Brilliance型16排螺旋CT的故障分析与维修

针对日常使用中遇到的Brilliance 16排螺旋CT高压系统、机架以及控制器局域网络(CAN)通讯等故障现象进行分析与维修,最终通过更换滤波电容、机架数据采集控制器(DMC)电源以及信号刷等配件得以排除故障。通过对故障准确判断以及合理运用厂家Service模式下的维修工具软件快速解决故障,保障了影像科检查工作的顺利进行,从而提高设备的稳定性。     

Perivascular fat attenuation for predicting adverse cardiac events in stable patients undergoing invasive coronary angiography

BackgroundInflammation surrounding the coronary arteries can be non-invasively assessed using pericoronary adipose tissue attenuation (PCAT). While PCAT holds promise for further risk stratification of patients with low coronary artery disease (CAD) prevalence, its value in higher risk populations remains unknown.MethodsCORE320 enrolled patients referred for invasive coronary angiography with known or suspected CAD. Coronary computed tomography angiography (CCTA) images were collected for 381 patients for whom clinical outcomes were assessed 5 years after enrollment. Using semi-automated image analysis software, PCAT was obtained and normalized for the right coronary (RCA), left anterior descending (LAD), and left circumflex arteries (LCx). The association between PCAT and major adverse cardiovascular events (MACE) during follow up was assessed using Cox regression models.ResultsThirty-seven patients were excluded due to technical failure. For the remaining 344 patients, median age was 62 (interquartile range, 55–68) with 59% having ≥1 coronary artery stenosis of ≥50% by quantitative coronary angiography. Mean attenuation values for PCAT in RCA, LAD, and LCx were ?74.9, ?74.2, and ?71.2, respectively. Hazard ratios and 95% confidence intervals (CI) for normalized PCAT in the RCA, LAD, and LCx for MACE were 0.96 (CI: 0.75–1.22, p ?= ?0.71), 1.31 (95% CI: 0.96–1.78, p ?= ?0.09), and 0.98 (95% CI: 0.78–1.22, p ?= ?0.84), respectively. For death, stroke, or myocardial infarction only, hazard ratios were 0.68 (0.44–1.07), 0.85 (0.56–1.29), and 0.57 (0.41–0.80), respectively.ConclusionsIn patients referred for invasive coronary angiography with suspected CAD, PCAT did not predict MACE during long term follow up. Further studies are needed to understand the relationship of PCAT with CAD risk.     

