三维超声在实验兔VX2乳腺癌研究中的应用

目的探讨实验兔VX2乳腺癌肿瘤内血流动力学变化特征。方法应用二维及三维超声分别对注射VX2乳腺癌肿瘤悬液的17只实验兔肿瘤内部及周边血流动力学参数收缩期峰值流速(PSV)、搏动指数(PI)和阻力指数(RI)进行比较,利用VOCAL-Ⅱ功能量化分析肿瘤内部及周边的血供,并测量血管形成指数(VI);观察17只实验兔乳腺肿瘤内血流变化情况,比较二维和三维超声观察肿瘤大小及血流变化的差异。结果注射肿瘤悬液1周,17只实验兔乳腺部位均出现肿瘤图像,但二维及三维超声于肿瘤内部及周边均未测及血流信号;第2～3周于肿瘤内部及周边分别测及Ⅰ、Ⅱ级为主的血流信号;第4～5周二维及三维超声测及肿瘤内Ⅱ～Ⅲ级为主的血流信号;但三维超声测及肿瘤内的Ⅲ级血流信号多于二维超声。乳腺肿瘤内测及血流参数PSV:0～23.96cm/s,RI:0～0.54,PI:0～0.88,VI:0～60.38%;第3～5周与第2周PSV、VI血流参数测值比较差异无统计学意义,注射肿瘤悬液后3～5周,肿瘤内VI、PSV测值与第2周测值比较差异均有统计学意义(P<0.05)。结论注射肿瘤悬液后随着肿瘤体积逐渐增大,实验兔乳腺VX2肿瘤内测及的Ⅲ级血流明显增多,三维超声可对实验兔VX2乳腺肿瘤内的血流级别作出准确评估,为乳腺癌血流动力学研究提供实验依据。     

兔肾VX2肿瘤模型超声显像与肿瘤增殖活性及侵袭性的关系

目的 探讨兔肾VX2肿瘤超声观测指标与其增殖活性及侵袭性的关系。方法 建立56只兔肾VX：肿瘤模型，种植3周后应用二次谐波和声像图定量技术检测癌灶大小、回声强度、边缘回声及能量面积比，并与肿瘤的组织病理学、流式细胞仪测定的增殖指数(PI)及倍体细胞率(PCR)相比较。结果 兔肾VX2肿瘤的PI及PCR与肿瘤边缘回声无明显相关，而与肿瘤大小、内部回声强度及血流丰富程度有一定关系。结论 超声观测指标可用于推测肾癌的增殖活性及侵袭性，为肾癌的早期诊断与疗效评估提供参考依据。     

乳腺肿块的高频彩超诊断与病理基础分析

目的探讨高频彩超诊断乳腺良恶性肿块的声像图特征及其诊断价值。方法对经病理证实的乳腺良性肿块22例和恶性肿块20例的高频彩超声像图进行回顾性分析。结果本组大多数恶性肿块形态不规则,边界不清,内部回声不均匀,以低回声为主,部分后方有衰减,肿块纵横比〉1。彩色多普勒血流分级大多数为-级;PI值〉1.2,RI值〉0.70。8例（36.3%）同侧腋窝淋巴结肿大,血流丰富。乳腺良性肿块大多表现为：形态规则,边缘光整,内部回声均匀,侧缘回声减弱,纵横比〈1;彩色多普勒血流分级大多数为0-级;PI值〈1.2RI值〈0.70。结论高频彩超对乳腺肿块的检出率高,高频二维超声特征接合彩色多普勒表现对乳腺良恶性肿瘤的鉴别诊断具有较高的临床应用价值。     

