Non-invasive assessment of vasospasm following aneurysmal SAH using C-arm FDCT parenchymal blood volume measurement in the neuro-interventional suite: Technical feasibility

Introduction

Cerebral vasospasm is the leading cause of morbidity and mortality in patients with aneurysmal subarachnoid haemorrhage (SAH) surviving the initial ictus. Commonly used techniques for vasospasm assessment are digital subtraction angiography and transcranial Doppler sonography. These techniques can reliably identify only the major vessel spasm and fail to estimate its haemodynamic significance. To overcome these issues and to enable comprehensive non-invasive assessment of vasospasm inside the interventional suite, a novel protocol involving measurement of parenchymal blood volume (PBV) using C-arm flat detector computed tomography (FDCT) was implemented.

Materials and methods

Patients from the neuro-intensive treatment unit (ITU) with suspected vasospasm following aneurysmal SAH were scanned with a biplane C-arm angiography system using an intravenous contrast injection protocol. The PBV maps were generated using prototype software. Contemporaneous clinically indicated MR scan including the diffusion- and perfusion-weighted sequences was performed. C-arm PBV maps were compared against the MR perfusion maps.

Results

Distribution of haemodynamic impairment on C-arm PBV maps closely matched the pattern of abnormality on MR perfusion maps. On visual comparison between the two techniques, the extent of abnormality indicated PBV to be both cerebral blood flow and cerebral blood volume weighted.

Conclusion

C-arm FDCT PBV measurements allow an objective assessment of the severity and localisation of cerebral hypoperfusion resulting from vasospasm. The technique has proved feasible and useful in very sick patients after aneurysmal SAH. The promise shown in this early study indicates that it deserves further evaluation both for post-SAH vasospasm and in other relevant clinical settings.     

扁平化管理在妇科优质护理服务中的实施

目的在优质护理服务过程中进一步提高护理管理及护理服务满意度。方法在妇科病区采用扁平化管理模式,即取消责任护士组长,按3个管床教授组将病区18名护士均分为3组,每组A班(7:30～17:00)2人,N班(17:00～8:00)1人,轮休3人;每人分管患者≤8例,另6名护理人员分别上辅助班、计算机操作班及主班等。每个月按护理部制定的标准进行护理质控,实施10个月后评价效果。结果患者对优质护理服务及责任护士知晓率≥95%,入院介绍、技术操作等10项满意度评分9.28～9.66分,均为满意和非常满意。结论扁平化管理模式的运用有利于护理人力资源的合理利用,从而提高护理质量和患者满意度。     

DR实际光野外影像成因的研究

目的:研究DR原始图像光野外的影像成因,减少患者辐射剂量,实现放射防护最优化。方法:分析原始图像光野外影像成因及射线来源,比较指示野与实际射线光野是否一致,外加遮线器以增加遮线器厚度减少漏线,使用自制可调手动遮线器对身体附近射线进行遮挡实验。结果:DR原始图像光野外影像是直射线方向产生的散射线照射到患者后在探测器形成的影像。结论:DR原始图像实际光野外影像是原发射线方向上的散射线照射到患者后,由于探测器(FD)比较灵敏,使患者肢体在探测器实际射线光野外形成的污渍影像,符合散射线"污渍效应"成像。     

Flat colonic adenomas in Malaysia: Fact or fancy?

BACKGROUND: Some two-thirds of colorectal carcinomas arise from adenomatous polyps, and as such, screening by colonoscopy and polyp removal should significantly reduce colorectal cancer. This has not been the case, as evidenced by recent studies, which revealed that endoscopy failed to prevent up to 50% of all subsequent carcinomas. Flat or depressed adenomas, frequently reported from Japan but rarely elsewhere, might explain the 'missed carcinomas.' Detection of flat adenomas has not been previously reported from Malaysia. METHODS: In the present prospective study, 426 consecutive patients underwent colonoscopic examination between March 1997 and January 2000, for a variety of bowel symptoms. The examinations were performed by an experienced endoscopist using a standard colonoscope and methylene blue dye spraying technique. Macroscopically, flat adenomas were defined using the criteria proposed by Sawada. RESULTS: Twenty-nine adenomas were identified in 12 patients, of which 15 were polypoid and 14 were flat, with no depressed lesions. Eight polypoidal lesions and all the flat adenomas contained mild or moderate areas of epithelial dysplasia. Seven severely dysplastic polyps were identified. One Duke's A polypoidal cancer and two advanced carcinomas were also found. All the severely dysplastic lesions and Duke's A carcinomas were found in polyps greater than 10 mm in mean size. The flat adenomas were all less than 5 mm in size. CONCLUSIONS: A significant proportion of colonic adenomas in Malaysian patients appear as small flat lesions, which could easily be missed during endoscopy. Increased recognition and treatment of flat adenomas among colonoscopists is warranted.     

