超声造影检测兔胆管缺血及其程度

目的以微血管密度(MVD)作为"金标准",探讨超声造影(CEUS)检测胆管缺血及其程度的可行性。方法对20只健康新西兰兔行胆管取材,进行CD34免疫组化染色后定量分析MVD,建立正常及缺血胆管壁MVD定量标准。另取健康新西兔30只,其中10只兔建立胆管缺血模型;10只兔进行假手术处理;另外10只兔不进行外科处理。30只兔均进行CEUS检查,分别记录胆总管、左中叶胆管及右中叶胆管共90条胆管壁CEUS增强模式。CEUS后处死动物取相应胆管节段进行MVD定量分析,并根据所建立的MVD定量标准,记录正常、轻度缺血及重度缺血胆管壁CEUS增强模式。结果正常胆管壁MVD值5.84,轻度缺血胆管壁MVD值为4.54~5.84,重度缺血胆管壁MVD值4.54。根据此MVD定量标准,52条正常胆管壁CEUS主要表现为动脉期高增强。缺血胆管壁CEUS增强水平降低;14条轻度缺血胆管壁增强模式为动脉期等增强,门脉期呈等或低增强;24条重度缺血胆管壁增强模式为动脉期低或无增强,或动脉期等增强而门脉期呈无增强。结论 CEUS及其增强模式反映胆管血供及其缺血程度;CEUS可用于临床无创性检测胆管血供相关疾病。     

超声造影定量评估实质期兔肝VX2瘤血供程度的演变过程

目的 探讨超声造影(CEUS)在定量评估实质期兔肝VX2瘤血供及血供演变过程中的价值. 方法 将18只兔肝VX2肿瘤模型随机分为3组(每组6只),分别于术后10、15、20天接受CEUS,绘制时间-强度曲线(TIC),计算各组肿瘤及周边正常肝组织的TIC参数.CEUS后取兔肝肿瘤及周边正常肝组织行病理免疫组化染色,计数微血管密度(MVD). 结果 CEUS及TIC显示实质期兔肝VX2瘤呈典型"快进快出".3组肿瘤达峰时间(TTP)均短于相应的正常组织(P＜0.01),但肿瘤TTP组间差异无统计学意义(P>0.05).肿瘤绝对峰值强度(AEI)及肿瘤MVD:10天组、15天组、20天组依次减低(P＜0.05).肿瘤MVD与正常肝组织比较:10天组肿瘤MVD高于正常肝组织(P＜0.01)、15天组等于正常肝组织(P>0.05),20天低于正常肝组织(P＜0.01).肿瘤AEI与MVD呈正相关(r=0.83,P＜0.05). 结论 超声造影TIC指标AEI能实时定量评估实质期兔肝VX2肿瘤血供状况.实质期兔肝VX2肿瘤血供呈"富血供-等血供-乏血供"逐渐递减的演变过程.     

移植肝胆道并发症与正常胆道的超声造影增强特点比较

目的 探讨肝移植后缺血性胆道病变(ITBL)区别于正常胆道及其他胆道并发症的超声造影表现.方法 选择正常健康者18例;无并发症移植肝18例;移植肝胆道并发症36例分为2组:①非ITBL组12例,包括3例胆管吻合口狭窄、4例胆管炎、1例胆泥和4例急性排异反应;②ITBL组24例.进行肝门部胆管超声造影(CEUS)检查.2名超声医生共同分析CEUS图像,记录胆管壁、肝动脉和肝实质增强时间及不同时期增强水平,总结各组肝门部胆管壁CEUS增强特点.结果 ①增强时间:除11例ITBL和1例非ITBL并发症患者胆管壁始终无增强外,其余胆管壁的开始增强时间均早于肝实质.②增强水平:动脉期,正常健康者、无并发症移植肝、非ITBL组胆管壁主要表现为等或高增强,两两比较差异无统计学意义(P＞0.05);ITBL与上述三组差异均有统计学意义(P＜0.05),主要表现为无或低增强.结论 动脉期胆管壁无或低增强是肝移植后ITBL区别于正常健康者、无并发症移植肝、非ITBL的主要特点,这或许可以成为诊断ITBL的CEUS诊断指标.     

