中西医结合治疗面神经麻痹200例

中西医结合治疗面神经麻痹２００例姜健山东曲阜市红十字医院（曲阜２７３１５０）面神经麻痹是以颜面表情肌群运动功能障碍为特征的一种常见病，中医称为“口僻”。现代医学对本病尚缺乏非常有效的措施。尤其是重症面神经麻痹及３个月以上患者治疗难度较大，容易落下面肌...     

可溶性B7-H4在早期胃癌中的诊断价值探讨

目的:探讨可溶性B7-H4(soluble B7-H4,sB7-H4)在早期胃癌中的诊断价值。方法:应用酶联免疫吸附试验(ELISA)夹心法检测80例早期胃癌患者与50例正常人血清sB7-H4水平,用化学发光法检测血清CEA、CA19-9水平,利用受试者工作特性曲线(ROC),比较分析sB7-H4作为早期胃癌血清标志物的诊断价值。结果:早期胃癌患者血清sB7-H4水平(47.61±13.57)ng/ml明显高于正常人(30.62±8.65)ng/ml,差异有统计学意义(P<0.01)。sB7-H4在早期胃癌诊断中的灵敏度(81.25%)和准确性(78.46%)均高于CEA及CA19-9,特异性(74%)低于CEA及A199。结论:sB7-H4在早期胃癌诊断中具有良好的临床应用前景,联合检测sB7-H4、CEA和CA19-9可提高胃癌的诊断率。     

弥散型与局限型脑干胶质瘤的病理学、超微结构特点及增殖特性分析

目的 探讨弥散型和局限型脑干胶质瘤的病理学、超微结构特点以及增殖特性.方法 收集18例脑干胶质瘤标本,应用苏木精-伊红染色观察18例脑干胶质瘤的形态变化,应用免疫组织化学方法检测10例脑干胶质瘤Ki-67蛋白表达,应用透射电子显微镜观察8例脑干胶质瘤细胞超微结构.结果 苏木精-伊红染色结果显示:大多数弥散型脑干胶质瘤细胞生长活跃或具有恶性转化倾向.透射电子显微镜结果显示:弥散型脑干胶质瘤生长较局限型脑干胶质瘤活跃.免疫组化结果显示:所有肿瘤均表达Ki-67蛋白,弥散型脑干胶质瘤增殖指数明显高于局限型脑干胶质瘤(P＜0.01).结论 弥散型脑干胶质瘤较局限型脑干胶质瘤生长活跃、细胞增殖快,可能与其恶性生物学行为有关.     

64层螺旋CT胸部低剂量扫描方案优选的多中心研究

目的 比较自动曝光控制技术(AEC)与管电流恒定技术(CCC)2种不同低剂量MSCT扫描方案对胸部CT图像质量的影响,探讨更加合理的肺低剂量扫描参数方案.方法 采用前瞻性多中心研究方法,研究对象为7所医院就诊的280例行胸部低剂量MSCT检查的受检者,设定管电流(mA)为研究变量,方法一为AEC技术,下设噪声标准差值(SD)为25(A1)及30(A2)各1组,并设定管电流上限为80 mA,下限为10 mA;方法二为CCC技术,下设40 mA(C1)及50 mA(C2)各1组;共4组,采用同一机型64层MSCT行胸部低剂量扪描.2名放射科医师应用双肓法阅片,比较2种不同扫描技术的曝光剂量、SD值,横断面、MPR的图像质量以及体质量指数(BMI)对图像质量的影响.曝光剂量及SD比较行方差分析及t检验;图像质量比较行Mann-Whitney检验;医师对图像诊断一致性检验行Kappa分析.结果 剂量长度乘积(DLP)AEC组较CCC组明显降低[(82.62±40.31)和(110.81±18.21)mGy·cm,F=56.88,P＜0.01].AEC技术中A2组DLP较A1组低[(72.77±36.68)和(92.46±41.61)mGy·cm],差异无统计学意义(t=0.82,P＞0.05).前者SD值在肺窗[(41.50±9.58)和(40.86±7.03)HU]及纵隔窗[(41.19±7.83)和(40.92±9.89)HU]均略高于后者,差异无统计学意义(F肺窗=0.835、1.910,P值均＞0.05).横断面图像质量AEC组肺窗得分除右下肺静脉水平[(4.92±0.25)和(4.93±0.17)分]、[左膈顶上缘水平(4.91±0.27)和(4.93±0.22)分]较CCC组略低外,AEC组得分均较CCC组略高[头臂静脉上缘(4.49±0.56)和(4.38±0.64)分;主动脉弓上缘(4.86±0.23)和(4.81±0.32)分;右肺上叶支气管开口(4.87±0.27)和(4.84±0.22)分;右肺中叶支气管开口(4.90±0.25)和(4.88±0.21)分],差异无统计学意义(F=0.076～1.748,P值均＞0.05);纵隔窗得分除头臂静脉上缘水平AEC组较CCC组高[(2.57±0.77)和(2.46±0.59)分],且差异有统计学意义(F=8.459,P=0.047)外,余各层面AEC组得分均较CCC组略低[(主动脉弓上缘(3.36±0.63)和(3.45±0.60)分;右肺上叶支气管开口(3.94±0.56)和(3.95±0.51)分;右肺中叶支气管开口(3.80±0.58)和(3.87±0.50)分;右下肺静脉(3.72±0.56)和(3.78±0.53)分;左膈顶上方(3.58±0.63)和(3.68 ±0.56)分],但差异均无统计学意义(F=0.083～3.380,P值均＞0.05).MPR图像质量肺窗及纵隔窗观察均略好于CCC组(Z肺窗=-2.358,Z纵隔窗=-1.330,P值均＞0.05).偏瘦、正常或偏重人群组,A1组肺窗及纵隔窗图像质量均优于A2组,差异无统计学意义(偏瘦:Z肺窗=0.000、Z纵隔窗=0.000;正常:Z肺窗=-0.062、Z纵隔窗=-0.746;偏重:Z肺窗=-1.177、Z纵隔窗=-1.715;P值均＞0.05),但在偏重人群纵隔窗图像质量A1组更好于A2组(Z=-1.715,P=0.144).结论 AEC组总曝光剂量明显低于CCC组,而AEC组的图像质量及SD值无论在肺窗或纵隔窗均与CCC组无明显差异,故建议在胸部低剂量筛查方案选择中应用AEC技术,对偏胖者宜采用SD=25方案,对正常及偏瘦者宜采用SD=30方案.

