核医学影像设备的发展与临床应用

γ相机和SPECT只能进行常规单光子显像，PET和双探头SPECT符合显像系统既能进行单光子显像，又能进行正电子符合显像，PET／CT系统的出现不仅提供高质量的衰减校正图像，保证了正电子显像校正数据的可靠性，而且能进行同机图像融合，提高了影像定位诊断的准确性。本文简要介绍了核医学影像设备发展历程，PET和PET／CT的原理以及在临床的应用。     

Implantation of Active Can Implantable Defibrillators in the right Pectoral Region

Routinely the active can ICD is placed in the left side pectoral position, which theoretically gives optimal conditions for a low defibrillation threshold. Some patients, bowever, demand a right pectoral position, which possibly could result in a bigger defibrillation threshold. A right pectoral position was used in 3 of 85 active can ICDs implanted in our institution from 1994. the DFT was 12 J in two and 18 f in one patient. Thus, right pectoral implantation is feasible and offers an alternative approach in selected patients.     

Early neuromuscular customized training after surgery for lumbar disc herniation: a prospective controlled study

A prospective and controlled study of training after surgery for lumbar disc herniation (LDH). The objective was to determine the effect of early neuromuscular customized training after LDH surgery. No consensus exists on the type and timing of physical rehabilitation after LDH surgery. Patients aged 15–50 years, disc prolapse at L4–L5 or L5–S1. Before surgery, at 6 weeks, 4, and 12 months postoperatively, the following evaluations were performed: low back pain and leg pain estimated on a visual analog scale, disability according to the Roland–Morris questionnaire (RMQ) and disability rating index (DRI). Clinical examination, including the SLR test, was performed using a single blind method. Consumption of analgesics was registered. Twenty-five patients started neuromuscular customized training 2 weeks after surgery (early training group=ETG). Thirty-one patients formed a control group (CG) and started traditional training after 6 weeks. There was no significant difference in pain and disability between the two training groups before surgery. Median preoperative leg pain was 63 mm in ETG and 70 mm in the CG. Preoperative median disability according to RMQ was 14 in the ETG and 14.5 in the CG. Disability according to DRI (33/56 patients) was 5.3 in the ETG vs. 4.6 in the CG. At 6 weeks, 4 months, and 12 months, pain was significantly reduced in both groups, to the same extent. Disability scores were lower in the ETG at all follow-ups, and after 12 months, the difference was significant (RMQ P=.034, DRI P=.015). The results of the present study show early neuromuscular customized training to have a superior effect on disability, with a significant difference compared to traditional training at a follow-up 12 months after surgery. No adverse effects of the early training were seen. A prospective, randomized study with a larger patient sample is warranted to ultimately demonstrate that early training as described is beneficial for patients undergoing LDH surgery.     

CTI和3G技术在120急救指挥中心的应用

介绍了120急救指挥中心的结构、计算机电话一体化和卫星定位系统、地理信息系统以及无线通讯系统的功能，分析了CTI和3G技术在120急救指挥中心的实际应用和取得的成效。     

Deleterious effects of the prone position in the full-term infant throughout the first year of life

Summary Seventy-one first-born infants who had been nursed in prone position since birth, were referred for motor assessment at 3 months, 5 months and 9 months. All infants were administered the same checklist of motor items, based on the Amiel-Tison Infant Neurological Evaluation and on the Brunet-Lézine Developmental Psychomotor Scale. Abnormalities in muscular shortening and delay in motor skills were found. These findings are critical as regards environmental influences on postural development, continuities in motor development and issues of early primary prevention. Early identification and follow-up programmes, including frequent changes in posture, are suggested in order to avoid abnormalities of motor behaviour and subsequently in postural patterns.     

The Cathlocator: A novel non-radiological method for the localization of enteral tubes

Safe placement of nasogastric tubes requires reliable positioning of the tip of the tube within the stomach. Radiology and aspiration are currently used to confirm tube position, but suffer from significant problems of cost and efficacy, respectively. We have developed a novel method to locate the position of a catheter tip within the body, using the detection of a low energy electromagnetic field generated in a coil located in the catheter with an external hand-held unit (Cathlocator). In vitro, the unit detected the distance of the coil from the detector with an accuracy of 0.1 cm over a range of 4–12 cm. In vivo studies were performed in 11 healthy volunteers using a purpose-built manometric assembly that incorporated the signal generating coil in its tip. In all subjects the Cathlocator showed the position of the signal generating coil to be cranial to the xiphisternum when manometric and transmucosal potential difference criteria showed it to be located above the lower oesophageal sphincter. When the coil was within the stomach, the Cathlocator identified its position within the epigastric, umbilical and left hypochondrial regions of the abdomen. The distance of the coil from the surface was significantly greater when in the duodenum mean (±s.e.m. 7.6±0.3 cm; P<0.001) and oesophagus (8.6±0.2 cm; P<0.002) than the stomach (5.0±0.4 cm). In one subject studied twice there was a close correlation between the location and depth measured by the device on each occasion. The Cathlocator is a novel non-radiological device that has the potential to be useful in the placement of gastrointestinal catheters.     

