军事应激对军人心理和免疫内分泌系统的影响

目的 探讨军事演习对官兵心理和免疫内分泌系统指标的影响.方法 选取参加军演部队指战员126名,采用放射免疫方法(RIA)检测参演前后血清IL-2、IL-6、IL-8、肿瘤坏死因子(TNF)、血清皮质醇(cortisol)和醛固酮(aldosterone)水平,应用军人心理应激自评问卷(PSET)进行心理状态调查,将血清学检测结果与军人心理应激自评结果进行相关性分析.结果 参加军演后,血清IL-2降低,IL-6、IL-8、TNF升高,与军演前比较有显著性差异(P＜0.05),PSET分值≥70的官兵(n=35)IL-2降低和IL-6、IL-8、TNF升高更明显(P＜0.05);军演后血清皮质醇和醛固酮均升高,与军演前比较有显著性差异(P＜0.05),PSET分值≥70的官兵皮质醇和醛固酮升高更明显(P＜0.05).结论 军演可对免疫系统产生一定的抑制作用,并可引起内分泌激素水平的改变,有必要选择适宜的心理训练和体能训练来提高官兵的免疫能力和心理应激能力.     

坑道内外作业士兵心理健康状态与个性特征的比较

目的 探讨军事坑道作业部队坑道内、外作业士兵的心理健康状况及个性特征.方法 采用症状自评量表(SCL-90)及艾森克(EPQ)个性问卷,对某坑道作业部队的104名坑道作业士兵(坑道组)以及88名非坑道作业士兵(非坑道组)进行心理测评.结果 除恐怖因子外,坑道组SCL-90各因子分均显著高于非坑道组(P<0.05);非坑道组的躯体化、忧郁、焦虑、精神病性因子分显著高于青年常模(P<0.05),其他5项与青年常模比较无显著差异(P0.05),而坑道组的各因子分均显著高于青年常模(P<0.05).EPQ测试的各维度中,坑道组神经质(N)分值显著高于非坑道组(P<0.05),掩饰(L)分值显著低于非坑道组(P<0.05),而内外向(E)和精神质(P)两个维度分值两组比较无显著差异.坑道组SCL-90部分因子评分与EPQ量表的精神质(P)和神经质(N)呈显著正相关,部分因子评分与内外向(E)呈显著负相关,但各因子评分与掩饰(L)均无明显相关.结论 个性特征是影响坑道作业士兵心理健康状态的重要因素,因此应因人施教,针对士兵出现的心理问题积极地采取干预措施,并开展相应的心理训练,培养士兵更好适应军事环境的意志品质.     

驻新疆维稳警察的心理应激状况及人格因素分析

 目的 了解驻新疆维稳警察的心理应激状况,及其与人格因素的关系.方法 应用军人心理应激自评问卷(PSET)和艾森克人格问卷(EPQ),对320名驻新疆维稳警察进行心理测试.结果 全部被测人员中有17人有明显的心理应激,占5.31％;心理应激评分与EPQ中的神经质(N)维度呈正相关(r=0.510,P ＜0.01),与外倾性(E)、精神质(P)、效度量表(L)评分呈负相关(r＝- 0.010,0.327,-0.231,P＜0.05).结论 驻新疆维稳警察有一定的心理应激,且其应激程度与人格特征相关.     

海上演习对某部官兵部分心理和生理指标的影响

目的 探讨海上演习对某部官兵部分心理和生理指标的影响.方法 采用放射免疫方法(RIA)检测126名参演官兵演习前后血清免疫抑制酸性蛋白(IAP)、可溶性肿瘤坏死因子受体1(sTNFR-1)、血清皮质醇和醛同酮水平,应用军人心理应激自评问卷(PSET)进行心理状态的调查,将血清学检测结果与军人心理应激自评结果进行相关性分析.结果 参加演习后血清IAP和sTNFR-1升高,与演习前比较差异有统计学意义(P＜0.05);而演习后PSET分值≥70官兵IAP和sTNFR-1升高更明显(P＜0.05).演习后血清皮质醇和醛同酮均升高,与演习前比较差异有统计学意义(P＜0.05),演习后PSET分值≥70官兵血清皮质醇和醛固酮升高更明显,差异有统计学意义(P＜0.05).结论 登陆演习作为一种强烈的应激行为,对机体免疫系统会产生一定的抑制,也可引起人体内分泌激素水平改变,因此有必要选择适宜的心理训练和体能训练来提高官兵的免疫能力和心理应激能力.     

