超声造影联合多层螺旋CT鉴别诊断肾嫌色细胞癌与肾嗜酸细胞腺瘤的价值

目的 探讨超声造影联合多层螺旋CT在肾嫌色细胞癌与肾嗜酸细胞腺瘤鉴别诊断中的临床应用价值.方法 回顾性分析经手术病理证实的45例肾嫌色细胞癌和30例肾嗜酸细胞腺瘤患者的检查资料,比较其常规超声、超声造影及多层螺旋CT检查情况.绘制受试者工作特征(ROC)曲线分析超声造影、多层螺旋CT单独及联合应用对肾嫌色细胞癌与肾嗜酸...     

86例肾嫌色细胞癌与33例嗜酸细胞腺瘤的临床病理特征的比较分析

目的探讨比较肾嫌色细胞癌(CRCC)与嗜酸细胞腺瘤(Oncocytoma)的临床病理特征差异,以及比较CD44、CK7、CK20和线粒体抗体的免疫组化在两者以及亚组中的诊断及鉴别诊断的意义。方法对北京协和医院2002-10—2014-05间手术切除的86例肾嫌色细胞癌和33例肾嗜酸细胞腺瘤标本进行总结,并对其组织进行CD44、CK7、CK20和线粒体抗体的免疫组化染色、镜下评判,评估他们在诊断以及鉴别诊断中的作用,并分析他们与临床病理特征之间的关系。结果在嫌色细胞癌、嗜酸亚型嫌色细胞癌与嗜酸细胞腺瘤三组中,患者的性别构成、肿瘤大小、肿瘤发生的左右部位、采取的手术切除方式、肿瘤是否侵犯包膜以及生存时间方面均无显著性差异。嫌色细胞癌组的患者年龄(均数51.3岁,标准差12.4)倾向于嗜酸细胞腺瘤组(均数56.4岁,标准差15.1)的患者年龄,但不具有统计学显著性差异(P0.05)。在嗜酸亚型嫌色细胞癌与非嗜酸亚型嫌色细胞癌组的比较中,临床分期有显著性差异(P0.01),前者为较低的临床分期(主要为I期及II期);而在TNM分期的比较中,两组未显示出有明显差异(P0.05)。CK7分子在嫌色细胞癌组(54/86,63%)与嗜酸细胞腺瘤组(0/33,0%)两组中的表达有显著性差异(P0.01),同时在嗜酸亚型嫌色细胞癌组(11/14,79%)与嗜酸细胞腺瘤组两组中的表达比较也有显著性差异(P0.01),CK7在嫌色细胞癌组中均高表达;而CK20分子的表达在嫌色细胞癌(49/86,57%)、嗜酸亚型嫌色细胞癌(8/14,57%)以及嗜酸细胞腺瘤(15/33,45%)三组中的表达无显著性差异;CD44分子的表达在嫌色细胞癌(20/86,23%)、嗜酸亚型嫌色细胞癌(1/14,7%)以及嗜酸细胞腺瘤(5/32,16%)三组中的表达也无显著性差异;线粒体抗体的表达在嫌色细胞癌(68/84,81%)、嗜酸亚型嫌色细胞癌(12/14,86%)以及嗜酸细胞腺瘤(25/32,78%)三组中的表达也无显著性差异。结论肾嫌色细胞癌、嗜酸亚型嫌色细胞癌与嗜酸细胞腺瘤三组病例中,包括生存时间等的多数临床病理特征均无显著的差异,三者具有诸多相似之处,嗜酸亚型嫌色细胞癌组比非嗜酸亚型嫌色细胞癌组临床分期低;CK7(+)支持肾嫌色细胞癌的诊断,CK20、CD44和线粒体抗体的免疫组化表达在嫌色细胞癌及其亚组与肾嗜酸细胞腺瘤的诊断与鉴别诊断中无显著差异。     

