面神经颞骨内段在横断薄层和CT上的定位及临床意义

目的：为面神经及耳科病变的影像诊断和手术治疗提供解剖学基础。方法：15例成人头部标本，以眦耳线(CML)为基线，获得间隔为1．0mm，厚度为1．0mm的CT图像，扫描后的头部标本按原定位截取以耳颞区为中心的组织块并将其制成厚为1．0mm的连续横断薄层切片。标本切片与CT图像对照，对颞骨内面神经、听小骨、骨半规管、前庭、耳蜗等结构进行观测。结果：(1)面神经膝状神经节(GG)多位于外半规管层面。(2)匙突多与锤砧关节位于同一层面。(3)锥隆起多位于鼓岬层面。结论：面神经水平段起始部，GG，面神经迷路段三者在外半规管层面内呈倒“V”字型排列；面神经垂直段位于面神经隐窝深面，面神经隐窝、锥隆起、锥隐窝三者在鼓岬层面内从内向外呈“ω”字型排列。     

面神经颞骨内段在冠状薄层切片与高分辨率计算机断层摄影图像上的应用解剖

目的:为面神经及耳科病变的影像诊断和手术治疗提供解剖学基础.方法:15例成人头部标本,以与眦耳线(CML)相垂直的直线为基线,获得间隔为1.0mm,厚度为1.0mm的高分辨率计算机断层摄影术(HRCT)图像,扫描后的头部标本按原定位截取以耳颞区为中心的组织块并将其制成厚为1.0mm的连续冠状薄层切片.标本切片与HRCT图像对照,对颞骨内面神经、听小骨、骨半规管、前庭、耳蜗等结构进行观测.结果:颞骨冠状HRCT扫描,有30～32层,膝状神经节居第5～7层,面神经水平段起始部和面神经迷路段居第7～8层,面神经垂直段居第16～17层,面神经隐窝、锥隆起、锥隐窝三者在第14～15层从外向内呈"M"字型排列.结论:耳颞区火棉胶冠状薄层断面标本能良好显示面神经及其周围结构的解剖位置和毗邻关系,可直接与高分辨率CT冠状扫描图像进行对照研究,其结果对耳科疾病的影像诊断及手术治疗有参考价值.     

P>面神经隐窝及其周围结构在耳的横断薄层和HRCT上的定位及毗邻关系/P>

目的 明确面神经隐窝及其周围结构在横断薄层和高分辨率CT(HRCT)上的定位及毗邻关系.方法 横断薄层切片与HRCT图像对照,辨识面神经隐窝及其周围结构.结果 面神经隐窝及其周围结构多在弓状隆起下方8～13层面出现,面神经、面神经隐窝、鼓索隆起、鼓索神经出现率为100%,岬小桥出现率为70%.面神经至鼓索神经之间的距离由上向下逐渐增大,至圆窗龛层面最大,男性右侧为(5.20±0.06)mm,左侧为(5.16±0.09)mm;女性右侧为(5.16±0.05)mm,左侧为(5.10±0.08)mm.两侧无显著性差异(P＞0.05).结论 火棉胶薄层切片与HRCT扫描图像结合能良好显示面神经隐窝及其周围各解剖结构.     

后鼓室颞骨切片与CT对照研究

目的：为后鼓室及耳科病变的影像诊断和手术治疗提供解剖学基础。方法：l5例成人头部标本，以眦耳线（cML）为基线，获得间隔为1．00mm，厚度为1．00mm的CT图像，扫描后的头部标本按原定位截取以耳颞区为中心的组织块并将其制成厚为1．00mm的连续横断薄层切片。标本切片与CT图像对照，对颞骨内砧骨窝、鼓索隆起、茎突隆起、面神经隐窝、鼓室窦、岬小桥、外耳道上棘等结构进行观察。结果：砧骨窝深度为1．49mm，至面神经锥曲的距离为5．67mm。后鼓室窦内侧壁至面神经水平部的距离为3．14mm。外耳道上棘至面神经垂直段、鼓索神经、鼓岬的距离分别为16．76mm、15．94mm和21．81mm。结论：耳颞区断面标本与CT图像进行对照研究，其结果对耳科疾病的影像诊断及手术治疗具有参考价值。     

