颈动脉内膜中层厚度与心血管危险因素聚集性的关系

目的:通过对颈动脉IMT(颈动脉内中膜厚度intima-media thickness)和粥样斑块进行超声检测,分析心血管危险因素聚集性与颈动脉粥样硬化的关系.方法:227例受检者,男139例,女88例,年龄45～57岁(平均53.25±3.01岁).大部分受检者有多重危险因素但临床上无严重动脉粥样硬化疾病并以药物治疗为主.1.记录身高、体重、腰围及血压、空腹血糖、血脂,吸烟史及家族史.2.颈动脉彩色多普勒超声检查:分别测量颈总动脉、颈动脉膨大处,颈内动脉取平均IMT.3.根据颈动脉超声结果分组,正常对照组,IMT增厚组,斑块形成组.4.冠心病危险因素按国际标准确定:危险因素评分范围为0～5,以危险因素评分≥2定义为危险因素聚集.结果:1.各组间心血管危险因素水平的比较 :三组有统计学意义(P＜0.05).并且随血压、血糖、胆固醇、腰围水平升高,随LDL-L下降,颈动脉(IMT)加重.2.各组间心血管危险因素异常检出率比较:高血压、高血糖、高胆固醇血症、高LDL-C血症组间比较有统计学意义(P＜0.05),随颈动脉IMT加重,高血压、高血糖、高胆固醇血症、高LDL-C血症异常检出率明显升高.3.各组心血管危险因素积分比较:根据心血管危险因素积分按等级检验进行秩和检验(H=20.16,P＜0.05),并且随IMT增厚,危险因素积分逐渐升高.4.颈动脉IMT与心血管危险因素的相关分析:在双变量Spearsman相关分析中,颈动脉内中膜厚度与各危险因素及危险因素评分呈显著相关(P＜0.05),在调整性别、年龄进行偏相关分析中,IMT与舒张压、HDL-C的相关性无统计学意义(P＞0.05),与FBG、SBP、TC、TG、LDL-C、RFS存在显著相关性(P＜0.01).IMT与危险因素评分的相关系数分别为0.407与0.219.结论:心血管危险因素的聚集,提示颈动脉粥样硬化程度严重,预示颈动脉粥样硬化病变与多种心血管危险因素的聚集有显著相关性.     

关于超声实践教学模式改革的探讨

随着医学教育改革进程的不断深入,基于医教改革的内容与目标,探讨了新的超声实践教学模式在医学影像学中的教学应用,建立完善的考核机制,促进超声影像学的人才培养,提高医学生的实践能力、创新能力、思维能力。     

55例卵巢囊性畸胎瘤的超声诊断分析

目的探讨超声对卵巢囊性畸胎瘤的诊断价值。方法对55例经手术及病理证实的囊性畸胎瘤的超声图像进行回顾性分析。结果55例囊性畸胎瘤中超声诊断51例,诊断符合率92．7％,2例误诊为巧克力囊肿,1例误诊为浆液性乳头状囊腺瘤,1例误诊为卵巢囊肿。结论超声对卵巢囊性畸胎瘤的诊断具有重要的价值,可作为首选检查方法。     

非酒精性脂肪性肝病和内脏脂肪厚度相关性研究

目的：评价超声测量内脏脂肪厚度对非酒精性脂肪性肝病（NAFLD）的诊断和分级的价值。方法：收集2010年8月至2011年4月在某院体检中心进行健康体检资料共122例,NAFLD组74例,非NAFLD组48例,经超声测量内脏脂肪厚度。结果：超声测量内脏脂肪厚度在NAFLD组和非NAFLD组之间差异有显著性统计学意义（P=0．004）。轻度、中度、重度NAFLD组测量的内脏脂肪厚度经方差分析结果为差异有统计学意义（F=9．91,P〈0．001）,进一步用LSD法分析显示两两之间都有差异。经超声测量的VFT诊断NAFLD的ROC曲线下面积为0．794,p=0．011,诊断切点值为2．70cm。结论：经超声测量的内脏脂肪厚度可作为NAFLD诊断和分级的指标。     

