目的 通过建立特征参数曲线模型分析在不同CT扫描条件下对肺结节鉴别诊断的量化意义。方法 回顾性分析2018年9月—2019年10月我院收治的肺结节患者的CT胸部平扫图像为研究对象,纳入标准为结节直径≥3 mm,无其他病史。在筛选出的96例样本中,符合条件的样本68例(男性39例,女性29例),按扫描剂量的不同将研究对象分为低剂量观察组(管电压120 kV,管电流20 mA)和常规剂量组(管电压120 kV,管电流150 mA),每组各34例;通过测量并计算扫描长度、有效剂量、样本体型、信噪比相关参数,观察不同管电流与有效辐射剂量之间的相关性以及图像质量;运用PACS人工智能软件以及人工综合提取肺结节特征信息(直径、体积、密度纹理、边缘细节、内部结构)并记录数据,进而通过公式计算出肺结节质量;应用U检验分析比较不同管电流下各参数的组间差异,经过单元逻辑对确定的重要参数体积与质量纳入多元逻辑分析,建立特征参数曲线模型并测量曲线下面积及勾画ROC;使用卡方分析评价不同管电流下建立特征参数曲线模型对肺结节定量诊断分析的差异并同时比较不同管电流下的图像质量。结果 研究中发现,样本接受的有效辐射剂量在管电压一定的条件下,随管电流的增加而线性增加;样本肥胖患者(BMI≥23.9)的CT图像在使用低剂量扫描中呈现出明显噪声,影响组织间观察,而BMI标准(18.5≤BMI≤23.9)的样本的CT图像中,肺结节的信噪比与管电流变化未出现明显趋势阈值,差异无统计学意义(P＜0.05);通过特征参数曲线模型显示,肺结节的体积与质量均质性曲线显示出其变化趋势与管电流变化成相关性,且稳定性和一致性较好,故此二要素为模型主要分析成分,观察组ROC曲线显示其曲线下面积为0.826高于常规组ROC曲线显示其曲线下面积为0.747。结论 与常规剂量相比,低剂量CT扫描模式下建立特征参数曲线模型对肺结节鉴别诊断更有可量化意义。

Objective The quantitative significance of differential diagnosis of pulmonary nodules under different CT scanning conditions was analyzed by establishing characteristic parameter curve model. Methods CT plain chest scan images of patients with pulmonary nodules treated in our hospital from September 2018 to October 2019 were analyzed retrospectively. The inclusion criteria were nodule diameter ≥3 mm and no other medical history. Of the 96 selected samples, 68 met the criteria (39 males and 29 females).According to the different scanning dose, the subjects were divided into low dose observation group (tube voltage 120 kV, tube current 20 mA) and conventional dose group (tube voltage 120 kV, tube current 150 mA).There were 34 cases in each group, and the correlation between different tube current and effective radiation dose and image quality were observed by measuring and calculating the relevant parameters of scanning length, effective dose, sample shape and signal-to-noise ratio. PACS artificial intelligence software and artificial synthesis were used to extract the characteristic information (diameter, volume, density texture, edge details, internal structure) of pulmonary nodules and record the data. Furthermore, the mass of pulmonary nodules was calculated by formula, the differences of parameters under different tube currents were compared by U test, the volume and mass of important parameters determined by unit logic were incorporated into multivariate logic analysis. The curve model of characteristic parameters was established, the area under the curve was measured and ROC was sketched. Chi-square analysis was used to evaluate the difference of characteristic parameter curve model for quantitative diagnosis of pulmonary nodules under different tube currents, and to compare the image quality under different tube currents at the same time. Results In the study, it is found that the effective radiation dose received by the sample increases linearly with the increase of tube current under the condition of constant tube voltage. The CT images of obese patients (BMI≥23.9) showed obvious noise when using low dose scan, which affected the inter-tissue observation. However, in the CT images of the samples with BMI standard (18.5 ≤ BMI ≤ 23.9), there was no obvious trend threshold between the signal-to-noise ratio and tube current of pulmonary nodules, and the difference was not statistically significant (P<0.05).The characteristic parameter curve model showed that the volume and mass homogeneity curve of pulmonary nodules showed the change trend was correlated with the change of tube current, and the stability and consistency were good, so the two elements were the main analytical components of the model. The ROC curve of the observation group showed that the area under the curve was 0.826, which was higher than that of the conventional group, the area under the curve of the ROC curve was 0.747. Conclusion Compared with conventional dose, the establishment of characteristic parameter curve model under low dose CT scan mode is more quantifiable for differential diagnosis of pulmonary nodules.

