三期螺旋CT扫描、经动脉门静脉造影CT扫描及经肝动脉造影CT扫描对经动脉化学栓塞治疗肝细胞肝癌计划及其实施情况的影响

目的 探讨在制定不可切除的肝细胞肝癌患者的化学栓塞计划及其实施情况方面,采用CTAP联合CTHA检查是否较常规的THCT联合肝动脉DSA检查更有利、更有价值.材料和方法采用前瞻性研究方式,连续有49名患有不可切除的肝细胞肝癌患者进入本项研究.该49名患者的平均年龄为64.9岁.全部患者在施行TACE前的1个月内均接受了...     

High-resolution optical coherence tomography correlates in ischemic radiation retinopathy

Purpose: To find the abnormalities in various retinal layers caused by radiation retinopathy using spectral domain optical coherence tomography (SD-OCT).

Methods: We report a case of radiation retinopathy that was imaged using SD-OCT Copernicus (Optopol, Zawiercie, Poland). Analysis and synthesis of the OCT image were done using information both at the fovea and 2.5?mm temporal to the fovea.

Results: The layers that were reduced in thickness included the inner plexiform layer (47?μm vs. 74?μm), the inner nuclear layer (17?μm vs. 48?μm), and the outer plexiform layer (25?μm vs. 45?μm), whereas the layers with comparable thickness included the nerve fiber layer (24?μm vs. 25?μm), the outer nuclear layer (42?μm vs. 43?μm), the outer segment–inner segment junction (52?μm vs. 54?μm), and the retinal pigment epithelium (RPE) choriocapillaris layer (30?μm vs. 28?μm).

Conclusion: This report suggests that the radiation-induced damage was confined to the inner layers of the retina. However, secondary outer retinal layer changes may also occur, as suggested by functional derangements.     

A young people's perspective on computer game addiction

In this article, I examine computer game addiction as a social phenomenon, analyzing the consequences of using the term in order to express a concern about high frequency consumption or even a problematic usage of computer games. I argue that while it is obviously very important to take seriously these concerns about young people “at risk,” there is a gap between the phenomenon as a suggested psychiatric diagnosis and young people's reflections on the matter. Following the work of Goffman and Becker, computer game addiction is not necessarily something negative in the eyes of the player and other young people. It is shown that the classification can be a positive element in young people's identity work. On the other hand, a high consumption of computer games is also considered as “culturally unacceptable.” From this perspective, computer game addiction becomes a question of how to construct the boundaries between normality and deviance and how prejudices are governing and controlling young people's lives. All this suggests more caution in classifying frequent and problematic computer game play as a disorder in itself. We need a more complex understanding of computer game addiction than research so far has offered us.     

Radiological anatomy assessment of the fissura pterygomaxillaris for a surgical approach to ganglion pterygopalatinum

The ganglion pterygopalatinum has become a therapeutic target to treat various pain syndromes in recent years. It is located in the fossa pterygopalatina, and the fissura pterygomaxillaris is the main access to surgically approach this structure. Recently, the neuromodulation of the ganglion pterygopalatinum by microstimulator implantation has become the first therapeutic line in refractory cluster headache treatment. This invasive technique is performed transorally through the fissura pterygomaxillaris, and is limited by the size of the implantation device, which requires an opening of at least 2 mm. Therefore, extensive knowledge about the anatomy of the fissura pterygomaxillaris prior to surgery is necessary to predict the success of both the approach and intervention. Likewise, establishing a morphological typology of the different fissura pterygomaxillaris variations would be a valuable predictive tool in the clinical practice. In this work, an anatomical analysis was performed of the morphological characteristics of the 242 fissurae pterygomaxillares, which corresponded to 121 adult patients, 58 males and 63 females, aged between 18 and 87 years. For each subject, right and left fissures were studied with radiological computed tomography images. Aperture fissura pterygomaxillaris measurements were taken in an upper (Measure A), middle (Measure B) and lower craneo‐caudal third (Measure C). Intra‐subject differences were studied between the measurements taken of each patient's right and left fissures, and the inter‐subject measures in which fissures were compared according to patients’ age and gender. The obtained results showed no significant differences between each patient's right and left fissures in any three measurements taken. Intra‐subject differences were not significant for gender or age. No statistically significant differences were found for the inter‐subject measures between the measures of fissures according to patients’ age. However, our data revealed that males’ fissurae pterygomaxillares were significantly larger than those of females in all three measures. Having analysed fissures, a typological classification was made according to the morphological patterns found. A 2‐mm limiting measure was considered, and Measures A, B and C of each fissure were classified depending on whether they had a value above or equal to 2 mm, or below 2 mm. With this classification criterion, four fissurae pterygomaxillares types were obtained. Type I and II fissure values (with a higher prevalence) were equal to or were greater than 2 mm in all three measures, or in two measures. Type III fissure values were only greater than or equal to 2 mm in Measure A, whereas all the Type IV fissure values were below 2 mm. Future studies are necessary to correlate the fissure types successfully proposed in the surgical ganglion pterygopalatinum approach.     

