Value of Sonohysterography in Preoperative Assessment of Myometrial Invasion for Patients With Endometrial Cancer

Objective. The aims of this study were to compare the diagnostic performance of sonohysterography (SH) with that of magnetic resonance imaging (MRI) in estimation of myometrial invasion and to evaluate the influence of SH on peritoneal cytologic results for patients with endometrial cancer. Methods. Seventy‐four patients with endometrial cancer were included. Sonohysterography and MRI were performed before surgery. All patients had complete staging procedures, including peritoneal cytologic analyses. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined for SH and MRI. Results. The concordance rates of myometrial invasion for SH and MRI were 82.4% and 81.1%, respectively. The sensitivity, specificity, PPV, and NPV for identification of deep myometrial invasion were 64.7%, 87.7%, 61.1%, and 89.3% on SH and 70.6%, 84.2%, 57.1%, and 90.6% on MRI. Two patients (2.7%) were found to have positive results for malignant cells on peritoneal cytologic analyses. Conclusions. Sonohysterography appears to be a useful preoperative method for predicting myometrial invasion, comparable to MRI.     

Transvaginal ultrasonography with and without saline infusion in assessment of myometrial invasion of endometrial cancer.

OBJECTIVE: The purpose of this study was to determine the diagnostic accuracy of saline infusion ultrasonography (SIUS) compared with transvaginal ultrasonography (TVUS) in the assessment of myometrial invasion of endometrial cancer. METHODS: A total of 53 patients with endometrial cancer were examined preoperatively with TVUS and SIUS with respect to myometrial invasion. All patients were postmenopausal. Ultrasonographic findings were compared with histopathologic findings of the surgical specimens. RESULTS: The median age of the patients +/- SD was 64 +/- 7 years (range, 51-77 years). In all patients, the procedure was well tolerated. The median thickness of malignant endometria was 17 +/- 9 mm (range, 2-51 mm). The specimens consisted of 40 endometrioid adenocarcinomas, 2 serous papillary carcinomas, 5 clear cell adenocarcinomas, 2 adenosquamous carcinomas, 3 mixed types, and 1 undifferentiated carcinoma. There were 18 grade G1, 24 G2, and 11 G3 cases. On histopathologic examination, superficial myometrial invasion (50% of the myometrium) was present in 28 (52.8%). For superficial myometrial invasion, evaluation by TVUS was accurate in 19 (76.0%) of 25 cases, and evaluation by SIUS was accurate in 18 (72.0%) of 25. For deep myometrial invasion, evaluation by TVUS was accurate in 24 (85.7%) of 28 cases, and evaluation by SIUS was accurate in 27 (96.4%) of 28. CONCLUSIONS: Transvaginal ultrasonography is a reliable method for assessing myometrial invasion of endometrial cancer. Saline infusion ultrasonography showed slightly better accuracy in the assessment of myometrial invasion than TVUS, but the differences were not statistically significant.     

High frequency transvaginal ultrasonography in preoperative assessment of myometrial invasion in endometrial cancer.

The aim of the study was to assess the depth of myometrial invasion by endometrial cancer using preoperative 5-9 MHz, high frequency transvaginal ultrasonography as compared with postoperative assessment using histopathologic examination. The study included 120 patients with histologically proven cancers of the endometrium. All patients underwent transvaginal sonography before surgery. The depth of myometrial invasion was classified as none, inner half of uterine wall, and outer half of uterine wall. Of 106 (88.3%) patients with proven myometrial invasion, 98 cases (92.5%) were revealed by sonography. In 109 cases (90.8%) invasion was believed to be present on transvaginal sonography. Histologically proven invasion that correlated with sonography was shown in 88 patients (73.3%). In 32 patients (26.7%) ultrasonography could not correctly predict the depth of myometrial invasion. The depth of invasion was underestimated in 10 (8.3%) cases and overestimated in 22 (18.3%) cases. Preoperative assessment of invasion of the uterine wall by transvaginal ultrasonography had an accuracy of 73% if correlated with the definitive histopathologic examination. The role of high frequency transvaginal ultrasonography in preoperative assessment of the depth of myometrial invasion in patients with endometrial cancer is limited.     

