Novel method for selecting slices of the same cross-sectional view from digital tomosynthesis for monitoring posterior spinal instrumentation

BackgroundA method to evaluate pedicle screw loosening on digital tomosynthesis images is yet to be established owing to lack of methods for selecting slices of the same cross-sectional view. We aimed to develop an objective method for selecting slices of the same cross-sectional view on digital tomosynthesis images.MethodsFirst, an objective method of pixel selection was developed by measuring the size of glass disk and titanium alloy screw on digital tomosynthesis images followed by comparison with the actual sizes. Second, a method for selecting slices of the same cross-sectional view was explored on a bone model with posterior spinal instrumentation using the screw centerline and rod curvature as indicators of the same cross section. The angle between the screw centerline and rod was calculated to verify the accuracy in obtaining the same cross-sectional view. Third, the method for selecting slices of the same cross-sectional view was applied to six patients after posterior lumbar spinal instrumentation.ResultsThe pixel selection method enabled objective determination of a pixel on the peripheral lines of objects with an error as low as 200 μm in distance measurements on titanium alloy and glass. The mean differences of rod-screw angles between two slices were less than 1° and were not statistically significant in the bone model and patient images.ConclusionA method for selecting slices of the same cross-sectional view on digital tomosynthesis images was successfully developed. This method can enable objective and quantitative evaluations of pedicle screw loosening.     

ViewRay磁共振引导放疗系统的研究进展

ViewRay磁共振引导放疗系统不但解决了成像剂量的问题,还能根据MRI进行精准摆位、在线自适应放疗以及门控照射。该系统的发展为精准放疗提供了一种新的技术手段。本文介绍ViewRay系统的主要结构,并综述质量控制体系、剂量学比较、呼吸运动管理、在线自适应放疗以及初步治疗效果。     

Identification of BVT.2938 metabolites by LC/MS and LC/MS/MS after in vitro incubations with liver microsomes and hepatocytes

The metabolism of the 5HT2c agonist BVT.2938, 1-(3-{2-[(2-ethoxy-3-pyridinyl)oxy]ethoxy}-2-pyrazinyl)-2(R)-methylpiperazine, was studied in vitro by incubation with rat, monkey and human liver microsomes as well as cryopreserved hepatocytes, followed by liquid chromatography/mass spectrometry (LC/MS) and LC/MS/MS analysis on a quadrupole-time of flight mass spectrometer for structural elucidation. Deuterium exchange on column was used to differentiate between hydroxylation and N-oxidation. Liver microsomes were incubated in two different buffer systems with optimum conditions for cytochrome P450 activity or UDP-glucuronosyltransferase activity. The major phase I metabolites of BVT.2938 originated from O-deethylation of the pyridine ring, O-dealkylation of the ethylene bridge, pyrazine ring hydroxylation, hydroxylation of pyridine ring and piperazine ring N-hydroxylation. When a hydrogen carbonate buffer system was supplemented with UDPGA, the piperazine carbamoyl-glucuronide from the parent compound was identified together with several glucuronides of the phase I metabolites. The metabolite pattern in hepatocytes was similar to microsomes except that the sulphate at the N-position of the piperazine ring of BVT.2938 was identified, while the carbamoyl-glucuronide was missing. Excellent correlation was obtained between radioactivity detection and the chemiluminescent nitrogen detector when the nitrogen content of the analytes was taken into account.     

Utility of ambulatory blood pressure monitoring in children and adolescents

Diagnosis of hypertension is critically dependent on accurate blood pressure measurement. “Accurate” refers to carefully following the guidelines for blood pressure measurement laid out for children and adults to minimize observer and subject errors that commonly occur in clinical blood pressure measurement. Accurate blood pressure measurement is more important in children and adolescents as the misdiagnosis of hypertension may have a life-long adverse impact on insurability and employment. Automated blood pressure measurement offers multiple advantages in achieving high-quality blood pressure determinations by reducing observer errors. The most commonly used form of automated blood pressure measurement is 24-h ambulatory blood pressure measurement (ABPM). Information on ABPM in children has grown exponentially over the last decade. Normative data exists for diagnosis of hypertension in children using ABPM including a novel method for determining normal values with the LMS method. There is further information about the utility of different determinants of 24-h blood pressure such as dipping status, morning surge and blood pressure load. ABPM has been able to detect significant differences in blood pressure in many disease states in children including chronic renal failure, polycystic kidney disease, solitary functioning kidney, and after renal transplantation. Increasingly nonambulatory automated blood pressure determinations have been used in management of hypertension in children. Although nonambulatory automated readings lack information about nocturnal blood pressure or blood pressure during daily activity, studies have suggested that home automated blood pressure measurements are a helpful adjunct to the usual office blood pressure reading.     

