计算机重建技术辅助胸椎椎弓根钉置入的准确性

背景：由于椎骨周围组织关系复杂,使得胸椎椎弓根钉手术成功率不是很理想。随着更精密的成像设备出现,骨科手术前检查变的更清晰,准确。借组数字化成像设备势必要提高椎椎弓根置钉书准确性大大提高。 目的：分析在螺旋CT计算机三维重建辅助指导手术技术与传统徒手技术置入胸椎椎弓根钉的效果。 方法：选取临床病例,分为三组：螺旋CT计算机三维技术辅助手术组（A组）：传统技术手术组（B组）。所有病例记录钉置入的成功率,术后再次进行螺旋CT扫描评估置钉成功率和准确性。 结果与结论：A组较B两组的置入成功率大大提高;椎弓根穿破率显著降低。利用螺旋CT三维重建技术辅助胸腰椎椎弓根钉内固定手术,可以显著提高椎弓根钉置入的成功率和准确性。     

应用数字化模板导航颅颈交界区后路螺钉内固定（附9例报告）

目的结合人体解剖学、现代影像学、计算机三维重建、逆向工程技术及快速成形技术,设计一种新的颈椎弓根后路螺钉内固定方法。方法采集患者CT原始三维数据建立颈椎三维模型,导入三维重建软件Amira3．1,虚拟图像上采集拟固定椎弓根数据,应用逆向成形技术（RE）设计进针导航模板,利用激光快速成形（RP）技术制作颈椎模型和导航模板。在该模板导航下,后路螺钉内固定治疗9例颅底畸形。术中利用制作的导航模板与颈椎的后部结构相贴合,通过导航孔进行颈椎椎弓根的定位,植入椎弓根螺钉。术后根据X平片和CT扫描评价椎弓根螺钉的位置。结果建立制作个体化颈椎导航模板的方法,通过RE、RP技术生产出的导航模板具有较好的准确性、安全性、可靠性,适用于颅颈交界区后路螺钉内固定。结论利用RE和RP技术为颅颈交界区后路螺钉内固定定位、固定提供了一种全新、准确、安全、可靠的方法,在神经外科领域具有较大的应用前景,可广泛应用于颅颈交界和胸腰椎椎弓根的固定。     

100例老年性腰椎退行性变CR与SCT片诊断比较

目的对老年性腰椎退行性变的计算机X线摄影（CR）照片及螺旋CT（SCT）片进行对比分析,探讨老年性腰椎退行性变的CR、SCT片影像学特点、诊断价值及鉴别诊断.方法老年性腰椎退行性变患者100例,同时做CR和SCT检查并进行对比分析.结果总结出各种老年性腰椎退行性变CR表现特点及SCT扫描表现.结论 CR片能准确判断老年性腰椎骨质疏松及因骨质疏松所致脊柱畸形的程度,椎体骨折的部位、数量、形态的改变.SCT扫描能清晰显示松质骨的影像特点、椎间盘病变,并能进一步观察韧带钙化、分离骨片、椎管、硬膜囊、脊髓及软组织情况.两种检查方法结合应用,可充分起到互补作用.     