CA125、脉管癌栓、肌层浸润预测子宫内膜癌前哨淋巴结转移

目的 探讨术前外周血中性粒细胞与淋巴细胞比值(NLR)及血小板与淋巴细胞比值(PLR)、CA125、脉管癌栓、肌层浸润等对子宫内膜癌患者行淋巴结清扫决策的临床价值。方法 收集2019年4月至2021年4月潍坊医学院附属医院收治的102例子宫内膜癌患者的临床病理资料,患者术前均行血常规、CA125、MRI检查,术前5 min均宫颈注射纳米炭2 ml,后行腹腔镜手术,均行前哨淋巴结(SLN)切除及系统淋巴结清扫。采用多因素Logistic回归分析筛选出高危因素行ROC曲线分析。结果 102例患者中,SLN阳性22例(21.6%),SLN阴性80例(78.4%)。多因素Logistic回归分析显示,CA125≥35u/ml(P=0.016,OR=4.873,95%CI=1.352～17.570)、脉管癌栓(P=0.004,OR=7.891,95%CI=1.956～31.832)、肌层浸润≥1/2(P=0.003,OR=13.714,95%CI=2.410～78.034)是SLN转移的独立影响因素。ROC曲线分析发现三因素联合预测SLN转移的AUC最高,为0.892。结论 用无创检查术前外周血...     

A comparative study of the risk of malignancy index and the ovarian crescent sign for the diagnosis of invasive ovarian cancer.

OBJECTIVE: To compare the value of the risk of malignancy index (RMI) and the ovarian crescent sign (OCS) in the diagnosis of ovarian malignancy. METHODS: This was a prospective observational study of women with ultrasonographic diagnosis of an ovarian cyst. The RMI was calculated in all cases using a previously published formula (RMI = U (ultrasound score) x M (menopausal status) x serum CA125 (kU/L)). A value > 200 was considered to be diagnostic of ovarian cancer. The OCS was defined as a rim of visible healthy ovarian tissue in the ipsilateral ovary. Its absence was taken as being diagnostic of invasive cancer. RESULTS: A total of 106 consecutive women were included in the study, of whom 92 (86.8%) had a benign ovarian tumor, five (4.7%) had borderline lesions and nine (8.5%) had an invasive ovarian cancer. The absence of an OCS diagnosed invasive ovarian cancer with a sensitivity of 100% (95% CI, 70-100%), specificity of 93% (95% CI, 86-96%), positive predictive value (PPV) of 56%, negative predictive value (NPV) of 100% and positive likelihood ratio (LR+) of 13.86 (95% CI, 6.79-28.29). This compared favorably with a sensitivity of 89% (95% CI, 57-98%), specificity of 92% (95% CI, 85-96%), PPV of 50%, NPV of 99% and LR+ of 10.78 (95% CI, 5.34-21.77), which were achieved using RMI > 200 (P < 0.01). CONCLUSIONS: The RMI and the OCS are useful tests for discriminating between invasive and non-invasive ovarian tumors. The application of these tests in a sequential manner might improve the overall accuracy of ovarian cancer diagnosis.     

Depth of myometrial invasion in endometrial cancer: preoperative assessment by transvaginal ultrasonography and magnetic resonance imaging.

Depth of myometrial invasion in endometrial cancer correlates with pelvic lymph node metastases and tumor recurrence. Thirty patients diagnosed as having FIGO stage I endometrial carcinoma on the basis of D&C were evaluated preoperatively by magnetic resonance imaging (MRI); 14 cases of the same group were also evaluated by transvaginal ultrasound. The degree of invasion evaluated by MRI and transvaginal sonography was compared to the pathological specimens. MRI was successful in evaluating myometrial invasion in 2.5 of 30 cases (accuracy 83%, sensitivity 87%, specificity 78%, positive predictive value 82%, negative predictive value 84%). Evaluation with transvaginal sonography was accurate in 11 of 14 cases (accuracy 78%, sensitivity 80% specificity 77%, positive predictive value 87%, negative predictive value 66%).     

