目的:探讨多层螺旋CT在结节性甲状腺肿(NG)患者诊断中的应用价值,分析CT表现特征及其病灶检出情况.方法:选取医院收治的35例高度疑似NG患者进行回顾性分析,所有患者入院后均应用多层螺旋CT检查诊断,以最终手术病理诊断结果为"金标准",比较多层螺旋CT应用于NG中的诊断准确率、灵敏度和特异度.结果:经手术病理诊断35例确诊为NG,其中1例为结节性甲状腺肿合并乳头状微小癌(癌病灶直径2 mm),诊断准确率、灵敏度和特异度均为100％,CT诊断30例为NG,误诊5例,诊断准确率、灵敏度和特异度分别为85.71％、96.77％和83.33％;病理诊断与CT诊断的准确率、灵敏度及和特异度比较,差异无统计学意义.CT诊断与手术病理诊断均是单发病灶最高,分别为51.61％和50.00％,CT诊断最大结节、最小结节和病灶分布时,三种情况在左叶、右叶发生率分别为54.84％和35.48％,手术病理诊断时,分别为46.67％和40.00％;病灶类型中,CT诊断与手术病理诊断均是囊实结节占比最高,分别为54.28％和46.67％,其差异均无统计学意义.结论:应用多层螺旋CT诊断NG效果显著,具有较高的诊断准确率、灵敏度和特异度,且具有无创性、操作简便等显著优势,可作为NG患者的首选诊断方法.

Objective:To evaluate the effect of sedation management based on visual analysis of electroencephalography (EEG) on postoperative delirium in patients undergoing cardiac valve replacement with cardiopulmonary bypass (CPB).Methods:Eighty patients, aged ≥ 18 yr, of American Society of Anesthesiologists physical status Ⅲ or Ⅳ, with New York Heart Association Ⅱ-Ⅳ, scheduled for elective cardiac valve replacement with CPB, were randomly divided into visual analysis of EEG-guided sedation management group (group A, n=40) and BIS-guided sedation management group (group B, n=40). The target plasma concentration of propofol was adjusted to maintain the depth of anaesthesia at grade C or grade D in group A and BIS value at 40-60 in group B. Propofol consumption during CPB and total consumption of propofol during surgery, requirement for vasoactive agents during surgery, and parameters of intraoperative arterial blood gas analysis were recorded.Postoperative delirium was evaluated using Confusion Assessment Method for the Intensive Care Unit (ICU) at 1-7 days after surgery.Extubation time, length of ICU stay, length of postoperative hospital stay and intraoperative awareness were also recorded. Results:Compared with group B, the length of postoperative hospital stay was significantly shortened, the incidence of postoperative delirium was decreased, and no significant change was found in the parameters of arterial blood gas analysis, propofol consumption, requirement for vasoactive agents, extubation time, or length of postoperative ICU stay in group A ( P<0.05). No intraoperative awareness occurred in both groups. Conclusion:Sedation management based on visual analysis of EEG is helpful in decreasing the development of postoperative delirium in the patients undergoing cardiac valve replacement with CPB.

目的 探究Ⅱ～Ⅲ期乳腺癌患者使用标准剂量表阿霉素的疗效与安全性及疗效相关因素在疗效预测中的应用.方法 经空心针穿刺活检确诊为Ⅱ～Ⅲ期浸润性(除外Luminal A型)乳腺癌患者为表阿霉素(100 mg/m2)标准剂量组,共65例,使用EC-TC方案;另回顾性研究1年前使用FEC-T方案的65例患者为表阿霉素(75 mg/m2)低剂量组.评价并比较两组的病理完全缓解率(pCR)及安全性.比较标准剂量组疗效相关因素的pCR率及有效率并利用二代测序(NGS)技术对标准剂量组患者进行检测,寻找评价疗效的敏感指标.结果 标准剂量组与低剂量组pCR率分别为24.62％、9.23％,差异有统计学意义.标准剂量组疗效相关因素中Ki-67％≥14％的pCR率(28.26％)与Ki-67％＜14％(15.79％)相比差异有统计学意义.标准剂量组中TP53为突变率最高的乳腺癌相关基因,乳腺癌相关单核苷酸多态性(SNP)中SETD2 rs4082155、XPCrs 1870134、CYP2B6rs2279343、ERBB2rs1058808的差异有统计学意义.标准剂量组与低剂量组间毒副反应差异均无统计学意义.结论 Ⅱ～Ⅲ期乳腺癌患者使用标准剂量表阿霉素时有效性优于低剂量,且耐受性良好.疗效相关因素中Ki-67的表达与疗效相关,TP53基因突变及SETD2rs4082155、XPCrs1870134、CYP2B6rs2279343、ERBB2rs1058808可能会是新辅助化疗疗效的敏感预测指标.

目的 了解脑分水岭梗死(CWI)可能的发生机制.方法 选取经磁共振弥散加权成像(DWI)及磁共振血管成像(MRA)检查证实过的45例超急性或急性期CWI患者进行对照研究.结果 在所有的45例超急性或急性期CWI患者中,7例(15.6％)为皮质前型,8例(17.8％)为皮质后型,26例(57.8％)为皮质下型,4例(8.9％)为混合型,所有患者的脑动脉病变中都存在有一支或多支脑动脉严重狭窄、闭塞或分支减少.45例CWI患者中33例只有一支动脉发生变窄,包括颈内动脉(ICA)变窄者9例,大脑前动脉(ACA)变窄者2例,大脑中动脉(MCA)变窄者22例,未发现大脑后动脉(PCA)变窄患者.结论 CWI与脑内动脉血管狭窄显著相关,脑动脉血管严重狭窄、闭塞以及远端分支减少引起血流灌注的减少是重要发病原因,特别是ICA和MCA血管病变更易发生.

Objective To investigate the association between the serum levels of homocysteine ( Hcy) , soluble thrombomodulin ( sTM) and protein C ( PC) with the clinic characteristics in patients with Crohn's disease ( CD) . Methods 74 CD patients'clinical data in the first affiliated hospital of Anhui medical university were collected. The levels of Hcy, sTM and PC in CD patients were detected by ELISA, and the correlation analysis of them with clinic parameters were performed. Results The levels of Hcy and sTM in patients were significantly higher than those in the normal groups (P＜0. 01), the level of PC was slightly lower than normal control, the difference was not statistically significant. However, the levels of PC in the subgroup of non-stenotic with non-penetrating was sig-nificantly higher than that in the subgroup of stenosis(P＜0. 05). Moreover, the levels of sTM were positive related with PC levels in all the patients with CD, and the difference was statistically significant. Conclusion The levels of Hcy and sTM in CD patients were increasing and which indicated that possible high risk of thrombosis events in patients with CD.

目的：研究分析西比灵结合生脉注射液对急诊老年眩晕症的临床治疗效果。方法选取2013年1月—2015年12月在我院有过治疗经历的急诊老年眩晕症患者52例为研究对象，以随机数字表法将患者分为2组。对照组26例采用西比灵进行治疗，研究组26例采用西比灵结合生脉注射液治疗。对2组治疗效果进行对比。结果研究组治疗总有效率为92.3%，明显高于对照组的65.4%，同时不良反应及复发率也明显低于对照组，均存在明显差异（P<0.05）。结论西比灵结合生脉注射液治疗急诊老年眩晕症是一种比较理想的方案，有利于改善患者的症状，减少复发率，安全性、可控性更强，值得推广。