Influence of colour Doppler echocardiography on the ultrasonic assessment of congenital heart disease: a prospective study.

OBJECTIVE--To evaluate the additional information provided by colour Doppler in the ultrasonic assessment of congenital heart disease. PATIENTS AND METHODS--A prospective study of 215 children (age range 1 day-16 years) presenting with clinical signs of congenital heart disease. RESULTS--Colour Doppler was essential for the diagnosis of an anomalous left coronary artery and altered the management of a patient initially diagnosed as having cardiomyopathy. Colour Doppler provided extra information, but without major impact on management, in the following: the diagnosis of ventricular septal defects associated with other defects, of multiple ventricular septal defects, of anomalous pulmonary venous drainage, and of mild mitral regurgitation; the demonstration of site of coarctation, of stenotic or hypoplastic pulmonary artery branches, of unobstructed flow through a right atrial membrane, and of left ventricle to right atrium regurgitation; the assessment of the width of the duct and of flow through the patent foramen ovale in transposition and tricuspid atresia; the differentiation of pulmonary atresia from critical pulmonary stenosis and the measurement of maximum velocity of tricuspid regurgitation. CONCLUSIONS--Ideally all patients should undergo colour Doppler studies before cardiac surgery to ensure a more accurate diagnosis. However, since the additional information provided does not affect the management in most patients, machines without colour Doppler can provide a satisfactory service in paediatric cardiology centres in countries where resources are limited.     

Childhood scoliosis: MR imaging

The spinal cords of 28 scoliosis patients between the ages of 1 month and 17 years were examined with magnetic resonance (MR) imaging. Complete visualization was obtained in all cases. In 15 patients (53%) neuropathologic abnormalities demonstrated by MR imaging significantly affected their clinical course, including tethered cords (n = 7), syringomyelia (n = 5), Arnold-Chiari I malformation (n = 4), spinal cord tumors (n = 2), Arnold-Chiari II malformation (n = 3), and diastematomyelia (n = 1). The advantages of MR imaging in the evaluation of the scoliotic spine in children include a high sensitivity for the occult conditions associated with scoliosis, good anatomic demonstration of the cord, and absence of bone artifacts. MR imaging is recommended as a primary imaging modality in scoliosis, following conventional radiography.     

Response to symptoms of stroke in the UK: a systematic review

Background  

The English National Stroke Strategy suggests that there is a need to improve the response of patients and witnesses to the symptoms of acute stroke to increase rapid access to specialist care. We wished to review the evidence base regarding the knowledge, attitudes and behaviours of stroke patients, witnesses and the public to the symptoms of stroke and the need for an urgent response at the onset of symptoms.     

Congested deep subcortical veins as a sign of dural venous thrombosis: MR and CT correlations

Dural venous thrombosis can have a rapidly progressive fatal course if unrecognized; its clinical picture is often confusing. Numerous CT, magnetic resonance (MR), and angiographic findings have been described to help recognize this entity. We present a case of dilated transcerebral medullary veins as a sign of superior satittal sinus thrombosis with CT and MR correlation.     

澳大利亚John Murtagh全科病案研究(二十三)——受惊吓的男孩患了失眠症

John Murtagh,澳大利亚Monash大学全科医学系兼职教授和Melbourne大学的全科医学专家。1966年毕业于Monash大学,1986年担任《Australian Family Physician》杂志主编,1988年获得医学博士学位,1993年被Monash大学聘为教授。1995年,鉴于他在医学教育、研究和著作方面的卓越贡献,被授予澳大利亚勋章,他的著作《Murtagh′s General Practice》被奉为澳大利亚全科医生的＂圣经＂。     

澳大利亚John Murtagh全科病案研究（二十七）——繁忙的生意人得了高血压

1 故事的开始 这么多年来,我们只在诊所遇到莫恩先生两次,他很少来诊所,只是在他的公司给他购买的人寿保险公司要求例行体检的时候,他才不得不抽空来一次.体检的结果,也只有一些皮肤瘙痒的症状,估计和他工作紧张有关.     

Health status disparities in ethnic minority patients with rheumatoid arthritis: a cross-sectional study

OBJECTIVE: To examine disparities in disability, pain, and global health between Caucasian (n = 4294) and African American (n = 283) and Caucasian and Hispanic (n = 153) patients with rheumatoid arthritis (RA). METHODS: Patients were from 9 Arthritis, Rheumatism, and Aging Medical Information System databanks. Cross-sectional data were derived from the Health Assessment Questionnaire. Staged multivariate analysis of covariance was used to explore roles of possible contributing factors (age, sex, education, disease duration, number of comorbid conditions, and treatment) to ethnic minority disparities. RESULTS: The cohort was 91% Caucasian and 76% female. Caucasians were significantly older than African Americans and Hispanics (62 vs 56 and 55 yrs; both p < 0.0001 from Caucasians), better educated (13 vs 12 and 12 yrs; both p < 0.0001 from Caucasians), and had their RA longer (16 vs 13 and 15 yrs; p < 0.01 for African Americans). Unadjusted disability scores were statistically indistinguishable, but pain was worse in both ethnic groups (p < 0.01), and global health worse in Hispanics (p < 0.05). After adjustment for covariates, African Americans had the poorest outcomes in all 3 measures, although only pain in African Americans (p < 0.05) was statistically different from Caucasians. CONCLUSION: Results of this exploratory study suggest that in a relatively similar cohort of patients with RA, minority health disparities exist. Both ethnic groups had poorer outcomes for all 3 measures than Caucasians after adjustment. Additional study and longitudinal research with larger numbers of patients are needed to improve our understanding of these differences and to assess potential causal roles.     

Biologically Inspired Tensor Features

According to the research results reported in the past decades, it is well acknowledged that face recognition is not a trivial task. With the development of electronic devices, we are gradually revealing the secret of object recognition in the primate’s visual cortex. Therefore, it is time to reconsider face recognition by using biologically inspired features. In this paper, we represent face images by utilizing the C1 units, which correspond to complex cells in the visual cortex, and pool over S1 units by using a maximum operation to reserve only the maximum response of each local area of S1 units. The new representation is termed C1 Face. Because C1 Face is naturally a third-order tensor (or a three dimensional array), we propose three-way discriminative locality alignment (TWDLA), an extension of the discriminative locality alignment, which is a top-level discriminate manifold learning-based subspace learning algorithm. TWDLA has the following advantages: (1) it takes third-order tensors as input directly so the structure information can be well preserved; (2) it models the local geometry over every modality of the input tensors so the spatial relations of input tensors within a class can be preserved; (3) it maximizes the margin between a tensor and tensors from other classes over each modality so it performs well for recognition tasks and (4) it has no under sampling problem. Extensive experiments on YALE and FERET datasets show (1) the proposed C1Face representation can better represent face images than raw pixels and (2) TWDLA can duly preserve both the local geometry and the discriminative information over every modality for recognition.     

第一届中澳(2011.5·深圳)全科医学学术交流论坛暨全国全科医生高级师资培训班内容摘登

今天我与大家讨论的主题是"全科医学的核心临床技术".换句话说,我们要谈谈成为一名优秀医生要面临哪些挑战.经常有人跟我说,成为医生多么幸运,医生一定很优秀等.他们期望当医生的人是很优秀的人,所以今天我想跟大家分享一下我所认为的好医生是什么样子的.