声触诊组织成像量化技术在乳腺实性病灶中的临床应用研究

目的 探讨声触诊组织成像量化技术（VTIQ）在乳腺实性病灶中的临床应用价值。方法 对238例患有乳腺肿块的患者（乳腺实性病灶254个）进行常规二维超声检查及声触诊组织量化技术（VTIQ）检查,所有病灶都通过穿刺活检或手术得到病理结果。分析乳腺良性病灶组、恶性病灶组各弹性指标的差异,包括VTIQ成像速度模式图及乳腺病灶的剪切波速度值Vmax、Vmin、Vmean,并绘制三者受试者工作特征（ROC）曲线,确定诊断界点值,评估VTIQ技术诊断乳腺良恶性病灶的诊断效能。结果 VTIQ成像中,乳腺实性病灶所显示的速度模式彩色编码图可分为五种类型：均匀型、欠均匀型、杂乱型、扩散型、硬环型。均匀型、欠均匀型多见于乳腺良性病灶,杂乱型、扩散型、硬环型多见于乳腺恶性病灶。VTIQ成像剪切波速度指标Vmax、Vmin、Vmean在诊断乳腺良恶性病灶中均具有较高的诊断效能,经综合判断,Vmean可作为诊断乳腺良恶性病灶的最佳指标,诊断界点值为4.84m/s。结论 VTIQ技术应用于乳腺实性病灶良恶性诊断时具有较高的诊断效能,Vmean可作为乳腺良恶性病灶诊断的可靠评价指标,Vmax、Vmin可作为特殊乳腺病灶的辅助评价指标。     

超声能量多普勒与弹性成像对冈上肌肌腱炎的诊断及与预后的相关分析

目的：探索超声能量多普勒与弹性成像对冈上肌肌腱炎的诊断及与预后的相关性。方法：回顾性分析在2018年5月至2020年10月期间选取的70例健康体检者(对照组)、72例冈上肌肌腱炎患者(观察组),均进行超声检查,分析观察组患者患侧、健侧超声声像图表现,启动超声能量多普勒、弹性成像模式,比较两组受检者剪切模量值、SWV值、血流信号分级、弹性超声分级,用ROC曲线分析各项数值对冈上肌肌腱炎及预后的预测价值,并用Spearman法分析各项参数与预后的相关性。结果：观察组患者患侧的血流增多率、回声杂乱率、内部钙化点率、回声不均率均高于健侧(P＜0.05)。观察组SWV值、剪切模量值、血流信号分级、弹性超声分级高于对照组(P＜0.05),经ROC曲线分析,SWV值、剪切模量值、弹性超声分级、血流信号分级及四项联合早期预测冈上肌肌腱炎的AUC分别为0.932、0.917、0.905、0.921、0.996。同时预后良好组血流信号分级、弹性超声分级、剪切模量值、SWV值低于预后不佳组(P＜0.05),经ROC曲线分析,SWV值、剪切模量值、弹性超声分级、血流信号分级及四项联合早期预测预后情况的AUC分别为0.881、0.922、0.914、0.914、0.995,经Spearman法分析,预后情况与SWV值、剪切模量值、血流信号分级、弹性超声分级呈正相关性。结论：超声能量多普勒联合弹性成像可预测冈上肌肌腱炎发生、发展、预后情况。     

彩色多普勒超声联合弹性成像对软组织血管瘤的诊断价值

目的:探讨彩色多普勒超声联合实时剪切波弹性成像技术对软组织血管瘤的诊断价值。方法 :对2013年6月—2014年8月我院收治的43例软组织肿块进行回顾性分析,与术后病理结果进行比较。结果 :病理诊断为血管瘤43例,其中毛细血管型血管瘤8例、海绵状血管瘤28例、蔓状血管瘤7例。彩色多普勒超声诊断血管瘤的符合率为81.40%;彩色多普勒超声联合实时剪切波弹性成像技术诊断血管瘤的符合率为93.02%。结论:彩色多普勒超声联合实时剪切波弹性成像技术可以大大提高血管瘤的诊断率。     

