声触诊组织成像联合Adobe Photoshop灰度定量技术评估乳腺实性肿块硬度

目的应用声触诊组织成像(VTI)联合Adobe Photoshop灰度定量技术评估乳腺实性肿块整体硬度,探讨其鉴别乳腺实性肿块良恶性的应用价值。方法选取我院经病理证实的乳腺肿瘤患者98例,共108个实性肿块,应用VTI技术获得病灶组织弹性图并将其导入Adobe Photoshop CS4图像处理系统,计算弹性图中病灶整体灰度平均值,比较良恶性乳腺肿块整体灰度平均值;绘制受试者工作特征(ROC)曲线获得鉴别良恶性肿块的截断值,判断VTI联合Adobe Photoshop灰度定量技术的诊断效能。结果恶、良性乳腺实性肿块VTI弹性图病灶整体灰度平均值均值分别为39.21±16.60和63.94±19.42,差异有统计学意义(P=0.000)。ROC曲线显示截断值为50.75,其对应曲线下面积为0.845,诊断恶性乳腺肿块的敏感性为77.27%,特异性为78.13%,准确率为77.78%。结论 VTI联合Adobe Photoshop灰度定量技术可定量评估乳腺实性肿块整体硬度,有助于鉴别乳腺实性肿块性质。     

两种弹性定量方法评估良恶性乳腺实性肿块硬度的对比研究

目的对比分析声触诊组织量化(VTQ)和声触诊组织成像(VTI)联合Adobe Photoshop灰度定量两种弹性定量方法在鉴别诊断乳腺实性肿块良恶性中的应用价值。方法选取98例乳腺肿瘤患者(108个乳腺实性肿块),应用VTQ获得代表肿块中央局部硬度的剪切波速度(VS),同时应用VTI联合Adobe Photoshop灰度定量技术计算VTI弹性图中病灶整体灰度平均值,代表乳腺肿块整体硬度。与病理结果对照,分别比较良恶性乳腺肿块中央局部硬度和整体硬度的差异,获得最佳截断值,比较两个指标的诊断效能。结果恶性和良性乳腺肿块的局部硬度VS值分别为(6.96±2.50)m/s和(2.62±1.82)m/s,差异有统计学意义(P=0.000)。ROC曲线获得最佳截断值为2.78 m/s,以肿块中央局部硬度VS2.78 m/s诊断恶性乳腺肿块的敏感性、特异性及准确率分别为91.18%、88.64%及89.74%,与病理结果高度一致(校正χ2=0.125,P=0.724;Kappa=0.793,P=0.000)。恶性和良性乳腺肿块整体硬度灰度平均值分别为39.21±16.60和63.94±19.42,差异有统计学意义(P=0.000)。ROC曲线获得最佳截断值为50.75,以肿块整体硬度灰度平均值50.75诊断恶性乳腺肿块的敏感性、特异性及准确率分别为79.41%、77.27%及78.21%,与病理结果中度一致(校正χ2=0.235,P=0.628;Kappa=0.561,P=0.000)。结论 VTQ诊断效能高于VTI联合Adobe Photoshop灰度定量技术,但二者均有助于鉴别乳腺实性肿块性质。     

实时组织弹性成像在乳腺病灶诊断中的定量研究

目的评价实时组织弹性成像定量分析对乳腺实性病灶定性诊断中的价值。方法对经超声检查得以显示并经手术病理确诊的68个乳腺病灶行实时组织弹性成像定量检测,绘制病灶整体与局部弹性数值两种模式的ROC曲线,并比较不同性质的病灶整体与局部弹性数值曲线下的面积。结果乳腺病灶整体弹性比值在3.48时诊断的敏感度为85.7%,特异度为78.8%;乳腺病灶局部弹性比值在32.05时诊断的敏感度为97.1%,特异度为81.8%。实时组织弹性成像定量分析乳腺病灶整体与局部弹性数值对诊断乳腺良恶性病灶的ROC曲线下面积(AUC)分别为0.853和0.919,两者的差异有统计学意义(P<0.01);结论根据病灶整体与局部弹性数值可评价肿物硬度及其均匀性,为判断乳腺病灶良恶性提供诊断依据。     

声触诊组织显像技术在乳腺实性结节良恶性鉴别中的价值

目的探讨声触诊组织显像(VTI)技术鉴别乳腺良恶性实性病灶的价值。方法应用VTI技术对46例女性患者共54个乳腺实性病灶进行测量,并采用Image J软件对VTI图像进行量化分析。结果良性乳腺实性病灶VTI图像面积为(174.91±44.07)mm2,明显小于恶性乳腺病灶(558.37±60.11)mm2(P0.05)。良性乳腺病灶VTI图像面积与二维灰阶图像面积比为1.71,而恶性乳腺病灶为2.18。恶性乳腺病灶的灰度为41.06±12.50,明显低于良性乳腺病灶灰度(102.41±18.80,P0.05)。良性乳腺病灶VTI图像灰度与二维灰阶声像图比为2.53,而恶性乳腺病灶为2.23。结论 VTI作为一种新技术具有临床应用价值,为乳腺良恶性病灶的鉴别提供了新信息。     

