乳腺影像学的现状与使命

乳腺癌是女性最常见的恶性肿瘤。乳腺影像学在乳腺癌的诊断、治疗方案的选择、疗效的评估及治疗后随诊监测中均具有重要作用。该文以国内外大量文献作为依据,对乳腺影像学常用检查方法（乳腺X线摄影、乳腺超声检查、乳腺MRI、PET-CT及其他乳腺影像技术）其临床应用的现状进行了较为全面而简要的阐述,作者结合自己的临床实践,针对乳腺影像学未来的发展趋势及使命提出了自己的见解。     

乳腺癌超声、MRI、X线征象与分子分型的相关性

超声、MRI、X线是临床对乳腺癌进行诊断、分期及随访的重要方法。随着乳腺癌个体化治疗的发展,乳腺癌各分子分型的划分对治疗方案的选择具有重要参考价值。对影像学检查方法的要求也从依据乳腺影像形态学特征检出乳腺癌发展为利用功能影像学检查对乳腺癌进行更为准确的判断,超声、X线和MRI的乳腺影像学特征与乳腺癌分子分型的相关性逐渐成为研究热点。本文对乳腺癌各分子亚型与超声、MRI、X线特征的相关性进行综述。     

不同影像学技术引导下乳腺癌穿刺活检研究进展

早发现、早诊断是提高乳腺癌疗效的关键,早期乳腺癌往往不具备典型临床症状和体征。影像学检查可发现临床无法触及的肿块,通过影像学技术引导定位活检现已成为诊断乳腺癌的重要工具。目前乳腺癌影像学检查方法主要包括乳腺超声、乳腺X线摄影、MR及锥束乳腺CT。本文就影像学技术引导定位穿刺活检诊断乳腺癌的进展进行综述。     

磁共振成像在乳腺癌影像学筛查中的应用:2010ACR与SBI乳腺影像学筛查实践指南解读

影像学能够在临床出现可触及肿块之前早期发现乳腺癌已经成为不争的事实.在多种影像学检查中,乳腺X线摄影是惟一被偱证研究证实的能够早期发现乳腺癌而降低死亡率的影像学方法,但由于存在局限性,因而近年来大量临床研究致力于评估乳腺磁共振成像及乳腺超声在乳腺癌筛查中应用的可行性和效能.为进一步提高乳腺癌早期检出率,乳腺癌筛查方案日...     

高频彩超及X线钼靶检查对乳腺原位癌早期诊断价值的对照分析

目的:探讨高频彩超及X线钼靶检查诊断乳腺原位癌的影像学特点.方法:回顾性分析我院2007年1月-2013年12月经手术证实为乳腺原位癌共30例患者的高频彩超及X线钼靶检查的影像学资料,并作对照分析研究.结果:30例乳腺原位癌患者中,乳腺X线钼靶检查有乳腺癌征象共有21例,诊断正确率70％;乳腺高频彩超检查呈乳腺癌表现的有16例,诊断正确率53％.X线钼靶对乳腺原位癌的诊断正确率(70％)显著高于彩超(53％).X线钼靶对肿瘤微钙化的正确识别率(66.7％)显著高于彩超(40％).结论:对于乳腺原位癌的早期影像学诊断来说,乳腺X线钼靶优于高频彩超检查,但二者能取长补短,联合应用两种影像学方法能进一步提高乳腺原位癌的检出率,减少漏诊的发生.     

乳腺癌影像学诊断研究进展

乳腺癌是当前威胁妇女生命健康最常见的恶性肿瘤。我国乳腺癌的发病率也呈逐年上升。随着现代医学的发展,乳腺癌可以通过乳腺影像学检查方法如乳腺X线摄影等首先发现,进而提高了乳腺癌的诊断准确性和降低了死亡率。特别是近几十年,新的乳腺影像诊断技术的飞速发展更是为不断提高乳腺癌诊断的准确率奠定了基础。本文就乳腺X线摄影、乳腺超声声像图、CT和MRI等影像学检查方法对乳腺癌的诊断价值及其最新进展做综述评价。     

全数字化乳腺摄影及CT扫描对早期乳腺癌50例的诊断分析

目的探讨全数字化乳腺摄影及CT扫描对早期乳腺癌的诊断价值,提高乳腺癌的早期诊断率。方法总结近2 a来经全数字化乳腺摄影及螺旋CT扫描确诊同时经手术病理证实的早期乳腺癌患者50例,分析全数字化乳腺摄影及CT扫描的影像学征象对早期乳腺癌的诊断价值。结果 50例乳腺癌患者中28例有明显肿块影,部分有毛刺样改变,8例仅有细小的沙粒样钙化,其中30例伴有间接征象。结论全数字化乳腺摄影及CT扫描对乳腺癌的早期诊断具有重要意义,尤其对于触诊阳性患者,乳腺影像学检查更是必不可少的诊断方法。     

原发性乳腺淋巴瘤误诊分析

目的探讨原发性乳腺淋巴瘤(primary breast lymphoma,PBL)误诊原因及减少误诊的方法。方法回顾性分析14例术前误诊PBL患者乳腺彩超、乳腺钼靶X线、乳腺CT、手术组织病理等资料。结果 14例中以腋窝淋巴结肿大就诊2例,以皮肤红肿疑似乳腺炎就诊2例,以乳腺无痛性肿块就诊10例;术前误诊乳腺癌11例,乳腺炎性病变2例,乳腺纤维瘤1例;14例均行乳腺彩超检查,10例考虑乳腺癌,4例考虑乳腺纤维瘤;11例行乳腺钼靶X线检查,8例考虑恶性,3例考虑良性;7例行CT检查,1例考虑乳腺纤维瘤,3例考虑乳腺癌,1例考虑乳腺增生,2例考虑炎性病变但不排除炎性乳腺癌;术前误诊为乳腺癌11例,乳腺炎性病变2例,乳腺纤维瘤1例;14例均行手术治疗,术后组织病理及免疫组织化学检查证实为PBL,均为B系非霍奇金淋巴瘤。结论 PBL临床表现及影像学表现缺乏特异性,术前易误诊,确诊需依据组织病理及免疫组织化学检查。     

乳腺纤维瘤恶变的X线诊断

目的：探寻乳腺纤维瘤恶变规律,做好预防,自我检查,减少恶变率,减轻患者病痛.材料与方法：通过详细观察、分析对照乳腺纤维瘤、乳腺癌患者的X线表现,从中分析、判断纤维瘤恶变过程中出现哪些临床、影像学改变.结果：乳腺纤维瘤恶变过程中,往往病程较长,未予及时体检或自我检查不够,以致贻误病情,当发现乳腺包块短期内迅速增大、活动度减退时,应及时就诊,排除恶变可能,或及时手术治疗.结论：乳腺纤维瘤恶变完全可以预防,关键在于自我检查,发现异常应及时治疗.     

乳腺超声的临床应用进展

乳腺癌是现今全世界范围内女性发病率、死亡率最高的恶性肿瘤。在我国女性乳腺癌的发病、死亡均呈持续上升趋势，由于其危险因素及我国人口增长及老龄化的双重作用。乳腺癌将是近年来增长幅度最大的恶性肿瘤之一。乳腺癌发现早晚和诊断时的分期是影响预后的重要因素，如何早期发现、早期诊断是防治乳腺癌的重要课题。乳腺影像学检查是乳腺检查中最重要的组成部分，其中乳腺超声是一项同时被用于诊断和筛查的重要检查方法。现就此进展作如下综述。[第一段]     

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.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。