Comparaison de l’estimation du débit de filtration glomérulaire par le 99mTc-DTPA au radiotraceur de référence le 51Cr-EDTA comparativement aux méthodes basées sur la mesure de la créatininémie

Since the end of 2018, the distribution of the reference tracer for the measurement of glomerular filtration rate (GFR), the 51Cr-EDTA, is no longer provided by radiopharmaceutical companies around the world. In this study, we propose to compare the measurement of glomerular filtration rate by 99mTc-DTPA to that by 51Cr-EDTA. A double estimation of GFR by plasma clearance was performed in 12 patients, 10 of which were referred for GFR calculation prior to possible kidney donation. Linear regression coefficients and intraclass correlation coefficient (ICC) were calculated for the GFR measurement by 99mTc-DTPA, and by MDRD, CKD-EPI and Cockcroft and Gault formulas, relative to the 51Cr-EDTA measurement. The clearance measurement with 99mTc-DTPA is on average 7.25 [2.00; 14.96] mL/min/1.73m² higher than that of 51Cr-EDTA. The GFR measurement with 99mTc-DTPA showed a trend towards better agreement with the 51Cr-EDTA measurement in terms of linear regression parameters, but also in terms of ICC compared to the MDRD, CKD-EPI and Cockcroft and Gault methods. In conclusion, our study supports the use of the 99mTc-DTPA tracer in place of 51Cr-EDTA and shows a higher reliability compared to methods based on blood creatinine measurement.     

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。     

呼吸道感染患者多重耐药菌肺炎克雷伯菌的耐药及危险因素分析

摘要 目的：探讨与分析呼吸道感染患者多重耐药菌肺炎克雷伯菌的耐药及危险因素。方法：选择2015年1月到2020年2月本院诊治的呼吸道感染患者65例作为研究对象,收集患者的临床样本进行细菌分离与耐药分析,调查患者的临床资料并进行危险因素分析。结果：在呼吸道感染患者65例中,分离出多重耐药菌肺炎克雷伯菌32株,占比49.2 %,其中下呼吸道、上呼吸道、灌洗液、血液标本分别占50.0 %、9.4 %、25.0 %、6.3 %。32株多重耐药菌肺炎克雷伯菌对头孢曲松、头孢呋辛、氨苄西林、头孢吡肟、头孢噻肟的耐药率分别为71.9 %、87.5 %、96.9 %、84.4 %、81.3 %,对阿米卡星、头孢替坦、左氧氟沙星、亚胺培南、环丙沙星的敏感率分别为59.4 %、68.8 %、81.3 %、75.0 %、81.3 %。非条件 Logistic回归分析显示血型A型、碳青霉烯类抗菌药物使用、引流、机械通气、糖尿病等为导致多重耐药菌肺炎克雷伯菌感染的独立危险因素(P<0.05)。结论：多重耐药菌肺炎克雷伯菌感染在呼吸道感染患者中比较常见,对头孢呋辛、氨苄西林的耐药率比较高,对左氧氟沙星、环丙沙星的敏感率比较高,血型A型、碳青霉烯类抗菌药物使用、引流、机械通气、糖尿病等为导致多重耐药菌肺炎克雷伯菌感染的独立危险因素。     

CT定量分析在冠心病介入治疗前后血流灌注改变的评估价值

摘要 目的：探讨CT定量分析在冠心病介入治疗前后血流灌注改变的评估价值。方法：2018年2月到2020年11月选择在本院诊治的冠心病患者95例作为研究对象,所有患者都给予经皮冠状动脉介入治疗,在介入前1 d与介入后1个月进行CT定量与超声检查,随访介入后6个月的冠状动脉再狭窄情况并进行相关性分析。结果：所有患者都顺利完成介入治疗,介入期无严重并发症发生。95例患者介入后1个月的左室射血分数(ejectionfraction,EF)、左室短轴缩短率(fractionalshortening,FS)高于介入前1 d(P<0.05),介入前后左室等容舒张时间(iso-volumicrelaxationtime,IVRT)对比差异无统计学意义(P>0.05)。95例患者介入后1个月的心肌血流量(Myocardialbloodflow,MBF)、心肌血容量(Myocardialbloodvolume,MBV)高于介入前1d(P<0.05),达峰时间(Timetopeak,TTP)低于介入前1 d(P<0.05)。介入后随访6个月,冠状动脉再狭窄14例,再狭窄率14.7 %,其中中度狭窄12例,重度狭窄2例;Pearson分析显示冠心病患者介入前1 d的MBF、MBV、TTP与FS、EF都存在相关性(P<0.05);Logistic回归分析显示MBF、MBV、TTP、FS、EF为影响冠心病患者介入后随访再狭窄率的重要因素(P<0.05)。结论：CT定量分析在冠心病介入前后的应用能有效反映血流灌注改变情况,且与患者的心功能存在相关性,也可有效预测患者介入随访冠状动脉再狭窄发生情况。     

