B超联合血清CA125检测在子宫腺肌病诊断中的价值

目的 探讨B超联合血清体腔上皮细胞表面抗原(CA125)检测诊断子宫腺肌病的价值.方法 对术后病理证实的51例子宫腺肌病及93例子宫肌瘤病人术前B超及血清CA125的情况进行回顾分析.结果 子宫腺肌病B超诊断率达80.4%,血清CA125(96.32±79.62)U/ml,子宫肌瘤组CA125(17.87+26.21)U/ml,两组比较,差异有非常显著性(P＜0.01),B超联合血清CA125子宫腺肌病诊断率达94.1%.结论 B超联合血清CA125可提高子宫腺肌病的诊断率,降低误诊率.     

B超检查及血清CA_(125)测定诊断子宫腺肌病的临床分析

目的:探讨超声检查及血清CA125测定对子宫腺肌病的诊断价值。方法:对比分析62例子宫腺肌病患者和65例子宫肌瘤患者的临床资料。结果:两组发病年龄及临床症状相近,但子宫腺肌病的临床表现以痛经为特点,P<0.01;两组B超有特征性改变,符合率分别为62.90%、95.38%,有显著差异,P<0.01;血清CA125水平子宫腺肌病组明显升高,其阳性率为82.26%,明显高于子宫肌瘤组,P<0.01。结论:鉴别子宫腺肌病和子宫肌瘤可依据血清CA125值测定、临床表现及B超检查,综合分析能提高诊断的准确率。     

血清CA125及EMAb测定对子宫腺肌病的诊治价值

目的探讨血清CA125及EMAb测定对子宫腺肌病诊断及疗效评估的临床价值。方法经术后病理确诊子宫腺肌病患者62例和子宫肌瘤患者44例,均于术前及术后测定两组血清CA125水平和NEMAb。结果子宫腺肌病组术前血清CA125平均水平及EMAb阳性率均高于子宫肌瘤组,差异有统计学意义（P〈0．001及0．01）。联合测定血清CA125水平和EMAb,以两者均阳性为诊断标准,诊断子宫腺肌病的敏感性为54．71％,特异性为100％。子宫腺肌病组术后血清CA125水平和EMAb阳性率均较术前下降,差异有统计学意义（P〈0．01及0．05）。结论测定血清CA125及EMAb对子宫腺肌病有较好的辅助诊断价值,联合检测更能提高诊断的正确性,并可作为评价子宫腺肌病疗效的敏感指标。     

CA125及CA19-9在子宫腺肌病患者血清中的检测及意义

目的探讨子宫腺肌病患者血清中CA125及CA19-9的检测及意义.方法采用免疫放射法测定子宫腺肌病患者49例、子宫肌瘤患者32例血清中CA125、CA19-9水平.结果子宫腺肌病组CA125值显著高于子宫肌瘤组,P＜0.01.CA125在子宫腺肌病组中阳性率为79.59%,其敏感性、特异性、阳性预测值、阴性预测值分别为76.5%、93.4%、92.1%、78.3%,CA19-9值与子宫肌瘤组差异无显著性.结论子宫腺肌病血清中CA125升高,对子宫腺肌病有较好的诊断预测价值.     

血清CA125、EMAb联合测定诊断子宫腺肌病的临床价值

目的:探讨血清CA125、EMAb联合测定诊断子宫腺肌病的临床价值。方法:经术后病理学检查确诊子宫腺肌病患者179例和子宫肌瘤患者129例,均手术前测定血清CA125水平和EMAb。结果;子宫腺肌病组血清CA125平均水平及EM-Ab阳性率均高于子宫肌瘤组,两组相比有显著差异性(P<0.001)及(P<0.01)。联合测定血清CA125水平和EMAb,以两项均阳性为诊断标准,诊断子宫腺肌病的敏感性为51.04%,特异性为100%。结论:测定血清CA125及EMAb对子宫腺肌病有明显的辅助诊断价值,联合测定有助于子宫肌瘤的鉴别,进一步提高诊断的正确性。     

血清CA125在子宫内膜异位症和子宫腺肌病中的临床应用价值探讨

目的:探讨血清CA125在子宫内膜异位症和子宫腺肌病中的临床应用价值。方法:用化学发光免疫法测定336例患者的血清CA125水平,分为两组,病例组包括子宫内膜异位症98例,子宫腺肌病58例;对照组包括子宫肌瘤60例,卵巢良性肿瘤70例,正常育龄女性50例。对子宫内膜异位症患者分期测定血清CA125水平,复测手术后子宫内膜异位症及子宫腺肌病患者血清CA125水平并对其手术标本进行病理免疫组化CA125标记。结果:病例组血清CA125水平较对照组显著增高,差异均有统计学意义(P<0.01),子宫内膜异位症分Ⅰ、Ⅱ期组与Ⅲ、Ⅳ期组比较,差异有统计学意义(P<0.05),手术后子宫内膜异位症、子宫腺肌病患者血清CA125水平均明显下降,差异有统计学意义(P<0.01),子宫内膜异位症、子宫腺肌病患者手术后标本均行免疫组化CA125标记,术前化验检查血清CA125增高者,其手术后病理标本免疫组化CA125标记亦为阳性。结论:结合患者体征及影像学检查,血清CA125可作为子宫内膜异位症和卵巢良性肿瘤、子宫腺肌病和子宫肌瘤鉴别诊断以及疗效评价的指标。     

