簡介：中文中文5500字出處出處NIEDERMANMSRECENTADVANCESINCOMMUNITYACQUIREDPNEUMONIAINPATIENTANDOUTPATIENTJCHEST,2007,131412051215社區(qū)獲得性肺炎的住院與門診研究進展社區(qū)獲得性肺炎的住院與門診研究進展NIEDERMANMS病毒病毒過去幾年，由于SARS的出現(xiàn)，人們又重新對流行的病毒性疾病產(chǎn)生了興趣，最近正關(guān)注于禽流感。疾病的流行特征和迅速的人與人之間的傳播特性成為強調(diào)的重點。關(guān)于SARS，醫(yī)護工作者的危險性十分明顯。對日常CAP中病毒感染率還知之甚少，因此西班牙的一項研究21很具吸引力。研究者對338例CAP患者進行了雙份呼吸道病毒的血清學(xué)檢查，將病人分為單純病毒性、混合病毒性、細菌性或肺炎球菌性CAP21。研究的病毒包括流感、副流感、呼吸道合胞病毒和腺病毒。有18的病人檢測到病毒，其中病毒是唯一病原體的病人占半數(shù)。流感是最為常見的感染，占病毒感染的64。單純病毒性肺炎與肺炎球菌肺炎相比，心衰多見但缺乏咳痰的癥狀。僅有8的單純病毒性肺炎病人需入住ICU，但有58的病人為PSIⅣ和Ⅴ級。有趣的是，盡管這些病人具有高死亡風(fēng)險根據(jù)PSI等級確定，但都沒有死亡?？紤]到流感和呼吸道病毒感染的重要性，而且是MRSACAP的易患因素，這些資料強調(diào)了相對常見的感染和病毒性肺炎在社區(qū)中的重要性。吸入性肺炎吸入性肺炎社區(qū)中吸入性肺炎的細菌病原學(xué)還不十分明了，厭氧菌在其中的確切作用也不清楚。在一項研究22中，有95例65歲以上疑診為吸入性肺炎的病人從長期護理機構(gòu)轉(zhuǎn)入ICU，收集入住ICU4H內(nèi)的保護性BALF進行細菌學(xué)研究。推測病人存在誤吸是因為這些病人具有已知的危險因素，例如腸道或吞咽方面的疾病、神經(jīng)系統(tǒng)疾病和解剖學(xué)異常。資料顯示病原菌大部分是革蘭陰性菌，厭氧菌在95例病人中僅有11例，只有5例是單純的厭氧菌感染22。在另一項有關(guān)肺膿腫肺膿腫是一種常見的吸入性和厭氧菌感染的疾病的研究23中，90例病人采用“未污染”標(biāo)本進行細菌檢測，包括經(jīng)胸針吸活檢、胸水、血培養(yǎng)和外科取材樣本，而不單單是支氣管鏡取材。其中僅18例為單純厭氧菌感染，另有10例為混合型感染。但是有37例需氧的革蘭陰性菌感染，肺炎克雷伯桿菌28例。為此，在這兩個吸入相關(guān)性疾病中腸道革蘭陰性菌的感染率很高，所以在選擇治療方案時必須考慮這一點。治療的新方法CAP的治療指南強調(diào)經(jīng)驗性治療，因為得到明確的病原學(xué)資料很難，初期的治療選擇很重要。最近一項研究24發(fā)現(xiàn)，當(dāng)遵循指南治療時，較其他治療能更快地使病人達到臨床穩(wěn)定。來自荷蘭的一項研究25對經(jīng)驗性治療的重要性進行了直接的評估，這是一項前瞻性、隨機和開放性研究，研究對象為262例根據(jù)臨床和X線檢查確定為CAP的病人，比較了經(jīng)驗性治療與針對病原體治療之間的差別。所有病人都進行了多方面的診斷性檢查。在經(jīng)驗治療組，非ICU病人應(yīng)用Β內(nèi)酰胺/Β內(nèi)酰胺酶抑制劑聯(lián)合紅霉素治療，ICU病人應(yīng)用頭孢菌素加紅霉素治療。針對病原體組進行痰的革蘭染色和尿抗原檢測，同時進行臨床評估以確定可疑病原體；對于肺炎球菌應(yīng)用青霉素治療，紅霉素針對非典型病原體，阿莫西林/克拉維酸鉀針對混合感染，氟氯西林選擇性加用慶大霉素用于流感后感染的治療。兩組在住院時間、臨床治療失敗的時間和30D病死率等方面沒有差異圖3。但是如果ICU病人進行經(jīng)驗性治療，病死率確實較高并有較多的不良事件發(fā)生，可能與經(jīng)驗治療組較多地應(yīng)用靜脈紅霉素，而相對靜脈不良反應(yīng)少的新型大環(huán)內(nèi)酯類應(yīng)用較少有關(guān)。此研究證實經(jīng)驗性治療是安全的，但沒有分析有關(guān)診斷性檢查的其他益處，例如長期控制抗生素使用避免耐藥性產(chǎn)生的問題。MO存活益處的下降都降低了這種治療成本－有效性帶來的影響。業(yè)已證明使用全身皮質(zhì)類固醇激素治療感染性休克和相對的腎上腺分泌不足是有效的。在一項新的研究37中，嘗試應(yīng)用全身皮質(zhì)類固醇激素治療重癥CAP病人，其理論依據(jù)是感染引起的炎癥反應(yīng)較未控制的感染對預(yù)后的負面影響更大。在一項小樣本48例病人、多中心、隨機雙盲試驗37中，對持續(xù)應(yīng)用氫化可的松治療與安慰劑進行比較。盡管病人均為重癥CAP，但并不都在ICU接受治療。結(jié)果顯示激素治療組的病死率明顯低于安慰劑組，入住ICU時間以及機械通氣時間均短于安慰劑組。另外，激素組很少有晚期并發(fā)癥。盡管這些資料使人印象深刻，但尚需一個更大樣本的研究來加以證實。無論如何，這些結(jié)果顯示激素治療并不危險，即使對于CAP這樣的嚴(yán)重感染病人。住院治療的核心措施自1998年，CMS聯(lián)合健康保健鑒定機構(gòu)的聯(lián)合委員會提出了CAP病人的治療標(biāo)準(zhǔn)。因為這些標(biāo)準(zhǔn)能夠改善預(yù)后，希望醫(yī)院能夠認(rèn)真遵循這些標(biāo)準(zhǔn)表1。為了追求治療的高標(biāo)準(zhǔn)化率，要不斷地收集這方面的有關(guān)資料并進行公開的報道，故壓力也隨之增加。雖然有很廣泛及有力的證據(jù)支持這些核心措施，但并不意味著適用于所有的臨床機構(gòu)及所有的病人，合理目標(biāo)是達到80～85的標(biāo)準(zhǔn)化率。如果標(biāo)準(zhǔn)化率過高，則會出現(xiàn)各種不希望看到的負面結(jié)果38。目前循證醫(yī)學(xué)的治療標(biāo)準(zhǔn)大部分基于回顧性數(shù)據(jù)庫分析如下首劑抗生素在病人到院后4H內(nèi)給予；入院病人選擇一種推薦的抗生素治療方案，ICU病人和普通病房病人有不同的選擇；如果血培養(yǎng)是可行的，確保在抗生素給予之前采集標(biāo)本；為合適的病人提供戒煙建議；評估病人是否需要接種肺炎球菌和流感疫苗并給需要的病人接種。目前在多個領(lǐng)域還存在疑問，如新資料在指導(dǎo)臨床醫(yī)師時所推薦的4H內(nèi)給予治療，不推薦入住ICU的CAP病人單藥治療，血培養(yǎng)的價值，以及重復(fù)接種肺炎球菌疫苗的安全性。核心措施應(yīng)用中的一個重要變化是認(rèn)識到一些因肺炎入院的病人為健康保健相關(guān)性肺炎HCAP，這些病人很可能感染的是多藥耐藥革蘭陰性菌以及MRSA，這就需要采取與通常CAP不同的治療方法39。作為醫(yī)院感染的一種形式，HCAP包括在2005年醫(yī)院肺炎指南中。為此，自2005年7月HCAP就不包括在CMS的CAP抗生素選擇的核心措施中。因為有資料顯示，HCAP與CAP比較表現(xiàn)為不同的自然病程和細菌學(xué)，故推測治療也應(yīng)該不同40。有關(guān)在病人到院4H內(nèi)給予抗生素治療的爭論很多，即使大規(guī)模數(shù)據(jù)庫分析顯示在這個時間窗內(nèi)給予治療患者的病死率降低，但隨之也會出現(xiàn)不希望看到的結(jié)果38。包括在急診科對于所有有呼吸道癥狀的病人都不加選擇地使用抗生素，甚至在明確診斷之前就開始使用。并在一個忙碌的急診室里，誘使醫(yī)師在考慮其他病人之前優(yōu)先考慮到肺炎病人。最近有兩項研究41，42加入了爭論中。第1項研究41進一步證實在4H內(nèi)給予治療病死率降低。延誤抗生素使用的誘因包括精神狀態(tài)異常﹑不發(fā)熱﹑不缺氧以及高齡。當(dāng)這些因素被控制后，抗生素給藥時機就不再是影響病死率的重要指標(biāo)，為此作者認(rèn)為縮短抗生素給藥時間不是一個好的措施。支持此結(jié)果的另一項研究42發(fā)現(xiàn)，在86例醫(yī)保的CAP患者中有22的臨床癥狀不典型，從而導(dǎo)致診斷不明確，抗生素應(yīng)用延誤。在一篇論及這些論文的述評中，經(jīng)觀察研究證實給予抗生素的時機僅對65歲以上病人的病死率有影響。這些研究的結(jié)果最終支持100的標(biāo)準(zhǔn)化治療并不一定意味就是好的醫(yī)療，所以4H內(nèi)使用抗生素的病人應(yīng)較前減少38。2007年可能會更改4H內(nèi)使用抗生素這一標(biāo)準(zhǔn)。沒有研究表明血培養(yǎng)能夠改善CAP病人的預(yù)后，故有些人反對常規(guī)進行血培養(yǎng)檢查。雖然所有入院病人可能都不需要該項檢查，但對于那些重癥病人給予血培養(yǎng)檢查可能還是明智的，而且在應(yīng)用抗生素之前抽血是十分重要的。METERSKY等43研究了13043例罹患CAP的醫(yī)保病人，這些病人住院進行了有關(guān)提示菌血癥方面的檢查。結(jié)果發(fā)現(xiàn)某些病人尤其是之前接受了抗生素治療的病人不可能有真正陽性的血培養(yǎng)結(jié)果；在陽性結(jié)果中有相當(dāng)一部分是假陽性并導(dǎo)致了錯誤的治療。影響菌血癥陽性結(jié)果的因素包括之前抗生素治療OR05；合并肝臟疾病OR23；收縮壓＜90MMHGOR17；體溫＜35℃或＞40℃OR19；脈搏＞125次/MINOR19；BUN水平＞30

簡介：10中文中文3340字畢業(yè)論文（設(shè)計）外文翻譯譯文題目譯文題目全自動生化分析儀常見故障診斷、分析與維修（側(cè)重維修）學(xué)生姓名學(xué)生姓名學(xué)號號專業(yè)業(yè)生物醫(yī)學(xué)工程方向向醫(yī)療器械指導(dǎo)教師指導(dǎo)教師2008年12月24日12CLASSIFYINGSUCHDISEASES,ANDUNDERAPPROPRIATECIRCUMSTANCES,RESULTSAREUSEDFORDIAGNOSTICPURPOSESINRECENTYEARS,AUTOMATIONINCLINICALCHEMISTRYHASPROGRESSEDWITHACHANGEFROMRIGIDTOVERYFLEXIBLEINSTRUMENTSAUTOMATIONOFCLINICALINSTRUMENTSHASBROUGHTABOUTAREVOLUTIONINTHEFIELDOFMEDICALINSTRUMENTATIONITHASREDUCEDTHELOADONCLINICALLABORATORIESTOAGREATEXTENTBYREDUCINGTHETIMETAKENINTHETESTANDMINIMIZINGTHEINVOLVEMENTOFLABORATORYSTAFFINSTRUMENTDEVELOPEDISCLASSIFIEDASSEMIAUTOMATEDANALYSER2ANDHASADVANTAGESOFPRECISIONANDACCURACYTHESESYSTEMSAREUSEDINHOSPITALSTOTESTVARIOUSBLOODBIOCHEMICALPARAMETERSALLPRIMARYHEALTHCENTRES,COMMUNITYHEALTHCENTRES,ANDDISTRICTHOSPITALSARETHEPOTENTIALUSERSOFTHISMACHINE2MATERIALSANDMETHODS21THEINSTRUMENTIDESIGNPRINCIPLETHEINSTRUMENTISDESIGNEDUSINGTHEPRINCIPLEOFABSORBANCETRANSMITTANCEPHOTOMETRYACCORDINGTOLAMBERTANDBEER’FIGURE1SCHEMATICOFLAMBERTANDBEER’SLAWFIGURE2RELATIONBETWEENPERCENTTRANSMISSIONANDCONCENTRATIONLAW3,WHENMONOCHROMATICLIGHTISPASSEDTHROUGHCOLOUREDSOLUTION,THEINTENSITYOFTHETRANSMITTEDLIGHTDECREASESEXPONENTIALLYWITHTHEINCREASEINCONCENTRATIONOFTHEABSORBINGSUBSTANCETHEVALUEOFABSORPTIONOFLIGHTENERGYISDEPENDENTONTHENUMBEROFMOLECULESPRESENTINABSORBINGMATERIALANDTHETHICKNESSOFTHEMEDIUMTHUS,INTENSITYOFLIGHTENERGYLEAVINGTHEABSORBINGSUBSTANCEISUSEDASANINDICATIONOFCONCENTRATIONOFTHATPARTICULARSUBSTANCEASSHOWNINFIGURES1AND2,IFI0ISTHEINTENSITYOFINCIDENTLIGHTINCOLOUREDSOLUTIONANDITISTHETRANSMITTEDLIGHT,THENACCORDINGTOTHISLAWITI0EKCT1

簡介：附錄Ⅳ英文文獻及翻譯附錄Ⅳ英文文獻及翻譯BIOLOGICALEFFECTSOFTHEMAGNETICSTIMULATIONONTHETOADHEARTHONGWEILEI,YUYUANDU,YINALI,CHUNLINGLIU,XUWAN2007IEEE/ICMEINTERNATIONALCONFERENCEONCOMPLEXMEDICALENGINEERINGCME2007INSTITUTEOFBIOMEDICALENGINEERING,NORTHEASTERNUNIVERSITY,SHENYANG,LIAONING110004,PRCHINAABSTRACTWESTIMULATEDTHEEXPOSEDTOADHEARTBYALOWFREQUENCYANDHIGHENERGYMAGNETICBYANALYZETHEDATAOFTHISEXPERIMENT,ITSHOWSTHATTHEPULSATINGOFTHEWEAKTOADHEARTWOULDMAKECHANGEAFTERSTIMULATEDBYMAGNETICWEAKHEARTBEATSTRENGTHENED,THESINGLEPEAKCURVEWOULDBECOMETHETWOPEAKSCURVEWITHATRIAWAVEANDVENTRICLEWAVEAFTERTHEMAGNETICSTIMULATIONBUTTHECYCLINGOFRHYTHMICPULSATILECURVEOFTOADDOESNTCHANGEIINTRODUTIONALLLIFEFORMSHAVEMAGNETISMALLKINDSOFMAGNETICFIELDWOULDHAVESOMEEFFECTSONTHECONFIGURATIONANDACTIVITIESOFLIFEFORMSTHATWHICHEVERENVIRONMENTALMAGNETIC,ADDITIONALMAGNETICORINSIDEMAGNETICOFORGANISMTHEBIOLOGICEFFECTSARERELATEDTOTHECHARACTERISTICSANDTHEINTENSIONOFTHEMAGNETICFIELD,ASWELLASTHESPECIESANDTHETISSUESOFTHELIFEFORMSTHEEXPERIMENTATIONSHOWEDTHATMAGNETISMSTIMULATIONINSOMERANGEWOULDCONTROLTHEGROWTHOFRATTUMOUR,WHATEVERTHEYAREINOROUTTHEBODYMUCHMORETHEYCANINDUCETHECANCERCELLSDEAD30MTMAGNETICSTIMULATIONWOULDINCREASETHECONTENTOFNOINTHELIVERANDTHEKIDNEYMAGNETICALSOCANIMPROVETHEACTIVITYOFSOMEENZYMEANDPROMOTETHEREGENERATIONOFNERVETISSUECELLWOULDINCREASE,THEBONESWOULDBECONCRESCENCE,THESCARWOULDBEREHABILITATETHEBLOODRHEOLOGYANDBLOODCELLNUMBERBOTHOFHUMANANDRATWOULDCHANGEOBVIOUSLY,DITHEBLOODMUCOSITYWOULDBELOWHEARTISTHEMOSTIMPORTANTAPPARATUSOFLIFEITPULSATESDAYANDNIGHTHEARTONCESTOPPULSATING,THELIFEFORDANGERNUMEROUSSCHOLARPAYSATTENTIONTOTHEROLEOFMAGNETICFIELDBUTTHEYJUSTSTUDIEDTHEEFFECTSOFMAGNETICSTIMULATIONOFTHEHEARTPACEMAKERTHEEXPERIMENTSABOUTDIRECTEFFECTSOFSTIMULATEHEARTBYMAGNETICISVERYMADEBYOURSELVES③CARDIOMUSCULARTRANSDUCER④RINGERSOL⑤BATRACHIAINSTRUMENTS⑥CLIPOFFROGHEART⑦COTTONTHREAD?BURETTEBEXPERIMENTANIMALSTOADSIIIMETHODADESTROYTHEBRAINANDTHESPINALCORDOFTHETOADBYSTYLETPENETRATEINTOTHEOCCIPITALAPERTUREUPRIGHTWITHSTYLET,DESTROYEDTHEBRAINUPWARDS,TAKEBACKTHESTYLETANDDESTROYTHESPINALDOWNWARDSIFTHELIMBOFTOADWERERELAXED,ITSHOWEDTHATTHEBRAINANDSPINALWEREDESTROYEDCOMPLETELYBEXPOSETHETOADHEARTMAKETHETOADLYINGONITSBACKONTHEWINDINGCENTERTHEMAGNETICASPECTISUPRIGHTTHROUGHTHETOADHEARTCUTTHEVENTRALSKINOFTOAD,SNIPTHEBREASTBONE,EXPOSETHERATHEARTNIPTHEHEARTTIPBYCLIPCAREFULLYMAKETHECOTTONTHREADTIEDWITHTHECLIPOFFROGHEARTHELINKEDWITHTHECARDIOMUSCULARTRANSDUCERDONOTMAKETHETOADHEARTLEAVETHORAX,ORITWOULDDISTURBTHEEXPERIMENTRESULTSCNOTEDTHERESULTCONNECTTHECARDIOMUSCULARTRANSDUCERWITHTHECOMPUTERTAKENOTESTHECURVEOFTOADHEARTWITHOUTGIVINGTHESTIMULATEOFMAGNETICFIELDDAFTERTHREEMINUTES,NOTEDTHEWEAKPULSATILECURVEEMAKETHEMAGNETICINTENSION10T,ELECTRICIZE10SSTIMULATETHETOADHEARTANDRECORDTHEPULSATILECURVEIVRESULTSTHEABSCISSAOFCARDIACRHYTHMICPULSATILECURVEISTIME,THEORDINATEISCONSTRICTIONPOWERTAKENOTESFORTHEPULSATILECURVEOFTOADHEARTTHATEXPOSEDJUSTWECANKNOWTHERHYTHMICPULSATILECYCLEOFTHETOADHEARTIS15SFROMFIG1WHICHSHOWTHECARDIACRHYTHMICPULSATILECURVEOFTHETOADWHICHWASEXPOSEDTHEHEARTJUSTNOWTHEREARETWOWAVESINEACHCYCLE,ONEISATRIAWAVE,THEOTHERISVENTRICLEWAVETHEATRIAWAVEIS05SANDTHEVENTRICLEWAVEIS10STHECONSTRICTIONPOWEROFATRIAISLESSTHANTHATOFVENTRICLETHEAMPLITUDEOFCONSTRICTIONPOWEROFVENTRICLEISTHE2TIMESOFTHEATRIA

簡介：畢業(yè)設(shè)計（論文）外文翻譯譯文題目譯文題目國內(nèi)醫(yī)療儀器的現(xiàn)狀和存在的問題學(xué)生姓名學(xué)生姓名學(xué)號號專業(yè)業(yè)生物醫(yī)學(xué)工程方向向醫(yī)療儀器指導(dǎo)教師指導(dǎo)教師2013年3月8日NEEDEDRELATIVELYLOWUPDATINGINDICESAREOBSERVEDAMONGTHEDEVICESFORINTENSIVECAREANDRESUSCITATION16OFNEWITEMSANDCOMPARATIVELYMANYOBSOLETEDEVICES26AMONGNEWMODELSAPPARATUSESFORARTIFICIALLUNGVENTILATIONAREWORTHMENTIONHOWEVER,SOMEAPPARATUSES,WHICHHAVEBEENDEVELOPEDLONGAGOARESTILLONTHEMARKETBECAUSETHEYHAVEGOODPERFORMANCE,AREQUITERELIABLE,ANDSTILLAREINDEMANDTHISREDUCESTHEUPDATINGINDEXOFTHEGROUPASAWHOLEALLRUSSIANSCIENTIFICRESEARCHINSTITUTEFORMEDICALINSTRUMENTENGINEERING,RUSAIANACADEMYOFMEDICALSCIENCESVNIIMPVITAJOINTSTOCKCOMPANY,MOSCOWTRANSLATEDFROMMEDITSINSKAYATEKHNIKA,NO1,PP49,JANUARYFEBRUARY,1996ORIGINALARTICLESUBMITTEDAUGUST23,199500063398/96/3001000151500YPLENUMPUBLISHINGCORPORATIONTABLE1UPDATINGOFBASICGROUPSOFMEDICALDEVICESANDAPPARATUSESOFTOTALNOMENCLATURE這里有個表THELOWESTUPDATINGINDICESAREOBSERVEDFORDEVICESFOREXAMININGAPATIENTSBODYSTRUCTURESTHESEAREOPHTHALMOLOGICAL,OTOLARYNGOLOGICAL,ANDANTHROPOMETRICDEVICES,ENDOSCOPES,ETCTHESHAREOFOBSOLETEDEVICESISHIGH44,WHILETHEDEVICESWHICHHAVEBEENPRODUCEDFORNOMORETHAN5YEARSACCOUNTFORONLY20OFTOTALPRODUCTIONITSHOULDBENOTEDTHATTHESERESULTSONMEDICALEQUIPMENTUPDATINGAREIMPORTANTGENERALESTIMATES,ALTHOUGHTHEYDONOTTAKEINTOCONSIDERATIONSPECIFICACHIEVEMENTSANDSHORTCOMINGSINTHEPRODUCTIONOFINDIVIDUALITEMSTHEREFORE,SOMECORRESPONDINGAMENDMENTSAREREQUIREDOURSURVEYOFAVAILABLEINFORMATION,INCLUDINGTHEVNIIMPVITAJOINTSTOCKCOMPANYDATABANK,MATERIALSPRESENTEDATVARIOUSEXHIBITIONS,ANDRECENTLITERATURE,SHOWSTHATDOMESTICMEDICALINDUSTRYHASDEVELOPEDANUMBEROFORIGINALMEDICALDEVICESANDAPPARATUSESWHICHWEREDESIGNEDTOREPLACESIMILAROBSOLETEMODELSHOWEVER,MANYTYPESOFIMPORTANTANDNECESSARYMEDICALDEVICESSTILLDONOTMEETCONTEMPORARYREQUIREMENTS,ANDSOMETYPESOFDEVICESARENOTPRODUCEDATALLFOREXAMPLE,INRECENTYEARSPRODUCTIONOFSOMESOPHISTICATEDMEDICALDEVICESAPPARATUSESFORINTENSIVECARE,RESUSCITATION,ANDANESTHESIOLOGYDEVICESFORARTIFICIALLUNGVENTILATION,RESPIRATORYNARCOSISDEVICES,EXTRACORPOREALCIRCULATIONSIGNIFICANTLYROSE,PARTICULARLYATTHEFORMERDEFENSEINDUSTRYFACILITIES,ANDTHEIRQUALITYHASBEENSIGNIFICANTLYIMPROVEDTHEFUNCTIONALPERFORMANCEOFTHEDEVICESISGENERALLYONPARWITHFOREIGNANALOGSPERFUSIONUNITSHAVEALSOBEENIMPROVEDANDTHEIRPRODUCTIONHASEXPANDEDTHISALLOWEDTHEDEMANDOFTHEHEALTHSERVICEORGANIZATIONSFORSUCHEQUIPMENTTOBESATISFIEDCOMPLETELYMODERNDOMESTICHEMODIALYSISDEVICESRENART10,RENAN10RT,ETCHAVEBEENDEVELOPEDANDBROUGHTINTOWIDECLINICALPRACTICETHEDEVELOPMENTANDPRODUCTIONOFDIAGNOSTICMAGNETICRESONANCEIMAGINGSYSTEMSOBRAZ3,TOROSARECONSIDERABLEBREAKTHROUGHSINDOMESTICMEDICALINDUSTRYTHISSUBSTANTIALLYEXTENDSDIAGNOSTICCAPACITIESOFMANYHEALTHSERVICEORGANIZATIONSANDPROVIDESTHEMWITHTOPICALDIAGNOSISPREVIOUSLYUNAVAILABLEDOMESTICALLY,ALTHOUGHITISQUITECOMMONINDEVELOPEDFOREIGNCOUNTRIESDOMESTICMEDICALINDUSTRYHASBEGUNPRODUCTIONOFPULSEOXIMETERSTHESEAREOFPARTICULARUSEINSURGERYANDRESUSCITA

簡介：RECENTADVANCESINCOMMUNITYACQUIREDPNEUMONIAINPATIENTANDOUTPATIENTMICHAELSNIEDERMAN,MD,FCCPCOMMUNITYACQUIREDPNEUMONIACAPISACOMMONILLNESS,WITHTHEMAJORITYOFPATIENTSTREATEDOUTOFTHEHOSPITAL,YETTHEGREATESTBURDENOFTHECOSTOFCARECOMESFROMINPATIENTMANAGEMENTINTHEPASTSEVERALYEARS,THEMANAGEMENTOFTHESEPATIENTSHASADVANCED,WITHNEWINFORMATIONABOUTTHENATURALHISTORYANDPROGNOSISOFILLNESS,THEUTILITYOFSERUMMARKERSTOGUIDEMANAGEMENT,THEUSEOFAPPROPRIATECLINICALTOOLSTOGUIDETHESITEOFCAREDECISION,ANDTHEFINDINGTHATGUIDELINESCANBEDEVELOPEDINAWAYTHATIMPROVESPATIENTOUTCOMETHECHALLENGESTOPATIENTMANAGEMENTINCLUDETHEEMERGENCEOFNEWPATHOGENSANDTHEPROGRESSIONOFANTIBIOTICRESISTANCEINSOMEOFTHECOMMONPATHOGENSSUCHASSTREPTOCOCCUSPNEUMONIAEFEWNEWANTIMICROBIALTREATMENTOPTIONSAREAVAILABLE,ANDTHEUTILITYOFSOMENEWTHERAPIESHASBEENLIMITEDBYDRUGRELATEDTOXICITYANCILLARYCAREFORSEVEREPNEUMONIAWITHACTIVATEDPROTEINCANDCORTICOSTEROIDSISBEINGSTUDIED,BUTRECENTLY,INPATIENTCAREHASBEENMOSTAFFECTEDBYTHEDEVELOPMENTOFEVIDENCEBASED“COREMEASURES”FORMANAGEMENTTHATHAVEBEENPROMOTEDBYTHECENTERSFORMEDICAREANDMEDICAIDSERVICES,WHICHFORMTHEBASISFORTHEPUBLICREPORTINGOFHOSPITALPERFORMANCEINCAPCARECHEST20071311205–1215KEYWORDSCOMMUNITYACQUIREDPNEUMONIADRUGRESISTANCEMETHICILLLINRESISTANTPNEUMONIASEVEREPNEUMONIASEVERITYINDEXSTAPHYLOCOCCUSAUREUSSTREPTOCOCCUSPNEUMONIAEABBREVIATIONSAPACHE?ACUTEPHYSIOLOGYANDCHRONICHEALTHEVALUATIONCAP?COMMUNITYACQUIREDPNEUMONIACMS?CENTERSFORMEDICAREANDMEDICAIDSERVICESCRP?CREACTIVEPROTEINCURB65?CONFUSION,ELEVATEDBUNLEVEL,ELEVATEDRESPIRATORYRATE,LOWSYSTOLICORDIASTOLICBP,ANDAGE?65YEARSOFAGEDRSP?DRUGRESISTANTSTREPTOCOCCUSPNEUMONIAEHCAP?HEALTHCAREASSOCIATEDPNEUMONIAMRSA?METHICILLINRESISTANTSTAPHYLOCOCCUSAUREUSOR?ODDSRATIOPCT?PROCALCITONINPSI?PNEUMONIASEVERITYINDEXSARS?SEVEREACUTERESPIRATORYSYNDROMEINTHEPASTSEVERALYEARS,CLINICALADVANCESINCOMMUNITYACQUIREDPNEUMONIACAPHAVEEMERGEDINANUMBEROFAREASTHATCANAIDINTHECAREOFBOTHINPATIENTSANDOUTPATIENTSMAJORCLINICALISSUESFORALLCAPPATIENTSHAVEBEENTHECHANGINGSPECTRUMOFETIOLOGY,INCLUDINGDRUGRESISTANTSTREPTOCOCCUSPNEUMONIAEDRSP,METHICILLINRESISTANTSTAPHYLOCOCCUSAUREUSMRSA,ANDEMERGINGVIRALPATHOGENSEG,SEVEREACUTERESPIRATORYSYNDROMESARSANDAVIANINFLUENZAINADDITION,THEREHASBEENANINTERESTINBETTERUNDERSTANDINGTHENATURALHISTORYANDPROGNOSISOFCAPBYTRYINGTODEFINETHEROLEOFPROGNOSTICSCORINGSYSTEMSINGUIDINGTHEDECISIONABOUTSITEOFCAREIE,INPATIENT,OUTPATIENT,ORICUANDBYAPPLYINGANUMBEROFSERUMMARKERSIE,CREACTIVEPROTEINCRPANDPROCALCITONINPCTTOPROGNOSTICATEOUTCOMENEWANTIMICROBIALAGENTSHAVEBECOMEAVAILABLEFORBOTHOUTPATIENTSANDINPATIENTS,INSEVERALANTIBIOTICCLASSES,BUTTHEUTILITYOFSOMEOFTHESEAGENTSHASBEENLIMITEDBYNEWFINDINGSOFTOXICITIESTHATWERENOTEVIDENTINREGISTRATIONTRIALSOFTHESEMEDICATIONSIE,GATIFLOXAFROMTHEDEPARTMENTOFMEDICINE,STATEUNIVERSITYOFNEWYORKATSTONYBROOK,STONYBROOK,NYDRNIEDERMANHASBEENASPEAKER,CONSULTANT,ORRESEARCHERFORSCHERING,JOHNSONANDJOHNSON,AVENTIS,PFIZER,BAYER,MERCK,ELAN,ANDWYETHMANUSCRIPTRECEIVEDAUGUST10,2006REVISIONACCEPTEDOCTOBER5,2005REPRODUCTIONOFTHISARTICLEISPROHIBITEDWITHOUTWRITTENPERMISSIONFROMTHEAMERICANCOLLEGEOFCHESTPHYSICIANSWWWCHESTJOURNALORG/MISC/REPRINTSSHTMLCORRESPONDENCETOMICHAELNIEDERMAN,MD,FCCP,DEPARTMENTOFMEDICINE,WINTHROPUNIVERSITYHOSPITAL,222STATIONPLAZAN,SUITE509,MINEOLA,NY11501EMAILMNIEDERMANWINTHROPORGDOI101378/CHEST061994CHESTRECENTADVANCESINCHESTMEDICINEWWWCHESTJOURNALORGCHEST/131/4/APRIL,20071205BYWHETHERORNOTAPATIENTISADMITTEDTOTHEHOSPITAL3INTHEUNITEDSTATES,?20OFALLCAPPATIENTSAREADMITTEDTOTHEHOSPITAL,BUTTHEDOLLARSSPENTONTHESEPATIENTSACCOUNTFOR?90OFTHETOTALCOSTOFCAREFORTHISDISEASE,EMPHASIZINGTHEIMPACTOFTHEHOSPITALADMISSIONDECISION3FORANUMBEROFYEARS,PROGNOSTICSCORINGSYSTEMSHAVEBEENUSEDTODEFINENOTONLYTHEPREDICTEDMORTALITYRATEOFCAP,BUTALSO,BYINFERENCE,THESITEOFCARE,RESERVINGHOSPITALADMISSIONFORTHOSEWITHAHIGHPREDICTEDMORTALITYRATETHETWOCOMMONLYUSEDTOOLSFORTHEPURPOSEOFPREDICTINGOUTCOMEINCAPPATIENTSHAVEBEENTHEPNEUMONIASEVERITYINDEXPSI,WHICHWASDEVELOPEDINTHEUNITEDSTATES,ANDTHEBRITISHTHORACICSOCIETYRULE,WHICHHASRECENTLYBEENMODIFIEDTOTHECURB65REFERRINGTOITSASSESSMENTOFTHEFOLLOWINGFIVEFACTORSCONFUSIONELEVATEDBUNLEVELELEVATEDRESPIRATORYRATELOWSYSTOLICORDIASTOLICBPANDAGE?65YEARSOFAGERULE4EACHOFTHESEAPPROACHESHASLIMITATIONS,ANDITMAYBEBESTTOVIEWTHEMASCOMPLEMENTARY,IDEALLYIDENTIFYINGPATIENTSATOPPOSITEENDSOFTHEDISEASESPECTRUM5THEPSIHASBEENBESTVALIDATEDASAWAYTOIDENTIFYPATIENTSWITHALOWRISKOFMORTALITY,BUTTHESCORINGSYSTEMCANOCCASIONALLYUNDERESTIMATESEVERITYOFILLNESS,ESPECIALLYINYOUNGPATIENTSWITHOUTCOMORBIDILLNESSBECAUSEITHEAVILYWEIGHTSAGEANDCOMORBIDITY,ANDDOESNOTMEASURECAPSPECIFICDISEASESEVERITY5ONTHEOTHERHAND,THECURB65APPROACHMAYBEIDEALFORIDENTIFYINGPATIENTSWITHAHIGHRISKOFMORTALITYWITHSEVEREILLNESSDUETOCAP,WHOMIGHTOTHERWISEBEOVERLOOKEDWITHOUTTHEFORMALASSESSMENTOFSUBTLEABERRATIONSINKEYVITALSIGNS5HOWEVER,ONEDEFICIENCYOFTHECURB65APPROACHISTHATITDOESNOTGENERALLYACCOUNTFORCOMORBIDILLNESSANDTHUSMAYNOTBEEASILYAPPLIEDINOLDERPATIENTSWHOMAYSTILLHAVEASUBSTANTIALMORTALITYRISKIFEVENAMILDFORMOFCAPDESTABILIZESACHRONIC,BUTCOMPENSATED,DISEASEPROCESSINONERECENTSTUDY4THATCOMPAREDTHEPSITOTHECURB65IN3,181PATIENTSSEENINANEMERGENCYDEPARTMENT,BOTHWEREDETERMINEDTOBEGOODFORPREDICTINGMORTALITYANDFORIDENTIFYINGPATIENTSWITHALOWRISKOFMORTALITYHOWEVER,THEPSIAPPEAREDTOBEMOREDISCRIMINATINGINIDENTIFYINGPATIENTSWITHALOWRISKOFMORTALITY,WITH68BEINGDEFINEDBYPSITOHAVEALOWRISKCLASSESITOIII,WITHAMORTALITYRATEOF14,WHILE61WEREDEFINEDBYTHECURB65TOHAVEALOWRISKSCOREOF0TO1WITHAMORTALITYRATEOF17HOWEVER,THECURB65MAYHAVEBEENMOREVALUABLEATTHESEVEREDISEASEENDOFTHESPECTRUMBECAUSEITDEFINEDHIGHRISKPATIENTSASTHOSEWITHASCOREOF2,3,4,OR5,EACHWITHAPROGRESSIVELYINCREASINGRISKOFDEATH,WHILETHEPSIWASLESSDISCRIMINATING,DEFININGONLYTWOGROUPSASBEINGSEVERELYILLINANOTHERANALYSIS,6THECURB65SCOREALSOAPPEAREDTOIDENTIFY,MOSTACCURATELY,THOSEPATIENTSWITHCAPWHOWERELIKELYTOBENEFITFROMTREATMENTWITHDROTRECOGINALFAINTHERECOMBINANTHUMANACTIVATEDPROTEINCWORLDWIDEEVALUATIONINSEVERESEPSISORPROWESSSTUDYAREEXAMINATIONOFTHEDATAFROMTHATSTUDYDEMONSTRATEDTHATATHRESHOLDCURB65SCOREOF?3WASASSOCIATEDWITHADECREASEINTHE28DAYMORTALITYRATEINDROTRECOGINALFATREATEDPATIENTSOF108WHENCOMPAREDTOCONTROLSUBJECTSP?0018VSADECREASEINMORTALITYRATEINTREATEDPATIENTSINPSICLASSESIVANDVOF97COMPAREDTOCONTROLSUBJECTSP?00136CAPELASTEGUIANDCOLLEAGUES7USEDBOTHTHEPSIANDTHECURB65APPROACHTOEVALUATEALARGENUMBEROFBOTHINPATIENTSANDOUTPATIENTSWITHCAPINSPAINTHEYOBSERVEDTHATTHECURB65ANDITSSIMPLERCRB65VERSION,WHICHEXCLUDESTHEMEASUREMENTOFBUN,ANDTHEREFORECANBEUSEDINOUTPATIENTSCOULDACCURATELYPREDICTTHE30DAYMORTALITYRATE,THENEEDFORMECHANICALVENTILATION,AND,TOSOMEEXTENT,THENEEDFORHOSPITALIZATIONINADDITION,THECURB65CRITERIACORRELATEDWITHTHETIMETOCLINICALSTABILITY,ANDTHUSAHIGHERSCOREWASPREDICTIVEOFALONGERDURATIONOFIVTHERAPYANDALONGERLENGTHOFHOSPITALSTAYTHEPSIALSOWORKEDWELLTOPREDICTMORTALITYINTHATSTUDYWHILEBOTHTHEPSIANDCURB65AREGOODFORPREDICTINGMORTALITY,NEITHERCANBEUSEDTODEFINETHESITEOFCARE,WITHOUTCONSIDERINGOTHERCLINICALANDSOCIALVARIABLESASTUDYATAPUBLICHOSPITALINTHEUNITEDSTATES,WITHMANYINDIGENTPATIENTS,SHOWEDTHATTHEPSICOULDNOTDEFINETHENEEDFORHOSPITALADMISSIONIFPATIENTSWEREHOMELESSORACUTELYINTOXICATED,ORIFTHEYDIDNOTHAVEASTABLEHOMEENVIRONMENTTHATALLOWEDTHEMTOBEDISCHARGEDFROMTHEHOSPITALWHILERECEIVINGORALANTIBIOTICTHERAPY8INONERECENTCOMMENTARY,5THESUGGESTIONWASMADETOCOMBINEBOTHOFTHESEPROGNOSTICSCORINGTOOLS,RECOGNIZINGTHATNEITHERAPPROACHCANSTANDALONELOWRISKPATIENTSIE,PSICLASSESITOIIIORCURB65SCOREOF0TO1CANBEMANAGEDATHOMEIFSERIOUSVITALSIGNABNORMALITIESINTHECASEOFPSIORCOMORBIDITIESINTHECASEOFCURB65AREABSENT,ANDIFPATIENTSDONOTHAVESOCIALFACTORSOROTHERILLNESSESTHATAREUNSTABLEANDTHATNECESSITATEHOSPITALIZATIONMODERATERISKPATIENTSIE,CURB65SCOREOF?2ORPSICLASSESIVANDVPROBABLYSHOULDBEADMITTEDTOTHEHOSPITAL,ANDCLINICALASSESSMENTSHOULDBEUSEDTOSEPARATETHOSEWHONEEDICUCAREFROMTHOSEWHOARELIKELYTOBECOMECLINICALLYSTABLERAPIDLYANDWHOWOULDTHENREQUIREONLYASHORTHOSPITALSTAYWWWCHESTJOURNALORGCHEST/131/4/APRIL,20071207

簡介：中文中文6600字出處出處BARBIERIA,BURSIF,POLITIL,ETALECHOCARDIOGRAPHICDIASTOLICDYSFUNCTIONANDMAGNETICRESONANCEINFARCTSIZEINHEALEDMYOCARDIALINFARCTIONTREATEDWITHPRIMARYANGIOPLASTYJECHOCARDIOGRAPHY,2008,256575583心肌梗死初級血管成形術(shù)治療術(shù)后的超聲心動圖下舒張功能障心肌梗死初級血管成形術(shù)治療術(shù)后的超聲心動圖下舒張功能障礙與磁共振心肌梗死面積的關(guān)系礙與磁共振心肌梗死面積的關(guān)系BARBIERIA,BURSIF,POLITIL,ETAL背景背景急性心肌梗死后，超聲心動圖顯示的舒張功能障礙代表一個獨立的預(yù)后因素。然而，舒張功能障礙預(yù)示心梗后危險因素增加的機制尚不完全清楚。我們已經(jīng)研究過超聲心動圖舒張功能障礙嚴(yán)重程度與造影劑增強磁共振下測量的梗死面積數(shù)值的關(guān)系。方法方法橫斷面前瞻性研究。我們通過測量磁共振延遲增強百分比來量化陳舊性梗死的面積，同時在多普勒超聲下測量左室重量和舒張功能。這兩種測量預(yù)計至少在成功運用血管成形術(shù)與支架植入術(shù)治療初始第一次急性ST段抬高性心肌梗死后的一個月后才能實施。為了提高特異性，個體超聲心動圖參數(shù)被納入全球舒張功能等級，共分為4級舒張功能正常，舒張功能受損，但灌注壓正常或接近正常；舒張功能受損，灌注壓中度升高；舒張功能受損，灌注壓明顯升高，“限制性充盈”。結(jié)果結(jié)果我們預(yù)先登記了52名患者（平均年齡62±13歲，77為男性）。在心梗后48±15天后檢查增強磁共振和超聲心動圖。在舒張功能能分級與梗死面積之間有具有統(tǒng)計學(xué)意義的中度相關(guān)性（R0423，P0002），這種關(guān)聯(lián)性與整體和局部的收縮功能無關(guān)，在進一步調(diào)整過年齡、性別、體表面積、左室重量、終末舒張容積和球形舒張指數(shù)后，結(jié)果相同（所有的P005）。在超聲心動圖單獨變量中，梗死面積與組織多普勒速度EM（R0307，P003），AM（R039，P0005），血流傳播速度（R034，P0015）相關(guān)性最好結(jié)論結(jié)論在經(jīng)初始血管成形術(shù)和支架植入術(shù)成功治療的陳舊性ST段抬高性心肌梗死患者中，盡管與心肌梗死的面積有弱相關(guān)性，但是舒張功能分級是獨立的。因此，心肌梗死面積不能充分的解釋舒張功能障礙增加的風(fēng)險。關(guān)鍵詞關(guān)鍵詞舒張功能梗死面積磁共振初次血管成形術(shù)由多普勒超聲心動圖評估舒張功能障礙是急性心肌梗死（MI）后不良后果的一種預(yù)測1,2。然而，舒張功能障礙可以預(yù)示心梗后危險因素增加的機制尚不完全清楚3。舒張功能障礙可能只是表明嚴(yán)重收縮功能障礙4,5和心肌數(shù)目減少的大面積梗死6,7。另一方面，大量的研究表明，急性心肌梗死后心臟舒張功能障礙是一個獨立的預(yù)后預(yù)測因子，它是一個增量，如同傳統(tǒng)的梗死面積指標(biāo)，例如KILLIP分級，酶學(xué)，射血分?jǐn)?shù)（EF），室壁運動積分指數(shù)（WMSI）和終末收縮容積810，此外，少數(shù)的探討舒張功能障礙和梗死面積的研究只是使用了間接指標(biāo)代替量化的梗死面積4,5。對比增強磁共振（CE磁共振）城像是一種準(zhǔn)確的重復(fù)性好的量化梗死面積的方法，目前被認(rèn)為是監(jiān)測不可逆心肌損傷的金標(biāo)準(zhǔn)11。我們假設(shè)，心肌梗死后，用超聲心動圖評價的舒張功能障礙與心肌梗死面積相關(guān)。因此，我們試圖評價多普勒超聲下的舒張功能障礙和CE磁共振量化的梗死面積之間的關(guān)系。在急性心梗后至少一個月、組織水腫和細胞炎癥不再明顯時，我們用評估“治愈”梗死面積與舒張功能障礙，分別通過測量過度增強的數(shù)量和多普勒超聲心動圖指標(biāo)12。由兩個獨立的調(diào)查員在同一天做超聲心動圖和CE磁共振并進行解釋。為了排除正存在的缺血，使生理條件可比，只有被初始血管成形術(shù)救治的成功第一次急性ST段抬高型增強磁共振成像確定梗死面積增強磁共振成像確定梗死面積MRI試驗試驗MRI在一個15噸的全身的掃描儀中進行（INTERACV,PHILIPSMEDICALSYSTEMS）。心臟MRI是用五元心協(xié)同線圈。心臟同步化用心電向量法獲得。研究方案包括檢查休息時MRI來評價局部與整體左室功能和體積，在用增強MRI來判定組織梗死的存在與程度。