结直肠癌肝转移TACE后疗效评价的RECIST和mRECIST对比研究

目的比较实体瘤疗效价标准(RECIST)和改良实体瘤疗效评价标准(mRECIST),为结直肠癌肝脏转移瘤经肝动脉化疗栓塞治疗找到更为合适的疗效评价方法。方法 30例确诊为结直肠癌肝转移接受两次经肝动脉化疗栓塞术(TACE)。术前1周内、治疗后4周患者接受CT或MR三期扫描。根据RECIST和mRECIST标准评价肿瘤缓解程度。两种方法评价结果的比较采用卡方检验。结果据RECIST和mRECIST标准分别评价疗效,达完全缓解、部分缓解、稳定、进展患者例数分别为0、6、17、7例,0、14、9、7例;据两种标准评价治疗的缓解率分别为20.0%和46.7%,差异有统计学意义(P=0.028)。结论 RECIST标准与mRECIST标准相比,低估了结直肠癌肝转移瘤TACE后治疗效果,由于mRECIST标准在测量时强调避开肿瘤液化坏死区域和碘油沉积区域只测量动脉期存活肿瘤,故而对疗效的评价更加准确。     

MRI在乳腺癌脑转移疗效评价中的应用

目的 探讨MRI在乳腺癌脑转移疗效评价中的价值,以合理选择检查方法.方法 选择明确诊断的乳腺癌脑转移瘤患者65例,在放疗前和放疗后1月行头颅MRI常规平扫及增强(T1WI、FLAIR),采用实体瘤疗效评价标准(RECIST) 1.1版作为评价脑转移肿瘤放疗疗效的标准.结果 65例患者放疗后,头颅MRI平扫及增强复查,以RECIST1.1评价结果显示,完全缓解8例(12.3％),部分缓解37例(56.9％),稳定16例(24.6％),进展4例(6.2％).放疗前后平扫FLAIR序列中瘤周水肿显示较佳;DWI序列中瘤周水肿与脑室及脑沟脑积液无明显交通者,瘤周水肿显示较佳;增强T1WI、FLAIR序列中肿瘤大小和瘤周水肿显示较佳.结论 MRI可从多个体位评价病灶,同时可从平扫FLAIR、DWI和增强T1WI、FLAIR序列进行综合疗效评价.     

晚期肺癌免疫治疗现状及影像学疗效评价和预测

免疫治疗是近年新兴的治疗手段,为部分传统治疗疗效不佳的肿瘤患者提供新的治疗思路,已成为部分晚期肺癌患者的一线治疗方案。目前,实体瘤疗效评价标准(response evaluation criteria in solid tumors, RECIST)仍是实体瘤疗效评价的主流标准。但免疫治疗因其治疗反应的特殊性,传统RECIST评估不能及时准确评价肿瘤治疗疗效。而影像学成像已进入功能化成像新时代,可提供微观分子及代谢改变信息。人工智能与放射影像组学通过挖掘图像背后更多的数学规律,可提供更多具有诊断价值的信息,有望为肺癌免疫治疗的疗效评价与预测提供新方法和新思路。本文就晚期肺癌免疫治疗的机制、现状及评价标准作一综述,重点分析影像学疗效评价与预测,并对其作出展望。     

MSCT成像技术在小肠间质瘤诊断中的临床应用

胃肠道间质瘤（Gastrointestinal stromal tumor，GIST）是消化系统非上皮源性肿瘤中最为常见的一种肿瘤，具有高度潜在恶性的生物学行为，由于肿瘤分子靶向药物格列卫的问世，该肿瘤已受到关注。作者搜集2004年8月至2006年12月18例小肠间质瘤中12例应有多排螺旋CT造影检查（multi slice CT，MSCT）及临床、手术和病理结果进行回顾性分析，以提高对本病的认识水平及探讨小肠多排CT造影检查的临床应用价值。     

内镜全层切除术治疗胃间质瘤的临床研究

目的：探讨内镜全层切除术（EFR）对胃固有肌层间质瘤的治疗价值。方法选取2011年2月至2013年8月于烟台毓璜顶医院消化内镜中心行胃镜检查发现并经超声胃镜、CT 或MRI 检查,提示为胃固有肌层间质瘤患者18例,在气管插管全麻下行 EFR 治疗,术后随访评价其疗效及安全性。结果经 EFR 治疗的18例患者,病变均一次性完整切除。切除肿瘤最大直径1.2～3.0 cm,平均最大直径为1.8 cm。EFR 手术时间为45～120 min,平均手术时间为85.5 min。术后病理证实2例位于胃体的肿瘤为平滑肌瘤,其余均为间质瘤。术后均未出现出血、腹膜炎等并发症。术后随访1～12个月,创面愈合良好,病变均无残留或复发。结论 EFR 治疗胃固有肌层间质瘤安全、有效,具有创伤小、整体切除率高的优点,具有良好的临床推广价值。     

