头部位移对纵向研究波谱结果可重复性的影响

目的 探讨不同形式位移经校正后对MRS结果可重复性的影响。方法 纳入20名被试者于无位移、平动位移、平动-转动位移时分别进行MRS扫描,每次间隔10 min,位移状态扫描前由SPM软件自动获取VOI位置,测量并比较平动位移、平动-转动位移经校正后VOI内N-乙酰天门冬氨酸(NAA)、肌酸(Cr)、磷酸肌酸(PCr)和胆碱复合物(Cho)含量及NAA/(Cr+PCr)和Cho/(Cr+PCr);计算上述参数位移对比无位移时差异性系数(CV)和重复性指数(RI)。结果 平动位移经校正后各参数与无位移间差异均无统计学意义(P均>0.05),平动-转动位移经校正后除Cr外,NAA、Cho、NAA/Cr+PCr、Cho/Cr+PCr与无位移间差异均有统计学意义(P均<0.01)。平动位移和平动-转动位移经校正后与无位移时比较,NAA、Cho、Cr含量及NAA/(Cr+PCr)、Cho/(Cr+PCr)的平均CV均<12%,重复性可接受;RI值除Cr外,余参数均<20%,重复性可接受。结论 MRS中对患者头部平动位移可准确校正,所得结果重复性较好。     

The causes of total knee arthroplasty failure: Avoiding your next revision

This article is a personal retrospective of the author׳s more than 35 years of experience as an arthroplasty surgeon and specifically addresses how to avoid revision total knee arthroplasty.

• 1.Avoid revision surgery if the patient is satisfied, unless imminent danger of prosthetic failure appears.
• 2.Use proper technique at the primary arthroplasty to avoid the problems of aseptic loosening, instability, malalignment, and infection that force most revisions. Scrupulous attention to detail in patient selection and operative technique at the primary surgery will help avert revision surgery.
• 3.Remember that surgical technique is prosthesis specific. Understanding the design and insertion philosophy of each implant is crucial to success; every implant system is different.
• 4.Strive to understand the underlying reason that an arthroplasty has failed to make a patient satisfied and fix the problem at revision. If the reason for revision is unclear, it is unlikely that surgery will make the patient better.
• 5.Avoid revision surgery if the problem is pain with no identifiable, surgically correctable problem.
• 6.Maintain strict selection criteria for obese patients, who have higher prevalence of problems that can lead to total knee revision. Surgeons who operate on obese patients likely will have more revision cases. Often, however, obese patients have gratifying results in terms of pain relief and improved function.

     

电针为主治疗腰椎间盘突出所致坐骨神经痛:多中心随机对照试验

目的:筛选以电针为主治疗腰椎间盘突出所致坐骨神经痛的简便优效方案。方法:开展多中心随机对照试验,将198例腰椎间盘突出所致坐骨神经痛患者随机分成电针治疗组(A组)66例、电针联合牵引治疗组(B组)67例、电针联合牵引治疗组(C组)65例。3组均第1~2 w,5次/w,第3~4 w每周治疗3次,第5~6 w每周治疗2次,第12 w随访。比较各组治疗前后腿痛VAS视觉模拟评分(Vas LP)、改良罗兰功能问卷(Roland)、Likert总体恢复自我评价量表的改变。结果:治疗6 w后,3组Vas LP评分、Roland评分均显著降低(均P0.01),Likert总体恢复评分逐渐增高,且在治疗后第12 w疗效更加显著。3组Vas LP评分、Roland评分、Likert总体恢复组间差异均无统计学意义(均P0.05)。结论:三种治疗方案对腰椎间盘突出所致坐骨神经痛均有减轻患腿疼痛、增强患腿运动功能、促进总体恢复的疗效,且三者疗效相当,并未随着疗法的增加出现明显的疗效叠加效应。     

Use of the alkaline phosphatase to prealbumin ratio as an independent predictive factor for the prognosis of gastric cancer

BACKGROUNDGastric cancer (GC) is characterized by a low 5-year survival rate. The prognosis is still not satisfactory although it has significantly improved due to developments in medicine. Thus, the identification of more efficient indices for the evaluation of GC prognosis is required. We propose, for the first time, that the alkaline phosphatase (ALP) to prealbumin (PA) ratio (APR) can be used as an independent prognostic factor in GC.AIMTo evaluate the prognostic value the APR in GC.METHODSAccording to the exclusion strategy, we collected the preoperative serologic examination results and clinical information of 409 GC patients treated in Shandong Provincial Hospital from January to December, 2016. By calculating the APR, the neutrophil and lymphocyte ratio (NLR), C-reactive protein (CRP) and albumin (ALB) ratio, platelet and lymphocyte ratio, lymphocyte and monocyte ratio, and the relationship with clinical information, we verified the role of preoperative APR ratio in the prognosis of GC. In addition, we used a Cox model combined with the APR and tumor stage to demonstrate its efficacy in assessing the prognosis of GC patients.RESULTSPreoperative APR was an independent prognostic factor for GC. The median age of patients in the APR-high group was greater compared with that in the APR-low group. Patients with a higher APR had a more advanced clinical stage, higher neutrophil to lymphocyte, CRP to ALB, and platelet to lymphocyte ratios, but a lower lymphocyte to monocyte ratio (P < 0.05). The APR-high group also had higher glycoprotein antigen 199 and carbohydrate antigen 125 levels than the APR-low group (P < 0.05). Median overall survival and disease-free survival were significantly longer in the APR-low group than in the APR-high group. In addition, a Cox model based on the APR and tumor stage was more effective in evaluating the prognosis of patients than models based on stage alone or stage plus the NLR.CONCLUSIONA higher APR is an independent and negative prognostic factor for GC. The prognosis of GC can be better evaluated using a Cox model based on the APR and stage.     

