不同年龄段儿童与成人肺部CT扫描体型特异性剂量估计

目的 使用常规辐射剂量评估参数与体型特异性剂量估计方法比较不同年龄段儿童和成人肺部CT扫描时所受辐射剂量的差异。方法 回顾性连续抽样华中科技大学同济医学院附属协和医院2017年1月至2018年7月肺部CT扫描患者,共406例,按照年龄分为6组（0~2岁、3~6岁、7~10岁、11~14岁、15~18岁、18岁以上）。基于MATLAB平台开发的dicom数据处理软件,抽取每例患者的容积CT剂量指数（CTDI_vol）值、剂量长度乘积（DLP）值,同时根据美国医学物理师学会（AAPM）220报告提出的体型特异性剂量估计（SSDE）方法,计算每例患者的水当量直径D_w及SSDE值。分析分别使用两种方法时,不同年龄段儿童和成人肺部CT扫描时所受辐射剂量的差异。结果 各年龄组CTDI_vol值均显著低于SSDE值,差异有统计学意义（t=-36.36、-32.83、-30.36、-28.74、-23.89,P<0.05）,不同年龄组SSDE值较CTDI_vol值分别增加137%、94%、79%、57%、42%。成人组的CTDI_vol值同样低于SSDE值,差异有统计学意义（t=-21.92,P<0.05）,SSDE值较CTDI_vol值增加41%。随着年龄的升高,各年龄组儿童患者CTDI_vol值、DLP值、D_w值、SSDE值逐渐升高,并均明显小于成人组,差异有统计学意义（F=63.39、203.28、89.27、103.44,P<0.05）。各年龄组的转换系数f随着年龄的增加显著降低,均明显高于成人组,差异有统计学意义（F=109.83,P<0.05）。结论 在肺部扫描中,相比于成人,CTDI_vol会严重地低估儿童所受的辐射剂量,年龄越小的患者,被低估得越严重,而SSDE方法考虑到受检者体型差异,能够更准确地反映不同患者所受的辐射剂量。     

胆清胶囊联合熊去氧胆酸胶囊治疗胆囊结石的疗效观察

目的探讨胆清胶囊联合熊去氧胆酸胶囊治疗胆囊结石的临床效果。方法选择2016年3月—2017年8月中国医科大学附属盛京医院收治的126例胆囊结石患者,随机分为对照组和治疗组,每组各63例。对照组口服熊去氧胆酸胶囊,250 mg/次,1次/d。治疗组在对照组基础上口服胆清胶囊,3~5粒/次,3次/d。两组均连续治疗2个月。观察两组的临床疗效,比较两组治疗前后中医症状积分、结石直径、VAS评分的变化情况。结果治疗后,对照组和治疗组的总有效率分别为76.19%、93.65%,两组比较差异具有统计学意义(P0.05)。治疗后,两组右上腹疼痛评分、不思饮食评分、恶心呕吐评分、口苦咽干评分、总评分均显著降低,同组治疗前后差异有统计学意义(P0.05);治疗后,治疗组右上腹疼痛评分、不思饮食评分、恶心呕吐评分、口苦咽干评分、总评分均显著低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组结石直径均明显缩小,VAS评分均明显降低,同组治疗前后差异有统计学意义(P0.05);治疗后,治疗组结石直径、VAS评分均显著低于对照组,两组比较差异具有统计学意义(P0.05)。结论胆清胶囊联合熊去氧胆酸胶囊治疗胆囊结石具有较好的临床疗效,可显著降低中医症状积分,缩小胆囊结石体积,缓解腹痛,具有一定的临床推广应用价值。     

Changes in retinal vessels related to varicocele: a pilot investigation

The aim of this study was to investigate whether retinal vasculature changes had occurred (retinal artery diameter, retinal vein diameter and artery/vein ratio) in patients with varicocele. This pilot study included 50 healthy subjects with any eye disease apart from slight refractive errors and 55 patients with varicocele. Retinal arteriolar and venular diameters were measured and summarised as central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE). Retinal microvascular diameters and the arteriolar–to‐venular ratio (AVR) were assessed with a digital retinal camera. All measurements and calculations were performed using a computer‐based program. The mean CRAE value was 151.8 ± 3.6 μm in the study group and 150.4 ± 4.5 μm in the control group. Mean CRVE value was 209.4 ± 5.9 μm in the study group and 200.1 ± 8.7 μm in the control group. AVR was found 0.72 ± 0.02 in the study group and 0.75 ± 0.03 in the control group. There were significant differences between groups in terms of CRVE and AVR. There were no significant differences between groups in terms of CRAE. The results of this study showed that the patients with varicocele showed significant changes on retinal vascular diameter.     