3D Slicer三维重建技术在脑功能区肿瘤手术治疗中的应用价值

目的 探讨3D-Slicer三维重建技术在脑功能区肿瘤手术治疗中的应用价值。方法 回顾性分析2017年9月至2021年12月手术治疗的39例中央区脑膜瘤、21例中央区胶质瘤的临床资料。术前利用3D-Slicer软件将MRI、3D-MPRAGE、3D-TOF-MRA和CEMRV序列影像进行三维重建，评估肿瘤的形态特征、位置、与周围静脉及上矢状窦的关系。以术中所见为标准，采用Kappa系数检验三维重建模型和术中所见的一致性。结果 3D-Slicer三维重建模型评估肿瘤位置、肿瘤与大脑浅静脉关系、肿瘤与上矢状窦关系均具有良好一致性（Kappa系数均为1.000，P<0.01），准确率均为100.0%。对肿瘤形态特征，胶质瘤的评估一致性差（准确率为18.2%；Kappa系数为0.414，P>0.05），脑膜瘤的评估一致性较好（准确率为97.4%；Kappa系数为1.000，P<0.001）。结论 3D-Slicer软件三维重建技术在脑功能区肿瘤手术治疗中具有较高的应用价值，可清晰显示脑组织、脑动脉、脑静脉、肿瘤组织，并三维可视化，对脑组织、大脑浅静脉、动脉及肿瘤的解剖关系进行多方位、多角度的观察，进行个体化的术前设计，术中可以更好地保护大脑浅静脉及功能区脑组织，从而最大化地切除功能区脑肿瘤，减少术后并发症。     

神经导航融合技术在颅底肿瘤中的应用

目的 探讨神经导航融合技术在颅底肿瘤中的应用。方法 通过术前准备、注册、CT与MRI等影像模式融合、术中导航定位,比较各种注册方法的精确性,融合精确度,术中定位精确性、术中持续精确性,扩大暴露范围等,提出和改进神经导航技术在颅底手术中的应用技术。结果 神经导航用于颅底肿瘤手术切除,术前有助于开颅皮肤切口及骨瓣的设计,选择最短的手术途径;术中可为肿瘤的切除定向定位,在颅底手术中使术者随时了解颅底肿瘤与周围重要解剖结构（如脑干、颅神经及重要血管等的关系）。结论 颅底肿瘤以及颅底结构位置相对固定,影响因素较小,脑移位最小,定位精确,及时反馈肿瘤的切除深度,增加手术的安全性,加快手术进程,避免脑重要结构的副损伤。     

多层螺旋CT三维重建技术在辅助微螺钉种植支抗植入中的选择应用

背景：提高正畸支抗系统微螺钉种植体稳定性的关键在于种植前对局部骨质、骨量进行精确评估，但常规二维影像学检查，如根尖片、曲面断层摄影片、侧位头影测量片等均存在不同程度的局限性。 目的：分析总结多层螺旋CT多种图像重建技术在辅助微螺钉种植支抗植入中的不同特点及优势，以便精确指导微螺钉的种植，提高其稳定性。 方法：种植前以多层螺旋CT对猪颅骨进行定位扫描及多种图像重建，通过多种图像联合应用初步观测种植区骨质骨量及解剖情况，然后利用计算机在影像上精确设计三维种植角度，根据影像信息制作隧道式手术模板指导种植32枚微螺钉支抗，种植后多层螺旋CT再次扫描重建，将种植前后多层螺旋CT设计及测量角度与术后解剖组织块实物测量角度作对比分析。 结果与结论：32枚微螺钉种植情况满意，无伤及邻近牙根及周围重要组织结构的情况。种植前设计与种植后多层螺旋CT测量角度比较，以及种植后多层螺旋CT测量与实物测量角度比较，在轴位面及侧断面上其差异均无显著性意义(P > 0.05)，且一致性极好。说明多层螺旋CT能够提供精确而丰富的影像信息，恰当选择合理应用能充分实现微螺钉种植影像学检查目的，从而为提高种植的成功率提供可靠保障。     

螺旋CT多平面重建三维重建技术在小儿隐性脊柱裂诊断中的临床应用

目的探讨螺旋CT多平面重建技术（MPR）及三维重建（3D）技术在小儿隐性脊柱裂诊断中的应用。方法使用GE prospeed AI型螺旋CT机对80例小儿隐性脊柱裂扫描后进行MPR、3D重建观察，并与二维CT（2DCT）比较。结果MPR、3D重建图像清晰显示了脊柱裂的裂隙缝位置、范围及程度。结论螺旋CT的MPR、3D是诊断小儿脊柱裂的有效手段，有助于病变的早发现早治疗。     

