肺癌CT普查:基础扫描与7年随访

目的　探讨肺癌CT普查对肺癌诊断分期和预后的影响。方法　前瞻性观察肺癌CT普查中不同年龄、性别、吸烟组肺癌发生率及分期 ,追踪预后和长期CT随访对非钙化性结节进一步定性的价值。结果　 2 43 0人共 10 0 2 0人次参加了肺癌CT普查 ,1994年至 2 0 0 1年共发现肺癌 2 5例 ;I期肺癌 12例 ,II期肺癌 6例 ,III期肺癌 7例 ;首次CT普查发现肺钙化结节 89例 ,其中首次诊断为肺癌的 19例 ,1～ 2年增大 ,证实为肺癌 4例 ;1995年至 1999年未参加普查 ,而 2 0 0 0年再普查发现新生肺癌 1例 ;1994年发现结节 ,2 0 0 1年才确诊 1例 ;新生结核肉芽肿 3例 ,隐球菌肉芽肿 1例 ;结核瘤再活动增大 2例。长期稳定 60例。结论　①肺癌CT普查能及时发现并诊断早期肺癌 ,主要在 5 0～ 69岁年龄组。②肺癌CT普查会发现大量非钙化结节 ,大部分为良性 ,需要配合HRCT、局部SpiralCT、活检、CT复查仔细鉴别 ,提高诊断水平。     

低剂量螺旋CT在不同性别及年龄段之间肺癌筛查的价值

目的通过分析胸部的资料,探讨低剂量螺旋CT(LDCT)在不同性别及年龄段人群进行早期肺癌筛查的临床价值。方法对8 075例体检人员胸部LDCT体检资料进行回顾性分析,比较不同性别、年龄段人群组的肺结节和肺癌的检出率差异。结果非钙化结节≥4 mm者共516名,检出率为6.4%,其中肺癌37例,检出率为0.46%。年龄≥55岁结节阳性率和肺癌检出率显著高于55岁者,差异均有高度统计学意义(P0.001)。实性结节在男性组高发,亚实性结节多见于女性组。男性与女性间的肺癌检出率差异有统计学意义(P0.05)。结论肺结节和肺癌在性别和年龄段之间存在一定差异,LDCT在早期肺癌筛查中具有较高的临床价值。     

多层螺旋CT低剂量扫描在肺磨玻璃结节检查中的应用研究

目的:低剂量多层螺旋CT(MSCT)扫描应用于肺磨玻璃结节(GGN)患者临床检查的价值。方法:选取2016年3月-2017年5月在本院接受MSCT检查的58例GGN患者作为对象,分别给予患者常规、低剂量MSCT检查,回顾分析2组检查结果。结果:常规、低剂量MSCT扫描GGN检出率比较无显著差异(P0.05);GGN影像主要表现为有局灶性磨玻璃影存在于肺内,边缘模糊不清,淡密度,结节内有血管,可见支气管影穿过;与病理学诊断结果比较,常规MSCT检查诊断符合率为82.76%,低剂量MSCT检查诊断符合率为79.31%,二者比较无显著性差异(P0.05)。结论:给予GGN患者低剂量MSCT扫描检查能够获得较高检出率及诊断符合率,有利于早期肺癌筛查结果的提高。     

胸部低剂量CT对健康体检者肺结节及肺癌的筛查

目的:探讨在健康体检者肺结节及肺癌的筛查中实施胸部低剂量CT检测的临床应用价值。方法:从我院2018年1—12月期间行胸部CT体检的健康体检者中抽取1200例作为研究样本,所有体检者均需要接受低剂量胸部CT检查与常规剂量胸部CT检查,比较两种检查方法对肺结节及肺癌的诊断结果。结果:经常规剂量胸部CT检查后,1200例体检者中检出5例肺癌病灶,占比0.42%;经低剂量胸部CT检查后,1200例体检者中检出6例肺癌病灶,占比0.5%,二者之间对肺癌病灶的检出率并无明显差异(P>0.05);经常规剂量胸部CT检查后,1200例体检者中检出2例肉芽肿性病变、1例肺转移癌、1例炎性结节、1例肺癌;经低剂量胸部CT检查后,1200例体检者中检出1例肉芽肿性病变、1例肺转移癌、1例炎性结节、3例肺癌,二者之间对肺结节的检出率并无明显差异(P>0.05)。结论:胸部低剂量CT检查对健康体检者的肺结节、肺癌筛查具有一定的应用价值,对早期筛查肺癌患者具有重要意义,值得临床推广应用。     

CT筛查早期肺癌的价值分析

目的对多排螺旋CT在早期肺癌筛查中的临床应用价值进行探讨。方法选取2012-08—2013-08进行体检的1 602例无症状体检者作为研究对象,对所有人员均给予低剂量胸部扫描,并定期随访高危人群。结果检查后,共发现110个非钙化结节;经病理证实,共检出5例早期肺癌,早期肺癌诊断率为0.31%;其中,2例在高危人群中检出,检出率为1.3%;3例在非高危人群内检出,检出率为0.2%。结论对早期肺癌患者应用低剂量多排螺旋CT进行扫描,能够获得满意筛查效果。     

