Clinical engineering(CE) has evolved rapidly over the last 25 years in China. Among the 34 provincial-level administrative units within China, the Zhejiang Province is one of the most advanced in terms of healthcare t...Clinical engineering(CE) has evolved rapidly over the last 25 years in China. Among the 34 provincial-level administrative units within China, the Zhejiang Province is one of the most advanced in terms of healthcare technology maintenance and management. In order to determine Zhejiang's current stage of development and opportunities for further improvement, a comparison of the performance of its CE departments was made against hospitals in the USA. Data were collected from 21 Zhejiang hospitals and compared to those from 270 acute-care hospitals in USA collected by Truven Health Analytics. The benchmarking comparison was made in three categories: operational, financial, and productivity. Within the operational category, the following metrics were compared: equipment inventory size/operating beds, annual repairs/inventory size, and annual scheduled maintenance/inventory size. Within the Financial category, the following metrics were compared: total CE expense/operating beds and total CE expense/total hospital expense. Within the Productivity category, the following metrics were compared: total CE full-time equivalent(FTE)/inventory size and total CE FTE/total hospital expense. These comparisons showed that:(1) While the equipment inventory in Zhejiang tends to be much smaller than USA for hospitals of comparable amount of operating beds, the numbers of repairs and scheduled maintenance per inventory size are similar;(2) The total CE expense/total hospital expense ratio is around 1% in both Zhejiang and USA; however, the total CE expense/operating beds and total CE expense/cost of equipment inventory are significantly lower in Zhejiang than USA;(3) The FTE amount in Zhejiang is significantly higher than in USA relative to both inventory size and total hospital operating expense, but significantly lower relative to the number of operating beds. The fact that repairs and scheduled maintenance are similar in Zhejiang and USA shows that CE leaders are managing equipment in comparable manner. Most of the differences found in the comparisons were traced to a few factors. First, the average length of stay in China is substantially higher than USA, which explains why hospitals in Zhejiang tend to have more operating beds but fewer pieces of equipment. Second, labor cost is significantly lower in China than USA, thus allowing Zhejiang hospitals to employ more workers than their American counterparts. Third, there is significantly difference in the cost of living between China and USA; Finally, being public entities Chinese hospitals are managed and operated in a different manner than American hospitals, which are mostly private, albeit nonprofit organizations. Nonetheless, it is interesting to note that hospitals in both areas spend roughly 1% of their total expenditure for CE. The results suggest that CE in Zhejiang is comparable to USA in terms of managerial excellence but there could be some room for improvement in financial management and productivity.展开更多
Japanese clinical engineer(CE) is a significant and unique profession compared with other nations with its dual clinical and technology focus and national licensing. The CE system of licensing was established in May 1...Japanese clinical engineer(CE) is a significant and unique profession compared with other nations with its dual clinical and technology focus and national licensing. The CE system of licensing was established in May 1987 under the Clinical Engineers Act. CEs are required to complete 3 to 4 years in designated schools and pass a national examination. It is a professional medical position responsible for the operation and maintenance of life-support and non-life-support medical device systems under the direction of physicians. Currently approximately 70 educational institutes- including technical colleges and universities- provide diverse and wide-ranging curricula from engineering to various clinical disciplines to produce CEs. Since clinical practice training is mandatory as a part of institute work, an important approach for CEs is gained by working in hospitals. The comprehensive curricula and the licensing system in Japan together serve to keep the appropriate quantity and quality of CEs. The Japan Association for Clinical Engineers(JACE) was established in February 1990; one of its aims is to support improvement of CEs throughout their careers through various lectures, seminars, on-the-job trainings, workshops, and an annual member meeting. New CEs can now take advantage of video e-learning. For junior CEs, there are seminars for hyperbaric oxygen therapy, blood purification, heart-lung bypass, respiratory therapy, operating room, intensive care unit, arrhythmia and aphaeresis related devices, as well as healthcare technology management(HTM). Also, the institutes provide a leadership seminar alongside this clinical practice training. Besides the licensing process, a proper certification system for CEs is a critical element in the clinical field. This enhances the ability of CEs to engage in more extensive duties and develop specialties, as well as to provide better healthcare. Associated societies provide certification with technology qualifications in dialysis, extracorporeal circulation, respiratory therapy, clinical medical devices, hyperbaric oxygen therapy, and aphaeresis treatment. JACE also launched a unique certification system in 2010, with specializations in blood purification, arrhythmia, respiratory, and hyperbaric oxygen care. What is the difference between certification by the associated societies and that offered by JACE? Certification by the associated societies provides basic knowledge to pass specialty examinations. Certifications by JACE promote deeper knowledge to enhance clinical decisionmaking and to encourage wider experience. JACE also continues to investigate other certifications. In summary, Japan has introduced a national licensing system for keeping an intake of constant quality and quantity of CEs. Additionally, ongoing workshops and seminars stimulate in-depth knowledge and a higher level of medical care for patients. Together, a system of lifelong education for CEs has been built.展开更多
Objective: Medical equipment safety in clinical use has been an increasingly concerned issue in China. This paper aims to design and implement a web-based medical equipment maintenance system to be used at clinical en...Objective: Medical equipment safety in clinical use has been an increasingly concerned issue in China. This paper aims to design and implement a web-based medical equipment maintenance system to be used at clinical engineering department, orienting to the improvement of quality and efficiency of technology service so as to meet the 2010 regulations homologated with China's Ministry of Health. Methods: The system adopted three-layer structure based on B/S mode with oracle database and ASP.NET development technologies. Based on risk management and inclusion criteria for maintenance, the software system modules consist of hospital equipment inventory management, personnel information management, breakdown maintenance, preventive maintenance(PM) and analysis graphical representations.Results: An user friendly web interface was provided for easy and secure access to the system. Medical equipment management activities from log-in to acceptance test to maintenance services were implemented. Conclusion: The application of this system has achieved benefits for the risk management of medical equipment.展开更多
