A new analytical cut-off point for determining 18 years of age using MRI on medial clavicular epiphysis

Evaluation of the ossification of the medial clavicular epiphysis plays a key role in forensic age estimation. The purpose of the present study was to assess a new numerical cut-off at the age of 18 years, taking into consideration Magnetic Resonance (MR) images of the medial clavicular epiphysis. We analyzed 163 MR scans of Italian subjects aged between 14 and 25 years. Using the data obtained we calculated two ratios: REM-1 (ratio between the length of the whole epiphysis and the length of the metaphysis) and REM-2 (ratio between the length of epiphyseal-metaphyseal fusion and the length of the metaphysis). In 68 out of 163 cases it was not possible to measure REM-2. The reproducibility was demonstrated using the Intraclass Correlation Coefficient (ICC) (Cronbach’s alpha > 0.80). REM-1 and REM-2 were compared in each category of age (adult and minor) by the Wilcoxon signed-rank test. The cut-off points for measurements of REM-1 and REM-2 were determined by logistic regression. For REM-1, the cut-off scores were 0.83 for all individuals (accuracy = 94.77%) and males (accuracy = 96.05%), and 0.86 for females (accuracy = 92.30%). For REM-2, the cut-off values were 0.40 for all individuals and males (accuracy = 100.00%), and 0.41 for females (accuracy = 100.00%). Finally, receiver operating characteristic (ROC) curves for age classification based on REM-1 and REM-2 were constructed, showing that REM-2 had the highest discriminative power. Thus, a new cut-off model for predicting the age of majority has been introduced, conducting a quantitative analysis thanks to the use of a high-resolution imaging tool.     

Five-year follow-up of clinical and radiological outcomes of LP-ESP elastomeric lumbar total disc replacement in active patients

Background context

The surgical treatment of degenerative disc disease at the lumbar spine may involve fusion. Total disc replacement (TDR) is an alternative treatment to avoid fusion-related adverse events, specifically adjacent segment disease. New generation of elastomeric non-articulating devices has been developed to more effectively replicate the shock absorption and flexural stiffness of native disc.

中医特色护理技术干预混合痔术后疼痛临床研究

目的:观察在常规术后治疗与护理基础上加用中药熏洗结合针刺、耳穴贴压的综合特色护理技术干预混合痔吻合器痔上黏膜环切术(PPH)术后疼痛的效果。方法:将110例PPH术后患者随机分为对照组和观察组各55例。2组术后患者均行常规补液、抗炎、止血等对症处理,术后第1天起常规每天清洁换药,应用吲哚美辛栓术后纳肛,肛泰软膏适量外涂肛周,口服氨酚双氢可待因片,高锰酸钾坐浴,并予疼痛护理、饮食指导、排便指导等护理措施。观察组加予中药熏洗、针刺、耳穴贴压等中医护理技术。2组疗程均为5天。采用视觉模拟评分法(VAS)分别于术后12 h、1天、2天、3天和5天评价疼痛情况,记录术后5天的氨酚双氢可待因片用量;术后1天、3天、5天评定创面水肿、渗液、便血和尿潴留的症状积分。结果:术后1天、3天、5天,2组VAS评分均较术后12 h下降(P<0.01),观察组术后1天、3天、5天的VAS评分均低于对照组(P<0.01)。术后3天、5天,2组症状积分均较术后1天下降(P<0.01),观察组术后3天、5天的症状积分均低于对照组(P<0.01)。术后5天的氨酚双氢可待因片使用量观察组为(8.62±2.11)片,少于对照组的(12.37±2.53)片(P<0.01)。结论:在常规术后治疗与护理的基础上加用中医综合特色护理技术,能更为有效地减轻混合痔PPH术后疼痛,减少镇痛药物的使用,减少术后其他并发症的发生,从而有利于患者的恢复。     

生大黄贴敷神阙穴在经皮肾镜钬激光碎石术后应用观察

目的探讨生大黄贴敷神阙穴配合莱菔子热熨,预防经皮肾镜钬激光碎石术后患者腹胀便秘的效果。方法选取2015年1月—2019年12月收治的行经皮肾镜钬激光碎石术后患者100例,随机分为试验组50例,对照组50例;在临床护理方法相同的基础上试验组采用生大黄加75%酒精调贴敷神阙穴配合莱菔子热熨。结果2组患者腹胀便秘发生率比较差异有统计学意义(P<0.05),试验组发生腹胀便秘发生率明显低于对照组。结论生大黄贴敷神阙穴配合莱菔子热熨有效地预防经皮肾镜钬激光碎石术后患者腹胀、便秘,促进患者康复。     

The effects of human following behaviours on decision making during aperture crossing scenarios