军演官兵心理状态与应对方式、社会支持的相关性研究

目的 探讨联合军演条件下官兵心理健康状态与应对方式、社会支持的相关性.方法 选取参加军演的陆海空三军官兵538名,采用SCL-90症状自评量表、艾森克个性问卷(EPQ)、应对方式量表(SCSQ)和社会支持量表(SSRS)进行现场测试.并进行统计学t检验、方差分析和相关分析.结果 军演后参演官兵SCL-90各因子分显著高于军队常模(P＜0.01);SCL-90各因子分中有一项以上≥3分(阳性症状)的有79名,占受检人数的14.7%(79/538),从阳性症状分布来看,以焦虑、恐怖、躯体化、人际敏感为常见,而精神病性、强迫症状、抑郁少见,初次参加军演官兵的SCL-90各因子分均高于曾参加过军演者(P＜0.05);军演条件下官兵心理健康状态与其应对方式、社会支持显著相关(P＜0.05),官兵SCL-90因子中抑郁与解决问题方式呈显著负相关(P＜0.05);除躯体化外,SCL-90各因子均与自责呈显著负相关(P＜0.05);除人际敏感、偏执、精神病性外,SCL-90各因子均与求助呈显著负相关(P＜0.05);SCL-90各因子与幻想呈显著正相关(P＜0.05);除躯体化、敌对性外,SCL-90各因子均与退避呈显著负相关(P＜0.05);除躯体化、抑郁外,SCL-90各因子均与合理化呈显著正相关(P＜0.05).参加军演官兵SCL-90各因子分中人际敏感、抑郁、恐怖、偏执和精神病性与社会支持呈显著负相关(P＜0.05),焦虑、强迫、人际关系、抑郁、恐怖、偏执和精神病性与客观支持呈显著负相关(P＜0.05),抑郁、恐怖和精神病性与主观支持呈显著负相关(P＜0.05),抑郁与支持利用度呈显著负相关(P＜0.05).结论 参加军演的官兵心理上处于一种强烈的应激状态,其心理健康状态与应对方式和社会支持密切相关.     

驻岛官兵幸福感指数等与心理健康水平相关性研究

目的：探讨驻岛官兵幸福感指数、心理应激与心理健康水平的相关性。方法：随机抽取某驻岛官兵591例,按照症状自评量表（SCL-90）总分分为阳性组（≥160分）71例和阴性组（≤159分）520例。采用幸福感指数量表、军人心理应激自评问卷（PSET）和SCL-90对其进行测评,并分析驻岛官兵幸福感指数、心理应激与心理健康水平的相关性。结果：阴性组情感内涵、生活满意度因子和幸福感指数分值均非常显著高于阳性组（P〈0．01）,而PSET总分非常显著低于阳性组（P〈0．01）。Pearson相关分析结果显示,幸福感指数、情感内涵、生活满意度因子分值,与SCL-90总分及焦虑、抑郁、人际关系敏感因子、PSET总分分值呈显著或非常显著负相关（P〈0．05,P〈0．01）,PSET总分与SCL-90总分及焦虑、抑郁、人际关系敏感因子分值呈非常显著正相关（P〈0．01）。多元逐步回归分析结果显示,抑郁因子进入以幸福感指数为因变量的回归方程,焦虑和抑镌因子进入以PSET总分为因变量的回归方程。结论：驻岛官兵幸福感指数、心理应激与心理健康水平显著相关,焦虑和抑郁是主要影响因素。     

