Doppler imaging of vibrations as a tool for quantifying first tarsometatarsal joint stiffness

Objective. To assess whether first tarsometatarsal joint stiffness can be measured by Doppler imaging of vibrations and if so, to assess reference values.

Design. Repeated in vivo Doppler imaging of vibrations measurements at the first tarsometatarsal joint in healthy persons.

Background. Clinical hypermobility of the first tarsometatarsal joint is an important factor in a hallux valgus deformity. No objective and non-invasive test is available to quantify first tarsometatarsal joint mobility. Doppler imaging of vibrations, a technique recently developed to measure joint stiffness, might be an effective tool to quantify stiffness of this joint.

Methods. Vibrations were applied to the head of the first metatarsal in 46 feet of 23 healthy subjects and picked up by a transducer at both sides of the first tarsometatarsal joint. A pilot study was performed on three patients with hypermobility of the first tarsometatarsal joint. Measurements are expressed in threshold units related to colour Doppler imaging.

Results. The values of the threshold units were found to be very similar in healthy persons, with a good repeatibility; 95% of the healthy persons had a threshold unit below 3.4. No significant difference was found between the left and right foot, or between male and female subjects. Also there was no significant correlation with age or weight of the subjects. In the three patients with first tarsometatarsal hypermobility we found threshold units above 5.

Conclusions. With Doppler imaging of vibrations first tarsometatarsal joint stiffness can be measured in healthy persons in a non-invasive and objective way. In a pilot study, three patients with first tarsometatarsal hypermobility showed lower stiffness values than the healthy subjects.

Relevance This study presents a new method for quantification of first tarsometatarsal joint stiffness and provides reference values in healthy persons. First measurements on patients gave promising results to future use of this method for assessment of clinical hypermobility in hallux valgus patients.     

Tantalum trabecular metal implants in anterior cervical corpectomy and fusion: 2-year prospective analysis

Anterior cervical decompression for two or more cervical spondylotic levels can be performed using either multiple anterior cervical discectomies and fusion or anterior cervical corpectomy and fusion (ACCF). A variety of options for ACCF implants exist but to our knowledge, there is no clinical data for the use of tantalum trabecular metal implants (TTMI) for ACCF. A retrospective review was performed of prospectively collected data for ten patients undergoing ACCF with TTMI between 2011 and 2012. Radiological outcome was assessed by measuring the change in cervical (C) lordosis (fusion Cobb and C2–C7 Cobb), graft subsidence (anterior/posterior, determined by the subsidence of anterior/posterior body height of fused segments; cranial/caudal, determined by the cranial/caudal plate-to-disc distances) and rate of fusion using lateral cervical X-rays of patients at 0, 6, 12 and 24 months post-operatively. The Neck Disability Index (NDI) assessed clinical outcome pre-operatively and at 6, 12 and 24 months post-operatively. Cervical lordosis (Cobb angle of fused segment) was 5.2° (± 4.2°) at 0 months and 6.0° (± 5.7°) at 24 months post-operatively. Graft subsidence was observed to occur at 6 months post-operatively and continued throughout follow-up. Anterior, posterior and caudal subsidence occurred more in the first 12 months post-operatively than in the following 12 months (p < 0.05). Average pre-operative NDI was 45%. Average NDIs were 18%, 13% and 10% at 6, 12 and 24 months post-operatively, respectively. ACCF patients treated with TTMI demonstrated stable cervical lordosis over 2 years of follow-up and 100% fusion rates after 2 years. Measures of subsidence appeared to decrease with time. Patients experienced improved clinical outcomes over the 2-year period.     

妇幼保健医院门诊实施艾滋病PITC策略效果

目的了解在妇幼保健医院实施医务人员提供艾滋病检测咨询（PITC）策略的可行性，探讨艾滋病检测率的影响因素，为在艾滋病防治工作中推广实施PITC策略提供参考。方法2010年6月-2011年8月，选择广州市番禺区妇幼保健医院作为临床医疗机构试点，共选择3个门诊量较大的门诊科室作为试点，收集试点工作报表和访谈结果等资料进行分析。结果项日周期内，共计为57309人提供PITC服务，其中19809人（34．57％）接受艾滋病检测，婚检科、产科和妇科的艾滋病检测人数分别为9817人（100．00％）、6157人（35．63％）和3569人（12.37％）。产科艾滋病检测率高于妇科，差异有统计学意义（X^23514．72，P〈0．01）。在接受检测的19809人中，确认HIV阳性者3人（0．15％。1。产科和妇科调查对象拒绝艾滋病检测的主要原因均为认为自身没有感染艾滋病的可能性，分别占41．00％和59．00％。产科和妇科检测率与前15个月相比，差异均有统计学意义（P〈0．01）。结论在妇幼保健医院实施PITC策略具有可行性，政策支持、检测费用等对PITC的开展有重要影响。     

Magnetic Resonance Imaging and Spectroscopy to Assess Leg Muscle Macrostructure and Microstructure in Healthy Older Women: A Feasibility Assessment

