鼻塞式持续气道正压通气联合肺表面活性物质治疗早产儿肺透明膜病对照研究

目的探讨鼻塞式持续气道正压通气(NCPAP)联合肺表面活性物质(PS)和NCPAP联合沐舒坦(MU)两种方法治疗早产儿肺透明膜病的疗效差异。方法将90例肺透明膜病(HMD)早产儿随机分为NCPAP联合PS(NC+PS治疗组)和NCPAP联合MU(NC+MU治疗组),分别进行治疗,并比较两组的疗效、动脉血气分析和近远期并发症的差异。结果 (NC+PS)组的总有效率显著高于(NC+MU)组,而在呼吸困难缓解时间、上呼吸机时间和平均住院时间方面均小于(NC+MU)组,两组间的差异具有统计学意义(P<0.05)。治疗前两组早产儿的pH、PaO2、PaCO2和PaO2/FiO2无统计学差异(P>0.05);治疗后,两组早产儿的pH、PaO2和PaO2/FiO2均逐渐升高,PaCO2逐渐降低,两组间的差异具有统计学意义(P<0.05)。近期并发症主要为肺炎、颅内出血和肺出血,远期并发症主要为脑性瘫痪、听力障碍和早产儿视网膜病,(NC+PS)组的早产儿在早期和远期并发症方面均显著低于(NC+MU)组(P<0.05)。结论 NCPAP联合PS能显著提高早产儿肺透明膜病疗效,近远期并发症低,疗效显著高于NCPAP联合MU的疗效。     

整体离体肺受照后表面活性物质含量变化

本文报道了739纯种小鼠,Wistarl大鼠肺在整体、离体水平受照射后早期均可测出明显增高的肺泡表面活性物质,并且这种放射损伤效应与照射剂量呈一定的相关性,照射前给予受照动物中药活血化瘀制剂764-1可明显降低这种增高的表面活性物质含量。从而证明放射可以引起肺Ⅱ型上皮细胞早期损伤,且这种损伤是射线对肺Ⅱ型上皮细胞的原发作用,同时也初步表明中药活血化瘀制剂764-1可以直接改善放射对Ⅱ型上皮细胞造成的早期损伤。     

内耳结构及病变的MRI技术应用研究

目的：探讨内耳膜迷路、面神经及位听神经的MRI技术方法及其临床应用价值。方法：对35例可疑内耳病变的急者采用平衡式三维梯度回波(B—TFE)尽三维快速自旋回波T2W序列(T2／3D／TSE)、轴位及斜失状位扫描，最大信号强度投影(MIP)、多平面投影(MPR)法图像重建。结果：所有内耳膜迷路、面神经及位听神经结构均得到了良好显示。其中26例正常，9例异常。结论：MRIB—TFE和T2／3D／TSE扫描序列及MIP、MPR重建技术，可很好地显示内耳结构及其微小病变，对内耳病变的诊断具有较高的临床应用价值。     

胸椎椎弓根螺钉置入中"漏斗技术"的准确性研究

目的 探讨"漏斗技术"在胸椎椎弓根螺钉置入中的准确性,并对该技术的实验和临床应用一致性进行比较.方法 回顾性分析2006年8月-2008年7月至少有1枚螺钉置于T1～T12的3具人类尸体标本和11例患者的资料.由一位缺乏胸椎弓根螺钉置钉经验的年轻脊柱外科医师采用"漏斗技术"完成全部螺钉的置入.根据术后薄层CT扫描评估置钉准确性及各种并发症.结果 平均随访时间23.1个月,未见医源性血管、神经或内脏损伤等并发症;置钉失败率在标本和患者分别为14%(10/72)和15%(8/55);标本和患者危险性穿破分别为2枚(3%)和1枚(2%);置钉准确性在标本和患者之间差异无统计学意义;11例患者中,6枚(11%)螺钉穿破椎弓根外侧壁,1枚(2%)螺钉穿破椎弓根内侧壁,1枚(2%)螺钉穿破椎弓根上壁,未见椎弓根下壁和前壁穿破;患者置钉准确性比较:T1～T4比T5～T8(P＞0.05)、T1～T4比T9～T12(P＞0.05)、T1～T8比T9～T12(P＞0.05).在所有患者中,仅1枚螺钉需要重置.年轻脊柱外科医师在第1、第2、第3具标本上发生置钉失败数分别为6枚、3枚和1枚.结论 "漏斗技术"是一种简单、安全、准确和经济的椎弓根螺钉置入方法.实验研究与临床应用一致,通过该技术使年轻医师迅速安全、准确置入胸椎弓根螺钉成为可能.     

The uncertainties associated with the application of batch technique for distribution coefficients determination—A case study of cesium adsorption on four different bentonites

The uncertainties associated with the batch method used often as adsorption data source for performance assessments of radioactive waste repositories have been analyzed and evaluated. The adsorption of cesium on four different bentonites (two Na- and two Ca-bentonites) using a radiotracer (¹³⁷Cs) technique has been studied to evaluate experimental uncertainties and compare their effects on calculated distribution coefficients (K_ds). Three main factors influencing uncertainty of K_d at given conditions were identified—the radiotracer operation (mainly tracer addition to experimental systems), the phase separations efficiency and the mineralogical heterogeneity of samples. It was found that the determination of quantitative contributions of the last two factors to the uncertainty of K_d is difficult, depending on input material and conditions. The centrifugation and ultrafiltration method has been tested for removing colloids in sample solutions, but the results obtained were disputable. The mineral heterogeneity (complex mineral composition) effect has been identified mainly in kinetics of cesium adsorption where three different trends were described. This has important influence on the time-scale of the experiment's planning and equilibrium time estimation or identification. It has been concluded that experimental procedure may represent important uncertainty source of calculated K_d. In performance assessment studies, this uncertainty of K_d given by the appropriate experimental procedure should be taken into account and properly evaluated.     

