目的 采用基于支持向量机(SVM)的方法,对动态磁敏感对比增强灌注加权成像(DSC-PWI)、3D动脉自旋标记(3D-ASL)和多b值扩散加权成像(DWI)三种功能磁共振成像(fMRI)技术进行建模分析,以期构建一种效能最高的胶质瘤术前分级预测模型,为临床医师对胶质瘤患者术前分级的评估和治疗方案的确定提供更多有用的信息和帮助.方法 回顾性分析50例被病理证实胶质瘤患者的影像学检查资料.测量患者DSC-PWI得到瘤侧和对应健康侧的脑血容量(CBV)和脑血流量(CBF)值,3D-ASL得到瘤侧和对应健康侧的CBF值.多b值DWI得到瘤侧和对应健康侧的ADCstand 、ADCfast、ADCslow、灌注分数(f)和水通道蛋白(AQP)值.采用特征递归消除(RFE)算法对变量进行筛选后建立SVM预测模型并与常规预测模型比较,并用受试者工作特征曲线(ROC)曲线下面积(AUC)评价模型预测性能以及采用决策曲线(DCA)分析其临床实用价值.结果 年龄、性别以及MRI灌注参数ASL-CBF、ASL-CBF健侧、DSC-CBF、DSC-CBV、ADCstand和f健侧在高低级别胶质瘤中分布差异有统计学意义(P＜0.05).根据RFE算法发现最终纳入模型的8个变量分别为:rASL-CBF、DSC-CBV、DSC-CBF、ADCstand、Age、rf、AQP值和ADCslow-bi.ROC曲线分析发现SVM模型预测效能和精度最高,其次是基于RFE法建立的Logistic模型,而采用患者瘤体侧与健康侧的相对值等传统的方法建立的DSC、DWI和3D-ASL常规预测模型其预测效能和精确度都较低;其AUC分别为0.969(95％ CI:0.931～1.000)、0.879 (95％ CI:0.786～0.969)、0.767 (95％ CI:0.630～0.903)、0.696(95％ CI:0.542 ～0.849)和0.836(95％ CI:0.724～0.947).PCA分析表明,概率阈值从5％起采用基于SVM的术前预测模型可以使得患者净获益,且当概率阈值≥10％时,SVM的临床获益显著要优于基于Logistic回归建立的常规预测模型.结论 DSC-PWI、3D-ASL和多b值DWI三种fMRI技术对高低级别的鉴别诊断均具有一定的预测价值,而采用SVM构建的预测模型与常规预测模型比较具有更好的预测能力.利用SVM预测模型的指标重要性分布图的可视化特点,可清晰地了解那些参数在模型的重要程度,有助于临床影像科医师对胶质瘤的级别加以判断.

目的 通过CT纹理分析(CTTA)技术分析肺结节的良恶性特征,基于CTTA参数构建预测肺结节良恶性的鉴别诊断模型.方法 将经病理证实的153例肺结节患者(2015年12月至2016年10月95例作为训练集,2016年10月至2017年4月58例作为测试集)纳入CTTA研究,其中结节为良性的患者69例,结节为恶性的患者84例.所有患者均在术前行CT增强扫描,对肺结节动、静脉期的图像采用FireVoxel软件进行纹理特征分析[熵(entropy)、不均匀性(inhomogenity)、峰度(kurtosis)、均值(mean)和偏度(skewness)].根据Logistic回归分析结果构建列线图模型,并用测试集验证模型的预测价值.采用受试者工作特征(ROC)曲线分析各CTTA参数的诊断效能以及比较预测模型在训练集和测试集的差异性;最后采用决策曲线分析(DCA)法综合评价模型临床实用价值.结果 动脉期entropy、inhomogenity、kurtosis、mean和skewness和静脉期entropy、mean和skewness在良恶性结节中差异有统计学意义(P值均＜0.05);而静脉期inhomogenity和kurtosis两组间差异无统计学意义(P值均＞0.05).ROC曲线分析发现动脉期entropy、inhomogenity、kurtosis、mean、skewness以及静脉期entropy、mean和skewness具有一定的鉴别诊断价值(P值均＜0.05).多因素Logistic回归分析显示动脉期entropy和静脉期mean是危险因素,而动脉期skewness是保护性因素;基于多因素Logistic回归分析结果构建的列线图模型在训练集中其鉴别能力稍高于测试集[训练集曲线下面积(AUC) =0.981,95％ CI:0.960 ～1.000,测试集AUC=0.936,95％ CI:0.870 ～1.000],但差异无统计学意义(P =0.1919).DCA表明,概率阈值从10％起采用CT纹理特征参数构建的肺结节良恶性的鉴别诊断模型可以使得患者净获益.结论 CTTA的动脉期entropy、静脉期mean和skewness对肺结节具有较大的鉴别诊断价值,构建的预测模型具有良好的鉴别诊断能力,利用列线图模型的可视化特点,可对肺结节进行准确分类,有助于临床影像科医师对结节的良恶性加以判断.

