Effects of acute static,ballistic, and PNF stretching exercise on the muscle and tendon tissue properties

The purpose of this study was to investigate the influence of a single static, ballistic, or proprioceptive neuromuscular facilitation (PNF) stretching exercise on the various muscle‐tendon parameters of the lower leg and to detect possible differences in the effects between the methods. Volunteers (n = 122) were randomly divided into static, ballistic, and PNF stretching groups and a control group. Before and after the 4 × 30 s stretching intervention, we determined the maximum dorsiflexion range of motion (RoM) with the corresponding fascicle length and pennation angle of the gastrocnemius medialis. Passive resistive torque (PRT) and maximum voluntary contraction (MVC) were measured with a dynamometer. Observation of muscle‐tendon junction (MTJ) displacement with ultrasound allowed us to determine the length changes in the tendon and muscle, respectively, and hence to calculate stiffness. Although RoM increased (static: +4.3%, ballistic: +4.5%, PNF: +3.5%), PRT (static: ?11.4%, ballistic: ?11.5%, PNF: ?13,7%), muscle stiffness (static: ?13.1%, ballistic: ?20.3%, PNF: ?20.2%), and muscle‐tendon stiffness (static: ?11.3%, ballistic: ?10.5%, PNF: ?13.7%) decreased significantly in all the stretching groups. Only in the PNF stretching group, the pennation angle in the stretched position (?4.2%) and plantar flexor MVC (?4.6%) decreased significantly. Multivariate analysis showed no clinically relevant difference between the stretching groups. The increase in RoM and the decrease in PRT and muscle‐tendon stiffness could be explained by more compliant muscle tissue following a single static, ballistic, or PNF stretching exercise.     

实时超声引导静脉穿刺在增强CT检查肥胖患儿中的应用价值

目的 探讨实时超声引导及动脉穿刺针用于肥胖患儿肘正中静脉穿刺置管进行增强CT检查的临床效果及优势.方法 选取2013-12至2015-10我院小儿骨科及骨肿瘤科收治年龄5～14周岁,体重指数BMI＞ 24,拟行肘正中静脉穿刺置管的患儿共60例进行本研究,按计算机生成随机数字表分为传统操作方法组(TM组,n=30)及实施超声引导组(UG组,n =30).观察并记录两组的穿刺准备时间、穿刺置管时间、总时间、进针次数及成功率,置管成功后即刻及置管后24 h观察并记录有无并发症的发生,置管后24h随访家长对穿刺工作满意度.结果 US组穿刺置管前准备时间(3.4 0.7)min较TM组(1.9 0.7)min较长,差异有统计学意义(P＜0.01),穿刺置管时间明显短于TM组[TM组(3.8 ±4.9)min vs US组(1.4±0.5) min,P=0.041],两组患者总操作时间差异无统计学意义;US组进针次数均为1针,明显少于TM组(TM组2.0±1.8次vs US组1.0±0.0次,P=0.028),两组患儿出现并发症情况、患儿配合度及家长满意度差异无统计学意义.结论 超声引导肘正中静脉穿刺可以明显缩短穿刺时间,明显减少反复进针次数,提高置管成功率,避免并发症发生.     

Effects of an alveolar recruitment manoeuvre guided by lung ultrasound on anaesthesia‐induced atelectasis in infants: a randomised,controlled trial

Atelectasis occurs in the majority of children undergoing general anaesthesia. Lung ultrasound has shown reliable sensitivity and specificity for diagnosing anaesthesia‐induced atelectasis. We assessed the effects of a recruitment manoeuvre on atelectasis using lung ultrasound in infants undergoing general anaesthesia. Forty infants, randomly allocated to either a recruitment manoeuvre group or a control group, received volume‐controlled ventilation with 5 cmH₂O positive end‐expiratory pressure. Lung ultrasound examination was performed twice in each patient, the first a minute after starting mechanical ventilation of the lungs and the second at the end of surgery. Patients in the recruitment manoeuvre group received ultrasound‐guided recruitment manoeuvres after each lung ultrasound examination. The incidence of significant anaesthesia‐induced atelectasis at the second lung ultrasound examination was less in the recruitment manoeuvre group compared with the control group (25% vs. 80%; p = 0.001; odds ratio (OR) 0.083; 95% confidence interval (CI): 0.019–0.370). The median (IQR [range]) lung ultrasound scores for consolidation and B‐lines on the second examination were lower in the recruitment manoeuvre group compared with the control group; 6.0 (3.0–9.3 [0.0–14.0]) vs. 13.5 (11.0–16.5 [8.0–23.0]); p < 0.001 and 6.5 (3.0–12.0 [0.0–28.0]) vs. 15.0 (10.8–20.5 [7.0–28.0]); p < 0.001, respectively. The lung ultrasound scores for consolidation on the first and second examinations showed a negative correlation with age (r = ?0.340, p = 0.008; r = ?0.380, p = 0.003). We conclude that ultrasound‐guided recruitment manoeuvres with positive end‐expiratory pressure proved useful in reducing the incidence of anaesthesia‐induced atelectasis in infants, although 5 cmH₂O positive end‐expiratory pressure alone was not sufficient to eliminate it. In addition, the younger the patient, the more susceptible they were to atelectasis.     

