数字化三维重建技术辅助腹壁浅动脉皮瓣修复口腔颌面部缺损的应用研究

目的探讨数字化三维重建技术在腹壁浅动脉皮瓣修复口腔颌面部缺损中的应用价值。方法选取2018年1月至2019年10月就诊于蚌埠医学院第一附属医院口腔颌面外科拟行腹壁浅动脉皮瓣修复的口腔癌患者12例,其中男性8例,女性4例;年龄(57.4±12.6)岁。其中鳞状细胞癌10例,腺样囊性癌1例,黏液表皮样癌1例。术前均行下腹部CT血管造影,并将数据导入AW4.7软件进行后处理,挑选左侧或右侧优势供区,明确皮瓣血供的起源、管径、走行及穿出点位置,利用数字化三维重建技术指导皮瓣术前设计。结果12例患者中采用腹壁浅动脉皮瓣修复者11例,1例由于未发现腹壁浅动脉,术中转为旋髂浅动脉皮瓣修复。11例采用腹壁浅动脉皮瓣修复的患者,其术前CT血管造影测量的腹壁浅动脉管径[(1.0±0.3)mm]与术中实际测量值[(1.1±0.3)mm]差异均无统计学意义(P>0.05)。1例术后发生静脉血管危象,其余皮瓣均顺利成活。随访6~12个月,平均10个月,供区受区均一期愈合,未出现明显并发症,腹部瘢痕隐蔽。结论在腹壁浅动脉皮瓣修复口腔颌面部缺损重建术中,术前采用数字化三维重建技术可客观反映腹壁浅动脉的管径及走行位置等信息,有效降低皮瓣手术难度和风险。     

全景片对下颌智齿拔除时神经损伤风险的评估

目的:评估全景曲面体层片中哪些影像学标志可用于判断智齿与下牙槽神经的解剖关系,以此预测智齿拔除时神经暴露的风险几率方法:选择5个影像学标志,由一名医生先判定上述5个影像学标志是否存在,再由另一名医生判定在智齿拔除后是否会有下牙槽神经暴露,智齿拔除后经临床检查是否有下牙槽神经暴露确定阳性结果经统计学分析判断哪些影像标志可以用于评估下牙槽神经暴露(P<0.05)。结果:评估210名患者的302颗智齿,智齿拔除后神经暴露19例(6.3%),其中4个影像学标志可用于预测智齿拔除后神经暴露,敏感度和特异度分别为0.57～0.79和0.62～0.91;临床的术前预测神经暴露具有统计学意义,可用于判断结果(P<0.001,敏感度0.79,特异度0.83)。结论:4个影像学标志(智齿牙根根尖1/3密度降低、下牙槽神经管上壁的骨白线中断、下牙槽神经管位置上移或方向改变、牙根变窄),可用于预测智齿拔除后神经暴露;临床的术前预测神经暴露具有统计学意义,可用于判断结果。     

Centromere-localized breaks indicate the generation of DNA damage by the mitotic spindle

Most carcinomas present some form of chromosome instability in combination with spindle defects. Numerical instability is likely caused by spindle aberrations, but the origin of breaks and translocations remains elusive. To determine whether one mechanism can bring about both types of instability, we studied the relationship between DNA damage and spindle defects. Although lacking apparent repair defects, primary Dido mutant cells formed micronuclei containing damaged DNA. The presence of centromeres showed that micronuclei were caused by spindle defects, and cell cycle markers showed that DNA damage was generated during mitosis. Although the micronuclei themselves persisted, the DNA damage within was repaired during S and G2 phases. DNA breaks in Dido mutant cells regularly colocalized with centromeres, which were occasionally distorted. Comparable defects were found in APC mutant cell lines, an independent system for spindle defects. On the basis of these results, we propose a model for break formation in which spindle defects lead to centromere shearing.     

Lesions of the Mitral Valve as a Cause of Central Retinal Artery Occlusion: Presentation and Discussion of Two Cases

We present two cases of mitral valve lesions that manifested with unilateral blindness caused by central retinal artery occlusion (CRAO): Case 1. A 68-year-old woman was admitted to our clinic for sudden blindness. Retinal artery angiogram showed CRAO. Transthoracic and transesophageal echocardiography (TEE) documented a mass attached to the ventricular side of the posterior mitral leaflet, which at pathology was identified as a blood cyst. Case 2. A 67-year-old man was admitted for a sudden unilateral painless loss of vision. Retinal angiogram documented CRAO, and TEE showed a highly mobile, spherical, lesion on the atrial side of anterior mitral leaflet. In this case, the pathological finding was a degenerated calcified thrombosis. We report on two cases of very rare abnormalities of the mitral valve presenting with a very rare embolic complication, i.e., CRAO. Like for cryptogenic stroke, transesophageal echocardiography plays a central role in the diagnosis of cardiogenic embolic sources. (Echocardiography 2010;27:E1-E3)     