AIM:To predict the post-operative vault and the suitable size of the implantable collamer lens(ICL)by comparing the performance of multiple artificial intelligence(AI)algorithms.METHODS:A retrospective analysis of 83 ...AIM:To predict the post-operative vault and the suitable size of the implantable collamer lens(ICL)by comparing the performance of multiple artificial intelligence(AI)algorithms.METHODS:A retrospective analysis of 83 patients with 132 eyes was conducted from 2020 to 2023.All patients underwent implantation of EVO-V4C ICLs.ICLs were selected based on STAAR’s recommended formula.Postoperative vault values were measured using anterior segment optical coherence tomography(ASOCT).First,feature selection was performed on patients’preoperative examination parameters to identify those most closely related to postoperative vault and incorporate them into the machine learning model.Subsequently,four regression models,namely MLP,XGBoost,RFR,and KNN,were employed to predict the vault,and their predictive performances were compared.The ICL size was set as the prediction target,with the vault and other input features serving as new inputs for predicting the ICL size.RESULTS:Among all preoperative parameters,16 parameters were most closely related to postoperative vault and were included in the prediction model.In vault prediction,XGBoost performed the best in the regression model(R^(2)=0.9999),followed by MLP(R^(2)=0.9987)and RFR(R^(2)=0.8982),while the KNN model had the lowest predictive performance(R^(2)=0.3852).XGBoost achieved a prediction accuracy of 99.8%,MLP had a prediction accuracy of 98.9%,while RFR and KNN had accuracies of 87.1%and 57.4%,respectively.CONCLUSION:AI effectively predicts postoperative vault and determines ICL size.XGBoost outperforms other machine-learning algorithms tested.Its accurate predictions help ophthalmologists choose the right ICL size,ensuring proper vaulting.展开更多
Background: Provoked spasm might have influence on cardiovascular events even after successful DES implantation. Methods and results: A consecutive 122 patients who underwent first-generation DES (CypherTM, and TaxusT...Background: Provoked spasm might have influence on cardiovascular events even after successful DES implantation. Methods and results: A consecutive 122 patients who underwent first-generation DES (CypherTM, and TaxusTM) implantation and had no residual stenosis at follow-up coronary angiography were included. All patients also underwent acetylcholine provocation test (ACh) at follow-up angiography. Age, sex, coronary risk factors (smoking, hypertension, diabetes mellitus, dyslipidemia), medication (calcium channel blockers, angiotensin receptor blockers, angiotensin converting enzyme inhibitors, nitrates, β blockers, statins), duration from stent implantation to follow-up angiography (15.5 ± 14.5 months), old myocardial infarction, Ach + were included as variables for multivariate analysis for cardiovascular events (angina pectoris without intervention, target lesion revascularization, acute myocardial infarction, definite or probable stent thrombosis, cardiac death, and stroke). ACh provocation test was positive in 64.8%. The following events occurred during a mean follow-up period of 26.9 ± 9.5 months;angina pectoris without intervention in 12, very late stent thrombosis in 1, acute myocardial infarction in 1, sudden death in 1, and stroke in 4. By Adjusted Cox hazard model, age was the independent predictor of future cardiovascular events. ACh was unbalanced data for Cox hazard model, and by logistic regression model, ACh was the strongest predictor. Conclusions: Coronary endothelial dysfunction at chronic stage is the strongest predictor of further prognosis in patients with first-generation DES.展开更多
The detection of biothiols such as cysteine(Cys),homocysteine(Hcy),and glutathione(GSH)are critical for understanding their roles in biology and their involvement in various physiological and pathological processes.Re...The detection of biothiols such as cysteine(Cys),homocysteine(Hcy),and glutathione(GSH)are critical for understanding their roles in biology and their involvement in various physiological and pathological processes.Recently,significant progress has been made in constructing fluorescent probes capable of detecting and visualizing biothiols.This review provides an in-depth look at the latest advancements in simultaneous and selective molecular probes,focusing on developments over the last 5 years.We examine design techniques,sensing mechanisms,and imaging methods to assess their effectiveness and responsiveness to thiols.Additionally,we discuss the prevailing challenges and offer recommendations to address them.展开更多
Despite its role in disease there is still no definitive method to assess oesophago-gastric junction competence （OGJ）. Traditionally the OGJ has been assessed using manometry with lower oesophageal sphincter pressur...Despite its role in disease there is still no definitive method to assess oesophago-gastric junction competence （OGJ）. Traditionally the OGJ has been assessed using manometry with lower oesophageal sphincter pressure as the indicator. More recently this has been shown not to be a very reliable marker of sphincter function and competence against reflux. Disorders such as gastro-oesophageal reflux disease and to a lesser extend achalasia still effects a significant number of patients. This review looks at using a new technique known as impedance planimetry to profile the geometry and pressure in the OGJ during distension of a bag. The data gathered can be reconstructed into a dynamic representation of OGJ action. This has been shown to provide a useful representation of the OGJ and to show changes to the competence of the OGJ in terms of compliance and distensibility as a result of endoluminal therapy.展开更多
Recently,organ-on-chips have become a fast-growing research field with the widespread development of microfluidic chips and synthetic materials in tissue engineering.Due to the existing cardiotoxicity of many cardiova...Recently,organ-on-chips have become a fast-growing research field with the widespread development of microfluidic chips and synthetic materials in tissue engineering.Due to the existing cardiotoxicity of many cardiovascular drugs,heart-onchips which are promising to replace traditional animal models have been extensively researched and developed to mimic human organ functions in vitro.The heart-on-chips mainly focus on cardiac mechanics,which is regarded as the central indicator of in vitro heart models and drug testing.Traditional methods for the detection of myocardial mechanics have been demonstrated complex and inefficient in heart-on-chips.Therefore,photonic crystal materials with unique optical properties have attracted interests and have been introduced into the heart-on-chips,developing a visualized self-reporting system for cardiomyocytes activity monitoring.In this review,photonic crystal-based heart-on-chips for biosensing are introduced,as well as the fabricationmethods and design criteria of them.The characterizations of the photonic crystal materials are classified into optical properties and structural properties,and their applications in cell culture and biosensing are further discussed.Then,several representative examples and developments of the integration of photonic crystal materials into microfluidic chips are described in detail.Finally,potentials and limitations are put forward to promote the development of the photonic crystal-based intelligent heart-on-chips.展开更多
