腹部CT检查发现的939例肾上腺病变患者的临床分析

目的探讨腹部CT检查发现的肾上腺病变的检出率、病因构成、临床特点及诊治现状。方法回顾性分析2014年7月~2015年6月于南方医科大学南方医院影像中心行腹部CT检查报告提示肾上腺有异常改变的门诊和住院患者的病历资料,包括患者性别、年龄、影像特征、生化检验、临床诊断、治疗方式、术后病理、发现病变的原因等。结果(1)本院1年内行腹部CT检查的患者共19 004例,检查提示存在肾上腺病变的患者共939例,检出率为4.9%。其中男性560例(59.6%),女性379例(40.4%),平均就诊年龄为53.2岁。肾上腺占位在总体肾上腺病变中所占比例随年龄递增呈有上升趋势。行内分泌功能评估的患者有270例(28.8%),无功能性病变占38.9%,功能性病变中原发性醛固酮增多症比例最高,占16.3%;库欣综合征和亚临床库欣综合征各占4.1%和7.0%;嗜铬细胞瘤占7.0%。(2)共发现肾上腺意外瘤191例,检出率为1.0%,其中良性腺瘤占70.3%,肾上腺皮质癌和肾上腺转移癌的比例分别为2.4%和0.5%。只有76例(39.8%)患者进行了内分泌功能评估,其中无功能瘤34例,占44.7%;功能性病变以嗜铬细胞瘤最常见,占22.4%,而原发性醛固酮增多症和亚临床库欣综合征各占9.2%和6.6%。结论我院所有腹部CT检查中肾上腺病变的检出率达4.9%,肾上腺意外瘤的检出率1.0%。虽然大多数肾上腺病变为良性无功能病变,但仍有部分具有内分泌功能或为恶性病变。临床上约有60%的肾上腺意外瘤患者未进行内分泌功能的评估,功能亢进的病变极易被漏诊。临床医生需要进一步提高对肾上腺意外瘤的认识并规范其诊疗流程。

Empirical Analysis on Rural Financial Development and Farmers' Income Increase in China

The growth of farmer＇s incomes is cIoseIy reIated to rural finance. The research analyzed the dynamic reIationship of rural financial deveIopment, efficiency and farmer＇s incomes based on VAR modeI, and the resuIts indicated that the ex-pansion of rural finance wouId stimuIate farmer＇s incomes in a Iong term, and the growth of rural financial efficiency significantIy improves farmer＇s incomes in a short term, instead of a Iong term. Hence, it is necessary to introduce more credit funds and social funds to rural areas, deepen rural financial system reform and acceIerate use rate of Ioan capital and enhance guidance for farmers and township enterprises in use of Ioan capitals.

垂体性Cushing病的再手术

目的 探讨再手术的垂体性Cushing病手术适应证及手术技巧.方法 回顾分析再次手术的垂体性Cushing病16例（初次手术后不缓解8例、复发的8例）,再次手术前内分泌评估仍然是垂体性Cushing病;均采用经蝶窦手术,术中鞍底广泛暴露、鞍内探查广泛,有肿瘤者选择性肿瘤切除,同时肿瘤周边垂体低功率电凝电灼;没有明显肿瘤者,在原有肿瘤侧半垂体切除;若原有病理提示垂体增生或正常垂体,做次全（全）垂体切除.结果 术后缓解11例（69％）,不缓解与复发患者、再手术前垂体MRI是否发现肿瘤之间的缓解率差异无统计学意义（P＞0.05）.结论 复发（不缓解）垂体性Cushing病再手术前的内分泌评估很重要,再次手术是治疗的选择,但建议治疗在拥有完善内分泌诊断条件和丰富垂体腺瘤手术治疗经验的垂体中心治疗.

