多发性骨关节损伤185例分析

多发性骨关节损伤并185例，以交通意外伤和坠落伤居多；骨折最常见部位依次是胫腓骨、股骨、足踝和脊柱，最常见的合并伤为颅脑损伤及腹部脏器损伤，开放性损伤占半数以上；1／4的病例并发休克。作者认为随着经济的发展，交通意外伤和坠落伤等创伤病例明显增加，伤情十分复杂化，多发性骨关节损伤更为常见。本文就其诊断标准及早期处理原则，结合本组病例的实践加以探讨如下。     

肺硬化性血管瘤的MSCT征象

目的探讨肺硬化性血管瘤(pulmonary sclerosing hemangioma,PSH)的多层螺旋CT(MSCT)征象,以提高对该病的诊断水平。方法回顾性分析9例经手术病理证实的PSH患者的MSCT征象。结果 9例患者中,7例为单发病灶,2例为多发病灶。病灶大小为1.2 cm×1.3 cm～6.5 cm×6.2 cm;CT平扫均表现为"圆"形或"卵圆"形软组织结节或肿块;2例可见突入支气管内生长,2例呈"分叶征",2例可见钙化,1例示"晕征",1例示"空气半月征";增强扫描病灶明显持续性强化,部分呈"花斑"样。5例示"贴边血管征"。结论边界清晰、光滑,密度均匀、明显持续性强化为PSH的主要表现,综合分析其他征象更有利于提高其诊断准确率。     

The diagnostic value of a non-contrast computed tomography scan-based radiomics model for acute aortic dissection

To investigate the diagnostic value of a computed tomography (CT) scan-based radiomics model for acute aortic dissection.For the dissection group, we retrospectively selected 50 patients clinically diagnosed with acute aortic dissection between October 2018 and November 2019, for whom non-contrast CT and CT angiography images were available. Fifty individuals with available non-contrast CT and CT angiography images for other causes were selected for inclusion in the non-dissection group. Based on the aortic dissection locations on the CT angiography images, we marked the corresponding regions-of-interest on the non-contrast CT images of both groups. We collected 1203 characteristic parameters from these regions by extracting radiomics features. Subsequently, we used a random number table to include 70 individuals in the training group and 30 in the validation group. Finally, we used the Lasso regression for dimension reduction and predictive model construction. The diagnostic performance of the model was evaluated by a receiver operating characteristic (ROC) curve.Fourteen characteristic parameters with non-zero coefficients were selected after dimension reduction. The accuracy, sensitivity, specificity, and area under the ROC curve of the prediction model for the training group were 94.3% (66/70), 91.2% (31/34), 97.2% (35/36), and 0.988 (95% confidence interval [CI]: 0.970–0.998), respectively. The respective values for the validation group were 90.0% (27/30), 94.1% (16/17), 84.6% (11/13), and 0.952 (95% CI: 0.883–0.986).Our non-contrast CT scan-based radiomics model accurately facilitated acute aortic dissection diagnosis.     

网络环境下的影像学启发式实践教学研究

目的　探讨网络环境下医学影像学启发式实践教学模式及其教学实效。方法　以进入影像科接受实践教学轮训的临床研究生及培训医师共70人为研究对象,随机分配至对照组（３８人）、实验组（３２人）,均在PACS网络环境下进行影像学实践教学,实验组再由课题组专人进行启发式教学培训。通过理论考试、读片实践考试及教学前后的问卷调查,评估两组的实践教学效果。利用Excel数据表格的统计功能进行数据处理,并用SPSS 17.0软件进行统计学分析,成绩对照分析采用t检验。结果　实验组的考试成绩[理论、实践成绩分别为（59.87±13.79）分和（65.46±16.81）分]比对照组的考试成绩[理论、实践成绩分别为（47.26±13.43）分和（53.68±14.96）分]好,差异具有统计学意义（t值分别为3.863 6、3.101 7,P值分别为0.000 3、0.002 8）。实验组对教学方式的认同度较对照组高,其在影像科参加实践教学的总体看法“很好”的占42.31%（11/26）,对照组为23.08%（6/26）;实验组表示能“熟练应用PACS”的占26.92%（7/26）,对照组为7.69%（2/26）。结论　PACS网络环境下的影像学启发式实践教学模式具有较好的教学效果,值得进一步研究。     

