肾良恶性占位超声造影定量参数分析的初步研究

目的 探讨肾良恶性占位超声造影定量参数特点及临床应用价值.方法 对60例经病理证实的肾占位行超声造影检查,用Sonoliver定量分析软件行脱机分析,获得最大峰值强度(maximum intcnsity,IMAX)、上升时间(rise time,RT)、达峰值时间(time to peak,TTP)、平均渡越时间(mean transit time,mTT)及曲线下面积(area under the curve,AUC)等参数,并进行统计学分析.结果 肾良恶性占位超声造影定量参数RT、mTT、AUC差异有统计学意义(P＜0.05),IMAX差异有显著统计学意义(P＜0.01),恶性肿瘤的RT及mTT均小于良性病灶,IMAX与AUC均大于良性病灶.结论 超声造影定量参数分析对肾占位性病变的诊断提供了更多的信息.     

应用SonoLiver定量分析评价超声造影对眼眶淋巴瘤和炎性假瘤的鉴别诊断价值

目的应用SonoLiver定量分析探讨超声造影对眼眶淋巴瘤和炎性假瘤鉴别诊断价值。方法对23例眼眶淋巴瘤和25例眼眶炎性假瘤超声造影图像行Sonoliver软件分析,获取动态血管模式曲线(DVPC)及时间-强度曲线(TIC),归纳两者的动态血流灌注模式特点,并分析比较两者的定量参数:峰值强度(IMAX)、到达时间(AT)、上升时间(RT)、达峰时间(TTP)、平均渡越时间(mTT)、上升支斜率(K_1)及下降支斜率绝对值(K_2),作为鉴别诊断的量化指标。结果眼眶淋巴瘤和炎性假瘤的血流灌注模式不同:(1)淋巴瘤DVPC以正负双向波为主,炎性假瘤DVPC以正向波为主,两者DVPC模式差异具有统计学意义(P0.05);(2)两组TIC定量参数IMAX、K_1、K_2、mTT、RT差异均具有统计学意义(P0.05),而AT、TTP差异无统计学意义(P0.05)。结论应用SonoLiver软件得到的DVPC、TIC对眼眶淋巴瘤和炎性假瘤的超声造影过程进行定量分析,对其鉴别诊断具有一定价值。     

超声造影参数成像技术在眼球后方占位性病变中的应用价值

目的运用超声造影参数成像技术评价超声造影在眼球后方占位性病变中的应用价值。方法回顾性分析经超声造影检查的眼球后方占位性病变患者63例,以病理结果为金标准分为恶性组14例,良性组49例。应用SonoLiver造影软件分析超声造影图像,获取时间-强度曲线(TIC)、动态血管模式曲线(DVPC)及定量参数,分析及比较两组间DVPC、TIC曲线特点,比较两组病灶区的到达时间(AT)、上升时间(RT)、达峰时间(TTP)、峰值强度(IMAX)、平均渡越时间(mTT)、上升支斜率(RS)及下降支斜率绝对值(DS)等指标的差异,并行ROC曲线分析获取鉴别诊断的最佳截断值。结果(1)良性组TIC主要表现为快升慢降波,DVPC主要表现为正向波,恶性组TIC主要表现为快升快降波,DVPC主要表现为正负双向波,两组差异均具有统计学意义(P<0.05);(2)两组TIC定量参数mTT、RT、RS、DS差异均具有统计学意义(P<0.05),而IMAX、AT、TTP差异无统计学意义(P>0.05);(3)当RT为11.8,mTT为29.2,RS为115.8,DS为45.4是鉴别眼球后方良恶性肿瘤的最佳截断值,其中RS为115.8鉴别诊断价值最高。结论超声造影参数成像技术可为眼球后方占位性病变的鉴别提供一定的诊断依据。     

乳腺良恶性肿瘤的超声造影定量分析研究

目的探讨乳腺良恶性肿瘤超声造影灌注曲线的特点及临床价值。方法 87例乳腺肿瘤患者分为恶性组57例和良性组30例,Sonolver软件获取其超声造影图像,定量分析其分析区和参考区灌注曲线参数。结果与良性组分析区比较,恶性组分析区上升时间(RT)、达峰时间(TTP)及平均渡越时间(mTT)均减小,上升斜率(RS)和下降斜率(DS)均增大(P<0.05);恶性组分析区RT、TTP及mTT的95%可信区间均减小(P<0.05)。与良性组参考区比较,恶性组参考区RT减小,RS和DS增大(P<0.05)。乳腺良性和恶性肿瘤分析区RT、TTP及mTT小于参考区,分析区峰值强度RS、DS及拟合优度大于参考区,差异均有统计学意义(P<0.05)。结论乳腺肿瘤的灌注参数可评估肿瘤内的血流灌注,为乳腺良恶性肿瘤的诊断提供了新的定量指标。     