影像学评估免疫治疗后肿瘤假性进展和超进展北大核心CSCD

免疫治疗过程中,肿瘤可出现假性进展或超进展。实体瘤疗效评价标准(RECIST)协作组优化了免疫治疗实体瘤疗效的评价标准,以提高识别肿瘤假性进展的能力;但目前对于超进展尚缺乏统一诊断标准,部分研究以肿瘤生长速率(TGR)等动力学指标评价肿瘤加速生长的动态特征。影像组学及MR功能成像在评估肿瘤免疫治疗方面展现出巨大潜力。本文对影像学评估免疫治疗致肿瘤假性进展和超进展的研究现状进行综述。     

基于MRI的瘤周影像组学在肿瘤研究中的应用进展

影像组学可定量挖掘和分析医学图像的深层次信息,目前基于MRI的影像组学已广泛应用于肿瘤研究,但大多数研究忽视了瘤周影像组学特征,而瘤周影像组学特征可能蕴含肿瘤微环境相关信息。因此,越来越多的研究开始将MRI瘤周影像组学特征纳入到肿瘤研究中,在肿瘤的鉴别诊断、分子分型、转移预测、疗效评估、复发和预后预测等方面取得了一定的进展。本文就基于MRI的瘤周影像组学在肿瘤研究中的应用进展进行综述。      

卵巢Brenner瘤的超声表现

卵巢Brenner瘤又称卵巢纤维上皮瘤,是一种极少见的卵巢上皮源性肿瘤,仅占所有卵巢肿瘤的1.5%~2.5%[1],分为良性、交界性及恶性,其中良性Brenner瘤较多见。由于Brenner瘤少见,医师对该病的认识不足,诊断标准不一,漏误诊率较高。本组结合临床和病理资料回顾性分析15例卵巢Brenner瘤患者的超声表现,以期为经阴道超声诊断卵巢Brenner瘤提供依据。     

附睾结节样病变133例临床病理分析

目的探讨附睾常见肿瘤及肿瘤样病变的临床病理特征。方法对133例经手术切除的附睾病变的临床和病理资料进行回顾性分析,对8例炎性假瘤和伴有结节状增生的附睾炎进行免疫组化检查。结果肿瘤性病变12例(9%),囊肿29例(21.8%),结核21例(15.8%),精子肉芽肿13例(9.8%),非肉芽肿性附睾炎40例(30.1%),炎性假瘤、纤维性假瘤及平滑肌增生结节18例(13.5%)。结论附睾肿瘤样病变中真性肿瘤只占少数,肿瘤样病变多数由附睾炎引起,病变形态多样。     

子宫平滑肌肿瘤541例临床病理分析

目的分析子宫平滑肌肿瘤的临床病理学特征,探讨其病理诊断标准及预后。方法回顾性复习秦皇岛市开发区医院541例子宫平滑肌肿瘤患者的临床资料和组织病理学特点,分析肿瘤的病理诊断标准和预后,并复习相关文献。结果属于子宫平滑肌肉瘤者6例;不能确定恶性潜能的平滑肌肿瘤2例;富于细胞性平滑肌瘤28例;奇异性平滑肌瘤6例,血管平滑肌瘤6例;上皮样平滑肌瘤1例。结论子宫平滑肌肿瘤的良恶性诊断因其关系到患者的治疗和预后,临床病理分析尤显重要。     

Liver transplantation for hepatocellular carcinoma: Historical evolution of transplantation criteria

Liver transplantation (LT) for hepatocellular carcinoma is still a hot topic, and the main factor that is associated with the success of treatment is to determine the patients who will benefit from LT. Milan criteria have been defined 25 years ago and still is being used for patient selection for LT. However, in living donor LT, the Milan criteria is being extended. Current criteria for patient selection do not only consider morphologic characteristics such as tumor size and number of tumor nodules but also biologic markers that show tumor aggressiveness is also being considered. In the present review article, we have summarized all the criteria and scoring systems regarding LT for hepatocellular carcinoma. All criteria have 5-year overall survival rates that were comparable to the Milan Criteria and ranged between 60%-85%. On the other hand, it was seen that the recurrence rates had increased as the Milan criteria were exceeded; the 5-year recurrence rates ranged between 4.9% to 39.9%. Treatment of hepatocellular carcinoma needs a multidisciplinary approach. Ideal selection criteria are yet to be discovered. The same is true for treatment modalities. The goal will be achieved by a harmonic interplay between basic science researchers and clinicians.     

