CEUS定量分析鉴别诊断乳腺肿瘤的价值及其与微血管密度的相关性分析

目的 采用CEUS时间-强度曲线(TICs)各参数鉴别良恶性肿瘤的价值及其与微血管密度(MVD)间的关系。方法 纳入获得病理诊断的患者79例,其中良性病变56例,恶性病变23 例。手术病理标本切片行免疫组织化学染色检测MVD。采用SonoLiver软件定量分析各参数与MVD关系。结果 乳腺病灶TICs的各参数在良恶性肿瘤之间比较差异无统计学意义(P>0.05);乳腺病灶的IMAX 及QOF明显高于乳腺实质,而且RT、TTP、mTT均较乳腺实质短(P <0.05)。恶性病灶MVD数目为(173.16±64.67)个/mm²,良性病灶MVD数目为(149.01±35.16)个/mm²,差异有统计学意义(P =0.04)。TICs各参数只有IMAX与MVD相关(r=0.229,P=0.048)。结论 乳腺病变CEUS定量参数的IMAX与MVD存在正相关,通过定量分析的峰值强度参数可以初步评估乳腺肿瘤内微血管密度。     

Lung water assessment by lung ultrasonography in intensive care: a pilot study

Objective

To investigate the accuracy of lung ultrasonography (LUS) in the quantification of lung water in critically ill patients by using quantitative computed tomography (CT) as the gold standard for the determination of lung weight.

Methods

Twenty consecutive patients admitted to an intensive care unit who underwent chest CT as a step in their clinical management were evaluated within 4?h by LUS. Lung weight, lung volume, and physical lung density were calculated from the CT scans using ad hoc software. Semiquantitative ultrasound assessment of lung water was performed by determining the ultrasound B-line score, defined as the total number of B-lines detectable in an anterolateral LUS examination.

Results

Good correlations were found between the B-line score and lung weight (r?=?0.75, p?<?0.05) and density (r?=?0.82, p?<?0.01), that only marginally increased when the lung density of the first 10?mm of subpleural lung tissue was evaluated (r?=?0.83, p?<?0.01). Moreover, values of subpleural lung density were not significantly different from values of the whole lung density (0.34?±?0.11 vs. 0.37?±?0.16?g/ml, p?=?ns). Very good correlations were found between the B-line score and both the weight (r?=?0.85, p?<?0.01) and the density (r?=?0.88, p?<?0.01) of the upper lobes. The weight of the lower lobes was not correlated with the B-line score (r?=?0.14, p?=?ns).

Conclusions

Lung ultrasound B-lines are correlated with lung weight and density determined by CT. LUS may provide a reliable, simple and radiation-free lung densitometry in the intensive care setting.     

胃癌的超声造影参数与微血管密度的相关性

目的 探讨胃癌CEUS参数与微血管密度(MVD)的相关性。方法 对确诊的37例胃癌患者行术前CEUS,分别记录胃癌病变区及正常胃壁TIC曲线的峰值时间(TTP)、增强时间(ET)、曲线上升支斜率(WIR)。计数胃癌病变及其旁正常胃壁的MVD。分析CEUS的TIC参数与MVD的相关性。结果 胃癌病变区TIC的ET、TTP低于其旁正常胃壁(P均<0.05),WIR、MVD高于其旁正常胃壁(P<0.01);胃癌病变区的ET、TTP与MVD呈负相关(r=-0.70、-0.59,P均<0.01),WIR与MVD呈正相关(r=0.70,P<0.01)。结论 对术前经胃镜病理活检确诊的胃癌行CEUS,可以直接显示并评估肿瘤血流灌注状态,从而间接评价新生血管生成程度,可预测肿瘤的发生发展并判断预后。     

Contrast-Enhanced Ultrasound Characteristics of Renal Pelvis Urothelial Carcinoma and Its Relationship with Microvessel Density