Distinct patterns of neuronal inputs and outputs of the juxtaparaventricular and suprafornical regions of the lateral hypothalamic area in the male rat

We have analyzed at high resolution the neuroanatomical connections of the juxtaparaventricular region of the lateral hypothalamic area (LHAjp); as a control and in comparison to this, we also performed a preliminary analysis of a nearby LHA region that is dorsal to the fornix, namely the LHA suprafornical region (LHAs). The connections of these LHA regions were revealed with a coinjection tract-tracing technique involving a retrograde (cholera toxin B subunit) and anterograde (Phaseolus vulgaris leucoagglutinin) tracer. The LHAjp and LHAs together connect with almost every major division of the cerebrum and cerebrospinal trunk, but their connection profiles are markedly different and distinct. In simple terms, the connections of the LHAjp indicate a possible primary role in the modulation of defensive behavior; for the LHAs, a role in the modulation of ingestive behavior is suggested. However, the relation of the LHAjp and LHAs to potential modulation of these behaviors, as indicated by their neuroanatomical connections, appears to be highly integrative as it includes each of the major functional divisions of the nervous system that together determine behavior, i.e., cognitive, state, sensory, and motor. Furthermore, although a primary role is indicated for each region with respect to a particular mode of behavior, intermode modulation of behavior is also indicated. In summary, the extrinsic connections of the LHAjp and LHAs (so far as we have described them) suggest that these regions have a profoundly integrative role in which they may participate in the orchestrated modulation of elaborate behavioral repertoires.     

臀部穿支皮瓣在褥疮修复中的应用

目的：探讨臀上或臀下穿支皮瓣修复臀部褥疮的方法及效果。方法：采用臀上或臀下穿支皮瓣修复臀部褥疮共9例。皮瓣面积为6cm×10cm～8cm×20cm,覆盖受区溃疡大小为4cm×7cm～7cm×18cm。结果：术后皮瓣全部成活,随访3个月～1年半,皮瓣质地良好,外形不臃肿,供区愈合良好。结论：臀上或臀下穿支皮瓣血运可靠,设计灵活,手术切取简便安全,保留臀大肌,供区无须植皮,是修复臀部褥疮创面的理想方法。     

杞菊地黄汤改善实验性大鼠视网膜变性的作用观察

目的:观察杞菊地黄汤对实验性视网膜变性大鼠的治疗作用。方法:将生后45 d的SD大鼠分为正常组、模型组和杞菊地黄汤组。中药组大鼠ig杞菊地黄汤8.3 g.kg-1(15 mL.kg-1),模型组ig等体积生理盐水。两组动物均于生后47 d开始ig,每天1次,直至动物处死。生后50 d以N-甲基-N-亚硝脲(N-methyl-N-nitrosourea,MNU)ip造成视网膜变性模型,预定时间行闪光视网膜电图(flash electroretinograms,FERG)检测,造模后2,5 d时分批处死动物,取右眼行病理切片,分别以TUNEL法检测视网膜外核层细胞的凋亡、HE染色检测视网膜外核层的厚度。结果:ig杞菊地黄汤8.3 g.kg-1组大鼠FERG消失时间较模型对照组明显延迟;造模后2 d,其外核层细胞凋亡指数(50.8±7.3)%低于同期模型组大鼠(81.1±9.7)%(P<0.01);造模后5 d,其视网膜外核层厚度(71±27)μm大于同期模型组大鼠(22±10)μm(P<0.01)。结论:杞菊地黄汤对MNU诱导的光感受器细胞凋亡有保护作用。     

阴式子宫次全切除术手术配合的护理体会

目的：总结阴式子宫次全切除术的手术配合经验。方法：回顾性总结50例行阴式子宫次全切除术手术配合护理。结果：50例患者手术中医护配合顺利,无1例改开腹行子宫切除,术后恢复快,出血少,无1例患者因术中出血过量而输血。结论：充分的术前准备,熟悉器官解剖位置及手术步骤,术中密切观察配合,特别是体位的摆放和术中良好的光照是本术式手术配合的重点,也是保证手术顺利进行的关键。