目的:比较不同病理类型的肺部磨玻璃结节(GGO)患者术前中性粒细胞与淋巴细胞比率(NLR)、血小板与淋巴细胞比率(PLR)、淋巴细胞与单核细胞比率(LMR)和血清癌胚抗原(CEA)的差异及其临床意义.方法:收集接受手术治疗的494例患者的NLR、PLR、LMR,其中浸润性腺癌176例,微浸润性腺癌150例,腺体前驱病变117例,良性病变51例.仅收集到150例浸润性腺癌、127例微浸润性腺癌、95例腺体前驱病变和45例良性病变的血清CEA数值.分别比较各组之间的NLR、PLR、LMR、CEA.结果:腺体前驱病变组的NLR(2.32±1.59)较良性病变组(1.82±0.64)高(P<0.05).肺腺癌组的PLR(141.19±53.14)、腺体前驱病变组的PLR(145.94±51.92)较良性病变组(124.90±37.04)高(均P<0.05).肺腺癌组的CEA?[1.83(1.18,2.73)ng/mL]较腺体前驱病变+良性病变组?[1.49(1.03,2.08)ng/mL]高(P<0.01).浸润性腺癌组的CEA?[2.14(1.29,2.92)ng/mL]分别较微浸润性腺癌组?[1.67(1.09,2.43)ng/mL]、腺体前驱病变组?[1.46(1.03,2.06)ng/mL]、良性病变组?[1.53(1.00,2.10)ng/mL]高(P<0.05).结论:全身免疫炎症指标在早期肺腺癌,甚至是腺体前驱病变阶段就开始发生变化,血清CEA在早期肺腺癌就开始发生变化.动态观察上述指标的变化,有利于早期发现恶性病变,从而尽早进行干预.

目的 18F-FDG PET/CT成像的时相变异性会影响鼻咽癌(NPC)的代谢有效量和治疗规划,本研究旨在评估常用于NPC肿瘤体积勾画的8种方法的时相稳健性.方法 选择经活检证实的NPC患者20例,并进行多次时相18F-FDG PET/CT成像.确定大体肿瘤体积(GTV)、绝对SUV、基于梯度的分水岭分割(GTV-GWT)和解剖生物轮廓(GTV-ABC)值.封闭GTV-CT和8个基于PET的GTV的重叠体积,并计算重叠部分(OF-CT).颜色矩阵用于半定量时相差异比较.记录采用不同方法获得的大体肿瘤体积值,用配对t检验比较.通过用Tukey显著性检验进行方差分析,比较各组间GTV和SUVmax的时相差异.计算变异系数,以评估患者内时相变异性.计算相似系数,以评估相似性.结果 使用不同勾画程序在不同时间点获得GTV差异有统计学意义.与其他方法相比,GTV-GWT(88.17％)和GTV-ABC(86.98％)获得的百分比无显著提高,表明其具有稳健性.与其他方法相比,GTV-40％(0.81～0.88)和GTV-ABC(0.82～0.88)的GTV-MRI相似性更高.结论 基于PET/CT的GTV-ABC介于35～55 min,应是NPC治疗规划的首选.

Objective: To determinate the optimal keV levels of single source spectral CT by evaluating imaging qualities of CT cerebral angiography.Methods: A total of 53 cases underwent spectral CT were enrolled in this study. All images of cerebral angiography were reconstructed by software of spectral CT from 40 to 140 keV in 10 keV increments. The mean vessel attenuation and the contrast-to-noise ratio (CNR), signal-to-noise ra-tio (SNR) of the following arteries: basilar artery, internal carotid artery, anterior cerebral artery, middle cerebral artery and posterior cerebral artery were measured and calculated respectively. Subjective assessment on imaging quality was performed by using a 5-point scoring system. The results of objective image quality among different keV levels were compared using one-way analysis of variance. For subjective assessment, the Nonparametric Wilcoxon test was used to analyze the differences in subjective scores.Results: The image noise at 70-140 keV levels was statistically lower than that at 40, 50 and 60 keV levels. The image CNR and SNR between 60 keV and 70 keV levels showed on statistically differences, but markedly higher than other keV levels (P<0.05). The scores of subjective image quality at 70 keV level were all higher than other keV levels including 60 keV level (P<0.05).Conclusion: The 70 keV level can be commended as an optimal keV setting for spectral CT cerebral angiography by improving image CNR, SNR and reducing image noise.