苓桂术甘汤联合电针风池供血穴治疗椎基底动脉供血不足性眩晕的临床研究

目的:探讨苓桂术甘汤联合电针风池供血穴治疗椎基底动脉供血不足(VBI)性眩晕的临床疗效。方法:选择2017年11月-2019年8月我院收治的VBI性眩晕患者145例为研究对象,采用随机数字表法分成联合组(75例)和对照组(70例)。在基础治疗的前提下,联合组采用苓桂术甘汤联合电针风池供血穴治疗,对照组采用西比灵治疗。比较两组临床疗效、眩晕改善情况、脑动脉血流速度指标、动脉硬化指数(AI)以及血液流变学指标。结果:治疗后联合组总有效率为89.33%,高于对照组的75.71%(P<0.05);治疗后联合组眩晕症状积分、欧洲眩晕评分量表(EEV)评分和眩晕障碍量表(DHI)评分低于对照组(P<0.05);联合组治疗后左侧动脉、基底动脉峰值流速(Vp)、左右侧动脉、基底动脉平均血流速度(Vm)均高于对照组,左侧动脉、基底动脉血管搏动指数(PI)、右侧动脉血管阻力指数(RI)、AI、高切全血黏度、中切全血黏度、低切全血黏度、血浆黏度、红细胞压积均低于对照组(P<0.05)。结论:苓桂术甘汤联合电针风池供血穴治疗VBI性眩晕,能够缓解患者的眩晕状况,疗效确切,改善脑动脉血流速度和脑动脉硬化程度,降低血液黏度。     

6MWT在评价老年肺结核应用及与血气分析相关性

摘要 目的：探究6分钟步行试验（6-minute walk test,6MWT）在评价老年肺结核患者病情中的应用,并分析6MWT同肺结核患者血气指标的相关性。方法：选择2019年1月至2019年12月于我院接受治疗的200例高龄肺结核患者为实验组,另选取同期于我院接受体格检查的50例健康个体为对照组,分别对两组患者实施6MWT实验,测量两组个体的步行距离、实验前后血氧饱和度（SpO₂）,计算SpO₂下降率,并对所有实验组患者实施肺功能实验,评估肺功能相关指标同6MWT相关性。结果：（1）对比显示实验组患者的6MWT、SpO₂、PaO₂明显低于对照组,PaCO₂高于对照组（P<0.05）;（2）实验前后比较显示实验组患者试验后的SpO₂、PaO₂低于实验前,PaCO₂高于实验前（P<0.05）;（3）相关性分析显示,实验组患者的6MWT同FEV1、FEV1/FVC呈正相关（P<0.05）;（4）相关性分析显示实验组患者的6MWT同SpO₂、PaO₂呈正相关,同PaCO₂呈负相关（P<0.05）。结论：6MWT同高龄肺结核患者肺功能及血气相关指标存在明显的相关性,可将6MWT作为老年肺结核患者病情评估指标之一。     

Growth performance,nutrient digestibility,blood parameters,and carcass characteristics by lambs fed an oregano and cobalt blend

