[摘 要] 目的：探讨肝内胆管癌（intrahepatic cholangiocarcinoma，ICCA）围手术期外周血中性粒细胞与淋巴细胞比率（neutrophil-to-lymphocyte ratio，NLR）和血小板与淋巴细胞比率（platelet-to-lymphocyte ratio，PLR）对患者预后的预测价值。方法：收集2015年1月至2018年1月在上海市松江区中心医院接受肝切除术治疗的ICCA患者97例作为ICCA组，选择同期在本院做健康体检的志愿者100例作为正常对照组。检测两组受试者术前1 d、术后3 d和7 d外周血的NLR、PLR，采用单因素、多因素分析ICCA患者术后随访期死亡的危险因素，采用Kaplan-Meier生存曲线分析术后3 d的NLR和PLR对ICCA患者术后生存时间的影响，采用受试者工作特征曲线（receiver operating characteristic curve，ROC）分析术后3 d的NLR和PLR水平对患者术后随访期死亡的预测价值。结果：ICCA组患者术前1 d、术后3和7 d外周血的NLR、PLR均高于正常对照组（均P<0.05），术前1 d和7 d外周血NLR、PLR差异无统计学意义（P>0.05），术后3 d外周血NLR、PLR水平最高（P<0.05）。多发肿瘤、合并淋巴结转移、TNM分期Ⅲ~Ⅳ、CA199水平增高、术后3 d的NLR和PLR较高分别是ICCA患者随访期死亡的独立危险因素（均P<0.05）。ROC曲线显示，术后3 d的NLR和PLR高低对ICCA患者术后生存时间具有预测价值。Kaplan-Meier生存曲线显示，低NLR[（50.32±3.69） vs （30.12±2.36）个月]和低PLR[（53.6±3.75） vs （37.6±2.96）个月]患者生存时间均长于高NLR和PLR的ICCA患者（均P<0.05）。结论：ICCA术后3 d的NLR和PLR异常增高是患者肝切除术后死亡的独立危险因素，其对患者生存时间具有早期预测价值。

Objective To determine the feasibility of neck vessel wall imaging technology with three?dimensional variable?flip?angle turbo spin?echo (3D T1w?SPACE) for the detection of carotid atherosclerotic disease before revascularization. Methods Thirty?one patients who underwent carotid endarterectomy (CEA) and fifty?three patients who underwent carotid stenting (CAS) were enrolled prospectively. Neck vessel wall imaging examination were performed in all patients whilecarotid artery DSA were performed in all CAS patients. Quantitative measurements including stenosis, lesion length, and the presence or absence of plaque ulceration obtained with 3D T1w?SPACE and DSA were independently determined. And images of the 3D T1w?SPACE were compared with corresponding histology to identify major plaque components including intraplaque hemorrhage (IPH), lipid rich necrotic core (LRNC), and calcification (CA). The consistency rate, sensitivity, specificity, positive predictive value and negative predictive value were used to assess diagnostic value. Bland?Altman plots, intraclass correlation coefficient (ICC), and Cohen Kappa were determined. Results DSA was served as the reference standard. There was an excellent correlation between 3D T1w?SPACE and DSA images in measuring stenosis (r=0.984, P<0.01) and luminal stenosis [ICC=0.98 (95% confidence interval: 0.96-0.99)]. Bland?Altman plots showed that the two examinations were in good consistency in evaluating the extent of stenosis. Sensitivity (89.5%) and specificity (95.1%) was high in 3D T1w?SPACE images compared to DSA for the detection of ulcers. The consistency rate between 3D T1w?SPACE images and histological results for IPH, LRNC and CA detection were 85.7%, 82.1% and 92.9%, respectively. Sensitivity and specificity were 90.0% and 75.0% for IPH;83.3% and 80.0% for LRNC; 91.3% and 100.0% for CA respectively. However, lesion length measurements by using 3D T1w?SPACE were longer than those measured by using DSA (P<0.01).Conclusion Neck vessel wall imaging technology with 3D T1w?SPACE is a noninvasive and accurate technique for the diagnosis of carotid artery atherosclerotic disease before revascularization.