目的 探讨厦门市思明区开元街道社区卫生服务中心与三甲医院联合标准化管理模式对2型糖尿病患者代谢指标的影响.方法 于2016年11月—2017年10月对厦门市开元社区409例血糖不达标的2型糖尿病患者进行了为期24个月的治疗和随访.结果 研究对象在标准化管理后糖化血红蛋白、低密度脂蛋白胆固醇、收缩压、舒张压的达标率分别为29.0％、45.4％、76.3％、94.2％,均较管理前(0.0％、31.7％、58.8％、83.4％)明显提高,差异有统计学意义(P<0.001);血糖、血脂、血压三者的联合达标率也明显高于管理前(12.9％vs 0.0％),差异有统计学意义(P<0.001).结论 社区卫生服务中心与三甲医院联合标准化管理模式可有效提高2型糖尿病患者血糖、血脂、血压及三者联合达标率,对糖尿病整体防治水平的提高有重要意义.

目的 系统评价高脂饮食与小鼠/大鼠肠道微生态结构改变的相关性.方法 计算机检索PubMed、EMBASE、Cochrane图书馆、中国生物医学文献数据库、中国知网、维普期刊数据库、万方数据库,查找关于高脂饮食与肠道微生态相关性的随机对照研究.对纳入的研究利用RevMan 5.3进行Meta分析.结果 共纳入研究15篇,皆是随机对照实验研究.Meta分析结果表明,高脂饮食小鼠/大鼠肠道双歧杆菌的含量减少(标准化均数差-4.08,95％可信区间-6.10～-2.05,P=0.000 1);高脂饮食对小鼠拟杆菌水平变化无明显差异(标准化均数差-0.5,95％可信区间-1.73～0.72,P=0.42),而高脂饮食的大鼠内拟杆菌明显减少(标准化均数差-1.46,95％可信区间-2.58～-0.35,P=0.01);同时肠道内乳酸杆菌的含量减少(标准化均数差-4.52,95％可信区间-7.39～-1.52,P＜0.002);而肠道肠杆菌含量增加(标准化均数差3.93,95％可信区间0.53～7.32,P=0.02).结果 也表明高脂饮食后小鼠/大鼠体质量增加(标准化均数差3.74,95％可信区间2.81 ～4.67,P＜0.000 01);血浆总胆固醇(标准化均数差3.52,95％可信区间2.39～4.65,P＜0.000 01)及甘油三酯(标准化均数差1.87,95％可信区间1.14～2.60,P＜ 0.000 01)在高脂饮食后均显著升高.结论 高脂饮食可导致小鼠/大鼠肠道微生态结构的改变.肠道微生态结构改变可能在肥胖、高脂血症等代谢性疾病的发生中发挥重要作用.

Objective To investigate the expression and activity of pyruvate kinase in interstitial cells of Cajal (ICCs) in the bladder of rats with diabetic cystopathy (DCP).Methods Forty 8-week-old female rats were divided into two groups randomly,31 as the experiment group and the rest 9 as the control group.The experiment group was intraperitoneally injected with streptozotocin (STZ) to establish diabetic models and 18 rats were succeeded to be induced.Nine diabetic rats were further raised for 12 weeks getting DCP rats.ICCs from bladder muscle were cultured.The expression of pyruvate kinase protein and mRNA was detected by Western blotting and real-time quantitative polymerase chain reaction (Real-time PCR) respectively,and pyruvate kinase activity was measured.Results The expression levels of pyruvate kinase protein and mRNA and activity in DCP rats were reduced significantly as compared with those of the diabetic rats and control rats [(0.537 ± 0.015),(0.624 ± 0.026),(0.098 ±0.010) U/g· prot respectively,vs.(0.722 ± 0.026),(0.739 ± 0.045),(0.178 ± 0.017) U/g· prot,vs.(0.923±0.031),(1.000±0.022),(0.277±0.030) U/g·prot;P＜0.01].Conclusion The reduction of pyruvate kinase activity in ICCs may play an important role in the development of DCP.

