Dynamic perfusion CT: optimizing the temporal resolution for the calculation of perfusion CT parameters in stroke patients

PURPOSE: To assess the influence of different temporal sampling rates on the accuracy of the results from cerebral perfusion CTs in patients with an acute ischemic stroke. MATERIAL AND METHODS: Thirty consecutive patients with acute stroke symptoms received a dynamic perfusion CT (LightSpeed 16, GE). Forty millilitres of iomeprol (Imeron 400) were administered at an injection rate of 4 ml/s. After a scan delay of 7s, two adjacent 10mm slices at 80 kV and 190 mA were acquired in a cine mode technique with a cine duration of 49 s. Parametric maps for the blood flow (BF), blood volume (BV) and mean transit time (MTT) were calculated for temporal sampling intervals of 0.5, 1, 2, 3 and 4s using GE's Perfusion 3 software package. In addition to the quantitative ROI data analysis, a visual perfusion map analysis was performed. RESULTS: The perfusion analysis proved to be technically feasible with all patients. The calculated perfusion values revealed significant differences with regard to the BF, BV and MTT, depending on the employed temporal resolution. The perfusion contrast between ischemic lesions and healthy brain tissue decreased continuously at the lower temporal resolutions. The visual analysis revealed that ischemic lesions were best depicted with sampling intervals of 0.5 and 1s. CONCLUSION: We recommend a temporal scan resolution of two images per second for the best detection and depiction of ischemic areas.     

血清降钙素原对老年细菌性肺炎临床诊断价值

目的 探讨降钙素原（PCT）对老年细菌性肺炎患者诊断价值的研究.方法 选择230例老年细菌性肺炎患者分成肺炎感染组（A组）、缓解组（B组） 和选择234例健康对照组（N组）作为研究对象,测定血清PCT（procalcitionin,PCT）、血清C-反应蛋白（CRP）和周围血白细胞计数,并对测得结果作比较.结果 老年肺炎患者感染时血清PCT、CRP、周围血白细胞计数明显升高,经过治疗后其患者病情缓解时上述三项参数值明显降低.结论 测定血清PCT比测定血清CRP、周围血白细胞对诊断老年肺炎的价值高,而上述三项联合检测对诊断老年肺炎更具有临床意义.     

降钙素原动态值对血液病伴不明原因发热患者合理使用抗菌药物的价值

目的监测血液病伴不明原因发热(FUO)患者的血清降钙素原(PCT)动态水平值,探讨临床优化感染用药及其使用价值。方法将96例患者随机分为试验组和对照组。试验组57例采用快速半定量法(PCT-Q)检测,观察临床优化感染用药前后PCT动态水平值的变化;对照组39例采用常规治疗,比较两组患者PCT动态水平值的变化。结果血清PCT动态水平值与患者感染细菌严重程度有关。试验组的抗菌疗程、住院天数、抗菌药使用强度(AUD)和药品不良反应等均明显低于对照组(P<0.01)。结论临床药师利用PCT动态水平值,对血液病伴不明原因发热感染者的鉴别判断、早期诊断及临床抗菌药短期优化治疗有应用价值。     

降钙素原检测对新生儿败血症早期诊断治疗及病情评估的临床意义

目的：探讨降钙素原（PCT）对新生儿败血症的早期诊断及病情评估的价值。方法：将2008年7月～2010年7月我院收治的新生儿败血症55例作为研究对象,其中合并休克的20例作为重症组,其余35例作为轻症组,将同期住院非败血症新生儿40例作为对照组,用免疫色谱法对比检测新生儿败血症与其他新生儿患者在入院时及住院抗生素治疗1周后血浆PCT及C反应蛋白（CRP）浓度的变化。结果：新生儿败血症患者入院时（急性期）PCT较对照组明显升高[（15.6±7.1）μg/L vs（0.8±0.4）μg/L]（P〈0.01）],经抗生素治疗1周后下降接近正常[（1.2±1.0）μg/L],与对照组比较差异无统计学意义（P〉0.05）;PCT的敏感性、特异性（89.0%、82.4%）均高于CRP（78.2%、69.6%）;新生儿败血症PCT重症较轻症患者明显增高（P〈0.01）。结论：PCT的检测对新生儿败血症的早期诊断、病情及治疗效果的评估有一定价值。     