超声声速匹配技术在均匀性脂肪肝分度中应用价值

目的探讨超声声速匹配技术在均匀性脂肪肝分度中的诊断价值。方法均匀性脂肪肝患者146例,其中轻度脂肪肝62例(轻度组),中度脂肪肝54例(中度组),重度脂肪肝30例(重度组),应用声速匹配技术测量3组肝脏区域速度指数(zone speed index,ZSI),并与118例体检健康者(对照组)进行比较;ROC曲线分析诊断轻、中、重度脂肪肝的ZSI值。结果轻度组ZSI为(-16.03±4.21)m/s,中度组为(-30.04±5.58)m/s,重度组为(-48.75±7.65)m/s,对照组ZSI为(9.00±3.52)m/s,轻、中、重度组ZSI均低于对照组(P0.05),轻、中、重度组间ZSI比较差异有统计学意义(P0.05);ROC曲线分析结果显示,ZSI≤-42.5 m/s可诊断为重度脂肪肝,-42.5~-27.5 m/s可诊断为中度脂肪肝,-27.5~-12.5m/s可诊断为轻度脂肪肝。结论应用超声声速匹配技术测量ZSI值,可初步对脂肪肝进行分度诊断。     

彩色多普勒超声在肝脏肿块中的诊断价值

目的探讨彩色多普勒超声(CDFI)在肝脏肿块中的诊断价值。方法回顾性分析68例肝脏肿块病变患者的超声资料,评估CDFI的诊断价值。结果 CDFI显示肝血管瘤(n=43)无血流信号;原发性肝癌(n=13)血流信号丰富,动脉流速较高,阻力指数较大;转移性肝癌(n=12)在瘤体外围有较少的彩色血流信号。原发性肝癌及转移性肝癌患者血流灌注指数(DPI)、门静脉充血指数(PCI)、阻力比(RR)以及肝总血流量(TLBF)明显高于肝血管瘤患者(均P<0.05)。结论 CDFI在肝脏肿块中的诊断价值较大。     

声触诊组织定量分析对肝脏肿瘤鉴别诊断价值的探讨

目的 探讨声触诊组织定量分析(VTQ)对肝脏肿瘤的鉴别诊断价值.方法 健康对照组60例,病理证实的肝脏占位性病灶41例;采用VTQ测量反映组织弹性顺应力的横向剪切波速度(Vs)来评价其诊断价值.结果 VTQ对肝脏恶性病灶检测的敏感性和实时超声弹性成像(UE)比较无明显差异,但特异性和准确性均明显高于UE检测结果.VTQ检测结果显示肝血管瘤的Vs测值和正常肝组织比较无明显差异;原发性、转移性肝癌的Vs测值和正常肝组织比较有统计学差异;原发性、转移性肝癌的Vs测值和肝血管瘤比较有统计学差异,但原发性和转移性肝癌两者之间的Vs测值无明显统计学差异.结论 应用VTQ技术对肝脏肿瘤的性质有一定的鉴别诊断价值.     

超声弹性成像在肝泡型包虫病诊断中的应用价值

目的探讨超声弹性成像技术在肝泡型包虫病诊断中的应用价值。方法对95例肝脏占位性疾病患者分别行常规超声和超声弹性成像检查,分别记录病灶的大小和弹性评分,并将其诊断结果与手术或病理结果比较。结果 95例肝脏占位性疾病患者中,肝泡型包虫病54例,原发性肝癌21例,肝囊型包虫病14例,肝血管瘤6例。超声弹性成像测得原发性肝癌和肝泡型包虫病患者的病灶面积、周长及体积均显著大于常规超声检查测值,差异均有统计学意义(均P0.05)。肝泡型包虫病、原发性肝癌、肝囊型包虫病及肝血管瘤的弹性评分分别为(4.24±0.43)分、(4.57±0.51)分、(2.28±0.47)分及(2.50±0.55)分,弹性评分比较差异有统计学意义(F=100.153,P0.01);肝泡型包虫病与原发性肝癌、肝血管瘤的弹性评分比较,差异均有统计学意义(均P0.05)。结论超声弹性成像通过测定肝泡型包虫病病灶的硬度,为临床早期诊断提供了一种新的影像学检查方法。     

