Meta分析比较超声和MRI对胎盘植入的诊断价值

目的应用Meta分析比较超声（us）和MRI对胎盘植入的诊断价值。方法通过电子文献检索系统检索在中吲期刊网（CNKI）和PubMed上发表的有关US和MRI诊断胎盘植入的中英文文献．并对文献进行评价及筛选。应用Meta—Dis（1．4软件对纳入的试验结果进行分析。结果US诊断胎盘植入共纳入2400例．加权灵敏度为79％．加权特异度为95％．加权诊断比值比（DOR）为65．15,受试者工作特性（SROC）曲线下面积（AUC）为0．9495：MRI诊断胎盘植入共纳入386例．加权灵敏度为83％,加权特异度为88％,加权DOR为22．69,SROC曲线下AUC为0．8955。结论Meta分析表明US对胎盘槽入的诊断价信与MRT相比蒡异无统计学膏义     

The development of spatial capacity in piloting and dead reckoning by infant rats: use of the huddle as a home base for spatial navigation

Two forms of spatial navigation, piloting using external cues and dead reckoning using self-movement cues, are manifest in the outward and homeward trips of adult rats exploring from a home base. Here, the development of these two forms of spatial behavior are described for rats aged 14-65 days using a new paradigm in which a huddle of pups or an artificial huddle, a small heat pad, served as a home base on an open circular table that the rats could explore. When moving away from both home bases, the travel distance, path complexity, and number of stops of outward trips from the home base increased progressively with age from postnatal day 16 through 22. When returning to the home bases, the return trips to the home base were always more direct and had high travel velocities even though travel distance increased with age for the longest trips. The results are discussed in relation to the ideas that: (1) the pups pilot on the outward portion of their excursion and dead reckon on the homeward portion of their excursion, and (2) the two forms of navigation and associated spatial capacity are interdependent and develop in parallel and in close association with locomotor skill.     

Architectural and morphological assessment of rat abdominal wall muscles: comparison for use as a human model

The abdominal wall is a composite of muscles that are important for the mechanical stability of the spine and pelvis. Tremendous clinical attention is given to these muscles, yet little is known about how they function in isolation or how they interact with one another. Given the morphological, vascular, and innervation complexities associated with these muscles and their proximity to the internal organs, an appropriate animal model is important for understanding their physiological and mechanical significance during function. To determine the extent to which the rat abdominal wall resembles that of human, 10 adult male Sprague‐Dawley rats were killed and formalin‐fixed for architectural and morphological analyses of the four abdominal wall muscles (rectus abdominis, external oblique, internal oblique, and transversus abdominis). Physiological cross‐sectional areas and optimal fascicle lengths demonstrated a pattern that was similar to human abdominal wall muscles. In addition, sarcomere lengths measured in the neutral spine posture were similar to human in their relation to optimal sarcomere length. These data indicate that the force‐generating and length change capabilities of these muscles, relative to one another, are similar in rat and human. Finally, the fiber lines of action of each abdominal muscle were similar to human over most of the abdominal wall. The main exception was in the lower abdominal region (inferior to the pelvic crest), where the external oblique becomes aponeurotic in human but continues as muscle fibers into its pelvic insertion in the rat. We conclude that, based on the morphology and architecture of the abdominal wall muscles, the adult male Sprague‐Dawley rat is a good candidate for a model representation of human, particularly in the middle and upper abdominal wall regions.     

早期Legg-Perthes病双重介入和显微外科治疗的解剖学基础

目的观察髋关节骨、内外静脉回流途径及构筑特点,论证早期Legg-Perthes病介入和显微外科治疗的可行性。方法采用多种形态学方法对25例胎儿、新生儿及儿童的髋关节骨内、外静脉回流途径及构筑特点进行观察。结果股骨头内静脉在近股骨头表面形成15～20条属支,即前、后、上、下骺静脉及内骺静脉,于头、颈交界处引流至骨外,汇入相应颈升静脉。股骨颈内的前、后、上、下干骺静脉,最终汇入颈升静脉及股骨颈表面滑膜下静脉网。股骨头、颈内的微动脉发自骺动脉,一般有2～3级,呈树状分支,一条微动脉一般有两条微静脉伴行,微静脉间有丰富的横行吻合支。四组颈升静脉可于头、颈交界处形成囊内静脉环,此环完整率为39%。旋股内、外侧静脉于股骨颈基底部形成囊外静脉环,其中旋股内侧静脉构成环的内、后、外侧部,旋股外侧静脉构成环的前部,且有10%臀下静脉和2%臀上静脉参与此环后外侧部构成,此环完整率为33%。结论髋关节骨内、外静脉回流及构筑特点为早期Legg-Perthes病双重介入和显微外科可行性治疗提供了直接的解剖学依据。     

