Prevalence of viral infection markers by polymerase chain reaction amplification and interferon-alpha measurements among patients undergoing lumbar puncture in an emergency department

Aseptic meningitis is a frequent diagnosis in emergency departments. Nevertheless, viral investigations are not carried out currently and the viral etiology in adult population has not been studied extensively. We conducted a prospective study including all consecutive patients undergoing lumbar puncture during a 15 months period in an adult emergency department. Bloody and purulent cerebrospinal fluid (CSF) were excluded. The main tests undertaken were: CSF genomic amplification by the polymerase chain reaction (PCR) for neurotropic viruses and serum and CSF interferon-alpha (IFN-alpha) measurements. Among 194 patients included, 45 had and 149 did not have aseptic meningitis. Of 45 patients with aseptic meningitis, 10 had alternative non-virological final diagnosis, and 35/45 were presumed to have neurological disorders of viral origin. Patients (27/35) completed virological analysis: 21/27 (78%) had either positive viral PCR (enterovirus: 8 patients, Varicella zoster virus (VZV): 5, Epstein-Barr virus (EBV): 2, herpes simplex virus (HSV): 1, human herpes virus 6: 1) or only raised serum or CSF IFN-alpha (4 patients). Overall, 59% of patients with a positive viral PCR had either CSF or serum raised IFN-alpha. Twentyone patients without meningitis had either positive viral PCR (enterovirus: 3 patients) or only high serum IFN-alpha level (18 patients). In the setting of aseptic meningitis diagnosed in an adult emergency department, viruses are the most common agents encountered, with enterovirus and VZV as the two main etiological agents. Current CSF viral genome amplification and IFN-alpha measurement are informative and could be useful to confirm the viral origin of various neurological disorders, although the sensitivity and specificity of IFN-alpha measurement for the diagnosis of viral infection need further confirmation.     

基于膝关节三维模型的髌股关节动力学特性研究

目的构建有效的膝关节三维模型以计算髌股关节动力学参数。方法基于CT图像处理和CAD技术, 重建包括股骨下端、胫骨上端及髌骨的膝关节的骨骼三维模型,并定义髌股关节运动起重要作用的股四头肌直线模型、韧带及其它软组织的非线性弹性纤维束模型,以股四头肌肉力为输入控制变量。结果构造出一个有效的膝关节三维模型。结论该模型可以有效的计算髌股关节动力学参数。     

Osteotomy around the knee: Assessment of quality,content and readability of online information

BackgroundAs knee osteotomy surgery becomes increasingly accessible, more patients may turn to the Internet for information. This study examined the source, quality, content and readability of online information regarding osteotomy around the knee.MethodsThe first 70 websites returned by the top four search engines were identified using the key words: “knee osteotomy” and “high tibial osteotomy.” The websites were categorised by type and assessed using the DISCERN score, Journal of the American Medical Association (JAMA) benchmark criteria and a novel Knee Osteotomy-Specific Score (KOSS). The presence of the Health On the Net (HON) code accreditation seal was noted. Readability of each website was assessed using eight readability formulae. The mean reading grade level (RGL) was compared to the 6th and 8th grade reading levels. The mean RGL of each category was also compared.ResultsOf the 45 unique websites analysed, the majority were Physician (33%) and Journal websites (31%). The mean DISCERN score was 36.7 (±8.9) which is classified as ‘poor.’ The mean JAMA benchmark criteria score was 2.04 (±1.5) and Physician websites were most likely to be scored zero. The mean KOSS was 15.4 (±5.7). The highest scoring website was a Commercial site but, overall, Journal category sites provided the best quality information. Websites that bore the HONcode seal obtained higher DISCERN, JAMA benchmark criteria and Knee Osteotomy - Specific Scores.The cumulative mean RGL was 13.2 (±2.2) which exceeded the 6th grade level by an average of 7.2 grade levels and the 8th grade level by an average of 5.2 grade levels. No website (0%) was written at or below either the 6th or the 8th grade reading levels. The mean Flesch Reading Ease Score of all websites was 41.13 (±14.7) which is classified as ‘difficult.’ Journal websites had the highest RGL.ConclusionThe information available online regarding osteotomy around the knee varies tremendously in quality and completeness. Physician sites predominate, but these were among the lowest scoring of all websites. Even where high quality information is available, it is set at too high a level to be easily understood.Level of evidenceSurvey of materials – Internet.     

