近端胃切除人工三角瓣成形抗反流术的力学机理仿真分析

目的:对食管胃结合部腺癌近端胃切除术（PG）人工三角瓣成形后残胃食糜进行流体动力学数值模拟，并计算不同性质胃内食糜的流动特征。方法:构建常规PG和人工三角瓣成形术术后胃仿真模型，运用Fluent软件对不同粘度胃内食糜反流问题进行数值模拟。结果:站立位姿态时，相对常规PG方案，人工三角瓣成形手术方案表现出较好的抗反流作用；卧位姿态时，当胃内食糜粘度大于0.145 2 Pa[?s，且胃内食糜不超过人工三角瓣情况下，人工三角瓣成形抗反流手术表现出较好的抗反流效果；人工三角瓣抗反流成形手术方案数值模拟结果与临床上患者表现一致。结论:本研究仿真分析为人工三角瓣成形抗反流手术方案的有效性机理分析、临床患者术后饮食及手术方案的进一步改进提供理论及数值依据。 【关键词】食管胃结合部腺癌；抗反流；人工三角瓣；计算流体力学     

主动脉出口血压对左心室血流特性的影响

采用Mimics对心脏进行三维重构，用3-matic进行模型优化以及模型误差分析，对左心室室壁运动做速度分布假设，基于UDF宏文件对左心室室壁运动编写程序，将血液视为非牛顿流体，采用动网格技术研究不同血压对左心室血液流动的影响。模拟发现当左心室收缩时，压力梯度明显，内部压力减小。当左心室舒张时，内部压力逐渐增高。二尖瓣口处的速率先增大后减小。血压升高，左心室内剪切应力持续增大，极易破坏红细胞结构，产生溶血现象，导致心脏功能紊乱。     

Anti-Oxidant,Anti-Hemolytic Effects of Crataegus aronia Leaves and Its Anti- Proliferative Effect Enhance Cisplatin Cytotoxicity in A549 Human Lung Cancer Cell Line

Objective: For Arabian traditional medicine, Crataegus aronia syn. Azarolus (L) Bosc. ex DC (Rosaceae) is widely used to treat diabetes, sexual weakness, cardiovascular diseases and cancer. The anti-cancerous and anti-hemolysis effects of the hydroalcoholic extract of this plant have never been investigated before. The present study aims to evaluate the biological activities of the hydroalcoholic extract of Crataegus aronia leaves in combination with cisplatin, one of the most widely employed chemotherapeutics, on A549 human lung cancer cell line. Methods: The anti-oxidant and anti-proliferative activities of leaves, fruits, seeds of C. aronia were investigated by DPPH method and MTT assay; respectively. Cell migration activity was investigated by wound healing and by cell aggregation assays. The effect of C. aronia in inducing cell cycle arrest along with activating cell apoptosis was evaluated by flow cytometry and Western blot assays, respectively. Results: Our results showed that C. aronia leaves (C. aronia L.) had the highest anti-oxidant and anti-proliferative activities. The leaves extract was potent against hemolysis of the human erythrocytes and showed elevated decrease in migration by reducing wound healing migration and by increasing cell aggregation. Finally, C. aronia L. treatment exhibited apoptotic activity on A549 cells by the down-regulation of PARP-1, caspase-3 and Bcl-2 proteins and by increasing the percentage of A549 cells in sub G0 cell cycle. Moreover, the co-treatment of C. aronia L. and cisplatin remarkably sensitised A549 cells to cisplatin. Conclusion: The results suggested that C. aronia L. could be used as a potential treatment against human lung cancer exhibiting minimal side effects on human health.     

Laparoendoscopic Single-site Surgery for Comprehensive Staging of Early Ovarian Cancer

Study ObjectiveTo demonstrate the procedure and suspension skills of laparoendoscopic single-site (LESS) staging surgery with infrarenal para-aortic lymphadenectomy for early-stage ovarian cancer.DesignA presentation of the surgery through this technical video.SettingA hospital.Patient and InterventionsA 45-year-old woman presented with a pelvic mass on gynecologic examination and a serum cancer antigen 125 level of 5910 U/mL (normal = <35 U/mL). A computed tomographic scan revealed a mixture of solid and cystic components (70 × 77 × 71 mm) arising from the right ovary and characterized by the “ovarian vascular pelvic” sign. Clinically early-stage ovarian cancer was suspected. Subsequently, LESS staging surgery was performed by an experienced surgeon in our department.ResultsThe surgery lasted 280 minutes, and the volume of blood loss was 50 mL; there were no intra- or postoperative complications. We “hid” the incision perfectly for cosmetic purposes. The histopathologic findings supported high-grade serous ovarian cancer of the right ovary with the left fallopian tube involved as well. In addition, a total of 34 negative pelvic and 18 negative para-aortic lymph nodes were identified, and a stage of IIA was diagnosed as a result.ConclusionWe performed an LESS staging surgery for early-stage ovarian cancer successfully. Our video shows that the LESS approach provided feasible, cosmetic, and safe access among the selected malignant gynecologic surgery. Therefore, we have experienced that the effective suspension was an auxiliary measure for LESS lymphadenectomy. In addition, compared with multiport laparoscopy, the LESS approach could provide easier access to infrarenal para-aortic regions; furthermore, it was safe and quick to extract an unknown sample.     

