MRT1WI瘤体及瘤周影像组学联合临床特征预测乳腺癌新辅助化疗疗效

目的 观察MR T1WI瘤体和瘤周影像组学联合临床特征预测新辅助化疗(NAC)疗效的价值。方法 回顾性分析110例接受NAC的乳腺癌患者，其中43例NAC后病理完全缓解(pCR)、67例为非pCR(non-pCR);按7∶3比例将其分为训练集(n=76,30例pCR、46例non-pCR)和测试集(n=34,13例pCR、21例non-pCR)。以单因素及多因素logistic回归分析训练集临床及MRI表现，筛选NAC用于乳腺癌疗效的独立预测因子，并建立临床模型；于训练集NAC前MR T1WI所示瘤体及瘤周感兴趣体积(VOI)提取并筛选最佳影像组学特征，构建NAC治疗乳腺癌效果预测模型，包括模型_瘤体、模型_瘤周及模型_{瘤体+瘤周};联合瘤体及瘤周影像组学及临床相关独立预测因子建立联合模型。采用受试者工作特征(ROC)曲线评估模型诊断效能。结果 淋巴结转移(OR=0.17)、人表皮生长因子受体2(OR=4.52)及孕激素受体表达(OR=0.20)均为临床相关独立预测因子(P均<0.05)。于瘤体及瘤周VOI各选出4个最佳影...     

血清CA15-3在非病理性完全缓解新辅助化疗乳腺癌患者中的表达及临床意义

目的 探讨血清癌抗原15-3(CA15-3)在非病理性完全缓解(non-pCR)新辅助化疗(NAC)乳腺癌患者中的表达及临床意义.方法 选取2011年1月—2013年12月就诊的原发性浸润性乳腺癌123例作为研究对象,比较病理性完全缓解(pCR)和non-pCR NAC乳腺癌患者及CA15-3高表达和低表达non-pC...     

三阴性乳腺癌新辅助化疗病理完全缓解的影响因素

目的 分析影响三阴性乳腺癌(TNBC)新辅助化疗(NAC)后病理完全缓解(pCR)的临床与病理因素。方法 收集2018年1月至2023年9月于新疆医科大学第一附属医院行NAC及手术治疗的78例TNBC患者的临床与病理资料行回顾性分析,按其是否达到pCR分为pCR组(n=28)和non-pCR组(n=50),采用logistic回归分析影响pCR的临床与病理因素,并比较TP方案(紫杉类+铂类)与TAC方案(紫杉类+蒽环类+环磷酰胺)NAC后pCR率和不良反应发生率。结果 总体pCR率为35.9%,两组患者在瘤体直径、化疗周期、化疗方案、紫杉醇类型、人类表皮生长因子受体2 (HER-2)表达、Ki-67表达及雄激素受体(AR)阳性表达方面差异均具有统计学意义(P<0.05)。多因素分析显示,瘤体直径≤3 cm是pCR的独立有利因素(OR=4.191, 95%CI:1.246～14.094,P=0.021),AR阳性表达是pCR的独立不利因素(OR=0.124, 95%CI:0.020～0.784,P=0.027)。另外,TP方案的pCR率显著优于TAC方案[54.8%(17/31)v...     

剪切波弹性成像参数早期预测浸润性乳腺癌新辅助化疗病理反应的临床应用

目的 探讨剪切波弹性成像(SWE)参数早期预测浸润性乳腺癌新辅助化疗(NAC)病理反应的价值。方法 纳入96例接受全程NAC的浸润性乳腺癌患者,NAC前及NAC第2周期后均对患者进行常规超声和SWE检查,获得NAC第2周期末病灶最大直径变化率(ΔD)以及NAC第2个周期末弹性最大值变化率(ΔE_max)和NAC第2个周期末弹性平均值变化率(ΔE_mean)。所有患者均进行手术治疗并根据Miller&Payne病理反应分级将患者分为病理完全缓解(PCR)组(33例)和非PCR组(63例),并对上述2组临床病理资料和弹性定量参数进行比较。运用多因素Logistic回归分析获得对NAC病理反应有效的关键影响因素。绘制受试者工作特征(ROC)曲线分析和比较其预测能力。结果 多因素Logistic回归分析发现,人表皮生长因子受体2(HER2)和ΔE_max是乳腺癌患者NAC后是否达到PCR的独立预测因子(OR=6.25,P<0 05;OR=3.72,P<0 05)。HER2和ΔE_max联合模型的...     

超声联合Ki-67预测新辅助化疗后三阴性乳腺癌腋窝淋巴结病理完全缓解

目的 探讨超声联合Ki-67预测新辅助化疗(NAC)后三阴性乳腺癌腋窝淋巴结病理完全缓解的临床价值。方法 回顾性分析经新辅助化疗后行手术治疗的三阴性乳腺癌患者190例。所有患者在接受NAC前和NAC治疗2周期、4周期后行超声检查，依据术后腋窝淋巴结病理结果分为病理完全缓解(pCR)组和非pCR组。比较pCR组和非pCR组NAC前及NAC治疗2周期、4周期后超声及Ki-67参数的差异，行二元Logistic回归分析确定淋巴结pCR的独立预测因素，绘制受试者工作特征(ROC)曲线评估预测淋巴结pCR的诊断效能。结果 年龄，淋巴结短径，NAC治疗2周期、4周期后肿瘤长径变化率(ΔD2和ΔD4)及淋巴结短径变化率(ΔS2和ΔS4),N分期及Ki-67参数在pCR组与非pCR组间差异有统计学意义(P<0.05),将两组间P<0.20的参数纳入多因素二元Logistic回归分析，结果显示淋巴结短径、ΔS4、N分期及Ki-67是三阴性乳腺癌腋窝淋巴结pCR的独立预测因素(OR=0.918,P=0.018;OR=1.035,P=0.046;OR=0.392,P<0.001;OR=1....     

