彩色多普勒联合3D-Glassbody能量多普勒超声对剖宫产瘢痕妊娠诊断价值

目的探讨彩色多普勒联合3D-Glassbody能量多普勒超声对剖宫产瘢痕妊娠诊断价值。方法选取2015年10月—2020年5月就诊经二维超声初步诊断为剖宫产瘢痕妊娠122例,采取彩色多普勒超声、彩色多普勒联合3D-Glassbody能量多普勒超声和MRI 3种方法分别检查,以病理检查结果为金标准,探讨彩色多普勒超声、彩色多普勒联合3D-Glassbody能量多普勒超声和MRI 3种检查方法对剖宫产瘢痕妊娠诊断价值;比较不同分型剖宫产瘢痕妊娠患者Vocal血管参数;评价Vocal血管参数对重度剖宫产瘢痕妊娠预测价值。结果 McNemar检验结果显示,彩色多普勒超声、彩色多普勒联合3D-Glassbody能量多普勒超声和MRI对剖宫产瘢痕妊娠诊断价值与病理检查比较差异无统计学意义(P0.05);Kappa检验结果显示,彩色多普勒超声、彩色多普勒联合3D-Glassbody能量多普勒超声和MRI对剖宫产瘢痕妊娠诊断价值与病理检查具有一致性(P0.05或P0.01)。对剖宫产瘢痕妊娠诊断彩色多普勒联合3D-Glassbody能量多普勒超声与病理检查一致性的Kappa值为0.865,敏感度、特异度、阳性预测值和阴性预测值分别为95.29%、91.89%、96.43%和89.47%。Kruskal-wallis H检验结果显示,不同分型剖宫产瘢痕妊娠患者血管化指数(VI)、血流指数(FI)和血管化血流指数(VFI)总体比较差异有统计学意义(P0.01)。受试者工作特征曲线分析结果显示,VI、FI和VFI对重度剖宫产瘢痕妊娠预测价值的曲线下面积分别为0.845、0.755和0.832,最佳截断值分别为4.47、1.21和15.39。结论彩色多普勒联合3D-Glassbody能量多普勒超声可进一步提高对剖宫产瘢痕妊娠的诊断价值,与病理检查诊断一致性较好,且Vocal血管参数对重度剖宫产瘢痕妊娠有一定预测价值。     

阴道彩色多普勒超声对剖宫产切口瘢痕妊娠诊断符合率的影响

目的分析阴道彩色多普勒超声(TVCDS)在剖宫产切口瘢痕妊娠诊断符合率的影响。方法选取2015年8月～2018年8月我院收治的剖宫产切口瘢痕妊娠患者82例,对患者分别采取TVCDS及腹部彩色多普勒超声检查,以病理检查结果为金标准,对比两种检查方法对剖宫产切口瘢痕妊娠的诊断符合率。结果 TVCDS诊断混合包块型、部分位于宫腔型、单纯妊娠囊型的诊断符合率分别为93.33%(28/33)、77.78%(7/9)、93.02%(40/43),腹部彩色多勒普超声检查分别为76.67%(23/30)、55.56%(5/9)、81.40%(35/43),两组比较差异无统计学意义(P>0.05);TVCDS诊断剖宫产切口瘢痕妊娠的整体符合率为91.46%,高于腹部彩色多普勒超声的76.83%,差异有统计学意义(P<0.05)。结论与腹部彩色多普勒超声对比,TVCDS可明显提高剖宫产切口瘢痕妊娠整体诊断符合率,减少漏诊情况。     

