Avoiding MRI-Related Accidents: A Practical Approach to Implementing MR Safety

MRI is a ubiquitous medical imaging technology typically using superconductivity to generate a strong, homogeneous, and generally ceaseless magnetic field. MRI and its magnetic field pose many safety hazards, including magnetic forces on metals, tissue heating and burns, nerve stimulation, bioeffects, acoustic noise, and contrast agent complications. The primary concern is that a wide variety of patients, staff members, technologists, and physicians can approach the incessant magnetic field, creating great potential for accidents that could occur if metals from the environment, adornments, implants, and other unintended sources are also present in or near the field. Many accidents have occurred and are occasionally reported in the United States and countries all over the world. Through carefully structured oversight and the establishment of strict guidelines regarding access, responsibilities, and training, these risks can be mitigated, and accidents can be prevented. Fortunately, there is currently a wide variety of resources available to facilitate the successful implementation of an effective MRI safety program. This article presents a general overview of and the authors’ experience with an MRI safety program in terms of risk management and training. The MR safety program requirements and regulations in the United States devised by The Joint Commission and the ACR are also discussed. With these resources and a carefully selected team, the risk for MRI-related accidents can be vastly reduced if not completely eliminated.     

L市社区老年人卫生服务利用情况及综合评价*

目的研究L市社区老年人的卫生服务利用情况,对不同社区进行综合评价,根据调查结果提出切实可行的对策和建议,为社区卫生服务中心针对老年人开展工作提供参考。方法对所调查老年人的基本情况进行描述性分析;采用logistic回归方法分析社区卫生服务利用的影响因素;采用TOPSIS法对不同社区卫生服务利用情况进行综合评价。结果被调查老年人的两周就诊率为29.7%,两周患者就诊率为68.5%,老年人过去一年住院率为28.3%;logistic回归分析结果显示,影响老年人两周就诊率和住院率的主要因素为是否患有慢性疾病(P0.05);Topsis评价结果显示,经济水平和文化程度高的被调查者社区卫生服务利用情况相对较好。结论 L市社区老年人卫生服务利用情况整体较好,但是不同社区之间存在差异,部分老年人认为社区医疗机构的医生技术能力较低。因此,要提高基层医务人员的能力,加快培养全科医生,从而提高社区卫生资源的利用。     

Guide des procédures de radiothérapie externe et de curiethérapie : présentation de la 2e édition

In 2007, a first edition was published with the objective to produce guidelines for optimization, harmonization and homogenization of practices in external radiation therapy in France. The second edition, including brachytherapy, has the same objective and takes into account recent technologic improvements (intensity modulation radiation therapy, stereotactic radiotherapy, and 3-dimension brachytherapy) and recent results of the literature. The first part is about daily use of general principles (quality, security, image-guided radiation therapy) and the second is to describe each step of treatment of main cancers.     

动物药材生产及产地加工技术标准体系建设

药用动物资源是中药资源的重要组成部分,是中医药发展的重要战略储备资源,在野生药用动物资源日渐匮乏的今天,大力开展药用动物人工养殖才能确保我国中医药产业的可持续发展。然而《中国药典》2015年版一部收载的106种药用动物中仅有22种(除家畜家禽外)有现行选育、养殖相关标准,共211项,其中除国家标准7项、行业标准(农业、水产)11项外均为地方标准,远远落后于同类型农业标准化程度,无法实现动物药材规范化生产。亟需对常见动物药材蟾酥、水蛭、全蝎等建立包括基础标准、产品标准、工艺过程标准、安全标准、环境保护标准、管理标准、工作标准在内的动物药材生产及产地加工技术标准体系,补充产业空白,从源头把控动物药材、动物类中药饮片及含有动物性成分中药产品质量。     

Low-dose l-isoproterenol versus salbutamol in hospitalized pediatric patients with severe acute exacerbation of asthma: A double-blind,randomized controlled trial

