目的 评价动态对比增强MRI(DCE-MRI)放射状采集容积内插屏气检查(Radial-VIBE)序列定量参数预测膀胱癌病理学分级的价值.方法 前瞻性纳入60例经术后病理证实为膀胱尿路上皮癌的膀胱癌患者,将其分为低级别组(n=36)和高级别组(n=24).比较组间DCE-MRI参数,包括容积转运常数(Ktrans)、速率常数(Kep)、血管外细胞外间隙容积(Ve)及对比剂浓度-时间曲线下初始面积(IAUC)的差异;采用组内相关系数(ICC)评价观察者间测量结果的一致性.采用Spearman秩相关分析评价各参数与膀胱癌病理分级的相关性.绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价各参数预测高级别膀胱癌的效能.结果 观察者间测量定量参数Ktrans、Kep、Ve及IAUC结果的一致性良好(ICC=0.82、0.83、0.83、0.85,P均<0.05).高级别组Ktrans、Kep及IAUC均显著高于低级别组(P均<0.05),Ve显著低于低级别组(P<0.05).Ktrans、Kep及IAUC均与病理分级呈正相关(r=0.61、0.54、0.29,P均<0.05),Ve与病理分级呈负相关(r=-0.36,P<0.05).Ktrans、Kep及IAUC预测高级别尿路上皮癌的AUC分别为0.86、0.82及0.67.结论 DCE-MRI Radial-VIBE序列定量参数Ktrans、Kep、Ve及IAUC可辅助预测膀胱癌病理学分级.

目的:分析早期康复护理对老年脑梗死保守治疗患者认知功能的影响。方法:回顾性收集2016年5月至2018年5月河南省人民医院126例老年脑梗死保守治疗患者的资料，依据随机数字表进行分组，各63例。对照组行常规护理，观察组行早期康复护理。对比两组患者认知功能及家属满意度情况。结果:观察组护理完成后简易智能状态检查表(MMSE)、作业疗法认知评定量表(LOTCA)评分情况显著优于对照组，差异有统计学意义( P<0.05)；满意度情况显著优于对照组，差异有统计学意义(均 P<0.05)。 结论:针对老年脑梗死保守治疗患者，实施早期康复护理方式具有较高的治疗效果及护理意义，对于改善患者的认知功能具有积极的效果。

目的:探讨咽部冰刺激联合电子生物反馈治疗在脑卒中吞咽障碍患者早期康复中的应用效果。方法:选取该院接受治疗的脑卒中吞咽障碍患者60例为研究对象，随机分为对照组和试验组各30例。对照组实施常规康复治疗，试验组在常规康复治疗的基础上实施冰刺激(口腔、咽部)联合电子生物反馈治疗。对比两组临床治疗效果。结果:试验组的治疗总有效率为96.67%，明显高于对照组的66.67%( P<0.05)。 结论:咽部冰刺激联合电子生物反馈治疗有利于提升早期脑卒中吞咽障碍患者口腔、咽部肌肉功能，具有广阔的临床应用前景。

目的 分析神经内科临床护理教学中微信平台的应用方式及应用效果.方法 纳入2018年～2019年神经内科76名护生作为研究对象,按照随机数字表法进行分组,每组各38例;按照护理教学方式的不同分为实验组和常规组,实验组开展融合微信平台的教学,常规组实施传统教学模式,将两组护生出科时的理论成绩、技能操作成绩、护生满意度、不良事件发生情况进行对比.结果 实验组38名护生出科时的理论成绩、技能操作成绩、护生满意度均高于常规组,差异有统计学意义(P<0.05);实验组不良事件发生率为0,显著低于常规组(5.26％),差异有统计学意义(P<0.05).结论 在神经内科临床护理教学中应用微信平台,有助于增进学生的理论知识储备与护理操作技能,提高护生对临床护理教学的认可度,减少护理不良事件的发生.借助微信平台建立师生平等沟通、交流、互动的平台,是一种有效的护理教学方式,值得加大推广力度.

