miRNA-146b在甲状腺术前细针穿刺样本中的表达

目的探讨在超声引导下甲状腺结节针吸引活检标本中miRNA-146b的表达水平对术前诊断的影响。方法回顾性选取2015年1月至2016年12月在新疆医科大第二附属医院行细针穿刺细胞学检查(FNAB)的40例甲状腺结节患者。采用RT-PCR技术检测甲状腺结节FNAB样本中miRNA-146b的表达,比较甲状腺乳头状癌与甲状腺良性结节miRNA-146b表达差异。其结果与细胞学诊断与术后病理诊断进行比较。结果使用miRNA-146b的2~(-△△CT)值鉴别甲状腺乳头状癌和甲状腺良性结节,其诊断甲状腺乳头状癌和甲状腺良性结节的ROC曲线下面积为0.818,敏感度为80%,特异度为80%,显示miRNA表达诊断甲状腺良恶性结节有较高的效能。在与传统穿刺细胞病理学比对中敏感度100%比85%,优于传统方法,但敏感度一致均为100%。结论 miRNA-146b在甲状腺乳头状癌及甲状腺良性结节中的表达差异有统计学意义,即miRNA-146b表达可鉴别甲状腺良恶性结节,优于传统穿刺细胞病理学检查。     

CD57联合US-FNAB、FNA-Tg检查在甲状腺乳头状癌中的应用价值

目的:分析超声引导下细针穿刺细胞学检查(ultrasound-guided fine-needle aspiration biopsy,US-FNAB)联合细针穿刺洗脱液甲状腺球蛋白(washout fluid thyroglobulin in fine-needle aspiration,FNA-Tg)检查以及病变组织CD57检查诊断甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的价值。方法:回顾并分析2016年12月—2018年6月于河北医科大学第二医院就诊的220例甲状腺结节患者,其中PTC患者120例,甲状腺良性病变(benign thyroid lesion,BTL)患者100例。用免疫组织化学法检测两组病变组织中CD57的表达情况,分析CD57诊断PTC的效能;PTC患者在术前均行US-FNAB和FNA-Tg检测,分析US-FNAB联合FNA-Tg诊断PTC患者术后淋巴结转移的效能。结果:CD57在PTC组中的阳性表达率(83.33%)较BTL组(4.00%)高(χ2=11.32;P=0.000),诊断PTC的灵敏度、特异度、准确率分别为83.33%、96.00%、89.09%。病理学检查结果中,50例患者共120枚颈部淋巴结转移。以FNA-Tg血清Tg为转移阳性指标时,灵敏度、特异度、准确率为90.00%、95.89%、95.83%;FNA-Tg10 ng/mL为转移阳性时,灵敏度、特异度、准确率分别为88.89%、96.00%、93.33%。US-FNAB联合FNA-Tg诊断淋巴结转移灵敏度、特异度、准确率(98.00%、100.00%、99.17%)高于USFNAB(60.00%、97.14%、97.14%),特异度高于FNA-Tg(96.00%),差异有统计学意义(P0.05)。结论:US-FNAB联合FNA-Tg、CD57能够辅助PTC及淋巴结转移诊断。     

甲状腺乳头状癌伴颈部淋巴结转移相关超声征象分析

目的：探讨甲状腺乳头状癌（PTC）与颈部淋巴结转移相关的超声征象,为判断PTC有无颈部淋巴结转移提供参考。方法回顾性分析2011-2013年哈尔滨医科大学附属第一医院经手术后病理证实的170例PTC患者的超声征象。其中59例伴颈部淋巴结转移,111例无颈部淋巴结转移。采用操作者工作特性（ROC）曲线分析阻力指数（RI）、收缩期峰值血流速度（PSV）判断PTC有无颈部淋巴结转移的最佳诊断界限值。采用χ2和秩和检验比较PTC伴颈部淋巴结转移患者与无颈部淋巴结转移患者原发灶超声征象差异。采用Logistic回归分析PTC伴颈部淋巴结转移的相关因素。结果 ROC曲线分析显示,RI、PSV判断PTC有无颈部淋巴结转移的最佳诊断界限值分别为0.735、13.95 cm/s。与PTC无颈部淋巴结转移患者比较,PTC伴颈部淋巴结转移患者原发灶直径、是否有晕环、是否累及甲状腺上极、有无微钙化、血供分级、RI及PSV差异均有统计学意义;而原发灶回声、边界是否清晰、纵横比差异均无统计学意义。多因素Logistic回归分析显示,PTC原发灶直径及PSV这2个因素是PTC伴颈部淋巴结转移的相关独立因素。结论 PTC原发灶的一些超声征象与PTC有无颈部淋巴结转移有密切的相关性,可为术前PTC患者颈部淋巴结有无转移的诊断提供有价值的信息。     

