Reduced nontarget embolization and increased targeted delivery with a reflux-control microcatheter in a swine model

PurposeTo evaluate the potential differences in non-target embolization and vessel microsphere filling of a reflux-control microcatheter (RCM) compared to a standard end-hole microcatheter (SEHM) in a swine model.Materials and methodsRadiopaque microspheres were injected with both RCM and SEHM (2.4-Fr and 2.7-Fr) in the kidneys of a preclinical swine model. Transarterial renal embolization procedures with RCM or SEHM were performed in both kidneys of 14 pigs. Renal arteries were selectively embolized with an automated injection protocol of radio-opaque microspheres. Ex-vivo X-ray microtomography images of the kidneys were utilized to evaluate the embolization by quantification of the deposition of injected microspheres in the target vs. the non-target area of injection. X-ray microtomography images were blindly analyzed by five interventional radiologists. The degree of vessel filling and the non-target embolization were quantified using a scale from 1 to 5 for each parameter. An analysis of variance was used to compare the paired scores.ResultsTotal volumes of radio-opaque microspheres injected were similar for RCM (11.5 ± 3.6 [SD] mL; range: 6–17 mL) and SEHM (10.6 ± 5.2 [SD] mL; range: 4–19 mL) (P = 0.38). The voxels enhanced ratio in the target (T) vs. non-target (NT) areas was greater with RCM (T = 98.3% vs. NT = 1.7%) than with SEHM (T = 89% vs. NT = 11%) but the difference was not significant (P = 0.30). The total score blindly given by the five interventional radiologists was significantly different between RCM (12.3 ± 2.1 [SD]; range: 6–15) and the standard catheter (11.3 ± 2.5 [SD]; range: 4–15) (P = 0.0073), with a significant decrease of non-target embolization for RCM (3.8 ± 1.3 [SD]; range: 3.5–4.2) compared to SEHM (3.2 ± 1.5 [SD]; range: 2.9–3.5) (P = 0.014).ConclusionIn an animal model, RCM microcatheters reduce the risk of non-target embolization from 11% to 1.7%, increasing the delivery of microspheres of 98% to the target vessels, compared to SEHM microcatheters.     

CT引导下经皮穿刺二次活检诊断肺部病变的可行性及安全性

目的 评价CT引导下经皮二次穿刺活检用于明确诊断肺部病变的可行性及安全性。方法 回顾性分析40例接受2次肺穿刺活检患者的临床、影像学及随访资料,根据最终诊断结果,比较2次活检的诊断准确率,分析并发症及初次活检误诊的危险因素。结果 40例中,17例初次活检诊断结果与最终诊断一致(确诊组)、23例诊断不一致(误诊组),诊断准确率为42.50%(17/40),并发症发生率为27.50%(11/40);39例二次活检诊断结果与最终诊断一致,诊断准确率为97.50%(39/40),并发症发生率为25.00%(10/40)。二次活检诊断准确率明显提高,并发症发生率与初次活检差异无统计学意义(P＞0.05)。组间病灶性质和气胸发生率差异均有统计学意义(P均＜0.05)。结论 CT引导下经皮二次穿刺活检用于明确诊断肺部病变安全、可行。     

The effect of different statistical approaches on image quality data obtained from radiological examinations

IntroductionSelection of optimal image acquisition protocols in medical imaging remains a grey area, the superimposed use of the Likert scale in radiological image quality evaluations creates an additional challenge for the statistical analysis of image quality data.Using a simulation study, we have trialled a novel approach to analysing radiological image quality Likert scale data.MethodsA simulation study was undertaken where simulated datasets were generated based on the distribution of Likert scale values according to varying image acquisition protocols from a real dataset. Simulated Likert scale values were pooled in four different ways; the mean, median, mode and the summation of patient Likert scale values of which the total was assigned a categorical Likert scale value. Estimates of bias, MAPE and RMSPE were then calculated for all four pooling approaches to determine which method most accurately represented an expert's opinion.ResultsWhen compared to an expert's opinion, the method of summation and categorisation of Likert scale values was most accurate 49 times out of the 114 (43.0%) tests. The mean 28 times out of 114 (24.6%), the median 23 times out of 114 (20.2%) and the mode 17 times out of 114 (14.9%).ConclusionWe conclude that our method of summation and categorisation of Likert scale values is most often the best representation of the simulated data compared to the expert's opinion.Implications for practiceThere is scope to reproduce this simulation study with multiple observers to reflect clinical reality more accurately with the dynamic nature of multiple observers. This also prompts future investigation into other anatomical areas, to see if the same methods produce similar results.     

The Duration of the correction loss after removing cheneau brace in patients with adolescent idiopathic scoliosis

Objective

The aim of the study was to evaluate the loss of truncal rotation over 54 hours after removing Chêneau brace.

