Dorsal column stimulation in pain treatment

Thirty-five patients with chronic pain were treated by electrical stimulation of the dorsal columns through implanted epidural electrodes. In 5, such stimulation had minimal pain-reducing effect during an immediate postoperative trial period, and the electrodes were removed. In the remaining 30, an electrode system for chronic stimulation was implanted. Four of these died of related or unrelated causes. The electrode system was removed in 2 patients due to infections, and in 1 due to mechanical discomfort. The remaining 23 patients answered a questionnaire concerning the pain reducing effect of stimulation (4-60 months postoperatively, median 15 months). The group as a whole estimated the pain reducing effect of stimulation as weak. Only 10 patients (43.5%) used the stimulator regularly. Even in these patients, the pain-reducing effect was limited. Chronic back pain after repeated back surgery responded relatively better to stimulation than did the other cases. Phantom limb pain was most resistant. The modest results suggest future restriction on the use of such stimulation.     

非均匀人形体模及医用诊断X线工作人员的有效剂量当量估算

本文根据ICRP有效剂量当量的概念,应用所研制的人干骨,干粉模拟软组织非均匀人形体模,求出了胃肠检查和胸透时医用诊断X线工作人员的器官剂量、有效剂量当量与个人剂量计读数的比值,也计算了它们与工作人员所在位置自由空气照射量率的比值。得出男女性别不同的医用诊断X线工作人员的有效剂量当量与佩戴在左胸的个人剂量计读数的比值,胃肠检查时分别为0.52和0.43,胸透时分别为0.32和0.21。应用这些比值和个人剂量监测数据估算了该类人员的有效剂量当量。     

乳腺仿真体模在超声专业住培教学中的应用

分析使用乳腺仿真体模在超声专业规培教学中的可行性。方法：选取2018年12月在杭州市第一人民医院培训的规培生作为实验组、进修生作为对照组,将乳腺仿真体模应用于规培教学,并进行进阶式理论及操作手法培训。通过操作考试、理论考试、课后问卷调查等方式进行教学效果分析。结果： 本研究实验组21人,对照组8人。培训后理论考试成绩实验组为68.10±8.14,对照组为50±12.24,两者有显著统计学意义。在同一年级不同阶段考试中,不同次的操作分数差异有统计学意义(F=106.59 P=0.00),问卷调查中100%学员认为在相关学习中获益。讨论：乳腺体模应用于超声规培教学的优点在于授课时便于规培医生理解解剖关系,方便男生进行敏感部位练习操作手法；缺点在于病变图像及位置固定,不利于高年级的业务能力提升。     

A novel realistic three-layer phantom for intravascular ultrasound imaging

Intravascular ultrasound (IVUS) is an imaging modality that experienced a tremendous development over the last 20 years. Phantoms for IVUS are rare and poorly documented. The aim of this paper is to propose an original IVUS phantom that has geometries and specular textures closer to those of coronary arteries than conventional tube-like phantoms. The proposed phantom has a three-layer aspect, reproducing the intima, media and adventitia that compose the arterial wall. It is made of an agar-based compound, with water, glycerol and cellulose particles. Fourteen phantoms were quantified using IVUS. Six phantoms were evaluated by both photomacroscopy and IVUS. There was an excellent correlation between phantom dimensions evaluated by photomacroscopy and the nominal values (mold dimensions). The IVUS quantification of the phantom was closely correlated to the measurements obtained by photomacroscopy. These results demonstrate that a multilayer phantom, with known and reproducible dimensions and with realistic geometric and echographic properties has been developed.     

