我国重要自然疫源地地理信息系统的建立

目的：建立我国重要自然疫源地地理信息系统。方法：系统地收集我国存在的各种自然疫源地及其相关因素的资料，整理分析后建立数据库。以地理信息系统软件MapInfo为平台，构建自然疫源地地理信息系统，将建立的数据库与中国电子地图相连接，并实现用户对信息管理、分析、操作、显示等方面的要求。结果：建立的我国重要自然疫源地地理信息系统具有地图管理、信息维护、检索查询、数据分析、专题地图、辅助决策等功能，汇集了我国22种重要自然疫源性疾病的疫源地类型、分布、发病情况、流行特征、防治对策、主要宿主媒介的分布以及与疫源地有关的地理、气象、土地利用和人口等方面的数据，可以按不同的地理范围，从地区、病种、宿主媒介分别查询和显示疫源地相关信息，将结果以文字、表格、图形(包括统计图和专题地图)不同方式显示出来，可对疫源地的分布、发病情况与相关的地理环境因素制作专题地图并进行叠加分析。结论：本系统的建立为我国自然疫源地的管理、研究和控制提供了一种新的技术手段。     

Interpretation and reporting of myocardial perfusion SPECT: a summary for technologists

Interpretation of cardiac perfusion SPECT images, and the subsequent reporting of results to referring physicians, are sometimes taken to be outside the sphere of the nuclear medicine technologist. However, all personnel involved with nuclear medicine procedures contribute to the timeliness and usefulness of the final report. The goal of this article is to review the principles of scan interpretation and reporting, from the standpoint of what technologists need to understand about these processes. In addition, software tools to aid these processes will be discussed, including quantitative image analysis, telemedicine, computer-aided scan interpretation, databases, computer-aided reporting, and Internet-based reporting. Finally, the accuracy of the scan report will be related to the tasks normally performed by technologists, such as the acquisition and processing of images and the entry, transfer, and networking of data. After reading this article, the reader will be able to describe the principles of scan interpretation and reporting, the software tools for telemedicine and computer-aided interpretation, and the role of the technologist in this process.     

F344大鼠4种饮用水饲养2年实验病理学观察

目的观察F344大鼠在自然生存状态下常年饮用天然矿泉水、自来水、纯净水和矿物质水等4种饮用水对其生存寿命、疾病发生率、死亡率等指标的影响,为GLP条件下动物饲养用水选择和动物自发病变的研究提供背景数据。方法 SPF级8周龄F344大鼠336只,雌雄各半,随机分为4组,分别饮用天然矿泉水、自来水、纯净水和矿物质水4种饮用水,每组84只动物。实验开始后第6个月、12个月、18个月和24个月每组分别活杀8、16、16和44只动物,称重动物心脏、肺脏、肝脏、脾脏、肾脏、胸腺、肾上腺、睾丸（或卵巢）、附睾（或子宫）和脑等脏器并计算脏器系数,常规病理学取材、制片后显微镜检查,比较各组动物在4个时间点发生病变的类型和发病率。结果各组动物发病以F344大鼠常见的自发性病变为主,包括非增殖性病变和增殖性病变。主要的非增殖性病变包括心脏乳头肌纤维化,肺细支气管旁慢性炎症,肾脏肾小管扩张、蛋白管型、肾小管萎缩和钙沉积等,生殖器官退行性改变等;高发的肿瘤性病变主要包括睾丸间质细胞瘤、垂体腺瘤、单核细胞白血病、皮下纤维瘤、乳腺纤维腺瘤、嗜铬细胞瘤等。各组动物上述病变类型及发病率、生存时间、死亡率等指标比较均未见明显差异。结论天然矿泉水、自来水、纯净水和矿物质水等4种饮用水对F344大鼠生存时间、死亡率、自发病变类型与发生率没有影响。本研究为了解不同饮用水对实验动物的影响提供了参考,丰富了F344大鼠自发病变的病理学数据积累。     

The musculoskeletal manifestations of epidermolysis bullosa: an analysis of 19 cases with a review of the literature.

