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Kümmell病影像学参数测量及临床意义

Kümmell病影像学参数测量及临床意义

作者：强宏宇内蒙古医科大学

学位级别：硕士

目的:统计各期Kümmell病椎体内真空裂隙征(intravertebral vacuum cleft,IVC)的发生率,并将各期的IVC影像学参数进行比较,探索其与Kümmell病病情严重程度之间的关系;明确Kümmell病患者的病程、腰椎骨密度值、伤椎前缘压缩程度、脊柱... 详细信息

目的:统计各期Kümmell病椎体内真空裂隙征(intravertebral vacuum cleft,IVC)的发生率,并将各期的IVC影像学参数进行比较,探索其与Kümmell病病情严重程度之间的关系;明确Kümmell病患者的病程、腰椎骨密度值、伤椎前缘压缩程度、脊柱后凸Cobb角和IVC影像学参数之间的相关性;通过对比影像学表现有IVC组和无IVC组各项数据,探讨IVC可能的发生机制。方法:利用内蒙古医科大学第二附属医院的电子病历系统、影像存储与传输(vision picture archiving and communication system,VISIONPACS)临床浏览系统和美国豪洛捷公司发现者号(Hologic Discovery)双能X线骨密度仪操作系统,严格按照纳入排除标准筛选2019年1月至2022年12月于内蒙古医科大学第二附属医院脊柱外科中心住院的所有患者,共纳入临床诊断为Kümmell病的患者89例。记录患者性别、年龄、病程、病变椎体、腰椎骨密度值等信息,测量伤椎椎体前缘高度、伤椎上下相邻椎体的前缘高度、脊柱后凸Cobb角和IVC影像学参数,并用伤椎椎体前缘高度和伤椎上下相邻椎体的前缘高度的平均值计算伤椎前缘压缩程度。采用SPSS 25.0统计软件进行数据处理,统计Kümmell病各期IVC的发生率;分析腰椎骨密度值、病程、脊柱后凸Cobb角、伤椎前缘压缩程度、IVC影像学参数之间的相关性;通过对有IVC组与无IVC组的各项数据进行比较,分析可能影响IVC发生的因素;比较各期IVC影像学参数之间的差异,分析病情发展与IVC的关系。结果:本研究中,Kümmell病患者总体IVC发生率为37.1%,其中Ⅰ期病例的IVC发生率为15.4%,Ⅱ期病例的IVC发生率为25.7%,Ⅲ期病例的IVC发生率为53.7%,Ⅲ期Kümmell病的IVC发生率显著高于Ⅰ期(P=0.016)和Ⅱ期(P=0.013)。Kümmell病患者的腰椎骨密度值与脊柱后凸Cobb角之间呈较弱负相关(r=-0.226,P=0.033),腰椎骨密度值与伤椎前缘压缩程度之间呈较弱负相关(r=-0.285,P=0.007),伤椎前缘压缩程度和脊柱后凸Cobb角之间相关性较高(r=0.646,P0.05)。有IVC组的脊柱后凸Cobb角与伤椎前缘压缩程度之间相关性较高(r=0.724,PIVC的最大高度值与伤椎前缘压缩程度之间呈中度负相关(r=-0.414,P=0.016),IVC的最大长度值与最大宽度值之间相关性较高(r=0.665,P0.05)。各期的脊柱后凸Cobb角之间有显著差异(P0.05);Ⅱ期、Ⅲ期的病程明显长于Ⅰ期,但其差异无统计学意义(P>0.05);年龄、性别在各期间无明显差异(P>0.05)。有IVC组的脊柱后凸Cobb角明显大于无IVC组(P=0.001);有IVC组的伤椎前缘压缩程度大于无IVC组(P=0.02);有IVC组的腰椎骨密度值低于无IVC组,但差异无统计学意义(P>0.05);有IVC组的女性比例低于无IVC组,但差异无统计学意义(P>0.05);两组间的年龄和病程无明显差异(P>0.05)。IVC的发生与伤椎前缘压缩程度(r=0.246,P=0.02)、脊柱后凸Cobb角(r=0.344,P=0.001)之间呈正相关。对各期的IVC影像学参数进行比较,各期间的IVC最大宽度值存在差异,Ⅰ期和Ⅲ期间有差异(P0.05);Ⅱ期和Ⅲ期的最大长度值和最大高度值明显大于Ⅰ期,但各期间均无明显差异(P>0.05)。结论:1.IVC的发生与伤椎前缘压缩程度、脊柱后凸Cobb角呈正相关,且其发生率与Kümmell病病情严重程度呈正相关;2.有IVC组的伤椎前缘压缩程度和脊柱后凸Cobb角明显大于无IVC组,提示IVC的发生可能与脊柱生物力学改变后局部应力增大有关;3.伤椎前缘压缩程度、脊柱后凸Cobb角与腰椎骨密度值呈负相关,提示Kümmell病病情严重程度可能与骨质疏松程度有关;4.IVC的最大高度值与伤椎前缘压缩程度呈负相关,IVC的最大长度值和最大宽度值呈正相关,且IVC最大宽度值会随着Kümmell病病情的加重而增加,提示IVC的高度随着椎体的塌陷而降低,横截面积可能会随着病情的加重而增大。

