双源CT低剂量扫描技术在窦口鼻道复合体检查中的应用价值

目的探讨双源CT低剂量扫描技术在窦口鼻道复合体检查中的应用价值。方法行副鼻窦CT扫描检查的患者100例,其中50例行DSCT双源模式双能量成像扫描,50例行单源模式常规剂量扫描。记录扫描窗口显示的容积CT剂量指数,评价OMC区域内中鼻甲、钩突、上颌窦开口、筛漏斗、额隐窝、筛板6个重要解剖结构及其变异的显示情况。比较2种扫描方法辐射剂量及不同扫描条件下所得图像质量显示正常结构及解剖变异有无统计学意义。结果双源CT双能量成像扫描,两组不同扫描条件下获得的图像及融合图像均能清楚显示OMC区的细微结构,图像质量良好,能够满足临床诊断需要,与常规剂量扫描图像比较,图像质量无明显下降(P>0.05)。常规剂量扫描时容积CT剂量指数平均为18.26mGy,双能量成像扫描时容积CT剂量指数平均为7.54mGy,较常规剂量扫描下降58.71%,两种扫描方法辐射剂量有显著差异(P<0.05)。结论在不影响图像质量的前提下,双源CT低剂量扫描技术可明显降低患者在接受检查时的辐射水平。     

双源CT双能量上腹部虚拟平扫的临床应用研究

目的探讨双源CT双能量上腹部虚拟平扫的临床应用价值。方法选取2013年3月至2014年8月我院收治的拟诊上腹部病变患者共120例,所有患者行常规上腹部平扫后,再行双源双能量CT扫描,并应用后处理技术得出虚拟平扫图像,将常规扫描图像作为对照,比较两组图像在图像质量、辐射剂量、CT值、信噪比等方面的差异。结果两种CT扫描所得的图像均可清楚辨识,虚拟平扫图像的颗粒感较粗,其图像质量、平均CT值、图像性噪比与常规平扫图像无明显差异,组间差异无统计学意义,P>0.05;而VNC组的辐射剂量显著低于CNC组,组间比较结果有显著差异,P<0.05。结论应用双源CT双能量虚拟平扫进行上腹部疾病的诊断,不仅诊断准确率较高,还能显著降低辐射剂量,具有较高的临床应用价值。     

双源 CT 双能量 CTA 与常规 CTA-DSA 技术在头颈部血管成像的效果比较

目的：探讨双源CT双能量CTA与常规CTA-DSA 技术在头颈部血管成像中的应用效果。方法将48例行双源CT头颅CTA的临床怀疑头颈部血管病变患者按影像号码单,双号平均分为DE-CTA组和Neuro-DSA组。比较两组血管图像质量、辐射剂量。结果 DE-CTA组与Neuro-DSA组血管颅外段,颈动脉管段图像质量差异无统计学意义（P＞0．05）,但虹吸段颅底部去骨的效果Neuro-DSA优于DE-CTA （P＜0.05）;DE-CTA组辐射剂量为（20．56±0．05）mGy,低于Neuro-DSA组的（25．64±0．08）mGy（t＝-0．036,P＜0．05）。结论头颈部血管DE-CTA与Neuro-DSA成像对比DE-CTA辐射小,成像质量效果较好,但虹吸段颅底去骨效果欠佳,技术亟需改进。     

两种不同头颅CT血管造影图像处理方法的对比分析

目的比较常规方法和减影法头颅CT血管造影(CTA)的图像质量和颅内动脉瘤的检出率,评价其临床应用价值。方法选取72例非创伤性蛛网膜下腔出血,需行头颅CTA检查的患者,扫描后的图像A组用直接使用增强后薄层图像进行图像后处理,B组用减影法进行图像处理。以数字减影血管造影(DSA)检查结果为金标准,对2种方法的诊断结果进行对比分析。结果 2组图像质量评分差异无统计学意义(P>0.05);2组动脉瘤的诊断结果与DSA结果相比差异无统计学意义(P>0.05)。对于颈内动脉颅内段动脉瘤的诊断,常规法漏诊3例,减影法漏诊1例,减影法检出率比常规法高13%(P<0.05)。结论与常规处理方法相比,减影技术头颅CTA能够提高颈内动脉段动脉瘤诊断准确性,但颅内动脉瘤的整体检出率和图像质量差异无统计学意义。     

低管电压及低浓度对比剂在下肢动脉CTA中的临床应用

目的 探讨低管电压、低浓度对比剂在下肢动脉计算机断层血管造影增强成像(CTA)中的临床应用.方法 124例患者随机分成3组,常规组41例(120 kV、370造影剂0.8 ml/kg),低管电压组42例(100 kV、370造影剂0.8 ml/kg),低管电压低剂量组41例(100 kV、300造影剂0.8 ml/kg),采用PHILIPS iCT256CT进行螺旋扫描,对患者的重建图像进行主管和客观评价,比较辐射剂量.结果 3组原始轴位图像评分、VR图像评分、MIP图像评分比较差异均无统计学意义(均P＞0.05);同时伴随管电压以及对比剂浓度的降低,3组下肢动脉CT值依次降低,但差异无统计学意义(P＞0.05),而图像噪声明显增加,信噪比及对比噪声比、辐射剂量明显减小(P＜0.05).结论 低管电压低浓度对比剂对患者进行CTA检查,在不影响图像质量的基础上,能减少患者的辐射剂量,是患者下肢CTA检查、评估的有效手段.     

