三阴性与非三阴性乳腺癌的X线特征探讨

目的与非三阴性乳腺癌(non-TNBC)比较,探讨三阴性乳腺癌(TNBC)的乳腺X线特征。方法根据ER、PR、HER2表达情况,将737个乳腺癌肿块分成TNBC组(n=112)和non-TNBC组(n=625),回顾性分析两组患者的X线图像及临床病理资料。结果 TNBC肿瘤组织学分级高,腋窝淋巴结转移率高于non-TNBC组(P0.05)。在钼靶X线中,TNBC主要表现肿块(69.7%),很少表现为肿块伴钙化(16.5%)、局限性非对称致密(4.6%)、单纯钙化(2.8%)和结构扭曲(6.4%);肿块形状多为圆形(30.9%)或椭圆形(38.3%),很少表现为不规则形(11.7%);肿块边缘多为清晰边缘(30.9%),毛刺肿块少见(19.1%)。non-TNBC通常表现为肿块伴钙化(43.5%),钙化多见(58.8%);肿块形态主要为分叶形(40.4%)和不规则形(28.9%),毛刺征多见(43.6%)。结论 TNBC有其独特的影像表现,更倾向于良性肿瘤的特点,了解其X线特征有助于提高TNBC的诊断水平。     

婴儿体位性扁头综合征的研究进展

<正>扁头综合征 (flat head syndrome) 是指婴儿头骨发生不同程度的扁平畸形,多由产前或者产后的机械变形力作用于婴儿的枕骨所导致的颅骨不对称以及由此带来的婴儿机能损伤。这是特指新生儿时期形成的颅骨非骨性链接的头部发育畸形的分型,与颅缝早闭引发的头部畸形相区分。按照有无骨缝闭合可分为骨缝闭合性扁头综合征 (synostotic plagiocephaly,SP)和非骨缝闭合性扁头综合征(non-synostotic plagi     

口服氟康唑在预防早产儿深静脉置管时真菌感染中的临床意义

Objective With the widespread application of peripherally inserted central catheters (PICC) in neonatal intensive care unit (NICU), the incidence of invasive fungal infections increased significantly than ever. The present study aimed to explore the clinical significance of oral fluconazole in premature infants with gestational age ≤ 32 weeks and/or birth weight ≤ 1500 grams who had catheter insertions. Method This study enrolled 118 infants admitted between January 2006 and December 2007 who did not receive fluconazole prophylaxis (control group) and 106 infants admitted between January 2008 and June 2009 who received oral fluconazole prophylaxis (prophylaxis group). Statistical analyses were performed by using SPSS 11.5 software. The clinical characteristics and the risk factors for invasive fungal infection between the two groups were compared. Liver functions ( alanine transaminase, ALT and direct bilirubin) were monitored to evaluate the safety of fluconazole prophylaxis. Result Except for the proportion of infants bom via vaginal delivery in the control group (56/118, 47. 5% ) was significantly lower than that in prophylaxis group (69/106, 65.1%, P = 0.007), there were no significant significant differences in the demographics and other baseline clinical characteristics between the two groups. There were no significant differences in the risk factors for invasive fungal infection between the two groups either.Nine infants developed invasive fungal infection in control group (7. 6% ), while no invasive fungal infection was found in prophylaxis group (0%, P=0.01 ). Compared to infants in control group, those in prophylaxis group showed no significant changes in alanine transaminase ALT and direct bilirubin levels at 2 weeks and 4 weeks after fluconazole prophylaxis: the incidences of abnormal ALT and direct bilirubin levels were 8. 5%(10/118) and6.8% (8/118) in control group compared to 11.3% (12/106) and 8.5% (9/106) in prophylaxis group after 2 weeks ( P = 0. 47 and 0. 63 ); the incidences of abnormal ALT and direct bilirubin levels were 3.4% (4/118) and 3.4% (4/118) in control group compared to 5.7% (6/106) and 8.5%(9/106) in prophylaxis group after 4 weeks (P = 0. 62 and 0. 15). Conclusion For infants with PICC insertions and gestational ages at birth ≤32 weeks and/or low birth weight ≤ 1500 grams, oral fluconazole is effective to prevent invasive fungal infection. Oral fluconazole in premature infants neither affected the liver function, nor increased the incidence of cholestasis.     

