Phylogenic analysis and forensic genetic characterization of Guizhou Miao tribes from 58 microareas via autosomal STR

Genetic polymorphism of 17 autosomal short tandem repeat (STR) loci, included in the PowerPlex®18D amplification kit, were analyzed in Miao tribes from 58 different sampling microareas (N = 5255) of Guizhou as well as two cities (N = 151) of Hunan, China. Allele frequencies and forensic efficiency parameters were calculated. Moreover, comprehensive population genetic comparisons among 91 nationwide populations and 174 Asian populations were conducted based on raw genotype data and allele frequency data, respectively. Our results of forensic efficiency parameters showed that the panel was a robust tool in forensic individual identification and paternity cases for this population. Genetic affinities were observed among most of the Miao tribes revealed by multidimensional scaling plot, principal component analysis, and neighboring-joining tree. The genetic distance between Miao tribes and Han nationalities were varies by different geographical positions. Some of the Miao tribes were genetically closer to the Hmong-Mien populations living in southeastern contiguous regions and even the Indochina. The result coincided with the migration or reverse migration routes for Miao nationality in modern history. This study of the Miao tribes from plenty of microareas in Guizhou would be useful in reconstructing the population history and establishing a more comprehensive forensic reference database.     

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.

     

Forensic genetic polymorphisms of 16 X-STR loci in the Yunnan Miao population and their relationship to other Chinese groups

Allele frequencies for 16 X-chromosomal STR (X-STR) loci were obtained from a sample set of 440 unrelated Yunnan Miao individuals in China. A total of 117 alleles were observed in this group, with allele frequencies ranging from 0.0016 to 0.7565. The most informative marker for the studied population was DXS10134, with a polymorphism information content (PIC) of 0.8499, and the least polymorphic locus was DXS6810 (PIC = 0.3071). The power of discrimination (PD) varied from 0.4046 (DXS6800) to 0.8642 (DXS10134) in males and from 0.6188 (DXS6800) to 0.9673 (DXS10134) in females. The combined PDM and PDF were 0.999999989975990 and 0.999999999999949, respectively. The combined MECD and MECT were 0.999983301904059 and 0.999999915883733, respectively. Furthermore, population genetic structure investigation between the Yunnan Miao and 20 other populations using principal component analysis (PCA), multidimensional scaling plot (MDS), and neighboring-joining (NJ) phylogenetic tree analyses illustrated significant genetic difference between the Yunnan Miao and the other populations. This study is the first to provide X chromosome genetic polymorphism data of the Miao population in Yunnan Province and can be used as a supplementary reference to enrich the national database.     

椎弓根固定联合伊班膦酸钠对胸腰段脊柱爆裂骨折的疗效影响

目的探讨椎弓根固定联合伊班膦酸钠对胸腰段脊柱爆裂骨折的治疗效果及对碱性磷酸酶(ALP)和抗酒石酸酸性磷酸酶-5b(TRACP-5b)水平的影响。方法 2014年6月—2017年6月恩施土家族、苗族自治州中心医院收治90例胸腰段脊柱爆裂性骨折患者,根据随机数字表法分为对照组(45例)和研究组(45例),两组均采用椎弓根固定手术,研究组同时在术后1周给予伊班膦酸钠静脉滴注,2mg/次,1次/d,连续应用2d,每3个月进行1次。比较两组的治疗效果及手术前后血清ALP、TRACP-5b水平变化情况。结果术后1、6、12个月时研究组疼痛视觉模拟评分(VAS评分)分别为(5.06±0.82)、(3.67±0.40)、(1.77±0.21)分,均显著低于对照组(6.94±1.07)、(4.53±0.61)、(2.41±0.19)分(P<0.05);术后3、6、12个月时研究组日本骨科协会胸腰椎治疗评估表(JOA)评分(16.45±2.12)、(10.57±1.74)、(4.47±1.04)分,均显著低于对照组(18.40±2.37)、(13.68±1.81)、(6.69±1.20)分,P<0.05;研究组术后6、12个月时脊柱后凸畸形Cobb角(4.06±1.77)°、(5.46±2.13)°显著小于对照组(5.29±1.71)°、(7.51±3.09)°,伤椎前缘和中部高度显著高于对照组(P<0.05);两组并发症发生率比较差异无统计学意义(P<0.05);术后血清ALP及TRACP-5b水平较术前均明显降低,且术后研究组的血清ALP及TRACP-5b水平均显著低于对照组(P<0.05)。结论椎弓根固定联合伊班膦酸钠对胸腰段脊柱爆裂骨折治疗效果显著,可有效缓解疼痛,矫正脊柱后凸畸形,促进骨生化指标尽早恢复,进而促进骨折的愈合和胸腰椎功能的恢复,而且并发症少,是一种安全有效的治疗方式。     

