非典型肺栓塞症临床分析

目的：分析非典型肺栓塞症误诊的常见原因,提高对非典型肺栓塞症的认识。方法回顾性分析第三军医大学新桥医院及泸州医学院附属医院心血管内科、呼吸内科2006年1月至2013年12月临床确诊的120例非典型肺栓塞症患者的危险因素、临床表现、实验室及影像学检查资料。结果120例非典型肺栓塞症入院时误诊39例（误诊率32．5％）。误诊为急性冠状动脉综合征8例,冠心病稳定型心绞痛7例,慢性阻塞性肺疾病（COPD）所致慢性肺源性心脏病7例,肺炎5例,胸腔积液3例,肺结核3例,支气管哮喘3例,房间隔缺损1例,急性左心衰竭1例,心源性晕厥1例。结论非典型肺栓塞症因其临床表现缺乏特异性,很容易误诊、误治,临床医师应提高诊断与鉴别诊断水平,对于高度怀疑的患者,应尽早行肺部增强CT 或肺动脉CT 血管造影等检查,减少对非典型肺栓塞症的误诊。     

Developing Item Response Theory–Based Short Forms to Measure the Social Impact of Burn Injuries

Objective

To develop self-reported short forms for the Life Impact Burn Recovery Evaluation (LIBRE) Profile.

原发性小肠肿瘤47例临床分析

目的：探讨原发性小肠肿瘤的临床表现、诊断方法及预后。方法回顾性分析47例原发性小肠肿瘤患者的临床资料。结果47例原发性小肠肿瘤临床表现无特异性,术前确诊率为34．0％（16／47）。良性肿瘤占12．8％（6／47）,病理以腺瘤为主,预后好。恶性肿瘤占70．2％（33／47）,贫血是其较为突出的临床表现,病理主要为腺癌（29例,失访3例）,好发于十二指肠,预后差。26例腺癌患者1、2、3、5年生存率分别为67．4％、42．4％、29．4％、22．8％,中位生存期为20．3个月。间质瘤占17％（8／47）,主要来源于空肠,以腹部包块为主要表现,术后使用靶向药物有助于改善患者预后。结论小肠肿瘤发病率低,但以恶性为主,预后差,采取有效的检查手段尽早发现病灶并行手术切除是治疗的关键。     

Two Cases of Prenatally Diagnosed Membranous and Muscular Ventricular Septal Aneurysms

A ventricular septal aneurysm is a rare heart defect located in the muscular or membranous part of the septum. Muscular ventricular septal aneurysms are usually isolated, with a favorable prognosis. Membranous ventricular septal aneurysms are often associated with other heart anomalies, could result in serious complications, and may require surgical treatment. We describe 2 cases of prenatally diagnosed ventricular septal aneurysms: an isolated membranous ventricular septal aneurysm with a good outcome, which was initially misdiagnosed as an atrioventricular septal defect; and a muscular ventricular septal aneurysm associated with a hypoplastic aortic arch and severe hydrocephaly, which resulted in termination of the pregnancy. To our knowledge, the combination of a muscular ventricular septal aneurysm with an extracardiac anomaly has not been reported previously.     

Value‐Based Differential Pricing: Efficient Prices for Drugs in a Global Context

This paper analyzes pharmaceutical pricing between and within countries to achieve second‐best static and dynamic efficiency. We distinguish countries with and without universal insurance, because insurance undermines patients' price sensitivity, potentially leading to prices above second‐best efficient levels. In countries with universal insurance, if each payer unilaterally sets an incremental cost‐effectiveness ratio (ICER) threshold based on its citizens' willingness‐to‐pay for health; manufacturers price to that ICER threshold; and payers limit reimbursement to patients for whom a drug is cost‐effective at that price and ICER, then the resulting price levels and use within each country and price differentials across countries are roughly consistent with second‐best static and dynamic efficiency. These value‐based prices are expected to differ cross‐nationally with per capita income and be broadly consistent with Ramsey optimal prices. Countries without comprehensive insurance avoid its distorting effects on prices but also lack financial protection and affordability for the poor. Improving pricing efficiency in these self‐pay countries includes improving regulation and consumer information about product quality and enabling firms to price discriminate within and between countries. © 2013 The Authors. Health Economics published by John Wiley & Sons Ltd.     

