MRI诊断30例乳腺癌患者临床分析

目的:探讨MRI对维吾尔族乳腺癌患者诊断的指导意义。方法:回顾性分析乳腺外科30例MRI诊断为乳腺癌的维吾尔族病例资料。结果:30例病患者术前MRI诊断均为乳腺癌,手术病理检查结果证实有25例为乳腺癌,3例乳腺纤维腺瘤,1例乳腺囊肿,1例导管内乳头状瘤。乳腺癌的MRI诊断符合率为83.3%。在手术病例证实的25例乳腺癌中,乳腺钼靶X线摄影诊断为良性病例的5例,其中4例为致密型乳腺。结论:MRI的乳腺癌诊断灵敏度较高,但特异度欠佳。在对致密型乳腺癌的诊断中,MRI较乳腺钼靶X线摄影更具优势。     

数字化乳腺断层融合摄影对致密型乳腺病变的诊断价值

目的: 探讨数字化乳腺断层融合摄影（DBT）在致密型乳腺患者中诊断乳腺良恶性病变的效能。方法: 收集2017年1月至2018年12月绍兴市中心医院经病理组织学检查证实的163例乳腺良恶性病变患者的资料（良性病灶58个,恶性病灶122个,共计180个）。根据BI-RADS标准患者乳腺腺体类型均归类于不均质致密腺体型和极度致密型。所有患者术前均行乳腺MRI、DBT检查。以病理结果为金标准绘制ROC曲线,评价两种影像学检查方法: 对乳腺良恶性病变的诊断效能,用Z检验对ROC曲线下面积进行比较;采用χ²检验比较乳腺MRI和DBT检查对乳腺良恶性病变检出率、诊断准确率的差异;采用Pearson相关性分析MRI、DBT术前评估乳腺病灶大小的准确度。结果: MRI、DBT对乳腺良性病变的检出率和准确率分别为91.4%、75.9%和89.7%、67.2%,差异有统计学意义（χ²=5.098、8.617,P < 0.05或P < 0.01）;MRI、DBT对乳腺恶性病变的检出率和准确率分别为98.4%、95.1%和94.3%、91.8%,差异无统计学意义（χ²=2.068、0.569,均P>0.05）。MRI、DBT诊断致密型乳腺病变的ROC曲线下面积分别为0.910、0.832,差异无统计学意义（Z=1.860,P>0.05）。MRI、DBT诊断致密型乳腺良恶性病变的敏感度分别为93.3%、86.7%,特异度分别为68.3%、79.1%。DBT、MRI测量值与病理测量结果呈正相关（r=0.887、0.949,均P < 0.01）。结论: DBT简单易行,能较好地诊断致密腺体背景下乳腺的良恶性病变,尤其对乳腺恶性病变的诊断效能与乳腺MRI相近。     

动态增强MRI对女性乳腺疾病性质的鉴别诊断价值研究

目的对动态增强MRI对女性乳腺疾病性质的鉴别诊断价值进行研究。方法收集在本院2017年3月至2019年5月收治的96例乳腺疾病女性患者的临床资料,其中恶性病变52例,良性病变44例,均进行MRI检查,并对乳腺疾病患者的MRI影像学表现进行分析,对比良、恶性病变增强后边缘形态分布情况,及良、恶性病变各动态强化参数比较。结果 52例恶性病变中,MRI增强扫描后边缘形态分布以毛刺和不规则形态为主,分别占42.31%、30.76%。良性病变则以光滑形态为主,占48.88%。良、恶性病变增强后边缘形态分布有明显差异(P0.05)。恶性病变强化参数E_(max)、Slope_(max)明显高于良性病变(P0.05)。但在T_(max)中恶性病变明显低于良性病差(P0.05)。结论动态增强MRI对女性乳腺疾病性质的鉴别诊断有较高的研究价值,可广泛应用与女性乳腺疾病检查中。     

