经阴道三维彩色血管能量成像对卵巢良恶性肿瘤的诊断价值

目的:探讨经阴道三维彩色血管能量成像(TV3D-CPA)对卵巢肿瘤的诊断价值及其与恶性肿瘤临床分期的关系。方法:术前应用TV3D-CPA技术检测65例卵巢肿瘤(47例恶性肿瘤,18例良性肿瘤),定量计算肿瘤内血管指数(VI),分析VI值在良、恶性肿瘤中的差异性及其与恶性肿瘤临床分期的关系。结果:卵巢恶性肿瘤VI值(0.080±0.052)条/cm³,明显高于良性组(0.043±0.031)条/cm³(P<0.05)。以VI≥0.035条/cm³诊断卵巢恶性肿瘤敏感性87.8%,特异性75%。Ⅲ、Ⅳ期卵巢恶性肿瘤VI值(0.089±0.037)条/cm³,明显高于Ⅰ、Ⅱ期(0.056±0.04)条/cm³(P<0.05)。结论:应用TV3D-CPA计测VI值是鉴别卵巢良、恶性肿瘤的有效方法。VI值随临床分期的增高而升高,是预后评价的重要指标。     

三维彩色血管能量成像对卵巢肿瘤血管的研究

目的 应用三维彩色血管能量成像（three-dimensional color power Doppler energy,3D-CDE）观察卵巢肿瘤的血流特征,探讨其临床应用价值.方法 对32例卵巢肿瘤患者进行经阴道三维彩色血管能量成像,分析肿瘤血管三维结构形态与肿瘤良恶性的相关性.结果卵巢恶性肿瘤以复杂型（Ⅱ、Ⅲ型）血管为主,卵巢良性肿瘤以简单型（Ⅰ型）血管为主,两者之间差异具有显著性（P＜0.05）.结论 3D-CDE可客观地评价卵巢肿瘤的血管,对卵巢肿瘤的良恶性鉴别具有重要的参考意义.     

卵巢肿瘤经阴道彩色多普勒超声与微血管密度的对比研究

目的探讨卵巢肿瘤经阴道彩色多普勒超声检查(TVCDU)的血管病理学基础,评价其鉴别卵巢良、恶性肿瘤的临床应用价值及与临床分期的关系。方法对61例卵巢肿瘤(38例恶性肿瘤,5例交界性肿瘤,18例良性肿瘤)患者术前行TVCDU检查,计测血流定量指标RI。术后应用免疫组织化学方法对病理组织切片进行微血管染色,计数微血管密度(MVD)。确定卵巢恶性肿瘤临床分期。统计分析RI与MVD的相关性及其与临床分期的关系。结果38例卵巢恶性肿瘤动脉血流RI值(0.44±0.13),明显低于18例良性组(0.58±0.11,P<0.05)。临床Ⅲ、Ⅳ期的卵巢恶性肿瘤RI值(0.39±0.05),明显低于Ⅰ、Ⅱ期(0.45±0.13,P<0.05)。以RI≤0.5诊断卵巢恶性肿瘤敏感性89.5%,特异性78.3%。卵巢恶性肿瘤MVD(37.5±18.22)/400倍视野,明显高于良性组(14.85±8.02)/400倍视野(P<0.05)。Ⅲ、Ⅳ期卵巢恶性肿瘤MVD(43.29±12.2)/400倍视野,明显高于Ⅰ、Ⅱ期(27.86±9.9)/400倍视野(P<0.05)。卵巢恶性肿瘤RI与MVD呈负相关(rs=-0.412,P<0.01)。结论TVCDU能反映卵巢肿瘤内血管生成状况,为临床诊断和鉴别提供可靠依据。     

