Multi-institution assessment of the use and risk of cardiovascular computed tomography in pediatric patients with congenital heart disease

BackgroundCardiac computed tomography (CT) is increasingly used in pediatric patients with congenital heart disease (CHD). Variability of practice and of comprehensive diagnostic risk across institutions is not known.MethodsFour centers prospectively enrolled consecutive pediatric CHD patients <18 years of age undergoing cardiac CT from January 6, 2017 to 1/30/2020. Patient characteristics, cardiac CT data and comprehensive diagnostic risk were compared by age and institutions. Risk categories included sedation and anesthesia use, vascular access, contrast exposure, cardiovascular medication, adverse events (AEs), and estimated radiation dose.ResultsCardiac CT was performed in 1045 pediatric patients at a median (interquartile range, IQR) age of 1.7 years (0.3, 11.0). The most common indications were arterial abnormalities, suspected coronary artery anomalies, functionally single ventricle heart disease, and tetralogy of Fallot/pulmonary atresia. Sedation was used in 8% and anesthesia in 11% of patients. Peripheral vascular access was utilized for 93%. Median contrast volume was 2 ​ml/kg. Beta blockers were administered in 11% of cases and nitroglycerin in 2% of cases. The median (IQR) total procedural dose length product (DLP) was 20 ​mGy1cm (10, 50). Sedation, vascular access, contrast exposure, use of cardiovascular medications and radiation dose estimates varied significantly by institution and age (p ​< ​0.001). Seven minor adverse events (0.7%) and no major adverse events were reported.ConclusionCardiac CT for CHD is safe in pediatric patients when appropriate CT technology and expertise are available. Scans can be acquired at relatively low radiation exposure with few minor adverse events.     

国内外智慧医养平台研究的可视化分析

目的采用文献计量学方法比较国内外智慧医养平台的研究现状,从宏观层面为我国健康养老产业的智慧化转型提供参考。方法以Web of Science核心合集和CNKI为来源,分析2010—2020年国内外的研究进展,利用数据库的分析功能和VOSviewer、CiteSpace软件对智慧医养平台的研究情况和研究热点进行定量分析和可视化展示,并对纳入文献进行定性分析。结果最终纳入166篇英文文献,78篇中文文献。国内外年发文量总体呈增长趋势,研究领域涉及多个学科。国外智慧医养平台相关研究中出现次数较多的关键词为“assistive technology”“elderly”“smart home”“e-health”“telecare”“rehabilitation”;国内出现次数排序前5名的关键词分别为“智慧养老”“物联网”“智能家居”“互联网+”“医养结合”。国外研究在平台技术准备、功能、隐私和数据保护、效果评价4个方面更加深入和多样。结论智慧医养平台及其相关技术的学术研究发展稳健且多样。但相较于国外,国内在内容和技术方面还存在一定差距,需要在符合国情的基础上借鉴和学习国外优秀技术和理念,促进智慧医养平台的进一步发展。     

Comparison of conventional radiography and MDCT in suspected scaphoid fractures

AIM: To determine the diagnostic accuracy and radiation dose of conventional radiography and multidetector computed tomography(MDCT) in suspected scaphoid fractures.METHODS: One hundred twenty-four consecutive patients were enrolled in our study who had suffered from a wrist trauma and showed typical clinical symptoms suspicious of an acute scaphoid fracture. All patients had initially undergone conventional radiography. Subsequent MDCT was performed within 10 d because of persisting clinical symptoms. Using the MDCT data as the reference standard, a fourfold table was used to classify the test results. The effective dose and impaired energy were assessed in order to compare the radiation burden of the two techniques. The Wilcoxon test was performed to compare the two diagnostic modalities.RESULTS: Conventional radiography showed 34 acute fractures of the scaphoid in 124 patients(42.2%). Subsequent MDCT revealed a total of 42 scaphoid fractures. The sensitivity of conventional radiography for scaphoid fracture detection was 42.8% and its specificity was 80% resulting in an overall accuracy of 59.6%. Conventional radiography was significantly inferior to MDCT(P < 0.01) concerning scaphoidfracture detection. The mean effective dose of MDCT was 0.1 m Sv compared to 0.002 m Sv of conventional radiography.CONCLUSION: Conventional radiography is insufficient for accurate scaphoid fracture detection. Regarding the almost negligible effective dose, MDCT should serve as the first imaging modality in wrist trauma.     

