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Chinese Medical Journal 2019年第12期132卷 1478-1481页

作者： U Po Lam Edmundo Patricio Lopes Lao Kan Chit Lam Mario Evora Na-Qiong Wu Department of Cardiology Centro Hospital Conde de Sao JanuarioMacaoChina University of Michigan Ann ArborMichigan 48104USA Department of Cardiology Center of Endocrinology & CardiometabolismNational Center for Cardiovascular DiseasesFuwai HospitalBeijing 100037China

Compared with trans-femoral artery access (TFA), trans-radial artery access (TRA) for percutaneous coronary interventions (PCI) has been shown to significantly reduce 30-day mortality, in-hospital major adverse cardiac and cardiovascular events (a composite of 30-day mortality and in-hospital myocardial re-infarction, target vessel revascularization, and cerebrovascular events), major bleeding, and access site complications.[1] TRA is more easily compressible, minimizing hematoma risk, and lower crossover rates to another access. Patients may ambulate immediately after procedure, that hospitalization can be shortened significantly. In some centers, patient with TRA can be discharged on the same day of procedure. It is also superior to TFA with closure devices, and becomes the preferred access site for recent PCI.[2]

关键词： Trans-brachial artery access coronary artery procedures

Radiation exposure during image-guided endoscopic procedures: The next quality indicator for endoscopic retrograde cholangiopancreatography

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World Journal of Clinical Cases 2018年第16期6卷 1087-1093页

作者： Shiro Hayashi Mamoru Takenaka Makoto Hosono Tsutomu Nishida Department of Gastroenterology and Internal Medicine Hayashi Clinic Department of Gastroenterology Toyonaka Municipal Hospital Department of Gastroenterology and Hepatology Kindai University Faculty of Medicine Department of Radiology Kindai University Faculty of Medicine

Endoscopic retrograde cholangiopancreatography(ERCP) is one of the most frequently used image-guided procedures in gastrointestinal endoscopy. Post-ERCP pancreatitis is an important concern, and prophylaxis, cannulation and other related technical procedures have been well documented by endoscopists. In addition, medical radiation exposure is of great concern in the general population because of its rapidly increasing frequency and its potential carcinogenic effects. International organizations and radiological societies have established diagnostic reference levels, which guide proper radiation use and serve as global standards for all procedures that use ionizing radiation. However, data on gastrointestinal fluoroscopic procedures are still lacking because the demand for these procedures has recently increased. In this review, we present the current status of quality indicators for ERCP and the methods for measuring radiation exposure in the clinical setting as the next quality indicator for ERCP. To reduce radiation exposure, knowledge of its adverse effects and the procedures for proper measurement and protection are essential. Additionally, further studies on the factors that affect radiation exposure, exposure management and diagnostic reference levels are necessary. Then, we can discuss how to manage medical radiation use inthese complex fluoroscopic procedures. This knowledge will help us to protect not only patients but also endoscopists and medical staff in the fluoroscopy unit.

关键词： Quality indicator Fluoroscopic procedures Endoscopic retrograde cholangiopancreatography Diagnostic reference levels Radiation exposure

Ultrasound-assisted musculoskeletal procedures:A practical overview of current literature

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World Journal of Orthopedics 2011年第7期2卷 57-66页

作者： Nelson A Royall Emily Farrin David P Bahner Stanislaw PA Stawicki Department of Emergency Medicine The Ohio State University Medical CenterColumbusOH 43210United States Department of Orthopaedics The Ohio State University Medical CenterColumbusOH 43210United States Department of Surgery Division of Critical CareTrauma and BurnThe Ohio State Unviersity Medical CenterColumbusOH 43210United States

Traditionally performed by a small group of highly trained specialists,bedside sonographic procedures involving the musculoskeletal system are often delayed despite the critical need for timely diagnosis and treatment.Due to this limitation,a need evolved for more portability and accessibility to allow performance of emergent musculoskeletal procedures by adequately trained non-radiology personnel.The emergence of ultrasound-assisted bedside techniques and increased availability of portable sonography provided such an opportunity in select clinical scenarios.This review summarizes the current literature describing common ultrasound-based musculoskeletal procedures.In-depth discussion of each ultrasound procedure including pertinent technical details,indications and contraindications is provided.Despite the limited amount of prospective,randomized data in this area,a substantial body of observational and retrospective evidence suggests potential benefits from the use of musculoskeletal bedside sonography.

关键词： Musculoskeletal ultrasound-guided procedures Arthrocentesis Tendon injection Articular injection Fluid collection Abscess drainage Foreign body removal

Clinical features and surgical procedures of intradural-epidural and epidural cervical dumbbell tumors

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Chinese Medical Journal 2013年第14期126卷 2797-2798页

作者： Wang Yong Lou Ping-yang Li Ming Henan Prov Peoples Hosp Dept Neurosurg Zhengzhou 450003 Henan Peoples R China

To the editor： Depending on the relationship between the tumor and the dura mater, dumbbell tumors can be dividedinto intradural-epidural （ID-ED） and epidural （ED） tumors. The surgical procedures and postoperative complications of both types are different. Nine cases of cervical dumbbell Schwannomas were treated at our hospital between June 2004 and August 2012. There were five cases of ED tumors and four cases of 1D-ED tumors （Figure 1）.

