MRI与CT图像融合在颅内肿瘤的靶区勾画和对治疗计划影响的初步研究

目的探讨MRI与CT的图像融合对于靶区勾画的影响。方法 28例颅内肿瘤患者,其中男性12例,女性16例;年龄20~86岁,中位年龄57岁。MRI和CT图像采用自动法进行融合,在CT和融合图像上分别勾画靶区,并比较靶区的区别。结果运用融合图像勾画靶区比单纯CT上勾画更为清晰和准确。三维空间总的融合误差仅为（0.55±0.14）mm,融合精度较高,CT图像上的靶区体积是（28.55±7.23）cm^3,融合图像上的靶区体积是（35.83±5.38）cm^3。结论 MRI和CT图像融合技术应用于射波刀治疗颅内肿瘤中勾画靶区,能提高靶区勾画的准确性,并且为外科手术治疗提供一定指导意义。     

透明质酸凝胶联合Nd:YAG激光对老年牙周炎患者牙根敏感的实验研究及临床疗效观察

目的:观察和评价透明质酸凝胶联合Nd:YAG激光对老年患者牙周基础治疗后牙根敏感并发症的疗效.方法:收集老年患者因慢性牙周炎拔除的完整无龋前磨牙24颗,随机分为4组,制备成牙根敏感标本分别用生理盐水、透明质酸凝胶、Nd:YAG激光、透明质酸凝胶联合Nd:YAG激光处理,扫描电镜下观察各样本牙本质小管封闭情况.临床观察60例牙周基础治疗后出现牙根敏感并发症的老年患者,随机分为3组,分别为透明质酸凝胶组(20例,66颗患牙)、Nd:YAG激光组(20例,81颗患牙)、联合组(20例,102颗患牙).透明质酸凝胶组采用单独透明质酸凝胶涂擦敏感牙根,Nd:YAG激光组采用单独Nd:YAG激光照射敏感牙根,联合组先用透明质酸凝胶涂擦敏感牙根,再联合Nd:YAG激光照射.采用Schiff冷空气敏感指数评价,比较3组治疗的有效率.结果:扫描电镜结果显示透明质酸凝胶、Nd:YAG激光照射、透明质酸凝胶联合Nd:YAG激光照射均可封闭牙本质小管,透明质酸凝胶联合Nd:YAG激光效果最佳.临床观察结果显示透明质酸凝胶组、Nd:YAG激光组、联合组治疗有效率分别为69.70％、83.95％、93.13％.联合组治疗有效率显著优于透明质酸凝胶组及Nd:YAG激光组,结果具有统计学意义(P<0.05).结论:透明质酸凝胶联合Nd:YAG激光对老年患者牙周基础治疗后牙根敏感并发症具有较好的临床效果.     

Efficacy of Entecavir Treatment for up to 5 Years in Nucleos(t)ide-Na?ve Chronic Hepatitis B Patients in Real Life

Objective: To analyze the efficacy and safety of entecavir (ETV) treatment for up to 5 years in nucleos(t)ide-naïve chronic hepatitis B patients in real life.Methods: We retrospectively analyzed 230 nucleos(t)ide naïve chronic hepatitis B patients who received ETV 0.5 mg/day monotherapy for at least 3 months, of whom 113 were HBeAg positive and 117 were HBeAg negative. The primary endpoints was cumulative probability of achieving a virological response (undetectable serum HBV DNA, <100IU/mL). Secondary endpoints were rates of ALT normalization (ALT < upper limit of normal), HBeAg seroconversion, resistance, and safety.Results: The median follow-up duration was 27.5 months (3-73 months) and mean age was 42 years. With 230, 214, 180, 142, 88, 42 and 11 patients followed-up for at least 3 months,6 months, 1, 2, 3, 4 and 5 years, respectively. In all, Incremental increases were observed in the rates of undetectable HBV DNA. 67.0%, 85.0%, 89.4%, 94.4%, 95.5%, 97.6%, 100% had undetectable HBV DNA at month 3, month 6, 1 year, 2 years, 3 years, 4 years and 5 years. Proportions of patients achieving normal ALT were 73.9%, 85.5%, 82.8%, 89.4%, 80.7%, 85.7%, 100%, respectively. The rate of HBeAg seroconversion reached 21.4% and 15.4% at year2, 3, respectively. One patient achieved HBsAg seroclearance after 1 year, and achieved anti-HBs seroconversion at year 3. Of 180 patients, HBV DNA was detectable (partial virological response, PVR) in 19 patients at year 1 of follow-up, twelve of 14 (85.7%) patients with PVR need more than 1 year of continuous ETV therapy to achieved VR. At baseline, no ETV-resistance was detected in 25 ETV-naïve patients. One patient developed ETV-resistance mutations due to noncompliance. No serious adverse event was reported.Conclusion: Long-term ETV treatment of nucleos(t)ide-naïve was effective and safe in real life. Adjustment of ETV monotherapy in nucleos(t)ide-naïve patients with a partial virological response at 1 year may be unnecessary.     

