超声在预测乳腺癌新辅助化疗后病理完全缓解中的应用价值

目的 分析乳腺癌新辅助化疗(NAC)前后的声像图变化，探讨高频超声对NAC疗效的评估价值。方法 回顾性分析81位乳腺癌患者共87个病灶的NAC前、及NAC 2个周期后及4个周期后超声测量病灶的大小、血流特征改变，并与病理对照评估。结果 NAC前后以残余灶的最大径线、血流等级可作为NAC后评效的有效指标；与病理组织学对照其评估化疗有效的超声评价的准确率、灵敏度、特异度分别为80.5％、89.8％ 、60.7％。结论 超声对乳腺癌NAC疗效有重要评估价值，NAC前后以最大径线、血流等级为评效指标对比研究对于NAC治疗效果有重要指导价值，并与病理组织学评估化疗的有效性具有较高的一致性。     

超声弹性成像评估乳腺癌新辅助化疗疗效的价值

目的 探讨超声弹性成像评估乳腺癌新辅助化疗疗效的价值。 方法 收集在我院行乳腺癌新辅助化疗（Neoadjuvant Chemotherapy, NAC）并手术的患者40例，分别于化疗前和术前行常规超声和超声弹性成像检查。用弹性评分法、应变率比值法评估其化疗前后的变化，并与术后的病理结果相比较。 结果 超声弹性评分评估NAC疗效的准确性为78.1%，有效组和无效组具有明显差异（P=0.002）。弹性应变率比值法评估NAC疗效以周围正常乳腺组织和以脂肪组织作为参照时，有效组和无效组均具有明显差异（P=0.001和0.005），评估NAC疗效的准确性分别为82.0%和75.3%。 结论 超声弹性成像技术可用于评价乳腺癌新辅助化疗的疗效，具有一定的临床应用价值。     

影像学在评估乳腺癌新辅助化疗中反应的应用与进展

乳腺癌新辅助化疗(neoadjuvant chemotherapy,NAC)作为乳腺癌治疗的重要组成部分,在临床上的应用越来越广泛。规范的影像学评估为治疗反应提供重要信息,是新辅助治疗的保障。本文详细讨论了目前用于评估NAC疗效常用影像学方法[乳腺X线摄影(mammography,MG)、超声、磁共振成像(magnetic resonance imaging,MRI)及PET/CT]的优势与缺点、各种方法在治疗过程中的应用价值及新兴技术的研究进展。     

MRI在早期评价乳腺癌新辅助化疗效果中的应用

新辅助化疗(NAC)已成为局部进展期乳腺癌(LABC)的标准治疗方法。正确评价LABC对NAC的反应,对进一步选择适当的手术方式、判断患者预后意义重大。评价乳腺癌NAC疗效的影像学方法主要有超声、乳腺X线摄影和MRI。本文综述MRI在早期评价乳腺癌NAC疗效中的作用。     

超声造影及弹性成像评价乳腺癌新辅助化疗疗效的研究进展

术前新辅助化疗(NAC)作为乳腺癌综合治疗的重要手段之一,可改善局部中晚期乳腺癌患者预后,并提高其生存质量。超声造影及弹性成像不仅可以对瘤体大小进行评估,还可以对肿瘤功能及内部成分变化(微血管、硬度等)进行评价,其对乳腺癌NAC疗效的评估具有潜在价值。本文就超声造影及弹性成像在乳腺癌NAC疗效评估中的研究进展进行综述。     

超声成像技术对乳腺癌新辅助化疗疗效评估研究进展

乳腺癌是我国女性最常见的恶性肿瘤,发病率呈上升趋势。新辅助化疗(NAC)是乳腺癌综合治疗的重要组成部分。超声成像技术多样,是一种实时、安全、无创的影像学方法,能有效评估乳腺癌新辅化疗的疗效。本文综述了超声成像技术在评估NAC疗效方面的研究进展。     

