超声造影对甲状腺良恶性结节的漏误诊分析

目的分析超声造影对甲状腺良恶性结节的漏诊和误诊原因,提高超声造影对其的诊断水平。方法回顾性分析我院经手术病理证实,超声造影误诊、漏诊的25例甲状腺结节患者的声像图资料,总结其超声造影特征。结果 25例甲状腺结节患者中,19例良性结节超声造影均误诊为甲状腺癌,其中13例为结节性甲状腺肿,6例为桥本氏甲状腺炎背景下的结节;6例漏诊的恶性结节均为甲状腺乳头状癌。超声造影图像中,误诊的结节有13例为低增强,6例为等增强,其中16例造影剂分布不均匀;漏诊的结节中有5例为等增强,1例为高增强,其中2例造影剂分布均匀。结论常规超声图像的影响、结节的体积过小及甲状腺良恶性结节之间相似的增强模式是影响超声造影诊断的主要因素。     

超声造影对甲状腺实质性结节良恶性诊断价值的研究

目的 探讨甲状腺结节实时超声造影(CEUS)的增强模式及其对甲状腺实质性结节的鉴别诊断价值.方法 对常规超声检测出且定性诊断困难的55例患者80个甲状腺实质性结节行超声造影检查,分析总结其增强模式,做出良、恶性判断,并与手术病理结果对照.分析超声造影各项指标包括造影剂进入结节时间、方式、增强强度、造影剂分布是否均匀、以及结节内造影剂消退快慢.结果 术后病理结果甲状腺实性结节良性病灶34个,恶性病灶46个.大于1 cm的良、恶性结节上述超声造影表现均有显著性差异(P＜0.05).其中造影剂早期消退对于诊断甲状腺乳头状癌的灵敏度最高(82.6％),不均匀性增强的特异度最高(89.5％).小于等于1 cm的良、恶性结节造影模式无明显差异(P＞0.05).结论 对于大于1 cm的甲状腺实性结节,造影剂晚进、向心性增强、不均匀增强及造影剂早期消退有助于对甲状腺乳头状癌的诊断.     

超声造影对甲状腺良恶性结节的诊断价值

目的探讨超声造影对甲状腺良恶性结节的诊断价值。方法对常规超声检出但定性诊断困难的69个甲状腺实性结节行超声造影检查,与手术病理结果对照,分析良恶性结节的增强模式,即造影剂进入结节时间、方式、增强程度、造影剂分布是否均匀以及结节内造影剂消退快慢的情况。结果超声造影表现:63.9%(23/36)甲状腺良性结节表现为等增强或高增强,84.8%(28/33)甲状腺癌表现为低增强或等增强。低或等增强、不均匀增强、早期消退对甲状腺乳头状癌的诊断敏感性分别为72.7%、87.9%、84.8%,良恶性结节的峰值强度、始增时间、达峰时间差异无统计学意义,但恶性结节消退时间早于良性结节(P0.05)。结论超声造影能为甲状腺结节良恶性鉴别诊断提供更有效的诊断方法。     

甲状腺结节的超声造影分析

目的:探讨甲状腺良恶性结节的超声造影表现及其鉴别诊断价值。方法:回顾性分析69例甲状腺结节患者(共计69个结节)超声造影表现,其中恶性结节33个,良性结节36个,对比观察甲状腺良恶性结节超声造影增强模式,总结甲状腺结节超声造影表现。评价指标包括造影剂进入结节的快慢、结节增强程度、结节强化是否均匀以及造影剂廓清时间。结果:甲状腺良恶性结节在结节增强程度、结节强化是否均匀以及造影剂廓清时间3个方面的差异均有统计学意义(χ2=48.45、48.98、45.22,P0.01)。恶性结节以"快进快出、不均匀低增强"为主,良性结节以"快进慢出、均匀高增强"为主。结论:甲状腺良恶性结节的超声造影表现有一定特异性,在鉴别诊断中有重要临床价值。     

超声造影在单发甲状腺结节中的诊断价值

目的 探讨超声造影在甲状腺单发结节定性诊断中的应用价值.方法 对107例甲状腺单发结节行超声造影检查,观察结节的造影剂灌注过程,并采用TomTec软件进行量化分析,获得灌注参数.结果 46例甲状腺乳头状癌注入造影剂后表现为结节不均匀弱增强,在整个增强过程中增强程度较正常甲状腺组织低;61例甲状腺良性结界造影后表现为等增强或高增强,增强程度高于周边甲状腺组织,恶性结节其始增时间、达峰时间晚于良性结节,峰值强度低于良性结节,差别具有统计学意义.结论 超声造影能为甲状腺单发结节良恶性鉴别提供更有效的诊断方法.     

