健康国人嗅球体积MRI测值及其与年龄和嗅觉功能的相关性

目的 探讨MRI测量嗅球(OB)体积的可行性,观察健康国人OB体积随年龄增长的演变规律和与嗅觉功能的相关性。方法 随机选择103名右利手健康志愿者,采用1.5T临床型MR系统行全脑扫描,在冠状位以手绘法测量OB体积。采用Sniffin' Sticks方法检测嗅觉功能,包括嗅觉阈值、嗅觉辨别和嗅觉识别,计算嗅觉总评分(TDI)。结果 男性左、右侧OB体积平均值分别为(88.66±29.36)cm³和(92.54±30.63)cm³,女性左、右侧OB体积平均为(74.84±19.34)cm³和(72.63±20.71)cm³;男性和女性两侧OB体积差异均有统计学意义(P均<0.05)。左、右侧OB体积与年龄均呈负相关(左侧:r=-0.24,P=0.02;右侧:r=-0.28,P=0.01)。左、右侧OB体积分别与同侧TDI评分呈正相关(左侧:r=0.21,P=0.03;右侧:r=0.22, P=0.02);右侧THR和ID评分与同侧OB体积也具有相关性(THR:r=0.19,P=0.04;ID:r=0.19,P=0.04)。结论 采用1.5T临床型MR仪可清晰显示和准确测量OB体积;国人OB体积随年龄增大而逐渐减小,并与相应嗅觉功能具有相关性。     

基于高分辨力MRI的正常中国成人脑桥体积的测量

目的 应用高分辨力MRI和三维体积分析软件(Midob)测量正常中国成人脑桥体积。 方法 选取1000名中国成年健康志愿者,按≤30岁、31~40岁、41~50岁、51~60岁、≥61岁分为5组(每组200名,男女各100名)。对所有受试者均行全脑T1加权三维磁化强度预备梯度回波(T1W-3D-MP RAGE)序列成像,利用Midob软件确定脑桥边界,测量脑桥体积。并对所测量的数据进行标准化处理,对标准化后不同年龄组、不同性别受试者的脑桥体积进行统计学分析。 结果 标准化后各年龄组男性脑桥体积分别为(19 747.78±2404.41)mm³、(20 295.26±2524.51)mm³、(20 895.50±2089.63)mm³、(21 053.66±2378.06)mm³、(20 854.57±2405.26)mm³;女性各年龄组脑桥体积分别为(18 927.01±2019.17)mm³、(20 193.65±2270.92)mm³、(20 547.92±2517.20)mm³、(20 860.26±2412.94)mm³、(20 714.53±2562.68)mm³。≤30岁组、31~40岁组中男、女性脑桥体积差异有统计学意义(P均＜0.05),而41~50岁组、51~60岁组及≥61岁组中男、女性脑桥体积差异无统计学意义(P均＞0.05)。总体上男性脑桥体积大于女性(P＜0.05)。男、女性脑桥体积均有随年龄增加而增大的趋势,且女性增大趋势更明显。 结论 基于高分辨力MRI和Midob软件的脑桥体积测量,可为临床某些神经系统疾病的诊断和治疗提供有价值的参考信息,且为建立活体正常中国成人数字化标准脑打下基础。     

磁敏感加权成像诊断慢性大脑中动脉狭窄或闭塞

目的 利用SWI评价慢性大脑中动脉(MCA)狭窄或闭塞患者相应供血区域的脑氧代谢,检出易损脑组织。方法 对单侧慢性MCA重度狭窄或闭塞患者11例(患病组)和性别、年龄与之相匹配的正常人10名(正常对照组)行TOF-MRA及SWI检查,选取相同大小的ROI测量,并比较患者患侧、健侧以及正常对照组两侧脑组织的相位弧度值及SWI信号值。结果 患者患侧、健侧、正常对照组左侧及右侧的相位弧度值分别为(6.00±2.10)×10^-3、(11.66±3.52)×10^-3、(12.08±2.86)×10^-3、(10.51±2.30)×10^-3(F=13.48,P<0.05),SWI信号值分别为194.29±28.08、238.33±24.76、245.05±8.76、233.06±11.66(F=13.36,P<0.05),差异均有统计学意义。患侧相位弧度值及SWI信号值均低于健侧及正常对照组(P<0.05)。患病组患者中2例大脑后动脉侧支循环丰富区域(枕叶为主)SWI信号及相位弧度值高于健侧。结论 SWI能间接反映慢性缺血脑组织氧摄取分数升高及脑血流量降低,可代替CT或MR灌注成像评价MCA狭窄或闭塞患者缺血范围及缺血程度,指导临床治疗。     

