MR-safety in clinical practice at 7T: Evaluation of a multistep screening process in 1819 subjects

IntroductionMR facilities must implement and maintain adequate screening and safety procedures to ensure safety during MR examinations. The aim of this study was to evaluate a multi-step MR safety screening process used at a 7T facility regarding incidence of different types of safety risks detected during the safety procedure.MethodsSubjects scheduled for an MR examination and having entered the 7T facility during 2016–2019 underwent a pre-defined multi-step MR safety screening process. Screening documentation of 1819 included subjects was reviewed, and risks identified during the different screening steps were compiled. These data were also related to documented decisions made by a 7T MR safety committee and reported MR safety incidents.ResultsPassive or active implants (n = 315) were identified in a screening form and/or an additional documented interview in 305 subjects. Additional information not previously self-reported by the subject, regarding implants necessitating safety decisions performed by the staff was revealed in the documented interview in 102 subjects (106 items). In total, the 7T MR safety committee documented a decision in 36 (2%) of the included subjects. All of these subjects were finally cleared for scanning.ConclusionA multi-step screening process allows a thorough MR screening of subjects, avoiding safety incidents. Different steps in the process allow awareness to rise and items to be detected that were missed in earlier steps.Implications for practiceSafety questions posed at a single timepoint during an MR screening process might not reveal all safety risks. Repetition and rephrasing of screening questions leads to increased detection of safety risks. This could be effectively mitigated by a multi-step screening process. A multi-disciplinary safety committee is efficient at short notice responding to unexpected safety issues.     

胰腺囊性肿瘤诊疗及进展

胰腺囊性肿瘤(PCNs)是少见肿瘤，发病原因尚不明确，不良生活习惯（吸烟、饮酒、重咖啡、高脂高蛋白饮食等）、慢性胰腺炎、环境污染因素及遗传因素等是潜在致病因素。PCNs分为浆液性囊性肿瘤（SCN）、黏液性囊性肿瘤（MCN）、胰腺导管内乳头状黏液肿瘤(IPMN)和实性假乳头状瘤（SPN）四种类型。发病症状常不典型，早期诊断难。PCNs具有典型影像特点，单个影像检查技术对PCNs的准确性和局限性不同，CT检查在胰腺病变中仍是最基本、最主要的检查方式。MRI对于小的囊性病灶比CT更有优势。超声内镜（EUS）充分结合了内镜和超声检查的优势，与CT、MRI检查相辅相成，同时还可进行细针穿刺取病理及囊液分析。尽管PCNs大部分为良性，但只要达到切除标准，均应推荐患者进行手术治疗，严格遵循PCNs诊治流程，制订个体化PCNs治疗策略，使患者利益最大化。     

大剂量静脉滴注免疫球蛋白治疗系统性红斑狼疮的疗效

目的探讨大剂量静脉滴注免疫球蛋白治疗系统性红斑狼疮的疗效。方法选取2015年12月～2018年12月在我院收治的系统性红斑狼疮患者100例,将其随机分为对照组与观察组,每组50例,对照组采用环磷酰胺静脉滴注、强的松口服、甲基强的松龙冲击治疗。观察组在对照组治疗的基础上,使用大剂量静脉滴注免疫球蛋白治疗。比较两组患者的治疗效果。结果观察组患者血小板达高峰平均时间,明显短于对照组,差异有统计学意义(P0.05)。治疗前,两组患者系统性红斑狼疮疾病活动度评分(SLEDAI)、系统性红斑狼疮生活质量量表(SLEQOL)评分比较,差异无统计学意义(P0.05)。治疗后,观察组患者的SLE-QOL评分、SLEDAI评分明显低于对照组,差异有统计学意义(P0.05)。观察组患者4周内血小板上50%以上的为100%,明显高于对照组的76%,差异有统计学意义(P0.05)。两组不良反应发生情况比较无明显差异(P0.05)。结论大剂量静脉滴注免疫球蛋白对系统性红斑狼疮的治疗有积极的作用,能够控制疾病活动度,提高患者的生活质量,不会增加不良反应。     