超低剂量前瞻性冠状动脉CTA成像技术在低体质量指数患者中的应用

目的分析对低体质量患者使用超低剂量前瞻性冠状动脉CTA成像的效果观察。方法收集50例低体质量指数冠心病患者和50例健康志愿者作为研究对象,分别对其实施常规冠状动脉CTA成像和超低剂量前瞻性冠状动脉CTA成像检查,比较两种方法的效果。结果两种方法的诊断特异率、敏感率差异不显著(P> 0.05),但两种方法的辐射剂量差异有统计学意义(P <0.05)。结论在对低体质量指数患者实施临床诊断时,使用超低剂量前瞻性冠状动脉CTA成像可取得较好效果,同时辐射剂量较低,值得推广使用。     

第二代双源CT大螺距扫描肺动脉成像临床应用价值研究

目的:初步探讨第二代双源CT大螺距(Flash模式)肺动脉成像对肺栓塞的诊断价值。方法:将临床怀疑肺栓塞行肺动脉成像的患者60例随机分为两组,每组30例。实验组采用大螺距CT肺动脉扫描,对照组采用常规螺旋CT肺动脉扫描,比较两组图像质量、对比剂用量、扫描时间及有效辐射剂量是否有统计学差异。结果:两组图像质量评分、对比剂用量、扫描时间及有效辐射剂量差异均有统计学意义(P<0.05)。结论:双源CT Flash大螺距肺动脉成像在满足临床诊断的前提下,可以保证低辐射剂量、低对比剂用量及无运动伪影,尤其适用于临床危重患者。     

双能CTA在肾癌术前评估中的新应用

目的通过双能CTA与常规CTA在肾癌术前评估中的对比研究,探讨双能CTA在肾癌术前评估中的新应用。方法从肾癌患者中随机挑选行双能CTA检查的30例,行常规CTA检查的30例,分别重建VR、MIP、CPR图像;对行双能CTA的患者行虚拟平扫及碘分布图重建;对比两种方法在肾癌供血动脉、变异血管的图像质量、图像重建效率、辐射剂量、定性诊断价值方面各自的优势。结果双能CTA组图像质量评分为:1分7例(23.4%)、2分12例(40.0%)、3分10例(33.3%)、4分1例(3.3%);常规CTA组图像质量评分为:1分8例(26.7%)、2分13例(43.3%)、3分9例(30.0%)、4分0例(0),P值均大于0.05,故两组显示血管图像质量无明显差异。双能CTA图像处理时间为(303±18)秒,常规CTA图像处理时间为(581±36)s,两组图像重建时间对比差异具有统计学意义(P<0.05)。双能CTA组因为有虚拟平扫功能,从而较常规CTA组减少一次平扫,故辐射剂量低于常规CTA组,并且双能CTA能定量分析肾癌瘤体的强化程度。结论双能CTA与常规CTA相比,不仅优化了常规CTA的图像后处理功能,还增加了虚拟平扫及碘分布图重建功能,使肾癌的术前评估更加准确、快捷、安全、全面。     

CT脑血管成像中减影去骨技术的评价

目的比较减影去骨成像技术与手动去骨成像技术在脑CT血管成像中的差异,寻求诊断脑血管疾病影像诊断的最好方式。方法60位患者行脑CT血管成像,患者在平扫、增强时保持头部固定不动。通过增强图像、平扫图像同层自动减影获得血管图像;用手动方法处理增强的原始图像也获得血管图像。两位高年资医师通过盲法比较两种方法处理血管的清晰锐利度,脑血管根据大小分1～5级。结果减影去骨成像技术处理1—3级血管的效果更优（χ2=64．6,P〈0．0001）,4—5级血管无差异;减影图像显示颅底血管狭窄及动脉瘤更好。结论CT减影技术显示脑血管的效果比手动去骨技术更好,更加适宜颅底血管疾病的诊断。     

