宫颈癌术前或放疗中辅助介入治疗的临床应用

目的评价宫颈癌患者于放疗前或放疗过程中,以及部分Ⅱa期以前患者术前采用动脉灌注化疗和介入栓塞治疗进行新辅助化疗的效果。方法回顾性分析2000年4月—2006年12月来我科进行介入化疗的Ⅰb～Ⅲa宫颈癌患者31例,评价介入效果,观察并发症并定期随访。结果31例治疗的患者中,Ⅰb～Ⅱb期15例,经1～2次介入治疗后,行广泛性子宫切除4例,次广泛子宫切除11例;Ⅲ期宫颈癌16例,放疗过程中出血7例,治疗后放疗得以继续进行,其余9例于治疗后常规进行放疗,效果较好。结论介入化疗及栓塞治疗可作为宫颈癌患者术前及放疗过程中的新辅助化疗手段,应用前景好,值得临床推广。     

Ⅱ、Ⅲ期宫颈癌放疗效果与血红蛋白浓度的关系（附113例分析）

目的：探讨Ⅱ、Ⅲ期宫颈癌放疗后近期、远期疗效的关系。方法：2005～2007年113例Ⅱ、Ⅲ宫颈癌患者接受根治性放疗,放疗前及放疗中检测患者血红蛋白浓度,观察Hb和CR、无病生存的关系。结果：放疗中持续性贫血对Ⅱ、Ⅲ期宫颈癌的局部控制率及远期疗效有明显影响。结论：纠正贫血有助于宫颈癌的局部控制及提高远期疗效。     

1.5 T磁共振成像系统平扫联合扩散加权成像在 宫颈癌临床分期中应用价值

目的探讨1.5T磁共振成像(MRI)平扫+扩散加权成像(DWI)在宫颈癌临床分期中的应用价值。方法选取自2015年7月至2018年7月江汉大学附属医院武汉市第六医院收治的128例宫颈癌患者为观察组,另选取同期在我院体检的32例健康者为健康组。观察两组研究对象的MRI影像学资料,比较正常宫颈与癌组织、不同病理分期宫颈癌影像学指标值,同时分析宫颈癌患者病理诊断结果与MRI平扫、MRI平扫+DWI诊断结果的差异。结果观察组患者表观扩散系数(ADC)显著低于健康组,指数化表观扩散系数(eADC)显著高于健康组,组间比较,差异均有统计学意义(P<0.05)。宫颈癌Ⅱa期、Ⅱb期及Ⅲ+Ⅳ期患者ADC值显著高于Ⅰb期;宫颈癌Ⅲ+Ⅳ期患者ADC值显著高于Ⅱa期、Ⅱb期;宫颈癌Ⅱa期、Ⅱb期及Ⅲ+Ⅳ期eADC值显著低于Ⅰb期;宫颈癌Ⅱb期和Ⅲ+Ⅳ期eADC值显著低于Ⅱa期;宫颈癌Ⅲ+Ⅳ期eADC值显著低于Ⅱb期,组间比较,差异有统计学意义(P<0.05)。MRI平扫+DWI用于宫颈癌分期诊断的准确率略高于MRI平扫,但组间比较,差异无统计学意义(P>0.05)。结论 1.5T MRI平扫+DWI用于宫颈癌临床分期诊断准确性更高,且更有助于鉴别诊断正常宫颈和宫颈癌组织。     