十到十二，在大約15秒的時間中，根據(jù)心臟大小的不同，從心尖到心底，動態(tài)短軸視圖可由平衡快速場回聲序列編碼（BFFE）敏感性的方法成像。以下參數(shù)可用回聲時間，17MSEC；重復(fù)時間，40MSEC，片厚度，8MM，沒有間距，視角場，320MM；數(shù)據(jù)矩陣大小，256224MM；場相，075；觸發(fā)延遲，最?。幻慷?5個視圖，心率814，翻轉(zhuǎn)角，45°。每個切片可獲得至少30個動態(tài)框架?；€掃描處相同的幾何設(shè)定要重復(fù)進行，以獲得可比的切片。在注射造影劑15分鐘后，從左室短軸切面中可獲得舒張末期造影延遲圖像，用來評價心肌超增強的分布。一個基于預(yù)脈沖序列的三維回聲被應(yīng)用，參數(shù)如下回聲時間，42MSEC，翻轉(zhuǎn)角，20°；矩陣，256160；NEX，200；FOV，36CM；片厚度，8MM。反轉(zhuǎn)時間從260MSEC到340MSEC。直到心肌死亡時，我們使用允許反轉(zhuǎn)時間有相互作用的改變的真實時間選項來調(diào)整這個參數(shù)。用一個從基地部到心尖處的數(shù)目可變的短軸片來覆蓋整個左心室。評估心尖還從縱行和水平的長軸。定義與數(shù)據(jù)分析定義與數(shù)據(jù)分析在離線工作站分析圖像（VIEWFORUM32；PHILIPSMEDICALSYSTEMS）。在局部分析中，左心室被分為17個心肌節(jié)段14。使用一個半自動的以前被證明有效地軟件來測量延遲增強的面積，以評估梗死面積22。分析所有的短軸圖像和兩個長軸圖像以分析心尖部位。在每個圖像中，增強區(qū)域的邊界被自動的確定，最后進行糾正。梗死的分部程度由兩名調(diào)查者（FF和GL公司）達成共識后得出，這兩名調(diào)查者對臨床數(shù)據(jù)不知情。如果平均信號強度至少高于梗死心肌的兩倍，這些區(qū)域會被認(rèn)為是感興趣區(qū)，會被過度增強。心內(nèi)膜下的環(huán)繞高增強區(qū)的低增強區(qū)被包含在梗死區(qū)內(nèi)。增強區(qū)可用來表示梗死區(qū)，用克和占整個心肌面積的百分比來表示。數(shù)據(jù)分析數(shù)據(jù)分析分類變量用百分比來表示，連續(xù)變量用平均值±標(biāo)準(zhǔn)差來表示。對于高度縫變量的數(shù)據(jù)以中位數(shù)（第25第75百分位）表示。連續(xù)變量之間相關(guān)性用PEARSON相關(guān)來檢測。用多元線性回歸來評估收縮功能的級別與梗死面積之間的相關(guān)性，梗死面積與局部和整體的收縮功能無關(guān)。測試三種不同的模式第一個是整體收縮功能指標(biāo)，第二個是局部舒張功能指標(biāo)，第三個是左室重構(gòu)指標(biāo)（左室重量，收縮與舒張球形指數(shù)，終末舒張容積）。用增強磁共振在超聲心動圖評價舒張指數(shù)的同一天，評價局部與整體收縮功能、左室容積。P005是有意義的。所用的分析都用SPSS130來進行分析。結(jié)果結(jié)果我們將57例患有STEMI并用初級血管成形術(shù)治療的患者納入前瞻性研究，5例因為從前患有心肌梗死被排除，剩下的52名患者最終被納入研究。平均年齡為618±129歲，77為男性。所用的患者都進行血管成形術(shù)制都安裝過裸金屬支架，在進行過球囊擴張之后，平均球囊擴張的時間為61±26分鐘。心梗后都接受過MRI，時間為48±15天。延遲增強的中位（第25和第75百分位）百分比為140（60199），中尉延遲增強重量為145克（67248克）。表I顯示了受試者的基礎(chǔ)情況。平均射血分?jǐn)?shù)為605±142，33的患者舒張功能正常，其余的77有輕微的舒張功能障礙（I級）。所有的患者都

簡介：中文中文3050字出處出處MATSUSHITAA,NAKASHIMAY,JINGUSHIS,ETALEFFECTSOFTHEFEMORALOFFSETANDTHEHEADSIZEONTHESAFERANGEOFMOTIONINTOTALHIPARTHROPLASTYJTHEJOURNALOFARTHROPLASTY,2009,244646651股骨柄偏距和股骨頭直徑對于全髖關(guān)節(jié)置換術(shù)后股骨柄偏距和股骨頭直徑對于全髖關(guān)節(jié)置換術(shù)后髖關(guān)節(jié)安全活動范圍髖關(guān)節(jié)安全活動范圍的影響的影響摘要本研究旨在量化股骨柄偏距和股骨頭直徑對于全髖關(guān)節(jié)置換術(shù)后髖關(guān)節(jié)活動范圍（RANGEOFMOTION，ROM）的影響。采用后外側(cè)手術(shù)入路，在11個尸體標(biāo)本髖關(guān)節(jié)中植入組配型全髖關(guān)節(jié)假體。研究三種不同的的股骨柄偏距和五種不同的股骨頭直徑對髖關(guān)節(jié)活動度的影響。將股骨柄偏距增至4MM和8MM時，髖關(guān)節(jié)屈曲度分別增加211°和267°，髖關(guān)節(jié)內(nèi)旋度分別增加137°和212°。髖關(guān)節(jié)活動度隨股骨頭直徑的增加而增加，主要是因為增加了股骨頭的脫位行程而非延遲了撞擊。與之相比，增加股骨柄偏距的作用在于延遲了骨性結(jié)構(gòu)的撞擊。關(guān)鍵詞全髖關(guān)節(jié)置換術(shù)（THA），股骨柄偏距，股骨頭直徑，活動范圍（ROM），脫位行程。髖關(guān)節(jié)脫位是全髖關(guān)節(jié)置換術(shù)（TOTALHIPARTHROPLASTY，THA）后最常見和最重要的并發(fā)癥之一13。據(jù)報道，初次全髖關(guān)節(jié)置換術(shù)后髖關(guān)節(jié)脫位的發(fā)生率達2546。有多種因素影響術(shù)后脫位的發(fā)生?；颊呦嚓P(guān)因素包括年齡、性別、有無肢體麻痹或力弱4,7。手術(shù)相關(guān)因素包括髖臼和股骨柄假體的安裝位置是否準(zhǔn)確、是否采取后側(cè)入路、軟組織的修復(fù)程度及術(shù)中體位等35,8,9。假體相關(guān)因素也與全髖關(guān)節(jié)置換術(shù)后髖關(guān)節(jié)的穩(wěn)定性相關(guān)，例如股骨頭直徑及頭頸比1013。在大多數(shù)脫位中，股骨頭脫出與假體或骨結(jié)構(gòu)的撞擊相關(guān)。因此延緩假體撞擊對于預(yù)防脫位至關(guān)重要。應(yīng)精心設(shè)計假體，減少撞擊的風(fēng)險。增大股骨頭直徑和/或增大股骨柄偏距可能對此有所幫助。已有很多研究報告了股骨頭直徑對髖關(guān)節(jié)活動范圍（RANGEOFMOTION，ROM）的影響2,4,13,14。但據(jù)我們所知，僅有少量研究關(guān)注股骨頭直徑與髖關(guān)節(jié)撞擊和脫位行程之間的關(guān)系。股骨柄偏距與髖關(guān)節(jié)活動范圍間的量化關(guān)系也未見報道。本研究中，我們通過尸體標(biāo)本研究股骨柄偏距和股骨頭直徑與全髖關(guān)節(jié)置換術(shù)后髖關(guān)節(jié)安全活動范圍之間的量化關(guān)系，同時分析股骨頭直徑對脫位行程的影響方法假體的植入在8個尸體標(biāo)本（11髖）中植入組配型全髖關(guān)節(jié)假體（PERFIXHA；JAPANMEDICALMATERIAL，OSAKA，JAPAN），全部采用后外側(cè)手術(shù)入路。手術(shù)中保留髖關(guān)節(jié)前方關(guān)節(jié)囊和臀中肌。髖臼假體外傾角固定安放為45°，髖臼和股骨柄的聯(lián)合前傾角在40°50°之間15。所有手術(shù)中使用的髖臼內(nèi)襯均不帶增高邊。股骨柄偏距和股骨頭直徑動度，直至骨盆和股骨干發(fā)生撞擊。此外，增加股骨柄偏距可以增加軟組織張力，例如臀中肌的張力，從而增加關(guān)節(jié)的穩(wěn)定性16,17。ASAYAMA等報道，增加股骨柄偏距可增加髖關(guān)節(jié)活動度，同時增加外展肌效能，在增加關(guān)節(jié)穩(wěn)定性的同時減少聚乙烯內(nèi)襯的磨損。增加股骨柄偏距，可減少步行時臀中肌的張力和做功，同時減少關(guān)節(jié)內(nèi)的應(yīng)力18。這些因素都可增加髖關(guān)節(jié)置換術(shù)后的活動度。為了在不改變肢體長度的同時增加股骨柄偏距，必須設(shè)計小頸干角、長股骨頸的股骨柄假體。但是這種設(shè)計將導(dǎo)致假體近端折彎力矩的增加，進而增加骨皮質(zhì)的疲勞。這些不利影響可能是早期股骨柄組件松動失敗的原因之一19。DAVEY等報道，隨著股骨柄偏距的增加，股骨柄近段折彎力臂隨之增加，但由于合并應(yīng)力的減小，折彎力矩的增加很少20。因而，骨皮質(zhì)疲勞的凈增加并不大，是可以接受的。審視目前常用的假體系統(tǒng)，CPT股骨柄（ZIMMER，INC，WARSAW，IND）頸干角為125°，CENTPILLAR股骨柄（STRYKER，INC，KALAMAZOO，MICH）頸干角為127°，到目前為止，還未發(fā)現(xiàn)重大問題。當(dāng)然，還需要進一步的長期隨訪。股骨頭直徑髖關(guān)節(jié)的屈曲和內(nèi)旋范圍與股骨頭直徑大小呈正相關(guān)。股骨頭直徑由22MM增加至36MM，0°外展的情況下，髖關(guān)節(jié)的屈曲度和內(nèi)旋度分別增加了113°和100°。本研究結(jié)果與前人研究結(jié)論相一致，確認(rèn)了大直徑股骨頭的有效性2,4,14,21。增加髖關(guān)節(jié)的穩(wěn)定性可從兩個方面入手。首先，增加股骨頭直徑可增加股骨柄在髖臼內(nèi)襯中的擺動角，當(dāng)然這最終是由股骨頭頸比來決定的。D’LIMA等報道，股骨頭直徑由22MM增至32MM，活動度增加8°22。YOSHIMINE和GINBAYASHI報道，股骨頭直徑由22MM增至26MM，擺動角增加了12°23。另一方面，髖關(guān)節(jié)的撞擊不僅發(fā)生于股骨頸和髖臼內(nèi)襯之間，還發(fā)生于股骨和骨盆之間。BARTZ等報道，股骨頸和髖臼內(nèi)襯的撞擊通常發(fā)生于22MM直徑股骨頭；隨著股骨頭直徑的加大，撞擊更常見于股骨和骨盆之間24。正是由于這種股骨和骨盆之間的撞擊，使得股骨頭直徑增大對于增加髖關(guān)節(jié)活動范圍的作用不如預(yù)期明顯。BURROUGHS等也發(fā)現(xiàn)，隨著股骨頭直徑的增加，股骨和骨盆的撞擊逐漸超過了股骨頸和內(nèi)襯的撞擊14。CHANDLER等發(fā)現(xiàn)，增加股骨頭直徑延緩了股骨頸和髖臼內(nèi)襯邊緣接觸的時間，從而增加了活動范圍12。此外還發(fā)現(xiàn)，撞擊逐漸轉(zhuǎn)移至股骨和骨盆之間以及大粗隆和恥骨髂骨之間，限制了內(nèi)旋和屈曲。如果發(fā)生了骨性撞擊，那么繼續(xù)增加股骨頭直徑對增加髖關(guān)節(jié)活動度不再起作用。本研究結(jié)果表明，股骨頭直徑由22MM增至26MM和由28MM增至32MM時，活動度分別增加了10°和8°。這一結(jié)果同時顯示，使用大直徑股骨頭時，骨性撞擊超過了假體撞擊。其次，使用大直徑股骨頭增加了自撞擊發(fā)生至脫位的距離（即脫位行程，圖6），進而增加了髖關(guān)節(jié)活動度。本研究符合這一觀點。當(dāng)股骨頭直徑由22MM增至36MM時，脫位行程由68°增加至211°，同時觀察到髖關(guān)節(jié)活動度的增加。SCIFERT等應(yīng)用有限元分析發(fā)

簡介：中文中文2300字單中心分析應(yīng)用奧里根一次性套扎治療痔瘡單中心分析應(yīng)用奧里根一次性套扎治療痔瘡摘要背景摘要背景在西方世界痔瘡是最常見的肛腸疾病，也是活動性、復(fù)發(fā)性、慢性直腸出血的主要因素。已經(jīng)有很多方法被提議及嘗試來用于早期痔瘡的治療。大體來說橡膠帶結(jié)扎方法（RBL）是安全和有效地。目的目的用于評估在有癥狀的患有痔瘡的門診患者中，運用橡膠帶結(jié)扎方法（RBL）并使用奧里根一次性套扎裝置治療的有效性及并發(fā)癥。結(jié)果結(jié)果接受奧里根一次性套扎治療痔瘡的60個連續(xù)患者，一臺手術(shù)平均需要的時間是62分鐘，最長的是10分鐘。未提及有主要的并發(fā)癥。顯示有10的患者出現(xiàn)少量的早期出血，67的患者出現(xiàn)少量的晚期出血，但沒有一個是嚴(yán)重的。67的患者出現(xiàn)疼痛但不嚴(yán)重。在所有的病例中，觀察到在臨床上和內(nèi)窺鏡下都得到改善，而且發(fā)現(xiàn)各個年齡層次的患者，包括老年人，都可以耐受整個過程。結(jié)論結(jié)論運用橡膠帶結(jié)扎方法（RBL）并使用奧里根一次性套扎裝置治療有癥狀的患有痔瘡的門診患者，有著良好的反應(yīng)及低并發(fā)癥發(fā)生率。我們推薦這項技術(shù)作為一個安全、可靠的治療方法。關(guān)鍵詞關(guān)鍵詞痔，奧里根一次性套扎，橡膠帶結(jié)扎介紹介紹在西方世界，痔瘡是最常見的肛管直腸疾病。已經(jīng)提議及嘗試過很多治療方法，普遍認(rèn)為橡膠帶結(jié)扎方法是安全和有效地。手術(shù)方法適用于3到4期的內(nèi)痔患者，混合痔或處于抗凝血狀態(tài)的患者不適用于橡膠帶結(jié)扎法。理想的治療方法是容易上手，花費實在，有滿意的結(jié)果及少有并發(fā)癥。橡膠帶套扎法被認(rèn)為是治療1到3期內(nèi)痔患者的首選方法。材料和方法材料和方法在2005年9月到2006年3月期間，運用橡膠帶結(jié)扎方法（RBL）并使用奧里根一次性套扎裝置治療的60名連續(xù)的患者（包括32名男性，28名女性）。所有患者為1到4期的內(nèi)痔患者（根據(jù)內(nèi)痔4期分類的戈利格分類系統(tǒng)），所有患者都采用過保守治療后不愈。此研究計劃是經(jīng)醫(yī)學(xué)倫理委員會批準(zhǔn)的，與每一個患者都簽署了知情同意。本研究排除了患有相關(guān)肛裂、腦和中樞神經(jīng)系統(tǒng)其他部位的良性腫瘤、患者傳染性的肛周疾病以及拒絕簽署知情同意的患者。所有患者術(shù)前都運用鹽水灌腸，以及肛管內(nèi)應(yīng)用局麻藥膏（2利多卡因凝膠，德國制造生產(chǎn)）做準(zhǔn)備。一周內(nèi)發(fā)生的為早期并發(fā)癥。所有的橡膠帶結(jié)扎法都是在門診基礎(chǔ)上實行的。負荷裝置的前端先是完整地插入到直腸內(nèi)，然后與結(jié)扎血管的一側(cè)成銳角緩慢地退出，均在齒狀線上1CM以上操作。隨著活塞的撤離，組織被吸入到結(jié)扎器內(nèi)。評定疼痛通過采用當(dāng)維持吸力時180°旋轉(zhuǎn)結(jié)扎器，如果這個手法引起不適，則結(jié)扎器被定在較高的位置。當(dāng)180°旋轉(zhuǎn)結(jié)扎器數(shù)次，吸力應(yīng)至少維持30秒，使得組織在適當(dāng)?shù)拇掏聪卤晃氲浇Y(jié)扎器內(nèi)。釋放壓圈器和吸引器，橡膠圈就撤離了。在這個方法中應(yīng)盡可能多地結(jié)扎內(nèi)痔。環(huán)形分布決定范圍，且將其分為5級0級沒有；1級1/4周長；2級周長的一半；3級3/4周長；4級整個周長。外形由最大的痔的直徑?jīng)Q定，分為4種尺寸0型沒有；1型直徑小于6MM；2型直徑大于6MM，小于12MM；3型直徑大于12MM。根據(jù)出血、脫出、疼痛的癥狀分為0到3級0級沒有；1級排便時偶爾出現(xiàn)；2級每次排便均有；3級與排便無關(guān)。在首次術(shù)后及反復(fù)進行內(nèi)鏡檢查評定內(nèi)痔的范圍和外形后觀察患者癥狀數(shù)周，來評價患者預(yù)后。首次術(shù)后3個月仍然根據(jù)癥狀評定患者，3個月反應(yīng)出的表現(xiàn)分為極好（無癥狀）；好（明確得到改善，但偶爾仍有癥狀）；不好（沒有得到改善，癥狀惡化）。結(jié)果在一次手術(shù)中平均置入19個橡膠圈，平均用時為62分鐘（范圍為310分鐘）在表I列出我們患者的特點如下總?cè)藬?shù)60（100）平均年齡536（7633）男女比例3228飲酒者占總數(shù)比4（67）吸煙者占總數(shù)比14（233）平均身體質(zhì)量指數(shù)229（17339）根據(jù)戈利格分類將痔進行分類1度6（10）；2度36（60）；3度266；4度2個（34）。沒有嚴(yán)重的并發(fā)癥，如大出血或盆腔膿腫發(fā)生。