新型胸部CT参考体模的实验研究

作者报道新型胸部CT参考体模的实验研究和制作。本体模是按中国人体参数设计,高分子材料制成,对X线、γ线的吸收和散射与人体组织有相似特性,具有心、肺、骨骼、肌肉、脂肪和皮肤,是CT诊断、放射治疗、放射防护、教学和辐射剂量标准等研究的重要实验工具,可作为人的替身使用。CT研究结果显示,本新型胸部CT参考体模的解剖形态仿真,组织密度等效,同真人相似,由4或5个横断面组装成形,是一种多功能新型胸部CT参考体模,在放射科质量保证(qualityassurence,QA)和质量控制(quality control,QC)中有重要的理论和实用价值。作者对其临床应用和操作技术进行了讨论。     

Radionuclide left ventricular volume determination. Influence of scattered radiation and surrounding activity

Summary. Radionuclide measurements of left ventricular volumes, ejection fractions and stroke volumes were performed by an equilibrium technique in nine patients using left anterior oblique projection and individual depth correction. Phantom studies were made in order to evaluate attenuation and scattering of the radiation. It was found that a simple depth correction factor, k(d)= e^μd, can be used under certain conditions. However, the determination of left ventricular volume by radionuclide techniques is not a truly absolute method. The depth correction factor to be used is dependent on the condition of measuring and evaluation, for instance how the region of interest for the left ventricle is selected. Therefore, this method should be carefully standardized, evaluated and compared to other techniques. Stroke volume measured by radionuclide and dye-dilution technique showed a correlation coefficient of 0·76 (nine patients) at rest and 0·77 (seven patients) at work. This method can be easily performed during routine ejection fraction determination and can thus be useful in clinical studies.     

迟发性运动障碍脑MRI研究进展

迟发性运动障碍(Tardive Dyskinesia,TD)为长期应用抗精神病药后,出现异常不自主运动的综合征[1-2].使用典型抗精神病药治疗10年以上的病例,TD年发生率高达50％,具有明显的致残性和不可逆性[3].随着非典型抗精神病药物的应用,迟发性运动障碍的发生率和流行率似乎相对稳定[4].     

Bilateral thalamic gray matter changes in patients with restless legs syndrome

Restless legs syndrome (RLS) is a common neurological disorder of a primary unpleasant sensation with an urge to move the legs occurring at rest. The etiology of idiopathic RLS is unknown and structural cerebral abnormalities have so far not been detected. We studied 51 right-handed patients with an idiopathic restless legs syndrome in two independent samples (Regensburg RLS-group: n = 28, Munich RLS-group: n = 23) and compared them to 51 sex- and age-matched healthy volunteers. High-resolution T1-weighted magnetic resonance imaging (MRI) of each subject was obtained and analyzed using voxel-based morphometry (VBM) to detect regionally specific differences in gray matter between patients and controls. Conjunction analysis was used to combine results from both centers. In patients with idiopathic RLS, both study centers observed independently a bilateral gray matter increase in the pulvinar. In the conjunction analysis including all patients and controls from both study centers, a significant gray matter increase in the pulvinar bilaterally (right: x = 16, y = -21, z = 12, Z = 4.57; left: x = -16, y = -24, z = 12, Z = 4.10) was present. This is the first demonstration of structural changes in the brain of patients with idiopathic RLS. These changes in thalamic structures are either involved in the pathogenesis of RLS or may reflect a consequence of chronic increase in afferent input of behaviorally relevant information.     

先天性主动脉瓣畸形的多平面经食管体元模型动态三维超声显像

为了评价多平面经食管体元模型动态三维超声显像对先天性主动脉瓣畸形的诊断价值，我们对本院经食管超声检查的８例先天性主动脉瓣畸形患者进行研究。均为男性，平均年龄４４．６岁（３６～５２岁）。其中二叶式主动脉瓣畸形７例，四叶式主动脉瓣畸形合并主动脉窦瘤破入右房、赘生物形成１例。图像采集用美国ＨＰＳＯＮＯＳ２５００多功能超声诊断仪和５ＭＨｚ多平面经食管探头。三维重建采用德国Ｔｏｍｔｅｃ公司生产的计算机工作站。结果８例患者均获得了成功的三维重建。可模拟手术途径清晰显示畸形主动脉瓣叶和主动脉窦的立体形态、瓣叶个数、瓣际交界、合并赘生物的大小和形态和主动脉瓣的返流情况。特别是对主动脉瓣穿孔的显示比二维显像更客观。