自由呼吸StarVIBE序列用于采集胸部T1WI

目的 观察自由呼吸StarVIBE序列用于采集胸部T1WI的价值。方法 前瞻性收集37例CT提示胸部病变患者，根据能否配合屏气20 s分为无法屏气组（17例）及配合屏气组（20例），行StarVIBE序列及常规VIBE序列MR平扫及增强延迟期成像。以"5分法"评价两序列图像中病变清晰度、伪影、肺血管清晰度、纵隔结构清晰度及总体图像质量，并进行组间比较。结果 无法屏气组StarVIBE序列平扫及增强图像各项评分均高于常规VIBE序列（P均<0.05）。配合屏气组中，病变清晰度、肺血管清晰度评分在平扫StarVIBE序列图像中均低于常规VIBE序列（P均<0.05），但增强图像差异均无统计学意义（P均>0.05）；图像伪影及总体图像质量评分差异亦无统计学意义（P均>0.05），而纵隔清晰度评分在StarVIBE序列平扫及增强图像中均高于常规VIBE序列（P均<0.05）。结论 采集胸部T1WI时，对于能配合屏气者，自由呼吸StarVIBE序列可获得与常规VIBE序列相近的图像质量；而对于无法屏气者，自由呼吸StarVIBE序列可提供较好质量的图像。     

常规三维容积内插屏气检查序列与自由呼吸StarVIBE序列T1WI肝脏图像质量对比

目的 对比分析常规三维容积内插屏气检查（VIBE）与StarVIBE序列的图像质量,探讨StarVIBE序列自由呼吸扫描在肝脏T1WI中的应用价值。方法 对48例超声提示肝脏病变患者行StarVIBE序列自由呼吸扫描及常规VIBE序列屏气扫描,根据患者能否配合屏气16 s分为无法屏气组（n=24）及配合屏气组（n=24）;采用"5分法"对肝脏边缘锐利度、肝脏血管清晰度、病变清晰度、伪影、脂肪抑制效果及图像总体质量进行主观评分,并计算平扫信号强度变异系数（CV）及增强后病灶肝脏信号比（LLR）;比较组内2序列间及2组间StarVIBE序列的图像质量差异。结果 无法屏气组StarVIBE序列图像的主观评分及定量评估参数值均高于常规VIBE序列（P均<0.05）;配合屏气组StarVIBE序列图像病灶清晰度（平扫）、伪影及脂肪抑制效果评分低于常规VIBE序列（P均<0.05）,而2序列间其余主观评分及定量评估差异均无统计学意义（P均>0.05）。2组间StarVIBE序列LLR差异有统计学意义（P<0.05）,各项主观评分及CV差异均无统计学意义（P均>0.05）。结论 在肝脏T1WI中,对于能配合屏气患者,StarVIBE序列图像质量略差于常规VIBE序列;而对于无法屏气患者,StarVIBE序列可获得更佳图像质量。     

对比自由呼吸Star-VIBE序列与呼吸末屏气C-VIBE序列胸部MR图像质量

目的 比较分析以自由呼吸Star-VIBE序列与呼吸末屏气C-VIBE序列采及胸部MRI的图像质量。方法 对20例患者行胸部MR检查，采集呼气末屏气C-VIBE（C-VIBE）和自由呼吸Star-VIBE（Star-VIBE）序列图像。于肺动脉干水平分别测量升主动脉、肺动脉干、降主动脉的信号强度（SI）和标准差（SD），计算图像信噪比（SNR）和SI变异系数（CV）。对图像质量进行主观评分。比较2个序列图像的SNR、CV及主观评分差异。结果 Star-VIBE图像升主动脉、肺动脉干及降主动脉SNR值均高于C-VIBE（t=－4.87、－3.38、－9.42，P均<0.05），而SI CV均低于C-VIBE图像（t=5.52、3.67、8.04，P均<0.05）。Star-VIBE图像的主观评分高于C-VIBE图像（Z=－3.74，P<0.05）。结论 自由呼吸Star-VIBE序列胸部MRI的图像质量优于呼气末屏气C-VIBE序列。     

