彩色流速流量定量测定动静脉内瘘流量的临床初步应用

目的 研究血透用动静脉内普流量与其畅性及透析效果之间的关系。方法 用彩色流速流量定量（ＣＶＯＱ）对７２个动静脉内瘘进行了７８人次流量测定,其中自体血管动静脉内瘘９Ｐｒｅｓｃｉａ－Ｃｉｍｉｎｏ内瘘）５７个,人造血管内瘘１５个。随访内瘘通畅性及血透流量能否达标。结果 根据血透流量及内瘘关型,将患者分为三组。血透流量≥２００ｍｌ／ｍｉｎ者归入Ａ组（Ｂｒｅｓｃｉａ－Ｃｈｉｍｉｎｏ内瘘）、Ｂ超（人造血管内瘘     

3D扫描容积法评定上肢远端体积的信度和效度

目的 明确3D扫描容积法测量上肢远端体积的可行性,分析其评定者间信度和效标关联效度。方法 2022年1月至3月,由1名未接触过3D扫描容积法和排水法的康复治疗师(操作者A)经过培训后,分别使用手持式3D激光扫描仪和溢水杯,对PVC材质上肢远端模型进行体积测量。分别记录两种方法各操作30次的时间,采用累积和分析法(CUSUM)绘制两种操作方法的学习曲线,以曲线顶点为界,划分为学习提高阶段和熟练掌握阶段,记录两种方法达到熟练掌握阶段所需次数以及熟练掌握阶段的操作时间。从复旦大学附属华山医院招募20例健康受试者,由2名康复治疗师(操作者A、操作者B)经过培训后,分别使用手持式3D激光扫描仪测量双侧上肢远端体积,由操作者A使用溢水杯测量双侧上肢远端体积。结果 3D扫描容积法学习曲线的拟合曲线(R2=0.984)在操作8次时到达顶点;排水法学习曲线的拟合曲线(R2=0.494)在操作5次时到达顶点。熟练掌握阶段,3D扫描容积法操作时间较排水法短(P <0.05)。2名操作者使用3D扫描容积法2次测量双上肢的组内相关系数均为0.979 (P <0.001)。3D扫描容积法测得体积与排水...     

Hypnotherapy as a treatment for pain in patients with burns: research and clinical considerations

Hypnotherapy has increasingly been included in the management of burn patients, particularly in the area of acute pain. To better understand such issues as (1) overall efficacy of hypnotherapy to alleviate acute burn pain, (2) instances in which hypnotherapy is contraindicated, (3) interaction of hypnotherapy with medication, (4) standard induction techniques to use with various age groups, (5) role of nursing and other staff in facilitating hypnotic effects, and (6) future methodological directions, we examined the clinical and methodological merits of recent studies of hypnoanalgesia. Through a computer search of the medical literature and cross-referencing recent bibliographies, we were able to find 17 studies in which hypnotherapy was applied to the management of burns. The literature generally supports the efficacy of this approach to reduce burn pain; however, little else can be concluded from these studies. Several recent studies have applied hypnotherapy to aspects of burn care other than pain using excellent experimental designs. It is suggested that future studies of acute pain management follow suit.     

激光扫描三维特征提取的临床应用及主要技术研究

背景:三维测量技术在逆向工程、质量检测、虚拟现实等各种领域的广泛应用,也逐渐进入到医学领域.选择安全、准确、快速、具有较高性价比的测量方法,可获得满足临床需求的测量数据,提供精确的手术模拟效果.目的:综述激光扫描与三维特征提取技术在临床中的应用,并对应用中的主要技术进行分析.方法:由第一作者检索2000/2009中国期刊全文数据库(http://ckrd.cnki.net),万方数据库(http://www.wanfangdata.com.cn)及ScienceDirect数据库(http://www.sciencedirect.com)中已发表的关于利用激光扫描进行三维特征提取以及在临床中应用的文献,中文检索词为"激光扫描,三维重建,临床应用",英文检索词为"laser scanning.three-dimensional reconstruction,clinical application".结果与结论:激光扫描进行三维特征提取完全能够满足临床要求,并已经广泛用于口腔正畸学、额面外科、整形设计、矫形设计、康复研究等领域,并且相比于CT,MRI等传统方法,具有快速、精确,对人体无伤害的优点;通过对利用激光扫描进行特征提取主要技术的研究,发现相关技术可以很好的满足临床要求,但是也存在一些问题,比如进行数据分块需要通过交互方式或迭代方式给出,不能自动分块;重构物体是由许多面片组成,这些面片对于造型处理起来也不直观;发展基于集成的逆向工程技术,包括测量技术、基于特征和集成的模型重建技术、基于网络的协同设计和数字化制造技术以及如何快速准确的提取特征等都是以后研究的主要内容.     

