上海22351例无症状体检者低剂量CT肺癌筛查及随访结果初步分析

目的:分析采用低剂量CT(low-dose CT,LDCT)在无症状体检者中进行肺癌筛查的结果。方法:2015年4月至2018年4月共有22 351例无症状体检者(16～95)岁接受肺LDCT检查,根据结节有无及大小、类型分成阳性结节、半阳性结节、阴性结节组,分析不同年龄段、性别体检者LDCT肺结节和肺癌筛查结果,并分析不同类型结节在阳性、半阳性结节中的检出情况,记录随访复查过程中结节的变化。结果:肺结节总检出率为31%,男性及女性的结节检出率分别为34.1%、28.8%,差异有统计学意义(χ~2=70.47,P0.001)。不同年龄段人群的结节检出率也不同,差异有统计学意义(χ~2=1032.96,P0.001),年龄越大,结节检出率越高,81～95岁人群的结节检出率(50.0%)最高。不同性别间的阳性结节检出率不同,差异有统计学意义(χ~2=184.36,P0.001),男性群体的阳性结节检出率(10.1%)高于女性群体(8.6%)。不同年龄段的阳性结节检出率不同,年龄越大,阳性结节检出率越高,差异有统计学意义(χ~2=434.89,P0.001)。22 351例无症状体检者的总体肺癌检出率为0.4%。以手术病理为对照,基线筛查检出肺癌48例;35个月随访期内,经复查后检出肺癌47例。男性和女性的肺癌检出率分别约为0.6%和0.3%,不同性别间的肺癌检出率差异有统计学意义(χ~2=7.52,P=0.006);50岁以上人群的肺癌检出率明显高于50岁以下者(0.7%比0.1%),差异有统计学意义(χ~2=42.20,P0.001)。阳性结节组和半阳性结节组的肺癌检出率分别为4.5%和0.1%,差异有统计学意义(χ~2=207.78,P0.001)。阳性与半阳结节在不同密度类型结节中的构成比不同(χ~2=267.06,P0.001)。不同密度类型结节中恶性结节检出率不同,差异有统计学意义(χ~2=131.77,P0.001),且部分实性结节中恶性结节检出率高,达4.3%。随访期内,接受了年度复查或双年度复查的4 557例半阳性结节受检者,仅2例受检者经病理证实为早期肺癌。总的检出结节中恶性结节占比0.7%。结论:采用LDCT进行肺癌筛查对中老年人群十分重要,尤其是50岁以上人群。对于半阳性结节,年度复查是可行的;对于筛查出的肺结节,总体恶性结节的占比(0.7%)仍较低,应结合结节大小、类型和形态学特征等,制定合理的随访处理方案。     

单排螺旋CT行肺低剂量扫描的应用价值

目的探讨单排螺旋CT行肺低剂量扫描的技术可行性及其应用价值。方法从132例行肺低剂量扫描的受检者中,选择13例作为单排螺旋肺低剂量扫描(50mAs)与常规剂量扫描(170mAs)的对照对象(7例已确诊肺外恶性肿瘤肺内有多发转移结节,3例有肺内孤立结节,3例有肺内类结节斑点状病灶),对比两种扫描诊断效果,从肺内结节的数量及其细节征象和肺各叶段支气管的检出几方面比较。分析单排螺旋CT肺低剂量扫描参数及其总计毫安秒量,评价该扫描技术的可行性和安全性。结果两种扫描对肺内结节数量,大小的检出均相同,对肺内结节细节征象和肺各叶段支气管的检出无显著性差异(χ2=0.123～3.39,P>0.05)。低剂量扫描毫安秒量约为常规剂量的29%。结论单排螺旋CT肺低剂量扫描,是一种安全、有效、可行的筛查早期肺内结节病变的检查方法。     

螺旋CT肺癌普查最佳条件的研究

目的　探讨螺旋CT普查肺癌的最佳条件。方法　对 6例直径 5～ 10mm的肺结节行 4种不同条件mAs的低剂量扫描 ,并对 2 0例因咳嗽等原因行肺部CT检查成人采用全肺 2 0mAs扫描 ,结果采用 4点分级法盲法评价图像质量和肺结节显示效果。结果　 6例肺结节位于上肺野 1例、中肺野 2例和下肺野 3例。 2 0mAs可以满意显示肺各部位结节 ,而 10mAs图像于肺尖和肺底处有较多伪影 ,明显影响结节的显示 ,2 0例采用全肺 2 0mAs扫描者其图像质量均为可以。结论　 2 0mAs可作为螺旋CT低剂量扫描普查肺癌的条件     