Whilst methods exist to indirectly measure the effects of increased flow or gastro-oesophageal refluxing, they cannot quantitatively measure the amount of acid travelling back up into the oesophagus during reflux, nor...Whilst methods exist to indirectly measure the effects of increased flow or gastro-oesophageal refluxing, they cannot quantitatively measure the amount of acid travelling back up into the oesophagus during reflux, nor can they indicate the flow rate through the oesophagogastric junction (OGJ). Since OGJ dysfunction affects flow it seems most appropriate to describe the geometry of the OGJ and its effect on the flow. A device known as the functional lumen imaging probe (FLIP) has been shown to reliably measure the geometry of and pressure changes in the OGJ. FLIP cannot directly measure flow but the data gathered from the probe can be used to model flow through the junction by using computational flow dynamics (CFD). CFD uses a set of equations known as the Navier-Stokes equations to predict flow patterns and is a technique widely used in engineering. These equations are complex and require appropriate assumptions to provide simplifications before useful data can be obtained. With the assumption that the cross-sectional areas obtained via FLIP are circular, the radii of these circles can be obtained. A cubic interpolation scheme can then be applied to give a high-resolution geometry for the OGJ. In the case of modelling a reflux scenario, it can be seen that at the narrowest section a jet of fluid squirts into the oesophagus at a higher velocity than the fluid surrounding it. This jet has a maximum velocity of almost 2 ms-1 that occurs where the OGJ is at its narrowest. This simple prediction of acid ‘squirting’ into the oesophagusillustrates how the use of numerical methods can be used to develop a better understanding of the OGJ. This initial work using CFD shows some considerable promise for the future.展开更多
Recent advances in artificial intelligence(AI)have sparked a surge in the application of computer vision(CV)in surgical video analysis.Laparoscopic surgery produces a large number of surgical videos,which provides a n...Recent advances in artificial intelligence(AI)have sparked a surge in the application of computer vision(CV)in surgical video analysis.Laparoscopic surgery produces a large number of surgical videos,which provides a new opportunity for improving of CV technology in laparoscopic surgery.AI-based CV techniques may leverage these surgical video data to develop real-time automated decision support tools and surgeon training systems,which shows a new direction in dealing with the shortcomings of laparoscopic surgery.The effectiveness of CV applications in surgical procedures is still under early evaluation,so it is necessary to discuss challenges and obstacles.The review introduced the commonly used deep learning algorithms in CV and described their usage in detail in four application scenes,including phase recognition,anatomy detection,instrument detection and action recognition in laparoscopic surgery.The currently described applications of CV in laparoscopic surgery are limited.Most of the current research focuses on the identification of workflow and anatomical structure,while the identification of instruments and surgical actions is still awaiting further breakthroughs.Future research on the use of CV in laparoscopic surgery should focus on applications in more scenarios,such as surgeon skill assessment and the development of more efficient models.展开更多
Circadian rhythms are daily oscillations of multiple biological processes. Recently, relationships between circadian rhythms and immune functions have also been described. In a mouse sepsis model, the death rate due t...Circadian rhythms are daily oscillations of multiple biological processes. Recently, relationships between circadian rhythms and immune functions have also been described. In a mouse sepsis model, the death rate due to lipopolysaccharide (LPS)-induced endotoxic shock was found to be dependent on LPS administration as determined by circadian time. In humans, a pronounced inflammatory response to endotoxemia differs depending on whether it is daytime or night-time: Levels of tumor necrosis factor-alpha and interleukin-6 were higher during the night. Therefore, it is reasonable to assume that circadian rhythms influence not only organ dysfunction and the prognosis induced by LPS, but also the therapeutic effect of anti-LPS therapy such as Polymyxin-B direct hemoperfusion. We herein postulate the concept that it is important to discuss septic shock treatment in terms of whether or not the treatment is adjusted for the optimal time window as determined by circadian rhythms.展开更多
The role of the oesophago-gastric junction (OGJ) in gastro-oesophageal reflux disease is still not completely understood, and there is no clinically used method to assess the OGJ function in patients. Only indirect me...The role of the oesophago-gastric junction (OGJ) in gastro-oesophageal reflux disease is still not completely understood, and there is no clinically used method to assess the OGJ function in patients. Only indirect methods such as pH studies are carried out. The OGJ acts a valve controlling the flow of solids, liquids and gases between the oesophagus and the stomach. Manometry can determine if a sphincter is toned or relaxed; but, it cannot confirm that the sphincter region is actually open. Distension is a new technique for measuring function in the OGJ. By measuring the cross-sectional area through the narrow region in the junction during distension of a catheter mounted bag, much more information on the opening and closing patterns of the junction can be determined. This technique has already been demonstrated to show changes in the OGJ after surgical treatments for reflux disease. New measurement ideas around the concept of distending the OGJ offer new hope that a clinically useable test for compliance at the junction can be developed and could potentially help in determining appropriate therapy.展开更多
Heart and skeletal muscle insulin resistance and abnormal myocardial flow reserve (MFR) occurs in patients with type-II diabetes. Improvement of heart and skeletal muscle insulin resistance with rosiglitazone use over...Heart and skeletal muscle insulin resistance and abnormal myocardial flow reserve (MFR) occurs in patients with type-II diabetes. Improvement of heart and skeletal muscle insulin resistance with rosiglitazone use over 16 weeks have been reported. However, it is not clear whether chronic use of troglitazone can improve heart and skeletal muscle insulin resistance and MFR. Materials and Methods: To test the hypothesis whether effects of troglitazone on heart and skeletal muscle insulin resistance and MFR in patients with type-II diabetes, rest and dipyridamole stress perfusion positron emission tomography (PET) with 13N-ammonia and heart and skeletal muscle 18FDG PET scans under insulin clamping were undertaken before and 12 month after the initiation of troglitazone therapy (400 mg/day) in 23 patients with type-II diabetes. Twenty patients with type-II diabetes without CAD and without medications were served as controls. In controls, any medications were not added from the first PET study and 12 months after the second PET study. Results: Baseline myocardial blood flow (MBF) was comparable before and after the troglitazone group as was the controls. MBF during dipyridamole administration (0.56 mg/min/kg) was not significantly improved in troglitazone group and controls. MFR was not improved in troglitazone group and controls. In troglitazone group, whole body glucose disposal rate (GDR;μmole/min/kg) significantly improved (pre;19.0 ± 9.55, post;28.7 ± 15.3, p as did the skeletal muscle glucose utilization rate (SMGU (μmole/min/kg);pre;20.3 ± 12.0, post;34.8 ± 10.6, p insulin resistance is implicated in patients with type-II diabetes and impaired MFR is uncoupled with insulin resistance in the whole body and heart and skeletal muscle in patients with type-II diabetes.展开更多