Epidermolysis bullosa encompasses a group of rare disorders characterized by marked skin fragility and blister formation. In patients with dystrophic epidermolysis bullosa, skeletal and soft-tissue abnormalities are an important feature. An analysis of the musculoskeletal manifestations in 19 patients is presented. In the hands and feet, features included generalized osteoporosis, wedge-shaped thinning and hooking of distal phalanges, overconstricted bones, acro-osteolysis, flexion contractures, metatarsal and metacarpal subluxation, distal trophic changes, webbing of digits, encasement of the whole extremity in a pouch of skin, soft-tissue calcification and retarded skeletal maturity. Previously undescribed findings in the hands and feet are bony ankylosis of the proximal interphalangeal joints, resorption of the metatarsal and metacarpal heads, shortened metatarsal bones, carpal and tarsal fusion and destruction, and cystic changes of the distal radius and ulna. In the remainder of the skeleton, hip dysplasia with premature osteoarthritis, knee joint bony ankylosis and thoracic and thoraco-lumbar scoliosis are other undescribed findings.     

The invisible sentry

Radiological imaging may enable the recognition and documentation of acts of terror. Search by X-rays can assist in the detection of weapons, drugs, contraband, and hidden persons. Fluoroscopy, backscatter imaging, and computed tomography are being employed for the evaluation of luggage, humans, trucks, and containers. The identification of drugs and explosives is possible by additional spectral analysis. The images can show individuals nearly naked, which may lead to a discussion on violation of privacy and dignity. There are, however, clinical questions raised about the exposure to X-rays and the possible absence of informed consent. Finally, although the use of X-rays is part of terror prevention, it has been part of the terror, too. The Stasi, the secret service of the German Democratic Republic, used diagnostic X-rays and ionizing radiation in order to control opponents of the political system.     

四肢软组织损伤的评估与治疗

软组织损伤通常是指皮肤、皮下组织、筋膜、肌肉、肌腱、韧带、滑膜、关节囊等软组织及周围神经、血管的损伤。四肢软组织损伤在临床工作中常会遇到,处理不当会使治疗周期大大延长,增加致残率和病死率,降低患者生活质量,对患者和社会造成严重影响。对软组织损伤严重性的评估,不仅是对患者整体评价的一个重要组成部分,而且也影响着骨折的处理。随着科技的迅速发展和机械化程度的不断提高,使得机械化因素在各类致伤因素中成为主要因素,尤其是交通事故等引起的各类高能量损伤,往往都是多发伤,伤情大多较严重。因此,充分认识软组织的损伤程度并正确处理,是创伤和骨折得以有效治疗的基础。     

歼击机飞行员体能训练致横纹肌溶解症一例并文献复习

目的 探讨飞行员运动性横纹肌溶解症的诊断、治疗及医学鉴定,以提高对本病的认识,指导临床航空医疗工作和飞行员体能训练. 方法 分析1例飞行员运动性横纹肌溶解症的诊断、治疗、医学鉴定情况,结合相关文献,总结飞行员运动性横纹肌溶解症的病因、发病机制、临床特点、防治及医学鉴定. 结果 突然大量运动训练可导致机体能量耗损,自由基产生增加,组织渗透性加强,从而引起炎性因子释放,造成横纹肌溶解.本例飞行员经针对病因治疗,减少横纹肌损伤,恢复血流,防治急性肾功能衰竭等治疗,临床治愈.经康复疗养、地面观察,逐渐恢复体能训练,复查各项指标均正常,结论为飞行合格. 结论 运动性横纹肌溶解症是由于过度运动后所致的横纹肌损伤,对该病要做到预防为主,早发现、早诊断、早治疗,对飞行员改善预后和医学鉴定有着重要的临床意义.     

周围型肺腺癌CT征象与CD147、VEGF表达的关系

目的 分析周围型肺腺癌在CT上的一些典型征象,并探讨这些征象与CD147、VEGF表达的关系。方法 收集2006-01至2012-12周围型肺腺癌73例可作免疫组化的蜡块及术前CT检查资料。采用免疫组化SP法分别测定肺腺癌组织中CD147及VEGF的表达结果,对阳性结果根据染色面积及染色强度进行等级划分。将CD147、VEGF的表达结果与术前CT检查的各特异性征象进行对比,观察两种基因表达结果与CT征象之间是否相关。结果 CD147表达与CT征象中的空泡征、肿块大小、棘突征、深分叶征、纵隔淋巴结转移之间有相关性（P〈0.05）,与毛刺征、胸膜凹陷征无相关性（P〉0.05）;VEGF表达与毛刺征、棘突征、深分叶征、纵隔淋巴结转移之间有相关性（P〈0.05）,与肿块大小、空泡征、胸膜凹陷征无相关性（P〉0.05）。结论 肺腺癌的某些CT特异性征象与CD147、VEGF表达有相关性,可为判断肺腺癌的预后提供依据。     

Image quality, lesion detection, and diagnostic efficacy in digital mammography: full-field digital mammography versus computed radiography-based mammography using digital storage phosphor plates

