三维CT及X线卵圆孔定位射频热凝治疗顽固性三叉神经痛

目的：探讨三维CT及X线卵圆孔定位在三叉神经痛射频热凝治疗中的应用及手术技巧。方法：Hartel前入路穿刺法，仰卧位，对38例三叉神经痛病人，于射频热凝治疗术中应用三维CT及X线卵圆孔定位，以明确卵圆孔的位置，调整穿刺针的方向和深度，然后进行温控热凝射频治疗。结果：穿刺针均位于卵圆孔内，病人疼痛即刻缓解，无严重并发症发生。结论：三维CT及X线卵圆孔定位弥补了徒手穿刺的缺陷，提高了卵圆孔穿刺的成功率和精确性，增加了操作的安全性，降低了并发症的发生，具有一定的学术价值，可供临床推广应用。     

腰椎椎弓崩裂CT征象的临床诊断价值

目的分析腰椎椎弓峡部裂的CT表现,探讨各个征象的诊断价值和意义.方法自可疑椎弓峡部裂脊椎的椎弓根的上缘至下一个椎弓根上缘,层厚2～3mm连续扫描.结果86例中发生L5椎弓峡部裂51例,L4者33例,L3,者2例.各种CT征象发现率为:环裂征91%,椎体前移征85%,双椎体征50%,椎管拉长征45%,双关节面征38%,葫芦征26%,游移征15%,磨旋征6%.结论环裂征是该病的特征性表现;双关节面征及葫芦征发现率较低,但特异性较高.椎管拉长征具有一定诊断价值,其它征象无论其发现率大小,均是该病的继发改变,不能作为确诊的直接依据.     

CT卫生技术评估报告分析及启示

目的为我国开展影像学诊断设备卫生技术评估（HTA）提供方法学参考。方法检索国际卫生技术评估机构网站,对纳入的CT HTA报告进行结构化信息提取和分析。结果共纳入4个国家6家机构的24篇HTA报告。其中,快速卫生技术评估12篇,全面卫生技术评估12篇。评估核心维度为有效性、经济性和安全性。纳入报告均采用了文献综述分析,部分针对重大决策的HTA进行了Meta分析、成本-效果分析和预算影响分析。 结论可为我国CT等影像学诊断设备技术评估提供参考,提高我国大型医疗设备治理决策的科学化水平。     

制剂中利福平晶型的确定

目的确定制剂中利福平的晶型.方法利用粉末X-射线衍射方法测定不同晶型的利福平原料,结合文献数据,总结出利福平各晶型的主要特征衍射峰;直接测定利福平胶囊内容物或片剂研细的固体粉末的粉末X-射线衍射图谱,根据图谱中存在的利福平主要特征衍射峰,确定制剂中利福平的晶型.结果利福平晶体的主要特征衍射峰(2θ)分别为8.79°和14.48°(Ⅰ型结晶),1 5.84°和20.06°(Ⅱ型结晶),18.36°(SV型结晶);制剂中的辅料不干扰对主要特征衍射峰的判断;国内5个企业的12批利福平片和37个企业的88批利福平胶囊中的利福平均为Ⅰ型结晶.结论本方法可方便地判断制剂中利福平的晶型.     

Philips Bucky DiagnostTS X线机的数字化改造

采用友通公司的方案，对PhilipsX线机进行了数字化改造，改造后的系统增加了数字化X线平板探测器、控制盒和DR影像工作站，使摄片更加方便快捷，为临床诊断提供了更高质量的图像。     

Imaging update on soft tissue sarcoma

Soft tissue sarcomas (STS) are rare tumours presenting as soft tissue lumps. Ultrasound is often the primary modality for the initial assessment, with MRI the mainstay for lesion characterisation. PET/CT along with other emerging MRI sequences are used in certain situations as an adjunct and problem solving tool in STS staging and assessment of disease recurrence. Recent advances include the promise of whole body MRI, hybrid PET/MRI, diffusion weighted imaging, dynamic contrast enhanced MRI and advances in artificial intelligence. This article discusses current concepts in extremity STS imaging and highlights recent advances.     