Augmented-and mixed-reality technologies have pioneered the realization of real-time fusion and interactive projection for laparoscopic surgeries.Indocyanine green fluorescence imaging technology has enabled anatomica...Augmented-and mixed-reality technologies have pioneered the realization of real-time fusion and interactive projection for laparoscopic surgeries.Indocyanine green fluorescence imaging technology has enabled anatomical,functional,and radical hepatectomy through tumor identification and localization of target hepatic segments,driving a transformative shift in themanagement of hepatic surgical diseases,moving away from traditional,empirical diagnostic and treatment approaches toward digital,intelligent ones.The Hepatic Surgery Group of the Surgery Branch of the Chinese Medical Association,Digital Medicine Branch of the Chinese Medical Association,Digital Intelligent Surgery Committee of the Chinese Society of ResearchHospitals,and Liver Cancer Committee of the Chinese Medical Doctor Association organized the relevant experts in China to formulate this consensus.This consensus provides a comprehensive outline of the principles,advantages,processes,and key considerations associated with the application of augmented reality and mixed-reality technology combined with indocyanine green fluorescence imaging technology for hepatic segmental and subsegmental resection.The purpose is to streamline and standardize the application of these technologies.展开更多
Continuous renal replacement therapy (CRRT) is the preferred dialysis modality in critical care settings for patients with hemodynamic instability. Nafamostat mesylate (NM) is an anticoagulant commonly used (mainly in...Continuous renal replacement therapy (CRRT) is the preferred dialysis modality in critical care settings for patients with hemodynamic instability. Nafamostat mesylate (NM) is an anticoagulant commonly used (mainly in Japan) during CRRT in patients with high bleeding risk. In this study, we evaluated the pharmacokinetics of NM during CRRT. Patients undergoing CRRT therapy and using NM as the anticoagulant in the intensive care unit were enrolled in the study. Blood was collected from the CRRT circuit just after blood removal, just before and after the membrane for CRRT, and from the filtrates after the membrane. NM concentrations were measured using high-performance liquid chromatography. NM was detected in the intracorporeal circulation during CRRT in some cases, and liver enzymes were severely elevated in almost all of the cases. Coagulation time was prolonged even before the initiation of NM administration in these cases and may be associated with liver damage. This study suggests that NM dosage should take into account liver damage assessed by elevated liver enzymes.展开更多
Appropriate heart rate in a failing pulmonary ventricle remains unknown, particularly in congenital heart diseasewith unique hemodynamics. A 71-year-old male with repaired tetralogy of Fallot and a pacemaker for a sin...Appropriate heart rate in a failing pulmonary ventricle remains unknown, particularly in congenital heart diseasewith unique hemodynamics. A 71-year-old male with repaired tetralogy of Fallot and a pacemaker for a sinusnode dysfunction suffered from heart failure symptoms with preserved left ventricular function. Simply changingthe pacemaker’s lower rate from 60 to 75 bpm, New York Heart Association classification improved from III to II,and hemodynamic parameters drastically improved. We regarded this case as informative. Appropriate heart ratecould be higher in congenital patients with failing right and non-failing left ventricles than in adults with malfunctioningLV.展开更多
Current output dose measurement in CT is based on (CTDI). The conventional methodology of CT dosimetric performance characterization is not appropriate to modern CT scanners with helical scanning modes, dose modulatio...Current output dose measurement in CT is based on (CTDI). The conventional methodology of CT dosimetric performance characterization is not appropriate to modern CT scanners with helical scanning modes, dose modulation, array detectors and multiple slice planes or cone-beam irradiation geometries. AAPM TG 111 report recognizes the shortfall of the CTDI methods and recommends a new technique that more accurately characterizes the dose profile from modern CT scanners, which utilizes a short conventional ion chamber rather than a pencil chamber. We developed and characterize a in-house phantom design using a three separate anatomical regions of clinical scan sequences (Head, chest and abdomen), and determined the equilibrium dose in our dose equilibrium phantom, measured if the attenuation of the beam is the equal to that of CTDI Perspex phantom and compare CTDI dose estimations using a standard pencil chamber to the dose equilibrium phantom measurements. This methodology allows measurements of the accumulated dose for any clinical scan length and allowing measurement of the equilibrium dose. Using the new methodology, we determined that the CTDI approach can underestimate the dose by 25% to 35% and all of our dose values from the water phantom and farmer chamber were independently verified with TLD measurements.展开更多
BACKGROUND High-flow nasal cannula(HFNC)therapy and morphine continuous subcutaneous infusion(CSI)have been used to ameliorate dyspnea in non-cancer patients with end-stage respiratory diseases,including chronic obstr...BACKGROUND High-flow nasal cannula(HFNC)therapy and morphine continuous subcutaneous infusion(CSI)have been used to ameliorate dyspnea in non-cancer patients with end-stage respiratory diseases,including chronic obstructive pulmonary disease and interstitial pneumonia,primarily in hospital settings.However,it is rare to perform home-based medical treatment using these.We observe a case to assess the feasibility of this treatment strategy.CASE SUMMARY Here,we report a case of a 75-year-old man who was diagnosed with interstitial pneumonia 11 years ago and was successfully nursed at home during his terminal phase for over 10 mo without hospitalization,by introducing domiciliary uses of HFNC and morphine CSI with a patient-controlled analgesia device.CONCLUSION Active utilization of HFNC and morphine CSI with patient-controlled analgesia device would substantiate successful end-of-life palliative home care of idiopathic interstitial pneumonia patients.展开更多
Insulin resistance is associated with several coronary risk factors and is thought to play a critical role for the development of coronary artery disease. Insulin resistance has several causes, including an impaired s...Insulin resistance is associated with several coronary risk factors and is thought to play a critical role for the development of coronary artery disease. Insulin resistance has several causes, including an impaired skeletal muscle glucose utilization rate (SMGU), reduced peripheral blood flow, and altered fatty tissue metabolism, with SMGU being considered the most important. Nonetheless, insulin resistance has only been estimated by the glucose disposal rate (GDR) in previous studies. Methods: Skeletal muscle metabolic imaging with 18FDG and positron emission tomography (PET) was undertaken to measure SMGU during hyperinsulinemiceuglycemic clamping in 22 normotensive type-2 diabetics under no medications (T2- DM), 17 normotensive non-diabetic hypertriglyceridemics, 22 patients with hypertension, and 12 agematched controls. Whole body insulin resistance was assessed by the GDR during hyperinsulinemiceuglycemic insulin clamping. Results: The SMGU and GDR were significantly reduced in T2DM (32.1 ± 16.6 μmol/min/kg and 24.3 ± 13.0 μmol/min/kg, respectively), hypertriglyceridemics (36.5 ± 13.5 μmol/min/ kg and 22.7 ± 8.07 μmol/min/kg respectively) and patients with hypertension (35.4 ± 26.6 μmol/min/kg and 29.0 ± 9.90 μmol/min/kg, respectively) compared with controls (72.2 ± 44.1 μmol/min/kg and 43.0 ± 22.9 μmol/min/kg, p < 0.01, respectively). In all groups studied, SMGU was significantly correlated with GDR (r = 0.76, p < 0.01) and GDR (F = 13.9) was independently related to SMGU (r = 0.81, p < 0.01). Conclusion: Insulin resistance is significantly associated with SMGU to a similar degree among patients with T2DM, essential hypertension and hypertriglyceridemia. 18FDG PET functional imaging allows insulin resistance to be assessed.展开更多
