Objective: To compare and analyze the image quality and radiation dose of three scanning modes of dual-source CT coronary artery retrospectively, and to discuss the application value of TurboFlash coarse pitch scannin...Objective: To compare and analyze the image quality and radiation dose of three scanning modes of dual-source CT coronary artery retrospectively, and to discuss the application value of TurboFlash coarse pitch scanning mode. Methods: The imaging data of 100 patients who underwent CT coronary angiography (CCTA) using Siemens force CT retrospective gated triggering spiral scan (RES-SPIRAL), adaptive prospective gated triggering sequence scan (SEQ) and prospective coarse pitch scan (TurboFlash) retrospectively was collected. The image quality was evaluated by objective and subjective methods. The effective radiation dose of patients was compared and analyzed, and the indications of the three scanning modes were analyzed. The application value of dual-source CT TurboFlash coarse pitch scanning in coronary artery imaging was evaluated. Results: The results showed that the left main coronary artery, the right coronary artery and their tertiary branches could be clearly displayed in the three groups of images: the left anterior descending branch, the left circumflex branch, and their three-level branches. There was no statistical difference in subjective image quality among the three groups of pictures (P > 0.05). There was no statistical difference in objective evaluation indexes, such as CT value, SNR, CNR and Noise among the three groups (P > 0.05). The patient radiation dose results showed that the effective radiation dose ED of RES-SPIRA scan was (9.22 ± 1.33) mSv. The dose of SEQ was (2.88 ± 2.47) mSv, and the dose of TurboFlash was (0.51 ± 0.16) mSv. There was significant difference in comparison of the three groups (P 0.05). RES-spiral scanning had the highest radiation dose and TurboFlash coarse pitch scanning (TurboFlash) had the lowest radiation dose. Conclusion: TurboFlash coarse pitch scanning is low in dosage, fast in speed and wide in adaptability. It is especially suitable for the elderly, children, coma and other patients who cannot cooperate with breath-holding examination, as well as for the screening and examination of coronary artery diseases in asymptomatic population. Undoubtedly, it is a worthy method of heart coronary artery examination.展开更多
Purpose: To explore the significance of dual-source computed tomography (DECT) virtual monoenergetic reconstructions technology in improving the imaging quality of esophageal cancer patients. Materials and methods: 68...Purpose: To explore the significance of dual-source computed tomography (DECT) virtual monoenergetic reconstructions technology in improving the imaging quality of esophageal cancer patients. Materials and methods: 68 patients with clinically suspected esophageal cancer (all confirmed by pathology) were collected. Routine plain scan was performed with SIEMENS Force dual-energy CT and then dual-phase scans were performed. The venous phase images were respectively subjected to traditional virtual monoenergetic reconstructions (Mono_E) and new generation virtual monoenergetic reconstructions (Mono+). Mono_E 55 keV and Mono+ 55 keV virtual single-energy images were obtained respectively. The signal-to-noise ratio (SNR) of normal esophageal tissue and esophageal cancer lesions, noise and contrast noise ratio (CNR tumor) of normal esophageal tissue and esophageal cancer lesions were compared among 100 kV images, Mono_E images and Mono+ images. At the same time, two imaging physicians read the films and scored the images of each group by using a 5-point scoring method. Results: Mono+ 55 keV images, SNR, SNRtumor, noise and CNRtumor were statistically different from those of 100 kV images and Mono_E images (P < 0.05). And Mono+ 55 keV images also had the highest subjective score, with statistical significance (P 55 keV images had the best quality. Conclusion: The new generation of virtual monoenergetic reconstructions post-processing (Mono+) could reduce image noise and improve the contrast between esophageal cancer lesions and normal esophageal tissues, which was of great significance to improve the imaging quality of esophageal cancer patients and improve the early detection rate of esophageal cancer.展开更多
