时间-空间相关成像技术在胎儿心脏超声检查中的应用

目的 探讨时间-空间相关成像(STIC)技术在正常胎儿心脏超声检查中的成像方式及其临床应用价值. 方法分别使用常规二维超声和STIC技术对120例孕龄在22～28周的正常胎儿进行心脏扫查,比较两种方法获得胎儿心脏图像的质量和扫查时间有无统计学差异,并分析STIC技术的成像方法. 结果 120例正常胎儿心脏均获得满意的容积图像,各切面图像的显示合格率与常规二维扫描图像的差异无统计学意义(P>0.05),且能显示出常规二维不能显示的切面.所研究的120例样本中,共有85例可计算常规二维超声筛查时间,平均每个胎儿心脏用时(5.26±2.01)min;共有104例可计算STIC扫描时间,平均每次STIC扫描用时(4.47±2.32)min. 结论 STIC技术比常规二维超声能提供更多的观察心脏解剖结构的切面和信息,可简化图像采集过程,缩短检查时间,减少对检查者经验的依赖,提高工作效率,同时大大减少胎儿心脏接受超声波照射的时间.     

空间-时间相关成像技术诊断胎儿室间隔缺损的应用研究

目的应用空间-时间相关成像技术(STIC)多种处理模式对胎儿室间隔缺损(VSD)声像学特征进行研究,探讨STIC技术多种模式在评价胎儿VSD中的应用价值,并比较STIC技术多种模式间诊断效能的差异。方法选取疑诊为先天性心脏病胎儿54例,应用常规超声心动图(UCG)和STIC技术多种处理模式分别进行分析,并以产后新生儿心脏超声诊断或引产的胎儿尸体解剖结果为金标准。结果常规超声心动图、断层超声成像和表面成像模式对胎儿VSD的诊断效能较高,ROC曲线下面积三者之间进行比较差异无统计学意义(P>0.05),多平面成像、透明成像和反转成像模式的诊断效能较差。结论 STIC技术多种处理模式虽各具特色,但并不能代替二维超声心动图,联合应用可提供更清晰、更稳定、更丰富的图像内容。可作为常规超声心动图诊断胎儿VSD的最佳补充手段。     

空间-时间相关成像技术在胎儿心脏超声检查中的应用价值

目的：探讨应用空间-时间相关成像（STIC）技术进行胎儿心脏超声检查的可行性和临床价值。方法：应用STIC技术对30例孕龄20～34周正常胎儿进行数据采集及脱机分析和处理，对胎儿心脏各解剖结构进行显示和观察。结果：30例研究对象在获得容积数据后，通过正交三平面模式对图像进行切割平移或旋转，有26例成功获得了心脏各解剖结构，4例心脏结构未能完全显示。结论：STIC技术较传统超声心动图具有优势，具有广阔的临床应用前景。     

应用时间-空间关联成像技术评价正常胎儿房室瓣

目的评价应用三维超声时间-空间关联成像(STIC)技术观察胎儿房室瓣结构、测量正常胎儿房室瓣的周长和面积、观察其随孕周的变化的可行性。方法利用STIC技术采集176胎胎龄20～32周正常胎儿的心脏容积数据,在不同成像模式下观察胎儿房室瓣立体形态,手动测量房室瓣环的周长和面积,分析所得数值与孕周的关系。结果①176胎中,144胎应用STIC技术观测房室瓣成功,成功率为81.82%(144/176)。二、三尖瓣的周长和面积与孕周呈正相关。从20周到32周,二尖瓣平均周长从(2.41±0.35)cm增至(3.49±0.25)cm,平均面积从(0.36±0.14)cm2增至(0.97±0.23)cm2;三尖瓣平均周长从(2.46±0.23)cm增至(3.56±0.21)cm,平均面积从(0.34±0.10)cm2增至(0.96±0.23)cm2。②与二维超声相比,STIC技术可以更好地显示房室瓣结构,瓣叶在各种模式下均可得到较好显示,瓣环、乳头肌分别在表面模式、断层显像模式下显像效果较好。结论 STIC技术评价胎儿房室瓣具有一定优势,应用价值较高。     

时间-空间相关成像技术“A平面旋转法”在中孕期胎儿心脏结构筛查中的应用

目的 研究时间-空间相关成像技术(STIC)在中孕期胎儿心脏结构筛查中的应用,分析STIC技术应用于中孕期胎儿心脏检查中的最优条件及影响心脏容积数据采集成功的因素,探索后期图像快速处理的方法.方法 150例中孕期胎儿,经常规超声检查心脏结构无异常.采用STIC技术扫描获得整个胎儿心动周期的容积数据并采用“A平面旋转法”重建出左心室流出道切面(LVOT)、右心室流出道切面(RV-OT)、主动脉弓切面(LAV-AOA)、动脉导管弓切面(LAV-DA)、三血管切面(3VT)五个常用切面,根据胎心位置分为尖位四腔心组和侧位四腔心组,分析比较上述两组切面的重建率;分析影响数据采集的相关因素,如最大羊水深度、胎儿孕周、胎儿体重、胎儿心率、胎盘位置等.结果 运用STIC技术采集150例中孕期胎儿心脏容积数据成功123例(82％),未成功27例(18％).各因素对数据采集成功率的影响无统计学差异(P＞0.05).尖位四腔心组、侧位四腔心组两组间STIC重建率无统计学差异(x2 =0.624,P=0.891).结论 在胎儿静止状态下,其他因素对使用STIC技术采集容积数据影响较小,可获得满意容积数据.对不同体位胎儿后期图像处理,运用STIC正交平面技术可得到质量比较满意的图像.因此STIC技术可普遍用于中孕筛查期胎儿心脏检查,具有重要的临床应用价值.     

