愈髋丸结合带旋髂深血管蒂髂骨瓣植骨治疗中青年股骨颈骨折的临床研究

目的观察愈髋丸结合带旋髂深血管蒂髂骨瓣植骨治疗中青年股骨颈骨折的临床疗效。方法选择150例急性外伤性股骨颈骨折患者,按随机数字表法分为A组、B组、C组,三组在开放整复内固定加带旋髂深血管蒂髂骨瓣植骨的基础上,分别口服中药愈髋丸、愈髋饮和愈伤灵,并于治疗后1周、2周、4周、6周、8周、12周量化评定患者疼痛、肿胀、瘀斑、纵向叩击痛、功能活动等5个主、次症候,对比分析两组间及组内治疗前后症候计分总值;三组在治疗后2、4、8、12、20周分别摄取患髋X线片,观察骨折愈合情况。结果 A、B组各时相点症候总体计分改善程度优于C组;A、B组较C组能明显缩短骨折愈合时间;A组与B组比较疗效无差异。结论愈髋丸结合带旋髂深血管蒂髂骨瓣植骨治疗中青年股骨颈骨折疗效肯定。     

三分支主动脉弓覆膜支架植入治疗Stanford A型主动脉夹层的研究

目的：总结三分支主动脉弓覆膜支架治疗Stanford A型主动脉夹层的临床经验。方法：2009年3月至2011年4月,13例Stanford A型主动脉夹层患者在体外循环下先进近心端操作,降温至20℃,停循环,选择性脑灌注,经无名动脉近端升主动脉横断切口,采用三分支主动脉弓覆膜支架重建主动脉弓,主干支架血管近端与替换近端升主动脉的人造血管端端吻合,主动脉根部用自体心包片与右房建立分流,出院复查心脏彩超和主动脉电子束CT。结果：所有患者术中均顺利植入三分支主动脉弓覆膜支架,体外循环时间（221.33±37.98）min,心肌阻断时间（124.77±50.00）min,停循环时间（28.38±8.12）min,选择性脑灌注时间（19.30±9.57）min。术后早期死亡1例,死因分别为不完全肠梗阻以及急性缺血性脑病,最终引起多器官功能衰竭。出院时复查主动脉电子束CT提示：主干支架血管及分支血管通畅,无扭曲,主动脉弓和胸降主动脉假腔部分血栓形成。结论：采用三分支主动脉弓覆膜支架治疗Stanford A型主动脉夹层可简化主动脉弓部手术,降低手术风险,适合于人多数Stanford A型主动脉夹层患者的治疗,长期效果尚需进一步观察。     

脑深部电刺激双侧伏核对吗啡成瘾大鼠复吸行为的影响

目的 研究脑深部电刺激双侧伏核核心部对吗啡成瘾大鼠复吸行为的影响.方法 手术前筛选大鼠,筛选后大鼠随机分为空白组、空白电刺激组、吗啡组、吗啡假手术组、吗啡电刺激组.电极植入7d后采用隔日递增原则皮下注射吗啡(5mg/kg起始,每次递增5mg/kg,至20mg/kg稳定)建立大鼠吗啡成瘾模型.通过改进后的DBS电路进行电刺激,刺激参数为130Hz、150A、60s、1 h/d、14d.干预前后变化由条件位置偏爱实验检测.复吸行为采用小剂量吗啡(3 mg/kg)诱导,24h后再次检测CPP.数据统计采用two-way ANOVA,组间比较用Bonferroni方法.结果 ①完成CPP训练后,吗啡组、吗啡假手术组、吗啡电刺激组三个组的CPP评分为(155.87±20.45)s、(107.33 ± 18.10)s、(135.45±22.09)s,与前两组均有明显差异[与空白组(-70.34±15.40)s比较t值和P值分别为:t=9.45,P＜0.01;t=6.94,P＜0.01;t=8.04,P＜0.01].②7天DBS后,吗啡电刺激组大鼠CPP评分与吗啡组(t=4.21,P＜0.01)、吗啡假手术组(t=1.10,P＜0.05)差异明显.14d DBS后差异更加明显(t=5.15,P＜0.01;t=3.92,P＜0.01).③给予小剂量吗啡诱导复吸后,吗啡电刺激组CPP评分小于吗啡组(t=4.04,P＜0.01)和吗啡假手术组(t=4.13,P＜0.01)组,且与空白组(-53.50 ± 11.10)s(t=2.60,P＞0.05)差异无显著性,但与空白电刺激组(t=3.70,P＜0.01)仍差异有显著性.结论 DBS双侧伏核核心部不仅可以干预吗啡成瘾大鼠的CPP行为,而且能抑制小剂量吗啡诱导的复吸行为.

