弹性定量参数对触诊阴性乳腺病灶的诊断价值

目的探讨弹性定量参数应变率(SR)比值、直径变化率及面积比对临床触诊阴性乳腺病灶(non-palpable breast lesions,NPBL)的诊断价值。方法选取150例经超声检查和手术病理证实的NPBL患者,根据术后病理结果分为良性病灶组(A组,n=110)和恶性病灶组(B组,n=40),比较两组SR比值、直径变化率及面积比。应用ROC曲线分析SR比值、直径变化率、面积比及其联合诊断乳腺恶性病灶的ROC曲线下面积、临界值、敏感性及特异性,并对其进行比较。结果 B组SR比值(6.04±2.53)显著高于A组(2.86±1.51),差异有统计学意义(t=5.031,P=0.000),常规超声与弹性成像测得A组病灶的直径和面积差异均无统计学意义,而弹性成像测得B组病灶的直径与面积均显著高于常规超声测值,差异均有统计学意义(P=0.000、0.016)。B组病灶的直径变化率显著高于A组(P=0.000),面积比亦显著高于A组(P=0.025)。应用SR比值、直径变化率及面积比联合诊断乳腺恶性病灶的敏感性为77.5%,特异性为94.5%,曲线下面积为0.937,高于SR比值、直径变化率及面积比单独诊断的效能。结论弹性定量参数SR比值、直径变化率及面积比在NPBL良恶性鉴别中均有效,而其联合诊断能够显著提高对乳腺病灶良恶性的鉴别能力。     

实时组织超声弹性成像组织弥散定量分析技术对肝外梗阻性黄疸的定量化研究

目的探讨弹性定量参数在梗阻性黄疸(obstructive jaundice,OJ)中的诊断价值。方法回顾性分析2014年1月-2015年6月于我院诊断为梗阻性黄疸的患者90例,依据血总胆红素水平将患者分别分为梗阻重中轻组(A、B、C三组)同时选取无临床黄疸的对照组30例为D组。分别比较并分析有无黄疸两组、ABCD四组％AREA、MEAN。应用受试者操作特性曲线(receiver operator characteristic curve,ROC)曲线分析％AREA、MEAN鉴别黄疸、轻度黄疸、中重度黄疸的ROC曲线下面积(Area Under Curve,AUC)、最佳界值、敏感度和特异度。应用Pearson相关性分析,评估％AREA、MEAN水平与总胆红素相关性。结果黄疸组％AREA水平(45.09±2.38)显著高于非黄疸组(43.04±1.86),差异有统计学意义(t=8.74;P=0.000);根据有无黄疸两组%AREA水平制作ROC曲线,AUC为0.729,以44.44作为最佳界值,诊断黄疸的敏感度为58.9％,特异度为83.7％。同时黄疸组MEAN水平(78.43±3.53)显著低于非黄疸组(84.75±3.53),差异有统计学意义(t=-8.56;P=0.000)。根据有无黄疸两组MEAN水平制作ROC曲线,AUC为0.889,以81.04作为最佳界值,诊断黄疸的敏感度为83.3％,特异度为78.9％。四组间两两比较显示,A、B组的％AREA与MEAN水平差异无统计学意义;其他各组比较,胆红素水平越高,％AREA水平越高,而MEAN水平越低。经Pearson相关性分析,％AREA水平与总胆红素水平呈显著正相关;MEAN水平与总胆红素水平呈显著负相关。其中根据C、D两组%AREA水平制作ROC曲线,AUC为0.811,以43.54作为最佳界值,诊断轻度黄疸的敏感度为65％,特异度为86.7％。根据A、B组均值及C组%AREA水平制作ROC曲线,AUC为0.879,以47.21作为最佳界值,鉴别轻度与中重度黄疸的敏感度为68％,特异度为92.5％。根据D、C两组MEAN水平制作ROC曲线,AUC为0.750,以83.07作为最佳界值,诊断轻度黄疸的敏感度为53.3％,特异度为90％。根据A、B组均值及C组MEAN水平制作ROC曲线,AUC为0.791,以79.95作为最佳界值,鉴别轻度与中重度黄疸的敏感度为65％,特异度为98％。结论通过两种弹性定量参数初步能够诊断梗阻性黄疸,并评估患者梗阻程度。     

