Myocardial extracellular volume fraction to differentiate healthy from cardiomyopathic myocardium using dual-source dual-energy CT

ObjectiveTo evaluate the feasibility of dual-energy CT (DECT)-based iodine quantification to estimate myocardial extracellular volume (ECV) fraction in patients with and without cardiomyopathy (CM), as well as to assess its ability to distinguish healthy myocardial tissue from cardiomyopathic, with the goal of defining a threshold ECV value for disease detection.MethodsTen subjects free of heart disease and 60 patients with CM (mean age 66.4 ± 9.4; 59 males and 11 females; 40 ischemic and 20 non-ischemic CM) underwent late iodine enhanced DECT imaging. Myocardial iodine maps were obtained using 3-material decomposition. ECV of the left ventricle was estimated from hematocrit levels and the iodine maps using the AHA 16-segment model. Receiver operating characteristic curve analysis was performed, with corresponding area under the curve, along with Youden's index assessment, to establish a threshold for CM detection.ResultsThe median ECV for healthy myocardium, non-ischemic CM, and ischemic CM were 25.4% (22.9–27.3), 38.3% (33.7–43.0), and 36.9% (32.4–41.1), respectively. Healthy myocardium showed significantly lower ECV values compared to ischemic and non-ischemic CM (p < 0.001). From Youden's index analysis, an ECV>29.5% would indicate the presence of CM in the myocardium (sensitivity = 90.3; specificity = 90.3); the AUC for this criterion was 0.950 (p < 0.001).ConclusionThe findings of this study resulted in a statistically significant distinction between healthy myocardium and CM ECVs. This led to the establishment of a promising threshold ECV value that could facilitate the differentiation between healthy and diseased myocardium, and highlights the potential of this DECT methodology to detect cardiomyopathic tissue.     

Changes in iodine status among US adults, 2001–2012

Urinary iodine concentrations (UICs) in the US have been reported to be stable since 1988–1994, although those in selected subgroups remained low. We aimed to investigate iodine status among adults (≥20 years) by two different criteria of assessing iodine deficiency in population. Utilizing National Health and Nutrition Examination Surveys 2001–2012, we conducted linear logistic regressions adjusting for covariates. The prevalence of <50?μg/L UIC was higher in women than in men; increased from 11.6% (2001–2004) to 13.2% (2009–2012) at the national level and in young adults, non-Hispanic blacks (NHBs) and non-users of iodine-containing supplements (all, p?<0.05); the adjusted odds ratios (95%CI) in young adults (1.54 [1.11–2.15], p =?0.0007) and NHBs (1.70 [1.15–2.52], p =?0.0078). Median UICs confirm women and NHBs being in borderline iodine status. Recognizing the critical consequence of iodine deficiency particularly in women and NHBs, regular monitoring of iodine status is important for public health in the US.     

儿童分化型甲状腺癌肺转移14 例131I 治疗分析

目的探讨儿童分化型甲状腺癌(DTC)肺转移的临床特征及~(131)I治疗效果。方法回顾分析14例首次接受~(131)I治疗时年龄≤18岁的DTC肺转移患儿的临床资料。结果 14例患儿中男5例、女9例,平均年龄(12.71±3.05)岁,均在甲状腺全切或次全切术后接受~(131)I治疗,平均接受~(131)I治疗4次,中位累积剂量为9.43(8.25～19.74)GBq。14例患儿治疗后完全消除4例(28.6%)、好转或稳定8例(57.1%)、无效或进展2例(14.3%),有效率为85.7%(12/14)。中位随访时间63.4(6～124)月,患儿生存率为100%,中位无进展生存期63.5个月,2年无进展生存率84.61%,5年无进展生存率80.0%。结论儿童DTC肺转移发生率较高,~(131)I治疗有效。     

Antibacterial treatment needed for severe early childhood caries

OBJECTIVES: To assess the effects of a single 10% povidone iodine application as an adjunct to extensive surgical procedures in the clinical treatment of children with early childhood caries. METHODS: Twenty-two children scheduled for dental treatment under general anesthesia were randomized into either an intervention group (10% povidone iodine), or a control group (phosphate buffered saline). Either povidone iodine or phosphate buffered saline was applied to teeth and soft tissues after prophylaxis and all operative dental procedures, followed by 1.23% acidulated phosphate fluoride gel. Saliva samples taken at baseline, and after 1 hour, 3 weeks and 3 months were assayed for mutans streptococci, lactobacilli and total viable bacteria. Caries lesions were recorded at baseline and at one year. RESULTS: Mutans streptococci and lactobacilli levels in the povidone iodine group were significantly reduced relative to baseline at 1 hour, 3 weeks and 3 months. At one year at least 60% of subjects had new caries lesions in each group, and there was no significant difference in caries increment between the two groups. CONCLUSIONS: Even prophylaxis, fluoride gel application and complete surgical treatment of caries at baseline were insufficient to prevent new caries in over 60% of the patients in these high caries risk infants. Although the one-time treatment with povidone iodine reduced mutans streptococci and lactobacilli levels for up to 3 months this therapy failed to additionally reduce future caries formation over one year, indicating that repeated antibacterial treatments will be needed to control high levels of cariogenic bacteria.     

