下肢动脉阻塞性病变多层螺旋CT 低剂量扫描成像初探

目的:探讨低剂量CT扫描在下肢动脉脉阻塞性病变诊断中的应用价值.方法:选择127段经DSA确诊的不同部位下肢动脉阻塞性病变行低剂量CT扫描,并采用MPR,VR,MIP等重建方法获得各下肢动脉CTA图像,将CTA图像与DSA图像的诊断结果利用统计学软件SAS8.1行加权Kappa一致性检验,检验水准为:Kaapa.系数大于0.75.结果:所得CTA图像与DSA图像诊断结果的一致性检验的kappa系数为0.8058,两种诊断结果的一致性为优.结论:采用低剂量扫描条件获得高质量的CTA图像在下肢动脉阻塞性病变的诊断上有肯定的价值.     

六味地黄丸联合小剂量雌孕激素替代疗法对围绝经期综合征患者性激素、骨密度和血脂的影响

摘要 目的：探讨六味地黄丸联合小剂量雌孕激素替代疗法对围绝经期综合征（PMS）患者性激素、骨密度和血脂的影响。方法：研究对象选取2018年12月~2020年5月期间我院接收的PMS患者93例,根据乱数表法将患者随机分为对照组（n=46）和研究组（n=47）,对照组给予小剂量雌孕激素替代疗法,研究组给予六味地黄丸联合小剂量雌孕激素替代疗法,28d为一个治疗周期,对比两组患者治疗3个周期后的疗效、性激素、腰椎L2～L4骨密度、血脂、子宫内膜厚度及不良反应。结果：治疗3个周期后,研究组的总有效率为91.49%（43/47）,高于对照组的76.09%（35/46）（P<0.05）。治疗3个周期后,研究组改良Kupperman评分表（KMI）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、促卵泡刺激素(FSH)、促黄体生成素(LH)低于对照组,高密度脂蛋白胆固醇（HDL-C）、子宫内膜厚度、腰椎L2～L4骨密度、雌二醇（E2）高于对照组（P<0.05）。两组不良反应总发生率对比差异无统计学意义（P>0.05）。结论：六味地黄丸联合小剂量雌孕激素替代疗法治疗PMS患者,可有效缓解临床症状,提高骨密度,改善PMS患者的性激素及血脂水平,疗效确切。     

Multiplicity-adjusted inferences in risk assessment: benchmark analysis with quantal response data

A primary objective in quantitative risk or safety assessment is characterization of the severity and likelihood of an adverse effect caused by a chemical toxin or pharmaceutical agent. In many cases data are not available at low doses or low exposures to the agent, and inferences at those doses must be based on the high-dose data. A modern method for making low-dose inferences is known as benchmark analysis, where attention centers on the dose at which a fixed benchmark level of risk is achieved. Both upper confidence limits on the risk and lower confidence limits on the "benchmark dose" are of interest. In practice, a number of possible benchmark risks may be under study; if so, corrections must be applied to adjust the limits for multiplicity. In this short note, we discuss approaches for doing so with quantal response data.     

A model for radiation-induced bystander effects, with allowance for spatial position and the effects of cell turnover

Bystander effects, whereby cells that are not directly exposed to ionizing radiation exhibit adverse biological effects, have been observed in a number of experimental systems. A novel stochastic model of the radiation-induced bystander effect is developed that takes account of spatial location, cell killing and repopulation. The ionizing radiation dose- and time-responses of this model are explored, and it is shown to exhibit pronounced downward curvature in the high dose-rate region, similar to that observed in many experimental systems, reviewed in the paper. It is also shown to predict the augmentation of effect after fractionated delivery of dose that has been observed in certain experimental systems. It is shown that the generally intractable solution of the full stochastic system can be considerably simplified by assumption of pairwise conditional dependence that varies exponentially over time.     

How to evaluate the risk-benefit ratio of the low-dose hormone replacement therapy?

Since the results of the women health initiative study showing an overall negative risk-benefit ratio with 0.625 mg of conjugated estrogens plus 2.5 mg of medroxyprogesterone acetate, the use of the lowest effective dose of steroids in hormone replacement therapy (HRT) is recommended.

A low-dose regimen appears to induce less side effects such as breast tenderness or leg pain than do higher dose preparations.

The decrease in hot flashes with low-dose estrogens, range 60–70%, is less than the 80–90% reduction with standard dosing. But this mean that 60–70% of menopausal women do not need higher doses.

The same applies to bone preservation which is dose dependent: the number of non-respondant women will be higher than with standard doses. However, randomized double-blind, placebo controls trials have defined positive effects on bone of low doses of HRT with adequate calcium and Vitamin D in elderly women. The use of bone densitometry and of biochemical markers of bone turnover is mandatory in women using low or ultra-low-dose preparations.