有6個患者（10，4個女性，2個男性）出現(xiàn)早期出血，但沒有一個嚴(yán)重到需要進行輸血或者住院治療。有4個患者（67，4男4女）出現(xiàn)疼痛，3個為輕度疼痛，其余為中度疼痛。有4個患者（67）在套扎后的第1012天發(fā)生出血，似乎是由于將大量的組織從蒂上分離導(dǎo)致的，這些出血都自行止住。有4例因反復(fù)出血需行第二次套扎治療，所有患者臨床癥狀都得到緩解。3個月后的復(fù)查反應(yīng)在1、2、3度內(nèi)痔患者中所有均表現(xiàn)為極好的，在4度患者中有2個表現(xiàn)為不好（無改善），需行手術(shù)治療。所有患者均觀察到在臨床和內(nèi)鏡檢查下都得到改善，且任何年齡階段的患者對此操作均能耐受。討論討論痔瘡在西方世界中是最常見的肛管直腸疾病，也是引起直腸出血的主要因素。針對早期痔瘡，已經(jīng)有很多治療方法被提及嘗試，普遍認(rèn)為橡膠帶結(jié)扎方法（RBL）是安全和有效地。一種能使肛墊恢復(fù)到原來的形狀及位置的方法，自然要優(yōu)于損傷組織、干擾自制機制的方法。由于13度內(nèi)痔引起癥狀的患者建議行非手術(shù)治療，橡膠帶結(jié)扎方法對于13度內(nèi)痔患者應(yīng)為首選的治療方法。此研究證實應(yīng)用橡膠帶結(jié)扎方法（RBL）并使用奧里根一次性套扎裝置治療的技術(shù)在人群中是快速、安全及有效的。平均一次操作的時間為62分鐘，最長為10分鐘。無嚴(yán)重的并發(fā)癥，在早期和晚期有出現(xiàn)輕微出血，但均不嚴(yán)重。67的患者感覺疼痛，但不嚴(yán)重。手術(shù)切除痔的患者中有1050會發(fā)生尿潴留，SCHWARTZ引證在行套扎術(shù)后有1的患者會出現(xiàn)尿潴留，盡管他評價在多點結(jié)扎后的患者中有多達1020的患者有尿潴留的體驗，在我們的研究組中沒有尿潴留和膿腫發(fā)生。有一個最近的研究報告指出橡膠帶結(jié)扎方法（RBL）適用于治療2度內(nèi)痔，而對于3度內(nèi)痔及RBL術(shù)后復(fù)發(fā)的患者仍應(yīng)行手術(shù)切除痔。另一報道指出橡膠帶結(jié)扎方法（RBL）能適用于任何分度的內(nèi)痔且有相似的有效性。在我們的研究中，除了4度內(nèi)痔患者，所有患者在3個月的隨訪中均表示滿意。總體來說，運用橡膠帶結(jié)扎方法（RBL）并使用奧里根一次性套扎裝置治療有癥狀的患有痔瘡的門診患者，有著良好的反應(yīng)及低并發(fā)癥發(fā)生率。我們推薦這項技術(shù)作為一個安全、可靠的治療方法。

簡介：中文中文11萬字萬字出處出處CONGF,PUOLIV?LIT,ALLURIV,ETALKEYISSUESINDECOMPOSINGFMRIDURINGNATURALISTICANDCONTINUOUSMUSICEXPERIENCEWITHINDEPENDENTCOMPONENTANALYSISJJOURNALOFNEUROSCIENCEMETHODS,2014,2237484利用獨立分量分析對自然連續(xù)音樂刺激下功能性利用獨立分量分析對自然連續(xù)音樂刺激下功能性磁共振（磁共振（FMRIFMRI）分解中關(guān)鍵性問題的研究）分解中關(guān)鍵性問題的研究KEYISSUESINDECOMPOSINGFMRIDURINGNATURALISTICANDCONTINUOUSMUSICEXPERIENCEWITHINDEPENDENTCOMPONENTANALYSIS學(xué)部（院）專業(yè)生物醫(yī)學(xué)工程學(xué)生姓名學(xué)號指導(dǎo)教師完成日期利用獨立分量分析對自然連續(xù)音樂刺激下功能性磁共振（利用獨立分量分析對自然連續(xù)音樂刺激下功能性磁共振（FMRIFMRI）分解中關(guān)鍵性問題的研究）分解中關(guān)鍵性問題的研究–2–1介紹介紹在過去二十多年中，對于功能性磁共振（FMRI）的研究越來越廣泛。FMRI是用于研究人類腦部處理類似于語言、音樂、圖片等刺激的一種獨立而又交互的新的方法。按照慣例，刺激產(chǎn)生FMRI數(shù)據(jù)的范式包括BLOCK實驗和事件相關(guān)實驗。對于BLOCK實驗，刺激產(chǎn)生和刺激相消通常會對比分析研究。在事件相關(guān)實驗中，當(dāng)時間進程中的一個像素或相應(yīng)的空間地形圖的獲得過程中，初始化矩陣可以被復(fù)原。隨著FMRI研究的不斷深入，一些研究已經(jīng)開始著手自然連續(xù)長時間刺激下的FMRI數(shù)據(jù)。研究表明，一些自然腦部數(shù)據(jù)擁有豐富的可用于研究的腦部響應(yīng)數(shù)據(jù)，但是根據(jù)相應(yīng)的實驗范式，準(zhǔn)確的對照矩陣或者初始化矩陣等這些數(shù)據(jù)漸漸變得難以直接獲得。為了處理和分析這些自然腦數(shù)據(jù)，內(nèi)部對象相關(guān)（ISC）這一方法被廣泛應(yīng)用。ISC是基于兩個被試者在相同空間位置上（有相同坐標(biāo)的像素點）的腦部時域活動之間做相關(guān)。最近，基于聲學(xué)特征提取算法被用于音樂信息恢復(fù)，被用于實驗中音樂刺激的音效特征已經(jīng)被提取了出來，并與每個像素的時域做相關(guān)。由于FMRI數(shù)據(jù)包含著大量的像素點的信息，所以在相關(guān)運算中相乘運算也是相當(dāng)多的。因此，在此類研究中，統(tǒng)計學(xué)方法被用于避免誤報。一個非常直接有效的方法就是減少做相關(guān)的次數(shù)。例如當(dāng)獨立分量分析（ICA）被用于分解FMRI數(shù)據(jù)時，獨立分量（通常少于100）比起像素點的數(shù)量（上百到上千）。數(shù)據(jù)驅(qū)使著數(shù)據(jù)處理方法的改變，像ICA，已經(jīng)廣泛應(yīng)用于自然狀態(tài)下腦數(shù)據(jù)的分析，而且還需計算刺激的時域特征彤ICA成分之間的相似性。我們發(fā)現(xiàn)應(yīng)用ICA分解自然狀態(tài)下腦數(shù)據(jù)中的一些關(guān)鍵性問題并未被解決。本研究致力于分析應(yīng)用這一高級方法的每一步。在眾多ICA算法中，我們使用FASTICA。自1998年以來，ICA已經(jīng)被廣泛應(yīng)用于FMRI數(shù)據(jù)處理。對于不同的采樣率和各種各樣的線性變換模型，ICA的應(yīng)用可以被分為時域ICA和空間域ICA。在此之前，獨立成分通常是指時域的。后來，一個獨立成分是一個能夠畫出FMRI空間地形圖的像素序列。對于特定維數(shù)的FMRI數(shù)據(jù)集，空間ICA通常需要同時滿足潛在的神經(jīng)生理模型和計算的需求。因此，在此次FMRI數(shù)據(jù)分析中，我們選擇空間ICA。在下文中，當(dāng)提及ICA時，那就是指空間ICA。ICA能進一步被分為獨立ICA對于獨立數(shù)據(jù)集，例如某一受試者的數(shù)據(jù)和組ICA（對于串聯(lián)起來的數(shù)據(jù)集，包括很多受試者的數(shù)據(jù)）。組ICA被認(rèn)為是數(shù)據(jù)時域連接的一種方法（多名受試者數(shù)據(jù)在時域上連接起來）也是空間域連接的一種方法（多名受試者數(shù)據(jù)在空間域上連接起來）。時域和空間域的這些方法也可用于分析獨立腦數(shù)據(jù)的時域特征和腦地形圖。而且使用這種方法，在眾多收拾者中表現(xiàn)出相類似的腦地形圖和時域特征。事實上，組ICA還需要一些獨立ICA之外的假設(shè)。眾所周知，F(xiàn)MRI數(shù)據(jù)在真實環(huán)境或者實驗環(huán)境中都能滿足這些假設(shè)。因此，在本次研究中，我們同時

簡介：1RESEARCHONCEREBRALANEURYSMDETECTIONBASEDONOPTAALGORITHMJIANWU,GUANGMINGZHANG,JIEXIA,ANDZHIMINGCUIPROCEEDINGSOFTHE2009INTERNATIONALSYMPOSIUMONINFORMATIONPROCESSINGHUANGSHAN,PRCHINA,AUGUST2123,2009,PP037040基于OPTA細化算法的有關(guān)腦動脈瘤檢測的研究吳建，張廣明，謝杰，崔志明2009年8月21日23日中國黃山2009年信息處理國際研討會論文集037頁040頁3Ⅰ前言腦血管疾病，尤其是腦動脈瘤，是導(dǎo)致成年人生病最后死亡的關(guān)鍵因素之一，它嚴(yán)重威脅著人們得生命安全。隨著計算機技術(shù)的不斷發(fā)展和成熟，信息技術(shù)和醫(yī)學(xué)成像技術(shù)結(jié)合而產(chǎn)生的CAD應(yīng)用計算機輔助診斷系統(tǒng)在腦血管疾病的檢測與治療中起到越來越重要的作用，它已經(jīng)成為了醫(yī)學(xué)成像上的一個研究重點。腦血管瘤一般位于血管的交叉位置，尤其是在腦動脈周圍。原因是血液的流動對血管交叉位置的影響很大。腦血管的影響類似于河流形成的網(wǎng)絡(luò)，會出現(xiàn)許多分支的動脈血管。一般來說，血管是對稱的，它的兩側(cè)的血管壁是相互平行的。而腦動脈瘤是由于血管壁損壞而導(dǎo)致的突出的部分。腦動脈瘤的示意圖如圖1所示。圖1腦動脈瘤的示意圖如圖1，圖中用方格標(biāo)志的地方就是腦動脈瘤。正常的血管出已經(jīng)形成了突出的部分，大致平行的血管壁被破壞了。被破壞的位置明顯是在交叉處。所以我們可以確定腦動脈瘤的位置應(yīng)該在血管骨架結(jié)構(gòu)的交叉處。在基于DSA數(shù)字減法血管造影術(shù)的腦動脈瘤CAD系統(tǒng)中，它是特征提取及識別的前提和重要步驟，應(yīng)用在檢測腦動脈瘤位置的DSA中。本文分析了腦動脈瘤的形態(tài)特征，包括通過細化算法得到的血管骨架的拓撲結(jié)構(gòu)，然后對骨架樹進行深度優(yōu)先遍歷，最后定位出腦動脈瘤的位置。ⅡOPTA算法OPTA一次通過細化算法是一種典型的基于模板的圖像細化算法，其核心是通過應(yīng)用消去和保留模板實現(xiàn)細化過程。OPTA是一個迭代的過程。如果當(dāng)前的點滿足消去模板同時不滿足保留模板，那么這個點就被消去，否則，保留此點。不斷遍歷原始圖片，直到再沒有點滿足上述要求。對OPTA算法的主要改進的地方就在于根據(jù)原算法的效果和速度增加了消去和保留模板。其中最典型的參考文件是13。文獻1的作者發(fā)現(xiàn)原始的OPTA算法細化的不

簡介：此文檔是畢業(yè)設(shè)計外文翻譯成品（含英文原文中文翻譯），無需調(diào)整復(fù)雜的格式下載之后直接可用，方便快捷本文價格不貴,也就幾十塊錢一輩子也就一次的事外文標(biāo)題LABVIEWBASEDECGSIGNALACQUISITIONANDANALYSIS外文作者NINADJERMANOVA,MARINMARINOV,BORISLAVGANEV,SERAFIMTABAKOVANDGEORGINIKOLOV文獻出處INTERNATIONALSCIENTIFICCONFERENCEELECTRONICSET2016,SEPTEMBER1214,2018,SOZOPOL,BULGARIA如覺得年份太老，可改為近2年，畢竟很多畢業(yè)生都這樣做英文2248單詞，14953字符字符就是印刷符，中文3526漢字。（如果字?jǐn)?shù)多了，可自行刪減，大多數(shù)學(xué)校都是要求選取外文的一部分內(nèi)容進行翻譯的。）LABVIEWBASEDECGSIGNALACQUISITIONANDANALYSISABSTRACT–THISPAPERPRESENTSALABVIEWBASEDSYSTEMOFACQUISITION,PROCESSINGANDANALYSISOFECGELECTROCARDIOGRAMSIGNALSBIOMEDICALSIGNALACQUISITIONHASMADEGREATADVANCESINRECENTYEARSDUETOTHEINTRODUCTIONOFMODERNHARDWAREANDSOFTWARETECHNOLOGIESCOMPUTERBASEDSIGNALPROCESSINGSYSTEMSAREBECOMINGANEFFICIENTAPPROACHFORACQUISITIONANDANALYZINGOFSUCHSIGNALSINOURIMPLEMENTATIONANAD8232INTEGRATEDSIGNALCONDITIONINGFRONTENDOFANALOGDEVICESISUSEDFORMEASUREMENTANDPREPROCESSINGOFTHEECGSIGNALSBATTERYPOWEREDDATAACQUISITIONSYSTEM,WHICHAVOIDS50HZNOISEANDALLOWSFORSAFETYMEASUREMENTWITHOUTADDITIONALISOLATIONISEMPLOYEDLABVIEWBIOMEDICALTOOLKITTIMEDOMAINANALYSISISAPPLIEDTOSTUDYHEARTRATEVARIABILITYTOGETHERWITHADDITIONALPARAMETERSKEYWORDS–ECGSIGNALTIMEDOMAINANALYSIS,BATTERYPOWEREDLABVIEWDAQ,HEARTRATEVARIABILITYIINTRODUCTIONHEALTHMONITORINGISNOWBECOMINGPARTOFEVERYDAYLIFETODAY’SHEALTHCAREINDUSTRYIIHEARTRATEVARIABILITYANORMALONECYCLEECGSIGNALCONSISTSOFSEVERALWAVES,ASSHOWNINFIG1THEWAVEWITHTHEHIGHESTAMPLITUDEISTHERWAVEANRRINTERVALISTHETIMEELAPSEDBETWEENTWOSUCCESSIVERWAVESTHEWAVESWITHTHELOWERAMPLITUDESARETHEPWAVE,THETWAVE,ANDTHEUWAVERRINTERVALSSHOWTHEVARIATIONBETWEENCONSECUTIVEHEARTBEATSHEARTRATEVARIABILITYHRVMEASUREMENTSANALYZEHOWTHESERRINTERVALSCHANGEOVERTIMEFIG1RPEAKSANDRRINTERVALSOFANECGSIGNAL7AACQUIRINGRRINTERVALSTOANALYZEHEARTRATEVARIABILITYHRV,THERRINTERVALSMUSTFIRSTBEACQUIREDANDPREPROCESSEDBYAD8232ANALOGUEFRONTENDFIG2SHOWSTHEPROCESSOFACQUIRINGRRINTERVALSFIG2RRINTERVALACQUISITIONPROCESS7BEXTRACTINGRRINTERVALSFROMECGSIGNALSTHEEXTRACTIONPROCESSUSUALLYINVOLVESAPREPROCESSINGSTEPANDAPEAKDETECTIONSTEPITISNECESSARYTOPREPROCESSTHERAWECGSIGNALSIFTHEYHAVENOISECORRUPTION

