MRI诊断胎儿泌尿系统异常:Meta分析

目的 应用Meta分析探讨MRI作为超声补充检查诊断胎儿泌尿系统异常的价值。方法 检索1991年1月—2014年11月Pubmed、Elsevier-SDOL(Science Direct OnLine)、中国知网(CNKI)检索平台、万方数据库、维普期刊数据库及中国生物医学文献数据库中,对超声怀疑泌尿系统异常的胎儿行MRI检查并评估其诊断价值的相关文献。采用QUADAS-2评分标准评价文献质量,采用Metadisc1.4软件分析诊断的特异度、敏感度、阳性似然比及阴性似然比,并绘制汇总受试者工作特征(SROC)曲线,计算曲线下面积(AUC)。结果 共纳入9篇文献。对存在异质性的阳性似然比采用随机效应模型进行效应量合并。Meta分析显示,MRI诊断胎儿泌尿系统异常的汇总敏感度、汇总特异度、汇总阳性似然比、汇总阴性似然比及各自95%CI 分别为0.96(95%CI 0.93~0.98)、0.75(95%CI 0.57~0.88)、2.98(95%CI 1.05~8.45)、0.07(95%CI 0.04~0.13)。SROC曲线的AUC为0.96。结论 MRI作为超声补充检查诊断胎儿泌尿系统异常具有较高的价值。     

增强能谱乳腺摄影与MRI诊断乳腺癌效能比较:Meta分析

目的 采用Meta分析综合评价对比增强能谱乳腺摄影（CESM）与MRI对乳腺癌的诊断效能。方法 检索中国知网数据库、万方数据库、中国生物医学文献服务系统、Cochrane Library、Web of Science等国内外数据库中近10年发表的CESM与MRI比较诊断乳腺癌效能的文献,采用Review Manager 5.3软件根据诊断准确性实验质量评价工具-2（QUADAS-2）评价文献质量,以Meta Disc 1.4检验纳入文献的异质性,并根据结果选择对应效应模型,对两种方法诊断乳腺癌的敏感度、特异度、阳性似然比（PLR）、阴性似然比（NLR）和诊断比值比（DOR）进行汇总分析,绘制诊断性实验Deek''s漏斗图,对纳入文献的发表偏倚及其真实性进行评价。结果 共检索出相关中英文文献661篇,经过筛选纳入12篇文献。汇总结果显示,CESM和MRI诊断乳腺癌的敏感度均为0.97,特异度分别为0.69和0.51,DOR分别为105.44和33.73,PLR分别为2.94和1.95,NLR分别为0.05和0.07,AUC（95%CI）分别为0.964 5（0.955 8,0.981 5）和0.919 8 （0.892 7,0.946 8）,CESM的AUC大于MRI。Deek''s漏斗图表明纳入文献不存在明显发表偏倚（P>0.05）。结论 CESM能有效诊断乳腺癌,较MRI有一定优势。     

乳腺癌动态增强MRI表现与腋窝淋巴结转移的关系

目的 探讨乳腺癌动态增强MRI表现与腋窝淋巴结转移的关系。方法 对79例乳腺癌患者（腋窝淋巴结转移31例、无腋窝淋巴结转移48例）的临床及动态增强MRI资料进行回顾性分析,参照乳腺影像报告和数据系统（BI-RADS）标准系统描述病变MRI表现,分析MRI表现与腋窝淋巴结转移的关系。结果 MRI显示肿块样病变71例（71/79,89.87%）,病理诊断腋窝淋巴结转移27例。腋窝淋巴结转移与未转移乳腺癌病变位置差异有统计学意义（P<0.05）,病变类型差异无统计学意义（P>0.05）。腋窝淋巴结转移与未转移乳腺肿块样病变边缘特征、早期强化模式及肿块最大径差异均有统计学意义（P均<0.05）,病变形态、内部强化方式、延迟期时间-信号强度曲线类型差异均无统计学意义（P均>0.05）。结论 动态增强MRI显示的乳腺癌病灶位置及肿块大小、边缘特征、早期强化模式均与腋窝淋巴结转移有关。     

超声造影诊断乳腺癌不同分子分型腋窝淋巴结转移的价值

目的 探讨CEUS对乳腺癌不同分子分型腋窝淋巴结转移的诊断价值。 方法 对女性乳腺癌患者89例,术前于肿瘤周围皮下注射超声造影剂,探查前哨淋巴结并标记,与术后免疫组织化学分子分型结果进行对照。 结果 乳腺癌Luminal B型腋窝淋巴结转移率最高(69.57%),其次为HER-2型(55.00%)和三阴型(42.86%),Luminal A型转移率最低(28.00%)。CEUS判断腋窝淋巴结转移的敏感度为84.09%(37/44),特异度为86.67%(39/45)。 结论 CEUS对于诊断乳腺癌不同分子分型腋窝淋巴结转移具有一定价值。     

超微超顺磁性氧化铁增强MRI诊断腹盆部恶性肿瘤淋巴结转移:Meta分析

目的 采用Meta分析观察超微超顺磁性氧化铁（USPIO）增强MRI诊断腹盆部恶性肿瘤淋巴结转移的价值。方法 检索PubMed、Embase、Cochrane Library、万方、维普及CNKI数据库,按照纳入及排除标准筛选文献,并提取四格表数据。采用Meta Disc 1.4及STATA 11.0软件检验异质性并进行统计学分析,选择相应效应模型,合并其效应量（敏感度、特异度）,绘制综合受试者工作特征曲线并计算曲线下面积（AUC）。结果 共纳入20篇英文文献,1 211例患者,3 583个淋巴结。USPIO增强MRI诊断腹盆部恶性肿瘤淋巴结转移汇总敏感度、特异度分别为0.89、0.96,AUC为0.98。回归分析显示异质性可能来源于肿瘤部位;亚组分析显示USPIO增强MRI诊断腹腔肿瘤淋巴结转移敏感度更高。结论 USPIO增强MRI对腹盆部恶性肿瘤淋巴结转移有较高诊断效能。     