甲状腺结节的MR扩散加权成像与病理对照

目的 探讨甲状腺结节MR DWI表现,评价DWI鉴别甲状腺良、恶性结节的价值.方法 对111例甲状腺单发结节性病变进行MR DWI检查.其中,恶性结节23例,良性结节88例.观察和比较不同良、恶性结节的ADC值差异,确定最佳b值和ADC阈值,并与病理结果相对照.结果 随着b值增大,ADC值均降低.不同b值时甲状腺恶性结节的ADC值均低于良性结节(P均＜().05).甲状腺癌的ADC值明显低于腺瘤和结节性甲状腺肿(P＜0.01),而与甲状腺炎差异无统计学意义(P＞0.05).b=500 s/mm2时,选取ADC值1.70×10-3mm2/s为阈值,诊断甲状腺恶性结节的敏感度、特异度和准确率分别为92.32％、87.51％和86.93％.良、恶性结节的ADC值差异与其病理表现有关.结论 DWIADC值对鉴别甲状腺良、恶性结节有较高价值.     

甲状腺结节伴乳头状癌临床特征及恶性风险因素分析

目的 探讨甲状腺结节伴乳头状癌(papillary thyroid cancinoma,PTC)的临床特征和危险征象.方法 409例首次行甲状腺结节手术患者,经组织病理确诊PTC 175例(PTC组),甲状腺良性结节234例(良性组),回顾性分析2组临床资料,比较甲状腺超声及甲状腺血清学特点,logistic回归分析PTC的独立危险征象.结果 PTC组中位年龄(44岁)低于良性组(51岁)(P＜0.01);甲状腺超声显示PTC组2个结节(17.7％)、实性结节(61.7％)、结节直径≤2 cm(72.6％)、低回声(61.7％)、边界不清(43.4％)、形态不规则(59.4％)及微小钙化率(62.8％)高于良性组(8.1％、50.4％、42.3％、41.5％、17.9％、18.8％、22.2％)(P＜0.05);PTC组抗甲状腺球蛋白抗体(3.6(0.0,596.0) u/mL)高于良性组(3.0(0.0,423.0) u/mL)(P＜0.05);年龄≤40岁(OR=0.969,95％CI:0.951～0.987,P=0.001)、结节形态不规则(OR=4.176,95％CI:2.572～6.780,P=0.000)、微小钙化(OR=2.487,95％CI:1.528～4.049,P=0.000)、结节数目(OR=1.403,95％CI:1.035～1.90l,P=0.029)及结节直径(OR=0.702,95％CI:0.579～0.852,P=0.000)是PTC的独立危险征象.结论 PTC好发于40岁以下患者,超声声像中结节形态不规则、微小钙化、结节直径有助于术前判断PTC.     

