CA153、CEA、AFP、CA125在恶性乳腺肿瘤治疗前后的变化

目的对肿瘤标志物癌抗原153(CA153)、癌胚抗原(CEA)、甲胎蛋白(AFP)、CA125在恶性乳腺肿瘤治疗前后进行不同时间段的动态监测,并探讨其临床应用价值。方法采用电化学发光免疫分析法测定恶性乳腺肿瘤患者不同时间段的血清(或血浆)CA153、CEA、AFP、CA125值,观测其在恶性乳腺肿瘤患者治疗前后的变化。结果在恶性乳腺肿瘤患者治疗中,术前及术后5个不同时间段CA153、CEA、AFP、CA125的检测结果显示:术前与术后结果有变化,均有不同程度下降,但AFP值较术前由9.5U/mL,升高为术后3个月的98.3U/mL。结论 CA153、CEA、CA125的动态监测,在恶性乳腺肿瘤患者治疗中有较好的临床应用价值,以CA153敏感性最高;而AFP则可预测治疗后的肿瘤转移。     

消化道疾病血清CRP与肿瘤标志物的联合检测意义

目的探讨消化系统恶性肿瘤和良性炎症疾病手术前后CRP与CEA、AFP、CA125、CA19-9联合检测的临床意义。方法对76例健康体检者7、9例良性消化化道疾病患者、146例恶性消化道疾病患者进行了手术前后血清CRP和CEA、CA19-9、CA125和AFP检测。结果术前恶性肿瘤组CRP、CEA、AFP、CA125和CA19-9均显高于对照组;良性组CRP明显高于对照组,CEA、AFP、CA125、CA19-9与对照组没有明显差别:恶性肿瘤组CRP明显低于良性病变组CRP,但恶性肿瘤组CEA、AFP、CA125、CA19-9明显高于良性端病变组。术后恶性肿瘤CRP降低缓慢同时恶性四种肿瘤标记物血清浓度均有下降的趋势(其中肝癌中术后CA19-9,CA125及AFP浓度,大肠癌术后CEA和胰腺癌术后CA19-9的浓度降低有统计学差异);良性消化道疾手术一周后,四种肿瘤标记物血清浓度无下降的趋势。结论CRP在恶性消化道肿瘤的早期诊断和与良性消化道疾病鉴别方面有一定的价值;联合检测患者血清的CRP、CEA、AFP、CA125、CA19-9在消化系统疾病诊断和治疗监测中具有显著的互补性。     

非小细胞肺癌化疗前后肿瘤标记物CEA、CA125、CA19-9、CA50水平变化及其意义

目的探讨化疗前后肿瘤标记物CEA、CA125、CA19-9、CA5O水平变化对于非小细胞肺癌化疗效果评价的价值。方法23例非小细胞肺癌患者经过2个疗程MVP方案化疗,监测第1次化疗前和第3次化疗前肿瘤标记物CEA、CA125、CA19-9、CA50水平的变化,并根据化疗前后肺部CT影像学改变进行分析。结果2次化疗后,CEA、CA125、CA50水平较化疗前下降,其中CEA对于肺腺癌,CA125、CA50对于肺鳞癌及肺腺癌化疗效果的评定具有一定的价值。而化疗后CA19-9的下降没有统计学意义。结论通过监测CEA、CA125、CA50水平的变化可以有助于非小细胞肺癌化疗后疗效的判断。     

肿瘤标记物联合检测在非小细胞肺癌化疗中的意义

目的探讨联合检测肿瘤标记物CEA、CA125、CA19-9、CA50对于非小细胞肺癌化疗的意义。方法对60例非小细胞肺癌病人行4个疗程化疗，化疗方案为NP、TP或GP，监测第1次化疗前和第3次化疗前肿瘤标记物CEA、CA125、CA19-9、CA50水平的变化，并根据化疗前后肺部CT改变进行分析。结果第3次化疗前，非小细胞肺癌病人CEA、CA125、CA50水平较第1次化疗前下降，差异有显著意义（t=2．367～3．125，P〈0．05、0．01）。化疗有效病人第3次化疗前CEA、CA125、CAS0水平低于第1次化疗前，差异有显著意义（t=2．123～3．089，P〈0．05、0．01）。结论监测肿瘤标记物CEA、CA125、CA50水平的变化有助于非小细胞肺癌化疗后疗效的判断。     

血清CEA、CA199、CA125、CA153联检对肺癌的诊断价值

目的：评价血清CEA、CA199、CA125、CA153水平对肺癌诊断的临床价值。方法：测定60例肺癌患者血清CEA、CA199、CA125、CA153水平,并观察其在不同TNM分期的变化及其不同病理水平变化。结果：肺癌组CEA、CA199、CA125、CA153水平明显高于正常对照组和良性肺病组。4项肿瘤标志扬水平以腺癌最高,鳞癌次之;联合检测可提高肺癌诊断率,TNM临床分期越晚,CEA、CA199、CA125、CA153水平越高。结论：讠4项肿瘤标志物在肺癌的诊断,病情监测方面可为临床提供有价值的资料。     

