Background: The Ki-67 expression level, which represents the proliferation status of cells, serves as a prognostic marker for hepatocellular carcinoma (HCC); however, the immunochemistry method currently used to evaluate Ki-67 is invasive and is not suitable for patients who have lost the chance for surgery, such as those with advanced tumors or those with other serious organic diseases. This study aimed to investigate the value of quantitative dual-energy computed tomography (DECT) parameters in predicting the expression level of Ki-67 in HCC. Methods: This study analyzed the data of 123 consecutive patients with HCC who underwent both Ki-67 immunohistochemistry analysis and two-phase contrast-enhanced DECT imaging. The patients were divided into the following two groups based on the positive rate of Ki-67 (Ki-67%): the high-expression group (Ki67% >20%, n=74); and the low-expression group (Ki-67% <= 20%, n=49). The computed tomography (CT) values in the 130 and 140 keV monochromatic energy images (HU 130-140keV ), normalized effective atomic number (NeffZ), fat density (D-fat), and water density (D-water ) were measured and calculated at the arterial phase (AP) and portal venous phase (PVP). A Spearman correlation coefficient analysis, a comparison of parameters between groups, a receiver operating characteristic (ROC) curve analysis for evaluating predictive efficacy, and a multivariable logistic regression analysis were conducted. Results: The NeffZ-AP, HU 130 keV-PVP, HU 140 keV-PVP, D-fat-PVP, and D-water -PVP were positively correlated with the Ki-67% (all P<0.05), and the DECT parameter values in the high-expression group were significantly higher than those in the low-expression group (all P<0.05). The D-water -PVP [odds ratio (OR) =1.353, 95% confidence interval (CI): 1.204-1.521, P<0.001] and tumor diameter (OR =1.258, 95% CI: 1.08-1.465, P=0.003) were independent predictive factors for high Ki-67 expression. D-water-PVP had the highest predictive efficacy with an area under the curve (AUC) of 0.810. The multivariable analysis combining the DECT parameters and morphological characteristics improved the predictive efficacy of the model in predicting high Ki-67 expression (AUC =0.857). Conclusions: DECT provides a non-invasive method to evaluate the proliferation status of HCC cells, and the predictive efficacy of high Ki-67 expression could be improved by combining DECT parameters and morphologic features.

