目的:研究在模拟遮挡性病灶的体外模型上,利用导航模板进行曲针穿刺的可行性.方法:设计3款模拟遮挡性病灶的体外模型,按照靶区遮挡程度从小到大分为模型A、模型B、模型C.其中模型A和模型B采用直针穿刺(straight needle puncture,SNP)、曲针穿刺(curved needle puncture,CNP)和导航模板辅助曲针穿刺(navigation template guided curved needle puncture,简称"T-CNP")3种穿刺模式,而模型C只采用CNP和T-CNP 2种穿刺模式.分析3种穿刺模式安全操作(损伤次数为0次)、便捷操作(CT扫描次数≤3次)的占比及其与靶区遮挡程度的关系.采用SPSS 13.0软件进行统计学分析.结果:在3种穿刺模式中,CNP的安全操作和便捷操作占比均最低.随着靶区遮挡程度的增大,从模型A到模型B,SNP和T-CNP的安全操作和便捷操作占比均呈下降趋势,但T-CNP的占比小于SNP.从模型A到模型B再到模型C,T-CNP的安全操作和便捷操作占比呈减速下降趋势,数值变动较小,穿刺结果较为稳定.结论:在导航模板的辅助下,曲针穿刺的临床可行性(安全性和便捷性)得到提高,可实现对遮挡性病灶的穿刺.

目的:以99 m Tc-DTPA双血浆法(99 m Tc-DTPAdouble-phase plasma method)为"金标准",分析CKD-EPI 2009公式及改良MDRD公式评估肾小球滤过率的准确性.方法:收集慢性肾脏病(chronickidney disease,CKD)1～5期患者166例,以99 m Tc-DTPA双血浆法测得值(rGFR)为"金标准",应用CKD-EPI 2009公式和改良的MDRD公式计算eGFR,使用统计软件分析2个公式计算值与rGFR的相关性及偏倚等指标,评价公式法评估GFR在不同CKD分期中的准确性.结果:CKD1期患者中,CKD-EPI 2009公式的偏倚较改良MDRD公式小;CKD-EPI 2009公式和改良MDRD公式均与rGFR呈弱相关(P<0.01);CKD-EPI 2009公式计算值的误差小于15％、30％、50％rGFR的概率更小.CKD2期患者中,CKD-EPI 2009公式的偏倚较改良MDRD公式小;两公式均与rGFR呈中等程度相关(P<0.01);CKD-EPI 2009公式计算值的误差小于15％、30％、50％rGFR的概率更小.CKD3期患者中,CKD-EPI 2009公式的偏倚较改良MDRD公式小,两个公式均与rGFR呈强相关(P<0.01);改良MDRD公式计算值的误差小于15％、30％、50％rGFR的概率更小.CKD4期和5期患者中,CKD-EPI 2009公式的偏倚较改良MDRD公式小;两个公式与rGFR均为极强相关(P<0.01);CKD-EPI 2009公式计算值的误差小于15％、30％、50％rGFR的概率更小.在GFR<60 mL/min的患者中,CKD-EPI 2009公式诊断"肾功能下降"的灵敏度及阳性预期值更高,特异度两者相当.结论:⑴在肾功能仅轻度下降时两个公式准确性均欠佳,此时CKD-EPI 2009公式相比之下更为准确,推荐使用;⑵还需进一步改进目前的公式,以提高其对肾功能下降早期GFR的评估效能;⑶对CKD患者进行临床分期时,仅依据eGFR是可能造成分期误判的,建议联合病因-GFR-白蛋白尿分期来评估病情.

