成人肺部自动毫安与固定毫安CT检查的辐射剂量比较

目的 通过对成人肺部自动毫安与固定毫安CT检查辐射剂量的对比分析,自动毫安技术在肺部CT扫描中的优势。方法 20例肺部病变的成人患者,在初查时均采用固定毫安(200mA)行螺旋CT肺部扫描;复查时,在其他扫描条件不变的情况下,采用自动毫安(70~200mA)扫描;分别记录单层毫安值和DLP值,由两名放射科高年资诊断医生观察比较两者的图像质量差异。结果 自动毫安与固定毫安CT扫描后的图像质量无明显差异,前者单层毫安值最低可为后者的35%。两者之间差异有统计学意义(P < 0.01)。结论 肺部CT检查采用自动毫安技术扫描,与常规固定毫安扫描图像质量无差别,并且能大幅度降低毫安值及辐射剂量,是较理想的肺部CT扫描方案。     

全腹CT自动毫安扫描技术临床应用探讨

[目的]探讨全腹CT应用自动毫安扫描技术改变噪声指数、接受辐射剂量及图像质量变化。[方法]选择全腹检查成人患者40例,随机分成4组。A组作为参照组采用常规腹部扫描参数,B、C、D组应用自动毫安扫描技术。分别记录各组扫描平均mAs、CTDIvol、DLP,各组数据进行对比分析。[结果]自动毫安扫描辐射剂量较常规参数扫描有显著下降,噪声指数越高,扫描剂量越低,图像质量亦会随之下降。[结论]应用适当的噪声指数进行全腹CT自动毫安扫描既可保证图像质量,还能显著降低患者能接受的辐射剂量。     

自动毫安技术在儿童四肢CT扫描中的应用

目的 探讨改进自动毫安技术(自动管电流技术)在儿童四肢低剂量多层螺旋CT扫描中的防护价值。方法 固定kV值,仅对噪声指数(亦称画质分级参数SD)进行调整。其余扫描条件完全一致,观察比较其图像质量和辐射剂量的差异。结果 与常规螺旋CT扫描相比,改进自动毫安技术对病变的定性定量诊断无明显差异,但是辐射剂量有明显降低。结论 改进自动毫安技术适用儿童四肢低剂量多层螺旋CT扫描,有利于减少儿童的辐射剂量。     

螺旋CT自动管电流技术在胸部扫描中的应用价值

目的 探讨螺旋CT自动管电流技术在胸部扫描中的应用价值。方法 分别采用CT自动毫安技术(Auto mA)和固定管电流(230mA)技术进行胸部扫描,对所获的图像质量及CT辐射剂量进行比较。结果 图像质量无明显差别,但CT辐射剂量自动毫安技术(Auto mA)比固定管电流(230mA)技术下降大约60%~80%。结论 螺旋CT自动管电流技术(Auto mA)在胸部扫描与固定管电流(230mA)技术在胸部扫描比较无明显图像质量差别,但受检者辐射剂量明显减少。     

自动毫安技术在腹部增强CT检查中可行性研究

目的:探讨腹部CT增强检查中使用自动毫安(ATCM)技术对降低患者辐射剂量的可行性方法:搜集50例腹部疾病的患者行自纵隔上2 mm至髂嵴线水平CT容积扫描,每例常规3期(平扫期、动脉期、静脉期),随机分为固定毫安(FM)组和自动毫安(ATCM)技术组,FM组使用固定300 mA,ATCM组使用自动毫安技术,通过预实验改变噪声指数(NI)调节管电流,得出NI值为9.10 Hu时图像质量与辐射剂量匹配较佳;分别选择隔下腹主动脉、肝门静脉作为观察平面,对2种毫安技术的图像质量、图像噪声和辐射剂量均采用t检验方法进行统计学分析 结果:FM组的辐射剂量平均CTDIvol为23.68 mGy,平均DLP为597.22 mGy·cm;ATCM组的平均CTDIvol为6.44 mCy,平均DLP为154.226 mGy·cm,比FM组降低约74.2％2组差异有统计学意义(CTDIvol、DLP的t值分别为45.100、112.57,P值均＜0.05)结论:在腹部增强CT检查中使用自动毫安控制技术,在保证图像质量的前提下,可以使患者所受辐射剂量降低约74.2％.     

头颈部CT血管成像检查中两种扫描方式辐射剂量对比分析

目的 评估自动毫安调节方式和常规扫描方式在头颈部CT血管成像(CTA)检查中的图像质量及辐射剂量的差别。方法 收集92例行头颈部CTA检查的患者,随机分为A、B两组,各组46例,A组采用常规扫描方式,B组采用自动毫安调节方式;观察其成像质量,比较并计算其单次扫描的容积CT剂量指数(CTDIvol)、剂量长度乘积(DLP)及有效剂量(ED)。结果 自动毫安调节组与常规剂量组间的成像质量主观评判均可满足临床诊断要求,分别为(4.31±0.92)分和(4.22±0.68)分;成像质量评分差异无统计学意义;自动毫安调节扫描与常规剂量的CTDIvol、DLP及ED值两两比较差异均有统计学意义。结论 自动毫安调节扫描方式能保证图像满足诊断要求,又大幅降低了受检者辐射剂量,应该作为头颈部CTA首选方式。     

