SEM-EDS解析药物对玻璃注射剂瓶内表面的侵蚀程度

目的 研究碱性药物对直接接触的低硼硅玻璃注射剂瓶内表面的侵蚀情况,考察药品包装材料与药物的相容性。方法 采用扫描电镜观察灌装注射用帕瑞昔布钠的低硼硅玻璃注射剂瓶内表面,并结合X射线能谱仪确证侵蚀部位。结果 通过对低硼硅玻璃注射剂瓶内表面的扫描电镜图的研究,显示阳性对照样品能较好区分不同的侵蚀程度,加速试验的各时期样品均未发生明显侵蚀现象。结论 扫描电镜结合X射线能谱仪能直观显示低硼硅玻璃注射剂瓶内表面结构被接触药物侵蚀的程度,可作为药包材和药物相容性的评价依据。     

胃癌浆膜外侵犯CT征象分析

目的 探讨多种CT征象对胃癌浆膜外侵犯的诊断价值。方法 回顾性分析2015年1月至2016年12月在马鞍山市人民医院进行胃癌根治性切除术的173例患者的术前CT检查资料。根据手术病理结果有无浆膜外侵犯分为浆膜外侵犯阳性组96例（阳性组）和浆膜外侵犯阴性组77例（阴性组）,对比分析亮线征、浆膜面毛糙、索条、膨隆、结节、脂肪浑浊及血管异常等CT征象在两组患者中的差异。结果 阳性组中亮线征、浆膜面毛糙、索条、膨隆、结节、脂肪浑浊及血管异常等CT征象的出现率分别为35.42%、96.88%、86.46%、64.58%、40.63%、68.75%、26.04%,均高于阴性组,差异有统计学意义（P<0.05）。诊断胃癌浆膜外侵犯的CT征象中,亮线征的特异度和阳性预测值最高,分别为97.40%、94.44%,浆膜面毛糙的灵敏度和阴性预测值最高,分别为96.88%、93.88%,浆膜面索条的符合率、比值比和ROC曲线下面积最高,分别为83.24%、12.767、0.828（P<0.001）。多种CT征象联合诊断胃癌浆膜外侵犯的ROC曲线下面积为0.927（P<0.01）。结论 亮线征、浆膜面毛糙、索条、膨隆、结节、脂肪浑浊及血管异常等CT征象对胃癌浆膜外侵犯有诊断价值。浆膜面索条的诊断性能较好,多种CT征象联合可提高诊断的准确性。     

A national survey: percussion, vibration, shaking and active cycle breathing techniques used in patients with acute exacerbations of chronic obstructive pulmonary disease

Objectives

Chronic obstructive pulmonary disease (COPD) is a frequent cause of hospital admission in older people. There is a perception that manual chest physiotherapy techniques are commonly used in the treatment of patients admitted with acute exacerbations of COPD (AECOPD). However, it is not clear which chest physiotherapy techniques benefit patients admitted with AECOPD, or even which techniques are currently being employed. The aim of this study was to investigate the use of percussion, vibration, shaking and active cycle breathing techniques (ACBT) by physiotherapists working in respiratory care and treating patients admitted with AECOPD.

Design

A postal questionnaire was used to survey physiotherapists working in respiratory care in 190 acute hospital trusts in the UK about chest clearance physiotherapy techniques used in the treatment of patients admitted with AECOPD.

Results

Of the 190 questionnaires mailed, 146 (77%) complete responses were received. One hundred and twenty-nine (88%) respondents reported that they always or often used ACBT, compared with 38 (26%), 16 (11%) and 12 (8%) respondents for vibration, shaking and percussion, respectively. The differences were statistically significant: ACBT used always/often versus vibration used always/often (χ² = 5.8, P = 0.01); ACBT used always/often versus percussion used always/often (χ² = 8.3, P < 0.0001); and ACBT used always/often versus shaking used always/often (χ² = 6.7, P < 0.001).

Conclusions

Manual chest physiotherapy techniques (vibration, percussion and shaking) were used infrequently for chest clearance in patients admitted with AECOPD, whereas ACBT was used always or often by 88% of responders.     

