医护人员暴发肺炎衣原体肺炎12例临床特征分析

目的总结肺炎衣原体(CP)肺炎暴发流行的临床特征及治疗方法。方法收集2009-01-04—2009-03-01中国医科大学附属第四医院暴发流行的12例医护人员CP肺炎咽试纸标本,应用聚合酶联反应(PCR)检测DNA,使用微量免疫荧光技术检测CP的IgG和IgM抗体,同时对肺高分辨CT结果进行分析,并评价疗效。结果本组暴发流行的CP肺炎其病原学介于CP与鹦鹉热衣原体之间的一种变异的衣原体种,且更倾向于鹦鹉热衣原体。临床表现为乏力10例,周身酸痛10例,发热6例,咳嗽、咳少量白痰2例,心悸、气短2例,皮疹1例,稀水样便1例,12例均无咯血、胸痛、呼吸困难及精神症状,肺部体征均为阴性。所有患者肺部高分辨CT均有改变,表现为多发或单发以小叶为中心阴影和腺泡状结节影3例,病变可发生在两肺各个叶段,多以外、中带分布;以小叶分布的气腔实变和磨玻璃样阴影分别为4例和1例,伴有支气管血管束增厚3例;球形影1例;结节影与实变影混合存在3例。结论医护人员CP肺炎的暴发流行具有群体发病,早期高分辨CT检查更能真实地反映病变大小、多少和分布范围。对氟喹诺酮类联合大环内酯类药物治疗有效。诊断时应与严重急性呼吸综合征、禽流感、支原体肺炎等进行鉴别。     

Association between occlusal force distribution in implant overdenture prostheses and residual ridge resorption

This study aimed to investigate residual ridge resorption (RRR) of anterior and posterior maxillary and mandibular edentulous ridges, in patients treated with mandibular implant overdentures (IOD) and compare with conventional complete denture (CD) wearers, and to determine at each location, the association of RRR with the occlusal forces distribution and other patients’ variables. The anterior and posterior RRR of IOD (six males, 17 females) and CD (12 males, 11 females) groups were determined using baseline and follow‐up dental panaromic radiographs (DPT) (mean intervals 4 ± 1·8 years). The bone ratios were calculated using proportional area: anatomic to fixed reference areas and mean difference of ratios between the intervals determined RRR. The ridge locations included anterior and posterior maxillary and posterior mandibular arches. The T‐Scan III digital occlusal system was used to record anterior and posterior percentage occlusal force (%OF) distributions. There were significant differences in anterior and posterior %OF between treatment groups. Two‐way anova showed RRR was significant for arch locations (P = 0·005), treatment group (IOD versus CD) (P = 0·001), however, no significant interaction (P = 0·799). Multivariate regression analyses showed significant association between RRR and %OF at anterior maxilla (P = 0·000) and posterior mandible (P = 0·023) and for treatment groups at posterior maxilla (P = 0·033) and mandibular areas (P = 0·021). Resorption was observed in IOD compared to CD groups, with 8·5% chance of less resorption in former and 7·8% in the latter location. Depending on arch location, ridge resorption at various locations was associated with occlusal force distribution and/or treatment groups (implant prostheses or conventional complete dentures).     

The noninvasive assessment of anomalous origin of the left coronary artery from the pulmonary artery

We present a patient with anomalous origin of the left main coronary artery from the pulmonary artery. We correlate the findings of echocardiography and myocardial imaging with angiography, and discuss the value of the noninvasive techniques in the diagnosis and in the followup of such patients.     