AIM:To assess neovascularization within human ca-rotid atherosclerotic soft plaques in patients with isch-emic stroke.METHODS:Eighty-one patients with ischemic stroke and 95 patients without stroke who had soft athero...AIM:To assess neovascularization within human ca-rotid atherosclerotic soft plaques in patients with isch-emic stroke.METHODS:Eighty-one patients with ischemic stroke and 95 patients without stroke who had soft athero-sclerotic plaques in the internal carotid artery were studied.The thickest soft plaque in each patient was examined using contrast-enhanced ultrasound.Time-intensity curves were collected from 5 s to 3 min after contrast injection.The neovascularization within the plaques in the internal carotid artery was evaluated using the ACQ software built into the scanner by 2 of the experienced investigators who were blinded to the clinical history of the patients.RESULTS:Ischemic stroke was present in 7 of 33 patients(21%) with grade Ⅰ plaque,in 14 of 51 pa-tients(28%) with grade Ⅱ plaque,in 26 of 43 patients(61%) with grade Ⅲ plaque,and in 34 of 49 patients(69%) with grade Ⅳ plaque(P < 0.001 comparing grade Ⅳ plaque with grade I plaque and with grade Ⅱ plaque and P = 0.001 comparing grade Ⅲ plaque with grade Ⅰ plaque and with grade Ⅱ plaque).Analysis of the time intensity curves revealed that patients with ischemic stroke had a significantly higher intensity of enhancement(IE) than those without ischemic stroke(P < 0.01).The wash-in time(WT) of plaque was signifi-cantly shorter in stroke patients(P < 0.05).The sensi-tivity and specificity for IE in the plaque were 82% and 80%,respectively,and for WT were 68% and 74%,respectively.There was no significant difference in the peak intensity or time to peak between the 2 groups.CONCLUSION:This study shows that the higher the grade of plaque enhancement,the higher the risk of ischemic stroke.The data suggest that the presence of neovascularization is a marker for unstable plaque.展开更多
Since the efficiency of treatment of thyroid disorder depends on the risk of malignancy, indeterminate follicular neoplasm (FN) images should be classified. The diagnosis process has been done by visual interpretation...Since the efficiency of treatment of thyroid disorder depends on the risk of malignancy, indeterminate follicular neoplasm (FN) images should be classified. The diagnosis process has been done by visual interpretation of experienced pathologists. However, it is difficult to separate the favor benign from borderline types. Thus, this paper presents a classification approach based on 3D nuclei model to classify favor benign and borderline types of follicular thyroid adenoma (FTA) in cytological specimens. The proposed method utilized 3D gray level co-occurrence matrix (GLCM) and random forest classifier. It was applied to 22 data sets of FN images. Furthermore, the use of 3D GLCM was compared with 2D GLCM to evaluate the classification results. From experimental results, the proposed system achieved 95.45% of the classification. The use of 3D GLCM was better than 2D GLCM according to the accuracy of classification. Consequently, the proposed method probably helps a pathologist as a prescreening tool.展开更多
Objective: To explore the significance of dual-energy CT non-linear fusion technique in improving the quality of CTA image of renal cancer. Methods: The CTA images of 100 patients who had been confirmed by pathology a...Objective: To explore the significance of dual-energy CT non-linear fusion technique in improving the quality of CTA image of renal cancer. Methods: The CTA images of 100 patients who had been confirmed by pathology as renal cancer were collected and were randomly divided into experimental group and control group with 50 cases respectively. The two groups of patients were treated with iodine concentration of 300 mg/ml and 350 mg/ml non-ionic contrast agent, with a dosage of 1.5 ml/kg and an injection rate of 4 ml/s. The contrast agent intelligently tracking method was adopted bolus. The control group used the conventional CTA scanning, with a reference tube voltage/tube current of 100 kv/ref150 mas. The experimental group adopted the double energy scanning, with ball tube A and ball tube B. The reference tube voltage/tube current was 100 kv/ref250 mas and sn150 kv/ref125 mas respectively. The images of the experimental group were non-linear fused to obtain the Mono+ 55 kev single-energy images. The CT value, SNR contrast ratio of the abdominal aorta, renal artery and tumor tissue of the experimental group images and the 100 KV images and the Mono+ 55 kev images of the control group were compared. The objective evaluation and subjective evaluation of the image quality of the three groups of images was performed. Results: The results showed that the 100 kV images of the experimental group were statistically different from those of the control group (P05) in CT value, SNR and CNR (P 0.05). And there was no statistically significant difference between the non-linear fusion single-energy Mono+ 55 kev images and the control group images in CT value, SNR and CNR (P > 0.05). The subjective evaluation of image quality showed that there was no significant difference between Mono+ 55 kev images and control group images, and the quality of Mono+ 55 kev images was higher than that of experimental group 100 kV images. Conclusion: The dual-energy CT non-linear fusion technique can improve the quality of CTA image in patients with renal cancer, and it is possible to obtain high quality CTA images with low iodine concentration contrast agent.展开更多
