Medición automática de la zona avascular foveal de ojos sanos en angiografía por tomografía de coherencia óptica de dominio espectral Heidelberg

PurposeTo develop and evaluate an automated method to measure the foveal avascular zone (FAZ) area in healthy eyes on Heidelberg Spectralis Optical Coherence Tomography Angiography (HS-OCTA). This method is referred to as the modified Kanno-Saitama macro (mKSM) which is an evolution of the Kanno-Saitama macro (KSM) approach.MethodsThis cross-sectional study included 29 eyes of 25 healthy volunteers who underwent HS-OCTA at the macular area twice at the same time. Regardless of the quality of the images, all of them were included. Macular data on the superficial vascular plexus, intermediate capillary plexus (ICP) and deep capillary plexus were processed by mKSM. The FAZ area was measured twice automatically using the mKSM and KSM and twice manually by two independent examiners.ResultsFrom 174 images, KSM could not measure correctly 31% while mKSM could successfully measure all of them. Intrascan intraclass coefficient ranged from 0.948 to 0.993 for manual measurements and was 1 for mKSM method. Despite that the difference between human examiners is smaller than between human examiners and mKSM according to Bland-Altman plots, the scatterplots show a strong correlation between human and automatic measurements. The best results are obtained in ICP.ConclusionsWith mKSM, the automated determination of the FAZ area in HS-OCTA is feasible and less human-dependent. It solves the inability of KSM to measure the FAZ area in suboptimal quality images which are frequent in daily clinical practice. Therefore, the mKSM processing could contribute to our understanding of the three vascular plexuses.     

RESIRT: A Phase 1 Study of Selective Internal Radiation Therapy Using Yttrium-90 Resin Microspheres in Patients With Primary Renal Cell Carcinoma

IntroductionSelective internal radiation therapy (SIRT) is a potential treatment of primary renal cell carcinoma (RCC) deemed unsuitable for conventional therapy. RESIRT is the first-in-human study to evaluate safety and feasibility of SIRT for primary RCC.Patients and MethodsPatients with RCC, unsuitable for, or who declined conventional therapy, were eligible. A single transfemoral micro-catheter administration of yttrium-90 (Y-90) resin microspheres (SIR-Spheres) was delivered super selectively via the renal artery to the tumour at intended radiation doses of 75, 100, 150, 200, 300 Gy and a final cohort with a procedural endpoint of “imminent stasis,” in a dose-escalation design. Post-SIRT follow-up was 12 months. Study endpoints included safety and toxicity 30-days and 12-months post-SIRT and tumour response (RECIST v1.1).ResultsIn total, 21 patients were enrolled, mean (SD) age was 75 (9.3) years, WHO performance status was 0 in 81%, 12 (57%) had stage 3 chronic kidney disease, and 7 (33%) had prior contralateral nephrectomy. Overall, 71% of patients completed 12 months of follow-up. Intended doses were delivered without any dose-limiting toxicity. Seventeen out of 21 (81%) patients experienced an adverse event (AE) from any cause within 30 days post-SIRT; all SIRT-related AEs were grade 1 to 2. Best overall tumour responses were partial response 1/21 (4.8%), stable disease 19/21 (90.5%) and progressive disease 1/21 (4.8%).ConclusionThis study demonstrated good tolerability of SIRT at all dose levels including “imminent stasis” in treating primary tumours in RCC patients otherwise unsuitable for conventional therapy. SIRT with Y-90 resin microspheres may be a feasible treatment option for RCC.     

Neural selectivity,efficiency, and dose equivalence in deep brain stimulation through pulse width tuning and segmented electrodes

BackgroundAchieving deep brain stimulation (DBS) dose equivalence is challenging, especially with pulse width tuning and directional contacts. Further, the precise effects of pulse width tuning are unknown, and recent reports of the effects of pulse width tuning on neural selectivity are at odds with classic biophysical studies.MethodsWe created multicompartment neuron models for two axon diameters and used finite element modeling to determine extracellular influence from standard and segmented electrodes. We analyzed axon activation profiles and calculated volumes of tissue activated.ResultsWe find that long pulse widths focus the stimulation effect on small, nearby fibers, suppressing distant white matter tract activation (responsible for some DBS side effects) and improving battery utilization when equivalent activation is maintained for small axons. Directional leads enable similar benefits to a greater degree. Reexamining previous reports of short pulse stimulation reducing side effects, we explore a possible alternate explanation: non-dose equivalent stimulation may have resulted in reduced spread of neural activation. Finally, using internal capsule avoidance as an example in the context of subthalamic stimulation, we present a patient-specific model to show how long pulse widths could help increase the biophysical therapeutic window.DiscussionWe find agreement with classic studies and predict that long pulse widths may focus the stimulation effect on small, nearby fibers and improve power consumption. While future pre-clinical and clinical work is necessary regarding pulse width tuning, it is clear that future studies must ensure dose equivalence, noting that energy- and charge-equivalent amplitudes do not result in equivalent spread of neural activation when changing pulse width.     

