Usefulness of contrast enhanced FLAIR imaging for predicting the severity of meningitis

The aim of this study was to evaluate whether contrast enhanced fluid attenuated inversion recovery (CE-FLAIR) imaging can be used to predict the severity of meningitis based on leptomeningeal enhancement (LE) score and cerebrospinal fluid signal intensity (CSF-SI) on CE-FLAIR. We retrospectively analyzed data collected from 43 consecutive patients admitted to our hospital due to meningitis. Clinical factors including initial Glasgow Coma Scale (GCS) score, CSF glucose ratio, log CSF protein, log CSF WBC, and prognosis were evaluated. The LE score was semi-quantitatively scored, and we evaluated CSF-SI ratio at the interpeduncular or quadrigerminal cisterns on CE-FLAIR. We evaluated the differences in clinical variables, LE scores and CSF-SI ratios between the recovery and the complication group. We assessed the correlation between clinical variables, LE scores and CSF-SI ratios. The values of log CSF protein, CSF-SI ratio, and LE score were significantly higher in the complication group (p value <0.05). GCS score and CSF glucose ratio were significantly lower in the complication group (p value <0.01). The LE scores had significant negative correlation with GCS scores and CSF glucose ratios (p value <0.001). The LE score was significantly positively correlated with the value of log CSF protein and CSF-SI ratio (p value <0.01). The CSF-SI ratio was negatively correlated with GCS score and CSF glucose ratio (p value <0.01). The CSF-SI ratio was positively correlated with the value of log CSF protein (p value <0.05). Our results suggest that LE score and CSF-SI ratio are well correlated with clinical prognostic factors. We may predict the clinical severity of meningitis by using LE scores and CSF-SI ration on CE-FLAIR imaging.     

多普勒超声测定左心室Max（dp／dt）的新方法

心室内压力变化率峰值Ｍａｘ（ｄｐ／ｄｔ）是一项评价心肌收缩功能的重要指标。但其测定常需借助于心导管术，临床应用受到限制。依据流体力学基本定律，本文提出：等容收缩期内表现为压力的势能将在射血期部分地转化为以１／２ｐＶ２为形式的动能，因而势能的最大变化率Ｍａｘ（ｄｐ／ｄｔ）将在动能的最大变化率Ｍａｘ（ｄｋ／ｄｔ）上得到反映。应用特制计算机软件将主动脉血流速度曲线转化为４Ｖ２曲线，该曲线的一级导数峰值即为Ｍａｘ（ｄｋ／ｄｔ）。应用脉冲多普勒超声测定２３例先天性心脏病患儿的主动脉血流频谱参数并与心导管测定的左心室Ｍａｘ（ｄｐ／ｄｔ）进行对比分析。结果显示：主动脉血流频谱参数Ｍａｘ（ｄｋ／ｄｔ）与左心室Ｍａｘ（ｄｐ／ｄｔ）呈良好相关（ｒ＝０．８１７，Ｐ＜０．００１），直线回归方程为：Ｍａｘ（ｄｐ／ｄｔ）＝０．４７Ｍａｘ（ｄｋ／ｄｔ）＋６７．９（Ｋｐａ／ｓ），平均加速度ｍＡ及Ｖｐ２／ＡＴ与Ｍａｘ（ｄｐ／ｄｔ）亦有较好的相关性。表明由多普勒超声获得的主动脉血流频谱参数Ｍａｘ（ｄｋ／ｄｔ）能较准确地估侧左室Ｍａｘ（ｄｐ／ｄｔ），因而可作为评价心脏收缩功能的可靠指标     

Efficacy and Safety of Accelerated Partial Breast Irradiation after Breast‐conserving Surgery: A Meta‐analysis of Published Comparative Studies

To compare the treatment outcomes between accelerated partial breast irradiation (APBI) and conventional whole‐breast irradiation (WBI) and to explore the efficacy and safety of APBI as an adjuvant treatment for early‐stage breast cancer who received breast‐conserving therapy. Eligible studies were identified on Medline, Embase, and the Cochrane Library updated to July 10, 2012. Comparative studies were considered for inclusion. Analyses were carried out using Stata software. Eleven comparative studies with a total of 7,097 patients were included. The meta‐analysis showed that there were no statistically significant differences between group APBI and group WBI associated with the supraclavicular failure, distant metastasis, overall survival, and disease‐free survival, while local recurrence (LR) and axillary failure (AF) increased in group APBI. The sensitivity analysis indicated that both the LR and AF were not statistically significant difference between the two groups. In the subgroup analysis, LR was statistically significantly higher in group APBI for patients with the age <60, large tumor size, and unknown margin status. APBI is a safe treatment modality and could become a potential option for the delivery of adjuvant radiation therapy in patients receiving breast‐conserving therapy, especially for the suitable group that was classified by the American Society of Radiation Oncology Consensus Panel.     

全陶瓷关节在全髋关节置换中的应用

近年来,随着陶瓷材料制作工艺的快速发展,提高陶瓷材料的磨损性,生物相容性,无金属离子释放,低摩擦系数和良好的浸润性等特性,使得陶瓷材料取得了令人瞩目的成就,陶瓷-陶瓷假体也被认为是年轻患者最佳选择之一。     

食管胃结合部腺癌的微创外科治疗

食管胃结合部腺癌具有相对独立的临床病理特征和治疗策略。随着微创外科的快速发展,部分早期食管胃结合部腺癌可通过腹腔镜或内镜手术获得治愈性切除。食管胃结合部腺癌的微创外科治疗应遵循恶性肿瘤根治手术的基本原则,重视术前分期评估的准确性,严格把握适应证,合理选择微创外科治疗方式。未来,应加强微创外科治疗的技术培训,进一步规范食管胃结合部腺癌微创外科治疗技术,并开展多中心、前瞻性、随机对照临床研究,明确食管冒结合部腺痛微创外科治疗的安伞件和疗效。     

胎羊单侧输尿管梗阻后肾脏病理相关研究

【摘要】〓目的〓探讨胎儿期发生单侧输尿管梗阻后,梗阻侧肾脏的病理变化过程。方法〓对孕75~85天的胎羊实行手术造成其单侧输尿管不完全性梗阻,在术后不同时期,取双侧肾脏(对侧肾脏作为对照),进行大体标本、组织学和分子学(PAX2和VEGF的表达)的检测。结果〓梗阻侧肾脏,表现为皮质变薄,皮质囊性改变、间质纤维化、肾小球数目减少;PAX2表达显著升高,而VEGF表达明显减少。结论〓在胎羊模型中,输尿管发生梗阻后,梗阻侧肾脏随之而来发生明显的病理变化。