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991.
Summary. In a retrospective study a close relationship was found between the rate constant for renal clearance of the radioactive indicator (λpk) and the glomerular filtration rate (GFR) measured by 51Cr-EDTA plasma clearance. The material comprised eighteen adult subjects submitted to 123I-hippuran gamma camera renography (IHGR) and twenty-two adult subjects to 99mTc-DTPA gamma camera renography (TDGR). The rate constant was calculated from a bi-exponential decomposition of the activity-time curve recorded within a small region of interest over the left ventricle. The total cleared renal fraction (TCRF) of the cardiac output with respect to the radioactive indicator has previously been shown to be closely related to GFR. A pooled estimate of GFR (GFRp) was calculated from the stochastically independent estimates of GFR based on λpk and TCRF. The comparison of GFRp with measured GFR was satisfactory and yielded substantially smaller standard deviations (SD) of GFRp than estimates based on λpk and TCRF separately. The standard deviations of GFRp were about 7 and 12 ml/min/1·73 m2 in IHGR for GFR equal to 50 and 100 ml/min/1·73 m2, respectively. The corresponding SD in TDGR were about 7 and 11 ml/min/1·73 m2. These standard deviations are sufficiently small for many clinical purposes and the method requires no blood samples or urine collections. 相似文献
992.
993.
Functional imaging of intratumoral hypoxia. 总被引:4,自引:0,他引:4
994.
995.
Chester J. Donnally Deborah J. Li James A. Maguire Eric S. Roth Grant P. Barker Johnathon R. McCormick Augustus J. Rush Nathan H. Lebwohl 《The spine journal》2018,18(11):2081-2090
Background Context
The future of health care is consumer driven with a focus on outcome metrics and patient feedback. Physician review websites have grown in popularity and are guiding patients to certain health-care providers, for better or worse. No prior study has specifically evaluated Internet reviews of spine surgeons, determined if social media (SM) correlates with patient reviews, or evaluated Google as a physician review website.Purpose
This study aimed to evaluate patient satisfaction scores for spine surgeons in Florida using leading physician ratings websites.Study Design
A retrospective study was carried out.Sample Population
The sample comprised spine surgeons with a review on Healthgrades.com (HG), Vitals.com (V), or Google.com (G) online rating websites as of August 17, 2017.Outcome Measures
Number of ratings, number of comments, overall rating, patient-reported wait times, physician website presence, and physician SM presence were the outcome measures.Methods
Using the directory of registered North American Spine Society physicians, we identified all spine surgeons practicing in Florida (137 orthopedic trained; 78 neurosurgery trained). Surgeon demographics and ratings data were collected from three physician rating websites (HG, V, G) from July 19, 2017 to August 17, 2017. Using only the first 10 search results from Google.com we then identified if the surgeon had accounts on Facebook (FB), Twitter (TW), or Instagram (IG).Results
Nearly every surgeon in this cohort had either an institutional or personal website (98.1%), and 38.6% had at least one SM outlet of our three reviewed. Both personal and institutional website presence significantly correlated with higher G scores. Spine surgeons with a searchable account on FB, TW, or IG made up 35.4%, 10.2%, and 0.5% of the cohort, respectively. Surgeons with an SM presence had a significantly higher number of ratings and comments on HG, V, and G, but not overall scores. In multivariable analysis, only V showed a significant inverse correlation between overall score and age, private institution, and orthopedic surgery training. Wait times >30 minutes were significantly associated with worse overall scores across all three review sites. Overall ratings between HG, V, and G all had significantly positive correlations on Pearson correlation analysis.Conclusion
Social media presence correlates with patient communication in the form of number of ratings and comments, yet does not impact overall scores, suggesting social media may influence patient feedback. Longer wait times are indicative of lower scores across all three platforms. Overall ratings from all three websites correlate significantly with each other, indicating agreement between physician ratings across different platforms. Understanding the factors that optimize a patient's overall experience with a physician is an important and emerging outcome measure for the future of patient-centered health care. 相似文献996.