BackgroundAlthough the guidelines in most countries do not recommend continuous inhalation of l-isoproterenol to treat pediatric patients with acute severe exacerbation of asthma, lower dose of l-isoproterenol has been widely used in Japan. To determine whether the efficacy of low-dose l-isoproterenol was superior to that of salbutamol, we conducted a double-blind, randomized controlled trial.MethodsHospitalized patients aged 1–17 years were eligible if they had severe asthma exacerbation defined by the modified pulmonary index score (MPIS). Patients were randomly assigned (1:1) to receive inhalation of l-isoproterenol (10 μg/kg/h) or salbutamol (500 μg/kg/h) for 12 hours via a large-volume nebulizer with oxygen. The primary outcome was the change in MPIS from baseline to 3 hours after starting inhalation. Trial registration number UMIN000001991.ResultsFrom December 2009 to October 2013, 83 patients (42 in the l-isoproterenol group and 41 in the salbutamol group) were enrolled into the study. Of these, one patient in the l-isoproterenol group did not receive the study drug and was excluded from the analysis. Compared with salbutamol, l-isoproterenol reduced MPIS more rapidly. Mean (SD) changes in MPIS at 3 hours were −2.9 (2.5) in the l-isoproterenol group and −0.9 (2.3) in the salbutamol group (difference −2.0, 95% confidence interval −3.1 to −0.9; P < 0.001). Adverse events occurred in 1 (2%) and 11 (27%) patients in the l-isoproterenol and salbutamol groups, respectively (P = 0.003). Hypokalemia and tachycardia occurred only in the salbutamol group.ConclusionsLow-dose l-isoproterenol has a more rapid effect with fewer adverse events than salbutamol.     

实测法在半髋关节置换术中确保下肢等长的应用

目的分析实测法在半髋关节置换术中确保下肢长度的有效性。方法笔者自2010-01—2012-12共采用非骨水泥固定型双动头人工半髋关节置换术治疗279例移位股骨颈骨折。随机分成实测法组(应用实测法)和经验测量法组(应用解剖标志测量法),比较2组术后双下肢长度差异、手术时间、Harris评分、平均住院日及术后并发症。结果所有患者获得平均47.5(30~69)个月随访。实测法组与经验测量法组术后双下肢平均长度差异分别为(4.15±2.68)mm和(6.93±3.71)mm,实测法组小于经验测量法组,差异有统计学意义(t=-2.276,P=0.031)。实测法组和经验测量法组在手术时间、术后及末次随访时髋关节Harris评分、平均住院日、术后并发症方面比较差异无统计学意义(P0.05)。2组各1例发生脱位,无坐骨神经麻痹、伤口感染、假体周围骨折发生。结论实测法是一种在半髋关节置换术中减小下肢长度差异的简单、有效、准确的方法。     

中医正骨配合外固定架在股骨粗隆间骨折中的应用效果

目的：分析中医正骨配合外固定架在股骨粗隆间骨折治疗中的应用效果。方法我院2010年1月~2012年12月间收治的股骨粗隆间骨折患者104例，按照治疗方案分为对照组和观察组，对照组采用切开复位内固定治疗，观察组采用中医正骨配合外固定治疗，比较两组手术相关指标及疗效。结果观察组手术时间、住院时间明显短于对照组，术中出血量明显少于对照组，差异均具有统计学意义（P＜0.05）；观察组治疗优良率略低于对照组，但两者差异无统计学意义（P＞0.05）。结论中医正骨配合外固定架治疗股骨粗隆间骨折疗效较好，创伤小，且费用较低，临床中应把握好手术适应证、禁忌证及手术时机，以最大限度提高治疗效果。     

In vitro cultivation of rat bone marrow mesenchymal stem cells and establishment of pEGFP/Ang-1 transfection method

ObjectiveTo obtain the bone marrow mesenchymal stem cells (BMSCs), complete phenotypic identification and successfully transfect rat BMSCs by recombinant plasmid pEGFP/Ang-1.MethodsBMSCs were isolated from bone marrow using density gradient centrifugation method and adherence screening method, and purified. Then the recombinant plasmid pEGFP/Ang-1 was used to transfect BMSCs and the positive clones were obtained by the screen of G418 and observed under light microscopy inversely. Green fluorescent exhibited by protein was enhanced to measure the change time of the expression amount of Ang-1.ResultsBMSCs cell lines were obtained successfully by adherence screening method and density gradient centrifugation. Ang-1 recombinant plasmid was transfected smoothly into rat BMSCs, which can express Ang-1 for 3 d and decreased after 7 d.ConclusionsAdherence screening method and density gradient centrifugation can be effective methods to obtain BMSCs with high purity and rapid proliferation. Besides, the expression of transfected recombinant plasmid pEGFP/Ang-1 in rat BMSCs is satisfactory.