经直肠彩色多普勒血流显像诊断老年前列腺癌的研究

目的 探讨经直肠彩色多普勒血流显像(CDFI)在老年前列腺癌诊断中的价值.方法 对60例疑诊为前列腺癌的老年患者,进行前列腺结节CDFI检测及穿刺.结果 经直肠CDFI检测60例前列腺结节中42例有血流显像,占70.0%;18例无血流显像,占30.0%.前列腺癌患者共30例,28例有血流显像,占93.3%,2例无血流显像,仅占6.7%.30例良性前列腺增生(BPH)患者14例有血流显像,占46.7%.CDFI检测结果:前列腺癌患者收缩期血流峰值流速(Vs)为(20.52±4.11)cm/s,阻力指数(RI)为0.70±0.06;BPH患者Vs为(13.87±2.56)cm/s,RI为0.68±0.04.两者Vs比较差异有统计学意义(P<0.01),RI比较差异无统计学意义(P>0.05).CDFI的灵敏度0.87,特异度0.57,阳性预测值0.70.结论 经直肠CDFI检测对诊断老年前列腺癌有重要意义.     

彩色多普勒超声诊断乳腺良恶性肿瘤的价值

目的 探讨二维超声、彩色多普勒血流显像在乳腺良恶性肿瘤中的血流信号及超声特征,评价彩色多普勒超声在乳腺良恶性肿瘤诊断中的应用价值.方法 应用二维超声对78例乳腺肿瘤患者检查,观察肿块的形态、大小、边界、纵横比、内部回声、微小钙化、有无腋窝淋巴结肿大;彩色多普勒血流显像观察肿瘤血流信号,测量收缩期峰值血流速度(PSV)和血流阻力指数(RI).与术后病理结果 对比.结果 乳腺良性肿瘤PSV为(0.22±0.15)m/s,乳腺恶性肿瘤为(0.30±0.06)m/s,差异有统计学意义(P＜0.01).乳腺恶性肿瘤内部中心血流、混合血流显示率分别为100.0%(40/40)、42.5%(17/40),乳腺良性肿瘤分别为2.6%(1/38)、0,差异有统计学意义(P＜0.01).统计学分析显示乳腺良恶性肿瘤之间的PSV临界值为0.12 m/s,该值对直径＜2 cm乳腺恶性肿瘤诊断敏感度、特异度和准确度分别为95.3%、100.0%、96.7%.结论 二维超声结合彩色多普勒血流显像在乳腺良恶性肿瘤的鉴别诊断中有重要的临床应用价值.     

彩色多普勒超声检查对血栓闭塞性脉管炎病变的探讨

目的探讨应用二维超声及彩色多普勒血流显像(CDFI)技术诊断血栓闭塞性脉管炎的声像图改变及血流特征.方法对40例47条临床拟诊血栓闭塞性脉管炎病例的血管进行二维超声及彩色多普勒超声(彩超)检查,并与CT血管成像对照.结果CDFI显像可直观地显示动脉管壁回声及血流充盈情况,多普勒血流频谱可以显示血流动力学改变.结论彩超是血栓闭塞性脉管炎无创辅助检查的首选项目,价值与血管造影接近,是一种敏感、准确、方便的诊断方法.     

