后路内固定融合术联合术后伊班膦酸钠治疗创伤性胸腰椎椎体压缩性骨折临床疗效

目的探究后路内固定融合术联合术后伊班膦酸钠治疗创伤性胸腰椎椎体压缩性骨折患者的效果及对VAS评分、Barthel指数的影响。方法 2016年10月—2017年10月汉中市中心医院脊柱科收治胸腰椎椎体压缩性骨折患者90例,按照随机数字表法分为联合组和对照组,各45例。两组患者均接受后路手术内固定融合术治疗,联合组在术后1周联合伊班膦酸钠治疗。比较两组患者的术中指标,检测并比较两组患者治疗前后椎体前缘高度、Cobb角、VAS评分、Barthel指数及骨密度和血清抗酒石酸酸性膦酸酶(TRACP-5b)水平。结果两组的手术时间、术中出血量、切口长度以及住院天数差异无统计学意义(P>0.05)。治疗前两组椎体前缘高度和Cobb角差异无统计学意义(P>0.05),治疗后均显著改善(P<0.05),治疗后6个月联合组椎体前缘高度(24.64±2.53)mm显著高于对照组(19.37±1.56)mm,Cobb角(9.23±2.64)°显著低于对照组(16.31±3.06)°。术后两组VAS评分和Barthel评分均有改善,术后3个月联合组VAS评分(1.74±0.45)分显著低于对照组(2.36±0.54)分(P<0.05),术后6个月联合组Barthel评分(87.42±5.21)分显著高于对照组(81.53±4.75)分(P<0.05)。治疗后两组骨密度和血清TRACP-5b有不同程度改善,联合组的骨密度显著高于对照组,血清TRACP-5b显著低于对照组(P<0.05)。结论使用伊班膦酸钠可减轻接受后路手术内固定融合术患者的疼痛,并可以提高胸腰椎压缩性骨折患者的骨密度,提高疗效。     

后路椎弓根内固定术联合椎体成形术治疗老年胸腰段脊柱骨折疗效分析

【摘要】 目的 探讨后路椎弓根内固定术联合椎体成形术治疗老年胸腰段脊柱骨折的临床疗效。方法 选取2017年2月至2020年2月驻马店段庄孙全贵骨科医院收治的126例老年胸腰段脊柱骨折患者作为研究对象, 并按照不同治疗方法将其分为研究组(63例)与对照组(63例),研究组患者采用后路椎弓根内固定术联合椎 体成形术治疗,对照组患者单纯采用后路椎弓根内固定术治疗,对比观察两组患者 Cobb角、椎管狭窄率(SSR)、椎体高度压缩率、内固定松动率及骨性愈合率。结果 术后 7 d 及术后 6 个月, 研究组患者 Cobb 角、SSR、椎体前缘压缩率及椎体后缘压缩率均明显小于对照组 (术后 7 d: t = 17.860、7.559、6.251、8.402, P均<0.001;术后6个月:t=16.460、9.641、8.122、9.107,P均<0.001); 术后6个月, 研究组患者内固定松动率为4.8%, 与对照组患者的内固定松动率14.3%无明显差异 (χ2=3.316, P = 0.069); 术后 6 个月, 研究组患者骨性愈合率为95.2%,显著高于对照组患者的骨性愈合率 58.7% (χ2=23.695, P<0.001)。结论 后路椎弓根内固定术联合椎体成形术治疗老年胸腰段脊柱骨折, 有利于椎体高度重建, 减少椎管狭窄的发生,促进骨性愈合,治疗效果较好,值得临床推广应用。     

经椎旁肌间隙入路和传统正中入路行GSS内固定系统治疗胸腰段椎体骨折的效果观察

目的探讨椎旁肌间隙入路并通用型脊柱内固定系统(GSS)治疗胸腰段椎体骨折的临床效果。方法采用随机数字表法将2011年3月~2013年8月收治的90例胸腰段椎体骨折患者分为研究组和对照组各45例,研究组患者采用椎旁肌间隙入路+GSS内固定系统治疗,对照组采用传统正中入路+GSS内固定系统治疗,比较两组患者的手术情况、术前术后不同时间的X线片疗效评价指标、手术前后不同时间的腰背部视觉模拟疼痛评分(VAS)及患者Oswestry(ODI)功能障碍指数的变化情况。结果研究组患者的手术时间(86.3±14.7)min、术中出血量(155.7±38.2)m L、术毕切口内残腔体积(10.3±2.6)m L、手术后引流量(106.6±21.7)m L均显著低于对照组患者(P0.05),两组患者的术后住院时间差异不显著(P0.05)。术后1周两组患者的伤椎椎体前缘高度比值、Cobb角测定值较术前均显著好转(P0.05)。术后末次随访研究组的伤椎前缘高度丢失(1.67±0.21)mm、Cobb角丢失(1.45±0.81)°,均与对照组患者比较差异无统计学意义(P0.05)。术后第3个月、末次随访研究组的VAS评分值均显著低于对照组患者(P0.05)。术后末次随访研究组ODI评价为优的比例为75.56%,高于对照组的53.33%,术后末次随访研究组的ODI指数显著高于对照组(P0.05)。结论椎旁肌间隙入路并GSS内固定系统治疗胸腰段椎体骨折具有手术时间短、操作简单、固定牢固可靠、术后患者恢复更加良好的优点。     