The effects of forearm fatigue on baseball fastball pitching,with implications about elbow injury

This study investigated the contribution of flexor muscles to the forearm through fatigue; therefore, the differences in forearm mechanisms on the pitching motion in fastball were analysed. Fifteen baseball pitchers were included in this study. Ultrasonographical examination of participants’ ulnar nerve in the cubital tunnel with the elbow extended and at 45°, 90° and 120° of flexion was carried. A three-dimensional motion analysis system with 14 reflective markers attached on participants was used for motion data collection. The electromyography system was applied over the flexor carpi ulnaris, flexor carpi radialis and extensor carpi radialis muscles of the dominant arm. Flexor carpi ulnaris muscle activity showed a significant difference during the acceleration phase, with a peak value during fastball post-fatigue (P = 0.02). Significant differences in the distance between ulnar nerve and medial condyle on throwing arm and non-throwing arm were observed as the distance increased with the elbow movement from 0° to 120° of flexion (P = 0.01). The significant increase of the flexor carpi ulnaris muscle activity might be responsible for maintaining the stability of the wrist joint. The increased diameter might compress the ulnar nerve and cause several pathological changes. Therefore, fatigue in baseball pitchers still poses a threat to the ulnar nerve because the flexor carpi ulnaris and flexor carpi radialis all originate from the medial side of the elbow, and the swelling tendons after fatigue might be a key point.     

32例肾囊肿的X线和B超分析

对３２例肾囊肿做了Ｘ线和Ｂ超分析．显示尿路平片可见肾外形的改变，静脉尿路造影表现出肾盂、肾盏移位、变形的各种形态．并探讨了其形成的机理．通过Ｘ线检查７例肾囊肿误为正常或肾癌，分析造成误诊的原因。Ｂ超检查显示边界清楚的圆形或椭圆形无回声液性暗区，其中仅１例将肾囊肿误诊为肾积水，诊断符合率为９７％（３１／３２）．因此，临床上颖有肾囊肿的影象检查应首选Ｂ超检查，Ｘ线检查能显示肾解剖结构和轮廓，提高对本病的诊断率，并讨论了ＣＴ对肾囊肿诊断的价值。     

Is there a real diagnostic impact of elastosonography and contrast-enhanced ultrasonography in the management of thyroid nodules?

Ultrasonography(US) and the new applications US elastography(USE) and contrast-enhanced US(CEUS) are used in the screening of thyroid nodules,for which fine-needle aspiration biopsy(FNAB) is the best single diagnostic test.The aim of the study was to compare the sensitivity,specificity,positive predictive value(PPV),and accuracy of the four examinations in nodules with cytological and histological diagnoses.The study used data from US,FNAB,USE(elasticity(ELX 2/1) index),and CEUS(Peak index and time to peak(TTP) index) evaluated in 73 thyroid nodules in 63 consecutive patients likely to undergo surgery.Cytological-histological correlation was available for 38 nodules.No correlation emerged between nodule size and cytological results.A significant(P=0.03) positive correlation between cumulative US findings and cytological results was found.In addition,significant correlations between cumulative US findings and cytology(P=0.02) and between cumulative US findings and histology(P<0.0001) were found.US showed the best specificity and PPV,and FNAB the best sensitivity.There was no significant difference in the ELX 2/1 index,Peak index,or TTP index among nodules subdivided according to cytological scores.No significant correlation was found between ELX 2/1 index,Peak index,and TTP index,on the one hand,and nodule size,US cumulative findings,cytology,and histology on the other hand.The sensitivity of the ELX 2/1 index was high,but its specificity was very low.The accuracy and PPV of USE were lower than those of the other procedures.Only the correlation between Peak index and cumulative US findings reached a value close to significance.Our ultimate aim is to minimise unnecessary thyroidectomy.US and FNAB continue to play a central diagnostic role.The use of a US score showed high specificity and PPV.The specificity of FNAB was low in this selected series because of the numbers of indeterminate cytological responses.USE and CEUS are innovative techniques that need to be standardized.The ELX 2/1 index,Peak index,and TTP index seem to be unrelated to histology.The best statistical data on USE and CEUS concerned their sensitivity and PPV,respectively.At present,USE and CEUS are too time-consuming and of limited utility in selecting patients for surgery.     

