能量平衡疗法治疗心脾两虚型失眠

能量平衡疗法治疗心脾两虚型失眠,其机理是通过医者身心协调、手法刚柔相济产生的能量作用于患者身体的一定部位达到补益心脾、调整脏腑、平衡脏腑整体能量,达到治疗心脾两虚型失眠的目的。临证运用时强调医者与患者的能量共振及二者的共同平衡。     

癌性疼痛治疗不充分的原因及对策

癌症是目前我国城市居民第一位死亡原因。我国现有癌症患者200多万,这些患者40％至50％发生癌性疼痛,其中25％的病人未得到治疗^[1],63．4％的病人治疗不充分,这意味着高达88．4％的癌性疼痛患者未能得到满意的控制,25％的患者在疼痛中死亡^[2],由此可知我国目前正在忍受癌性疼痛折磨的病人数量之众。癌性疼痛从心理、生理、精神和社会等多方面影响患者的生活质量,可见癌性疼痛的充分治疗已成为一个急需解决的课题。因此,探讨癌性疼痛治疗不充分的原因及寻找对策具有重要的临床意义和社会意义。     

现代教育技术在人体解剖学教学中应用的思考

现代教育技术在教育领域的日益广泛的应用 ,促进了教育事业迅速发展 ,对于传统教学方法、教学手段 ,甚至教学思想、教学体模式带来了前所未有的冲击。作为医学领域中的基础课程 ,人体解剖学同样也受到了现代教育技术革命的挑战。传统的教学方法和模式在某些方面已经不能适应现代化教学的要求 ,到了非改不可的时候了。作为从事解剖学教学多年的教师 ,这方面的体会颇深。人体解剖学是一门重要的医学基础课程 ,是医学生接触最早的主干学科之一。几十年来 ,解剖教学手段单一、设施陈旧 ,授课方式停留在传统的挂图加板书模式中。由于人体结构复杂…     

16例鼻咽癌合并皮肌炎患者放疗效果临床分析

目的 探讨16例鼻咽癌合并皮肌炎患者的放疗疗效及副作用情况。方法对16例鼻咽癌合并皮肌炎患者进行配对研究,比较两组生存率、急性及晚期放疗反应发生情况,探讨鼻咽癌合并皮肌炎患者的发病及治疗特点。结果16例鼻咽癌合并皮肌炎患者5年生存率为47％,与对照组相比无显著差异,皮肌炎组患者放疗中出现严重急性反应发生情况较对照组明显增加,晚期反应发生率无明显差别。结论鼻咽癌合并皮肌炎患者疗效与非皮肌炎患者相近,但放疗中出现较严重急性反应值得临床注意,大剂量激素治疗不需要常规使用。     

复方甘草甜素联合大剂量丹参治疗原发性胆汁性肝硬化31例

原发性胆汁性肝硬化（primary biliary cirrhosis,PBC）是一种累及肝内胆管系统的慢性进展性疾病,多见于中年女性。以往认为PBC在我国罕见,近年来随着认识的提高及诊断技术的进步,国内的报道也逐年增多[1]。目前,该病尚无疗效确切的治疗方法。     

备用变压器的“热,冷备”及“冷备”转“运行”

就配电变压器节能降耗、经济运行中遇到的热点问题：备用变压器的＂热备＂,＂冷备＂和如何使备用变压器安全地由＂冷备＂状态转为＂运行＂状态提出了一些具体做法,并从行业规程中找到支持这些做法的文字性的依据。对企业将备用变压器由＂热备＂转为＂冷备＂和＂冷备＂转＂运行＂的具体操作能有所帮助。     

腹腔镜胃癌根治术的临床应用

目的探讨腹腔镜胃癌根治术的可行性。方法 2006年4月～2010年4月我院完成腹腔镜胃癌根治术36例,对其临床资料进行回顾性分析。结果 36例全部在腹腔镜下成功完成胃的游离及淋巴结的清扫;其中全胃切除1例,近端胃大部切除3例,远端胃大部切除32例。手术时间180～360min,术中出血量100～280ml。所有标本切缘均阴性;清扫淋巴结14～26枚。术后患者胃肠功能恢复时间3～4d,下床活动时间3～4d。本组病例未出现吻合口漏,出现切口感染2例。36例术后均获随访,随访时间6～24个月,无局部复发及穿刺孔种植转移。结论胃癌病人行腹腔镜胃癌根治术安全可行,近期疗效好。     