超声造影与SWE技术在乙肝肝纤维化评估中的应用

目的：探讨超声造影与剪切波弹性成像（SWE）技术在慢性乙型肝炎（CHB）肝纤维化评估中的应用价值。方法：选取2015年1月~2018年12月我院收治的CHB患者120例,均行超声造影及SWE检查,获得肝动静脉渡越时间（HAVTT）值及肝脏弹性测值。结果：随着肝纤维化分期提高,HAVTT1、HAVTT2逐渐缩短,肝脏弹性测值逐渐增大;HAVTT1、HAVTT2及肝脏弹性测值在无纤维化组、纤维化组及肝硬化组之间两两比较均有统计学差异（P <0.05）。ROC曲线分析显示,HAVTT1、HAVTT2诊断肝纤维化及肝硬化的曲线下面积分别为0.870、0.851和0.889、0.856,肝脏弹性测值诊断肝纤维化及肝硬化的曲线下面积为分别为0.953、0.898;肝脏弹性测值的诊断效能明显优于HAVTT1及HAVTT2（P<0.05）。结论：SWE技术获得肝脏弹性值对乙肝纤维化及肝硬化的诊断优于超声造影。     

原发性睾丸淋巴瘤多模态超声特征的初步研究

目的 研究分析原发性睾丸淋巴瘤的多模态超声声像图特征。方法 回顾性分析20例经病理证实的原发性睾丸淋巴瘤患者的声像图资料，包括灰阶超声、彩色多普勒超声、超声造影和弹性成像。结果 20例原发性睾丸淋巴瘤，其中19例为弥漫性大B细胞淋巴瘤，1例为成熟T细胞淋巴瘤。灰阶超声显示8例患者为弥漫型，表现为睾丸明显肿大伴回声弥漫性减低；12例患者为结节型，表现为睾丸实质内单个或多发低回声结节。彩色多普勒超声显示弥漫型和结节型病灶内均可见丰富的血流信号，为Ⅲ级血流。3例患者超声造影检查发现睾丸病灶平均灌注时间为5.7 s,睾丸病灶灌注强度高于正常睾丸实质。1例弥漫型患者行剪切波弹性成像，病变侧睾丸弹性值为17 kPa,而对侧正常睾丸弹性值为3.4 kPa。结论 原发性睾丸淋巴瘤的超声声像图具有一定的特征，充分应用多模态超声成像有助于原发性睾丸淋巴瘤的准确诊断。     

声速测算与压迫式弹性成像对乳腺肿物诊断价值的比较

目的 通过声速匹配技术测定乳腺肿物的声速(sound velocity,SV),比较声速与压迫式弹性成像对乳腺良恶性肿物鉴别诊断的价值.方法 对75例女性患者共99个乳腺肿物进行声速匹配技术检查,获得相应的声速匹配值(zone speed index,ZSI),进而得到病灶的SV.并对乳腺肿物进行压迫式弹性成像检查,获得相应的弹性图,用5分法判断良恶性.以病理结果作为金标准,构建ROC曲线,判断两种方法对乳腺病灶的诊断价值.结果 乳腺肿物的SV在良恶性组之间的差异具有统计学意义(P=0.0001).SV判断乳腺良恶性肿物的最佳临界点为1561 m/s,ROC曲线下面积为0.842,与压迫式弹性成像技术之间的差异有统计学意义(P=0.023).SV判断乳腺恶性病变的敏感性、特异性、准确性分别为81.5％、91.7％、88.9％,与压迫式弹性成像技术之间的差异无统计学意义(P=1.0,P=0.125,P=0.146).结论 SV法与压迫式弹性成像技术均对乳腺肿物良恶性判断有较高的诊断价值.     

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.     

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.     

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.     

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.