Genetic analysis of 20 autosomal STR loci in the Miao ethnic group from Yunnan Province,Southwest China

The genetic polymorphisms of 20 autosomal short tandem repeat (STR) loci included in the PowerPlex^® 21 kit were evaluated from 748 unrelated healthy individuals of the Miao ethnic minority living in the Yunnan province in southwestern China. All of the loci reached Hardy–Weinberg equilibrium. These loci were examined to determine allele frequencies and forensic statistical parameters. The genetic relationship between the Miao population and other Chinese populations were also estimated. The combined discrimination power and probability of excluding paternity of the 20 STR loci were 0.999 999 999 999 999 999 999 991 26 and 0.999 999 975, respectively. The results suggested that the 20 STR loci were highly polymorphic, which makes them suitable for forensic personal identification and paternity testing.     

Genetic analysis of 50 Y-STR loci in Dong,Miao, Tujia,and Yao populations from Hunan

International Journal of Legal Medicine - To investigate the genetic polymorphism of Y chromosome short tandem repeat (Y-STR) loci in Dong, Miao, Tujia, and Yao minority populations from Hunan...     

Haplotype analysis of the polymorphic 24 Y-STR markers in six ethnic populations from China

Twenty-four Y-STR loci were analysed in 1446 males from the following six Chinese ethnic populations: Guangxi Han (n=600), Gin (n=161), Maonan (n=135), Miao (n=186), Zhuang (n=226) and Yao (n=138) using the AGCU Y24 STR amplification kit. The lowest estimates of genetic diversity (below 0.5) correspond to markers DYS391 (0.4006), DYS438 (0.4300), and DS388 (0.4907), and the greatest diversity corresponds to markers DYS385a/b (0.9636) and DYS527a/b (0.9439). Moreover, there were 1331 different haplotypes identified from the 1446 total samples, of which 1233 were unique. Notably, we observed shared haplotypes between the four ethnic populations (Maonan, Miao, Zhuang, Yao ethnic population), except between the Guangxi Han and Gin population. The estimated overall haplotype diversity (HD) was 0.9997. A multidimensional scaling (MDS) plot based on the genetic distances between populations demonstrates the genetic similarity of the Maonan, Miao and Zhuang populations with genetic distance below 3.0. No substructure correction is required to estimate the rarity of a haplotype comprising 24 markers. In summary, the results of our study indicate that the 24 Y-STRs have a high level of polymorphism in these six Chinese ethnic populations and could therefore be a powerful tool for forensic applications and population genetic studies.     

Genetic diversity and haplotype analysis of Guizhou Miao identified with 19 X-chromosomal short tandem repeats

We analyzed Chinese Miao population samples (n = 268) from Guizhou province, Southwest China, with 19 X-chromosomal short tandem repeats (STRs) included in the AGCU X19 amplification kit. The combined PE is 0.999999922 and the combined PDs in males and females are 0.9999999999999999999994 and 0.9999999999998, respectively. The mean paternity exclusion change values are larger than 0.99999996. The HDs in seven linkage groups vary from 0.9324 to 0.9968. Subsequently, comparison among different Chinese populations shows that the substructures of Chinese were significantly influenced by ethno-linguistic rather than geographical boundaries, including most prominently Turkic-speaking and Tibeto-Burman-speaking populations.