3D自由呼吸Star VIBE序列在儿童腹部增强MR中的应用

目的 探讨3D自由呼吸径向采集K空间放射填充容积内插成像（Star VIBE）序列在儿童腹部MR增强检查中的应用价值。方法 对72例患儿采用超快速小角度激发（tfl）梯度回波序列及3D自由呼吸Star VIBE序列进行腹部增强MR扫描,对2种扫描序列得到的增强T1WI进行主观评分,并测量其SNR和CNR,比较2种图像的差异。结果 3D自由呼吸Star VIBE序列图像呼吸运动伪影、肝内血管和下腔静脉结构显示、胃肠道蠕动伪影、病灶清晰度和整体图像质量评分均高于tfl序列（P均<0.001）。3D自由呼吸Star VIBE序列的SNR为25.14（20.42,30.50）,CNR为9.20（7.36,10.42）,tfl序列的SNR为20.67（19.00,23.50）,CNR为6.08（3.00,8.50）;3D自由呼吸Star VIBE序列的SNR、CNR均高于tfl序列（P均<0.001）。结论 3D自由呼吸Star VIBE序列可明显减少儿童腹部增强MRI运动伪影,增加SNR和CNR,对于诊断儿童腹部病变具有重要临床应用价值。     

对比Star-容积内插屏气检查序列与常规容积内插屏气检查序列胎儿脑图像质量

目的 对比分析Star-容积内插屏气检查（Star-VIBE）序列及常规容积内插屏气检查（VIBE）序列胎儿脑图像质量。方法 对81名妊娠中晚期孕妇分别行Star-VIBE序列（自由呼吸）及常规VIBE序列MR体部扫描,比较2种序列图像中胎儿基底核及脑白质部位SNR及CNR,并比较胎儿脑沟回、基底核及丘脑、脑室系统、小脑及脑干部位2种序列图像质量评分。结果 胎儿基底核及脑白质部位Star-VIBE序列图像的SNR、CNR均高于常规VIBE序列（P均<0.01）。胎儿脑沟回、基底核及丘脑、脑室系统、小脑及脑干部位Star-VIBE序列图像质量评分均高于常规VIBE序列（P均<0.01）。结论 Star-VIBE序列扫描获得的胎儿脑图像质量好于常规VIBE序列,显示胎儿颅内结构更清晰。     

对比分析屏气三维梯度-自旋回波与呼吸门控触发三维快速自旋回波MR胰胆管成像

目的 对比屏气三维梯度-自旋回波MR胰胆管造影（3D-Grase-MRCP）与呼吸门控触发三维快速自旋回波MR胰胆管造影（3D-Tse-MRCP）图像质量。方法 对96例疑诊胰腺或胆道疾病患者行屏气3D-Grase-MRCP和呼吸门控触发3D-TSE-MRCP序列扫描，比较2种序列图像质量评分、显示病变情况及胆总管对比噪声比（CNR）。将3D-Grase-MRCP图像分为屏气组和屏气配合不佳组，对比2组图像质量评分。结果 3D-Tse-MRCP图像胆总管CNR值[357.08（209.73，594.38）]高于3D-Grase-MRCP[256.14（141.54，417.87），Z=-3.01，P<0.05]。3D-Grase-MRCP图像胆囊、胆囊管、胆总管及肝内胆管主要分支评分均高于3D-Tse-MRCP（P均<0.01），显示胆囊结石（n=42）和胆囊管结石（n=7）更清晰（P均<0.05）；屏气组（n=68）3D-Grase-MRCP图像胆囊、胆囊管、胆总管、胰管及肝内胆管主要分支质量评分均高于屏气配合不佳组（n=28，P均<0.01）。结论 屏气3D-Grase-MRCP图像质量及显示病变优于呼吸门控触发3D-Tse-MRCP，且扫描时间明显缩短。     