The patient: a novel source of error in clinical temperature measurement using infrared aural thermometry

INTRODUCTION: The vital signs are an important component of patient assessment. With respect to body temperature; there has been a move away from mercury-in-glass thermometers toward the relatively inexpensive, safer to use infrared tympanic, auricular, or ear thermometer. Although already in widespread use, the reliability of these devices has increasingly been called into question. Few studies, however, have considered that the problem might reside outside the device itself. OBJECTIVE: To investigate the correlation between left ear temperature and right ear temperature using an infrared tympanic thermometer (ITT). DESIGN: A prospective, single-blind trail with randomized assignment of the first ear to be assessed. SETTING/LOCATION: Welsh Institute of Chiropractic (WIOC), University of Glamorgan. SUBJECTS: One hundred and thirty two (132) asymptomatic subjects who were opportunistically sampled on entry into the WIOC. None of the subjects had any neurologic deficit, or any known underlying pathologic problems. All were students at the University of Glamorgan (age range, 18-48 years). A smaller sample of the same cohort was used on a separate occasion to compare ITTs from 2 different manufacturers using the same protocol. INTERVENTION: Measurement of ear (ear canal/tympanic) temperature bilaterally using an ITT. OUTCOME MEASURES: Bilateral asymmetry in ear canal temperature. Analysis consisted of nonparametric statistical tests, using Spearman's correlation for comparison and the Wilcoxon matched pairs test for differences. RESULTS: In 132 subjects who completed the main study, although a degree of correlation was found, the relationship did not extrapolate through zero. At temperatures more than 0.4 degrees C above or below 36.7 degrees C, there was a significant difference in temperature in the left compared with the right ear. Additionally, the left ear tended to register a lower temperature than the right ear at temperatures below 36.7 degrees C, whereas the left ear tended to read a higher temperature than the right ear above 36.7 degrees C. CONCLUSIONS: The authors suggest that clinicians consider measuring both ears, and take the greater of the readings to be a more accurate reflection of the patient's core temperature. The difference may perhaps even be related to the person's health. This change in methodology should increase the reliability of the measurement and go some way toward restoring confidence in the use of ITT devices.     

耳颞部高分辨螺旋CT扫描以及听骨链三维成像的临床应用

目的:探讨耳颞部高分辨螺旋CT扫描以及三维重建成像(SSD)的临床应用价值。方法:对49例正常、79例耳部病变患者,采用高分辨螺旋CT扫描。层厚1mm,小视野FOV:5cm,矩阵512×512,放大1.5倍,骨算法FC30重建。床速1mm?s,螺矩1,0.2mm小间隔重建,放大5倍,阈值最小值100～300Hu,最大值4085Hu,近于无穷大。电压120kV,电流50～200mA,窗位-50～300Hu,窗宽大于3000Hu。对15例病变行听骨链重建。结果:HRCT清晰显示了耳部微小病灶,明确了病变范围与周围结构的关系,对听骨链的大部破坏未做3D即明确诊断,而听骨链SSD更具有明显优越性,对锤骨、砧骨及锤砧关节的立体显示是常规CT不能比拟的,为临床制定手术方案提供了影像依据。结论:高分辨螺旋CT扫描有利于耳、颞部病变的诊断,可作为耳颞部更为可靠的影像筛选方法。SSD成像可选择性应用。     

True colour imaging of the fundus using a scanning laser ophthalmoscope

Currently retinal imaging is performed with the fundus camera. This has a number of limitations, in particular the high level of illuminations required for imaging. The scanning laser ophthalmoscope (SLO) has been proposed as an alternative imaging device but to date one of its main limitations has been that it gives only monochromatic images. In this paper we describe an SLO which uses low power red, green and blue lasers to image the human fundus. Using three lasers simultaneously to produce a colour image will increase the fundus exposure by a factor of three. To overcome this problem, a technique has been developed for multiplexing the lasers so that each point on the retina is imaged by the three lasers pulsed rapidly in sequence. The total exposure is thus kept to the same level as for a single laser and total imaging time is not increased. An example is shown of the image from a patient with diabetic retinopathy.     