BackgroundEveryday locomotion often requires that we navigate crowded and cluttered environments. Individuals navigating through nonconfined space will require a deviation from the straight path in order to avoid apertures smaller than 1.4 times their shoulder width. When in a crowd, humans will follow the behaviours of those directly in front of them, making changes to their walking speed and direction heading based on the changes made by the people they are following.Research QuestionThe current study aimed to discover whether the decisions made by young adults regarding the passability of an aperture would be influenced by the presence of a leader completing the same nonconfined aperture crossing task.MethodsParticipants (N = 24) walked in a virtual reality environment along a 6.5 m pathway towards a goal while avoiding two virtual poles which created an aperture (0.8–1.8 times the participants’ shoulder widths). For some trials, a sex-matched avatar (shoulder width of 0.8, 1.0, or 1.2 times the participants’ shoulder widths) completed the aperture crossing task, using its own body-scaled information, ahead of the participant.ResultsParticipants walked through apertures smaller than 1.4 times their shoulder width (i.e. critical point) regardless of avatars’ independent behaviours. Participants began to deviate 3.69 m from the aperture on all trials that required a deviation and approached their goal at a slower speed when the avatar was present.SignificanceThis study demonstrates that during a nonconfined aperture crossing task, individuals are not influenced by human following behaviours and will continue to make decisions based on their own body-scaled information.     

补中益气汤联合耳穴贴压对消化道肿瘤癌因性疲乏患者免疫功能及血清皮质醇的影响

目的:探讨补中益气汤联合耳穴贴压对消化道肿瘤癌因性疲乏患者免疫功能及血清皮质醇的影响。方法:选择消化道肿瘤癌因性疲乏患者92例,以随机数字表法分为两组,各46例。对照组常规治疗加耳穴贴压,观察组在对照组基础上加用补中益气汤。对比两组临床疗效、疲劳症状、生活质量、免疫功能指标、血清皮质醇及不良反应。结果:观察组总有效率为80.43%,高于对照组的60.87%(P<0.05)。治疗后两组患者PFS、CD₈⁺均降低,但观察组降低水平更大; 治疗后两组QLQ-C30、CD₃⁺、CD₄⁺及Cor水平均明显升高,且观察组升高幅度更大(P<0.05)。治疗期间对照组未出现明显不良反应,观察组出现2例,组间比较差异无统计学意义(P>0.05)。对照组平均生存时间为(11.80±0.62)个月,观察组平均生存时间为(14.47±0.67)个月,两组比较差异有统计学意义(P<0.05)。结论:补中益气汤联合耳穴贴压可提高消化道肿瘤癌因性疲乏患者临床疗效,延长患者生存期,改善疲劳症状、免疫功能指标,提高生活质量及皮质醇水平。     

Three-dimensional facial volume analysis using algorithm-based personalized aesthetic templates

Three-dimensional stereophotogrammetry is commonly used to assess volumetric changes after facial procedures. A lack of clear landmarks in aesthetic regions complicates the reproduction of selected areas in sequential images. A three-dimensional volumetric analysis was developed based on a personalized aesthetic template. The accuracy and reproducibility of this method were assessed. Six female volunteers were photographed using the 3dMDtrio system according to a clinical protocol, twice at baseline (T1) and twice after 1 year (T2). A styrofoam head was used as control. A standardized aesthetic template was morphed over the baseline images of the volunteers using a coherent point drift algorithm. The resulting personalized template was projected over all sequential images to assess surface area differences, volume differences, and root mean square errors. In 12 well-defined aesthetic areas, mean average surface area and volume differences between the two T1 images ranged from −7.6 mm² to 10.1 mm² and −0.11 cm³ to 0.13 cm³, respectively. T1 root mean square errors ranged between 0.24 mm and 0.62 mm (standard deviation 0.18–0.73 mm). Comparable differences were found between the T2 images. An increase in volume between T1 and T2 was only observed for volunteers who gained in body weight. Personalized aesthetic templates are an accurate and reproducible method to assess changes in aesthetic areas.     

药物联合心理剧治疗对女性抑郁症患者抑郁、自尊、心理资本的影响

目的 探索药物联合心理剧治疗对女性抑郁症患者抑郁情绪、自尊、心理资本的影响，为女性抑郁症的临床治疗提供更多可能性。方法 纳入在重庆医科大学附属第一医院精神科就诊的、符合《国际疾病分类（第10版）》（ICD-10）诊断标准的女性抑郁症患者共50例，采用随机数字表法分为观察组和对照组各25例。在一线抗抑郁药物治疗的基础上，对观察组予以每两月一次、每次四天，共三次易术心理剧治疗，对照组接受一般健康教育。于干预前和干预6个月结束时采用贝克抑郁量表（BDI）、自尊量表（SES）及积极心理资本问卷（PPQ）对两组患者进行评定。结果 ①重复测量方差分析结果显示，抑郁情绪、自尊、心理资本及其各维度在时间测量与分组干预交互作用方面具有统计学意义（P均<0.05）。②简单效应分析结果显示，干预前，观察组及对照组在抑郁情绪、自尊、心理资本及其各维度评分差异无统计学意义（P>0.05）；干预6个月后，两组患者抑郁情绪、自尊、心理资本及其各维度评分差异均有统计学意义（P均<0.05）。结论 抗抑郁药物联合心理剧治疗可能有助于改善女性抑郁症患者抑郁情绪、自尊及心理资本，且其效果较抗抑郁药物联合一般健康教育更好。