肺超声联合超声弹性成像技术评价结缔组织病相关间质性肺疾病研究进展

结缔组织病相关间质性肺病（CTD-ILD）发病率和死亡率均高，早发现、早治疗是控制CTD-ILD进展的关键。目前，肺超声（LUS）及超声弹性成像（UE）用于临床评估CTD-ILD，其中常规灰阶超声可观察B线、胸膜不规则等异常改变，UE可发现肺表面组织的弹性改变。本文对LUS及UE在CTD-ILD中的应用价值及研究进展进行综述。     

UE技术联合常规超声检查在桥本甲状腺炎背景下甲状腺结节定性诊断中的应用价值

目的：探讨超声弹性成像（UE）技术联合常规超声检查在桥本甲状腺炎（HT）背景下甲状腺结节（TN）定性诊断中的应用价值。方法：选取2018年5月~2020年5月收治的HT背景下TN患者73例，TN 92个，患者均行常规超声、UE技术及病理检查，以病理检查为“金标准”，比较常规超声、UE技术及常规超声+UE技术检查诊断HT背景下TN良恶性准确度、灵敏度、特异度、阳性预测值及阴性预测值。结果：常规超声+UE技术检查的准确度92.39%、灵敏度96.49%、阴性预测值93.75%均高于常规超声检查的73.91%、64.91%、60.78%和UE技术检查的76.09%、66.67%、62.75%（P＜0.05）；常规超声+UE技术检查HT背景下TN良恶性特异度85.71%、阳性预测值91.67%与常规超声检查88.57%、90.24%和UE技术检查91.43%、92.68%比较，差异无统计学意义（P＞0.05）。结论：常规超声联合UE技术检查对HT背景下TN良恶性具有一定诊断价值，可为临床提供有效筛查方法。     

超声心动图定量分析技术评估早期心功能受损的研究进展

随着超声心动图定量分析技术的广泛应用，收缩后收缩（PSS）和收缩早期伸长（ESL）这类微小心肌运动的分析得以实现。PSS和ESL对于客观且早期地评估心功能受损有较高的价值，有助于提高心肌缺血的诊断准确性，且在一些方面相比常规参数更有优势。另外，PSS和ESL在非缺血性心脏疾病的心功能评估中也有一定的应用价值。本文就PSS和ESL及其在心脏疾病中的应用进展进行综述。     

病灶位置对乳腺超声弹性成像检查结果的影响

目的探讨病灶位置对乳腺超声弹性成像（UE）检查结果的影响。方法对681例患者共885个乳腺病灶进行了超声弹性成像检查，根据病灶底部距体表的距离（D）分为3组（I组：D〈1cm；Ⅱ组：1cm≤D〈2cm；Ⅲ组：D〉2cm），UE评分采用改良5分法，≤3分判为良性，≥4分判为恶性。结果三组患者UE诊断恶性病变的敏感性、特异性、准确性无显著差异。结论病灶位置对UE检查结果无显著影响。     

超声弹性成像与常规超声对小儿先天性肌性斜颈的诊断价值

目的探讨超声弹性成像（UE）及常规超声对先天性肌性斜颈（CMT）的诊断价值。方法回顾53例CMT患儿超声检查资料,比较常规超声、UE及二者联合诊断CMT符合率的差异性。结果常规超声诊断CMT的符合率为75．47％,UE的符合率为81．13％,差异无统计学意义;二者联合诊断符合率为94．34％,与单一检查方法比较差异均有统计学意义（P〈0．05）。结论UE联合常规超声对CMT的诊断符合率明显提高,优于单一的检测方法。     

中毒严重度评分与APACHE-Ⅱ在中毒评估应用中的对比研究

目的比较中毒严重度评分（PSS）与APACHE-Ⅱ在中毒评估中的价值，探讨将中毒严重度评分用于中毒评估的可行性。方法回顾分析我院急诊科61例中毒患者的临床资料，比较两种评估方法结果与毒物种类、住院时间、并发症、转归间的关系。结果PSS值与APACHE-Ⅱ评分具有显著一致性（P〈0．01）；不同毒物中毒PSS与APACHE-Ⅱ评分差异无显著性（P〉0．05）；PSS与APACHE-Ⅱ评分均与住院时间存在显著正相关（P〈0．01）；PSS≥3或APACHE-Ⅱ〉／30时死亡率明显升高；不同PSS和APACHE-Ⅱ评分值的并发症发生率均有显著性差异。结论PSS与APACHE-Ⅱ在中毒评估中价值一致，但PSS记分简单、直观，可以取代APACHE-Ⅱ评分系统而起到比较准确的中毒严重度评估作用。     