超声引导下细针穿刺洗脱液测定BRAFV600E突变丰度预测甲状腺乳头状癌颈部淋巴结转移

目的探索超声引导下细针穿刺洗脱液测定BRAF^V600E突变丰度在预测甲状腺乳头状癌（PTC）颈部淋巴结转移中的临床价值。 方法收集在上海交通大学医学院附属瑞金医院2020年1月至12月间行甲状腺手术且病理证实为PTC的1046例患者,术前均行超声引导下细针穿刺活检测定BRAF^V600E突变丰度。根据淋巴结转移情况将患者分为淋巴结转移组（419例）和无淋巴结转移组（627例）。采用χ²检验或t检验分析2组患者间的临床特征（性别、年龄、肿瘤最大径、结节数目、结节位置）以及突变丰度之间是否存在差异,并采用二元Logistic回归进行多因素分析,同时构建受试者操作特征（ROC）曲线评估BRAF^V600E基因突变丰度预测PTC患者淋巴结转移的诊断效能。 结果淋巴结转移组中男性、＜45岁、肿瘤最大径≥1 cm、多发结节数目以及多侧结节比例高于无淋巴结转移组（32.0% vs 19.9%;72.1% vs 54.5%;38.9% vs 19.0%;25.8% vs 18.0%;16.2% vs 10.4%）,差异均具有统计学意义（χ²=19.56、32.62、50.63、9.06、7.78;P＜0.001、＜0.001、＜0.001、=0.003、=0.005）;PTC伴有淋巴结转移的BRAF^V600E突变丰度高于无淋巴结转移者［（32.44±20.23）% vs（27.21±20.82）%］,差异具有统计学意义（t=-4.29,P＜0.001）。多因素回归分析结果提示男性、年龄、最大径≥1 cm、多发结节、BRAF^V600E突变丰度高为PTC颈部淋巴结转移的独立危险因素（OR=1.935、0.425、2.578、1.651、2.057;P均＜0.05）。ROC曲线显示BRAF^V600E突变丰度预测颈部淋巴结转移的敏感度、特异度、阳性预测值、阴性预测值和曲线下面积分别为48.69%、65.71%、48.69%、65.71%、0.574。 结论BRAF^V600E突变丰度高的PTC患者更容易发生淋巴结转移,BRAF^V600E突变丰度高是PTC颈部淋巴结转移的危险因素。     

甲状腺滤泡型乳头状癌的超声及临床特征

目的评估甲状腺滤泡型乳头状癌（FVPTC）的超声表现及临床特征。 方法回顾性分析2007年1月至2017年10月于上海交通大学医学院附属瑞金医院手术并经病理证实为FVPTC的127个结节。超声评估指标包括：最大径、边缘、纵横比、内部结构、回声水平、钙化、后方衰减、声晕、血供程度,将超声指标纳入甲状腺超声影像报告和数据系统（TI-RADS）,并与经典型PTC相比较。同时分析FVPTC超声引导下细针穿刺抽吸活检结果（US-FNAB）及淋巴结转移率。采用t检验比较FVPTC和经典型PTC组结节大小的差异;采用χ²检验比较FVPTC和经典型PTC组的淋巴结转移和TI-RADS分类的差异。 结果（1）FVPTC结节大小为（23.47±12.75）mm,大于经典型PTC的大小［（10.84±6.10）mm］,差异具有统计学意义（t=10.077,P＜0.001）;大部分FVPTC结节表现为边缘规则、纵横比≤1、实性、低回声、无钙化、无后方衰减、无声晕、中等血供。TI-RADS分类在FVPTC与经典型PTC之间差异具有统计学意义（χ²=28.891,P＜0.001）,在非腺瘤样FVPTC与经典型PTC之间差异无统计学意义（χ²=3.988,P=0.125）。（2）US-FNAB诊断FVPTC良性6例,滤泡性病变6例,可疑恶性及恶性15例,符合率55.56%（15/27）。（3）FVPTC淋巴结转移率低于经典型PTC（10.68% vs 29.92%;χ²=12.560,P=0.001）。 结论FVPTC的超声表现多样,淋巴结转移率低,加深认识能有效提高诊断的准确性。     