128层CT自动毫安调节方式在头颈部CTA检查中辐射剂量的分析

目的：评估常规扫描方式及自动毫安调节扫描方式在头颈部CTA检查中的图像质量及辐射剂量。方法：选取92例行头颈部CTA检查的患者,随机分为A、B2组,每组46例,A组采用常规扫描方式,B组采用自动毫安调节扫描方式。观察其成像质量,比较并计算其单次扫描的CT剂量加权指数（CTDIvol）、剂量长度乘积（DLP）及有效剂量（ED）。结果：自动毫安调节扫描组与常规扫描组间的成像质量主观评判均符合临床诊断要求,评分分别为4．31±0．92及4．22±0．68,P〉0．05,成像质量差异无统计学意义。自动毫安调节扫描组与常规扫描组的CTDIvol、DLP及ED值两两比较,差异均有统计学意义（P〈O．05）。结论：自动毫安调节扫描方式可以在保证图像诊断要求的同时达到均衡控制X线剂量的目的,应该作为头颈部CTA的首选方式。     

副鼻窦低剂量CT扫描的临床研究

目的 观察四种不同毫安秒(mAs)对副鼻窦图像的影响,以筛选出最低的扫描条件。方法 93例病人分4组按不同条件进行扫描,对CT图像进行评分,以确定其质量。使用SAS软件包进行分析,秩和检验分析。CT中的计算机软件自动计算出每层的辐射剂量。结果 不同mAs组图像质量评分差异均无显著性。不同mAs组病人的辐射剂量:300 mAs扫描组每层扫描的辐射剂量为65.5 mGy,而100、50及40 mAs组的辐射剂量分别为16.4、8.2及6.5 mGy。结论 副鼻窦CT可以用40 mAs的低剂量CT扫描,而对图像的诊断质量没有影响。     

自动毫安技术在多层螺旋CT诊断食道异物的应用

目的 总结分析16层螺旋CT自动毫安扫描诊断食管异物价值。方法 回顾对37例食管异物患者行16层螺旋CT扫描,15例行常规螺旋剂量CT扫描,22例行自动毫安技术扫描的影像资料;全部病例均经内窥镜或手术证实。结果 经食管镜取出异物17例,经胃镜下取出异物13例,其中推入胃内后随便排出3例,4例经开胸取出。结论 16层螺旋CT应用自动毫安技术诊断食道异物,常规剂量与自动毫安检查技术检查结果无明显差异。     

螺旋CT低剂量照射在儿童骨骼应用评价

目的 评价儿童骨骼多层螺旋CT低剂量与常规剂量扫描的图像质量,探讨低剂量扫描在儿童骨骼应用的可行性及防护价值.方法 入选50例年龄为3～10岁幼儿病例,无性别限制,所选病例都经X线片筛查;疑有病变者,全部病例用固定毫安技术(厂家设定)初查和低毫安剂量扫描技术复查对照扫描,低毫安剂量.扫描采用按患儿体重分别在固有管电流30%的基础上,按每公斤体重增加1毫安量进行个性化扫描,对每位患者两次的扫描峰值电压(kv)、管电流(mA)、CT容积剂量指数(CTDIw)和剂量长度乘积(DLP)及入射体表剂量由3名主管技师进行测量和记录,观察比较其对病变的定量及定性诊断和辐射剂量的差异.结果 与常规剂量多层螺旋扫描相比,多层螺旋低剂量扫描对病变的定性与定量诊断差异无统计学意义,但是辐射剂量有大幅度下降.结论 多层螺旋低剂量扫描技术适用于儿童骨骼病变的常规检查,有利于患者的辐射防护.     

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。     

乙型肝炎母婴传播影响因素的研究

目的了解深圳市乙型肝炎母婴阻断效果及其影响因素,为制定乙肝防控策略提供科学依据。方法从医院收集2007-2009年HBsAg阳性产妇及其新生儿基本资料,设计统一的调查问卷,采集儿童静脉血2ml,ELISA法检测乙肝表面抗原、表面抗体和核心抗体。结果共调查158例HBsAg阳性产妇,其中乙肝大三阳占35.44%(56/158);孕晚期接种HBIG占22.29%(35/158),婴儿出生后母乳喂养占58.86%(93/158)。158例儿童中出生后乙肝免疫球蛋白接种率90.50%(143/158),乙肝疫苗接种率100%,其中接种5ug乙肝疫苗占97.47%(154/158),接种10ug乙肝疫苗占2.53%(4/158)。检测158名儿童乙肝表面抗原阳性率6.96%(11/158),乙肝表面抗体阳性率56.33%(89/158),乙肝核心抗体阳性率70.25%(111/158)。母亲是否大三阳与乙肝母婴阻断是否成功有关(连续校正χ2=5.538,P=0.019)。结论母婴传播仍然是乙肝重要传播途径,其主要因素影响是母亲乙肝感染状况。     

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。     

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。     

医学院学生14例癔症分析

目的为了解高校大学生癔症发病情况,以利于做好癔症发作的预防。方法对徐州医学院14例癔症病人发作诱因、临床表现及诊治情况进行回顾性分析。结果具备＂癔症性格特征＂的女大学生易受精神刺激出现心理障碍而发病,且临床症状与体征不符,有复发倾向,暗示治疗有效。结论癔症的起病与精神因素和暗示密切相关,在治疗中暗示疗法同样起着重要作用。应加强女大学生心理健康教育,积极预防癔症发作。     

10例肺吸虫病临床分析

目的了解肺吸虫病的临床表现,诊断和鉴别诊断,为临床防治肺吸虫病提供科学依据。方法采用回顾性分析法,对临床收治的10例肺吸虫病人进行统计分析。结果10例肺吸虫病人,男性多于女性,儿童多发。人体感染肺吸虫后,可表现为胸肺型、胸腹混合型、皮肤型、脑型,但因虫体寄生部位不同,临床表现不一。肺吸虫病人白细胞和嗜酸细胞计数升高。肺吸虫病最易误诊的疾病为结核病。结论肺吸虫病的临床表现和体征并不一致,主要与疾病临床分型有关。临床医生应熟悉肺吸虫病防治知识,提高对肺吸虫病的诊断和鉴别诊断能力,防止误诊、误治。     

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.