An anatomic classification of the ethmoidal bulla

OBJECTIVE: The ethmoid bone is arguably the most complex and varied osseous structure in the human body. The partitions within form a unique labyrinth of lamellae and spaces from specimen to specimen or, as in this study, from patient to patient. The surgical anatomy of the ethmoid bone, and the ethmoidal bulla in particular, is ill-defined and heretofore largely unclassified. In an attempt to better understand the ethmoid labyrinth, a prospective anatomic study of 107 patients undergoing primary intranasal endoscopic ethmoidectomy was undertaken. STUDY DESIGN: Two hundred fourteen ethmoidal bullae were dissected intraoperatively with video-documentation obtained in over 90% of cases. Based on these dissections, the compartments or cells formed by the partitioning within the ethmoidal bulla and the respective communication with adjacent spaces were the parameters used to develop the classification system. SETTING: Private midwestern rhinologic referral practice. RESULTS: Three main categories of ethmoidal development were identified: simple, compound, and complex. Forty-seven percent of bullae were of the simple type, 26% were compound, and 27% complex. Sixty-eight percent of ethmoidal bullae had a single opening into the hiatus semilunaris superior; 6 (2.8%) ethmoidal bullae had a single anterior opening to the ethmoidal infundibulum. The remaining 28.7% had multiple cells with multiple openings, at least 1 of which opened into the hiatus semilunaris superior 98.4% of the time. There was a cell in the complex bulla opening anteriorly to the ethmoidal infundibulum in 46.5%. In 58% of cases, there was symmetry from side to side. CONCLUSION: A novel anatomic classification for the ethmoidal bulla is presented, with examples of the 3 types of sinus development encountered. We believe that understanding ethmoid sinus anatomy and potential drainage pathways is a core principle to functional sinus surgery.     

Building capacity for system-level change in schools: lessons from the Gatehouse Project.

The Gatehouse Project is an innovative, comprehensive approach to mental health promotion in secondary schools. It sets out to promote student engagement and school connectedness as the way to improve emotional well-being and learning outcomes. The key elements of the whole-school intervention are the establishment and support of a school-based adolescent health team; the identification of risk and protective factors in each school's social and leaning environment from student surveys; and, through the use of these data, the identification and implementation of effective strategies to address these issues. The project evaluation used a cluster-randomized controlled trial design involving 26 schools with initial results demonstrating considerable success in reducing smoking rates among Year 8 children. This article describes and accounts for how system-level changes have been made in schools through a process of capacity building. This encourages teachers, parents, and students to view the core business of education differently.     

3.0 Tesla vs 1.5 Tesla breast magnetic resonance imaging in newly diagnosed breast cancer patients

AIM:To compare 3.0 Tesla(T) vs 1.5T magnetic resonance(MR) imaging systems in newly diagnosed breast cancer patients.METHODS:Upon Institutional Review Board approval,a Health Insurance Portability and Accountability Actcompliant retrospective review of 147 consecutive 3.0T MR examinations and 98 consecutive 1.5T MR examinations in patients with newly diagnosed breast cancer between 7/2009 and 5/2010 was performed.Eleven patients who underwent neoadjuvant chemotherapy in the 3.0T group were excluded.Mammographically occult suspicious lesions(BIRADS Code 4 and 5) additional to the index cancer in the ipsilateral and contralateral breast were identified.Lesion characteristics and pathologic diagnoses were recorded,and results achieved with both systems compared.Statistical significance was analyzed using Fisher’s exact test.RESULTS:In the 3.0T group,206 suspicious lesions were identified in 55%(75/136) of patients and 96%(198/206) of these lesions were biopsied.In the 1.5T group,98 suspicious lesions were identified in 53%(52/98) of patients and 90%(88/98) of these lesions were biopsied.Biopsy results yielded additional malignancies in 24% of patients in the 3.0T group vs 14% of patients in the 1.5T group(33/136 vs 14/98,P = 0.07).Average size and histology of the additional cancers was comparable.Of patients who had a suspicious MR imaging study,additional cancers were found in 44% of patients in the 3.0T group vs 27% in the 1.5T group(33/75 vs 14/52,P = 0.06),yielding a higher positive predictive value(PPV) for biopsies performed with the 3.0T system.CONCLUSION:3.0T MR imaging detected more additional malignancies in patients with newly diagnosed breast cancer and yielded a higher PPV for biopsies performed with the 3.0T system.     

13925例男性婚前医学检查分析

目的：了解男性婚前医学检查疾病的检出情况。方法：成都市妇幼保健院男性婚检资料分析。结果：在13925例男性婚检中,异常检出数2244例,异常检出率为16．11％（15．80％－16．42％）,其中遗传性疾病25例,直接影响婚育的疾病33例,检出的疾病以生殖系统异常最高,有1688例占75．22％。结论：婚检能检出男性婚前的疾病和缺陷,有针对性地矫治,促进优生。     

HDR brachytherapy well chamber calibration and stability evaluated over twenty years of clinical use

PurposeThe purpose of the study was to establish, using a retrospective analysis of existing hospital records, the long-term stability and accuracy of a high-dose-rate brachytherapy well chamber. This should be assessed to determine reliability and appropriate calibration frequency. The accrual of long-term data that demonstrates the stability of our chamber may inform others of the performance they might expect from similar equipment.Methods and MaterialsWe evaluated air kerma strength measurements made with the PTW 32002 (Nucletron 077.091) high-dose-rate well chamber on 72 ¹⁹²Ir sources over an 18-year period and the seven calibrations of that chamber which span a 27-year period.ResultsConsecutive air kerma strength measurements agreed within 0.01% on average. The chamber measurement agreed with the source specification within 0.02% on average, but was up to 1.4% during some calibration periods. The chamber calibration coefficient varied by a maximum of 5% over seven chamber calibration measurements.ConclusionsThe constancy of the well chamber current compared with the source manufacturer suggests that our chamber has been stable to better than 2% over a period of 18 years. Although the chamber has received different calibration coefficients over time, these coefficients are within the combined uncertainties of any two calibrations and are consistent with the chamber being stable. The agreement we have observed between clinical measurements and the source manufacturer would justify an action level for further investigation of 1%, for this specific chamber.     

Emotion, moral perception, and nursing practice

Abstract Many of the activities of clinical practice happen to, with or upon vulnerable human beings. For this reason numerous nursing authors draw attention to or claim a significant moral domain in clinical practice. A number of nursing authors also discuss the emotional involvement and/or emotional labour which is often experienced in clinical practice. In this article I explore the importance of emotion for moral perception and moral agency. I suggest that an aspect of being a good nurse is having an emotional sensitivity to other human beings (patients), because this emotional sensitivity allows the nurse to perceive more accurately the context and perspective of the patient. It is thus important to the moral agency of the nurse and to morally sensitive clinical practice. As such education of the emotions should be a feature of the moral education of the nurse. A useful conception of the role of educated emotion in the moral life can be discovered in Aristotelian ethics.