妊娠合并子宫腺肌病38例病例分析

目的探讨妊娠合并子宫腺肌病患者的临床表现、血清CA125值及B超检查的特点，提高诊断率。方法对比分析38例妊娠合并子宫腺肌病和40例妊娠合并子宫肌瘤的临床表现、血清CA125值及B超资料。结果两组有相似的临床表现，但妊娠合并子宫腺肌病以痛经，流产后下腹剧痛，宫体压痛为特点（P〈0．01），两组B超检查均有特征性改变，B超诊断符合率分别为65．79％及95％，有显著差异（P〈0．01）；妊娠合并子宫腺肌病组血清CA125水平明显升高，其阳性率为78．94％，明显高于子宫肌瘤组（P〈0．01）。结论诊断妊娠合并子宫腺肌病可依据临床表现、血清CA125值测定及B超检查，综合分析能提高诊断的准确率。     

经阴道彩色多普勒超声及血清CA125测定鉴别子宫腺肌瘤和子宫肌瘤

目的:研究阴道彩色多普勒超声(TVCDS)及血清CA125对子宫腺肌瘤和子宫肌瘤的鉴别诊断价值。方法:对经病理证实的60例子宫腺肌瘤及150例子宫肌瘤患者术前TVCDS及血清CA125的情况进行比较分析。结果:TVCDS特征:瘤体边界,宫壁积血小囊以及瘤体血流可帮助鉴别。诊断子宫腺肌瘤符合率90%,诊断子宫肌瘤符合率86%。子宫腺肌瘤血清阳性87%,子宫肌瘤血清阳性3.3%。结论:TVCDS及血清CA125结合诊断和鉴别子宫腺肌瘤及子宫肌瘤具有重要价值。     

血清CA125、EMAb联合检测对子宫腺肌病诊断价值的ROC曲线评价

目的采用ROC曲线评价血清CA125、EMAb联合检测对子宫腺肌病的诊断价值。方法选取2014年11月-2015年10月该院确诊的子宫腺肌病患者48例为观察组,另选同期拟于该院体检的健康女性45例为对照组。采用酶联免疫吸附法(ELISA)检测两组血清中EMAb水平,采用放射免疫法(RIA)测定两组血清中的CA125水平。比较两组血清CA125、EMAb水平,同时采用Roc曲线分析血清CA125、EMAb单独及联合检测对子宫腺肌病的诊断价值。结果观察组的EMAb水平和CA125水平明显高于对照组,差异有统计学意义(P0.05)。ROC曲线分析结果显示,血清CA125、EMAb联合预测子宫腺肌病的ROC曲线下面积、灵敏度、特异度分别为0.937、95.92%和97.73%,血清CA125、EMAb单独预测子宫腺肌病的ROC曲线下面积分别为0.832和0.797,灵敏度分别为93.75%和91.30%,特异度分别为93.33%和87.23%,二者联合检测的ROC曲线下面积、灵敏度和特异度明显较高(P0.05)。结论血清CA125、EMAb水平检测对子宫腺肌病的辅助诊断价值良好,二者联合检测有利于提高诊断子宫腺肌病的准确性,血清CA125、EMAb水平可作为诊断子宫腺肌病的参考指标。     

240例子宫内膜异位症与子宫腺肌病患者血清CA125的诊断价值观察

目的：分析CA125对于子宫内膜异位症与子宫腺肌病的诊断价值.方法：选取从2012年1月至2014年2月于我院经腹腔镜确诊的240例子宫内膜异位症及子宫腺肌病患者作为病例组,其中子宫内膜异位症患者113例,子宫腺肌病患者127例;另选取240例子宫肌瘤与其他正常体检患者作为对照组,其中子宫肌瘤者120例,正常体检患者120例,通过微粒子化学发光法检测两组病人的CA125水平,并将病例组中的患者在治疗期间的1个月、6个月的血清CA125进行检测,通过变化差异,分析血清CA125对于子宫内膜异位症及子宫腺肌病的诊断价值. 结果：病例组其血清CA125水平较对照组显著升高（p〈0.05）,而对照组中子宫肌瘤病例和正常人群的CA125水平无统计差异（p〉0.05）.病例组在治疗1个月与6个月后,血清CA125明显下降,并较治疗前差异显著（p〈0.05）,术后1个月CA125下降明显,阳性率也随之减少,但在术后第6月CA125水平有所回升,阳性指标也出现上升,术后随访中有5例病例复发,考虑CA125可作为复发显示指标.结论：血清CA125在子宫内膜异位与子宫腺肌病患者中升高明显,可作为诊断鉴别子宫肌瘤、正常人群与子宫内膜异位及子宫腺肌病的参考指标,诊断价值显著,值得推广.     