目的 探讨Sysmex-2100全自动血液分析仪检测β-地中海贫血(β-地贫)患儿血小板参数显示不全的原因。方法 收集2017年4月—2020年4月期间本院确诊β-地贫患儿301人,其中重型病例204例,非重型97例。对301例患儿均采用希森美康Sysmex-2100血细胞分析仪进行血细胞分析,标本制作血涂片充分干燥后经瑞氏-吉姆萨染色,由主管技师及以上检验人员进行人工镜检。结果 301例β-地贫患儿血细胞分析结果出现血小板参数不显示者102例,占33.89％;其中有小红细胞、红细胞碎片、血小板聚集97例(95.10％);血小板直方图异常93例(91.18％)。重型β-地贫患儿血小板参数显示不全者75例,非重型β-地贫患儿血小板参数显示不全者27例,两组间血小板参数显示不全比例差异无统计学意义(P= 0.126)。血小板参数全显示病例的平均红细胞体积高于血小板参数显示不全病例,差异有统计学意义(P< 0.0001)。结论 小细胞低色素性红细胞及红细胞碎片化是β-地贫患儿血小板参数显示不全的主要原因,通过血小板直方图正常与否可大致判断血小板参数的可信度,采用PLT-O通道检测及涂片镜检查找原因,可提高结果的准确性。

目的 我们探讨2019年6月—2020年1月复发性流产夫妇男性患者精浆弹性蛋白酶同精液参数及DNA碎片率的可能关系。方法 研究对象纳入80例复发性流产的男性患者及25例因女方输卵管因素行IVF-ET正常生育的男性患者。精液标本用来进行精浆弹性蛋白酶、精液常规分析、精子核染色质分析及精子形态学等参数分析。结果 结果表明同正常生育男性相比,复发性流产的弹性蛋白酶是增高(P=0.010)。我们将复发性流产男性患者分为正常组(<600 ng/mL)及异常组(≥600 ng/mL)。结果表明异常组患者的精子前向运动比例(P=0.002)及正常形态百分率(P=0.009)均降低,而精子DNA碎片率(P=0.002)增高。Spearman相关性分析发现精浆弹性蛋白酶同精子前向运动比例(r=-0.43,P<0.001)及正常形态百分率(r=-0.39,P<0.001)负相关,而同精子DNA碎片率(r=0.36,P=0.001)正相关。结论 精浆弹性蛋白酶可能影响复发性流产男性患者的精子活力、形态及DNA碎片率。复发性流产男性患者的生殖道隐性感染值得重视,其相关临床探讨性值得深入研究。

Objective Our study is aim to investigate the possible relationship of seminal elastase, on semen parameters and DNA fragmentation in male patients of recurrent pregnancy loss (RPL) between June 2019 and January 2020. Methods The patients included 80 male patients of RPL couple and 25 male patients from couples with clinical pregnancy through in vitro fertilization due to the female tubal factor. The semen samples were used to determine the seminal elastase, computed assisted semen analysis, sperm dispersion test and sperm morphology analysis. Results Compared to the control group, the levels of seminal elastase was increased in the RPL group. The RPL group was divided into the normal group (Elastase<600 ng/mL) and abnormal group (Elastase ≤ 600 ng/mL).The abnormal group exhibited the lower percentage of progressive sperm (P=0.002) and normal morphology (P=0.009),but higher precentage of DNA fragmentation (P=0.002). Meanwhile, the seminal elastase was positively associated with DNA fragmentation (r=0.36,P=0.001), but was inversely associated with the sperm motility (r=-0.43,P<0.001) and normal morphology (r=-0.39,P<0.001). Conclusion Our study may unveil the possible effects of the seminal elastase on the semen parameters and DNA fragmentation in the male patients of RPL couples. Further studies should put more emphasis on the silent genital tract inflammation of the patients.