文摘Clinical engineering(CE) has evolved rapidly over the last 25 years in China. Among the 34 provincial-level administrative units within China, the Zhejiang Province is one of the most advanced in terms of healthcare technology maintenance and management. In order to determine Zhejiang's current stage of development and opportunities for further improvement, a comparison of the performance of its CE departments was made against hospitals in the USA. Data were collected from 21 Zhejiang hospitals and compared to those from 270 acute-care hospitals in USA collected by Truven Health Analytics. The benchmarking comparison was made in three categories: operational, financial, and productivity. Within the operational category, the following metrics were compared: equipment inventory size/operating beds, annual repairs/inventory size, and annual scheduled maintenance/inventory size. Within the Financial category, the following metrics were compared: total CE expense/operating beds and total CE expense/total hospital expense. Within the Productivity category, the following metrics were compared: total CE full-time equivalent(FTE)/inventory size and total CE FTE/total hospital expense. These comparisons showed that:(1) While the equipment inventory in Zhejiang tends to be much smaller than USA for hospitals of comparable amount of operating beds, the numbers of repairs and scheduled maintenance per inventory size are similar;(2) The total CE expense/total hospital expense ratio is around 1% in both Zhejiang and USA; however, the total CE expense/operating beds and total CE expense/cost of equipment inventory are significantly lower in Zhejiang than USA;(3) The FTE amount in Zhejiang is significantly higher than in USA relative to both inventory size and total hospital operating expense, but significantly lower relative to the number of operating beds. The fact that repairs and scheduled maintenance are similar in Zhejiang and USA shows that CE leaders are managing equipment in comparable manner. Most of the differences found in the comparisons were traced to a few factors. First, the average length of stay in China is substantially higher than USA, which explains why hospitals in Zhejiang tend to have more operating beds but fewer pieces of equipment. Second, labor cost is significantly lower in China than USA, thus allowing Zhejiang hospitals to employ more workers than their American counterparts. Third, there is significantly difference in the cost of living between China and USA; Finally, being public entities Chinese hospitals are managed and operated in a different manner than American hospitals, which are mostly private, albeit nonprofit organizations. Nonetheless, it is interesting to note that hospitals in both areas spend roughly 1% of their total expenditure for CE. The results suggest that CE in Zhejiang is comparable to USA in terms of managerial excellence but there could be some room for improvement in financial management and productivity.
文摘Japanese clinical engineer(CE) is a significant and unique profession compared with other nations with its dual clinical and technology focus and national licensing. The CE system of licensing was established in May 1987 under the Clinical Engineers Act. CEs are required to complete 3 to 4 years in designated schools and pass a national examination. It is a professional medical position responsible for the operation and maintenance of life-support and non-life-support medical device systems under the direction of physicians. Currently approximately 70 educational institutes- including technical colleges and universities- provide diverse and wide-ranging curricula from engineering to various clinical disciplines to produce CEs. Since clinical practice training is mandatory as a part of institute work, an important approach for CEs is gained by working in hospitals. The comprehensive curricula and the licensing system in Japan together serve to keep the appropriate quantity and quality of CEs. The Japan Association for Clinical Engineers(JACE) was established in February 1990; one of its aims is to support improvement of CEs throughout their careers through various lectures, seminars, on-the-job trainings, workshops, and an annual member meeting. New CEs can now take advantage of video e-learning. For junior CEs, there are seminars for hyperbaric oxygen therapy, blood purification, heart-lung bypass, respiratory therapy, operating room, intensive care unit, arrhythmia and aphaeresis related devices, as well as healthcare technology management(HTM). Also, the institutes provide a leadership seminar alongside this clinical practice training. Besides the licensing process, a proper certification system for CEs is a critical element in the clinical field. This enhances the ability of CEs to engage in more extensive duties and develop specialties, as well as to provide better healthcare. Associated societies provide certification with technology qualifications in dialysis, extracorporeal circulation, respiratory therapy, clinical medical devices, hyperbaric oxygen therapy, and aphaeresis treatment. JACE also launched a unique certification system in 2010, with specializations in blood purification, arrhythmia, respiratory, and hyperbaric oxygen care. What is the difference between certification by the associated societies and that offered by JACE? Certification by the associated societies provides basic knowledge to pass specialty examinations. Certifications by JACE promote deeper knowledge to enhance clinical decisionmaking and to encourage wider experience. JACE also continues to investigate other certifications. In summary, Japan has introduced a national licensing system for keeping an intake of constant quality and quantity of CEs. Additionally, ongoing workshops and seminars stimulate in-depth knowledge and a higher level of medical care for patients. Together, a system of lifelong education for CEs has been built.
文摘Objective: Medical equipment safety in clinical use has been an increasingly concerned issue in China. This paper aims to design and implement a web-based medical equipment maintenance system to be used at clinical engineering department, orienting to the improvement of quality and efficiency of technology service so as to meet the 2010 regulations homologated with China's Ministry of Health. Methods: The system adopted three-layer structure based on B/S mode with oracle database and ASP.NET development technologies. Based on risk management and inclusion criteria for maintenance, the software system modules consist of hospital equipment inventory management, personnel information management, breakdown maintenance, preventive maintenance(PM) and analysis graphical representations.Results: An user friendly web interface was provided for easy and secure access to the system. Medical equipment management activities from log-in to acceptance test to maintenance services were implemented. Conclusion: The application of this system has achieved benefits for the risk management of medical equipment.
基金Supported by the National Natural Science Foundation of China(No.82271100)the Jiangsu Science and Technology Support Program(No.BE2022805)the Clinical Skills Enhancement Program of Jiangsu Province Hospital(No.JSPH-MC-2022-24).
