肾癌彩色血流平均密度与病理组织学分级及微血管密度的对比研究

目的探讨肾癌术前超声检测彩色血流平均密度（mean color vessel density，MCVD）与术后病理组织学分级、微血管密度（microvessel density，MVD）的相关性。方法对50例肾癌患者术前行超声检查，计测MCVD值，术后对肿瘤组织标本进行病理组织学分级，用抗CD105单克隆抗体行免疫组织化学染色计测MVD值，对结果进行统计学分析。结果MCVD与MVD呈正相关（r=0．480，P〈0．05），术后病理组织学分级Ⅰ～Ⅲ级，各病理组织学分级的MCVD及MVD比较差异均有显著性意义（均P〈0．05）。结论随肾癌病理组织学分级的增高，MVD值增加，MCVD值也增加，MCVD能客观显示不同病理组织学分级肾癌的血管分布情况，可作为术前判断肾癌预后的指标。     

肾细胞癌三维彩色血管能量成像与病理免疫组化对比研究

肾细胞癌(简称。肾癌)是恶性度较高的多血管肿瘤,约占成人肾脏恶性肿瘤的85％．其临床症状出现较晚,预后不良。肾癌生长和转移取决于组织内血管生成、分布情况,准确、无创地判断肿瘤区域血管及血供情况对肾癌的早期诊断、治疗及预后判断有重要的临床意义。本研究应用三维彩色血管能量成像(3D-CPA)技术,对36例。肾癌患者进行术前检查,观察肿瘤血管分布情况．定量计算肿瘤血管指数(vascularity index．VI)．术后肿瘤组织用抗CD105单克隆抗体免疫组织化学染色,计数肿瘤微血管密度(microvessel density,MVD)。统计分析VI、MVD与肾癌组织类型的关系．以探讨3D-CPA定量检测。肾癌血管的病理学基础,评价其对。肾癌血供定量诊断的临床价值。     

肝癌三维彩色血管能量成像与病理微血管密度研究

目的:探讨三维彩色血管能量成像(three-dimensional color power angiography,3D-CPA)检测肝癌血管的临床价值。方法:应用3D-CPA检测37例原发性肝癌(Primary Hepatocarcinomas,HCC)肿瘤血供及血管分布情况,计测肿瘤血管指数(Vascularity Index,VI),术后肿瘤组织切片行CD34单克隆抗体免疫组化染色,计数肿瘤微血管密度(Microvessel Density,MVD),对上述结果进行分析。结果:37个肝癌病灶VI为0.2647±0.1249条/cm3,免疫组化计测MVD为(63.31±29.93)/400倍视野,两者比较呈高度线性正相关(r=0.874,P<0.001)。结论:3D-CPA能客观评价肝癌血供,较准确地定量其血管,为临床定性诊断、估测预后及疗效判定提供依据。     

经阴道超声三维血管定量与病理微血管密度对卵巢癌临床分期及病理类型的应用价值

目的：评价经阴道超声血管定量指标与卵巢癌的血管病理学指标的相关性,探讨经阴道三维彩色血管能量成像（TR3D-CPA）对不同临床分期及不同病理类型的卵巢癌的临床应用价值。方法：术前应用TR3D-CPA检测48例卵巢癌患者,测定肿瘤血管指数（VI）。术后应用抗CD34单克隆抗体对病理切片进行免疫组织化学染色,计数肿瘤微血管密度（MVD）。根据FIGO 2000年标准确定临床分期;根据术后病理结果划分不同病理类型。统计分析上述超声指标在卵巢癌不同临床分期及不同病理类型中的差异。结果：48例卵巢癌VI值（0.087±0.045）条/cm3,MVD值（38.6±17.15）个/400×。VI与MVD呈正相关（rs=0.701,P<0.01）。VI随临床分期的升高而升高;临床Ⅲ、Ⅳ期VI明显高于Ⅰ、Ⅱ期（P<0.05）。在不同病理类型之间VI,MVD差异均无统计学意义（P>0.05）。结论：VI随临床分期增高而升高,可于术前评价卵巢癌血管生成,为术前诊断及预后评估提供有价值的信息。     

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。     

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。     

进展期胃癌三维超声血管指数与微血管密度及淋巴结转移的相关性研究

目的 研究进展期胃癌三维超声血管指数(vascularity index,VI)与病理微血管密度(microvessel density,MVD)及转移淋巴结个数的相关性.方法 对55例进展期胃癌患者行三维彩色能量成像(three-dimensional color power angiography,3D-CPA),计算肿瘤的VI,对术后标本进行CD34免疫组织化学染色,计数MVD,根据术后病理统计转移淋巴结个数.结果 55例胃癌的三维超声VI为7.635±5.116,病理MVD为(31.375±7.767)条/200倍视野.进展期胃癌VI与MVD呈线性正相关(r=0.767,P<0.001),VI与转移淋巴结个数呈线性正相关(r=0.538,P<0.001).结论 三维超声测量胃癌VI可以作为一种术前无创评估进展期胃癌血管生成及淋巴结转移的新方法,从而为选择治疗方案和判断预后提供更多信息.     

