An anatomically based imaging sign to detect adventitial cyst derived from the superior tibiofibular joint

The origin for complex intraneural cysts remains controversial despite recent emerging evidence to support their articular origin. The coexistence of intraneural and adventitial cysts has been described due to the proximate neurovascular bundle, i.e., the articular (neural) branch and vessels at the joint capsule. To clarify the pathogenesis, anatomically based imaging patterns can be identified. This paper characterizes a common finding identified on MRI describing the adventitial component originating from the superior tibiofibular joint (STFJ). MRIs of patients with fibular (peroneal) (n = 24) and tibial (n = 7) intraneural ganglion cysts were reviewed. Eleven patients with fibular intraneural ganglion cysts were identified as having a coexisting adventitial component. In all cases, the adventitial cyst extended from the anterior portion of the STFJ, within the capsular vessels, and along the anterior tibial vessels. The reproducible anatomy permitted the identification of an imaging pattern: the "vascular U" sign, consisting of cystic anterior tibial vessels running through the interosseous membrane between the proximal tibia and fibula. This sign was seen on axial MR image(s) obtained at the level of the fibular neck in all cases. To generalize these findings, the rare tibial intraneural ganglion cysts (derived from the posterior aspect of the STFJ) were examined; two cases had coexisting adventitial cysts with visualization of the vascular U sign. This new imaging pattern can improve the identification of adventitial cysts at the level of the STFJ.     

Qualifying a quantitative approach to women’s expectations of continence surgery

Introduction and hypothesis  The objective of this study is to explore expectations and goals of women undergoing continence surgery using a combined quantitative and qualitative approach. Methods  Women with urinary incontinence, recruited from the waiting list, were assessed with a structured clinical interview, and these data were transcribed and analysed thematically (grounded theory). The Kings Health Questionnaire (KHQ) was used to determine incontinence impact on patient’s life. Results  Incontinence was objectively quantified using videocystourethrography. KHQ quantitative analysis suggested that the main domains affected were incontinence impact on life and physical limitations. However, qualitative analysis based on the interview found women were most affected by incontinence impact on physical or social limitation, sexual function, emotions and body image. Conclusion  Whilst disease-specific QoL questionnaires allow broad comparisons to be made assessing patient bother; they lack sensitivity to assess individual symptoms. A qualitative approach may individualise patient care and improve patient satisfaction and overall outcome.     

Examining the neural basis of episodic memory: ERP evidence that faces are recollected differently from names

Episodic memory is supported by recollection, the conscious retrieval of contextual information associated with the encoding of a stimulus. Event-Related Potential (ERP) studies of episodic memory have identified a robust neural correlate of recollection—the left parietal old/new effect—that has been widely observed during recognition memory tests. This left parietal old/new effect is believed to provide an index of generic cognitive operations related to recollection; however, it has recently been suggested that the neural correlate of recollection observed when faces are used as retrieval cues has an anterior scalp distribution, raising the possibility that faces are recollected differently from other types of information. To investigate this possibility, we directly compared neural activity associated with remember responses for correctly recognized face and name retrieval cues. Compound face–name stimuli were studied, and at test either a face or a name was presented alone. Participants discriminated studied from unstudied stimuli, and made a remember/familiar decision for stimuli judged ‘old’. Remembering faces was associated with anterior (500–700 ms) and late right frontal old/new effects (700–900 ms), whereas remembering names elicited mid frontal (300–500 ms) and left parietal (500–700 ms) effects. These findings demonstrate that when directly compared, with reference to common episodes, distinct cognitive operations are associated with remembering faces and names. We discuss whether faces can be remembered in the absence of recollection, or whether there may be more than one way of retrieving episodic context.     

Athletic Trainers' Beliefs Toward Working With Special Olympics Athletes

Context:

Certified athletic trainers (ATs) are often the first health care providers to treat injured athletes. However, few researchers have studied ATs'' beliefs concerning working with Special Olympics athletes.

