CT、MRI对喉癌治疗方案选择的价值

目的 探讨CT、MRI对喉癌侵及范围及治疗方案选择的价值。 方法 分析35例喉癌患者平扫及强化CT、MRI显示声门上区、声门下区、声带、前联合、甲状软骨、声门旁间隙、杓状软骨肿瘤原发或侵及部位及颈部淋巴结转移情况,并与喉镜及手术病理结果对照。 结果 MRI平扫及强化显示声门上区、声门下区、声带、前联合、甲状软骨、声门旁间隙、杓状软骨病变及颈部淋巴结转移数多于CT,但无统计学差异,MRI平扫及强化敏感性一致,均高于CT平扫及强化,CT强化敏感性高于CT平扫;平扫及强化MRI、CT特异性、阳性预测值基本一致;MRI平扫、强化及CT强化Kappa值基本一致,均高于CT平扫;MRI平扫及强化阴性预测值一致,均高于CT平扫及强化,CT平扫及强化阴性预测值基本一致。 结论 MRI对喉癌侵及范围及治疗方案选择较CT能够提供更多信息。     

病毒性脑膜炎患儿血清及脑脊液PCT、VEGF、S100B蛋白、NSE、MMP及CGRP变化研究

目的:探讨病毒性脑膜炎患儿血清及脑脊液PCT、VEGF、S100B蛋白、NSE、MMP及CGRP变化情况。方法:选取2010年2月～2012年8月于本院进行诊治的35例病毒性脑膜炎患儿为观察组,选取同期进行体检的35名排除颅脑疾病的健康儿童为对照组,将两组小儿的血清及脑脊液PCT、VEGF、S100B蛋白、NSE、MMP-2、MMP-9及CGRP水平进行检测及比较,并将观察组中不同严重程度及分期患者的上述指标进行比较。结果:观察组的血清及脑脊液PCT、VEGF、S100B蛋白、NSE、MMP及CGRP水平均高于对照组,而观察组中重症患者高于轻症患者,急性期患者高于恢复期及后遗症期患者差异有统计学意义(P<0.05)。结论:病毒性脑膜炎患儿血清及脑脊液PCT、VEGF、S100B蛋白、NSE、MMP及CGRP水平均呈现升高的趋势,且不同严重程度及分期患者的这些指标均有一定的差异。     

在肺癌及癌前病变诊断和预后估计中计算机的应用及程序设计

目的:为了提高肺癌及癌前病变的早期诊断率及预后估计的准确性,在对肺癌及癌前病变进行大量的定量细胞学及免疫组织化学研究及医学统计的基础上,采用计算机技术建立一种对肺组织病变进行定量诊断及预后估计的新方法。方法:应用显微分光光度计法及免疫组织化学技术对129例肺正常、鳞化增生、非典型性增生组织及I、II、III期肺癌组织进行组织化学DNA、RNA定量研究和p53、nm23/NDPK、CD44v6基因蛋白的检测分析,并应用统计学处理和检验,获得各病变组织DNA、RNA和p53、nm23/NDPK、CD44V6的诊断范围。结果:在以上工作的基础上,由计算机按设计程序对肺癌及癌前病变进行定量诊断及预后估计。结论:该方法为肺组织病变的快速定量诊断及预后估计提供了一个新途径,在临床上有很好的应用前景。     

临床实习医学生测量儿童体格指标的可信度研究

目的 评价临床实习学生测量儿童体格数据的可信度.方法 采用方便抽样,收集实习学生入科培训后及出科时对婴幼儿头围、身长及顶臀长的测量数据,同步收集带教老师的复测数据,比较实习学生与带教老师的测量差异.采用测量者之间测量差异绝对值的均值(M AD)、关键差异值百分率等指标描述数据的可信度.结果 入科时头围、身长及顶臀长的M AD分别为0.46、0.55及0.81cm,出科时分别为0.30、0.43及0.51cm,差异有统计学意义(P<0.05).入科时头围、身长及顶臀长数据属于较好质量标准的关键差异值百分率分别为41.5%、58.0%及36.0%,出科时分别提高至53.5%、70.0%及59.0%,出科时头围、身长及顶臀长属于错误的数据分别为19.0%、10.0%及13.0%.结论 临床实习学生测量儿童身长数据质量较好,头围及顶臀长测量值存在较大的误差.     