     

Genetic analysis of 17 Y-chromosomal STR loci of Chinese Tujia ethnic group residing in Youyang Region of Southern China

Y-STR haplotype data were obtained in a population sample of 197 unrelated healthy male individuals of Chinese Tujia ethnic minority group residing in an autonomous county of Southern China using 17 Y-chromosome STR markers. A total of 197 haplotypes were identified in the set of Y-STR loci. The overall haplotype diversity for the Tujia population at 17 Y-STR loci was 1.0000 ± 0.0005. Genetic distance was estimated between this population and other 14 Chinese populations including Paiwan and Atayal populations of Taiwan, and Southern Han, Dong, Jing, Miao, Yao, Zhuang, Yi, Maonan, She, Hui, Sala, and Tibetan ethnic groups. The results demonstrated that the 17 Y-STR loci analyzed were highly polymorphic in Tujia ethnic group examined and hence useful for forensic cases, paternity testing, and population genetic studies.     

Genetic polymorphisms and haplotypic structure analysis of the Guizhou Gelao ethnic group based on 35 Y-STR loci

In this research, 35 Y-chromosomal short tandem repeat (Y-STR) loci were analyzed in 286 unrelated healthy Gelao male individuals from Guizhou Province, China. Allelic and haplotype frequencies, haplotype diversity (HD), haplotype match probability (HMP), and discrimination capacity (DC) values were computed. Pairwise Rst values were assessed by AMOVA analysis and visualized through multidimensional scaling and neighbor-joining tree construction. A total of 609 alleles were detected at the 35 Y-STR loci, and the allelic frequencies ranged from 0.0035 to 0.8322. The HD, HMP, and DC were 0.9999, 0.0036, and 0.9825, respectively. A total of 281 haplotypes were found at 35 loci in the 286 Gelao individuals, 98.25% of which were unique. Related forensic parameters revealed that this panel of 35 loci had a high level of genetic polymorphisms in the Gelao group. However, the use of multi-copy and rapidly mutating Y-STR loci could significantly increase the discrimination power of a common Y-STR panel. Analyses of population differentiation with the same set of common Y-STR loci demonstrated that the Gelao group has a closer genetic relationship with the Guizhou Han and Guizhou Miao groups than other groups.     

Tai-Kadai-speaking Gelao population: Forensic features,genetic diversity and population structure

Genetic analyses of geographically and ethno-linguistically different populations are essential for understanding population stratification and genomic structure in medical Genome-Wide Association Studies (GWAS) and genetic variation and diversity related to forensic and population genetics studies. Here, we genotyped 30 autosomal insertion/deletion (Indel) markers from 502 Tai-Kadai-speaking Gelao individuals residing in the rugged topographical area in Southeastern China. In addition, two comprehensive population genetic comparisons of 15,327 individuals from 95 worldwide populations and of 6122 individuals from Asia and adjoining populations were conducted based on allele frequency data and raw genotype data, respectively. All studied markers were found to be in Hardy-Weinberg equilibrium. The combined power of discrimination in the Gelao minority group was 0.999999999975, and the combined probability of exclusion was 0.9879. Our results from the forensic statistical parameters indicated that this Indel panel can be independently used as a powerful tool in forensic individual identification but can only be used as a complementary tool in paternity cases involving East Asians. We also found significant allele frequency differences between the Gelao and other continental populations with respect to the markers grouped in clusters ∼Ⅳ, suggesting that these can be used as forensic ancestry informative Indel markers to distinguish the Gelao from other continental populations. Genetic ancestry analyses demonstrated that Tai-Kadai-speaking Gelao share a dominant ancestry component with Hmong-Mien-speaking Miao. Our population genetic results from multidimensional scaling plots, principal component analysis, neighboring-joining tree construction and hierarchical clustering also suggested that the Zunyi Gelao are genetically closer to their linguistically or geographically close populations, such as the Han Chinese, Guizhou Bouyei and the Hubei Tujia, than to Turkic and Tibeto-Burman speakers.     