CT测量儿童正常肾皮质厚度

目的 通过测量分析儿童正常肾脏CT图像,探讨不同年龄段儿童肾皮质厚度的CT测量值的参考范围,为判断儿童肾脏形态异常提供对照标准。方法 连续选取接受腹部CT增强扫描检查的无肾脏疾病、无服用肾脏损害药物史的儿童204名,按年龄分为5组:婴儿期、幼儿期、学龄前期、学龄期、青春期,测量每侧肾脏肾门层面皮质、实质的厚度和肾脏径线长度,并进行统计分析。结果 各年龄组肾皮质厚度分别为(0.41±0.09)cm、(0.48±0.09)cm、(0.54±0.12)cm、(0.65±0.13)cm、(0.76±0.18)cm,两两组间差异均有统计学意义(P均＜0.05)。肾皮质厚度与年龄呈正相关(右侧:r=0.65,左侧:r=0.65,P均＜0.05),肾皮质与肾实质厚度之比与年龄相关性最弱(右侧:r=0.19,左侧: r=0.16,P均＜0.05)。结论 肾皮质厚度随年龄增加,肾皮质与肾实质厚度之比则随年龄变化不明显,可作为监测儿童部分肾脏疾病发展、转归的重要CT解剖依据。     

MSCT测量胃癌体积的层厚选取及可重复性

目的 探讨MSCT测量胃癌体积的层厚选取,评价MSCT测量胃癌体积的可重复性。方法 将33例胃癌的MSCT图像传输至工作站,分别用3 mm、5 mm和7 mm层厚进行胃癌体积测量,并由另1名医师以5 mm层厚对所有胃癌体积进行重复测量。计算观察者内或观察者间的差异。结果 3 mm、5 mm、7 mm层厚测得胃癌体积分别为 (65.06±46.87)cm³、(64.74±47.13)cm³和(63.56±45.82)cm³(F=5.409,P<0.05)。3 mm和5 mm层厚测量胃癌体积差异无统计学意义(P=0.298);3 mm和7 mm层厚、5 mm和7 mm层厚测量结果差异有统计学意义(P均<0.05)。3 mm和5 mm、3 mm和7 mm、5 mm和7 mm层厚测量胃癌体积的组内相关系数分别为0.992、0.990、0.988。用3 mm、5 mm、7 mm层厚测量胃癌体积所需时间分别为(30.6±15.5) min、(20.0±11.8) min和(12.3±6.4)min。两名观察者用5 mm层厚测量的胃癌体积平均值分别是(64.74±47.13)cm³和 (65.32±45.82)cm³,差异无统计学意义(F=1.386,P=0.248),组内相关系数为0.998。结论 MSCT测量胃癌体积时选用3 mm和5 mm层厚较佳;选用5 mm层厚测量胃癌体积节省工作时间;MSCT胃癌体积测量具有较高的一致性和可重复性。     

基于高分辨力MRI的正常中国成人小脑体积测量

目的 建立中国正常成人小脑体积的95%可信区间,为建立中国成人数字标准脑提供基础性数据。 方法 500名中国健康成年志愿者,按年龄18~30岁(第1组)、31~40岁(第2组)、41~50岁(第3组)、51~60岁(第4组)、61~69岁(第5组)分为5组,每组男女各50名,接受大脑T1加权三维磁化强度预备梯度回波序列扫描。应用三维体积分析软件测量小脑的体积,并对不同性别、不同年龄组的小脑体积分别进行统计学分析。 结果 成年男女的小脑总体积的95%可信区间分别为176 770.0~270 444.9 mm³、163 460.4~245 932.0 mm³(P<0.05);成年男性第5组小脑体积与前3组差异均有统计学意义(P均<0.01);成年女性第5组小脑体积与前4组差异均有统计学意义(P均<0.05);成年男女小脑体积与年龄均呈负相关(r=－0.443、－0.318,P均<0.001)。 结论 基于高分辨力MR图像和三维体积分析软件可准确测量小脑体积,为中国成人数字标准脑提供基础性数据,为可能引起小脑体积改变的相关疾病诊断提供正常对照标准。     