面神经垂直段在横、冠状断层和CT上的定位及临床意义

目的为面神经及耳科病变的影像诊断和手术治疗提供解剖学基础.方法30例成人头部标本,15例以眦耳线(CML)为基线,15例以CML相垂直的直线为基线,获得间隔为1.0mm,厚度为1.0mm的CT图像,扫描后的头部标本按原定位截取以耳颞区为中心的组织块并将其制成厚为1.0mm的连续横(冠)状薄层切片.标本切片与CT图像对照,对颞骨内面神经垂直段及邻近结构进行观测.结果(1)横断层VFN距面神经隐窝、鼓室窦、鼓索神经、外耳道上棘距离分别为(0.63±0.15)mm、(2.17±0.12)mm、(5.16±0.10)mm和(16.80±1.19)mm;(2)冠状断层VFN长度平均值为(14.28±1.30)mm,VFN至鼓索神经、后半规管距离分别为(2.49±0.19)mm和(2.53±0.33)mm.结论耳颞区火棉胶横断和冠状薄层断面标本能良好显示VFN及其周围结构的解剖位置和毗邻关系,可直接与HRCT扫描图像图像进行对照研究,其结果对耳科疾病的影像诊断及手术治疗有参考价值.     

耳横断高分辨率CT中表盘定位的应用

目的:探讨耳颞区高分辩率体层摄影术(HRCT)横断扫描图像上表盘定位的可行性,为耳颞区病变的影像诊断和手术治疗提供一种新的定位方法。方法:30例无耳部病变的成人以眦耳线(CML)为基线,用GE Hispeed NX/i Sys#CT扫描,获得间隔为1·00mm,厚度为1·00mm的CT图像,在扫描图像上套用表盘,逐一对颞骨内各主要结构进行定位。结果:利用表盘法对外半规管上部、外半规管、锤砧关节、鼓岬和圆窗龛等5个横断层面内的面神经、中耳及内耳的各重要结构进行了定位。结论:耳颞区HRCT扫描图像用表盘法定位,其方法简单实用,在耳科的教学与科研、耳科病变的诊断与治疗等方面均具有广泛的应用前景。     

人工耳蜗植入术的应用解剖学研究

目的探讨后鼓室入路人工耳蜗植入术的有关解剖,为人工耳蜗植入手术提供解剖学基础。方法取成人颞骨标本60侧(左、右各30侧),在放大6倍的手术显微镜下进行观察和测量,结果进行统计学处理。结果圆窗龛(窝)的形态大体分为2种类型:近圆形(52%)和近半圆形(48%)。圆窗龛下壁有一窦腔者占86.7%。岬下脚出现率为11.7%,岬小桥出现率为33.3%。颈静脉窝高位,窝顶达圆窗龛上缘者占11.7%,均未影响圆窗龛的形态。外耳道上棘至锥隆起、鼓索隆起、圆窗龛前唇(缘)、面神经管锥曲的距离分别是(18.02±1.21)mm、(15.22±1.32)mm、(20.09±1.20)mm、(14.96±2.03)mm。鼓索隆起至面神经管锥曲、锥隆起的距离分别是(3.33±0.42)mm、(3.79±0.56)mm。锥隆起向后至面神经管的距离平均为(3.58±0.47)mm。结论后鼓室进路即是通过面神经隐窝的进路,面神经隐窝大小各异,鼓索隆起至面神经管锥曲和至锥隆起的距离,可作为面神经隐窝的宽度。人工耳蜗植入术经面神经隐窝入路较理想,距圆窗龛较近,有利于电极插入。该入路靠近面神经管,手术操作时应注意保护面神经。圆窗龛前唇遮盖圆窗膜,手术时必须磨去前唇暴露圆窗膜。     

