RATIONALE AND OBJECTIVES:To characterize perfusion phenotypes of hepatic alveolar echinococcosis (HAE) on contrast-enhanced ultrasound (CEUS) and analyze their links to pathology and aggressive biological behavior. MATERIALS AND METHODS:One hundred thirty-nine patients (mean age, 40.9 ± 15.1 years; 65 men) with pathologically confirmed HAE comprising 183 lesions were evaluated. Lesions were classified into 7 CEUS patterns (E1-E7) based on peripheral and internal enhancement features. Comparisons were performed across Ulm subtypes regarding CEUS distribution, quantitative parameters and microvessel density (MVD) in peripheral zones. Vascular invasion was analyzed according to CEUS patterns, and multivariate analyses were conducted to identify predictors of extrahepatic metastasis. RESULTS:Peripheral enhancement occurred in 165/183 lesions (90.2%), internal enhancement in 43 (23.5%). E1 (complete peripheral enhancement without internal enhancement) was most frequent (55.7%). Positive peripheral enhancement was linked to higher portal vein (26.1%) and hepatic vein (21.2%) invasion versus none in negative cases. E2 (discontinuous peripheral ring without internal enhancement) and E4 (discontinuous peripheral ring with internal branching perfusion) were most strongly associated with vascular invasion. Hemangioma-like and hailstorm types had significantly greater perfusion and MVD than pseudocystic types (P < 0.05). Whereas CEUS pattern alone was not directly associated with extrahepatic metastasis, vascular invasion-including inflow (portal vein or hepatic artery) and outflow (hepatic vein or inferior vena cava)-emerged as independent predictors: inflow-vascular invasion increased the odds of extrahepatic metastasis (OR = 9.567, P < 0.01), as did outflow-vascular invasion (OR = 5.855, P = 0.01). A multivariate logistic regression model incorporating these predictors achieved an area under the receiver operating characteristic curve of 0.881 (95% CI: 0.799-0.963), indicating good discriminative performance. This suggests that CEUS perfusion phenotypes may influence metastatic risk indirectly through vascular involvement. CONCLUSION:Peripheral CEUS enhancement, particularly E2 and E4, indicates high vascular invasion risk in HAE. CEUS provides a combined morphological and perfusion assessment to guide surgical planning.

In this work, we have reported the biogenic supported silver nanoparticles over surface of magnetic Fe3O4 nanoparticles by using Pomegranate peel extract. The extract was used as a green reducing agent and an excellent stabilizer of the synthesized Ag NPs. Physicochemical characterization of the as-synthesized Fe3O4/Ag NPs was carried out through electron microscopy (SEM and TEM), energy dispersive X-ray spectroscopy (EDX), elemental mapping (WDX), vibrating sample magnetometer (VSM), X-ray diffraction (XRD) and inductively coupled plasma-optical emission spectroscopy (ICP-OES). Theanti-ovarian cancer effects of biologically synthesized Fe3O4/Ag NPs against ovarian cancer cell lines were assessed. The anti-ovarian cancer properties of the Fe3O4/Ag NPs could significantly remove NIH: OVCAR-3‎, ES-2‎, TOV-21G cancer cell lines in a time and concentration-dependent manner by MTT assay. The antioxidant activity of Fe3O4/Ag NPs was determined by DPPH method. The Fe3O4/Ag NPs showed the high antioxidant activity according to the IC50 value. It seems that the anti-human ovarian cancer effect of recent nanoparticles is due to their antioxidant effects. After clinical study, Fe3O4/Ag NPs bio-composite can be utilized as an efficient drug in the treatment of human ovarian cancer in humans.

患者男,73 岁,因 "发现左侧胸壁包块 2 个月"入院.专科查体:左侧胸壁包块边界尚清晰,活动度可,突出于皮肤表面,表面皮肤无破溃、无波动感,皮温正常,未闻及血管杂音.