Transvaginal sonography in the diagnosis of adenomyosis: which findings are most accurate?

OBJECTIVES: To evaluate the accuracy of various transvaginal sonographic findings in adenomyosis by comparing them with histopathological results and to determine the most valuable sonographic feature in the diagnosis of adenomyosis. METHODS: In this prospective study, 70 consecutive patients scheduled for hysterectomy underwent preoperative transvaginal sonography. If at least one of the following sonographic features was present, a diagnosis of adenomyosis was made: heterogeneous myometrial echotexture, globular-appearing uterus, asymmetrical thickness of the anteroposterior wall of the myometrium, subendometrial myometrial cysts, subendometrial echogenic linear striations or poor definition of the endometrial-myometrial junction. The sonographic features were compared with the histopathological results. RESULTS: The prevalence of adenomyosis was 37.1% (26/70 patients). The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and accuracy of transvaginal ultrasound for the diagnosis of adenomyosis were 80.8%, 61.4%, 55.3%, 84.4% and 68.6%, respectively. We found that a regularly enlarged uterus with a globular appearance, subendometrial echogenic linear striations and myometrial cysts had the highest accuracy for the diagnosis of adenomyosis. Of all findings evaluated, heterogeneous myometrium was the most common in patients with adenomyosis (21/26 patients), but it had a poor specificity. The presence of subendometrial linear striations was the most specific sonographic feature (95.5%) and it had the highest PPV (80.0%) for the diagnosis of adenomyosis. CONCLUSIONS: The presence of subendometrial echogenic linear striations, a globular configuration and myometrial cysts on transvaginal ultrasound supports the diagnosis of adenomyosis. Among the transvaginal ultrasound diagnostic findings of adenomyosis, subendometrial linear striations have the highest diagnostic accuracy.     

Vitamin K-dependent coagulation factor deficiency in trauma: a comparative analysis between international normalized ratio and thromboelastography

BACKGROUND: The use of international normalized ratio (INR) to diagnose vitamin K‐dependent coagulation factor (VitK‐CF) deficiency in trauma has limitations (inability to predict bleeding and long turnaround times). Thromboelastography (TEG) assesses the entire coagulation process. With TEG, reaction time (TEG‐R) is used to assess global coagulation factor activity and takes less than 10 minutes. We assessed the ability of TEG‐R to detect VitK‐CF deficiency in trauma, compared to the INR. STUDY DESIGN AND METHODS: A total of 219 trauma patients with INR, TEG, and all VitK‐CF measured at admission were included. Demographics and laboratory tests, drugs, blood transfusions, and severity scores were analyzed. Specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) of INR (≥1.3 and ≥1.5) and TEG‐R (>8 min) to diagnose VitK‐CF deficits (≤50%) were calculated. Secondary outcomes included time to INR and TEG results. RESULTS: Overall, TEG‐R performed worse than INR. TEG‐R had a sensitivity of 33% (95% CI, 16%‐55%), specificity of 95% (95% CI, 91%‐98%), PPV of 47% (95% CI, 23%‐72%), and NPV of 92% (95% CI, 87%‐95%). An INR of 1.5 or greater had a sensitivity of 67% (95% CI, 45%‐84%), specificity of 98% (95% CI, 96%‐99.7%), PPV of 84% (95% CI, 60%‐97%), and NPV of 96% (95% CI, 92%‐98%). An INR of 1.3 or greater also had better sensitivity, PPV, and NPV. For patients on warfarin, the times to INR results and TEG completion were 58 (±23) and 92 (±40) minutes (p = 0.07), respectively. TEG‐R was abnormal in only one patient on warfarin. CONCLUSION: Our study suggests that TEG‐R is not superior at identifying VitK‐CF deficiency compared to INR in trauma.     

