Arthroscopic Knot Tying on a Single Suture Limb in Case of a Torn Suture

During arthroscopic knot tying, one of the suture limbs may break before completion of the knot. With a single suture limb left, it may not be possible to secure the knot against slipping, and the surgeon may be forced to use an additional anchor to obtain a secure repair. We present a tool and method that allow completion of the knot on a single suture limb. Alternatively, the method can be used to perform all-inside endoscopic or arthroscopic knot tying without removal of the instrument from the body.     

Global topological dominance in the left hemisphere

A series of experiments with right-handers demonstrated that the left hemisphere (LH) is reliably and consistently superior to the right hemisphere (RH) for global topological perception. These experiments generalized the topological account of lateralization to different kinds of topological properties (including holes, inside/outside relation, and “presence vs. absence”) in comparison with a broad spectrum of geometric properties, including orientation, distance, size, mirror-symmetry, parallelism, collinearity, etc. The stimuli and paradigms used were also designed to prevent subjects from using various nontopological properties in performing the tasks of topological discrimination. Furthermore, task factors commonly considered in the study of hemispheric asymmetry, such as response latency vs. accuracy, vertical vs. horizontal presentation, detection vs. recognition, and simultaneous vs. sequential judgment, were manipulated to not be confounding factors. Moreover, left-handed subjects were tested and showed the right lateralization of topological perception, in the opposite direction of lateralization compared with right-handers. In addition, the functional magnetic resonance imaging measure revealed that only a region in the left temporal gyrus was consistently more activated across subjects in the task of topological discrimination, consistent with the behavioral results. In summary, the global topological dominance in the LH is well supported by the converging evidence from the variety of paradigms and techniques, and it suggests a unified solution to the current major controversies on visual lateralization.     

QT比值在后凸成形术中L5椎弓根穿刺的意义及临床应用

目的探讨椎体前方形态对L5椎体后凸成形术经皮椎弓根穿刺的影响,评价其临床应用价值。方法①选取正常胸腰椎（T8～L5）CT图片120椎,借助计算机软件GSP4．06测量椎体前1／4侧距与中央横径的比值（QT比值）,并进行统计分析;②2002年10月-2008年10月,开展146例后凸成形术中21例L5椎体穿刺,术前采取CT平扫并测量QT比值,以此推算椎体后凸成形术经皮椎弓根穿刺内倾角,指导术中穿刺,评价其临床应用效果。结果L—L4椎体QT比值为0．40（0．40±0．02）,且不因椎序的递增而改变（P〉0．05）;L5椎体QT比值为0．38（0．38±0．02）,与其它椎体间差异有统计学意义（P〈0．01）。L5椎体的QT比值与椎弓根内倾角呈直线关系（P〈0．01）,且呈负相关,当QT=0．40时,最小椎弓根内倾角为20°,当QT比值减小0．01时,植钉角应相应增大2°,反之亦然。临床应用21例中,经术前QT比值测量,4例骶椎腰化,3例腰椎骶化,14例正常腰椎,分别根据其QT比值调整方向,均顺利获得穿刺成功。结论QT比值是描述胸腰椎椎体前方形态的重要参数,是椎弓根技术的个体化指标;正常椎体的QT比值恒定,在T5—L4为0．40,L5为0．38;QT比值偏大应减小内倾角,QT比值偏小应增大内倾角;研究表明,应用QT比值指导术中穿刺方向,具有一定临床价值。     

Arthroscopic physeal sparing all inside repair of the tibial avulsion fracture in the anterior cruciate ligament: technical note

We describe a new and effective arthroscopic physeal sparing repair of the tibial eminence avulsion fracture using all an inside repair technique. The treatment of ACL avulsion is controversial, especially in skeletally immature patients, with concerns about physeal damage, and a more reliable way of fixation is still being pursued for small or comminuted fragments. Screw fixation and suture cerclage has some limitations, especially in the small fragment or skeletally immature patients. We fixed avulsion fragment using all inside repair between the distal portion of the ACL and transverse ligament and periosteum. A crescent suture hook loaded with NO. 0 PDS is introduced and the suture hook pierces the transverse intermeniscal ligament and periosteum. The half length of the PDS is now advanced out through the hook and the end is brought out to the anterolateral portal. With the suture hook located intra-articularly and loaded with half the length of the original PDS, the suture hook repierces the transverse intermeniscal ligament at 5 mm on the side and the remaining half length of PDS is now advanced out through the hook and the end is brought out to the anterolateral portal. After that procedure, the suture hook loaded with NO. 0 absorbable Maxon is introduced through the anteromedial portal for the role of shuttle relay. The suture hook pierces the ACL just above the superior border of the avulsion fragment, the Maxon is now advanced out through the hook and the end is brought out to the anterolateral portal. Subsequently, the suture hook is removed and a suture retriever is introduced through the anterolateral portal. PDS and Maxon are held together and retrieved out of the anterolateral portal by the suture retriever at the same time. Our technique has advantages in small comminuted fractures and skeletally immature patients.     