Immediate Efficacy of Laterally Wedged Insoles With Arch Support on Walking in Persons With Bilateral Medial Knee Osteoarthritis

ObjectiveTo investigate the immediate efficacy of laterally wedged insoles with arch support (LWAS) on gait in persons with bilateral medial knee osteoarthritis (OA).DesignA prospective case-control intervention study.SettingA gait laboratory with a 6-camera motion analysis system and 2 forceplates.ParticipantsFifteen women with bilateral medial knee OA and 15 healthy control subjects (N=30).InterventionsLWAS.Main Outcome MeasuresSubjective knee pain and objective biomechanical indices, namely, joint angles and moments in the frontal plane, frontal plane ground reaction force and lever arm, as well as medial/lateral center of mass and center of pressure during gait.ResultsWhen wearing the LWAS, knee pain during gait in persons with medial knee OA decreased (P=.01). Peak internal knee abductor moments were also reduced (P<.001) with increasing foot progression angles, laterally shifted center of pressure, and a shortened frontal plane lever arm (all P<.05). However, ankle invertor moments were increased (P<.05) when wearing the LWAS.ConclusionsAlthough peak internal knee abductor moment and knee pain were immediately reduced during gait when wearing the LWAS, increased ankle invertor moments were found, suggesting that the LWAS should be used with caution. Strengthening and monitoring the condition of the ankle invertor muscles may be necessary if the LWAS is used as an intervention for persons with bilateral medial knee OA.     

Associations Between Periosteal Reaction of Proximal Tibial and Medial Compartment Knee Osteoarthritis

ObjectiveTo evaluate and analyze the potential relationship between periosteal reaction and medial compartment knee osteoarthritis (KOA), and to assess the independent risk factors for the development of periosteal reaction associated with medial compartment KOA.MethodsThis is a retrospective comparative study. From January 2019 to December 2019 at the Third Hospital of Hebei Medical University, a total of 363 patients (726 knees) with medial compartment KOA were enrolled in this study according to our inclusion and exclusion criteria, including 91 males and 272 females, with an mean age of 57.9 ± 12.8 years (range, 18–82 years). Among these patients, 206 patients (412 knees) were allocated to the periosteal reaction group (44 males and 162 females) and 157 patients (314 knees) were allocated to the non‐periosteal reaction group (47 males and 110 females). The classification of KOA severity was based on Kellgren and Lawrence (K‐L) grading system. The malalignment of the lower extremities in coronal plane was evaluated as medial proximal tibial angle (MPTA), hip‐knee‐ankle angle (HKA), and lateral distal femoral angle (LDFA). Patients demographics and radiographic parameters were recorded in the two groups. Intra‐observer and inter‐observer reliabilities of all radiological measurements were analyzed by intraclass correlation coefficients (ICCs). Univariate analyses were conducted for comparison of differences with continuous variables between patients with periosteal reaction and without periosteal reaction. Multivariate logistical regression analysis was performed to determine the independent risk factors of radiographic parameters for periosteal reaction.ResultsThe overall incidence of periosteal reaction associated with medial compartment KOA was 56.7%. Furthermore, we observed that the incidence of periosteal reaction significantly increased with age and correlated with K‐L grade progression (P < 0.05). There was a statistically significant difference between the two groups. In the multivariate logistical regression analysis, HKA and JLCA were identified as independent risk factors of the development of periosteal reaction in patients with medial compartment KOA (odds ratio [OR], 0.594; 95% confidence interval [CI] 0.544–0.648; P < 0.05; OR, 0.851; 95% confidence interval CI 0.737–0.983; P < 0.05; respectively), with other radiographic parameters including MTPA (OR 0.959; 95% CI 0.511–0.648; P > 0.05), LDFA (OR 0.990; 95% CI 0.899–1.089; P > 0.05), and JSW (OR 1.005; 95% CI 0.865–1.167; P > 0.05).ConclusionsIn this retrospective study, patients with lower HKA and higher JLCA were identified as independent risk factors for the development of periosteal reaction, which occurred most commonly adjacent to the lateral of proximal tibia diaphysis, and thus we concluded that periosteal reaction may be an anatomical adaptation for medial compartment KOA based upon these results.     