Precision of distance determination using 3D to 2D projections: the error of migration measurement using X-ray images

The goal of this study has been to objectively and reliably estimate the precision of measuring 2D migration of hip prostheses. This is the distance change over time between the implant and the bone observable in X-ray images. To reach this goal, a generally valid scheme for determining the standard deviation of distance measurements in 3D to 2D projections has been worked out. The scheme was applied to four previously published methods for measuring the migration of the prosthetic cup using standard radiographs. Applying the scheme yields measures for the sensitivity of the migration measurement towards the relevant sources of error. Inserting previously published data for the amounts of the entering errors, the standard deviation of the migration measurement has been calculated numerically resulting in values up to several millimeters.     

Intragastric pH measurement using a novel disposable sensor

An unique disposable pH sensor molded into the end of a nasogastric tube was tested in twelve healthy human volunteers. A Spearman's rank corelation coefficient (r _s) of 0.90 was observed for the sensor and an indwelling miniature glass membrane electrode. The sensor did not correlate as well with aspirated stomach fluid (r _s=0.68). No sensor calibration was necessary and the sensors measured ±0.1 pH in laboratory pH buffers before and after the clinical study. Both bare and shielded disposable sensors closely agreed with a shielded miniature glass electrode.     

Computational opioid prescribing: a novel application of clinical pharmacokinetics

We implemented a pharmacokinetics-based mathematical modeling technique using algebra to assist prescribers with point-of-care opioid dosing. We call this technique computational opioid prescribing (COP). Because population pharmacokinetic parameter values are needed to estimate drug dosing regimen designs for individual patients using COP, and those values are not readily available to prescribers because they exist scattered in the vast pharmacology literature, we estimated the population pharmacokinetic parameter values for 12 commonly prescribed opioids from various sources using the bootstrap resampling technique. Our results show that opioid dosing regimen design, evaluation, and modification is feasible using COP. We conclude that COP is a new technique for the quantitative assessment of opioid dosing regimen design evaluation and adjustment, which may help prescribers to manage acute and chronic pain at the point-of-care. Potential benefits include opioid dose optimization and minimization of adverse opioid drug events, leading to potential improvement in patient treatment outcomes and safety.     

Meeting the clinical challenges of burns management: a review

This article will look at some of the major clinical challenges faced by the clinician when managing the burn wound, identify how the M?lnlycke Health Care range of dressings with Safetac? is designed to meet these needs and provide evidence of the effectiveness of these products in this challenging field of wound care.     

3D imaging of biofilms on implants by detection of scattered light with a scanning laser optical tomograph

Biofilms - communities of microorganisms attached to surfaces - are a constant threat for long-term success in modern implantology. The application of laser scanning microscopy (LSM) has increased the knowledge about microscopic properties of biofilms, whereas a 3D imaging technique for the large scale visualization of bacterial growth and migration on curved and non-transparent surfaces is not realized so far.Towards this goal, we built a scanning laser optical tomography (SLOT) setup detecting scattered laser light to image biofilm on dental implant surfaces. SLOT enables the visualization of living biofilms in 3D by detecting the wavelength-dependent absorption of non-fluorescent stains like e.g. reduced triphenyltetrazolium chloride (TTC) accumulated within metabolically active bacterial cells. Thus, the presented system allows the large scale investigation of vital biofilm structure and in vitro development on cylindrical and non-transparent objects without the need for fluorescent vital staining. We suggest SLOT to be a valuable tool for the structural and volumetric investigation of biofilm formation on implants with sizes up to several millimeters.     

Potential for clinical use of the analytical laser microprobe for element measurement.

Use of the laser microprobe for rapid emission spectroscopic analysis of elements in microscopic samples of biological material is described. The technique depends on vaporization of the microsample with a focused laser beam at a temperature that renders the vapor incandescent for spectrochemical analysis. Spectral line intensities are recorded photographically with densitometry of the negatives or photoelectrically. Current capability permits analysis of about 10(-8) to 10(-10) g of tissue, with detection limits of 10-12 to 10-15 g of element. Groups of elements can be simultaneously analyzed. Minimum sample preparation is required, and the analysis is done on the stage of a light microscope, usually on an air-dried sample on a plastic slide. We exemplify the technique in analysis of gold in cultured fibroblasts treated with gold salts and in human skin after treatment with gold salts for rheumatoid arthritis, in element changes in biopsies of transplanted human hearts, and in unique profiles of groups of elements in human cancer tissue.     

