Multifocal

多焦
  • 文章类型: Journal Article
    对于不适合手术切除的多灶性肝细胞癌(HCC)患者的常见治疗策略是经动脉化疗栓塞(TACE)。将TACE与125I种子插入(ISI)组合可以提供增强治疗功效的手段。这项研究的目的是比较有和没有ISI的TACE治疗多灶性HCC的疗效。
    对两个中心的数据进行了回顾性分析。本研究涉及2018年1月至2021年12月期间接受TACE的85例多灶性HCC连续患者。在这些病人中,43人在联合组,接收与ISI的TACE,只有42人属于TACE组,接收没有ISI的TACE。比较这些组之间的治疗结果。
    在这些患者组之间没有观察到基线数据的显着差异。更高的完成率(60.5%与33.3%,P=0.016)和总计(93.0%vs.61.9%,与仅TACE组相比,联合组的P=0.001)反应明显。中位无进展生存期(PFS,13vs.10个月,P=0.014)和总生存率(OS,22vs.17个月,联合组的P=0.035)也明显长于仅TACE组。使用Cox回归分析,与较短PFS和OS相关的风险变量包括Child-PughB状态(P=0.027和0.004)和仅TACE治疗(P=0.011和0.022).
    总之,这些发现表明,与单独的TACE相比,联合TACE和ISI可以提高HCC患者的治疗结果和生存率。
    UNASSIGNED: A common treatment strategy for individuals with multifocal hepatocellular carcinoma (HCC) who are not candidates for surgical resection is transarterial chemoembolization (TACE). Combining TACE with 125I seed insertion (ISI) may offer a means of enhancing therapeutic efficacy. The purpose of this study was to compare the therapeutic efficacy of TACE administered with and without ISI for the treatment of multifocal HCC.
    UNASSIGNED: The data from the two centers were analyzed retrospectively. The present study involved 85 consecutive patients with multifocal HCC who underwent TACE between January 2018 and December 2021. Of these patients, 43 were in the combined group, receiving TACE with ISI, and 42 were in the TACE-only group, receiving TACE without ISI. Comparisons of treatment outcomes were made between these groups.
    UNASSIGNED: No significant differences in baseline data were observed between these groups of patients. Higher rates of complete (60.5% vs. 33.3%, P = 0.016) and total (93.0% vs. 61.9%, P = 0.001) responses were evident in the combined group compared to the TACE-only group. Median progression-free survival (PFS, 13 vs. 10 months, P = 0.014) and overall survival (OS, 22 vs. 17 months, P = 0.035) were also significantly longer in the combined group than in the TACE-only group. Using a Cox regression analysis, risk variables associated with shorter PFS and OS included Child-Pugh B status (P = 0.027 and 0.004) and only TACE treatment (P = 0.011 and 0.022).
    UNASSIGNED: In summary, these findings suggest that, as compared to TACE alone, combining TACE and ISI can enhance HCC patients\' treatment outcomes and survival.
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  • 背景:神经淋巴瘤病(NL)是一种罕见的疾病。超声(US)在NL的诊断和随访中起着至关重要的作用。
    方法:一名59岁男子因左上肢急性疼痛住院。超声显示左肘周围多个神经节段性肿胀,血流信号丰富。对比增强超声(CEUS)显示,在动脉早期,神经病变的完整和均匀增强。通过成像和流式细胞术证实了NL,他接受了化疗.治疗后超声显示左上肢神经基本正常。不幸的是,患者在5个月内因脑转移死亡。
    结论:神经US和CEUS可以显示特定的表现,并提供有关NL的更多诊断信息。
    Neurolymphomatosis (NL) is a rare disease. Ultrasound (US) plays a crucial role in diagnosing and following up the NL.
    A 59-year-old man was hospitalized with acute pain in the left upper extremity. Ultrasound revealed segmental swelling of multiple nerves around his left elbow with abundant blood flow signals. Contrast-Enhanced Ultrasound (CEUS) showed a rapid, complete and homogenous enhancement in the nerve lesions in the early arterial phase. The NL was confirmed by imaging and flow cytometry, and he accepted chemotherapy. The posttherapeutic ultrasound showed that the nerves in the left upper limb were basically normal. Unfortunately, the patient died of cerebral metastasis in 5 months.
