三维超声体积自动测量技术计算兔肝脏体积准确性的实验研究

目的评价三维超声体积自动测量(VOCAL)技术计算兔子肝脏体积的准确性,并探讨不同旋转步长对准确性的影响。方法对30只新西兰健康大白兔肝脏进行三维图像采集,应用VOCAL技术选择30°、15°、9°、6°旋转步长分别计算兔子肝脏体积;随后处死兔,以离体肝脏体积作为对照,比较不同旋转步长计算兔子肝脏体积的准确性。结果 30°、15°、9°、6°4种不同旋转步长所测量肝脏体积分别为(60.31±12.96)cm3、(55.66±10.23)cm3、(55.51±9.76)cm3、(56.02±10.89)cm3,离体肝脏实际体积为(56.33±10.90)cm3;30°测量值与实际体积的差异有统计学意义(P<0.05),15°、9°、6°测值与实际体积的差异无统计学意义(P>0.05),30°、15°、9°、6°旋转步长测量值与实际值的相关系数分别为0.872、0.880、0.915、0.953。结论 15°、9°、6°可作为三维超声测量兔子肝脏体积的合适旋转步长,15°为兼顾准确和简便的最佳选择。     

实时三维超声测量模拟前列腺体积的实验研究

目的 评价实时三维超声测量模拟前列腺体积的准确性与可行性,并探讨超声测量的最佳旋转步长.方法 实时三维超声测量10个模拟前列腺形状的李子,容积分析软件在不同旋转步长(6°、9°、15°、30°)测量李子体积;同时量筒取得李子实际体积与三维超声测值比较.结果 在李子体积的测量中,实时三维超声在不同旋转步长测值与实际值无显著性差异(P＞0.05),且与实际值均呈高度正相关.结论 实时三维超声测量李子体积准确可靠,重复性高;且选择旋转步长30°可提供足够信息,为兼顾准确与简便的最佳选择.     

不同旋转步长三维超声体积自动测量技术测量体积准确性的仿体实验研究

目的测试三维超声体积自动测量技术在不同旋转步长下的误差。方法将大小形状不同的离体新鲜猪肉组织块置于水囊中,对目标物进行三维容积采样后,启动三维超声体积自动测量程序,分别使用旋转步长30°、15°、9°、6°测量组织块的体积,记录数据并进行统计。结果使用旋转步长30°、15°、9°、6°的误差分别为(14.49±7.45)%,(10.93±5.97)%,(6.05±5.06)%和(12.92±6.77)%。测量体积与实际体积的相关回归方程分别为y=1.0642x 0.8374(r=0.9903),y=1.0674x 0.5093(r=0.9936),y=1.0235x 0.6614(r=0.9968),y=1.0514x 0.7767(r=0.9927),以上方程P<0.05。其中旋转步长为9°时,r值最大。不同旋转步长测量条件下,实际体积与相对误差的相关系数r值在0.2083～0.3762之间。结论三维超声体积自动测量技术对体积的测量结果与实际体积相关性较高,可用旋转步长为9°进行精测,30°进行估测。     

三维超声体积自动测量技术在移植肾容积参数采集中的方法学研究

目的探讨三维超声容积自动测量技术在移植肾容积参数采集中的方法学问题。方法20例肾功能稳定期移植肾患者,分为a取值30°、15°、9°、6°旋转步长组、同一操作者9°旋转步长组及不同操作者9。旋转步长组,进行三维血管容积参数的采集与分析。结果a取值为30°、15°、9°、6°组,同一操作者a取值为9°前、后两次测量组以及不同操作者a取值9°分别测量组,所得到的三维血管容积参数比较差异均无统计学意义（P〉0．05）。结论选取a取值9°为旋转步长,进行移植肾三维血管容积数据的采集最为适宜;三维超声容积自动测量技术在不同操作者内及相同操作者间的测量值变异小,重复性好。     

对比三维超声VOCAL技术与CT评估兔肝脏体积

目的对比评估三维超声VOCAL技术和CT测量兔肝脏体积的准确性。方法分别采用三维超声VOCAL技术和CT测量30只兔肝脏体积,将测量结果与采用水浸法测得的肝脏实际体积值进行比较。结果兔肝脏体积的三维超声VOCAL测量值、CT测量值与实际值间两两比较差异均无统计学意义(P均>0.05)。VOCAL法与CT法的测量误差分别为8.40%±4.40%及6.68%±4.45%(P>0.05)。三维超声VOCAL法测得的兔肝脏体积与实际值高度相关(r2=0.880,Y=9.146+0.826 X,P<0.001)。结论三维超声VOCAL技术可以准确测量兔肝脏体积,为评估不规则脏器体积提供了新的方法。     

