眼位对观察综合显示头盔信息的影响

目的 研究中心眼位和上调眼位时受试者对观察综合显示头盔信息的影响,测定两种眼位下头盔的位移与观察信息的关系,为综合显示头盔设计和使用提供依据. 方法 受试者为6名青年男性健康志愿者,视力良好.受试者佩戴综合显示头盔,头盔显示器为右眼单目,视场20°.中心眼位时,水平视线通过出瞳中心.上调眼位时,出瞳中心调整到水平视线上5°.通过分别施加与2.5Gz～8.0Gz的载荷相对应重量的沙袋模拟静载荷,保持10 s,重复3次；由低到高逐次加载.在AMST-HC-4E型载人离心机上,依次进行G值增长率为3 G/s,峰值分别为3.5Gz～8.0Gz持续10s的离心机试验.由受试者报告观察到的显示信息变化.通过三维坐标测量仪测量头盔位移. 结果 静加载时,上调眼位的头盔平均位移约为中心眼位的50％,信息丢失仅在视场上、下端小于2.5°的范围.离心机试验,上调眼位的头盔在6.5Gz10 s时整个视场信息基本可见,但中心眼位的头盔在6.0Gz10s时50％以上的信息丢失.静加载试验和离心机试验,上调眼位观察信息的变化趋势是一致的. 结论 上调眼位明显好于中心眼位对信息的观察.上调眼位对观察综合显示头盔信息的优势,为综合显示头盔的设计和使用提供了一条新途径.     

Motion estimation of 3D coronary vessel skeletons from X-ray angiographic sequences

A method for quantitatively estimating global displacement fields of coronary arterial vessel skeletons during cardiac cycles from X-ray coronary angiographic (CAG) image sequences is proposed. First, dynamic sequence of arterial lumen skeletons is semi-automatically reconstructed from a pair of angiographic image sequences acquired from two nearly orthogonal view angles covering one or several cardiac cycles. Then, displacement fields of 3D vessel skeletons at different cardiac phases are quantitatively estimated through searching optimal correspondences between skeletons of a same vessel branch at different time-points of image sequences with dynamic programming algorithm. The main advantage of this method is that possible errors introduced by calibration parameters of the imaging system are avoided and application of dynamic programming ensures low computation cost. Also, any a priori knowledge and model about cardiac and arterial dynamics is not needed and the same matching error function and similarity measurement can be used to estimate global displacement fields of vessel skeletons performing different kinds of motion. Validation experiments with computer-simulated data and clinically acquired image data are designed and results are given to demonstrate the accuracy and validity of the proposed method.     

住院患者管道脱出危险因素评估单研发与应用

目的 研发住院患者管道脱出危险因素评估单,并应用于临床.方法 成立管道管理小组,在文献研究基础上研发评估单.采取简单随机抽样方法,应用评估单对住院带管患者进行调查,评价其信度和效度.结果 住院患者管道脱出危险因素评估单由6个维度18个条目组成,具有较好的信度和效度,评估单有效降低了带管患者管道脱出率,减少了护理纠纷,提高了患者满意度.结论 住院患者管道脱出危险因素评估单使用简便、易操作,为临床护士预测带管患者管道脱出危险因素提供了测量工具,确保了患者安全.     

Measurement of Intra-Fraction Displacement of the Mediastinal Metastatic Lymph Nodes Using Four-Dimensional CT in Non-Small Cell Lung Cancer

Objective

To measure the intra-fraction displacements of the mediastinal metastatic lymph nodes by using four-dimensional CT (4D-CT) in non-small cell lung cancer (NSCLC).

Materials and Methods

Twenty-four patients with NSCLC, who were to be treated by using three dimensional conformal radiation therapy (3D-CRT), underwent a 4D-CT simulation during free breathing. The mediastinal metastatic lymph nodes were delineated on the CT images of 10 phases of the breath cycle. The lymph nodes were grouped as the upper, middle and lower mediastinal groups depending on the mediastinal regions. The displacements of the center of the lymph node in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions were measured.

Results

The mean displacements of the center of the mediastinal lymph node in the LR, AP, and SI directions were 2.24 mm, 1.87 mm, and 3.28 mm, respectively. There were statistically significant differences between the displacements in the SI and LR, and the SI and AP directions (p < 0.05). For the middle and lower mediastinal lymph nodes, the displacement difference between the AP and SI was statistically significant (p = 0.005; p = 0.015), while there was no significant difference between the LR and AP directions (p < 0.05).