OBJECTIVE: To compare image quality, the lesion detection, and the diagnostic efficacy of full-field digital mammography (FFDM) and computed radiography-based mammography using digital storage phosphor plates (DSPM) in the evaluation of breast lesions. MATERIALS AND METHODS: In this prospective study, 150 patients with suspicious breast lesions underwent FFDM and DSPM. Nine aspects of image quality (brightness, contrast, sharpness, noise, artifacts, and the detection of anatomic structures, i.e., skin, retromamillary space, glandular tissue, and calcifications) were evaluated by five radiologists. In addition, the detection of breast lesions and the diagnostic efficacy, based on the BI-RADS classification, were evaluated with histologic and follow-up correlation. RESULTS: For contrast, sharpness, and the detection of all anatomic structures, FFDM was rated significantly better (p<0.05). Mass lesions were equally detected, whereas FFDM detected more lesions consisting of calcifications (85 versus 75). DSPM yielded two false-negative results. Both lesions were rated BI-RADS 4 with FFDM, but BI-RADS 2 with DSPM. Both were invasive carcinoma at histology. The sensitivity, specificity, PPV, NPV, and accuracy of FFDM were 1.0, 0.397, 0.636, 1.0, and 0.707, compared to 0.974, 0.397, 0.630, 0.935, and 0.693 of DSPM. CONCLUSION: Based on image quality parameters, FFDM is, in part, significantly better than DSPM. Furthermore, the detection of breast lesions with calcifications is favorable with FFDM. However, the diagnostic efficacy of FFDM and DSPM was equal. The interpretation of the false-negative results suggests that the perception and characterization of breast lesions is not defined solely by the digital mammography system but is strongly influenced by the radiologist, who is one of the determinants in the interpretation of breast imaging.     

一起暴发麻疹的临床特征和流行病学特征分析及防控处理

 目的 分析某学院15例聚集麻疹患者发病的流行病学和临床特征及防控处理,有利于防止麻疹暴发。方法 对15例麻疹患者聚集发病的流行病学资料和临床资料进行调查分析、采样,对聚集发病原因、流行病学特点、临床特点及采取的防控措施进行分析。结果 15例麻疹患者春季聚集发病,临床特征为发热、皮疹、咽痛、咳嗽、流涕、鼻塞,口腔黏膜斑、发热、皮疹,合并肺部感染及结膜炎1例,心肌炎1例,麻疹病毒核酸13例阳性。流行病学特征:首发病例发生于2015-04-01,疫情高峰在4月13日至4月17日,4月17日结束,二代感染病例集中于该病的最长潜伏期内。有明确的流行病学接触史11例,占73%,主要集中在同一层楼的3个宿舍,呈现聚集性分布。均为男性学员,年龄19～25岁。结论 麻疹暴发与季节、疫苗接种、发病年龄、防控措施是否及时实施有关。建议各大专院校及居住比较密集单位的临床医师注意春季麻疹散发病例,立即隔离麻疹患者,密切接触者及时进行预防接种,防止麻疹暴发。     

"雪龙2号"极地科考船乘船队员的伤病分析

目的探讨极地科考船乘船队员的伤病特点,提出针对性防治建议,为提高极地科考医疗保障水平提供策略。方法收集238名搭乘"雪龙2号"极地科考船的中国第36次南极科考队员在航程中的伤病情况,统计发生伤病就诊人数和构成比、各种伤病例数和构成比、各系统伤病例数及构成比,分析常见伤病可能的诱发因素。结果在198 d航程中,238名乘船队员中发生伤病就诊的有138人,占比58.0%;诊治伤病276人次(不含复诊),前10种伤病依次为:软组织损伤、咽炎、牙龈炎、上呼吸道感染、失眠、眼疲劳、晕船、高血压、皮肤损伤、胃炎;根据发病系统和专科不同,前10类伤病依次为:耳鼻喉疾病、创伤与骨科疾病、消化系统疾病、口腔科疾病、眼科疾病、呼吸系统疾病、皮肤科疾病、神经心理疾病、心血管疾病、代谢与内分泌疾病。结论为减少极地科考船乘船队员伤病发生,应采取安全和健康宣教、严格执行操作规范、合理安排值班、适时调节空气温湿度、加强后勤补给、调整饮食结构、丰富业余生活、纠正不良行为、改善居住环境、随船医生技能培训等措施。     