Abstract：

Objective To compare the image quality of chest low dose CT (LDCT) using automatic exposure control (AEC) and constant current control (CCC) and explore a more reasonable scanning protocol. Methods Two hundred and eighty participants were examined with 64 CT scanner at 7 centers in China. All were divided into 4 groups. Two groups underwent LDCT using AEC with standard deviation set at 25 (A1) and 30 (A2) respectively and the tube current ranged from 10 mA to 80 mA. The other two groups underwent LDCT using CCC with tube current set at 40 mA (C1) and 50 mA (C2) respectively. The axial and MPR images were evaluated by two radiologists who were blinded to the scanning protocols.The radiation dose, noise and the image quality of the 4 groups were compared and analyzed statistically.Differences of radiation dose and noise among groups were determined with variance analysis and t test,image quality with Mann-Whitney test and the consistency of diagnosis with Kappa test. Results There was a significant lower DLP in AEC group than in CCC group [(82.62±40.31)vs ( 110.81±18.21) mGy·cm (F =56. 88 ,P ＜ 0. 01 )], whereas no significant difference was observed between group A2 and group A1 0. 05]. The noisy of AEC group was higher than that of CCC group both on lung window(41.50±9.58 vs 40.86±7.03) and mediastinum window (41.19±7.83 vs 40.92±9.89), but there was no significant difference( Flung =0.835, P=0.476, Fmediastinum =1.910, P=0.128).The quality score of axial image in AEC group was higher than that in CCC group (superior margin of the brachiocephalic vein level: 4.49±0.56 vs4.38±0.64,superior margin of the aortic arch: 4.86±0.23 vs 4.81±0.32,the right superior lobar bronchus Level:4.87±0.27 vs 4. 84 ± 0. 22, the right middle lobar bronchus Level: 4.90±0.25 vs 4.88±0.21) except on the right inferior pulmonary vein level(4. 92 ±0. 25 vs 4. 93 ±0. 17) and superior margin of the left diaphragmatic dome level (4. 91±0.27 vs 4.93±0.22) on lung window, but no significant differences (F=0.076-1.748, P＞0.05) were observed. A significant higher score in AEC group was observed on mediastinum window compared with CCC group on superior margin of brachiocephalic vein level (2.57±0.77 vs 2. 46 ± 0. 59, F = 8. 459, P ＜ 0. 05 ), however, the score of AEC group was lower than that of CCC group on other levels without significant differences (superior margin of the aortic arch:3.36 ±0. 63 vs 3.45 ±0. 60,the right superior lobar bronchus level: 3.94 ±0. 56 vs 3. 95 ±0. 51 ,the right middle lobar bronchus Level: 3.80 ±0. 58 vs 3. 87 ±0. 50,the right inferior pulmonary vein level: 3.72 ±0. 56 vs 3.78 ±0. 53, superior margin of the left diaphragmatic dome level: 3.58 ± 0.63 vs 3.68±0.56,F=0.083-3.380,P ＞ 0.05 ). The MPR image quality of AEC group was better than that of CCC group both on lung window and mediastinum window (Zlung =-2.258, Zmedlastinum=-1.330, P＞0.05). For all participants including the underweighted group, the normal group and the overweighted group, the image quality of A1 group was better than that of A2 group without significant differences (the underweighted group: Zlung=0.000, P=1.000, Zmedastinum= 0.000, P=1.000;the normal group: Zlung =-0.062, P=0.950, Zmediastinum =-0.746, P = 0.456; the overweighted group: Zlung = - 1.177, P = 0.239,Zmediastinum =-1.715, P=0.144) both on lung and mediastinum windows, and for the higher BMI participants, a better image quality was obtained in A1 group than in A2 group on the mediastinum window (Z = -1. 715, P = 0. 144). Conclusions The total radiation exposure dose of AEC group is significantly lower than that of CCC group, but no statistical significant differences are observed between both groups in image quality and noise level. The AEC technique is highly recommended in thoracic LDCT scan for screening program, and the SD25 ( SD value = 25) scan protocol is suggested for higher BMI population while the SD30 (SD value = 30) scan protocol for lower BMI population.     

