Comparative study of direct MR arthrography and CT arthrography with arthroscopic correlation in preoperative evaluation of anterior shoulder instability

Purpose

To compare direct MR arthrography and CT arthrography for the preoperative planning of shoulder anterior instability.

Patients and methods

47 patients were included in this study. 43 patients with clinical history of anterior GHI or recurrent shoulder pain had no clinical findings of rotator cuff abnormality. They experienced multiple anterior dislocations of the shoulder. No patient showed evidence of multidirectional instability or generalized ligamentous laxity. The remaining 4 patients complained of anterior shoulder instability after anchor repair. All the patients underwent direct CT and MR arthrography. The results of CTA and MRA were compared with results obtained from arthroscopy in each patient to detect the sensitivity and specificity of each modality.

Results

The sensitivity and specificity of CTA for bankart lesion are 89.4% and 96.4% respectively and of MRA 94.7% and 96.4%, for Perthes lesion the sensitivity and specificity of CTA are 33.3% and 100% respectively and of MRA 66.6% and 100%, for ALPSA the sensitivity and specificity of CTA are 85.7% and 97.5% respectively and of MRA 100% and 97.5%, for GLAD the sensitivity and specificity of CTA are 80% and 97.6% respectively and of MRA 60% and 97.6%, for SLAP lesion the sensitivity and specificity of CTA are 100% and 100% respectively and of MRA 100% and 100%, for absent or degenerated labrum the sensitivity and specificity of CTA are 100% and 100% respectively and of MRA 66.6% and 97.7%, for post operative recurrent Bankart lesion the sensitivity and specificity of CTA are 100% and 100% respectively and of MRA 50% and 100%, for bony glenoid fracture the sensitivity and specificity of CTA are 100% and 100% respectively and of MRA 66.6% and 97.5%.

Conclusion

CTA and MRA were equivalent in demonstrating labro-ligamentous and cartilaginous lesions associated with shoulder instability. CTA was superior in detecting post operative instability and glenoid rim osseous lesions that are known to be a decisional element in the surgical strategy. Hence, CTA may be considered a method of choice in the preoperative evaluation of shoulder anterior instability.     

Influence of detector collimation and beam pitch for identification and image quality of ground-glass attenuation and nodules on 16- and 64-detector row CT systems: experimental study using chest phantom

OBJECTIVE: The purpose of the present study was to determine the influence of detector collimation and beam pitch for identification and image quality of ground-glass attenuation (GGA) and nodules on 16- and 64-detector row CTs, by using a commercially available chest phantom. MATERIALS AND METHODS: A chest CT phantom including simulated GGAs and nodules was scanned with different detector collimations, beam pitches and tube currents. The probability and image quality of each simulated abnormality was visually assessed with a five-point scoring system. ROC-analysis and ANOVA were then performed to compare the identification and image quality of either protocol with standard values. RESULTS: Detection rates of low-dose CTs were significantly reduced when tube currents were set at 40mA or less by using detector collimation 16 and 64x0.5mm and 16 and 32mmx1.0mm for low pitch, and at 100mA or less by using detector collimation 16 and 64x0.5mm and 16 and 32mmx1.0mm for high pitch (p<0.05). Image qualities of low-dose CTs deteriorated significantly when tube current was set at 100mA or less by using detector collimation 16 and 64x0.5mm and 16 and 32x1.0mm for low pitch, and at 150mA or less by using detector collimation 16 and 64x0.5mm and 16 and 32x1.0mm for high pitch (p<0.05). CONCLUSION: Detector collimation and beam pitch were important factors for the image quality and identification of GGA and nodules by 16- and 64-detector row CT.     

