强直性脊柱炎之骶髂关节炎36例的CT诊断价值

目的：回顾性分析强直性脊柱炎(AS)的骶髂关节(SIJ)CT表现，评价CT诊断AS的价值。方法：分析22例临床诊断为强直性脊柱炎的骶髂关节的CT征象，进行分级，与临床分期对照。结果：①SIJ早期(CTⅠ～Ⅱ级)表现为关节面对称性或不对称受累；关节面毛糙、皮质白线消失；骨关节面皮质中断；关节面下小囊变。②中期(CTⅢ级)；骶髂关节面局部呈锯齿状或毛刷样改变；关节面下小囊状骨质破坏及其周围增生硬化；关节间隙假性增宽或不规则狭窄；关节间隙气体影；为临床进展期。③晚期(CTⅣ级)为韧带钙化；关节骨性强直、关节间隙消失；明显骨质疏松，为临床稳定期。结论：CT能够清晰显示骶髂关节的细微结构，做出正确的分级诊断，为临床分期提供依据。     

强直性脊椎炎骶髂关节病变35例CT诊断分析

目的回顾性分析强直性脊柱炎骶髂关节病变的CT表现,以提高临床诊断与鉴别诊断水平。方法分析35例临床确诊强直性脊柱炎患者的骶髂关节CT表现特点。结果强直性脊柱炎骶髂关节病变CT表现特点:关节边缘骨侵蚀、关节面破坏、关节间隙改变、软骨下骨硬化、骨性强直以及骶髂韧带钙化。结论根据骶髂关节的CT表现,结合临床资料,CT检查可准确诊断早期强直性脊柱炎。     

强直性脊柱炎骶髂关节、腰椎小关节及髋关节的CT表现

目的探讨强直性脊柱炎(AS)受累骶髂关节、腰椎小关节及髋关节的病变CT表现特点,以提高诊断与鉴别诊断水平。方法 2011年1月-10月对临床确诊的强直性脊柱炎患者44例骶髂关节、28例腰椎及14例髋关节行CT扫描,回顾性分析骶髂关节、腰椎小关节及髋关节的CT表现。结果 AS患者的CT表现特点为病变主要累及骶髂关节滑膜部的髂骨侧,腰椎小关节及髋关节则表现为关节间隙改变、关节面毛糙及囊状破坏、面下骨硬化或吸收等改变。结论 AS骶髂关节、腰椎小关节及髋关节的CT表现具有一定特征,CT具有重要的诊断及鉴别诊断价值。     

强直性脊柱炎64例骶髂关节病变CT表现分析

目的探讨强直性脊柱炎骶髂关节病变的CT诊断与鉴别诊断。方法对郑州市第七人民医院临床确诊的64例强直性脊柱炎的CT片进行回顾性分析。结果 64例骶髂关节均有不同程度的异常改变。6例表现为单侧骶髂关节间隙增宽,髂骨侧关节面毛糙伴骨质硬化,36例表现为双侧骶髂关节髂骨侧硬化、毛糙,邻近骨质不同范围骨质硬化,关节面下可示小囊状透亮影。16例双侧骶髂关节面毛糙、硬化,呈锯齿样改变,关节间隙假性增宽或缩窄。6例双侧骶髂关节间隙消失,骨小梁贯通,形成骨性强直。结论强直性脊柱炎CT检查对病变细节显示清楚,对早期病变更具有敏感性。双侧骶髂关节CT平扫对早期发现强直性脊柱炎的骶髂关节病变有着重要意义。     

螺旋CT在强直性脊柱炎骶髂关节病变的诊断价值

目的 探讨螺旋CT对强直性脊柱炎骶髂关节病变的诊断价值。方法对28例临床诊断为强直性脊柱炎的骶髂关节之螺旋CT征象及临床资料进行分级，并与临床分期对照。结果CT Ⅰ～Ⅲ级即临床早期，表现为骶髂关节面呈对称性或不对称受累，关节面毛糙，皮质白线消失，骨关节面皮质中断，关节面下小囊变。CTⅢ级即临床中期，表现为骶髂关节面局部呈锯齿状或毛刷样改变，关节面下小囊状骨质破坏及其周围增生硬化，关节间隙不规则狭窄，关节间隙含气征等。CTIV级即临床晚期，可见明显骨质疏松，韧带钙化，关节骨性强直和关节间隙消失。结论螺旋CT能够清晰显示骶髂关节的细微结构，做出正确的分级诊断，为临床分期提供依据。     

