造影条件下声像图纹理分析评价HIFU消融兔VX2乳腺肿瘤的价值

目的 探讨高强度聚焦超声(HIFU)治疗过程中,纹理分析监控声像图对肿瘤凝固性坏死的判断,提高超声监控的灵敏度.方法 60只新西兰大白兔,左乳腺为造影剂组,右乳腺为非造影剂组.HIFU辐照在体兔VX2乳腺肿瘤,辐照强度80 W,辐照时间3s.采集辐照前后声像图,通过小波变换提取4个纹理参数作为纹理分析方法1;另提取Tamura纹理参数作为纹理分析方法2.运用支撑适量机(support vector machine,SVM)建立决策平面分析样本.结果 纹理分析方法运用于凝固性坏死的判断,造影和非造影条件下灵敏度和准确性均优于灰度评价,其差异有统计学意义(P＜0.05),2种纹理分析方法之间没有显著性差异.结论 纹理分析对凝固性坏死的判断,灵敏度和准确性较灰度评价更高.     

载Fe3O4高分子微球联合高强度聚焦超声损伤兔乳腺移植瘤的实验研究

目的 探讨自制载氧化铁高分子微球(Fe3O4/PLGA)联合高强度聚焦超声(HIFU)对兔VX2乳腺癌消融效果的影响.方法 双乳化法制备载Fe3O4的高分子微球.建立兔VX2乳腺癌模型32只,于肿瘤接种后14d,随机分为4组,第1组实验兔给予单纯HIFU辐照;第2、3、4组在HIFU辐照前,距肿瘤中心约3 mm处,经肿瘤3、6、9、12点钟方向,分别注入生理盐水、PLGA、Fe3O4/PLGA共0.5 ml,局部按摩1 min后行HIFU定点辐照,辐照声功率150 W,辐照时间5 s.HIFU辐照结束后,观测靶区凝固性坏死体积,采集标本行HE染色,增殖细胞核抗原(PCNA)检测及透射电镜观察.结果 Fe3O4/PLGA微球联合HIFU辐照明显增加肿瘤组织凝固性坏死体积(P＜0.05),降低肿瘤PCNA阳性表达率(P＜0.05).光镜下观察坏死区与周围组织分界清楚,电镜下癌细胞结构欠清晰,可见Fe颗粒沉积于胞浆.结论 自制Fe3O4/PLGA能有效增强HIFU消融兔乳腺VX2肿瘤的生物学效应.     

高强度聚焦超声对兔乳腺肿瘤急性损伤的研究

目的　应用高强度聚集超声(HIFU)对兔移植性乳腺肿瘤进行急性损伤研究。方法　以纯种荷瘤新西兰兔为实验对象,将1mm3VX2肿瘤组织块移植于兔乳腺组织内制作出VX2兔乳腺肿瘤动物模型。HIFU治疗探头频率为1.6MHz,焦域声强为5800W/cm2,连续超声波照射6s。结果　HIFU能准确地定位损伤靶区内兔乳腺肿瘤,其损伤程度为不可逆性。结论　实验结果表明HIFU能准确破坏乳腺肿瘤,为进一步开展临床研究提供了一定的实验依据     

超声造影剂对高强度聚集超声治疗兔肝VX2肿瘤的影响

目的探讨高强度聚焦超声（HIFU）联合超声造影剂治疗兔肝VX2肿瘤时，不同剂量的超声造影剂对治疗效应的影响。方法45只荷瘤兔随机分为三组：A组，单纯HIFU辐照组；B组和C组，均为联合辐照组，超声造影剂剂量分别为0．03ml／kg和0．05ml／kg。结果超声造影剂能够增强HIFU治疗效率，且超声造影剂的剂量越高，HIFU治疗效率提高越明显（P〈0．05）。结论超声造影剂可以提高HIFU治疗效率，而且超声造影剂剂量越高则HIFU的治疗效率越高。     

高强度聚焦超声联合阿霉素治疗兔移植性乳腺癌的疗效评价

目的　探讨高强度聚焦超声 (High intensity focused ultrasound,HIFU)联合阿霉素治疗兔移植性乳腺恶性肿瘤的疗效。方法　 2 1只可移植性鳞癌 (VX2 )兔移植性乳腺肿瘤于肿瘤移植后 3周 ,于腋部扪及直径约 8mm大小的转移淋巴结时随机分为 HIFU 阿霉素治疗组 (7只 ) ,阿霉素治疗组 (7只 ) ,对照组 (7只 ) ,分别接受 HIFU 阿霉素治疗、阿霉素化疗和假照治疗。 HIFU治疗探头频率 1.6 MHz,声强 115 0 0 W/ cm2 ,行全覆盖病灶辐照治疗 ;阿霉素剂量为 2 mg/ kg,分别于 HIFU治疗前3d及治疗后 3周分 2次给药。 HIFU治疗后观察 6个月 ,观察动物的平均存活时间、 6个月存活率及肿瘤的生长和转移情况。结果　 HIFU辐照前肿瘤声像图呈低回声团块 ,辐照后肿瘤声像图呈明显强回声。 HIFU 阿霉素治疗组的平均存活时间、 6个月存活率及肿瘤的转移率分别为 (15 7.2 9± 2 7.2 9) d、4 2 .9%和 0 ,明显优于阿霉素治疗组 [(113.3± 39.3) d、14 .3%和 71.4 % ]和对照组 [(5 9.1± 11.4 ) d、 0和 10 0 % ]。结论　 HIFU联合阿霉素能有效地治疗兔移植性乳腺肿瘤 ,为 HIFU联合化疗药物治疗乳癌的临床研究提供实验依据。     

