彩色多普勒超声在诊断致密型乳腺癌患者术后对侧乳腺癌中的价值

目的:探讨彩色多普勒超声检查在提高致密型乳腺癌患者术后对侧乳腺癌(contralateral breast cancer,CBC)检出率中的应用价值。方法:对我院乳腺癌患者行术后常规乳腺超声及钼靶检查,229名患者考虑对侧乳腺病变,根据腺体含量对其进行分型,并应用BI-RADS分级对病变进行评估。结果:超声诊断CBC的特异性、准确率与阳性预测值均明显好于钼靶检查,致密型乳腺钼靶CBC检出率明显下降,超声检查CBC检出率明显增高,BI-RADS 4A与4B分级中脂肪型及少量腺体型乳腺钼靶CBC的检出率明显高于超声检查,BI-RADS 4C与5分级中,乳腺分型对超声及钼靶筛查CBC的结果影响不大。结论:超声及钼靶的联合检查在CBC的检出中发挥重要作用,而乳腺分型与BI-RADS分类诊断对乳腺肿瘤的临床诊断效能和应用价值意义重大。     

剪切波弹性成像技术定量评估肿块周围组织硬度对乳腺良恶性肿瘤鉴别诊断的价值

目的:探讨剪切波弹性成像技术定量评估肿块周围组织硬度在乳腺良恶性肿瘤诊断中的应用价值。 方法:收集2019年7月至2022年6月,在我院经手术病理结果证实的乳腺肿瘤患者141例,共152 个肿块,良性肿块66个,恶性肿块86个,进行BI-RADS 分类并测量肿块及周围1 mm、2 mm、3 mm范围组织弹性模量值（Emax、Emean、Esd、Emin、SEmax1、SEmean1、SEsd1、SEmin1、SEmax2、SEmean2、SEsd2、SEmin2、SEmax3、SEmean3、SEsd3、SEmin3）,比较良恶性肿块及其周围组织这16组参数之间的差异。 以病理诊断为金标准,绘制受试者工作特征曲线(ROC),比较各参数的曲线下面积(AUC),获得诊断价值最大的参数。结果:乳腺良恶性肿块及其周围组织弹性模量值差异均具有统计学意义,Emax、Emean、Esd值恶性肿块高于良性,Emin恶性肿块低于良性;Emax、SEmax1、SEmax2、SEmax3,4组参数的AUC值均大于0.90,其中SEmax2的AUC值最大,为0.958,诊断截断值为>128.33 kPa,诊断的敏感性77.9%,特异性85.0%,准确率85.5%。 结论:乳腺良恶性肿块周围2 mm范围组织的SEmax2值诊断效能最高,诊断的敏感性、特异性、准确率均优于二维超声,有良好的临床应用价值。     

医疗过程中的质量控制

闸述了医院医疗过程中的质量管理，并提出了医院的信息管理系统质量监控新模式、新思路，在此基础上开发的相应管理系统。     

乳腺MR影像报告和数据系统(BI-RADS-MBI)的临床应用

近年来乳腺癌发病率呈逐年上升趋势,现已居妇女恶性肿瘤之首.乳腺X线、超声和MRI是乳腺检查的主要手段.     

The liver as A self-organizing system. I

Summary The liver is described as a composite system consisting of a set of operative creodic microunits open to a continuous flow of matter, energy and informations. Its dynamics depend on two interactive and interrelated subsystems with actions described ashomopoiesis andhomeorhesis, making it anautoisodiasostic system. The system’s emergent (equifinal) or emergence states, operative potential, diffusion and reaction phenomena and compensation states are also formally described. For readers not familiar with the language of general system theory, of system dynamics and of categorical analysis, a glossary of some terms is provided. This paper forms part of research on pre-cancer states of the liver system, financed by theAssociazione Italiana per la Ricerca sul Cancro (AIRC), Milan and by theOspedale Maggiore — Istituto Scientifico di Ricovero e Cura — Milan.     

BI-RADS系统在乳腺钼靶普查的应用价值

目的:探讨BI-RADS系统在乳腺钼靶普壹的应用价值.方法:对910饲参加乳腺普查的妇女采用BI-RADS报告系统,结合本院全数字化乳腺X线影像特征进行评估分级.结果:根据BI-RADS数据系统分类和统计.其中0级197例,Ⅰ级421例,Ⅱ级21C例,Ⅲ级57例,Ⅳ级23倒,ⅤV级2例,结论:BI-RADS报告系统对乳腺疾病的普查有重要意义.     

fMRI mapping of a morphed continuum of 3D shapes within inferior temporal cortex

Here, we mapped fMRI responses to incrementally changing shapes along a continuous 3D morph, ranging from a head ("face") to a house ("place"). The response to each shape was mapped independently by using single-stimulus imaging, and stimulus shapes were equated for lower-level visual cues. We measured activity in 2-mm samples across human inferior temporal cortex from the fusiform face area (FFA) (apparently selective for faces) to the parahippocampal place area (PPA) (apparently selective for places), testing for (i) incremental changes in the topography of FFA and PPA (predicted by the continuous-mapping model) or (ii) little or no response to the intermediate morphed shapes (predicted by the category model). Neither result occurred; instead, we found approximately linearly graded changes in the response amplitudes to graded-shape changes, without changes in topography-similar to visual responses in different lower-tier cortical areas.     

Visual assessment of intra ventricular flow from colour M-mode Doppler images

Left intra ventricular filling was studied by colour M-mode Doppler ultrasound to determine whether the flow pattern can be assessed visually, and explore its relation to left ventricular (LV) function. Patients with coronary artery disease (CAD) or dilated cardiomyopathy (DCM) were divided into three groups according to angiographically evaluated LV function. The groups were compared with a control group of 54 healthy volunteers. The mitral to apical delay of early diastolic flow was qualitatively assessed from printed colour M-mode images, twice by four independent observers blinded to the subject's status. The repeatability of the assessments as determined by the kappa statistic was good intra observer (k=0.75) and moderate inter observer (k=0.53). The CAD-group with angiographically normal LV function (n=25) had flow patterns resembling those observed in the control group. The group with ejection fraction (EF) <50% (n=19) had flow patterns clearly different from the control group. Patients with regional wall motion abnormality (RWMA) but EF >50% (n=16) exhibited flow patterns intermediate between the control and the low EF group. Among the 50 CAD patients there was a negative correlation between EF and the presence of delay of apical peak velocity (Spearman's r _s =–0.62, p < 0.0001). A visible delay of apical peak velocity had a sensitivity towards DCM of 83% and specificity of 75%. The sensitivity towards CAD with either RWMA or low EF was 55% and the specificity 75%. In conclusion, visual assessment of intra ventricular flow patterns was feasible and allowed discrimination between normal and diseased ventricles.Abbreviations CAD coronary artery disease - DCM dilated cardiomyopathy - EF ejection fraction - LV left ventricle/left ventricular - LVEDP left ventricular end diastolic pressure - RWMA regional wall motion abnormality Marie Stugaard and Torkel Steen were recipients of fellowships from the Norwegian Council on Cardiovascular Diseases during the study.