颈椎前路钢板位置与术后颈肩痛的相关性影响

目的观察颈椎前路钢板内固定术后颈肩痛与钢板位置之间的关系。方法回顾分析1999年8月~2006年7月间实施的219例颈椎前路钢板内固定手术的临床和影像学资料。分别观察颈椎侧位X线片上钢板在上下位椎体的覆盖率,正位X线片评估其侧方移位和成角,应用视觉模拟评分(VAS)、颈椎活动障碍指数(NDI)评价手术前、后颈肩痛。应用Pearsons相关系数、线性回归分析进行统计学分析。结果平均随访16.8个月(6~42个月),钢板侧方偏移和成角与术后颈肩痛高度相关(相关系数P=0.417,P<0.001,n=87),线性回归分析显示钢板偏移和成角与术后VAS评分高度正相关(相关系数P=0.314,P<0.001,n=82),与术后NDI成正相关(相关系数P=0.379,P<0.001,n=66)。结论颈椎前路钢板侧方偏移和成角是术后颈肩痛的原因之一,术中应注意调整钢板位置,尽量避免侧方偏移和成角。     

俯卧位双镜联合微通道经皮肾镜同期治疗复杂性肾结石的有效性与安全性

目的:探讨俯卧位输尿管软镜联合微通道经皮肾镜同期治疗复杂性肾结石的有效性与安全性。方法:选取2017年7月至2019年3月于本院就诊的30例复杂性肾结石患者。其中15例患者一期均采取俯卧位输尿管软镜联合微通道经皮肾镜钬激光碎石术(双镜联合组),另外15例采取截石位单一微通道经皮肾镜钬激光碎石术治疗(对照组)。结果:双镜...     

FDGPET在非小细胞肺癌诊断中的应用研究

目的对非小细胞肺癌(NSCLC)准确和早期的诊断在临床治疗中是非常必要的.材料和方法我们把98例临床拟诊NSCLC患者及22例肺癌术后患者肺部CT扫描、全身FDGPET显像与病理结果进行回顾性的分析,并与病理结果对照研究PET对鉴别肺部孤立性结节的性质、判断远处转移的准确性进行分析以及PET在NSCLC诊断中的某些特殊情况的优越性.结果FDGPET对NSCLC总的诊断的灵敏度和特异性为96.9%和86.6%,CT总的灵敏度和特异性为74.6%和80%.其中33例肺部孤立性结节患者中,23例恶性病变出现局部FDG浓聚(SUV=4.7±2.2),明显高于良性病变(SUV=1.2±1.2),其中7例可观察到一侧纵隔的转移,15例患者尚可见肺门病灶伴胸内转移,PET所示病灶数目明显多于CT.在判断22例术后患者NSCLC复发的灵敏度和特异性为92.3%及88.9%,均高于同期的CT.此外,对于有其他检查有困难的患者(如大量胸水等),PET是寻找肿瘤病灶的最佳检测手段.结论FDGPET在对NSCLC的诊断优于解剖显像,通过PET全身显像,可以及早发现早期转移灶,避免对已属晚期的患者盲目进行手术治疗.在肺癌术后随访可提供有价值的参考信息.但PET在精确定位方面仍然需要结合解剖显像,图像融合技术等是发展的方向.     

Optimized Fluoroscopy Setting and Appropriate Project Position Can Reduce X-ray Radiation Doses Rates during Electrophysiology Procedures

Background:

Nonfluoroscopic three-dimensional electroanatomical system is widely used nowadays, but X-ray remains indispensable for complex electrophysiology procedures. This study aimed to evaluate the value of optimized parameter setting and different projection position to reduce X-ray radiation dose rates.

Methods:

From June 2013 to October 2013, 105 consecutive patients who underwent complex ablation were enrolled in the study. After the ablation, the radiation dose rates were measured by two different settings (default setting and optimized setting) with three projection positions (posteroanterior [PA] projection; left anterior oblique [LAO] 30° projection; and LAO 45° projection). The parameter of preset voltage, pulse width, critical voltage, peak voltage, noise reduction, edge enhancement, pulse rate, and dose per frame was modified in the optimized setting.

Results:

The optimized setting reduced radiation dose rates by 87.5% (1.7 Gy/min vs. 13.6 Gy/min, P < 0.001) in PA, 87.3% (2.5 Gy/min vs. 19.7 Gy/min, P < 0.001) in LAO 30°, 85.9% (3.1 Gy/min vs. 22.1 Gy/min, P < 0.001) in LAO 45°. Increase the angle of projection position will increase the radiation dose rate.

Conclusions:

We can reduce X-ray radiation dose rates by adjusting the parameter setting of X-ray system. Avoiding oblique projection of large angle is another way to reduce X-ray radiation dose rates.     

The processing of compounds in bilingual aphasia: A multiple‐case study

Background: While converging evidence has led to the view that people with aphasia exploit compositional procedures when producing compound words, the issue of what compound‐internal characteristics are at play during these procedures is still under debate. It has been argued that constituent position and/or morphosyntactic prominence, i.e., being the head constituent of a compound, may influence the manner in which compounds are accessed. However, findings obtained from patient performances are thus far inconclusive, because positional and headedness effects are frequently confounded in a language.

