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Objective To investigate the characteristics of clopidogrel-associated thrombocytopenia to provide references for clinically safe drug use.Methods The case reports of thrombocytopenia induced by clopidogrel published in PubMed,Embase,CNKI,Wanfang and VIP were searched from the establishment of each database to November 2022,and their occurrence was collated and analysed.Results A total of 44 cases from 43 articles were identified and included in the analysis.There were 30 males(68.2%)and 14 females(31.8%).Ages ranged from 37 to 88(65.0±11.4)years,of which 30(68.2%)were ≥60 years old.Thrombocytopenia was found from 8 h to 9 months after medication,of which 29 cases(65.9%)appeared within two weeks.There were 31 cases(70.5%)with severe thrombocytopenia and 38 cases(86.4%)with complications,of which 24 cases(63.2%)with bleeding and 19 cases(50.0%)with thrombotic thrombocytopenic purpura(TTP).The platelet countof41 cases(93.2%)returned to normal after drug withdrawal and symptomatic treatment,and 3 cases(6.8%)died finally.Conclusion Clopidogrel related thrombocytopenia is mainly severe thrombocytopenia,and often accompanied by bleeding or thrombotic thrombocytopenic purpura(TTP),but the overall outcome is good.Platelet count should be regularly monitored within the first two weeks after medication.Clopidogrel should be stopped and symptomatic treatment should be given in case of any abnormality.
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OBJECTIVE To comprehensively evaluate the three oral Janus kinase inhibitors (JAKi) such as upadacitinib, abrocitinib and baricitinib in the treatment of atopic dermatitis. METHODS The six dimensions of safety, efficacy, economy, appropriateness, accessibility and innovativeness were used for evaluation. Meta-analysis was conducted to evaluate the safety and efficacy of three oral JAKi; pharmacoeconomic studies were searched, and the treatment costs were calculated to evaluate the economy of each JAKi. Appropriateness was described based on literature review and drug labels. Accessibility of three oral JAKi was assessed by using a questionnaire survey. The innovation of JAKi was elucidated from the perspective of its mechanism of action. RESULTS In terms of safety, the incidence of upper respiratory tract infection (OR=1.47, 95%CI of 1.04-2.08, P=0.03) and nasopharyngitis (OR=1.44, 95%CI of 1.06-1.95, P=0.02) in the upadacitinib 30 mg group was significantly higher than that in the placebo group; the incidence of nasopharyngitis in baricitinib 4 mg group was significantly higher than that in the placebo group (OR=2.24, 95%CI of 1.39-3.61, P=0.000 8) and baricitinib 2 mg group (OR=0.48, 95%CI of 0.31-0.74,P=0.001). In terms of efficacy, regardless of the dosage, all three JAKi groups were superior to the placebo group, and the high-dose groups of upadacitinib and abrocitinib were superior to the low-dose groups (P<0.000 1). In terms of economy, the annual treatment cost of baricitinib was the lowest (13 870.0 yuan), but it has not been approved for atopic dermatitis indication in China; next was upadacitinib (27 192.5 yuan). In terms of appropriateness, the overall appropriateness of the three JAKis was good, but none of them was suitable for patients with severe liver injury. In terms of accessibility, baricitinib had the highest availability rate (59.4%), but the affordability of upadacitinib was relatively good under China’s medical insurance system. In terms of innovation, among the three types of JAKi, upadacitinib and abrocitinib had better innovation. CONCLUSIONS Three oral JAKi treatments for atopic dermatitis have controllable safety and good efficacy. Considering the issue of medical insurance reimbursement, it is recommended that Chinese patients use upadacitinib.