甲状腺肿瘤三维血管定量与病理微血管定量相关性研究

目的研究甲状腺肿瘤的三维血管定量与病理微血管密度的相关性,评价其临床应用价值.方法应用三维彩色血管能量成像技术(3D-CPA),术前检测38例甲状腺肿瘤血流信号(恶性22例,良性16例)计算3D-CPA血管指数(VI),术后对手术标本行抗CD34因子免疫组化染色,计数肿瘤微血管密度(MVD),行统计学对比分析.结果 22例甲状腺癌3D-CPA VI和MVD分别为(9.69±4.37)条/cm3和(51.33±12.86)/400倍视野,二者呈线性正相关(r=0.796,P＜0.01),16例良性甲状腺肿瘤3D-CPA VI和MVD分别为(4.96±1.19)条/cm3和(20.11±8.05)/400倍视野,二者呈线性正相关(r=0.814,P＜0.01),良、恶性两组3D-CPA VI、MVD分别对比差异有显著性(t=2.020,P＜0.001;t=2.016,P＜0.001).以VI大于6条/cm3诊断甲状腺癌,其敏感性、特异性分别为81.82%、87.50%.结论 3D-CPA能立体、直观显示甲状腺肿瘤血供,血管三维定量测值与肿瘤微血管密度相关性较好,血管三维能为良、恶性甲状腺肿瘤鉴别提供有效血流信息.     

原发性肝癌超声造影彩色血管密度与病理微血管密度的对比分析

目的 探讨原发性肝癌(HCC)术前超声造影(CEUS)定量、半定量血流灌注参数与术后病理微血管密度(MVD)的相关性.方法 HCC 34例术前行CEUS,超声造影能量多普勒(CEUS-PD)状态下选取血流信号最丰富的切面,计算机计测病灶平均彩色血管密度(MCVD),并对图像血流信号进行半定量分级,所得定量、半定量参数与术后病理组织免疫组化染色计测的MVD对照,进行相关性分析.结果 CEUS-PD状态下34例病灶血流信号最丰富切面MCVD为0.17±0.09,术后病理组织切片免疫组化染色计测的MVD为(62.59±23.96)/400倍视野,二者呈正相关(r=0.56.P<0.05);病灶血流信号分级为:Ⅰ级3例,Ⅱ级12例,Ⅲ级19例;血流信号各半定量分级的MVD存在差异(F=8.06,P<0.05),趋势检验表明各半定量分级的MVD无线性趋势(F=7.57,P>0.05).结论 HCC术前CEUS-PD状态下计测的MCVD与术后病理MVD呈正相关,可于术前评价肿瘤的血流灌注.     

卵巢恶性肿瘤经阴道超声定量指标与病理微血管密度及临床分期相关研究

目的探讨卵巢恶性肿瘤血管病理学特征,评价经阴道超声定量指标与病理微血管密度的相关性及其与临床分期的关系。方法术前应用经阴道彩色多普勒超声(transvaginalcolor Dopplerultrasonography,TVCDU)与三维彩色血管能量成像(three-dimensional colorpower angiography,TR3D-CPA)检测38例卵巢恶性肿瘤患者,测定肿瘤血流阻力指数(RI)与血管指数(VI)。术后对组织切片进行免疫组化染色,计数微血管密度(microvesseldensity,MVD);确定卵巢恶性肿瘤临床分期;统计分析RI、VI与MVD的相关性及其与临床分期的关系。结果38例卵巢恶性肿瘤RI值0.44±0.13,VI值(0.08±0.052)条/cm3,MVD值(37.5±18.22)个/400倍视野。RI与MVD呈负相关(rs=-0.412,P<0.01)。VI与MVD呈正相关(rs=0.684,P<0.01)。RI随临床分期的升高而降低,VI随临床分期的升高而升高;临床、期VI、MVD明显高于、期,RI反之(P<0.05)。结论RI与VI可于术前评价卵巢恶性肿瘤血管生成,为术前诊断及预后评估提供有价值的信息。     

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.