飞行员年度体检疾病谱比较分析

目的 比较2012年陆军航空兵直升机飞行员和空军歼击机飞行员疾病谱,分析其异同,为航卫保障提供依据. 方法 随机抽取参加2012年大体检的陆军航空兵直升机飞行员652人和空军歼击机飞行员830人,分别计算其疾病谱前10位疾病的患病率.分别按年龄分为20～29岁、30～39岁、40岁以上组,计算两个人群各年龄组疾病谱前10位疾病的患病率;计算并比较两个人群各系统疾病的患病人数及其构成比. 结果 ①陆军航空兵飞行员和空军飞行员前4位疾病均为高脂血症、脂肪肝、高尿酸血症、胆囊息肉,患病率分别是15.64％、14.57％、6.44％、5.37％和24.22％、19.85％、14.08％、9.17％.②高脂血症、脂肪肝在陆军航空兵飞行员和空军飞行员各年龄段中均排在前两位.③消化系统疾病与内分泌、营养和代谢疾病在2012年陆军航空兵飞行员和空军飞行员疾病谱中均居前两位,患病率分别是45.66％、26.91％和39.69％、28.37％. 结论 陆军航空兵飞行员主要疾病与空军飞行员基本相似;消化系统疾病及内分泌、营养和代谢疾病是本组飞行员疾病的主要类型;高脂血症、脂肪肝是其主要病种.内分泌、营养和代谢疾病成为影响陆军航空兵飞行员身体健康的重要疾病.     

Gender differences in the pre-competition temporal patterning of anxiety and hormonal responses

AIM: This study examined gender differences in the pre-competition temporal patterning of anxiety and hormonal responses. METHODS: Six male and 6 female field hockey players completed the modified Competitive State Anxiety Inventory-2, including both intensity and direction subscales, and provided saliva and urine samples 24, 2, and 1 hour prior to competition. These samples were analyzed for cortisol, and noradrenaline and adrenaline, respectively. RESULTS: Two x 3 repeated measures ANOVAs revealed significant gender x time interactions for cognitive and somatic anxiety intensity and adrenaline and noradrenaline, but not cortisol. While males' anxiety and hormonal responses demonstrated no significant changes, significant increases in females' anxiety, and significant decreases in their adrenaline and noradrenaline were observed over time. Moreover, while males' anxiety and hormonal responses mirrored each other, this was not the case for the females with increases in females' cognitive and somatic anxiety intensity levels accompanied by decreases in adrenaline and noradrenaline. CONCLUSIONS: Although this study has extended this line of research by adopting a psycho-physiological approach and measuring anxiety intensity and direction in male and female athletes, replication is required with larger samples from a greater diversity of sports.     

Physical activity from rehabilitation to independent community function: the role of physical activity in handicapping conditions.

All ingredients are there--philosophies and principles, models and examples, competent and committed professionals, ready and willing agencies and organizations, and anxious-to-get-involved persons with handicapping conditions. The time has never been so right to go forward and onward to the heights with sport, recreation, and physical activity to produce lives worth living by persons with handicapping conditions. George Washington warned: "We ought not to look back unless it is to derive useful lessons from past errors, and for the purpose of profiting by dearly bought experience." In this case some might advise not to look back at all, because pessimists and disbelievers may be trying to overtake optimists and believers. As Henry David Thoreau stated: "If you build castles in the air, your work need not be lost; that is where they should be. Now put the foundations under them." Physical activity, recreation, and sport are important in physical, mental, emotional, and social adjustment of individuals with handicapping conditions. In many cases, active participation in such activities provides more effective and efficient rehabilitation and therapy than formal rehabilitation and therapeutic modalities and approaches. Throughout history some pioneers striving to introduce and use such techniques and approaches have been rebuffed and rejected by many facets of the medical establishment. Often, progress has come from highly committed advocates from various professional specializations with interests in activity programs for their populations. Although progress continues to be made, much greater recognition by and involvement of the medical profession are needed from the classrooms in medical schools, through all internships and residencies, to hospitals and clinics of all types, and among all medical branches and specialties.     

医院门急诊灾后重建中的问题及对策

目的 探讨医院门急诊在灾后重建中存在的问题和应对策略.方法 以调研、检查、走访、坐谈和问卷等形式,对2008年6月～2009年6月的就诊患者2万人次、社会各界人士800人次、医护人员1600人次进行调查,集成地震后医院门急诊重建中存在的问题,针对问题实施改进措施,对比整改措施实施前后的效果.结果 灾后重建中门急诊面临大...     