Objective: To investigate the correlation between dynamic enhanced energy spectral CT parameters and Ki-67 high expression in hepatocellular carcinoma (HCC). Methods: A cross-sectional study. This retrospective case-control study analyzed the clinical data of 101 patients with pathologically confirmed HCC in Xiamen Hospital of Traditional Chinese Medicine and Zhongshan Hospital of Xiamen University from December 2017 to March 2023. These 101 patients included 84 males and 17 females, and the age[M(Q1, Q3)] was 59.0(49.0,66.0)years. These patients were divided into two groups according to the immunohistochemical Ki-67 expression levels in tumor tissues: the high expression group (Ki-67%>20%, n=59) and the low expression group (Ki-67%≤20%, n=42).CT values on 70 keV and 140 keV monochromatic energy images (HU70 keV-a, HU140 keV-a, HU70 keV-p, HU140 keV-p) and water density (Dwater-a, Dwater-p) were measured in arterial phase and portal vein phase, and the difference of HU70 keV, HU140 keV, Dwater values between portal vein and arterial phase (ΔHU70 keV, ΔHU140 keV, ΔDwater), as well as ratio of HU70 keV, HU140 keV, Dwatervalues between portal vein and arterial phase (HU70 keVratio, HU140 keVratio, Dwaterratio) were calculated. Spearman correlation analysis was used to analyze the correlation between the CT spectral parameters and Ki-67%. Multivariate logistic regression model was used to determine the factors associated with high expression of Ki-67. The receiver operating characteristics (ROC) curves were used to indicate the efficacy of dynamic enhanced spectral CT in evaluating Ki-67 high expression in HCC. Results: The high Ki-67 expression group revealed higher alpha fetal protein levels, larger tumor diameter and more irregular tumor shape compared with the low Ki-67 expression group,and the differences were statistically significant (all P<0.05). Spearman correlation analysis showed that the HU140 keV-p, Dwater-p, HU70 keV ratio, HU140 keV ratio, Dwater ratio, ΔHU70 keV, ΔHU140 keV, ΔDwater were positively correlated with Ki-67 positivity rate (r:0.31-0.50, all P<0.05). The spectral CT parameters (HU70 keV-p, HU140 keV-p, Dwater-p, HU70 keV ratio, HU140 keV ratio, Dwater ratio, ΔHU70 keV, ΔHU140 keV, ΔDwater) in high Ki-67 expression group were significantly higher than those in low Ki-67 expression group (all P<0.05). Multivariate logistic regression model shows that Dwater-p(OR=1.16, 95%CI: 1.05-1.29, P=0.005), ΔHU140 keV(OR=1.39, 95%CI: 1.20-1.62, P<0.001) and irregular tumor morphology (OR=5.25, 95%CI: 1.61-17.12, P=0.006) were correlative factors for high Ki-67 expression. The HU140 keV ratio and ΔHU140 keV alone evaluated the highest AUC of high Ki-67 high expression in HCC, which were 0.82 (95%CI: 0.74-0.90), the sensitivity were 61.0%, and the specificity were 88.1% and 85.7%. The combined analysis of Dwater-p, ΔHU140 keV and irregular tumor morphology had an increased AUC of 0.88 (95%CI: 0.81-0.95) in assessment high Ki-67 expression, with the sensitivity of 84.7% and the specificity of 78.6%. Conclusions: Dynamic enhanced spectral CT parameters were positively correlated with the Ki-67 expression in HCC. Spectral CT provides a non-invasive method to evaluate the proliferation status of HCC cells, and the efficiency could be improved by multi-parameter analysis combining spectral CT parameters and morphologic features.

Introduction:Preoperative computed tomography (CT)-guided localization can shorten the time of video-assisted thoracoscopic surgery (VATS) and accurately aid in pulmonary nodule removal.Aim:To discuss the application value and safety of 2 kinds of breast localization needles and anchor localization needles in clinical practice for pulmonary nodules under CT guidance before VATS.Material and methods:We retrospectively studied 215 patients with 247 pulmonary nodules, who underwent CT-guided pulmonary nodule location before VATS. The 2 kinds of localization needles were randomly used, and we collected and analysed the clinical data.Results:We used breast and anchor localization needles in 27.9% and 72.1% of cases, respectively. Differences were observed in puncture localization time, detachment rate, and visual analogue scale (VAS). The detachment rate (0%) and positioning time (median: 12 min) were less in the anchor than in the breast localization needle group (8.7% and median: 13 min, respectively). The median VAS was approximately 2 and 5 in the anchor and breast localization needle groups, respectively. Surgical pathology revealed that 155 (62.8%) pulmonary nodules were malignant while 92 (37.2%) were benign. The primary distinction in surgical procedures is the higher proportion of segmental resections in the middle and inner band group (19.3%) compared to the periphery band group (4.2%).Conclusions:Unlike breast localization needles, anchor localization needles can reduce pain and discomfort after positioning, and they are not easy to decouple. These 2 needles are safe for CT-guided localization, which can shorten the time of VATS and accurately aid in pulmonary nodule removal.

目的 通过图像存档与通信系统(picture archiving and communication system,PACS)内置CT二维重建功能研究优化现行及既往股骨颈前倾角(femoral neck anteversion,FNA)的测量方法,旨在简捷、高效且精准地测量FNA.方法 回顾性分析2015年9月至2022年3月在厦门市中医院行股骨检查的患者47例,A/B测量者采用CT二维重建"优化捷测法"各自测量FNA,其中A者隔月用断层CT法复测.结果 A者及B者采用CT二维重建"优化捷测法"测得FNA平均值分别为(14.58°±4.88°)、(14.37°±4.83°),差异无统计学意义(t=1.142,P=0.256);A者隔月复测FNA平均为(14.68°±4.54°),A者隔月测量结果与初次测量结果比较,差异无统计学意义(t=-0.555,P=0.580).结论 基于PACS系统股骨CT二维重建的"优化捷测法"益于简捷、高效、即时、精准地测量FNA.