肾脏嗜酸细胞腺瘤和肾癌的螺旋CT鉴别诊断

目的 提高对肾嗜酸性细胞腺瘤螺旋CT表现的认识水平，增加本病诊断的准确性。方法 分析经手术病理证实的16例共17个肾嗜酸细胞腺瘤的螺旋CT表现。结果 ①嗜酸细胞腺瘤和肾癌的CT形态表现比较：16例共17个嗜酸细胞腺瘤中，88.2%（15/17）的肾脏嗜酸细胞腺瘤平扫为密度均匀的肿块，70.6%（12/17）为等密度，所有肿瘤内均未见钙化，增强扫描时52.9%（9/17）不均匀强化，11.8%（2/17）在增强扫描皮髓期表现病灶中央星状瘢痕，其中1例星状瘢痕在肾盂期强化，呈星状高密度。30例早期肾细胞癌平扫时76.7%（23/30）为密度均匀的肿块，70.6%（19/30）为低密度，增强扫描时86.7%呈不均匀强化（26/30），13.3%（4/30）在皮髓期病灶出现中央星状瘢痕，2例出现轮辐状强化，其中1例可同时观察到轮辐状强化及中央瘢痕。②平扫时肾脏嗜酸细胞腺瘤的CT值较肾癌高，P值〈0.05。增强扫描各时相二者CT值无明显差异，但是嗜酸细胞腺瘤的增强峰值出现在皮髓期，而肾细胞癌的增强峰值出现在实质期。结论 肾脏嗜酸细胞腺瘤与肾癌鉴别诊断很困难，平扫多为等密度、没有包膜、没有钙化、增强扫描的峰值为皮髓期的肿块可提示嗜酸细胞腺瘤，但确诊还需穿刺活检。     

多层螺旋CT鉴别肾癌WHO病理类型的应用价值

目的：探讨多层螺旋CT鉴别不同类型肾癌的价值。方法：回顾性分析经病理证实的92例肾癌的CT表现，依据WHO病理分类包括透明细胞癌54例、乳头状癌25例、嫌色细胞癌13例。比较平扫、皮髓质期、肾实质期及排泄期各类肾癌的CT值及强化模式。结果：3种肾癌在平扫的CT值无统计学差异。在增强扫描皮髓质期、肾实质期及排泄期，透明细胞癌的CT值均高于乳头状癌和嫌色细胞癌，而后两者在增强各期均无统计学差异。均匀强化最常见于嫌色细胞癌，不均匀强化最常见于透明细胞癌。螺旋CT鉴别透明细胞癌与非透明细胞癌的准确性在皮髓质期、肾实质期、排泄期分别为93.5%、86.9%、81.5%。结论：多层螺旋CT鉴别透明细胞癌与非透明细胞癌有应用价值，但较难鉴别乳头状癌和嫌色细胞癌。     

螺旋CT动态增强扫描在肾癌亚型诊断中的应用

目的：探讨肾癌螺旋CT动态增强扫描表现,提高诊断水平。方法：回顾性分析72例经手术病理证实的肾脏恶性肿瘤CT动态增强扫描资料,其中肾细胞癌57例,依据WHO病理分类包括透明细胞癌38例、乳头状癌10例、嫌色细胞癌8例、梭形细胞癌1例。比较平扫、皮髓质期、肾实质期及排泄期各型肾癌的强化程度及强化模式。结果：3种肾癌在平扫的CT值无统计学差异。在增强扫描皮髓质期、肾实质期及排泄期,透明细胞癌的CT值均高于乳头状癌和嫌色细胞癌（P值分别为0.01、0.01和0.03）,而后二者在增强各期均无统计学差异。均匀强化最常见于嫌色细胞癌,不均匀强化最常见于透明细胞癌。结论：螺旋CT动态增强扫描鉴别透明细胞癌与非透明细胞癌有应用价值,同时在肾癌的鉴别诊断上具有重要意义,可用于在术前指导治疗方案的制定。     