Objective To analyze the clinical features of acute methanol poisoning and to provide references for clinical diagnosis and treatment.Methods A retrospective study was performed on 57 patients with acute methanol poisoning who had mistaken alcohol-based fuel and visited the Affiliated Hospital of Southwest Medical University from February 2017 to February 2018.Relation between clinical records and death was analyzed;relevant indicators including gender,age,intake of alcohol-based fuel,length of hospital stay,latency,laboratory indicators and prognosis were involved.Results There were 50 males and 7 females with an average age of (49 ± 12)years.Median intake of alcohol-based fuel was 50(40,150) ml,which was equivalent to methanol 32.95 (26.36,98.85) g.Central nervous system damage,gastrointestinal symptoms and visual disturbance were present in 49 (86.0％),39(68.4％) and 29(50.9％) patients.Among them,54 patients survived and 3 patients dead after comprehensive support therapies.Correlation analysis showed that delirium and coma,dyspnea,chest tightness/palpitation,intake of alcohol-based fuel,length of hospital stay,white blood cell count,neutrophil count,hematocrit,arterial partial pressure of oxygen,pH value,alkali residue,HCO-,K +,carbon dioxide binding capacity,anion gap,alanine aminotransferase,aspartate aminotransferase,serum urea nitrogen,uric acid,creatinine,cystatin C,prothrombin time,prothrombin time activity,cardiac troponin Ⅰ,myoglobin,blood hemodlastase and random blood sugar were related with risk of death(all P ＜ 0.05).Conclusions Nerve damage,metabolic acidosis and gastrointestinal injury are common manifestations of acute methanol poisoning.Most patients recover well after timely and effective comprehensive treatments and blood purification;severe metabolic acidosis may lead to poor outcomes.

Background:It is very difficult to diagnose surgical site infection (SSI) as soon as it happened after major sur-gery in orthopedics department. Serum procalcitonin (PCT) has been proved a good biomarker in detecting infection. How-ever, its effect is still unknown in the field of orthopedics. Objective:To evaluate the effect of PCT on the diagnosis of SSI after major surgery in orthopedics department. Methods:Fifty-three patients undergoing major surgery in orthopedics depart-ment between January 2011 and June 2016 were included in this prospective clinical study. Drainage, a clinical sign of SSI, was found in these patients after surgery. According to the results of bacterial cultures of specimens from the wound and the findings in the process of debridement, the patients were divided into non-infection group and SSI group. Serum PCT and C-reactive protein (CRP) were detected and compared between the two groups. Sensitivity and specificity of PCT in diagnosis of SSI were evaluated. Results:Eventually, 31 patients were diagnosed as SSI, and the infection rate of Gram-positive bacte-ria was 54.8%(17/31). Serum PCT level was (0.498±0.753) ng/ml in SSI group, which was significantly higher than that in non-infection group ([0.133 ± 0.164] ng/ml, P<0.05). When 0.5ng/ml PCT was applied as threshold in diagnosing SSI, the sensitivity and specificity of diagnosis were 26.7% and 95.5%, respectively. Conclusions: With a poor sensitivity, serum PCT is not proper for a marker in diagnosing SSI after major surgery in orthopedics department.

Objective To analyze the unusual CT images of gastrointestinal stromal tumors ( GIST) , in order to im-prove the accuracy of diagnosis of the disease .Methods Clinical data were collected from 98 patients who were diag-nosed with GIST based on pathological results from April 2011 to November 2013.Then, 11 cases were screened out ac-cording to unusual location , complications and route of metastasis before retrospective analysis .Results There were 7 colorectal GIST patients , 3 patients with GIST complications , including 1 patient showing abdominal cocoon , 1 patient with GIST rupture and intestinal obstruction and 1 patient with intussusception , and 1 GIST patient with mesenteric lymph node metastasis .Conclusion Some GIST patients are difficult to be diagnosed due to unusual CT findings .Therefore , it is necessary to consider medical history , clinical symptoms and other imaging results in order to improve the accuracy of diagnosis.

目的:研究采用不同用药方法治疗急性肾小球肾炎的患者治疗效果的比较分析.方法:随机选择于我院接受治疗的急性肾小球肾炎患者86例,将患者按照治疗用药的不同分为采用常规药物与抗感染西药合用的方法治疗的对照组患者43例和在对照组用药方法基础上与中药方剂联合用药治疗的实验组患者43例.在进行一段时间的治疗后对患者的治疗有效率及患者的肾小球滤过率进行统计比较.结果:采用中药联合治疗的方法进行治疗的实验组患者的治疗有效率明显较仅采用西药治疗的对照组患者高,前者的肾小球滤过率也较后者有明显的提升.结论:在对急性肾小球肾炎的患者进行药物治疗时采用中药与西药联合的方式进行抗感染治疗对疾病的治疗效果更加明显.

