应用64排螺旋CT多种后处理技术在肋骨骨折诊断中的临床价值分析

目的探讨应用64排螺旋CT多种后处理技术在肋骨骨折诊断中的临床价值。方法选取本院2016年6月～2018年6月就诊的疑似肋骨骨折60例胸部外伤患者。均行DR摄片,并行64排螺旋CT轴位检查、容积再现(VR)、多平面重建(MPR)等后处理技术检查,比较后处理技术方法对肋骨骨折、骨折数量尤其是隐匿性骨折检出情况。结果影像学检查及复查确诊肋骨骨折146处,CT轴位、CT后处理技术对肋骨骨折例数检出率分别为96.00%和98.00%,显著高于X线平片的80.00%,差异有统计学意义(P<0.05)。CT后处理技术对肋骨骨折数量检出率为99.32%,高于X线平片、CT轴位的69.18%和80.82%,差异有统计学意义(P<0.05)。漏诊情况:X线平片漏诊7例,36处,其中以肋软骨附近漏诊最多,占66.67%%;CT轴位漏诊2例、16处,分别是肋软骨附近4处,第1肋骨3处,腋段肋骨3处,膈下肋骨2处,前肋4处;CT后处理技术未漏诊,可疑骨折数1处。结论 64排螺旋CT后处理技术对肋骨骨折以及骨折数量检出率高,能有效降低漏诊率,弥补X线平片、CT轴位存在的不足,减少不必要的医疗纠纷。     

64层螺旋CT在无错位性肋骨骨折诊断中的应用价值

目的探讨64层螺旋CT的扫描技术和后处理功能在无错位性肋骨骨折诊断中的应用价值。方法对外伤怀疑肋骨骨折或X线平片诊断肋骨骨折的患者进行64层螺旋CT扫描,所有图像均进行多平面重建(MPR)、容积再现技术(VR)、曲面重组技术(CPR)及轴位图像结合分析。结果 829例患者中肋骨骨折数为1820根,其中无错位性肋骨骨折601根,占骨折总数的33.0%。601根中,前肋141根,腋中线处238根,后肋185根,多发骨折37根。发生于肋软骨交界处89根,胸肋关节处103根。结论无错位性肋骨骨折X线平片准确诊断困难,应用MPR、VR、CPR及轴位图像结合分析更能准确诊断无错位性肋骨骨折,可清晰、直观、完整地显示肋骨结构、骨折位置、形态及程度。     

16层螺旋CT三维重建技术在肋骨隐匿性骨折中的诊断价值

目的探讨16层螺旋CT三维重建技术在肋骨隐匿性骨折检查中的诊断价值。方法利用PHILIPS公司16层螺旋CT对1 000例胸部外伤患者进行扫描检查,对原始数据做薄层图像重建并传输至工作站,然后进行图像三维重建。包括容积再现（VR）、最大密度投影（MIP）、表面遮盖显示（SSD）等图像重建方法,将不全或无错位骨折定为隐匿性骨折。观察分析肋骨和肋软骨骨折情况,及其周围解剖结构的病变。结果 1 000例中,170例诊断为单发或多发肋骨隐匿性骨折。肋骨骨折总数为195根。CT轴位扫描显示肋骨骨折184根,检出率为94.4%。三维容积重建图像后显示肋骨骨折193根,检出率为99.0%。其中2根肋骨骨折CT轴位扫描显示而三维重建未能显示,11根肋骨（肋软骨）骨折三维重建显示而CT轴位扫描未显示。结论利用多排螺旋CT图像重建技术,对诊断肋骨隐匿骨折的准确性要优于常规CT轴位扫描,为临床诊治肋骨骨折提供重要诊断依据。     

多层螺旋重建技术在肋骨骨折诊断价值

目的探讨螺旋CT应用多层螺旋重建技术在肋骨骨折诊断价值。方法2007年10月至2009年2月我科应用多层螺旋三维重建后处理技术诊断的264例肋骨骨折患者全部患者均行常规摄正位、斜位X线肋骨片,并进行比较。结果264例肋骨骨折经多层螺旋CT检查发现肋骨骨折321处,单根肋骨骨折180例,多发肋骨骨折57例。肋软骨骨折27例。264例肋骨骨折X线检查共发现明确肋骨骨折219例229处骨折,可疑骨折3例5处,肋软骨骨折0处,其余未见明显骨折。结论通过本组数据显示普通X线肋骨片检出率82．95％,漏诊率17．05％;螺旋CT应用多层螺旋三维重建后处理技术检出率100％,漏诊率0。说明多层螺旋三维重建后处理技术可从不同方位显示各复杂部位的骨折,详细了解骨折形态、累及范围和周围结构受累情况,提高检出率降低漏诊率。     

肋软骨骨折的64层螺旋CT诊断价值分析

目的探讨64层螺旋CT在肋软骨骨折诊断中的价值,提高诊断水平。方法回顾性分析28例肋软骨骨折患者的64层螺旋CT三维重组图像,并与X线平片CT直接扫描横断位图像对照。结果28例患者中64层螺旋CT三维重组图像发现肋软骨骨折33处,23例X线平片、9例CT直接横断位图像未显示。结论64层螺旋CT对肋软骨骨折的显示优于普通X线平片及常规CT胸部横断位图像,可望成为检测肋软骨骨折的最佳影像学检查手段。     

