多层螺旋CT灌注成像扫描对乳腺肿块的诊断价值

目的 探究多层螺旋CT灌注成像扫描对乳腺肿块的诊断价值。方法 选取河北北方学院附属第一医院2019年1月至2020年1月期间120例乳腺肿块性病变患者,经多层螺旋CT灌注扫描,其中,乳腺癌63例,良性肿块57例。测量分析血流量(BF)、血容量(BV)、平均通过时间(MTT)、血管表面通透性(PS)等动态图像数据,依据乳腺癌与良性肿块划分不同组别,实施统计学分析。结果 乳腺癌组患者的BF、BV、PS均高于良性肿块组,两组差异有统计学意义(P 0. 05);两组患者的MTT差异无统计学意义(P 0. 05);乳腺癌患者的毛细血管数量增多,管径较正常宽,使微血管容量增加,血流加快。良性肿块患者的微血管密度与乳腺癌实质相似或轻度增多,微血管管径与正常乳腺微血管管径相同,灌注的微血管与非灌注的微血管比例增加不明显。结论 在乳腺肿块诊断中实施多层螺旋CT灌注成像扫描,准确率高,利于鉴别、诊断乳腺癌。     

CT灌注成像评价甲状腺病变

目的 探讨多排螺旋CT灌注成像(MSCTPI)在甲状腺占位性病变诊断和鉴别诊断中的临床应用价值.方法 43例符合入选标准的病例,分为良性组33例和恶性组10例,良性组包括结节性甲状腺肿亚组(17例)和甲状腺腺瘤亚组(16例),恶性组为甲状腺癌10例.采用GE LightSpeed 16排螺旋CT,常规CT平扫后动态增强扫描;绘制颈总动脉、甲状腺良性病变和甲状腺癌的时间-密度曲线(TDC),并计算各组BF、BV、MTT、PS值.对灌注参数各指标进行统计学分析.结果 颈总动脉TDC为单峰型,良性组的TDC表现为速升-缓降的小峰,恶性组TDC可分为基线段、上升段、下降段和水平段.良性组与恶性组间比较,BV、BF、MTT、PS值差异均有统计学意义(P=0.001、<0.001、0.003、<0.001);BV值和MTT值良性组各亚组与甲状腺癌组比较差异无统计学意义(P均>0.05);BF值良性组各亚组与甲状腺癌组比较差异有统计学意义(P均<0.05);PS值恶性组与结节性甲状腺肿组差异有统计学意义(P<0.05).良性结节甲状腺肿组与甲状腺腺瘤组在BF、BV、MTT、PS值比较差异均无统计学意义.结论 MSCTPI可准确反映甲状腺病变的血流特点;分析灌注参数BF、BV、MTT及PS值有利于鉴别诊断甲状腺良恶性病变.     

CT灌注曲线形状的量化及对乳腺癌的诊断价值——计算机模拟和乳腺灌注

目的 探讨血流动力学参数及参数组合对CT灌注时间-密度曲线(TDC)形状的影响,寻找定量评价TDC形状的方法,并应用于乳腺癌的前瞻性灌注研究.方法 在Excel 2003中构建算式,并编写相应程序代码以实现自动卷积、去卷积算法,其中推动剩余函数采用Weibull函数,在固定其他参数的情况下,分别以连续递增的血流量(BF)、平均通过时间(MTT)、血流量与平均通过时间之比(BF/MTT)、Weibull函数的形状参数和一个固定的动脉输入函数卷积,得到一系列TDC;考察上述指标对TDC形状的影响,筛选出能够定量描述TDC形状的变量.对28例乳腺肿块患者行CT灌注扫描,按TDC的形状分为速升速降型、持续上升型、平台型,以术后病理诊断为金标准,用受试者工作特性曲线(ROC)分析BF、MTT、血容量(BV)、BF/MTT、TDC形状分型在乳腺癌诊断中的价值.结果 ①Weibull函数的形状参数对TDC的影响轻微;BF影响TDC的高度,BF越大TDC高度越大;MTT影响TDC的高度和峰值时间,MTT越大TDC高度越大同时峰值时间推后;BF/MTT决定TDC的形状,取值偏大时TDC呈速升速降型,取值偏小时呈持续上升型,取值在两者之间时呈平台型;②乳腺灌注BF/MTT与TDC形状分型相关;③乳腺灌注各指标ROC曲线下面积由高到低依次为BF/MTT、BF、TDC形状分型、BV、MTT,前三者大于对角线下面积(P<0.05),可鉴别乳腺肿块的良恶性.结论 BF/MTT能够定量描述CT灌注TDC的形状,以非线性的方式整合BF和MTT的诊断信息,在乳腺癌的诊断中有重要的参考价值.     