New Alcohol and Onyx Mixture for Embolization: Feasibility and Proof of Concept in Both In Vitro and In Vivo Models

Onyx and ethanol are well-known embolic and sclerotic agents that are frequently used in embolization. These agents present advantages and disadvantages regarding visibility, injection control and penetration depth. Mixing both products might yield a new product with different characteristics. The aim of this study is to evaluate the injectability, radiopacity, and mechanical and occlusive properties of different mixtures of Onyx 18 and ethanol in vitro and in vivo (in a swine model). Various Onyx 18 and ethanol formulations were prepared and tested in vitro for their injectability, solidification rate and shrinkage, cohesion and occlusive properties. In vivo tests were performed using 3 swine. Ease of injection, radiopacity, cohesiveness and penetration were analyzed using fluoroscopy and high-resolution CT. All mixtures were easy to inject through a microcatheter with no resistance or blockage in vitro and in vivo. The 50%-ethanol mixture showed delayed copolymerization with fragmentation and proximal occlusion. The 75%-ethanol mixture showed poor radiopacity in vivo and was not tested in vitro. The 25%-ethanol mixture showed good occlusive properties and accepted penetration and radiopacity. Mixing Onyx and ethanol is feasible. The mixture of 25% of ethanol and 75% of Onyx 18 could be a new sclero-embolic agent. Further research is needed to study the chemical changes of the mixture, to confirm the significance of the added sclerotic effect and to find out the ideal mixture percentages.     

Acquired tracheomalacia: detection by expiratory CT scan

PURPOSE: The purpose of this work was to determine whether cross-sectional area and coronal and sagittal diameter measurements of the trachea between inspiration and end-expiration on CT are significantly different between patients with acquired tracheomalacia and those without this condition. METHOD: Inspiratory and end-expiratory CT scans of the trachea of 23 normal patients and 10 patients with acquired tracheomalacia were analyzed. Percent changes in cross-sectional area, coronal, and sagittal diameters were calculated. RESULTS: For patients with tracheomalacia, mean percent changes in the upper and middle trachea between inspiration and expiration were 49 and 44%; mean changes in the coronal and sagittal diameters in the upper and middle tracheal were 4 and 10% and 39 and 54%, respectively. Control group mean percent changes in the upper and middle tracheal area were 12 and 14%, respectively, and mean changes in the coronal and sagittal diameters in the upper and middle trachea were 4 and 4% and 11 and 13%, respectively. Significant differences were calculated for changes in cross-sectional area and sagittal diameter between groups (p < 10-5). Based on receiver operator curve analysis, a > 18% change in the upper trachea and 28% change in the midtrachea between inspiration and expiration were observed; the probability of tracheomalacia was 89-100%. The probability of tracheomalacia was > 89%, especially if the change in sagittal diameter was > 28%. CONCLUSION: By measuring changes in tracheal cross-sectional area and sagittal diameters between inspiratory and end-expiratory CT, a significant difference can be identified between normal patients and those with acquired tracheomalacia.     

草酸艾司西酞普兰与米氮平治疗抑郁和焦虑共病的疗效对照

目的比较草酸艾司西酞普兰与米氮平抗抑郁和焦虑的共病作用和不良反应。方法 79例同时符合抑郁症和焦虑障碍诊断标准的门诊和住院患者,HAMD17项总分≥18分≤24分、HAMA总分≥15分≤28分。随机分为草酸艾司西酞普兰组（简称A组）和米氮平组（简称B组）,分别口服草酸艾司西酞普兰和米氮平。研究全程5周。结果草酸艾司西酞普兰、米氮平治疗抑郁和焦虑共病疗效相当（P〉0.05）,其显效率分别为75%、72.2%,且均无严重不良反应,用药安全,耐受性好。结论对具有抑郁和焦虑共病的患者可用草酸艾司西酞普兰。     

