自制心肌超声造影定量分析软件的设计与评价

目的评价自制心肌超声造影(MCE)图像定量分析软件对心肌灌注研究的可行性。方法根据阻断和再灌注冠状动脉时间不同,家兔被分为两组:阻断15min再灌注30min(Ⅰ组)和阻断120min再灌注60min(Ⅱ组)。分别于基础状态、冠状动脉阻断时和再灌注后行MCE,应用基于淘汰粒子群优化(EPSO)聚类算法的自制计算机图像定量分析软件对造影图像进行自动处理,获得多个心肌灌注定量参数。结果 (1)阻断时,Ⅰ组与Ⅱ组危险心肌的标化CI值均明显减低,与基础状态比较差异有统计学意义(t=5.104和t=4.327,P0.01)。再灌注后,Ⅰ组危险心肌标化CI值比阻断时增高(t=2.933,P0.01),与基础状态时相比仍减低(t=2.653,P0.01),Ⅱ组危险心肌标化CI值与阻断时相比差异无统计学意义(P0.05);(2)Ⅱ组危险心肌红色编码区和TTC中梗死心肌面积分别为(21.4±12.3)%和(18.0±9.5)%,且与TTC结果呈正相关(r=0.89,P0.01);(3)阻断时,危险心肌节段直方图呈偏态分布,再灌注后,Ⅰ组危险心肌基本恢复至正态分布,而Ⅱ组危险心肌仍呈偏态分布。结论基于淘汰粒子群优化聚类算法的心肌超声图像分析软件在定量评价心肌微灌注和识别灌注异常方面具有较好的可行性和较高的应用价值。     

An augmented reality system for liver thermal ablation: Design and evaluation on clinical cases

We present in this paper an augmented reality guidance system for liver thermal ablation in interventional radiology. To show the relevance of our methodology, the system is incrementally evaluated on an abdominal phantom and then on patients in the operating room. The system registers in a common coordinate system a preoperative image of the patient and the position of the needle that the practitioner manipulates. The breathing motion uncertainty is taken into account with a respiratory gating technique: the preoperative image and the guidance step are synchronized on expiratory phases. In order to fulfil the real-time constraints, we have developed and validated algorithms that automatically process and extract feature points. Since the guidance interface is also a major component of the system effectiveness, we validate the overall targeting accuracy on an abdominal phantom. This experiment showed that a practitioner can reach a predefined target with an accuracy of 2 mm with an insertion time below one minute. Finally, we propose a passive evaluation protocol of the overall system in the operating room during five interventions on patients. These experiments show that the system can provide a guidance information during expiratory phases with an error below 5 mm.     

Catheter ablation of atrial fibrillation using the Navx-/Ensite-system and a CT-/MRI-guided approach

Background  Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug refractory atrial fibrillation. However, catheter ablation of atrial fibrillation is still a challenge. This is partially due to the high degree of variability with regard to the individual anatomy. Nevertheless, 3D imaging systems (CT, MRI) provide detailed information about the individual left atrial and pulmonary vein morphology. A 3D CT or MRI reconstruction of the left atrium can be displayed in the Navx-/Ensite-system in a synchronised way during the ablation procedure, thereby facilitating the intervention. This study summarizes our preliminary experience with different strategies of AF ablation using the Navx-/Ensite-system and a CT-/MRI-guided approach. Methods  In a total of 41 patients, cardiac MRI (n = 7) or multi-detector spiral computed tomography (n = 34) was performed prior to an ablation procedure. Catheter ablation was performed for paroxysmal atrial fibrillation in 31 patients and for persistent atrial fibrillation in 10 patients. A 3D MRI or high resolution spiral CT data acquisition was performed and a surface rendered model of the LA was created. This model was displayed in the Navx-/Ensite-system throughout the ablation procedure. Results  Catheter ablation was performed using the Navx-system (n = 38) or the Ensite-system (n = 3). Three strategies were used depending on the type of atrial fibrillation: segmental isolation of the pulmonary veins (facilitated by a 3D real-time visualization of the ablation catheter and a circumferential mapping catheter; group A: 20 patients), linear lesions (group C: 3 patients) and a combined approach (group B; 18 patients). The CT-/MRI-models provided an excellent overview over the pulmonary veins and the left atrial appendage. They revealed a high degree of variability with regard to the individual anatomy (e.g. dimensions of the left atrial appendage, pulmonary vein ostia). The CT scans provided a more detailed reconstruction of the left atrial anatomy than the MRI scans (especially in patients who were in atrial fibrillation at the time of the data acquisition). In some patients, the CT-/MRI-models revealed a very small diameter of some pulmonary veins or side branches close to the ostium (e.g. right inferior pulmonary vein). Therefore, no attempt was made to achieve complete pulmonary vein isolation in some patients. In group A, 16/20 (80%) patients had no arrhythmia recurrence [mean follow-up 359 days (SD ± 317 days)]. Twelve out of eighteen (67%) patients in group B [mean follow-up 452 days (SD ± 311 days)] and 2/3 (67%) patients in group C did not experience an arrhythmia recurrence [mean follow-up 1,000 days (SD ± 34 days)]. There were no major complications. Conclusions  The information derived from 3D CT- or MRI-reconstructions facilitates AF ablations performed with the Navx-/Ensite-mapping system and enhances the safety of these procedures. Furthermore, the availability of an additional impedance-based 3D real-time visualization of the ablation catheter and the circular mapping catheter placed in the pulmonary veins represents a major advantage of the Navx system.     

