目的 探讨双源CT低剂量扫描技术在胸部普通检查中的应用价值。 方法 将2011年8月－2012年12月收治的875例患者依次分为7组，分别采用常规管电流量110 mAs和低管电流量105、100、95、90、85、80 mAs测量，计算并评估7组患者纵隔窗图像的胸骨前空气CT值标准差（SD空气）、肺动脉分叉平面肺动脉信噪比、降主动脉信噪比、肺动脉-竖脊肌对比噪声比、降主动脉-竖脊肌对比噪声比；纵隔窗图像和肺窗图像主观质量评分以及射线剂量指标：CT剂量指数（CTDI）、剂量长度乘积（DLP）、有效剂量（ED）。 结果 7组患者纵隔窗图像肺动脉信噪比、降主动脉信噪比、图像主观质量评分和射线剂量CTDI、DLP、ED之间差异均有统计学意义（P＜0.05）；肺动脉-竖脊肌对比噪声比、降主动脉-竖脊肌对比噪声比之间差异无统计学意义（P＞0.05）；其中第7组图像信噪比、射线剂量和主观质量评分均为最低，部分图像肩背部出现横条状伪影，影响肺尖部病变的显示，难以提供足够的诊断信息。 结论 胸部普通CT检查，通过阶段性降低管电流量使诊断医生逐渐适应低剂量图像质量，从而普及现有设备的低剂量扫描的方法是可行的。双源CT采用85 mAs的参考管电流量，既能获得满足临床诊断的合格图像，又能明显降低患者群体接受的辐射剂量。
ObjectiveTo evaluate the predictive value of mini-fluid challenge for volume responsiveness in patients under shock.MethodsSixty patients diagnosed as shock were included in the study. A 50 mL infusion of physiological saline over 10 seconds and a further 450 mL over 15 minutes were conducted through the central venous catheter. Cardiac output (CO), global end-diastolic volume index (GEDVI), central venous pressure (CVP) and extravascular pulmonary water index (EVLWI) were monitored by the pulse indicator continuous cardiac output monitoring. If the increase of CO after 500 mL volume expansion (ΔCO500) ≥10%, the patient was considered to be with volume responsiveness. The relevance between ΔCO50 and ΔCO500 was analyzed, and the sensitivity and specificity of the ΔCO50 were analyzed by receiver operating characteristic (ROC) curve.ResultsAfter 50 mL volume injection, the heart rate and systolic blood pressure of the two groups did not change obviously. The CVP of non-responders changed slightly higher than that of responders, but neither of them had obviously difference (P>0.05). The CO of responders had increased significantly (P<0.05) which was in accord with that after a further 450 mL volume injection. GEDVI and EVLWI did not change significantly (P>0.05). ΔCO50 and ΔCO500 were strongly correlated (r=0.706, 95%CI 0.677 - 0.891, P>0.05). The area under ROC curve for ΔCO50 was 0.814 (95%CI 0.707 - 0.922).ConclusionThe volume responsiveness of patients under shock can be predicted by mini-fluid challenge study which is related to normal volume expansion and it does not increase the risk of pulmonary edema.
目的：了解2007年成都地区17家医院间心血管系统药物的使用状况。方法：采用限定日剂量(DDD)的方法，对成都地区2007年17家医院中心血管系统用药的销售金额、用药频度(DDDs)等进行统计分析。结果：2007年成都地区17家医院心血管系统用药总金额为13 753.86万元，占所有药物销售总额的9.05%。在金额排序和用药频度排序前列中，主要包括中药制剂、钙离子拮抗剂等，中药制剂类产品也销售状况良好。结论：中药制剂发挥巨大作用，依从性好、不良反应发生率低、疗效确切的药物已成为临床医师治疗心血管疾病的首选。
摘要:目的:了解2007~2008年成都地区17家医院生物制品及生化药品的使用状况。方法:采用限定日剂量(DDD)的方法,对成都地区2007~2008年17家医院生物制品及生化药品的销售金额、用药频度(DDDs)等进行统计分析。结果:2007年、2008年成都地区17家医院生物制品及生化药品销售总额分别为7338万元、9786万元;分别占总销售额的4.83%、5.00%。销售金额进入总销售额排名前100位的生物制品及生化药品有:人血白蛋白、胸腺肽、丙种球蛋白、促白细胞生长素和环磷腺苷。环磷腺苷在生物制品及生化药品中的DDDs最高。结论:生物制品及生化药品的价格及供给对其临床使用有较大的限制。Abstract: Objective: To evaluate the current situation and the trend of biological products and biochemical drugs used in Chengdu city in 2007 to 2008. Methods: Consumption of biological products and biochemical drugs used in 17 hospitals of Chengdu city in 2007 to 2008 were analyzed by the way of sum DDD and DDDs ranking. Results: The total cost of the biological products and biochemical drugs used in Chengdu city in was 73.38 and 97.86 million yuan in 2007 to 2008, it accounted for 4.83% and 5.00% of the total cost. Human serum albumin, thymosin, gamma globulin, interleukin promoting growth hormone and adenosine cyclophosphate were the drugs in the first 100 cost list. The DDDs of adenosine cyclophosphate was highest among biological products and biochemical drugs. Conclusion: The cost and supply of biological products and biochemical drugs were great limitations of their clinical application.