New evidence supporting lung cancer screening with low dose CT & surgical implications

IntroductionLung cancer is the leading cause of cancer-death worldwide. The U.S. Preventative Services Task Force (USPTSF) approved screening for current or former smokers aged 55–80 based on the results of the National Lung Screening trial (NLST). Following the NLST, new evidence has emerged from clinical trials and updates to previous trials prior to the anticipated update to the USPSTF guideline. We review the new evidence on lung cancer screening with low dose computed tomography (LDCT) and the surgical implications.MethodsA review of new literature was performed pertaining to lung cancer screening since implementation of UPSTF guidelines. Articles for inclusion were identified by both authors’, then search of the Pubmed and Cochrane database was performed from January 1st, 2013 through February 4th, 2020 using the MeSH search terms: “lung cancer”; “screening”; “low dose CT”. The results of these studies are summarized.ResultsWe identified multiple prospective randomized control trials and meta-analysis since the NLST supporting lung cancer-specific mortality with screening. We identified new nodule classification systems and the development of risk-models which may reduce false positive rates and identify high risk patients not currently eligible for screening. Finally, we discussed the surgical implications of screening.ConclusionNew data supports NLST findings and show ongoing benefit to LDCT for lung cancer screening. Standardized LDCT screening classification has been shown to reduce harm and lower false positive rates. Further study is needed regarding use of risk-modeling. Screening will require an increase in the thoracic workforce to accommodate the amount of surgically operable cancers.     

Evaluation of the effectiveness of Er: YAG laser and calcium sodium phosphosilicate (Novamine) prophylaxis paste on remineralization of incipient enamel lesions in primary teeth: An in-vitro study

AimThe aim of this study was to evaluate the potential remineralization effect of Novamine and Er:YAG laser on artificial enamel lesions in primary teeth.Materials and methodsIn this in vitro study, 30 sound buccal and lingual surfaces of human primary canines were randomly divided (6 per group) into 5 groups (Novamine, Laser, Novamine+ Laser, Positive control, and a negative control). Remineralization agents were applied for 1 min to teeth using a rubber cup after creating artificially demineralised lesions. EDX analysis was performed to evaluate the Ca/P ratio and take Scanning electron microscope images.ResultsData were analyzed using Kruskal Wallis analysis. Ca/P ratio was higher in all 4 groups than the negative control group, and higher in Novamine+ Laser group than the positive control group with a statistically significant difference between groups. Overall Ca/P ratio was found to be highest in the Novamine group followed by the laser then positive control group. There were no significant differences between groups regard to Ca/P Ratios.ConclusionBased on these result Er:YAG laser combined with Novamine was provided the greatest contribution to remineralization process of primary teeth.     

非活动性结核性胸膜炎与活动性结核性胸膜炎的CT扫描影像特征分析

目的: 探讨非活动性结核性胸膜炎与活动性结核性胸膜炎CT扫描影像表现。方法: 对2012年6月1日至2021年3月30日在首都医科大学附属北京胸科医院就诊的单纯非活动性结核性胸膜炎患者68例和同期活动性结核性胸膜炎44例的CT扫描影像表现进行比较。结果: (1) 68例非活动性结核性胸膜炎患者 CT扫描影像表现中胸膜粘连62例(91.2%),胸膜有钙化者28例(41.2%),叶间裂受累22例(32.4%),胸腔积液12例(17.6%),包裹性胸腔积液8例(11.8%)。(2)44例活动性结核性胸膜炎患者CT扫描影像表现中胸膜粘连30例(68.2%),未见胸膜钙化,叶间裂受累32例(72.7%),胸腔积液43例(97.7%),包裹性胸腔积液26例(59.1%)。(3)非活动性与活动性结核性胸膜炎CT扫描影像比较:胸膜粘连、胸膜钙化发生率高,差异均有统计学意义(χ²=9.630,P=0.002;χ²=23.737,P=0.000);叶间裂受累、胸腔积液、包裹性胸腔积液的发生率低,差异均有统计学意义(χ²=12.692,P=0.000;χ²=68.548,P=0.000;χ²=28.301,P=0.000)。结论: 非活动性结核性胸膜炎的CT扫描影像与活动性结核性胸膜炎比较胸膜粘连、胸膜钙化的发生率高,胸腔积液、包裹性胸腔积液、叶间裂受累的发生率低。识别非活动性和活动性结核性胸膜炎的CT扫描影像特点,对患者临床治疗有指导意义。     