Objective To investigate the diagnostic value of the MSCT performance in rectal stromal tumors.Methods The clinical and CT features of 10 RST cases which were confirmed by surgery and pathology from December 2011 to October 2014 were analyzed retrospectively.Results Nine cases of ten located in the middle-lower segment of rectum,only 1 case located in the upper segment.The maximum diameters were 3.9 ~ 15.0 cm with a average of 6.8cm,most lesions manifested round-like masses (7/10),5 cases had clear boundary and the other had unclear boundary,7 cases were exophytic growth. Most cases showed heterogenous density in the non-enhanced CT images. And 8 cases showed heterogeneous enhancement after enhanced.Local calcification was found in one case.Liver metastasis was found in one case.No lymph node metastasis was detected in 10 cases.All the RSTs were made by spindle cells,five high-risk cases and one low-risk case were evaluated patholoically,the risk-degree in four cases were not assessed. Immunohistochemistry showed CD117 positive rate of 100% and CD34 positive rate of 90%.Conclusion The relative characteristic CT fingings of RSTs include a well-defined exophytic mass closely related with the rectum,and with heterogenous enhancement after enhanced.The location, origin, components and surrounding structures of the tumor could be clearly demonstrated in Multiplanar reconstruction (MPR) imaging, which provide a preliminary prognosis of the tumors' risk and useful information for clinical treatment and follow-up.

目的:探讨在头颈部CT血管成像(CTA)中,以患者体重指数(BMr)为基础的低剂量扫描方案实施前后对图像质量及辐射剂量的影响.方法:连续选取拟行头颈CTA检查患者186例,按检查先后分为,A组:采用管电压120 kV,滤波反投影法(FBP)重建;B组:采用管电压100kV,自适应性迭代重建(ASiR).A、B组根据患者的BMI进一步分组,A1组和B1组:BMI＜24kg/m2 A2组和B2组:24kg/m2≤BMI＜28kg/m2;A3组和B3组:BMI≥28kg/m.对各组的辐射剂量、客观图像质量评价采用两独立样本t检验.由两名有经验的放射科医师对两组图像质量进行主观评价,并对两名医师的阅片结果进行Kappa检验.结果:B1组、B2组及B3组的CT容积剂量指数(CTDIvol)较AI组、A2组及A3组分别下降29.29％、32.70％及40.24％(均P＜0.05);B1组、B2组及B3组的剂量长度乘积(DLP)较A1组、A2组及A3组分别下降32.44％、35.10％和40.98％(均P＜0.05).头部,颈部以及胸廓入口处的血管CT值B组各分组较A组对应组均增高,图像噪声均减低,信噪比(SNR)和对比噪声比(CNR)均增高,差异均有统计学意义(均P＜0.05).B组各分组的主观评分较A组对应组均高(均P＜0.05),B1组、B2组及B3组图像质量的一致性(Kappa值=0.634,0.644,0.628,均P＜o.05)分别高于A1组、A2组及A3组(Kappa值=0.476,0.566,0.595,均P＜o.05). 结论:不同BMI患者行头颈CTA检查,采用100kV管电压结合ASiR迭代重建扫描方案,可以降低辐射剂量(尤其是肥胖患者),并且可获得满意的图像质量.