彩色多普勒血流显像诊断主动脉夹层动脉瘤的应用价值

目的 分析并探讨彩色多普勒血流显像对主动脉夹层动脉瘤的诊断价值.方法 选择某院2008年1月～2012年4月收治的32例主动脉夹层动脉瘤患者.所有患者均进行彩色多普勒血流显像检查、CT检查、MRI检查及动脉造影检查,分析在彩色多普勒血流显像检查明确破口位置、末端部位、夹层真假腔、假腔内血栓、内脏动脉与真假腔关系、主动脉直径、内脏动脉缺血原因等方面的作用.结果 彩色多普勒血流显像对近端破口检出率明显高于CT、MRI检查,差异有统计学意义(P＜0.05),而与动脉造影检查差异无统计学意义(P＞0.05).彩色多普勒血流显像对近端破口检出率与CT、MRI和动脉造影差异无统计学意义(P＞0.05).彩色多普勒血流显像对夹层内内脏动脉检出率为96.88％,显著高于CT检查(56.25％)、MRI检查(46.88％)和动脉造影检查(65.63％),差异有统计学意义(P＜0.05).通过彩色多普勒血流显像发现2例患者夹层累及动脉开口为静态狭窄,1例患者为动态狭窄,而CT、MRI及动脉造影检查未检出此类征象.结论 彩色多普勒血流显像能较好地反映主动脉夹层动脉瘤的全貌,在明确内脏动脉缺血原因以及内脏动脉与真假腔关系方面具有一定优势.     

彩色多普勒超声对门静脉癌栓肝动脉血流动力学变化的研究

目的 探讨肝细胞癌合并门静脉主干癌栓时的肝动脉血流动力学变化.方法 将60例肝细胞癌合并门静脉主干癌栓患者根据癌栓对门静脉主干的阻塞程度分为部分性阻塞组和完全性阻塞组,每组30例,应用彩色多普勒超声测量肝固有动脉内径( PHA-D)、收缩期最大血流速度(Vmax)以及阻力指数(RI),并与80例肝细胞癌无门静脉癌栓患者(肝癌组)和20例健康体检者(对照组)作对比.结果 对照组、肝癌组、部分性阻塞组、完全性阻塞组PHA-D分别为(0.33±0.05)、(0.44±0.04)、(0.45±0.04)、(0.61 ±0.07) cm,Vmax分别为(31.32±9.31)、(66.76±20.34)、(68.16±21.96)、(132.65±38.84) cm/s,RI分别为0.75±0.08、0.68±0.13、0.65±0.11、0.55±0.10.肝癌组、部分性阻塞组、完全性阻塞组PHA-D、Vmax、RI与对照组比较差异均有统计学意义(P＜0.01或＜0.05);完全性阻塞组PHA-D、Vmax、RI与肝癌组和部分性阻塞组比较差异均有统计学意义(P＜0.01).结论 肝细胞癌合并门静脉主干癌栓时,肝动脉血流量明显代偿性增加,RI明显减低,但肝动脉血流动力学的改变主要取决于癌栓对门静脉主干的阻塞程度,而并非取决于门静脉癌栓的有无.     

超声检查对颈部淋巴结的良恶性鉴别诊断的价值

目的 探讨超声对颈部肿大淋巴结的良恶性鉴别诊断价值.方法 应用彩色多普勒超声观察96例患者的166个颈部良性及恶性淋巴结的L/S比值,内部回声,血流形态及频谱特征.结果 良性淋巴结及恶性淋巴结的L/S比值分别为1.98±0.24、1.43±0.25,髓质动脉Vmax分别为(18.1±5.2)cm/s、(26.5±12.6)cm/s,R1分别为0.61±0.06、0.68±0.07,这三项指标比较差异均有统计学意义(P＜0.01).良性淋巴结内部回声多为门部髓质增宽,皮质变窄或均匀增宽,恶性淋巴结反之.彩色多普勒血流(CDFI)示良性淋巴结见门部规则血流,而恶性淋巴结血流中央血管紊乱型占80.0%,周边血管型占15.3%,结内无血管型占4.7%.结论 彩色多普勒超声有助于颈部肿大淋巴结的良恶性鉴别诊断.     