BackgroundAdvanced magnetic resonance (MR) scanning techniques, such as diffusion tensor imaging (DTI) and proton MR spectroscopy (¹H-MRS) permit microstructural evaluation of water diffusivity and intramyocellular lipid content, respectively. We aimed to determine the feasibility of performing advanced MR scanning (proton density [PD] weighted imaging, DTI, and ¹H-MRS) to evaluate properties of leg muscles in older women with respect to: (1) participant recruitment using three community-based strategies; (2) participant tolerance to the MRI scan acquisition protocol; and (3) scan acquisition and analyses protocols.MethodsRecruitment feasibility was evaluated based on the number of participants enrolled using various strategies. Participant tolerance was feasible if the scanning session was uninterrupted and image artifacts were absent. Optimal PD imaging, DTI, and ¹H-MRS acquisition and analyses protocols were established.ResultsNine women (mean age = 71 years) were recruited over four months. The acquisition protocol was well tolerated by all participants. Adaptations were required for women with short stature and vertebral fracture risk. PD-weighted image analyses were improved by using the phased array uniformity enhancement filter to increase tissue contrast.ConclusionsIt is feasible to use a combination of MR scanning methods to evaluate muscle macrostructure and microstructure in the leg of older women. Our findings suggest that advanced MR scanning methods can be used for future studies interested in quantifying components of muscle structure in older women, but prospective studies are needed to confirm whether change in microstructure can be detected in response to an intervention.     

A pilot randomised controlled trial exploring the effects of antenatal reflexology on labour outcomes

Objectiveto investigate the effects of antenatal reflexology on labour outcomes.Designsecondary analysis of a pilot three-armed randomised controlled trial conducted between July 2012 and September 2013.Settinga large UK inner city hospital maternity department.Participantsninety primiparous women with a singleton pregnancy experiencing low back and / or pelvic girdle pain.Interventionssix weekly 30-minute reflexology treatments compared to sham (footbath) treatments or usual antenatal care only.Measurementslabour outcome data including labour onset, duration of the second stage of labour, epidural and Entonox usage, and mode of delivery. Participant feedback was collected prior to each treatment.Findingslabour outcomes were collected for 61 women (95.3%) who completed the study. The second stage of labour duration data, available for 42 women (62.5%) who had vaginal births, showed a mean reduction of 44 minutes in the reflexology group (73.56 minutes; SD= 53.78) compared to the usual care (117.92 minutes; SD=56.15) (p<0.05) and footbath groups (117.4 minutes; SD=68.54) (p=0.08). No adverse effects were reported.Key conclusionsin this trial antenatal reflexology reduced labour duration for primiparous women who had experienced low back and/ or pelvic girdle pain during their pregnancy, compared with usual care and footbaths.Implications for practicereflexology is suitable for use during pregnancy, is safe and enjoyable and may reduce labour duration. Midwives may wish to recommend reflexology to promote normal childbirth and facilitate women centred care.Trial registrationthis trial was listed with the International Standard Randomised Controlled Trial Number Register (ISRCTN26607527).     

Evaluation of progressive hepatic histopathology in long-term tamoxifen therapy

Tamoxifen (TAM) therapy is the better treatment for breast cancer and the drug use the prophylaxis of this disease in young premenopausal women. Yet, the effects associated with this therapy are unknown. To better understand the extension of this problem, we developed an animal model to mimic this therapy, aiming to evaluate its potential biochemical and histopathological changes in the liver. Young cycling female rats were treated with TAM for one, two and three months and toxicological biomarkers and liver histomorphometry were evaluated. Starting at two months, TAM-treatment prevented the normal age-dependent increase in body weight, without inducing changes in food intake. Serum levels of cholesterol and of the metabolic enzymes creatine kinase and aspartate aminotransferase were reduced in all TAM treatment periods. Serum levels of the metabolic enzymes alkaline phosphatase and lactate dehydrogenase were increased after the first month but returned to control levels upon 3 months of drug exposition. Moderate microvesicular steatosis, classified only at the first month of TAM treatment, was reduced afterwards. Our model showed an adaptive response of liver upon 3 months of treatment, suggesting that at the stated conditions, TAM will not promote hepatotoxicity. In this way, the present model may be useful in the study of possible key endocrine effects of TAM use and the search for better clinical outcomes.     

健康飞行员中心动脉反射波增强指数的测定及其临床应用

目的初步观察我军健康现役飞行员中心动脉反射增强指数(augmentation index,AIx)的变化及其影响因素,为招飞及现役飞行员心血管疾病的预防、治疗提供参考。方法采用无创主动脉搏波分析仪(Sphygmocor)对在空军总医院住院、体检、改装的58例现役飞行员中心动脉收缩压(cSBP)及AIx进行定量检测,并随机选择住院体检的63例健康男性人群作为对照组,两组间进行年龄、血压配对比较无差异,并经病史询问无心血管疾病史,体格检查无阳性体征。心电图、X线胸片、肝肾功能、生化全套等检查无异常者。结果两组间临床资料及生化检测指标的比较无统计学差异(P>0.05),健康飞行员组AIx值低于对照组(P<0.05),相关性分析结果表明AIx与年龄呈正相关(飞行员组:r=0.367,P<0.05)。多元逐步回归分析示年龄、cSBP、收缩压、舒张压是健康飞行员AIx的主要影响因素。结论健康飞行员AIx值低于正常健康人,但受年龄、cSBP、收缩压、舒张压影响。AIx值可为招飞及飞行员心血管疾病的预防、治疗提供理论参考。