    The nerve US and CEUS can show specific manifestations and provide more diagnostic information about NL.
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  • 文章类型: Journal Article
    目的:为了评估可行性,效率,微波消融(MWA)治疗多灶性甲状腺乳头状微小癌(PTMC)的安全性。
    方法:这是一项回顾性研究,我们回顾了2016年10月至2021年12月期间接受MWA治疗多灶性PTMC的患者数据.消融后,肿瘤大小和体积的变化,以及技术成功率,肿瘤消失,疾病进展,和并发症,被评估。根据肿瘤的位置,将病例进一步分为单侧多灶性疾病(UMD)亚组和双侧多灶性疾病(BMD)亚组.进行了进一步的分析。
    结果:本研究共纳入94例,其中包括24名男性和70名女性。中位年龄为40岁(22-66岁);中位随访时间为14个月(6-48个月)。所有登记病例均实现了完全消融。因此,技术成功率为100%。由于消融扩大,消融区的MD和体积在消融术后的第1个月和第3个月增加,从消融术后的第12个月减少(全部p<0.05)。肿瘤完全消失率为45/94(47.87%),UMD亚组40.625%(13/32),BMD亚组51.61%(32/62)(p=0.312)。总体疾病进展率为4.26%(4/94),UMD亚组6.25%(2/32),BMD亚组3.23%(2/62)(p=0.881)。总并发症发生率为4.26%(4/94)。
    结论:这项初步研究表明,MWA是多灶性PTMC的安全有效治疗方法。
    OBJECTIVE: To evaluate the feasibility, efficiency, and safety of microwave ablation (MWA) for multifocal papillary thyroid microcarcinoma (PTMC).
    METHODS: This was a retrospective study, and the data of patients who underwent MWA for multifocal PTMC from October 2016 to December 2021 were reviewed. After ablation, the changes in tumor size and volume, as well as the rates of technical success, tumor disappearance, disease progression, and complications, were assessed. According to the tumor location, the cases were further divided into a unilateral multifocal disease (UMD) subgroup and a bilateral multifocal disease (BMD) subgroup. Further analyses were carried out.
    RESULTS: There was a total of 94 cases enrolled in the present study, which included 24 males and 70 females. The median age was 40 years (22-66 years); the median follow-up time was 14 months (6-48 months). Complete ablation was achieved in all enrolled cases. Therefore, the technical success rate was 100%. Due to expanding ablation, the MD and volume of the ablation zone increased at the 1st and 3rd months after ablation and decreased from the 12th month after ablation (p < 0.05 for all). The total complete tumor disappearance rates were 45/94 (47.87%) overall, 40.625% (13/32) in the UMD subgroup and 51.61% (32/62) in the BMD subgroup (p = 0.312). The total disease progression rates were 4.26% (4/94) overall, 6.25% (2/32) in the UMD subgroup and 3.23% (2/62) in the BMD subgroup (p = 0.881). The overall complication rate was 4.26% (4/94).
    CONCLUSIONS: This preliminary study indicates that MWA is a safe and effective treatment for multifocal PTMC.
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  • 文章类型: Journal Article
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  • 文章类型: Case Reports
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  • 文章类型: Case Reports
    肺炎克雷伯菌引起的高度侵袭性感染,包括菌血症,肝脓肿,脑膜炎,化脓性关节炎,骨髓炎,在成人免疫功能正常和免疫功能低下的患者中不常见。这里,我们报告了1例肺炎克雷伯菌引起的严重颅骨受累的慢性多灶性骨髓炎成人病例.患者有5年的眼眶脓肿和多处头皮创伤病史。CT扫描显示右侧颞部和眶周骨质溶解,多发性顶骨溶解。收集脓液两次,常规培养为肺炎克雷伯菌阳性。清创和抗生素治疗取得了良好的临床效果。当怀疑影像或术中发现骨感染时,微生物学家和临床医师应及时对活检标本进行细菌学培养,以利于诊断,尤其是马里人口。
    Highly invasive infections caused by Klebsiella pneumonia, which includes bacteremia, liver abscess, meningitis, septic arthritis, and osteomyelitis, in not commonly seen in adult immunocompetent and immunocompromised patients. Here, we report an adult case of chronic multifocal osteomyelitis with severe cranial involvement caused by Klebsiella pneumonia. The patient has a 5-year history of orbital abscess and multiple scalp traumas. CT scan showed right temporal and periorbital osteolysis, multiple parietal osteolysis. The pus was collected twice and routine culture was positive for Klebsiella pneumoniae. Good clinical outcome was achieved with debridement and antibiotic treatment. Microbiologists and clinicians should promptly perform bacteriological cultures on biopsy specimens to facilitate diagnosis when imaging or intraoperative findings of bone infection are suspected, especially in the Mali population.