实验性兔肾VX2肿瘤的血流动力学变化研究

目的　探讨小肾癌对肾脏血流动力学的影响。方法　采用超声引导下经皮组织块推注法建立 5 6只兔肾VX2肿瘤模型 ,检测种植前及种植后不同时期的肾动脉 ,观察癌周和癌灶内部血流分布 ,检测肾动脉、癌周和癌灶内部的最大血流速度 (Vmax)、血流速度积分 (VTI)和阻力指数 (RI) ,分别对种植前及种植后不同时期的血流动力学参数进行对比分析。结果　随着种植时间的延长、肿瘤的增大 ,肾动脉的内径逐渐增宽 ,血流量逐渐增多。肾动脉Vmax、RI无明显变化。癌灶内血流分布以短线状和树枝状居多 (87.5 % ) ,癌灶周边以环状居多 (85 .7% )。癌灶内血流收缩期峰值速度明显低于周边 ,而阻力指数明显高于周边。兔肾VX2 瘤血流动力学特点为癌灶内部呈低速高阻型 ,周边呈高速低阻型。结论　随着小肾癌癌灶的增大肾脏血供增加 ;癌灶内部和癌灶周边血流动力学有明显差异。此点有助于小肾癌的诊断     

超声造影监测兔肾VX2移植瘤生长特性

目的 探讨超声造影技术在监测兔肾VX2移植瘤生长及评价其特性中的应用价值。方法 应用组织包埋法建立20只兔肾VX2移植瘤模型,将其随机均分为4组,分别于植瘤后1~4周进行超声造影检查,造影结束后切除荷瘤肾脏,进行病理检查。结果 所有动物均成功建模,超声造影测量的各组肿瘤大小与实体标本测量结果差异无统计学意义(P均>0.05),两种方法的测量结果存在一致性。各组兔肾VX2移植瘤超声造影均呈低增强表现,强度弱于肾实质。植瘤后1~2周,主要表现为肿瘤大部增强(7/10),在植瘤后3~4周,主要呈现肿瘤周边增强(8/10)。结论 超声造影可准确显示兔肾VX2移植肿瘤的边界和肿瘤内部的血流灌注特点,在监测兔肾VX2移植瘤的生长和评估移植瘤特性方面具有重要应用价值。     

兔早期脑动脉粥样硬化血流动力学研究

目的 :通过应用超声多普勒寻找早期脑动脉粥样硬化血流动力学参数变化规律。方法 :大耳白兔2 2只 ,随机分为两组 :15只为实验组 ,7只为对照组。分别于 0、 4、 8、 12周测量所有兔血流动力学参数 ,并同期行病理检查。实验组内采取自身对照 ,同时与对照组采取组间对照。结果 :自身对照 PSV、EDV、TAMAX4周、8周均增高 (P<0 .0 5) ;12周仅 PSV、 TAMAX增高 (P<0 .0 5)。 PI、 RI、 S/D 4周时均降低 (P<0 .0 5)。组间对照 4周时实验组 PSV、 EDV、 TAMAX高于对照组 (P<0 .0 5) ;8周时仅 PSV高于对照组 (P<0 .0 5) ;12周时实验组 EDV、 TAMAX低于对照组 (P<0 .0 5) ,PI、 RI高于对照组 (P<0 .0 5)。实验组 8周时内膜有少量泡沫细胞沉积 ;12周时可见脂纹。结论 :兔早期脑动脉粥样硬化时 PSV、 EDV、 TAMAX呈先升高后回落趋势 ;PI、RI、 S/D呈先降低后回升趋势。 PSV可能是诊断早期脑动脉粥样硬化最敏感的血流动力学参数     

二维及多普勒超声观察射频治疗兔VX2肝肿瘤早期疗效的实验研究

目的　评价超声在观察集束电极射频治疗兔VX2 肝肿瘤早期疗效中的作用。方法　超声引导下将 2 5只大白兔建立VX2 肝肿瘤模型 ,随机抽取 5只作为对照组 ,其余 2 0只作为治疗组进行射频治疗 ,分别于治疗前 1d和治疗后当日 ,3d ,7d及 14d对肿瘤形态学及血流动力学变化进行超声观察。在治疗后每次超声检测结束处死 5只大白兔 ,取肿瘤标本进行病理检查。结果　肿瘤射频治疗后 ,治疗区呈极不均匀斑点状强回声及低回声 ,瘤内血流信号全部消失 ,部分肿块瘤周局部区域仍有血流信号。治疗后肿块未见明显长大 ,治疗组肿块治疗后 14d明显小于相应时间对照组肿块 (P <0 .0 1)。病理证实极不均匀回声及血流信号消失区域即为肿瘤组织凝固坏死区域 ,局部仍有术前肿瘤回声特点及血流信号存在的区域即为残存肿瘤或治疗不完全的区域。结论　兔VX2 肝肿瘤射频治疗后凝固坏死区具有一定的声像图特异性表现 ,结合彩色多普勒血流显像及能量多普勒超声 ,对肝肿瘤疗效观察确切可行。     