超声对类风湿关节炎髌上囊滑膜炎疗效评价及与风湿病活动期指标相关性分析

目的 探讨超声对类风湿关节炎髌上囊滑膜炎疗效评价及与风湿病活动期血清炎性指标的相关性.方法 选取类风湿关节炎活动期患者32例(64膝),分别于治疗前当日、治疗后4周进行超声检查.超声检查指标包括膝关节髌上囊滑膜厚度、髌上囊积液最大深度、滑膜内血流显示情况、最高血流速度、血流阻力指数,血清炎性指标包括红细胞沉降率(ESR)、C反应蛋白(CRP).结果 超声检查显示治疗后膝关节髌上囊滑膜厚度、髌上囊积液最大深度、滑膜内血流显示情况均较治疗前明显改善,差异有统计学意义(P＜0.01).24例(48膝)Ⅱ、Ⅲ级类风湿关节炎患者治疗前后最高血流速度、血流阻力指数比较差异有统计学意义[(0.35±0.09)m/s比(0.24±0.06) m/s,0.38±0.03比0.54±0.08,P＜0.01].治疗后血清ESR、CRP均较治疗前明显降低(P＜0.01).超声检查髌上囊积液最大深度、髌上囊滑膜厚度、滑膜内血流显示情况、最高血流速度与ESR、CRP呈正相关(P＜0.05)；血流阻力指数与ESR、CRP呈负相关(P＜0.05).结论 超声可以对类风湿关节炎髌上囊滑膜炎进行疗效评价；超声检查指标与风湿病活动期血清炎性指标ESR、CRP有明显的相关性.     

TCD、CDFI检测在颈动脉重度狭窄介入治疗前的应用研究

目的 探讨经颅多普勒(TCD)超声及彩色多普勒血流显像(CDFI)联合检测技术在颈动脉重度狭窄血管内支架成形术前的应用价值.方法 38例颈动脉重度狭窄患者在介入治疗术前分别进行TCD及CDFI检查,对颈动脉形态学、血流动力学进行评价.结果 术前TCD及CDFI诊断38例颈动脉狭窄,狭窄程度＞70％,与数字减影血管造影(DSA)对比相符.结论 CDFI对颈动脉重度狭窄的诊断有较高的准确性,TCD用于对颅内动脉侧枝血流的检测,TCD与CDFI结合提高了颈动脉狭窄诊断的准确率,可用于血管内支架成形术治疗颈动脉重度狭窄之前筛选的重要检测手段.     

超声引导下无水乙醇注射治疗子宫肌瘤的疗效观察

目的 观察超声引导下无水乙醇注射治疗子宫肌瘤的疗效.方法 选取2009年1月～2011年1月某院收治的56例子宫肌瘤患者为研究对象,A组8例要求手术治疗的患者在超声引导下经皮子宫肌瘤内注射无水乙醇,治疗后7d行手术切除子宫肌瘤.B组48例患者只在超声引导下经皮子宫肌瘤内注射无水乙醇治疗,观察治疗前后子宫肌瘤变化及疗效.结果 ①A组8例患者切除后观察均有不同范围肌瘤中央球形坏死.子宫肌瘤内部血管均有不同程度血管栓塞.②B组患者治疗后12个月时月经周期为(29.4±3.4)d、经期为(5.6±1.7)d和月经量为(60.4±10.2) ml,月经情况优于治疗前,比较差异有统计学意义(P＜0.05)；治疗后6个月时月经周期为(29.1±2.8)d、经期为(5.9±1.8)d和月经量为(72.8±13.9) ml,月经情况优于治疗前,比较差异有统计学意义(P＜0.05)；治疗后12个月月经情况优于治疗后6月,比较差异无统计学意义(P＞0.05).③B组患者治疗前均可探及肌瘤内部血流信号,治疗后6个月27例血流信号消失或明显减少,治疗后12个月30例血流信号消失或明显减少.治疗后12个月子宫肌瘤体积为(28.3±2.1)ml,治疗后6个月子宫肌瘤体积为(34.5±3.1) ml,均小于治疗前,比较差异有统计学意义(P＜0.05)；治疗后12个月子宫肌瘤体积小于治疗后6月,比较差异无统计学意义(P＞0.05).治疗后12个月总有效率为87.5％,治疗后6个月总有效率为75.0％,与治疗前比较差异有统计学意义(P＜0.05).治疗后12个月总有效率高于治疗后6个月,但比较差异无统计学意义(P＞0.05).④B组患者有4例注射后出现下腹坠胀感,1周后自行消失.结论 超声引导下注射无水乙醇治疗子宫肌瘤,效果满意,无明显不良反应,值得临床推广应用.     