MRI测量正常人脑氧摄取分数

目的 利用MRI梯度回波采样自旋回波(GESSE)序列测量不同年龄段正常人脑的氧摄取分数(OEF),比较灰、白质OEF值及其随年龄变化规律。 方法 将53名健康志愿者按年龄分为青年(20~39岁,20名)、中年(40~59岁,20名)、老年(60岁及以上,13名)组,均行GESSE序列扫描,应用Matlab 7.6软件对图像进行后处理。在双侧大脑半球皮层、半卵圆中心白质各设置6个ROI,测量其OEF值。 结果 各年龄组内灰、白质OEF值在左、右大脑半球间差异无统计学意义(P均>0.05);双侧大脑半球灰、白质间OEF值无差异统计学意义(P均>0.05)。灰质OEF值在各年龄组间差异有统计学意义(P均<0.05),青年组(0.32±0.04)小于中年组(0.34±0.05)、老年组(0.35±0.05)。仅灰质OEF值与年龄呈弱相关(r=0.15,P=0.01)。全脑OEF平均值为(0.34±0.05)。 结论 GESSE序列可以准确测量人脑OEF值,正常人脑灰、白质间OEF值差异无统计学意义,仅灰质OEF值随年龄增长而轻度升高。     

基于高分辨力MRI的中国正常成人侧脑室的体积测量

目的 建立中国正常成人侧脑室体积的正常值范围,为建立中国成人数字标准脑提供基础性数据。 方法 500名中国健康成年志愿者,按年龄分为五组,第1组18~30岁,第2组31~40岁,第3组41~50岁,第4组51~60岁,第5组≥61岁,分别接受颅脑T1加权三维磁化强度预备梯度回波序列扫描,应用图像分析处理软件测量侧脑室体积,分析侧脑室体积与性别、年龄的关系。结果 中国正常成年人的双侧侧脑室总体积的95%可信区间:男性为27 759.05~31 955.52 mm³,女性为21 696.45~24 885.02 mm³。左侧侧脑室体积95%可信区间:男性为14 690.69~16 913.79 mm³,女性为11 301.18~13 079.25 mm³;右侧侧脑室体积95%可信区间:男性为13 004.32~15 105.77 mm³,女性为10 298.55~11 902.48 mm³。成年男性侧脑室总体积大于女性(P<0.001),成年男、女性左侧侧脑室体积均大于右侧(P<0.001)。随着年龄增长,男性和女性双侧侧脑室的体积逐渐增大,显著性增大的起始年龄男性为51岁以上,女性为41岁以上。61 岁及以上是侧脑室体积增大的一个高峰。结论 基于高分辨力磁共振图像和三维体积分析软件可以准确测量侧脑室的体积。     

正常人肝脏3.0T磁共振弹性成像

目的 探讨我国正常成人肝脏磁共振弹性值测量的参考范围,分析弹性值与性别、年龄及体质量指数(BMI)的关系。 方法 对64名健康志愿者按年龄、性别、BMI分组,应用3.0T磁共振弹性成像(MRE)测量肝弹性值,统计分析肝弹性值与年龄、BMI的相关性,评价不同年龄、BMI及性别的组间差异。 结果 我国正常成人肝弹性值范围为1.83~3.02 kPa,平均(2.37±0.28)kPa。肝弹性值与年龄、BMI均无相关性(r=0.20、0.02,P均>0.05)。男性平均肝弹性值略高于女性(U=309.00,P=0.01),不同年龄组、BMI组间肝弹性值的差异无统计学意义(χ²=3.31、2.16,P>0.05)。 结论 定量研究我国正常成人肝弹性值可为MRE的临床应用提供依据和指导。     

MRI测量中国汉族不同性别正常成人枕叶体积

目的 采用MRI测量不同性别中国汉族正常成人枕叶体积。方法 于中国汉族健康成年脑数据库中选取200名志愿者，采集大脑三维磁化预备梯度回波T1WI。手动勾画ROI，测量左、右侧枕叶体积及全脑体积。将测量结果标准化，比较不同性别左、右侧枕叶体积的差异，分析枕叶体积与年龄的关系以及性别、年龄对枕叶体积的影响。结果 正常成人枕叶体积（105.37±10.41）cm³，标准化后为（105.44±9.20）cm³。标准化前男性与女性大脑枕叶体积[（111.34±9.15）cm³和（99.38±7.85）cm³]及标准化后男性与女性枕叶体积[（111.39±7.31）cm³和（99.48±6.72）cm³]差异均有统计学意义（t=9.91、12.01，P均<0.05）。标准化前、后男性左、右侧枕叶体积及女性左、右侧枕叶体积差异均无统计学意义（P均>0.05）。标准化前后男性、女性枕叶体积与年龄均无明显相关（标准化前r=-0.01、0.18，P=0.90、0.08，标准化后r=0.05、0.01，P=0.64、0.92）。性别及年龄对枕叶体积的影响无明显交互作用。结论 中国健康成年人枕叶体积男性大于女性，双侧枕叶体积基本一致。枕叶体积不易随年龄增长而出现萎缩。     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

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.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.