双源CT上腹部增强两种扫描方式对显示胰腺血管的图像质量及辐射剂量的对比研究

目的探讨双源CT常规上腹部增强扫描与双能量(DE)增强扫描对胰腺血管显示、图像质量及辐射剂量比较。方法将40例行上腹平扫+增强扫描的患者随机分为A、B两组,其中A组采用常规上腹部增强扫描方案,B组采用双能量增强扫描方案,A组球管管电压为120k V,B组球管1和2的管电压分别为Sn140k Vp/80k Vp,两组均采用迭代重建技术,其余扫描参数保持一致.根据原始图像和最大密度投影(MIP)重组图像对两组血管图像质量进行评分,测量血管CT值、信噪比(SNR)、对比信噪比(CNR)。结果 (1)两组图像血管CT值A组低,B组高,两组间差异有统计学意义(P<0.05);图像CNR、SNR组间差异无统计学意义(P>0.05);(2)辐射剂量A组高,B组低.与A组相比,B组CT剂量指数(CTDIvol)、剂量长度乘积(DLP)及有效剂量(ED)均比A组低。结论双能CT能谱纯化联合迭代重建技术对胰腺血管成像可满足临床诊断需求,且可大大提高胰腺血管成像的显示,同时能降患者所接受的辐射剂量。     

Dual Diagnosis

Abstract

It is estimated that 10 million persons in me United States have at least one mental disorder and at least one substance-related disorder in any given year. Dual disorders are common in psychiatry, but misdiagnosis may be even more common. Drug and alcohol testing should be expanded from routine use in the Olympics and intercollegiate athletics to psychiatric diagnosis of drug intoxication, dependence, and withdrawal states. Major Depression is co-morbid with opiate addiction, alcohol dependency, tobacco smoking, and many other substance abuse disorders. Drug use induces adaptations in brain systems associated with mood and motivation. The acute rewarding effects of drugs change the mesolimbic dopaminergic system. Cessation of drug self-administration induces dysphoria and anhedonia as a result of changes in monoamine levels in brain reward circuits; opposite to the effects that occur after the administration of drugs of abuse. While most models for dual disorders assume compulsive or volitional use or self administration, we have been interested in second-hand exposure which was common in the past among flight attendants and occurs today between smoking parent and child. We expand the concept from parent-to-child environmental tobacco toxicity to a workplace toxicity hypothesis for anesthesiologists. Such a hypothesis can explain the high rates of depression, workplace and social distress, drug abuse, and drug addiction among anesthesiologists. While co-occurring disorders have been the focus of epidemiolog-ical studies and twin and genetic studies, the role of exposure to potent drugs of abuse in the intra-uterine, home, and workplace environment has been neglected. We have demonstrated the unequivocal presence of fentanyl and other potent drugs of abuse in the air that anesthesiologists breathe in the operating room. Drug exposure sensitizes the brain. When sensitization is coupled with the stress of operating room, employment may produce the pattern of co-occurring disorders seen in anesthesiologists but not psychiatrists. Prevention is the goal in environmental or toxicity-related illness. After diagnosis, treatment for dual disorders should be vigorous with remission of all disorders in mind. For anesthesiologists, limiting toxic environmental exposure may prevent both drug and affective disorders.     

Dual acting antihistaminergic agents

Histamine is a primary mediator in allergic response and acts in concert with other agents to impact disease progression. Respiratory disorders such as asthma, rhinitis and dermatological conditions such as urticaria involve histamine along with other mediators. An antihistamine that possesses an additional property of counteracting the effects mediated by these other mediators should offer some therapeutic benefit over a selective antihistaminergic agent.     

Dual antagonists of integrins

The roles of integrins in pathologies have been studied intensively and only partially explained. This has resulted in the development of several nanomolar antagonists to certain integrins. In most cases, the aim was to produce compounds which are highly selective towards specific integrins. This paradigm has recently shifted a little. Targeting two or more integrins with one compound has become a very attractive concept, especially since it has become clear that several severe disorders, such as pathological angiogenesis, cannot be treated just with highly specific integrin antagonists. This review is aimed to elucidate some aspects regarding the design of drugs with dual activity towards integrins. Integrin structure and tissue distribution will first be described, in order to provide the basis for their functions in various pathologies which will follow. Inhibitors of several pairs of integrins will be described.     