肾嫌色细胞癌误诊为嗜酸细胞瘤的临床分析

目的探讨肾嫌色细胞癌和嗜酸细胞瘤的鉴别诊断要点并分析其误诊原因。方法回顾性分析我院2例肾嫌色细胞癌临床资料,总结其临床病理特征,进行文献复习及诊治分析。结果 2例均于术前误诊为良性肿瘤,术中冰冻切片提示嗜酸细胞瘤,术后病理为肾嫌色细胞癌。结论肾嫌色细胞癌和嗜酸细胞腺瘤形态学各有特征,免疫表型相似,鉴别诊断基于生长方式、细胞学特征及影像学分析。     

肾细胞癌及错构瘤超声造影灌注特点的探讨

目的探讨超声造影结合时间-强度曲线分析在肾细胞癌及肾错构瘤诊断与鉴别诊断中的应用价值。方法分析68例肾细胞癌及19例肾错构瘤患者的超声造影增强方式及其时间-强度曲线,比较两者造影增强的到达时间（AT）、达峰时间（TTP）、峰值强度（PI）、基准强度（BI）及β值。结果肾细胞癌超声造影增强方式主要为“快进”,肾错构瘤造影增强方式主要为“慢退”。在时间-强度曲线上,肾细胞癌的PI、β明显高于肾错构痫,TTP值低于肾错构瘤（P=0．000）,而两者的AT及BI值差异无统计学意义。结论超声造影结合时间一强度曲线分析有助于肾肿瘤的诊断与鉴别诊断。     

肾细胞癌的超声造影与增强CT对照研究

目的 探讨超声造影对肾细胞癌诊断的临床价值.方法 对65例肾细胞癌患者分别进行实时超声造影和增强CT检查,比较两种成像方法在肾细胞癌中的灌注特征及敏感性、特异性和准确性.所有病例均经手术和病理结果证实,其中肾透明细胞型肾细胞癌54例,肾嫌色细胞型肾细胞癌4例,肾乳头状肾细胞癌7例.结果 肾细胞癌在超声造影和增强CT中的灌注特点表现为"快进快退"者分别为76.9%(50/65)和83.1%(54/65).超声造影鉴别诊断肾细胞癌的敏感性、特异性和准确性分别为100%(60/60)、60.0%(3/5)、92.3%(60/65);增强CT鉴别诊断肾细胞癌的敏感性、特异性和准确性分别为96.7%(58/60)、40.0%(2/5)、78.5%(51/65).超声造影对肾细胞癌诊断的准确性高于增强CT(P＜0.05);而两者对肾细胞癌诊断的敏感性和特异性差异均无统计学意义(均P＞0.05).结论 超声造影可作为诊断肾细胞癌的一种重要方法.     

肾细胞癌超声造影与病理对照分析研究

目的：应用新型超声造影剂SonoVue观察肾细胞癌超声造影血流灌注特点,术后分析其病理特点。方法：对42例肾细胞癌患者术前进行超声造影检查,观察造影剂开始显影、达峰及消退的全过程,并用ACQ软件分析时间-强度曲线数值。结果：28个肾透明细胞癌超声造影呈富血供表现,时间－强度曲线分析显示透明细胞癌的ΔAT、ΔTTP低于其他两组,其ΔPI和ΔI60s明显高于其他两组,即“快进慢退高增强”的造影模式。另外3个肾透明细胞癌及所有的嫌色细胞癌和乳头状癌呈乏血供表现,嫌色细胞癌和乳头状癌的AT、TTP慢于周边肾组织,PI和I60低于周边肾组织,呈“慢进低增强”的造影特点。结论：实时超声造影能够提供不同肾细胞癌微血管灌注特征,为肾细胞癌的诊断及鉴别诊断提供了更多的参考依据,有较高的临床应用价值。     

