MSCT冠状动脉成像与冠状动脉造影的对比研究

目的 :研究MSCT在冠状动脉成像中的临床应用价值。方法 :4 0例疑冠状动脉狭窄者行MSCT扫描 ,利用最大密度投影 (MIP)重建 ,2D重建 ,仿真内窥镜技术 ,了解冠状动脉病变情况 ,并与冠状动脉造影对比。结果 :4 0例 16 0支血管经MSCT成像 ,134支 (84 % )可用于影像学评价 ,2 6支 (16 % )不能评价。冠状动脉造影发现狭窄 4 6支 ,其中左前降支 (LAD)病变 18支 ,回旋支 (LCA)病变 12支 ,左主干 (LMA) 3支 ,右冠 (RCA)病变 13支。MSCT发现狭窄 4 1支 ,其中左前降支病变 14支 ,回旋支病变 12支 ,左主干病变 3支 ,右冠病变 12支。敏感性为 82 .6 % (38/ 4 6 ) ,特异性 97.3% (111/ 114 )。结论 :在控制心率的情况下 ,MSCT可作为冠状动脉狭窄的一种无创筛选检查方法。     

多层螺旋CT显示冠状动脉狭窄的初步临床应用

目的：探讨多层螺旋CT(MSCT)在显示冠状动脉狭窄中的价值和限度。方法：对临床疑诊冠心病的38例患作MSCT冠状动脉成像检查(回顾性心电门控、0．5s螺旋扫描、一12,脏单扇区重建算法和静脉注射对比剂)，其检查结果与插管法冠状动脉造影对照。结果：在38例患的152支冠状动脉中，CT图像能够满足管腔评价为104支(占68.4％)。对于CT图像能够满足管腔评价的冠状动脉(左前降支、左回旋支和右冠状动脉)，MSCT显示冠状动脉狭窄(≥50％)的敏感度和特异度分别为87．1％和78．4％。阳性和阴性预测值分别为77．1％和87．9％。若将CT图像不能满足评价的≥50％狭窄的13支冠状动脉包括在内，其诊断敏感度为61.4％。结论：如CT图像能够满足影像学评价．MSCT对冠状动脉狭窄(≥50％)的显示具有较高的准确性。     

对比增强磁共振冠状动脉成像的初步研究

目的　利用三维对比增强磁共振血管成像技术 ,对正常冠状动脉成像进行初步研究。方法　 30例健康志愿者进行对比增强磁共振冠状动脉成像 ,采用 3DFLASH压脂序列 ,心电触发、屏气状态下分别行左、右冠状动脉成像 ;经后处理得到左主干、左前降支、左回旋支和右冠脉的图像 ,对图像质量进行评分 ,并且测量血管分支显示长度。结果　对其中 2 6例健康志愿者的 10 4支冠状动脉分支进行了分析 ,85支血管较满意显示 (评分在 3分以上 ) ,其中左前降支 2 6例和右冠脉 2 6例均满意显示 ,左主干和左回旋支显示满意者分别为 2 1例和 12例。血管显示长度 :左主干(1.5 4± 0 .31)cm、左前降支 (6 .6 4± 0 .5 4 )cm、左回旋支 (2 .4 6± 0 .98)cm、右冠脉 (9.75± 1.14 )cm。显示血管分支长度与国内外同类研究相比近似。结论　对比增强磁共振技术可用于冠状动脉成像 ,但存在一些技术障碍。     

64排螺旋CT冠状动脉成像重建的最佳R-R时相及其对图像质量的影响

目的探讨重建相位对64排螺旋CT冠状动脉造影图像质量的影响。方法对56例拟诊冠心病患者行64排螺旋CT扫描后,使用Philips独立工作站提供的冠状动脉分析软件,进行冠状动脉重建。重建的方法包括容积再现、多平面重组、最大密度投影和曲面重组等。分析不同R-R时相各支冠状动脉的显示情况。结果右冠状动脉近段、远段及左前降支、左回旋支近段的最佳重建时相是70%～75%,右冠状动脉中段、后降支及左回旋支远段重建的最佳时相为70%～75%或35%～40%。结论选择回顾性心电门控最佳R-R时相重建冠状动脉可最大限度减轻心脏运动伪影,提高图像质量。     