DWI联合MRI动态增强扫描在诊断宫颈癌分期中的应用

目的：分析DWI联合MRI动态增强扫描在宫颈癌国际妇产科联盟（FIGO）2018分期中的应用效果。方法：回顾性分析68例经病理证实的宫颈癌患者,均行DWI和动态增强扫描,分析DWI联合动态增强扫描与FIGO2018分期的诊断一致性。结果：68例中,FIGO2018分期ⅠB1期20例、ⅠB2期15例、ⅠB3期4例、ⅡA1期11例、ⅡA2期7例、ⅡB期2例、ⅢB期2例、ⅢC1期2例、ⅣA期5例;DWI联合动态增强扫描示55例与FIGO2018分期一致,其中,ⅠB1期18例、ⅠB2期13例、ⅠB3期2例、ⅡA1期9例、ⅡA2期5例、ⅡB期2例、ⅢB期1例、ⅢC1期1例、ⅣA期4例。经Kappa检验,2种诊断方法的一致性较好（K=0.768,P<0.05）。DWI联合动态增强扫描诊断宫颈癌ⅠB1、ⅠB2、ⅠB3、ⅡA1、ⅡA2、ⅡB、ⅢB、ⅢC1、ⅣA期的约登指数分别为0.879、0.848、0.469、0.801、0.665、0.985、0.470、0.485、0.784,准确率分别为95.59%、95.59%、94.12%、95.59%、92.65%、98.53%、95.59%、97...     

MRI与MSCT检查对浸润性宫颈癌术前分期的临床价值

目的 探讨MRI与MSCT在浸润性宫颈癌术前分期的应用价值。方法 选取本院121例疑似浸润性宫颈癌患者,均行MRI和MSCT检查,以病理检查结果为金标准,观察MRI和MSCT对浸润性宫颈癌的诊断价值。结果 金标准诊断显示阳性102例、阴性19例; MRI检查显示阳性99例、阴性22例; MSCT检查显示阳性96例、阴性25例,三种方式诊断结果比较无明显差异(P> 0.05)。MRI诊断灵敏度96.08%、阴性预测值98%和准确度95.04%均高于MSCT(86.27%、44%和81.82%)(P <0.05)。病理检查确诊患者临床分期显示ⅠA期8例、ⅠB期31例、ⅡA期36例、ⅡB期23例、≥ⅢA期4例;病理检查确诊患者经MRI检查情况显示ⅠA期8例、ⅠB期35例、ⅡA期38例、ⅡB期17例、≥ⅢA期4例;经MSCT检查情况显示ⅠA期6例、ⅠB期28例、ⅡA期35例、ⅡB期27例、≥ⅢA期6例; MRI与病理检查结果在术前临床分期方面一致性较高(Kappa值:0.8364,95.00%可信区间:0.7214～0.9513),MSCT与病理检查结果在术前临床分期方面一致性一般...     

经阴道彩色多普勒超声诊断宫颈癌的临床研究

目的探讨经阴道彩色多普勒超声检查宫颈癌的影像学特征及其诊断价值。方法选取130例经新柏氏液基细胞学技术(TCT)、宫颈活检和病理检查证实为宫颈上皮内瘤样变(CIN)Ⅰ-Ⅲ级及宫颈癌的病例进行经阴道彩色多普勒检查,对声像图特征及彩色多普勒血流显像(CDFI)结果进行分析。选取同期宫颈视诊和细胞学检查均无异常的41例就诊患者为正常对照。结果由正常宫颈、CIN、宫颈原位癌到宫颈浸润癌,经阴道彩色多普勒超声检查中测量宫颈径线增大、宫颈呈低回声病灶表现的病例逐渐增多,其中宫颈低回声病灶仅出现在宫颈癌中,是宫颈癌的特异性超声影像变化,特异度为100%。宫颈黏膜线缺失是宫颈癌Ⅱ期特有的表现,特异度为100%。CDFI和血流阻力指数(RI)均提示宫颈浸润癌局部血流明显较正常宫颈、CIN和原位癌丰富,宫颈浸润癌Ⅰ期与Ⅱ期之间差异亦有统计学意义(P<0.05)。Kappa分析显示,宫颈径线增大诊断宫颈浸润癌的敏感度和特异度分别为89.1%和82.8%,宫颈低回声病灶在诊断宫颈癌和宫颈浸润癌中的特异度分别为100%和94.8%,树枝状血流分布诊断宫颈浸润癌的特异度为100%。结论经阴道彩色多普勒超声检查在宫颈浸润癌中有较多特征性影像学改变,其诊断可信度较高,对宫颈癌前病变、原位癌的诊断可靠性较低,联合其他辅助检查,可作为宫颈癌诊断以及放疗与化疗前后评价疗效的方法之一。     

