细针穿刺与对比增强超声对TI-RADS4类甲状腺结节诊断价值的比较

目的：评价超声引导下细针穿刺活检(ultrasound-guided fi ne needle aspiration biopsy,US-FNAB)和对比增强超 声(contrast-enhanced ultrasound,CEU)对甲状腺影像报告和数据系统(thyroid imaging reported and data system,TI- RA DS) 4类甲状腺结节的诊断价值。方法：回顾性分析已行手术治疗的甲状腺结节、其术前常规彩色B超检查结果为TI- RA DS 4类的患者134例,并收集US-FNAB,CEU和术后病理切片结果的资料。以手术后组织病理结果为金标准,对US-FNAB 标本行HE染色和细胞学检查。计算CEU和US-FNAB的灵敏度、特异度、准确率及费用。比较CEU与US-FNAB的诊 断价值。结果：134例甲状腺结节中,有恶性结节131例,良性结节3例。US-FNAB和CEU的灵敏度分别为87.02%和 93.89%,特异度分别为100.00%和66.67%,准确率分别为87.31%和93.28%。配对χ2检验显示：CEU和US-FNAB的灵敏度 差异无统计学意义(P>0.05);但在结节直径≤10 mm的患者中,US-FNAB和CEU的灵敏度分别为87.50%和100.00%,差 异有统计学意义(P<0.05);结节直径>10 mm的患者中,US-FNAB和CEU的灵敏度分别为92.73%和85.45%,差异无统计 学意义(P>0.05)。US-FNAB费用及风险均高于CEU。结论：对于直径>10 mm的甲状腺结节,US-FNAB检查的敏感度高 于CEU,而对于US-FNAB诊断为阴性、直径≤10 mm的甲状腺结节,仍可推荐检出率高、安全、经济的CEU检查。     

双腔气囊小肠镜对小肠炎症性疾病相关狭窄的治疗

目的：探讨双腔气囊小肠镜的内镜下球囊扩张(endoscopic balloon dilation,EBD)和狭窄切开(endoscopic stricturotomy with needle knife,NKSt)对于小肠炎症性疾病相关狭窄治疗的安全性及有效性。方法：收集2015年7月至 2018年9月在中南大学湘雅三医院行双腔气囊小肠镜狭窄治疗的患者14例,病变部位16处,内镜下干预16次(EBD 11次 和NKSt 5次)。术后定期随访,观察患者的临床症状缓解和复发情况,以及是否能替代外科手术。结果：14例患者均 成功行内镜治疗,操作成功率100%,未发生穿孔、大出血等严重并发症。EBD和NKSt患者分别在随访5.9~35.3(中位 数26.1)个月及1.6~17.8(中位数8.3)个月内梗阻症状得到有效缓解,其中2例患者随访期间出现再次梗阻,予以保守对 症处理后缓解,未行外科手术干预。结论：小肠镜下治疗(EBD和NKSt)对小肠炎症性疾病狭窄安全有效,可以推迟 外科手术时间。     

Mammographically Occult Asymptomatic Radial Scars/Complex Sclerosing Lesions at Ultrasonography-Guided Core Needle Biopsy: Follow-Up Can Be Recommended

An increasing number of radial scars are detected by ultrasound (US), but their management is controversial. This study investigated the upgrade rate in mammographically occult radial scars/complex sclerosing lesions without epithelial atypia at US-guided 14-gauge core needle biopsy in asymptomatic patients. Nineteen mammographically occult benign radial scars/complex sclerosing lesions (median size, 7 mm; range, 3–23 mm) were included. Patients underwent surgical excision (n = 10) or vacuum-assisted excision, with follow-up US at least 6 mo after benign vacuum-assisted excision results (n = 8), or underwent US follow-up for 2 y after core needle biopsy (n = 1). Any cases with change in diagnosis to high-risk lesions or malignancy at excision were considered upgrades. The upgrade rate was 0.0%. Based on US findings, 15.8% (3/19) were Breast Imaging Reporting and Data System (BI-RADS) category 3, 68.4% (13/19) were BI-RADS category 4a and 15.8% (3/19) were BI-RADS category 4b. Follow-up with US can be considered for mammographically occult benign radial scar/complex sclerosing lesions diagnosed by US core needle biopsy in asymptomatic patients.     