目的 归纳并分析冰雹型肝泡型包虫病的超声造影表现模式.方法 回顾性分析 40 例(47 个病灶)经术后病理证实的冰雹型肝泡型包虫病患者超声造影声像图,结合镜下病理表现,归纳并探讨其造影表现模式.结果 病灶共有 4 种增强模式:①68.1%表现为"边缘环状增强,内部无增强";②14.9%表现为"边缘环状增强,内部低增强";③14.9%表现为"边缘环状增强,内部片状增强";④2.1%表现为"整体无增强".不同增强方式的病灶最大径线组间差异有统计学意义(P<0.05),其中"边缘环状增强,内部低增强"的病灶最大径线明显小于"边缘环状增强,内部无增强",差异有统计学意义(P<0.05).镜下病灶边缘存在大量新生血管形成的"边缘带",病灶内部可见大范围坏死区,部分病灶内存在少量血供痕迹,部分病灶内残留正常肝组织与周围肝组织相连续.结论 冰雹型肝泡型包虫病超声造影模式具有一定特异度,超声造影实时动态成像可为探究病灶生物学行为与代谢活性提供影像学信息.

As an accurate, safe, and effective noninvasive examination method, imaging examination has been widely used in the diagnosis and differential diagnosis of focal liver lesions. Enhanced ultrasonography (CEUS), enhanced CT (CECT), and enhanced magnetic resonance imaging (CEMRI) are the most commonly used enhanced imaging methods in clinical practice, all of which can accurately determine the nature of liver lesions. The purpose of this paper is to study the application of contrast-enhanced ultrasound and magnetic resonance enhancement in cancer diagnosis based on the Internet of Things medical system. The basic clinical data, CEUS, and enhanced CT/MRI findings of 120 CHC patients were retrospectively analyzed. The clinicopathological features of CHC patients were investigated by contrast-enhanced ultrasonography and CT/MRI enhanced mode. The diagnostic value of contrast-enhanced ultrasound and enhanced CT/MRI combined with tumor markers in CHC was analyzed. The experimental results showed that the sensitivities of CEUS, enhanced MRI, and their combination in diagnosing CHC were 72.44%, 81.56%, and 93.78%, respectively. This experiment has an important value in the diagnosis of primary liver cancer.

目的 探讨CT测量主肺动脉(MPA)/降主动脉(DA)截面积比值与慢性阻塞性肺病(COPD)合并肺心病患者心功能的关系.方法 选取2019年11月至2020年2月本院收治的103例COPD合并肺心病患者为病例组,另选取同期行健康体检人员50例为对照组.CT测量两组MPA和DA截面积,检测右心功能指标及实验室指标,Pearson检验MPA/DA截面积比值与心功能指标之间的相关性.结果 病例组的MPA截面积、DA截面积、MPA/DA截面积比值、高敏C反应蛋白(hs-CRP)及脑利钠肽(BNP)分别为(808.64±98.64)mm2、(498.34±94.57)mm2、(1.62±0.12)、(96.34±20.47)mg/L、(69.56±6.38)ng/L,显著高于对照组的(592.06±23.52)mm2、(449.53±89.36)mm2、(1.31±0.18)、(4.37±1.49)mg/L、(20.93±3.15)ng/L.病例组的右室射血分数(EFRV)、右室舒张末期内径(EDRV)及右室前壁(RVAW)分别为(47.68±3.13)％、(11.07±1.19)mm、(3.41±0.51)mm,明显低于对照组的(63.31±5.46)％、(17.57±2.29)mm、(5.82±0.41)mm,差异均有统计学意义(P均<0.05).MPA/DA截面积比值与hs-CRP及BNP呈正相关关系(r=0.6538/0.7106,P均<0.05),与EFRV、EDRV、RVAW呈负相关关系(r=-0.6964/-0.7839/-0.7322,P均<0.05).结论 CT测量MPA/DA截面积比值与COPD合并肺心病患者心功能密切相关,有助于监测病情.