横突上嵴椎弓根螺钉置入治疗胸椎骨折的疗效

 目的 探讨采用横突上嵴椎弓根螺钉置入治疗胸椎骨折的临床效果。方法 对本院骨科2012-02至2014-12收治的73例胸椎骨折患者的诊治及随访资料进行分析,根据手术方法分为研究组(39例,采用横突上塉椎弓根螺钉置入治疗)和对照组(34例,采用传统植钉法置入治疗),对两组患者的手术情况及术后12个月的随访情况进行比较分析。结果 研究组的手术时间(189.5±27.9)min、术中出血量(420.4±61.5)ml均显著低于对照组(P＜0.05)。研究组在术后即刻、末次随访时的椎体前缘高度(36.1±1.5)mm、椎体后缘高度(36.2±1.5)mm均显著高于对照组(P＜0.05)。术后即刻研究组的Cobb角(4.1±0.7)°显著小于对照组的(6.2±0.8)°(P＜0.05),术后末次随访研究组的Cobb角丢失度为(2.3±0.5)°显著小于对照组的(3.9±0.8)°(P＜0.05)。研究组的术后并发症率为10.25%低于对照组的14.71%但两组差异无统计学意义。结论 采用横突上塉椎弓根螺钉置入治疗胸椎骨折较传统置钉法置入术能够显著缩短手术时间、减少术中出血,有利于术后患者的恢复且疗效可靠。     

伊班膦酸钠对髋关节置换后假体柄周围骨丢失的预防效果

目的评价全髋关节置换术后伊班膦酸钠的应用对预防股骨假体柄周围骨丢失的临床疗效。方法前瞻性纳入2014年1月—2015年12月汉中市中心医院骨关节创伤科进行全髋关节置换患者100例,采用随机数字表法分为对照组(50例)和试验组(50例),其中试验组患者术后5～7d给予伊班膦酸钠4mg静滴,并于术后每3个月滴注1次。对照组患者不给予,其余治疗方案相同。比较两组患者术前及术后12个月的股骨假体柄周围基于Gruen分区法的7个感兴趣区(region of interest,ROI)的骨密度值改变,以及血钙、磷和碱性磷酸酶水平改变。结果术后12个月,两组股骨假体柄周围骨密度均较术前有所下降,差异有统计学意义(P<0.05),但试验组患者术后12个月的骨密度显著高于对照组,试验组和对照组股骨各测量ROI的骨密度分别为1区(0.94±0.14)g/cm^2vs.(0.81±0.19)g/cm^2,2区(1.54±0.2)g/cm^2vs.(1.34±0.31)g/cm^2,3区(1.71±0.23)g/cm^2vs.(1.39±0.19)g/cm^2,4区(2.04±0.29)g/cm^2vs.(1.74±0.38)g/cm^2,5区(1.81±0.31)g/cm^2vs.(1.62±0.39)g/cm^2,6区(1.62±0.28)g/cm^2vs.(1.40±0.14)g/cm^2,7区(1.21±0.32)g/cm^2vs.(0.94±0.29)g/cm^2,总体均值(1.49±0.32)g/cm^2vs.(1.29±0.41)g/cm^2,差异均有统计学意义(P<0.05)。试验组患者术后12个月的碱性磷酸酶水平显著低于对照组患者[(56.41±8.74)mmol/L vs.(56.41±8.74)mmol/L,P<0.05],但血钙和血磷差异无统计学意义(P>0.05)。试验组中有11例患者在滴注伊班膦酸钠后出现体温升高、头痛、肌肉酸痛等症状,予以对症处理后好转。结论全髋关节置换术后应用伊班膦酸钠能够有效减少股骨假体柄周围骨密度的丢失。     

