应用64排螺旋CTA超早期诊断基底动脉尖综合征的临床研究

目的 观察64排螺旋全身血管成像检查(CTA)超早期诊断基底动脉尖综合征的临床价值。方法 选取2017年1月～2019年1月到我院接受治疗的80例基底动脉尖综合征患者,随机分为检查组和对照组,每组40例,两组病例入院后均立即行64排螺旋头颅CT检查,检查组同时进行CTA检查,分析CTA诊断结果,结合检查结果给予对应治疗,对比两组患者治疗前后NIHSS评分及ADL评分,随访患者病死率。结果 CTA诊断结果显示,40例基底动脉尖综合征中基底动脉狭窄占比最高,为62.5%(25/40),其次为基底动脉瘤,占15.0%(6/40);两组间神经功能缺损程度评分(NIHSS)、日常生活活动评分(ADL)对比,治疗前无差异,治疗后检查组明显改善,差异有统计学意义(P0.05);检查组死亡率为5.0%低于对照组的12.5%,差异有统计学意义(P0.05)。结论 64排螺旋CTA能够检出早期基底动脉尖综合征,为早期发现病灶并及时治疗提供参考,有利于提升患者预后,具有较高诊断价值。     

Prognostic value of baseline and serial carcinoembryonic antigen and carbohydrate antigen 19.9 measurements in patients with pseudomyxoma peritonei treated with cytoreduction and hyperthermic intraperitoneal chemotherapy

Background Tumor markers are useful for diagnosis and follow-up. We studied the prognostic value of baseline and serial carcinembryonic antigen (CEA) and carbohydrate antigen 19.9 (CA 19.9) measurements in patients with pseudomyxoma peritonei treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). Methods Sixty-three patients with pseudomyxoma peritonei were treated with cytoreductive surgery and HIPEC. The tumor markers CEA and CA19.9 were collected before therapy and at 3-month intervals during follow-up. Results Preoperative CEA and CA19.9 levels were increased in, respectively, 75% and 58% of the patients. Baseline tumor marker values were related to the extent of tumor. Immediately after HIPEC, both tumor markers decreased markedly (P<.0001). CA19.9 was shown to be a more useful tumor marker than CEA for follow-up. During follow-up, a high absolute CA19.9 level (P=.0005) was predictive for imminent recurrence. Patients who never attained a normal CA19.9 level showed a higher recurrence rate at 1 year (53%; SE, 15%), in comparison to patients with did so (6%; SE 4%). The median lead time of increased CA19.9 to recurrence was 9 months. Conclusions The measurement of the tumor marker CA19.9 is useful in evaluating therapy in patients with pseudomyxoma peritonei treated with cytoreductive surgery and HIPEC. CA19.9 is a prognostic factor for predicting recurrent disease.     

Fibrinogen level on admission is a predictor for massive transfusion in patients with severe blunt trauma: Analyses of a retrospective multicentre observational study

IntroductionIn the early phase of trauma, fibrinogen (Fbg) plays an important role in clot formation. However, to the best of our knowledge, few studies have analysed methods of predicting the need for massive transfusion (MT) based on Fbg levels using multiple logistic regression. Therefore, the present study aimed to evaluate whether Fbg levels on admission can be used to predict the need for MT in patients with trauma.MethodsWe conducted a retrospective multicentre observational study. Patients with blunt trauma with ISS ≥16 who were admitted to 15 tertiary emergency and critical care centres in Japan participating in the J-OCTET were enrolled in the present study. MT was defined as the transfusion of packed red blood cells (PRBC) ≥10 units or death caused by bleeding within 24 h after admission. Patients were divided into non-MT and MT groups. Multiple logistic-regression analysis was used to assess the predictive value of the variables age, sex, vital signs, Glasgow Coma Scale (GCS) score, and Fbg levels for MT. We also evaluated the discrimination threshold of MT prediction via receiver operating characteristic curve (ROC) analysis for each variable.ResultsHigher heart rate (HR; per 10 beats per minutes [bpm]), systolic blood pressure (SBP; per 10 mm Hg), GCS, and Fbg levels (per 10 mg/dL) were independent predictors of MT (odds ratio [OR] 1.480, 95% confidence interval [CI] 1.326–1.668; OR 0.851, 95% CI 0.789–0.914; OR 0.907, 95% CI 0.855–0.962; and OR 0.931, 95% CI 0.898–0.963, respectively). The optimal cut-off values for HR, SBP, GCS, and Fbg levels were ≥100 bpm (sensitivity 62.4%, specificity 79.8%), ≤120 mm Hg (sensitivity 61.5%, specificity 70.5%), ≤12 points (sensitivity 63.3%, specificity 63.6%), and ≤190 mg/dL (sensitivity 55.1%, specificity 78.6%), respectively.ConclusionsOur findings suggest that vital signs, GCS, and decreased Fbg levels can be regarded as predictors of MT. Therefore, future studies should consider Fbg levels when devising models for the prediction of MT.     

