HRCT在支气管扩张症的诊断价值

目的:通过比较研究胸部平片、CT、HRCT对支气管扩张的诊断,探讨HRCT在支气管扩张症中的诊断价值。材料与方法:对32例临床诊断为支气管扩张的患者分别行胸片、CT、HRCT检查。结果:32例患者胸片显示支气管扩张18例,常规CT显示支气管扩张23例,HRCT显示支扩30例。结论:HRCT较其他影像学方法更有优越性,对临床怀疑为支气管扩张的患者应在胸片筛选后首选HRCT。     

UIP临床与HRCT的对照研究--附27例报告及文献回顾

目的 探讨普通型间质性肺炎（UIP）的临床、病理及HRCT特征，深化对UIP的认识，以提高诊断率。方法 分析27例经病理学证实的UIP患者的临床表现、支气管镜检查及HRCT的特点并复习相关文献。结果 27例病人中，男性15例，女性12例，年龄范围42-79岁，平均年龄57岁，病程3月-2年。27例均有进行性呼吸困难，其中干咳22例，杵状指9例，发热2例。肺功能检查示肺总量、残气量下降及一氧化碳弥散（DLCO）降低。支气管肺泡灌洗液（BALF）中性粒细胞增加。胸部高分辨率CT（HRCT）示病灶主要分布在胸膜下区和双肺基底部，以斑片关磨玻璃影及网织样改变为主。结论 通过对普通型间质性肺炎的临床、肺功能、病理及HRCT的分析，有助于提高对该病的早期诊断率。     

3种不同影像学检查方法诊断特发性肺纤维化的比较

目的探讨高分辨率CT(HRCT)对特发性肺纤维化(idiopathic pulmonary fibrosis,IPF)的诊断价值。方法回顾性分析53例疑诊IPF患者的病理组织学资料及HRCT、普通CT和X射线平片显示情况。结果按照病理组织学(金标准)诊断结果 ,HRCT与普通CT对IPF的诊断符合率均高于普通CT(χ2分别为24.10,10.88,P0.005),而HRCT与普通CT差异无统计学意义(χ2=2.23,P0.100);HRCT在小片状阴影、网织状阴影、牵引性支气管扩张、小叶内间质增厚、磨玻璃影的显示上其诊断准确性显著优于普通CT和X线平片,并且从图像质量来看,HRCT显示的影像清晰度更高。结论 HRCT技术是一种安全、无创的诊断手段,可准确反映IPF的影像学特征。     

原发性干燥综合征继发间质性肺炎患者胸部高分辨CT分析

目的 提高对原发性干燥综合征(PSS)继发间质性肺炎患者胸部影像学特点的认识.方法 回顾性分析33例PSS继发间质性肺炎患者的胸部高分辨CT(HRCT)结果 .结果 33例PSS患者,男8例(24.2%),女25例(75.8%);中位年龄55岁.胸部HRCT的主要影像学特征痛灶多位于下叶和胸膜下,毛玻璃影87.9%、气腔实变影21.2%、蜂窝样影39.4%、牵拉性细支气管扩张或支气管扩张66.7%、薄壁囊状影27.3%、小叶中心性结节9.1%、线状阴影18.2%、空气潴留征6.1%、小叶间隔增厚91.0%、网状阴影69.7%、肺门或纵隔淋巴结肿大51.5%、胸腔积液12.1%.参照2002年美国胸科协会/欧洲呼吸病学会(ATS/ERS)的分类标准,CT-普通型间质性肺炎(UIP)型9例(27.3%);CT-非UIP型24例(72.2%),其中CT-淋巴细胞性问质性肺炎(LIP)型4例(12.1%),CT-机化性肺炎(OP)型5例(15.2%),CT-非特异性间质性肺炎(NSIP)型15例(45.5%).结论 PSS继发间质性肺炎患者胸部影像学多在双下肺及胸膜下分布,具有多样性,CT-NSIP型可能是胸部影像学的主要类型.     