前、后路内固定融合术治疗脊柱胸腰段骨折的比较研究

目的探讨比较脊柱前、后路内固定融合术治疗胸腰段骨折的临床疗效。方法笔者对2011年1月~2013年12月收治的90例胸腰段骨折患者的临床治疗及随访资料进行回顾性分析,按照手术方式采用前路内固定融合治疗(42例)和后路内固定融合术治疗(48例),统计分析两组患者的术中情况、术后不同时间的X线评价指标、美国脊柱损伤协会(ASIA)神经功能恢复及临床疗效差异。结果后路组的手术时间(147.3±38.7)min、术中出血量(607.5±162.3)m L、手术切口长度(10.3±1.8)cm、术后住院时间(10.6±2.0)d均显著低于前路组患者(P0.05)。术前、术后即刻两组患者的前缘高度比值、Cobb角测量值差异均不具有统计学意义(P0.05)。术后末次随访,后路组术后即刻伤椎前缘高度丢失(1.55±0.17)mm、Cobb角丢失(1.26±0.72)°,均显著低于前路组(7.18±1.51)mm、(7.43±1.85)°。术前、术后后路组和前路组ASIA分布差异不显著(P0.05);术后两组ASIA神经功能恢复分布较术前均显著好转(P0.05)。末次随访时,后路组患者的Oswestry功能障碍指数(ODI)优级率(77.08%)高于前路组(52.38%),良和差均显著低于前路组患者,后路组的ODI功能分布显著优于前路组(P0.05)。结论脊柱后路内固定融合术治疗胸腰段骨折较前路术创伤小、术后恢复快、Cobb角度丢失小,临床疗效更加可靠。     

肌间隙入路椎弓根置钉治疗胸腰段脊柱骨折的临床效果

目的 探讨肌间隙入路(Wiltse入路)椎弓根置钉治疗胸腰段脊柱骨折的临床效果.方法 前瞻性研究2017年1月—2019年10月太仓市第一人民医院骨科收治的100例胸腰段脊柱骨折患者,按随机数字表法分为Wiltse入路组和常规入路组各50例.Wiltse入路组男性29例,女性21例;年龄18～60岁,平均42.2岁;高处坠落伤19例,道路交通伤25例,砸伤6例.常规入路组男性32例,女性18例;年龄18～60岁,平均41.5岁;高处坠落伤17例,道路交通伤28例,砸伤5例.比较两组患者相关康复指标、手术效果、恢复情况及术后切口浅表感染、腰背疼痛等并发症发生情况.结果 Wiltse入路组术中出血量、手术时间、住院时间均少于常规入路组[(119.8±8.3)mL vs.(192.2±10.5)mL、(90.7±6.4)min vs.(119.1±8.7)min、(11.8±1.6)d vs.(15.1±2.0)d,P<0.05].Wiltse入路组术前、术后12个月椎体前缘高度分别为(15.5±1.8)mm、(26.1±3.0)mm,常规入路组分别为(15.2±1.1)mm、(25.3±3.1)mm,两组术后12个月椎体前缘高度较术前均提高(P<0.05);Wiltse入路组术前、术后12个月矢状位椎体Cobb角分别为(23.2±2.5)°、(5.9±0.7)°,常规入路组分别为(22.7±3.3)°、(6.3±1.0)°,两组术后12个月矢状位椎体Cobb角度较术前均降低(P<0.05);两组术后12个月椎体前缘高度、矢状位椎体Cobb角度比较差异均无统计学意义(P>0.05).Wiltse入路组术前、术后6个月Oswestry功能障碍指数问卷表(ODI)评分分别为(40.7±5.2)分、(5.0±0.8)分,常规入路组分别为(39.8±6.4)分、(5.2±0.7)分,两组术后6个月ODI评分较术前均降低(P<0.05),且术后6个月ODI评分两组间比较差异无统计学意义(P>0.05).Wiltse入路组术后总并发症发生率低于常规入路组(2％vs.16％,P<0.05).结论 胸腰段脊柱骨折中实施Wiltse入路椎弓根置钉治疗可减少术中出血量,缩短手术时间及住院时间,其解剖结构及脊柱功能恢复效果与常规入路治疗相当,但可减少术后并发症的发生.     

