慢性乙型肝炎患者免疫清除期肝脏弹性成像相关性研究

目的 探讨实时剪切波弹性成像(shear-wave elastography, SWE)评估免疫清除期慢性乙型肝炎患者肝纤维程度与病理结果相关性,为其研究提供可参考依据。方法 对213例免疫清除期慢性肝炎患者进行肝脏弹性模量值测量,以病理结果为金标准,分析免疫清除期慢性乙型肝炎患者肝脏纤维化分期与SWE技术测量结果之间的相关性,采用受试者工作特征曲线(ROC)分析剪切波弹性成像诊断≥ S2 期肝纤维化的效能。结果 肝纤维化 S0、S1、S2、S3～S4 期的弹性模量值分别为(6.73±2.04)kPa、(7.06±2.60)kPa、(88.34±4.12) kPa、 (12.82±6.63)kPa, 组间比较差异有统计学意义 (F=22.141,P<0.01)。SWE技术诊断显著肝纤维化 (≥ S2 期)的 ROC 曲线下面积为0.739,阈值为8.81 kPa,对应的敏感度与特异度分别为58.8%、81.9%。结论 SWE技术为诊断免疫清除期慢性乙型肝炎患者肝纤维化分期提供参考依据,为进一步治疗及预后提供一定帮助。     

剪切波弹性成像评估大鼠非酒精性脂肪肝病肝纤维化程度

目的探讨剪切波弹性成像(SWE)技术评估大鼠非酒精性脂肪肝病(NAFLD)肝纤维化程度的应用价值。方法将88只SD大鼠随机分为对照组(40只)和实验组(48只),对照组给予普通饲喂,实验组通过饮食调配建立不同肝纤维化分期的NAFLD模型,分别于第1、2、3、8、12周末随机抽取对照组大鼠8只,与预定喂养结束的实验组大鼠一起行SWE检查获取肝脏杨氏模量平均值(Emean),并处死行病理检查;绘制受试者工作特征(ROC)曲线分析Emean预测不同肝纤维化程度的诊断效能。结果肝纤维化F0期、F1期、F2期、F3期、F4期分别有52只、6只、6只、18只、6只,考虑建模成功,其对应的Emean分别为(5.46±0.37)kPa、(6.28±0.33)kPa、(6.42±0.41)kPa、(9.01±0.95)kPa及(15.88±2.49)kPa,不同肝纤维化分期Emean比较差异有统计学意义(F=25.5,P<0.05);除F1期与F2期比较差异无统计学意义外,其余任意两两比较差异均有统计学意义(均P<0.05)。所有大鼠肝脏Emean与肝纤维化程度呈显著正相关(r=0.82,P<0.001)。SWE诊断肝纤维化≥F1、≥F2、≥F3、F4期的截断值分别为6.3 kPa、7.4 kPa、8.6 kPa、9.7 kPa,曲线下面积分别为0.87、0.89、0.93、0.98,敏感性和特异性分别为83.3%、93.3%、100%、100%和85.5%、83.1%、91.3%、92.7%。结论SWE技术可有效评估大鼠NAFLD肝纤维化程度。     

声脉冲辐射力弹性成像与生化S指数评定兔肝纤维化的实验研究

目的探讨声脉冲辐射力弹性成像(ARFI)技术与血清生化指标S指数在兔肝纤维化分期中的诊断价值。方法 32只家兔皮下注射5%硫代乙酰胺制备肝纤维化模型(实验组),8只家兔于颈背部皮下注射生理盐水(对照组)。于造模第4、8、12周末行ARFI和血清实验室检查,获取肝脏剪切波速度(SWV),计算S指数,取肝脏制作标本行病理肝纤维化分期,比较SWV与S指数在兔肝纤维化分期中的诊断价值。结果实验组中29只家兔造模成功,肝纤维化分期S1、S2、S3、S4期分别为10只、8只、7只、4只;另3只家兔肝脏严重炎症坏死而无纤维化。SWV与S指数均随着纤维化程度的加重而增大,各组间差异均有统计学意义(P﹤0.05);SWV较S指数与肝纤维化病理分期具有更显著的相关性(r=0.724、0.472,P﹤0.05);应用SWV和S指数诊断肝纤维化程度≥S1、≥S2、≥S3、S4对应的ROC曲线下面积分别为0.92、0.87、0.82、0.89和0.76、0.75、0.71、0.74。结论 ARFI较生化S指数能更准确地诊断兔肝纤维化程度。     

