超声引导下冷循环射频治疗肝癌的疗效观察

目的 评价超声引导下冷循环射频系统治疗肝癌的疗效及并发症。方法 在超声引导下经皮经肝穿刺射频或术中射频治疗肝癌患者40例，共48个病灶，对比治疗前后的影像检查，评价肝癌消融是否完全，并记录射频治疗后的并发症及其转归情况。结果 冷循环射频治疗后，当肝癌直径〈3cm，直径3-5cm，直径〉5cm时，一次治疗完全坏死率分别为95.8%,78.4%及40%，三组治疗后一年时复发率分别为0.16,40%，主要并发症是疼痛，发热，出血等。结论 冷循环电极射频治疗肝癌，是一种适应证较广泛，疗效较为确切，副作用较少的良好方法。     

超声引导下经皮冷循环射频消融治疗肾上腺肿瘤的护理

目的探讨超声引导下经皮冷循环射频消融治疗肾上腺肿瘤的护理方法和效果。方法对10例肾上腺肿瘤患者进行超声引导下经皮冷循环射频消融治疗，并对各个阶段进行认真分析、观察。结果10例患者9例病灶在1次消融后完全坏死，1例病灶在2次消融后完全坏死，无严重并发症出现，随访6～12个月，随访期内无肿瘤复发。结论超声引导下经皮冷循环射频消融治疗肾上腺肿瘤安全可靠，关键在于完善术前准备，加强术后观察，而护理是有效减少术后并发症、保证手术成功、确保患者安全的关键。     

超声影像在经皮射频治疗肾VX2肿瘤中应用体会

目的探讨超声影像在经皮集束电极射频消融肾肿瘤模型中的引导方法及应用价值。方法将27只新西兰大白兔在超声引导下经皮穿刺组织块悬液注射法建立肾VX2肿瘤模型，成模后超声影像观测肿瘤结节并确定穿刺点，行超声引导下经皮射频消融肿瘤结节，于治疗后观察肿瘤的生长情况和消融灶的位置、大小及声像图变化。结果27只兔形成31个肿瘤灶接受射频治疗。超声影像引导穿刺成功率1DO％；二维声像图显示19个消融灶电极针放置合理，病灶消融完全，12个病灶消融不完全，出现残余灶，均经病理解剖证实。4只兔出现周围脏器灼伤，3只兔出现针道转移。结论超声影像引导经皮射频消融肾脏肿瘤安全、有效，超声准确的术前定位、精确的术中引导和医师熟练的配合是操作成功的关键。     

冷循环射频消融治疗多灶性转移性肝癌的疗效评价

目的评价冷循环射频消融治疗多个病灶的转移性肝癌的效果.方法对20例病人的42个转移性肝癌灶进行了58次冷循环射频消融治疗.射频采用单极电极输出,单探头或集束探头(2～4个)组合,每个病灶治疗1～3次.结果治疗后肿瘤有不同程度缩小,完全坏死30个(71.4%),大部坏死12个(28.6%),无严重并发症.结论冷循环射频消融技术简单、安全、有效,可作为不能手术切除的多灶性转移性肝癌的微创治疗方法.     

超声引导下射频消融治疗肝癌的疗效分析

目的分析经皮射频消融(RFA)治疗肝癌的疗效。方法 33例肝癌患者的40个肿块接受了经皮肝穿射频消融治疗,行超声造影检查评估RFA的治疗效果,并随访观察其复发情况。结果射频消融治疗后,直径<3 cm的肿瘤完全消融率95%,直径≥3 cm的肿瘤完全消融率79%;单个病灶的完全消融率86%,多发病灶者完全消融率75%。结论射频消融治疗肝癌的完全消融率与肿瘤的大小有关。     