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OBJECTIVE To evaluate the quality of guidelines/consensus on therapeutic drug monitoring (TDM) of anti-tumor necrosis factor-α (TNF-α) in patients with inflammatory bowel disease (IBD) in China and globally. METHODS PubMed, Embase, CNKI, Wanfang data, VIP, and release websites of guidelines/consensus in China and globally were searched to collect guidelines/expert consensus on TDM with anti-TNF-α for IBD patients. The search period was from database establishment to June 2023. After two investigators independently screened the literature and extracted the data, the methodological quality of the included guidelines/consensuses was evaluated using the Appraisal of Guidelines for Research and Evaluation Ⅱ. The main recommendations of the included guidelines/consensuses were summarized. RESULTS A total of 9 articles were included, 3 were guidelines and 6 were expert consensus. The standardized percentages of the 9 guidelines/consensus in the 6 dimensions (scope and aims, participants, rigor of formulation, clarity of expression, application, and editorial independence) were 90.43%, 41.98%, 52.55%, 85.49%, 19.00%, and 76.85%, respectively. Eight guidelines/consensus had a recommendation of grade B and one consensus of grade C. The main recommendations involve TDM application scenarios, threshold ranges, strategy adjustments, detection methods, and interpretation of results. Most guidelines/consensus recommend passive TDM for non-responders. It is recommended to set the TDM concentration range according to the expected treatment results and make strategy adjustments in combination with the disease condition and TDM results. Additionally, the same test method is recommended for the same patient. Some guidelines/consensus hold that no differences were noted in the interpretation of results between biosimilar and original drug. CONCLUSIONS The overall quality of the included guidelines/consensus was fair, with relatively consistent recommendation. Clinicians need to understand the characteristics and limitations of TDM with this class of drugs, and interpret and apply results of TDM in combination with specific clinical treatment goals.
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OBJECTIVE To develop a whole-process intelligent model of pharmaceutical care for peritoneal dialysis (PD) patients, and to provide a reference for clinical pharmacists to provide standardized PD pharmaceutical care. METHODS The pharmaceutical care mode of PD patients at home and abroad was investigated and analyzed. Based on the actual situation of the First Affiliated Hospital of Soochow University (hereinafter referred to as “our hospital”), with “home→PD center outpatient→ inpatient department” as the main node, the recycling process of medication reconciliation was optimized. The whole-process intelligent pharmaceutical care model of PD was illustrated by improving the Chinese version of the drug-related problems (DRPs) classification tool, developing the corresponding pharmaceutical care process, and presenting specific cases. RESULTS Based on the medication therapy management (MTM) platform, our hospital had built a closed-loop PD whole-process intelligent pharmaceutical care model of “in-hospital pharmaceutical care (building document)-PD outpatient MTM-home pharmaceutical care (online App management)”. A “double cycle” workflow of “admission→discharge→outpatient” medication reconciliation cycle and “discovery-analysis-intervention-follow-up-record-evaluation” DRPs cycle was formed. CONCLUSIONS The establishment of the whole-process intelligent pharmaceutical care model for PD in our hospital provides experience for standardizing pharmaceutical care for PD patients, and can reduce DRPs.
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Objective:To understand the 131I activity in thyroid of therapy workers in nuclear medicine department, and estimate the annual committed effective dose, in order to analyze the internal exposure of them. Methods:Six hospitals were investigated and 131I activity of thyroid was measured. The detection rate and activity value of thyroid 131I activity of therapy workers in nuclear medicine department were obtained from the six hospitals, and then the intake and annual committed effective dose were calculated. Results:A total of 63 iodine therapy workers from six hospitals were measured and 131I was detected for 52 workers among them, with the detection rate of 83% and 131I activities mostly lower than 200 Bq. The estimated annual committed effective dose ranged from 0.23 to 7.78 mSv. The annual committed effective dose to 84.6% of the workers was less than 2 mSv. Conclusions:Iodine therapy workers in nuclear medicine department should receive routine internal exposure personal monitoring, and the radiation protection system in all hospitals needs to be further improved.