64层螺旋CT在评价冠状动脉支架中的价值

目的探讨64层螺旋CT冠状动脉造影在评价冠状动脉支架中的价值。方法对56例冠状动脉支架术后患者行MSCT冠状动脉造影检查,利用MSCT的各种先进的图像后处理功能对各支冠状动脉进行重建,以显示冠状动脉支架的形态、位置并观察有无再狭窄。结果在56例行MSCT冠状动脉造影的患者中1例由于患者有严重的窦性心率不齐,重建图像质量欠佳,其余患者均成功显示冠状动脉各主支(左主支、回旋支、前降支右支冠状动脉)及部分3、4级分支,且可显示所有冠状动脉支架的形态、位置,其中18例患者的31个支架术后出现再狭窄,所有行MSCT冠状动脉造影检查的患者无一例出现并发症,所有CT诊断支架术后再狭窄的患者同时行选择性血管造影检查,其中14例患者的25个支架有支架术后再狭窄,CT诊断的准确率为80.65%。结论64层螺旋CT冠状动脉造影是评价冠状动脉支架的一种安全可靠的检查方法。     

心电门控多层螺旋CT冠脉显像与常规冠脉造影对比研究

目的:回顾性分析心电门控多层螺旋CT(MSCT)经静脉注射对比剂冠状动脉成像的可行性,探讨MSCT在冠状动脉疾病诊断的可行性及对冠脉狭窄的显示能力。方法:30例窦性心律患者经MSCT检查1~3天后行定量冠脉造影。以3.5ml/s速率经静脉注入对比剂,延迟15s,用GE公司MSCT机进行扫描,要求患者1次屏气30s,采用回顾性心电门控显像窗进行显像重建。分析所有直径≥2mm冠脉及分支并识别狭窄(≥50%)及闭塞病变。其结果与定量冠脉造影进行对比。结果:在253支冠脉(左主干、左前降支、左回旋支和右冠脉,包括≥2mm的侧支)中218支(86.2%)可评价;11例(36.7%)患者所有冠脉均可评价。检测明显狭窄(≥50%)的敏感性是82.6%、特异性是97.9%;阳性预测值(PPV)是82.6%、阴性预测值(NPV)是97.9%;高度狭窄(≥75%)的敏感性、特异性分别是83.3%、98.1%。总的敏感性(包括MSCT不可评价的血管)是68.4%。对于右冠脉近段、左主干、前降支的MSCT直径测量与定量冠脉造影相比相关性较好。结论:采用回顾性心电门控多层螺旋CT冠脉成像在显像质量较好的情况下,具有较高的准确性。由于目前MSCT不能有效消除冠脉运动的伪影影响,限制了该技术的临床应用,但仍然是一项有前途的冠状动脉疾病诊断方法。     

多层螺旋CT冠状动脉成像技术的临床应用

[目的]探讨16层螺旋CT冠状动脉成像技术及临床应用价值.[方法]36例临床诊断或可疑冠心病的患者做16层螺旋CT冠状动脉成像检查,在6个心电相位窗上采用多种重建方法对原始数据进行重建并分析影像学表现.[结果]左冠状动脉主干及前降支重建的最佳时相为75%R-R时相,左回旋支及右冠状动脉为60%R-R时相.以75%的相位窗重建得到客积再现的图像为最好.[结论]多层螺旋CT在多数情况下能较好地显示冠状动脉,可以作为冠状动脉病变的筛选方法.     