目的 探讨经支气管镜局部灌注抗结核药物联合全身化疗对气管支气管结核的临床疗效及应用价值.方法 对62例确诊的气管支气管结核患者,采用随机数表法分为两组,即经支气管镜局部灌注药物联合化疗组(简称“联合治疗组”)31例和单纯化疗组31例,比较两组患者在治疗2个月后的临床表现、胸部CT检查情况、抗酸杆菌阴转率,以及不同镜下类型气管支气管结核治疗转归的差异.结果 治疗2个月后,联合治疗组支气管镜下病变好转的总有效率(87.10％,27/31)高于单纯化疗组(45.16％,14/31)(x2=12.17,P＜0.01),临床症状改善总有效率(87.10％,27/31)高于单纯化疗组(54.84％,17/31)(x2=7.828,P＜0.05),镜下刷检找抗酸杆菌阴转率(87.10％,27/31)高于单纯化疗组(64.52％,20/31)(x2=4.309,P＜0.05),胸部CT检查总有效率(82.14％,23/28)高于单纯化疗组(57.69％,15/26)(x2=3.865,P＜0.05).结论 局部抗结核药物灌注联合全身化疗能缓解气管支气管结核患者的症状,促进病灶吸收,临床疗效优于单纯全身化疗.

Purpose To investigate the effect of 80 kV and 120 kV tube voltage on image quality and radiation dose of cerebral CT angiography (CTA), and to explore the possibility of low tube voltage in cerebral CTA. Materials and Methods A total of 100 patients underwent cerebral CTA were selected, and divided into 80 kV group (n=50) and 120 kV group (n=50). CT values were evaluated for the following anatomic structures:basilar artery, internal carotid artery, anterior cerebral artery, middle cerebral artery and posterior cerebral artery. The contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR) were calculated, then the subjective assessment on image quality (including reconstructed images, vascular margin, presentation of small vessels and the whole image quality) and diagnostic confidence were evaluated. Results Compared with 120 kV group, the CT dose index volume (CTDIvol), dose length product (DLP) and effective dose (ED) of 80 kV group reduced 63.97%, 64.54%and 64.65%, respectively. The mean CT values of blood vessels in 80 kV group were substantially higher than those in 120 kV group (P<0.001). Although the noise level was markedly higher in 80 kV group (P<0.001), the CNR and SNR showed no difference between the two groups (P>0.05). With 80 kV low tube voltage, the vascular margin showed rougher and the presentations of small vessels were obviously more than those with 120 kV tube voltage. However, the subjective scorings of the reconstructed images qualities, the whole image quality and diagnostic confidence showed no statistical difference between the two groups (P>0.05). Conclusion With 80 kV low tube voltage of cerebral CTA, the radiation dose can be markedly reduced without degradation of image quality and diagnostic confidence.

目的 探讨低管电压颈动脉CT血管造影检查对图像质量及辐射剂量的影响.方法 将60例需行颈动脉CT血管造影检查的患者依据扫描管电压的不同分为A(80 kV)、B(100 kV)、C(120 kV)3组,每组20例.分析比较3组图像的CT值、对比噪声比(CNR)、信号噪声比(SNR)及辐射剂量,并对重建图像质量、血管边缘形态及诊断信心进行评估分析.结果 A组容积CT剂量指数(CTDIvol)、剂量长度乘积(DLP)及有效剂量(ED)较C组分别降低63.97％、63.83％及63.79％,B组CTDIvol、DLP及ED较C组分别降低35.65％、34.00％及34.05％.图像质量评价结果:A、B2组颈动脉平均CT值较C组显著增加,且组间差异具有统计学意义(P值均＜0.05).A、B、C3组CNR、SNR值组间差异及两两比较均无显著统计学意义(P值均＞0.05)；且A、B2组颈动脉重建图像质量、血管边缘形态及图像诊断信心评价整体满意,与C组无明显差别(P值均＞0.05).结论 低管电压颈动脉CTA扫描在不影响图像质量及诊断信心的前提下,能大幅度降低辐射剂量.因此,低管电压颈动脉CTA检查的临床应用价值较高,推荐常规使用.