大鼠星形胶质细胞和少突胶质细胞的纯化培养与鉴定

目的 纯化培养并鉴定大鼠脑组织星形胶质细胞和少突胶质细胞。方法 根据星形胶质细胞和少突胶质细胞的生长时间差异、细胞生长方式及细胞对培养层粘附等特性的不同,改进ＭｃＣａｒｔｈｙ方法纯化培养星形胶质细胞和少突胶质细胞,用免疫组化法对其鉴定。结果 （１）混合培养的星形胶质细胞和少突胶质细胞生长分化状况均优于纯化后的生长,以少突胶质细胞表现更为明显;（２）星形胶质细胞呈向心性生长,细胞相邻的接触面有较多的     

腹腔及腹膜后包虫病的B型超声及CT诊断

目的：探讨腹腔及腹膜后包虫病的B型超声及CT表现特征。材料和方法：回顾分析38例包虫病(29例手术病理证实,38例Casoni试验阳性)的B型超声及CT表现。结果：CT检查24例,表现为单发10例,多发14例；单囊型16例,多囊型8例。B型超声检查35例,表现为单发15例,多发20例；单囊型21例,多囊型14例。B型超声和CT对本病的确诊率分别为71．4%和100%。结论：B型超声和CT检查能准确地显示腹腔包虫囊肿的部位和形态特征,对该病的诊断和治疗有重要意义。     

iNOS、CD34在翼状胬肉中的表达与血管形成的关系

目的探讨诱导型一氧化氮合酶(iNOS)和CD34在翼状胬肉中的表达及其发病过程中的作用。方法采用免疫组化Elivision法检测20例翼状胬肉、10例正常结膜中iNOS和CD34的表达,并检测MVD。结果20例翼状胬肉中iNOS的阳性表达率为80%(16/20),正常结膜中iNOS的阳性表达率为10%(1/10)。CD34在翼状胬肉和正常结膜的阳性表达率分别为85%(17/20)和30%(3/10)。iNOS、CD34阳性表达两组间差异有显著统计学意义(P<0.005)。翼状胬肉和正常结膜中微血管密度(MVD)分别为45.85±11.06和23.64±6.87,两组间差异有显著统计学意义(P<0.001)。结论iNOS、CD34在翼状胬肉中的高表达,提示iNOS、CD34可促进血管形成,可能与翼状胬肉的发生、发展有关。因此,选择性抑制iNOS和CD34可望成为治疗翼状胬肉,减少术后复发的新思路。     

Use trends and geographic variation in neuroimaging: nationwide medicare data for 1993 and 1998.

BACKGROUND AND PURPOSE: Powerful tools, including CT and MR imaging, have revolutionized neuroimaging. These are routinely used, but the extent and variation of use has not been studied. Our purposes were to determine the use rates of MR imaging and CT (of spine, brain, or head and neck), myelography, conventional angiography, and MR angiography in diagnosing neurologic disorders; to study trends in use; and to determine regional variations in use. METHODS: We used the National Part B Medicare Database for 1993 and 1998 to compare rates of use for these procedures in 10 geographic regions. RESULTS: In 1993 and 1998, respectively, 13,897 and 19,431 (39.8% increase) neuroimaging procedures were performed per 100,000 Medicare beneficiaries nationwide. Use of brain or head and neck CT (30.4%) and MR imaging (43.6%), spinal CT (3.5%) and MR imaging (83.0%), myelography (56.6%), and conventional angiography (24.3%) increased in 1998 versus 1993. Increases in MR angiography were not assessed, because this procedure was not reimbursable in 1993. Regional use of brain or head and neck and spinal CT and MR studies varied considerably; ratios of highest and lowest rates were 1.38-1.56. Use of MR angiography, myelography, and conventional angiography varied three- to fourfold. CONCLUSION: Use of MR and CT studies of the brain or head and neck and of the spine increased considerably in the Medicare population between 1993 and 1998. Use of conventional invasive procedures such as myelography and angiography increased strikingly, contrary to the expected decline. Regional use varied substantially.     