64层螺旋CT胸部低剂量扫描方案优选的多中心研究

目的 比较自动曝光控制技术(AEC)与管电流恒定技术(CCC)2种不同低剂量MSCT扫描方案对胸部CT图像质量的影响,探讨更加合理的肺低剂量扫描参数方案.方法 采用前瞻性多中心研究方法,研究对象为7所医院就诊的280例行胸部低剂量MSCT检查的受检者,设定管电流(mA)为研究变量,方法一为AEC技术,下设噪声标准差值(SD)为25(A1)及30(A2)各1组,并设定管电流上限为80 mA,下限为10 mA;方法二为CCC技术,下设40 mA(C1)及50 mA(C2)各1组;共4组,采用同一机型64层MSCT行胸部低剂量扪描.2名放射科医师应用双肓法阅片,比较2种不同扫描技术的曝光剂量、SD值,横断面、MPR的图像质量以及体质量指数(BMI)对图像质量的影响.曝光剂量及SD比较行方差分析及t检验;图像质量比较行Mann-Whitney检验;医师对图像诊断一致性检验行Kappa分析.结果 剂量长度乘积(DLP)AEC组较CCC组明显降低[(82.62±40.31)和(110.81±18.21)mGy·cm,F=56.88,P＜0.01].AEC技术中A2组DLP较A1组低[(72.77±36.68)和(92.46±41.61)mGy·cm],差异无统计学意义(t=0.82,P＞0.05).前者SD值在肺窗[(41.50±9.58)和(40.86±7.03)HU]及纵隔窗[(41.19±7.83)和(40.92±9.89)HU]均略高于后者,差异无统计学意义(F肺窗=0.835、1.910,P值均＞0.05).横断面图像质量AEC组肺窗得分除右下肺静脉水平[(4.92±0.25)和(4.93±0.17)分]、[左膈顶上缘水平(4.91±0.27)和(4.93±0.22)分]较CCC组略低外,AEC组得分均较CCC组略高[头臂静脉上缘(4.49±0.56)和(4.38±0.64)分;主动脉弓上缘(4.86±0.23)和(4.81±0.32)分;右肺上叶支气管开口(4.87±0.27)和(4.84±0.22)分;右肺中叶支气管开口(4.90±0.25)和(4.88±0.21)分],差异无统计学意义(F=0.076～1.748,P值均＞0.05);纵隔窗得分除头臂静脉上缘水平AEC组较CCC组高[(2.57±0.77)和(2.46±0.59)分],且差异有统计学意义(F=8.459,P=0.047)外,余各层面AEC组得分均较CCC组略低[(主动脉弓上缘(3.36±0.63)和(3.45±0.60)分;右肺上叶支气管开口(3.94±0.56)和(3.95±0.51)分;右肺中叶支气管开口(3.80±0.58)和(3.87±0.50)分;右下肺静脉(3.72±0.56)和(3.78±0.53)分;左膈顶上方(3.58±0.63)和(3.68 ±0.56)分],但差异均无统计学意义(F=0.083～3.380,P值均＞0.05).MPR图像质量肺窗及纵隔窗观察均略好于CCC组(Z肺窗=-2.358,Z纵隔窗=-1.330,P值均＞0.05).偏瘦、正常或偏重人群组,A1组肺窗及纵隔窗图像质量均优于A2组,差异无统计学意义(偏瘦:Z肺窗=0.000、Z纵隔窗=0.000;正常:Z肺窗=-0.062、Z纵隔窗=-0.746;偏重:Z肺窗=-1.177、Z纵隔窗=-1.715;P值均＞0.05),但在偏重人群纵隔窗图像质量A1组更好于A2组(Z=-1.715,P=0.144).结论 AEC组总曝光剂量明显低于CCC组,而AEC组的图像质量及SD值无论在肺窗或纵隔窗均与CCC组无明显差异,故建议在胸部低剂量筛查方案选择中应用AEC技术,对偏胖者宜采用SD=25方案,对正常及偏瘦者宜采用SD=30方案.