术前 CT 平扫指导跟骨骨折闭合复位内固定的临床疗效观察

目的：探讨术前 CT 扫描指导跟骨骨折闭合复位术中固定方式的临床意义。方法对拟行手术的 SandersⅡ～Ⅲ型跟骨骨折患者36例,分为闭合复位空心螺钉内固定组18例、切开复位钢板内固定组18例,对闭合复位内固定进行患侧 CT 扫描,了解骨折具体移位形态,指导术中螺钉植入方式,并对术后3 d 及术后6个月的跟骨 bohler’s 角及跟骨高度进行测量、比较,并对跟骨功能进行 AOFAS（美国足踝外科学会踝—后足评分标准）评分。结果闭合复位空心螺钉内固定组术后第3天bohler’s 角25．3°～40°（34．8±5．12°）,跟骨高度41～54 mm（47．5±3．94 mm）,术后6个月 bohler’s 角25．4°～39．8°（34．7°±5．15°）,跟骨高度40～54 mm（47．4±5．29 mm）,术后6月 AOFAS 评分优15足,良2足,可1足,优良率94．4％,切开复位钢板内固定组术后3 d bohler’s 角26．3°～39．6°（34．8°±5．24°）,跟骨高度35．5～53．5 mm（47．6±5．25 mm）,术后6个月bohler’s 角26．2°～39．7°（34．7°±5．24°）,跟骨高度35．3～53．4 mm（47．5±5．29 mm）,术后6月 AOFAS 评分优13足,良3足,可2足,优良率88．9％,两组组内比较有统计学差异（P ＜0．05）,组间比较,跟骨高度和 bohler’s 角角度测量结果无统计学差异。结论闭合复位空心螺钉内固定术前 CT 平扫,可以直观的了解跟骨折的具体移位情况,可以更加准确的复位及调整螺钉的布局,符合骨折复位、固定的基本原则,术后关节面塌陷及骨折再移位较切开复位内固定无统计学差异,但减少了切开复位的手术并发症,提高了临床疗效。     

Dissolution Curve Comparisons Through the F2 Parameter,a Bayesian Extension of the f2 Statistic

Dissolution (or in vitro release) studies constitute an important aspect of pharmaceutical drug development. One important use of such studies is for justifying a biowaiver for post-approval changes which requires establishing equivalence between the new and old product. We propose a statistically rigorous modeling approach for this purpose based on the estimation of what we refer to as the F₂ parameter, an extension of the commonly used f₂ statistic. A Bayesian test procedure is proposed in relation to a set of composite hypotheses that capture the similarity requirement on the absolute mean differences between test and reference dissolution profiles. Several examples are provided to illustrate the application. Results of our simulation study comparing the performance of f₂ and the proposed method show that our Bayesian approach is comparable to or in many cases superior to the f₂ statistic as a decision rule. Further useful extensions of the method, such as the use of continuous-time dissolution modeling, are considered.     

The value of repeated CT in monitoring the disease progression in moderate COVID-19 pneumonia: A single-center,retrospective study

The role of thoracic CT (computerized tomography) in monitoring disease course of COVID-19 is controversial. The purpose of this study is to investigate the risk factors and predictive value of deterioration on repeatedly performed CT scan during hospitalization.All COVID-19 patients treated in our isolation ward, from January 22, 2020 to February 7, 2020, were reviewed. Patients included were categorized into RD (Radiological Deterioration) group or NRD (No Radiological Deterioration) group according to the manifestation on the CT routinely performed during the hospitalization. All clinical data and CT images were analyzed.Forty three patients were included in our study. All are moderate cases with at least 4 CT scans each. Eighteen (42.9%) patients had radiological deteriorations which were all identified in CT2 (the first CT after admission). Patients in RD group had lower leukocyte count (P = .003), lymphocyte count (P = .030), and higher prevalence (P = .012) of elevated C-reactive protein (CRP) at admission. NRD patients had a lower prevalence of reticulations (P = .034) on baseline CT (CT1, performed within 2 days before admission) and a longer duration between symptom onset and the time of CT2 (P < .01). There was no significant difference in hospital stay or fibrotic change on CT4 (follow-up CT scan performed 4 weeks after discharge) between 2 groups. Shorter duration between symptom onset and CT2 time (odds ratio [OR], 0.436; 95% confidence interval: 0.233–0.816; P < .01) and lower leukocyte count in baseline evaluation (OR, 0.316; 95% CI: 0.116–0.859; P < .05) were associated with increased odds of radiological deterioration on CT image during hospitalization.For moderate COVID-19 patients, the value of routinely performed CT during the treatment is limited. We recommend avoiding using CT as a routine monitor in moderate COVID-19 patients.     