邵阳地区3~14岁儿童先心病流行病学调查

目的调查2011年9月~2013年9月湖南省邵阳地区3~14岁儿童先天性心脏病流行病学特征。方法对邵阳地区158291名3~14岁幼儿园、小学一年级到初中二年级儿童按初筛、复筛、彩超多普勒确诊三个阶段进行调查。将该地区9县、3区先天性心脏病的患病率、病种分布、性别等各项指标进行了统计分析,并进行病因的调查研究。结果确诊先天性心脏病患者208例,总患病率为1．31％0,男性为1．12‰,女性为1．57％e（X^2=5．970,P〈0．05）。9县3区中,新宁县、绥宁县、城步苗族自治区三县区先天性心脏病患病率分别为2．31％0、2．29％0、2．50％o,明显高于其他县区,不同县区之间发病率有统计学差异。病种构成以室间隔缺损占首位（54．32％）,其次是房间隔缺损（19．71％）、动脉导管未闭（14．42％）。对母亲孕期相关暴露因素采用条件logistic回归模型多因素分析,得出本地先天性心脏病发生的危险因素为母孕3个月内病毒感染、先兆流产史及高龄妊娠。结论邵阳地区新宁县、绥宁县、城步苗族自治区三县区先天性心脏病患病率明显高于其他县区,女性患病率高于男性;当地的先天性心脏病构成以室间隔缺损和房间隔缺损为主。本地先天性心脏病发生的危险因素为母孕3个月内病毒感染、先兆流产史及高龄妊娠,因此应加强孕期保健,教育孕妇尽量避免暴露于危险因素中。     

Criterion related validity of self-reported knee symptoms among athletes

The objective of this study was to investigate the validity of self-reported knee symptoms among athletes. During 12 months, 252 athletes answered a weekly questionnaire about concurrent sports activity, knee pain, knee instability, knee swelling and knee locking. Finally, the athletes answered a retrospective questionnaire summing up symptoms during the preceding 12 months. Accordingly, two 12 month period prevalences of the same period were calculated for each knee symptom. The proportion of agreement between the retrospective 12 month questionnaire and the concurrent weekly questionnaires was for knee pain, knee instability, knee swelling and knee locking, 86%, 89%, 89% and 90%, respectively. Using weekly reports as reference, the corresponding sensitivity of the 12 month period prevalence question was 0.86, 0.71, 0.66 and 0.56, respectively. The sensitivities were all significantly associated with the number of weeks since the last episode of the corresponding knee symptom. As concerns estimation of 12 month period prevalences, a retrospective summary questionnaire at the end of the period is a valid substitute for concurrent weekly questionnaire information on knee pain, knee instability and knee swelling, but only a moderate substitute for information on knee locking. A reduction in the length of the period the athlete should recall knee symptoms might improve the questionnaire validity.     

