目的 探讨扩散峰度成像(DKI)联合动态增强磁共振成像(DCE-MRI)对乳腺癌分子分型的诊断价值.方法 选取经病理证实的乳腺癌患者148 例,所有病例均行DKI及DCE-MRI检查.分析两组间的临床病例资料和平均扩散峰度值(MK)、平均扩散率(MD)、容量转移常数(Ktrans)、血管外细胞外间隙容积比(Ve)和速率常数(Kep),绘制受试者工作特征曲线比较其诊断效能.结果 Luminal A型和Luminal B型的MD值小于HER-2 阳性型、三阴型(P<0.05);Luminal B型的MK值大于HER-2 阳性型(P =0.021);HER-2 阳性型的Ktrans和Ve 值均大于其他分子分型(P<0.05);三阴型组Ve 值均小于其他分子分型(P<0.05).当 MD≤1.96×10-3 mm2/s、MK≥0.70/min、Ktrans≤0.36(min-1)、Kep≤0.41(min-1)时,对鉴别Luminal A/B型与非Luminal型有价值,联合后受试者工作特征曲线下面积(AUC)为0.811,诊断效能高于单一参数(Z =2.040～3.352,P =0.001～0.041).当MD≥2.28×10-3mm2/s、MK≤0.66/min、Ktrans≥0.36(min-1)、Ve≥0.49 时,对鉴别HER-2 阳性型与非HER-2 阳性型有价值,联合后AUC为0.872,诊断效能高于单一参数(Z =2.038～3.397,P =0.001～0.048).当MD≥1.96×10-3 mm2/s、Kep≥0.39(min-1)、Ve≤0.59 时,对鉴别三阴型与非三阴型有价值,Ve 的诊断效能高于MD及Kep值(Z = 2.032,P =0.042;Z =2.562,P =0.01);三者联合后AUC为 0.834,与单一参数差异有统计学意义(Z =2.051～3.852,P =0.001～0.042).结论 DKI联合DCE-MRI可用于乳腺癌分子分型的预测,有利于患者的个体化治疗.

目的 探讨粘液纤维肉瘤(MFS)的CT及MRI表现.方法 分析20例经手术病理证实的MFS患者的CT及MRI资料(4例行CT检查,17例行MRI检查,其中1例同时行CT、MRI检查),观察其形态、大小、密度/信号、强化特点及瘤周浸润等征象.结果 20例MFS中8例为低度恶性,2例中度恶性,10例高度恶性.18例位于浅筋膜下,2例位于肌间隙内,10例呈类圆形,7例呈梭形,3例呈不规则形,肿瘤最大径约3.5～13.2cm,平均(7.58±2.76)cm;CT扫描,3例呈均匀等或稍低密度,增强扫描呈中重度均匀延迟强化,1例病灶呈不均匀中度强化,内见斑片状低密度影,增强扫描呈轻度延迟强化;MRI上,2例呈T1WI呈均匀稍高信号,15例呈混杂等/低信号,2例T2WI呈均匀高信号,15例呈混杂高信号,11例病变呈DWI混杂高信号,10例增强扫描呈不均匀明显强化;18例可见“筋膜尾征”,13例见瘤周水肿,11例病灶内见“双低信号征”,10例见囊变、坏死,6例见粘液样变.结论 MFS的CT及MRI表现具有一定特征性,有助于术前诊断,最终确诊依靠病理.

目的:探讨Sandwich教学法在实验诊断学病例分析教学中的应用效果.方法:选择济宁医学院2012级临床本科班100人为研究对象,根据随机数字表法分成对照组和实验组.每组均为50人.对照组采用传统教学法,实验组则应用Sandwich教学法.结果:实验组学生理论考试成绩和实践操作成绩为(81.38±8.69)分和(84.39±8.79)分,显著高于对照组的(75.34±7.06)分和(72.63±7.76)分,差异具有统计学意义(P＜0.05);多数学生对Sandwich教学法表示满意.结论:Sandwich教学法在实验诊断学病例分析教学中的应用,提升了学生的学习质量和教师综合素质,培养了学生临床思维能力.