分次团注对比增强能谱CT成像:肾透明细胞癌的显示及辐射剂量研究

目的评价分次团注对比剂单期增强能谱CT成像对肾透明细胞癌的显示及辐射剂量。方法本研究经医院伦理委员会的批准和患者的知情同意。收集经腹部彩超及超声造影诊断怀疑肾恶性肿瘤患者90例,随机将患者分为实验组和对照组。实验组采用分次团注单期增强扫描能谱成像,对照组采用单次注射对比剂双期动态增强扫描。实验组扫描方案:先团注70 ml对比剂,注入对比剂后25 s再注射50 ml对比剂并以相同流率跟注40 ml生理盐水。在第一次注射对比剂开始后70 s行能谱CT扫描。利用后处理软件,计算显示肿物、肾动脉和肾静脉的最佳单能量keV,并重组图像。对照组扫描方案:一次性注入对比剂120 ml,行多层螺旋CT双期扫描,于动脉CT值达到100 HU时扫描动脉期,延迟60 s扫描静脉期。测量肿瘤组织和相邻肾皮质间的比值LKR(LKR越远离1肿瘤显示越好)和对比噪声比CNR,肾动脉、肾静脉的CT值。记录患者BMI指数和辐射剂量。统计学分析采用t检验,Fisher精确检验和Mann-Whitney检验。结果实验组中肾透明细胞癌43例,嫌色细胞和乏脂肪血管平滑肌脂肪瘤各1例。对照组肾透明细胞癌44例,肾乳头状癌1例。两组患者在年龄、体重、性别和BMI指数无统计学差异。显示肾肿物、肾动脉的最佳单能量为58 keV,显示肾静脉最佳单能量为67 keV。实验组58 keV单能量图肿瘤显示力和CNR(0.7±0.02和10.3±3.2)优于常规组动脉期(1.08±0.04和5.3±2.2)(P0.01);实验组58 keV单能量图肾动脉CT值198±20.3 HU与常规组动脉期肾动脉CT值203±14.5 HU无明显差异(P0.05)。实验组67 keV单能量图肾静脉CT值200±34.0 HU高于常规组静脉期肾静脉CT值140±12.6 HU(P0.05)。实验组扫描剂量长度乘积[(735±162)mGy·cm]明显小于常规组[(1032±324)mGy·cm](P0.01)。结论分次团注对比剂单期增强能谱成像在肾透明细胞癌、肾动脉、肾静脉的显示等同于或优于常规双期增强扫描,同时辐射剂量明显减少。     

现代残疾康复理念、政策与社区康复体系研究

本研究分析了当代残疾康复的理念和理论架构,构建了以国际公约、决议和政策、国内法律和政策以及操作性工具3个层次的康复理论体系;运用包容性发展,分析探讨了当代社区康复的体系和特点;就发展康复事业、为残疾人提供全面系统的康复服务提出相关的政策建议。     

国内外唇腭裂专科护理发展现状的文献研究及分析

目的了解和分析国内唇腭裂专科护理工作发展的现状。方法检索并分析万方医学网、中国知网、Springer Link及PubMed英文数据库近6年有关唇腭裂手术的围术期护理、患儿的喂养、手术安全管理、围术期疼痛研究以及心理护理的相关文献。结果共检索出国内文献89篇(核心期刊20篇)、国外文献22篇,其中围术期护理38篇、患儿的喂养16篇、手术安全管理10篇、围术期疼痛研究10篇、心理护理15篇。结论与国外文献相比,国内论文总结和回顾性居多,应增加研究探讨性论文,从而促进唇腭裂临床护理工作专科化的发展。     

我院文职护士管理和培训的实践与体会

目的构建文职护士培训、使用及管理的科学方法。方法通过规范管理、科学施训、作为骨干大胆任用等多种管理方式,使文职护士得到充分的发展。结果文职护士群体成长为医院优秀骨干,首批满3年的文职护士顺利通过续聘考核。结论科学的管理培训是文职护士成长的重要基石,对医院护理管理有着重要作用。     