超声多指标评估乳腺癌新辅化疗早期疗效的临床价值

目的:探讨和分析超声评估乳腺癌新辅化疗(NAC)早期疗效的可靠指标。方法:收集我院2019年5月至2021年9月84例乳腺癌患者于化疗前及每2个疗程后行常规超声、弹性超声,明确血流阻力指数(RI)、收缩期峰值流速(PSV)、弹性应变率(SR)、血流分级。根据单项及多项因素Logistic回归法,甄别乳腺癌NAC早期疗效评估指标。结果:单项指标分析结果显示,化疗前后上述五项指标比较差异均具有统计学意义,P<0.05;其中RI、PSV、SR被纳入Logistic回归分析法。结论:超声的多项指标(RI、SR、PSV)为评估乳腺癌新辅化疗(NAC)早期疗效的可靠因素,多项指标回归模型较单项指标评判乳腺癌早期疗效具有更高准确率,具有较高的临床应用价值。     

新辅助化疗后乳腺癌腋下淋巴结的超声影像分析

目的分析常规超声检查在新辅助化疗后乳腺癌腋下淋巴结评估中的作用。方法对2013年3月至2014年3月在复旦大学附属肿瘤医院新辅助化疗后的254例乳腺癌患者腋下淋巴结行常规超声、磁共振成像及钼靶X线检查并与手术病理检查结果进行对照分析。结果病理检查显示254例新辅助化疗后乳腺癌患者腋下淋巴结转移161例(63.4%,161/254),无淋巴结转移93例(36.6%,93/254)。与病理检查结果对照,术前常规超声正确诊断159例(62.6%,159/254),其中正确诊断腋下淋巴结转移93例,无淋巴结转移66例。MRI正确诊断118例(46.5%,118/254),其中正确诊断腋下淋巴结转移50例,无淋巴结转移68例。钼靶X线正确诊断134例(52.8%,134/254),其中正确诊断腋下淋巴结转移60例,无淋巴结转移74例。254例新辅助化疗后常规超声、MRI和钼靶X线扫查诊断乳腺癌患者腋下淋巴结转移的正确率分别为62.6%、46.5%、52.8%,敏感度分别为57.8%、31.1%、37.3%。常规超声扫查正确诊断新辅助化疗后乳腺癌患者腋下淋巴结转移的正确率和敏感度均高于MRI和钼靶X线检查。结论术前常规超声检查对新辅助化疗后乳腺癌患者腋下淋巴结转移状态的评估有一定的临床诊断价值。     

MRI影像组学在乳腺癌新辅助化疗中应用的研究进展

新辅助化疗（Neoadjuvant chemotherapy,NAC）对于不适于直接手术的乳腺癌患者能够起到降低分期、提高保乳率及改善预后的作用。MRI检查对于乳腺癌具有独特的诊断价值。在NAC方面，MRI检查不仅能够对乳腺癌NAC疗效进行预测，从而优化治疗方案，而且对于乳腺癌NAC治疗后复发风险预测及预后评估也具有很大价值。本文就MRI影像组学对于乳腺癌NAC的研究进展做一综述。     

超声在乳腺癌新辅助化疗疗效评估中的应用价值

目的分析乳腺癌新辅助化疗(NAC)前后的声像图变化,探讨超声评估乳腺癌NAC疗效的应用价值。方法回顾性分析81例乳腺癌患者(共87个病灶)NAC前、NAC 2个周期后及4个周期后的二维和彩色多普勒超声表现。以病灶最大径线和血流等级作为NAC后评价的有效指标,评估其临床疗效。将超声检查结果与病理结果进行对比,分析超声的诊断价值。结果与NAC前比较,NAC 2个周期及4个周期后病灶血流丰富程度显著降低甚至消失,最大流速和阻力指数均显著下降,差异均有统计学意义(均P0.05)。NAC后术前超声评价完全缓解9个,部分缓解55个,稳定17个,进展6个。超声评价的准确率为80.5%,敏感性为89.8%,特异性为60.7%。结论超声对乳腺癌NAC疗效有重要评估价值,NAC前后以最大径线和血流等级作为评效指标对于NAC治疗效果有重要指导价值。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.