目的:探讨基于病友之家模式的护理干预对脑卒中患者自我管理意识及功能恢复的影响。方法:选取2018年6月至2019年6月该院神经内科收治的脑卒中患者80例，根据随机数字表法分为观察组和对照组各40例。对照组行常规随访指导，观察组基于病友之家模式对患者实施护理随访指导。比较两组患者干预前后自我管理意识、运动功能恢复情况及生活质量。结果:观察组干预后对疾病认识、锻炼依从性、日常生活管理能力、用药管理能力、症状自我监控能力评分及总分均显著高于对照组( P<0.05)。观察组干预后Barthel指数、Fugl-Meyer运动功能量表及总体健康状况量表(GHQ-28)评分均显著高于对照组( P<0.05)。 结论:基于病友之家的护理干预模式能有效提高脑卒中患者出院后自我管理意识，提升其运动功能锻炼依从性，有利于患者运动功能恢复，改善患者生活质量。

Objective To explore whether CT perfusion imaging (CTPI)parameters can early predict the curative effect of anlotinib hydrochloride and their predictive accuracy for the treatment in lung cancer patients.Methods 2 6 patients with advanced nonGsmall cell lung cancer (NSCLC)were treated with anlotinib hydrochloride and underwent CTPI scanning before chemotherapy,after the first and second treatment cycle respectively.The average values of perfusion value (PV),peak enhancement image (PEI),time to peak (TTP),blood volume (BV)and the change rate of these parameters after one treatment cycle every time were measured and recorded. According to the response evaluation criteria in solid tumors 1.1 (RECIST1.1),the maximum diameter of the target tumor was measured and the tumor regression rate after two treatment cycles was calculated.Then a correlation analysis was conducted between the change rate of perfusion parameters (PV%,PEI%,TTP%,BV%)after one treatment cycle and the tumor regression rate (D%)after two treatment cycles. The ROC curve was performed to evaluate the accuracy of those parameters.Results PV after one treatment cycle was significantly lower than that before treatment,and PV% showed a statistical difference (P＝0.00).The PV% after one treatment cycle was positively correlated with D% after two treatment cycles (r＝0.56).In addition,the AUC of PV% and BV% were 0.99 and 0.88 respectively, and specificity were both 100%,with sensitivity respectively 75.7% and 82.6%.Conclusion CTPI can early reflect the curative effect of anlotinib hydrochloride for advanced NSCLC and provide more options for clinical evaluation.

目的 探讨低剂量CT灌注成像(CTPI)在早期评估抗血管生成治疗非小细胞肺癌(NSCLC)中的应用及盐酸安罗替尼的疗效.方法 收集我院38例NSCLC患者,分别于治疗前、治疗1个周期后行低剂量CTPI检查,分别对比治疗前与治疗1个周期后,实验组与对照组各个CT灌注参数(CTPP)的差异,并根据治疗2个周期后的疗效,将实验组患者分为进展组、控制组;分别对比进展组和控制组治疗前后各个CTPP的差异.结果 治疗第1个周期后,所有患者均为疾病稳定,在治疗第2个周期后,实验组疾病控制率为88.00％,而对照组为8.33％,两组疗效有差异(P<0.05);治疗前,实验组与对照组各个CTPP无差异,治疗1个周期后,实验组的perfusion、PEI较对照组减低(P<0.05);控制组治疗1个周期后perfusion、PEI、BV较治疗前减低(P<0.05),而进展组治疗前后各个CTPP无差异.所有低剂量CTPI图像均符合诊断要求,最终受检者中位有效辐射剂量为13.3 mSv.结论 低剂量CTPI可以早期评估抗血管生成治疗NSCLC的疗效,盐酸安罗替尼疗效值得肯定.

