胰腺多层螺旋CT灌注成像

目的应用多层螺旋CT(MSCT)灌注扫描成像技术评价正常人胰腺与胰腺癌的血流动力学表现,并探讨其临床应用价值.方法 60例患者行多层螺旋CT胰腺灌注扫描,其中胰腺癌29例,正常胰腺31例.采用GE Lightspeed 16层MSCT ADW 4.1工作站,使用Perfusion-3软件包分析.分别测量血流量(BF)、血容量(BV)、平均通过时间(MTT)和毛细血管表面通透性(PS).结果正常组BF、BV、MTT及PS分别为:(176.54±76.18) ml/(100 mg*min)、(14.62±3.60) ml/100 mg、(7.02±3.09) s、(15.70±9.92) ml/(100 mg*min).癌组分别为(74.89±91.50) ml/(100 mg*min)、(6.12±3.62) ml/100 mg、(10.38±5.31) s和(27.43±11.97) ml/(100 mg*min).胰腺癌组和正常组的BF、BV、MTT和PS均有显著的统计学差异(BF、BV:P＜0.01;MTT、PS: P＜0.05).结论胰腺癌时的血流灌注与正常胰腺的血流灌注相比明显减少,MSCT灌注成像对胰腺癌血流变化的分析有一定临床价值.     

多层螺旋CT灌注成像在胰腺癌诊断中的应用价值

目的探讨多层螺旋CT(MSCT)灌注成像对胰腺癌的诊断及鉴别诊断价值。方法收集93例患者,按纳入标准分为正常对照组(48例)、胰腺癌组(31例)和急性胰腺炎组(14例),分别行胰腺MSCT灌注成像,随后将灌注原始数据传输至图像后处理工作站,设腹主动脉为输入动脉,门静脉或脾静脉为输出静脉,自动生成时间密度曲线(TDC)及灌注伪彩图。多点选取胰腺组织感兴趣区(ROI),需避开肉眼可见血管及胰腺边缘,ROI大小约20³0 mm2,分别测量3次,取其平均值,读出各ROI血流量(BF)、血容量(BV)、表面通透性(PS)和平均通过时间(MTT),分别计算三组BF、BV、PS、MTT和PS/BF。结果正常对照组BF、BV、PS、MTT、PS/BF分别为(120.196±27.686)ml·(100 g)-1·min-1、(25.324±5.012)ml/100 g、(18.314±22.227)ml·(100 g)-1·min-1、(13.655±2.780)s、0.150±0.770;胰腺癌组为(52.674±19.823)ml·(100 g)-1·min-1、(10.369±5.439)ml/100 g、(42.612±17.040)ml·(100 g)-1·min-1、(13.559±5.514)s、0.844±0.312;急性胰腺炎组为(89.689±26.788)ml·(100 g)-1·min-1、(18.221±7.600)ml/100 g、(41.342±21.581)ml·(100 g)-1·min-1、(15.018±6.600)s、0.498±0.287。胰腺癌BF、BV、PS/BF与正常胰腺和急性胰腺炎均有统计学差异(P<0.01);胰腺癌PS与正常胰腺有统计学差异(P<0.05),与急性胰腺炎组无统计学差异(P>0.05);三组间MTT无统计学差异(P>0.05)。结论 MSCT灌注成像对胰腺癌的诊断有重要参考价值,灌注参数BF、PS/BF对胰腺癌的诊断及鉴别诊断价值最大。     

64层CT灌注在胰腺癌诊断中的价值

目的：探讨胰腺CT灌注成像的可行性，研究正常胰腺与胰腺癌的64-CT灌注参数特征。方法：采用64层螺旋CT对24例正常胰腺志愿者和35例胰腺癌患者进行胰腺灌注扫描，测量并比较正常胰腺和胰腺癌的血流量（BF）、血容量（BV）、峰值（PE）、达峰时间（TTP）和渗透性（P值）等灌注参数。结果：胰腺癌组的BF、BV、PE小于正常组，TTP、P大于正常组，差异有显著性。癌组织BF、BV、PE明显小于残余正常胰腺组织，TTP、P大于残余正常胰腺组织，差异有显著性。第2、3、4期P值高于第1期胰腺癌，差异有统计学意义。结论：胰腺CT灌注成像能够在一定程度上反映出胰腺及胰腺癌的血流灌注特点，对胰腺癌的诊断有提示意义。胰腺癌组织和残余正常胰腺组织灌注参数对比在临床上对胰腺癌的诊断有价值。     