螺旋CT在矽肺诊断中的价值

目的探讨螺旋CT在矽肺诊断中的价值。方法回顾性对比分析32例已确诊为矽肺病人的X线胸片与螺旋CT的影像表现。结果32例中20例螺旋CT显示有多发且分布密集的小矽结节（直径％10mm）,而X线胸片显示12例,两者比较差异具有显著性（χ^2=4．00,P〈0．05）;直径〉10mm的融合结节和团块CT共检出12例,X线胸片检出9例,两者比较差异具有显著性（χ^=5．27,P〈0．05）。CT检出矽肺并发肺气肿11例,X线胸片检出6例;CT检出矽肺并发肺结核5例,X线胸片检出3例;CT检出矽肺并发纵隔和肺门淋巴结大或钙化21例,X线胸片检出15例。结论螺旋CT在矽肺大小结节的显示及并发症的检出上优于X线平片,对矽肺的正确、综合诊断具有重要价值。     

胸部低剂量螺旋CT在健康人群中筛查肺结节的应用价值分析

目的：比较胸部CT常规剂量扫描与低剂量扫描在健康人群中进行肺结节筛查的价值。方法对300例健康体检者肺部CT扫描进行分析,比较常规剂量扫描与低剂量扫描筛查肺结节的图像质量、检出率和辐射剂量。结果常规剂量组、低剂量组两组图像质量评分比较,差异无统计学意义（t=1.08,P＞0.05）,均能满足诊断要求。常规剂量组150例检出肺结节22例34个,病理证实早期肺癌2例;低剂量组150例检出肺结节19例30个,病理证实早期肺癌1例,两者在检出率比较,差异无统计学意义（χ2=1.61,P＞0.05）。而辐射剂量方面,常规剂量组的剂量长度乘积、平均有效管球剂量、总管球剂量和放射容积剂量指数分别为（492.64±43.96）mGy·cm、（110.22±9.76）mAs 、（3110.36±143.34）mAs和（9.53±2.63）mGy,低剂量组分别为（153.22±18.45）mGy·cm、（42.58±3.43）mAs 、（978.45±40.87）mAs和（3.53±1.73）mGy,两组比较,差异均有统计学意义（t分别=7.78、6.52、10.44、8.16,P均＜0.05）。结论胸部低剂量螺旋CT扫描对肺结节的显示及检出与常规剂量相同,辐射剂量更小,更适合健康群体中肺结节的筛查。     

肺部低剂量CT扫描对图像质量和辐射剂量的影响

目的：探讨肺部低剂量CT(LDCT)扫描技术对图像质量和辐射剂量的影响。方法：选取2022年8月—2023年2月于铜陵市第三人民医院进行肺部CT检查的门诊患者和住院患者各50例。将门诊患者作为LDCT组,采用LDCT扫描检查(电压110 kV,电流20 mAs,careDOSE模式);将住院患者作为常规剂量组,采用常规剂量CT检查(电压130 kV,电流80 mAs,careDOSE模式),两组肺窗及纵隔窗重建方法相同。比较两种肺部CT扫描方案对图像质量和辐射剂量的影响,图像质量由2名影像学医师采用5分法进行评价,并比较二者图像质量评分的一致性,计算信号噪声比(SNR)。依据CT剂量报告比较两组剂量长度乘积(DLP)、有效辐射剂量(ED)和容积CT剂量指数(CTDI_vol)。结果：2名阅片医师对LDCT组、常规剂量组的肺部CT图像质量评分均有极好一致性(Kappa值=0.923、0.936)。组间图像质量评分比较,差异无统计学意义(Z=0.612,P=0.537);组间图像合格率、图像满意率比较,差异无统计学意义(P> 0.05);LDCT组SNR、DLP、...     

多排低剂量螺旋CT鉴别肺结节:两种重建层厚比较

目的 比较16排低剂量螺旋CT两种重建层厚对肺结节的数目、内部以及周边特征的检出情况.方法 在健康人群低剂量胸部螺旋CT检查中,对80例疑似或确诊有肺部小结节患者的图像分别进行1.25 mm与2.50 mm层厚重建,共得到160组图像,所检出结节按直径分为≤5 mm组(第1组)、5～10 mm组(第2组)、≥10 mm组(第3组),记录每组图像结节的数目、结节的边界清晰程度、边缘特征(分叶征、毛刺征)、密度(钙化、空洞).结果 两种重建层厚检测肺部结节数目差异无统计学意义,检测第1组结节的边界清晰程度、分叶征、钙化差异有统计学意义,但毛刺征、空洞差异无统计学意义,检测第2组及第3组结节的边缘特征、内部密度差异均无统计学意义.结论 在胸部低剂量螺旋CT扫描过程中,可采用2.50 mm重建层厚扫描,设定图像噪声与重建层厚1.25 mm噪声相等,以进一步减少辐射剂量.     

