艾滋病合并肺结核的影像学分析

目的：探讨艾滋病（AIDS）合并肺结核（PTB）的影像学表现。材料与方法：回顾性分析21例AIDS合并PTB的影像学表现。21例均行X线胸片检查，其中9例行CT检查。结果：21例中浸润型肺结核15例，血行播散型肺结核4例，原发型肺结核2例；病变多为大片状、斑片状或小片状渗出实变阴影，其中可有小结节、空洞、肺门和／或纵隔淋巴结肿大等病灶阴影混杂存在，境界模糊，呈双肺多叶、段受累的随机分布，病灶多有融合趋势。结论：艾滋病合并肺结核后，多种性质的病灶共存，多形态表现，多叶、段分布，确诊有赖于HIV血清抗体试验及痰细菌学检查。     

34例陈旧性肺结核并发周围型肺癌的X线和CT诊断

对34例陈旧性肺结核并发周围型肺癌的X线和CT影像资料进行回顾性分析。陈旧性肺结核并发周围型肺癌较常见,本组10例不典型周围型肺癌被漏诊。     

老年人肺结核的X线分析

目的 探讨老年人肺结核X线及临床特点，提高对老年的肺结核的认识。方法 回顾性分析109例老年人肺结核的X线及临床表现，并以109例大学生肺结核作对比。结果 老年人肺结核患者有以下特征：①临床症状不典型（63.3%）；②男性多于女性；③病变广泛，易形成空洞（62.3%），双肺发病多见（56.9%）；④易开成支气管播散（32.1%）。老年人肺结核组与大学生肺结核组比较，有显著差异（P＜0.01）。结论 老年人肺结核病变部位缺乏特征，多种形态病灶并存，合并症多，每年对老年人进行一次X线检查很有必要。     

艾滋病合并肺结核的X线平片分析

目的探讨艾滋病（AIDS）合并肺结核（PTB）的胸部X线影像表现。方法回顾性分析42例AIDS合并PTB的正侧位X线胸片，42例均有胸部CT检查资料。结果42例中浸润型肺结核30例，其中合并胸腔积液8例，血行播散型肺结核7例，原发型肺结核5例；肺部阴影多为大片状或小片状互相融合状，边缘模糊，其中可有空洞；肺门、纵隔淋巴结肿大多见；病灶分布广泛，常常双肺多叶多段同时受累。结论胸部X线检查对艾滋病合并肺结核的诊断以及在确定病变的范围与程度、抗结核治疗动态效果评价等方面具有重要价值。     

23例不典型肺结核X线特征分析

目的：探讨不典型肺结核的X线表现特征,提高其诊断准确率,减少误诊率。材料与方法：回顾性分析23例不典型肺结核的X线表现特征。结果：23例不典型肺结核中右肺中下叶结核13例,慢性粟粒型肺结核2例,左肺继发型结核合并空洞1例,左肺下叶结核5例,两肺中下叶结核2例。结论：不典型肺结核X线表现不典型,临床表现复杂多样,普放工作者应提高对不典型肺结核的X线特征的认识,以减少误诊率,提高诊断准确率。     

老年肺结核合并肺癌90例临床分析

目的 探讨老年肺结核合并肺癌的临床特点。方法 回顾性分析90例老年肺结核合并肺癌患者的临床特点及治疗与转归。结果 患者平均年龄68．2岁。临床表现以刺激性咳嗽、咯血、进行性气短、胸痛、消瘦为主。影像学多表现为肺结核病变与团块并存，部分病例表现为陈旧性肺结核病灶基础上出现团块或结节状阴影，容易造成漏诊或误诊.结论 老年肺结核患者应高度警惕肺癌发生，定期复查X线胸片，做到早期诊断，早期治疗。     

无X线引导下经纤维支气管镜肺活检对肺部周围性病灶的诊断价值

目的：评价在无X线引导下经纤维支气管镜肺活检（简称经纤支镜肺活检）对肺部周围性病灶的诊断价值。方法：在无X线引导下对42例肺部周围性病人进行经纤支镜肺活检。结果：42例共行经纤支镜肺活检50次，诊断率为81．0％（34／42），其中肺癌诊断率为82．8％（24／29），肺结核诊断率为71．4％（5／7）。全组并发症发生率为44．0％（22／50），均为痰中带血，无大咯血、气胸及其它严重并发症情况发生。结论：无X线引导下经纤支镜肺活栓对肺部周围病灶有较高的诊断率。     

