64层螺旋CT冠脉CTA对比剂注射方案优化

目的 比较相同碘负荷情况下,不同对比剂注射方案以及相同碘浓度情况下,不同对比剂注射流率在64层螺旋CT冠脉CTA的应用效果.方法 58例可疑冠心病病例分为3组,分别采用不同对比剂注射方案进行冠脉CTA检查;对血管强化程度、重建血管清晰度进行评价.结果 300 mgI/ml×5 ml/s和370 mgI/ml×4 ml/s两种注射方案冠脉平均强化水平相似,约350～370 HU,两者差异不具有统计学意义.370 mgl/ml×4 ml/s和370 mgI/ml×3 ml/s两种注射方案在升主动脉,左、右冠状动脉主干平均强化程度分别为360 HU左右和330 HU左右,但两组间的差异不具有统计学意义,两组重建血管清晰度无统计学差异,96.3%的重建血管能够满足诊断.结论 应用370 mgI/ml×3 ml/s注射方案相当的单位时间碘负荷量,平均强化程度330 HU,能够满足64层螺旋CT冠脉CTA检查.     

血液循环速度与冠脉CT血管造影增强效果的相关性及对比剂优化方案

  目的  探究血液循环速度与冠状动脉CT血管造影（CTA）增强效果的相关性,并分析对比剂优化方案。  方法  选取2020年1月~2021年4月于我院行冠状动脉CT血管造影患者161例,按照血液循环速度分为快速组（n=32）、中等组（n=35）和缓慢组（n= 94）,分析血液循环速度与增强效果关系,并将缓慢组分为A、B、C 3个亚组,A组与快速组、中等组使用的对比剂浓度和注射速率相同（均为碘浓度320 mgI/mL,速率5 mL/s）;B组采用对比剂的碘浓度为350 mgI/mL,速率5.5 mL/s;C组采用对比剂的碘浓度为370 mgI/mL,速率5.5 mL/s,比较各组伪影发生、室间隔显示、冠脉CT值及图像质量情况。  结果  快速组、中等组、B组、C组产生伪影概率均低于A组,且快速组低于中等组,C组低于B组（P < 0.05）;快速组、中等组、B组、C组主动脉根部CT值、图像质量评分、室间隔显示评分均高于A组,且快速组高于中等组,C组高于B组（P < 0.05）。  结论  血液循环速度能增加冠脉CTA增强效果,清晰显示室间隔,对于血液循环较慢者可适当增加对比剂浓度和注射速率以保证图像质量。      

不同浓度对比剂在64层CT下肢动脉成像中的应用比较

目的 探讨不同浓度对比剂在下肢动脉CTA中的应用价值.方法 将112例患者按照对比剂浓度随机分为4组,分别为对照组(350mgI/ml)、A组(300mgI/ml)、B组(240mgI/ml)及C组(200mgI/ml),每组各28例,各组行下肢动脉CTA检查,采集原始数据后,传至AW4.7工作站进行图像处理及评分并主、客观评价4组患者腹主动脉下段及下肢各段动脉显影情况及图像质量.结果 腹主动脉下段至小腿动脉全景MIP图像质量评分A、B两组与对照组比较分析差异无统计学意义(P>0.05),C组图像质量评分与对照组差异有统计学意义(P<0.05).各段动脉图像质量比较分析 A 组、B 组腹主动脉下段、髂外动脉、股动脉、腘动脉图像质量评分与对照组差异无统计学意义,小腿动脉图像质量评分略低于对照组,但差异无统计学意义(P>0.05);C组腹主动脉至小腿各段动脉图像质量评分与对照组差异有统计学意义(P<0.05).各段动脉图像信号强度(signal intensity,SI)分析比较A组腹主动脉下段至小腿各段动脉图像质量信号强度SI评分与对照组差异无统计学意义;B组腹主动脉下段至腘动脉图像质量信号强度SI评分与对照组差异无统计学意义,小腿动脉SI略低于对照组,但差异无统计学意义(P>0.05);C组腹主动脉下段至小腿各段动脉图像质量信号强度SI与对照组差异有统计学意义(P<0.05).结论 下肢动脉CTA中,240mgI/ml为最佳对比剂造影浓度,既减少碘对比剂用量,降低对比剂不良反应发生的风险,同时满足临床诊断的需求,具有较强的临床应用价值.     