A multidisciplinary approach to designing and evaluating Electronic Medical Record portal messages that support patient self-care

We describe a project intended to improve the use of Electronic Medical Record (EMR) patient portal information by older adults with diverse numeracy and literacy abilities, so that portals can better support patient-centered care. Patient portals are intended to bridge patients and providers by ensuring patients have continuous access to their health information and services. However, they are underutilized, especially by older adults with low health literacy, because they often function more as information repositories than as tools to engage patients. We outline an interdisciplinary approach to designing and evaluating portal-based messages that convey clinical test results so as to support patient-centered care. We first describe a theory-based framework for designing effective messages for patients. This involves analyzing shortcomings of the standard portal message format (presenting numerical test results with little context to guide comprehension) and developing verbally, graphically, video- and computer agent-based formats that enhance context. The framework encompasses theories from cognitive and behavioral science (health literacy, fuzzy trace memory, behavior change) as well as computational/engineering approaches (e.g., image and speech processing models). We then describe an approach to evaluating whether the formats improve comprehension of and responses to the messages about test results, focusing on our methods. The approach combines quantitative (e.g., response accuracy, Likert scale responses) and qualitative (interview) measures, as well as experimental and individual difference methods in order to investigate which formats are more effective, and whether some formats benefit some types of patients more than others. We also report the results of two pilot studies conducted as part of developing the message formats.     

多层螺旋CT在儿童完全性肺静脉异位引流诊断中的研究

目的:探讨多层螺旋CT在完全性肺静脉异位引流中的诊断价值。方法:回顾性分析2005年5月～2010年4月经心脏外科手术证实的30例完全性肺静脉异位引流患儿的MSCT图像特点,探讨MSCT在完全性肺静脉异位引流及并发畸形诊断中的价值,为术前诊断、手术方式选择及术后随访提供信息。结果:30例中心上型15例,心内型12例,心下型2例,混合型1例;术前经MSCT诊断为完全型28例(心上型15例,心内型10例,心下型2例,混合型1例),漏诊2例,诊断符合率为93.3%;TTE诊断心上型11例,心内型9例,心下型1例,漏诊9例,诊断符合率为70.0%。结论:多层螺旋CT是完全性肺静脉异位引流准确、重要的检查方法。     

Clinical usefulness of F-18 FDG PET in lymphoepithelioma-like gastric carcinoma

PurposeLymphoepithelioma-like carcinoma (LELC) is a rare type of gastric cancer. We evaluated the clinical usefulness of F-18 FDG positron emission tomography/computed tomography (PET/CT) in LELC of stomach.Materials and methodsA total of 28 patients (mean age = 59 years) who underwent preoperative F-18 FDG PET/CT were enrolled retrospectively. Nine patients underwent follow-up F-18 FDG PET/CT. Pathologic information was obtained through gastrectomy and the association with Epstein-Barr virus (EBV) was investigated in 26 patients.ResultsPET/CT detected 85.0% (17/20) of advanced gastric cancers (AGC) and 12.5% (1/8) of early gastric cancers (EGC). Most tumors (23/26, 88.5%) were EBV-associated. The maximum standardized uptake value of FDG-avid tumors was 7.5 ± 3.0. The sensitivity and specificity of PET/CT for the presence of lymph node metastasis was 47.8% (11/23) and 100.0% (13/13), respectively. PET/CT also detected a hepatic sarcomatoid carcinoma in one patient. The specificity of PET/CT for distant metastasis or second malignancy was 96.3%. Follow-up PET/CT detected malignant lesions in 3 of 9 patients; a liver metastasis, recurrent hepatic sarcomatoid carcinomas and a metachronous cholangiocarcinoma. PET/CT correctly excluded recurrence in the rest of the patients (6/6). The sensitivity and specificity of PET/CT for detecting recurrence or second malignancy was 100% and 100%, respectively.ConclusionF-18 FDG PET/CT would be a useful tool in evaluating distant metastasis or recurrence in patients with gastric LELC.     

Enamel remineralization effect of a dentifrice containing calcium sodium phosphosilicate: an optical coherence tomography observation

Objective: The purpose of this study was to examine the effects of a dentifrice containing 5% calcium sodium phosphosilicate (CSP) on the remineralization of the enamel using optical coherence tomography (OCT).

Materials and methods: Bovine incisors were sliced and shaped in a rectangular form. One group of five specimens was treated with undersaturated 0.1 M lactic acid buffer solution (pH 4.75) for 10?min and then placed in artificial saliva (pH 7.0) (De group). Other specimens were stored in solutions of toothpaste containing CSP for 10?min, followed by 10-min immersion in the lactic acid buffer solution twice a day before storage in artificial saliva (CSP group). An additional group was stored in only artificial saliva (control group). OCT imaging on the selected location of the enamel surface was performed. The peak intensity and width at 1/e² were recorded in each of the six areas on the sample and averaged, and the sample size of each group was six. The integrated value in units (dB?×?μm) was calculated in the area of peak intensity. The data for each group was subjected to one-way repeated-measures ANOVA and Tukey HSD tests (α?=?0.05).

Results: The changes in integrated values of each group were different. A slight but significant increase in the integrated value was observed in the control group, whereas a slight but significant decrease in the value was observed the De group. Integrated values increased in the CSP group.

Conclusions: Remineralization occurred upon immersion in the toothpaste containing CSP.