Effects of isoflurane on oxygenation during one-lung ventilation in pulmonary emphysema patients

Background: Hypoxic pulmonary vasoconstriction has an important role in human one-lung ventilation (OLV) in the lateral decubitus position under general anesthesia. During OLV, inhalational anesthesia may inhibit hypoxic pulmonary vasoconstriction and the decrease in arterial oxygenation. We studied the effect of isoflurane administration on arterial oxygen tension in chronic obstructive pulmonary disease patients.
Methods: Ten patients who had thoracoscopic laser ablation of bullous emphysema were studied. Patients received 2% isoflurane in oxygen from induction until the first 20 min of OLV in the lateral decubitus position, then were switched to 1% isoflurane lasting 20 min and next were switched to 0.5% isoflurane lasting 20 min. After each 20-min inhalation, pulmonary and hemodynamic parameters were measured. The given concentrations for isoflurane were merely vapor meter concentrations.
Results: PaO₂/FIO₂, Qs/Qt respiratory rate peak inspiratory pressure and PaCO₂ showed no significant changes at each point of isoflurane. Expiratory tidal volume significantly decreased (P<0.05) with 0.5% isoflurane compared to that with 2% isoflurane. Cardiac output, mean arterial pressure, mean pulmonary arterial pressure, systemic vascular resistance and pulmonary vascular resistance showed no significant changes at each point of isoflurane.
Conclusions: In patients with pulmonary emphysema, arterial oxygenation is not affected by low isoflurane concentration during OLV in the lateral decubitus position.     

全口义齿异常颌位排牙的体会

牙列缺失后,由于未及时的进行全口义齿修复,常常造成上下颌骨及上下颌弓在形状、大小、位置等方面的不协调,表现为异常颌位,给全口义齿的修复带来一系列的不便,使全口义齿的修复难以达到理想的修复效果。为获得满意的修复效果,异常颌位的排牙成了关键的一步,它不能按常规的排牙方法来进行,必须根据患者的具体情况作适当的调整。只有这样,才有利于全口义齿的固位和稳定,有利于全口义齿功能发挥。     

Sex and Intrauterine Position Influence the Size of the Gerbil Hippocampus

Sex differences in home range size and spatial ability are predictive of sex differences in the relative size of the hippocampus in rodents. Such differences in behavior and hippocampal volume are presumed to be, in part, the result of differences in perinatal exposure to hormones. We predicted from differences in the size of home ranges of male and female Mongolian gerbils (Meriones unguiculatus) in the wild that the hippocampus of male gerbils would be relatively larger than that of females. We examined the effect of prenatal hormonal influences on hippocampal size by comparing hippocampal volume of males and females from 2F and 2M intrauterine positions to that of randomly selected males and females. We found that, as predicted, randomly selected males had a significantly larger hippocampus, relative to telencephalon, than did randomly selected females. However, males and females from 2F and 2M intrauterine positions did not differ in relative hippocampal size. Possible explanations for the absence of a sex difference in hippocampal size in male and female gerbils from 2F and 2M intrauterine positions are discussed.     

头颈部肿瘤射野摆位误差的差异性研究

目的：研究采用电子射野系统评价头颈部肿瘤患者摆位误差时的观察者间变异和观察者自身变异。方法：两队研究小组，分别由四名医师和四名技师组成，两组分别对6名头颈部肿瘤的患者，采用电子射野影像仪（electronic portal imaging device，EPID）拍摄验证片（electronic portal images，EPIs），在EPIs上勾画骨性标志，以放疗计划生成的数字重建图像（digitally reconstructed radiographs，DRRs）做为参考图像，定量分析不同观察研究人员之间和研究人员自身采用EPID确定头颈部肿瘤患者的射野摆位误差（field placement errors，FPEs）的差异性。结果：在前／后位射野图像上．不同医师之间、医师自身及技师自身对摆位误差的判断无明显差异，但在技师之间出现了明显的自身差异性．医师组和技师组在前／后射野图像上的均方根（root-mean—square，RMS）分别为2．52±0．46和3．43±0．43，两者具有明显差异；在侧位野图像上，医师自身对摆位误差的判断有较好的稳定性，但部分不同医师之间在腹背、头足方向上部分患者中出现差异，而不同的技师之间存在明显差异性，医师组和技师组在侧位射野图像上的RMS分别为2．72±0．16和2．62±0．22．两者无明显差异。结论：医师和技师组在采用电子射野系统对头颈部摆位误差进行判断时存在人员之间的误差，应对所有人员进行统一训练才能减少射野摆位误差，从而提高IMRT治疗效果。