胎儿脐带缠绕时宫内缺氧的超声诊断

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Invasive Cardiologists Are Exposed to Greater Left Sided Cranial Radiation: The BRAIN Study (Brain Radiation Exposure and Attenuation During Invasive Cardiology Procedures)

ObjectivesThis study sought to determine radiation exposure across the cranium of cardiologists and the protective ability of a nonlead, XPF (barium sulfate/bismuth oxide) layered cap (BLOXR, Salt Lake City, Utah) during fluoroscopically guided, invasive cardiovascular (CV) procedures.BackgroundCranial radiation exposure and potential for protection during contemporary invasive CV procedures is unclear.MethodsInvasive cardiologists wore an XPF cap with radiation attenuation ability. Six dosimeters were fixed across the outside and inside of the cap (left, center, and right), and 3 dosimeters were placed outside the catheterization lab to measure ambient exposure.ResultsSeven cardiology fellows and 4 attending physicians (38.4 ± 7.2 years of age; all male) performed diagnostic and interventional CV procedures (n = 66.2 ± 27 cases/operator; fluoroscopy time: 14.9 ± 5.0 min). There was significantly greater total radiation exposure at the outside left and outside center (106.1 ± 33.6 mrad and 83.1 ± 18.9 mrad) versus outside right (50.2 ± 16.2 mrad; p < 0.001 for both) locations of the cranium. The XPF cap attenuated radiation exposure (42.3 ± 3.5 mrad, 42.0 ± 3.0 mrad, and 41.8 ± 2.9 mrad at the inside left, inside center, and inside right locations, respectively) to a level slightly higher than that of the ambient control (38.3 ± 1.2 mrad, p = 0.046). After subtracting ambient radiation, exposure at the outside left was 16 times higher than the inside left (p < 0.001) and 4.7 times higher than the outside right (p < 0.001). Exposure at the outside center location was 11 times higher than the inside center (p < 0.001), whereas no difference was observed on the right side.ConclusionsRadiation exposure to invasive cardiologists is significantly higher on the left and center compared with the right side of the cranium. Exposure may be reduced similar to an ambient control level by wearing a nonlead XPF cap. (Brain Radiation Exposure and Attenuation During Invasive Cardiology Procedures [BRAIN]; NCT01910272)     

卵巢过度刺激综合征合并宫内外同时妊娠患者的护理

目的探讨卵巢过度刺激综合征合并宫内外同时妊娠患者的病情观察及护理方法。方法对2012年5月至2014年7月永康市妇幼保健院妇科病区6例卵巢过度刺激综合征合并宫内宫外同时妊娠患者的护理方法进行总结和分析。结果6例患者均痊愈,并继续正常妊娠。结论术前心理护理、掌握疾病特点、严密观察病情、做好抢救及手术准备以及术后的精心护理,是此类患者尽快康复并继续正常妊娠的重要保证。     

Researcher's and parents' perspectives on quality of care and education

Based on arguments according to which the concept of quality is multifaceted, difficult to be defined and defined differently by various stakeholders, it has been suggested that the quality of care and education be evaluated from different perspectives if one aims to create a global picture of the early childhood education and care programmes. The present study aimed to examine the level of quality and care provided by Greek preschool programmes from the researcher's and parents' perspectives and verify whether they evaluated using the same mechanism. Correlation analysis indicated that the parents rated the quality of care and education provided by their child's classrooms higher compared with the researcher. The age and level of education were found to correlate with the parents' ratings. Thus, the type of setting was found to correlate both with the researcher's and parents' ratings. The research results suggest that the quality of care and education is a relative concept and, substantiating the previous research results, highlight the need to take into account the perspectives of all those involved (parents, children and educators) when attempts are being made to define and evaluate the quality.     

不同方法治疗老年性股骨粗隆间骨折的临床分析

Objective Probe into different method safe and effective fixation method,clinical result and cliniical to indications of different treatments in intertrochanter fracture of femur in the old elderly.Methods Adopting the femur near end dissecting type to lock the stencil plate fixation 14 of 58 cases of old intertrochanter fracture of femur separately.the hip screw of motive force(DHS) fixation was used in 24,femur near end stencil plate fixation in 20,and the blood loss,operation time,ossicle split off situation and fracture heal time were compared among the three groups.Sanders grade results and complications were followed up.Results Postoperative follow up Was done in all patients,from 8 months to 3 years,averaged 1.5 years.three groups of skill type fine rate of the three groups being 92.9%,92%,90%respectively.Conclusions Different methods showed good clinical results in treating the old intertrochanter fracture of femur,each having its indications.Operation should be done should follow based on fracture type,age,physique factors and patient's osteoporosis intensity,choosing the best healing solution by characteristics of intermal flxation while each combining.The hook board(ALHP)is suitable for old patients with serious osteoporosis,DHS for Evans Ⅰ,Ⅱ types and some Evans Ⅲ type,and femur near end dissecting type stencil plate for Ⅳ and Ⅴ types fractures.