上、下项线间相关距离测量及临床应用研究

目的　测量完整人颅骨的上、下项线及枕骨大孔间的距离,为临床应用提供数据。 方法　在113例中国成年人正常、干燥颅骨标本上,取枕外隆突最高点、上项线上枕外隆突最高点左、右两侧旁开1 cm、2 cm各取一点,颅骨后正中线上枕外嵴中点及其左、右两侧旁开1 cm点各取一点,从上、下项线所取测量点向枕骨大孔方向作与颅骨后正中线平行的直线,用游标卡尺测量枕骨上、下项线间及上、下项线分别与枕骨大孔间的弧面、直线、垂直及水平距离。 结果　在后正中线上,上、下项线间的距离最小,直线距离为（18.11±2.99）mm、弧面距离为（19.18±2.83）mm、垂直距离为（11.11±3.44）mm、水平距离为（14.65±3.19）mm,向左、右旁开后除水平距离变小,其余各距离指标变大;枕外嵴中点到枕骨大孔后缘间两点的距离最小,直线距离为（21.73±3.35）mm、弧面距离为（22.74±3.47）mm、垂直距离为（10.69±3.44）mm、水平距离为（19.10±3.35）mm,向左、右旁开后,各距离指标变大。 结论　下项线准确定位是临床操作安全和有效的关键,以枕外隆突和上项线可以确定下项线位置,在后正中线上,下项线距上项线的垂直距离最小,为（11.11±3.44）mm。     

眶下孔相关径线测量及定位研究

目的　测量完整人颅骨的眶下孔的相关径线,为临床应用提供数据。 方法　用游标卡尺测量60例（120侧）成人眶下孔内径的长径和短径,并观察孔的形状,观察副孔的数量。测量眶下孔到眶下缘的距离,切此线与面部前正中线平行。测量眶下孔到梨状孔外缘的距离,切此线与面部前正中线垂直。 结果　① 眶下孔为圆孔（10%）和椭圆形孔（90%）;②左右两侧眶下孔副孔总的出现率为2.5%。③眶下孔的长径为（4.24±0.91）mm（2.48~7.59 mm）。④眶下孔的短径为（2.55±0.48）mm（1.37~3.63 mm）。⑤眶下孔到眶下缘的距离为（8.54±1.60）mm（5.16~13.63 mm）。⑥眶下孔到梨状孔外缘的距离为（16.55±2.01）mm（11.73~23.17 mm）。 结论　完善人颅骨眶下孔的形态学资料,为临床开展眶下孔的应用研究提供数据。     

Is forceps more useful than visualization for measurement of colon polyp size?

AIM: To identify whether the forceps estimation is more useful than visual estimation in the measurement of colon polyp size.METHODS: We recorded colonoscopy video clips that included scenes visualizing the polyp and scenes using open biopsy forceps in association with the polyp, which were used for an exam. A total of 40 endoscopists from the Busan Ulsan Gyeongnam Intestinal Study Group Society(BIGS) participated in this study. Participants watched 40 pairs of video clips of the scenes for visual estimation and forceps estimation, and wrote down the estimated polyp size on the exam paper. When analyzing the results of the exam, we assessed interobserver differences, diagnostic accuracy, and error range in the measurement of the polyp size.R E S U LT S : The overall intra-class correlation coefficients(ICC) of inter-observer agreement for forceps estimation and visual estimation were 0.804(95%CI: 0.731-0.873, P 0.001) and 0.743(95%CI: 0.656-0.828, P 0.001), respectively. The ICCs of each group for forceps estimation were higher than those for visual estimation(Beginner group, 0.761 vs 0.693; Expert group, 0.887 vs 0.840, respectively). The overall diagnostic accuracy for visual estimation was 0.639 and for forceps estimation was 0.754(P 0.001). In the beginner group and the expert group, the diagnostic accuracy for the forceps estimation was significantly higher than that of the visual estimation(Beginner group, 0.734 vs 0.613, P 0.001; Expert group, 0.784 vs 0.680, P 0.001, respectively). The overall error range for visual estimation and forceps estimation were 1.48 ± 1.18 and 1.20 ± 1.10, respectively(P 0.001). The error ranges of each group for forceps estimation were significantly smaller than those for visual estimation(Beginner group, 1.38 ± 1.08 vs 1.68 ± 1.30, P 0.001; Expert group, 1.12 ± 1.11 vs 1.42 ± 1.11, P 0.001, respectively).CONCLUSION: Application of the open biopsy forceps method when measuring colon polyp size could help reduce inter-observer differences and error rates.     

Measurement of wave velocity in arterial walls with ultrasound transducers

Arterial wall stiffness can be associated with various diseases. The stiffness of an artery can be measured with the pulse wave velocity (PWV) using the "foot-to-foot" method. However, the foot of the pressure pulse is not very clear, due to reflected waves. The blood pressure pulse generated by the heart is a low frequency wave and its time resolution is low. PWV is an average indicator of artery stiffness between the two measuring positions; therefore, it cannot easily identify local stiffness. In this paper, a sinusoidally modulated force with a high frequency is generated noninvasively on the arterial wall by the radiation force of ultrasound (US). The resulting vibration in the artery is measured with an US Doppler transceiver. The wave velocity in the artery is measured from a wave image obtained by scanning the force transducer and fixing the sensor transducer. Because of the high imposed force frequency, the temporal resolution of this method is much higher than the conventional pressure PWV method. Local wave velocity more than a few millimeters can be measured, which is not possible with the PWV method.     

