循证护理模式对关节镜下前交叉韧带重建术患者康复锻炼遵从性的影响

目的探讨了循证护理模式对关节镜下前交叉韧带重建术患者康复锻炼遵从性的影响。方法选取在武汉科技大学附属孝感医院接受治疗的63例关节镜下前交叉韧带重建术患者,随机分为观察组32例,对照组31例,对照组行常规护理,观察组实施循证护理,比较两组护理前后康复锻炼总遵从率。结果护理后对照组总遵从率为77.42%,观察组为100%,组间比较差异具有统计学意义(P0.05)。结论对关节镜下前交叉韧带重建术患者行循证护理,可有效提高患者康复锻炼遵从性。     

急停起跳落地阶段的下肢生物力学分析

比较了不同性别间的运动学参数差异, 采用皮尔森相关系数检验确定了下肢动力学和运动学参数间的相关性. 结果表明: 女性受试者在整个落地阶段膝、髋关节最大屈曲角度、前后方向上摩擦力峰值、膝关节屈伸力矩峰值出现了显著性的减小. 落地阶段髋关节屈曲角度与前后方向上的摩擦力峰值呈现显著相关. 落地初期膝关节屈曲角度与前后方向上摩擦力峰值和垂直方向上地面反作用力均呈现显著相关. 落地初期膝、髋关节的屈曲角度不一定会降低落地阶段的冲击力, 但是积极的髋、膝关节活动可以降低落地阶段的冲击力. 落地初期髋、膝关节的活动度是影响膝关节前十字交叉韧带损伤的重要因素.     

前方小切口入路治疗股骨颈骨折的围术期指标观察

目的研究前方小切口入路治疗股骨颈骨折的围术期指标观察。方法选取湖北省孝感市中心医院2011年2月—2013年7月收治的98例股骨颈骨折患者,抽签随机分为对照组和观察组各49例。对照组患者采用传统后外侧入路切开复位术,观察组采用前外侧小切口入路复位术,观察两组围术期相关指标。结果观察组手术切口(7.8±1.1)cm较对照组(15.3±1.7)cm明显较小,术中出血量(107.2±21.4)m L较对照组(187.4±32.1)m L明显较低,具有统计学意义(P0.05);观察组骨折愈合率100%较对照组89.80%明显较高,观察组并发症率4.08%较对照组16.33%显著较低,具有统计学意义(P0.05)。结论前方小切口入路术切口小,术中出血量低且术后并发症较少,有利于股骨颈骨折患者病情恢复。     

前、后路手术治疗颈脊髓损伤的效果比较

目的比较前、后路手术治疗颈脊髓损伤的临床效果。方法选取78例颈脊髓损伤患者,抽签随机分为两组,其中39例采用前路手术治疗患者记为前路术组,另外39例采用后路手术治疗记为后路术组,观察两组手术相关指标并结合术后有效随访比较治疗综合效果。结果前路术组手术时间(75.4±10.2)min、术中出血量(206.3±31.5)m L较后路术组明显较低,术后1年颈椎功能JOA评分(14.4±1.8)分较后路术组显著较高(P0.05);前路术组不良结果发生率5.13%较后路术组低(P0.05)。结论同后路手术相比,前路手术具有手术时间短、术中出血量少的特点,且能有效减少术后不良结果的发生,对病情康复和改善预后具有重要意义。     

Minimum SNR and acquisition for bias-free estimation of fractional anisotropy in diffusion tensor imaging - a comparison of two analytical techniques and field strengths

Although it is known that low signal-to-noise ratio (SNR) can affect tensor metrics, few studies reporting disease or treatment effects on fractional anisotropy (FA) report SNR; the implicit assumption is that SNR is adequate. However, the level at which low SNR causes bias in FA may vary with tissue FA, field strength and analytical methodology. We determined the SNR thresholds at 1.5 T vs. 3 T in regions of white matter (WM) with different FA and compared FA derived using manual region-of-interest (ROI) analysis to tract-based spatial statistics (TBSS), an operator-independent whole-brain analysis tool. Using ROI analysis, SNR thresholds on our hardware-software magnetic resonance platforms were 25 at 1.5 T and 20 at 3 T in the callosal genu (CG), 40 at 1.5 and 3 T in the anterior corona radiata (ACR), and 50 at 1.5 T and 70 at 3 T in the putamen (PUT). Using TBSS, SNR thresholds were 20 at 1.5 T and 3 T in the CG, and 35 at 1.5 T and 40 at 3 T in the ACR. Below these thresholds, the mean FA increased logarithmically, and the standard deviations widened. Achieving bias-free SNR in the PUT required at least nine acquisitions at 1.5 T and six acquisitions at 3 T. In the CG and ACR, bias-free SNR was achieved with at least three acquisitions at 1.5 T and one acquisition at 3 T. Using diffusion tensor imaging (DTI) to study regions of low FA, e.g., basal ganglia, cerebral cortex, and WM in the abnormal brain, SNR should be documented. SNR thresholds below which FA is biased varied with the analytical technique, inherent tissue FA and field strength. Studies using DTI to study WM injury should document that bias-free SNR has been achieved in the region of the brain being studied as part of quality control.     