Objective To investigate the distribution and susceptibility patterns of common uropathogens causing community-acquired urinary tract infection (UTI) in Beijing.MethodsA total of 300non-duplicate isolates were randomly collected from 3 hospitals in Beijing between Jan,1 2010 and Mar,312011.Minimal inhibitory concentrations (MICs) were determined by the broth microdilution methods,which were performed and interpreted according to the guidelines established by the Clinical and Laboratory Standards Institute (CLSI).A panel of 8 antimicrobial agents were tested:amikacin,cefaclor,cefepime,cefoperazone/sulbactam,ciprofloxacin,levofloxacin,gentamicin and nitrofurantoin. Fosfomycin trometamol MICs were determined by the agar-dilution method in cation-adjusted MH agar supplemented with glucose 6-phosphate at a concentration of 25 mg/L as detailed in the guidelines issued by 2010 CLSI. All the Escherichia coli,Klebsiella pneumoniae and Proteus mirabilis strains were screened and confirmed by double-disk synergy test for extended-spectrum β-lactamase (ESBLs).Results Among the organisms cultured,E.coli wasthepredominantpathogen(65.0％ ), followedby Enterococcus(11.7％ ),Staphylococcus( 6.3％ ), Klebsiella pneumoniae( 5. 3％ ), Proteus mirabilis( 4. 7％ ), and Pseudomonas aeruginosa (3.0％).Lower susceptibility rates to ciprofloxacin and levofloxacin (31.4％ -47.4％ ) were observed among all the stains.Amikacin,cefoperazone/sulbactam,nitrofurantoin and fosfomycin trometamol were the most active drugs (92.1％,92.1％,88.4％ and 87.9％ susceptible strains,respectively) among the Gram-negative strains.Isolates of Staphylococcus were highly sensitive to amikacin ( 100.0％ ),cefoperazone/sulbactam (94.7％),nitrofurantoin ( 100.0％ ).Higher susceptibility rates to nitrofurantoin (91.4％) and fosfomycin trometamol (90.0％) were observed in Enterococcus.ESBLs-producing strains accounted for 52.3％ (102/195) in E.coli,43.8％ (7/16) in K.pneumoniae and 14.3％(2/14) in P.mirabilis,respectively.ConclusionsResistance is most common to ciprofloxacin and levofloxacin of all the stains.Currently,the most appropriate agents for the empirical management of uncomplicated UTI seems to be amikacin,cefoperazone/sulbactam,nitrofurantoin and fosfomycin trometamol.

To clarify the source of deviations of drug combination effects evaluated with different drug interaction mathematical models, the cytotoxicity of SAHA and arsenic trioxide and their combinations were observed in a series of human cancer cell lines and a normal cell line. The combined effects were evaluated with three drug interaction models: Loewe Additivity (LA), Bliss Independence (BI) and Chou's Median Effect Model. The evaluations with three different models were further compared with each other. We demonstrated that when dose-response curves were fitted with the same method, similar evaluated results for drug combinations would be derived with different models. The deviations of evaluated effects of drug combinations were attributed to different curve fitting methods used rather than the models themselves. The effects of drug combinations showed discrepancies on different cell lines, and at different combined drug concentrations on same cell line.

ObjectiveTo explore the value of low-dose gated dual-source CT(DSCT)in the diagnosis of interrupted aortic.arch.MethodsNine pediatric patients performed DSCT angiography and color Doppler flow imaging(CDFI)in the thoracic aorta and heart.All patients were operated.ResultsDSCT examination was finished in all patients with interrupted aortic arch.Nine patients were associated with ventricular septal defect(VSD),8 patients with patent ductus arteriosus(PDA),2 with bronchus artery dilation and 3 with abnormal origin of the coronary artery.Seven patients were diagnosed as interrupted aortic arch by CDFI,2 patients were diagnosed as truncus arteriosus and coarctation of the aorta respectively.All VSDs and PDAs were detected by CDFI.The diagnostic accuracy of DSCT and CDFI were 94.12%(32/34)and 82.35(28/34)respectively.Conclusion DSCT is a valuable imaging method for the diagnosis of pediatric interrupted aortic arch.

Objective To introduce the procedures and evaluate the clinic value of CT-guided interstitial 125I seeds implantation in treating lung cancer. Methods Thirty-one cases patients with lung cancer underwent CT-guided interstitial 125I seeds implantation. All patients were scanned on multi-spiral CT (Philips, MX 8000) with optical navigating system (pinpoint), and treatment plan system, needle, and 125I seeds (Chinese Academy of Science) were used. First of all, according to the size of tumor, TPS calculated the optimal quantity of seeds. Then, under the guidance of CT, 125I seeds were percutaneously implanted into the tumors for interstitial radiotherapy. CT follow-up examinations were performed 1, 2, and 6 months after the therapy, respectively. According to the size of tumor, curative effects were graded as 4 grades: grade Ⅰ: obvious relief (OR) (the size of tumor reduced up to 50%), grade Ⅱ: relief (PR) (the size of tumor reduced by 25%-50%), grade Ⅲ: slight relief (SD) (the size of tumor reduced by 1%-25%), and grade Ⅳ: no effect (PD) (the size of tumor did not reduce or increase, and clinic symptoms showed no relief). Results At 1 month, 9 cases were classified as grade Ⅰ, 6 as grade Ⅱ, 13 as grade Ⅲ, and 3 as grade Ⅳ, respectively. At 2 months, 17 cases were grade Ⅰ, 8 grade Ⅱ, 3 grade Ⅲ, and 3 grade Ⅳ, respectively. At 6 months, 23 cases were grade Ⅰ, 3 grade Ⅱ, 2 grade Ⅲ, and 3 grade Ⅳ, respectively. Conclusion CT-guided interstitial 125I seeds implanted was a safe, reliable, and effective curative method for lung cancer.

