能谱CT对甲状腺乳头状癌的诊断价值

目的探讨能谱CT成像（GSI）技术对于甲状腺乳头状癌（PTC）的诊断价值。方法收集经手术病理证实的32例（共45个结节）甲状腺乳头状癌患者,行甲状腺能谱CT单能模式平扫及增强扫描,测量结节的碘浓度,计算能谱曲线斜率,并与病理结果对照。结果平扫期、动脉期、静脉期甲状腺乳头状癌的碘浓度（100μg/ml）分别为5.77±4.23、10.42±5.78、18.27±5.09;能谱衰减曲线斜率分别为-0.53±0.26、-0.84±0.52、-1.24±0.30。各期乳头状癌组的碘浓度及曲线斜率绝对值均小于良性结节组和正常甲状腺组（P均〈0.05）。32例中有23例出现淋巴结转移,其中18例能谱曲线与原发灶完全一致。结论能谱CT对甲状腺乳头状癌的准确诊断具有重要价值。     

宝石能谱CT对肺部良性和恶性结节病变的鉴别诊断价值

目的分析宝石能谱CT对肺部良性和恶性结节病变的诊断价值。方法选取2014年9月至2016年9月63例肺部良恶性结节病变患者的临床资料,患者均接受宝石能谱CT能谱成像模式扫描,并取得静脉期、动脉期的70 keV碘基图像与单能量图像,通过单能量图像能谱分析的功能,观察肺部良恶性结节动脉期、静脉期的水基值与碘基值以及不同keV下的CT值。结果肺部良性结节病变的静脉期与动脉期碘基值均低于恶性结节(P0.05),良性恶性结节病变的静脉期与动脉期水基值对比,差异未见统计学意义(P0.05);静脉期及动脉期肺部良性结节病变在不同keV下的CT值均低于恶性结节(P0.05)。结论肺部良恶性病变患者行能谱CT诊断,可提高诊断准确性,并初步区分肺部恶性结节与良性结节。     

CT在乳头状甲状腺结节微小癌和微小结节性甲状腺肿鉴别诊断中的应用价值

目的探究CT在乳头状甲状腺结节微小癌和微小结节性甲状腺肿鉴别诊断中的应用价值。方法选取我院在2016年1月至2018年1月收治的100例患有甲状腺微小结节的病例。按病例分为乳头状甲状腺结节微小癌组和微小结节性甲状腺肿组,比较俩组患者的一般CT特征和不同部位CT值。结果乳头状甲状腺结节微小癌组CT特征中单发结节、瘤体不规则、增强后边界模糊、细颗粒状钙化和边缘中断特征高于微小结节性甲状腺肿组,混合钙化显著低,P<0.01;微小结节性甲状腺肿组腺体和结节平扫,增强CT值无差异,P>0.05。结论根据本文研究发现,CT在乳头状甲状腺结节微小癌和微小结节性甲状腺肿鉴别诊断中有很大的应用价值,值得在临床上进一步采用和进一步推广。     

探究乳头状甲状腺微小癌和微小结节性甲状腺肿的CT鉴别诊断分析

目的:研究并探讨CT在乳头状甲状腺微小癌和微小结节性甲状腺肿鉴别诊断中的应用价值。材料与方法:于2012年1月~2015年12月,选取该阶段内我院收治的50例微小结节性甲状腺肿确诊病例和50例乳头状甲状腺微小癌确诊病例作为此次研究的对象,将其设置为A组、B组,A组有78枚微小结节性甲状腺肿瘤体,B组有62枚乳头状甲状腺微小癌瘤体。两组患者均进行CT平扫、CT增强扫描,对两组患者的CT图像进行观察,计算诊断符合率,并对比两组患者的结节大小、腺体各部位体积大小以及瘤体情况。结果:CT对微小结节性甲状腺肿的诊断符合率为96%,对乳头状甲状腺微小癌的诊断符合率为94%,两组相比,差异无统计学意义(P0.05),与病理确诊结果比较也无明显差异(P0.05)。与A组相比,B组患者的单发结节占比、不规则瘤体占比、增强后边界模糊占比、细颗粒状钙化率、边缘中断征发生率均明显更高(P0.05),但其混合钙化率明显更低(P0.05)。与A组相比,B组的甲状腺腺体左叶体积、右叶体积均明显更小(P0.05),其峡部体积和结节体积均明显更大(P0.05)。结论:在乳头状甲状腺微小癌、微小结节性甲状腺肿的鉴别诊断中,CT可通过对瘤体发生状态、形态、边界、钙化等情况,有效区分乳头状甲状腺微小癌、微小结节性甲状腺肿。     

CT对乳头状甲状腺结节微小癌和微小结节性甲状腺肿鉴别诊断的价值探讨

目的:探讨分析CT对乳头状甲状腺结节微小癌和微小结节性甲状腺肿鉴别诊断的价值。方法:选取我院2018年11月至2019年10月收治的50例甲状腺微小结节患者,按照病理检查结果划分为乳头状甲状腺结节微小癌组(A组)和微小结节性甲状腺肿组(B组),比较分析两组患者CT检查结果。结果:通过对两组患者CT常规征象进行比较,结果显示,A组患者在结节单发、形态不规则、边界模糊、钙化等征象上均与B组患者表现出显著差异(P<0.05);且A组患者在结节体积、峡部体积、右叶体积及左叶体积等指标上与B组患者存在显著差异(P<0.05)。结论:在鉴别诊断乳头状甲状腺结节微小癌和微小结节性甲状腺肿患者时,应用CT诊断技术的效果比较显著,能够为临床治疗提供参考依据。     