评价椎弓根螺钉联合连接棒内固定治疗胸腰段脊柱骨折的临床疗效

目的 探讨椎弓根螺钉联合连接棒内固定治疗胸腰段脊柱骨折患者的临床疗效.方法 2015年3月-2016年3月选择接受治疗的胸腰段脊柱骨折患者作为研究对象,共选择108例,所有患者均实施椎弓根螺钉联合连接棒内固定治方式,记录患者的椎体前缘高度、椎体后缘高度及Cobb角,并利用视觉模拟评分量表评价患者疼痛程度,并进行治疗前后各指标的比较,分析椎弓根螺钉联合连接棒内固定治疗的临床疗效.结果 经过椎弓根螺钉联合连接棒内固定治疗后,患者体前缘高度、椎体后缘高度均显著高于对照组,Cobb角与疼痛评价均显著低于对照组,数据比较差异具有统计学意义(P<0.05).结论 对胸腰段脊柱骨折患者采用椎弓根螺钉联合连接棒内固定治疗具有较高的临床疗效,是降低患者疼痛程度的有效措施.     

经椎弓根内侧入路减压复位治疗胸腰段椎体爆裂骨折76例临床疗效分析

目的探讨经椎弓根内侧入路减压复位在治疗胸腰段椎体爆裂骨折合并脊髓神经损伤中的临床疗效。方法回顾性分析2012年8月—2018年12月陆军军医大学大坪医院脊柱外科收治的胸腰段椎体爆裂骨折合并脊髓神经损伤患者76例,男性47例,女性29例;年龄17～61岁,平均35.6岁。骨折AO分型:A1.3型43例,A2.1型19例,A2.2型7例,A3.1型5例,A3.2型2例。按脊髓损伤程度分为完全性脊髓损伤组5例、不完全性脊髓损伤组71例;根据美国脊髓损伤学会(ASIA)感觉评分和运动评分进行评估,所有患者行后路切开经椎弓根内侧入路减压复位、椎弓根钉棒系统内固定及后外侧植骨融合治疗,均于术前、术后末次随访12个月摄脊柱正侧位X线片和CT片,通过术前、末次随访伤椎椎体前缘高度恢复率、Cobb角、椎管侵占率、ASIA评分4个主要指标评估临床疗效。结果所有患者随访12个月,未发生内固定物断裂及椎体前缘高度丢失等并发症;椎体前缘高度恢复率:术前(47.3%±9.8%),术后12个月(87.1%±4.7%),差异有统计学意义(P0.05);Cobb角:术前(29.3°±5.8°),术后12个月(6.3°±2.8°),差异有统计学意义(P0.05);椎管侵占率:术前(29.5%±6.7%),术后12个月(11.3%±5.8%),差异有统计学意义(P0.05);完全性脊髓损伤组感觉评分:术前(150±17)分,术后12个月(175±16)分;运动评分:术前(47±14)分,术后12个月(79±11)分,差异均有统计学意义(P0.05);不完全性脊髓损伤组感觉评分:术前(167±21)分,术后12个月(186±13)分;运动评分:术前(71±15)分,术后12个月(82±14)分,差异均有统计学意义(P0.05)。结论经椎弓根内侧入路减压复位、椎弓根钉棒系统内固定治疗胸腰段椎体爆裂骨折能有效减压、恢复椎体高度、促进脊髓神经功能恢复,临床疗效良好。     

椎弓根外穿刺撬拨复位椎弓根钉固定治疗胸腰椎骨折

目的探讨经椎弓根外穿刺撬拨复位椎弓根螺钉固定治疗胸腰骨折的可行性和有效性。方法回顾性分析2012年2月—2015年3月深圳平乐骨伤科医院收治的64例胸腰椎骨折患者,观察组和对照组各32例,观察组采用经椎弓根外穿刺撬拨复位、植骨、椎弓根钉内固定治疗,对照组采用椎弓根钉棒撑开复位固定、经伤椎椎弓根穿刺植骨治疗。记录手术时间、术中出血量、术后引流量、住院时间;测量术前、术后伤椎体前、后缘高度比和后凸Cobb角;同时对两组患者进行手术前、后VAS评分和Oswestry功能障碍指数评分。结果观察组与对照组相比较,术前VAS评分[(6.782±1.821)%vs.(6.827±1.762)%]、术前伤椎体前缘高度百分比[(57.658±23.645)%vs.(58.162±24.852)%]、术前伤椎体后缘高度百分比[(88.645±8.624)%vs.(87.927±7.848)%]、术前后凸Cobb角[(28.665±4.824)°vs.(29.134±5.508)°]、手术时间[(135.675±23.318)min vs.(130.731±21.761)min]、术中出血量[(456.214±63.525)m L vs.(461.532±60.753)m L]、术后引流量[(43.847±16.358)m L vs.(42.971±15.523)m L]、住院时间[(10.878±2.148)d vs.(11.323±2.512)d]、术后末次随访VAS评分(0.184±0.263 vs.0.195±0.325)和Oswestry功能障碍指数(2.463±0.652 vs.2.624±0.765),差异均无统计学意义(P0.05)。观察组与对照组相比较,术后末次随访伤椎体前缘高度百分比(98.083±1.635)%vs.(93.157±2.019)%、后缘高度百分比[(98.504±2.572)%vs.(96.248±4.824)%]和后凸Cobb角[(3.623±2.563)°vs.(7.626±3.613)°],差异均有统计学意义(P0.05)。结论经椎弓根外穿刺撬拨复位椎弓根螺钉固定治疗Denis B型、D型胸腰椎体压缩骨折、B型椎体爆裂骨折,可较好恢复椎体前、后缘高度,矫正后凸Cobb角。     