Here we report a case of postoperative metachronous distant metastasis after endoscopic mucosal resection (EMR) for early gastric cancer.The process of diagnosis and treatment is described in detail,with data including laboratory tests,imaging examinations,endoscopic findings,pathological examinations,and treatment plan reported.The patient received 12 cycles of chemotherapy with the FOLFOX4 regimen [oxaliplatin 85 mg/m2 as a 2-h infusion on day 1 and a 2-h infusion of LV 200 mg/(m2 d) followed by a 5-fluorouridine bolus 400 mg/(m2 ·d) and 22-h infusion 600 mg/(m2 ·d) for 2 consecutive days every 2 wk] and apatinib,and a partial response was achieved.This case suggests that,as a treatment for early gastric cancer,EMR may not completely resect the lesions and cannot handle metastatic lymph nodes.Its clinical effects remain controversial.

目的 探讨妊娠期急性胰腺炎(APIP)的病因、发病机制、临床表现、治疗及预后.方法 回顾性分析郑州大学第一附属医院2008年1月至2016年4月收治的72例APIP患者的临床资料.结果 72例患者均有腹痛表现,65例有血淀粉酶升高.36例(50.0％)为胆源性胰腺炎,25例(34.7％)有不同程度的高脂血症,4例(5.6％)为高脂血症合并胆道系统疾病,7例(9.7％)病因不明确.31例(43.1％)急性胰腺炎发生于妊娠中期,37例(51.4％)发生于妊娠晚期,4例(5.6％)发生在妊娠早期.孕妇死亡1例,胎儿死亡6例,所有出生婴儿全部健康存活.结论 胆源性和高脂血症仍是造成APIP的主要病因,及时、准确的诊断及治疗对改善预后至关重要.

选取2015年8月~2016年8月收治的70例急性重症胆囊炎患者,随机分为对照组和观察组各35例.对照组采取传统胆囊切除术,观察组采取超声引导经皮胆囊穿刺引流.对比两组临床疗效.结果观察组胃肠减压时间、导管留置时间、抗生素治疗时间、住院时间明显短于对照组(P<0.05).观察组总满意度为94.29%,对照组总满意度为77.14%,观察组显著高于对照组(P<0.05).观察组并未出现严重并发症,对照组并发症发生率为11.43%,观察组显著低于对照组(P<0.05).采用超声引导经皮胆囊穿刺引流治疗急性重症胆囊炎,安全有效,并发症少,具有临床应用价值.

目的 综合定量评价分析马铃薯外敷与50％硫酸镁湿敷治疗甘露醇外渗的研究结果,以期探讨马铃薯外敷治疗甘露醇外渗的临床疗效,为甘露醇外渗的有效治疗提供可靠的循证依据.方法 通过计算机检索中国期刊全国数据库(CNKI)、万方数据库、中国生物医学文献数据库(CBM)、维普数据库(VIP)及Cochrane Library、Pubmed、Web of Science,筛选有关马铃薯片外敷与50％硫酸镁湿敷治疗甘露醇外渗疗效的随机、半随机对照试验,根据文献的排除与纳入标准进一步筛选文献,由2名研究者对文献质量进行严格评价和资料提取,对符合质量标准的研究应用RevMan 5.3软件进行Meta分析.结果 共纳入11项研究,发生20％甘露醇外渗的患者共818例.Meta分析结果证实,马铃薯外敷的痊愈率是50％硫酸镁外敷治疗的1.39倍,马铃薯治疗20％甘露醇外渗的痊愈率高于硫酸镁湿敷[RR=1.39,95％ 6I(1.14～ 1.69),P＜0.001];马铃薯的无效率是50％硫酸镁的0.35倍,马铃薯治疗的无效率显著低于硫酸镁组[RR =0.35,95％ CI(0.19 ～0.65),P＜0.001];11项试验研究的漏斗图对称性良好,未见显著发表偏倚.结论 马铃薯片治疗20％甘露醇外渗的效果优于50％硫镁湿敷,而且新鲜马铃薯取材方便,价格低廉,无毒副作用,值得临床推广运用.