Preanalytical phase of sport biochemistry and haematology

Biochemistry and haematology are more and more important and sometimes crucial in sport medicine for diagnosing, controlling and preventing purposes. The analytical process and the global laboratory quality are heavily influenced by the preanalytical phase, including biological material collection, identification, storage and transport of the specimen, preparation for analyses of the specimen through centrifugation, freezing and thawing, aliquoting and sampling. The increasing interest of sport biochemistry should be linked to a knowledge of principal problems and pitfalls in the preanalytical phase of various parameters, commonly used in following training, diet, and performances of athletes, to avoid misinterpretation of data and to improve usefulness of biochemical investigations. We prepared a practical review of preanalytical aspects of principal analyses applied to the athletes. We include the choice of anticoagulant and its limits for haematological tests, the preparation and manipulation of specimens for hormonological investigation, especially for labile molecules, and for cardiac markers, lactate, cytokines, micronutrients, antioxidant molecules. Preanalytical phase of specimens different from blood are also showed, including urine and saliva, and some aspects of preparation of materials to be analyzed with molecular biology technology are treated. Stability of some analytes, when the parameter is fundamental for the clinical usefulness of the results, is supplied. Preparation of the subjects, however, including the possible influence of physical exercise and biological rhythms on the biochemical and haematological parameters, are not listed.     

Anatomical study of the femoral and tibial insertions of the anterolateral and posteromedial bundles of human posterior cruciate ligament

For posterior cruciate ligament (PCL) reconstruction, two root, anterolateral and posteromedial bundles restruction are performed. However, little has been mentioned of anatomical measurements of the insertions to the bone of these bundles in previous publications. The aim of this study is to determine the precise anatomical measurements of the femoral and tibial insertions for anterolateral and posteromedial bundles of PCL. A total of 32 femur and 33 tibiae were selected from 50 cadavers after exclusion of knees that displayed macroscopically degenerative changes or evidence of trauma. PCL were divided into anterolateral bundles and posteromedial bundles to the insertion footprint, and those locations were measured and described. The distance from the center of the femoral insertions of the anterolateral and posteromedial bundles, and the Wrisberg ligament to the anterior margin of the medial femoral condyle averaged 9.6, 10.6, and 17.1 mm, respectively. The distance from the center of the femoral insertions of the anterolateral, posteromedial bundles, and Wrisberg ligament to the intercondylar roof averaged 4.8, 11.4, and 10.4 mm, respectively. The distance from the medial margin of the articular cartilage of the tibial plateau to the center of the tibial insertions of the anterolateral and posteromedial bundles averaged 51.0 and 50.0% of the total widest width of the tibial plateau, respectively. The vertical distance from the tibial insertion of the center of the posteromedial bundle to the plane of the tibial articular surface averaged 4.6 mm. This study leads to a better definition of the anatomy of the anterolateral and posteromedial bundles of PCL. It is very important to know the precise anatomy of PCL bundles when performing PCL reconstruction, and to evaluate PCL reconstruction surgery on an anatomical basis.     

Efficiency of different radiodiagnostic techniques in pancreatic disorders

Using figures from the literature and from our own case material, the diagnostic efficiency of the barium meal, computerized tomography, angiography, ERPC and biopsy have been compared in acute and chronic pancreatitis, pancreatic and papillary carcinoma and islet cell tumour. In acute pancreatitis, CT is the method of choice. In chronic pancreatitis, ERPC has the highest diagnostic accuracy. Furthermore, it is capable of giving an indication for operative intervention, and facilitating the choice of operative method. In pancreatic carcinoma, combination of ERPC, angiography and/or biopsy provides the highest diagnostic accuracy. Angiography and ERPC can provide early diagnosis, and angiography and CT can predict the operability of a tumour. CT is also the most important of the non-invasive diagnostic techniques. Carcinoma of the papilla is easily and reliably recognized by endoscopy. For islet cell tumours, angiography still remains the method of choice.     

The importance of radiologic studies for the differentiated treatment of scoliosis

Structural scoliosis is defined by curvature, fixation, rotation and torsion. Each case is different and must be assessed on the basis of etiology, flexibility, patient age, skeletal age, progression and degree, level, and the number of the deformities in order to decide whether conservative or operative treatment should be administered. The most important factor in the choice of therapy is radiographic evaluation to allow accurate measurement. This involves standing X-rays of the whole spine (plan d'éléction), checking with corset and cast, tomography, spot-film radiography, CT and MRI in congenital and neuromuscular deformities and neurofibromatosis, oblique projection after operations, and radiography of the left hand and the iliac crest to determine the bone age. The classification and terminology of scoliosis are presented, as are the interpretation and measurement of the radiographs and the treatment indications.     