超声弹性成像参数在乳腺肿瘤诊断中的应用价值

目的 探讨超声弹性成像参数在判断乳腺病灶良恶性中的应用价值.方法 对74个乳腺肿块进行弹性成像检查,与病理结果比较分析乳腺良恶性病变的弹性参数差异.结果 乳腺恶性肿瘤的弹性分级4级以上的出现率明显高于良性病变(P<0.05);肿块在弹性图与二维图中的直径变化率和面积比参数在良恶性组间差异均有统计学意义(P<0.05);比较2种参数的ROC曲线发现,肿块的面积比较直径变化率在鉴别良恶性方面的准确性更高.结论 超声弹性成像能客观地评价乳腺肿块的相对弹性硬度,定量参数直径变化率和面积比有助于乳腺肿块良恶性的鉴别.     

超声弹性成像在乳腺小实性病灶中的诊断价值

目的 评价实时组织弹性成像(RTE)对乳腺小实性病灶(≤10 mm)的诊断价值.方法 对118例患者的129个乳腺病灶进行回顾性分析超声弹性成像评分,并与术后的病理结果进行对照.采用受试者工作特性曲线(ROC曲线)评价超声弹性评分法对其诊断价值.结果 以评分＞3分(ROC曲线下面积为0.945)诊断乳腺小实性恶性病灶敏感性、特异性和准确性分别为83.3％、91.4％和89.9％.结论 RTE有助于≤10 mm乳腺小实性病灶良恶性鉴别,且具有临床诊断价值.     

乳腺微小实性病灶的弹性应变率比值分析

目的：探讨弹性应变率比值（Strain ratio,SR）在乳腺微小实性病灶（≤10 mm）良恶性鉴别诊断中的价值.方法：对165例共184个乳腺微小病灶进行术前超声实时组织弹性成像（Ultrasonography real-time tissue elastography,URTE）检查,采用SR法分析计算病灶与周围对照组织的SR及其平均值.以病理诊断为金标准,构建受试者工作特征曲线（Receiver operating characteristic,ROC）,获得SR的最佳诊断临界值并分析其对乳腺微小实性病灶良恶性鉴别诊断的价值.结果：184个乳腺病灶中,良性114个,恶性70个.良、恶性病灶SR平均值分别为1.81±0.334,2.92±0.753.根据本组良恶性病灶SR绘制的ROC曲线,曲线下面积（Area under the ROC curve,AUC）为0.891,面积标准误为0.023.面积的95％可信区间为0.846～0.935,不包括0.5,P=0.000,差异具有显著统计学意义.通过ROC曲线分析确定良恶性病灶SR的最佳诊断临界值为2.165.其对应的诊断敏感性（Se）81.4％,特异性（Sp）77.2％,约登指数（YI）为0.586,Se与Sp之和最大（1.586）,误诊率与漏诊率之和最小（0.414）.结论：SR能提供乳腺微小实性病灶硬度信息,有助于病灶的良恶性鉴别诊断.     

甲状腺实性结节的声脉冲辐射力弹性成像诊断研究

目的 评估声脉冲辐射力弹性成像技术(ARFI)对甲状腺实性结节良恶性鉴别诊断价值.方法 对100例患者的118个实性结节行ARFI弹性成像声触诊组织成像(VTI)及声触诊组织定量(VTQ)两种技术检查,以VTI弹性分级≥IV级判断为恶性结节;VTQ中计算结节剪切波速度(SWV)平均值、结节周围非病灶组织平均值及两者的比值.结果 根据ROC曲线得出甲状腺良恶性结节SWV平均值及比值的最佳诊断界值分别为2.66m/s、1.21,曲线下面积(AUC)分别为0.780、0.762,敏感性、特异性、准确率分别为56%、89%、74%,69%、73%、71%;以VTI弹性分级≥IV级判断甲状腺实性结节良恶性具有显著性意义(P=0.000),其敏感性为78%,特异性为77%,准确率为77%.结论 ARFI技术定性及定量评价组织硬度,对甲状腺实性结节良恶性鉴别均有较高价值,两者结合应用对甲状腺实性结节的超声鉴别诊断有较大帮助.     

