MRI诊断胎儿泌尿系统异常:Meta分析

目的 应用Meta分析探讨MRI作为超声补充检查诊断胎儿泌尿系统异常的价值。方法 检索1991年1月—2014年11月Pubmed、Elsevier-SDOL(Science Direct OnLine)、中国知网(CNKI)检索平台、万方数据库、维普期刊数据库及中国生物医学文献数据库中,对超声怀疑泌尿系统异常的胎儿行MRI检查并评估其诊断价值的相关文献。采用QUADAS-2评分标准评价文献质量,采用Metadisc1.4软件分析诊断的特异度、敏感度、阳性似然比及阴性似然比,并绘制汇总受试者工作特征(SROC)曲线,计算曲线下面积(AUC)。结果 共纳入9篇文献。对存在异质性的阳性似然比采用随机效应模型进行效应量合并。Meta分析显示,MRI诊断胎儿泌尿系统异常的汇总敏感度、汇总特异度、汇总阳性似然比、汇总阴性似然比及各自95%CI 分别为0.96(95%CI 0.93~0.98)、0.75(95%CI 0.57~0.88)、2.98(95%CI 1.05~8.45)、0.07(95%CI 0.04~0.13)。SROC曲线的AUC为0.96。结论 MRI作为超声补充检查诊断胎儿泌尿系统异常具有较高的价值。     

增强能谱乳腺摄影与MRI诊断乳腺癌效能比较:Meta分析

目的 采用Meta分析综合评价对比增强能谱乳腺摄影（CESM）与MRI对乳腺癌的诊断效能。方法 检索中国知网数据库、万方数据库、中国生物医学文献服务系统、Cochrane Library、Web of Science等国内外数据库中近10年发表的CESM与MRI比较诊断乳腺癌效能的文献,采用Review Manager 5.3软件根据诊断准确性实验质量评价工具-2（QUADAS-2）评价文献质量,以Meta Disc 1.4检验纳入文献的异质性,并根据结果选择对应效应模型,对两种方法诊断乳腺癌的敏感度、特异度、阳性似然比（PLR）、阴性似然比（NLR）和诊断比值比（DOR）进行汇总分析,绘制诊断性实验Deek''s漏斗图,对纳入文献的发表偏倚及其真实性进行评价。结果 共检索出相关中英文文献661篇,经过筛选纳入12篇文献。汇总结果显示,CESM和MRI诊断乳腺癌的敏感度均为0.97,特异度分别为0.69和0.51,DOR分别为105.44和33.73,PLR分别为2.94和1.95,NLR分别为0.05和0.07,AUC（95%CI）分别为0.964 5（0.955 8,0.981 5）和0.919 8 （0.892 7,0.946 8）,CESM的AUC大于MRI。Deek''s漏斗图表明纳入文献不存在明显发表偏倚（P>0.05）。结论 CESM能有效诊断乳腺癌,较MRI有一定优势。     

乳腺癌动态增强MRI表现与腋窝淋巴结转移的关系

目的 探讨乳腺癌动态增强MRI表现与腋窝淋巴结转移的关系。方法 对79例乳腺癌患者（腋窝淋巴结转移31例、无腋窝淋巴结转移48例）的临床及动态增强MRI资料进行回顾性分析,参照乳腺影像报告和数据系统（BI-RADS）标准系统描述病变MRI表现,分析MRI表现与腋窝淋巴结转移的关系。结果 MRI显示肿块样病变71例（71/79,89.87%）,病理诊断腋窝淋巴结转移27例。腋窝淋巴结转移与未转移乳腺癌病变位置差异有统计学意义（P<0.05）,病变类型差异无统计学意义（P>0.05）。腋窝淋巴结转移与未转移乳腺肿块样病变边缘特征、早期强化模式及肿块最大径差异均有统计学意义（P均<0.05）,病变形态、内部强化方式、延迟期时间-信号强度曲线类型差异均无统计学意义（P均>0.05）。结论 动态增强MRI显示的乳腺癌病灶位置及肿块大小、边缘特征、早期强化模式均与腋窝淋巴结转移有关。     

超声造影诊断乳腺癌不同分子分型腋窝淋巴结转移的价值

目的 探讨CEUS对乳腺癌不同分子分型腋窝淋巴结转移的诊断价值。 方法 对女性乳腺癌患者89例,术前于肿瘤周围皮下注射超声造影剂,探查前哨淋巴结并标记,与术后免疫组织化学分子分型结果进行对照。 结果 乳腺癌Luminal B型腋窝淋巴结转移率最高(69.57%),其次为HER-2型(55.00%)和三阴型(42.86%),Luminal A型转移率最低(28.00%)。CEUS判断腋窝淋巴结转移的敏感度为84.09%(37/44),特异度为86.67%(39/45)。 结论 CEUS对于诊断乳腺癌不同分子分型腋窝淋巴结转移具有一定价值。     

超微超顺磁性氧化铁增强MRI诊断腹盆部恶性肿瘤淋巴结转移:Meta分析

目的 采用Meta分析观察超微超顺磁性氧化铁（USPIO）增强MRI诊断腹盆部恶性肿瘤淋巴结转移的价值。方法 检索PubMed、Embase、Cochrane Library、万方、维普及CNKI数据库,按照纳入及排除标准筛选文献,并提取四格表数据。采用Meta Disc 1.4及STATA 11.0软件检验异质性并进行统计学分析,选择相应效应模型,合并其效应量（敏感度、特异度）,绘制综合受试者工作特征曲线并计算曲线下面积（AUC）。结果 共纳入20篇英文文献,1 211例患者,3 583个淋巴结。USPIO增强MRI诊断腹盆部恶性肿瘤淋巴结转移汇总敏感度、特异度分别为0.89、0.96,AUC为0.98。回归分析显示异质性可能来源于肿瘤部位;亚组分析显示USPIO增强MRI诊断腹腔肿瘤淋巴结转移敏感度更高。结论 USPIO增强MRI对腹盆部恶性肿瘤淋巴结转移有较高诊断效能。     

