MSCT MPR重建与Lung Care软件对周围型小肺癌边缘征象的诊断价值

目的探讨MSCT MPR重建与Lung Care软件结节分析对周围型小肺癌边缘征象的诊断价值并进行比较。方法对56例周围型小肺癌（其中腺癌23例,鳞癌16例,细支气管肺泡癌9例,转移癌8例）患者均行MSCT全肺容积扫描,再经MPR重建及进行Lung Care软件分析结节边缘征象。结果MSCT及Lung Care软件结节分析与MPR重建可对周围型肺癌边缘改变做出分析,二者比较在显示深分叶征、胸膜凹陷征、细短毛刺征、血管集束征方面无统计学意义（P〉0．05）,在显示胸膜侧肺部病变方面有统计学意义（P〈0．05）。结论MSCT MPR重建与Lung Care软件结节分析对周围性肺癌边缘征象显示有重要的价值,对于周围型小肺癌的早期定性诊断可提供更多的依据。     

周围型小肺癌的CT表现及病理基础

目的:探讨周围型小肺癌的CT表现,以提高CT诊断的准确性。材料与方法:搜集20例病理证实的周围型小肺癌完整CT资料,进行CT征象分析。结果:20例周围型小肺癌的主要CT表现:分叶征16例,毛刺征17例,胸膜凹陷征10例,血管聚集征4例,空泡征及空气支气管征7例,空洞1例,磨玻璃密度改变2例,肿瘤胸膜侧模糊小片影2例,13例增强扫描中,CT强化差值>20Hu。结论:当肺内出现边缘分叶、毛刺、胸膜凹陷等征象时,均高度提示肺癌可能,肿瘤胸膜侧模糊小片影、磨玻璃密度影对肺癌的诊断有价值。     

CT在周围型小肺癌诊断中的应用

目的; 探讨CT对周围型小肺癌诊断及其鉴别诊断的价值.方法:手术或穿刺病理证实的周围型小肺癌29例,行CT检查并行工作站后处理.对病灶内部结构、边缘形态、邻近组织改变及增强后CT征象进行分析.结果:圆形及类圆形结节25例、呈斑片状4例,有分叶征25例;毛刺征22例,血管集束征14例,支气管充气征6例,空泡征5例,空洞2例,钙化1例,胸膜凹陷征15例,邻近胸膜增厚1例.增强扫描24例中,强化CT值增幅在40 ～ 60 Hu 21例.结论:CT对周围型小肺癌诊断及其鉴别诊断具有很大价值.     

多层螺旋CT薄层扫描对早期周围小肺癌的诊断价值

目的：探讨多层螺旋CT薄层扫描及MPR重建对早期周围型小肺癌的征象显示率及诊断价值。方法：20例早期小肺癌均进行了多层螺旋CT常规扫描后对病变区域再次进行薄层扫描，16例进行了动态增强扫描。结果：薄层CT扫描对早期周围型小肺癌的征象显示率明显高于常规CT扫描，空泡征（6／3）、小结节堆积征（7／4）、支气管充气征（4／1）、分叶征（8／4）、毛刺征（15／8）、胸膜凹陷征（7／3）。结论：多层螺旋CT薄层扫描及MPR重建对早期周围型小肺癌的征象显示及诊断、鉴别诊断具有很高的临床应用价值。     

以孤立肺结节为表现的周围型肺癌28例CT诊断与鉴别分析

目的 探讨以孤立肺结节为表现的周围型肺癌的CT诊断与鉴别诊断.方法 周围性肺癌28例应用GEBrightspeed螺旋CT机平扫及增强扫描.结果 28例在CT片上均显示为肺内的孤立性小结节,均位于肺外周,19例浅或深分叶征、16例毛刺征;12例胸膜凹陷征;11例血管集中征;5例空气支气管征和空泡征.结论 CT影像学能够为肺孤立结节周围型肺癌诊断提供有价值的资料,需与腺瘤、结核球鉴别,暂时不能作出诊断者,定期复查或穿刺活捡进一步定性.     

