目的 探讨亚实性肺腺癌结节CT征象在预测侵袭风险中的价值。方法 选取经胸部CT检查发现并经病理证实为肺腺癌的亚实性结节共76个病灶,病灶分为侵袭前组与侵袭组2组,分析结节CT征象,行统计学分析,明确亚实性肺腺癌结节侵袭性的预测因素。结果 侵袭前组（包括原位腺癌、微浸润性腺癌）共31例;侵袭组[浸润性腺癌（IAC）]共45例。2组在最大平均直径、结节平均CT值、结节形状、分叶、毛刺、胸膜牵拉征、有无实性成分、肿瘤微血管CT成像征间比较差异有统计学意义（P<0.05）,而在空泡征、空气支气管征方面比较差异无统计学意义（P>0.05）。结节最大直径预测浸润性腺癌侵袭性界值为13.63 mm,敏感度、特异度分别为68.9%、96.8%,AUC为0.885;平均CT值预测IAC侵袭性界值为-528 HU,敏感度、特异度分别为84.4%、83.9%,AUC为0.867。回归分析显示病灶最大平均直径（OR=2.015、P=0.01）可以作为浸润性肺腺癌结节的独立预测因子。结论 亚实性肺腺癌结节侵袭前组和侵袭组在最大直径、平均CT值、形状、分叶、毛刺、微血管征存在差异;结节的最大平均直径是IAC的独立预测因子。

Objective To investigate the value of CT signs in predicting the risk of invasion of subsolid lung adenocarcinoma nodules．Methods A total of 76 subsolid pulmonary adenocarcinoma nodules detected by chest CT and pathologically confirmed were selected,and the lesions were divided into pre-invasion group and invasion group．CT signs of nodules were analyzed and statistical analysis was performed to determine the predictive factors of invasion of subsolid pulmonary adenocarcinoma nodules．Results There were 31 cases in the pre-invasion group（including adenocarcinoma in situ and minimally invasive adenocarcinoma）and 45 cases ininvasion group[invasive adenocarcinoma（IAC）]．There were significant differences in maximum mean diameter,mean CT value of nodule,nodule shape,lobule,burr,pleural stretch sign,solid component and microvascular CT imaging signs between the two groups（P<0.05）,but there were no significant differences in vacuole sign and air bronchial sign between the two groups（P>0.05）．The maximum diameter of nodules predicted the invasion boundary of invasive adenocarcinoma was 13.63 mm,the sensitivity and specificity were 68.9% and 96.8%,respectively,and the AUC was 0.885．The mean CT value predicted the invasive boundary of IAC was -528 HU,the sensitivity and specificity were 84.4% and 83.9%,respectively,and the AUC was 0.867．Regression analysis showed that the maximum mean lesion diameter（OR=2.015,P=0.01）was an independent predictor of infiltrating lung adenocarcinoma nodules．Conclusions There were differences in the maximum diameter,mean CT value,shape,lobed,burr and microvascular signs between the pre-invasion group and the invasion group．The maximum mean diameter of nodules was an independent predictor of IAC．

目的 通过分析收费员在工作过程中态度、行为及对工作内容的熟悉情况,提出提高医院窗口收费人员职业道德建设的一些措施。方法 对前来广州市南沙中心医院就诊的患者随机进行问卷调查,收集资料并进行统计分析。结果 调查显示,目前医院窗口存在以下问题:医患沟通不畅、收费员本身对工作内容熟悉程度不够、收费员在处理问题时的行为态度存在不足等。结论 提高医院收费人员的职业道德建设刻不容缓,其需要医院加强收费员的业务培训,建立合理有效的奖惩制度;收费员自身应积极投入到各自的岗位,做到诚实守信,爱岗敬业,廉洁自律,为医院树立良好形象。