目的 完善并拓展YY0175系列单柄直板型金属手术冷刀的通配性及安全性,为降减人因失误,提升人机工效,主动防范手术刀间触性锐器伤提供参考.方法 创新研制由掣卸型滑梯尾俪槽并置通配体、免择向防溅型刀座及多功能偏尾卸刀型握柄构成的模块化稳拾舒持通配掣卸型手术刀柄,在原创的"斜坡尾"配合体采用相对安全的"低抬稳卸"法基础上,又新研了"滑梯尾"通配体及刀片掣卸型偏置柄尾独具匠心运用安全防崩御剚、降耗性能卓越的"单步抽卸"法安全通配掣卸各型刀片及柄尾"压翘"法稳拾舒持刀柄.结果 舒持刀柄益于稳拾舒握、通配利手、安全掣卸,达到设计目标.结论 舒持刀柄具有一柄多用、安全通配、单步掣卸、主动防护、御剚防崩、易携益储及平战通用的优越性.

目的 为克服YY0175单刃直板型金属手术冷刀无法独立一次性完整竭切疤瘢、繁琐低效的缺欠,研制并排叠置通配体多功能捷罄双切手术刀柄.方法 创新研制以"滑坡尾直卸式并排叠置通用配合体"为主动防护核心安全装置和人机化隐设了集约备械属具镂空握柄构成的多功能捷罄双切手术刀柄,并首创了术者可独立一次性完整彻底切净疤瘢的"双刃同步齐切"法,与普通刀柄对比验证效果.结果 实验模拟手术割切动物表皮,双切刀柄定宽同步的"齐切谱"广,术者独立单手一次性便捷完整切净疤瘢及单步直接抽卸手术刀片安全便捷、设计达标.结论 双切刀柄具有单手独控、舒握稳执、定宽切疤、降减皮损、愈痕美观、刀片通配、任向插装、单步直卸、一柄多用、携储两便、备械便捷及平战通用的优越性.

目的 针对国内外各型卸刀器操作繁复、性价比低、普及受限等缺欠,探讨安全御刺、优化简骤、降耗增效、防范及降减手术刀锐器伤的职业意外伤害隐患,保护医护人员健康.方法 以不同开口及材质的易拉罐作为隔离、卡卸及封储YY0174手术刀片的安全媒介替代品,对其安全性、便捷性、可行性及经济性进行相关研究.结果 以撕裂式矮梨口全马口铁易拉罐作为"隔卸储"锐利术械的集约一体化首选安全媒介,益于实现"一步式"安全霎卸即储刀片.结论 以饮料型易拉罐替代持针器实现"一步式"封闭式卡卸刀片优于传统的"端抬推退两步式"开放式卸除刀片,主动防范锐器伤并降低血源性感染的职业危害,优化流程、减骤增效、降耗环保,益于减少人因失误、实现医护安全目标.

目的:探讨CT与MRI对肾脏囊性病变的诊断与鉴别诊断的临床价值.方法:回顾性分析2015年1月-2020年10月在本院诊治经手术病理确诊为肾脏囊性病变的90例(共108个病灶,其中良性60个,恶性48个)患者的临床影像学资料,90例患者接受过CT与MRI检查,比较两种检查方法的Bosniak分级结果和诊断效能.结果:CT与MRI的Bosniak分级结果提示,CT与MRI均能有效明确病灶组织,在Bosniak分级鉴别方面比较,差异无统计学意义(P>0.05);在诊断效能方面,MRI下的Bosniak分级诊断符合率95.37％、敏感性95.83％、特异性95.00％均明显高于CT下Bosniak分级的76.85％、72.92％、80.00％,差异有统计学意义(P<0.05).结论:与CT相比,MRI的Bosniak分级在肾脏囊性病变中的诊断效能更显著,建议首选MRI下的Bosniak分级.