脱脂奶粉勾兑牛奶酒工艺中pH值的影响

探讨了以脱脂奶粉为原料勾兑奶酒的工艺条件,主要研究了牛奶蛋白在乙醇存在下影响其稳定性的一个重要因素——pH值.实验表明,在以脱脂奶粉为原料勾兑奶酒时,酒精应该先进行适量的稀释再加入到复配奶中;随着复配奶pH值的升高,其牛奶蛋白的乙醇稳定性也随之升高.复配奶的pH值决定着勾兑奶酒的pH值,其最适pH值为6.5～7.3,但是酒精的pH对于勾兑奶酒的pH并没有决定性的影响.实验还研究了勾兑奶酒在储存过程中其体系的pH值的变化.     

CT扫描对复杂性肾结石经皮肾镜取石术后疗效的预测价值

目的探讨cT扫描对复杂性肾结石经皮肾镜取石术（PCNL）后疗效的预测价值。方法对296例接受PCNL治疗复杂性肾结石患者的临床资料进行回顾性研究,分析术前CT扫描相关指标,如HU值、结石大小、结石位置、结石x线通透性等与术后结石清除率的关系,同时对HU值预测复杂性肾结石术后临床疗效进行评价及总结。结果根据结石清除率分组,多因素方差分析发现结石X线通透性、结石位置、HU值以及结石大小等指标均为影响结石清除率的因素（P〈0．05）。利用ROC曲线确定HU值诊断结石完全清除与否的阈值,发现最佳诊断点为688．4,低于此值,结石清除率明显降低。对结石成分与结石清除率的关系进行了探讨,发现含钙结石清除率高于其他成分的结石,但两组之间无统计学差异（P〉0．05）;同时发现HU值与术中出血量之间存在明显的正相关关系（P〈0．05）。结论术前CT扫描明确结石大小、结石位置以及HU值测定对复杂性肾结石PCNL术后临床疗效具有预测价值;术前明确结石的CT表现,采取恰当的手术方式能进一步提高碎石效率。     

镁合金对骨髓间充质干细胞增殖及成骨分化的影响研究

目的：探讨镁合金对人骨髓间充质干细胞（BMSCs）增殖及成骨分化的影响。方法抽取人骨BMSCs并予以鉴定;采用AZ31B镁合金浸提液培养人BMSCs 1、3、5、7 d,以普通培养基为对照组,CCK-8法检测细胞增殖活性;应用浸提液培养人BMSCs,诱导分化后检测成骨分化相关基因（COLⅠ、ALP、OPN）的表达。另设置调节pH值AZ31B组（pH-AZ31B组）,以观察pH值变化对实验结果的影响。结果 BMSCs表达CD34（-）、CD45（-）、CD44（＋）、CD73（＋）、CD90（＋）、CD105（＋）。浸提液培养1、3、5、7 d,AZ31B组细胞相对增殖率低于对照组（P＜0.05）,毒性评级为2级;对照组和pH-AZ31B组细胞活性较好,两组细胞相对增殖率比较,差异无统计学意义（P ＞0.05）。AZ31B组COLⅠ基因表达量与对照组比较,差异无统计学意义（P ＞0.05）;AZ31B组ALP基因表达量较低（P＜0.05）,pH-AZ31B组与对照组无显著差异（P＞0.05）;AZ31B组OPN基因表达量在诱导分化后6 d、12 d显著高于对照组（P＜0.05）,pH-AZ31B组与对照组无显著差异（P＞0.05）。结论镁合金对BMSCs增殖及成骨分化无不良影响,其影响可能与浸提液pH值的变化有关。     