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Objective To investigate the clinical application of multi-criteria optimization (MCO) in radiotherapy for cervical cancer. Methods A retrospective analysis was performed on the clinical data of 15 patients who received radiotherapy for cervical cancer in Shandong Cancer Hospital and Institute. A fixed field intensity-modulated radiotherapy plan was re-optimized using 9 fields on the Halcyon platform, with the goal of achieving a target coverage of > 95% and the lowest dose to organs at risk. The plan was refined until it reached the goal (Plan I) and was calculated using MCO to reach the goal (Plan MI), and the quality assurance verification was performed. The Wilcoxon rank-sum test was used to compare design time, target coverage, radiation dose to organs at risk, and number of monitor units between the plans. Results Both plans met the clinical requirements. There were no significant differences in target dose indices between Plan I and Plan MI (P > 0.05). Plan MI reduced the maximum dose to the small intestine by 0.51 Gy (P < 0.05). There was no significant difference in dose coverage between the bladder and the rectum (P > 0.05). Compared with Plan I, Plan MI saved 34.04 min in design time (P < 0.05). Conclusion MCO can improve the optimization and adjustment, significantly shorten the design time, and improve the efficiency of the plan.
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OBJECTIVE:To investi gate the role of clinical pharmacists in the treatment of delayed excretion of acute renal failure (ARF) with epileptic seizure caused by HD-MTX in a patient ,and to provide reference for rational drug use and pharmaceutical care in such type of patients. METHODS :A patient with diffuse large B-cell lymphoma was given HD-MTX for chemotherapy,and ARF caused by delayed methotrexate excretion occurred on the second day after methotrexate administration. Clinical physicians adjusted the rescue dose and frequency of calcium folinate but the effect was poor. Clinical pharmacists analyzed the causes of delayed methotrexate excretion by reviewing literature and combining with the patient ’s condition. It was suggested to monitor the blood concentration of methotrexate ,strengthen alkalization and hydration ,increase the volume of intravenous sodium bicarbonate from 125 mL to 250 mL,take Sodium bicarbonate tablets orally ,and monitor the pH value of urine (pH value of urine maintained above 7). In addition ,the pharmacist told the patient to drink water as much as possible to ensure the daily urine output reached 3 000 to 4 000 mL. The blood concentration of methotrexate was 16.14 μmol/L 44 h after administration ,which proved to be excretion delay. The patient had epileptic seizure on the 13th day after methotrexate medication. The physician gave sodium valproate 0.8 g intravenously to control epilepsy. The clinical pharmacist conducted pharmaceutical care for the patient ,and found that the compliance of the patient taking Sodium bicarbonate tablets and Sodium valproate tablets orally was not good ,so medication education and pharmaceutical care were conducted ,then the patient accepted and took the drugs on time. RESULTS : The physician adopted the suggestions of the pharmacist to monitor the blood concentration of methotrexate and performed symptomatic treatment. The urine volume of the patient increased ,the edema was reduced ,serum creatinine gradually returned to normal,and renal function recovered gradually ;the symptoms of epilepsy was controlled. CONCLUSIONS :In the treatment process of ARF complicated with epileptic seizure caused by excretion delay of HD-MTX ,the clinical pharmacist assisted physician to improve the treatment plan and conducted pharmaceutical care and medication education for the patient ,therefore ensure the safe and rational use of drugs .
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Objective:To understand the activity concentration of 131I aerosol in the air of the iodine treatment workplace and estimate the internal dose of 131I inhaled by medical staff in nuclear medicine. Methods:Using CF-1001BRL portable large capacity air sampler, the 131I aerosol in the iodine treatment workplace of nuclear medicine department of 6 hospitals in Shandong province was collected by iodine box, and the HPGe-γ energy spectrometer was used to measure the samples. The 131I activity concentration in iodine treatment workplace at 6 hospitals was obtained, and the internal dose to medical staff was estimated. Results:The 131I activity concentration in the air in iodine treatment workplaces at 6 hospitals ranged from 3.64 to 2.94×10 3 Bq/m 3. The 131I activity concentration in the controlled area (ward, patient passageway, subpacking room, operation administration room) was significantly higher than that in the supervised area. The highest 131I activity concentration, 2.62×10 2 Bq/m 3, in the supervised area was found in the medical care passageway. The estimated effective dose to nuclear medicine workers was 0.07-5.68 mSv, not exceeding the national limit. Conclusions:The phenomenon of 131I aerosol contamination still exists in the iodine treatment workplaces of nuclear medicine departments in hospitals, so it is necessary to carry out internal radiation monitoring for nuclear medicine departments all around the country, and explore more reasonable protection standards and methods.