高端CT冠状动脉成像对单冠状动脉畸形分型诊断价值

目的:通过对冠状动脉CTA对先天性单冠状动脉畸形的影像分析,探讨冠状动脉CTA对先天性单冠状动脉畸形分型诊断价值及其与临床症状相关性。方法:回顾性分析25例经冠状动脉CT血管造影(CTA)诊断为单冠状动脉畸形患者资料,使用CT多种后处理方法进行重建分析,观察冠状动脉的起始及走行情况。结果:25单冠状动脉畸形病例中,右冠状动脉缺如左冠状动脉供血整个心脏20例(其中回旋支供血右心系统15例,前降支供血右心系统3例;前降支及回旋支分别发出分支供血右心系统2例);左冠状动脉缺如单右冠状动脉畸形5例,所有病例均通过VR、MIP和MPR等重建显示冠状动脉的形态。结论:冠状动脉CTA能准确显示冠状动脉的走行分布,可以作为诊断先天性单冠状动脉畸形及其分型的首选检查方法,为临床症状诊断提供依据。     

心率、扇区重组、时相重建对64层螺旋CT冠状动脉成像质量的影响

目的探讨心率、重组方法和重建时相窗对64层螺旋CT冠状动脉成像质量的影响。方法398例64层螺旋CT冠状动脉造影扫描,根据不同心率应用不同扇区重组、多相位重建,传入后处理工作站进行图像重建。结果心率在50-70次/分所得冠状动脉图像质量较好,但扫描时心律变化幅度大者成像质量下降。心率〉75次/分,用双扇区和四扇区重组能获得相对高质量的图像。左前降支、回旋支在75%R-R时相重建图像较好,右冠状动脉在45%R-R时相显示较好。结论64层螺旋CT冠状动脉成像质量与心率、扇区重组的应用和多相位重建密切相关。     

64 层CT诊断冠状动脉支架内再狭窄准确性的影响因素分析

目的:探讨影响64层CT诊断冠状动脉支架内再狭窄诊断的可能因素.方法:入选131名患者,采用64层CT重建208枚支架血管图像,用4分评分法评估图像质量;冠状动脉造影检查为再狭窄诊断的金标准.结果:208枚支架中发现35例再狭窄.64层CT诊断支架内再狭窄其敏感性为100%,特异性为93.6%,其位于左主干和前降支的图像质量显著优于回旋支和右冠状动脉,而且大直径支架的图像质量也显著优于小直径( ＜ 3.0 mm)支架,此外,支架重叠也因伪影加重而干扰图像的质量.结论:64层CT冠状动脉成像诊断支架内再狭窄具有一定的准确性,尤其可作为左主干、前降支等大直径单支架植入术后的随访检查方法.     

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.     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.     

自动化酸碱平衡图在急诊社区获得性肺炎诊治中的应用

目的 探讨自动化酸碱平衡图在急诊科社区获得性肺炎(CAP)患者诊断中的价值.方法 根据病史、肺功能测定结果、慢性阻塞性肺疾病(COPD)诊断标准,将111例CAP患者分为单纯CAP组(56例)和COPD合并CAP组[即慢性阻塞性肺疾病急性加重(AECOPD)组,55例].询问患者病史后即刻抽取动脉血测血气并进行自动化酸碱平衡图分析.结果 血气分析结果显示,AECOPD组动脉血二氧化碳分压(PaCO2,kPa)、HCO3- (mmol/L)、剩余碱(BE,mmol/L)均显著高于CAP组(PaCO2:7.714±2.414比5.896±1.308,HCO3-:30.767±7.185比25.014±3.043,BE:4.345±5.371比-0.354±3.180,均P＜0.01).自动化酸碱平衡图分析结果显示,AECOPD组患者酸碱平衡紊乱高达89.1％,CAP组为66.1％.将AECOPD组和CAP组患者中正常(10.9％、33.9％)、急性呼吸性酸中毒(急性呼酸,12.7％、14.3％)、慢性呼吸性酸中毒(慢性呼酸,49.1％、10.7％)、呼吸性碱中毒(呼碱,7.3％、14.3％)、代谢性酸中毒(代酸,12.7％、17.9％)、代谢性碱中毒(代碱,12.7％、8.9％)综合进行x2分析,差异有统计学意义(x2=24.421,P=0.001),而将正常、急性呼酸、呼碱、代酸及代碱进行x2分析,差异无统计学意义(x2=5.280,P=0.260),提示AECOPD患者慢性呼酸的发生率较单纯CAP患者显著增加.结论 自动化酸碱平衡图能帮助急诊科医师快速识别CAP患者是否存在多重酸碱平衡紊乱,并可快速识别急、慢性呼吸系统疾病.