Dose‐Intensified Granulocyte‐Monocyte Apheresis in Therapy Refractory Ulcerative Colitis

Granulocyte‐monocyte apheresis (GMA) is an emerging therapeutic option in active course of ulcerative colitis (UC). Appropriate GMA dose, including total number, frequency, and duration of the individual GMA session, is a matter of debate. It was the aim of the present study to evaluate the efficacy of a dose‐intensified GMA regimen in patients with moderately to severely active UC. A prospective open‐label, single‐center study was performed in 10 patients with active UC (Rachmilewitz Clinical Activity Index [CAI] ≥ 8 points; Rachmilewitz Endoscopic Index ≥ 7 points). Patients had failed to improve after treatment with steroids and/or immunomodulators. GMA was performed twice weekly for 2 h to a maximum of 10 sessions. In each GMA session, the adsorber was changed after 1 h of treatment time. Four patients achieved remission with a CAI ≤ 4 points. Three patients had a response with an improvement of CAI of ≥3 points. Three patients showed no benefit from GMA. The quality of life score determined by the inflammatory bowel disease questionnaire‐Deutschland increased by 26 points in median. First and second filters had similar efficiency in granulocyte and monocyte adsorption. No major adverse effects were observed. Dose‐intensified GMA as reported in this study provided an encouraging short‐term response rate of 70% in patients with moderately to severely active UC not responding to standard steroid or immunomodulator therapy. Although all patients relapsed not later than 16 weeks, GMA might be useful to reduce steroid and immunomodulator usage, or to delay surgery in this patient group.     

不同年龄患者意识消失时丙泊酚的用量

目的 观察患者麻醉诱导意识消失时丙泊酚用量及Narcotrend指数(NI)变化,探讨意识消失时年龄与丙泊酚用量和NI的相关性.方法 3～70岁择期手术患者140例,按年龄分为7组,3～10岁组(G1组)、11～20岁组(G2组)、21～30岁组(G3组)、31～40岁组(G4组)、41～50岁组(G5组)、51～60岁组(G6组)及61～70岁组(G7组),每组纳入BMI在正常范围内的男女患者各10例.静脉持续输注丙泊酚20 mg·kg-1·h-1至患者意识消失时停药,记录患者丙泊酚用量、意识消失时间及用药前后MAP、HR、NI的变化.结果 患者意识消失时G1组丙泊酚用量明显高于G2～G7组(P＜0.01),G2～G4组明显高于G6、G7组(P＜0.05).患者意识消失时丙泊酚用量与年龄呈显著负相关(r=-0.566,P＜0.001).意识消失时间随年龄的增长而缩短.与输注丙泊酚前比较,七组患者意识消失时MAP和NI均明显降低(P＜0.05).G1组NI明显高于G2～G6组(P＜0.05).年龄与NI无明显相关性(r=-0.082,P=0.289).结论 麻醉诱导意识消失时不同年龄患者丙泊酚用量和NI不同,年幼患者丙泊酚用量和NI高于其他年龄患者.     

Low-dose aspirin in patients with stable cardiovascular disease: a meta-analysis

Objective

Many recommendations for aspirin in stable cardiovascular disease are based on analyses of all antiplatelet therapies at all dosages and in both stable and unstable patients. Our objective was to evaluate the benefit and risk of low-dose aspirin (50-325 mg/d) in patients with stable cardiovascular disease.

Methods

Secondary prevention trials of low-dose aspirin in patients with stable cardiovascular disease were identified by searches of the MEDLINE database from 1966 to 2006. Six randomized trials were identified that enrolled patients with a prior myocardial infarction (MI) (n = 1), stable angina (n = 1), or stroke/transient ischemic attack (n = 4). A random effects model was used to combine results from individual trials.

