数字化乳腺X线引导下切除活检及导丝定位钙化患者的影像学病理及相关表现

目的:分析数字化乳腺X线引导下切除活检及导丝定位钙化患者的X线征象。方法:回顾性分析2015年12月至2017年12月间收治102例数字化乳腺X线引导下切除活检及导丝定位钙化患者进行实验研究,观察X影像中分布征象及微钙化形态,比较X征象与乳腺癌A、B、C不同数据系统(BI-RADS)分型之间的差异。结果:102例乳腺癌患者中,良性病变患者80例(78.43%),恶性病变患者22例(21.56%)。不同类型病变的钙化类型与BI-RADS分型差异明显(P <0.05);恶性病变在BI-RADS4C中占比最大(9/12,75.00%),良性病变在BI-RADS4A中占比最大(24/27,88.88%),良性病变在BI-RADS类患者构成比差异明显(P<0.05)。结论:乳腺疾病可通过数字化乳腺X线引导下活检术诊断乳腺癌,乳腺病灶是否钙化的主要影响因素是BI-RADS和钙化类型,具有一定的临床价值,值得推广应用。     

医学数字资源长期保存标准体系研究

针对医学数字资源构建长期保存标准体系,结合研究现状,设计体系框架,为具有长期保存价值的医学数字资源提供保存标准,以期指导后续保存系统应用实践。     

Prostate-specific antigen 1.5-4.0 ng/mL: a diagnostic challenge and danger zone

Study Type – Prognosis (inception cohort) Level of Evidence 1b What’s known on the subject? and What does the study add? Large population screening trials like the ERSPC, PCPT and PLCO have noted that men with seemingly low PSA (even as low as 0.5 ng/dL) still can have prostate cancer. Despite these findings, PSA is still predominantly used as a current indicator for possible presence of prostate cancer rather than also serving as a prognostic marker. This study examines a larger number of men in a diverse US population to determine the prognostic value of a man’s baseline or first PSA.

OBJECTIVES

? To assess the value of a PSA threshold of 1.5 ng/mL as a predictor of increased prostate cancer risk over a four‐year period based on a man’s first PSA test, including racial differences. ? To review the risk of progression of benign prostatic hyperplasia (BPH) based on a similar PSA threshold.

PATIENTS AND METHODS

? A retrospective review involving 21 502 men from a large Midwestern health system was performed. ? Men at least 40 years old with baseline PSA values between 0 and 4.0 ng/mL and at least four years of follow‐up after initial PSA test were included. ? Optimal PSA threshold and predictive value of PSA for development of prostate cancer were calculated.

RESULTS

? Prostate cancer rates were 15‐fold higher in patients with PSA ≥1.5 ng/mL vs patients with PSA <1.5 ng/mL (7.85% vs 0.51%). ? African American patients with baseline PSA <1.5 ng/mL faced prostate cancer rates similar to the whole study population (0.54% vs 0.51%, respectively), while African American patients with PSA 1.5–4.0 ng/mL faced a 19‐fold increase in prostate cancer.

CONCLUSION

? Both Caucasian and African American men with baseline PSA values between 1.5 and 4.0 ng/mL are at increased risk for future prostate cancer compared with those who have an initial PSA value below the 1.5 ng/mL threshold. ? Based on a growing body of literature and this analysis, it is recommended that a first PSA test threshold of 1.5 ng/mL and above, or somewhere between 1.5 and 4.0 ng/mL, represent the Early‐Warning PSA Zone (EWP Zone). ? This should serve to inform patients and clinicians alike to future clinical activities with respect to prostate cancer and BPH.     

数字减影造影介入后手术切除骶骨肿瘤

目的 研究和评价经数字减影造影术（DSA）介入后手术治疗骶骨肿瘤的价值。方法 24例骶骨肿瘤术前经双侧髂内动脉行DSA介入治疗,介入后1周内行手术切除肿瘤。结果 全部病例肿瘤均顺利切除,术中出血减少,平均出血量为1200ml;20例获随访,平均随访28个月,仅1例局部复发,2例恶性肿瘤死亡。结论 经DSA介入后手术治疗骶骨肿瘤,可有效减少术中出血及手术并发症。     

An intraoperative assessment of the ascending aorta: a comparison of digital palpation, transesophageal echocardiography, and epiaortic ultrasonography

