脓毒症是一种由感染引起的异质性疾病,感染触发了一系列复杂的局部或者全身的免疫炎症反应,引起多器官功能衰竭,发病率和病死率显著升高。由于至今仍然没有诊断脓毒症的金标准,所以脓毒症的临床诊断仍是一个难题。因此,脓毒症的临床诊...脓毒症是一种由感染引起的异质性疾病,感染触发了一系列复杂的局部或者全身的免疫炎症反应,引起多器官功能衰竭,发病率和病死率显著升高。由于至今仍然没有诊断脓毒症的金标准,所以脓毒症的临床诊断仍是一个难题。因此,脓毒症的临床诊断需要不断改变来满足临床和研究的要求。然而,尽管有许多新型的生物标记和筛选工具去预测脓毒症发生的风险,但是这些措施的诊断价值和有效性不足以让人满意,并且没有充分的证据去建议临床使用这些新技术。因此,脓毒症的临床诊断标准需要定期更新去适应不断产生的新证据。这篇综述旨在呈现当前脓毒症的诊断和早期识别方面的最新研究证据。临床运用不同的诊断方法的推荐意见依赖于推荐、评价、发展和评估分级体系(Grades of Recommendation Assessment,Development and Evaluation,GRADE),因为大部分的研究是观察性研究,并没有对这些方法进行可靠评估,采用的是两步推理方法。未来需要更多研究来确认或者反驳某一特殊的指标检测,同时应该直接采用相关病人的结果数据。展开更多
AIM： To investigate indications, surgical challenges, and outcome of Descemet -membrane endothelial keratoplasty （DMEK） in patients with retinal comorbidities （RC）. METHODS： In a prospective cohort study, 8 eye...AIM： To investigate indications, surgical challenges, and outcome of Descemet -membrane endothelial keratoplasty （DMEK） in patients with retinal comorbidities （RC）. METHODS： In a prospective cohort study, 8 eyes of 8 DMEK-patients with known RC were compared to 38 eyes of 38 DMEK-patients without RC. The duration of surgery, the degree of difficulty graded by the surgeon, and the complications through DMEK-surgery were analyzed for each patient. The best-corrected visual acuity （BCVA）, the endothelial cell count, the intraocular pressure, and the subjective satisfaction was evaluated after a 6-month follow-up. Data were compared applying the non-parametric Wilcoxon-, Chi-square- and Fisher＇s-exact-test with P≤ 0. 05 as level of significance. RESULTS： RC-patients had dry age-related macular degeneration （n=4） or history of pars-plana vitrectomy （n=4）. The main indication for DMEK was pain due to bullous keratopathy for the RC-patlents （n=7, 88%） and visual impairment due to Fuchs endothelial keratoplasty for the non-RC-patients （n=33, 87% ）. The BCVA increased for both groups （P=0.01, P〈0.001） and all corneas cleared. For the RC-patients, the subjective satisfaction improved significantly （P=0.02）. Oil-filling and missing support of the vitreous body complicated surgery in vitrectomized eyes. CONCLUSION： DMEK is a favorable technique to treat endothelial disorders even if patients suffer from a retinal comorbidity. By enhancing the corneal clarity, it enables retinal examination or intraocular surgery and increases the patients satisfaction. However, in vitrectomized or silicone-oil filled eyes, the duration of surgery and degree of complexity are increased. An experienced surgeon should perform DMEK in these patients. Clinical trial registration number： DRKS00007566.展开更多
Background: In the present study, we sought to describe a procedure for the creation of co-registered positron emission tomography (PET) and magnetic resonance imaging (MRI) polar plots of cardiac PET/MRI examinations...Background: In the present study, we sought to describe a procedure for the creation of co-registered positron emission tomography (PET) and magnetic resonance imaging (MRI) polar plots of cardiac PET/MRI examinations, validate the resulting plots against available standard methods in patients with myocardial infarction and provide examples that demonstrate the advantage of the novel approach over existing standards. Methods: Co-registered LGE and PET short-axis images were transformed into polar maps based on a radial sampling pattern. LGE was automatically detected using an automated thresholding algorithm (ATA). In 20 PET/MRI examinations in patients with acute myocardial infarction, agreement between manual LGE assessment and the ATA classification was calculated. Also agreement between MRI-segmentation based PET polar plots and standard PET polar plots (created with the Corridor4DM software package) was assessed. Results: No statistically significant difference in infarct sizes between manual and ATA segmentation was found (p = 0.12). Both methods were highly correlated (Pearson’s r = 0.96, p Conclusion: A straightforward software approach for the creation of co-registered PET and MRI polar plots was described and successfully demonstrated in PET/MRI studies of myocardial infarction and inflammation.展开更多
Hepatocellular carcinoma(HCC)ranks sixth in population age-standardized incidence(ASI)and fourth in population age-standardized mortality(ASM)globally and is the fourth ASI and the second ASM.