Objective To explore the correlation between CT characters and epidermal growth factor receptor (EGFR) gene mutations in lung adenocarcinoma. Methods Two hundred and three lung adenocarcinoma patients (from September,2014 to March,2015) confirmed by pathology were divided into effective mutation group (97 cases) and non?effective mutation group (106 cases) on the basis of the site and the response to tyrosine kinase inhibitors. Among all the CT characters, rank?sum test was adopted to analyze the difference of diameter between the two groups; Fisher's exact test was applied to explain the difference of density type and Chi?square test was applied to analyze the difference of lobulation, spiculation, necrosis, pleural indentation, cavitation and air?brochogram signs. Logistic regression was used to analyze the significant signs and evaluate the odds ratio (OR). Results There were 65, 67, 45, 74 cases of lobulation, spiculation, necrosis, pleural indentation in the EGFR gene effective mutation group and 56, 51, 26, 61 cases in non?effective mutation group with statistically significant difference between the two groups (χ2=4.230, 9.141, 10.646, 7.986, P<0.05). However, there were no significant difference between the two groups in the diameter, density, cavitation and air?brochogram (P>0.05). Logistics regression analysis showed that, spiculation (OR=2.120), necrosis (OR=2.853) and pleural indentation (OR=2.094) were in correlation with EGFR effective mutations, and lobulation was not in correlation with EGFR effective mutations. Conclusions Among all the CT sings, spiculation, necrosis and pleural indentation were in correlation with EGFR gene effective mutation, they were more likely to appear in lung adenocarcinoma patients with EGFR gene effective mutation.

Objective To explore CT and MRI imaging features of multilocular cystic renal cell carcinoma( MCRCC)to improve its diagnostic accuracy. Methods CT and MRI imaging data of 23 cases with MCRCC confirmed by operation and pathology were retrospectively analyzed. Results 23 lesions were found in 23 patients. 13 lesions in the right kidney and 10 in the left kidney. All the lesions were composed of smooth sharp border,multiple cyst and septa,mural nodule was seen in 14 cases and calcification in 3 cases. Cystic wall,septa and mural nodule were enhanced. Thickening capsule wall,septa and intracystic fluid component of higher density could be seen in 5 cystic lesions diagnosed as multilocular cystic renal cell carcinoma during follow up. Conclusion CT and MRI findings of multilocular cystic carcinoma of kidney have some characteristics,CT and MRI play important roles in the diagnosis of multilocular cystic renal cell carcinoma.Thickening capsule wall,septa,or higher density of the cystic lesion indicate malignancy during follow up.

患者男,41岁,无吸烟史.于2011年12月29日因咳嗽半年加重1个月入院,行CT检查示,左肺门占位,考虑肺癌;纵隔多发肿大淋巴结;少量心包积液;肝胃间多发淋巴结肿大.支气管镜检病理显示,左肺低分化癌,倾向腺癌.全身骨扫描示,全身多发骨转移.2012年1月6日开始给予吉西他滨1.8g,第1、8天;顺铂30 mg,第1、2、3、4天化疗及唑来膦酸抗骨转移治疗.化疗期间患者出现3～4度消化道反应.2个周期化疗后,患者出现左眼视野缺损,伴视物模糊.2012年2月11日经河南省人民医院眼科会诊.视力:右眼0.8,左眼0.4;眼底检查示,左眼底鼻上方局限性淡蓝色隆起伴有新生血管;眼底照相示,左眼眼底结节,性质待定.为明确诊断,进一步行MRI及眼球超声检查.MRI检查示,双侧眼球对称,左眼球后壁可见两处局限性增厚区.眼球超声检查示,左眼球壁扁平实性隆起,厚约3.05 mm,内呈中等回声,均匀,提示左眼球后壁实性占位.眼科会诊考虑恶性肿瘤眼部转移.复查CT示,左肺门肿块较前略缩小,多发骨质破坏范围较前略增大.遂换用厄洛替尼口服治疗.厄洛替尼治疗1个月后视力:右眼0.8,左眼0.6;左眼视野缺损消失.复查胸部CT示,左肺门肿块及纵隔淋巴结较前明显缩小.