复合三维超声成像技术在肝脏肿瘤的诊断价值

目的研究复合三维超声成像技术在肝肿瘤诊断中的临床价值。方法应用GE Voluson730三维超声成像系统对50个肝占位性病灶进行三维组织成像、三维血管成像及三维肿瘤体积精测。结果①彩色多普勒显示血管的断面图像，表现为点状、短棒状血管形态。彩色多普勒与三维超声成像技术的结合更易于显示肿瘤血管“抱球征”、“提篮征”、“周围血管绕行征”的立体构型。②三维超声对肿瘤体积的测量较二维超声精确。结论复合三维超声成像技术与传统的二维超声成像相比，有许多独特的优点，能提供更加丰富的诊断信息。     

三维超声成像对乳腺肿块诊断价值的初步探讨

目的初步探讨三维超声成像技术在乳腺肿块中的诊断价值。方法对20例24个乳腺肿块术前进行二维彩色多普勒超声及三维超声检查，分析其血流情况及三维超声成像效果。结果三维超声成像可立体、直观地显示乳腺肿块的立体形态、与周边组织的关系以及内部细微结构特征。二维超声的诊断符合率为87．5％，三维超声的诊断符合率为95．8％。结论在原有二维及彩色多普勒的基础上结合三维超声，可进一步提高诊断水平，三维超声对乳腺肿块的良恶性有鉴别诊断作用。     

三维超声成像在乳腺良恶性肿瘤诊断中的临床应用

目的探讨三维超声在乳腺肿块中的应用价值.。方法对107例130个乳腺肿块,在二维超声检查的基础上,进行三维重建及三维彩色血流成像并与手术、病理结果对照分析。结果三维超声能更逼真地提供乳腺肿块及肿块内血管的多少、走行的立体形态学特点,为乳腺良恶性肿瘤的诊断提供了更多依据。结论三维彩色超声成像为乳腺良恶性肿瘤的鉴别提供了更为重要的鉴别诊断信息。     

脉络膜黑色素瘤的三维与二维超声成像的比较

目的 :通过三维与二维超声成像对脉络膜黑色素瘤的检查及比较 ,了解三维诊断技术的优越性。方法 :应用 OTI3Di- Scan眼科专用超声仪首先进行二维 B超检查 ,取肿瘤最清晰方位作三维检查 ,探头旋转 1 80度 ,连续取二维扫描图像 ,然后重建成三维图像。体积测定按需要设定病变的切割厚度 ,画出各切面的轮廓 ,由计算机算出体积。结果 :4例脉络膜黑色素瘤三维图像中 1例呈圆球形 ,3例为椭圆球形 ,并可观察任何切面的肿块内部结构。精确测定出肿块体积 ,其中最大 1例体积为 1 4 99.9mm3 。二维超声显像显示 1例圆形 ,3例为椭圆形。 4例都有挖空现象 ,3例有脉络膜凹陷及球后声影。测量肿块面积最大 1例为 1 1 .1 5mm× 1 7.66mm。结论 :诊断脉络膜黑色素瘤三维超声成像比二维超声成像更具有优越性。外部形态呈立体球形 ,与肿瘤实际形态接近 ,并可观察任意切面内部结构 ,能够精确测量肿瘤的体积     

乳腺癌彩色多普勒超声的诊断及鉴别诊断

目的探讨彩色多普勒超声在乳腺癌诊断与鉴别诊断中的应用价值。方法回顾性分析经手术病理证实的68例乳腺癌患者与67例乳腺良性肿块患者声像图资料,对乳腺癌二维超声图像与彩色多普勒血流图像(CDFI)特点进行总结,并将超声与病理结果相对照。结果乳腺恶性肿块与乳腺良性肿块的二维声像图存在差别;彩色多普勒血流图检查恶性肿块血流显示率为96%,良性肿块血流显示率为48%;恶性肿块多表现为穿入性动脉血管(76%),并呈高阻血流信号(RI>0.7)。结论彩色多普勒血流的分布特点与频谱变化是反映乳腺新生血管的一个重要特征,二维超声与彩色多普勒血流图结合能进一步提高乳腺癌的诊断率。     