急性脑梗死临床诊断中MRI、多层螺旋CT与数字减影血管造影的比较

目的探讨MRI、多层螺旋CT（MSCT）与数字减影血管造影（DSA）在急性脑梗死临床诊断中的应用。方法对本院2019年3月~2020年12月100例疑似急性脑梗死患者的临床资料进行回顾性分析,所有患者均接受MRI、MSCT及DSA检查,以DSA结果为金标准,分析MRI、MSCT诊断结果与DSA结果的一致性,计算MRI、MSCT诊断急性脑梗死的准确度、特异性、敏感度、阳性预测值、阴性预测值。结果DSA诊断结果显示,100例疑似急性脑梗死患者中,急性脑梗死患者79例,非急性脑梗死患者21例;MRI诊断结果显示,急性脑梗死患者77例,非急性脑梗死患者23例,与DSA诊断结果一致性分析,Kappa值为0.637;MSCT诊断结果显示,急性脑梗死患者71例,非急性脑梗死患者29例,与DSA诊断结果一致性分析,Kappa值为0.524。MRI对急性脑梗死的诊断准确度、敏感度分别为92.00%、93.67%均高于MSCT的82.00%、83.54%（P < 0.05）。MRI对发病24 h内、发病72 h内检出率分别为89.29%、87.50%,高于MSCT的64.29%、70.83%（P < 0.05）。结论MRI、MSCT对急性脑梗死的诊断结果与DSA具有较好的一致性,但MRI诊断优势更加明显,可为临床尽早拟定治疗方案提供参考。      

护理人员时间管理倾向与主观幸福感关系的研究进展

阐述时间管理倾向的概念,从护理人员时间管理倾向的现状、护理人员主观幸福感及两者之间的关系等方面进行综述,旨在了解护理人员时间管理倾向与幸福感关系的现状,以期能制定出更适合护理人员的时间管理机制,提高护理人员的主观幸福感,从而提高护理质量。     

快速康复训练在全镜下LARS韧带增强修复治疗慢性踝关节不稳效果研究

目的 探讨快速康复训练对全镜下LARS韧带增强修复治疗慢性踝关节不稳患者的临床效果.方法 选取自2017年11月至2019年10月行全镜下LARS韧带增强修复的36例慢性踝关节不稳者为研究对象,术后随机选取18例为快速康复组,18例为常规康复组,分别进行快速康复训练和常规康复训练.分析各组术后3、6、12个月随访的美国足踝外科协会(AOFAS)踝-后足评分和Tegner运动功能评分.结果 术后3个月所有患者均无持续性疼痛症状,快速康复组与常规康复组的AOFAS踝-后足评分、Tegner运动功能评分比较,差异无统计学意义(P>0.05).结论 快速康复训练在全镜下LARS韧带增强修复治疗慢性踝关节不稳术后应用具有可行性及有效性,快速康复训练可在术后较早地恢复正常生活、工作及体育活动,获得较好的肌力及本体感觉,有利于踝关节功能恢复.     

肥厚型心肌病误诊为血管肉瘤一例

患者,女,73岁,以气促1年,夜间阵发性呼吸困难1周就诊于我院.患者1年前无明显诱因出现气促,伴乏力,表现为咳嗽后气促明显,逐渐感活动耐力下降,1周前患者于夜间气促加重,出现阵发性呼吸困难,伴双下肢凹陷性水肿,乏力加重,食欲减退,无胸痛、肩背部疼痛,无恶心、呕吐等不适.既往高血压病史3年,最高达150+/100 mmHg (1 mmHg=0.1333 kPa),予"北京零号"降压控制,自诉血压监测正常.心电图:窦性心动过速,心率(hreat rate,HR)108 次/min,胸3至胸6导联(V3-V6) ST段抬高并T波倒置.     