An estimate of physical activity prevalence in a large population-based cohort

PURPOSE: The purpose of this study was to describe the prevalence of self-reported moderate and vigorous physical activity (PA) among 40,261 native Californians in relation to age, gender, education, race/ethnicity, and self-reported disease risk factors. METHODS: Subjects, from the California Twin Program, completed a questionnaire that included three PA questions and were categorized by their level of PA: moderate and vigorous PA sufficient to meet CDC and ACSM guidelines. The relationship between demographic variables, chronic disease risk factors, and meeting the PA guidelines are reported. RESULTS: For moderate and vigorous PA, 22.3% and 37.4% of the total group reported meeting the guidelines respectively. Approximately one-half of all subjects met either duration or frequency criteria, but not both, for moderate and vigorous PA. Only 11.2% and 27.4% reported no moderate or vigorous PA, respectively. Significant age and education gradients existed for both moderate and vigorous PA. An inverse association was noted between both moderate and vigorous PA guidelines and prevalence of chronic disease risk factors. Both frequency and duration of PA were required to adequately characterize the association between PA and health outcomes. CONCLUSIONS: These data demonstrate 1) greater prevalence of sufficient moderate and vigorous PA and lower prevalence of sedentary behavior in this sample compared with adults nationwide, 2) a greater association between vigorous PA and improved health outcomes than was observed for moderate PA, 3) PA guidelines must focus on both frequency and duration of activity, and 4) age and education gradients in moderate and vigorous PA that could have implications for more effective targeting of guidelines to improve the PA prevalence of American adults.     

Comparison of three different sit and reach tests for measurement of hamstring flexibility in female university students

BACKGROUND: The sit and reach test is the most common flexibility test used in health related fitness test batteries. OBJECTIVE: To examine and compare three different sit and reach tests as a measure of hamstring flexibility in 102 female students. METHOD: The traditional sit and reach test, the chair sit and reach test, the back saver sit and reach test, and passive straight leg raise were administered in three trials to all 102 students (mean (SD) age 22 (1) years) on the same day. RESULTS: A Pearson correlation coefficient analysis was significant (p<0.01) for the traditional sit and reach test with back saver sit and reach test and flexibility of hamstrings (r = 0.45 and 0.65 for left and right legs, and 0.63 and 0.53 for left and right legs respectively). Also, the back saver sit and reach test for the left (p<0.01) and right (p<0.05) leg was significantly associated with hamstring flexibility (r = 0.37 and 0.25 for the left leg and 0.50 and 0.44 for the right leg respectively). CONCLUSION: The results indicate that the back saver sit and reach test produces reasonably accurate and stable measures of hamstring flexibility. Moreover, it appears that this test is a safe and acceptable alternative to the traditional and chair sit and reach tests as a measure of hamstring flexibility in young women.     

健康成年人膝关节髁间窝宽度与高度的MRI研究及临床意义

目的:以MRI观察健康成年人髁间窝宽度、高度与年龄、性别的相关性,并分析其临床意义。方法:选取150例健康成年人,其中男71例,女79例。按年龄分为3组行膝关节MRI扫描,其中青年组20～29岁,中年组30～49岁,老年组≥50岁。在MRI T2WI图像上测量髁间窝宽度及高度,并分析髁间窝高度、宽度与性别、年龄的关系。结果:青年组50例,男25例,女25例,髁间窝宽度为(22.36±1.93)mm,髁间窝高度为(30.14±3.39)mm;中年组50例,男25例,女25例,髁间窝宽度为(20.98±1.71)mm,髁间窝高度为(28.41±2.51)mm;老年组50例,男21例,女29例,髁间窝宽度为(19.65±2.89)mm,髁间窝高度为(27.27±2.46)mm。髁间窝宽度、高度与年龄呈显著负相关(P<0.000,P<0.000),相关系数r分别为-0.455,-0.378。各组髁间窝高度及宽度的平均值差异均无统计学意义。结论:髁间窝的宽度、高度与年龄具有显著负相关性,即随着年龄的增长,髁间窝宽度与高度均有逐渐变小的趋势。MRI是测量髁间窝大小的准确可靠的影像学方法,具有重要的临床意义。     

MR-guided radiofrequency ablation: do magnetic fields influence extent of coagulation in ex vivo bovine livers?