COMPUTED TOMOGRAPHY IMAGING STRATEGIES AND PERSPECTIVES IN ORBITAL FRACTURES

Objective:

The objective of this study was to demonstrate the sensitivity and specificity of multislice computed tomography (CT) for diagnosis of orbital fractures following different protocols, using an independent workstation.

Materials and methods:

CT images of 36 patients with maxillofacial fractures (symptomatic to orbit region) who were submitted to multislice CT scanning were analyzed, retrospectively. The images were interpreted based on 5 protocols, using an independent workstation: 1) axial (original images); 2) multiplanar reconstruction (MPR); 3) 3D images; 4) association of axial/MPR/3D images and 5) coronal images. The evaluated anatomical sites were divided according to the orbital walls: lateral (with or without zygomatic frontal process fracture); medial; superior (roof) and inferior (anterior, medial). The collected data were analyzed statistically using a validity test (Youden''s J index; p<0.05). The clinical and/or surgical findings (medical records) were considered as the gold standard to corroborate the diagnosis of the anatomical localization of the orbital fracture.

Results:

3D-CT scanning presented sensitivity of 78.9%, which was not superior to that of MPR (84.0%), axial/MPR/3D (90.5%) and coronal images (86.1%). On the other hand, the diagnostic value of axial images was considered limited for orbital fractures region, with sensitivity of 44.2%.

Conclusions:

Except for the axial images, which presented a low sensitivity, all methods evaluated in this study showed high specificity and sensitivity for the diagnosis of orbital fractures according to the proposed methodology. This protocol can add valuable information to the diagnosis of fractures using the association of axial/MPR/3D with multislice CT.     

MSCT在腮腺warthin瘤和多形性腺瘤鉴别诊断中的临床价值

［摘要］ 目的 回顾warthin瘤和腮腺多形性腺瘤的临床特点,分析MSCT影像在Warthin瘤和腮腺多形性腺瘤鉴别诊断中的作用。方法 选取Warthin瘤65例和腮腺多形性腺瘤62例作为研究对象,分析其临床病例特点及MSCT影像学特征,所得数据均采用SPSS23.0 软件包进行统计学分析。 结果1. 临床特点方面Warthin 瘤平均年龄和吸烟率均高于腮腺多形性腺瘤组且有统计学差异（Ｐ＜0.05）。2.MSCT影像学方面腮腺 Warthin 瘤与腮腺多形性腺瘤在病灶均质性和形态方面差异无统计学意义( P＞0.05)。 但在MSCT边界清晰率和平均密度值方面二者之间有明显差异,结果有统计学意义( P＜0.05)。结论 在MSCT影像中,Warthin 瘤的边界清晰度和平均密度值都高于腮腺多形性腺瘤。 双期增强扫描中多形性腺瘤与warthin瘤呈现不同的强化方式,这对临床医生明确肿物的大小范围和术前鉴别有重要的诊断参考价值。     

基于临床及影像组学构建中轴性脊柱关节病支持向量机预测模型

目的：基于临床及影像组学采用支持向量机（SVM）构建中轴性脊柱关节病（axSpA）的预测模型。方法：回顾性收集2012 年10月至2019 年2月在温州医科大学附属第一医院就诊的568 例腰背痛患者,最终诊断axSpA 319 例,非axSpA 249 例。按7:3 将患者随机分为训练组与验证组。于骶髂关节CT上手动勾画三维感兴趣区（VOI）并提取影像组学特征,应用最小冗余最大相关性（mRMR）及最小绝对收缩和选择算子（LASSO）算法进行降维及选择最优影像组学特征;采用单因素和多因素Logistic回归分析寻找诊断axSpA的临床危险因素。最后使用SVM分别构建临床、影像组学及临床-影像组学联合模型,利用受试者工作特征（ROC）曲线及Delong检验评估模型的诊断效能。结果：临床-影像组学联合模型在验证组中具有最佳诊断效能,诊断准确性为0.83,灵敏度和特异度分别为85.2%、79.7%,其ROC曲线下面积（AUC=0.91）高于临床模型（AUC=0.81）及影像组学模型（AUC=0.83）,差异均有统计学意义（P ＜0.05）。结论：基于临床和影像组学构建SVM模型对诊断axSpA具有较高价值。     