强直性脊柱炎早期骶髂关节炎40例CT分析

目的探讨强直性脊柱炎（AS）早期骶髂关节（SU）炎CT表现，旨在提高AS早期诊断水平。方法回顾性分析40例确诊强直性脊柱炎的骶髂关节（80个）早期CT（≤Ⅱ级）表现。结果CT SIJ0级10个，关节未见异常改变。Ⅰ级30个，表现为骶髂关节面模糊，毛糙，可疑局部凹陷、不规则；关节间隙积气。Ⅱ级40个，表现为骨板局部凹陷，不融合小侵蚀灶，或斑点状硬化，关节间隙同侧出现轻微局部不等宽或双侧不等宽，关节旁可见小囊变。结论CT可以发现SIJ炎的早期改变，对AS的早期诊断和随访有重要价值。     

强直性脊柱炎骶髂关节的CT表现

目的探讨强直性脊柱炎骶髂关节病变的CT表现。方法收集分析52例强直性脊柱炎患者的骶髂关节CT资料。结果50例患者骶髂关节有异常表现,包括：早期：骨关节面受侵蚀,骨皮质局限增厚、硬化,关节间隙正常;后期：关节面呈虫蚀状改变,关节面皮质密度不规则增高,关节间隙增宽或变窄,最终关节间隙消失,关节强直。结论强直性脊柱炎患者CT检查有助于早期诊断。     

强直性脊柱炎早期CT表现——白边征

目的 探讨强直性脊柱炎患者中骶髂关节白边征的形态学表现及临床意义。 方法 收集92例强直性脊柱炎患者,均接受骶髂关节CT检查,分析其影像学表现,并进行统计学分析。 结果 白边征表现为CT图像上骶髂关节髂骨关节面骨皮质带状、不均匀骨质致密区,骨缘不光滑。92例中,双侧骶髂关节受累84例(84/92,91.30%),单侧骶髂关节受累8例(8/92,8.70%);单纯髂骨面受累73例(73/92,79.35%)。骶髂关节炎Ⅰ级19例(19/92,20.65%),其中白边征9例(9/19,47.37%);Ⅱ级24例(24/92,26.09%),其中白边征13例(13/24,54.17%);Ⅲ级35例(35/92,38.04%),Ⅳ级14例(14/92,15.22%),均未见白边征。Ⅰ级、Ⅱ级及Ⅲ级以上骶髂关节炎中白边征出现率的差异有统计学意义(χ²=33.218,P<0.001)。 结论 骶髂关节白边征是AS的早期CT征象,可以考虑将其作为骶髂关节炎分级的参考指标。     

MRI与CT在诊断早期强直性脊柱炎骶髂关节病变中的效果比较

目的探讨磁共振成像(MRI)与电子计算机断层扫描(CT)诊断早期强直性脊柱炎(AS)骶髂关节病变的效果。方法选择AS骶髂关节病变患者150例,先后进行CT与MRI诊断。比较CT与MRI对AS分级的检出率与总检出率,以及对AS各种征象的检出效果。结果 MRI对ASⅠ级、Ⅱ级检出率及总检出率均显著高于CT(P 0. 05)。MRI与CT对ASⅢ级与Ⅳ级检出率比较无显著差异(P 0. 05)。MRI对AS关节面下骨质囊变、关节面侵蚀、关节面增生硬化的检出率显著高于CT(P 0. 05); MRI与CT对AS关节间隙狭窄或增宽、关节软骨肿胀的检出率比较,差异无统计学意义(P 0. 05)。结论MRI诊断早期AS骶髂关节病变的效果,以及对关节面下骨质囊变、关节面侵蚀、关节面增生硬化等早期症状检出率均优于CT,可作为早期AS骶髂关节病变的首选诊断技术。     

X线、CT和MRI在强直性脊柱炎骶髂关节病变早期的影像学价值对比观察

对120例临床及实验室检查符合AS特征、骶髂关节X线平片Ⅱ级以下早期病变的患者行CT和MR检查,分析并比较各检查发现的影像学征象。结果 120例患者的240个骶髂关节中,CT发现228个关节(95%)存在Ⅱ级及以下早期骶髂关节病变,检出率明显优于X线平片(81.25%),在判断关节面的细微破坏、关节间隙的轻微改变等方面也优于X线平片。MRI除可见AS骶髂关节慢性骨结构改变外,所有病例均显示骨髓水肿、脂肪浸润、关节滑膜增厚、关节软骨增厚或破坏、韧带附着点炎症等。MRI能发现X线平片和CT无法显示的骨髓水肿、关节软骨破坏、滑膜炎症等早期征象,在早期强直性脊柱炎的诊断价值方面优于X线平片和CT。     

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.     

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.