胸部CT检查是临床上常用的检查方法,很多人到医院看病都会进行胸部CT检查,医生通过检查结果知道患者哪里出现了问题,是何种类型的疾病以及发展程度.但有些患者觉得自己的疾病与胸部CT无关,不理解为什么医生会要求做胸部CT检查,下面我们一起了解下胸部CT都能检查出什么,避免接受不必要的胸部CT检查.

目的:探讨人际心理治疗(IPT)及认知行为治疗(CBT)对产后抑郁障碍(PPD)的疗效及社会支持的影响.方法:60例PPD患者随机分为IPT组和CBT组,并分别接受相应的治疗,为期12周.治疗前后分别进行爱丁堡产后抑郁量表(EPDS)及社会支持量表评定.结果:治疗后两组EPDS评分明显低于治疗前(P均<0.01),且两组间差异无统计学意义(P>0.05).治疗前两组间社会支持量表评分总分比较差异无统计学意义(P>0.05);治疗后两组社会支持量表总分及分量表评分均较治疗前显著增加(P均<0.01),且IPT组社会支持量表总分及各分量表评分均显著高于CBT组(P均<0.05).结论:IPT及CBT治疗PPD的疗效相当,但IPT可更好地改善PPD患者的社会支持.

目的 探讨异体血管重建肝静脉流出道在离体肝切除并自体肝移植术中运用的效果.方法 回顾性分析四川省人民医院器官移植中心2019年8月收治的1例行离体肝切除并自体肝移植联合异体血管重建的晚期复杂肝包虫患者的临床资料.结果 患者为44岁女性,因“右侧腹部疼痛伴皮肤、巩膜黄染6+个月且加重20+d”入四川省人民医院.患者入院时一般情况差,如高胆红素、低蛋白血症等,体质量45 kg,标准肝体积为852 mL.包虫病灶侵蚀第一、二肝门、肝右静脉及肝后下腔静脉,肝静脉流出道在体重建困难,肝包虫病灶完全在体切除也极为困难.患者入院后经PTCD减黄治疗后一般情况良好,经讨论并严格评估后需采用离体肝切除联合自体肝移植手术.手术时间为15h,术中出血量约为2000 mL.术后行常规治疗,继续抗病毒治疗,监测国际标准化比率值在1.5～2.5,无需服用抗免疫排斥药物.患者术后第4天转回普通病房,无胆汁漏、出血、感染等并发症发生.术后病理学诊断:泡性棘球蚴病.术后1周复查增强CT提示,异体血管重建的肝脏流出道通畅,无狭窄,无血栓形成,患者目前在随访中.结论 采用自体肝移植术治疗复杂肝包虫病,肝静脉流出道重建宜采取个体化策略;异体静脉因管径长度匹配、无需抗排斥、低感染风险等优点可作为重建肝静脉流出道的理想材料.

OBJECTIVE: This is a case report on a patient with advanced hepatic alveolar echinococcosis (HAE) treated with autologous liver transplantation without any veno-venous bypass using the modified technique of ex vivo liver resection and autologous liver transplantation (the ERAT technique). METHOD: A 27-year old male with advanced HAE underwent in situ reconstruction of vascular inflow/outflow to left lateral liver section, ex-vivo liver resection and autologous liver transplantation of remaining liver remnant (the modified ERAT technique). The operation consisted of hepatotomy along the right border of the falciform ligament, reconstruction of portal vein supplying the left lateral liver section, reconstruction of left hepatic vein, followed by removal of liver segments S1, S4 to S8, ex vivo resection of all involved tissues within these liver segments in the liver remnant, and autologous liver transplantation of the resected liver remnant. The whole surgical procedure lasted for 12 h, and the blood lost was 800 mL. The patient recovered uneventfully in the post-operation period. CONCLUSION: The in situ reconstruction of the vascular inflow/outflow of left lateral liver section maintained the PV circulation and provided liver functional support during the operation. The subsequent autologous liver transplantation provided additional liver functional tissues, thus reduced the risk of post-hepatectomy liver failure. This surgical procedure did not require any veno-venous bypass. (C) 2020 The Author(s). Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.