预测宫颈癌患者的肿瘤控制情况:用容量和动态增强MR联合分析

已有用容积或动态增强MR的量化分析可以预测宫颈癌对放疗反应的报道。为评价两者相结合后能否提高预测率,作者对20例宫颈癌进展期患者(25～89岁)进行联合分析,分期为Ⅰ_B(2例)、Ⅱ_B(6例)、Ⅲ_A(1例)、Ⅲ_B(9例)、Ⅳ_A(1例),1例为复发,12例为鳞癌,3例为腺癌,肿瘤大小(13～293cm~3,平均为86cm~3)。每例均在放疗前及早期治疗时(即20～22Gy治疗2周后)进行MR检查。用场强     

常规超声联合超声造影成像对宫颈癌诊断及分期初步研究

目的探讨常规超声联合超声造影检查(CEUS)在诊断宫颈癌及分期中的应用价值。方法对36例临床诊断为宫颈癌的患者,在术前进行超声及CEUS根据肿块部位、大小、对周围组织的侵犯情况进行分期,并与手术病理分期对照,分析其诊断宫颈癌分期的准确性。结果常规超声联合CEUS诊断宫颈癌Ⅰb、Ⅱ、Ⅲ、Ⅳ期准确率分别为100.0%(4/4)、75.0%(9/12)、92.9%(13/14)和100.0%(6/6),总准确率达88.9%(32/36),两者检查结果高度一致(Kappa值=0.866)。结论超声联合CEUS诊断宫颈癌分期的准确率较高,可以作为主要影像学检查方法之一。     

鼻咽癌CT类型和放射治疗剂量与鼻咽癌预后的初步研究

探讨鼻咽癌ＣＴ类型和放射剂量与鼻咽癌预后的关系，为设置合理的放疗剂量提供依据，方法５６例疗前ＮＰＣ，均有完整的放疗后３年追踪资料，鼻咽癌复发者１７例，鼻咽正常３９例；根据疗前ＣＴ表现，５６例ＮＰＣ分为Ⅰ型１３例，Ⅱ型２８例，Ⅲ型１５例；鼻咽癌     

低氧降低放疗病人副作用及并发症的临床研究

通过对８０例宫颈癌病人采用低氧放疗和常规放疗的资料分析,初步探讨了低氧在降低宫颈癌放疗副作用及并发症的临床应用价值。临床资料：１９９５年２月至１９９８年６月,自愿接受本治疗的８０例宫颈癌病人,其中Ⅱｂ期４２例,Ⅲｂ期３８例,均经病理证实为鳞癌。病理形...     

快速进入高原后的心功能变化

本实验采用多阶踏阶方法在平原和高原测定运动后即刻心率和耗氧量,用功率与心率、功率与耗氧量间的线性关系,计算出6种劳动强度对应的心率、耗氧量测量值的直线回归方程,推算出人体工作能力(PWC_(170))、亚极量踏阶心率(HR_(720))、亚极量踏阶耗氧量(■_2_(172))、工作效率(E)等指标,并计算氧脉搏(O_2P)。通过在平原和到达高原后不同天数所得数据的比较,得出在所观测的两周里从平原快速空运进入高原后各项指标的变化特点:在高原人体的亚极量踏阶运动心率和耗氧量上升;人体工作能力和工作效率降低;氧脉搏增加。认为快速进入高原后5～7天心功能由快速反应性的下降转变为高原适应期的适应性下降。     