螺旋CT三维血管成像在脑膜瘤外科治疗中的应用

目的探讨螺旋CT三维血管成像（3D-CTA）对脑膜瘤及其周围组织的显示能力，评价其在外科治疗中的价值。方法脑膜瘤患者32例，所有病例均行CT平扫和增强扫描。图像送至AW工作站进行多平面重建（MPR）、最大密度投影（MIP）、容积再现（VR）、表面遮蔽法（SSD）后处理观察。结果重建图像显示瘤体充分强化，颅骨、血管、肿瘤三者立体关系显示清楚，主要的征象包括血管被肿瘤包绕，颅骨受侵犯，肿瘤周围组织移位等。结论3D-CTA可以充分显示脑膜瘤的影像特征，使血管充分强化，重建后可清楚显示肿瘤、血管及其与邻近组织的关系，有助于脑膜瘤的诊断及治疗方案的制订，评估手术风险。     

螺旋CT扫描与多模式三维重建在腰椎间盘突出症诊治中的应用*

背景：螺旋CT扫描与多模式三维重建在治疗腰椎间盘突出中有术前定位、术中指导手术和术后复查等作用。 目的：评价螺旋CT扫描与多模式三维重建在腰椎间盘突出中的应用,寻找合理的治疗方法。 方法：以“腰椎间盘突出症,螺旋CT,三维重建”为中文关键词,“Lumbar disc herniation,Spiral,Three dimensional reconstruction”为英文关键词,采用计算机检索PubMed数据库与万方数据库1998-01/2010-12相关文章。纳入与有螺旋CT扫描技术及其后处理的各种数据对腰椎间盘突出症的进行诊断和治疗相关的文章;排除重复研究或Meta分析类文章。以36篇文献为主重点进行讨论。 结果与结论：目前国内外学者多应用螺旋CT扫描技术及其后处理的多模式三维重建对腰椎间盘突出症的诊断,现已有部分学者把螺旋CT扫描技术及其后处理的各种数据应用在腰椎间盘突出症的治疗上,取得了比较理想的效果。利用多层螺旋CT配合多层面重组技术能更加准确显示腰椎间盘突出的直接征象与间接征象,提高椎间盘突出诊断率,并能与其他引起腰腿痛的疾病相鉴别;引入手术时还有定位、引导和复查等作用。提示科学合理的综合运用螺旋CT扫描技术及其后处理的各种三维重建数据对腰椎间盘突出症进行诊断和治疗是末来的发展方向之一。     

脊髓造影螺旋CT重建颈椎病仿真解剖模型的意义☆

背景：随着螺旋CT及计算机图像后处理技术的进步，医学仿真影像学在复杂颈椎病的诊断与治疗中获得了良好的临床应用效果。 目的：观察脊髓造影螺旋CT扫描多平面重建及三维重建颈椎影像仿真解剖模型的效果及其临床意义。 设计、时间及地点：计算机三维重建，金标准对比实验，于2001-01/2006-01在苏州大学附属第二医院完成。 对象：接受手术治疗的20例病情复杂的颈椎病患者。 方法：对20例患者进行颈脊髓造影螺旋CT薄层扫描，分别行多平面重建和三维重建，建立颈椎CT仿真解剖模型。将扫描及其重建结果用于术前病情评估、模拟手术，并以手术直视所见为金标准评价仿真解剖模型的准确性和效能。 主要观察指标：仿真解剖模型的准确性和效能。 结果：仿真解剖模型可同步显示骨性椎管和膜性椎管，为术前评估和模拟手术提供了颈椎全面、细微骨性解剖结构和硬膜囊、脊髓、神经根袖等软组织受压等解剖信息，与患者实际解剖相符合。 结论：仿真解剖模型直观、逼真，准确再现了颈椎解剖，可应用于综合评估颈椎病病情并模拟手术。     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

