MRI测量对坐骨股骨撞击综合征的诊断价值

目的 探讨MRI对坐骨股骨撞击综合征（IFIS）患者的诊断价值。方法 回顾性分析70例IFIS患者（IFIS组）和40名健康志愿者（对照组）的MRI资料。于轴位脂肪抑制T2WI测量坐骨股骨间隙（IFS）宽度、股方肌间隙（QFS）宽度,于轴位T1WI测量坐骨角,于冠状位T2WI测量股骨颈干角,比较2组间的差异,分析IFS宽度与其他3个指标的相关性,绘制ROC曲线,评价其对IFIS的诊断效能。对IFIS组患者股方肌水肿和脂肪浸润程度进行分级,比较不同级别间IFS宽度的差异。结果 IFIS组患者IFS宽度、QFS宽度、坐骨角及股骨颈干角分别为（11.76±2.22）mm、（8.33±2.20）mm、（132.59±1.39）°和132.70（131.18,134.13）°,与对照组比较差异均有统计学意义（P均<0.001）。IFS宽度、QFS宽度、坐骨角度及股骨颈干角诊断IFIS的ROC曲线下面积分别为1.000、0.999、0.996和0.975（P均<0.001）。IFS宽度与QFS宽度呈正相关（r=0.743,P<0.001）,与坐骨角度及股骨颈干角呈负相关（r=-0.273,P=0.022;r=-0.332,P=0.005）。IFIS组患者不同股方肌水肿、脂肪浸润分级间IFS宽度总体差异均有统计学意义（P均<0.05）。结论 IFIS患者IFS、QFS均明显狭窄;股方肌水肿及脂肪浸润是IFIS常见MRI表现。     

坐骨-股骨撞击相关MSCT影像分析

目的 探讨无症状人群坐骨-股骨间隙（IFS）宽度范围,并分析生理指标（年龄、性别、身高、体质量、坐骨间距、偏心距、小转子高径等）对其的影响。方法 回顾性分析61例无髋关节疼痛症状者的盆腔MSCT扫描资料,测量并记录髋关节的IFS宽度、坐骨间距、偏心距、小转子高径、头颈轴长、股骨颈角、坐骨角,并分析IFS宽度与生理指标的相关性。结果 男性受检者的身高、体质量及IFS宽度、偏心距、小转子高径、头颈轴长均大于女性（P均<0.05）,坐骨间距、坐骨角均小于女性（P均<0.001）。IFS宽度与头颈轴长呈正相关（P<0.001）,与年龄、坐骨间距、股骨颈角、坐骨角均呈负相关（P均<0.001）,与身高、体质量、偏心距、小转子高径均无相关性（P均>0.05）。结论 MSCT可应用于坐骨-股骨撞击相关影像学测量与评估,女性骨盆结构与男性有所不同,这些差异可能是导致女性更易罹患坐骨-股骨撞击综合征的原因。     

超声定量评估结节间沟

目的 探讨超声测量正常成人结节间沟的可行性。方法 对120名健康成人（正常组）、20个成人肱骨大体标本（标本组）及19例肱二头肌长头肌腱脱位患者（脱位组）进行结节间沟超声扫查,分别测量结节间沟深度（D）、顶部宽度（W）及中部宽度（^1/2W）,计算W/D比值并据此对结节间沟进行分型;对3组的结节间沟测值及分型进行比较。结果 正常组中,优势手亚组D为（4.14±0.07）mm,W为（10.22±0.17）mm,^1/2W为（6.46±0.09）mm,W/^1/2W为1.59±0.19;非优势手亚组D为（4.19±0.06）mm,W为（10.26±0.19）mm,^1/2W为（6.33±0.10）mm,W/^1/2W为1.62±0.18,优势手与非优势手结节间沟D、W、^1/2W、W/^1/2W比较,差异均无统计学意义（P均>0.05）。标本组中,D为（4.24±0.10）mm,W为（9.96±0.24）mm,^1/2W为（6.29±0.11）mm;脱位组中,D为（3.15±0.08）mm,W为（14.95±0.26）mm,^1/2W为（8.35±0.16）mm。优势手亚组结节间沟的D、W、^1/2W及结节间沟分型与标本组的差异均无统计学意义（P均>0.05）,而优势手亚组、标本组与脱位组结节间沟测值及分型的差异均有统计学意义（P均<0.01）。结论 超声可清晰显示成人结节间沟形态并进行测量,可作为结节间沟定量评估的有效方法。     