三维多平面切面法联合时间空间关联成像技术在评价正常胎儿右心室功能中的应用

目的 探讨三维多平面切面法( 3D slice)和时间空间关联成像技术(STIC)测量正常孕中晚期胎儿右心室功能及其随孕周变化的可行性.方法 选择20～32孕周正常胎儿165例,利用STIC技术采集胎儿心脏容积数据,采用3D slice描绘右心室每层心室面的心内膜面积,最后计算机通过层厚和所描层数积分获得右心室容积,利用测量值计算右心室每搏量、射血分数和心输出量,分析所得数值与孕周的关系.结果 165例胎儿中,137例应用3D slice测量右心室容积成功,成功率为83.03％.胎儿右心室容积、每搏量和心输出量与孕周呈正相关;右心室每搏量从孕20周(0.42±0.10) ml/次上升到32周(1.88±0.28) ml/次;右心室心输出量从孕20周(62.06±15.10) ml/min上升到32周(273.88±48.61) ml/min;右心室的平均射血分数约恒定于49％,其与孕周无明显相关性.结论 3D slice联合STIC技术可作为一种新的评价胎儿右心室功能的方法.     

时间-空间关联成像技术A平面平推＋旋转法快速筛查孕中期胎儿心脏结构

目的 评价时间-空间关联成像(STIC)技术A平面平推＋旋转法在快速筛查孕中期胎儿心脏结构中的应用.方法 将常规超声检查正常的胎儿400胎分为常规扫查组(200胎)和STIC组(200胎),根据胎儿心脏与探头的相对位置,将STIC组胎儿分为心尖四腔心、横位四腔心及心底四腔心3个亚组.对STIC组使用A平面平推法获得上腹部横切面、四腔心切面、左心室流出道、右心室流出道及三血管切面,并进行动态连续观察; 在三血管切面的基础上,使用A平面旋转法获得主动脉弓及动脉导管弓切面.计算两组胎儿心脏筛查所需时间,评价STIC各亚组所获得图像的质量.结果 应用STIC技术进行胎儿心脏筛查,用时较常规超声筛查明显缩短.心尖四腔心及横位四腔心亚组所获图像质量优于心底四腔心亚组 (P均<0.01).结论 与常规扫查方法相比,应用STIC技术A平面平推法＋旋转法可快速筛查孕中期胎儿心脏结构,具有重要临床应用价值.     

三维超声STIC技术在诊断胎儿完全型房室间隔缺损中的应用

目的 探讨三维超声时空关联成像(STIC)技术在胎儿完全型房室间隔缺损(AVSD)诊断中的临床应用价值.方法 回顾性分析32例诊断为完全型AVSD的胎儿超声心动图特点,应用STIC技术显示共同房室瓣及乳头肌,与尸检或生后超声心动图的结果进行比较.结果 三维超声STIC技术与二维超声相比在胎儿完全型AVSD的检出率上没有明显差别.通过STIC技术可显示共同房室瓣的形态特征及乳头肌的位置的异常等.结论 三维超声STIC技术为观察共同房室瓣提供了新视野,是一种能准确、简便地诊断胎儿完全型AVSD的新方法.     

三维表面成像技术显示胎儿正常室间隔的探索

目的 探索表面成像(surface rendering)技术显示胎儿正常室间隔的方法及图像特征,为进一步了解室间隔的立体结构提供新手段.方法 正常中孕期胎儿51例,应用时空关联成像(spatio-temporal image correlation,STIC)获取胎儿心脏容积数据,尔后应用表面成像技术进行脱机分析,通过...     

超声时间-空间关联成像技术检测胎儿脐-门静脉系统发育异常

目的应用超声时间-空间关联成像(STIC)技术分析胎儿脐-门静脉系统发育异常(CAPVS)的声像图特点,探讨STIC成像技术的应用价值。方法收集产前超声筛查中心诊断的脐-门静脉系统发育异常(CAPVS)胎儿5例,孕妇年龄25~35岁,胎儿孕周13~28周。应用四维彩色多普勒超声诊断仪检测胎儿发育状况,启动STIC模式扫查胎儿脐-门静脉系统,分析脐-门静脉声像图特征。结果 5例胎儿均诊断为静脉导管缺失,其中3例经下腔静脉直接汇入体循环;1例脐静脉直接汇入右心房;1例未探及正常肝门静脉分支,仅显示一肝门静脉主干。结论二维彩色超声血流显示不清时,STIC成像技术可清晰显示脐-门静脉处血管关系,能及时发现胎儿生长受限或胎儿畸形,以便给予多次随访,改善预后。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."