To identify the associations of clinical and magnetic resonance (MR) features with overall survival (OS) in patients with unresectable hepatocellular carcinoma (HCC) achieving complete response (CR) after conventional transcatheter arterial chemoembolization (TACE) and to further develop an individual nomograph to estimate the survival probability. A total of 112 patients with unresectable HCC treated with TACE as first-line treatment were retrospectively evaluated. Potential risk factors associated with OS were identified by univariate and multivariate Cox analyses. The survival model was developed by multivariate Cox proportional hazard model. The area under the receiver operating characteristic curve was calculated to assess the performance of each marker and of the whole model. Discrimination was performed using Kaplan–Meier curves, and the survival curves were compared by the log-rank test. A nomogram derived from the survival model was established. Multivariate Cox analyses indicated that nonsmooth tumor margin, peritumoral enhancement, fat sparing in solid mass, and Barcelona clinic liver cancer (BCLC) stage were independent risk indicators associated with OS. The survival model showed acceptable diagnostic power, with an area under the curve (AUC) of 0.687. Kaplan–Meier curves demonstrated that the model discriminated well, as the high-risk and low-risk groups had median survival times of 21.6 months and 34.8 months, respectively (log-rank test, P = 0.01). Nonsmooth tumor margin, peritumoral enhancement, fat sparing in solid mass, and BCLC stage were potential biomarkers to evaluate the survival with favorable performance and discriminate HCC patients with CR under conventional TACE treatment.

在回顾归纳台湾地区RBRVS的发展历程及不同阶段的技术体系基础上,提出对大陆地区医保支付制度改革的政策启示:建立定调价多元主体参与机制,强化专科医学会对支付制度的支撑功能;建立医务人员人力技术价值评价体系和支付标准点值体系;完善公立医院区域成本数据库建设,健全专科间串联机制;探索基于点值体系的收付费一体化机制;建立健全公立医院薪酬制度与支付制度联动机制等政策建议.

Contrast-enhanced computed tomography (CECT) is commonly used for staging and diagnosing recurrent gastric cancer. Recently, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET)/CT gained popularity as a diagnostic tool owing to advantages including dual functional and anatomical imaging, which may facilitate early diagnosis. The diagnostic performance of 18F-FDG PET/CT and CECT has been assessed in several studies but with variable results. Therefore, the present meta-analysis aimed to evaluate the accuracy of 18F-FDG PET/CT and CECT for primary TNM staging and the diagnosis of recurrent gastric cancers. A systematic search of the PubMed Central, Medline, Scopus, Cochrane and Embase databases from inception until January 2020 was performed. The Quality Assessment of Diagnostic Accuracy Study-2 tool was used to determine the quality of the selected studies. Pooled estimates of sensitivity and specificity were calculated. A total of 58 studies comprising 9,997 patients were included. Most studies had a low risk of bias. The sensitivity and specificity for nodal staging of gastric cancer were 49% (95% CI, 37-61%) and 92% (95% CI, 86-96%) for 18F-FDG PET/CT, respectively, and 67% (95% CI, 57-76%) and 86% (95% CI, 81-89%) for CECT, respectively. For metastasis staging, the sensitivity and specificity were 56% (95% CI, 40-71%) and 97% (95% CI, 87-99%) for 18F-FDG PET/CT, respectively, and 59% (95% CI, 41-75%) and 96% (95% CI, 83-99%) for CECT, respectively. For diagnosing cancer recurrence, the pooled sensitivity and specificity were 81% (95% CI, 72-88%) and 83% (95% CI, 74-89%) for 18F-FDG PET/CT, respectively, and 59% (95% CI, 41-75%) and 96% (95% CI, 83-99%) for CECT, respectively. Both 18F-FDG PET/CT and CECT were deemed highly useful for diagnosing recurrent gastric cancer due to their high sensitivities and specificities. However, these techniques cannot be used to exclude or confirm the presence of lymph node metastases or recurrent gastric cancer tumors, but can be used for the confirmation of distal metastasis.