组织弥散弹性成像定量分析软件评价大鼠肝纤维化分期

目的 探讨组织弥散弹性成像定量分析软件评价大鼠肝纤维化分期的可行性。 方法 对48只不同肝纤维化分期的大鼠及8只正常大鼠进行实时超声弹性成像(RTE)检查,通过组织弥散定量分析软件分析弹性图,获得弹性特征参数,包括应变均值、标准差、低应变区面积百分比、复杂度、峰度、偏度、对比度、均等性、杂乱度、一致性和相关性;比较不同肝纤维化分期大鼠上述参数的差异,分析其与肝纤维化分期的相关性。 结果 除复杂度和一致性外,其他参数在不同肝纤维化分期大鼠间差异均有统计学意义(P<0.05);相关分析显示除复杂度和一致性外,其他参数均与病理分期具有相关性(P<0.05),其中低应变区面积百分比与病理分期相关性最好(r=0.75,P<0.001)。以低应变区面积百分比判断肝纤维化分期绘制ROC曲线,曲线下面积分别为0.88(≥F1期)、0.92(≥F2期)、0.90(≥F3期)、0.94(F4期)。 结论 RTE中应用组织弥散定量分析软件可评估大鼠肝纤维化分期。     

实时剪切波弹性成像检测免疫清除期慢性乙型肝炎患者肝纤维化程度的研究

目的探讨实时剪切波弹性成像(SWE)在检测免疫清除期慢性乙型肝炎患者肝纤维化程度中的临床应用价值。方法应用SWE技术测量213例免疫清除期慢性乙型肝炎患者的肝脏弹性模量值,以病理结果为金标准,分析免疫清除期慢性乙型肝炎患者肝脏纤维化分期与SWE测值间的相关性;应用ROC曲线分析SWE诊断≥S2期肝纤维化的效能。结果 213例患者肝纤维化S0、S1、S2及S3~S4期的弹性模量值分别为(6.73±2.04)k Pa、(7.06±2.60)k Pa、(88.34±4.12)k Pa及(12.82±6.63)k Pa,差异有统计学意义(F=22.141,P0.01)。肝脏弹性模量值与免疫清除期肝纤维化程度呈正相关(r=0.488,P=0.000)。SWE诊断≥S2期肝纤维化的ROC曲线下面积为0.739,截断值为8.81 k Pa,敏感性为58.8%,特异性为81.9%。结论 SWE技术可为诊断免疫清除期慢性乙型肝炎患者肝纤维化分期提供参考依据,为进一步治疗及预后提供一定帮助。     

SWE评估非酒精性脂肪肝病大鼠肝纤维化程度

目的 探讨剪切波弹性成像(SWE)技术评估非酒精性脂肪肝病(NAFLD)大鼠肝纤维化程度的应用价值。 方法 SD大鼠88只,随机分为对照组(40只)和实验组(44只),对照组给予普通饲喂,实验组通过不同饮食建立不同纤维化分期的NAFLD大鼠模型,分别于第 1、2、3、8、12周末行大鼠肝脏SWE检查及病理分析。 结果 所有大鼠肝脏Emean与肝纤维化程度呈显著正相关(r=0.82,P＜0.001)。不同纤维化分期的Emean组间差异有统计学意义(F=25.5,P＜0.05);除了F1和F2组之间Emean没有显着差异(P＞0.05),其余任意两组之间的肝 Emean 比较差异均有统计学意义(均P＜0.05)。SWE诊断肝纤维化≥F1、≥F2、≥F3、＝F4的截值分别为6.3、7.4、8.6、9.7kPa,曲线下面积(AUC)分别为0.87、0.89、0.93、0.98,敏感性和特异性分别为83.3%、93.3%、100%、100%和85.5％、83.1%、91.3%、92.7%。 结论 SWE技术可有效评估NAFLD的肝纤维化程度。     

声辐射力脉冲技术和天门冬氨酸氨基转移酶与血小板比值指数评价家兔肝纤维化

目的 探讨声辐射力脉冲（ARFI）技术和天门冬氨酸氨基转移酶与血小板比值指数（APRI）评价家兔肝纤维化模型的价值。方法 应用硫代乙酰胺（TAA）对32只家兔以皮下注射的方法建立肝纤维化模型,以8只家兔作为对照组。于首次注射后第4、8、12周分批应用ARFI获取剪切波速度（SWV）,计算APRI,取其肝脏行病理肝纤维化分期。以病理检查结果为金标准,比较SWV和APRI指数对家兔肝纤维化分期的诊断价值。结果 共29只家兔造模成功,其中肝纤维化分期为S1、S2、S3和S4期者分别为10、8、7和4只。SWV值和APRI均随纤维化程度加重而增高（P<0.05）。SWV（r=0.724,P<0.05）和APRI（r=0.555,P<0.05）与肝纤维化病理分级均存在相关性。SWV和APRI诊断家兔肝纤维化S≥1、S≥2、S≥3、S=4的ROC曲线下面积分别为0.92、0.81,0.87、0.78,0.82、0.76,0.89、0.79。SWV和APRI联合诊断S≥3的AUC为0.84,敏感度为81.80%,特异度为73.10%,阳性预测值为56.23%,阴性预测值为90.48%。结论 ARFI技术与APRI可定量评估家兔肝纤维化程度,ARFI技术的价值较高。     