目的 为克服YY0175普通手术刀柄无护刃安全装置且通体无孔、功寡难携的弊端,实现主动防护手术刀锐器伤.方法 阶梯式人机优化设计"主动防护型捷卸通配御刺滑鞘",并与普通刀柄一体化匹装后参照对比验证应用.结果 该护鞘具有安全御刺、磁吸利刃、护械抗损、通配通用、度量卡测、便携易储、防滑稳执、单手霎卸、整体洗消、一鞘多能及性价比高的优越性.结论 普通刀柄匹装实用且性价比高的御刺滑移式安全护鞘后,益于积极主动防范人因失误、职业伤害,平战通用,利于落实医患安全目标.

穿刺活检术在肿瘤微创介入诊疗中越来越受到重视,但穿刺复杂部位肿瘤仍存在潜在风险[1-2],如误中附近重要结构,可能带来重大危险甚至危及患者生命.人工气胸是指通过针管将空气、氧气或其他气体注入胸膜腔而人为形成的气胸,随着胸部肿瘤微创介入诊疗技术不断发展,近年来已逐渐用于近心脏大血管及纵隔的肺转移瘤及近膈顶肝肿瘤等高风险部位病灶活检.本研究观察建立人工气胸后CT引导下经皮胸部穿刺活检心脏血管旁或纵隔内病灶的效果及安全性.

目的:观察盆腔动脉栓塞术(Pelvic arterial embolization,PAE)在严重产后出血治疗中的效果.方法:选取2015-01～2016-12在我院治疗的96例严重产后出血患者作为研究对象,运用随机数表法将其分为两组,各48例.给予对照组盆腔血管结扎术治疗,观察组采取PAE治疗.观察两组临床相关指标、治疗疗效与术后相关并发症.结果:观察组手术时间、起效时间、术后下床活动时间、住院时间以及术中出血量均少于对照组,差异有统计学意义(P＜0.05);观察组相关并发症发生率低于对照组,差异有统计学意义(P＜ 0.05);观察组治疗总有效率高于对照组,差异有统计学意义(P＜0.05).结论:严重产后出血者应用PAE治疗止血效果理想,利于保全患者子宫,促进其术后身心健康的快速康复,临床普及价值高.

目的 研究经颈静脉门体分流术(TIPS)治疗食管胃底静脉曲张破裂出血的临床效果.方法 选择我院收治的食管胃底静脉曲张破裂出血患者60例,所有患者均行TIPS治疗,观察患者术后1年内不同时期肝功能与凝血功能的变化情况.结果 术后总胆红素指标始终明显高于术前,差异显著(P<0.05);谷草转氨酶(AST)与谷丙转氨酶(ALT)术后20 d有所升高,但之后基本恢复至术前水平,与术前相比无明显差异(P>0.05);术后1周,患者血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血浆凝血时间(TT)与D-二聚体指标均明显高于术前,差异显著(P<0.05);但后期PT、APTT、TT均逐渐降低,与术前比较无明显差异(P>0.05),而D-二聚体指标3个月后较术前明显降低,差异显著(P<0.05).结论 经颈静脉门体分流术在一定程度上(尤其是短期)可对患者肝功能及凝血功能造成影响,但术后肝功能逐渐恢复,中、远期肝功能未明显受损;术后需尽早发现凝血功能异常,以便及时处理,恢复凝血功能,减少并发症的发生.

