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@#Prenatal ultrasound screening is an important means to exclude fetal structural abnormalities. With the continuous development of technology, more vascular abnormalities can be found more early, which improves the quality of the social population. Traditional Doppler ultrasonic images have a low resolution and poorly display small blood vessels. SlowflowHD is a particularly sensitive power Doppler designed to detect small microvessels with a low flow rate, and can improve the resolution of fine blood vessels. SlowflowHD has been gradually applied to prenatal screening because of its unique characteristics such as high display frame rate, high line density (high resolution), and good sensitivity. This article aims to explore the clinical application progress of SlowflowHD in prenatal screening.
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Objective@#To explore the effect of dialectical behavior therapy (DBT) on cognitive emotion regulation in adolescents with non suicidal self injury (NSSI), so as to provide reference for improving the cognitive and emotional well being of NSSI adolescents.@*Methods@#A total of 166 adolescents with non suicidal self injury who were hospitalized in the Department of Child and Adolescent Psychiatry of the Second Affiliated Hospital of Xinxiang Medical University from March 2021 to March 2023, were selected by the convenient sampling method. According to the random number table method, participants were divided into the experimental group and the control group, with 83 cases in each group. The control group was given routine nursing, while the experimental group was given dialectical behavior therapy on the basis of routine nursing. The 8 week intervention was conducted once a week, with 45- 60 minutes each time. The control group and the experimental group were evaluated with Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) and Cognitive Emotion Regulation Questionnaire (CERQ) before and after the intervention. Statistical analysis was conducted using t test and χ 2 test.@*Results@#Before the intervention, there was no significant difference in the scores of each scale include HAMA, HAMD and CERQ between the experimental group and control group ( P >0.05). The scores of HAMD (13.58±3.24, 33.02±7.59), HAMA (12.41±2.51, 24.25±7.14), adaptive adjustment strategy score (69.20± 11.97 , 60.51±7.29) and nonadaptive adjustment strategy scores (37.43±7.87, 47.87±5.20) of CERQ, significantly changed after 8 weeks of intervention ( t=-21.46, -14.25, 5.57, -10.08, P <0.01).@*Conclusions@#Dialectical behavior therapy can improve the anxiety, depression and cognitive emotion regulation of adolescents with NSST. Active intervention should be taken to regulate the emotions of adolescent with NSSI and reduce the occurrence of NSSI.
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Objective:To provide a theoretical basis for the clinical application of the posterior route through atlas occipital articular slope screw internal fixation system through the biomechanical study.Methods:Eight cadavers of healthy adults aged 35-60 years and 155-180 cm in height were selected. The specimens with complete anatomical structure and without surgical operation were established as normal models. The model of occipito-atlantoaxial complex was established by breaking the articular capsule, ligament and other connecting structures and cutting the dentate process. The device was established as an internal fixation model through the specimen of atlantooccipital joint slope screw internal fixation system. Given normal model and internal fixation of 1.5 N·m in the moment of flexion, lateral bending and axial rotation and to measure the specimen C 0-C 1 and C 0-C 2 segment of the range (range of motion, ROM), comparative analysis of pillow neck area within the normal model and fixed model changes the range of movement, after the evaluation through the slope between atlas and the occipital screw internal fixation system of mechanical properties. Results:In the normal model, the flexion, flexion and extension, lateral bend and axial rotation ranges of C 0-C 1 segments were 23.85°±2.43°, 4.74°±0.55°, 5.77°±0.75°, respectively; the corresponding activity ranges of C 0-C 2 segments were 30.66°±3.05°, 9.09°±1.37°, 70.97°±9.48°, respectively; in the internal fixation model, the flexion and extension, lateral bend and axial rotation ranges of C 0-C 1 segments were 0.71°±0.24°, 0.24°±0.06°, 0.34°±0.09°, respectively. The corresponding activity range of C 0-C 2 segment was 3.09°±0.82°, 0.74°±0.07°, 1.22°±0.10°, respectively. Compared with the normal model, the range of activity of the internal fixation model in all directions was significantly reduced (<3°), and the reduction ratio of activity was more than 90%. Conclusion:The posterior route through pillow slope screw internal fixation system can effectively reduce the range of motion of the occipital neck in flexion, extension, lateral bending and rotation, and has safe and reliable biomechanical stability.
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Objective:To explore the difference in properties of anterior occipital condyle plate screws compared with common anterior occipitalcervical fusion internal fixation.Methods:A 28-year-old healthy adult male volunteer's CT data of the occiput and neck was selected to establish finite element models：including the normal model，simple artificial vertebral fixation model（special-shaped titanium cage+clival screws），anterior occipital condyle plate and screw fixation model，and clival plate and screw fixation model，then a 50 N gravity and a torque of 1.5 N m were exerted upon the upper surface of the occipital bone to make the model produce flexion and extension，lateral bending and rotation. The motion range，internal fixation stress distribution and occipital bone stress distribution of each model under varying conditions were compared.Results:Under the conditions of flexion，extension，lateral bending and rotation，the range of motion of the normal model was 18.65°，15.35°，9.82° and 34.68°，respectively；that of the simple artificial vertebral fixation model was 3.20°，3.63°，2.94° and 3.92°，respectively；that of the clival plate and screw fixation model was 0.40°，0.50°，0.35° and 0.89°，respectively；that of the anterior occipital condylar plate and screw fixation model was 0.27°，0.33°，0.13° and 0.30°，respectively. Compared with the simple artificial vertebral fixation model，the range of motion of the clival plate and screw fixation model decreased by 87.5%，86.2%，88.1% and 77.3% in flexion，extension，lateral bending and rotation. The range of motion of the anterior occipital condylar plate and screw fixation model decreased by 91.5%，90.1%，95.6% and 92.3%，respectively. Under the conditions of flexion and extension，lateral bending and rotation，the stress peak of the simple artificial vertebral fixation model was 52.3 MPa，51.9 MPa，52.6 MPa，respectively；that of the clival plate and screw fixation was 100.1 MPa，158.1 MPa，170.6 MPa，respectively；that of the anterior occipital condylar plate and screw fixation was 114.2 MPa，62.9 MPa，132.9 MPa，respectively. Under the condition of flexion and extension，lateral bending and rotation，the stress peak of the occipital bone in the simple artificial vertebral body internal fixation model was 52.9 MPa，50.9 MPa and 62.3 MPa，respectively；that of the clival plate and screw fixation model was 19.7 MPa，55.9 MPa and 38.3 MPa，respectively；that of the anterior occipital condylar plate and screw fixation model was 37.8 MPa，15.0 MPa and 16.3 MPa，respectively. The stress in bone near the hypoglossal canal was close to 0 MPa，much smaller than the stress peak in occipital bone.Conclusion:Anterior occipital condylar plate and screw fixation in front of the special-shaped titanium cage can improve the stability of occipitocervical fusion with little effect on the occipital bone and hypoglossal canal or without obvious stress concentration，and hence is a safe and reliable anterior fixation method for upper cervical spine instability.
