双线性非局部特征结合中继监督网络用于视网膜血管分割

对眼底图像中的视网膜血管精准分割是检测多种疾病的关键技术,在相关疾病自动筛查系统中发挥着重要的作用。针对现存方法追求分割精度时忽略对算法复杂性的考虑,导致在资源受限的医疗设备上部署困难的问题。本文通过进一步合理减少卷积层的特征通道数量来轻量化分割网络并提出了BNIS-Net。该网络采用多尺度图像作为输入融合到编码过程中,使得不同感受野之间建立良好的联系,并提出一种双线性非局部模块来增强相关上下文信息的捕捉能力。最后,在解码过程中采用中继监督的策略,为解码部分各级输出提供监督来约束网络的学习,这样可以有效改善收敛行为使浅层部分得到充分训练。BNIS-Net以0.41 M的参数量在DRIVE、STARE和CHASE_DB1 3个公开数据集上分别取得了81.02%、81.07%、78.15%的DSC值和0.983 3、0.986 1、0.985 9的AUC值。通过大量对比实验和消融研究证明,该方法能够更好地分割血管的边缘细节。     

1例三高病史患者同种异体肝移植手术配合报道

报道1例三高病史患者同种异体肝移植患者的病例资料,归纳总结术中配合要点及护理关注点。特殊患者术前全面评估、术中细致配合是保障肝移植手术成功的保障。     

Occultation oculaire et négligence spatiale unilatérale. Intérêt en rééducation

The use of eye-patches allows to modulate the visual information treating process. Twelve subjects with a left unilateral spatial neglect, randomly divided into three groups — non treated, treated by right eye complete patching, treated by right hemifield patching — were assessed at 1 month and 3 months after acute episode, by means of functional and neuropsychological tests. Results in the subjects treated by complete eye-patch [5]show an improvement of all the assessment parameters whatever the unilateral spatial neglect seriousness degree may be. The progression is less convincing in the patients treated by eye-patch in right hemifield. The effects of the different modalities of occultation interpreted on the basis of anatomo-physiological and psychophysiological patterns of attention, suggest the role of ocular occultation in the initial, voluntary and directed, coven attention recovery and secondary of the automatic and divided overt attention.     

Cervical zygapophyseal joints: geometrical parameters and relationship to cervical kinematics

The relationship was examined between the height and slope of the cervical zygapophyseal joints and the patterns of motion of the cervical vertebrae. The height and orientation of the C₃---C₇ superior articular processes were measured in lateral radiographs of 40 normal subjects. The C₄-C₆ facets were oriented at approximately 40° to the vertical, while the C₃ and C₇ facets were more steeply oriented. The heights of the superior articular processes were found to increase at progressively lower vertebral levels. Contrary to published views, the slope of the superior articular facets has no bearing on the pattern of motion of the cervical vertebrae. No relationship was found between slope of the facets and the location of the instantaneous axes of rotation of the cervical vertebrae. In contrast the height of the articular processes was perfectly related to the location of the axes of rotation. Articular height, but not slope, is a major determinant of the patterns of motions of the cervical vertebrae.

This study provides data necessary to confirm or deny the putative roles of the cervical zygapophyseal joints in determining motion of the cervical spine in the sagittal plane.     

Relative stiffness, transverse displacement and dynamization in comparable external fixators

Several unilateral external fixators were laboratory tested under applied axial, bending, and torsional loads. In certain cases the shear movement at the fracture site was substantial, up to 4 mm, and in all cases it was as significant as axial displacement. Also, under average full weight bearing, all the fixator/bone screw frameworks will allow too much axial movement at the fracture. This could inhibit healing and cause peak bone and screw stresses to approach yield.     