帕金森病与阿尔茨海默病患者的经颅超声图像分析

目的 对比分析帕金森病（PD）和阿尔茨海默病（AD）患者的经颅超声（TCS）图像变化特点。方法 对38例PD、28例AD及26名健康志愿者行TCS检查,分析其黑质回声、3脑室宽度及大脑中动脉血流参数变化特点。结果 黑质异常强回声比例PD组（31/38,81.58%）高于AD组（8/28,28.57%）和对照组（3/26,11.54%）,差异均有统计学意义（χ²=18.74、30.41,P均<0.001）,而AD组和对照组间无明显差异（χ²=2.41,P=0.120）;3脑室宽度AD组[（0.82±0.14）cm]大于PD组[（0.63±0.16）cm]和对照组[（0.56±0.16）cm],差异均有统计学意义（P均<0.001）,而PD组和对照组间差异无统计学意义（P=0.098）;双侧大脑中动脉平均流速AD组均低于PD组和对照组,右侧大脑中动脉搏动指数AD组高于PD组和对照组,差异均有统计学意义（P均<0.05）。结论 通过TCS检查,联合黑质回声、3脑室宽度及大脑中动脉血流变化,可为PD及AD的诊断提供有价值的神经影像学信息。     

超声测量育龄期未生育女性腹直肌间隙

目的 观察超声测量育龄期未生育女性腹直肌间隙（IRD）的价值。方法 随机选取330名接受体检的育龄期健康女性，分别于其平卧及屈膝卧位下，采用高频超声探头于脐上3 cm、紧贴脐上缘、紧贴脐下缘及脐下3 cm处测量IRD，即左、右侧腹直肌内缘的距离；于脐水平测量左右侧腹直肌厚度。结果 平卧和屈膝状态下，育龄期未生育女性脐上3 cm处IRD宽度分别为（10.46±3.91）和（10.82±3.87）mm，紧贴脐上缘处IRD宽度分别为（11.84±4.54）和（12.36±4.52）mm，紧贴脐下缘处分别为（9.53±3.72）和（9.76±3.95）mm，脐下3 cm处宽度分别为（5.87±2.46）和（6.13±2.65）mm；其脐上3 cm处左、右侧腹直肌厚度分别为（10.05±1.41）和（10.26±1.40）mm、（9.73±1.24）和（9.85±1.28）mm。屈膝卧位下，各部位IRD宽度（除脐下缘处）大于平卧下（P均<0.05），且IRD宽度在紧贴脐上缘处最大、脐下3 cm处最小（（P均<0.001）；左、右侧腹直肌厚度在屈膝卧位下大于平卧下（P均<0.05）。结论 超声测量IRD安全、便捷；育龄期未生育女性正常IRD在不同状态及不同位置均有所不同。     

实时剪切波弹性成像诊断女性膀胱颈梗阻

目的 探讨实时剪切波弹性成像（SWE）诊断女性膀胱颈梗阻（FBNO）的价值。方法 收集27例FBNO患者（FBNO组）和24名健康志愿者（对照组）,均接受经会阴超声检查及SWE。观察2组的超声表现,测量并比较2组膀胱颈前唇、后唇厚度及杨氏模量值平均值（E_mean）和最大值（E_max）。结果 FBNO组膀胱颈前唇、后唇厚度分别为（0.64±0.08）cm和（0.68±0.09）cm,对照组分别为（0.45±0.07）cm和（0.51±0.07）cm,2组间差异均有统计学意义（t=8.420、7.231,P均<0.001）。FBNO组膀胱颈E_mean、E_max分别为（27.20±8.63）kPa和（51.20±12.31）kPa,对照组分别为（15.30±3.62）kPa和（29.20±8.73）kPa,2组间差异均有统计学意义（t=6.004、7.407,P均<0.001）。结论 SWE能定量反映膀胱颈硬度,对诊断FBNO有一定价值。     

MR集合序列定量参数评价中轴型脊柱关节炎骶髂关节病变

目的 观察MR集合序列（MAGiC）定量参数对于中轴型脊柱关节炎（axSpA）骶髂关节病变的应用价值。方法 对临床诊断axSpA患者分别采用常规序列和MAGiC序列行骶髂关节MR扫描,对比常规T1WI及短时翻转恢复（STIR）序列图像所示病理性脂肪沉积及骨髓水肿（BME）,比较MAGiC T1-mapping、T2-mapping和质子密度（PD）-mapping定量图所示骶髂关节病理性脂肪沉积及BME与S_2-3骶孔间正常骨髓（正常对照）的T1、T2及PD值差异。结果 共纳入28例axSpA患者。常规T1WI及STIR图像显示24例存在48处骶髂关节病理性脂肪沉积,23例存在57处BME。病理性脂肪沉积的T1值[（477.37±5.60）ms]低于正常骨髓[（614.65±17.83）ms,t=-6.952,P<0.05],T2值及PD值[（103.26±2.42）ms、（113.93±4.27）pu]均高于正常骨髓[（83.30±2.28）ms,78.30（62.50,84.00）pu,t=5.858,Z=-3.440,P均<0.05）]。BME的T1、T2、PD值分别为（2 617.92±176.85）ms、[101（94.00,96.90）]ms和（89.70±3.78）pu,均高于正常骨髓[（614.65±17.83）ms、（83.30±2.28）ms和78.30（62.50,84.00）pu,t=11.219、Z=-4.031、-2.266,P均<0.05]。结论 MAGiC定量参数有助于评价axSpA骶髂关节病变。     