腹腔探查对结核性腹膜炎诊断价值的临床观察研究

目的:探究腹腔探查对结核性腹膜炎诊断价值的研究,为临床提供指导。方法:以2010年1月1日—2018年4月30日我院37例疑似结核性腹膜炎患者作为观察对象,对37例疑似结核性腹膜炎患者均实施术前CT检查,其中13例行腹腔镜探查,24例行开腹探查,将CT检查结果、腹腔探查结果和术后病理活检结果进行比较,研究对比腹腔探查对结核性腹膜炎的诊断结果。结果:36例腹腔探查取腹膜活检病理回报证实为结核性腹膜炎,其中1例未确证结核性腹膜炎。腹腔探查诊断结核性腹膜炎的敏感度、特异度、总准确率分别为90%、100.00%、97.30%,CT诊断结核性腹膜炎的敏感度、特异度、总准确率分别为60.00%、50.00%、56.76%,腹腔探查诊断结核性腹膜炎的总准确率相比CT明显更高,P0.05;腹腔探查可有效对结核性腹膜炎进行分型诊断,总符合率为90.00%,将腹腔探查结果和术后病理活检结果进行对比发现,P0.05。结论:对结核性腹膜炎患者采取腹腔探查切实可行,具有较高的准确率,可为临床医师分析病情提供依据。     

超声引导下幼儿骶管麻醉在小儿疝手术中的应用

目的探讨超声引导下幼儿骶管麻醉在小儿疝手术中的应用价值。 方法回顾性分析2016年1至12月,陆军特色医学中心行小儿疝手术的100例患儿的临床资料。根据麻醉方式不同,将其分为观察组（52例）与对照组（48例）。观察组患儿行超声引导下骶管麻醉,对照组患儿行阻力消失技术定位骶管穿刺,比较2组患儿的麻醉效果。 结果（1）观察组患儿穿刺时间、穿刺次数及术后苏醒时间、氯胺酮使用剂量、术毕离开手术室时间均明显低于对照组,差异均有统计学意义（P均<0.05）。（2）观察组患儿骶管阻滞成功率明显高于对照组,差异有统计学意义（P<0.05）。（3）观察组患儿术后镇痛效果明显优于对照组,差异有统计学意义（P<0.05）。（4）观察组患儿苏醒期躁动评分与术后（2、4、8 h）疼痛评分明显低于对照组,差异均有统计学意义（P均<0.05）。（5）气腹前,2组患儿心率、平均动脉压（mean artery pressure,MAP）、呼气末二氧化碳分压（end-tidal carbon dioxide partial pressure,PetCO₂）比较,差异无统计学意义（P>0.05）;气腹后,观察组心率、MAP、PetCO₂水平明显高于对照组,差异均有统计学意义（P均<0.05）。2组患儿治疗前后血压、血氧饱和度、pH值比较,差异均无统计学意义（P均>0.05）。（6）观察组不良反应发生情况明显低于对照组,差异有统计学意义（P<0.05）。 结论超声引导下幼儿骶管麻醉应用于小儿疝手术,定位准确,患儿苏醒时间短,镇痛效果好,并减少其苏醒期躁动,改善患儿血气与循环,安全有效。     

不同DR探测器技术临床应用价值的分析与探讨

目的探讨不同DR探测器技术的临床应用价值,为探测器技术的临床应用和设备综合评价提供科学依据。方法依据前期文献调查法、专家咨询法和百分权重法建立的临床应用价值评价体系,邀请专家对4种不同DR探测器技术进行多维度评价和综合评价。结果不同探测器技术临床应用价值差异较大,非晶硒平板探测器技术和非晶硅平板探测器技术综合评分分别为3.76和4.21,而多丝正比线扫描探测器技术综合评分为2.72。结论不同DR探测器技术性能差距较大,主要表现在图像质量指标上;平板探测器的临床应用价值优于传统的多丝正比线扫描技术和CCD探测器技术。在DR的选型配置中应依据主要临床应用选择合适的探测器,为DR技术的合理应用和设备的规划配置提供参考。