组织弹性成像鉴别乳腺良恶性肿块的价值评估

目的评价组织弹性成像技术在鉴别诊断乳腺良恶性肿块中的价值.方法用组织弹性成像技术对175名患者的184个乳腺肿块进行良恶性的鉴别诊断,并与术后的病理结果进行对照.结果组织弹性成像技术对乳腺肿块的良恶性鉴别诊断准确性、灵敏度和特异度分别为78.8%(145/184),76.1%(51/67)和80.3%(94/117).结论组织弹性成像为超声鉴别诊断良恶性乳腺肿块提供了一个新的手段.尽管可能会增加一定数量的假阳性,但更重要的是弹性成像能有效地减少假阴性的发生.     

超声弹性成像在鉴别诊断BI-RADS-US 4B级乳腺肿块中的价值评估

目的评价组织弹性成像技术在鉴别诊断BI-RADS-US 4B级乳腺肿块中的价值评估。方法用组织弹性成像技术对41名常规超声诊断为US BI-RADS 4B的患者进行乳腺肿块良恶性的鉴别诊断,并与术后的病理结果进行对照。结果乳腺良性和恶性肿块的组织弹性分级和面积比有显著性差异,利用弹性分级和面积比对乳腺肿块的良恶性鉴别诊断的灵敏度和特异度分别为75%(9/12)和86.21%(25/29)。结论常规超声如结合组织弹性成像技术,可有效提高US BI-RADS 4B级乳腺肿块的良恶性鉴别诊断准确性。     

常规超声结合弹性成像对乳腺肿块良恶性的鉴别诊断价值

目的探讨常规超声结合弹性成像对乳腺肿块良恶性的鉴别诊断价值。方法 98例乳腺肿块患者共106个肿块,其中良性60个,恶性46个;术前行常规超声和弹性成像检查,并与术后病理结果对照。结果乳腺良性肿块弹性评分1~3分53例,占88.33%,平均(1.95±1.06)分;恶性肿块弹性评分4~5分35例,占76.09%,平均(4.02±0.95)分,两者差异有统计学意义(P0.05)。以弹性评分≥4分为界点,常规超声联合弹性成像诊断乳腺恶性肿块的敏感性、特异性、准确性分别为93.48%、88.33%、90.57%;联合应用诊断乳腺肿块良恶性的敏感性、准确性高于单独应用常规超声和弹性评分法(均P0.05),三者诊断特异性差异无统计学意义。结论乳腺良恶性肿块弹性评分分布情况各有特点,超声弹性成像联合常规超声能提高对乳腺肿块良恶性的鉴别诊断能力。     

超声弹性成像与彩色多普勒超声在乳腺占位性病变诊断中的对比研究

目的 比较超声弹性成像超声(UE)与彩色多普勒超声(CDFI)在乳腺占位性病变鉴别诊断中的应用价值.方法 对93例,100个乳腺占位性病灶术前行彩色多普勒和超声弹性成像检查,以手术病理为金标准,对比分析彩色多普勒超声和超声弹性成像诊断乳腺肿块良恶性的准确度.结果 超声弹性成像(UE)诊断乳腺恶性病灶的敏感度90.2%,特异度93.9%,准确度92.0%,彩色多普勒超声中根据肿块内血流情况(对显示最多血管条数的肿块超声切面进行评价)参照Adler分级诊断乳腺恶性病灶的敏感度64.7%,特异度77.5%,准确度71.0%,脉冲多普勒中根据血流的阻力指数(RI)诊断乳腺恶性病灶的敏感度74.5%,特异度71.4%,准确度73.0%.联合彩色多普勒和脉冲多普勒诊断乳腺恶性病灶的灵敏度为50.9%,特异度为89.7%,准确度为70%.结论 超声弹性成像在鉴别诊断乳腺占位性病变良恶性中的准确度高于彩色多普勒超声.     