城乡学童个性行为特征调查

目的探讨农村与城市儿童的个性行为特征。方法将97名农村学龄儿童设为农村组,97名城市学龄儿童设为城市组,采用艾森克个性问卷一儿童版和Achenbach’s 行为量表一儿童版进行评定分析。结果两组学龄儿童艾森克个性问卷各维度评分均无显著性差异（P均〉0．05）,且与全国常模相一致（P均〉0．05）;农村组男学童Achenbach’s行为量表违纪行为、攻击行为及外向型因子分均显著高于城市组,女学童退缩、社交问题因子分均显著高于城市组（P〈0．05或0．01）,其他因子分均无显著性差异（P均〉0．05）。结论农村与城市儿童个性无显著差异,而农村儿童存在较多的行为问题,可能与其所受教养和生活方式有关。     

Comparison of short-term and long-term protocols for stabilization and preservation of RNA and DNA of Leishmania, Trypanosoma, and Plasmodium

Molecular tools continue to be important in the prevention and control of parasitic diseases. However, using these techniques directly in the field remains a major challenge. Therefore, the preservation of clinical samples collected from endemic field areas for later analysis remains an important preanalytical process. This study aimed at identifying a suitable protocol for stabilization and preservation of RNA and DNA in bioclinical specimens for Trypanosoma, Leishmania, and Plasmodium research. Both spiked and unspiked blood samples were preserved in 7 protocols (different media; storage temperatures). Samples were evaluated for possible degradation of DNA and RNA along the storage duration up to the 10th week. Nucleic acid targets were assessed as follows: (i) Trypanosoma and Plasmodium RNA analysis was done using real-time nucleic acid sequence-based amplification (RT-NASBA) for 18S rRNA and for stage-specific Pfs25 mRNA, respectively; (ii) Trypanosoma DNA assessment analysis was conducted by using a conventional PCR for 18S rDNA; (iii) Leishmania RNA analysis was performed with a quantitative NASBA for 18S rRNA and Leishmania DNA assessment with an RT-PCR for 18S rDNA. Findings suggested that a newly developed L3™ buffer proved to be reliable and suitable for both short- and long-term preservation of parasite nucleic acid material. This buffer is envisaged to be suitable for utilization in field situations where resources are limited.     

Rates and risks of transmission of smallpox and mechanisms of prevention

In 1980, the World Health Organization declared smallpox eradicated from the world; the last known natural case had occurred in Somalia in 1977, and the United States had stopped routinely vaccinating its citizens in 1972. However, with increasing concerns regarding domestic and international terrorism, smallpox has resurfaced as a potential threat to global health. We review the direct and indirect modes of smallpox transmission and how patterns of transmission vary substantially, depending on the severity of circulating disease, vaccination status, environmental and socioeconomic factors, and the setting of an outbreak. We examine mechanisms for controlling outbreaks of disease and preventing further transmission in the event of an outbreak, with an emphasis on smallpox vaccination.     

History of violence and subjective health of mother and child

Objective: To study the self-reported prevalence of experienced violence among a cohort of women about two years after giving birth, their health during pregnancy, pregnancy outcomes and their experience of their child’s health.

Setting and subjects: In 2011, a total of 657 women participated in phase III of the Childbirth and Health Cohort Study in Icelandic Primary Health Care, 18 to 24 months after delivery. The women had previously participated in phase I around pregnancy week 16 and phase II 5–6 months after delivery. Data were collected by postal questionnaires.

Main outcome measures: Women’s reported history of experienced violence, sociodemographic and obstetric background, self-perceived health, the use of medications and their child’s perceived health.

Results: In phase III, 16% of women reported experiencing violence. These women felt less support from their current partner (p?p?p?p?p?p?=?0.008).

Conclusions: Our study confirms that a history of violence is common among women. A history of violence is associated with various maternal health problems during and after pregnancy, a higher rate of caesarean sections and maternal reports of health problems in their child 18–24 months after birth.

• KEY POINTS

• Violence is a major concern worldwide. Understanding the impact of violence on human health and developing effective preventive measures are important elements of any public health agenda.

• ??The reported prevalence of experiencing violence was 16% among women attending antenatal care in the primary health care setting in Iceland.

• ??Women with a history of violence reported worse health in general during pregnancy and delivered more often by caesarean section, compared to women with no such history.