Intra-articular morphine and postoperative analgesia after knee arthroscopy

The aim of this study was to evaluate the postoperative analgesic effect of intra-articular administration of a low- and a high-dose morphine solution after knee arthroscopy. Thirty patients who underwent diagnostic arthroscopy or arthroscopic meniscectomy were allocated in three groups. At the end of the arthroscopic procedure patients in Group A received intra-articularly 20 ml normal saline (N/S), Group B received 5 mg morphine in 20 ml N/S and Group C received 15 mg morphine in 20 ml N/S. The postoperative pain was assessed using a visual analogue scale for 24 h, while all the patients stayed at hospital. Side effects from the central action of opioids were not detected. Although the pain scores in the group of low-dose morphine were lower than in the control group, we failed to detect any significant differences in pain scores among the three groups. There was evidence that a high-dose can cause hyperalgesia.     

长骨内开口效应对其力学性能影响的理论模型研究

建立一个股骨中段的外侧皮质带有矩形开口的力学模型,采用有限元方法,计算骨开口区的尺寸改变时,股骨的扭转刚度和应力分布的变化。结果表明:骨开口长度为骨外径的1倍时(1OD),对股骨扭转刚度和剪应力分布的影响较小;开口长度从2OD增至4OD时扭转刚度急剧减小,而且剪应力的最大值位于开口区中心。本结论对临床骨科的手术治疗方法和骨开口尺寸的控制提供了重要的理论依据。     

膝关节动脉的血液供应

本文通过动脉灌注,对120侧不同年龄(新生儿至87岁)尸体的膝关节骨性部和软组织的血液供应分别进行了研究。新生儿的膝动脉在软骨内分布呈节段性,软骨骨化后,骨骺和髌骨的动脉间建立广泛的吻合。骺软骨板分隔膝关节的骨骺与干骺端。随骺板的闭合,两者间有血管互相交通。骺板的血液供应来自骺动脉、干骺动脉和滋养动脉终末的毛细血管袢以及骨膜动脉网的小支。髌骨的动脉分3组,发自髌前丛和髌周动脉环。滑膜和髌下脂垫的血管分布丰富。肌睫和韧带在骨的附着处缺乏血管。成人半月板外1/5有血管分布,内4/5无血管。本文对膝关节血管分布的临床意义作了简要讨论。     

MR imaging of posteromedial and posterolateral stabilisers of the knee: anatomic basis and patterns of lesions in knee injuries

Summary The angular points are the ligamentous and tendinous structures that reinforce the posteromedial and posterolateral capsule of the knee and share in fixation of the posterior horns of the menisci. They are often damaged in acute injuries and this is usually associated with ruptures of the cruciate and collateral ligaments and may add to the degree of laxity. We describe the normal appearance of these structures in terms of the sectional anatomy, correlated with the lesional appearances of complete and incomplete ruptures and associated meniscal detachments as shown by clinical testing and arthrotomy findings.

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IRM des points d'angle du genou : bases anatomiques et applications aux genoux traumatiques

Résumé Les points d'angle sont des structures ligamentaires et tendineuses qui renforcent la capsule postéro-médiale et postéro-latérale et participent à la fixation des cornes postérieures des ménisques. Leurs lésions, fréquentes au cours des traumatismes aigus, sont généralement associées à des ruptures des ligaments croisés et des ligaments collatéraux et peuvent être source d'une aggravation de la laxité. Nous rapportons, en corrélation avec l'anatomie en coupe, l'aspect normal de ces structures, et en corrélation avec les données de l'arthrotomie et du testing les aspects lésionnels observés au cours des traumatismes : ruptures complètes, incomplètes et désinsertions méniscales associées.

