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Is computed tomography cystography indicated in children with pelvic fractures?

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Chinese Journal of Traumatology 2020年第3期23卷 181-184页

作者： Alexander Becker Ori Yaslowitz Joseph Dubose Kobi Peleg Yaakov Daskal Adi Givon israel Trauma Group Boris Kessel Department of Surgery Emek Medical Center.AfulaIsrael The Rappoport School of Medicine TechnionHaifaIsrael Department of Surgery A Meir Medical CenterKfar-SabaIsrael R Adams Cowley Shock Trauma Center University of Maryland Medical SystemBaltimoreMDUSA National Center for Trauma and Emergency Medicine Research Gertner Institute for Epidemiology and Health Policy ResearchTel HashomerIsrael Emergency and Disaster Management Department Faculty of Medicine.School of Public Health.Tel-Aviv UniversityIsrael Trauma Unit Hillel Yaffe Medical CenterHaderaIsrael

Purpose: Pelvic fracture evaluation with abdominopelvic computed tomography (CT) and formal CT cystography for rule out of urine bladder injury have been commonly employed in pediatric trauma patients. The additional delayed imaging required to obtain optimal CT cystography is, however, associated with increased doses of ionizing radiation to pelvic organs and represent a significant risk in the pediatric population for future carcinogenic risk. We hypothesized that avoidance of routine CT cystography among pediatric pelvic fracture victims would not result in an appreciable rate of missed bladder injuries and would aid in mitigating the radiation exposure risk associated with these additional ***: A retrospective cohort study involving blunt trauma pelvic fractures among pediatric trauma patients (ageisraeli National Trauma Registry. Statistical analysis was performed using SAS statistical software version 9.4 via the tests of Chisquare test and two-sided Fisher’s exact test. Ap value of less than 0.05 was considered statistically ***: A total of 1072 children were identified from the registry for inclusion. Mean age of patients was 7.7 years (range 0-14) and 713 (66.5%) were male. Overall mortality in this population was 4.1% (44/1072). Only 2.1% (23) of pediatric patients with pelvic fractures had bladder injury identified, with just 9 children having intraperitoneal bladder rupture (0.8% of all the patients).Conclusion: The vast majority of blunt pediatric trauma victims with pelvic fractures do not have urine bladder injuries. Based on our study results we do not recommend the routine utilization of CT cystography in this unique population.

关键词： Tomography,X-ray computed Cystography Bladder injury Child Pelvic fracture

异丙酚降低帕金森病患者丘脑下核神经元放电活动

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麻醉与镇痛 2012年第3期8卷 76-80页

作者： Aeyal Raz, md, PhD Dan Eimerl, md Adam Zaidel, MSc Hagai Bergman, md, PhD Zvi israel, md 吴德华(译) 曹晖(校) 徐美英(校) Rabin Medical Center Beilison Hospital Petah Tikva: Hadassah Hebrew University Medical Center Jerusalem Hebrew University Hadassah Medical School Jerusalem Israel 不详

背景治疗帕金森病患者时，通常采用微电极记录仪（microelectrode recording，MER）记录丘脑下核（subthalamic nucleus，STN）神经元峰电位活动来指导实施在STN植入深部脑刺激（deep brain stimulation，DBS）电极。镇静药物对丘脑下... 详细信息

背景治疗帕金森病患者时，通常采用微电极记录仪（microelectrode recording，MER）记录丘脑下核（subthalamic nucleus，STN）神经元峰电位活动来指导实施在STN植入深部脑刺激（deep brain stimulation，DBS）电极。镇静药物对丘脑下核的微电极记录干扰程度如何目前仍不清楚。本研究监测了异丙酚镇静期间丘脑下核神经元放电活动，及对神经元电活动的影响。方法选择需要进行深部脑电刺激手术的帕金森病患者，固定电极定位于丘脑下核部位，给患者静脉输注异丙酚50μg·kg^-1·mm^-1，直到患者处于稳定镇静期。记录神经元电活动，计算异丙酚输注前、中、后神经元电活动的均方根（root mean square，RMS）。结果16例患者中记录了24次电极轨迹的活动，异丙酚注射后其中18次出现明显的丘脑下核电活动的均方根降低。异丙酚输注期间，平均均方根降低23．2％±9．1％（均数±标准差）（P〈0．001），停止输注后回到基线时间为（9．3±4．0）分钟。结论异丙酚输注导致丘脑下核神经峰电活动显著降低，说明它可能干扰丘脑下核边缘微电极记录电活动的识别。停止异丙酚输注后，神经元电活动很快恢复到基线，因此，异丙酚在微电极记录仪指导DBS前可安全地使用。

