超声图像综合分析对于甲状腺微小乳头状癌诊断的意义

目的:本研究旨在探讨超声图像综合分析对于甲状腺微小乳头状癌诊断的意义。方法:2011年1月-201 6年1月我院经病理确诊的60例甲状腺微小乳头状癌患者纳入观察组(结节数65个),再选取同时期病理证实的60例甲状腺良性结节患者作为对照组(结节数64个),搜集整理其临床资料和超声图像资料,作回顾性的分析研究。结果:两组患者分析其超声图像特征,结节的回声、形态、边界、血流特征等方面组间比较,有显著差异,有统计学意义(P0.05)。结论:超声图像综合分析对于甲状腺微小乳头状癌的诊断具有重要的参考意义。     

高频超声诊断甲状腺微小乳头状癌颈部淋巴结转移的临床价值分析

目的探讨高频超声诊断甲状腺微小乳头状癌颈部淋巴结转移的临床价值。方法回顾性分析2017年1月至2019年12月期间我院收治的100例甲状腺微小乳头状癌患者的临床资料,以手术病理结果为金标准,将其分为转移组(n=29)和无转移组(n=71)。患者均采用高频超声诊断,分析其对甲状腺微小乳头状癌颈部淋巴结转移的诊断价值。结果两组的结节数目、结节形态、结节回声、结节边界情况比较无统计学差异(P>0.05)。转移组结节直径≥5 mm、内部微钙化、侵及被膜占比均高于无转移组(P<0.05)。100例甲状腺微小乳头状癌患者中,经病理检查显示颈部淋巴结转移29例,无转移71例;经高频超声检查结果显示颈部淋巴结转移28例,无转移72例。高频超声的诊断准确率高达95.00%。结论高频超声诊断甲状腺微小乳头状癌颈部淋巴结转移的准确率较高,值得临床推广应用。     

甲状腺微小癌超声诊断

目的：探讨甲状腺微小乳头状癌（PTMC）的超声征象,提高术前诊断水平。方法：对最大直径≤1．0cm的甲状腺结节进行研究,所有患者均行二维及彩色多普勒超声扫描并经手术病理证实。结果：PTMC的发生率与甲状腺结节单发或多发关系不大;声像图表现为形态不规则、边界不清晰、周边无声晕、低回声、回声不均匀、实性结节,内可见微小钙化,颈部淋巴结肿大,内部血流信号为主。结论：超声对PTMC是一种有效的诊断方法     

超声检查对甲状腺弥漫性病变合并结节的诊断价值分析

目的:研究超声检查方法实施在甲状腺弥漫性病变并存结节患者中的临床诊断价值。方法:对本医院收治的68例甲状腺弥漫性病变并存结节患者实施调查,2018年5月—2019年5月是抽签时间,均实行超声检查及病理检查,评估患者的超声诊断结果、病理诊断结果,研究患者良性结节、恶性结节的超声检查血流分级状况。结果:病理诊断检出75个结节,超声诊断检出70个结节,超声诊断对结节的检出总计率是93.33%,患者采取超声诊断方法检出良性结节个数、检出恶性结节个数和病理诊断结果相比,未表明数值指标测定统计学意义(P0.05);患者良性结节的超声检查血流分级为0级、I级个数多于恶性结节,患者良性结节的超声检查血流分级为III级个数少于恶性结节,表明数值指标测定统计学意义(P0.05),良性结节的超声检查血流分级为II级个数和恶性结节相比,未表明数值指标测定统计学意义(P0.05)。结论:对甲状腺弥漫性病变并存结节患者实行超声检查展示出较优临床诊断价值。     

CEUS联合UE技术对甲状腺微小乳头状癌的诊断准确度

目的分析弹性成像(UE)技术联合超声造影(CEUS)诊断甲状腺微小乳头状癌的准确度。方法选取2018年1月至2019年5月本院收治的87例疑似甲状腺微小乳头状癌患者,均行UE和CEUS检查,以手术病理结果为金标准,分析UE、CEUS单项及联合检查的诊断准确度。结果本组102个结节中良性结节58个、恶性结节44个。UE检出恶性结节32个,CEUS检出恶性结节34个,联合检测检出恶性结节42个。UE和CEUS联合检测甲状腺微小乳头状癌的敏感度和诊断准确度均高于单项检测,差异均有统计学意义(均P0.05)。结论 UE联合CEUS联合检测可显著提高甲状腺微小乳头状癌诊断敏感度和准确度,值得推广。     