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Objective:To investigate the predictive value of blood routine and blood biochemical indicators for immunotherapy combined with chemotherapy-related interstitial pneumonia (IP) in patients with diffuse large B-cell lymphoma (DLBCL).Methods:The data of 151 newly-diagnosed DLBCL patients treated with rituximab combined with chemotherapy in the First Affiliated Hospital of Soochow University from December 2017 to October 2020 were retrospectively analyzed. According to whether IP occurred, the patients were divided into IP group and non-IP group. The patient's clinical data and baseline laboratory test results were collected. The differences in clinicopathological features and laboratory indicators between IP group and non-IP group were analyzed. In addition, the relationship between the variety of blood routine and blood biochemical indicators and the occurrence of IP was analyzed. The receiver operating characteristic (ROC) curve of the selected indicators to predict the occurrence of IP was drawn, and the predictive performance of each indicator was analyzed.Results:The incidence of IP was 9.3% (14/151) in DLBCL patients after receiving immunotherapy combined with chemotherapy. The lymphocyte count (LYM) in IP group at the first diagnosis was higher than that in non-IP group [1.60×10 9/L (1.40×10 9/L, 2.51×10 9/L) vs. 1.28×10 9/L (0.89×10 9/L, 1.78×10 9/L), U=-2.194, P=0.028], but there was no significant difference in the levels of platelet count, neutrophil count, monocyte count, lactate dehydrogenase (LDH), α-hydroxybutyrate dehydrogenase (α-HBDH), serum albumin (ALB) and the proportion of patients with elevated C-reactive protein (CRP) between the two groups (all P > 0.05). Compared with the laboratory indicators in non-IP group before the 4th cycle of treatment, LYM and ALB in IP group were significantly reduced at IP onset [0.72×10 9/L (0.46×10 9/L, 0.92×10 9/L) vs. 0.93×10 9/L (0.71×10 9/L, 1.15×10 9/L), 32.9 g/L (28.6 g/L, 34.9 g/L) vs. 40.3 g/L (36.1 g/L, 43.1 g/L)], but LDH and α-HBDH increased [332 U/L (255 U/L, 396 U/L) vs. 233 U/L (200 U/L, 286 U/L), 277 U/L (206 U/L, 315 U/L) vs. 189 U/L (159 U/L, 229 U/L)], and the differences were statistically significant (all P<0.05). The proportion of patients with elevated CRP in IP group was high than that in non-IP group [100.0% (14/14) vs. 56.9% (78/137), P=0.001]. The area under ROC curve of LYM, ALB, LDH and α-HBDH alone for predicting the occurrence of IP was 0.668, 0.820, 0.789 and 0.802. The best cut-off values of ALB, LDH and α-HBDH was 34.6 g/L, 241 U/L and 199 U/L. ALB had the highest sensitivity for predicting the occurrence of IP (81.8%). The areas under ROC curve of ALB+LDH, ALB+α-HBDH, LDH+α-HBDH, ALB+LDH+α-HBDH for predicting the occurrence of IP was 0.850, 0.844, 0.777 and 0.851, respectively. LDH+α-HBDH had the highest predictive sensitivity (92.9%), but the specificity was low (53.3%). The prediction sensitivity (both 78.6%) and specificity (both 86.1%) of ALB+LDH and ALB+LDH+α-HBDH were high. Conclusions:DLBCL patients are at risk of IP during immunotherapy combined with chemotherapy. The increased LYM at initial diagnosis is a risk factor for the occurrence of IP. The variety of LYM, ALB, LDH, α-HBDH and CRP during the treatment may be related to the occurrence of IP. Among them, ALB, LDH and α-HBDH have important predictive values for the occurrence of IP.
