The Direct Anterior Approach for Complex Primary Total Hip Arthroplasty: The Extensile Acetabular Approach on a Regular Operating Room Table

Background

The direct anterior approach on a regular operating room table has been reported with low dislocation rates. This might be beneficial for complex primary total hip arthroplasty (THA) such as in patients with cerebral palsy or following femoral or pelvic osteotomies. Extending the approach is often required to overcome problems such as acetabular deformities or severe contractures.

Moving-table reduced-dose gadolinium-enhanced three-dimensional magnetic resonance angiography: velocity-dependent method with three-phase gadolinium infusion

The purpose of this study was to develop a method for reducing gadolinium dose and suppressing venous overlap in moving-table three-dimensional (3D) magnetic resonance (MR) angiography from the abdomen to the feet. Thirty-one patients underwent three-phase infusion of 16-18 mL of gadolinium: infusion rates and imaging times were determined after taking into account mean blood flow velocity, so that image acquisition was synchronized with peak arterial enhancement at both the first and third stations (velocity-dependent method). Twenty-three other patients underwent slow infusion of 38 mL of gadolinium with fixed acquisition time (high-dose method). The image quality for the two methods was compared. The velocity-dependent method produced good image quality with significantly less venous overlap than the high-dose method, especially in the below-the-knee region (P <.001). The velocity-dependent method provides satisfactory MR angiograms using 16-18 mL of gadolinium in patients having various blood flow velocities.     

The telltale triangle: Use of the supine cross table lateral radiograph of the abdomen in early detection of pneumoperitoneum

The most sensitive method for detecting a small pneumoperitoneum depends upon directing a horizontal x-ray beam tangential to the collection of free air. We have observed in the detection of small amounts of free intraabdominal air that the supine cross table lateral abdominal view is most valuable. Such small amounts of free intraperitoneal air collect between loops of bowel at the highest points in the peritoneal space forming typical small triangular lucencies with their bases at the peritoneal reflection.     

Evaluation of Singh index for assessment of osteoporosis using digital radiography

Evaluation of Singh index (SI) as a simple means for estimating bone mass on radiographs has been subject of numerous studies. All of these studies used plain film radiographs for assessment of SI. Digital radiography may improve validity and reliability of SI assessment. Aim of this study was to evaluate SI gradings assessed on digital radiographs.Digital pelvic radiographs of 100 patients were graded using SI by five independent observers (two radiologists, three traumatologists) blinded to dual energy X-ray absorptiometry (DXA) results and re-graded by all observers for assessment of intraobserver agreement. SI was correlated with DXA measurements and after grouping the patients according to World Health Organisation (WHO) criteria (osteoporosis, osteopenia, normal). Logistic regression analysis was performed in order to identify influential parameters on the SI grading process.Mean intraobserver agreement was 0.648 ± 0.18 (Kendall's Tau) and 0.43 ± 0.28 (kappa). Mean interobserver agreement was 0.488 ± 0.193 (Kendall's Tau) and 0.199 ± 0.248 (kappa). Mean correlation between SI and trochanteric BMD and T scores was 0.219 ± 0.04 and 0.210 ± 0.05 (Spearman's coefficient). Only one observer (senior radiologist) reached the significance level after grouping the patients’ DXA results according to WHO criteria and correlating the results with SI gradings. Logistic regression analysis revealed a significant influence of trochanteric T score in two observers while other variable parameters failed to reach the significance level.Even though we found reasonable intraobserver agreement assessment of SI is highly subjective and interobserver agreement is generally poor. Moreover, using digital radiography could not improve correlation with DXA measurements.     

1981—1985年及1986—1990年南京市居民寿命表分析

就南京市1981--1985年(简称前五年)及1986--1990年(简称后五年)居民的寿命表作了分析。结果提示:随着时间的推移,居民的各种寿命表指标均在发生改变,其中寿命表死亡概率、年龄别死亡率均不同程度在下降,而尚存率、预期寿命等均不同程度在提高。预期寿命男性由前五年的69.91岁增加到后五年的71.77岁,女性由73.81岁增加到75.43岁,明显高于全国同期水平。居民的尚存半数年龄亦由前五年的73.4岁后移至77.1岁,女性由74.6岁后移至78.4岁.     