PURPOSE: To prospectively determine if static magnetic fields of magnetic resonance (MR) imagers affect radiofrequency (RF) ablation coagulation volume and shape. MATERIALS AND METHODS: Ex vivo RF ablations of bovine livers were performed with magnetic field strengths of 0.2, 1.5, and 3.0 T and were compared with ablations performed outside the magnetic field in a control group. Two MR-compatible monopolar RF devices (internally cooled single and cluster electrodes) were systematically tested. Length of long axis (y-axis), length of two short axes (x- and z-axes), and coagulation volume and shape measured outside and inside different magnetic fields were compared with the Dunnett test. Significance level was set to .05. RESULTS: For the single electrode, no significant difference was observed between length of short axes and coagulation volume and shape measured inside and outside the magnetic field. Mean x- and z-axis lengths were 2.3 and 2.6 cm, respectively, outside the magnetic field; 2.4 and 2.4 cm, respectively, at 0.2 T; 2.5 and 2.6 cm, respectively, at 1.5 T; and 2.2 and 2.5 cm, respectively, at 3.0 T. Differences between length of long axis, length of short axis perpendicular to static magnetic field, and coagulation volume and shape achieved with the cluster electrode inside and outside the magnetic field were not significant. Mean x- and z-axis lengths were 3.9 and 3.9 cm, respectively, outside the magnetic field; 3.7 and 3.8 cm, respectively, at 0.2 T; 4.0 and 4.3 cm, respectively, at 1.5 T; and 3.8 and 3.8 cm, respectively, at 3.0 T. Differences between ablations performed at 1.5 T and those performed in the control group with the cluster electrode were significant (P = .026). In this case, a difference of 4 mm in the length of the short axis parallel to the magnetic field was detected, but there was no significant difference in coagulation volume. CONCLUSION: No significant differences in coagulation volume and shape could be recorded between RF ablations performed outside and those performed inside the static magnetic field.     

老年baPWV与股总动脉超声检测参数相关性及影响因素研究

目的 探讨老年肱踝脉搏波传导速度（baPWV）与股总动脉超声参数IMT、AC、β、Ep相关性,分析影响因素.方法 以141例老年人为对象,检测空腹GLU、TC、TG、LDL等生化指标;采用动脉硬化检测仪、高分辨率超声检测baPWV和股总动脉中膜厚度（IMT）、舒张期内径（Dd）及收缩期内径（Ds）,计算超声检测参数顺应性（AC）、僵硬度（β）、弹性系数（Ep）,分析baPWV与上述指标的相关性.结果 baPWV与β、Ep、IMT正相关（P＜0.01,r分别为0.41、0.43和0.48）,与AC负相关（P＜0.01,r=-0.31）.随年龄、TC、LDL和收缩压增高,IMT增厚（P＜0.05）;血糖、血压异常和饮酒者的β、Ep增大,AC下降,血压及饮酒对β、Ep有显著影响（P＜0.05）.baPWV受年龄、吸烟、饮酒、血压、GLU、TC及LDL影响显著（P＜0.05）;Logistic回归分析显示,年龄、收缩压及饮酒为baPWV主要影响因素.结论 老年人baPWV与IMT、AC、β、Ep具有相关性;年龄、收缩压及饮酒为baPWV主要影响因素;影响β、Ep因素包括血糖、血压异常和饮酒;年龄、TC、LDL和收缩压增高是IMT的重要影响因素;动脉硬化检测仪与超声检测相结合,对提高动脉硬化检测准确性、综合判断影响因素更具临床价值.