Quantitative measurements of second harmonic Doppler using ultrasound contrast agents

Quantitative measurements of second harmonic and first harmonic Doppler were carried out using two ultrasound contrast agents, Albunex^® and FS069. The RMS amplitudes of the Doppler shift spectra were measured as a function of the concentration of the agents, frequency and transmitted acoustic pressure. The results showed that, for a given lot of contrast agent investigated, FS069 was able to produce higher levels of first and, especially, second harmonic signals compared to Albunex. Under the same experimental conditions, the RMS Doppler amplitude (RDA) of FS069 was 3.8 ± 0.8 dB higher than Albunex at first harmonic and 12.6 ± 0.8 dB higher at second harmonic. The ratio of the second harmonic to first harmonic RDA, which we called R₂/R₁, decreases at a rate of 7 dB/MHz for both agents with increasing frequency. The difference in the value of R₂/R₁ between FS069 and Albunex at any frequency was approximately 4.5 dB. R₂/R₁ was found to increase linearly as a function of the transmitted acoustic pressure for both agents. Simulations using the Rayleigh-Plesset equation show a decrease of R₂/R₁ at a rate of 5 dB/MHz. Comparison of experimental results with theory indicates that the shell elasticity parameter may be an increasing function of the mean diameter of the bubbles.     

皮肤原位再生复原技术结合可调脉宽倍频Nd∶YAG激光治疗黄褐斑的临床疗效观察

目的 观察皮肤原位再生复原技术结合可调脉宽倍频Nd∶YAG激光治疗黄褐斑的临床疗效,并总结临床经验.方法 应用皮肤原位再生复原技术结合可调脉宽倍频Nd∶YAG激光治疗黄褐斑380例,根据评定标准对治疗结果进行评价.结果 380例黄褐斑患者经治疗后基本治愈272例,显效57例,好转51例,无效0例,有效率86.58%.结论 皮肤原位再生复原技术结合可调脉宽倍频Nd∶YAG激光治疗黄褐斑疗效确切,该技术值得临床推广.     

Ultra-brief Screeners for Detecting Delirium Superimposed on Dementia

ObjectiveDelirium superimposed on dementia (DSD) is common, morbid, and costly, yet frequently undiagnosed. Our study aimed to develop a brief screening test to improve health care worker recognition of DSD.Design/Setting/ParticipantsOlder hospitalized adults with dementia were prospectively enrolled from medical and surgical inpatient units of 3 hospitals (2 in Pennsylvania, 1 in Tennessee).MeasuresThe reference standard delirium assessment used Confusion Assessment Method (CAM) criteria and was based on a structured interview including the Mini-Mental State Examination, interviewer observations, and medical record review. To develop the screening test, 1-, 2-, and 3-item combinations from the reference standard assessment were analyzed to determine their sensitivity and specificity in diagnosing delirium presence in a dementia population compared to the reference standard. For multiple-item screeners, error on 1 or more items was considered a positive screen.ResultsOverall, 391 older adults with dementia were enrolled (mean age: 83.9 years, 71.1% female), and 95 (24.4%) developed DSD during their hospitalization, based on the reference standard. The best single-item screen for DSD was “What day of the week is it?” with 84% sensitivity [95% confidence interval (CI): 0.75, 0.91] and 41% specificity (CI: 0.35, 0.47). The best 2-item screen was “list the days of the week backwards” and “What day of the week is it?” with 93% sensitivity (CI: 0.85, 0.97) and 30% specificity (CI: 0.25, 0.36). The best 3-item screen was “list the days of the week backwards,” “What type of place is this? [hospital]” and “Does the patient appear sleepy?” with 94% sensitivity (CI: 0.87, 0.98) and 42% specificity (CI: 0.36, 0.48).Conclusions/ImplicationsWe identified a 3-item DSD screener with excellent sensitivity but limited specificity. This screener can be used to quickly rule out DSD in populations with a high prevalence of dementia and is a promising step toward developing efficient tools for DSD recognition among care providers.     

氯氮平撤药致谵妄2例

2例双相障碍患者长期应用氯氮平(分别为100 mg/d,150 mg/d)维持治疗,在骤停氯氮平1天后出现谵妄状态,复用氯氮平后症状迅速缓解。     

Lower anticoagulation for mechanical heart valves: experience with the ATS bileaflet valve

Background: The design of the bileaflet ATS (ATS Medical Inc., Minneapolis, USA) mechanical valve incorporates an open pivot at the hinge mechanism. Total washout of the blood at the pivot area was observed using 3-D computational fluid dynamics modelling. This phenomenon could make the valve less vulnerable to clot formation in patients without major thromboembolic risk factors.

Methods: From January 1993 to June 1999, 286 consecutive patients had the ATS valve inserted in the aortic position. Patients were divided into two groups. Group 1 comprised all patients in regular sinus rhythm with good left ventricular function (144 patients). Group 2 included patients in non-sinus rhythm and/or with large hypocontractile left ventricles (142 patients). The anticoagulation regime in group 1 was used to obtain an international normalised ratio (INR) between 1.5 and 2.5. This contrasts with our regular aim to maintain the INR strictly between 2.5 and 3.5 for all mechanical valves, as achieved in group 2.