血清降钙素原水平检测在脓毒症患者中的临床意义

目的探讨脓毒症患者检测血清降钙素原水平的临床意义。方法收集脓毒症患者100例入脓毒症组及健康体检成年人80例为对照组,检测脓毒症组和对照组血清降钙素原水平。脓毒症患者予以Sepsis集束化治疗及乌司他丁治疗。检测治疗前及治疗后PCT、CRP水平,及APACHEⅡ评分,探讨PCT水平变化及其与APACHEⅡ评分的关系,探讨不同预后患者PCT水平的差异。结果脓毒症患者血清PCT水平明显高于对照组(P<0.01),且随着治疗进展血浆PCT水平逐渐降低(P<0.01)。死亡患者PCT水平明显高于存活患者(P<0.05)且PCT与APACHEⅡ评分呈正相关(P<0.05)。结论血浆PCT水平对脓毒症患者的诊断及严重程度评价有重要价值。     

95例脑梗死患者血小板参数检测的临床意义

目的:探讨血小板参数与脑梗死患者发病的关系。方法:Sysmex XE-2100血细胞计数仪检测PLT、PCT、MPV、PDW。结果:脑梗死组PLT减少、MPV增高,有显著差异(P<0.05或P<0.01);PCT及PDW则无显著差异(P>0.05)。经有效治疗后MPV治疗后减小(P<0.05)。结论:MPV增高是脑梗死的独立危险因素,动态观察MPV对脑梗死的疗效观察有一定的临床意义。     

Predictive value of procalcitonin, interleukin-6, and C-reactive protein for survival in postoperative patients with severe sepsis

Purpose

To prospectively evaluate the performance of procalcitonin (PCT), interleukin-6 (IL-6), and C-reactive protein (CRP) as percentage of baseline (POB) in predicting hospital survival, we studied 64 consecutive, postoperative patients with severe sepsis.

Materials and Methods

Plasma PCT, IL-6, and CRP were serially measured from day 1 (onset of sepsis) to day 14 in parallel with clinical data until day 28. Multivariate logistic regression and univariate analysis of predictive accuracy of PCT-, IL-6-, and CRP-POB were performed. Newly derived binary prediction rules were evaluated by calculating sensitivity, specificity, positive predictive value, and negative predictive value.

Results

In survivors, PCT and IL-6 significantly decreased from days 1 to 14, whereas CRP did not. In nonsurvivors, the inflammation markers mostly increased within the second week. At day 7, logistic regression analysis revealed PCT-POB as an independent determinant for survival. Especially, PCT-POB not exceeding 50% and PCT-POB not exceeding 25% with CRP-POB not exceeding 75% on day 7 indicated a favorable outcome with a positive predictive value/sensitivity of 75%/97% and 92%/67%, respectively. In comparison, pretest likelihood to survive by day 28 and observed survival rate were 60% and 67%, respectively.

Conclusions

Prediction rules of decrease in PCT-POB on day 7 in combination with CRP-POB may serve to monitor efficacy and guide duration of therapy in critically ill patients.     

亚甲蓝衍生物光化学反应对人成骨肉瘤细胞细胞株灭活作用的实验研究

目的探讨光化学反应中不同浓度亚甲蓝衍生物(M007)对人成骨肉瘤细胞(MG-63)的灭活作用,提供将M007应用于肿瘤手术血液回收的前期研究基础。方法实验设空白(C)对照组、单纯光照(P)对照组、不作红光光照的M007对照组及实验组(M007-PCT)。将106个/ml的MG-63单细胞悬液与不同浓度的M007混匀反应,经震荡暗反应及可见红外光照射(M007-PCT)后,采用台盼蓝染色检测肿瘤细胞死亡率。结果 M007-PCT组,M007为(2~4)μmol/L时,MG-63细胞株死亡率随光敏剂浓度增加而增大(P<0.05);M007在(4~32)μmol/L内,MG-63细胞的死亡率达到较高水平(>93%),且不再随M007浓度增加而增大(P>0.05)。M007对照组的MG-63细胞株死亡率随M007浓度增加有增加的趋势,但明显低于相同光敏剂浓度M007-PCT组肿瘤细胞死亡率(P<0.05)。结论新型光敏剂M007对MG-63细胞具有有效的灭活作用,是肿瘤手术术中血液回收方面极具应用前景的光敏剂。     

福尔可定联合头孢唑林钠治疗急性支气管炎的临床研究

目的 探讨福尔可定联合头孢唑林钠治疗急性支气管炎的临床疗效.方法 选择2019年7月—2021年7月河南省人民医院收治的80例急性支气管炎患者,随机分为对照组和治疗组,每组各40例.对照组患者静脉滴注注射用头孢唑林钠,1 g/次加入生理盐水200 mL中,2次/d.在对照组的基础上,治疗组口服复方福尔可定口服溶液,10...