超声在亚临床甲状腺功能减退诊断中的应用

目的 探讨超声在亚临床甲状腺功能减退诊断中的应用价值.方法 选择本院亚临床甲状腺功能减退患者30例为观察组,另选30例健康志愿者为对照组,比较两组甲状腺腺体彩色多普勒血流显像情况、甲状腺左、右叶径线及上动脉Vmax、RI、PI及AT值的差异.结果 超声显示观察组患者甲状腺体积增大,边缘不光滑,内部回声弥漫性降低,显示不均匀粗光点回声,其甲状腺左叶及右叶径线均高于对照组,差异有统计学意义(t =9.99,9.27,P＜0.01);观察组患者甲状腺内血流呈现弥漫性增多,血流明显增粗,血管分布不均匀,密度增加.其甲状腺上动脉血流速度增加,Vmax值高于对照组,PI值低于对照组,AT值长于对照组,差异均具有统计学意义(t=24.33,4.08,21.76,P＜0.01).结论 超声检查亚临床甲状腺功能减退具有操作简单、价格便宜、无辐射损伤及可以观察血流动力学特征的优点,可提供有价值的诊断信息.     

Investigation and Control of Anthrax Outbreak at the Human–Animal Interface,Bhutan, 2010

In 2010, we investigated anthrax outbreak in Bhutan. A total of 43 domestic animals died, and cutaneous anthrax developed in 9 persons, and 1 died. All affected persons had contact with the carcasses of infected animals. Comprehensive preparedness and response guidelines are needed to increase public awareness of anthrax in Bhutan.     

Risk for Travel-associated Legionnaires’ Disease,Europe, 2009

Legionnaires’ disease is underreported in Europe; notification rates differ substantially among countries. Approximately 20% of reported cases are travel-associated. To assess the risk for travel-associated Legionnaires’ disease (TALD) associated with travel patterns in European countries, we retrieved TALD surveillance data for 2009 from the European Surveillance System, and tourism denominator data from the Statistical Office of the European Union. Risk (number cases reported/number nights spent) was calculated by travel country. In 2009, the network reported 607 cases among European travelers, possibly associated with 825 accommodation sites in European Union countries. The overall risk associated with travel abroad was 0.3 cases/million nights. We observed an increasing trend in risk from northwestern to southeastern Europe; Greece had the highest risk (1.7). Our findings underscore the need for countries with high TALD risks to improve prevention and control of legionellosis; and for countries with high TALD risks, but low notification rates of Legionnaires’ disease to improve diagnostics and reporting.     

Travel-associated Diseases,Indian Ocean Islands, 1997–2010

Data collected by the GeoSentinel Surveillance Network for 1,415 ill travelers returning from Indian Ocean islands during 1997–2010 were analyzed. Malaria (from Comoros and Madagascar), acute nonparasitic diarrhea, and parasitoses were the most frequently diagnosed infectious diseases. An increase in arboviral diseases reflected the 2005 outbreak of chikungunya fever.     

Haemophilus ducreyi Associated with Skin Ulcers among Children,Solomon Islands

During a survey of yaws prevalence in the Solomon Islands, we collected samples from skin ulcers of 41 children. Using PCR, we identified Haemophilus ducreyi infection in 13 (32%) children. PCR-positive and PCR-negative ulcers were phenotypically indistinguishable. Emergence of H. ducreyi as a cause of nongenital ulcers may affect the World Health Organization’s yaws eradication program.     

