多层螺旋CT冠状面重建图像在临床尘肺诊断中应用研究

目的:分析多层螺旋CT冠状面重建图像在临床尘肺诊断中的应用效果,为临床诊断提供参考。方法选取我院已经确诊为尘肺患者120例为研究对象,患者分别采取高千伏胸片诊断和多层螺旋CT冠状面重建图像诊断,分析二者对尘肺诊断的差异。结果高千伏胸片发现可疑病例30例,MSCT未出现可疑病例,高千伏胸片显示可疑病例比例(25.0%)。MSCT和高千伏胸片对尘肺征象显示能力存在显著差异,P0.05,MSCT对小阴影聚集、胸膜下透光带、肺门及纵膈淋巴结钙化、大阴影内部结构等显示能力显著高于高千伏胸片组,P0.05,两种诊断方法对尘肺阴影密集度1的显示无明显差异,P0.05。MSCT组诊断出并发症比例显著高于高千伏胸片组,P0.05。结论在尘肺诊断中,采用多层螺旋CT冠状面重建图像具有明显优势,比高千伏胸片诊断结果更加可靠。     

多层螺旋CT及后处理功能对早期尘肺诊断的应用价值

目的:探讨多层螺旋CT及各种后处理功能对早期尘肺诊断的应用价值。方法:以72例早期尘肺患者作为研究对象,对其临床资料进行回顾性分析和总结。患者均进行多层螺旋CT扫描和X线胸片检查,观察其诊断结果。结果:72例早期尘肺病例多层螺旋CT发现圆形小阴影71例(98.6%),不规则小阴影69例(95.8%),而X线胸片发现圆形小阴影45例(62.5%)、不规则小阴影31(43.1),两者相比存在显著差异(p0.05)。结论:与X线胸片相比,采用多层螺旋CT诊断及后处理技术在观察病灶形态、分布方面具有较大的优势,可全方位评价病灶的形态以及病灶范围,对早期尘肺的诊断具有重要意义。     

低剂量螺旋CT扫描对尘肺小阴影肺结节的诊断价值分析

目的探讨低剂量螺旋CT扫描对尘肺小阴影肺结节的诊断价值。方法选取2017年10月至2018年10月52例确诊为尘肺的患者作为研究对象,分别对其进行常规剂量和低剂量螺旋CT扫描,观察并比较两种扫描方法的诊断符合率以及对尘肺小阴影肺结节的检出情况。结果 52例患者中经常规剂量和低剂量扫描均未出现漏诊,诊断符合率分别为96. 15%(50/52)和92. 31%(48/52),差异未见统计学意义(P 0. 05)。低剂量扫描与常规剂量扫描对各种尘肺小阴影肺结节的检出情况比较,差异也未见统计学意义(P 0. 05)。结论低剂量螺旋CT扫描对尘肺的诊断价值以及对尘肺小阴影结节的检出率与常规剂量相当。     

探讨多层螺旋CT在石材加工不同工种尘肺诊断中的应用

目的:探讨多层螺旋CT在石材加工不同工种尘肺诊断中的临床应用价值。方法:本研究选取2020年7月至2022年7月我院体检700例可疑尘肺患者为研究对象,根据回顾性研究资料,对患者进行多层螺旋CT(MSCT)检查,同时以临床诊断结果为金标准,对MSCT筛查尘肺检出情况及尘肺分期结果进行诊断效能分析。结果:临床诊断确诊尘肺65例,MSCT诊断尘肺检出率为93.85%(61/65),不同工种检出率为凿岩工(37.70%)、切工(18.03%)、运输工(9.84%)、磨工(16.39%)、其他石材加工(18.03%);MSCT诊断灵敏度(87.69%)、特异度(99.37%)、准确率(87.06%)。同时不同工种尘肺患者病灶显示征象、小阴影密集度等在MSCT影像上的显示更加丰富。结论:多层螺旋CT检查对职业性尘肺检出率及诊断准确性价值更高,有助于对职业性尘肺病进行准确分期,特别是多层螺旋CT在基层医院的普及,更有利于尘肺疾病早期诊断和干预治疗。     

尘肺的CT影像学表现及鉴别诊断

目的探讨CT应用于尘肺病诊断的价值及临床表现。方法选择2013—2015年收治的50例尘肺病患者,Ⅰ期尘肺33例,Ⅱ期尘肺11例,Ⅲ期尘肺6例,均行CT诊断,并将CT诊断结果与X线胸片进行比较。对比两种诊断方法影像检出情况,探讨尘肺与浸润型肺结核、特发性肺纤维化、肺结节、粟粒性肺结核结节、粟粒性肺转移瘤的鉴别诊断。结果 CT阴影检出率98.0%,X线阴影检出率52.0%,组间比较,差异有统计学意义,P0.05。结论 CT诊断有助于提高尘肺病的检出率,对尘肺微细病变的显示敏感度高,直观性强,可减少影像判读的推测性成分,有利于做出较为准确的诊断结果,为尘肺治疗提供了更丰富的影像信息。     