脑卒中患者恐惧疾病进展的研究现状

脑卒中患者在面对复杂的治疗期、漫长的康复期及难以预测的病情变化时容易产生对疾病或疾病进展的恐惧。恐惧疾病进展会损害脑卒中患者的身心健康和社会功能,最终影响患者的康复和预后。从恐惧疾病进展的定义、测量工具、国内外研究现状及影响因素几个方面进行综述,为临床护理人员深入了解脑卒中患者恐惧疾病进展现状、开展相关护理实践和临床研究提供依据。     

漏斗胸Nuss矫形术对胸廓的影响及相关因素分析

目的通过CT影像测量了解漏斗胸Nuss矫形术前后胸廓径线的改变情况,探讨并分析Nuss矫形术对胸廓的影响及相关因素。方法对2014年1月至2018年12月郑州大学第一附属医院收治的50例行漏斗胸Nuss矫形术患儿的临床资料进行回顾性分析。50例患儿中男43例,女7例。所有患儿中存在脊柱侧弯6例,胸廓不对称12例,胸骨旋转11例。通过CT影像测量其放置矫形器前及取出矫形器后胸廓各椎体平面最大横内径及该平面胸脊间的距离,通过配对样本t检验比较矫形前后各径线的改变情况,以及通过独立样本t检验分析在不同年龄、性别、矫形时间、漏斗胸对称与否、是否合并脊柱侧弯等情况间的差异性。结果50例患儿均顺利完成矫形器置入术及矫形器拔除术,无明显术中及术后并发症,Nuss矫形后较矫形前相比,胸廓前后径在第8~12胸椎水平均较前增加,第3~5胸椎平面较前减小,胸廓横径在第8~10胸椎平面较前减小;年龄≤10岁、矫形时长≥2年及女性患儿胸廓前后径改变量在多个胸椎平面分别较年龄>10岁、矫形时长<2年及男性患儿大,P<0.05,差异具有统计学意义。结论漏斗胸Nuss矫形后前胸壁凹陷较前明显改善,并且在不同年龄和不同矫形时长间存在差异性,年龄较小及适当增加矫形时间可获得较好的矫形效果,而胸廓横径生长在一定程度上受限。     

Precision and Accuracy of Measurements on CT Scout View

ObjectivesThe purposes of this study were to (1) investigate the limits of measurements on scout view in three computed tomography axes, x, y and z and (2) develop a model to provide better understanding of measurement accuracy.MethodsFor the first objective, anteroposterior and lateral scout views of a Catphan phantom 200 mm in diameter and length were acquired with a GE scanner at 21 different table heights. Phantom measurements on scout view were performed by two experienced readers. The comparison of their measures provided estimation of precision. The accuracy was assessed by determining the bias, calculated as the difference between the values measured on scout view and the real phantom size. Second, a model was developed investigating the relationship between the dimensions of the object, its image, and the table height. This relationship was tested on our data.ResultsScout view measurements were precise, with less than 0.53% difference between readers. In addition, small biases of about 1 mm were detected in the z-axis, whatever the table height. In the other axes, serious biases from −13 to +73 mm were measured. Furthermore, at isocentre, overestimations up to 7 mm were shown. The results also indicated that biases in scout view measurements are because of the geometrical projection related to the object-detector distance.ConclusionsMeasurements in the table movement axis are precise and accurate, conferring to scout views an added value for preoperative planning in orthopedic surgery.     

国内外护理学本科生毕业考核现状与分析

教育测量与评价对实现教育目标具有重要作用。科学的教育评价既促进学生学习,又为教育决策提供依据,以实现持续质量改进。"健康中国2030"的整体目标、医学科学的发展及人民的健康需求,对新时代护理人才的培养提出了更高、更具体的要求。高等护理院校应以国家和社会对护理人才需求、院校培养目标为导向,以测量理论为基础,制定完善的学业评定标准,科学地开展毕业考核,保证人才"出口"质量。毕业考核作为终结性评价,测试内容在评价质量中起核心作用,应符合国家护理学专业培养标准,并与院校培养目标、课程目标契合。院校应关注护理本科生毕业考核质量,在保障测试信度的同时,做到实施公平、评价适当、标准一致,以确保测试的效度。教育管理部门及各院校应优化评价体系,加强对护理本科生毕业管理,在充分开展系统调查与分析的基础上,基于胜任力导向和结果导向,建立综合性评价体系,在教学过程中进行全方位反馈评价管理。文章结合国内外护理学专业本科生毕业考核的现状,从考核目的、内容、方式、评价主体、质量控制等方面进行综述与分析,为我国加强护理学本科教育,完善护理学专业本科生毕业评价体系建设提供借鉴。