目的 观察核黄素磷酸钠联合康复新液对局部晚期头颈部肿瘤同步放化疗过程中口腔黏膜炎预防及治疗的有效性.方法 入组局部晚期头颈部肿瘤患者60例,随机分为两组.观察组同期放化疗开始时即应用核黄素磷酸钠加康复新液至放疗结束;对照组治疗期间仅常规对症处理.比较观察两组治疗过程中口腔黏膜炎的分级程度,并比较口腔黏膜炎恢复时间.结果 观察组治疗过程中口腔黏膜炎的1、2、3、4级反应患者分别占76.7％、16.7％、6.7％和0;而对照组的1、2、3、4级反应的患者分别占50％、40％、6.7％和3.3％.观察组患者口腔黏膜炎恢复时间<7 d和≥7 d的比例分别为90％、10％;对照组分别占60％、40％.两组口腔黏膜炎的分级程度和恢复时间长短差异均有统计学意义(P<0.05).结论 核黄素磷酸钠联合康复新液能有效防治局部晚期头颈部肿瘤放化疗所致口腔黏膜炎的发生,能更好地促进黏膜炎的愈合,值得临床推广应用.

目的:研究并探讨腹部磁共振弥散加权成像(Diffusion weighted imaging,DWI)技术在肝脏良、恶性肿瘤鉴别诊断中的应用价值.方法:选择2015年1月1日—2017年12月31日就诊于我院的75例肝脏肿瘤患者,对其进行常规MRI、DWI检查,以手术病理诊断结果 为参照,计算和比较常规MRI、DWI的鉴别诊断灵敏度、特异度、准确性.根据手术病理诊断结果,将患者分为良性病变组、恶性病变组,比较两组在不同b值下的表观弥散系数(Apparent diffusion coefficient,ADC).结果:DWI的鉴别诊断灵敏度、特异度、准确率均高于常规MRI(P<0.05).在不同b值下,恶性病变组的ADC值均低于良性病变组(P<0.05).结论:在肝脏良恶性肿瘤鉴别诊断时,应用磁共振DWI技术可对肝脏良性肿瘤与肝脏恶性肿瘤予以准确鉴别区分,其定性诊断价值显著.

伪满时期,东北地区鼠疫、霍乱、天花、结核、麻风、性病等急慢性传染病流行,危及民众健康.日本侵略者为了保护在中国东北的百万日本人的健康,构建了现代卫生防疫体系,设立卫生防疫机构,出台卫生防疫法律,改善居民卫生状况,开展全面的卫生宣传教育,企图通过发展医疗卫生缓和东北民众的反抗情绪,维护其长期统治.在伪满洲国,教育、公共卫生和各项事业不可能扩展到全体中国人口.卫生防疫是日本对殖民地进行统治的重要手段和工具,是定义日本殖民主义性质的一个重要因素.

Objective:To explore the clinical application of endoscopic ligation operation coalition plastic injection in the treatment and prevention of the ruptured esophageal gastric varices bleeding.Methods:52 patients with ruptured esophageal gastric varices bleeding from August 2011 to August 2013 were treated with plastic injection and ligation according to the forms and sizes of varices.The effect of the treatment was observed.Results:3 cases had the ruptured esophageal gastric varices bleeding and succeed in one-time hemostatic after the treatment.The residual varicose vein had ligation and plastic injection when reviewed after 4 weeks.All of the patients had the review of gastroscope after 8 weeks;the total effective rate of esophageal varices was 91.2%;the total effective rate of gastric varices was 82.6%.There was no thrombosis and 1 patient with rehemorrhage occurred which needed plastic injection again,and the rest of the patients had no rehemorrhage.Conclusion:Endoscopic ligation operation coalition plastic injection in the treatment and prevention of ruptured esophageal gastric varices bleeding had distinct clinical curative effect and fewer complications,which had clinical utility.

Objective:To investigate the significance of sleeve body and the recovery of tumor stromal tumor ligation in the treatment of stomach.Methods:40 cases of gastric stromal tumor were selected.The preparation of preoperative was same with painless gastroscopy.Patients were given the line ligation device for treating common gastroscope sleeve after anesthesia.All layers of stomach that the diameter<12 mm along with cancer inhalated into the transparent cap,then released the rubber ring,but for the superficial and larger lesions.We can choose the nylon endoloop,nylon rope in the lesions of the basal through the biopsy channel,tighten the nylon rope,and then made the mucosal surface tumor of gastric and normal mucosa together using clipping metal titanium clamp.Results:After 5~7 days of the rubber ring off in all patients,the tumor with titanium clip attached to the stomach wall,and recoved with the trap successful.Conclusion:Ligation of gastric stromal tumor and recoveration of tumor stromal has extremely important significance on postoperative pathological diagnosis and guide the treatment of patients.