Objectives:

To examine ATs'' beliefs toward working with Special Olympics athletes by using the theory of planned behavior model and to examine the influence of moderator variables.

Design:

Cross-sectional survey.

Setting:

Athletic Trainers'' Beliefs Toward Special Olympics Athletes survey instruments were mailed to 147 directors of Commission on Accreditation of Allied Health Education Programs–accredited athletic training education programs (ATEPDs) in 43 states and 120 cities.

Patients or Other Participants:

One hundred twenty ATEPDs (44 women, 76 men).

Main Outcome Measure(s):

We used stepwise multiple regression analysis to determine whether attitude toward the behavior, subjective norm, and perceived behavioral control predicted intention and to determine which moderator variables predicted attitude toward the behavior, subjective norm, and perceived behavioral control. Pearson product moment correlations were used to determine ATEPDs'' beliefs about how competent they felt working with Special Olympics athletes and whether they were currently working with these athletes.

Results:

We found that subjective norm, attitude toward the behavior, and perceived behavioral control predicted intention (R  =  0.697, R²  =  0.486, F_3,112  =  35.3, P < .001) and that intention predicted ATEPDs'' actual behaviors (R  =  0.503, R²  =  0.253, F_1,118  =  39.995, P < .001). Moderator variables that predicted attitude toward the behavior included more years of experience working with Special Olympics athletes, completion of 1 or more courses in adapted physical activity, ATEPDs'' competence, completion of 1 or more special education courses, and sex (R  =  0.589, R²  =  0.347, F_5,111  =  11.780, P < .001). Moderator variables that predicted subjective norm included more experience working with Special Olympics athletes and more Special Olympics certifications (R  =  0.472, R²  =  0.222, F_2,112  =  16.009, P < .001). Moderator variables that predicted perceived behavioral control included ATEPDs'' competence, more years of experience working with Special Olympics athletes, and a higher educational degree (R  =  0.642, R²  =  0.412, F_4,113  =  19.793, P < .001).

Conclusions:

Certified athletic trainers had favorable attitudes about the behavior beliefs toward working with Special Olympics athletes; however, their subjective norm, perceived behavioral control, and intention beliefs were unfavorable. The ATEPDs reported they did not feel competent to work with Special Olympics athletes.     

Using a web-based system for the continuous distance education in cytopathology

Background

The evolution of information technologies and telecommunications has made the World Wide Web a low cost and easily accessible tool for the dissemination of information and knowledge. Continuous Medical Education (CME) sites dedicated in cytopathology field are rather poor, they do not succeed in following the constant changes and lack the ability of providing cytopathologists with a dynamic learning environment, adaptable to the development of cytopathology. Learning methods including skills such as decision making, reasoning and problem solving are critical in the development of such a learning environment.

Objectives

The objectives of this study are (1) to demonstrate on the basis of a web-based training system the successful application of traditional learning theories and methods and (2) to effectively evaluate users’ perception towards the educational program, using a combination of observers, theories and methods.

Implementation

Trainees are given the opportunity to browse through the educational material, collaborate in synchronous and asynchronous mode, practice their skills through problems and tasks and test their knowledge using the self-evaluation tool. On the other hand, the trainers are responsible for editing learning material, attending students’ progress and organizing the problem-based and task-based scenarios. The implementation of the web-based training system is based on the three-tier architecture and uses an Apache Tomcat web server and a MySQL database server.

Methods

By December 2008, CytoTrainer's learning environment contains two courses in cytopathology: Gynaecological Cytology and Thyroid Cytology offering about 2000 digital images and 20 case sessions. Our evaluation method is a combination of both qualitative and quantitative approaches to explore how the various parts of the system and students’ attitudes work together.

Results

Trainees approved of the course's content, methodology and learning activities. The triangulation of evaluation methods revealed that the training program is suitable for the continuous distance education in cytopathology and that it has improved the trainees’ skills in diagnostic cytopathology.