Abstract：

Objective To compare the image quality of chest low dose CT (LDCT) using automatic exposure control (AEC) and constant current control (CCC) and explore a more reasonable scanning protocol. Methods Two hundred and eighty participants were examined with 64 CT scanner at 7 centers in China. All were divided into 4 groups. Two groups underwent LDCT using AEC with standard deviation set at 25 (A1) and 30 (A2) respectively and the tube current ranged from 10 mA to 80 mA. The other two groups underwent LDCT using CCC with tube current set at 40 mA (C1) and 50 mA (C2) respectively. The axial and MPR images were evaluated by two radiologists who were blinded to the scanning protocols.The radiation dose, noise and the image quality of the 4 groups were compared and analyzed statistically.Differences of radiation dose and noise among groups were determined with variance analysis and t test,image quality with Mann-Whitney test and the consistency of diagnosis with Kappa test. Results There was a significant lower DLP in AEC group than in CCC group [(82.62±40.31)vs ( 110.81±18.21) mGy·cm (F =56. 88 ,P ＜ 0. 01 )], whereas no significant difference was observed between group A2 and group A1 0. 05]. The noisy of AEC group was higher than that of CCC group both on lung window(41.50±9.58 vs 40.86±7.03) and mediastinum window (41.19±7.83 vs 40.92±9.89), but there was no significant difference( Flung =0.835, P=0.476, Fmediastinum =1.910, P=0.128).The quality score of axial image in AEC group was higher than that in CCC group (superior margin of the brachiocephalic vein level: 4.49±0.56 vs4.38±0.64,superior margin of the aortic arch: 4.86±0.23 vs 4.81±0.32,the right superior lobar bronchus Level:4.87±0.27 vs 4. 84 ± 0. 22, the right middle lobar bronchus Level: 4.90±0.25 vs 4.88±0.21) except on the right inferior pulmonary vein level(4. 92 ±0. 25 vs 4. 93 ±0. 17) and superior margin of the left diaphragmatic dome level (4. 91±0.27 vs 4.93±0.22) on lung window, but no significant differences (F=0.076-1.748, P＞0.05) were observed. A significant higher score in AEC group was observed on mediastinum window compared with CCC group on superior margin of brachiocephalic vein level (2.57±0.77 vs 2. 46 ± 0. 59, F = 8. 459, P ＜ 0. 05 ), however, the score of AEC group was lower than that of CCC group on other levels without significant differences (superior margin of the aortic arch:3.36 ±0. 63 vs 3.45 ±0. 60,the right superior lobar bronchus level: 3.94 ±0. 56 vs 3. 95 ±0. 51 ,the right middle lobar bronchus Level: 3.80 ±0. 58 vs 3. 87 ±0. 50,the right inferior pulmonary vein level: 3.72 ±0. 56 vs 3.78 ±0. 53, superior margin of the left diaphragmatic dome level: 3.58 ± 0.63 vs 3.68±0.56,F=0.083-3.380,P ＞ 0.05 ). The MPR image quality of AEC group was better than that of CCC group both on lung window and mediastinum window (Zlung =-2.258, Zmedlastinum=-1.330, P＞0.05). For all participants including the underweighted group, the normal group and the overweighted group, the image quality of A1 group was better than that of A2 group without significant differences (the underweighted group: Zlung=0.000, P=1.000, Zmedastinum= 0.000, P=1.000;the normal group: Zlung =-0.062, P=0.950, Zmediastinum =-0.746, P = 0.456; the overweighted group: Zlung = - 1.177, P = 0.239,Zmediastinum =-1.715, P=0.144) both on lung and mediastinum windows, and for the higher BMI participants, a better image quality was obtained in A1 group than in A2 group on the mediastinum window (Z = -1. 715, P = 0. 144). Conclusions The total radiation exposure dose of AEC group is significantly lower than that of CCC group, but no statistical significant differences are observed between both groups in image quality and noise level. The AEC technique is highly recommended in thoracic LDCT scan for screening program, and the SD25 ( SD value = 25) scan protocol is suggested for higher BMI population while the SD30 (SD value = 30) scan protocol for lower BMI population.     

205例中风预测及血液流变学普查分析

中风是老年人的高发病,近年随着人们生活水平的提高,发病率有明显上升趋势。该病我国发生率7‰,部分地区可高达1%。我院采用中风预测仪对重庆市天然气公司45岁以上职工和江北区老干局离休干部进行中风预测及血液流变学普查,结果报告如下,供同行商讨。