超声造影在肾脏小肿瘤良恶性鉴别诊断中的价值

目的研究超声造影不同增强强度及定量参数在肾脏小肿瘤良恶性鉴别诊断中的价值。方法 118例肾脏小肿瘤患者行术前超声造影,采用Sono Liver超声造影分析软件进行量化分析,获得最大峰值强度(IMAX)、上升时间(RT)、达峰时间(TTP)、平均渡越时间(mTT)及曲线下面积(AUC)等参数,并与病理结果进行对照,比较不同增强强度及各参数指标对肾脏小肿瘤良恶性的诊断价值。结果注射造影剂后118例肾脏小肿瘤均增强,其中低增强28例(23.6%),包括恶性8例,良性20例;等增强30例(25.4%),包括恶性22例,良性8例;高增强60例(51.0%),包括恶性54例,良性6例。低增强肾脏小肿瘤超声造影诊断敏感性62.5%,特异性85.0%,准确率78.6%;等增强肾脏小肿瘤超声造影诊断敏感性81.8%,特异性75.0%,准确率80.0%;高增强肾脏小肿瘤超声造影诊断敏感性92.5%,特异性83.3%,准确率91.7%。低增强良、恶性肾脏小肿瘤超声造影定量参数IMAX、RT、mTT、AUC比较差异均无统计学意义;等增强及高增强恶性肾脏小肿瘤RT、mTT均小于良性病灶,IMAX、AUC均大于良性病灶,差异均有统计学意义(均P0.05)。结论不同增强强度超声造影联合定量参数分析可为肾脏良恶性小肿瘤的诊断提供更多的信息。     

超声造影增强强度联合定量分析对肾脏小肿瘤良恶性诊断的价值

目的 研究超声造影不同增强强度及定量参数对肾脏小肿瘤良恶性鉴别诊断的价值。方法 118例肾脏小肿瘤患者行术前超声造影,依据肿瘤增强的强度分为低增强组,等增强组,高增强组,用Sonoliver超声造影分析软件进行量化分析,获得最大峰值强度(maximum intcnsity,IMAX)、上升时间(rise time,RT)、达峰值时间（time to peak,TTP)、平均渡越时闻(mean transit time,mTT)及曲线下面积(area under the curve,AUC)等参数,并与病理结果进行对照,比较不同增强强度及各参数指标对肾脏小肿瘤良恶性的诊断价值。结果 低增强组与等或高增强组肾脏小肿瘤的病理类型存在差异（P<0.05）。28例低增强组肾脏肿物中20 例低度恶性或良性肿物,6例透明细胞癌,1例乳头状细胞癌,1 例转移性肾癌。90例高或等增强组肾脏肿物中,66例透明细胞癌,6例乳头状细胞癌,1例嫌色性细胞癌,1例多房囊性肾癌,1例转移性肾癌,1 例低度恶性血管平滑肌脂肪瘤,14例良性肿瘤。低增强组超声造影定量参数IMAX、RT、mTT、AUC差异无统计学意义(P＞O．05),等及高强组超声造影定量参数RT、mTT、AUC差异有统计学意义(P相似文献   

超声造影定量分析组织血流灌注参数评价肿瘤化疗疗效

目的探讨超声造影定量分析组织血流灌注参数在评价肿瘤化疗疗效中的作用。方法 18只小鼠建立H22肝癌皮下移植瘤模型,随机分为治疗组和对照组,每组各9只。自模型建立次日起分别经腹腔注射顺铂1mg/kg体重(顺铂治疗组)和0.5%羧甲基纤维素钠(CMC)(对照组),每天1次,连续给药5d。超声造影检查前,常规二维超声测量肿瘤3个最大径线,然后计算肿瘤体积。肿瘤接种后第8天行超声造影检查,然后脱机采用时间-强度曲线软件进行分析,获取曲线下面积(AUC)、峰值强度(IMAX)、灌注指数(PI)、平均通过时间(mTT)、峰值时间(TTP)和拟合优度(GOF)等参数。超声检查完成后完整剥离肿瘤,免疫组化检测肿瘤CD34表达情况,计算肿瘤微血管密度。结果与对照组相比,顺铂治疗组的肿瘤体积明显缩小(P=0.000)。顺铂治疗组的PI、IMAX和MVD均明显低于对照组(P0.05),但AUC、mTT和TTP在两组之间的差异无统计学意义。结论超声造影定量分析组织血流灌注参数的改变可以有效评价肿瘤化疗的疗效。     

