食管癌~(18)F-FDG PET/CT显像SUV_(max)的临床研究

目的:探讨食管癌~(18)F-FDG PET/CT显像最大标准摄取值(maximum standardized uptake value,SUV_(max))的临床意义。方法:回顾性分析60例食管癌患者PET/CT显像数据,研究食管癌原发病灶SUV_(max)与病灶大小(横径和长度)的相关性、不同长度原发病灶之间SUV_(max)的差异及原发病灶SUV_(max)与淋巴结转移和远处转移的相关性。结果:60例患者食管鳞癌病灶SUV_(max)与病灶的横径、长度相关性差异有统计学意义(r=0.495,P=0.000;r=0.420,P=0.001)。不同长度病灶间SUV_(max)比较,3.0 cm与3.0～5.0 cm病灶之间差异有统计学意义(t=-2.860,P=0.007),3.0 cm与5.0 cm病灶之间差异有统计学意义(t=-3.036,P=0.005),但3.0～5.0 cm与5.0 cm病灶之间差异无统计学意义(t=-1.164,P=0.251)。SUV_(max)与淋巴结转移和远处转移无相关性(F=1.256,P=0.293)。结论:食管癌SUV_(max)对评价肿瘤原发病灶的大小具有重要价值,但SUV_(max)无法预测是否有淋巴结转移和远处转移。     

治疗前~(18)F-FDG PET/CT在成人伯基特淋巴瘤诊断、分期及预后评价中的应用

目的:探讨治疗前~(18)F-FDG PET/CT在成人伯基特淋巴瘤(Burkitt's lymphoma,BL)的病灶检测、临床分期及预后评价中的价值。方法:回顾性分析2008年12月至2015年2在我院经病理确诊的18例成人BL患者的临床资料及治疗前~(18)F-FDG PET/CT显像资料,观察病灶的分布特点,测量病灶的最大标准摄取值(SUV_(max))及受累淋巴结的最大径。采用单因素方差分析对各组SUV_(max)进行比较;淋巴结大小与SUV_(max)的相关性采用Spearman相关性检验;采用Kaplan-Meier法对患者的预后进行生存分析。结果:18例患者治疗前~(18)F-FDG PET/CT显像均阳性,均可见淋巴结侵犯,其中最常累及的部位为腹腔淋巴结(9例,50%);结外软组织侵犯8例,胃肠道最常见(6/8,75%);7例患者可见骨髓浸润,其中表现为多发局灶型4例(4/7,57.1%)。淋巴结、结外软组织及骨髓病灶的SUV_(max)分别为11.7(3.4-28.5)、9.85(6.7-21.9)和11.8(5.6-23.8),3者差异无统计学意义(F=1.013,P=0.369)。2例(2/8,11.1%)患者的临床分期因PET/CT而发生改变,均为上调。单因素分析结果显示,仅有国际预后指数(international prognostic index,IPI)与患者的预后相关(χ2=6.602,P=0.010),而所有病灶及受累淋巴结的SUV_(max)低者与高者的预后均无统计学差异(P0.05)。结论:成人BL病灶呈~(18)F-FDG高摄取,在其病灶检测及分期方面PET/CT显像具有优势,但在治疗前~(18)F-FDG PET/CT预测预后的价值不明确,目前尚不能通过其来判断患者的预后。     