特发性肺含铁血黄素沉着症的X线和CT诊断

目的 探讨特发性肺含铁血黄素沉着症（IPH）的X线和CT诊断。方法 收集2000年1月-2004年12月我院诊治的IPH15例，所有病例均行X线胸片及CT常规检查。其中10例加行HRCT检查。回顾性分析其X线和CT影像表现。结果 X线表现：9例表现为双肺小片状阴影或（和）磨玻璃样改变。8例表现为肺内弥漫性分布的片絮状阴影，6例表现为肺内弥漫分布网格影，4例表现为双肺散在分布的粟粒状、结节状阴影。CT表现：6例表现为双肺广泛结节及小片状阴影，5例表现为双肺不同程度纤维化。结论 IPH的X线和CT表现多样化，不具有特征性，当l艋床具有反复咳嗽咯血、呼吸困难和不明原因缺铁性贫血时，应考虑本病的诊断。     

螺旋CT在矽肺诊断中的价值

目的探讨螺旋CT在矽肺诊断中的价值。方法回顾性对比分析32例已确诊为矽肺病人的X线胸片与螺旋CT的影像表现。结果32例中20例螺旋CT显示有多发且分布密集的小矽结节（直径％10mm）,而X线胸片显示12例,两者比较差异具有显著性（χ^2=4．00,P〈0．05）;直径〉10mm的融合结节和团块CT共检出12例,X线胸片检出9例,两者比较差异具有显著性（χ^=5．27,P〈0．05）。CT检出矽肺并发肺气肿11例,X线胸片检出6例;CT检出矽肺并发肺结核5例,X线胸片检出3例;CT检出矽肺并发纵隔和肺门淋巴结大或钙化21例,X线胸片检出15例。结论螺旋CT在矽肺大小结节的显示及并发症的检出上优于X线平片,对矽肺的正确、综合诊断具有重要价值。     

尘肺小阴影在CT和高分辨率CT上的表现

目的探讨尘肺阴影在CT和高分辨率CT（HRCT）上的表现,为尘肺的早期诊断提供依据。方法选择某钢铁企业73例粉尘作业工人,其中观察对象15例,Ⅰ期36例,Ⅱ期17例,Ⅲ期5例。进行常规CT和HRCT扫描,观察各期尘肺小阴影在CT及HRCT下的形态、分布特点。结果在HRCT上,圆形小阴影更为明确,且相对独立,以小叶中心、支气管血管束及胸膜下较为显著;除圆形小阴影外还有细小分支状影,有较多的支气管血管束呈串珠样改变。不规则小阴影主要表现为双肺线状影、小叶中心气肿及小叶中心分支状影、小叶间隔增厚及网织影、蜂窝影以及肺大泡。大阴影的CT值在95~115HU之间,周围有气肿及大疱,且大阴影的上下层面均有相当数量的q影、r影。结论CT尤其是HRCT在显示小阴影的分布、形态、大小方面有着重要的价值,对大阴影的早期改变以及大阴影的内部病变和外围情况的显示上优于X线平片。因此在尘肺的诊断,尤其是鉴别诊断中,CT有着独特的优势。     

高仟伏X线与高分辨率CT(HRCT)对0+矽肺小阴影影像学的比较研究

目的本研究通过对30例0 矽肺患者分别拍摄高仟伏X线胸片与高分辨率CT(HRCT),对比研究高仟伏X线胸片与HRCT在矽肺小阴影影像学中差异。方法选取30例0 矽肺患者,分别拍摄高仟伏X线胸片与HRCT。按GBZ70-2002尘肺诊断标准及尘肺诊断标准片阅片,对比观察高仟伏X线胸片与HRCT在矽肺小阴影影像上的差异。结果在摄高仟伏X线胸片诊断为0 的30例矽肺患者中,HRCT发现其中5例影像学改变符合I矽肺诊断标准。结论在中上肺区小阴影的显示上,HRCT明显高于高仟伏X线胸片。     

X线胸片及胸部CT平扫在肺栓塞初筛中的应用32例分析

目的分析肺栓塞的X线胸片及胸部CT平扫表现,探讨胸片及胸部CT平扫的间接征象对肺栓塞在初筛中的应用。方法对32例经16排螺旋CT增强扫描确诊的肺栓塞进行回顾性分析。结果影像表现异常者22例,无异常者10例。结论 X线胸片及胸部CT平扫对肺栓塞的初筛有一定的参考价值。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

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.