关键词：神经元放电活动异丙酚镇静帕金森病丘脑患者神经元电活动微电极记录静脉输注

胎儿心律失常的产前诊断——一种新的心脏超声技术

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中国医学影像技术 1986年第1期 65+67-65+67页

作者： israel Shapiro,刘吉斌 md

胎儿心律失常通常被多普勒检查发现。某些心律失常可引起胎儿心衰水肿甚至死亡。亟需在胎儿出生前诊断心律失常的类型:因为①某些心律失常可通过给母亲服药来纠正,使肺已成熟的胎儿提前出生则可

关键词：胎儿心律失常心音图心脏功能试验多普勒

依据清创术后细菌培养结果确定开放骨折创面关闭时机

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中华骨科杂志 2011年第3期31卷 I0001-I0005页

作者： Christopher J. Lenarz, md J. Tracy Watson, md Berton R. Moed, md Heidi israel, PhD, RN J. Daniel Mullen MSPH, BA, BS James B. MacDonald, BS 叶伟胜(译) Investigation performed at the Department of Orthopaedic Surgery Division of Orthopaedic Traunutology Saint Louis University School of Medicine Saint Louis Missouri 天津医院创伤骨科 300211

背景：目前，对开放骨折创面缝合关闭的时机尚没有客观的标准。许多学者对于开放骨折创面缝合关闭最佳时机提出了各种各样的建议，但均依据主观评判的参数。本研究的目的是应用前瞻性方法，在四肢开放骨折清创和冲洗木后，依据创面细菌... 详细信息

背景：目前，对开放骨折创面缝合关闭的时机尚没有客观的标准。许多学者对于开放骨折创面缝合关闭最佳时机提出了各种各样的建议，但均依据主观评判的参数。本研究的目的是应用前瞻性方法，在四肢开放骨折清创和冲洗木后，依据创面细菌培养结果来指导创面的缝合关闭时机。方法：本组对422例急诊开放骨折患者，进行了创面清创冲洗、骨折固定和开放创面处理。清创术后创面采样进行厌氧菌和有氧菌培养。清创术后48h，患者再次手术。如果初次细菌培养结果为阳性，则再次进行冲洗和清创术，之后再次留取菌培样本。创面不关闭直到细菌培养结果为阴性为止，否则重复进行冲洗和清创术。结果：在422例开放骨折中，有346例获得了长期随访。全组创面深部感染率为4｜3％。GustiloⅡ型开放骨折创面深部感染率为4％，GustiloⅢ型开放骨折为5．7％。在GustiloⅢ型开放骨折中，依骨折类型不同，感染率出现变化，GustiloⅢA型开放骨折为1．8％，GustiloⅢB型开放骨折为10．6％，GustiloⅢC型开放骨折为20％。需要反复清创的骨折患者，伴有糖尿病患者以及体重指数增加的患者，感染率均出现上升。研究数据表明，开放骨折在菌培阳性条件下关闭创面（违反本研究原则）并未显著增加深部感染风险（p=0．0501）。结论：采用本文提出的标准处理方法，与历史对照方法相比，开放骨折深部感染率降到很低。但取得这样结果是以增加冲洗和清创术次数为代价。可信水平：治疗性研究Ⅳ级。关于证据等级的完整描述详见投稿须知。