Clinical application of three-dimensional transvaginal ultrasonography in the diagnosis of intrauterine adhesions

ObjectiveThe present study aimed to evaluate the diagnostic accuracy of three-dimensional transvaginal ultrasonography (3D-TVS) for intrauterine adhesions (IUA).MethodsWe performed a retrospective cohort study. A total of 500 women aged 19 to 46 years with uterine lesions who received treatment from the Department of Obstetrics and Gynecology were enrolled. Endometrial 3D imaging was conducted to obtain the display plane and 3D-TVS parameters. Patients also underwent hysteroscopy for a definitive diagnosis.ResultsFor diagnosing IUA, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy of 3D-TVS were 98.8%, 90.8%, 91.4%, 98.7%, and 94.8%, respectively. For diagnosing a submucosal myoma, the sensitivity, specificity, PPV, NPV, and overall accuracy of 3D-TVS were 88.2%, 97.9%, 88.2%, 97.9%, and 96.4%, respectively. For diagnosing endometrial polyps, the sensitivity, specificity, PPV, NPV, and overall accuracy of 3D-TVS were 94.7%, 96.8%, 92.9%, 97.7%, and 96.2%, respectively.ConclusionsBefore hysteroscopy, 3D-TVS, as a method of screening, has great value for comparing differences before and after treatment, and for evaluating therapeutic effects.     

Using color flow detection of air insufflation to improve accuracy in verifying nasogastric tube position

Objectives

Previous studies have shown that ultrasonography (USG), as an alternative to radiography, has a good accuracy in confirming nasogastric tube (NGT) position. Color flow detection of air insufflation is a novel approach in verifying NGT position. In our study, we aimed at evaluating its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy in confirming the NGT position, as compared with 2-dimensional (2D) USG.

Confirmation of Endotracheal Tube Placement after Intubation Using the Ultrasound Sliding Lung Sign

Objectives: To evaluate the performance of the ultrasound (US) sliding lung sign as a predictor of endotracheal tube (ETT) placement. Many other tools and examination findings have been used to confirm ETT placement; erroneous placement of the ETT has even been confirmed by US. Methods: This was a laboratory study using fresh, recently dead cadavers. Cadavers were obtained at a medical school anatomy laboratory on the basis of availability during a four‐month period. Subjects who died from significant trauma or after thoracic surgery were excluded. A numerical randomization tool was used to direct where the tube would be placed on intubation. Laryngoscopy was performed, and the ETT was placed in the esophagus, in the trachea, or in the right main stem (RMS) bronchus. Placement was confirmed by direct laryngoscopic visualization of ETT passage through vocal cords or with fiber optic visualization, as needed. US images of the sliding lung sign, sliding of visceral and parietal pleura past each other, were taken on both sides of the chest at the mid axillary line during ventilation with an ambu bag. Two board‐certified emergency physicians with hospital credentialing in emergency US used a 4‐2 MHz micro‐convex transducer on a Sonosite 180 Plus for imaging. The sonologists were blinded to the location of the endotracheal tube and imaged and recorded their results individually. A positive sliding lung sign was taken to signify lung expansion with ventilation in a hemithorax. Endotracheal versus esophageal ETT placement, as well as tracheal versus RMS, was determined on the basis of sliding lung findings on both sides of the chest. Interpreter agreement, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios (LHR) were calculated for tracheal (including RMS) versus esophageal, as well as main trachea versus RMS intubation. Results: Nine cadavers yielded 68 intubations. For esophageal versus tracheal (including RMS) intubation, sonologist 1 (S1) had a sensitivity of 95.4% (95% CI = 84.2% to 99.4%), a specificity of 100% (95% CI = 86.3% to 100%), an NPV of 92.6% (95% CI = 75.7% to 99.1%), and a PPV of 100% (95% CI = 91.4% to 100%) with an LHR of 0.05 (95% CI = 0.01 to 0.2) for a negative test. Sonologist 2 (S2) had a sensitivity of 100% (95% CI = 91.8% to 100%), a specificity of 100% (95% CI = 86.3% to 100%), an NPV of 100% (95% CI = 86.3% to 100%), and a PPV of 100% (95% CI = 91.8% to 100%); agreement was 97% (κ= 0.94; 95% CI = 0.7 to 1.2). In RMS versus tracheal, S1 had a sensitivity of 69.2% (95% CI = 48.2% to 85.7%), a specificity of 93.3% (95% CI = 68.1% to 99.8%), a PPV of 94.7% (95% CI = 73.9% to 99.9%), and an NPV of 63.6% (95% CI = 40.7% to 82.8%) with an LHR for a positive test of 10.4 (95% CI = 2.2 to 59.1) and of 0.4 (95% CI = 0.2 to 0.6) for negative test. S2 had a sensitivity of 78.6% (95% CI = 59.1% to 91.7%), a specificity of 100% (95% CI = 78.2% to 100%), a PPV of 100% (95% CI = 84.6% to 100%), NPV of 71.4% (95% CI = 47.8% to 88.7%), with an LHR for a negative test of 0.2 (95% CI = 0.1 to 0.4); agreement was 85.9% (κ= 0.6; 95% CI = 0.4 to 0.9). Conclusions: These results show that US imaging of the sliding lung sign in a cadaver model is an accurate method for confirmation of ETT placement. Further, the technique may have some utility in differentiating RMS bronchus from main tracheal intubations.     