卵巢肿瘤三维多普勒能量成像与病理MVD表达的相关性研究

目的探讨三维彩色血管能量成像（three-dimensional color power angiography,3D-CPA）术前观察卵巢肿瘤的血流特点与术后病理组织微血管密度（micro vessel density,MVD）之间的关系。 方法应用3D-CPA观察76个卵巢肿瘤的血管形态,判断血管分级并计算肿瘤内血管指数（vascular index VI）,采用免疫组织化学染色技术检测肿瘤内的MVD,并且进行相关性分析,评价三维能量多普勒成像与病理微血管密度的相关性。 结果三维多普勒能量成像所观测卵巢肿瘤的血管分级在良恶性肿瘤之间存在显著差异;级血管分型的血管分级与MVD相关;卵巢癌的血管指数与MVD有显著相关性（r=0.84,P〈0.005）。 结论应用3D-CPA对卵巢肿瘤的血供情况进行血管分型及VI的计算与免疫组化指标（MVD）有较好的相关性,综合分析可以从不同角度反应卵巢肿瘤的血管生成情况,为卵巢肿瘤的诊断及鉴别诊断提供有价值的信息。     

三维多普勒能量成像检测卵巢肿瘤及其与病理MVD、VEGF表达的相关性研究

目的探讨三维彩色血管能量成像（3D-CPA）术前观察卵巢肿瘤的血流特点与术后病理微血管密度（MVD）及血管内皮生长因子（VEGF）的关系。方法术前应用3D-CPA观察76例卵巢肿瘤的血流信号,判断血管分级并计算肿瘤内血管指数（VI）,术后病理标本应用免疫组织化学染色技术检测肿瘤内的MVD及VEGF染色强度,进行相关性分析,评价三维能量多普勒成像的病理基础。结果卵巢癌的VEGF表达强度均显著高于良性上皮性卵巢肿瘤（P〈0.05）,Ⅲ级血管分型的VEGF染色强度高于Ⅰ、Ⅱ级;卵巢癌的血管分级及VI与MVD有相关性（r=0.84,P〈0.005）。结论血管分型、VI可用于术前间接评价肿瘤的血管生成,为卵巢肿瘤的诊断及鉴别诊断提供有价值的信息。     

上皮性卵巢肿瘤的彩色血管能量成像与微血管密度对比研究

目的研究上皮性卵巢肿瘤的血管病理学特征,评价彩色血管能量成像(CPA)在鉴别良恶性上皮性卵巢肿瘤中的应用价值.方法对67例上皮性卵巢肿瘤患者术前应用CPA检查,术后应用免疫组化方法对肿瘤组织进行微血管染色,计数微血管密度(microvessel density,MVD).结果上皮性恶性卵巢肿瘤的MVD(38.8±5.9)明显高于良性卵巢肿瘤(15.5±5.0,P<0.05),恶性肿瘤中CPA Ⅲ型病例的MVD(43.9± 5.2)明显高于Ⅱ型病例(32.6±5.6,P<0.05).以CPA Ⅲ型诊断卵巢癌的敏感性为 75%,特异性为100%.结论良恶性上皮性卵巢肿瘤不同的微血管特征为临床应用CPA提供了可靠的病理学基础,CPA为临床鉴别良恶性卵巢肿瘤提供了敏感的血流信息.     

卵巢恶性肿瘤经阴道超声定量指标与病理微血管密度及临床分期相关研究

目的探讨卵巢恶性肿瘤血管病理学特征,评价经阴道超声定量指标与病理微血管密度的相关性及其与临床分期的关系。方法术前应用经阴道彩色多普勒超声(transvaginalcolor Dopplerultrasonography,TVCDU)与三维彩色血管能量成像(three-dimensional colorpower angiography,TR3D-CPA)检测38例卵巢恶性肿瘤患者,测定肿瘤血流阻力指数(RI)与血管指数(VI)。术后对组织切片进行免疫组化染色,计数微血管密度(microvesseldensity,MVD);确定卵巢恶性肿瘤临床分期;统计分析RI、VI与MVD的相关性及其与临床分期的关系。结果38例卵巢恶性肿瘤RI值0.44±0.13,VI值(0.08±0.052)条/cm3,MVD值(37.5±18.22)个/400倍视野。RI与MVD呈负相关(rs=-0.412,P<0.01)。VI与MVD呈正相关(rs=0.684,P<0.01)。RI随临床分期的升高而降低,VI随临床分期的升高而升高;临床、期VI、MVD明显高于、期,RI反之(P<0.05)。结论RI与VI可于术前评价卵巢恶性肿瘤血管生成,为术前诊断及预后评估提供有价值的信息。     