Forensic performance of 30 InDels included in the Investigator DIPplex system in Miao population and comprehensive genetic relationship in China

Binary markers of insertion and deletion (InDel) play an important role in forensic personal identification, parentage testing, and individual ancestry inference. We first genotyped 30 InDels included in the Investigator DIPplex in 403 unrelated healthy Zunyi Miao people and analyzed the genetic polymorphisms, as well as explored the genetic relationship between Miao and 32 Chinese reference populations. No departures from the HWE were observed. The combined power of discrimination and the combined probability of exclusion were 0.99999999998 and 0.9884, respectively. Forensic parameters demonstrated that 30 markers are polymorphic and informative in the Zunyi Miao population and can be used as a tool for forensic personal identification and parentage testing. Allele frequency divergence analysis found that 12 out of 30 displaying high allele frequency difference between Turkic-speaking populations and other Chinese populations can be used as candidates of ancestry informative markers for ancestry inference of sub-population in East Asia. Population genetic parameters in the comprehensive population comparison among 33 Chinese populations indicated that our studied Hmong-Mien-speaking Miao has a close genetic relationship with geographically adjacent Enshi Tujia and genetically differentiate from Turkic-speaking populations.

     

Prostatic Artery Embolization Using 100–300-μm Trisacryl Gelatin Microspheres to Treat Lower Urinary Tract Symptoms Attributable to Benign Prostatic Hyperplasia: A Single-Center Outcomes Analysis with Medium-Term Follow-up

PurposeTo report medium-term outcomes of prostatic artery embolization (PAE) using 100–300-μm trisacryl gelatin microspheres to treat lower urinary tract symptoms (LUTS) from benign prostatic hyperplasia (BPH) and to evaluate how cone-beam computed tomography-measured prostate gland volume (PGV), median lobe enlargement (MLE), age, and Charlson Comorbidity Index (CCI) affect these results.Materials and MethodsSeventy-four consecutive patients who underwent PAE from April 2014 through August 2018 were retrospectively reviewed. Patients had International Prostate Symptom Score (IPSS) >12, Quality of Life (QoL) score >2, prostate gland volume (PGV) >40 mL, age older than 45 years, and medical therapy failure. Twelve patients were excluded for bladder pathology or prostate cancer. Patients (n = 62, age = 71.8 ± 9.3 years, CCI = 3.5 ± 1.7, PGV = 174 ± 110 mL) had pre-procedure IPSS = 22.4 ± 5.6, QoL score = 4.4 ± 0.9, and post-void residual (PVR) = 172 ± 144 mL. Post-procedure values were compared to baseline at 1, 3, 6, 12, and 24 months. Associations between outcomes and PGV, MLE, age, and CCI were evaluated. Adverse event recording used Clavien-Dindo classification.ResultsOne month after PAE (n = 37), IPSS improved to 7.6 ± 5.2 (P < .0001) and QoL score improved to 1.7 ± 1.4 (P < .0001). At 3 months (n = 32), improvements continued, with IPSS = 6.4 ± 5.1 (P < .0001), QoL score = 1.2 ± 1.2 (P < .0001), PVR = 53 ± 41 mL (P < .001), and PGV = 73 ± 38 mL (P < .0001). Results were sustained at 6 months (n = 35): IPSS = 6.4 ± 4.1 (P < .0001), QoL score = 1.2 ± 1.2 (P < .0001), PVR = 68 ± 80 mL (P < .0001), PGV = 60 ± 19 mL (P < .001). At 12 months, patients (n = 26) had IPSS = 7.3 ± 5.5 (P < .0001), QoL score = 1.2 ± 0.8 (P <.0001), PVR = 89 ± 117 mL (P < .0001), PGV = 60 ± 48 mL (P < .01). At 24 months, patients (n = 8) had IPSS = 8.0 ± 5.4 (P < .0001), QoL score = 0.7 ± 0.5 (P < .0001), PVR = 91 ± 99mL (P = 0.17), and PGV = 30 ± 5mL (P = .11). Improvements were independent of PGV, MLE, age, and CCI. Two grade II urinary infections occurred.ConclusionsPAE with 100–300-μm microspheres produced sustained substantial improvements in LUTS, PGV, and PVR, which were independent of baseline PGV, MLE, age, or CCI.     