子宫内膜癌经阴道超声表现与肌层浸润深度的相关性研究

目的探讨子宫内膜癌经阴道超声表现与病理诊断肌层浸润深度的相关性。方法46例子宫内膜癌术前均经阴道超声观测子宫三径之和、宫内膜厚度、彩色血流分布特点及血流阻力指数。根据病理检查肌层浸润深度分为Ⅰa期9例,Ib期22例,IC期15例。结果子宫三径之和为12．9～27．4cm,宫内膜厚度为4．7～65．0mm,在Ⅰa期、Ⅰb期、Ⅰc期的子宫三径之和、宫内膜厚度逐渐增大,差异有统计学意义（P〈0．05）。37例探及血流信号,血流显示率80．4％;Ⅰa、Ⅰb期、Ⅰc期血流显示率逐渐增大,差异有统计学意义（P〈0．05）。肌层浸润越深,阻力指数越低,各期比较无统计学差异（P〉0．05）。结论子宫内膜癌经阴道超声表现与病理诊断肌层浸润深度相关,经阴道超声检查可作为子宫内膜癌的术前检查方法。     

体素内不相干运动扩散加权成像术前评估子宫内膜癌分级、肌层侵犯的价值

目的探讨体素内不相干运动(intravoxel incoherent motion,IVIM)扩散加权成像在子宫内膜癌病理分级及肌层侵犯中的价值。材料与方法搜集行IVIM检查并经手术病理证实的子宫内膜癌患者43例。测量肿瘤表观扩散系数(apparent diffusion coefficient,ADC)值、慢扩散系数D值、快速扩散系数D*值及灌注分数f值。对计量资料进行正态性检验,采用Spearman相关性分析检验各参数值与子宫内膜癌病理分级之间的相关性,不同病理分级(G1级、G2级、G3级)之间各参数值的比较采用单因素ANOVA检验(正态分布)或Kruskal-Wallis H检验(非正态分布),深浅肌层侵犯之间的比较采用两个独立样本t检验(正态分布)或Mann-Whitney U检验(非正态分布),对于不同病理级别、不同肌层浸润深度组间差异具有统计学意义的参数,应用受试者工作特征(receiver operating characteristic,ROC)曲线分析其鉴别G3级子宫内膜癌、子宫内膜癌深肌层侵犯的诊断效能,计算诊断的最佳截值。结果 ADC值、D值及f值与病理分级均呈负相关(r=-0.604、-0.448及-0.428,P=0.000、0.002及0.004)。ADC值在G1与G3、G2与G3之间差异有统计学意义(P=0.000、0.009),D值、f值仅在G1与G3之间差异有统计学意义(P=0.01),其中ADC值鉴别G3级子宫内膜癌的诊断效能最高(ROC曲线下面积为0.825,95%可信区间:0.679~0.924;P=0.0001),以ADC值0.796×10~(-3) mm~2/s作为阈值,诊断子宫内膜癌G3级的敏感度、特异度及准确性分别为71.43%、89.66%及83.72%。各参数值在子宫内膜癌深浅肌层侵犯之间的差异均具有统计学意义(P0.05),其中D值鉴别深浅肌层侵犯的诊断效能最高(ROC曲线下面积为0.879,95%可信区间:0.744~0.959;P=0.0001),以D值0.631×10~(-3) mm~2/s作为阈值,诊断深肌层浸润的敏感度、特异度及准确性100%、76.67%、83.72%。结论 IVIM扩散加权成像能定量反映组织扩散及灌注情况,对术前评价子宫内膜癌病理分级和肌层侵犯程度有一定的补充作用。     