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  • 文章类型: Journal Article
    术前准确预测mPTMC患者的颈淋巴结转移(LNM)为手术决策和肿瘤切除程度提供了依据。本研究旨在开发和验证用于术前评估LN状态的超声影像组学列线图。
    共纳入450例经病理诊断为mPTMC的患者,包括建模组348例患者和验证组102例患者。对基本信息进行单因素和多因素logistic回归分析,超声特征,和美国放射学会甲状腺成像报告和数据系统(ACRTI-RADS)评分,以确定mPTMC中LNM的独立危险因素,并构建逻辑回归方程和列线图来预测LNM的风险。验证组数据用于评估列线图的预测性能。
    男性,年龄<40岁,单个病灶最大直径>0.5cm,囊侵犯,ACR最高得分>9分,ACR总分>19分是mPTMC发生宫颈LNM的独立危险因素。由上述6个因素构建的预测模型的曲线下面积(AUC)和一致性指数(C指数)均为0.838。列线图的校准曲线接近理想对角线。此外,决策曲线分析(DCA)表明该模型的净收益显著更大。外部验证证明了预测列线图的可靠性。
    提供的放射组学列线图,基于ACRTI-RADS分数,对mPTMC患者术前评估LN具有良好的预测价值。这些发现可能为手术决策和肿瘤切除程度提供依据。
    Accurate preoperative prediction of cervical lymph node metastasis (LNM) in patients with mPTMC provides a basis for surgical decision making and the extent of tumor resection. This study aimed to develop and validate an ultrasound radiomics nomogram for the preoperative assessment of LN status.
    A total of 450 patients pathologically diagnosed with mPTMC were enrolled, including 348 patients in the modeling group and 102 patients in the validation group. Univariate and multivariate logistic regression analyses were performed on the basic information, ultrasound characteristics, and American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS) scores of the patients in the modeling group to identify independent risk factors for LNM in mPTMC and to construct a logistic regression equation and nomogram to predict the risk of LNM. The validation group data were used to evaluate the predictive performance of the nomogram.
    Male sex, age <40 years, a single lesion with a maximum diameter >0.5 cm, capsular invasion, a maximum ACR score >9 points, and a total ACR score >19 points were independent risk factors for the development of cervical LNM in mPTMC. Both the area under the curve (AUC) and concordance index (C-index) of the prediction model constructed from the above six factors were 0.838. The calibration curve of the nomogram was close to the ideal diagonal line. Furthermore, decision curve analysis (DCA) demonstrated a significantly greater net benefit of the model. The external validation demonstrated the reliability of the prediction nomogram.
    The presented radiomics nomogram, which is based on ACR TI-RADS scores, shows favorable predictive value for the preoperative assessment of LNs in patients with mPTMC. These findings may provide a basis for surgical decision making and the extent of tumor resection.
