脑星形细胞瘤影像表现与病理对照研究

目的:分析不同级别脑星形细胞瘤的影像表现,探讨影像表现与脑星形细胞瘤病理分级的相关性。方法:收集经CT及MRI诊断和手术病理证实的脑星形细胞瘤85例,按病理诊断标准分为四级,Ⅰ级13例,Ⅱ级21例,Ⅲ级28例,Ⅳ级23例。对肿瘤大小、密度、水肿、钙化、强化程度、强化类型等CT表现与病理分级进行对照研究,采用卡方检验;对MRI表现的8个特征(信号不均匀性、囊变坏死、出血、越过中线、水肿、边界、强化程度及强化不均匀性)与星形细胞瘤病理分级进行统计分析,采用卡方检验。结果:(1)肿瘤的大小、钙化等情况在各组间差异无显著性(P>0.05);而肿瘤密度、瘤周水肿、强化程度及类型在各组间差异存在显著性(P<0.05)或高度显著性(P<0.01);(2)除越过中线外,其余7个MRI征象均对星形细胞瘤分级有较大的帮助,尤其是囊变坏死、边界、水肿、肿瘤强化程度及强化不均匀性在各级星形细胞瘤之间差异均有极显著性意义(P<0.01)。结论:星形细胞瘤影像表现与其病理分级有一定的相关性,CT及MRI对星形细胞瘤的分级诊断有较大的价值。     

脑星形细胞瘤的分级与CT诊断(附100例报告)

目的:探讨CT对星形细胞瘤分级定性诊断的价值,以提高对星形细胞瘤术前分级定性的准确率。材料和方法:分析了100例经手术病理证实的脑星形细胞瘤的病理分级与CF表现,其中原因是Ⅰ级20例,Ⅱ级60例,Ⅲ、Ⅳ级20例。年龄5～75岁。结果:Ⅱ级星形细胞瘤在发病年龄、发病部位、肿瘤大小、瘤周水肿及CT表现上与Ⅰ级星形细胞瘤存在显著性差异(P<0.01),与Ⅲ、Ⅳ级星形细胞瘤无显著性差异(P>0.05),并具有复发及转移特性。结论:Ⅱ级星形细胞瘤属于恶性肿瘤,CT扫描在星形细胞瘤的诊断、病理分级及病变定性方面有很大价值。     

不同级别少突胶质细胞瘤影像病理对照

目的：通过探讨不同级别少突胶质细胞瘤的影像学特点并与病理表现对照,为少突胶质细胞瘤的临床治疗提供帮助。方法：回顾性分析57例经病理证实的不同级别少突胶质细胞瘤的影像表现,并和病理作对照。结果：少突胶质细胞瘤（WHO Ⅱ级）35例,中位年龄34岁,好发于额、顶叶皮髓质交界区,边界模糊,29例CT呈稍低密度,6例CT呈混杂密度,31例T1WI呈低信号,4例呈等信号,35例T2WI呈高信号,增强扫描32例呈轻度强化,3例呈不均匀强化,32例伴钙化,7例囊变,8例出血,5例伴瘤周水肿;间变少突胶质细胞瘤（WHO Ⅲ级）22例,中位年龄32岁,好发于额、顶、颞皮髓质交界区,边界较清,10例CT呈稍低密度,12例CT呈混杂密度,19例T1WI例呈低信号,3例呈等信号,19例T2WI呈高信号,增强扫描2例轻度强化,20例呈明显强化,3例伴钙化,12例囊变坏死,9例出血,22例伴瘤周水肿。结论：间变型少突胶质细胞瘤（WHO Ⅲ级）在囊变坏死、出血、瘤周水肿及强化形式方面较少突胶质细胞瘤更加明显,这些影像学特征有助于对该类肿瘤术前分级的诊断,为肿瘤的临床治疗提供帮助。     

幕上星形细胞瘤核DNA含量与病理分级,CT表现的相关研究

目的:研究幕上星形细胞瘤核DNA含量与病理分级、CT表现的相关性。材料和方法:对43例幕上星形细胞瘤流式细胞计致结果与病理分级、CT表现作对照分析。结果:幕上星形细胞瘤瘤核DI、PI及AT出现率与病理分级成正相关;Ⅰ/Ⅱ级与Ⅲ/Ⅳ级DI、AT出现率差异非常显著(P<0.01);Ⅰ级、Ⅱ级、Ⅲ/Ⅳ级PI差异有显著性(P<0.05);肿瘤大小、坏死、瘤周水肿及囊肿型与DI、PI及AT出现率有显著相关性。结论:幕上星形细胞瘤核DNA含量与病理分级、CT表现有一定的关系,流式细胞计数测量瘤核DNA含量评价幕上星形细胞瘤生物行为不能取代组织病理学检查。     