低剂量螺旋CT联合血清p16基因甲基化检测筛查早期肺癌的研究

目的:研究胸部低剂量螺旋CT联合血清p16基因甲基化检测筛查早期肺癌的可行性.方法:本院体检的无症状肺癌高危人群共2 332例按2:1随机分为2组,低剂量螺旋CT-p16组1 555例,首先给予低剂量螺旋CT扫描,发现肺非钙化结节者行常规剂量CT及血清p16基因甲基化检测;标准剂量CT-p16组777例,给予标准剂量CT扫描,发现肺非钙化结节者行血清p16基因甲基化检测.结果:低剂量螺旋CT-p16组中11.4%及标准剂量CT-p16组12.1%患者可疑肺癌,其中低剂量螺旋CT-p16组中108例及标准剂量CT-p16组中50例确诊为肺癌.2组肺癌检出率比较差异无统计学意义(P>0.05).结论:低剂量CT联合血清p16基因甲基化检测是一种敏感、安全、可行的筛查早期肺癌的方法.     

多层螺旋CT在肺磨玻璃结节中的应用

目的:探讨多层螺旋CT(MSCT)扫描在肺磨玻璃结节(GGN)检查中的应用价值。材料与方法:对50例GGN病例进行肺部常规剂量和低剂量MSCT扫描,观察GGN的形态、大小、密度、内部特点和结节边缘等情况。结果:常规剂量MSCT扫描发现45个GGN,低剂量MSCT扫描发现40个GGN,GGN直径为5~20 mm,其中26例GGN患者诊断为原发性肺腺癌。结论:MSCT低剂量扫描对于GGN有较高的检出率,可应用于早期肺癌的筛查。     

多层螺旋CT用于甲状腺结节良恶性诊断的准确性研究

目的探讨多层螺旋CT(MSCT)在甲状腺良恶性结节鉴别诊断中的应用价值。方法选取四川省中西医结合医院2013年1月至2017年6月收集的88例甲状腺结节患者,根据手术或穿刺病理学活检结果分为两组:良性组64例(甲状腺良性结节患者),恶性组24例(甲状腺癌患者)。回顾性分析患者的MSCT资料,对比两组患者甲状腺结节的MSCT特征,并以病理学检查结果作为诊断金标准计算MSCT鉴别诊断甲状腺良恶性结节的临床价值。结果恶性组的囊实性及实性率、形态不规则率、砂砾样钙化率、结节边缘模糊率、不均匀强化率均显著高于良性组,差异具有统计学意义(P0.05)。良性组和恶性组结节的直径构成情况差异无统计学意义(P0.05)。MSCT鉴别诊断甲状腺良性结节的灵敏度为87.50%(21/24),特异度为84.38%(54/64),漏诊率为12.50%(3/24),误诊率为15.63%(10/64)。结论甲状腺良恶性结节具有典型的MSCT影像学特征,通过归纳总结,MSCT在临床上鉴别诊断甲状腺良恶性结节具有重要的价值。     

早期肺癌诊断应用低剂量CT扫描的价值分析

目的:探究早期肺癌诊断应用低剂量CT扫描的价值。方法:选取2018年11月-2019年11月我院收治的50例低剂量CT扫描筛查肺癌患者为研究对象,同期选择50例常规剂量扫描筛查患者进行对比分析。就不同检验方式结节检出情况及肺癌结节细节情况进行对比。结果:不同检查方式结节检出情况有所差异,相比之下,低剂量CT检验结果显著高于常规剂量CT(P<0.05),且不同检验方式下肺癌结节细节情况比较差异显著,低剂量CT检验结果明显高于常规剂量CT(P<0.05)。结论:早期肺癌患者诊断中以低剂量CT扫描作为筛查方式能够满足患者诊断需求,故而可以在临床中应用。     

MSCT鉴别诊断慢性淋巴细胞性甲状腺炎合并良恶性结节

目的 比较慢性淋巴细胞性甲状腺炎(CLT)合并良恶性结节的MSCT特征,探讨MSCT的诊断和鉴别诊断价值。 方法 回顾分析经手术病理证实的74例(79个结节)CLT合并结节的MSCT表现,包括结节的大小、实质部分所占百分比、钙化、边缘、包膜、结节的强化方式及程度,并进行统计学分析。 结果 有81.82%(18/22)的恶性结节为完全实性,16例(16/57,28.07%)囊性为主的结节全部为良性结节(P均<0.05)。恶性结节钙化多于良性,多为细颗粒钙化,位于病灶内部(P均<0.05)。恶性结节边缘多不清,无包膜或包膜不完整,多均匀强化(P均<0.05)。良恶性结节在结节与结节外甲状腺组织平扫、动脉期及实质期CT值之比差异无统计学意义(P均>0.05)。 结论 MSCT有助于鉴别诊断CLT患者合并良恶性结节典型特征。     

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.