Volume measurement of a pediatric ventricular phantom model using three-dimensional echocardiography

Purpose Volume measurement of the ventricle is necessary to evaluate cardiac function. Accurate volume measurement of the ventricle by three-dimensional (3D) echocardiography will mark a new step in pediatric cardiovascular diagnosis and treatment. We studied volume measurement of a pediatric ventricular model using 3D echocardiography. Methods The ultrasonic diagnostic setup used in this study comprised a Philips Sonos 7500 ultrasound system with an electronic sector probe of a ×4 matrix phased array transducer. The ventricular model was made from a latex surgical glove. The tip of the third finger of the glove was cut off and fixed to a manifold. The ventricular model was gently placed in a reservoir filled with water. Volumes of physiological saline solution ranging from 2 ml to 50 ml in 2-ml increments were injected into the ventricular model and examined. Twenty-five ultrasound images of the ventricular model were obtained using 4D Cardio View RT 1.2 software. Results There was excellent correlation and agreement between the injected volumes and the calculated volumes (Y = −0.539 + 1.005X, r = 0.997, four cut plane; Y = −0.191 + 1.006X, r = 0.997, eight cut plane). Thus, accurate volume measurement of the ventricular model by 3D echocardiography was confirmed. Conclusions Our study demonstrated that 3D echocardiography is highly accurate for volume measurement in a pediatric ventricular model (for volumes of 2 to 50 ml) under static conditions.     

The clinical specialist-staff nurse research team: a model for clinical research

Increasing sophistication in nursing research has created a demand for preliminary work before the completion of a design for a major research project. This report presents a method which meets this need and provides research experience to nurses working on the clinical units. The role of the doctorally prepared clinical nurse specialist (CNS) in promoting collaborative research is presented. For the staff nurse the purpose of this collaboration was to facilitate an introduction of nursing research during the completion of her BSN. A secondary purpose was to provide the doctorally prepared CNS with preliminary data on the effects of nursing care on preterm infants with bronchopulmonary dysplasia. Through collaborative effort, a research protocol was developed and implemented with four preterm infants. The successful completion of this project provided the CNS with preliminary data and the staff nurse with a better understanding of the complexities as well as the rewards of clinical nursing research.     

Maternal confidence in toddlerhood: its measurement for clinical practice and research

There are currently no measures of maternal confidence specifically for the developmental issues that arise in children between 12 months and 36 months of age. Yet, maternal confidence has been correlated with indices of maternal and child competence. The purpose of this study was to assess the reliability and validity of the Toddler Care Questionnaire (TCQ), a measure of maternal confidence in toddlerhood, for use in clinical and research settings. The data provide strong evidence that the TCQ is a reliable instrument and has validity among middle-class mothers of toddlers. The data are discussed in terms of their clinical significance and directions for future research.     

Improved flow measurement using microbubble contrast agents and disruption-replenishment: clinical application to tumour monitoring

Dynamic contrast-enhanced ultrasound (DCE-US) and the method of disruption replenishment has been used for the past 10 years to measure flow noninvasively in the microcirculation. However, the method’s perceived poor reproducibility remains a major impediment to widespread clinical acceptance. Poor reproducibility can be attributed, in part, to the curve fitting model that is used to quantify microbubble enhancement. Flow measurement in tumours is further complicated by the spatial and temporal heterogeneity of tumour blood flow. In this work, we evaluate three models of microbubble disruption and replenishment (mono-exponential, a simplified multivessel model by Krix and the lognormal perfusion model) using clinical data (11 patients, 41 sessions) from an antiangiogenic drug trial for metastatic renal cell carcinoma (RCC) and evaluate their contribution to the measurement’s variability. Compared with the mono-exponential model, the lognormal perfusion model decreased the variability of intra-session velocity and blood volume measurements by 33% and 34%, respectively. Blood volume assessment using the lognormal perfusion model was comparable to Krix’s mutlivessel model. Flow velocity measurement was 18% less variable for the lognormal perfusion model compared with the multivessel model. To further decrease flow measurement variability, we examine a method that exploits microbubble flow dynamics to discard the contribution of flow in large arteries and isolate the portion of the tumour microvasculature that is most sensitive to vessel targeting therapies. The method is validated with an in vitro phantom study prior to its application to the RCC clinical data set. Combined with the lognormal perfusion model, this method decreased the inter-plane variability of clinical measurements of relative tumour blood volume, in some cases by up to 20%.     

3D and 4D ultrasound in fetal cardiac scanning: a new look at the fetal heart.

Over the last decade we have been witness to a burgeoning literature on three-dimensional (3D) and four-dimensional (4D) ultrasound-based studies of the fetal cardiovascular system. Recent advances in the technology of 3D/4D ultrasound systems allow almost real-time 3D/4D fetal heart scans. It appears that 3D/4D ultrasound in fetal echocardiography may make a significant contribution to interdisciplinary management team consultation, health delivery systems, parental counseling, and professional training.Our aim is to review the state of the art in 3D/4D fetal echocardiography through the literature and index cases of normal and anomalous fetal hearts.