超声造影与MRI对小乳腺癌(直径≤2.0cm)的诊断价值对比分析

目的 对比分析超声造影(CEUS)与磁共振成像(MRI)对小乳腺癌的诊断价值。方法 本研究选取我院2018年10月至2021年5月诊治的65例经手术切除乳腺肿块(直径≤2.0 cm)患者作为研究对象,以临床病理诊断结果作为“金标准”,分析CEUS与MRI对小乳腺癌的诊断价值,比较CEUS与MRI成像增强特征、良恶性病变患者CEUS及MRI成像TIC曲线类型。结果 病理结果显示65例乳腺肿块患者中,恶性病变者33例,良性病变者32例;CEUS诊断小乳腺癌的敏感度、特异度、准确率分别为81.81%、90.62%、86.15%;MRI诊断小乳腺癌的敏感度、特异度、准确率分别为84.84%、96.87%、90.76%;CEUS误诊9例(9/65,13.85%);MRI误诊6例(6/65,9.23%),二者误诊率比较无差异(P>0.05);CEUS均匀增强例数少于MRI,不均匀增强例数多于MRI(P<0.05),内部灌注缺损面积大于MRI(P<0.05);恶性病变组超声影像时间-强度曲线(TIC)结果多表现为快进快出型或快进慢出型,良性病变组超声影像TIC曲线结果多表现为慢进慢...     

3.0T MRI动态增强扫描结合DWI在乳腺良恶性病变诊断中的临床应用

目的探讨3.0T MRI动态增强扫描结合DWI在乳腺良恶性病变临床诊断中的应用价值。方法 RI动态增强扫描结合DWI,以手术病理结果为基准比较良性及恶性病变患者在MRI影像表现、形态与强化特征方面的差异,计算3.0T MRI动态增强扫描结合DWI诊断乳腺良恶性病变的准确率。结果良性病变患者中边界清晰、形态规则及强化均匀患者所占比例显著高于恶性病变患者,差异有统计学意义(P0.05)。良性病变患者中,Ⅰ型11例、Ⅱ型26例、Ⅲ型1例,(Ⅰ型+Ⅱ型)占97.4%(37/38);恶性病变患者中,Ⅰ型0例、Ⅱ型4例、Ⅲ型13例,(Ⅰ型+Ⅱ型)占23.5%(4/17),差异有统计学意义(P0.05)。结论 3.0T MRI动态增强扫描结合DWI在乳腺良恶性病变诊断中的临床应用可实现有效互补,利于诊断准确性的提高,实现良、恶性病变的有效鉴别。     

MR动态增强联合扩散加权成像技术在乳腺疾病诊断中的价值

目的探讨乳腺MR动态增强扫描联合扩散加权成像技术在乳腺疾病影像诊断中的价值。方法对48例女性乳腺患者进行MRI检查,先进行双侧乳腺常规MRI平扫,再进行双侧乳腺扩散加权平面回波（EPI）序列扫描,最后行乳腺动态增强扫描。通过后处理,得到病灶处表观弥散系数（ADC）值及时间-信号强度曲线。结果根据时间-信号强度曲线特点及ADC值,结合常规MRI形态学特点进行良、恶性病变诊断。MRI诊断为恶性肿瘤19例,良性病变29例。手术或活检病理结果证实MRI诊断为恶性肿瘤的19例患者中,18例为恶性肿瘤,另外1例为良性肿瘤（旺炽性腺瘤）;MRI诊断为良性病变的29例患者,手术或病理活检均证实为良性病变。MRI区分乳腺良、恶性病变的准确率为97.9%（47/48）,与手术或病理活检准确率（100%）比较差异无统计学意义（字2=0.044,P=0.834）。结论动态增强扫描联合扩散加权成像技术,可提高乳腺疾病影像诊断准确率。     

乳腺钼靶X线及B超对乳腺癌诊断价值的比较

目的:比较乳腺钼靶X线和乳腺B超对女性乳腺癌的诊断价值?方法:回顾性分析164例乳腺癌患者的乳腺钼靶X线及乳腺B超检查结果,并与病理结果进行对照分析?结果:乳腺钼靶X线和乳腺B超的诊断正确率分别为79.27%(130/164)?82.32%(135/164),而假阴性率分别为20.73%(34/164)?17.68%(29/164),差异均无统计学意义(P > 0.05),钼靶X线与乳腺B超的联合诊断正确率为92.07%(151/164),与单纯钼靶X线或B超检查相比,差异均有统计学意义(P < 0.01)?结论:乳腺B超可作为钼靶X线的重要补充,以提高诊断正确率,降低假阴性率?     

