3.0 T磁共振弥散加权成像表观弥散系数对肾脏肿瘤性病变的诊断价值

目的:探讨3.0T磁共振(MRI)弥散加权成像(DWI)量化指标对肾脏肿瘤性病变的诊断和鉴别诊断价值。方法:收集行肾脏MRI检查并经病理确诊的肾脏实质肿瘤89例。其中,肾细胞癌60例,包括39例肾透明细胞癌、8例乳头状肾细胞癌、9例肾嫌色细胞癌、4例多房囊性肾细胞癌;良性病变29例,包括肾血管平滑肌脂肪瘤25例,嗜酸细胞瘤4例。所有患者采用GE Signa HD 3.0T MR进行横断面DWI成像并行表观弥散系数(apparent diffusion coefficient,ADC)值测量。结果:肾透明细胞癌、乳头状肾细胞癌、肾嫌色细胞癌、多房囊性肾细胞癌ADC平均值分别为(1.681 5±0.176 9)×10~(-3)、(1.165 0±0.217 0)×10~(-3)、(1.121 0±0.231 6)×10~(-3)、(2.030 0±0.235 1)×10~(-3) mm~2/s,肾血管平滑肌脂肪瘤、肾嗜酸细胞瘤ADC平均值分别为(1.155 2±0.132 0)×10~(-3)、(1.580 0±0.212 3)×10~(-3) mm~2/s。肾透明细胞癌ADC值与乳头状肾细胞癌、肾嫌色细胞癌、肾血管平滑肌脂肪瘤ADC值差异均有统计学意义(P=0.000);而与多房囊性肾细胞癌、肾嗜酸细胞瘤ADC值差异无统计意义。结论:3.0T MR-DWI成像ADC值对肾脏肿瘤性病变具有鉴别诊断价值,有利于指导患者治疗方案的选择。     

A PRIM approach to predictive‐signature development for patient stratification

Patients often respond differently to a treatment because of individual heterogeneity. Failures of clinical trials can be substantially reduced if, prior to an investigational treatment, patients are stratified into responders and nonresponders based on biological or demographic characteristics. These characteristics are captured by a predictive signature. In this paper, we propose a procedure to search for predictive signatures based on the approach of patient rule induction method. Specifically, we discuss selection of a proper objective function for the search, present its algorithm, and describe a resampling scheme that can enhance search performance. Through simulations, we characterize conditions under which the procedure works well. To demonstrate practical uses of the procedure, we apply it to two real‐world data sets. We also compare the results with those obtained from a recent regression‐based approach, Adaptive Index Models, and discuss their respective advantages. In this study, we focus on oncology applications with survival responses. © 2014 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd.     

北京市三阶段新生儿听力筛查成本效果分析

目的 比较新生儿听力筛查两阶段和三阶段的成本效果, 为普遍性筛查提供依据。方法 对2010年10月至2012年12月北京市7家医院出生的正常新生儿进行听力筛查, 分别采用两阶段和三阶段策略及听力诊断性检查, 比较两种筛查的成本/效果比。其中筛查和诊断成本数据源自医院, 采用自行设计问卷对家长调查额外交通费和误工费。根据依从率进行敏感性分析。结果 新生儿初筛62 695人, 未通过5 809人, 阳性率为9.30%;复筛4 933人, 未通过972人, 阳性率为19.70%;复筛未通过并就诊于指定医疗机构者412人。完成诊断性评估360人, 听力异常者217例, 听力异常率为60.28%。完成三阶段筛查共276人, 未通过163人。其中125人完成诊断性检查, 异常112例(中度以上45例), 听力异常率为89.60%。以实际筛查率和诊断率计算成本/效果比, 两阶段(19 985元/例)优于三阶段(37 242元/例), 但随着筛查依从率的提高, 三阶段筛查的成本效果也随之提高。结论 筛查依从率影响三阶段筛查的成本效果, 在筛查依从率较高(>90%)的地区可考虑使用三阶段筛查方法。     