Endoscopic laser ablation of duodenal carcinoids: a new treatment modality

Four cases of polypoidal carcinoid tumors in the duodenum were treated with Nd:YAG laser ablation after histological confirmation. None of the patients had any distant spread of the tumor. All the four tumors were less than 2 cm in size. In each case, the tumor was fully ablated in a single endoscopic laser sitting. All cases were done under local anesthesia and the patients were hospitalized for 1 day. All patients have been symptom free over a mean follow up period of 13 months (6 to 20 months). There has been no endoscopic evidence of local recurrence. Laser therapy is safe and effective and carries no mortality or morbidity. Endoscopic laser ablation is an effective alternative to surgical resection of small carcinoid tumors.     

An advanced system for the simulation and planning of orthodontic treatment

This paper presents a new system for three-dimensional (3-D) orthodontic treatment planning and movement of teeth. We describe a computer vision technique for the acquisition and processing of 3-D images of the profile of hydrocolloid dental imprints. Profile measurement is based on the triangulation method which detects deformation of the projection of a laser line on the dental imprints. The system is computer-controlled and designed to achieve depth and lateral resolutions of 0.1 and 0.2 mm, respectively, within a depth range of 40 mm. The 3-D image of the imprint is segmented in order to identify different teeth. Two operators are presented: one for the detection of molars and premolars based on a directional gradient, and one for incisors and canines based on 3-D registration with dental models contained in a database. We apply these 3-D dental models to simulate the 3-D movement of teeth, including rotations, during orthodontic treatment. With this objective, we have developed an original simplified model of arch-wire behaviour and a viscoplastic behaviour law for the alveolar bone in order to simulate teeth displacements during orthodontic treatment. The contribution of the paper is part of a diagnosis system (called MAGALLANES) that is designed to replace manual measurement methods, which use costly plaster models, with computer measurement methods and teeth movement simulation using cheap hydrocolloid dental wafers. This procedure will reduce the cost and acquisition time of orthodontic data and facilitate the conduct of epidemiological studies.     

射频CO2激光青光眼治疗系统的设计与实现

以25W射频激光器神工SGRF-25为基础,以WinCE为系统开发平台,采用EVC4.0编写系统应用软件,通过软硬件的设计与调试,进行系统的开发.该系统使用多线程微秒定时,完成精密的脉冲宽度调制.系统主要包括激光器控制、CCD图像采集、病例管理3部分内容,很好地完成了整个系统的开发.激光输出功率准确、稳定,界面友好,CCD图像采集成像清晰.结果提示,该系统为青光眼手术治疗提供了安全保障和便捷操作,基本满足了当今医院青光眼手术和信息化管理的要求.     

Defining a child's zone of proximal development: evaluation process for treatment planning

Therapists who evaluate children in school settings often find that information provided by standardized tests is insufficient for effective treatment planning. Vygotsky's concept of defining a child's zone of proximal development is introduced to help therapists gain insight into why a child experiences task failure and assistance that can facilitate the child's task success. This evaluation process and treatment planning framework may be used by both school and clinic-based therapists to differentiate children who should receive direct occupational therapy services from those who can benefit from indirect service.     

