原发性肝癌的CT灌注成像

目的研究原发性肝癌CT灌注参数的改变和临床价值。方法本组78例行肝血流的CT灌注扫描,其中原发性肝癌组70例、正常组8例。应用去卷积算法模式计算相应病变区域的血流量(BF)、血容量(BV)、平均通过时间(MTT)、毛细血管通透性(PS)、肝动脉指数(HAF),来评价肝癌的血流动力学状态。结果70例原发性肝癌患者HAF、BF明显高于正常组织,而MTT明显降低;BV和PS值与正常组织无显著差异。结论肝癌CT灌注参数(HAF、BF和MTT)可有效的评价原发性肝癌的血流状态,具有重要的临床应用价值。     

基于改良德尔菲法对乳腺癌“分期辨证”方案的调查分析

目的:通过德尔菲法研究乳腺癌"分期辨证"合理性,为制定中医乳腺癌治疗规范奠定基础.方法:在充分的文献调研基础上,由课题专家组进行讨论确立咨询表,对全国中医、中西医结合乳腺病专家进行咨询调查,根据专家对咨询主题认可频数(>80.00%)判别主题设立的合理性.结果:第1轮专家对分期辨证的方案认为合理的为96.88%、第2轮为97.26%;第1轮调查咨询结果中,"围手术期"中的冲任失调证、正虚毒炽证、有病无证型以及"围放疗期"的阴虚火毒证和"巩固期"的冲任失调证均未超过预设的合理性判别标准(<80.00%),第2轮调查结果中,上述证型设立的合理性的频数均超过80.00%,但"巩固期"中有病无证型认可频数为8.22%.结论:中医药参与乳腺癌治疗应该"分期辩证"治疗,巩固期中不应设立"有病无证"型.     

PDCA循环在药物常识课程教学管理中的应用

在药物常识课程教学管理中引入PDCA循环管理方法,并根据教学规律将plan（计划）-do（执行）-check（检查）-action（处理）四个过程改良为prepair（准备）-do（执行）-check（检查）--assemble（总结）,促使课程教学管理更加规范与科学,促进了教员专业化发展,提高了人才培养质量。     

多发复发及恶性嗜铬细胞瘤

目的：探讨多发复发及感性嗜铬细胞瘤的特点，提高诊疗效果。方法：回顾性分析23例多发、复发及恶性嗜铬细胞瘤资料。结果：23例多发、复发及恶性嗜铬细胞瘤占同期嗜铬细胞瘤的18．4％(23／125)。多发性嗜铬细胞瘤11例，其中位于肾上腺6例，腹后壁5例，6例为单发嗜铬细胞瘤筋后单发肾上腺或腹后壁肿瘤。恶性嗜铬细胞瘤6例。结论：多发、复发嗜铬组织肿瘤存在同时多发和异时复发的可能，为良性肿瘤，而非嗜铬组织的多发、复发则为恶性嗜铬细胞瘤。     

小体积精原细胞瘤15例临床分析

对于睾丸肿瘤来讲,无论是TNM分期,还是英国皇家Marsden医院的分期都没有将肿瘤的大小列入分期标准,但仍有一些研究表明肿瘤大小与复发和预后紧密相关.Von der Maase等[1]认为＜3 cm的肿瘤术后4年复发率为6%.我们将＜3 cm的精原细胞瘤称为小体积精原细胞瘤,小体积精原细胞瘤并不等同于早期肿瘤,本文回顾分析了15例患者临床资料,总结其发病特点和治疗经验.     

Three-dimensional finite element analysis of the stress of the patellofemoral joint after medial patellofemoral ligament reconstruction by different femoral reconstruction insertion points北大核心