姜黄素对直肠癌CD133+肿瘤干细胞样细胞群体放疗增敏作用的研究

目的 探讨姜黄素对体外、体内直肠癌CD133+肿瘤干细胞样细胞群放疗敏感性的影响.方法 采用免疫磁珠分选法对直肠癌HRT-18细胞进行干细胞分选后随机分成姜黄素组、放疗组、姜黄素联合放疗组,应用MTT法检测24、48和72 h各组细胞生长抑制情况;采用Annexin V/PI双染流式细胞仪检测各组细胞凋亡情况.将分选的CD133+直肠癌细胞移植于裸鼠右脚垫建立移植瘤模型,将模型鼠分为姜黄素组、放疗组、姜黄素联合放疗组,每组8只,观察瘤体动态生长情况并用原位末端标记技术检测瘤体内细胞凋亡情况.结果 低剂量姜黄素联合放疗对直肠癌CD133+肿瘤干细胞样细胞群(24 h生长抑制率:18.7％±1.7％)较放疗组(14.6％±1.0％)具有明显的生长抑制作用(P＜0.01);姜黄素联合放疗组细胞凋亡率(28.8％±3.7％)与放疗组(13.1％±1.4％)比较差异有统计学意义(P＜0.01);治疗6d时,姜黄素联合放疗组的瘤体体积为(521 ±79) mm3,与放疗组的(717 ±134) mm3比较差异有统计学意义(P＜0.01);姜黄素联合放疗组瘤体细胞凋亡指数(26.1％±3.3％)较放疗组(12.0％±2.1％)明显增高,两者比较差异有统计学意义(P＜0.01).结论 姜黄素可显著提高CD133+肿瘤干细胞样细胞群的放疗敏感性.     

Is the stability of a tibial fracture influenced by the type of unilateral external fixator?

Objective. To examine whether the type of unilateral external fixator significantly influences the stability of a tibial fracture.

Design. Inter-fragmentary displacements were measured during walking while the fractures were stabilized, first with one type of fixator then with another.

Background. It is commonly claimed that one type of fixator exerts a different influence on mechanical stability at a fracture in comparison with another.

Methods. This study compares inter-fragmentary displacement, fixator displacement and weight bearing during walking, in four patients stabilized with an Orthofix DAF, which was replaced by a Howmedica International Monotube.

Results. The null hypothesis of no difference in fixator performance was unproved (P < 0.05) through insufficient data. Inter-patient variability in inter-fragmentary displacement implies that anthropometry, gait and fracture type may influence fracture stability more than the type of fixator.

Conclusions. Since weight-bearing and displacements were not substantially different, no basis was found for the claim that one fixator provides a mechanical environment substantially different to another. Sample size was not large enough to prove that a small but statistically significant difference exists.     

经口内镜下肌切开术在儿童贲门失弛缓症中的应用

目的探讨经口内镜下肌切开术(POEM)治疗儿童贲门失弛缓症(AC)的临床疗效及并发症发生情况。方法回顾性分析该院2012年11月-2016年11月确诊AC并接受POEM治疗的17例患儿的临床表现、POEM手术过程及术后随访情况。结果 17例患儿均成功完成POEM,无严重并发症发生,手术时间(62.65±35.54)min;17例患儿术后随访12~36个月,手术前后AC临床症状评分(Eckardt评分)分别为5(4.0-6.0)和0(0.0-1.0)分,差异有统计学意义(P=0.000),临床症状明显缓解,体重减轻情况明显改善。结论 POEM治疗儿童AC安全性高,短期疗效确切,长期疗效及远期并发症有待大样本量的随访监测。     

Puncture of veins and arteries assisted by ultrasound

The localisation of arteries or veins is facilitated by the use of an ultrasonic Doppler unit.* When a beam emitted by a detector transducer impinges on a blood vessel, an audible “flow” signal characteristic for an artery or a vein is produced. Since both the localisation of the blood vessel and the direction of puncture can be established with this unit, the method proves to be particularly useful in the search for vessels difficult to locate such as the subclavian vein. In 48 out of 50 cases the ultrasound assisted puncture of the subclavian vein and the placement of a venous catheter were successful. Such dangerous complications as haemorrhages and pneumothorax did not develop. The possibility of ultrasonic blood vessel localisation suggests itself also for the puncture of other veins and arteries provided they are not deeper than 4 cm below the skin.