三维超声成像在良恶性乳腺肿块鉴别诊断的价值

目的研究三维超声在二维彩色超声和X线钼靶照像(简称钼靶)诊断不同的乳腺疑难肿块中的鉴别诊断价值。方法对我院二维彩色超声和钼靶定性不同的35个乳腺肿块,研究其三维超声成像的特点,并与手术、病理结果进行对照分析。结果乳腺肿块超声和钼靶检查经手术病理确诊的148个肿块中,两种方法定性不同的35个肿块占23.6%,钼靶误诊17个肿块,误诊率为11.5%;二维彩色超声误诊18个肿块,误诊率为12.2%(与乳腺纤维囊性增生症患者混淆的15例,占83.3%),通过三维超声灰阶表现汇聚征和冠状切面来判断其良恶性,误诊率降低为2.7%(4/148)。结论三维容积超声成像可观察到二维超声所不能显示的冠状切面,更直观、更形象地获得肿块立体形态及与周围组织的关系,提高了彩色超声对乳腺纤维囊性增生症的良恶性鉴别诊断的正确性,但对无症状的乳腺慢性炎症和常规超声漏诊病例尚需造影等进一步检查。     

正常移植肾血流的三维彩色多普勒成像特征

目的探讨正常移植肾血流的三维彩色多普勒成像特征。方法功能正常的同种异体移植肾患者22例；仪器为Acuson X／P 128彩色多普勒超声诊断仪(探头频率3.5MHz)和Tom Tec Echoscan 4．2三维彩色多普勒图像处理工作站，采用磁场空间定位自由扫查系统进行三维图像获取，脱机后进行移植肾血流的三维图像重建与显示。结果移植肾血流的三维彩色多普勒图像特征为，可以立体地显示整个肾脏的血管树结构及血管变异特征。结论三维彩色多普勒超声成像技术能够对肾脏血管进行完整、直观、立体地显示，是对二维超声切面成像的一个有意义的改进和提高。     

乳腺肿块三维超声成像的临床应用

目的探讨三维超声在乳腺肿块中的应用价值。方法对22例32个乳腺肿块,在二维超声检查的基础上,进行三维重建并与手术、病理结果对照分析。三维各切面方位的确定用水槽内鹌鹑蛋模拟试验和人体颈动脉检查比较。结果三维超声能用多角度、多切面对病灶进行切割,因此能直接提供乳腺肿块的立体形态学特点,使图像更逼真。同时,三维能量图模式上血管的细粗、多少、走行的自然和陡直更提供了一种直观的血流分布模式．对鉴别乳腺疾病提供了帮助。结论三维超声成像可弥补二维超声的不足,提供了直观的、立体的形态学和肿块血供的三维能量图模式特点,对疾病分析又多了一种方法。     

二维彩色多普勒超声及三维超声成像对乳腺肿块的诊断价值

目的探讨二维彩色多普勒超声及三维超声成像对乳腺肿块的诊断价值。方法对 115例乳腺良恶性肿块术前进行二维彩色多普勒超声及三维超声检查 ,分析其血流情况及三维超声成像效果。结果三维超声成像图像清晰 ,可直观、立体地显示乳腺肿块X、Y、Z轴三个断面及内部结构。乳腺良恶性肿块超声诊断符合率分别为 77.5 %、89% ,乳腺恶性肿块诊断敏感性为 98% ,特异性为 90 .5 %。彩色多普勒在恶性肿块中 10 0 %可探到动脉型血流 ,中等量至多血流占 6 2 .3% ,RI值为 0 .75± 0 .0 6 ;而良性肿块中 ,80 .6 %为无至少量血流 ,RI值为 0 .6 0± 0 .0 7,两者相比具有显著性差异 (P <0 .0 0 1)。结论彩色多普勒超声对乳腺良恶性肿块的鉴别诊断有一定的临床应用价值 ,结合三维超声成像 ,在一定程度上弥补了二维超声的不足 ,为疾病的诊断提供了更可靠的形态学依据     

产科三维超声的临床应用价值

超声诊断技术为产科临床的发展作出了非常重要的贡献，三维超声在产科的应用也越来越普遍，特别在胎儿诊断方面显示了其优越性。三维超声采集一个包含无数二维切面的容积数据．这些二维切面均能够以三个正交切面显示。三维超声最主要的优势在于能够在一个平面内直接显示立体图像，获得二维超声不能观察的冠状切面，并开辟了一种测量容积的新方法。三维超声是监测胎儿发育的有效工具，在筛查胎儿畸形方面也具有明显优势，现综述如下。     

Migraine and genetic and acquired vasculopathies

It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.     