Development and preliminary evaluation of software for planning selective liver embolizations from three-dimensional rotational fluoroscopy imaging

Purpose  Liver cancer can be treated by transcatheter hepatic arterial embolization. Selective embolizations are desirable as they impact tumors and with limited damage to the surrounding healthy liver. These interventions are typically performed under fluoroscopy guidance. The advent of modern C-arms allows for the acquisition of three-dimensional images that offer a very detailed, unambiguous view of the hepatic arterial network. Methods  We developed a software specifically for planning selective liver tumor embolization from three-dimensional fluoroscopy. Based on the geometry of the vasculature around a targeted tumor, feeding vessels are inferred and highlighted. This accelerates and simplifies the determination of selective treatment points. Results  A retrospective study on nine patients (15 tumors) in two centers showed that the proposed software detected 89% of tumor feeding vessels (unaided radiologists detected 69% based on two-dimensional fluoroscopy) with a positive predictive value of 94% (90% for radiologists). Processing time was 142 s. Conclusion  The current report describes a feasibility analysis of a treatment planning software specifically geared to selective transcatheter delivery procedures in interventional oncology. This software takes advantage of recent advances in three-dimensional rotational angiography and vascular segmentation algorithms. It is likely that in the near term these types of tools will become integral parts of transcatheter therapies.     

Computerized tomography in evaluation and treatment planning of calcaneal fractures

Background. The tarsal bones and their articular surfaces have been difficult to show on standard roentgenograms including supplementary projections. Authors present different radiologic methods and classification systems of the fractures of the calcaneus.
Material and methods. Computerized tomography was used to evaluate 20 fractures of the calcaneus which was treated at the Orthopedic and Traumatology Department in Wejherowo from July to October 2001. To treatment planning a classification systems based on CT scans was developed.
Results. TC scans showed intraarticular fractures in 17 cases. There were four type 1 (not displaced), ten type 2 (displaced), three typ 3 (comminuted).
Conclusions. Computerized tomography should be a technique of choice in the calcaneal fracture evaluation and treatment planning.     

Hypothesis-oriented algorithm for clinicians. A method for evaluation and treatment planning

The purpose of this article is to introduce the hypothesis-oriented algorithm for clinicians (HOAC), which is designed to aid physical therapists in clinical decision making and patient management. The HOAC consists of two parts. The first part is a sequential guide to evaluation and treatment planning; the second part consists of a branching program used for reevaluation and the analysis of treatment effectiveness. Problem statements used in the HOAC are similar to those used for problem oriented medical records. The HOAC, however, requires therapists to state hypotheses about why the problems exist and to generate criteria that can be used to test the hypotheses. The benefits of the HOAC are that therapists must clearly state problems in a consistent manner, generate and list hypotheses and test criteria, develop treatment strategies and methods based solely on the hypotheses, and systematically review treatment. The rationale for treatment is identified clearly in the algorithm, facilitating the identification of inappropriate treatments (ie, those not related to the hypotheses). In addition, the branching program is used to identify where in the treatment process failures may be occurring and when a therapist needs to make a referral or seek assistance from a colleague.     

The development of a co-location system for the treatment of the severely brain damaged

Summary

The development of a close liaison multidisciplinary approach to the rehabilitation of the severely brain-damaged individual is described. The treatment programme, based within a single location, consists of a blend of individual and group therapy for the combined retraining of physical, functional and social skills.

Résumé

Dans cet article, on décrit l'organisation d'une étroite approche interdisciplinaire dans la rééducation fonctionnelle du sujet ayant subi un traumatisme craˇnio-cérébral grave. Le programme de prise en charge qui est appliqué dans une et meme institution et consiste en une approche thérapeutique à la fois individuelle et par groupe visant ainsi à obtenir une bonne récupération physique, fonctionnelle et réinsertion sociale.

Zussammenfassung

Die Entwicklung eines Programms enger multidisziplinaerer Zusammenarbeit in der Rehabilitation von Patienten mit schweren Hirnschäden wird beschrieben. Dieses in einem einzigen Gebäude zusammengefasste Behandlungsprogramm besteht aus einer Palette von Einzel- und Gruppentherapien für das kombinierte Training physischer, funktioneller and sozialer Funktionen.     