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  • 文章类型: Journal Article
    脊柱结核,也被称为波特病或结核性脊柱炎,通常继发于肺部或其他系统的原发感染,在大多数情况下,被认为是通过血液传播的。感染的典型表现包括由侵蚀引起的椎间盘变窄和相邻椎骨的骨破坏。不典型脊柱结核是一种特殊类型的脊柱结核。它主要由单个椎体病变组成,单个后部结构病变,多发性椎体病变,和脊髓内病变。跳跃的多灶性脊柱结核是这些类型中的一种,其特征是两个或多个椎体病变而不涉及相邻的椎间盘,不管他们的位置。迄今为止,只有少数病例报告。临床入院时,它可以保守或手术治疗,取决于病人的症状。此外,正在研究基因或生物疗法。然而,由于特殊的影像学发现和阴险的症状,它经常被误诊为肿瘤病变,骨质疏松性骨折,或者其他感染性脊柱炎,增加神经功能缺损和后凸畸形的风险,并延迟最佳治疗窗口。在这项研究中,我们回顾了多灶性脊柱结核病变的诊断和治疗策略,并列举了常见的鉴别诊断,为临床治疗和诊断方向提供参考和指导。
    Spinal tuberculosis, also known as Pott\'s disease or tuberculous spondylitis, is usually secondary to primary infection in the lungs or other systems, and in most instances, is thought to be transmitted via blood. Typical manifestations of infection include narrowing of the intervertebral disc by erosion and bone destruction of adjacent vertebrae. Atypical spinal tuberculosis is a specific type of spinal tuberculosis. It mainly consists of single vertebral lesions, single posterior structure lesions, multiple vertebral lesions, and intra-spinal lesions. Skipped multifocal spinal tuberculosis is one of these types and is characterized by two or more vertebral lesions without the involvement of the adjoining intervertebral discs, regardless of their location. To date, only a few cases have been reported. Upon clinical admission, it can be treated conservatively or surgically, depending on the patient\'s symptoms. In addition, gene or biological therapies are being investigated. However, because of the exceptional imaging findings and insidious symptoms, it is often misdiagnosed as a neoplastic lesion, osteoporotic fracture, or other infectious spondylitis, increasing the risk of neurological deficit and kyphotic deformity, and delaying the optimal treatment window. In this study, we review the diagnosis and treatment strategies for skipped multifocal spinal tuberculosis lesions and enumerate the common differential diagnoses, to provide reference and guidance for clinical treatment and diagnosis direction.
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  • DOI:
    文章类型: Journal Article
    目的:探讨屈光手术后白内障手术的临床特点。
    方法:在本研究中,回顾性分析2017年至2021年在深圳爱尔眼科医院接受屈光手术后接受白内障手术的23例(38眼)白内障患者。患者进行了飞秒激光辅助白内障手术(FLACS)联合人工晶状体植入术(IOLI),或常规超声乳化(Phaco)联合IOLI。人工晶状体(IOL)的类型和度数是根据眼部情况选择的,需要,以及患者的生活习惯。术中并发症,术后眼压(IOP),未矫正视力(UCVA),记录和分析术后屈光状态。
    结果:患者术后UCVA明显优于基线(手术前),术后IOP和屈光度(D)与基线相似,术后满意度较高.术后视力,FLACS+IOLI组D及并发症发生率与Phaco+IOLI组差异无统计学意义。前者的IOP在统计学上低于后者。
    结论:FLACS联合IOLI或常规Phaco联合IOLI对于接受屈光手术的白内障患者是可行的。在IOL选择方面,多焦点,扩展视野范围(ERV),可以选择或三焦点类型来实现手术后摘除晶状体的目标,但该决定应根据患者的具体眼部状况做出,生活需要,和经济环境。为了取得满意的疗效,有必要全面了解此类患者的病情特征,掌握术前、术后的诊断和治疗方法,为了准确计算IOLP,与患者充分沟通他们的手术期望,制定可行的手术计划。
    OBJECTIVE: To characterize the clinical features of cataract surgery performed after refractive surgery.
    METHODS: In this study, 23 patients with cataracts (38 eyes) who underwent cataract surgery following refractive surgery at the Shenzhen Aier Eye Hospital between the years 2017 and 2021 were retrospectively included for analysis. The patients had either femtosecond laser-assisted cataract surgery (FLACS) combined with intraocular lens implantation (IOLI), or conventional phacoemulsification (Phaco) combined with IOLI. The type and power of an intraocular lens (IOL) were selected based on the ocular condition, needs, and living habits of patients. Intraoperative complications, postoperative intraocular pressure (IOP), uncorrected visual acuity (UCVA), and postoperative refractive status were all recorded and analyzed.