Fibrinogen and fibrin structure and functions

Fibrinogen molecules are comprised of two sets of disulfide-bridged Aalpha-, Bbeta-, and gamma-chains. Each molecule contains two outer D domains connected to a central E domain by a coiled-coil segment. Fibrin is formed after thrombin cleavage of fibrinopeptide A (FPA) from fibrinogen Aalpha-chains, thus initiating fibrin polymerization. Double-stranded fibrils form through end-to-middle domain (D:E) associations, and concomitant lateral fibril associations and branching create a clot network. Fibrin assembly facilitates intermolecular antiparallel C-terminal alignment of gamma-chain pairs, which are then covalently 'cross-linked' by factor XIII ('plasma protransglutaminase') or XIIIa to form 'gamma-dimers'. In addition to its primary role of providing scaffolding for the intravascular thrombus and also accounting for important clot viscoelastic properties, fibrin(ogen) participates in other biologic functions involving unique binding sites, some of which become exposed as a consequence of fibrin formation. This review provides details about fibrinogen and fibrin structure, and correlates this information with biological functions that include: (i) suppression of plasma factor XIII-mediated cross-linking activity in blood by binding the factor XIII A2B2 complex. (ii) Non-substrate thrombin binding to fibrin, termed antithrombin I (AT-I), which down-regulates thrombin generation in clotting blood. (iii) Tissue-type plasminogen activator (tPA)-stimulated plasminogen activation by fibrin that results from formation of a ternary tPA-plasminogen-fibrin complex. Binding of inhibitors such as alpha2-antiplasmin, plasminogen activator inhibitor-2, lipoprotein(a), or histidine-rich glycoprotein, impairs plasminogen activation. (iv) Enhanced interactions with the extracellular matrix by binding of fibronectin to fibrin(ogen). (v) Molecular and cellular interactions of fibrin beta15-42. This sequence binds to heparin and mediates platelet and endothelial cell spreading, fibroblast proliferation, and capillary tube formation. Interactions between beta15-42 and vascular endothelial (VE)-cadherin, an endothelial cell receptor, also promote capillary tube formation and angiogenesis. These activities are enhanced by binding of growth factors like fibroblast growth factor-2 (FGF-2) and vascular endothelial growth factor (VEGF), and cytokines like interleukin (IL)-1. (vi) Fibrinogen binding to the platelet alpha(IIb)beta3 receptor, which is important for incorporating platelets into a developing thrombus. (vii) Leukocyte binding to fibrin(ogen) via integrin alpha(M)beta2 (Mac-1), which is a high affinity receptor on stimulated monocytes and neutrophils.     

Telemedicine and teleradiology technologies and applications

Summary. Telemedicine and teleradiology hold the key for improving future health care delivery. In this paper we first review current communication and computer technologies used in telemedicine and teleradiology. Five examples in teleradiology applications are given including hospital-integrated picture archiving and communication systems, tele-neuro-imaging, telemammography, university consortium teleradiology service, and teleradiology for second opinion. Parameters important to teleradiology applications like costs, image quality, system reliability, and turn around time are considered. Data security is discussed, including patient confidentiality and image authenticity-which will be a major issue in future teleradiology applications.     