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Objective By measuring the induced radioactivity of the medical electron linear accelerator, and analyzing the measuring results and the measuring process, the cooling law of the induced radioactivity was studied, to provide basic data for evaluating additional doses to patients, medical staff and the public. Methods Five Medical Electron Linear accelerators were used to measure the induced radioactivity by using automes-6150AD6/H+6150AD-b/H x-γ radiation peripheral dose equivalent rate meter for environmental monitoring. Results The level of induced radioactivity of 5 medical electron linear accelerators is related to the factors such as measuring position and time: 10 second after the end of beam output, the maximum dose equivalent rate is 5.55 μSv/h around 5 cm on the surface of the head housing of the accelerator, and the maximum ambient dose equivalent rate at 1 m from the fixed point of the housing is 4.07 μSv/h, 5 minutes after the end of output, the maximum dose equivalent rate is 2.11 μSv/h around the 5 cm surface and 1.77 μSv/h around the 1 m fixed point. Conclusion The measured radioactivity induced by the medical electron linear accelerator gradually cools over time, the measurement valuesare maintained in a relatively fixed range, and the fluctuation range of the values is narrow.
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OBJECTIVE:To evaluate the benefit and risk of tirofiban in the treatment of acute coronary syndrome (ACS),and to provide evidence-based reference for clinical drug selection and decision. METHODS :Retrieved from domestic and foreign database as PubMed ,the Cochrane Library ,CNKI and Wanfang database ,during the establishment of database to Apr. 2020,two researcher independently screened the literature based on inclusion and exclusion criteria and extracted the data. After the quality evaluation of the included literatures ,based on rapid health technology assessment ,the extracted results were classifiedly evaluated and comprehensively analyzed. RESULTS :A total of 13 researches of systematic review/Meta-analysis and 1 research of pharmacoeconomics were included. Compared with placebo ,tirofiban could significantly reduce all-cause mortality [OR =0.68, 95%CI(0.54,0.86),P=0.000 1] and the incidence of major adverse cardiac events (MACE)in patients with ACS [RR =0.24, 95%CI(0.14,0.40),P<0.01],and increased the incidence of TIMI 3 [OR=5.73,95%CI(2.99.10.97),P<0.01]. Tirofiban and eptifibatide had similar therapeutic efficacy in the treatment of ACS ,but tirofiban significantly increased the risk of TIMI small bleeding in patients with ACS [RR =0.61,95%CI(0.38,0.98),P=0.04]. For ACS patients with non-ST elevation (NSTE-ACS), compared with placbo ,tirofiban significantly reduced the incidence of MACE [RR =0.76,95% CI(0.61,0.96),P=0.018],but significantly increased the risk of bleeding [OR =1.49,95%CI(1.12,1.98),P=0.006],while there was no significant difference in its effects on the all-cause mortality of NSTE-ACS patients (P>0.05). For STEMI patients ,compared with placebo ,tirofiban significantly reduced the all-cause mortality [RR=0.61,95%CI(0.35,1.05),P=0.007] and the incidence of MACE [RR =0.63,95% CI(0.44,0.90),P=0.007]. When combined with liposuction ,tirofiban also significantly reduced the incidence of MACE [RR = 2.05,95%CI(1.71,2.46),P<0.01],and significantly increased the incidence of TIMI 3 [OR=3.18,95% CI(2.4,4.22),P< 0.01],but there was no significant difference in its effects on bleeding risk (P>0.05). The included pharmacoeconomic study showed that patients treated with bivalutine could get 10.07 QALYs,patients treated with heparin combined with tirofiban could get 9.98 QALYs,and the incremental cost-effectiveness ratio bivalutine compared to the latter one was 28 575.77 yuan/QALYs,which was lower than 3 times of the per capita GDP of some cities. CONCLUSIONS :Tirofiban has good efficacy in the treatment of ACS,but it can increase the risk of bleeding than eptifibatide and placebo. Domestic bivalirudin treating for ACS has a cost-effectiveness advantage over tirofiban combined with heparin.
