卵巢肿瘤三维多普勒能量成像与病理MVD表达的相关性研究

目的探讨三维彩色血管能量成像（three-dimensional color power angiography,3D-CPA）术前观察卵巢肿瘤的血流特点与术后病理组织微血管密度（micro vessel density,MVD）之间的关系。 方法应用3D-CPA观察76个卵巢肿瘤的血管形态,判断血管分级并计算肿瘤内血管指数（vascular index VI）,采用免疫组织化学染色技术检测肿瘤内的MVD,并且进行相关性分析,评价三维能量多普勒成像与病理微血管密度的相关性。 结果三维多普勒能量成像所观测卵巢肿瘤的血管分级在良恶性肿瘤之间存在显著差异;级血管分型的血管分级与MVD相关;卵巢癌的血管指数与MVD有显著相关性（r=0.84,P〈0.005）。 结论应用3D-CPA对卵巢肿瘤的血供情况进行血管分型及VI的计算与免疫组化指标（MVD）有较好的相关性,综合分析可以从不同角度反应卵巢肿瘤的血管生成情况,为卵巢肿瘤的诊断及鉴别诊断提供有价值的信息。     

三维能量多普勒直方图鉴别诊断卵巢肿物良恶性的价值

目的应用三维能量多普勒直方图定量测量卵巢肿物血管参数,并评价其鉴别诊断卵巢肿物良恶性的价值及与临床分期的关系。方法应用三维能量多普勒超声在术前1周内对57例卵巢肿物患者进行检查,测量肿物内实性部分的血管参数,包括血管形成指数(VI)、血流指数(FI)、血管形成-血流指数(VFI)。比较卵巢良性与恶性肿物之间血管参数的差异及其与临床分期的关系。结果 57例患者中共检出卵巢肿物62个(双侧卵巢肿物5例),经病理证实为良性肿物22个(良性组),恶性肿物40个(恶性组,包括交界性肿瘤8个)。恶性组肿瘤VI(6.3±5.9)%、FI(32.0±8.6)和VFI(2.4±2.7)测值均明显高于良性组肿物VI(2.1±3.3)%、FI(21.0±12.5)和VFI(0.7±1.1),差异有统计学意义(P均<0.01)。以VI>2.1%为界值鉴别卵巢肿瘤良恶性的灵敏度和特异度分别为80.0%、73.0%;卵巢癌FIGO分期Ⅰ、Ⅱ期肿瘤与Ⅲ、Ⅳ期肿瘤VI、FI和VFI测值比较差异均无统计学意义。结论三维能量多普勒直方图是术前评估卵巢肿物良恶性的新方法,可为其提供有价值的信息,但不能术前评估卵巢癌分期情况。     

卵巢肿瘤的三维彩色血管能量成像与病理微血管密度对比研究

目的：探讨上皮性卵巢肿瘤的三维彩色血管能量成像（three-dimensional color power angio,3D－CPA)特点及其血管病理学基础,评价3D－CPA鉴别卵巢肿瘤的临床应用价值。方法：对67例上皮性卵巢肿瘤患者（40例卵巢癌,27例良性上皮性卵巢肿瘤）术前应用3D－CPA检测肿瘤的血管分布类型并计算肿瘤血管指数（vascularity index,VI),术后分别应用抗血管内皮生长因子（VEGF）、抗CD34单克隆抗体对组织进行免疫组织化学染色,计数肿瘤的微血管密度（microvessel density,MVD)及VEGF染色强度。结果：卵巢癌的MVD及VEGF表达强度均显著高于良性上皮性卵巢肿瘤（P＜0．05）。以3D－CPA血管指数＞0．02条／cm^3诊断卵巢癌敏感性77．5％,特异性81．5％。卵巢癌的血管指数与MVD呈等级相关（rs= 0.503,P＜0．01）。结论：3D－CPA可用于术前间接评价肿瘤的血管生成,为卵巢肿瘤的诊断及鉴别提供有价值的信息。     

三维多普勒能量成像检测卵巢肿瘤及其与病理MVD、VEGF表达的相关性研究

目的探讨三维彩色血管能量成像（3D-CPA）术前观察卵巢肿瘤的血流特点与术后病理微血管密度（MVD）及血管内皮生长因子（VEGF）的关系。方法术前应用3D-CPA观察76例卵巢肿瘤的血流信号,判断血管分级并计算肿瘤内血管指数（VI）,术后病理标本应用免疫组织化学染色技术检测肿瘤内的MVD及VEGF染色强度,进行相关性分析,评价三维能量多普勒成像的病理基础。结果卵巢癌的VEGF表达强度均显著高于良性上皮性卵巢肿瘤（P〈0.05）,Ⅲ级血管分型的VEGF染色强度高于Ⅰ、Ⅱ级;卵巢癌的血管分级及VI与MVD有相关性（r=0.84,P〈0.005）。结论血管分型、VI可用于术前间接评价肿瘤的血管生成,为卵巢肿瘤的诊断及鉴别诊断提供有价值的信息。     