Flat colorectal neoplasms and the impact of the revised Vienna Classification on their reporting: A case-control study in UK and Japanese patients

Objective. The prevalence and interpretation of flat colorectal neoplasms in the East or West remain highly variable. Several factors may contribute to this variability including differences in reporting techniques between Japanese and Western histopathologists when lesions are classified. The aims of this study were (i) to determine the frequency and characteristics of flat colorectal neoplasms in British and Japanese patients, (ii) to examine whether histopathological discrepancies exist between Western and Japanese-trained pathologists applying conventional classification methods and (iii) to determine the impact of the revised Vienna Classification on any differences observed. Material and methods. One hundred and forty-four patients in the United Kingdom with neoplastic lesions prospectively identified by a colonoscopist, fully-trained in Japan, were age and gender-matched with 144 Japanese patients with neoplastic lesions detected by the same colonoscopist. Two British and two Japanese pathologists were independently asked to assess all neoplasms using both conventional and revised Vienna Classification methods. Results. No significant difference in the frequency of flat neoplasms was found between British and Japanese patients; however, flat neoplasia from Japanese patients tended to contain more advanced pathologies. Discrepancies in histological diagnoses were observed between pathologists but which were reduced with the revised Vienna Classification. Japanese pathologists tended to diagnose higher grades of dysplasia for the same lesion compared to their British counterparts. Conclusions. The frequency of flat neoplasms in British and Japanese patients is similar. However Japanese lesions, especially flat (IIb) and slightly depressed (IIc) neoplasms tend to be more biologically aggressive. The revised Vienna Classification achieves greater consensus.     

Foot pain and disability in individuals with Ehlers – Danlos syndrome (EDS): Impact on daily life activities

Purpose: to investigate the amount and severity of podiatric problems in individuals with EDS as well as the consequences on daily life activities, and to compare these results with the results from a comparison group of the general population.

Method: The Manchester Foot Pain and Disability Schedule (MFPDS) and a demographic and foot-specific form were mailed.

Results: One hundred and thirty-six individuals with EDS and 292 from the comparison group responded. The median MFPDS total score in the EDS group was 33 (range 17?–?49) (mean 32, SD 8) and in the comparison group 17 (range 17?–?41) (mean 19, SD 4) (P?<?0.001). The items most frequently marked with 3 points in the EDS group were: ‘I avoid standing for a long time’, ‘I catch the bus or use the car more often’, and ‘I get irritable when my feet hurt’ (55, 46 and 43%, respectively). When comparing the NRS scores (i.e. Numeric Rating Scale) regarding pain intensity between the EDS group (median 5) and the comparison group (median 0), a statistically significant difference was found (P?<?0.001). Other foot problems than pain were reported by 73% (n?=?100) of the EDS group and by 21% (n?=?60) of the comparison group (P?<?0.001). The presence of flat feet in the EDS group and the comparison group was reported by 55% (n?=?75) and 8% (n?=?23), respectively.

Conclusions: Individuals' with EDS endure difficulties with their mobility due to their foot problems and related disability. It is therefore of utmost importance to find ways to assess the actual foot status for this group and to support the individuals with solutions to their problems with ambulation.     

跟外侧血管蒂骨膜瓣移植治疗儿童距骨坏死随访

应用跟外侧血管蒂骨膜瓣植入治疗儿童距骨坏死5例,结果显示:术后3～4个月X线片距骨密度及形态明显改善,8个月距骨形态恢复正常。并经3～10年的随访,疗效肯定。其具有以下优点:①清除死骨彻底减压;②重建距骨血液循环系统;③带血管的骨膜植入可为距骨带入成骨效应成分,加速骨重建。