    RESULTS: The patients had a postoperative UCVA that was significantly better than the baseline (prior to operation), a postoperative IOP and diopter (D) similar to the baseline and a high level of postoperative satisfaction. The postoperative visual acuity, D and complication rate of FLACS+IOLI group were not significantly different from those of Phaco+IOLI group, and the IOP of the former was statistically lower than that of the latter.
    CONCLUSIONS: FLACS with IOLI or conventional Phaco with IOLI is feasible for cataract patients who have undergone refractive surgery. In terms of IOL selection, multifocal, extended range of vision (ERV), or trifocal types can be selected to achieve the goal of lens removal after surgery, but the decision should be made based on the patient\'s specific eye condition, living needs, and economic circumstances. To achieve satisfactory curative effects, it is necessary to have a comprehensive understanding of the characteristics of the condition of such patients, to master the pre- and post-operative diagnosis and treatment methods, to accurately calculate the IOLP, to fully communicate with patients about their surgical expectations, and to develop feasible surgical plans.
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  • 文章类型: Journal Article
    背景:多病灶(MF)和多中心(MC)乳腺癌病例由于广泛使用了改良的术前乳腺成像技术而越来越多地被诊断。当前的肿瘤淋巴结转移分期系统使用最大肿瘤的尺寸,并建议报告MF/MC乳腺癌中最大肿瘤的病理特征。
    目的:本研究旨在探讨MF和MC乳腺癌的最大或聚集尺寸是否可以更好地预测肿瘤行为。我们还试图研究MF和MC乳腺癌中单独病灶的组织学和生物学异质性,以确定是否有必要检查每个病灶。
    方法:我们回顾性分析了南京医科大学第一附属医院收治的121例MF/MC(103例MF和18例MC)乳腺癌和484例单灶性乳腺癌患者。使用两种方法记录T分期(使用最大病变的尺寸和所有病变的聚集尺寸)。组织学分级,免疫组织化学参数,研究了MF/MC乳腺癌中最大病变和其他病变的分子亚型,以评估肿瘤间的异质性。
    结果:与使用最大尺寸相比,使用集合尺寸将63例MF/MC乳腺癌患者的分期提高到更晚期,并消除了癌症多重性对淋巴结阳性的独立影响。病理类型不匹配(9.9%),组织学分级(4.1%),不同病灶中的分子亚型(8.3%)。
    结论:MF/MC乳腺肿瘤的转移倾向可能与肿瘤负荷有关。可以通过所有焦点的聚合尺寸更好地预测。当前分级系统的使用可能需要进一步评估和修改。肿瘤间异质性表明MF/MC乳腺癌患者需要对每个病变进行病理和免疫组织化学评估。
    Multifocal (MF) and multicentric (MC) breast cancer cases have been increasingly diagnosed owing to the extensive use of improved preoperative breast imaging. The current tumor-node-metastasis staging system uses the dimension of the largest tumor and recommends reporting the pathological features of the largest tumor in MF/MC breast cancers.
    This study aimed to explore whether the largest or aggregate dimensions of MF and MC breast cancers can better predict tumor behavior. We also attempted to study the histological and biological heterogeneities of separate foci in MF and MC breast cancers to determine whether it was necessary to examine each lesion.
    We retrospectively analyzed 121 patients with MF/MC (103 with MF and 18 with MC) breast cancers and 484 patients with unifocal breast cancer who were treated at the First Affiliated Hospital of Nanjing Medical University. Two methods were used to record the T stage (using the dimensions of the largest lesion and aggregate dimensions of all lesions). The histological grade, immunohistochemical parameters, and molecular subtypes of the largest lesion and other lesions in MF/MC breast cancers were studied to assess intertumoral heterogeneity.
    The use of aggregate dimensions upstaged 63 patients with MF/MC breast cancers to a more advanced stage and removed the independent effect of cancer multiplicity on lymph node positivity compared with the use of the largest dimension. Mismatches were found in the pathological type (9.9%), histological grade (4.1%), and molecular subtype (8.3%) among different foci.
    The tendency of MF/MC breast tumors to metastasize may be related to tumor load, which can be better predicted by the aggregate dimensions of all foci. The use of the current staging systems may require further evaluation and modification. Intertumoral heterogeneity indicates the necessity for pathological and immunohistochemical assessments of each lesion in patients with MF/MC breast cancers.
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