经阴道彩色多普勒超声对剖宫产切口瘢痕妊娠的临床价值

目的探讨剖宫产切口瘢痕妊娠的声像图特征,评价经阴道彩色多普勒超声对剖宫产切口瘢痕妊娠的临床诊断价值。方法对30例在中山大学附属东华医院住院治疗的剖宫产切口瘢痕妊娠者的超声特征进行回顾性分析,观察妊娠囊位置、子宫切口部位回声、瘢痕处肌层厚度、妊娠囊与子宫切口关系以及血流分布。结果 30例剖宫产切口瘢痕妊娠者超声诊断正确18例,误诊2例,诊断符合率为93.3%。所有孕妇在宫腔正常位置未见妊娠囊,在子宫下段切口部位可见妊娠囊或混合性团块,妊娠囊或团块与膀胱之间的子宫肌层明显变薄。根据声像图特征,将子宫下段瘢痕妊娠分为妊娠囊完全嵌于瘢痕型（13例）、妊娠囊部分向宫腔内生长型（6例）及瘢痕处混合性团块型（11例）。彩色多普勒血流图（CDFI）观察瘢痕处妊娠囊或混合性团块周边可见丰富的血流信号,PW显示平均RI值〈0.5。结论经阴道彩色多普勒超声能对剖宫产切口瘢痕妊娠提供较准确的定位和定性诊断,有重要的临床价值。     

疑似子宫瘢痕妊娠11例经阴道彩色多普勒超声诊断分析

目的:探讨经阴道彩色多普勒超声对子宫瘢痕妊娠的诊断意义.方法:对11例诊断子宫瘢痕妊娠的住院患者(已行经阴道彩色多普勒超声检查)进行回顾性分析.结果:经阴道彩色多普勒超声检查子宫瘢痕妊娠诊断符合率72.7%,动态追踪观察有利于提高诊断率.结论:经阴道彩色多普勒超声对子宫瘢痕妊娠做出准确的诊断,具有诊断价值.     

腔内彩超诊断剖宫产术后子宫下段早期瘢痕妊娠的作用分析

探讨腔内彩色多普勒超声检查对剖宫产术后子宫下段早期瘢痕妊娠诊断结果的准确度,为提高临床诊断正确率提供可靠依据,使患者尽早接受治疗,达到满意疗效。采用彩色多普勒超声诊断仪对33例剖宫产术后子宫下段早期瘢痕妊娠患者进行腔内及腹部彩色多普勒超声检查,观察并记录患者不同检查方法所得结果,给予统计学分析,得出结论。33例剖宫产术后子宫下段早期瘢痕妊娠患者经腹部彩超检查与病理结果符合率为72.73%,经腔内彩超检查与病理结果符合率为93.94%,两种检查途径结果相比,差异具有统计学意义（P〈0.05）。在条件允许的情况下,对剖宫产术后子宫下段早期瘢痕妊娠患者进行腹部与腔内联合进行彩色多普勒超声检查,能够将两种途径优缺点相互弥补,从而有效提高诊断正确率,快速确诊早期剖宫产术后子宫下段早期瘢痕妊娠,有利于患者尽快接受治疗,保障患者生活质量与生命安全,但临床在选择彩色多普勒超声检查方式时,还应根据患者实际情况等因素综合考虑决定。     

彩色多普勒阴道超声诊断剖宫产术后子宫瘢痕部位妊娠的临床价值

目的 探讨彩色多普勒阴道超声在剖宫产术后子宫瘢痕部位妊娠患者中的诊断价值。方法 选择经手术确定为剖宫产术后子宫瘢痕妊娠的患者100例，所有患者均开展彩色多普勒阴道超声检查，分析其检出率和检出类型。结果 100例剖宫产术后子宫瘢痕妊娠的患者中，刮宫术后确定妊娠囊型67例和包块型33例。经彩色多普勒阴道超声检查，共检出93例子宫瘢痕妊娠，其中妊娠囊型65例，包块型28例，子宫瘢痕妊娠检出率为93.00%(93/100)。结论 彩色多普勒阴道超声对剖宫产术后子宫瘢痕妊娠的检出率较高。     