原发性干燥综合征的腮腺超声声像图特征

目的 探讨原发性干燥综合征（PSS）的腮腺超声声像图特征。方法 43例PSS患（A组）与69例非PSS患（B组）未经治疗行腮腺二维及彩色多普勒超声检测。结果 A组腮腺声像图表现较为特异，并具有规律性，与B组比较，A组腮腺厚度，实质光点增粗率，实质回声不均匀率，实质回声减低率增加，面横动脉收缩期峰值流速显增加，阻力指数减低。结论 PSS具有典型腮腺声像图特征。     

超声弹性成像在乳腺肿块诊断中的价值

目的探讨超声弹性成像（UE）在乳腺肿块诊断中的价值。方法应用UE对50例患者共60个乳腺肿块进行检查,均获手术病理证实。UE检查结果与病理结果进行比较。结果 UE在乳腺肿块诊断中敏感性为85.7%（12/14）,特异性为91.3%（42/46）,准确性为90%（54/60）。结论 UE在乳腺肿块诊断中具有重要的价值。     

超声弹性成像在颈部淋巴结良恶性诊断中的价值

目的：对比常规超声评价超声弹性成像（UE）在颈部淋巴结良恶性诊断中的价值。方法：对74例患者的99个淋巴结行灰阶超声（B超）、彩色多普勒血流图（CDFI）及UE检查。再行超声引导下穿刺活检,取得组织学病理结果作为最终诊断与B超、CDFI及UE进行对照。结果：在UE检查中,采用弹性应变率比值（Strain ratio,SR）法,以SR≥1.78作为颈部淋巴结的恶性诊断标准时,其灵敏度、特异度及准确度分别为98.3%,65.9%和84.8%;B超的灵敏度、特异度及准确度分别为55.2%,82.9%和66.7%;CDFI的灵敏度、特异度及准确度分别为72.4%,75.6%和73.7%。UE较B超具有更高的灵敏度、准确度及更大的ROC曲线下面积,且差异具有统计学意义（P＜0.05）;UE较CDFI具有更高的灵敏度,且差异具有统计学意义（P＜0.05）,但二者的ROC曲线下面积无统计学差异。结论：超声弹性成像中以SR 1.78为分界值对颈部淋巴结良恶性的鉴别诊断具有一定价值,与B超比较价值更大。     

超声弹性成像评分标准对乳腺良恶性病变诊断价值的探讨

目的：探讨超声弹性成像（Ultrasonic Elastography，UE）评分标准对乳腺良恶性疾病的诊断价值。方法：应用UE对458例患者共597个乳腺结节进行检查，以手术病理为诊断金标准，评价UE评分标准的意义。结果：评分1，2，3分者诊断乳腺良性病变的准确性分别为97.5%，96.7%，85.7%；UE 4、5分诊断为恶性病变的准确性为88.9%，97.6%。结论：UE 5分评分法有助于评判组织硬度，但仍有待完善。     

Upper extremity strength and range of motion and their relationship to function in breast cancer survivors

The impact upper extremity impairments (UE) have on UE function in breast cancer survivors (BCS) is unclear. The purpose of this study was to evaluate the associations between upper extremity active range of motion (AROM), passive range of motion (PROM), and strength with self-reported function in BCS. BCS (n = 24) completed the Disabilities of Arm, Shoulder and Hand (DASH) and the Pennsylvania Shoulder Score (PSS). AROM and PROM of shoulder flexion, extension, external rotation (ER) at 0° and 90° of abduction, and internal rotation (IR) at 90° of abduction were measured using a digital inclinometer. Strength was measured using a hand-held dynamometer for scapular abduction and upward rotation, scapular depression and adduction, flexion, IR, ER, scaption, and horizontal adduction. All constructs of AROM, PROM, and strength were correlated with the DASH and PSS. DASH was moderately to highly correlated with 2 of 5 AROM, 2 of 5 PROM, and 6 of 7 shoulder strength measures. PSS was moderately to highly correlated with 2 of 5 AROM, 2 of 5 PROM, and 4 of 7 shoulder strength measures. Regression analysis showed that AROM explained 40% of the DASH scores and strength explained 20% of scores on the PSS. This study characterizes the impact that shoulder motion, flexibility, and strength losses have on shoulder function in BCS. Deficits in AROM and shoulder strength explained the greatest proportion of shoulder disability. Future clinical trials should consider incorporating AROM and strengthening techniques to improve shoulder use after breast cancer treatments.     