联合检测CEA、AFP、CA-125、CA-199对胃癌术后复发的诊断价值

目的：探讨联合检测CEA、AFP、CA-125、CA-199等肿瘤标志物对胃癌术后复发的诊断价值。方法：观察了118例胃癌患者，皆行胃癌根治手术或姑息手术，其中追踪观察到46例患者术后胃癌复发或发生转移癌，25例未发生胃癌复发或转移癌。分别于术前、术后与复发（复诊）后联合检测CEA、AFP、CA-125、CA-199等肿瘤标志物，对比观察术前、术后与复发后CEA、AFP、CA-125、CA-199等肿瘤标志物的特点。结果：术后各项肿瘤标志物水平均明显下降；复发病例各项肿瘤标志物水平则明显上升，甚至高于术前水平。转移癌肿瘤标志物水平均明显高于残胃癌。CA199与CA125联检阳性者76．8％确诊为胃癌复发或发生转移癌；CEA、CA199与CA125联检均为阳性者91．9％确诊为胃癌复发或发生转移癌。CEA、AFP、CA199与CA125四项联检均为阳性者95．5％确诊为胃癌复发或发生转移癌。结论：CEA、AFP、CA-125、CA-199等联合检验对提高肿瘤标志物对胃癌术后的临床诊断价值具有重要的意义，值得推广运用。     

肿瘤标志物在监测乳腺癌患者复发转移中的意义

目的探讨血清CA153，CEA，TPS，CA125联合检测在监测乳腺癌患者复发转移中的意义。方法采用化学发光法检测1000例乳腺癌患者和245例良肚疾病者的血清CA153，CEA，TPS，CA125水平，根据患者是否进行手术和术后有无转移分组，分别比较4项标志物和联合检测的敏感性。结果乳腺癌术前患者与乳腺癌术后发牛转移患者的CEA，CA153，TPS水平的差异有统计学意义（P〈0．001）；而术后发生转移的患者与术后无转移患者的CEA，CA153，TPS，CA125水平的差异有统计学意义（P〈0．001）。单个监测4项标志物，其敏感性均在术后转移患者中提高，与术前患者、术后无转移患者比较，其差异有统计学意义（P〈0．05）。采用4项肿瘤标志物的联合检测，埘术前患者的敏感性提高到56．72％，术后转移患者的敏感性提高到94．68％。CA153和CEA水平、TPS和CEA水平存乳腺癌患者巾的分布有明显的相关性，r分别为0．410，0．396（P=0．0001）。结论分别检测四项标志物，其对术后转移患者的敏感性均更高，而联合检测对监测孔腺癌进展期、复发和转移有重要的指导意义。     

乳腺癌手术前后血清CA153、CA125、CEA检测的临床意义

目的：探讨乳腺癌患者手术前后血清CA153、CA125和CEA水平的变化。方法：应用化学发光免疫分析法（CLIA）检测168例乳腺癌（Ⅰ＋Ⅱ期125例,Ⅲ＋Ⅳ期43例）患者血清CA153、CA125和CEA含量,并与132例非肿瘤患者作比较。结果：乳腺癌患者手术治疗前血清CA153、CA125和CEA含量非常显著地高于非肿瘤患者组（P〈0.01）;三者联合检测较单一检测阳性率明显增高（P〈0.01）。Ⅰ＋Ⅱ期患者手术后3个月CA153、CA125和CEA水平下降（P〈0.05）,与非肿瘤患者组比较无显著性差异（P〉0.05）;Ⅲ＋Ⅳ期患者手术后3个月CA153、CA125和CEA水平明显下降（P〈0.05）,但仍高于非肿瘤患者组（P〈0.05）。结论：检测乳腺癌患者血清CA153、CA125和CEA含量对临床诊断和预后观察具有重要的临床价值。     

多种肿瘤标志物联合检测在女性乳腺癌筛查中的价值分析

目的探讨女性乳腺癌筛查诊断中血清中CEA、AFP、CA199、CA125、CA153等多种肿瘤标志物联合检测的价值。方法随机选取2016年10月～2018年10月期间120例接受乳腺癌筛查的女性作为研究对象,其中包括20例乳腺癌患者,70例乳腺良性疾病患者和30例健康女性,对所有研究对象血清中的多种肿瘤标志物进行检测。结果乳腺癌患者血清中的CEA、AFP、CA199、CA125、CA153水平相较于乳腺良性疾病高,P0.05;乳腺良性疾病的CEA、AFP、CA199、CA125、CA153水平与健康女性之间差异较小,P0.05。结论血清中CEA、AFP、CA199、CA125、CA153等多种肿瘤标志物联合检测在女性乳腺癌筛查诊断中具有较高的应用价值,可为临床提供有价值的参考依据。     

联合检测CEA、CA125、NSE、Cyfra21-1对肺癌术后复发的诊断价值

目的：联合检测CEA、CA125、NSE、Cyfra21-1对肺癌术后复发的诊断价值。方法：监测44例肺癌患者术后和复发后的肿瘤标记物CEA、CA125、NSE和Cyfra21-1的变化。结果：期和复发者肿瘤标志物阳性的数目比期、期者多。联合检测三项或四项阳性者100%确诊为肺癌术后复发,两项阳性者为70%,一项阳性者为43%。结论：联合检测肿瘤标志物对肺癌术后复发的诊断具有重要的意义。     

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.