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Objective@#To estimate the doses to patients from ERCP operation through experimental measurements.@*Methods@#A retrospective analysis was made of 56 ERCP operations in three hospitals, and meanwhile, the tube voltage and current, fluoroscopy time, accumulated doses, DAPs (dose-area product) and photographic frames were also recorded for statistical analysis. Three cases of RECP operation that had led to high, medium and low DAP values were selected, respectively, as high, medium and low dose groups based on anthropomorphic phatom (AP). ERCP operation was simulated on AP on the basis of putting TLDs in it. The absorbed doses of organs were measured while effective doses while calculated.@*Results@#The effective doses for high, medium and low groups were 2.69, 11.52 and 39.27 mSv, respectively. The effective dose was 14 times higher in high dose group than that in low group. The highest organ doses for three groups were all concentrated in the irradiation fields.@*Conclusions@#Organ doses from ERCP phantom experiments vary largely in different groups. Compared with phantom experiments of other interventional types, ERCP can be regarded as one of interventional means leading to high-dose. It is advisable to reasonably and safely use intervention diagnosis and therapy and in order optimize radiation doses to patients.
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Objective To estimate the doses to patients from ERCP operation through experimental measurements.Methods A retrospective analysis was made of 56 ERCP operations in three hospitals,and meanwhile,the tube voltage and current,fluoroscopy time,accumulated doses,DAPs (dose-area product) and photographic frames were also recorded for statistical analysis.Three cases of RECP operation that had led to high,medium and low DAP values were selected,respectively,as high,medium and low dose groups based on anthropomorphic phatom (AP).ERCP operation was simulated on AP on the basis of putting TLDs in it.The absorbed doses of organs were measured while effective doses while calculated.Results The effective doses for high,medium and low groups were 2.69,11.52 and 39.27 mSv,respectively.The effective dose was 14 times higher in high dose group than that in low group.The highest organ doses for three groups were all concentrated in the irradiation fields.Conclusions Organ doses from ERCP phantom experiments vary largely in different groups.Compared with phantom experiments of other interventional types,ERCP can be regarded as one of interventional means leading to high-dose.It is advisable to reasonably and safely use intervention diagnosis and therapy and in order optimize radiation doses to patients.
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Objective To evaluate the effectiveness and safety of percutaneous nephrolithotomy(PCNL) with the all-seeing needle system (Microperc) for the treatment of upper urinary calculi in children.Methods Retrospective analysis of 25 cases of upper urolithiasis treated with Microperc from November 2016 to January 2018 in Guizhou Provincial People's Hospital was performed,including 18 boys and 7 girls.The age of patients was (6.4 ± 3.9) years (10 months-14 years),and 4 cases were less than 3 years old.Among them,3 cases had upper ureteral calculi and 22 cases had renal calculi.The mean stone size was 14.5 mm(8-20 rmm).Stone fragmentation was performed by using a 200 μm holmium (YAG laser fiber).Results All patients were successfully treated in stage I.In 6 patients,access was achieved through the 4.8Fr all-seeing needle method.Conversion to mini-PCNL (10-12Fr) was required in 19 patients due to intraoperative bleeding and high stone burden.The duration of operation time was (60.8 ± 15.1) min (40-100 rain).The mean postoperative drop in hemoglobin was (7.5 ± 5.4) g/L,and no patient required blood transfusion.The hospital stay was (4.9 ± 1.2) days (3-6 days).There were residual fragments in 3 patients,and the overall stone-free rate at 4 weeks was 88% (22/25 cases).Four cases had a fever(Clavien grade Ⅰ) complications,while no grade Ⅱ and grade Ⅲ complications were observed.Conclusions Microperc can establish a surgical channel through visual images quickly and safely,and it greatly reduces the risk and difficulty in doing operation.This technology is not only suitable for learner of surgery,but also for patients with mild hydronephrosis and children with calculus.