BACKGROUND AND AIMS: Infiltration of hepatic venous outflow in hepatic alveolar echinococcosis can lead to development of Budd-Chiari syndrome. Medical treatment of this condition is generally unsatisfactory. Radical hepatic resection is impossible for extensive parasitic involvement of liver. This is a case report on a patient who was successfully treated with percutaneous stenting of left hepatic vein followed by Ex vivo Liver Resection and Autotransplantation (ELRA). METHODS: Using the transjugular approach, a metal mesh stent was placed in the left hepatic vein of a 45-year-old man who presented with Budd-Chiari syndrome. After disappearance of ascites and improvement in liver function, Ex vivo Liver Resection and Autotransplantation were performed. RESULTS: The patient underwent left hepatic vein stenting for Budd-Chiari syndrome without complication. Three months later, liver biopsy showed fibrous proliferation of interlobular portal areas and normal hepatic lobules. After successful Ex vivo Liver Resection and Autotransplantation, follow-up examination at 6 months showed normal liver function and no evidence of recurrence. CONCLUSIONS: Allotransplantation is an accepted treatment for advanced hepatic alveolar echinococcosis with Budd-Chiari syndrome. However, shortage of organ donors and need for immunosuppression are challenging problems. In selected patients with hepatic vein stenoses presenting as Budd-Chiari syndreme, percutaneous stenting of hepatic veins followed by ex vivo liver resection and autotransplantation represent an alternative curative treatment option. (C) 2020 The Authors. Published by Elsevier Ltd on behalf of US Publishing Group Ltd.

目的 探讨自体肝移植技术在治疗晚期肝泡型包虫病的疗效及安全性.方法 回顾性分析本中心2017年8月至2018年11月收治的16例晚期肝泡型包虫病患者的临床资料,其中8例行半离体肝切除和8例行离体肝切除联合自体肝移植技术,分析患者的术中及术后随访情况.结果 16例患者手术时间(11.5±3.1)h,术中输血(8.2±8)UU,术中失血(2253±842.5)ml,术后住院时间(15±13)d.围手术期并发症6例,死亡1例;术后15例均随访,随访期间14例患者未见包虫复发及远处转移,1例术后5月死亡.结论 自体肝移植是治疗晚期泡型包虫病的有效治疗方法,术中肝脏劈裂及个体化管道重建是手术的关键步骤,术前的精确评估、围手术期管理、手术方式非常重要.

目的 探讨高原地区藏族人群肝棘球蚴病患者右心结构和功能改变的超声心动图特征.方法 随机选取经超声诊断为肝棘球蚴病的高原地区藏族患者113例,其中多房棘球蚴组(AE组)62例,细粒棘球蚴组(CE组)51例,另选同期生活于同一地区且经超声检查未发现肝脏病变的藏族居民49例为对照组.均行常规超声心动图检查,测量并比较各组右心结构和功能相关参数,统计肺动脉压力增高比率.结果 AE组和CE组右室前后径、右室横径、肺动脉前向血流速度、肺动脉前向血流压差均低于对照组,差异均有统计学意义(均P<0.05),但AE组与CE组上述参数比较差异均无统计学意义;CE组舒张早期三尖瓣血流速度与三尖瓣环运动速度比值高于对照组,差异有统计学意义(P<0.05);AE组和CE组三尖瓣环收缩期位移均低于对照组,差异均有统计学意义(均P<0.05).AE组、CE组和对照组肺动脉压力增高比率分别为38％、35％和31％,差异无统计学意义.结论 超声心动图可检出高原地区藏族人群肝棘球蚴病患者右室缩小和右心舒缩功能受损,具有一定的临床应用价值.