• ??Mothers with a history of violence also evaluated the general health of their child as worse than women with no such history.

• ??The findings of this study support the importance of recognizing and addressing experienced violence among women in primary care.

     

通用设计原则与产品研发策略

本文介绍了通用设计的概念和设计原则,并阐述了根据此原则实施通用设计的产品研发策略。通用设计惠及的不仅是残疾人,也惠及了包括普通公众在内的广泛人群,以及企业。应将通用设计的原理应融入政府相关政策和未来发展的规划中,为残疾人以及更多人群提供合理便利的通用设计产品。     

Prevalence and severity of nausea and vomiting of pregnancy and effect of vitamin supplementation.

OBJECTIVE: Although nausea and vomiting of pregnancy is the most common medical condition during pregnancy, there are many unanswered questions regarding its cause, epidemiologic features and optimal management. The objectives of this study were to ascertain the prevalence of nausea and vomiting in a sample of Canadian women, to characterize the distribution of their severity and to investigate the role of vitamin B6 deficiency in their etiology. DESIGN: Prospective study. SETTING: Antenatal counselling service for pregnant women. PATIENTS: Three cohorts of women: a prospective, population-based cohort of 193 women, to estimate the rate and severity of nausea and vomiting (cohort A); a cohort of 555 women who sought advice for nausea with or without vomiting, to study the correlation between the maximal daily number of episodes of vomiting and maximal weight loss (cohort B); and a prospective cohort of 301 women who reported vomiting, to correlate vitamin supplementation with vomiting (cohort C). INTERVENTIONS: All 3 cohorts were interviewed during the counselling session, and cohort B was followed up prospectively. OUTCOME MEASURES: Frequency of nausea and vomiting, weight loss, maximal number of daily episodes of vomiting, rate of multivitamin supplementation. RESULTS: Overall, 67% of the women in cohort A reported experiencing nausea or vomiting, or both; 22% reported vomiting, and 9% experienced weight loss. In cohort B there was a significant correlation between the maximal number of daily episodes of vomiting and maximal weight loss, although there was wide variation (r2 = 0.25, p < 0.001). There was a highly significant correlation between the number of daily vomiting episodes and mean weight loss (r2 = 0.99). In cohort C, vomiting was significantly associated with lack of supplementation with multivitamins before 6 weeks' gestation (p = 0.002). CONCLUSIONS: The relation between number of daily vomiting episodes and mean weight loss may serve as a clinical tool to assess the severity of nausea and vomiting in pregnancy and the success of anti-emetics and rehydration regimens. Further study is needed to elucidate the biologic basis of the observed association between vomiting and lack of multivitamin supplementation in early pregnancy.     

胃癌DNA含量与E-cad、EGFR表达的关系及其意义

目的　探讨胃癌组织DNA含量与E cad、EGFR表达的关系 ,评价其在浸润、转移潜能及预后判断中的作用。方法　应用图像分析仪及SP免疫组化法检测 30例正常胃黏膜上皮、30例不典型增生和 5 0例胃癌组织DNA含量与E cad、EGFR蛋白表达情况。结果　①正常胃黏膜上皮、Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌组的DI、PI、S %、>5c %逐渐增高 ,与胃癌分期、淋巴结转移显著相关 (P <0 0 1)。②E cad在正常胃黏膜上皮阳性表达率 10 0 % ,EGFR呈阴性表达 ;Ⅰ、Ⅱ、Ⅲ级不典型增生及胃癌E cad阳性表达率逐渐降低 ,EGFR的阳性表达率逐渐升高 ,且差异显著 (P <0 0 5 ) ;E cad表达减弱、EGFR表达升高与胃癌分化差、淋巴结转移显著相关 (P <0 0 1)。③E cad表达阴性的胃癌DNA指数及EGFR表达水平显著高于E cad阳性 (P <0 0 1)。结论　检测DNA含量及E cad、EGFR蛋白表达有助于胃癌的早期诊断及转移潜能和预后的判断。