血管迷走性晕厥儿童的心理因素

目的探讨血管迷走性晕厥(VVS)儿童的心理因素。方法选取2007年6-11月在中南大学湘雅二医院儿童晕厥专科门诊就诊或住院的不明原因晕厥或先兆晕厥儿童84例(VVS组)。男47例,女37例;年龄7～16岁[(11.01±2.00)岁]。将VVS儿童分为直立倾斜试验(HUTT)阳性组(n=43)和HUTT阴性组(n=41)。受试儿童均完成儿童抑郁障碍自评量表与儿童焦虑性情绪障碍筛查表,采用SPSS11.0软件进行分析。结果1.儿童抑郁障碍自评量表得分,VVS组儿童睡得很香、吃东西香及爱与家人交谈等项目得分显著低于全国常模组(Pa<0.05,0.01),VVS组患儿总是想哭、肚子痛、感到孤单、感到悲哀、感到烦恼得分及抑郁总分高于全国常模组(Pa<0.05,0.01)。HUTT阳性组患儿盼望美好事物和容易高兴起来得分高于HUTT阴性组(Pa<0.01),HUTT阴性组患儿生活没有意思得分高于HUTT阳性组(P<0.05)。2.儿童焦虑性情绪障碍筛查表得分,躯体化/惊恐、广泛性焦虑、分离性焦虑、社交恐怖、学校恐怖、焦虑量表总分与简明焦虑量表等得分VVS组显著高于全国常模组(Pa<0.01)。HUTT阴性组与HUTT阳...     

农村乡镇卫生院突发公共卫生事件危机管理脆弱性评价指标体系的构建

目的 构建一套科学合理的农村乡镇卫生院突发公共卫生事件危机管理的脆弱性评价指标体系并对其进行检验。方法 通过文献研究,构建指标框架,采用专家咨询法建立评价指标体系,并进行信效度检验。结果 两轮专家咨询参与程度分别为80.0%和92.0%,权威程度分别为0.600和0.652,协调系数分别为0.160和0.442(〖XC小五号.EPS;P〗=573.096,P<0.01),差异具有统计学意义。指标体系包括4个一级指标,9个二级指标,33个三级指标。4个一级指标的权重分别为0.217 2,0.274 2,0.298 5和0.212 7。结论 该指标框架的可靠性和可信性程度较高,能够为测量农村基层乡镇卫生院突发公共卫生事件危机管理的脆弱性提供依据。     

自然界中华按蚊种群研究工具及其在生命表制作中的应用

目的：为了能在自然界大型水体和旷野中对中华按蚊种群进行研究。方法：研制出适合于稻田浅水定量研究的实验简,适合于深水的实验网和接近自然状态的大实验笼。应用这些工具进行了自然界中华按蚊种群生命表的研究。结果：利用系列研究工具定量研究出1988年第8代中华按蚊自然种群生命表。求出各发育历期的死亡数和死亡因素,死亡率,存活率和死亡因素k值,分析出各发育阶段的关键死亡因素,计算下代预计产卵量为8288粒,种群趋势指数I为6．3027。结论：系列研究工具使中华按蚊自然种群的定量研究成为可能。郑州中华按蚊第9代种群数量还趋于增加之中。     

失眠患者睡眠质量与心理健康状况的相关性研究

目的:探索原发性失眠患者睡眠质量与心理健康状况的关系。方法:采用横断面的研究方法,选取2015年7月至2017年7月北京中医药大学第三附属医院收治的符合纳入标准的原发性失眠患者308例作为研究对象,以PSQI、SCL-90采集原发性失眠患者的睡眠质量、心理健康状况等资料进行统计分析。结果:308例失眠患者的PSQI总分均值为(12.65±3.04),241例SCL-90筛选阳性。失眠患者SCL-90各因子测评结果除偏执、敌对外均与全国常模比较差异有统计学意义(P<0.01)。睡眠、饮食方面不适的患者211例,伴强迫者144例,伴焦虑者86例。睡眠质量、催眠药物、PSQI总分与SCL-90各因子显著正相关,此外强迫与睡眠障碍呈中度正相关。结论:失眠患者的心理健康水平较正常人差。失眠患者伴有最多的3种自觉症状为睡眠饮食不适感、强迫及焦虑。失眠患者的睡眠质量、药物使用情况及睡眠整体状况与其心理障碍相互影响,强迫与睡眠障碍有较强的相关性。     

Sample size calculations for blinding assessment

Blinding is a critical component in randomized clinical trials along with treatment effect estimation and comparisons between the treatments. Various methods have been proposed for the statistical analyses of blinding-related data, but there is little guidance for determining the sample size for this type of data, especially if blinding assessment is done in pilot studies. In this paper, we try to fill this gap and provide simple methods to address sample size calculations for a “new” study with different research questions and scenarios. The proposed methods are framed in terms of estimation/precision or statistical testing to allow investigators to choose the best suited method for their goals. We illustrate the methods using worked examples with real data.