依脉特灵治疗脑梗塞前后脑电地形图观察

依脉特灵系贵州小蘖科植物提取物,药理实验证实为钙通道阻滞剂,首次应用于治疗经临床及头颅CT诊断的急性脑梗塞20例(A组),与706代血浆治疗22例(B组)作对照。治疗前后用脑电地形图(CET)观察,A、B两组好转率分别为85％、68.2％,P<0.01,有显著差异,CET能较敏感地反映脑功能在治疗前后的变化。还应用血小板聚集功能、血液流变学及临床症、征观察,A组均较B组改善明显。     

Effectiveness and usability of Scanning Wizard software: a tool for enhancing switch scanning

Scanning Wizard software helps scanning users improve the setup of their switch and scanning system. This study evaluated Scanning Wizard’s effectiveness and usability. Ten people who use switch scanning and ten practitioners used Scanning Wizard in the initial session. Usability was high, based on survey responses averaging over 4.5 out of 5, and qualitative feedback was very positive. Five switch users were able to complete the multi-week protocol, using settings on their own scanning system that were recommended from the Scanning Wizard session. Using these revised settings, text entry rates improved by an average of 71%, ranging from 29% to 172% improvement. Results suggest that Scanning Wizard is a useful tool for improving the configuration of scanning systems for people who use switch scanning to communicate.

• Implications for Rehabilitation

• Some individuals with severe physical impairments use switch scanning for spoken and written communication.

• Scanning Wizard software helps scanning users improve the setup of their switch and scanning system.

• This study demonstrated high usability of Scanning Wizard (with 10 switch userpractitioner teams) and increased text entry rate by an average of 71% (for five switch users).

• Results suggest that Scanning Wizard is a useful tool for improving the configuration of scanning systems for people who use switch scanning to communicate.

     

Automatic selection of tidal volume, respiratory frequency and minute ventilation in intubated ICU patients as startup procedure for closed-loop controlled ventilation

Objective: Before a patient can be connected to a mechanical ventilator, the controls of the apparatus need to be set up appropriately. Today, this is done by the intensive care professional. With the advent of closed loop controlled mechanical ventilation, methods will be needed to select appropriate startup settings automatically. The objective of our study was to test such a computerized method which could eventually be used as a start-up procedure (first 5–10 minutes of ventilation) for closed-loop controlled ventilation.Design: Prospective Study.Settings: ICU's in two adult and one children's hospital.Patients: 25 critically ill adult patients (age15 y) and 17 critically ill children selected at random were studied.Interventions: To simulate initial connection, the patients were disconnected from their ventilator and transiently connected to a modified Hamilton AMADEUS ventilator for maximally one minute. During that time they were ventilated with a fixed and standardized breath pattern (Test Breaths) based on pressure controlled synchronized intermittent mandatory ventilation (PCSIMV).Measurements and main results: Measurements of airway flow, airway pressure and instantaneous CO₂ concentration using a mainstream CO₂ analyzer were made at the mouth during application of the Test-Breaths. Test-Breaths were analyzed in terms of tidal volume, expiratory time constant and series dead space. Using this data an initial ventilation pattern consisting of respiratory frequency and tidal volume was calculated. This ventilation pattern was compared to the one measured prior to the onset of the study using a two-tailed paired t-test. Additionally, it was compared to a conventional method for setting up ventilators. The computer-proposed ventilation pattern did not differ significantly from the actual pattern (p>0.05), while the conventional method did. However the scatter was large and in 6 cases deviations in the minute ventilation of more than 50% were observed.Conclusions: The analysis of standardized Test Breaths allows automatic determination of an initial ventilation pattern for intubated ICU patients. While this pattern does not seem to be superior to the one chosen by the conventional method, it is derived fully automatically and without need for manual patient data entry such as weight or height. This makes the method potentially useful as a startup procedure for closed-loop controlled ventilation.     

Effect of computer game intervention on the attention capacity of mentally retarded children

The low rate of understanding and the limited domain of attention are two important and distinctive characteristics of mental retardation. One of the important strategies to provide effective education for these subjects is to lessen the backgrounds and impacts of these affective factors. The aim of this research was to find the effect of computer games program on the amount of mentally retarded persons' attention. Sixty educable male mentally retarded subjects were selected from two 24-h care centres in Tehran. The Toulouse-Pieron Scale was used to determinate the subjects' attention at pre-post test. Members of the experimental group were subjected to 35 sets of computer games. After use of the sets of computer games, the attention scores of the subjects were assessed immediately after the intervention and 5 weeks later. The results showed that exactly after the intervention the average attention scores of the experimental group were significantly higher than those of the control group. But, 5 weeks after the intervention, there was actually no significant difference.     