超声对TIPS术后分流道功能评估的方法学研究

对60例肝硬化患者行经颈静脉肝内门体分流术(TIPS),分别在术前及术后1周、1、3、6、12个月行多普勒超声检查,比较术后1周与术前疗效,并采用凸阵探头CDFI、B-flow及相控阵探头CDFI 3种模式监测分流道功能,数据显示术后1周门静脉内径、脾脏大小显著下降,门静脉流速显著增快,胃左静脉血流方向以向肝血流为主.凸阵探头CDFI、B-flow模式以及相控阵探头CDFI模式对TIPS分流道全程血流显示率分别为82.4%、74.0%及97.9%.数据分析表明相控阵探头CDFI模式对判断分流道闭塞具有较高准确性;"至少2种模式显示局部充盈缺损和(或)局部血流加速"的方法有利于判断分流道内血栓存在或狭窄;同时,结合患者腹水变化、胃左静脉血流方向、临床一般症状等,更加有利于判断TIPS分流道功能状态.     

睾丸畸胎瘤的超声诊断价值

目的：探讨超声在睾丸畸胎瘤诊断中的应用价值。方法：回顾性分析20例睾丸畸胎瘤的二维声像图特点和彩色多普勒表现，并与手术及病理结果对照分析。结果：在20例睾丸畸胎瘤病灶中，成熟型畸胎瘤11例，未成熟型畸胎瘤6例，畸胎瘤恶变1例，合并精原细胞瘤1例，混合性生殖肿瘤1例。睾丸畸胎瘤的声像图表现：体积大小不等，内呈囊实性回声或不均质实性回声，内伴强回声，后方伴声影，大部分肿物周边可见正常睾丸组织。结论：睾丸畸胎瘤的声像图表现有较高的特异性，高频超声可以作为临床辅助诊断睾丸畸胎瘤的重要方法。     

The role of imaging in the surveillance and diagnosis of hepatocellular cancer

A decision support tool has been developed as part of a suite of on‐line evidence‐based and consensus‐based guidelines Diagnostic imaging Pathways (DIP): www.imagingpathways.health.wa.gov.au ) in the form of an algorithmic flow chart with supporting evidence and consensus to inform referrers to diagnostic imaging and radiologists as to the optimum strategy for surveillance and diagnosis of primary hepatocellular cancer (HCC) in those patients with risk factors of this disease. A literature review, including reference to several international consensus‐based expert guidelines, has been employed to develop this tool.     

Ultrasound‐Guided Fasciotomy for Anterior Chronic Exertional Compartment Syndrome of the Leg

Chronic exertional compartment syndrome is characterized by exertional pain and elevated intracompartmental pressures affecting the leg in physically active young people. In patients who have failed conservative measures, fasciotomy is the treatment of choice. This study presents a new method for performing fasciotomy using high‐resolution ultrasound (US) guidance and reports on the clinical outcomes in a group of these patients. Over a 3‐year period, 7 consecutive patients with a total of 9 involved legs presented clinically with anterior compartment chronic exertional compartment syndrome, which was confirmed by intracompartmental pressure measurements before and after exercise. After a US examination, fasciotomy under US guidance was performed. Preoperative and postoperative pain and activity levels were assessed as well as number of days needed to “return to play.” All patients had a decrease in pain, and all except 1 returned to presymptomatic exercise levels with a median return to play of 35 days.