牙周炎患者血清及龈沟液IL-8、TNF-α、IL-6、IL-21及骨代谢的变化研究

目的:探讨牙周炎患者血清及龈沟液IL-8、TNF-α、IL-6、IL-21及骨代谢的变化规律.方法:选取2008年12月-2010年2月于我院进行治疗的60例牙周炎患者为研究对象,选取同期的60名健康人为对照组,分别检测其血清及龈沟液IL-8、TNF-α、IL-6、IL-21及血清骨钙素、碱性磷酸酶、总钙及磷的水平.结果:经研究比较发现,观察组的IL-8、TNF-α、IL-6、IL-21、总钙及磷均高于对照组,血清骨钙素、碱性磷酸酶低于对照组,经比较,P均<0.05,均有显著性差异.结论:牙周炎患者血清及龈沟液TNF-α、IL-8、TNF-α、IL-6、IL-21及骨代谢的变化较大,可从一定程度上反应疾病的情况,值得临床进一步研究及探讨.     

血清CA125、CEA及AFP联合检测对卵巢癌的诊断价值

目的探讨联合检测血清肿瘤标志物CA125、CEA及AFP对卵巢的诊断价值及其意义。方法选择我院卵巢癌患者30例作为卵巢癌组,卵巢良性肿瘤患者30例作为良性肿瘤组,健康体检者30例作为对照组,进行血清CA125、CEA及AFP检测,比较三组CA125、CEA及AFP表达水平的差异j并比较卵巢癌组患者CA125、CEA及AFP单独检测及联合检测的阳性预测值和阴性预测值。结果卵巢癌组血清CA125、CEA及AFP表达水平高于对照组及良性肿瘤组,血清CA125、CEA及AFP联合检测的阳性预测值、阴性预测值高于CA125、CEA及AFP单独检测。结论血清CA125、CEA及AFP联合检测能够提高卵巢癌的诊断特异性,提高卵巢癌检出率。     

血液透析患者血管通路狭窄及血栓形成原因分析和护理对策

目的探讨血管通路多次发生狭窄及血栓形成的原因及护理对策。方法对8例反复发生血管狭窄及血栓形成的血液透析患者的临床资料进行回顾性调查分析。结果高脂血症、瘢痕体质、穿刺及按压不当均是血管通路狭窄及血栓形成的高危因素。结论针对各种高危因素,早期预防、给予心理及营养支持、穿刺中注意防护,可以降低血管通路狭窄及血栓的发生率。     

在肺癌及癌前病变诊断和预后估计中计算机的应用及程序设计

目的为了提高肺癌及癌前病变的早期诊断率及预后估计的准确性,在对肺癌及癌前病变进行大量的定量细胞学及免疫组织化学研究及医学统计的基础上,采用计算机技术建立一种对肺组织病变进行定量诊断及预后估计的新方法.方法应用显微分光光度计法及免疫组织化学技术对129例肺正常、鳞化增生、非典型性增生组织及Ⅰ、Ⅱ、Ⅲ期肺癌组织进行组织化学DNA、RNA定量研究和p53、nm23/NDPK、CD44v6基因蛋白的检测分析,并应用统计学处理和检验,获得各病变组织DNA、RNA和p53、nm23/NDPK、CD44V6的诊断范围.结果在以上工作的基础上,由计算机按设计程序对肺癌及癌前病变进行定量诊断及预后估计.结论该方法为肺组织病变的快速定量诊断及预后估计提供了一个新途径,在临床上有很好的应用前景.     

