ABSTRACT
Objective To evaluate the value of contrast-enhanced ultrasonography (CEUS) in quantitative diagnosis of chronic kidney dysfunction(CKD) by comparing it with color Doppler imaging (CDFI). Methods Tirty-three cases (15 males and 18 females) of clinical confirmed CKD (stage Ⅲ～Ⅴ)were included. Forty-five healthy volunteers were performed as control group. CEUS and CDFI were performed on each patient. After intravenous bolus injection of 1ml SonoVue each side,CEUS of renal cortex blood perfusion was collected successively,and a time-intensity curve(TIC) was created with Philips iU22 system's QLAB software. Resistance index(RI) and peak systolic velocity(PSV) of renal partial arteries were also tested. Results Compared with normal kidney,CKD patients had delayed perfusion and decreased intensity. Changes of area under curve(AUC), derived peak intensity(DPI), slope rate of ascending curve(A)and time to peak(TTP) were statistically significant ( P ＜0. 05). Sensitivities of AUC,DPI,A and TTP in diagnosis of CKD (stage Ⅲ～Ⅴ ) were 91.2% ,84. 9% ,90.9% and 85.3%, their specificities were 95.4%,88.9% ,93.3% and 90.9%, their accuracies were 93.6%, 87. 2%, 92.3% and 88. 5%, respectively. The results of CEUS were better than RI in CDFI (sensitivity 70.4%, specificity 37. 8%, accuracy 52.2%).Conclusions CEUS can precisely display the hemodynamic change in CKD ( stage Ⅲ～Ⅴ ), and is more sensitive than CDFI.
ABSTRACT
The patients are in a relatively disadvantaged position in the relationship between doctors and patients.In order to safeguard an equal and harmonious doctor-patient relationship,society and hospital administrators usually emphasize on doctors' responsibility in constructing the harmonious doctor-patient relationship,which is not a comprehensive consideration.This paper shows that the contradiction between the patients and doctors lies on the differences between them and the both have responsibilities.However,the evaluation from the media is not objective,and the awareness of the role of patients has enhanced,all of which lead to a distrust to the doctors and even a deterioration of their relationship.The author analyzes the reasons above from both theoretical and practical point of view and points out that the patients should bear certain responsibility for the doctor-patient relationship.Furthermore,the author puts forward several countermeasures to construct a harmonious relationship between doctors and patients,such as creating an objective direction of public opinion and social environment,propagandizing the knowledge about medical risk,raising the level of the awareness of moral responsibility.