目的 探讨基于单个最大层面(2D)及体积(3D)感兴趣区(ROI)的ADC直方图参数在区分肺良性及恶性孤立性实性病灶的价值。方法 本回顾性研究共纳入69例肺部孤立性实性病变患者,其中恶性56例,良性13例。所有患者术前均采用MRI、DWI(b=600 mm/s²)检查,使用OK软件获取病灶最大截面面积(2D)及体积(3D)ADC直方图特征参数值。运用ROC曲线比较两种测量方法的鉴别效能。结果 2D、3D直方图大部分参数在肺良恶性病变组间差异具有统计学意义(P＜0.05),其中以ADC 50分位数(50^th)、75分位数(75^th)、90分位数(90^th)为著(P＜0.001)。2D直方图中的ADC 75^th 及3D直方图中的ADC 50^th有较好诊断效能(AUC分别为0.891、0.894)。当3D ADC 50^th取1.41×10^-3 mm²/s时,诊断的准确性最高,敏感度为80.00%,特异度为92.86%。ADC 最大值(maximum)、ADC 25分位数(25^th)及峰度组间差异无统计学意义(P＞0.05)。结论 2D及3D ADC直方图在肺部病变鉴别有一定价值,其中以3D直方图的ADC 50^th最佳。

Objective To investigate the value of ADC histogram parameters measured by 2D and 3D ROI in distinguishing benign and malignant solitary solid pulmonary lesions (SPL). Methods A total of 69 patients with SPL were included in this retrospective study, including 56 patients with malignant disease and 13 patients with benign disease. All patients underwent preoperative MRI and DWI (b=600 mm/s²) examinations. The ADC histogram parameters of the lesion from 2D and 3D ROI were obtained by OK software. ROC curve was used to compare the discriminative efficacy of these two methods. Results Most parameters of 2D and 3D histogram showed a statistically significant difference between benign and malignant pulmonary lesions (P<0.05), especially ADC 50 quantiles (50^th), 75 quantiles (75^th) and 90 quantiles (90^th) (P<0.001). The ADC 75^th in 2D histogram and ADC 50^th in 3D histogram had better diagnostic efficiency (AUC were 0.891 and 0.894, respectively). When the ADC 50^th of 3D histogram was 1.41×10^-3 mm²/s, the accuracy of diagnosis was the highest, with a sensitivity of 80.00% and a specificity of 92.86%. There were no significant differences in ADC maximum, 25^th and kurtosis among groups (P>0.05). Conclusion Both 2D and 3D ADC histograms had a certain value in the diagnosis of SPL, and ADC 50^th of 3D histogram showed the best efficacy.

目的 探讨分析氨茶碱治疗早产儿呼吸暂停的临床疗效及其在治疗过程中所出现的不良事件。方法 选取2014年9—2016年3月广州市第一人民医院新生儿科接受住院治疗的胎龄＜34周,生后2 h内入住新生儿科的早产儿42例。随机分为对照组和氨茶碱组,对照组(20例)给予保暖、吸氧、补充能量、保持呼吸道通畅、物理刺激等对症治疗,不使用氨茶碱及其它改善呼吸的药物;氨茶碱组(22例)患儿除给予对照组治疗措施外,同时给予氨茶碱静脉滴注,首剂负荷量5 mg/kg,在20min内完成,12 h后以2～2.5 mg/kg维持量,每隔12 h一次。观察两组的疗效与不良影响。结果 ①两组患儿性别、出生胎龄、出生体重、产前孕母糖皮质激素的应用、受孕方式、分娩方式、多胎妊娠、5min Apgar评分、机械通气及CPAP辅助通气例数、低-中流量吸氧(箱内或头罩给氧)例数等方面差异均无统计学意义(P均＞0.05)。②与对照组相比,氨茶碱组早产儿呼吸暂停(AOP)发生的次数较少,AOP消失所需时间较短,差异均有统计学意义(P＜0.05)。③不良影响方面,氨茶碱组脑白质发育不良发生率(63.6%,14/22例)显著高于对照组(25%,5/20例),差异有统计学意义(P＜0.05);两组患儿在听力检查异常、喂养不耐受、血糖紊乱、血脂代谢紊乱、血红蛋白下降、电解质紊乱、出院时体重及住院时间等方面均无统计学意义(P均＞0.05)。④氨茶碱组视网膜发育不完全的发生率(40.9%,9/22例)明显高于对照组(15.0%,3/20例),但差异无统计学意义(P＞0.05)。结论 小剂量氨茶碱在防治AOP方面的作用是值得肯定的,但它有可能增加早产儿脑白质发育不良的风险与视网膜发育不完全的风险。