关键词： Kümmell病 IVC 骨质疏松发生机制相关性

Digital radiograph(DR)guided bedside IVC filter placements in patients with intracranial pressure monitors

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Journal of Interventional Medicine 2021年第4期4卷 208-211页

作者： Arthur S.Joseph Jorge E.Lopera UT Health San Antonio.San Antonio TXUSA

Purpose:The purpose of this study is to report a single center experience with portable digital radiographically(DR)guided bedside IVC filters placed in intensive care unit(ICU)patients with high ICP and elevated head of bed(HOB).Materials and methods:A retrospective chart review was conducted on all bedside IVC filters placed from January 1,2010 to September 16,2020.Patients with high ICP and elevated head of bed requirements were included.Charts were reviewed for filter type,common femoral vein(CFV)access,filter location,pre procedure imaging,pre and post filter ICPs,glascow coma scale,number of radiographs taken,and filter removal.ICPs were obtained 1 h prior to procedure and 2 h post procedure and analyzed with a paired T test.Filters were placed by reviewing prior CT scan for IVC size,caval variants,renal and iliac veins and vertebral body landmarks.Then,CFV access was obtained and a Bentson wire was advanced 30-40 cm.A radiograph was used to confirm adequate position of the of the wire.The filter sheath was advanced and serial radiographs were used to position the filter sheath at the final predetermined position below the renal veins and above the iliac bifurcation.The filter was deployed,and a radiograph was obtained to confirm filter positioning.Results:A total of 9 DR guided bedside IVC filters were placed(4 Denali,3 Option Elite,2 Celect).Indications included prophylactic placement(n=8)and acute DVT(n=1).The average patient age was 35.8 years(range:18-56 years)CT abdomen and pelvis was used to assess for the level of renal veins in all patients(n=9).No caval variants were encountered on pre-procedural planning.The average pre,intraprocedural,and post procedure intracranial pressure was 16 mmHg,13 mmHg,and 16 mmHg,respectively.Confirmation of placement after final placement was available in 7 patients(4 DR,2 CT and one fluoroscopic examination).Two non-procedural related deaths occurred.Technical success,defined as successful placement of IVC filter at the predetermined level,was achieved in 100%of pati

关键词： IVC Filter Prophylactic Inferior Vena Cava Thrombus

Invisible Visual Cryptography

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Chinese Physics Letters 2017年第11期34卷 36-40页

作者：史祎诗杨秀波 College of Opto-Electronics University of Chinese Academy of Sciences Academy of Opto-Electronics Chinese Academy of Sciences

We propose to realize visual cryptography in an indirect way with the help of diffractive optics, the pure-amplitude keys being substituted with the phase-only keys that are invisible for common-used intensity detectors, leading to the significantly enhanced security and improved usability for practice. Three typical realizations are provided by using static or dynamic diffractive optical elements, and the new concept of invisible visual cryptography （IVC） may be established. This concept is demonstrated by a compact opto-electronic system with only one spatial light modulator within time-delayed exposure, maintaining the fast speed of decryption and no requirement to the calculation of decryption in conventional visual cryptography. Further, IVC shows the immunity to noises and good information capacity, which is partly inherited from diffractive optics. IVC might suggest a new strategy for visual cryptography with the respective of diverse realizations, such as opto-electronic or even bio-chemical or other methods.