Aims: In order to disentangle position‐in‐the‐string and headedness effects in compound production in aphasia, the main objective of this study is to investigate the performance of bilingual patients speaking languages in which these effects can be teased apart. Our secondary goal is to probe the roles of grammatical category (adjectives vs nouns) and of between‐language phonological similarity, as both these factors have been demonstrated to influence compound processing.

Methods & Procedures: Three English–French bilingual persons with aphasia participated in the study. Three experimental tasks, reading, repetition, and translation of isolated compound words, were administrated in each language. We contrasted French and English compounds that differ in the position of the head constituent: left for French and right for English.

Outcomes & Results: Two participants showed a similar pattern—a significantly reduced number of errors for the head (or first) constituent as compared to the non‐head (or second) constituent in French and an equivalent number of errors for both constituents in English—pointing to the cumulative effects of headedness and first‐position‐in‐the‐string in French, and to the mutual cancelling out of these effects in English. The third participant exhibited a non‐head constituent advantage in both languages, indicating that semantic modification of the head constituent by the non‐head constituent plays a prominent role in her accessing procedures. For all three participants phonological similarity influenced production, while grammatical category did not.

Conclusions: Our results reveal that headedness and position interact in the processing of compounds. They also demonstrate that compound constituents are processed asymmetrically across and within languages, thus confirming that people with aphasia are sensitive to compound‐internal structure. Moreover, they show that patients rely on varying structural information when accessing compounds.     

俯卧位辅助治疗极低出生体重儿呼吸暂停68例临床观察

目的探讨俯卧位辅助治疗极低出生体重儿呼吸暂停的疗效。方法将近年来 NICU 收治的68例患儿随机分为两组。治疗组38例采用俯卧头侧位疗法,头部抬高15°,两组其余治疗相同,均采用多功能监护仪监护,设置呼吸暂停报警,观察临床疗效。结果治疗组疗效优于对照组,治疗组呼吸暂停发作次数、消失时间均短于对照组,差异有显著性。结论俯卧位适于极低出生体重儿呼吸暂停的治疗疗效显著。     

位置偏离对腰椎体模及人体腰椎骨密度的影响

目的 探讨位置的偏离对腰椎体模及人体腰椎骨密度的影响;方法 用美国LUNAR公司生产的DPX-MD对体模分别于正中位、左偏1cm位、右偏1cm位、左偏1mm位、左偏2mm位连续扫描各25次;及对16位正常人群腰椎分别于正中位、左偏位、右偏位进行扫描;结果 体模正中位时的骨密度最接近正常值,位置偏离时结果下降;人体正中位时腰椎骨密度值最高,偏离时结果下降;结论 位置偏离可以导致腰椎体模及人体腰椎骨密度的下降.     

基于岗位管理的病区临床护理岗位工作职责的研究

目的 研究不同层级护士在病区临床护理岗位的工作职责.方法 在前期对护士进行分层级管理的基础上,通过资料分析、实地观察法,总结出护士在病区临床护理岗位的工作任务,根据工作任务形成各层级护士岗位职责调查问卷,对重庆市某三级甲等综合医院132名病区临床护士进行问卷调查,并对调查结果进行分析.结果 病区临床护士主要承担包括临床护理、护理管理、护理教学和护理科研4个方面共11项工作任务,根据11项工作任务,界定出N0级护士4项、N1级护士6项、N2级护士10项、N3级护士11项、N4级护士8项和N5级护士5项共44项工作职责.结论 通过科学化、系统化的方法明确不同层级护士在病区临床护理岗位的工作职责,为病区临床护士的工作提供具体明确的指导;为医院能科学的对病区临床护士进行人员配置、绩效考核、能力培训等提供决策依据;也为我国护士岗位管理工作的推进提供参考.     

Esophageal positions relative to the left atrium; data from 293 patients before catheter ablation of atrial fibrillation

AimsThree-dimensional rotational angiography (3DRA) of the left atrium (LA) and the esophagus is a simple and safe method for analyzing the relationship between the esophagus and the LA during catheter ablation of atrial fibrillation. The purpose of this study is to describe the location of the esophagus relative to the LA and mobility of the esophagus during ablation procedure.MethodsFrom 3/2011 to 9/2015, 3DRA of the LA and esophagus was performed in 326 patients before catheter ablation of atrial fibrillation. 3DRAwas performed with visualization of the esophagus via peroral administration of a contrast agent. The positions of the esophagus were determined at the beginning of the procedure, for part of patients also at the end of procedure with contrast esophagography.ResultsThe most frequent position is behind the center of the LA (91 pts., 31.9%) The least frequent position is behind the right pulmonary veins (27 pts., 9.4%). The average shift of the esophagus position was 3.36 ± 2.15 mm, 3.59 ± 2.37 mm and 3.67 ± 3.23 mm for superior, middle and inferior segment resp.ConclusionsThe position of the esophagus to the LA is highly variable. The most common position of the esophagus relative to the LA is behind the middle and left part of the posterior wall of the LA. The least frequently observed position is behind the right pulmonary veins. No significant position change of esophagus motion from before to after the ablation procedure in the majority (≥95%) of the patients was observed.