2018年 · 第98卷第23期

Cone-beam CT (CBCT) was introduced into stomatology in the middle and late 1990s and has been continuously improved, which has brought about great changes in oral and maxillofacial imaging. CBCT uses a flat panel detector for imaging, with a spatial resolution of up to 0.07 mm, and is a truly isotropic imaging, which provides a reliable imaging basis for stomatologists to diagnose clinical malocclusion, formulate and adjust orthodontic protocols, etc. Because CBCT has the dual advantages of high spatial resolution and low radiation dose, its clinical application should not be limited to stomatology, but should be further expanded to other areas where fine structures need to be displayed, such as the temporal bone.

In recent years, radioactive seed implantation has been applied in the treatment of patients with malignant tumors in various forms and has achieved certain curative effects^[1,2,3,4]。 The target area of tumor and the actual exposure dose of the endangered organ are the direct factors affecting the efficacy and complications. The report of the American Society of Medical Physicists Working Group No. 137 (AAPM TG-137), the American Brachytherapy Association and several European organizations stipulate that the application of three-dimensional treatment planning system (TPS) to CT images after prostate cancer radioactive seed implantation is the gold standard for evaluating the quality of seed implantation and the actual exposure dose^[5]。 At present, only prostate cancer has clear guidelines in the field of radioactive particle therapy, but it is still controversial about when to perform the verification plan after surgery, and the verification plan time is different in different units^[6,7]。 In order to avoid the effect of puncture edema, most scholars believe that dose verification at 1 month after operation is more accurate^[8,9]。 Most tumors in other sites rely on the subjective experience of physicians to evaluate the validated dose parameters on the same day or 1 week after surgery. The accuracy of dosimetric parameters, as factors directly related to prognosis, depends on the accurate verification of TPS. The use of TPS for peripheral dose verification is affected by many factors such as the shape, size, particle position and activity of the target area. Because the target area and the spatial position of prostate cancer particles have little change after seed implantation, the verification plan immediately after operation or one month after operation can be used as the actual absorbed dose. However, for tumors in other parts, the actual irradiation dose of target area and surrounding endangered organs changes constantly after seed implantation, and the verification plan immediately after operation or one month after operation alone is not enough to accurately evaluate the changes of actual dosimetric parameters of target area and endangered organs^[10]。 Dose validation time is the key factor affecting dosimetric parameters. Regular dose validation with TPS after seed implantation is helpful to fully evaluate the influence of activity and volume changes on dosimetric parameters of target areas and endangered organs, understand the influence of dynamic dose changes on curative effect and complications, and is beneficial to the formulation of prescription dose and endangered organ limit. At the same time, it provides a basis for formulating specifications for tumor seed implantation in other sites.

deep venous thrombosis (DVT) is a disease caused by abnormal blood coagulation in the deep veins of the lower limbs. Due to the obstruction of blood return, the patient has swelling, pain and dysfunction of the lower limbs, and the thrombus shedding can cause pulmonary embolism (PE), resulting in gas exchange disorder, pulmonary hypertension, right ventricular dysfunction, and dyspnea, shock and even death in severe cases. DVT and PE are collectively known as venous thromboembolism (VTE)^[1,2]。 Because the incidence of PE after DVT is high, or the embolus of PE is mostly derived from DVT, DVT and PE can be regarded as different stages or processes of VTE. If DVT is not effectively treated in the acute phase, the thrombosis is organized, and venous insufficiency is often left behind, which is called postthrombosis syndrome (PTS)^[3,4]； If PE is not dissolved in time, it can affect pulmonary artery blood flow and lead to chronic thromboembolic pulmonary hypertension (CTEPH).