Objective To observe the efficiency and safety of brachytherapy by CT-guided percutaneous paracentesis implantationof iodine-125 seed for lung cancer in elder patients.Methods 46 elder patients with lung cancer(65~81 years)were undergonebrachytherapy by CT-guided percutanepus paracentesis implantation of iodine-125 seeds with implanting needle(18-gauge). The effect of treatment according to observe the changes of tumors in size was evaluated after operation 1,2,3 and 6 months,respectively. Results There were totally 57 lesions in 46 cases,7 cases were undergone two times of implantation,and 1 case was undergone three times of implantation,totally the puncture accounted for 76. The effective rate (CR+PR) of treatment after one ,two, three, and six months was 8.77%(5/57), 40.35%(23/57),89.47%(51/57) and 96.49%(55/57),respectively. 5 patients(6.58%) accompanied by pneumathorax.Conclusion Brachytherapy by CT-guided percutaneous paracentesis implantation of iodine-125 seed is a safe, reliable and effective treatment for lung cancer, especially for elder patients.

Objective To investigate the role of the classification of Lauren in staging of gastric carcinoma and preoperative assessment using spiral CT. Methods Forty eight patients, 32 men and 16 women, who were 24～78 years old, with histologically and endoscopically proven gastric carcinoma, underwent spiral CT scans in prone position, with drug induced hypotonia and water filling. To induce gastric wall hypotonia and to maintain it during the entire examination, 10～15 mg of 654 2 was administered iv before basal scanning. All patinets underwent 2D, 3D and axial imaging using spiral CT, and 46 patients underwent dual phase contrast within one breathhold each. All patients with gastric carcinoma underwent staging and preoperative assessment by two radiologists according to the classification of Lauren. Results Spiral CT correctly detected all tumours. In our series, gastric carcinoma was of the diffuse type in 33 cases, of intestinal type in 15 cases; first stage in 2 cases, second stage in 18 cases, third stage in 15 cases and forth stage in 13 cases. There were 40 patients being performed operation, gastrectomy was performed in 33 patients and laparotomy was performed in 7 patients. The staging and preoperative assessment accuracy was 85.4% and 95.0% respectively, overstaging was 10.4%, and understaging was 4.2% according to the classification of Lauren. Correct rate of spiral CT detected lymph nodes (N1,N2) was 74.1% and 82.7% respectively. There are about 18 patienes whose arteries were invaded by tumors. With dual phase contrast, spiral CT can get well in detecting tumour, especially in staging gastric carcinoma in artery phase. Conclusions The classification of Lauren is recommended for staging of gastric carcinoma and preoperative assessment using spiral CT.

Objective To establish two-dimensional electrophoresis(2-DE) profiles with high resolution and reproducibility in analysis of hypothalamuses in the spontaneous hypertension rats(SHR) with hyperactivity of liver-yang to analyze the difference on the total proteins of hypothalamuses between the SHR and normal rats.Methods The total proteins of hypothalamuses in the rats were separated by immobilized pH gradient-based two-dimensional gel electrophoresis.With coomassie blue staining,the 2-DE image was analyzed by PDQuest 7.0 software.Results The average matching rate of the 2-DE images of hypothalamuses in the two kinds rats was 92% with good reproducibility.Proteins were mainly displayed at range of pI3-8,Mr(14.4～75) kD.The average spots in the SHR with hyperactivity of liver-yang and in the normal rats were 777?27 and 780?31 respectively.There were 22 spots of proteins up-regulated more than two times and 25 spots down-regulated more than two times in the SHR with hyperactivity of liver-yang than those of the normal rats.Conclusion There are 22 spots of proteins up-regulated and 25 spots of proteins down-regulated in the SHR with hyperactivity of liver-yang,which may be involved in the development of hyperactivity of liver-yang.

Objective To study the clin ic al application of 64-slices spiral CT in coronary artery. Methods Twenty-six patients were performed 64-slices spiral CT in coronary artery, 15 of the 26 patients underwent selective coronary artery angiography. Results The main branches and part of the sub-branches o f the coronary artery were clearly displayed. 38 coronary artery branches of 16 patients were found stenosis. In 15 cases with conventional angiography, all mai n branches and parts of sub-branches of coronary artery were displayed clearly. All patients demonstrated coronary artery stenosis. The diagnostic accuracy of 64-slices spiral CT was 94.12%. Conclusion As a minimall y invasive examination, 64-slices spiral CT is a valuable method to detect and diagnose the diseases of coronary artery.