前列腺癌骨转移~(18)F-脱氧葡萄糖PET/CT代谢参数与肿瘤标志物的相关性研究

目的:研究前列腺癌骨转移~(18)F-脱氧葡萄糖(~(18)F-fluorodeoxyglucose,~(18)F-FDG)PET/CT代谢参数与血清肿瘤标志物的相关性。方法:回顾性分析2012年1月—2014年12月于山东大学附属山东省肿瘤医院入院1周内行~(18)F-FDG PET/CT检查的48例前列腺癌患者的资料,通过~(18)F-FDG PET/CT图像获得病灶数量、最大标准摄取值(maximum standardized uptake value,SUV_(max))、平均SUV(mean SUV,SUV_(mean))、肿瘤代谢体积(metabolic tumor volume,MTV)和总病灶糖酵解值(total lesion glycolysis,TLG),并与患者同期血清肿瘤标志物总前列腺特异性抗原(total prostate-specific antigen,t PSA)、游离前列腺特异性抗原(free prostate-specific antigen,f PSA)和碱性磷酸酶(alkaline phosphatase,ALP)进行相关性分析。结果:对于发生骨转移的前列腺癌患者,骨转移灶数量为8个是预测前列腺癌患者总生存期(overall survival,OS)的最佳界值点,并以此将患者分为无骨转移组、局限性骨转移组(1~8个)和弥漫性骨转移组(8个)。除局限性骨转移组与无骨转移组间ALP水平差异无统计学意义外,各组间t PSA、fPSA和ALP水平差异均有统计学意义。骨转移灶的数量与患者同期tPSA、fPSA和ALP水平均呈正相关(r=0.604,P=0.02;r=0.531,P=0.03;r=0.478,P=0.018)。除前列腺癌骨转移灶SUV_(max)与同期ALP水平,以及SUV_(mean)与同期fPSA、ALP水平相关关系不显著外,其余均有相关性。结论:前列腺癌患者骨转移灶数量为8个是预测前列腺癌患者OS的最佳界值点;tPSA、fPSA和ALP均可作为评价前列腺癌弥漫性骨转移的临床血生化指标;∑_(MTV)和∑_(TLG)联合同期tPSA、fPSA和ALP水平在评价前列腺癌患者骨转移程度方面优于SUV_(max)和SUV_(mean);∑_(TLG)可用于评价前列腺癌患者的预后。     

缺氧诱导因子-1α和Ki-67在乳腺浸润性导管癌中的表达及其与肿瘤微血管密度的关系

目的:探讨缺氧诱导因子-1α(hypoxia-inducible factor 1α,HIF-1α)和Ki-67在乳腺浸润性导管癌(invasive ductal carcinoma,IDC)中的表达及其与肿瘤微血管密度(microvessel density,MVD)的关系。方法:将82例乳腺IDC按照组织学分级分为I级组(n=11)、II级组(n=40)、III级组(n=31);按照肿块大小分为φ1组(φmax≤2 cm,n=18)、φ2组(2 cmφmax≤5 cm,n=50)、φ3组(φmax5 cm,n=14);以及根据有无淋巴结转移分为有淋巴结转移组(n=50)、无淋巴结转移组(n=32),并随机选取同期乳腺纤维腺瘤20例作为对照组。用免疫组织化学SP法检测各分组肿瘤组织中HIF-1α,Ki-67和CD34的表达。结果:组织学分级各分组中,I级、II级与III级各分组间HIF-1α,Ki-67表达和MVD分布差异均有统计学意义(P0.05或P0.01)。肿块大小各分组中,φ1,φ2与φ3各分组间HIF-1α表达和MVD分布差异均有统计学意义(P0.05或P0.01),但Ki-67在不同肿块大小的各分组中的差异无统计学意义(P0.05)。有无淋巴结转移的两组间HIF-1α,Ki-67表达和MVD分布差异均有统计学意义(均P0.01)。82例乳腺IDC中HIF-1α和Ki-67的总阳性率分别为75.6%和73.2%,MVD均值为(78.1±19.7)个/HP,与对照组相比较差异均有统计学意义(均P0.01)。乳腺IDC中,HIF-1α(r=0.817,P0.01),Ki-67(r=0.656,P0.05)与MVD均呈正相关,HIF-1α与Ki-67也呈正相关(r=0.743,P0.05)。结论:HIF-1α,Ki-67及MVD与乳腺IDC组织学分级、肿块大小(其中Ki-67与肿块大小无相关性)和有无淋巴结转移密切相关;抑制HIF-1α的表达和/或抑制血管的生成可能在一定程度上减缓肿瘤细胞的分裂和血管转移。     