The benefits and limitations of using ultrasonography to supplement anatomical understanding

Anatomical understanding is critical to medical education. With reduced teaching time and limited cadaver availability, it is important to investigate how best to utilize in vivo imaging to supplement anatomical understanding and better prepare medical graduates for the proliferation of point‐of‐care imaging in the future. To investigate whether using short sessions of in vivo imaging using ultrasonography could benefit students' anatomical knowledge and clinical application, we conducted a 2‐hour session on abdominal anatomy using ultrasonography in small groups of five to six students, for both first‐ and second‐year student cohorts. Individual feedback was collected to assess student perceptions. To measure retention and understanding, a short examination containing ultrasound images and questions and performance of a clinical skill (gastrointestinal' tract examination) were assessed. Ultrasonography sessions were highly valued by the students, with 90% of the students reporting their understanding was improved, and over 70% reporting increased confidence in their anatomical knowledge. However, the assessments showed no appreciable impact on skills or understanding related to abdominal anatomy and examination. We conclude that the risk associated with limited exposure increasing confidence without increasing skills remains real and that in vivo imaging is not effective when used as a short adjunct teaching tool. The widespread use of ultrasonography means finding the best way to incorporate ultrasound into medical education remains important. To this end, we are currently implementing an extended program including echocardiography and multiple anatomical sessions that will determine if frequency and repetition of use can positively impact on student performance and understanding. Anat Sci Educ. © 2013 American Association of Anatomists.     

高频超声在创伤性周围神经病变中的诊断价值

目的：探讨高频超声在创伤性周围神经病变中的诊断价值。方法：对31例患者（35条神经）临床诊断周围神经病变进行高频彩超检查与病理或其它影像学进行比较分析。结果：高频超声能清晰显示周围神经神经外膜、神经束膜及神经纤维束走行及内部结构,根据不同周围神经超声声像图特征,能判断其损伤部位、程度、范围及损伤类型。结论：高频超声能清晰显示不同类型周围神经损伤,准确判断损伤部位及程度,具有较高临床应用价值。     

Undergraduate student perceptions of the use of ultrasonography in the study of “Living Anatomy”

Ultrasonography is a noninvasive imaging modality, and modern ultrasound machines are portable, inexpensive (relative to other imaging modalities), and user friendly. The aim of this study was to explore student perceptions of the use of ultrasound to teach “living anatomy”. A module utilizing transthoracic echocardiography was developed and presented to undergraduate medical, science, and dental students at a time they were learning cardiac anatomy as part of their curriculum. Relevant cardiac anatomy was explored on a student volunteer and images were projected in real‐time to all students via an AV projection system. Students were asked to complete a questionnaire about the learning experience and were given the opportunity to provide open feedback. The students' evaluations of this learning experience were very positive. They agreed or strongly agreed that it was an effective way to teach anatomy (90% medical; 77% dental; 100% science) and that it was incorporated in a way that promoted reinforcement of the lecture material (83% medical; 76% dental; 100% science). They agreed or strongly agreed with statements that the experience was innovative (93% medical; 92% dental; 100% science) and stimulated interest in the subject matter (86% medical; 75% dental; 96% science), and that they would like to see more modules, exploring other anatomical sites, incorporated into the curricula (83% medical; 72% dental; 100% science). We believe that ultrasound could be a useful tool, in conjunction with traditional teaching methods, to reinforce the learning of anatomy of a variety of different undergraduate student groups. Anat Sci Educ. © 2010 American Association of Anatomists.