关键词： Clinical procedures relationship

Study on the facilities and procedures for meltwater erosion of thawed soil

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International Soil and Water Conservation Research 2016年第2期4卷 142-147页

作者： Yunyun Ban Tingwu Lei Chao Chen Zhiqiang Liu China Agricultural University Beijing 100083PR China State Key Laboratory of Soil Erosion and Dryland Farming on the Loess Plateau Institute of Soil and Water ConservationCAS and MWRYangling 712100PR China

High erosion rate of seasonal thawed soils by snow-and ice-melting runoff in the high altitude and latitude cold regions has great impacts on ecological systems,industries,agriculture and various manmade infrastructures as well as people's lives.The facilities and procedures are of great importance for the studies on simulating erosion processes of melt-frozen soil.This study focuses on the method and facility for simulating the thawing process of frozen soil.The facility includes soil freezing system,meltwater supply system and experimental flume system for thawed soil erosion.The soil freezing system provides enough space to freeze soil columns in flumes.The water supply system deliveries snow-or icemelting water flow of constant-rate at 0℃.The soil flumes of 200 or 300 cm long,10 cm wide and 12 cm high are designed to be assemble and convenient for soil freezing before they are thawed in one-dimensional manner from top to bottom.The one-dimensional thawing process is realized as follows.The frozen soil flume is put on ice boxes and thermally insulated with heat-insulating materials all around to prevent frozen soil from being thawed from sidewalls and bottom.The soil thaws with this system shows that it can meet the requirements of simulating the process of soil thawing from top to bottom.The thawed soil flumes are connected from end to end to form rills of 6–8 m long to run the erosion experiments under different designed hydraulic condition.The equipment provides facility,method and operation process for simulating one-dimensional soil thawing to serve research on the effect of thawed soil depth on erosion process.

关键词： Melt-frozen Soil erosion Method Facilities procedures

Use of Bivalirudin for Anticoagulation in Interventional Cardiovascular procedures

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Cardiovascular Innovations and Applications 2018年第B7期3卷 163-174页

作者： Zhen Ge Jaya Chandrasekhar Roxana Mehran The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount SinaiNew YorkNYUSA

Anticoagulation is imperative to reduce the incidence of thrombotic complications in patients undergoing percutaneous interventional cardiovascular procedures;however,this is at the expense of increased risk of bleeding.The optimal anticoagulation strategy for these procedures remains unclear.Unfractionated heparin is the most commonly used anticoagulant during interventional procedures,but has several limitations,such as relatively high incidence of bleeding events,occurrence of heparin-induced thrombocytopenia,and a paradoxical thrombotic effect.Contemporary studies have demonstrated that bivalirudin decreases the occurrence of bleeding complications,but potentially increases the risk of acute stent thrombosis.This review discusses the pharmacology of bivalirudin and its current clinical application in patients undergoing percutaneous coronary intervention and transcatheter aortic valve replacement procedures.

关键词： bivalirudin anticoagulation interventional cardiovascular procedures

Physician-Rated Utility of Procedure Videos for Teaching procedures in the Emergency Department, Overall and during Emergency Department Crowding

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International Journal of Clinical Medicine 2012年第7期3卷 758-764页

作者： Clare L. Atzema R. Alexandra Stefan Refik Saskin Greg Michlik Peter C. Austin Department of Emergency Services Sunnybrook Health Sciences Centre Toronto Canada Division of Emergency Medicine Department of Medicine University of Toronto Toronto Canada The Institute for Clinical Evaluative Sciences Toronto Canada

Background: Real-time use of procedure videos as educational tools has not been studied. We sought to determine whether viewing a video of a medical procedure prior to procedure performance in the emergency department improves the quality of teaching of procedures, and whether videos are particularly beneficial during periods of emergency department crowding. Methods: In this single-centre, prospective, before and after study standardized data collection forms were completed by both trainees and supervising emergency physicians (EPs) at the end of each emergency department shift in the before (August 2008-March 2009) and after (August 2009-March 2010) phase. Online procedure videos were introduced on emergency department computers in the after phase. The primary outcome measure was EP rating of the quality of teaching provided (5-point Likert scale). The interaction between crowding and videos was also assessed, to determine whether videos provide a specific additional benefit during periods of emergency department crowding. Results: There were 1159 procedures performed by 192 trainees. Median procedures performed per shift was 1.0 (IQR 0 - 2.0). Mean EP rating of teaching provided was significantly higher in the group that viewed videos, at 4.2 versus 3.7 (p 0.001). In the adjusted analysis, EP ratings increased by 0.5 with a video (p 0.001), while the odds of a score of 5.0 were 2.2 times greater if a video was viewed (p = 0.03). The interaction of crowding and procedure videos was not significant (the use of videos increased the average score by 0.24 in times of crowding compared to times of non-crowding, p = 0.19). Conclusions: Use of procedural videos was associated with EP perception of improved quality of teaching provided around procedures. While EPs rated the quality of their teaching as improved overall, the effect of videos on teaching quality was the same in crowded settings as it was in non-crowded setting.