256层螺旋CT主动脉成像中不同触发监测点对对比剂剂量的影响

目的 探讨256层螺旋CT主动脉成像中不同触发监测点对对比剂剂量的影响。 方法 将接受主动脉CTA的40例患者随机分为A组和B组,对比剂为碘佛醇(350 mgI/ml),注射速度为4.0 ml/s。A组监测点在主动脉弓降部,对比剂剂量为70 ml;B组监测点在肺动脉主干,对比剂剂量为55 ml。测定主动脉增强后平均CT值,统计分析两种监测点下的主动脉增强后平均CT值和图像质量。 结果 40例均触发成功;A、B组主动脉增强后平均CT值分别为(267.4±21.6)HU、(257.7±27.0)HU,差异无统计学意义(t=1.25,P=0.22)。A组20例图像质量均为优;B组19例图像质量为优,1例为良;两组满足诊断率均达100%,差异无统计学意义(P=1.000)。 结论 以肺动脉主干为触发监测点行256层螺旋CT主动脉成像是可行的,可降低对比剂剂量,优越性明显。     

320排冠脉CT成像中根据体重调整的对比剂最低用量的可行性研究

目的探讨320排冠脉CT成像(CCTA)检查中,获得满足诊断要求的冠脉成像所需的最低的对比剂(CM)用量。方法收集拟行320排CCTA检查的患者98例(男62例,女36例),采用随机数表法分为三组:A组(n=34)接受0.7ml/kg的CM(350 mg I/ml),B组(n=34)接受0.6ml/kg的CM,C组(n=30)接受0.5 ml/kg的CM,注射流率均为5.0ml/s,随后推注30 ml生理盐水冲刷。测量并比较心脏和冠脉不同兴趣区的CT值,双人评价各组CCTA的图像质量。结果 C组冠脉近段CT值均低于A组和B组(P0.05),而A、B组间差异均无统计学意义(P0.017)。同时,C组冠脉近段CT值≥300HU和主要冠脉节段评分≥3在血管总数和患者总数中的百分比均低于A组和B组(P0.05),而A、B组间差异均无统计学意义(P0.05)。结论总量为0.6ml/kg的对比剂(350mg I/ml)用量是320排CCTA检查中获得满足诊断要求的冠脉成像所必需的。     

小剂量对比剂在颈部64层CTA中的应用

目的探讨常规注射速率下小剂量对比剂在颈部CTA中的应用。方法颈部CTA检查采用常规注射速率(3～4ml/s)下经由肘静脉注射器团注优维显(370mgI/ml),由阈值触发扫描。35例低剂量组采用50ml对比剂,35例常规组则用70ml对比剂。由2名有经验的影像科医师双盲法独立进行图像评价分析。结果 2名医师对图像评判结果中度一致(Kappa=0.802);低剂量组图像优良率88.6%(31/35),常规剂量组优良率62.9%(22/35)。小剂量组图像质量优于常规剂量组(Z=-3.236,P=0.001)。结论与常规剂量相比,低剂量对比剂可以明显减少静脉伪影,为临床提供可靠的诊疗依据。     

探讨急性主动脉综合征患者CT血管成像采用双低剂量技术临床应用价值

目的:探讨急性主动脉综合征患者CT血管成像采用双低剂量技术临床应用价值。方法:将2018年1月至2019年6月在我院接受CT血管成像检查的90例急性主动脉综合征患者作为主要对象,研究过程中使用数字随机表法分组,45例/组。观察组患者检查时的管电压为80~100kV,图像行iDose4迭代算法重建,对比剂碘海醇为300mgI/ml;对照组患者检查时的管电压为120kV,图像行滤波反投影算法重建,对比剂碘海醇为370mgI/ml。对两组有效辐射剂量以及碘摄入量进行比较。结果:观察组的对比剂碘摄入量少于对照组,有效辐射剂量少于对照组(P<0.05)。结论:急性主动脉综合征患者在行CT血管成像检查时选择双低剂量技术可在保障图像质量和目标血管CT值的基础上,减少有效辐射剂量和碘摄入量,更值得在临床上推广应用。     