In spite of the lack of trials conducted with low-dose HRT, this treatment seems to be safer:

• the plasma levels of estradiol are lower; as far as breast cancer risk is concerned, the decrease of this subrogate marker is considered as favourable;

• the increase in breast density is less pronounced;

• the nurses's health study found a dose relationship for stroke, with no increase in risk with low-dose of estrogens;

• the effects on subrogate markers of cardiovascular risk seem to be more favourable.

Beside the low-dose HRT, one must consider some other facts:

• the “critical window” theory: it is biologically plausible that HRT, if started early after the menopause can slow the progression of coronary atherosclerosis;

• the way of administration of HRT: some observational studies have shown no increase in the risk of venous thromboembolism risk among women treated with transdermal estrogens;

• the progestogen used: a French cohort study recently performed found no increase in breast cancer risk with the use of micronized progesterone meanwhile the increase in risk observed with other progestogens was similar to the findings of the WHI study.

In the future, it is conceivable that more comprehensive pharmacogenomic studies will lead to effective algorithms for individualizing the right dose of steroids to be used in HRT.     

The accumulation of chromosome aberrations and Dlb-1 mutations in mice with highly fractionated exposure to gamma radiation

The dichotomy between the doses at which experimental measurements of genetic effects can be made and the doses to which people are exposed is often different by two or more orders of magnitude. This presents a significant problem when determining the effects of low doses of radiation or chemicals. The solution has usually involved extrapolating the data by curve-fitting or by applying theoretical considerations. Both approaches are unsatisfactory due to uncertainties of the assumptions used in each process. The alternative solution has been to increase the sample size enormously at the lower doses. This is impractical beyond a certain point due to the variation in the spontaneous frequency and the need to quadruple the sample size for a doubling of precision. The development of new methods for measuring stable genetic effects, however, permits a simple and effective approach to this problem: if the genetic events being detected have no effect on survival, i.e., are selectively neutral, then the effects of multiple independent treatments will be additive. If the independent treatments are identical, then the effect of each is easily calculated by dividing the total effect by the number of treatments. Here we report a limited test of this approach using mice. Chromosome aberrations induced in lymphocytes and Dlb-1 mutations induced in the small intestine were measured after daily doses of 0.64, 1.85 or 5.5 cGy ¹³⁷Cs gamma rays administered for 21, 42 or 63 days. The dose response curve for chromosome translocations obtained in this way, combined with the data from single larger acute doses, shows no evidence for a threshold over a 500-fold dose range. Dlb-1 mutations were increased at each dose and time but the results do not permit reliable extrapolations. The results suggest that translocations might be useful for quantifying the effect of doses below 0.05 cGy and that the effect of dose rate and dose fractionation at much lower doses than reported here could be investigated.     

Relationship between radiation induced adaptive response in human fibroblasts and changes in chromatin conformation

Chromatin conformation changes in the normal human fibroblasts VH-10 were studied by the method of anomalous viscosity time dependence (AVTD). Gamma-irradiation of cells in a dose range of 0.1–3 Gy caused an increase in maximal viscosity of cell lysates. Conversely, irradiation of cells with low doses of 0.5 or 2 cGy resulted in a decrease in the AVTD peaks with a maximum effect approximately 40 min after irradiation. The same exposure conditions were used to study a possible adaptive effect of low doses, measured by changes in cell survival. A primary dose of 2 cGy caused significant modification of cell response to a challenge dose. Approximately 20% protection to challenge doses of 0.5 Gy (p < 0.003), 2 Gy (p < 0.02) and 2.5 Gy (p < 0.002) was observed. However, the direction of this effect (adaptation or synergism) was found to be dependent on a challenge dose. The combined effect of 2 cGy and 1 Gy was significantly synergistic, while no modification was observed for 1.5 Gy and 3 Gy. A partial correlation was found between the AVTD changes and cell survival when the combined effect of a primary dose of 2 cGy and challenge dose was examined. The dose of 2 cGy alone increased survival by 16% (p < 0.0003). These results suggest that the low-dose induced effects on survival may be related to chromatin reorganization.     

Low-dose melphalan-induced shift in the production of a Th2-type cytokine to a Th1-type cytokine in mice bearing a large MOPC-315 tumor