骶髂关节螺钉手术导航机器人系统设计及实验研究

目的 针对骶髂关节螺钉手术设计手术导航机器人系统,完成空间定位和路径导航,开展精度测试实验,检测系统定位的位置误差和角度误差.方法 本文开发手术导航机器人系统,利用基于透视视觉的双平面定位算法完成空间定位,利用串并混联结构的机器人完成路径导航.使用模型骨和尸体骨共完成模拟手术实验16例,通过术前规划与术后结果图片的重叠来评价手术导航机器人的系统精度.结果 本机器人系统最终测得的位置误差为(1.91±1.15)mm,角度误差为1.88°±0.915°.结论 本文开发的手术导航机器人可提高手术精度和手术安全性,并减少术中透视的使用.系统的平均误差能够满足骶髂关节手术的要求,但误差的标准差较大,需在后续研究中通过算法和系统优化来改善.     

Validation of a fast method for quantification of intra‐abdominal and subcutaneous adipose tissue for large‐scale human studies

Central obesity is the hallmark of a number of non‐inheritable disorders. The advent of imaging techniques such as MRI has allowed for a fast and accurate assessment of body fat content and distribution. However, image analysis continues to be one of the major obstacles to the use of MRI in large‐scale studies. In this study we assess the validity of the recently proposed fat–muscle quantitation system (AMRA^TM Profiler) for the quantification of intra‐abdominal adipose tissue (IAAT) and abdominal subcutaneous adipose tissue (ASAT) from abdominal MR images. Abdominal MR images were acquired from 23 volunteers with a broad range of BMIs and analysed using sliceOmatic, the current gold‐standard, and the AMRA^TM Profiler based on a non‐rigid image registration of a library of segmented atlases. The results show that there was a highly significant correlation between the fat volumes generated by the two analysis methods, (Pearson correlation r = 0.97, p < 0.001), with the AMRA^TM Profiler analysis being significantly faster (~3 min) than the conventional sliceOmatic approach (~40 min). There was also excellent agreement between the methods for the quantification of IAAT (AMRA 4.73 ± 1.99 versus sliceOmatic 4.73 ± 1.75 l, p = 0.97). For the AMRA^TM Profiler analysis, the intra‐observer coefficient of variation was 1.6% for IAAT and 1.1% for ASAT, the inter‐observer coefficient of variation was 1.4% for IAAT and 1.2% for ASAT, the intra‐observer correlation was 0.998 for IAAT and 0.999 for ASAT, and the inter‐observer correlation was 0.999 for both IAAT and ASAT. These results indicate that precise and accurate measures of body fat content and distribution can be obtained in a fast and reliable form by the AMRA^TM Profiler, opening up the possibility of large‐scale human phenotypic studies. Copyright © 2015 John Wiley & Sons, Ltd.     

舒芬太尼用于腹部手术患者自控静脉镇痛的临床观察

目的探讨腹部手术病人自控舒芬太尼静脉镇痛的临床效果及安全性。方法选择气管内插管全身麻醉腹部手术患者计80例，ASA分级Ⅰ～Ⅱ级，年龄18～86岁，高中以上文化程度。随机分为两组，每组40例，一组为舒芬太尼镇痛组（S组），术后镇痛药物配方：舒芬太尼2μg／kg＋格拉司琼6mg加生理盐水至100ml；另一组为芬太尼镇痛组（F组），术后镇痛药物配方：芬太尼20μg／kg＋格拉司琼6mg加生理盐水至100ml。镇痛泵参数均设置为：负荷剂量4ml，背景输注速度1ml／h，自控剂量0．5ml，锁定时间15min。观察S组与F组的镇痛效果及不良反应。结果S组在各个时段静态和动态VAS评分均低于F组（P〈0．05）；S组镇静效果较F组评分略高，但两者差异无统计学意义（P〉0．05）；S组不良反应发生率少于F组（P〈0．01）；两组患者均未见明显的呼吸抑制发生。术后随访两组患者对镇痛效果的总满意度均在90％以上。结论腹部手术病人自控舒芬太尼静脉镇痛，具有良好的镇痛和镇静作用及安全性，且心血管的稳定性好，不良反应低。     