The aim of the present study was to analyze the value of applying dual-source 64-layer spiral computed tomography (CT) in the differential diagnosis of solitary pulmonary nodules (SPNs). Mediastinal windows from 45 cases were selected to study SPNs (maximum diameter, ≤3 cm), and the pathological nature of lesions was determined by clinical and pathological diagnosis. Conventional 64-layer spiral CT scanning, local enhancement and 3D recombination technologies were used to determine the occurrence rate, lesion diameter, degree of enhancement, lobular sign, spicule sign, pleural indentation sign, vessel convergence sign and bronchus sign. The final diagnoses indicated 34 cases of malignant SPNs (75.6%) and 11 benign cases (24.4%). When the nodule diameter in the malignant group was compared with that of the benign group, the difference was not statistically significant (P>0.05). Nodules in the malignant group showed inhomogeneous enhancement while nodules in the benign group showed homogeneous enhancement. The enhanced CT values in the malignant group were higher than those in the benign group, and the difference was statistically significant (P<0.05). The proportion of nodules with lobular sign in the malignant group was significantly higher than that in the benign group (P<0.05). The proportion of nodules with calcification, vessel convergence sign and bronchus sign in the malignant group were significantly higher than those in the benign group, and the differences were statistically significant (P<0.05). A comparison of vacuole sign, pleural indentation sign, spiculate protuberance and fat occurrence between the two groups yielded no statistically significant differences (P>0.05). The sensitivity of CT enhancement was 85.6%, specificity was 79.6%, positive predicated value was 92.3%, and the negative predicted value was 85.2%. In conclusion, SPNs diagnosed by CT enhancement manifested with enhancement degree, lobular sign, calcification, vessel convergence sign and bronchus sign with high diagnostic accuracy.

PURPOSE:This study was designed to discuss feasibility, short-term efficacy, and complications of iodine-125 radioactive seed tissue implantation for remedying recurrent cervical cancer.MATERIALS AND METHODS:From June 2009 to December 2010, 17 patients with recurrent cervical cancer received radioactive seed implantation under computed tomography (CT) guidance. Matched peripheral dose was 145 Gy, while the number of implanted seeds was from 6 to 68 with a median of 20. Efficacy was determined based on the results of CT and 18 F-fluorodeoxyglucose positron emission tomography/CT.RESULTS:Postoperative follow-ups were from 4 to 18 months with a median follow-up time of 9.5 months. Nine patients died during follow-up while remaining patients survived during the follow-up period. Evaluation of efficacy: six patients had a complete response, four patients had a partial response, and seven patients had progressive disease, clinical efficacy rate as 58% (10/17). No patients had complications of radiation injury. Rate of 6 months and 1-year survival period was 74.8% and 18.3%, respectively. Comparing to patients who responded ineffectively to radioactive seed implantation, patients who responded effectively to radioactive seed implantation had a longer survival period (median 7.2 vs. median 10.4), in which the difference was statistically significant (P = 0.038).CONCLUSION:Iodine-125 radioactive seed tissue implantation is a feasible, effective, and safe treatment method for remedying or palliative treatment of recurrent cervical cancer. Patients who have recurrent cervical cancer and responded effectively to radioactive seed implantation will have a longer survival period.

Objective To observe the clinical value of the TACE (transcatheter arterial chemoembolization ) combined with the microwave ablation and vein chemotherapy in treatment of hepatic metastasis of malignant tumor from digestive tract .Methods 72 patients who had no chance for operation or were not willing to accept the operation were selected ,were randomly divided into the combination group and control group .The combination group were given the combined therapy of TACE ,vein chemotherapy of tegafur for 4 days ,and then given the mi‐crowave ablation successively .The control group was only given the vein chemotherapy .The response rate and survival time were measured .Results The response rate of combination group was 64 .9% ,which was higer than the control group (28 .6% ) .The overall survival at 6 months ,12months ,18 months ,24months were 100% , 78.4% ,48.7% ,and 24.3% ,respectively in the combination group ,which was longer than control group signifi‐cantly .Conclusion The combination of TACE with microwave ablation and vein chemotherapy plays an important role in treating hepatic metastasis of malignant tumor from digestive tract ,which is safe and effective .