MRI测量中国汉族不同性别正常成人枕叶体积

目的 采用MRI测量不同性别中国汉族正常成人枕叶体积。方法 于中国汉族健康成年脑数据库中选取200名志愿者，采集大脑三维磁化预备梯度回波T1WI。手动勾画ROI，测量左、右侧枕叶体积及全脑体积。将测量结果标准化，比较不同性别左、右侧枕叶体积的差异，分析枕叶体积与年龄的关系以及性别、年龄对枕叶体积的影响。结果 正常成人枕叶体积（105.37±10.41）cm³，标准化后为（105.44±9.20）cm³。标准化前男性与女性大脑枕叶体积[（111.34±9.15）cm³和（99.38±7.85）cm³]及标准化后男性与女性枕叶体积[（111.39±7.31）cm³和（99.48±6.72）cm³]差异均有统计学意义（t=9.91、12.01，P均<0.05）。标准化前、后男性左、右侧枕叶体积及女性左、右侧枕叶体积差异均无统计学意义（P均>0.05）。标准化前后男性、女性枕叶体积与年龄均无明显相关（标准化前r=-0.01、0.18，P=0.90、0.08，标准化后r=0.05、0.01，P=0.64、0.92）。性别及年龄对枕叶体积的影响无明显交互作用。结论 中国健康成年人枕叶体积男性大于女性，双侧枕叶体积基本一致。枕叶体积不易随年龄增长而出现萎缩。     

三维可视化技术在肝胆外科临床解剖教学中的应用研究

目的：探讨三维可视化技术在肝胆外科临床解剖教学中的应用价值。方法：选取30名就读于复旦大学附属中山医院外科学专业研究生，分别完成传统教学方法和三维可视化教学方法。传统教学方法基于外科学教材、肝脏解剖图谱、肝脏增强CT图像和手术录像，三维可视化教学基于增强CT的肝脏三维可视化模型和手术录像。每种教学方法结束后，受培训学生分别完成对应的评估量表，包括受培训者主观评价、肝脏脉管解剖、肝段解剖和模拟手术规划4个方面评估内容。结果：三维可视化教学方法下的受培训学生主观评价得分显著高于传统二维影像教学方法得分[（33.3±5.4）分vs（22.0±9.2）分，P<0.001]。三维可视化教学下的学生在掌握肝脏基本脉管解剖得分[（30.5±6.3）分vs（19.8±9.2）分，P<0.001]、肝脏空间脉管解剖得分[（15.9±2.5）分vs（10.0±4.6）分，P<0.001]和模拟手术规划得分[（16.1±2.7）分vs（11.4±4.5）分，P<0.001]的得分能力上均优于传统教学方法；而2种教学方法下受培训学生对于掌握肝段解剖得分能力方面则差异无统计学意义[（16.7±9.3）分vs（15.7±9.9）分]。结论：基于三维可视化技术的临床教学在临床医学生中有较高的接受度，其教学效果总体上优于传统教学方法，可有效提高教学质量和效率，值得推广应用。     

阈值提取法用于压缩感知3D mDIXON肝脏脂肪定量的可行性

目的 探讨肝脏阈值提取法用于压缩感知3D mDIXON肝脏脂肪定量的可行性。方法 对28名健康志愿者以加速因子2行肝脏压缩感知3D mDIXON序列扫描。由2名影像科医师分别采用阈值提取法和传统轴位ROI法测量全肝脂肪含量，并记录2种方法测量脂肪分数的时间；分析2种方法定量肝脏脂肪分数的可重复性及2种方法测量结果的相关性。结果 2名医师采用阈值法获得的脂肪分数分别为（3.53±1.34）%及（3.40±1.24）%，一致性较好（ICC=0.996，P=0.001）；采用传统轴位ROI法测量的脂肪分数分别为（2.35±1.35）%及（2.31±1.13）%，一致性亦较好（ICC=0.994，P=0.001）。阈值提取法[（3.47±1.29）%]和轴位ROI法[（2.45±1.30）%]获得的肝脏脂肪分数呈高度正相关（r=0.997，P=0.001）。阈值提取法平均测量时间（3.2±0.8）min，轴位ROI法平均测量时间（5.0±0.3）min。结论 阈值提取法可方便快捷地用于压缩感知3D mDIXON肝脏脂肪定量。     

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.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

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.