实时组织弹性成像对乳腺良、恶性肿块诊断价值的Meta分析

目的 采用Meta分析评价实时组织弹性成像(RTE)对乳腺良、恶性肿块的诊断价值。方法 检索1994—2010年国内外公开发表的有关RTE诊断乳腺肿瘤的中文、英文文献,按照诊断试验的纳入和排除标准筛选文献,提取纳入研究的特征信息,进行Meta分析。结果 共纳入12篇文献,RTE对乳腺良、恶性肿块诊断的敏感度为0.78~0.89,特异度为0.84~1.00。合并敏感度和特异度分别为0.82(95%CI 0.79~0.85)、0.95(95%CI 0.93~0.96);合并阳性和阴性似然比分别为14.16(95%CI 8.38~23.93)、0.20(95%CI 0.17~0.23);SROC曲线下面积为0.91±0.01。结论 RTE对乳腺良恶性肿块的鉴别诊断具有较高的临床诊断价值。     

超声造影对乳腺癌诊断价值的Meta分析

目的 采用Meta分析评价超声造影对乳腺癌的临床诊断价值。方法 检索Cochrane图书馆、PubMed和中国国家知识基础设施(CNKI)文献库中的文献,根据Cochrane协作网筛选与诊断试验方法组推荐的诊断试验纳入标准筛选文献,对文献进行质量评价,并提取纳入研究的特征信息。采用Stata 11.0统计软件检验异质性,根据双变量随机效应模型,获得敏感度和特异度均值及其95%可信区间,计算曲线下面积,最后进行敏感性和漏斗图分析。结果 共纳入13篇英文文献,研究对象共计745例。纳入研究存在异质性,汇总的敏感度和特异度均值及其95%可信区间为0.89(0.82~0.94)和0.79(0.69~0.87),SROC曲线下面积为0.92(0.89~0.94)。纳入文献稳定性较好,Deeks漏斗图分析提示未见明显发表偏倚(P＝0.67)。 结论 Meta分析提示,超声造影诊断乳腺癌具有较高的敏感度,但特异度中等,还需要高质量的前瞻性研究以更准确地评价其临床价值。     

超声造影鉴别诊断胆囊良恶性病变Meta分析

目的 应用Meta分析方法评价CEUS对胆囊病变的诊断价值.方法 对Cochrane library、Pubmed数据库、Sciencedirect数据库、CNKI以及万方数据库中有关CEUS诊断胆囊占位性病变的中、英文文献进行筛选和评价,提取纳入研究的特征信息,通过Meta-disc1.4软件对入选文献的研究数据进行分析. 结果 共纳入16篇文献,包括中文12篇,英文4篇.CEUS诊断胆囊良恶性病变的合并诊断敏感度和特异度分别为90.9%(95%CI:87.5%~93.7%)、95.4%(95%CI:94.0%~96.5%),合并阳性和阴性似然比分别为12.77(95%CI:8.46~19.27)、0.12(95%CI:0.09~0.18),综合受试者工作特征曲线下面积为0.9695,Q^*指数0.9191.结论 CEUS对胆囊病变具有较高的诊断价值,可广泛应用于临床.     

经颅超声对我国帕金森病患者的诊断价值:Meta分析

目的 采用Meta分析的方法,评价我国经颅超声（TCS）对帕金森病（PD）患者的诊断价值。方法 检索建库至2017年11月间PubMed、Cochrone图书馆、CNKI和中国生物医学文献数据库中有关TCS诊断国人PD的文献,以诊断性试验准确性评价工具（QUADAS）评价纳入文献的质量,并采用Meta-disc 1.4软件进行数据分析,计算我国TCS诊断PD患者的汇总敏感度、特异度、阳性似然比、阴性似然比和诊断比值比,并绘制汇总受试者工作特征（SROC）曲线。结果 共纳入15篇文献,中文12篇,英文3篇,我国TCS诊断PD的敏感度范围为0.62~0.93,特异度范围为0.50~0.94。纳入研究存在异质性,采用随机效应模型进行分析。我国TCS诊断的汇总敏感度、特异度、阳性似然比、阴性似然比和诊断比值比及其95% CI分别为0.78（0.76,0.81）、0.85（0.83,0.88）、5.46（4.01,7.44）、0.22（0.17,0.29）和27.15（16.96,43.46）,SROC曲线下面积为0.904 9,Q指数为0.836 5。结论 在我国,TCS诊断PD具有一定价值,可作为辅助检查手段。     

全身弥散加权成像对恶性肿瘤骨转移诊断试验的系统评价

目的 系统评价全身弥散加权成像(WB-DWI)对恶性肿瘤骨转移的诊断效能。方法 全面检索相关文献,按照制定的标准对文献进行筛选,并对纳入研究的文献进行相关数据提取、质量评价和系统评价。结果 5篇文献最终纳入研究;由于文献数、病例数、肿瘤类型、病灶数均较少,不适合进行Meta分析,因此仅做定性系统评价。WB-DWI对骨转移灶的诊断敏感度、特异度、准确率分别为86.67%~95.68%、60.00%~99.07%、82.14%~95.39%,平均值分别为91.43%、86.11%、91.47%。结论 WB-DWI对恶性肿瘤骨转移具有较高的诊断敏感度、特异度、准确率,具有广阔的应用价值和推广前景。     

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.     

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.     

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.