运用回顾性研究方法,分析实施与未实施病例引导式教学法的两级临床本科医学生在课程满意度调查、期末考试试卷病例分析试题的平均分值之间的统计学差异,探索实验诊断学病例引导式教学法的效果.结果表明,临床医学生对病例引导式教学法在实验诊断教学的应用高度认可,病例引导式教学法有助于提高临床医学生分析、解决临床病例问题的能力,是改革传统实验诊断学教学的有效方法.

目的 探索理论与病例分析结合式教学法在临床专升本实验诊断学教学改革中的成效.方法 从两级临床专升本医学生对课程满意度的调查、病例分析试题得分方面分析实施与未实施该教学法的统计学差异.结果 实施理论与病例分析结合式教学法的2011级临床专升本学生对实验诊断教学的满意度及病例分析试题平均分值均明显高于未实施该教学法的2010级临床专升本学生.结论 理论与病例分析结合式教学法是临床专升本实验诊断教学改革的可行和有效方法.

Objective To study the effects of combined 1,25-dihydroxyvitamin D3[1,25(OH)2D3]and Celecoxib on the proliferation in breast cancer cell line HS578T.Methods We compared cell numbers by using MTT method,The expression of Ki-67 was detected by immunohistochemical method.Results Incubation with 10-7mol/L and 10-8mol/L1,25(OH)2D3,Hs578T cells exhibited significant growth inhibition,The immunohistochemical staining showed that the expression rate of Ki-67 protein was down-regulated in any treatemnt group compared to normal group.Conclusion 1,25(OH)2D3 and Celecoxib could inhibit the proliferation and induce apoptosis of breast cancer cell line HS578T.

目的 研究1,25二羟维生素D3[1,25(OH)2D3](VitD3)联合塞莱昔布(CELE)对乳腺癌细胞株Hs578T的增殖抑制及凋亡诱导作用.方法 采用四唑氮蓝比色(MTT)法检测细胞增殖,流式细胞仪测定细胞周期和凋亡率,末端脱氧核苷酸转移酶介导的原位酶标记(TUNEL)法计数凋亡细胞,免疫组化SP法分别检测凋亡与凋亡相关基因bcl-2、Bax表达的变化.结果 10-7mol/L的VitD3联合5×10-5mol/L CELE、10-8 mol/L的VitD3联合5×10-5mol/L CELE联合用药组通过MTT法测得72 h对Hs578T细胞的A值分别为0.517±0.045、0.572±0.022,有统计学意义;流式细胞术显示72 h后细胞凋亡实验组细胞凋亡率高于对照组凋亡率;细胞周期分析实验组可分别造成S期、G0/G1期阻滞;免疫组化SP法显示实验组凋亡相关基因Bax增高,bcl-2降低.结论 VitD3联合CELE可以抑制Hs578T细胞增殖,改变细胞周期时相分布并诱导其调亡.

大量体内外实验证实1,25-二羟维生素D3[1,25(OH)2D3]具有抗肿瘤活性.1,25(OH)2D3抗肿瘤机制尚未完全明确,但认为与其能抑制肿瘤增殖、诱导细胞凋亡、促进细胞分化、降低肿瘤侵袭性及抑制肿瘤血管形成有关.国内外众多学者以1,25(OH)2D3为基础,联合细胞毒药物、放疗、地塞米松等制剂干预肿瘤,发现能增强1,25(OH)2D3抗肿瘤活性,有望成为未来的抗癌剂.