超声造影评价高强度聚焦超声治疗子宫腺肌瘤的疗效

目的探讨超声造影在高强度聚焦超声（HIFU）治疗子宫腺肌瘤疗效评价中的应用价值。方法选择痛经症状明显,经临床、超声检查诊断为子宫腺肌瘤,不愿接受手术治疗的已生育患者20例,在二维超声定位及实时监控下应用HIFU进行治疗。于HIFU治疗前1周、治疗后1、3及6个月采用常规二维超声、彩色多普勒超声及超声造影观察腺肌瘤大小、内部回声、血流变化及超声造影图像改变。结果HIFU治疗后3个月及6个月,20个子宫腺肌瘤体积逐渐缩小,所有瘤体内部回声增强、彩色血流均消失。超声造影显示18个腺肌瘤内造影剂持续无灌注,2个瘤体内部呈网格状少许灌注。结论超声造影是HIFU治疗子宫腺肌瘤疗效评价的有效方法。     

高强度聚焦超声治疗子宫肌瘤和子宫腺肌瘤的临床应用

目的 探讨高强度聚焦超声(HIFU)应用于临床治疗子宫肌瘤和子宫腺肌瘤的效果和安全性.方法 以子宫肌瘤和子宫腺肌瘤患者为研究对象,采用HIFUNIT-9000型超声聚焦肿瘤消融机实施治疗.观察治疗前后患者临床症状和瘤体超声回声、血流及大小的变化.结果 共治疗子宫肌瘤和子宫腺肌瘤患者116例,治疗瘤体共192个,其中肌瘤166个,腺肌瘤26个.治疗后82例患者各种症状得到改善;瘤体缩小,瘤体超声回声增强,血流减少.治疗效果总有效率94.2%,其中显效率53.8%.结论 HIFU治疗子宫肌瘤和子宫腺肌瘤效果明显,无创、安全.     

彩色多普勒超声评价高强度聚焦超声治疗子宫肌瘤

目的 探讨高强度聚焦超声（HIFU）治疗子宫肌瘤的近期疗效及评价彩色多普勒血流显像（CDFI）在治疗前后的应用价值。方法 应用CDFI对经HIFU治疗的子宫肌瘤患者114例共175个肌瘤进行检测，观察治疗前后声像图的变化，并以治疗后瘤体的缩小程度为治疗有效指标对比分析，分析彩色多普勒血流信号变化与HIFU治疗效果的关系。结果 114例患者的175个肌瘤中，169个治疗后二维图像显示回声明显增强。158个治疗后3个月瘤体明显缩小，与治疗前相比差异有显著意义（P＜0．05）。143个治疗后血流信号消失，瘤体缩小；8个血流信号无明显变化，瘤体逐渐增大。24个血流信号明显减少，随着随访时间的延长，11例瘤体血流信号消失者中有9例血流信号重新变得丰富。结论 应用彩色多普勒超声技术能正确评价HIFU治疗子宫肌瘤的疗效，并在治疗后短期内指导临床治疗方案的修订及实施。     

