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Objective:To investigate the application value of susceptibility-weighted imaging (SWI) in the diagnosis of intracranial dural arteriovenous fistula (DAVF).Methods:Patients with DAVF confirmed by digital subtraction angiography (DSA) in Weihai Municipal Hospital from January 2014 to January 2021 were retrospectively included. All patients underwent conventional T 1-weighted imaging (T 1WI), T 2-weighted imaging (T 2WI) and SWI, and some patients also underwent 3D time-of-flight magnetic resonance angiography (3D-TOF-MRA). Results:A total of 36 patients with DAVF were enrolled, 29 of them received 3D-TOF-MRA. The fistula location of 24 patients (24/36, 66.7%) underwent SWI and 26 patients (26/29, 89.7%) underwent 3D-TOF-MRA were correctly judged, and the difference was statistically significant (Fisher's Exact Test, P=0.039). SWI showed that the proportion of patients with thickened supply arteries (7/36, 19.4%) was significantly lower than that on 3D-TOF-MRA (14/29, 48.3%; χ2=6.105, P=0.013). T 2WI, 3D-TOF-MRA and SWI showed no cerebral venous abnormalities in all 7 patients with DAVF without cortical venous reflux; in 29 patients with DAVF with cortical venous reflux revealed by DSA, SWI and T 2WI showed all patients (100%) and 26 patients (89.7%) had superficial venous dilatation respectively, but there was no significant difference ( χ2=0.693, P=0.405). SWI showed medullary vein dilation in 17 patients (47.2%), and only 2 patients (5.6%) had medullary vein thickening on T 2WI, and the difference was statistically significant ( P<0.001). The proportion of patients with venous cerebral infarction on T 2WI was significantly higher than that on SWI (22.2% vs. 0%; Fisher’s Exact Test P=0.005), and the proportion of patients with intracerebral hemorrhage on SWI was significantly higher than that on T 2WI (61.1% vs. 25.0%; χ2=9.574, P=0.004). Conclusion:SWI is helpful to evaluate the abnormal drainage vein of DAVF and the secondary changes in brain, especially intracerebral hemorrhage.
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OBJECTIVE:To investigate the effects of clinical pharmacists participating in the implementation of clinical path-way under the condition of disease diagnosis related groups-prospective payment system(DRGs-PPS),and to provide reference for promoting rational drug use in the clinic. METHODS:Patients with femoral neck fracture in the clinical pathway were collected from our hospital as research objects. The patient collected during Jan.-Dec. 2015 were included in control group(52 patients includ-ed,41 patients completed)and those collected during Jan.-Dec. 2016 were included in observation group(58 patients included,46 patients completed). Clinical pharmacists participated in the implementation of clinical pathway in observation group,and provided technological intervention and administrative intervention. No intervention was performed in control group. Hospitalization time, hospitalization cost,drug cost and ADR were observed in 2 groups. The rationality of antibiotics for prophylactic use,analgesic drugs,adjuvant drugs,anti-osteoporosis drugs and anticoagulant were compared between 2 groups. RESULTS:After clinical pharma-cists participating in the implementation of clinical pathway in observation group,there was no statistical significance in hospitalization time or the incidence of ADR between 2 groups(P>0.05); hospitalization cost and drug cost of observation group were significantly lower than those of control group,with statistical significance(P<0.05). Medication time and cost of antibiotics for prophylactic use,cost of analgesic drugs,medication time of adjuvant drugs in observation group were significantly shorter/lower than control group;type of anti-osteoporosis drugs was significantly more than control group,with statistical significance(P<0.05). CONCLUSIONS:Under DRGs-PPS,the participation of linical pharmacists participating in the implementation of femoral neck fracture clinical pathway can play an important role in regulating the clinical rational use of 5 kinds of drugs and ensuring the safety,effectiveness and econom-ics of drug use.