目的:探讨磁共振定量非对称回波的最小二乘估算法迭代水脂分离序列(IDEAL-IQ)技术在急性胰腺炎诊断及治疗中的应用价值.方法:搜集2016年10月-2018年12月急性胰腺炎患者及正常对照组各40例,其中急性胰腺炎治疗前为A组,有效治疗1周后为B组,正常对照组为C组;分别行MRI T1 WI、T2 WI、IDEAL-IQ成像,分别在脂肪分数图和R2*弛豫率图对胰腺头、体、尾部兴趣区脂肪分数值(FF)和R2*值,比较各组对象FF、R2*值差异;分析急性胰腺炎治疗前后FF、R2*差值与血清胰淀粉酶(P-Amy)、脂肪酶(Lps)浓度差之间的相关性.结果:A组(9.84±1.62)、B组(6.51±1.49)、C组(4.93±1.16)FF值(％)差异有统计学意义(P＜0.001);A组(26.26±4.86)、B组(19.05±6.65)、C组(13.47±6.43)R2*值(Hz)差异有统计学意义(P＜0.001).相关分析显示△FFA-B、△R2LB与△P-AmyA-B和△LpsA-B均呈中度正相关(P＜0.001).结论:IDEAL-IQ是一种可重复性好、结果可靠的非侵入性胰腺脂肪定量方法,可对急性胰腺炎患者胰腺内的脂肪含量、铁含量进行定量分析,对急性胰腺炎的诊断及治疗具有重要的指导价值.

RBRVS在公立医院内部绩效管理实践的重点在于建立“人价高、点值高”与“结余高、绩效高”一体化机制.本研究基于RBRVS框架,从操作时间、技术水平、技术风险、工作强度、工作难度、价格成本比六个维度构建了公立医院内部绩效管理指标体系,并实现与医疗物价体系、真实医疗服务项目成本、薪酬制度改革要求、医保支付制度改革、公立医院补偿机制的对接.

合理体现医务人员技术劳务价值是薪酬制度改革成功的关键,RBRVS能客观量化医务人员技术劳务价值.本文将我国公立医院内部绩效管理的RBRVS实践归纳为工作量绩效、医师绩效费率、本土化自主创新三种典型模式,系统描述各模式基本特征,分析存在的主要问题,为公立医院薪酬制度改革提供决策支持.

Objective To discuss the application value of QCT in diagnosing spontaneous lumbar vertebral compression frac-ture and to calculate the best diagnosis threshold value of female and male of different age groups.Methods Mineral density measurement software and body model of Siemens CT were used to measure the bone mineral density of normal old crowds over 60 years old and crowds with spontaneous lumbar vertebral compression fracture of local region.The bone mineral density data were calculated out for comparative analysis.ROC curves were separately drawn according to the statistical data.The best diagnosis cut-point of men and women at different ages were calculated according to youden index principle.Results Bone density of QCT measurement value of the elderly male and female in the northern region of Chongqing decreased evidently with aging.The bone density of the male at different ages were all greater than the female, and the difference had significant difference ( P <0.05). QCT values of local male and female with spontaneous lumbar vertebral compression fracture at the age levels of 60~69, 70~79, over 80 were all lower than that of the normal old male and female without fracture and of the same age level, and the difference had statistical significance ( P <0.05).The best diagnosis threshold of lumbar vertebra bone density QCT of male and female pa-tients with spontaneous lumbar vertebral compression fracture of different age levels in the northern region of Chongqing were:the male:60~69, 70 ~79, over 80 were separately 109.750 mg/cm3 (95%CI: 73.19, 120.05), 72.983 mg/cm3 (95%CI:71.041, 118.082), 76.867 mg/cm3 (95%CI: 76.312, 82.733); the female: 60 ~69, 70 ~79, over 80 were separately 78.017 mg/cm3(95%CI:65.283, 95.545), 49.900 mg/cm3(95%CI:43.138, 75.900), 40.633 mg/cm3(95%CI:31.382, 65.931) .Conclusion QCT has a relatively high accuracy and sensitivity to the measurement of spontaneous lumbar vertebral compression fracture occurred among old people, so it has a good clinical application value on diagnosing and preventing spontane-ous lumbar vertebral compression fracture occurred among old people.