潜艇官兵人格特征、应对方式及社会支持与心理应激的关系研究

目的 探讨潜艇官兵心理应激与人格特征、应对方式及社会支持的关系.方法 对460名潜艇官兵进行量表测评,包括心理社会应激调查表(PSSG)、艾森克人格问卷(EPQ)、特质应对问卷(TCSQ)和领悟社会支持量表(PSSS),数据采用SPSS 15.0和Amos 7.0进行统计分析.结果 (1)潜艇官兵不同衔级组心理应激水平差异有统计学意义(F=12.12,P<0.01),其中高级士官及军官组心理应激水平最高(51.46±25.19),义务兵组最低(35.63±16.94);(2)潜艇官兵心理应激水平与神经质(0.77)、消极应对(0.63)和精神质(0.33)等呈高度正相关,与掩饰(-0.42)、社会支持(-0.33)、积极应对(-0.32)和内外向(-0.12)等呈显著或高度负相关;(3)多元逐步回归分析标准回归系数排在前5位的变量依次为神经质、消极应对、社会支持、掩饰、积极应对(标准回归系数依次为0.592、0.116、-0.106、-0.081、-0.078);(4)路径分析显示,神经质对潜艇官兵心理应激既有直接效应又有间接效应,且以直接效应为主(总效应0.744,直接效应0.640);消极应对和社会支持对心理应激具有直接效应(分别为0.137、-0.117);精神质、内外向和积极应对对心理应激具有间接效应(依次为0.055、-0.035、-0.023).结论 潜艇官兵心理应激水平受个性特征、应对方式及社会支持的影响.     

高原不同岗位官兵心理健康水平调查与分析

目的：调查了解高原不同岗位官兵的心理健康水平。方法：采用症状自评量表（SCL-90）、抑郁问卷（BDI）和艾森克个性问卷（EPQ）对高原不同岗位官兵进行心理健康水平测评。结果：边防连官兵除焦虑和偏执2个因子外,SCL-90其他各因子分值均显著或非常显著低于机务站官兵（P〈0.05,P〈0.01）;敌对、偏执因子分值和总分分值显著高于兵站官兵（P〈0.05）,SCL-90其他各因子分值差异不显著（P〉0.05）。精神质或情绪稳定性（N）分值边防连和机务站官兵显著高于兵站官兵（P〈0.01）;掩饰倾向（L）分值边防连官兵显著高于机务站和兵站官兵（P〈0.01）。结论：机务站官兵心理健康水平低于边防连和兵站官兵,值得关注。     

赴苏丹瓦乌维和官兵人格特征和心理健康状况相关分析

目的分析中国第八批赴苏丹瓦乌地区,运输、医疗两个分队的维和官兵初期心理健康状况及人格特征的相关性,为针对性的心理教育提供依据。方法使用症状自评量表(SCL-90)和艾森克个性问卷(EPQ)对运输分队和医疗分队共160名维和官兵进行集中测试。结果 (1)维和官兵在执行任务初期SCL-90除躯体化因子高于军人常模(P<0.01)外,其他各因子分均低于中国军人常模(P<0.01)。(2)维和官兵心理健康状况与人格特征相关。EPQ内外向维度与SCL-90强迫、抑郁、恐怖、偏执、精神病性因子呈负相关(P<0.05,P<0.01),与人际关系、焦虑、敌对因子呈正相关(P<0.05,P<0.01);神经质维度与SCL-90各因子呈正相关(P<0.05,P<0.01),除躯体化、强迫因子外,精神质维度与SCL-90其余各因子呈正相关(P<0.05,P<0.01);掩饰性维度与抑郁、焦虑因子呈正相关(P<0.05,P<0.01)。(3)运输分队的强迫、抑郁、焦虑及恐怖因子分显著高于医疗分队(P<0.05)。结论赴苏丹瓦乌地区初期,维和官兵心理健康状况良好;维和官兵心理健康状况与自身的人格特征相关;医疗分队相对运输分队心理健康状况要好。     