数字乳腺断层摄影与MRI在乳腺良恶性疾病诊断中的比较

  目的  探讨数字化乳腺摄影(digital mammography,DM)、数字乳腺断层摄影(digital breast tomosynthesis,DBT)和MRI在乳腺良恶性疾病诊断中的比较。  方法  回顾性分析2019年1月—2020年10月就诊蚌埠医学院第一附属医院,临床触诊怀疑存在乳腺病灶且同时行DM、DBT、MRI三种检查的116例乳腺疾病患者的资料。对所有图像中病灶参照乳腺影像报告和数据系统(BI-RADS)标准分类,以病理结果为“金标准”,评价DM+DBT和MRI对乳腺良恶性疾病的诊断效能、显示恶性病灶大小和相关恶性征象的能力、DM与DBT的辐射剂量差异。  结果  116例病灶中恶性86例,良性30例。DM+DBT、MRI诊断乳腺良恶性疾病的敏感度为88.4%、96.5%,特异度为86.7%、73.3%,准确度为87.9%、90.5%;两者的ROC曲线下面积(AUC)分别为0.911和0.948,差异无统计学意义(Z=1.084,P=0.278);DM+DBT与MRI均稍高估恶性肿瘤大小,但两者与病理大小均存在较好的一致性(均P＞0.05);DM+DBT在显示微钙化方面优于MRI(χ2=22.114,P＜0.05),在显示胸大肌浸润和腋窝淋巴结方面低于MRI(χ2=4.900、21.333,均P＜0.05)。DM的平均辐射剂量为(1.574±0.422)mGy,DBT的平均辐射剂量为(2.534±0.521)mGy,DBT的辐射剂量高于DM的辐射剂量,差异具有统计学意义(t=-29.213,P＜0.001)。  结论  DM+DBT可以较准确的诊断乳腺良恶性疾病,与MRI相似。而且简单易行,无须注射对比剂,建议有致密型乳腺内病变的患者常规行DM+DBT检查。      

120例乳腺癌组织中HDAC-1蛋白表达的临床病理

目的:探讨乳腺癌组织中组蛋白去乙酰化酶-1(histone deacetylase 1,HDAC-1)的表达意义及其与临床病理特征之间存在的相关性?方法:应用免疫组织化学Envision二步法检测120例乳腺癌组织和对照组20例乳腺增生症乳腺组织中HDAC-1蛋白的表达,分析其与临床特征,以及常规检测指标雌激素受体(ER)?孕激素受体(PR)?人表皮生长因子受体-2(human epidermalgrowth factor receptor-2,HER-2)之间的关系?结果:120例乳腺浸润性导管癌中,HDAC-1高表达43例(35.83%),对照组20例乳腺增生病变中HDAC-1低表达或不表达,两者之间表达差异有统计学意义?乳腺癌中HDAC-1高表达与年龄?临床分期?HER-2表达均有显著相关性(P < 0.01),即与患者年龄 > 50岁组(49.50%)和临床分期为Ⅲ~Ⅳ期组(64.28%)及HER-2(55.26%)的表达呈正相关;与肿瘤的大小?组织学分级?淋巴结转移的有无?以及癌组织间及癌旁组织中有无淋巴细胞的浸润无相关(P > 0.05),与ER(33.89%)?PR(39.28%)的表达无相关(P > 0.05)?结论:HDAC-1在乳腺癌和良性增生性病变诊断及鉴别诊断中有参考意义;HDAC-1蛋白在乳腺癌的发生发展中起重要作用;HDAC-1抑制剂有望成为乳腺癌治疗的新靶向药物?     

MRI平扫结合DWI对乳腺癌及乳腺良性增生的鉴别诊断

目的研究MRI平扫结合DWI对乳腺良恶性病变中的诊断价值。方法对63例乳腺癌及乳腺良性增生患者MRI常规平扫及DWI成像,测量肿块各序列的信号强度,DWI图像后处理ADC和eADC值。对照分析,得出所用序列对乳腺癌和良性增生的诊断价值。结果 MRI平扫及DWI对乳腺病变的显示良好。病变检出率比较无统计学意义（P〉0.05）,对乳腺癌及良性增生鉴别DWI明显高于常规MR平扫（P〈0.05）,有统计学差异。结论 MRI平扫结合DWI成像有助于提高对乳腺良恶性病变的诊断价值。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.