中医药综合疗效标准在晚期肺癌中的应用

Tumorobjectiveremissionratecan＇tembodytraditionalChinesemedicinetreatmentsurviveassociatedwithtumorandtheeffectcharactersofhighlivingquality，buttomaketheassess－mentoftraditionalChinesemedicinetreatmenteffectmoreobjec－tive，qualitative，standardizationwillhelptoresolvethequestionoftraditionalChinesemedicineeffect犤１犦．Webroughtforwardtheconceptofsynthetictreatmentcriteriawiththehelpofsomeex－pertsonwesternandtraditionalChinesemedicine犤２犦．Followingisthesummaryofitsutilizationinlatesta…     

中医药综合疗效标准在晚期肺癌中的应用

（Formissue２）２．３．４Comparisonamongmainsymptomschange，syntheticeffectcriteriaandtumorobjectiveeffectcriteriaItshowsthattherewasapparentdifferentebetweensynthericeffectcriteriaandmainsymptomschange（P＜０．０５）．Itsuggestedthattherewascloserelationshipbetweensyntheticeffectcriteriaandmainsymptomschange，butatsametime，therewasnosignificiantdifferencebetweentumorobjectiveeffectcriteriaandmainsymptomschange（P＞０．０５）．Itsuggestedthattumorobjectiveeffectcriteriacouldn＇treflectmainsy…     

慢性胃炎与消化不良认识历程的回顾

简要、系统地回顾了国内外有关慢性胃炎分类、国外功能性胃肠病(FGID)中功能性消化不良(FD)罗马标准、国内历次有关FD诊治流程、指南或共识、HP根除适应证的变化、FD与非溃疡性消化不良(NUD)概念以及FD与器质性消化不良(OD)界限,并对其重点内容做了简单介绍,对部分内容作者提出了自己的观点和评价。     

Rigor in cross-cultural nursing research

With the increasing number of cross-cultural nursing studies, many scholars have suggested methods for conducting cross-cultural research. However, rigor in cross-cultural research has rarely been addressed. In this paper, five evaluation criteria for rigor in cross-cultural nursing research are proposed based on a review of the literature related to cross-cultural research published from 1965 to 2003. The proposed evaluation criteria include: (a) cultural relevance; (b) contextuality; (c) appropriateness; (d) mutual respect; and (e) flexibility. We advocate that these evaluation criteria be used to ensure rigor of cross-cultural nursing research, whether quantitative or qualitative work.     

急性肾损伤RIFLE与AKIN标准在重症监护病房患者的应用比较

目的 比较急性肾损伤(AKI)RIFLE标准(危险、损伤、衰竭、肾功能丧失、终末期肾病)与急性肾损伤网络工作小组(AKIN)诊断标准在重症监护病房(ICU)成人患者中的应用价值.方法 收集广东省人民医院ICU2009年10月至2010年7月成人患者的病历资料.分别采用RIFLE标准与AKIN标准对ICU中AKI及其严重程度进行定义分期,比较两种标准诊断的敏感性及预测院内病死率的准确性.结果 共入选患者524例,其中符合RIFLE标准的AKI 95例,符合AKIN标准的AKI 135例,两种标准在判断ICU患者AKI的发生率方面差异有统计学意义(18.1％比25.8％,P＜0.05).AKI为院内死亡的独立危险因素;RIFLE标准预测患者院内死亡的受试者工作特征曲线(ROC曲线)下面积(AUC)为0.729 3,95％可信区间(95％CI)为0.600 5～0.858 1,P＜0.001;AKIN标准预测患者院内死亡的AUC为0.777 7,95 ％CI为0.666 4～0.889 0,P＜0.001;二者诊断AKI的预测能力比较差异无统计学意义(37.9％比34.1％,P＞0.05).结论 与RIFLE标准相比,AKIN标准在诊断ICU成人患者AKI的发生方面更敏感,但是在预测院内死亡方面并未体现优势.     

Evaluation of qualitative research

It is necessary to subject published research to critical scrutiny, in order to evaluate the robustness of the findings. The criteria used in evaluation require to be appropriate for the research paradigm, i.e. quantitative or qualitative. Quantitative conceptualizations of reliability and validity are unsuitable for evaluation of qualitative research as they were not devised for this purpose. The use of quantitative criteria to evaluate qualitative research may create the impression that the latter is not academically rigorous. Evaluation criteria which are specific to qualitative research require identification and application, in order to provide a formalized and rigorous approach to critical appraisal. A formalized framework for evaluation will help to ensure that the contribution of qualitative studies, with specific reference to health services research, receives optimum recognition. The work of a number of writers is used in this paper to examine the features which distinguish qualitative research and the following are discussed: the need for researcher reflexivity; the use of the 'first person' in academic work; the context in which research takes place; the selection of research participants; the interpretation of participants' accounts; the active acknowledgement of 'lay' knowledge; researcher flexibility within the research process; the generalizability of findings. It is concluded that academically rigorous criteria, which are appropriate for evaluation of qualitative research, exist and are available for use by practitioners and researchers.     

基础护理质量评价标准细则的制定及应用

目的:探讨基础护理质量评价标准细则的制定方法及实施效果.方法:回顾和分析以往基础护理在执行落实中的缺陷,以<住院患者基础服务项目(试行)>,<基础护理服务工作规范>等为指南,结合2007-2009年医院基础护理质量检查评价标准及医院实际情况,针对性地制定基础护理质量评价标准细则;用定量评价法综合判断基础护理落实情况.结果:2009-2010年基础护理合格率明显提升,患者对护理工作综合满意率从92.61%提高至97.0%.结论:基础护理质量评价标准的细则制定和应用,为患者提供高质量、人性化的护理服务,可有效提高基础护理质量,提升患者对护理工作满意度.