不同超声弹性定量参数鉴别诊断乳腺肿块的对比研究

目的 探讨不同超声弹性定量参数鉴别诊断乳腺肿块(BM)的价值。方法 选择2013年8月至2014年6月收治的111例(共150个病灶)BM患者,均行超声弹性成像检查(UE),且经穿刺或手术活检明确病理性质,并构建受试者工作特征曲线(ROC),比较弹性评分、面积比(A2/A1)、应变率比值(SR)对于BM良恶性的鉴别诊断价值。结果 (1)临床资料:150个病灶中,良性病灶90个,恶性病灶60个。(2)弹性评分:对于BM良恶性诊断,弹性评分的敏感性、特异性、准确性分别为95.0%、81.1%、86.7%。构建ROC曲线后显示,其曲线下面积(AUC)、诊断临界值分别为0.925、3.5。(3)A2/A1:较之良性肿块,恶性肿瘤的A2/A1明显大,差异有统计学意义(P<0.05)。构建ROC曲线后显示,其AUC、诊断临界值分别为0.896、1.2,敏感性、特异性、准确性分别为91.7%、80.0%、84.7%。(4)应变率比值(SR):较之良性肿块,恶性肿瘤的SR均明显大,差异有统计学意义(P<0.05)。构建ROC曲线后显示,SR的AUC、诊断临界值分别为0.803、2.4,敏感性、特异性、准确性分别为63.3%、84.4%、76.0%。(5)各弹性参数比较:对于BM的鉴别诊断,以弹性评分的价值最高,其次为A2/A1,而SR的鉴别诊断价值较前两者要低。结论 对于BM良恶性鉴别诊断,各弹性定量参数均有一定诊断价值,其中弹性评分、A2/A1的鉴别诊断价值较高。     

超声弹性应变率比值在肝脏局灶性病变诊断中的初步应用

目的 探讨超声弹性应变率比值(strain ratio,SR)对肝脏局灶性病变的鉴别诊断价值.方法 应用实时超声弹性成像技术对91个肝局灶性病变行弹性成像检查,测量病灶组织与周围肝脏组织的SR,通过受试者工作特征(receiver operating characteristic,ROC)曲线获取鉴别良恶性病灶的最佳诊断界点,以病理结果或临床诊断作为标准,评估其诊断价值.结果 良性病灶25个,SR范围为0.44～7.01,中位SR为1.75;恶性病灶66个,SR范围为2.17～52.33,中位SR为6.79.良性病灶组的SR显著低于恶性病灶组的SR,两者的差异有统计学意义(P＜0.05).通过ROC曲线确定的最佳诊断界点为3.47,曲线下面积为0.943,其敏感性、特异性、准确性、阳性预测值和阴性预测值分别为87.9％、88.0％、87.9％、95.1％、73.3％.结论 超声弹性应变率比值可用于肝脏良恶性病灶的鉴别,为肝脏局灶性病变的超声诊断提供了一项新的方法.     

周围组织与乳腺病灶的应变比值对乳腺良恶性病变的诊断价值

目的探讨周围组织与乳腺病灶的应变比值(SR)对乳腺良恶性病变的诊断价值。方法选择2010年10月至2011年4月我院乳腺病变患者98例,全部病例均经病理证实,其中良性38例,恶性60例。采用超声弹性成像技术测量周围组织与乳腺病灶的SR,比较良性与恶性乳腺病灶间SR的差异,应用受试者工作特性曲线(ROC)评价SR诊断乳腺良恶性病变的价值。结果 38例良性乳腺病灶及60例恶性乳腺病灶的SR值分别为2.79±1.33及6.95±3.01,差异有统计学意义(t=9.359,P=0.000)。应用ROC曲线评价SR诊断乳腺恶性病变的曲线下面积为0.957,取SR阈值为3.51时,敏感度、特异度、准确性、阳性预测值及阴性预测值分别为90.0%、92.1%、90.8%、94.7%及85.4%。结论超声弹性参数SR对乳腺良恶性病变的鉴别有较好的应用价值。     

超声实时弹性成像整体应变率与局部应变率诊断乳腺病灶的比较

目的 比较超声实时弹性成像整体应变率(ESR)、局部应变率(LSR)对乳腺良恶性病灶的诊断价值。 方法 对113例患者共145个乳腺病灶(良性组:85个,恶性组:60个)分别行LSR、ESR两种应变率测量。以病理诊断为金标准,构建ROC曲线,分别获得两种方法鉴别乳腺病灶良恶性的最佳临界点,比较其诊断效率。 结果 构建ROC曲线后,ESR ROC曲线下面积(AUC)为0.90±0.03,最佳临界点为3.16,其敏感度、特异度、准确率分别为88.33%(53/60)、88.24%(75/85)、88.28%(128/145)。LSR的AUC为0.97±0.02,最佳临界点为31.15,其敏感度、特异度、准确率分别为96.67%(58/60)、94.12%(80/85)、95.17%(138/145)。LSR对乳腺病灶良恶性的诊断价值及准确率均优于ESR(P＜0.05)。 结论 ESR和LSR对乳腺病灶良恶性的鉴别诊断具有较大价值,LSR优于ESR。     

经直肠超声弹性成像在前列腺良恶性病变中的预测价值

目的 探讨经直肠超声弹性成像(TRTE)技术在预测前列腺良恶性病变中的应用价值.方法 回顾性分析在TRTE引导下穿刺活检并经病理证实的43例患者,共68个病灶(良性36个,恶性32个),绘制超声弹性成像应变率比值(SR)法对恶性结局的受试者工作特征(ROC)曲线并找出最佳诊断界点;以病理结果为金标准,比较TRTE、前列腺特异性抗原检测(PSA)及MRI 3种方法检出效率的差异性.结果 针对SR构建的ROC曲线确定的最佳诊断界点为2.900,其曲线下面积为0.937;综合弹性分级及SR 2种方法,TRTE预测前列腺良恶性病变的灵敏度、特异度分别为84.38％、83.33％;TRTE诊断前列腺良恶性病灶的符合率高于PSA检查(x2 =8.526 3,P=0.003 5),与MRI比较却无明显差异(x2=0.037 0,P=0.847 4).结论 TRTE经济、易行,其中的弹性分级法和SR法与经直肠超声(TRUS)结合使用,可作为鉴别前列腺良恶性病变的首选检查方法;在TRTE引导下靶向穿刺可提高活检准确率.     