Investigating tunneling nanotubes in ovarian cancer based on two-photon excitation FLIM-FRET

Precise and efficient cell-to-cell communication is critical to the growth and differentiation of organisms, the formation of various organism, the maintenance of tissue function and the coordination of their various physiological activities, especially to the growth and invasion of cancer cells. Tunneling nanotubes (TNTs) were discovered as a new method of cell-to-cell communication in many cell lines. In this paper, we investigated TNTs-like structures in ovarian cancer cells and proved their elements by fluorescent staining, which showed that TNTs are comprised of natural lipid bilayers with microtubules as the skeleton that can transmit ions and organelles between adjacent cells. We then used fluorescence resonance energy transfer (FRET) based on two-photon excitation fluorescence lifetime imaging microscopy (FLIM) (TP-FLIM-FRET) to detect material transport in TNTs. The experimental results showed that the number of TNTs have an impact on the drug treatment of cancer cells, which provided a new perspective for TNTs involvement in cancer treatment. Our results also showed that TP-FLIM-FRET would potentially become a new optical method for TNTs study.     

2种浓度利多卡因对下颌智牙拔除麻醉效果的影响

目的：探讨低浓度利多卡因行下牙槽、舌、颊神经一次阻滞麻醉的效果。方法：采用自身对照研究,前瞻性分析3 mL 1%利多卡因1∶100 000肾上腺素（低浓度组）或3 mL 2%利多卡因1∶100 000肾上腺素（高浓度组）行下牙槽、舌、颊神经阻滞麻醉拔除下颌智牙的差异。患者术后经过21 d的洗脱期,选择对应浓度的利多卡因拔除对侧阻生牙。分析2组间注射时疼痛水平（疼痛评估量表,NRS）、麻醉起效时间、麻醉深度及麻醉持续时间的差异。采用SPSS 17.0 软件包对数据进行统计学分析。结果：21例患者（平均年龄24岁）完成试验,其中62%为女性。低浓度组的疼痛水平（1.09,95% CI,0.77~1.41）显著低于高浓度组（1.66,95%CI,1.33-1.99）（P=0.010）。低浓度组下牙槽、颊、舌神经阻滞麻醉起效时间（52~63 s）显著快于高浓度组（259~335 s）（P=0.000）。下牙槽、舌、颊神经麻醉深度2组之间未见显著差异（P=0.751）。在疼痛NRS值为1~3的患者中,低浓度组,9例（100%）均在分牙时疼痛（下牙槽神经麻醉深度浅）;高浓度组3例（43%）分牙时疼痛,4例(57%)翻瓣时疼痛（颊神经麻醉深度浅）（P=0.019）。高浓度组麻醉持续时间比低浓度组平均长61 min（52~69 min）（P=0.000）。结论：用低浓度利多卡因组行下牙槽、舌、颊神经阻滞麻醉起效快,注射时疼痛水平低,术后下唇麻木不适感消失快。术中轻微疼痛,高浓度组常因颊神经麻醉深度较浅引起,低浓度组因下牙槽神经麻醉深度较浅引起。     

超声龈上洁治术对全瓷冠边缘微渗漏的影响

目的：探讨超声龈上洁治术对全瓷冠边缘微渗漏的影响。方法：收集形态、大小基本一致的前磨牙48颗,全瓷冠牙体预备后随机分为2组（二氧化锆冠组和玻璃陶瓷冠组,每组24颗）,每组再随机分为2个亚组（树脂水门汀组和树脂改性玻璃水门汀组）。修复体粘接、固化、人工唾液保存24 h后,每个亚组内随机抽取3个样本进行超声龈上洁治60 s,另外3个样本为阴性对照组。将所有样本于室温下用5%品红溶液浸泡48 h,沿颊舌向切开,对样本冠边缘微渗漏情况进行双盲评分。采用SPSS 17.0软件包进行独立样本t检验,比较各组样本中修复体冠边缘微渗漏差异。结果：使用树脂加强型玻璃水门汀粘接的冠边缘微渗漏在超声龈上洁治后与阴性组有显著差异（P<0.05）,而使用树脂水门汀粘接的冠边缘微渗漏在超声龈上洁治后与阴性组无显著差异（P>0.05）。采用同种粘接剂时,无论是否接受超声龈上洁治术,二氧化锆全瓷冠与玻璃陶瓷冠之间微渗漏均有统计学差异（P<0.05）。结论：超声龈上洁治对树脂加强型玻璃水门汀粘接的二氧化锆和玻璃陶瓷冠边缘微渗漏有显著影响,而对树脂水门汀粘接的二氧化锆和玻璃陶瓷冠边缘微渗漏无显著影响。