彩色多普勒超声对高强度聚焦超声治疗剖宫产瘢痕妊娠的疗效观察

目的 探讨彩色多普勒超声观察高强度聚焦超声(HIFU)治疗剖宫产术后瘢痕妊娠疗效的价值.方法 分析20例经超声诊断子宫瘢痕妊娠患者HIFU治疗前、治疗后1周、4周的彩色多普勒超声声像图,并对其周边血流阻力指数(RI)及血人绒毛膜促性腺激素(T-HCG)值进行统计分析.结果 14例胚囊型治疗后孕囊塌陷、变形、胚芽未见长大,6例卵黄囊回声稍增强、壁增厚,血流轻度减少;6例包块型治疗后回声先稍增高,而后中央区回声减低,最终表现为稍高回声,血流明显减少.治疗后1周、4周RI均高于治疗前,治疗后4周RI高于治疗后1周(P均＜0.05);但T-HCG在治疗前后差异均无统计学意义(P均＞0.05).结论 彩色多普勒超声对HIFU治疗割宫产术后瘢痕妊娠的疗效观察及随访具有临床价值.     

经阴道超声在剖宫产术后子宫瘢痕妊娠中的诊断价值

目的:探讨经阴道彩色多普勒超声诊断剖宫产术后子宫瘢痕妊娠的临床价值。方法:回顾性分析2015年6月—2017年5月上海交通大学医学院附属国际和平妇幼保健院住院收治的268例剖宫产术后子宫瘢痕妊娠患者的超声声像图特征及临床资料。结果:268例剖宫产术后子宫瘢痕妊娠患者中,超声确诊250例,诊断符合率93.3%;误诊18例,误诊率6.7%,其中单纯孕囊型212例,混合回声型56例。根据孕囊与子宫前壁峡部浆膜层的距离将单纯孕囊型分为两种亚型:Ⅰ型(3 mm)130例,Ⅱ型(≤3 mm)82例。结论:经阴道彩色多普勒超声检查是诊断剖宫产术后子宫瘢痕妊娠简便、准确、快捷及有效的诊断方法。     

彩色多普勒超声对子宫瘢痕妊娠的诊断及治疗研究

目的:探讨彩色多普勒超声对子宫瘢痕妊娠的诊断及治疗效果。方法:选择我院2013年1月-2017年8月收治的经临床综合诊断为子宫瘢痕妊娠的患者22例作为研究对象,纳入对象有完整临床资料,愿意配合研究,且全部接受彩色多普勒超声诊断及治疗,总结彩色多普勒超声诊断结果、声像图特点,以及治疗情况。结果:22例患者经彩色多普勒超声诊断符合20例、误诊2例,诊断符合率为90.91%;根据彩色多普勒超声诊断声像图特点可将其分为孕囊型12例、团块型3例、混合型7例;治疗方案包括彩超引导下病灶穿刺注药治疗12例、清宫术7例、保守治疗2例、其他综合治疗1例,治疗后1周、4周血流RI值与血β-HCG值均有变化,治疗后4周显著优于治疗前(P0.05)。结论:彩色多普勒超声诊断子宫瘢痕妊娠有不错的价值,诊断符合率高,而且在彩色多普勒超声引导下病灶穿刺注药治疗属于比较有效的方案,值得在临床推广。     

彩色多普勒超声子宫瘢痕妊娠中的诊断效果观察

目的:探析子宫瘢痕妊娠中应用腹部彩色多普勒超声、经阴道彩色多普勒超声进行诊断的效果。方法:回顾性分析我院2018年1月-2019年12月期间收治的62例确诊为子宫瘢痕妊娠患者的临床资料,所有患者均通过经腹部彩色多普勒超声、经阴道彩色多普勒超声进行诊断,对比两种检查方法的诊断正确率。结果:经腹部彩色多普勒超声诊断准确率为85.48%,经阴道彩色多普勒超声诊断准确率为96.77%,两种检查方式的诊断符合率对比差异明显(P<0.05)。结论:与经腹部彩色多普勒超声诊断相比,子宫瘢痕妊娠通过经阴道彩色多普勒超声进行诊断能够获得较高的诊断准确率,应该全面推广应用。     

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.