健侧乳腺MRI背景实质强化与新辅助化疗后肿瘤反应的相关性

目的 探讨乳腺癌新辅助化疗(NAC)后健侧乳腺MRI背景实质强化(BPE)与肿瘤反应的相关性.方法 回顾性分析129例乳腺癌患者健侧乳腺NAC前后BPE差异,比较病理完全缓解(pCR)组与非pCR组、绝经前组(70例)与绝经后组(59例)患者基线BPE差异及NAC后各组间BPE差异,分析影响疗效的相关因素及BPE水平与...     

超声联合免疫组织化学指标预测新辅助化疗后乳腺癌转移性腋窝淋巴结病理完全缓解

目的 观察超声联合免疫组织化学指标预测新辅助化疗(NACT)后乳腺癌转移性腋窝淋巴结病理完全缓解(pCR)的价值.方法 纳入155例接受NACT的乳腺癌伴腋窝淋巴结转移患者,根据腋窝淋巴结清扫(ALND)术后病理结果将其分为pCR组(n=59)及非pCR组(n=96);比较2组NACT前免疫组织化学指标及乳腺癌病灶及腋...     

CD133在乳腺癌新辅助化疗后的表达及其临床意义

目的探讨分化抗原簇蛋白133(CD133)表达与新辅助化疗(NAC)化学敏感性的关系。方法对51例原发性乳腺癌患者在NAC治疗前后分别采用免疫组化方法检测CD133表达,观察NAC治疗前后CD133的差异性。结果CD133与病理完全缓解率(pCR)存在明显相关性(P=0.023)。NAC治疗后临床完全缓解率及部分缓解率(cCR+cPR)达到82.4%(42/51),病理反应2级+3级达到54.9%,pCR 31.3%(16/51)。CD133表达与乳腺癌淋巴结转移有关(P=0.042);CD133(+)在pCR方面明显低于CD133(-)(P=0.035);病理1级者较2级或3级更易出现CD133(+)(P=0.002)。CD133(+)在NAC治疗后57.1%(20/41)高于NAC治疗前47.1%(24/51),NAC治疗前后均为CD133(-)与病理反应有效率(2级)呈正相关关系(P0.001)。同样,经NAC治疗后,8例CD133(+)转为CD133(-),其与病理有效率亦呈正相关关系(P=0.019)。结论 CD133可以作为一种有效标志物来预测NAC治疗乳腺癌的化学敏感性。     

剪切波弹性成像对乳腺癌新辅助化疗后残存癌的评估

目的:阐明剪切波弹性成像(SWE)对新辅助化疗(NAC)后残存乳腺癌的评估价值。方法:连续纳入进行NAC的乳腺癌患者66例,使用SWE评估NAC后病灶的平均和最大硬度。明确残余肿瘤负荷(RCB)量化的病理反应性与NAC后病灶硬度之间的关联,并以病理完全缓解(pCR)作为诊断金标准,明确SWE硬度指标对pCR的诊断效能。结果:平均及最大硬度与pCR密切相关。诊断试验证实最大硬度的总体诊断效能高于平均硬度(AUC=0.96 vs 0.83),且差异有显著统计学意义(P<0.01)。结论 :最大硬度评估乳腺癌NAC后残存癌的效能较好,SWE可为个体化乳腺癌治疗方案提供重要参考。     

磁共振功能成像在乳腺癌新辅助化疗早期疗效评价中的应用分析

目的:研究功能磁共振成像在乳腺癌新辅助化疗早期疗效评价中的临床应用效果分析。方法:提取本院2016年2月至2018年2月期间在我院进行新辅助化疗的乳腺癌患者50例,患者化疗后依据病理组织检查结果分为对照组(n=12)和观察组(n=38),比较两组患者NAC前和NAC后5个周期后磁共振功能成像下肿瘤直径、ADC值变化情况。结果:观察组NAC前后肿瘤最大直径由4.58±1.95cm缩短为(3.02±2.20)cm,差异具有统计学意义(p0.05),观察组NAC前后AD值由(0.92±0.27)x10~(-3) mm~2/s增加到1.02±0.31x10~(-3)mm~2/s差异存在统计学意义,(p0.05)。患者NAC前和NAC5个周期后AD值变化与肿瘤最大直径成正相关p0.05,对照组肿瘤最大直径在NAC5个周期后变化没有明显差距,差异无统计学意义p0.05。结论:磁共振功能成像在乳腺癌新辅助化疗早期疗效评价中的应用进行了疗效评估,具有非常高的安全性、和可靠性,值得临床推广借鉴。     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.