D-二聚体、纤溶酶原激活物抑制物在急性肾衰竭患者血液净化中的临床意义

目的探讨急性肾衰竭(ARF)时D-二聚体(D-D)、纤溶酶原激活物抑制物(PAI)在不同的血液净化方法中的动态变化及临床意义。方法对我院2007年1月—2010年3月急诊住院58例ARF患者血液净化前、净化后4 h及38例健康人进行血浆中D-D含量及PAI水平测定。ARF患者血液净化方法随机采用血液透析(HD)(31例)、血液透析滤过(HDF)(27例)。结果 ARF患者D-D含量及PAI水平较对照组明显升高[D-D(0.83±0.04)与(0.48±0.03)mg/L,P=0.000 2;PAI(14.95±0.73)与(8.03±0.30)103kat/L,P<0.0001;]HD治疗4 h后D-D含量和PAI活性较治疗前升高[D-D(0.89±0.05)与(1.48±0.37)mg/L,P=0.018;PAI(14.89±1.78)与(22.10±3.56)103kat/L,P=0.025],而HDF治疗后D-D含量和PAI无明显变化[D-D(0.91±0.06)与(1.12±0.09)mg/L,P=0.65;PAI(15.81±1.98)与(16.10±2.56)103kat/L,P=0.86]。结论 ARF患者D-D、PAI水平升高,存在凝血-纤溶系统的紊乱,HD可以加重这种改变,而采用HDF治疗可避免对患者凝血机能的影响,在急性肾衰竭治疗中有一定临床价值。     

Anterior interosseous nerve lession and distal myoclonus revealing a parsonage turner syndrome associated with hashimoto thyroiditys

Parsonage-Turner Syndrome (PTS), also known as brachial neuritis or neuralgic amyotrophy, is a rare disorder affecting 2 to 3 individuals per 100,000 each year. Abrupt onset shoulder pain, followed by motor weakness, paresthesia and hypoesthesia, is usually reported, lasting several months with variable recovery. The etiology of the disease may be idiopathic or triggered by an underlying autoimmune disease in genetically susceptible individuals. Our report addresses a unique case of Parsonage-Turner Syndrome in a patient suffering from concurrent Hashimoto Thyroiditis. A previously healthy A 22 year-old female was referred to the Department of Neurology after complaints of sudden-onset motor weakness in her left upper limb. On physical examination, the patient could not make an “Ok sign” with her thumb and distal phalanx or form a complete fist, revealing weakness within the anterior interosseous branch of the median nerve. Further testing with electromyography demonstrated muscular atrophy within the arm''s anterior compartment, forearm, and triceps brachii of the posterior compartment. Additional imaging and physical examination were unremarkable, confirming our diagnosis of PTS. Furthermore, lab reports revealed elevated levels of anti-thyroglobulin and anti-thyroid peroxidase antibodies and our patient was concurrently diagnosed with Hashimoto''s thyroiditis.This case aims to highlight the rare co-occurrence of Hashimoto''s thyroiditis with Parsonage-Turner Syndrome in an otherwise healthy patient. A 2014 study published by Nugent et al. had also shed light on brachial neuritis in a patient suffering from autoimmune connective tissue disease, and through this case study, we hope to add to the growing literature regarding the correlation between PTS and autoimmune diseases. Symptoms of PTS can easily be misdiagnosed given its similarity to other peripheral neuropathies, and careful assessment and thorough understanding of the disease is required to successfully distinguish it from other neurological pathologies.     

Validity of apparent diffusion coefficient (ADC) value in diagnosis and follow-up of multiple sclerosis patients in different clinical subtypes

Background

Multiple sclerosis (MS) is a chronic disease with a wide range of pathologic changes that modify the apparent diffusion coefficient (ADC) value.