护士职业倦怠因素调查分析

目的:了解护士产生职业倦怠的因素,寻求缓解工作压力的有效方法.方法:选取3所二级医院的内科、外科及急诊科护士130名,采用工作压力源、焦虑和抑郁量表进行问卷调查,并对结果进行相关性分析及t检验.结果:三个科室护士的压力源主要来自护理专业及工作方面、工作量及时间分配方面、工作环境及仪器设备问题方面,其次为患者护理方面、管理及人际方面.护士的焦虑、抑郁得分均与工作压力源的护理专业及工作方面、工作量及时间分配方面、患者护理方面、管理及人际关系方面存在显著相关性.与工作环境及仪器设备问题不存在显著相关性.结论:内科、外科及急诊科护士存在多种工作压力源,导致心理健康水平低下,极易产生职业倦怠.管理者应采取相应的措施,缓解护士的工作压力,提高其心理健康水平.     

妊娠期激素及酶的功能

胎盘是重要的内分泌器官,通过合成多种激素、酶及蛋白质来维持妊娠、孕育胎儿.胎盘合成的激素及酶,主要有人绒毛膜促性腺激素、人胎盘生乳素、雌激素、孕激素等,缩宫素酶、耐热性碱性磷酸酶、前列腺素、多种神经递质和多种细胞因子及生长因子,这些激素及酶在整个妊娠期起着重要的作用.     

细针穿刺对淋巴瘤诊断技术的价值

1文献来源Hehn ST,Grogan TM,Miller TR.Utility offine needle aspiration as a diagnostic technique inlymphoma[J].J Clin Oncol,2004,22（15）：3046-3052.     

细针穿刺术诊断头颈部淋巴瘤的价值

1文献来源Kuvezdic＇KG,Aurer I,Ries S,et al.FNAbased diagnosis of head and neck nodal lymphoma[J].Coll Antropol,2010,34（1）：7-12.2证据水平2b。     

Hypercalcemic crisis due to a mediastinal parathyroid cyst diagnosed by ultrasound-guided fine needle aspiration

Hypercalcemic crisis, generally accepted as serum calcium concentration greater than 3.5 mmol/L,constitues a life-threatening endocrinologic emergency,and is most frequently caused by either primary hyperparathyroidism （PHPT） or malignant diseases.Parathyroid cysts are uncommon lesions, most of that are located in the low part of the neck. By routine neck ultrasound scan investigation in a large series of 6621 patients, only 5 parathyroid cysts were detected, yielding a prevalence of 0.075% in setting of unselected patients.The parathyroid cysts in the mediastinum are much less frequently encountered, with only 106 cases reported in English literature.2,3 Moreover, less than half of these cases presented as functional with elevated serum calcium and parathyroid hormone, and only 10 cases were associated with hypercalcemic crisis.3 Herein, we present a rare case of mediastinal parathyroid cyst associated with recurrent hypercalcemic crisis, which diagnosed by ultrasound-guided fine needle aspiration （FNA）.     

流式细胞免疫表型分析结合细针穿刺细胞学在非霍奇金淋巴瘤诊断中的应用

1文献来源Demurtas A,Accinelli G,Pacchioni D,et al.Utility of flow cytometry immunophenotyping in fine-needle aspirate cytologic diagnosis of non-Hodgkin lymphoma：A series of 252 cases and review of the     

细针穿刺活检在WHO分类基础上的非霍奇金淋巴瘤诊断价值

1文献来源Mourad WA,Tulbah A,Shoukri M,et al.Primary diagnosis and REAL/WHO classification of non-Hodgkin＇s lymphoma by fine-needle aspiration：     

The role of central nervous system on hypoglycemia and the feasibility of the brain theory in traditional Chinese medicine on treatment of diabetes mellitus