目的：探究妇产科继发性大出血急诊介入栓塞治疗的临床效果。方法36例妇产科继发性大出血患者，随机分为观察组和对照组，各18例。对照组患者未行急诊介入栓塞治疗，观察组患者行急诊介入栓塞术治疗，对比两组患者术后的临床疗效。结果观察组患者均止血成功，均未发生与介入栓塞相关的严重并发症；观察组的总有效率为100.00%，高于对照组的66.67%，差异具有统计学意义(P<0.05)。结论急诊介入栓塞治疗在妇产科继发性大出血治疗中具有良好的临床效果，可以快速有效的控制出血，是一种安全有效的治疗方法，值得临床推广应用。

目的 探讨聚桂醇泡沫硬化剂、无水乙醇治疗头颈部静脉畸形的临床疗效及作用机制.方法 总结分析福建医科大学附属协和医院2012年3月至2014年3月住院治疗的71例静脉畸形患者共82病灶,分为A组(n=40,接受聚桂醇泡沫硬化剂治疗)和B组(n=42,接受无水乙醇注射治疗).A组中高回流型病灶23个(A1组),低回流型病灶17个(A2组);B组中高回流型病灶25个(B1组),低回流型病灶17个(B2组).对比分析A、B两组以及A1、A2组,B1、B2组,A1、B1组,A2、B2组临床疗效,并记录术后不良反应情况.结果 A组、B组总有效率分别为70.0％、95.2％ (P＜0.05),A1组、A2组总有效率分别为56.5％、88.2％ (P＜0.05),B1组、B2组总有效率分别为92.0％、100％ (P＞0.05);A1组、B1组有效率间差异有统计学意义(P＜0.05),A2组、B2组有效率间差异无统计学意义(P＞0.05).结论 无水乙醇硬化治疗头颈部静脉畸形较聚桂醇泡沫硬化剂更有效,其主要机制在于能更彻底地栓塞回流静脉;聚桂醇泡沫硬化剂治疗安全、不良反应少,对低流速型静脉畸形有较好疗效.

Objective To observe the short-term effects of Chinese Medicine Gan-tai mixture (肝泰合剂) in combination with radiofrequency ablation to treat HCC. Methods 74 patients with HCC Ⅱ, Ⅲ stage were reviewed. The patients were divided into two groups randomly, 38 patients given Gan-tai mixture (肝泰合剂) in combination with radiofrequency ablation in treatment group, and 36 patients given Glutathione in combination with radiofrequency ablation in control group respectively. Results In comparison with control group, the ther-apy efficiency of treatment group(CR+PR)71.05% was strikingly higher than control group 58.33%(P<0.05). Besides, the decreasing rate of AFP in treatment group was also more obvious than control group (P<0.01). Further more, the main clinical symptoms of treatment group ameliorated much better than control group(P<0.01). Finally, after 12-month and 24-month therapy the survival rate of treatment group was higher than con-trol group conspicuously(P<0.05). Conclusion Gan-tai mixture (肝泰合剂) in combination with radiofre-quency ablation could not only ameliorate clinical symptoms of patients effectively, but also enhance immunity function of cells, and improve life quality and life span. In summary, it could serve as one of the effective thera-pies for treatment of advanced HCC patients.

<正> 经动脉化疗栓塞介入术是无法手术切除肝癌患者的首选治疗手段。肝癌介入治疗后,多出现腹胀,腹痛,恶心、呕吐,纳差,发热、乏力等栓塞后综合征。患者的持续腹胀和便秘,影响其饮食、睡眠,延长了术后的恢复期。为探求合适的处理措施,笔者收集30例中晚期肝癌介入术后腹胀患者,15例采用常规治疗加芒硝腹壁外敷治疗,效果良好,现报告如下。

锁骨下动脉位置深,前面有锁骨重叠,故锁骨下动脉的损伤在临床上比较少见,但在锁骨骨折尤其中段骨折时容易伴发锁骨下动脉的损伤.笔者搜集该类患者3例,应用经皮血管内成形术(percutaneous transluminal angioplasty,PTA)和血管内支架术获得满意疗效,现总结如下.