Objective:To evaluate the clinical effect and safety of endoscopic band ligation(EBL) combined with tissue adhesive injection treatment of Dieulafoy lesions hemorrhage.Methods:19 patients with Dieulafoy lesions hemorrhage were selected.They were given EBL combined with tissue adhesive injection treatment.Results:The ligation of 19 patients with Dieulafoy lesions hemorrhage were all success.The formative false tumors after lesions were given injection of tissue adhesive;hey were all success, and the hemostatic rate was 100%.The hospitalization was 7 to 10 days.There was no 1 case of rebleeding.The transfer surgery rate was 0.After 18 months of follow-up,no 1 case appeared upper gastrointestinal hemorrhage,and the long-term hemostatic rate was 100%.Conclusion:EBL combined with tissue adhesive injection is a brand new,safe and effective method in the treatment of Dieulafoy lesions hemorrhage.

Objective:To explore the diagnostic efficiency and practical application value of MRI 3D-SPACE and VIBE sequence on trigeminal microvascular oppression.Methods:18 patients with unilateral primary trigeminal neuralgia were given MR 3D-SPACE and VIBE sequence checking.All patients were confirmed by microvascular decompression of the trigeminal nerve. The imaging characteristics of trigeminal microvascular oppression were analyzed.The ability and advantage of showing the relationship between trigeminal nerve brain pool and surrounding blood-vessel were evaluated.Results:In 18 patients,3 cases(16.6% ) were symptoms Ⅰ type lateral neurovascular relations,12 cases(66.6% ) were Ⅱ type,3 cases(16.6% ) were Ⅲtype.12 cases(66.7%) were asymptomatic side Ⅰ type,6 cases(33.3%) were Ⅱ type,0 case was Ⅲ type.The difference of bilateral compression level was statistically significant(P=0.000).In the neurovascular contact and compression of nerve,9 cases were proximal oppression in 15 cases of symptomatic side,6 cases were distal oppression,4 cases were proximal oppression in 6 cases of asymptomatic side,2 cases were distal oppression.The difference of the pressure point locations between symptomatic side and asymptomatic side was no statistically significant(P=0.328).The arteria cerebelli superior of symptomatic side was the main contact and pressure vessel(58%).3D-SPACE and VIBE sequence can have multiplanar reconstruction of trigeminal nerve,can show the location,degree of vascular compression trigeminal nerve and the source of offending vessel.Conclusion:3D-SPACE sequence can clearly show the relationship between the trigeminal nerve and surrounding structures.VIBE sequence is Commonly used complementary sequence of trigeminal MR imaging.3D-SPACE combined with VIBE sequence can provide accurate diagnostic information,has a important value in the diagnosis of primary trigeminal neuralgia.

Objective To survey the incidence of nutritional risk and undernutrition and the status of nutritional support on surgical inpatients in general surgery departments of 5 middle and small hospitals in Jilin province.Methods A total of 4 330 hospitalized patients from the surgical departments of 5 hospitals in Changchun,Songyu,and Baicheng of Jilin province were recruited from May2010 to March 2013.Among them 687 cases entered the final analysis based on the exclusion criteria.They were further divided as group Ⅰ (n =140,including patients with gastric cancer or colorectal cancer) and group Ⅱ (n =547,including patients with gastric ulcer,intestinal obstruction,or Crohn's disease).Nutritional Risk Screening 2002 was performed within 24 hours after admission.The incidence of undernutrition and nutrition risk was calculated,and the nutritional support was evaluated until the discharge.Results In these two groups,167 patients (24.3％) were at nutritional risk,among whom 73.7％ received nutritional support and 26.3％ received non-nutritional support.Also,520 cases were not at nutritional risk,among whom 8.8％ received nutritional support and 91.2％ received non-nutritional support.In addition,64.3％ of patients were at nutritional risk in group Ⅰ and 14.1％ in group Ⅱ (P =0.000).Among these 687 cases,body mass index was ＜ 18.5 kg/m2 in 3.2％ of patients and nutritional status ≥3 scores in 8.3 ％ (P =0.000).Conclusions Patients with different gastrointestinal diseases may have different nutritional risks and undernutrition status.Parenteral nutrition support has been applied in 5 middle and small hospitals in Jilin provinicne,while enteral nutrition and combination of parenteral nutrition and enteral nutrition has not been introduced.