Objective To investigate the clinical significance of not matching in cranial MRI DWI-FLAIR sequence in patients with a-cute cerebral ischemic stroke. Methods 32 patients with acute ischemic stroke from May 2015 to December 2015 in our hospital were included as the research object. All patients were diagnosed by imaging methods and clinical symptoms as acute ischemic stroke. According to the time of pa-tients with stroke incidence and the changes DWI-FLAIR sequence signal,these patients were divided into the different group,0~4. 5 h group, 4. 5~6. 0 h flair positive group and 4. 5~6. 0 h flair and negative group. The sensitivity and specificity were observed in the different phase with the DWI-FLAIR not matching. At the same time,we compared the effect of thrombolytic therapy and evaluated the application value of DWI-FLAIR not matching in guiding the thrombolytic therapy. Results The sensitivity of acute ischemic brain after stroke onset in 0~3 h,0~4. 5 h groups DWI-FLAIR not matching was 67. 1%,87. 5% and the specificity was 40. 6%,74. 5%,the positive predictive value of 77. 9%,87. 0% and the negative predictive value was 76. 9%,43. 5%. The effect of thrombolytic therapy in patients with negative thrombolysis DWI-FLAIR again pass rate was significantly higher than that of DWI-FLAIR positive group,the difference has statistical significance( P ﹤0. 05). NIHSS and Mrs scores of DWI-FLAIR negative group after thrombolysis were significantly lower than DWI-FLAIR positive group,with statistical signifi-cance( P ﹤0. 05). Conclusion Acute ischemic stroke patients outfit transcranial magnetic MRI,DWI-FLAIR mismatch of in guiding the dif-ferent time of onset of thrombolytic therapy in patients with is of great significance. After the onset of 4. 5~6h,patients with negative flair are still of intravenous thrombolytic therapy. DWI-FLAIR can be an objective image as index to determine the onset time range.

2012年12月2日,乌克兰能源与工业部长列夫·雅丹参加乌克兰与南非共和国能源协议签字仪式.但签字仪式过后,南非有关方面却向乌克兰政府提交了一份抗议:雅丹部长的签字,不是他本人的名字……原来,雅丹在签字时神情恍惚,签的名字谁也看不清是什么.真是咄咄怪事!乌克兰方面负责人立即去找雅丹.然而,雅丹却在家中自杀了.

Objective:To assess the value of CT diagnosis of renal column hypertrophy.Methods:The CT findings of 25 cases of renal column hypertrophy were retrospectively analyzed.All cases made plain and three enhanced CT scan.Results:CT plain scan in all cases showed partial thickening of renal parenchyma,such as strip-density mass broke into the renal sinus,renal sinus fat reduction.Three enhanced CT scan mass was evenly strengthened,in line with the renal parenchyma.Conclusion:Renal column hypertrophy has the typical CT performance,especially three enhanced scanning has an important role in the diagnosis.

对本院2005年3月～2006年9月采用奥美拉唑诊断性治疗慢性顽固性咽喉炎108例分析如下. 1 临床资料 1.1 筛选研究对象凡符合下列标准者纳入本研究:(1)符合慢性咽喉炎诊断标准:局部症状有咽部不适,干燥,灼热,干咳,隐痛,感觉有黏稠物附着,声音嘶哑;局部体征见咽部充血,咽后壁黏膜萎缩,淋巴滤泡增生,黏稠物附着.有其中4个以上症状,以及2项以上体征者.(2)耳鼻喉科检查排除上呼吸道感染、肿瘤等明显的器质性疾病.(3)经耳鼻喉科医师给予积极抗炎药物治疗1个月以上但效果不明显.

患者男,37岁,右上腹隐痛2个月,来院就诊.患者2个月前偶感右上腹隐痛不适,间断低热,无明显急性病史.体检:慢性病容,腹软,肝区轻压痛,右背部扣击痛,腹部未触及包块,无其他阳性发现.B超提示:右肝后段强回声光团,实性包块,边界不清.实验室检查:外周血白细胞10.8×109/L,中性0.88,血沉65 mm/1h,大小便常规未见异常.

患者男,42岁,患者10多年前开始出现慢性咳嗽,胸闷,活动后加重,无咯血.2年前开始偶尔痰中带血,曾作胸部CT(图1)及CR检查发现右肺门肿块,考虑肺癌可能.纤支镜检查未见异常.本次因咳嗽、胸痛4天就诊.查体:慢性病容,呼吸急促,P2＞A2,未闻及明显心脏杂音.超声心动图:右心室肥厚,肺动脉扩张,右肺动脉栓子,肺动脉中重度反流,重度肺动脉高压.并行胸部CT及MRI检查.

患者,男,51岁,以右肾癌收入我院泌尿外科拟行右肾切除术.术前到我科行右肾动脉栓塞术.