目的 探讨基于自适应系统迭代算法(ASiR)的Dose Reduction (DR)技术结合低管电压(100 kV)技术在降低胸部增强CT辐射剂量的应用价值.方法 搜集行胸部增强CT检查连续病例90例(18.5 kg/m2≤BMI≤27kg/m2)分为三组(每组30例),A组:120 kV+自动mA(NI=12),DR =0,FBP重建;B组:120 kV+自动mA(NI=12),DR=40％,ASIR40％重建;C组:100 kV+自动mA(NI=13),DR=40％,ASIR40％重建.比较三组动脉期的辐射剂量、客观图像质量(感兴趣区CT值、信噪比、对比噪声比)以及主观图像质量,主观图像质量由两名放射科医师采用双盲法阅片进行评价.辐射剂量及客观图像质量评价指标行方差分析,主观图像质量比较行非参数秩和检验,医师对图像诊断一致性检验行Kappa分析.结果 C组肺动脉及胸主动脉CT值[(298.55±87.12) HU,(357.34±44.94) HU]均高于A组[(250.84±68.60) HU,(266.34±34.20) HU]和B组[(233.51±60.63) HU,(270.81 ±42.39) HU] (P ＜0.05),C组胸主动脉感兴趣区信噪比及对比噪声比(50.42 ± 10.91,41.69±9.70)高于A组(43.26±8.45,33.11 ±7.39)和B组(43.55±9.26,33.52±8.34) (P ＜0.05),三组主观图像质量差异无统计学意义(P＞0.05,Kappa值=0.613),辐射剂量(DLP)C组[(98.96±29.16) mGy/cm]与B组[(126.24 ±37.12)mGy/cm]较A组[(240.41±77.81) mGy/cm]分别降低约48.5％与58.9％ (P ＜0.05).结论 在保证图像质量前提下,应用DR技术可以降低一定的辐射剂量,基于ASiR的DR技术结合低管电压(100 kV)技术能够进一步降低胸部增强CT辐射剂量.

ObjectiveTo investigate the association of urinary sediment scoring system created on the basis of the number of renal tubular epithelial cells and granular casts with the severity of acute kidney injury. Methods Of 60 patients consulted for AKI, fresh morning urine was examined by two experts with phase-contrast microscopy, who did not know clinical information, counting the number of renal tubular epithelial cells and granular casts, scored on the basis of urinary sediment grading system, staged AKI on the base of the RIFLE standard, the worsening of AKI was progressing to higher AKI network stage, dialysis, or death. The association of score of urinary sediment with worsening of AKI was investigated, then the difference between worsening group with not worsening group was compared, the relationship of score of urinary sediment and the risk factors of worsening in AKI were analyzed by Logistic regression analysis. ResultsThe urinary sediment scores were lowest in those with stage 1 and highest in stage 3 of AKI (0.72±0.64vs. 1.36±0.97,P<0.05). 40% patients experienced worsening of AKI, the urinary sediment scores of worsening group were significantly higher than that of not worsening group (1.88±0.74vs.0.52±0.56,P<0.05). Multivariate stepwise Logistic regression analysis showed that the urinary sediment scores and serum creatinine were the independent risk factors of AKI worsening. ConclusionThe urinary sediment score may be a useful tool to predict worsening of AKI.

中心静脉置管是目前血液透析患者建立临时性血管通路的最常用方法,具有操作简便、快捷、创伤小及血流量大等优点,但也可能导致一些严重甚至致命的并发症(如大静脉穿通伤).我院收治1例左颈内静脉置管穿通无名静脉后继发血胸、纵膈血肿的患者并成功诊治,结合相关病例进行复习,现报道如下.

终末期肾衰竭（end stage renal disease，ESRD）患者往往合并不同程度的肾性贫血，严重影响患者的生活质量。20世纪80年代，人们首次利用基因工程技术合成重组人促红细胞生成素（recombinant human erythropoietin，rHuEPO）并将其应用于临床，成为肾性贫血治疗史上的里程碑。然而，在其使用过程中，人们逐渐发现促红细胞生成素（EPO）一些罕见的不良反应，如导致纯红细胞再生障碍性贫血（pure red cells aplasia， PRCA）。本科发现1例使用 EPO诱发 PRCA的病例，现报道如下。

培养具有较高医学英语水平的复合型人才是高等医药院校学生培养中的一项重大任务.结合临床实习阶段的特点,在肾病内科实习医师中开展以问题为基础的学习法(PBL)进行医学英语教学,取得了较好的教学效果,值得在临床科室进行推广.