基于人工智能的骨龄辅助评价系统对四川地区完全性生长激素缺乏症患儿骨龄研究

目的探讨采用基于"人工智能(AI)的骨龄辅助评价系统(上海初云医疗科技有限公司与四川大学华西第二医院合作开发)"(以下简称为AI系统)对完全性生长激素缺乏症(CGHD)患儿诊断及骨龄评价准确性。 方法选择2014年7月至2019年11月，于四川大学华西第二医院确诊的66例来自四川地区CGHD患儿为研究对象，纳入研究组。选择同期于病例收集医院儿童保健科进行骨龄测定的67例来自四川地区身高达标儿童作为对照，纳入对照组。对每例受试儿进行左手腕关节正位X射线摄片骨龄测定，由2位医师采用《TW₂骨龄评分法中国未成年人南方标准》(以下简称为TW₂CHN)》与《TW₃骨龄评分法标准》(以下简称为TW₃)，盲法评价受试儿TW₂CHN-桡、尺、掌指骨(RUS)与TW₂CHN-腕骨(carpal)、TW₂CHN-20、TW₃-RUS及TW₃-carpal骨龄(以下简称为5种传统骨龄)，以及以同性别、年龄身高达标儿童5种传统骨龄为标准，计算受试儿5种传统骨龄百分位数。同时，采用AI系统分别对每例受试儿采取TW₂CHN与TW₃法，评价其AI-TW₂CHN-RUS、AI-TW₂CHN-carpal、AI-TW₂CHN-20、AI-TW₃-RUS及AI-TW₃-carpal骨龄(以下简称为5种AI骨龄)及其相应百分位数。以上述5种传统骨龄＋5种AI骨龄(以下简称为10种骨龄)相应的P₅₀、P₂₅、P₁₀、P₃值(统称为P_n值)作为诊断CGHD患儿临界值，分别计算其诊断CGHD患儿的敏感度、特异度、约登(Youden)指数、准确率、阳性似然比、阴性似然比、阳性预测值、阴性预测值。采用Kappa值评价2组受试儿5种传统骨龄百分位数与对应的5种AI骨龄百分位数评价结果的一致性，以及2位医师对2组受试儿TW₂CHN-RUS骨龄百分位数评价结果一致性。绘制上述10种骨龄百分位数诊断CGHD患儿的受试者工作特征(ROC)曲线，并计算曲线下面积(AUC)。采用配对t检验，对2组受试儿TW₂CHN骨龄与TW₃骨龄进行比较。本研究遵循的程序符合2013年新修订的《世界医学协会赫尔辛基宣言》要求。2组受试儿年龄、性别构成比等一般临床资料比较，差异均无统计学意义(P>0.05)。 结果①采用10种骨龄的P_n值分别作为诊断CGHD临界值，对133例受试儿CGHD诊断结果显示，除了TW₃-RUS骨龄中，以骨龄≤P₁₀作为诊断CGHD患儿临界值时的诊断准确率最高(85.0%)，TW₂CHN-RUS、TW₂CHN-carpal、TW₂CHN-20、TW₃-carpal、AI-TW₂CHN-RUS、AI-TW₂CHN-carpal、AI-TW₂CHN-20、AI-TW₃-carpal、AI-TW₃-RUS骨龄中，均为以骨龄≤P₂₅作为临界值时，对CGHD的诊断准确率最高，分别为81.9%、75.2%、88.0%、78.2%、75.2%、73.6%、81.2%、72.9%、78.9%。②一致性检验结果显示，2组受试儿TW₂CHN-RUS与AI-TW₂CHN-RUS、TW₂CHN-carpal与AI-TW₂CHN-carpal、TW₂CHN-20与AI-TW₂CHN-20、TW₃-RUS与AI-TW₃-RUS、TW₃-carpal与AI-TW₃-carpal骨龄百分位数评价结果均为中等一致性，Kappa值分别为0.445、0.578、0.570、0.446、0.430(均为P<0.001)。③对2位医师对2组受试儿TW₂CHN-RUS骨龄百分位数评价结果进行一致性检验显示，其Kappa值为0.790(P<0.001)，一致性较高。④绘制10种骨龄百分位数评价结果诊断CGHD的ROC曲线分析结果显示，TW₂CHN-RUS、TW₂CHN-carpal、TW₂CHN-20、TW₃-carpal、TW₃-RUS、AI-TW₂CHN-RUS、AI-TW₂CHN-carpal、AI-TW₂CHN-20、AI-TW₃-carpal、AI-TW₃-RUS骨龄百分位数诊断CGHD患儿的AUC分别为0.932、0.859、0.915、0.895、0.844、0.823、0.805、0.866、0.860、0.764(均为P<0.001)。⑤133例受试儿的TW₃-RUS、TW₃-carpal、AI-TW₃-RUS、AI-TW₃-carpal骨龄，均分别显著低于TW₂CHN-RUS、TW₂CHN-carpal、AI-TW₂CHN-RUS、AI-TW₂CHN-carpal骨龄，并且差异均有统计学意义(t＝21.746、25.287、16.498、9.290，P<0.001)。 结论TW₂CHN法、TW₃法对CGHD患儿骨龄评价及诊断均有临床价值，TW₂CHN-RUS骨龄对于CGDH患儿诊断效能高。四川地区儿童TW₃骨龄较TW₂CHN骨龄低，TW₃法可能不完全适用于四川地区儿童骨龄评价。AI系统对于四川地区CGHD患儿骨龄评价结果与传统骨龄评价结果具有中等一致性，可为临床医师评价受试儿骨龄提供帮助。     

Optical coherence tomography angiography in the evaluation of vascular patterns of ocular surface squamous neoplasia during topical medical treatment

PurposeOptical coherence tomography angiography (OCTA) was utilized to examine changes in ocular surface squamous neoplasia (OSSN) vascular patterns over time in individuals treated with topical medical therapy.MethodsTen individuals with OSSN diagnosed by clinical examination and high resolution (HR)-optical coherence tomography (OCT) were recruited. All individuals received topical immuno- or chemotherapy. OCTA images were obtained and analyzed at three points: presentation, mid-treatment and tumor resolution. Tumor metrics including tumor area (TA), tumor volume (TV), tumor depth (TD), and total tumor density (TTD) were calculated. Vessel area density (VAD) was also quantified within the OSSN, the subepithelium under and adjacent to the OSSN and the subepithelium of the uninvolved, contralateral eye. Vascular network changes were also subjectively evaluated.ResultsTA, TV, TD and TTD all significantly decreased with time (p < 0.001). The mean VAD within the OSSN significantly decreased (p < 0.001) between visits (presentation: 26.52 ± 6.8%, mid-treatment: 7.19 ± 5.88%, tumor resolution: 0.11 ± 0.34%). The mean subepithelial VAD under the OSSN also decreased with time (23.22 ± 11.03%, 20.99 ± 5.99% and 19.58 ± 7.08%), and after resolution the sub-tumor VAD (19.58 ± 7.08%) was comparable to the subepithelial VAD in the contralateral eye (15.47 ± 4.37%, p > 0.05). The mean VAD in the subepithelium adjacent to the OSSN increased with treatment, then decreased significantly between mid-treatment and resolution (23.26 ± 4.54, 28.30 ± 7.43% and 21.68 ± 6.10%, p = 0.009). Qualitatively, the tumor subepithelial vascular network was complex and dense but with tumor resolution appeared less tortuous and similar to the uninvolved eye.ConclusionOCTA provided insight into the pathophysiology of tumor angiogenesis, showing decreased vascular density and normalization of vascular networks associated with tumor resolution.     