高分辨率CT诊断间质性肺炎的价值及准确性分析

目的：分析在间质性肺炎（IP）诊断中应用高分辨率CT的临床效果。方法：选取2022年6月—2023年6月于聊城市第四人民医院受检的180例疑似IP患者,均应用常规CT检查和高分辨率CT检查,以病理学结果为金标准,比较常规CT及高分辨率CT检查的诊断效能。结果：病理检查结果,阳性140例,阴性40例;高分辨率CT检测阳性139例,阴性41例;常规CT检查阳性131例,阴性49例。高分辨率CT检测IP灵敏度、特异度、准确率分别为96.43%、90.00%、95.00%,均高于常规CT检查的85.00%、70.00%、81.67%,差异有统计学意义（P <0.05）。IP患者高分辨率CT(HRCT)层面图像分析,各影像特点占比从高到低依次为磨玻璃影、小叶间质增厚、支气管血管束增粗、小叶内质增厚、细支气管扩张、蜂窝影、小叶内结影、肺气肿、网格影、胸膜下线影、马赛克征。结论：HRCT对IP的诊断效果可观,相较于常规CT检查方式诊断效能更佳,可推广。     

肺部超声与床旁胸部X线在老年社区获得性肺炎中的诊断价值比较

目的 比较肺部超声与床旁胸部X线在老年社区获得性肺炎（CAP）中的诊断价值。方法 选取2021年2月至5月我院重症医学科收治的98例疑似老年CAP患者作为研究对象。所有患者均行肺部超声、床旁胸部X线及电子计算机断层扫描（CT）检查。以CT诊断结果为金标准,比较肺部超声、床旁胸部X线的诊断效能及对大叶性肺炎、小叶性肺炎及间质性肺炎的检出率。结果 肺部超声诊断CAP的灵敏度、特异度、阳性预测值、阴性预测值及准确度均高于床旁胸部X线（P<0.05）。肺部超声和床旁胸部X线对大叶性肺炎、小叶性肺炎及间质性肺炎的检出率比较,差异无统计学意义（P>0.05）。床旁胸部X线声像图显示肺纹理增粗且伴有点片状高回声影,为炎性渗出,图像直观、立体,但二维图像分辨率低、清晰度差。肺部超声声像图可见多条B线、肺实变、肺实变区及含气支气管征,为炎症改变,其分辨率较高、图像质量较好。结论 肺部超声对老年CAP的诊断效能优于床旁胸部X线,其价格低廉、便携,对大叶性肺炎、小叶性肺炎及间质性肺炎的检出率高,可作为老年CAP诊断的首选检查。     

HRCT对肺间质性病变的诊断价值

目的研究肺间质病变的高分辨CT（HRCT）表现及鉴别诊断。方法采用HRCT法对88例临床病理证实的肺间质病变作影像分析。结果HRCT可清晰显示所有病例的肺间质病变征象，常表现为支气管血管束周围间质增厚（27例）；肺小叶改变，其中包括小叶内间质异常（35例）、小叶间隔增厚（36例）；毛玻璃影（38例）；蜂窝征（41例）；胸膜下间质改变（33例）：出现界面影、胸膜下线、网织样变；受牵支气管扩大（28例）。结论HRCT对判断肺间质病变有影像诊断价值。     

高分辨CT(HRCT)对支气管内膜结核的诊断价值

目的 评价高分辨CT（HRCT）等对支气管内膜结核的诊断价值。方法 收集103例支气管内膜结核患者的治疗前胸片、气管支气管断层、CT等影像资料和临床资料进行分析。结果 CT平扫，尤其是HRCT检查较胸片及气管支气管断层可以显示更多的直接征象（气管支气管狭窄、管壁增厚、腔内结节、堵塞等异常）、显示更多的受累支气和客小的病灶。结论 CT平扫，尤其是HRCT检查较胸片及气和气管断层对支气管内膜结核有较高的诊断价值。     

116例老年慢性肺炎患者的影像诊断及鉴别诊断

目的老年人慢性肺炎临床症状不典型，并发症发生率高，极易引起临床误诊误治，评价影像检查（以全胸片及CT为主）在该病的诊断与鉴别诊断中的作用，以减少临床误诊误治。方法将116例经临床证实的老年慢性肺炎患者影像检查结果与临床贲料进行回顾性分析。结果老年患者慢性肺炎常发生于下肺及肺根部，一般可见含气支气管影，影像学动态跟踪观察，病灶大部分可逐渐吸收消散。结论影像学动态跟踪观察是老年慢性肺炎的诊断以及避免误诊的一种最简便有效的方法。     

胸部高分辨率CT与支气管造影术在诊断支气管扩张症中的对比研究

目的：评价非创伤性HRCT诊断支气管扩张的价值。材料与方法：对300例临床拟诊为支气管扩张症的病人进行HRCT检查,其中120例进行了支气管造影检查,对二种方法检查结果进行对照研究。结果300例患者中HRCT均呈现不同类型的支气管扩张表现,其诊断准确性为100％,而支气管造影术为85％。结论：HRCT能够明确支气管扩张的部位和程度,其诊断敏感性明显高于支气管造影术,它是一种安全、简便、可靠的检查手段。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

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.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

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.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."