目的 观察阿魏酸哌嗪片治疗狼疮肾炎的临床疗效.方法 将80例狼疮肾炎患者随机分为两组.对照组给予激素加免疫抑制剂常规治疗.治疗组在对照组基础上加用阿魏酸哌嗪片治疗.观察并比较两组的临床疗效及血肌酐、尿素氮、血浆白蛋白、血红蛋白、尿蛋白定量、补体C3、抗核抗体、抗双链DNA抗体等指标的改变情况.结果 治疗组在治疗后血尿素氮、血肌酐、尿蛋白定量均明显下降,血浆白蛋白、血红蛋白较治疗前明显上升,且与对照组比较有统计学差异.结论 阿魏酸哌嗪联合激素加免疫抑制剂治疗狼疮肾炎疗效优于常规治疗,对狼疮肾炎患者纠正贫血、改善肾功能、降低尿蛋白有一定疗效.

Objective To observe the clinical efficacies of hemiarthroplasty and dynamic hip screw( DHS) in treatment of unstable intertrochanteric femoral fracture in the elderly. Methods In order to collecting controlled trials on DHS and hemiarthroplasty in treatment of intertrochanteric fractures,MEDLINE( 1995 to May 2012),Pubmed( 1995 to Sep-May 2012),SPRINGER( 1995 to Sep- May2012),John Wiley( 1995 to Sep- May 2012),Science Direct( 1995 to Sep- May 2012),EBSCO( 1995to Sep- May 2012),CNKI( 1995 to Sep- May 2012) and WANFANG( 1995 to Sep- May 2012) were searched by computer; manual search of related journals was also performed. The included studies were randomized controlled tests and data analysis was performed by the Cochrane Collaboration's RevMan 4. 2software. Results Eight randomized controlled trials involving a total of 548 patients were included. The surgery time of control group decreased more significantly than the test group [RR: 2. 66,95% CI(-7. 88,-2. 48),P 0. 01]. Meta analysis showed that the medical complications occurred in both groups,but the incidence of medical complications in the control group was significantly higher than that in the test group [RR = 2. 66,95% CI( 1. 57,4. 50),P 0. 01]. The implant-related complications occurred in both groups,but the incidence of control group was significantly higher than that of the test group [RR =5. 09,95% CI( 2. 49,10. 41),P 0. 01]. The postoperative Harris scores increased in both groups,but it increased more in the test group than in the control group [RR =- 8. 19,95% CI(- 9. 45,- 6. 93),P 0. 01]. Conclusion Compared with hemiarthroplasty,DHS may reduce the surgery time,but DHS has higher incidence of the medical and implant-related complications than hemiarthroplasty. The postoperative Harris scores of hemiarthroplasty increased more than that of DHS.

Objective To investigate the efficacy of nerve damage prevention using electrophysiological monitoring techniques during reconstruction of pelvic fracture combined with sacroiliac joint dislocation. Methods Intraoperative real-time monitoring by motor evoked potentials with trans-cranial electrical stimulation (TES-MEP) and spontaneous electromyogram (EMG) were performed during surgical treatment for the patient of pelvic fracture combined with sacroiliac joint dislocation. The preventive effects on iatrogenic injury of sciatic nerve and L5 nerve root were observed. Results The TES-MEP volatility of biceps femoris, tibialis anterior muscle and posterior tibial muscle dropped on the surgical side when resetting sacroiliac joint, but the waveform could be elicited. The TES-MEP waveform was stable when resetting pubis. Some short, high-amplitude EMG response appeared in extensor digitorum brevis and posterior tibial muscle due to surgical operation, so that the surgeons could be immediately aware of avoiding irritation for nerve tissues. Sacroiliac joint and pubis were restored well and iatrogenic nerve injury was not observed after operation. Conclusion During reconstruction of pelvic fracture combined with sacroiliac joint dislocation, application of both TES-MEP and EMG can improve surgical accuracy by synchronous monitoring the status of the sciatic nerve and L5 nerve root. This technique is worthy of recommendation in clinic.