Objective:To study CT features and pathologic types of primary retroperitoneal liposarcoma(PRL).Methods:All the 12 cases of PRL were performed CT scanning and proved by pathology.The CT features and pathologic types were analyzed retrospectively.Results:The diameters of tumors ranged from 8~27cm.Except for one round cell PRL and one pleomorphic PRL were oval shaped,the shape of other 10 cases were irregular.Fat tissue was observed in well differentiated(n=3),mixed(n=3)and dedifferentiated(n=2)primary retroperitoneal liposarcoma.Myxoid PRL(n=2) was mainly composed by liquid density on CT,while calcification could be found in 2cases of mixed type PRL.Eight of 12 cases were performed CT enhancement.Five of them(2lipoma PRLs,one sclerosing PRL,and 2myxoid PRLs)enhanced slightly,other 3tumors(one dedifferentiated,one pleomorphic and one mixed type PRL)enhanced intensively and heterogeneously.Conclusion:Different types of PRL showed different imaging features on CT images.CT features of different subtypes have some characteristics and can reflect the different pathologic subtypes of PRL.

OBJECTIVE: To prepare Fluconazole/moxifloxacin in situ forming eye gel,and to establish a quality control method for it.METHODS: The gel was prepared with different concentrations of poloxamer 407 as base,and the contents of fluconazole,moxifolxaein and ethylparaben were determined by HPLC.The determination was performed on Elite Hypersil ODS column with mobile phase consisted of triethylamine buffer solution(pH 3.3)-methanol(61 ∶ 39) at the flow rate of 1.0 mL·min-1.The column temperature was 30 ℃ and the detection wavelength was set at 260 nm.RESULTS: The gel was prepared using 15.5% poloxamer 407 as base and its gel-forming temperature was 32 ℃.The linear ranges were 100～600 μg·mL-1 for fluconazole(r=0.999 9),100～600 μg·mL-1 for moxifolxacin(r=0.999 9) and 10～60 μg·mL-1 for ethylparaben(r=0.999 8).Moreover,their average recovery rates were 99.75%(RSD=1.26%),99.89%(RSD=1.08%) and 100.10%(RSD=1.72%).CONCLUSION: The gel is reasonable in design,simple in preparation method and reliable in quality control.

为有效预防和控制学校肺结核暴发流行,温州市瓯海区疾病预防控制中心(疾控中心)从2008年开始对瓯海区学校肺结核病例开展主动监测工作.本文对91例学校肺结核病例发病情况进行分析,探索学校肺结核暴发流行的影响因素,以建立一种多方参与、共同协作的早期预防控制模式.

对本院2010年度519例ADR报告进行统计和分析。519例ADR报告中,涉及药物共150种,其中抗感染药物居首位,占64.93%,其次是中药及中成药,占11.18%。ADR的临床表现主要为皮肤及其附件损害,占62.04%;其次为消化系统损害等,占11.18%。在不同年龄组中,1~10岁患儿发生率最高,为21.00%;根据给药途径分类,静脉给药发生率最高,为73.99%。

目的 建立高效液相色谱法测定氟康唑莫西沙星眼用即型凝胶含量,同时测定制剂中氟康唑、莫西沙星和羟苯乙酯的含量.方法 采用ODS-C18色谱柱,以三乙胺缓冲液-甲醇为流动相,流速1.0mL·min-1,检测波长260nm.结果 氟康唑、莫西沙星、羟苯乙酯的线性范围分别为25～250μg·mL-1(r=0.9999,n=6),25～250μg·mL-1(r=0.9999,n=6),2.5～25μg·mL-1(r=0.9997,n=6),平均回收率分别为99.6％,99.4％,99.3％.RSD分别为1.23％,1.20％,1.17％.结论 本方法操作简便,灵敏度高,重复性好,可用于该制剂的含量测定.