大鼠右肝血供不同程度阻断后的病理变化及磁共振表现

目的:探讨用磁共振新技术活体检测肝细胞凋亡和坏死的可能性。方法:①体重为0.25～0.3kg的SD大鼠90只随机分成A、B、C三组,每组30只,分别行右肝门静脉结扎(A组)、右肝门静脉及肝动脉双结扎(B组)及假手术(C组),术后3h、1天、3天、7天、14天作为5个时间点,各观察6只。②每组大鼠进行磁共振成像(MRI)、磁共振扩散加权成像(DWI)、1H磁共振波谱(1H-MRS)及磁共振灌注成像(PWI)检查。③取肝脏标本行病理学及电镜检查。④将磁共振检查结果同病理学及电镜对照分析。结果:①A组病理学及电镜检查证实肝细胞发生凋亡;B组肝组织发生凝固性坏死。②A组T1WI信号增高,T2WI信号刚开始略减低,后呈小片状增高;DWI呈小片状高信号,表观扩散系数(ADC)图则相反;MRS表现为胆碱(Choline,Cho)、肌酸(Creatine,Cr)、谷氨酸(Glutamate,Glx)峰稍下降,乳酸(Lactate,Lac)峰、脂质(Lipid,Lip)峰增加;PWI灌注曲线下降;③B组T1WI信号减低,T2WI信号增高;DWI呈高信号;Cho峰下降明显,Cr、Glx峰下降,Lac峰明显升高,Lip峰略增高;PWI曲线低平。结论:右肝血供不同程度阻断后肝细胞分别发生凋亡和坏死;磁共振检查(DWI、MRS、PWI)具有特征性表现,可活体检测细胞凋亡和坏死的存在。     

兔间接视神经损伤的组织病理学观察

目的观察间接视神经损伤病理过程听规律以指导临床救治。方法 日本大耳白兔８４０只,按不同时相分为８个组,左眼致伤,右眼为对照。建立兔间接视神经损伤模型后,分别于伤后１２ｈ、１,３,７,１５,３０,６０,９０ｄ处死动物取视神经,按常规方法制备光、电镜标本后,切片观察。结果 伤后１２～２４ｈ神经软膜及神经组织水肿,毛细 管扩张、血管周围间隙增宽。鞘膜下血肿及神经实质内灶性出血,血管内皮细胞肿胀,管和管腔     

MR imaging in gynecologic oncology

Cross-sectional imaging is becoming an integral part of the diagnostic workup in patients with carcinoma of the female reproductive system. US, CT and MRI, however, are not tissue-specific, and benign and malignant disease cannot be differentiated using these modalities alone. The diagnosis is made on clinical grounds and based on history, physical examination and histology. After the diagnosis has been established, cross-sectional imaging is recommended for the non-invasive evaluation of tumor extent, which influences the design of therapy and facilitates more effective treatment. A vast array of imaging options are available, and to avoid duplication and achieve the best results efficiently, it is necessary to understand the advantages and limitations of each of these approaches. This review describes in detail the potential role of MRI in the evaluation of cancer of the endometrium, cervix and ovary, discussing the value of MRI relative to US and CT, and concludes with the recommended imaging approach for each tumor type.     

肝硬化CT分型与中医证型相关性研究

目的:探索肝硬化CT分型与中医证型之间的关系及其意义。方法:通过分析142例肝硬化患者CT表现和中医征象,对其进行CT分型和中医辨证分型,并分析两种类型之间的关系。结果:142例肝硬化根据CT征象分为3个类型,均匀型32例(22.54%),节段型21例(14.79%),结节型89例(62.68%)。中医辨证分为6个证型,肝郁脾虚证17例(11.97%),湿热蕴结证18例(12.68%),气滞血瘀证31例(21.83%),水湿内停证41例(28.87%),脾肾阳虚证21例(14.79%),肝肾阴虚证14例(占9.86%)。均匀型和节段型肝硬化病例中大多为肝郁脾虚证和湿热蕴结证,分别占62.49%和47.62%;其次为气滞血瘀证和水湿内停证,分别占28.13%和42.86%;脾肾阳虚证和肝肾阴虚证最少,分别占9.38%和9.52%。而结节型肝硬化病例中以肝郁脾虚证和湿热蕴结证最少,占5.62%;其次为脾肾阳虚证和肝肾阴虚证,占33.71%;气滞血瘀证和水湿内停证最多,占60.67%,与均匀型和节段型具有显著性差异(χ2值分别为49.40和32.06,P值均小于0.001)。结论:肝硬化的CT分型与中医证型之间存在密切的关联,2种分型均与肝硬化肝损害的严重程度相关。