The cushion scanning technique: A method of dynamic tongue sonography and its comparison with the transducer-skin coupling scanning technique during swallowing

Rationale and Objectives

We describe the cushion scanning technique (CST), which solves common difficulties encountered during ultrasound investigations of swallowing. These problems arise when the transducer is held in direct contact with the submental area. Some of these problems include movements of the ultrasound transducer during swallowing and compression of the submental region, which causes abnormal swallowing patterns.

Methods

To compare ultrasound images produced with the conventional hand-held transducer-skin coupling scanning technique with the CST, we studied five participants with no clinical signs of tongue dysfunction. All tongue movements were recorded by real-time B+M-mode sonography.

Results

Images produced with the hand-held transducer were found to be unstable because the transducer moved during swallowing, thereby changing the scanning section. By contrast, the transducer and the participant's head remained in a constant position throughout the CST trial. There was no obvious compression of the submental muscles.

Conclusion

The CST allows for a better intraindividual reproducibility of the swallowing pattern and for a more standardized and objective ultrasound examination than the hand-held transducer-skin coupling scanning technique.     

乙酰半胱氨酸溶液对急性肺损伤肺泡灌洗液中炎性因子及肺表面活性蛋白的影响

目的 探讨乙酰半胱氨酸溶液对急性肺损伤肺泡灌洗液(bronchoalveolar lavage fluid,BALF)炎性因子及肺表面活性蛋白的影响.方法 选取2017-02至2020-01医院收治的急性肺损伤患者100例,随机分为对照组和观察组,每组50例,两组入院后均行支气管肺泡灌洗,并均给予机械通气,对照组给予常...     

Effect of brachytherapy technique and patient characteristics on cervical cancer implant dosimetry

Our purpose was to evaluate the relationship between brachytherapy technique and patient characteristics on dose to organs-at-risk (OARs) in patients undergoing high dose rate (HDR) brachytherapy for cervical cancer. From 1998 to 2008, 31 patients with cervical cancer with full dosimetric data were identified who received definitive external-beam radiation and HDR brachytherapy with tandem and ovoid applicators. Doses were recorded at point A, the International Commission on Radiation Units and Measurements (ICRU)-38 rectal point, the ICRU-38 bladder point, the vaginal surface, and the pelvic sidewall. Generalized estimating equations were used to determine the significance of changes in OAR to point A dose ratios with differences in brachytherapy technique or patient characteristics. Patients underwent a median of 5 brachytherapy procedures (range, 3 to 5), with a total of 179 procedures for 31 patients. For all brachytherapy treatments, the average ratios between the doses for the rectal, bladder, vaginal surface, and pelvic sidewall reference points to those at point A were 0.49, 0.59, 1.15, and 0.17, respectively. In general, decreased OAR dose was associated with a lower stage, younger age, increased ovoid size, increased tandem length, and earlier implant number. Increased tandem curvature significantly increased bladder dose and decreased rectal dose. Intravenous anesthesia usage was not correlated with improved dosimetry. This study allowed identification of patient and procedure characteristics influencing OAR dosing. Although the advent of 3-dimensional (3D) image-guided brachytherapy will bring new advances in treatment optimization, the actual technique involved at the time of the brachytherapy implant procedure will remain important.     

胸椎椎弓根螺钉置入中"漏斗技术"的准确性研究

目的 探讨"漏斗技术"在胸椎椎弓根螺钉置入中的准确性,并对该技术的实验和临床应用一致性进行比较.方法 回顾性分析2006年8月-2008年7月至少有1枚螺钉置于T1～T12的3具人类尸体标本和11例患者的资料.由一位缺乏胸椎弓根螺钉置钉经验的年轻脊柱外科医师采用"漏斗技术"完成全部螺钉的置入.根据术后薄层CT扫描评估置钉准确性及各种并发症.结果 平均随访时间23.1个月,未见医源性血管、神经或内脏损伤等并发症;置钉失败率在标本和患者分别为14%(10/72)和15%(8/55);标本和患者危险性穿破分别为2枚(3%)和1枚(2%);置钉准确性在标本和患者之间差异无统计学意义;11例患者中,6枚(11%)螺钉穿破椎弓根外侧壁,1枚(2%)螺钉穿破椎弓根内侧壁,1枚(2%)螺钉穿破椎弓根上壁,未见椎弓根下壁和前壁穿破;患者置钉准确性比较:T1～T4比T5～T8(P＞0.05)、T1～T4比T9～T12(P＞0.05)、T1～T8比T9～T12(P＞0.05).在所有患者中,仅1枚螺钉需要重置.年轻脊柱外科医师在第1、第2、第3具标本上发生置钉失败数分别为6枚、3枚和1枚.结论 "漏斗技术"是一种简单、安全、准确和经济的椎弓根螺钉置入方法.实验研究与临床应用一致,通过该技术使年轻医师迅速安全、准确置入胸椎弓根螺钉成为可能.     

加强骨与关节介入技术的研究,促进介入放射学的均衡发展

回顾骨与关节介入/微创技术的发展历史与现状,对经皮骨活检,椎间盘突出症的介入治疗,经皮椎体成形术等常见介入技术作一述评。尽管骨与关节介入技术历史悠久,前景良好,但与血管介入等其他介入技术比较,仍有较大的发展空间。