应用高分辨率CT鉴别诊断肺部孤立性结节(SPN)的价值

目的:探讨应用高分辨率计算机断层扫描(HRCT)鉴别诊断肺部孤立性结节(SPN)的价值。方法:在2020年1月至2021年12月,将北京中医医院延庆医院查体发现孤立性肺结节的120例患者纳入,对患者实施胸部X线检查、HRCT检查,对比胸部X线和HRCT检查对于孤立性肺结节开展定性诊断的结果各项指标,并对比X线与HRCT对不同临床分期肺癌的诊断符合率。结果:在孤立性肺结节定性诊断中,参照院外随访结果,关于诊断结果中的灵敏度、特异度、阳性预测值、阴性预测值、准确率,HRCT各项数值均比X线高(P<0.05)。HRCT对Ⅰ期、Ⅱ期肺癌的诊断符合率均高于X线(P<0.05),而在Ⅲ期、Ⅳ期肺癌诊断时,X线与HRCT的符合率对比无明显差异(P>0.05)。结论:HRCT对孤立性肺结节的定性诊断价值良好,不仅可准确区分肺良性结节与肺癌,还可对肺癌的临床分期进行辅助鉴别。     

HRCT在周围型小肺癌诊断中的应用

目的：探讨HRCT对周围型小肺癌的诊断价值。材料与方法：对45例直径小于2．0cm的周围型小肺癌HRCT表现进行回顾性分析,其中腺癌34例,细支气管肺泡癌7例,鳞癌4例,全部病例均由病理诊断证实。结果：HRCT能从结节内部表现、界面影像、结节周围影像三方面反映出周围型小肺癌的一些特征性改变。结论：HRCT对周围型小肺癌的诊断及鉴别诊断具有较高的价值。     

高分辨螺旋CT在肺孤立性结节诊断中的应用

肺孤立性结节（solitary pulmonary nodule，SPN）是指肺内直径≤3cm的单发结节状病灶。SPN一直是临床影像学诊断与鉴别诊断中的难题之一。据我们所见肺内孤立性结节在胸片和CT上绝大多数为肺内孤立球形病变，常以原发性肺癌、结核瘤、炎性假瘤、错构瘤居多。我们研究了50例SPN高分辨CT的不同表现，探讨高分辨螺旋CT对SPN的定性诊断的价值。     

MPR联合VR对肺小结节(直径≤1 cm)的早期诊断价值

正随着吸烟人数的增加及空气污染逐渐加重,肺癌发生率呈逐年上升趋势。肺癌早期并无突出临床表现,一般可出现呼吸道感染症状,当出现较为严重的症状时已发展为肺癌晚期[1]。临床中,肺癌早期一般是孤立性肺结节形式表现,但直径在1 cm及以下的肺小结节病灶极小,所以临床确诊难度较大[2]。本研究探讨MPR联合VR用于肺小结节(直径≤1 cm)诊断价值,现报告如下。1资料与方法1.1一般资料     

肺孤立良性结节的HRCT表现及病理基础研究

目的 探讨肺良性结节HRCT表现特征及其病理基础以提高诊断正确率。方法 分析39例经手术病理证实直径≤3．0cm肺孤立良性结节HRCT图像边缘和内部表现特征并与病理组织学对照研究，其中包括结核球15例，炎性假瘤10例，错构瘤10例，硬化性血管瘤2例，其他2例。结果 形态呈圆形或类圆形33例(85％)，边缘清楚35例(90％)，病理上多有包膜或周围肺膨胀不全带；浅分叶者25例(64％)；粗长毛刺14例(36％)，为小叶间隔炎性增厚或被牵拉的小血管；血管集束征13例(33％)，为正常血管伸达病灶边缘或进入病灶；胸膜凹陷征13例(33％)；卫星病灶13例(33％)，为病灶周围肉芽肿或干酪坏死病灶。内部结构密度均匀者23例(59％)；不均匀者16例(41％)，钙化12例(30．7％)，空洞6例(15％)，多为向心性，裂隙样或新月样，内壁光滑。结论 HRCT能最大程度反映肺良性结节边缘和内部病理特征，在肺孤立性结节的鉴别诊断中发挥主导作用。     