甲状腺癌的弥漫性微小钙化的超声分析

目的：探讨超声对甲状腺癌弥漫性微小钙化的诊断价值。方法：对32例术前超声检查手术病理证实为甲状腺癌患者的超声声像图进行观察。结果：本组32例患者60个不同性质结节中超声检出甲状腺内微小钙化12个，其中甲状腺良性疾病微小钙化率为8．9％，恶性肿瘤微小钙化率为53．3％，两组相比有显着性差异，微小钙化主要发生为乳头状癌。结论：超声甲状腺结节内微小钙化灶的检测对诊断甲状腺癌具有重要的临床应用价值。     

超声鉴别甲状腺良恶性结节的多因素分析

目的 探讨彩色多普勒超声诊断甲状腺良恶性结节的应用价值.方法 回顾性分析152例甲状腺结节患者的临床资料.结果 病理证实,良性结节103例(67.8％),恶性结节49例(32.2％).良性结节包括结节性甲状腺肿69例,甲状腺腺瘤34例;恶性结节包括乳头状腺癌13例,鳞状细胞癌11例,滤泡状腺癌12例,未分化癌13例.良恶性结节形态、边界、钙化及晕化情况比较差异有统计学意义(P＜0.01),甲状腺血流状态比较差异亦有统计学意义(P＜0.01).结论 超声检查对甲状腺良恶性结节的诊断准确率较高,应用于临床可为甲状腺癌的预防治疗提供重要指导.     

体检中彩色超声联合弹性成像对甲状腺微小癌的诊断价值

目的探讨体检中彩色超声联合弹性成像对甲状腺微小癌的诊断价值。方法选取2015年5月-2016年12月在我院体检查出甲状腺微小结节(≤1 cm)的患者131例(共196个结节),均行常规彩超及彩超联合弹性成像检查,以病理结果为"金标准",评估常规彩超与彩超联合弹性成像诊断甲状腺微小癌的敏感性、特异性及准确性。结果病理活检证实良性结节150个,恶性结节46个,其中甲状腺乳头状癌43个,滤泡状癌1个,髓样癌2个。单纯应用彩色超声对甲状腺微小癌诊断的敏感性、特异性及准确性分别为65.2%、77.3%、74.5%,彩色超声联合弹性成像对甲状腺微小癌诊断的敏感性、特异性及准确性分别为89.1%、87.1%、88.8%。彩色超声联合弹性成像诊断准确性明显高于单纯彩色超声,差异有统计学意义(P0.05)。结论彩色超声联合弹性成像可显著提高甲状腺微小癌诊断的准确性。     

彩色多普勒超声在甲状腺微小癌诊断中的应用

目的：探讨高频彩色多普勒超声对甲状腺微小癌（TMC）的诊断价值。方法：对经手术及病理证实的最大直径≤1.0cm的56例甲状腺微小癌患者及76例甲状腺良性结节患者的高频超声表现进行回顾性分析。结果：甲状腺微小癌多表现为实质性不均匀低回声肿块,边缘不规则,边界不整,结节内有微小钙化灶。结论：高频彩色多普勒超声对甲状腺癌的诊断具有重要价值。     

常规超声和多普勒超声对甲状腺结节定性探讨

目的探讨常规二维超声和多普勒超声对甲状腺结节的定性价值。方法选择武清区人民医院2015年1月-2017年8月80例甲状腺结节患者的资料140个结节,对比二维超声、彩色多普勒超声和病理手术诊断的准确率,并对比彩色多普勒超声检测甲状腺良恶性结节的血流级别。结果病理结果为80例患者中甲状腺结节共140个,其中良性结节患者30例60个结节,恶性结节患者50例80个结节。二维超声、彩色多普勒超声单一诊断准确率低于联合检测,差异有统计学意义(P0.05)。恶性结节与良性结节对比,恶性结节彩色多普勒超声检测血流信号等级I级检出率更低,II级和III级检出率更高,差异有统计学意义(P0.05)。结论常规二维超声和多普勒超声联合检测甲状腺结节,可准确诊断甲状腺结节的良恶性,值得临床推广。     

长春新碱过量引起严重毒副反应1例的护理体会

报道1例霍奇金淋巴瘤患者因误用长春新碱（VCR）10mg一次性静脉推注后治疗护理情况。其出现间断性神志恍惚、眼睑闭合不全、言语不清、口腔黏膜糜烂、全身疼痛、麻痹性肠梗阻、尿潴留、手足麻木等症状,经积极解救,禁食,持续胃肠减压、胃管内注入麻油、开塞露、生理盐水灌肠,合理应用肠外营养,注重疼痛、心理护理,做好口腔、肛周护理,预防感染加重,患者病情得到控制好转出院。     

Correlates of stages of change of smoking among inhabitants of deprived neighbourhoods