We studied the characteristics of contrast-enhanced ultrasound (CEUS) in renal pelvic urothelial carcinomas and explored its performance in assessing microvessel density (MVD) of tumor tissues. We retrospectively analyzed the characteristics of 125 cases, which were confirmed pathologically to be renal pelvic urothelial carcinomas using CEUS. We performed CEUS and found that most tumors presented with an enhanced mode of “slow-in (mean = 16.7 ± 2.6 s, range: 12–25 s), hypo-enhancement and fast-out (mean = 69.3 ± 16.2 s, range: 42–113 s).” However, the wash-in pattern, homogeneity and wash-out pattern observed with CEUS was not correlated with pT stage and grade (p > 0.05). But advanced-pT-stage and high-grade tumors had a higher peak enhancement than early-pT-stage and low-grade tumors (p < 0.01). Peak enhancement obtained with CEUS can be used to evaluate the pT stage and grade of renal pelvic urothelial carcinomas more effectively. The MVD of those tissues was observed using immunohistochemical staining of cluster of differentiation 34 (CD34). MVD in the advanced-pT-stage and high-grade groups was significantly higher than that in the early-pT-stage and low-grade groups (p < 0.01). As tumor pT stage and grade improved, CEUS peak enhancement intensity and MVD of tumors also exhibited an upward trend. CEUS peak enhancement intensity has the potential to determine MVD of renal pelvic urothelial carcinomas.     

Quantitative Analysis of Hepatic Microcirculation in Rabbits After Liver Ischemia-Reperfusion Injury Using Contrast-Enhanced Ultrasound

Previous studies have shown that contrast-enhanced ultrasound (CEUS) can be used quantitatively to analyze microcirculation blood perfusion in hepatocellular carcinoma patients. However, limited data have described the application of CEUS in hepatic microcirculation after liver ischemic-reperfusion injury (IRI). The purpose of this study was to explore the use of CEUS quantitatively to assess liver microcirculation after liver IRI. We randomly sorted 45 New Zealand rabbits into 3 groups (15 in each). Group A was a control group in which the rabbits underwent laparotomy alone. In groups B and C, hepatic blood was blocked for 30 min. Simultaneously, rabbits in group C underwent left lateral lobe resection. After 30 min of ischemia, CEUS was conducted after 0 h, 1 h, 6 h and 24 h of reperfusion in the 3 groups. Time-intensity curves (TICs) for CEUS were constructed and quantitative parameters (maximum intensity [IMAX], rise time [RT], time to peak [TTP] and mean transit time [mTT]) were obtained. In addition, serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were computed to estimate liver function before the operation and at 0 h, 1 h, 6 h and 24 h after reperfusion, respectively. Pathologic changes in the liver after reperfusion were also observed. Simultaneously, the correlations between serum transaminase and a variety of quantitative analysis parameters were analyzed. In groups B and C, the IMAX value decreased; whereas RT, TTP, mTT and serum ALT and AST levels increased significantly in comparison with those in group A after 0 h and 1 h of reperfusion. The pathology revealed that erythrocytes were destroyed and microcirculation was disturbed. Then, at 6 h of reperfusion, the IMAX continued to decrease. Additionally, the levels of RT, TTP, mTT and serum ALT and AST increased in comparison with those at 1 h of reperfusion. The pathologic analysis revealed inflammatory cell aggregation and leukocyte infiltration. After 24 h of reperfusion, the IMAX was reduced in comparison with that of the 6-h group. The levels of RT, TTP, mTT and serum ALT and serum AST were increased in comparison with that of the 6-h group. These findings were in accordance with the pathologic analysis. In addition, serum transaminase had a negative correlation with IMAX (p < 0.001) and a positive correlation with RT, TTP and mTT (all p < 0.001). So, in conclusion, the quantitative analysis of CEUS can be used to assess hepatic microcirculation after liver IRI.     

Comparison of Standardized Uptake Values in Normal Structures Between PET/CT and PET/MRI in an Oncology Patient Population

Purpose

The purpose of this study was to compare and correlate standardized uptake values (SUV) derived from magnetic resonance attenuation correction (MRAC) with those derived from computed tomography attenuation correction (CTAC) in an oncology patient population.

Procedures

The HIPAA-compliant study was approved by the Internal Review Board and all subjects gave written informed consent prior to inclusion in the study. Forty patients (mean age 61?±?15.1; 20 male) referred for clinically indicated 2-deoxy-2-[¹⁸F]fluoro-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) scans also underwent a PET/magnetic resonance imaging (MRI) examination. MRAC was performed using an automatic three-segment model. Regions of interest were drawn over eight normal structures in order to obtain SUVmax and SUVmean values. Spearman rank correlation coefficients (r) were calculated and two-tailed paired t tests were performed to compare the SUVmax and SUVmean values obtained from CTAC with those from MRAC.

