动态监测技术在塔里木油田套损井诊断中的应用

塔里木油田砂岩油藏深井、超深井近年来套损井数量增加,套损诊断和找漏采用了油藏工程法、生产测井法、井下作业坐封打压综合分析法,应用了产量和含水变化、压力温度梯度及动静液面监测、产吸剖面测井、工程测井、地层流体分析、井下液性液量等资料,较好地指导了快速准确判断套损位置及有效补救措施。截至2011年底,及时指导套损油井、注水井补救,修复率分别达到71.6%、76.9%,减少了油水井生产综合时率损失,对油田平稳高效开发发挥了积极作用。     

机械通气患者套囊压力的监测

目的 讨论机械通气患者气管插管导管、气管切开套管的套囊压力和注气量是否合适,提供正确给套囊注气的科学依据.方法 对35例气管插管、气管切开进行机械通气患者的气管套管套囊压力和注气量的实际值和理想值进行准确测量.结果 65％的患者气管套管套囊实际压力和注气量过高,大于理想值.其中套囊实际注气量大于理想注气量2～4ml,套囊压力超过理想压力2～26 cm H2O.结论 临床上大部分气管套管套囊压力和注气量偏高,因此,应对人工气道患者采用专用套囊测压仪指导套囊注气量及控制囊内压,最大限度地避免气道黏膜的损伤.     

气管插管或气切套管套囊压力控制方法的对比研究

开放气道是临床常用的救治患者和实施麻醉的方法,而现行广泛开展的是气管插管或气管切开.气管插管或气管切开留置的导管一般带有套囊,气管插管或气切套管套囊的作用在于给套囊内注入一定量的气体.     

诊疗护理埃博拉出血热患者时高腰靴套穿着方法的改进

目的探讨诊疗护理埃博拉出血热患者时护理人员高腰靴套穿着方法的改进,防止出现高腰靴套潮湿、磨损及下滑等现象。方法便利抽样法选取2014年10月11-31日进入病区工作人员(共计93名、640人次)为研究对象,按时间先后将其分为3组,分别采取3种不同的方法穿着高腰靴套,工作1h,对所有工作人员进行问卷调查,比较高腰靴套下滑、磨损、潮湿等情况以及对3种方法防护效果的满意情况。结果方法1、2、3组之间出现潮湿、磨损、下滑程度的差异有统计学意义(P0.05),方法3优于方法1和2。3种方法除"便于观察和使用"项的差异无统计学意义(P0.05)外,其余项的差异均有统计学意义(均P0.05)。结论在诊疗护理埃博拉出血热患者时,为避免出现高腰靴套潮湿、磨损及下滑,在其外面加穿1副普通鞋套的效果最好。     

气管导管或气切套管套囊压力的测定及意义

开放气道是临床常用的救治病人和实施麻醉的方法,而现行广泛开展的是气管插管或气管切开。气管插管或气管切开留置的导管一般带有套囊。气管导管或气切套管套囊的作用在于给套囊内注入一定量的气体。其目的在于:①施行控制呼吸或辅助呼吸时提供无漏气的条件;②防止呕吐物等沿导管壁与气管壁之间的空隙流入下呼吸道[1] 。人们已经意识到气囊压力过高可阻断气管黏膜血流,从而发生一系列并发症。因此,对导管或套管套囊压力的测定就有了很大的意义。我们将从以下方面进行阐述。1　气管的解剖生理气管全长约10～14cm ,上连喉头环状软骨,下止于隆…     

塔中地区寒武系深层白云岩储层测井评价技术

塔中地区寒武系深层白云岩储层非均质强,油水关系复杂,储层定量评价及流体性质判别困难。首次提出一套适用于塔中地区寒武系深层白云岩储层测井评价技术,该技术充分利用微电阻率扫描成像、元素俘获、热中子(APS)及声波扫描成像(Sonic Scanner)等测井新技术资料,依靠以电成像孔隙度谱和视地层水电阻率谱为主的专利技术,精细刻画白云岩储层的孔、洞、缝特征,评价储层有效性,确定储层流体性质,在塔中寒武系深层白云岩油气藏的发现与评价中见到明显的地质效果。     