基于目标管理法减少住院患者非计划性拔管长效机制的建立及效果评价

目的建立基于目标管理法减少住院患者非计划性拔管(UE)的长效机制并评价其管理效果。方法重庆医科大学附属第一医院自2015年开始实施目标管理法。遵循目标管理的基本原则及流程,通过成立领导和实施小组、确定控制目标、制订现场检查追踪内容和评价标准、加强全员培训、过程追踪并及时反馈等方法建立减少住院患者UE的长效机制,评价2014—2018年患者UE发生率、重置率和病区UE管理的合格率。结果2014—2018年UE发生率及重置率比较,差异有统计学意义(P<0.01)。2015—2018年住院患者UE发生率分别为0.21%(141/72112)、0.08%(62/79284)、0.07%(52/69840)、0.06%(41/71994);UE重置率分别为31.58%(48/152)、46.77%(29/62)、26.92%(14/52)、26.83%(11/41)。2015—2018年病区UE管理合格率分别为61.33%(92/150)、90.54%(134/148)、98.66%(147/149)、98.37%(181/184)。结论目标管理长效机制的建立可持续降低住院患者UE发生率和重置率,提高病区UE管理的合格率,提升护士对非计划拔管的正确管理能力,达到持续质量改进的目的。     

Upper extremity function and activity in facioscapulohumeral dystrophy and limb-girdle muscular dystrophies: a systematic review

Abstract

Purpose: The aims of this review were (1) to provide insight into the natural course of upper-extremity (UE) impairments and UE activity limitations associated with facioscapulohumeral dystrophy (FSHD) and limb-girdle muscular dystrophies (LGMD), and (2) to provide an overview of outcome measures used to evaluate UE function and activity in patients with FSHD and LGMD. Methods: Scientific literature databases (PubMed, MEDLINE, EMBASE, CINAHL and Cochrane) were searched for relevant publications. Inclusion criteria: (1) studies that included persons with a diagnosis of FSHD or LGMD; and (2) studies that reported the natural course of the UE functions and/or activity with outcome measures at these levels. Results: 247 publications were screened, of which 16 fulfilled the selection criteria. Most studies used manual muscle testing (MMT) to evaluate UE function and the Brooke Scale to evaluate UE mobility activities. The clinical picture of UE impairments and limitations of UE activities in FSHD and LGMD patients was highly variable. In general, FSHD and LGMD patients experience difficulty elevating their upper extremities and the execution of tasks takes considerably longer time. Conclusions: The clinical course of UE impairments and activity limitations associated with FSHD and LGMD is difficult to predict due to its high variability. Although measures like MMT and the Brooke Scale are often used, there is a lack of more specific outcome measures to assess UE function and UE capacity and performance in daily life. Measures such as 3D motion analysis and electromyography (EMG) recordings are recommended to provide additional insight in UE function. Questionnaires like the Abilhand are recommended to assess UE capacity and accelerometry to assess UE performance in daily life.

• Implications for Rehabilitation

• There is a need for specific outcome measures on the level of UE activity.

• Both the level of capacity and performance should be assessed.

• Possible outcome measures include 3D motion analysis to assess UE function, questionnaires like the Abilhand to assess UE capacity and accelerometry to assess performance of UE activities in daily life.