Results

The mean time after FDG injection was 66?±?7 min for PET/CT and 117?±?15 min for PET/MRI examination. MRAC SUV values were significantly lower than the CTAC SUV values in mediastinal blood pool (p?<?0.001 for both SUVmax and SUVmean) and liver (p?=?0.01 for SUVmean). The MRAC SUV values were significantly higher in bone marrow (p?<?0.001 for both SUVmax and SUVmean), psoas major muscle (p?<?0.001 for SUVmax), and left ventricular myocardium (p?<?0.001 for SUVmax and p?=?0.01 for SUVmean). For the other normal structures, no significant difference was observed. When comparing SUV values generated from CTAC versus MRAC, high correlations between CTAC and MRAC were observed in myocardium (r?=?0.96/0.97 for SUVmax/mean), liver (r?=?0.68 for SUVmax), bone marrow (r?=?0.80/0.83 for SUVmax/mean), lung tissue (r?=?0.70 for SUVmax), and mediastinal blood pool (r?=?0.0.68/.069 for SUVmax/mean). Moderate correlations were found in lung tissue (r?=?0.67 for SUV mean), liver (r?=?0.66 for SUVmean), fat (r?=?0.48/0.53 for SUVmax/mean), psoas major muscle (r?=?0.54/0.58 for SUVmax/mean), and iliacus muscle (r?=?0.41 for SUVmax). Low correlation was found in iliacus muscle (r?=?0.32 for SUVmean).

Conclusions

Using the automatic three-segment model, our study showed high correlation for measurement of SUV values obtained from MRAC compared to those from CTAC, as the reference standard. Differences observed between MRAC and CTAC derived SUV values may be attributed to the time-delay between the PET/CT and PET/MRI scans or biologic clearance of radiotracer. Further studies are required to assess SUV measurements when performing different MR attenuation correction techniques.     

卵巢癌超声造影与血管生成拟态和MVD的相关性分析

目的 分析不同时期裸鼠卵巢癌移植瘤血管生成拟态(VM)密度、微血管密度(MVD)及其CEUS参数的相关性。方法 分别建立生长21天组、28天组裸鼠移植瘤模型,每组10只,对两组移植瘤模型行CEUS检查,分析各组时间强度曲线(TIC)及相关参数。应用CD31及PAS双重染色检测卵巢癌中VM表达及MVD。对两个时期移植瘤造影的峰值强度(PI)与相应的VM密度及MVD进行相关性分析。结果 成功制备移植瘤模型。CEUS显示,21天组、28天组的峰值强度(PI)、达峰时间(TTP)、持续时间(TTD)差异有统计学意义(P<0.05)。染色检测显示,21天组、28天组VM密度、MVD差异均有统计学意义(P均<0.05)。21天组PI与VM密度、MVD均呈正相关(r=0.657、0.652,P均<0.05);28天组PI与VM密度无相关性(P>0.05),PI与MVD呈正相关(r=0.687,P=0.03)。结论 不同时期卵巢癌CEUS与VM密度或MVD密切相关,对卵巢癌早期诊断有一定价值。     

Changes in nutritional status, body composition, quality of life, and physical activity levels of cancer patients undergoing autologous peripheral blood stem cell transplantation

Purpose

This pilot exploratory study aimed to describe the changes in nutritional status, body composition, quality of life (QoL), and physical activity levels (PAL) of cancer patients undergoing high-dose conditioning and autologous peripheral blood stem cell transplantation (PBSCT) at pre-admission, hospital discharge, and at 100 days post-transplantation, and to examine if changes in these parameters are interrelated.

Methods

Twenty-four patients (56.2?±?12.9 years; 7 females, 17 males) were recruited from an Australian transplant center. Assessment was prospectively conducted at pre-admission, hospital discharge, and 100 days post-transplantation using the scored patient-generated subjective global assessment, air displacement plethysmography, EORTC QLQ-C30 (version 3), and the international physical activity questionnaire.