簡介：EFFECTSOFTHEFEMORALOFFSETANDTHEHEADSIZEONTHESAFERANGEOFMOTIONINTOTALHIPARTHROPLASTYAKINOBUMATSUSHITA,MD,YASUHARUNAKASHIMA,MD,PHD,SEIYAJINGUSHI,MD,PHD,TAKUAKIYAMAMOTO,MD,PHD,AKIOKURAOKA,PHD,?ANDYUKIHIDEIWAMOTO,MD,PHDABSTRACTTHEPURPOSEOFTHISSTUDYWASTOQUANTIFYTHEEFFECTSOFFEMORALOFFSETANDHEADSIZEONRANGEOFMOTIONROMAFTERTOTALHIPARTHROPLASTYMODULARPROSTHESESWEREIMPLANTEDINTO11CADAVERICHIPSUSINGAPOSTEROLATERALAPPROACHANDTESTEDFORROMWITH3DIFFERENTOFFSETSAND5DIFFERENTFEMORALHEADSIZESINCREASINGTHEFEMORALOFFSETTO4AND8MMRESULTEDIN211°AND267°OFIMPROVEDFLEXION,AND137°AND212°OFIMPROVEDINTERNALROTATION,RESPECTIVELYTHEROMIMPROVEDINAHEADSIZE–DEPENDENTMANNERPRIMARILYBECAUSEOFINCREASINGTHEJUMPINGDISTANCEOFTHEFEMORALHEADRATHERTHANDELAYINGANYIMPINGEMENTINCONTRAST,THEEFFECTIVENESSOFFEMORALOFFSETWASDRIVENBYDELAYEDOSSEOUSIMPINGEMENTKEYWORDSTOTALHIPARTHROPLASTYTHA,FEMORALOFFSET,FEMORALHEADSIZE,RANGEOFMOTIONROM,JUMPINGDISTANCE?2009ELSEVIERINCALLRIGHTSRESERVEDDISLOCATIONISONEOFTHEMOSTFREQUENTANDIMPORTANTCOMPLICATIONSAFTERTOTALHIPARTHROPLASTYTHA13THERATEOFDISLOCATIONAFTERPRIMARYTHAHASBEENREPORTEDTOBE2TO546VARIOUSFACTORSINFLUENCEDISLOCATIONPATIENTASSOCIATEDFACTORSINCLUDEAGE,SEX,PARALYSIS,ANDMUSCLEWEAKNESS4,7FACTORSASSOCIATEDWITHTHESURGERYINCLUDEINAPPROPRIATECUPORSTEMPOSITION,USEOFAPOSTERIORAPPROACH,REPAIROFTHESOFTTISSUE,ANDINTRAOPERATIVEPOSITIONING35,8,9CHARACTERISTICSOFTHEPROSTHESIS,SUCHASHEADSIZEANDHEADNECKRATIO,ALSOINFLUENCEHIPSTABILITYAFTERTHA1013INMOSTDISLOCATIONS,FEMORALHEADSDEVIATEBECAUSEOFIMPLANTOROSSEOUSIMPINGEMENTTHEREFORE,ITISIMPORTANTTODELAYIMPINGEMENTTOPREVENTDISLOCATIONSANDIMPLANTSSHOULDBECAREFULLYDESIGNEDTOREDUCETHERISKOFIMPINGEMENTIMPROVEMENTSCANPOTENTIALLYBEACHIEVEDBYINCREASINGTHEFEMORALHEADSIZEAND/ORTHEFEMORALOFFSETNUMEROUSSTUDIESHAVEPREVIOUSLYREPORTEDTHEEFFECTSOFHEADSIZEONRANGEOFMOTIONROM2,4,13,14HOWEVER,TOOURKNOWLEDGE,ONLYAFEWSTUDIESHAVEFOCUSEDONTHERELATIONBETWEENHEADSIZEANDIMPINGEMENTANDJUMPINGDISTANCEQUANTIFICATIONOFTHEEFFECTSOFFEMORALOFFSETONROMALSOHASNOTYETBEENREPORTEDINTHISSTUDY,WECONDUCTEDEXPERIMENTSUSINGCADAVERSTOQUANTIFYTHEEFFECTSOFFEMORALOFFSETANDFEMORALHEADSIZEONSAFEROMOFTHEHIPAFTERTHAWEALSOANALYZEDTHEEFFECTSOFFEMORALHEADSIZEONTHEJUMPINGDISTANCEMETHODSIMPLANTATIONMODULARTOTALHIPPROSTHESESPERFIXHAJAPANMEDICALMATERIAL,OSAKA,JAPANWEREIMPLANTEDUSINGAPOSTEROLATERALAPPROACHIN11HIPJOINTSFROM8CADAVERSINEACHSURGERY,THEANTERIORJOINTFROMTHEDEPARTMENTOFORTHOPEDICSURGERY,GRADUATESCHOOLOFMEDICAL,SCIENCES,KYUSHUUNIVERSITY,HIGASHIKU,FUKUOKA,JAPANAND?DEPARTMENTOFANATOMYANDCELLBIOLOGY,GRADUATESCHOOLOFMEDICALSCIENCES,KYUSHUUNIVERSITY,HIGASHIKU,FUKUOKA,JAPANSUBMITTEDNOVEMBER14,2007ACCEPTEDFEBRUARY10,2008NOBENEFITSORFUNDSWERERECEIVEDINSUPPORTOFTHESTUDYREPRINTREQUESTSYASUHARUNAKASHIMA,MD,PHD,DEPARTMENTOFORTHOPEDICSURGERY,GRADUATESCHOOLOFMEDICAL,SCIENCES,KYUSHUUNIVERSITY,311MAIDASHI,HIGASHIKU,FUKUOKA8128582,JAPAN?2009ELSEVIERINCALLRIGHTSRESERVED08835403/08/240400243600/0DOI101016/JARTH200802008646THEJOURNALOFARTHROPLASTYVOL24NO42009HOCTUKEYTESTSIGNIFICANCEWASDEFINEDASAPVALUELESSTHAN05RESULTSEFFECTOFFEMORALOFFSETTHEROMOFTHEHIPINCREASEDINAFEMORALOFFSET–DEPENDENTMANNERINCREASINGTHEFEMORALOFFSETTO4AND8MMSIGNIFICANTLYINCREASEDTHERANGEOFFLEXIONBY211°AND267°,RESPECTIVELYFIG3ATHERANGEOFFLEXIONREACHEDANAVERAGEOF1325°WITHAN8MMFEMORALOFFSETINCREASINGTHEFEMORALOFFSETTO4AND8MMWITHANADDUCTIONOF0°SIGNIFICANTLYINCREASEDTHERANGEOFINTERNALROTATIONBY137°AND212°,RESPECTIVELYFIG3BSIGNIFICANTIMPROVEMENTINTHERANGEOFINTERNALROTATIONWASALSOOBSERVEDWITHA20°ADDUCTIONHEADSIZETHERANGEOFFLEXIONANDINTERNALROTATIONIMPROVEDINAHEADSIZE–DEPENDENTMANNERINCREASINGTHEHEADSIZEFROM22TO36MMWITHA0°ADDUCTIONSIGNIFICANTLYINCREASEDTHERANGEOFFLEXIONANDTHERANGEOFINTERNALROTATIONBY113°AND100°,RESPECTIVELYFIG4A,BSIGNIFICANTIMPROVEMENTINTHERANGEOFINTERNALROTATIONWASALSOOBSERVEDWITH0°AND20°ADDUCTIONSFIG3EFFECTSOFTHEFEMORALOFFSETINTHEROMDATAARESHOWNASTHEIMPROVEMENTDEGREESFROMTHATWITH22MMHEADSIZEA,RANGEOFFLEXIONUNTILDISLOCATIONINCREASINGTHEFEMORALOFFSETTO4AND8MMLATERALLYSIGNIFICANTLYINCREASEDTHERANGEOFFLEXIONBY211°AND267°,RESPECTIVELYB,RANGEOFINTERNALROTATIONUNTILDISLOCATIONWITHA90°FLEXIONANDWITHORWITHOUTA20°ADDUCTIONINCREASINGTHEFEMORALOFFSETTO4AND8MMLATERALLYWITH0°ADDUCTIONSIGNIFICANTLYINCREASEDTHERANGEOFINTERNALROTATIONBY137°AND212°,RESPECTIVELYSIGNIFICANTIMPROVEMENTSOFTHEINTERNALROTATIONWEREALSONOTEDWITH20°ADDUCTIONPB05FIG4EFFECTSOFHEADSIZEONROMDATAARESHOWNASTHEIMPROVEMENTDEGREESFROMTHATWITH22MMHEADSIZEA,RANGEOFFLEXIONUNTILDISLOCATIONTHERANGEOFFLEXIONINCREASEDINAHEADSIZE–DEPENDENTMANNERINCREASINGTHEHEADSIZEFROM22TO36MMWITH0°ADDUCTIONSIGNIFICANTLYINCREASEDTHERANGEOFFLEXIONBY113°B,RANGEOFTHEINTERNALROTATIONUNTILDISLOCATIONWITHA90°FLEXIONANDWITHORWITHOUTA20°ADDUCTIONINCREASINGTHEHEADSIZEFROM22TO36MMWITH0°ADDUCTIONSIGNIFICANTLYINCREASEDTHERANGEOFINTERNALROTATIONBY10°THEREWASNOSIGNIFICANCEINTHEROMWITH20°ADDUCTIONTHEHEADSIZELARGERTHAN28MMSIGNIFICANTLYINCREASEDROMCOMPAREDWITHTHATLESSTHAN26MMTHEREWASNOSIGNIFICANCEINTHEROMBETWEENTHE28MMAND36MMHEADSIZEPB05648THEJOURNALOFARTHROPLASTYVOL24NO4JUNE2009

簡介：C?2008,THEAUTHORSJOURNALCOMPILATIONC?2008,BLACKWELLPUBLISHING,INCDOI101111/J15408175200800679XECHOCARDIOGRAPHICDIASTOLICDYSFUNCTIONANDMAGNETICRESONANCEINFARCTSIZEINHEALEDMYOCARDIALINFARCTIONTREATEDWITHPRIMARYANGIOPLASTYANDREABARBIERI,MD,?FRANCESCABURSI,MD,MSC,?LUIGIPOLITI,MD,?LUCAROSSI,MD,?FEDERICAFIOCCHI,MD,?GUIDOLIGABUE,MD,?ALESSANDROPINGITORE,MD,?VINCENZOPOSITANO,MD,?PIETROTORRICELLI,MD,?ANDMARIAGRAZIAMODENA,MD??DEPARTMENTOFCARDIOLOGY,?DEPARTMENTOFRADIOLOGY,MODENAANDREGGIOEMILIAUNIVERSITY,MODENA,ITALYAND?CNRINSTITUTEOFCLINICALPHYSIOLOGY,PISA,ITALYBACKGROUNDAFTERACUTEMYOCARDIALINFARCTIONMITHESEVERITYOFDIASTOLICDYSFUNCTIONBYECHOCARDIOGRAPHYREPRESENTSANINDEPENDENTPROGNOSTICMARKERHOWEVER,THEMECHANISMSWHEREBYDIASTOLICDYSFUNCTIONPORTENDSANINCREASEDRISKAFTERMIARENOTFULLYUNDERSTOODWEINVESTIGATEDTHERELATIONSHIPBETWEENECHOCARDIOGRAPHICDIASTOLICDYSFUNCTIONSEVERITYANDINFARCTSIZEQUANTITATIVELYMEASUREDBYCONTRASTENHANCEDMAGNETICRESONANCECEMRMETHODSCROSSSECTIONALPROSPECTIVESTUDYWEQUANTIFIED“HEALED”INFARCTSIZEBYCEMRMEASURINGTHEPERCENTAGEOFDELAYEDENHANCEMENTWITHRESPECTTOLEFTVENTRICULARMASSANDDIASTOLICFUNCTIONBYDOPPLERECHOCARDIOGRAPHYBOTHEXAMSWERESCHEDULEDATLEAST1MONTHAFTERAFIRSTACUTESTSEGMENTELEVATIONMISTEMISUCCESSFULLYTREATEDWITHPRIMARYANGIOPLASTYANDSTENTINGTOINCREASETHESPECIFICITY,INDIVIDUALECHOCARDIOGRAPHICPARAMETERSWEREINTEGRATEDTOGRADEGLOBALDIASTOLICFUNCTIONIN4GRADESNORMALDIASTOLICFUNCTION,IMPAIREDRELAXATIONWITHNORMAL,ORNEARNORMALFILLINGPRESSURESIMPAIREDRELAXATIONWITHMODERATEELEVATIONOFFILLINGPRESSURES,ANDIMPAIREDRELAXATIONWITHMARKEDELEVATIONOFFILLINGPRESSURES,“RESTRICTIVEFILLING”RESULTSWEPROSPECTIVELYENROLLED52PATIENTSMEANAGE62±13YEARS,77MENCEMRANDECHOCARDIOGRAPHYWEREPERFORMED48±15DAYSAFTERTHEMITHEREWASASIGNIFICANTBUTMODESTCORRELATIONBETWEENDIASTOLICFUNCTIONGRADEANDINFARCTSIZER0423,P0002,WHICHWASINDEPENDENTOFGLOBALANDREGIONALSYSTOLICFUNCTIONANDPERSISTEDAFTERFURTHERADJUSTMENTFORAGE,SEX,BODYSURFACEAREA,LEFTVENTRICULARMASS,ENDDIASTOLICVOLUMES,ANDSPHERICITYINDEXALLP10,E/VP15,DECREASEINE/A≥05DURINGVALSALVAMANEUVER,“PSEUDONORMALFILLING”GRADEII/IVANDIMPAIREDRELAXATIONWITHMARKEDELEVATIONOFFILLINGPRESSURES,“RESTRICTIVEFILLING”DECELERATIONTIME15GRADESIIIIV/IVASPREVIOUSLYDESCRIBED19LEFTATRIALVOLUMEWASASSESSEDBYTHEMODIFIEDSIMPSONMETHODFROMAPICALFOURANDTWOCHAMBERVIEWSMEASUREMENTSWEREOBTAINEDINENDSYSTOLEFROMTHEFRAMEPRECEDINGMITRALVALVEOPENING,ANDTHEVOLUMEWASINDEXEDTOBSA20MITRALREGURGITATIONWASQUANTIFIEDBYCALCULATINGTHEAREAOFTHEREGURGITANTJETWITHCOLORDOPPLER21EACHVALUEREPRESENTSTHEAVERAGEOFTHREECONSECUTIVEBEATSDETERMINATIONOFINFARCTSIZEBYCEMRIMAGINGMRIPROTOCOLMRIWASPERFORMEDONA15TWHOLEBODYSCANNERINTERACV,PHILIPSMEDICALSYSTEMSEQUIPPEDWITHQUASARGRADIENTSCARDIACMRIWASPERFORMEDWITHTHEFIVEELEMENTCARDIACSYNERGYCOILCARDIACSYNCHRONIZATIONWASOBTAINEDBYMEANSOFVECTORELECTROCARDIOGRAPHICGATINGTHESTUDYPROTOCOLCONSISTEDOFCINEMRIATRESTTOEVALUATEREGIONALANDGLOBALLEFTVENTRICULARFUNCTIONANDVOLUMES,FOLLOWEDBYACEMRITODETERMINETHEPRESENCEANDTHEEXTENTOFINFARCTEDTISSUETENTOTWELVE,DEPENDINGONTHEHEARTSIZE,CINESHORTAXISVIEWSWEREIMAGEDFROMAPEXTOBASEWITHASENSITIVITYENCODEDBALANCEDFASTFIELDECHOBFFESEQUENCEDURINGBREATHHOLDSOFAPPROXIMATELY15SECONDSTHEFOLLOWINGPARAMETERSWEREUSEDECHOTIME,17MSECREPETITIONTIME,40MSECSLICETHICKNESS,8MMWITHNOINTERSLICEGAPFIELDOFVIEW,320MMDATAMATRIXSIZE,256224MMPHASEOFFIELD,075TRIGGERDELAY,MINIMUM85VIEWSPERSEGMENTS,8–14ACCORDINGTOTHEHEARTRATEFLIPANGLE,45?ATLEAST30CINEFRAMESWEREOBTAINEDFOREACHSLICETHESAMEGEOMETRYSETTINGSOFTHEBASELINESCANSWEREREPEATEDTOOBTAINCOMPARABLESLICESPOSTCONTRASTDELAYEDIMAGESWEREACQUIREDINTHESHORTAXISOFTHELEFTVENTRICLE15MINUTESAFTERBOLUSINJECTIONOFGADOLINIUMINENDDIASTOLEFORTHEEVALUATIONOFMYOCARDIALDISTRIBUTIONOFHYPERENHANCEMENTA3DGRADIENTECHOBASEDSEQUENCEWITHINVERSIONPREPULSEWASUSEDWITHTHEFOLLOWINGPARAMETERSECHOTIME,42MSECFLIPANGLE,20MATRIX,256160NEX,200FOV,36CMSLICETHICKNESS,8MMTHEINVERSIONTIMERANGEDFROM260TO340MSECAREALTIMEOPTIONALLOWINGTHEINTERACTIVECHANGEOFINVERSIONTIMEWASUSEDTOOPTIMIZETHISPARAMETERUNTILTHENULLINGOFMYOCARDIUMWASOBTAINEDAVARIABLENUMBEROFSHORTAXISSLICES10±18,MAXIMUM11,MINIMUM8WERETRACEDFROMTHEBASETOTHEAPEXTOCOVERTHEENTIRELEFTVENTRICLEALSO,ONEVERTICALANDONEHORIZONTALLONGAXISVIEWSWEREACQUIREDTOASSESSTHEAPEXDEFINITIONSANDDATAANALYSISIMAGESWEREANALYZEDONAOFFLINEWORKSTATIONVIEWFORUM32PHILIPSMEDICALSYSTEMSFORREGIONALANALYSIS,THELEFTVENTRICLEWASDIVIDEDINTO17MYOCARDIALSEGMENTS14TOASSESSINFARCTSIZE,THEEXTENTOFDELAYEDENHANCEDAREASWASMEASUREDUSINGASEMIAUTOMATIC,PREVIOUSLYVALIDATEDSOFTWARE22THEANALYSISWASDONEINALLSHORTAXISIMAGESANDINTWOLONGAXISIMAGESFORTHEANALYSISOFVENTRICULARAPEXINEACHIMAGE,THEBOUNDARIESOFCONTRASTENHANCEDAREASWEREAUTOMATICALLYTRACEDAND,EVENTUALLY,MANUALLYCORRECTEDSEGMENTALEXTENTOFINFARCTIONWASSCOREDBYTHECONSENSUSOFTWOINVESTIGATORSFF,GL,BLINDEDTOTHECLINICALDATAREGIONSOFINTERESTWEREACCEPTEDVOL25,NO6,2008ECHOCARDIOGRAPHYAJRNLOFCVULTRASOUNDALLIEDTECH577

簡介：THISARTICLEAPPEAREDINAJOURNALPUBLISHEDBYELSEVIERTHEATTACHEDCOPYISFURNISHEDTOTHEAUTHORFORINTERNALNONCOMMERCIALRESEARCHANDEDUCATIONUSE,INCLUDINGFORINSTRUCTIONATTHEAUTHORSINSTITUTIONANDSHARINGWITHCOLLEAGUESOTHERUSES,INCLUDINGREPRODUCTIONANDDISTRIBUTION,ORSELLINGORLICENSINGCOPIES,ORPOSTINGTOPERSONAL,INSTITUTIONALORTHIRDPARTYWEBSITESAREPROHIBITEDINMOSTCASESAUTHORSAREPERMITTEDTOPOSTTHEIRVERSIONOFTHEARTICLEEGINWORDORTEXFORMTOTHEIRPERSONALWEBSITEORINSTITUTIONALREPOSITORYAUTHORSREQUIRINGFURTHERINFORMATIONREGARDINGELSEVIER’SARCHIVINGANDMANUSCRIPTPOLICIESAREENCOURAGEDTOVISITHTTP//WWWELSEVIERCOM/AUTHORSRIGHTSAUTHORSPERSONALCOPYFCONGETAL/JOURNALOFNEUROSCIENCEMETHODS223201474–8475FMRIDATAINCLUDETHEBLOCKDESIGNANDTHEEVENTRELATEDDESIGNPANETAL,2011FORTHEBLOCKDESIGN,THECONTRASTOFFMRIDATABETWEENTHESTIMULUSONSETANDTHESTIMULUSOFFSETISANALYZEDFORTHEEVENTRELATEDONE,THEDESIGNMATRIXCANBEUSEDFORREGRESSIONDURINGWHICHTHETEMPORALCOURSEOFAVOXELANDTHECORRESPONDINGSPATIALMAPARELEARNEDWITHTHEDEVELOPMENTOFFMRIRESEARCH,SOMESTUDIESEVENREPORTEDFMRIDATAOBTAINEDDURINGAREALISTICEXPERIENCEWHERETHESTIMULUSISNATURALISTIC,CONTINUOUSANDLONGALLURIETAL,2012HASSONETAL,2004HAYNESANDREES,2006KAUPPIETAL,2010KAYETAL,2008SPIERSANDMAGUIRE,2007SUCHNATURALISTICBRAINDATACANPROVIDEMUCHRICHERBRAINRESPONSESFORRESEARCHANDITTENDSTOBEDIFFICULTTODIRECTLYOBTAINTHEPRECISECONTRASTORDESIGNMATRIXACCORDINGTOTHEEXPERIMENTALDESIGNINORDERTOPROCESSANDANALYZESUCHNATURALISTICBRAINDATA,THEINTERSUBJECTCORRELATIONISCHASSONETAL,2004HASBEENWIDELYUSEDISCISBASEDONTHECORRELATIONBETWEENTWOTEMPORALCOURSESOFTWOPARTICIPANTSGIVENTHESAMESPATIALLOCATION,IE,THEVOXELWITHTHESAMECOORDINATESRECENTLY,BASEDONACOUSTICALFEATUREEXTRACTIONALGORITHMSUSEDINMUSICINFORMATIONRETRIEVAL,MUSICALFEATURESOFTHEMUSICSTIMULUSHAVEBEENEXTRACTEDANDCORRELATEDTOTHETEMPORALCOURSEOFEACHVOXELOFTHEFMRIDATAALLURIETAL,2012DUETOTHELARGEAMOUNTOFVOXELSINFMRIDATA,THENUMBEROFMULTIPLECOMPARISONSINSUCHCORRELATIONANALYSESISLARGEASWELLTHEREFORE,SOMESTATISTICALMETHODSARETYPICALLYUSEDTOAVOIDTHEFALSEALARMONESTRAIGHTFORWARDMETHODISTOREDUCETHENUMBEROFTIMESOFCORRELATIONSFOREXAMPLE,WHENINDEPENDENTCOMPONENTANALYSISICAISAPPLIEDTODECOMPOSEFMRIMCKEOWNETAL,1998,THENUMBEROFICACOMPONENTSUSUALLYLESSTHANHUNDREDSISMUCHSMALLERTHANTHENUMBEROFVOXELSHUNDREDSOFTHOUSANDSTHEDATADRIVENDATAPROCESSINGMETHODS,LIKEICA,HAVEBEENUSEDTOPROCESSNATURALISTICBRAINDATAMALINENETAL,2007YLIPAAVALNIEMIETAL,2009ANDTHESIMILARITYBETWEENTHETEMPORALCOURSESOFTHESTIMULUSANDTHETEMPORALCOURSESOFICACOMPONENTSIE,SPATIALMAPSWASEXAMINEDWEFINDTHATSOMEKEYISSUESINAPPLYINGICATODECOMPOSENATURALISTICBRAINDATAHAVENOTBEENWELLADDRESSEDYETTHISSTUDYISDEVOTEDTOANALYZINGEVERYSTEPFORTHEAPPLICATIONOFTHISADVANCEDMETHODFORICA,THEFASTICAALGORITHMHYV?RINEN,1999WASUSEDSINCE1998MCKEOWNETAL,1998ICAHASBEENEXTENSIVELYUSEDFORTHEFMRIDATAPROCESSINGFORDIFFERENTDEFINITIONSOFSAMPLESANDVARIABLESINTHELINEARTRANSFORMMODEL,THEAPPLICATIONOFICACANBEDIVIDEDINTOTEMPORALICAANDSPATIALICAMCKEOWNETAL,1998ERHARDTETAL,2010CALHOUNETAL,2001HUETAL,2005LEEETAL,2011INTHEFORMER,ANINDEPENDENTCOMPONENTISATEMPORALCOURSEFORTHELATTER,ANINDEPENDENTCOMPONENTISAVOXELSERIES,WHICHCANBEASSEMBLEDINTOASPATIALMAPOFFMRIGIVENTHETYPICALDIMENSIONSOFFMRIDATASETS,THESPATIALICAISUSUALLYPREFERREDBOTHFORTHEPLAUSIBILITYOFTHEUNDERLYINGNEUROPHYSIOLOGICALMODELANDFORCOMPUTATIONALREQUIREMENTSHENCE,THESPATIALICAISCHOSENFORTHEFMRIDATAANALYSISINTHISSTUDYHEREINAFTER,WHENICAISMENTIONED,ITISREFERREDTOSPATIALICAICACANBEFURTHERDIVIDEDINTOINDIVIDUALICAFORANINDIVIDUALDATASETEG,INCLUDINGONEPARTICIPANT’SDATAANDGROUPICAFORTHECONCATENATEDDATASETEG,INCLUDINGMULTIPLEPARTICIPANTS’DATACALHOUNETAL,2009GROUPICACANBEEVENCATEGORIZEDASTHETEMPORALCONCATENATIONAPPROACHEG,MULTIPLEPARTICIPANTS’DATAARECONCATENATEDINTHETIMEDOMAINANDTHESPATIALONEEG,MULTIPLEPARTICIPANTS’DATAARECONCATENATEDINTHESPATIALDOMAINCALHOUNETAL,2009THETEMPORALANDSPATIALAPPROACHESALLOWEXAMININGINDIVIDUALTEMPORALCOURSESANDINDIVIDUALSPATIALMAPS,RESPECTIVELY,ANDTHEYPROVIDECOMMONSPATIALMAPSANDCOMMONTEMPORALCOURSESOVERMULTIPLEPARTICIPANTS,RESPECTIVELYACTUALLY,GROUPICAREQUIRESADDITIONALASSUMPTIONSBESIDESTHOSENEEDEDBYINDIVIDUALICACONGETAL,2013ITISUNKNOWNWHETHERFMRIDATADURINGREALWORLDEXPERIENCESCANMEETTHEADDITIONALASSUMPTIONSCONSEQUENTLY,BOTHINDIVIDUALICAANDGROUPICAAREAPPLIEDTODECOMPOSETHEFMRIDATAHERETOEXAMINEWHETHERSIMILARFINDINGSCANBEOBTAINEDBYBOTHMETHODSNOMATTERWHICHMEANSOFICAISAPPLIED,ITISVERYCRITICALTODETERMINETHENUMBEROFEXTRACTEDCOMPONENTSMODELORDERSELECTIONMOSHASBEENAPPLIEDFORTHISPURPOSELIETAL,2007ANDTHEINFORMATIONTHEORYBASEDMOSALGORITHMSAREOFTENUSED,FOREXAMPLE,AKAIKE’SINFORMATIONCRITERIONAICAKAIKE,1974,MINIMUMDISTANCELENGTHMDLRISSANEN,1978,ANDKULLBACK–LEIBLERINFORMATIONCRITERIONKICCAVANAUGH,1999THISTYPEOFMOSALGORITHMSASSUMESTHEDATAAREINDEPENDENTLYANDIDENTICALLYDISTRIBUTEDANDTHECOLLECTEDBRAINDATAHAVETOBERESAMPLEDTOSATISFYTHISASSUMPTIONFORMOSLIETAL,2007INTHISSTUDY,WEEXAMINEANOTHERRECENTLYDEVELOPEDALGORITHMCALLEDSORTEHEETAL,2010FORMOSOFFMRIDATASORTEISVERYEFFICIENTINTHECOMPUTINGANDDOESNOTREQUIRETHERESAMPLINGPROCESSHEETAL,2010ALTHOUGHMOSHASBEENEXTENSIVELYUSEDFORFMRIDATA,THEREAREFEWEXPLICITMETHODSTOVALIDATEWHETHERTHEESTIMATIONOFMOSISACCURATEORNOTFORTHEREALFMRIDATARECENTLY,ASIMULATIONSTUDYHASSHOWNTHATMOSCANNOTPRECISELYESTIMATETHENUMBEROFSOURCESINTHELINEARTRANSFORMMODELWHENSIGNALNOISERATIOSNRISLOWEG,LESSTHAN0DB,ANDTHATWHENSNRISLOWSORTEANDMDLTENDTOOVERESTIMATEANDUNDERESTIMATETHETRUENUMBEROFSOURCES,RESPECTIVELYCONGETAL,2012INTHISSTUDY,SORTE,AIC,MDLANDKICAREPERFORMEDONTHECONVENTIONALLYPREPROCESSEDFMRIDATAANDFURTHERPREPROCESSEDBYADIGITALFILTERFMRIDATATOEXAMINETHEIRPERFORMANCEINESTIMATINGTHENUMBEROFSOURCESINFMRIDATAOFINDIVIDUALPARTICIPANTSFORINDIVIDUALICA,CLUSTERINGTHEEXTRACTEDICACOMPONENTSOFFMRIDATAISUSUALLYAPPLIEDTOFINDTHECOMMONCOMPONENTSACROSSDIFFERENTPARTICIPANTS,ANDTHESIMILARITYMATRIXBASEDHIERARCHICALCLUSTERINGHASBEENOFTENUSEDCALHOUNETAL,2009ESPOSITOETAL,2005THENUMBEROFICACOMPONENTSNISALWAYSMUCHSMALLERTHANTHENUMBEROFVOXELSPINFMRIDATA,PCANBEHUNDREDSOFTHOUSANDSFORTHEVERYHIGHDIMENSIONALDATA,DIMENSIONREDUCTIONTENDSTOBEPERFORMEDBEFOREMACHINELEARNING,LIKECLUSTERINGANDCLASSIFICATIONINTHISSTUDY,ARECENTLYDEVELOPEDDIMENSIONREDUCTIONMETHODCALLEDDIFFUSIONMAPDMCOIFMANANDLAFON,2006ISAPPLIEDTOREDUCETHEDIMENSIONOFTHEDATATOBECLUSTEREDIE,THENICACOMPONENTSHEREFROMPTO2,ANDTHEN,THEDEGREEOFCLOSENESSOFTHENICACOMPONENTSCANBEVISUALIZEDBYTHESCATTERPLOTOFTHETWODIMENSIONALDATAFURTHERMORE,THESPECTRALCLUSTERINGNADLERETAL,2006ISUSEDTOFINDTHECOMMONCOMPONENTSACROSSMULTIPLEPARTICIPANTSINTHISSTUDYFORGROUPICA,THETEMPORALCONCATENATIONSEEMSTOOUTPERFORMTHESPATIALCONCATENATIONCALHOUNETAL,2009INDEED,THISCONCLUSIONISBASEDONGROUPICAFORFMRIDATAMOSTLYINTHEBLOCKOREVENTRELATEDDESIGNSITISUNKNOWNWHETHERTHECONCLUSIONISVALIDFORTHEFMRIDATADURINGREALWORLDEXPERIENCESTHEREFORE,BOTHAPPROACHESARETRIEDTODECOMPOSETHEFMRIHEREINORDERTOADDRESSTHEISSUESMENTIONEDABOVE,FMRIDATAOFELEVENMUSICIANSINAFREELISTENINGEXPERIMENTALLURIETAL,2012AREUSEDINTHISSTUDY2METHOD21DATADESCRIPTION211FMRIELEVENHEALTHYPARTICIPANTSWITHNONEUROLOGICAL,HEARINGORPSYCHOLOGICALPROBLEMSWITHFORMALMUSICALTRAININGPARTICIPATEDINTHESTUDYMEANAGE232±37SD5FEMALESTHEPARTICIPANTSWERESCANNEDWITHFMRIWHILELISTENINGTOASTIMULUSWITHARICHMUSICALSTRUCTURE,AMODERNTANGOADIOSNONINOBYASTORPIAZZOLLATHEPARTICIPANTSWEREINSTRUCTEDTOSTAYSTILLANDTORELAXWHILE

簡介：BANDINGLIGATIONOFHEMORRHOIDSJGASTROINTESTINLIVERDISJUNE2007VOL16NO2,163165ADDRESSFORCORRESPONDENCEMOSCHOSJOHNMD,PHDPAPADIMITRIOU10STRKALAMARIA55131,GREECEEMAILGUTINGRBANDINGHEMORRHOIDSUSINGTHEO’REGANDISPOSABLEBANDERSINGLECENTEREXPERIENCEDIMITRIOSPAIKOS1,ANTHIEGATOPOULOU1,JOHNMOSCHOS1,ANASTASIOSKOULAOUZIDIS2,SHIVRAMBHAT2,DIMITRIOSTZILVES1,KONSTANTINOSSOUFLERIS1,DIMITRIOSTRAGIANNIDIS1,IOANNISKATSOS1,ANESTISTARPAGOS11“THEAGENIO”HOSPITAL,THESSALONIKI,GREECE2WARRINGTONGENERALHOSPITAL,CHESHIRE,UKABSTRACTBACKGROUNDHEMORRHOIDSARETHEMOSTCOMMONANORECTALDISORDERINTHEWESTERNWORLDANDAREAMAJORCAUSEOFACTIVE,RELAPSINGORCHRONICRECTALBLEEDINGMANYTREATMENTOPTIONSHAVEBEENPROPOSEDANDTRIEDFOREARLYSTAGEHEMORRHOIDSTHEREISGENERALAGREEMENTTHATRUBBERBANDINGLIGATIONRBLISSAFEANDEFFECTIVEAIMSTOEVALUATETHEEFFECTIVENESSANDCOMPLICATIONSASSOCIATEDWITHRBLPERFORMEDINOUTPATIENTSFORSYMPTOMATICHEMORRHOIDSUSINGTHEO’REGANDISPOSABLEBANDERDEVICERESULTSSIXTYCONSECUTIVEPATIENTSUNDERWENTHEMORRHOIDBANDINGWITHTHEO’REGANDISPOSABLEBANDERTHEMEANTIMEREQUIREDFORONESESSIONWAS62MINTHELONGESTWAS10MINNOMAJORCOMPLICATIONSWERENOTEDMINOREARLYANDLATEBLEEDINGWASREPORTEDIN10AND67RESPECTIVELY,BUTNONEWASSEVEREPAINOCCURREDIN67BUTWASNOTSEVEREINALLCASES,CLINICALANDENDOSCOPICRANGEANDFORMSCORESIMPROVEMENTWASOBSERVEDANDPATIENTSOFALLAGES,INCLUDINGTHEELDERLY,WEREFOUNDTOBETOLERANTTOTHEPROCEDURECONCLUSIONRBLPERFORMEDINOUTPATIENTSFORSYMPTOMATICHEMORRHOIDSUSINGTHEO’REGANDISPOSABLEBANDERDEVICEISASSOCIATEDWITHAGOODRESPONSEANDLOWCOMPLICATIONRATEWERECOMMENDTHETECHNIQUEASASAFEANDRELIABLETREATMENTOPTIONKEYWORDSHEMORRHOIDSO’REAGANDISPOSABLEBANDERRUBBERBANDINGLIGATIONINTRODUCTIONHEMORRHOIDSARETHEMOSTCOMMONANORECTALDISORDERINTHEWESTERNWORLD1MANYTREATMENTOPTIONSHAVEBEENPROPOSEDANDTRIEDTHEREISGENERALAGREEMENTTHATRUBBERBANDINGLIGATIONRBLISSAFEANDEFFECTIVESURGERYSHOULDBERESERVEDFOR3RDOR4THGRADEHEMORRHOIDS,“MIXED”HEMORRHOIDSNOTRESPONDINGTORBLORPATIENTSONANTICOAGULANTSTHEIDEALTREATMENTISEASILYLEARNED,COSTEFFECTIVE,GIVESSATISFACTORYRESULTSANDLACKSCOMPLICATIONSRBLISRECOMMENDEDASTHEINITIALMODEOFTHERAPYFORHEMORRHOIDSOFGRADE1TO3OURAIMWASTOEVALUATETHEEFFECTIVENESSANDCOMPLICATIONSASSOCIATEDWITHRBLPERFORMEDINOUTPATIENTSFORSYMPTOMATICHEMORRHOIDSUSINGTHEO’REGANDISPOSABLEBANDERDEVICEMATERIALANDMETHODSBETWEENSEPTEMBER2005ANDMARCH2006,60CONSECUTIVEPATIENTS32MEN,28WOMENUNDERWENTRBLWITHTHEO’REGANDISPOSABLEBANDERALLPATIENTSHADINTERNALHEMORRHOIDSOFGRADE1TO4ACCORDINGTOTHEGOLIGHERGRADINGSYSTEMWHICHISAFOURSTAGEGRADINGFORINTERNALHEMORRHOIDS2ALLPATIENTSHADUNDERGONEUNSUCCESSFULCONSERVATIVETREATMENTTHESTUDYDESIGNWASAPPROVEDBYTHEHOSPITAL’SETHICSCOMMITTEEWRITTENINFORMEDCONSENTWASOBTAINEDFROMEACHPATIENTPATIENTSWITHASSOCIATEDANALFISSURES,ANALSPASMORINFECTIOUSANALPATHOLOGIESANDPATIENTSWHOREFUSEDTOSIGNTHEINFORMEDCONSENTFORMWEREEXCLUDEDFROMTHESTUDYALLPATIENTSWEREPREPAREDFORTREATMENTBYADMINISTRATIONOFASALINESOLUTIONENEMAANDAPPLICATIONOFALOCALANESTHETICOINTMENTXYLOCAINEGEL2ASTRAZENECA,WEBEL,GERMANYINTOTHEANALCANALEARLYCOMPLICATIONSWEREDEFINEDASTHOSEOCCURRINGWITHINAWEEKALLRBLSWEREPERFORMEDONANOUTPATIENTBASISTHEFRONTENDOFTHELOADEDLIGATORWASINITIALLYINSERTEDFULLYINTOTHERECTUMANDTHENSLOWLYWITHDRAWNASITWASANGLEDACUTELYTOPOINTDIRECTLYTOWARDTHESITETOBELIGATED,1CMABOVETHEDENTATELINETHETISSUEWASSUCKEDINTOTHELIGATORBYWITHDRAWINGITSPLUNGERATESTFORPAINWASPERFORMEDBYROTATINGTHELIGATORTHROUGH180OWHILEMAINTAININGSUCTIONIFTHISMANEUVERCAUSEDDISCOMFORTTHELIGATORWASREPOSITIONEDATAHIGHERLEVELSUCTIONWASMAINTAINEDFORATLEAST30SECONDSWHILETHELIGATORWASROTATEDTHROUGH180OSEVERALTIMESTOALLOWANADEQUATEBITEOFTISSUETOBEBANDINGLIGATIONOFHEMORRHOIDS165SUGGESTSRBLFORTREATMENTFORGRADE2HEMORRHOIDSWHILERESERVINGHAEMORRHOIDECTOMYFORGRADE3HEMORRHOIDSORRECURRENCESAFTERRBL11ANOTHERRECENTSTUDYREPORTEDTHATRBLCANBEUSEDTOTREATALLDEGREESOFHEMORRHOIDSWITHSIMILAREFFECTIVENESS12INOURSTUDY,3MONTHFOLLOWUPWASSATISFACTORYREGARDINGALLGRADESOFHEMORRHOIDSAPARTFROMGRADEIVINCONCLUSION,RBLPERFORMEDINOUTPATIENTSFORSYMPTOMATICHEMORRHOIDSUSINGTHEO’REGANDISPOSABLEBANDERDEVICEISASSOCIATEDWITHAGOODRESPONSEANDLOWCOMPLICATIONRATEWERECOMMENDTHETECHNIQUEASASAFEANDRELIABLETREATMENTOPTION4FUKUDAA,KAYJIYAMAT,ARAKAWAHETALRETROFLEXEDENDOSCOPICMULTIPLEBANDLIGATIONOFSYMPTOMATICINTERNALHEMORRHOIDSGASTROINTESTENDOSC2004593803845GUPTAPJRADIOFREQUENCYCOAGULATIONVERSUSRUBBERBANDLIGATIONINEARLYHEMORRHOIDSPAINVERSUSGAINMEDICINAKAUNAS2004402322376CLEATORIG,CLEATORMMBANDINGHEMORRHOIDSUSINGTHEO’REGANDISPOSABLEBANDERBUSINESSBRIEFINGUSGASTROENTEROLOGYREVIEW200569737GUPTAPJINFRAREDCOAGULATIONVERSUSRUBBERBANDLIGATIONINEARLYSTAGEHEMORRHOIDSBRAZJMEDRES200336143314388PFENNINGERJL,SURRELLJNONSURGICALTREATMENTOPTIONSFORINTERNALHEMORRHOIDSAMFAMPHYCISIAN1995528218349MACRAEHM,MCLEODRSCOMPARISONOFHEMORRHOIDTREATMENTAMETAANALYSISCANJSURG199740141710SCHWARTZSIPRINCIPLESOFSURGERY,6THED,MCGRAWHILL,NYORK1994,PP,222122911SHANMUGAMV,THAHAMA,RABINDRANATHKS,CAMPBELLKL,STEELERJ,LOUDONMARUBBERBANDLIGATIONVERSUSEXCISIONALHAEMORRHOIDECTOMYFORHEMORRHOIDSCOCHRANEDATABASESYSTREV200520CD00503412IYERVS,SHRIERI,GORDONPHLONGTERMOUTCOMEOFRUBBERBANDLIGATIONFORSYMPTOMATICPRIMARYANDRECURRENTINTERNALHEMORRHOIDSDISCOLONRECTUM20044713641370REFERENCES1LEFFEHEMORRHOIDSPOSTGRADMEDICINE198782951012SUMY,CHIUCT,WUCS,ETALENDOSCOPICHEMORRHOIDALLIGATIONOFSYMPTOMATICINTERNALHEMORRHOIDSGASTROINTESTENDOSC2003588718743O’REGANPJDISPOSABLEDEVICEANDAMINIMALLYINVASIVETECHNIQUEFORRUBBERBANDLIGATIONOFHEMORRHOIDSDISCOLONRECTUM199942683685CONFLICTOFINTERESTNONETODECLARE