BACKGROUND: This study examines the prevalence and correlates of stages of change of smoking, in terms of psychosocial, structural and sociodemographic factors, among inhabitants of deprived neighbourhoods. METHODS: Cross-sectional data were obtained from a survey on health related behaviour. Subjects were 2009 current and former smokers, aged 20-46, living in deprived neighbourhoods in Rotterdam, the second largest city in the Netherlands. Three groups of smokers were formed according to the stages of change-definitions of the Transtheoretical Model: smokers not planning to quit (precontemplators), smokers planning to quit (contemplators/preparators) and former smokers (actors/maintainers). Smokers planning to quit and smokers not planning to quit were compared regarding psychosocial factors (attitude, social norm, self-efficacy), structural factors (neighbourhood problems, material deprivation, financial problems, employment status) and sociodemographic factors (age, gender, marital status, cultural background, educational level). Former smokers were compared with smokers planning to quit regarding structural and sociodemographic factors. Logistic regression was used to assess correlates of stages of change. RESULTS: Smokers planning to quit (prevalence = 19%) reported a more positive attitude, stronger social norms and higher self-efficacy expectations in quitting smoking than smokers not planning to quit (prevalence = 57%). Smokers planning to quit less often were Dutch-born, more often had attended higher vocational schooling or university and more often reported experiencing two or more neighbourhood problems compared to smokers not planning to quit. Former smokers (prevalence = 24%) were older, more often Dutch-born, married, employed and higher educated, compared to smokers planning to quit. Furthermore, former smokers less often reported material deprivation and financial problems than smokers planning to quit. CONCLUSION: Among people living in deprived neighbourhoods, different factors correlate with different stages of change of smoking. Implications for health promotion are discussed.     

Choice of measures of vaccination and estimates of risk of pediatric pertussis

BackgroundVaccination uptake at the individual level can be assessed in a variety of ways, including traditional measures of being up-to-date (UTD), measures of UTD that consider dose timing, like age-appropriate vaccination, and risk reduction from individual doses. This analysis compared methods of operationalizing vaccination uptake and corresponding risk of pertussis infection.MethodsCity-wide case-control study of children in Philadelphia aged 3 months through 6 years, between 2001 and 2013. Multiple logistic regression was used to isolate the independent effects of each measure of vaccination uptake and the corresponding relative odds of pertussis.ResultsBeing UTD on vaccinations was associated with a 52% reduction in risk of pertussis (OR 0.48, 95% CI: 0.34, 0.69). Evaluation of delayed receipt of vaccine versus on-time UTD yielded similar results. There was a decrease in risk of pertussis for each additional dose received with the greatest reduction in pertussis infection observed from the first (OR 0.48, 95% CI: 0.28, 0.83) and second dose (OR 0.17, 95% CI: 0.08, 0.34). Additional doses conferred minimal additional protection in this age group.ConclusionExamining vaccination status by individual doses may offer improved predictive capacity for identifying children at risk for pertussis infection compared to the traditional UTD measure.     

上海市某医院骨科平均住院日影响因素分析

对上海市某医院2003年-2007年骨科出院病人的住院日描述性分析．2003年-2007年骨科的床位利用指数与平均住院日相关性分析．2003年-2007年骨科床位与医护比例分析．2007年骨科前10大病种平均住院目影响因素分别进行单因素相关性分析和多因素逐步回归分析（STATA软件）。通过对骨科10大病种住院日影响因素分析,术前等待天数、手术类型、是否输血分别对10个、9个和8个病种的住院目有影响。输血因素和手术类型是医院不可控、由病人的病情决定的,术前等待天数是管理因素,是最值得医院重视的影响因素。     

两种不同肌瘤剔除术治疗子宫肌瘤的临床疗效比较

目的:比较腹腔镜子宫肌瘤剔除术与腹式子宫肌瘤剔除术的临床疗效。方法:回顾分析63例腹腔镜子宫肌瘤剔除术与61例腹式子宫肌瘤剔除术的临床资料,比较2种手术方式的手术时间、术中出血量、肛门排气时间、使用抗生素时间、术后感染率、体温恢复正常时间、住院时间等情况。结果:两组患者接受子宫肌瘤剔除术顺利完成,腹腔镜组手术时间长于开腹组(P0.05),腹腔镜组术中出血量及剔除肌瘤个数均少于开腹组(P0.05),术后腹腔镜组体温恢复正常时间、肛门排气时间、抗生素使用及住院时间均短于开腹组,两组患者最多随访6个月,腹腔镜组平均康复时间较开腹组短(P0.05),两组随访B超均未发现明显肌瘤结节。结论:腹腔镜子宫肌瘤剔除术损伤小,恢复快,住院时间短,是值得推广的微创手术。     