Objective To observe the effects on rabbit corneas and retinas after single intravitreal injection of voriconazole at different doses. Methods According to the randomization table, 25 healthy rabbits were randomly divided into control group, and voriconazole 50, 100, 200, and 400 μg groups. Therefore, there were 5 rabbits in each group. The eyes of control group received intravitreal injection of 0.1 ml balanced saline solution, and those treatment groups received 0.1 ml voriconazole injection of corresponding dose. Before the injection and 1, 7, and 14 days after the injection, endothelial cell counts and corneal thicknesses were measured; full-field electroretinogram were performed and b-wave amplitudes in maximal combined reaction (Max-R) were recorded. On 14 days after the injection, histologic structures were observed by light microscope and transmission electron microscope. Results There was no significant difference in endothelial cell counts (F=0.320, 0.291, 0.467, 0.649) and corneal thicknesses (F=0.214, 0.284, 0.360, 0.225) with those of control group at any time points (P > 0.05). Before and 1 day after the injection, b-wave amplitudes of each voriconazole group had no significant difference compared with those of control group (F=0.220, 0.106; P > 0.05). On 7 days after the injection, b-wave amplitudes decreased significantly at doses of 200 μg and 400 μg (P < 0.05). On 14 days after the injection, there was no significant difference between the the amplitude of 200 μg group and that of control group (P > 0.05). However, the amplitude of the 400 μg group decreased continuously and there was still significant difference (P < 0.05). Light microscopy did not reveal any corneal abnormality in both control group and voriconazole groups. The retinas were normal except that of the 400 μg group, which hadathinner and degenerated inner nuclear layer and disordered photoreceptor layer. Under transmission electron microscope, there were no ultrastructure damages of corneas in both control group and voriconazole groups, either. The rabbit retinas of the 50 μg and 200 μg group have normal inner nuclear layer and photoreceptor layer, but degrees of changes in both layers were observed in the eyes of 200 μg and 400 μg group. Conclusions There is no obvious effects on rabbit corneas and retinas after single intravitreal injection of voriconazole at he dose less than or equal 100 μg. There are no obvious effects on rabbit corneas at the dose of 200 μg and 400 μg, while there are damages to the retinas in both functions and histological structures.
ObjectivesTo compare different formula calculated dosages with the actual doses of warfarin from patients in Beijing Hospital so as to investigate suitable warfarin dosing models for Chinese patients.MethodsOne hundred and three Chinese patients with long-term prescription of warfarin were randomly selected from Beijing Hospital from July 2012 to May 2013. The CYP2C9 and VKROC1 genotypes and basic statistical information were collected. SPSS 18.0 software was used to compare the differences between different formula calculated dosages and the actual dosages of warfarin.ResultsFive genotypes were found in 103 patients, including: CYP2C9 AA genotype + VKORC1 AA genotype (n=72, 69.9%), CYP2C9 AA genotype + VKORC1 AG genotype (n=17, 16.5%), CYP2C9 AC genotype + VKORC1 AA genotype (n=10, 9.7%), CYP2C9 AC genotype + VKORC1 AG genotype (n=3, 2.9%) and CYP2C9 AA genotype + VKORC1 GG genotype (n=1, 1%). Compared with the actual dosages of warfarin, the degree of coincidence was highest for dosages calculated by Jeffrey’s formula.Conclusions Using Jeffrey’s formula to calculate warfarin dosages may be more suitable for Chinese patients with using long-term warfarin. Due to limited sample size, prospective and large sample size studies are required to verify the above conclusion.