     

Comparison of Diffuse Optical Tomography,Ultrasound Elastography and Mammography in the Diagnosis of Breast Tumors

Previous studies have reported the usefulness of diffuse optical tomography (DOT), ultrasound elastography (UE) and mammography in differentiating breast tumors. This study was aimed at evaluating and comparing DOT, UE and mammography with respect to their diagnostic performance in differentiating benign and malignant breast tumors. Of the 67 tumors, 45 were histopathologically benign, and 22 were malignant. UE was the most specific (93.33%) of the three diagnostics modalities. DOT and UE were both more accurate (80.60% and 89.55%, respectively) than mammography (63.08%). UE + mammography (93.33% and 91.04%) and DOT + mammography (77.78% and 82.09%) exhibited higher specificity and accuracy, respectively, than mammography alone (57.78% and 63.08%). Receiver operating characteristic (ROC) curves were constructed to assess the performance of the modalities. In conclusion, UE and DOT were superior to conventional mammography in terms of both specificity and accuracy. DOT and UE improve the specificity and accuracy of breast cancer diagnosis, and combining the two modalities improves the diagnostic value.     

超声弹性成像与常规超声对乳腺病灶鉴别诊断价值的对比研究

目的比较常规超声（包括灰阶超声、彩色多普勒血流显像、频谱多普勒超声）及超声弹性成像对良、恶性乳腺肿块的鉴别诊断价值。方法对手术病理证实的475个乳腺病灶的常规超声、超声弹性成像图像进行回顾性分析,用ROC曲线评价其诊断价值。结果超声弹性成像及常规超声诊断乳腺良恶性病灶的ROC曲线下面积（Az）分别为：0.959和0.899,差异有统计学意义（Z=2.7,P〈0.01）。结论在乳腺良恶性病灶的鉴别诊断方面,超声弹性成像的综合诊断价值优于常规超声。     

Upper vs lower extremity functional loss in neuromuscular disease

Functional rating scales have been developed for evaluation of upper extremity (UE) and lower extremity (LE) function in Duchenne muscular dystrophy (DMD). The Vignos scale is accepted for LE function and the Brooke scale for UE evaluation. The assumption that UE functional loss parallels LE loss has never been tested. Furthermore, there are no studies examining the relationship between UE/LE strength. This study tests the hypothesis that UE/LE strength and functional losses are parallel in DMD and other neuromuscular disorders. Vignos grades, Brooke grades, and manual muscle test scores were determined for 27 patients with DMD, 10 patients with fascioscapulohumeral muscular dystrophy (FSH), 24 patients with myotonic muscular dystrophy (MMD) and 29 patients with other (Becker's dystrophy and limb-girdle syndrome) proximal myopathies (PM). Spearman correlation coefficients were calculated for UE vs LE functional grade and strength scores and subjected to significance analysis. While all correlations were statistically significantly different from zero (p less than 0.01), all were also significantly different from one (p less than 0.01), none representing perfect equivalence. Coefficients of determination indicated that a maximum of 86% (FSH) of variation in UE rank could be explained purely by observing LE rank. While there is a significant relationship between UE/LE strength and functional grade, these measurements were not found to be entirely equivalent. Therefore, while measures of lower body function or strength might be used as a substitute for UE measurements in drug trials in which global effects are expected, the two measurements are not equivalent when evaluating an individual's clinical status.     

Predictive ability of 2-day measurement of active range of motion on 3-mo upper-extremity motor function in people with poststroke hemiparesis

OBJECTIVE. We determined (1) whether active range of motion (AROM) of shoulder flexion and wrist extension measured at the initial therapy evaluation in the acute hospital predicted upper-extremity (UE) motor function 3 mo after stroke and (2) whether the presence of nonmotor impairments influenced this prediction. METHOD. We collected AROM data from 50 people with stroke during their initial acute hospital therapy evaluation and UE motor function data 3 mo later. Multiple regression techniques determined the predictive ability of initial AROM on later UE motor function. RESULTS. Initial AROM explained 28% of the variance in UE motor function 3 mo poststroke. Nonmotor deficits did not contribute to the variance. CONCLUSION. Compared with later AROM measurements, initial values did not adequately predict UE motor function 3 mo after stroke. Clinicians should use caution when informing clients of UE functional prognosis in the early days after stroke.     

