What is the prognostic value of myocardial perfusion imaging using rubidium-82 positron emission tomography?

OBJECTIVES: The objective was to determine the prognostic value of rubidium-82 (82Rb) positron emission tomography (PET) myocardial perfusion imaging (MPI). BACKGROUND: 82Rb PET MPI accurately diagnoses coronary artery disease (CAD). However, there are limited data evaluating its prognostic value. METHODS: Follow-up (3.1 +/- 0.9 years) was obtained in 367 patients who underwent dipyridamole 82Rb PET MPI. Patients were divided into groups based on their summed stress score (SSS): group I, normal (<4); group II, mild (4 to 7); and group III, moderate (8 to 11) to severe (> or =12). RESULTS: There were significant differences among patients in the 3 SSS groups for hard events (cardiac death and myocardial infarction [MI]) (p < 0.001) and total cardiac events (hard events, revascularization and hospitalization) (p < 0.001). The annual hard events rates were 0.4%, 2.3%, and 7.0% in the normal, mild, and moderate-severe groups, respectively. In adjusted survival models, 82Rb PET SSS was the strongest predictor of total cardiac events and a significant predictor of hard events. Among patients referred for PET after 99mTc single-photon emission computed tomography, the annual total event rate was higher with abnormal versus normal SSS on PET (15.2% vs. 1.3%, p < 0.001). In patients with obesity, the annual total event rate was 11.1% with an abnormal scan and 1.5% with a normal scan (p < 0.001). CONCLUSIONS: This study shows that 82Rb PET MPI has significant prognostic value for predicting cardiac events, including death and MI. It also seems to have prognostic value in patients whose diagnosis remains uncertain after single-photon emission computed tomography MPI and in obese patients. The prognostic value of PET MPI may improve the management of cardiac patients.     

对哲学基本问题第二层含义的思考

哲学基本问题之所以有第二层含义，一是科学和哲学发展的必然结果；二是马克思主义哲学严密性和科学性的内在要求；三是只有科学回答和解决第二层含义问题，才能确立正确的人与世界的关系。     

听觉诱发电位在无痛人流手术麻醉中的应用研究

目的 观察异丙酚复合氯胺酮在无痛人流术中对听觉诱发电位指数（auditory evoked potentials index．AAI）的影响。方法 选择门诊无痛人流患者56例，随机分成异丙酚（Ⅰ组，n=28）和异丙酚复合氯胺酮（Ⅱ组，n=28）。记录给药前、后，整个手术过程度术毕苏醒过程中各时点的AAI值、OAA／S评分、平均动脉压．（MAP）、心率（HR）及血氧饱和度（SpO2）以度异丙酚用量、苏醒时间度质量。结果 两组AAI值和OAA／S评分在给药后及整个手术期间均明显降低，与自身给药前相比，有非常显著差异（P〈0．01）；Ⅱ组AAI下降的时间度恢复时间滞后于Ⅰ组，AAI值与OAA／S评分有良好的相关性。两组在给药后MAP均有下降，与给药前相比，有显著性差异（P〈0．05）；而HR和SpO2无明显变化。Ⅱ组与Ⅰ组相比，Ⅱ组异丙酚用量明显少于Ⅰ组。苏醒时间长于Ⅰ组；苏醒质量无显著性差异。结论 AAI能较好的反映异丙酚的镇静水平。同时也可反映异丙酚复合氯胺酮后的总体镇静程度。但反映速度滞后，需结合临床进行整体判断。氯胺酮对AAI的影响不大。氯胺酮不干扰异丙酚引起的AAI值的变化。     

Congenital toxoplasmosis—prenatal aspects of Toxoplasma gondii infection

Toxoplasma gondii (T. gondii) is the cause of toxoplasmosis. Primary infection in an immunocompetent person is usually asymptomatic. Serological surveys demonstrate that world-wide exposure to T. gondii is high (30% in US and 50–80% in Europe). Vertical transmission from a recently infected pregnant woman to her fetus may lead to congenital toxoplasmosis. The risk of such transmission increases as primary maternal infection occurs later in pregnancy. However, consequences for the fetus are more severe with transmission closer to conception. The timing of maternal primary infection is, therefore, critically linked to the clinical manifestations of the infection. Fetal infection may result in natural abortion. Often, no apparent symptoms are observed at birth and complications develop only later in life. The laboratory methods of assessing fetal risk of T. gondii infection are serology and direct tests.Screening programs for women at childbearing age or of the newborn, as well as education of the public regarding infection prevention, proved to be cost-effective and reduce the rate of infection.The impact of antiparasytic therapy on vertical transmission from mother to fetus is still controversial. However, specific therapy is recommended to be initiated as soon as infection is diagnosed.     