Purpose: To explore the significance of dual-source computed tomography (DECT) virtual monoenergetic reconstructions technology in improving image quality for portal vein system of pancreatic cancer patients. Material...Purpose: To explore the significance of dual-source computed tomography (DECT) virtual monoenergetic reconstructions technology in improving image quality for portal vein system of pancreatic cancer patients. Materials and methods: 47 patients with clinically suspected pancreatic cancer (all confirmed by pathology) were collected. Routine plain scan was performed with Siemens Force dual-source dual-energy CT followed by 3 scans respectively carried out in arterial phase, portal phase and delayed phase. Traditional virtual monoenergetic reconstructions (Mono_E) and new generation of virtual monoenergetic reconstructions (Mono+) were respectively performed on portal vein images to obtain virtual single energy images including Mono_ E70 keV, Mono_E 55 keV and Mono+ 70 keV and Mono+ 55 keV. The signal-to-noise ratio (SNR) and noise of portal vein, normal pancreatic tissues and pancreatic lesions of 100 kV, Mono_E and Mono+ images were compared. In addition, the contrast noise ratio of portal vein and lesions as well as pancreatic tissues and lesions (CNR PV, CNRtumor) were also compared. At the same time, two imaging physicians with rich clinical experiences read the films and scored the images of each group by using the 5-point scoring method. Results: Mono+ 55 keV images including SNRpv, SNRpanc, SNRtumor, Noise, CNRpv, CNRtumor were statistically different from 100 KV images and Mono_E images (P < 0.05). As for the subjective score, Mono+ 55 keV image score also had the highest score, which had statistical significance (P < 0.05). The results showed that Mono+ 55 keV images had the best quality. Conclusion: The new generation of virtual Mono+ post-treatment can reduce image noise. Low energy Mono+ images can improve the contrast between pancreatic cancer lesions and portal of pancreatic cancer patients.展开更多
Improving the danger prediction during driving can significantly reduce the risk of accidents.However,previous danger prediction training systems had not been sufficiently effective owing to the lack of realism.In thi...Improving the danger prediction during driving can significantly reduce the risk of accidents.However,previous danger prediction training systems had not been sufficiently effective owing to the lack of realism.In this study,we propose an immersive training system for danger prediction training using virtual reality(VR)technology.This system provides drivers with a highly realistic training environment with 360°videos viewed with VR goggles.Users can practice various dangerous scenarios in an environment that simulates a real-driving situation.In addition,we introduced a system to select dangerous spots with a controller and implement training schemes on a voluntary basis.This setup enables them to train in a highly interactive state.In addition,we proposed a method to express multiple indices numerically so that users can understand the training effect.We tested the effect of the system on the danger prediction abilities of various users with two experiments by using this approach.These results show that our system was more effective in improving the driver’s danger prediction ability than previous systems.展开更多
A 65-year-old female patient was brought to our emergency department (ED) with alleged history of road traffic collision (RTC). The patient had respiratory distress on arrival and hence she was immediately intubated a...A 65-year-old female patient was brought to our emergency department (ED) with alleged history of road traffic collision (RTC). The patient had respiratory distress on arrival and hence she was immediately intubated and ventilated. Blood pressure and peripheral pulses were not measurable;however the central pulses were present. Aggressive fluid resuscitation was started. Primary assessment revealed distended neck veins, bony crepitus over right chest. Bedside plain chest radiograph and focused assessment with sonograph in trauma (FAST) were done which did not establish an immediate diagnosis. Computed tomography (CT) of the thorax revealed a tension pneumopericardium and moderate right hemopneumothorax, with multiple ribs fracture. An intercostal drainage tube (ICD) was inserted on right chest. The patient suffered a cardiac arrest and resuscitation measures were unsuccessful. The diagnostic pitfalls, the CT findings, possible clues to the diagnosis and the discussion of this rare case are presented in this case report.展开更多