CT灌注成像的时间-密度曲线及灌注参数在肺内肿块诊断中的作用

目的 探讨多层螺旋CT灌注成像的时间密度曲线及灌注参数在肺内良、恶性肿块鉴别诊断中的作用.方法 对64例肺内良、恶性肿块患者行16层螺旋CT灌注成像,应用CT体部灌注软件,分析肺内肿块的时间密度曲线(TDC)、灌注图像和各灌注参数值(PH、PHa /PHpm、BF、BV、PS、MTT).利用免疫组化染色测定微血管密度(MVD)并标定血管内皮生长因子(VEGF),评价肺内良、恶性肿块各灌注参数与MVD 及VEGF的相关性.结果 周围型肺癌和炎性肿块的TDC相似,二者与良性肿块的TDC明显不同.周围型肺癌与炎性肿块的PH、PHpm/PHa、BV差异无统计学意义(P>0.05);二者高于良性肿块者,差异有统计学意义(P<0.05).周围型肺癌的PS值大于炎性肿块和良性肿块,差异有统计学意义(P<0.05).VEGF阳性表达的周围型肺癌的PH、PHpm/PHa、BF、BV、PS值和MVD明显高于VEGF阴性表达者(P值均<0.05),也高于VEGF阳性表达的良性肿块者(P值均<0.05).VEGF阳性表达的周围型肺癌PH、PHpm/PHa、BF、BV、PS与MVD均呈正相关(P值均＜0.05).结论 多层螺旋CT灌注成像的时间密度曲线及灌注参数与肿瘤血管生成具有良好的相关性,能够反映肿瘤的微血管密度及VEGF表达,提供了一种定量评价肺内肿块血流模式的非创伤性方法 ,有利于肺内良、恶性肿块的鉴别诊断.     

宫颈癌Aquilion ONE 320 CT灌注成像表现初探

目的：探讨宫颈癌320 CT灌注成像参数及其临床应用价值。方法：对36例临床诊断为宫颈癌患者行子宫颈CT灌注扫描,其中Ⅰ~Ⅱ期宫颈癌组16例,Ⅲ~Ⅳ期宫颈癌组20例,取15例宫颈癌旁正常组织作为对照组。应用Perfusion CT软件包对灌注图像进行后处理,得到时间-密度曲线（Time density curve,TDC）,灌注参数包括：血流量（Blood flow,BF）、血容量（Blood volume,BV）及表面通透性（Permeability surface,PS）。结果：Ⅰ~Ⅱ期宫颈癌组和Ⅲ~Ⅳ期宫颈癌组的BF、BV、PS均高于宫旁正常对照组;Ⅲ~Ⅳ期宫颈癌组的BF、BV、PS均高于Ⅰ~Ⅱ期宫颈癌组,差异均有统计学意义（P<0.05）。灌注值随肿瘤病理分期的升高而增加。结论：子宫颈癌320 CT灌注成像作为一种新的影像学方法,反映子宫肿瘤灌注成像参数及其内部灌注状态可靠,对肿瘤的分期及预后评估、评价肿瘤治疗疗效有重要的临床指导意义。     

感兴趣区的划分对周围型肺癌CT灌注成像影响的研究

目的：探讨CT灌注后处理中感兴趣区的选择对周围型肺癌CT灌注参数结果的影响。材料与方法：对56例经病理证实为肺癌的周边型结节和肿块患者行灌注扫描及常规增强扫描。①按照感兴趣区不同的划分方法分为3组，分析3组间诸参数有无统计学差异。②对每个病灶以第2组及第3组的测量方法在常规增强图像上测量CT值，比较两种方法所测结果无差异的病灶的灌注参数结果有无统计学差异。③观察病灶TDC的形态与位置。结果：①BF、BV组间两两比较均有统计学差异；PS、PBV仅2组与3组间有统计学差异（P值均＜0.05）；TS、TP组间两两比较均无统计学差异。②在常规增强扫描图像中以第2组及第3组方法测量CT值无差异病灶，其BF、BV、PS、PBV均有统计学差异（P值均＜0.05）。③所有病灶的TDC曲线均呈速升－缓降形态，而后有一较长的平台期。54例病灶的TDC峰值位于输入动脉之后，2例位于其前方。结论：周围型肺癌在CT灌注成像后处理中感兴趣区的选择较为科学的方法是沿病灶边缘包括整个病灶，由此得出的参数结果更能代表肿瘤实际的灌注情况，而且该方法具有较好的可重复性；灌注参数图像与常规增强图像相比能更好地反应肺癌的血供情况；初步探讨CT灌注成像对肺癌血供来源的判定有可能提供帮助。     