Objective To observe the influence of interleukin-1beta; (IL-1beta;) on the expression of phosphorylated signal transducers and activators of transcription 3 (pSTAT 3) in rat retinal Muuml;ller cells.Methods For in vitro study cultured Muuml;ller cells were treated with IL-1beta; of different concentrations (0, 0.1, 1, 5 and 10 ng/ml) for 24 hours. For in vivo study, 32 Sprague-Dawley（SD）rats were divided into 4 groups randomly (control group，100，500 and 1000 ng/ml group) with 8 rats in each group. After 24 hours of injection with phosphate buffered solution (PBS), or 100,500,1000 ng/ml IL-1beta; into the vitreous cavities of the above rats, retinas were harvested. The expressions of pSTAT3 in cultured Muuml;ller cells or treated retinas were evaluated by indirect immunofluorescence and western blotting.Results After 24 hours of incubation without IL-1beta;, pSTAT3 has little expression in cultured Muuml;ller cells, but was upregulated by 1 ng/ml or higher IL-1beta; in a dosagedependent manner (F=46.64, 43.78;P＜0.01). pSTAT3 was not expressed in adult rat retina, but was upregulated by vitreous injection of 100 ng/ml or higher IL-1beta; in a dosagedependent manner (F=73.53,43.70;P＜0.01).pSTAT3 expressed mainly in inner nuclear layer and ganglion cell layer. Doublelabeling showed that there was no costaining of pSTAT3 and glial fibrillary acidic protein (GFAP) in retina of control group, but there were many costained Muuml;ller cells in retinas treated with IL-1beta;.Conclusions Expression of pSTAT3 in Muuml;ller cells could be activated by IL-1beta; which may represent one pathway link to reactive gliosis.
Objective To assess the effectiveness and safety of autologous stem cell transplantation after high-dose chemotherapy in first-line treatment of follicular lymphoma. Method Randomized controlled trials (RCTs) of autologous stem cell transplantation after high-dose chemotherapy in first-line treatment of follicular lymphoma were collected from MEDLINE (1990-2009), EMBASE (1990-2009), OVID (1990-2009), and the Cochrane Library (Issue 2, 2009), and the proceedings of ASH were searched manually. The methodological quality of included studies was evaluated, and data analysis was performed with software STATA 10.0 and RevMan 4.3. Result A total of 4 RCTs involving 941 patients were included. The results of meta-analysis showed that overall survival rate (HR=0.82, 95%CI 0.49 to 1.15), event-free survival rate (HR=0.35, 95%CI 0.24 to 0.47), total remission rate (RR=0.35, 95%CI 0.96 to 1.30), and secondary malignant tumor incidence rate (RR=1.68, 95%CI 0.47 to 6.07). Conclusion According to the present evidences, autologous stem cell transplantation after high-dose chemotherapy can not improve overall survival rate and total remission rate, but can improve event-free survival rate, and do not increase secondary malignant tumor incidence rate. However, more high-quality, multiple-center, large-sample randomized controlled trials are required.
目的:比较宫颈癌术后的三维适形放疗(3D-CRT)和调强放射治疗(IMRT)放射治疗计划的剂量学差异。方法:使用Elekta公司的PrecisePLAN Release2.11计划系统设计常规四箱形野(3D-CRT)和调强放疗(IMRT)计划。通过剂量体积直方图比较二者的放射物理参数,评价其应用价值.结果:IMRT计划中靶区平均剂量略高于3D-CRT计划中的相应值,其靶区适形度明显占优。同时,IMRT计划中的膀胱、直肠、小肠、股骨头等危险器官受到的平均剂量低于3D-CRT计划中的相应值,除右股骨头受到的平均剂量差异没有统计学意义,其它数据的差异都具有统计学意义。结论:对于宫颈癌术后患者的放射治疗,IMRT技术在保证肿瘤放射剂量的同时最大限度地减少了危险器官的照射剂量,减少了并发症的发生,应该更广泛地应用于临床。