临证实痛辨治

痛之命名,始见<内经>.有<素问·举痛论>之专篇论痛,百病多痛,临证习之,辨证常用六法行气止痛、散寒止痛、活血止痛、化痰止痛、清热止痛、调神止痛.     

Characterization and reduction of the transient response in steady-state MR imaging.

Refocused steady-state free precession (SSFP) imaging sequences have recently regained popularity as faster gradient hardware has allowed shorter repetition times, thereby reducing SSFP's sensitivity to off-resonance effects. Although these sequences offer fast scanning with good signal-to-noise efficiency, the "transient response," or time taken to reach a steady-state, can be long compared with the total imaging time, particularly when using 2D sequences. This results in lost imaging time and has made SSFP difficult to use for real-time and cardiac-gated applications. A linear-systems analysis of the steady-state and transient response for general periodic sequences is shown. The analysis is applied to refocused-SSFP sequences to generate a two-stage method of "catalyzing," or speeding up the progression to steady-state by first scaling, then directing the magnetization. This catalyzing method is compared with previous methods in simulations and experimentally. Although the second stage of the method exhibits some sensitivity to B(1) variations, our results show that the transient time can be significantly reduced, allowing imaging in a shorter total scan time. Magn Reson Med 46:149-158, 2001.     

AT1 antagonism by eprosartan lowers heart rate variability and baroreflex gain

INTRODUCTION: Blockade of the renin-angiotensin system (RAS) by ACE inhibitors has been demonstrated to reduce total mortality in cardiovascular diseases. This advantage was attributed in part to changes of autonomic cardiovascular control, exemplified by an increase of heart rate variability (HRV) and baroreflex gain (BRG). We sought to assess the effects of the angiotensin type 1 (AT1) receptor blocker eprosartan on HRV and BRG. MATERIALS AND METHODS: In a double-blind randomized cross-over design 25 young males took eprosartan (600 mg/day) and placebo each for a period of 7 days with a wash-out period of at least 4 weeks in between. At the end of the intake phases simultaneous recordings of arterial blood pressure (AP; Finapres) and electrocardiogram (ECG) were taken. Power spectra of HRV and arterial blood pressure variability (APV) were calculated by fast Fourier transform (FFT) and served to calculate BRG. Ang-II levels were measured by radioimmunoassay. RESULTS: Eprosartan tended to lower mean AP, it slightly increased heart rate (HR) (p<0.05), and markedly increased circulating Ang-II levels (p<0.01). Eprosartan diminished the total power of HRV (p<0.05) and the BRG (p<0.01). The low/high frequency (LF/HF) ratio of HRV and the APV were not altered. CONCLUSIONS: AT1 antagonism by eprosartan lowers heart rate variability and baroreflex gain. We speculate that these findings are due to the marked increase in circulating angiotensin II (Ang II). Further studies are needed to clarify whether angiotensin type 1 (AT1) blockers with potential actions inside the blood-brain barrier (BBB) may have different effects on HRV and BRG.     

A pseudoisochromosome 18q and an isodicentric chromosome 18

A case of pseudoisochromosome 18q of prezygotic origin and a case of isodicentric chromosome 18 of postzygotic origin are presented to validate the differentiation between a true isochromosome and a pseudoisochromosome. This differentiation may be useful in elucidating the mechanism of the origin of an isochromosome.     

Efficient implementation of hardware‐optimized gradient sequences for real‐time imaging

This work improves the performance of interactive real‐time imaging with balanced steady‐state free precession. The method employs hardware‐optimized gradient pulses, together with a novel phase‐encoding strategy that simplifies the design and implementation of the optimized gradient waveforms. In particular, the waveforms for intermediate phase‐encode steps are obtained by simple linear combination, rather than separate optimized waveform calculations. Gradient waveforms are redesigned in real time as the scan plane is manipulated, and the resulting sequence operates at the specified limits of the MRI gradient subsystem for each new scan‐plane orientation. The implementation provides 14‐25% improvement in the sequence pulse repetition time over the vendor‐supplied interactive real‐time imaging sequence for similar scan parameters on our MRI scanner. Magn Reson Med, 2010. © 2010 Wiley‐Liss, Inc.     

临证实痛辨治

痛之命名,始见《内经》。有《素问.举痛论》之专篇论痛,百病多痛,临证习之,辨证常用六法:行气止痛、散寒止痛、活血止痛、化痰止痛、清热止痛、调神止痛。     

Multishot EPI-SSFP in the heart.