Adaptive superpixel based Markov random field model for unsupervised change detection using remotely sensed images

This study presents an adaptive superpixel based Markov Random Field (ASP_MRF) model for unsupervised remotely sensed images change detection. Firstly, the difference image is generated by change vector analysis (CVA) and the zero parameter version of the ‘simple linear iterative clustering’ method (SLICO) is applied on the difference image to obtain the superpixel map. Then, the superpixel map is initially labeled as changed and unchanged class by Fuzzy c-means (FCM) clustering method. Thirdly, the region adjacent graph (RAG) is built on the superpixel map to model the spatial constraints between the adjacent superpixels. Specially, the spectral dissimilarity between the adjacent superpixels and the label fuzziness of the neighbored superpixels were incorporated in the RAG. Lastly, The initial labels of the superpixel map are iteratively refined with ASP_MRF to generate the final change map. The experimental results prove that ASP_MRF obtained the most accurate change map and outperformed the results by pixel level MRF and superpixel based MRF, which verifies the effectiveness of ASP_MRF.     

Arterial stimulation with simultaneous venous sampling for localizing insulinomas

Purpose: The present study aimed to assess the accuracies of arterial stimulation with simultaneous venous sampling (ASVS) in preoperative localization of insulinomas.Materials and Methods: A cohort consisting of 6 males and 14 females (median age, 48.5y; range, 28–62y) with pathologically proven insulinomas were included in this study. Selective angiographies were performed with the superior mesenteric artery (SMA), gastroduodenal artery (GDA), proximal splenic artery, and midsplenic artery in all individuals. Then ASVS procedures were followed after angiographies for these arteries. Clinical characteristics of the patient and the tumor number, location, and size were recorded. The accuracy of preoperative localization of insulinomas was tested.Results: A total of 22 tumors were identified by histopathological diagnosis. The mean size of the tumor was 1.40±0.60cm. Five tumors were in the head/neck region and 17 in the body/tail region. ASVS accurately localized 17/20 (85%) cases with only biochemical data and 19/20 (95%) cases with biochemical data and angiography images. Variant pancreatic arterial anatomy was revealed in 2 false cases with inferior pancreatic artery replaced by the superior mesenteric artery.Conclusion: ASVS was highly accurate in localizing insulinomas and should be performed in most of the patients with suspected insulinomas before the operation.     

乙型肝炎病毒 B、C 基因型与临床表现

目的：研究广东地区乙型肝炎病毒基因型分布情况,B、C 基因型与乙型肝炎患者临床表现之间的关系。方法：回顾性分析172例慢性乙型肝炎病毒患者[慢性乙型病毒性肝炎（CHB）、乙型肝炎后肝硬化（LC）、原发性肝癌（HCC）]的乙型肝炎病毒基因分型结果,并根据基因分型结果进行分组,比较 B、C基因型患者的临床表现、HBeAg 定性、HBV-DNA 定量、ALT 及 AST 结果。结果：172例患者的乙肝病毒型分别为 B 型94例（54.7％）、C 型69例（40.1％）、D 型3例（1.7％）、未分型6例（3.5％）;C 型在 LC 组、HCC组中的比例与 CHB 组比较,差异有统计学意义（P﹤0.05）;C 型的 HBeAg 阳性率高于 B 型（P﹤0.05）;B、C型两组的 ALT、AST 差异有显著统计学意义（P﹤0.01）;两组基因型间 HBV-DNA 水平的差异无统计学意义（P﹥0.05）。结论：广东地区 HBV 感染以 B、C 基因型为主,以 B 型居高;C 基因型肝功能损害更严重,发展为肝硬化、肝癌的可能性更大,感染不同 HBV 基因型与 HBV-DNA 水平无明显相关。     