Assessment of intra- and interobserver reproducibility of rest and cold pressor test-stimulated myocardial blood flow with <Superscript>13</Superscript>N-ammonia and PET

Purpose We investigated the intraobserver reproducibility of myocardial blood flow (MBF) measurements with PET at rest and during cold pressor test (CPT), and the interobserver agreement. Methods Twenty normal volunteers were studied. Using ¹³N-ammonia, MBF was measured at rest and during CPT and measurement was repeated in a 1-day session (short-term reproducibility; SR). After a follow-up of 2 weeks, MBF was measured again at rest and during CPT and compared with the initial baseline measurement (long-term reproducibility; LR). In addition, adenosine-induced hyperemic MBF increases were assessed. Results Assessment of the SR did not show a significant absolute difference in MBF at rest, MBF during CPT or the endothelium-related change in MBF from rest to CPT (ΔMBF) (0.09 ± 0.10, 0.11 ± 0.09, and 0.08 ± 0.05 ml/g/min; p = NS), and they were linearly correlated (r = 0.72, r = 0.76 and r = 0.84; p < 0.0001). Corresponding values for standard error of the estimate (SEE), as indicative for the range of MBF measurement error, were 0.14, 0.14, and 0.09 ml/g/min. The LR yielded relatively higher but non-significant absolute differences in the MBF at rest, MBF during CPT and ΔMBF (0.10 ± 0.10, 0.14 ± 0.10, and 0.19 ± 0.10 ml/g/min; p = NS), and paired MBFs significantly correlated (r = 0.75, r = 0.71, and r = 0.60; p < 0.001). Corresponding SEEs were 0.13, 0.15, and 0.16 ml/g/min. The interobserver analysis yielded a high correlation for MBF at rest, MBF during CPT, and hyperemic MBF (r = 0.96, SEE=0.04; r = 0.78, SEE=0.11; and r = 0.87, SEE=0.28; p < 0.0001, respectively), and also a good interobserver correlation for ΔMBF (r = 0.62, SEE=0.09; p < 0.003). Conclusion Short- and long-term MBF responses to CPT, as an index for endothelium-related coronary vasomotion, can be measured reproducibly with ¹³N-ammonia PET. In addition, the high interobserver reproducibility for repeat analysis of MBF values suggests the measurements to be largely operator independent. Thomas H. Schindler and Xiao-Li Zhang contributed equally to this paper.     

Patient Radiation Doses in IR Procedures: The American College of Radiology Dose Index Registry-Fluoroscopy Pilot

PurposeTo update normative data on fluoroscopy dose indices in the United States for the first time since the Radiation Doses in Interventional Radiology study in the late 1990s.Materials and MethodsThe Dose Index Registry-Fluoroscopy pilot study collected data from March 2018 through December 2019, with 50 fluoroscopes from 10 sites submitting data. Primary radiation dose indices including fluoroscopy time (FT), cumulative air kerma (K_a,r), and kerma area product (P_KA) were collected for interventional radiology fluoroscopically guided interventional (FGI) procedures. Clinical facility procedure names were mapped to the American College of Radiology (ACR) common procedure lexicon. Distribution parameters including the 10th, 25th, 50th, 75th, 95th, and 99th percentiles were computed.ResultsDose indices were collected for 70,377 FGI procedures, with 50,501 ultimately eligible for analysis. Distribution parameters are reported for 100 ACR Common IDs. FT in minutes, K_a,r in mGy, and P_KA in Gy-cm² are reported in this study as (n; median) for select ACR Common IDs: inferior vena cava filter insertion (1,726; FT: 2.9; K_a,r: 55.8; P_KA: 14.19); inferior vena cava filter removal (464; FT: 5.7; K_a,r: 178.6; P_KA: 34.73); nephrostomy placement (2,037; FT: 4.1; K_a,r: 39.2; P_KA: 6.61); percutaneous biliary drainage (952; FT: 12.4; K_a,r: 160.5; P_KA: 21.32); gastrostomy placement (1,643; FT: 3.2; K_a,r: 29.1; P_KA: 7.29); and transjugular intrahepatic portosystemic shunt placement (327; FT: 34.8; K_a,r: 813.0; P_KA: 181.47).ConclusionsThe ACR DIR-Fluoro pilot has provided state-of-the-practice statistics for radiation dose indices from IR FGI procedures. These data can be used to prioritize procedures for radiation optimization, as demonstrated in this work.     