相关函数应用于HIFU辐照兔VX2乳腺肿瘤的监控声像图研究

目的 探讨在高强度聚焦超声(HIFU)辐照后,声像图相关函数与HIFU辐照发生凝固性坏死的关系,以提高监控超声的判断灵敏度. 方法 120只兔VX2乳腺移植性肿瘤随机分为4组,在相同辐照时间、不同辐照强度下,采用HIFU定点辐照,观测靶区辐照前后声像图变化和灰度值变化,并对靶区声像图进行相关函数运算,用支持向量机(support vector machine,SVM)筛选参数得到其最佳决策超平面. 结果 监控声像图相关函数处理可以评价HIFU辐照组织的凝固性坏死情况,其灵敏度高于用声像图灰度评价(P＜0.05). 结论 声像图相关函数判断HIFU辐照的靶组织有无凝固性坏死比灰度评价更为准确可靠.     

高强度聚焦超声治疗及控制兔肝VX2肿瘤发展的实验研究

目的 探讨高强度聚焦超声(HIFU)治疗及控制肝肿瘤发展转移的效果.方法 采用兔肝VX2肿瘤模型进行HIFU辐照.辐照后不同时期处死动物以观察其病理变化.另以辐照组及对照组动物各8只,于2周后处死,比较肿瘤生长及肺转移的情况.结果 HIFU辐照后肿瘤细胞立即发生凝固性坏死,电镜下亦见到不可逆的破坏.2周后有6只动物的肿瘤原发灶已被完全破坏;另2只靶区外有少量肿瘤残存,其体积为59.8 mm3和10.4mm3,而对照组的肿瘤平均体积为(1571.1±349.7)mm3.辐照组有2只(25%)发生肺转移,转移结节数为10和3;对照组全部发生肺转移,转移结节数为54±30.两组差异有显著性.结论 HIFU对兔肝VX2肿瘤有很强的杀伤作用,对控制肿瘤的发展及转移有一定的疗效.     

脉冲高强度聚焦超声联合微泡非热损伤兔肝VX2移植瘤的病理观察

目的探讨脉冲高强度聚焦超声(HIFU)联合微泡非热损伤兔肝VX2移植瘤的病理变化。方法将36只荷瘤兔随机分为假照组、P-HIFU组和P-HIFU UCA组进行HIFU辐照,观察辐照后组织的病理学变化。结果假照组、P-HIFU组和P-HIFU UCA组TTC染色后,肉眼下各组肿瘤组织被均匀红染,而组织学检查显示P-HIFU组和P-HIFU UCA组肿瘤细胞有损伤征象,胞浆内有大小不等空泡。结论脉冲高强度聚焦超声(HIFU)以及联合微泡均可对兔肝VX2移植瘤通过非热损伤达到治疗目的。     

高强度聚焦超声联用超声造影剂对治疗兔肝焦域效应的影响

目的探讨超声造影剂改变动物体内生物组织对入射超声的反应,以增强高强度聚焦超声(HIFU)治疗实体肿瘤的生物学效应.方法采用前瞻性配对方法,把32只新西兰纯种大白兔按体质量配对分为两组,每组16只,两组兔肝分别接受①单纯HIFU治疗;②增强HIFU治疗,即先静脉注射超声造影剂(白蛋白包裹的含全氟丙烷的气体微泡,全氟显),再接受HIFU治疗.两组治疗参数包括辐照时间、功率、频率、焦距相同.记录并比较两组肝在辐照前与辐照后20 s、2 min、5 min靶区的超声灰度值改变并在术后2 h、第2 d、第3 d和第7 d各解剖4只兔,对比两组肝脏的焦域体积大小及显微镜下肝组织的病理学改变.结果单纯HIFU组辐照前后的超声灰度改变值分别为 20.2± 12.4(20 s), 16.8± 9.3(2 min)和 15.1± 11.9(5 min);增强HIFU治疗组为 63.9± 29.4(20 s), 60.0± 25.9(2 min), 59.3± 28.7(5 min),两组差异有显著性意义(P< 0.05).两组肝的焦域体积分别为( 130.5± 200.2)mm3(单纯HIFU组)和( 1613.6± 2620.7)mm3(增强HIFU组,P< 0.05).两组在治疗当天光镜下靶区肝细胞即出现不可逆的变性坏死,1 d后出现明显的大片凝固性坏死,与周围组织分界清楚.结论超声造影剂可改变动物体内的声学环境,从而增强HIFU对兔肝的作用效应,可作为HIFU增效剂用于临床治疗实体肿瘤.     

载多西紫杉醇脂质超声微泡造影剂对兔VX2肝癌增殖和凋亡的作用

目的 研究载多西紫杉醇脂质超声微泡造影剂对兔VX2肝癌的作用.方法 建立兔VX2肝癌动物模型,将实验兔30只随机分为6组,比较各组的肿瘤生长率、TUNEL法检测肿瘤细胞凋亡、免疫组化法检测PCNA的表达情况.结果 治疗后载药微泡+超声组肿瘤生长速度明显减慢,其肿瘤生长率与其他各组相比差异有显著性(P<0.01);载药微泡+超声组的凋亡指数显著高于其他各组(P<0.01);载药微泡+超声组的肿瘤增殖受到明显抑制,其增殖指数明显低于其他各组(P<0.01).结论 载多西紫杉醇脂质超声微泡造影剂在超声作用下能延缓兔VX2肝癌的增殖、促进其凋亡,对VX2肝癌具有显著的生长抑制作用.     

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.