16层螺旋CT对先天性心脏病心外大血管畸形的初步研究

目的：研究16层螺旋CT（MSCT）及其三维重建在先天性心脏病（简称先心病）心外大血管畸形中的应用价值。方法：对26例手术证实的先心病患者心外大血管畸形进行分析，所有病例均行MSCT增强扫描，随后在工作站进行三维重建，并与26例经胸超声心动（UCG）及13例心血管造影（CAG）结果进行对比。结果：手术证实心外大血管畸形83处，其中心脏大血管连接处畸形20处，完全大血管畸形63处，MSCT、UCG、CAG诊断准确率分别为98.8%、89.2%、100%，MSCT及CAG诊断准确率与UCG诊断准确率有显著性差异（χ2=4.76，P<0.05）；（χ2=4.11，P<0.05），MSCT与CAG诊断准确率无显著性差异（χ2=0.43，P>0.05）。结论：MSCT及其三维重建对先心病心外大血管畸形诊断明显优于UCG，且成像速度快，可以清晰显示心外大血管的病理解剖结构，对于临床术前评估、选择术式是一种很好的无创检查方法，MSCT与UCG联合应用在很大程度可以取代有创CAG检查。     

双源CT在小儿复杂性先天性心脏病诊断中的应用

目的 探讨双源CT（DSCT）在小儿复杂性先天性心脏病（简称复杂性先心病）诊断中的应用价值.方法 对45例经临床及经胸壁超声心动图（TTE）检查拟诊为复杂性先心病患儿性行DSCT心脏造影检查.以手术结果为标准,对DSCT与TTE在心脏部分、心脏-大血管连接部分及大血管部分畸形的诊断准确率进行比较.结果 45例患儿经手术证实心内外畸形共177处,DSCT检出162处,诊断准确率为91.53％;TTE检出153处,检出率为86.44％.177处畸形中心脏部分畸形75处,DSCT检出62处,诊断准确率为82.67％;TTE检出71处,诊断准确率为94.67％,DSCT的诊断准确率低于TTE的诊断准确率（P＜0.05）.心脏-大血管连接部畸形35处,DSCT与TTE诊断准确率均为100.00％.大血管部分畸形67处,DSCT检出65处,诊断准确率为97.01％;TTE检出47处,诊断准确率为70.15％,DSCT的诊断准确率显著高于TTE的诊断准确率（P＜0.05）.结论 DSCT可以清晰地显示心外大血管的解剖异常,能弥补TTE检查的不足,对合并心外大血管畸形的复杂性先心病具有重要诊断价值.     

先天性心脏病心外大血管畸形73例16层螺旋CT诊断分析

目的探讨16层螺旋CT(MSCT)对先天性心脏病心外大血管畸形的诊断价值。方法对73例经手术证实的心脏MSCT和超声心动图(TTE)资料进行回顾性分析,并与手术结果对照。结果 73例患者MSCT显示动脉导管未闭23例,肺动脉狭窄17例,主动脉骑跨9例,肺静脉异位引流8例,主动脉缩窄2例,右位主动脉弓、降主动脉7例,肺动脉缺如2例,主动脉异位1例,主动脉-肺动脉异位引流1例,永存动脉干1例,左侧上腔静脉2例,经手术证实畸形92处,其中MSCT、TTE的诊断准确率分别为为100%、83.3%。结论 MSCT对先心病心外大血管畸形具有重要的诊断价值,其与TTE联合应用可提高先心病的诊断准确率。     

超声心动图与电子束计算机断层摄影术在小儿心脏病诊断中应用的比较

目的比较经胸常规超声心动图(TTE)与电子束计算机摄影术(EBCT)对小儿心脏病的诊断价值.方法回顾性分析102例心脏病患儿的TTE表现,并与EBCT结果对照.结果全组22种先心病共226处畸形.心内畸形78处,TTE误诊1处,TTE诊断准确率98.7 %.心外大血管畸形及心室-大血管连接异常畸形共148处,TTE诊断准确率89.2%(132/148);EBCT诊断准确率97.3 %(144/148).二者比较差异显著(x2=4.787,P＜0.05).外科手术共71例,纠治心脏病变共123处,TTE诊断准确率89.4 %(110/123);EBCT诊断准确率96.7 %(119/123).二者比较无显著差异(x2=2.792,P>0.05).非先心病4例,TTE与EBCT均作出准确诊断.TTE与EBCT结合使诊断的总准确率提高到99.6 %(225/226).结论TTE是无创诊断小儿心脏病的最基本有效方法,结合无创 EBCT检查,可提高小儿心脏病诊断的准确率,以指导手术或药物治疗.     