高原地区首例新型冠状病毒肺炎CT诊断分析并文献复习

目的回顾性分析高原地区首例新型冠状病毒肺炎的CT影像特征及临床表现,以提高对该病的认识。方法回顾性分析高原地区1例确诊新型冠状病毒患者的CT影像及临床资料并进行文献复习。结果患者患病过程中早期、进展期及转归期的CT表现较为典型,与内地文献报道无明显差异,但诊断时应与高原性病种相互鉴别。结论新型冠状病毒肺炎的诊断除结合临床特征、实验室检查、流行病学史及核酸检测外,CT扫描在治疗后的复查及早期的诊断可以提供必要的补充资料,熟悉该病CT诊断的分期表现有助于诊断。     

Elaboración de modelos predictivos de la gravedad y la mortalidad en pacientes con COVID-19 que acuden al servicio de urgencias,incluida la radiografía torácica

ObjectivesTo develop prognosis prediction models for COVID-19 patients attending an emergency department (ED) based on initial chest X-ray (CXR), demographics, clinical and laboratory parameters.MethodsAll symptomatic confirmed COVID-19 patients admitted to our hospital ED between February 24th and April 24th 2020 were recruited. CXR features, clinical and laboratory variables and CXR abnormality indices extracted by a convolutional neural network (CNN) diagnostic tool were considered potential predictors on this first visit. The most serious individual outcome defined the three severity level: 0) home discharge or hospitalization ≤ 3 days, 1) hospital stay >3 days and 2) intensive care requirement or death. Severity and in-hospital mortality multivariable prediction models were developed and internally validated. The Youden index was used for the optimal threshold selection of the classification model.ResultsA total of 440 patients were enrolled (median 64 years; 55.9% male); 13.6% patients were discharged, 64% hospitalized, 6.6% required intensive care and 15.7% died. The severity prediction model included oxygen saturation/inspired oxygen fraction (SatO2/FiO2), age, C-reactive protein (CRP), lymphocyte count, extent score of lung involvement on CXR (ExtScoreCXR), lactate dehydrogenase (LDH), D-dimer level and platelets count, with AUC-ROC = 0.94 and AUC-PRC = 0.88. The mortality prediction model included age, SatO2/FiO2, CRP, LDH, CXR extent score, lymphocyte count and D-dimer level, with AUC-ROC = 0.97 and AUC-PRC = 0.78. The addition of CXR CNN-based indices did not improve significantly the predictive metrics.ConclusionThe developed and internally validated severity and mortality prediction models could be useful as triage tools in ED for patients with COVID-19 or other virus infections with similar behaviour.     

Hallazgos iniciales en la radiografía de tórax como predictores de empeoramiento en la infección pulmonar por SARS-CoV-2. Correlación en 265 pacientes

Background and aimsWe aimed to analyze the relationship between the initial chest X-ray findings in patients with severe acute respiratory syndrome due to infection with SARS-CoV-2 and eventual clinical worsening and to compare three systems of quantifying these findings.Material and methodsThis retrospective study reviewed the clinical and radiological evolution of 265 adult patients with COVID-19 attended at our center between March 2020 and April 2020. We recorded data related to patients’ comorbidities, hospital stay, and clinical worsening (admission to the ICU, intubation, and death). We used three scoring systems taking into consideration 6 or 8 lung fields (designated 6 A, 6 B, and 8) to quantify lung involvement in each patient's initial abnormal chest X-ray and to classify its severity as mild, moderate, or severe, and we compared these three systems. We also recorded the presence of alveolar opacities and linear opacities (fundamentally linear atelectasis) in the first chest X-ray with pathologic findings.ResultsIn the χ2 analysis, moderate or severe involvement in the three classification systems correlated with hospital admission (p = 0.009 in 6 A, p = 0.001 in 6 B, and p = 0.001 in 8) and with death (p = 0.02 in 6 A, p = 0.01 in 6 B, and p = 0.006 in 8). In the regression analysis, the most significant associations were 6 B with alveolar involvement (OR 2.3; 95%CI 1.1.–4.7; p = 0.025;) and 8 with alveolar involvement (OR 2.07; 95% CI 1.01.–4.25; p = 0.046). No differences were observed in the ability of the three systems to predict clinical worsening by classifications of involvement in chest X-rays as moderate or severe.ConclusionModerate/severe extension in the three chest X-ray scoring systems evaluating the extent of involvement over 6 or 8 lung fields and the finding of alveolar opacities in the first abnormal X-ray correlated with mortality and the rate of hospitalization in the patients studied. No significant difference was found in the predictive ability of the three classification systems proposed.     

Comparison of a Mediterranean to a low-fat diet intervention in adults with type 1 diabetes and metabolic syndrome: A 6–month randomized trial

Background and aims

The metabolic syndrome (MS) is an emerging complication in patients with type 1 diabetes (T1D), with no preventive or therapeutic treatment reported yet. We wanted to compare the impact of two 6-month nutritional interventions, based on a Mediterranean (MED) or a low-fat diet, on waist circumference, anthropometric and metabolic outcomes in patients with both T1D and the MS.