三维彩色血管能量成像对乳腺肿物血管的定量研究

目的探讨三维彩色血管能量成像（3D—CPA）定量检测乳腺肿物内血管参数对鉴别诊断肿物良恶性的临床价值。方法61例乳腺肿瘤患者,良性组31例,恶性组30例,对其行3D—CPA重建。采用Vocal分析软件,选择三维能量直方图获得血管形成指数（vI）、血流指数（FI）和血管形成一血流指数（VFI）;并对乳腺肿物进行3D—CPA血流分级,比较乳腺良恶性肿物vI、FI、VFI及其与乳腺肿物内血流分级的关系。结果3D—CPA血流Ⅲ级患者的VI、FI、VFI高于Ⅱ级（P〈0．05）,以Ⅲ级作为诊断乳腺良恶性标准,敏感性、特异性、准确性分别为91．3％、76．3％、82．0％。恶性组VI、FI、VFI均高于良性组（P〈0．05）。以vI≥1．157诊断乳腺恶性肿瘤的敏感性分别为87％,准确性为77％,特异性为68％;以FI≥32．397诊断乳腺恶性肿瘤的敏感性为83％,准确性为67％,特异性为52％;以VFI／〉0．426诊断乳腺恶性肿瘤的敏感性为83％,准确性为73％,特异性为61％。结论乳腺肿物3D—CPA血管定量参数VI、FI、VFI与乳腺肿物血流分级结果一致,可用来判断乳腺肿物内部血管丰富程度,恶性肿物参数均高于良性肿物,有助于乳腺良恶性肿瘤的鉴别。     

彩色多普勒超声对卵巢肿瘤的诊断价值

目的 探讨卵巢良恶性肿瘤的彩色多普勒超声血流形态学和血流动力学特征。方法 对95例患者105个卵巢病变，用能量多普勒观察肿物内的血流形态学改变(包括血管的分级，血管是否有畸形)，用脉冲多普勒检测肿瘤内的血流动力学。观测指标：收缩期峰值流速(VPS)、舒张末期流速(VεD)、平均流速(VM)、搏动指数(PI)、阻力指数(RI)及是否存在舒张期切迹。用逐步回归的方法对上述指标进行分析。结果 所观测的血流形态学及动力学各指标在良恶性卵巢肿瘤之间的差异均存在显著性意义。逐步回归显示，RI的意义最大。RI界值定为0．51时，其鉴别良恶性卵巢肿瘤的敏感性和特异性分别为98．0％，96．2％。结论 RI是鉴别卵巢肿瘤良恶性质的最有意义的血流动力学指标。     

三维能量多普勒超声鉴别乳腺良恶性肿瘤的价值

目的评价三维能量多普勒超声鉴别乳腺良恶性肿瘤的价值。方法乳腺肿块（恶性98例,良性108例）患者进行三维能量多普勒超声成像及直方图血管容积参数的采集与分析,直方图指数包括平均灰度、血管指数、血流指数和血管一血流指数。结果单因素分析以患者的年龄、肿瘤大小、肿瘤体积及血管各项指数鉴别乳腺良恶性肿瘤,参数之间差异均有统计学意义（P〈0．05）;鉴别病灶良恶性以肿瘤体积参数的准确性最高（80．2％）,以血流指数的敏感性最高（73．8％）,以血管指数、血管一血流指数的特异性为最高（均为90．3％）。多元Logistic逐步回归分析,模型（包括患者的年龄、体积及血流指数）是对乳腺恶性肿瘤定性诊断的最佳模型,此模型的ROC曲线下面积为0．958。结论三维能量多普勒超声能充分评估乳腺肿瘤的血管及血流情况,可以提高乳腺肿瘤的鉴别诊断能力。     

三维能量多普勒超声定量研究卵巢肿物血管的价值

目的应用阴式三维能量多普勒超声定量测量卵巢肿物内血管参数并评价其对鉴别卵巢肿物良恶性的价值。 方法使用三维能量多普勒超声对44例术前诊断卵巢肿物的患者及20例正常卵巢的育龄妇女进行检查并测量相应的血管参数：血管形成指数（VI）、血流指数（FI）、血管形成一血流指数（VFI）。比较卵巢良性肿物组（23例）、恶性肿物组（21例）和正常卵巢对照组（20例）血管参数值的差异及其与肿物血管分型的关系。 结果卵巢恶性肿物组的VI、FIVFI值均明显高于良性肿物组和正常卵巢对照组。良性肿物组的VI值亦高于正常卵巢对照组。 结论三维能量多普勒超声定量测量卵巢肿物血管参数可为鉴别卵巢肿物良恶性及卵巢恶性肿物的早期诊断提供有价值的信息。     

三维能量多普勒超声检测宫颈癌血流的价值

目的 评价三维能量多普勒超声成像对宫颈血流的检测价值及对宫颈癌的诊断价值.方法 对30例慢性宫颈炎(对照组)、34例宫颈上皮内瘤变(CIN)及44例宫颈癌进行三维能量多普勒超声成像,对宫颈血流进行分级并计算血管指数(VI),最后进行比较分析.结果 宫颈癌的血管形态及血管分级与对照组及CIN组间存在显著差异,以Ⅲ级血管分型诊断宫颈癌的敏感性为90.9%,特异性为95.3%;宫颈血流的VI值在三组间存在显著差异,以VI≥0.723条/cm3诊断宫颈癌的敏感性为86.4%,特异性为72.2%.结论 三维能量成像能在术前客观地反映宫颈的血流情况,可为宫颈癌提供有意义的诊断指标.     

三维彩色血管能量成像对卵巢肿瘤血管的研究

目的 应用三维彩色血管能量成像（three-dimensional color power Doppler energy,3D-CDE）观察卵巢肿瘤的血流特征,探讨其临床应用价值.方法 对32例卵巢肿瘤患者进行经阴道三维彩色血管能量成像,分析肿瘤血管三维结构形态与肿瘤良恶性的相关性.结果卵巢恶性肿瘤以复杂型（Ⅱ、Ⅲ型）血管为主,卵巢良性肿瘤以简单型（Ⅰ型）血管为主,两者之间差异具有显著性（P＜0.05）.结论 3D-CDE可客观地评价卵巢肿瘤的血管,对卵巢肿瘤的良恶性鉴别具有重要的参考意义.     

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.     

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.     

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.     

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.