导管消融治疗心房颤动的进展与评价

1 引 言 心房颤动是最常见的一种快速性心律失常,然而迄今仍无一种理想的治疗方法。经导管射频消融治愈心房颤动是1994年以后才发展起来的一种新的治疗手段,包括线性消融和局灶性消融两种方案。本文就近年来这一治疗的若干进展作一简要介绍,并对其结果进行评价。2 线性消融线性消融是Swarit于1994年首先报道的一种方法,目前主要包括右心房消融、左心房消融和双心房消融三种形式。对于阵发性心房颤动,右心房线性消融的即时成功率仅约40％,而远期成功率更降至10％左右。若术后再辅以药物治疗,维持窦性心律的比例可达到33％至56％。左…     

超声引导下经皮激光消融治疗甲状腺良性结节的疗效及影响因素

目的：探讨对甲状腺良性结节超声引导下经皮激光消融（percutaneous laser ablation,PLA）的疗效及影响因素。方法：对164例接受PLA治疗的甲状腺良性结节的临床资料进行回顾性分析,对其术后2年的随访资料进行评估,包括结节的体积及体积缩小率（volume reduction ratio,VRR）,并评价影响PLA疗效的相关因素。结果：甲状腺良性结节PLA术后2年内体积明显缩小,对比术前差异有统计学意义（P均<0.05）,术后1、3、6、12、18及24个月VRR分别为：（5.2±71.1）%,（45.5±41.7）%,（70.4±26.3）%,（86.3±16.3）%,（87.8±15.6）%,（89.2±15.1）%;甲状腺结节按内部成分不同分组,术后1、3个月组间VRR差异具有统计学意义（P＜0.05）,以囊性为主的结节VRR更大;将实性结节按照体积分组,术后6个月至24个月组间VRR差异有统计学意义（P均＜0.001）, 5ml以下的实性结节消融后VRR更大。多元线性回归分析显示,结节初始体积是影响随访终点VRR唯一影响因素。结论：PLA治疗甲状腺良性结节是一种安全、有效的微创治疗方法,结节初始体积是对术后VRR唯一影响因素。     

肺癌化疗患者延续护理软件系统的运用效果

目的 运用肺癌化疗患者延续护理软件系统对肺癌化疗出院患者进行延续护理,并评价其效果。方法 选取2014年10~12月328例肺癌化疗患者作为对照组,实施常规电话随访;选取2015年10~12月336例肺癌化疗患者作为实验组,通过延续护理软件系统进行电话随访、个性化健康指导。比较2组患者随访率、满意度和生存质量。结果 实验组随访率明显高于对照组(χ²=56.347,P<0.001),满意度高于对照组(χ²=6.501,P=0.011),患者出院期间生存质量高于对照组。结论 运用肺癌化疗患者延续护理软件系统,可为患者提供综合的连续性护理,有效提高出院患者随访率、患者满意度及生存质量。     

基于linux平台的医学影像软件系统设计与应用

背景：随着VTK和ITK两个软件开发包的研制成功,医学影像领域内的研究人员越来越重视本领域内的软件开发问题。目的：开发一种结合VTK和ITK的医学影像软件系统。方法：首先对可视化软件包和图像处理包整合,进而基于整合框架对体数据进行处理、同步可视化和测量分析,最后结合病历信息与医学影像分析数据建立管理系统,在linux平台上对该软件系统进行了实现,利用上气道CT体数据对系统进行了测试。结果与结论：该系统能够结合VTK和ITK对体数据进行可视化和图像处理,基于MySQL数据库对病历信息和医学影像数据进行合理管理,体积、长度等测量精度都在1%之内。     

腔内激光闭合术与传统剥脱手术治疗小隐静脉曲张的对比研究

目的:评估腔内激光闭合术(EVLA)治疗小隐静脉曲张的临床疗效。方法:通过与传统剥脱手术比较,采用非盲随机对照试验,将107例小隐静脉曲张患者分为51例EVLA组和56例传统手术组,分别进行EVLA术及高位结扎剥脱术,观察比较两组手术时间、住院时间、术后疼痛、术后并发症、症状改善情况、创口满意度及术后1年的复发率。结果:两组患者经治疗症状均得到明显改善;术后严重程度评分(VCSS)、生活质量评分(EQ-5D)差异无统计学意义。而EVLA组术后创口满意度较高(P0.05);手术时间、住院时间均低于传统手术组(P0.05)。EVLA组无创口感染及深静脉血栓发生。传统手术组发生神经损伤4例,EVLA组仅1例神经损伤。结论:腔内激光闭合术治疗小隐静脉曲张疗效与传统手术相当,但具有操作简便、术后恢复快、美容效果好等优势。     