目的 探讨超声及CT对囊性肝包虫病的分型及其在临床诊治中的价值.方法 回顾性分析我院105例经手术病理或穿刺活检证实的肝包虫囊肿患者的超声和CT图像资料,根据WHO超声分型标准对其进行分型,总结每种分型的超声图像特征;以手术结果为标准,比较超声和CT测得的包虫囊肿最大径.结果 肝包虫囊肿CE1型9例,CE2型13例,CE3a型12例,CE3b型24例,CE4型22例,CE5型25例.其中CE1型主要表现为单房的类圆形囊性团块,囊壁增厚,呈"双壁征";CE2型主要表现为多房囊性团块,呈"蜂窝样"或"玫瑰花瓣样";CE3a型主要表现为内、外囊壁分离,呈"水中百合征";CE3b型母囊以实性成分为主,其内可见子囊回声;CE4型主要表现为囊肿实变,内无子囊回声;CE5型主要表现为囊壁钙化.超声和CT测得包虫囊肿最大径分别为(10.50±5.37)cm和(9.90±5.04)cm,与术后标本测值(10.50±5.64)cm比较,差异均无统计学差异.结论 超声和CT能通过分型反映不同时期包虫囊肿的病理变化,对囊性肝包虫病的临床诊治具有重要价值.

目的 了解四川省石渠县肝包虫病患者B超影像的变化过程及趋势,分析变化规律,提高对包虫病的超声影像识别能力,了解阿苯达唑大规模社区治疗情况.方法 通过现场超声检查及血清学检测,对患者进行跟踪随访;通过Excel建立2个队列数据库,分别比较病灶1年及2年后的影像变化特点;以Fisher确切概率法,对病灶退化率进行比较.结果 共计随访606例,获得618个病灶的清晰图像;1年随访后,与其他阶段的囊型包虫病相比,CE3型病灶退化率较高,达到16.42％ (P ＜0.05),其他各型之间退化率差异无统计学意义(P＞0.05);2年随访后,与其他阶段的囊型包虫病相比,CE3型病灶退化率较高,达到45.45％(P ＜0.05),其他各型之间退化率差异无统计学意义(P＞0.05).结论 本研究中涉及的病灶变化可推测为自然转归,表明阿苯达唑大规模社区治疗依从性差;CE3是囊型包虫病中最不稳定的类型,易退化为CF4;CE3、CE4的囊壁可直接被肝组织吸收;泡型包虫病中似血管瘤型不稳定,发展为伪囊型.

目的:总结泡型肝包虫病的超声造影表现特征,探讨超声造影诊断泡型肝包虫病的临床应用价值.方法:回顾分析23例经临床病理确诊的泡型肝包虫病的超声造影表现,比较常规超声与超声造影诊断符合率.结果:23例泡型肝包虫病超声造影主要表现为病灶各时相内部及周边均无增强或边缘处虫蚀样等增强或环状高增强,内部各时相无增强.与病理诊断结果对照,常规超声诊断泡型肝包虫病与病理诊断符合17例,误诊6例,诊断符合率73.9％(17/23);超声造影与病理诊断结果符合22例,误诊1例,诊断符合率95.6％(22/23),高于常规超声,差异具有统计学意义(χ2=4.212,P<0.05).结论:超声造影可有效提高超声检查对泡型肝包虫病诊断和鉴别诊断的准确性.

Media access control is an important technology in ad hoc networks. Based on the multi-hop Pseudo Bayesian (PB) algorithm and the single-hop Fast Conflict Resolution algorithm (FCR), in this paper, we propose a Multi-hop Fast Conflict Resolution (MFCR) algorithm for ad hoc networks. We make the detailed introduction of the theoretical model, the pseudo Bayesian analysis and the algorithm deign. MFCR employs a competition probability forecasting method, which is similar to the backoff counter used in FCR, combined with the handshake process used in PB to solve the utilization and the fairness problems of the time slot allocation. Simulations show that the MFCR has evident improvement in the network performance.