血清PCT、NLR及BUN水平与急性胰腺炎严重程度的相关性分析

目的探讨急性胰腺炎(acute pancreatitis,AP)患者血清降钙素原(procalcitonin,PCT)、中性粒细胞与淋巴细胞比值(neutrophil lymphocyte ratio,NLR)以及尿素氮(blood urea nitrogen,BUN)水平与疾病严重程度的关系。方法收集2014年3月—2018年5月在成都医学院第二附属医院就诊的148例AP患者。所有病例均在入院后完善血生化检查,将患者按照2012亚特兰大分类标准分为轻度急性胰腺炎(mild acute pancreatitis,MAP)、中度急性胰腺炎(moderately severe acute pancreatitis,MSAP)、重度急性胰腺炎(severe acute pancreatitis,SAP)3组。比较3组患者入院后第1天清晨血清PCT、NLR及BUN水平,使用受试者工作特征(receiver operating characteristic,ROC)曲线评价血清PCT、NLR及BUN水平预测轻度、中度、重度AP的效力。使用Ranson评分对患者进行病情评估。结果SAP组血清PCT、NLR、BUN水平及Ranson评分高于MAP组、MSAP组,且MSAP组上述指标高于MAP组,差异比较具有统计学意义(P<0.05);SAP组住院天数多于MAP组、MSAP组,MSAP组住院天数多于MAP组(P<0.05);Pearson相关分析结果显示血清PCT、NLR、BUN水平均与Ranson评分得分显著正相关((r=0.48,P<0.05;r=0.62,P<0.05;r=0.40,P<0.05);ROC曲线分析表明PCT、NLR、BUN 3者联合评估轻度、中度、重度AP的AUC分别大于PCT和BUN单项(P<0.05),与NLR差异比较无统计学意义(P>0.05)。结论血清PCT、NLR、BUN水平均与AP病情严重程度呈正相关,且对轻度、中度、重度AP预测具有一定价值,3者联合应用对评估AP病情严重程度具有较好的早期预测价值。     

The therapeutic impact of abdominal ultrasound in patients with acute abdominal symptoms

AIM: The technical performance of abdominal ultrasound in the investigation of acute abdominal pain has been thoroughly investigated but its therapeutic effects are less well understood. We aimed to determine the therapeutic effect of abdominal ultrasound in the investigation of acute abdominal pain. MATERIAL AND METHODS: A pre- and post-intervention observational study design was used to determine the diagnostic and therapeutic effects of abdominal ultrasound for acute abdominal pain. Referring clinicians completed a pre-ultrasound questionnaire that detailed their leading diagnosis, confidence in this and intended management in 100 consecutive adult patients. Following ultrasound a second questionnaire was completed. This again detailed the leading diagnosis, confidence in this and their intended management. Clinicians quantified the management contribution of ultrasound both for the individual case in question and in their clinical experience generally. RESULTS: The leading diagnosis was either confirmed or rejected in 72 patients and a new diagnosis provided where no prior differential diagnosis existed in 10. Diagnostic confidence increased significantly following ultrasound (mean score 6.5 pre-ultrasound vs 7.6 post-ultrasound, P < 0.001). Intended management changed following ultrasound in 22 patients; 15 intended laparotomies were halted and a further seven patients underwent surgery where this was not originally intended. Ultrasound was rated either 'very' or 'moderately' helpful in 87% of patients, with 99% of clinicians finding it either 'very' or 'moderately' helpful generally. CONCLUSION: Abdominal ultrasound has considerable diagnostic and therapeutic effect in the setting of acute abdominal pain.     