定量超声弹性成像技术与X线钼靶对乳腺小结节诊断价值的比较

目的 评价定量超声弹性成像技术与X线钼靶对乳腺良恶性小结节的诊断价值.方法 对53例女性患者共72个乳腺实性小结节病灶用定量超声弹性成像技术测定病灶应变率与周围正常乳腺组织弹性应变率比值,判断病灶良恶性,并与手术病理结果及术前X线钼靶检查结果进行对照.通过与术后病理结果比较,绘制ROC曲线图,获得区分乳腺小结节良恶性应变率比值的临界值.结果 (1)乳腺良性组应变率比值为2.46±1.11,恶性组应变率比值为5.85±1.69,二者比较差异有统计学意义(P<0.05).(2)通过ROC曲线确定良、恶性肿块弹性应变率比值的临界点为4.38,其特异性、敏感性、准确性分别为87.09%、90.24%和88.89%,X线钼靶的特异性、敏感性、准确性分别为77.74%、73.17%、70.83%.统计学结果显示二者比较差异有统计学意义(P<0.05);且两者联合运用可进一步提高乳腺小结节病变性质诊断的准确性(P<0.05).结论 定量超声弹性成像技术对乳腺小结节病变性质的诊断价值明显高于X线钼靶,而联合检查能进一步提高恶性病灶的检出率.     

弹性定量在乳腺病变鉴别诊断中的价值

目的探讨声触诊弹性图像灰度定量技术在乳腺良恶性病变鉴别诊断中的应用价值。方法选取我院行穿刺活检或手术切除的乳腺病变患者66例,共70个乳腺结节进行了弹性图灰度定量分析,采用ROC曲线分析该方法在鉴别诊断乳腺良恶性病变的敏感性和特异性。结果乳腺良性、恶性病变的弹性图平均灰度值分别为68.72±39.88和25.26±11.35,两者比较差异有统计学意义(P0.001),ROC曲线显示:当诊断阈值为32.13时,弹性图灰度值鉴别诊断良恶性病变的敏感性和特异性分别为94.1%和85.7%,曲线下面积为0.918±0.038。结论弹性图像的灰度定量方法可有助于乳腺良恶性病变的鉴别诊断。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

Organ Preservation: Current Concepts and New Strategies for the Next Decade

SUMMARY: Organ transplantation has developed over the past 50 years to reach the sophisticated and integrated clinical service of today through several advances in science. One of the most important of these has been the ability to apply organ preservation protocols to deliver donor organs of high quality, via a network of organ exchange to match the most suitable recipient patient to the best available organ, capable of rapid resumption of life-sustaining function in the recipient patient. This has only been possible by amassing a good understanding of the potential effects of hypoxic injury on donated organs, and how to prevent these by applying organ preservation. This review sets out the history of organ preservation, how applications of hypothermia have become central to the process, and what the current status is for the range of solid organs commonly transplanted. The science of organ preservation is constantly being updated with new knowledge and ideas, and the review also discusses what innovations are coming close to clinical reality to meet the growing demands for high quality organs in transplantation over the next few years.     

Calcified primary tumors of the gastrointestinal tract

The dominant pattern and location of calcifications occurring within 23 primary gastrointestinal tumors have been analysed and correlated with the data from the literature. The provided guidelines for radiologic diagnosis of such calcified tumors include: (1) a retrocardiac mass containing amorphous calcifications is typical of leiomyoma of the esophagus; (2) calcific deposits similar to that in uterine fibroids may be the feature of gastric leiomyoma or intestinal leiomyosarcoma; (3) sand-like deposits within the wall of the stomach or colon are characteristic of a mucinous adenocarcinoma; (4) clusters of phleboliths in the gastrointestinal wall suggest a hemangioma particularly if recurrent intestinal bleeding and cutaneous hemangiomas are associated; (5) sunburst type of calcification in the pancreas indicates a cystadenoma or cystadenocarcinoma of that organ; and (6) aggregates of granular calcifications in the liver are diagnostic for metastatic adenocarcinoma of the colon but may rarely be seen in a primary malignancy of the liver.     

他汀时代对高甘油三酯血症再认识

近年来,越来越多的证据表明降低低密度脂蛋白胆固醇可以减少心血管事件的发生,降低死亡率,但不容忽视的是,即使经标准治疗后低密度脂蛋白胆固醇达标,仍然存在发生大血管和微血管事件的风险（即心血管剩留风险）。我国成人高甘油三酯血症患病率高,与心血管疾病剩留风险关系密切,应该引起足够的重视。     

Ultrasound examination of the liver: Variations in the vascular anatomy

The hepatic vasculature is highly complex. The hepatic artery (a branch of the celiac tripod) and the portal vein (formed by the confluence of the splenic and superior mesenteric veins) provide a dual blood supply while venous drainage is guaranteed by the hepatic veins. There are also numerous anatomic variants that can involve one or more of the system’s three components.Hepatic artery variants are the least common. Ten types have been identified, including several that are fairly frequent and others that are quite rare, and the variation generally involves the extrahepatic portion of the vessel. Portal vein variants are found in around 20% of the population. They can involve the main portal trunk or segmental branches. Variants of the hepatic veins are the most common. They involve the number and course (supernumerary veins) or the number, course, and openings (accessory veins).Knowledge of portal vein and hepatic vein variants, which are extremely common, is of prime importance for precise localization of lesions. Hepatic artery variants are equally important for surgical treatment of hepatic disease, especially liver transplantation, where it is essential for preoperative workup and postoperative follow-up of the recipient as well as for assessment of potential donors.     

