目的 探讨芪参还五胶囊治疗无骨折脱位型颈脊髓损伤(CSCIWORA)急性期痛觉过敏(DPS)的临床疗效.方法 选取2017年1月—2018年1月在河北省沧州中西医结合医院住院治疗的CSCIWORA以DPS为主要表现,且辨证为气虚血瘀证患者60例,采用随机对照方法 分为对照组30例、治疗组30例.对照组给予甘露醇、甲泼尼龙琥珀酸钠常规治疗,治疗组在此基础上服用芪参还五胶囊2周,观察比较2组入院后及治疗1周后、2周后、1个月后VAS评分、ASIA评分、颈椎JOA评分.结果 2组治疗1周后、治疗2周后及1个月后随访时ASIA评分均较治疗前明显增加(P均<0.05),且治疗组治疗后各时间点ASIA评分均明显高于对照组(P均<0.05).2组治疗1周后、治疗2周后及1个月后随访时VAS评分均较治疗前明显降低(P均<0.05),且治疗组治疗后各时间点VAS评分均明显低于对照组(P均<0.05).2组治疗1周后、治疗2周后及1个月随访时颈椎JOA评分均较治疗前明显增高(P均<0.05),且治疗组治疗1周后、治疗2周后颈椎JOA评分均明显高于对照组(P均<0.05),1个月随访时2组JOA评分比较差异无统计学意义(P>0.05).结论 采用芪参还五胶囊联合治疗CSCIWOR急性期以DPS为主要症状的患者,可明显减轻脊髓水肿,促进神经功能恢复,改善患者临床症状.

目的 比较超声造影与多期增强MSCT对肝脏局灶性病变诊断效能.方法 选取本院2017年4月至2019年8月收治的64例肝脏局灶性病变患者作为研究对象,比较良、恶性病变的超声造影参数及DVP曲线特征,分析超声造影和MSCT检查对病变的诊断情况.结果 肝脏恶性病变患者的开始增强时间(RT)、达峰时间(TTP)、平均通过时间(mTT)明显低于良性病变者,灌注指数(PI)值明显高于良性病变者(P<0.05);肝脏恶性病变DVP曲线形态以Ⅰ型居多,良性病变以Ⅱ型和Ⅲ型居多;超声造影诊断肝脏局灶性病变的敏感性、特异性及诊断符合率分别为95.31％、90.63％、96.88％,MSCT检查诊断肝脏局灶性病变的敏感性及符合率明显低于超声造影(P<0.05).结论 MSCT和超声造影均可有效诊断肝脏局灶性病变,但超声造影诊断肝脏局灶性病变敏感性及符合率明显较高,可为临床上初步诊断肝脏局灶性病变提供可靠的依据,值得推广应用.

目的:观察超声造影在肝硬化合并早期肝癌中的诊断意义.方法:选择2019年1—12月至我院行肝硬化合并肝脏占位性病变检查的患者80例进行临床研究.所有患者均给予超声造影检查.以病理检查为最终结果,观察超声造影诊断肝硬化合并早期肝癌的诊断效能.比较中-低分化肝癌和高分化肝癌开始增强时间、达峰时间和开始消退时间.结果:超声造影诊断肝硬化合并早期肝癌灵敏度为96.49％(55/57),特异度为86.96％(20/23),阳性预测值为94.83％(55/58),阴性预测值为81.48％(20/22).57例肝癌患者共计63处病灶,其中低-中分化病灶55个,高分化病灶8个.低-中分化病灶与高分化病灶超声造影的增强时间、达峰时间无明显差异(P>0.05),但消退时间明显低于高分化病灶,且具有统计学差异(P<0.05).结论:超声造影对于肝硬化合并早期肝癌的诊断中具有重要的临床应用价值.而且对于肝癌分化程度的鉴别诊断也能够提供可靠的依据.

甲状腺结节是内分泌系统疾病中的多发病和常见病.甲状腺结节通过触诊发现的患病率为3％～7％,高分辨率超声检查发现的患病率为20％～76％[1].其中甲状腺癌的患病率为5％～15％[1],是头、颈部最为常见的恶性肿瘤.近年来,全球范围内甲状腺癌的发病率显著增高[2],SEER数据库显示,显著增加的甲状腺癌中以甲状腺微小乳头状癌的增长为主,且增速最快[3].我国甲状腺癌的发病率也明显增加.

目的:探究并对比A B V S与乳腺钼靶、手持超声在诊断乳腺肿块时的价值.方法:选取自2017年2月至2018年8月入住本医院的100例患者的影像学资料,进行回顾性分析,比较A B V S与乳腺钼靶、手持超声三种方法的检查结果.结果:100例有乳腺癌病灶的患者中,A B V S可检出98例,乳腺钼靶可检出76例,手持超声可检出68例.A B V S的诊断准确度、灵敏度、特异性程度分别是90.23％、92.34％、89.92％,而乳腺钼靶的诊断准确度、灵敏度、特异性程度分别是82.14％、76.92％、68.23％,手持超声的诊断准确度、灵敏度、特异性程度分别是74.67％、71.36％、70.35％.ABVS与乳腺钼靶及手持超声分别做比较,其间差异均具有统计学意义(P<0.05).