体素内不相干运动扩散加权成像定量参数对前列腺癌的诊断及鉴别价值及其与PSA的相关性

目的:研究体素内不相干运动扩散加权成像(IVIM-DWI)定量参数对前列腺癌的诊断及鉴别价值,并探讨与PSA值间的相关性.方法:回顾分析病理证实的30例前列腺癌及30例前列腺增生患者磁共振资料.所有患者均行常规MRI和IVIM-DWI检查,IVIM-DWI采用10个b值(10、20、30、50、80、100、200、400、1 000、1 500 s/mm2),将不同b值DWI数据传入后处理工作站,通过双指数模型拟合算法计算出病变区纯水分子扩散系数D值及灌注分数f值.记录所有患者的PSA值.比较前列腺癌和前列腺增生组间D、f值及PSA值之间的差异,并分析各参数之间的相关性.结果:前列腺癌组的D值明显低于前列腺增生组,f值及PSA值明显高于前列腺增生组,差异均有统计学意义(P<0.01).D值和f值、D值和PSA值呈负相关,f值和PSA值呈正相关,其相关性均有统计学意义(P<0.05).结论:IVIM-DWI定量参数对前列腺癌的诊断及其与前列腺增生的鉴别具有较高的价值;D值与PSA值呈负相关,f值与PSA值呈正相关,三者结合可为前列腺癌的诊断及恶性程度评估提供一定参考信息.     

甘孜州藏族与彝族结膜囊细菌状况对照研究

目的:了解藏族与彝族中老年人结膜囊细菌状况的异同。方法:研究遵循统一的调查流程及方法。由经过培训的眼科医师整群抽取四川甘孜州两个藏族聚居点的中老年人145例290眼及居住地地域近似的2个彝族聚居地136例272眼进行眼科检查、问卷调查并睑结膜囊分泌物接种于血琼脂培养基上,培养48h后进行细菌分离鉴定,并对两组受检人群的结果进行比较。结果:藏族和彝族受检者的人口基线特征比较差异无统计学意义(P>0.05)。藏族中老年人结膜囊细菌培养阳性率为50.7%,彝族为69.9%,差异有统计学意义(P<0.05)。藏族结膜囊多种细菌共存者占11.6%,彝族为2.6%;藏族人群中多种细菌共存的构成比明显高于彝族(P<0.05)。藏族结膜囊中棒状杆菌培养的阳性率为15.9%,彝族的为22.4%,差异有统计学意义(P<0.05);藏族结膜囊中表皮葡萄球菌培养的阳性率为26.6%,彝族人群为26.1%,差异无统计学意义(P>0.05)。结论:藏族中老年人结膜囊细菌培养阳性率低于彝族,藏族和彝族中老年人结膜囊的细菌大多为单一菌株,但藏族人多种菌株共存的现象比彝族更为多见。藏族人与彝族人结膜囊细菌菌属有一定的区别。     

Comparison on conjunctival sac bacterial flora of the seniors with dry eye in Ganzi autonomous prefecture

AIM: To compare the bacterial flora in palpebral conjunctiva of xerophthalmia seniors of Tibetan, Yi and Han, and analyze the differences and similarities of the bacteria.METHODS:The test subjects were selected from 2 Tibetan, 2 Yi and 3 Han populated places, respectively. Total 222 seniors (444 eyes) with dry eye were examined. Secretion was collected from the palpebral conjunctiva of the subjects and then inoculated onto a blood agar plate. After 48h of incubation, the bacteria were examined for the differences and similarities between different ethnics.RESULTS: There was no significant difference (P>0.05) of Gram stain characterization, dominant bacteria and number of the bacterial species present in oxrophthalmia patients among Tibetan, Yi and Han nationalities. The bacteria presented in all groups include staphylococcus epidermidis, corynebacterium, micrococcus luteu, intracellular bacteria sphingomonas, pseudomonas aeruginosa. The bacteria detected from the two of three ethnic groups were staphylococcus aureus, staphylococcus haemolyticus, escherichia coli, kytococcus sedentarius, streptococcus angina, micrococcus lylae, and staphylococcus heads. The incidence rate of bacteria-associated dry eye in Tibetan population was significantly lower than that of Han and Yi population.CONCLUSION:There is no significant difference in the bacteria flora of palpebral conjunctiva observed among dry eye elder populations of Tibetan, Yi and Han people. All of staphylococcus epidermidis, corynebacterium, micrococcus luteu, intracellular bacteria sphingomonas, pseudomonas aeruginosa, staphylococcus aureus, staphylococcus haemolyticus, escherichia coli, kytococcus sedentarius, streptococcus angina, micrococcus lylae and staphylococcus heads are common bacteria flora of the three nationalities inhibiting in this area.     