实时三维超声测量膀胱容积的初步探讨

目的:评价实时三维超声技术测量膀胱容积的准确性与可行性,并探讨测量的最佳旋转角度。方法:使用实时三维超声采集10个模拟膀胱的橡胶水囊及33例正常成人的膀胱“锥形”三维数据库,应用其容积分析软件,用不同旋转角度:6°,9°,15°,30°测量水囊及膀胱容积;同时用二维计算公式测量水囊及膀胱容积,将三维及二维测值与实际值比较。结果:在水囊及成人膀胱容积测量,实时三维超声不同平面间角度与实际值均呈正相关(r2>0.90),两者无显著性差异(P>0.05);二维超声测值与实际值虽呈正相关(r2>0.85),但两者间有显著性差异(P<0.05)。各旋转角度之间相比较,水囊及膀胱容积测量时不同旋转角度之间无显著性差异(P>0.05);实时三维超声测量误差较二维超声明显为小(P<0.05)。结论:实时三维超声技术测量膀胱容积准确可靠,重复性高。临床应用实时三维超声测量膀胱容积时,选择平面间角度30°即可提供足够信息,为兼顾准确与简便的最佳选择。     

第11~13周胎儿额上颌角的二维及三维超声测量

目的 比较及评价二维和三维超声在测量胎儿额上颌(FMF)角中的作用.方法 分别应用二维及三维超声方法在颜面正中矢状面测量11～13周正常胎儿的FMF角,比较两种测量方法所得测值的差异及可重复性,分析三维测量的FMF角与胎儿头臀长(CRL)的关系.结果 共37名胎儿测得FMF角.随CRL增大,测量例数增加,而FMF角减小.其中18名(48.65%)得到符合要求的二维测量平面,30名(81.08%)胎儿获得符合要求的三维重建平面.对同一胎儿,二维测量平面两次测值间的平均差异为2.78°±1.95°,明显大于三维重建平面两次测值间的平均差异(1.68°±1.01°,P<0.01).11名胎儿同时应用两种方法进行测量,所得FMF角差异无统计学意义.三维重建平面测得的FMF角随CRL的增加而减小,二者明显相关(r＝-0.540,P<0.01).结论 在 11～13周正常胎儿中,与二维超声相比,应用三维超声可以快速而精确地测量FMF角.     

激光散斑成像仪测量结果的影响因素

目的通过模拟不同的使用条件,找出影响激光散斑衬比成像(LSCI)结果值的影响因素。方法在暨南大学第一附属医院的疼痛门诊模拟各种使用条件。采用武汉迅微光电子技术有限公司的商用仪器(Laser Speckle Blood Flow Imager Ⅱ),利用仿皮肤硅胶模型作为被测物体,探索4种使用条件下散斑成像系统结果值的变化:包括肤色、绿、黄、蓝、红、黑6种物体颜色的不同的曝光时间(1~15 ms)、不同的光线条件(遮光、室内灯光及无额外光照)、不同的探头距被测物体距离(15、20、25、30、35、40、45、50 cm)以及不同的探头激光束与被测物体夹角(90°、85°、80°、75°、70°、65°)。结果曝光时间影响:6种被测物体颜色的散斑成像测量结果值都会随着曝光时间的增加而减少;仅当被测物体表面是黑色时,测量结果值减少的变化规律和其他5种颜色的变化规律不一致。光线条件影响:被测物体表面颜色为红色时,3种光线条件下的散斑成像测量结果值差异无统计学意义;当被测物体表面颜色为黑色时,仅室内灯光和无光条件下的散斑成像测量结果值差异无统计学意义。探头距被测物体距离的影响:被测物体表面颜色为红色时,在20~40 cm探头距被测物体距离范围内,散斑成像测量结果值差异无统计学意义;当被测物体表面颜色为黑色时,在20~35 cm探头距被测物体距离范围内,散斑成像测量结果值无明显统计学差异。探头激光束与被测物体夹角的影响:被测物体表面颜色为红色,曝光时间为5 ms时,6个探头激光束与被测物体夹角下的散斑成像测量结果值差异均无统计学意义;曝光时间为10 ms时,在80°~90°和65°~85°两个探头激光束与被测物体夹角范围内,散斑成像测量结果值差异无统计学意义。当被测物体表面颜色为黑色,曝光时间为5 ms、角度在80°~90°及65°~75°范围内时,散斑成像测量结果值差异无统计学意义;曝光时间为10 ms、角度在85°~90°及65°~80°范围内时,散斑成像测量结果值差异无统计学意义。结论曝光时间、光线条件、探头距被测物体距离及激光束与被测物体夹角均是影响激光散斑成像仪测量结果值的影响因素。除此之外,被测物体表面颜色是黑色时的测量结果值和其他任何颜色都不一致,我们应该重新审视不同被测者的测量结果值的可比性。      

