多层螺旋CT在眼部异物定位中的的诊断价值

目的探究多层螺旋CT对眼部异物定位中的诊断价值。方法选取2014年10月~2016年10月在我院就医的70例(70眼)疑似眼部异物患者,所有患者均行X线检查及多层螺旋CT检查,对比两种检查方法的敏感度、特异度和准确度。结果手术结果示70例疑似眼部异物患者中,62例患者存在眼部异物,其中47例为球内异物,15例为球外异物。多层螺旋CT检查定位准确率为85.71%,X线为51.43%,差异有统计学意义(P0.05)。多层螺旋CT对眼部异物的诊断敏感性、特异性、准确性分别为85.71%、83.33%%、85.71%,均高于X线51.43%,56.67%,51.43%,差异具有统计学意义(P0.05)。在定位点钟位,异物水平面、矢状面及角巩膜缘的距离的比较上,X线检出结果与多层螺旋CT比较,差异无统计学意义(P0.05)。结论多层螺旋CT对眼部异物定位准确,可为临床医师分析病情提供依据。     

MSCT与X线在气管支气管异物中的诊断价值

目的：探讨MSCT三维重建与X线在诊断气管支气管异物中的临床应用价值及其优缺点。方法：选择武汉大学中南医院2001—01／2009—01收治的27例经纤维支气管镜检查证实为气管支气管异物患者临床资料,全部患者均行常规的胸部X线检查、螺旋CT轴位扫描及三维重建。结果：27例异物均经纤维支气管镜取出。两者比较,CT的诊断阳性符合率高于X线。结论：MSCT对气管支气管异物的诊断及手术定位具有重要价值,与胸部X线相比,具有明显的优越性。     

X线与螺旋CT对气道异物的诊断价值比较

目的:比较X线与螺旋CT对气道异物的诊断价值。方法:选取我院2015年5月—2017年6月收治的49例气道异物患者,均行X线与螺旋CT检查,观察比较两种不同检查方法对气道异物诊断结果,并分析气道异物在X线及螺旋CT上的表现。结果:螺旋CT对气道异物检出率为97.96%(48/49),高于X线检查79.59%(39/49),差异具有统计学意义(P0.05);X线显示左侧10例,右侧39例,表现为肺不张、阻塞性肺炎、肺气肿、纵膈摆动、患侧膈肌动度减弱;螺旋CT显示在轴位像上表现为支气管、气管管腔内不同形态的密度增高影,以斑点状居多,且异物多位于右侧支气管。结论:螺旋CT相比于X线检查对气道异物检出率高,定位准确,但X线检查辐射小、费用低廉,临床对气道异物进行诊断时可先行X线检查,难以确诊时再行螺旋CT检查。     

眼内异物的CT诊断和定位

目的 探讨CT在眼内异物定位中的使用价值。方法 参阅CT横扫序列片将异物按照测量的结果标画在CT眼内异物定位图上。结果 40例可疑眼内异物患者有16例查出为眼内异物或球壁异物(其中6例普通x线不显影)，采用此法定位，迅速、准确地作出了诊断和定位。结论 利用CT诊断和定位眼内异物，简便易行、迅速准确，值得推广。     

比较X线与螺旋CT诊断气管异物的价值

目的比较X线与螺旋CT在气管异物诊断中的应用价值。方法选取2010年9月至2013年9月收治的68例气管异物患者作为研究对象,所有患者均行X线和螺旋CT检查诊断,对两种诊断方式的诊断价值进行比较。结果螺旋CT的正确检出率显著高于X线(P0.05);与X线相比,螺旋CT检查能够将异物本身直接显示出来,其间接征象和X线相似。结论 X线诊断具有操作简单、检查方便的特点,螺旋CT的正确诊断率较高,两种诊断方式可互相补充,如不能及时明确异物吸入史,则可将螺旋CT作为首选的诊断方式。     