聚乙二醇-达沙替尼结合物的合成及初步药效研究

目的 合成2种聚乙二醇-达沙替尼结合物（JK120303和JK120304）,并评价结合物JK120303和JK120304在K562人慢性髓系白血病皮下瘤模型中的抗肿瘤作用。方法 将达沙替尼用缬氨酸衍生后分别和mPEG-二肽酸和4arm-PEG-乙酸反应得到聚乙二醇-达沙替尼结合物,于NOD/SCID小鼠右侧背部皮下接种K562细胞,建立人慢性髓系白血病异种移植动物皮下模型,根据相对肿瘤增殖率进行疗效评价。结果 合成得到2个聚乙二醇-达沙替尼结合物。结合物JK120303（2.5 mg·kg^-1和5 mg·kg^-1）的药效优于达沙替尼（5 mg·kg^-1）,结合物JK120304（2.5 mg·kg^-1和5 mg·kg^-1）的药效与达沙替尼（5 mg·kg^-1）相当。结论 聚乙二醇-达沙替尼结合物JK120303药效优于达沙替尼,值得进一步研究。     

原发性结外淋巴瘤的影像诊断及共性特征分析

目的:探讨原发性结外淋巴瘤（primary extranodal lymphoma,PENL）的共性影像学特征,提高其诊断水平。方法:回顾性分析经病理证实的38例PENL患者的CT及MRI影像资料。结果:38例PENL病例中,发生于头颈部13例,胃肠道10例,骨骼7例,胸部5例,泌尿系3例。20例行CT检查,11例行MRI检查,7例同时行CT和MRI检查。27例CT影像中17例（63%）肿瘤发病部位固有解剖结构存留,21例（78%）肿瘤密度及强化均匀,22例（81%）增强呈轻-中度强化。18例MRI影像中11例（61%）发病部位固有解剖结构存留,13例（72%）肿瘤信号及强化均匀,12例（67%）增强呈轻-中度强化,10例（56%）肿瘤T2WI信号呈等或稍低信号,8例行DWI检查均表现为弥散受限高信号。38例PENL病例中,10例CT或MRI影像可见自相矛盾现象,5例可见“血管漂浮征”,2例见“骨皮质开窗征”。结论:原发性结外淋巴瘤的CT及MRI表现具有一定的共性特征,这些特征有助于提高诊断准确性及鉴别诊断。     

甘孜州汉族中老年人结膜囊细菌状况调查

目的:了解藏区汉族中老年人结膜囊细菌状况。方法:对甘孜州康定县姑咱镇、炉城镇,九龙县呷尔镇的汉族中老年人群173例346眼刮取下睑结膜囊分泌物,接种于血平板,培养48h后进行细菌分离鉴定。结果:选取346眼中结膜囊细菌培养阳性209眼,培养阳性率60.4%。培养出菌株232株,其中表皮葡萄球菌115(49.6%);棒状杆菌60株(25.9%)。康定县姑咱镇、炉城镇的汉族中老年人结膜囊细菌阳性率分别为69.2%和65.8%,差异无统计学意义(χ2=0.1709,P>0.05)。九龙县呷尔镇中老年人结膜囊细菌阳性率为44.3%,分别低于康定姑咱镇、炉城镇的中老年人结膜囊细菌阳性率,差异有统计学意义(姑咱镇vs呷尔镇:χ2=13.2002,P<0.05;炉城镇vs呷尔镇:χ2=9.6869,P<0.05)。结论:甘孜州多数汉族中老年人结膜囊存在细菌;绝大多数细菌为革兰氏阳性菌;表皮葡萄球菌、棒状杆菌是其结膜囊的优势菌种。区域不同,结膜囊细菌阳性率不同。