Conclusions

The web-based training system can be successfully involved in the continuous distance education in cytopathology. It provides the opportunity to access learning material from any place at any time and supports the acquisition of diagnostic knowledge.     

腹主动脉阻断术临床原理及其上中下段安全时限探讨——兼述缺血再灌注损伤机制与对策及“二叉树耐受法则”

目的深入探讨腹主动脉阻断术的临床原理及其高中低位阻断安全时限等问题,以期在临床上安全地使用该技术。方法1980年-1982年我们首次进行了腹主动脉阻断安全时限及其阻断与撤钳后病理生理变化的前瞻性实验研究。结果表明:犬腹主动脉阻断25min为安全时限;在阻断安全时限内,犬体内血液动力学、血气酸碱、血液生化和主要的脏器超微结构(脑肺肝肾胰肠脊髓)仅发生轻度可逆性改变;如超出安全时限,上述指标则会发生难以代偿的严重改变。基于广义生命时空场论学说,通过对腹主动脉阻断术解剖学基础,腹主动脉阻断后与撤钳后综合征群(呼吸宭迫综合征、急性高血压性脑水肿、多脏器微栓塞病细胞综合征、撤钳后中枢性呼吸衰竭)及腹主动脉阻断所致的缺血再灌注损伤病理生理与细胞分子生物学机制等讨论,并根据近期实验与临床研究结果和结合文献复习对相关问题做了探讨,对临床上预防和治疗腹主动脉阻断术所致的缺血再灌注损伤提出了一整套对策。此外还叙述了预防腹主动脉阻断术并发症的远端主动脉灌注、脑脊液引流以及硬膜外冷却、控制性再灌注与缺血预/后处理等几种新技术。结果如果超出腹主动脉阻断术安全时限,则在术中与术后将发生缺血再灌注损伤、全身炎症反应综合征和多脏器衰竭。临床上,人类一次性持续腹主动脉阻断术安全时限如下:高位(T12水平,腹腔干A上)、中位(L2水平,肾A上)与低位(L4水平,髂总A上)均不能轻易超越25-30min。如术中须延时宁可采用间断阻断法。结论如果"二叉树耐受法则"(即体内任何一处大血管阻断均不能超出其固有安全时限,否则受术者非死必伤)被严格遵守,则腹主动脉阻断术中与术后病人的安全将得到保证。     

临床实践经验与中医理论的建构——经验思维与中医理论建构研究之二

临床实践经验是中医理论建构与不断发展的不竭动力,也是中医学在现代社会存在、发展的根本保障,以金元四大家的形成、瘀血生风病机的提出以及中风病机理论的创新为例,阐述了临床实践经验在中医理论建构中的价值。     

多元概化理论在后期临床技能考核中的应用研究

信度问题一直是人们所关注的焦点,它直接影响到考核的准确性及公平性。传统信度分析方法不能探查和分解各种误差来源,更难考察测量情景变化所引起的误差的相对变化,且对多变量的信度分析没有一个综合统一的评价指标,这给实际工作带来诸多不便。概化理论在解决一些测评情景比较复杂,影响因素较多,评分主观性较强的实际工作具有很大优势。医学临床技能考核属于测评情景比较复杂的考核．因此比较适合应用概化理论研究。     

解剖学理论与实验一体化教学模式的应用研究

目的：改革解剖学教学方法,培养学生的理论与实践结合能力。方法：在我校护理专业解剖学教学中实行理论课与实验课有机结合,探索新的教学模式。结果：新的教学模式取得了良好的效果。结论：新的教学模式提高了教学质量,是一种行之有效的教学方式。     

论中医的核心内容——和

中医在辨证用药运用发散的思维方式,同时大道至简地可用＂和＂这一字概况,认为以＂和＂的理念灵活运用临床实践和基础理论研究中,能获得较好的临床疗效和学术见地。