Results

At discharge, nutritional status deteriorated (patient-generated subjective global assessment (PG-SGA) median, +8.0; interquartile range, 6.0–13.0; p?<?0.001) and the number of malnourished patients increased (n?=?8/23; p?=?0.023). Patients experienced significant loss of lean body mass (LBM; ?2.2 kg, CI 95 % ?3.0, ?1.4; p?<?0.001), and decrease in QoL (?10.6, CI 95 % ?24.1, 2.9; p?=?0.117); the proportion of patients with high PAL decreased (p?=?0.012). By 100 days post-transplantation, all patients were well-nourished; however, LBM remained lower ?1.0 kg (CI 95 % ?1.9, ?0.1; p?=?0.028). Change in nutritional status (PG-SGA score) was associated with weight (r?=??0.46; p?=?0.039) and fat mass (r?=??0.57; p?=?0.013). Change in QoL was associated with nutritional reservoir (i.e., fat; r?=?0.54; p?=?0.024); QoL was consistently higher for patients with high PAL.

Conclusions

High-dose conditioning and autologous PBSCT is associated with deterioration in nutritional status, QoL and PAL, with LBM remaining below baseline levels at 100 days post-transplantation. A nutrition and exercise intervention program post-hospital discharge may be beneficial for these patients.     

裸鼠胆囊癌皮下移植瘤超声造影定量参数与血管生成及细胞增殖的相关性

目的 探讨裸鼠胆囊癌皮下移植瘤CEUS定量参数与肿瘤血管生成和细胞增殖状态的相关性。方法 建立裸鼠胆囊癌皮下移植瘤模型,测定CEUS定量参数和微血管密度（MVD）、血管内皮生长因子（VEGF）及增殖细胞核抗原（PCNA）的表达,并进行相关性分析。结果 成功建立移植瘤20个,最终CEUS成功16个。裸鼠胆囊癌皮下移植瘤PI与MVD、PCNA呈正相关（r=0.635、0.514,P=0.008、0.042）,而CEUS各定量参数与VEGF表达均无相关性（P均>0.05）。裸鼠胆囊癌皮下移植瘤MVD与VEGF、PCNA表达呈正相关（r=0.680、0.650,P=0.004、0.006）,VEGF与PCNA呈正相关（r=0.611,P=0.012）。结论 裸鼠胆囊癌皮下移植瘤PI与MVD、PCNA呈正相关,有助于评估肿瘤的血管生成及细胞增殖状态;MVD、VEGF、PCNA两两之间均呈正相关,表明肿瘤血管生成与细胞增殖之间相互促进,共同促进肿瘤生长。     

Contrast-Enhanced Ultrasound Evaluation of Renal Blood Perfusion Changes After Percutaneous Transluminal Renal Angioplasty and Stenting for Severe Atherosclerotic Renal Artery Stenosis

This study used contrast-enhanced ultrasound (CEUS) to evaluate changes in renal cortical blood perfusion after percutaneous transluminal renal angioplasty and stenting (PTRAS) for severe renal artery stenosis (RAS) (≥70%). CEUS was performed in 21 patients with 24 severe RASs that underwent PTRAS. Renal cortical perfusion was quantitatively evaluated by comparing time intensity curve (TIC) parameters for SonoVue (Bracco, Milan, Italy) contrast enhancement, including peak intensity (PI), time to peak (TTP), mean transmit time (MTT), curve ascending slope (S), area under the curve (AUC), AUC-wash-in and AUC-wash-out. The parameters PI, TTP, MTT and S differed significantly between the pre-intervention and post-intervention TIC analysis (p < 0.05). Of the 24 pre-intervention curve appearances, 58.3% (14/24) improved after operation. The PI difference correlated positively with the estimated glomerular filtration rate difference (r = 0.433, p < 0.05). In conclusion, changes in some ultrasound perfusion parameters on CEUS and the shape of the TIC can be used to quantitatively and intuitively evaluate renal cortical blood perfusion change after PTRAS.     

TNF-α, myocardial perfusion and function in patients with ST-segment elevation myocardial infarction and primary percutaneous coronary intervention

Aims

To characterize the time course of tumor necrosis factor-α (TNF-α) serum levels along with myocardial perfusion and contractile function in patients with ST-segment elevation myocardial infarction (STEMI) and successful primary percutaneous coronary intervention (PCI).

Methods

Serum levels of TNF-α, interleukin 6 (IL-6), and C-reactive protein (CRP) were measured in 42 patients with STEMI before, one and 6?days after successful PCI. Myocardial perfusion was assessed by contrast-enhanced echocardiography (ceEcho), contractile function by unenhanced two-dimensional (2DE) and real-time three-dimensional echocardiography. In a subset of 18 patients, infarct size was quantified by late gadolinium enhancement cardiovascular magnetic resonance imaging (LGE-CMR) on day six.