三维超声容积自动测量技术的准确性及重复性研究

目的：评价三维超声容积自动测量方法的准确性及重复性。方法：用二维及三维超声分别对22个规则水囊模型和25个不规则水囊模型作容积测量。二维超声测量采用标准的椭圆体计算公式，三维超声测量采用自动测量技术。结果：1，二维超声对规则及不规则模型的测量误差，系统偏倚及一致界限均较三维超声大（均P＜0．05）。三维超声对规则和不规则模型容积的测量误差无显著性差异（P＞0．05）；2，二维及三维超声测量规则及不规则模型容积与实际容积间均有良好的相关性，但三维超声测量值与实际容积间的相关系数稍高；3，三维容积自动测量技术测量规则及不规则模型时观察者内及观察者间的变异极小，有良好的重复性；4，三维容积自动测量技术测量规则模型及不规则模型平均耗时分别为6．7分钟和7．2分钟（P＞0．05）。结论：与二维超声比较，三维超声自动容积测量技术测量容积误差及系统偏倚小，与实际容积间的相关性好，有良好的重复性。与三维超声平行面积法比较，测量耗时明显缩短。     

胎儿外耳长度超声测量观察面的分析

目的探讨产前超声测量胎儿外耳长度的最佳观察面及方法。方法对90例孕17～28周胎儿进行左右外耳长度测量,并进行对比分析;筛选160例妊娠37～40+6周正常发育的胎儿,通过胎儿外耳旁矢状切面(A)、外耳冠状切面(B)、外耳轮廓的三维超声立体成像(C)测量其外耳长度,并与出生后新生儿外耳长度进行对比分析。结果 17～28周中孕期胎儿左、右外耳长度比较,差异无统计学意义。胎儿外耳长度观察面A和C的外耳长度与出生后外耳长度在妊娠37～38+6周间比较差异无统计学意义(P>0.05),在妊娠39～40+6周间比较差异有统计学意义(P<0.05)。胎儿外耳观察面B的长度与出生后外耳长度在妊娠37～40+6周间比较差异均有统计学意义(P<0.01)。结论胎儿外耳观察面A和C可作为产前超声测量胎儿外耳长度的标准观察面,为产前筛查胎儿外耳畸形提供良好依据,具有广泛的临床应用价值。     

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.     

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.     

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.     

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.     

Clinical Trial Updates and Hotline Sessions presented at the European Society of Cardiology Congress 2007

This article provides information and commentaries on trials which were presented at the Hotline and Clinical Trial Update Sessions at the European Society of Cardiology Congress 2007 in Vienna. The key presentations were performed by leading experts in the field with relevant positions in the trials or registries. It is important to note that unpublished reports should be considered as preliminary data, as the analysis may change in the final publications. The comprehensive summaries have been generated from the oral presentation and the webcasts of the European Society of Cardiology and should provide the readers with the most comprehensive information of relevant publications.     

Balance and Boundaries in Grief Counseling: An Intervention Framework for Volunteer Training

Volunteers or paraprofessional counselors are commonly used to provide supportive care to the bereaved. These counselors generally are trained in basic listening skills, providing a generic, nonspecific approach to intervention that remains to be proven effective. The present paper outlines a framework that provides paraprofessionals with a broader model for intervention with the bereaved. Attention to boundaries as a helper and balance in the grief recovery are central to the model. Interventions are described that provide the paraprofessional counselor with more options for tailoring their counseling strategy to the individual. These include techniques that are presumed to be more specific to the enhancement of grief recovery.     

A new method for the simultaneous analysis of unmodified and modified urinary nucleosides and nucleobases by high performance liquid chromatography

Details are given of a new, rapid and simple pre-fractionation method and an isocratic high performance liquid chromatography system suitable for parallel analysis of nucleosides and nucleobases from urine and other biological fluids. The quantitative recovery and excellent reproducibility of the method is demonstrated by analysis of representative standard RNA catabolites. The advantage of this new method for application to biological samples is discussed.     

Adsorption of Charged Non-albumin Bound Drugs by Amorphous Silica

We investigated the in vitro drug adsorption of PQ 10150 sodium silicate gel (AIS, Santa Clara, CA) with particle size of 230 um and surface area of 400 nr/g. We observed 99% to 88% adsorption of gentamicin; a mean 91 % of disopyramide; a mean 89% of quinidine at low concentration, falling to 75% at higher concentration. Insulin was 88% adsorbed at low concentrations but less so (65%) at higher concentrations. We observed a mean 83 % adsorption of procainamide, a mean 84% of N-acetyl procainamide, 74% oflidocaine, 73% of amitriptyline; and 44% of desipramine. We found an average 14% reduction of total digoxin concentration when serum containing digoxin (2 to 33 ng/mL) was exposed to sodium silicate, while the reduction in free digoxin concentration was 16%. Five percent ethosuximide was also removed. The adsorption of theophylline, phenobarbital, acetaminophen, phenytoin, ethylene glycol, methotrexate, salicylate, thiocyanate and diazepam was minimal and not significant. We conclude that significant amounts of charged, non-albumin bound drugs can be removed by PQ 10150 sodium silicate gel.