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Objective:To investigate the anatomical safety and feasibility ofposterior occipitocervical fixation with atlan-tooccipital-clivus screw.Methods:Data of 60 patients who treated in the spinal department of our hospital with upper cervical computed tomographic scans from February 2017 to November 2019 were retrospectively collected. Occipitocervical infection, injury, tumor and deformity were excluded. The Mimics software was used to reconstruct the occiput, atlas and measure the anatomical parameters, including the height and width of the anterior edge of the clivus, the height and width of the middle part of the clivus, the thinnest distance of the soft tissue in front of the clivus, the anteroposterior diameter, transverse diameter, the angle of inside tilting in coronary plane of the occipital condyle, the distance from the hypoglossal canal to the atlantooccipital articular surface, the anteroposterior diameter and transverse diameter of the superior joint of atlas, the height of the lateral mass, and the height and transverse diameter of the inferior articular process of the superior atlas joint. The three-dimensional digital modeling was performed and the screw diameter of 3.5mm was simulated. 3-Matic software were used to measure the screw placement parameters, including the inside tilting angle in coronary plane of screw, and the angle of upper tilting in sagittal plane and length of screw. The atlanto-occipital junction was exposed at the rear of 8 cadavers. According to the above parameters, the titanium alloy screws with a diameter of 3.5 mm were transferred from the inferior articular process and posterior arch of the atlas to the clivus through the atlantooccipital. Finally, the screw path was cut along the nail path with a pendulum saw, and the track of the screw was observed to confirm the safety and effectiveness of the screw.Results:The leading edge height and width of male clivus was 16.8±2.5 mm and 20.1±3.1 mm. The middle part of the clivus was 9.7±2.3 mm and 22.4±3.7 mm. The thinnest soft tissue in front of the clivus was 5.8±1.48 mm. The anteroposterior diameter of the occipital condyle was 19.1±1.9 mm, the transverse diameter was 12.6±2.0 mm, the inside tilting angle was 33.7°±4.5°, and the vertical distance from the lowest point of the neural tube to the articular surface of the occipital condyle was 9.6±1.1 mm. The height of the lateral mass of atlas was 12.9±2.4 mm, the anteroposterior diameter of the upper joint of atlas was 21.7±1.9 mm, and the transverse diameter was 11.7±1.4 mm. The width of the inferior facet was 14.9±1.4 mm and the height of the inferior facet was 5.7±0.85 mm. The distance from the screw entry point to the vertical line of the lateral mass migration midpoint was 2.5±0.6 mm; The distance from the screw entry point to the horizontal line of the midpoint was 2.3±0.7 mm.The inside titling angle of screw was 18.4°±1.6°, the upper tilting angle was 55.6°±3.1°, the length of the screw track was 53.0±2.8 mm, the adjustment range of upper tilting angle was 15.0±2.8 mm, the adjustment range of inside tilting angle was 10.4±2.4 mm. The anatomical parameters of females were slightly smaller than those of males, and the difference was statistically significant, but there was no significant difference between left and right parameters. The screws of 8 specimens could be inserted safely and effectively.Conclusion:Atlan-tooccipital-clivus screw can be implanted without damaging the nerve and vascular structure, and it can be used as a choice for occipitocervical fixation.
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Objective: To explore value of 6-minute walking in rehabilitation therapy of patients with chronic heart failure (CHF). Methods: A total of 78 CHF patients were selected from department of geriatrics of our hospital. They were randomly and equally divided into 6min walking test (6MWT) group (received 6-min walking training based on routine treatment, twice/d) and routine treatment group. After six weeks, 6min walking distance (6MWD), heart rate and left ventricular ejection fraction (LVEF) were compared between two groups before and after treatment. Results: After six weeks, there were significant improvements in related indexes in both groups, P<0.05 all; compared with routine treatment group, there were significant increase in 6MWD [(307.6±39.3) m vs. (503.4±44.4) m] and LVEF [(45.3±17.9) % vs. (58.7±19.2) %], and significant decrease in heart rate of recovery period after 6MWT [(73.3±2.9) times/min vs. (65.7±2.1) times/min] in 6MWT group, P<0.05 all. Conclusion: Six-minute walking can significantly improve symptoms of heart failure and enhance exercise tolerance, and it possesses important value for recovery of heart function in these patients.