住院电子病历质量控制的内容和方法

随着医院电子病历系统的应用,电子病历的质量管理已成为医院管理的重要组成部分。本文针对住院电子病历系统的质量控制内容和方法进行了探讨。     

^11C-乙酸盐合成模块的故障判断与排除

本文针对国产PET-CS-II-IT-I型11CH3I-CPCU与PET-CS-I-IT-I型11C多功能-CPCU在联合使用合成乙酸盐的过程中遇到的问题,以及一些常见故障加以分析,并提供相应的解决方案。     

超声诊断在评价门腔静脉分流术后门静脉血流动力学中的研究价值

目的运用彩色多普勒超声检查监测直接性经皮经肝门腔分流术（direct intrahe paticportacaval shunt,DIPS）前后门静脉系血流动力学变化并评价该检查方法的临床应用价值。方法对12例门静脉高压症患者DIPS前后的门静脉系管腔内径、血流方向、血流速度的超声测值进行对比研究。结果超声引导下12例DIPS均一次穿刺成功;术后分流道为高速离肝血流信号,支架周围未见明显渗液;门静脉主干、右支、脾静脉及肠系膜上静脉内径较术前缩小（P〈0．05）,门静脉左支内径无明显变化（P〉0．05）,手术前后门静脉系血流速度差异有统计学意义（P〈0．01）。结论DIPS通过分流门静脉系血流入下腔静脉缓解门静脉高压。作为DIPS术中引导穿刺及术后监测门静脉系血流动力学变化及评价支架功能的首选方法,彩色多普勒超声可为临床评估手术疗效提供重要依据。     

投影旋转间隔对CT重建图像的影响

目的探讨CT扇形束扫描的投影旋转间隔对成像时间、成像质量以及图像重建计算齄的影响。方法采用Matlab软件编程,实现对仿真模型的投影数据取得、图像反投影重建,外将此方法用于实际颅脑的CT图像进行投影和反投影重建验证。结果本文通过对模型图像重建研究,得到了投影及重建过程中投影旋转间隔对成像时间、成像质量以及图像重建计算量的影响因素。结论在扇形束投影CT的成像过程中,投影旋转间隔在〈2°的范围内会对成像时间、成像质苗以及计算量产生较小影响。     

TNF-α在胆脂瘤中的表达与64排CT的表现的关系

目的研究TNF-α在胆脂瘤中的表达与64排CT的表现的关系。方法收集30例胆脂瘤患者的耳部64排CT扫描图像,采用免疫组织化学方法检测TNF-α的表达情况,并分析其CT表现与TNF-α表达的相关性。结果①胆脂瘤组织的TNF-α表达水平明显高于正常外耳道皮肤,两者之间差异具有统计学意义（P〈0.05）。②胆脂瘤组织中TNF-α表达上调,且TNF-α的表达量与CT表现的骨质破坏的程度具有一定的相关性。结论 TNF-α在胆脂瘤骨质破坏过程中起着重要作用,因此在以后的胆脂瘤临床诊断、治疗过程中,我们可以通过观察胆脂瘤患者的颞骨HRCT扫描了解骨质破环程度,进而推断出TNF-α的表达水平,为将来应用抗生素和抗炎药物切断细胞因子的产生和控制胆脂瘤骨质破坏提供理论依据。     

MR动态增强和扩散加权成像对前列腺良恶性病变的评价

目的探讨MR动态增强（DEC-MRI）及扩散加权成像（DWI）在前列腺良恶性病变诊断中的价值。方法对83例经病理证实的前列腺疾病患者行MRI常规平扫、DWI及MR动态增强检查,同时将55例正常志愿者作为对照组,分析正常组、前列腺增生组（BPH）以及前列腺癌肿组（Pca）的前列腺的外周带和中央叶的DEC-MRI信号变化、SI-T曲线特征及DWI-ADC值的变化特点。结果 MR动态增强和DWI对前列腺良恶性疾病的检出具有较高的敏感性和特异性。SI-T曲线的达峰时间（Tmax）从高到低依次为正常前列腺外周带、正常中央叶、BPH及Pca（P=0.000）;强化程度（SI%）从高到低为BPH、正常中央叶、Pca及正常外周带（P=0.000）;强化率（R）从高到低为Pca、BPH、正常中央叶及正常外周带（P=0.000）。ADC值从高到低为正常外周带、正常中央叶、BPH及Pca（P=0.000）。结论 MR动态增强及DWI可明显提高对前列腺良恶性疾病的诊断和鉴别诊断率。     

宫颈癌患者 Kruppel 样因子 6，p21 蛋白表达水平与病理特征及化疗敏感性的相关性分析

目的　探讨宫颈癌患者 Kruppel 样因子 6（KLF6）,p21 蛋白表达水平与病理特征及化疗敏感性的相关性。方法　回顾性分析 2016 年 1 月 ~2018 年 12 月接受化疗的 40 例宫颈癌患者,化疗结束后根据化疗效果将患者分为化疗敏感组（CR+PR）、化疗抵抗组（SD+PD）。采用免疫组化检测宫颈癌组织 KLF6,p21 蛋白的表达,分析其与临床病理特征、化疗敏感性及总生存期（OS）的关系。结果　宫颈癌中 KLF6,p21 蛋白阳性率与病理分期、肿瘤直径、分化类型及化疗敏感性相关（χ 2 =2.14~5.74,均 P<0.05）。KLF6+/p21- 者 ORR 为 85.71%,显著高于非 KLF6+/p21- 者 42.11%（χ 2 =8.33,P<0.05）。宫颈癌患者的中位 OS 为 11.20 个月（95%CI: 9.73~12.71）,其中 KLF6 阳性者中位 OS 为 11.90个月（95%CI: 10.81~12.99）,显著高于阴性表达者 9.20 个月（95%CI: 9.05~9.35）;p21 蛋白阳性者中位 OS 为 9.14 个月（95%CI: 8.26~10.22）,显著低于 p21 阴性表达者 11.62 个月（95%CI: 9.63~13.58）（χ 2 =11.50,6.23,均 P<0.05）。结论　宫颈癌患者 KLF6,p21 表达水平与其临床病理特征相关。KLF6 高表达、p21 低表达者化疗敏感性高,且预后更好,可作为预后、个体化治疗方案选择的评价指标。     