Brain tissue volumes in the general population of the elderly: the AGES-Reykjavik study

Imaging studies have reported conflicting findings on how brain structure differs with age and sex. This may be explained by discrepancies and limitations in study population and study design. We report a study on brain tissue volumes in one of the largest cohorts of individuals studied to date of subjects with high mean age (mean ± standard deviation (SD) 76 ± 6 years). These analyses are based on magnetic resonance imaging (MRI) scans acquired at baseline on 4303 non-demented elderly, and 367 who had a second MRI, on average 2.5 ± 0.2 years later. Tissue segmentation was performed with an automatic image analysis pipeline. Total brain parenchymal (TBP) volume decreased with increasing age while there was an increase in white matter hyperintensities (WMH) in both sexes. A reduction in both normal white matter (NWM)- and gray matter (GM) volume contributed to the brain shrinkage. After adjusting for intra-cranial volume, women had larger brain volumes compared to men (3.32%, p < 0.001) for TBP volume in the cross-sectional analysis. The longitudinal analysis showed a significant age-sex interaction in TBP volume with a greater rate of annual change in men (− 0.70%, 95%CI: − 0.78% to − 0.63%) than women (− 0.55%, 95%CI: − 0.61% to − 0.49%). The annual change in the cross-sectional data was approximately 40% less than the annual change in the longitudinal data and did not show significant age-sex interaction. The findings indicate that the cross-sectional data underestimate the rate of change in tissue volumes with age as the longitudinal data show greater rate of change in tissue volumes with age for all tissues.     

医学生职业选择量表的汉化及信效度检验

目的：引进、汉化医学生职业选择量表,并在医学生中进行信度和效度检验。方法：对医学生职业选择量表进行翻译、回译和跨文化调试,形成中文版医学生职业选择量表;方便抽取某医学院校医学生280例,使用该量表进行调查,评价量表的信度和效度。 结果：中文版医学生职业选择量表内容效度指数为0.971;共提取6个公因子,累积方差贡献率为60.996%;量表总的Cronbach’s α系数为0.869,根据奇偶数折半,奇数条目18条折半信度为0.805,偶数条目17条为0.824。结论：中文版医学生职业选择量表具有良好的信效度,可作为医学生职业选择的测量工具。     

Abscess incision and drainage in the emergency department--Part I

Superficial abscesses are commonly seen in the emergency department. In most cases, they can be adequately treated by the emergency physician without hospital admission. Treatment consists of surgical drainage with the addition of antibiotics in selected cases. Incision is generally performed using local anesthesia, with intraoperative and postoperative systemic analgesia. Care must be taken to make a surgically appropriate incision that allows adequate drainage without injuring important structures. Postoperative care includes warm soaks, drains or wicks, analgesia, and close follow-up. Antibiotics are usually unnecessary. Complications of incision and drainage include damage to adjacent structures, bacteremic complications, misdiagnosis of such entities as mycotic aneurysms, and spread of infection owing to inadequate drainage. The infectious agents responsible for abscess formation are numerous and depend largely on the anatomic location of the abscess. Staphylococcus aureus accounts for less than half of all cutaneous abscesses. Anaerobic bacteria are common etiologic agents in the perineum and account for the majority of all cutaneous abscesses. Abscesses at specific locations involve special consideration for diagnosis and treatment and may require specialty consultation.     

康养人才培养产教融合生态圈的构建研究

近年来,我国人口老龄化程度加快,高龄化、空巢化对于康养需求激增,职业教育通过产教融合打造康养人才培养生态圈,对于整合各方资源、提高提高行业适应性具有积极意义。基于康养行业的发展趋势,打造康养人才培养产教融合生态圈需要具有有拓展性、现代化和先进性,要服务国家发展战略规划找准产教融合生态圈的出发点,明确人才培养问题导向确立产教融合生态圈的支撑点,明确产教融合生态圈的结合点。由此,提出通过建立基本架构、做优专业链条、深化三教改革、聚焦创新链条、拓宽培训渠道等方面打造康养人才培养产教融合生态圈。