心率不稳定时3种不同重建算法对影像质量的影响:MSCT动态心脏体模研究

目的研究心率不稳定时,多层螺旋CT3种不同重建算法对影像质量的影响及时间分辨力,明确快速心率条件下最佳成像方式。方法对象为一个新型动态心脏体模。调节体模,模拟心率60bpm、85bpm和105bpm,各种基础心率都有0、2.5、5、10、15次几种波动。采用GE公司LightSpeed16层螺旋CT机进行扫描。基础心率为60bpm和105bpm时电流300mA,X线管旋转时间为0.5s/周;基础心率85bpm时电流250mA,X线管旋转时间为0.6s/周。将原始数据分别以Snapshot Segment、SnapshotBurst、Snapshot Burst Plus3种方式重建成层厚0.625mm,间隔0.625mm影像,标准重建算法(std),舒张期(ED)采用R-R间期的90%,在Adw4.2工作站进行VR及能显示狭窄层面的MPR重组。依影像质量优劣制定5分评分标准,由3位放射医师采用盲法对影像质量进行评分,取3位医师对重建影像的平均评分进行比较。计算不同基础心率不同重建模式下的时间分辨力。结果(1)在每种基础心率下,随波动幅度增加,3种不同算法所得影像质量都下降。(2)心率60bpm时,同一波动幅度下3种不同算法在对影像质量影响差别不大,仅波动2.5次时Snapshot Segment略差,而波动10、15次时Snapshot Segment略好。对应的时间分辨力分别为250ms、245ms、245ms。(3)心率85bpm及心率波动为0、2.5、5时Snapshot Burst Plus所得影像质量最高,而心率波动为10、15时以Snapshot Burst所得影像质量最高。相应的时间分辨力分别为为300ms、214ms、80ms。(4)心率105bpm时,心率波动为0、2.5、5、10时Snapshot Burst Plus所得影像质量最高,而心率波动为15时以Snapshot Burst所得影像质量最高。相应的时间分辨力分别为250ms、191ms、84ms。结论在每种基础心率状态下,3种不同重建算法所得最好影像质量皆随心率波动幅度的加大而下降。     

Population crises and population cycles

To prevent a population irretrievably depleting its resources, mammals have evolved a behavioural and physiological response to population crisis. When a mammalian population becomes dangerously dense, there is a reversal of behaviour. Co‐operation and parental behaviour are replaced by competition, dominance and aggressive violence, leading to high mortality, especially of females and young, and a reduced population. The stress of overpopulation and the resulting violence impairs both the immune and the reproductive systems. Hence epidemics complete the crash of the population, and reproduction is slowed for three or four generations, giving the resources ample time to recover. In some mammal species, crisis and crisis response recur regularly, leading to cycles of population growth and relapse, oscillating about a fixed mean.

Population crisis response and population cycles have been equally prominent in the history of human societies. But in man successive advances in food production have made possible growing populations, though with every such advance population soon outgrew resources again. Hence human cycles have been superimposed on a rising curve, producing a saw‐tooth graph. Because advances in food production amounted to sudden disturbances in the relations between human populations and their environments, the crisis response in man has failed to avert famine and resource damage. In the large human societies evolved since the coming of settled agriculture and cities, the basic effects of violence, epidemics, famine and resource damage have been mediated by such specifically human disasters as inflation, unemployment, and political tyranny.

An account of past crises, periods of relative relief from population pressure, and resulting cycles, is given for a number of regions: China, North Africa and Western Asia, the northern Mediterranean, and north‐western Europe. The paper ends with an account of the present world‐wide population crisis, and the solution made possible by Malthus's discovery that, unlike animals, we can choose to check population growth by reducing the birth‐rate, instead of raising the death‐rate, as in other mammals, by the population crisis response.     

A case of fatal multi-organ inflammation following COVID-19 vaccination

A 14-year-old Japanese girl died unexpectedly 2 days after receiving the third dose of the BNT1262b2 mRNA COVID-19 vaccine. Autopsy findings showed congestive edema of the lungs, T-cell lymphocytic and macrophage infiltration in the lungs, pericardium, and myocardium of the left atria and left ventricle, liver, kidneys, stomach, duodenum, bladder, and diaphragm. Since there was no preceding infection, allergy, or drug toxicity exposure, the patient was diagnosed with post-vaccination pneumonia, myopericarditis, hepatitis, nephritis, gastroenteritis, cystitis, and myositis. Although neither type of inflammation is fatal by itself, arrhythmia is reported to be the most common cause of death in patients with atrial myopericarditis. In the present case, arrhythmia of atrial origin was assumed as the cause of cardiac failure and death. In sudden post-vaccination deaths, aggressive autopsy systemic search and histological examination involving extensive sectioning of the heart, including the atrium, are indispensable.     