目的：应用氢质子磁共振波谱（1H-MRS）研究缺血性脑梗死的代谢物绝对浓度的变换特点及其演变规律,探讨其在评估缺血性脑梗死中的价值。方法：通过表观扩散系数图（ADC图）精确定位氢质子磁共振波谱,采用绝对定量方法,对30例不同时期缺血性脑梗死患者的NAA、Cr、Cho、mI、lac代谢物绝对浓度含量的变化进行检测,观察不同分期脑梗死中各代谢物的变化特点。结果：在超急性期,脑梗死区NAA浓度较对侧下降,但仍保持较高的水平;Cr浓度亦较对侧轻度下降,Cho、mI浓度略有下降,lac浓度明显升高。在急性期,脑梗死区NAA、Cr、Cho、mI浓度均较对侧明显下降,其中NAA浓度下降最为显著,平均浓度只为对侧的18.9%,而lac浓度继续升高,并达到高峰。在亚急性期,脑梗死区NAA、Cr、Cho、mI浓度均较对侧明显下降,lac浓度开始下降,但仍持续较高水平。在慢性早期和晚期,NAA、Cr、Cho、mI浓度继续维持很低的水平。Cr、Cho、mI与NAA均有平行下降趋势,但没有NAA、Lac变化显著。结论：在脑梗死的MRS研究中,绝对定量技术能直观、准确地检测缺血脑组织内代谢物的动态演变过程,对深入研究脑梗死的发病机理有重要意义。

Objective:Application of proton magnetic resonance spectroscopy(1H-MRS)transform characteristics and evolution law of ischemic cerebral infarction metabolite concentration,explore the value evaluation of ischemic cerebral infarction.Methods:The apparent diffusion coefficient diagram(ADC diagram)precise positioning of proton magnetic resonance spectroscopy,using the absolute quantification method,changes of 30cases patients with different stages of ischemic cerebral infarction of NAA、 Cr、Cho、mI、lac metabolites of absolute concentrations were detected to observe the different characteristics of each metabolite,changes in the staging of cerebral infarction.Results:In super acute period of cerebral infarction area,NAA concentration is on the side down,but still maintained a higher level;the concentration of Cr is slightly to the contralateral side down,Cho,mI concentration decreased slightly,the concentration of Lac increased significantly.In the acute phase of cerebral infarction area,NAA,Cr、Cho、mI concentration was lower than contralateral decreased significantly,NAA concentration decreased most significantly,the average concentration of side 18.9%,while the lac concentration continues to increase,and reached a peak.In the subacute stage of cerebral infarction area,NAA、Cr、Cho、mI concentration was lower than contralateral decreased significantly,lac concentration began to decline,but still high level.In chronic early and late,NAA、 Cr、 Cho、 mI concentration to maintain a very low level,Cr、Cho、mI and NAA have parallel downward trend,but no significant change in NAA、Lac.Conclusion:In the MRS study of cerebral infarction,absolute quantitative technology can accurately detect the dynamic evolution process.The metabolites within ischemic brain tissue,are of great significance to study the pathogenesis of cerebral infarction.

Objective To investigate the features of postoperative complication and length of hospital stay caused by nutritional risk on surgical inpatients with gastrointestinal diseases in general surgery department of 5 middle and small hospitals in Jilin province.Observe the impact of parenteral nutrition on clinical outcome in the surgical patients with gastrointestinal diseases. Methods In the cohort study, a total of 4349 hospitalized patients from 5 hospitals of relatively developed Changchun area, Songyu area, and Baicheng area in general surgery department of Jilin province were recruited from May 2010 to March 2013. After the patients were excluded for hospital lengh of age less than 18 years old or more than 80 years old, stay less than 24 hours or operation before the next day 8 o'clock, obnubiation and /or refuse to participate in the research, and inconformity to scheduled diagnosis, 405 cases were sampled. Collected research material mainly included nutrition risk screening, the status of application on enteral and paraenteral nutritional support, operation, complications and length of hospital stay. Results A total of 405 cases met the inclusion criteria were recruited from these areas. There are 235 cases at non- nutritional-risk, and there are 26 at complications.The incidence of complication was 4.9% in at-nutritional risk patients recieved enteral nutritional support and 14.7% in at-nutritional risk patients non-enteral nutritional support. Conclusion Nutrition support can decrease compliactions of at-nutritional-risk patients and length of hospital stay, but non-nutritional-risk patients is not so。

<正>DWI是MR扩散加权成像,是利用磁共振成像(MRI)的特殊序列检测活体组织中水分子的微观弥散运动的一种成像技术,与以往常规MRIT1WI、T2WI等序列不同,DWI作为MRI功能成像新技术,是目前惟一从分子水平上在宏观成像中反映人体组织在病理、生理状态下各组织