中晚期肝癌化学免疫治疗与单纯TAE治疗疗效比较

本文采用肝动脉化学栓塞(TAE)后1～2周内行LAK/IL2的化学免疫治疗(Chemo-immu-notherapy CIT)中晚期肝癌(Mid-advanced HCC)42例(CIT组),TAE治疗2 7例为对照(TAE组)。结果:Ⅱ期HCC 2年生存率47.4％,Ⅱ期HCC部分缓解率(PR)和3个月、半年、1年生存率分别为39.1％、73.9％、56.5％和34.7％,显著高于TAE组Ⅱ期HCC二年生存率16.7％,(P<0.05)和Ⅱ期HCC部分缓解率为6.7％,三个月、半年、1年生存率40.0％,13.3％和6.7％,P<0.05;Ⅱ期HCC 1年内肝外转移率(25.5％)明显低于TAE组(66.7％,P<0.05)。表明化学免疫治疗能显著提高中晚期肝癌疗效。     

高压氧辅助治疗对卒中后抑郁患者血清5-HT、NE及神经功能的影响

目的：观察高压氧（HBO）辅助治疗对卒中后抑郁（PSD）患者血清5-羟色胺（5-HT）、去甲肾上腺素（NE）及神经功能的影响。方法70例PSD患者根据数字表法随机分为2组,对照组（n=35例）采用常规措施治疗,观察组（n=35例）待确定活动性出血已稳定或已趋于稳定后,在对照组治疗基础上加用HBO治疗。两组疗程均为30d,比较两组患者治疗前后血清5-HT、NE表达水平及汉密尔顿抑郁量表（HAMD）、中国脑卒中量表（CSS）,改良Barthel指数（MBI）评分变化。结果两组患者治疗后血清5-HT、NE表达水平均明显升高（P<0.05）,且观察组升高较对照组更为显著（P<0.05）;两组患者治疗后HAMD、CSS评分明显降低（P<0.05）,而MBI评分明显升高（P<0.05）,且观察组降低或升高较对照组更为显著（P<0.05）。结论 HBO辅助治疗可明显升高PSD患者血清5-HT、NE表达水平,改善抑郁状态和神经功能。     

Computer-aided detection of pulmonary embolism: Influence on radiologists’ detection performance with respect to vessel segments

The purpose was to assess the sensitivity of a CAD software prototype for the detection of pulmonary embolism in MDCT chest examinations with regard to vessel level and to assess the influence on radiologists' detection performance. Forty-three patients with suspected PE were included in this retrospective study. MDCT chest examinations with a standard PE protocol were acquired at a 16-slice MDCT. All patient data were read by three radiologists (R1, R2, R3), and all thrombi were marked. A CAD prototype software was applied to all datasets, and each finding of the software was analyzed with regard to vessel level. The standard of reference was assessed in a consensus read. Sensitivity for the radiologists and CAD software was assessed. Thirty-three patients were positive for PE, with a total of 215 thrombi. The mean overall sensitivity for the CAD software alone was 83% (specificity, 80%). Radiologist sensitivity was 77% = R3, 82% = R2, and R1 = 87%. With the aid of the CAD software, sensitivities increased to 98% (R1), 93% (R2), and 92% (R3) (p<0.0001). CAD performance at the lobar level was 87%, at the segmental 90% and at the subsegmental 77%. With the use of CAD for PE, the detection performance of radiologists can be improved.     

Application of selective saturation to image the dynamics of arterial blood flow during brain activation using magnetic resonance imaging.

A saturation-based approach is proposed to image the arterial blood flow signal with temporal resolution of 1 to 2 s and in-plane spatial resolution of a few millimeters. Using a saturation approach to suppress the undesired background stationary signal allows the blood water that enters the slice to be imaged at some specified later time. Since the blood protons that are being imaged are not restricted to the intravascular space, this technique is also sensitive to tissue perfusion signal contributions. The signal uptake characteristics of the saturation method proposed were used to study the different signal contributions as a function of the acquisition parameters. A typical perfusion acquisition (FAIR) was also used for comparison. The proposed method was demonstrated in a functional motor activation experiment and the observed signal changes were smaller than those obtained using the FAIR acquisition. The dynamics of the saturation method and FAIR temporal signal changes were investigated and time constants between 2 and 44 s were estimated. The tissue signal contribution to the saturation method's signal was small over the range of acquisition parameters that sensitized it to the arterial compartment.