Computed tomography features of acinar cell carcinoma of the pancreas

PurposeTo report the computed tomography (CT) features of pancreatic acinar cell carcinoma (ACC) and identify CT features that may help discriminate between pancreatic ACC and pancreatic ductal adenocarcinoma (PDA).Materials and methodsThe CT examinations of 20 patients (13 men, 7 women; mean age, 66.5 ± 10.7 [SD] years; range: 51–88 years) with 20 histopathologically proven pancreatic ACC were reviewed. CT images were analyzed qualitatively and quantitatively and compared to those obtained in 20 patients with PDA. Comparisons were performed using univariate analysis with a conditional logistic regression model.ResultsPancreatic ACC presented as an enhancing (20/20; 100%), oval (15/20; 75%), well-delineated (14/20; 70%) and purely solid (13/20; 65%) pancreatic mass with a mean diameter of 52.6 ± 28.0 (SD) mm (range: 24–120 mm) in association with visible lymph nodes (14/20; 70%). At univariate analysis, well-defined margins (Odds ratio [OR], 7.00; P = 0.005), nondilated bile ducts (OR, 9.00; P = 0.007), visible lymph nodes (OR, 4.33; P = 0.028) and adjacent organ involvement (OR, 5.67; P = 0.02) were the most discriminating CT features to differentiate pancreatic ACC from PDA. When present, lymph nodes were larger in patients with pancreatic ACC (14 ± 4.8 [SD]; range: 7–25 mm) than in those with PDA (8.8 ± 4.1 [SD]; range: 5–15 mm) (P = 0.039).ConclusionOn CT, pancreatic ACC presents as an enhancing, predominantly oval and purely solid pancreatic mass that most frequently present with no bile duct dilatation, no visible lymph nodes, no adjacent organ involvement and larger visible lymph nodes compared to PDA.     

四川省首例COVID-19婴儿病例分析及文献复习

目的探讨1例输入性、家庭聚集性严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染的2^＋个月龄新型冠状病毒疾病(COVID-19)婴儿的临床流行病学资料及影像学资料特点，并进行文献复习。 方法选择2020年2月7日，四川省金堂县第一人民医院收治的2^＋个月龄COVID-19婴儿为研究对象。采用回顾性分析方法，收集该例婴儿的临床病例资料，对其临床流行病学特点、影像学资料、诊断、治疗方案及预后进行分析。本研究对报道COVID-19婴儿的相关文献进行复习，设定检索策略为：以"婴儿""新型冠状病毒肺炎""新型冠状病毒疾病""2019-nCoV""NCP""SARS-CoV-2""COVID-19""infant"等为关键词，在PubMed、Medline、中国知网、维普中文科技期刊数据库、万方数据知识服务平台，以及"医学界儿科频道"等公众平台及新闻网站中，检索相关文献，检索时间设定为2019年12月1日至2020年2月21日。总结符合本研究纳入、排除标准的文献中报道的COVID-19婴儿临床特点及其诊断、治疗方案与预后。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。 结果①病史采集、诊断、治疗结果：患儿，男性，生后2个月＋29 d；2020年1月18日，患儿姨妈自武汉返蓉，密切接触后，患儿出现气促、轻微咳嗽、腹泻等症状。入院后，患儿检查结果显示，肺炎支原体及衣原体、甲型及乙型流感病毒抗原均呈阴性。胸部CT检查结果显示，患儿双肺胸膜下多发性浅淡磨玻璃病灶。2次鼻咽拭子SARS-CoV-2核酸检测均呈阳性。根据流行病学史、临床与影像学表现及核酸检测结果，确诊为普通型COVID-19患儿。经过对症治疗后，患儿气促、咳嗽临床症状消失，胸部影像学检查结果显示，肺部炎症病灶吸收，SARS-CoV-2核酸检测呈阴性。目前，患儿继续观察中，等候出院。②文献复习结果：按照本研究设定的文献检索策略，共计检索出5篇国内有关婴儿COVID-19文献及2篇婴儿COVID-19新闻报道，涉及18例COVID-19婴儿的临床特点、诊断、治疗方案及预后等研究。这18例COVID-19婴儿，均具有家庭聚集性、输入性感染特点(武汉COVID-19患者接触史)。其中，3例新生儿及其母亲均为SARS-CoV-2感染者。出生后，对2例新生儿进行有效隔离，无感染者接触史。这18例COVID-19婴儿的首发症状为：发热5例(27.8%)、咳嗽及下呼吸道症状3例(16.7%)、打喷嚏及吐奶1例(5.6%)、无症状3例(16.7%)、病史不详6例(33.3%)。其中，7例婴儿文献报道胸部CT检查结果，并且均存在异常，表现为双肺或单侧肺纹理增粗、磨玻璃影和(或)实变影。除2例婴儿未报道预后情况外，其余16例婴儿均预后良好，无死亡病例报道。 结论文献报道的COVID-19婴儿及纳入本研究的1例婴儿，均具有输入性、家庭聚集性感染特点，而且对新生儿患者，目前尚不能排除母婴垂直传播可能性。对于临床症状相对较轻，肺部病变范围相对较小且局限的COVID-19婴儿，一般预后较好。在COVID-19暴发流行期，应尽可能加强儿童，特别是婴儿的防护，避免输入性、家庭聚集性SARS-CoV-2感染。