尿毒症脑病患者临床特点与危险因素分析

目的:比较尿毒症脑病（uremic encephalopathy,UE）患者与尿毒症患者的临床特点,以明确尿毒症脑病患者的独立危险因素。方法:回顾性分析广州医科大学附属第二医院2014年1月至2019年1月期间入院的符合慢性肾病（chronic kidney disease,CKD）5期诊断标准的患者,其中所有符合尿毒症脑病诊断标准者为尿毒症脑病组,以性别、年龄、发病时长相匹配为原则,选取与尿毒症脑病组的同一期间住院的主要诊断为CKD 5期的非尿毒症脑病患者为非尿毒症脑病组。采用 t检验和卡方检验比较两组患者的临床基线资料、化验与影像学结果;采用Logistic回归分析尿毒症脑病的独立危险因素。 结果:共收集尿毒症脑病组患者70例,非尿毒症脑病组患者70例。尿毒症脑病组患者中存在饮酒史、慢性阻塞性肺疾病和多囊肾病史的比例均较非尿毒症脑病组高（ P<0.05）。两组患者在高血压病、糖尿病、冠心病方面比较,差异均无统计学意义（ P>0.05）;尿毒症脑病组患者中头颅CT或MRI结果显示存在脑软化灶或白质病变的比例均较非尿毒症脑病组高,差异有统计学意义（ P<0.05）。尿毒症脑病组中血中性粒/淋巴细胞比值（NLR）与尿酸（UA）均高于非尿毒症脑病组（ P<0.05）,而血血红蛋白（ALB）与游离T3（FT3）水平均低于非尿毒症脑病组（ P<0.05）。Logistic回归模型分析显示,血NLR、FT3和ALB水平是尿毒症脑病患者的独立危险因素。 结论:头颅影像中常出现的脑软化灶和脑白质病变是尿毒症脑病患者区别于CKD 5期未发生脑病患者的变化特点。NLR、FT3和ALB水平是尿毒症脑病患者的独立危险因素。     

二维超声、实时组织弹性成像及声触诊组织量化技术诊断乳腺浸润性导管癌

目的 探讨二维超声(2D-US)、实时组织弹性成像(UE)及声触诊组织量化(VTQ)技术对乳腺浸润性导管癌(IDC)的诊断价值。方法 对188例患者共213个乳腺病灶术前分别行2D-US、UE及VTQ检查,对各病灶2D-US声像图表现进行超声乳腺影像报告数据系统(BI-RADS-US)分类,UE采用5级评分法判断结节性质,VTQ技术定量测定结节内剪切波速度(SWV)。绘制ROC曲线,比较2D-US、UE、SWV曲线下面积(AUC)。结果 2D-US诊断IDC的敏感度为82.35%(126/153),特异度为71.67%(43/60),准确率为79.34%(169/213)。UE诊断IDC的敏感度为86.27%(132/153),特异度为73.33%(44/60),准确率为82.63%(176/213)。良性及恶性结节的SWV别为(3.09±1.26)m/s、(6.83±2.18)m/s(P<0.05);以3.59 m/s作为诊断恶性病灶的最佳截断值,VTQ诊断IDC的敏感度为86.93%(133/153),特异度为76.67%(46/60),准确率为84.04%(179/213)。2D-US、UE、SWV诊断乳腺IDC的AUC分别为0.811、0.843、0.899,差异有统计学意义(P<0.01)。结论 US、UE及VTQ均有助于鉴别诊断乳腺良性结节及乳腺IDC,UE优于2D-US,VTQ可获得客观的量化指标,重复性好,优于UE和2D-US。     

超声弹性成像对比声脉冲辐射力成像鉴别诊断良恶性甲状腺结节

目的 探讨超声弹性成像(UE)对比声脉冲辐射力成像(ARFI)鉴别诊断良恶性甲状腺结节的价值.方法 对30例甲状腺结节患者共58个结节进行UE及ARFI检测,以手术后病理结果为标准,应用ROC曲线评价UE和ARFI对良恶性甲状腺结节的鉴别诊断效果.结果 UE诊断甲状腺结节ROC曲线下面积(0.78)小于ARFI(0.95,P＜0.01).结论 ARFI对诊断甲状腺结节比UE具有更高的准确性,有助于鉴别诊断良恶性甲状腺结节.