目的 探讨乳腺癌原发病灶超声声像图特点及病理分子分型与腋窝淋巴结转移的相关性。方法 回顾性分析106例接受乳腺超声检查及腋窝淋巴结活检,病理确诊为乳腺癌的患者资料。超声观察乳腺癌原发病灶的位置、大小、有无钙化、纵横比、内部血流、腋窝淋巴结声像图特点,结合临床病理学特点,分析与腋窝淋巴结转移相关的因素。结果 超声诊断未见明显异常的腋窝淋巴结75例,可疑的腋窝淋巴结31例;病理证实腋窝淋巴结未转移70例,转移36例。灵敏度66.7%、特异度90%、阳性预测值77.4%、阴性预测值84%。单因素分析显示原发肿块的位置、最大径、腋窝淋巴结淋巴门消失、ER表达与腋窝淋巴结转移有关(P<0.05 )。多因素分析显示原发肿块的位置、腋窝淋巴结淋巴门消失与腋窝淋巴结转移有关(P<0.05)。结论 腋窝淋巴结常规超声检查结合乳腺癌原发病灶超声声像图及病理分子分型有助于评估腋窝淋巴结状态。

Objective To analyse the ultrasonographic features and pathological molecular typing of the primary lesions and axillary lymph node (ALN) of breast cancer related to axillary lymph node metasta-sis(ALNM). Methods The Grey-scale and color Doppler ultrasound and axillary lymph node biopsy were performed in 106 patients with breastcarcinomas. The observed features included the position,the most dimen-sion,inner calcification,aspect ratio,the type of blood supply of the primary tumor and axillary lymph node image. Combining with the clinicopathological features, we analyzed the factors associated with axillary lymph node metastasis. Results Ultrasound found normal axillary lymphnodes in 70 patients and abnormal in 31 patients. Pathology confirmed axillary lymph node metastasis in 36 patients, and no metastasis in 70 patients.The sensitivity, specificity, positive predictive value, negative predictive value were 66.7%, 90%, 77.4% and 84% r-espectively.Univariate analysis showed that the location, maximum diameter, lymphnode with disappearance hilus and ER expression were related to axillary lymph node metastasis (P< 0.05). Multivariate analysis showed that the location of primary mass and lymph node with disappearance hilus were related to axillary lymph node metastasis (P< 0.05). Conclusion Axillary lymph node routine ultrasound examination combined with ultrasonographic and pathological molecular typing of primary breast cancer is helpful to evaluate axillary lymph node status.

目的 运用Sirius系统对准分子术前患者的前房参数以及角膜中央厚度进行检测,探讨上述因素之间的相关性、规律性,以及性别、年龄对其的影响。方法 分组:对210例近视眼患者(420只眼)根据屈光度分为低度近视组,中度近视组、高度近视组。采用Sirius系统对三组检测眼进行角膜中央厚度、中央前房深度、前房容积、颞侧及鼻侧房角宽度进行测量,并采用相关性分析,单因素方差分析对检测数据进行统计学分析。结果 屈光度数绝对值与颞侧房角呈正相关,中央前房深度与前房容积呈正相关、与颞侧及鼻侧房角宽度均呈正相关。颞侧与鼻侧房角宽度亦呈正相关。年龄与中央前房深度呈负相关。不同屈光度度数组别之间颞侧房角宽度存在统计学差异性。男性中央前房深度及颞侧房角宽度明显大于女性。结论 Sirius系统可以作为一种便捷、准确且无创的角膜厚度及前房参数的测量工具。近视眼患者的前房参数与屈光度数、中央角膜厚度、年龄、性别存在一定的相关性性、规律性。