超声弹性成像联合超声BI-RADS评分分级在乳腺肿块良恶性诊断中的应用价值

目的探讨超声弹性成像和超声图像报告与数据系统(BI-RADS评分分级)在乳腺肿块良恶性鉴别诊断中的应用价值。方法 116例患者175个乳腺肿块术前分别行超声弹性成像评分、BI-RADS评分分级及超声弹性成像评分联合BI-RADS评分分级检查,结果与病理对照分析,以评价其对肿块的诊断价值。结果 175个乳腺肿块,术后病理诊断为恶性77个,良性98个。恶性肿块BI-RADS评分分级和超声弹性成像评分明显高于良性肿块(P<0.05);超声弹性成像评分与BI-RADS评分分级在乳腺肿块良恶性诊断中的敏感性、特异性、准确率、阳性预测值及阴性预测值间比较差异均无统计学意义;超声弹性成像评分联合BI-RADS评分分级诊断乳腺肿块良恶性与两种方法单独诊断的敏感性、特异性、准确率、阳性预测值及阴性预测值比较差异均有统计学意义(均P<0.05)。结论超声弹性成像评分与BI-RADS评分分级联合应用有助于鉴别诊断乳腺肿块的良恶性,可提高诊断准确性。     

超声弹性成像技术鉴别乳腺肿块良恶性应用价值分析

目的探讨超声弹性成像技术对女性乳腺肿块良恶性的诊断价值。方法收集自2008年1月至2010年1月期间因乳腺肿块就诊于我院的420例患者的临床资料,并进行回顾性分析。所有患者均采用5分法对肿块的弹性硬度进行半定量分析,测量并记录肿块硬度、灰阶模式与弹性模式下的面积比,通过两种成像模式下所获面积比值的分析,得到肿块良恶性的最佳鉴别点,并对超声弹性成像技术在诊断乳腺良恶性肿块方面的灵敏度、特意度及准确率进行统计。结果乳腺肿块恶性鉴别的灵敏度、特异度及准确率分别为77.5%、91.1%、86.9%。运用两种成像模式下的图像面积比值对乳腺肿块良恶性鉴别时所获得的最佳诊断界点为1.8。结论超声弹性成像技术对乳腺恶性肿块的检查具有较高的检出率,与病理诊断的吻合度高。超声弹性成像技术对女性乳腺恶性肿块的诊断具重要价值。     

超声弹性成像联合常规超声鉴别甲状腺微小结节良恶性价值分析

目的分析超声弹性成像联合常规超声鉴别甲状腺微小结节良恶性的价值。方法选择健康体检结果为甲状腺微小结节患者100例(120个结节),全部患者均给予超声弹性成像联合常规超声检查,并经手术病理检查或穿刺检查证实;将手术病理检查结果作为诊断金标准,对超声弹性成像检查、常规超声检查的诊断准确率进行计算。结果病理检查结果显示,全部120个甲状腺微小结节中良性33个,恶性87个;常规超声检查、超声弹性成像检查、两者联合检查诊断甲状腺微小结节良恶性的准确率分别为80.0%(96/120)、71.7%(86/120)、85.8%(103/120)。结论在鉴别诊断甲状腺微小结节良恶性时,可以将常规超声检查作为常规检查技术,而超声弹性成像检查则是常规超声检查的有效补充,联合应用超声弹性成像检查和常规超声检查可显著提高鉴别诊断的准确性。     

超声弹性成像联合超声造影在乳腺BI-RADS 4级肿块良恶性鉴别诊断中的价值

目的探讨超声弹性成像(UE)联合超声造影(CEUS)在乳腺BI-RADS 4级肿块良恶性鉴别诊断中的应用价值。方法对112例乳腺BI-RADS 4级肿块患者行超声弹性成像和超声造影检测,并对术后病理结果进行对比。结果 112例患者共125个乳腺肿块,病理学诊断良性85例,恶性40例。85个良性乳腺肿块超声弹性成像评分(2.56±0.48)分,40个恶性乳腺肿块评分(3.85±0.67)分,恶性乳腺肿块超声弹性成像评分较良性乳腺肿块显著升高(P<0.05);良、恶性乳腺肿块超声造影形态特征在增强水平、对比剂分布、增强方式、肿块内血管形态、增强后边界、肿块周边放射状增强、造影后肿块大小等方面比较差异均有统计学意义(P<0.05)。超声弹性成像、超声造影及二者联合诊断的敏感性分别为75.0%、82.5%、92.5%,特异性分别为89.4%、85.9%、94.1%,准确性分别为84.8%、84.8%、93.6%。二者联合诊断的的敏感性、特异性及准确性均显著高于二者单独应用,差异具有统计学意义(P<0.05)。结论超声弹性成像联合超声造影技术更有助于乳腺BI-RADS 4级肿块良恶性的鉴别。     