The current studies demonstrate that MOPC-315 tumor cells secrete large amounts of interleukin-10 (IL-10), which contributes to the inhibitory activity of MOPC-315 culture supernatants for the in vitro generation of antitumor cytotoxicity by MOPC-315-immune spleen cells. Moreover, addition of neutralizing monoclonal anti-IL-10 antibody to the in vitro stimulation cultures of cells from the tumor infiltrated spleens of mice bearing a large MOPC-315 tumor resulted in the generation of enhanced anti-MOPC-315 cytotoxicity. In contrast, addition of monoclonal anti-IL-10 antibody to the in vitro stimulation cultures of splenic cells from mice that are in the final stages of immune-mediated tumor eradication as a consequence of low-dose melphalan (l-phenylalanine mustard; L-PAM) therapy (and whose spleens no longer contain metastatic tumor cells) did not lead to enhancement in the in vitro generation of antitumor cytotoxicity. The cessation of IL-10 secretion as a consequence of low-dose L-PAM therapy of MOPC-315 tumor bearers was found to be accompanied by the acquisition of the ability to secrete interferon (IFN) by the splenic cells. In addition, by day 2 after low-dose L-PAM therapy a drastic decrease in the amount of IL-10 secreted by the s.c. tumor nodules was noted, which preceded the accumulation of tumor-infiltrating lymphocytes capable of secreting IFN. Thus, low-dose L-PAM therapy of mice bearing a large MOPC-315 tumor leads to a shift in cytokine production from a Th2-type cytokine to a Th1-type cytokine, and it is conceivable that this shift in cytokine production plays an important role in the low-dose L-PAM-induced acquisition of antitumor immunity by hitherto immunosuppressed mice bearing a large MOPC-315 tumor.Supported by research grant IM-435 from the American Cancer Society and CA54413 from the National Cancer InstituteIn partial fulfillment of the requirements for the Doctor of Philosophy DegreeRecipient of career development award CA-01350 from the National Cancer Institute     

不同剂量瑞芬太尼复合小剂量艾司氯胺酮用于腹腔镜妇科手术患者的效果及对麻醉效能、疼痛的影响

摘要 目的：研究不同剂量瑞芬太尼复合小剂量艾司氯胺酮对腹腔镜妇科手术患者麻醉效果的影响。方法：选取2020年4月～2023年2月在本院接受腹腔镜妇科手术治疗的60例患者进行研究,根据瑞芬太尼静脉输注剂量将其分为小剂量组、中剂量组和大剂量组,每组各20例。三组均给予患者小剂量艾司氯胺酮（0.1 μg?kg）,小剂量组给予患者0.1 μg/（Kg?min）瑞芬太尼,中剂量组给予患者0.3 μg/（Kg?min）瑞芬太尼,大剂量组给予患者0.5 μg/（Kg?min）瑞芬太尼。记录三组患者的麻醉起效时间、麻醉诱导时间、拔管时间和不良反应发生率,并检测其不同时间段的血流动力学和疼痛。结果：麻醉起效、麻醉诱导拔管时间比较,三组无显著差异（P＞0.05）。平均动脉压（MAP）和心率（HR）比较,大剂量组和中剂量组T1、T2时间段均低于小剂量组,中剂量组T1、T2时间段低于大剂量组;三组T2时间段MAP、HR水平低于T0、T1时间段,T1时间段低于T0时间段（P＜0.05）。疼痛视觉模拟量表（VAS）评分比较,大剂量组和中剂量组T1、T2时间段均低于小剂量组,中剂量组T1、T2时间段低于大剂量组;三组T2时间段MAP、HR水平低于T0、T1时间段,T1时间段低于T0时间段（P＜0.05）。不良反应发生率比较,三组无显著差异（P＞0.05）。结论：不同剂量瑞芬太尼复合小剂量艾司氯胺酮均能保障腹腔镜妇科手术的麻醉效果和安全性,但中剂量瑞芬太尼的应用更有利于稳定血流动力学,并减轻患者的疼痛程度。     

Low-dose CT measurements of airway dimensions and emphysema associated with airflow limitation in heavy smokers: a cross sectional study

Background

Increased airway wall thickness (AWT) and parenchymal lung destruction both contribute to airflow limitation. Advances in computed tomography (CT) post-processing imaging allow to quantify these features. The aim of this Dutch population study is to assess the relationships between AWT, lung function, emphysema and respiratory symptoms.

Methods

AWT and emphysema were assessed by low-dose CT in 500 male heavy smokers, randomly selected from a lung cancer screening population. AWT was measured in each lung lobe in cross-sectionally reformatted images with an automated imaging program at locations with an internal diameter of 3.5 mm, and validated in smaller cohorts of patients. The 15^th percentile method (Perc15) was used to assess the severity of emphysema. Information about respiratory symptoms and smoking behavior was collected by questionnaires and lung function by spirometry.

Results

Median AWT in airways with an internal diameter of 3.5 mm (AWT_3.5) was 0.57 (0.44 - 0.74) mm. Median AWT in subjects without symptoms was 0.52 (0.41-0.66) and in those with dyspnea and/or wheezing 0.65 (0.52-0.81) mm (p<0.001). In the multivariate analysis only AWT_3.5 and emphysema independently explained 31.1%and 9.5%of the variance in FEV₁%predicted, respectively, after adjustment for smoking behavior.

Conclusions

Post processing standardization of airway wall measurements provides a reliable and useful method to assess airway wall thickness. Increased airway wall thickness contributes more to airflow limitation than emphysema in a smoking male population even after adjustment for smoking behavior.