MR动态增强及减影成像对乳腺良恶性疾病的诊断价值

目的探讨MR动态增强成像技术所获得的参数及减影成像在乳腺良、恶性疾病诊断及鉴别诊断中的价值。资料与方法经病理证实乳腺病变50例，共计58个病灶。采用快速小角度激发扰相梯度回波序列（FLASH）行动态增强扫描。观察：时间一信号强度曲线类型，早期增强率，增强后病灶形态学特征及间接征象，于3D减影最大强度投影（MIP）图计数肿瘤血管数目。结果50例58个病灶经病理证实，其中恶性32个，良性26个。良性病变中时间一信号强度曲线57．7％为单向型，38．5％为平台型。恶性病变中71．9％为流出型。良、恶性病变的时间一信号强度曲线类型比较，差异有统计学意义（X^2=32．365，P＜0．05）。良性肿瘤中95％边缘光滑，55％均匀强化；恶性肿瘤中93．8％的形态不规则，78．1％有毛刺和分叶，81．3％不均匀强化。良、恶性肿瘤的形态特点差异有统计学意义（X^2=44．25，P＜0．05）。良性病变中73．1％无肿瘤血管：恶性病变中68．8％有多支肿瘤血管，良、恶性病变肿瘤血管计数差异有统计学意义（X^2=32．288，P＜0．05）。结论乳腺增强MRI及减影成像能够提供清晰、丰富的形态学信息，时间一信号强度曲线反映了病变的血流动力学信息，两者的结合对乳腺良、恶性疾病的正确诊断和鉴别诊断具有重要价值。     

术中皮质体感诱发电位与电刺激术定位脑功能区

目的探讨脑功能区手术中利用脑皮质体感诱发电位(SEP)及直接皮质电刺激定位脑功能区的方法及意义。方法对10例脑功能区病变病人在唤醒麻醉下进行手术，利用皮质SEP及皮质直接电刺激定位感觉区、运动区及语占区，住保护脑功能区的前提下，手术切除病变。结果7例病人利用SEP及皮质电刺激确定出运动感觉区，其中4例利用SEP位相倒置确定出中央沟，3例病变位于左侧额颞叶的病人通过皮质直接电刺激确定出语言区?术后功能均较术前明显好转。结论术中SEP及直接皮质电刺激可准确、实时确定脑功能区，最大程度地保护功能，切除病变。     

Gd-DTPA动态增强MRI评价心肌微血管损伤

目的：探讨Gd-DTPA动态增强MRI评价心肌微血管损伤的可行性。方法：制作急性犬心肌梗死动物模型，在活体上用放射微球^99Tc—MAA测量心肌血流量，0．5％伊文蓝染色区分缺血心肌；心脏离体后用3％TTC染色区分梗死心肌，SP免疫组化染色观察心肌微血管并计算微血管体积分数。犬离体心脏左冠状动脉插管后作MRI平扫及Gd—DTPA动态增强扫描，测量正常、缺血和梗死心肌的信号强度，绘制时间-信号强度曲线。结果：在T1WI上，心肌信号强度无明显差异；在T2WI上，病变心肌信号强度较正常增高；Gd-DTPA灌注动态增强扫描，正常心肌时间-信号强度曲线呈下降形，危险心肌呈上升形，梗死心肌呈平直形，灌注晚期病变区呈明显环状强化。正常、危险和梗死心肌血流量、微血管体密度差异显著。结论：急性心肌梗死后心肌间质水肿、心肌含水量增加致T2WI信号增高。Gd-DTPA动态增强时间-信号强度曲线上升的斜率及峰值可以反映心肌微血管损伤及组织水肿的程度。     

中国2000～2001年流行性感冒流行概况

目的：了解中国2000－2001年流行性感冒（流感）流行及抗原性变异情况。方法：鸡胚传代病毒用于抗原分析；病毒液提取RNA进行逆转录－聚合酶链反应（RT－CR），扩增产物纯化后测序。然后用MegAlign(Version1.03）和Editseq（Version3．69）软件进行基因种系发生树分析。结果：2001年流行的H1N1亚型病毒血凝素蛋白重链（H1N1）相比，在抗原决定簇D区的190位发生了氨基酸替换；基因种系发生树表明2001年的H1N1亚型流感病毒存在基因特性不同的两系病病毒株，国内人群中仍然同时流行着两种抗原性明显不同的B型流感病毒（Yamagata系和Victoria系），Yamagata系病毒占大多数，Version系的HA1区基因与B／山东／7／97毒株相比，其197和199位氨基酸发生了替换。B型的基因种系发生树也证实Version系病毒株的抗原性改变。2000年分离的H3N2亚型流感病毒的HA1区氨基酸序列与A／悉尼／5／97（H3N2）间有7－8个氨基酸的差异；2001年分离的H3N2病毒株与2000年的病毒株相比，又有83、186、202、222位发生了氨基酸替换，表明H3N2亚型病毒株间的抗原性发生了较明显的变异。结论：2000－2001年中国流感的流行情况较为平静；H3N2亚型的抗原性发生了变异，H1N1亚型和B型病毒的抗原性虽没有发生明显的变异，但它们均同时流行着两系抗原性不同的毒株。     

Direct solution to an optimal control problem of econometric systems

A direct solution is proposed to an optimal control problem of linear econometric systems with a quadratic welfare loss function when there are linear equality constraints on the control variables. The direct solution proposed here eliminates the problem of non-uniqueness of the optimal solution, which is present when this optimal control problem is solved using the recursive algorithm proposed by Chow,¹ Pindyck² and Tan.³ If a unique solution to the optimal control problem exists, then the direct solution and the recursive solution coincide.     

