was significantly higher than that in control group[96.4％ (27/28) vs 75.0％ (21/28)] (P =0.002).Condasions Elastography can help to improve the diagnostic accuracy of papillary thyroid microcarcinoma in combination with two-dimensional and color Doppler ultrasound.Hypoechoic nodules with irregular shape,blurred border,angular border,lobulate and speculate border,multiple punctate and gravel-like microcalcification,aspect ratio≥ 1,elastography score 4-5 are characteristic changes of papillary thyroid microcarcinoma.

Objectives To explore the effect of simulated weightlessness on male volunteers' flow-mediated vascular endothelial function of brachial artery and popliteal artery. Methods Twenty-two male volunteers were involved in this study. Weightlessness condition was simulated by continuous-6 degree head down tilt bed rest and lasted for 45 d. Vascular endothelial function was examined by ultrasound on schedule. Results Flow-mediated vascular endothelial function of brachial artery increased during simulated weightlessness,but the increasing amplitude decreased gradually, then decreased after simulated weightlessness. Flow-mediated vascular endothelial function of popliteal artery increased during simulated weightlessness,and the amplitude increased gradually,then decreased after simulated weightlessness. The amplitude after weightlessness was larger than before. But no significance difference between these changes was found. Conclusion Flow-mediated vascular endothelial function of brachial artery and popliteal artery of male volunteers was stable during simulated weightlessness,which indicated that simulated weightlessness had no significant effects on flow-mediated vascular endothelial function of brachial artery and popliteal artery.

Objective To explore the relationship between perinatal mortality and complications of pregnancy.Methods The 190 cases of perinatal death were analyzed from October 1,2010 to September 30,2011 and the pregnancy complications were classified.Results Complication of pregnancy was an important cause of perinatal death.Fetal malformation accounted for 26.3％ (50/190) ; umbilical cord factors accounted for 25.3％ (49/190) ;pregnancy induced hypertension syndrome accounted for 21.0％ (40/190) ; placenta factors accounted for 11.6％ (21/190).Conclusion Fetal malformation,abnormal umbilical cord,preeclampsia and placenta dysfunction are the major causes of perinatal death.

Purpose To investigate the value of automatic breast volume scanning (ABVS) in the breast disease treatment, and to compare with the manual ultrasound and molybdenum target. Materials and Methods Molybdenum target, manual ultrasound and ABVS were applied to 155 patients with 165 breast nodules, which were confirmed by biopsy or surgical pathology. The detection rate, sensitivity, specificity, positive predictive value and negative predictive value of breast lesions were calculated based on ABVS, manual ultrasound and molybdenum target. Results The detection rate of ABVS (97.6%) and manual ultrasound (95.8%) were higher than that of molybdenum target (87.9%) (χ 2 =6.356, P<0.05). The accuracy, sensitivity and specificity of manual ultrasonic were 91.5%, 93.2% and 88.7%, respectively; which of ABVS were 94.5%, 96.1% and 91.9%, respectively; which of molybdenum target were 86.1%, 83.5% and 90.3%, respectively; and which of combined three examinations were 96.4%, 97.1% and 95.2%, respectively. The accuracy and sensitivity of manual ultrasonic and ABVS for diagnosing breast lesions were significantly higher than those of molybdenum target (χ 2 =4.368, 3.569, P<0.05), and there was no significant difference between manual ultrasonic and ABVS (χ 2 =1.313, 0.893, P>0.05). The combination of three examinations for diagnosing breast lesions was significantly higher than molybdenum target (χ 2 =6.525, 4.816, 3.868, P<0.05). The specificity of burr-like and satellite-like boundaries for diagnosing malignant lesions was 98.4% on the coronal section based on ABVS. Conclusion ABVS can provide additional information in the differential diagnosis of breast lesions. The diagnostic sensitivity of ABVS is higher than that of molybdenum target, and is analogous with that of manual ultrasonic.

非洲黑人,男,31岁,因下腹部不适就诊.超声检查:右肾大小10.0cm×5.0cm,形态和内部结构未见异常,脾脏下方肾窝区未见肾脏结构回声,扩大扫查范围于脐下盆腔左侧探及多个大小不等囊性暗区,类似肾脏肾盏积水"花瓣样"样结构(图1),范围10.5 cm ×4.9 cm,最大的暗区大小6.9 cm×4.0 cm,肾实质厚0.3 cm,肾门位于下方,左肾输尿管起始段内径0.6 cm,扩张不明显,彩色多普勒血流显示肾脏稀疏的血流信号.超声诊断:异位肾(左肾)并重度积水,左侧输尿管上段轻度扩张.CT检查示:先天性左肾异位,左肾积水(图2).