孤立性肺结节的良恶性鉴别诊断

孤立性肺结节（Solitary pulmonary nodule,SPN）指肺内直径≤3 cm 的单一圆形或椭圆形致密影,且不伴有肺不张或肺门,纵隔淋巴结肿大的肺部结节1 .肺孤立性结节的良恶性鉴别诊断尤为重要.我们自2008 年1月-2011年9月,从胸部手术病人中随机选择肺孤立性结节,直径≤3 cm的病人共计337例进行回顾研究分析,现报告如下.     

孤立结节性肺癌的CT分析

目的:探寻以孤立性结节为表现的肺癌CT征象及特点。方法:搜集42例经手术病理证实的孤立结节性肺癌的CT资料,从其边缘、密度以及与周边结构的关系等进行回顾性分析。结果:42例孤立结节性肺癌的主要CT表现:11例结节边缘毛糙,有明确小毛刺或锯齿状改变;15例边缘分叶状加小毛刺或锯齿状改变;3例边缘光整无分叶状及毛刺者;13例边缘细长毛刺并达脏层胸膜。“毛虫”征、HRCT靶扫描以及增强扫描在诊断孤立结节性肺癌方面起到了关键性作用。结论:把结节边缘有小毛刺者统称为“毛虫”征来进行分析,结合HRCT靶扫描等,其诊断符合率达83.3%。     

56例孤立性肺小结节MSCT影像诊断体会

目的:分析肺部小结节的MSCT表现特征,总结肺小结节的良恶性鉴别征象及诊断依据。方法:收集56例肺部孤立性小结节(直径小于10mm)的患者,观察结节的大小、结节边缘、内部密度及增强特性等情况,其中16例加行增强扫描,总结肺小结节的CT征象。结果:56例孤立性肺小结节中,经手术病理证实早期肺癌12例,其中CT表现为磨玻璃密度为主结节7例,实性3例,中心实性边缘磨玻璃密度小结节2例;肺良性结节中错构瘤5例,结核瘤7例,硬化性血管瘤1例,炎性病变20例,短期随访复查病灶消失;11例随访超过12月病变无变化,性质未定,继续定期随访。结论:孤立性肺小结节体积小、定性困难,但通过分析其MSCT表现,可对其作出较准确的诊断,能为临床进一步处理提供指导。     

多排螺旋CT对肺内孤立性结节诊断的探讨

目的用多因素回顾性研究的方法,探讨肺内直径≤3em的孤立性结节（SPN）定性诊断的可能性,并评价多排螺旋CT的鉴别诊断价值。方法搜集经证实的直径≤3cm的SPNs病例80例,通过对病灶的强化时间-密度曲线（T-DC）模式、肺内结节的CT形态学特征等行多因素分析,探讨SPN定性诊断的相关因素。结果恶性、良性及炎性结节显示了不同的T—DC模式。睬分叶征、钙化在小肺癌与良性结节两组病例间有显著统计学差异。肺结节内点状、多点状透亮影在良、恶性结节中出现率有显著差异。结论多排螺旋CT对病变全方位显示,动态对比增强功能CT提供了SPN血流模式的定量信息,结合临床资料,能较好地无创地定性诊断,从而提高肺内孤立性小结节的诊断率。     

孤立性肺结节的CT诊断价值

目的:探讨孤立性肺结节的CT表现,提高CT对孤立性肺结节的诊断及鉴别诊断价值。材料与方法:回顾性分析资料较全并经病理证实的36例孤立性肺结节的CT检查资料。结果:周围型肺癌22例,结核球6例,球形肺炎2例,转移瘤2例,错构瘤1例,纤维瘤1例,肺囊肿1例。结论:CT扫描是孤立性肺结节诊断的主要方法,对大多数孤立性肺结节能做出较正确诊断。     

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.