儿童地高辛血药浓度的回顾性分析

目的 :探讨血药浓度监测对个体化、合理化用药的重要作用。方法 :荧光偏振免疫法 (FPIA)和通过近十年住院病人地高辛用药的回顾性分析。结果 :地高辛血药浓度监测结果分三个范围 :低值小于 0 .8μg/ L,中值 0 .8～ 2 .2 μg/ L,高值大于 2 .2μg/ L。对实验数据进行统计 ,得出有效浓度范围内的病人占 4 0 %左右 ,低值平均约 >5 0 % ,高值平均为 6 .1%。结论 :通过对地高辛用药的监测回顾 ,说明地高辛的药物代谢过程受许多因素如吸收、分布、代谢、排泄、药物间的相互作用等的影响。所以临床在用药过程中 ,药物浓度的监测对实施个体化、合理化用药 ,减少药物中毒的发生起着重要作用     

基层药品不良反应监测体系建设的实践和探讨

目的 探讨基层药品不良反应监测网络建设模式,为药品不良反应监测组织体系的完善提供参考.方法 通过建立山东省基层药品不良反应监测网络的实践,研究、分析基层药品不良反应监测网络的建设模式.结果 建立了高效、快捷的三级药品不良反应监测网络,促进了山东省药品不良反应监测工作的全面发展.结论 建立健全机构设施完备、职责明确、运作规范的基层监测网络,有利于完善我国药品不良反应监测组织体系,推动药品不良反应监测工作的深入开展.     

Anaesthesia monitoring: the human factors component of technology transfer

Resistance to change in monitoring practices from within the anaesthesiology community is a formidable obstacle, and coercive and exhortatory solutions are likely to be unsuccessful in some situations. An analysis of publications about technology transfer and professional obsolescence, and application of this data to the practice of anaesthesia, reveals various stresses that technology transfer from research areas to the workplace may induce in vulnerable anaesthesiologists and account for their attitudes. It is suggested that the invaluable pronouncements of high profile anaesthesiologist groups must be supplemented by supportive behaviour by physicians and administrators at an institutional level. The human factors issues to be addressed include: (i) Monitored data acquisition skills. (ii) Possibility of acting on monitored data. (iii) Assistance for personal insight into attitudinal difficulties that may be encountered. (iv) Data supporting the value of the device. (v) Ergonomically effective integration of the monitor into the work station.Alternatively the perceptions of potential users may accurately reflect changes in their status in the new work situation created by monitors, and decision making aids that may or may not be derived from them. Thus, plans to present job satisfaction in related clinical areas or to associate the proposed new system with evaluation of its effect on patient outcome will be necessary. In this way the clinician becomes involved in clinical research, a quality of personal and quality care development.     

烧伤血清肌红蛋白动态监测中次高峰的意义

严重烧伤皿清肌红蛋白动态监测曲线，对创面感染和病情恶化有预警意义的回升高值，命名为次高峰。次高峰对严重并发症存在与否的诊断指标是：＋Ｐｖ＝８７．５％。－Ｐｖ＝１００％，Ｓｅ＝１００％，Ｓｐ＝９７．１％，Ａｃ＝９７．６％。井推算出漏诊率是０％，误诊率是２．９％，诊断指数１９７．１％。证明血清肌红蛋白试验达到临床诊断对生化试验的要求水平。     

Voluntary head stabilization in space during oscillatory trunk movements in the frontal plane performed in weightlessness

 The ability voluntarily to stabilize the head in space during lateral rhythmic oscillations (0.59±0.09 Hz) of the trunk has been investigated during microgravity (μG) and normal gravity (nG) conditions (parabolic flights). Five healthy young subjects, who gave informed consent, were examined. The movements were performed with eyes open or eyes closed, during phases of either μG or nG. The main result was that head orientation with respect to vertical may be stabilized about the roll axis under μG with, as well as without vision, despite the reduction in vestibular afferent and muscle proprioceptive inputs. Moreover, the absence of head stabilization about the yaw axis confirms that the degrees of freedom of the neck can be independently controlled, as was previously reported. These results seem to indicate that voluntary head stabilization does not depend crucially upon static vestibular afferents. Head stabilization in space may in fact be organized on the basis of either dynamic vestibular afferents or a short-term memorized postural body schema. Received: 4 October 1995 / Accepted: 30 September 1996