Results

TNF-α serum levels were in the upper normal range within the first 12?h from symptom onset and increased continuously until day six, while IL-6 and CRP increased subsequently with a peak on day one after STEMI. Serum TNF-α on day one after PCI correlated with perfusion defects, wall motion abnormalities, and infarct size (ceEcho: r?=?0.52, p?=?0.005; 2DE: r?=?0.56, p?=?0.002; LGE-CMR: r?=?0.83–0.86; p?p?=?0.006, adjusted R ² 0.638).

Conclusion

Our data reflect the clinical significance of early TNF-α elevation in patients with STEMI and primary PCI (Controlled Clinical Trials number, NCT00529607).     

超声造影定量分析评估原发性肝细胞肝癌患者行经导管肝动脉化疗栓塞术前后血流灌注的改变

目的通过超声造影定量分析技术评价原发性肝细胞肝癌（HCC）接受经导管肝动脉化疗栓塞（TACE）术后1个月内残余肿瘤血流灌注随时间变化情况,探讨其在TACE中的应用价值。 方法选取2011年8月至2014年3月在广东省广州市中山大学附属第一医院接受一次TACE治疗的HCC患者61例纳入本前瞻性研究。其中,男性60例,女性1例,年龄18~76岁,平均年龄（53±13）岁。纳入病例在TACE术前及术后接受多次超声造影（CEUS）检查。利用定量分析软件进行脱机分析,提取出各个定量参数,采用wilcoxon符号秩和检验及配对t检验进行比较。 结果TACE术前的峰值强度（IMAX）及灌注指数（PI）明显高于术后3 d,差异均有统计学意义（Z=-4.852、-3.723,P均< 0.01）。TACE术后3 d的PI低于术后30 d,差异有统计学意义（Z=-2.272,P=0.009）。TACE前后峰值强度及灌注指数的变化大致表现为术后3 d IMAX及PI值显著下降,术后15 d较术后3 d略有上升,术后30 d较术后3 d则有较明显上升,但仍低于术前。 结论TACE术后残余病灶的血流灌注水平在术后3~15 d范围内处于最低。超声造影定量分析技术提供了一种评估TACE术后血流灌注改变的无创性方法。     

乳腺肿瘤CEUS特点及时间-强度曲线参数与微血管密度的关系

目的探讨CEUS鉴别乳腺良、恶性肿瘤的价值,观察CEUS时间-强度曲线各参数与微血管密度(MVD)的相关性。方法对88例乳腺肿瘤患者(恶性52例,良性36例)行实时CEUS,分析肿瘤特点,记录时间-强度曲线各参数值,计算MVD。结果良、恶性肿瘤在CEUS增强强度、增强形态、增强边界及有无穿支血管方面差异均有统计学意义(P均<0.05)。恶性肿瘤峰值减半差值时间(ΔHT)、峰值强度(PI)、MVD均高于良性肿瘤,差异有统计学意义(P均<0.05)。PI与MVD呈显著正相关(r=0.85,P<0.05)。结论 CEUS有助于判断乳腺肿瘤的良、恶性,且肿瘤增强强度与MVD有关。     

经直肠超声造影鉴别诊断直肠癌与直肠间质瘤

目的探讨经直肠CEUS鉴别诊断直肠癌与直肠间质瘤的价值。方法选取接受手术切除的直肠肿瘤患者44例,根据术前经直肠CEUS检查结果分为直肠癌组29例和直肠间质瘤组15例,另设同种肿瘤周围正常肠壁分别为对照1组和对照2组。观察造影剂在直肠肿瘤患者的充盈灌注情况,并与各自相应对照组比较。以对照组为参照,采用SonoLiver分析软件绘制肿瘤与正常肠壁的时间强-度曲线(TIC),并对曲线形态和峰值强度(IMAX)、上升时间(RT)、达峰时间(TTP)及平均渡越时间(mTT)进行比较。结果与各自相应对照组比较,直肠癌组总体造影表现为"快进快出"的高增强模式,直肠间质瘤组表现为"慢进慢出"的低增强模式。直肠癌组IMAX值高于对照1组[(122.42±15.99)%vs100%],而RT[(6.02±1.54)s vs(8.01±1.63)s]、TTP[(8.30±1.59)s vs(10.73±3.03)s]、mTT[(14.40±2.51)s vs(18.77±4.14)s]均小于对照1组(P均<0.05);直肠间质瘤组IMAX低于对照2组[(55.40±8.33)%vs 100%],而RT[(9.73±1.61)s vs(7.50±1.82)s]、TTP[(18.03±1.91)s vs(9.51±1.24)s]、mTT[(20.17±23.10)s vs(17.92±1.81)s]均大于对照2组(P均<0.05)。结论直肠癌与直肠间质瘤的CEUS表现存在明显差异,结合TIC和造影参数,有助于鉴别直肠癌和直肠间质瘤。     