超声弹性成像技术预测甲状腺微小乳头状癌中央组淋巴结转移的价值

目的 探讨超声弹性成像技术弹性评分及弹性应变率（SR）预测甲状腺微小乳头状癌（PTMC）中央组淋巴结转移的价值。方法 选择2012年6月至2013年3月上海交通大学医学院附属瑞金医院经手术病理证实的82例PTMC患者共82个病灶,其中12例患者12个病灶伴有中央组淋巴结转移,70例患者70个病灶无中央组淋巴结转移。对所有病灶进行弹性评分,并检测病灶与周围正常甲状腺组织的SR。分别采用χ^2检验、独立样本t检验比较有中央淋巴结转移PTMC与无中央淋巴结转移PTMC弹性评分、SR的差异,并绘制操作者工作特性（ROC）曲线评价SR判断PTMC有无中央淋巴结转移的价值。结果 有中央淋巴结转移PTMC与无中央淋巴结转移PTMC的弹性评分差异无统计学意义（χ^2=5.00,P=0.08）;有中央组淋巴结转移PTMC的平均SR为2.44±0.61,高于无中央组淋巴结转移PTMC的平均SR 1.67±0.42,且差异有统计学意义（t=5.5,P=0.00）;PTMC与周围正常甲状腺组织的SR的ROC曲线下面积为0.847,当SR为2.01时判断PTMC有中央组淋巴结转移的敏感度、特异度和准确性分别为83.3%、81.4%、78.6%。结论 超声弹性成像技术弹性评分不能作为判断PTMC有无中央组淋巴结转移的指标,而SR可作为预测PTMC有无中央组淋巴结转移的指标。     

CT纹理分析鉴别甲状腺良恶性结节和预测淋巴结转移

目的探讨CT纹理分析鉴别甲状腺结节良恶性和预测恶性结节淋巴结转移的价值。方法回顾性分析174例经手术病理证实的甲状腺结节患者,包括122例良性病变(良性组)及52例恶性病变(恶性组);根据是否淋巴结转移将恶性组患者分为转移亚组(n=22)与无转移亚组(n=30)。采用Mazda软件于动脉期CT图像提取纹理特征,并以Fisher方法对纹理特征进行降维,分别获得良性组与恶性组、转移亚组与无转移亚组的最优纹理特征。比较良性组与恶性组、转移亚组与无转移亚组间最优纹理特征差异;针对差异有统计学意义的纹理参数采用二元Logistic回归分析影响甲状腺结节良恶性的独立预测因子,以ROC曲线法分析独立预测因子鉴别甲状腺结节良恶性的效能。结果共提取279个纹理特征,经降维后获得良性组与恶性组各10个最优纹理特征参数,除参数S(5,-5)InvDfMom外,其余参数组间差异均有统计学意义(P均<0.05)。参数Vertl_GlevNonU、45dgr_GlevNonU是甲状腺良恶性结节的独立预测因子(P均<0.05)。Vertl_GlevNonU、45dgr_GlevNonU鉴别甲状腺良恶性结节的最佳阈值分别为21.11和33.61,前者的AUC、敏感度和特异度分别为0.76、73.80%及73.10%,后者分别为0.77、68.90%及75.00%。恶性组内转移亚组与无转移亚组间最优纹理特征差异均无统计学意义(P均>0.05)。结论基于CT甲状腺结节纹理特征分析对鉴别甲状腺良恶性结节具有一定价值,而对预测甲状腺恶性结节淋巴结转移价值有限。     

超声造影联合Lemur-酪氨酸激酶3水平诊断甲状腺乳头状癌及预测其颈部淋巴结转移的价值

目的 探讨超声造影（CEUS）联合Lemur-酪氨酸激酶3(LMTK3)水平诊断甲状腺乳头状癌（PTC）及预测其颈部淋巴结转移的价值。方法 选取我院经手术病理证实的92例甲状腺结节患者,根据病理结果分为良性组42例和PTC组50例,其中PTC组根据有无颈部淋巴结转移进一步分为转移组28例和非转移组22例,术前均行甲状腺CEUS检查和LMTK3水平检测,比较良性组与PTC组、转移组与非转移组CEUS特征和LMTK3水平的差异。绘制受试者工作特征（ROC）曲线评估CEUS和LMTK3水平单独及联合应用诊断PTC及预测其颈部淋巴结转移的效能。结果 PTC组CEUS等增强、低增强、非均匀增强、灌注缺损、增强时边界不清晰占比及达峰时间（TTP）、CEUS量化值、LMTK3水平均高于良性组,峰值强度（PI）低于良性组,差异均有统计学意义（均P<0.001）。转移组CEUS等增强、高增强、非均匀增强、灌注缺损、增强时边界不清晰占比及TTP、PI、CEUS量化值、LMTK3水平均高于非转移组,差异均有统计学意义（均P<0.05）。ROC曲线分析显示,与CEUS和LMTK3水平单独应用比较,...     

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.     

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.     

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.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

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.