Severe acute pancreatitis is commonly associated with pancreatic and extrapancreatic necrosis(EPN).Progressive EPN leading to necrotizing fasciitis of the retroperitoneum and abdominal wall has been reported.However,e...Severe acute pancreatitis is commonly associated with pancreatic and extrapancreatic necrosis(EPN).Progressive EPN leading to necrotizing fasciitis of the retroperitoneum and abdominal wall has been reported.However,extension of retroperitoneal necrosis to the scrotum causing Fournier’s gangrene is uncommon.We present a case of 39-year-old male admitted with severe acute pancreatitis requiring prolonged mechanical ventilation.He was managed with percutaneous drainage and culture specific antibiotics during the 1st month of hospital stay.During the 3rd month of hospital stay,the patient started developing pain and ulceration over the scrotum.He was diagnosed with Fournier’s gangrene based on clinical examination and was planned for debridement.During surgery,the track extending up to the deep inguinal ring was widened and drain was placed into the right lateral pelvic wall through the deep ring via a separate stab incision to reduce further scrotal wound contamination.The case highlights a rare but potentially fatal complication of Fournier’s gangrene following severe acute necrotizing pancreatitis and the importance of measures to prevent further contamination of scrotum after surgical debridement.Concomitant management of two potentially fatal conditions poses numerous challenges.展开更多
The report explores a unique and treatable“butterfly”-glioma mimic and the neuroimaging characteristics that help to diagnose this entity.A 35-year-old patient presented with subacute-onset,progressive frontal lobe ...The report explores a unique and treatable“butterfly”-glioma mimic and the neuroimaging characteristics that help to diagnose this entity.A 35-year-old patient presented with subacute-onset,progressive frontal lobe dysfunction followed by features of raised intracranial pressure.Neuroimaging features were consistent with a“butterfly”lesion that favored the possibility of a gliomatosis cerebri with significant edema and marked corpus callosum and fornix thickening.Contrast-enhanced and perfusion images revealed a confluent tumefactive lesion with a characteristic“broken-ring”pattern of enhancement,mass-effect and low perfusion;features favoring an alternative inflammatory pathology.This was peculiar as calloso-forniceal involvement of this nature has not been previously reported in inflammatory demyelinating mass lesions.This was confirmed as a tumefactive demyelination on histopathology.Following treatment,on clinical and imaging follow-up,significant resolution was evident suggesting a monophasic illness.This case highlights the stringent clinico-radiological-pathological approach required in the evaluation and management of butterfly lesions despite the striking imaging appearances.Tumefactive demyelination in this patient represents a clinically isolated syndromic presentation of an inflammatory pathology that can resemble gliomatosis cerebri.These“butterfly”-glioma mimics are scarcely reported in the literature,are eminently treatable with variable prognosis and prone for relapse.展开更多
文摘Objective: To compare and analyze the image quality and radiation dose of three scanning modes of dual-source CT coronary artery retrospectively, and to discuss the application value of TurboFlash coarse pitch scanning mode. Methods: The imaging data of 100 patients who underwent CT coronary angiography (CCTA) using Siemens force CT retrospective gated triggering spiral scan (RES-SPIRAL), adaptive prospective gated triggering sequence scan (SEQ) and prospective coarse pitch scan (TurboFlash) retrospectively was collected. The image quality was evaluated by objective and subjective methods. The effective radiation dose of patients was compared and analyzed, and the indications of the three scanning modes were analyzed. The application value of dual-source CT TurboFlash coarse pitch scanning in coronary artery imaging was evaluated. Results: The results showed that the left main coronary artery, the right coronary artery and their tertiary branches could be clearly displayed in the three groups of images: the left anterior descending branch, the left circumflex branch, and their three-level branches. There was no statistical difference in subjective image quality among the three groups of pictures (P > 0.05). There was no statistical difference in objective evaluation indexes, such as CT value, SNR, CNR and Noise among the three groups (P > 0.05). The patient radiation dose results showed that the effective radiation dose ED of RES-SPIRA scan was (9.22 ± 1.33) mSv. The dose of SEQ was (2.88 ± 2.47) mSv, and the dose of TurboFlash was (0.51 ± 0.16) mSv. There was significant difference in comparison of the three groups (P 0.05). RES-spiral scanning had the highest radiation dose and TurboFlash coarse pitch scanning (TurboFlash) had the lowest radiation dose. Conclusion: TurboFlash coarse pitch scanning is low in dosage, fast in speed and wide in adaptability. It is especially suitable for the elderly, children, coma and other patients who cannot cooperate with breath-holding examination, as well as for the screening and examination of coronary artery diseases in asymptomatic population. Undoubtedly, it is a worthy method of heart coronary artery examination.