Dual acting anti-inflammatory drugs

Drugs able to inhibit both cyclooxygenases (COX-1 and COX-2) and 5-lipoxygenase (5-LOX) (dual acting anti-inflammatory drugs) have been designed in order to obtain compounds that retain the activity of classical nonsteroidal anti-inflammatory drugs (NSAIDs) while avoiding their main drawbacks. The classical NSAIDs display their anti-inflammatory action mainly through inhibition of COX and one of their main drawbacks is the curtailed production of gastroprotective prostaglandins (PGs) being associated with the concurrent increased production of the gastro-damaging and bronchoconstrictive leukotrienes (LTs). Leukotrienes and cysteinyl-leukotrienes are moreover pro-inflammatory and increase microvascular permeability. One of the leukotrienes (LTB(4)) is the most potent chemotactic agent and it induces chemotaxis of eosinophils, neutrophils and monocytes in the inflamed tissue, increases superoxide generation and proinflammatory cytokines production. It is further advantageous for a drug to have both COX and 5-LOX inhibiting activities because prostaglandins enhance leukotriene-mediated inflammation. Various structural families of dual inhibitors have been designed and several compounds are currently undergoing clinical development. In the post-COX-2 selective inhibitors era, these dual acting inhibitors may turn out to be promising new drugs to treat inflammatory diseases and possibly other diseases. Indeed, both COX-2 and 5-LOX are also involved in the development and progression of several types of cancer; in these conditions, selective inhibition of COX-2 alone may lead to a shunt of arachidonic acid metabolism towards the leukotriene pathway, and therefore the blockade of both COX-2 and 5-LOX may produce a better anticancer response. In addition, the dual inhibition of both COX and 5-LOX is neuroprotective by suppressing toxic actions of reactive microglia and macrophages, that are increased in aging brain and in age-related degenerative conditions, particularly Alzheimer's and Parkinson's diseases. Finally, the blockade of 5-LOX does not impair the synthesis of lipoxins (LXs), which are mainly produced by further lipoxygenation of 15-HPETE, and which have potent anti-inflammatory properties and can be considered as stop-signal mediators. Leukocyte 15-LOX and platelet 12-LOX by intercellular mechanism via leukocyte/platelet cell-cell interaction convert 15-HPETE into lipoxins.     

Dual aromatase-steroid sulfatase inhibitors

By introducting the steroid sulfatase inhibitory pharmacophore into aromatase inhibitor 1 (YM511), two series of single agent dual aromatase-sulfatase inhibitors (DASIs) were generated. The best DASIs in vitro (JEG-3 cells) are 5, (IC50(aromatase) = 0.82 nM; IC50(sulfatase) = 39 nM), and 14, (IC50(aromatase) = 0.77 nM; IC50(sulfatase) = 590 nM). X-ray crystallography of 5, and docking studies of selected compounds into an aromatase homology model and the steroid sulfatase crystal structure are presented. Both 5 and 14 inhibit aromatase and sulfatase in PMSG pretreated adult female Wistar rats potently 3 h after a single oral 10 mg/kg dose. Almost complete dual inhibition is observed for 5 but the levels were reduced to 85% (aromatase) and 72% (sulfatase) after 24 h. DASI 5 did not inhibit aldosterone synthesis. The development of a potent and selective DASI should allow the therapeutic potential of dual aromatase-sulfatase inhibition in hormone-dependent breast cancer to be assessed.     

Recovery from Dual Diagnosis

Abstract

God was communicating through the graffiti scratched on the walls of an isolated cell in Georgia's Forsyth County Jail. Zooming thoughts connected key words left by previous inmates in a divine code only I could understand as a chosen apostle. The calming intoxication of the wine consumed prior to incarceration dissolved into endless euphoric ideas that exploded in my mind like the climatic conclusion of a fireworks show. I was on a divine mission. Being jailed was only a temporary detainment-persecution expected of a true messenger of the Lord.     

Dual effects of carbamazepine-phenytoin interaction

By intrapatient comparison at constant phenytoin (PHT) dose, the effect of increased carbamazepine (CBZ) dose was studied in 32 epileptic outpatients treated with a combination of PHT and CBZ. The mean PHT plasma concentration, as well as the concentration/dose ratio for PHT, became significantly higher secondary to increased doses of CBZ (14.1 +/- 3.5 vs. 19.3 +/- 3.6 micrograms/ml and 2.8 +/- 1.0 vs. 3.9 +/- 1.4 micrograms/ml plasma per milligram/kilogram daily dose, respectively; p less than 0.001). Concomitantly, in spite of CBZ dose higher by 17.6%, the CBZ concentration increased by only 6.4%, and the CBZ concentration/dose ratio actually decreased by 10%. In contrast, by intrapatient comparison at constant CBZ dose, the effect of reduced PHT dose on CBZ was studied in 22 patients. The mean CBZ plasma concentration as well as the concentration/dose ratio for CBZ appeared significantly higher, with a concomitant reduction of PHT (6.7 +/- 1.6 vs. 8.6 +/- 1.6 micrograms/ml and 0.37 +/- 0.1 vs. 0.49 +/- 0.2 micrograms/ml plasma per milligram/kilogram daily dose, respectively; p less than 0.001). This simultaneous dual effect--inhibition of PHT metabolism by CBZ and induction of CBZ metabolism by PHT--can result in PHT intoxication along with a fall in CBZ plasma concentration to a subtherapeutic range. This effect may be avoided or reduced if the PHT concentration is adjusted to approximately 13 micrograms/ml before CBZ is added or increased.