22-j?hriger Sportler mit Sinusarrest und Pausen bis 7?Sekunden

A 22-year-old athlete with nocturnal asymptomatic episodes of transient sinus arrest/sinoatrial block up to 7.3?s and recurrent inappropriate sinus tachycardias which had been incidentally found during Holter electrocardiography diagnostics is presented. In spite of extensive diagnostic work-up including invasive procedures like coronary angiography and electrophysiological study, no causal etiology was found. Based on the normal findings and the lack of symptoms, we decided not to implant a permanent pacemaker. After 14?months, the patient is still asymptomatic. Howerver, the 24-h Holter electrocardiography shows unchanged frequency of nocturnal transient sinus arrest episodes.     

Maternal humoral factors associated with perinatal human immunodeficiency virus type-1 transmission in a cohort from Kigali, Rwanda, 1988-1994

OBJECTIVES: to study different parameters of humoral immunity responses in the serum of 39 human immunodeficiency virus type-1 infected pregnant women from Kigali, (Rwanda) in correlation with perinatal transmission. METHODS: this study was done between 1988 and 1994. Thirty nine HIV-1 infected women, 18 transmitting (T) and 21 non-transmitting (NT) mothers, have been chosen based on the quantity of sera available for analysis. Maternal data were collected at the time of delivery or during the preceding month. Quantification of viral load was performed by the signal amplification bDNA assay. Specific reactivity of antibody was tested against recombinant p24 protein and five different synthetic peptides from gp120 and gp41 based on HIV LAI-strain sequences. Neutralization assays were performed against laboratory (RII strain of the HIV-1 C subtype) and primary strains (two NSI and one SI of the HIV-1 A subtype). Antibody Dependent Cellular Cytotoxicity assay was performed with CEM.NK(R) cells against a laboratory HIV-1 strain. RESULTS: absence of correlation regarding maternal viral load, or viral subtype and vertical transmission was observed. By contrast, the CD4/CD8 ratio was significantly higher in non-transmitting mothers compared to transmitting mothers. Moreover, high anti-p24 antibody avidity was correlated with a lower risk of perinatal transmission. Furthermore, transmission risk appeared significantly higher with reactivity of serum samples to linear epitopes of gp41 (amino acids 566-582, 578-594), whereas risk appeared lower with reactivity to the immunodominant domain of gp41 (amino acids 597-609). No significant difference was observed in titres of antibody neutralizing primary isolates (two NSI (non syncitium inducer) and one SI (syncitium inducer) of the HIV-1 A subtype) and laboratory strain (RII strain, of the HIV-1 C subtype) between transmitting and non-transmitting mother's sera. In addition, titres of Antibody Dependent Cellular Cytotoxicity were similar in transmitting versus non-transmitting mothers. However, high Antibody Dependent Cellular Cytotoxicity titres were correlated with a good clinical status of children. CONCLUSIONS: three parameters such as high CD4/CD8 ratio, high anti-p24 antibody avidity and high reactivity against the immunodominant epitope of gp41 have been shown to be correlated with no perinatal transmission. High Antibody Dependent Cellular Cytotoxicity titres appeared to be linked to a good clinical status of children after birth. One parameter, reactivity against two linear epitopes of gp41, appeared to be correlated with vertical transmission.     

系统性硬化症肺部受累的胸部高分辨力CT表现特点分析

目的分析系统性硬化症（SSc）肺部受累时胸部高分辨力计算机体层摄影术（HRCT）表现,提高对SSc肺部损害的认识。方法选择2009年1月~2012年6月明确诊断的45例SSc患者,其中男性9例,女性36例;年龄为20~80岁,平均年龄58.50岁。回顾其胸部HRCT表现,并进行HRCT评分,对其胸部HRCT特点进行总结分析。结果胸部HRCT证实,存在间质性肺疾病患者为32例（71.1%）,其中34.4%患者（11/32）无呼吸系统症状。SSc肺部受累在HRCT图像上以磨玻璃影（81.3%）和网格影（56.3%）最为常见,分布以双下肺（71.9%）及胸膜下分布（81.3%）为主。对两侧的上中下肺野的HRCT评分进行t检验发现双侧病变差异无统计学意义（P〉0.05）,呈对称性分布。对上中下肺野的HRCT评分进行两两比较,下肺野受累最明显,中野次之,上野受累最少（P〈0.05）。在存在肺间质受累的患者中,弥漫型患者的HRCT评分（8.82±5.56）与局限型患者的评分（8.73±5.61）间差异无统计学意义（P〉0.05）。肺外胸部脏器受累包括肺动脉增宽、胸膜病变、心包积液、纵隔淋巴结肿大、食管扩张。肺动脉增宽33.3%（15/45）,弥漫型患者中肺动脉增宽的发生率与局限型患者的发生率差异无统计学意义;有雷诺现象者的肺动脉增宽的发生率高（15/34 vs 0/11;P=0.005）。结论胸部HRCT对SSs的肺、胸膜、食道、肺动脉的评估均有较高价值,其中肺间质受累是最为常见的,对称性分布、双下肺突出的间质性病变为其主要特点。