文摘Purpose: To explore the significance of dual-source computed tomography (DECT) virtual monoenergetic reconstructions technology in improving the imaging quality of esophageal cancer patients. Materials and methods: 68 patients with clinically suspected esophageal cancer (all confirmed by pathology) were collected. Routine plain scan was performed with SIEMENS Force dual-energy CT and then dual-phase scans were performed. The venous phase images were respectively subjected to traditional virtual monoenergetic reconstructions (Mono_E) and new generation virtual monoenergetic reconstructions (Mono+). Mono_E 55 keV and Mono+ 55 keV virtual single-energy images were obtained respectively. The signal-to-noise ratio (SNR) of normal esophageal tissue and esophageal cancer lesions, noise and contrast noise ratio (CNR tumor) of normal esophageal tissue and esophageal cancer lesions were compared among 100 kV images, Mono_E images and Mono+ images. At the same time, two imaging physicians read the films and scored the images of each group by using a 5-point scoring method. Results: Mono+ 55 keV images, SNR, SNRtumor, noise and CNRtumor were statistically different from those of 100 kV images and Mono_E images (P < 0.05). And Mono+ 55 keV images also had the highest subjective score, with statistical significance (P 55 keV images had the best quality. Conclusion: The new generation of virtual monoenergetic reconstructions post-processing (Mono+) could reduce image noise and improve the contrast between esophageal cancer lesions and normal esophageal tissues, which was of great significance to improve the imaging quality of esophageal cancer patients and improve the early detection rate of esophageal cancer.
基金Supported by The Science and Technology Department of Zhejiang Province,No.2008C33012Zhejiang Nature Science Foundation,No.Y2080718
文摘AIM:To assess neovascularization within human ca-rotid atherosclerotic soft plaques in patients with isch-emic stroke.METHODS:Eighty-one patients with ischemic stroke and 95 patients without stroke who had soft athero-sclerotic plaques in the internal carotid artery were studied.The thickest soft plaque in each patient was examined using contrast-enhanced ultrasound.Time-intensity curves were collected from 5 s to 3 min after contrast injection.The neovascularization within the plaques in the internal carotid artery was evaluated using the ACQ software built into the scanner by 2 of the experienced investigators who were blinded to the clinical history of the patients.RESULTS:Ischemic stroke was present in 7 of 33 patients(21%) with grade Ⅰ plaque,in 14 of 51 pa-tients(28%) with grade Ⅱ plaque,in 26 of 43 patients(61%) with grade Ⅲ plaque,and in 34 of 49 patients(69%) with grade Ⅳ plaque(P < 0.001 comparing grade Ⅳ plaque with grade I plaque and with grade Ⅱ plaque and P = 0.001 comparing grade Ⅲ plaque with grade Ⅰ plaque and with grade Ⅱ plaque).Analysis of the time intensity curves revealed that patients with ischemic stroke had a significantly higher intensity of enhancement(IE) than those without ischemic stroke(P < 0.01).The wash-in time(WT) of plaque was signifi-cantly shorter in stroke patients(P < 0.05).The sensi-tivity and specificity for IE in the plaque were 82% and 80%,respectively,and for WT were 68% and 74%,respectively.There was no significant difference in the peak intensity or time to peak between the 2 groups.CONCLUSION:This study shows that the higher the grade of plaque enhancement,the higher the risk of ischemic stroke.The data suggest that the presence of neovascularization is a marker for unstable plaque.