     

膝关节动脉血液供应的初步观察

本文选择固定和新鲜尸体下肢标本57侧,采用局部解剖、动脉铸型、动脉造影和标本透明等方法,对膝关节动脉血液供应作了初步观察。动脉关节支起点变异和共干形式,以右侧居多。膝区各动脉均有特殊的形态和一定的分布区域,在每一局部几个血液供应来源中,总有一个主次关系和层次关系。膝区动脉按口径大小,可以分成3组。口径的变化除了可以评价局部血液供应丰富的程度外,也是衡量相邻动脉大小的指征。整个膝区动脉血液供应配布比较均匀对称。供应膝关节的各动脉起点的高度是恒定的,相互间保持一定关系。本文还就纯关节支和肌关节支的概念、动脉吻合、局部“乏血管区”、髌前动脉网与髌骨血液供应的关系等进行了简单讨论。     

Antagonist moment of force during maximal knee extension in pubertal boys: effects of quadriceps fatigue

The examination of the moment exerted by the hamstrings during maximum isokinetic knee extensor tests is useful when comparing isokinetic strength and muscle activity patterns between children and adults. The purpose of this study was to examine the effect of antagonist moment of the hamstrings on the isokinetic moment of the knee extensors in pubertal children and to determine whether this effect is altered following a fatigue task. Eighteen healthy pubertal males [age 14.3 (0.5) years] performed 34 maximal isokinetic concentric efforts of the knee extensors at 60°·s⁻¹. The average moment of force and electromyographic (aEMG) signal of vastus medialis (VM), vastus lateralis (VL) and biceps femoris (BF) at 11–30°, 31–50°, 51–70° and 71–90° of knee flexion were calculated for each repetition. The hamstrings antagonist moment was determined before and after the fatigue task by fitting the aEMG–moment relationship at different levels of muscle effort using second-degree polynomials. The percentage contribution of the antagonist moment to the resultant joint moment ranged from 7.1 % to 60.4 % throughout the range of motion, with the highest percentage observed close to full knee extension (11–30°). The antagonist effect was significantly greater during concentric tests of the knee extensors compared to the corresponding eccentric tests (p<0.05). Following the fatigue test, there was an overall decline of the resultant joint moment, but no changes in the predicted hamstrings moment were observed. These results indicate that when testing maximal knee extensor isokinetic strength in pubertal boys, activity of the hamstrings implies a reduction of the net extensor moment as compared to the isolated capacity of the knee extensors. However, this antagonist effect is not altered following the performance of an isokinetic fatigue knee extension task. Electronic Publication     

Contraction history affects the in vivo quadriceps torque-velocity relationship in humans

We hypothesized that the history of contraction would affect the in vivo quadriceps torque-velocity relationship. We examined the quadriceps torque-velocity relationship of the human knee extensors at the descending and ascending limb of the torque-position relationship by initiating the knee extension at a knee angle position of 1.39 rad (80°) or 0.87 rad (50°) over a 0.52 rad (30°) range of motion under conditions of constant or linearly increasing velocity. Maximal voluntary isometric knee extension torque (M₀) was measured at 1.87 rad, 0.87 rad, and 0.35 rad, and concentric torque was measured. The subjects carried out ten maximal knee extensions at ten distinct velocities, each velocity ranging between 0.52 rad·s^–1 to 5.24 rad·s^–1 in steps of 0.52 rad·s^–1. Peak concentric torque was measured and mean torque calculated from the respective torque-time curves. Peak or mean torque, computed from the individual torque-time curves, and velocity data were fitted to the Hill equation under the four experimental conditions and the curve parameters computed. The M₀ was similar at 0.87 rad and 1.39 rad, but it was significantly lower at 0.35 rad. In the low-velocity domain of the torque-velocity curve where a plateau normally occurs, peak torque was always lower than M₀. Peak and mean torque were significantly greater under linearly increasing velocity conditions and the 1.39 rad starting knee position. Mean torque but not peak torque data could be well fitted to the Hill equation and the two computations resulted in significantly different Hill curve parameters including the concavity ratio, peak power, and maximal angular velocity. We concluded that the history of contraction significantly modifies the in vivo torque-velocity relationship of the human quadriceps muscle. Muscle mechanics and not neural factors may have accounted for the inconsistencies in the human torque-velocity relationships reported previously. Electronic Publication