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。     

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.     

Ultrasonic characterization of aging in skin tissue

The propagation velocity (c) and attenuation coefficient () of ultrasound were measured at room temperature in skin tissues excised from twenty aged (27 months) and eight young (2 months) Bar Harbor strain female mice. Frequencies used were 2.25, 5.0, 7.5 and 10.0 MHz. Both velocity and attenuation data were obtained using a pulse-echo technique. Transit times were measured with a universal counter timer to 10 nsec resolution, and corrected for the “dead time” due to the transducer matching layer.

Aged skin had significantly lower values of c and at all frequencies than did the corresponding young tissues.

This preliminary study suggests that the tissue changes which collectively constitute aging may, in some instances, be predictably associated with measurable changes in the acoustic properties of those tissues.     

Pediatric carbon monoxide toxicity

We report a series of 28 pediatric carbon monoxide exposures. Sixteen patients (57%) were judged to have potentially toxic carboxyhemeglobin (COHb) levels (greater than 15%). In this group the range of COHb blood levels was 16.7% to 44.0% (mean = 26.5%). An unusually high incidence of syncope (56.3%, 9/16) and lethargy (68.7%, 11/16) was observed. Every patient with a COHb level ≥ 24% experienced syncope; a marked departure from published adult values. lethargy was reported at a mean COHb concentration of 25.9%. All patients with levels over 25016 COHb, neurologic findings, acidosis, or syncope were considered candidates for hyperbaric oxygen therapy (HB0T). No morbidity from HBOT was encountered. Eighty-nine percent (25/28) of the patients are reportedly doing well, with no late sequelae identified. Delayed neurologic sequelae in three patients include chronic headaches, memory difficulties, or decline in school performance.     

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.     

Comparison of the mechanical performance of three types of external fixators: linear, circular and hybrid

Different configurations of the Monticelli-Spinelli and Ilizarov external fixation systems were tested to define their mechanical properties. In five configurations the external fixator consisted of rings with tensioned wires (circular), while in one configuration two pairs of the tensioned wires and their correspondent ring were replaced by threaded pins (hybrid). Testing was performed in axial compression, bending and torsion. The results were compared to the characteristics of a selected linear fixator group. Both the circular and the hybrid configurations were non-linear in compression. In bending, circular fixators had a similar pattern in both anteroposterior and oblique loading directions. The bending load-displacement pattern for the hybrid fixators was similar to the linear fixators, higher stiffness in the plane of the pins. Torsion was linear for both circular and hybrid fixators, as for the linear fixators. By combination of wires and pins (hybrid configuration), the mechanical behaviour had characteristics from both linear and circular fixators. It is concluded that the three studied groups own different mechanical performance and can be considered as different types of fixators. While it has been demonstrated that osteogenesis can be achieved independently of the mechanical behaviour of the fixator, this study supports the suggestion that some complications can be related to the mechanical behaviour of the fixator.     

N0tchl、N0tch2表达与移行细胞肿瘤恶变及发展关系的研究

目的研究Notch通路相关基因蛋白Notchl、Notch2在移行细胞肿瘤恶变中的作用。方法利用免疫组化SP法对比检测Notchl、Notch2在移行上皮乳头状瘤、具有恶性潜能的乳头状瘤、低级别尿路上皮癌、高级别尿路上皮癌各30例中的表达,并与其临床病理参数进行对比研究。结果各个级别肿瘤中均存在Notchl、Notch2的表达;Notchl在移行上皮乳头状瘤、具有恶性潜能的乳头状瘤、低级别尿路上皮癌、高级别尿路上皮癌中的阳性表达率呈现下降趋势,其阳性表达率随病变级别升高而明显降低;其表达水平与病变程度间存在明显负相关（r=-0．6791,P=0．0021）。Notch2在移行上皮乳头状瘤、具有恶性潜能的乳头状瘤、低级别尿路上皮癌、高级别尿路上皮癌中的阳性表达率呈现上升趋势,其阳性表达率随病变级别升高而明显增加;其表达水平与病变程度间存在明显正相关（r=0．6612,P=0．0001）。Notchl在尿路上皮癌中表达水平与组织学类型、浸润深度、淋巴结转移密切负相关（P〈O．05）,与肿瘤体积、TNM分期无关（P〉O．05）;Notch2表达水平与肿瘤体积、组织学类型密切相关（P〈O．05）,与淋巴结转移、TNM分期、浸润深度无关（P〉O．05）。Notchl和Notch2在移行细胞肿瘤不同病变中的表达水平的相关性分析显示：两者表达存在明显负相关（r=-0．6608,P〈0．05）。结论Notchl、Notch2介导的上皮间质转换参与移行细胞肿瘤恶变,同时两者在移行上皮癌变中发挥协同作用,与肿瘤发展密切相关。     

Lymphoproliferative response to synthetic V3 loop P18 peptide and HIV-1 envelope glycoprotein among individuals immunized with gp160 candidate vaccines

Because T-cell responses are critical for defense against viral infections, the synthetic P18 peptide (RIQRGPGRAFVTIGK) and active component of gp160 protein has previously been shown to induce cytotoxic and helper T-lymphocyte responses. In order to further define the T-helper cells, responses which are known to play a role in enhancing the immunological response to foreign antigen, we studied the response of individuals immunized with HIV gp160 candidate vaccines. We investigated the proliferative cellular response of peripheral blood mononuclear cells (PBMC) derived from individuals immunized with gp160 antigens in three different protocols. We found a PBMC proliferative response to synthetic P18 peptide in healthy immunized individuals induced by gp160 antigen with or without vaccinia virus. There was correlation between the proliferative response to P18 peptide and other antigens such as HIV-like proteins and gp160 molecule. HLA-DR typing revealed the possible presentation of P18 peptide by several different class II molecules. Since these class II molecules occur frequently in the general population, P18 peptide appears to contain broadly reactive epitopes and thus is presented by mutiple HLA class II molecules. Due to its broad reactivity P18 peptide is one of the candidates for inclusion as a subunit vaccine against HIV-1.     

一种基于肝分段和肝癌轮廓融合的放疗靶区数据库建立方法

提出一种基于肝分段和肝癌轮廓融合的放疗靶区数据库建立和全过程数据质量管理方法,为后续人工智能靶区勾画或评估当前手工勾画提供数据支持。从肝癌数据库中取出原始图像,分别对其做带有肝脏放疗靶区勾画和分区分段轮廓标注工作,并通过图像融合技术使肝癌的放射治疗精确到肝段,最后使用深度学习的方法训练Unet网络以得到精准肝分割的神经网络模型,以实现针对肝癌的精准放疗。