2020年 · 第100卷第31期

The list of members of the expert group for the formulation of this consensus:

In December 2019, cases of novel coronavirus disease 2019 (COVID-19) appeared in Wuhan, Hubei Province, and rapidly spread to other parts of Hubei Province and even the whole country. To this end, the National Health and Wellness Commission has included COVID-19 as a Class B infectious disease stipulated in the Law of the People's Republic of China on the Prevention and Control of Infectious Diseases, and adopted prevention and control measures for Class A infectious diseases. With the deepening of the understanding of clinical manifestations and pathology of the disease and the accumulation of experience in diagnosis and treatment, in order to further strengthen the early diagnosis and treatment of the disease and avoid nosocomial infection as much as possible, on the basis of "Emergency Process Management and Prevention and Control Strategy of Novel Coronavirus Infection" put forward by the Department of Neurosurgery, Wuhan Union Medical College Hospital, Huazhong University of Science and Technology, we widely listened to the opinions and suggestions of experts, especially those in the front line of epidemic prevention, and made targeted supplements and improvements with reference to the latest national and Hubei Provincial relevant prevention and control guidance. The contents are summarized as follows for the reference of peers.

At present, the incidence of pulmonary micronodules and early lung cancer is on the rise. Surgery is the first choice for the treatment of early lung cancer at present, and accurate localization of early microlung cancer is the key to successful surgery. At present, there are many surgical localization methods in clinical application and each has its own advantages and disadvantages. In order to study the localization value of preoperative CT-guided radiotracing technique in palpation-negative pulmonary nodules, this study was applied in 47 lesions [confirmed by positron emission computed tomography (PET-CT) or increased at follow-up] in 44 patients admitted from November 2007 to February 2010⁹⁹mTc isotope combined with iodine contrast agent for CT-guided local injection labeling, all nodules meet at least 1 of the following, 1: diameter<1 cm; 2: Subsolid nodule; 3: Distance from visceral pleura>1 cm. The results showed that the mean size of localized nodules was 11 mm (mean 5-24 mm); 24 nodules were non-solid; Fifteen nodules were partially solid, and eight nodules had solid morphology; The average distance from the visceral pleura was 11 mm (0 to 35 mm); Localization complications included 13 cases of asymptomatic mild pneumothorax; Minor bleeding in 9 cases; 1 case of allergic reaction to contrast medium; Chest pain after puncture in 2 cases; Nine patients had pleural leakage with tracer; 2 cases of obvious tracer pleural cavity leakage; Thirty patients underwent thoracoscopic biopsies; 2 cases converted to thoracotomy; Direct thoracotomy was performed in 12 patients. The asymptomatic suspected pulmonary micronodules found by screening or CT physical examination have non-solid morphology, which increases the difficulty of thoracoscopic biopsy or resection, but it is very suitable for radiotracer localization technology. It is a safe, universal and simple technical means for minimally invasive biopsy of pulmonary nodules with negative palpation.

In recent years, dual-energy CT imaging studies of gout have found that urate deposition can occur in patients with asymptomatic hyperuricemia, which indicates that subclinical urate deposition occurs in gout patients earlier than the onset of clinical symptoms of gout. However, there is no clear explanation in the industry for the reason why such patients have no clinical symptoms, which may be related to the location, quantity and volume of urate deposition. In this study, 25 patients with asymptomatic hyperuricemia and 33 patients with symptomatic gout were examined by dual-energy CT of foot and ankle gout, and the differences in the detection rate, deposition location and urate volume of dual-energy CT were compared between the two groups. Among them, the blood uric acid level of asymptomatic hyperuricemia patients was ≥540 μ mol/L, and the symptomatic gout patients had no tophi visible on the body surface. The results showed that the detection rates of urate deposition in dual-energy CT were 24% (6/25), 79% (11/14) and 84% (16/19) in asymptomatic hyperuricemia patients and gout patients with a course of 3 years and over 3 years, respectively (P<0.001）。 Urate deposition was detected in joints and tendons of asymptomatic hyperuricemia patients, but the detection rate and volume of urate in joints and tendons were lower than those of symptomatic gout patients (P<0.001）。 There was no statistically significant difference in urate volume between gout patients within 3 years and over 3 years.