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OBJECTIVE:To provide reference for clinical rational use of antibiotics. METHODS:The use of antibiotics in our hospital from Jan. 2012 to Dec. 2015 was analyzed,the DDDs was calculated,bacterial resistance rates over the same period was analyzed,and the relationship between them were analyzed with Pearson method. RESULTS:During 2012-2015,the top 3 antibiot-ic DDDs in our hospital were cephalosporins,macrolides and quinolones;bacterial with the top 5 detection rate was Escherichia co-li,Pseudomonas aeruginosa,Klebsiella pneumoniae,Acinetobacter Bauman and Staphylococcus aureus;the DDDs of imipenem cilastatin sodium showed a positive correlation with the resistance rate of P. aeruginosa(r=0.95,P<0.05)and the total resistance rate of Gram-negative bacteria (r=0.98,P<0.05),meropenem showed a positive correlation with the resistance rate of K. pneu-moniae(r=0.97,P<0.05),piperacillin sulbactam sodium showed a negative correlation with the resistance of P. aeruginosa(r=-0.98,P<0.05). CONCLUSIONS:DDDs is correlated with the antibiotic drug resistance rate of bacteria,which should be planned and scientific used to reduce the bacterial resistance.
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Objective To investigate the influence of microbleeds on the onset and development of different types of stroke. Methods According to stroke subtypes, 163 patients were classified into lacunar infarction (n= 56), transient iscbemia attach (n=31), atherothrombotic infarction (n=37), intracerebral hemorrhage (n=39), and control groups (n=43). Suaceptibility-weighted imaging , T1WI, T2WI and diffusion-weighted imaging were performed with 3.0 T system to observe cerebral microbleed and infarction. Results The incidence and the number of micrehleeds were significantly greater in patients with intracerebral hemorrhage (75.6% and 14.5±11.6, re-spectively),then lacunar infarction and therothrombetic infarction atherothrombotic infarction [(55.3% and 8.1± 3.4), (37.8% and 4.5±2.6)] and the incidence and the number of microhleeds in above groups are higher than transient ischemia attach (9.7% and 0.3±0.1), and controls (9.3% and 0.2±0.1) (P<0.01). There was a correlation between the number of microbleeds and the severity of lacunar infarction, aslo a correlation between the number of microbleeds and the number of intracerebral hemorrahages (r=0.402, P<0.001). Conclusion Microb-leeds are closely associated with stroke, which may indicate more advanced microangiopathy and higher risk of bleeding.
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Objective To investigate the pathogenesis of the syringomyelia in Chiari I malformation by measuring the posterior cranial fossa structures. Methods The posterior cranial fossa structures on mid sagittal MR image were measured in 50 normal subjects,and 24 Chiari I malformation patients associated with syringomyelia and 26 Chiari I malformation patients without syringomyelia. The t test was used for statistical analysis. Results In Chiari I malformation patients and normal subjects, the width of the CSF space anterior to the medulla oblongata was (4 2?1 8) mm and (6 6?1 4) mm respectively( t =7 30, P 0 05). In Chiari I malformation with syringomyelia group and without syringomyelia group, the width of the CSF space anterior to the medulla oblongata was (2 9?1 4) mm and (5 5?1 1) mm respectively( t =7 30, P
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Objective To study the diagnostic value of proton magnetic resonance spectroscopy(MRS) in patients with minimal hepatic encephalopathy(MHE).Methods MRS of cingulated cortex and frontal lobe were acquired using point resolved echo spin spectroscopy(PRESS) sequences in 26 patients with MHE.Peak area of each metabolite,including NAA,Cr,Cho,mI,Glx and their ratios to Cr were computed,respectively.Then the results were compared with normal control group.Results Compared with the normal control group,MHE group showed significant decreased Cho/Cr,mI/Cr(P0.05).Conclusions The patients with MHE show that Cho and mI significantly decrease and Glx significantly elevate in cingulate cortex and frontal lobe on MRS.Diagnostic value of MRS is significant to MHE.