文摘AIM:To predict the post-operative vault and the suitable size of the implantable collamer lens(ICL)by comparing the performance of multiple artificial intelligence(AI)algorithms.METHODS:A retrospective analysis of 83 patients with 132 eyes was conducted from 2020 to 2023.All patients underwent implantation of EVO-V4C ICLs.ICLs were selected based on STAAR’s recommended formula.Postoperative vault values were measured using anterior segment optical coherence tomography(ASOCT).First,feature selection was performed on patients’preoperative examination parameters to identify those most closely related to postoperative vault and incorporate them into the machine learning model.Subsequently,four regression models,namely MLP,XGBoost,RFR,and KNN,were employed to predict the vault,and their predictive performances were compared.The ICL size was set as the prediction target,with the vault and other input features serving as new inputs for predicting the ICL size.RESULTS:Among all preoperative parameters,16 parameters were most closely related to postoperative vault and were included in the prediction model.In vault prediction,XGBoost performed the best in the regression model(R^(2)=0.9999),followed by MLP(R^(2)=0.9987)and RFR(R^(2)=0.8982),while the KNN model had the lowest predictive performance(R^(2)=0.3852).XGBoost achieved a prediction accuracy of 99.8%,MLP had a prediction accuracy of 98.9%,while RFR and KNN had accuracies of 87.1%and 57.4%,respectively.CONCLUSION:AI effectively predicts postoperative vault and determines ICL size.XGBoost outperforms other machine-learning algorithms tested.Its accurate predictions help ophthalmologists choose the right ICL size,ensuring proper vaulting.
文摘Background: Provoked spasm might have influence on cardiovascular events even after successful DES implantation. Methods and results: A consecutive 122 patients who underwent first-generation DES (CypherTM, and TaxusTM) implantation and had no residual stenosis at follow-up coronary angiography were included. All patients also underwent acetylcholine provocation test (ACh) at follow-up angiography. Age, sex, coronary risk factors (smoking, hypertension, diabetes mellitus, dyslipidemia), medication (calcium channel blockers, angiotensin receptor blockers, angiotensin converting enzyme inhibitors, nitrates, β blockers, statins), duration from stent implantation to follow-up angiography (15.5 ± 14.5 months), old myocardial infarction, Ach + were included as variables for multivariate analysis for cardiovascular events (angina pectoris without intervention, target lesion revascularization, acute myocardial infarction, definite or probable stent thrombosis, cardiac death, and stroke). ACh provocation test was positive in 64.8%. The following events occurred during a mean follow-up period of 26.9 ± 9.5 months;angina pectoris without intervention in 12, very late stent thrombosis in 1, acute myocardial infarction in 1, sudden death in 1, and stroke in 4. By Adjusted Cox hazard model, age was the independent predictor of future cardiovascular events. ACh was unbalanced data for Cox hazard model, and by logistic regression model, ACh was the strongest predictor. Conclusions: Coronary endothelial dysfunction at chronic stage is the strongest predictor of further prognosis in patients with first-generation DES.
基金XLS thanks the National Natural Science Foundation of China(No.21907080,22278330)the Youth Innovative Team(No.xtr052022012)from Xi'an Jiaotong Universitysupported by the Natural Science Basic Research Program of Shaanxi(Program No.2023-JC-QN-0246).
文摘The detection of biothiols such as cysteine(Cys),homocysteine(Hcy),and glutathione(GSH)are critical for understanding their roles in biology and their involvement in various physiological and pathological processes.Recently,significant progress has been made in constructing fluorescent probes capable of detecting and visualizing biothiols.This review provides an in-depth look at the latest advancements in simultaneous and selective molecular probes,focusing on developments over the last 5 years.We examine design techniques,sensing mechanisms,and imaging methods to assess their effectiveness and responsiveness to thiols.Additionally,we discuss the prevailing challenges and offer recommendations to address them.
文摘Despite its role in disease there is still no definitive method to assess oesophago-gastric junction competence （OGJ）. Traditionally the OGJ has been assessed using manometry with lower oesophageal sphincter pressure as the indicator. More recently this has been shown not to be a very reliable marker of sphincter function and competence against reflux. Disorders such as gastro-oesophageal reflux disease and to a lesser extend achalasia still effects a significant number of patients. This review looks at using a new technique known as impedance planimetry to profile the geometry and pressure in the OGJ during distension of a bag. The data gathered can be reconstructed into a dynamic representation of OGJ action. This has been shown to provide a useful representation of the OGJ and to show changes to the competence of the OGJ in terms of compliance and distensibility as a result of endoluminal therapy.
基金This work was supported by the National Natural Science Foundation of China(Grants 61927805)the Natural Science Foundation of Jiangsu(Grant No.BE2018707)the Scientific Research Foundation of Nanjing University and Drum Tower Hospital.
文摘Recently,organ-on-chips have become a fast-growing research field with the widespread development of microfluidic chips and synthetic materials in tissue engineering.Due to the existing cardiotoxicity of many cardiovascular drugs,heart-onchips which are promising to replace traditional animal models have been extensively researched and developed to mimic human organ functions in vitro.The heart-on-chips mainly focus on cardiac mechanics,which is regarded as the central indicator of in vitro heart models and drug testing.Traditional methods for the detection of myocardial mechanics have been demonstrated complex and inefficient in heart-on-chips.Therefore,photonic crystal materials with unique optical properties have attracted interests and have been introduced into the heart-on-chips,developing a visualized self-reporting system for cardiomyocytes activity monitoring.In this review,photonic crystal-based heart-on-chips for biosensing are introduced,as well as the fabricationmethods and design criteria of them.The characterizations of the photonic crystal materials are classified into optical properties and structural properties,and their applications in cell culture and biosensing are further discussed.Then,several representative examples and developments of the integration of photonic crystal materials into microfluidic chips are described in detail.Finally,potentials and limitations are put forward to promote the development of the photonic crystal-based intelligent heart-on-chips.