能谱CT评价射频消融治疗非小细胞肺癌的早期疗效

目的 探讨CT宝石能谱成像(GSI)在射频消融治疗非小细胞肺癌(NSCLC)早期疗效评价中的应用价值。方法 收集经临床和病理证实的NSCLC患者20例,其中腺癌12例,鳞癌8例。于射频消融治疗前和治疗后早期(< 1个月)进行能谱CT扫描,获得肺动脉期图像,并进行图像重建,得到碘基物质图像、水基物质图像、70 keV水平的单能量CT值及能谱曲线斜率,并对治疗前后进行对比分析。结果 20例患者病灶射频消融治疗后的碘(水)基含量、70 keV水平CT值、能谱曲线斜率明显低于治疗前,水(碘)基含量略高于治疗前,差异均有统计学意义(P均< 0.05)。结论 GSI可反映NSCLC射频消融治疗前后病灶的血供特点及灌注程度变化,有助于评价射频消融治疗NSCLC的早期疗效。     

Revolution CT能谱成像在诊断肺结节中的应用价值

目的分析Revolution CT能谱成像在诊断肺结节中的临床价值。方法选取肺结节患者162例,根据手术病理学检查结果分为良性结节组(n=55)和恶性结节组(n=107),均行Revolution CT能谱成像扫描,比较2组Revolution CT能谱成像动脉期、静脉期增强扫描参数[标准化浓度(NIC)、净增碘浓度(ΔIC)、能谱曲线斜率(K)、40 keV的CT值(CT 40 keV)及净增CT值(ΔCT 40 keV)],分析其对肺结节良恶性诊断价值。结果恶性结节组动脉期、静脉期增强扫描NIC、ΔIC、K、CT 40 keV、ΔCT 40 keV均低于良性结节组(P<0.05);Revolution CT能谱成像诊断肺结节良恶性的特异度为98.18%,敏感度为96.26%,准确性为96.91%。结论Revolution CT能谱成像通过NIC、ΔIC、K、CT 40 keV、ΔCT 40 keV定量参数,可为鉴别诊断肺结节性质、实施个性化治疗方案、促进预后改善等提供参考依据。     

宝石CT能谱成像140 keV单能图结合水基图检查肝脏

目的 探讨宝石CT能谱成像(GSI)140 keV单能图结合水基图扫查肝脏的价值。 方法 对45例接受肝脏平扫和增强扫描CT患者,在完成常规平扫及三期增强扫描后,采用肝脏能谱后处理分析软件生成140 keV单能图和水基图;比较平扫图像、140 keV单能图和水基图对肝内病灶的显示情况,对比分析平扫图像与140 keV单能图中肝脏、肌肉的CT值、SNR以及单期和总容积CT剂量指数(CTDIvol)、剂量长度乘积(DLP)。 结果 在显示病灶方面,140 keV单能图、水基图与平扫图像无明显差异;肝脏CT值140 keV单能图略高于平扫图像,而SNR 140 keV单能图低于平扫图像(P均<0.05);140 keV单能图和水基图的总CTDIvol和DLP均低于平扫图像(P均<0.05)。 结论 GSI肝脏三期增强扫描中,利用140 keV单能图结合水基图有可能取代平扫图像,以利于降低辐射剂量。     

比较宝石能谱CT与常规超声诊断甲状腺结节良恶性的临床意义

目的:研究宝石能谱CT、常规超声诊断甲状腺结节良恶性的异同点,总结宝石能谱CT临床诊断价值。方法:在我院就诊的数名甲状腺结节患者中,有72例患者自愿参与研究并经病理学检查确诊为甲状腺结节,患者分别进行能谱CT扫描及超声检查,按照检查结果分良性、恶性组,对比分析超声诊断与CT诊断效果。结果:良性组、恶性组的碘浓度、标准化碘浓度、能谱曲线斜率在CT平扫存在明显差异(P<0.05),动脉扫描期参数差异不显著。能谱CT扫描比超声诊断更能清楚确定结节边界、结节形态,CT扫描敏感度、特异度高于超声诊断。结论:与常规超声诊断相比,能谱CT诊断准确性较高,可作为甲状腺结节良恶性判定的重要标准。     

能谱CT成像技术指标与脂肪密度模型相关性

目的探讨能谱CT成像技术指标与脂肪密度模型的相关性。方法 11组已知脂肪密度的离体组织行CT能谱成像技术扫描,测量其40、70、140keV下的CT值、能谱曲线和3种基物质对的密度值,采用Pearson相关分析法分析测量值与实际脂肪密度值的相关性。结果 keV相同时,CT值与脂肪密度值呈负相关(r=-0.938,P=0.021);脂肪密度相同时,CT值与keV值呈正相关(r=0.936,P=0.035);脂肪密度与能谱曲线斜率呈正相关(r=0.994,P=0.027);脂肪密度与水(碘)、水(脂肪)和脂肪(碘)基物质对的密度值均呈正相关(r=0.939,P=0.016;r=0.995,P=0.008;r=0.939,P=0.016)。结论脂肪密度与单能量图像的CT值、能谱曲线斜率及基物质对的密度值具有良好的相关性,初步认为能谱CT成像可对人体组织进行精确测量和定量分析,为诊断和治疗提供参考数据。     

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.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.