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Objective@#To evaluate the effectiveness and safety of percutaneous nephrolithotomy(PCNL) with the all-seeing needle system(Microperc)for the treatment of upper urinary calculi in children.@*Methods@#Retrospective analysis of 25 cases of upper urolithiasis treated with Microperc from November 2016 to January 2018 in Guizhou Provincial People′s Hospital was performed, including 18 boys and 7 girls.The age of patients was (6.4±3.9) years(10 months-14 years), and 4 cases were less than 3 years old.Among them, 3 cases had upper ureteral calculi and 22 cases had renal calculi.The mean stone size was 14.5 mm(8-20 mm). Stone fragmentation was performed by using a 200 μm holmium(YAG laser fiber).@*Results@#All patients were successfully treated in stage I. In 6 patients, access was achieved through the 4.8Fr all-seeing needle method.Conversion to mini-PCNL (10-12Fr) was required in 19 patients due to intraoperative bleeding and high stone burden.The duration of operation time was (60.8±15.1) min (40-100 min). The mean postoperative drop in hemoglobin was (7.5±5.4) g/L, and no patient required blood transfusion.The hospital stay was (4.9±1.2) days (3-6 days). There were residual fragments in 3 patients, and the overall stone-free rate at 4 weeks was 88%(22/25 cases). Four cases had a fever(Clavien grade Ⅰ) complications, while no grade Ⅱ and grade Ⅲ complications were observed.@*Conclusions@#Microperc can establish a surgical channel through visual images quickly and safely, and it greatly reduces the risk and difficulty in doing operation.This technology is not only suitable for learner of surgery, but also for patients with mild hydronephrosis and children with calculus.
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Objective To explore the improvement of cognitive impairment in patients with mild and moderate vascular cognitive impairment( VCI) treated with cerebralcare granule ( CG) and basic treat-ment.Methods From October in 2014 to December in 2016 year,143 cases of VCI patients were admitted from six hospitals in some areas of Hebei Province as the research objects,and divided into CG treatment group (experimental group,n=98) and conventional treatment group (control group,n=66).Three months and six months after treatment,the score of mental state examination ( MMSE) ,the Montreal cognitive assess-ment scale ( MoCA) and the daily living capacity scale( ADL) of the two groups were compared after 3 and 6 moths of treatment.Results ①The total score of MMSE in the experimental group was higher than that of the control group for six months after treatment, and the difference was statistically significant ( ( 23. 76 ± 4.02) vs (21.52±5.13),P<0.05).②Six months after treatment,the total score of MoCA ((21.06±4.66) vs (18.32±5.20)) and visual spatial/executive function((3.05±1.37) vs (2.42±1.66)),calculation force ((2.24±0.84) vs (1.83±1.05)) and orientation ability((5.20±1.12) vs (4.06±1.35)) scores in the ex-perimental group were significantly higher than those in the control group (P<0.05) .③Six months after treat-ment,the ADL score in the experimental group was lower than that before treatment,and the difference was statistically significant((24.96±8.74) vs (29.20±11.55),P<0.05);while there was no significant difference in the ADL score between the experimental group and the control group after 6 months (P>0.05).Conclusion CG can improve cognitive function in mild to moderate VCI patients,mainly in visual space/execution func-tion,calculation ability and orientation ability,and with the extension of treatment time,the curative effect is more obvious.
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Objective To estimate the absorbed dose and effective dose to the examined adult patients during digital tomosynthesis and to provide reference data for radiation dosimetry.Methods The phantom experiments were grouped according to the examined site(main beam scanned site),and the data displayed in real time during digital tomosynthesis are used as conditions for the phantom experiments.The effective doses to the examined patients were estimated on the basis of phantom scanning and tissue-absorbed dose calculation.Results During digital tomosynthesis,the effective doses to the examined patients of various groups were 0.524 mSv for head,0.736 mSv for cervical spine,2.719 mSv for thoracic vertebra,1.810 mSv for chest,1.240 mSv for lumbar spine,2.317 mSv for abdomen and 2.316 mSv for pelvis,respectively.Conclusions During digital tomography,the highest value of effective doses was estimated to be 2.719 mSv in thoracic vertebra group,followed by abdominal group 2.317 mSv and pelvic group 2.316 mS,with the lowest 0.524 mSv in head group.The main factors influencing the effective dose include tube voltage,total mAs,irradiation field size,main beam irradiation range,and the number of tissues or organs in scanned range.