病区护理人员履行告知义务的注意事项

随着社会主义市场经济体制的逐步建立和完善,卫生保障制度的改革及《医疗事故处理条例》和“举证责任倒置”的司法解释公布后,病人的自我保护意识增强,各种维权迅速增长,病人有权了解自己所患疾病的信息,有权根据自己的条件选择医务人员和治疗护理方案。为了维护护患双方的合法权益,护理人员如何在护理活动中为病人正确履行告知义务,就显得尤为重要。1对护理人员的基本要求1.1学习法律法规知识,明确告知意义为了增加护理人员的法律意识,使每位护理人员均能够重视,我院护理部组织护理人员学习了《医疗事故处理条例》及护理人员相关法律法规,…     

第一极体不能精确定位人卵母细胞纺锤体

目的 观测人卵母细胞纺锤体的确切位置，从而指导今后的生殖医学临床工作。方法 应用纺锤体成像系统观测体外成熟及体内成熟组人卵母细胞纺锤体，测量卵子中心、纺锤体与第一极体之间形成的角度。比较两组结果的差异。结果 体外成熟组纺锤体与第一极体形成角度和体内成熟组存在显著差异(P=0．006)。结论 人卵母细胞的位置并不能准确定位卵母细胞纺锤体的位置。体外成熟组纺锤体与第一极体形成的角度要明显小于体内成熟组。应用纺锤体成像系统可以安全、有效地观察人卵母细胞纺锤体。     

眶骨的改变在眶部疾病HR-MRI诊断中的作用

目的:探讨眶骨的影像学所见及其在眶部疾病诊断中的作用。方法:回顾性分析诊断明确的眶部疾病80例的HR-MRI影像表现。80例中良性囊肿18例，外伤6例，炎性疾病6例，蝶骨嵴脑膜瘤9例，其他肿瘤41例。磁共振扫描采用1．5T GE Signa及Siemens Magnetom Sp63磁共振扫描机，用眶部表面线圈，SE系列常规轴位、冠状位及矢状位扫描，部分病例行脂肪抑制及增强扫描。结果：正常眶骨的HR-MRI表现为结构完整，边缘光整，皮质骨在T1WI及。T2WI上均为无信号区。15例眶骨受压迫性改变全见于良性囊肿的病例，骨质增生改变主要见于蝶骨脑膜瘤，2例骨折见于外伤病例，21例骨质破坏大多见于不同的恶性肿瘤病变中。结论：不同的眶部病变对眶骨的影响有差异，良性囊肿主要表现为眶骨受压迫性改变，蝶骨脑膜瘤多表现为骨质增生，外伤病例伴有眶骨骨折，恶性肿瘤病例常伴有眶骨的破坏。眶骨的改变对眶部疾病HR-MRI的诊断和鉴别诊断有重要作用。     

Dynamic evaluation of 18F-FDG uptake by microPET and whole-body autoradiography in a fibrosarcoma-bearing mouse model.

BACKGROUND AND PURPOSE: Fluorine-18-2-deoxy-D-glucose (18F-FDG) has been used in the clinic as a diagnostic radiotracer for monitoring many kinds of tumors, but its value for monitoring fibrosarcoma is not well established. METHODS: In this study, the uptake of 18F-FDG in a fibrosarcoma-bearing mouse model was evaluated using the high resolution positron emission tomography (PET) system microPET. Tumor cells were implanted in 3 FVB/N mice, and static microPET scanning was performed on day 1, 7, 12 and 15 after implantation. A dynamic microPET image was scanned on day 12 to determine the 18F-FDG uptake in 3 other tumor-bearing mice. Time-activity curves were plotted by drawing regions of interest in the tumor, liver, kidneys and muscles. The mice were sacrificed after dynamic microPET imaging and whole-body autoradiography (WBAR) was performed. For biodistribution study, 9 tumor-bearing mice, 3 per experimental group, were studied at 3 time points and the results were compared with the static microPET images. RESULTS: MicroPET images suggested that 18F-FDG could be used to monitor the growth of tumors 7 days after implantation. Dynamic scans of 18F-FDG uptake reached a plateau in the tumor after 20 minutes on day 12 after implantation. Both microPET and WBAR revealed evidence of tumor necrosis. The results of biodistribution and WBAR agreed with those from microPET images. CONCLUSION: MicroPET was useful for monitoring the growth of fibrosarcoma and determination of the maximal uptake time point of 18F-FDG in tumors in this tumor-bearing mouse model.     

144例脑血管意外患者死亡时间节律分析

目的　揭示脑血管意外死亡的年节律、月相节律以及昼夜节律 ,为临床及时防治提供时间依据。方法　采用流行病学调查方法收集资料 ,用 χ2 检验及圆形分布法来分析资料。结果　①脑出血死亡时间存在向上半夜集中的昼夜节律 ;②脑梗死死亡时间存在向冬季和下半夜集中的年节律和昼夜节律。结论　脑出血死亡存在昼夜节律 ,脑梗死死亡存在年节律和昼夜节律。