驻疆某部新兵人格特征与心理健康水平相关性研究

目的:探讨驻疆某部新兵人格特征与心理健康水平的相关性。方法:随机整群抽取驻疆某部新兵200例,采用艾森克个性问卷(EPQ)和症状自评量表(SCL-90)对其人格特征与心理健康水平进行测评,并分析两者的相关性。结果:新兵精神质(P)、神经质(N)因子分值非常显著低于中国军人常模(P<0.01),内、外向(E)因子分值非常显著高于中国军人常模(P<0.01);掩饰性(L)因子分值两者比较,差异不显著(P>0.05)。新兵除抑郁、偏执因子分值显著或非常显著低于中国军人常模外(P<0.05,P<0.01),SCL-90其他各因子分值两者比较,均差异不显著(P>0.05)。Pearson相关分析结果显示,P与E、L呈显著负相关(P<0.05),P与N呈非常显著正相关(P<0.01),E与N呈显著负相关(P<0.05),N与L呈显著负相关(P<0.05);EPQ各因子与SCL-90各因子间均呈非常显著正相关(P<0.01)。结论:新兵人格特征与心理健康水平显著相关,人格特征可影响新兵的心理健康水平。     

CT Arthrography and Virtual Arthroscopy in the Diagnosis of the Anterior Cruciate Ligament and Meniscal Abnormalities of the Knee Joint

Objective

To determine the diagnostic accuracy of CT arthrography and virtual arthroscopy in the diagnosis of anterior cruciate ligament and meniscus pathology.

Materials and Methods

Thirty-eight consecutive patients who underwent CT arthrography and arthroscopy of the knee were included in this study. The ages of the patients ranged from 19 to 52 years and all of the patients were male. Sagittal, coronal, transverse and oblique coronal multiplanar reconstruction images were reformatted from CT arthrography. Virtual arthroscopy was performed from 6 standard views using a volume rendering technique. Three radiologists analyzed the MPR images and two orthopedic surgeons analyzed the virtual arthroscopic images.

Results

The sensitivity and specificity of CT arthrography for the diagnosis of anterior cruciate ligament abnormalities were 87.5%-100% and 93.3-96.7%, respectively, and those for meniscus abnormalities were 91.7%-100% and 98.1%, respectively. The sensitivity and specificity of virtual arthroscopy for the diagnosis of anterior cruciate ligament abnormalities were 87.5% and 83.3-90%, respectively, and those for meniscus abnormalities were 83.3%-87.5% and 96.1-98.1%, respectively.

Conclusion

CT arthrography and virtual arthroscopy showed good diagnostic accuracy for anterior cruciate ligament and meniscal abnormalities.     

Percutaneous needle biopsy of the spine

The purpose of this review article is to provide a brief overview of the recent literature on the two main types of percutaneous biopsy methods done in the spinal column: fine needle aspiration biopsy (FNAB) and core needle biopsy (CNB). FNAB is the process of obtaining a sample of cells and bits of tissue for examination by applying suction through a fine needle attached to a syringe. Core needle biopsy involves extracting a cylindrical sample of tissue using a large, hollow needle. The decision for needle biopsy is a joint effort between the clinician, pathologist, radiologist, surgeon, and patient. Specific techniques and approaches with varying needle systems are described for each spinal region. Percutaneous image-guided spine biopsy is a safe and effective procedure. It is the procedure of choice in definitive diagnosis of pathologic lesions of the spine.     