关键词： IVC SLM

Combined cavo-atrial thrombectomy and hepatectomy in hepatocellular carcinoma

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Hepatobiliary & Pancreatic Diseases International 2017年第3期16卷 329-333页

作者： Julian Tsang Albert Chan Kenneth Chok Flora Tsang Chung Mau Lo Division of Hepatobiliary & Pancreatic Surgery and Liver Transplantation Queen Mary Hospital University of Hong Kong Hong Kong China Division of Cardiothoracic Surgery Queen Mary Hospital University of Hong Kong Hong Kong China

To the Editor： Hepatocellular carcinoma （HCC） remains one of the commonest cancers worldwide especially in hepatitis B endemic regions. Its aggressive behavior is characterised by the natural history of increasing size, a tendency for vascular invasion into the hepatic veins and portal veins. Further growth into the inferior vena cava （IVC） and right atrium （RA） is an infrequent finding but signifies a pre-terminal event with a dismal prognosis.

关键词： in on as or HCC IVC Combined cavo-atrial thrombectomy and hepatectomy in hepatocellular carcinoma

Preliminary Process Design of ITER ELM Coil Bracket Brazing

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Plasma Science and Technology 2015年第3期17卷 259-264页

作者：李向宾施毅 Institute of Plasma Physics Chinese Academy of Sciences China International Nuclear Fusion Energy Program Execution Center

With the technical requirement of the International Thermonuclear Experimental Reactor （ITER） project, the manufacture and assembly technology of the mid Edge Localized Modes （ELM） coil was developed by the Institute of Plasma Physics, Chinese Academy of Science （ASIPP）. As the gap hetween the bracket and the Stainless Steel jacketed and Mineral Insulated Conductor （SSMIC） can be larger than 0.5 mm instead of 0.01 mm to 0.1 nnn as in normal industrial cases, the process of mid ELM coil bracket brazing to the SSMICT becomes quiet challenging. from a technical viewpoint. This paper described the preliminary design of ELM coil bracket brazing to the SSMIC process, the optimal bracket brazing curve and the thermal simulation of the bracket furnace brazing method developed by ANSYS. BAg-6 foil （Bag50Cu34Zn16） plus BAg-1a paste （Bag45CuZnCd） solders were chosen as the brazing filler. By testing an SSMICT prototype, it is shown that the average gap between the bracket and the SSMIC could be controlled to 0.2- 0.3 mm, and that there were few voids in the brazing surface. The results also verified that the prelilninary design had a favorable heat conducting performance in the bracket.

关键词： brazing IVC thermal simulation fluidity conductivity

IVC换笼标准操作程序与小鼠病毒病原的传播风险

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中国比较医学杂志 2020年第10期30卷 107-109页

作者：佟巍郭智刘子洋潘思丹高虹向志光中国医学科学院医学实验动物研究所北京协和医学院比较医学中心北京100021

目的研究独立通风笼具换笼标准操作程序与实验动物负压屏障设施内使用IVC(individual ventilated cage,IVC)设备饲养小鼠的病毒感染风险。方法选择小鼠易感的小鼠肝炎病毒(MHV)A59株感染6周龄BALB/c雄性小鼠,按照IVC换笼标准操作程序进... 详细信息

目的研究独立通风笼具换笼标准操作程序与实验动物负压屏障设施内使用IVC(individual ventilated cage,IVC)设备饲养小鼠的病毒感染风险。方法选择小鼠易感的小鼠肝炎病毒(MHV)A59株感染6周龄BALB/c雄性小鼠,按照IVC换笼标准操作程序进行换笼操作;使用IFA和ELISA血清学方法以及针对MHV的核酸检测方法测定同一笼架具相邻笼盒、同一IVC系统不同笼架具的不同位置、以及IVC系统外负压屏障设施内哨兵动物的MHV感染情况。结果接种病毒小鼠在感染6 d后出现临床症状,粪便中可检出MHV病原;动物感染3周后可检出MHV抗体阳性;其他监测组在5周实验终点均无MHV阳性检出。结论IVC换笼标准操作程序可指导IVC换笼操作,用以控制病毒类病原对小鼠的感染风险。