关键词：四肢开放骨折创面关闭清创术后培养结果细菌 GustiloⅢC型骨折患者再次手术

A new index for measuring aging inequality: An application to Asian countries

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Health 2012年第9期4卷 685-694页

作者： Mohammed Taj Uddin md. Nazrul Islam Ahmad Kabir Dilip Chandra Nath Department of Statistics Gauhati University Guwahati India Department of Statistics Shahjalal University of Science and Technology Sylhet Bangladesh

Although the Gini coefficient is an ideal measure of income inequality, it may be applied to measure the aging inequality in a society. In this paper, an attempt has been made to develop alternative measures of aging inequality based on the Gini index. The study uses the secondary population data of Asian countries collected from the international data base, US census Bureau. From the analysis it is observed that the Gini coefficient shows equally sensitivity at all levels. The coefficient is more concern for the country which are closed to the line of absolute equality. For example, the sensitivity level in the Gini coefficient is observed much higher in israel than in Qatar. The logarithmic transformation of Gini coefficient does not work well because it violates the transfer principle. The Geometric measure of Gini coefficient fails to measure inequality because of violating the transfer principle. On the other hand, the logarithmic transformation of geometric equivalent of the Gini coefficient works better because it shows more sensitivity than the Gini coefficient and satisfies the transfer principle. From the analysis it is also found that the trigonometric measure of Gini coefficient works better than the logarithmic transformation of geometric equivalent of the Gini coefficient because it satisfies transfer principle as well as shows higher sensitivity. Therefore, the trigonometric measure of the Gini coefficient is the best measure of aging inequality among the measures considered in the study.

关键词： Inequality Aging Gini Index Geometric Measure

预扩张硬膜外腔可减少硬膜外导管误入血管的发生率

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麻醉与镇痛 2008年第6期4卷 70-75页

作者： Shmuel Evron, md Vladimir Gladkov, md Daniel I. Sessler, md Vadim Khazin, md Oscar Sadan,md Mona Boaz, PhD Tiberiu Ezri, md 张瑞林(译) 郭政(校) Department of Anesthesia Edith Wolfson Medical Center Holon and Sackler School of Medicine Tel Aviv University Israel Outcomes Research Institute and Department of Anesthesiology and Perioperative Medi-cine University of Louisville Louisville Kentuckyl Department of Outcomes Research Cleveland ClinicCleveland Ohio Departments of Obstetrics and Gynecology and Epidemiology Edith Wolfson MedicalCenter Holon and Sackler School of Medicine Tel Aviv University Israel 不详

背景硬膜外导管误入静脉是硬膜外腔麻醉或镇痛的常见并发症。在初步研究和以往报道的基础上，我们试图证明这种假设：用盐水预扩张硬膜外腔，可使硬膜外导管更容易置入并可减少导管误入静脉的发生率。方法203例接受硬膜外麻醉的产妇被... 详细信息

背景硬膜外导管误入静脉是硬膜外腔麻醉或镇痛的常见并发症。在初步研究和以往报道的基础上，我们试图证明这种假设：用盐水预扩张硬膜外腔，可使硬膜外导管更容易置入并可减少导管误入静脉的发生率。方法203例接受硬膜外麻醉的产妇被随机分为2组。一组为扩张组：在硬膜外导管置入前行阻力消失试验时注入生理盐水5ml，并且保持注射入口处于封闭状态；一组为非扩张组：在硬膜外导管置入前行阻力消失试验时注入生理盐水2ml。两组均在置入导管后通过硬膜外导管注入1．5％利多卡因试验剂量3ml。结果扩张组：硬膜外导管误入血管的发生率明显降低（2％vs16％，P=0．0001）。扩张组91％患者未出现阻滞不全，而非扩张组为67％（P=0．0001）。2组镇痛起效时间差异小（扩张组：5．0±2分钟，非扩张组：6．0±3分钟，P=0．0001）且无临床意义。2组间镇痛效果（视觉模拟评分和罗哌卡因用量）相似。结论置入硬膜外导管前注入5ml生理盐水预扩张硬膜外腔可减少导管误入静脉和麻醉阻滞不全的发生率。