Results: The follow-up period (99% completeness) ranged from 18 to 84 months. Survival (Kaplan-Meier) was 97 and 98% and 92 and 81% at 1 and 5 years in group 1 and group 2, respectively (P = 0.12). Log rank analysis failed to detect a statistical difference in thromboembolism or bleeding between both groups (P > 0.05). However, trends were in favour of group 1. Univariate analysis selected poor ventricular function and an ‘erratic’ INR value (P = 0.002) as risk factors for death. The sole independent risk factor for bleeding was the use of aspirin (P = 0.025).

Conclusions: The excellent group 1 data and outcome encouraged us to continue our low intensive anticoagulation regime and perhaps should be regarded as a new concept for treatment of selected mechanical valve patients.     

Functional tricuspid regurgitation secondary to aortic annular abscess: An unusual presentation of infective endocarditis

An unusual case of aortic annular abscess is presented, in which the patient presented with features of gross tricuspid regurgitation. There was no direct involvement of the tricuspid valve. Tricuspid regurgitation disappeared following surgical repair of the annular abscess. The present case also illustrates the utility of trans-oesophageal echocardiography in establishing the diagnosis and planning surgical intervention.     

Anti-thrombotic, anti-platelet and fibrinolytic therapy: current management of acute myocardial infarction

Significant advances in the treatment of patients with acute myocardial infarction (MI) have been obtained in recent times. In particular, thrombolytic therapy has been shown to preserve ventricular function and improve survival in patients with acute MI. Therapies now include third-generation thrombolytic agents, percutaneous transluminal coronary angioplasty (PTCA) and intracoronary stenting, and new anti-thrombotic therapies including anti-platelet treatment with glycoprotein (GP) IIb/IIIa inhibition and direct anti-thrombin agents. This review will focus on the use of GP IIb/IIIa antagonists and thrombin inhibitors as adjunctive therapies to thrombolytic treatment of patients with acute MI.     

Lymphome non hodgkinien Ki-1 positif révélé par des ulcérations cutanéomuqueuses et une glomérulonéphrite

Malignant lymphoma particularly of T phenotype can be associated with specific or non specific cutaneous lesions. These cutaneous manifestations can occur at the onset of the disease being sometimes the revealing sign or they can appear during the course of the lymphoreticular malignancies. Glomerulonephritis was also described in lymphoma. Ki- positive large cell lymphoma was recently identified. A new case is reported with lymphadenopathy and intestinal localisation revealed by cutaneous and mucosal ulcerations principally in the mouth and a focal segmental glomerulonephritis with endo- and extracapillary proliferation. The absence of lymphoma in cutaneous and renal lesions and the clinical presentation support the hypothesis of paraneoplastic manifestations, may be related to a vasculitis.     

序贯镇痛镇静对预防行机械通气治疗患儿撤机后谵妄及撤药反应的效果研究北大核心CSCD

目的探讨行机械通气治疗患儿在撤机后序贯维持镇痛镇静药物对预防谵妄及撤药反应的效果。方法回顾性将2019年12月至2021年9月广东医科大学附属东莞市儿童医院儿童重症监护室收治的机械通气支持≥5 d的61例患儿分为对照组(30例,撤机后无镇痛镇静药物维持)及观察组(31例,撤机后序贯镇痛镇静药物维持48 h),记录两组患儿撤机后24 h及72 h索菲亚撤药反应观察量表(Sophia Observation Withdrawal Symptoms Scale,SOS)评分、儿童谵妄量表(Paediatric Delirium Scale,PD)评分、Richmond躁动镇静量表(Richmond Agitation-Sedation Scale,RASS)评分及谵妄发生例数、撤药反应发生例数,并进行比较分析。结果两组患儿撤机后24 h及72 h谵妄发生率比较差异无统计学意义(P>0.05);观察组撤机后24 h及72 h撤药反应发生率、SOS评分、PD评分、RASS评分均低于对照组(P<0.01)。结论撤机后序贯镇痛镇静可降低行机械通气治疗重症患儿撤机后72 h内撤药反应发生率,但不能有效降低患儿撤机后谵妄发生率。     

显微手术治疗脑胶质瘤的临床疗效探讨

目的对显微手术治疗脑胶质瘤的临床疗效及复发影响因素进行探讨。方法回顾性分析2010年1月至2013年1月运用显微手术治疗96例脑胶质瘤患者的临床资料,分析其手术疗效和复发影响因素。结果所选患者使用显微外科手术肿瘤全切74例,占77.1%,次全切19例,占19.8%,部分切除3例,占3.1%;出院时恢复良好57例(59.4%),基本好转26例(27.1%),显效8例(8.3%),进步5例(5.2%),无1例死亡;随访1~3年,所有患者获得随访,恢复正常者58例,占60.4%,38例复发,其中19例再次手术,死亡3例(非手术死亡),15例拒绝再次手术,死亡6例;低级别胶质瘤复发的发生率为15.4%,明显低于高级别胶质瘤的68.2%,差异有统计学意义(P0.05);年龄小于等于40岁的发生率为29.2%,明显低于大于40岁的50%,差异有统计学意义(P0.05);全切组的复发发生率为16.2%,明显低于次全切、部分切除的72.7%,差异有统计学意义(P0.05)。结论显微手术可明显提高肿瘤全切率,使手术疗效大大提高,从而提高生活质量,降低复发率及病死率;且术后的复发率与肿瘤组织分型、年龄、手术方式有关。