16层螺旋CT后重建技术在诊断小肠肠梗阻中的临床价值分析

目的:分析16层螺旋CT后重建技术在诊断小肠肠梗阻(SBO)中的临床价值。方法:选取我院2014年8月至2016年9月经手术证实的小肠肠梗阻患者52例。所有手术前均实施腹部X线片及16层螺旋CT检查,且CT检查后对图像数据实施薄层重建及多平面图像重建(MPR),统计对比两种检查方法判定小肠肠梗阻存在情况、定位诊断情况,并诊断小肠肠梗阻病因。结果:16层螺旋CT检查后重建技术诊断为小肠肠梗阻准确率为100%(52/52),明显高于腹部X线平片诊断准确率69.23%(36/52),差异有统计学意义(x2=18.909,P0.05);16层螺旋CT后重建技术定位准确率为96.15%(50/52),明显高于X线平片梗阻定位准确率44.23%(23/52),差异有统计学意义(x2=33.502,P0.05);16层螺旋CT后重建技术诊断小肠肠梗阻病因准确率为92.31%(48/52)。结论:16层螺旋CT后重建技术可较准确判定小肠肠梗阻分布位置、梗阻原因,具有较高临床诊断价值。     

超声检测在眼外伤中的应用价值

目的 评价B超检查在眼外伤中的应用价值。方法 对132例眼外伤B超检查阳性结果进行分析。结果 132眼中，有的2种或2种以上损伤同时并存，其中玻璃体病变114眼，视网膜出血20眼，眼内异物18眼，外伤性视网膜脱离12眼等。结论 B超检查不胺屈光间质混浊影响，优于光学检查。疑有眼内异物，B超检查不受异物性质影响，对球内、球壁、球外异物的鉴别，优于X线检查。是临床诊断、治疗眼外伤的重要依据。     

结肠癌致肠梗阻患者的CT诊断方法及准确率分析

目的:观察CT检查在结肠癌致肠梗阻诊断中的应用价值及准确率。方法:回顾性分析2015年7月-2016年7月我院肛肠外科收治的84例结肠癌致肠梗阻患者的临床资料,所有患者经手术结合病理学检查已经确诊。术前对患者先后进行腹部X线检查、CT检查,观察两种检查方法对结肠癌致肠梗阻的准确检出率。结果:CT检查准确检出76例,检出率为90.48%;腹部X线检出52例,检出率为61.90%,两种检测方法准确检出率对比差异有统计学意义(P0.05)。CT检查在病因诊断中检出84例,检出率为100%;腹部X线在病因诊断中检出28例,检出率为33.33%。结论:多层螺旋CT对结肠癌致肠梗阻的检出率高,可以明确肠梗阻病因,为下一步治疗方案的选择提供诊断依据,具有较高的临床应用价值。     

眼科脉冲电磁吸铁器在软组织金属异物取出中的应用

对软组织金属异物定位,文献报道各异,如二维定位、三维定位,手术操作包括套管吸取、磁性吸引等方法[1].异物取出一般是先用X线拍片定位以后切开软组织寻找,由于金属异物可以随着肌肉的收缩而改变位置,导致金属异物在体内游走,在取异物时定位的位置往往发生改变,致使异物取出困难,往往需要在X线透视下取出,病人和医护人员需受一定量的X线辐射,对身体健康有一定的影响.我院自1996年-2003年采用眼科脉冲电磁吸铁器用于外伤、术中断针等原因引起的软组织金属异物残留病人89例,其中83例顺利取出,失败6例,在X线透视下取出,操作简单,花时少,病人痛苦小,病人和医护人员免于X射线的照射,取得了良好的效果.现总结如下.……     

多层螺旋CT三维重建在脊柱骨折中的临床应用价值分析

目的:讨论多层螺旋CT三维重建在脊柱骨折中的临床应用价值。方法:将我院2018年4月—2019年4月,收治75例脊柱骨折患者作为研究对象,患者术前均经过多层螺旋CT三维重建与X线平片检查,比较两组诊断结果。结果:多层螺旋CT三维重建扫描前柱骨折、中柱骨折、后柱骨折的脊柱骨折部位检出率高于X线平片检查方式,P<0.05。多层螺旋CT三维重建扫描小关节滑脱、椎管狭窄、骨碎片、椎体骨折的脊柱损伤显示率高于X线平片检查方式,P<0.05。结论:多层螺旋CT三维重建对脊柱骨折的诊断更加准确,值得应用推广。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.