尘肺病患者145例死因调查

目的分析汉中市尘肺病的发生、发展和死亡原因，以提高尘肺病患者的生存质量。方法对145例尘肺病患者的死因进行回顾性分析，计算其平均发病年龄、死亡年龄及患尘肺病后的存活年限。结果矽肺的平均发病年龄和死亡年龄均早于煤工尘肺和石棉肺，尘肺病的主要死因为患肺部疾患，患尘肺病后的平均存活年限为12a。结论加强职业健康体检工作，对尘肺病人做到早发现早治疗和预防并发症的发生。     

性发育异常发病机制的研究进展

正常的性腺分化可分为3个过程：原始性腺形成、性别决定和卵巢/睾丸发育。在任一环节中,基因表达或调控发生异常均有可能导致性发育异常疾病的发生。性发育异常是指染色体、性腺和解剖性别不典型。随着分子生物学技术的发展,不断地发现新的基因或信号通路参与性腺分化和发育,如SRY、SF1、WT1、Sox9等基因与睾丸发育密切相关,Wnt/Rspo1/B连环蛋白通路、Dax1、Foxl2等基因在卵巢分化中发挥着重要作用,一些非编码RNA和转化生长因子也有重要的调节功能,且睾丸和卵巢发育均为主动过程,即使在出生后因某些基因的改变两者间也可出现横向分化。这些为揭示性分化异常的发病机制提供了可能。     

西林瓶装注射用水的装量检查分析

为了检查西林瓶装注射用水的实际分装量是否符合2005年版《药典》三部要求,按照2005年版《药典》三部中“生物制品分装和冻干规程”,分装规格为0．8ml的西林瓶装注射用水10000瓶,随机在分装过程的前、中、后阶段共抽取100瓶,轧盖、目检。分别用1ml标定注射器及1ml普通无菌注射器抽取每瓶注射用水的实际体积,以t检验法对实际抽取量与标示量的差值进行统计学分析,结果显示其与2005年版《药典》三部要求分装附加量为0．1ml相比有显著性差异（P〈0．001）。     

One-year stability of the Measure of Processes of Care

BACKGROUND: The Measure of Processes of Care (MPOC) is a 56-item self-administered measure designed to examine what parents of a child with a chronic health problem think of the services they and their child receive, and to measure the extent to which these services are family-centred. Reliability and validity of the MPOC were established in prior studies. The aim of the present study was to assess the 1-year stability of the MPOC to justify its use as an evaluative tool. METHODS: Nine paediatric rehabilitation centres in the Netherlands participated in this short longitudinal survey study. Subjects were 205 parents (response rate 74.8%) of children aged 1-18 years who received care in one of the participating paediatric rehabilitation centres. All subjects filled out two MPOCs with a 1-year interval. RESULTS: All correlations between the scale scores of the MPOC at the first and second administration were relatively high and significant (range: 0.443-0.609, all P < 0.001), demonstrating high inter-individual stability. However, all mean scale scores, except for Providing General Information, significantly reduced after 1 year. CONCLUSIONS: The MPOC has a moderate 1-year stability. However, because of its tendency to score lower when repeated after 1 year, its use as an evaluative follow-up instrument to assess the effectiveness of a programme intervention is restricted.     

儿童皮质发育畸形的MRI诊断

目的探讨儿童皮质发育畸形(MCD)的MRI表现特点,为MCD的早期诊断提供依据。 方法选择2010年1月至2012年12月在四川省医学科学院·四川省人民医院放射科经MRI检查确诊为MCD的44例患儿为研究对象。回顾性分析及总结其MRI影像学特征。本研究遵循的程序符合四川省医学科学院·四川省人民医院人体试验委员会制定的伦理学标准,得到该委员会批准,征得受试对象及其监护人知情同意,并与监护人签署临床研究知情同意书。 结果本组44例经MRI确诊为MCD患儿中,巨脑回-无脑回为17例,多小脑回为14例,灰质异位为9例,脑裂畸形为4例。MCD的MRI特点中,巨脑回表现为脑回增宽、皮质增厚及白质变薄;无脑回表现为正常脑沟、脑回消失,皮质增厚及白质变薄;多小脑回表现为脑回增多、细小;灰质异位表现为皮质下及侧脑室周围深部白质区结节状、团块状或带状病灶,信号与灰质信号相同;脑裂畸形表现为从侧脑室到脑表面贯穿大脑半球的裂隙,表面覆盖灰质。 结论MRI是诊断儿童MCD的可靠影像学方法。