A feasibility study exploring self-care and parenting for adults recovering from addictive substances

Little information is available on parental self-care while in recovery from addictive substances, and its relationship to parenting and recovery outcomes. We evaluated the feasibility of obtaining self-care and parenting outcomes for adults in long-term recovery from addictive substances, and explored potential contributing factors. Nineteen mothers and fathers who self-reported at least two years of sobriety participated in this study. Feasibility challenges included recruitment and scheduling interviews, given multiple work and personal demands on participants' schedules. Possible associations of self-care to parental efficacy (PE), parenting behaviors, resilience, and total recovery years were examined as indicators to parental functioning. The exploratory analyses showed a significant moderate correlation between PE and parenting behaviors (r?=?0.45, p?<?0.05) as well as total years in recovery and age (r?=?0.43, p?<?0.05); total years in recovery differed significantly when compared by race (χ2 (1)?=?5.63; p?=?0.018) and education (χ2 (1)?=?3.94; p?=?0.048). There was also a significant inverse relationship between total years in recovery and PE (r?=??0.43, p?<?0.05) and parental self-care (r?=??0.59, p?<?0.01). Recruiting parents (especially minorities) in long-term recovery was very challenging indicating that recruitment through community organizations was not feasible without a site champion. Preliminary findings showed statistically significant correlations among self-care, parental efficacy, age, and total years in recovery. As researchers and clinicians, it is necessary to determine the role and impact of self-care for future intervention development, however, recruitment strategies need to be modified to ensure sufficiently large study samples.     

Symptom clusters and symptom interference of HCC patients undergoing TACE: a cross-sectional study in China

Objective

The aim of this study was to investigate the symptom and symptom clusters of patients with hepatocellular carcinoma (HCC) before and after transcatheter arterial chemoembolization (TACE), and to discuss the relationship between symptoms, symptom clusters, and symptom interference.

Materials and methods

Patients with HCC who received TACE were asked to rate their symptoms using the M. D. Anderson Symptom Inventory and the symptom checklist particularly for HCC. To determine the interrelationships among symptoms and identify the symptom clusters, a principal component analysis with varimax rotation was carried out on the symptom items. Spearman correlation analysis was done to assess the relationship between symptom clusters and symptom interference.

Results

A total of 155 patients finished the whole procedure between November 2010 and May 2011. Before TACE, the five most severe symptoms, ranked in order, were fatigue (3.40?±?2.26), distress (3.35?±?2.60), sadness (3.01?±?2.66), sleep disturbance (2.63?±?2.57), and lack of appetite (2.26?±?2.38). After TACE, fatigue (4.88?±?2.31) was the most serious symptom, followed by sleep disturbance (4.80?±?2.25), distress (4.59?±?2.32), sadness (4.45?±?2.16), lack of appetite (4.25?±?2.51). Two symptom clusters were found before TACE: psychological symptom cluster and sickness symptom cluster. Two new symptom clusters were found after TACE: upper gastrointestinal symptom cluster and liver function impairment symptom cluster, with the two original symptom clusters remained relatively stable. The highest symptom interference items pre- and post-TACE were work and enjoyment of life, followed by mood. The symptoms of distress, sadness, fatigue, sleep disturbance, and lack of appetite were all significantly associated with the total interference (r?=?0.443–0.615, p?<?0.01 or p?<?0.05). Symptom clusters were significantly correlated with the total symptom interference before and after TACE (r?=?0.176–0.638, p?<?0.01 or p?<?0.05).

