Digital volume tomography (DVT) as a diagnostic modality of the anterior skull base

Conclusion. Because of high resolution and the relatively lower costs in comparison with modern helical CT scanners, digital volume tomography (DVT) can be recommended in the diagnosis of the nasal cavity and paranasal sinuses. Objectives. DVT is an advancement of panoramic tomography and is based on the principles of rotational tomography. It enables high resolution visualization of osseous structures. The slices can be displayed in three orthogonal planes that can be changed in angle arbitrarily. Data volumes of up to 12×17 cm can be examined with a new generation of the DVT. The aim of this study was to point out the potential of DVT in the anterior skull base. Subjects and methods. DVT scans with a cylindrical size of 10 cm in diameter and 10 cm in height were performed in 23 patients. The identification of surgical key landmarks (uncinate process, middle turbinate, ethmoidal bulla, agger nasi cells, Haller cells, frontal recess, anterior ethmoidal artery in its relationship to the skull base, the cribiform plate of the sphenoidal sinus in relation to the optic nerve, and the internal carotid artery) was evaluated. Results. Display of the essential surgical key landmarks was possible in all patients     

CT、MRI对鼻咽癌颅底骨质侵犯的检测及诊断价值

目的研究螺旋CT与MRI诊断鼻咽癌颅底骨质侵犯的价值。方法收集本院2010年1—12月经病理证实的29例鼻咽癌颅底骨质侵犯患者的临床资料．并对这些患者的CT和MRI检查结果进行分析。结果CT的表现为虫蚀样，皮质骨模糊增厚，或有皮质骨因硬化而增生，在同一病例中，可在不同部位出现骨质破坏，MRI的影像表现为高信号的骨髓信号消失，取代为肿瘤的中等信号。且增强扫描后有明显强化。29例患者中，CT检出10例，检出率为34．5％，其中，单部位3例，占10-3％；多部位7例，占24．1％。MRI检出21例，检出率为72．4％，其中，单部位8例，占27．6％；多部位13例，占44．8％，两种检测结果比较，差异有统计学意义（P〈0．05）。CT检出颅底各部位骨质侵犯最多的是岩锥尖，其次是翼板：MRI检出颅底各部位骨质侵犯最多的是岩锥尖，其次是斜坡骨。结论MRI诊断能够提高鼻咽癌颅底骨质侵犯的确诊率，有利于早日确诊并及时得以治疗，在鼻咽癌颅底骨质侵犯的定位和治疗方案的选择上有一定的价值。     

Sentence comprehension in Swahili–English bilingual agrammatic speakers

For this study, sentence comprehension was tested in Swahili–English bilingual agrammatic speakers. The sentences were controlled for four factors: (1) order of the arguments (base vs. derived); (2) embedding (declarative vs. relative sentences); (3) overt use of the relative pronoun “who”; (4) language (English and Swahili). Two theories were tested: the Trace Deletion Hypothesis (TDH; [Grodzinsky, Y. (1995). A restrictive theory of agrammatic comprehension. Brain and Language, 50, 27–51]) that assumes a representational deficit in agrammatic aphasia and the Derived Order Problem Hypothesis (DOP-H; Bastiaanse & Van Zonneveld, 2005), which is a processing account. Both theories have the same predictions for sentences in derived order. The difference is that the TDH predicts chance level performance for sentences in which the arguments are not in base order, whereas the DOP-H predicts poorer performance when processing demands increase. The results show that word order influences performance, in that sentences in which the arguments are in derived order are harder to comprehend than sentences in which the arguments are in base order. However, there is a significant interaction with the factor “embedding”: sentences with an embedding are harder to comprehend than simple declaratives and this influence is larger in derived order sentences. There is no effect of language nor of the use of a relative pronoun. These results are correctly accounted for by the DOP-H.     

医院科研基地的节能措施与成效-以四川大学华西医院科研基地为例

文章以四川大学华西医院科研基地为例，分析了科研基地的既有设施设备用能设计指标与当前实际环境需求的差异，提出了对公共区域照明、围墙灯、绿地照明以及中央空调系统末端等方面改进的相应措施，并分析了实施效果。     

Health economic evidence gaps and methodological constraints in low back pain and neck pain: Results of the Research Agenda for Health Economic Evaluation (RAHEE) project

Despite the increased interest in economic evaluations, there are difficulties in applying the results of such studies in practice. Therefore, the “Research Agenda for Health Economic Evaluation” (RAHEE) project was initiated, which aimed to improve the use of health economic evidence in practice for the 10 highest burden conditions in the European Union (including low back pain [LBP] and neck pain [NP]). This was done by undertaking literature mapping and convening an Expert Panel meeting, during which the literature mapping results were discussed and evidence gaps and methodological constraints were identified. The current paper is a part of the RAHEE project and aimed to identify economic evidence gaps and methodological constraints in the LBP and NP literature, in particular.The literature mapping revealed that economic evidence was unavailable for various commonly used LBP and NP treatments (e.g., injections, traction, and discography). Even if economic evidence was available, many treatments were only evaluated in a single study or studies for the same intervention were highly heterogeneous in terms of their patient population, control condition, follow-up duration, setting, and/or economic perspective. Up until now, this has prevented economic evaluation results from being statistically pooled in the LBP and NP literature, and strong conclusions about the cost-effectiveness of LBP and NP treatments can therefore not be made. The Expert Panel identified the need for further high-quality economic evaluations, especially on surgery versus conservative care and competing treatment options for chronic LBP. Handling of uncertainty and reporting quality were considered the most important methodological challenges.     

Pediatric Lisfranc variants and equivalent injuries: A review

IntroductionPediatric Lisfranc injuries are rare and a limited number of series or case reports have been published. Diagnosis can be easily missed and long-term outcome is not sufficiently presented. The primary aim of this paper is to review the literature about pediatric Lisfranc variants and equivalent injuries. This article also provides a review on Lisfranc joint anatomy, pediatric Lisfranc injuries, and stress or acute fractures involving the first and central (second to third) metatarsal (MT) bases, in an effort to detect potential pediatric Lisfranc variants and equivalent injuries, which were not accurately diagnosed.MethodsThe bibliographic survey to identify pediatric Lisfranc variants and equivalent injuries was conducted in the PubMed and Scopus databases, with no time limit. Four terms were used for searching in all possible combinations: Pediatric/children, Lisfranc/tarsometatarsal, variant/equivalent, injury/fracture. The only inclusion criterion was the age of the patients, which had to be less than 12 years. Reports on adolescents or adults were excluded.ResultsThe research indicated that there was only one study mentioning the pediatric Lisfranc equivalent injury, while there were no cases recorded as pediatric Lisfranc variants. The literature review regarding the final clinical outcome of both pediatric Lisfranc injuries and fractures, either stress or acute, involving the central MT base, indicated that early degenerative changes often occur, and may be responsible for chronic pain and activity limitation, even after mild and subtle low energy injuries.Discussion/ConclusionsThis review suggests that stress fractures involving the central MT base could be considered as a variant of the Lisfranc injury in children. Care should be taken to exclude occult fractures or ligamentous injuries to the medial and central Lisfranc joint complex in the presence of fractures involving the base or proximal portion of the first MT, including injuries to the physeal plate, to rule out the pediatric Lisfranc equivalent injury.