The effects of multi-directional,high intensity exercise on the vestibular/ocular motor screening (VOMS) assessment in recreational athletes

ObjectiveIdentify the effects of multi-directional, high intensity exercise on VOMS symptom scores in male and female recreational, college-aged athletes.DesignCross-sectional study.SettingAthletic Therapy facility.ParticipantsA convenience sample of 29 (15 females, 14 males; 21.48 ± 1.40 years old) healthy recreational athletes.Main outcome measuresVOMS symptom scores pre, immediately post-, and 10 min post a multidirectional, high intensity intermittent exercise protocol (HIIP). Friedman tests and Wilcoxon Signed Rank tests identified significant differences at the time points. A Mann-Whitney U Test investigated the effect of sex.ResultsThe majority of component and overall VOMS symptom scores increased post-HIIP (p < 0.001–0.007, effect sizes 0.39–0.50) and 10 min post-HIIP (p = 0.003–0.015, effect sizes 0.32–0.39). Near point convergence distance increased immediately post-HIIP (p < 0.001, effect size 0.52). Females had higher smooth pursuits (z = −2.340, p = 0.019, r = 0.31), vertical vestibular ocular reflex (z = −2.81, p = 0.04, r = 0.39) visual motion sensitivity (z = −2.312, p = 0.021 r = 0.30) and overall VOMS symptom scores (z = −2.84, p = 0.04, r = 0.27) 10 min post-HIIP.ConclusionsMultidirectional, high intensity exercise can induce concussive-like changes in VOMS symptom scores in healthy, recreational athletes, particularly in females. These results may assist in SRC assessment and management of athletes involved in multidirectional, high intensity sports.     

Technical determinants of biathlon standing shooting performance before and after race simulation

The aim of this study was to identify performance‐determining factors in biathlon standing shooting in rest and after intense exercise. Eight Finnish national‐ and nine junior‐team biathletes participated in the study. Participants fired 40 resting shots (REST ) and 2 × 5 competition simulation shots (LOAD ) after 5 minutes of roller skiing at 95% of peak heart rate. Hit percentage, aiming point trajectory and postural balance were measured from each shot. Cleanness of triggering (ATV , movement of the aiming point 0‐0.2 second before the shot) and vertical stability of hold (DevY) were the most important components affecting shooting performance both in REST (DevY, R  = −0.61, P  < .01; ATV , R  = −0.65, P  < .01) and in LOAD (DevY, R  = −0.50, P  < .05; ATV , R  = −0.77, P  < .001). Postural balance, especially in shooting direction, was related to DevY and ATV . Stability of hold in horizontal (F (1,15) = 7.025, P  < .05) and vertical (F (1,15) = 21.285, P  < .001) directions, aiming accuracy (F (1,15) = 9.060, P  < .01), and cleanness of triggering (F (1,15) = 59.584, P  < .001) decreased from REST to LOAD , accompanied by a decrease in postural balance. National‐ and junior‐team biathletes differed only in hit percentage in REST (92 ± 8% vs 81 ± 8%, P  < .05) and left leg postural balance in shooting direction in LOAD (0.31 ± 0.18 mm vs 0.52 ± 0.20 mm, P  < .05), and the intense exercise affected the shooting technical components similarly in both national and junior groups. Biathletes should focus on cleanness of triggering and vertical stability of hold in order to improve biathlon standing shooting performance. More stable postural balance in shooting direction could help to improve these shooting technical components.     

