Clinical Mimics: An Emergency Medicine–Focused Review of Syncope Mimics

Background

Syncope is an event that causes a transient loss of consciousness (LOC) secondary to global cerebral hypoperfusion. The transient nature of the event can make diagnosis in the emergency department (ED) difficult, as symptoms have often resolved by time of initial presentation. The symptoms and presentation of syncope are similar to many other conditions, which can lead to difficulty in establishing a diagnosis in the ED.

基于Mimics软件虚拟人膝关节三维图像融合实验

背景:国内外已有学者利用不同的方法对人体膝关节进行三维建模,根据各自研究侧重点不同,在方法和最终效果上各有不同。目的:根据不同模态中膝关节影像的特点,将膝关节建模结果进行配准、融合,为进一步生物力学研究提供一种方便的方法。方法:采用MimicsV10.0软件根据膝关节在CT和MR断层图像的特点,选择不同分割算法进行膝关节解剖组织分割,并对不同的分割图像进行三维重建。结果与结论:基于逆向工程原理,利用虚拟人膝关节连续CT断面图像分别重建出膝关节的骨性结构如股骨、胫骨、腓骨、髌骨;并利用膝关节的连续MRI断面图像重建出半月板、髌韧带、内侧副韧带、前交叉韧带、后交叉韧带等结构,并成功对上述结构进行融合,融合后的三维膝关节模型可以任意角度或单独观察,并可以进行体视学测量。说明通过不同模态图像融合的方法可以建立膝关节的三维模型,为计算机辅助膝关节损伤康复研究奠定基础。     

Bestandsaufnahme der Schmerzsituation von Schwerstverletzten zwei Jahre nach Trauma

Background and objectives

Trauma patients often suffer from persisting pain even years after injury, and data on long-term pain management is lacking. The aim of this study was to evaluate the frequency of persisting pain and health-related quality of life (HrQoL) among trauma victims 2 years after injury. Furthermore, the frequency of pain specialist consultation and the quality of outpatient pain management, including phamacological management, was assessed.

Materials and methods

We analyzed prospectively collected data on severely injured adult patients treated between 2008–2011 at the Cologne Merheim Medical Center (CMMC)/Germany.  Data included the ‘Polytrauma Outcome Profile’ and a standardized questionnaire on outpatient pain management. Exclusion criteria were death, inability to answer the questionnaire due to cognitive disabilities and lack of language knowledge.

Results and conclusions

207/391 (53?%) data sets were available for analysis, presenting a typical trauma collective with injury severity of ISS 19, predominantly male and a mean age of 44 years. 2 years after trauma 59?% still reported that they suffered from severe persisting pain; 53?% of these patients were under pharmacological pain medication. Only 1/5 of the patients with severe persisting pain was treated by a pain specialist. Successful treatment options do exist; improvement of treatment is required.

     

An Emergency Medicine–Focused Review of Seizure Mimics

Background

Seizures result in a change in motor, sensory, and behavioral symptoms caused by abnormal neurologic electrical activity. The symptoms share similar presentations of several other conditions, leading to difficulties in diagnosis and frequent improper management.

Labrumrekonstruktion – wie ist die Evidenz?

Background

The labrum is a biomechanically important structure of the hip joint. In the event of labral loss the new technique of labral reconstruction is aimed at restoring the anatomy and function of the labrum and thus prevention of joint degeneration.

Objective

The results and evidence relating to labral reconstruction are presented.

Material and methods

The currently available studies were evaluated and the biomechanical and clinical articles on labral reconstruction are discussed.

Results

There are a large number of different indications and surgical variants of this procedure. Biomechanical and clinical studies concerning labral defects show that the situation is improved by a reconstruction.

Discussion

As a result of the small number of cases and the low quality of the publications, there is as yet a lack of clinical evidence concerning this new surgical method. The biomechanical results suggest that reconstruction of a segmental labral defect is plausible for selected cases. Initial clinical results have to be confirmed by further studies in the long term.