超声造影监测缺血再灌注损伤兔肾皮质血流动力学改变的实验研究

目的:采用超声造影(CEUS)定量分析技术动态监测肾缺血再灌注损伤(Renal ischemia reperfusion injury,RIRI)后兔肾皮质血流灌注的改变.方法:54只家兔随机分为正常对照组,肾缺血后再灌注第2h组、第16h组、第24 h组、第3d组、第5d组.行CEUS并应用时间-强度曲线测量灌注峰值时间(TTP)、曲线上升支斜率(β)、灌注峰值强度(A)、曲线下面积(AUC),观察各参数的变化并分析与病理改变的相关性.结果:肾缺血恢复灌注后各组与对照组相比TTP值增加,β值降低,AUC增大(P＜0.05);缺血再灌注组各组间TTP、β有统计学差异,其中恢复灌注后第3d的TIP的延长和β的下降最为显著(P＜0.01).A值在RIRI后第16h,24 h,3d较对照组降低(P＜0.05),第3d最为显著(P＜0.01).结论:CEUS定量分析技术能在缺血再灌注损伤发生后早期发现肾皮质血流灌注的异常,肾缺血再灌注损伤早期即发生肾皮质微循环障碍,在第3d肾皮质微循环灌注受损最为严重,度过这一“危险期”,肾皮质微循环受损得以改善,CEUS定量分析技术能敏感反映这一过程.     

超声造影评价糖尿病足背部足拇短伸肌微循环的价值

目的 探讨超声造影(CEUS)评价糖尿病足背部足拇短伸肌微循环的应用价值。 方法 收集正常对照组25例、2型糖尿病(DM)组14例及2型糖尿病合并微血管病变(DM+MC)组16例。利用超声造影(CEUS)测量足拇短伸肌的血流灌注情况,获取造影剂到达时间(AT)、自跗外侧动脉到达足拇短伸肌时间(ΔAT)、峰值强度(PI)和实际增强强度(ΔPI)等灌注参数,各组造影参数有差异者进行事后两两比较;以DM+MC为判定标准,探讨造影参数对早期微循环障碍的诊断效能。 结果 三组CEUS的PI及ΔPI两两比较差异均有统计学意义(P均＜0.05),三组CEUS的AT及ΔAT在正常组与DM组之间差异没有统计学意义(P＞0.05),在DM组与DM+MC组、正常组与DM+MC组之间的差异有统计学意义(P＜0.05),以临床诊断DM+MC为结果,CEUS的ΔAT(AUC 0.989)、ΔPI(AUC 0.954)诊断效能最佳。 结论 超声造影可以评价糖尿病足背部足拇短伸肌的微循环情况,ΔPI及ΔAT可为临床早期发现糖尿病足提供一定的诊断依据。     

超声造影参数鉴别胆管细胞癌与肝细胞癌的价值及其与MVD的关系

目的：探讨超声造影参数鉴别胆管细胞癌与肝细胞癌的价值及其与MVD的关系。方法：回顾性分析经病理确诊的42例胆管细胞癌患者与114例肝细胞癌患者的临床资料。研究时间为2015年05月至2019年08月,肝细胞癌患者按照不同分化程度分为高分化组、中分化组、低分化组,各38例；予以超声造影与免疫组化方法检测,评估检测后始增时间、峰值时间、始退时间、持续时间、微血管定量(MVD),分析超声造影定量灌注参数与MVD的关系,以及ROC曲线。结果：胆管细胞癌组的始增时间、峰值强度高于高、中、低分化组(P＜0.05)；胆管细胞癌组的峰值时间与高分化、中分化组相比,差异无统计学意义(P＞0.05)；胆管细胞癌组的峰值时间高于低分化组(P＜0.05)；胆管细胞癌组的始退时间、持续时间、MVD低于高、中、低分化组(P＜0.05)。胆管细胞癌组的始增强度与高、中、低分化组相比,差异无统计学意义(P＞0.05)。相关性分析显示,始增时间、始退时间与MVD无相关性(P＞0.05)；峰值时间、峰值强度与MVD呈负相关(P＜0.05)；持续时间、始增强度与MVD呈正相关(P＜0.05)。ROC曲线分析显示,始增时间的曲线下面积AUC值为(0.695,P＜0.05)；峰值时间的曲线下面积AUC值为(0.779,P＜0.05)；始退时间的曲线下面积AUC值为(0.655,P＜0.05)；持续时间的曲线下面积AUC值为(0.624,P＜0.05)；始增强度的曲线下面积AUC值为(0.635,P＜0.05)；峰值强度的曲线下面积AUC值为(0.639,P＜0.05)；MVD的曲线下面积AUC值为(0.998,P＜0.05)。结论：超声造影能够鉴别胆管细胞癌与肝细胞癌,通过时间-强度曲线各定量参数值评估肿瘤的分化程度,以及反映肿瘤内新生血管,能为其治疗提供客观依据。     