目的:探讨乳腺X线纹理分析技术对预测浸润性导管癌患者腋窝淋巴结转移的价值.方法:收集手术病理证实的乳腺浸润性导管癌患者106例,X线均表现为单发肿块,根据腋窝淋巴结转移情况分为转移组和非转移组.使用纹理软件与SPSS进行纹理分析,评估纹理参数预测腋窝淋巴结转移的效能.结果:均值、偏度、峰度值在两组间差异无统计学意义(P>0.05),熵值、标准偏差及不均匀度在腋窝淋巴结转移组中高于非转移组(P<0.05).熵值、标准偏差及不均匀度的诊断敏感度分别为71.9％、63.2％ 及73.7％;特异度分别为55.1％、63.3％ 及57.1％.结论:乳腺 X 线纹理分析可以有效预测浸润性导管癌患者的腋窝淋巴结转移情况,辅助 X 线提高对浸润性导管癌患者腋窝淋巴结转移的诊断敏感度.

目的:探讨定量X线纹理分析对鉴别乳腺纤维腺瘤与浸润性导管癌的临床价值.方法:收集经手术病理证实的纤维腺瘤患者73例,浸润性导管癌患者110例,X线上均示单发肿块.使用纹理分析软件,提取肿块X线纹理参数,包括均值、标准偏差、偏度、峰度、不均匀度和熵等.采用两独立样本t检验和Mann-WhitneyU检验进行比较分析并绘制ROC曲线,分析乳腺X线、纹理特征、乳腺X线联合纹理特征鉴别乳腺肿块良恶性的诊断效能.结果:均值、偏度、峰度及不均匀度值在纤维腺瘤和浸润性导管癌肿块间差异无统计学意义(P>0.05),熵值和标准偏差在浸润性导管癌中高于纤维腺瘤(P<0.05).熵值和标准偏差鉴别两者的曲线下面积(AUC)分别为0.652和0.614(P<0.05).将2种纹理特征与X线联合后,纹理特征和X线联合纹理特征鉴别诊断的敏感度分别为54.5％ 及77.3％;特异度分别为76.7％ 及89.0％;准确度分别为63.4％ 及82.0％.结论:定量X线纹理分析可以区分乳腺纤维腺瘤与浸润性导管癌,应用纹理分析技术可以提高X线对浸润性导管癌的诊断灵敏度和准确度.

孕期体重过度增加及产后体重不能恢复,是女性发生肥胖的一个重要原因.坚持哺乳、合理膳食、科学运动,有利于产后女性身体复原和体重恢复.

有一天,门诊快下班了,50岁的王女士急匆匆地跑到泌尿外科的诊室,希望医生能加个号给她看看.王女士患有肾结石,预约了肾内科,结果肾内科医生告诉她看错了科室,让她看泌尿外科.王女士小声嘟囔着:“我这个肾结石不大,也不想做手术,看外科干吗?”王女士的疑问,诸君往下看,自会找到答案.

目的 探讨原发性睾丸淋巴瘤(PTL)的CT表现特征及诊断价值.方法 回顾性分析经手术病理证实的7例PTL的影像特征,并与睾丸精原细胞瘤进行比较.7例PTL患者与11例精原细胞瘤患者均行CT平扫+增强扫描;观察病灶的形态、大小、密度、强化特征、侵犯附睾或精索及淋巴结转移情况,并采用Fisher检验进行两者的对比分析.结果 PTL多呈类圆形,密度相对均匀,增强后中度至明显强化,可见小血管穿行;同侧附睾或精索及腹膜后淋巴结常受累;精原细胞瘤易见坏死,密度混杂,增强后不均匀轻至中度强化,8例出现增粗血管;两者在以上CT表现的差异均有统计学意义(均P＜0.05).结论 PTL的CT表现具有类圆形,增强后中度至明显强化,伴小血管穿行的特征性,对于鉴别精原细胞瘤有一定的价值.