早期肺癌动态进展的多层螺旋CT低剂量扫描诊断研究

目的：探讨早期肺癌动态进展的低剂量CT征象及特点。材料与方法：通过某企事业单位职工的肺部低剂量CT扫描普查,对发现的肺内结节进行追踪观察。对17例确诊早期肺癌不同时期的低剂量CT征象进行分析,寻找早期肺癌的生长规律和具有诊断价值的新征象。结果：17例中,初次扫描时典型的CT诊断征象显示率明显偏低。其中,分叶征6例,血管集束征7例,胸膜凹陷征4例,空泡征/细支气管充气征3例,毛刺征1例。在结节的生长过程中,结节周围模糊征12例。结论：“结节周围模糊征”是早期肺癌生长过程中的一个重要征象。     

周围型小肺癌52例胸部CT特点分析

目的:分析总结周围型小肺癌胸部CT影像学特点,提高周围型肺癌的影像诊断水平。方法:搜集52例经手术病理证实直径≤3 cm的周围型小肺癌的胸部CT影像学资料进行分析。全部病例术前均行螺旋CT扫描,其中行HRCT扫描20例,增强扫描32例。结果:胸部CT影像学特点为:分叶征45例,毛刺征40例,胸膜凹陷征29例,血管纠集征28例,空泡征17例,空气支气管征10例。在32例增强扫描病例中,30例CT值增幅均>35 Hu。结论:螺旋CT扫描与HRCT的结合或增强扫描,对周围型小肺癌的诊断与鉴别诊断具有重要意义。     

周围性小肺癌的X线、CT诊断

目的 探讨周围性小肺癌(SPLC)的X线、CT影像表现，提高对SPLC的正确诊断。方法 经X线、CT初步诊断及手术病理证实的周围性小肺癌58例，全部病例均摄胸部正侧片及CT片。结果 (1)X线、CT征象特点：分叶征、边缘毛刺征、空泡征、胸膜凹陷征、毛玻璃样征及蜂窝征。小空洞及血管集束征为SPLC基本征象。(2)X线、CT表现差异：肿块密度、分叶、毛刺、胸膜凹陷、纵隔淋巴结肿大的观察CT优于胸片。病灶形态、边缘的显示胸片优于CT。(3)CT对SPLC定性诊断的准确性高于X线胸片。结论 X线胸片、CT征象显示3种边缘征象以上的肺周围型肿块应高度提示SPLC。增强扫描对鉴别肿块的良恶性很有帮助。     

周围型肺癌CT诊断价值及其影像学特征探讨

目的：探讨周围型肺癌应用CT诊断的临床价值及其影像学特征。方法：选取泗阳县中医院2019年5月—2021年5月期间收治的175例疑似周围型肺癌患者作为研究对象,全部患者均接受CT检查,并以病理检查结果为金标准,分析CT检查的诊断灵敏度、特异度和准确率,同时分析周围型肺癌患者CT影像学特征。结果：全部175例疑似周围型肺癌患者经病理检查证实170例为周围型肺癌,CT共检出169例,诊断灵敏度、特异度和准确率分别为97.06(165/170)、80.00%(4/5)、96.57%(169/175)。CT影像学特征：在病灶形态方面,156例为孤立结节影,34例为不规则片状影。在病灶内部结构方面,54例为空泡征,48例为细支气管征,7例为空洞征,14例为钙化。在病灶边缘征方面,134例为分叶征,117例为细短毛刺征,65例为棘状突起征。在病灶周围征方面,107例为胸膜凹陷征,122例为血管集束征。在增强扫描特征方面,CT值增强区间为20～50 HU。结论：CT检查应用在周围型肺癌的临床诊断中价值明显,具有较高准确性。周围型肺癌CT检查的常见征象包括空泡征、分叶征、毛刺征、胸膜凹陷征、棘状突起征...     

周围型肺癌早期影像学诊断分析

目的:探讨周围型肺癌早期的CT表现特点。材料与方法:收集经病理证实的31例周围型肺癌患者的影像资料,分析其胸部正侧位片及CT片的影像学特征。结果:X线胸片上26例病灶密度较高、轮廓模糊,结节状或球形,5例呈肺炎样小片状稍高密度,CT图像上有23例显示分叶征;18例显示细短毛刺和锯齿征;26例有血管集束征;22例显示空泡征/细支气管充气征;20例显示胸膜凹陷征。CT动态增强扫描6例中有4例CT增强值在20 Hu～60 Hu之间,<20 Hu 1例,>60 Hu 1例。结论:X线胸片及CT对周围型肺癌的诊断及鉴别诊断具有重要的价值。     

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.