超声造影对兔股骨头坏死微循环灌注的定量研究

目的探讨超声造影(CEUS)在激素致兔股骨头坏死微循环灌注中的诊断价值。方法 12只新西兰兔随机分为空白组与模型组,造模3周后均行CEUS检查,并与病理相对照。结果 AS、DS、TTP、mTT两组间比较均有统计学意义(P<0.05),其中TTP、mTT意义更为显著(P<0.01)。病理学空骨陷窝率及微血管密度计数组间比较亦具有统计学意义。结论 CEUS可从微循环灌注的改变定量分析早期股骨头坏死,可为早期股骨头坏死的诊断提供有利的影像学依据。     

兔肌肉VX2肿瘤超声造影定量参数与MVD、VEGF的相关性

目的 探讨兔肌肉VX2肿瘤的超声造影(CEUS)定量参数与微血管密度(MVD)、血管内皮生长因子(VEGF)之间的相关性.方法 选用肌肉VX2肿瘤模型兔12只(双侧后肢大腿肌肉内种植VX2肿瘤),建模成功14～21天时接受CEUS,分析肿瘤的时间-强度曲线(TIC),测定定量参数.肿瘤标本采用免疫组织化学技术检测MVD及VEGF评分,并与超声造影定量参数进行相关性分析.结果 MVD与CEUS的定量参数峰值强度(PI)、曲线下面积(AUC)呈正相关(r=0.453,P<0.05;r=0.666,P<0.01),但与达峰时间(TTP)无相关(r=-0.185,P>0.05);肿瘤的VEGF评分与MVD呈正相关(r=0.543,P<0.01),但与CEUS各定量参数间均无相关(P均>0.05).结论 肌肉VX2肿瘤的CEUS定量参数PI、AUC与MVD呈正相关,在一定程度上可以间接提示肿瘤的MVD,有助于评估肿瘤的血管生成.     

超声造影定量评估失血性休克晶体复苏肝血流灌注变化的实验研究

目的:研究超声造影(CEUS)定量分析失血性休克(HS)晶体液复苏肝实质微循环灌注变化情况。方法:采用前瞻性研究方法,2016年3月选取我院45只实验兔随机分为五组,一组为正常对照组,其余四组采用Wiggers改良法建立可逆性HS模型,一组为休克组,其余三组用晶体液对动物模型复苏,随机分为复苏1 h组、4 h组、24 h组。各组均采血送检(肝功能:ALT、AST,血乳酸:LAC),同时行CEUS检查,生成TIC曲线定量分析。实验后取肝组织病检。结果:与正常对照组比较,休克组AT、TTP显著增加,PI、AUC降低(P<0.05);复苏1 h组PI、AUC升高,AT减低(P<0.05);复苏4 h组、24 h组,PI、AUC增加,AT、TTP减低(P>0.05)。与休克组比较,复苏1 h组PI、AUC增加,AT减低(P<0.05),TTP减低(P>0.05);复苏4 h组、24 h组,各参数均有统计学意义(P<0.05)。结论HS复苏期肝实质微循环灌注的改变可用CEUS定量评价,对临床疗效评估有一定价值。     

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.     

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.     

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.     

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.     

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.