膝关节后纵隔与后交叉韧带下止点的解剖关系及临床意义

目的 探讨膝关节后纵隔与后交叉韧带(PCL)下止点的解剖关系及其在PCL重建中的临床价值. 方法 解剖22例新鲜冷冻膝关节,将PCL在屈膝90°下按纤维张力的不同分为前外束和后内束,解剖出它们在胫骨上的足迹,并用墨汁标记足迹的轮廓;使用带标尺的数码相机测量PCL前外束、后内束胫骨止点中心点与后纵隔的水平距离,并同时测量两束止点中心点与外侧胫骨平台后软骨缘上表面的垂直距离. 结果 膝关节存在一个从前至后的纵隔结构,其前方与脂肪垫、翼状皱襞或黏膜韧带相连,中间位于前、后交叉韧带之间,后方形成膝关节的后纵隔.在22个膝关节中,8个膝关节的后纵隔从PCL的外缘绕过以后止于后关节囊,占36.36%;14个膝关节的后纵隔在PCL前方分叉,包绕PCL后止于后关节囊,占63.64%.PCL前外束胫骨止点中心点距离后纵隔内侧的水平距离(0.90±2.40)mm,距离外侧胫骨平台后软骨缘上表面的垂直距离是(3.25±1.20)mm.后内束胫骨止点中心点距离后纵隔内侧的水平距离为(4.35±2.46)mm,距离外侧胫骨平台后软骨缘上表面的垂直距离为(6.91±1.57)mm. 结论 膝关节后纵隔与PCL下止点的解剖关系密切,后纵隔可以成为PCL单束重建和双束重建手术中胫骨止点定位的重要解剖标志之一.     

Stronger feelings of loneliness among Moroccan and Turkish older adults in the Netherlands: in search for an explanation

The prevalence of loneliness among Turkish–Dutch and Moroccan–Dutch older adults is higher than among Dutch older adults of non-migrant origin. Three explanations may account for this difference: (1) differential item functioning might result in scores that vary in intensity and in meaning across categories; (2) the position of migrants is much more vulnerable than that of non-migrants; (3) the lack of protective factors has more severe consequences for older migrants. The Longitudinal Aging Study Amsterdam interviewed 176 persons born in Morocco and 235 born in Turkey, aged 55–66 and living in urban areas. They are compared with a matched sample of 292 Dutch persons. The psychometric properties of the loneliness scale are satisfying, although there is some differential item functioning. Older migrants have more frequent social contacts but are at a disadvantage in other domains. Taking into account differences in social participation, satisfaction with income, mastery and depressive symptoms, the difference between older migrants’ and non-migrants’ loneliness is reduced by more than half. Protective factors are equally important for older migrants and non-migrants. Exceptions are marriage (less protective for Moroccans), frequent contact with children/children-in-law (mostly for Turks), a higher educational level (protects Moroccans and Turks) and better physical functioning (less for Turks). Being an older migrant and belonging to a minority might further contribute to feelings of loneliness. Interventions can be directed at stimulating social contact, but also at aspects like enhancing the appreciation of their social status and avoiding negative interpretations of a situation.Electronic supplementary materialThe online version of this article (10.1007/s10433-020-00562-x) contains supplementary material, which is available to authorized users.     

Validation of Modelflow Estimates of Cardiac Output in Hemodialysis Patients

Volume‐clamp technology (e.g. Finometer) has become a popular method of collecting continuous, non‐invasive, hemodynamic information during hemodialysis. There is minimal data validating the technique in this patient group. A gold standard cardiac output measurement can be obtained using ultrasound dilution in patients with arterio‐venous fistulae. Continuous cardiac output was measured in 124 hemodialysis sessions in 27 patients using a volume‐clamp device (Finometer PRO). Ultrasound dilution measurement was first taken at baseline (Transonic HD03), then used to calibrate the Finometer. Ultrasound dilution measurement was repeated 2 h into hemodialysis to assess drift following calibration. Pearson’s correlation and Bland–Altman statistics, modified for repeated measures, were used to assess agreement between methods. Linear mixed models were constructed to identify factors that could explain session‐level and patient‐level variation in agreement. For baseline cardiac output before calibration, agreement between volume‐clamp and ultrasound dilution measurements was poor, at 25 ± 75% (correlation 0.26, P < 0.001). There was significant variation in agreement between patients, with age, peripheral vascular disease and hemodialysis vintage contributing to poorer agreement. For cardiac output 2 h after calibration, agreement was ?5.2 ± 57.5% (correlation 0.6, P < 0.001). Dynamic changes in blood pressure and fluid balance during hemodialysis resulted in greater drift over time after calibration. There was a large error, both random and systematic, in volume‐clamp estimates of absolute, pre‐calibration cardiac output in this prevalent hemodialysis population. There was minimal bias and reasonable correlation for cardiac output 2 h post‐calibration, but limits of agreement remained too wide to meet current clinical standards.     

医疗设备质量控制刍议

从分析医疗设备质量控制的现状人手,结合医疗设备质量控制的临床实践,详细阐述了医疗设备质量控制标准实验室的建立和运行,并提出如何加强医疗设备质量控制的服务和发展.     

The Preliminary Development of the Children’s Overall Satisfaction with Schooling Scale (COSSS)

Schooling is associated with a broad set of outcomes other than just learning. For example, factors related to satisfaction with schooling and school learning are also factors that are known to be related to overall life satisfaction. Because of the importance of school satisfaction in the holistic well-being of students, we have developed a reliable, six-item scale meant to measure elementary-school-aged students’ overall satisfaction with schooling. The scale was developed by administering an initial set of 25 items, from an item pool developed by the Finnish National Board of Education, to 331 Finnish and Dutch students aged from six to 13. After factor and item analysis, six items were chosen for a final response set. The Finnish and Dutch versions of the six-item scale have been shown to exhibit high unidimensionality, internal consistency, and high test-retest reliability. Finnish, Dutch, and English versions of the scale are presented here along with guidelines for the scale’s administration, scoring, and interpretation. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.