Purpose:The mortality rate for severely injured patients with the injury severity score(ISS)>16 has decreased in Germany.There is robust evidence that mortality is influenced not only by the acute trauma itself but...Purpose:The mortality rate for severely injured patients with the injury severity score(ISS)>16 has decreased in Germany.There is robust evidence that mortality is influenced not only by the acute trauma itself but also by physical health,age and sex.The aim of this study was to identify other possible influences on the mortality of severely injured patients.Methods:In a matched-pair analysis of data from Trauma Register DGU(R),non-surviving patients from Germany between 2009 and 2014 with an ISS_>16 were compared with surviving matching partners.Matching was performed on the basis of age,sex,physical health,injury pattern,trauma mechanism,conscious state at the scene of the accident based on the Glasgow coma scale,and the presence of shock on arrival at the emergency room.Results:We matched two homogeneous groups,each of which consisted of 657 patients(535 male,average age 37 years).There was no significant difference in the vital parameters at the scene of the accident,the length of the pre-hospital phase,the type of transport(ground or air),pre-hospital fluid management and amounts,ISS,initial care level,the length of the emergency room stay,the care received at night or from on-call personnel during the weekend,the use of abdominal sonographic imaging,the type of X-ray imaging used,and the percentage of patients who developed sepsis.We found a significant difference in the new injury severity score,the frequency of multi-organ failure,hemoglobine at admission,base excess and international normalized ratio in the emergency room,the type of accident(fall or road traffic accident),the pre-hospital intubation rate,reanimation,in-hospital fluid management,the frequency of transfusion,tomography(whole-body computed tomography),and the necessity of emergency intervention.Conclusion:Previously postulated factors such as the level of care and the length of the emergency room stay did not appear to have a significant influence in this study.Further studies should be conducted to analyse the identified factors with a view to optimising the treatment of severely injured patients.Our study shows that there are significant factors that can predict or influence the mortality of severely injured patients.展开更多
文摘脓毒症是一种由感染引起的异质性疾病,感染触发了一系列复杂的局部或者全身的免疫炎症反应,引起多器官功能衰竭,发病率和病死率显著升高。由于至今仍然没有诊断脓毒症的金标准,所以脓毒症的临床诊断仍是一个难题。因此,脓毒症的临床诊断需要不断改变来满足临床和研究的要求。然而,尽管有许多新型的生物标记和筛选工具去预测脓毒症发生的风险,但是这些措施的诊断价值和有效性不足以让人满意,并且没有充分的证据去建议临床使用这些新技术。因此,脓毒症的临床诊断标准需要定期更新去适应不断产生的新证据。这篇综述旨在呈现当前脓毒症的诊断和早期识别方面的最新研究证据。临床运用不同的诊断方法的推荐意见依赖于推荐、评价、发展和评估分级体系(Grades of Recommendation Assessment,Development and Evaluation,GRADE),因为大部分的研究是观察性研究,并没有对这些方法进行可靠评估,采用的是两步推理方法。未来需要更多研究来确认或者反驳某一特殊的指标检测,同时应该直接采用相关病人的结果数据。
文摘AIM： To investigate indications, surgical challenges, and outcome of Descemet -membrane endothelial keratoplasty （DMEK） in patients with retinal comorbidities （RC）. METHODS： In a prospective cohort study, 8 eyes of 8 DMEK-patients with known RC were compared to 38 eyes of 38 DMEK-patients without RC. The duration of surgery, the degree of difficulty graded by the surgeon, and the complications through DMEK-surgery were analyzed for each patient. The best-corrected visual acuity （BCVA）, the endothelial cell count, the intraocular pressure, and the subjective satisfaction was evaluated after a 6-month follow-up. Data were compared applying the non-parametric Wilcoxon-, Chi-square- and Fisher＇s-exact-test with P≤ 0. 05 as level of significance. RESULTS： RC-patients had dry age-related macular degeneration （n=4） or history of pars-plana vitrectomy （n=4）. The main indication for DMEK was pain due to bullous keratopathy for the RC-patlents （n=7, 88%） and visual impairment due to Fuchs endothelial keratoplasty for the non-RC-patients （n=33, 87% ）. The BCVA increased for both groups （P=0.01, P〈0.001） and all corneas cleared. For the RC-patients, the subjective satisfaction improved significantly （P=0.02）. Oil-filling and missing support of the vitreous body complicated surgery in vitrectomized eyes. CONCLUSION： DMEK is a favorable technique to treat endothelial disorders even if patients suffer from a retinal comorbidity. By enhancing the corneal clarity, it enables retinal examination or intraocular surgery and increases the patients satisfaction. However, in vitrectomized or silicone-oil filled eyes, the duration of surgery and degree of complexity are increased. An experienced surgeon should perform DMEK in these patients. Clinical trial registration number： DRKS00007566.