长春新碱过量引起严重毒副反应1例的护理体会

报道1例霍奇金淋巴瘤患者因误用长春新碱（VCR）10mg一次性静脉推注后治疗护理情况。其出现间断性神志恍惚、眼睑闭合不全、言语不清、口腔黏膜糜烂、全身疼痛、麻痹性肠梗阻、尿潴留、手足麻木等症状,经积极解救,禁食,持续胃肠减压、胃管内注入麻油、开塞露、生理盐水灌肠,合理应用肠外营养,注重疼痛、心理护理,做好口腔、肛周护理,预防感染加重,患者病情得到控制好转出院。     

Choice of measures of vaccination and estimates of risk of pediatric pertussis

BackgroundVaccination uptake at the individual level can be assessed in a variety of ways, including traditional measures of being up-to-date (UTD), measures of UTD that consider dose timing, like age-appropriate vaccination, and risk reduction from individual doses. This analysis compared methods of operationalizing vaccination uptake and corresponding risk of pertussis infection.MethodsCity-wide case-control study of children in Philadelphia aged 3 months through 6 years, between 2001 and 2013. Multiple logistic regression was used to isolate the independent effects of each measure of vaccination uptake and the corresponding relative odds of pertussis.ResultsBeing UTD on vaccinations was associated with a 52% reduction in risk of pertussis (OR 0.48, 95% CI: 0.34, 0.69). Evaluation of delayed receipt of vaccine versus on-time UTD yielded similar results. There was a decrease in risk of pertussis for each additional dose received with the greatest reduction in pertussis infection observed from the first (OR 0.48, 95% CI: 0.28, 0.83) and second dose (OR 0.17, 95% CI: 0.08, 0.34). Additional doses conferred minimal additional protection in this age group.ConclusionExamining vaccination status by individual doses may offer improved predictive capacity for identifying children at risk for pertussis infection compared to the traditional UTD measure.     

上海市某医院骨科平均住院日影响因素分析

对上海市某医院2003年-2007年骨科出院病人的住院日描述性分析．2003年-2007年骨科的床位利用指数与平均住院日相关性分析．2003年-2007年骨科床位与医护比例分析．2007年骨科前10大病种平均住院目影响因素分别进行单因素相关性分析和多因素逐步回归分析（STATA软件）。通过对骨科10大病种住院日影响因素分析,术前等待天数、手术类型、是否输血分别对10个、9个和8个病种的住院目有影响。输血因素和手术类型是医院不可控、由病人的病情决定的,术前等待天数是管理因素,是最值得医院重视的影响因素。     

Correlates of stages of change of smoking among inhabitants of deprived neighbourhoods

BACKGROUND: This study examines the prevalence and correlates of stages of change of smoking, in terms of psychosocial, structural and sociodemographic factors, among inhabitants of deprived neighbourhoods. METHODS: Cross-sectional data were obtained from a survey on health related behaviour. Subjects were 2009 current and former smokers, aged 20-46, living in deprived neighbourhoods in Rotterdam, the second largest city in the Netherlands. Three groups of smokers were formed according to the stages of change-definitions of the Transtheoretical Model: smokers not planning to quit (precontemplators), smokers planning to quit (contemplators/preparators) and former smokers (actors/maintainers). Smokers planning to quit and smokers not planning to quit were compared regarding psychosocial factors (attitude, social norm, self-efficacy), structural factors (neighbourhood problems, material deprivation, financial problems, employment status) and sociodemographic factors (age, gender, marital status, cultural background, educational level). Former smokers were compared with smokers planning to quit regarding structural and sociodemographic factors. Logistic regression was used to assess correlates of stages of change. RESULTS: Smokers planning to quit (prevalence = 19%) reported a more positive attitude, stronger social norms and higher self-efficacy expectations in quitting smoking than smokers not planning to quit (prevalence = 57%). Smokers planning to quit less often were Dutch-born, more often had attended higher vocational schooling or university and more often reported experiencing two or more neighbourhood problems compared to smokers not planning to quit. Former smokers (prevalence = 24%) were older, more often Dutch-born, married, employed and higher educated, compared to smokers planning to quit. Furthermore, former smokers less often reported material deprivation and financial problems than smokers planning to quit. CONCLUSION: Among people living in deprived neighbourhoods, different factors correlate with different stages of change of smoking. Implications for health promotion are discussed.     