The central nervous system （CNS） plays a key regulatory role in glucose homeostasis. In particular, the brain is important in initiating and coordinating protective counterregulatory responses when blood glucose levels fall. This may due to the metabolic dependency of the CNS on glucose, and protection of food supply to the brain. In healthy subjects, blood glucose is normally maintained within a relatively narrow range. Hypoglycemia in diabetic patients can increase the risk of complications, such as heart disease and diabetic peripheral neuropathy. The clinical research finds that the use of traditional Chinese medicine （TCM） has a positive effect on the treatment of hypoglycemia. Here the authors reviewed the current understanding of sensing and counterregulatory responses to hypoglycemia, and discuss combining traditional Chinese and Western medicine and the theory of iatrogenic hypoglycemia in diabetes treatment. Furthermore, the authors clarify the feasibility of treating hypoglycemia on the basis of TCM theory and CNS and have an insight on its clinical practice.     

Chinese herbal medicine Xinfeng Capsule in treatment of rheumatoid arthritis： study protocol of a multicenter randomized controlled trial

BACKGROUND： Rheumatoid arthritis （RA）, as a common systemic inflammatory autoimmune disease, affects approximately 1 in 100 individuals. Effective treatment for RA is not yet available because current research does not have a clear understanding of the etiology and pathogenesis of RA. Xinfeng Capsule, a patent Chinese herbal medicine, has been used in the treatment of RA in recent years. Despite its reported clinical efficacy, there are no large-sample, multicenter, randomized trials that support the use of Xinfeng Capsule for RA. Therefore, we designed a randomized, double-blind, multicenter, placebo-controlled trial to assess the efficacy and safety of Xinfeng Capsule in the treatment of RA. METHODS AND DESIGN： This is a 12-week, randomized, placebo-controlled, double-blind, multicenter trial on the treatment of RA. The participants will be randomly assigned to the experimental group and the control group at a ratio of 1：1. Participants in the experimental group will receive Xinfeng Capsule and a pharmaceutical placebo （imitation leflunomide）. The control group will receive leflunomide and an herbal placebo （imitation Xinfeng Capsule）. The American College of Rheumatology （ACR） Criteria for RA will be used to measure the efficacy of the Xinfeng Capsule. The primary outcome measure will be the percentage of study participants who achieve an ACR 20% response rate （ACR20）, which will be measured every 4 weeks after randomization. Secondary outcomes will include the ACR50 and ACR70 responses, the side effects of the medications, the Disease Activity Score 28, RA biomarkers, quality of life, and X-rays of the hands and wrists. The first four of the secondary outcomes will be measured every 4 weeks and the others will be measured at baseline and after 12 weeks of treatment. DISCUSSION： The result of this trial will help to evaluate whether Xinfeng Capsule is effective and safe in the treatment of RA. TRIAL REGISTRATION： This trial has been registered in ClinicalTrials.gov. The identifier is N CT01774877.     

Relevance of muscle biopsy for diagnosing multifocal motor neuropathy

Multifocal motor neuropathy （MMN） is a rare,.focal,inflammatory,demyelinating disease of the peripheral nerves with pure motor involvementJ MMN is clinically characterized by slowly progressive,asymmetric,distal,upper limb predominant weakness,in the absence of sensory disturbances） Weakness is usually multifocal and connected to a distinct motor nerve,such as the musculocutaneous nerve resulting in biceps weakness,the posterior interosseus nerve resulting in finger drop,the median,ulnar,or radial nerve resulting in dexterity problems or grip weakness,or the peroneal nerve resulting in a foot drop.Onset of clinical manifestations is between 20 and 50 years of age.The prevalence of MMN is reported as 1-2 per 100 000.2 MMN is three times more frequent in men as compared to women.     

Association between intervertebral disc degeneration and disturbances of blood supply to the vertebrae

Low back pain is a common public health problem in western industrialized societies and the world as well.Studies indicate that the prevalence rate ranges to 35%, with around 10% of patients from 12% becoming chronically disabled. It also places an enormous economic burden on society. Although the exact cause of low back pain has yet to be defined, intervertebral disc degeneration is considered a major source of it. Since patients with degenerative discs are often asymptomatic, the mechanisms of it are still unclear.