三叉神经责任血管MRTA扫描序列的优化

目的探讨应用磁共振断层血管成像(MRTA)技术诊断三叉神经责任血管时对于扫描序列的优化。方法对32例临床诊断为三叉神经痛的患者行MRTA,采用三维时间飞跃法扰相梯度回波(3D-TOF FLASH)与容积内插屏气检查(VIBE)的大体素和小体素模式扫描,分析比较其图像质量。结果 VIBE序列图像所显示的三叉神经周围血管数目多于3D-TOF FLASH序列。大、小体素VIBE序列图像与大、小体素3D-TOF FLASH序列图像显示三叉神经周围血管的差异有统计学意义(P均<0.05)。VIBE序列图像的SNR与CNR均显著高于3D-TOF FLASH序列(P<0.05)。两种扫描序列中,应用大体素扫描模式获得图像的SNR与CNR均显著高于小体素扫描模式(P均<0.05)。结论应用MR-TA检查三叉神经时,采用大体素3D-TOF FLASH序列大范围扫描,能够准确、快速地辨认责任动脉血管,小范围内采用小体素VIBE序列能够精确显示脑桥小脑角池内三叉神经与邻近血管的关系。     

双源CT双能量胸部虚拟平扫的应用价值

目的通过对比胸部常规平扫与双源CT双能量虚拟平扫(VNC),探讨VNC临床应用的可行性。方法对155例怀疑胸部疾病的患者行常规CT平扫和双能CT增强扫描,后处理得到VNC图像,对VNC和常规平扫平均CT值、SNR、图像质量、病灶显示情况、辐射剂量等方面进行比较。结果肺动脉干处平均CT值VNC高于常规平扫(P<0.05),而左心室及脊柱后方肌肉处差异均无统计学意义(P均>0.05)。VNC ROI选在肺动脉干、左心室、脊柱后方肌肉的图像SNR均高于常规平扫(P<0.05)。VNC图像质量与常规平扫比较差异无统计学意义(P>0.05)。VNC的病灶显示情况类似,除部分钙化灶(6/21)及腔静脉旁小淋巴结(3/37)在VNC未见显示外,其余病变均可显示。VNC有效剂量稍高于常规平扫(P<0.05)。结论双能量胸部增强扫描一次扫描可获得增强图像和VNC图像,VNC图像在不影响图像质量及病灶检出的情况下降低了辐射剂量,具有潜在的临床应用价值。     

One beat冠状动脉轴扫结合Snap shot Freeze重组的应用价值:与常规屏气扫描模式对比

目的探讨One beat冠状动脉轴扫结合Snap shot Freeze重组技术在自由呼吸冠脉扫描(CCTA)中的价值。方法收集我院行16 cm宽体探测器One beat轴扫的冠脉CTA检查者126例,按屏气和自由呼吸分为两组,其中屏气组74例,自由呼吸52例。再根据受检者心率分为低中高三个心率组(A、B、C),其中屏气组:A1组(小于70 bpm)41例,B1组(71～85 bpm)24例,C1组(大于85 bpm)9例;自由呼吸组:A2 (小于70 bpm)27例,B2组(71～85 bpm)16例,C2组(大于85 bpm)9例。所有受检者均采用手动选取最佳时相并结合冠状动脉冻结技术(SSF)技术进行重组,得到运动伪影补偿前、后的图像。客观评分:分别测量屏气组和自由呼吸组冠状动脉CTA图像的主动脉弓根部CT值、噪声值、信噪比、对比度噪声比;主观评分:由2名有经验的放射科医师采用5分法对SSF前后的5组图像的右冠状动脉(RCA)、左前降支(LAD)、左旋支(LCX)进行评分。比较各分支在SSF前后图像质量的变化并比较在自由呼吸和屏气扫描下SSF后不同心率组图像质量的差异。结果屏气组和自由呼吸组的主动脉弓根部CT值、噪声、信噪比、对比度噪声比均无明显差别(P0.05)。在使用SSF后无论在自由呼吸组还是屏气组均能够提高图像质量(P0.05);自由呼吸组和屏气组在使用SSF后对于不同心率冠状动脉图像的质量的提升均无明显差别(P0.05)。结论通过自由呼吸组和屏气组的主客观的比较,依赖于One beat冠状动脉轴扫结合SSF重组,自由呼吸冠状动脉扫描可以提供高质量的图像。     