Refocused steady-state free precession (SSFP), or fast imaging with steady precession (FISP or TrueFISP), has recently proven valuable for cardiac imaging because of its high signal-to-noise ratio (SNR) and excellent blood-myocardium contrast. In this study, various implementations of multiecho SSFP or EPI-SSFP for imaging in the heart are presented. EPI-SSFP has higher scan-time efficiency than single-echo SSFP, as two or more phase-encode lines are acquired per repetition time (TR) at the cost of a modest increase in TR. To minimize TR, a noninterleaved phase-encode order in conjunction with a phased-array ghost elimination (PAGE) technique was employed, removing the need for echo time shifting (ETS). The multishot implementation of EPI-SSFP was used to decrease the breath-hold duration for cine acquisitions or to increase the temporal or spatial resolution for a fixed breath-hold duration. The greatest gain in efficiency was obtained with the use of a three-echo acquisition. Image quality for cardiac cine applications using multishot EPI-SSFP was comparable to that of single-echo SSFP in terms of blood-myocardium contrast and contrast-to-noise ratio (CNR). The PAGE method considerably reduced flow artifacts due to both the inherent ghost suppression and the concomitant reduction in phase-encode blip size. The increased TR of multishot EPI-SSFP led to a reduced specific absorption rate (SAR) for a fixed RF flip angle, and allowed the use of a larger flip angle without increasing the SAR above the FDA-approved limits.     

肿瘤患者知情权与护理满意度关系的探讨

目的 探讨肿瘤患者知情权与护理满意度之间的关系.方法 随机抽取肿瘤中心,及循环科、呼吸科及普外科患者746例,针对患者知情权和护理工作满意度制订调查问卷进行调查,并对结果进行分析.结果 不知情的肿瘤患者想获得更多关于自身疾病的真实信息,而护理人员被要求对其病情保密,这种矛盾导致了肿瘤科患者对此方面护理工作的满意度低于其他科室,差异有统计学意义,P<0.05.结论 知情权对于肿瘤患者非常重要,它可增加肿瘤患者的治疗依从性,促进沟通,接受优质护理,从而提高护理满意度.     

Three-dimensional power Doppler sonography in the prenatal diagnosis of a true knot of the umbilical cord: value and limitations.

OBJECTIVE: The purpose of this study was to examine the value of 3-dimensional power Doppler sonography in the prenatal diagnosis of a true knot of the umbilical cord. METHODS: Cases in which the diagnosis of a true knot of the umbilical cord was suspected by prenatal 2-dimensional sonography were reviewed. The presumably affected segment of the cord was examined with 3-dimensional power Doppler sonography for further characterization. Confirmation of the prenatal diagnosis was sought by reviewing the delivery records and contacting the referring obstetrician and the patients themselves. RESULTS: Eight consecutive cases were studied. Three-dimensional power Doppler sonography displayed a vascular spatial configuration pattern consistent with a true knot of the umbilical cord in all of them. However, the prenatal diagnosis was confirmed at delivery in only 5 cases (62.5%). Although there were no cases of a false knot mimicking a true knot of the umbilical cord, all incorrect diagnoses in this series were associated with multiple loops of the umbilical cord in the third trimester. CONCLUSIONS: Three-dimensional power Doppler sonography seems to be helpful in determining the presence of a true knot of the umbilical cord in utero, especially in the second trimester. However, this should not be considered a definitive method for the diagnosis because multiple loops of the umbilical cord lying close to each other can generate a sonographic image that can be undistinguishable from a true knot of the umbilical cord prenatally, especially when located in a small pocket of amniotic fluid. Therefore, the presumable diagnosis of a true knot of the umbilical cord in utero should be taken with caution.     

阿苯达唑对华支睾吸虫体壁和肠管超微结构的影响

阿苯达唑对实验大鼠体内华支睾吸虫体壁和肠管影响的超微结构观察结果表明,该药对虫体皮层和肠绒毛,在给药1h即出现皮层突起肿胀、粘连和肠绒毛肿胀,其内的点线模糊不清。给药24h损害已相当严重,皮层突起出现坏死、崩溃,部分肠绒毛溶解、坏死。而且皮层和肠管损害的发生发展过程是同步的。可以认为阿苯达唑是通过对皮层和肠管的双重损害,进而影响其生理机能,使虫体死亡的。