Dengue Virus Transmission by Blood Stem Cell Donor after Travel to Sri Lanka; Germany, 2013

Three days after donation of peripheral blood stem cells to a recipient with acute myeloblastic leukemia, dengue virus was detected in the donor, who had recently traveled to Sri Lanka. Transmission to the recipient, who died 9 days after transplant, was confirmed.     

Long-Term Survival Among Histological Subtypes in Advanced Epithelial Ovarian Cancer: Population-Based Study Using the Surveillance,Epidemiology, and End Results Database

BackgroundActual long-term survival rates for advanced epithelial ovarian cancer (EOC) are rarely reported.ObjectiveThis study aimed to assess the role of histological subtypes in predicting the prognosis among long-term survivors (≥5 years) of advanced EOC.MethodsWe performed a retrospective analysis of data among patients with stage III-IV EOC diagnosed from 2000 to 2014 using the Surveillance, Epidemiology, and End Results cancer data of the United States. We used the chi-square test, Kaplan–Meier analysis, and multivariate Cox proportional hazards model for the analyses.ResultsWe included 8050 patients in this study, including 6929 (86.1%), 743 (9.2%), 237 (2.9%), and 141 (1.8%) patients with serous, endometrioid, clear cell, and mucinous tumors, respectively. With a median follow-up of 91 months, the most common cause of death was primary ovarian cancer (80.3%), followed by other cancers (8.1%), other causes of death (7.3%), cardiac-related death (3.2%), and nonmalignant pulmonary disease (3.2%). Patients with the serous subtype were more likely to die from primary ovarian cancer, and patients with the mucinous subtype were more likely to die from other cancers and cardiac-related disease. Multivariate Cox analysis showed that patients with endometrioid (hazard ratio [HR] 0.534, P<.001), mucinous (HR 0.454, P<.001), and clear cell (HR 0.563, P<.001) subtypes showed better ovarian cancer-specific survival than those with the serous subtype. Similar results were found regarding overall survival. However, ovarian cancer–specific survival and overall survival were comparable among those with endometrioid, clear cell, and mucinous tumors.ConclusionsOvarian cancer remains the primary cause of death in long-term ovarian cancer survivors. Moreover, the probability of death was significantly different among those with different histological subtypes. It is important for clinicians to individualize the surveillance program for long-term ovarian cancer survivors.     

Outbreak of Panton-Valentine Leukocidin–Associated Methicillin-Susceptible Staphylococcus aureus Infection in a Rugby Team,France, 2010–2011

Staphylococcus aureus strains that produce Panton-Valentine leukocidin are known to cause community infections. We describe an outbreak of skin abscesses caused by Panton-Valentine leukocidin–producing methicillin-susceptible S. aureus (clonal complex 121) in a professional rugby team in France during July 2010–February 2011. Eight team members were carriers; 7 had skin abscesses.     

大龄单身女性寻求生育力保存的伦理问题探析

近年来,在肿瘤和卵巢相关疾病发生率逐年增加、不少大龄单身女性渴望为自己购买一份“生殖保险”等社会及个人因素催化下,人类对于生育力保存的需求急剧增加,满足这一需求正在或将成为重大挑战。对于寻求进行生育力保存的大龄单身女性来说,在合适的年龄应用玻璃化冷冻技术将其卵母细胞冻存是目前可采用的最佳生育力保存手段。而单身女性卵子冷冻将面临来自伦理道德、社会乃至法律的巨大挑战。本文概述国内外大龄单身女性卵子冷冻的现状,并对其可能涉及的相关伦理问题及解决途径进行综述,以促进理性正视单身女性卵子冷冻问题。     

Reemergence and Autochthonous Transmission of Dengue Virus,Eastern China, 2014

In 2014, 20 dengue cases were reported in the cities of Wenzhou (5 cases) and Wuhan (15 cases), China, where dengue has rarely been reported. Dengue virus 1 was detected in 4 patients. Although most of these cases were likely imported, epidemiologic analysis provided evidence for autochthonous transmission.