64层螺旋CT诊断小儿法洛四联症

目的探讨64层螺旋CT心血管成像技术对小儿法洛四联症(TOF)的诊断价值,并与超声心动图(ECG)对比。方法对26例临床诊断TOF患儿进行64层螺旋CT增强心脏检查,并用多平面重建(MPR)、最大密度投影(MIP)及容积成像(VR)进行图像重建。所有病例均作ECG对照,以24例手术为金标准比较64层螺旋CT和ECG对心血管畸形的诊断准确率。结果手术证实的心血管畸形152处,64层螺旋CT的诊断准确率93.42%,明显高于ECG的诊断准确率69.74%(χ2=14.18,P<0.01)。对手术证实的18例小儿TOF,64层螺旋CT的诊断准确率达到100%。64层螺旋CT对TOF伴发畸形的诊断准确率为86.67%,ECG为33.33%(χ2=17.78,P<0.01)。结论64层螺旋CT对心血管畸形的诊断准确率优于ECG,能准确诊断小儿TOF,同时能评价肺动脉和冠状动脉,对术前手术方案的制定具有重要价值。     

320-CTA联合TTE检查在复杂型先天性心脏病患者诊断中的应用价值

目的:分析320排CT血管造影(320-CTA)与经胸冠状动脉超声(TTE)联合检查在复杂型先天性心脏病(CCHD)患者诊断中的应用价值。方法:选择2016年1月～2018年1月我院经手术确诊的复杂型先天性心脏病28例,所有患者均进行320-CTA与TTE检查,比较单一320-CTA检查与320-CTA联合TTE诊断准确率。结果:手术证实心内畸形38处中320-CTA漏诊2处单心房,320-CTA联合TTE漏诊1处三心房;大血管与心脏连接部分45处畸形中,320-CTA漏诊8处,320-CTA联合TTE无漏诊; 320-CTA联合TTE诊断准确率99. 02%(101/102)高于单一320-CTA检测90. 20%(92/102)(χ2=7. 783,P=0. 005)。结论:320-CTA联合TTE检查可有效提高CCHD患者诊断准确率,为临床制定合理治疗方案提供依据。     

二维超声联合时空关联成像技术在胎儿心脏大动脉畸形诊断中的应用

目的评价二维超声心动图(2DE)与2DE联合时空关联成像(STIC)技术在胎儿先天性心脏大动脉畸形的诊断价值。方法选择我院可疑有胎儿心脏大动脉畸形175例孕妇,先行2DE后,在2DE基础上联合STIC成像技术,以胎儿心尖四腔心切面及主动脉弓长轴切面作为初始采集图像,结合多平面成像模式(MPR)、超声断层成像模式(TUI)、表面成像等进行脱机离线分析进行诊断。最终诊断以病理尸检、出生后行新生儿2DE或心外手术结果为准。对比2DE与2DE联合STIC技术在胎儿先天性心脏大动脉畸形检查的准确度。结果 175例可疑心脏大血管畸形胎儿,其中9例(5.1%)失访,在166例产前诊断病例中,患有心脏大动脉畸形41例(24.7%),其中22例胎儿终止妊娠并尸检,10例产后手术证实,9例行心脏超声检查并长期随访证实。2DE正确诊断大动脉畸形33例,8例未正确诊断,2DE联合STIC成像正确诊断大动脉畸形40例,1例未正确诊断,2DE与2DE联合STIC技术在诊断胎儿心脏大动脉畸形符合率分别为95.2%和99.4%,差异有统计学意义(χ2=4.111,P=0.043)。结论 STIC技术对胎儿心脏大动脉畸形诊断具有独特优势,2DE联合STIC技术可以获得更加准确的诊断信息。     

MSCT联合TTE对早期主动脉夹层患者诊断准确率的影响

目的:分析多层螺旋CT(MSCT)联合经胸超声心动图(TTE)对早期主动脉夹层(AD)患者诊断准确率的影响。方法:选取我院收治的手术结果证实为AD患者46例。术前均行MSCT、TTE检查。统计对比MSCT、TTE单一与联合检查诊断准确率。结果:联合诊断准确率为95.65%(44/46),高于TTE 71.74%(33/46)、MSCT80.43%(37/46),差异均有统计学意义(X~2=9.382、P=0.009);MSCT、TTE单一与联合检查De Bakey I型诊断率均较高,而TTE对De BakeyⅢ诊断率最低。结论:MSCT联合TTE检查可提高早期主动脉夹层患者诊断准确率,临床应用价值较高。     

DCE-MRI联合DWI对子宫内膜癌患者术前肌层浸润及临床分期诊断准确率的影响

目的:探究动态增强MRI(DCE-MRI)联合弥散加权成像(DWI)对子宫内膜癌患者术前肌层浸润及临床分期诊断准确率的影响。方法:选取2015年7月~2017年5月郑州市第九人民医院收治的48例经病理证实的子宫内膜癌患者,均行DCE-MRI、DWI检查。统计两者联合肌层浸润诊断准确率、临床分期诊断准确率。结果:DCE-MRI、DWI联合肌层浸润诊断准确率为93. 02%,与病理结果符合率较高(χ2=1. 381,P=0. 239);DCE-MRI、DWI联合临床分期诊断准确率为87. 50%,与病理结果符合率较高(χ2=4. 444,P=0. 035)。结论:DCE-MRI联合DWI在子宫内膜癌患者中可提高肌层浸润诊断准确度及临床分期诊断准确度,可为临床后续治疗提供指导信息。     

多排螺旋CT对急性阑尾炎的诊断价值分析

目的探讨多排螺旋CT(MSCT)对急性阑尾炎的诊断价值。方法收集经临床手术确诊为急性阑尾炎的患者552例,其中有68例术前先后进行了超声和MSCT检查,分析其腹部MSCT诊断及超声诊断结果。结果 68例阑尾炎中MSCT诊断正确共67例(98.5%),超声诊断准确共54例(79.4%),MSCT诊断准确率高于超声诊断(χ2=12.663,P=0.001)。结论 MSCT可提高急性阑尾炎术前诊断准确率,具有较高的临床应用价值。     

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.     

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.     

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.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

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.