乳腺肿块610例细针穿刺细胞学检查结果分析

目的:探讨细针穿刺细胞学检查及快速准确地鉴别乳腺肿块性质的效果.方法:对610例乳腺肿块患者通过询问病史、触摸肿块、细针吸取细胞学检查综合分析,作出诊断.结果:细针穿刺细胞学检查对乳腺肿块恶性病变的准确率达96%;良性病变的准确率达97.6%.结论:综合分析能提高乳腺肿块的诊断准确率.     

数字化设计结合3D打印技术精准治疗复杂肩胛骨骨折的应用研究

目的 探讨应用数字化设计结合3D打印骨骼模型的个体化、精确化的手术治疗方案应用于复杂肩胛骨骨折患者的临床疗效。方法 对东莞市石排医院骨科2018年6月至2020年6月40例复杂肩胛骨骨折患者进行随机分组。其中，试验组20例，肩关节螺旋CT扫描，将所得DICOM格式数据导入Mimics 15.0软件重建复杂肩胛骨骨折三维模型，并对相应骨折块进行模拟平移、旋转等操作，将骨折端进行虚拟复位。应用3D打印技术获得患者复位后的肩胛骨骨折模型。根据模型进行术前规划，塑形钢板后进行手术治疗。对照组20例，采用传统切开复位内固定方式进行治疗。记录手术中相关数据，术后复查X光线及CT，与术前设计相比对，采用Hardegger肩关节功能评分评定疗效。结果 全部病例均获得5 ～ 13个月的随访，试验组手术时间与术中出血量均较对照组更少，差异有统计学意义（P<0.05）。两组骨折愈合时间差异无统计学意义（P>0.05）。末次随访，试验组优良率95%（19/20），对照组优良率为65%（13/20），两组临床效果对比，差异有统计学意义（P<0.05）。结论 应用数字化设计结合3D打印技术，为复杂肩胛骨骨折患者制定治疗方案，可满足微创化、精确化、个体化的要求，继而可以有效减少手术创伤、缩短手术时间、降低手术操作难度，为患者更快、更好地恢复肩关节功能创造有利的条件。     

应用螺旋CT技术在诊断肠梗阻方面的准确性分析

目的分析评价应用螺旋CT技术在诊断肠梗阻方面的准确性。方法选取2018年1月至2019年6月本院接诊的28例肠梗阻患者为研究对象,根据就诊顺序分为对照组和观察组,各14例。对照组行腹部X线平片检查,观察组行螺旋CT扫描,比较两种诊断方式的准确率、漏诊率、疾病类型诊断情况以及病因诊断准确率,分析诊断肠梗阻的价值。结果观察组检出肠梗阻13例,检出率为92.86%,漏检1例,漏检率为7.14%;对照组检出肠梗阻8例,检出率为57.14%,漏检6例,漏检率为42.86%。观察组检出率高于对照组,漏检率低于对照组(P<0.05)。对照组检出肠套2例,肠粘连2例,肿瘤1例,肠麻痹3例,观察组检出肠套3例,肠粘连3例,肿瘤1例,肠麻痹6例。观察组肠麻痹检出率均高于对照组(P<0.05),两组肠套、肠粘连及肿瘤检出率比较差异无统计学意义。对照组机械性肠梗阻3例,动力性肠梗阻1例,血液性肠梗阻4例,观察组机械性肠梗阻4例,动力性肠梗阻2例,血液性肠梗阻7例。结论给予肠梗阻患者螺旋CT技术诊断,可提高检出率、降低漏诊率,诊断准确性较高,可明确患者病因以及肠梗阻类型,为临床治疗疾病提供依据,应用价值较高。