创伤高血糖与感染和MODS早期诊断和干预

本文详细介绍了创伤后血糖应激适度理论,以及高血糖与感染和多器官功能不全综合征的关系;提出涉及胰岛B细胞功能不全的MODS实验诊断新方案和极化液个体化干预新措施,可早期发现创伤MODS、降低感染率及MODS发生率和病死率。     

腹膜后纤维化与肾积水发生关系的临床研究

目的：探讨腹膜后纤维化（RPF）导致肾积水的原因及诊治经验。方法：回顾分析2004年1月—2010年12月24例腹膜后纤维化致肾积水患者的诊治资料。结果：（1）RPF患者常见首发症状为腰背痛或腹痛（69.2%）;（2）红细胞沉降率（ESR）增快和血清IgG4升高最常见。超声检查仅提示上尿路积水。RPF的静脉肾盂造影（IVP）和CT尿路成像（CTU）表现具有特征性。IVP肾盂输尿管显影不良时,CTU能较清晰的显示上尿路影像。CT扫描发现腹膜后软组织肿块9例（37.5%）,优于超声检查;（3）输尿管松解和腹腔化手术治疗22例;行肾切除术1例;行输尿管置双J管术1例。最终确诊为继发性RPF8例,其中4例为术前诊断,3例为术中腹膜后软组织肿块冷冻活检证实,1例为术后病理证实;（4）特发性RPF手术后肾积水均获长期缓解,而继发性RPF的预后取决于原发疾病及其治疗方案。结论：影像学检查是诊断RPF的重要手段,CTU优于超声检查和IVP。输尿管松解和腹腔化手术可以使特发性RPF输尿管梗阻得到长期的缓解,术中对肿块进行冷冻活检有助于鉴别特发性和继发性RPF,及时调整治疗方案。     

探讨儿童慢性顽固性咳嗽与支原体感染的关系及临床治疗观察

目的探讨儿童慢性顽固性咳嗽与肺炎支原体（MP）感染的关系及临床疗效观察。方法采用回顾性研究方法对于现将2005年3月至2008年3月在我院的55例确诊慢性顽固性咳嗽患儿,主要表现为肺炎支原体感染为临床特点进行分析,并进一步临床治疗研究。结果①临床特点：在55例确诊慢性咳嗽的患儿中,以慢性顽固性咳嗽为主要症状。58％（32／55）的病例无肺部体征;②外周血：85％（47／55）的病例外周血变化不大,WBC（4—10）×10 9／L之间,嗜酸性粒细胞增多;③特别检查：47．27％（26／55）肺炎支原体IgM（MP—IgM）抗体阳性,83．64％（46／55）PeR技术检测肺炎支原体特异性DNA;④X光报告为多种形式。结论肺炎支原体（MP）感染是引起儿童慢性顽固性咳嗽的病因之一,对儿童慢性咳嗽,特别是顽固性咳嗽的诊治中应更加重视。     

Acetaminophen and acetylcysteine dose and duration: Past,present and future

Abstract

Acetylcysteine has been utilized successfully in the treatment of acetaminophen overdose since the 1970s. Although prospective trials as to efficacy and safety of acetylcysteine were conducted, there were no randomized controlled trials. This commentary addresses the reasons for this, and the background to choice of dose of acetylcysteine utilized in the oral and IV dosing regimens. Nomograms to predict possible hepatotoxicity based upon time of ingestion of acetaminophen were developed from a relatively arbitrary definition of toxicity as an aspartate aminotransferase/alanine aminotransferase (ALT/AST) greater than 1000 IU/L. While these have proved generally useful, patients still continue to develop hepatic damage after acetaminophen overdose, particularly if they present late after ingestion. The optimum management of these patients remains unclear, and one area of uncertainty is the dose and duration of acetylcysteine in various circumstances. This article discusses the issues that need to be elucidated to better target changes in acetylcysteine dose. The potential for measurements of other markers to improve treatment selection is the subject of further research.     

Physician and Nurse Practitioner Teamwork and Job Satisfaction: Gender and Profession

Designing interprofessional primary care teams composed of physicians and nurse practitioners (NPs) is a national priority. We assessed how profession and gender affect teamwork and job satisfaction among primary care physicians and NPs by using survey data from 186 physicians and 398 NPs practicing in New York State. Our regression models show profession (NP vs physician) moderates the associations of gender with teamwork and job satisfaction. Among NPs, men had higher job satisfaction than women. Among physicians, women had higher job satisfaction than men. Our results can benefit interprofessional primary care teams to optimize their professional and gender mix.