关键词： IVC 换笼标准操作程序 MHV 小鼠

Liver tumors invading the hepatocaval confluence:treatment improvements still not completed

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Hepatobiliary & Pancreatic Diseases International 2016年第6期15卷 570-571页

作者： Isidoro Di Carlo Department of Surgical Sciences and Advanced Technologies University of Catania

Also if rarely, hepatocellular carcinoma, cholangiocarcinoma, and metastatic carcinoma can invade the retrohepatic portion of the inferior vena cava （IVC）, because of the proximity of this vessel to the liver.

关键词： IVC Liver tumors invading the hepatocaval confluence

独立通风笼具(IVC)技术指标检测及参数稳定性评价

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中国比较医学杂志 2020年第4期30卷 106-109页

作者：闵凡贵王静潘金春黄树武龚宝勇张钰广东省实验动物监测所广东省实验动物重点实验室广州510663

目的探讨IVC技术指标的检测方法并评价IVC参数的稳定性。方法依据GB 14925-2010与DB32/T 972-2006标准规定的方法,对摆放在普通环境和屏障环境的IVC进行检测,分析IVC微环境对外环境技术指标的依赖程度,比较不同换气次数测定方法的差异,... 详细信息

目的探讨IVC技术指标的检测方法并评价IVC参数的稳定性。方法依据GB 14925-2010与DB32/T 972-2006标准规定的方法,对摆放在普通环境和屏障环境的IVC进行检测,分析IVC微环境对外环境技术指标的依赖程度,比较不同换气次数测定方法的差异,并计算各指标的相对偏差和笼盒泄漏率。结果IVC微环境的温度、湿度与外环境参数正相关;依据GB14925-2010附录方法测定的笼盒内换气次数明显高于流量计法的测定值(t-test,P=0.0001);IVC笼架对角线上5个笼盒的换气次数、噪声、风速的相对偏差较小,但静压差的相对偏差较大;IVC笼盒泄漏率检测结果高达75%。结论IVC的使用受制于外环境条件,笼架不同位置的笼盒内静压差的稳定性差,与较高的笼盒泄漏率相关,研究结果可为IVC国家或行业准制(修)订提供参考。

关键词： IVC 技术指标检测相对偏差泄漏率

伴有椎体内裂隙征的骨质疏松性椎体压缩骨折的诊治进展

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中国脊柱脊髓杂志 2017年第7期27卷 647-651页

作者：李哲苏庆军海涌首都医科大学附属北京朝阳医院北京市100020

随着现代社会人口老龄化的加剧，骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fractures,OVCFs）的发病率越来越高，据统计，全世界每年大约发生骨质疏松椎体骨折140万例。椎体内裂隙征（intravertebral cleft，IVC）... 详细信息

随着现代社会人口老龄化的加剧，骨质疏松性椎体压缩骨折（osteoporotic vertebral compression fractures,OVCFs）的发病率越来越高，据统计，全世界每年大约发生骨质疏松椎体骨折140万例。椎体内裂隙征（intravertebral cleft，IVC）最早见于1978年Maldague的报道，作者最先描述了此现象：椎体压缩骨折的患者在伸展位时，X线平片上可见椎体内存在低密度影，并认为此现象与椎体内骨缺血坏死和椎体内不稳定有关。近年来，随着影像技术以及治疗手段的发展，国内外出现了许多关于椎体内裂隙征的研究。文献中的“椎体真空征”（intravertebral vacuum cleft）、“线样椎体内真空”（linear intravertebral vacuum）、“骨内真空现象”（intraosseous vacuum phenomenon）、“椎体内真空现象”（intravertebral vacuum phenomenon）都是IVC的同义词。合并IVC的OVCFs不同于一般OVCFs，有其特殊的临床特点。笔者通过总结最新的文献，对伴有椎体内裂隙征的IVC的诊治进展综述如下。

关键词：骨质疏松性椎体压缩骨折椎体内真空现象诊治人口老龄化骨缺血坏死 IVC 椎体骨折低密度影