Results

Six studies randomized 9853 patients. Aspirin therapy was associated with a significant 21% reduction in the risk of cardiovascular events (nonfatal MI, nonfatal stroke, and cardiovascular death) (95% confidence interval [CI], 0.72-0.88), 26% reduction in the risk of nonfatal MI (95% CI, 0.60-0.91), 25% reduction in the risk of stroke (95% CI, 0.65-0.87), and 13% reduction in the risk of all-cause mortality (95% CI, 0.76-0.98). Patients treated with aspirin were significantly more likely to experience severe bleeding (odds ratio 2.2, 95% CI, 1.4-3.4). Treatment of 1000 patients for an average of 33 months would prevent 33 cardiovascular events, 12 nonfatal MIs, 25 nonfatal strokes, and 14 deaths, and cause 9 major bleeding events. Among those with ischemic heart disease, aspirin was most effective at reducing the risk of nonfatal MI and all-cause mortality; however, among those with cerebrovascular disease, aspirin was most effective at reducing the risk of stroke.

Conclusion

In patients with stable cardiovascular disease, low-dose aspirin therapy reduces the incidence of adverse cardiovascular events and all-cause mortality, and increases the risk of severe bleeding.     

Optimized Fluoroscopy Setting and Appropriate Project Position Can Reduce X-ray Radiation Doses Rates during Electrophysiology Procedures

Background:

Nonfluoroscopic three-dimensional electroanatomical system is widely used nowadays, but X-ray remains indispensable for complex electrophysiology procedures. This study aimed to evaluate the value of optimized parameter setting and different projection position to reduce X-ray radiation dose rates.

Methods:

From June 2013 to October 2013, 105 consecutive patients who underwent complex ablation were enrolled in the study. After the ablation, the radiation dose rates were measured by two different settings (default setting and optimized setting) with three projection positions (posteroanterior [PA] projection; left anterior oblique [LAO] 30° projection; and LAO 45° projection). The parameter of preset voltage, pulse width, critical voltage, peak voltage, noise reduction, edge enhancement, pulse rate, and dose per frame was modified in the optimized setting.

Results:

The optimized setting reduced radiation dose rates by 87.5% (1.7 Gy/min vs. 13.6 Gy/min, P < 0.001) in PA, 87.3% (2.5 Gy/min vs. 19.7 Gy/min, P < 0.001) in LAO 30°, 85.9% (3.1 Gy/min vs. 22.1 Gy/min, P < 0.001) in LAO 45°. Increase the angle of projection position will increase the radiation dose rate.

Conclusions:

We can reduce X-ray radiation dose rates by adjusting the parameter setting of X-ray system. Avoiding oblique projection of large angle is another way to reduce X-ray radiation dose rates.     

儿童鼻窦低剂量CT扫描的临床应用研究

目的：探讨儿童(1~12岁)鼻窦低剂量CT扫描的临床应用价值。方法300例行鼻窦CT检查的儿童(1~12岁)随机分为三组,分别行低剂量[(100 kV,40 mA)、(100 kV,25 mA)]和常规剂量(100 kV,100 mA)扫描,比较三组的剂量指数(CTDIw);对各组CT图像的窦口鼻道复合体成像质量进行评分及分析。结果低剂量组的CTDIw与常规剂量组相比较,40 mA组下降约59.97%,25 mA组下降约74.95%;40 mA组的CT图像质量与常规剂量组相比较,差异无统计学意义(P>0.05),25 mA组的CT图像质量与常规剂量组相比较,差异有统计学意义(P<0.05)。结论儿童鼻窦CT检查时,实行低剂量扫描可以有效地降低辐射剂量,100 kV、40 mA的扫描参数较为适宜。     

不同剂量胺碘酮治疗心律失常老年患者的疗效分析

目的观察不同剂量胺碘酮治疗心律失常老年患者的疗效。方法 120例老年心律失常患者随机分为A、B、C三组,分别采用高、中、低剂量的胺碘酮口服治疗,观察两组患者治疗前后心悸、胸闷等症状和动态心电图的变化,并监测三组患者用药后的血药浓度峰值。结果三组患者总有效率分别为82.5%、80.0%、80.0%,三组患者疗效对比差异无统计学意义（P〉0.05）;用药后A组患者的血药浓度峰值明显高于B组和C组,且B组高于C组,差异均具有统计学意义（P〈0.05）;A组和B组起效时间明显短于C组,差异具有统计学意义（P〈0.05）,但A组和B组差异无统计学意义（P〉0.05）。结论口服胺碘酮要根据临床实际疗效,调整负荷量和维持量,以最小的维持量求得最好的疗效。