三维彩色多普勒超声成像在诊断颈动脉粥样硬化中的应用研究

目的：探讨颈动脉粥样硬化的三维超声成像特征及其价值。方法：健康志愿者32例；颈动脉粥样硬化患者30例，均经二维超声证有1处以上的粥样斑块形成，应用彩色多普勒超声诊断仪及三维彩色多普勒超成像系统，三维图像采集方法选用自由臂方式，扫描过程包括血管长轴扇形扫描和血管短轴平行扫描，脱机进行血管壁，管腔血流的三维重与显示。结果：正常颈动脉的三维重图像能够连续，完整地同颈总动脉，颈内动脉，颈外动脉的空间走行，可见其管壁内膜面光滑平整，管腔通畅，血流充填完满，粥样斑块形成的颈动脉三维重建图像可直观显示斑块的立体形状，表面特征，确切部位，血管腔大小及血流的空间走行情况，结论。三维彩色多普勒超声成像对于颈动脉粥样硬化的影像诊断具有 临床价值和应用潜力。     

A new automated method for analysis of gated-SPECT images based on a three-dimensional heart shaped model

A new automated method for quantification of left ventricular function from gated-single photon emission computed tomography (SPECT) images has been developed. The method for quantification of cardiac function (CAFU) is based on a heart shaped model and the active shape algorithm. The model contains statistical information of the variability of left ventricular shape. CAFU was adjusted based on the results from the analysis of five simulated gated-SPECT studies with well defined volumes of the left ventricle. The digital phantom NURBS-based Cardiac-Torso (NCAT) and the Monte-Carlo method SIMIND were used to simulate the studies. Finally CAFU was validated on ten rest studies from patients referred for routine stress/rest myocardial perfusion scintigraphy and compared with Cedar-Sinai quantitative gated-SPECT (QGS), a commercially available program for quantification of gated-SPECT images. The maximal differences between the CAFU estimations and the true left ventricular volumes of the digital phantoms were 11 ml for the end-diastolic volume (EDV), 3 ml for the end-systolic volume (ESV) and 3% for the ejection fraction (EF). The largest differences were seen in the smallest heart. In the patient group the EDV calculated using QGS and CAFU showed good agreement for large hearts and higher CAFU values compared with QGS for the smaller hearts. In the larger hearts, ESV was much larger for QGS than for CAFU both in the phantom and patient studies. In the smallest hearts there was good agreement between QGS and CAFU. The findings of this study indicate that our new automated method for quantification of gated-SPECT images can accurately measure left ventricular volumes and EF.     

Euthanasia and assisted suicide in the Netherlands: Clarifying the practice and the nurse's role

Many people believe that euthanasia and assisted suicide are condoned carte blanche in the Netherlands. Not true. Both are formally forbidden by criminal law and can be administered only when certain procedures and criteria have been followed. Below, a look at the policies and practices regarding euthanasia and assisted suicide in The Netherlands and the role of nurses in this area.     

An automated skills assessment framework for laparoscopic training tasks

Background

Various sensors and methods are used for evaluating trainees' skills in laparoscopic procedures. These methods are usually task‐specific and involve high costs or advanced setups.

Methods

In this paper, we propose a novel manoeuver representation feature space (MRFS) constructed by tracking the vanishing points of the edges of the graspers on the video sequence frames, acquired by the standard box trainer camera. This study aims to provide task‐agnostic classification of trainees in experts and novices using a single MRFS over two basic laparoscopic tasks.

Results

The system achieves an average of 96% correct classification ratio (CCR) when no information on the performed task is available and >98% CCR when the task is known, outperforming a recently proposed video‐based technique by >13%.

Conclusions

Robustness, extensibility and accurate task‐agnostic classification between novices and experts is achieved by utilizing advanced computer vision techniques and derived features from a novel MRFS.     

Prostate‐specific antigen screening impacts on biochemical recurrence in patients with clinically localized prostate cancer

Objective

To clarify the impact of prostate‐specific antigen screening on surgical outcomes of prostate cancer.

Methods

Patients who underwent radical prostatectomy were divided into two groups according to prostate‐specific antigen testing opportunity (group 1, prostate‐specific antigen screening; group 2, non‐prostate‐specific antigen screening). Perioperative clinical characteristics were compared using the Wilcoxon rank‐sum and χ²‐tests. Cox proportional hazards models were used to identify independent predictors of postoperative biochemical recurrence‐free survival.

Results

In total, 798 patients (63.2%) and 464 patients (36.8%) were categorized into groups 1 and 2, respectively. Group 2 patients were more likely to have a higher prostate‐specific antigen level and age at diagnosis and larger prostate volume. Clinical T stage, percentage of positive cores and pathological Gleason score did not differ between the groups. The 5‐year biochemical recurrence‐free survival rate was 83.9% for group 1 and 71.0% for group 2 (P < 0.001). On multivariate analysis, prostate‐specific antigen testing opportunity (hazard ratio 2.530; P < 0.001) was an independent predictive factor for biochemical recurrence after surgery, as well as pathological T stage, pathological Gleason score, positive surgical margin and lymphovascular invasion. Additional analyses showed that prostate‐specific antigen screening had a greater impact on biochemical recurrence in a younger patients, patients with a high prostate‐specific antigen level, large prostate volume and D'Amico high risk, and patients meeting the exclusion criteria of the Prostate Cancer Research International Active Surveillance study.

Conclusions

Detection by screening results in favorable outcomes after surgery. Prostate‐specific antigen screening might contribute to reducing biochemical recurrence in patients with localized prostate cancer.