320排CT双低扫描在小儿川崎病冠状动脉造影的应用价值

目的:分析探讨320排CT在小儿(6~12岁)川崎病患者冠脉CT检查中使用低碘浓度(270mgI/ml)对比剂成像的可能性.方法:将我院于2018年6月至2019年6月收治的小儿(6~12岁)川崎病患者80例作为观察对象,按照其家长自愿使用不同浓度对比剂进行分组,分为观察组(n=40)及对照组(n=40),观察组使用碘浓度对比剂270mgI/ml、用量0.625mL/Kg,管电压80Kv条件下,使用智能毫安技术;对照组使用碘浓度对比剂320mgI/ml、用量0.625mL/Kg,管电压120kV条件下,使用智能毫安技术;对比观察两组技术指标:(1)图像质量;(2)图像增强效果(CT值)与图像噪声比较辐射量.结果:两组患者图像质量差异值不具有统计学意义(P>0.05),观察组有效辐射量明显优于对照组(P<0.05).结论:对比剂浓度低、辐射低用于小儿(6~12岁)川崎病患者冠脉C T检查成像效果不低于常规剂量及辐射,有效降低对患者的危害,值得临床借鉴.     

CT中不同对比剂注射方案对小型猪腹部大血管及肝脏强化模式的影响

目的 比较不同对比剂注射方案对小型猪腹部大血管及肝实质强化峰值及达峰时间的影响。方法 对3头健康小型猪行3种方案交叉重复CT扫描,每组方案扫描6次,碘总量均为600 mgI/kg体质量,A组:碘浓度270 mgI/ml,注射流率3.4 ml/s,IDR 918 mgI/s;B组:碘浓度370 mgI/ml,注射流率2.5 ml/s,IDR 925 mgI/s;C组:碘浓度370 mgI/ml,注射流率3.4 ml/s,IDR 1258 mgI/s。比较不同注射方案下腹主动脉、下腔静脉、门静脉主干、肝中静脉及肝实质的强化峰值及达峰时间,对图像强化效果进行评分。结果 达峰时间腹主动脉C组小于B组,下腔静脉C组小于A和B组(P均<0.05),门静脉主干、肝中静脉和肝实质各组间差异均无统计学意义(P均>0.05);强化峰值腹主动脉、下腔静脉、门静脉主干和肝中静脉C组均大于A组和B组(P均<0.05),肝实质各组间差异无统计学意义(P均>0.05)。C组图像强化质量优于A组(P<0.05),余组间差异无统计学意义(P均>0.05)。结论 对比剂IDR可影响猪腹部大血管强化峰值,碘总量一定时,肝实质强化模式不受对比剂碘浓度、注射流率及IDR的影响。     

高浓度碘对比剂在重度肥胖患者冠状动脉CTA血管成像中的应用

目的探讨高浓度碘对比剂对重度肥胖患者冠状动脉CT血管造影(CTA)图像质量的影响。方法采用随机、对照、前瞻性研究方法,将2018年2～6月首都医科大学附属北京友谊医院收治的52例接受冠脉CTA检查的重度肥胖(BMI≥35 kg/m2)患者随机分为A、B两组,每组各26例。两组患者均采用一致的扫描参数。注射碘对比剂总量为80 ml,注射流率为5 ml/s。A组碘对比剂浓度为400 mg I/ml,碘流率(IDR)为2. 0 g I/s,; B组碘对比剂浓度为350mg I/ml,IDR为1. 75 g I/s。记录患者的BMI、主动脉根部CT值、客观噪声(SD)、剂量长度乘积(DLP),计算信噪比(SNR)及有效剂量(ED)。对图像进行三维重建处理,采用美国心脏病协会推荐使用的冠状动脉15分段方法进行主观评分。比较两组患者主观评价及客观数据的差异。结果 A、B两组患者的图像主动脉根部CT值分别为(392. 97±89. 22) Hu、(291. 81±43. 42) Hu,差异具有统计学意义(P 0. 05),A组患者的SNR(11. 71±2. 97)和主观评分(3. 62±0. 52分)明显高于对照组(8. 33±2. 11,3. 19±0. 63分),差异均具有统计学意义(P 0. 05)。两组患者的SD及ED差异均无统计学意义(P 0. 05)。结论重度肥胖人群(BMI≥35 kg/m2)行CTA检查时,采用高浓度对比剂可以提高IDR,在减少注射风险的同时改善强化效果,保证图像质量。     

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.