弹性成像对乳腺良恶性肿物鉴别诊断价值

目的:探讨弹性成像对乳腺良恶性肿物鉴别诊断价值。方法:采用回顾性方法分析我院自2016年6月—2019年6月收治的89例乳腺肿瘤患者的临床资料,所有患者均给予超声弹性成像诊断,并以手术病理诊断为金标准,进行对比,分析乳腺良恶性肿瘤的弹性成像评分及敏感性、特异性及准确性。结果:恶性的弹性成像评分与良性肿块的弹性评分分布经对比分析,有显著差异(P<0.05)。弹性成像技术诊断乳腺癌良恶性肿瘤的敏感性92.42%(61/66)、特异性91.30%(21/23)、准确性92.13%(82/89)。结论:超声弹性成像可准确鉴别乳腺良恶性肿物,为临床治疗提供参考依据,值得推广应用。     

彩色多普勒超声与弹性成像对乳腺肿块诊断价值的比较

目的比较彩色多普勒超声与弹性成像对乳腺肿块良恶性的鉴别诊断价值。方法选取经过手术病理证实的乳腺肿块患者55例,比较彩色多普勒超声与弹性成像对乳腺良恶性的诊断价值。结果彩色多普勒超声诊断乳腺良恶性肿块的敏感性为87.50%,特异性为84.62%,正确指数为0.7212,误诊率15.38%,漏诊率12.50%,诊断符合率85.45%;弹性成像硬度评分诊断乳腺恶性病变的敏感性为85.00%,特异性为91.43%,正确指数为0.7643,误诊率8.57%,漏诊率15.00%,诊断符合率89.09%,两种方法诊断效能比较差异无统计学意义。结论彩色多普勒超声与超声弹性成像评分诊断乳腺肿块良恶性均具有较高的敏感性及特异性,可作为诊断乳腺肿瘤良恶性的重要手段。     

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.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.     

Spiritual Dimensions of Nursing Practice. edited by V. B. Carson

The Cochrane Library of Systematic Reviewsis published quarterly. Issue one for 2004 of the library was published in February 2004. This issue contains 3,329 reviews and protocols of which 1,921 are fully published reviews. The trials database now stands at over 400,000 records with an additional 4,427 one-page summaries of non-Cochrane reviews in the NHS database of reviews of effectiveness (DARE). This version of the library contains the results of an extensive search for RCTs on EMBASE. The latest library contains 84 new reviews, seven are considered relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews.     

Advance Care Planning

Predictors of patient wishes and influence of family and clinicians are discussed. Research findings on patient decision-making relating to preferences in end-of-life care are described. Advance directives and durable powers of attorney are defined and differentiated. Most patients have not participated in advance care planning and the need for more effective planning is documented. Appropriate times for discussions of such planning are described. Scenarios discussed include terminal cancer, chronic obstructive pulmonary disease, AIDS, stroke, and dementia. Patient satisfaction is discussed, as is a structured process for discussions about patient preferences. Results of patient responses to hypothetical scenarios are described. Invasiveness of interventions, prognosis and other factors that favor or discourage patient preferences for treatment are discussed. Findings resulting from research funded by the Agency for Healthcare Research and Quality (AHRQ) are discussed. This research can help providers offer end-of-life care based on preferences held by the majority of patients under similar circumstances.     

Évaluation,par l’imagerie ultrasonore,du recrutement musculaire,de la force motrice et de la détente verticale du quadriceps après électromyostimulation (cas de 15 étudiants de l’INJS)

The increase of strength seems to be an element of performance in some sports.