基金the United Kingdom Department of Health, British Medical Research Council, Grant No. G99000178 and the United Kingdom National Health Service Research and Development Initiative
文摘Since the efficiency of treatment of thyroid disorder depends on the risk of malignancy, indeterminate follicular neoplasm (FN) images should be classified. The diagnosis process has been done by visual interpretation of experienced pathologists. However, it is difficult to separate the favor benign from borderline types. Thus, this paper presents a classification approach based on 3D nuclei model to classify favor benign and borderline types of follicular thyroid adenoma (FTA) in cytological specimens. The proposed method utilized 3D gray level co-occurrence matrix (GLCM) and random forest classifier. It was applied to 22 data sets of FN images. Furthermore, the use of 3D GLCM was compared with 2D GLCM to evaluate the classification results. From experimental results, the proposed system achieved 95.45% of the classification. The use of 3D GLCM was better than 2D GLCM according to the accuracy of classification. Consequently, the proposed method probably helps a pathologist as a prescreening tool.
文摘Objective: To explore the significance of dual-energy CT non-linear fusion technique in improving the quality of CTA image of renal cancer. Methods: The CTA images of 100 patients who had been confirmed by pathology as renal cancer were collected and were randomly divided into experimental group and control group with 50 cases respectively. The two groups of patients were treated with iodine concentration of 300 mg/ml and 350 mg/ml non-ionic contrast agent, with a dosage of 1.5 ml/kg and an injection rate of 4 ml/s. The contrast agent intelligently tracking method was adopted bolus. The control group used the conventional CTA scanning, with a reference tube voltage/tube current of 100 kv/ref150 mas. The experimental group adopted the double energy scanning, with ball tube A and ball tube B. The reference tube voltage/tube current was 100 kv/ref250 mas and sn150 kv/ref125 mas respectively. The images of the experimental group were non-linear fused to obtain the Mono+ 55 kev single-energy images. The CT value, SNR contrast ratio of the abdominal aorta, renal artery and tumor tissue of the experimental group images and the 100 KV images and the Mono+ 55 kev images of the control group were compared. The objective evaluation and subjective evaluation of the image quality of the three groups of images was performed. Results: The results showed that the 100 kV images of the experimental group were statistically different from those of the control group (P05) in CT value, SNR and CNR (P 0.05). And there was no statistically significant difference between the non-linear fusion single-energy Mono+ 55 kev images and the control group images in CT value, SNR and CNR (P > 0.05). The subjective evaluation of image quality showed that there was no significant difference between Mono+ 55 kev images and control group images, and the quality of Mono+ 55 kev images was higher than that of experimental group 100 kV images. Conclusion: The dual-energy CT non-linear fusion technique can improve the quality of CTA image in patients with renal cancer, and it is possible to obtain high quality CTA images with low iodine concentration contrast agent.
文摘Purpose: To explore the significance of dual-source computed tomography (DECT) virtual monoenergetic reconstructions technology in improving image quality for portal vein system of pancreatic cancer patients. Materials and methods: 47 patients with clinically suspected pancreatic cancer (all confirmed by pathology) were collected. Routine plain scan was performed with Siemens Force dual-source dual-energy CT followed by 3 scans respectively carried out in arterial phase, portal phase and delayed phase. Traditional virtual monoenergetic reconstructions (Mono_E) and new generation of virtual monoenergetic reconstructions (Mono+) were respectively performed on portal vein images to obtain virtual single energy images including Mono_ E70 keV, Mono_E 55 keV and Mono+ 70 keV and Mono+ 55 keV. The signal-to-noise ratio (SNR) and noise of portal vein, normal pancreatic tissues and pancreatic lesions of 100 kV, Mono_E and Mono+ images were compared. In addition, the contrast noise ratio of portal vein and lesions as well as pancreatic tissues and lesions (CNR PV, CNRtumor) were also compared. At the same time, two imaging physicians with rich clinical experiences read the films and scored the images of each group by using the 5-point scoring method. Results: Mono+ 55 keV images including SNRpv, SNRpanc, SNRtumor, Noise, CNRpv, CNRtumor were statistically different from 100 KV images and Mono_E images (P < 0.05). As for the subjective score, Mono+ 55 keV image score also had the highest score, which had statistical significance (P < 0.05). The results showed that Mono+ 55 keV images had the best quality. Conclusion: The new generation of virtual Mono+ post-treatment can reduce image noise. Low energy Mono+ images can improve the contrast between pancreatic cancer lesions and portal of pancreatic cancer patients.