目的 研究慢性肾衰竭(CRF)患者血清脂联素水平及其相关因素,探讨脂联素在CRF患者心血管病变的发生、发展中的作用及机制.方法 收集2010年4月至2010年10月在泸州医学院附属医院肾病内科住院的CRF患者,根据有无合并临床心血管事件将其分为CRF无心血管病变组和CRF伴心血管病变组,测定空腹血清脂联素,分析脂联素与各指标的相关性,用Logistic回归分析CRF心血管病变的危险因素.结果 CRF患者脂联素水平高于正常对照组[(37.44±13.27)mg/L vs(25.47±9.21) mg/L,t=0.708,P<0.05],CRF合并心血管病变组脂联素水平显著低于CRF未合并心血管病变组[(43.17±9.43) mg/L vs(30.71±14.11) mg/L,t=2.625,P<0.05].体质量指数、肌酐、三酰甘油、空腹血糖是影响血清脂联素水平的因素.结论 低脂联素血症可能为CRF患者心血管病变的预测因子;低脂联素血症和微炎症反应及其相互作用共同参与了CRF患者心血管病变的发生和发展.

目的 探讨辛伐他汀联合氯吡格雷对糖尿病肾病合并高脂血症的血液透析患者动静脉内瘘血栓形成的预防作用及可能机制. 方法 选取65例维持性透析的糖尿病肾病合并高脂血症的动静脉内瘘患者,随机分为对照组,治疗组,治疗组患者予以口服“辛伐他汀20mg,qd及氯吡格雷50mg,qd”,对照组不使用任何调脂和抗血小板药物,观察12个月,统计内瘘总通畅率.结果 治疗组内瘘通畅率明显高于对照组,治疗组明显减少了内瘘血栓的形成.结论 联合使用辛伐他汀及氯吡格雷对预防糖尿病肾病合并高脂血症的血液透析患者动静脉内瘘血栓形成具有显著效果,其操作简单,费用少,有较高的临床应用价值.

Objective To explore the change of S-adenosylhomocysteine(SAH),the precursor of homocysteine(Hcy),in patients with chronic kidney disease(CKD) and the relationship between serum SAH level and cardiovascular complications(CVD).Methods Fifty-five CKD patients and 32 healthy volunteers were included in this study.Serum SAH level was measured by continuous cycle enzyme colorimetric method.Serum Hcy level was measured by ELISA.Serum folate and Vitamin B12 levels were measured by automatic immunity analyzer.Results The mean levels of serum Hcy and SAH in CKD patients were significantly higher than that in the healthy controls,especially SAH.The mean level of serum SAH in CKD patients with CVD was significantly higher than that of patients without CVD.Logistic regression analysis indicated SAH was an independent risk factor for cardiovascular disease in patients with CKD.Levels of folate and vitamin B12 do not differ significantly between groups.Conclusion Serum SAH appears to be a much more sensitive indicator of the cardiovascular complications in patients with CKD than Hcy.Serum SAH and Hcy level are significantly correlated with serum creatinine level in patients.

Objective To investigate the combined application value of cortical somatosensory evoked potentials(CSEP) and transcranial electrical stimulation motor evoked potentials(TES-MEP) in thoracic vertebral tuberculosis surgery.Methods 27 cases of patients with thoracic vertebral tuberculosis were given CSEP + TES-MEP monitoring during surgery.Amplitude and latency changes of CSEP and TES-MEP were observed continuously during surgery.Patients whose amplitude decreased by 50%,latency extended by 10% or 100 V stimulus intensity higher than the initial stimulus intensity yet failed to extract,were stopped the surgery and conducted symptomatic treatment.Results The success rate of CSEP monitoring was 100.0%(27/27),which of TES-MEP was 92.6%(25/27),and the success rate of combined monitoring was 92.6%(25/27).CSEP showed 1 positive case and TES-MEP showed 7 positive cases,of which 1 case was positive in both CSEP and TES-MEP,6 cases were negative in CSEP and positive in TES-MEP,and 1 case was postoperative neural function injury.Conclusion Combined application of CSEP and TES-MEP in the thoracic vertebral tuberculosis surgery can accurately reflect the intraoperative spinal function and improve the monitoring effects,after excluding various interference factors.