Conclusion

The metastatic mediastinal lymph node movements are different in the LR, AP, and SI directions in patients with NSCLC, particularly for the middle and lower mediastinal lymph nodes. The spatial non-uniform margins should be considered for the metastatic mediastinal lymph nodes in involved-field radiotherapy.     

Outcomes of Acute and Chronic Patients With Magnetic Resonance Imaging–Confirmed Symptomatic Lumbar Disc Herniations Receiving High-Velocity,Low-Amplitude,Spinal Manipulative Therapy: A Prospective Observational Cohort Study With One-Year Follow-Up

Objective

The purposes of this study were to evaluate patients with low-back pain (LBP) and leg pain due to magnetic resonance imaging–confirmed disc herniation who are treated with high-velocity, low-amplitude spinal manipulation in terms of their short-, medium-, and long-term outcomes of self-reported global impression of change and pain levels at various time points up to 1 year and to determine if outcomes differ between acute and chronic patients using a prospective, cohort design.

Methods

This prospective cohort outcomes study includes 148 patients (between ages of 18 and 65 years) with LBP, leg pain, and physical examination abnormalities with concordant lumbar disc herniations. Baseline numerical rating scale (NRS) data for LBP, leg pain, and the Oswestry questionnaire were obtained. The specific lumbar spinal manipulation was dependent upon whether the disc herniation was intraforaminal or paramedian as seen on the magnetic resonance images and was performed by a doctor of chiropractic. Outcomes included the patient’s global impression of change scale for overall improvement, the NRS for LBP, leg pain, and the Oswestry questionnaire at 2 weeks, 1, 3, and 6 months, and 1 year after the first treatment. The proportion of patients reporting “improvement” on the patient’s global impression of change scale was calculated for all patients and acute vs chronic patients. Pretreatment and posttreatment NRS scores were compared using the paired t test. Baseline and follow-up Oswestry scores were compared using the Wilcoxon test. Numerical rating scale and Oswestry scores for acute vs chronic patients were compared using the unpaired t test for NRS scores and the Mann-Whitney U test for Oswestry scores. Logistic regression analysis compared baseline variables with “improvement.”

Results

Significant improvement for all outcomes at all time points was reported (P < .0001). At 3 months, 90.5% of patients were “improved” with 88.0% “improved” at 1 year. Although acute patients improved faster by 3 months, 81.8% of chronic patients reported “improvement” with 89.2% “improved” at 1 year. There were no adverse events reported.

Conclusions

A large percentage of acute and importantly chronic lumbar disc herniation patients treated with chiropractic spinal manipulation reported clinically relevant improvement.     

Third molar tooth agenesis and pattern of impaction in patients with palatally displaced canines

Objectives:To investigate the association between third molar agenesis and pattern of impaction, missing teeth, and peg-shaped lateral incisor with palatal canine displacement (PDC).Materials and Methods:The pretreatment orthodontic orthopantomograms of 438 patients (122 males and 316 females) diagnosed with PDC were included. A total of 338 patients with normally erupted canines who had a preexisting radiograph as part of their orthodontic treatment (125 males and 313 females) served as controls. Orthopantomograms were evaluated for missing third molars, third molar eruption status, and type of impaction, third molar spaces, third molar width, and angulation.Results:In the PDC group, at least one third molar was missing in 48% and 19% in the upper and lower arches, respectively. Also, 38% and 67% of PDC patients had at least one third molar impaction in the upper and lower arches, respectively. The difference between the PDC and control groups was significant for both missing and impacted third molars (P < .001 for each). The most common type of third molar impaction in the upper arch was vertical and distoangular in the PDC and control groups, respectively. Upper and lower third molar width and spaces were reduced in PDC patients when compared with the control group (P < .001). In PDC patients, missing teeth and peg-shaped lateral incisors were recorded in 5.6% and 9.1%, respectively.Conclusions:PDC patients showed a high prevalence of third molar agenesis and impaction. Upper and lower third molar width and space were reduced in the PDC patients. There were no significant associations between tooth agenesis (other than third molars) and the PDC anomaly.     