动态增强MRI在乳腺良恶性疾病鉴别诊断中的价值

目的：探讨动态增强核磁共振成像( MRI)在乳腺良恶性疾病鉴别诊断中的价值。方法回顾性分析自2012年1月至2014年6月经病理证实的乳腺占位性病变70例(78乳)患者的MRI资料,其中乳腺癌46乳,良性占位32乳,观察良恶性乳腺病变的MRI征象及强化参数,比较MRI动态增强扫描与MRI平扫诊断乳腺癌的特异度、灵敏度及准确性。结果①良性病变患者平均年龄显著低于恶性病变患者(t=8.225,P<0.05),乳腺恶性病变不均匀性分布较良性病变显著升高(χ2=11.287,P<0.05),乳腺良恶性病变MRI平扫显示率、T1WI与T2WI信号强度分布比较差异无统计学意义(χ2值分别为4.126、3.855、5.362,均P>0.05);②乳腺恶性病变峰值增强率(Emax)显著高于良性肿块,峰值时间(Tmax)、最大强化速率(Slopemax)显著低于良性病变(t值分别为10.286、11.445、7.236,均P<0.05);③乳腺恶性病变SI-Time曲线廓清型、平台型、渐进型分别为38例、6例、2例,良性病变分别为0例、5例、27例,两组比较SI-Time曲线类型分布差异有统计学意义(χ2=10.381,P<0.05);④MRI动态增强扫描检查乳腺恶性病变灵敏度、特异度及准确率分别为100%、96.88%、98.72%,均高于 MRI 平扫的78.26%、78.13%、78.20%,比较差异有统计学意义(χ2值分别为7.382、8.164、8.237,均P<0.05)。结论乳腺良恶性疾病动态增强MRI扫描具有特异性表现,具有较高的鉴别诊断参考价值。     

Calendering as a direct shaping tool for the continuous production of fixed-dose combination products via co-extrusion

In this study calendering is used as a downstream technique to shape monolithic co-extruded fixed-dose combination products in a continuous way. Co-extrudates with a metoprolol tartrate-loaded sustained-release core and a hydrochlorothiazide-loaded immediate-release coat were produced and immediately shaped into a monolithic drug delivery system via calendering, using chilled rolls with tablet-shaped cavities. In vitro metoprolol tartrate release from the ethylcellulose core of the calendered tablets was prolonged in comparison with the sustained release of a multiparticulate dosage form, prepared manually by cutting co-extrudates into mini-matrices. Analysis of the dosage forms using X-ray micro-computed tomography only detected small differences between the pore structure of the core of the calendered tablet and the mini-matrices. Diffusion path length was shown to be the main mechanism behind the release kinetics. Terahertz pulsed imaging visualized that adhesion between the core and coat of the calendered tablet was not complete and a gradient in coat thickness (varying from 200 to 600 μm) was observed. Modulated differential scanning calorimetry and X-ray diffraction indicated that the solid-state properties of both drugs were not affected by the calendering procedure.     

正电子发射计算机断层显像-CT在肺结核活动性评价中的价值

影像学一直是结核病活动性评价的重要方法之一,¹⁸F-氟代脱氧葡萄糖(¹⁸F-FDG)正电子发射计算机断层显像(PET)-CT能反映细胞的葡萄糖代谢程度,可以从代谢角度结合形态学层面综合评价结核病的活动性。¹⁸F-FDG PET-CT有可能识别出结核分枝杆菌潜伏感染者中处于亚临床状态的患者。陈旧性结核病灶无¹⁸F-FDG摄取的患者复发风险低。¹⁸F-FDG PET-CT能早期评估抗结核治疗效果,标准化摄取值(standard uptake value,SUV)降低表明治疗效果好,无¹⁸F-FDG摄取可能提示治疗达到了杀灭结核分枝杆菌的效果,¹⁸F-FDG PET-CT有望作为抗结核新药疗效评价及确定治疗时间截点的检查方法。本文中,笔者即对¹⁸F-FDG PET-CT识别结核分枝杆菌潜伏感染者,以及评价结核病患者抗结核治疗疗效、预后等方面的应用与价值进行综述。     

The estimation of the lymphocyte percentage by the Coulter Counter Model S Plus III

Summary. The accuracy of the Coulter Counter Model S Plus III in determining lymphocyte percentage was assessed. In ‘routine’ adult blood counts accuracy was satisfactory but in infectious mononucleosis, and in chronic lymphocytic leukaemia and other lymphoproliferative disorders, there was a high rejection rate and an often considerable underestimation of the lymphocyte percentage. The S Plus III lymphocyte percentage was of no use in neonates because of inaccuracy and a high rejection rate. In infants the relationship with lymphocyte percentages based on manual differential counts was non-linear, and there was underestimation of some high percentages. The white cell size histogram was useful in alerting staff to abnormalities, and also suggested that lymphocytes of neonates and infants were larger than those of adults, with plots being very similar to those of some adults with lymphoproliferative disorders. The S Plus III lymphocyte percentage was useful in reducing the need for differential counts in adult patients but did not replace examination of a blood film or a manual lymphocyte percentage in patients with chronic lymphocytic leukaemia or a lymphoproliferative disorder.