对比分析两种胸部能谱CT虚拟平扫图像与常规平扫图像

目的 比较虚拟平扫图像（VUE）和抑碘图像（MSI）与常规CT平扫图像（TUE）质量,观察能谱CT虚拟平扫技术在胸部CT成像中的应用价值。方法 前瞻性收集40例患者行胸部平扫联合增强检查,采用常规扫描模式获得胸部TUE,以GSI Assist模式行双期增强扫描。采用VUE技术基于原始数据重建动脉期、静脉期虚拟平扫图像（AP-VUE、VP-VUE）,通过后处理抑碘技术获得双期抑碘图（AP-MSI、VP-MSI）。测量胸主动脉、肺动脉、竖脊肌及胸壁皮下脂肪CT值及其标准差（SD值）,并计算CNR,采用5分法对图像进行主观评分,以单因素方差分析及Kruskal-Wallis H法、Mann-Whitney U法进行统计学分析。结果 AP-MSI肺动脉及胸主动脉CT值与TUE比较差异有统计学意义（P均<0.005）,VP-MSI及双期VUE各部位CT值、CNR值及SD值与TUE间差异无统计学意义（P均>0.005）。双期MSI及AP-VUE图像各项主观评分均低于TUE（P均<0.005）,VP-VUE图像各项主观评分与TUE比较差异均无统计学意义（P均>0.005）。虚拟平扫较常规平扫辐射剂量降低19.29%。结论 VUE技术可在降低辐射剂量的同时获得较MSI更好的图像质量,尤其VP-VUE与TUE图像质量相当,有代替常规胸部平扫的潜能。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Modified micro-superior percutaneously-assisted total hip: early experiences & case reports

Because of the extensile nature and familiarity of the standard posterior-lateral approach to the hip, a family of "micro-posterior" approaches has been developed. This family includes the Percutaneously-Assisted Total Hip (PATH) approach, the Supercapsular (SuperCap) approach and a newer hybrid approach, the Supercapsular Percutaneously-Assisted Total Hip (SuperPATH) approach. Such approaches should ideally provide a continuum for the surgeon: from a "micro" (external rotator sparing) posterior approach, to a "mini" (external rotator sacrificing) posterior approach, to a standard posterior approach. This could keep a surgeon within his comfort zone during the learning curve of the procedure, while leaving options for complicated reconstructions for the more practiced micro-posterior surgeons. This paper details one author's experiences utilizing this combined approach, as well as permutations of this entire micro-posterior family of approaches as applied to more complex hip reconstructions.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.     

Structure and function of "metalloantibiotics"

Although most antibiotics do not need metal ions for their biological activities, there are a number of antibiotics that require metal ions to function properly, such as bleomycin (BLM), streptonigrin (SN), and bacitracin. The coordinated metal ions in these antibiotics play an important role in maintaining proper structure and/or function of these antibiotics. Removal of the metal ions from these antibiotics can cause changes in structure and/or function of these antibiotics. Similar to the case of "metalloproteins," these antibiotics are dubbed "metalloantibiotics" which are the title subjects of this review. Metalloantibiotics can interact with several different kinds of biomolecules, including DNA, RNA, proteins, receptors, and lipids, rendering their unique and specific bioactivities. In addition to the microbial-originated metalloantibiotics, many metalloantibiotic derivatives and metal complexes of synthetic ligands also show antibacterial, antiviral, and anti-neoplastic activities which are also briefly discussed to provide a broad sense of the term "metalloantibiotics."