Abstract：

Objective To investigate the influence on the behavior of withdrawal and relapse after deep brain stimulation of bilateral nucleus accumbens in morphine-dependent rats. Methods The rats with a strong unconditioned preference were discarded in preconditioning test, the selected rats were distributed into five groups randomly. After operation,morphine hydrochloride was injected subcutaneously into SD rats for 12 days (once every day,initial 5 mg/kg,increasing by 5 mg/kg per time,stable in 20 mg/kg ). A modified electrical circuit was used to procedure the DBS,the parameter was 130 Hz,150 A,60 s,l h/d,14 d. CPP test was used to exam the effect of DBS. A minor morphine dose (3 mg/kg) was injected to induce the behavior of relapse, and CPP was tested again after 24 h. Two-way ANOVA was performed on the data with Bonferroni posttest. Result ①After CPP training,CPP score of group morphine, morphine + sham and morphine + DBS was ( 155. 87 ± 20. 45 ) s, (107.33 ± 18.10)s,(135.45 ±22.09)s,and had significant difference with group of control( ( -70.34 ± 15.40) s)(t = 9.45,P＜0.01; t = 6.94,P＜0.01;t = 8.04,P＜0.01).②After 7 days' DBS,the CPP score in group of morphine + DBS reduced significantly compared to group of morphine( t = 4.21, P＜0.01) and morphine + sham( t=1.10, P＜0.05).0n the 14th day,there was more pronounced reduction ( t = 5. 15, P＜0.01; t = 3.92, P＜ 0.01). ③ 24 hours after the minor morphine dose was injected,the CPP score in morphine + DBS didn't increase significantly, and had significant difference with group of morphine ( t = 4.04, P＜0.01) and morphine + sham ( t= 4. 13, P＜0.01). Conclusion DBS bilateral nucleus accumbens in morphine-dependent rats can interfere the behavior of morphine-induced CPP and relapse.     

Assessment of a novel deep learning-based marker-less motion capture system for gait study

BackgroundMarker-less systems based on digital video cameras and deep learning for gait analysis could have a deep impact in clinical routine. A recently developed system has shown promising results in terms of joint center position but has not been yet evaluated in terms of gait outcomes.Research questionHow does this novel marker-less system compare to a marker-based reference system in terms of clinically relevant gait parameters?MethodsThe deep learning method behind the developed marker-less system was trained on a dedicated dataset consisting of forty-one asymptomatic and pathological subjects each performing ten walking trials. The system could estimate the three-dimensional position of seventeen joint centers or keypoints (e.g., neck, shoulders, hip, knee, and ankles). We evaluated the marker-less system against a marker-based system in terms of differences in joint position (Euclidean distance), detection of gait events (e.g., heel strike and toe-off), spatiotemporal parameters (e.g., step length, time), kinematic parameters (e.g., hip and knee extension-flexion), and inter-trial reliability for kinematic parameters.ResultsThe marker-less system was able to estimate the three-dimensional position of joint centers with a mean difference of 13.1 mm (SD = 10.2 mm). 99% of the estimated gait events were estimated within 10 ms of the corresponding reference values. Estimated spatiotemporal parameters showed zero bias. The mean and standard deviation of the differences of the estimated kinematic parameters varied by parameter (for example, the mean and standard deviation for knee extension flexion angle were −3.0° and 2.7°). Inter-trial reliability of the measured parameters was similar to that of the marker-based references.SignificanceThe developed marker-less system can measure the spatiotemporal parameters within the range of the minimum detectable changes obtained using the marker-based reference system. Moreover, except for hip extension flexion, the system showed promising results in terms of several kinematic parameters.     

A fully automated sex estimation for proximal femur X-ray images through deep learning detection and classification

PurposeTo develop a fully automated deep learning pipeline using digital radiographs to detect the proximal femur region for accurate automated sex estimation.MethodRadiograph predictive features from 2122 Chinese Han clinical pelvic with ages ranging from 18 to 26 years were collected retrospectively to train and test the sex prediction model using deep machine learning’s convolutional neural networks (CNN). Model performance was assessed using a Chinese Han population with 361 samples and a white population with 50 samples. The average accuracy of the sex estimation of the two test datasets was determined.ResultsFor the Chinese Han population test dataset, the sex estimation accuracy was 94.6% (males: 93.9% and females: 94.7%). For the white population samples, the accuracy of sex estimation was 82.9% (males: 80.9% and females: 88.6%). The accuracy of CNN tested in the Chinese population was significantly higher than that tested in the White population (p < 0.001)ConclusionsThe model based on convolutional neural networks has an accuracy similar to that of current state-of-the-art mathematical functions using manually extracted features for the Chinese Han population samples, proving to be a reliable choice for the human sex estimation.     

Use of hyperthermia versus normothermia during intraperitoneal chemoperfusion with oxaliplatin for colorectal peritoneal carcinomatosis: A propensity score matched analysis

BackgroundHyperthermic intraperitoneal chemotherapy (HIPEC) with oxaliplatin (OX) is increasingly used in the treatment of colorectal peritoneal carcinomatosis (PC). However, the additional benefit of hyperthermia remains clinically unproven, while it may aggravate postoperative morbidity. Here, we report the correlation of perfusion temperature with postoperative morbidity during clinical HIPEC with OX.Patients and methodsPatients who underwent hyperthermic (41 °C, HT) or normothermic (37 °C, NT) chemoperfusion with OX for colorectal PC were identified from a prospectively kept database of HIPEC cases and matched for baseline characteristics using propensity score (PS) analysis. The groups were compared to assess the impact of perfusion temperature on morbidity. Morbidity was graded using the Clavien-Dindo (CD) classification and the Comprehensive Complication Index (CCI).ResultsOut of 612 patients, 146 patients met the inclusion criteria and from these patients, 45 HT patients were matched with 45 NT patients. Baseline variables were comparable between the PS matched groups. Overall mortality was 0.7% and major morbidity (CD ≥ 3) occurred in 35,6% of patients. There were no significant differences between the HT and NT cohorts in mortality, major morbidity (RR 1.33, 95% CI 0.71 to 2.49, p = 0.36), anastomotic leakage (13.8% versus 11.1%, p = 1.0), hemorrhagic complications, or systemic toxicity. A trend of increased wound infections was observed in the hyperthermia group (13.3% versus 4.4%, P = 0.27).ConclusionsCompared to NT, the use of HT during HIPEC with OX does not aggravate postoperative mortality or morbidity in a high-volume center.