超声造影成像TIC新指标对甲状腺良恶性结节的诊断价值

目的探讨超声造影(CEUS)成像时间-强度曲线(TIC)新指标对甲状腺良恶性结节的诊断价值。方法回顾性分析67个甲状腺结节造影成像TIC曲线,记录结节内感兴趣区(ROI)峰值强度(IMAX)、始增时间(RT)、达峰时间(TTP),以周围甲状腺组织ROI为基准,得到病灶相对IMAX(△Ι)、相对RT(△RT)、相对TTP(△TTP)。结果甲状腺良性结节IMAX、△Ι(142.6±55.6,46.3±55.4)明显大于恶性结节(75.2±34.7,-17.7±34.9)(P0.05),△RT、△TTP(-0.3±1.7,-0.4±1.6)明显小于恶性(1cm)结节(0.8±1.9,0.7±1.8)(P0.05)。恶性(1cm)结节△RT(-0.4±1.3)明显小于恶性(1cm)结节(0.8±1.9)(P0.05)。结论超声造影成像有助于甲状腺结节良恶性的鉴别诊断。     

超声造影定量分析评价前列腺良恶性组织血流灌注特征的初步研究

目的 探讨超声造影定量分析在鉴别前列腺外腺良恶性组织中的应用价值.方法 对52例行前列腺活检的患者行实时灰阶超声造影检查,对穿刺点处作时间强度曲线分析,获得以下参数:基础强度(BI)、峰值强度(PI)、增强强度(△SI)、到达时间(AT)、达峰时间(TTP)、曲线上升时间(ACT)、上升斜率(a3)、下降斜率(a2)、曲线下面积(AUC),对比分析前列腺良恶性组织的造影参数.结果 52例患者造影切面穿刺病理诊断为前列腺癌22例.52例患者前列腺癌区的BI、ΔSI与良性组织区相比,差异有统计学意义(P=0.036、P=0.017);对22例前列腺癌患者行自身配对检验,前列腺癌区的BI、ΔSI、AT、a3与良性组织区相比,差异有统计学意义(P=0.031、P=0.028、P=0.007、P=0.009);对30例良性前列腺病变患者行自身配对检验,双侧外腺的BI、PI差异有统计学意义(P=0.009、P=0.008).结论 超声造影定量分析对前列腺癌病灶具有显示快进、快速达峰、高增强的血流灌注特点,有利于良恶性组织的鉴别.并且,实时灰阶超声造影能客观地反映前列腺双侧外腺良性组织对称性的血流灌注特点.     

超声造影定量分析肾脏占位性病变鉴别诊断中的应用价值

目的探讨超声造影定量分析在对直径≤4cm肾脏常见占位性病变鉴别诊断中的应用价值。方法收集我院收治的肾脏占位性病变患者99例,术前均行超声造影检查,根据术后病理结果分为4组,其中1组为良性,其余3组均为恶性。应用SonoLiver软件对4组不同病理类型肾脏占位性病变的超声造影特征进行回顾性定量分析,以肾脏病灶与周围正常肾皮质的增强强度为参数进行动态血管模型(DVP)参数成像。结果肾血管平滑肌脂肪瘤(RAML)组与肾透明细胞癌(CCRCC)组比较,ΔIMAX、ΔmTT、ΔAUC差异有统计学意义(P0.05);RAML组与肾脏低度恶性肿瘤(LMRCC)组比较ΔIMAX、ΔTTP、ΔAUC差异有统计学意义(P0.05);CCRCC组与LMRCC组比较,ΔIMAX、ΔRT、ΔAUC差异有统计学意义(P0.05);CCRCC组与肾盂癌(RPC)组比较,ΔIMAX、ΔRT、ΔAUC差异有统计学意义(P0.05);LMRCC组与RPC组比较,ΔRT、ΔmTT差异有统计学意义(P0.05)。4组病例DVP曲线具有各自特点。结论超声造影定量分析参数和DVP曲线为RAML、CCRCC、LMRCC、RPC的鉴别诊断提供了诊断依据,提高了超声造影的鉴别诊断能力。     

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.