Objective To analyze the correlation and principle of anterior chamber parameter and central cornea thickness, the influence by the sexual and age in the pre-operative patients with excimer laser by using Sirius system. Methods 210 patients (410 eyes)were divided into 3 groups based on refractive status:low myopia,moderate myopia and high myopia.Central cornea thickness(CCT),anterior chamber depth(ACD),anterior chamber volume(ACV),temporal(T) and nasal anterior chamber width(N) were measured by Sirius system. The results are analyzed by correlation and one-way anova of statistics. Results A positive correlation was found in the absolute value of diopter and temporal anterior chamber width, the anterior chamber depth(ACD) and anterior chamber volume(ACV), temporal(T) and nasal anterior chamber width(N), and also in the temporal and nasal anterior chamber width. There was a negative correlation between age and temporal and nasal anterior chamber width. There were significantly statistics differences in the temporal anterior chamber width between different diopter groups. The anterior chamber depth(ACD) and temporal anterior chamber width of males were obvious deeper than females. Conclusion The Sirius system may be used as a convenient, precise and noninvasive technique in cornea thickness and anterior chamber parameter measurement. There is a definite correlation and principle in the anterior chamber parameter and diopter, central cornea thickness, age and sexual.

      目的   分析高原地区3～6年级学生屈光状态及屈光参数之间的关系。方法  2023年9月，采用随机抽样方法选取林芝市波密县某两所小学3～6年级535名学生进行校园筛查。计算并记录裸眼远视力（UCVA），非睫状肌麻痹电脑验光下散光及其轴位、等效球镜（SE）、眼轴（AL）、角膜曲率半径（CR）和眼轴/角膜曲率半径轴率比（AL/CR）。采用SPSS 22.00统计软件分析数据。结果  3～6年级学生AL和AL/CR大体趋势为随年级升高而增长，SE随年级升高而降低。3～6年级学生总体筛查性近视患病率为29.91%，且3～6年级筛查性近视患病率分别为20.35%、25.53%、30.53%和51.38%。总体散光患病率为51.59%，其中顺规散光、逆规散光及斜轴散光分别占90.22%、7.61%及2.17%。视力不良者约40.37%。以非睫状肌麻痹验光SE≤-0.50 D同时UCVA＜5.0作为筛查性近视的诊断，AL/CR诊断筛查性近视的灵敏度为0.656、特异度为0.887和Youden指数为0.534，曲线下面积（AUC）为0.802，优于AL评估（AUC=0.764）。结论   高原地区3～6年级学生的筛查性近视患病率随年级升高而快速增长，且散光患病率较高，视力不良者较多。AL／CR值对筛查性近视监测具有一定的临床意义。

      Objective  To analyze the  relationship  between  refractive  status and  refractive  parameters of  students in grades three-six in plateau area．Methods  In September，2023，a random sampling method was used to select 535 students from grades three-six of two primary schools in Bomi County，Nyingchi City，for school screening．Distance uncorrected visual acuity（UCVA），astigmatism and its axis position，equivalent spherical（SE），axial length（AL），corneal radius（CR），and axial length/corneal radius ratio（AL/CR）were calculated and recorded．The data was analyzed using the statistical software SPSS 22.00．Results  The general trend of AL and AL/CR for grade three-six students was increased with grade increasing，while SE decreased with grade increasing．The overall prevalence of screening myopia was 29.91%，and the prevalence of screening myopia in grades three to six was 20.35%，25.53%，30.53% and 51.38%，respectively．The overall prevalence rate of astigmatism was 51.59%，including 90.22%，7.61% and 2.17% for astigmatism with the rule，astigmatism against the rule and oblique astigmatism，respectively．About 40.37% of the students had poor vision．Screening myopia was diagnosed using non-cycloplegic optometry with SE ≤-0.50 D combined with UCVA＜5.0．The sensitivity and specificity of AL/CR for screening myopia were 0.656 and 0.887，respectively，with a Youden index of 0.534 and an area under the curve（AUC）of 0.802．This was superior to the AL evaluation，which had an AUC of 0.764．Conclusions  The prevalence of screening myopia increased rapidly with the increase of grade in grade 3 to 6 in plateau area．And there were high prevalence of astigmatism and more poor vision．AL/CR value has a certain clinical significance in the monitoring of screening myopia．