基于“(3+X)+1”模式的研究生思政课教学创新改革与实践研究

目的:增强研究生思政课教学效果,提高研究生培养质量,同时为高校研究生思政课教学改革提供借鉴。方法:对高校研究生思想政治理论课进行创新改革与实践,分析高校研究生思想政治理论课教学现状,提出高校研究生思政课程"(3+X)+1"教学创新模式的构建。通过实施合班上大讲坛、邀请专家专题讲座、引入多样化实践环节和论文学术不端检测、建立保障机制等手段,总结创新改革取得的成效。结果:"(3+X)+1"模式的研究生思政课教学改革改变了传统理论授课模式,丰富了教学内容,改变了老师强制灌输、研究生被动接受的局面,增进了教、学双方的积极性,有利于教学相长;新模式引入了丰富多彩地实践环节,加深了理论内化,有助于培养研究生的自主学习能力,激发其思维灵活性;论文写作引入论文学术不端检测,端正了研究生学习态度;建立了工作量和津贴计算等有效保障机制,激励教师全身心投入教学。结论:基于"(3+X)+1"模式的高校研究生思政课教学创新改革实践,对增强研究生思政课的教学效果和提高研究生培养质量有着积极促进意义,教改经验可操作性强,继续完善教改模式后将持续实施,亦可向其它高校推广。     

肾综合征出血热患者血清CRP、β2-M的变化及意义

目的:探讨肾综合征出血热(HFRS)患者血清C-反应蛋白(CRP)、β2-微球蛋白(β2-M)的变化及其临床意义.方法:选取本院收治的不同病期HFRS患者222例,采用胶乳法、放射免疫法分别检测患者血清中CRP、β2-M水平,并与正常健康人进行对比分析.结果:HFRS患者发热第2日CRP阳性率为83.3％,同期尿蛋白阳性率为33.3％;HFRS患者发热期、低血压期、少尿期CRP、β2-M均较正常人明显增高,差异具有统计学意义(P＜0.05),多尿期、恢复期,逐渐下降并恢复正常.重危型患者CRP明显高于中型患者.血清β2-M在发热期、低血压期、少尿期、多尿期均高于正常人.结论:HFRS患者检测血清CRP、β2-M有助于的早期诊断,病情分析和预后判断.     

健脾祛湿方对2型糖尿病并非酒精性脂肪肝患者脂联素、肿瘤坏死因子-α和肝脏脂肪含量的影响

【目的】观察健脾祛湿方对2型糖尿病（type 2 diabetes mellitus, T2DM）并非酒精性脂肪肝（non-alcoholic fatty liver disease, NAFLD）患者脂联素（adiponectin, APN）、肿瘤坏死因子-α（tumor necrosis facto al’pha, TNF-α）及肝脏脂肪含量变化的影响。【方法】将120例T2DM并NAFLD患者随机分为健脾祛湿方组（治疗组）和吡格列酮组（对照组）各60例,在基础降糖治疗的同时,分别给予健脾祛湿方和吡格列酮治疗,观察时间均为24周。利用声触诊组织量化成像技术（virtual touch tissue quantification technique, VTQ）、酶联免疫吸附（ ELISA）法和生化分析仪观察2组治疗前后肝脏脂肪含量、 APN、TNF-α、血糖、血脂和肝功能等指标的变化。【结果】治疗后,2组空腹血糖（FPG）、餐后2 h血糖（2hPG）、糖化血红蛋白（HbA1c）、空腹胰岛素（FINS）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、 TNF-α含量及肝实质ARFI (acoustic radiation force impulse)值较治疗前均显著下降(P<0．05),高密度脂蛋白胆固醇（HDL-C）、 APN含量较治疗前显著上升(P<0．05);治疗组治疗前后FINS、 TNF-α差值大于对照组(P<0．05)。【结论】健脾祛湿方可能通过升高APN、降低TNF-α,从而达到纠正糖脂代谢紊乱,保护胰岛功能以及减少肝脏脂肪含量的功效。