基金Supported by a Science Foundation Ireland through the ETS Walton Visiting Professor Programme a grant from the Higher Education Authority in Ireland
文摘Whilst methods exist to indirectly measure the effects of increased flow or gastro-oesophageal refluxing, they cannot quantitatively measure the amount of acid travelling back up into the oesophagus during reflux, nor can they indicate the flow rate through the oesophagogastric junction (OGJ). Since OGJ dysfunction affects flow it seems most appropriate to describe the geometry of the OGJ and its effect on the flow. A device known as the functional lumen imaging probe (FLIP) has been shown to reliably measure the geometry of and pressure changes in the OGJ. FLIP cannot directly measure flow but the data gathered from the probe can be used to model flow through the junction by using computational flow dynamics (CFD). CFD uses a set of equations known as the Navier-Stokes equations to predict flow patterns and is a technique widely used in engineering. These equations are complex and require appropriate assumptions to provide simplifications before useful data can be obtained. With the assumption that the cross-sectional areas obtained via FLIP are circular, the radii of these circles can be obtained. A cubic interpolation scheme can then be applied to give a high-resolution geometry for the OGJ. In the case of modelling a reflux scenario, it can be seen that at the narrowest section a jet of fluid squirts into the oesophagus at a higher velocity than the fluid surrounding it. This jet has a maximum velocity of almost 2 ms-1 that occurs where the OGJ is at its narrowest. This simple prediction of acid ‘squirting’ into the oesophagusillustrates how the use of numerical methods can be used to develop a better understanding of the OGJ. This initial work using CFD shows some considerable promise for the future.
基金supported by the China Postdoctoral Science Foundation(2022M721514)the National Natural Science Foundation of China(82272132)+2 种基金the Guangdong Basic and Applied Basic Research Foundation(2021A1515011869)the Regional Joint Fund of Guangdong(Guangdong-Hong Kong-Macao Research Team Project,2021B1515130003)the Science and Technology Plan Project of Guangdong Province(2021A1414020003).
文摘Recent advances in artificial intelligence(AI)have sparked a surge in the application of computer vision(CV)in surgical video analysis.Laparoscopic surgery produces a large number of surgical videos,which provides a new opportunity for improving of CV technology in laparoscopic surgery.AI-based CV techniques may leverage these surgical video data to develop real-time automated decision support tools and surgeon training systems,which shows a new direction in dealing with the shortcomings of laparoscopic surgery.The effectiveness of CV applications in surgical procedures is still under early evaluation,so it is necessary to discuss challenges and obstacles.The review introduced the commonly used deep learning algorithms in CV and described their usage in detail in four application scenes,including phase recognition,anatomy detection,instrument detection and action recognition in laparoscopic surgery.The currently described applications of CV in laparoscopic surgery are limited.Most of the current research focuses on the identification of workflow and anatomical structure,while the identification of instruments and surgical actions is still awaiting further breakthroughs.Future research on the use of CV in laparoscopic surgery should focus on applications in more scenarios,such as surgeon skill assessment and the development of more efficient models.
文摘Circadian rhythms are daily oscillations of multiple biological processes. Recently, relationships between circadian rhythms and immune functions have also been described. In a mouse sepsis model, the death rate due to lipopolysaccharide (LPS)-induced endotoxic shock was found to be dependent on LPS administration as determined by circadian time. In humans, a pronounced inflammatory response to endotoxemia differs depending on whether it is daytime or night-time: Levels of tumor necrosis factor-alpha and interleukin-6 were higher during the night. Therefore, it is reasonable to assume that circadian rhythms influence not only organ dysfunction and the prognosis induced by LPS, but also the therapeutic effect of anti-LPS therapy such as Polymyxin-B direct hemoperfusion. We herein postulate the concept that it is important to discuss septic shock treatment in terms of whether or not the treatment is adjusted for the optimal time window as determined by circadian rhythms.
文摘The role of the oesophago-gastric junction (OGJ) in gastro-oesophageal reflux disease is still not completely understood, and there is no clinically used method to assess the OGJ function in patients. Only indirect methods such as pH studies are carried out. The OGJ acts a valve controlling the flow of solids, liquids and gases between the oesophagus and the stomach. Manometry can determine if a sphincter is toned or relaxed; but, it cannot confirm that the sphincter region is actually open. Distension is a new technique for measuring function in the OGJ. By measuring the cross-sectional area through the narrow region in the junction during distension of a catheter mounted bag, much more information on the opening and closing patterns of the junction can be determined. This technique has already been demonstrated to show changes in the OGJ after surgical treatments for reflux disease. New measurement ideas around the concept of distending the OGJ offer new hope that a clinically useable test for compliance at the junction can be developed and could potentially help in determining appropriate therapy.
文摘Heart and skeletal muscle insulin resistance and abnormal myocardial flow reserve (MFR) occurs in patients with type-II diabetes. Improvement of heart and skeletal muscle insulin resistance with rosiglitazone use over 16 weeks have been reported. However, it is not clear whether chronic use of troglitazone can improve heart and skeletal muscle insulin resistance and MFR. Materials and Methods: To test the hypothesis whether effects of troglitazone on heart and skeletal muscle insulin resistance and MFR in patients with type-II diabetes, rest and dipyridamole stress perfusion positron emission tomography (PET) with 13N-ammonia and heart and skeletal muscle 18FDG PET scans under insulin clamping were undertaken before and 12 month after the initiation of troglitazone therapy (400 mg/day) in 23 patients with type-II diabetes. Twenty patients with type-II diabetes without CAD and without medications were served as controls. In controls, any medications were not added from the first PET study and 12 months after the second PET study. Results: Baseline myocardial blood flow (MBF) was comparable before and after the troglitazone group as was the controls. MBF during dipyridamole administration (0.56 mg/min/kg) was not significantly improved in troglitazone group and controls. MFR was not improved in troglitazone group and controls. In troglitazone group, whole body glucose disposal rate (GDR;μmole/min/kg) significantly improved (pre;19.0 ± 9.55, post;28.7 ± 15.3, p as did the skeletal muscle glucose utilization rate (SMGU (μmole/min/kg);pre;20.3 ± 12.0, post;34.8 ± 10.6, p insulin resistance is implicated in patients with type-II diabetes and impaired MFR is uncoupled with insulin resistance in the whole body and heart and skeletal muscle in patients with type-II diabetes.
基金National Key Research and Development Program(2016YFC0106500800)NationalMajor Scientific Instruments and Equipments Development Project of National Natural Science Foundation of China(81627805)+3 种基金National Natural Science Foundation of China-Guangdong Joint Fund Key Program(U1401254)National Natural Science Foundation of China Mathematics Tianyuan Foundation(12026602)Guangdong Provincial Natural Science Foundation Team Project(6200171)Guangdong Provincial Health Appropriate Technology Promotion Project(20230319214525105,20230322152307666).