Effect of joint position and ligament tension on the MR signal intensity of the cruciate ligaments of the knee

Six cadaveric lower extremities were imaged with T1-weighted spin-echo pulse sequences with the knees extended and flexed to 90°. Magnetic resonance signal intensities of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) were compared. Changing from extension to flexion resulted in decreased signal intensity in six of six ACLs and five of six PCLs. Two of the knees were then imaged with and without tension applied to the ACL. Both specimens showed a decrease in signal intensity with tension, followed by an increase in signal intensity with release of the tension. Finally, in three of the limbs the ACL was surgically reconstructed and then imaged with and without tension applied to the tension graft. Signal intensity decreased with tension and increased with release of the tension in all three specimens. Thus, joint position and changes in ligament tension affect the signal intensity of the ACL and PCL, generally resulting in a signal intensity decrease with tension.     

Three-dimensional MR visualization of the intracisternal course of the cranial nerves V-VIII by virtual cisternoscopy

Purpose:
A post-processing protocol for 3D visualization of the cranial nerves V-VIII along their intracisternal course is presented. Material and Methods:
Six healthy volunteers underwent MR imaging (1.5 T) to obtain high-resolution heavily T2-weighted data sets (3DFT CISS) with isotropic voxels (0.5 mm³). The data sets were post-processed by using volume rendering software in order to visualize the intracisternal courses of the cranial nerves V-VIII as well as their root entry zones. The data acquisition and post-processing protocol was then applied in 14 patients with a suspected neural compression syndrome according to the clinical findings as well as cross-sectional images and evaluated with respect to image quality and diagnostic value by two neuroradiologists, using a five-point scale. Results:
Virtual cisternoscopy allowed a comprehensive intracisternal 3D visualization of the affected cranial nerves in 12/14 patients. The mean post-processing time amounted to 13.1/5.6/13.7 min for the cranial nerves V/VI/VII and VIII. The mean score for image quality was 4.2, that for diagnostic value 4.1. 2D and/or 3D reference images were indispensable for appreciating the spatial information provided by virtual cisternoscopy. Conclusion:
The data acquisition and post-processing protocol presented here allows comprehensive and standardized intracisternal 3D visualization of the cranial nerves V-VIII in a routine setting as a complementary imaging procedure.     

Localized proton MR spectroscopy of the brain in children

Small-voxel (3.0–8.0 cm³), magnetic resonance (MR) imaging–guided proton MR spectroscopy was performed in 54 patients (aged 6 days to 19 years) with intracranial masses (n = 16), neurodegenerative disorders (n = 34), and other neurologic diseases (n = 4) and in 23 age-matched control subjects without brain disease. A combined short TE (18 msec) stimulatedecho acquisition mode (STEAM) and long TE (135 and/or 270 msec) spin-echo point-resolved spatially localized spectroscopy (PRESS) protocol, using designed radio-frequency pulses, was performed at 1.5 T. STEAM spectra revealed short T2 and/or strongly coupled metabolites; prominent resonances were obtained from N-acetyl aspartate (NAA), choline-containing compounds (Cho), and total creatine (tCr). Lactate was well resolved with the long TE PRESS sequence. Intracranial tumors were readily differentiated from cerebrospinal fluid (CSF) collections. All tumors showed low NAA, high Cho, and reduced tCr levels. Neurodegenerative disorders showed low or absent NAA levels and enhanced mobile lipid, glutamate and glutamine, and inositol levels, consistent with neuronal loss, gliosis, demyelination, and amino acid neuro-toxicity. Preliminary experience indicates that proton MR spectroscopy can contribute in the evaluation of central nervous system abnormalities of infants and children.     

MR imaging of disorders of the brachial plexus

The authors evaluated 64 consecutive patients with suspected brachial plexus (BP) abnormalities of diverse cause with magnetic resonance (MR) imaging, using the body coil and a standardized protocol. Of the 43 patients for whom follow-up was available, 25 were suspected of having neoplastic involvement of the BP, nine had sustained injuries, and nine presented with BP symptoms of uncertain cause. MR imaging was 63% sensitive, 100% specific, and 77% accurate in demonstrating the abnormality in this diverse patient population. When patients with neoplastic and traumatic disorders were considered separately, sensitivity increased to 81%, accuracy to 88%, and specificity remained unchanged. In the patients with a clinical diagnosis of idiopathic or viral plexitis, the MR imaging findings were normal, serving to exclude other structural abnormalities. It is concluded that MR imaging is valuable in the assessment of a wide range of BP disorders.     

