人体肾脏超分辨超声造影

目的 观察应用超分辨技术提高肾脏血流超声造影（CEUS）成像空间分辨率的可行性。方法 提出一种基于造影图像序列统计变换的超声衍射衰减显微镜（UDAM），并用于人体肾脏CEUS图像重建；通过与最大强度投影（MIP）成像结果对比，探究UDAM超分辨成像对于空间分辨率的改善效果。结果 相比MIP图像，视觉上超分辨成像显示肾脏血流的空间分辨率显著提高。结论 UDAM可对临床采集的肾血流造影视频进行重建，并提高成像的空间分辨率，为观察微小血流结构提供新的有效手段。     

肾脏血流灌注的评估：造影增强彩色多普勒时间-强度曲线分析

背景：超声评价肾脏功能主要通过测量较粗大的肾脏各级动脉的血流参数或肾切面内动脉彩色血流面积所占的比例来推断，误差较大。目的：应用超声仪器随机配置的彩色多普勒时间-强度曲线软件评价肾脏血流灌注情况。设计：动物实验观察。单位：广州市第一人民医院功能检查科。材料：实验于1999-01／2000-04在广州军区广州总医院动物实验室完成，选择8只健康新西兰兔，雌雄各4只，体质量2.5～3．5k。观察肾脏16个。声学造影剂为全氟显，主要成分为声振白蛋白的微泡，微泡内有一定浓度的全氟丙烷气体。方法：兔外周静脉团注造影剂全氟显后用彩色多普勒能量图、彩色多普勒血流显像和彩色多普勒能量谐波成像连续采集肾脏彩色血流图像，随机配置软件显示时间-强度曲线。主要观察指标：造影增强肾脏血流灌注时间一强度曲线的形态。结果：进入结果分析8只家兔。肾脏血流造影增强的时间一强度曲线呈单峰状，上升支陡直，下降支平缓。调节时间轴上的感兴趣线可作定量分析，回放显示注射造影剂后对应某一时刻的造影增强的彩色多普勒图像。结论：造影增强彩色多普勒血流显像和彩色多普勒能量图的时间-强度曲线能有效的观察肾脏血流灌注特征，既可显示整个肾脏的血流灌注情况，也用于观察低血流灌注区域，发现病灶进一步绘制肾功能图。     

超声造影定量小鼠肾血流灌注的研究

目的评估超声造影定量小鼠肾脏血流灌注的可靠性。方法雌性小鼠7只,经颈静脉匀速泵入微泡造影剂,全程记录造影图像,脱机定量造影剂再充填曲线参数,软件自动计算声学造影平台强度、再充填曲线上升斜率以及两者乘积。比较小鼠两次造影结果的一致性,并评估造影强度对造影定量曲线拟合优度的影响。结果所有小鼠均取得良好的肾脏显影效果。全部造影定量分析曲线的拟合优度极佳,其决定系数高达0．945±0．050（P〈0．05）。在一定范围内,超声造影平台强度与超声造影定量曲线的拟合优度之间呈正相关（r=0．760,P=0．002）。同一只小鼠两次超声造影的肾脏血管密度、血流速度及肾血流量比较差异均无统计学意义（P〉0．05）。结论应用超声造影定量小鼠肾脏血流有良好的重复性,提高超声造影平台强度,对于改善定量分析结果有一定的帮助。     

自制氟碳声学造影剂定量评价正常肾血流灌注的实验研究

目的：探讨应用自制氟碳声学造影剂和声学定量技术定量评价肾脏血流灌注的可行性。方法：观察大白兔造影前，后肾脏二维超声图像，分析造影效果，测定造影后不同时间肾实质有关时间－强度曲线参数。结果：造影后肾脏二维超声图像较造影前明显增强，皮质灌注峰值（PI），曲线下面积（AUC）明显增大，并在较高水平约40s后迅速下降，平均通过时间（MTT）则变化不大。髓质的各项参数与造影前相比均无显著差异。结论：通过测定造影后,PI,AUC等时间－强度曲线参数，能够对肾脏血流灌注作出定量评价。     

超声超分辨率微血流成像研究进展

由直径小于10 μm毛细血管组成的微血管网络是组织稳态的基础,维持人体生理功能正常运行;其结构或功能改变将损害正常器官功能或导致疾病发生。超声超分辨率微血流成像可无创识别微血管,通过定位单个微泡并以亚波长分辨率跟踪其位移而生成微米尺度的血管和速度图,对于诊断和监测疾病发展具有巨大潜力。本文就超声超分辨率微血流成像起源、超声定位显微镜具体操作步骤及其临床前应用进展进行综述。     