腹腔双套管在肝叶切除术后应用的护理体会

目的观察肝叶切除术后腹腔留置双套管的效果,探讨双套管的护理要点和注意事项。方法对88例肝叶切除术后分别留置腹腔单套管和双套管术后引流情况作对比、观察。结果肝叶切除术后留置双套管明显优于单套管。结论加强对双套管的护理有利于患者的术后康复并减少并发症。     

气管切开术后意外情况分析及护理措施

气管切开术是通过切口适当大小的套管插入气管,病人可以直接经导管呼吸,以解除或预防气管阻塞所引起的呼吸困难或窒息,它是临床抢救呼吸道梗阻患者的重要措施之一。术后患者依赖气管套管呼吸,如发生意外,处理不当,将产生严重后果,甚至危及生命。我科近年来共行气管切开术30余例,其中4例气管切开术后发生意外。现就其原因及护理措施报告如下。1临床资料本组4例均为男性,年龄52~87岁。4例意外情况表征各不相同,其中,套管脱出、气管内套管阻塞、内套管取出与安放困难、皮下及纵隔气肿各1例。2原因及相应处理2.1套管脱出其原因为外套管固定带结扎过松,患者强烈咳嗽将套管喷出,出现呼吸困难并发出声音。护士迅速将病人头位放正,消毒钳插入切口,撑开气管。请医师将消毒好的套管重新安放复位。2.2气管内套管阻塞因管腔窄小,呼吸道分泌物粘稠、不易吸出,又未能及时湿化而形成痰痂,阻塞气管内套管,造成呼吸困难和发绀。及时取出内套管后,呼吸改善,将内套管予以清洗煮沸消毒后重新放置,未再发生呼吸困难。2.3内套管取出与安放困难经过吸痰并在外套管间滴入生理盐水、α-糜蛋白酶药液或盐酸氨溴索,湿润后顺利取出。笔者认为,消毒内套管时勿用硬物操作或用力过猛,要...     

腹腔双套管在肝叶切除术后应用的护理体会

目的观察肝叶切除术后腹腔留置双套管的效果，探讨双套管的护理要点和注意事项。方法对88例肝叶切除术后分别留置腹腔单套管和双套管术后引流情况作对比、观察。结果肝叶切除术后留置双套管明显优于单套管。结论加强对双套管的护理有利于患者的术后康复并减少并发症。     

两种不同材质气管套管的清洗效果比较

[目的]比较两种不同材质的气管套管保湿处理后的清洗效果。[方法]选择我院耳鼻喉科病房使用的金属内套管(A组)和放疗科病房使用的硅胶内套管(B组)各15套,套管均为全新的,A组15套内套管共清洗356次,B组15套内套管共清洗205次,两组使用后均用1∶400多酶清洗液稀释液喷洒保湿后密闭保存,清洗时采用多酶浸泡超声+人工刷洗+高压水枪冲洗法,比较两组气管套管的清洗质量。[结果]两组套管清洗后质量合格率比较,差异有统计学意义(P0.05)。[结论]同样的保湿方法及同样的清洗方法,而金属气管套管的清洗质量较硅胶气管套管清洗质量高。     

Accuracy of High-Frequency Ultrasound Scanner in Detecting Peri-implant Bone Defects

The purpose of this study was to assess the accuracy of high-frequency ultrasound (US) in the measurement of peri-implant bone defects in comparison with cone-beam computed tomography (CBCT) and micro-computed tomography (µCT). Bone defects were mechanically created around dental implants inserted into porcine ribs (n?=?10). The bone samples were scanned by CBCT, µCT and US. Linear dimensions of the peri-implant defects were determined for supra-alveolar component, intra-bony component and width. The accuracy of measurements was evaluated with repeated-measures analysis of variance and the intra-class correlation coefficient at p ≤ 0.05. US underestimated the measurements for the supra-alveolar and intra-bony components in comparison to CBCT and µCT, and there were no statistically significant differences in the measurements of width. The intra-class correlation coefficient of US ranged from 0.96 to 0.98, whereas that for CBCT ranged from 0.77 to 0.97. US was accurate in measuring the width of peri-implant defects, although vertical measurements were underestimated by approximately 1 mm in comparison to those of CBCT and µCT.     