Effects of the Cerebral Aneurysm Treatment Method on Coil Packing Density and Its Relationship with the Ostium Area

PurposeTo test the following hypotheses: (a) balloon or stent assistance increases coil packing density (CPD) in the endovascular treatment of intracranial aneurysms, and (b) CPD correlates to ostium area (OA) and aneurysm volume (AV).Materials and MethodsThis retrospective study included 60 aneurysms (54 ruptured and 6 unruptured) treated with simple coiling (SC) (n = 18), balloon-assisted coiling (BAC) (n = 7), or stent-assisted coiling (SAC) (n = 35) at the authors’ institution between August 2017 and December 2019. AV and OA measurements were obtained from 3-dimensional digital subtraction angiography images using commercial software. Coil sizes were retrieved from patient files, and coil volume (CV) measurements were obtained from https://www.angiocalc.com/. Analysis of covariance, multivariate covariance analysis, and Pearson correlation analyses were performed.ResultsThe median value for AV, CV, CPD, and OA was 63.4 mm³ (range, 5.5–1,771.4 mm³), 23.13 mm³ (range, 2.03–296.95 mm³), 33.29% (range, 13.41%–81.02%), and 10.7 mm² (range, 2.7–49.9 mm²), respectively. Multivariate analysis showed that the CPD values were not significantly different among the treatment groups, although OA significantly differed between the SC and SAC groups (P < .05). Pearson correlations showed that similar to AV, OA was negatively correlated with CPD (r = ?0.321, P < .05).ConclusionsThe CPD value in cerebral aneurysms treated with BAC or SAC did not differ from that in aneurysms treated with SC.     

基于标准化患者法评价四川农村基层医生两种慢性病诊断准确性及其影响因素

目的 运用标准化患者法评估四川农村地区基层医生不稳定型心绞痛和2型糖尿病两种慢性病诊断准确性现状,探讨基层医生两种慢性病诊断准确性的主要影响因素,为提升基层医生两种慢性病诊断准确性提供科学依据。方法 采用多阶段随机整群抽样方法,抽取四川省自贡市5个区/县50个乡镇100个村为研究现场,以调查当日在岗的全科及内科医生作为研究对象。共进行两轮数据采集,第1轮采集样本乡镇卫生院和村卫生室医生的基本信息;第1轮调查完成1个月后,运用标准化患者法开展第2轮调查,收集农村基层医生对不稳定型心绞痛和2型糖尿病诊断结果信息。运用Logistic回归分析农村基层医生不稳定型心绞痛和2型糖尿病诊断准确性的影响因素。结果 共纳入172名农村基层医生,完成186次标准化患者访问,正确诊断率为48.39%。其中不稳定型心绞痛的正确诊断率为18.68%(17/91),2型糖尿病的正确诊断率为76.84%(73/95)。Logistic回归分析显示,具有执业医师资质的农村基层医生更有可能做出正确诊断(OR=4.857,95%CI=1.076~21.933,P=0.040)。农村基层医生在诊断过程中涉及的必要问诊和检查条目越多,做出正确诊断的概率越高(OR=1.627,95%CI=1.065~2.485,P=0.024)。与不稳定型心绞痛相比,农村基层医生对2型糖尿病做出正确诊断的可能性更高(OR=6.306,95%CI=3.611~11.013,P<0.001)。结论 四川农村基层医生不稳定型心绞痛和2型糖尿病诊断准确性整体较差,建议以基层医生慢性病诊断过程质量改善为突破口,提升基层医生执业水平,进而提高慢性病诊断准确性。     

Validation of donor fraction cell-free DNA with biopsy-proven cardiac allograft rejection in children and adults