Purpose. To investigate the effect of low tube voltage (80 kV) on image quality, radiation dose, and low-contrast detectability (LCD) at abdominal computed tomography (CT). Materials and Methods. A phantom containing low-contrast objects was scanned with a CT scanner at 80 and 120 kV, with tube current-time product settings at 150–650 mAs. The differences between image noise, contrast-to-noise ratio (CNR), and scores of LCD obtained with 80 kV at 150–650 mAs and those obtained with 120 kV at 300 mAs were compared respectively. Results. The image noise substantially increased with low tube voltage. However, with identical dose, use of 80 kV resulted in higher CNR compared with CNR at 120 kV. There were no statistically significant difference in CNR and scores of LCD between 120 kV at 300 mAs and 80 kV at 550–650 mAs (P > 0.05). The relative dose delivered at 80 kV ranged from 58% at 550 mAs to 68% at 650 mAs. Conclusion. With a reduction of the tube voltage from 120 kV to 80 kV at abdominal CT, the radiation dose can be reduced by 32% to 42% without degradation of CNR and LCD.

目的:探讨盐酸羟甲唑啉眼用即型凝胶的制备及其药物含量的测定方法.方法:采用冷溶法,以泊洛沙姆407(F127)为主要眼用即型凝胶截体材料,0.6％的泊洛沙姆188(F68)为促渗剂,制备盐酸羟甲唑啉眼用即型凝胶溶液；采用高效液相色谱(HPLC)法测定眼用即型凝胶中盐酸羟甲唑啉的含量.结果:盐酸羟甲唑啉眼用即型凝胶最佳处方组成为21％ F127,胶凝温度为27.6℃；盐酸羟甲唑啉在线性范围为50～500 mg·L-1浓度范围内与峰面积呈良好的线性关系(r=0.9999),日内和日间精密度良好,平均回收率为100.48％.结论:本滴眼剂处方工艺简单,质量容易控制,热可逆性好.

Objectives To investigate the clinical characteristics and use of antibiotics in severe respiratory syncytial virus(RSV)pneumonia in children.Methods Retrospective analysis of clinical and etiological data was performed in children with severe RSV pneumonia admitted to our hospital from January 2005 to December 2009.Results Among total of 4189 cases of RSV infection,306 patients(7.3%)met the diagnostic criteria of severe pneumonia;214 were male and 92 were female,aged from 8 days to 4 years old.The proportion of patients younger than 6 months was 81.0%.Overall,161(52.6%)had respiratory failure,22(7.2%)developed heart failure,7(2.3%)had toxic encephalopathy,3(1.0%)developed sepsis and multiple organ dysfunction,1 had septic shock and alimentary tract hemorrhage.126(41.2%)were admitted to ICU,of which 36(11.8%)were applied mechanical ventilation.Underlying diseases were observed in 217(70.9%)patients,they are congenital heart disease,followed by premature birth and low birth weight,malnutrition,and nervous system disease.All cases were performed sputum pathogen detections and 51 were also got blood cultures.Combined pathogenic infection were found in 102 cases(33.3%).In sputum 129 strains of pathogens were identified,of which 114 strains were bacteria,the predominant one was Gram-negative bacteria(69.0%),followed by Gram-positive bacteria(19.4%);blood culture were positive in 3 cases.All patients were treated with antibiotics,the use of cephalosporins utilization was up to 88.9%.The use of one antibiotic accounted for 63.4%,while the combination of two antibiotics accounted for 35.0%.Using of antibiotics in 68 cases(22.2%)was less than one week,168(54.9%)were between one to two weeks.The outcome are 217 cases cured,81 improved,and 1 died.Conclusions RSV was the most important pathogenic virus in severe pneumonia in children.Severe RSV pneumonia were mainly seen in infants under 6 months and the underlying diseases were found in 70.9% of cases;More than half of children had respiratory failure and 33.3% of them had combined pathogenic infection,and Gram-negative was the most common bacteria.Cephalosporin treatment was used in 88.9% of case,The use of single antibiotics for 1-2 weeks was the usual choice.