关键词：硬膜外导管误入血管硬膜外腔麻醉发生率预扩张生理盐水导管置入试验剂量视觉模拟评分

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Introduction

Journal of Geriatric Cardiology 2005年第1期2卷 2-2页

作者： Samuel J.Shubrooks Guest Editor Associate Professor of Medicine Harvard Medical School Co-director Cardiac Catheterization Laboratory Cardiovascular Division Beth israel Deaconess Medical Center Jr. md

Since the population worldwide is becoming increasingly older and heart disease, at least in much of the world, remains a leading cause of death, it is not surprising that there is growing interest in innovative metho... 详细信息

关键词： Introduction PCI

透皮东莨菪碱贴剂联合昂丹司琼对比单独应用昂丹司琼用于预防门诊手术后恶心呕吐的一项随机双盲多中心研究

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麻醉与镇痛 2010年第5期6卷 34-40页

作者： Tong J. Gan, md Ashish C. Sinha, md, PhD Anthony L. Kovac, md R. Kevin Jones, md, CPI Stephen A.Cohen,md,MBA Jean P. Battildaa, MS Jonathan S. Deutsch, md Joseph V. Pergolizzi, Jr., md] TDS Study Group 王琦(译) 李文志(校) Department of Anesthesiology Duke University Medical Center Durham North Carolina University of Pennsylvania Philadelphia Pennsylvania ＊University of Kansas Medical Center Kansas City Kansas Accurate Clinical Trials Inc./Saddleback Memorial Medical Center Laguna Hills California Beth israel Deaconess Medical Center Boston Massachusetts Baxter Healthcare Corporation New Providence New Jersey Departrnent of Medicine Johns Hopkins University School of Medicine Baltimore Maryland The TDS Study Group consists of the following members: Gregory H. Adkisson (St. Agnes Healthcare Inc. Baltimore MD St. Agnes Healthcare Inc. Clinical Research Center Baltimore MD) I(eith Candiotti(University of Miami School of Medidne Jackson Health Systems Miami FL) Stephen & Cohen(Beth Israel Deaconess Medical Center Boston MA) Nell R. Connelly(Baystate Medical Center Springfield MA) Patricia L. Dalby(Magee Women's Hospital of UPMC Pittsburgh PA) Robert D'Angelo(Forsyth Medical Center Winston-Salem NC) Albert R. Davis(Loyola University Medical Center Chicago IL) David 1L Drover (Stanford Hospital and Clinics Stanford CA) Tong J. Gan Fernando Altermatt Dianne Scott(Duke University Medical Center Durham NC Duke Health Raleigh Hospital Raleigh NC and Duke Center for Aesthetic Services Durham NC) Joseph S. Gimbel(AZ Research Center John C. Lincoln Hospital North Mountain and John C. Lincoln Hospital Deer Valley Phoenix AZ)R.Kevin Jones (Saddleback Memorial Medical Center Laguna Hills CA) Anthony L. Kovac(University of Kansas Medical Center Kansas City Kansas KS) John B. Leslie(Mayo Clinic Hospital Phoenix AZ) Roberta McI(inney Jr. (Trinity Clinic North Park Mother Frances Hospital and Tyler Square Tyler TX) Tricia A. Meyer ( Scott and White Hospital Temple TX ) Joseph Pergolizzi (Physicians Day Surgery Center Naples FL) Beverly tC Philip (Brigham and Women's Hospital Boston MA) Martin I. Redmond(State University of New York at Stony Brook Ambulatory Surgica

背景手术后恶心、呕吐（PONV）是门诊手术常见的并发症。本试验目的是观察透皮东莨菪碱贴剂（TDS）联合静脉注射昂丹司琼（OND）对门诊患者PONV的疗效是否优于单独应用昂丹司琼。方法此项随机双盲多中心的临床试验纳入了620例接受门诊... 详细信息