腺垂体功能减退症临床特征变化分析

目的探讨腺垂体功能减退症患者的病因结构变化及临床表现。方法回顾性分析我院2013-01—2016-12住院及门诊78例腺垂体功能减退症患者的临床资料。结果男32例(41.03%),女46例(58.97%);诊断时年龄11~89岁,平均62.5岁;鞍区占位(包括术前及术后)52例(66.67%),席汉综合征8例(10.26%),空泡蝶鞍9例(11.65%),病因不明8例(10.26%),垂体-下丘脑发育不良1例(1.28%)。首次就诊科室:纳差厌食、恶心呕吐就诊于消化内科36例(46.15%)最常见。ACTH+TSH+Gn+G激素缺乏为19例最多,占24.36%,ACTH+TSH+Gn缺乏15例,占19.23%。结论腺垂体功能减退症病因结构发生变化,发病人群、首发症状及受累激素也不同,患者女性多于男性,发病年龄偏高,症状不典型,分布于临床多个科室,其中以低钠血症为首发临床表现就诊消化内科最多。     

Standards of instrumentation of EMG

Standardization of Electromyography (EMG) instrumentation is of particular importance to ensure high quality recordings. This consensus report on “Standards of Instrumentation of EMG” is an update and extension of the earlier IFCN Guidelines published in 1999. First, a panel of experts in different fields from different geographical distributions was invited to submit a section on their particular interest and expertise. Then, the merged document was circulated for comments and edits until a consensus emerged.The first sections in this document cover technical aspects such as instrumentation, EMG hardware and software including amplifiers and filters, digital signal analysis and instrumentation settings. Other sections cover the topics such as temporary storage, trigger and delay line, averaging, electrode types, stimulation techniques for optimal and standardised EMG examinations, and the artefacts electromyographers may face and safety rules they should follow. Finally, storage of data and databases, report generators and external communication are summarized.     

帕金森病运动症状进展分析

目的分析帕金森病(PD)患者运动症状进展特点。方法采用PD统一评分量表(UPDRS)Ⅲ对912例PD患者进行评估。结果与病程1年的患者比较,除病程1~2年的患者外,其他病程患者的UPDRSⅢ评分、强直分、姿势或步态异常分、轴性症状总分、言语分、步态分显著升高(均P0.05),病程5~6年及14年患者的震颤分,病程5~6年、7~8年、9~13年、14年患者的运动迟缓分、姿势分显著升高(P0.05~0.01)。轴性症状进展速度高于UPDRSⅢ评分。结论 PD患者病程早期UPDRSⅢ评分进展快,震颤症状进展独立于其他症状,轴性症状评分较UPDRSⅢ更敏感地反映疾病加重趋势。     

Frequency of accumulation of filaments in adaxonal cytoplasm of Schwann cells of myelinated fibers of rat spinal roots

Summary The frequency of accumulation of 6-nm filaments in the adaxonal cytoplasm of Schwann cells in the 6th lumbar dorsal and ventral roots was evaluated in 4-, 8-, 26- and 45-week-old Sprague-Dawley rats. The frequency was higher in 4- and 8-week-old (growing) rats than in 26- and 45-week old (mature) rats, and also higher in ventral than in dorsal roots in 4-, 8- and 26-week old rats. There were no clusters on certain groups of myelinated fibers according to the size of transverse axonal area, in both the ventral and dorsal roots. Therefore, this accumulation may reflect certain functions of the adaxonal cytoplasm of Schwann cell during natural growth and maturation of the axon and myelin sheath.     

Function of circle of Willis

Nearly 400 years ago, Thomas Willis described the arterial ring at the base of the brain (the circle of Willis, CW) and recognized it as a compensatory system in the case of arterial occlusion. This theory is still accepted. We present several arguments that via negativa should discard the compensatory theory. (1) Current theory is anthropocentric; it ignores other species and their analog structures. (2) Arterial pathologies are diseases of old age, appearing after gene propagation. (3) According to the current theory, evolution has foresight. (4) Its commonness among animals indicates that it is probably a convergent evolutionary structure. (5) It was observed that communicating arteries are too small for effective blood flow, and (6) missing or hypoplastic in the majority of the population. We infer that CW, under physiologic conditions, serves as a passive pressure dissipating system; without considerable blood flow, pressure is transferred from the high to low pressure end, the latter being another arterial component of CW. Pressure gradient exists because pulse wave and blood flow arrive into the skull through different cerebral arteries asynchronously, due to arterial tree asymmetry. Therefore, CW and its communicating arteries protect cerebral artery and blood–brain barrier from hemodynamic stress.     