Comparison of estimates of left ventricular ejection fraction obtained from gated blood pool imaging,different software packages and cameras

Serial measurement of LVEF using gated blood pool (GBP) imaging is an established technique for monitoring LVEF in patients undergoing chemotherapy with cardiotoxic medication and in patients after heart transplants.11,2 The nuclear medicine department at Groote Schuur Hospital performs up to a thousand GBP studies annually. The majority of these studies are for patients receiving cardiotoxic chemotherapy and have a significant impact on patient management.In our hospital, the radiation oncologists consider not starting cardiotoxic chemotherapy if the LVEF is below 50% and terminating chemotherapy if there is a 10% decrease. In patients who have had heart transplants, the cardiologists start patients on glucocorticosteroids if a patient’s LVEF decreases by10%. It is therefore imperative that serial studies on an individual patient are comparable.Two software systems are used in our nuclear medicine department. The Siemens system (Siemens Medical Solutions, Chicago, USA) was introduced in February 2006 and the Hermes system (Hermes Medical Solutions, Stockholm Sweden) in September 2007. After the introduction of the Hermes system, we found large differences between the LVEFs calculated by the two systems. This was confirmed by a pilot study and is consistent with the literature that different software programs for processing equilibrium gated radionuclide studies cannot be used interchangeably.3-7The department also uses two different cameras, a General Electric (GE) Starcam 400 AC single-head and a Siemens Signature Series e.cam dual-head camera to acquire the raw data. These are then transferred to the Siemens and Hermes processing systems.This study was done to determine how the software packages used for processing GBP studies should be integrated into our department and if the use of different cameras for acquisition influences results. The study had two components. The first examined the values and reproducibility of estimates of LVEF from two software packages using data acquired on the GE gamma camera and processed independently by three operators. The second component examined the values and reproducibility of estimates of LVEF calculated with the same software packages using matched pairs of raw data acquired on both gamma cameras (GE and Siemens) processed by one operator.     

Risk of adrenal crisis in dental patients: Results of a systematic search of the literature

BackgroundThe authors performed a systematic search of the literature to identify the frequency of, risk of experiencing and factors associated with adrenal crises in dental patients.MethodsThe authors searched PubMed and Ovid MEDLINE (1947-June 20, 2012) and Embase (1974-2012) for English-language articles related to cases of adrenal crisis in dentistry and extracted and analyzed data from the articles. The six authors determined whether the cases identified met a consensus definition of adrenal crisis.ResultsOf 148 articles identified in the initial screening, 34 articles were included in the final review, from which six cases met the criteria of adrenal crisis. The authors categorized four cases as “suggestive of adrenal crisis” and two cases as “consistent with adrenal crisis.” Risk factors were significant adrenal insufficiency, pain, infection, having undergone an invasive procedure, having received a barbiturate general anesthetic, and poor health status and stability at the time of presentation. The authors estimated risk to be less than one in 650,000 in patients with adrenal insufficiency.ConclusionsAdrenal crisis is rare in dental patients, with only six reports of it having been published in the past 66 years. Risk is associated with unrecognized adrenal insufficiency, poor health status and stability at the time of treatment, pain, infection, having undergone an invasive procedure and having received a barbiturate general anesthetic.Clinical ImplicationsRisk of adrenal crisis is reduced through proper evaluation of the patient, identification of risk factors and following appropriate preventive measures.     

Looking for a Learning Curve in EVAR Based on the Zenith Stent Graft

The purpose of this study was to report the learning curve of endovascular aneurysm repair (EVAR) based on the Zenith stent graft (Cook Medical Inc., Bloomington, IN). In the last 9 years, 101 patients were treated with a Zenith stent graft. To display the learning curve, a cumulative sum (CUSUM) failure analysis curve of the 30-day technical success rate was calculated. For detailed analysis, our EVAR patient cohort was chronologically divided into three groups. Technical and clinical results, basic patient parameters, and procedural data were compared. The CUSUM graph indicated an initial sharp rise within the first 35 cases and a plateau thereafter. The 30-day technical success rate significantly increased from the first to the second group (83 vs. 100%; p = 0.019), as did the primary technical success rate (66 vs. 97%; p = 0.001). EVAR based on the Zenith stent graft required ∼35 cases to reach a stably high rate of short-term technical success.     

游离尺动脉腕上皮支皮瓣修复手指创面

目的探讨尺动脉腕上皮支皮瓣修复手指创面的手术方法及效果。方法对11例手指皮肤软组织缺损合并肌腱或骨外露者,采用游离尺动脉腕上皮支皮瓣进行修复。其中8例面积为2．5cm×1．0cm-5．2cm×2．2cm的皮瓣．在腕上皮支下行支轴线上切取：3例面积为5．5cm×3．0cm×6．2cm×3．8cm的皮瓣,在腕上皮支下行支及上行支轴线上切取。皮瓣切取后,8例下行支皮瓣内腕上皮支主干均直接与受区指动脉吻合,3例合并有上行支的皮瓣均移植了前臂静脉与受区的指动脉吻合,皮瓣内的皮下静脉或伴行静脉分别与近端指掌侧或指背侧2-3根静脉吻合,将皮瓣内携带的1条尺神经手背支与指固有神经接合。结果术后11例皮瓣全部成活．并获得4～17个月随访。皮肤弹性、色泽、质地良好,外形满意。两点辨别觉9-12mm。结论游离尺动脉腕上皮支皮瓣供区隐蔽,血管穿支位置恒定,不损伤主干血管,供区损伤小,切取简单。修复手指缺损外观满意,可携带神经恢复皮瓣感觉,是修复手指创面的一种理想选择。