临床护理路径（CNP）在腹部CT增强扫描检查中的应用研究

目的 探究临床护理路径在行腹部CT增强扫描检查患者中的应用效果。方法 收集本院2017年7月～2018年6月收治的120例行腹部CT增强扫描检查患者的临床资料,依据不同的干预方法归纳为对照组和实验组,各60例。前者采取常规护理方法,后者采取临床护理路径。对照并分析两组患者的检查配合度、不良反应发生率、护理满意度及护理差错数。结果 实验组患者的检查配合度为93.3%,明显优于对照组的73.3%(P0.05);实验组患者的不良反应发生率为5.0%,明显低于对照组的18.3%(P0.05);实验组患者的满意度评分为(4.37±0.40)分,明显优于对照组患者的(3.26±0.73)分(P0.05);实验组护理差错共1次,明显少于对照组的8次(P0.05)。结论 临床护理路径在腹部CT增强扫描检查中应用效果较好,能够明显提升患者的依从性,进而更好地配合检查,提高患者的满意度,具有较高的临床实用性。     

Risk factors of rib metastases in nasopharyngeal carcinoma patients with rib 99mTc- MDP foci on whole-body bone scansCSCD

Objective To investigate the correlation of rib 99mTc-MDP foci on whole-body bone scan with clinical variables and rib metastases in nasopharyngeal carcinoma(NPC) patients, and to screen the risk factors of rib metastases. Methods We retrospectively reviewed 312 NPC patients with rib 99mTc-MDP foci on wholebody bone scan. Chi-square test and logistic regression were performed to evaluate the correlation between clinical variables and rib metastases. Results In all 312 NPC patients, rib metastases were associated with T stage, skull base bone invasion, other bone metastasis, number of rib foci, lateral localization on rib and foci type (P<0.01), and the risk factors of rib metastasis included skull base bone invasion, other bone metastases, lateral localization on rib and foci type (P<0.05). In 176 patients with pure rib foci, rib metastases were closely related to T stage, skull base bone invasion, other bone metastasis, number of rib foci and lateral localization on rib (P<0.05), while only lobar distribution (P=0.029) was the effective risk factor. In 198 patients with single rib focus, rib metastases were affected by skull base bone invasion and foci type (P<0.01), while only foci type (P=0.000) was the effective risk factor. In all 566 rib foci, uptake level and localization on rib were the effective risk factors of rib metastases(P<0.01). Conclusion In NPC patients with rib foci on whole body bone scan, the effective risk factors of rib metastases include skull base bone invasion, other bone metastases, lateral localization on rib, foci type, uptake level and anterior and posterior localization on rib. Follow up should be the main way for the pure rib foci on unilateral ribs. For multiples rib foci on bilateral ribs or single rib focus combined with other bones foci, additional image modalities should be required to exclude bone metastasis. © 2020, CHINA RESEARCH ON PREVENTION AND TREATMENT. All rights reserved.     

Limited benefit of CT scans in tuberculosis contact tracing

ObjectiveThe detection of abnormal findings on computed tomography (CT) scans of tuberculosis contacts combined with normal plain radiographs contributes to the early detection of tuberculosis. However, the benefit of the early detection of abnormalities for the prevention of active tuberculosis during follow-up requires evaluation.MethodWe conducted retrospective comparison of the existence of CT scans of tuberculosis contacts without findings of active tuberculosis on plain radiographs at a hospital in Japan. Results: Among 243 contacts without CT scans, five developed tuberculosis during follow-up. Among 229 contacts with CT scans, 24 were judged as targets of multi-drug therapy since their CT findings were suggestive of active tuberculosis at the time of the CT screening. Among 205 contacts judged as having latent tuberculous infection with CT screening, three developed tuberculosis diseases during follow-up. Conclusion: CT scans detected abnormal findings among contacts without abnormalities of plain radiographs but there were some contacts that developed tuberculosis diseases among those with contact investigation including CT scan. The value of CT is equivocal considering the balance of true treatment, overtreatment and harm of radiation.     

两例父源性17q12微缺失综合征胎儿的产前诊断和遗传学分析

目的探讨两例父源性17q12微缺失综合征胎儿的产前诊断和遗传咨询。方法一名孕妇的两例胎儿的孕中晚期超声检查均提示肾脏异常和羊水过多,应用单核苷酸多态性分析(single nucleotide polymorphism array,SNP-array)分别对第1胎的脐血样本和第2胎的羊水样本进行产前诊断。发现第1胎染色体17q12微缺失后,父母进行外周血SNP-array检测以确定遗传来源。结合双亲临床病史,其父亲进行泌尿系统相关的565个基因的高通量测序,以排除泌尿系统及生殖器官先天性结构畸形相关的已知致病变异或疑似致病变异可能。结果该家系两例胎儿SNP-array结果均为arr[hg19]17q12(34822465~36243365)×1,大小约1.4 Mb,为17q12微缺失综合征,遗传自父亲。胎儿父亲未发现泌尿系统相关的致病或疑似致病变异。结论父源性17q12微缺失可能为两例胎儿超声肾脏异常和羊水过多的遗传学病因。产前SNP-array检测可明确诊断,为该家系的遗传咨询及产前诊断提供依据。