ADC值的变化对急性CO中毒迟发性脑病的预测价值

目的利用MR扩散加权成像监测CO中毒家兔模型急性期脑组织ADC值的变化并与病理对照，探讨MR扩散加权成像对CO中毒急性期诊断的价值并尝试寻找一种能预测CO中毒迟发性脑病的指标。方法通过静吸法建立家兔CO中毒模型15只，成功13只。行磁共振功能成像（本文主要探讨MR扩散加权成像）动态观察家兔中毒后1h、第3天、第5天、第7天的脑部损伤情况，动态测量兔脑皮层的ADC值，并结合病理结果分别与中毒前ADC值相对照。与此同时，连续观察染毒家兔临床表现60d，并根据临床表现不同分为两组，即出现迟发性脑病组和未出现迟发性脑病组。结果所有染毒成功家兔在染毒后1h兔脑皮层均出现ADC值不同程度下降，平均ADC值与染毒前对照差别有显著性（P〈0．05），部分出现了异常信号；未出现迟发性脑病的家兔组各时间点脑皮层ADC值与染毒前对照差异均无显著性意义（P〉0．05）；出现迟发性脑病的家兔组染毒后1h脑皮层ADC值与染毒前对照差异有显著性（P〈O．05）。病理表现与影像学表现一致。结论ADC值对评价急性CO中毒的程度具有重要价值，并且可以初步预测CO中毒迟发性脑病发生的可能性。     

磁共振弥散成像在脑梗塞诊断中的应用体会

目的：探讨磁共振弥散成像在脑梗塞病变的应用价值和方法。材料与方法：对30例脑梗塞患者行磁共振常规及弥散成像。结果：早期脑梗塞DWI显示优于常规MRI，急性、亚急性和慢性脑梗塞病灶在磁共振弥散加权图像的表现各有特点，ADC值呈规律性变化。结论：合理的应用磁共振弥散成像可提高脑梗塞的诊断准确性。     

护士职业精神及其影响因素的研究进展

阐述护士职业精神的概念与内涵,介绍国外护士职业精神测评工具研究现状,综合论述了护士职业精神的影响因素包括个人因素、组织因素和职业因素,并提出构建我国护士职业精神的理论体系和评价方式、倡导护士职业精神培育和营造健康的护理职业环境等建议,为发展我国护士职业精神理论和提高护士职业精神提供参考。     

脑梗死正常、病变区ADC差值对出血性转化风险的评估价值

目的研究脑梗死正常、病变区表观弥散系数差值对出血性转化风险的评估价值。方法选取我院2014年7月-2016年6月神经内科收治的50例早期脑梗死患者,入院后给予螺旋CT和MRI常规颅脑平扫,所有患者均行DWI、ADC扫描,在患者MR ADC图上分别测量并计算脑梗死正常区、病变区的ADC差值;发病2周后随访行MR复查,观察HT发生情况,并进一步分析HT和ADC差值的相关性。结果通过随访复查,50例CI患者中共有5例出现HT,未发生HT(NHT)为45例,HT发病率为10.0%,低于未发生HT(NHT)比重90.0%;早期ADC差值测量显示5例明显205.5×10-6mm2/s,且与随访复查出现HT的5例患者完全吻合,ADC差值预测体现较好的准确度和特异性;HT患者ADC差值(221.4±10.2)×10-6mm2/s高于NHT(145.3±11.4)×10-6mm2/s,差异显著(P0.05)。结论早期脑梗死正常、病变区ADC差值测量能较好的反映梗死灶出血状况,本次研究认为当ADC差值205.5×10-6mm2/s即提示HT发生的高风险可能,对临床预测评估HT和指导治疗具有较高的参考价值。     

New Reference Data on Bone Mineral Density and the Prevalence of Osteoporosis in Korean Adults Aged 50 Years or Older: The Korea National Health and Nutrition Examination Survey 2008-2010

This cross-sectional study was performed to investigate the reference values for bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) and the prevalence of osteoporosis in the Korean population by applying domestic reference data. In total, 25,043 Korean adults ≥20 yr of age (11,792 men and 13,251 women) participated in the study. The BMDs of the total hip, femoral neck, and lumbar spine were measured by DXA (Discovery-W, Hologic Inc.), and subjects with a BMD - 2.5 standard deviations or lower than the mean BMD for young adults (20-29 yr old) were considered to have osteoporosis. When applying the new reference values determined in this study from Korean subjects, the overall prevalence of osteoporosis increased in men aged ≥50 yr compared with that provided by the DXA manufacturer from Japanese subjects (12.2% vs. 7.8%, P<0.001) and decreased in postmenopausal women aged ≥50 yr (32.9% vs. 38.7%, P<0.001). According to the findings of this study, use of the reference values provided by the DXA manufacturer has resulted in the underdiagnosis of osteoporosis in Korean men and the overdiagnosis of osteoporosis in Korean women. Our data will serve as valuable reference standards for the diagnosis and management for osteoporosis in the Korean population.