子宫内膜癌患者血清CA125 水平与外周血RDW 检测在临床病理分期中的应用价值

目的 探讨子宫内膜癌患者血清糖类抗原125(CA125)水平与外周血红细胞分布宽度(RDW)检测在临床病理分期中的应用价值。方法 以柳州市中医医院东院2019年1～7月收集的81例子宫内膜癌患者的临床资料作为观察组,并抽取40例健康体检人员作为对照组,采用分组t检验比较丙氨酸氨基转移酶(ALT)、总蛋白(TP)、肌酐、尿素(UREA)和CA125在观察组与对照组之间的差异; 另外子宫内膜癌患者被分为Ⅰ～Ⅱ组和Ⅲ～Ⅳ组,比较RDW与CA125在两组之间的差异; 通过受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)分析评价RDW与CA125联合诊断子宫内膜癌的价值。结果 RDW与CA125在观察组与对照组之间存在明显差异(P<0.05),RDW在Ⅰ～Ⅱ组和Ⅲ～Ⅳ组之间存在明显差异(t=-4.85,P<0.05),而CA125在Ⅰ～Ⅱ组和Ⅲ～Ⅳ组之间差异无统计学意义(t=-0.90,P= 0.370)。CA125, RDW诊断子宫内膜癌的ROC曲线下面积(AUC)分别为0.821(95%置信区间为0.749～0.894)和0.819(95%置信区间为0.746～0.892),而两者联合诊断子宫内膜癌的AUC为0.914(95%置信区间为0.866～0.962)。结论 检测子宫内膜癌患者外周血RDW对其临床病理分期有重要的应用价值。     

Transtracheal ultrasonographic confirmation of endotracheal intubation using I-gel and an endotracheal tube introducer

BackgroundThis study aimed to investigate the efficacy of transtracheal ultrasonography in confirming the placement of an endotracheal tube introducer during endotracheal intubation using the I-gel supraglottic airway as a guide.MethodsIn this prospective study, endotracheal intubation using an endotracheal tube introducer through the I-gel was performed in patients with return of spontaneous circulation after I-gel insertion for out-of-hospital cardiac arrest. The introducer placement was assessed by the occurrence of hyperechoic artifacts within the trachea or esophagus in transtracheal ultrasonography. Results of ultrasonography were confirmed by waveform capnography in the case of tracheal artifacts and direct visualization by laryngoscopy in the case of esophageal artifacts.ResultsOne hundred and six patients were enrolled in this study. In transtracheal ultrasonography, artifacts of introducer in the trachea and esophagus were observed in 80 (75.5%) and 26 (24.5%) patients, respectively. Transtracheal ultrasonography in identifying the placement of introducers revealed a sensitivity of 100% (95% CI 95.4 to 100), specificity of 96.3% (95% CI 81.0 to 99.9), a PPV of 98.7% (95% CI 92.0 to 99.8), and a NPV of 100% (95% CI 94.8 to 99.9).ConclusionTranstracheal ultrasonography is an accurate method for identifying introducer placement during endotracheal intubation using an endotracheal tube introducer through the I-gel.     