超声引导单极冷循环经皮射频消融治疗毗邻胆囊肝癌安全性及疗效评估

目的 评估单极冷循环电极经皮射频消融治疗毗邻胆囊部位肝癌的安全性及疗效.方法 对42 例毗邻胆囊部位肝癌应用单极冷循环电极经皮多点扇形定位法射频消融治疗,其中电极垂直插入肿瘤26 个,平行插入肿瘤16 个,应用超声造影(CEUS)或增强CT(CECT) 穿刺活检随访3 ～48 个月(平均21 个月),对电极方向、电极类型、肿瘤部位及残留肿瘤和肿瘤局部复发进行分析;对其治疗的安全性和疗效应用影像学随访评估.结果 未见较大并发症,有轻微并发症,即时超声及CT 显示右侧胸腔积液1 例;局灶性胆囊壁增厚15 例(15/42,35.7%),3 个月后超声及CT 随访显示胆囊壁增厚消失.在1个月的CECT 随访中治疗有效率88.10%(37/42),CECT 肿瘤残留5 例(11.91%,5/42);CEUS 肿瘤残留7 例(16.67%,7/42);病理肿瘤残留4 例(18.81%,4/37).在后续的随访中肿瘤局部复发7 例(16.67%,7/42).电极垂直与平行胆囊插入肿瘤灭活不完全的风险性差异无统计学意义,与该研究多点重叠、小功率及长时间消融有关.平行胆囊穿刺肿瘤较垂直胆囊穿刺肿瘤灼伤胆囊壁的风险性明显增加,两组比较差异有统计学意义(P ＝0.41);垂直胆囊穿刺肿瘤导致误穿胆囊引起胆汁漏的风险性增大,本组垂直胆囊穿刺肿瘤导致误穿胆囊1 例.结论 单极冷循环电极系统经皮射频消融治疗毗邻胆囊部位肝癌是一种安全有效的治疗方法.导致早期肿瘤不能完全灭活的显著危险因素包括肿瘤大小,肿瘤位置和电极方向.     

超声造影对肝癌射频微创治疗的应用价值

目的：评价超声造影对肝癌射频微创治疗的价值。方法：98例肝癌患者126个病灶在超声引导下射频消融治疗,其中原发性肝癌51例60个病灶,转移性肝癌47例66个病灶。治疗前及治疗后行超声造影检查,并与同期增强CT比较,治疗中51例69个病灶使用了超声造影引导消融。结果：126个病灶治疗1个月后超声造影判定89.7%（113/126）的病灶达到完全消融,10.3%（13/126）的病灶消融不全;增强CT判定88.9%（112/126）的病灶达到完全消融,11.1%（14/126）的病灶消融不全,两者比较差异无显著性,P＞0.01。结论：超声造影在肝癌射频微创治疗中不但起着定位肿瘤、引导穿刺、监测治疗过程的作用,而且是评价肝癌射频消融疗效的有效方法。     

超声引导下冷循环射频治疗小肝癌的初步探讨

目的：探讨超声引导下经皮肝穿刺冷循环射频(PRFA)治疗小肝癌的价值。方法：10例小肝癌患(5例男性，5例女性)，肿瘤直径2．1～3．5cm，平均3．1cm。肝内的10个病灶采用超声引导下冷循环射频治疗，治疗后一月复查CT或MRI。结果：术后影像学检查显示有8个病灶完全坏死。有1例患出现新的复发灶。经再次射频治疗后病灶坏死。随访时间7～16个月，患存活率90％。结论：冷循环射频治疗是一种安全、有效、耐受性好的治疗小肝癌的技术。     

低杆温微波刀与冷循环射频消融在肝肿瘤治疗中的临床应用

目的探讨低杆温微波刀（cool-needle microwave coagulation treatment，MCT）与冷循环射频消融（cool-tipradiofrequency ablation，RFA）在恶性肝肿瘤治疗中的临床应用价值。方法超声引导下冷循环射频消融治疗原发性肝癌患者20例共22个病灶，而经超声引导下低杆温微波刀治疗原发性肝癌和肝转移癌19例共21个病灶，治疗前后经超声造影、增强CT或／和增强MRI检查明确诊断及评价疗效。结果22个病灶经一次RFA治疗后完全消融16个，5例经再次RFA后达完全消融；21个病灶经一次MCT治疗后16个达完全消融，4例经再次MCT治疗后达完全消融。两者一次完全消融率分别为72．7％（RFA）和76．2％（MCT），差异无统计学意义。结论低杆温MCT和冷循环RFA均能有效地原位灭活肝肿瘤，是有效的非手术治疗恶性肝肿瘤的方法之一。     

冷循环射频消融治疗肝癌近期疗效观察

目的 探讨运用冷循环射频固化治疗肝癌的技术并初步评价其临床应用价值。方法 采用冷循环电极，在B超引导下经皮穿刺病灶后进行射频固化治疗，观察疗效及并发症。结果 本组病例均未发生射频术并发症，术后患者自觉症状有不同改善。术后两周彩色多普勒超声复查：治疗区呈强弱不等回声改变，1例肿瘤周边及内部血流信号消失，另1例肿瘤周边有星点状血流信号。结论 冷循环射频治疗肝癌是一种微创、时间短、安全方便、疗效可靠的新方法。     

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.     

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.