     

Präventionsprogramm „Aktiv von Kopf bis Fuß“

By virtue of specific diagnostic workup, manual medicine is capable of identifying functional disorders early and avoiding future structural dysfunctions. In addition to supervised preventive exercises, patients can also perform exercises independently, during their daily routine at work or at home. This article presents the “Active from Head to Toe” prevention program. Specific target-oriented exercises were selected and combined under consideration of manual medical aspects as well as our experiences in manual therapy. Activation of core stability forms the basis of all exercises. This simultaneously stimulates body awareness as well as concentration and relaxation. Via repeated referral to this central concept during the program, the goal of automized behavior is pursued.     

基于Mimics软件虚拟人膝关节三维图像融合实验

背景：国内外已有学者利用不同的方法对人体膝关节进行三维建模,根据各自研究侧重点不同,在方法和最终效果上各有不同。目的：根据不同模态中膝关节影像的特点,将膝关节建模结果进行配准、融合,为进一步生物力学研究提供一种方便的方法。方法：采用MimicsV10.0软件根据膝关节在CT和MR断层图像的特点,选择不同分割算法进行膝关节解剖组织分割,并对不同的分割图像进行三维重建。结果与结论：基于逆向工程原理,利用虚拟人膝关节连续CT断面图像分别重建出膝关节的骨性结构如股骨、胫骨、腓骨、髌骨;并利用膝关节的连续MRI断面图像重建出半月板、髌韧带、内侧副韧带、前交叉韧带、后交叉韧带等结构,并成功对上述结构进行融合,融合后的三维膝关节模型可以任意角度或单独观察,并可以进行体视学测量。说明通过不同模态图像融合的方法可以建立膝关节的三维模型,为计算机辅助膝关节损伤康复研究奠定基础。     

Mimics软件在个体化全髋关节假体翻修中的应用

背景：人工髋关节翻修中髋臼骨质缺损常常是难以定位及定量的,因而利用计算机辅助设计与计算机辅助加工技术进行置换前准备可减少髋臼重建的难度及风险。目的：探讨Mimics软件在个体化全髋关节假体翻修中的应用及意义。方法：将全髋关节翻修患者髋关节CT扫描图像数据导入Mimics软件,重建髋关节三维模型。测量髋关节假体前倾角、外翻角、颈干角、股骨头直径、髋臼壁厚度/直径以及假体松动破碎情况,对髋臼骨质缺损范围进行定位以及定量,同时通过模拟翻修,设计植骨范围,拟植入全髋关节假体规格。结果与结论：通过Mimics三维窗口,精确定位该破碎假体,碎片最大纵径预测33.68mm,距离股骨头假体距离48.93mm,距离髋臼假体20.14mm。髋臼选取130.47mm2可视区域平均阈值339.98,骨质缺损区130.47mm2可视区域平均阈值-481.25,缺损面积21.41mm×21.38mm,根据三维模型评估骨质缺损并分类：AAOS分类ⅠB型,Gross分类ⅡA型,Engh分类Ⅰ型。结果证实,在髋关节翻修中借助Mimics软件可优化置换方案及方式,减少并发症,降低置换风险。     

Quantitative Analysis of Hepatic Microcirculation in Rabbits After Liver Ischemia-Reperfusion Injury Using Contrast-Enhanced Ultrasound