Performance of HEART and TIMI scores in predicting major adverse cardiovascular events (MACEs) of chest pain patients in the emergency department: A prospective observational study

Objective: To compare the value of HEART and TIMI scores in predicting major adverse cardiovascular events (MACEs) of patients with chest pain in the emergency department at a tertiary care hospital in Ahmedabad, a city in western India. Methods: A prospective study was conducted on chest pain patients from January to December 2019. All adult patients with non-traumatic chest pain presenting to the emergency department were included, and their HEART and TIMI scores were evaluated. The patients were followed up within 4 weeks for monitoring any major adverse cardiac events or death. The receiver-operating characteristics (ROC) curve was used to determine the value of HEART and TIMI scores in predicting MACEs. Besides, the specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) of the two scores were assessed and compared. Results: A total of 350 patients were evaluated [mean age (55.03±16.6) years, 56.6％ of males]. HEART score had the highest predictive value of MACEs with an area under the curve (AUC) of 0.98, followed by the TIMI score with an AUC of 0.92. HEART score had the highest specificity of 98.0％ (95％ CI: 96.4％-99.6％), the sensitivity of 75.0％ (95％ CI: 70.7％-79.3％), and PPV of 97.0％ (95％ CI: 94.1％-99.9％) and NPV of 82.5％ (95％ CI: 74.6％-90.4％) for low-risk patients. TIMI score had a specificity of 95.0％ (95％ CI: 92.4％-97.6％), sensitivity of 75.0％ (95％ CI: 69.4％-80.6％), PPV of 92.3％ (95％ CI: 88.1％-96.5％) and NPV of 82.3％ (95％ CI: 73.8％-90.8％) for low-risk patients. Conclusions: HEART score is an easier and more practical triage instrument to identify chest pain patients with low-risk for MACEs compared to TIMI score. Patients with high HEART scores have a higher risk of MACEs and require early therapeutic intervention and aggressive management.     

血清CA125水平及Survivin蛋白在子宫内膜癌中的表达及临床意义

目的研究血清CA125水平及Survivin蛋白在子宫内膜癌中的表达及临床意义。方法正常子宫内膜组（40例）、子宫内膜不典型增生组（40例）及子宫内膜癌组（40例）。比较各组手术前后及子宫内膜癌组不同临床、病理分期中血清CA125水平变化及Survivin蛋白的表达情况。结果子宫内膜癌组血清CAl25水平在手术前后均明显高于其余两组,差异均有统计学意义（P〈0．05）。子宫内膜不典型增生组及子宫内膜癌组的Survivin阳性表达率及强阳性表达率与正常子宫内膜组,差异有统计学意义（P〈0．05）。血清CA125在子宫内膜癌Ⅱ-Ⅳ期、病理级别高、深肌层浸润及复发组中的阳性表达率明显升高。Survivin蛋白的强阳性表达率在Ⅱ·Ⅳ期、G3、深肌层浸润及复发病例中明显升高。结论血清CA125水平对子宫内膜癌的手术病理分期有一定的指导意义。Survivin蛋白对子宫内膜癌的早期诊断及临床预后有一定的参考价值。     

The accuracy of bedside USG in the diagnosis of nasal fractures

A comparison of the sensitivity and specificity of bedside ultrasonography with conventional radiography for the evaluation of nasal fractures.