目的 应用氢谱磁共振(1 H-NMR)代谢组学方法研究2型糖尿病(T2DM)患者尿液中小分子代谢物代谢轮廓的变化.方法 选择T2DM患者98例及健康对照组82例,利用1H-NMR方法检测尿液的代谢轮廓,结合偏最小二乘判别分析法的模式识别分析方法,比较两组尿液中小分子代谢物差异.结果 尿液的偏最小二乘判别分析法得分图显示与T2DM有关的特征代谢物包括乙酸、乳酸、牛磺酸、乙酰乙酸、葡萄糖、丙氨酸、甲基丙二酸、肌酐、柠檬酸、三甲胺等.结论 糖代谢紊乱、氧化应激、氨基酸及脂类代谢异常、维生素缺乏在T2DM及其并发症的发生发展中起到重要作用.1H-NMR代谢组学方法,可以全景监测小分子代谢终端产物的变化,符合T2DM代谢性疾病的特点.

78岁的郭老太太有个难言之隐,每当咳嗽、打喷嚏时,尿液会不自主地漏出来.她患有这个病快30年了,近一年来明显加重,快走时也会有漏尿现象.郭老太太每次外出,特意减少喝水,垫着卫生巾.卫生巾总是湿漉漉的,弄得她很是烦恼、尴尬.

目的:探讨脂联素与2型糖尿病(T2DM)合并颈动脉粥样硬化的相关性.方法:选取受试者127例,分为3组:单纯T2DM组39例、T2DM合并颈动脉粥样硬化病变组48例、正常对照组(NC)40例.采用酶联免疫吸附法(ELISA)测定血清脂联素水平,用彩色多普勒超声诊断系统测定各组颈动脉血管病变情况.结果:T2DM合并颈动脉粥样硬化病变组的血清脂联素水平显著低于单纯T2DM组和正常对照组.多元逐步回归分析显示血清脂联素水平与糖尿病病程、空腹血糖、颈动脉内中膜厚度(IM T)呈负相关,与HDL-C呈正相关.Logistic回归分析示低脂联素血症、总胆固醇是2型糖尿病患者颈动脉粥样硬化发生的危险因素.结论:低脂联素血症可能参与T2DM及其大血管病变的发生、发展,提高脂联素水平可能成为2型糖尿病大血管病变治疗的新靶点.

Objective To study the clinical value of MR diffusion weighted imaging and dynamic enhancement in the di-agnosis of prostate cancer. Methods 50 patients with suspected prostate cancer who underwent biopsy were selected and 30 healthy subjects were selected as the control group. MR diffusion weighted imaging and dynamic enhancement were performed on all subjects. The clinical pathology of 50 patients were observed,the MR diffusion weighted imaging signal strength value,apparent diffusion coefficient value and MR dynamic enhancement scan parameters ( Ve,Ktrans and Kep) between normal prostate,pros-tate cancer and benign prostatic hyperplasia were compared. Results 50 patients were diagnosed by biopsy or surgical diagnosis of benign prostatic hyperplasia in 24 cases, accounting for 48. 00%;Diagnosis of prostate cancer in 26 cases, accounting for 52. 00%;There was no significant difference in the MR diffusion weighted imaging signal intensity values and apparent diffusion coefficient values between the benign prostatic hyperplasia group and the normal prostate group,and there were significant differ-ences between the other groups with pairwise comparisons;There was no significant difference in the Ve,Ktrans and Kep between the benign prostatic hyperplasia group and the normal prostate group, and there were significant differences between the other groups with pairwise comparisons. Conclusion MR diffusion weighted imaging combined with dynamic enhancement contributes to the identification and diagnosis of prostate lesions,and has high clinical value in the diagnosis of prostate cancer.