Evaluation of the cervical spine in the obtunded patient

Assessment of cervical spine stability in the posttraumatic obtunded patient can be difficult to accomplish with currently available imaging modalities. Dynamic fluoroscopy during passive flexion and extension has been proposed by some authors as a method for the evaluation of cervical spine stability. We present our experience with dynamic fluoroscopy, the general opinions of multiple trauma centers, and alternative methods for evaluating cervical spine stability in the obtunded patient. The potential risks and problems associated with each method are discussed.     

Interventional procedures in the upper urinary tract

The introduction and acceptance of percutaneous nephrostomy as a safe and effective alternative to surgical nephrostomy served as the impetus for the development and expansion of an ever-increasing number of techniques that are encompassed by the term “interventional uroradiology.” This article reviews many of the non-vascular interventional techniques that have proliferated during the past decade and that are currently used in the kidney, ureter, and perinephric space. The authors emphasize those procedures that are most frequently employed, as well as their own preferences and perspectives on these procedures.     

Immediate postgadolinium spoiled gradient-echo MRI for evaluating the abdominal aorta in the setting of abdominal MR examination

To assess the reproducibility and image quality of immediate postgadolinium chelate spoiled gradient-echo MRI in demonstrating disease of the abdominal aorta. All patients (27 patients: 21 men, 6 women) with substantial disease of the abdominal aorta, who underwent abdominal MR examinations at 1.5 T between 1991 and 1995, were entered in the study. Patients were referred for evaluation of suspected aortic disease (14 patients) or other abdominal diseases (13 patients). Three experienced investigators manually measured luminal and external aortic wall diameters and rated image quality, definition of inner and outer walls, extent of disease, and presence of other abdominal abnormalities, in an independent fashion. A cardiovascular surgeon then rated all studies to determine whether clinical management could be based on the MR findings alone. There was 98 to 99% agreement in measurements of luminal and external wall diameter between the three investigators. Overall image quality was rated as good in 77.8 to 88.9% of patients. A total of 31 additional nonaortic abdominal abnormalities were detected by all observers. The cardiovascular surgeon rated 25 of 27 studies as adequate to determine clinical management based on MR findings alone. Immediate postgadolinium spoiled gradient-echo MRI is a reproducible technique for the demonstration of abdominal aortic disease and possesses good image quality. Advantages of this technique include simultaneous evaluation of other nonvascular diseases of the abdomen, short examination time, and easy implementation as part of routine abdominal MRI scanning protocol.     

Trauma of the chest

Trauma to the chest may cause a wide range of injuries including fractures of the thoracic skeleton, contusion or laceration of pulmonary parenchyma, damage to the tracheobronchial tree, diaphragmatic rupture or cardiac contusion. Conditions affecting primarily extrathoracic sites may have indirect effects on the lungs causing adult respiratory distress syndrome or fat embolism. Laceration of the aorta is the typical and likewise most life threatening complication of massive blunt chest trauma necessitating immediate diagnosis and repair.Conventional radiography rather than cross-sectional imaging is the mainstay in diagnosing thoracic trauma. During the critical phase with often concomitant shock, pelvic and spinal injuries tailored radiographic views or even upright chest radiographs are impractical. The severely traumatized patient is usually radiographed in the supine position and suboptimal roentgenograms may have to be accepted for several reasons. It is well documented that many abnormalities detected on CT were not apparent on conventional radiographs, but CT is reserved for hemodynamical stable patients. Nevertheless certain situations like aortic rupture require further evaluation by CT and aortography.The value of conventional radiography, CT, MRI and aortography in chest trauma is reviewed and typical radiographic findings are presented.