Combining NSAM and CPC concentrations to determine airborne nanoparticle count median diameter: Application to various laboratory and workplace aerosols

Because nanomaterials have been increasingly developed and used in many technology and industry sectors over the last 20 years, an increasing number of workers is likely to be exposed to airborne nanoparticles. In addition, the question of the nanomaterial characteristics that should be assessed in epidemiological studies remains open. Thus, assessing occupational exposure to airborne nanoparticles will not only rely on mass concentration and chemical composition. Rather, key parameters, such as particle size, have to be included in measurement strategies.

We previously proposed a methodology to estimate the Count Median Diameter (CMD) of an aerosol based on the simultaneous size-integrated measurement of two particle concentrations, lung-deposited surface area, and number, thanks to field-portable, commercially available aerosol instruments (Nanoparticle Surface Area Monitor/Condensation Particle Counter combination).

In addition to previous work, this study investigates the case of various polydisperse metal oxides, organic oil, and salt particles with CMDs ranging from 16–410 nm. Once corrected, the CMDs derived from the NSAM/CPC agree within ±20% with regard to the reference electrical mobility equivalent diameter, regardless of aerosol composition, morphology, or geometric standard deviation (GSD).

Furthermore, the field-applicability of the method was tested through 6 sets of experimental data stemming from workplace measurement campaigns where different materials were produced and handled (TiO₂, SiO₂, Ag, Multi-Walled Carbon Nanotubes—MWCNT), covering a range of CMDs between 40 and 190 nm. All situations considered, the approach based on the combination of a NSAM and a CPC leads to a satisfying estimation of particle CMD, within ±20% compared to reference CMD.     

他氟前列素滴眼液联合盐酸卡替洛尔滴眼液治疗开角型青光眼的疗效观察

目的探究他氟前列素滴眼液联合盐酸卡替洛尔滴眼液治疗开角型青光眼的临床疗效。方法选取2016年4月—2017年4月于宝鸡市人民医院治疗的80例(146眼)高眼压型原发性开角型青光眼患者为研究对象,根据数字表法将患者分为对照组(40例72眼)和治疗组(40例74眼)。对照组给予盐酸卡替洛尔滴眼液,1滴/次,2次/d。治疗组在对照组基础上给予他氟前列素滴眼液,1滴/次,1次/d。4周为1个疗程,两组均治疗3个疗程。观察两组患者的临床疗效,比较治疗前后两组患者的视盘参数、杯盘直径比、角膜中央厚度、前房深度和眼压。结果治疗后,对照组和治疗组的改善率分别为80.56%、97.30%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者盘沿面积(RA)、盘沿容积(RV)和视盘容积(DV)指数均显著升高,同组治疗前后比较差异具有统计学意义(P0.05)。治疗后,治疗组的视盘参数显著高于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者水平杯盘直径比(C/D)显著升高,垂直C/D显著降低,同组治疗前后比较差异具有统计学意义(P0.05)。治疗后,治疗组的杯盘直径比改善程度显著优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组角膜中央厚度均显著降低,同组治疗前后比较差异具有统计学意义(P0.05)。治疗后,治疗组的角膜中央厚度显著低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者眼压均显著降低,同组治疗前后比较差异具有统计学意义(P0.05)。治疗后,治疗组眼压显著低于对照组,两组比较差异具有统计学意义(P0.05)。结论他氟前列素滴眼液联合盐酸卡替洛尔滴眼液治疗开角型青光眼患者具有较好的临床疗效,可有效提高患者视力,改善视盘参数和视网膜神经纤维层厚度,具有一定的临床推广应用价值。     

Direct Anterior Approach for Primary Total Hip Arthroplasty Lowers the Risk of Dislocation Compared to the Posterior Approach: A Single Institution Experience