彩超对乳腺良、恶性肿瘤的鉴别诊断

目的：探讨彩超诊断乳腺良恶性肿块的声像图特征及其诊断价值。材料与方法：对经病理证实的乳腺良性肿块35例和恶性肿块18例的高频彩超声像图进行回顾性分析。结果：本组大多数恶性肿块形态不规则，边界不清，内部回声不均，以低回声为主，部分后方回声衰减，肿块纵横比≥1。彩色多普勒血流分级大多为Ⅱ-Ⅲ级；PI〉1．2，RI〉0．7。6例（33．3％）同侧腋窝淋巴结肿大，血流丰富。乳腺良性肿块大多形态规则，边缘光整，内部回声均匀，侧缘回声减弱，纵横比〈1；彩色多普勒血流分级大多为0-Ⅰ级；PI〈1．2，RI〈0．7。结论：高频彩超对乳腺肿块的检出率高，对乳腺良恶性肿瘤的鉴别诊断具有很高的临床应用价值。     

兔脂肪肝及正常肝内VX2移植瘤常规超声特征及超声造影定量比较研究

目的 探讨脂肪肝与正常肝内VX2移植瘤常规超声特征,对比分析两种肝背景及其内VX2移植瘤血流灌注特征.方法 建立兔脂肪肝与正常肝内VX2移植瘤并进行常规超声及超声造影检查,应用QontraXt超声造影定量分析软件进行定量分析.结果 成功建立兔脂肪肝内VX2移植瘤结节20个,正常肝内VX2移植瘤结节23个.两组肝内等、低回声肿瘤结节发生率差异无统计学意义(P＞0.05),脂肪肝内高回声VX2移植瘤结节较正常肝内少(P=0.008).脂肪肝背景造影始增时间晚于正常肝(P＜0.05),峰值强度低于正常肝(P＜0.05).脂肪肝内VX2移植瘤造影始增时间、峰值强度、曲线尖度、曲线下面积与正常肝内VX2移植瘤比较,差异均无统计学意义(均P＞0.05).结论 脂肪肝内VX2移植瘤常规超声回声与正常肝内有所差异;脂肪肝背景造影剂灌注效应低于正常肝.超声造影定量参数更能客观准确地反映VX2移植瘤及脂肪肝的血流动力学特征.     

彩色多普勒血流成像在乳腺肿瘤中的价值

目的探讨乳腺肿瘤彩色多普勒血流成像在BI-RDAS-US(超声乳腺影像报告与数据系统)中的应用价值。方法回顾性分析经手术组织病理证实的289例女性乳腺肿瘤患者的彩色多普勒超声影像资料,并进行BI-RADS-US评估。结果乳腺恶性肿瘤血流检出率、肿瘤血流丰富程度2～3级者比例、收缩期最高峰速(peak systolicvelocity,PSV)、阻力指数(resistance index,RI)高于良性肿瘤(P<0.01);随BI-RADS-US评估分类级别增高,血流检出率、肿瘤血流丰富程度2～3级者比例及PSV,RI均逐渐增高;BI-RADS-US评估分类诊断乳腺恶性肿瘤的敏感性64.33%,特异性99.24%,准确性80.62%,阳性预测值99.01%;BI-RADS-US结合PSV(≥12cm/s),RI(≥0.7),诊断乳腺恶性肿瘤的敏感性88.30%,特异性99.15%,准确性92.73%,阳性预测值99.34%。结论 PSV,RI结合肿瘤二维声像图表现,可提高乳腺恶性肿瘤的诊断敏感性、准确性,有助于改善BI-RADS-US 4类病变的诊断。     

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.     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.