尘肺病患者145例死因调查

目的分析汉中市尘肺病的发生、发展和死亡原因，以提高尘肺病患者的生存质量。方法对145例尘肺病患者的死因进行回顾性分析，计算其平均发病年龄、死亡年龄及患尘肺病后的存活年限。结果矽肺的平均发病年龄和死亡年龄均早于煤工尘肺和石棉肺，尘肺病的主要死因为患肺部疾患，患尘肺病后的平均存活年限为12a。结论加强职业健康体检工作，对尘肺病人做到早发现早治疗和预防并发症的发生。     

西林瓶装注射用水的装量检查分析

为了检查西林瓶装注射用水的实际分装量是否符合2005年版《药典》三部要求,按照2005年版《药典》三部中“生物制品分装和冻干规程”,分装规格为0．8ml的西林瓶装注射用水10000瓶,随机在分装过程的前、中、后阶段共抽取100瓶,轧盖、目检。分别用1ml标定注射器及1ml普通无菌注射器抽取每瓶注射用水的实际体积,以t检验法对实际抽取量与标示量的差值进行统计学分析,结果显示其与2005年版《药典》三部要求分装附加量为0．1ml相比有显著性差异（P〈0．001）。     

两种不同肌瘤剔除术治疗子宫肌瘤的临床疗效比较

目的:比较腹腔镜子宫肌瘤剔除术与腹式子宫肌瘤剔除术的临床疗效。方法:回顾分析63例腹腔镜子宫肌瘤剔除术与61例腹式子宫肌瘤剔除术的临床资料,比较2种手术方式的手术时间、术中出血量、肛门排气时间、使用抗生素时间、术后感染率、体温恢复正常时间、住院时间等情况。结果:两组患者接受子宫肌瘤剔除术顺利完成,腹腔镜组手术时间长于开腹组(P0.05),腹腔镜组术中出血量及剔除肌瘤个数均少于开腹组(P0.05),术后腹腔镜组体温恢复正常时间、肛门排气时间、抗生素使用及住院时间均短于开腹组,两组患者最多随访6个月,腹腔镜组平均康复时间较开腹组短(P0.05),两组随访B超均未发现明显肌瘤结节。结论:腹腔镜子宫肌瘤剔除术损伤小,恢复快,住院时间短,是值得推广的微创手术。     

对《医疗事故处理条例》的几点认识--学习《医疗事故处理条例》的一点体会

国务院颁布的《医疗事故处理条例》（以下简称《条例》）在吸收、总结原《医疗事故处理办法》（以下简称《办法》）实施十几年以来正反两方面经验教训的基础上，对《办法》作了许多重大的修改：《条例》扩大了医疗事故的主体与范围，提出了防范医疗事故的一些重要措施，授权医学会独立担纲医疗事故技术鉴定工作，赋予了患者更多的权利，规定医疗事故民事责任争议可以“私了”，制定了更为规范的医疗事故的赔偿制度等。《条例》作出的这些新规定必将使医疗事故得以更加科学、客观、公正、公平、合理的解决。认真学习、把握《条例》的这些新规定，很好地透视《条例》的立法宗旨与原则，必将极大地提高学习、宣传《条例》的主动性与积极性，更好地推进《条例》的贯彻执行工作。     

The analysis of case-control studies of the efficacy of screening for recurrence of cancer

Occasionally, the efficacy of screening for cancer recurrence has been evaluated by means of case-control studies. However, these studies generally have not been designed and analyzed in a manner that will yield an unbiased result. The commentary shows that by adhering to the principles developed for the analysis of studies of the efficacy of screening for the presence of a given cancer in persons with no history of this disease, a case-control study of screening for recurrence will improve its chances of obtaining valid findings.     

137例地中海贫血出生相关因素分析

目的:揭示地中海贫血患儿出生相关因素,提出干预措施,为进一步制定地贫预防控制总体规划提供决策参考。方法:对近3年137例地贫儿(45例重型β-地贫、29例中间型β-地贫、32例中间型α-地贫和31例巴氏胎儿水肿综合征)出生相关因素进行调查研究。结果:地贫儿出生相关社会心理因素顺位依次为:基因携带者不知情(70.07%)、经济困难(21.17%)、心理因素(5.11%)、其它(3.65%)。基因携带者对自身情况不知情是本组地贫儿主要出生相关因素,与其它出生相关因素有显著差异(P<0.05)。结论:基因携带者自身的认识与重视是预防控制工作的一个重要组成部分,地贫高发区人群携带者(轻型β-地贫、α-地贫特征和静止型携带者)的检出及系统管理是预防控制工作的关键环节,应进一步应用生物、社会及心理的医学模式搞好地贫预防控制工作。