基于MRI和三维CT个性化截骨导板在内轴型膝关节假体置换中的应用

背景:基于三维CT数据的个性化定位导板可提高后稳定型假体关节置换的精确度,但基于三维CT扫描数据的骨性结构重建忽略了股骨远端关节软骨厚度,将影响个性化截骨导板使用及全膝关节置换后的临床效果。目的:探讨基于MRI和三维CT的个性化截骨导板辅助内轴型膝关节假体置换的安全性、准确性及早期临床疗效。方法:选择南京医科大学附属南京医院骨科2018年2月至2019年4月收治的110例膝关节骨关节炎患者,均使用内轴型膝关节假体行全膝关节置换,随机分2组进行手术,试验组58例在基于MRI和三维CT的个性化截骨导板辅助下完成膝关节截骨,对照组52例采用传统髓内、髓外定位方法完成膝关节截骨,记录两组手术时间、术中出血量。术后随访复查X射线片,并评估膝关节协会功能KSS评分与目测类比评分。结果与结论:①110例患者获得6-10个月随访,未出现严重术后并发症;②试验组手术时间、术中出血量少于对照组(P<0.01);③术后1个月X射线片显示,试验组术后髋-膝-踝角、冠状面股骨组件角、冠状面胫骨组件角、矢状面胫骨组件角与理论设计值的偏差均小于对照组(P<0.01);④试验组术后1,3,6个月的膝关节功能KSS评分高于对照组(P<0.05),两组间目测类比评分比较差异无显著性意义(P>0.05);⑤结果表明基于MRI和三维CT的个性化截骨导板辅助内轴型膝关节假体置换,能有效提高假体安放准确性,缩短手术时间,该方法安全可行,早期临床效果满意。     

创伤性脊髓损伤康复治疗最佳介入时间窗观察

目的 观察不同介入时机康复治疗对创伤性脊髓损伤患者日常生活活动能力以及运动功能的影响,探讨康复治疗的最佳时间窗。方法 收集我院2015年10月~ 2017年7月收治的符合纳入标准的创伤性脊髓损伤患者55例,按介入的时间不同分为早期组（脊髓休克期过后2~4周内）和对照组（脊髓休克期过后4~8周内）,两组采用标准康复训练方法,即根据两组患者不同病程、不同损伤阶段及程度,采用不同的训练方法,同时配以相应的物理治疗及心理治疗。所有患者的康复治疗时间均为3个月。分别于康复治疗前（脊髓休克期过后）及康复治疗3个月后进行运动功能（ASIA运动评分）及日常生活活动能力评定（Barthel评分）。结果 康复治疗后,两组患者Barthel指数及ASIA运动评分较治疗前均提高,差异有统计学意义（P＜0.01）;治疗后,早期组Barthel指数[（67.67±27.97）分 vs （53.60±26.52）分]及ASIA运动分[（66.60±25.34）分 vs （53.24±23.72）分]均高于对照组,差异有统计学意义（P＜0.01）;在相关性研究中,早期组Barthel指数增加值与ASIA 运动评分增加值成显著正相关（P＜0.01）,而在对照组中呈低度正相关（P＜0.05）。结论 脊髓休克后2~4周是一个更好的康复治疗介入的时间窗。     

健康中国人MRI脑室外脑脊液含量测定的研究

目的探讨依靠立体定向MRI资料和计算机技术进行脑室外脑脊液容积测定的可行性。方法选取60名健康成年自愿者按立体定向基线行1mm厚的轴位全脑MR扫描,在资料上对脑室外脑脊液进行识别、分割、提取,利用计算机技术对脑脊液的容积进行测定。结果男性脑室外脑脊液含量为(29.09±3.18)mm3;女性为(28.18±3.53)mm3。结论男、女两性脑室外脑脊液体积差异无统计学意义,利用计算机技术测定MRI脑脊液含量具有可行性。     

介入治疗对冠心病合并左心功能不全患者的心功能 及生活质量的影响

目的 观察冠心病合并左心功能不全患者应用介入治疗的效果及预后。方法 选取2017年6月~2018年12月我院收治的冠心病合并左心功能不全患者146例作为研究对象,随机分为对照组和介入组,各73例。对照组采用常规药物方法干预,介入组采用药物联合介入治疗方法干预,比较两组患者术后心功能指标、3个月后生活质量评分情况及护理满意度。结果 两组治疗后左心室舒张末内径及左心室收缩末内径均较治疗前降低,且介入组低于对照组,差异均有统计学意义（P＜0.05）;两组左室射血分数均较治疗前增加,且介入组优于对照组,差异均有统计学意义（P＜0.05）;介入组术后3个月的病情恢复、生活自理能力、心理情绪健康及总体状况评分均高于对照组,差异有统计学意义（P＜0.05）;介入组治疗满意度高于对照组,差异有统计学意义（P＜0.05）。结论 对冠心病合并左心功能不全患者,应用介入治疗辅以药物,可有效恢复心功能,安全性高,可延长患者生命,提高患者生活质量。     