静脉注射FX530声学造影剂对组织器官血流灌注的实验研究

目的评价新型声学造影剂应用于观察组织器官的血流灌注情况。方法经静脉注射ＦＸ５３０后,应用二维灰阶图像、彩色多普勒血流成像、彩色多普勒能量图、三维超声成像以及二次谐波成像、瞬间反应成像等技术观察兔肝脏、肾脏以及多部位移植性ＶＸ２肿瘤等的血流灌注情况。结果造影后增强了肝脏、肾脏等组织器官的灰阶图像和组织小血管的彩色多普勒血流信号,提高了肿瘤的可视性,并增加了对肿瘤的检出。结论静脉注射新型声学造影剂是观察组织器官血流灌注的有效方法     

肾脏血流灌注的评估:造影增强彩色多普勒时间-强度曲线分析

背景超声评价肾脏功能主要通过测量较粗大的肾脏各级动脉的血流参数或肾切面内动脉彩色血流面积所占的比例来推断,误差较大.目的应用超声仪器随机配置的彩色多普勒时间-强度曲线软件评价肾脏血流灌注情况.设计动物实验观察.单位广州市第一人民医院功能检查科.材料实验于1999-01/2000-04在广州军区广州总医院动物实验室完成,选择8只健康新西兰兔,雌雄各4只,体质量2.5～3.5 kg.观察肾脏16个.声学造影剂为全氟显,主要成分为声振白蛋白的微泡,微泡内有一定浓度的全氟丙烷气体.方法兔外周静脉团注造影剂全氟显后用彩色多普勒能量图、彩色多普勒血流显像和彩色多普勒能量谐波成像连续采集肾脏彩色血流图像,随机配置软件显示时间-强度曲线.主要观察指标造影增强肾脏血流灌注时间-强度曲线的形态.结果进入结果分析8只家兔.肾脏血流造影增强的时间-强度曲线呈单峰状,上升支陡直,下降支平缓.调节时间轴上的感兴趣线可作定量分析,回放显示注射造影剂后对应某一时刻的造影增强的彩色多普勒图像.结论造影增强彩色多普勒血流显像和彩色多普勒能量图的时间-强度曲线能有效的观察肾脏血流灌注特征,既可显示整个肾脏的血流灌注情况,也用于观察低血流灌注区域,发现病灶进一步绘制肾功能图.     

四维超声、断层成像和容积对比成像对胆囊疾病的应用价值

目的：探讨四维超声、断层成像和容积对比成像对胆囊疾病的应用价值。方法：采用GE Voluson-E8超声系统和4D view分析软件对60例胆囊疾病患者进行超声研究。结果：57例胆囊疾病均获得满意图像。四维超声显示胆囊结石、息肉形状直观、立体、逼真;多平面断层成像技术显示出不同断层、不同平面的丰富超声信息;容积对比成像技术明显提高图像的信噪比和分辨率。结论：①四维超声、断层成像和容积对比成像技术的联合应用能使病灶组织显示出逼真的动态立体图像、丰富的断层超声信息和良好的分辨率及信噪比。②三种技术联合应用对于胆囊疾病有着独特的诊断价值,能节省检查时间,减少操作者的技术因素影响,提高诊断正确性,有着广阔的应用前景。     

正常移植肾血流的三维彩色多普勒成像特征

目的探讨正常移植肾血流的三维彩色多普勒成像特征。方法功能正常的同种异体移植肾患者22例；仪器为Acuson X／P 128彩色多普勒超声诊断仪(探头频率3.5MHz)和Tom Tec Echoscan 4．2三维彩色多普勒图像处理工作站，采用磁场空间定位自由扫查系统进行三维图像获取，脱机后进行移植肾血流的三维图像重建与显示。结果移植肾血流的三维彩色多普勒图像特征为，可以立体地显示整个肾脏的血管树结构及血管变异特征。结论三维彩色多普勒超声成像技术能够对肾脏血管进行完整、直观、立体地显示，是对二维超声切面成像的一个有意义的改进和提高。     

正常颈动脉分叉MRA成像的实验研究

目的：探讨不同成像参数及成像序列对ＭＲＡ图像的影响。方法：对７名健康自愿者分别进行ＭＲＡ检查,观察第一种主要成像参数改变及不同成像序更对ＭＲＡ图像的影响。结果：血流／组织信号对比随ＴＲ时间延长而降低;ＴＥ时间越长,颈动脉分叉部血流信号减弱越明显;射频偏转角越大,血流／组织信号对比就越高,但血管搏动伪影也越明显;激励层面增厚可增加成像范围,且可提高信噪比,但空间分辨率下降。３ＤＭＲＡ空间分辨比２ＤＭ     

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.