26151例无症状健康体检人群低剂量CT肺癌筛查结果及肺癌结节的CT影像学特征与病理学研究

目的探讨低剂量CT(LDCT)在无症状健康体检人群中早期肺癌的筛查效果,并分析肺癌结节的CT影像学特征与病理学之间的相关性。方法回顾性分析2017年1月至2019年12月期间在我院行胸部LDCT早期肺癌筛查的26 151例无症状健康人群,分析LDCT的肺癌筛查效果,并按照肺腺癌多学科分类标准将肺癌结节分为不典型增生结节(AAH)组、原位癌(AIS)组、微浸润癌(MIA)组及浸润癌(IAC)组,总结肺癌结节的CT影像学特征、病理资料,分析不同病理类型结节之间的差异。结果 26 151例LDCT早期肺癌筛查人群中,共检出肺癌患者135例,总检出率为5.16‰,男性检出率为3.87‰(52/13 449),女性检出率为6.53‰(83/12 702);检出肺癌结节数目为154个。结节分叶征、分叶类型、毛刺征、毛刺类型、空泡征、空气支气管征、胸膜凹陷及结节性质在四组间具有统计学差异(χ~2分别=52.78、6.74、38.56、5.86、13.04、17.54、23.53、56.22,P均<0.05);利用最大径、m-CT值评估结节是否为浸润性病变(含微浸润癌、浸润癌)的ROC曲线下面积分别为0.78、0.84,当结节的最大径≥10.5 mm时,提示结节为浸润性病变的特异度为88.90%,灵敏度为55.10%;当结节的m-CT值≥-548 HU时,提示结节为浸润性病变的特异度为88.90%,灵敏度为72.90%;并且m-CT值评估结节为浸润性病变的诊断效能优于结节最大径,差异具有统计学意义(χ~2=4.76,P<0.05)。结论 LDCT检查能够良好评估结节的影像学特征,可明显提高无症状体检人群早期肺癌的检出率,帮助临床制定个体化治疗方案、改善肺癌患者的预后。     

低剂量CT动态监测孤立性肺结节调查研究

目的探讨低剂量CT(LDCT)检出孤立性肺结节(SPN)的临床特点和动态变化。方法采用回顾性研究方法,收集2013年1月至2014年12月在首都医科大学附属北京友谊医院体检中心经LDCT检出年龄≥40岁的SPN患者217例。按照《2012年美国国家综合癌症网肺癌筛查指南》标准分为高危组41例、中危组83例、低危组93例,分析患者的一般资料、影像学特点和病理结果,并每年复查1次LDCT,且连续3次动态监测SPN变化。结果高危组男性比率和肺基础疾病比率最高(P<0.05),SPN直径最大(P<0.05);中危组被动吸烟者比率最高(P<0.05);低危组最年轻(P<0.05),吸烟比率最低(P<0.05)。SPN中位直径4 mm(2~23 mm);实性结节80例(36.9%),亚实性结节137例(63.1例);上叶96例(44.2%),中叶48例(22.1%),下叶73例(33.7%);伴有毛刺6例(2.8%)。截至随访时间,确诊肺癌11例。肺癌中位直径18 mm(12~32 mm),均为亚实性结节;上叶8例,中叶3例;伴有毛刺8例。11例均为I期,LDCT1时肺癌发病率为2.8%,LDCT2时肺癌发病率为1.4%,LDCT3时肺癌发病率为1.0%,发病率差异无统计学意义(P>0.05)。结论LDCT监测肺结节有助于肺癌患者获得早期诊断、及时处理从而改善预后,但是不会降低或杜绝肺癌的发生。SPN的大小和特征信息对于结节良恶性的判断有着重要的意义。     

经胸超声心动图对无支架生物主动脉瓣功能特点的评估

目的　应用经胸超声心动图 (TTE)评估无支架生物主动脉瓣功能特点 ,指导临床术后心功能恢复用药 ,观察其远期效果。方法　随机对无支架生物主动脉瓣及有支架生物主动脉瓣置换术患者各 8例于术前及术后 4周进行超声心动图检查。结果　无支架组和有支架组患者术前TTE各项指标测值差异无显著性意义 ,术后的各项指标测值差异有显著性意义。两组的主动瓣跨瓣压差分别为 ( 2 .33± 0 .6 7)kPa和 ( 4 .40± 1.18)kPa( P =0 .0 5 ) ;左室舒张末期内径分别为 ( 4 3.6± 3.1)mm和 ( 5 0 .9± 9.4)mm ( P =0 .0 35 ) ;左室射血分数分别为( 6 7.3± 7.3) %和 ( 5 5 .4± 12 .6 ) % ( P =0 .0 3) ;瓣环内径分别为 ( 2 1.0± 1.9)mm和 ( 17.1± 1.8)mm ( P =0 .0 1)。结论　TTE显示无支架生物主动脉瓣较有支架生物主动脉瓣更符合人体半月瓣及血流动力学。     

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.     

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.     

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.     

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.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

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."