2型糖尿病患者跟腱病变的超声特征

目的利用剪切波弹性成像(SWE)评估2型糖尿病(T2DM)跟腱截面积、周长、厚径及生物学弹性的变化,并探讨T2DM患者跟腱剪切波速度与糖化血红蛋白水平之间的相关性。方法收集T2DM患者及健康体检志愿者各50例。测量跟腱中段横截面积、周长及厚径,剪切波弹性成像测量该处跟腱弹性的剪切波速度(SWV),记录T2DM患者的入院糖化血红蛋白值,绘制剪切波速度与T2DM患者糖化血红蛋白水平的相关性散点图。结果受试者左、右侧中段跟腱弹性对比及性别间对比均无统计学意义(P>0.05);对照组跟腱各参数较A组均无统计学意义(P>0.05),较B组仅SWV值有统计学意义(P<0.05),较C组跟腱周长、厚径、截面积及SWV均有显著差异,且差异有统计学意义(P<0.05);A组较B组仅SWV有统计学差异(P<0.05),A组较C组除周长无统计学意义外,其余参数均有统计学差异(P<0.05);B组较C组截面积与SWV值两参数统计学差异显著(P<0.05)。相关性分析显示,糖化血红蛋白水平与跟腱SWV值显著相关(r=0.601,P<0.05),糖化血红蛋白值越高对跟腱生物学弹性的影响也就越大。结论SWE技术可定量评估T2DM患者跟腱生物学弹性的改变,为临床医师在预防糖尿病下肢病变的过程中提供参考。     

定点剪切波弹性成像联合血清学指标无创评估肝纤维化临床研究

目的:对定点剪切波弹性成像(SWE)联合血清学指标无创评估肝纤维化进行探究,评估其临床价值价值。方法:(1)采用SWE检测29名正常健康志愿者的肝脏硬度,建立正常参考值范围;(2)选取我院2017年5月至2019年3月临床诊断为具有肝纤维化患者99例,其中肝病患者30例,慢性乙型肝炎患者62例,肝硬化患者7例。收集患者基本信息及相关实验室指标,经SWE检测其肝脏硬度,以肝穿刺活检病理学检查为金标准,采用METAVIRI评分标准进行肝纤维化分期,收集患者血清学指标并计算血小板计数比值指数(APRI)指数,评估SWE和血清学指标诊断肝纤维化程度的效能,构建多参数诊断模型,寻找诊断阈值。结果:肝纤维化指数与APRI、诊断肝纤维化Metavir分期F≥2、F≥3、F=4 ROC曲线下面积比较,差异都不存在统计学意义(P 0.05)。通过使用SWE和血清学指标APRI,以此获得诊断肝纤维化程度的效能,构建的多参数诊断模型显示诊断阈值为7.1～7.6KPa。结论:通过使用定点剪切波弹性成像(SWE)联合血清学指标诊断肝纤维化,此方法的敏感度和特异度高于单一血清学指标诊断,说明其具有重要的临床价值。     

声触诊组织量化技术——脾脏剪切波速度无创评估乙型肝炎肝纤维化程度的可行性分析

目的探讨声触诊组织量化(VTQ)技术测量脾脏剪切波速度无创评估乙型肝炎患者肝纤维化程度的可行性。方法应用VTQ技术对246例受试者测量脾脏剪切波速度(SWV),包括60例健康志愿者(归为S0期),53例慢性乙型肝炎患者(S1期12例,S2期19例,S3期20例,S4期2例)及133例临床诊断的乙型肝炎后肝硬化患者(归为S4期),将所得结果按纤维化分期进行分析。结果脾脏SWV与肝纤维化分期相关,相关系数为0.73(P<0.01);SWV在S0、S1、S2、S3期与S4期间差异均有统计学意义(P<0.01),其余各组间SWV差异无统计学意义(P>0.05);诊断S4期的受试者工作特征曲线下面积为0.95,诊断的临界值为2.78 m/s,灵敏性、特异性分别为0.86、0.94。结论基于VTQ技术的脾脏SWV在无创诊断乙型肝炎S4期有较好的应用前景。     

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.     

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.     

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.