64层螺旋CT灌注成像对肝纤维化的临床应用研究

目的 探讨64层螺旋CT灌注成像技术对慢性乙型肝炎肝纤维化诊断的应用价值.方法 分别对68例经病理诊断为慢性乙型肝炎肝纤维化患者和20例正常志愿者行64层螺旋CT肝脏灌注扫描,应用肝脏灌注分析软件获得不同病理阶段的肝脏灌注参数肝动脉灌注量(ALP)、门脉灌注量(PVP)、肝脏灌注指数(HPI)、血流量(BF)、血容量(BV)和渗透性(P),与病理作对照并进行统计学分析.结果 计算所得时间-密度灌注曲线符合数据分析要求.正常对照组的ALP为(26.96±3.11) ml·100 ml-1·min-1,PVP为(102.84±5.56) ml·100 ml-1·min-1,HPI为(20.31±2.03)%,BF为(47.70±3.13) ml·100 ml-1·min-1,BV为(135.55±4.53) ml/L和 P为(68.08±1.05) 0.5 ml·100 ml-1·min-1.乙型肝炎肝纤维化组的ALP、PVP、HPI、BF、BV和P分别为(28.73±4.09) ml·100 ml-1·min-1、(94.14±5.56) ml·100 ml-1·min-1、(22.42±2.07)%、(40.95±3.94) ml·100 ml-1·min-1、(123.80±7.21) ml/L和(68.59±1.39)0.5 ml·100 ml-1·min-1.统计结果显示肝纤维化组的PVP、BF、BV较对照组降低,差异有显著性(P＜0.05),且随肝纤维化程度加重呈逐渐降低趋势,S3、S4期分别与对照组、S1期比较有统计学差异,S2期与对照组比较有统计学差异;HPI较对照组升高(P＜0.05),且随肝纤维化程度加重逐渐增高,S3、S4期分别与对照组、S1期比较有统计学差异;ALP和P组间比较无统计学差异(P＞0.05).结论 64层螺旋CT肝脏灌注成像能够反映乙型肝炎肝纤维化及早期肝硬化的血流灌注改变,灌注参数的变化与肝纤维化的严重程度相关,对临床的早期诊断、治疗和疗效观察有重要价值.     

正常胰腺64层螺旋CT灌注成像的初探

目的对正常胰腺进行CT灌注成像检查,探索正常胰腺的CT灌注特征,提供正常胰腺灌注参数参考值。方法对2010年2月—2011年3月45例非胰腺疾病患者进行64层螺旋CT灌注检查。灌注扫描采取连续容积扫描模式,7.2 mm层厚（4/3 cm）,120 kV,150 mA,512×512像素。以高压注射器通过肘正中静脉留置管注射碘帕醇300 mgI/mL,5 mL/s,共50 mL,延迟6 s,数据采集40 s,数据传到Syngo multi-modality工作站,测量感兴趣区（ROI）的血流量（BF）、血容量（BV）、达峰时间（TTP）和表面通透性（PS）的值,并进行统计学处理。结果正常胰腺的灌注参数BF、BV、TTP、PS值分别为（128.41±23.25）mL.min-1.100g-1、（203.75±31.29）mL.kg-1、（143.73±14.26）s、（65.70±15.86）mL.min-1.100g-1。各部位及不同性别的血流灌注均匀,血流动力学特征一致。结论正常胰腺的CT灌注成像特征表现为局部组织血流量、血容量均匀,达峰时间相同,表面通透性一致的实质性器官。     

正常肝脏与微小转移性肝癌多层螺旋CT灌注成像的临床研究

目的研究CT灌注成像在正常肝组织和微小转移性肝癌的应用价值。方法21例肝转移癌患者选取48个微小转移灶和12例正常肝脏志愿者行多层螺旋CT灌注扫描,通过兴趣区(ROI)的时间密度曲线,应用去卷积法获得血流量(BF)、血容量(BV)、平均通过时间(MTT)、毛细血管表面通透性(PS)和肝动脉灌注指数(HAF)、肝动脉灌注量(HAP)、门静脉灌注量(PVP)等参数值。结果正常肝组织的BF、BV、MTT、PS、HAF、HAP、PVP和IRFT0的平均值分别为(111.55±32.80)ml.min-1.100ml-1、(22.69±2.99)ml.100g-1、(15.73±1.74)s、(19.12±6.86)ml.min-1.100ml-1、(16.67±6.12)%、(19±9.05)ml.min-1.100ml-1、(92.55±27.24)ml.min-1.100ml-1、(2.80±1.66)s。转移癌组分别为(132.44±76.87)ml.min-1.100ml-1、(12.94±5.62)ml.100g-1、(10.91±3.68)s、(29.12±12.90)ml.min-1.100ml-1、(81.24±17.42)%、(90.75±47.85)ml.min-1.100ml-1、(41.69±47.85)ml.min-1.100ml-1、(2.09±1.58)s。转移癌组与正常肝组比较,BF、HAF、MTT、HAP、BV和PS两组的平均值有显著性差异(P<0.05);PVP(P=0.06)和IRFT0(P=0.77)的平均值无显著性差异。结论CT灌注成像或以检测到微小转移癌引起的血流动力学变化,CT灌注技术对于诊断微小转移癌能够提供更多的信息。     

