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91.
This article explores the tenets of the responsible conduct of research. The proper treatment of human and animal subjects, recognition and avoidance of conflicts of interest, management of data to ensure privacy and confidentiality, authorship, academic freedom, and scientific misconduct are discussed. Historically significant events that have influenced the ethical climate, along with a review of guiding principles and regulations that define the conduct of ethical research are presented. Circumstances more specific to emergency medicine are examined in detail to provide meaningful guidance to practicing emergency medicine researchers. 相似文献
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El Hassani Y Fournet M Momjian S Pollo C Seeck M Pegna A Schaller K 《Acta neurochirurgica》2012,154(8):1337-1342
Background
The neuropsychological results of temporal lobe epilepsy surgery are well reported in the literature. The aim of this study was to analyse the neuropsychological outcome in a consecutive series of patients with extra-temporal epilepsy.Methods
We retrospectively analysed the data of patients operated between 1996 and 2008 for extra-temporal epilepsy. Standard neuropsychological tests were applied. We assessed the neuropsychological outcome after surgery and the correlation of the neuropsychological outcome with (1) side and localisation of surgery, (2) Engel scale for seizure outcome and (3) timing of surgery.Findings
Patients had a better neuropsychological outcome when undergoing non-frontal resection [χ2 (2) =6.66, p?=?0.036]. Subjects who had undergone left or right resection showed no difference in outcome [χ2 (2) =0.533, p?=?0.766]. The correlation between the Engel scale for seizure re-occurence and the neuropsychological scores showed only a tendency for better outcome (Spearman ρ?=??0.437; p?=?0.069). The global measure of change did not correlate significantly with delay of surgery (Spearman ρ?=??0.163; p?=?0.518).Conclusions
Resective epilepsy surgery improves neuropsychological status outcome in patients with extra-temporal epilepsy even if the patient did not become seizure free. The outcome is better for non-frontal localisation.95.
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Prediction of soft-tissue injuries in Schatzker II tibial plateau fractures based on measurements of plain radiographs 总被引:2,自引:0,他引:2
Gardner MJ Yacoubian S Geller D Pode M Mintz D Helfet DL Lorich DG 《The Journal of trauma》2006,60(2):319-23; discussion 324
BACKGROUND: Split-depression fractures of the lateral tibial plateau (Schatzker II) are associated with a significant risk of capsuloligamentous and meniscal injury. We hypothesized that the amount of fracture depression and widening on anteroposterior (AP) plain radiographs would correlate with the incidence of injury to these structures on magnetic resonance imaging (MRI). METHODS: Sixty-two consecutive patients with Schatzker II tibial plateau fractures had a knee x-ray series and MRI preoperatively. AP plain radiographs were measured for lateral joint line depression and condylar widening, and MRIs were evaluated for injury to soft-tissue structures around the knee. For each structure, the threshold of depression and widening that led to the greatest disparity in soft-tissue injury was determined. Multiple logistic regressions were applied to calculate whether depression and/or widening above the thresholds were predictive for injury to individual soft-tissue structures. RESULTS: When depression was greater than 6 mm and widening was greater than 5 mm, lateral meniscal injury occurred in 83% of fractures, compared with 50% of fractures with less displacement (p < 0.05). When either depression or widening was at least 8 mm, medial meniscal injury occurred more frequently (depression 53%, p < 0.05; widening 78%, p < 0.05; versus neither 15%). Lateral collateral ligament and posterior cruciate ligament tears were not seen with minimally displaced fractures (< 4 mm), but the incidence of injury approached 30% with increasing displacement. CONCLUSIONS: Due to the limited availability of MRI in some centers, correlation of lateral condylar depression and widening, as measured on plain radiographs, to injury of various soft-tissue structures may be extremely helpful in planning open or arthroscopic treatment methods. Using these guidelines, Schatzker II fractures with depression or widening approaching 5 mm deserve heightened vigilance in diagnosing and treating these concomitant soft-tissue injuries. 相似文献
98.
Observing responses produce contact with stimuli that are to be discriminated and have been considered an animal model of attending. In the observing-response procedure, alternating periods of drug availability versus extinction for one response are not signaled, but a second response (i.e. the observing response) produces stimuli signaling whether drug is available or not. This experiment examined the effects of the concentration of self-administered alcohol and increases in observing-response requirement on rats' observing alcohol stimuli. In addition, the effects of alcohol concentration on the persistence of observing were examined when alcohol was no longer available. Results showed that observing tracked bitonic changes in the number of alcohol deliveries rather than monotonic increases in total alcohol consumption resulting from increases in alcohol concentration. Increasing the observing-response requirement decreased the number of stimulus presentations earned. The resultant decreases in time spent in the presence of the alcohol stimulus were associated with decreases in alcohol consumption. During extinction of alcohol responding, observing was more persistent when it produced a stimulus previously associated with a higher alcohol concentration. Finally, responding for alcohol was more resistant to extinction in the presence of an observing-response-produced alcohol stimulus than in its absence, but did not depend on alcohol concentration. These results suggest that increases in the difficulty of obtaining access to alcohol cues can decrease alcohol consumption by reducing contact with those cues. In addition, if observing behavior in the present procedure is analogous to attending to alcohol cues, the results suggest that attending to alcohol cues is more persistent with cues previously associated with higher doses, and that the persistence of attending to alcohol cues and their impact on drinking may be dissociable. 相似文献
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Intramedullary fixation of tibial shaft fractures using an expandable nail: early results of 54 acute tibial shaft fractures 总被引:8,自引:0,他引:8
Steinberg EL Geller DS Yacoubian SV Shasha N Dekel S Lorich DG 《Journal of orthopaedic trauma》2006,20(5):303-9; discussion 315-6
OBJECTIVE: To evaluate and present our experience using the expandable nail system for the treatment of acute tibial shaft fractures. DESIGN: Retrospective study. SETTING: Two level-1 trauma centers-University teaching hospitals. METHODS: Fifty-four consecutive patients were treated by this nail system for acute tibial shaft fracture. Two nail diameters were used, 8.5 mm and 10 mm. Operation, hospitalization and healing times, reaming versus nonreaming, isolated versus multiple injuries, and reoperations were recorded and analyzed statistically. RESULTS: Follow-up was obtained either until fracture healing or for a minimum of 1 year with an average of 14 months (12 to 24). All fractures healed in an average time of 72 days (21 to 204). The average healing times for patients treated with 8.5-mm and 10-mm nails were 77.2 days (27 to 204) and 63.4 days (21 to 121), respectively. Average operative time was 103 minutes (40 to 185) if reamed and 56 minutes (30 to 80) if unreamed. Average healing times were 65.4 days (21 to 190) if reamed and 79.5 days (42 to 204) if unreamed. There were 11 complications (20.4%) related to the nailing: 3 deep infections, 2 superficial infections, 2 bone shortenings of 1 cm secondary to nail protrusion in the knee, 1 compartment syndrome, 1 fracture propagation, 1 distal malalignment, and 1 delayed union. Hardware was removed in 6 patients (3 infections, 2 patients' request and 1 protrusion into the knee), and 1 additional patient underwent exchange nailing due to a delayed union. CONCLUSIONS: The expandable nail offers the theoretical advantages of improved load sharing and rotational control without the need for interlocking screws. This study demonstrates satisfactory healing and alignment for the treatment of tibial shaft fractures using this device. However, caution must be exercised when using this nail in cases of significant comminution and in cases where the fracture pattern involves the more proximal or distal aspect of the tibial shaft. 相似文献