小针刀治疗屈指肌腱狭窄性腱鞘炎疗效的Meta分析

目的 :通过系统评价,比较小针刀疗法和封闭疗法治疗屈指肌腱狭窄性腱鞘炎的疗效以及安全性。方法 :检索中国知网(1962~2015年)、维普数据库(1993~2015年)、万方数据(2000~2015年)、pubmed中文数据库(1994~2015年),并且应用手工输入法检索相关医学期刊,纳入小针刀疗法与封闭疗法对比治疗屈指肌腱狭窄性腱鞘炎的随机对照试验,经2名评价者按要求对筛选后的资料进行交叉核对后,采用Rev Man 5.2软件进行Meta分析。结果:共纳入7个随机对照试验,包含患者1 174例,但没有筛选到高质量文献。Meta分析结果显示,小针刀组治疗屈指肌腱狭窄性腱鞘炎总有效率明显高于对照组,OR=9.07,95%CI[4.64,17.76],Z=6.44,P0.00001;小针刀组治疗屈指肌腱狭窄性腱鞘炎痊愈率明显高于对照组,OR=7.86,95%CI[5.75,10.74],Z=12.93,P0.00001。结论:小针刀治疗屈指肌腱狭窄性腱鞘炎疗效优于封闭疗法。由于纳入试验数目有限且文献质量较低,漏斗图表现出发表偏倚,需设计更严格的随机对照试验来进一步验证上述结论。     

Anabolic steroids in the UK: an increasing issue for public health

Aim: The aim of the paper was to identify changes in the extent and patterns of anabolic steroid use in the United Kingdom to better understand the public health implications within the context of the current health-related evidence base. Methods: Using the two time points between 1995 (prior to legislation changes in the United Kingdom) and 2015, a review of the evidence related to health harms was conducted, in conjunction with needle and syringe programme (NSP) data in Cheshire & Merseyside (UK) relating to anabolic steroid users. Findings: Dramatic increase in the number of anabolic steroid users accessing NSPs, 553 in 1995 to 2446 in 2015, now accounting for 54.9% of clients. With the inclusion of pharmacy NSPs, this rose to 5336 individual anabolic steroid users. Conclusions: Key changes in our knowledge during the 20 years, in particular, in relation to HIV prevalence, changes in the market and patterns of use make anabolic steroid use a public health concern. In the context of increasing numbers of injectors, there is a need for comprehensive interventions.     

输卵管结扎术抽芯近端包埋法与普氏改良法的效果观察

目的:探讨输卵管结扎术抽芯近端包埋法与普氏改良法的临床效果。方法:将我院行输卵管结扎术的育龄期妇女540例随机分为对照组270例和观察组270例,对照组行常规抽芯近端包埋输卵管结扎术,观察组行普氏改良输卵管结扎术,比较2组的临床效果。结果:观察组手术时间、并发症发生率明显少于对照组,差异有统计学意义(p<0.05),而术后妊娠和异位妊娠的发生率,观察组高于对照组,差异有统计学意义(p<0.05)。结论:输卵管结扎术是一种安全有效的节育手术,普氏改良法的术后妊娠及异位妊娠发生率需引起重视。     

碱性和中性多酶清洗剂清洗复用骨穿针效果比较

目的：比较碱性和中性多酶清洗剂清洗复用骨穿针的效果。方法：将2014年1-2月本院消毒供应中心回收的污染复用骨穿针按清洗日期分为实验组和对照组,每组150件。实验组用1：270的碱性多酶清洗剂清洗,对照组用1：270中性多酶清洗剂清洗,比较两组器械的清洗效果。结果：实验组和对照组的器械表面清洗合格率分别为98.67%、97.33%,比较差异无统计学意义（P〉0.05）,而实验组针腔内壁清洗合格率为96.00%、杰力试纸检测合格率为95.33%,分别高于对照组的90.00%、88.67%,差异均有统计学意义（P〈0.05）。结论：碱性多酶清洗剂清洗复用骨穿针的效果优于中性多酶清洗剂,值得推广使用。