CT灌注成像在脊柱病变定量、定性诊断中的应用价值

目的 探讨CT灌注成像技术在脊柱病变定量、定性诊断中的作用.方法 对125例脊柱病变患者进行CT灌注成像扫描,计算并分析感兴趣区的灌注参数值,包括血流量（BF）,血容量（BV）,平均通过时间（MTT）和表面通透性（PS）.对照实际病理结果,分为良性病变和恶性病变两组,定量、定性分析良、恶性肿瘤的灌注成像规律.结果 良、恶性病变组病变区域的BF、BV和PS值为均明显高于各自正常组织,而MTT值小于正常组织（P〈0 05）.恶性病变组病变区的BF值和PS值明显高于良性病变组（P〈0.05）,而BV值和MTT值无统计学差异.结论 CT灌注成像是一种在定量、定性分析脊柱病变血流灌注状态方面具有重要价值的功能成像方法.     

双源CT灌注成像参数与胃癌肿瘤血管生成的相关性研究

目的：探讨双源CT灌注成像参数在评估胃癌肿瘤血管生成中的作用和价值。材料与方法：收集中国医科大学附属第一医院胃癌病人55例。术前均通过双源CT行灌注扫描，获得BV、BF、TTP、TTS、Patlak P、PBV等灌注图及其具体参数数值。获取术后手术标本，制作石蜡切片，采用CD34、VEGF单克隆抗体对组织切片行免疫组化染色。分析双源CT灌注成像参数与肿瘤MVD计数、VEGF表达之间的相关性。结果：胃癌的双源CT灌注参数PBV、Patlak P、BF、BV值与MVD计数、VEGF表达评分值呈正相关。结论：双源CT灌注参数BV、BF、 Patlak P、PBV可用来评估胃癌肿瘤血管生成及VEGF的表达。     

一站式CT灌注成像联合增强扫描用于胰腺神经内分泌肿瘤

目的探讨一站式CT灌注成像联合增强扫描对于胰腺神经内分泌肿瘤(pNEN)的应用价值。方法回顾30例接受一站式CT灌注成像联合增强扫描并经组织病理证实的pNEN患者,分析pNEN影像学特点,比较其灌注伪彩图灌注参数[血容量(BV)、血流量(BF)、平均通过时间(MTT)、毛细血管表面通透性(PS)]及时间-密度曲线(TDC),分析不同分级pNEN灌注参数差异和辐射剂量。结果灌注伪彩图显示pNEN病灶较正常实质呈明显高灌注状态,其BV、BF分别为(22.80±6.42)ml/100 g、(237.38±134.86)ml/(min·100 g),均高于正常实质(P均<0.05);MTT、PS分别为(7.03±3.48)s、(3.25±1.99)ml/(min·100 g),均低于正常实质(P均<0.05)。pNEN病灶早期显影时间为19.42~24.14 s,其TDC表现为速升后速降至平台期。依据不同pNEN级别,将pNEN病灶分为A组(G1级)和B组(G2/G3级),A组病灶PS为(4.48±2.21)ml/(min·100 g-),高于B组(2.23±1.34)ml/(min·100 g,P<0.05),组间BV、BF、MTT差别均无统计学意义(P均>0.05),PS与pNEN级别呈负相关(r=-0.52,P<0.01)。扫描全过程有效辐射剂量为(19.88±3.03)mSv。结论CT灌注联合增强扫描可依据病灶形态学表现及灌注参数诊断pNEN,并有助于常规增强CT扫描选择对可疑pNEN病灶的最佳扫描时间,且辐射剂量较低,并可根据PS预测肿瘤分级,对临床有一定指导意义。     

多层螺旋CT灌注成像在骨肿瘤性病变中的应用

目的初步探讨MSCT灌注成像方法在骨肿瘤性病变中的临床应用价值.方法对10例骨肿瘤患者进行MSCT灌注成像,图像重建后送至AW 4.0工作站,利用Perfusion 2 软件计算并分析灌注图像和灌注参数值,包括血流量(BF),血容量(BV),平均通过时间(MTT)和表面通透性(PS).结果所有肿瘤部位的BF、BV、PS值明显高于正常组织,而MTT值明显小于正常组织,两者之间具有显著性差异.结论 MSCT灌注成像是一种准确且相对简捷的定量评估骨肿瘤性病变血流灌注状态的功能成像方法.     

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.     

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.     

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.     

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.