肺癌患者Ki-67阳性表达与~(18)F-脱氧葡萄糖PET/CT最大标准摄入值的关系

目的探讨肺癌患者Ki-67阳性表达情况及与~(18)F-脱氧葡萄糖(fluorodeoxyglucose,FDG)PET/CT扫描最大标准摄入值(standardized uptake value,SUVmax)的关系。方法肺癌患者353例,其中肺鳞癌69例,肺腺癌202例,小细胞肺癌82例,取手术切除肺癌组织标本,采用免疫组织化学法检测Ki-67表达,比较Ki-67阳性表达率;均于术前行~(18)F-FDG PET/CT扫描,测量SUVmax;Spearman秩相关分析Ki-67阳性表达与SUVmax值的相关性。结果小细胞肺癌、肺鳞癌、肺腺癌Ki-67阳性表达率呈下降趋势(98.78%、92.75%、79.70%)(P0.05),肺鳞癌SUVmax值(13.51±6.65)高于肺腺癌(10.19±5.2)、小细胞肺癌(10.72±5.46)(P0.05),肺腺癌与小细胞肺癌比较差异无统计学意义(P0.05);Spearman秩相关分析结果显示,腺癌Ki-67阳性表达与SUVmax呈正相关(r=0.251,P0.001),鳞癌、小细胞肺癌Ki-67阳性表达与SUVmax无相关性(r=-0.045,P=0.712;r=-0.031,P=0.784)。结论肺腺癌患者~(18)F-FDG PET/CT扫描SUVmax值可反映肿瘤细胞的增殖状态。     

成人Still病的~(18)F-FDG PET/CT表现特点

目的总结成人Still病(AOSD)~(18)F-脱氧葡萄糖(FDG) PET/CT的成像特征,并与淋巴瘤比较,从而提高~(18)FFDG PET/CT在本病诊断及鉴别诊断中的价值。方法回顾性分析我院9例临床确诊为AOSD的患者,总结AOSD的主要~(18)F-FDG PET/CT表现特点,并分析主要受累部位最大标准化摄取值(SUV_(max))与主要实验室指标的相关性。比较淋巴瘤与AOSD在PET/CT上的表现异同;并采用受试者工作特征曲线(ROC)明确部分PET/CT特征诊断AOSD与淋巴瘤的效能及最佳临界点。结果 AOSD在PET/CT上主要表现为骨髓(8/9,88.9%)、脾脏(8/9,88.9%)、淋巴结(9/9,100%)FDG摄取增高,还可见关节(3/9,33.3%)、颌下腺(2/9,22.2%)和肌肉(1/9,11.1%)FDG摄取增高;同次CT可见脾大(5/9,55.6%),胸腔、盆腔及心包积液(2/9,22.2%);相关性分析表明骨髓、脾脏、淋巴结SUV_(max)与主要实验室指标无显著相关性(P0.05),但受累淋巴结SUV_(max)与淋巴结最大短径之间呈正相关(r=0.670,P=0.048)。与淋巴瘤相比,AOSD患者受累淋巴结最大短经明显较小(P0.05),受累淋巴结SUV_(max)显著较低(P0.05)。ROC曲线分析AOSD与淋巴瘤组受累淋巴结最大短经及淋巴结SUV_(max)结果:曲线下面积(AUC)分别为0.708、0.773,鉴别两组的最佳临界点分别为19、12。结论 PET/CT在AOSD的器官受累、疾病分布情况、诊断及鉴别诊断等方面提供了丰富的影像学依据。     

超声造影肝脏影像数据和报告系统分类与肝细胞癌分化程度及Ki-67指数的相关性分析

目的探讨不同超声造影(CEUS)肝脏影像数据和报告系统(LI-RADS)类别与肝细胞癌(HCC)分化程度及Ki-67指数相关性。方法采用回顾性病例研究, 纳入分析中国CEUS数据库中2017年12月至2020年12月共208例HCC患者(208个病灶)的临床和影像学资料, 根据美国放射学会提出的CEUS LI-RADS(V2017)对病灶分类。以组织病理学诊断结果为金标准, 评估HCC的分化程度及Ki-67指数在CEUS LI-RADS不同类别中分布是否存在差异, 并采用Kendall′s tau-b相关系数检验分析CEUS LI-RADS类别与肿瘤分化程度及Ki-67指数的相关性。结果不同CEUS LI-RADS类别的HCC之间分化程度及Ki-67指数的分布差异有统计学意义(P<0.001, P=0.009), CEUS LI-RADS M类HCC更容易呈低分化且表现出更高的Ki-67指数。CEUS LI-RADS类别与肿瘤分化程度呈负相关(tau-b=-0.250, P<0.001), 与Ki-67指数呈正相关(tau-b=0.178, P=0.002), 即CEUS ...     