ObjectivesDonor-specific cell-free DNA shows promise as a noninvasive marker for allograft rejection, but as yet has not been validated in both adult and pediatric recipients. The study objective was to validate donor fraction cell-free DNA as a noninvasive test to assess for risk of acute cellular rejection and antibody-mediated rejection after heart transplantation in pediatric and adult recipients.MethodsPediatric and adult heart transplant recipients were enrolled from 7 participating sites and followed for 12 months or more with plasma samples collected immediately before all endomyocardial biopsies. Donor fraction cell-free DNA was extracted, and quantitative genotyping was performed. Blinded donor fraction cell-free DNA and clinical data were analyzed and compared with a previously determined threshold of 0.14%. Sensitivity, specificity, negative predictive value, positive predictive value, and receiver operating characteristic curves were calculated.ResultsA total of 987 samples from 144 subjects were collected. After applying predefined clinical and technical exclusions, 745 samples from 130 subjects produced 54 rejection samples associated with the composite outcome of acute cellular rejection grade 2R or greater and pathologic antibody-mediated rejection 2 or greater and 323 healthy samples. For all participants, donor fraction cell-free DNA at a threshold of 0.14% had a sensitivity of 67%, a specificity of 79%, a positive predictive value of 34%, and a negative predictive value of 94% with an area under the curve of 0.78 for detecting rejection. When analyzed independently, these results held true for both pediatric and adult cohorts at the same threshold of 0.14% (negative predictive value 92% and 95%, respectively).ConclusionsDonor fraction cell-free DNA at a threshold of 0.14% can be used to assess for risk of rejection after heart transplantation in both pediatric and adult patients with excellent negative predictive value.     

Meek植皮术和微粒皮移植术治疗特大面积深度烧伤患者的效果比较

目的:比较Meek植皮术和微粒皮移植术治疗特大面积深度烧伤患者的效果。方法:回顾性分析2018年6月至2020年6月该院烧伤科收治的100例特大面积深度烧伤患者的临床资料,按手术方法不同分为对照组和研究组各50例。对照组采用微粒皮移植术,研究组采用Meek植皮术。比较两组植皮效果、手术相关指标(手术时间、创面愈合时间、住院时间和治疗费用)、患者满意度和并发症发生率。结果:研究组植皮优良率为90.00%(45/50),显著高于对照组的56.00%(28/50),植皮达优率为60.00%(30/50),显著高于对照组的20.00%(10/50),差异均有统计学意义(P<0.05);研究组手术时间、住院时间、创面愈合时间均显著短于对照组,治疗费用和并发症发生率均低于对照组,差异有统计学意义(P<0.05);研究组满意度为96.00%(48/50),显著高于对照组的76.00%(38/50)。结论:Meek植皮术治疗特大面积深度烧伤患者的效果优于微粒皮移植术,能缩短手术时间、创面愈合时间和住院时间,降低并发症发生率和治疗费用,且患者满意度较好。     

Oxygen delivery-guided perfusion for the prevention of acute kidney injury: A randomized controlled trial

ObjectivesThe reduction of postoperative acute kidney injury in patients undergoing cardiopulmonary bypass surgery using an oxygen delivery-guided perfusion strategy (oxygen delivery strategy) for cardiopulmonary bypass management compared with a fixed flow perfusion (conventional strategy) remains controversial. The purpose of this study was to determine whether a oxygen delivery strategy would reduce the incidence of postoperative acute kidney injury in patients undergoing cardiopulmonary bypass surgery.MethodsWe randomly enrolled 300 patients undergoing cardiopulmonary bypass surgery. Patients were randomly assigned to a oxygen delivery strategy (maintaining a oxygen delivery index value >300 mL/min/m² through pump flow adjustments during cardiopulmonary bypass) or a conventional strategy (a target pump flow was determined on the basis of the body surface area). The primary end point was the development of acute kidney injury. Secondary end points were the red blood cell transfusion rate and number of red blood cell units, intubation time, postoperative length of stay in the intensive care unit and the hospital, predischarge estimated glomerular filtration rate, and hospital mortality.ResultsAcute kidney injury occurred in 20 patients (14.6%) receiving the oxygen delivery strategy and in 42 patients (30.4%) receiving the conventional strategy (relative risk, 0.48; 95% confidence interval, 0.30-0.77; P = .002). The secondary end points were not significantly different between strategies. In a prespecified subgroup analysis of patients who had nadir hematocrit less than 23% or body surface area less than 1.40 m², the oxygen delivery strategy seemed to be superior to the conventional strategy and the existence of quantitative interactions was suggested.ConclusionsAn oxygen delivery strategy for cardiopulmonary bypass management was superior to a conventional strategy with respect to preventing the development of acute kidney injury.