介入性超声羊膜腔内治疗与母儿安危评估

目的 :应用介入性超声对胎儿进行羊膜腔内治疗 ,以探讨其成功率和对母儿的安危。方法 :对 44例晚期妊娠 ,因并发羊水过少或胎儿宫内发育迟缓孕妇 ,行介入性超声羊膜腔内治疗 1 3次 ,其中包括 8例前壁胎盘的羊膜腔穿刺。结果 :44例孕妇超声引导下均穿刺成功。胎动、胎心及NST检查在介入性超声诊疗前后比较无显著性差异 (P <0 .0 5 ) ,而羊水和I UGR的改善则有显著意义 (P <0 .0 1) ,且无一例早产、胎膜早破、胎膜早剥、羊水栓塞、穿刺感染等并发症 ,更无死胎、死产及新生儿死亡。结论 :介入性超声是在实时超声显像引导下进行穿刺而达到定性诊断或 /和治疗目的的一种新技术 ,它成功率高 ,并发症极少 ,创伤小 ,可重复 ,是一种相对安全 ,可靠的产科治疗手段 ,对前壁胎盘同样安全、有效。     

Neurocognitive disorder detection based on feature vectors extracted from VBM analysis of structural MRI

Dementia is a growing concern due to the aging process of the western societies. Non-invasive detection is therefore a high priority research endeavor. In this paper we report results of classification systems applied to the feature vectors obtained by a feature extraction method computed on structural magnetic resonance imaging (sMRI) volumes for the detection of two neurological disorders with cognitive impairment: myotonic dystrophy of type 1 (MD1) and Alzheimer disease (AD). The feature extraction process is based on the voxel clusters detected by voxel-based morphometry (VBM) analysis of sMRI upon a set of patient and control subjects. This feature extraction process is specific for each kind of disease and is grounded on the findings obtained by medical experts. The 10-fold cross-validation results of several statistical and neural network based classification algorithms trained and tested on these features show high specificity and moderate sensitivity of the classifiers, suggesting that the approach is better suited for rejecting than for detecting early stages of the diseases.     

Engineering of perfluorooctylbromide polypyrrole nano-/microcapsules for simultaneous contrast enhanced ultrasound imaging and photothermal treatment of cancer

A versatile oil-in-water emulsion method has been explored for constructing water-dispersible polypyrrole (PPy) nano-/microcapsules with a soluble PPy complex as multifunctional photothermal agents for tumor ablation. In this work, both PPy nanocapsules (280.4 ± 79.0 nm) and microcapsules (1.31 ± 0.45 μm) with liquid perfluorooctylbromide (PFOB) core could be obtained by simply tuning the process energy for emulsion formation from ultrasonication to homogenization. Owing to the encapsulated liquid PFOB and strong near-infrared (NIR) absorption of PPy shell, the resulted PPy capsules showed great promise in ultrasound imaging guided photothermal ablation of tumor cells without inducing any significant side effect. Thus, it is anticipated that fine-tuning of the other encapsulated drugs or functional materials in PPy capsules would foster avenues for the development of multifunctional platforms for cancer treatments.     

A technique for surgical treatment of infected wounds based on photodynamic and ultrasound therapy

This work considers two technologies for treatment of infected wounds in clinics. Particular emphasis was placed on the PUS technology developed in our laboratory. High efficacy of this method encourages us to continue its development. A number of improvements will be made in the future. In addition, development of PUS BTS and research into its efficacy will be continued. The results of this research will be reported in the future. __________ Translated from Meditsinskaya Tekhnika, Vol. 40, No. 6, 2006, pp. 18–24.     

肝癌根治术后抗病毒治疗对肿瘤复发率的影响

目的 研究肝癌根治术后抗病毒治疗对肿瘤复发率的影响.方法 选择2010年3月到2013年5月之间来我院进行肝癌根治术治疗的患者84例,其中男44例,女40例,年龄38～78岁,平均年龄(67.5±1.4)岁.按1:1的随机方式分为治疗组和对照组,每组42人,采用回顾性研究方法,对各组进行肝功能检测及生存率比较.结果 治疗组与对照组经肝癌根治术后的肝功能比较无明显差异,不具有统计学意义;治疗组的生存曲线在对照组之上,可以认为治疗组的生存率要好于对照组,两组之间差异有统计学意义(P =0.028).结论 肝癌根治术后抗病毒治疗对肿瘤复发率有一定影响.     