幼儿人工耳蜗植入面神经隐窝的应用解剖学

目的:对幼儿面神经隐窝等相关结构进行观测,为幼儿人工耳蜗植入及其它耳科手术提供形态学依据。方法:取1～5岁儿童尸头14个(28侧),模仿经乳突后鼓室径路,进入后鼓室;在手术显微镜下观察测量与面神经隐窝相关的解剖学数据。结果:经面神经隐窝入路从不同的角度可清楚地看到锥隆起、面神经管凸(面神经水平段)、砧镫关节、镫骨底板、匙突、圆窗龛及鼓岬等主要结构。面神经垂直段长度为(10.58±1.20)mm,面神经圆窗龛平面到乳突表面、面神经锥曲段到鼓索神经、水平半规管到面神经水平段以及鼓索神经起点到茎乳孔的距离分别为:(11.90±1.80)mm,(3.79±0.45)mm,(1.94±0.43)mm,(5.14±0.80)mm。结论:幼儿面神经隐窝与成人的不同点以及幼儿面神经隐窝的相关测量数据,可为幼儿手术中避免面神经损伤提供形态学依据。     

后鼓室手术入路的应用解剖学研究

目的　为后鼓室入路手术提供解剖学依据。方法　利用成人 6 0侧颞骨标本 ,用牙科钻磨开乳突腔 ,打开外耳道外侧壁和鼓室盾板 ,充分暴露后鼓室入路手术中有关的解剖结构。以外耳道上棘、面神经管锥曲为测量标志 ,在手术显微镜下 ,对在手术中遇到的解剖结构之间的距离进行了测量。结果　外耳道上棘至砧骨窝、锥隆起、鼓索隆起、面神经管锥曲、外侧半规管、后半规管、前庭窗、蜗窗、匙突、乙状窦垂直部前缘中点、窦膜角的距离分别是 17 19、18 0 2、15 2 2、14 4 9、15 39、17 35、19 5 8、2 0 0 9、2 0 32、15 6 8、18 76mm。面神经管锥曲至鼓索隆起、水平半规管、后半规管的距离分别是 3 33、1 5 3、2 15mm。结论　外耳道上棘、面神经管锥曲是后鼓室入路的重要手术标志 ,鼓索隆起向内 3mm是手术入路的安全区 ,面神经减压术时应避免损伤水平半规管及后半规管等结构     

利用螺旋CT确定面神经管锥段位置

目的为临床医生提供面神经管锥段位置关系的信息。方法取15例开颅取脑后颅底标本,对面神经管锥段与外半规管凸、后骨半规管、锥隆起、鼓索隆起之间的直线距离进行直接测量与64层螺旋CT测量;对118例患者头颅CT扫描图像进行相同项目的测量。对颅底标本两种方法测量结果和男女患者头颅CT扫描资料测量结果分别进行t检验。结果尸骨直接测量与CT测量结果（（x珚±s）mm,以下同）分别是1.49±0.61与1.55±0.60,2.27±1.02与2.19±1.07,3.31±1.31与3.39±1.28,3.78±1.26与3.87±1.42;两种方法测量值差异无显著统计学意义（P〉0.05）。活体测量男女性的测量值分别为1.68±0.86与1.34±0.69,2.49±1.44与1.95±1.35,3.60±1.24与3.13±1.23,3.96±1.21与3.47±1.32;两性的测量值差异有显著统计学意义（P〈0.05）。结论 CT测量方法可靠,测得值可信;CT扫描除可助医生明确诊断外,CT测量和面神经管的三维重建还可助临床医生术前、术中对面神经管锥段及其他解剖结构的定位与保护。在术中可以外半规管凸、后骨半规管、锥隆起对锥段定位;相反亦可以面神经定位骨半规管。     

Association between functional alterations of senescence and senility and disorders of gait and balance

OBJECTIVES:

Declines in cognition and mobility are frequently observed in the elderly, and it has been suggested that the appearance of gait disorders in older individuals may constitute a marker of cognitive decline that precedes significant findings in functional performance screening tests. This study sought to evaluate the relationship between functional capacities and gait and balance in an elderly community monitored by the Preventive and Integrated Care Unit of the Hospital Adventista Silvestre in Rio de Janeiro, RJ, Brazil.

