Plasma D-dimer safely reduces unnecessary CT scans obtained in the evaluation of pediatric head trauma

Purpose

Serum D-dimer has been proposed as a biomarker to aid in the diagnosis of pediatric traumatic brain injury (TBI). We investigated the accuracy of D-dimer in predicting the absence of TBI and evaluated the degree by which D-dimer could limit unnecessary computed tomography scans of the head (CTH).

Time to appendectomy for acute appendicitis: A systematic review

Objective

The goal of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee was to develop recommendations regarding time to appendectomy for acute appendicitis in children within the context of preventing adverse events, reducing cost, and optimizing patient/parent satisfaction.

藏西医结合治疗类风湿性关节炎72例

<正> 类风湿性关节炎(RA)是一种以关节周围组织的感染炎症为主的全身慢性疾病。与自身免疫反应、遗传因素、感染因素、内分泌因素等有关。属祖国医学"痹证"之范畴。我院应用藏西医结合方法治疗RA72例,取得良好效果。     

冠状动脉分叉病变斑块分布的CT研究

目的:应用多层螺旋CT(MDCT)分析冠状动脉分叉病变的斑块分布特点。方法:利用MDCT对冠状动脉分叉病变分叉远端(分叉嵴平面)和分叉近端(分支入口平面)定性定量分析,比较不同位点的斑块分布厚度,研究MDCT下分叉病变的斑块分布特点,确定影响斑块分布位置的因素。结果:MDCT和冠状动脉造影(CAG)对主支血管定量分析无明显区别,二者测量分支血管最小管腔面积(5.22±2.85mm2vs 3.65±2.94mm2,P=0.027)、外弹力膜面积(7.69±1.69mm2vs 6.61±2.58mm2,P=0.041)、血管直径(2.98±0.50mm vs 2.72±0.41mm,P=0.023)有明显区别,CAG测量分支血管面积狭窄率高于MDCT(0.44±0.31 vs 0.20±0.14,P=0.041)。分叉近端斑块厚度在PT0,°PT90°,PT180°,PT270°四个位点无明显差别(0.95±0.65mm vs 1.00±0.61mm vs 0.99±0.62mm vs 0.96±0.65mm,P0.05)。分叉远端斑块厚度PT180°(1.24±0.49mm)明显大于PT90°和PT270°,PT90°和PT270°斑块厚度明显大于PT0°(0.08±0.12mm)。分叉远端斑块最厚点与分支的角度和分叉角度正相关(r=0.93,r2=0.864)。结论:MDCT在大血管(3.0mm)的定量分析上与CAG有很好的一致性,对小血管(3.0mm)的定量分析结果与CAG有差别,且不能识别CAG显示的轻度病变;MDCT下分叉近端斑块呈360°向心性环周分布;分叉远端斑块呈偏心性分布,多占1/2～2/3管周,斑块主要分布在分叉嵴的对侧;MDCT下分叉远端斑块距离分支开口的位置与分叉角度相关,分叉角度接近直角时,斑块分布在分支开口的对侧壁(180°±),分叉角度为锐角时,斑块分布在分支开口的旁侧壁(90°或270°±)。     

Reliability of PET activation across statistical methods,subject groups,and sample sizes

Four pixel-based methods for estimating regional activation in positron emission tomography (PET) images were implemented so as to allow the comparison of their performances in the same dataset. Change distribution analysis, Worsley's method, a pixelwise general linear model, a nonparametric method, and several methods derived from them were investigated. Important technical factors, including the degree of smoothing, stereotactic transform, coregistration algorithm, search volume, and the volumetric alpha level, were held constant. The dataset, which was obtained with a verb generation paradigm, was large enough to permit assessment of concordance between independent samples of conventional size, as well assessment of within-cohort replicability. (Eighteen normal subjects performed four GENERATE-READ pairs each.) Same-task (noise) images were also analyzed. In noise datasets, type I errors (false positives) occurred at the nominal rate (in 5% of datasets). Detected regions of activation were highly likely to be internally replicated (93%). The detected activations were a superset of activations previously reported using the same paradigm. The methods were chiefly distinguished by type II error rates and by the stability of the location of activation clusters. Those methods dependent on local variance estimates were less powerful with small sample sizes and less stable with respect to the attributed location of task-induced changes. The use of pooled variance (Worsley's method) reduced these problems, but variance was not stationary. Overall, the power of all analyses was modest with samples of conventional size (nine subjects × one or two task-pairs). Modeling of the sources of variance, particularly improvement of anatomical standardization, is likely to improve the power of pixel-based analyses. © 1996 Wiley-Liss, Inc.     

Elevated nitric oxide production in rheumatoid arthritis: Detection using the fasting urinary nitrate:creatinine ratio

Objective. To develop a simple method for assessing endogenous nitric oxide (NO) production applicable to routine clinical practice in rheumatology. Methods. NO production was assessed in patients with rheumatoid arthritis (RA) as serum nitrate levels and as the urinary nitrate:creatinine ratio in morning samples of urine following an overnight fast. The influence of dietary intake of nitrate on these measurements was investigated in healthy volunteers. The clinical value of the urinary nitrate:creatinine ratio was validated in patients with infectious gastroenteritis, in whom its production is known to be increased. Results. Urinary nitrate:creatinine ratios were significantly elevated in patients with RA (average 3-fold elevation over controls; P < 0.005) or infectious gastroenteritis (average 10-fold elevation, P < 0.001). Serum nitrate was significantly elevated only in patients with infectious gastroenteritis (P < 0.001). Dietary intake of nitrate had no significant influence on the fasting morning urinary nitrate:creatinine ratio in the healthy volunteers, showing that this parameter is a useful indicator of endogenous NO production. Conclusion. We have developed a simple procedure for evaluating endogenous NO production that is readily applicable to routine clinical practice. Assessment of NO production will help in our understanding of its role in inflammatory conditions such as RA.     

A gigant cystic lymphangioma of the neck

The cystic lymphangiomas are congenital pathology of lymphatic system which concern 90% of children population, adults suffer very seldom. The authors present the case of giant cystic lymphangioma of the neck in the 37-year-old man with symptoms of tumor of the neck. The USG, CT and MRI confirm the presence of polycystic tumour with feature of bleeding into one of the cavities. Surgical treatment was performed. The patient is controlled without any relaps. The authors remind this rare pathology that should be considered in case of neck tumours.     

抑郁症与焦虑症脑血流灌注SPECT显像对照研究

目的：探讨抑郁症、焦虑症患者局部脑血流量（rCBF）的特点及脑单光子计算机断层扫描（SPECT）对抑郁症的诊断价值。方法：对21例抑郁症患者、17例焦虑症患者和20例正常对照者进行脑SPECT显像,并比较检查结果。结果：抑郁症组与正常对照组比较,双侧前额叶、颞叶前部、双侧扣带回前部、双侧顶叶、枕叶以及尾状核rCBF明显低于正常对照组（P＜0.05或0.01）。焦虑症组与正常对照组比较,额叶、部分颞叶和丘脑的rCBF明显低于正常对照组（P＜0.05或0.01）。抑郁症组与焦虑症组相比较,抑郁症组在双侧扣带回前部、右顶叶及尾状核的rCBF明显低于焦虑症组（P＜0.05或0.01）。结论：抑郁症和焦虑症对脑血流灌注均有重要影响,抑郁症患者在双侧扣带回前部、右顶叶及尾状核的脑血流灌注明显低于焦虑症组。SPECT脑灌注显像在抑郁症和焦虑症的诊断与鉴别诊断中具有重要价值。