目的:探讨16排螺旋CT血管成像(MSCTA)在主动脉夹层的诊断和临床治疗中的应用价值。方法:2例夹层动脉瘤均进行了16排螺旋CT(MSCT)胸腹联合平扫及增强并将原始数据在MD工作站进行多平面重建(MPR)、阴影表面显示(SSD)、最大密度投影(MIP)及容积处理(VR)等后处理。结果:2例均很好地显示了主动脉全程及其分支,夹层动脉瘤的部位、范围并得到满意显示。结论:MSCTA是诊断夹层动脉瘤准确、快捷、有效的首选检查方法,具有较高的临床应用价值。

目的:评价弥散加权成像（DWI）中ADC图在脑梗死分期演变诊断中的可行性、实用性及其临床应用价值。方法:对临床上拟诊为不同时期脑梗死患者160例共进行172次常规MRI检查及DWI扫描,其中超急性期23例次,急性期57例次,亚急性期40例次,稳定期32例次,慢性期20例次。应用单次激发平面回波三向同性扩散加权成像（DWI）的示踪图（ADC图）信号强度的改变及病灶中心区平均ADC值、相对ADC（rADC）进行量化分析评议。结果:从梗死时间长短上进行分析,梗死后病灶随时间延长、病程发展ADC图上由极低信号强度（超急性期、急性期）逐渐回升变为低信号（亚急性期）,到等信号改变（稳定期）,出现假正常化现象,最后变为高信号（慢性期）的规律演变;病灶中心区ADC值、rADC由明显低值（超急性期、急性期）到较低值（亚急性期）、到等值（稳定期）,最后到高值（慢性期）的规律演变。病灶中心区ADC值、rADC与梗死时间分期具有显著性相关（R=0.982,P＜0.001）。结论:DWI、ADC图信号强度变化与ADC值、rADC量化分析相结合对临床脑梗死演变分期具有高度准确性,但单从DWI图像上的信号高、低并不能准确地判断梗死灶的时间,不能完全鉴别急性与非急性期脑梗死,DWI、ADC图信号强度变化与ADC值、rADC量化分析相结合才能对临床脑梗死演变分期进行准确的判断。指导临床及时、有效治疗,为临床治疗及愈后判断提供帮助。

目的:评价MRI对膝关节骨挫伤的诊断价值和临床意义。方法:回顾性分析30例X线平片及CT检查未显示骨折但MRI显示有外伤性骨挫伤的膝关节外伤患者影像学资料,观察其骨挫伤病灶的部位。病灶数。MRI表现以及合并韧带、半月板等关节附属结构损伤的影像表现。结果:30例骨挫伤54处,合并韧带损伤12例,合并半月板损伤7例。股骨挫伤占比率最大,约占52%,股骨髁挫伤约占43%,其次为胫骨上端骨挫伤,占38%,腓骨近端占3.7%,其中前交叉韧带撕裂中80%有股骨外侧髁及胫骨外侧平台的骨挫伤。结论:MRI可以准确显示膝关节骨挫伤的部位、范围及膝关节附属结构的损伤,对临床诊断和治疗具有重要意义,应作为常规检查方法应用。

近年来磁敏感技术逐渐应用于临床,但目前国内对于SWI技术诊断病变的临床价值评估方面报道尚少,总结近2年来120多例患者经临床或病理证实的影像检查资料.通过对不同序列的影像进行对比,并重点对含血液代谢物、铁质以及钙化成分病变的影像特征进行分析,以评估SWI技术对诊断中枢神经系统病变的可行性、实用性及其临床应用价值.

目的:评价真实稳态进动快速成像(True Fisp)序列和胰胆管造影(MRCP)对梗阻性黄疸病因学及定位诊断的临床应用价值。方法:采用Tree Fisp序列多方位扫描成像及核磁共振MRCP成像对55例梗阻性黄疸患者进行MRI检查,根据MRI表现进行病变的定位及病因学诊断,并与临床和病理结果进行对比分析,评价Tree Fisp序列和MRCP对梗阻性黄疸病因学及定位诊断的临床应用价值。结果:二种序列组合均定位诊断。对于胆道及胆道内病变所致梗阻性黄疸,True Fisp序列的诊断符合率为80.2%,MRCP为85.3%,两者间差异无显著性意义。对于胆道外病变所致梗阻性黄疸,True Fisp序列的诊断符合率为85.2%,MRCP为29.5%,前者优于后者。对于各种原因所致梗阻性黄疸,联合运用2种成像方法的诊断符合率为90.2%,明显优于MRCP。结论:True Fisp序列的准确性高于MRCP,能较准确地对梗阻原因作出定性诊断,或提示临床进一步做何种检查有效,如果再结合常规平扫及增强扫描,对于梗阻性黄疸的定位、定性诊断将会有更高的临床诊断符合率。