Objective To investigate the clinical efficacy and adverse effects of aminophylline in prevention of apnea of prematurity. Methods Forty-two infants with gestational age ＜34 weeks admitted to department of pediatrics, Guangzhou first people's hospital between Sep. 2014 and Mar. 2016 were randomly divided into 2 groups: control group and aminophylline group. Control group(n=20): 20 infants received warming, oxygen inhalation, supplement energy, maintain airway patency, physical stimulation, such as symptomatic treatment, without aminophylline or any other drugs for improving breathing. Aminophylline group(n=22): In addition to the control group treatment measures, 22 infants received a loading dose of 5 mg/kg of aminophylline and then maintained by a dose of 2mg/kg with intravenous drip q 12 h. Then we compared the efficacy and adverse effects of the two groups. Results ①There was no significant difference in gender, gestational age, birth weight, maternal antenatal glucocorticoid application, pregnancy(including multiple pregnancy) and delivery,5 min Apgar score, oxygen therapy, the application of mechanical ventilation, nasal continuous positive airway pressure, and the low-medium flow oxygen inhalation between the 2 groups(all P＞0.05). ② Compared with the control group, the incidence of apnea in aminophylline group were significant lower, and the time needed for apnea to disappear were significant shorter(all P＞0.05). ③ The incidence of cerebral white matter development dysplasia of aminophylline group(63.6%,14/22 cases) were significant higher than the control group(25%,5/20 cases, P＜0.05). There was no statistically significant difference in hearing loss, feeding intolerance, blood glucose disturbance, blood lipid metabolism disorder, hemoglobin decrease, electrolyte disorder, body weight at discharge, the duration and cost of hospitalization between the 2 groups(all P＞0.05). ④ The incidence of retinal incompleted development of aminophylline group(40.9%, 9/22 cases) were higher than control group(15.0%, 3/20 cases), but there was no statistical significance between the 2 groups(P＞0.05). Conclusion Effects of aminophylline in treating apnea of prematurity is positive, but it is likely to increase the risk of premature brain white matter development dysplasia and the risk of retinal incompleted development.

目的 评估大光斑低能量Q开关Nd:YAG激光治疗黄褐斑的疗效和安全性。方法 采用Q开关Nd∶YAG激光器以波长1064 nm,光斑6～7 mm,能量2.0～2.5 J/cm²,对黄褐斑患者进行治疗,以治疗处呈现微红为治疗终点,每月1次,治疗5次,共治疗黄褐斑36例。结果 36例患者中基本治愈8 例(22.23%),显效15例(41.67%),好转9例(25%),无效4例(11.11%),前两者之和为总有效率,达63.89%。患者耐受性好,无明显副作用。结论 大光斑低能量Q开关Nd:YAG激光为治疗黄褐斑提供了安全有效的方法。

Objective To evaluate the efficacy and security of Q-switched laser with Large Spot and Low Fluence for the treatment of melasma. Methods Thirty-six patients with melasma were enrolled in study. 1064 nm Q-switched Nd:YAG laser was used with light spot of 6-7 mm and 2.0-2.5 J/cm² in fluence.Treatments are ended when the melasma area turns slight red. Subjects were received a total of 5 treatments at one month intervals. Results Thirty-six patients completed the trial. 22.23% of patients achieved 90% to 100% clearance and 41.67% achieved 60% to 90% clearance. The total efficient rate reached 63.89% .Side effects was minimal and all the patients tolerated the treatment well. Conclusion Q-switched Nd:YAG laser with Large Spot and Low Fluence provides a safe and effective treatment method for melasma.