背景手术后恶心、呕吐（PONV）是门诊手术常见的并发症。本试验目的是观察透皮东莨菪碱贴剂（TDS）联合静脉注射昂丹司琼（OND）对门诊患者PONV的疗效是否优于单独应用昂丹司琼。方法此项随机双盲多中心的临床试验纳入了620例接受门诊腹腔镜或隆胸手术的PONV高危女性患者，进入手术室前2小时分别给患者贴上TDS贴剂或外观相同的空白贴剂。在全麻诱导前2—5分钟给所有患者静脉注射OND4mg。手术后24~48小时评估止吐是否完善（彻底止吐标准为无呕吐或干呕，且没有追加止吐药）。同时记录发生呕吐、干呕、恶心以及追加止吐药的患者比例，记录手术后首次发生PONV的时间及离院时间，记录呕吐、干呕、恶心的发作次数与严重程度及患者对于止吐治疗的满意度。结果TDS＋OND组与OND组相比，手术后24小时恶心、呕吐的发生率显著降低，但手术后48小时两者差异无显著性。TDS＋OND组没有呕吐、干呕且未追加过止吐药的患者占48％，而OND组占39％（P〈0．02）。TDS＋OND组的彻底止吐（无恶心、呕吐或干呕，且未追加止吐药）率显著高于OND组（分别为35％和25％，P〈0．01）。TDS＋OND组手术后首次发生恶心、呕吐、干呕及追加止吐药的时间明显晚于OND组（P〈0．05）。前者不良反应的总发生率也低于后者（分别为36．7％和49％，P〈0．01）。结论与单独应用OND相比。TDS＋OND能更大程度地减少PONV，主要是通过减少不良反应而获得。

关键词：手术后恶心呕吐东莨菪碱贴剂多中心研究昂丹司琼门诊手术随机双盲应用单独

中年女性和男性发生高血压的余生风险—— Framingham心脏研究

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美国医学会杂志（中文版） 2003年第3期22卷 124-130页

作者： RamachandranS.Vasan,md AlexaBeiser,PhD SudhaSeshadri,md MartinG.Larson,ScD WilliamB.Kannel,md RalphB.D‘Agostino,PhD DanielLevy,md 金雪娟 the National Heart Lung and Blood Institute's Framingham Heart StudyFraminghamMass Preventive Medicine and Epidemiology Boston University Boston Mass School of Medicine Epidemiology and Biostatistics Boston University Boston Mass the National Heart Lung and Blood Institute's Framingham Heart StudyFraminghamMass Department of Neurology Boston University Boston Mass School of Public Health and the Department of Mathematics Boston University Boston Mass the National Heart Lung and Blood Institute's Framingham Heart StudyFraminghamMass Preventive Medicine and Epidemiology Boston University Boston Mass the Divisions of Cardiology and Clinical Epidemiology Beth Israel Deaconess Medical CenterBoston

目的：确定年龄较长的美国成年人余生发生高血压的风险并评估此风险的时间趋势。结果：55岁和65岁两组参试者发生高血压以及1期以上高血压(血压≥1140／90mmHg，不论治疗与否)的余生风险均为90％。一生中接受降压药治疗的概率为60％。... 详细信息

目的：确定年龄较长的美国成年人余生发生高血压的风险并评估此风险的时间趋势。结果：55岁和65岁两组参试者发生高血压以及1期以上高血压(血压≥1140／90mmHg，不论治疗与否)的余生风险均为90％。一生中接受降压药治疗的概率为60％。与较早的1952-1975年的资料相比，1976-1998年女性总高血压的风险无变化，而男性则上升了约60％。与此相反，男性与女性发生2期以上高血压(血压≥10／100MHg，不论治疗与否)的余生风险在近期均显著降低(1952-1975年的35％-75％比1976-1998年的35％-44％)，其原因可能是血压很高并接受治疗者显著增多。结论：中年和中年以上者高血压的余生风险为90％，表明这是一巨大的公众健康负担。虽然2期以上高血压的终生风险下降表明已经取得了较大成绩，但仍应努力开展高血压的一级预防。

关键词：高血压余生风险血压测量短期风险