Conclusion

Psychological symptom cluster and sickness symptom cluster are common for HCC patients before and after TACE. Liver function impairment and upper gastrointestinal symptom clusters are directly related to TACE treatment. Both the symptoms and symptom clusters have significant interference on the daily life of HCC patients undergoing TACE. However, more work is needed to further clarify the symptom clusters associated with TACE and to test the effectiveness of TACE in easing symptoms and improving quality of life of HCC patients.     

胰腺局灶性病变的超声造影表现及与微血管密度的相关性

目的 探讨胰腺局灶性病变(FLPs)的增强超声(CEUS)造影模式及定量参数特征,分析定量参数与病灶微血管密度的相关性.方法 对26例疑有胰腺占位的患者进行CEUS检查.分析不同病理类型FLPs的造影表现,并定量分析病灶的始增时间、达峰时间及峰值强度,计算始增-峰值时间进行分析.对病灶组织切片进行免疫组化标记CD34,计数病灶组织的MVD,分析病灶MVD与TIC定量参数间的相关性.结果 在CEUS中,胰腺腺癌多呈低增强,胰腺内分泌肿瘤呈高增强,胰腺实性假乳头状瘤表现为周边环状等增强及内部不均匀增强.用低增强模式诊断胰腺腺癌的敏感性为85.71%,特异性为100%,阳性预测值100%,阴性预测值80.00%,准确性为90.91%.恶性组病灶与正常胰腺实质的平均始增-峰值时间比较差异有统计学意义(P<0.01).病灶的峰值强度与MVD呈显著正相关(r=0.75,P<0.01).结论 不同病理类型FLPs的CEUS增强表现不同,CEUS能评价病灶的血管生成情况,在病灶的分期及预后评估上有很好的应用前景.     

Reliability of Contrast-Enhanced Ultrasound for the Assessment of Muscle Perfusion in Health and Peripheral Arterial Disease

We investigated the reliability of contrast-enhanced ultrasound (CEUS) in assessing calf muscle microvascular perfusion in health and disease. Response to a post-occlusive reactive hyperaemia test was repeated on two occasions >48 h apart in healthy young (28 ± 7 y) and elderly controls (70 ± 5 y), and in peripheral arterial disease patients (PAD, 69 ± 7 y; n = 10, 9 and 8 respectively). Overall, within-individual reliability was poor (coefficient of variation [CV] range: 15–87%); the most reliable parameter was time to peak (TTP, 15–48% CV). Nevertheless, TTP was twice as long in elderly controls and PAD compared to young (19.3 ± 10.4 and 22.0 ± 8.6 vs. 8.9 ± 6.2 s respectively; p < 0.01), and area under the curve for contrast intensity post-occlusion (a reflection of blood volume) was ∼50% lower in elderly controls (p < 0.01 versus PAD and young). Thus, CEUS assessment of muscle perfusion during reactive hyperaemia demonstrated poor reliability, yet still distinguished differences between PAD patients, elderly and young controls.     

The association of presurgery psychological symptoms with postsurgery pain among cancer patients receiving implantable devices for pain management

Purpose

Psychological symptoms are a common part of the cancer pain experience, yet little is known about how these factors relate to implantable device outcomes in patients with cancer pain. The purpose of this study was to examine how psychological symptoms relate to implantable device outcomes in cancer pain management.

Methods

We retrospectively examined the medical records of 79 cancer patients, collecting information on psychological symptoms and pain, as assessed on the Edmonton Symptom Assessment System. Data were collected prior to and at three points following the implantation of either a spinal cord stimulator or an intrathecal pump.

Results

Pain was correlated with both anxiety, r?=?0.39 (n?=?74, p?<?0.01), and depression, r?=?0.38, (n?=?75, p?<?0.01), at the presurgery baseline. Results of linear mixed model (LMM) analysis indicated that neither baseline anxiety nor baseline depression main effects were significantly associated with pain at postimplant assessments, when adjusting for baseline pain, demographics, and clinical factors. However, the group-by-time interaction was significant for anxiety (beta?=?0.223, p value?=?0.037). The trajectory of pain scores over time differed by baseline anxiety scores, with pain scores increasing over time at a higher rate for those with a high baseline anxiety score, compared to those with low baseline anxiety scores.

Conclusion

Presurgery psychological symptoms should be considered, along with other medical, psychosocial, and individual characteristics in multidisciplinary treatment planning. Multidisciplinary care which includes aspects of mood management or supportive psychotherapy would likely be beneficial to cancer patients presenting with high psychological symptoms.