多排螺旋CT在肋骨骨折诊断中的价值探讨

目的:探讨多排螺旋CT在肋骨骨折扫描检查中的应用价值。方法:利用GE的Lightspeed8排螺旋CT对56例胸部外伤患者进行多排螺旋CT扫描检查,对原始数据进行薄层图像重建并传至工作站,进行容积再现(VR)、多平面重组(MPR)、最大密度投影(MIP)、表面遮掩(SSD)图像重建,观察和分析肋骨骨折情况、周围其他解剖结构病变。结果:56例患者中除1例患者无肋骨骨折外其余55例患者均有单发或多发肋骨骨折,共计检查出肋骨数量为105根,CT原始扫描数据发现肋骨骨折103根,CT层厚为2.5mm薄层重建图像数据发现肋骨骨折为105根,重建三维图像VR、MIP、MPR、SSD发现肋骨骨折为102根,结合上述图像能清晰显示肋骨骨折情况、骨折数量、是否错位,除发现X线片肋骨骨折不明显骨折情况,同时还发现周围其他解剖结构外伤情况。结论:利用多排螺旋CT多种图像重建,其对肋骨骨折诊断准确性要优于常规X线检查,可弥补X线检查中不足,为临床诊治肋骨骨折提供重要价值。     

X线与高频超声诊断细微肋骨骨折的对比分析

回顾性分析2012年1月~2014年1月共131例228处病史资料完整地肋骨(包括肋软骨)骨折患者的临床资料,均采用X线胸片检查及高频超声检查,比较X线检查和高频超声检查诊断对肋骨及肋软件骨折的检出率及细微骨折检出率。结果 X线检查确诊肋骨骨折的检出率为78.1%,所有肋软骨骨折X线检查均未能显示,漏诊50例;而高频超声骨折检出率高达96.5,且肋软骨骨折检出11处。高频超声对肋骨骨折及肋软骨骨折的检出率明显高于对照组,差异显著,有统计学意义(P<0.05);且X线检查对细微骨折检出率为5.70%;高频超声对细微骨折检出率为14.47%。高频超声对肋骨骨折及肋软骨细微骨折的检出率明显高于对照组,差异显著,有统计学意义(P<0.05)。高频超声能快速检出X线检查无法显示的细微肋骨及肋软骨骨折,并可重复检查,方便快捷,可作为肋骨及肋软骨骨折的常规检查手段,值得临床推广应用。     

多排螺旋CT三维重建在肋骨骨折中的应用价值

目的:探讨多排螺旋CT三维重建在肋骨骨折中的应用价值。材料与方法:对84例肋骨骨折病人进行螺旋CT轴位扫描,并做三维表面遮盖成像法(SSD)、最大密度投影(MIP)、多平面重建(MPR)、容积再现(VRT)及三维重建图像,对比各组图像结果。结果:胸部多排螺旋CT扫描并三维重建对诊断肋骨骨折具有一定的特征性。对胸部外伤患者的检查价值大于常规X线。结论:常规CT轴位扫描后通过不同的重建方法,能清楚的显示骨折形态、位置,立体感强。但三维重建图像容积资料丢失较多,细节显示不够,诊断时需与其它重建方法对照。     

浅谈16排螺旋CT结合三维重建技术在肋骨骨折诊断中的应用

选取2010年1月-2013年1月我院60例临床拟诊或者确诊为肋骨骨折患者,利用Philips公司的Brilliance16层螺旋CT进行扫描检查,并且对原始数据进行VR、MPR、MIP和SSD的图像重建,观察分析肋骨骨折情况。结果 60例患者肋骨骨折数为114根,其中X线片显示21处为可疑骨折,但利用16排螺旋CT扫描结果显示,其中有17处为明确骨折,其它4处无骨折现象。X线片13处未见明显骨折,但应用16排螺旋CT显示有17处骨折。总计,单发性肋骨骨折有28例（46.67%）,多发性肋骨骨折32例（53.33%）。对肋骨骨折的诊断,16排螺旋CT扫描结合三维重建技术明显优于X线检查。     

多排螺旋CT低剂量扫描技术在肋骨骨折中的诊断价值分析

目的:分析多排螺旋CT低剂量扫描技术在肋骨骨折中的诊断价值。方法:选取我院63例肋骨骨折患者,均实施胸部数字X射线摄影正斜位X线摄影(Digit radiography,DR)及多排螺旋CT低剂量扫描技术,观察比较两种不同检查方法获取图像质量及诊断准确率。结果:64排螺旋CT低剂量扫描技术图像优良率为95.24%,可用图像为100%,DR获取图像优良率为92.06%,可用图像为100%,组间比较差异无统计学意义(P0.05);64排螺旋CT低剂量诊断准确率为96.83%,高于对照组69.84%,差异具有统计学意义(P0.05)。结论:多排螺旋CT低剂量扫描技术在肋骨骨折中诊断价值较高,值得临床推广。     

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.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。