Radiation Dose Reduction in Kidney Stone CT: A Randomized,Facility-Based Intervention

ObjectiveKidney stones are common, tend to recur, and afflict a young population. Despite evidence and recommendations, adoption of reduced-radiation dose CT (RDCT) for kidney stone CT (KSCT) is slow. We sought to design and test an intervention to improve adoption of RDCT protocols for KSCT using a randomized facility-based intervention.MethodsFacilities contributing at least 40 KSCTs to the American College of Radiology dose index registry (DIR) during calendar year 2015 were randomized to intervention or control groups. The Dose Optimization for Stone Evaluation intervention included customized CME modules, personalized consultation, and protocol recommendations for RDCT. Dose length product (DLP) of all KSCTs was recorded at baseline (2015) and compared with 2017, 2018, and 2019. Change in mean DLP was compared between facilities that participated (intervened-on), facilities randomized to intervention that did not participate (intervened-off), and control facilities. Difference-in-difference between intervened-on and control facilities is reported before and after intervention.ResultsOf 314 eligible facilities, 155 were randomized to intervention and 159 to control. There were 25 intervened-on facilities, 71 intervened-off facilities, and 96 control facilities. From 2015 to 2017, there was a drop of 110 mGy ∙ cm (a 16% reduction) in the mean DLP in the intervened-on group, which was significantly lower compared with the control group (P < .05). The proportion of RDCTs increased for each year in the intervened-on group relative to the other groups for all 3 years (P < .01).DiscussionThe Dose Optimization for Stone Evaluation intervention resulted in a significant (P < .05) and persistent reduction in mean radiation doses for engaged facilities performing KSCTs.     

Risk prediction of common bile duct stone recurrence based on new common bile duct morphological subtypes

Stones in the common bile duct (CBD) are reported worldwide, and this condition is majorly managed through endoscopic retrograde cholangiopancreatography (ERCP). CBD stone recurrence is an important issue after endoscopic stone removal. Therefore, it is essential to identify its risk factors to determine the necessity of regular follow-up in patients who underwent endoscopic removal of CBD stones. The authors identified that the S and polyline morphological subtypes of CBD were associated with increased stone recurrence. New morphological subtypes of CBD presented by the authors can be important risk predictors of recurrence after endoscopic stone removal. Furthermore, the new morphological subtypes of CBD may predict the risk of residual CBD stones or technical difficulty in CBD stone removal. Further studies with a large sample size and longer follow-up durations are warranted to examine the usefulness of the newly identified morphological subtypes of CBD in predicting the outcomes of ERCP for CBD stone removal.     

嘌呤配体P2X门控离子通道型受体7及其下游分子在痛风性关节炎中作用机制的研究进展

目前随着痛风性关节炎的发病率逐年上升,对该病炎性反应及疼痛机制的研究越来越多,该病主要由尿酸盐沉积及ATP刺激P2X7R、Nod样受体蛋白3、NEK7表达诱导炎性反应递质成熟与分泌所致,但具体机制尚不明确。现对P2X7R、NLRP3、NEK7的国内外研究进展进行综述,以探讨GA炎性反应及疼痛的发病机制,为防治GA提供新思路与治疗靶点。     

乳头括约肌小切开加大口径柱状气囊扩张治疗胆总管结石的价值

目的探讨采用内镜下乳头括约肌小切开加大口径气囊扩张(ESBD)治疗胆总管结石的有效性及并发症。方法将90例肝外胆管结石且胆管直径13 mm的患者,随机分成3组各30例,EST(内镜下乳头括约肌切开)组、EPBD(内镜下乳头柱状气囊扩张术)组、ESBD组,再行取石治疗。观察3组病例的结石清除率、结石清除时间、多次取石数、碎石器使用率及并发症等情况。结果 EST、EPBD和ESBD组I期结石清除率分别为96.7%(29/30)、90.0%(27/30)和100%(30/30)(P=0.160),结石清除时间分别为(21.50±6.69)min、(22.97±6.62)min和(17.77±4.37)min(P=0.004),碎石器使用率分别为36.7%、30.0%和10.0%(P=0.048),多次取石数分别为23、25和16例(P=0.027)。3组近期并发症差异无统计学意义;远期并发症分别为8、4和1例(P=0.036)。结论内镜下乳头括约肌小切开加大口径气囊扩张是清除胆总管结石的有效方法,尤其适合于胆总管巨大结石或行乳头切开取石困难者。     

胆道镜联合输尿管镜气压弹道碎石治疗难取胆管结石的临床应用

【摘要】〓目的〓探讨胆道镜联合输尿管镜气压弹道碎石治疗难取胆管结石的临床效果。方法〓回顾性分析采用胆道镜联合输尿管镜气压弹道碎石65例患者的临床资料。结果〓全组手术均成功,取石时间25~70分钟,平均40分钟,结石取尽63例,结石残留2例,术中无胆管出血和胆管壁穿孔等并发症。随访一年,胆管不扩张,未发现肝外胆管残余结石,肝功能检查均正常,所有患者未再出现腹痛、发热、黄疸等症状。结论〓胆道镜联合输尿管镜气压弹道碎石治疗难取性胆管结石有效、可行。