Zum Beweiswert der Stauungs- und Weichteilblutungen beim Erdrosseln und Erwürgen

Zusammenfassung Experimentell wurde geprüft, unter welchen hypostatischen Bedingungen am menschlichen Leichnam petechiale Blutungen bzw. Pseudoekchymosen und -hämatome an Kopf, Hals und Nacken entstehen. Eine nahezu charakteristische komplette Ekchymosierung war nur nach Scheitellage (Kopfstand) zu erreichen. Hämatome entwickelten sich nach kopflastigen Bauchlagen und Scheitellage. Teilweise waren sie, ebenso wie die Ekchymosen, nicht von intravitalen Blutungen z.B. nach Erwürgen und/oder Erdrosseln zu unterscheiden. Außerdem stellten wir Pseudohämatome in den Weichteilen des Hirnschädels fest, welche Gewalteinwirkungen vortäuschten.In Zweifelsfällen muß der gesamte Status (Totenflecke, Vibices, Ekchymosen, Hämatome) in Verbindung mit der atypischen Kopftieflage gewürdigt werden. Dabei ist zu berücksichtigen, daß auch intravital entstandene Ekchymosen und Hämatome durch Hypostase überlagert und verstärkt werden.

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Summary 14 fresh cadavers of adult persons were placed with the head or body tilted in atypical positions 3 to 65 hours after death. The persons concerned were neither asphyxiated nor had they suffered cranial trauma. Hypostasis in the head and neck occurred more rapidly and intensively the deeper the cranial parts of the body were placed. In the simulated cadaver positions, artificialecchymoses were observed in only a few places, mainly in the eyelids, the conjunctiva, the galea and the temporal muscles except when the head was vertically downwards. Just as with the postmortem haematomas, the hypostatic settling to the plane of the heart was decisive.The experiments have shown that such generalised ecchymosis as occurs in death by throttling and/or choking can never be simulated by postmortem hypostasis. For true strangulation, ecchymoses in the skin of the face, the eyelids, the conjunctivae, in the mucous membranes of the lips, gums, cheeks, tongue, pharynx, tonsils, palate, larynx, nose, the submandibular glands and possibly of the cervical glands are obligatory.Haematomas formed in the musculature of the neck only when the body was lying supine or on its back and in the laryngeal region when the head was vertically downwards; in the throat and neck muscles when the face was lowest; and when lying prone, with the body tilted at least 15°, in the throat and neck muscles and in the laryngeal region. In contrast to intravital bleeding into the soft tissues, in death by strangulation or after blunt cranial traumas pseudo-ecchymoses and pseudo-haematomas both in the galea and also in the temporal muscles were mainly limited to the lowest hypostatic area. Macroscopically these haematomas could not be differentiated from intravital haematomas as, for example after throttling and/or choking. In doubtful cases it must therefore be established whether the cadaver was found in an atypical positon with the head hanging down. If necessary, the fact that true intravital ecchymoses or haematomas may have been overlayed or intensified by hypostasis must be borne in mind.

     

大鼠深静脉血栓形成模型建立及观察

目的建立大鼠深静脉血栓形成（DVT）模型,观察实验大鼠术前及术后不同时间凝血酶原时间、纤维蛋白原含量、D-二聚体含量及血栓长度的变化情况。 方法将30只SD大鼠用结扎阻断下腔静脉及其分支,并用微血管夹钳夹损伤静脉壁的方法诱导深静脉血栓形成。于术前第1天及术后第1、4、7、10、14、21天采静脉血检测纤维蛋白原含量、D-二聚体含量及凝血酶原时间,并行血管造影观察血栓及血管再通情况。 结果共23只大鼠深静脉血栓模型制作成功,功率76.67%（23/30）。纤维蛋白原含量、凝血酶原时间及D-二聚体含量在术前与术后之间的差异有统计学意义,但术后不同时间之间差异无统计学意义;术后血栓长度在不同时间的差异均有统计学意义。 结论凝血酶原时间、纤维蛋白原及D-二聚体可作为是否有血栓形成的重要参考指标,但在评价病情进展及严重程度方面价值有限;血栓长度随时间先增长,后又溶解,直至消失。     