Clinical Value of the Total White Blood Cell Count and Temperature in the Evaluation of Patients with Suspected Appendicitis

OBJECTIVES: The total white blood cell (WBC) count and temperature are often expected to be elevated in patients with appendicitis. Clinicians often use the results of these parameters in making a judgment about the presence or absence of disease. The objective of this study was to assess the discriminatory value of the total WBC count and presenting body temperature in patients presenting to the emergency department (ED) with signs and symptoms suggestive of appendicitis. METHODS: This was a prospective consecutive case series in a university ED with an annual census of 38,000. All patients presenting to the ED in whom the diagnosis of appendicitis was the attending physician's primary consideration were enrolled. Measures included age, gender, symptoms, physical findings, patient temperature as taken in the ED, initial total WBC count, and discharge diagnosis. Admitted patients were followed up until surgical or clinical outcomes, and discharged patients were followed up by telephone two weeks after the initial visit. All statistical analysis was performed using StatsDirect version 1.9.8. RESULTS: A total of 293 patients were enrolled over a two-year study period. The total WBC count was measured in 274 cases, and the temperature was measured in 293 cases. There were 130 male patients and 163 female patients. The mean age of the patients was 30.8 years (range, 7-75 years). Appendicitis was confirmed in 92 patients. In this study group of patients, a total WBC count >10,000 cells/mm(3) had a sensitivity of 76% (95% confidence interval [95% CI] = 65% to 84%) and a specificity of 52% (95% CI = 45% to 60%). The positive predictive value (PPV) was 42% (95% CI = 35% to 51%), and the negative predictive value (NPV) was 82% (95% CI = 74% to 89%). The positive likelihood ratio (LR) was 1.59 (95% CI = 1.31 to 1.93), and the negative LR was 0.46 (95% CI = 0.31 to 0.67). A temperature >99.0 degrees F had a sensitivity of 47% (95% CI = 36% to 57%) and a specificity of 64% (95% CI = 57% to 71%). The PPV was 37% (95% CI = 29% to 46%), and the NPV was 72% (95% CI = 65% to 79%). The positive LR was 1.3 (95% CI = 0.97 to 1.72), and the negative LR was 0.82 (95% CI = 0.65 to 1.01). The areas under the curve for the receiver-operating characteristic (ROC) curve were 0.72 (95% CI = 0.65 to 0.79) and 0.59 (95% CI = 0.52 to 0.66) for an elevated total WBC count and an elevated temperature, respectively. CONCLUSIONS: An elevated total WBC count >10,000 cells/mm(3), while statistically associated with the presence of appendicitis, had very poor sensitivity and specificity and almost no clinical utility. There was minimal statistical association between a temperature of >99 degrees F and the presence of appendicitis. The ROC curve suggests there is no value of total WBC count or temperature that has sufficient sensitivity and specificity to be of clinical value in the diagnosis of appendicitis. Clinicians should be wary of reliance on either elevated temperature or total WBC count as an indicator of the presence of appendicitis.     

S100A8/A9: A Potential New Diagnostic Aid for Acute Appendicitis

Objectives: Diagnosing acute appendicitis is a daunting clinical challenge, as there is no single test that reliably distinguishes acute appendicitis from other etiologies of acute abdominal pain. In this study, the authors examined whether circulating levels of S100A8/A9 could be useful as a marker to aid in the diagnosis of acute appendicitis. Methods: Plasma samples from emergency department (ED) patients with acute abdominal pain (n = 181) were tested using an immunoassay for S100A8/A9. Results: The sensitivity and specificity for S100A8/A9 in diagnosing acute appendicitis were estimated to be 93% (95% confidence interval [CI] = 81% to 97%) and 54% (95% CI = 45% to 62%), respectively. Negative predictive value (NPV) was 96% (95% CI = 89% to 99%), and positive predictive value (PPV) was 37% (95% CI = 28% to 47%). Performance characteristics of elevated white blood cell (WBC) count were also estimated: sensitivity 63% (95% CI = 47% to 76%), specificity 67% (95% CI = 59% to 75%), NPV 86% (95% CI = 78% to 91%), and PPV 36% (95% CI = 26% to 47%). Conclusions: This is the first report exploring the relationship between circulating S100A8/A9 and acute appendicitis and establishes proof of concept for this biomarker as a diagnostic test for acute appendicitis. Further studies are indicated to optimize the use of this biomarker, in conjunction with other established approaches. ACADEMIC EMERGENCY MEDICINE 2010; 17:333–336 © 2010 by the Society for Academic Emergency Medicine