Assessment of Land Comprehensive Carrying Capacity in Lin'an City

According to regional characteristics and the actual situation in Lin ’an City, an evaluation index system of land comprehensive carrying capacity composed of three support subsystems （eco-environment, social and economic carrying capaci-ties） containing 22 evaluation indexes was established to evaluate the comprehen-sive carrying capacity of land resource in Lin’an City during 2005-2012. Meanwhile, based on the target data of overal land use plan, the level of land comprehensive carrying capacity was predicted at the end of the plan period （2020） .The results showed that land comprehensive carrying capacity had a significant growth in Lin ’an from 2005 to 2012, and the development trend was basical y sustainable. The sub-systems also had been greatly improved, in which the constant improvement of ec-ological environment carrying capacity made the largest contribution to the constant raising of land comprehensive carrying capacity. The degree of coordination between the systems was poor, in which eco-environment carrying capacity had the maxi-mum growth, far more than the social and economic carrying capacities. According to the land comprehensive carrying capacity in 2020, utilization of land resources in Lin＆#39;an city can achieve sustainable development in general. Final y, proposals of im-proving comprehensive carrying capacity were put forward in terms of the enhance-ment of eco-environment protection, accelerating economic development and policy guidance.

A novel image encryption scheme based on Keplers third law and random Hadamard transform

In this paper, a novel image encryption scheme based on Keplers third law and random Hadamard transform is proposed to ensure the security of a digital image. First, a set of Kepler periodic sequences is generated to permutate image data, which is characteristic of the plain-image and the Keplers third law. Then, a random Hadamard matrix is constructed by combining the standard Hadamard matrix with the hyper-Chen chaotic system, which is used to further scramble the image coefficients when the image is transformed through random Hadamard transform. In the end, the permuted image presents interweaving diffusion based on two special matrices, which are constructed by Kepler periodic sequence and chaos system. The experimental results and performance analysis show that the proposed encrypted scheme is highly sensitive to the plain-image and external keys, and has a high security and speed, which are very suitable for secure real-time communication of image data.

Improvement of the thermoelectric efficiency of pyrene-based molecular junction with doping engineering

In this study, the thermoelectric properties of pyrene molecule doped with boron and nitrogen atom at different sites of molecule are investigated using density functional theory and none-equilibrium Greens function formalism in the linear response regime. Our calculations show that when the impurities are added to the edge of the molecule, the anti-resonant peaks will appear in the transmission diagram in the vicinity of the Fermi energy level. So it increases the thermoelectric figure of merit of the system in comparison with the one that the impurity is located in the center of molecule. Additionally, the seebeck coefficient signs are not the same among the B, N, and N ＆ B doped devices, indicating that the types of the carriers can be changed with different types of doping.

双侧孤立性肾上腺肿瘤引起的库欣综合征的临床诊治分析

目的评估单侧肾上腺肿瘤切除加同侧肾上腺大部切除术对于治疗双侧孤立性肾上腺肿瘤所致库欣综合征的效果,并探讨其治疗原则。方法2007年至2013年,共有10例患者被诊断为双侧孤立性肾上腺肿瘤引起的库欣综合征。对比分析患者术前和术后的临床症状、激素水平、生化和代谢参数以及影像数据的变化。5例患者根据双侧肾上腺静脉采血的结果,选择优势分泌侧进行手术切除。5例患者根据计算机断层扫描结果直接选择直径大者进行切除手术。结果单侧肾上腺肿瘤切除加同侧肾上腺大部切除术术后,24 h尿皮质醇显著降低（P〈0.05）,午夜血皮质醇水平显著降低（P〈0.01）。血促肾上腺皮质激素水平显著增加（P〈0.01）。9例患者不再需要接受对侧手术,1例患者因为库欣综合征症状未得到缓解而在5个月后接受了对侧肾上腺肿瘤切除术。结论单侧肾上腺肿瘤切除加同侧肾上腺大部切除术对于治疗由双侧孤立性肾上腺肿瘤所致库欣综合征是一个有效且安全的方法。