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Objective To assess the activity of Crohn’s disease (CD)by using the quantitative parameter of dynamic contrast-enhanced MRI (DCE-MRI).Methods 50 CD patients with ileocecal solitary lesion were recruited in this study.All of patients underwent con-ventional and DCE-MRI.The quantitative parameter of volume transfer constant (Ktrans )and the clinical data including Harvey-Brad-show index (HBI)and C-reactive protein (CRP)were recorded.(1)the reliability and repeatability of Ktrans measurement were analyzed. (2)the correlation between Ktrans value and clinical data was analyzed by using Pearson analysis.(3)according to HBI,all of the CD patients were divided into severe group,mild-moderate group,and static group.The differences of Ktrans values among the three groups were compared by using Mann-Whitney U test.Results (1)the reliability of Ktrans measurement was high (Cronbach’s Alpha=0.993).(2)there was positive correlation between HBI and Ktrans(r=0.635,P<0.001),and between CRP and Ktrans(r= 0.764,P<0.001).(3)there was significant difference of Ktrans value between the static group and the mild-moderate group (P<0.001),be-tween the static group and the severe group (P<0.001),and.between the mild-moderate group and the severe group (P<0.001). Conclusion Quantitative parameter of DCE-MRI (Ktrans )had a high reliability and can be used to assess the inflammation activity of CD.
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Objective Visceral pain in patients with inflammatory bowel disease (IBD) may be associated with the abnormal processing of pain in the central nervous system.The aim of the study is to investigate the characteristic changes of brain functions in the IBD patients using resting-state functional magnetic resonance imaging (rs-fMRI) with the amplitude of low-frequency fluctuation (ALFF) algorithm.Methods This study included 27 cases of IBD treated in our hospital from December 2015 to August of 2016 and 21 healthy volunteers as normal controls.We recorded the high-resolution structure imaging and rs-fMRI data, compared the brain activities of the two groups patients by ALFF analysis, and evaluated the correlation of the ALFF values with the clinical parameters of the IBD patients.Results Compared with the normal control group, the IBD patients showed significantly decreased ALFF values in the medial frontal gyrus, right putamen, right insula, left middle cingulate gyrus (MCC), and bilateral supplementary motor region (P<0.05), increased ALFF values in the middle frontal gyrus, left superior frontal gyrus, and medial prefrontal lobe region (P<0.05).The ALFF values in the inferior parietal lobule, precuneus and MCC of the IBD patients were correlated negatively with the blood sedimentation rate (r=-0.537,-0.588, and-0.588, P<0.05), disease course (P<0.05), and C-reactive protein (CRP) level (P<0.05), while that in the medial frontal gyrus positively with the CRP level (r=-0.623, P<0.001).Conclusion IBD patients have abnormal ALFF values in various brain regions, mainly in those involved in the processing of visceral pain and emotion.
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[Abstract ] Objective Stenosis is a common complication of Crohn′s disease (CD), different treatments for different cau-ses.The article aimed to investigate bowel stenosis by the application of MRI diffusion-weighted imaging(DWI) and explore its value of identifying CD. Methods From Jan 2014 to Jun 2014, 31 patients with histologically proven CD (18 males and 13 females;mean age:38.90 ±13.65 years) were recruited in this approved retrospective study .All patients underwent conventional 3.0T MRI and DWI sequences .According to the most serious stenosis part identified by MRI , DWI sequence examination was added and the apparent diffusion coefficient (ADC) of the lesion was measured.All patients would undergo colonoscopy in 24 hours.According to the endo-scopic manifestations and pathological results , the patients were divided into inflammatory group (n=21) and fibrotic group (n=10). We observed the difference of ADC between two groups and worked out the cutoff points . Results In the inflammatory group , the ADC value andthe mean ADC value of stenosis bowel wall were (1.01 ±1.83) ×103 mm2/s and (1.40 ±0.23) ×103 mm2/s, whereas (0.53 ±1.03) ×103 mm2/s and (0.80 ±0.16) ×103 mm2/s in the fibrotic group(P<0.05).The area under receiver operating characteristic curve was 0.981 (95%confidence interval 0.943-1.000), taking 1.11 ×103mm2/s as the cutoff point.The sensitivity of low ADC values in detecting inflammatory bowels was 90.5%, and the specificity of high ADC values in excluding inflammatory bowels was 100%. Conclusion Different pathological components limit the movement of water molecular at different degrees , therefore quantitative parameters can be acquired by measuring ADCs , which contributes to the identification and diagnosis of CD secondary bowel stenosis.