超声造影评价高强度聚焦超声治疗子宫肌瘤早期疗效的临床研究

目的 探讨超声造影对高强度聚焦超声（HIFU）治疗子宫肌瘤早期疗效评价的应用价值.方法 选择50例HIFU治疗子宫肌瘤的连续病例,共检出肌瘤65枚,于治疗前和治疗后2～5 d行常规超声、彩色多普勒血流显像及超声造影检查,观察瘤体大小、内部及周边组织回声和血流灌注变化.结果 HIFU治疗前常规超声示肌瘤内部为不均匀性低回声或中等回声,治疗后2～5 d内肌瘤内部回声不均匀性增强占 92.3%,回声无明显变化占 7.7%,治疗前后肌瘤大小变化差异无统计学意义（P＞0.05）;治疗前彩色多普勒血流显像示肌瘤内部均可见点状、条状或网状血流信号,治疗后肌瘤内部血流信号消失占95.4%,肌瘤周边有少许点状血流信号占 3.1%;HIFU治疗前超声造影能清晰显示肌瘤大小及边界且瘤体内造影剂强度高于子宫肌壁,治疗后肌瘤内无造影剂显示占 92.3%,瘤体边缘有散在造影剂增强占 6.2%;HIFU治疗前肌瘤内时间强度曲线幅度明显高于子宫肌壁;治疗后肌瘤内时间强度曲线幅度为零占 92.3%,瘤体边缘有散在造影剂增强的时间强度曲线幅度也较治疗前明显降低（P＜0.05）.结论 超声造影能准确评价HIFU治疗子宫肌瘤的消融范围及程度,为子宫肌瘤HIFU治疗后的早期疗效判断提供依据,并可在短期内修订HIFU的治疗方案.     

高强度聚焦超声治疗在体人子宫腺肌瘤病理变化初探

目的研究高强度聚焦超声(high intensity focused ultrasound，HIFU)对在体人子宫腺肌瘤的杀伤作用。方法利用重庆海扶(Ⅲ-fu)技术有限公司研制提供的Jc型高强度聚焦超声治疗系统，对7例诊断为子宫腺肌瘤需要做全子宫切除术的病人，用HIFU定点照射充分暴露的子宫腺肌瘤120s，常规切除子宫后，沿照射点垂直切开瘤体，用靶区内的组织进行TTC(2，3，5-三苯基氯化四氮唑，2，3，5-Triphenyhetrazohum chloride)染色，并送HE光镜和电镜观察。结果7例子宫腺肌瘤照射靶区组织TTC染色不着色；光镜和电镜下，子宫腺肌瘤平滑肌细胞、腺上皮细胞及间质细胞均发生不可逆性凝固性坏死。结论HIFU对在体人子宫腺肌瘤的平滑肌细胞、腺上皮细胞和间质细胞具有杀伤作用。     

经阴道及腹部彩色多普勒超声在子宫肌瘤与子宫腺肌瘤鉴别诊断中的应用

目的探讨子宫肌瘤和子宫腺肌瘤的二维图像及彩色血流分布特点,提高两种疾病的诊断率。方法对45例子宫肌瘤和38例子宫腺肌瘤患者行彩色多普勒超声(CDFI),分析其二维图像及彩色血流分布特点。随机选择40名健康妇女为正常对照组。结果子宫肌瘤组和子宫腺肌瘤组患者发病年龄及临床表现相近,但子宫腺肌瘤的痛经、子宫体触痛明显;二维图像上子宫肌瘤及子宫腺肌瘤均呈特征性改变。CDFI示子宫肌瘤及子宫腺肌瘤患者子宫动脉平均阻力指数(RI)低于正常对照组(P<0.05)。子宫肌瘤周围有环绕血流,浆膜下肌瘤及黏膜下肌瘤的蒂部显示丰富的血流;子宫腺肌瘤周边血流信号稀少,内部见丰富或星点状血流信号;频谱显示子宫腺肌瘤阻力指数高于子宫肌瘤周边及内部动脉RI。结论 经阴道及腹部超声对子宫肌瘤与子宫腺肌瘤的鉴别有重要价值,但必须结合临床表现才能提高二者诊断的准确率。     

高强度聚焦超声治疗子宫肌瘤及彩色多普勒能量图判断疗效

目的 探讨高强度聚焦超声(high intensity focused ultrasound HIFU)治疗子宫肌瘤的安全性和有效性，评价彩色多普勒能量图(CDE)对HIFU治疗的疗效判断。方法 选择86例子宫肌瘤患，观察HIFU治疗前后肌瘤的超声回声、肌瘤大小及临床症状变化，用CDE对治疗前后肌瘤内部血流灌注对比观察。结果 治疗后肌瘤内部回声增强，血流信号减少，肌瘤缩小，临床症状改善，无严重副作用。结论 HIFU治疗子宫肌瘤安全、有效。CDE可客观评估子宫肌瘤血流灌注状态，有效评价HIFU治疗的疗效，作为治疗后疗效判断是一项较好的检测指标。     