考察甲氯芬酯在葡萄糖氯化钠,5％葡萄糖,氯化钠3种输液中的配伍稳定性.结果盐酸甲氧芬酯与5％葡萄糖注射液,葡萄糖氯化钠注射液配伍后宜4h内使用,与氯化钠注射液配伍须2h内使用.

收集我院2008年度上报的576例ADR报告进行分类统计、分析。576例ADR报告中,31~40岁的患者ADR发生率最高(19.80%);静脉给药途径ADR发生率最高(64.93%);涉及的药物共有178种,其中抗感染药物居首位(66.15%),其次是中药及中成药(12.33%);主要的ADR表现为皮肤及其附件损害,占(61.14%),其次为消化系统损害等全身症状,分别占(10.77%)、(11.78%)。

Objective To explore the influence of cardiopulmonary bypass(CPB) on platelet and its relationship with postoperative acute lung injury.Methods The retrospective analysis was performed on 20 patients undergoing cardiac surgery under CPB.The platelet count(PLT) and thromboxane B2(TXB2)value were measured before heparinization,at 30 min after CPB,end of CPB and postoperative 24 h.After surgery,ulinastatin injection 200 000 U was added into normal saline 100 mL and Shenmai injection 30 mL was added into 5%glucose solution 250 mL for intravenous drip,once daily for successive 14 d.The arterial blood gas analysis,lung dynamic com1served at different postoperative time points.Results The PLT count during CPB and after CPB was lower than that before surgery.The TXB2 value during CPB was significantly increased compared with before surgery,decreased very rapidly after CPB,but was significantly higher than that before surgery,which showing statistical difference(P < 0.05 or P < 0.01).The lung dynamic compliance and the oxygenation index were reduced after CPB(P < 0.05 or P < 0.01).Conclusion CPB can lead to changes of platelet count and activation index,which plays an important role to lung injury in the CPB-induced PLT change.

Objective To explore cardiopulmonary bypass's influence on platelet and megakaryocytes.Methods Megakaryocytes and platelet count(PLT)in 20 patients before and after cardiopulmonary bypass(CPB)were measured.To explore cardiopulmonary bypass's influence on platelet and megakaryocytes.Results The total number of megakaryocytes and 4-type of megakaryocytes in venous blood were higher than the same arterial blood.The total number of megakaryocytes and 4-type of megakaryocytes in venous blood within CPB were higher than before and after CPB.PLT within CPB were lower than before and after CPB(P<0.01).Conclusion CPB can lead to changes of platelet count and megakaryocytes.Platelets and megakaryocytes were destructed in lung by CPB.Injury in acute lung may affect the quantity of platelet.

急性Stanford A型主动脉夹层一旦确诊,应予急诊手术治疗.但手术风险大,术后并发症高,急诊手术死亡率为20%左右[1-2].我院于2006年2月至2009年8月,对17例该病患者行升主动脉及主动脉弓替换加降主动脉支架植入术,效果满意,现将围术期并发症及其治疗体会总结如下.

OBJECTIVE To study the stability of meclofenoxate hydrochloride for injection when mixed with fructose injection,fructose and sodium chloride injection and inverl sugar injection.METHODS Three kinds of mixture were prepared at water bath,then dertermine the content change by HPLC,observe the changes of pH value by pH-meter.RESULTS The appearances value of three mixture have no change in 6 hours at 25℃,and the pH value of them has little change.No significant changes in the mixture of meclofenoxate hydrochloride with fructose injection about 6h,mixed with fructose and sodium chloride is stable for 2h,mixed with fructose and sodium chloride is stable for 1h.CONCLUSION The results show that the mixture should be used within 2h when meclofenoxate hydrochloride mixed with fructose injection and inverl sugar injection,and should be used within 1h when mixed with fructose and sodium chloride injection.