文摘Augmented-and mixed-reality technologies have pioneered the realization of real-time fusion and interactive projection for laparoscopic surgeries.Indocyanine green fluorescence imaging technology has enabled anatomical,functional,and radical hepatectomy through tumor identification and localization of target hepatic segments,driving a transformative shift in themanagement of hepatic surgical diseases,moving away from traditional,empirical diagnostic and treatment approaches toward digital,intelligent ones.The Hepatic Surgery Group of the Surgery Branch of the Chinese Medical Association,Digital Medicine Branch of the Chinese Medical Association,Digital Intelligent Surgery Committee of the Chinese Society of ResearchHospitals,and Liver Cancer Committee of the Chinese Medical Doctor Association organized the relevant experts in China to formulate this consensus.This consensus provides a comprehensive outline of the principles,advantages,processes,and key considerations associated with the application of augmented reality and mixed-reality technology combined with indocyanine green fluorescence imaging technology for hepatic segmental and subsegmental resection.The purpose is to streamline and standardize the application of these technologies.
文摘Continuous renal replacement therapy (CRRT) is the preferred dialysis modality in critical care settings for patients with hemodynamic instability. Nafamostat mesylate (NM) is an anticoagulant commonly used (mainly in Japan) during CRRT in patients with high bleeding risk. In this study, we evaluated the pharmacokinetics of NM during CRRT. Patients undergoing CRRT therapy and using NM as the anticoagulant in the intensive care unit were enrolled in the study. Blood was collected from the CRRT circuit just after blood removal, just before and after the membrane for CRRT, and from the filtrates after the membrane. NM concentrations were measured using high-performance liquid chromatography. NM was detected in the intracorporeal circulation during CRRT in some cases, and liver enzymes were severely elevated in almost all of the cases. Coagulation time was prolonged even before the initiation of NM administration in these cases and may be associated with liver damage. This study suggests that NM dosage should take into account liver damage assessed by elevated liver enzymes.
文摘Appropriate heart rate in a failing pulmonary ventricle remains unknown, particularly in congenital heart diseasewith unique hemodynamics. A 71-year-old male with repaired tetralogy of Fallot and a pacemaker for a sinusnode dysfunction suffered from heart failure symptoms with preserved left ventricular function. Simply changingthe pacemaker’s lower rate from 60 to 75 bpm, New York Heart Association classification improved from III to II,and hemodynamic parameters drastically improved. We regarded this case as informative. Appropriate heart ratecould be higher in congenital patients with failing right and non-failing left ventricles than in adults with malfunctioningLV.
文摘Current output dose measurement in CT is based on (CTDI). The conventional methodology of CT dosimetric performance characterization is not appropriate to modern CT scanners with helical scanning modes, dose modulation, array detectors and multiple slice planes or cone-beam irradiation geometries. AAPM TG 111 report recognizes the shortfall of the CTDI methods and recommends a new technique that more accurately characterizes the dose profile from modern CT scanners, which utilizes a short conventional ion chamber rather than a pencil chamber. We developed and characterize a in-house phantom design using a three separate anatomical regions of clinical scan sequences (Head, chest and abdomen), and determined the equilibrium dose in our dose equilibrium phantom, measured if the attenuation of the beam is the equal to that of CTDI Perspex phantom and compare CTDI dose estimations using a standard pencil chamber to the dose equilibrium phantom measurements. This methodology allows measurements of the accumulated dose for any clinical scan length and allowing measurement of the equilibrium dose. Using the new methodology, we determined that the CTDI approach can underestimate the dose by 25% to 35% and all of our dose values from the water phantom and farmer chamber were independently verified with TLD measurements.
文摘BACKGROUND High-flow nasal cannula(HFNC)therapy and morphine continuous subcutaneous infusion(CSI)have been used to ameliorate dyspnea in non-cancer patients with end-stage respiratory diseases,including chronic obstructive pulmonary disease and interstitial pneumonia,primarily in hospital settings.However,it is rare to perform home-based medical treatment using these.We observe a case to assess the feasibility of this treatment strategy.CASE SUMMARY Here,we report a case of a 75-year-old man who was diagnosed with interstitial pneumonia 11 years ago and was successfully nursed at home during his terminal phase for over 10 mo without hospitalization,by introducing domiciliary uses of HFNC and morphine CSI with a patient-controlled analgesia device.CONCLUSION Active utilization of HFNC and morphine CSI with patient-controlled analgesia device would substantiate successful end-of-life palliative home care of idiopathic interstitial pneumonia patients.
文摘Insulin resistance is associated with several coronary risk factors and is thought to play a critical role for the development of coronary artery disease. Insulin resistance has several causes, including an impaired skeletal muscle glucose utilization rate (SMGU), reduced peripheral blood flow, and altered fatty tissue metabolism, with SMGU being considered the most important. Nonetheless, insulin resistance has only been estimated by the glucose disposal rate (GDR) in previous studies. Methods: Skeletal muscle metabolic imaging with 18FDG and positron emission tomography (PET) was undertaken to measure SMGU during hyperinsulinemiceuglycemic clamping in 22 normotensive type-2 diabetics under no medications (T2- DM), 17 normotensive non-diabetic hypertriglyceridemics, 22 patients with hypertension, and 12 agematched controls. Whole body insulin resistance was assessed by the GDR during hyperinsulinemiceuglycemic insulin clamping. Results: The SMGU and GDR were significantly reduced in T2DM (32.1 ± 16.6 μmol/min/kg and 24.3 ± 13.0 μmol/min/kg, respectively), hypertriglyceridemics (36.5 ± 13.5 μmol/min/ kg and 22.7 ± 8.07 μmol/min/kg respectively) and patients with hypertension (35.4 ± 26.6 μmol/min/kg and 29.0 ± 9.90 μmol/min/kg, respectively) compared with controls (72.2 ± 44.1 μmol/min/kg and 43.0 ± 22.9 μmol/min/kg, p < 0.01, respectively). In all groups studied, SMGU was significantly correlated with GDR (r = 0.76, p < 0.01) and GDR (F = 13.9) was independently related to SMGU (r = 0.81, p < 0.01). Conclusion: Insulin resistance is significantly associated with SMGU to a similar degree among patients with T2DM, essential hypertension and hypertriglyceridemia. 18FDG PET functional imaging allows insulin resistance to be assessed.