焦虑情绪对腰椎间盘突出症手术疗效的影响

目的探讨焦虑情绪对腰椎间盘突出症手术疗效的影响。方法入住常州市第二人民医院脊柱外科的腰椎间盘突出症拟行手术患者,在术前用汉密尔顿焦虑量表筛选出有焦虑的患者(H AMA≥17分),将其纳入观察组(30例),无焦虑的患者(HAMA<7分)纳入对照组(30例)。在术前术后分别用 Oswestry 功能障碍指数(ODI)评估患者腰椎功能改善情况,采用视觉疼痛模拟评分(VAS)对患者腰痛、腿痛进行评定,比较两组间疗效的差异。结果有焦虑情绪的观察组患者术后 ODI评分、腰痛 VAS评分、腿痛 VAS评分均显著高于对照组,差异均有统计学意义(P<0.05)。结论焦虑与腰椎间盘突出症的手术疗效有相关性,术前评定患者的焦虑情绪以指导实施针对性干预有一定意义。     

腰椎间盘术后早期深部感染的临床处理与疗效评价

【目的】探讨腰椎间盘术后早期深部感染的临床处理方法,评价其疗效。【方法】回顾分析湖南省人民医院骨科2006年5月至2014年5月腰椎间盘术后早期深部感染确诊病例,共17例。实施手术13例,行前路和（或）后路病灶清除＋置管灌洗术;非手术4例,根据细菌培养及药敏试验使用抗生素（＞4～6周）并卧床。达到感染治愈标准后的1～2周,佩戴外固定支具下床活动。【结果】13例手术治疗者术后24～48 h腰痛VAS评分由术前（8．7±2．1）分改善至术后（3．2±1．3）分,平均抗生素使用时间（35±2） d ,2例患者因减张缝合术后4周拆线,其余均12～16 d一期拆线,切口愈合良好;4例非手术者治疗约4周后症状明显改善,平均抗生素使用时间（28±1）d,腰痛VAS评分由治疗前（7．9±2．2）分改善至治疗后（2．3±1．4）分。所有病例实验室复查白细胞、CRP正常和（或）ESR基本恢复正常,MRI复查信号均正常或有明显改善后予以出院,住院时间平均（74±2．5） d。随访6～60个月,均无感染复发情况,常规复查X线和（或）C T提示骨性融合,脊柱稳定性恢复,MRI提示信号正常或明显改善,达到临床愈合。【结论】腰椎间盘术后早期深部感染确诊后以有效抗生素治疗（＞4～6周）和卧床为主,若短期内药物治疗无效,体温和白细胞持续升高、C-反应蛋白（CRP）与血沉（ESR）持续不降或升高,或者影像学显示软组织或终板有破坏信号改变者应及时手术治疗,能迅速缓解疼痛、缩短病程,获得临床愈合。     

Is perceived angular displacement the time integral of perceived angular velocity?

Estimates of rotational self-displacement and self-velocity have been used interchangeably in vestibular psychophysics to characterize vestibular ego-motion perception. However, the assumption underlying this indiscriminate use has never been tested. The assumption holds that the two estimates are equivalent, with the displacement estimates reflecting the time integral of the signal underlying the velocity estimate. We tested this hypothesis by directly comparing displacement and velocity estimates. Two groups of healthy young subjects (2 × N = 15) were presented with the same vestibular stimuli (horizontal whole body rotations in the dark in the form of velocity steps of 5, 10, 20, and 40°/s with 1, 2, 4, 8, and 16 s duration, yielding position ramps of 5, 10, 20, 40, 80, 160, and 320° total displacement). The first subject group estimated peak velocity, and the second group estimated total displacement, both groups using a comparable psychophysical procedure (Stevens' magnitude estimation). The experimentally obtained velocity estimates were used to predict the displacement estimates. To this end, the velocity signal was assumed to decay exponentially from the reported peak value (reflecting the dynamics of peripheral and early central vestibular mechanisms) and was mathematically integrated. Predicted and measured displacement estimates were similar when a time constant of 20 s was assumed, which is in good agreement with earlier studies. We conclude that vestibular displacement estimates can, indeed, be considered equivalent to vestibular velocity estimates, at least for the stimulus parameters used.