双源CT灌注扫描对胰腺癌诊断的应用价值

目的 探讨CT灌注对胰腺癌诊断的应用价值.方法 采用Siemens双源CT扫描仪,对104例临床怀疑为胰腺癌或经超声检查发现胰腺占位性病变者进行CT灌注检查.比较胰腺癌组织与周围正常组织间各灌注参数值差异,比较常规增强CT方法及其与CT灌注相结合对于胰腺癌的检出率.结果 经手术病理或临床检查证实73例为胰腺癌.胰腺癌组织的灌注参数值血流量（Flow）,血容量（blood volume,BV）,通透性（permeability,per）及Patlak血流量（patlak blood volume,pBV）分别为（68.34±30.06） ml·（100 ml）-1·min-1,（112.75 ±39.57）∶ 1000,（64.14±27.28）0.5 ml· （100 ml）-1·min-1,（56.87 ±32.62）∶1000,均较周围正常胰腺组织低（P＜0.05）.CT灌注方法结合常规增强CT检查具有较高的敏感度（98.6％）、特异度（90.3％）、阳性预测值（96.0％）、阴性预测值（96.5％）及准确度（96.2％）.结论 胰腺CT灌注方法能够定量反映胰腺癌低血供的特点,结合常规增强CT可提高胰腺癌的诊断能力.     

2型糖尿病患者胰腺的多排螺旋CT灌注研究

目的应用多排螺旋CT(MSCT)灌注扫描技术评价2型糖尿病患者与正常人胰腺组织的血流动力学特点,探讨其临床应用价值。方法使用GE Lightspeed 16排MSCT对30例2型糖尿病患者及30例非胰腺疾病患者行胰腺CT灌注检查,按是否患糖尿病分为患病组与正常组,分别测量两组胰腺不同部位组织的血流量(BF)、血容量(BV)、平均通过时间(MTT)和表面通透性(PS)的平均值,并进行统计学分析。结果患病组与正常组胰腺体部的BV值(13.41±3.69)ml/kg vs(16.43±5.14)ml/kg,其差异有统计学意义(P<0.05),而BF、MTT及PS值之间比较差异无统计学意义;胰头部及胰腺尾部各灌注参数间差异无统计学意义。结论 MSCT灌注成像对2型糖尿病患者胰腺组织的血流变化分析有一定的临床价值。     

螺旋CT灌注成像对肺结核的诊断价值

目的探讨与研究螺旋CT灌注成像对肺结核病变的诊断价值。方法选择肺结核患者25例,对比观察肺恶性肿瘤患者25例,行螺旋CT灌注扫描,计算肺部病灶的灌注量（perfusion volume,PV）、血容量（blood volume,BV）、增强峰值（peak height,PH）和对比剂的平均通过时间（mean transit time,MTT）的数值。结果结核PV、BV、PH均值分别为12.15±4.12 ml.min-1.ml-1、10.36±5.87 ml/100 g、18.21±5.58 HU。恶性肿瘤PV、BV、PH均值分别为37.33±15.22ml.min-1.ml-1、22.34±9.36 ml/100 g、38.05±13.21 HU。二者PV、BV、PH均值比较,结核明显低于恶性肿瘤,具有统计学意义（P〈0.05）。二者MTT均值分别为30.33±14.36 s、26.36±13.53 s,无明显差异（P=0.917）。结论螺旋CT灌注成像可作为肺结核病变诊断和鉴别诊断的辅助方法。     

急性胰腺炎的多层螺旋CT灌注成像研究

目的评价急性胰腺炎的多层螺旋CT(MSCT)灌注成像特点。方法应用16层螺旋CT对胰腺正常者44例,急性胰腺炎患者23例进行灌注扫描,使用AW4.1工作站perfusion3软件包进行图像处理,得到血流量(BF)、血容量(BV)、平均通过时间(MTT)和表面通透性(PS)等参数值。结果正常组BF、BV、MTT、PS值分别为:(174.77±75.62)ml/(100g·min)、(15.62±3.39)ml/100g、(7.45±2.82)s、(14.01±9.20)ml/(100g·min);急性胰腺炎组分别为:(101.50±49.50)ml/(100g·min)、(8.86±3.08)ml/100g、(8.31±3.06)s、(21.61±9.38)ml/(100g·min)。两组之间的BF、BV、PS值之间的差别有统计学意义(P<0.01),MTT值的差别没有统计学意义(P>0.05)。结论急性胰腺炎的血液灌注量减少,MSCT灌注成像对急性胰腺炎的诊断有一定的临床应用价值。     

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."