Development and use of iron oxide nanoparticles (Part 1): Synthesis of iron oxide nanoparticles for MRI

Contrast agents, such as iron oxide, enhance MR images by altering the relaxation times of tissues in which the agent is present. They can also be used to label targeted molecular imaging probes. Unfortunately, no molecular imaging probe is currently available on the clinical MRI market. A promising platform for MRI contrast agent development is nanotechnology, where superparamagnetic iron oxide nanoparticles (SPIONS) are tailored for MR contrast enhancement, and/or for molecular imaging. SPIONs can be produced using a range of methods and the choice of method will be influenced by the characteristics most important for a particular application. In addition, the ability to attach molecular markers to SPIONS heralds their application in molecular imaging.There are many reviews on SPION synthesis for MRI; however, these tend to be targeted to a chemistry audience. The development of MRI contrast agents attracts experienced researchers from many fields including some researchers with little knowledge of medical imaging or MRI. This situation presents medical radiation practitioners with opportunities for involvement, collaboration or leadership in research depending on their level of commitment and their ability to learn. Medical radiation practitioners already possess a large portion of the understanding, knowledge and skills necessary for involvement in MRI development and molecular imaging. Their expertise in imaging technology, patient care and radiation safety provides them with skills that are directly applicable to research on the development and application of SPIONs and MRI.In this paper we argue that MRI SPIONs, currently limited to major research centres, will have widespread clinical use in the future. We believe that knowledge about this growing area of research provides an opportunity for medical radiation practitioners to enhance their specialised expertise to ensure best practice in a truly multi-disciplinary environment. This review outlines how and why SPIONs can be synthesised and examines their characteristics and limitations in the context of MR imaging.     

A new MRI method, tested in vitro for the assessment of thermal coagulation and demonstrated in vivo on focused ultrasound ablation

A new MRI method is described. It is implemented for the assessment of thermal coagulation after thermal treatment. The method does not require injection of a contrast agent. The image is based on the amount of magnetization exchange between macromolecules and water in the tissue. Coagulated tissue has a faster magnetization exchange rate, forming the new contrast. In this study, the new imaging method is shown to have good contrast between coagulated and untreated excised tissues of porcine liver and muscle. The method is also successfully demonstrated in vivo in rat thigh muscle thermally treated with focused ultrasound.     

Methotrexate-loaded PLGA nanobubbles for ultrasound imaging and Synergistic Targeted therapy of residual tumor during HIFU ablation

High intensity focused ultrasound (HIFU) has attracted the great attention in tumor ablation due to its non-invasive, efficient and economic features. However, HIFU ablation has its intrinsic limitations for removing the residual tumor cells, thus the tumor recurrence and metastasis cannot be avoided in this case. Herein, we developed a multifunctional targeted poly(lactic-co-glycolic acid) (PLGA) nanobubbles (NBs), which not only function as an efficient ultrasound contrast agent for tumor imaging, but also a targeted anticancer drug carrier and excellent synergistic agent for enhancing the therapeutic efficiency of HIFU ablation. Methotrexate (MTX)-loaded NBs were synthesized and filled with perfluorocarbon gas subsequently using a facile but general double emulsion evaporation method. The active tumor-targeting monoclonal anti-HLA-G antibodies (mAb_HLA-G) were further conjugated onto the surface of nanobubbles. The mAb_HLA-G/MTX/PLGA NBs could enhance the ultrasound imaging both in vitro and in vivo, and the targeting efficiency to HLA-G overexpressing JEG-3 cells has been demonstrated. The elaborately designed mAb_HLA-G/MTX/PLGA NBs can specifically target to the tumor cells both in vitro and in vivo, and their blood circulation time in vivo was much longer than non-targeted MTX/PLGA NBs. Further therapeutic evaluations showed that the targeted NBs as a synergistic agent can significantly improve the efficiency of HIFU ablation by changing the acoustic environment, and the focused ultrasound can promote the on-demand MTX release both in vitro and in vivo. The in vivo histopathology test and immunohistochemical analysis showed that the mAb_HLA-G/MTX/PLGA NBs plus HIFU group presented most serious coagulative necrosis, the lowest proliferation index and the highest apoptotic index. Therefore, the successful introduction of targeted mAb_HLA-G/MTX/PLGA NBs provides an excellent platform for the highly efficient, imaging-guided and non-invasive HIFU synergistic therapy of cancer with the supplementary functions of killing residual tumor cells and preventing tumor recurrence/metastasis.