Biopsy has been used in the diagnosis of thoracic diseases for more than 100 years. According to different sampling methods, chest tumor biopsy can be divided into trans-bronchoscopic biopsy, percutaneous puncture biopsy, trans-thoracoscopic biopsy and open thoracic biopsy. percutaneous transthoracic needle biopsy (PTNB) is a biopsy operation guided by imaging equipment. With the continuous update of imaging technology and equipment, the clinical application scope of percutaneous biopsy is constantly expanding, from the earliest pathological diagnosis to tissue subtype classification and genetic diagnosis, and the clinical demand is increasing day by day. At the same time, it is particularly important to improve the understanding of percutaneous puncture chest tumor biopsy, standardize its operation flow and strengthen perioperative management. As early as 2003, the British Thoracic Society (BTS) issued guidelines for percutaneous lung biopsy (hereinafter referred to as "BTS guidelines")^[1]In 2016, the Respiratory Disease Branch of the Chinese Medical Association and the China Lung Cancer Prevention and Treatment Alliance organized and released the "Chinese Expert Consensus on Issues Related to Small Sample Sampling of Lung Cancer"^[2]In this paper, the common key questions in the clinical practice of percutaneous lung biopsy were classified and answered. At present, there is no Chinese expert consensus on percutaneous biopsy of chest tumors, which systematically standardizes and guides the clinical practice of percutaneous biopsy of chest tumors. Accordingly, the Cancer Interventional Committee of China Anti-Cancer Association initiated the formulation of the Chinese expert consensus on percutaneous biopsy of chest tumors, updated the evidence on the basis of fully learning from the BTS Guidelines and the Chinese expert consensus on issues related to small sample collection of lung cancer, and gathered the opinions of multidisciplinary experts, finally forming the Chinese expert consensus on percutaneous biopsy of chest tumors suitable for China's national conditions.

A 42-year-old male underwent aortic and mitral valve replacement in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine in 1997 due to rheumatic valvular heart disease, and was followed up regularly. On July 22, 2013, the patient went to the doctor for "waist soreness and swelling for more than 8 months with fever for 2 weeks". No obvious abnormalities were found on cardiac ultrasound, and CT showed: psoas major abscess (FIG. 1A), thoracolumbar vertebral body (T₁₁-L₁) destroy (FIG. 1B)。 Puncture and drainage were performed, and histopathology showed "granulomatous inflammation, excluding tuberculosis". The result of drainage culture was: Mycobacterium. Lumbar tuberculosis with psoas major abscess was diagnosed, and quadruple anti-tuberculosis treatment was started on August 7, 2013. The specific regimen was: isoniazid 0.3 g oral once daily + rifampicin 0.45 g oral once daily + pyrazinamide 0.5 g oral 3 times daily + ethambutol 0.75 g oral once daily. On September 4, 2013, he was re-admitted due to fever. Physical examination showed that his body temperature was 38.3 ℃, his heart rate was 100 beats/min, his breathing was 20 beats/min, and his blood pressure was 105/61 mmHg (1 mmHg =0.133 kPa). Laboratory test: white blood cell count 5.7×10⁹/L, red blood cell count 2.83×10¹²/L, hemoglobin 73 g/L, platelet count 194×10⁹/L, neutrophil percentage 69.1%, high-sensitivity C-reactive protein 149.4 mg/L, procalcitonin 0.1 μ g/L. Cardiac ultrasound showed: 15.3 mm ×11.6 mm moderate echo at the root of chordae tendineae in P1/P2 area of mitral prosthetic valve, and neoplasm was considered (Figure 2)。 Multiple negative routine blood cultures, combined with medical history and clinical manifestations, clinical diagnosis: "infectious endocarditis, Mycobacterium tuberculosis". The anti-tuberculosis treatment of the quadruple regimen was continued, and the anti-tuberculosis treatment was ended in July 2014. The CT reexamination on August 6, 2014 showed that the psoas major abscess was absorbed (FIG. 3A), vertebral bone destruction and healing (FIG. 3B)。 After regular follow-up, reexamination of cardiac ultrasound showed: endocardial neoplasms, smaller than before (FIG. 4A，FIG. 4B)。 Consider fibrotic tissue left after tuberculosis cure. Follow-up until August 2017, the patient was re-admitted due to "1 d ago fever with persistent palpitation". Physical examination: body temperature 36.4℃, heart rate 169 beats/min, breathing 24 beats/min, blood pressure 109/87 mmHg, white blood cell count 9.5×10⁹/L, neutrophil percentage 71.1%, platelet count 185×10⁹/L, NT proBNP 4 044 ng/L, high-sensitivity C-reactive protein 43.8 mg/L, procalcitonin 0.3 μ g/L, cardiac ultrasound showed: mitral paravalvular leakage and old vegetation. Chest CT: The old lesions of thoracic vertebra were similar to those before. Following cardiac surgical evaluation, mitral valve replacement (mechanical valve) was performed on August 7, 2017, considering mitral valve leaflet noose, and postoperative neoplasm pathology suggested scar fibrosis (Figure 5), and was discharged after postoperative rehabilitation. The patient was followed up all the time after the operation. The patient's general condition was stable. Reexamination of cardiac ultrasound showed changes after mitral valve replacement and good valve function.