Design and preliminary evaluation of an expert system for platelet request evaluation

In spite of growing awareness of the potential risks associated with transfusion, the number of platelet units transfused in the United States continues to increase each year. There is a growing interest in ensuring that all transfusions are administered for appropriate reasons. Prospective review of requests for transfusions has been used to accomplish this goal. Although successful in reducing the number of inappropriate transfusions, this review method requires great time commitments by blood bank personnel and physicians. A knowledge-based system (ESPRE) that aids hospital blood bank personnel in the review of requests for platelet transfusions has been developed. The system automatically obtains most of the required patient data via a direct link to the hospital's main laboratory computers. The system generates a printed report that includes a list of patient-specific data, a list of the conditions for which a transfusion would be appropriate for the particular patient (given the clinical condition), and the conclusions drawn by the system. During a preliminary clinical evaluation of ESPRE, 73 randomly selected platelet transfusion requests were evaluated for approval by laboratory personnel and ESPRE. Overall, ESPRE would have approved 71 of the requests and laboratory staff would have approved 72. Forty-four percent of the requests would have been approved for the same reasons given by the staff. There were only three disagreements on final approval between ESPRE and blood bank personnel. This computerized expert system is a promising approach to the prospective review of all platelet transfusions.     

基于linux平台的医学影像软件系统设计与应用

背景:随着VTK 和ITK 两个软件开发包的研制成功,医学影像领域内的研究人员越来越重视本领域内的软件开发问题.目的:开发一种结合VTK 和ITK 的医学影像软件系统.方法:首先对可视化软件包和图像处理包整合,进而基于整合框架对体数据进行处理、同步可视化和测量分析,最后结合病历信息与医学影像分析数据建立管理系统,在linux 平台上对该软件系统进行了实现,利用上气道CT 体数据对系统进行了测试.结果与结论:该系统能够结合VTK 和ITK 对体数据进行可视化和图像处理,基于MySQL 数据库对病历信息和医学影像数据进行合理管理,体积、长度等测量精度都在1%之内.     

超微血管成像评价甲状腺结节激光消融疗效

目的 探讨超微血管成像（SMI）评价甲状腺结节激光消融疗效的价值。方法 选取46例甲状腺结节患者（共56个结节）,进行激光消融治疗。分别采用二维超声、CEUS及SMI检查测量消融灶体积,采用CEUS及SMI判断有无未完全消融结节和二维超声低回声区边缘是否存在残余微血管,并进行统计学分析。结果 CEUS检出未完全消融结节11个（11/56,19.64%）,SMI检出未完全消融结节9个（9/56,16.07%）,差异无统计学意义（P=0.50）。二维超声、CEUS及SMI测量消融灶体积分别为（2.10±2.13）cm³、（1.75±1.67）cm³和（1.79±1.80）cm³,二维超声测量消融灶的体积大于CEUS及SMI（P均<0.05）,CEUS测量消融灶的体积与SMI差异无统计学意义（P=0.554）。SMI与CEUS对消融后二维超声低回声区边缘存在残余微血管的检出率差异无统计学意义（P=0.125）。20个单点消融患者中,CEUS及SMI测量消融灶长度、宽度与消融能量均呈线性正相关（r=0.82、0.78,0.80、0.80,P均<0.05）。结论 SMI对未完全消融结节的检出率及对消融灶大小的评估与CEUS具有较好的一致性。     

An evaluation of the Hyland laser nephelometer PDQ system for the measurement of immunoglobulins

The Hyland laser nephelometer PDQ system for the assay of specific proteins is described. The results of evaluating the system to measure immunoglobulins IgA, IgG, and IgM are summarised. Within-batch and between-batch precision, accuracy, reliability, and safety are discussed. This instrument represents an important development in the immunochemical assay of proteins in clinical medicine. The speed, precision, and convenience of this new generation of discrete nephelometric analysers make such systems attractive to the clinical chemist.