OBJECTIVE:To compare the efficacy among the combined treatment of flying needling therapy and clomiphene, the simple application of flying needling therapy and simple clomiphene in the treatment of ovulation failure in polycystic ovary syndrome (PCOS). METHODS:Ninety patients of PCOS were randomized into a flying needling therapy group, a medication group and a combined treatment group, 30 cases in each one. In the flying needling therapy group, the flying needling therapy was simply applied to Ganshu (BL 18), Shenshu (BL 23), Zhongwan (CV 12), Shuifen (CV 9), Guanyuan (CV 4) and Zhongji (CV 3). The unilateral back-shu points were used alternatively in each treatment. The needles were inserted rapidly with rotation technique and even-needling manipulation. The needles were retained for 30 min. The treatment was given once every two days, 3 times a week. In the medication group, clomiphene was taken orally on the 5th day of menstruation, continuously for 5 days. In the combined treatment group, the flying needling therapy and clomiphene were used in combination. All of the patients were treated for 3 months and followed up for 1 month. The ovulation rates were compared among the three groups. The levels of androgen testosterone were compared before and after treatment. RESULTS:In the combined treatment group, the ovulation rate was 86.2% (100/116), better than 66.7% (80/120) in the flying needling therapy group and 69.6% (78/112) in the medication group (both P<0.05). The efficacy was similar between the fly needling therapy group and the medication group (P>0.05). After treatment, the level of testosterone was reduced in the three groups (all P<0.05). In the combined treatment group, the improvement in androgen level was better than those in the flying needling therapy group and the medication group (both P<0.05). The efficacy was similar between the flying needling therapy group and the medication group (P>0.05). The adverse reactions in the combined treatment group and the flying needling therapy group were lower than those in the medication group (both P<0.05). CONCLUSIONS:The flying needling therapy effectively improves in the ovulation failure of PCOS and its effect is similar to clomiphene. The allied treatment of them apparently improves the clinical efficacy and alleviates the adverse reactions.

Objective To explore the effect of different anode-filter combinations on radiation dose and image quality of digital mammography.Methods Firstly,the phantoms with thickness of 44 mm,54 mm and 64 mm were exposed respectively under the automatic exposure control (AEC)mode,and then explored manually under the three different anode-filter combination modes inclu-ding molybdenum-molybdenum (Mo/Mo),molybdenum-rhodium (Mo/Rh)and rhodium-rhodium (Rh/Rh)combination with the tube voltages and currents similar to the AEC mode,The entrance skin exposure (ESE)and average glandular dose (AGD)were re-corded for each exposure.The ESE-to-AGD ratio,signal-to-noise ratio (SNR),contrast-to-noise ratio (CNR)and the figure of merit (FOM)were calculated to compare the radiation dose and image quality of the different anode-filter combinations.The randomized block design analysis of variance was used for statistical analysis.Results For the three phantom thickness,the AGD,ESE and ESE-to-AGD ratio in the three anode-filter combinations changed as Mo/Mo>Mo/Rh>Rh/Rh,and the differences were statistically sig-nificant (P <0.01);the SNRs of Mo/Mo were the highest,but its FOMs were the lowest;the differences of SNR between Mo/Mo and Mo/Rh had no statistical significance (P >0.05).For the 44 mm phantom thickness,the SNR of Rh/Rh was the lowest,but CNR and FOM of Mo/Rh were the highest,and the differences were all statistically significant (P <0.01).For the 54 mm and 64 mm phantom thickness,CNR and FOM of Mo/Mo were lower than those of the other two combinations,and the differences had statistical signifi-cance (P <0.01);the differences between Mo/Rh and Rh/Rh had no statistical significance (P >0.05).Conclusion Different anode-filter combinations have significant influences on radiation dose;the effects on image quality were related to the phantom thickness, the thicker the phantom,the worse the images of Mo/Mo,and the better the performance of Rh/Rh.