关键词： Teaching Education procedures Emergency Department Video

THE　ANIMAL　EXPERIMENTAL　OBSERVATION　OF　THE　INFLUENCE　OF　THE　DIFFERENT　FONTAN　procedures　ON　PULMONARY　MICROCIRCULATION

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Chinese Journal of Biomedical Engineering(English Edition) 1994年第4期3卷 161-166页

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ＴＨＥＡＮＩＭＡＬＥＸＰＥＲＩＭＥＮＴＡＬＯＢＳＥＲＶＡＴＩＯＮＯＦＴＨＥＩＮＦＬＵＥＮＣＥＯＦＴＨＥＤＩＦＦＥＲＥＮＴＦＯＮＴＡＮＰＲＯＣＥＤＵＲＥＳＯＮＰＵＬＭＯＮＡＲＹＭＩＣＲＯＣＩＲＣＵＬＡＴＩＯＮＴＨＥＡＮＩＭＡＬＥＸＰＥＲＩＭＥＮＴＡＬＯ...

关键词：人民卫生出版社医学生理 ANIMAL DIFFERENT EXPERIMENTAL FONTAN INFLUENCE OBSERVATION OF procedures

Post-Procedure Mortality after Cardiovascular Treatment procedures in Patients with Pneumoconiosis

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Occupational Diseases and Environmental Medicine 2015年第1期3卷 10-16页

作者： Alexander V. Sergeev Department of Social and Public Health Ohio University Athens Ohio USA

Pneumoconiosis (PNC) is a major occupational disease that develops as a result of occupational exposure to dust via inhalation. In addition to its harmful effects on the respiratory system, PNC can increase vulnerability to coronary heart disease (CHD)—the leading cause of death in the United States and in the world. Currently, two types of cardiovascular intervention procedures for CHD treatment are percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). The objective of this study was to investigate comparative effectiveness of the two major cardiovascular intervention procedures—PCI and CABG—in PNC patients with CHD. Data from 1094 hospitalizations of adult patients with PNC and CHD (CHD-PNC patients) and 534,120 hospi-talizations of CHD patients without PNC (CHD-nonPNC) were investigated. Adjusted odds ratios for in-hospital death in relation to the type of procedure, adjusted for patient socio-demographic and clinical characteristics and hospital characteristics, were calculated using multivariable logistic regression. Men constituted 97.8% of CHD-PNC patients and 68.6% of CHD-nonPNC patients. Within the CHD-PNC group, crude (unadjusted) in-hospital mortality after CABG and PCI did not differ significantly (1.35% vs. 2.00%, p = 0.425) and remained insignificant in the multivariable analysis, adjusted for patient and hospital characteristics (adjusted OR = 0.714, 95% CI 0.220 - 2.323, p = 0.576). But in the CHD-nonPNC group, in-hospital mortality after CABG was significantly higher than after PCI both in crude analysis (2.83% vs. 1.28%,

关键词： Occupational Lung Disease Pneumoconiosis Complications Cardiovascular Disease Cardiovascular Treatment procedures Mortality

Monte Carlo Study of 3D Stray Radiation during Interventional procedures

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International Journal of Medical Physics, Clinical Engineering and Radiation Oncology 2018年第4期7卷 453-463页

作者： Khalid S. Alzimami Department of Radiological Sciences College of Applied Medical Sciences King Saud University Riyadh KSA

In interventional medical procedures, other than the highly important issue of optimizing image quality and patient exposure using the primary beam, there remains a continuing need for the study of staff exposure from the scattered radiation. Herein, investigation is made of the 3D stray-radiation distribution, the simulation being made of a realistic interventional scenario through use of the Monte Carlo code Geant4 (version 10.3). The simulation is conducted based on the high definition reference Korean-man (HDRK-man) computational phantom and a GE Infinia 3/8” C-arm machine, focusing on the effect of variation of kVp and field of view (FoV) on the scattered particles’ spatial distribution. With direct measurement of the absorbed dose remaining challenging, not least in respect of the organs at risk, we computed the scatter fractions, defined as the ratio of the air kerma free-in-air to the entrance surface air kerma (ESAK), which are both easily quantifiable. Scatter fraction distributions were simulated for X-ray tube outputs (and half-value layers, HVL) of 60 kVp (2.3 mm Al), 80 kVp (3.2 mm Al) and 120 kVp (4.3 mm Al) and FoV of 15, 20, 25 and 30 cm. The distributions are obtained for different height levels, corresponding to the lens of the eye, and the lung and prostate, all radiosensitive organs. Investigations are made for eight likely locations around the patient. At fixed FoV results reveal an inverse relationship between ESAK and kVp, also that change in kVp from 60 to 80 has a greater effect than from 80 to 120. For change in FoV at fixed kVp, the scatter fraction remains constant. The particular staff locations are found to be optimal in seeking mitigation of dose. Moreover, the combined usage of numerical human model and Monte Carlo simulation can be considered as an added value to the radiation safety research field, especially to the interventional radiology staff and to the patient.

关键词： Stray Radiation Interventional procedures Operator Exposure Geant4