热扫描成像系统在监测肿瘤转移中价值的探讨

恶性肿瘤的治疗中，早期发现转移灶并给予合理的治疗，是提高患者生存率的重要环节。本文的目的在于探讨热扫描成像系统在监测肿瘤转移中的价值。我们于１９９６年８月－１２月应用热扫描成像系统监测了７５例恶性肿瘤病人的肿瘤转移情况，与临床检查结果进行对照，诊断符合率为８１．３％（６１／７５），其中１０例病人为无症状或临床其它检查手段尚未发现者，给临床提供了极有价值的治疗参考。本文认为，热扫描成像系统对人体无损害，检查灵敏，快捷，可用于临床对病变进行诊断和鉴别诊断。     

Detection of peripheral vascular disease using the Duplex Scanner III

Ultrasound provides a convenient means for the clinical evaluation of both the anatomy and the blood velocity patterns in large peripheral blood vessels. Continued development of ultrasound techniques has reached the point of providing useful diagnostic information in a routine fashion. This paper describes the Duplex Scanner III, which provides B-mode images of vascular anatomy combined with a pulsed 5 MHz Doppler to analyze blood flow within those vessels imaged. Improvements over the Duplex Scanner II include: increased scan head reliability; additional operating features and processing techniques to more accurately evaluate anatomy and blood flow characteristics; and display and recording techniques to facilitate clinical use.     

A Dedicated Breast Positron Emission Tomography Scanner: Proof of Concept

PurposeThis study developed and tested a novel scanner constructed for dedicated positron emission tomography (PET) of the breast. The breast PET (B-PET) scanner is designed with two opposing detectors using curve plate NaI(Tl) detectors to achieve a combination of high spatial resolution and energy resolution.MethodsPhantom and clinical studies (n = 20) with ¹⁸F-fluorodeoxyglucose were carried out on the whole-body Philips Allegro scanner and the B-PET scanner. Images were subjectively assessed by an expert panel.ResultsPhantom studies indicated improved contrast for B-PET over conventional PET. Of the 20 clinical studies with breast cancer demonstrated on whole-body fluorodeoxyglucose PET, 10 B-PET scans showed agreement. Of the remaining 10 studies, three had breasts that were too small to be imaged, four had lesions that were too deep to be captured in the field of view, and three were excluded due to technical errors.ConclusionsCompared with conventional PET, B-PET images provided greater detail in breast lesions suggesting that the low-cost and relatively simple design of B-PET may potentially be an important adjunct to traditional mammography in helping determine the nature of a lesion.     

Speckle Tracking-Derived Longitudinal Strain: Validation and Influence of Scanner Settings

Speckle tracking-based strain analysis is an evolving technique for the assessment of left ventricular function. We evaluated the influence of machine settings on global longitudinal peak systolic strain (GLPSS) values in an everyday patient population (n = 35). In each patient, the four-chamber view was recorded multiple times with different machine parameters. Ejection fraction ranged between 10% and 76% and correlated well with GLPSS (r = –0.778). GLPSS was not altered systematically by modifications of gain and frame rate. Conversely, higher transducer frequencies (mean effect: 1.102%/MHz, p < 0.001, and 0.662%/MHz, p = 0.033, for harmonic and fundamental imaging frequencies, respectively) and lower sector depth (mean effect: –0.156%/cm, p < 0.001) were associated with a slight—but statistically significant—reduction in absolute GLPSS values. Intra- and inter-observer variability exhibited satisfactory repeatability. GLPSS analysis proved to be reproducible and robust in our patient cohort if common settings for adult echocardiography were applied.     