高频通气结合一氧化氮吸入治疗新生儿胎粪吸入综合征伴肺动脉高压的护理

总结 6例新生儿胎粪吸入综合征伴肺动脉高压的患儿高频通气结合一氧化氮吸入治疗时的护理方法。提出入科时关键的是第一步是正确地清理气道 ;高频通气结合一氧化氮吸入治疗时要监测心血管功能和一氧化氮毒副作用 ;进行严格的气道管理 ,遵循科学的吸痰原则 ;掌握静注药物的注意事项和严格无菌操作。认为生命体征及血氧饱和度的监护应贯穿始终 ,重点是正确的气道管理和维持心血管功能的稳定。     

极低出生体质量儿经鼻无创高频震荡通气鼻损伤的原因分析及预防护理

回顾性分析20例极低出生体质量儿经鼻无创高频振荡通气临床资料,分析鼻损伤的原因,并提出预防护理措施。鼻损伤的主要原因是极低出生体质量儿鼻部发育不成熟、为保证足够的通气压力而施压、管道重力牵拉等。干预措施是使用立体鼻贴进行局部保护,利用面部三角形受力点的原则固定鼻部连接装置,正确选择鼻塞(罩)和头帽,倡导阶梯卧位进行体位管理,治疗期间动态评估鼻部皮肤,鼻损伤发生时及时移除压力源。20例患儿中发生鼻部皮肤损伤10例、鼻孔增大2例、鼻中隔偏移1例,7例患儿治疗期间未发生鼻部皮肤并发症。     

胺碘酮致Ⅲ度房室传导阻滞1例

患者，男，71岁。因阵发性心房颤动转复后予胺碘酮（杭州产）口服，半年后渐减量至每天1次，每次200mg，维持治疗。半年后再次出现快速心房颤动，追加胺碘酮200mg，每日3次，连服9d后出现心悸、胸闷、头晕，立即作心电图。心电图示：（1）异位心律，平均室律39次／min；（2）电轴不偏；（3）心房颤动伴Ⅲ度房室传导阻滞。考虑为胺碘酮致严重不良反应。[第一段]     

新生儿安宁疗护服务体系的构建

目的 构建新生儿安宁疗护服务体系,以指导临床实践。方法 以人性化护理理论、舒适护理理论为基础,在文献回顾、质性研究的基础上拟订新生儿安宁疗护服务体系。2020年9月—11月,对来自7个省（市）的25名专家进行2轮专家函询,确定具体内容。结果 2轮函询的有效问卷回收率均为100%,专家的权威系数为0.852,肯德尔和谐系数分别为0.124~0.212、0.111~0.204（均P<0.001）,条目重要性评分的变异系数分别为0~0.34、0.07~0.24,可行性评分的变异系数分别为0~0.39、0.08~0.24。形成的新生儿安宁疗护服务体系包括组建安宁疗护团队以及安宁疗护的介入时机、服务对象、服务内容4个一级条目,12个二级条目,38个三级条目。结论 新生儿安宁疗护服务体系具有较好的科学性、可行性,可为临床护理实践提供参考。     

学习ICD-10的体会

新版国际疾病分类ＩＣＤ－１０是一个概括死亡和疾病统计需要的核心。它解决了ＩＣＤ－９中存在的问题，补充了各系统的内容，使ＩＣＤ更加完善，更符合流行病学和统计学的要求，使用起来更加方便。所以，我们应在熟练掌握ＩＣＤ－９的基础上，着手ＩＣＤ－１０的学习，使我国能尽早赶上国际水平     

祛痰止咳合剂的薄层色谱鉴别研究

目的：探讨祛痰止咳合剂的质量控制方法。方法：采用薄层色谱（TLC）法对祛痰止咳合剂处方中的主要成分黄芩、甘草、陈皮药材进行定性鉴别。结果：黄芩、甘草、陈皮药材的特征斑点清晰，分离度良好，阴性液无干扰。结论：用薄层色谱法能有效地对祛痰止咳合荆进行定性鉴别。     

鱼腥草中黄酮类成分的有效提取

目的研究鱼腥草中黄酮类成分的有效提取方法。方法采用改良流体萃取法提取鱼腥草中黄酮类化合物,优选最佳提取工艺,并进行含量测定。结果乙醇浓度50%,乙醇溶液流量1.8ml/分钟,温度70℃。萃取时间为27分钟,萃取率为3.15%,总黄酮含量为24.0%,其中芦丁、金丝桃苷、槲皮苷、槲皮素的萃取率分别为0.35%mg/g,1.52%mg/g,1.70%mg/g,0.50mg/g。结论鱼腥草中黄酮类成分的改良流体萃取法效果明显,值得推广。