TV3D-CPA技术联合血清CA-125 B7-H4检测在卵巢肿瘤中的应用

卵巢肿瘤是女性常见的肿瘤，而卵巢恶性肿瘤早期症状不典型，常到晚期才发现，5年存活率低，如早期能作出诊断，5年存活率生存率可提高至94％［1］，所以早期诊断对预后极为重要［2］。目前，诸多辅助检查发现附件肿块并不困难，困难的是定性。本资料采用经阴道三维彩色血管能量成像（TV3D-CPA）技术，中血管化指数（VI）、血流指数（FI）、血管化血流指数（VFI）3项指数测量，并检测血清中CA-125、B7-H4含量，结合对照病理学结果，探讨TV3D-CPA技术联合血清CA-125、B7-H4检测在诊断良恶性卵巢上皮性肿瘤的价值。     

经阴道超声三维血管定量与病理微血管密度对卵巢癌临床分期及病理类型的应用价值

目的：评价经阴道超声血管定量指标与卵巢癌的血管病理学指标的相关性,探讨经阴道三维彩色血管能量成像（TR3D-CPA）对不同临床分期及不同病理类型的卵巢癌的临床应用价值。方法：术前应用TR3D-CPA检测48例卵巢癌患者,测定肿瘤血管指数（VI）。术后应用抗CD34单克隆抗体对病理切片进行免疫组织化学染色,计数肿瘤微血管密度（MVD）。根据FIGO 2000年标准确定临床分期;根据术后病理结果划分不同病理类型。统计分析上述超声指标在卵巢癌不同临床分期及不同病理类型中的差异。结果：48例卵巢癌VI值（0.087±0.045）条/cm3,MVD值（38.6±17.15）个/400×。VI与MVD呈正相关（rs=0.701,P<0.01）。VI随临床分期的升高而升高;临床Ⅲ、Ⅳ期VI明显高于Ⅰ、Ⅱ期（P<0.05）。在不同病理类型之间VI,MVD差异均无统计学意义（P>0.05）。结论：VI随临床分期增高而升高,可于术前评价卵巢癌血管生成,为术前诊断及预后评估提供有价值的信息。     

甲状腺肿瘤三维血管定量与病理微血管定量相关性研究

目的研究甲状腺肿瘤的三维血管定量与病理微血管密度的相关性,评价其临床应用价值.方法应用三维彩色血管能量成像技术(3D-CPA),术前检测38例甲状腺肿瘤血流信号(恶性22例,良性16例)计算3D-CPA血管指数(VI),术后对手术标本行抗CD34因子免疫组化染色,计数肿瘤微血管密度(MVD),行统计学对比分析.结果 22例甲状腺癌3D-CPA VI和MVD分别为(9.69±4.37)条/cm3和(51.33±12.86)/400倍视野,二者呈线性正相关(r=0.796,P＜0.01),16例良性甲状腺肿瘤3D-CPA VI和MVD分别为(4.96±1.19)条/cm3和(20.11±8.05)/400倍视野,二者呈线性正相关(r=0.814,P＜0.01),良、恶性两组3D-CPA VI、MVD分别对比差异有显著性(t=2.020,P＜0.001;t=2.016,P＜0.001).以VI大于6条/cm3诊断甲状腺癌,其敏感性、特异性分别为81.82%、87.50%.结论 3D-CPA能立体、直观显示甲状腺肿瘤血供,血管三维定量测值与肿瘤微血管密度相关性较好,血管三维能为良、恶性甲状腺肿瘤鉴别提供有效血流信息.     

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.     

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.     

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.     

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.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

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.