Dopamine/noradrenaline reuptake inhibition in women improves endurance exercise performance in the heat

Catecholamine reuptake inhibition improves the performance of male volunteers exercising in warm conditions, but sex differences in thermoregulation, circulating hormones, and central neurotransmission may alter this response. With local ethics committee approval, nine physically active women (mean ± SD age 21 ± 2 years; height 1.68 ± 0.08 m; body mass 64.1 ± 6.0 kg; VO_2peak 51 ± 7 mL/kg/min) were recruited to examine the effect of pre‐exercise administration of Bupropion (BUP; 4 × 150 mg) on prolonged exercise performance in a warm environment. Participants completed a VO_2peak test, two familiarization trials, and two randomized, double‐blind experimental trials. All trials took place during the first 10 days of the follicular phase of the menstrual cycle. Participants cycled for 1 h at 60% VO_2peak followed by a 30‐min performance test. Total work done was greater during the BUP trial (291 ± 48 kJ) than the placebo trial (269 ± 46 kJ, P = 0.042, d = 0.497). At the end of the performance test, core temperature was higher on the BUP trial (39.5 ± 0.4 °C) than on the placebo trial (39.2 ± 0.6 °C, P = 0.021; d = 0.588), as was heart rate (185 ± 9 vs 179 ± 13, P = 0.043; d = 0.537). The results indicate that during the follicular phase of the menstrual cycle, an acute dosing protocol of BUP can improve self‐regulated performance in warm conditions.     

Energy dissipation differs between females with and without chronic ankle instability

Chronic ankle instability (CAI ) is associated with altered energy dissipation patterns, but comparisons to lateral ankle sprain (LAS ) copers have not been explored. The purpose of this study was to examine differences in relative sagittal plane energy dissipation during a single‐leg landing between female CAI and LAS coper participants. We separated 33 females (23.6 ± 4.6 years, 164.3 ± 6.2 cm, 69.4 ± 13.7 kg) into CAI (n = 17) and LAS coper (n = 16) groups. Participants completed 5 single‐leg landings followed by a 5‐second stabilization. We collected sagittal plane kinematics and joint moments at the ankle, knee, hip, and proximal joints (knee and hip) combined then calculated each joint's energy dissipation at 50, 100, 150, and 200 ms post‐landing. We compared the percentage of total energy dissipated by the ankle, knee, hip, and proximal joints during each interval utilizing independent t tests and Cohen's d effect sizes. Statistical significance was set a priori at P  < .05. The CAI group had lower relative energy dissipation from the ankle at 50 (24.7 ± 11.5% vs 39.2 ± 11.8%, P  < .01, d  =  1.25 [0.47, 1.95]), 100 (66.9 ± 19.4% vs 77.7 ± 6.5%, P  = .04, d  =  0.74 [0.01, 1.42]), and 150 ms (70.7 ± 17.8% vs 81.0 ± 5.7%, P  = .03, d  =  0.77 [0.04, 1.46]) compared to LAS copers. The CAI group had a greater hip contribution through 150 ms (17.9 ± 10.7% vs 11.7 ± 4.4%, P  = .04, d  =‐0.75 [‐1.44, ‐0.03]) and the proximal joints at 50 (75.3 ± 11.5% vs 60.8 ± 11.8%, P  < .01, d  =  ‐1.25 [‐1.96, ‐0.47]), 100 (33.1 ± 19.4% vs 22.3 ± 6.5%, P  = .04, d  =  ‐0.74 [‐1.42, ‐0.01]), and 150 ms (29.3 ± 17.8 vs 19.0 ± 5.7%, P  = .03, d  =‐0.77 [‐1.46, ‐0.04]) compared to LAS copers. Females with CAI may benefit from therapeutic exercises designed to correct a single‐leg energy dissipation strategy that relies less on the ankle joint.     

Evaluation of right ventricular function with multidetector computed tomography: comparison with magnetic resonance imaging and analysis of inter- and intraobserver variability

This study was performed to prospectively compare multidetector computed tomography (MDCT) with 16 simultaneous sections and magnetic resonance imaging (MRI) for the assessment of global right ventricular function in 50 patients. MDCT using a semiautomatic analysis tool showed good correlation with MRI for end-diastolic volume (EDV, r = 0.83, p < 0.001), end-systolic volume (ESV, r = 0.86, p < 0.001) and stroke volume (SV, r = 0.74, p < 0.001), but only a moderate correlation for the ejection fraction (EF, r = 0.67, p < 0.001). Bland Altman analysis revealed a slight, but insignificant overestimation of EDV (4.0 ml, p = 0.08) and ESV (2.4 ml, p = 0.07), and underestimation of EF (0.1%, p = 0.92) with MDCT compared with MRI. All limits of agreement between both modalities (EF: ±15.7%, EDV: ±31.0 ml, ESV: ±18.0 ml) were in a moderate but acceptable range. Interobserver variability of MDCT was not significantly different from that of MRI. For MDCT software, the post-processing time was significantly longer (19.6 ± 5.8 min) than for MRI (11.8 ± 2.6 min, p < 0.001). Accurate assessment of right ventricular volumes by 16-detector CT is feasible but still rather time-consuming.