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.     

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。     

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.     

碘化钾制备的碘涂层钛板的抗菌性能研究

目的探讨利用碘化钾制备碘涂层钛板的可行性,并验证其抗菌性能。方法以碘化钾作为电解液,使用电泳沉积法将碘负载到钛板表面,制备出碘涂层钛板。通过扫描电镜与能谱分析,观察碘涂层钛板的表面征象和成分结构。实验分组:对照组是经过预处理但未行载碘的钛板,共10块;实验组是经过预处理后再行载碘的碘涂层钛板,根据电解液浓度的不同分为3组:1000 mg/L、2000 mg/L、4000 mg/L组,每组各10块。使用1×106 CFU/mL的金黄色葡萄球菌(ATCC25923)进行体外抗菌实验,并对其抗菌性能进行研究。结果碘涂层钛板外观呈灰色,表面可均匀覆盖一层平整、无塌陷的涂层,电镜下见其表面可形成碘涂层,局部散在分布大小不等的不规则陷凹。对照组、1000 mg/L组、2000 mg/L组、4000 mg/L组的钛板碘含量分别为0、5.10、10.32、15.05 mass%;其体外抗菌菌落计数分别为56.00±5.09、21.40±2.76、9.10±2.51和2.00±1.88,4组之间菌落计数比较差异均有统计学意义(P<0.05)。结论碘化钾作为电解液,使用电泳沉积法可成功制备出碘含量稳定、涂层分布均匀的碘涂层钛板。体外抗菌实验证明碘涂层钛板的抗菌性能强于未载碘钛板。     

放射性核素磷近距离治疗小儿皮肤血管瘤的近期疗效

目的:探讨放射性核素磷(32P)近距离治疗小儿皮肤血管瘤的临床疗效及辐射损伤。方法:173例小儿皮肤血管瘤患儿随机分为治疗组92例,对照组81例,采用32P敷贴器以不同的剂量、不同的治疗疗程行近距离治疗,观察其临床疗效及辐射损伤。结果:32P敷贴器放射性面密度的估算值与实测值误差为5.4%±0.9%;治疗组和对照组患者经32P治疗1个～4个疗程后病灶总治愈率均为100%;两组病例治疗后均出现皮肤辐射损伤,且与皮肤血管瘤病变的面积密切相关,治疗组的辐射损伤比对照组轻(P<0.05),皮肤血管瘤病变较厚者疗效较低,增加治疗疗程可提高疗效(P<0.05)。结论:多疗程、低剂量的32P近距离治疗小儿皮肤血管瘤可取得更佳的临床治疗效果。     

Basal asynchrony and resynchronization with biventricular pacing predict long-term improvement of LV function in heart failure patients

Biventricular pacing (BiV) is emerging for patients with dilated cardiomyopathy (DCM) and asynchrony. We measured basal asynchrony and early resynchronization by radionuclide angioscintigraphy (RNA) in order to predict long-term evolution of ventricular function after BiV. Thirty-four patients (NYHA Class III-IV,65.4 +/- 11 years) with large QRS(179 +/- 18 ms)were implanted with BiV and studied by RNA before (D0), at day 8 (D8), and during follow-up(20 +/- 7 months). We calculated left and right ejection fractions, the interventricular dyssynchrony (TRVLV), and the apicobasal dyssynchrony (Tab). LVEF improved from 20.2 +/- 8.1%(D0) to27.1%+/- 12.6%(follow-up,P < 0.003 vs D0) and RVEF from 28.6%+/- 13%(D0) to 34.3 +/- 11.5%(follow-up,P < 0.03 vs D0). Inter- (DeltaTRVLV) and intraventricular resynchronization was immediate and remained stable: TRVLV decreased from 68.3 +/- 38 ms(D0) to 13.4 +/- 48.5 ms(D8) and1.8 +/- 39.2 ms(follow-up,P < 0.0001 vs D0); and Tab from 45.8 +/- 64.1 msto-18 +/- 68(D8) and-28.3 +/- 53.6 ms(follow-up,P < 0.0001 vs D0). Early inter- and intraventricular resynchronization (DeltaTab) at D8 were related to late LVEF and RVEF improvement. Together, an LVEF > 15% and a significant interventricular dyssynchrony (TRVLV > 60 ms) at D0 have a sensitivity of 79% and a positive predictive value of 83% to predict an improvement of LVEF superior to 5% at follow-up. In DCM patients, BiV resynchronizes ventricles early and in the long-term, while RVEF and LVEF improve progressively. Patients with large electromechanical dyssynchrony benefit most from BiV.     

超声介导125I放射性粒子植入治疗晚期恶性肿瘤

目的探讨超声引导^125I放射性粒子植入治疗晚期恶性肿瘤的可行性和效果。 方法在超声引导下，经皮或经阴道穿刺晚期恶性肿瘤，并依据放射治疗计划植入适当数量的^125I放射性粒子。 结果28例患者均获成功。超声能清晰显示肿块，准确引导植入针的插入，成功监视粒子的植入。 结论超声引导^125I放射粒子植入治疗晚期恶性肿瘤安全、微创、并发症少，疗效肯定。