超声造影在伴有微钙化的甲状腺结节中的诊断价值

目的探讨超声造影在鉴别伴有微钙化的甲状腺结节良恶性中的诊断价值。方法对92例经手术病理证实的伴有微钙化的甲状腺结节患者行超声造影检查,评估超声造影判断其良恶性的敏感性、特异性、阳性预测值、阴性预测值及诊断符合率。结果注入造影剂后,59个恶性结节中,54个表现为不均匀弱增强,4个为等增强,1个呈高增强;33个良性结节中,26个呈均匀等增强,3个呈均匀高增强,4个呈不均匀弱增强;良恶性结节的超声造影增强程度比较差异有统计学意义(P<0.05)。超声造影诊断伴有微钙化的甲状腺结节良恶性的敏感性、特异性、阳性预测值、阴性预测值及诊断符合率分别为91.53%、87.88%、93.10%、85.29%及90.22%。结论超声造影对伴有微钙化的甲状腺结节的良恶性具有较高的诊断价值。     

超声造影对甲状腺单发实性结节良恶性的诊断价值

目的探讨超声造影对甲状腺单发实性结节良恶性的诊断价值。方法 75例经病理证实为甲状腺单发实性结节,先行常规超声检查,后超声造影观察其增强特征和时间-强度曲线定量参数:峰值强度(Peak)、达峰时间(Tp)、曲线下面积(AUC)及造影剂平均通过时间(MTT),判断结节的良恶性。结果甲状腺良性结节造影后形态多规则,边界清晰,明显增强,分布均匀且无灌注缺损;恶性结节表现为形态不规则,边界不清,无明显增强,分布不均匀,可见灌注缺损;两者差异有统计学意义(P0.05)。与常规超声比较,超声造影测量甲状腺良性结节大小差异无统计学意义,测量恶性结节直径较大(P0.05)。与良性结节比较,恶性结节AUC和Peak降低,Tp延迟(P0.05);两组MTT差异无统计学意义。以病理结果为金标准,超声造影诊断甲状腺良恶性结节的符合率为89.3%。结论甲状腺良恶性结节造影增强特征明显不同,定量参数Peak、AUC及Tp可作为甲状腺良恶性结节鉴别诊断中的参考指标。     

实时灰阶超声造影增强模式在甲状腺结节鉴别诊断中的应用

目的 探讨实时灰阶超声造影增强模式在甲状腺结节鉴别诊断中的诊断意义.方法 术前常规二维及彩色多普勒超声检查后,对117个甲状腺结节进行超声造影检查,观察各结节造影过程并进行图像后处理,分析不同性质结节的造影模式特征.结果 注入造影剂后,甲状腺结节呈无增强、均匀增强、不均匀增强、周边增强4种增强模式,甲状腺良恶性结节的增强模式比较有差异(P＜0.001),造影后病灶边界清晰程度有差异(P＜0.001).结论 实时灰阶超声造影技术在鉴别甲状腺结节性质方面可以提供更多的信息,具有一定的诊断意义.     

超声造影在甲状腺良恶性结节鉴别诊断中的价值

目的评价超声造影在甲状腺良恶性结节鉴别诊断中的价值。方法 67例甲状腺结节患者,共103个结节,对结节行超声造影及穿刺活检。结果超声造影准确诊断93个结节,其中良性35个,恶性58个;误诊10个结节,其中良性6个,恶性4个;诊断准确性90.3%,敏感性93.5%,特异性85.4%。结论超声造影在甲状腺良恶性结节的诊断中具有较高的诊断价值。     

常规超声及超声造影在囊实性甲状腺结节良恶性鉴别诊断中的应用价值

目的：探讨囊实性甲状腺结节良恶性鉴别诊断中常规超声及超声造影的应用价值。方法：选取河池市人民医院2022年7月—12月收治的甲状腺结节患者40例（共计58个囊实性甲状腺结节）,患者均进行常规超声及超声造影检查,以病理检查结果为金标准,比较常规超声及超声造影检查的诊断效能,分析良恶性结节超声表现。结果：超声造影检查的灵敏度、特异度、准确率均高于常规超声检查,漏诊率、误诊率低于常规超声检查,但差异不显著（P> 0.05）;常规超声检查下甲状腺良、恶性结节表现、血流阻力指数的差异均有统计学意义（P <0.05）;超声造影检查下甲状腺良性结节均匀增强多于恶性结节,不均匀增强少于恶性结节,周边环状增强表现多于恶性结节,差异有统计学意义（P <0.05）,无增强表现占比差异无统计学意义（P> 0.05）;超声造影检查中良性结节和恶性结节的超声强化程度差异不显著（P>0.05）,恶性结节与良性结节超声造影峰值到达时间差异显著（P <0.01）。结论：囊实性甲状腺结节良恶性鉴别诊断中超声造影检查可更清晰观察甲状腺结节特征,提升诊断的准确性。     

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.     

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.