The value of ultrasonography in the preoperative diagnostic evaluation of patients with recurrent anterior shoulder dislocation: a prospective study of 44 patients

The purpose of this study was to investigate the value of ultrasonography in the pre-operative assessment of patients with recurrent post-traumatic, anterior shoulder instability. Forty-four consecutive patients, 44 men and 12 women, with unilateral, post-traumatic, recurrent instability of the shoulder were included in the study. One experienced radiologist examined all patients, using a 5.0 or 7.5 MHz linear-array transducer, with the arm in different positions, one of which was used to provoke apprehension of the shoulder. Special attention was paid to the evaluation of the joint capsule, the anterior labrum, especially in terms of the presence of a Bankart lesion. All patients were subsequently treated surgically. After a diagnostic arthroscopy either an open or arthroscopic stabilisation of the shoulder was performed. Ultrasonography disclosed an unstable anterior labrum (equivalent to a Bankart lesion) in 36 shoulders; the lesion was verified in all 36 shoulders during arthroscopy. In three shoulders, arthroscopy disclosed an injured labrum, which had healed in an anterio-medial position on the scapular neck. In these three shoulders, ultrasonography failed to show any lesion. In five shoulders no Bankart lesion was found at arthroscopy. All these patients had increased shoulder laxity, and ultrasonography did not show any Bankart lesion. Furthermore a judgement of the joint capsule was not possible either. A bony Bankart lesion was found in four shoulders, using both arthroscopy and ultrasonography. The sensitivity of the ultrasonographic evaluation was 92%, and the specificity 100%. The positive predictive value was 100%, and the negative predictive value 63%. Ultrasonography showed a high correlation with the arthroscopic findings, with a high sensitivity and specificity. Therefore, we conclude that US can give important pre-operative information in patients with recurrent, unilateral, post-traumatic, anterior shoulder instability.     

Image quality, lesion detection, and diagnostic efficacy in digital mammography: full-field digital mammography versus computed radiography-based mammography using digital storage phosphor plates

OBJECTIVE: To compare image quality, the lesion detection, and the diagnostic efficacy of full-field digital mammography (FFDM) and computed radiography-based mammography using digital storage phosphor plates (DSPM) in the evaluation of breast lesions. MATERIALS AND METHODS: In this prospective study, 150 patients with suspicious breast lesions underwent FFDM and DSPM. Nine aspects of image quality (brightness, contrast, sharpness, noise, artifacts, and the detection of anatomic structures, i.e., skin, retromamillary space, glandular tissue, and calcifications) were evaluated by five radiologists. In addition, the detection of breast lesions and the diagnostic efficacy, based on the BI-RADS classification, were evaluated with histologic and follow-up correlation. RESULTS: For contrast, sharpness, and the detection of all anatomic structures, FFDM was rated significantly better (p<0.05). Mass lesions were equally detected, whereas FFDM detected more lesions consisting of calcifications (85 versus 75). DSPM yielded two false-negative results. Both lesions were rated BI-RADS 4 with FFDM, but BI-RADS 2 with DSPM. Both were invasive carcinoma at histology. The sensitivity, specificity, PPV, NPV, and accuracy of FFDM were 1.0, 0.397, 0.636, 1.0, and 0.707, compared to 0.974, 0.397, 0.630, 0.935, and 0.693 of DSPM. CONCLUSION: Based on image quality parameters, FFDM is, in part, significantly better than DSPM. Furthermore, the detection of breast lesions with calcifications is favorable with FFDM. However, the diagnostic efficacy of FFDM and DSPM was equal. The interpretation of the false-negative results suggests that the perception and characterization of breast lesions is not defined solely by the digital mammography system but is strongly influenced by the radiologist, who is one of the determinants in the interpretation of breast imaging.