Isolation and enumeration of circulating endothelial cells by immunomagnetic isolation: proposal of a definition and a consensus protocol

BACKGROUND: Circulating endothelial cells (CECs) have been identified as markers of vascular damage in a variety of disorders, such as myocardial infarction, vasculitis, and transplantation. CD146-driven immunomagnetic isolation has gained widespread use, but the technique is hampered by the lack of a definition of CECs and the absence of a consensus for their enumeration. AIM: To evaluate several variables influencing immunomagnetic isolation of CECs, formulate a definition for CECs and propose a consensus protocol for their enumeration. METHODS: We devised a protocol based on CD146-driven immunomagnetic isolation and a subsequent confirmatory step with Ulex-Europaeus-Lectin-1 staining. In a multi-center effort, we evaluated the preanalytical and analytical phases of this protocol. We evaluated the effects of storage, anticoagulation and density centrifugation, and compiled previous experience with this technique. RESULTS: Our protocol permitted unequivocal identification of CECs with acceptable reproducibility. There was an effect of storage time in that median cell numbers declined to only 87.5% of their baseline values during 24 h of storage at 4 degrees C. Recovery was lower with citrate than with ethylene-diamine tetra-acetic acid after 4 h of storage; density centrifugation was also associated with lower recovery. We provide a comprehensive list of technical recommendations and potential pitfalls. Finally, based on our experience with this protocol and a recent consensus workshop, we formulated a working definition for CECs. CONCLUSION: Our work represents an important step toward consensus regarding the CECs. Our recommendations represent the experience of three major centers and should now be scrutinized by others in the field.     

High-Frequency Quantitative Ultrasound for Imaging Prostate Cancer Using a Novel Micro-Ultrasound Scanner

Currently, biopsies guided by transrectal ultrasound (TRUS) are the only method for definitive diagnosis of prostate cancer. Studies by our group suggest that quantitative ultrasound (QUS) could provide a more sensitive means of targeting biopsies and directing focal treatments to cancer-suspicious regions in the prostate. Previous studies have utilized ultrasound signals at typical clinical frequencies, i.e., in the 6-MHz range. In the present study, a 29-MHz, TRUS, micro-ultrasound system and transducer (ExactVu micro-ultrasound, Exact Imaging, Markham, Canada) was used to acquire radio frequency data from 163 patients immediately before 12-core biopsy procedures, comprising 1956 cores. These retrospective data are a subset of data acquired in an ongoing, multisite, 2000-patient, randomized, clinical trial (clinicaltrials.gov NCT02079025). Spectrum-based QUS estimates of effective scatter diameter (ESD), effective acoustic concentration (EAC), midband (M), intercept (I) and slope (S) as well as envelope statistics employing a Nakagami distribution were used to train linear discriminant classifiers (LDCs) and support vector machines (SVMs). Classifier performance was assessed using area-under-the-curve (AUC) values obtained from receiver operating characteristic (ROC) analyses with 10-fold cross validation. A combination of ESD and EAC parameters resulted in an AUC value of 0.77 using a LDC. When Nakagami-µ or prostate-specific antigen (PSA) values were added as features, the AUC value increased to 0.79. SVM produced an AUC value of 0.77, using a combination of envelope and spectral QUS estimates. The best classification produced an AUC value of 0.81 using an LDC when combining envelope statistics, PSA, ESD and EAC. In a previous study, B-mode-based scoring and evaluation using the PRI-MUS protocol produced a maximal AUC value of 0.74 for higher Gleason-score values (GS >7) when read by an expert. Our initial results with AUC values of 0.81 are very encouraging for developing a new, predominantly user-independent, prostate-cancer, risk-assessing tool.