Objective To explore X-ray anatomical landmarks of adult superior vena cava and their applications for localizing cath-eter tip of PICC placement.Methods The authors retrospectively reviewed chest radiographs of 2 1 9 PICC insertions,and 5 7 of them were carried out with chest CT scan in a week.For each patient,the vertical distances from the carina to the right superior heart bor-der or the cavoatrial j unction(CAJ),the right tracheobronchial angle and PICC tip position were measured,recorded,and analyzed, respectively.The obtained data from 5 7 patients were divided into chest X-ray group and CT group,which were then statistically an-alyzed accordingly.Results Between chest X-ray group and CT group,the vertical distances from the carina to CAJ,the right tra-cheobronchial angle and PICC tip position had no significant difference (each P>0.05)and showed positive correlation(r=0.744, 0.332,0.778,each P<0.05).No significant difference existed in PICC catheter tip locations estimated by chest X-ray group and by CT group (P>0.05).The matching coefficient was k=0.542 and was statistical difference (P<0.05).The mean vertical distance from the carina to the right superior heart border was (3.21±0.84)cm and from the carina to the right tracheobronchial angle was (1.38±0.28)cm.The above measured values in males were higher than in females(P<0.05).Conclusion It is applicable and ac-curate that using the carina,right tracheobronchial angle and right superior heart border as the radiographic landmarks for adult supe-rior vena cava and catheter tip positioning of PICC placement.The average vertical distances from the carina to the right tracheo-bronchial angle,and to the right superior heart border in the chest X-rays can provide reference basis for j udging PICC catheter end position in clinical.

目的：分析服用地塞米松导致医源性 Cushing 综合征的临床表现及治疗。方法：对我院诊治的1例超生理剂量服用地塞米松引起的医源性 Cushing 综合征进行临床诊断分析并文献复习。结果：患者停用地塞米松，改为口服强的松，并逐渐减量至停用，给予吸入激素等治疗后哮喘症状逐渐缓解，肾上腺皮质功能恢复正常。结论：长期使用地塞米松可引起医源性 Cushing 综合征，临床医生应合理使用糖皮质激素，尽量减少各种副作用的发生。

Objective To investigate the relationship among adiponectin,its receptors (AdipoR1,AdipoR2 and T-cadherin) and the pathological characteristics of human hepatocellular carcinoma (HCC).Methods The expression of Adiponectin,AdipoRl,AdipoR2 and T-cadherin was detected by immunohistochemistry in 42 cases of HCC tissues (tumor hepatic tissues and pericarcinomatous tissues).Results The expression of Adiponectin (2.88 ± 1.06 vs.5.98 ± 0.95),AdipoR1 (2.36 ± 1.38 vs.5.43 ±1.04),AdipoR2 (2.29±1.55 vs.5.14±1.22) andT-cadherin (2.17±1.34 vs.5.21 ±1.18) was decreased in tumor hepatic tissues compared to pericarcinomatous tissues.The expression of Adiponectin (2.57±1.03 vs.3.19±1.03),AdipoR1 (1.81 ±1.44 vs.2.90±1.09),AdipoR2 (1.48±1.47 vs.3.10 ± 1.18) and T-cadherin (1.76 ± 1.34 vs.2.57 ± 1.25) in HCC tissues with tumor thrombi was lower than in cancerous tissues without tumor thrombi.Adiponectin (2.30 ± 1.16 vs.3.06 ±0.98) and AdipoR2 (1.20 ± 1.48 vs.2.63 ± 1.43) expression in HCC tissues with satellite lesions was lower than in cancerous tissues without satellite lesions.The expression of T-cadherin in large size (＞5 cm) tumor tissues (1.59 ± 1.33) was lower than in the small size (≤5 cm) tumor tissues (2.56 ± 1.23).Conclusion The decreased expression of Adiponectin and its receptors may play a role in the intrahepatic metastasis of HCC.

亨廷顿病(Huntington disease,HD)是一种常染色体显性遗传的神经退行性疾病,由位于4号染色体4p16.3区域的IT-15基因内CAG三核苷酸重复序列异常扩增所致.典型症状包括舞蹈样症状、认知和精神障碍.本病见于各种族人群,其中以白种人最多见,东方人中较少见[1-3].国内有关亨廷顿病的影像研究主要集中在其形态学表现上[4-5],MR新技术DWI、扩散张量成像(diffusion tensor imaging,DTI)及磁敏感加权成像(susceptility weighted imaging,SWI)在亨廷顿病中的应用报道较少,笔者搜集经基因检测证实的2个亨廷顿家系6例亨廷顿病患者的DWI、DTI及SWI影像资料[3],报道如下。