胰腺囊性肿瘤恶性风险预测模型研究

目的 明确与恶性胰腺囊性肿瘤（PCN）相关的术前危险因素，建立准确的预测模型，并予以验证。方法 纳入2013年1月至2020年5月复旦大学附属华东医院经术后病理检查证实的114例PCN病例，分为模型组（n=80）和验证组（n=34）。回顾性分析模型组术前的临床资料并探索与恶性PCN相关的影响因素，建立PCN恶性风险预测模型，绘制受试者工作特征（ROC）曲线和校正曲线评价模型，最后基于验证组数据对模型进行临床验证。结果 单因素回归分析提示临床症状、CA19-9水平升高、中性粒细胞淋巴细胞比值（NLR）、淋巴细胞单核细胞比值（LMR）、肿瘤最大直径、胰管扩张和实性成分与恶性PCN显著相关，进一步行多因素回归分析确定了NLR≥2.146、CA19-9水平升高、胰管扩张是恶性PCN的独立预测因素。基于多因素回归分析结果建立恶性PCN预测模型，绘制模型的ROC曲线，计算AUC为0.921（95%CI 0.863~0.979），Youden指数最大时取得最佳临界预测值为0.203，此时相对应的特异度为83.3%，敏感度为92.9%，准确率为85%。同时校正曲线显示模型具有较好的拟合度，最后代入验证组数据显示模型预测准确率为82.4%，特异度81.2%，敏感度100%。结论 CA19-9水平升高、NLR升高以及胰管扩张是恶性PCN的高危因素，基于此建立的恶性胰腺囊性肿瘤的预测模型具有较好的准确率，可为今后的临床诊疗提供辅助参考。     

Current thinking in the management of adenoid cystic carcinoma of the head and neck

Adenoid cystic carcinoma (ACC) is an aggressive, rare, malignant tumour that accounts for about 1% of all head and neck neoplasms and 10% of all salivary gland tumours. It is characterised by frequent local recurrences and distant metastases. Growth is slow but relentless, and progression poses a challenge to head and neck clinicians. Many small retrospective studies have described its clinical management, but the lack of multicentre, randomised, controlled trials has resulted in inconsistencies in management globally. We have focused on three key management-related controversies: the role of elective neck dissection (END) for the N0 neck; the role of adjuvant treatment or radiotherapy; and finally, the follow-up protocol, particularly cross-sectional surveillance imaging of the full body or chest computed tomography (CT) alone, and options for treatment if metastases are found. The paucity of published studies may reflect the inconsistencies that exist in the management of ACC of the head and neck in the UK. The collaboration of head and neck centres would, we think, help to correct the imbalance in these three domains of care.     

Tracking Spinal Cord Injury Functional Outcomes Across the Lifespan: Validation of Linking Coefficients

ObjectiveValidation of linking coefficients to transform Pediatric Spinal Cord Injury Activity Measure (PEDI-SCI/AM) scores to adult Spinal Cord Injury-Functional Index (SCI-FI) scores.DesignThis cross-sectional study administered PEDI-SCI/AM and SCI-FI computerized adaptive tests (CATs) and short forms (SFs) to children with SCI and parents or caregivers.SettingHospitals, university, and rehabilitation institute.ParticipantsAbout 107 children with SCI and 96 parent or caregivers.InterventionsNot applicable.Main Outcome MeasuresLinking coefficients estimated SCI-FI (est-SCI-FI) scores from PEDI-SCI/AM scores for matched domains. Correlations between est-SCI-FI and actual SCI-FI scores were calculated. If correlations exceeded the criterion linking (0.866), the following analyses to compare est-SCI-FI and actual SCI-FI scores were conducted: paired t tests, intraclass correlation coefficients (ICCs 3, 1), percent of cases with absolute score differences at different thresholds.ResultsTwo matched domains, PEDI-SCI/AM Daily Routine/SCI-FI Self-Care and PEDI-SCI/AM General Mobility/SCI-FI Basic Mobility, met the linking criterion for both respondent-types (parent and child) and administration modes (CAT and SF). PEDI-SCI/AM Daily Routine and SCI-FI Fine Motor Function did not meet linking criterion for respondent type or mode. The linking criterion was met for wheelchair domains (child SF and CAT) and ambulation domains (child SF only). Significant differences between est-SCI-FI and actual SCI-FI scores were noted for all matched domains except Daily Routine/Self-Care (child SF only; parent SF and CAT). ICC values showed excellent agreement (range=0.75-0.89). Absolute differences between est-SCI-FI and actual SCI-FI scores were less than 1 standard deviation (except wheelchair CAT child).ConclusionsLinking coefficients applied to PEDI-SCI/AM scores can provide valid SCI-FI estimates that vary by domain, mode, and respondent type.