Graphical Abstract

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Stroke penumbra defined by an MRI-based oxygen challenge technique: 1. Validation using [14C]2-deoxyglucose autoradiography

Accurate identification of ischemic penumbra will improve stroke patient selection for reperfusion therapies and clinical trials. Current magnetic resonance imaging (MRI) techniques have limitations and lack validation. Oxygen challenge T₂^* MRI (T₂^* OC) uses oxygen as a biotracer to detect tissue metabolism, with penumbra displaying the greatest T₂^* signal change during OC. [¹⁴C]2-deoxyglucose (2-DG) autoradiography was combined with T₂^* OC to determine metabolic status of T₂^*-defined penumbra. Permanent middle cerebral artery occlusion was induced in anesthetized male Sprague-Dawley rats (n=6). Ischemic injury and perfusion deficit were determined by diffusion- and perfusion-weighted imaging, respectively. At 147±32 minutes after stroke, T₂^* signal change was measured during a 5-minute 100% OC, immediately followed by 125 μCi/kg 2-DG, intravenously. Magnetic resonance images were coregistered with the corresponding autoradiograms. Regions of interest were located within ischemic core, T₂^*-defined penumbra, equivalent contralateral structures, and a region of hyperglycolysis. A T₂^* signal increase of 9.22%±3.9% (mean±s.d.) was recorded in presumed penumbra, which displayed local cerebral glucose utilization values equivalent to contralateral cortex. T₂^* signal change was negligible in ischemic core, 3.2%±0.78% in contralateral regions, and 1.41%±0.62% in hyperglycolytic tissue, located outside OC-defined penumbra and within the diffusion abnormality. The results support the utility of OC-MRI to detect viable penumbral tissue following stroke.     

Extensive changes to occupational exposure limits in Korea

Occupational exposure limits (OELs) are used as an important tool to protect workers from adverse chemical exposures and its detrimental effects on their health. The Ministry of Labor (MOL) can establish and publish OELs based on the Industrial Safety and Health Act in Korea. The first set of OELs was announced by the MOL in 1986. At that time, it was identical to the Threshold Limit Values of the American Conference of Governmental Industrial Hygienists. Until 2006, none the first OELs except for those of three chemicals (asbestos, benzene, and 2-bromopropane) were updated during the last twenty years. The Hazardous Agents Review Committee established under the MOL selected 126 chemicals from 698 chemicals covered by OELs using several criteria. From 2005 to 2006, the MOL provided research funds for academic institutions and toxicological laboratories to gather the evidence documenting the need to revise the outdated OELs. Finally, the MOL notified the revised OELs for 126 chemicals from 2007 to 2008. The revised OELs of 58 substances from among these chemicals were lowered to equal or less than half the value of the original OELs. This is the most substantial change in the history of OEL revisions in Korea.     

北京地区汉族人群缺血修饰白蛋白参考范围的建立

目的：应用全自动生化分析仪建立缺血修饰白蛋白（IMA）的生物学参考范围。方法：在Hitachi7170A全自动生化分析仪上设计合理参数,采用白蛋白钴结合（ACB）试验测定IMA,测定561例健康人群血清IMA含量,建立健康人群IMA参考范围。结果：健康人群中小于30岁人群的5%参考下限为67 U/ml,〉30岁人群的5%参考下限为64 U/ml。结论：用全自动生化分析仪建立ACB方法测定的IMA参考范围,有助于临床对心肌缺血的诊断。     

Differentiation between hepatic alveolar echinococcosis and primary hepatic malignancy with diffusion-weighted magnetic resonance imaging

Purpose

To determine the value of diffusion-weighted magnetic resonance imaging (DW-MRI) in discriminating between hepatic alveolar echinococcosis (AE) and hepatocellular carcinoma and intrahepatic cholangiocarcinoma.

经皮肾穿刺活检临床应用价值探讨

目的探讨肾活检病理与临床诊断的关系及其价值。方法采用ToshibaNemi30彩色超声诊断仪，凸阵3．0—6．0MHz变频探头显示肾脏纵切和横切声象图定位于肾脏下级，采用活检枪经皮肾穿刺活检（PRB），穿刺重复两次，抽取两条肾组织标本送检。结果107例肾穿刺均成功，105例取材良好，22倒出现镜下血尿，均在1周内消失，无严重并发症；经肾活检病理诊断后，32例改变了治疗方案，修正率29．91％。结论肾活检手术并发症少且轻，病理诊断能指导临床治疗。