METHODS:

Elderly individuals (193 females and 90 males) were submitted to a broad geriatric evaluation, which included the following tests: 1) a performance-oriented mobility assessment (POMA) to evaluate gait; 2) a mini-mental state examination (MMSE); 3) the use of Katz and Lawton scales to assess functional capacity; 4) the application of the geriatric depression scale (GDS); and 5) a mini-nutritional assessment (MNA) scale.

RESULTS:

Reductions in MMSE, Katz and Lawton scores were associated with reductions in POMA scores, and we also observed that significant reductions in POMA scores were present in persons for whom the MMSE and Katz scores did not clearly indicate cognitive dysfunction. We also demonstrated that a decline in the scores obtained with the GDS and MNA scales was associated with a decline in the POMA scores.

CONCLUSIONS:

Considering that significant alterations in the POMA scores were observed prior to the identification of significant alterations in cognitive capacity using either the MMSE or the Katz systems, a prospective study seems warranted to assess the predictive capacity of POMA scores regarding the associated decline in functional capacity.     

男性乳腺发育症临床病理分析及雌,孕激素受体检测

对１１３例男性乳腺发育症进行临床病理分析。同时检测其中３０例乳腺组织中雌激素受体和孕激素受体分布情况，结果发现两者阳性率分别为８０．０％和８３．３３％。结合文献讨论了男性乳腺发育症的发生与高血清激素浓度及乳腺组织高受体水平的关系。     

纳米水平分子成像与诊疗一体化研究进展与挑战

分子成像能以非侵入性的方式重现活体细胞的生理功能和生物学过程,提高疾病的早期和特异性诊断水平。纳米颗粒/材料具有物理性质可控性高、易于表面修饰、血液循环时间长和可功能化等优点,在疾病诊断与治疗中显示出巨大潜力。但如何阐明纳米材料多功能间的内在联系、解决其代谢及安全性等关键机制难题、实现纳米颗粒/材料多功能性到临床多功能...     

Pathology and genetics of phaeochromocytoma and paraganglioma

Phaeochromocytoma and paraganglioma (PHEO/PGL) are rare tumours with an estimated annual incidence of 3 per million. Advances in molecular understanding have led to the recognition that at least 30–40% arise in the setting of hereditary disease. Germline mutations in the succinate dehydrogenase genes SDHA, SDHB, SDHC, SDHD and SDHAF2 are the most prevalent of the more than 19 hereditary genetic abnormalities which have been reported. It is therefore recommended that, depending on local resources and availability, at least some degree of genetic testing should be offered to all PHEO/PGL patients, including those with clinically sporadic disease. It is now accepted that that all PHEO/PGL have some metastatic potential; therefore, concepts of benign and malignant PHEO/PGL have no meaning and have been replaced by a risk stratification approach. Although there is broad acceptance that certain features, including high proliferative activity, invasive growth, increased cellularity, large tumour nests and comedonecrosis, are associated with an increased risk of metastasis, it remains difficult to predict the clinical behaviour of individual tumours and no single risk stratification scheme is endorsed or in widespread use. In this review, we provide an update on advances in the pathology and genetics of PHEO/PGL with an emphasis on the changes introduced in the WHO 2017 classification of endocrine neoplasia relevant to practising surgical pathologists.     