OBJECTIVES: There are a number of techniques available to assess the aorta for atheromatous disease in the intraoperative period. This study compared the relationship among the findings of digital palpation (DP), transesophageal echocardiography (TEE), and epiaortic ultrasound (EAU) in the detection of atheroma in the ascending aorta. DESIGN: A prospective, observational study. SETTING: A single-institution, cardiothoracic specialty hospital. Participants: One hundred fifty-four patients undergoing elective cardiac surgery. INTERVENTIONS: The ascending aorta of patients undergoing elective coronary artery bypass surgery was assessed for atheroma by means of the 3 techniques. Atheroma was scored as present or absent. The sensitivity and specificity of the techniques were compared. MEASUREMENTS AND MAIN RESULTS: Assuming EAU provides the "gold standard," the sensitivity of both TEE and DP were low. Digital palpation identified only 20 patients (12%); TEE 31 patients (20%); and, in contrast, EAU detected atheroma in 81 patients (53%). There were 3 and 6 false-positives by DP and TEE, respectively. CONCLUSION: Assuming EAU as the "gold standard" to detect atheroma, this study has shown that when assessing the ascending aorta neither DP nor TEE appear sensitive. This study supports the proposal that detection of atheroma should be performed by EAU.     

数字化技术辅助手术治疗 Pilon 骨折疗效分析

目的研究数字化技术辅助手术治疗 Pilon 骨折的疗效。方法选取30例 Pilon 骨折患者,随机分为 A 组和 B 组（各15例）。A 组采用数字化技术辅助手术,将患者计算机断层扫描（CT）数据导入Mimics10．01软件进行三维重建,选择合适术式行模拟复位手术,再进行手术治疗;B 组则采用传统的非数字化技术辅助手术。术后第2天,采用放射学疗效评价标准（Burwell-Charnley 标准）评估患者术后骨折复位情况;术后6个月、12个月,采用临床疗效评价标准（Olerud-Molander 主观评分标准）评估患者术后踝关节功能恢复情况。结果术后第2天,A 组解剖复位及功能复位例数多于 B 组,差异有统计学意义（P＜0．05）;术后6个月、12个月,A 组踝关节功能评分高于 B 组,差异有统计学意义（P＜0．05）。结论数字化技术辅助手术治疗 Pilon 骨折可使骨折块更好复位,术后踝关节功能恢复更好。     

Direct and reversed dorsal digital island flaps: A review of 65 cases

BackgroundReconstruction of soft tissue defects in fingers continues to be a challenging problem. The purpose of this study is to report the reconstruction of small-to-moderate defects of fingers with dorsal digital island flap (DDIF) and to evaluate the efficacy of use of the flap.MethodsOver last six years, a retrospective study was conducted with 65 patients who had soft tissue defects of fingers treated with the DDIF. Sixty-nine soft-tissue defects were found in 69 fingers in 65 patients. Based on the flow direction of blood supply, the patients were divided into two groups: the direct (n = 35) and reversed (n = 30) DDIF groups. In addition, based on the different donor sites, the direct DDIF group was divided into two subgroups: the proximal phalangeal direct DDIF subgroup (n = 16) and the extended pedicle direct DDIF subgroup (n = 19). The main outcomes were static 2-point discrimination and Semmes–Weinstein monofilament scores of flap and joint motion.ResultsAt the final follow-up, the mean static two-point discrimination of the flaps was 9.7 mm (range, 8 to 12 mm) in the proximal phalangeal direct DDIF subgroup and 8.3 mm (range, 7 to 11 mm) in the extended pedicle direct DDIF subgroup, with a significant difference (p = 0.005). In the direct DDIF group, there was no significant difference in total active motion between the donor fingers and the opposite sides. In the reversed DDIF group, the mean total active motion of the donor fingers was 170° and the data of the opposite sides was 181°, with a significant difference (p = 0.024). Maximum amplitude losses of 15° were seen in 12% of patients in the distal interphalangeal joint.ConclusionsThe DDIF is reliable and technically easy for reconstructing small-to-moderate defects of fingers. The extended pedicle direct DDIF may be an optional solution when sensory reconstruction is needed.     

Acral Fibrokeratoma of the Foot Treated with Excision and Trap Door Flap Closure: A Case Report

Acral fibrokeratoma is a relatively rare, benign lesion that is typically found on the fingers and toes but can also be found on the palms and soles. Several case reports have been published of this rare lesion, with only a few investigators describing lesions of the feet. The techniques of using skin from a portion of the mass to close the defect left from mass excision have been poorly reported. Our technique, which we have termed the “trap door flap,” has design similarities to the appearance and mechanics of a trap door. We present the case of a patient with a 7-year history of a slow-growing, soft tissue mass on the plantar and medial aspect of his left hallux. The mass was subsequently excised and closed with a local flap. The flap had healed uneventfully by 2 weeks postoperatively, and the patient denied any evidence of recurrence or pain at 12 months of follow-up.