Shifting ruminal fermentation via feeding a blend of oregano (Organum vulgare L.) essential oils and Co-lactate (EOC; Rum-A-Fresh, Ralco, Inc. Marshall, MN) could improve lamb growth and carcass performance. Eighteen Suffolk × Little Han Tail F1 male lambs (20.3 ± 0.23 kg BW and approximately 3 months old) were randomly assigned using a completely random design to one of three treatments. Treatments were (1) EOC0: basal ration without EOC, (2) EOC4: basal ration plus 4 g/d EOC, and (3) EOC7: basal ration plus 7 g/d EOC. Initial and 24 d BW was similar (P > 0.10), but at 48 and 72 d, lambs fed EOC7 demonstrated greater (P = 0.01) BW compared with EOC0 fed lambs, while lambs fed EOC4 were intermediate and similar (P > 0.05). Average daily gains (ADGs) for 0–24 and 0–72 d were greater (P < 0.05) for lambs fed EOC4 and EOC7 compared with lambs fed EOC0, while DM intake was similar (P > 0.10). Feed conversions for 0–24 d were improved (P < 0.02) for lambs fed EOC4 and EOC7 compared with lambs fed EOC0. However, 0–72-d feed conversions were greater (P < 0.01) for lambs fed EOC7 compared to lambs fed EOC0, with lambs fed EOC4 being intermediate and similar (P > 0.05). DM, NDF, and ADF digestibilities were similar (P > 0.10) among treatments, while CP digestibility was greater (P < 0.01) for lambs fed EOC4 and EOC7 compared with lambs fed EOC0. Carcass weight and dressing percentages were improved (P < 0.01) for lambs fed EOC7 compared with lambs fed EOC0 and EOC4. Head width was greater (P > 0.01) for lambs fed EOC7 compared with lambs fed EOC0 and EOC4, while rump width was greater (P > 0.01) for lambs fed EOC4 and EOC7 compared with lambs fed EOC0. Plasma triglyceride and cholesterol concentrations were lower (P < 0.05) for lambs fed EOC4 and EOC7 compared with lambs fed EOC0, while albumin, total serum protein, and glucose concentrations were greater (P < 0.05) for lambs fed EOC4 and EOC7 compared with lambs fed EOC0. Feeding an EOC blend as an alternative antibiotic growth promoter at 4 and 7 g/d linearly improved lamb growth performance, feed conversions, frame growth, carcass weights, dressing percentages, and immunity.     

Characterization of the growth plate-bone interphase region using cryo-FIB SEM 3D volume imaging

The interphase region at the base of the growth plate includes blood vessels, cells and mineralized tissues. In this region, cartilage is mineralized and replaced with bone. Blood vessel extremities permeate this space providing nutrients, oxygen and signaling factors. All these different components form a complex intertwined 3D structure. Here we use cryo-FIB SEM to elaborate this 3D structure without removing the water. As it is challenging to image mineralized and unmineralized tissues in a hydrated state, we provide technical details of the parameters used. We obtained two FIB SEM image stacks that show that the blood vessels are in intimate contact not only with cells, but in some locations also with mineralized tissues. There are abundant red blood cells at the extremities of the vessels. We also documented large multinucleated cells in contact with mineralized cartilage and possibly also with bone. We observed membrane bound mineralized particles in these cells, as well as in blood serum, but not in the hypertrophic chondrocytes. We confirm that there is an open pathway from the blood vessel extremities to the mineralizing cartilage. Based on the sparsity of the mineralized particles, we conclude that mainly ions in solution are used for mineralizing cartilage and bone, but these are augmented by the supply of mineralized particles.     

Anisotropic adaptive finite element method for modelling blood flow

In this study, we present an adaptive anisotropic finite element method (FEM) and demonstrate how computational efficiency can be increased when applying the method to the simulation of blood flow in the cardiovascular system. We use the SUPG formulation for the transient 3D incompressible Navier–Stokes equations which are discretised by linear finite elements for both the pressure and the velocity field.

Given the pulsatile nature of the flow in blood vessels we have pursued adaptivity based on the average flow over a cardiac cycle. Error indicators are derived to define an anisotropic mesh metric field. Mesh modification algorithms are used to anisotropically adapt the mesh according to the desired size field. We demonstrate the efficiency of the method by first applying it to pulsatile flow in a straight cylindrical vessel and then to a porcine aorta with a stenosis bypassed by a graft. We demonstrate that the use of an anisotropic adaptive FEM can result in an order of magnitude reduction in computing time with no loss of accuracy compared to analyses obtained with uniform meshes.     

The technique of detecting systolic and diastolic pressure from the transducer output of a PC-based blood pressure monitoring system

A pressure to voltage transducer is used along with a cuff, in a PC-based blood pressure and pulse rate monitoring system for human body. During the blood pressure measurement cycle, the output voltage of the pressure to voltage transducer is recorded digitally using a data acquisition system. The recorded data are then analyzed using software routines to determine the blood pressure and pulse rate of the person under test. However, it is difficult to identify the points of systole and diastole correctly from the recorded data. This paper presents the technique that may be used to determine the systolic and diastolic pressure from the collected data.