保乳术后放疗中钛夹动度与乳腺大小及钛夹位置的相关性

【摘要】目的:分析保乳术后放疗患者钛夹动度，并探讨其与乳腺大小、钛夹位置的相关性。方法:随机选取保乳术后放疗患者15例，每周两次锥形束CT。测量乳腺基底面直径（D）和乳高轴（H），以瘤床质心为原点将临床靶区分4个象限。记录各象限内钛夹在左右、腹背、头脚方向动度（MLR、MAP、MSI）以及其与临床靶区最内、最前、最上的距离（DSLR、DSAP、DSSI）。结果:MLR、MAP、MSI分别为（2.2±3.0）、（-1.1±3.6）、（0.8±4.7） mm；系统误差Σ在左、右、腹、背、头、脚分别为1.7、2.2、2.0、2.4、2.9、3.0 mm，随机误差σ分别为2.4、4.0、3.2、4.0、4.7、4.7 mm；靶区对应外放5.9、8.3、7.2、8.8、10.5、10.9 mm。一象限内，当D×H<99.89 cm2，MAP和D×H强相关（r=0.805），MLR、MAP均和DSLR、DSAP、DSSI强正相关（r=0.94, 0.94, 0.91；0.87, 0.91, 0.92），MSI和DSLR、DSAP强正相关（r=0.91, 0.94）；四象限内，当D×H<90.71 cm2，MAP和DSLR，MSI和DSAP均强负相关（r=-0.96；-0.95），MLR和DSLR强正相关（r=0.91）。结论:钛夹动度有各向异性，以SI方向外扩最大，并易受乳腺大小、钛夹位置影响。     

超声引导下腰方肌阻滞联合丙泊酚麻醉在腹腔镜结直肠癌根治术中的应用

目的:研究超声引导下腰方肌阻滞联合丙泊酚麻醉在腹腔镜结直肠癌根治术中的应用价值。方法:选取90例择期进行腹腔镜结直肠癌根治术患者作为研究对象，随机分为观察组和对照组，各45例。对照组采用传统腰麻联合丙泊酚麻醉，观察组采用超声引导下腰方肌阻滞联合丙泊酚麻醉，比较两组患者术中（麻醉后5、15、30、60 min）收缩压（SBP）、舒张压（DBP）、心率（HR）和术后不同时间段的疼痛评分（VAS评分），以及加用镇痛药情况和肠道恢复排气时间和术后48 h内不良反应发生情况。结果:两组患者SBP、DBP、HR组间、不同时间点及交互差异均有统计学意义（P<0.05），且观察组麻醉后上述指标波动较对照组小（P<0.05）；麻醉前，两组患者皮质醇、肾上腺素水平无显著差异（P>0.05），麻醉后各时间点观察组患者上述指标水平均显著低于对照组（P<0.05）；两组患者VAS评分组间、不同时间点及交互差异均有统计学意义（P<0.05），且观察组术后各时间点VAS评分均显著低于对照组（P<0.05）；观察组不良反应发生率显著低于对照组（8.89% vs 24.44%, P<0.05）；观察组患者加用镇痛药的人数、剂量和肠道恢复排气时间均显著少于对照组（P<0.05）。结论:超声引导下腰方肌阻滞联合丙泊酚麻醉在腹腔镜结直肠癌手术中具有良好、稳定的麻醉效果，可有效缓解患者疼痛，减少术后不良反应发生。     

重复经颅磁刺激在孤独症谱系障碍中的应用进展

孤独症谱系障碍是一种患病率日益增长的神经发育综合征，可出现多种行为障碍。近年来，重复经颅磁刺激在孤独症谱系障碍治疗中取得了一些研究成果，但关于刺激参数选择、安全性及可行性评估方面仍存在一定争议。本文就其关于诱导长时程增强/抑制、调节皮质抑制的治疗机制、低频和高频经颅磁刺激的临床应用及目前涉及的安全性、道德伦理问题等局限性进行综述，从而为今后的研究与临床应用提供一定的参考依据。     

基于交叉对比神经网络的心音分类

目的:通过交叉对比神经网络（CCNN）实现心音信号的自动分类，从而对心血管疾病进行早期诊断。方法:实验基于PhysioNet/Cinc 2016心音数据库。训练集和测试集数据来自互斥的健康受试者/病理患者，并以4:1的比例进行划分，输入CCNN。CCNN利用深度卷积神经网络进行特征提取，结合基于信息的相似度度量理论（IBS），对特征向量间的相似性进行度量并分类。结果:实验结果得出灵敏度为0.834 6，特异性为0.962 3，最终大赛综合得分为0.898 5。结论:CCNN使用交叉对比的输入模式扩充数据量，引入信号间的对比信息，同时在神经网络的训练过程中应用统计学思想，使网络具备良好的泛化性，更加适应医学数据量较少的场景，在心音分类中取得较好的结果。