超声弹性应变率比值法（SR）在乳腺微小非肿块实质性病灶良恶性鉴别中的应用研究

目的:探讨超声弹性应变率比值(strain ratio,SR)法在鉴别良恶性微小非肿块实质性乳腺癌病灶中的应用价值。方法:选取2019年10月—2022年5月湖州市南浔区人民医院的113例经病理学检查(金标准)确诊的乳腺微小(≤1cm)非肿块实质性病灶患者为研究对象,依据病理结果将患者分别列入良性组和恶性组,两组均行超声弹性成像检查,测定病灶部位与周围组织区域之间应变率的比值,并采用ROC曲线检测其诊断效能。结果:113例患者中良性病灶患者82例,恶性31例,SR法鉴别准确率为85.84%(97/113),灵敏度87.80%(72/82),特异度80.65%(25/31),阳性预测值92.31%(72/78),阴性预测值71.43%(25/35),SR法鉴别结果与病理检查结果相比,差异无统计学意义(χ²=0.563,P=0.453>0.05),Kappa值0.658;乳腺微小非肿块实质性恶性病灶超声成像SR值显著高于良性病灶(P<0.01);ROC曲线显示,超声弹性成像SR值鉴别的最佳截断值为2.930,灵敏度76.80%,特异度91.80%,最大约登...     

超声造影与弹性成像联合评分对乳腺BI-RADS 4类病灶的应用价值

目的探讨超声造影（CEUS）与实时组织弹性成像（UE）联合评分对乳腺超声影像报告和数据系统（BI-RADS）诊断为4类的乳腺病灶的良恶性鉴别诊断价值。 方法选取2012年4月至2016年2月在浙江大学医学院附属第二医院常规超声检查且诊断为BI-RADS 4类的158例患者共172个乳腺病灶行CEUS及UE检查,分别对每个病灶进行赋值评分,以穿刺或手术病理为金标准,构建ROC曲线,分析CEUS和UE联合评分法对BI-RADS 4类病灶的良恶性鉴别诊断价值。 结果172个病灶中,病理学诊断良性80个,恶性92个,单独应用CEUS评分法分析乳腺BI-RADS 4类病灶的ROC曲线下面积（AUC）、敏感度、特异度、准确性分别为0.894、84.78%、85.00%、84.88%;单独应用UE评分法分析乳腺BI-RADS 4类病灶的ROC曲线下面积（AUC）、敏感度、特异度、准确性分别为0.844、82.61%、82.50%、82.56%。把造影和弹性评分法联合,以7分为诊断界点（AUC为0.951）,其敏感度、特异度、准确性为94.57%、93.75%、94.19%,均高于单独评分法（P<0.05）。 结论应用超声造影及弹性成像联合评分法能够明显提高乳腺BI-RADS 4类病灶的诊断准确率,可作为BI-RADS分类的补充,减少不必要的术前活检,值得临床推广应用。     

加速时间指数及弹性应变率比值鉴别诊断乳腺良恶性肿瘤的价值

目的探讨加速时间指数(ATI)及弹性应变率比值(SR)鉴别诊断乳腺良恶性肿瘤的应用价值。方法回顾性分析120例乳腺肿瘤患者的临床资料,根据病理结果分为良性组76例(98个病灶)和恶性组44例(57个病灶),均行常规超声和超声弹性成像检查,计算并比较两组二维超声图像特征、ATI及SR值。绘制受试者工作特征(ROC)曲线分析ATI、SR值及其联合鉴别诊断乳腺恶性肿瘤的价值,计算曲线下面积(AUC)。结果良、恶性组二维超声图像特征(病灶形态、长轴方向、回声强度、内部回声是否均匀、边界情况、钙化程度、后方回声强度)比较,差异均有统计学意义(均P<0.05);恶性组ATI、SR值均高于良性组(0.18±0.05 vs.0.11±0.03,3.05±0.65 vs.2.33±0.41),差异均有统计学意义(均P<0.05)。ROC曲线分析显示,ATI、SR值鉴别诊断乳腺恶性肿瘤的AUC分别为0.842、0.813,且联合应用的AUC(0.906)高于其单独应用(均P<0.05)。结论ATI、SR值均能准确鉴别乳腺良、恶性肿瘤,两者联合应用价值更高。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."