Previous studies have shown that contrast-enhanced ultrasound (CEUS) can be used quantitatively to analyze microcirculation blood perfusion in hepatocellular carcinoma patients. However, limited data have described the application of CEUS in hepatic microcirculation after liver ischemic-reperfusion injury (IRI). The purpose of this study was to explore the use of CEUS quantitatively to assess liver microcirculation after liver IRI. We randomly sorted 45 New Zealand rabbits into 3 groups (15 in each). Group A was a control group in which the rabbits underwent laparotomy alone. In groups B and C, hepatic blood was blocked for 30 min. Simultaneously, rabbits in group C underwent left lateral lobe resection. After 30 min of ischemia, CEUS was conducted after 0 h, 1 h, 6 h and 24 h of reperfusion in the 3 groups. Time-intensity curves (TICs) for CEUS were constructed and quantitative parameters (maximum intensity [IMAX], rise time [RT], time to peak [TTP] and mean transit time [mTT]) were obtained. In addition, serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were computed to estimate liver function before the operation and at 0 h, 1 h, 6 h and 24 h after reperfusion, respectively. Pathologic changes in the liver after reperfusion were also observed. Simultaneously, the correlations between serum transaminase and a variety of quantitative analysis parameters were analyzed. In groups B and C, the IMAX value decreased; whereas RT, TTP, mTT and serum ALT and AST levels increased significantly in comparison with those in group A after 0 h and 1 h of reperfusion. The pathology revealed that erythrocytes were destroyed and microcirculation was disturbed. Then, at 6 h of reperfusion, the IMAX continued to decrease. Additionally, the levels of RT, TTP, mTT and serum ALT and AST increased in comparison with those at 1 h of reperfusion. The pathologic analysis revealed inflammatory cell aggregation and leukocyte infiltration. After 24 h of reperfusion, the IMAX was reduced in comparison with that of the 6-h group. The levels of RT, TTP, mTT and serum ALT and serum AST were increased in comparison with that of the 6-h group. These findings were in accordance with the pathologic analysis. In addition, serum transaminase had a negative correlation with IMAX (p < 0.001) and a positive correlation with RT, TTP and mTT (all p < 0.001). So, in conclusion, the quantitative analysis of CEUS can be used to assess hepatic microcirculation after liver IRI.     

Mimics软件在Ⅲ型Pilon骨折治疗中的临床应用

目的分析Mimics软件在Ⅲ型Pilon骨折治疗中的临床应用疗效。方法选取2015年5月至2016年4月本院收治90例Ⅲ型Pilon骨折患者作为研究对象,按照随机数字表将其分为对照组(n=45)及试验组(n=45),对照组采用常规内固定方法进行治疗,试验组Mimics 10.0软件进行三维实体重建后在进行内固定的治疗,对比两组手术时间以及患者踝关节恢复情况。结果接受治疗后,试验组的手术时间为(185.6±64.5)min,对照组的手术时间为(145.6±42.5)min,试验组手术时间明显短于对照组(P<0.05);接受治疗12个月之后,试验组的有效率为93.33%,对照组的有效率为77.78%,试验组的功能疗效评价明显好于对照组(P<0.05)。结论在Ⅲ型Pilon骨折治疗过程中应用Mimics软件,可以有效、全面地对患者的骨折情况进行评估,不断优化、完善术前计划,降低手术风险,提高内固定的治疗效果,手术时间大大缩短,值得推广。     

Mimics辅助快速建立颅上颌复合体的三维有限元模型

背景:颅颌面部是骨骼系统中结构最复杂、功能最多样的的结构之一,要进行颅上颌骨复合体生物力学分析,就必须建立一个精准的三维有限元模型.目的:探索快速建立完整颅上颌复合体三维有限元模型的方法.方法:以牙列完整、咬合关系正常、磨牙为中性关系、牙周组织健康的成年志愿者作为建模素材.进行多层螺旋CT扫描,利用Mimics软件和MSC.Patran软件建立颅上颌复合体三维有限元模型.结果与结论:探索出一条快速建立颅上颌复合体三维有限元模型的新方法.建立了三维坐标系下的可以从任意角度观察的健康人颅上颌复合体三维重建生物医学模型和三维有限元模型,由76 035个节点和373 819个单元组成.该模型具有较好的几何相似性和力学相似性.     