OBJECTIVE: C-reactive protein (CRP) independently predicts cardiovascular disease (CVD); whether it can stratify risk in those with metabolic syndrome and diabetes is not well documented. We evaluated whether elevated CRP levels modify the relationship of metabolic syndrome and diabetes with CVD in U.S. adults. RESEARCH DESIGN AND METHODS: In a cross-sectional study of 3,873 subjects (weighted to 156 million) aged >/=18 years participating in the National Health and Nutrition Examination Survey 1999-2000, subjects were classified as having diabetes, metabolic syndrome according to modified National Cholesterol Education Program criteria, or neither condition by low (<1 mg/l), intermediate (1-3 mg/l), or high (>3 mg/l) CRP levels. Logistic regression examined the odds of CVD by disease condition and CRP group. RESULTS: After adjusting for age, sex, smoking, and total cholesterol, compared with those with neither metabolic syndrome nor diabetes and low CRP levels, the odds of CVD were 1.99 (95% CI 1.10-3.59) for those with no disease and high CRP levels and 2.67 (1.30-5.48) for those with metabolic syndrome and intermediate CRP. Persons with metabolic syndrome but high CRP had an odds ratio (OR) of 3.33 (1.80-6.16), similar to those with diabetes and low CRP (3.21 [1.27-8.09]). The likelihood of CVD was highest in those with diabetes who had intermediate CRP levels (6.01 [2.54-14.20]) and in those with diabetes and high CRP (7.73 [3.99-14.95]). CONCLUSIONS: In this cross-sectional analysis, CVD is more common in those with metabolic syndrome or diabetes who have elevated CRP. Stratification by CRP may add prognostic information in patients with metabolic syndrome or diabetes. 相似文献
997.
Background
Lumbar spine magnetic resonance imaging is frequently said to be “overused” in the evaluation of low back pain, yet data concerning the extent of overuse and the potential harmful effects are lacking.Purpose
The objective of this study was to determine the proportion of examinations with a detectable impact on patient care (actionable outcomes).Study Design
This is a retrospective cohort study.Patient Sample
A total of 5,365 outpatient lumbar spine magnetic resonance (MR) examinations were conducted.Outcome Measures
Actionable outcomes included (1) findings leading to an intervention making use of anatomical information such as surgery; (2) new diagnoses of cancer, infection, or fracture; or (3) following known lumbar spine pathology. Potential harm was assessed by identifying examinations where suspicion of cancer or infection was raised but no positive diagnosis made.Methods
A medical record aggregation/search system was used to identify lumbar spine MR examinations with positive outcome measures. Patient notes were examined to verify outcomes. A random sample was manually inspected to identify missed positive outcomes.Results
The proportion of actionable lumbar spine magnetic resonance imaging was 13%, although 93% were appropriate according to the American College of Radiology guidelines. Of 36 suspected cases of cancer or infection, 81% were false positives. Further investigations were ordered on 59% of suspicious examinations, 86% of which were false positives.Conclusions
The proportion of lumbar spine MR examinations that inform management is small. The false-positive rate and the proportion of false positives involving further investigation are high. Further study to improve the efficiency of imaging is warranted. 相似文献998.
999.
1000.
Arno Hnninen Nathan R. Martinez Gayle M. Davey William R. Heath Leonard C. Harrison 《The Journal of clinical investigation》2002,109(2):261-267
Antigen administration via oral and other mucosal routes can suppress systemic immunity to the antigen and has been used to prevent experimental autoimmune disease. This approach may prove ineffective or even harmful if it leads to a concomitant induction of cytotoxic T lymphocytes (CTLs), and indeed, mucosal administration of the model antigen ovalbumin (OVA) has been shown to elicit CTL activation while simultaneously inducing oral tolerance. Here we show that induction by oral OVA of CTLs in wild-type mice, and of diabetes in mice expressing OVA transgenically in pancreatic beta cells, can be prevented by transiently blocking the CD40 ligand (CD40L). However, CD40L blockade did not diminish oral tolerance, as measured by suppression of systemic OVA-primed T cell proliferation, IFN-gamma secretion, and Ab production. Consistent with these findings, mice lacking CD40 expression could be orally tolerized to OVA. Transient CD40L blockade therefore dissociates pathogenic from protective immunity and should enhance the efficacy and safety of oral tolerance for preventing autoimmune disease. 相似文献