两种QCT骨密度测量软件检测腰椎骨密度的比较

目的 探讨飞利浦工作站IntelliSpace (IP) （无体模）和Mindways (MW) QCT Pro（有体模）两种骨密度测量软件测量腰椎BMD值的重复性、相关性、一致性及其在临床中的应用价值。方法 临床需要进行腹部扫描患者222例,将扫描数据分别传到IP和MW骨密度测量软件进行测量,应用 Pearson 相关性检验分析两种软件测量结果的相关性,应用配对样本 t 检验分析两种方法测量结果平均值是否有差异,应用Bland-Altman 图分析二者的一致性。自222例数据中随机抽取30例,由 2 名测量者在不同时间分别在各自软件上测量2 次椎体BMD 值,评价两个软件测量重复性。结果 重复性研究：IP及MW 对于所选 30 例 2 次测量结果之间均具有显著相关性(r=0.977,P＜0.01) 。2次测量结果之间差异均无统计学意义 (P>0.05) 。IP测量BMD值（92.93±36.16 mg/cm3）显著低于MW测量BMD值（112.78±41.36 mg/ cm3）,但两者测量值之间成正相关（r=0.911,P＜0.01）,对原始数据进行Bland-Altman 分析,差值大部分位于差值平均值±1. 96 标准差范围内,提示两种测量一致性好。结论 IP骨密度测量软件不能直接采用QCT诊断标准,但其与MW骨密度测量软件的一致性及相关性好,可用于对临床患者骨密度的评价及随访。     

CT引导下软线爪钩定位肺结节准确性的影响因素

目的 分析CT引导下软线爪钩定位肺结节准确性的影响因素。方法 回顾性分析214例接受CT引导下软线爪钩定位的单发肺结节患者,均于定位后24 h内接受电视胸腔镜手术（VATS）切除肺结节。于CT图像上测量肺内定位爪钩与结节外缘之间的最短距离,以该距离<1 cm为定位准确性较好,≥ 1 cm为准确性较差。采用单因素及多因素logistic回归分析观察CT引导下软线爪钩定位肺结节准确性的影响因素。结果 214枚肺结节均一次性穿刺定位成功,其中189枚定位准确性较好（较好组）、25枚定位准确性较差（较差组）;组间结节深度、（进针处）胸壁厚度、进针深度、穿刺针与水平面的角度及术中针道出血率差异均有统计学意义（P均<0.05）。多因素回归分析结果显示,结节最大径（OR=10.422,P=0.034）、结节深度（OR=0.045,P<0.001）、胸壁厚度（OR=0.635,P=0.029）及穿刺针与水平面的角度（OR=1.044,P=0.009）均为影响准确定位的因素。结论 于CT引导下以软线爪钩定位肺结节时,结节径线和深度、胸壁厚度及穿刺针与水平面的角度均影响其准确性。     

腰椎管内混杂性神经鞘瘤/神经束膜瘤1例

患者女,58岁,无明显诱因出现右侧腰骶部及右下肢疼痛麻木3年余,伴右下肢上抬无力和大小便感觉异常,近半年来症状加重;既往无腰部外伤史及其他疾病史。查体:右下肢肌力4级,实体觉、图形觉、两点分辨异常,巴宾斯基征及霍夫曼征阴性。实验室检查未见明显异常。腰椎CT:L3~L4椎体层面椎管内不规则稍高密度影,内见斑点状钙化(图1A),邻近骨质无破坏。     

18F-FDG PET/CT影像组学预测恶性肿瘤预后

¹⁸F-FDG PET/CT影像组学可通过自动、高通量方法自PET/CT图像中提取大量定量特征。应用人工智能和机器学习技术进一步推动了¹⁸F-FDG PET/CT影像组学在恶性肿瘤预后研究的进展,有望更好地指导临床管理恶性肿瘤患者。本文对¹⁸F-FDG PET/CT影像组学用于评估常见恶性肿瘤预后进展进行综述。