彩色多普勒超声对子宫肌瘤、子宫腺肌瘤的鉴别诊断价值

目的探讨彩色多普勒超声(CDFI)对子宫肌瘤、子宫腺肌瘤的鉴别诊断价值。方法收集2015年12月至2018年12月在我院经术后病理检查确诊的子宫肌瘤患者600例,子宫腺肌瘤患者180例,对两组患者联合经阴和经腹彩色多普勒超声检查结果进行分析,比较CDFI对这两种疾病的诊断准确率,以及病灶周围血流情况,血流阻力指数(RI)、搏动指数(PI)。结果联合经阴和经腹CDFI对子宫肌瘤和子宫腺肌瘤的诊断准确率比较,差异未见统计学意义(P0.05);子宫肌瘤CDFI多表现为边界清,均匀、低回声,肌瘤周围伴有声晕,子宫增大,多伴形态改变,肌瘤发生部位和数目不一,而子宫腺肌瘤CDFI多表现为边界不清,回声多不均,子宫弥漫性增大,多不伴形态改变;内膜多移位,病灶多发生于子宫后壁。子宫肌瘤组患者病灶周围环状血流检出率为73.67%(442/600),显著高于子宫腺肌瘤组[15.00%(27/180)],子宫肌瘤组RI、PI均显著低于子宫腺肌瘤组(P均0.05)。结论彩色多普勒超声对子宫肌瘤和子宫腺肌瘤具有较高的诊断准确率,且对二者有较高的鉴别诊断价值。     

高强度聚焦超声对子宫平滑肌瘤微血管的破坏作用

目的探讨高强度聚焦超声(HIFU)在治疗子宫平滑肌瘤中对微血管的破坏作用。方法114例患者共175个子宫肌瘤行HIFU治疗,分别于治疗前后1周同时行彩色多普勒血流显像(CDFI)和实时超声造影(CEUS)检查,分析HIFU治疗后瘤体血流灌注情况。其中64个肌瘤术前、术后行超声引导下穿刺活检,用免疫组化法对标本用CD31单克隆抗体进行肿瘤血管内皮染色,计数肿瘤微血管密度(MVD),分析比较HIFU治疗前后MVD变化情况。结果175个子宫肌瘤行HIFU治疗后,CDFI在143个肌瘤内未测及任何血流信号,24个肌瘤血流信号明显减少,8个肌瘤血流信号无明显变化;CEUS在141个肌瘤内显示造影剂完全充盈缺损,13个肌瘤瘤体内大部分组织充盈缺损,周边有局灶性增强,21个肌瘤显示为造影剂弥漫增强。术前64例活检组织免疫组化染色MVD计数平均为60.3±17.0;术后显示微血管大量破坏,64例组织MVD计数平均12.1±16.3,术前、术后MVD比较差异有统计学意义(P<0.001)。结论HIFU能从体外破坏肿瘤血管,加强了HIFU杀死子宫平滑肌瘤细胞的直接效应。     

高强度聚焦超声治疗子宫肌瘤135例临床疗效观察

目的 探讨高强度聚焦超声(简称HIFU)治疗子宫肌瘤的临床疗效观察. 方法对135例238个子宫肌瘤患者行HIFU治疗,术前及术后对肌瘤大小、回声、血流、临床症状进行观察比较.结果 随访6～18个月,治疗后肌瘤缩小,血流信号减小或消失,回声变化比较复杂,可有回声增强、强弱不均匀、无明显变化3种表现,近期总有效率97.4%(显效165个,有效68个,无效5个).结论 HIFU治疗子宫肌瘤疗效满意,是一种无创、无辐射、有效安全的方法.     

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.     

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.     

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.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

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.