Mimics软件三维重建全骨盆几何模型模拟骨盆肿瘤切除假体置换

背景:CT扫描所得DICOM数据在Mimics软件中的运用是目前国际上公认的计算机辅助手术的"金标准".目地:探索一条可行的计算机辅助手术途径.方法;将骨盆肿瘤病例CT扫描图像数据导入Mimics10.01软件,三维重建包含髂血管的全骨盆几何模型,并按EnnekingandDunhan提出的标准分型,该病例为Type Ⅱ型.利用mimics软件的三维重建全骨盆几何模型的各项数据进行术前测量,设计肿瘤切除范围,并进行模拟肿瘤切除假体置换.结果与结论:利用mimics软件重建的全骨盆三维几何模型可准确反映骨盆的三维立体结构和预测肿瘤的大小,并可进行任意旋转观察,精确测量出相关的各项指标.为定制假体提供有意义的参考数据,有效实现了骨盆肿瘤广泛切除特制假体置换术的模拟.结果提示Mimics软件重建的包含髂血管的全骨盆几何模型可立体直观显示骨盆内部解剖结构并明确肿瘤分型.Mimics可以为术前设计和手术模拟提供快捷、便利、精确、可重复运用的模型.     

Team-focused Cardiopulmonary Resuscitation: Prehospital Principles Adapted for Emergency Department Cardiac Arrest Resuscitation

Background

Out-of-hospital cardiac arrest has high rates of morbidity and mortality, and a growing body of evidence is redefining our approach to the resuscitation of these high-risk patients.

基于Mimics软件个体化重建咯血模型在呼吸内科护理教学中的应用

目的 探讨Mimics软件三维重建咯血模型在护理教学中的应用效果。方法 采用便利抽样法选取2020年1月至2021年12月在杭州市某医院实习的47名护生作为研究对象,其中2020年1-12月入科的25名实习护生为对照组,采取传统教学模式;2021年1-12月入科的22名实习护生为试验组,采取基于三维影像辅助的教学模式。评价并比较两组实习护生的理论知识考核、实践技能考核成绩及自主学习能力、临床思维能力、护患沟通能力等。结果 试验组实习护生的理论知识考核成绩及自主学习能力、临床思维能力、护患沟通能力得分均高于对照组(均P<0.05);实践技能考核成绩与对照组相比,差异无统计学意义(P>0.05)。结论 基于Mimics软件的三维影像辅助教学模式,可激发实习护生的学习积极性,提高教学效果。     

Hepatic Artery Rupture in a Young Man with Abdominal Pain and a Testicular Mass

Background

Male patients presenting to the emergency department (ED) with abdominal pain accompanied by a testicular mass should be evaluated for the presence of hernia, epididymitis, orchitis, and testicular torsion. When a patient presents with an asymptomatic testicular nodule or mass, the emergency physician should consider testicular carcinoma, a diagnosis that typically warrants no more than prompt urologic outpatient referral.

SAPS II revisited

Objective To construct and validate an update of the Simplified Acute Physiology Score II (SAPS II) for the evaluation of clinical performance of Intensive Care Units (ICU).Design and setting Retrospective analysis of prospectively collected multicenter data in 32 ICUs located in the Paris area belonging to the Cub-Rea database and participating in a performance evaluation project.Patients 33,471 patients treated between 1999 and 2000.Measurements and results Two logistic regression models based on SAPS II were developed to estimate in-hospital mortality among ICU patients. The second model comprised reevaluation of original items of SAPS II and integration of the preadmission location and chronic comorbidity. Internal and external validation were performed. In the two validation samples the most complex model had better calibration than the original SAPS II for in-hospital mortality but its discrimination was not significantly higher (area under ROC curve 0.89 vs. 0.87 for SAPS II). Second-level customization and integration of new items improved uniformity of fit for various categories of patients except for diagnosis-related groups. The rank order of ICUs was modified according to the model used.Conclusions The overall performance of SAPS II derived models was good, even in the context of a community cohort and routinely gathered data. However, one-half the variation of outcome remains unexplained after controlling for admission characteristics, and uniformity of prediction across diagnostic subgroups was not achieved. Differences in case-mix still limit comparisons of quality of care.Electronic Supplementary Material Electronic supplementary material to this paper can be obtained by using the Springer Link server located at .This research was financed by The Clinical Research Program of the French Ministry of Health (PHRC AOM 98-124). ICUs participating in the study are listed in the Appendix