文摘Background: In the present study, we sought to describe a procedure for the creation of co-registered positron emission tomography (PET) and magnetic resonance imaging (MRI) polar plots of cardiac PET/MRI examinations, validate the resulting plots against available standard methods in patients with myocardial infarction and provide examples that demonstrate the advantage of the novel approach over existing standards. Methods: Co-registered LGE and PET short-axis images were transformed into polar maps based on a radial sampling pattern. LGE was automatically detected using an automated thresholding algorithm (ATA). In 20 PET/MRI examinations in patients with acute myocardial infarction, agreement between manual LGE assessment and the ATA classification was calculated. Also agreement between MRI-segmentation based PET polar plots and standard PET polar plots (created with the Corridor4DM software package) was assessed. Results: No statistically significant difference in infarct sizes between manual and ATA segmentation was found (p = 0.12). Both methods were highly correlated (Pearson’s r = 0.96, p Conclusion: A straightforward software approach for the creation of co-registered PET and MRI polar plots was described and successfully demonstrated in PET/MRI studies of myocardial infarction and inflammation.
基金supported by grants from the National Natural Science Foundation(Nos.81672725 and 81970525)。
文摘Hepatocellular carcinoma(HCC)ranks sixth in population age-standardized incidence(ASI)and fourth in population age-standardized mortality(ASM)globally and is the fourth ASI and the second ASM.
文摘Purpose:The mortality rate for severely injured patients with the injury severity score(ISS)>16 has decreased in Germany.There is robust evidence that mortality is influenced not only by the acute trauma itself but also by physical health,age and sex.The aim of this study was to identify other possible influences on the mortality of severely injured patients.Methods:In a matched-pair analysis of data from Trauma Register DGU(R),non-surviving patients from Germany between 2009 and 2014 with an ISS_>16 were compared with surviving matching partners.Matching was performed on the basis of age,sex,physical health,injury pattern,trauma mechanism,conscious state at the scene of the accident based on the Glasgow coma scale,and the presence of shock on arrival at the emergency room.Results:We matched two homogeneous groups,each of which consisted of 657 patients(535 male,average age 37 years).There was no significant difference in the vital parameters at the scene of the accident,the length of the pre-hospital phase,the type of transport(ground or air),pre-hospital fluid management and amounts,ISS,initial care level,the length of the emergency room stay,the care received at night or from on-call personnel during the weekend,the use of abdominal sonographic imaging,the type of X-ray imaging used,and the percentage of patients who developed sepsis.We found a significant difference in the new injury severity score,the frequency of multi-organ failure,hemoglobine at admission,base excess and international normalized ratio in the emergency room,the type of accident(fall or road traffic accident),the pre-hospital intubation rate,reanimation,in-hospital fluid management,the frequency of transfusion,tomography(whole-body computed tomography),and the necessity of emergency intervention.Conclusion:Previously postulated factors such as the level of care and the length of the emergency room stay did not appear to have a significant influence in this study.Further studies should be conducted to analyse the identified factors with a view to optimising the treatment of severely injured patients.Our study shows that there are significant factors that can predict or influence the mortality of severely injured patients.