实时组织弹性成像对乳腺良、恶性肿块诊断价值的Meta分析

目的 采用Meta分析评价实时组织弹性成像(RTE)对乳腺良、恶性肿块的诊断价值。方法 检索1994—2010年国内外公开发表的有关RTE诊断乳腺肿瘤的中文、英文文献,按照诊断试验的纳入和排除标准筛选文献,提取纳入研究的特征信息,进行Meta分析。结果 共纳入12篇文献,RTE对乳腺良、恶性肿块诊断的敏感度为0.78~0.89,特异度为0.84~1.00。合并敏感度和特异度分别为0.82(95%CI 0.79~0.85)、0.95(95%CI 0.93~0.96);合并阳性和阴性似然比分别为14.16(95%CI 8.38~23.93)、0.20(95%CI 0.17~0.23);SROC曲线下面积为0.91±0.01。结论 RTE对乳腺良恶性肿块的鉴别诊断具有较高的临床诊断价值。     

超声造影对乳腺癌诊断价值的Meta分析

目的 采用Meta分析评价超声造影对乳腺癌的临床诊断价值。方法 检索Cochrane图书馆、PubMed和中国国家知识基础设施(CNKI)文献库中的文献,根据Cochrane协作网筛选与诊断试验方法组推荐的诊断试验纳入标准筛选文献,对文献进行质量评价,并提取纳入研究的特征信息。采用Stata 11.0统计软件检验异质性,根据双变量随机效应模型,获得敏感度和特异度均值及其95%可信区间,计算曲线下面积,最后进行敏感性和漏斗图分析。结果 共纳入13篇英文文献,研究对象共计745例。纳入研究存在异质性,汇总的敏感度和特异度均值及其95%可信区间为0.89(0.82~0.94)和0.79(0.69~0.87),SROC曲线下面积为0.92(0.89~0.94)。纳入文献稳定性较好,Deeks漏斗图分析提示未见明显发表偏倚(P＝0.67)。 结论 Meta分析提示,超声造影诊断乳腺癌具有较高的敏感度,但特异度中等,还需要高质量的前瞻性研究以更准确地评价其临床价值。     

超声造影鉴别诊断胆囊良恶性病变Meta分析

目的 应用Meta分析方法评价CEUS对胆囊病变的诊断价值.方法 对Cochrane library、Pubmed数据库、Sciencedirect数据库、CNKI以及万方数据库中有关CEUS诊断胆囊占位性病变的中、英文文献进行筛选和评价,提取纳入研究的特征信息,通过Meta-disc1.4软件对入选文献的研究数据进行分析. 结果 共纳入16篇文献,包括中文12篇,英文4篇.CEUS诊断胆囊良恶性病变的合并诊断敏感度和特异度分别为90.9%(95%CI:87.5%~93.7%)、95.4%(95%CI:94.0%~96.5%),合并阳性和阴性似然比分别为12.77(95%CI:8.46~19.27)、0.12(95%CI:0.09~0.18),综合受试者工作特征曲线下面积为0.9695,Q^*指数0.9191.结论 CEUS对胆囊病变具有较高的诊断价值,可广泛应用于临床.     

经颅超声对我国帕金森病患者的诊断价值:Meta分析

目的 采用Meta分析的方法,评价我国经颅超声（TCS）对帕金森病（PD）患者的诊断价值。方法 检索建库至2017年11月间PubMed、Cochrone图书馆、CNKI和中国生物医学文献数据库中有关TCS诊断国人PD的文献,以诊断性试验准确性评价工具（QUADAS）评价纳入文献的质量,并采用Meta-disc 1.4软件进行数据分析,计算我国TCS诊断PD患者的汇总敏感度、特异度、阳性似然比、阴性似然比和诊断比值比,并绘制汇总受试者工作特征（SROC）曲线。结果 共纳入15篇文献,中文12篇,英文3篇,我国TCS诊断PD的敏感度范围为0.62~0.93,特异度范围为0.50~0.94。纳入研究存在异质性,采用随机效应模型进行分析。我国TCS诊断的汇总敏感度、特异度、阳性似然比、阴性似然比和诊断比值比及其95% CI分别为0.78（0.76,0.81）、0.85（0.83,0.88）、5.46（4.01,7.44）、0.22（0.17,0.29）和27.15（16.96,43.46）,SROC曲线下面积为0.904 9,Q指数为0.836 5。结论 在我国,TCS诊断PD具有一定价值,可作为辅助检查手段。     

全身弥散加权成像对恶性肿瘤骨转移诊断试验的系统评价

目的 系统评价全身弥散加权成像(WB-DWI)对恶性肿瘤骨转移的诊断效能。方法 全面检索相关文献,按照制定的标准对文献进行筛选,并对纳入研究的文献进行相关数据提取、质量评价和系统评价。结果 5篇文献最终纳入研究;由于文献数、病例数、肿瘤类型、病灶数均较少,不适合进行Meta分析,因此仅做定性系统评价。WB-DWI对骨转移灶的诊断敏感度、特异度、准确率分别为86.67%~95.68%、60.00%~99.07%、82.14%~95.39%,平均值分别为91.43%、86.11%、91.47%。结论 WB-DWI对恶性肿瘤骨转移具有较高的诊断敏感度、特异度、准确率,具有广阔的应用价值和推广前景。     

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.