In China, lung cancer is the tumor with the first incidence and mortality in men, and the second incidence and first mortality in women^[1]。 In recent decades, significant progress has been made in all aspects of lung cancer diagnosis and treatment, including screening, diagnostic tests, surgery, radiotherapy and chemotherapy. Surgery is still the preferred treatment for non-small cell lung cancer (NSCLC), and only patients who undergo radical surgery have hope of cure. However, cruelly, only about 20% of patients with early-middle-stage lung cancer have access to surgery; If these patients do not receive follow-up adjuvant treatment, the 5-year survival rate is disappointing. How to prolong the disease free survival (DFS) and overall survival (OS) of these patients has always been an important direction of clinical research. Here, we present a review of systemic adjuvant therapy after radical NSCLC surgery.

X-ray computed tomography (CT) plays an irreplaceable role in medical imaging, safety inspection, industrial non-destructive testing and other fields^[1]。 With the development of hardware equipment, algorithm and computer technology, CT system is becoming more and more mature, and the evaluation indexes such as image quality, reconstruction speed and radiation dose have been significantly improved.

Perinatal cardiomyopathy (PPCM) refers to idiopathic heart failure that occurs between the last month of pregnancy and 5 months after delivery, is characterized by cardiomyopathy as the basic feature, and does not meet other known heart failure diagnoses^[1]。 The mortality rate of untreated PPCM is between 9% and 50%. Early diagnosis and standardized treatment of PPCM can significantly reduce the mortality rate^[2]。 This article mainly describes the recent progress in the diagnosis and treatment of PPCM in recent years.

The risk of venous thromboembolism (VTE) is significantly increased in pregnant and puerperial women due to their special physiological changes, such as hypercoagulability, venous stasis, vascular endothelial injury and other factors. The incidence of VTE in pregnant women is 1:500, which is 4-5 times higher than that in non-pregnant women^[1,2]。 VTE is one of the leading causes of maternal mortality in developed countries^[3]The World Health Organization reports that 14.8% of maternal deaths are caused by thromboembolic diseases^[4]。 Excluding thrombosis-related gene mutation factors, the risk of developing VTE in Asian population is the same as in western countries^[5]Therefore, the Society of Obstetrics and Gynecology of developed countries such as the United Kingdom and the United States and the Working Group of the Asian Venous Thrombosis Forum have proposed to attach great importance to venous thrombotic diseases in pregnancy and puerperium, and suggest that all women of childbearing age should be assessed before, during and after pregnancy, and corresponding preventive measures should be taken for those at risk of thrombosis^[6]。 Combined with the latest foreign guidelines and research progress at home and abroad, this paper reviews the risk assessment and prevention of pregnancy thromboembolic diseases, so as to strengthen the screening, prevention and management of pregnancy-related VTE, reduce the risk of thrombosis and embolism, and improve pregnancy outcome.