The meta-analysis of the effect of 68Ga-PSMA-PET/CT diagnosis of prostatic cancer compared with bone scan

Background:⁶⁸Ga-PSMA-PET/CT (positron emission tomography/computed tomography) is a promising method for prostate cancer (PC) detection. However, the ability of ⁶⁸Ga-PSMA-PET/CT to detect malignant bone lesions, and whether this method is superior to the existing bone imaging methods are still lack of systematic analysis.Purpose:To evaluate the value of ⁶⁸Ga-PSMA-PET/CT and bone scan in clinical diagnosis of prostatic cancer from the perspective of evidence-based medicine.Methods:PubMed, The Cochrane Library, EMBASE, Springer Link, Sinomed, CNKI, Wanfang database, and CQVIP database were searched to find the satisfactory studies that needed systematic review of trials and compared the value of 68Ga-PSMA-PET/CT and bone scan. All studies published from inception to March 31, 2020. According to the inclusion and exclusion criteria, 2 reviewers independently evaluated and extracted the literature. Review Manager 5.3 was applied to evaluate the included literature quality. The heterogeneity of the included literature was tested by Meta Disc 1.4, and the effect model was selected according to the heterogeneity test results, and the sensitivity (SEN), specificity (SPE), PLR, NLR and diagnostic odds ratio (DOR) were analyzed. After testing the heterogeneity results of literature by using the 95% confidence interval and the forest map.Results:A total of 4 studies were eligible for inclusion in the meta-analysis, which included 318 patients, 120 cases with bone metastasis and 198 cases without bone metastasis. The results of summary evaluation for ⁶⁸Ga-PSMA-PET/CT and bone scan in diagnosis of prostatic cancer as follow respectively: The SEN were 0.97 and 0.86; the SPE were 1.00 and 0.87; the DOR were 1468.33 and 36.23; PLR were 88.45 and 6.67; NLR were 0.05 and 0.19; and the area under curve (AUC) and 95% CI were 0.9973 (1.0000–0.9927) and 0.8838 (0.9584–0.8092).Conclusion:By comparing the diagnostic results of ⁶⁸Ga-PSMA-PET/CT and bone scan imaging diagnosis methods, the ⁶⁸Ga-PSMA-PET/CT has a higher SEN and SPE than bone scan, and it has a higher diagnostic efficiency for prostate cancer bone metastasis, which is worthy of clinical application.     

血管内皮生长因子对尾吊大鼠后肢胫骨骨丢失的影响

目的探究血管内皮生长因子(vascular endothelial growth factor,VEGF)对废用性骨丢失的影响。方法建立尾吊大鼠的动物模型,并随机平均分为尾吊盐水组、尾吊VEGF组、对照盐水组、对照VEGF组。实验过程中,每周两次对大鼠右腓肠肌注射VEGF或者等量的生理盐水,4周后通过micro-CT对大鼠胫骨近端进行扫描,以松质骨和皮质骨骨密度(bone mineral density,BMD)、骨体积分数(BV/TV)、骨小梁数量(Tb.N)、骨小梁间距(Tb.Sp)和结构模型指数(SMI)等松质骨微结构参数以及皮质骨厚度作为评价指标,探讨VEGF对尾吊大鼠后肢胫骨骨丢失的影响。结果与对照组大鼠相比,尾吊组大鼠松质骨表观BMD、BV/TV、Tb.N以及皮质骨厚度均显著降低,Tb.Sp与SMI显著升高,尾吊会造成大鼠的骨丢失,而注射VEGF能够缓解尾吊大鼠松质骨的骨丢失。结论血供的改变可能与骨重建之间存在着一定的联系,改善血供有助于对抗废用性的骨丢失。     

Comparison of scintigraphy with indium-111 leukocyte scan and ultrasonography in assessment of x-ray-demonstrated lesions of crohn's disease

The aim of this study was to compare the results obtained with an indium-111 scan with those obtained with less expensive and harmless ultrasonography to evaluate the location and inflammatory activity of Crohn's disease. Thirty-one patients previously studied with x-ray underwent abdominal¹¹¹In scans and ultrasonography (US). Sensitivity and specificity of US in detecting lesions seen with¹¹¹In scan were 77% and 92.8%, respectively. Sensitivity and specificity of¹¹¹In scan in detecting x-ray-defined lesions were 69.2% and 92.7%; the figures for US were 73% and 93.3%, respectively. Considering the evaluation of disease activity, ultrasonographic bowel wall thickness was significantly related to scintigraphic intensity of emission (r=0.75 P<0.01). Our experience suggests that US provided information about the location and inflammatory activity of lesions similar to that obtained from¹¹¹In scan.