壬基酚与卵清蛋白的结合与鉴定

目的：合成壬基酚与卵清蛋白的偶联物。方法：在磷酸盐（PBS，pH=8．0）缓冲液中利用甲醛通过曼尼希反应连接壬基酚与卵清蛋白（OVA）；通过抗体芯片技术与紫外扫描鉴定偶联物。结果：壬基酚与OVA偶联成功，壬基酚单克隆抗体对偶联物的识别浓度小于2．68μg／ml。结论：本方法可用于壬基酚与卵清蛋白的偶联，且方法简单易实现。     

Alterations of regular and mature monocytes are distinct,and dependent of intensity and duration of exercise

Circulating monocytes comprise functionally distinct regular (CD14^bright+) and mature (CD141^low+) cells. Cell surface receptors were determined by three colour flow cytometry in 8 healthy control subjects. Compared to regular monocytes, mature monocytes had lower levels of the high affinity Fcy receptor 1 (CD64), complement receptor 3 (CDllb), CD45RO and higher levels for HLA-DR, LFA-1 (CD11a/CD18), interleukin-2 receptor (CD25), CD45RA and the Fc receptor 3 (CD16). Both regular and mature monocytes were measured before and up to three hours after four different types of exercise (Ex) in endurance trained athletes (n=9-16). Immediately after anaerobic exercise of I min with a maximal lactate concentration (la_max) of I2.3 (SD I.4) mmol · l^–1 and exhaustive exercise of 24 (SD 8) min with a maximal lactate concentration (la_max) of 7.4 (SD 2.6) mmol· l^–1 mature monocytes increased more than regular monocytes. Exhaustive endurance exercise of 87 (SD 21) min [la_max 3.7 (SD I.0)] led to a similar increase of regular and mature monocytes. 15–33 min after a 100km run regular monocytes increased significantly, whereas mature monocytes decreased. Up to three hours after the end of all exercises mature monocytes fell below pre-exercise values. In conclusion, duration and intensity of exercise alter distinct maturation stages of monocytes differently. It is probable that the avidity of adhesion molecules like LFA-1 to their endothelial ligands is increased to enable the firm attachment to the endothelium.     

韧带和肌腱的生物力学和力学生物学研究

国际韧带和肌腱研讨会(The International Symposium on Ligaments and Tendons,ISI&T)于2000年在美国佛罗里达州奥兰多市首次召开。研讨会的宗旨是引起对韧带和肌腱研究的重视,并为生物工程师、生物学家、临床医师提供一个可以分享、评论、讨论韧带和肌腱最新研究成果的论坛。从2000年起,国际韧带和肌腱研讨会已经开展了15届;每届研讨会上涌现了大量令人振奋的关于当前韧带和肌腱研究热点和未来挑战的讨论。多年来,韧带和肌腱领域内的研究数量大幅增加,研究质量不断提升。为纪念《医用生物力学》杂志创刊30周年,本文总结过去30年里韧带和肌腱研究的主要进展,包括组织力学、力学生物学、损伤与治愈机制、组织修复和再生。     

Morphology and cytochemistry of leucocytes and thrombocytes of six species of fish

Cytochemical reactions of blood leucocytes and thrombocytes from six species of fish, rainbow trout (Onchorhynchus mykiss), coho salmon (Onchorhynchus kisutch), white sturgeon (Acipenser transmontanus), goldfish (Carassius auratus), striped bass (Morone saxatulis), and channel catfish (Ictalurus punctatus) were determined. Because the staining reactions were generally similar to the reactions found in mammalian leucocytes with similar morphological features, it is reasonable to classify fish leucocytes using the same terminology as is used for mammalian leucocytes. However, in some species leucocytes with features similar to mammalian eosinophils or basophils were not found. In goldfish leucocytes were found that had segmented nuclei and unstained, moderately refractile cytoplasmic granules. These cells were classified as segmented, granular leucocytes. Although these cells do not appear similar to any mammalian or avian leucocyte, the pattern of positive cytoplasmic alkaline phosphatase staining and negative granular staining is similar to that of equine eosinophils.