Effects of prevention of afferentation of the development of the chick optic lobe

BONDY, S. C., M. E. HARRINGTON AND C. L. ANDERSON. Effects of prevention of afferentation on the developmentof the chick optic lobe. BRAIN RES. BULL. 3(5) 411–413, 1978.—The effects of unilateral extirpation of the right optic cup of the three-day incubated chick embryo upon the rate of synthesis and the stability of DNA in the non-innervated optic lobe, have been studied. This surgical procedure prevents innervation of the optic lobe contralateral to the removed eye, while the other optic lobe is normally innervated by retinal ganglion cells of the remaining eye. At the 20th day of incubation, the DNA content of the non-innervated lobe was below that of the paired lobe receiving normal innervation. This deficiency of cell number was caused by two events; death of an excess number of neurons formed early in embryogenesis and a reduced rate of glial proliferation in the later stages of incubation.     

Release of endogenous catecholamines from slices of hypothalamus of rats

The release of endogenous catecholamines from superfused slices of rat hypothalamus was studied under basal conditions and during release evoked by 40 mM K⁺. Catecholamines in superfusates, and in extracts of the tissue after stimulation, were isolated by column chromatography and quantitated by liquid chromatography with electrochemical detection. Norepinephrine (NE) was not consistently demonstrable in superfusate collected under basal conditions, but 40 mM K⁺ caused the release of from 2 to 4 ng/g of tissue per min. The addition of cocaine to the superfusate caused increases in basal and evoked release of NE. Epinephrine (E) could be measured in superfusates of slices from male but not female rats and then only when cocaine was added to the superfusate. Accordingly, the concentration of E in hypothalamus was greater in male rats than in female rats. Dopamine (DA) was not consistently measurable in the spontaneous overflow from slices either in the presence or absence of cocaine. K⁺-evoked release of DA could be demonstrated in slices from female rats. The addition of cocaine increased the evoked release of DA from slices from both sexes. Corticosterone, added to cocaine, had no effects on the efflux of any of the catecholamines. The experiments suggest that neuronal reuptake of all catecholamines is very efficient in the hypothalamus both under basal conditions and during evoked release.     

《绵阳市社会心理服务工作管理办法》解读

2018年,国家卫生健康委员会等10部委联合发布《关于印发全国社会心理服务体系建设试点工作方案的通知》,四川省绵阳市被列为全国第一批试点地区。绵阳市人民政府依据《中华人民共和国精神卫生法》等相关法律法规和文件精神,结合前期调查研究和社会心理服务工作的试点实际,编制出台了《绵阳市社会心理服务工作管理办法》,并于2021年12月25日起施行。本文围绕社会心理服务的相关概念、办法总则、重点内容、保障措施等方面进行解读,以期为社会心理服务工作的规范、持续和有效开展提供参考。     

阿立哌唑对精神分裂症患者生活质量的影响

目的:比较阿立哌唑与利培酮对精神分裂症患者生活质量的影响。方法:60例精神分裂患者随机平分为两组各30例,分别给予阿立哌唑和利培酮治疗。疗程8周。用生活质量综合评定问卷-74(GQOLI-74)、阳性与阴性症状量表(PANSS)及副反应量表(TESS)评定疗效及不良反应。结果:阿立哌唑与利培酮均能显著提高精神分裂症患者生活质量,但阿立哌唑在改善GQOLI-74总分、躯体健康及社会功能维度优于利培酮。结论:阿立哌唑治疗有利于提高精神分裂症患者生活质量。