18F-FDG PET/CT鉴别诊断心包良、恶性病变

目的 探讨~(18)F-FDG PET/CT鉴别诊断心包良、恶性病变的可行性及诊断价值.方法 收集16例心包病变患者的~(18)F-FDG PET/CT资料,其中恶性9例,良性7例.测得病灶SUV_(max)值,并观察病灶内部密度及与周围组织关系.对病变或心包穿刺液行病理学检查,确定良恶性.结果 恶性病变及良性病变SUV_(max)分别为10.1±6.0、3.0±2.1(P<0.01).以病灶SUV_(max)值3.5～4.5作为鉴别心包病变良恶性的阈值,判断心包病变的灵敏度为100%、特异度为85.71%、准确率为93.75%、阳性预测值为90.00%、阴性预测值为100%.结论 ~(18)F-FDG PET/CT可较准确地鉴别诊断心包病变的良、恶性.     

^(18)F-FDG与^(68)Ga-FAPI PET/CT诊断分化型甲状腺癌甲状腺全切术后转移北大核心CSCD

目的对比^(18)F-FDG与^(68)Ga-FAPI PET/CT诊断分化型甲状腺癌(DTC)甲状腺全切术后转移的价值。方法前瞻性纳入35例甲状腺全切术后DTC转移患者、共101处转移灶,包括淋巴结转移39处、骨转移30处、肺转移30处、脑转移及肝转移各1处;先后行^(18)F-FDG及^(68)Ga-FAPI PET/CT检查,对比二者诊断DTC术后转移的价值。结果35例共101处DTC转移灶中,^(18)F-FDG PET/CT、^(68)Ga-FAPI PET/CT分别检出淋巴结转移32处/32处、骨转移20处/29处、肺转移28处/26处、脑转移1处/1处及肝转移1处/1处。^(68)Ga-FAPI PET/CT所测骨转移灶最大标准摄取值(SUV_(max))显著大于^(18)F-FDG PET/CT(P<0.001),所测脑转移灶(0.89 vs.2.08)及肝转移灶的SUV_(max)(18.80 vs.4.73)亦存在差异,而淋巴结及肺转移灶的SUV_(max)差异无统计学意义(P均>0.05)。^(68)Ga-FAPI PET/CT诊断淋巴结转移的阳性预测值(PPV)、诊断骨转移的敏感度和PPV均大于^(18)F-FDG PET/CT(P均<0.05)。结论^(68)Ga-FAPI PET/CT诊断DTC甲状腺全切术后转移的效能优于^(18)F-FDG PET/CT。     

鼻咽癌~(18)F-FDG PET/CT标准摄取值与表观扩散系数的相关性分析

目的:该研究旨在探讨鼻咽癌~(18)F-脱氧葡萄糖(~(18)F-fluorodeoxyglucose,~(18)F-FDG)PET/CT最大标准摄取值(maximum standardized uptake value,SUV_(max))和磁共振扩散加权成像(diffusion weighted imaging,DWI)最小表观扩散系数(minimum apparent diffusion coefficient,ADC_(min))的相关性,同时分别探讨这两个参数在鼻咽癌T_(1-2)与T_(3-4)患者之间的差异是否有统计学意义。方法:回顾性分析27例放化疗前同时行~(18)F-FDGPET/CT和头颈部DWI-磁共振成像(magneticresonanceimaging,MRI)检查的鼻咽癌患者的图像资料。勾画感兴趣区(region of interest,ROI),测量病灶SUV_(max)和ADC_(min),对这两个参数进行Spearman相关性分析。采用独立样本t检验对T_(1-2)与T_(3-4)患者SUV_(max)进行统计学分析,比较T_(1-2)与T_(3-4)组ADC_(min)的差异。结果:鼻咽癌SUV_(max)(9.12±4.01)与ADC_(min) [(0.674±0.~(18)6)×10~(-3) mm~2/s]之间无相关关系(r=-0.031,P=0.876)。T_(1-2)与T_(3-4)组鼻咽癌病灶的SUV_(max)差异有统计学意义(P0.001),且T_(3-4)组病灶的SUV_(max)高于T_(1-2)组。T_(1-2)与T_(3-4)组鼻咽癌病灶的ADC_(min)差异无统计学意义(P=0.798)。结论:鼻咽癌~(18)F-FDGPET/CT的SUV_(max)和DWI的ADC_(min)是相互独立的生物学参数,这些诊断技术可能在诊断、评估鼻咽癌等方面发挥补充作用。SUV_(max)可在一定程度上反映鼻咽癌的T分期。     

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.     

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.     

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.