双源 CT 能谱曲线与碘浓度在甲状腺 良恶性病变中的应用价值

〔摘 要〕 目的：探究双源计算机断层扫描（CT）能谱曲线与碘浓度在甲状腺良恶性病变中的应用价值。方法：回顾性 选取商丘市第一人民医院 2018 年 1 月至 2021 年 1 月收治的 30 例甲状腺癌患者作为甲状腺癌组,选取同期 30 例结节性甲 状腺肿患者作为结节性甲状腺肿组,两组患者均经病理学检查确诊,且接受双源 CT 检查。比较两组患者平扫时能谱曲线 斜率值及碘浓度,动脉期能谱曲线斜率值及甲状腺与颈总动脉碘浓度比值,静脉期能谱曲线斜率值及甲状腺与颈总动脉碘 浓度比值情况。结果：经双源 CT 平扫时,结节性甲状腺肿组患者的能谱曲线斜率值、碘浓度水平均高于甲状腺癌组,差 异具有统计学意义（P ＜ 0.05）;结节性甲状腺肿组患者动脉期的能谱曲线斜率值、甲状腺与颈总动脉碘浓度比值均高于 甲状腺癌组患者,差异具有统计学意义（P ＜ 0.05）;结节性甲状腺肿组患者静脉期的能谱曲线斜率值、甲状腺与颈总动 脉碘浓度比值与甲状腺癌组患者相比,差异无统计学意义（P ＞ 0.05）。结论：双源 CT 能谱曲线与碘浓度在甲状腺良恶性 病变的诊断中联用,可获得甲状腺癌、结节性甲状腺肿平扫时、动脉期及静脉期的能谱曲线斜率及碘浓度情况,鉴别出患 者病情进展情况。     

科学规范化管理在防控碘质血管造影对比剂临床风险中的应用

探讨防控碘质血管造影对比剂临床风险的科学规范化管理措施。回顾我院自2012年制定并实施的一系列专门针对碘质血管造影对比剂应用过程中所出现的不良反应防控措施,以及所取得的成就和灵感。我院制订并实施的碘质血管造影对比剂不良反应综合处理治疗方案可提高医护人员对突发事件应对能力,更好应对不良事件,未发生因碘质血管造影对比剂出现不良反应导致的医疗不良事件。科学规范化管理措施可有效防控碘质血管造影对比剂临床风险,值得临床推广应用。     

碘131配合选择性颈淋巴结清除术对甲状腺癌的疗效及唾液腺功能的影响

目的:探讨I131配合选择性颈淋巴结清除术治疗甲状腺癌(TC)的疗效和对患者唾液腺功能的影响。方法:选取2009年1月—2013年9月期间确诊治疗的TC患者60例,随机分均分为对照与观察组,对照组患者给予常规甲状腺切除术,观察组患者在此基础上给予选择性颈淋巴结清除术与I131治疗,其中又根据I131摄入量均分为高剂量亚组(3 500 m Bq)和低剂量亚组(1 000 m Bq),分析患者疗效和唾液腺功能指标及术后生存情况。结果:观察组首次清甲成功率与治疗总有效率均明显高于对照组(均P0.05);唾液腺功能参数方面,手术组优于低剂量亚组,低剂量亚组优于高剂量亚组(均P0.05);观察组中高、低剂量亚组5年生存率无明显差异,但均高于对照组(均P0.05)。结论:I131配合选择性颈淋巴结清除术治疗可有效提高对TC手术患者的疗效并改善预后,虽有唾液腺功能方面不良反应,但低剂量治疗症状较轻,在患者接受范围内。     

放射性125I粒子植入治疗原发性肝癌研究进展

~(125)碘粒子植入治疗具有高度适形性,通过近距离照射肿瘤杀伤癌细胞,近年来已广泛应用于原发性肝癌的综合介入治疗。本文对~(125)I粒子植入在肝癌治疗中的研究进展进行综述。     

TACE联合放射性125I粒子植入治疗不宜消融肝癌的安全性及有效性分析

目的 评价TACE联合¹²⁵I粒子植入治疗不宜消融肝癌的疗效。方法 将82例不宜消融的肝癌患者分为2组：联合组40例,予TACE联合¹²⁵I粒子植入治疗;对照组42例,予单纯TACE治疗。比较2组治疗后肝功能、血常规、血清甲胎蛋白（AFP）、并发症、客观有效率及远期生存率。结果 联合组¹²⁵I粒子植入术前、术后剂量学差异均无统计学意义（P均>0.05）。联合组术后3、6个月客观有效率[85.00%（34/40）、67.50%（27/40）]明显高于对照组[61.90%（26/42）、45.24%（19/42）;P均<0.05]。联合组患者中位生存时间为25.7个月,对照组为10.7个月;联合组1、2、3年累积生存率分别为77.50%、54.30%、23.30%,对照组为45.20%、32.60%、13.60%。联合组术后3个月及6个月血清AFP水平明显低于对照组（P均<0.05）。联合组治疗后1个月肝功能及血常规与术前差异均无统计学意义（P均>0.05）。结论 TACE联合¹²⁵I治疗不宜消融肝癌安全、有效。