星形细胞瘤瘤内CT征象与微血管密度相关性的初步研究

目的 研究星形细胞瘤瘤内CT征象与微血管密度(Microvessel density,MVD)间的关系。探讨CT评估星形细胞瘤新生微血管的作用。方法 运用SP免疫组化法,检测52例术后经病理证实的星形细胞瘤MVD。分析瘤内CT征象与MVD间的关系。结果 MVD与病理分级相关。混杂密度及高密度组的MVD显著高于低密度组(P<0.01)。坏死明显组的MVD比坏死不明显组高,二者间存在显著差异(P<0.01)。钙化组的MVD为13.7±4.7,明显少于无钙化组(20.9±5.8)。囊变与MVD无明显相关性。结论 星形细胞瘤瘤内CT征象,如密度、钙化、坏死等征象在判断肿瘤新生血管方面有一定的价值。     

脑星形细胞瘤的分级与CT诊断

目的：探讨ＣＴ对星形细胞瘤分级定笥诊断的价值,以提高对星形细胞瘤术前分级定性的准确率。材料和方法：分析了１００例手术病理证实的脑星形细胞瘤的病理分级与ＣＴ表现,其中Ⅰ级２０例,Ⅱ级６０例,Ⅲ,Ⅳ级２０例。年龄５－７５岁。结果：Ⅱ级星形细胞瘤在发病年龄,发病部位,肿瘤大小,瘤周水肿及ＣＴ表现上与Ⅰ级星形细胞瘤存在显著性差异,与Ⅲ,Ⅳ级星形细胞瘤无显著性差异,并具有复发及转移特性。     

星形细胞瘤瘤周水肿的MRI、CT扫描的对比研究

目的:探讨MRI、CT对星形细胞瘤瘤周水肿程度和范围的观察价值及影响星形细胞瘤瘤周水肿的因素。材料与方法:回顾性分析89例经手术病理证实的脑星形细胞瘤的影像学资料,病例术前均经MRI检查,其中19例先行CT检查,分别测量MRI、CT图像上肿瘤大小和瘤周水肿范围。结果:MRI的T2WI与增强T1WI结合与CT、平扫T1WI图像分别测量19例瘤周水肿最大宽度间比较有显著性差异;位于皮髓质交界区的肿瘤,瘤周水肿最明显;瘤周水肿的程度与肿瘤的大小无明显相关性,而与病理分级明显相关。结论:MRI的T2WI与增强扫描结合有利于准确判断瘤周水肿的范围,对临床选择治疗方案有重要价值。     

高、低级别脑星形细胞瘤瘤周区CTP研究

目的：探讨高、低级别星形细胞瘤瘤周区CT灌注成像（CTP）参数的差异及其病理基础。方法：对30例手术与病理证实的脑星形细胞瘤（低级别星形细胞瘤10例、高级别星形细胞瘤20例）行术前CT平扫、增强及CTP检查,测量强化区近侧1cm处或低强化区距边缘1cm处的脑血流量（CBF）、脑血容量（CBV）、平均通过时间（MTT）及脑血管表面通透性（PS）值。比较高、低级别脑星形细胞瘤瘤周区CTP参数差异。对照影像学,采用肿瘤切除前活检的方法取得标本,观察瘤周区病理表现。结果：高级别星形细胞瘤瘤周区CBF、CBV、MTT及PS值高于低级别星形细胞瘤瘤周区。CBF、CBV、MTT及PS值,高级别星形细胞瘤瘤周区分别为（50.05±14.05）ml?蛐（min·100g）、（3.50±1.79）ml?蛐100g、（5.84±2.95）s及（1.23±1.75）ml?蛐（min·100g）,低级别星形细胞瘤瘤周区分别为（25.20±8.67）ml?蛐（min·100g）、（1.61±0.68）ml?蛐100g、（4.83±1.63）s及（0.33±0.27）ml?蛐（min·100g）,二组间CBF、CBV差异有统计学意义（P<0.05）。组织学上,高级别与低级别星形细胞瘤瘤周区均可见散在肿瘤细胞,前者肿瘤细胞密度较大、血管较多。结论：高级别与低级别脑星形细胞瘤瘤周区CBF、CBV有明显差别,其病理基础不同。     

27例脑胶质瘤的CT诊断分析

脑胶质瘤是颅内最常见的弥漫性生长的肿瘤,无包膜,肿瘤易囊变,坏死,也可钙化和出血。CT表现为脑内异常密度肿块,边界多不清,形态不一,周围多有脑水肿,几乎均有占位表现。注射造影剂后作增强扫描多有环状或不规则的强化,强化的明显与否与胶质瘤的病理类型有关:Ⅰ级星型细胞瘤强化不明显,呈边缘稍强化或小结节状强化,Ⅱ、Ⅲ级星形细胞瘤逐渐强化     

星形细胞瘤CT表现与GFAP表达的关系

目的:探讨星形细胞瘤CT表现与GFAP表达的关系。材料与方法:收集手术病理证实的脑星形细胞瘤46例,分析其CT表现。采用免疫组化方法标记肿瘤GFAP。对照GFAP表达程度与CT表现的关系。结果:星形细胞瘤GFAP表达强弱与病理级别相关,星形细胞瘤CT密度均匀性、边界清楚与否、瘤周水肿程度及增强程度与GFAP表达之间有统计学差异,但肿瘤部位及大小与GFAP表达没有相关性。结论:星形细胞瘤CT表现,特别是脑水肿、增强程度等征象,在一定程度上可以反映GFAP表达强弱。     

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.     

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.     

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.     

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.