老年性肺结核80例隘床X线分析

目的研究老年性肺结核的X线特征，提高影像诊断准确率。方法收集80例最终确诊为老年性肺结核的临床、病理和X线资料，男50例，女30例，平均年龄71岁，结合文献回顾性分析。结果症状：80例均咳嗽咳痰，伴发热57例（其中高热2例），痰中带血21例，盗汗22例，消瘦乏力71例，胸闷气短44例，浮肿5例。实验室检查：WBC增高5例，分类淋巴细胞升高67例，OT试验阳性19例，血沉加快50例，痰菌阳性42例。抗结核：明显吸收67例，吸收不明显16例，恶化6例。性质：渗出增殖为主38例，粟粒性为主2例，干酪性肺炎17例，空洞性病变为主11例，结核性胸膜炎12例，支气管播散14例。结论国内外资料显示，近年结核呈逐年升高趋势，老年人肺结核患者已成为目前主要的传染源。主要原因有：人口的老年化；易感因素增加；免疫功能的下降；营养不良；全身生理性改变；有较为严重的基础疾病及肺部病变。通过80例病例的分析，笔者认为老年性肺结核不论在临床还是x线胸片上都具有一定特殊性：（1）临床症状不典型，甚至与肺内病变不相称。常缺乏典型的结核中毒症状，咯血较少，咳嗽、心悸、胸闷气短、乏力、消瘦相对较多；有的仅有全身乏力、食欲减退、胃肠功能紊乱等；偶以神经精神紊乱为主要表现；无症状病例约占1／4，故漏诊率高；（2）胸部X线表现特殊。典型早期表现为中、下肺野浸润，逐渐发展为硬结纤维化灶，多双肺发病，累及下肺者多见于中青年；病灶主要为干酪样变，X线以浸润型为主，并易形成支气管播散及多发空洞，需与癌性空洞或结节鉴别。不常见征象：肺不张、大叶性肺实变、胸腔积液等较中青年多；（3）并发症多；（4）排菌率高。血沉加快明显；结核菌素试验阳性率低，但痰菌阳性率大大高于青壮年，近50％的人痰菌阳性；（5）治疗效果差；（6）复发率高；（7）病死率高；（8）卡介苗预防接种无效。老年性肺结核临床表现和X线表现均有一定特点，故定期为老年人做胸部X线检查，结合临床资料综合分析影像学资料，有利于早期发现并提高鉴别诊断能力。     

肺结核合并肺癌45例临床分析

目的　探讨肺结核并发肺癌的关系及其临床特点。方法　回顾性分析肺结核合并肺癌 4 5例患者的临床特点、影像学表现 ,并与同期单纯肺结核 4 5例进行对照。结果　肺结核合并肺癌组 (TB CA组 )中 ,肺癌与肺结核位于同侧同叶肺者 33例 (73.3% )。同侧不同叶肺 7例 (15 .5 % )。该组患者以大量吸烟史者居多 ,胸痛、痰血、消瘦、气急更加多见。X线表现 :(TB CA)组肺癌病灶以团块阴影、分叶毛刺、肺不张多见。结论　肺癌与肺结核有一定的因果关系。肺结核与肺癌并存易误诊 ,应注意多种征象的联合分析和病灶的短期动态观察     

下肺结核的CT研究

目的：研究下肺结核的CT诊断价值。方法：回顾性分析54例经病理、痰查结核菌或抗结核治疗追踪的不合并上肺结核的下肺结核的CT表现。结果：大片实变型和小叶肺炎型病灶内常见虫蚀样空洞、支气管含气征、支气管扩张和钙化。空洞型以薄壁空洞多见,内外壁多光滑,无或少液平,壁上多见钙化,同侧／对侧支气管插散有特征性。团块或类圆型无／浅分叶,平扫密度接近水,无／轻度强化,包膜和间隔强化和钙化。近肺门侧病灶周围炎、无强化和不典型胸膜凹陷征为其特征表现。结核肉芽肿可显著强化。结论：CT有助于下肺结核的诊断。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

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.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."