俞募配穴针灸治疗慢性疲劳综合征的临床随机对照研究

目的:观察俞募配穴针灸治疗慢性疲劳综合征的临床疗效。方法:将77例患者随机分为治疗组39例和对照组38例。治疗组采用俞募配穴针灸治疗;对照组采用Streitberger’s安慰针具治疗,连续治疗4周。对比两组患者治疗前后疲劳量表、疼痛视觉模拟量表、抑郁状态问卷的评分情况。结果:治疗组治疗后躯体疲劳积分、脑力疲劳积分、疲劳总分均显著降低(P<0.01),对照组治疗后躯体疲劳积分、疲劳总分均有所降低(P<0.05),而脑力疲劳积分无明显变化(P>0.05);两组治疗后比较,躯体疲劳积分、脑力疲劳积分、疲劳总分均有显著性差异(P<0.05或P<0.01),表明两组均可减轻患者疲劳程度,而治疗组明显优于对照组。治疗组治疗后VAS评分显著降低(P<0.01),对照组治疗后VAS评分有所降低(P<0.05);两组治疗后比较有显著性差异(P<0.01),表明两组均可减轻患者疼痛程度,而治疗组明显优于对照组。治疗组治疗后DSI评分显著降低(P<0.01),对照组治疗后DSI评分有所降低(P<0.05);两组治疗后比较有显著性差异(P<0.01),表明两组均可减轻患者抑郁程度,而治疗组明显优于对照组。结论:俞募配穴针灸对慢性疲劳综合征患者临床上出现较多的疲劳、疼痛、精神抑郁三大症状均有较好的疗效,且安全、经济、操作简单,值得临床推广应用。     

乳腺原位癌与浸润性癌声像图特征比较

乳腺原位癌与浸润癌的治疗与预后有很大不同,虽然准确鉴别两者仍需依赖病理学方法,但研究二者的声像图特点对于更深入了解声像图与乳腺癌病理性质的关系有着重要的意义.本研究对乳腺原位癌与浸润癌的声像图特征进行比较,以期提高对乳腺原位癌的诊断水平.     

无锡地区献血者D变异体的检定结果

目的准确地检定D变异体,并探讨其在安全输血中的意义。方法通过AS-PCR方法测定RHD1227A等位基因,检定Del血型;通过血清学方法检出D弱反应性标本,然后通过PCR方法鉴定部分D和弱D。结果 351份盐水抗-D阴性标本,检出Del32例,部分D 3例,弱D 4例。结论准确检定D变异体对制定安全有效的临床输血策略具有重要意义。     

XRCC 1多态性与肿瘤化疗敏感性和预后的研究

化疗是恶性肿瘤最重要的治疗手段,对肿瘤化疗耐药机制以及化疗效果预测一直是肿瘤学研究的热点.DNA修复能力是影响化疗疗效的重要因素,修复基因的单核苷酸多态性可改变修复能力,X线修复交叉互补基因1(XRCC1)是参与DNA修复的重要成分,检测XRCC 1基因的单核苷酸多态性可以预测治疗疗效.     

急性右室梗塞并心源性休克抢救成功1例

急性下、后壁心肌梗塞中,25～52.7%并有右室梗塞(RVMI)。大面积梗塞常合并休克、右心衰竭和过缓性心律失常,预后不佳。现将我院收治的1例急性右室、左室下壁梗塞合并心源性休克、窦性停搏、三度房室传导阻滞的抢救经过报告如下。患者,男,64岁。因心前区闷痛、气促7小时急诊入院。体检:T 35℃、P28次/分、R 24次/分、BP 10/0 kPa。急性重病容,神清,平卧。大汗淋漓,四肢厥冷,口唇及肢端明显发绀。颈静     

脑活素治疗血管性痴呆病的甲皱微循环观察

脑活素是从动物脑组织中提炼而成的一种水溶液，能增强脑组织的耐氧能力及糖的利用。对血管性痴呆患者有效好治疗效果。甲皱循环是观察微血管状态及红细胞功能和带氧能力的客观指标，是动态观察脑活素治疗血管性痴呆治疗效果的一种物理方法，对脑活素药物疗效及病情的转归有较好监测作用。