双侧标准外伤大骨瓣开颅术中自体骨瓣临时回纳脑保护作用的探讨

目的探讨双侧标准外伤大骨瓣开颅术中脑组织医源性损伤的发生机制及防范措施,以降低非预期再次手术率及病死率.方法选择97例具双侧标准外伤大骨瓣开颅手术指征的颅脑损伤患者,采用随机数字表法分为回纳组(41例)和常规组(56例).回纳组术中采用自体骨瓣临时回纳技术,常规组采用双侧标准外伤大骨瓣开颅术.记录两组患者非预期再次手术率及病死率,并进行统计学分析.结果回纳组患者术后非预期再次手术5例(12.20%),其中先手术侧3例(7.3%),后手术侧2例(4.9%);死亡6例(14.6%).常规组患者术后非预期再次手术17例(30.3%),其中先手术侧14例(25.0%),后手术侧3例(5.3%);死亡19例(33.9%).回纳组非预期再次手术率及病死率均显著低于常规组,常规组先手术侧再次手术率较同组后手术侧及回纳组的先手术侧明显为高,差异均有统计学意义(均P<0.05).结论自体骨瓣术中临时回纳能有效减少术中脑组织医源性损伤,显著降低非预期再次手术率及病死率.     

脑电图监测对额叶癫痫发作性患者的早期诊断及术中辅助定位价值研究

癫痫的早期诊断对预后恢复具有重要意义,因此本文对脑电图在癫痫患者术前诊断和辅助手术治疗方面的应用价值进行了综合性探究.选择经临床确诊为额叶癫痫的60例患者作为研究对象进行回顾性研究,术前、术后分别通过头颅核磁共振和脑电图对患者进行检查,比较两种检测方法的灵敏度、特异度和准确率.经研究发现,脑电图与MRI检查相比,其诊断...     

Subsurface Microscopical visualization of brain tissue in vivo: Present, problems and prospects

The location of the brain within the cranium has prevented in vivo studies with microscopical resolution for a long time. Cranial window techniques provide microscopical access to the brain surface, but subsurface structures cannot be visualized with conventional microscopy. Confocal microscopy with its increased depth of penetration and optical sectioning capabilities is ideally suited for the investigation of thick biological specimens. Due to the scanning process, however, temporal resolution is limited, a significant disadvantage in the in vivo setting. In this article we demonstrate that confocal laser scanning microscopy can be utilized to study brain cortex microvascular morphology, capillary hemodynamics, leukocyte behaviour and intracellular ion concentrations in anesthetized rats through a closed cranial window. Three different confocal microscopes are compared: a Biorad MRC-600 with multiline Kr/Ar-Laser (488/568/647 nm), a Noran Odyssey acousto-optic scanning microscope with multiline Ar-Laser (458/488/514/529 nm) and a Biorad Viewscan DVC-250 slit scanning microscope with Ar-Laser (488/514 nm). With all microscopes a Zeiss × 40 water immersion objective, n.a. 0.75 is used. A Laser-Doppler flowmeter continuously measures regional cerebral blood flow in the area of microscopical investigation. As fluorescent dyes we used: fluorescein sodium as blood plasma marker (given I.V.); rhodamine 6G to label leukocytes (given I.V.); and the AM-esters of BCECF (pH-sensitive), Fluo-3 and Calcium-Green (both calcium-sensitive) as intracellular ion-concentration markers (loaded via superfusion over the cranial window). With this setup, we are able to study the flow dynamics in the capillary network of the cortex (erythrocyte flow velocities and flux rates), the behaviour of leukocytes in capillaries and postcapillary veins (plugging of capillaries, adhesion to the endothelium, extravasation into the parenchyma), and intracellular changes of [H⁺] and [Ca²⁺] under physiological and pathophysiological conditions (cerebral ischemia and meningitis). The comparison between the conventional CLSM (Biorad 600) and the real time CLSMs revealed that the increase in temporal resolution afforded by the real time instruments is offset by a reduction in spatial resolution and, most importantly, in the signal to noise ratio, resulting in a lower depth of penetration into the tissue and necessitating frame averaging.     

Parametric harmonic-to-fundamental ratio contrast echocardiography: a novel approach to identification and accurate measurement of left ventricular area under variable levels of ultrasound signal attenuation

Objectives

We introduced a harmonic-to-fundamental ratio (HFR) of the radiofrequency (RF) signals that reduces confounding effects of attenuation. We studied whether HFR analysis of RF signals received from contrast microbubbles allows accurate measurement of the left ventricular (LV) cavity area under varying levels of attenuation.

Background

Attenuation is a fundamental problem in ultrasound imaging and limits the use of clinical echocardiography.

Methods

RF data from short axis systolic and diastolic scans were obtained from 14 open-chest dogs following left-atrial bolus of Optison. Attenuation was induced by interposed silicone pads calibrated to induce 7 dB or 14 dB reductions of the backscattered RF signal. RF images were reconstructed from the RF signals, HFR values calculated for each image pixel for 0 dB, 7 dB and 14 dB attenuation conditions, and LV area obtained by summation of “LV cavity pixels”. A reference LV cavity area was obtained from endocardial border tracings in enhanced scans by experts.

Results

Correlation of the HFR-defined and reference areas at systole was R = 0.95, R = 0.94, and R = 0.91 for 0 dB, 7 dB and 14 dB levels of attenuation, respectively, and at diastole was R = 0.95 for 0 dB, 7 dB and 14 dB levels of attenuation. The mean difference from both systolic and diastolic values was <1.45 cm² (i.e. negligible) in all attenuation settings.

Conclusion

Our novel HFR method supports precise measurement of the LV cavity area in contrast images with simulated high attenuation of ultrasound signals.     

心电图结合中性粒细胞/淋巴细胞比值对急性前壁心肌梗死患者PCI术后预后的预测价值

本文分析心电图结合中性粒细胞/淋巴细胞比值(NLR)对急性前壁心肌梗死患者PCI术后预后的预测价值.选取行PCI术的急性前壁AMI患者180例,观察其心电图和NLR水平变化,并应用Cox回归分析心电图变化、NLR水平高低与预后的相关性.180例患者不良心血管事件发生率为17.78％;NLR水平＞3人数有113人;存在有...