文摘Improving the danger prediction during driving can significantly reduce the risk of accidents.However,previous danger prediction training systems had not been sufficiently effective owing to the lack of realism.In this study,we propose an immersive training system for danger prediction training using virtual reality(VR)technology.This system provides drivers with a highly realistic training environment with 360°videos viewed with VR goggles.Users can practice various dangerous scenarios in an environment that simulates a real-driving situation.In addition,we introduced a system to select dangerous spots with a controller and implement training schemes on a voluntary basis.This setup enables them to train in a highly interactive state.In addition,we proposed a method to express multiple indices numerically so that users can understand the training effect.We tested the effect of the system on the danger prediction abilities of various users with two experiments by using this approach.These results show that our system was more effective in improving the driver’s danger prediction ability than previous systems.
文摘A 65-year-old female patient was brought to our emergency department (ED) with alleged history of road traffic collision (RTC). The patient had respiratory distress on arrival and hence she was immediately intubated and ventilated. Blood pressure and peripheral pulses were not measurable;however the central pulses were present. Aggressive fluid resuscitation was started. Primary assessment revealed distended neck veins, bony crepitus over right chest. Bedside plain chest radiograph and focused assessment with sonograph in trauma (FAST) were done which did not establish an immediate diagnosis. Computed tomography (CT) of the thorax revealed a tension pneumopericardium and moderate right hemopneumothorax, with multiple ribs fracture. An intercostal drainage tube (ICD) was inserted on right chest. The patient suffered a cardiac arrest and resuscitation measures were unsuccessful. The diagnostic pitfalls, the CT findings, possible clues to the diagnosis and the discussion of this rare case are presented in this case report.
文摘Severe acute pancreatitis is commonly associated with pancreatic and extrapancreatic necrosis(EPN).Progressive EPN leading to necrotizing fasciitis of the retroperitoneum and abdominal wall has been reported.However,extension of retroperitoneal necrosis to the scrotum causing Fournier’s gangrene is uncommon.We present a case of 39-year-old male admitted with severe acute pancreatitis requiring prolonged mechanical ventilation.He was managed with percutaneous drainage and culture specific antibiotics during the 1st month of hospital stay.During the 3rd month of hospital stay,the patient started developing pain and ulceration over the scrotum.He was diagnosed with Fournier’s gangrene based on clinical examination and was planned for debridement.During surgery,the track extending up to the deep inguinal ring was widened and drain was placed into the right lateral pelvic wall through the deep ring via a separate stab incision to reduce further scrotal wound contamination.The case highlights a rare but potentially fatal complication of Fournier’s gangrene following severe acute necrotizing pancreatitis and the importance of measures to prevent further contamination of scrotum after surgical debridement.Concomitant management of two potentially fatal conditions poses numerous challenges.
文摘The report explores a unique and treatable“butterfly”-glioma mimic and the neuroimaging characteristics that help to diagnose this entity.A 35-year-old patient presented with subacute-onset,progressive frontal lobe dysfunction followed by features of raised intracranial pressure.Neuroimaging features were consistent with a“butterfly”lesion that favored the possibility of a gliomatosis cerebri with significant edema and marked corpus callosum and fornix thickening.Contrast-enhanced and perfusion images revealed a confluent tumefactive lesion with a characteristic“broken-ring”pattern of enhancement,mass-effect and low perfusion;features favoring an alternative inflammatory pathology.This was peculiar as calloso-forniceal involvement of this nature has not been previously reported in inflammatory demyelinating mass lesions.This was confirmed as a tumefactive demyelination on histopathology.Following treatment,on clinical and imaging follow-up,significant resolution was evident suggesting a monophasic illness.This case highlights the stringent clinico-radiological-pathological approach required in the evaluation and management of butterfly lesions despite the striking imaging appearances.Tumefactive demyelination in this patient represents a clinically isolated syndromic presentation of an inflammatory pathology that can resemble gliomatosis cerebri.These“butterfly”-glioma mimics are scarcely reported in the literature,are eminently treatable with variable prognosis and prone for relapse.