Objective:To estimate the relations between tumor's longest diameter,area,volume and their reduction rate after neoadjuvant chemotherapy (NACT) and pathological response classification in patients of locally advanced breast cancer,and then investigate the application value of automated breast volume scanner (ABVS) in evaluating the curative effect of NACT.Methods:A prospective study was undertaken in patients undergoing NACT for locally advanced breast cancer in order to determine the ability of quantitative ABVS to assess the final pathologic response.Eighty-one patients were divided into two groups based on pathological response.Pathological response was assessed according to Miller & Payne grading system,of which grade 4 and 5 defined as major histological response (MHR),and grade l to 3 as non-major histological response (NMHR).Eighty-one cases with pathologically confirmed locally advanced breast cancer who had been performed four courses of NACT underwent preoperative breast ABVS three times during the NACT.The results are analyzed with T test (or MannWhitney U test).Concordance correlation coefficient (CCC) was used to evaluate the agreement among above methods.Receiver operating characteristic curve (ROC) analysis was applied to assess the predictive value of tumor size and the reduction rate.Results:Before,after the second and the fourth cycle of NACT,there were statistical differences in tumor's longest diameters,areas and volumes among three measurements in MHR group(P＜0.05),so does NMHR group(P＜0.05).There were also statistical difference in tumor's longest diameters between MHR and NMHR (P＜0.05),while no difference in tumor's areas and volumes(P＞0.05).The differences between first and second measurements after NACT showed significantly statistical difference (P＜ 0.05).The reduction rate in MHR group was higher.The same results of reduction rate were found in inter-group between first and second measurements (P＜0.05).And the value of second measurement was higher,while the tendency was more obvious in MHR group.Base on reduction rate of their longest diameters,areas and volumes of two times,we take postoperative pathological response as golden standard to get the ROC curve and area under curve (AUC),the above indicators results of first measurement were as follows:0.696,0.693,0.723,the second measurements results were 0.807,0.824,0.858.But there were no statistical significance between them.Conclusion:To measure the lesion's longest diameters,areas and volumes of breast cancer patients with ABVS before and after NACT,we found their agreement are well.ABVS is valuable in evaluating the curative effect of neoadjuvant chemotherapy in patients with breast cancer.After NACT the assessment efficacy of the reduction rate of tumor's longest diameter,area and volume had significantly predicted effect on e~imating pathological reaction.

目的 探讨自动乳腺全容积扫描(Automated?breast?volume?scanner?,ABVS)图像特征与临床特点及病理表达的关系,进而分析ABVS在乳腺癌治疗敏感性中的预测价值.方法 回顾性分析患者120例乳腺癌患者122个乳腺癌灶的ABVS图像特征——汇聚征和毛刺征与临床病理特征的关系,包括与孕激素受体(progesterone receptor,PR)、雌激素受体(estrogenreceptor,ER)和人表皮生长因子受体2(human epidermal growth factor receptor2,HER2)表达的关系,及与肿块大小、淋巴结转移的关系,从而探讨ABVS在乳腺癌治疗敏感性中的预测价值.结果 122个癌灶中出现汇聚征51个,边缘毛刺征61个,其他10个.汇聚征在ER阳性组出现的比例高于ER阴性组,差异有统计学意义(P<0.05);在PR阳性组出现的比例低于PR阴性组,但差异无统计学意义(P>0.05);在HER2阴性组出现的比例高于HER2阳性组,差异有统计学意义(P<0.05).毛刺征在ER阳性组出现的比例低于ER阴性组,但差异无统计学意义(P>0.05);在PR阳性组出现的比例低于PR阴性组,但差异无统计学意义(P>0.05);在HER2阴性组出现的比例低于HER2阳性组,但差异无统计学意义(P>0.05).汇聚征和毛刺征在不同大小和不同腋窝淋巴结状态组中出现比例差异无统计学意义(P>0.05).结论 ABVS的冠状面"汇聚征"对于乳腺癌治疗预测其敏感性中具有一定的评估应用价值.

<正>孕妇,32岁,孕2产0。孕27周外院产前超声检查提示胎儿畸形来我院行产前超声检查。超声显示:宫腔内可见两个胎儿,位于同一羊膜囊内。A胎胎头双顶径67 mm;心腔不大,四腔心显示,大血管交叉排列,无心衰表现;股骨长47 mm;脐动脉:RI为0.59,S/D=2.44,胎心率149次/min,律齐;脐血管血流方向正常,脐带较粗。

孕妇,26岁,孕2产1,孕20周来我院行产前超声检查.常规超声检查显示:胎儿双顶径4.89 cm,股骨长3.37 cm,胎儿颅脑、胸腔、腹腔、脊柱及四肢未见明显异常,胎儿心脏超声检查:心房正位,心室右襻,左、右心室大小对称,心脏中央"十"字交叉存在,室间隔回声中断0.29 cm,二尖瓣及三尖瓣清楚,启闭运动两侧均可见,左、右心室流出道切面显示清晰,心底仅探及一粗大动脉,内径0.56 cm,骑跨于室间隔之上(图1),于粗大动脉侧壁探及肺动脉主干及左、右肺动脉(图2,3),超声诊断:共同动脉干Ⅰ型.引产后尸解证实胎儿心血管畸形:共同动脉干Ⅰ型(图4).