BackgroundOne purported benefit of the direct anterior approach (DAA) for total hip arthroplasty (THA) is a lower rate of postoperative dislocation.MethodsAn institutional database was used to identify 8840 primary THAs performed from 2003 to 2020 including 5065 (57%) performed using the DAA and 3775 (43%) performed via the posterior approach (PA). Direction and mechanism of dislocation were determined from chart review. Outcomes were compared using Kaplan-Meier survivorship with dislocation as the endpoint and a Cox multivariate regression was used to investigate factors associated with dislocation. The mean follow-up was 1.7 ± 2.0 years for the DAA and 3.1 ± 3.3 years for the PA.ResultsThe 0.5% (26/5065) incidence of dislocation among DAA hips was significantly less than the 3.3% (126/3775) among PA cases (P < .001). The majority of dislocations were posterior (DAA 57%, PA 79%) and occurred during activities of daily living (DAA 82%, PA 77%). Five-year survivorship was significantly higher for the DAA group compared to the PA group (99.1% vs 95.4%, P < .001). Dislocation risk was 4.9 times higher for the PA compared to the DAA (hazard ratio = 4.9, 95% confidence interval = 3.2-7.5, P < .001). Increasing head diameter reduced the risk (hazard ratio = 0.70, 95% confidence interval = 0.57-0.86, P < .001). The 0.2% incidence (10/5065) of revision for instability among the DAA group was significantly lower than the 1.1% (43/3775) rate for the PA group (P < .001).ConclusionCompared to primary THAs performed with the PA, DAA cases had a lower risk of dislocation, higher survivorship with dislocation as an endpoint, and a lower risk of revision for instability in this single institution cohort.     

Practical approach for estimation of subcutaneous and visceral adipose tissue

OBJECTIVES: The first objective was to investigate the correlations between anthropometrical measurements and visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) in two cohorts differing in age using magnetic resonance imaging (MRI) as reference. A second objective was to investigate the potential usage of abdominal diameters in practical estimation of adipose tissue compartments using these cohorts. METHODS: Measurements of body mass index, waist circumference, sagittal abdominal diameter (sagittal AD) and transverse abdominal diameter (transverse AD) were obtained from 336 volunteers of age 14-70 years. Manual measurements of VAT and SAT from single slice MRI at the L4-L5 level were used as reference. The abdominal diameters were measured from the MR images. Linear correlations between the anthropometrical measurements and the reference were studied. RESULTS: Sagittal AD showed the strongest correlation to VAT (r >or= 0 x 780, P<0 x 0001) and transverse AD was found to give information about the amount of SAT (r >or= 0 x 866, P<0 x 0001). The ellipse spanned by the sagittal AD and the transverse AD was strongly correlated to the total amount of adipose tissue (r >or= 0 x 962, P<0 x 0001). CONCLUSION: Strong correlations were found between sagittal and transverse abdominal diameters, assessed using MRI, and VAT and SAT, respectively. These results suggest the use of abdominal diameters in practical estimations of VAT and SAT depots.     

郑氏“颈四步”手法治疗神经根型颈椎病疗效研究

目的:探究郑氏“颈四步”手法治疗神经根型颈椎病(CSR)的临床疗效,以及对患者临床症状、颈部生物学相关参数的影响。方法:选取60例CSR患者,按照随机数字表法分为观察组和对照组,每组各30例。观察组予郑氏“颈四步”手法治疗,对照组予一般推拿治疗,比较两组治疗总有效率、疼痛改善情况、颈功能活动度和椎间孔内臂丛神经根内径。结果:观察组治疗总有效率为86.67%,高于对照组的63.33%,差异有统计学意义(P<0.05)。治疗后,两组颈痛量表(NPQ)、视觉模拟评分(VAS)均降低,左旋转、右旋转、左侧屈和右侧屈等颈功能活动度明显改善,C_5～7神经根内径明显减小,且观察组的NPQ、VAS评分低于对照组(均P<0.05),各方向颈功能活动度大于对照组(均P<0.05),C_5～7神经根内径小于对照组(P<0.05)。结论:郑氏“颈四步”手法治疗CSR疗效较好,可有效缓解患者颈肩疼痛,改善颈椎活动度,缓解神经根水肿。