BACKGROUND: There are many ways to reconstruct the patellofemoral ligament. Among them, the lateral insertion of the femur has a greater influence. At present, there are many ways to select femoral insertion points, but there are no conclusions. OBJECTIVE: Through the analysis of three-dimensional finite element software, the change of femoral reconstruction insertion position of medial patellofemoral ligament under different flexion states can analyze the stress of the patellofemoral joint to select a suitable femoral reconstruction insertion. METHODS: CT data of normal knee joints of adults were obtained to import Mimics, Geomagic and Soildworks software to extract molds and add ligaments. The femoral insertion points of the ligament were the midpoint between the medial epicondyle and the adductor tubercle, the medial epicondyle, the adductor tubercle, the projection point from the top of the femoral intercondylar fossa to the medial condyle and 10 mm below the adductor tubercle. The mold added with ligament was imported into the mechanical software Ansys to analyze the stress of patellofemoral joint after reconstruction of different femoral insertion points using finite element analysis. RESULTS AND CONCLUSION: (1) When the knee flexion was 0° and 30°, the stress of patellofemoral joint at any femoral insertion point of reconstructed medial patellofemoral ligament was greater than that at other angles (60°, 90°, and 120°). No matter which position was used as the femoral insertion point, when the knee joint was flexed more than 30°, there was basically no difference in the contact stress between the patellofemoral joints. (2) At 0° and 30° of knee flexion, the patellofemoral contact pressure was the largest at the point of the adductor tubercle, and the contact force at the midpoint between the medial epicondyle and the adductor tubercle was the smallest. When the knee was flexed 30°, the midpoint between the medial epicondyle and the adductor tubercle, the projection point from the top of the femoral intercondylar fossa to the medial condyle, and 10 mm below the adductor tubercle as the insertion point showed no significant difference in the contact stress. (3) Results indicate that when reconstructing medial patellofemoral ligament, the best choice of femoral lateral insertion point is the midpoint between the medial epicondyle and the adductor tubercle. This point can effectively restore the stability of knee joint and delay the degeneration of joint and cartilage. © 2023, Publishing House of Chinese Journal of Tissue Engineering Research. All rights reserved.     

内侧副韧带不同程度损伤时膝关节的应力变化

背景:膝关节内侧副韧带损伤易导致继发性的半月板及软骨损伤,长期慢性损害会引起骨关节炎的发生。目前,关于内侧副韧带断裂所致半月板及关节软骨损伤的力学研究较少。目的:探讨膝关节内侧副韧带不同程度损伤对膝关节半月板及软骨生物力学的影响。方法:选择一名健康志愿者行膝关节CT和MRI检查,获取其影像资料,将扫描数据依次导入Mimics、Geomagic及Solidworks软件,经配准融合后建立正常膝关节三维模型,并在此基础上模拟出膝关节内侧副韧带不同程度损伤的模型,共分为4组,包括:①内侧副韧带完整;②内侧副韧带深层断裂;③内侧副韧带浅层断裂;④内侧副韧带完全断裂。最后导入Ansys软件,对膝关节施加3种模式载荷:①股骨顶端施加10 N·m外翻力矩;②股骨顶端施加4 N·m内旋力矩;③股骨顶端施加4 N·m外旋力矩。分析4组模型在不同载荷下对膝关节生物力学的影响。结果与结论:①在膝关节伸直位,对膝关节施加10N·m外翻力矩时,内侧副韧带不同程度损伤后外侧半月板总体应力均增加,关节软骨应力变化不明显,并且当内侧副韧带浅层出现断裂后外侧半月板应力峰值明显增大;②在膝关节伸直位,对膝关节施加4 N·m内旋力矩时,内侧副韧带不同程度损伤后内外侧半月板总体应力均增加,当内侧副韧带浅层出现断裂时半月板应力峰值从内侧半月板前角转移至外侧半月板前角;③在膝关节伸直位,对膝关节施加4 N·m外旋力矩,内侧副韧带不同程度损伤后外侧半月板应力峰值较内侧半月板增加更明显,关节软骨应力变化较小;④结果表明,膝关节处于伸直状态下,膝关节内侧副韧带浅层断裂继发半月板损伤的风险远大于内侧副韧带深层断裂,而外侧半月板较内侧半月板更易受到损伤;内侧副韧带浅层和深层对膝关节的旋转稳定性均有重要作用。     

天津市和平区354名老年人生活质量调查分析

目的 了解老年人的生存质量。方法 以健康状况调查问卷SF—36对天津市和平区新兴街354名印岁以上的老人进行调查。结果 天津市新兴街老年人的生活质量水平较高，但经济状况和慢性疾病是影响老年人生活质量的两个重要因素。结论 改善老年人的经济状况，预防和延缓老年性疾病的发生是提高老年人生活质量的重要措施。     

托伐普坦固体分散体的制备及体外溶出特性考察

目的 采用固体分散技术提高难溶性药物托伐普坦的体外溶出度。方法 选用聚维酮K_29/32为载体材料,以溶剂蒸发法制备托伐普坦固体分散体。采用差示扫描量热法(DSC)、X-射线粉末衍射法(XRPD)对所得固体分散体进行鉴定, 并进行溶解度、体外溶出实验。结果 固体分散体的DSC 图谱及X-射线粉末衍射确定了托伐普坦以无定形态分散在载体中, 体外溶解实验表明其溶出较原料药、物理混合物均有明显提高。结论 将托伐普坦与PVP K_29/32制成固体分散体,其分散状态发生了改变,溶出性能明显提高。